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

Section 16
A Case Study Example of Gestalt Art Therapy

CEU Question 16 | CEU Answer Booklet | Table of Contents | Gestalt
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

Sharon is living on many levels all at once; I marvel that she can move about in the everyday world practically and effectively while carrying on such a lot of symbolic activity in her inner life. Tiny and delicate physically, she is inclined to be quiet and still. Only her shining, expressive eyes move about quickly, and she tilts her head from side to side as if she wants to see things from many angles. When she feels shy and fearful, Sharon's whole bearing becomes that of a little girl, on the verge of but never quite giving up her held-back tears. When she has that look I see the child who learned to go into her closet and be alone rather than ask for any sort of open emotional expression with her parents. Her mother says that Sharon was an obnoxious child whom she has never understood; her father, a quiet, bookish man, dramatically taught Sharon that the best thing to do with bad feelings was to bury them underground: in a planned ceremony the two went out one evening, dug a hole in the ground, and six-year-old Sharon was told to bury her temper and never let it show again. Sharon learned her lesson well; her conscious suppression gradually became habitual and her outward behavior fit into the family's pattern of keeping out of sight anything that might be disturbing.

Sharon went to college, painted, went to a New York art school on a scholarship, and worked for the New York State Council of the Arts. Her inventive techniques for three-dimensional print-making brought her success but not much happiness. She tried psychotherapy; that didn't seem to help. Her prints were in galleries, and she was in limbo. She took LSD and was shocked out of lethargy; on the drug she felt transported beyond all individuality and felt ecstasy in belonging with all-beingness. She saw joys in non-ego-involvement and envisioned wondrous release in non-being. But she was frightened, too; when she saw herself in a mirror, Sharon saw only translucency. Was that what she wanted--to lose her identity in cosmic unity before she'd ever lived here on this earth? Sharon didn't know. She and a new husband, who was little more than another body in lostness, began wandering. John drove the car; Sharon sat and passively watched the world go by. "It" was "out there, fascinating" but none of "it" was here.

Back in San Francisco, Sharon functioned on a sort of minimal level, limiting herself to superficial involvements. But when her father developed terminal cancer, she chose to be with him during the long months of his dying. At his request, Sharon and her father together did what they could to help him express his buried feelings; he grieved that he had repressed so much of himself and hoped that Sharon would live more freely. After her father died, though, she felt more deadened than ever and could not involve herself deeply in art or anything else.

Sharon realized how much she had cut off her creativity when she saw in a stranger's home a three-dimensional print that she'd made two years before and now could not recognize or remember as her own creation. Shortly afterwards she began coming to art therapy groups and then to weekly private sessions with me.

For the first year, Sharon resisted expressing herself with art forms; given a large sheet of paper, she would draw tiny, delicate decorations in one corner and was inarticulate about them. Six months ago Sharon told me that she was "making little things" at home; she "enjoyed tinkering," she said. She made gifts for people, grew potted plants, decorated her apartment for Christmas--small things, but all of her own creation. She brought small, neat, black and white collages to our sessions, discussing how she was beginning to discover elements in them that related to her individuality. A month ago she brought in four forms.

About six inches high, made from plastic, glass, cotton, and metal, they are very personally Sharon's. At my suggestion, she began expressing her thoughts and feelings by writing. At first this was difficult for her, but now she pours out words, pages and pages of them. In her own way, she describes her self-trait figures:

"Aspect I"
I am obscure, unclear, non-functional, split, non-directional. I am soft and dream-like, with sharp tangents of reality and discomfort. I neither radiate nor direct. I feel helpless and static. My movement is dependent--I can be picked up, placed, and given meaning by an "other." I can also be ignored, passed over, unseen. I can be loved or unloved, unhappy or happy, observant but indecisive, a willing object. I am between a dream and a reality. Life becomes an echo.

"Aspect II"
I am definite, definitive, directed. My movement starts slowly with a spiraling to conclusions. I am unreasonable, brilliant, angry, rash, permanent, stubborn, and purposeful. I am right, tall, and impenetrable. I have no feeling, but I have logical progressions of a third sense. I reach an end, lose connections with the spiral or process or why, and I become implacable, dreamless, determined, and compassionless. I am not here to be loved or loving. I am here to do and to be. There is no echo, I am the voice and the conception. Brittle and breakable.

