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Enhancing Your Therapy with Gestalt Approaches
Gestalt Therapy continuing education psychologist CEUs

Section 23
Gestalt Use of Glass: Addressing Feeling Transparent and Exposed

CEU Question 23 | CEU Answer Booklet | Table of Contents | Gestalt
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

Glass had never been one of the many media we offered to our patients. We first encountered its therapeutic usefulness when traumatized patients informed us that they were using the material, spontaneously, as a mode of emotional expression. Patients reported that some of the material's properties were of particular value to them. Glass could be broken, shattered, smashed, and crushed, producing explosive sounds and visually dramatic outcomes. Schreiber (1973) presented one of the earliest descriptions of a patient's drive to achieve emotional release by breaking glass. Her patient, Sybil, was quoted as saying that at times she felt so angry, she wanted to break glass (p.87), or smash a window (p.330). The aim of this article is to suggest some ways for using glass in psychotherapy and art therapy, and to discuss the potential risks involved. We will also discuss the possible impact of the use of this material on the therapist-patient relationship.

Safety first: It is understandable that the first response of many therapists to the idea of introducing glass into art therapy would be concern for the potential risks to both patient and clinician. It is, therefore, imperative to determine guidelines for safe work with this substance. This issue is particularly pertinent when patients with suicidal ideation or self-mutilating tendencies are drawn to it. Glass fragments can cause unintentional (or subconscious) cutting accidents, but can also be used intentionally in violent gestures. Suicidal patients could be tempted to use glass fragments to injure themselves. Therapists considering the use of glass in therapy need to ascertain their patient's ego-strength and capacity to resist self-destructive impulses. Proper patient preparation should include thorough training in the techniques of glasswork. There should be agreement on ways for at-risk patients to notify their therapists about the increased danger of self-injury. Provision should be made for making the material inaccessible during those times patients do not feel they can handle it safely. A careful preparatory training phase can deepen the sense of care and nurturing in the patient-therapist relationship. It enhances the therapist's faith in the patient's capacity to master the hazardous substance, as well as trust in the patient's commitment to the safety contract. Above all, this can add confidence to the therapeutic relationship at a time when both parties are embarking on a joint venture that is as rich in potential for formidable threats as it is in opportunities for self-discovery. This mutual commitment to safety can re-create a time-regressed developmental stage, in which the child is encouraged to take controlled, growth-promoting risks under supervised (parental) guidance. Although such bonding processes are generally desirable in therapy, complicating transference issues may emerge in cases where patients have histories of childhood trauma and betrayal. Many of these patients may have initial concerns about being endangered by their caretakers, perhaps not unlike their own early familial experiences. Some testing of limits may also be expected, when patients will try to act out their despair, their self-loathing, and their compromised basic trust by responding with unsafe behavior. Such behavior can also be related to a need to elicit the therapist's protective behavior. This could help support the patient's belief that the therapist can and will keep his/her end of the bargain when the patient is no longer able to protect himself. Because therapist attention is advised when glass is used in art therapy, we would not recommend using this material in group therapy activities. Group settings do not permit the necessarily close supervision this activity requires.

The particular attributes of the material: Glass has unique characteristics that may trigger a variety of therapeutically relevant reactions. The various processing methods of glass can also be conducive to evoking different sensations, feelings, and memories. Glass can be melted and softly shaped while it is hot. Glass can be cut, sanded, broken, and shattered. Broken pieces can be soldered to form new shapes and designs. Solid glass is both smooth (on the surface) and sharp (on broken edges). It can be opaque, translucent or transparent, colorless or colorful. What follows are some examples of the usefulness of glasswork in art therapy.

1. Heating glass and glass blowing: Fire has a mythical aspect to it. Many of our ancestors gathered around bonfires to share legends and war stories, and to bond. Bonfires provided opportunities for cohesion of the tribe and the molding of its ethos. Fire is, therefore, etched in our common subconscious mind. In modern society, controlled fire is mostly associated with pleasant images of candlelight intimacy, cooking, and cozy fireplaces. Art therapists who decide to soften glass by warming it with fire will note that some patients may be drawn to the burning flame, and hypnotically stare at it. This behavior can be trance-inducing, and may facilitate significant disclosure and uncovering of important psychological material. The rigid and fragile attributes of hardened glass can remind patients of themselves and of their hopelessness with regard to "changing without breaking." The process of heating the glass can become a powerful metaphor for therapy itself, the literal flame a symbol for the "heat" of therapy. If this analogy is meaningful to the patient, therapy, much like the glass-softening fire, could be perceived as a facilitator of flexibility and personal change. Glass blowing permits an intimate encounter with the material, whereby the very breath of the patient shapes the glass container and gives it volume. The captivating feeling is one of breathing the person's own spirit, or essence of life, into the artwork, thus creating a powerful symbolic extension of the self.

