The Healing Relationship in Gestalt Therapy: A Dialogic - Self-Psychology Approach [1 ed.] 0939266253, 9780939266258

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The Gestalt Journal Press was founded in 1975 and is currently the leading publisher and distributor of books, journals, and educational recordings relating to the theory and practice of Gestalt therapy. Our list of titles includes new editions of all the classic works by Frederick Peris, Laura Peris, Paul Goodman, Ralph Hefferline, and Jan Christiaan Smuts. Our catalog also includes a wide variety of books bycontemporarytheoreticians and clinicians including Richard Hycner, Lynne Jacobs, Violet Oaklander, Peter Phillipson, Erving & Miriam Polster, Edward W. L. Smith, and Gary Yontef.

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The Healing Relationship In Gestalt Therapy A D1ALOG1C/SELF PSYCHOLOGY APPROACH

Richard Hycner and Lynne Jacobs

A Publication of The Gestalt Journal Press

To my father, an unsung hero.

To my courageous mother.

Copyright 1995 by Richard Hycner

To Dorothy, without whose support this work would not have been completed.

Copyright 1995 by The Gestalt Journal Press

ISBN: 978-0-939266-25-8 Published by: The Gestalt Journal Press, Inc. A Division of: The Center for Gestalt Development, Inc. P. O. Box 278 Gouldsboro ME 04607-0278 U.S.A.

To Bryce, for whom the future is.

CONTENTS Foreword

vii

Preface

ix

Acknowledgments

xv

Introduction

xix

I.

A DIALOGIC APPROACH

1. The Dialogic Ground Rich Hycner

3

2. Reva: Impasse and Inclusion — Two Perspectives Rich Hycner, and "Reva"

31

3. Dialogue in Gestalt Theory and Therapy Lynne Jacobs

51

4. Simone: Existential Mistrust and Trust Lynne Jacobs

85

5. After/Words: The Spirit of Dialogue Rich Hycner

91

II.

A BRIDGE BETWEEN

Self Psychology and Gestalt Therapy A Dialogic Perspective

6. A Brief Introduction to Self Psychology and Intersubjectivity Theory Rich Hycner

103

— THE HEALING RELATIONSHIP IN GESTALT THERAPY —

7. A Bridge Between Dialogic Psychotherapy and Intersubjectivity Theory Rich Hycner

8. Self Psychology, Intersubjectivity Theory, and Gestalt Therapy: A Dialogic Perspective Lynne Jacobs

113

Foreword 129

9. Gestalt Therapy and Intersubjectivity Theory Rich Hycner

159

10. Transference Meets Dialogue: A Case Transcript Lynne Jacobs

III.

171

DIALOGIC DIRECTIONS

Expanding Intersubjectivity Theory and Self Psychology

11. A Dialogic Critique of Intersubjectivity Theory and Self Psychology Rich Hycner 12. The Therapist as "Other": The Patient's Search for Relatedness Lynne Jacobs

199

215

Every theory needs to be vitalized by its new generations; Rich Hycner and Lynne Jacobs’s book represents and important contri­ bution to the continuing renewal of Gestalt therapy. The first generation of Gestalt therapists was headed by Fritz Peris, whose germinal work contributed to the therapeutic reformation which followed the Second World War. Peris’s work inspired a second generation whose contributions evolved from a different theoretical environment. The new people built on the theory’s fundamentals, culling out distortions, exagger­ ations and personalized/stylized emphases while trying to see each familiar elements in the fresh light of expanded understanding. They struggled between accepting the sloganized but misleading simplicity into which Gestalt therapy had been condensed and maintaining the breadth of focus which was its original focus. To coordinate these theoretical counterpoints was a challenge within Gestalt therapy’s own circles and left little room for the overlaps and correctives offered by other therapy theories. Concurrent within this internal reformation, many boundaries between contempo­ rary theories were relaxed by a breakdown of those stereotypes which inevitably develop out of devoted adherence to the principles of any theory. The breakdown of stereotypes opened the way for a third genera­ tion of Gestalt therapists, to which Hycner and Jacobs belong. The have written a rich book clarifying the parameters of Gestalt therapy principles as they co-exist with therapeutic contemporaries such as Intersubjective Self Psychology and Buberian Dialogic Psychotherapy.

— vii —

— THE HEALING RELATIONSHIP IN GESTALT THERAPY —

Rather than diluting Gestalt therapy, their thoughtful perspective gives depth and further confirmation to Gestalt therapy’s prime concepts of contact, self-awareness, healthy confluence and the phenomenology of relationship. The examples from their own therapeutic practice animate the centrality of Gestalt therapy’s contact experience by the warmth, humanity and sensitivity that pervades their work.

Preface

— Erving Polster — Miriam Polster

Gestalt therapy is a creative synthesis. — Erving Polster

The human heart yearns for contact — above all it yearns for genuine dialogue. Dialogue is at the heart of the human. Without it, we are not fully formed — there is a yawning abyss inside. With it, we have the possibility of our uniqueness, and our most human qualities emerging. Each of us secretly and desperately yearns to be “met” — to be recognized in our uniqueness, our fullness, and our vulnerability. We yearn to be genuinely valued by others as who we are, even that we are. The being of each of us needs to be revered — by ourselves, but also by others. Without that, we are not fulfilled — we are not fully ourselves. The paradox of the human spirit is that I am not fully myself till I am recognized in my uniqueness by another — and that other person needs my recognition in order to fully become the unique person she or he is. We are inextricably intertwined. Our valuing of another brings value to ourself. We are part of a loop of reciprocal relations. This book explores these reciprocal relations as the ground within Gestalt therapy.

— viii —

— ix —

___ THE HEALING RELATIONSHIP IN GESTALT THERAPY —

— Preface —

There are two clarion calls within this book: First and foremost is to explore the dialogic 1 dimension as the ground within Gestalt therapy. Secondarily, to explore how self psychology, particularly intersubjectivity theory, provides an extensive developmental focus and understanding of the “self’ which may further enrich the develop­ mental base and conceptualization of the self already inherent in Gestalt therapy. Gestalt therapy has an unsurpassed experiential and process focus which, more than any other therapy, supports its practitioners in leaning toward a dialogic approach. Such an approach within Gestalt therapy can provide the ground for a creative synthesis of the dialogic dimension of human existence, the experiential focus of Gestalt therapy, and the insights into self development arising from self psychology and intersubjectivity theory. Such a synthesis may provide an enriching perspective in the quest for deepening our understanding of the “interhuman” 2*4dimension of existence.

possible, it is essential to try to approach it. Ironically, modern psychology has done little to address this dimension of the human spirit. In discussing the dialogic, I am not referring to speech, but rather an attitude and awareness and openness about caring about the unique other person and our interhuman connectedness with that person. I am referring to an attitude of genuinely feeling/sensing/experiencing the other persons as a person (not an object, or part-object), and a willingness to deeply “hear” the other person’s experience without prejudgment. Furthermore, it is the willingness to “hear” what is not being spoken, and to “see” what is not visible. It is presence to the mystery of our interexistence. For nearly twenty-five years, I’ve believed that Gestalt therapy would be greatly enriched by being explicitly grounded in the philoso­ phy of dialogue of Martin Buber, $ (and its explication by Maurice Friedman). An early article of mine, “Dialogical Gestalt Therapy: An Initial Proposal” (1985) explored this possibility. Shortly afterward, Lynne Jacobs added her published voice with “Dialogue in Gestalt Theory and Therapy” (1989). In training therapists, I sensed that there was a need for a book which explicitly focused on the dialogical dimension as the ground within Gestalt therapy. (In the interim I wrote Between Person and Person: Toward A Dialogical Psychother­ apy 5 providing the foundation for a dialogical approach to psycho­ therapy in general.)

In this modem age alienation from others, our own self, and nature, is endemic. Much human suffering would be lessened if there were more of a concern about establishing a genuine dialogue between persons. If this is true, than it behooves therapists to create an atmo­ sphere in which the dialogic attitude can take seed and flourish. It requires therapists to go beyond technical healing, and toward healing the “between” — that invisible, yet most profound dimension of human interconnectedness. Though such healing is not always

$ I certainly am not the only one to think along these lines. In the Introduc­ tion I try to give a historical context for this perspective within Gestalt therapy.

1 Dialogical psychotherapy is a therapeutic application of the philosophy of dialogue pioneered by Martin Buber and further explicated by Maurice Friedman. Throughout this work I will use the terms “dialogic” and “dialogical” inter­ changeably. What I say here about applying a dialogic approach to Gestalt thera­ py I believe also applies to other psychotherapeutic approaches.

4 As I point out in the Introduction, Lynne Jacobs had been working long before this on these ideas. This is most evident in her dissertation, “I-Thou Relation in Gestalt Therapy” (1978).

By the “interhuman” Martin Buber meant something more inherently and ontologically interconnecting than what is usually meant by the intersubjective, or the interpersonal (Buber, 1965b). Friedman (1972b) poetically describes this as: “We live in an ever flowing interchange.”

Though the English publication was in 1991, the manuscript essentially was completed by 1988. It was translated into German and published as Zwischen Menschen (1989). The Portuguese translation was published in 1994.

------ X-------

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— THE HEALING RELATIONSHIP IN GESTALT THERAPY —

This book has grown out of a collaboration of shared beliefs and ongoing contact. My friendship and colleagueship with Lynne Jacobs has been very special. This work would not exist without her emo­ tional and intellectual courage, interest, and support. For years, we had shared a mutual interest in Gestalt therapy and the philosophy of dialogue of Martin Buber. As she became immersed in the areas of self psychology and intersubjectivity theory, I found myself, along with some independent interest, being pulled into investigating these areas. I still remember the moment at a conference 6 when in listen­ ing to Lynne, it hit me that she had developed an independent exper­ tise in Gestalt therapy, the dialogic philosophy of Martin Buber, and self psychology (particularly intersubjectivity theory) — and she was talking about an integration of all three. It’s as if she were fluent in three distinct languages, and then begins to develop a whole new language, that utilizes the best of the previous three! I was over­ whelmed by the magnitude of the task. It was daunting beyond my own task of attempting to integrate a dialogic approach within Gestalt therapy. To my eventual surprise, and dismay, I found myself moving along parallel lines. While thinking for many years that a book on an approach in Gestalt therapy would be valuable, and making a couple of fitful starts on earlier versions, the decision to write and edit this book formally begin in 1991. At first, I was going to present only the dialogic approach within Gestalt therapy. After several revisions of an early plan of the book, I decided to integrate the dialogic approach with some of the developmental and clinical insights from self psychology and intersubjectivity theory. Though I believe that the dialogic approach is the ground within Gestalt therapy, it seemed to me that the theories of self psychology and particularly intersubjectivity theory provided an intersubjective developmental focus and clinical specifici­ ty that could add to the already rich phenomenological basis of Gestalt therapy.

— Preface —

Knowing of Lynne’s expertise in all of these areas, I asked her to contribute her original writings to this work. 7 Through out many readings of each other’s writings and through out discussions, we more and more came to influence each other’s thinking. Though final editorial responsibility is mine, the book is the result of our shared influences and efforts. As Lynne as said, where one of us is the identified author of a particular chapter, the other’s “voice” is always also present. Being an integrative work, a great number of issues needed to be explored in the chapters. In the writing and editing process, I always strove to make clear the theoretical issues underlying this integration as well as their clinical applications. Along with numerous clinical examples and vignettes in all the chapters, there are also three extend­ ed case studies demonstrating the issues raised in previous chapters. I terms of the overall plan, Section I explores the dialogic approach in Gestalt therapy, both in theory and clinical application. Section II integrates a dialogically grounded Gestalt therapy with intersubjective theory and self psychology. Section III highlights the central themes of “otherness” for Gestalt therapists, and points to directions practi­ tioners utilizing insights from intersubjectivity theory and self psychol­ ogy may wish to explore further. I fervently hope the results of this work are fruitful for the reader. I furthermore hope that it inspires others to explore the clinical and theoretical implications of this approach. As Lynne is fond of reminding me, the purpose of this book is not to be definitive, but rather evocative.

— Rich Hycner

7

6 The Seventh Annual Conference on Dialogical Psychotherapy (1991) in San Diego. Robert Stolorow was the keynote speaker. ----- xii------

In most cases, these writings were kept essentially as they were, with primary formatting changes made to fit the overall plan of the book. In two cases, substantial editing was necessary in order for the original works to fit into the flow of the chapters of that section.

— xiii —

A ckno wledgmen ts

I wish to acknowledge Lynne Jacobs for her courage in pursuing her own direction. Her discussions with me, and her writings on the IThou relationship in Gestalt therapy, always have been confirming. In addition, her most recent project of integrating self psychology into a Gestalt therapy framework, along with some initial similar thoughts on my part, inspired me to transform the original thrust of this book to include not only the dialogic dimension in Gestalt therapy but also the most salient parts of self psychology and intersubjectivity theory. Her contributions to this work are enormous. My wife, Dorothy, as she did with my first published book, gave freely of her emotional support and understanding throughout the arduous and extended process of writing and editing. Without her being there I don’t think I could have completed this project. In a dayby-day manner, she teaches me what the relational truly means. Charlie Brice, a totally unique person in his own right, has been, and continues to be, a precious friend and an amazing person to discuss anything with. His deep insights into a dialogical understand­ ing of the psychotherapy process, his writings, and his personal authenticity, have always been confirming, and an inspiration to me. Oh yes, I can’t forget to mention how he always uplifts my spirit (and everyone around him) with his humor and infectious laughter. Just knowing he was there made this writing easier. I am grateful to my friends and colleagues, Maurice Friedman and Jim DeLeo. They have given me, now over more than twenty years, the intellectual support, and the support by their presence, to pursue the dialogic dimension in psychotherapy. It’s quite conceivable that without them, there would not be this book.

— xv —

— THE HEALING RELATIONSHIP IN GESTALT THERAPY —

— Acknowledgements —

From the bottom of my heart, I want to thank Erv and Miriam Polster for being who they are, and for teaching me just about everything I know about the creative experience of doing psychothera­ py. They have showed me what Gestalt therapy can be. I want to acknowledge my clients, who have privileged me with the opening up of their deep and rich lives, and have continuously added to my understanding of the psychotherapeutic process. They teach me. In particular, I want to single out those former clients of Lynne and myself (who of course must remain anonymous) who gave permission to publish cases based on their therapy. I especially want to thank my former client who not only agreed to allow me to publish my descrip­ tion of doing therapy with her but also gave me permission to use her audiotaped and written notes of her experience of the therapy. Further­ more, now many years later, she agreed to review the write-up, and even suggested changes for accuracy. I applaud her openness and courage. I also wish to thank the trainees of the Institute for Dialogical Psychotherapy, who by their commitment and involvement in the training have been an emotional support for me, as well as being a sounding board for my thinking and explorations. I particularly wish to thank the former trainee who gave me permission to publish her write-up of a healing experience in the group process training. Given the horrendous nature of the original trauma she was describing, I truly admire her courage in letting this be published. Joe Wysong and Molly Rawle deserve my gratefulness for deciding immediately, during an impulsive phone call from me, to agree to publish a book on a dialogical approach in Gestalt therapy. I had long thought about such a book, but the motivation to actually do it came when I knew it would be published. (Little did they, nor I, know the transformations the book would go through, and thus take four more years to complete.) Their faith in me was, and is, greatly appreciated. My friends and relatives deserve a heartfelt thanks, for their support and tolerance of my many absences as I would focus on the writing, and because I knew they would be there when I was done. My officemates, Judith Matson and Mary Dreyer, deserve my appreci­ ation, not only for their bemused tolerance of my using every spare

moment at the office to work on this book but also for the loving emotional support they gave me throughout. If I ever needed a reminder of the importance of our connectedness with each other, my then three-year-old son, Bryce, would crawl into my lap in the middle of some seemingly absolutely critical piece of writing I was absorbed in and decide at that moment that either my computer was a wonderful plaything or this was the most opportune moment to ask me to get him “twenty” different things he all of a sudden needed. In his inimitable way, he would tell me, in action and in words, “I need some ‘tention”—one of the most basic, yet pro­ found, needs of all of us. His chiding me, “Daddy, listen to my words," is perhaps the clearest, and best, definition of the dialogic. He was always more than willing to be a “presence” to remind me that our bond with those we love is far more important than any book. Finally, I need to thank the River. Without its steadfastness, and the inspiration and clarity that I experienced in its beautiful and calming surroundings, the quality of this work would have been greatly diminished.

— xvi —

— Rich Hycner

— xvii —

Introduction

Background

Aspects of a dialogically oriented Gestalt therapy have been present from early on; primarily in practice, and secondarily in the theory. Frederick Peris at times certainly spoke of the necessity of the I-Thou relationship in Gestalt therapy (Levitsky and Peris, 1970). At one point he defined Gestalt therapy by the catchphrase “I and Thou, here and now.” He also stated that Gestalt therapy should get beyond individualism and look at the “We”: . . .the We which is different from the I and You. The We doesn’t exist, but consists of I and You, is an ever-changing boundary where two people meet. And when we meet there, then I change and you change, through the process of encoun­ tering each other. . . . (Peris, 1969, p. 7)

Laura Peris seems to have been particularly interested in a dialogic attitude toward her therapy, especially as it related to the issue of techniques in therapy. Referring to the sometimes slavish imitation of Frederick Peris’s “immensely impressive demonstration method,” Laura Peris states that: “It is unfortunate that what has become very widely known and practiced as Gestalt therapy is only the method used by my late husband for demonstration workshops and films in

— xix —

— THE HEALING RELATIONSHIP IN GESTALT THERAPY ___

the last three or four years of his life.” Elaborating on this she says; “Fritz Peris — with a pre-psychiatry history of interest and active involvement in the theater — would use a psycho-dramatic approach” (L. Peris, 1976a, pp. 222-223). Laura Peris stated frequently that she was profoundly influenced by a personal meeting with Martin Buber (L. Peris, 1976b): “I think that Buber and Tillich were of much greater influence on me in the long run than analysis and Gestalt psychology, because it was an immedi­ ate, direct, existential approach to life” (1989, p. 17). “They were really psychologists. . . .Listening to Tillich or Buber, you felt they were talking directly to you and not just about some thing. The kind of contact they made was essential in their theories” (L. Peris, in Rosenblatt, 1991, p. 24). This may have influenced her thinking that the essence of Gestalt therapy was the relationship formed between therapist and client.

A Gestalt therapist does not use techniques; he applies himself in and to a situation with whatever professional skill and life experience he has accumulated and integrated. There are as many styles as there are therapists and clients who discover themselves and each other and together invent their relationship. (L. Peris, 1976a, p. 223, italics added) Certainly, many other Gestalt therapists have embodied an under­ standing of the I-Thou relationship in their practice. Yet it appears that only a few Gestalt therapists have actually written about the IThou relationship, and of those who do mention it, frequently there is not an extended discussion of it (Tobin, 1983, p. 77). Naranjo (1975) in an early work touches on the issue. Korb (1988) has done a great service for Gestalt therapists by sensitizing them to the I-Thou relation as the “numinous ground” within Gestalt therapy. Schoen (1989) has discussed the I-Thou relation as a “larger gestalt.” Primarily in the work of Gary Yontef (1975, 1979) and Lynne Jacobs (1978) has the I-Thou relation in Gestalt therapy been substantially and extensively discussed.

— xx —

— Introduction —

Even fewer Gestalt therapists have written about the dialogic in therapy (in contrast to the I-Thou moment). I suspect that it is rarely written about because it’s the “invisibility” of the ground in figure/ground phenomena — always there and essential, yet difficult to discern. It is often sensed rather than directly experienced. Polster and Polster in their book (1973) and clearly in their practice, 89 describe a number of important examples of a dialogic approach, without using that term. O’Connell (1970) mentions the importance of “dialogue” in Gestalt therapy. Yontef has gone so far as to refer to Gestalt therapy as a “dialogic method" $ (1983, 1984). He has further explicated this understanding in his recent (1993) book. Lynne Jacobs addressed the dialogic dimension by discussing the importance of the I-Thou attitude (1978, 1989). Hycner (1985) proposed that a dialogical approach within Gestalt therapy be made explicit. Jacobs (1978, 1989) further explicated how the philosophy of dialogue can be applied to the theory and practice of Gestalt therapy. Frew (1992) has touched on the necessity of being cognizant of the “between” in Gestalt work. In spite of the above, Gestalt therapy has not clearly explicated an adequate and consistent philosophical base. Its roots are based in

8 See also my article “An Interview with Erving and Miriam Polster: The Dialogical Dimension in Gestalt Therapy” (1987). 9 In fact, he states (June 1991, personal communication) that he was thinking about a dialogic method beginning around 1969. This is also about the time I was thinking about applying Buber’s understanding of the I-Thou relationship, and calling it an Existential-Gestalt therapy. By 1983,1 was referring to it as a dialogical Gestalt therapy. At an earlier point in my professional development, I labeled my therapeutic approach as Person-Centered Gestalt therapy, to differentiate it from the then more confrontive types of Gestalt therapy. I have come to realize that what Buber meant by the dialogical is far more encom­ passing an approach than that which is emphasized in Person-Centered theory. Person-Centered theory has primarily emphasized the focus on the client’s experience. It seems to me that a Person-Centered approach still fails to get beyond an individualistically-oriented model of the self. -----xxi ------

-----

THE HEALING RELATIONSHIP IN GESTALT THERAPY -----

psychoanalysis, Gestalt psychology, existentialism, phenomenology, and clinical experience. The philosophical bases of these roots and their incorporation into Gestalt therapy theory have never been consistently and programmatically worked out. This has led to contradictions in theory and in practice. The main contradiction is that despite its original grounding in the person-environment matrix, in practice Gestalt therapy at times has fallen into an individualistic model of the self. As Erving and Miriam Polster state it so well:

Thus, in the emphasis on immediacy, Gestalt therapy narrowed the focus of the psychotherapeutic experience and elevated individual independence and purity of experience above their relevance to larger human concerns. (1994, p. 24) Certainly it is easy for such an interpretation to occur. However this loses the original radicalness of the contact boundary as being the “between,” and not just the delimiting aspect of the individual self. Though espousing the exploration of the “contact between,” Frederick Peris at times lapsed back into an individualistic bias, such as in his “Gestalt Prayer.” In that statement the emphasis was on being an independent, separate individual, and the “meeting” with others was only secondary. Unfortunately, many inexperienced individuals have taken this to be the essence of Gestalt therapy. Yontef (1984, p. 72) points out that within the theory of Gestalt therapy there has been too much emphasis on certain Junctions of the person as if they were separate from the person that these functions are a part of. In the theory, and unfortunately at times in practice, the wholeness of the person sometimes has been obscured. In many of the original theoretical writings in Gestalt what appears foundational is concepts such as “awareness,” “contact,” “gestalts,” “organisms,” “figure and ground,” “closure,” “resistance,” etc. — rather than the relational. Tobin puts it rather bluntly; “ . . .many Gestaltists are continually talking about boundary disturbances and organismic self­ regulation and so forth instead of talking about people” (1983, p. 75).

— xxii —

Introduction —

Certainly this is not the way many, if not most, Gestalt therapists practice. If this is true, the theory should reflect the practice. Often it has been assumed that if awareness and contact functions are expanded then automatically the person’s self, the contact bound­ ary, will also be significantly expanded. 10 That is not necessarily true. A therapist can help expand contact functions in a narcissistic manner without helping this person develop a meaningful dialogic relationship to others. It is possible to focus so on functions that only the periphery of this person’s existence is expanded, leaving un­ touched that person’s “dynamic center.” A dialogic approach, as ar­ ticulated in this book, is the opposite of this. Though this review does not include all the literature within Gestalt therapy relevant to an understanding of the I-Thou moment and a dialogic approach, hopefully it does give a historical context for the chapters that follow. — Rich Hycner

10 I have participated in Gestalt experiments that were interesting exercises,

but which I think were more central to the needs of the therapist than my own. I am not saying that every experiment has to touch the core of the person: I do think however that there is a tremendous discipline which is required of the therapist in order to suggest those experiments which most likely have a chance of helping to restore the client’s dialogic relationship to others, rather than leading to a further societal pathology of narcissism, or existential alienation. ----- xxiii------

I. A DIALOGIC APPROACH

The chief presupposition for the rise of genuine dialogue is that each should regard his partner as the very one he is. I become aware of him, aware that he is different, essentially different from myself, in the definite, unique way which is peculiar to him, and I accept whom I thus see, so that in full I can direct what I say to him as the person he is.

Martin Buber (1965b, p. 79)

J

1. The Dialogic Ground

Rich Hycner

‘Between’ is not an auxiliary construction, but the real place and bearer of what happens between men; it has received no specific attention because in distinction from the individual soul and its context, it does not exhibit a smooth continuity, but is ever again re-con­ stituted in accordance with men’s meetings with one another. Buber (1965a, p. 203) When we say ‘boundary’ we think of a ‘boundary between’; but the contact-boundary, where experience occurs, does not separate the organism and its envi­ ronment; rather it limits the organism, contains and protects it, and at the same time it touches the envi­ ronment. Peris, Hefferline, and Goodman (1951, p. 229)

What unites us as humans is not necessarily the visible and the tangible, but rather the invisible intangible dimension “between” us. It is the human spirit that permeates our every interaction. It is the “numinous ground” (Korb, 1988) that surrounds and interpenetrates us, and out of which our separateness and uniqueness emerge, becoming figure. It is the source of healing.

—3—

— THE HEALING RELATIONSHIP IN GESTALT THERAPY —

— The Dialogic Ground —

I believe that a dialogical approach best addresses the human spirit — in its ground of connectedness as well as its figure of separateness. It grounds the theory and practice of Gestalt therapy in its original radicalness of exploring the “between.” The dialogical is the explora­ tion of the “between.” By the dialogical is meant the overall relational context in which the uniqueness of each person is valued and direct, mutual, and open relations between persons are emphasized, and the fullness and presence of the human spirit is honored and embraced. It is more of a heartfelt approach than a theory. 1 “It is, the response of one’s whole being to the otherness of the other, that otherness that is comprehended only when I open myself to him in the present and in the concrete situation and respond to his need even when he himself is not aware that he is addressing me” (Friedman, 1965a, p. xvii). Such an approach encompasses the rhythmic alternation of I-Thou and I-It relatedness. The basic tenet of a dialogically oriented Gestalt therapy 12 is that the overall approach, the process, and the “goal,"

Perhaps the most essential healing component in therapy is the dialogic attitude of the therapist (assuming some openness by the cli­ ent). All contact and awareness needs to be understood within this dialogic context. Yontef says it well: “The first reality is contact between” (1984, p. 62). Peris, Hefferline, and Goodman point out that contact always arises out of the “between,” the person/environment field (1951, p. 231). Peris states:

of psychotherapy is dialogic in focus. Any “techniques” arise out of the context of the relationship between client and therapist. The dialogical is found "... neither in one of the two partners nor in both together, but only in their dialogue itself, in this ‘between’ which they live together” (Buber, 1965b, p. 75). The “between” is parallel to the Gestalt idea that the whole (the dialogical realm) is greater than the sum of the “parts” (i.e., therapist and client). 3*

1 Maslow (1969) points out the radical differences of the two different ways of knowing for science: I-Thou and I-It knowing.

A

The basis for this chapter was an article entitled “Dialogical Gestalt Therapy: An Initial Proposal” completed in 1984, and published in 1985. a

There are also fascinating parallels with modem research on the “body/mind” connection. For example, Buber referred to his approach as “healing through meeting,” and there is research to indicate that we actually exchange atoms with each other (Simon, 1994) and presumably these exchanges may be healing. ----- 4 —

The study of the way the human being functions in his environ­ ment is the study of what goes on at the contact boundary between the individual and his environment. It is at this contact boundary that the psychological events take place. Our thoughts, our actions, our behavior and our emotions are our way of experiencing and meeting these boundary events. (1973, P- 17)

Since there is sometimes confusion about this issue, it is important to emphasize: All dialogue is contact — not all contact is dialogue. Much contact is not dialogic — it is technical contact. In Buber’s terms, this is an I-It encounter. Expanding contact or awareness is not a goal in itself. It is useful if it helps this person establish a better relational stance to the world. This by no means implies that there is not a focus on intrapsychic work or on seemingly isolated contact or awareness aspects, but rather that this work is always seen within the context of an overall dialogical approach. Any contact and awareness work needs to be grounded in the “between.” Out of this “between” arises an awareness and differentiation of self from not-self. “The contact boundary is the point at which one experiences the ‘me’ in relation to that which is not ‘me’ and through this contact, both are more clearly experienced” (Polster and Polster, 1973, pp. 102-103). A genuine dialogical approach requires a radical paradigm shift from an individualistic model of the self.

4 The model of the “holon” might be a helpful one here, whereby the whole is greater than the sum of the parts, yet each part paradoxically contains the whole in it (Wilber, 1982). There are also findings arising out of gender research such as at the Stone Center which emphasizes the strengths of a relational model. -----5 - -

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A Dialogic Approach Dialogical psychotherapy is defined primarily by an approach, attitude, or stance toward human existence in general, and the process of psychotherapy in particular. It is a ’’way of being.” There can never be any total and final statement on a dialogical approach. 5 By its very nature, it is always an ongoing process, requiring unique respons­ es to unique situations. At the heart of this approach is the belief that the ultimate basis of our existence is relational or dialogic in nature: we are all threads in an interhuman fabric. This is not to obscure uniqueness. On the contrary, a dialogic approach celebrates the uniqueness of the individual within the context of the relational. Our uniqueness emerges in relation to others. This is counter to the usual individualistic model of the person. A dialogic approach recognizes that one of the most fundamental tensions of human existence is the tension between our relatedness and our uniqueness. As Polster and Polster address this issue: Since our umbilicalectomy each of us has become separate be­ ings, seeking union with that which is other than ourselves. Never again can we return to the original symbiotic paradise; our sense of union depends paradoxically on a heightened sense of separateness and it is this paradox which we constantly seek to resolve. The function which synthesizes the need for union and for separation is contact. (Polster and Polster, 1973, pp. 9899)

The quality of our living is dependent on how this tension is resolved over and over again throughout our life. This is readily seen in working with couples in therapy. There is always the tension of how much each person needs to pursue individual interests, and how much to pursue relational needs. The balancing of those two polarities is often the key to healthy living.

5 What will be described here are sotne contours, or general directions, or movements of such an approach. — 6 —

— The Dialogic Ground —

It is important to emphasize that the dialogical is an approach to others; it is not to be equated to speech. Speech, at best, is the audible manifestation of a dialogic attitude. Words, far too often become the impediment to true dialogue. They become a psycho­ logical defense against real meeting. In fact, “. . .genuine dialogue can take place in silence, whereas much conversation is really mono­ logue” (Friedman, 1965a, p. xvii). Words may be the prelude to an I-Thou meeting, but do not define it. Some of the most healing encounters have occurred when my client’s eyes and mine meet, in the absence of words — yet so much is “spoken” between us. There is a meeting of something deep inside of me with something deep inside this other person. In this meeting of silence, a real speaking can occur, an interpenetration and merging of our human spirits, which enriches us both, and makes us whole. 6

1-Thou — 1-It

In the beginning is relation. Buber (1958a, p. 18) The dialogical takes place in the realm of the “between.” It encompasses two polar stances: the I-Thou and the I-It These are the two primary attitudes that a human being can take toward others. One

6 I clearly remember to this day a personal experience of being “met” in silence. I was going to a colleague’s home to hear Baba Ram Dass (formerly Richard Alpert) give a presentation. Though I had read some of his work and admired it, I approached the evening with a bit of skepticism. I was a little late, and as I walked into the house, Ram Dass from far in front of the room turned and looked directly at me, and smiled. I had never been introduced to him, yet there was something in his look, as if he could look deep inside of me, knew me, and cared about me as a person. This all happened in an instant. I never had an opportunity to talk to him about this encounter, but there is little doubt in my mind that his constant work on himself and consequent availability to others allowed him to be that emotionally, psychologically, and spiritually available to others — even total strangers. — 7 —

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is an attitude of natural “connection,” the other, natural “separation” (Buber, 1958a). Both are essential. This often is misunderstood. Healthy living requires a rhythmic alternation between the two. This tension of connectedness and separateness is present from the moment of conception. The fetus is profoundly flesh 7 of the moth­ er, yet also is bodying toward separateness. This physical develop­ ment is paralleled throughout life in our psychological development. We are always seeking the balancing point between our separateness and connectedness to others. In fact, it is the creative tension and integration of the two that is the hallmark of healthy living. Buber describes the primary attitude of natural combination as the I-Thou relationship and that of natural separation as the I-It rela­ tionship. The I-Thou experience is one of being as fully present as one can to another with little self-centered purpose or goal in mind. It is an experience of appreciating the “otherness,” the uniqueness, and the wholeness of another, while at the same time this is reciprocated by the other person. It is a mutual experience. It is an experience of profoundly valuing being in a relationship with this person. It is an experience of “meeting.” Recently, with a client, it was very clear that he was using words and getting sidetracked on tangential issues to protect himself (par­ ticularly his “five-year-old-wounded-self”) from feeling the seemingly overwhelming pain he has avoided, yet carried, for many years. From early on in his life, others represented threat, injury, and ultimately abandonment. He had perfected the use of words to erect a barrier to connectedness and intimacy. I gently, yet persistently, asked him what feeling was he avoiding by his focus on seemingly unimportant details and tangential thoughts. I did this for several minutes, as he kept trying to change the subject. Abruptly, he stopped talking, and shortly began sobbing. As the tears came down his face, it appeared that his self-protective barrier was “melting.” It looked like a cleansing. With gentle tears still in his eyes, he sheepishly looked at me. My gaze met his. We seemed to connect in the physical space between us. It

was an “embrace of gazes.” There was a timelessness (yet a passage of time). The intensity of this moment together was our total focus; everything else faded into a distant and irrelevant background. As we gently and warmly looked at each other, I could see the softening around his eyes, and in his face. I could feel my own eyes, face, and body progressively softening and warming in that same instant. This warm connectedness “within” each of us seemed to resonate to the other. Our gaze not only met between us, but also seemed to pene­ trate us both. We recognized something extraordinary had happened between us. I saw him in such a clear and profound maimer. He seemed to look at me similarly. The moment was effervescent. He knew he had been “seen.” Sheepishly again, he simply said, “I don’t think anyone ever noticed me before.” I-It stance. In contrast to an I-Thou moment, the I-It stance is thoroughly purpose-full. There is a goal in mind. There is a subservi­ ence of the personhood of the person to this goal. It is an objectifying of the other. Everyone must, at times, have to do this in order to accomplish a goal. It often is a by-product of so focusing on a goal that the other persons become secondary. It is an inevitability of human doing. At times, the task takes precedence over focusing on the relational: the task becomes figure, the “other” becomes ground. This is a necessary part of human becoming. In fact, Buber points out the profound irony that even the I-Thou meeting must eventually recede into an I-It memory: “But this is the exalted melancholy of our fate, that every Thou in our world must become an It” (1958a, p. 16). This is part of the flow of human relatedness. The I-It attitude is not wrong, or evil: Rather, it is its overwhelming predominance in the modem world that is problematic, even tragic. It is problematic when predominant; when this objectifying attitude is out of balance with a dialogic approach to one’s existence, and to others. Other and self reciprocity. The hyphens in the terms I-Thou and I-It are profoundly symbolic. They literally signify that the orientation with which one approaches others is always a relational one, and reciprocally reflects back on oneself. Thus they say something about the manner in which we relate to ourselves. If I approach others with an I-Thou attitude, that will reflect back on how I approach myself.

7

The literal intercorporeal experience of fetus and mother gives us an insight into the “philosophy of the flesh” of Merleau-Ponty, especially his posthumous work, The Visible and the Invisible.

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— The Dialogic Ground —

If I objectify others, I reciprocally objectify myself. There is a rela­ tional reciprocal circle that we need to be aware of. I-Thou “attitude ” — I-Thou “moment." It is important to differenti­ ate the I-Thou attitude or the dialogical, from an I-Thou moment. The dialogical is not the same as the I-Thou moment. An I-Thou encoun­ ter is but one moment, or dimension, of an overall rhythmic dialogical approach encompassing the alternation of I-Thou and I-It moments. It is certainly the most dramatic moment in the natural alternation of stances. But is must not be "frozen” as only a peak moment, and as some lofty goal to always achieve. This paradoxically overemphasiz­ es, or inflates, the I-Thou experience. This occurs when someone makes it a “goal” to have an I-Thou encounter. Ironically, this becomes an I-It encounter! One cannot directly “aim” at having an IThou relationship. One can only prepare the “ground” for it occur­ ring. We can only be as present as possible in this moment; we can’t force ourselves (nor another) to engage in genuine dialogue. That is outside our control. Once we have prepared the ground, a genuine meeting occurs through a mutual openness, and through “grace.” “The thou meets me through grace, it is not found in seeking” (Buber, 1958a, p. 11). Genuine dialogue is mutual. It can’t be forced. It can’t be “held onto.” We need to be open to its ebb and flow: “. . .the graciousness of its comings and the solemn sadness of its goings. . .” (Buber, 1958a, p. 33). Over and over again, I have had to learn the lesson of “letting go” to the process in the therapy in order for the possibility of a real meeting to occur. This means that I’m always in a paradoxi­ cal position of being open to, and wanting this experience to occur, yet not trying to force it. 8 Dialogue needs to be distinguished from an intrapsychic “dialectic.” A dialogue requires at least two persons entering into a genuine relationship with each other. A dialectic refers to the interaction between two polarities. In psychotherapeutic terms, a dialectic can be

observed “within” a single individual when she is of “two minds.” For example, she both wants to do something, and doesn’t want to do it. It is a tension — often an intrapsychic one — rather than a dialogue between persons. A dialectic is always an aspect of an I-It attitude. A dialectic must be transcended in order to achieve a genuine dia­ logue. 9 Irrevocably, dialectics are the backdrop of, and interpene­ trate with, any genuine dialogue. Yet it is important to distinguish between the two. Wholeness of the Person

At the core of a dialogical therapy approach is an overriding concern with the whole person, not focusing only on any one aspect such as the intrapsychic, or the interpersonal or transpersonal (ontological) dimension. A dialogical therapist attempts to get a sense of this person in his wholeness: This is always the context for understanding this person. At different stages in the therapy, or within a particular session, one aspect or another needs to be emphasized. Overall, however, a dialogically oriented therapist attempts to maintain the whole context — as well as the tension of looking at the rhythmic alternation between them. 10 “ Unmasking. ” There is an inevitable temptation for each therapist simply to dissect the client into various psychological “causes” and to diagnose and treat them accordingly. Buber calls this tendency “unmasking.” In a sense there is always the need within therapy to help this person remove the mask of “seeming” which keeps him out of genuine contact with others and his own greatest needs. However, unmasking can too easily become the main focus and consequently we lose sight of the whole person. This is what Buber calls “the error of seeing-through and unmasking.”

9 See also Bugental (1976, p. 137).

8

I point out in the chapter “The Paradoxical Profession” of my 1991 work how the practice of psychotherapy is fraught with paradoxes, and that the mature therapist learns to balance them and integrate them. This becomes a modeling for the client.

The picture is even far more complicated than this: The therapist also displays these various dimensions, which naturally interact with the client’s experience.

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The gist of the error is this: when an element in the psychical and spiritual existence of man which formerly was not or was too little noticed is now uncovered or clarified, one identifies it with man’s total structure instead of inserting it within the structure. (Buber, 1957b, p. 226, emphasis added)

Too often today we identify the person with some outstanding psychological motive as if that were the only dimension of that person’s existence. Perhaps too often we fail to ask ourselves what is the context of this person’s existence such that this motive or behavior is figural at this time. Proportionality and pathology. For Buber, “The decisive question is: what proportion exists between this element and the other, in what measure and in what way does it limit them and is limited by them” (Buber, 1957b, p. 226, emphasis added) No one aspect of human behavior is seen as absolute. Each behavior needs, and desperately “calls,” to be understood within the larger context of a person’s exis­ tence. To unmask the motive behind any single behavior becomes an arid exercise. Buber beautifully states: “Man is not to be seen through, but to be perceived even more completely in his openness and his hiddenness and the relation of the two to each other ” (Buber, 1957b, p. 227, emphasis added). In this light, pathology is seen as a disturbance of this person’s entire existence and as a statement of what needs to be attended to in order for this person’s existence to become more whole. Un­ masking the underlying psychological causes is not the main focus. Rather, viewing them in relation to that within human existence that needs to remain hidden, that is too depthful, mysterious, and perhaps vulnerable to be directly exposed to the light of consciousness. The whole person is both open and hidden (Friedman, 1974). Pathology arises when these dimensions are significantly out of balance with each other.

Steward of the Dialogical

In a genuine dialogical approach it seems to me that the therapist is a steward of the dialogical. By this I mean that in a very pro­ found sense, the individuality of the therapist is subsumed (at least momentarily) in the service of the dialogical. Some therapists may be put off because the tradition of Gestalt therapy has emphasized helping people develop their individuality (regrettably sometimes to the detriment of their relationships). A dialogical perspective assumes that “individuality” isn’t sufficient. It assumes that genuine unique­ ness arises out of real relatedness with others. Individuality is but one pole within an overall rhythmic alternation between our individual separateness and our participation in something larger than us — the interhuman. Why an individual begins therapy has to do with her or his disturbed dialogue with others, as well as being out of touch with themselves. It seems essential for the therapist to begin to heal this tear in the interhuman fabric by placing herself in the service of the dialogical and in a sense asking herself, “How do I need to be, and what is it I need to do, in order to begin to help this person either establish, or reestablish, a genuine dialogical relationship with the world?” Buber states it rather profoundly: “You have the great task, self-imposed, a great self-imposed task to supplement this need of his and to do rather more than in the normal situation” (1965b, p. 172). What I need to do when someone walks into my office is to use all my senses, all my experience, all my training, to become aware of what is “missing” in this potentially dialogical situation. There is an unconscious “dialogical therapeutic complementarity” that the therapist needs to be sensitive to. My experience of it is that in

1' See also the chapter, “The Problem is the Answer,” in my book Between Person and Person.

This idea harks back to the radical notion that one does not possess anything. This was especially evident in many societies in relationship to a “stewardship to the land.” Instead of believing that you “own” the land you are rather “in the service of’ the land and you are responsible for its well-being during the length of time it is in your stewardship. This implies a very different relation to reality than the acquisitive and controlling stance that seems to permeate Western and particularly American society, and that manifests itself even in the therapeutic endeavor.

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— The Dialogic Ground —

I find myself pulled to be a certain way, very often in the polar (i.e., complementary) manner to that in which the client treats either himself or me. With a client who is not very accepting of himself, I believe that the restoration of dialogue begins with my being particularly accepting of him. With a person who is very outgoing, I might find myself particularly interested in his “inner” world of feelings. This certainly doesn’t apply to every situation, nor is it always appropriate for me to act on this awareness. Such a stewardship requires a great deal of discipline and an “obedient listening.” Some Gestaltists might object that this places far too much responsibility on the shoulders of the therapist. I believe that a stewardship in the service of the dialogical requires walking the “narrow ridge” between responsibility for and responsibility to, other persons. It is quite likely that such a stance initially requires taking responsibility for the initiation of a genuine dialogic relationship, but that is done only to help establish a genuine relatedness. Within that atmosphere, both client and therapist are better able to take full responsibility for themselves.

The therapist doesn’t ignore all the knowledge she has, but rather this knowing is shaped by her overall sense of the client and what that person needs at that time. Throughout the therapy, there is the art of knowing when to emphasize the “general” or the unique. “Walking the narrow ridge” means that the dialogical therapist has no taken-for-granted security. Theory is a support, but no substitute for the experiential engagement.

The "Narrow Ridge ” A dialogical psychotherapy approach means that the therapist always walks a narrow ridge. That is, she does not:

. . .rest on the broad upland of a system that includes a series of sure statements about the absolute, but on a narrow, rocky ridge between the gulfs where there is no sureness of express­ ible knowledge but the certainty of meeting what remains undis­ closed (Buber, 1965a, p. 184). There are no absolute rules. The therapist walks the narrow ridge between objectivity and subjectivity. When the therapist needs to emphasize more of the subjective or objective depends on the meeting with this unique client, at this unique moment. Even when a therapist has worked many hours with a client, she never knows ahead of time what will be required in this session, or even the next moment. It requires the therapist to be present to this pregnant moment.

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The psychotherapist meets the situation, moreover, not like the priest, who is armed with sacred possessions of divine grace and holy word, but as a mere person equipped only with the tradi­ tion of his science and the theory of his school. It is under­ standable enough that he strives to objectivize the abyss that approaches him and to convert the raging “nothing-else-than process” into a thing that can in some degree, be handled. (Buber 1957a, p. 94)

That is the challenge: How to be present to the “nothing-else-than process” yet not get lost in the abyss. How to utilize the security of theory, yet not use it as a defense against the unknown. How to respond to uniqueness, yet appreciate our common humanity. The therapist, if aware of a broadened range of human possibilities, is engaged in a truly paradoxical undertaking — one in which there is scant security, only the certainty of meeting with the unknown, the unique, the never-before-experienced. “Turning Toward" — Presence The preliminary, yet essential, step in establishing the possibility of a genuine dialogical connectedness is a “turning” of my whole person to the other, in order to better engage this person. This “turning toward the other” (Buber, 1965a, p. 22) is inevitably a momentary “turning away” from being preoccupied with my self. This “turning toward” is far more encompassing than what is ordinarily meant by “attending.” It is viewing the other in her/his unique “otherness” — which is different from me, and any of my needs.

The chief presupposition for the rise of genuine dialogue is that each should regard his partner as the very one he is. I become — 15 —

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aware of him, aware that he is different, essentially different from myself, in the definite, unique way which is peculiar to him, and I accept whom I thus see, so that in full I can direct what I say to him as the person he is. (Buber, 1965b, p. 79)

being surprised. It means being present in an in-depth way. It engenders a sense of wonder at the very uniqueness and humanity of the person before you. This does not mean that the therapist should not have a great deal of theory, training, and experience. That submersion in training, theory, and experience is essential, but at the moment of meeting with the therapy participant, it forms the backdrop and should not be foreground. If it is foreground, as so often happens when we first start doing therapy or when we’re insecure, it will interfere with appreciating the otherness of the person and with genuinely meeting that person.

Presence is a quality difficult to define. Yet its absence is readily apparent. More than a “quality,” it is an existential stance. It is bringing all of myself to bear in this moment with this person. No other concern is paramount. It is a letting go of all my technical concerns and “goals.” The only goal is to be fully present — paradoxi­ cally a goal that is not achievable by technique. Being fully present can be a powerful experience. In fact, for those individuals who are not used to having another be fully present to them, or whose sense of personhood is tenuous, the other being fully present may be experienced as overwhelming. That is a danger. However, this being fully present is not monologic. For the therapist, it needs to be modulated by, and responsive to, the ability and willingness of the client to absorb this presence. It is never something imposed upon another: There needs to be a sensitivity to how this presence will impact this particular individual. If it were imposed, it would be the application of an abstraction, or a technique. True presence precludes both of those.

The deciding reality is the therapist, not the methods. Without methods one is a dilettante. I am for methods, but just in order to use them not to believe in them. Although no doctor can do without a typology, he knows that at a certain moment the incomparable person of the patient stands before the incom­ parable person of the doctor; he throws away as much of his typology as he can and accepts this unforeseeable thing that goes on between therapist and patient. (Buber, 1967, p. 168)

Essential to establishing a genuine dialogical stance is for the thera­ pist, as much as is humanly possible, to suspend, or “bracket” 13 her presuppositions: to place interfering experiences and understand­ ings in abeyance. In other words, the therapist attempts, at least momentarily, to suspend all her personal biases, general knowledge about people, general knowledge about psychopathology and diagnos­ tic categories in order to be as completely open to the uniqueness of the other person as possible. This is a form of “Zen” or meditative “cleansing” so that the therapist is open to the unique, the novel — to

Anyone seriously concerned about suspending assumptions quickly recognizes that it is impossible to completely suspend them. 14 Rather it’s a stance of acutely being aware of one’s presuppositions, as much as is consciously possible: It is also the humility and caution that arises in recognizing how much of our presuppositions are nonconscious, and out of the realm of awareness. With clients, this caution keeps me from too quickly jumping in with conclusions, suggestions and interpretations. Clients come to me to be heard — not just their words, but also what they are not saying. They need me to hear them beyond the literal level of what is spoken. They want (often not fully conscious of it themselves) to be met at a deeper level. That cannot occur if my own perspective takes up too much of the psychological space

This is based on the phenomenological “reduction” or “epoche” of Edmund Husserl’s phenomenology.

Referring to this, Merleau-Ponty, the phenomenological ontologist, said that in fact the phenomenological “reduction" teaches us the impossibility of a complete “reduction.”

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"Bracketing " — Suspending Presuppositions

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between us, or worse, is imposed on the other’s experience. I cannot stay in contact with and palpate my client’s experience if I am too captivated by my own. Temporarily suspending my presuppositions is no guarantee, but it increases the likelihood, of being more available at a depthful level to my clients.

“Touchstones" As I prepare to meet with a new client, I find myself wondering about the “being” of this person. How integrated is this person? What is the relationship of his conscious identity to his being? How will the uniqueness (as well as the common humanity) of this person be mani­ fested? What language, images, metaphors, will this person use? What is his unique history? What were the major paradigms for interpersonal relationships learned in the family, and how does that affect his present life and even relationship to me? How was his exis­ tence confirmed and not confirmed by others? Will the initial focus be more on the intrapsychic, the interpersonal, or the transpersonal dimensions of existence? What are the major “touchstones” (Friedman, 1972b), the major events and meanings in this person’s life so that I can begin to un­ derstand this person’s unique context? What will be this person’s major style of defending himself? Where will there be resistances to the therapeutic relationship and to further growth? Most importantly for a dialogical perspective, how can I begin to make contact with this person! Where can we touch? At what moment will there be the openness in his being to begin to enter into a meaningful dialogue? How do I need to present myself so as to facilitate this openness and the possibility of a genuine dialogue? There are so many questions because there are so many different dimensions to respond to, and because the answers are unique to each person, and each meeting.

15 This is a term put forward by Maurice Friedman in his book Touchstones

of Reality (1972b).

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— The Dialogic Ground —

“Tracking" — Following the Client’s Experiential Lead This is a moment by moment “staying-with” the phenomenological ex­ perience of the client. Sometimes I liken it to the human counterpart of radar waves being sent out by a transmitter and bouncing off an object, which then tells you where that object is, even if it is moving. A person’s experience is always changing. It is always in flux. The therapist’s task is to stay so close to this person’s experience that there is a visible resonance to the client’s experience. This is an initial step in a dialogic healing “dance.” I need to follow the experiential lead of the client in establishing the initial steps in this “dialogic dance.” I need to learn how to move with a rhythm similar to my client. I need to be present in a way that truly honors that experience — especially when my client fails to do so. Often, it is the failure to honor his experience that is so often self-disconfirming. It is the genuine honoring of experience that allows the individual to overcome resistances, and to be “bodied forth,” and therefore to extend his or her growing edge. It is the exploration of the outer reaches of his/her experiential “envelope.” It is being present to that which has not been allowed to see the light of day. It is a reverence for this person’s unique experience. It is a hallowing of this moment. It is teaching the client to stay within his/her experience, rather than getting caught up in an image, or shoulds — in a false self. It is helping the client to live at the experiential edge — which is the meeting point of person-with-person.

Inclusion — Experiencing “Both " Sides Buber indicates in his writings how the psychotherapist, like the educator and the parent, or anyone who wants to establish a genuine dialogical relationship, needs to practice what he calls inclusion. 15 16 By this he means “. . .a bold swinging — demanding the most inten­ sive stirring of one’s being — into the life of the other” (1965b, p. 81). In other words, the therapist needs to be able, as much as is humanly possible, to attempt to experience what the client is experiencing, from

16 The case presentation that follows this chapter demonstrates some of the difficulties and challenges of trying to practice inclusion. ---- 19----

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her side of the dialogue. At its best this is but a momentary experi­ ence since no one can maintain such a stance for very long, but it is also a general approach of attempting to do this as much as is possible in this situation at this moment. There is an experience of selflessness at these moments. Yet, at the same time, the therapist also needs to maintain her own centeredness. Inclusion is the back-and-forth movement of being able to go over to the “other side” and yet remain centered in my own existence. An example of this occurred in a group I was leading. A male member of the group had just finished saying that it was far easier for him to express anger at women than men. A woman in the group, who was a minister, began to talk about what his statement meant to her. It brought up an exceedingly painful memory. Her later write­ up of this experience follows:

felt radically different than all the other times I have relived what happened. What came was a certain quietness and powerfulness that made me blink my eyes, and then the moment was gone. But somehow I knew that I would never be at the same place in telling the story again. I would be conscious about who I would tell the story with. . .and I would not settle for “dealing” with it anymore. I would learn to tell the story where the im­ ages could come real and I would bring a person to the story. I felt I was bringing Rich to the whole story, which includ­ ed my whole self. . .not the part that was just raped and beaten. I felt that there was not a moment that Rich did not experience all of me telling the story, and that the part of me telling the story was more important than just the part that was beaten and raped. And this is what made it a redemptive and healing experience.

