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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.

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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Table of Contents

The article above contains foundational information. Articles below contain optional updates.
Being in-between: A model of cultural identity negotiation for emerging adult immigrants. - March 15, 2018
This qualitative study explored the cultural identity negotiation of young adult immigrants. Using a grounded theory research design, 10 semistructured interviews were conducted with emerging adult immigrants (EAI), ages 19–27. Results yielded a substantive model of cultural identity negotiation (MCIN) for EAI and posited that One’s Motivation and Sense of Agency to Negotiate Cultural Identity is at the core of how participants navigate their cultural identities. This model included 6 major categories: (a) Family Cultural Rigidity; (b) Connections Specific to Canada; (c) Connection to a Same Cultured Community; (d) Sense of Permanency; (e) Desire to Preserve Culture of Origin; (f) Desire to Fit in to Canadian Culture, as well as 2 overarching factors (Dimension of Time and Dimension of Age), which were found to be influential on participants’ cultural identity negotiation. The model also included the identification of 4 approaches to cultural identity negotiation: (a) Blended; (b) Dual; (c) Disconnected; and (d) Intermediate. The MCIN for EAI is discussed in terms of the current literature on cultural identity formation as well as implications for counseling psychology training and practice. Recommendations for further research are also suggested. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Helping others increases meaningful work: Evidence from three experiments. - May 11, 2017
The aim of the current research was to examine whether manipulating task significance increased the meaningfulness of work among students (Study 1), an online sample of working adults (Study 2), and public university employees (Study 3). In Study 1, students completed a typing task for the benefit of themselves, a charity, or someone they knew would directly benefit from their work. People who worked to benefit someone else, rather than themselves, reported greater task meaningfulness. In Study 2, a representative, online sample of employees reflected on a time when they worked to benefit themselves or someone else at work. Results revealed that people who reflected on working to benefit someone else, rather than themselves, reported greater work meaningfulness. In Study 3, public university employees participated in a community intervention by working as they normally would, finding new ways to help people each day, or finding several new ways to help others on a single day. People who helped others many times in a single day experienced greater gains in work meaningfulness over time. Across 3 experimental studies, we found that people who perceived their work as helping others experienced more meaningfulness in their work. This highlights the potential mechanisms practitioners, employers, and other parties can use to increase the meaningfulness of work, which has implications for workers’ well-being and productivity. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Change in post-traumatic cognitions mediates treatment effects for traumatized youth—A randomized controlled trial. - March 15, 2018
Posttraumatic stress symptoms (PTSS) are associated with serious impairments in psychological, social, and academic functioning in youth. The aim of this study was to investigate whether changes in posttraumatic cognitions mediate treatment effects. Participants were multitraumatized youth (N = 156, mean age = 15.1 years, range = 10–18; 79.5% girls) randomly assigned to receive trauma-focused cognitive–behavioral therapy (TF-CBT) or treatment-as-usual (TAU). Mixed-effects models were applied to investigate the impact of treatment conditions on posttraumatic cognitions. Mediation analyses were applied to examine whether changes in posttraumatic cognitions mediated the relationship between treatment conditions and outcome in posttraumatic stress symptoms, depressive symptoms, and general mental health. Participants receiving TF-CBT reported significantly lower levels of negative posttraumatic cognitions at the end of treatment compared to participants in TAU. Change in posttraumatic cognitions mediated the treatment effect difference found for PTSS. When the overall change in cognition was divided into early and late changes, it was only the late change that significantly mediated the PTSS treatment effect. A mediation effect of posttraumatic cognitions was also found for the treatment effect difference in depressive symptoms and in general mental health symptoms. Traumatized youth report having many negative posttraumatic cognitions and changes in negative cognitions plays a key role for treatment outcome. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Discrimination, work outcomes, and mental health among women of color: The protective role of womanist attitudes. - March 15, 2018
With a sample of employed women of color (N = 276), we tested the associations of sexist and racist discrimination with poor work outcomes (job-related burnout and turnover intentions) and mental health outcomes (i.e., psychological distress). Drawing from the Theory of Work Adjustment, Organizational Support Theory, and scholarship on discrimination, we tested perceived person-organization (P-O) fit, perceived organizational support, and self-esteem as mediators of the associations of workplace discrimination with the outcomes. Based on intersectionality scholarship, womanist attitudes were tested as a moderator. Participants provided cross-sectional data via an online survey. Latent variable structural equation modeling results indicated that a second-order latent workplace discrimination variable yielded better fit to the data than modeling sexist and racist discrimination separately. Workplace discrimination was directly and indirectly (via the mediating role of self-esteem) associated with higher psychological distress. Furthermore, workplace discrimination was indirectly associated with poor work outcomes through the mediating roles of perceived P-O fit, perceived organizational support, and self-esteem. Last, moderation analyses indicated that higher womanist attitudes weakened the direct association of workplace discrimination with psychological distress. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Associations among psychological distress, high-risk activism, and conflict between ethnic-racial and sexual minority identities in lesbian, gay, bisexual racial/ethnic minority adults. - July 06, 2017
In this brief report, we present results from a study exploring the associations of high-risk activism (HRA) orientation in lesbian, gay, and bisexual (LGB) issues; HRA orientation in racial/ethnic issues; conflicts in allegiances (CIA) between one’s ethnic-racial and sexual minority identities; and anxiety among LGB racial/ethnic minority adults. A racially and ethnically diverse sample of 208 LGB racial/ethnic minority adults (age: M = 27.52, SD = 8.76) completed an online survey. Bivariate correlations showed that HRA orientation in LGB and in racial/ethnic issues, as well as CIA, were each positively associated with anxiety. However, regression analyses indicated that CIA moderated the association between anxiety and HRA orientation in LGB issues (but not racial/ethnic minority issues) such that this association was significant and positive at low levels of CIA and nonsignificant at high levels of CIA. These findings can be used to not only inform psychological practice with this population (e.g., by encouraging practitioners to be more attentive to these issues as potential sources of stress), but also more broadly, as knowledge that can inform the burgeoning psychological literature on collective action. We highlight, for example, the importance of distinguishing between types of activism (i.e., high- vs. low-risk types) in relation to mental health outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

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