2. Stained glass: Glass fragments can be seen as symbols of a shattered life or a broken self. The display of broken glass fragments has been described by patients as a chaotic, useless collection of debris, lacking a cohesive shape, emitting an alienated, cold feeling, and seen as potentially lethal. Before soldering the pieces in the stained glass technique, the fragments' edges must be covered with adhesive copper tape. This procedure is necessary for bonding the glass pieces together, but it is also a protective procedure that reduces the risk of being cut. In the patient-material identification process, we noticed that this technique could also be seen as bandaging rough and broken representations of the self, and, therefore, experienced as a fairly soothing activity. Considerable physical and thermal energy is required for joining the glass fragments into a self-standing piece of art. For some of our patients, this has not only been a metaphor for their healing process, but also a statement about the potential effects of warmth and protection. Therapists can reflect on the process, discussing with their patient how wrapping, heating, and bonding are necessary steps toward achieving an integrated new entity.

3. Glass as a means for emotional abreaction: Even though glasswork in art therapy usually requires concentration and self-control, the material can also be used to facilitate affective expression, particularly the loosening of suppressed anger and rage. Activities like breaking and smashing require the use of protective gear, such as eye goggles, long sleeves, and work gloves. Normally, it would be quite difficult to engage in this type of activity inside the therapy room. Therapists who feel comfortable conducting sessions outside their offices could suggest a remote location, where the hurling of bottles would neither endanger anyone, nor contradict any local ecology standards. An abandoned quarry or a garbage dump could be suitable sites. Advance verbal preparation is always recommended to explore the patients' interpretations and emotional reactions to the suggested change of setting. Glass can also be shattered in the office. If carefully wrapped, it can be hammered or stepped on with work boots. Although the crashing sounds are considerably muffled with this technique, the material can provide a satisfying and empowering feeling.

4. Transparence, translucence, and reflectance: When light falls on a glass surface, it can be reflected back, it can be absorbed and filtered through it, or it can be broken into its optic color components, resulting in a variety of potential visual effects. One of our patients enjoyed capturing the sun's rays in the stained glass pictures he had created and later mounted on his bedroom window. He was delighted in his ability to control the penetration of light into his space. Broken glass mirrors can also be used in collage. We encourage patients who choose to utilize the mirrors' reflecting capacity in their artwork to explore their reactions to a finished product that accurately reflects their image. Invariably, they realize that they have created an opportunity to be literally included in their artwork. They can discover that their reflected representation is imbedded within their artwork. This allows patients to explore the perceived merger with the picture and their relationship with the other symbols represented in their artwork. Some may allow the artwork to frame their reflected facial image. Others may benefit from experimentally altering their reflected placement on the picture. Patients who integrate glass mirrors in their creations may find themselves conflicted about exposing their work to others, thereby allowing the onlookers' images to be reflected, instead of their own. On one occasion, negative reactions to the spontaneous use of glass fragments led one patient to apply a controlled, corrective exercise later in therapy. This patient was at first horrified to discover broken images of her face reflected from pieces of glass she imbedded in her work. The reflected images accurately expressed her subjective sense of a disintegrated, defiled, and unattractive self. As she progressed in therapy, this person was later able to deliberately cut a piece of mirror, coat its edges with copper paper, then solder it onto her artwork. As a result, she could observe her facial image reflected from her artwork as an intact unit. Ordinary window glass, colorless and transparent, can also be a significant material in art therapy. Transparent glass is simultaneously present and absent. Although it can be physically present as a cold, isolating barrier, covering the entire artwork or parts of it, glass in a window or a picture frame barely interferes with the artwork's internal space. In fact, it leaves the picture completely exposed as it covers it. This artistic expression may manifest a sense of alienation or dissociation from the self or the environment. Through identification with the glass sheets, some patients express their need to "see and not be seen," to be present but unnoticeable. This type of reaction is not atypical in survivors of childhood abuse, as it expresses a fear of being hunted down and hurt. Glass sheets can also be imbedded in the background of the picture, can be painted on, or can be an element of a collage. When integrated in a patient's artwork, these materials can represent an ambivalent disclosure, a conflict about allowing the therapist access to threatening intra-psychic material. One patient who had worked with pieces of sheet glass in our clinic was processing, during her verbal psychotherapy, her discomfort with feeling exposed. She constantly felt exposed to people. She felt transparent. She thought she was easy prey, at constant risk of being assaulted. She also firmly believed that her shame and disgrace were exposed, obvious to all. As a part of a coordinated therapeutic effort to enhance her ego-strength, it was suggested that she paint on the glass sheets so as to reduce transparency, or, alternatively, to allow graphic symbols, representing various aspects of the self, to show through. This helped the patient explore the notion that she was a complex person possessing a mixture of traits.

