Gestalt Therapy Plan - Essay Example

Gestalt therapy plan of the Condition Mental angst and interpersonal conflict of the patient, Mrs. Iris, are the issues of concern in thecase. It is through the case we come to know that the subject is under continuous conflict against people, with whom she has to interact on a daily basis. They include mainly her husband and her classmates at the school for learning language. One important issue in this context is that the subject never really has shared her feelings or has not gone for too much emotional attachment with people around her. Her husband is perhaps the only person with whom she shared a deep emotional attachment. Due to this reason she has always felt like staying closely attached with him but his work, his habit of consuming alcohol, his tendency to compare his wife with other women in his life and finally, in a drunken state, his threat to kill her, have created a psychological distance. This later led to detachment between Mrs. Iris and her husband. Compared to her husband the subject is deeply affected as she has developed a kind of perception that her last shelter for emotional dependence is lost. Consecutively, physical abuse from her husband has also created a kind of fear in her. The case under study also makes it clear that all the spheres from where the subject has sought for emotional support have deprived her. Each of the people, with whom she has tried to be close or attempted to be emotionally dependent, on most of the cases, are men. Apart from her relationships with men she always had an inclination to be close to her mother. Here again, she has also been by her father, who at the same time, gave more priority to her brother and inflicted verbal abuses on her. Thus, it is quite inevitable that she would develop a kind of psychological hostility or distance from men deep within her subconscious self and it has ultimately led her to the sense of detachment. This is one of the important issues of discussion in the paper. Her husband’s discussions about his ex-girlfriend as well as women in his workplace have provided her with an impression that he is not committed towards her. Additionally, the instructor of her school, with whom she also tried to be close with, had relationships with several other students. This has ultimately provided her with an impression that men are not committed. Consequently, she also has developed a perception that men are always unfaithful. Such disbelief over archetypical figures of her husband fused with fear developed an alienation-seeking psyche in her for which she takes herself away from social interaction, especially with her neighbors. Perhaps the kind of attitude, that she feels her neighbors exhibit towards her, is not a reality but she cannot help from thinking like in the same manner. She refers to this approach as “social phobia”. It is clear from her case that definitely she is suffering from some kind of phobia and in this context it becomes important for us to understand the definition of phobia, which may be expressed as follows - “Specific phobias … are characterized by fears of objects or situations known by affected persons to be harmless. Despite this knowledge, phobic individuals regularly react with intense fear when confronted with a phobic stimulus. … fears become a phobias when they exceed the demands of the situation, cannot be explained or reasoned away, are beyond voluntary control, lead to avoidance of feared situations, persists over an extended period, are maladaptive, and not age- or stage-specific.” (Noyes and Hoehn-Saric, 1998, p.205) A person who is suffering from ‘social phobia’ “may be highly anxious due to the close social interaction occurring as part of a lengthy interview; they may voice fears of being ridiculed or show obvious embarrassment.” (Bloch and Singh, 2001, p.100) In this context we see that the patient consists of all the traits that, as she has also identified it, lead her towards the signs of suffering from social phobia. Description of Subject: Subject of the case is one Mrs. Iris, who is 38 years old and belongs to European ethnic background. She shares a marital bond with her husband, who is faculty of an educational institution for 15 years. It seems from the available information that academically Mrs. Iris is not very strong and to pursue her academic career further she is admitted to an evening school so that she could learn some other language. During her childhood also she was not a very good student and she has mentioned this point while she was describing her disturbed childhood along with her parents and brother. She is not engaged in any kind of job or occupation, either part time or full time and she is just a housewife, financially dependent on her husband. Detachment from her husband and other members of the society has definitely contributed to her psychological alienation but another important reason is definitely her failure of becoming a mother. It is because of her husband’s careless approach and insensitive behavior that she lost her child. Such an unfortunate event leads to an emotional void that remains unfulfilled and untreated, leading her towards deeper psychological problems. Description and Assessment of the Fear Experience: Carefully looking at the case of Mrs. Iris, we understand that