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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 Test | 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 Test.

 
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The article above contains foundational information. Articles below contain optional updates.
Health disparities between genderqueer, transgender, and cisgender individuals: An extension of minority stress theory. - March 21, 2019
Interpersonal, social, and structural stressors have been identified as key elements that explain health disparities between transgender and cisgender individuals. However, most of this research has focused on binary transgender individuals or has not differentiated between binary and nonbinary individuals; little research has examined the experiences of minority stress or health of those identifying outside the gender binary. Guided by intersectionality and drawing on a sample of 3,568 college students from the Center for Collegiate Mental Health’s 2012−2016 database—of whom 892 identified outside the gender binary—we conducted analyses of demographic and outcome measures administered in participants’ 1st counseling appointment, examining differences between cisgender, transgender, and genderqueer individuals. We found that genderqueer individuals were harassed, sexually abused, and subjected to traumatic events at higher rates than were either cisgender or binary transgender individuals, with approximately 50% of genderqueer individuals reporting one of these experiences. We found that genderqueer individuals experienced more anxiety, depression, psychological distress, and eating concerns than did binary transgender and cisgender individuals and more social anxiety than did cisgender individuals. Genderqueer individuals more frequently reported self-harm and suicidality than did any other group, with approximately 2/3 of participants’ having contemplated and nearly 50% making a suicide attempt. We extend current theorizing about minority stress (Hendricks & Testa, 2012; Meyer, 2003) to include genderqueer individuals and delineate several structural aspects of genderqueer experiences that may be responsible for these trends, including others’ lack of knowledge about genderqueer experiences and pronouns, poor access to legal and medical resources, and systemic discrimination. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
A caballo regalao no se le mira el colmillo: Colonial mentality and Puerto Rican depression. - April 18, 2019
Dignifying the colonizer and depreciating the colonized is a reflection of internalized colonial oppression (i.e., colonial mentality). The current study examined the effect of colonial mentality on depression symptoms in a sample of mainland Puerto Ricans (N = 352). A structural equation model was examined, in which colonial mentality was hypothesized to be directly and positively associated with depression symptoms. The proposed model also tested the indirect effect of colonial mentality on depression symptoms via acculturative stress. Results indicated that a full mediation structural equation model (SEM) had a better fit to the data than our hypothesized partial mediation model. Bias-corrected bootstrapping indicated that the effect of colonial mentality on depressive symptoms was mediated by acculturative stress. That is, colonial mentality increased the risk of experiencing depression symptoms in Puerto Ricans when they felt pressured to maintaining a connection with Puerto Rican culture and society and when they experienced rejection by the society they want to emulate (acculturative stress). The current results underscore the need for researchers and clinicians to consider and assess colonial mentality when conceptualizing depression symptoms among mainland Puerto Ricans. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
The development and validation of the Emotional Cultivation Scale: An East Asian cultural perspective. - April 15, 2019
Research on emotion regulation in East Asian children and adolescents is limited. One obstacle hindering the development of emotion regulation for East Asian children and adolescents is the lack of a culturally sensitive measure. To fill this gap, we have developed and validated the Emotional Cultivation Scale using samples of Taiwanese children and adolescents. In Study 1, an exploratory factor analysis (n = 341) identified two factors: Cultivating Emotion Strategies and Understanding Emotion Connotations. A confirmatory factor analysis (n = 358) confirmed this two-factor structure. Coefficient αs were .69 to .88 for Emotional Cultivation. Convergent validity was evidenced by positive associations with cognitive reappraisal and cognitive flexibility. Discriminant validity was supported by a nonsignificant association with suppression. Concurrent validity was revealed by positive associations with positive affect, basic psychological need satisfaction, gratitude, responsiveness from teachers, responsiveness from parents, and academic self-efficacy. Incremental validity was evidenced by the finding that emotional cultivation significantly accounted for an additional 2 to 20% of the variance in predicting cognitive flexibility, positive affect, basic psychological need satisfaction, gratitude, responsiveness from teachers, responsiveness from parents, and academic self-efficacy above and beyond cognitive reappraisal and suppression. Results from the multigroup analysis further indicated factor loading invariance and validity invariance between boys and girls and between elementary and middle schools. The factor structure was cross-validated by a clinical sample of Taiwanese children and adolescents (N = 161) and their parents in Study 2 (N = 159). The counseling implications were discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Cognitive and affective expectation of stigma, coping efficacy, and psychological distress among sexual minority people of color. - May 30, 2019
There is a paucity of research on the potentially distinctive functions of cognitive and affective expectation of stigma. Moreover, expectation of stigma has received limited research attention with sexual minority people of color who may anticipate interlocking heterosexist and racist stigmatization. In this study, data from 209 sexual minority people of color were analyzed using path analysis and bootstrap procedures to test direct and indirect relations among perceived discrimination, expectation of stigma, coping self-efficacy, and psychological distress. Analyses disaggregated expectation of stigma into its cognitive (i.e., perceived likelihood of stigma) and affective (i.e., worry and anxiety about stigma) components. Results revealed that perceived discrimination had a unique direct link with psychological distress. In addition, perceived discrimination was linked indirectly with greater distress through affective expectation of stigma and problem-focused and emotion-focused coping self-efficacy. These findings suggest the importance of social justice interventions to reduce discrimination. Additionally, the findings suggest that interventions should attend to affective worry and anxiety about stigma and foster problem-focused and emotion-focused coping self-efficacy. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Surviving and thriving: Voices of Latina/o engineering students at a Hispanic serving institution. - April 15, 2019
This study examined factors that played a role in Latina/o undergraduate students’ persistence in engineering at a Hispanic serving institution (HSI; N = 10) using the consensual qualitative research method (CQR; Hill, Thompson, & Williams, 1997). Data analyses resulted in five domains: institutional conditions, additive intersectional burdens, personal and cultural wealth, coping skills, and engineering identity. Participants described how they persisted in the face of stressors, citing specific coping skills they developed over time as well as general personal and cultural strengths they carried with them into their pursuit of engineering. Although the structures of the students’ institution were generally described as supportive, Latina participants reported experiences with gendered racism that created added barriers to their persistence in engineering. Supportive institutional conditions, personal and cultural assets, and adaptive coping strategies appeared to facilitate the development of a strong engineering identity, which helped to solidify students’ sense of belonging, pride, and commitment to complete their degree. Results highlight the need to address intersecting experiences of privilege and oppression to promote access and equity for Latinas/os in engineering. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

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