I talked about having been beaten and raped by two men angry at the church, who found it easier to take it out on me. I have never known how to exactly talk about the violence and the terror I had experienced. To openly share with another my feelings without at times having the concrete images to go with the feelings felt too vulnerable. Most of the time I felt awk­ ward in sharing what had happened. It would feel forced, con­ trived, dramatic or neurotic. I had grown tired of people trying to help me “deal with it”. . .only to feel more different and peculiar than I already felt. What happened to me in a moment was for just a moment. As my eyes caught Rich’s eyes, I felt Rich immediately went with me to a place I had been too embarrassed to take anyone before. For a split moment I made a choice to let him cross the boundary, but it did not feel forced, it felt allowed. I am not really sure what prompted that choice within me. It seemed like the natural thing to do. I was deeply aware that I did not feel lonely in that place with Rich there, and I was surprised. I felt tremendously sad but I was not panicked because I did not feel alone and I felt the sadness was shared. I also felt that what was asked was to tell the story on the same ground in which it happened, and this

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Certainly it is no accident that human beings rarely practice experiencing the other side. It requires a person to have a very strong sense of her own centeredness, yet the existential and psychological flexibility to experience the other side, and further, to be able to establish and maintain a back-and-forth movement between these two sides. Anyone who has ever attempted this has certainly experienced the fear of the loss of self, yet this is precisely what we need to lose — our rigid sense of self — in order to experience the other side and establish a genuine dialogical relationship. Certainly, even someone who can at one time practice inclusion at one moment in a therapy session, or even throughout the session, cannot easily maintain such a stance hour after hour with person after person. Just like the I-Thou moment, one can’t “aim” at inclusion. It does require an intensive effort on one’s part to attempt to experience the other side as well as my own, yet it can’t be forced. We can only make ourselves as available as possible; yet, it too comes about through “grace.” One of the indicators that a person is ready to end therapy is that frequently she begins to experience the therapy situation from my side. That is, she will make comments to the effect that “It must’ve been very rough on you in the early part of the therapy” or “I guess I never ----- 21 ------

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saw it from your point of view before” or the client may even begin to become concerned about my health or other aspects of my life. She is now able to experience the other side. Empathy. For Buber, inclusion is not the same as empathy. For him, what is usually called empathy is a only a feeling — a very important feeling — but still only one feeling among many. Inclusion is instead an existential turning of one’s existence to the other and the attempt to experience that person’s side as well as yours. In the true moment of inclusion, neither side of the dialogue is ignored. For Buber, empathy ignores one existential pole of the dialogue; inclusion is the opposite of this.

This is both different from, yet similar to, Frederick Peris’s definition of the healthy person as one who is independent of environ­

mental support. It is different in that it recognizes that at the heart of our existence is the great need to be confirmed by those in our life who are significant to us, most usually our immediate family. It is similar in that once we have received this “Yes,” this “heavenly bread of self-being” from others, we then are able to be sufficiently centered in our own existence to stand our own ground. This is of course not something that happens just once in our life and we feel forever confirmed from then on. Rather, it is a complex spiral of events throughout our lifetime, whereby there is a certain need and readiness in our existence for such crucial confirmation. All the literature on development and “psychopathology” points out the most developmentally critical period is in our early years, when our family leaves the most powerful mark on our existence. If we do receive this confirmation in our early years, this lends to a sense of what Erik Erikson would call basic trust, and later experiences of being confirmed can build on that early foundation. Unfortunately, far too many of us either never receive that strong sense of initial confir­ mation and develop that basic trust, or else we have failed to build on that confirmation in later years when we reached other crucially ready stages of our development. I talk about crucially ready stages because it seems as if there are certain times, or even periods in our existence, when there is a certain vulnerability in how we are experienced by others, yet consequently an openness and even a desperate need to be confirmed, in order for us to have the “ontological security” to go on growing. It is because of the desperate need for confirmation that we end up becoming “false selves” (Laing, 1965). We are so desperate for this confirmation that if we do not receive confirmation for being who we are, we will attempt to elicit the next best thing — we will attempt to get confirmation by being the way we think someone else wants us to be. We will create an impression — we will engage in a kind of “seeming” in order to gain acceptance. Yet, this is an acceptance of a false self, and the individual secretly knows this. This acknowledg­ ment of a false self is preferable to no acknowledgment at all (May, 1969). However, this leaves the individual feeling empty inside and false to her or his own true self. Ironically, this becomes a vicious cycle in which the individual must desperately search for confirmation,

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Its elements are, first, a relation, of no matter what kind, between two persons, second, an event experienced by them in common, in which at least one of them actively participates, and, third, the fact that this one person, without forfeiting any­ thing of the felt reality of his activity, at the same time lives through the common event from the standpoint of the other. A relation between two persons that is characterized in more or less degree by the element of inclusion may be termed a dialog­ ical relation. (Buber, 1965a, p. 97) Confirmation At the heart of a dialogical approach is confirmation. The underlying basis for most non-organic psychopathology is the lack of confir­ mation that all of us suffer in this endeavor of becoming a human being.

Sent forth from the natural domain of species into the hazard of the solitary category, surrounded by the air of a chaos which came into being with him, secretly and bashfully he watches for a Yes which allows him to be and which can come to him only from one person to another. It is from one man to another that the heavenly bread of self-being is passed. (Buber, 1965b, p. 71)

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— ■ The Dialogic Ground —

yet continues to compromise her/himself to receive any acknowledg­ ment at all: It is a Faustian pact, with the same dire consequences. Consequently, at the heart of a dialogically oriented psychotherapy is the need for the client to be confirmed by the therapist. Though this confirmation is not confined to the therapist’s office, it may be that the therapy opens up the possibility for this person to be confirmed in other situations. The therapist needs to work on those blocks that clearly help protect this person’s being, but also keep her/him from receiving the very confirmation that is so desperately desired. Confirming the other means an active effort of turning toward and affirming the separate existence of the other person — his otherness — his uniqueness, and his common human bond with me and with others. This is always an implicit part of therapy and at times it is a very explicit one. Each of us has engaged in a certain amount of seeming (hiding) in order to psychologically survive, yet deep inside of us, there is something that cries out for recognition; recognition that we exist, that we are separate and yet that we are also acknowledged as a fellow human being. 18 The issue of confirmation implicitly acknowledges our existential interconnectedness — that we can validate ourselves only to a certain point. Being “creatures of the between” means we require confirmation from another. 19 What is meant here by confirmation is more than what is usually meant by acceptance though acceptance is an aspect of confirmation. Strictly speaking, acceptance means an acceptance of this person and his behavior and who he is at this time, and not requiring him to

change. Acceptance, as such, places no interhuman existential demand on the other person to be any different than s/he is. Confirmation, on the other hand, at a deep existential level, recognizes and affirms this person’s existence even perhaps while saying that his current behavior may be unacceptable. There may even be a good deal of contending with this person while confirming his existence. Acceptance is only the prelude to confirmation. Centeredness of the therapist. The process of therapy requires a tremendous centeredness on the part of the therapist. The therapist must have a sense of confirmation from those around her, as well as a real sense of self-acceptance. The therapist cannot be dependent on the vagaries of the therapy or the client for her sense of confirmation. In fact, the sense of feeling confirmed, of an “ontological security,” irrespective of the sometimes disturbing turns in the therapy, is a crucial part of the therapy and a very important modeling for the client. This sense of centeredness is never an absolute, since no one feels confirmed all the time and there are further existential voids to deal with; rather it is a sense of direction or movement on the part of the therapist, and hopefully this elicits a similar experience for the client.

।

The therapist may also be confirmed; however, confirmation of the therapist should not be the focus of the therapy. 1R

The remarkable play The Elephant Man poignantly exemplifies how crucial it is for each of us to have our existence recognized no matter how different we might appear either physically or psychologically.

“Techniques” “Techniques” arise within the context of the relationship. There is nothing wrong with techniques as such so long as they are not arbitrarily imposed on the situation. When there is a certain impasse in the therapy sessions, it is totally appropriate to utilize one of the many techniques that Gestalt therapists have found helpful throughout the years. However, this always requires that there is a trusting relationship that gives “permission” to the therapist to use certain techniques. If the therapist is really in good contact with the client, so-called techniques will be suggested by in the therapeutic context where this person and the therapist are at any given time. So-called techniques

Without a doubt the intersection of “self-acceptance” and interpersonal confirmation is a very complex and profound one. It barely can be touched on here.

Admittedly, these two dimensions are intimately interwoven and it is difficult much of the time to separate them.

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need to arise from “the between.” The therapist here must avoid the dangers of extreme objectivism or extreme subjectivism. This is not an easy task. It is certainly difficult to teach the art of responding to the between, which underlies subjective and objective ways of under­ standing human experience. It seems to me that the therapist is in much the same situation as a good improvisational jazz musician. Clearly there is much training in the technical aspects of music, reading music, and playing the scales; there may even be training in more formalized classical music. However, in the improvisational situation, the technical training becomes only an important backdrop out of which the musician is able to improvise her music. “The real master responds to uniqueness” (Buber, 1967, p. 168). “Empty chair" and dialogue. Most Gestalt therapists refer to empty chair work as setting up a “dialogue” between two polarities of a person. In the strictest sense, this seems to be a misnomer in that Buber would always emphasize being surprised by the “otherness” of another person, who is always different from me. Because of this otherness, I can never truly predict what the other person will do. This sense of unknowing and being surprised is fundamental to genuine dialogue. If would seem suspect to refer to an interaction between two polarities of a person as a true dialogue. On the surface it seems questionable as to whether there is that essential element of surprise and real otherness. It appears that a clear cut case could be made for the possibility of a dialogue between two personalities of a person diagnosed as a multiple personality. Yet, even here it is questionable as to whether this would be a dialogue, since each personality seems, at some level, to know something of the other per­ sonality. 21

we are trying to listen to both sides. In the strictest sense this is not a dialogue but is rather a kind of intrapsychic dialectic. However, frequently it is essential to work through intrapsychic impediments before a genuine meeting can occur. In all of the above cases I have been of the mind that this was not a true dialogue in that there was not the “otherness” and surprise that comes from interacting with a real other person, as opposed to how we imagine the other to be, or how we imagine an aspect of ourself. However, a number of clients have told me that in contacting a previ­ ously dissociated polarity, they often have been surprised by the sense of otherness of this polarity. Though hesitant that the I-Thou not be reduced to an intrapsychic encounter, my mind remains open on the question as to whether one can have a genuine dialogue with another aspect of oneself. Certainly the “voices within” us have a feel of otherness that can be quite compelling, and at times surprising.

Empty chair work appears to be a kind of self-dialogue in which we become aware that we are of two minds or that there are at least two polar thoughts or feelings within us that are in conflict, and that

71

I have never worked with a client exhibiting a true multiple personality dis­ order. Therefore, my discussion here is purely theoretical, and based on my reading and discussion with colleagues. It is meant to be evocative of further discussion.

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Dialogic “Goal” The therapist consistently attempts to establish a genuine dialogical relationship with the client. Rather than a goal as such, it would be much better to speak of the client’s dialogic responsiveness as more of a consequence of a dialogical therapy. As client and therapist work through the many stages of the therapy, the client, perhaps at first haltingly, but later with bolder and bolder steps, begins to be able to hold his own ground: He feels sufficiently confirmed in the therapy such that there is a real sense of his own separateness, centeredness, and yet relatedness. The client is now capable of experiencing another person as a Thou. No longer does this person lack the emotional re­ sources, or is too threatened and defended, to engage in a full relation­ ship. This does not mean that he was never able to do so before, but rather that now he is capable of comfortably and consistently engaging in a genuine dialogic relationship. This can occur frequently only after many of the intrapsychic conflicts, or perhaps “archaic styles” have been worked through. Prior to that, the therapist is in a sense a pseudo-person for the client. It is only in the working through of these conflicts that the therapist can become a real person for the client. This is of course not true for all

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situations, but it does seem to indicate a general direction in many therapeutic relationships.

may impose limits on how far they are willing to step into the be­ tween. The therapist cannot do both sides of the dialogue.

Limits to Dialogue . . .even in dialogue, full dialogue, there is a limit set. Buber (1965b, p. 175) The first issue that arises in looking at what Buber calls the “problem of limits” in a dialogical psychotherapy is that of the real mutuality between therapist and client throughout the various stages of the therapy. When the client walks into the therapist’s office it is always, at least initially, an unbalanced dialogical situation. There is not, nor could there be, full mutuality between therapist and client at this stage. By the very nature of the relationship, there is a certain necessary one­ sidedness. In fact this one-sidedness, and the humility that comes from the client recognizing this, may well be essential for the healing relationship to occur. It requires an opening on the part of the client before any genuine healing can take place. There are also limits set by dealing with certain neurotic or psychotic styles (Tobin, 1983). The specific dialogical limits are different working with a narcissistic personality versus someone who would be diagnosed as a severe obsessive-compulsive personality. There are also significant differences in working with a neurotic style versus someone displaying psychotic features. They are significantly different in their disturbed dialogical relationship with the world. “I can talk to a schizophrenic as far as he is willing to let me into his particular world.... But in the moment when he shuts himself, I cannot go in” (Buber, 1965b, p. 175). Even with healthy individuals there are certain levels beyond which they are not ready to go at this time. Some part of them intuitively senses that they currently don’t have the support to engage in a fuller dialogue with others. It takes a tremendous sense of security in order to risk one’s self in a genuine dialogical relationship. Even the best therapy cannot violate the basic dialogical principle that there are at least two sides to the interaction and that the client (or the therapist)

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A very important point in my thinking is the problem of limits. Meaning, I do something, I try something, I will something, and I give all my thoughts in existence into this doing. And then I come at a certain moment to a wall, to a boundary, to a limit that I cannot, I cannot ignore. This is true, also, for what interests me more than anything: human effective dialogue. (Buber, 1965b, p. 175)

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2, Reva: Impasse and Inclusion Two Perspectives Rich Hycner and "Reva"

Sometimes, the therapist doesn’t know what’s really going on. “Reva” . . .this gift is not a looking at the other, but a bold swinging — demanding the most intensive stirring of one’s being — into the life of the other. Buber (1965b, p. 81, emphasis added)

Introduction

In trying to understand the therapeutic relationship I’ve always believed it’s essential to have the client’s phenomenological experi­ ence, not only the therapist’s perspective. When the therapy with “Reva” (a pseudonym) ended, I was so intrigued by the impasse caused by radically different perspectives, and the process of its eventual resolution, that I asked her to either audiotape, or write up, her summary of the therapy. She audiotaped her reflections, and included written summary notes. The transcription of Reva’s original tape and the written notes were edited when it was necessary to give a context to the reader. Information not essential to the central issue — 31 —

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of the impasse, and the experience of inclusion was left out. No substantial statements of hers relevant to the impasse and inclusion were altered. My recollections were from notes, as well as a bodily sense that stays with me to this day. I had tried off and on over a seven year period to write up this experience. It was only in the context of writing this book that I was ready to do so. After this was written, it was shown to her, and she was in total agreement with the write-up, and recommended only minor changes which were incorpo­ rated. I am grateful to her for her courage and willingness to share this with others. Background. Reva came to me saying that she wanted to work on the issue of intimacy, particularly with men. She stated that she had a real fear of intimacy. She was in her mid-thirties and had been married twice and had several other significant relationships with men. She had also had an intimate relationship with a woman. However, she stated that it was men she would not let get too close to her. In fact, she often chose men whom she’d eventually get bored with. Later in the therapy she stated that, “My core issue is that after I grow to love someone I’m afraid they will leave me. After three to five years of being with someone, I get scared of being left.” She had a “father wound.” She described a father who was unre­ sponsive, so she felt abandoned by him. She believed she disengaged from him around the age of two. She never let him have an impact on her after that. Since she could not share herself with him, she kept emotional secrets from the other family members too. Her family was extremely covert in communications, so that she found herself feeling quite righteous about her honesty. (My experience later of her “honesty” was that it could be quite brutal and one-sided at times — honesty as almost an abstract principle, without recognition of the im­ pact it would have on the other person.) The issue of abandonment crossed at least two generations. When her mother’s family left Europe, they had left her mother behind until she was eight years old. Reva described her mother as passiveaggressive. There was a great deal of anger toward her mother. In the third session, Reva reported a dream in which she walked into a kitchen, and her mother was there with a large knife. Her mother started cutting off her leg in Reva’s presence. Reva reported being — 32 —

— Reva: Impasse and Inclusion —

disgusted at the sight. She felt her mother was so needy that she had to resort to being masochistic in order to get attention. Reva felt over­ whelmed by her mother’s neediness (to do otherwise at this develop­ mental stage would have thwarted her sense of self, which previously had been suppressed in the service of her mother’s identity). It had been most difficult in the past for her to establish boundaries with her mother, and consequently she was quite sensitive to boundary issues with others, including me. Reva was in her thirties and a graduate student in psychology. The therapy went on for twenty months. This therapy occurred during 1985-1986 and my style in the early part of the therapy was consider­ ably different from what it is now. The impasse revolving around polarized perspectives occurred approximately during the middle phase of the therapy. This therapy was pivotal in my developing a deeper understanding of Buber’s concept of inclusion — that it is truly a heart­ felt experience and an existential stance.

Reva’s Experience

Just before entering therapy I had a number of dreams about the dismemberment of a pet of mine, as well as the attempted self dismemberment of my mother! In one dream, my cat was dismem­ bered. When I discovered it, there was still a little sparkle in the cat’s eyes which indicated that it was still alive. As I was washing the blood off my cat, my watch fell down the kitchen sink. I looked again and the watch was lodged in the drain. I knew then that I had to go to a veterinarian, because if I didn’t, my cat would die. Around that same time I was trying to decide when to start therapy. I knew then I would be starting therapy soon. For the past three years I’ve been working hard on becoming more aware of the “bow and arrows” I carry. 1 Though they are helpful in assisting me in looking strong from the outside, the problem is that they work so well I often convince myself, as well as others, that I am

1 Reva had been influenced strongly by a recent graduate course in mythology, particularly as it related to certain goddesses, who were adapt at handling difficult situations. — 33 —

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without need. I have the ability to let enough softness and vulnerabili­ ty out that it serves as a guise — the guise being, “I am genuinely vulnerable” — while being fully aware of how selective my disclosures are. I wanted to work on my existential insecurity. *I2 On the other hand, this protection is not in itself selective, but a general reaction against rejection and abandonment. It comes in the form of a “bow and arrows.” Sometimes my protection is subtle, so subtle it’s hard for me to realize I’m doing it. Other times it’s acute; I can feel its presence keenly manifest in the instant of an eye blink. It not only protects me against emotional pain, it keeps me from being “truly vulnerable.” Being truly vulnerable is being in pain in the present and sharing that experience with another, not knowing what the outcome will be. For me being truly vulnerable happens rarely. I wanted that to occur in the therapy with you, and to help me to experience it more often with others. I wanted someone to be able to be with me, to touch me. I wanted someone to touch my soul, to feel my despair, to understand what I was going through, even though sometimes it was frightening. One of the main issues in the therapy was my prior relationships with men, particularly one man I was involved with; I later felt that it was not a healthy relationship because there was so much enmeshment. I wanted to look at this previous tumultuous relationship in which I felt I was so unconscious. It had felt like I had been in hell (though it felt like I needed to be there). I needed to get that deep to under­ stand some of the core issues and what was going on with me. It was extreme. It wasn’t the typical way I’ve lived my life: But it bore a lot of good information for me to learn from. I was also aware of a lot of unresolved mother and father complex material. I related a dream at one point of being invited to a dinner where the hostess turns out to be my mother, and she was wielding a knife in a threatening manner. I felt very scared. In the dream, my mother started cutting off her own leg and other limbs.

— Reva: Impasse and Inclusion —

I chose to enter therapy with you because I wanted an existential therapist and someone who I felt could “be” with me as I was going through this metamorphosis that I felt I had embarked on. I didn’t want to be “reasonable” in therapy. I wanted to be focused more in the here and now. One of the main reasons I had entered into therapy with you was because from your reputation and writings I had felt that you could make such a connection with me. I felt like I was putting a lot of effort into letting you know what was going on and what I was feeling. However, I felt like we weren’t connecting. I felt that you were being “objective” with me - so objective that we weren’t connecting — and that made me sad. My experience of it was as if you were in one corner of the room up high, looking down at me. I felt very objectified, and detached from you. I felt as if you were trying so hard to classify me, as if you were seeing this problem as chronic, and trying to figure out what was going on with me, whereas I saw this as more of an acute situation. I felt that you were trying too hard, or preoccupied with something else. 3 You were impotent. I felt like I was there by myself. My fantasy in starting therapy was that you would be able to connect with me immediately. I felt that you were not meeting me in the potentially transformative place that I was in. I felt you were seeing the chaos, but not the transformative possibilities. I had a dream in which there was no intimacy in my therapy. In fact I had a question as to whether a connection would ever occur. In driving to the sessions, I found myself getting quite emotional and feeling like I was ready to “work.” In fact I thought to myself

As I mentioned in the introduction, Reva was a graduate student in psychol­ ogy and had taken a course in existential psychotherapy.

3 Around this time my mother had suffered a life-threatening heart attack and stroke. Her condition was unstable for several months (which for me entailed a series of transcontinental trips). I was preoccupied. She also was aware that I was working on a book about the therapeutic relationship and the overriding necessity of experiencing it from the client's side. She “accosted” me by saying that as a consequence of my writing, I especially should be able to appreciate her experience. Later I realized that ironically my concentration on my editing and writing may have kept me from being as emotionally available to her as I wanted.

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that you must consider me a “basket case” because I was so overflow­ ing with emotion. I felt that the therapy stayed at a cognitive level and that felt condescending to me. I longed for someone to be there with me. I decided to confront the situation by agreeing to do some “empty chair” work in which I imagined myself sitting in the chair while I was present in the room “observing.” This was quite eye-opening. In doing this, I realized that part of the difficulty was that I wanted to be a “good client” and not upset you. I then felt that maybe we could just work on those things that you were “able to,” and to let go of the possibility of a deeper connection. I discounted both of us: myself by not making my deeper needs important; you because as with my father, I felt I wasn’t important. I felt like I was alone in the therapy. I was angry. I told “me” about my disappointment, my lack of connection with you. The reason I had chosen you was because you had written and taught about the therapeutic relationship. I had all these expectations and I expected you to be like Jim Bugental. 4 I vented my anger and criticalness. I did this vigorously, and even felt that I was obnoxious in doing so. I felt you were taken aback. I thought that you felt that I had turned on you. In fact I felt that you had turned on me. I felt that week after week I had tried to be nice and verbalize what was going on, and since this didn’t change anything, I felt that the only recourse was to act out my feelings. I felt that if I said this directly to you, that I would “blow you away.” However that didn’t seem fair or therapeutic for either of us. Things would be all right for a while and I would have outbursts like this every so often — in fact I had three, according to my recall. I felt that your trust in me was diminished because you would never know when I would go off on an outburst. I became aware that that kind of rage needed to be directed against my father — transference definitely was occurring. I felt that countertransference was occurring too. I fluctuated from being understanding of you to being angry because I didn’t feel connected with. That’s for me where a lack of

trust occurred because I felt that I couldn’t expect a connection. I felt like you were talking to my “head” and I wanted you to be talking to my soul. This made me both sad and angry. I felt like I fluctuated between being arrogant and trying too hard. I didn’t like that because it brought up an issue of men trying too hard with me; sometimes on dates men didn’t establish any boundaries for themselves and tried too hard. A similar thing occurred between me and my previous problematic relationship — there were no boundaries between us and I knew that that wasn’t healthy. However, I felt that that wasn’t my usual way of being. Yet there was this deep part of me that was greatly saddened by abandonment and rejection. It also brought up issues of my father, and feeling abandoned by him when I was two — and not expecting it to be any different and “accepting it” and that acceptance made my childhood “okay.” In some abstract way that seemed to be once again happening in therapy because I didn’t feel heard or listened to. On one hand I felt that what I needed to do was to let go of my expectation and everything would be “okay,” but that’s what I did with my dad. I didn’t want to hurt you, so I didn’t tell you. That’s what I felt with you - I just didn’t expect to be understood. I just didn’t expect you to be there for me because you weren’t. If I were to expect that of you I would be even more angry and hurt. I felt like I needed to take care of it myself. I felt like I was struggling through this myself. I had my female friends to share this with, but I wanted a man to share this with me — a “dad” to share this with me. I wanted to feel that connection. As much as I didn’t want to be worldwise, and as much as I didn’t enjoy the relationship that I did have with you, it’s what I needed to experience and where I needed to be. I remember that one night I did an “empty chair” at home with my imagined father. In this dialogue he was a little boy about seven or eight years old. He told me how hard he worked, and how much he loved the family and why he behaved the way he did. It was really sweet. I cried, and I wished that I could do that in therapy instead of at home. Several times things like that would occur, and I wanted to share them with you in therapy, but felt sad and disappointed and angry because it didn’t happen in therapy — it happened with me by myself. (I realize that

4 The well-known existential therapist. — 36 —

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this is my side of it, and that a lot went on on your side of it also, but I’m trying to stay focused on what was going on with me.) One time I can remember I was going to a therapy session and I felt real intense and felt like I wanted to work through some things and I decided not to have any expectations and just go with it and see what would happen — not to expect the connection, and not to go there with any expectations. What happened is that we connected'. We had actually been connecting little touches here and there, and so those touches were building up, and with those touches we were forming a relationship. Maybe they weren’t at a core level as I would’ve liked, but they were there. This time when I let go of any expectations, we connected strong. Ifelt like you were right there with me, at my core. And you were talking to me so that I knew — I knew you understood. We were talking about my abandonment issues — and not intellectually — you were there with me and it felt really good, and it felt really warm and joyous, and exciting. And then you scared me. It was an intimate time, and you merely shared with me an image of what you intuitively felt I needed (while making it crystal clear that this would not occur under any circum­ stances) — that you were my father, and I would sit on your lap like a little girl and be held, in the way I had so desperately wanted to be held by my father. I just got really scared (even though I knew this would not really happen). I felt myself pull back - just jolt — jolt out of being there and becoming defensive — just feeling like I had a shield in front of me, or a bow and arrow like I was ready to defend myself if I needed to. I didn’t want to get that close. And we were truly close. I moved away and I didn’t tell you because I didn’t want to hurt you. I was too scared to tell you how scared I was. I never moved back to where I needed to. I didn’t trust what happened. Maybe what that did is it brought to my awareness just how touched you were and how moved you were by our communication. And I felt like if I could have left it like that, I could have gone out with that feeling. But what happened was that I jolted myself out of being there, and got scared — scared of intimacy. The one issue I felt like we really worked on in therapy was my “grandiosity.” That’s what I needed to balance out because I can be very grandiose, almost like euphoric — things are going well and me — 38 —

— Reva: Impasse and Inclusion —

feeling like because I’m doing the right things, the right things hap­ pen. But it’s a grandiose feeling. It isn’t reality based. I felt like I was working on that vicariously. That was the balance that I was working on myself. I was working on my criticalness of people — men and women — more so if I had expectations, and they weren’t being met; and my peers — critical of them — I almost take too much grief from someone who I perceive as the underdog because we [therapists] are there to help. And then people who are my peers, I really expect them to be dynamic healers in all cases, in all instances, at all times, with all people. And I probably do that to myself also. I do do that to myself. I was learning about that — to just be with people where they are, to meet them where they’re at, and to let go of that critical part of me — that critical part that separates me from others, and separates me from myself. I do that to myself and I do that to other people. In our therapy I learned about true humility — to be humble, and to be really grounded. That’s what happened. I feel like a shift occurred there. I’m not all healed. I’m not all perfect. It’s not like I’ll never be grandiose again but I have a better sense of what to do about it than I’ve ever had before. I’ve been aware of my grandiosity for a long time but almost like not knowing what to do about it; except, I could talk myself down. Now I’m looking at that plus some other kinds of things. Looking outside of myself, inside myself and probably my having grandiose expectations of you too. I have very grand ex­ pectations that helped teach me about my own humility — that helped me look at myself and clients who are coming to me; I’m not going to be able to do the “miracle” that they want me to do. But what happened is — another new change, when I say the word “miracle” — another healing, the healing that really needs to be hap­ pening or taking place, did take place. Sometimes the therapist doesn’t know what’s really going on — they’re verbalizing all this stuff that they’re seeing changes in, and me as the client who’s going through them, that’s not really what changed in me but this is what’s really changed. You know I don’t feel as grandiose. I feel a real caring and connection for you. I feel out of my depression, or over my transformation.

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I feel excited about the future. I feel like the world isn’t perfect and it isn’t the pits either. I feel more feminine than I’ve felt in years. I came in feeling more masculine, and now I’m feeling more femi­ nine. I like that. I feel I know how to set limits on my parents. I feel differentiated from my mother and my father; though there’s lots of resistance to that on their part. Thinking about that with my parents it teaches me that sometimes energy can be one way. You know one person is trying to let go and the other person is holding on tight - that kind of thing: or that one person is real invested in someone and the other person is truly disinterested, or sometimes it’s difficult when someone is very demanding, to keep your boundaries and say “no” because of the intense energy that it takes to do that. It’s not that it’s difficult to say “no” but when someone is very demanding and has a lot of intense energy toward that then the energy that it takes to push back and say “no” is enormous: It’s enormous. That is some of what goes on in the dance between my parents and me. I’m real proud of myself because of my ability to say “no” and what I do know is that it’s against an enormous amount of energy that’s coming especially from my mother. You know about that dream with her cutting my leg off. In other words if I go forward to help my mother then she’s going to try to wound me somehow. You know, the mother complex kind of thing. As an indication to myself, I’m thinking about my relationship with my daughters. I’m proud that I can listen to them as a friend and feel like I don’t have to make it all better, and I feel like I listen to them as I do to friends. I don’t have to rush right out and do something to make it all better. I can allow them to go through their process, allow them to go through their growth and pain. That’s real difficult with my parents and maybe parents of that generation. You know my mother still would have liked everyone to incorporate her politics, think the way she does, be there when she wanted us to be, and that kind of thing — not allowing us to grow on our own. But like the dream of her cutting her leg off, if I moved

closer to try to stop or help her, she would cut my leg off. Somehow my wish is that (though she’s not like that) that she sees that this is definitely a better way. I know that it’s better for me and that there’s a part of my mother that knows it’s better for me, too. That is constantly being made clearer and it feels resolved when I’m here in California: When I go back for a visit and I know I have to put boundaries and limits and say “yes” and “no” and really pay attention to myself and what I’m needing and wanting to do, and what I’m willing to do and what I’m not willing to do. And it’s ongoing. About leaving therapy, it’s bittersweet. There’s a part of me that is relieved, and feels some freedom in that relief, and some joy in that relief, and there’s a part of me that is sad. It would be nice to continue and continue, to continue the relationship as a therapeutic relationship and not to let that go. I’ve looked forward to it every week; I’ve looked forward to my sessions. It hasn’t been difficult at all for me to get in my car and go. What I did intermittently, and for a period of time, was let go of expectations — that was real helpful in us meeting, and joining, and connecting. It’s something that I need to pay attention to in terms of therapy. I discounted the therapy because I knew that when I want something too badly I need to let go of it and then it could happen more naturally: If I’m hanging on and I want it too badly and if it doesn’t happen, the disappointment is greater, and often times that kind of energy isn’t healthy. I need to just let it go, and let go of relationships, and see what happens. For me, it’s important to remember to have expectations, and if expectations aren’t being met, to let them go and alter them if anything great or profound is going to happen, though that sense of intensity doesn’t always have to exist in a therapeutic session. That what happens happens. That’s the relationship that’s developing. We did a lot together. I’m going to miss you. You are tenacious. You told me you were. You are! I’m going to miss you and I’m sad. I’m going to miss you. I’m glad you were tenacious — I’ll say that again. You let go when it was necessary. You really let go when

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you said maybe you weren’t the right therapist for me. That was it — that’s when I came [sic], that’s when I came [laughter], 5 that’s when therapy - it was going all along but that’s when it really felt like it was moving — when you said, “Maybe I’m not the one who can be most helpful to you — maybe I’m not doing what you need me to be doing.” And the paradox in that was I was aware that a paradox was going on. There’s a part of me that’s rebellious enough to be aware, and yet it still worked. It still felt good. I think I felt more freedom of choice then because I didn’t want to leave saying this is no good. I didn’t want to do that — and maybe we needed to go down that road more, and we did, and I’m glad. You asked about a turning point — that was a big one, that was a big one. Also, another turning point was when I thought countertransference was occurring: You talked about your frustration and anger toward me - that impacted me greatly. I felt real alive at those times togeth­ er. That really, really impacted me, and made a positive impression. It took courage and guts, not just being tenacious. The session we talked about and shared emotionally together my “PAINFUL SPOT” — my feeling the “red hot" pain of abandonment. We touched that place. I think overall what impacted me was you being real, being real with me. You stopped being so damn therapeutic and you were just a human being, and just relaxed, and that was real, and that was healing.

had had such “deep intuitive empathic experiences” with close friends, and had heard of other clients in therapy having had such experiences with their therapists. Consequently she felt that I must not be empath­ ic enough with her since such deep intuitive understandings did not occur between us. She kept criticizing me and imploring me to be more willing to understand the therapeutic impasse from her side of it. I felt I was — but I disagreed with her interpretation of my experi­ ence of the situation. I felt pulled to appreciate her perspective, but it felt to me that to give in to her interpretation would relieve her of her responsibility in the situation, and abdicate my responsibility to give feedback to her, which earlier we had discussed was essential in understanding her impact on others. Consequently, she didn’t feel sufficiently understood by me, nor that I was connected enough with her. We were stuck. Given our stuckness, and that I was male, and that in her history she had reported some significant difficulties with men, I tried in our contact together to explore the possibility that she was interacting with me in a manner similar to the way she related to other men. I certainly understood her behavior as an attempt to protect herself, but also as an interference to entering into a real relationship with a man. Initially, I naively believed that if only she became more aware of how she could come across as distancing and critical that we would get past the impasse. The more I focused on this, the more our problematic encounters worsened. The more in our contact I tried to get her to “own” what I perceived was her responsibility in this situa­ tion, the more alienated from me she became. She began to consider prematurely ending therapy. She felt that she couldn’t trust me. I kept trying to demonstrate to her that the reason the trust wasn’t there was because of something she was doing. She felt it was me. We were both right — but she was more right! I had been unable to appreciate the extent to which she needed more heartfelt empathy, understanding, vulnerability, interest, and car­ ing, than I was able, or perhaps willing, to experience and give to her in that particular therapy at that time in my professional and personal development. I was holding back because I believed it was her existential responsibility to change; also, I constantly felt put off balance by her criticisms — I found myself wanting to protect myself,

Rich’s Experience of the Impasse The major difficulty in the therapy revolved around Reva feeling I was being insufficiently understanding of her, and emotionally unavailable to, her. She demanded, in what felt to me as a rather critical and attacking manner, that I intuitively (it felt to me “magical­ ly”) understand how she was feeling, even though at times she had considerable difficulty articulating her feelings. She reported that she

The laughter was on the audiotape of her retrospective of the therapy, and clearly was in response to her recognition of the sexual nuance of her “slip.” I see it more as a statement about the power of the emergence of her hidden “younger self," and the healing therein. — 42-----

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rather than risk being vulnerable in my encounters with her (uncon­ sciously, I was experiencing a similar lack of trust of another as she was). I felt hurt by her criticisms: It felt to me like a suspicion I had always had about myself had been confirmed: that there was some­ thing fundamentally wrong with me as a therapist, in that sometimes I seemed less inclined or able (comparing myself with my perception of other therapists) to experience a deep empathic connection with my client. I felt found out! Similarly, she was holding back until she deeply felt that there was someone — particularly a man — who was willing to be truly vul­ nerable with her, as well as deeply appreciate her side of an “untrust­ worthy” and threatening situation; right or wrong, without losing his own groundedness. I unconsciously had picked up correctly on the desire for a “strong man” (early on she told me slyly that she couldn’t stand “wishy-washy” men) but I had failed to appreciate and experi­ ence the far more important dimension of being aware of, appreciat­ ing, and genuinely valuing her phenomenological experience — particularly when it didn’t correspond to my own experience; or was threatening to me, or whether it met my then understanding of some abstract rule about individual responsibility in Gestalt therapy. My stance was in fact disconfirming her - and her heartfelt existential experience of justifiable mistrust of men — in the manner that she experienced several significant men had done with her previously. In a sense I was psychologically abandoning her — an experience with men she was all too familiar with. Two individual mistrusts had become mutual mistrust. A thicken­ ing wall was developing between us, rapidly becoming impenetrable. From my client’s “unconscious” stance, to drop this protective wall would dangerously and foolhardily expose her to a reoccurrence of an excruciatingly painful developmental injury. No one in their right mind would do so. My suspicion was that she had learned how to thicken the distance between, but not how to discriminately let a man into her world in a long-term, consistent, and trustworthy relationship. It would be only when I finally could genuinely appreciate her fear from her existential point of view that the basis for further significant therapeutic trusting could occur.

Though to this point she had not been able to express directly any anger with me about her frustration over our seemingly irresolvable impasse, it was inevitable given what was occurring between us. I sensed that the anger was part of her “dynamic center.” Given the significant frustrations she experienced with her father, and men after that, it was the hallmark of her ambivalence — the deep desire for intimate contact with a man, yet the almost inevitable ultimate frustra­ tion of that desire, and the anger resulting from this non-connection: how do you get angry directly at that which you most desire. Since she seemed unable to express directly her anger toward me, I suggest­ ed that she do some “empty chair work,” setting up an interaction between “me” and her. I felt genuine empathy for her frustration with me, and our inability to connect in the way she desired. What became crystal clear in watching her interacting with “me” was that even in this relatively protected format, she was still protecting me. I encour­ aged her to get more angry with me and to express all the ways in which I had failed her. She seemed able to get into that, and appreci­ ated that I (the “real” I) was able to step aside and not get personally injured by her angry statements. This was one of the events that helped free up our interactions. It’s difficult, even so many years later, to describe how I began to look at our impasse differently. I genuinely wanted to get past it, and it was obvious that what I was doing wasn’t working. What occurred in our contact was that I began to experience a heartfelt empathy for her sense of despair in relation to me! I began to feel how painful to her was our contact. I began to become aware, at a deeper level than previously, that this pain must have been experienced by her numerous times with men. I began to feel how injurious, and devastatingly disconfirming, this sort of contact must be to her. I began to feel her hurt. I developed a deepening existential realization that this was not by any stretch of the imagination a “repetition compulsion,” but rather her best effort to make contact with me, given her past injuries with men. It was I who was unable to appreciate her contactfulness with me because of the sharp edge (the “bow and arrows”) that seemed to ensue. I realized that a greater effort was needed on my part, to existen­ tially feel the impasse from her side. Part of the shift in my stance

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ironically was my intuitive sense (as well as her self-reports) that I hadn’t gone far enough to her side of the encounter — I hadn’t fully experienced it from her side. At the time, I was struggling with understanding, in an embodied way, what Buber meant by inclusion. Around the same time also I was reading extensively in the area of self psychology and intersubjectivity theory, and beginning to think about its implications for Gestalt therapy. It gave me a deepened intersubjective perspective on my client’s developmentally appropriate self-protectiveness (much less my own); it wasn’t an issue of avoiding existential responsibility, but rather being developmentally appropriate by not trusting. 1 became aware in a bodily way that in the here and now of the therapy, we were reexperiencing together a major develop­ mental challenge previously encountered, yet not “met” by others in my client’s life. We both were being given an opportunity to meet in this grievously injured place, and to grow through and transcend it. In order for this to occur, I needed to let go of my expectations of what she “should” do in the therapy (unknown to me this was around the time she was beginning to let go of her expectations of me!). $ In fact, I even needed to let go of whether I would continue working with her. By this time our impasse had become so polarized that I told her that even though I was genuinely interested in working it through with her, I might not be the right therapist for her. In fact, I acknowledged to her that I was part of the problem. I began to make even more of a conscious effort to experience “our” situation from her existential perspective. I would enter the therapy hour being more aware of trying to “feel and be” what it was like for her to sit in the chair opposite me. I tried to feel what I would need from my thera­ pist, if I were Reva. At times I felt as if I were sitting actually right next to her (at times more like in her skin), experiencing our encoun­ ter from her perspective. In that position I realized how scared I was of getting more intimate with my therapist — how fearful I was that he would be unresponsive, and fail to feel my innermost needs. In her position, I felt like I had despaired of any man ever being able to

really meet me. I felt like I was waiting behind my protective wall until a man clearly demonstrated that he would take the greater risk of appreciating my position, and therefore finally proving trustworthy. As I communicated my understanding of her experience to Reva, she seemed to visibly soften, and I began to feel allowed into her inner, and much more vulnerable, world. Around this time when some real trust and intimacy were develop­ ing between us, a pivotal event occurred. A number of the sessions focused on her feelings of abandonment by her father. As I felt more deeply empathic, appreciative, and valuing of her experience of having to take care of herself without emotional support from her parents, I had a wonderfully warm and lovely sense of feeling fatherly toward her. 67 As I sat there in the session being aware of this deep feeling, I considered whether to share this awareness with Reva. I realized that it entailed some considerable risk: Certainly there was the danger that my expression of this caring would be misunderstood as some kind of vague sexual overture. In my heart it didn’t feel sexual in the slightest; it did feel like a very deep caring of her “otherness,” and of the injured “young giriness” in her; of the deepest need that hadn’t been met by her father, nor any man since — something she was desperately seeking. I did share my “intuition” with her that since her father had been unable to enfold her emotionally, sometimes I wished that I could have gone back in time and been a father to her — to give her what she needed. We both recognized the unreality of that, yet she sensed that this was a statement of my genuine caring for her, and my wanting to give her something she desperately wanted, and so sadly hadn’t gotten.

unconscious connection between therapist and client—an “unconscious between” that transcends the individual unconscious of both.

7 That “fatherliness” arose out of now feeling very caring and protective of her (even against my previous interventions), as well as I suspect being “intu­ itively” (unconsciously inclusive) of her previous mismeetings with her real father. I suspect that I was now so in touch with that profoundly disturbing experience that the caring part of me unconsciously wanted to provide a new healing possibility. I had an intuition (in retrospect it seemed an “ontological intuition”) that Reva most needed, at the psychological-ontological level, to be enfolded in the arms of her father.

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6 Such synchronistic occurrences in the therapy often signal a deepened

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Yet it scared her. She pulled away. Immediately I thought I had made a serious mistake. There followed a number of sessions in which she was emotionally withdrawn. Only much later as we talked about it did we both become aware that her getting scared was neces­ sary. It forced her to become aware of how scared she got and pulled away when the very intimacy she so desperately sought was made available to her. That was an invaluable experience that all my previous efforts to get her to own her self-protectiveness had failed to achieve. This really corresponded to her phenomenological experience and profoundly illuminated to her her own part in all of this. I was no longer the enemy. I had become the ally of her emerging self. There followed a series of experiences of inclusion. They were experiences of deeply feeling what I imagined she felt, sometimes even in its subtler feeling-tones. There was genuinely a feeling that we were in this together. It was no longer a sense of her versus me. It was a feeling of her-me together facing the world. There was an “us-ness.” We had taught each other much. What had been an impasse, became a healing “dance.”

The “otherness” of the other person must always be in the for. ground of awareness. At times like that, my own experience becomes more background. I started to realize, to dialogically feel, that inclusion means that a certain kind of selflessness is necessary, and must be in the foreground of the therapeutic encounter. If my own experience is too precious to me, it becomes an unbreacheable barrier to making contact with the deepest and most injured parts of another person. True existential healing occurs only when those most griev­ ously injured and split-off facets of our being are respectfully and lovingly embraced and brought back into human connectedness. Then we become whole. As silly as it now seems in retrospect, early in the therapy I was fearful of losing my “self’ if I agreed with Reva’s experience of me (this in spite of years of doing therapy, and years letting go of layers of self-protectiveness). I was unaware of how core this was for me. Much of my personality development was based on being able to be strong and independent (much like Reva’s experience) and to resist vehemently another’s “pull” to accept their experience of me when it was significantly divergent from my own. Unknown even to myself, I had spent much of my life erecting a barrier against being invaded and invalidated by an other. That inevitably means holding my self too dear so that it becomes a barrier to being open to the experience of the other person. If I hold my own experience and sense of self as too precious, then I am too inwardly focused and too self-preoccupied and therefore can’t genuinely “see” the other person in his or her uniqueness, much less our human interconnectedness. Much like Zen, it is only when I empty out my self that the ontological crystal clarity of the other can truly be seen. When I empty out my self, I permit a creative void within which allows me to be filled by the other’s experience. This ontological openness is essential for a real meeting. Only with this trans-individual openness am I able to set aside my own neediness, vulnerability, and injuredness and be able to touch the injured and disowned parts of another. If I am too full of myself, there is no room for the other. If there is no room for the other, there is no healing. The paradox in this therapy was the paradox of all human encoun­ ters: the situation was both shared, and experienced radically differ­ ently. My emphasizing the difference created an abyss. It assured the

Epilogue This therapy experience was a turning point in my understanding of inclusion: It was not the only therapy at the time that this was occur­ ring in, but the issue became crystallized in this therapy. A major part of the shift in the therapy for me was that I realized that inclusion was not in any manner a cognitive act — rather it was an existential stance of paradoxically embodying the other’s experience (the “not-me asexperienced-by-me”) 8 without losing my experience. It need not

mean experiencing both sides simultaneously, as much as sequentially. There needs to be an existential fluidity between my experience, and my experience of my client’s experience — especially when my client’s experience is radically divergent from mine.

Q

The language may seem awkward at times, but I don’t know how else even to haltingly articulate these inherent existential and dialogical paradoxes. Ultimately, it is ineffable.

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emergence of an abyss often looming on the horizon whenever Reva reached out to others. A mismeeting occurred. Nor perhaps could it be otherwise. 910Mismeetings are inevitable. Given that we’re vastly different people, with sometimes radically divergent existential realities, they are unavoidable. In fact, they are necessary for the truly deepest existential and dialogical therapeutic work to occur. The mismeeting in this therapy was necessary to illuminate fully the mistrust she experienced with others. It challenged us to seek a solution to this seemingly unresolvable im­ passe. The real issue in life is not whether there are mismeetings — they are inevitable — but rather what do we do with those mismeet­ ings.

l

3. Dialogue in Gestalt Theory

and Therapy * Lynne Jacobs

There are two major emphases when describing the nature of the rela­ tionship in any therapy: The role of the relationship, and the charac­ teristics of the relationship. The role of the relationship refers to the importance of the relationship as a curative factor vis-a-vis the other curative factors, as well as the extent to which the relationship per se is a focus of the therapy. The characteristics of the relationship refer

9 See also the chapters “The Problem is the Answer,” and “The Wisdom of

Resistance” in my book, Between Person and Person (1991). 10 Obviously, I experienced a similar mistrust with her - though that was not

our focus.

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* Author’s Note: This chapter was based on an article (1989) of the same name and represents my early thoughts on a subject that are still evolving. In a thoughtful and stimulating article on the concept of dialogue in Gestalt therapy, Hycner (1985) asked for more public discussion to clarify the implications of Martin Buber’s philosophy of dialogue for Gestalt theory and practice. His article was the impetus for me to contribute my thoughts on this matter. He described clearly and simply the basic premises of Buber’s philosophy of dialogue. I shall elaborate on connections between the philosophy of dialogue and the theory and practice of Gestalt therapy. I am deeply grateful to Rich Hycner and Gary Yontef for their thoughtful and thorough criticisms of the drafts of the original article. The basis for that article was my doctoral dissertation, “I-Thou Relation in Gestalt Therapy” (1978). For further related references, see also Enright (1975); Friedman (1985a); Hycner (1985); Kempler (1973); Naranjo (1975); Yontef (1975, 1976); Zinker (1975). [R.H.: The substance of the original article has been maintained, but some editorial changes were made in order to focus the themes more clearly for this book. A number of subheadings were added, and some minor changes in content were made.]

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to the range of permissible and valued therapist behaviors, and the structure of the patient-therapist relationship. The therapeutic relationship in Gestalt therapy is not clear cut and simple to describe. However, there does seem to be widespread agreement on the characteristics of the relationship. In keeping with existential values, these include a nonhierarchical relationship and an emphasis on full and genuine engagement between patient and therapist. Unfortunately, there has been little attention to the role of the relationship in the published literature, though there is a rather wide range of opinions in the oral tradition. In the past there appears to have been two major emphases: the most familiar one, represented by Peris, Hefferline, and Goodman, which focused on awareness', the other one exemplified by Isadore From and Erving Polster and Miriam Polster, which focused on contact. In my opinion, when the implica­ tions of the catch-phrase “I and Thou, Here and Now” are fully appre­ hended, we will find that the restoration of awareness of which Peris, Hefferline and Goodman write can only occur when the therapy operates from an I-Thou context in which the process that Buber describes as “dialogue” is encouraged and developed.

I-Thou can only be spoken with the whole being. The primary word I-It can never be spoken with the whole being” (Buber, 1958a, p. 3). The I-Thou relation has the qualities of immediacy and directness presentness, and mutuality (Farber, 1966). It is a full-bodied tumingtoward-the-other, a surrender to, and trust of, the “between.” The IThou relation is seen: “. . .not as dimension of the self but as the existential and ontological reality in which the self comes into being and through which it fulfills and authenticates itself” (Friedman, 1965a, p. xvii). When two people surrender to the between — called “existential trust” — the possibility of an I-Thou relation emerges. But it will always be a temporary state: Both will return to the world of I-It, necessarily. Existence in either mode is an evolving process in dynamic relation to the other mode. Each alternates as background for the other. The hallmark of creative and healthy living is finding the proper balance between these modes in a person’s life (Hycner, 1985). Below, I will describe how Buber’s philosophy of dialogue pro­ vides a context for the concepts of contact, awareness, the phenom­ enological attitude, and the paradoxical theory of change.

I-Thou and I-It

Contact, Awareness, the Phenomenological Attitude and the Paradoxical Theory of Change

In the dialogue of which Buber writes, all living is a meeting. There is no “I” that stands alone, but only the I of I-It and the I of I-Thou. There is an alternation between these two modes of existence. The I-It mode is vitally necessary for survival, the I-Thou for the realization of personhood. As Buber stated, “Without It a human being cannot live. But whoever lives with only that is not human” (1970, p. 85). The I-It mode can be considered the “ego” mode (Farber, 1966). It involves such functions as judgment, will, orientation, and reflection (Farber, 1966). It also involves self-consciousness and the awareness of separation (Friedman, 1976b). It is in the I-It mode that a person organizes living in time and place. Importantly, ideas and feelings, and attempts to make him/herself understood to others, all comprise the world of I-It. In contrast to the necessary separation of I-It, the I-Thou relation is integrative, and affirms the person’s wholeness: “The primary word

Essentially the I-Thou relation, or dialogue, can be seen as a specific form of the contacting process between two people, through which each person realizes most fully his or her distinct humanity. For a person’s humanity is manifest only in dialogic relation to others: It emerges from, and requires, self-awareness, a uniquely human charac­ teristic. This specific form of contacting requires certain “elements of the interhuman” to be present for the dialogue to occur (Buber, 1965b). These elements — presence, genuine and unreserved commu­ nication, inclusion, and confirmation — will be described later the chapter. Buber says of the I-Thou relation that it is lived in both “actuality and latency” (1970, p. 69). This is important, because although most

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The I-Thou Relation and the Theory of Contacting

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attention is given to the momentary experience of an I-Thou relation, the term I-Thou refers both to this special moment and to an underly­ ing process. This distinction, while relatively unimportant to under­ standing the phenomenon and significance of an I-Thou encounter, is of particular importance to the practice of therapy, since much therapy is conducted in an I-It mode, with the I-Thou attitude in the back­ ground. Thus, while Buber makes no formal distinction between the two, I distinguish between the I-Thou moment, and the I-Thou process. Hycner (1985) prefers the term “dialogical” or “dialogic” to describe and differentiate an I-Thou process from the I-Thou moment. I worry that the term “dialogue” is used so commonly in our language that Buber’s specific meaning may be ignored. But I agree with his need to differentiate the two uses of I-Thou, and his preference for de­ emphasizing the “peak moment” in favor of a discussion of ongoing process. I shall use the terms I-Thou process, dialogical, and dialogic interchangeably. In the “Prologue” to I and Thou, Kaufmann asserts that there are many modes of I-Thou relationships (1970, p. 16). The writing in Buber’s I and Thou focuses largely on the most intense and exalted moment of I-Thou (Kaufmann, 1970). But some of his later writings, particularly on education, pay more attention to the process — to the variations where It and Thou are intermingled (Buber, 1965a, 1965b). For example, a teacher who cherishes the unique development of each pupil yet whose students are also the means for personal gratification engages in I-Thou relation. An individual who asks directions of an­ other with the genuine courtesy that comes from appreciation of personhood has permeated means with I-Thou relation (Kaufmann, 1970). When an individual is treated with full respect and apprecia­ tion but is also used as a means to an end, then there may be an IThou meeting (Kaufmann, 1970).

moment is the most intense moment of what Polster and Polster (1973) call a contact episode. Any experience of an I-Thou moment is a confirmation of the possibility of integration and wholeness, a confirmation of the healing process by which a person can restore his or her relation to the world. Sometimes this moment of illumination occurs between a therapist and patient who engage so unreservedly with each other that the essential being of both persons is touched. In Gestalt terms, such a completed contact episode is the realization of the Gestalt formation process within the special context of what Buber calls an interhuman event. A clinical vignette from my own experience will illustrate this:

The I-Thou Moment

The I-Thou moment is a special moment of illuminated meeting wherein the participants confirm each other as the unique being each is. Such moments occur at various times during genuine dialogue, and are often culminating points of the dialogic process. The I-Thou

The patient was argumentative and critical. She claimed to be desperate for help, but disparaged my attempts to understand her and to be helpful. I tended to react with unaware defensiveness by taking a particularly superior, authoritative stance toward her. The meeting — the momentary I-Thou — occurred after I realized that I was defensive, and decided to be more attentive to my own defensiveness. The next hour, I found myself again reacting defensively. I began to disclose this to the patient, while still operating from my defensive, authoritative stance. Suddenly I realized that at that moment I was still protecting myself by pushing against the patient. I brightened and exclaimed, “See! Oh my, I’m doing it right now! Damn it, E—, you are just too good. I give up!” I began laughing at my own absurd attempts to coerce the pa­ tient. The patient, surprised, also laughed heartily. She ad­ mitted she was very good at what she was doing, and enjoyed it, although she always left feeling bitter and dissatisfied. What ensued was our first authentically cooperative exchange of ideas. Both of us had gained a renewed respect for the anxi­ eties that had driven us into defensive styles at the expense of presence with each other.

