Therapy and Personhood It Is Essay

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The following describes the process of Gestalt therapy:

Gestalt therapy is a phenomenological-existential therapy founded by Frederick (Fritz) and Laura Perls in the 1940s. It teaches therapists and patients the phenomenological method of awareness, in which perceiving, feeling, and acting are distinguished from interpreting and reshuffling preexisting attitudes. Explanations and interpretations are considered less reliable than what is directly perceived and felt. Patients and therapists in Gestalt therapy dialogue, that is, communicate their phenomenological perspectives. Differences in perspectives become the focus of experimentation and continued dialogue. The goal is for clients to become aware of what they are doing, how they are doing it, and how they can change themselves, and at the same time, to learn to accept and value themselves (Gestalt Therapy, http://www.gestalt.org/yontef.htm).

In this way the therapist models to the client what it is like to be fully present in the moment, demonstrating not only that such "presence" is possible but also that far from being threatening (or self-annihilating), a commitment to being fully oneself in the present leads to a life that is more satisfying, more pleasurable and less stressful because less internally discordant. This triad can be seen as a description of overall mental health. Other factors can be added, for health is a complex concept, but these three factors I believe summarize the key indices of mental health.

Gestalt therapy is based on the assumption that human nature is flexible and adaptive and that by bringing together an authentic other and a troubled self, that self may through interactions begin to heal.

Cognitive Behavioral Therapy

As I begin to describe cognitive behavioral therapy I would like to note briefly (I will discuss this more below) that it is connected both to Gestalt therapy and to my overall understanding of human nature through its focus on the here-and-now. Cognitive behavioral therapy and Gestalt therapy are both based on the idea that people can change (an essential part of my understanding of human nature, and indeed -- I would think -- an underpinning of all therapeutic approaches). Both modes of therapy also posit the idea that clients gather the strength and power to undergo important changes by focusing on the present in the presence of a caring, attentive, and authentic therapist.

The following provides an overview of cognitive behavioral therapy:

CBT is based on the Cognitive Model of Emotional Response. Cognitive-behavioral therapy is based on the idea that our thoughts-cause our feelings and behaviors, not external things, like people, situations, and events. The benefit of this fact is that we can change the way we think to feel / act better even if the situation does not change. (National Association of Cognitive Behavioral Therapy, http://www.nacbt.org/whatiscbt.htm).

In this way, both of these modes of therapy break dramatically from classical psychoanalytic therapy, which can be seen as an excavation into the past. Freud (for example) felt that the farther and more meticulously the therapist and client could travel together into the past, the closer the two (but especially the therapist) would come to the truth.

Gestalt therapy and cognitive behavioral therapy begin with the moment that the client is in as the springboard for change. Rather than an attempt to negotiate the past like a mountain climber carefully feeling her way down a sheer face by moving from one embedded spike to another, Gestalt and cognitive behavioral therapy are more like rappelling -- a temporary but repeated letting go of security as the client swings clear of old restraints to find new footholds, secure in her belief that should she slip the therapist will be there to lend a steadying hand until the client feels safe enough to let go (Crocker, 1999, p. 37).

Throughout this paper (and as a part of my current ongoing process of coming to understand the kind of therapist that I want to be), I argue that it is impossible to believe in authentic change for the client unless one focusses on the present, for it is only in the moment that change is possible. A too-great connection to either the past or the future precludes change.

Problem-Solving as a Part of Healing

Cognitive behavioral therapy has as its main goal problem-solving for the client that is based on a systematic (and systemic) strategy to correct misguided behaviors and dysfunctional thinking and emotions. By helping the client develop a more reality-based way of being in the world, the cognitive behavioral therapist draws on research in both behavioral and cognitive therapy to help the client come into a more stable and satisfying relationship with self, with others, and with the world as a whole.

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As its name suggests, cognitive behavioral therapy derives from two different therapeutic approaches. Behavioral therapy is based on a model that essentially ignores internal states and focusses only on behavior. (We can see here the hand of Skinner, of course.) This approach (if taken by itself) would be (I believe) be a very poor form of therapy. To focus on behavior alone can be helpful in some very limited contexts (perhaps in some aspects of working with a client who wishes to stop using drugs, since this is a very behavior-oriented problem). But my understanding of both therapy and human nature demands that internal states be given at least as much importance and focus as behavior (Asay & Lambert, 1999, p. 34).

A pure behaviorist would argue that all we can measure or know about is behavior and therefore if we wish to change an individual (or help an individual change) then we must create conditions int which learning can occur that will reinforce new behaviors. It should be clear why this practice is not something that I could embrace as such. Rather than honoring subjective understanding and reality, behavioral therapy seeks to control behavior in what could well be argued to be a rigid model of human nature.

The Cognitive Side of CBT

What attracts me to cognitive behavioral therapy, then, is less the behavioral part than the cognitive part, although (of course) the two are not separable from each other within this approach. Cognitive therapy (as outlined by pioneers in this approach such as Beck and Ellis) centers on the idea that a client's well-being is based in very large measure on the way in which she perceives and interprets her own life. In other words, well-being (and healing) is based on how a person attributes meaning to her daily life. Misperceptions in these attributions of meaning can lead to serious mental disorders, especially mood disorders.

The perceptions that cognitive therapists are most concerned with are not the superficial ones that frequent one's daily life (although these are important too) but rather what Beck called the "schema" of people's lives. These schema might also be called paradigms: They are the over-arching concepts that each person uses to understand the world. (One example of such a schema might be the idea that the world is a just place in which people get what they deserve.)

Cognitive behavioral therapy centers on the cognitive therapeutic concept of the centrality of meaning-making as being at the core of human experience. But it blends this with the behaviorist's insistence on looking both at the practical elements of examining and changing behavior as well as the behaviorist's focus on the present. (Nothing is more present-centered and present-centering than behavior: Looking at what one is literally doing in the moment helps to banish past and future.)

This provides a good overview of cognitive behavioral therapy:

Cognitive-behavioral therapy does not tell people how they should feel. However, most people seeking therapy do not want to feel they way they have-been feeling. The approaches that emphasize stoicism teach the benefits of-feeling, at worst, calm when confronted with undesirable situations. They also emphasize the fact that we have our undesirable situations whether we are-upset about them or not. If we are upset about our problems, we have two-problems -- the problem, and our upset about it. Most people want to have the fewest number of problems possible. So when we learn how to more calmly-accept a personal problem, not only do we feel better, but we usually put-ourselves in a better position to make use of our intelligence, knowledge, energy, and resources to resolve the problem (National Association of Cognitive Behavioral Therapy, http://www.nacbt.org/whatiscbt.htm)

Cognitive behavioral therapy also borrows from behavioral therapy a certain standardization of treatment. A cognitive behavioral therapist believes that behavior and the understanding of it can be modulated in to carefully calibrated ways. This focus on such calibration (although, of course, the skilled cognitive behavioral therapist understands that there is always some latitude in all therapy and change) I believe balances what I see as a certain looseness (or creativity) in Gestalt therapy. I believe that Gestalt therapy on its own may leave some clients feeling too unsupported, too much on their own to make the kinds of changes….....

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