"Aspect III"
I am in balance, shorter but functioning. I can both feel and be at the same time. I combine softness with balance and brittle receptivity. I am open to change that I can maintain in various positions. I can be delighted and graceful, useful and willing. I have a synthesis of dream and reality. I am non-linear; I can be absurd but not dismissed. I do not alarm, nor do I feel alarmed or vulnerable to breakage. I am perhaps content with the image I am.

"Aspect IV"
I must combine my dream-observer with real-life situations. Softness can combine with sharpness and still give a pleasing feeling. I can joke about my situation because I am self-willed and not an object of a stranger's needs. I can work with my own needs and experiment with combinations of feelings. I can destroy myself when I feel I need to destroy an unworkable aspect of me. If I do it it's okay; I need the time to reach my own conclusions. I can laugh and give my experience to others 'cause I did it myself.

Sharon is now exploring her own experiences through art, with her own intelligence and imagination; recently she wrote: "I have developed a real feel for edges. I can sense an edge, or a limit, or a closing off of space and time and sound when I am in an uncomfortable situation .... I am trying to learn the process of expanding this space without the fear of edges, without the tendency to get lost in another, and without the need to scrap the whole picture if I can't find my place."

Sharon is finding her place: she is working for a public-service agency part time and is also acquiring a clientele for her free-lance services as a designer. She feels that she will have an agency in a few years and is excited about her possibilities. More important, Sharon is increasingly self-determining; she is realistically expanding to fit recognized spaces in her own potential.

This brief vignette is an unenclosed, open-ended image of the here-and-now awareness of a person in process. More eloquent than any words I can say are Sharon's own self-perceptions, both graphic and verbal.
- Rhyne, Janie; The Gestalt Approach To Experience, Art, And Art Therapy; American Journal of Art Therapy; Aug2001, Vol. 40 Issue 1
The article above contains foundational information. Articles below contain optional updates.