In the above example, the contact episode moved into an I-Thou moment. This was possible because in an instant of immediate, spontaneous awareness, I experienced a full acceptance of our beingin-situation, that is, my own and the patient’s defensiveness. This — 55 —

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acceptance, and then the patient’s willingness to be affected and to respond with her acceptance, allowed both of us to be fully who we were. There is another way the I-Thou moment enters therapy: That is when the patient’s saying “Thou” to the therapist frees the therapist to enter into an I-Thou relation. The strand of Gestalt therapy that emphasizes encounter between patient and therapist encourages such moments. For me, these moments often happen when I am stuck in my own defensiveness or frustration, and the patient recognizes this and points out what is happening with the attitude of, “It’s too bad we’ve gotten so messed up here. What can we do?” Once recently a patient said to me; “I can tell when you are on your guard with me. You become sarcastic. Have I done something that pushed on you just now?” I felt relieved to be able to pull back for a moment. I realized I had felt pressured by her conflicting messages to me, and was trying to coerce her into being more straightforward so that I would not feel pressured. As Polster and Polster (1973) said when talking of contact epi­ sodes, these moments “endow the therapy with substance and drama.” They are the critical moments that bring the whole process together, render it meaningful, and release the possibilities for its participants. Farber’s idea that the I-It “ego functions” provide grounding for the I-Thou moment parallels the Gestalt therapy view that the directed and willful actions of the middle state of contact are important for the successful resolution of a contact episode (Farber, 1966; Peris et al., 1951, p. 402). This usage does some injustice to Buber’s concept of I-Thou, in that not all contact episodes are dialogic episodes. Dialogic episodes involve the further “becoming” of two people. Contact episodes that involve, say, realizing his or her hunger and satisfying it appropriately, do not involve the development of personhood and so are not dialogic processes. But the references to I-Thou can be seen as an attempt to capture the flavor of this particular moment of contact: “The lively goal is the figure and is in touch. All deliberate­ ness is relaxed and there is a unitary action of perception, motion and feeling. The awareness is at its brightest, in the figure of the You” (Peris et al. 1951, p. 402).

The I-Thou moment has some of the terrors of the impasse. There is a danger of symbolic death. In the impasse this occurs as the indi­ vidual gives up his or her self-image in order to contact his or her emergent sense of self. In the moment of I-Thou, the danger is that the person’s boundaries will permanently dissolve. There is a soften­ ing of the individual’s boundaries, and sometimes the intensity of the moment feels explosive. Both Buber and Gestalt therapy assert the faith that surrender to the experience will take the individual through symbolic death into symbolic rebirth (Farber, 1966). In Gestalt therapy, contact has the polarities of isolation and of confluence. The danger in meeting is confluence. The risk of moving toward contactful engagement is that the person will become engulfed by union with the other. In addition to this fear of being entrapped in confluence is the fear that after the compelling, rending intensity is over, the individual’s loneliness and isolation will be even greater than before. A person who has settled for the “security” of isolation fears dialogue as a disruption of this state. For such a person,

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The I-Thou relation is not an unqualified good. In its lack of measure, continuity and order it threatens to be destructive of life. The moments of the Thou are “strange lyric and dramatic episodes, seductive and magical, but tearing us away to danger­ ous extremes, loosening the well-tried context, leaving more questions than satisfaction behind them shattering security.” (Friedman, 1976b, p. 60)

Farber (1966) points out that the more alienated the individual is, the less he/she can rejoice in either I-It or I-Thou (p. 148). When split off from the I-Thou realm, the I-It world is impoverished, lonely, and so divorced from its dynamic relation to I-Thou that it provides no support for entering into dialogic relation. The danger becomes that a moment’s grace in dialogue will leave the person all the more profoundly lonely when the moment is gone. Farber points to the most obvious and painful example of the schizophrenic, who has no continuity and order and cannot assimilate the “lyric and drama” of IThou. These intense moments tend to send such a patient into further retreat, further isolation, and further despair.

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Thus, the two dangers of isolation and confluence await on either side of the I-Thou moment — the moment of fullest contact of a person’s being with another person. The problem is that contact cannot be made static. The boundaries of self and other shift, and there is mutual influence which cannot be predicted. If a person wanders too far too long, he/she is in danger of becoming so far removed as to lose sight of the way back. Or this person’s boundaries may disappear in the merging with the other, or may explode from intensity. A person can never know the balance in advance, but following it allows him or her to live fully in the present, and to come to know his or her own possibilities. The importance of contacting for our identity as a human being — what makes it so compelling and also so complex — is the way it is different from contacting among all organisms. The interhuman contacting process is the process by which we come to know our­ selves and others, to apprehend our human existence and that of others. From Buber’s perspective, contacting takes on importance not only for organismic self-regulation, but also for our specifically human existence. All individuals have an urge toward growth. In Gestalt therapy this is described, under holism, as the “press for closure” whenever gestalten form. When a contact episode is begun, the individual is motivated to finish the episode in the most growth-producing manner, given the current conditions of the organism-environment field (Peris et al., 1951). I think this same principle motivates the individual toward dia­ logue. The contacting that occurs within the dialogic relation involves more of the being of the person than does any other kind of contact. The I-Thou moment is a moment in which we are totally absorbed with another, which paradoxically puts us profoundly in contact with our humanity, with the knowledge of being; in this moment the meaning of human existence is revealed.

I-Thou Process

Dialogue establishes the ontological significance of contacting. Contact is the means by which we feed ourselves, by which we under­ stand, orient, and meet our needs. But cast in the light of I-Thou,

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contact also stands at the ontic center of the psychological and spiritual development unique to our human existence. Buber stressed over and over again that only through dialogical relation can the person come to know the uniquely human aspects of his or her self (Friedman, 1976a), and that genuine dialogue between persons is most central to realizing the full potential of the person (Friedman, 1976b, p. 61). I think that many Gestalt therapists operate from an appreciation of the ontic significance of contacting, and in fact most of the clinical — as opposed to theoretical — literature on contacting focuses on contact as it occurs between persons (Latner, 1973; Polster and Polster, 1973, 1976). Compare the following quotation from Polster and Polster with Buber’s statement that the moment of “meeting” in the dialogic process is “ontologically complete” in simultaneously knowing and being known by the other, and that in such a moment the “inmost possibilities” of the person are released (1965b, p. 71): Contact is not just togetherness or joining. It can only happen between separate beings, always requiring independence and always risking capture in the union. At the moment of union, one’s fullest sense of his person is swept along into a new creation. I am no longer only me, but me and thee make we. Although me and thee become we in name only, through this naming we gamble with the dissolution of either me or thee. Unless I am experienced in knowing full contact, when I meet you full-eyed, full-bodied, and full-minded, you may become irresistible and engulfing. In contacting you, I wager my independent existence, but only through the contact function can the realization of identities fully develop. (Polster and Polster, 1973, p. 99) 1

1 Both Erving Polster and Miriam Polster are widely regarded for the dialogic

sensitivity they bring to their clinical work. In their writings they refer to “contact” to describe the existential patient-therapist relationship. In fact, some of the surge of interest in dialogue in Gestalt therapy can probably be traced most directly to the influence of their book, Gestalt Therapy Integrated (1973), which deals extensively with contact issues. Interestingly, a later article of theirs (1976), refers only to contact; awareness is not mentioned at all. — 59 —

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Buber says that dialogic relation unifies the person’s soul and makes the person whole (Friedman, 1976b, p. 97), whereas in Gestalt therapy, wholeness comes through awareness (Latner, 1973, p. 55). Actually, Peris, Hefferline, and Goodman stress contact, with aware­ ness as a subset, but for many Gestalt practitioners awareness has become the major focus, while contact has receded into the back­ ground. For me, all three positions are intimately related. Dialogue contact and awareness are all compatible aspects of a single whole when Gestalt therapy’s phenomenological approach to awareness is taken into account. Hycner (1985) believes that a dialogical Gestalt therapy would not take awareness as a goal, but rather the restoration of full dialogue. He also acknowledges that we cannot aim at dialogue. I agree that we

cannot aim. In fact, having the restoration of dialogue as the goal of therapy goes counter to the dialogic position that the patient is the only one who can choose his or her existence. I hope to show that a focus on dialogue does not change the Gestalt therapy emphasis on awareness as the goal of therapy when the ontic implications of awareness are fully understood. The awareness process which Gestalt therapy posits is a full-bodied “turning-toward” existence, that by implication is a precondition of dialogue. For Peris (in Stephenson, 1975) “the criterion of a successful treatment is: the achievement of that amount of integration which facilitates its further development” (p. 53). Yontef (1976) defines integrative awareness in Gestalt therapy: “[Awareness] is the process of being in vigilant contact with the most important element in the individual/environment field with full sensorimotor, emotional, cogni­ tive, and energetic support” (p. 67). “Awareness allows one to re­ spond to a given situation in a fashion appropriate to one’s needs and to the possibilities of the situation. Awareness is integrative. When one is aware, one does not alienate aspects of one’s existence; one is whole” (Yontef, 1976, p. 67). In order to experience this integration or wholeness, a person must not stand in judgment of his or her experiencing process, and not discount or alienate aspects of him/herself. The phenomenological approach in Gestalt therapy provides the discipline for this kind of awareness (Yontef, 1976). In the phenomenological approach thera­ pists and patients bracket off, or put aside, their preconceptions about what experiences are relevant, and allow their sensory processes to discover whatever is revealed by the self and the situation (Yontef, 1976). This phenomenological attitude implies acceptance. Patients who can accept themselves will have no need to judge and deny their expe­ rience. In the therapy relationship, the therapist’s acceptance seems to open for patients the possibility of self-acceptance, and this permits patients to deepen their own awareness. “Our deepest, most profound stirrings of self-appreciation, self-love and self-knowledge surface in the presence of the person whom we experience as totally accepting” (Zinker, 1975, p. 60). From the stance of the phenomenological attitude, the individual moves along the awareness continuum into the

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The dialogue that Buber describes is also a transcendental process. Thus, when contacting is in the form of dialogue, the contacting process becomes itself an evolving, spiraling developmental process. For Buber this development toward the higher reaches of existence was a product of his basic trust in the sphere of the “between.” He had faith in the dialogic relation as it developed and deepened. Tn the language of the theory of Gestalt therapy, as the contact process unfolds, the person must have faith in his or her “coming solutions” if the contacting process is going to resolve itself well. In both cases there is a surrender to the forming moment, rather than an attempt to control what will happen next. When the contact episode is an interhuman event, then trust in the coming solutions translates into trust in the between. Contact with another person involves entering into dialogue without controlling the other half of the dialogue. In summary, in Gestalt theory, the ontic importance of contact is stressed by some authors, such as Polster and Polster. Buber empha­ sizes even more that the specific form of contact — dialogue — be­ comes the ground of self-realization. In Buber’s view, contacting stands at the center of development, from psychological to spiritual. For human beings, the raison d'etre of contact is that it takes the person beyond mere survival into the realm of humanity. The Phenomenological Attitude

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integrative moment of awareness, much as I-It experience can spill over into an I-Thou moment. Polster and Polster (1976) describe well the faith Gestalt therapists have that integration evolves from the process of following the aware­ ness continuum of both patient and therapist:

implies the acceptance inherent in the phenomenological attitude. Beisser asserts that the therapist must take the patient where the patient is. He expresses faith that if the person invests him/herself fully where the individual is, then he/she will change just because all living is a process. Polster and Polster (1976) state that a Gestalt therapist believes in two axioms: What is, is, and one moment flows into the next. The acceptance that Buber describes in the I-Thou rela­ tion — “acknowledgment” — includes this faith in the process. A true apprehension of the dialogic attitude advocated by Buber provides a grounding for therapists who wish to operate according to Beisser’s paradigm. If therapists function from the perspective of IThou, then they have no desire to “change” patients, only to under­ stand their existence and to “meet” them. They will not be seduced into becoming a coercive change agent confronted by a helpless patient. They will be free simply to be with the patient as person-in­ conflict. Dialogue provides therapists with support for following Beisser’s paradigm of the paradoxical theory of change. In sum, change occurs with supported awareness of what is. The awareness comes by investing him/herself in this present experience, with no demands to change and no judgments that it should not be as it is. The acceptance of the I-Thou relation permits a deepening of awareness, and is itself an embodiment of the prerequisite for change, which is acceptance of what is. In this way, awareness and the IThou relation are integrally related.

When the therapist is absorbed with what is current, and brings the patient’s attention to current experience, a resusci­ tative process is started which brings liveliness to very simple events. . . . Amplification of experience emerges organically when one pays attention to what is already happening. One of the great recognitions of Gestalt therapy is that attending to one’s own personal experience from moment to moment mobilizes the individual into a growth of sensation and an urgency for person­ al expression. As this momentum gathers greater amplitude from each moment to the next, it impels the person to say or do what he must. This progression leads to closure; to the com­ pletion of a unit of experience. With closure comes a sense of clarity, as well as an absorption in fresh developments without the preoccupation which unfinished situations call forth, (p. 260) When a person’s awareness evolves from this ground of the phenomenological attitude, then the characteristics of dialogic process are present. The awareness changes and transcends itself (Yontef, 1976), just as the dialogic process does. More important, in the bracketing-off process, the person allows for directness and mutuality inherent in dialogue by not putting his/her categories between him/herself and the situation. The situation can affect the person how­ ever it will. And finally, the whole person is involved; the person is fully present. Thus it could be argued that the full awareness that Gestalt therapy values is an expression of dialogic relation.

The Paradoxical Theory of Change The acceptance of the phenomenological attitude is not required of only the patient. In order to foster the patient’s awareness, the thera­ pist must also share in the phenomenological attitude. Beisser’s (1970) suggestion for the therapist’s stance in the “paradox of change” — 62 —

Dialogue in the Therapy Process

I have suggested that the basic contact and awareness processes are preconditions for dialogue and that the dialogue is a specific form of the contacting process concerned with the illumination of interhuman becoming. The dialogic relation serves as an interpersonal model of the phenomenological approach to awareness valued in Gestalt therapy. Now I shall attempt to integrate these implications into the practice of Gestalt therapy by discussing dialogic relation (I-Thou process), and the dialogic attitude (I-Thou attitude) in the practice of Gestalt therapy.

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The Dialogic Relation

foster greater ability to be present. For instance, when I become defensive, I assume a self-protective posture of superiority. My therapy has improved as I have learned to recognize early my de­ fensive feelings. At a minimum I can make contact with my patient around that issue. Presence involves bringing the fullness of oneself to the interaction. Therapists must be willing to allow themselves to be touched and moved by the patient. The Gestalt therapist also tends to use the full range of emotions and behaviors available to him or her. Eye contact, physical touching, and movement all bespeak a person’s presence. Being present also means being willing to be both powerful and powerless. A therapist can be a powerful healing influence. At cru­ cial times the loving attitude of the therapist seems to provide an experience of grace for the patient. But ultimately the therapist is powerless to change the patient, and sometimes the pain of wanting to make the patient’s life better but being powerless to do so is keenly felt. The therapist who is present brings this pain too to the meeting.

Buber asserts that for dialogue to occur, certain “elements of the interhuman” must be present (Buber, 1965b). The elements of what Buber calls “genuine dialogue” — the I-Thou process — are 1) presence, 2) genuine and unreserved communication, and 3) inclusion. In therapy, these conditions become the prerequisites for a dialogic patient-therapist relationship. Each element will be discussed below in terms of its application to Gestalt therapy.

Presence The most basic element, and the most difficult, is presence, as opposed to seeming. An individual is present when he/she does not try to influence the other to see him or herself only according to his or her self-image. While no one is free of pretense — the desire to be seen in a certain way — presence must predominate in genuine dia­ logue. For instance, a therapist must give up, among other things, the desire to be validated as a “good therapist” by the patient. When a therapist “heals” primarily in order to be appreciated as a healer, then the dialogic process is interrupted. The other has become an object, a means only. Therapists’ love for healing must be “uninvested” — must not occur only to suit their needs for a certain self-image. Presence cannot be legislated. However, resistance to it can be examined. Buber and Gestalt therapy value authenticity and encour­ age both patient and therapist to be in touch with each other’s personhood.

Genuine and Unreserved Communication

If “seeming” rather than presence predominates, then only poor­ quality contact is possible. Where presence is difficult, many Gestalt therapists take the time to explore what their difficulty is, in order to

A corollary of this principle of presence is the requirement that a person’s participation in the dialogue be genuine and unreserved. By unreserved, Buber did not mean to say that all that occurs to someone must be said. Words that are impulsively spoken but are not relevant to the task at hand can serve to obscure genuine dialogue. What must be unreserved is the person’s willingness to be honestly involved, and to say what he/she believes will serve to create conditions for dia­ logue, or further the ongoing dialogue, even if he/she is fearful of how it will be received. Unreserved communication does not preclude silence. Such silence, however, must be a genuine responding and not based on pro­ tecting him or herself, or the other person, from such self-expression. The person must assume responsibility for the unreserved expression of that which occurs to him or her in the process of the dialogue. In Gestalt therapy, unreserved communication, stemming from the therapist’s authentic presence, conforms to the special circumstances of the therapy relationship. The need for unreserved communication is not a license for impulsive behavior; communications must be

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In a therapy where contact is seen as a major organ of personal­ ity, the personhood of the therapist is given central importance in the creation of behavioral change .... What is more crucial than [a listing] of desirable characteristics is the unavoidable fact that, social designations aside, the therapist is, after all, a human being. As one, he or she affects one. (Polster and Polster, 1976, pp. 267-268)

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relevant to the task at hand. For instance, Laura Peris and Walter Kempler differ greatly in the respective weights they place on the existential encounter in therapy, but both agree that unreserved communication must be related to the task of therapy. Laura Peris states:

Therapists often tend to say whatever comes to their minds, assuming that their stream of associations must have something to do with what is transpiring, and therefore must be valuable. What occurs to one is related, if only peripherally, to what is transpiring. But the expres­ sion of it may or may not further the dialogue, or the therapeutic task. The self-disclosure that results from serving the task of therapy by either furthering the dialogue (as Buber might say) or permitting the next step in awareness (as Laura Peris might say) opens the way for a deepening of the experience of the participants. With “presence” and with genuine and unreserved communication, the therapist’s role becomes wide-ranging, limited only by creativity and personal style, and the therapeutic task itself. Gestalt therapists do not confine themselves to a limited range of responses so that a transference can develop, as in the more traditional psychodynamic therapies. They are free to laugh and cry, to dance, yell, or sit quietly. They are free to be fully present with the patient in ways that suit their style, serve the dialogic relation, reflect the temper of the moment, and further the therapeutic task. Gestalt therapy expects that by being present, and by communi­ cating genuinely, the therapist will influence the patient. The artistry is in balancing the therapist’s presence in relation to the needs of the patient. Standing back is as antithetical to “healing through meeting” as is being overbearing (Peris, 1973, p. 105). At some point in the interaction of patient and therapist, even in traditional therapies, what is demanded of the therapist is to:

I share verbally only as much of my awareness as will enable the patient to take the next step [in awareness] on his own, and lend him support for taking a risk in the context of his actual present malfunction. . . I will describe some problems and ex­ periences from my own life or from other patients if I expect this to give support to this particular patient for a fuller realiza­ tion of his own position and potentialities. In other words, only if it will help him take the next step. (L. Peris, 1970, p. 127) The self-expression described by Laura Peris is a kind of sharing of the contents of lives, a telling about the therapist as a person. Kempler uses another, more immediate kind of self-expression. He often responds to the patient with a direct reaction based on how he feels with the client at the moment. He and others refer to this as an “existential encounter.” He values spontaneity and immediacy of interaction, but also within the context of the task: Nor does full self-expression mean saying everything that comes into the therapist’s mind. Full personal expression is not without judgment. The therapist is urged to say everything on his mind that he expects to be of value or that would diminish his ability to participate if he withheld it. (1973, p. 271, emphasis added)

Step forth out of his protected professional superiority into the elementary situation between one who asks and one who is asked. The abyss in the patient calls to the abyss, the real, unprotected self, in the doctor and not to his confidently func­ tioning security of action. The analyst returns from this paradox . . .as one for whom the necessity has opened of a genuine per­ sonal meeting between the one in need of help and the helper. (Friedman, 1976b, p. 190)

The last part of Kempler’s statement is crucial: Therapists must say that which would diminish their participation if it were to be withheld. Therapists cannot always know whether their expression will allow the patient to take the next step. But they can know what they need to do in order to remain available for contact. That is a responsibility of anyone who engages in genuine dialogue, of anyone who presumes to take the other as a Thou. Kempler’s statement is also a warning against the abuses of self­ disclosure that have been common in the practice of Gestalt therapy.

This paradox, that healing through meeting exposes what is possibly unhealed in the self, is only one of many paradoxes of therapy, but is a particularly anxiety-ridden one for therapist and

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patient alike. It is also crucial in a meeting that heals in genuine dialogic manner.

how they experience, and how they interfere with their own experi­ ence. Erving Polster describes this emphasis:

Inclusion

Buber defines “inclusion” in therapy in this way: “The therapist must feel the other side, the patient’s side of the relationship, as a bodily touch to know how the patient feels it” (1967, p. 173). It is a con­ crete imagining of the reality of the other, in oneself, while still retaining his or her own self-identity. In the I-Thou moment, the underlying process culminates and spills over into the peak moment which: . . .is ontologically complete only when the other knows that he is made present by me in his self and when this knowledge induces the process of his inmost self-becoming. For the inmost growth of the self is not accomplished, as people like to sup­ pose today, in man’s relation to himself, but in the relation between the one and the other, between men, that is, preemi­ nently in the mutuality of the making present — in the making present of another self and in the knowledge that one is made present in his own self by the other — together with the mutuali­ ty of acceptance, of affirmation and confirmation. (Buber, 1965b, p. 71) Both Buber and Friedman believed that Carl Rogers exemplified the practice of inclusion in his approach to therapy (Buber, 1965b; Friedman, 1976a). In a public dialogue with Buber, Rogers described what might be called inclusion: “I think that in those moments I am able to sense with a good deal of clarity the way his experience seems to him, really viewing it from within him, and yet without losing my own personhood or separateness in that” (Buber, 1965b, p. 170). Both Buber and Rogers appear to focus on what the patient is experiencing, whereas Gestalt therapy tends to focus on the experi­ encing process, or how one is experiencing. I think this difference stems from the Gestalt therapy emphasis on the awareness process. What Gestalt therapy has, which neither Rogers nor Buber had, is a technology for increasing awareness. The assumption is that patients can learn to deal with what they are experiencing, if they can learn — 68 —

The first step, therefore, is for the therapist himself to meet the patient in a face-to-face encounter where authenticity of expres­ sion and communication are primary. The basic psychological function involved is for the individual to meet otherness through his senses and his actions, much as this function is reflected in Buber’s writings about I-Thou interaction. Secondly, although for the therapist to be authentic is basic, it is hardly enough. The patient is really behaving in self-defeating ways, and the therapist must give specific attention to the characteristic ways barriers to contact are set up. (in Stephenson, 1975, pp. 156157)

I think Buber was overbalanced on the side of inclusion. He made occasional statements to the effect that a therapist could not operate without techniques (Buber, 1967, p. 164) or without attention to the patient’s defensive structure (Friedman, 1976b, p. 90), but he really did not seem to value the technical aspects of the healing process. His major attention was on “healing through meeting” (Friedman, 1976a). For him, the necessary ground for meeting is inclusion. But the capacity for dialogue and the healing effects of dialogue are inaccessible to the patient whose defensive structures prohibit entering into dialogue (Friedman, 1976a). While an absolutely necessary starting point, the practice of inclusion may not be enough. Patients can be assisted in their attempts to enter dialogue by increas­ ing awareness of their defensive structures. On the other hand, I also think that Gestalt therapy is over-bal­ anced on the side of attention to the awareness process. The expe­ rience of being “made present,” or included, in the eyes of another, has powerful healing potential in and of itself. Over the years I have noticed a shift in the practice of Gestalt therapists in relation to inclusion. There is an increasing appreciation of the value of the interpersonal event of inclusion as the starting point for dialogue in therapy. It is also an event that can contribute powerfully to restoring a derailed self-regulating process.

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Buber (1970) says that the therapist: “Must stand not only at his own pole of the bipolar relationship but also at the other pole, experi­ encing the effects of his own actions” (p. 179). This part of inclusion is well respected in Gestalt therapy. In his later years Peris wrote:

I do not advocate that Gestalt therapy reorient itself altogether by focusing totally on inclusion, but I do think that more attention to and practice of inclusion would be helpful. I think that a lack of spontane­ ous inclusion is an interruption of the dialogic relation, and only attention to inclusion can restore the dialogic relation in this case.

If the therapist withholds himself, in empathy, he deprives the field of its main instrument, his intuition and sensitivity to the patient’s on-going processes. ... He must have a relational awareness of the total situation, he must have contact with the total field — both his own needs and his reactions to the pa­ tient’s manipulations and the patient’s needs and reactions to the therapist. And he must feel free to express them. (1973, p. 105)

Gestalt therapists tend to be highly attuned to the effects of their actions on their patients, and to respond sensitively; this is particularly true of those therapists who stress contact. But even these therapists have tended to neglect the other part of inclusion: the willingness to enter into the patient’s phenomenological world (E. Polster, personal communication). An example drawn from my experience as a patient:

One day I was painting a bleak picture of humanity, and espe­ cially of myself. I felt that any “decent” impulse or deed was fraudulent, a lie because I had also been “indecent,” and this be­ trayed my true self. My therapist attempted to demonstrate to me how my thinking/valuing process was confused, “double­ binding.” I finally said, “Hey, I just want to be heard. I want you to practice inclusion.” (He was also reading Buber at the time.) I was both frustrated and despairing. My therapist began to listen, but in a half-hearted manner. I complained that he wasn’t really listening, and he blurted out, “I don’t want to really practice inclusion.” His eyes brimmed with tears as he said, “It’s a very sad and tormented experience.” Seeing his tears, knowing that he had tasted some of my present existence, caused a felt shift of experience in me. I felt momentarily at peace and whole, and was able to leave the bleak picture behind and move on. The practice of inclusion in this case was like a healing touch. — 70—

The Paradox of Inclusion, Confirmation, and Confrontation In dialogue, there is a special insight or illumination in the personally experienced confirmation of oneself by another. Confirmation means that the person is apprehended and acknowledged in his or her whole being (Buber, 1965b). The act of confirmation requires that a person enter into the phenomenological world of the other person without judgment, while still staying with his or her own being. A word must be said about the relation between inclusion and confirmation, and the confrontation and frustration that are so often a part of the Gestalt therapy process. Buber said that confrontation is not antithetical to a dialogic relation, and that in fact, sometimes a relation requires confrontation (Buber, 1965a). But some of Buber’s ideas about confrontation stem from a view of human nature, derived from traditional psychoanalysis, which is at odds with Gestalt ther­ apy’s view of organismic self-regulation. Steeped in the Old Testa­ ment, he had a polar view of good and evil that does fit quite nicely with Gestalt therapy (Hycner, personal communication). But his view of the dynamic relation between the two seems also to have been in­ formed by traditional drive theory of psychoanalysis, with which he was quite familiar. Buber talks of the necessity to do battle with the patient’s defenses, as if defenses are merely impediments to dialogue, as I have described above. From the vantage point of holism, de­ fenses are better seen as attempts to forge any kind of relationship under difficult field conditions. The defenses are a part of the whole, aspects of the patient’s self-regulating system to be contacted and revitalized, not cast aside. I believe it is this same difference in views of human nature that leads Buber and Friedman to distinguish so firmly between acceptance and confirmation. Friedman insists that the difference between mere acceptance and confirmation is that confirmation emphasizes that the patient is being affirmed for what he or she will become, even if in — 71 —

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their present state they engage in myriad defensive, devitalizing behaviors.

Both points of view are valid. By practicing inclusion — by entering the patient’s world — therapists might find themselves commenting on the need/fear dilemma that is being enacted instead of confronting the behavior itself. Or the confrontation will be suffused with the under­ standing acceptance one has gained through practicing inclusion. For me, the notion of inclusion has made me less confrontive than before, despite Buber’s insistence that the confirmation that emerges from inclusion sometimes requires doing battle with the patient. His belief in the necessity for battle is based, I believe, on his erroneous view of human nature. At times, practicing inclusion while also confronting requires patience and confidence in the elasticity of the therapist’s own bound­ aries. I may not like what a patient is doing. I may even be angry. But I try to keep these feelings against the background of the overall dialogic attitude that I am maintaining. This dialogic attitude is often not communicated in words. It develops over time, and is sustained more often by nonverbal behavior or by tone of voice than by any words spoken. In a few instances recently, when I confronted pa­ tients, I could really feel my ability to be with the patients in my anger, and still be open and receptive to them. The vibrancy of the meetings was remarkable. This was very different from times when I have set limits out of my own frustration, been psychologically cut off from the patients’ experiences, and wanted them to do something to make me feel better.

Everything is changed in real meeting. Confirmation can be misunderstood as static. I meet another — I accept and confirm him as he now is. But confirming a person as he is is only the first step. Confirmation does not mean that I take his appearance at this moment as being the person I want to confirm. I must take the person in his dynamic existence, in his specific potenti­ ality. In the present lies hidden what can become. (Friedman, 1985a, p. 135)

Friedman later states that Rogers and Buber disagreed about the difference between accepting and confirming. Rogers equated the two, saying that when the individual feels accepted, and through that, lowers his or her defensive barriers, “the forward-moving processes of life take over. It is precisely this assumption — that the processes of life will always be forward-moving — that Buber questions” (Friedman, 1985a, p. 135). I believe that Gestalt therapy is much closer to Rogers on this point than to Buber. There is no need to appeal to the ineffable “future becoming” of the patient. As you genuinely meet him or her now, you are meeting someone who is living/changing. At any rate, Gestalt therapists do tend to confront and frustrate those behaviors that keep the patient away from experiencing the present moment. But when the therapist is entering into the patient’s world as fully as the act of inclusion requires, I think the style and the attitude of confrontation are affected. For instance, the old notion of “bear-trapping” must be cast aside. That was a pejorative idea, most likely stemming from the therapist’s frustration. When the therapist can see the patient’s world from the patient's perspective, then there is not so much manipulation as there is a conflict between desire and fear. Patients use manipulative behaviors when they do not have faith in their own processes of self-regulation. But manipulation is a term that arises when therapists focus on the way the patient’s behavior is impacting them. Seen from the point of view of the patient, the behavior might be described as a frightened attempt to get a need met. — 72 —

The Dialogic Attitude Buber holds that the dialogic attitude is the requisite stance for anyone who would be an educator or therapist (1970). The dialogic attitude of the therapist is different from the dialogic relation of friendship: The dialogic attitude is assumed by the teacher or therapist who is voluntarily engaged in furthering the learning of the other individual. While the friendship is defined by fully mutual confirmation, the dialogic attitude of the therapist can be assumed independent of the inclinations of the patient. When both persons assume a dialogic attitude, then the fully mutual dialogic relation can occur, but one can appreciate another in — 73 —

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dialogue without mutuality. One person, the therapist, can be present and “imagine the reality” of the other. This is the dialogic attitude. The dialogic attitude is an expression of the latency of I-Thou. Thus the I-It phase, within the context of a dialogic attitude, is embedded in the process that permits the possibility of the I-Thou moment between the two people. Buber is in agreement with most of the psychotherapy literature that the position of the psychotherapist is a paradoxical one. A therapist must “live in confrontation yet be removed”: The therapist’s responsibility is to genuinely meet another person — for it is in the meeting that healing occurs — and yet the therapist cannot attempt to coerce or require such meeting without violating the ground of the meeting. The therapist cannot demand that the patient change. For Buber, therapy is a change process, but the therapist always first confirms the existence of the individual as he/she is. The Gestalt therapy position is even more radical, I think. For if the therapist is only starting where the patient is in an effort to move the patient, then the therapist is not truly confirming the patient, the patient is not a Thou, and the life-affirming potentials of the patient cannot be released. Whenever the apprehension of the patient by the therapist moves from I-It to I-Thou, then the paradox becomes irrelevant and there is only the genuine communication of that moment. In Gestalt therapy, therapists maintain a dialogic attitude that allows them to attempt, as much as conditions will permit, to develop such a relationship. It is a delicate dance. The therapist remains “aggressively in the I-Thou” (Yontef, 1976, p. 183) with someone who has only limited ability to allow for an I-Thou moment, much less a mutual dialogic relationship. Gestalt therapists do not demand that patients enter into such a relationship. They can only be present and authentic, and through the dialogic attitude refuse to forsake either their own “I” or the potential “I” of the other, while maintaining respect for the actuality of the other. Recall Enright’s statement: “. . .the strategy is always to keep a steady gentle pressure toward the direct and responsible I-Thou orientation, keeping the focus of awareness of the difficulties the patients experience in doing this and helping them find their own way through these difficulties” (1975, p. 25). — 74—

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Task as “Thou ”

Buber points out that the dialogic attitude must be present within all therapists who work to “heal through meeting” and release the po­ tentialities of the patient. Therapists serve not only the patients whom they meet, but also the task that brings the meeting about. Be it healing, teaching, or developing, the task is crucial; it defines the relationship, and the therapist must have faith in the invaluable impor­ tance of the task in order to meet the patient without reservation in the context of the therapy relationship. In effect, the Gestalt therapist maintains a dialogic attitude toward the task. In the I-Thou moment there is no intention, the attitude is simply part of the moment. But the dialogue flows between the momentary mutual confirmation and the period of I-It. In the period of I-It, the pressure of the paradoxical engagement tempts the therapist to abandon the dialogical attitude for a more coercive relationship. The pressure comes from the need that arises in the therapist (or anyone) during an encounter — the wish to be confirmed by the other. To engage at the level of I-Thou without the demand that the other person confirm the therapist is the essence of the therapist’s dialogic attitude. The goal of Gestalt therapy is awareness. To serve it is to partici­ pate in the patient’s discovery of his or her own way. Awareness in Gestalt therapy emerges at the boundary of the meeting “between” therapist and patient. It occurs within the context of the I-Thou relation, in the context of the alternating rhythms of I-Thou and I-It. It is the dilemma of the therapist that one encounters the patient with the attitude and involvement of dialogue, yet does not seek to be con­ firmed through the direct human encounter. The therapist’s confirma­ tion comes through the expression of himself or herself in the service of the task. Friedman has suggested, and I agree, that while therapists do not seek confirmation from patients, they must be open to the possibility as inherent in the dialogical relation. In fact, the therapist is confirmed when a patient allows him or herself to receive help (Friedman, 1985a, p. 19). Yet ultimately, the therapist’s own self­ acceptance, self-esteem, and faith in the “truth” of the task, in the lib­ eration of both people that the task will allow, enables him or her to hold aside the wish to be confirmed by the other, and instead to be ---- 75------

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confirmed through knowing that the task is most creatively served in this way. Taking the task as “Thou” requires this dialogic attitude: The therapist is confirmed by realizing the task, which includes the confir­ mation of the patient as Thou and the creativity of serving the task in relation to this unique other of the patient. To illustrate this point, examine an example that Yontef presents: Techniques arise out of the dialogue between I-Thou and the IThou sometimes requires a technological intervention. Exam­ ple: Patient talks without looking at the therapist. The dialogue has been interrupted in that the patient talks, but to no one in particular. A real dialogue now would require a vigorous re­ sponse by the therapist. Possibilities: 1.) “You aren’t looking at me,” 2.) “I feel left out,” 3.) “I suggest an experiment: Stop talking and just look at me and see what happens.” (1976, p. 72)

Any number of responses to the situation are possible, and thera­ pists will respond according to their style, feelings, and intuitive appreciation of the other at that moment. It is important that the response arise out of a dialogic attitude toward the patient, and that it attempt to serve the task of therapy. For instance, in the response, “I feel left out,” the therapist directly confronts the client. But the response is stated with an entirely undemanding authenticity, because the therapist offers the response as a creative involvement with the person and the task, and does not need for the patient to respond in any particular way, to take care of the therapist’s “left out” feelings. The therapist need not and should not require I-Thou reciprocity from the client; instead, the therapist is confirmed by having actively engaged with the patient in the service of the task, which is the highest fulfillment of his or her position as “helper,” or one-who-isasked. The Place of Technique in Genuine Dialogue

Existential therapists typically frown on the use of technique as a reduction or objectification of the patient’s being (Dublin, 1976). However, this attitude results in an unfortunate limitation of the

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therapeutic practice. A dialogic relationship is not limited to the interpersonal encounters in which the figure of interest is the relation­ ship itself. Often, engagement with an external issue is the truest dialogic relation of the moment, for dialogue, like awareness, is grounded in the dominant interest of the person in that moment. Buber appears not to have favored the use of technique; perhaps because of the infancy of psychotherapy at the time, he did not realize the implications for his own assertion that “without It a man cannot live” (Buber, 1970, p. 85). The ego functions are impaired in neurosis, just as the peak moment of contact is impaired. The recovery of ego skills through awareness techniques makes the dialogic process a possibility in the patient’s life. There are two types of awareness in Gestalt therapy: the integrative moment, and the awareness continuum or “attention to awareness.” It is through this attention to awareness that corrections to the contacting process are often initiated. Thus, when working on contact functions or on defenses, there is often a place for I-It in the therapy process. In a sense, when working on defenses the therapist is merely taking the patient exactly where he or she is — in an I-It state — and working to enable the patient to use his or her own awareness process to reclaim a more integrated state. Dublin provides an example: A young married male patient complains of “a deadened feel­ ing. . .hardly any sensation” upon ejaculation. He does not use “I”; he has no complaint of himself, or of his wife; he com­ plains of his penis as an “it,” disclaiming any responsibility for its functioning. . . [The therapist] asks the patient to split off his penis, and to dialogue with it. If the patient protests that this is silly, makes no sense, is not what he really wants, etc., the therapist points out that he (the patient) is already splitting it off, separating it from the rest of his personhood, and that he (the therapist) is only asking him to do so more thoroughly in order to experience more fully how he is doing so. As tech­ nique, this functional splitting off of the penis takes the form of an experiential dialogue between the person-minus-penis and the split-off penis, the patient taking both roles experientially, verbally, and perhaps motorically. As is well known to experi­ ----- 77------

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enced Gestalt therapists, the ultimate effect. . .is not a further experiential distancing or alienation. . .but rather an experiential reclaiming or owning. (1976, p. 132)

of integration. The art for the therapist is in knowing, by attending to and trusting what emerges, when to abandon directed, willful focus on awareness and simply be present for the patient. The integration that occurs is the existential trust (Buber, 1967): It is faith in one’s self­ regulation and in the process of dialogue. Much of the work in ther­ apy is addressed to how patients interrupt contact and awareness to such an extent that they lose this faith.

When working on contact functions the patient can gain skill in using It-mode functions to support deepening the dialogic process. A patient who can learn to allow his tone of voice to express emotion rather than always speaking in a deadpan manner will be freer in dialogues with others. The expressiveness may require practice and may initially even feel fraudulent, but by experimentation the patient finds his or her own appropriately expressive style (Polster and Polster, 1973, p. 239). The important point is that the awareness techniques emerge organically from the ongoing dialogue. When the timing is right for a patient to explore just how he or she interrupts him or herself, then an experiment based on what is transpiring in the therapy process is appropriate. Some techniques intensify and clarify current experience, such as when the patient exaggerates the tightening of the jaw. Other techniques focus on the evolving awareness process, such as when the patient “brackets off’ judgments, or allows body sensations to dictate body posture and movements. Still other techniques, such as role­ playing polarities, may experiment with blocks in awareness, or alienated awareness. A major caution is that in order to be operating from the context of the dialogic attitude, the therapist cannot expect any results from the experimentation. Possibly the most frequent misuse of techniques occurs because therapists are tempted to use them whenever they feel stymied. A technique becomes a way to “make something happen,” or to push the patient in a certain direction — say, toward fuller expression — in order to satisfy the therapist’s frustration. The experiments must be offered without investment in a particular result, but with investment in focusing on awareness, whatever the patient does. When experiments are offered with this attitude, the experimentation process becomes a model of the phenomenological approach to awareness. Goals and judgments are held aside, and attention is directed simply to what is happening. In the therapy process there are times when the attention to aware­ ness leads to evolving, transcending awareness, moving to the “Aha!”

Therapy as a Special Case of Dialogue Buber describes the healing relationship of psychotherapy as a particular form of dialogic relation (1965b, 1970). He considers it a necessary tragedy of helping relationships that, unlike friendships, they cannot be fully mutual (1965b, 1970). Buber contends that while a therapist may at certain moments experience full mutuality with the patient, therapy, by the nature of its task, involves a limited relation­ ship. Returning to and expanding an earlier statement of Buber’s: “The therapist must feel the other side, the patient’s side of the rela­ tionship, as a bodily touch to know how the patient feels it. If the patient could do this, there would be no need of therapy and no relationship" [emphasis added] (1967, p. 173). It is possible that in order to make his point clearly, Buber exag­ gerated the difference between therapy and a more fully mutual dia­ logue. Certainly, some patients are capable of fully mutual inclusion with the therapist. But even these patients would not be serving their own best interests by engaging in a predominantly mutual therapy relationship. The task of therapy requires that the focus be primarily on the patient, not on the therapist. Because of the nature of the task, the therapy relationship is limited. Buber describes the therapy relationship as a “one-sided inclusion” rather than mutual inclusion (1970). In one-sided inclusion, the helper strives to imagine the reality of the other, but the reverse does not ordinarily happen and is not intended. If the relationship is mutually inclusive, then it cannot be therapy. The essential difference between mutual inclusion and one-sided inclusion is not based on an assumption that the person of the therapist is different from the person of the patient. The difference comes from the fact that the task sets the two people in different relations to each other and to the task. The

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therapist has willingly set aside personal investments in order to serve the learning of the patient. Patients are invested in their own learning, not that of the therapist. At moments of the I-Thou relation, such role definitions are irrelevant, but the alternation between the phases of I-It and I-Thou (or the phases of a contact episode) occurs within the context of the one-sided dialogic attitude. If a fully mutual dialogic relationship develops, then, although the relationship will be therapeu­ tic for both participants, the therapy contract no longer exists. Buber’s second point is that in therapy it is the responsibility of the therapist to meet the patient, and not for the patient to meet the therapist (Buber, 1967). In a fully mutual dialogue, each participant may be expected to assume responsibility for meeting the other. In therapy there is no such expectation. The therapist’s willingness and receptivity to the sphere of “between” is the scaffolding against which the existential trust of the patient is formed. Frederick Peris and Laura Peris make similar assertions about the therapist’s responsibility for the therapy itself. “In these cases of ‘failures’ I either lack the ability to show them convincingly the need for change and reorientation, or else I myself am insufficiently integrated to be aware of the crucial resistance” (F. Peris, in Stephen­ son, 1975, p. 59). Laura Peris states: “As far as I am aware, I want my patients to get better. If they don’t, then I have to search for what I have failed to become aware of or to make them aware of in the on­ going relationship” (L. Peris, 1970, p. 126). Erving Polster (1975) suggests that it is up to the therapist to establish an interactive climate wherein good-quality contact is a possibility for the patient. Therapists do not impose the model of IThou on their patients (Yontef, 1975), but they retain the dialogic attitude themselves out of the belief that such an attitude is the means by which patients’ potentialities are released. Because therapists are responsible for setting up the interactive climate for this release, they must at times initiate contact, extending themselves to meet a severely restricted patient where the patient is (Polster and Polster, 1976, p. 157). This means that the requirements of the dialogue in therapy are different. The inclusion is one-sided, and confirmation is largely one­

sided as well. The therapist confirms the patient, but not vice versa, except in rare moments. In essence, it becomes the therapist’s respon­ sibility to establish the conditions for dialogue (Friedman, 1976a). The therapist must do everything possible to come fully to the relationship: be present, engage unreservedly in the dialogue, and perhaps most important, practice inclusion. To this end, Hycner makes an interesting point about the person­ hood of the therapist. He asserts that the therapist’s individuality is important only insofar as it serves the task. As Hycner (1985) says:

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In a genuine dialogical approach it seems to me that the thera­ pist is a “steward of the dialogical.” By this I mean that in a very profound sense, the individuality of the therapist is sub­ sumed (at least momentarily) in the service of the dialogical, which is the entire therapeutic Gestalt and includes the individu­ als in it. . . .It assumes that genuine uniqueness arises out of genuine relations with others and the world. Individuality is but one pole within an overall rhythmic alternation between our individual separateness and our participation in something larger than us, i.e., “Being.” (p. 33)

A special requirement of the therapy relationship is that the therapist must not only encourage the patient’s self-becoming through the dialogic relation — inclusion in particular — but must also put “before the patient the claim of the world” (Friedman, 1976a, p. 201). This means that the therapist does not view the patient’s individuation as something that can be achieved in isolation from real relationships in the real world. The neurotic person is someone who has withdrawn from dialogue, and healing involves resumption of the dialogue in that person’s con­ crete daily existence (Friedman, 1976a). I suggest that through aware­ ness work done within a dialogic context, we restore the possibility of dialogue. The patient’s involvement at that point is based on an aware choice to deepen dialogue or to turn away. I do not think a therapist can restore a mutual dialogue with the patient. A therapist

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can only work to meet the patient. The mutuality is a choice the pa­ tient must make. 2 Finally, Buber’s most important contribution to psychotherapy is his central tenet that in order to heal “the very roots of the patient’s being” therapy must incorporate a genuine meeting. For it is through the dialogic relation that healing occurs (Buber, 1967, p. 169).

dialogic relation is itself a vehicle for the restoration of awareness, which is the goal of Gestalt therapy. The dialogic relation is a model of contacting lived out to its highest potential. The process of organismic self-regulation, as reflected in contacting and awareness, is itself involved in a develop­ mental process: the development of the person’s uniquely human becoming. It is not enough to say that contact and awareness serve our biological and emotional needs. There appears to be a kind of ontological imperative, an urge toward growth, so that these processes operate at increasingly finer levels of complexity and abstraction from biology. Contact and awareness are not merely the processes that express the dynamic relation between stasis and growth; they are themselves spiraling developmental processes, always emerging and transcending. The epitome of their development is lived through in the dialogic relation. The dialogic relation is also a model for the kind of therapeutic relationship that is consistent with the Gestalt theory of change. A therapist who operates from a dialogic orientation will establish a present-centered, nonjudgmental dialogue that allows the patient both to deepen awareness and to find contact with another person. The therapy becomes a chance for the patient’s selfhood to unfold in the presence of another person. In Gestalt therapy, awareness is used to restore awareness, and this restoration can be facilitated by establishing a dialogic context. In this context, contact can be used to restore contact. The therapist’s meeting the patient in a dialogic relation becomes a model for the restoration of contact and awareness, and hence, the possibility for growth. Gestalt therapy is considered a “growth discipline” (Latner, 1973; Polster and Polster, 1973). Healing and growth through the restoration of awareness are an expression of the transcendental possibilities of human existence. But the Gestalt therapy language of contact and awareness does not evoke Buber’s sensitivity to the possibilities of wholeness. Whereas the concept of contact serves to ground Gestalt therapy in the natural biological rhythms of all organisms, the I-Thou attitude transforms contact into the realm of the uniquely human: the interhuman rela­ tionship and the development of the person.

The deciding reality is the therapist, not the methods. Without methods one is a dilettante. I am for methods, but just in order to use them, not to believe in them. Although no doctor can do without a typology, he knows that at a certain moment the incomparable person of the patient stands before the incompara­ ble person of the doctor, he throws away as much of his typo­ logy as he can and accepts this unforeseeable thing that goes on between therapist and patient. (Buber, 1967, p. 165)

In Gestalt therapy, the typology used is that of contact and awareness, with attention to the patient’s interference with these processes. We bring this typology and our intention toward a dialogic relationship when we begin to meet with the patient. At certain points the de­ mands of the dialogue require that we abandon the typology, and it is at these moments, according to Buber, that the essential healing may occur (1970, p. 179). Summary and Implications

This chapter argues for greater emphasis on the patient-therapist rela­ tionship in the Gestalt therapy process. Gestalt therapy is increasingly aware not only that the relationship is an important curative factor, but also that the relationship should be specifically the genuine, loving meeting described by Buber as the dialogic relation. I have attempted to show that use of the I-Thou model is a fitting and logical extension of the Gestalt therapy focus on the contacting process, and that the 2

lam indebted here to a personal conversation with Maurice Friedman where he suggested that on a continuum of means, ends, means and ends, in sequential steps, perhaps the end of awareness in Gestalt therapy is a means to dialogue in the larger context of the person’s life. ----- 82------

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The most important therapeutic implication is that the therapy must take place within a dialogic relation if it is to be true to the ontic possibilities of contacting. Patients must be afforded the chance to “meet” another person if they are going to know themselves. Therapy composed solely of awareness techniques, without the contactful engagement of the therapist/person with the patient/person, paradoxi­ cally limits the awareness possibilities for the patient and interrupts the becoming of both people! This is not to say that techniques should not be used. I agree with Erving Polster (in Stephenson, 1975) that contact is not enough. Without also increasing patients’ awareness of just how they avoid contact, the therapy runs the risk of becoming a “Dance of Orpheus”; patients will be able to respond, to engage, only when the therapist is present to initiate the contact. Awareness techniques teach patients how to correct their interrupted contacting. They are a powerful methodology. But the techniques must evolve organically from the dialogic process. In so doing they will reflect the next step in the patient’s becoming. Buber’s paradigm of the dialogic relation offers the Gestalt thera­ pist some concrete guideposts, as well as a vision for establishing with the patient a relationship that will be both conducive to the patient’s growth and gratifying to the therapist. When you enter into a dialogic relation, even in the sometimes unreciprocal relationship of therapy, you experience the release of your own potential as well as that of the patient. The practice of the art of therapy becomes not only an expression of your being, but a step in your becoming.

l 4. Simone: Existential Mistrust and Trust Lynne Jacobs

This is a story of a dialogue between a Jew and a non-Jew. It took place at a workshop for advanced therapists in Jerusalem in May, 1989. Simone was the fourth person I worked with on my first day in Jerusalem. I had noticed her right away. She had the demeanor of a woman with great substance. Her manner of dress indicated she was an observant Jew. She was quite uncomfortable with me; she was drawn to working with me because she liked what she saw, but she saw me as a non-Jew, and she was afraid of and hateful toward non­ Jews. She said that, in fact, she had never in her life had an intimate conversation with a non-Jew. Her parents are Holocaust survivors. The work began by her using some imagery from the person who worked before her, an image of a fish in an aquarium: S:

L:

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I feel choked up. Like a fish who dares not open my mouth or I will swallow water and drown. And you asked David before if his parents had suffered many losses. I wonder, is that part of what is going on for you now? Are there many losses in your family? (she nods assent) From the Holocaust?

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S:

L: S: L: S:

L:

Yes. And now I am not in an aquarium anymore. I am in a huge ocean, and I must fight or I will drown! If any other fish enters my area I will fight them. Why fight? Then I can feel big and strong. Then the ocean cannot drown you. I feel strong when I fight you and am angry with you. And I am very uncomfortable when I want to be closer to you. I insist that you are not representative of all non-Jews. You are different. But still I am afraid of you, angry with you, and envious of you. Envious that I do not live under the shadow of the shoah as you do?

At this point we engage in some talk of her desire to have me come into her water, to give me a taste of what she lives with. In the course of talking I point out that although I can get some taste, the fact that I will jump into the water and then jump out, whereas she lives in the water, changes the experience so that there is still some distance between what she wants me to know and what I can know.