in case of communicating with other people she always has faced some kind of trouble, hesitation or fear. Her interpersonal problems have not only existed with her husband and fellow students at the language class, but also she, in case of interacting with her husband’s friends or even with neighbors has faced the same kind of hesitation. In the case study, all the information that she has shared about her own life and relationship, makes it clear that in most of the cases she had to compromise her position and had to lead her life according to wishes of the others. During her childhood, her brother always received special attention from her parents and she has always been subject to verbal abuse from her father. Her wish of being close to her mother has also not been fulfilled as her father always acted as one of the major obstacles. The way she used to witness her mother being tortured and abused by her father instilled in her the fear of receiving the same treatment from her life partner. It seems that at the initial stage of her marriage life, the situation was not as bad as it has become after fifteen years of marriage. Her problems in interacting with her husband’s friends as well as with her neighbors has mainly generated because she has been represented to the others as a bad wife or a bad daughter and more than anything else, a bad human being. She automatically has started thinking that her presence in others’ life, instead of making their situation better, ultimately is making it worse. Thus, she tries to put herself away from others due to the fear that people will be ridiculing her or they will try to expose her to ignominy. This kind of social phobias can specifically be referred according to psychological terminology as, Androphobia and Anthropophobia. Possible Diagnosis: In Mrs. Iris, who has been suffering from Androphobia and Anthropophobia, these psychological problems have been diagnosed though her behaviorist and psychological approaches towards the affairs happening around her. It is clear from her statements that she has always tried to maintain a safe distance from people. Rather, she attempted to keep herself away from companionship of most of the people as she has always felt that she will be humiliated or else people, who are close to her, will expose her to ignominy. The term Androphobia, has been laid down in A dictionary of medical derivations: the real meaning of medical terms, as “Androphobia is fear of the male sex, just as gynophobia is fear of the female sex.” (Casselman, 1998, p.32) Richard Waters, in his book, Phobias Revealed and Explained, has elaborated the meaning of this term as, “This hatred of mixing with others derives from Latin world of friendship – socio – while Anthrophobia emanates in meaning from the Greek word anthropo, meaning mankind.” (Waters, 2003, p.37) Explanation of both the terms makes it clear that Mrs. Iris is suffering from both these phobias. On one hand she is scared to face all men around her and on the other as she has always been presented to others in a negative manner. That is why she has a fear to socialize with others. For example, we can cite one instance when her husband introduced her to his friends in a quite unsophisticated and derogative manner. As such phobias already germinated within Mrs. Iris since her very childhood and she already was on the path of desolating herself from others, in a gradual process, it affected her quite badly. Psychological diagnosis, actually, is not done in a manner in which other procedures of medical treatment generally follow. Under such situations, the counselor actually diagnoses psychological condition of a person from his/her behaviorist approach and the kind of psychological conflicts that happen within the person. In this context, we see that the behaviorist as well as psychological conflict of Mrs. Iris actually started since her childhood and finally the continuous conflict with her husband has only worsened her condition, leading her to the extreme limits of Androphobia and Anthropophobia. Gestalt’s therapy identifies four aspects of human nature – biological field theory, theory of organism, whole-making capacity and the understanding of contact. The first theory suggests that any organism is affected both from developments within him or her and from the external stimuli. In case of Mrs. Iris these two influences were in constant conflict and this hampered her ego-functions as well. The second suggests that the growth of an organism in terms of behavior is not systematic rather than random. Therefore, functions of a human being have more than one dimension – “physical, cognitive, emotional, aesthetic, spiritual, interpersonal, social, and economical” (Kirchner, 1994). If we look at Mrs. Iris’s case carefully we may find that all these dimensions were interlinked and somehow negatively affected. The concept of contact relates to the dialogues exchanges by an individual with the other people in the surroundings and whole-making capacity refers to the ability of human beings to incorporate their experiences as a learning process and incorporate the changes they come across in their personality. We may in this context even identify the case of Mrs. Iris as that of borderline personality disorder as identified in the book DSM-IV (Diagnostic and