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Personal Reflection Exercise #2
The preceding section contained information about a case study example of 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 16
What two statements did Sharon make that indicated her increased receptiveness to expressing herself through art? 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.
Critical consciousness moderates the relationship between transphobia and “bathroom bill” voting. - July 12, 2018
In recent years, antitransgender legislation that focuses on gender and the use of public restrooms—so-called bathroom bills—has been considered in many states in the United States. The present study was designed to extend research on transphobic attitudes and elucidate links between religious fundamentalism, social dominance orientation, transphobia, and voting for bathroom bills. Further, we examined the moderating influence of critical consciousness on the relationship between transphobic attitudes and voting on a hypothetical bathroom bill. Results of a moderated mediation multinomial logistic regression path analysis using data from a sample of 282 college students (154 women and 128 men) indicated that religious fundamentalism and social dominance orientation were associated with transphobic attitudes. Transphobia was associated with lower likelihood to vote against or abstain from voting on the bill, compared to voting for it. Critical consciousness was also associated with greater likelihood of voting against the bill rather than for it. The interaction between transphobia and critical consciousness was associated with voting against rather than for the bill, such that at higher levels of transphobia, those higher in critical consciousness were more likely to vote against the bill rather than for it. Implications for incorporating critical consciousness into advocacy efforts to promote transgender rights are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Socialization and well-being in multiracial individuals: A moderated mediation model of racial ambiguity and identity. - July 12, 2018
Scholarly interest in racial socialization is growing, but researchers’ understanding of how and when racial socialization relates to well-being is underdeveloped, particularly for multiracial populations. The present study investigated moderated mediation models to understand whether the indirect relations of egalitarian socialization to subjective well-being and self-esteem through integrated multiracial identification were conditional on phenotypic racial ambiguity among 383 multiracial adults. Tests of moderated mediation in primary analyses were significant for subjective well-being and self-esteem. Consistent with the hypotheses, egalitarian socialization was linked to a stronger multiracial integrated identity, which was positively associated with subjective well-being and self-esteem for those with moderate and high phenotypic racial ambiguity. This indirect effect was not significant for those reporting low phenotypic racial ambiguity. Results suggested a positive role of egalitarian socialization in relation to integrated identity and well-being for multiracial adults. This study highlights a culturally relevant pathway through which egalitarian socialization impacts well-being through racial identification for multiracial adults and the conditions of phenotypic racial ambiguity that contextualize this indirect effect. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Work as a calling: A theoretical model. - July 12, 2018
Perceiving work as a calling has been positioned as a key pathway to enhancing work-related well-being. However, no formal theory exists attempting to explain predictors and outcomes of living a calling at work. To address this important gap, this article introduces a theoretical, empirically testable model of work as a calling - the Work as Calling Theory (WCT) - that is suitable for the contemporary world of work. Drawing from research and theory in counseling, vocational, multicultural, and industrial-organizational psychology, as well as dozens of quantitative and qualitative studies on calling, the WCT is presented in three parts: (a) predictors of living a calling, (b) variables that moderate and mediate the relation of perceiving a calling to living a calling, and (c) positive (job satisfaction, job performance) and potentially negative (burnout, workaholism, exploitation) outcomes that result from living a calling. Finally, practical implications are suggested for counselors and managers, who respectively may seek to help clients and employees live a calling. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
When in doubt, sit quietly: A qualitative investigation of experienced therapists’ perceptions of self-disclosure. - July 12, 2018
Using consensual qualitative research (CQR), we analyzed 13 interviews of experienced psychotherapists about general intentions for therapist self-disclosure (TSD), experiences with successful TSDs, experiences with unsuccessful TSDs, and instances of unmanifested urges to disclose. For TSD generally (i.e., not about a specific instance), typical intentions were to facilitate exploration and build and maintain the therapeutic relationship. Therapists typically reported becoming more comfortable using TSD over time. In successful TSDs, the typical content was accurate, relevant similarities between therapist and client; typical consequences were positive. In unsuccessful TSDs, the typical antecedent was countertransference reactions; the typical intention was to provide support; typical content involved therapists mistakenly perceiving similarities with clients; and the general consequences were negative. In instances when therapists repressed the urge to disclose, the typical antecedent was countertransference and the content typically seemed relevant to the client’s issues. We conclude that effective use of TSD requires general attunement to the client’s dynamics, attunement to the client’s readiness in the moment, ability to manage countertransference, and ability to use a specific TSD appropriately. Implications for practice, training, and research are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Self-compassion buffers the link between self-criticism and depression in trauma-exposed firefighters. - June 21, 2018
Firefighters are frequently exposed to highly stressful, potentially traumatic events (PTEs). More than 50%, however, show no significant elevation in trauma-related symptomatology (e.g., depression). In the past, self-compassion has been discussed to promote psychological and behavioral flexibility that is vital to a successful adaptation to PTEs. The goal of this study was to understand whether and how self-compassion may alleviate personal suffering in the face of PTEs. We hypothesized that individuals who encounter their profession-related affective experiences with greater self-compassion, show lower levels of depressive symptoms because self-compassion buffers processes that perpetuate negative affectivity in response to PTEs (i.e., self-critical tendencies). Male firefighters (N = 123) completed self-report questionnaires about the severity of current depressive symptoms; prior traumatic, duty-related events; and the self-compassion scale that assesses two distinct factors: self-criticism and self-compassion. A stepwise regression model was employed to examine differential and interactive contributions of self-criticism and self-compassion to symptoms of depression across the cumulative range of exposure to PTEs. Our results indicate that the positive association between self-criticism and depression is buffered by enhanced levels of self-compassion. This moderation, however, only emerged for firefighters with substantial amounts of PTEs experience in the past. The present work provides insight into protective effects of self-compassion in the face of cumulative PTEs. It suggests that, particularly for severely trauma-exposed firefighters, self-compassion may confer resilience, that is, act as a protective factor from the development of depressive symptoms. Findings are discussed in light of counseling implications. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

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