You are free to live in a world of sun. Why am I not? It did not even happen to me. It happened to my parents before I was bom. Why do I carry it so much? (said in a self-critical tone of voice) L: There were too many losses for your parents to assimilate. There was too much degradation for any one person to bear. It is not surprising to me that the shoah casts a long shadow. The losses and humiliation seep into you almost by osmosis. (I am speaking with tears is my eyes. One or two tears have rolled down my face.) And so you swim in an ocean of tears that threatens to drown you. S: (in anguish) Why can you cry when I am so frozen! L: (spoken very gently) I can afford to. S: (spoken softly and with a slight sigh) Now I can trust you. S:

She has been appreciative of and responsive both to my attempts to get inside her shoes, and my recognition of the limits of my ability to do that. Now she talks of wanting to be able to go somewhere and — 86 —

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play with me, as though the ocean has no grip on her. I suggest she imagine the line where ocean and beach meet. We can start by meeting at the water’s edge together. She begins to tell me what is in her ocean. It includes her father’s first family; his wife and four children were killed in the camps. Then, her voice cracking, she tells of her mother’s first family. Her husband was killed, and then her infant baby was killed in her arms. She sees more tears from me and is puzzled:

S: L:

Why does my story affect you so? Why do you cry when I speak of these things? You, a non-Jew. I am afraid I cannot give you a satisfactory answer. I have worked with second-generation shoah people in the States, and their stories are always deeply affecting. How can anyone who hears your story not be moved? (I am crying a lot now — many tears)

We begin to play more with the idea of taking a walk together, away from the water. What emerges is that she cannot play with me while the others can see her, and she cannot reassure them that she will return in a minute, because she would be disloyal to them. I point out that nothing she gives them will give their situation its due. No one person can give their situation its due. She can give her own life its due. And yet of course she would want to honor their memory in some way, even though no way seems good enough. (I still have tears in my eyes)

S:

L:

S:

I want to trade. I want to give you two pounds of my anguish, and take from you two ounces of your tears. (I move closer so that we might trade). . .My anguish comes to my throat, no. . .my mouth, and stops there. It is too ugly and disgusting. I cannot show it to you. I can understand your fear. The shoah was disgusting. Your anguish does not disgust me. But I understand your fear, because in my own life I have had an experience that I was sure was too disgusting to be brought into the light. (softly) Perhaps that is why I trust you.

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A few more sentences are spoken softly between us. I speak of wanting to walk alongside her, the water lapping at our feet. She then says the ocean has disappeared now, and she is back in the aquarium, looking out the glass, and seeing that I am there looking at her. She feels grateful that I have not turned away, and with tears in her eyes, thanks me for staying with her. She then reminds me that her fear makes her want to remind all of us that she does not see me as representative of non-Jews in general. The next morning, on the second day of our two-day workshop, I told her that I had decided to tell her something that had occurred to me the day before but which I had held back for fear of being presumptuous (I also noted to myself that Simone was wearing bright colors — as opposed to the black of yesterday — and appeared more animated). I told her of my experience when I visited Dachau. In essence, I told her that all my life I had felt a vague sense of guilt about being alive, and was not very strongly cathected to being alive. Then I visited Dachau, and from the anguish of the experience, I emerged with an affirmation of life. I decided that the only true renunciation of Hitler was to live as vitally as possible, and not to let his destruction of other people destroy my meaningful life. She was amazed, and said in return that she had reached much the same conclusion after our dialogue yesterday. She very purposefully had chosen brighter colors for today to say she was alive again! At the end of the workshop she told me that her view of her world is changed now, even though she is still uncomfortable with how much she took me in (which I had told her I experienced as a gift), and that she is glad I will be leaving and going back to the United States, so that she can get comfortable again. But still, her “globe” is different; before, it was all dark except for the bright lights of Israel. Now Israel is still brightly lit, the rest of the globe is darkened, except for one pinprick of life far away on the other side of the globe from Israel. I was deeply moved, and told her so:

L:

S:

(tearfully) I think of myself as so wounded, so damaged, that I have no light to bring to others. I am amazed to have this effect on you. And humbled. Perhaps we are more alike than different.

(with tears in my eyes — again!) One of the legacies of the experience I alluded to yesterday, is a fear that I am toxic to others, rather than nourishing for others. I shall always treasure the gift you just gave me. What an antidote for my self-doubts!

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5, After/Words: The Spirit of Dialogue

Rich Hycner

There are many misunderstandings of the “dialogical.” This naturally occurs because of the subtle and complex nature of what we are trying to address and because it is such a different way of viewing the world. It certainly runs counter to the overemphasis on individualism that dominates our society. It is my hope to clarify briefly some of these possible misunderstandings as well as add some further reflections. First and foremost, I wish to reiterate the viewpoint that the dialogical is primarily an approach, an attitude, an orientation, an outlook. Ultimately it is a radical paradigm shift. When we take this paradigm shift seriously it changes entirely the way we approach therapy. It is a figure-ground reversal of our usual thinking. It places the relational at the heart of our existence and of our work as thera­ pists. It reconceptualizes our understanding of human development and “psychopathology.”

The basis for this chapter was an article entitled “The I-Thou Relationship and Gestalt Therapy” (1990). The writing of that article came from my desire to respond to the many questions and comments which had arisen at the 11th Annual Conference on the Theory and Practice of Gestalt Therapy (1989), as well as at the Annual Conferences on Dialogical Psychotherapy in San Diego. I was moved by the spirit and exchanges of those Conferences. — 91 —

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— After/Words: The Spirit of Dialogue —

Secondly, I want to reiterate that the dialogical encompasses both I-Thou and I-It moments. The I-Thou meeting is not an absolute state or technical “goal” in therapy. The dialogical is an approach of being open to otherness, the uniqueness of the other person, along with a desire to bring myself fully into the “meeting” with this other person. It is the willingness, after all my individual efforts, to submit to the “between” — to recognize that a genuine meeting can only occur through something beyond my control. As Martin Buber so poetically states it: “The Thou meets me through grace — it is not found by seeking” (1958a, p. 11). It is an openness to an expanded awareness, a “larger gestalt” (Schoen, 1989). It requires that both persons be open to the possi­ bility of a genuine meeting. Even then, such an I-Thou encounter may not occur despite the best of our personal intentions. A dialog­ ical approach acutely recognizes that an I-Thou moment occurs in an interplay with I-It encounters. They are figure and ground to each other. In a sense the dialogical can be seen as the context, the ground, encompassing both I-Thou and I-It moments. The dialogical requires a rhythmic alternation of I-Thou and I-It connectedness. There is often a great deal of confusion for Gestaltists as to whether “dialogue” can be equated to the Gestalt term “contact.” The simplest way to put this is that all dialogue is contact — not all contact is dialogue. There are innumerable ways of making contact, but it is a rare event to have a mutual and genuine dialogue with another. A dialogue is centered in neither person, yet originates in both. It is the recognition, deep in my being, of the mysteriousness and value of the other person as a person, who exists independently of my needs. Concurrently, there is an awareness that we are mysteriously connected. All the while, a similar experience is occurring for the other person. I look into the other, and she looks into me. Something happens between. There is a moment of meeting. Each of us is touched by something beyond our self — by this other person. It is simultaneously a moment of both union and separateness. Afterwards, neither of us is exactly the same as we were a moment ago. Our meeting is “something greater” than the sum total of what we sepa­ rately brought to this situation.

Some Gestaltists would describe this as “confluence.” I do not see this as confluence, not even “positive” confluence. Confluence implies to me the merging of two totally separate beings. Dialogue is not confluence, in the sense that there is a merging with a conse­ quent loss of self. Dialogue starts from the basis of recognizing our interrelational nature. Even the moment of I-Thou connectedness recognizes separateness and relatedness in the same moment. There have been a number of questions raised about this being a “spiritual” approach. Discussing a philosophy of dialogue, talking about the “between” and mentioning “grace” places my thought explicitly in a spiritual context. By spiritual, I mean a recognition of a reality greater than that of the sum total of our individual realities, and of the physical and visible world. It is inconceivable to me to steep myself in a dialogical approach without recognizing a spiritual or transpersonal dimension. 1 I feel more and more that in my best therapeutic moments, I am present to, and sometimes the instrument of, some spiritual reality. That is why I talk about a dialogical approach as “requiring” a stewardship from the person of the therapist. To take such an ap­ proach seriously means a willingness to set aside one’s own egooriented needs and intentions, at least momentarily (including the wellmeaning intention of “healing”) to be in the service of the dialogue between, and consequently attending to the deepest, yet often most hidden, needs of the other. Being “in the service of” means the deepest listening to hear what has been till now unheard, allowing the unspoken to be spoken, the hidden to be revealed, the invisible to become visible.1 23

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1 I am however fully respectful of the viewpoints of my colleagues, such as Lynne Jacobs and Charles Brice (personal communication, April 16, 1989), who hold that from their viewpoints such a connection is unnecessary. 2 Korb (1988).

2 See also Maurice Merleau-Ponty’s groundbreaking work, The Visible and the Invisible (1968).

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— After/Words: The Spirit of Dialogue —

The between is that reality which encompasses both therapist and client, and to which both approach to a greater or lesser degree. In fact, psychopathology can be seen as a significant retreat from, or solidification of, the between. I go so far as to define psychopatholo­ gy as the result of an early aborted dialogue (Hycner, 1991). That is, in the deepest reaching out to others, this person has not been heard and her voice has turned monologically and tragically inward (Triib, 1952/1964b). This fits in with Lynne Jacobs’s belief that “We are ‘wired’ to be dialogical.” 4 I think this very quaint expression points to our most primordial orientation. Such a conception means placing less emphasis on the individual as an entity and more emphasis on the relationship, and the relational ability of the client. Consequently, there is not the exclusive focus on se(/-actualization (Friedman, 1976a) to which humanistic psychology sometimes got stuck in. Instead, the focus is on a "relational actual­ ization” which encompasses self-actualization. Self-actualization arises as a by-product of enhanced relational connectedness. There are as many selves we are a-part-of, as well as a perduring self throughout all these relationships. At face value this appears to be a contradictory statement. I believe rather it is a statement of the inherent paradoxical nature of our existence. The self is not an entity; “It” is the relationship of self and other, and other with "self. ” We need to be careful not to take “self and other” as dichotomized entities, that come together only as after­ thoughts (Friedman, 1989). We are the inherent interplay of self and other. Perhaps to be more accurately phenomenological, we should in

fact speak of an interexistence. *6 Terms such as interexistence, and interrelational may sound awkward to the ear and unnecessary. Perhaps it is their very jolting quality that is necessary. I think we must start utilizing a language that more accurately, even if awkward­ ly, points to the inherent interwoveness of our existences. Our skin is not a barrier. It is the physical and symbolic meeting place both for connectedness and isolation. We are always inextricably interwoven with others, and they with us. I was once again struck by this awareness as I sat at a panel table, in front of a conference audience 7 and I started speaking to the audience. As I began to speak the words that unexpectedly came out of me were: “As I’m sitting here, looking at you, looking at me, looking at you. ...” As I had begun to speak, I had become acutely aware of the intermixing of our perceptions. I was aware that I was as much a part of the audience as they were of me — our perceptions, our existence, interpenetrated. That made me aware of how we ordi­ narily ignore our interexistence. Interpersonally this is often tragic. Globally, it may be fatal. If I may put down a few very simplistic thoughts about our global situation, it strikes me that to the extent that a monological attitude dominates world consciousness, there will continue to be tragic and perhaps cataclysmic consequences. The predominance of the monologic attitude precedes megalomania. There will always be human conflict. A dialogical approach acutely recognizes that at the heart of our interexistence, there are profound differences in viewpoints. This is both our “curse,” and our hope. Multiple viewpoints, when seen within a larger gestalt as complementary, create new possibilities and an infinite richness for human development. Human development would be stifled without differences. This is the core of a dialectical understanding of human existence. As Sreckovic has succinctly stated it: “Dialectic is based

4 Statement made in a workshop presentation on “The I-Thou Relation in Gestalt Therapy” at the Eleventh Annual Conference on the Theory and Practice of Gestalt Therapy, May 5, 1989, Chicago, IL.

Self and “environment” in the language of Peris, Hefferline, & Goodman, (1951). It is interesting that Fritz Peris seemed to focus more on the biological metaphor, whereas Laura Peris seemed to be more influenced by the dialogical and existential conceptualizations of Buber and Tillich (L. Peris, personal communication, September, 1987). — 94-----

$ Perhaps the best clinical demonstration of this is Irvin Yalom’s Love's Executioner and Other Tales of Psychotherapy (1989).

7 Eleventh Annual Conference on the Theory and Practice of Gestalt Therapy (1989). ----- 95 ------

— THE HEALING RELATIONSHIP IN GESTALT THERAPY —

on difference. Without differences, there is no dialectic.” 8 Healthy development occurs when there is a creative integration of differences and similarities between and among human beings. 9 In a world constantly growing smaller, an ever-present awareness of, and ability to engage in dialogue will be essential for emotional and physical survival. To the extent that each of us is entrapped in a monologue, we threaten our own survival: In terms of psychological evolution, a dialogical emphasis may be the next step necessary in order to sur­ vive. At a more concrete level, it strikes me that the “abyss” between women and men experienced in our society is to a great extent a consequence of our gender-based monologue. We make gender dif­ ferences into monological separateness. This creates isolation. We consign ourselves to categories, rather than reaching across the seeming abyss to be enriched by the uniqueness and difference of the other gender. Differences become a barrier, rather than an invitation. Undoubtedly, it will always be both. That in itself is not tragic. Tragedy reigns when differentness and separateness predominate to such an extent that inherent gender polar connectedness is squashed (Downing, 1987; Gilligan, 1982). We keep creating a world for our children that emphasizes this split, rather than healing it. We need to constantly remind ourselves to perceive our inherent differences as being within the context of our ontological connectedness. Once again we step into the arena of paradox. At the fringes of normal consciousness is the ever-present aware­ ness of paradox. Our conceptual mind has great difficulty holding in tension two seemingly opposed ideas, thoughts, or characteristics. Yet, as Gestalt therapists, we know that we confront paradox inces­ santly. It is of the nature of the therapeutic task to be permeated by paradox. As therapists, as supervisors of therapists, we need to educate ourselves to live in paradox — to tap the creative wellspring that lies just below the surface of insoluble paradoxes. We are in a paradoxical profession (Hycner, 1991), more so than in an “impossi­ Q

Personal communication, August 5, 1989.

9 Milan Sreckovic, personal communication, August 5, 1989.

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— After/Words: The Spirit of Dialogue —

ble” one (Greenson, 1977). To enter into the heart of paradox is to profoundly experience the “truth” of interexistence and interexperi­ ence. Our heads need to be educated to what our hearts already know. At the conferences I speak at there is sometimes confusion about the issue of therapeutic mutuality, that is, equality between the client and the therapist. In Buber’s thought there is not a true mutuality between therapist and client (Buber, 1965b). In my thought, there are moments of mutuality in therapy, but they often occur within a relationship that is mostly one-sided. When there is true mutuality between the two, that is essentially the end of therapy. The issue of mutuality for a true I-Thou relationship, versus an IThou attitude presiding in one individual has been brought home to me time and time again. In one exercise suggested by Schoen (1989) in his workshop, the audience broke off in pairs and were to silently attempt an I-Thou moment with the other person. Only later were we to discuss it between ourselves. When I thought my partner and I had achieved an I-Thou moment, I found out from him later that he hadn’t experienced that! When he thought he and I had had an I-Thou encounter, that wasn’t necessarily my experience. We both thought that there had been an I-Thou momentary meeting, yet that wasn’t borne out in the conscious awareness of the other participant. Approaching another with an I-Thou attitude does not assure the unfolding of an I-Thou mutual encounter. I may approach the other person genuinely open to the possibility of such a moment occurring, yet it can only occur by the other saying "Yes ” to my approach. I am helpless to “force” the other to meet me. I cannot unilaterally, by some superhuman or mystical effort, bring it about. Here I am profoundly and inexorably confronted by the limits of my own humanity (Yalom, 1989). As much as I may wholeheartedly desire “union” with another person, I am limited by the openness and willingness of that person to participate in such a betweeness. Each person must be willing to be met. The unwillingness of one person negates the possibility for both. My approach to the other may be thoroughly dialogical, yet an I-Thou meeting may not occur. Such an awareness instills humility. It is a profound recognition of our ego-oriented needs and of the limits of our individuality. To — 97 —

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try to force an I-Thou relationship is to be guilty of a modem hubris. To attempt to do so paradoxically creates an I-It relationship. Step­ ping beyond the interrelational limits of dialogue imprisons us in monologue. I am fond of Friedman’s statement that “The sphere in which man meets man has been ignored because it possesses no smooth continuity” (1965a, p. 17). Despite years of psychological theorizing, I think that this is still largely true today. For the most part, Psychology has been looking in the wrong place! Psychology is mostly studying the individual, and the individual’s psyche, rather than studying the “between,” and how the individual and her/his psyche exists within that relational context. What is proposed here is not meant in any manner to be idealistic, or seeking a “pure” viewpoint. What is proposed here is the opposite of idealism. It is an attempt to understand thoroughly (though recog­ nizing that one can never totally capture) the interrelational quality of our existence. In one sense it is an attempt to be more empirical than empiricism — not to reduce our commonality of differences to physical reality, but rather to embrace, hopefully and joyfully, the multitudi­ nous dimensions and richness of human interexistence. This is certainly a point of view that is difficult to grasp. I have been struggling for over twenty years to bring it into clearer focus. Yet I experience but brief moments of lucidity concerning it. A deeply embodied understanding of the dialogical is as ephemeral as it is real. I now believe that it is the richness, and inherently paradox­ ical nature of our existence, that creates the danger of sounding esoteric or idealistic in trying to describe it more fully. That is as it must be. However, we must avoid falling into mystification. A genuine dialogical approach is fraught with the difficulties of concrete and applied situations. To be truly dialogical is an extremely difficult and may even be a painful stance to take (Yalom, 1989). To retreat to a simple idealism or a simplistic behavioral empiricism would be a wonderful relief. These are drugs which numb the awareness of the richness of human interexistence. Our task is to be true to what is. Such a stance demands courage. The courage not only to maintain one’s own perspective, but also to remain resolutely open to the unfolding of what is, irrespective of whether what is fits our precon­ ceptions — even supposedly dialogical ones. This philosophy of “what

— After/Words: The Spirit of Dialogue —

is” stretches the limits of theory and imagination. Buber understood this only too well when he said, “The limits of the possibility of dialogue are the limits of awareness” (1965a, p. 10). It requires courage because we must remain open to whatever unfolds in the en­ counter. It is walking on the “narrow ridge” (Buber, 1965a, p. 184). To close off possibilities with preconceived categories is to stifle meaningful dialogue. It requires courage to hold innumerable tensions in juxtaposed and fruitful relation to each other without foreclosing their fullest emergence. In talking about the dialogical, there are often many questions about the issue of technique. I have often said that a dialogical approach is not opposed to technique. Rather, it provides a context within which appropriate techniques may emerge. Technique can be dialogical as long as it is not merely technique. It needs to be part of the ever-present effort to further an interrelational awareness, contact, and shared reality. Dialogue is the ever-changing interplay of I-Thou and I-It moments. Technique, properly contextualized, can be an es­ sential component of meeting. It can help reduce, or remove, the im­ pediments to dialogue. 10 Technique exists, not for itself, nor for the ego aggrandizement of the therapist, but ever again to be in the service of enhancing the “meeting.” As Gestaltists, we have probably been too guilty of “doing,” and not enough of “being” (Polster, 1987). Far too often we want to rush in with a technique that may, in effect, prematurely close off the tenuous opening to a genuine dialogue. Such technique traps us in a monologue. Far too often technique arises out of the objectifying orientation and the ego needs of the therapist. Far too often it is not phenomenologically true to what is (Yontef, 1989) nor what is being called for from the deepest parts of this person’s being. Many of my students and trainees report to me that they are startled that when they are “merely” being-with the client so much more occurs than when they overly strive to “do” something. An attitude of being-with requires a trust in whatever emerges. It means

Charles Brice, personal communication, April 16, 1989.

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giving up self control to allow a larger reality to emerge. Being-with embodies an openness to what is. However, being-with doesn’t exclude the use of technique, of doing. In fact, it enhances its effec­ tiveness. When we are truly open to “what is there,” it allows us to intervene, when necessary, far more effectively. Such courage to face the unknown requires much of the therapist. Often the therapist has not been trained to be trustful of “being,” and courageous in the face of it. That is the real and ever-present chal­ lenge for the dialogically oriented therapist.

II. A BRIDGE BETWEEN:

Self Psychology and Gestalt Therapy A Dialogic Perspective

I don't know about the implications of my ideas in various fields.

Martin Buber (1967, p. 165)

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6, A Brief introduction to Self Psychology and Intersubjectivity Theory

Rich Hycner

If there is one lesson that I have learned during my life as an analyst, it is the lesson that what my patients tell me is likely to be true — that many times when I believed that I was right and my patients were wrong, it turned out, though often only after a prolonged search, that my rightness was superficial whereas their rightness was profound. Heinz Kohut (1984, pp. 93-94) The previous chapters have addressed some of the foundational issues in establishing a dialogical approach to Gestalt therapy. 1 However there is still a lacuna, a missing piece, in both a dialogic approach and in Gestalt therapy. Dialogical psychotherapy is primarily an approach, and not a psychological theory as such. Its practitioners have until this time been primarily and necessarily concerned with foundational issues. As a consequence, they have not as yet articulated a compre-

1 Other recent works have explored a dialogical approach as a foundation for psychotherapy in particular, and healing in general, e.g. Friedman, M., 1985; Hycner, 1991; Friedman, A., 1992. — 103 —

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— A Brief Introduction —

hensive dialogical clinical theory, nor (and this is true of Gestalt therapy) a comprehensive clinical developmental understanding of hu­ man interexistence. At this time, some of this must come from a related approach. Intersubjectivity theory may be such an ap­ proach. Why is intersubjectivity theory important to explore in relation to a dialogical approach? Psychoanalytic approaches have a clinical richness to offer that needs to be included within a more comprehen­ sive metapsychological model. More than any other psychoanalytical ­ ly based perspective, intersubjectivity theory comes closest to that of a dialogical approach. 2 *3 Its program is to provide a comprehensive clinical theory while attempting a phenomenology of human experi­ ence. This is an impressive agenda, and it has had an exciting start. The clinical insights provided by this approach are deep and rich. Furthermore, there appear to be a number of natural meeting points between a dialogical approach and intersubjectivity theory. Propo­ nents of each approach see striking similarities in the other. It is therefore no accident that practitioners of these two approaches should move toward each other to meet. Though percolating below the surface in the thinking of several clinicians, it has been particularly the

thinking, clinical work, integrative writing, and person of Lynne Jacobs that have provided the impetus for the practitioners of both ap­ proaches to meet. A “bridge” needs to be established between a dialogical Gestalt therapy and intersubjectivity theory because there is much in both theories that elicits similar resonances, yet has not been articulated. I will discuss some of the many similarities that I think indicate a complementarity, and even a possible intertwining between these approaches. In a later chapter, I will also explore some of the major differences between them. While integrating the independent insights of Kohut’s self psy­ chology theory, 3 its proponents view intersubjective theory as having developed beyond some of the classical analytic metapsychological limitations, including those of Kohut’s theorizing. As its name indicates, it emphasizes an intersubjective understanding of the self. Clearly, this emphasis moves self psychology closer to a dialogical approach. The most comprehensive clinical statement on

2 The practitioners of this approach refer to their theory as “intersubjectivity theory.” Perhaps this should more accurately be termed “intersubjective self psychology.” However, some of the followers of this approach view it as broader than “self psychology as such” (Stolorow, 1991b), while acknowledging that they have assimilated the core of Heinz Kohut’s self psychology theory (Stolorow et al., 1987, p. 15; Atwood, 1989, p. 194). Yet it seems to me that intersubjectivity theory is currently so intertwined with self psychology that it is a misnomer to refer to it only as intersubjectivity theory. The term also is somewhat confusing since there have been a number of philosophical theories that could be classified as intersubjectivity theories.

a

Lynne Jacobs points out that of the nonpsychoanalytically-based approaches, Gestalt therapy is much closer to a dialogical approach than is intersubjectivity theory. However, she points out “But intersubjectivity theory has developed ‘inclusion’ more fully, shown its clinical significance, and is more highly developed as a clinical theory per se” (Jacobs, personal communication, October, 1991).

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4 This occurred at the Seventh Annual Conference on Dialogical Psychothera­ py in San Diego in 1991. This conference brought Robert Stolorow, one of the leading theoreticians of intersubjectivity theory, and Sanford Shapiro, an intersubjectively oriented analyst, into dialogue with representatives of the dialogical approach including Charles Brice, James DeLeo, Aleene Friedman, Maurice Friedman, Rich Hycner, Lynne Jacobs, and David Tansey. My own interest in self psychology probably began around early 1984, in hearing about self psychology in general, and in reading the initial manuscript chapter on self psychology of what later became Maurice Friedman’s The Healing Dialogue in Psychotherapy. Lynne Jacobs encouraged me to read further in intersubjectivity theory, and mentioned how close it was to a dialogic approach. It was she who recommended that I read Atwood and Stolorow’s Structures of Subjectivity: Explorations in Psychoanalytic Phenomenology (1984). 3 In a talk given on September 14, 1991 in San Diego, entitled “Subjectivity and Self Psychology: A Personal Odyssey,” Stolorow made it abundantly clear that intersubjectivity theory, as conceived by him and his collaborators, devel­ oped independently and in parallel to Kohut’s self psychology theory, and was not an outgrowth of it. Stolorow further mentioned that he was heavily influ­ enced early on by the “personology theory” of Henry Murray. ----- 105-----

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this approach is Psychoanalytic Treatment: An Intersubjective Approach (Stolorow, Brandchaft, and Atwood, 1987). The more recent Contexts of Being: The Intersubjective Foundations of Psycho­ logical Life (Stolorow and Atwood, 1992) expands on this earlier work and begins the search for a broader philosophical base for understand­ ing these issues. In order to understand intersubjectivity theory, it is necessary first to review briefly some of the foundational principles of Heinz Kohut’s self psychology. This is so because intersubjectivity theory has assimilated the foundational ideas of Kohut’s work into its own, while providing a different philosophical and metapsychological base. However, I should wam the reader that what will be presented of both Kohut’s theory and intersubjectivity theory will be quite succinct summaries and cannot do justice by any means to the complexity and richness of these systems. The brevity of these summaries is neces­ sary in order to focus primarily on the integration of these perspec­ tives with a dialogical approach. Kohut’s Self Psychology

In developing his self psychology theory, Kohut transcended many, though not all, of his original classical Freudian theoretical assump­ tions. 6 In his thinking, it was the development and cohesion of the self which became the prime motivating factor in an individual’s life, and determined how this individual reacts in specific situations. As a consequence, the subjective experience of the patient became the pri­ mary focus of the therapy. This was radically different from the classical analytic assumption that the analyst “knows” what reality is for the patient. For Kohut, the manner of approaching the patient’s experience was through the “empathic-introspective” stance. The word empathy in this context has created much misunderstand­ ing. What Kohut primarily meant by this term was that the analyst had an attitude of investigating the patient’s experience from the per­

Stolorow et al. (1987) point out that, for example, Kohut never completely broke away from drive theory. However, Detrick (1989, p. 459) asserts that in Kohut’s last book (1984) he moved away from drive theory.

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— A Brief Introduction —

spective of the subjective viewpoint of that patient. He did not usually mean by this word to imply a “fellow feeling.” Quite the contrary, the empathic stance, as theorized by him, was much more of a cognitive-investigative orientation of the analyst. However, he sometimes used the term empathy in the sense of fellow feeling, which has created much confusion. The introspective aspect referred to the commitment of the analyst to also look at the analyst’s experi­ ence in the therapeutic situation, as to how it might illuminate what might be contributing to the patient’s experience in that situation.

Selfobject One of the central ideas of Kohut’s self psychology is that of a “selfobject.” A selfobject does not refer to actual people, but rather to the function another person, an object, or an event, serves in order to maintain, or further develop, a sense of self and self-coherence (Stolorow et al., 1987, pp. 16-17). Selfobject functions primarily serve to integrate affects into self-experience. Developmentally, this integration can occur only if there is “attuned responsiveness” on the part of caregivers. It is precisely such attunement that supports the differentiation of the self from others’ needs (Stolorow et al., 1987, p. 20). Selfobject ties are necessary developmentally throughout life, not just in the early years. This was quite a radical departure from the early analytic doctrine that maturity was equated with independence from others. Kohut explicitly discussed three types of selfobject functions: 1) mirroring, 2) idealizing, and 3) twinship: Mirroring refers to the basic need in all of us, but perhaps most explicitly manifested in the early infant-parent bond, that in order to develop as a human being we need others to reflect back to us our pride and excitement at our develop­ mental steps forward. An idealized other allows us to feel protected, and thus to feel strong and calm in negotiating daily occurrences. Twinship needs refer to what might be called fellow feeling — a sense that we are like others. In therapy, a selfobject transference is an aspect of all transference “. . .wherein the patient attempts to reestablish with the analyst ties that were traumatically and phase-inappropriately ruptured during the formative years, and upon which he comes to rely once again for the — 107 —

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— A Brief Introduction —

restoration and maintenance of the sense of self” (Stolorow et al., 1987, p. 40). Empathic failure is when the therapist, as experienced by that individual, fails to meet the requisite needs of that individual. A selfobject tie is broken. As radical as his approach was compared to classical psycho­ analytic theory, Kohut’s work still is at times disappointing because in the final analysis he framed some of his radical insights within a traditional Freudian metapsychology, and at times engaged in Freudian mechanistic thinking (Stolorow et al., 1987, pp. 16, 20-21). He failed to take seriously enough the radical implications of his understanding of subjective experience, as well as our relatedness to others. This created the opening for a specifically intersubjective approach to self psychology.

as a self. It may even threaten the coherence of the self. The self may thus remain developmentally stuck. Within the context of psychotherapy, the therapeutic relationship is understood as a “reciprocal mutual influence” between patient and analyst. It is a reciprocal model because each participant influences the reactions of the other member of this dyad (assuming individual therapy). Within this context, though, the primary focus is on the subjective world of the patient. Nothing the patient says, does, or experiences in the therapy is only a product of the patient’s own idiosyncratic and intrapsychic world. The therapist contributes to the patient’s experience of the therapist, and the patient contributes to the therapist’s experience of the patient. There is an encounter of self with self 7 which is necessarily and inexorably informed by two individual histories, and populated by innumerable idiosyncratic experiences of both. It is the empathic stance of the therapist that allows the therapist to resonate to the unique meanings of this person’s subjective experience.

Intersubjectivity Theory Intersubjectivity theorists began independently of, yet later expanded upon, the work of Kohut. Its proponents’ goal is to be a “... pure psychology of human experience” (Stolorow, 1991b) utilizing the method of “psychoanalytic phenomenology.” As opposed to classical Freudian theory, the overall emphasis of this approach is "... subjec­ tive reality — that of the patient, that of the analyst, and the psycholog­ ical field created by the interplay between the two" (Stolorow et al., 1987, p. 4). Within this perspective, the subjective world of the patient is the primary interest. This world is the product of all the encounters, especially critically formative experiences, that make this person’s world unique. The self is the center of this subjective world. Within this subjective world, there are "structures of subjectivity” — consistent ways in which the self views the world.

Intersubjective Field The context for the subjective world is that of the intersubjective field; the subjective world is inextricably bound up with the reactions of others. As a result, the subjective world construct encompasses both the selfobject dimension as articulated by Kohut, as well as a conflictual or repetitive dimension. The conflictual dimension arises when a selfobject need has not been met. It elicits archaic feelings of failure — 108 —

Selfobject Ties

Stolorow (1991b) suggests further that there may in fact be numerous other dimensions of selfobject ties aside from the mirroring, twinship, and idealizing functions discussed by Kohut. The intersubjective theorists wish to expand Kohut’s original concept of selfobject function while not wanting to make the concept so extensive that it refers to any caregiving activity (Stolorow et al., 1987, p. 66). Furthermore, they suggest that probably there are other important dimensions of relating beyond those of the seifobject and conflictual aspects. 8 The intersubjective theorists, expanding on Kohut’s

7 This is the language of Stolorow and his co-authors since they do not wish to speak about “persons.” This issue of “self in contrast to “person’ will be explored in the later chapter entitled “A Dialogic Critique of Intersubjectivity Theory and Self Psychology.”

8 Lynne Jacobs, in a later chapter, “The Therapist as ‘Other’: The Patient s Search for Relatedness,” goes beyond the articulated thinking of Stolorow and (continued...) ----- 109 -----

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— A Brief Introduction —

thought, propose that the selfobject and conflictual dimensions of the patient become foreground or background depending on what is occurring within the intersubjective field. All of what was said above for the patient in regard to the selfob­ ject and conflictual dimensions is true also for the therapist. The therapist will unconsciously look to the patient to meet certain selfobject needs, although hopefully, in a less archaic manner (Stolo­ row, 1991b). The therapist also will reach certain impasses with the patient as a result of his or her conflictual dimensions emerging with the patient. The patient will not meet certain essential and probably unconscious needs of the therapist. This inevitably will lead to a conflict between the therapist and patient, especially if the therapist fails to become aware of how this is occurring. It is here that the introspective stance of the therapist is especially necessary. The therapist, either on his or her own, or with consultation, needs to become aware of how his or her needs have interfered with the emer­ gence of selfobject needs of the patient, and have created a disjunction — perhaps even a chasm — in the intersubjective field.

transference becomes clearer through understanding the often early and highly affective meanings of the subjective experience of this individual. Transference, like the rest of the subjective world, is bipolar — it manifests both the need for selfobject “caretaking” functions, as well as the conflictual (repetitive) dimensions of the patient’s experiences. These two dimensions represent the broad figure and ground aspects underlying transference. However, there are many other selfobject needs and aspects that may come to the fore in the exploration of transference. Different facets of the transference will become manifest at different times in the therapy, dependent on the corresponding selfobject needs of the patient at that time. The role of the analyst is central in understanding the patient’s transference within the therapeutic relationship. The analyst is always understood as eliciting, or contributing, at least in part, to the manifes­ tation of the transference in the therapy. Rather than being seen as only an intrapsychic manifestation as in classical analysis, transference instead is rigorously understood as being a function of the interaction of the therapist and the patient. It is through and through an intersubjective phenomenon. It is only by looking at what the analyst did, or did not do; and how that did, or did not meet certain selfobject needs, that the meanings of the transferential reactions of the patient can be illuminated. The therapist’s responses influence the emergence of certain selfobject needs (and consequently transference) from the patient; at the same time, the patient’s responses elicit certain counter­ transference reactions on the part of the analyst. This becomes an intersubjective loop of action and reaction. To the extent that the analyst fails to discern the selfobject needs currently in the forefront for the patient, there will be a disruption in the intersubjective bond being promoted in the therapy. These failures on the analyst’s part create further resistance, and derail the movement of the patient toward establishing more developmentally appropriate ways of interacting. The goal of the systematic exploration of transference is to open up the possibility of establishing new and presumably healthi­ er connections with the therapist, with the patient’s own sense of self, and also with others.

Transference Central within intersubjectivity theory is the issue of transference. Transference is not viewed as a negative phenomenon. Rather, because of the centrality of “structures of subjectivity,” transference is viewed as the . .expression of a universal psychological striving to organize experiences and construct meanings” (Stolorow et al., 1987, p. 37). It is impossible for there not to be transference. It is inevitable that the invariant subjective structures of meanings of the patient will be played out in therapy: It could not be otherwise. This is not a “regression” but rather a dramatic manifestation of the patient’s understanding of the world and his or her relations to others. As such, this phenomenon bears close investigation in order to help elucidate the unconscious structures of this person’s world. The

Q

(...continued) his coauthors, and suggests that there may in fact be a dimension of “meeting the other.” ----- 110-----

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In closing, I once again need to remind the reader that what has been presented in this chapter is obviously an extremely succinct summary of an exceedingly complex multidimensional model (Stolo­ row, 1991b). Such a summary, while helpful, runs the risk of doing great injustice to the richness of the theory. Further aspects of this approach will be explored in later chapters looking at the similarities, and the differences, between a dialogical approach and intersubjectiv­ ity theory, as well as the similarities and differences with Gestalt therapy.

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7. A Bridge Between Dialogic Psychotherapy and Intersubjectivity Theory

Rich Hycner

He can know the wholeness of the person and through it the wholeness of man only when he does not leave his subjectivity out and does not remain an untouched observer. Buber (1965a, p. 124)

The development of psychoanalytic understanding may be conceptualized as an intersubjective process involv­ ing a dialogue between two personal universes. Atwood and Stolorow (1984, p. 5)

Meeting Points

There are a number of striking similarities and interrelated thinking between a dialogic approach and intersubjectivity theory. I think it would be invaluable to explore these. In many ways, this is only an introduction to the topic, and may provide a basis for integrating this

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approach within Gestalt therapy. A later chapter will point out some of the major differences.

Philosophical Roots

In an early book, The Structures of Subjectivity: Explorations in Psychoanalytic Phenomenology (1984), Atwood and Stolorow in the first chapter explicitly discuss their approach as being grounded in a number of philosophies, including hermeneutics, existentialism, and phenomenology. Within these traditions, they thoroughly review the influence of Dilthey, Husserl, Heidegger, and Sartre on their think­ ing. 1* From the hermeneutic tradition, they mention their work being especially influenced by the thinking of Wilhelm Dilthey. Dilthey focused on discovering the meanings of events from the perspective of the experiencing subject, while emphasizing that this only can be done by the concurrent involvement of the investigator. Therefore the subjectivity of the researcher and the subject being investigated are inherently interconnected in this search for meaning. They approv­

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ingly quote Dilthey’s comment that this leads to "... the rediscovery of the I in the Thou” (cited in Atwood and Stolorow, 1984, p. 3), certainly language that a dialogical approach resonates to. There is an interrelationship here that needs to be embraced and honored by clinician-researchers. 2 It is within this perspective that Dilthey conceptualized the study of human experience as a “human science,” contrasting this to the so-called objective methods of the natural sci­ ences. Stolorow et al. propose that intersubjective psychoanalysis be conceived as a human science, explicitly recognizing the involvement of the clinician-researcher in the phenomena being clinically investi­ gated. I would propose that to do otherwise is to be guilty of an abortive bifurcation of human interexperience. Dilthey was a teacher of Martin Buber (Buber, 1965a, p. 126) and obviously influenced his thinking regarding a holistic approach to studying human beings, particularly, that such a study should be con­ ceptualized as a human science, or what was then sometimes referred to as “philosophical anthropology.” 3* In discussing the viewpoint of the philosophical anthropologist, Buber in a quote almost forty years before there were intersubjective self psychologists, could be easily mistaken for one; “He can know the wholeness of the person and through it the wholeness of man only when he does not leave his subjectivity out and does not remain an untouched observer” (1965a, p. 124). The human science researcher must be involved in the “phe­ nomenon” (this person’s unique experiences and meanings) and must recognize that involvement as part of the phenomenon being investi­

1 Perhaps an indication of the weight they give to these viewpoints is the fact that they devote twenty-five pages of one hundred and twenty pages of text in this book to a discussion of these philosophies. It is also interesting to note that Atwood, one of Stolorow’s main collaborators, has published at least two works on the impact of the existential philosophers Heidegger and Sartre on “psychoan­ alytic phenomenology” (Atwood, 1983,1989). Stolorow has mentioned that the term “psychoanalytic phenomenology” has “never taken off’ (1991b). In regard to self psychology in general, it is interesting to note several authors from within the self psychology perspective have pointed out the influence existentialphenomenological thought has had on self psychology (Masek, 1989; NissimSabat, 1989). There are further intriguing parallels in the most recent book, Contexts of Being, (Stolorow and Atwood, 1992) between this approach and the long­ standing existential analysis of the three modes of the subjective “world” of the individual: the umwelt (the biological world), the mitwelt (the world with others, and the eigenwelt (the “self* world). Stolorow and Atwood (1992, pp. 8-11) using virtually the same language, state that the myth of the isolated mind arises because of alienation from nature, social life, and from subjectivity.

“unique” and the “general” in the study of the person, than Husserl’s later phe­ nomenology which sought out general “essences” (Buber, 1965a, p. 159). As a further historical note, Wilhelm Dilthey was also a teacher of Franz Brentano, who strongly influenced the founder of phenomenology, Edmund Husserl, in his understanding of intentionality.

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This conceptualization was independently explored in Maslow’s pioneering and intriguing chapter, “Interpersonal (I-Thou) Knowledge as a Paradigm for Science” in The Psychology of Science : A Reconnaissance (1966).

3 Buber was much more influenced by Dilthey’s recognition of both the

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gated. There is no question here of succumbing to the illusion of some purported absolute objectivity. In regard to the label “existentialist,” it should be noted that though Buber’s philosophy of dialogue was certainly within the broad thrust of existential thought, he did not label his philosophy as existentialist, in the vein of Heidegger’s or Sartre’s outlooks. He criticized many of the existentialists because in their philosophies individual existence often was overemphasized at the expense of human interexistence — there was little room left for the possibility of genuine dialogue and relatedness between persons. He was primarily concerned with an intersubjective existentialism, or what he preferred to call the “interhu­ man” dimension of existence. There is a strong parallelism here be­ tween the philosophy of the interhuman and the psychology of the intersubjective. In the following sections I will explore the parallel concepts in intersubjectivity theory and dialogic psychotherapy. They are not equivalent concepts, but are parallel.

The Interhuman — The Intersubjective One of the most significant similarities between a dialogic approach and intersubjectivity theory is the overriding philosophy of understand­ ing the person as a person-in-relation or, in self psychology terms, an “intersubjective self.” This is a radical departure from the implicit philosophy most psychotherapies have (often quite subtly) of the person as a totally separate individual whose relation with others is but an “afterthought” of this individualness. When Buber refers to the interhuman, he is talking both about the ontological level and the ontic (which includes the psychological). At the ontological level, our very being is being-with. The unit of existence, and experience, is the self-with-other-and-other-with-self.

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This is the “between.” Buber views the person’s being-with as always oscillating between separateness and relatedness. The relatedness is an inherent part of our being, not a later add-on. The “intersubjective self” in the theory of Stolorow and his collaborators is a concept of a person’s self as inherently interrelated with other selves. Self identity and self coherence are integrally interwoven in the bonding with others and others’ relations to us. Psychotherapy must always take into account this interwovenness.

I-It Relations — Selfobject Functions Perhaps one of the most intriguing connections between Buber’s thought and that of intersubjectivity theory is the dimension of existence that Buber referred to as I-It relations, and that intersubjec­ tivity theory refers to as selfobject functions. Buber, of course, was coming from an ontological point of view, regarding one of the two main stances we can take in relation to other people. In fact, Buber decried the predominance of I-It relations in the modern world. 56 He was no nineteenth-century reactionary, but had the

5 Jacobs takes the position that selfobject functions aren’t only I-It, but can be a . .sign of dialogical relation” (personal communication, October, 1991). She goes on to state (personal communication, November, 1992): “When you look to the ‘other’ to meet a selfobject need of yours, that is I-It, perhaps interpenetrated by I-Thou, but still I-It. But when in ‘meeting the other,’ I am also enhanced because a selfobject need is met, is that not also I-Thou?” I agree that certain expanded I-It relations are “on the way” to a dialogical relation.

In a later chapter critiquing intersubjectivity theory, I will discuss the very crucial difference between what the intersubjective theorists mean by “self’ in contrast to “person.”

6 It is beyond the scope of this work to discuss fully this predominance. Suffice to say that modem industrialization, the fast pace of living, an obsession with consuming material goods, and the modem obsession with “doing” rather than “being,” leaves the person with the sense that there is no time to “be” in relationship, a relationship is to be “done.” An overly materialistic society is one whose members lack a feeling of value — unconsciously hoping against hope that material acquisitions will fulfill this desperate longing to be valued and loved. “Love” becomes only a feeling, and an acquisition, rather than an attitude of deep engagement toward the other — certainly beyond surface enticements. (continued...)

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sensitivity and wisdom to recognize that the relations between people seemed to be becoming primarily technical relations. Since his was an ontological understanding, and he was not a psychologist, he did not go into a psychological explanation of the multifarious ways in which I-It relations are lived out, nor as a philosopher was it in­ cumbent on him to have a comprehensive developmental theory. This intersubjectivity theory has begun to do quite well; in fact, undoubted­ ly at this time, this is it’s greatest contribution. What has been insufficiently developed in a dialogically oriented approach (Triib, von Weizsacker, Farber) has been a more clinicallyspecific phenomenology of the needs underlying at least some I-It relations. Such an understanding of the individual’s subjectivity needs to be mapped out, and in therapy the territory gently and gingerly explored and traversed. Selfobject functions are guideposts on this perilous journey. In fact, I would propose that this is a clinically specific and tangible mapping of the subjective world of the person that existential therapists and theoreticians have always spoken about (May, Angel, and Ellenberger, 1958) but have failed to articulate in a manner meaningful to many clinicians. On the other hand, Jacobs (1991) states that selfobject relations take us to the “edge” of other­ ness: Yet, it appears that intersubjectivity theory doesn’t deal with the real other person (versus a selfobject function). 67 A dialogic per­ spective may be helpful here. Dialogical Psychotherapy — Intersubjective Psychoanalysis

Patients enter analysis with hopes for an intersubjective context in which thwarted strivings for differentiated selfhood may

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become liberated (the tie that frees) and with fears that the violations of self-experience encountered in childhood will be repeated with the analyst (the bond that shackles). Stolorow et al. (1987, p. 65, emphasis added)

The regeneration of an atrophied personal centre. . .can only be attained in the person-to-person attitude of a partner, not by the consideration and examination of an object. Buber (1958c, p. 133) The Between — The Intersubjective Field

Perhaps most important for our purposes is the similarity of both ap­ proaches toward psychotherapy. Both a dialogic approach and intersubjectivity theory view healing as occurring in the “between,” or in the intersubjective field. This is in contrast to the often implicit philosophy of many theories that it is occurring intrapsychically in the client alone. When two persons engage in a dialogue, its meaning “. . .is to be found neither in one of the two partners nor in both together, but only in their dialogue itself, in the ‘between’ which they live together” (Buber, 1965b, p. 25). In fact, Buber refers to this approach as “healing through meeting.” The meeting is that of person-withperson. This entails an openness to whatever happens between them. Using strikingly similar language, Atwood and Stolorow propose that psychoanalysis is “. . .an intersubjective process involving a dialogue between two personal universes. . .” (1984, p. 4). Both approaches are thus vitally concerned with the relationship — the human engagement. Both view what arises in the therapy as a function not of the patient alone, nor of the therapist alone, but rather of the interaction between them: Each participant coconstitutes the

6 (...continued) It is a loving of the being of that person. Similarly, we are obsessed with “falling in love” rather than a “way of being.” It is no accident that Buber said that the marriage relationship was the greatest challenge to living out a dialogical relationship.

7 More will be said about this in the later chapter critiquing intersubjectivity theory.

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8 In this section I will integrate the thinking of dialogic psychotherapy with that of intersubjectivity theory. Since this is an integration, it would be awkward to specify each term or phrase as arising from dialogic psychotherapy or intersubjectivity theory. I will primarily allow the context of the sentence to indicate which theory is being referred to at that time.

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other’s reality. Both view the therapeutic relationship as creating the context that can facilitate this person/self of the client becoming more whole. Psychotherapy can be understood as two individuals with separate realities in search of a common ground — a “healing be­ tween.”

Uniqueness — The Subjective World Both approaches emphasize that the first step toward this common ground, as well as the overall focus of the therapy, must be to enter into the subjective world of this person, rigorously explore the meanings in this world, and to begin to understand this person from within his or her internal experiential perspective. From Buber’s point of view, each human being is graced with uniqueness. Our inter­ human nature — our commonality — interweaves us with community, but we are each also existentially unique, one of a kind for this time only and no other. This unique being elicits a unique response from all those around, and this contributes to the totally unique meanings of her or his experiences. The uniqueness of the person also presents the problematic that since he/she is unique and singular, no one will be able to either prereflectively or totally comprehend this person’s unique experience. It is certainly not something that is ever known ahead of time, like a textbook formula. It is as if each human being spoke such a com­ pletely distinct dialect of the presumably same language that it made that language virtually incomprehensible to the listener. It can be understood haltingly with only the greatest of efforts. Thus, there is the need for creating an atmosphere of trust and openness in order to explore this unique “dialect” — this individual’s subjective meanings. This is always done with the understanding that the subjective world of the client only emerges in relation to the subjective world of the therapist, and the consequent reality created between.

Entering the Client’s World — Sustained Empathic Inquiry The overall method of both approaches is to explore respectfully and faithfully the subjective world of the client. A dialogic approach to — 120 —

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exploring the client’s subjective world is that of “entering the world of the client” (Hycner, 1991). This requires a “listening obedience” (Buber, 1965b, p. 131) that entails rigorously attending to the unique world of meanings embodied by the client. It requires on the part of the therapist a bracketing of implicit subjective assumptions and meanings so that the therapist’s meanings do not get imposed on the client. This is in order to be present to the client’s unique understand­ ing of the world — its meaning for him or her. The overall method utilized by intersubjectivity theory to do this is an attitude of “sustained empathic inquiry.” This is an attitude of nonjudgmental interest and exploration of the unconscious organizing principles of this individual, as revealed within this particular intersub­ jective context. The approach by the therapist may be primarily cognitive though it may be quite an emotional experience (as in “empathic immersion”). When there is a positive resonance between the therapist’s stance and the patient’s experience, the patient feels deeply understood. If the client feels understood, especially as previously unacceptable as­ pects of the personality emerge, the client is more and more willing to trust the therapist, and begin to believe that even more vulnerable feelings can be understood, accepted, and perhaps even validated. The therapist’s interventions are guided primarily by a clinical sense of what will best build the trusting atmosphere necessary to facilitate this individual revealing herself in a relatively unguarded manner, and even allow previously unrevealed meanings to emerge. This is especially so for those regions of experience that are the result of being grievously injured and the individual is hypersensitive to being violated. Sustained empathic inquiry taken to its phenomenological limit begins to tap the emotional substratum between therapist and patient. At a minimum, it shakes the therapist’s taken-for-granted subjective meanings, so much so that it is “. . .like feeling the sand giving way under one’s psychological footing” (Stolorow and Atwood, 1992, p. 93). This indicates something far more than only cognitive involve-

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ment. In fact, Jacobs points out that “empathic inquiry done in a sustained manner might build in a crescendo-like way toward the ex­ perience of immersion” (personal communication, November, 1992). Thus, at its fullest, it may lead to a “full-bodied” sense of the patient’s experience, as well as correspondingly the patient being aware of the therapist’s stance. This is what Buber would call inclusion.

Inclusion — Empathic Immersion We come now to one of the most intriguing similarities (yet possible differences) between Buber and the intersubjectivity theorists — the centrality of inclusion and empathic immersion. $ Inclusion is the opposite of analytic objectification. It is . .a bold swinging — demanding the most intensive stirring of one’s being — into the life of the other” (Buber, 1965b, p. 81, emphasis added). It is the rhythmic back-and-forth ability of human beings to experience an event from the perspective of the other person while in the same moment maintaining one’s own experience. It is a back-and-forth movement because the individual doesn’t stay only at one pole of the interaction; rather she or he encompasses both. It is an immersion in the existential stance of the other without losing one’s own existential position. It is being inclusive of the other, yet concurrently respectful of oneself. It is the basis of the possibility of all dialogue. The paucity of inclusion has left human interaction emotionally and

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spiritually bankrupt - bereft of practicing that gift that truly distin­ guishes us as human. Buber referred to inclusion by several terms, such as “experiencing the other side,” “imagining the real,” and “making present.” Each of these terms points to the desire to be respectful of each person’s experience in a relationship. Perhaps the best portrayal of inclusion is the psychotherapist Hans Triib’s personal experience of how Buber had listened to him, which Triib poetically described "... as letting a soft tone sound and swell in himself and listening for the echo from the other side” 11 (in Friedman, 1985, p. 32). Buber contrasted inclusion with how he understood empathy. For him, empathy implied that one “went over” to the other person’s side and experience, and one’s own concrete reality was lost in this “aesthetic” endeavor: “. . .it means to ‘transpose’ oneself over there and in there. Thus it means the exclusion of one’s own concreteness, the extinguishing of the actual situation of life, the absorption in pure aestheticism of the reality in which one participates. Inclusion is the opposite of this” (Buber, 1965a, p. 97). I suspect, however, he would not be opposed to the attitude of empathic immersion as practiced by some intersubjective self psychol­ ogists. It extends the usual understanding of “sustained empathic inquiry.” This immersion is an experience of being as totally ab­ sorbed as possible in the emotional/cognitive subjective world of the patient. It is a tacit recognition of the need of people to be “emotion­ ally understood” and deeply connected with another. Within the understanding of empathic inclusion is the implicit recognition that the10 11

$ Jacobs (personal communication, October, 1991) would say that “empathic immersion,” as the intersubjective theorists describe it, is approximately equiva­ lent to what Buber would call inclusion. Furthermore, Jacobs (personal commu­ nication, November, 1992) points out that the term “empathic immersion” was used originally by Kohut, whereas Stolorow prefers the term “sustained empathic inquiry” because it does not have an “emotional demand quality.” She further states that these terms are “impossible concepts” because no strict definition can be given to them. Needless to say that at times this has made my task of comparing two approximate, but clearly not equivalent, approaches quite difficult.

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10 Interestingly, this is to be distinguished from consciousness of oneself: self consciousness is but one pole necessary for human existence; the other pole is the inclusion of the other. Only with inclusion can there be the possibility of a dialogue.

11 Interestingly, this sounds parallel to Kohut’s understanding of the “parental echo” (cited in Stolorow et al., 1987, p. 68).