statistical manual of mental disorders, 4th edition). (BPD Today, n.d.; APA, 1994) Thus her case shows instability of interpersonal relationships along with vulnerability of self-image. Development/Acquisition As it has already been mentioned before, since her very childhood, Mrs. Iris was suffering from these phobias. Rather, there were sufficient issues that actually led her to the situation where she is now today. During her childhood days, her father’s abuse on her and gradual detachment with her mother already developed both psychological and emotional void in her. After she was married her emotional attachment with her husband shows the kind of affection, love or support that she actually expected from her parents as well as other relations of her life. She therefore expected fulfillment of her desires through her husband. Later on, her frustrated relationship has also led her to the situation where she ultimately tried to compensate these through her intimacy with her language instructor. She intended to be friendly with others as well but she was always concerned within herself about the fact that her negativities, which she believes to possess, must never be disclosed to others. However, as pointed out by others, she was scared to mix with people and feared also that she will be judged according to those qualities only. Finally, her fears have led her to make a cocoon around her, where she attempted to find her isolated existence as well as solace of mind. The previous section has already identified the various aspects of her personality disorder, which have arisen due to the phobias experienced by her. According to the DSM-IV classification this may be referred as a case of borderline personality disorder (APA, 1994; BPD Today, n.d.) and very much akin to its symptoms, Mrs. Iris has developed the problems form her early adulthood itself. Treatment Program Gestalt’s therapy in dealing with problems of personality disorders has been looked upon by researchers and experts from two different perspectives. Some consider this to have limitations while dealing with the DSM-IV personality disorders while others find this especially useful for handling personality disorder related problems. Any kind of disorder is normally a product of change or divergence from the normal path. Gestalt’s therapy mainly addresses this change, which in turn in a consequence of contact and consciousness of the individual. The goal of this therapy is to allow an individual restore his or her power of self regulating and responding in a balanced and objective manner to the internal and internal changes. There are essentially five components of this therapy. First comes the therapeutic relationship where a genuine relationship exists between the therapist and the patient. Therefore, the therapist needs to abstain from being too critical or judgmental of Mrs. Iris’s ways. This contact may be verbal or non verbal but a desired figure would emerge form the interactions in order to help Mrs. Iris restore her balance. (Kirchner, 2000) Continuous counseling, psychological support and giving sufficient time to get out of such a condition are the most important procedures for treating a person. Edmund J. Bourne in this context provides a great deal of importance to three aspects, such as, 1) “Don’t placate the phobic. If the phobic makes excuses about not practicing, it’s better to gently confront him or her about … plan that to simply agree.” 2) “Don’t psychoanalyze. It’s your job as a support person to offer encouragement and support, not to tell the phobic what you think is wrong with him or her or how he or she got that way.” 3) Don’t lecture or preach. Assume a cooperative – not an authoritarian – stance….Avoid setting time limits. Respect the phobic’s own pace of recovery, even if it is slow.” (Bourne, 2005, p.157) In this case it seems that Mrs. Iris would surely take a long time to recover from such situation as her social phobia was germinating in her since her childhood. Additionally, each of the relationships that she looked towards for support and emotional sharing of thoughts, have finally isolated her even more. Even if the person, who will be taking the responsibility of her treatment, tries hard, it would be really hard for him/her to gain complete trust of Mrs. Iris immediately. The fear that has led her to isolation and detachment from others would surely stop her from being cooperative with the counselor. Thus, it will surely take certain time for the counselor to win her confidence and to make her realize that she can definitely depend on him/her if she wants to share her problems and feelings. The second approach is the phenomenological approach of the therapist during which Gestalt’s therapist would help Mrs. Iris reveal everything about her. The therapist describes and understands the patient from her surface behaviors only without trying much to probe into the details lying beneath the revelations. Time, support and proper care towards the patient are the best remedies in case of psychological therapy. As the problems are completely psychological, there is no possible way in which the patient can be treated completely with the help of medicinal drugs. Medication might give him/her a calm of mind but it would not help the patient to come out of the problem effectively