The notion of using glass in art therapy has not generally been well received among our colleagues. The reluctance to allow the use of glass in art therapy activities reflects, for the most part, therapists' lack of experience with the artistic use of the material. In our view, the notion that the deliberate therapist-sanctioned use of glass in therapy can compromise the patient's well-being is patronizing, in that the patient is regarded as an infant. If this line of reasoning were valid, it could also be argued that therapists should encourage patients to take public transportation to their sessions instead of driving themselves because they might be injured en-route in a car accident. The inclusion of glass as an optional material in art therapy can be considered in cases when the therapist is confident that the therapeutic relationship is firm. There is no difference between the use of glass in therapy and the use of a pair of scissors or a sharp cutting knife if the therapist is confident about his or her mastery of safe glasswork techniques, and if a secure working environment can be provided. The need for patient safety is ever present, and transcends any particular therapeutic technique. Clearly, even patients in "talk therapy," or those not in therapy at all, can pose a risk to themselves. We firmly believe that when patients feel drawn to working with glass, therapists should provide them with a supervised opportunity to explore the therapeutic possibilities offered by the material, instead of discouraging its use. In summary, we believe that therapists skilled in glasswork could encourage the use of the material when patients with whom they have developed a good working relationship spontaneously choose to use it in their artwork. Only those patients who evidence a reckless impulsiveness or are unable, by reason of mental, emotional, or physical limitations, to understand or follow safety instructions should be barred from the use of glass.
- Somer, Liora; Somer, Eli; Perspectives on the Use of Glass in Therapy; American Journal of Art Therapy, Feb2000, Vol. 38 Issue 3
The article above contains foundational information. Articles below contain optional updates.

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Personal Reflection Exercise #9
The preceding section contained information about considerations regarding the use of glass in Gestalt art therapy.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 23
How did painting on glass in Gestalt art therapy help the client who felt exposed and transparent? Record the letter of the correct answer the CEU Answer Booklet.