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therapist’s experience impacts the patient, and the patient’s willingness to allow the therapist in. This empathic immersion is often what the patient has been silently screaming for for years. Such immersion, by itself, may in fact be healing.

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Its practitioners believe that the overriding attitude of empathic inquiry, and at times immersion, leads to the patient’s willingness to deeply trust the therapist and explore those areas of developmental arrests behind which are held captive the most private, intimate and frequently the most injured parts of the self.

“Lost and Forgotten Things ” — Sequestered Regions of the Self Both approaches recognize the centrality of hidden aspects of the self, of the person. Healing can occur only if previously unaccepted and disconfirmed “parts” of this person are allowed to surface. This requires creating an empathic accepting atmosphere such that . .ever more vulnerable and sequestered regions. . .” (Stolorow et al., 1987, p. 10) of the self can be explored. These sequestered regions of the self are precisely those that are most central to the “being” of the indi­ vidual. They represent that center of the person that most explicitly places the stamp of uniqueness on him or her. Only when the “center of the person” is attended to, do the “lost and forgotten things” (Trub, 1935/1964c) emerge — those which are most core to the self, and correspondingly most vulnerable. Stolorow and Atwood describe these experiences as similar to a closed-off room “. . .in which are locked the most intimate of secrets and longings and the most personal of happenings” (1992, p. 94). As the therapy unfolds, if there is acceptance and attunement, it is likely the patient will be able to go from more archaic intrapsychic/intersubjective experiences to more mature ways of being. This corre­ sponds to Triib’s (1952/1964b) two-stage understanding of therapy. The first stage is primarily focused on the patient’s subjective world. The second stage brings in the actual existential reality of the world — the therapist as a real person, sitting with another real person. 12 Intersubjectivity theory’s primary theoretical focus is on the first stage.

19

Here intersubjectivity theory, as a theory, appears to stop short. It focuses on the selfobject function “within” persons, rathet than at a later point, the theory focusing on the real persons. The practice, as I understand it in this regard, does go beyond the theory. — 124 —

Confirmation — Affect Attunement

We come once again to an approximation, rather than a clearly delineated one-to-one equivalence, between two essential concepts of these two approaches. Dialogic practitioners believe that genuine healing requires confirmation of the “being” of that person. All human beings have the deep existential need to be confirmed by others. It is a need that is there throughout life, but is particularly paramount when there has been faulty attunement between the child and parents. Frequently, when a client seeks out therapy, he or she has for years been living out of a “false-self system — a chronic form of “seeming.” The client enters therapy with the sometimes faint, sometimes desperate, hope that he or she can be “real” with another human being. Furthermore, each human being needs to be validated by another for whom she or he “truly is. ” It is only in this validation by another that the deepest part of the being of the person can emerge most fully. Healing, in the deepest sense of “making whole,” can occur only in this manner. If this is an accurate portrayal, then psychotherapea (attending to the soul) is a structured situation in which the client is seeking validation of his or her real self. Confirmation is not something that magically occurs. Rather it is a profound experience that is approached by the step-by-step attune­ ment of the therapist to the multifarious feeling states of the client, many of which have heretofore not been responded to by others. This is the goal of affect attunement in self psychology: to attend to specific emotional experiences of the patient, especially those which were not developmentally attended to and consequently led to de­ railments in emotional growth. This attunement is a responsiveness to the changing emotional states of the client, and the emotional injury — 125 —

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that may reside therein. Such attunement creates a context of feeling understood, and thus increases openness to intersubjective relatedness. Though it is not the goal of attunement that the therapist, through this activity, be confirming of the being of this person, it may in fact be experienced as such by the patient (Jacobs, personal communication, October 1992).

The “Wisdom" of Resistance — Selfobject Failure and Resistance Both intersubjectivity theory and dialogic psychotherapy recognize the central role of resistance in human interaction. Both view resis­ tance as an essential unconscious attempt of the individual to protect the integrity of the self. Both approaches “value” resistance — particu­ larly its self-protective quality. If we take seriously “entering the subjective world” of the client, then it is essential to understand the resistant dimension of this person’s self. These resistant aspects are not anomalies of the self, but in fact are necessary existential dimensions of this person’s beingin-the-world, and need to be “valued.” This person could not at this time be this unique person without this resistant dimension. This resistant dimension needs to be recognized, and valued, as part of this whole person (in contrast to splitting it off, as the client is currently doing). Resistance is not something to be broken through, but rather needs to be recognized and genuinely appreciated as an essential part of this person. It needs to be understood as this person’s (often early) unconscious best effort to maintain a cohesive sense of self. Resistance is a two-sided wall. On the one hand it rebuffs new and threatening experiences; on the other hand it encloses those parts of the self that are most vulnerable — it encloses the earliest wounds to the self. Both dialogical psychotherapy and intersubjectivity theory

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are especially interested in this self-protective aspect of resistance It is only by the deep acknowledgment of this pervasive need that the individual will be willing to trust taking risks in exploring domains previously sealed off by this self-protective aspect. Resistance is a double call to the world. On the one hand it says to others: “I won’t let you injure me.” On the other hand there is the muffled and desperate scream of the most inward self which desires to break out of its inwardness and be recognized and valued by another. From a dialogical point of view, this is the ontological ambivalence that inheres in each person. Both dialogic psychotherapy and intersubjectivity theory are very much interested in the therapist’s role in the client’s resistance. This interest is inherent in any truly intersubjectively oriented psycho­ therapy. Both posit an interactive model of resistance. They view it as part of the “betweenness” of existence. There is no way to under­ stand the client’s resistance without understanding how that person perceives the actions of the therapist, and what in fact are the thera­ pist’s actual actions, as well as resistances in the interaction with this client. The entire cycle of action-reaction must be looked at in discussing resistance. Resistance is inherently a phenomenon of the between.

1 o

This perspective is such an integral dimension of a dialogical approach that in an earlier work, Between Person and Person: Toward A Dialogical Psycho­ therapy (1991) I devoted an entire chapter to exploring “The Wisdom of Resis­ tance.”

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8. Self Psychology, Intersubjectivity

Theory, and Gestalt Therapy A Dialogic Perspective *

Lynne Jacobs

This chapter will examine Gestalt therapy in light of clinical and theoretical insights from self psychology and intersubjectivity theory. These theories have stirred a great deal of controversy in the psycho­ analytic community, and many practitioners of these approaches believe that either one, or both, of the theories has revolutionized their

Author’s Note: I am indebted to Gordon Berger, Ph.D., Rich Hycner, Ph.D., Robert Stolorow, Ph.D., and Gary Yontef, Ph.D., for their thoughtful criticisms of an earlier draft of the paper on which this chapter is based. The existence of their names here does not imply agreement with my ideas. I am primarily responsible for the substance of the chapter. [R.H.: The original paper on which this chapter is based was entitled; “Insights from Psychoanalytic Self Psychology and Intersubjectivity Theory for Gestalt Therapists” (1992). Many editorial changes were made to the original manuscript including changing the title, adding subheadings, and changing a number of sentences in order to place this work within the context of this book. The major substantive changes had to do with highlighting the dialogic dimen­ sion, which had been embedded in the writing but not made sufficiently explicit. All changes were submitted to the author, and approved by her.] — 129 —

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approach to treatment. They challenge basic assumptions of psycho­ analysis, and through these challenges I believe they are moving psychoanalysis closer to humanism, and even to a dialogical perspec­ tive. Since Gestalt therapy was bom in part as a humanistic critique of psychoanalysis, insights from these theories offer a chance both to enrich Gestalt therapy’s current clinical theory, and to stretch its own original concepts by taking into account psychoanalytic perspectives that have emerged since the basic concepts of Gestalt therapy theory were articulated. Any new theory brings with it a new way of understanding clinical phenomena. Self psychology and intersubjectivity theory offer new clinical insights that any psychotherapeutic school might use. For instance, after a therapist understands the concept of selfobject func­ tions and selfobject relatedness, the therapist probably will view clinical material quite differently. I see self psychology and intersubjectivity theory influencing Gestalt therapy mainly in two areas: 1) They reinforce and enrich Gestalt therapy’s developmental perspective on psychopathology and therapy. 2) They enrich Gestalt therapy’s understanding of contacting — its phenomenology, its psychic function, and its vicissitudes — in the therapy process. Assimilating the newer psychoanalytic constructs may encourage a shift in emphases in Gestalt therapy, moving it to focus on some of the less developed aspects of its theory.

Similarities As both Kahn (1985) and Tobin (1990) have demonstrated, there are many basic similarities between self psychology and most humanistic therapies. The theorizing on “intersubjectivity” by Stolorow, Brandchaft, and Atwood (1987), which can be seen as an outgrowth of self psychology, has even greater compatibility. It is especially their thinking that I will be using in this chapter. Holistic view. The new psychoanalytic theories posit a holistic view of human nature. The holism is reflected in the centrality of “self structures” and “self-experience,” which brings it close to the Gestalt concept of organismic self-regulation. For Gestalt purposes self-structures can be translated as: “self-regulating capacities specifi­ — 130 —

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cally pertinent to self-experience.” When there are vivid, responsive differentiated sequential gestalten, self-structures (or processes) are operating intact. Experience-near. Self psychology and intersubjectivity theory focus quite radically on experience, both in theory building and in the process of psychotherapy. Intersubjectivity theory even proffers itself as a “psychoanalytic phenomenology,” because of its dedication to understanding both experience and the structures of experience. Both Kohut (the founder of self psychology) and Stolorow et al. (the intersubjectivists) posit that a theory of human experience must be built upon concepts that are in principle accessible to experience (Kohut, 1959; Atwood and Stolorow, 1984). They extract and separate out the clinical theory of psychoanalysis from classical metapsychology, in that the latter is inaccessible to experience. They endeavor to understand clinical phenomena not in terms of drives and mechanisms, but in terms of self-experience. The concepts of Gestalt therapy, such as gestalt formation, aware­ ness, contact, and organismic self-regulation are also “experiencenear.” While there is an important difference between self-experience and self-regulation — in that the former is an exclusively psychological concept — the important point of agreement among the theories is the renunciation of metapsychology (drives, etc.) which cannot be checked against experience. Drive metapsychology is replaced by a theory building that places primary emphasis on experience and the process (or structuring) of experience. Field theory compatibility. Intersubjectivity theory is especially compatible with field theory, as seen in the view of the nature of consciousness and unconsciousness. In intersubjectivity theory, experiencing emerges out of interactions within the intersubjective field, and behavior and experience can be understood only in the context of that field. Obviously, this perspective is compatible with Gestalt therapy’s view that experiencing emerges at the contact boundary of the organism/environment field, although the concept of the intersubjective field is more specifically psychological than Gestalt therapy’s. Similar to Gestalt therapy, Atwood and Stolorow (1989) point to the unconscious not as container of id impulses, but as a product of — 131 —

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interactions in the field. The boundary between what is conscious and what is unconscious is fluid, and is dependent on the context, specifi­ cally the conditions in the intersubjective field. These theories share with Gestalt therapy an emphasis on emotion and emotional develop­ ment as central to the development of self structures or the capacity for self-regulation. Also, they share with Gestalt therapy the view that resistances are not defenses and drives nor an attempt by the client to sabotage the therapy, but rather are an expression of self-protective­ ness or a self-striving, however disowned or unintegrated the expres­ sion. Process theories. Finally, all three are process theories. Gestalt therapy, self psychology, and intersubjectivity theory differ to some extent on what processes are important in therapy. For instance, the psychoanalytic theories focus on developmental processes pertinent to the development of self-structures, and the theory of therapy describes relational processes and their impact on the development of self­ structures (self-regulating capacities) in the patient. Gestalt therapy theory focuses on the here-and-now awareness processes, using such lenses as Gestalt formation and contacting to elucidate how the awareness process supports and refines self-regulating capacities.

Intersubjectivity Theory I will define and describe certain concepts from self psychology, and later critique them for their relevance and applicability to Gestalt therapy. Since I view intersubjectivity theory as an outgrowth of self psychology, the reader may assume the concepts I describe also are part of intersubjectivity theory. Where intersubjectivity theory differs from self psychology in ways relevant to the discussion (usually in ways that bring it even closer to a humanistic perspective), I make specific references to the ideas of intersubjectivity theory to distin­ guish it from self psychology. Stolorow et al. describe three essential contributions that self psychology makes to psychoanalysis: 1) the concepts of selfobject function and selfobject transference, 2) the unwavering application of the empathic-introspective mode of investigation as defining and delimiting the domain of psychoanalytic inquiry, 3) the primacy of — 132 —

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self-experience (1987, p. 15). I will examine each of these contribu­ tions for its potential to enrich the theory and practice of Gestalt therapy.

Selfobject Functions One of the field theoretical gems in self psychology is its concept of selfobject relatedness. Self structure is developed and maintained through “selfobject” ties to other people. The term “. . .selfobject refers to an object experienced subjectively as serving certain func­ tions. . .a dimension of experiencing an object in which a specific bond is required for maintaining, restoring, or consolidating the organization of self-experience ” (Stolorow et al., 1987, p. 16). Gold­ berg (1988) goes so far as to define self structure as certain resources and experiences of the subject, as well as the subject’s selfobject ties. A person serves a selfobject function for the subject to the degree that a particular type of tie to the person is experienced as helping the subject maintain a stable self structure. For instance, in the case of a typical narcissistic personality, we see someone whose self-coher­ ence is maintained only with the selfobject support of continuous mirroring of his or her grandiose sense of self. In everyday life, our sense of common purpose with colleagues or neighbors, or even the nation we live in, is a selfobject tie in that it reinforces our temporal stability and supports a positively toned sense of self-with-other. Kohut described three major selfobject needs that became apparent to him in the transference in therapy; mirror needs, idealizing needs, and twinship needs. We all need some people sometimes to “light up” over our presence, and to prize us, and reflect our pride and expan­ siveness (mirror needs). We need to draw strength and soothing and calm from feeling at one with someone we can idealize (idealizing needs). And we all need people with whom we can identify as like ourselves — to reaffirm that we are a human among humans, and welcome to be so (twinship needs). The intersubjective theorists suggest that most importantly, we develop firm, responsive, flexible self structure (or processes of self­ regulation) through identifying with, articulating and integrating our emotions, and that others serve selfobject needs to the extent that they — 133 —

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forge an empathic tie with us through which we are aided in the process of emotional integration. As Stolorow et al. state: “It is our contention that selfobject functions pertain fundamentally to the integration of affect into the organization of self-experience, and that the need for selfobject ties pertains most centrally to the need for attuned responsiveness to affect states in all stages of the life cycle” (1987, p. 66).

of one of the people and how the relationship impacts that person. This position is very similar to that of Gestalt therapy, and obviates the need to invoke the construct of transference. See how similar their view is to Gestalt therapy’s own:

Selfobject “Transference ” When patients establish selfobject ties to the therapist — that is, when their needs and longings for these specific relational experiences emerge in the therapy — a selfobject transference is said to exist. The notion of a selfobject transference may enrich Gestalt therapy in several ways. First, it delineates a psychological, subjectively based perspective on the interrelatedness of organism and environment. Whereas Buber claims there is no “I” without “It” or “Thou,” self psychology says self organization is contingent on at least a minimally responsive surround. The human person’s psychic organization is de­ pendent not only on the individual person, but also on the nature of his or her selfobject ties. Despite Gestalt therapists’ strong belief that people cannot be defined as isolated entities but only in terms of their interactions in the field, this belief so contradicts the American exaltation of the individual’s autonomy that in therapy, with Gestalt therapy’s emphasis on responsibility, we sometimes forget this. Self psychology is one more support for the idea of the inseparability of person and field, and provides intricate descriptions of the subjective experience of that relatedness, as well as descriptions of its psychic function in self organization. Selfobject “transference ” and contact. Secondly, self psychology describes dimensions of the therapy relationship that provide extreme­ ly useful guides for working with contact. The view of transference posited by intersubjectivity theory is a most radical renunciation of the classical psychoanalytic view; it moves boldly into the here-and-now. In fact, a reading of Stolorow et al., suggests that their view of therapy need not even include the word transference. It can be described as a process in which two people focus on the experiencing — 134 —

Transference, at the most general level of abstraction, is an in­ stance of organizing activity — the patient assimilates (Piaget, 1954) the analytic relationship into the thematic structures of his personal subjective world. The transference is actually a micro­ cosm of the patient’s total psychological life, and the analysis of the transference provides a focal point around which the patterns dominating his existence as a whole can be clarified, understood, and thereby transformed. From this perspective, transference is neither a regression to nor a displacement from the past, but rather as expression of the continuing influence of organizing principles and imagery that crystallized out of the patient’s early formative experiences. (Stolorow et al., 1987, p. 36)

Stolorow et al. emphasize the point that: “Transference and counter­ transference together form an intersubjective system of reciprocal mutual influence” (1987, p. 42). They assert, and Gestalt therapy strongly agrees, that the patient’s experience of the therapy relationship is influenced both by input from the therapist, and by the patient’s process of attributing meanings to the events in the therapy. The implications for treatment of under­ standing the therapy relationship as an “intersubjective system of reciprocal mutual influence" are not yet fully articulated in the evolving literature of intersubjectivity theory. In my opinion, this viewpoint will be moving closer still to the notions of I-Thou dia­ logue.

Affect Attunement and “Meeting ”

Intersubjectivity theory makes a strong case for reliable affect attune­ ment as the means whereby the affect integration necessary for self­ development occurs. Gestalt therapy believes another element of relatedness is central to self-development, and that is the interhuman

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meeting. In the meeting, attunement, while centrally important, is accompanied by the therapist’s “presence.” By presence, I mean that the therapist is willing to be open to a kind of contact in which the patient can touch the therapist’s subjective experience, both directly and indirectly. Quite often this occurs indirectly. But at crucial points in the therapy, for instance, in efforts to address serious disruptions in a selfobject “transference,” or at certain developmental thresholds, the patient may be intensely interested in, and require, access to the therapist’s experiencing. In my view, self-development proceeds not only through the selfobject experiences gained through systematic affect attunement, but through the experience of the attunement coming from a discernible, personal “other." While there is nothing in intersubjectivity theory that militates against certain experiences such as therapist self-disclo­ sure, this view is at present undeveloped, and the theory might be enriched by this aspect of Gestalt therapy. Below is a case example that demonstrates the mutual exploration of the “lack of fit” between discrepant perceptions of a shared event. The following example points to a developmental process fostered by the patient’s reaction to the therapist’s self-disclosure. Exploration of our different experiences, coupled with attunement to the meaning of the difference for the patient, strengthened the selfobject tie. To me, it illustrates how when a dialogical stance is sensitively pursued, it can illuminate selfobject needs. Benjamin first came to me for supervision. At the end of the first session he requested that we meet for fifty minutes instead of my usual forty-five minute sessions. I regret to admit I acceded to his request without further exploration. I did have a sense that the request was very important for him. As I was seeing him just before my lunch break anyway, I told him I would agree to trying out fifty minute sessions as an experiment. (As time has gone by, I have come to see this event as a “symbolic enactment,” a concept taken from self psychology. Benjamin needed some concrete example of the fact that his wishes had a place in our relationship, and he would probably not have stayed in consultation without being able to establish that fact initially.)

Benjamin soon, but with great trepidation, decided he wanted to change our contract from supervision to therapy. After a few months my schedule changed such that I did not want to meet for fifty-minute sessions any more. When I raised the issue with him he became enraged and accused me of being unfair, exploitive, etc. He said he would leave therapy rather than be treated this way. In the next session I was able to communicate to him my understanding of the significance of the issue to him. He lived in dread of being ruthlessly exploited by others who saw his needs not as expressions of his selfhood, but merely as obstacles that must be pushed aside. The five minute difference in sessions was a symbol to him that he would not be so exploited by me. Benjamin readily agreed with the above formulation — actually it was something we arrived at through mutual exploration — and acknowledged that the five minutes was a symbol, and was actually unimportant as far as his experience during the sessions went. But he did insist that “understanding” the meanings did not obviate his need for the fifty-minute sessions. I told him that the symbol and the needs it expressed were clear enough to me that I was willing to keep the sessions fifty minutes. After some reflection he suggested that we alternate, fifty minutes one session, forty-five minutes the next. He again said the time actually meant nothing, but the symbol was that if I could be trusted to take his needs into account, then he did not need to be so uncompromising in his self-protectiveness. In a much later session, he was exploring issues related to the fifty­ minute session, as he has done often. He was describing himself as a fair-minded person, and that he saw me as also fair-minded. He thought the agreement between us was a fair agreement. I told him that although I knew the agreement was important to him, I could not agree that the agreement was fair, in that I did not experience it as fair to me, despite his efforts to make it so. He was surprised by this, and asked me for my point of view, which I gave him. This included the fact that I made the agreement out of concern for his fears and his need for a concrete symbol that his fears and wishes would be taken seriously. He had assumed all along I was acting out of a “quid pro quo” sense of fairness. He was moved to discover that I might really

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do something out of concern for his needs. This led to more direct awareness of his strong desires to let down his guard and rely on me. As previously shown, both Gestalt therapists and the intersub­ jectivists would agree that the subjective world of the therapist is influencing the subjective world of the patient. The patient and I can explore together his views of the event, and his awareness of my views, and how that awareness influences him/her also. In Benjamin’s case, it did appear to deepen a selfobject dimension of our relation­ ship, although that was not necessarily my aim in speaking up. From a Gestalt therapy point of view, this exchange enriched our contact, and also increased the patient’s self-support for, and interest in, further deepening his contact with me. Thus, a developmental process was fostered. The repetitive dimension. Intersubjectivity theory offers other ideas regarding the therapy relationship that I have found quite useful. Stolorow et al. suggest that the relationship (transference) has two dimensions: the repetitive dimension and the selfobject dimension. In the repetitive dimension we meet the “character defenses” with which we are all familiar. Now they can be understood as selfprotective defenses brought to bear when something is occurring in the relationship that leads to a “dread to repeat" — a dread that the thera­ pist will hurt the patient in the same ways the patient has been hurt in the past when he or she has dared to reveal vulnerable aspects of him or herself to others. Once again, we can see here how the defense is conceptualized as a protection against injury while the individual pursues his/her development — not as a defense against a drive. As in Gestalt therapy, self psychology believes such a dread to repeat is triggered by an actual interpersonal event in the therapy. It may seem insignificant to the therapist, but the meanings that the patient gives it make it significant. The selfobject dimension. In the selfobject dimension, a selfobject tie has been established and is said to be working silently in the background to provide the support for self-exploration; or, the selfob­ ject dimension is in the foreground when the need to reestablish the tie emerges as the consequence of a rupture in the previously estab­ lished tie. At such a time, attention is paid not only to the reestablish­ ment of the tie, but to the function of the tie.

A.t times of rupture, the meaning of the tie to the patient’s self­ organization becomes apparent as the patient struggles with issues in two major areas, those of self-consolidation and self-differentiation. If the therapist can successfully tune into his or her impact on the patient, and help the patient understand, accept, and clarify the trigger, the selfobject failure that occurred, and possibly the developmental (or “fce-ing”) striving that is being expressed, the selfobject tie can be reestablished. The therapist, through such empathic attunement, provides a facilitative milieu for the development of more sophisticat­ ed self structures. This growing sophistication includes a maturation of the selfobject dimension of relatedness. In my opinion, the intact selfobject tie can also be a foreground phenomenon, and explorations similar to that done to repair disrup­ tions can also occur. It is a phenomenon that is perhaps more readily noticed and addressed in a dialogically based therapy. Stolorow (personal communication, October, 1990) agrees that though it is not spelled out in intersubjectivity literature, intact selfobject relatedness may become figural. An obvious example of an intact selfobject tie being in the foreground is when a patient feels grateful for an experi­ ence that leads to increased safety in revealing potentially shameful details of his or her life. The selfobject dimension clarifies for therapists the self-regulating use of people — including the therapist. In Gestalt therapy, when we see symptoms of a breakdown in the patient’s self-support for contacting, we can use the notion of selfobject transference to try to understand not only how the contact­ ing process has been ruptured, but what its meaning might be to the patient.

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"Meeting” the Other

There is, in fact, a third dimension of the therapy relationship, besides the repetitive dimension and the self-object dimension, and one that grounds them both — “meeting the other.” The selfobject dimension and the dialogic dimension are interconnected: Both are present in every contact episode. Stem’s review and analysis of infant research (1985) confirms the Gestalt therapy position that contacting is extant from birth. He — 139 —

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confirms that some degree of boundary discrimination, which is the ground of contact, occurs even in newborns. But his work, and the notion of selfobject relatedness, requires that Gestalt therapists refine their understanding of contacting. Gestalt therapists tend to emphasize awareness of boundary discriminations (“appreciation of difference”) when describing contacting. While there can be no “other” — no contact without such difference — often the foreground awareness of differences derails the forming contact episode. Sometimes the differences must be a background on which exquisite and necessary experiences of unity or oneness stand. It can be said that the confirmation that occurs in an I-Thou dialogue is an expression of the twinship aspect of selfobject related­ ness. In fact, I think self psychology underestimates the importance of mature twinship relatedness in its theorizing. Much more attention is paid to mirroring and idealizing as specific forms of selfobject tie than to twinship. When a person is confirmed as a human among humans, this is a mature form of twinship. Mirroring is also vital to the I-Thou dialogue. However, mirroring is an incomplete term to describe the bold immersion in the experi­ ence of the other that occurs in dialogue. Generally, the idealization selfobject need is not honored directly in dialogue. If you accept the thesis that for some people there is such a developmental need, then you might be influenced to be more careful about insisting, in the dialogue, that patients see you in “realistic” proportions. Rather you will allow their picture of you to develop more complexity and “human size” over time. Clearly, this is an area that needs further exploration. Multiple dimensions of relatedness. I am suggesting that in a healthy contacting process multiple dimensions of relatedness operate simultaneously. The notion of multiple dimensions of relatedness is not incompatible with the new psychoanalytic theories (Stolorow, 1986) but their focus has been more on articulating the selfobject dimension. Thus other dimensions of the contact process remain unexamined. Certainly the selfobject dimension is present in contacting, and while it may be necessary to prevent dissolution of self-functioning, the more complete realization of personhood is a by-product of the

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“dialogic encounter,” - more clearly an affirming meeting between two confirming others. The ground for such a meeting may be the selfobject dimension, but the selfobject dimension cannot take into account the between, that which cannot be controlled or brought about by either party alone, or because one’s selfobject needs are met. The between of which Buber writes is only possible when people not only wish to be confirmed, but when they reach to “meet,” and in so doing confirm, the other. In the therapeutic relationship, I believe that at times the patient’s interest in the subjectivity of the therapist is just such an attempt.

The Empathic-Introspective Stance The second essential contribution of self psychology to psychoanalysis that has much potential to enrich Gestalt therapy is the introduction of the empathic-introspective mode of listening. The empathic-introspec­ tive mode “. . .refers to the attempt to understand a person’s expres­ sions from a perspective within, rather than outside, that person’s own subjective frame of reference” (Stolorow et al., 1987, p. 15). By now, many clinicians have been influenced by Kohut’s approach of working with narcissistic patients as well as other diagnostic styles of patients. With narcissistic patients, the therapist attends to their subjective world quite consistently, leaving “reality testing” and other interven­ tions that will insult them with awareness of the therapist’s separate initiative lying fallow for a very long time. The therapist does not rebel against the establishment of those intense selfobject transferences that wreak havoc with his/her own narcissistic needs. Clinical experience has proven time and again the value of entering the therapeutic dialogue through being immersed in the patient’s experience, and then communicating, both verbally and nonverbally, this understanding of the patient’s experience. Carl Rogers believed this process was the essence of therapy, and has described in fine detail the psychological processes by which it works, and why it is so necessary. For Martin Buber, this aspect of engagement was called “making present,” or “inclusion.” When a person is made present by another person, this involves imagining as fully as possible this per­ son’s subjective world, with no judgment or attempt to influence it. — 141 —

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Self psychology has reminded therapists of the value of imagining the reality of the patient as fully as possible. Intersubjectivity theory goes a dramatic step further, by insisting that the dialogue is occurring between two people, both of whom, as participating subjects, have their unique way of perceiving the world and the therapeutic dialogue, with neither having a more direct claim to objective truth than the other. Such relativism reminds us to curb our tendency toward “moral therapy.” Moral therapy holds that patients have unrealistic goals and wishes, and need to be aided to relinquish their immaturity in favor of mature understanding of the unrealistic nature of their wishes. Existentially based therapists, such as Gestalt therapists, are prone to the error of moralism when they fall into aiming at authenticity and responsibility as righteous values. From the point of view of mutual dialogue where the subjective knowledge of each is equally valued (since there is no truly objective knowledge), no wish is irresponsible — it is an existent. The meaning of the wish can be explored to illuminate the patient’s organization of his or her self-experience. Often, a selfobject need is being expressed, that is, a need for a specific kind of relating that would foster self-cohesion or self­ development. When this process of discovery, repeated time and again over the course of therapy, takes place through “making pres­ ent,” or entering the subjective world of the patient as fully as pos­ sible, two major things happen. First, the experience of seeing the event through the patient’s eyes diminishes the therapist’s likelihood of forming value judgments. Second, the patient’s experience of being made present, or the patient’s experience of having another person’s empathically attuned immersion in his/her subjective world, enables the patient incrementally to build the emotional skills necessary for the self-regulating that Gestalt therapists would describe as authentic and responsible. This approach is entirely consistent with major tenets of Gestalt therapy. It is in keeping with the paradoxical theory of change which says that by identifying with the individual’s current existence, growth and change occur. Also, Gestalt therapy’s belief in self-regulation suggests that if the therapist allows the most immediate need to emerge, then the patients can move to get the need met: And when they find it cannot be met, they can close the Gestalt by mourning the — 142 —

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loss, if they are in the facilitative environment of contact with an accepting and attuned therapist. Thus the three concepts of the paradoxical theory of change, organismic self-regulation, and unfin­ ished gestalten can be used to support a psychotherapeutic approach that views selfobject needs as central to self development, as self psychology does, and I think Gestalt therapy should. Theory construction and the empathic-introspective stance A second interesting aspect of the empathic-introspective mode is its relevance for theory construction. Among those who have been influenced by Kohut, there is currently debate over whether the domain of psychoanalytic knowledge should be limited to that which is in principle accessible in subjective experience. Stolorow et al. propose such a limitation, whereas Wolf, Shane and Shane, and Basch among others do not want to be so limited. Wolf’s perspective is probably closer to Gestalt therapy’s. He proposes an oscillation between “extrospective and introspective” methods, looking sometimes from within the patient’s frame of reference, and sometimes from outside the patient’s frame of reference (Stolorow et al., 1987, p. 5). I am not comfortable with the term extrospective and prefer instead to say that we gather data through the empathic-introspective method applied to both the therapist and the patient. Gestalt therapy concepts are experience-near. That is, they are accessible to study through introspection and empathy (or the aware­ ness process). For Gestalt therapists, the question of whether to use an experience-near perspective for theory building has long been answered in the affirmative. But the corollary to that debate is whether Gestalt therapy’s concepts have greater clinical utility when elucidated from the perspective of an experiencing subject, or from an outside perspective. Gestalt therapy has always defined itself as an experiential therapy. One of Peris’s major critiques of psychoanalytic theory was that the psychoanalytic theory of his day reduced the experience of the patient to the status of an epiphenomenon. For Peris, experience and experi­ encing should be the cornerstone of any theory of therapy and person­ ality. But Peris followed Freud in attempting to articulate a theory that would be acceptable as a natural science. By shaping the method ----- 143 —

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From a natural science perspective, external observable behaviors, such as interactions with others, are studied. From a human sciences perspective, the meanings to the experiencing subject are explored. In the human sciences, both subjects become intimately involved in the attempt to understand one subject from the perspective of his or her experience. This necessarily involves the experiencing of the other subject, for instance, using empathy to enter the patient’s experiential world. Buber’s thinking parallels that of Dilthey’s. The mode of relatedness in the natural sciences is the I-It mode of subject-to-object. The mode of relatedness in the human sciences is the I-Thou mode of subject-to-subject. Gestalt therapy: a natural science or a human science ? Gestalt therapy has its feet in both camps. While its philosophical base is Martin Buber’s philosophy of dialogue (its emphasis on inclusion compatible with the human sciences perspective), Peris et al. take as

their starting point not experience per se, but the “contact boundary ” Certainly the contact boundary fits the definition of experience-near in that it is accessible to awareness. All experience occurs at the contact boundary, the meeting point of self and nonself. But there is a major difference between studying events at the contact boundary from the vantage point of the observer, and studying the experiences of the contact boundary from the perspective of the experiencing subject. In fact, what one is in contact with changes based on one’s observational stance; therefore the observed contact boundary is a different contact boundary from that of the experiencing subject. When Peris et al. state that “psychology is the study of events at the contact boundary” (1951), they are taking a natural science stance, rather than saying that psychology is the study of experience, which is the human science perspective. Psychology does have many facets, and much of academic psychology is natural science. But I think a therapeutic psychology that puts experiencing at the center of its clinical theory — as Gestalt therapy does with its theory of awareness as the key to self-regulation — must necessarily take more of a human science perspective if it is to fulfill its potential to illuminate the na­ ture of experiencing. Dialogue as the method of psychotherapy. Sciences are defined in part by their method of study. Psychotherapeutic method needs to be dialogical. The task is for the two participants to illuminate and clarify the experiencing of the patient. All experiences that emerge are influenced by the experiential worlds of both participants. This becomes increasingly true as the relationship intensifies. As we know well from Gestalt psychology, experience is always organized in meaningful wholes. The therapist’s world of meanings is constructed, just as the patient’s is. A natural science observational stance is im­ possible to maintain, given the intimate interactions of the therapist and patient. In line with a human science perspective, Gestalt therapy has explicitly adopted existential values. Martin Buber’s philosophy, with its emphasis on inclusion and the I-Thou relation, has been adopted (in theory though not always in practice) not only as an embodiment of existential values, but especially as a guide to the nature of the therapeutic relationship. Gestalt therapy went outside of psychology

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of investigation toward “scientific” observation rather than introspec­ tion, he restricted his ability to carry the implications of his belief in the centrality of experience to its fullest development in Gestalt therapy theory. The natural sciences and the human sciences. Natural science studies the observable properties and behaviors of objects, whereas the human sciences focus on subjective and intersubjective experience. The notion of human sciences was first introduced and defined by German philosopher Dilthey:

According to Dilthey, the human sciences are to be distin­ guished from the sciences of nature because of their fundamen­ tal difference in attitude toward their respective objects of investigation: The natural sciences investigate objects from the outside whereas the human sciences rely on a perspective from the inside. The supreme category of the human sciences is that of meaning, which is something that exists within human subjectivity rather than on the plane of material nature. The central emphasis in the natural sciences, as Dilthey viewed them, was upon causal explanation; the task of inquiry in the human sciences, by contrast, he saw as interpretation and understanding. (Atwood and Stolorow, 1984, p. 2)

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to philosophy because of the limitations of psychological theories of the day. There was no clinical theory of the therapeutic relationship that recognized its primacy as 1) the irreducible unit of personal existence, and 2) the ground of self-development. But philosophy has certain limitations for a theory of therapy. Philosophies are inherently moralistic, and in their search for univer­ sals, tend to be experience-distant in their formulations. Buber has very few experience-distant concepts — the “between” is one — but his moralism is clear throughout his writings. Note, for example, his credo that without a Thou, a person is not fully human. For another example, we recall his insistence that the therapist at some point meet the patient with the “address of the world.” These statements have ontic significance, but when transported unmodified into a therapeutic stance they become exhortations for a patient to “be a certain way.” Moralism impedes psychotherapy by attempting to shape experience or behavior along predetermined pathways, thereby interrupting the unfolding of the experience of the patient. Stolorow et al.’s theory of intersubjectivity posits a more purely psychological theory of the therapeutic relationship and its primacy in existence and development. The intersubjectivity theory can inform us more thoroughly of the psychological implications of Gestalt therapy’s model of the I-Thou relation. There is great clinical value in developing a purely psychological description of what Buber describes philosophically.

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At first I objected to developing a psychological perspective based on I-Thou dialogue as reductionistic. The reduction of ontology to psychology violated the meaningfulness given in the ontology. I now believe that a psychological (as contrasted with a philosophical) understanding of the process that Buber describes does not “reduce” Buber’s philosophy, but views the experiences of the events through a different lens. A psychological description should illuminate the IThou relation not in its ontological significance (a philosophical construct), but the manner in which such a relationship is experienced.

From the vantage point of a clinical approach defined method­ ologically by dialogue between two people, all that can be known is the experiencing of the two participants. Buber’s domain of investiga­ tion was the same. But he was interested in extrapolating from experience to some ideas about what it means to be human. For psychotherapy, whose domain is the experiencing pair, and whose aim is the illumination of experiencing, the extrapolation that Buber made while inspiring, guiding, and hopefully accurate, must be seen from the perspective of a psychotherapeutic phenomenology, as a reification of an experience holding neither truth nor falseness. From a psycho­ logical perspective, ontological truths exist as a particular organization of an individual’s subjective world, not as fact. The most we can know from a psychotherapeutic phenomenology is that this is the way someone ascribes meaning to his or her existence. Whether we refer to concepts derived from Buber’s philosophy, academic Gestalt psychology, or psychoanalysis, I believe that Gestalt therapy theory can be greatly enriched by a dedication to describing its concepts from a “within-subject” perspective. I think such theory development would be truer to Gestalt therapy’s roots as a phenomen­ ologically based experiential theory. The explanatory power of such concepts as the contact boundary will be greatly enhanced by more systematic attempts to elaborate them from the inclusive stance described above. I also think Gestalt therapists will become more precise as we attend to the differences between using an observational stance from outside the subject’s perspective, and one from within the subject’s perspective. For instance, we often use observational data, as well as introspective data, to assess the quality of the patient’s contacting. Take, for example, attention to a patient’s contact functions. I have repeatedly witnessed our most skillful and experienced therapists assume that the quality of a patient’s contact is poor because the therapist observes certain characteristics of the patient’s behavior (e.g. “deflection”), or because the therapist feels little resonant energy, interest, and so forth. Therapists tend to assume that if they feel out of touch with the patient, then logically the contact between therapist and patient has been disrupted. That assumption has moved the therapist from the

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Dialogue, and the Relationship as Experienced

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position of experiencing subject to outside observer. The potential danger of intervening from that perspective, no matter how logical it may seem, is that the therapist becomes the arbiter of reality, and will tend to disclaim patient reports that contradict what the therapist “knows” to be “true,” based on theoretical and logical beliefs about contact. For instance, suppose the therapist says, “Gee, I feel out of touch with you now.” And the patient responds, “I am surprised. I have a strong feeling of intimate connection with you right now, a sense of your deep involvement with me and what I am saying.” Therapists who hew to the logical reality that the contact must be poor between them if one of them is out of touch, will also logically assume now that the patient is distorting or denying reality. This has at least two deleterious effects on the therapy. First, the patient’s reported perceptual experience is invalidated. After several such experiences the patient is very likely to comply with the thera­ pist’s ideas rather than suffer the indignity, hurt, or other painful affects evoked in the face of repeated disconfirmations. Alternatively, the therapy may become stalemated by the chronic disjunction between the therapist’s beliefs about reality, and the patient’s insis­ tence that his or her experience be taken as valid. A second deleterious effect is that an opportunity to explore the patient’s experience of the relationship is missed. The patient may be able to describe certain assumptions he or she is making about the therapist’s listening stance that could reveal both certain fixed gestalten and the type of contacting experience that provides the patient a felt sense of intimacy with another. The mutual exploration of the lack of fit between the experiences of patient and therapist might also lead to shifts in the therapist’s awareness. The therapist might discover that he or she was unaware of having been deeply immersed in the patient’s words despite the more figural self-perception of being out of touch. Such a discovery will not be possible if the therapist approaches the exploration from the point of view that the patient’s reported experience of contact is mistaken. This last point is important for Gestalt therapists, who value some degree of transparency as vital for the patient’s growth. A common assumption Gestaltists make is that if the patient perceives (or experi­ — 148 —

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ences) something in relation to the therapist that is discrepant from the therapist’s self-experience, than the patient must be distorting. Therapists again become arbiters of reality. In this case the therapist insists that she or he knows better than the patient does, which may not be true. The patient may be resonating with or reacting to something within the therapist which operates outside the therapist’s awareness. Statements a therapist makes about her or himself, and agreements or disagreements with a patient’s assessment of the therapist, must be made as tentative statements of what the therapist knows to date, and cannot be used to gauge the accuracy of the patient’s perceptions. Finally, there is a heuristic value to a more systematic immersion in the patient’s experience, namely, that in my clinical experience, the patient is increasingly able to bring into awareness, and into the contact, more realms of previously disowned or otherwise sequestered self-experience. I have found that, in the context of a relationship where I systematically attune to the patient’s experience, patients feel safer with me to explore sensitive topics, especially their painful emotional reactions to aspects of our therapy relationship. The more realms of experience patients can bring into the therapy relationship, the more resilient, cohesive and integrated their selfregulatory capacities become — including, paradoxically, the willing­ ness and ability to acknowledge the existence of a consensually determined reality. The two major foci of Gestalt therapy are thus more fully developed: Contacting, and skillfulness with the awareness process. The contacting is evident in the decrease in defensiveness, and the increase in range of topics and affects that emerge. The skill with awareness is evidenced in an obvious increase of interest in, and capacity for, self-reflection. I believe we need to rework Gestalt therapy’s concepts to describe the experiencing subject rather than describe “observable reality.” In the case of “contact,” contacting would not be assessed by looking at patient-therapist behaviors, but the determiner of the quality of contacting would be the experience of the interaction for each of the participants. This might mean that each participant would legitimately rate a shared interpersonal event quite differently. — 149 —

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“Developmental Deficits” versus “Conflicts and Defenses” A corollary to the emphasis on the empathic-introspective stance is greater attention to developmental requisites. It appears that attempt­ ing to understand phenomena from the point of view of an experienc­ ing subject, rather than from the point of view of an observer, leads to a focus more on what one needs from the environment to sustain or develop, and less on what one is trying to “do to” another. In my view most of the field of psychotherapy is shifting from a conflict and defense model of psychopathology to a developmental model. In many schools of therapy, the conflict and defense model holds sway, as a remnant of drive theory. In the conflict and defense model, disorder arises from conflicts between impulses, or between an impulse and the reality principle of the ego, and the resultant defenses against these conflicts. People are seen as wishing to retain infantile impulses, giving them up only reluctantly to conform with the de­ mands of reality. In the developmental model, disorder arises when there is a poor fit between the needs of the developing person and the resources and capabilities of the environment, resulting in develop­ mental derailments; a developmental process, e.g., the establishment of contact boundaries, has been thwarted. Gestalt therapy has its feet in both camps again, largely without awareness. The influences of Frederick Peris and Wilhelm Reich led Gestalt therapists to view neurotic processes as avoidances, which is in keeping with the conflict and defense point of view. I am reminded of Peris’s statement — thankfully honored more in the breach than in practice — that “The therapist’s primary responsibility is not to let go unchallenged any statement or behavior which is not representative of the self, which is evidence of the patient’s lack of self-responsibility” (1973, p. 79). Actually, Peris’s last book is quite interesting in that much of the material focuses on developmental requisites of self­ regulation, and the respectful acceptance of needs which express one’s growthful strivings. While on the one hand this book contains some of his boldest language of confrontation and attention to “manipula­ tion,” on the other hand the chapter, “Who is Listening?” is a touch­

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ing, loving portrayal of the therapist as a “supplemental other,” which dovetails nicely with the selfobject concept. I think Gestalt therapy’s view of personality development and personality functioning makes it much more a developmental theory than a conflict and defense theory. Its humanistic belief in strivings toward growth is the opposite of the conflict and defense belief that people want to avoid maturity if at all possible, and must be encour­ aged to give up infantile longings. There is such a thing as conflict, but I think we will be truer to Gestalt therapy’s theory to view conflict as a subjective experience which is either acknowledged or denied. This is what the intersubjectivists propose. Given Gestalt’s avowed adherence to the phenomenological method, I think their idea fits well for it also.

Implications for Gestalt Therapy

What is the implication of all of the above for the practice of Gestalt therapy? In my own practice, my foreground has shifted. Where once I saw defenses and avoidances, I now usually see developmental strivings, however awkwardly or conflictually pursued. If I look at the same behavior from the two different perspectives, I arrive at two differing intervention styles as well. The defense model permits, perhaps encourages, confrontation. From the perspective of develop­ mental strivings, confrontation is generally less appealing. There are exceptions. There are times when confrontation enables patients to become aware of, and honor, their selfobject needs. There are also times when a confrontation is experienced as meeting a selfobject need (see especially Lachmann, 1986), as in the case of Benjamin I described earlier. However, confrontation generally tends to be experienced as a lack of empathic attunement, and that is the experience that tends to lead patients to abort their strivings. Thus, I am applying new meanings or hypotheses to what I see, and I am much more likely to lead with an attempt to see the experience through the eyes of the patient rather than to be confrontive. — 151 —

__ the healing relationship in gestalt therapy ---Let me describe a case where I was at first confrontive, and now regret it. By the way, I am not suggesting that adherence to Gestalt therapy led me to handle the situation as poorly as I did. Rather, I am saying that however I came to make my mistake (actually there were characterologic sensitivities that influenced me) self psychology helped me to understand better some of Gestalt therapy's own concepts so that I could reorient my work with this patient. Pam is a good story teller, interesting and articulate. For many months she wanted to tell stories of events in her life, large and small, and obtain my help in teaching her “how to cope.” As time went on I began to assume that her stories were an avoidance of deepening emotional contact with me, and with her own experience. In fact, she does carefully titrate her involvement with me. At times I asked her to explore her storytelling, and at times I confronted her on her avoidance. At one point I asked her to experiment with telling no stories. She felt quite hurt and angry at the suggestion. Three years later, despite progress in other areas, she alternately is defiant and apologet­ ic about telling stories, and worries that I will reject her again. Recently, I began to see the stories from the point of view of develop­ mental strivings. In one session, we explored how she seemed to organize her psychic life around her relationship with her quite domineering father. Influenced by the notion of selfobject ties, I began to see Pam’s confluence with her father as an attempt on her part to regulate her sense of self-coherence. Without him to organize around, she felt lost, confused, empty. In that same session, she com­ plained that organizing herself around her father left her feeling invisible in her own right. It then emerged that her stories were an attempt to say, “see, I exist,” to claim some experiential space free from interference. In the next session she described how much she was a satellite to her father; when he wanted the TV channel changed, he would call to her. She would come from whatever comer of the house she was in, and change the channel. She experienced this as humiliating. Pam then remembered going into the kitchen to “hang

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out” with her mother, which was soothing. She then said it was similar to the soothing she felt in telling stories to me! Now she is beginning, very gingerly, to deepen the contact with me through acknowledging her desires for my soothing support and my apprecia­ tion of her existence. I hope I have illustrated here how her self-understanding — and hopefully, her self-development — was enriched as I shifted from confronting the avoidance to exploring the developmental need that was being expressed. The above description is just one example of the usefulness of placing empathy (or Buber’s term, “inclusion”) at the center of Gestalt therapy’s approach to therapy. It is the cornerstone on which the other elements of dialogue — therapist’s presence, and commitment to dialogue — stand. Without empathic underpinnings, no true dialogue can take place.

Primacy of Self-Experience The third major contribution of self psychology to psychoanalysis is the “central emphasis on the primacy of self-experience.” By focusing on self-experience, the new psychoanalytic theories shift away from drive theory toward a “whole person” theory, and highlight subjective experience and the organization of the subjective experience as the primary domain of psychoanalytic inquiry. Obviously, Gestalt therapy made those shifts long ago with its assertion of the centrality of organismic self-regulation, and the awareness process as the key to healthy self-regulating. The term self-experience is commonly misinterpreted to refer to a monadic, isolated “self.” But for self psychology and intersubjectivity theory, self-experience is always a self-with-other experience, most particularly that of selfobject relatedness. Immersion in a patient’s self-experiencing includes a constant articulation of their selfobject needs and experiences. Obviously, a consistent focus on relational needs is closely aligned with the Gestalt therapy emphasis on contacting as central to self­ regulation. But there are differences in emphasis between Gestalt therapy and the psychoanalytic theories. For instance, in attempting

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to understand the emergent experiencing of a patient, a Gestalt therapist might try to identify what in the dialogic field influences the emergence of this particular figure. The added emphasis from self psychology is to define also what is needed from the therapist in order to carry the forming figure forward. The self psychological therapist might define what is needed, attune to the related affect state, and attempt to explore further the relational implications of the (selfobject) need. A Gestalt therapist might, in the same circumstance, view what is needed from the therapist as an indication of a lack of the patient’s self-support, and encourage the patient to experiment with ways to provide for him/herself that which he/she is seeking from the therapist. Self psychology offers in this case a more radical commitment to the inseparability of person/environment than Gestalt therapy does! It is in a corollary of the assertion of the centrality of self-experi­ ence that Gestalt therapy and self psychology part ways most strongly. This is a difference in Gestalt therapy’s view of human motivation. Both theories agree that self-development and maintenance are inextricably intertwined with others. Self psychology holds that a supraordinate motivation of human behavior is the development, consolidation, and maintenance of self structure. In Gestalt therapy, the notion of “creative adjustment” speaks to that motivation, but I think more fully than does self psychology — for there is more than maintenance and consolidation involved, there is growth and change as well. I know that is implied in “development and consolidation,” but it is not really addressed in self psychology: In the self psycholo­ gy conceptualization, people become reduced to aiming at themselves (i.e., maintaining the organization of their self experience). Gestalt therapy holds that organismic self-regulation is central, agrees that self-experience is primary (the experience of self-cohesion, continuity, differentiation, etc.), but that the individual is motivated toward maintaining self structure only when the smooth functioning of the self structure is threatened. Otherwise, the thrust of her or his experiencing is toward “being,” that is, living fully in the world of others. In Gestalt therapy, when the motivation of behavior is aimed at firming up self structure, that is a sign of disturbance in one’s being­ in-relationship. Gestalt therapy, based as it is on field theory, and also

Given the critiques listed above, I want to emphasize a major contri­ bution self psychology can make to Gestalt therapy. It broadens Gestalt therapy’s understanding of organismic self-regulation, and provides a developmental process perspective. Selfobject transferences can be articulated by focusing on the need clarification phase of gestalt formation. Therapist and patient can clarify what the patient needs now, in this particular contact, in this particular intersubjective field, for reparative or growthful self-functioning. Contact means “approach toward an assimilable novelty” (Peris et al., 1951). The assimilable novelty — that which is necessary for development — is at the boundary of self and other. Sometimes simply being able to

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on Buber’s existentialism, holds that relatedness is a basic irreducible fact of existence. People do not seek relatedness to maintain a self structure, but rather, self-realization is an occurrence of relatedness. It is true that relational disturbances do devitalize and disrupt self­ functioning — and the path to restoring cohesive self-functioning is the establishment of selfobject ties that firm up the individual’s self structure. But the purpose of restoring self-functioning is to enable resumption of living-in-relation. In therapy there is a necessary focus on the disturbances in a selfobject matrix as a major aspect of derailed development. Therefore, understanding and refinement of selfobject ties is a starting point for reestablishment of relatedness. It is not the end in itself, but rather a means toward multidimensioned, complex, full-bodied relatedness. Selfobject relatedness may be needed all through life, but so are relations where one can “make present” and confirm another. The dimension of “meeting the other” is neglected in self psychology and intersubjectivity theory to date. Self psychologists agree that self­ development is intertwined with relations with others. But their psychology aims at the organization of self-experience rather than at living-in-relation. When one aims at the self, the other is missed in his or her elemental “otherness,” and therefore self-development is limited.

Organismic Self-Regulation: A Developmental Process Perspective

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articulate a need and have it empathically grasped is new enough contact. Even if what a patient needs is more se/f-support for some action, the therapist must ask what is needed from the environment, or from relatedness with another, for such self-support to develop or be utilized. Self-support is, at any rate, relatively dependent on envi­ ronmental support; we are always engaged in a contacting process, so it is paradoxical that in a smoothly supportive environmental surround, a person may believe that she or he is a relatively independent center of initiative. Developmental derailments. A developmental perspective suggests that instead of viewing all boundary disturbances as defenses, they often represent developmental derailments. That is, the disruption we see is an attempt to establish a selfobject tie, in however awkward a manner, through which the developmental path of the patient can be reestablished. Thus, instead of setting about to frustrate such an attempt, understanding the attempt and accepting its experiential validity may be providing just the contact (selfobject milieu) needed to set growth in motion once again, so that the disturbance will melt away as greater sophistication with one’s boundary process occurs. I have come to believe that a most effective way of working with boundary disturbances is not to label and explore the boundary disturbance itself, but instead to immerse myself in the patient’s view of things which led to what I perceive as a boundary disturbance. If I can understand and appreciate the need being expressed (often a selfobject need), the patient will firm up clearer boundaries as a next developmental step. It appears that the process of establishing the boundaries has been derailed by a lack of awareness of a need, or by a lack of entitlement to the expression of the need. When the need is affirmed (although not necessarily met), the process of growth, including boundary development, continues. Following is an example: In a supervision session, Carol reported she was angry that I had not been well “tuned in” to her during our previous session, had not read between the lines and responded to the vulnerability under her cool mask. We talked about her pain of wanting me to be able, will­ ing, to read between the lines, and of my failure to do so. She then told of how she did that successfully with a client. At first, she denied she was sending a message to me in that, but then acknowl­ — 156 —

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edged thinking I should read between lines, and perhaps I did not care about her if I didn’t. I could have focused on clarifying boundaries. She wanted me to know she is vulnerable without direct contact with her vulnerability I decided first to acknowledge, through empathic listening, the importance of her desire, and the cost of my failure to her. This brought out ideas of my lack of caring and a sense of self-diminishment. In the next phase she began to mention her growing realization that she does not (has not wanted to) know me. Thus she was able to clarify our distinctness when well attuned by me regarding her prior unfulfilled wish for attunement. She “grew into” a clearer boundary process. I believe we should emphasize more such concepts as organismic self-regulation and pragnanz, which suggests that any gestalt is organized as best as field conditions allow. One of the field condi­ tions is developmental needs. A developmental need in longitudinal terms can be described in process terms as a gestalt pressing for closure. If the need expressed in the gestalt can be identified and accepted, the gestalt will close, and if the therapist has faith in organ­ ismic self-regulation, development occurs. Focusing more consistently on developmental needs is a movement away from the Reichian defense model of which Frederick Peris was so fond. In that defense model boundary disturbances are seen as an avoidance, and are to be frustrated. In the developmental model they are seen as best attempts at forward progress. Each view is useful at different times, or with different patients, and self psychology gives us greater sophistication with the developmental processes.

