Contact: Good & Ill-healthThe on-going, healthy process of living one's life as well as an on-going therapeutic encounter may be experienced as a series of contacts, of awareness of meetings between what is experienced as "me" and that which, in either internal or interpersonal worlds, as "not me." Contact has been described as a "spontaneous concentration" on something (Perls et al, 1951). Such "spontaneous concentrations" may be in awareness or subliminal. I am sitting in a room and someone enters a "not me." If the person enters in such a way that I may see or hear the entrance, I may be aware of my contact; if the person enters quietly I may have some sense of a presence; however, without conscious awareness. As the person enters contactful space, I may become aware that I had sensed the person was there but had not been aware of the presence.
For contact to occur, the individual mobilizes "aggressive" energy; that is, the individual actively moves from the closed internal sphere to the contactful sphere, either internal or external, a non-violent contact-function and a healthy one leading the individual to interact with self or the environment in a fruitful way.
The mobilization of "aggression" for contact is possible because the individual has an internal "impulse" (Perls et al, p 342) toward health and wholeness. Perls salutes the "courage and creative formative power in every person" (p 288). The impulse mobilizes the creative formative (aggressive) power toward health and wholeness; such power is evidenced in curiosity (see the discussion in Emergent Needs).
Healthy contact, then, signals the meeting of two entities; it has the function of enabling interaction between the individual and either an aspect of himself or an aspect of the environment. In Gestalt therapy theory, the experience of contact denotes a "boundary," a border; it limits but does not separate. "When we say boundary we think of a boundary between; but the contact-boundary [i.e., the sensitive skin] where experience occurs does not separate the organism and its environment; rather it limits the organism, contains and protects it and at the same time it touches the environment" (Perls et al, p 229). The healthy contact-boundary defines the organism (the human person) and at the same time enables growth and change through the interpenetration with that which is novel, nutritive, supportive or challenging, unknown until the moment of contact.
Many mechanisms may signal ill health, blocking what Miriam Polster has called "good-quality" contacting, the kind I have been describing. In essence, ill health is defined in Gestalt therapy theory as the absence of aliveness, novelty, interest, or challenge in a client's experience because of perceptual and conceptual screens that block out that which is unknown and therefore fearful. The neurotic erects a system that is conceived because it helps him/her in feeling safe or in control; it defines change as being too risky. Essentially, the neurotic deals with a self-limited, self-defined world. At some time in the past there was a good reason for erecting barriers around the self; however, although that reason may have disappeared, the belief system of that neurotic individual maintains the self and the world as if nothing had changed. For example, a client discovers that her basic belief about herself is as if she is an unlovable child. As a child in her experienced world that seemed true. At 54, that belief is outmoded but it is there in her habituated patterns of self definition and has a tenacious hold.
In speaking of "the Neurotic" I am including all of the classic ways of being neurotic that Shapiro (1965) has noted as "neurotic styles": narcissistic, obsessive-compulsive, manic-depressive, paranoid, hysteric, anxious, depressive; and also behavioral labels that have been added since Shapiro's book appeared: addictive, borderline, phobic, post-traumatic stress disorder, psycho-somatic disorder, disorders of aspects of the self. For most practicing therapists a label that denotes severe pathology such as schizophrenia is not useful. However, Gestalt therapists who work in hospital settings use such sets of symptoms because they work with such patients.
Symptoms of neurotic disorders are presented in each client who opts into therapy; each Gestalt therapist may observe such symptoms and may conceptualize a diagnosis such as any of those just mentioned. However, Gestalt therapists do not endeavor to discover causes; we use diagnostic concepts to organize the vast amount of information into meaningful units, as Melnich and Nevis (1992) have noted. And we do not treat "neurosis"; we treat persons who demonstrate various ways of blocking themselves from healthy functioning, from easy and effective gestalt formation and completion, from a sense of the self as "okay."
Melnich and Nevis have developed a system for description of the various neurotic or psychotic structures in terms of blockage at significant points in the gestalt formation and completion cycle. Such a system, although helpful in many ways, does not address itself to "disorders of the self" (a destructive top dog/underdog process for example) or of the self concept. Labeling such neurotic or psychotic structures may enable me as a Gestalt therapist to discuss clients with other therapists and may lead me to use certain interventions instead of others, if I lack inner direction; however, no label must contaminate contactful presence with each client in the moment-by-moment interactions.
The neurotic person may block good-quality contact in ways that seem to protect the self, while actually in many cases (i.e. retroflection) being harmful. I shall list some of the classic types of blockage here with brief examples; you will find excellent discussions in such books as Gestalt Therapy Integrated (Polster and Polster, 1971). The original list is in Perls et al, 1951.
There are examples here which are not necessarily neurotic. The crucial factor is awareness: I am conscious of what I am doing, making contact choices knowingly, not simply out of habit, in response to unique, present, and changing circumstances.
- Projection: I attribute to others thoughts, feelings or meanings which are products of my own imagination. Example: I observe a person being quiet and believe them to be angry.
- Introjection: I have "swallowed whole" a message from others without questioning its validity. Example: I believe that I am stupid because my father always said I was.
- Retroflection: I do to myself what I would like to do to others. Example: I bite my lip rather than let out the 'biting remarks' I really want to make. (The retroflective process often involves physical self-harm.)
- Confluence: I am not aware of myself as a separate, distinct or autonomous individual. Example #1: An infant's sense of self awareness in the parent-child relationship. Example #2: Perhaps a powerful sexual, romantic, or mystical experience.
- Deflection: I do not respond directly to contactful possibilities; I change the focus. Example: To the question "How are you?" I might respond with "Well, that's a good question."
- Egotism: I am so concerned with myself that I do not recognize genuinely contactful opportunities. Example: I am asked for my opinion, and I take this as an obvious sign of the other person's inferiority and weakness.
All therapy is change-oriented. What changes are the goals for the Gestalt therapist? The classic description of the goal is the general statement of Fritz Perls— "What we are after is the maturation of the person . . . to help him make the transition from environmental support to self support." In other words, the major targeted movement is from neurotic manipulation of self and environment for satisfaction of needs to "good quality contact" (again, Miriam Polster's term) from a fully functioning self with that self's environment.
The dimensions or components of "good quality contact" cannot be stated categorically because, since we honor the uniqueness of each individual, such contact may vary considerably between individuals and in each individual at different times. For example, if I attend a lecture my good quality contact may consist of listening carefully and taking notes; at a cocktail party good quality contact may mean glancing around, greeting a few people or it may mean plunging into an animated conversation about some political or environmental concern. In a one-to-one situation good quality contact may be significantly different—personal contact, eye contact, physical contact, more silence, fewer words, etc; it might mean speaking my truth to someone who doesn't want to hear.
Good quality contact means aggressing into the environment in ways that satisfy my needs at any particular moment. Good quality contact also necessitates some modifications of language systems. Clients come from very different cultural backgrounds and a therapist must be able to accommodate his/her language patterns to those of the client at least to some extent.
How each individual makes the change from self- and environmental-manipulation to self-structured and self-supported good-quality contact is the business of Gestalt therapy.
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