 
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The article above contains foundational information. Articles below contain optional updates.
Enhancing psychotherapy process with common factors feedback: A randomized, clinical trial.
In this study, we developed and tested a common factors feedback (CFF) system. The CFF system was designed to provide ongoing feedback to clients and therapists about client ratings of three common factors: (a) outcome expectations, (b) empathy, and (c) the therapeutic alliance. We evaluated the CFF system using randomized, clinical trial (RCT) methodology. Participants: Clients were 79 undergraduates who reported mild, moderate, or severe depressive symptoms at screening and pretreatment assessments. These clients were randomized to either: (a) treatment as usual (TAU) or (b) treatment as usual plus the CFF system (TAU + CFF). Both conditions entailed 5 weekly sessions of evidence-based therapy delivered by doctoral students in clinical psychology. Clients completed measures of common factors (i.e., outcome expectations, empathy, therapeutic alliance) and outcome at each session. Clients and therapists in TAU + CFF received feedback on client ratings of common factors at the beginning of Sessions 2 through 5. When surveyed, clients and therapists indicated that that they were satisfied with the CFF system and found it useful. Multilevel modeling revealed that TAU + CFF clients reported larger gains in perceived empathy and alliance over the course of treatment compared with TAU clients. No between-groups effects were found for outcome expectations or treatment outcome. These results imply that our CFF system was well received and has the potential to improve therapy process for clients with depressive symptoms. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Can reflecting on personal values online increase positive beliefs about counseling?
This research developed and tested an online values-affirmation exercise to attenuate threat and enhance positive beliefs about counseling among individuals struggling with mental health concerns. There is evidence that reflecting on personal values (values-affirmation) is an effective approach to eliciting self-affirmation—a psychological process that temporarily bolsters self-worth in order to forestall maladaptive, self-protective responses to counseling information. The present study utilized a randomized 2-group between-subjects design to test the effectiveness of a values-affirmation exercise with an online sample (N = 186) of adults who reported struggling with a mental health concern. It was predicted that values-affirmation would reduce threat related to reading mental health information and increase positive beliefs about counseling. Results indicated that those in the values-affirmation condition reported fewer negative emotions such as feeling upset, irritable, hostile, and scared after reading mental health information, indicating that the information was perceived as less threatening. There was also evidence that engaging in values-affirmation was associated with greater anticipated growth in counseling and greater intent to seek counseling, reflecting greater positive beliefs about counseling. Overall, the results suggest that reflecting on personal values may have the potential to enhance the positive effects of online psychoeducation. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Depression symptoms moderate the association between emotion and communal behavior.
Depression is associated with emotion regulation deficits which manifest as elevated negative affect and greater continuation of negative affect over time. The present study examined a possible emotion regulatory deficit, whether depression symptoms attenuate the association between communal (i.e., agreeable, quarrelsome) behavior and affect. A community sample reported on depression and anxiety symptoms before recording their affect and behavior following naturally occurring interpersonal interactions over 21 days. Participants’ behaviors were measured using items selected to represent the Interpersonal Circumplex Model of behavior. Results indicated an association between affect and communal behavior, which was stronger for negative than positive affect. Depression symptoms moderated this association; elevated depression symptoms were associated with decreased association of affect and interpersonal behavior. Comorbid anxiety symptoms did not moderate this association. Results suggest that elevated depression symptoms are associated with a diminished ability to adapt communal behavior to emotion cues. Given prior evidence of elevated overall quarrelsome behavior among individuals with elevated depression symptoms, this may demonstrate an interpersonal mechanism by which emotion regulation deficits impact the generation of interpersonal problems. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Thwarted belongingness, perceived burdensomeness, and depression among asian americans: A longitudinal study of interpersonal shame as a mediator and perfectionistic family discrepancy as a moderator.
This short-term longitudinal study applied Joiner’s (2005) Interpersonal-Psychological Theory of Suicide to Asian Americans’ experiences with depression. Interpersonal shame (i.e., the experience of inadequacy arising from interpersonal concerns) was hypothesized to mediate the effects of (a) thwarted belongingness and (b) perceived burdensomeness on future depression. Furthermore, the positive associations between (a) thwarted belongingness and (b) perceived burdensomeness on future depression were hypothesized to vary depending on students’ experiences with perfectionistic family discrepancy (PFD; their perceived gap between their actual performance and what their parents expect of them). A total of 605 Asian Americans attending predominantly White, Midwestern universities completed 3 online surveys. Conditional process modeling via Hayes’s (2013) PROCESS was used to analyze the data. Results demonstrated that (a) thwarted belongingness and (b) perceived burdensomeness contributed to higher interpersonal shame, which influenced students’ future depression. Furthermore, the effect of thwarted belongingness on future depression was significantly positive for those with PFD levels greater than the 12th percentile, after taking into account students’ initial level of depression. The effect of perceived burdensomeness on future depression was not significant for those with PFD levels greater than the 3.5th percentile. This study identified that students with perfectionistic family discrepancy may be at higher risk for depression while experiencing thwarted belongingness. Overall, findings supported using Joiner’s (2005) theory to understand Asian American students’ risk for future depression. Future studies may gather data across Asian American students’ years in college. Counselors can apply these findings to increase students’ awareness about possible risk factors for depression. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Distress disclosure and psychological functioning among Taiwanese nationals and European Americans: The moderating roles of mindfulness and nationality.
Research using Western samples shows that talking about unpleasant emotions—distress disclosure—is associated with fewer psychological symptoms and higher well-being. These benefits of distress disclosure may or may not be observed in East Asia where emotional control is valued. Instead, mindfulness may be more relevant to emotion regulation in East Asia (e.g., Taiwan). In the present study, cultural context (Taiwanese nationals vs. European Americans) and mindfulness were examined as moderators of the relation between distress disclosure and both depression symptoms and life satisfaction. A sample of 256 Taiwanese college students and a sample of 209 European American college students completed self-report measures in their native language. Moderated multiple regression analyses revealed significant interaction effects of mindfulness and distress disclosure on both depression symptoms and life satisfaction for Taiwanese participants but not for European Americans. Specifically, distress disclosure was negatively associated with depression symptoms and positively associated with life satisfaction for Taiwanese low in mindfulness but not for Taiwanese high in mindfulness. For European Americans, distress disclosure was not associated with depression symptoms but was associated with higher life satisfaction, regardless of one’s level of mindfulness. These findings suggest that the potential benefits of disclosing distress are a function of one’s cultural context as well as, for those from Taiwan, one’s mindfulness. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

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