Summary Self psychology and intersubjectivity theory offer important clinical insights for Gestalt therapists who wish to refine their understanding of the contacting process and its function in self-development. The concepts of selfobject functions and empathic attunement enrich Gestalt therapy’s understanding of the psychic functions of contact, the experience of contact, and the multidimensionality of contact.

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Gestalt therapy theory and clinical practice may be further devel­ oped by clarifying and exploring its concepts from an observational stance within the patient’s frame of reference. Intersubjectivity theory has developed more fully than Gestalt therapy the clinical implications of a shared belief that “reality” is always constructed, never known directly. Finally, because of the essential compatibility among self psycholo­ gy, intersubjectivity theory, and humanistic psychology, concepts from these theories may be used to build a Gestalt developmental theory. Gestalt therapists may also use the perspectives of these theories to enhance their developmental perspective by describing such concepts as contact, gestalt formation, and organismic self-regulation from the point of view of the experiencing subject.

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9. Gestalt Therapy and

Intersubjectivity Theory

Rich Hycner

I would like somebody in Gestalt therapy to really connect Gestalt therapeutic principles to a developmen­ tal theory. Miriam Polster (in Hycner, 1990, p. 65)

A concept of the self was one of Gestalt therapy’s most important early contributions. Erving Polster (1992) Awareness, contact and present are merely different aspects of one and the same process — self-realiza­ tion. Frederick Peris (1973, p. 66)

Building on Lynne Jacobs’s groundbreaking preceding chapter, I would like to explore how Gestalt therapy can interface with intersub­ jectivity theory 1 and even, perhaps, how intersubjectivity theory*

Within the tradition of Gestalt therapy there have been a few others who have suggested this integration. Among them are Tobin’s (1990) article "Self Psychology as a Bridge Between Existential-Humanistic Psychology and Psychoanalysis,” and Breshgold and Zahm’s (1992) article “A Case for the Integration of Self Psychology Developmental Theory into the Practice of Gestalt Therapy.” — 159 —

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may be influenced by Gestalt therapy. 2 I will be focusing primarily on the similarities, though mentioning a few of the differences, of the two approaches. This work merely touches on some of the major issues. I should mention that many of the issues discussed here cannot be easily separated from each other. In fact, I can only do so for the purpose of trying to clarify certain aspects as they stand out within the overall context of both Gestalt therapy and intersubjectivity theory. Much work needs to be done.

Psychoanalytic Roots Gestalt therapy’s roots in classical psychoanalysis are well known. These same roots are the base for self psychology and intersubjectivity theory. All three of these approaches were attempting to do greater justice to the human phenomenon than allowed by the philosophical assumptions of classical psychoanalysis. Frederick Peris was clearly seeking a much more relevant and active therapy than that allowed by analytic precepts. Self psychologists and intersubjectivity theorists are also seeking a therapy that was much more experience-near. Peris’s rebellion against the strictures of classical analysis freed up Gestalt therapy to be a far more process-oriented therapy and to open areas of investigation previously foreclosed. The practitioners of self psychology and intersubjectivity theory, while clearly differentiating themselves from classical psychoanalysts, and open to new areas of investigation, never totally break away from the general tenor of psychoanalytic theorizing.

Phenomenological Stance What I believe stands out most is the phenomenological stance of both Gestalt therapy and intersubjectivity theory. Self psychologists refer to this as striving to be “experience-near,” that is, to understand the

2

Lynne Jacobs has indicated tome (personal communication, summer, 1991) that she has had a number of discussions on this topic with Robert Stolorow, as well as with other self psychologists. Stolorow, in fact, read and commented on an early draft of a Jacobs manuscript, of which a revised version became Chapter 8 of this book.

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therapeutic situation explicitly from the subjective experience of the client. This becomes especially important when there are “transferential disjunctions” — misunderstandings between therapist and client. This is so because it is in the collision of two subjective worlds that the sometimes radically differing realities of the client and therapist become articulated: “From this vantage point, the reality of the patient’s perceptions of the analyst is neither debated nor confirmed. Instead, these perceptions serve as points of departure for an explora­ tion of the meanings and organizing principles that structure the patient’s psychic reality” (Stolorow et al., 1987, p. 43). The self psychologist is always striving to understand the experience from the viewpoint of the client, the situation-as-experienced-by-the-client, and not trying to impose an “objective” reality on the client’s experience. However, I would strongly emphasize that this approach is experi­ ence-near, not experiential. For example, I don’t believe that an analytic patient experiences a “selfobject tie.” The patient may experience certain feelings, which can be interpreted (perhaps accu­ rately) as indicative of a function that can be referred to as “selfobject relating.” In many ways I believe Gestalt therapy is more descriptive and experience-near. The phenomenological stance is the explicit orientation of Gestalt therapy (Yontef, 1981). Unfortunately, in practice, Gestalt therapists have sometimes become so fascinated by the phenomenology of their own experience that they have failed to “decenter” from their own experience and truly enter into and dwell within the subjective experience of the client. This raises a delicate issue in that a truly intersubjective pheno­ menological stance requires a knowledge of both the phenomenolog­ ical experience of the client, but also secondarily, a phenomenological awareness of the subjective experience of the therapist. I say second­ arily, not in a sequential sense, but in a priority sense, that is, first and foremost the phenomenological and subjective experience of the client has to take precedence because of the focus on creating a healing environment for that client. This is not to disparage the experience of the therapist, but rather to put it into the context of evaluating to what extent the therapist’s experience facilitates the healing of the client. Stolorow et al. address this through the “introspective” dimension —

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___ THE healing relationship in gestalt therapy — looking at the therapist’s experience as it contributes to the intersub­ jective field. $ Experience-Near. Gestalt therapy takes the experience-near concept further than intersubjectivity theory. Whereas self psychology especially articulates the experience-near in the “transference” situa­ tion, most Gestalt therapists would agree with Polster and Polster that “experience counts most” (1983, p. 7). Clearly, there are strong similarities between the two approaches. Compare Stolorow et al. to the Polster and Polster quote which follows it: “The transference is actually a microcosm of the patient’s total psychological life, and the analysis of the transference provides a focal point around which the patterns dominating his existence as a whole can be clarified, under­ stood and thereby transformed” (Stolorow et al., 1987, p. 36). Polster and Polster state it this way, “. . .present experience itself produces symbols which are valid statements and which extend the limits of the therapeutic interaction” (1973, pp. 13-14). However, Gestalt therapists do place a greater emphasis on the actual experiencing in the therapeutic situation, “developmentally arrested” ways of being, whereas it appears that self psychologists could put greater emphasis on the meaning of the experience. From the quote above, it is clear that self psychologists are not opposed to the client’s experiencing developmentally arrested ways of relating, but that such experiential knowing in itself is not particularly empha­ sized as it is in Gestalt therapy. As Polster and Polster clearly articulate the issue, “In psycho­ therapy, the symbol is most powerful when its meaningfulness arises

3

, . . It’s interesting to reiterate here that in Atwood and Stolorow’s early book (1984), they explicitly discussed their work as intellectually rooted within the existential-phenomenological perspective of Dilthey, Husserl, Heidegger, and Sartre. In fact, their earlier book bore the intriguing title and subtitle, Structures of Subjectivity. Explorations in Psychoanalytic Phenomenology. Both title and subtitle emphasize the role of phenomenological understanding as well as subjec­ tivity. As a side note Stolorow, in a talk in San Diego on September 14, 1991 entitled “Subjectivity and Self Psychology: A Personal Odyssey,” mentioned that the term “psychoanalytic phenomenology” never “took off.”

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out of experiences which exist first for their own sake and then project themselves into a natural and evident meaningfulness, which help tie experiences together” (1973, pp. 16-17). Furthermore, they warn us that, “Meaning and experience, therefore, have a complex interrela­ tionship and an excess of either can block out the necessary function of the other” (1973, p. 15). Perhaps there is a danger in self psychol­ ogy to focus so on the meaning of the self experience of the client that this may deemphasize some of the experience of this person. The Self

Let us revisit the self as harmonic counterpoint to our focus on raw experience. Erving Polster (1992) In a sense, therefore, the self has a life of its own, a configuration extending its guidance, often without awareness. Erving Polster (1992)

A second striking similarity is that of the “self.” In self psychology the self is defined as a psychological structure that organizes an individual’s experience (Atwood & Stolorow, 1984, p. 34). Compare this with Polster and Polster discussing a philosophy of the person which views that person as a “composition” of competing and chal­ lenging characteristics, in contrast to the person “at war” with himself. “We are delineating a new view of man, not a view of man against himself but rather a view of him as a composition, where each of the components is vitally for itself’ (1973, p. 57). In both of these views, the structure of the self is always such as to maintain coherence, and integrate disparate parts, when possible, and pursue growth; but also to become fixed when the “composition” of self becomes fragmented and diffuse. Over and over again both approaches point out how a person strives to maintain the integrity of self-experience (and func­ tioning) in the face of threats, challenges, and unknown encounters. The individual strives for growth, but in the absence of that, will settle for survival. When there is insufficient support for moving forward, the person will contact the world in ways that have become structured

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in earlier stages of development. For example, given a history of growing up with an unresponsive parent, the client expects the therapist to be unresponsive. There is a potential complementarity of approaches here. Self psychology offers an exceedingly detailed developmental picture of the structuralization of the self, while Gestalt therapy offers a medium and a technology of exploring this structuralization in the here-andnow of the therapy. Intersubjectivity

Both Gestalt therapy and intersubjectivity theory focus on the intersub­ jective nature of persons — in terms of development, psychopathology, and the psychotherapeutic situation. Gestalt therapists talk about the contact boundary, what is happening between “organism” and environ­ ment. Intersubjectivity theory is especially interested in how interper­ sonal derailments are experienced and become structuralized as part of the self. The world view of that person becomes patterned in this particular way, and paradoxically the individual elicits the very situations she wants to avoid. As stated earlier, in intersubjectivity theory, “Patient and analyst together form an indissoluble psychological system, and it is this system that constitutes the empirical domain of psychoanalytic inquiry” (Atwood & Stolorow, 1984, p. 64). This can be compared, for example, to Polster and Polster discussing the necessity of looking at the therapist’s experience as an indicator of what is going on intersubjectively; It is as if the therapist becomes a resonating chamber for what is going on between himself and the patient. He receives and reverberates to what happens in this interaction and he amplifies it so that it becomes part of the dynamic, of the therapy. . . .All of these reactions say something about both the patient and therapist and they comprise much of the vital data of the therapy experience. (Polster & Polster, 1973, p. 18)

— Gestalt Therapy and Intersubjectivity Theory ___

context in which the unique subjective reactions of both can be explicated. Stolorow et al. articulate the situation similarly in describ­ ing countertransference as having “. . .a decisive impact in shaping the transference and codetermining which of its specific dimensions will occupy the experiential foreground of the analysis” (1987, p. 42) They further emphasize this by underlining that; “Transference and countertransference together form an intersubjective system of recipro­ cal mutual influence” (Stolorow et al., 1987, p. 42). To focus only on what is happening “within” the patient is a fictive notion that has haunted all psychotherapies. The intersubjective emphasis within self psychology, and the dialogic within Gestalt therapy, points a way out of this fiction: It is a way fraught with the sometimes overwhelming ambiguity that inheres in all intersubjective events. This is not to be run away from, but to be embraced — for what we embrace is our own interconnected­ ness. All purported objectivity is our attempt to escape the over­ whelming richness of what is impossible to be captured, yet exceed­ ingly important to point to within the sphere of the “between.” It is not surprising that we all shrink from this task. So much of our personal development is to overcome that influence of others in our early emerging sense of self. This mutual influence needs first of all to be acknowledged, then to be explicated. Both tasks make the illusion of an individual self or “organism” a welcome relief. But such relief is to be not easily accorded to those who plumb the depths of the interhuman dimension. It is not Freudian “archaeology” of the unconscious that we’re involved in, but an engagement “in the between,” in order to explore the interhuman. Here and Now

Intersubjectivity theory agrees that it is the exploration of the transference/countertransference situation that best concretizes the prereflective unconscious of both therapist and patient, and is the

There are some meeting points between intersubjectivity theory and Gestalt therapy on the issue of the power of the present therapeutic situation. Gestalt therapy clearly emphasizes the need to investigate the client’s experience in the current therapeutic situation. If any­ thing, the dictum to “stay in the present” has sometimes been overuti­ lized, such that Erving Polster, one of the outstanding master Gestalt therapists, has mentioned repeatedly that Gestalt therapy has gone too far in one direction, and it needs to regain the connectedness of

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present behavior to past experience (in Hycner, 1990). He has even gone so far as to write a book extolling the need to explore the historical story of each person (Polster, 1983). Self psychologists believe that present behavior is very important, but in a slightly different way than Gestalt therapists. They are less interested in actual enactment of past behavior in the present than they are in how that enactment illuminates and begins to articulate the structure of the self, and its arrested development at critical stages. Once again, it is the “transference” situation in which this is investi­ gated, always remembering that transference is understood as an intersubjective phenomenon of the “therapeutic between.” Atwood and Stolorow write that “Every transference interpretation that suc­ cessfully illuminates for the patient his unconscious past simultaneous­ ly crystallizes an illusive present — the novelty of the therapist as an understanding presence” (1984, p. 60). Rather than eventually seeing this as an encounter between the person of the therapist and that of the client, the emphasis appears to be on whether the client has assimilat­ ed this understanding presence as a selfobject within his own self structure. The emphasis appears to be on an “intrapsychic” internal­ ization of an intersubjective event. Therefore, “Analysis thus intro­ duces a new object into the patient’s experience, an object unique in the capacity to invoke past images and yet also to demonstrate an essential difference from these early points of reference” (Atwood & Stolorow, 1984, p. 60).

— Gestalt Therapy and Intersubjectivity Theory ___

The role of awareness is central in Gestalt therapy. In fact, it is difficult to discuss Gestalt therapy without discussing awareness. Intersubjectivity theory rarely mentions awareness as such. When it does, it is usually referring to the process of making the unconscious conscious in the intersubjective therapeutic field. For example, “This unconscious organizing activity is lifted into awareness through intersubjective dialogue to which the analyst contributes his empathic understanding” (1987, p. 7). In this sense, the subjective awareness of the patient is “illuminated” and “articulated” rather than “discov­ ered” or “recovered” in the archaeological metaphor used by Freud (Stolorow et al., 1987, p. 7). Awareness, however, is not viewed as

a function in its own right, but rather as illuminating the prereflective self structure of the patient. Compare this with Polster and Polster: “At its best, awareness is a continuous means for keeping up to date with one’s self. It is an ongoing process, readily available at all times, rather than an exclusive or sporadic illumination that can be achieved — like insight — only at special moments or under special conditions” (1973, p. 211). This indicates one of the different emphases in Gestalt therapy on the availability and conscious utilization of awareness. However, there are even here striking similarities, such as when Polster and Polster discuss how awareness keeps the person current with her own “self.” Gestalt therapy and self psychology begin to sound especially close when Polster and Polster expound on the above: “With each succeeding awareness one moves closer to articu­ lating the themes of one’s own life and closer also to moving towards the expression of these themes” (1973, p. 212). Figure-Ground. A particular dimension of awareness, well articulated as a core aspect of Gestalt therapy is the figure-ground phenomenon. Its place is so well known in Gestalt therapy that it needs no further discussion. However, it is interesting that at times Stolorow et al. do discuss the “figure phenomenon” in terms of the therapeutic relationship. Once again, it is in the transference situation where an awareness of figure-ground oscillation of needs emerges. Particularly in the transference relationship there is an existential, as well as a psychological ambivalence, on the part of the patient. There is hope and fear. There is the fear that the therapist will be like many others in the patient’s past life, and fail to meet the particular develop­ mental need that is in her experiential foreground: On the other hand, there is a deep yearning — a hope against all hope — that the therapist may be able to meet the developmental needs that have become fore­ ground. Stolorow et al. address this: “We believe that a well-conducted psychoanalysis is characterized by inevitable, continual shifts in the figure-ground relationships between these two poles of the transfer­ ence, as they oscillate between the experiential foreground and back­ ground of the treatment” (1987, p. 102). In fact, “Our listening perspective becomes thereby focused on the complex figure-ground

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Awareness

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relationships among the selfobject and other dimensions of experienc­ ing another person” (1987, p. 25). There is such a variety of intersub­ jective dimensions that it leaves . .certain meanings and functions occupying the experiential foreground and others occupying the background depending on the subject’s motivational priorities at any given moment. Furthermore, the figure-ground relationship among these multiple dimensions of experience may significantly shift. . (Stolorow et al., 1987, p. 26). The Psychological Field

Both Gestalt therapy and self psychology recognize that whatever the patient produces in the therapy session is an experiential figure that emerges out of the background of the psychological field comprised of therapy and client. Self psychologists discuss the need for under­ standing the subjective experience of the client and of the therapist, “. . .and the psychological field created between the two” (Stolorow et al., 1987, p. 4). Clearly, the whole issue of the psychological field was inaugurated in Gestalt therapy by discussing the organism/environment matrix. Frederick Peris, however, goes much further in emphasizing the need for the therapist not only to be aware of the meanings inherent in the psychological field between therapist and patient, but also have the ability and willingness to express his own subjective reality. He must have a relational awareness of the total situation, he must have contact with the total field — both his own needs and his reactions to the patient’s manipulations and the patient’s needs and reactions to the therapist. And he must feel free to express them. (Peris, F., 1973, p. 106)

This emphasis seems to differ considerably from self psychology. In their chapter on “Transference and Countertransference,” Atwood and Stolorow (1984) give an admittedly dramatic and perhaps contro­ versial example for Gestalt therapists. They discuss possible transfer­ ence and countertransference issues in Wilhelm Reich’s analysis of Frederick Peris! They mention that one of the early experiences that influenced Peris’s entire life was a severely disturbed relationship with his father. They suggest that “It appears that many of the dominating — 168 —

— Gestalt Therapy and Intersubjectivity Theory .__

issues around which Peris’s subjective life was organized concerned his need to separate himself from the powerful negative influence of his father, with whom he also became closely identified” (Atwood & Stolorow, 1984, p. 48). As a consequence Peris was fascinated in particular by an “interpretation” of Reich concerning Peris’s lineage In Peris’s own words, “He never revealed to me how he came to that conclusion. He said I was Herman Staub’s son, which appealed to my vanity and never reached conviction” (Peris, 1969, p. 202). Earlier Peris mentions that “Uncle Staub was the pride of the family” and that Uncle Staub was a “symbol” for him “. . .and it was obvious that I should follow his footsteps” (Peris, 1969, p. 202). Atwood and Stolorow suggest that since there was nothing in the analysis that Peris was aware of, or that Reich made him aware of, to lead to this conclusion, this interpretation makes sense only if it is understood as a countertransference interpretation — a statement about Reich’s own experience imposed on a lacuna of Peris’s subjective world. “It was Reich’s allegiance to his father and identification with his values that led him at the age of 14 to betray his mother’s sexual infidelity. The father’s discovery of her adultery precipitated her suicide” (Atwood & Stolorow, 1984, p. 49). They suggest that Reich’s guilt over this betrayal led him to dissociate himself from his father so much that it led to “. . .a need that culminated in his convic­ tion that he could not possibly be his father’s son. He once even went so far as to suggest that he was the offspring of his mother and a man from outer space” (Atwood & Stolorow, 1984, p. 49). The authors suggest that it is only in understanding this extreme defensive configu­ ration in Reich’s psychic world that his “interpretation” concerning Peris’s father, lacking any factual evidence, makes any sense. Such is the extreme danger of a therapist’s being unaware of her own subjective experience, and imposing it, especially on the lacunae of a client’s subjective experience. Of course, there is the obvious danger of psychoanalyzing Reich’s psychoanalysis of Peris. Gestalt therapists would not be prone to make such blatant suggestions without phenomenological evidence. Yet it points to the confusion and even danger that even subtler suggestions might have when not based solidly in the client’s factual history or subjective experience. — 169 —

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Peris himself recognized the danger of “countertransference projection” onto the patient when he stated that each therapist will exhibit his/her own prejudices in therapy. In a comment that well may have applied to the situation with Reich, Peris reminds us; “But the more the therapist relies on his conviction and prejudices, the more he has to depend on speculation and figure out what is going on with the patient” (1973, p. 104).

10, Transference Meets Dialogue A Case Transcript *

Lynne Jacobs

Support and Frustration

Self psychology discusses extensively the need of the patient for support from the therapist. Interestingly, in spite of his sometime emphasis on frustrating the patient, Peris readily acknowledged that the patient has many needs and that, “Usually we find that the domi­ nant need is for security or approval from the therapist” (1973, p. 103). Peris’s response to this need was often quite different from self psychology. For him, this need for environmental support usually was to be frustrated. Consequently it appears that Peris would strongly disagree with self psychology’s emphasis on empathy. For him, empathy meant overidentification with the patient and consequently the therapist withholding himself. “Yet if the therapist withholds himself in empathy, he deprives the field of the main instrument, his intuition and sensitivity to the patient’s ongoing processes” (1973, p. 106). I believe the approaches of self psychology and that of Frederick Peris are complementary. I think that therapists always need to appropriately empathize with the client’s experience; and only after an extremely solid relationship is established is it time for the therapist to utilize her/his own experience. Peris saw it differently, in that he believed the therapist “. . .must learn to work with sympathy and at the same time with frustration. These two elements may seem incompatible, but the therapist’s art is to fuse them into an effective tool” (1973, p. 106). Peris goes on to say that: “Gestalt therapy makes the basic assumption that the patient is lacking in self support and that the therapist symbolizes the pa­ tient’s incomplete self’ (Peris, 1973, p. 111). This is certainly an intriguing thought for both dialogical psychotherapists and for inter­ subjective self psychologists. — 170 —

My purpose in presenting the following case example at a conference of Gestalt therapists was to encourage discussion of points of meeting between Gestalt methodology and the methodology of intersubjectivity theory. In particular in these sessions I was focused on 1) listening from the patient’s perspective, 2) using affect attunement, and 3) using interpretive clarifications of her subjectivity (including the contexts and fixed gestalten that shape it). In my opinion, this methodology was my effort to practice inclusion. Such inclusive gestures, when offered and received, are the ground of confirmation. I am interested in exploring and refining these ideas, without losing the freshness and vitality of our attention to moment-by-moment contact.

The transcription of this case was precirculated to participants at the Thir­ teenth Annual Conference on the Theory and Practice of Gestalt Therapy (1991) and was part of a panel entitled: “Transference Meets Dialogue: Advances in the Treatment of Self-Disordered Patients.” (The transcription of the panel discussion was later published as Alexander et al., 1992.) Symbols used in the transcription include: [ ] = information added in order to make session mote comprehensible; () = descriptive remarks to render a more accurate transcription; / = signifies one person interrupting, talking over, or rapid­ ly following the other’s speaking. ----- 171 ------

___ THE healing relationship in gestalt therapy

The patient, Kate, a 40-year-old black female, has been in therapy with me once weekly for ten years. For a period of time about five years ago, she came twice weekly. She always has paid an extremely low fee, and for the past few years has run up a bill, unable to pay anything at all, since she is in serious financial trouble while she attends graduate school. Our therapy includes many phone calls, some brief, some not. Also, Kate often leaves messages on my phone as a way to “keep me in touch with her.” Her mother has always favored her two sons, while decrying her poor fate that her daughter is not the feminine daughter she always wanted. Her father, who died of a heart attack about fifteen years ago, took an intense interest in her. He was alcoholic, prone to rages, was physically abusive to his wife, often made sexual advances toward Kate, but is described as the only family member who made my patient feel worthwhile. Kate has been enrolled in a graduate program in a mental health specialty for a few years. She was expelled from school about a year ago for failing to turn in papers in a timely manner. Some of the therapy has been focused on her need to rebel against authoritarian strictures in order to assert her individual identity. She was readmitted and functioning well as a student, therapist-in-training, and a teaching assistant, when she was expelled again for failing to register for the last year. She had applied for a student loan, which did not come through. Through a series of mistakes made by the registrar’s office, coupled with the patient’s avoidant inattentiveness, she was allowed to take classes and work in a local hospital, without being registered. When this situation was discovered she was immediately dismissed from school. The following session occurred after she was informed she must leave school and terminate with her clients. She had begun that process by the time of our session. I knew her current situation because she had spoken on the phone with me between sessions.

Session One P:

(pressured, fast speech) I’m hyped and I wanted to be depressed, (laughter)

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— Transference Meets Dialogue: A Case Transcript ___

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Well, yeah. Wanted me to know intimately the painful aspects of what is happening now. P: Yeah (pause) (straining) The significant things are (pause, then crying) Telling Katie [patient’s child client. We had discussed her meanings to P. many times] we have to stop. One of the hardest things I’ve ever had to do. T: Did it sink in? P: Yes. She cried. She doesn’t cry! I’ve seen her for two years. She would “play” cry, which we talked about, and she just burst into tears. We went about twenty minutes in tears, and a half-hour coming down from that, and then the last ten minutes playing a game. — She’s. . .she’s. . .(anguish, tears) What it did to me, was, it reminded me of all — since yester­ day afternoon — two things: one, how very painful separation is, and that, that, that used to really hurt. . . . I was thinking of times I have really felt the wrench that she seemed to be feeling. . .and one that really sunk in anywhere near what I saw in her, was. . .years ago when you told me you weren’t comfortable with my hugging you after every session. That’s the worst feeling I remember having, in years and years and years. That was really AWFUL. I felt like I was doing at least that to Katie. . .And. . .that brought it back to me. . . .separations. And especially, when you’re a kid, and you have no perspec­ tive. I’m not even sure that [perspective] matters. You’re a kid. I remember my father coming in to me one night, after my folks had a terrible argument — I think I was somewhere between 4 and 6 [years old] — And now, looking back I’m sure my father had been drinking, because I know the tone of voice he had at the time — I now know what that tone is — and he told me he was leaving and he wanted me to know that he loves me, that he would come by regularly and keep an eye on me, and say hello, and, . .(anguish, the laugh) even at that age I knew my mother was not my caretaker parent. . .(anguish) this was the worst pain I have ever, EVER felt.

T:

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And then my mother came in, and the only thing that helped was her using logic. . .(patient then describes how mother says there is no need for my patient to cry, if Dad was leaving mother would be crying too. And mother was not crying) (interrupting as patient about to change subject) /he brutalized you! He did?. . . pause). Oh, yeah. It’s true, (speaking slowly) I never thought about that. I never thought about that.... But I want to stop and say, “yeah, but he was drunk, it wasn’t conscious,”. . . . Of course. I’m sure. So, what then? Maybe he was so upset, and he needed your sympathy, needed to see his upset reflected in your eyes. . .something like that? (pause) (softly) It was a shitty thing to do. Hmmmm Especially to wake up in the night, to this argument, I was de­ fenseless. . .(soft weeping) And the other thing I was thinking last night, I was upset, I couldn’t go to sleep, and that’s standard, that’s normal [referring to that she experiences her feelings more fully now than when she entered therapy] but painful too. (tears) One of the things I was thinking was, for years one of the things I was most afraid of was. . .1 was afraid you might move away, you might marry Gordon, I didn’t even want to know. . .1 thought, even if you did what did it matter to me? And so I thought, “well, I don’t want to know, I don’t want to know.” And I thought how tenuous that was. . .it was terrible. Now, I feel solid. But now, I did that to Katie. And I have always questioned how important I was to her. My supervisor always said “yes.” She would point out Katie’s behaviors even if Katie doesn’t say anything. But she just kept saying. . . “You’re the best thing that’s happened to me in the last three years” (described more information concerning Katie’s life and therapy) And she said, “You’re my third ‘talk doctor.’ You’re the best. You listen. The others always butt in. You listen. You think about it. Then you talk to me.” (more details regarding transition to new therapist.)

I felt like I had sold her out! Part of me thinks I should just go up against the system. When [supervisor] returns, she will just shit. She knows Katie, she knows how important, we planned termination. All her stuff is abandonment. Part of me says, I just should have said “no.” What can they do to me? It was so final: “you are not covered. You must stop.” But. . .1 don’t know, I just keep going around and around. But I have nothing to stand on. . .And then I have survivor guilt, because I’ve still got you! (tears) I remember how fearful I’ve been about losing you. I know she’s got her Dad, but I know that is not a secure rela­ tionship. And she said. . .(tears) “I feel like I’ve got a 50-foot building to climb over, and only fifteen seconds to do it in.” (pause, crying) I felt so bad yesterday. Driving to tutoring, I just wanted to pull over to the side and rip it out, not rip, just. . .let it out rage? Pain. Pain. Sadness. Just such sadness. And not knowing, (crying) is it my sadness, or her sadness. . . (anguished moan) but remembering how very very very painful it can be to lose some­ one. So painful (crying). . .For years I’ve been thinking, “emotions? what are emotions? Ahh, anybody can survive anything. OK, so you feel bad for awhile,”. . .I’ve been so out of touch! I didn’t know I was this out of touch. These feelings might be unbearable? I guess. . .It’s not so much that this event is so much, but trigger­ ing all the others that were. . . Losing someone. . ./ /Yeah! I keep remembering this — (reaches for Kleenex and then expression suddenly changes) — Katie drew on a Kleenex yester­ day! So delicate. She drew a big heart, with my name on it, I didn’t even know she knew how to spell my name. She got the [letters of a difficult-to-spell name]/

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T: P:

T: P: T: P:

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T-

P;

T: P: T: P: T: P:

T: P:

/she knew your name [reference to previous session, where she admitted to being embarrassed when name called in roll when younger, and reluctant to say her name to others] Oh, God! (anguished recognition) You know, the hospital doesn’t even spell my name right! There’s so much here/ Christ! Your losses, her losses, anger at them, at you, shame, guilt. . . Yeah. . . .yes. . . .yes Tremendous grief, and sense of loss. That’s it. And what’s been happening for a month, and what’s intensified now, is vignettes of all the different ways my mother has been so cruel. It’s easy for her. She’s so insensitive, and unaware and hostile. The hostility. It’s funny, she called me the night before all this happened. I’ve been staying away. I needed to stay away. Ever since I took the money [a loan to try to register for school. But in the attempt to register, the problems related to the prior terms came to the surface and led to her dismissal] I’ve needed distance because I knew it would give her a sense of entitlement. So she called up and wanted to know if I’ve regis­ tered my car yet — which I haven’t — she must be using my brother’s access to check up on my tickets. Anyway. . .(described details of mother’s harassment, undermining, and invalidation) It lets me see — when I was little — how fucking crazy-making that was! She always said, “I’m not doing this.” And as a child I thought, “I thought you were, but I guess I’m mistaken!” (chuckles) (describes more details) She’s so unstable. She just goes from zero to blast-off. She yells at the drop of a hat. And she accuses me of being stupid. I’m not thick. I understand things faster than almost anybody (looks up quickly, a bit of fear in eyes) This is just true. I’m very quick, in class, in grad school, (looks up again apologetically) — I have to do this, blow my own horn/ You seem defensive/ /yes. As if you’re not going to believe me/

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— Transference Meets Dialogue: A Case Transcript ___

T: P:

T: P:

T:

P: T: P:

T:

. ■ as if you’re ready for an “attack.” Yeah. Right here. But with them I am wrong, (details of a disagreement between patient and mother and brother) And I yelled back at her. Which is something I’ve been doing the last five years. She doesn’t come at me anymore, until now. I bet it’s because she lent me the money, y'know? But with each incident, it reinforces that there have been hundreds of those, that I was growing up against this. That I was a five-year-old, learning logic from a crazy woman! And the frustration and the anger and the rage is starting to be unearthed. Man, here yes! There, yes! I want to kill her (tears). I am so enraged, (lets a long breath out) She was so awful. She was so awful. It’s hard to imagine, short of physical abuse, how someone could be that awful. I think back to what you said earlier, about surviving feelings. (deep, angry, helpless, plaintive crying) and now, I have a ME I’m not proud of (pause) I fucked up in school. I can’t trust me. But, but, I’ve always had a stellar work record. Any job I had. Even when I hated it, I knew, when I went to another job, I could expect excellent references. And that’s the ironic thing about therapy. The longer I’ve been in therapy, the more I’ve fucked up. And in a sense I can see that as a lessening of my rigidity. . .rigid. . .rigid. But it also leaves me very. . .identityless. Yeah. Unable to set a goal for yourself, and be able to know you will work towards it leaves you feeling not in charge of your life. . . .1 guess that’s part of “identityless.” And that’s so unknown to me. So unknown. (inaudible) Yeah. yeah. The other thing I’ve thought of. . .(tears, pause) man, what’s coming up now is just.. .1 hate them all. (said slowly with emphasis) I hate them all. 1 hate them all. And I want them to know I hate them. I want them to know! I want them to feel fucking guilty! (plaintive rageful tone) I want them to KNOW THEY HA VE BEEN BAD! To know they’ve hurt you.

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the HEALING RELATIONSHIP IN GESTALT THERAPY —

(shouting) Yes! They have to know. It has to square somewhere. I can’t carry this! It’s so twisted. Family so twisted! It’s like being in a concrete jail, with, I don’t know what. . . You pound and pound and pound until your hands get all bloody, and then they look at your hand and say, “you got blood all over your hand? What’s wrong with you?” This is the level of frustration in my dreams. My worst night­ mare, the worst level of frustration I have ever experienced was in a dream, I remember vividly: I was on a baseball diamond. At home plate and there are floodlights facing me. And my family is yelling, taunting at me. And I am screaming, screaming my rage and frustration. More frustration than anyone can stand. I don’t know what I’m scream­ ing, but I know they are taunting me. I’ve got all these floodlights in my face, and there is nobody for me. And everybody sees me as the. . .”fuck-up” doesn’t get it right,. . .the ANOMALY. It’s like I’m trying to say, “God, you taught me to reason, you, can I not show you by your own laws and rules. . .you suddenly changed the language on me! In the dream there’s so much anger. I am crying. And raging in frustration. It’s so annihilating. They won’t see you, take in what you want to convey/ /They won’t! They won’t! That’s it. If I could just accept that they can't. But there’s a sense of volition. That’s what I hate them for. That’s what I hate them for. That they’re doing it to you on purpose. KE'S! Because they wanna get me. They want to save their skins. They have no sense of honor. What they passed on to me is in name only, (pause) Do you know what would happen to that person in jail if they stopped bloodying their hands against the wall? He’d go crazy. That was right off the top. I see me sitting on the floor. . . . These impossible choices. Destroy yourself fighting for recogni­ tion, or go crazy. At least if you’re destroying yourself you’re feeling/ /It’s you/ — 178 —

P: T: P:

/I’m taking action/ /you’re acting (sigh) very nice intervention. . . .I’ve been living like this for so long, crazy, and can’t do anything. . . T: Are you feeling crazy now? P: At not being able to do it here? or with my Mom? T: Either. P: Yes. If I feel it, I won’t do it, she doesn’t change. I’m the crazy one. T: It reminds me of last week, talking of being paralyzed, not able to commit to dying or to living/ P: /yeah/ T: And you’re paralyzed here too. You can’t let go of needing to show her, and you can’t show her. P: And at school. As soon as you said it. . .at school. School or not in school. I haven’t been able to commit. T: If you committed, you’d be back in the cement jail, I think. P: Worse. A glass jail. Where I’m naked. There’s more shame. An amazing theme [referring to her relatively recent acknowledgment of depth of shame she experiences] T: Mortification. . . End of session.

Session Three^ P:

I had a dream about you Thursday night. I was seeing you at your house. In a garage office behind your house. And my sense was that we had talked and we had agreed that it was OK for me to come and sit in your garden. So I sat there for a couple of hours. And I think you were even seeing M. (a friend), and that didn’t even bother me. . .1 was struck with how warm and safe I felt. . . .1 was sitting there, I felt so good, it was like having a warm comforter wrapped around me. . . .

1 This session followed the previous session, and an unrecorded, untranscrib­ ed, “emergency” session (session two), on a Thursday evening. — 179 —

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T:

P:

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I was thinking. . .’’This is really good, just being here. I don’t have to see you, it’s OK I’m not in there, I'm Here," and I remem­ ber thinking. . .“This was a good idea”. . .and I stayed long time, really a couple of hours. . . . And you came out, and you were getting ready to leave. And you saw me there, and you were very disappointed in me — it was kind of like; “Wait a minute. We said it was OK. But I had no idea you were going to spend hours. It’s one thing to kind of touch base and move on, but. ...” And I was so surprised, because you’d said this would be OK, and here you were very, — you weren’t nasty, but you were very stern, you didn’t think this was appropriate, I was pushing the limits, etc. I got up to leave but I didn’t actually leave, I walked around to another side of the house. You were leaving then, and I was getting ready to leave. And I remember thinking, “She’s wrong. This was good for me. This was so good for me. If she could only know.” I felt unhappy that you didn’t appreciate it. And I kept going back (over our agreement), and thought, “No, we both agreed this would be OK for me to do!” And when I woke up I didn’t understand it, because the session I’d just had with you was very much like that comfort­ er. . .very, very much. ... But y'know, one of the things you said at the very end of last session. . .you were talking about a longing, and, and/ /fear that I am going to use all my chips? [referring to prior discussions concerning her belief that I have only a set amount of devotion to her, and she fears I will be drained and then unavail­ able to her when she needs me] Yeah, and wanting to be centrally important to me, which I took to mean that you would be assured that there is room for you to come and get comforted, but you are afraid you’re going to use it up. And so, on one hand I’m agreeing it’s OK. On the other hand. . .“You used up your chips, lady.” Yeah, I stayed too long. I remember thinking, “why does it matter to you how long I stayed?” For me, it was OK for me to stay as

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long as I needed. And when I was comforted I would leave and go on to something else, because I would be bored staying there. So it was curious, the timing of the dream. . .Why would I have it then. . . . I thought you were saying at the end of Thursday’s session too was, in a sense was,. . .’’Do we have to end?” Hmmm, what was I saying? That you wanted to be more central in my life. . .which I thought was so that you could have access to me whenever you need it. Oh, yeah. So it’s still you not getting with the program! (laughs) Yes! And that you get hurt when I’m not “with the program.” That’s what struck me. The best part for me really was, after I woke up I thought, I know I remember, “This is right.” I mean, I just sat there. I sat there, I felt calm, warm. . .protected. It was serene. . .(pause) (giggles) So, what’s your address? (softly) I think you’re saying you wish you could have it. Oh, yeah. But it sounds — I’m pressing a point here — it sounds like you’re saying you want it with me/ oh, definitely *./ and you feel. . .disappointed that I am not accessible in that way. It is surprising to me that I would have it [the dream] right then, because I was savoring the fact that you had been willing to stay late for me on Thursday. I held onto that. So, It’s surprising to you that you could feel that much comfort, a feeling I’m pulling a blanket around you, and yet have a dream that says, “You used up your chips?” yeah, yeah. . ./ /maybe you’re more concerned about the extra session than you realized?/ /You mean, using up my chips? /because you seemed concerned about my adding on time at the end of a long day, and I was somewhat distracted. . . You mentioned that. . .what was going on? Did you experience me in that way?

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NO (both laugh). But since you said something, afterwards I thought about it, and I wondered if I was supposed to ask about it? At the time, it didn’t even strike me. Y’know, I thought you were responding in the session to my misattunements. Like when you looked up at me, and my circuits weren’t working, and you said, “You’re not reacting”? Oh (laughing) so you were too tired. It was too late. I don’t think so. (laughing) Go ahead, try to save this. I don’t think I was tired. Actually, I was overstimulated by something that had just happened at work. . .(pause, waiting to see if P has a response). . . But you didn’t experience me as not with you during the session. . . I experienced me. . .1 came in, I thought, I looked forward to having the session, because the last one had been very emotional so far. I thought Thursday’s would be. And I’d felt so good after Monday’s session, where I’d really cried. I really felt clearer, cleaner the next day. . .and I thought, “given all the shit I’m going to go through on Thursday. . .” [terminating with clients] But then Thursday I felt kind of shut down, but shifted, like I could handle things. So I thought of letting you off the hook, because I didn’t need to come. (went on to describe in detail busy schedule, frequent thoughts of calling on Thursday to cancel, but never did call) I took that (not canceling) as a message, but, but, I wasn’t into it. I got here, and I was very up, and I enjoyed the session, being up and being with you, but I got the sense that you were disap­ pointed. And you were worried that you weren’t with me, and I was noticing that, and I took that to mean that you said you were distracted as your explanation for why I wasn’t more forthcoming. That I was responding to your relative shut-downness as/ /as my reacting to you not being there, (laughs) I remember the first or second time I ever saw you, we were talking and I was describing how I always watched myself, and you said, it sounds like there are three of us in the room, and I looked at you and said, “I bet there are four of us here!” (both laugh) — 182 —

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Still, what I’m struck with, more than anything in what you’re saying, is that you’re feeling responsible for the fact it was an extra session, and like you owed it then/ /to be emotional/ /yeah. Yeah. A model patient. This ties in to something about yesterday. So, you can figure how it does. I know it does but. . . (P tells story of caring for her mother’s dog, and how much she becomes burdened by worries about his comfort, pleasure, etc. whenever she cares for him) If I worry that much over a dog, no wonder I don’t want to be around people! I’ve often thought of picking him up and taking him to my place but. . . Sounds like it makes you feel obligated, the way you did about the session. Yeah, and there’s a phrase I use, “down time.” I need a lot of down time. . .The words I think of. . .1 need time where I don’t have to “interface” with the world. Yes, and I was just thinking your dream talks about you, in a way like the dog. Just needing to come and hang out. . .And maybe that’s what you needed Thursday night; was just to come and hang out. But you felt like that wasn’t good enough. Yeah, I think I even said that to you, “I feel like I’m just hanging out.” I think what I said was, the last week and a half has been so, so much like a roller coaster, that I was just coasting. And I thought you sounded apologetic about it. Yeah. Why do I feel so. . . .1 used to talk about. . . there’s always this “Third Ear” around others. I can never feel totally absorbed. I have to be listening to make sure everybody else in the house was comfy, and. . . Because if not? That was how I got by. A third ear always planted, alert to what shit was gonna come down so I could head it off, get out of the house, or something. Like the shit of me in the dream being disappointed.

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Yeah I could’ve listened for you, and as soon as I heard you coming, I could’ve left and just avoided you. But that would require me to not be able to just sit there and take it in. Exactly} Why is it so tiring for me?. . .’’Interface” is such a good word; there’s “interfacing” with the world, and being by myself. And “by myself’ is good just because I don’t have to interface. I’m struck with, you can “interface,” or you can “be.” (soberly) Yeah. How sad. Again, I keep thinking about Thursday night, and the poignancy of your need to just be here, and the degree to which you were just able to allow it. But then you worry it was wrong, that I’ll come down on you for it. . .if you don’t take care of me, it sounds like. You know what I’m really struck with today. . . .(pause) You’re supposed to say, “No, but I’m really interested!” (we both laugh) In fact, you said that once, and it was such a delight­ ful invitation (laughs with delight, then pauses and looks almost tearful) I’m really making eye contact with you today. I’m not uncomfortable at all. I don’t know what that’s about. . . . That also happened Thursday. Maybe when I’m lighter. I don’t know. My association when you said it was to the part of the dream where you say, “I know I’m right.” Yeah! I like that association. There’s not a need to divert my eyes if we disagree. It’s for,. . .I’m also kind of playing. . .so watch me manipulate you now (cynical laugh). What would you need to manipulate me for? That’s what I don’t understand, (pause, then a change in the look on her face, as though her face begins to crumble) What’s happening? Getting sad (pause) You look sad like someone who’s been hit. Exactly! Exactly. Is this it? If I make contact when I’m feeling emotional it’s too vulnerable? It was my mother’s favorite move. . .(goes on to describe mother using her vulnerabilities against her. A few examples) — 184-----

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I have two thoughts: one is that maybe you feel like you have to manipulate kindness from me in the face of your vulnerabilities you couldn’t just assume it. And the other thing is, maybe why you came in shut down Thursday night, is you cried on Monday, and you weren’t sure whether I was going to hurt you. P: I just had the image again, of the bloody hand. Smashing the hand. T: That just came up now? P: Yeah T: (somewhat more softly) Is there something you feel like I don’t get? P: No. I have no idea why it came up now, but it feels good. Like, “Oh, yeah, and I also want to find out more about what this bashing is.” T: Oh, that it feels good to have told me? P: AND. . .AND, when I told you, in some context. . .of the jail cell, the concrete jail, and we came up with that I could smash my hands to a pulp trying to get out, or I could just go crazy, and you pointed out to me that bashing my hand wasn’t crazy. Not like my folks. You understood} (tearfully) It’s not crazy to be bashing my hand. So going back to it. . .it’s a symbol of my being vulnerable with you. (softly, with utmost seriousness), YOU SUPPORTED ME. T: (softly) So different. . . P: (crying) I just. . .over and over, I hear all the time, bits and pieces, how she would just step on me, just step on me, step on me. It feels so deliberate. And cruel. Need to be big cheese. Feel good about herself, (plaintively), I was just a kid. . .no respect. . . T: Again, I think of the dream. With your mother you couldn’t trust she would say something and mean it. So if I say you can stay, maybe I don’t mean it. P: I remember the first time she ever made me a promise, (went on to tell of a few times mother made and broke promises). . .And when she broke it I was so upset, she broke it! And she just told me to be mature, adult, accept it.

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Yeah, I’m thinking of the phone calls we’ve had. If you pick up any hint that I’m tired, etc. . . . Y‘know, I say, “Call when you need to.” Then it must feel like I’ve taken back my promise. Like coming into the yard and saying, “What are you still doing here?” You’re bad for accepting a promise I made. P: I’m always afraid that when you offer, I read more into it than was really meant. T: Maybe that was some of your anxiety about the extra session Thursday night. Did I really mean what I said. . . . P: Instances like that (referring to mother again). . . . T: They’re coming back a lot now. P: Yeah, so many, so much arises. So, I think, “How did I survive that?”. . .1 guess because I thought everyone’s parents were like this. T: You didn’t know how grievous your situation was. And y'know, to stop pounding, you’d know. You’re left with/ P: [This is reality/ T: /and unbearable feelings: loss, grief, horror. . .certainly unbearable to a child who is all alone. P: I know of rage. . .and horror (then goes on to tell story of dread­ ful night terrors. Had to stay awake or walls and ceiling would close in on her.) End of session. T:

In the interim between sessions, P. called to leave a very tearful message on my answering machine. Sobbing regarding her loss of contact with her child client. There was a power surge, and in the middle of a sob, my machine cut her off. She called back about an hour later saying there was no need for me to call her back, but “Get a new tape!”

Session Four (She arrives about ten minutes late) [First comments are joking about her lateness as “acting out.” Then I ask what she does think her lateness was about] — 186 —

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Tape machine. Because I felt very embarrassed afterwards. (pointing to audiotape machine) Do you want me to turn it off? No, not this tape machine, your phone! Oh. So, what was embarrassing was the message that you left? Yeah. Yeah. The first one. I called and I was crying so hard, and even as I was crying I was feeling. . .at some point something just clicked and I felt terribly vulnerable, and then your machine went BEEEP. And it’s just a sense of, god, I’m talking to a silly machine, and even a machine won’t listen to you. And I don’t know if that’s it, I don’t know, but it’s the first thing that comes off the top of my head. . . . I imagine you’re pretty angry about that. . . . I think so (laughter) I don’t think I was in touch with it, until I left the second message, and I heard myself, and that I thought, yeah, I really was pissed! And I think, wounded. To be in the middle of that message and get cut off, it sucks! It was yucky. And what is so interesting, is that I felt immediately ashamed. And I thought, “that’s unusual,” I’ve left very emotional messages before. . .and I have felt a warmth about them, I mean usually there’s a good sense. . .I’m glad you didn’t pick up the phone because it’s too intimate, but leaving a message feels just right. . .and knowing you’re going to hear it, and knowing you’ll get back to me, which is pretty much what you do if. . .usually in those (emotional messages) I don’t even tell you whether to call or not, and usually you get back to me. . . And this didn’t feel like that. Maybe you needed me to actually be on the other end of the line. . .? Maybe. But I don’t know. I mean I was afraid I was going to get you when I first called/ Oh. OK/ /And just seems crazy to me. . .1 remember saying, “this is what I hate about relationships. . .the part that is so powerful and vulnera­ ble for me. . .that you can hurt that much. . .” I can only remem­ ber feeling that intensity in my throat, when I left R (boyfriend). And you felt it again, terminating with Katie. ----- 187------

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Oh SO MUCH. I mean, I was OK while I was there. . .the greatest thing was, we did a brief session with the new therapist, and after, Katie said, “She’s REALLY NICE.” And inside I’m going. . .“Hooray!” (happy, relieved laughter) I felt very relieved. That must make it a little easier to leave her. . . (details of final session) And then I said, “Five more minutes, Katie,” and then her tears came, and mine came. . . .(tears now) You’re speaking of terminating with her, and the sadness and grief, and my machine too, cut you off before you were ready. . . . And all she kept saying was, “I don’t want to stop seeing you,” and I kept saying, “I know”. . .1 gave her some acknowledg­ ment. . . . (pause) I don’t know why I felt so ashamed. I was cut off right in the middle of a good sob, and I hear that in my head, and then I hear the beep, and somehow that’s embarrassing. It’s so disjunct from where you were, what you needed. Y'know, you’re calling the machine and the machine is going to hold your feelings for me to hear, and then this wall just goes smash. (next few sentences inaudible) What’s going on? I was thinking about, I don’t know where this came from, but I remember my mother talking about her life, when she was really little, and then when her mother died, and I remember her saying that her mother was the last person who had known her when she was child. . .and. . .and. . .1 remember thinking, it won’t matter when my mother dies. I won’t have lost someone who knew me as a child. She doesn’t know me! Not now, not then! My father did. . .see this is where the train of thought left, it went to. . .1 immediately remember talks with my Dad, it used to piss me off because he would say, “I used to have so much fun with you when you were little. I would treasure taking you here and there,” and I resented that because it implied he no longer enjoyed me. . . . But I realize, my mother never says that. She never says, I really enjoyed you when you were a child. . .and that really kind

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of took it full circle. If my mother dies, she didn’t know me. She doesn’t know me. If she has any memories of me, they don’t have to do with me, they are just memories of somehow me supporting her. Somehow that all came up again, when you asked me how I was. . .1 guess that just all ties in to abandonment. I mean, I really have been abandoned by her. . . . (talk of T. giving plans with mother) And that’s the way I feel. When I talk to her. . .(got distracted by a stain on her jeans, made a joke) You seem pretty distressed today. (swallowed, softly) Yeah, (louder) Gee, it couldn’t have to do with saying good-bye to (supervisor and group) at noon today, could it? (sighs) I’m saying good-bye to everybody, (tears) It’s just all over the place. (crying) Yes, everywhere (pause) Sitting here for a minute, I started to withdraw into a warm cocoon. It, it took me to my fantasy of what I want life after death to be. I invented this in my teens. What it would be, would be to just be this infant, just float­ ing in the universe, seeing all the wonderful colors in the different galaxies, I have this image of being a floating fetus, in the, what’s it called, the amniotic sac, eyes wi-i-de open, just floating. And in that amniotic sac would be that perfectly cozy, warm feeling you get when you wake up in the middle of the night, and you pull the blanket up tighter around you. . .soft, warm. . . . (inaudible). . .with classical music playing, and I see that as peace. You’re floating so slowly through the universe. Slowly, so peaceful, that’s what I was feeling, I started to drift as I was sitting here and I shut my eyes. But you have to withdraw to have this feeling. In life, you have to brush your teeth, wash your clothes, take out the trash, it just doesn’t work! (tearful) It keeps pulling me back!

