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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.
Work and well-being in TGNC adults: The moderating effect of workplace protections. - September 13, 2018
The present study used a psychology of working theory (PWT) framework to test the direct and indirect relations of perceived social status and transgender and gender nonconforming (TGNC) marginalization (i.e., victimization, nonaffirmation of gender identity, negative expectations for the future) with work volition, overqualification, and vocational and emotional well-being outcomes (i.e., job satisfaction, meaningful work, satisfaction with life, depression) in a sample of 175 TGNC working adults. This study also tested the moderating effect of one form of structural marginalization (lack of legal protections from employment discrimination) on the overall pattern of results. Participants were recruited using online social media and discussion forums and completed the study survey online. For the full sample, perceived social status and nonaffirmation of gender identity were associated with vocational and emotional well-being outcomes through the mediating role of work volition, and for some paths, overqualification. Significant differences emerged in the overall pattern of results for those without protections, suggesting that protections from discrimination buffer the adverse links of some forms of TGNC marginalization with work volition and vocational outcomes. Implications of study findings for research, counseling, and advocacy are provided. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
The development and psychometric evaluation of the Trans Discrimination Scale: TDS-21. - July 23, 2018
[Correction Notice: An Erratum for this article was reported in Vol 66(1) of Journal of Counseling Psychology (see record 2018-66276-001). In the article “The development and psychometric evaluation of the Trans Discrimination Scale: TDS-21” by Laurel B. Watson, Luke R. Allen, Mirella J. Flores, Christine Serpe, and Michelle Farrell (Journal of Counseling Psychology, 2018, Advance online publication. http://dx.doi.org/10 .1037/cou0000301), there were two errors in the Methods section of the article. In Study 1, Participants paragraph of The development and psychometric evaluation of the Trans Discrimination Scale: TDS-21 for the Methods section, the gender listed at birth was incorrect in the following sentence, The majority of participants in this study identified as trans women and along a trans feminine spectrum, were assigned male at birth, White, had attained some college but no degree, and were employed full time. The correct gender assigned at birth was predominantly female. In addition, the gender coding procedures was incorrectly described. Specifically, those who identified as FAAB and AFAB were actually coded as trans men or along a transmasculine spectrum, whereas those who identified as MAAB and AMAB were coded as trans women and along a trans feminine perspective. In Study 3, Participants paragraph of The development and psychometric evaluation of the Trans Discrimination Scale: TDS-21 for the Methods section, the gender identity listed in the following sentence was incorrect, The majority of participants identified as trans women and along the trans feminine spectrum, were assigned female at birth, White, had attained some college but no degree, and were students. Rather, participants primarily identified as non-binary trans.] To date, researchers assessing the role of discrimination in trans peoples’ lives have relied upon measures that were developed and normed on LGB populations, culled specific items from large-scale survey data, or used more generalized measures of discrimination that do not specifically assess the unique forms of discrimination that trans people may encounter. Thus, the purpose of this three-part study was to develop and provide psychometric support for a measure of trans peoples’ discrimination. In Study 1, a five-factor model emerged, which included: Microaggressions and Harassment, Restricted Career and Work Opportunities, Maltreatment in Health Care Settings, Harassment by Law Enforcement, and Bullying and Harassment in Educational Settings. Internal consistency estimates for subscale and total scale scores ranged from acceptable to excellent. Results from Study 2 revealed that a bifactor model provided the best fit to the data, revealing that the scale is essentially unidimensional. In addition, convergent and concurrent validity was supported, demonstrating significant positive correlations with another measure of trans discrimination, internalized transphobia, nondisclosure, negative expectations for the future, psychological distress, and perceived stress. In Study 3, results revealed excellent test–retest reliability up to a three-week period. Collectively, results suggested that the Transgender Discrimination Scale-21 (TDS-21) is a psychometrically sound measure that may be used to advance research on the role of discrimination in trans peoples’ lives. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
“The Development and Psychometric Evaluation of the Trans Discrimination Scale: TDS-21”: Correction to Watson et al. (2018). - January 03, 2019
Reports an error in "The Development and Psychometric Evaluation of the Trans Discrimination Scale: TDS-21" by Laurel B. Watson, Luke R. Allen, Mirella J. Flores, Christine Serpe and Michelle Farrell (Journal of Counseling Psychology, Advanced Online Publication, Jul 23, 2018, np). In the article “The Development and Psychometric Evaluation of the Trans Discrimination Scale: TDS-21” by Laurel B. Watson, Luke R. Allen, Mirella J. Flores, Christine Serpe, and Michelle Farrell (Journal of Counseling Psychology, 2018, Advance online publication. http://dx.doi.org/10 .1037/cou0000301), there were two errors in the Methods section of the article. In Study 1, Participants paragraph of The Development and Psychometric Evaluation of the Trans Discrimination Scale: TDS-21 for the Methods section, the gender listed at birth was incorrect in the following sentence, The majority of participants in this study identified as trans women and along a trans feminine spectrum, were assigned male at birth, White, had attained some college but no degree, and were employed full time. The correct gender assigned at birth was predominantly female. In addition, the gender coding procedures was incorrectly