just in the manner emotional support and affection could have done. In case of Mrs. Iris, it becomes evident that she actually is not in any kind of situation that will demand medicinal treatment. What she needs instead is proper understanding of her situation and here comes the third and experimental approach of the therapist. This helps the therapist identify the actual nature of the problem by following the reactions of the patient in different situations. In this case role-playing could be a good method to deal with Mrs. Iris’s problem such that she reveals her actual feelings about the people around her. Medical research has also found out that most of the patients take long time to recover from such situation. (Hoffart, 2007, p. 7) In case of Mrs. Iris these traits are very explicitly present and the best way to treat her would be to give her the time that she actually expects for her spontaneous recovery. A counselor is also advised to use medication but “Medications should be used in combination with non-drug treatment approaches.” (Ries, 1996, p.50) It is important for the counselor to respect the psychological expectations of Mrs. Iris and identify where she is wrong. In this context, the fourth approach of Gestalt’s therapy is that of cognition where the therapist concentrates on the problems, contradictions and distortions in behavioral pattern of the patient. By following carefully the words spoken by Mrs. Iris, the therapist can identify the problems in the beliefs and thought process of the individual. This is because the therapist needs to reorganize or reframe the cognitive process of the individual. (Kirchner, 2000) One suitable approach can be to make her believe that she is not the one who is responsible for whatever has happened to her but the people, who have judged her in a wrong manner, are mainly responsible. Simultaneously, another point of controversy automatically arises. She might become arrogant towards the other people and it can worsen her condition. Thus, in this situation the counselor needs to balance both the sides. During her treatment if she should be asked to narrate the kind of tortures or abuses that she actually has suffered and if the counselor consecutively points out that she actually has been abused or humiliated not because of her faults but due to wrong thinking of the people with whom she was associated, that would possibly help her recover. Such interaction will help her visualize the old incidents where she only sees herself as a guilty figure but fails to see others’ faults and their actions against her. Gradually, she will be able to consider herself as a person with normal behaviorist approach and will learn to look around her with an optimistic viewpoint. The fifth approach of Gestalt’s therapy is working with the broader field. Here the therapist talks or interacts with the other family members of the patient or her friends. This may be accompanied with the treatment of internal dynamics of the patient. This might not be too applicable in case of Mrs. Iris owing to her insensitive husband unless the therapist interacts with him without revealing his identity. (Kirchner, 2000) According to the definition of ‘mental disorder’ presented in DSM-IV, it is “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g. a painful symptom) or disability (i.e. impairment in one or more important areas of functioning) or with a significantly increased risk of suffering, death, pain, or disability, or an important loss of freedom” (APA,1994, pp. xxi-xxii) Here Gestalt’s therapy addresses the DSM-IV definition by adopting an approach of diagnosing the specific needs of the client. Following the DSM-IV principle of gaining adequate information about the patient before going for the treatment (APA, 1994, p.xxv), Gestalt’s therapeutic approaches also aim towards deriving detailed specific information about the subject and her problems. However, this therapy could overcome its limitation by extending the diagnostic process to cover the entire development during the patient’s lifespan. References 1. APA/American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders. Washington, D.C.: American Psychiatric Association 2. Bourne, E.J., (2005), The anxiety & phobia workbook, California: New Harbinger Publications 3. BPD Today, (n.d.) “Borderline Personality Disorder DSM IV Criteria”, available at: http://www.borderlinepersonalitytoday.com/main/dsmiv.htm (accessed on September 12, 2009) 4. Casselman, B., (1998), A dictionary of medical derivations: the real meaning of medical terms, New Jersey: Informa Health Care 5. Hoehn-Saric, R., Noyes, R., (1998), The anxiety disorders, Cambridge: Cambridge University Press 6. Hoffart, A., (2007), A residential interpersonal treatment for social phobia, New York: Nova Publishers 7. Kirchner, M. “Gestalt Therapy Theory: An Overview”, Gestalt!, Volume 4, No. 3, available at: http://www.g-gej.org/4-3/theoryoverview.html (accessed on September 12, 2009) 8. Ries, R., (1996), Assessment and Treatment of Patients With Coexisting Mental Illness and Alcohol and Other Drug Abuse, Pennsylvania: DIANE Publishing 9. Singh, B.S., Bloch, S., (2001), Foundations of Clinical Psychiatry, Melbourne: Melbourne Univ. Publishing 10. Waters, R., (2003), Phobias revealed and explained, Sydney: Murdoch Books Read More