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(noticing P looks at clock) I hear the pressures out there, and this office is like the amniotic sac, but even here, you will be inter­ rupted by the end of the session. . . . (agonized sob) Yes! (while P sobbing) And maybe that’s what happened on the tape, the interruption punctured the sac/ /(anguished) Yes! You’re just falling/ /and so raw, and exposed to the elements/ And there’s no air, and cold comes in (sobbing). It’s sharp, sharp, Piercing. . . I think of that “birth without violence” idea, and when that sac breaks, there’s such a sharp slap (makes a slap) to be exposed to everything: To cold, and dark and the isolation. The isolation means you don’t count. You’re just stuck out here/ You’re cut off, severed. Yeah. . .yeah. You’re just severed. You’re just stuck out there and the rest of the world goes on. And it does not matter that you’re out there: To anybody. You don’t make a difference to anybody! And you want to make a difference to me. . .and my tape cut off, saying “you don’t”. . . . No, I know I make a difference to you. But not enough of a difference to make a difference in my life! This is where I get caught in what’s real, and what I want, and they are never, ever, ever, going to match. (P curls up in chair) You really need a mom. . .me (a play on words). It’s interesting when you said that. I would kill a mom. And then when you said you I thought, oh, yeah, okay. . ./ Oh, that kind of mommy (both laugh)/ Yeah. What was interesting is, I don’t know how you meant it, but you said, “You really need a mom. . .my.” And thought yeah, I don’t need a mom, I need a mommy. Oh, yeah

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It’s like, OK, right. I wouldn’t kill a mommy. But I’d kill a mom (pause) I still want to slap her, I still want her to know! Somehow I just had an image of putting my hand in a meat grinder. As soon as I say “I still want her to know.” I don’t know what it means. Like beating your fist against the wall. . . . (laughing) Yeah, only this is faster. . .(long pause) You know, today, you look to me like you’re in a lot of pain, and also like you’re tangled up/ /yeah tied up in knots. Yeah that, and also you look like what you want to do is just collapse in tears and grief, but you can’t/ It’s like a garden hose all smushed up. There’s a kink in it, and I don’t know where it is to untwist it to let everything flow. And I think it’s related to the phone machine. . .and maybe the shortened time of our session. . . . (tears) Just when you were saying that, I caught sight of that eye problem, and I was just awash with tenderness, “Take care of that thing,” (inaudible) [Referring to a visible problem with one of my eyes. We had spoken of it before. She knew it was not painful or dangerous, but was a nuisance.] (quietly) Yes. But I think there is more here than my eye. (inaudible but essentially she comments on her surprise at the strength of her tender feeling. Always accused of being cold and selfish, she came to believe it. Her family demanded caring, which she shut off to) I’m so glad when I can feel this much. I don’t feel much Sounds like you felt it very strongly/ I did! And it surprised me. Because I didn’t think I could feel it. (more details concerning: mother). I hate her (sobbing) I just hate her so much. She’s still there. “You’re still pushing me around. Controlling me. With your logic. And your logic is crazy!” It’s just so much control. And if it works she’s right. And if it doesn’t work, it’s because everyone else failed her. (crying) (pause)

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What’s happening now? Oh oh, images and words are just coming to me. I don’t have.. .like, “she has to die,” well, of course, and then I had an image, when she’s dead, of rubbing her hand with a steel wool pad, the kind you scrub pots and pans with, it seems a silly way to try to hurt someone. Maybe you’d like to scrape her hand raw. I’d love to do more than that. There’s so much happening now. Stuff is flowing through without much thought, (more details, but inaudible) (inaudible) (inaudible) How so? (inaudible) I have a sense of your images being very rich, and your wanting to cry, but being unable to. My first reaction is to say, “No Lynne, you’re good, you’re good. . .1 know I don’t have to take care of you but. . .” But you hear my comment as a plea for reassurance. But I do just want to let go. It’s like, a thick ketchup sack from a fast food place. And you just take a razor to it, and it oozes out. . .1 just want to lie down and. . . And. . . Somehow without puncturing me. The membrane is so thick I don’t wanna. . .wanna. . .mutilate myself to puncture the mem­ brane. . . And you’re wanting me to help you to let go, without puncturing you? (crying) And see, now I just see myself smashing my head against that concrete wall/ /yeah/ /(wailing) Why? Why does that come up now? I don’t get it! ‘Cuz when you stop that. . .there’s the grief. It’s an expression of your grief.

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I just don’t want to be here. Here? (anguished tears) I don’t even know if I mean “here” [signifying the office], or “HERE” [alive]. And I’m not just sad. I mean, I’m sitting here crying, but I’m thinking, “basically the last 3 or 4 days I’ve been pretty happy.” T: But now? P: Even now, I’m not this sad. I don’t feel like I’m as sad as I’m crying. T: You look like, also angry. P: (sigh) Yeah. Maybe. That’s closer. T: Like tears of anger, tears of rage/ P: /Yeah. . .yeah. It’s not sadness, it’s frustration! Yeah, (whis­ pered) Yeah. That's what the head against the wall is. The anger. If I just took a razor and went all across my fingertips, I could see all the blood coming (looks at me) — I’m not going to do — do any of this/ T: /It’s OK, keep going. You think you need to take care of me. P: Yeah. T: It’s a strong theme, you know. The more free, the less self censoring you get, the more this theme of taking care of me is coming up. The more you’re letting me hold you, the more you check and see if I’m still there, still OK. P: Yeah. Your machine dropped me. T: Yeah, it said “I can’t hold you.” P: You can’t! You have to cut off. You have to go “Beep.” (next passage inaudible). (Seems I commented on horror of that, she says she knows she must be horrified but does not feel it, is not feeling much.) T: You’re feeling numbed? P: Y'know, in a sense when the beeper went off I felt pissed. But there was also a sense of, “I can stop now.” And yet I didn’t stop. I cried for another few minutes, and then I kind of got it out

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of my system, and I kind of felt better. . .and I just allowed myself to be exhausted, and sad, go at a slow pace, and then I called to leave the second message to say I was fine and, "get your tape fixed!" It feels like it resolved for me, but yet everything I’m doing here, I guess that tells me I’m not. Well, y'know, there’s something, there’s something in your carriage today that keeps saying, “I can’t afford. I can’t afford to know how awful this feels. I can’t afford to know how angry I am. I can’t afford to know how much grief I feel.” Especially now. The way you look right now says/ /I give up/ “I can’t go another step. Too too much.” There are times when I’m here that I actually feel the despair. My body language is saying that, and I’m saying that, but I don’t feel it. I know it. . . I don’t think you know that I do. I think that’s what the tape did. I think it really disrupted your sense that I could hold you. Today. You’re really on your own here today. That’s what I sense. I do too. That makes sense, because that’s my sense of, “I’m OK for the day [referring to a defensive self-sufficient posture she takes repeatedly].” I mean, there are days when I walk out of here, and I think, “Oh, how can I leave? How am I going to get through the rest of the day?” But today I’m fine, y'know. . .(pause) (inaudi­ ble) (pause) In fact, your experience of the tape says, [pretending to be patient speaking to therapist] “OK, you’ll do it [hold me] for a minute. But when I let down, you’ll yank your hand back out from under me.” That just reminded me. . .(inaudible) yeah, I feel sad, but also confident of my ability to make it. To make it on your own. (inaudible) (pause) [details of plan for going to last meeting of her supervision group today] And all weekend I’ve thought, “I’m not

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going to be open, I know I’m just going to go in there, and say good-bye and then leave." I don’t like that! Because I miss what I could get! But it’s the same thing. Yeah, I just know I’m not there. And you’re afraid they’re not there. Yeah. Last week everything was so “business as usual.” They gave you a signal that they are not there. Yeah. The week before they were so completely there. More than I could have hoped. Yeah, and you really opened up. But at a signal from them that they are not going to be there, of course you’d shut down. I don’t want to lose ground. End of session. The patient called later in the day to leave a message saying the group meeting turned out to be quite nourishing for her.

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III. DIALOGIC DIRECTIONS

Expanding Intersubjectivity Theory

and Self Psychology

We need new terms and a new approach. If it will be done, it must be by new methods, by new insights. Martin Buber, (1967 p. 168)

11, A Dialogic Critique of Intersubjectivity Theory and Self Psychology

Rich Hycner

Paradoxically, the concept of the “self is without a doubt the most problematic one in the theory of self psychology. Stolorow et al. (1987, p. 17)

The self as such is not ultimately the essential. . . . Buber (1965b, p. 85) I wish to examine some foundational issues in intersubjectivity theory, and by implication, self psychology. I hope my intent will not be misunderstood: I intend to be a “friendly critic.” In fact, this critique has helped me articulate what differentiates a dialogical approach from that of intersubjectivity theory and self psychology; it has helped deepen my understanding of a dialogical perspective. My recent clinical work has been enriched by insights illuminated from intersubjectivity theory and self psychology. These theories have been most helpful in exploring the subjective world of the patient, especial­ ly as it is manifested unconsciously in the intersubjective field of psychotherapy. They have been helpful in exploring how the thera­ pist’s unconscious subjective world contributes to the responses of the patient. I find them quite helpful in articulating the selfobject needs of the patient, as well of those of the therapist.

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I am acutely aware of the courage, commitment, and hard work it has taken for the intersubjective theorists and self psychologists to put forward their approach to an often more traditional psychoanalytic audience. Obviously, I believe this approach has something of value to offer to Gestalt therapists (as well as other therapists). Consequent­ ly, I believe it is essential to examine rigorously certain foundational issues in order to do greater justice to the exquisite richness of the ontological reality between person and person. For all the strengths of self psychology and intersubjectivity theory, they do not directly address the central insight of dialogical psychotherapy — the “meeting” with the other.

inherent human need to meet, and to be met — to engage with the real otherness of an other — and to confirm an other, and to be confirmed in our otherness. This goes beyond any currently theorized selfobject need, and certainly is beyond any “intrapsychic projection” onto the other. It is on the other side of transference. In fact, this realm truly begins at the point where the intrapsychic ends.2 There is an ontological dynamic so central in the being of the human that it impels the person to seek out otherness, to meet this otherness, and to be confirmed by the other — and in fact to want to confirm the other. One is not human without this imperative some­ how being addressed. I believe that this is the profound meaning of Buber’s oft-quoted statement: “All real living is meeting” (1958a, p. 11). At the same time, one’s own “otherness to others” — one’s uniqueness — needs to be recognized and confirmed by others, lest we feel less than human. Our being, and consequently our self, is so intertwined with others that without this meeting with otherness one could not exist as a human. We need to genuinely meet others, validate their personhood, be met by others, and be validated by them. We need to live in an awareness of what Buber termed the interhu­ man.

An “Imperative” to Meet the Other: The Interhuman This instinct is something greater than the believers in the “libido” realize: it is the longing for the world to become present to us as a person, which goes out to us as we to it, which chooses and recognizes us as we do it, which is confirmed in us as we in it. Buber (1965a, p. 88)

The sexes were not two as they are now, but originally three in number; there was man, woman, and the union of the two, having a name corresponding to this double nature, which had once a real existence, but is now lost. . . . Plato (1920, p. 316)

Self psychology theory and intersubjectivity theory bring modem psy­ choanalysis to the brink of genuine dialogue — but stop abruptly short. 1 What they fail to do is to recognize what seems to be an

The Interhuman and the Intersubjective

The interhuman includes the intersubjective, but is not limited to it. The intersubjective means the awareness of interpersonal relations as they facilitate the development of one’s self in that relation (an I-it orientation). Friedman (1965b, p. 26) emphasizes that the interhuman is too easily confused with the intersubjective and the interpersonal: “Many interpersonal relations are really characterized by one person’s treating the other as an object to be known and used.” Intersubjectiv­ ity theory is primarily focused on the “psychological,” i.e., what is

2

probably does, differ). A theory, in order to be true to human experience, needs to correspond to what actually is experienced.

In most intersubjective experience there is always an admixture of the intrapsychic and the interpersonal. The relatively rare experience of genuine meeting takes us deepest into the realm of what Buber calls the interhuman — a realm that certainly includes the intersubjective, yet transcends it.

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1 At least as articulated in the theory (though the practice may, and in fact

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happening to one's self, even though certainly influenced by another self. This is not what is meant by the “between.” The interhuman — the between — is a distinct realm encompassing at least two subjectivities manifesting both I-Thou and I-It relations. This approach emphasizes that human beings are inextricably and ontologically — not only psychologically — intertwined with others. The dialogical — the unfolding of the sphere of the between — encom­ passes the psychological, even when the psychological is understood intersubjectively. There is so much emphasis on the self in intersub­ jectivity theory that one ends up “aiming”^ at one’s own self, almost in disregard of, and without responsibility for, one’s interconnected­ ness with others. The other becomes merely an “object” to be used in the pursuit of one’s own self. The other, as a unique and distinct person, becomes obscured in one’s own self-unfolding. From the dialogical perspective, the self is but one pole, though certainly an essential one, within the unfolding of the between. The self is a product of the between, not vice versa. Intersubjective self psychologists, in theory, come very close to the interhuman dimension when they discuss countertransference. Even here, however, the understanding of countertransference is on how it affects the patient, not what is the meaning for the real person of the therapist. This is as it should be, for much of the therapy. Yet there are instances that burst out of this disciplined “obedient listening” of the therapist, and call for a moment of true meeting, a momentary mutuality. This may happen rarely. However, if the possibility of this occurring is not present and sensed explicitly by the patient, then a profound opportunity for “healing through meeting” is lost. This may limit the soul-depth of the healing that can occur. Quite often, though not always, near the end of therapy there are increased moments of true mutuality, not so much being therapist and patient, though never totally leaving behind the shared history of these roles but of meeting person to person. A selfobject is not an other. It is important to remember that when Stolorow et al. speak about a selfobject they are not referring to a*

person. A selfobject subjectively serves the function of building or retaining a coherent sense of self (1987, pp. 16-17). Clearly, this is a very important concept. It is an essential beginning point, not the end point. We need a psychology which can deal in theory as well as in practice with persons, but also one that deals with Junctions, such as selfobject functions and selfobject transferences. Thus, when Buber mentions I-It relations, he is referring to a dimension experienced between people. Intersubjectivity theorists, on the other hand, are not referring to real people in discussing selfobject functions. They are referring to what is experienced subjectively by one individual, not how a situation is experienced together. In discussing what he meant by his term “reflexion,” Buber explicitly stated that the I-Thou experience is qualitatively distinguish­ able from what self psychologists many years later would refer to as selfobject functions. Reflexion occurs when a person fails to accept the essential otherness of the other person “. . .and lets the other exist as his own experience, only as part of myself’ (1965a, p. 24). This reflexion keeps the person trapped within his own self. Ultimately, selfobject functions are reflexive. They fail to reach the real other. The dialectical and the dialogical. Hans Triib, a Jungian turned dialogical therapist, over fifty years ago made the essential distinction between the “intrapsychic-dialectical” and the “interpersonal-dialogic­ al” phases of therapy (Hycner, 1991). These are not two sharply demarcated phases in the therapy, but rather emphases within a broad dialogical approach to the therapy. The intrapsychic-dialectical is usually the first phase of therapy during which the “inner world” of the patient is explored, including how the therapist is viewed by the patient. This view can be expanded to include the “inner world” of the therapist, and how that affects the patient, but these are still separate, though interacting, worlds. The dialogical is the next essential phase of the therapy, whereby there is an explicit acknowl­ edgment, and exploration, of the realm of the between, created by, and in some way greater than, both participants. Though it has been greatly expanded beyond classical psychoanalysis, it seems to me that intersubjectivity theory and self psychology still focus on the intrapsy­ chic-dialectical phase while stopping just short of the genuinely dia­ logical dimension of therapy. As Shapiro (January, 1993) has stated,

3 Buber (1958, p. 163). ----- 202 -----

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THE healing relationship in gestalt therapy —

self psychology holds that there are only two realities in the therapy — that of the patient, and that of the therapist. This is still the dialecti­ cal phase of therapy. The dialogical recognizes these two realities, yet proposes that there is a third — the between — an interhuman reality created by patient and therapist, yet belonging to neither.45 The theory of inter­ subjectivity theory and self psychology does not deal directly with the issue of real otherness (though the practice may), and the encounter that can occur between two real others, in contrast to two separate subjectivities.After everything is said and done, after there has been sustained empathic inquiry and exploration of the subjective world of the patient; after there has been empathic attunement and at times empathic immersion; after selfobject transferences have been explored and worked through; there is still the necessary dimension of real otherness that needs to be addressed (a realm that has been ignored in fact by the theory of most therapies). It is at once a realm that is so obvious and yet so alien. It is so obvious that it doesn’t

4 Ultimately, as therapist; “One’s therapeutic eye should be on the between” (Brice, personal communication, October, 1991).

5 As Charles Brice states, this is still a one-person psychology. “The classical psychoanalytic view is a one-person psychology, as observed from the analyst’s perspective. Self psychology and intersubjectivity theory is still a oneperson psychology—but as understood from the patient’s point of view” (personal communication, January, 1993). I would view these theories as “twoselves” psychologies, even as intersubjective psychologies (i.e., acknowledging two realities) but not dialogical—they do not acknowledge explicitly a reality between. Lynne Jacobs, in the following chapter entitled “The Therapist as ‘Other’: The Patient’s Search for Relatedness” explores this issue from the perspective of what occurs when the patient has had his/her “intrapsychic” and even intersubjec­ tive needs met in the therapy, and yet there is still the overarching basic human need to experience the therapist as an other, not only as a therapist. Further­ more, Jacobs emphasizes the necessity of “presence” in a dialogical approach; “Whereas intersubjectivity theory, while decrying ‘seeming’ has not yet devel­ oped an understanding of how presence can be a vital contribution to dialogue” (personal communication, October, 1991). — 204 —

— A Dialogic Critique —

seem to bear further exploration, yet it is one that brings all of us to the edge of the unknown of otherness, which permeates all creative and deep human living, and into the realm of genuine contact between persons. A selfobject need to “meet ” 1 Even if I were to stay within the thinking of self psychology and intersubjectivity theory (despite foundational differences), I could still propose that there may be a core selfobject need to have an I-Thou meeting with others. It is paradoxical, and problematic to the theory, of course, since such an encounter takes the person out of the realm of individual and intrapsy­ chic selfobject functions. Selfobject functions take us to the precipice of the I-Thou meeting. I believe that underlying many, perhaps all selfobject functions, is a deep yearning for a genuine encounter with others. As therapists we may begin$ with selfobject functions, but not end there. It is that deep underlying need for confirmation, not just from the therapist — since her motivation is to be helpful to the patient (thus this confirma­ tion may be suspect) — but from the person of the therapist, who presumably has no such “healing need” or motivation to cloud the “purity” of the encounter: Both patient and therapist may transcend socially proscribed roles, and in moments of encounter that take them both by surprise, they may truly meet — and such meeting confirms their very being. “Meeting” versus Affect Attunement

... so ancient is the desire of one another which is implanted in us, reuniting our original nature, making one of two, and healing the state of man. Plato (1920, p. 318)

6 Even this is questionable. I strongly believe that the way to begin is with the dialogical, but I did want to make the argument that it might be possible to stay within self psychology and intersubjectivity theory — though undoubtedly stretching them—and yet begin to address the issue of otherness and the I-Thou meeting. — 205 —

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Perhaps one of the most important correspondences, yet striking differ­ ences between Buber’s thought and intersubjectivity theory regards the issue of “meeting” in Buber and affect attunement in Stolorow et al. For Buber, all real healing occurs in the meeting between person and person. Though Buber would recognize the dimension that self psychologists refer to as selfobject functions, he believed that ultimate­ ly, overcoming interpersonal and intrapsychic fissures occurs in the interhuman domain of healing through meeting. This seems to exceed what Stolorow (1991a) means by healing. For him, healing occurs as the therapist is able to “affectively attune” with the selfobject needs of the patient. For Stolorow et al. (1987, p. 67) it is important to re­ member that selfobject functions refer primarily to the affective dimension of self-experience. A genuine meeting between persons goes beyond affect attunement. Affect attunement is merely a prelude to genuine dialogue. Affect attunement is the recognition of the other’s needs and the ability and willingness to be responsive to those needs. Yet this emphasis on selfobject functions and selfobject ties seems to leave out the per­ sonhood (the being) of the person who is affectively attuned to another. Buber’s discussion of inclusion is relevant here: In mutual inclusion (dialogue), both persons are concerned about meeting the needs of the other person, while concurrently attending to her/his own being. Affect attunement seems to leave out this dimension of the interhuman. Though the intersubjective is a dimension of the interhu­ man, it is not equivalent to it.

There is a fundamental disagreement between a dialogical approach and that of intersubjectivity theory. Ultimately, the premises of both predicate that they’re exploring two distinct, yet inextricably related, realms of experience. A dialogical approach is interested in the experience of a person-in-relation, whereas an intersubjective self psychologist is interested primarily in the se//-in-relation of that person. Atwood and Stolorow differentiate in theory between a person, and the self of that person. They believe that whereas the terms personal­ ity and character are overly broad ones, the term self is far more specific and refers to “. . . a psychological structure through which self-experience acquires cohesion and continuity. . .” (1984, p. 34). Interestingly, they view the self as “acquiring cohesion and continu­ ity,” not the person] They go on to make a surprising and critical distinction: “We have found it important to distinguish sharply between the concept of the self as a psychological structure and the concept of the person as an experiencing subject and agent who initiates action” (1984, p. 34). They do this because from their redefinition of psychoanalysis, only the experience, or absence, of personal agency can be accessible to sustained empathic inquiry. Personal agency, for them, is never directly accessible to sustained empathic inquiry. This strikes me as somewhat convoluted. I would suggest that personhood is in principle, and in fact, accessible to empathy and introspection. This distinction is central to differentiating the dialogical viewpoint from that of intersubjectivity theory and self psychology. A dialogic viewpoint focuses on persons-in-relation. Such a focus does not preclude the reality that persons do think of their personhood at times in terms of a self, as well as viewing others in a similar manner. In fact, I would propose that there is such an intertwining of the person and the self as to make this “sharp distinction” exceedingly ambigu­ ous, and in fact not rigorously descriptive of the experience of the per­ son. Undoubtedly in therapy, perhaps much of the time, more focus needs to be placed on the self functions of a person, yet never losing sight of the fact that we are dealing with a person. Person is a far more comprehensive category than self. The questions Stolorow et al. raise about self-experience become figural only because they assume

“Person” versus "Self”

Whatever personhood is, whatever that existential agent is, called the “person,”! don’t think we can decide on the basis of the psychoanalytic method. Stolorow (1991a) To begin with oneself, but not to end with oneself; to start from oneself, but not to aim at oneself; to com­ prehend oneself, but not to be preoccupied with one­ self. Buber(1958b, p. 163) — 206 —

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an essential background — the personhood of the person. I am saying simply that we need to be able to rigorously engage and examine both. I would suggest that self psychologists need to think along two distinct, yet intertwined and oscillating, dimensions: that of self (including the relationship of selfobject to selfobject) and the dimen­ sion of person to person. This will enrich the understanding of self­ structures and persons-in-relation. It is the richness of this figure-ground ambiguity that we need to make the subject of our inquiry. Intersubjectivity theory currently isn’t intersubjective enough! In fact, I would argue for an even more expansive intersubjectivity theory — one that investigates multiple viewpoints/ while giving primacy — though not exclusivity — to the patient’s viewpoint. We might have to call such an expanded self psychology, “person-to-person psychology”. I would certainly not be opposed to calling it a dialogic or dialogical psychology.

terminology) in contrast to what is observed is exactly one of the major reasons why that particular configuration of a self becomes interesting, and the focus of inquiry. If there were complete congru­ ence between the person and the self there would be no reason for that person to be in therapy. In fact, the patient is seeking the integration of self with his personhood, even if the latter is only vaguely felt or discerned. Self — an experience-distant concept! In spite of the desire of intersubjectivity theory to be “experience-near,” the concept of self, as here defined, paradoxically appears to be experience-distant. I do not experience myself as a self (object), but rather as a person — a multifarious being who exhibits personal agency and manifests certain cohesive characteristics that I can reflectively later identify as a self. Personhood in this context is far more comprehensive and elusive than the concept of the self (already sufficiently elusive).

Personal Agency: of Person or Self?

Constricted Phenomenology

Stolorow et al. propose that though from the perspective of an observer, patients are constantly performing actions, self psychologists are concerned as to; “. . .whether or not they experience themselves as abiding centers of initiative” (1987, p. 19). These centers of initiative indicate a sense of personal agency and they view this as inherent to a consolidated self (1987, p. 19). There are two points here: First of all, the experience of personal agency is first and foremost a characteristic of being a person, and secondarily a function of a self. Secondly, as therapists, we readily recognize the distinction between what is observed in a patient, and how that person experiences herself. However, if it is apparent to an observer that patients are always performing actions, then why, a priori, should that be eliminated from psychotherapeutic inquiry? In fact, the “discrepancy” in the patient’s “self (using Stolorow et al.’s

Undoubtedly, Stolorow et al. experience the person-to-person meeting, but because of their understanding of phenomenology as investigating only idiographic subjective experience^ (including that of the thera­ pist) and their consequent definition of psychoanalysis, they unfortu­ nately have to exclude the person to person experience from their conceptualization and theorizing (in spite of their interest in the reciprocal relationship of transference and countertransference). Phenomenology is not restricted to only the subjective experience of one individual at a time. It is the rigorous investigation of what is. From a dialogical perspective, that can include not only the individual subjective experience of the patient and that of therapist, but also the experience of the between, which transcends “individual” experiences. In effect, they are discussing the psychological world preceding or underlying, the meeting of person with person, though not yet the actual meeting.

~7

It goes far beyond the scope of this chapter to talk about the possible relationship between this understanding of psychology and some of the intriguing theories coming out of quantum physics. Hopefully, I can explore this at a later date. — 208 —

$ Atwood and Stolorow (1984). — 209 —

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This restriction is further indicated in an intriguing footnote in which they state that “selfobject failure” does not mean an “objective­ ly assessed” misunderstanding on the part of the therapist, but rather to a situation “subjectively experienced” by the patient as not meeting his needs (1987, p. 17). Their meaning of “objective” here is some­ what imprecise. They talk about objective and subjective as if they were clearly distinct. In fact, as they’ve pointed out, how an event is subjectively experienced is always part of an intersubjective context. That is, the aforementioned caregiver did, or did not do, something. I would suggest, in contrast, that it is profoundly important, and even essential, to understand if from the therapist’s perspective (or that of some other person, — such as a supervisor) how the therapist may have failed to empathize appropriately with the patient9 even if it was not consciously experienced as such by the patient. This discrepancy needs to be inquired into. This is by no means to say that the therapist’s experience is primary either — therapist and client, with all their subjective experiences, both mutually congruent and incongruent, are in a dialogue — in the profoundest sense of the term. Furthermore, I should note that the words “objectively assessed” seem to imply the possibility of an objective stance, outside of the intersubjective event. Such a so-called objective stance is only another subjective viewpoint on two other subjective viewpoints, the patient’s and the therapist’s. There is no truly objective viewpoint (which Stolorow et al. would agree with in principle), only “transsubjective” viewpoints, i.e., two subjective viewpoints cohere. All of these viewpoints, including the observer part of the participant­ observer analyst, or even of an outside observer, such as a supervisor, are part and parcel of a necessarily multiperspective stance, inherent to a dialogic approach. As Brice succinctly put it: “The therapist has a duty to approach the ‘between’ and to describe it — certainly from his point of view — but sooner or later the ‘between’ will emerge so strongly that both the therapist and patient will recognize it” (personal

communication, October, 1991). This may require different philosoph­ ical and theoretical assumptions, perhaps dialogical ones. This is an even more radical viewpoint of the therapeutic relation­ ship than that of intersubjectivity theory. The subjective experience of the patient should have the overall primacy of importance that Stolorow et al. argue for, but it cannot be exclusive. The incongru­ ence of the patient’s self-experience, especially as experienced by the person (not the self) of the therapist is essential information that fuels the curiosity and caring of the therapist, to engage in the disciplined and “sustained empathic inquiry.” I would suggest that in spite of the enormous difficulty of dealing with the inexhaustibility and ultimate uncategorizability of a “person,” that we not stop in our efforts to illuminate this mysterious phenome­ non of the person-in-relation. As mentioned earlier, “The sphere in which man meets man has been ignored because it possesses no smooth continuity” (Friedman, 1965b, p. 17). Psychology, and psychotherapists, need to deal with ontological issues, because these issues are always at the core of being human. If we are not present to them, acknowledge them, and give them their due, we do a grave disservice to the richness, though ultimate incomprehensibility, of what occurs between person and person.

9

I am not unaware of the difficulty of pitting one subjectivity against another. Quite the contrary, this engagement of differing viewpoints may be ultimately what is most healing.

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Philosophical Foundation What I believe is lacking in self psychology is an underlying and coherent philosophical foundation (in spite of the recent publication of the more philosophically intended Contexts of Being by Stolorow and Atwood, 1992). A dialogical approach provides such an ontological understanding of the interhuman dimension, and explores its implica­ tions for healing. Clearly, intersubjectivity theory is an extremely radical approach within psychoanalysis. From a dialogical perspec­ tive, it isn’t radical enoughl It needs to have an underlying and co­ herent philosophy and needs to open itself up to the exploration of the mystery of the I-Thou meeting, and the moments of reciprocal mutu­ ality in therapy.

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Despite Stolorow et al.’s definition of a self as a “psychological structure,” in contrast to defining a person as an “existential agent” (Stolorow et al., 1987, p. 18), the analyst (therapist) must at some time be a person, not just a selfobject. The healing of the client requires it, and the mysteriousness of person-with-person cannot be reduced to a psychological category, even that of selfobject. This isn’t so much a criticism of self psychology as a reminder of balancing the emphasis within it. Perhaps the question raised almost twenty-five years ago by no less a personage than Guntrip, one of the founders of the object relations school, in critiquing that particular approach, might also be raised as a question for self psychology and intersubjectivity theory.

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A Dialogic Critique ___

fact, the thrust of the cases appeared to be more person-oriented than se//-oriented. The theories of self psychology and intersubjectivity theory need to move more in that direction.

Conclusion I hope that this critique helps differentiate the dialogical from self psy­ chology, and from intersubjectivity theory. I also hope that it points toward a way in which these approaches may complement and, in fact, enrich each other.

But the theory has not yet properly conceptualized Buber’s IThou relation, two persons being both ego and object to each other at the same time, and in such a way that their reality as persons becomes, as it develops in the relationship, what neither of them would have become apart from the relationship. (Guntrip, 1969, p. 389)

A language of "objects, ” not persons. Finally, the language of self psychology and intersubjectivity theory is still so immersed in classi­ cal psychoanalytic theory and metapsychology, that it becomes difficult to remember that ultimately, it is a person, not an “object,” who is being discussed. In his defense, Stolorow (1991a) has stated that it needs to be understood that he is speaking primarily to a psychoanalytic audience and therefore he needs to retain its language. That is understandable certainly, even laudable, for what intersub­ jectivity theorists are trying to accomplish, yet it does not remove intersubjectivity theory from fundamental criticisms of its philosophi­ cal assumptions, and the language that flows from them. It also appears that the theory may not be rigorously congruent with the practice, in a rather positive manner, from a dialogic perspective. For example, the cases presented by Stolorow (1991a) and Shapiro (1991) at the “Seventh Annual Conference on Dialogical Psychotherapy” displayed a heartwarming humanity in their understanding of their patients, as well as their contributions to the patients’ experiences: In

— 212 —

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12. The Therapist as "Other": The Patient's Search for Relatedness *

Lynne Jacobs

In the practice of psychotherapy, philosophy and psychotherapy are intimately intertwined. Therapeutic interventions are guided as much by a therapist’s philosophy as they are by an understanding of psy­ chology and psychotherapeutic principles. Both philosophy and psychology attempt to address the question of what it means to be a human being. One gravitates toward certain philosophical assumptions in large part because they address fundamental personal, subjective themes in one’s life. From a psychological perspective, one’s philoso­ phy can be seen as an artistic and abstract description of one’s subjectivity. From a philosophical perspective, one’s psychology can be seen as an embodied, personal expression of some of the various universal themes that philosophies are dedicated to articulating.

Author’s Note: I wish to thank Gary Yontef for his careful reading and criticism of an earlier draft of this paper. [R.H.: Only minor changes, including inserting a number of subtitles, were made in the original manuscript. Though I am not in complete agreement with some of the seeming emphasis on self-disclosure, this chapter is so vitally important because it brings to the forefront the central issue of the “otherness” of the therapist, often not focused explicitly in self psychology and intetsubjectivity theory.]

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— The Therapist as "Other" ___

My Personal and Professional Search for “Otherness”

In my opinion, most clinical theories are moving toward the fundamental concepts of Buber’s philosophy of dialogue. They do so slowly, carefully, from a more “scientific,” as opposed to philosophi­ cal position. Not many of these theories trace their development directly to an influence from Buber’s philosophy, but Buber's philoso­ phy is part of a general “Weltanschauung” that definitely affects the development of new ideas in psychology. I have already referred to Gestalt therapy — representative of the humanistic tradition — as fertile ground for the philosophy of dialogue. Turning to the psychoanalytic tradition, a group of modem psychoana­ lytic theorists known as “intersubjective” theorists (a branch of self psychology) are attempting to influence psychoanalysis to renounce its natural science origins in favor of a so-called “human science” perspective. They in turn are influenced by a German philosopher, Dilthey, who influenced Buber’s philosophy:

Perhaps a description of my development as a psychotherapist can illustrate the interplay of personal psychology and philosophical interests. My professional interests have been shaped by my lifelong struggle to overcome a pervasive sense of isolation and disconnection in my life. My struggle to come out of isolation and to allow intima­ cy, to touch and be touched, has been of central importance. I was initially drawn to humanistic therapies — especially Gestalt therapy — because of what I witnessed in the therapeutic relationship; the Gestalt therapists I first met were intensely present and engaged. I saw in their willingness to really “meet” their patients, person to person, an emotionally intense encounter, some hope for salvation from my own emotional impoverishment and isolation. In fact, I first discovered Martin Buber’s philosophical anthropol­ ogy when I studied Gestalt therapy. The relationship in Gestalt therapy is said to be predicated on Martin Buber’s philosophy of dialogue. It is the only school of therapy I know of that has purposely placed Martin Buber’s philosophy as a cornerstone of its theory, although it is only recently that an elaborated description of the dia­ logic philosophy in Gestalt therapy has emerged (Hycner, 1985; Jacobs 1989). I was immediately drawn to Buber’s ideas. He spoke elegantly to my deeply felt yearnings for genuine engagement with others. His ideas helped me see my own personal struggles in the broader framework of universal human themes, thus reducing my sense of alienation from the world of other humans. Also, he asserted that strivings for genuine relatedness were something that could con­ tribute to the well-being of others, whereas I tended to think of my yearnings and strivings as anathema to others. My abiding personal interest in relatedness has fueled an abiding professional interest in the therapeutic relationship as a curative factor. This has led me to Gestalt therapy, with its emphasis on direct meeting, and to modem psychoanalysis, with its continuing refinement of the notion of transference as in part a search for new relatedness, and of the subtleties of empathy. Since I read Buber, my studies — be they humanistic or psychoanalytic — are integrated with the guiding principles of “healing through dialogue.”

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According to Dilthey, the human sciences are to be distin­ guished from the sciences of nature because of their fundamen­ tal difference in attitude toward their respective objects of investigation: The natural sciences investigate objects from the outside whereas the human sciences rely on a perspective from the inside. (Atwood & Stolorow, 1984, p. 2)

Inclusion From a natural science perspective, observable behaviors such as interactions with others are studied. From a human sciences perspec­ tive, the meanings to the experiencing subject are explored. In a description closely allied with Buber’s notion of “inclusion,” Stolorow and Atwood assert that within the human sciences, one attempts to understand another from a perspective within the other’s frame of reference. In fact, Dilthey’s thinking (in Atwood and Stolorow, 1984) is parallel to that of Buber. The mode of relatedness in the natural sciences is the I-It mode of subject-to-object. The mode of relatedness in the human sciences is the I-Thou mode of subject-to-subject. Self psychology and intersubjectivity theory assert, with their selfobject concept, that one’s self comes into being and is maintained as a self-with-other. They also emphasize empathic inquiry as the foundation of psychoanalysis. The intersubjectivists have developed — 217—

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and refined a listening stance which, in my view, is the basis for inclusion. Buber defines “inclusion” in therapy in this way: “The therapist must feel the other side, the patient’s side of the relationship, as a bodily touch to know how the patient feels it” (1967, p. 173). It is a concrete imagining of the reality of the other, in oneself, while still retaining one’s own self-identity. Confirmation means that one is apprehended and acknowledged in one’s whole being (Buber, 1965b). The act of confirmation requires that one enter into the phenomenological world of the other without judgment, while still knowing one’s own being. In my opinion, this is precisely what happens when an intersubjective analyst engages in sensitive attunement to the patient’s emotional experience, or engages in empathic immersion in the inner world of the patient. The modem psychoanalysts draw, in part, on exciting new findings in infant research studies put forward by Stem (1985) and Lichtenberg (1989). Both of these researcher/clinicians use infant research studies to argue that from birth infants are interacting with an “other.” The other may be only vaguely defined and perceived as an other, but evidence is ample of a rudimentary differentiation between self and other from birth. Another exciting discovery is that an infant’s sense of self and self-regulation (even regulation of physical states such as sleep and hunger) are patterned by the reciprocal, mutual interactions between caretaker and infant. These studies demonstrate that healthy self-development requires a sensitively attuned emotional responsiveness from the caretaking surround. The emotional attunement establishes both a mutual system of physiological and emotional regulation, and also embeds the infant in a web of relatedness, without which a sense of personal selfhood cannot form. Attunement and Relatedness The two themes — of sensitive attunement to the inner world of the “other,” and embeddedness in relation — are obviously compatible with Buber’s dialogical philosophy. They are major steps along the way to developing a theory that appreciates the central importance of en­

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gagement with otherness for self development. But they remain incomplete, in that their focus is on the caretaker’s responsiveness to the infant, and they do not explore fully the implications of the child’s engagement with the “otherness” of the other. Intersubjectivity theory brings these two developmental themes into the psychotherapy process. First, they emphasize that the therapist’s task is to establish an attuned, empathic grasp of the patient’s inner world. Second, their interpretations focus to a great extent, on understanding the patient’s experiences as emergent phenomena of the quality of relatedness which exists between therapist and patient. Thus, the patient’s experience of the therapy relationship is seen to be codetermined by the patient’s previously established ways of being, and also by input from the therapist. They further assert that the therapist’s experience is also codetermined by the therapist’s predispo­ sition, and by input from the patient. They conceptualize the therapy relationship as an “intersubjective system of reciprocal mutual influ­ ence” (Stolorow et al., 1987). The implications of such a fluid, “dialogic” view are not yet fully articulated in the evolving literature of intersubjectivity theory, but in my opinion the theory is moving closer to Buber’s philosophy of dialogue. At the present time, intersubjectivity theory makes a strong case for reliable affect attune­ ment as the means whereby the affect integration necessary for self­ development occurs. The Interhuman Meeting

From a dialogical perspective, another dimension of relatedness is cen­ tral to self-development, and that is the “interhuman meeting.” In the interhuman meeting, attunement, a centrally important embodiment of inclusion, is accompanied by the therapist’s presence. The therapist is first and foremost a human being. As Buber insisted, for a genuine meeting to take place, the therapist must be present as a human being who endeavors to meet the patient, from the depths of one vital center to another. To touch, and thereby to heal, the roots of the patient’s being, a therapist must:

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Step forth out of his protected professional superiority into the elementary situation between one who asks and one who is asked. The abyss in the patient calls to the abyss, the real, unprotected self, in the doctor and not to his confidently func­ tioning security of action. The analyst returns from this paradox . .as one for whom the necessity has opened of a genuine personal meeting between the one in need of help and the helper. (Friedman, 1976, p. 190)

Presence involves bringing the fullness of oneself to the interaction. Therapists must be willing to allow themselves to be touched and moved by the patient. As I described in an earlier chapter, in therapy, presence means also that the therapist is willing to be open to a kind of contact in which the patient can touch the therapist’s subjective experience, both directly and indirectly. Quite often this occurs indirectly. But at crucial points in the therapy, for instance in efforts to address serious disruptions in the therapy relationship, or at certain developmental thresholds, the patient may be intensely interested in, and require, access to the therapist’s experiencing. Self development proceeds not only through the experiences gained through sensitive attunement to the patient’s otherness, but through the experience of that attunement coming from a discernible, personal other.

Therapist as “Other” The remainder of this chapter is dedicated to exploring the therapeutic implications of practicing therapy from a stance which holds that the therapist’s presence is as much a necessity as skills, typology, even as much a necessity as is the practice of inclusion. I am especially drawn to understanding two related concepts, “presence” and “other­ ness,” in the therapeutic relationship. These notions find a welcome reception in the humanistic therapies, but they are often poorly understood and misused. Meanwhile, they are approached with a great deal of caution and timidity by psychodynamic/psychoanalytic therapies. I wish to elaborate on the place of presence and otherness in the therapeutic process in such a way as to

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render the concepts attractive and practical for a broad range of therapy theories.

Therapy Along a “Narrow Ridge ”

Therapists conduct therapy along a peculiar “narrow ridge.” On one side of the ridge is our commitment to, and faith in, exploring and articulating experience as fully as possible. This includes, most importantly, patients’ experiences of relatedness, and the myriad meanings relatedness holds for them. On the other side of the ridge is “the ineffable.” No matter how thoroughly we explore meanings, motivations, the drama of relatedness — no matter how richly patients come to articulate their world of relatedness — there comes a point where one has a concrete sense that there is more to the relationship than one is able to describe. We find ourselves thinking, or we hear our patients saying, “There is more here. But there are no words. But it is something primal, fundamental, that cannot be further ‘reduced.’ It just is.” It is easy to get lost trying to follow this narrow ridge. Some therapists lose themselves on the side of meanings. Sometimes their patients come away knowing a great deal about certain dimensions of relatedness and self-experience, but they are diminished in a profound way. For relationships are only understood as serving certain needs and functions for the patient. That which is ineffable has not been ac­ knowledged, and patients may now believe that the self-regulating or narcissistically relevant elements intrinsic to all relatedness is all that there is to relatedness. On the other hand, some therapists may so revere the ineffable that they do not help their patients to understand that which can be known and grasped about their relatedness. These patients may leave their therapy feeling vaguely at a loss and guilty about just how much of their relatedness does involve their narcissistic needs. They may try to purify themselves of such rewards of relatedness, until isolation becomes their only mode of being that does not demean the ineffable quality of relatedness, which it has become their duty to protect. In

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actuality, the ridge between these two dimensions of relatedness — the I-It and the I-Thou — is not a solid ridge. It is more like netting. The dialectical and the dialogical. Triib described two major phases of psychotherapy, the dialectic and the dialogical. In my experience, even in a more dialectic process during therapy, the ground that makes the therapeutic dialectic possible is the one-sided inclusion (referred to in an earlier chapter) — a dialogic process — which the therapist practices throughout the therapy. There are two paradoxes here. First is the fact that the I-Thou relation is also self­ enhancing. From a psychological perspective, the I-Thou relation serves narcissistic or self-regulating functions. As Buber describes: For the inmost growth of the self is not accomplished, as people like to suppose today, in man’s relation to himself, but in the relation between the one and the other, between men, that is, preeminently in the mutuality of the making present — in the making present of another self and in the knowledge that one is made present in his own self by the other — together with the mutuality of acceptance, of affirmation and confirmation. (1965b, p. 71)

Meanwhile, when patients are truly able to allow themselves to use me as an “it” — for their emotional or self-esteem regulation — and when I am permitted to be helpful to them and can surrender to it whole­ heartedly, the intimacy of such a reciprocal event touches us both profoundly. We may have started at some distance from each other — and they may need to use me more as a means than they can relate to me as an end — yet we move into fundamental relation to each other, speaking from center to center. At such moments the line between I-It and I-Thou becomes nonexistent — at least from my side of the dialogue. Curiously, it is through careful listening to, and engagement with, the patient’s experiences on the other side of the ridge, the side of meanings and functions, that I develop a feel for when the ineffable is upon us. For example, I have worked for four years with a woman who relates to people largely as means toward an end for herself. When others do not serve the functions she needs them to serve, she — 222 —

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spirals into a well of despair and self-loathing. About two years ago at the end of a very intense session where her despair was palpable to us both, she said to me she was amazed that I hung in there with her She also said, “I love you.” I suggested that perhaps she was grateful to me. I also suggested that her “I love you” was a way of saying “I need you.” I thought perhaps she was guilty and afraid of censure for saying, so baldly, “I need you,” because she was supposed to be mature and loving, not selfish and needy. She agreed at the time, and began to be more open with me about her self-regulatory needs of me. Her therapy has progressed, and recently she has been able to break free of a long pattern of enmeshed involvement with her adult chil­ dren. This was accomplished in part by a growth in her capacity to experience me, herself, and them as independent centers of initiative (I will discuss this issue in her treatment later). This shift in perspec­ tive now permeates the quality of her relatedness with all others. Recently she ended a phone conversation with me saying, “I really love you, Lynne. I know you think that means I need you, but I love you too.” I said we will talk more about it at our next session, that I thought there had been a shift that changed the meaning of her statement to me. It is my sense, at this time, that her “love” does carry more than need. Certainly she experiences herself as being confirmed by me in her otherness (which includes a strong attachment to me), and she is confirming me by allowing me to have helped her. Perhaps we are in the realm of the ineffable here.

Presence and Otherness Therapy is, in large part, a developmental process. At different points in the process, different qualities of otherness are sought and required for the patient’s growth, or for the patient’s healing. One of the arts of therapy is the attempt to bring your presence forward in a way that addresses the patient’s current particular relational need. A develop­ mental perspective on dialogue would assert that there is a natural developmental thrust toward dialogue. If the therapist can provide the ground by being available for various kinds of “meeting” as new

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developmental sequences emerge, then a full-bodied tuming-towardthe-other will emerge. In fact, confirmation, which is intrinsic to dialogue, does not come about simply through the act of inclusion. The inclusion is meaningful because it has been voluntarily proffered by a separate other. And yet the dimensions of otherness which the patient may seek relation to will differ over time. Initially, in fact, for some patients, any sense of the otherness of the therapist may be experienced as a burdensome impingement on them. These patients feel compelled to attend to the narcissistic needs of the other at the expense of their own needs. Their only safety lies in a relation to a therapist who will quietly, and without protest, keep his or her otherness lying fallow in the back­ ground for a sustained period of time. In this case, the therapist’s presence is manifested through a dedication to providing a necessary background, a culture in which the patient may begin to grow without conscious awareness that such a culture is being provided. The developmental thrust of relation to otherness is described in a recent popular song, “Wind Beneath My Wings.” The lyrics describe a woman looking back, grateful to a friend who stood in her shadow and provided the “wind beneath the wings” so that the protagonist might fly. At first the protagonist took the friend for granted. Only as the protagonist matured did she realize the gift that her friend had given her by quietly and gently supporting her (Stolorow, personal communication, October, 1990). At times the most loving, therapeutic presence the therapist can offer in therapy is a genuine, gentle willingness to provide a back­ ground against which the patient emerges, as in this statement by Hycner:

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one pole within an overall rhythmic alternation between our individual separateness and our participation in something larger than us, i.e. “Being.” (1985, p. 33) We know that patients come to us having been thwarted in their desires for genuine meeting. They often feel hopeless and despairing of ever relating genuinely and deeply with another. And we know that such genuine meeting is not possible unless the patient has a genuine other with whom to meet. And yet, if the therapist aims at bringing him or herself to the patient as an other, instead of aiming at meeting the otherness of the patient, then the inclusion has been violated. For therapists, their otherness must always emerge in re­ lation to the on-going inclusion in which they are immersed. It is through this process of inclusion that the developmental strivings of the patient can best be grasped. One of the most common mistakes made by Gestalt therapists is a tendency to impose their presence on their patients. For one’s presence to be a part of what heals the other, it must be delicately balanced against the patient’s readiness to encounter an other. Thera­ pists often bring their presence forward willy-nilly, rather than measured in response to the call from the patient. This imposition becomes justified as an expression of genuine dialogue. But it is an encounter lacking in an inclusive understanding of the patient’s needs and readiness. Presence and inclusion exist in a figure/ground relation to each other. Through the practice of inclusion we arrive at an understanding of how our presence is being experienced by the patient. We also come to understand what kind of otherness the patient seeks. We can adapt our presence to be relevant to the patient’s emergent develop­ mental needs. The ongoing practice of inclusion, and the ever-shifting adaptations of one’s presence, are both played out in the “between.”

In a genuine dialogical approach it seems to me that the thera­ pist is a “steward of the dialogical.” By this I mean that in a very profound sense, the individuality of the therapist is subsumed (at least momentarily) in the service of the dialogical, which is the entire therapeutic gestalt and includes the individu­ als in it. . . .It assumes that genuine uniqueness arises out of genuine relations with others and the world. Individuality is but

One obvious dimension of therapist presence is that of therapist self­ disclosure. Sometimes self-disclosure is a disciplined response to

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being called out as an other by the patient. Sometimes it is an enactment of the therapist’s narcissistic needs. Sometimes it is a sur­ prising moment of spontaneous reactivity. In any case, it is a moment in the therapy process when the patient is brought face-to-face with the otherness of the therapist. I offer below some examples from my own work that I hope will refine our understanding of how patients experience our presence, and how our use of our presence intersects with both the patients’ defensive needs and with the developmental readiness for, and ability to assimilate. I have found that when a therapist describes his or her own experience in the therapy relationship, it can have a quite different impact, depending on a variety of factors. Obviously, a self-disclosure is a complex motivated intervention. The patients, based on their characteristic way of organizing their experience, may be more affected by certain of the motivational factors, and relatively unaffect­ ed by others. The patient may respond, to the therapist’s dismay, to what, in the therapist’s mind, is either a relatively minor motivation, or one that is a source of embarrassment to the therapist (e.g., a narcissistic need). Other factors that will influence how a self-disclo­ sure is received is the patient’s particular developmental or defensive needs at the time, and his or her developmental readiness.

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different class of person than she was, and could only feel contempt for her defectiveness). Currently, four years later, she tentatively seeks a connection to my inner world, warts and all, as she begins to feel herself more and more a part of the planet. She now thinks that if I have problems and can function as well as I do, than maybe she can too. My presence over time with her has shifted as we both find our way in this evolving developmental relationship. I started out imposing myself too strongly on her, crushing her sense of herself as having her own mind. Then she experienced me as providing the water she could learn to swim in. During that phase I brought myself to her largely through systematic immersion in her world as best she and I could describe it. Now I am more active in bringing in my personal, particular personality, and she is reveling in the experience of engaging deeply as two distinct personalities. She never knew before that we could be different people and yet share the same passion — commitment to her development. Defining the Field of Experience

I am reminded of a patient I work with who is deeply ashamed of herself and considers herself to be inherently and irreparably defective. She also often believes that no one else in the world has the same problems that she has. In the first few years I was so pained by her sense of shameful isolation that I twice told her things about myself that were similar to problems she was describing. In both instances she became severely distressed, felt impinged on, and insisted that I not ever do that again. She said she needed me to be a “whole,” not defective like herself. Similarities between us were organized by her as a sign that I too was defective and therefore could not offer her any hope of wholeness for herself (in a painful paradox, she was also deeply humiliated by our perceived difference, as that meant I was a

For some patients, a therapist’s self-disclosure helps them to define and delimit their own self-experience, as well as determine the interpersonal field for which they are responsible. For other patients, the self-disclosure is experienced as a requirement for them to come to the aid of the therapist, and respond to the therapist’s narcissistic needs. Presence in the service of self-delineation. An example of the former is my work with a patient with whom I wrestle with seemingly intransigent countertransference difficulties. Unfortunately, this woman’s characterizations of me when she is disappointed in me confirm my worst fears about myself as a cold and heartless person. I react to what I experience as a humiliating exposure by psychologi­ cally withdrawing, thereby compounding her sense of my destructive (to her) defectiveness. Recently this recurrent pattern brought us to a point of impasse. I had, by this point, admitted to having counter­ transference difficulties, and I was working to lessen their impact on the therapy, although without much success. In agony, she sought a

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consultation with a colleague of mine. She was in an excruciating bind. She was very attached to me, and could not imagine surviving without me. On the other hand, this pattern was also “killing” her. The consultation proved useful for both of us in underscoring her des­ peration. I decided to tell her more about what I knew of my counter­ transference difficulties. I told her that I felt humiliated, and dreaded that her characterizations might prove to be true of me, and my defense against the humiliation was withdrawal. That session was transformative for both of us. By articulating my experience, directly with her, I am less dominated by my dread of humiliation. My patient was deeply moved, and relieved in that by my admission of my own agonizing self-doubts she was freed of the burden of trying to “work around” my problems. Now they could be addressed directly and empathically as they occurred. She no longer feels responsible for pushing me away, although she is saddened that this particular pattern has been so painful for both of us. I cannot describe in words the increased intimacy, humility, and depth of relating which has occurred between us, but it is quite palpable to both of us. Presence as annihilating impingement. On the other hand, when I disclosed a countertransference problem with another patient, in the same hope that it would help her to define her own experience and not be responsible for mine, the patient experienced it more as a usurpa­ tion of her experience. This particular patient knows a great deal about my life. She seems to use the knowledge as a way to stay in touch with me as an anchor in her life. She knew I had suffered a painful loss, and it stimulated her own grief regarding her father’s premature death many years ago. She averred that my recent tragedy was the stimulus for the mourning that she entered into for the next several sessions. In one session I could not bear the intensity of my own grief which was being stimulated by my patient’s mourning. I defensively distanced myself from her experience. She noticed the subtle change in my demeanor and asked what had happened. I explained what I was feeling and she became upset and angry. She said she felt undermined in her grief, as if I was telling her my grief was more important than hers, and that she should now abandon herself to shore me up. I was surprised. She knew I was grieving. I thought my — 228 —

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speaking of it would create a meeting of greater intimacy between us Only recently we have begun to understand some of the roots of her experience of the interaction; her mother used to be abusive to her and then later apologize, saying she was just having a bad day. My patient heard her mother’s “confession” as a plea to forgive, and most importantly, forget the injury my patient had suffered. My patient worried I wanted the same thing. For my part, in retrospect, I do think I was turning to her to meet my need for comfort and solace. This is a patient for whom I feel great fondness, and a desire for more closeness. Thus, I think there was a confluence of her fear of usurpa­ tion, and my intrusion of my neediness into her session. Empathy for the Other as a New Dimension of Relatedness Meanwhile, I have another patient who is reluctant to inquire as to how I am faring in my grief, even though she cares deeply for me, and would like to. offer support. She is afraid of intruding on my privacy, and on my sense of professionalism. She was also cruelly exploited in her childhood, and she feels terribly vulnerable when she shows tenderness toward others. In our latest session we were talking about her relationship with her infant son. We thought, based on a dream she reported, that the overpowering tenderness she felt toward her son might be paving the way for the risk of being tender with adults. At the same time, she rued that she is unable to believe that she is giving anything positive to her son. His calm, sweet disposition is attributed to his genes, or to the housekeeper, but never to her. She has a long-standing belief that she is toxic to others, and has nothing positive to offer people. She mentioned her concerns for me, and consequent embarrass­ ment, late in this session. It seems to me that my genuine desire to have her know of my grief, and how consoling it is for me when she inquires, is an example of where my presence provided for her a new relational experience. She was able to have her tenderness toward another adult be welcomed, she saw that it contributed to my own healing, and she has not been exploited. In this case, the relevant otherness of the therapist is as an other who can benefit from being in her presence!