described. Specifically, those who identified as FAAB and AFAB were actually coded as trans men or along a transmasculine spectrum, whereas those who identified as MAAB and AMAB were coded as trans women and along a trans feminine perspective. In Study 3, Participants paragraph of The Development and Psychometric Evaluation of the Trans Discrimination Scale: TDS-21 for the Methods section, the gender identity listed in the following sentence was incorrect, The majority of participants identified as trans women and along the trans feminine spectrum, were assigned female at birth, White, had attained some college but no degree, and were students. Rather, participants primarily identified as non-binary trans. (The following abstract of the original article appeared in record 2018-35350-001.) To date, researchers assessing the role of discrimination in trans peoples’ lives have relied upon measures that were developed and normed on LGB populations, culled specific items from large-scale survey data, or used more generalized measures of discrimination that do not specifically assess the unique forms of discrimination that trans people may encounter. Thus, the purpose of this three-part study was to develop and provide psychometric support for a measure of trans peoples’ discrimination. In Study 1, a five-factor model emerged, which included: Microaggressions and Harassment, Restricted Career and Work Opportunities, Maltreatment in Health Care Settings, Harassment by Law Enforcement, and Bullying and Harassment in Educational Settings. Internal consistency estimates for subscale and total scale scores ranged from acceptable to excellent. Results from Study 2 revealed that a bifactor model provided the best fit to the data, revealing that the scale is essentially unidimensional. In addition, convergent and concurrent validity was supported, demonstrating significant positive correlations with another measure of trans discrimination, internalized transphobia, nondisclosure, negative expectations for the future, psychological distress, and perceived stress. In Study 3, results revealed excellent test–retest reliability up to a three-week period. Collectively, results suggested that the Transgender Discrimination Scale-21 (TDS-21) is a psychometrically sound measure that may be used to advance research on the role of discrimination in trans peoples’ lives. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Testing intersectionality of race/ethnicity × gender in a social–cognitive career theory model with science identity. - October 04, 2018
Using social–cognitive career theory, we identified the experiential sources of learning that contribute to research self-efficacy beliefs, outcome expectations, and science identity for culturally diverse undergraduate students in science, technology, engineering, and math (i.e., STEM) majors. We examined group differences by race/ethnicity and gender to investigate potential cultural variations in a model to explain students’ research career intentions. Using a sample of 688 undergraduate students, we ran a series of path models testing the relationships between the experiential sources, research self-efficacy beliefs, outcome expectations, and science identity to research career intentions. Findings were largely consistent with our hypotheses in that research self-efficacy and outcome expectancies were directly and positively associated with research career intentions and the associations of the experiential sources to intentions were mediated via self-efficacy. Science identity contributed significant though modest variance to research career intentions indirectly via its positive association with outcome expectations. Science identity also partially mediated the efficacy-outcome expectancies path. The experiential sources of learning were associated in expected directions to research self-efficacy with 3 of the sources emerging as significantly correlated with science identity. An unexpected direct relationship from vicarious learning to intentions was observed. In testing for group differences by race/ethnicity and gender in subsamples of Black/African American and Latino/a students, we found that the hypothesized model incorporating science identity was supported, and most paths did not vary significantly across four Race/Ethnicity × Gender groups, except for 3 paths. Research and practice implications of the findings for supporting research career intentions of culturally diverse undergraduate students are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Construction and validation of the Multicultural Orientation Inventory—Group Version. - July 12, 2018
Given the continued racial/ethnic diversification of the United States, it is not uncommon for therapy groups to consist of members with diverse racial/ethnic backgrounds and various cultural identities. Scholars have underscored how this cultural diversity can directly impact many processes and outcomes of group-based interventions (Chen, Kakkad, & Balzano, 2008). However, there is presently a paucity of empirical research testing the relationship between cultural processes of therapy groups and members’ outcomes. Moreover, no psychometrically sound measure of the cultural process that unfolds in group therapy currently exists. As such, this study sought to adapt the Multicultural Orientation Inventory to develop and validate the Multicultural Orientation Inventory—Group Version (MCO-G), a measure assessing the cultural humility, cultural comfort, and cultural missed opportunities in therapy groups. Data for this validation study consisted of 208 members of 49 therapy groups across 10 university counseling centers. Confirmatory factor analyses supported a 3-factor structure of the MCO-G Inventory, wherein the 3 factors corresponded with the underlying constructs of cultural humility, cultural comfort, and cultural missed opportunities. This study provides initial evidence for the estimated internal and convergent validity of the MCO-G, as measured by clients’ perceptions of a higher-order group therapeutic factor and improvement in therapy. Results provide initial support for the psychometric properties of the MCO-G. Moreover, groups’ cultural humility and cultural missed opportunities were related to members’ improvement in therapy. Clinical implications and future research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

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