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The Address of the Other as Permission to Expand

Another use of the “other” may be as a guide to the range of permissi­ ble expressiveness or affectivity in the relationship. This was brought home to me recently in a session with the woman I mentioned above who has recently begun to enjoy getting to know me as a flawed person. She made reference to something that was a painful reminder of my recent loss. Unable to contain myself, I started to weep, and choked out a few grief-stricken words. My patient was shaken to have had such a powerful effect on me by an almost offhanded re­ mark. Then she began to weep, and spoke of the deep sadness which is her constant companion. This patient rarely cries, since for her, tears are a humiliation. The next session this patient felt lost and flustered, saying she wished she could push a button to recreate the feelings of closeness between us at the last session. She was angry and disappointed. She sees me as in charge of our intimacy. I can either offer it or withhold it. She is powerless. Her anger and frustrated disappointment carried over into our next session as well. In this session she was finally able to trace that the closeness for her began with my tears, and then had continued into her tears and my interest in them. It finally dawned on both of us that my tears were permission for her to have her own tears. Her parents had been rigid and highly controlled people, who demeaned her and disapproved of her emotions. What we came to realize was that, although we had often talked together about her being able to more freely show her emotions, the talking about was similar to happened to her parents. She was looking for me to concretely set the boundaries of permissible affectivity between us, by what I did, and she desperately hoped I would be more expressive than her parents were. This emerged from the same woman who for years had insisted I stay as anonymous as possible so as not to crush and disappoint her. The end result of this exploration was a realization that the “other” determines the range of acceptable emotional expres­ sion, and she is required to stay within the boundaries that the other person establishes. Another similar example comes from a case described in a case conference. The patient seemed unable to speak directly of herself in relation to the therapist. She would use words like “people,” and — 230 —

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“others” when she seemed to be expressing her own needs. Then the therapist asked if she might tape record their sessions. The therapist clearly stated it as a desire of hers. In the same session, and for the first time, the patient directly stated a wish of her own.

Meeting Otherness as an Affirmation of Existence

Some patients overtly may search out the therapist’s otherness. The therapist’s otherness serves the developmental aim of affirming the patient’s existence by being able to be affected by the patient. For instance, a patient may need the therapist’s emotional reactions as a sign that the patient is relating to a spontaneous other who has a vital center of his or her own. These patients often had parents who usually said all the right things, but were hidden behind a facade. The patients were never truly met, and they grew up feeling dead inside, expecting to meet others who are dead at their cores. Another patient may seek otherness as a boundary against which they can feel their own uniqueness. Someone else may use otherness as a way to discover the subjectivity of others, and also the relativity of their own subjectivity. Thus, I have a patient who, after many years of therapy, has begun to ask me how I feel about certain life dilemmas I may have, how I feel in certain life situations (such as differences with my lover). She seems to be attempting to make room for her own fears, vulnerabilities, etc., by finding out that everyone’s internal world is different, and that if one looks cool on the outside, it does not mean they have no vulnerabilities on the inside.

Defensive Search to Possess the Other

Sometimes patients overtly seek the otherness of the therapist for defensive reasons. I have a patient who insists that I acknowledge every anxiety that I experience in our relationship, and every defensive moment, and every moment of self-doubt and vulnerability. He watches me carefully, and is relentless when he spots a vulnerability of mine, until I can provide him with a satisfactory accounting of it, including a description of the relevant character limitations. Once I give such an accounting he is generous in spirit, compassionate, and accepting. But it has become clearer to both of us that, among other — 231 —

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things, this patient is defending against terrible feelings of mortifica­ tion by exposing me. His reasoning goes something like: if I expose her as having frailties, she will not be able to scrutinize my own because I will be able to point to hers as proof that mine are not so bad. He lives, in his view, in a world of dominating, brutal-critical others, and domination of others is his only defense. Another patient of mine interprets my possible motivations whenev­ er she experiences me as failing to be fully present and open to her. Recently I admitted to some irritation with her. In her usual fashion, she made some guesses about my vulnerabilities and defenses. She asked for corroboration and further elaboration from me. I hesitated to do so, telling her I did not feel open to such exploration with her. I told her I felt rebellious in the face of what I experienced as her attempts to control me. As we engaged further in this painful dia­ logue, it emerged that she believed that if she pointed out to me just what my psychological conflicts were, she thought she might be able to prevent them from impinging on her in the future. From this emerged a lack of faith that I would have the maturity, willingness, and skills to do the work I needed to do to provide the developmental climate she needed. Needless to say, this led back to stories of her parents and how woefully inadequate and immature they were when it came to providing a psychological climate conducive to her growth throughout her childhood. Interestingly, I never did tell her the nature of my countertransference problem as I understood it. We had several tense sessions where she waited with baited breath to see if I really could take care of the problem without her help. When she saw that I could, she became emboldened to break free of some stultifying merged relationships with her adult daughters where she was “help­ ing” them so much that they did nothing on their own and everyone was resentful. This is the first patient I mentioned, whose relation to my otherness is expanding into greater capacity for love and gratitude toward me. The difference to me is clear: at first she “loved” me in order to regulate her self esteem and soothe her painful feelings of despair and shame. Now she loves me for my dedication to her well­ being. Her self-esteem is being greatly enhanced by the newfound experience of loving another as part of the on-going stream of relat­ edness. Rather than aiming at feeling better, she is aimed at relating. — 232 —

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Not surprisingly, her shame and despair are abating as her esteem rises.

Conclusion In the cases described above, I endeavor to show that patients seek re­ latedness in differing ways, depending on their past experiences and their current developmental needs. Dialogical therapists must tailor their presence to the developmental readiness of the patient. The readiness of the patient is often discovered through systematic practic­ ing of inclusion. The therapy process becomes a fluid dialectical process of alternation between inclusion and presence, as differing types of relatedness are sought by the patient at different stages in the therapy process. There is an ongoing dialogue between Buber’s philosophy of dialogue and the psychology of therapeutic dialogue. In that process, therapists can continue to refine their abilities to engage in a dialogue with their patients that is both sensitive to their developmental needs and evocative of their richness as human beings.

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References

Alexander, R., Brickman, B., Jacobs, L., Trop, J., & Yontef, G. (1992). Transference meets Dialogue: A discussion between self psycholo­ gists and Gestalt therapists. The Gestalt Journal, 15(2), 61-108.

Atwood, G. E. (1983). The pursuit of being in the life and thought of Jean-Paul Sartre. Psychoanalytic Review, 70, 143-162. Atwood, G. E. (1989). Psychoanalytic phenomenology and the thinking of Martin Heidegger and Jean-Paul Sartre. In D. W. Detrick, & S. P. Detrick, (Eds.) Selfpsychology. Comparisons and contrasts (pp. 193-212). Hillsdale, NJ: The Analytic Press. Atwood, G. E., & Stolorow, R. D. (1984). Structures of subjectivity: Explorations in psychoanalytic phenomenology. Hillsdale, NJ: The Analytic Press.

Beisser, A. (1970). The paradoxical theory of change. In J. Fagan & I. Shepherd (Eds.), Gestalt therapy now (pp. 77-80). New York: Harper & Row.

Berger, D. M. (1987). Clinical empathy. Northvale, NJ: Jason Aronson,Inc. Blum, H. P. (1985). (Ed.). Defense and resistance: Historical perspec­ tives and current concepts. New York: International Universities Press, Inc Boszormenyi-Nagy, I., & Krasner, B. R. (1987). Between give and take: A clinical guide to contextual therapy. New York: Brunner/Mazel.

— 235 —

___ THE HEALING RELATIONSHIP IN GESTALT THERAPY —

Boszormenyi-Nagy, I., & Spark, G. M. (1973). Invisible loyalties. New York: Harper and Row. Brandchaft, B., & Stolorow, R. (1984). The borderline concept: Patho­ logical character or iatrogenic myth? In Lichtenberg, J. (Ed.), Empathy, Vol. 2. (pp. 333-357) Hillsdale, NJ: Analytic Press.

Breshgold E., & Zahm, S. (1992). A case for the integration of self psychology developmental theory into the practice of Gestalt therapy. The Gestalt Journal. 25(1), 61-94. Brice, C. W. (1984). Pathological modes of human relating and thera­ peutic mutuality: A dialogue between Buber’s existential-relational theory and object-relations theory. Psychiatry: Journal for the Study of Interpersonal Processes, 47, 109-123.

Brice, C. W. (1987). What forever means: An empirical existentialphenomenological investigation of the maternal mourning of a child’s death. Unpublished doctoral dissertation, Duquesne Univer­ sity. Ann Arbor, MI: (University Microfilms International, 8805348).

References

Buber, M. (1957a). Healing through meeting. In M. Buber, Pointing the way (pp. 93-97). (M. S. Friedman, Trans., & Ed.). New York: Schocken Books. (Original work published 1952) Buber, M. (1957b). Hope for this hour. In M. Buber, Pointing the way (pp. 220-229). (M. S. Friedman, Trans., & Ed.). New York: Schocken Books. (Original public address given in 1952)

Buber, M., (1957c). Pointing the way (M.S. Friedman, Ed. and Trans.) New York: Schocken Books. (Original work published in 1952) Buber, M. (1958a). I and thou (R. G. Smith, Trans.). New York: Charles Scribner and Sons. (Original work published 1923)

Buber, M. (1958b). Hasidism and modern man. (M. Friedman, Ed. & Trans.) New York: Harper and Row. (Original works published in 1918, 1928, 1943, 1950, 1955, & 1957)

Buber, M. (1958c). Postscript. In I and thou (pp. 121-134) (R. G. Smith, Trans.). New York: Charles Scribner and Sons. (Original work published 1923)

Brice, C. W. (1991). Paradoxes of maternal mourning. Psychiatry. 54,1-12.

Buber, M. (1965a). Between man and man (R. G. Smith, Trans.). New York: The Macmillan. (Original works published in 1926, 1929, 1936, 1938 & 1939)

Buber, M. (1952a). Eclipse of God: Studies in the relation between re­ ligion and philosophy (M. Friedman, E. Kamenka, N. Guterman, & I. Lask, Trans). New York: Harper & Row. (Original works published in 1929, 1932, 1943, & 1951)

Buber, M. (1965b). The knowledge of man: A philosophy of the inter­ human. Introduction by M. S. Friedman. (M. S. Friedman, & R. G. Smith, Trans.). New York: Harper & Row. (Original works published in 1951, 1954, 1958, I960, 1961, & 1963)

Buber, M. (1952b). Good and evil (R. G. Smith, Trans.). New York: Charles Scribner and Sons. (Original works published in 1952)

Buber, M. (1967). A believing humanism: Gleanings (M. S. Fried­ man, Trans.). New York: Simon & Schuster. (Original works published between 1902 and 1964)

Buber, M. (1952c). Religion and modern thinking. In M. Buber, Eclipse of God: Studies in the relation between religion and philosophy (M. Friedman, Trans.) (pp. 63-92). New York: Harper & Row.

Buber, M. (1952d). Supplement: Reply to C. G. Jung. In M. Buber, Eclipse of God: Studies in the relation between religion and philosophy (M. Friedman, Trans.) (pp. 131-138). New York: Harper & Row. — 236 —

Buber, M. (1970). I and Thou. (W. Kaufman, Trans.). New YorkScribner’s Sons. (Original work published 1923)

Buber, M. (1973). Meetings (M. Friedman, Trans.). LaSalle, IL: Open Court. Bugental, J. F. T. (1965). The search for authenticity. New York: Holt, Rinehart and Winston. — 237 —

THE HEALING RELATIONSHIP IN GESTALT THERAPY —

Bugental, J. F. T. (1976). The search for existential identity: Patient­ therapist dialogues in humanistic psychotherapy. San Francisco: Jossey-Bass. Bugental, J. F. T. (1985, March). Response to panel presentation on dialogical psychotherapy. Symposium on Existential-Dialogical Psychotherapy, San Diego. Bugental, J. F. T. (1987). The art of the psychotherapist. New York: W. W. Norton.

— References —

Dublin, J. (1976). Gestalt therapy, existential-Gestalt therapy and/versus “Perlsism.” In E. Smith (Ed.), The growing edge of Gestalt therapy (pp.124-150). New York: Brunner/Mazel.

Enright, J. (1975). An introduction to Gestalt therapy. Tn F. Ste­ phenson (Ed.), Gestalt therapy primer (pp. 13-33). Chicago: Charles Thomas.

Burton, A. (Ed.). (1976). What makes behavior change possible. New York: Brunner/Mazel.

Farber, L. H. (1966). The ways of the will: Essays toward a psy­ chology and psychopathology of the will. New York: Basic Books.

Colm, H. (1966). The existentialist approach to psychotherapy with adults and children. New York: Grune & Stratton.

Farber, L. H. (1967). Martin Buber and psychotherapy. In P. A. Schilpp & M. S. Friedman (Eds.), The philosophy of Martin Buber (pp. 557-601). La Salle, IL: Open Court.

Crocker, S. F. (1983). Truth and foolishness in the “Gestalt Prayer.” The Gestalt Journal 6(1), 4-15.

Deikman, A. (1983). The observing self: Mysticism and psychother­ apy. Boston: Beacon Press. DeLeo, J. V. (1984, September). Psychoanalytic and dialogical psycho­ therapy. Presentation at a meeting of The Institute for ExistentialDialogical Psychotherapy, San Diego.

Farber, L. H. (1976). Lying, despair, jealousy, envy, sex, suicide, drugs, and the good life. New York; Harper & Row.

Frank, K. A. (Ed.). (1977). The human dimension in psychoanalytic practice. New York: Grune & Stratton. Frew, J. (1992). From the perspective of the environment. The Gestalt Journal, 15(1), 39-60.

Friedman, A. (1992). Treating chronic pain: The healing partnership. New York: Plenum Press.

DeLeo, J. V. (1985, January). Diagnosis and treatment in dialogical psychotherapy. Presentation at a meeting of the Institute for Existential-Dialogical Psychotherapy, San Diego.

Friedman, M. S. (1960b). Martin Buber: The life of dialogue. New York: Harper & Row. (original work published 1955)

DeLeo, J. V. (1989). Martin Buber and psychotherapy: An introduc­ tion to dialogical psychotherapy. Work in progress.

Friedman, M. S. (1964a). Existential psychotherapy and the image of man. Journal of Humanistic Psychology, 4(2), 104-117.

Downing, C. (1987). Re-visioning the psychology of women: An exis­ tential-dialogical approach. Perspectives: The Journal of Dialogi­ cal Psychotherapy, /(I), 1-18.

Friedman, M. S. (1964b). The worlds of existentialism. Chicago: University of Chicago Press.

— 238 —

Friedman, M. S. (1965a). Introduction. In M. Buber, Between man and man (pp. xii-xxi). New York: Macmillan.

— 239 —

THE HEALING RELATIONSHIP IN GESTALT THERAPY -----

Friedman, M. S. (1965b). Introductory essay. In Buber, M. The knowl­ edge of man: A philosophy of the interhuman(pp. 11-58). (M. S. Friedman, & R. G. Smith, Trans.). New York: Harper & Row.

Friedman, M. S. (1967). Martin Buber’s credo. In M. Buber, A believ­ ing humanism: Gleanings by Martin Buber. (R. Anshen, Ed.)(pp, 21-26). New York: Simon and Schuster.

Friedman, M. S. (1972a). Dialogue and the unique in humanistic psychology. Journal of Humanistic Psychology, 12(2), 7-22. Friedman, M. S. (1972b). Touchstones of reality: Existential trust and the community of peace. New York: Dutton.

Friedman, M. S. (1974). The hidden human image. New York: Dell. Friedman, M. S. (1976a). Aiming at the self: The paradox of encounter and the human potential movement. Journal of Humanistic Psychology, 16(2), 5-34. Friedman, M. S. (1976b). Healing through meeting: A dialogical ap­ proach to psychotherapy and family therapy. In J. Smith (Ed.) Psychiatry and the Humanities (pp 191-234). New Haven: Yale University Press.

Friedman, M. S. (1976c). Martin Buber: The life of dialogue. Chica­ go: University of Chicago Press. Friedman, M. S. (1983a). The confirmation of otherness: In family, community and society. New York: The Pilgrim Press. Friedman, M. S. (1983b). Second visit to America: Encounter with psychotherapy. In M. S. Friedman, Martin Buber’s life and work: The later years, 1945-1965(pp. 205-229). New York: E. P. Dutton, Inc.

Friedman, M. S. (1984). Contemporary psychology: Revealing and obscuring the human. Pittsburgh: Duquesne University Press. Friedman, M. S. (1985a). The healing dialogue in psychotherapy. New York: Jason Aronson.

— 240 —

— References —

Friedman, M. S. (1985b). Healing through meeting and the problematic of mutuality. Journal of Humanistic Psychology, 25(1), 7-40. Friedman, M. S. (1986). Martin Buber and the eternal. New York: Human Sciences Press, Inc.

Friedman, M. S. (1989, May). Keynote Address. Eleventh Annual Conference on the Theory and Practice of Gestalt Therapy. Chicago, IL.

Gilligan, C. (1982) In a different voice: Psychological theory and women’s development. Cambridge, MA: Harvard University Press. Goldberg, A. (1988) A fresh look at psychoanalysis: The view from self psychology. Hillsdale, NJ: Analytic Press. Graf-Taylor, R. (1990). Freedom in dialogical psychotherapy. Unpub­ lished doctoral dissertation. Professional School of Psychological Studies, San Diego.

Greenson, R. R. (1977) That “impossible” profession. In K. A. Frank (Ed.), The human dimension in psychoanalytic practice(pp. 99114). New York: Grune & Stratton. Greenson, R. R. (1978) The “real” relationship between the patient and the psychoanalyst. In R. R. Greenson (Ed.). Explorations in Psychoanalysis (pp. 425-440). New York: International Universi­ ties Press.

Guntrip, H. (1975). My experience of analysis with Fairbairn and Winnicott (How complete a result does psychoanalytic therapy achieve?) International Review of Psychoanalysis, 2, 145-156.

Heard, W. (1993). The healing between: A clinical guide to dialogical psychotherapy. New York: Jossey-Bass.

— 241 —

__

the HEALING RELATIONSHIP IN GESTALT THERAPY —

— References —

Heidegger, M. (1962). Being and time. (J. Macquarrie, & E. Robinson, Trans.). New York: Harper & Row. (Original work published in 1927)

Kempler, W. (1973). Gestalt therapy. In R. Corsini (Ed.), Current psychotherapies, (2nd ed)(pp.251-286). Itasco, IL: Peacock Publishers.

Hycner, R. (1985). Dialogical Gestalt therapy: An initial proposal. The Gestalt Journal, 8(1), 23-49.

Kohut, H. (1959). Introspection, empathy and psychoanalysis. Journal, American Psychoanalytic Association, 7, 459-483.

Hycner, R. (1987). An interview with Erving and Miriam Polster: The dialogic dimension in Gestalt therapy. The Gestalt Journal, 70(2), 27.66.

Kohut, H. (1971). The analysis of the self. New York: International Universities Press.

Hycner, R. (1990). The I-Thou relationship and Gestalt therapy. The Gestalt Journal, 73(1), 41-54. Hycner, R. (1991). Between person and person: Toward a dialogical psychotherapy. Highland, NY: The Gestalt Journal Press. (Pub­ lished and translated in German as, Zwishcen Menschen: Ansatze zu einer dialogishen psychotherapie (1989). Koln: Edition Humanistishche Psychologic).

Jacobs, L. M. (1978). I-thou relation in Gestalt therapy. Unpublished doctoral dissertation, California School of Professional Psychology, Los Angeles.

Jacobs, L. M. (1989). Dialogue in Gestalt theory and therapy. The Gestalt Journal, 12(1), 25-67. Jacobs, L. M. (1991, February). Intersubjectivity Theory. Presentation to the San Diego Self Psychology Study Group, La Jolla, CA.

Kahn, E. (1985). Heinz Kohut and Carl Rogers: A timely comparison. American Psychologist. 40(8), 893-904.

Kaufman, W. (1970). I and you: A prologue. In M. Buber, I and Thou (W. Kaufman, Trans) (pp.7-48). New York: Scribner’s Sons.

— 242 —

Kohut, H. (1977). The restoration of the self. New York: International Universities Press. Kohut, H. (1984). How does analysis cure? (A. Goldberg, Ed., with collaboration of P. Stepansky). Chicago: The University of Chicago Press.

Korb, P. (1988). The numinous ground: I-thou and Gestalt work The Gestalt Journal, 77(1), 97-106. Kron, T., & Yungman, R. (1987). The dynamics of intimacy in group therapy. International Journal of Group Psychotherapy, 37(4), 529-548. Kron, T. (July, 1990). Two supervision case studies and their political context: An Arab therapist with a Jewish client; A Jewish thera­ pist with an Arab client. Presentation at a meeting of the Institute for Dialogical Psychotherapy, San Diego, CA. Lachmann, F. (1986). Interpretation of psychic conflict and adversarial relationships: A self-psychological perspective. Psychoanalytic Psychology, 3(4), 341-355.

Laing, R. D. (1965). The divided self. Baltimore: Penguin Books.

Lambert, M. J. (Ed.). (1982). Psychotherapy and patient relationships. Homewood, IL.: Richard D. Irwin. Langs, R., & Searles, H. F. (1980). Intrapsychic and interpersonal dimensions of treatment: A clinical dialogue. New York: Jason Aronson.

— 243 —

THE HEALING RELATIONSHIP IN GESTALT THERAPY —

Latner, J. (1973). The Gestalt therapy book. New York: The Julian Press.

Latner, J., (1983). This is the speed of light: Field and systems theories in Gestalt therapy, The Gestalt Journal, 2, 71-91.

Leavy, S. A. (1980). The psychoanalytic dialogue. New Haven: Yale University Press.

Levitsky, A, & Peris, F. (1970). The rules and games of gestalt therapy. In J. Fagan & I. E. Shepherd (Eds.), Gestalt therapy now. (pp. 140-149). New York: Harper & Row. Lichtenberg, J. (1989). Psychoanalysis and motivation. Hillsdale, NJ: The Analytic Press Masek, R. J. (1989). On Maurice Merleau-Ponty and the psychology of the self. In D. W. Detrick and S. P. Detrick, (Eds.) Self psy­ chology: Comparisons and contrasts (pp. 131-151). Hillsdale, NJ: The Analytic Press.

Maslow, A. H. (1964). Religions, values and peak-experiences. New York: The Viking Press. Maslow, A. H. (1968). Toward a psychology of being (2nd ed.). New York: Van Nostrand. Maslow, A. H. (1969). Interpersonal (I-Thou) knowledge as a paradigm for science. In A. Maslow, The psychology of science: A recon­ naissance (pp. 102-118). Chicago: Henry Regnery. Maslow, A. H. (1971). The farther reaches of human nature. New York: Viking.

— References —

Merleau-Ponty, M. (1962). The phenomenology ofperception (C. Smith, Trans.). New York: Routledge and Kegan Paul, (original work published 1945) Merleau-Ponty, M. (1964). The primacy ofperception and other essays on phenomenological psychology, the philosophy of art, history and politics. J. M. Edie, (Ed. & Trans.). Evanston, IL: Northwestern University Press. (Original works published 1946, 1947, 1955, 1960, & 1961)

Merleau-Ponty, M. (1968). The visible and the invisible. (A. Lingis, Trans.). (C. Lefort, Ed.) Evanston, IL: Northwestern University Press, (original work published 1964) Muller, J. P., & Richardson, W. J. (1982). Lacan and language: A reader’s guide to Ecrits. New York: International Universities Press.

Naranjo, C. (1975). I and thou, here and now: Contributions of gestalt therapy. In F. Stephenson (Ed.), Gestalt therapy primer (pp, 3453). Chicago: Charles Thomas.

Nissim-Sabat, M. (1989). Kohut and Husserl: The empathic bond. In D. W. Detrick and S. P. Detrick, (Eds.), Selfpsychology: Compar­ isons and contrasts, (pp. 151-174). Hillsdale, NJ: The Analytic Press.

O'Connell, V. F., (1970). Crisis therapy: Person, dialogue, and the organismic even. In J. Fagan, & I. L. Shepherd (Eds.), Gestalt therapy now (pp.243-256). New York: Harper and Row.

May, R. (1969). Love and will. New York: Dell. May, R. (1981). Freedom and destiny. New York: Norton. May, R. (1983). The discovery of being: Writings in existential psy­ chology. New York: Norton. May, R., Angel, E., & Ellenberger, H. F., (Eds.). (1958). Existence. New York: Simon & Schuster.

— 244 —

Peris, F. (1969). Gestalt therapy verbatim. New York: Bantam Books. Peris, F. (1973). The Gestalt approach and Eyewitness to therapy. Palo Alto, CA: Science and Behavior Books.

— 245 —

___ THE HEALING RELATIONSHIP IN GESTALT THERAPY —

Peris, F. (1975). Gestalt therapy and human potentialities. In F. Stephenson, (Ed.), Gestalt therapy primer(pp. 73-79). Springfield, IL: Charles Thomas Publishers.

Peris, F., Hefferline, F. R., & Goodman, P. (1951). Gestalt therapy: Excitement and growth in the human personality. New York: Dell. Peris, L. (1970). One Gestalt therapist’s approach. In J. Fagan and I. Shepherd (Eds.), Gestalt therapy now,(pp. 125-129). New YorkHarper and Row.

Peris, L. (1976a). Comments on new directions. In E. W. L. Smith (Ed.), The growing edge of Gestalt therapy(pp.221-226). New York: Brunner/Mazel, Publishers. Peris, L. (1976b, May). Presentation for The Gestalt Therapy Institute of Los Angeles. Peris, L. (1989). Leben an der grenze: Essays und anmerkungen zur Gestalt-therapie. M. Sreckovic (Hrsg.), Koln: Edition Humanistishche Psychologic.

Peris, L. (1989). Living at the Boundary. J. Wysong, (Ed.). Highland, NY: The Gestalt Journal Press.

— References —

Polster, E., & Polster, M. (1983). Every person’s life is worth a novel. The Gestalt Journal 1(2), 59-66. Polster, E., & Polster, M. (1986, May). Keynote Address the Second Annual Conference on Dialogical Psychotherapy, San Diego.

Polster, E., & Polster, M. (1994). Frederick Peris: Legacy and invitation. The Gestalt Journal, 16(2), 23-25 Rioch, M. J. (1960). The meaning of Martin Buber’s “Elements of the Interhuman” for the practice of psychotherapy, Psychiatry: The Journal of Interpersonal Processes, 23, 133-140. Rogers, C. R. (1961). On becoming a person. Boston: Houghton Mifflin.

Rogers, C. R. (1967). The interpersonal relationship: The core of guid­ ance. In C. R. Rogers & B. Stevens (Eds.), Person to person: The problem of being human(pp. 85-101). New York: Real People Press. Rogers, C. R. (1969). Freedom to learn. Columbus, OH: Merrill. Rogers, C. R. (1980). A way of being. Boston: Houghton Mifflin.

Plato, (1920). The dialogues of Plato, Vol. I. (B. Jowett, Trans.). New York: Random House.

Rogers, C. R., & Stevens, B. (1967b). Person to Person. Lafayette, CA: Real People Press.

Polster, E. (1987). Every person’s life is worth a novel. New York: Norton.

Rosenblatt, D. (1991). An interview with Laura Peris. The Gestalt Journal, 14(1), 7-26.

Polster, E. (1992). The self in action: A Gestalt outlook, pp. 143-154. In J. K Zeig, (Ed.). The Evolution of Psychotherapy: The Second Conference (pp. 143-154). New York: Brunner/Mazel.

Polster, E., & Polster, M. (1973). Gestalt therapy integrated. New York: Vintage Books.

Schoen, S. (1989, May). I-Thou: The larger gestalt. Workshop presentation at the Eleventh Annual Conference on the Theory and Practice of Gestalt Therapy, Chicago. Schuster, R. (1979). Empathy and mindfulness. Journal of Humanistic Psychology, 19, 71-77.

Polster, E., & Polster, M. (1976). Therapy without resistance: Gestalt therapy. In A. Burton (Ed.), What makes behavior change possible (pp. 259-297). New York: Brunner/Mazel.

Searles, H. (1986). My work with borderline patients. Northvale, NJ: Jason Aronson.

— 246 —

— 247 —

___ THE HEALING RELATIONSHIP IN GESTALT THERAPY —

Shapiro, S. (1991, May). Case Presentation. Seventh Annual Confer­ ence on Dialogical Psychotherapy, San Diego.

Shapiro, S. (1993, January). Talking to patients: Psychoanalytic tech­ niques and self psychology. Presentation to San Diego Self Psychology Study Group. Simkin, J. (1976). Gestalt therapy mini-lectures. Celestial Arts.

Millbrae, CA:

Simon, D. (1994, January). Mind-body medicine. Presentation at SharpCabrillo Hospital, San Diego, CA. Smith, E. W. L. (1976). The roots of Gestalt therapy. In E. W. L. Smith (Ed.), The growing edge of Gestalt therapy(pp. 3-36). New York: Brunner/Mazel, Publishers.

Stephenson, F. (Ed.). (1975). Gestalt therapy primer. Chicago: Charles Thomas. Stem, D. (1985) The interpersonal world of the infant. New York: Basic Books

Stolorow, R. (1986). On experiencing an object: A multidimensional perspective. In Goldberg, A. (Ed.), Progress in self psychology: Volume 2 (pp. 273-279). New York: Guilford Press. Stolorow, R. (1986). Critical reflections on the theory of self psy­ chology: An inside view. Psychoanalytic Inquiry, 6, 387-402.

Stolorow, R. (1991b, March). Subjectivity and self psychology: A personal odyssey. Paper read at “Clinical Applications of Self Psychology: Transference and Countertransference,” symposium sponsored by the San Diego Self Psychology Study Group.

— References —

Stolorow, R., & Atwood, G., (1989) The unconscious and unconscious fantasy: An intersubjective-developmental perspective. Psychoan­ alytic Inquiry. 9(3), 364-374. Stolorow, R. D., & Atwood, G. (1992). Contexts of being: The in­ tersubjective foundations ofpsychological life. Hillsdale, NJ: The Analytic Press. Stolorow, R. D., Brandchaft, B., & Atwood, G. E. (1983). Intersub­ jectivity in psychoanalytic treatment: With special reference to archaic states. Bulletin of the Menninger Clinic, 47, 117-128.

Stolorow, R. D., Brandchaft, B., & Atwood, G. E. (1987). Psychoana­ lytic treatment: An intersubjective approach. Hillsdale, N. J.: The Analytic Press.

Stolorow, R. D., & Lachman, F. (1984). Transference: The future of an illusion. The Annual of Psychoanalysis. 12, 19-37. Suzuki, S. (1970). Zen mind, beginner’s mind. New York: John Weatherhill.

Tallon, A. (1978). Intentionality, intersubjectivity, and the between: Buber and Levinas on affectivity and the dialogical principle. Thought: A Review of Culture and Idea, 53(210). 292-304.

Ticho, E. (1974). Donald W. Winnicott, Martin Buber and the theory of personal relationship. Psychiatry: Journal for the Study of Interpersonal Processes, 37, 240-253. Tobin, S. (1983). Gestalt therapy and the self: Reply to Yontef. The Gestalt Journal, 6(1), 71-90.

Stolorow, R. (1991a, May). The intersubjective context of intrapsychic experience. Keynote presentation at the Seventh Annual Confer­ ence on Dialogical Psychotherapy, San Diego, CA.

Tobin, S. (1990) Self psychology as a bridge between existentialhumanistic psychology and psychoanalysis. Journal of Humanistic Psychology. 30(1) 14-63.

Stolorow, R. D., & Atwood, G. (1979). Faces in a cloud: Subjectivity in personality theory. New York: Jason Aronson.

Triib, H. (1964a) From the self to the world. (W. Hallo, Trans.). In M. S. Friedman (Ed.), The worlds of existentialism: A critical reader(pp. 497-499) Chicago: University of Chicago Press, (original work published 1947)

— 248 —

— 249 —

__ the

HEALING RELATIONSHIP IN GESTALT THERAPY —

Triib, H. (1964b). Healing through meeting. (W. Hallo, Trans.). In M. S. Friedman (Ed.), The worlds of existentialism: A critical reader(pp. 499-505). Chicago: University of Chicago Press, (original work published 1952) Triib, H. (1964c). Individuation, guilt, and decision. (Trans., & Ed., M. S. Friedman)). In The worlds of existentialism^#. 497). Chicago: The University of Chicago Press, (original work published 1935)

Tubbs, W. (1972). Beyond Peris. Journal of Humanistic Psychology, 12(2), 5.

Ulman, R. B., & Stolorow, R. D. (1985). The “transference-countertransference neurosis.” In Psychoanalysis: An intersubjective view­ point. Bulletin of the Menninger Clinic, 49, 37-51.

Van de Riet, V., Korb, M. P., & Gorrel, J. J. (1980). Gestalt therapy: An introduction, New York: Pergamon. Van Dusen, W. (1967). The natural depth in man. In C. R. Rogers & B. Stevens, Person to Person (pp. 214-240). New York: Pocket Books. Van Heusdan, A., & Van Den Eerenbeemt, E. (1987). Balance in motion: Ivan Boszormenyi-Nagy and his vision of individual and family therapy. New York: Brunner/Mazel Publishers.

Weizsacker, V. von. (1964). Doctor and patient. (K. E. von Rhau, & M. S. Friedman, Trans.). In M. S. Friedman (Ed.), The worlds of existentialism: A critical reader, (pp. 405-409). Chicago: Univer­ sity of Chicago Press. (Original work published 1949)

Welwood, J. (Ed.). (1979). The meeting of the ways: Explorations in East/West psychology. New York: Schocken Books.

— 250 —

References —

Welwood, J. (Ed.) (1983). Awakening the heart: East/West approach­ es to psychotherapy and the healing relationship. Boulder, CO: Shambhala.

Wilber, K. (1979). A developmental view of consciousness. The Journal of Transpersonal Psychology, 11(1). Wilber, K. (1980). The pre/trans fallacy. The Journal of Humanistic Psychology. 22, 57-90. Wilber, K. (1984a) The developmental spectrum and psychopathology: Part I, Stages and types of pathology. The Journal of Transperson­ al Psychology, 16, 75-118.

Wilber, K. (1984b). The developmental spectrum and psychopathology: Part II, treatment modalities. The Journal of Transpersonal Psychology, 16, 137-166.

Wilber, K. (Ed.). (1982). The holographic paradigm. Boulder: Sham­ bala Publications Inc.

Yalom, I. D. (1974). Every day gets a little closer: A twice-told therapy. New York: Basic Books, Inc.

Yalom, I. D. (1989). Love’s executioner and other tales ofpsychother­ apy. New York: Basic Books, Inc. Yontef, G. M. (1975). A review of the practice of Gestalt therapy. In F. Stephenson (Ed.), Gestalt therapy primer, (pp. 161-208). Chicago: Charles Thomas Publishers. Y ontef, G. M. (1976). Clinical Phenomenology. In V. Binder, & B. Rimland (Eds.), Modern therapies (pp. 65-79). Englewood Cliffs, NJ: Prentice-Hall.

Y ontef, G. M. (1979). Gestalt therapy: Clinical phenomenology. The Gestalt Journal, 2(1), 27-45. Y ontef, G. M. (1979). Clinical Phenomenology. The Gestalt Journal, 2(1), 27-45.

— 251 —

the healing relationship in gestalt therapy

----

Yontef, G. M. (1983). Gestalttherapie als dialogische methode. Integrative Therapie, 9, Jg. Heft 2/3, 98-130. (Original work circulated 1981)

Index

Yontef, G. M. (1984). Modes of thinking in Gestalt therapy. The Gestalt Journal. 2(1), 33-74. Yontef, G. M. (1989, May). The “I-Thou” and Gestalt therapy. Panel presentation. Eleventh Annual Conference on the Theory and Practice of Gestalt Therapy, Chicago. Yontef, G. M. (1993). Awareness, dialogue, and process: Essays in Gestalt therapy. Highland, NY: The Gestalt Journal Press.

Acceptance: 23, 24, 25, 37, 56, 61, 63, 71, 124; and patient’s willingness 55; inherent 63; of beingin-situation 55; of needs 150; of phenomenologi­ cal attitude 62

Zinker, J. (1975). On loving encounters: A phenomenological view. In F. Stephenson (Ed.), Gestalt therapy primer (pp. 54-72). Chicago: Charles Thomas Publishers.

Archaeological metaphor 166

Zinker, J. (1977). Creative process in Gestalt therapy. New York: Brunner/Mazel.

Archaeology of unconscious (Freudian): 165 Attunement 124, 125, 126, 135, 136, 151, 157, 171, 204, 206, 218, 219, 220

Atwood, G.E. 113, 114, 119, 124, 130, 131, 144, 168, 169, 207, 217

Buber, Martin: 3, 7, 8, 9, 11, 12, 13, 15, 16, 17, 22, 26, 28, 29, 31, 46, 52, 53, 54, 55, 59, 60, 63, 64, 65, 68, 69, 70, 71, 72, 73, 74, 79, 82, 97, 99, 101, 113, 115, 116, 117, 119, 122, 123, 134, 141, 146, 147, 198, 199, 200, 201, 203, 206, 216, 217, 218, 219, 222; concept of inclusion: 33; dialogical philosophy: 218; domain of investigation: 147; existentialism: 154; paradigm of dialogic rela­ tion: 84; perspective: 58; philosophy: 146, 147, 217; philosophy of dialogue: 53, 116, 217, 219 Bugental, J.F.T.: 36

Behavioral change: 64

Betweeness: 97

Centeredness: 20, 21, 25, 27

Biological rhythms of organ­ isms: 83

Biology: 83

Brandchaft, B.: 130

— 252 —

Compulsive personality: 28 Confirmation: 22, 23, 24, 25, 53, 71, 72, 73, 75, 76, 125, 140, 171, 205, 222,

— 253 —

___ THE HEALING RELATIONSHIP IN GESTALT THERAPY —

224; mutual: 73, 75; means: 71, 218; of healing process: 55; of oneself: 71; one-sided: 80 Contactful engagement: 57

Countertransference: 36, 42, 165, 202; difficulties; 227, 228; form: 165; interpreta­ tion: 169; issues: 168; problems: 228, 232; pro­ jection: 170; reactions to: 111

Defensive structures: 69 Dialectics: 11 Dialogic: 4, 5, 6, 19, 54, 64, 125, 208; approach: 6, 9, 103, 113, 116, 119, 121, 210; attitude: 4, 6, 63, 73, 74, 75, 76, 78, 80; attitude of therapist: 73; context: 5, 81, 83; dance: 19; dimen­ sion: 139; episodes: 56; field: 154; goal: 27; man­ ner: 68; orientation: 83; perspective: 118, 212; philosophy: 216; position: 61; process: 54, 56, 59, 62, 64, 77, 78, 84, 222; psychotherapy: 116, 126,

127; relationship 82

27, 77,

Dialogical: 4, 6, 7, 9, 11, 13, 14, 15, 54, 81, 91, 92, 93, 94, 97, 98, 99, 103, 127, 145, 203, 204, 213, 222, 224, 233; approach 4, 5, 6, 10, 13, 22, 81, 92, 93, 95, 98, 99, 103, 104, 105, 106, 199, 203, 207, 211, 224; attitude: 75; connectedness: 15; dimen­ sion of therapy: 203; (and) Gestalt therapy: 60, 101; limits: 28; perspective: 13, 18, 130, 199, 202, 209, 219; phases of therapy: 203; principle: 28; psy­ chology: 208; psychothera­ py 5, 14, 28, 103, 127, 200; relationship: 13, 19, 21, 27, 28 Dialogue: 4, 5, 7, 15, 18, 20, 22, 29, 37, 52, 53, 59, 60, 61, 62, 66, 67, 69, 71, 79, 80, 81, 82,

10, 26, 54, 63, 75, 85,

11, 27, 57, 64, 76, 88,

13, 28, 58, 65, 78, 92,

93, 94, 96, 98, 99, 113, 116, 119, 122, 140, 142, 145, 147, 153, 200, 206,

Index

210, 217, 222, 223, 225, 232, 233; Buber’s philoso­ phy of: 144, 216; existen­ tial pole of: 22;experiential: 77; intersubjective: 166; mutual: 79, 80, 81, 142; philosophy of: 93, 217; therapeutic: 141, 142, 233 Dilthey, W.: 114-115

Domain of psychoanalytic in­ quiry: 132, 153, 164

Existential-Gestalt therapy: 239

Existential-relational theory: 236 Experience-near concept: 162 Experiential: figure: 168; fore­ ground: 168; theory: 147; validity: 156; world: 144

Figural: 139, 207

Ego: functions: 56, 77; mode: 52; needs: 93, 97, 99; skills: 77 Emotional: expression: 230; growth: 125; injury: 126; reactions: 149; regulation: 218; responsiveness: 218 Empathic-introspective: mode of investigation: 132; stance: 141, 143

Empiricism: 98

Empty chair work: 26, 36-37, 45 Enright, J.: 74

Environmental support: 22 Erikson, E: 23

— 254 —

Existential: position: 122; re­ sponsibility: 46; stance; 33, 48, 164; values: 145

Figure-ground: phenomenon: 167; relationships: 167

Freud, S.: 143, 166 Friedman, M: 220

57, 68, 71, 72,

From, I: 52

Gestalt therapy: 4, 13, 44, 46, 52, 57, 58, 60, 61, 63, 64, 65, 66, 67, 68, 70, 71, 72, 74, 75, 77, 82, 83, 103, 112, 113,129,130,131, 132, 133, 134, 135, 136, 138, 139, 141, 142, 143, 144, 145, 150, 152, 153, 154, 155, 158, 159, 160,

— 255 —

___ THE healing relationship in gestalt therapy

161, 162, 164, 165, 166, 167, 168, 170, 216; ap­ proach: 153; concepts: 142, 143, 149, 152; devel­ opmental perspective: 130; emphasis: 134; model: 146; phenomenological approach: 60; roots: 147; theory: 151; view of hu­ man motivation: 154; view of personality develop­ ment: 151

Goodman, P.: 3, 5, 52, 60

----

72, 73, 79, 81, 122, 123, 124, 141, 145, 171, 206, 217, 218, 220, 224, 225, 233; interpersonal event of: 69; mutual: 79, 206; one-sided:80; on-going: 225

Individualism: 91

Individualistic model: 5 Individuality: 13, 81, 97, 224

Infant-parent bond: 107

Infantile: impulses: 150; long­ ings: 151

Hefferline, R.: 3, 5, 52, 60

Interexistence: 95, 97, 116

Heidegger, M.: 114,116

Interexperience: 97

Holism: 58, 71, 130

Interhuman: 13, 53, 116, 201; dimension: 202; domain: 206; event: 55; existential demand: 25; fabric: 6, 13; meeting: 135: encounters: 77; relations: 201

Humanistic psychology: 94; concepts: 158 Humanistic psychotherapy: 130

Husserl, E.: 114

Interpersonal relationships: 18

Hycner, R.: 3, 31, 91, 103, 113, 159, 199

Impasse: 25, 31, 32, 33, 43, 45, 46, 48, 57, 110, 227

Inclusion: 19, 21, 22, 32, 46, 48, 53, 64, 68, 69, 70, 71,

Intersubjective: 109, 116, 117, 201, 202, 208, 217, 218; approach: 108; emphasis: 165; existentialism: 116; experiences: 124; field: 108, 110, 119, 131, 199; process: 113; system: 135, 165

— 256 —

Index —

Intersubjectivity theory: 46, 104, 105, 106, 110, 113, 116, 117, 118, 121, 126, 127, 129, 130, 131, 132, 134, 135, 136, 138, 142, 146, 153, 155, 158, 159, 160, 162, 164, 165, 166, 171, 199, 200, 201, 202, 203, 204, 205, 206, 207, 208, 211, 212, 213, 217, 219

Intrapsychic: 18, 27, 124, 203; conflicts: 27; dialectic: 10; dialectical phase; 203; en­ counter: 27; internalization of intersubjective event: 166; projection: 201; self­ object functions: 205 I-Thou: 4, 7, 9, 10, 27, 52, 54, 56, 57, 58, 63, 74, 75, 76, 80, 92, 99, 115,121-134, 146, 202, 222; attitude: 9, 54, 97; dialogic attitude: 63; connectedness: 93; context: 52; dialogue: 135, 140, 146; encounter: 9, 10, 54, 92, 97; experience: 8, 10; interaction: 69; meet­ ing: 7, 9, 54, 92, 97, 205, 211; mode of subject-tosubject: 144, 217; model: 82; moment: 9, 21, 54, 55, 56, 58, 62, 68, 74, 75, 92,

97; mutual encounter: 97; orientation: 74; process: 54, 64; relation: 52, 53, 54, 56, 57, 63, 75, 80, 145, 146, 222; relation­ ship: 8, 10, 97, 98

Jacobs, L.: 51, 85, 129, 171, 215 Kempler, W: 66

Kohut, H.: 103, 106, 107, 131

Libido: 200 Listening: perspective: 167; stance: 218

Megalomania: 95 Metapsychological: base: 106; limitations: 105; model: 104

Metapsychology: 131, 212; Drive: 131; Freudian: 108 Monologic: 16, 94, 95

Neurosis: 77 Neurotic: 81; processes: 150

Nonhierarchical relationship: 52 257 —

Index

___ THE HEALING RELATIONSHIP IN GESTALT THERAPY —

Nonverbal behavior: 73

Object-relations theory: 236

Objectivism: 26 Ontic: 61; center: 59; signifi­ cance: 59

Phenomenological world: 71; interpersonal model of: 63

ive: 115; philosophical as­ sumptions of classical: 160

Phenomenology: 114, 130, 209; psychoanalytic: 108, 131; of human experience: 104; of specific needs: 118

Psychoanalytic: approaches: 104; audience: 212; com­ munity: 129; theories: 108, 132, 134, 140, 143, 153, 212

Philosophical anthropology: 115, 216; assumptions: 212; base: 144; interests: 216

Ontological: 49, 53, 200; am­ bivalence: 127; connected­ ness: 96; security: 23; sig­ nificance: 58, 146; truths: 147

Plato: 200, 205

Ontology: 146

Polar view of good: 71

Organismic: 153, 157, 158; self regulation: 143

Polster, E: 52, 69, 80, 84, 159, 163, 165

Orpheus: 84

Polster, M: 52, 159 Process-oriented therapy: 160

Paradox of inclusion: 71

Psychology: 212, 213

Paradoxical theory of change: 53, 62

Psyche: 98 Psychiatry: 54

Peris, F: 3, 5, 22, 52, 60, 66, 80, 143, 150, 157, 159, 160, 168, 170, 168; Rela­ tionship with Uncle: 169

Peris, L: 66, 80

Personhood: 9, 16, 52, 54, 56, 64, 68, 77, 81, 140, 201, 206, 207, 208, 209

Psychic: 161; function: 130, 134; functions of contact, 157; organization: 134 Psychoanalysis: 71, 119, 130, 131, 132, 141, 147, 153, 160, 203, 207, 209, 211, 216, 217; humanistic cri­ tique of: 130; intersubject

Relational: ability: 94; connect­ edness: 94; context: 4; experiences: 134: needs: 153 Resistances: 18

Restoration: of awareness: 52, 83; of contact: 83 Rhythmic alternation: 13, 81, 92, 225

Psychodynamic: 220

Psychological: category: 212; causes: 12; concept: 131; description: 146; develop­ ment: 8; events: 5; field: 168; flexibility: 21; per­ spective: 146; structure: 163; theory: 103, 105, 146, 170, 200 Psychopathology: 16, 22, 23, 91, 94, 150, 164

Psychotherapeutic: approach: 143; inquiry: 208; pheno­ menology: 147; principles: 215; school: 130; situation: 164; terms: 10

Psychotherapy: 6, 24, 77, 79, 82, 109, 117, 119, 120, 127, 131, 145, 146, 147, 150, 162, 215, 222; litera­ ture: 74; process: 219

Rogers, C.: 68

Sartre, J.: 114

Scientific observation: 144 Self Psychology: 106

Self-regulating: capacities: 132; functions: 222 Selfhood: 83, 119, 218

Selfobject: 107, 109, 110, 133, 136, 138, 161, 166, 202, 212; caretaking functions: 111; concept: 151; dimen­ sion 108, 138, 139, 140, 141; dimension of related­ ness: 139; failure: 139, 210; function(s): 107, 109, 117, 118, 132, 133, 134, 157, 203, 205, 206; ma­ trix: 155; needs: 110, 111, 133, 136, 141, 143, 151,

Reichian defense model: 157 — 258 —

— 259 —

__ the healing relationship in gestalt therapy 153, 199, 206; relatedness: 130, 139, 140, 153, 155 support: 133; tie(s): 107, 109, 133, 134, 136, 138, 139, 140, 152, 155, 161, 206; transference(s): 107, 132, 134, 136, 139,141, 155, 203, 204

Will: 62

About the Authors

Zen: 16, 49

Stolorow, R.: 109, 113, 114, 119, 124, 130, 131, 134, 144, 169, 207, 217

Techniques: 4, 25, 69, 76, 78, 84, 99

Therapist’s responsibility: 80 Therapeutic context: 25; inter­ action: 162; presence: 224; relationship 18, 52, 83, 109, 111, 120, 146, 216; session: 41; situation: 162, 165; stance: 146; task: 67

Touchstones: 15, 18

Transcendental possibilities of human existence: 83 Transcendental process: 60

Transpersonal dimension; 11, 18, 93

Rich Hycner, Ph.D., is in private practice and is co-director of the Institute for Dialogical Psychotherapy in San Diego, CA, where he super­ vises the training program. He is a training faculty member with Erving Polster and Miriam Polster at the Gestalt Training Center in La Jolla, Califor­ nia. His thinking and therapy have been profoundly influenced by the creative clinical work of Erving Polster and Miriam Polster, and by Martin Buber's philosophy of dialogue and Maurice Friedman's exposition of this philosophy. He is the author of Between Person and Person: Toward a Dialogical Psychotherapy (translated into German and Portuguese), as well as a number of articles on Gestalt therapy and dialogic psychotherapy. He conducts training workshops internationally. He has been a psychotherapist for twenty-five years and is licensed as a Clinical Psychologist (in California and Oregon), and as a Marriage, Family and Child Therapist (in California). He is an Adjunct Faculty member at the California School of Professional Psychology-San Diego, and teaches at several other local graduate schools. He can be contacted at 225 Stevens Avenue, Suite 101, Solana Beach, CA 92075-2058, USA; Tel. (619) 481-8744.

Lynne Jacobs, Ph.D., has long been interested in the relational dimension of psychotherapy, and in integrating psychoanalytic theories with humanistic theories. Both a psychoanalyst and a Gestalt therapist, she is a faculty member of the Gestalt Therapy Institute of Los Angeles (where she received her training), a member of the editorial board of The Gestalt Journal and on the board of directors of the Institute for Dialogical Psychotherapy in San Diego where she and Rich Hycner have collaborated for many years. She is also a member of the Institute of Contemporary Psychoanalysis in Los Angeles. She teaches at ICP, and teaches Gestalt therapists locally, nation­ ally, and internationally. She has a private practice in Santa Monica.

Triib, H.: 94, 118, 123, 124, 203, 222

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