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

Section 18
Integrating Gestalt Theory into
Dual Process Model Grief and Mourning Work

CEU Question 18 | CEU Answer Booklet | Table of Contents | Gestalt
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

Dual Process Model of Coping with Bereavement (DPM)
Stroebe and Schut (2001) described their dual process model of coping with bereavement as an integration of existing ideas rather than a completely novel framework. Stroebe and Schut (1999,2001) argued the need for a stressor-specific model of coping with bereavement because death losses invariably involve multiple and diverse Stressors rather than a single Stressor. They classified these Stressors into two types: loss oriented vs. restoration oriented. Loss-oriented Stressors are those that pertain specifically to the death-loss experience itself. Examples include the disintegration of future plans with the deceased, the ending of the physical relationship with the deceased, and the lack of social support once offered by the deceased. In contrast, restoration-oriented Stressors are those that are secondary (with regard to timing rather than intensity) to the death loss such as the addition of new household chores, decreases in financial resources, and altered communication patterns with friends and family members. Associated with each of these two types of Stressors is a specific coping orientation. Loss-oriented coping involves focusing on and processing aspects of the loss (e.g., visiting the grave, looking at photographs, emoting related to the death), while restoration-oriented coping involves focusing on the secondary Stressors that must be dealt with (e.g., financial problems) and determining how to tackle them (e.g., selling one's house). The core of DPM is the contention that the oscillation between these two types of coping processes actually is essential for adaptive coping. Through the concept of oscillation, Stroebe and Schut have managed to maintain the benefits of two of the most difficult to reconcile aspects of the mourning process: the need to move on with life and the desire to remain connected to the deceased (DeSpelder & Strickland, 2002).

DPM and counseling theories. Although the primary emphasis, here, is placed on the intriguing parallels between DPM and Gestalt theory (Perls, 1969), mental health counselors identifying with a behavioral (Wilson, 2000), person-centered (Rogers, 1980), or Jungian (Douglas, 2000) framework may find DPM concepts useful in their work with bereaved clients. With regard to behavioral and person-center approaches, recent research (Schut et al., 1997) found that widowed males assigned to a person-centered intervention showed lower distress following treatment, as did widowed females assigned to the behavioral approach; whereas men assigned to the behavioral and women to a person-centered approach exhibited little improvement. Schut et al. suggested that women naturally tend toward loss-oriented coping while men naturally tend toward restoration-focused coping and argued that individuals may benefit more when treatment challenges them to concentrate on the type of coping processes to which they are less accustomed. Because DPM has a strong non-linear emphasis, the counseling theories that emphasize holism and balance are a natural fit. For instance, the link with Jung's analytical approach is clear as he viewed the world in terms of paired opposites engaged in active struggle (Douglas). Similarly, Gestalt counseling theory suggests that individuals are self-regulating and inclined toward growth, with health being defined as the organism's awareness, recognition, and appropriate attention to needs and desires as hierarchically required (Yontef & Jacobs, 2000). Through the process of organismic self-regulation, the most pressing need / desire emerges from the background of the mind as a figure. When this figured need is addressed and attended to, it then blends into the background as the next figure in the hierarchy emerges. For healthy individuals, this process is fluid, and figures shift quite rapidly.
As both emphasize the person-environment dialectic, the gestalt approach to health and adjustment blends well with the DPM distinction between the two major types of Stressors associated with death loss: Those that can be addressed through internal processing, and those associated with the secondary losses in the environment that may be more amenable to external adjustments. Creative adjustment is the Gestalt term used to describe the process employed by individuals when they are faced with the changing demands of the environment, such as a death loss (Sabar, 2000). More specifically, creative adjustment involves a balance between internally adjusting to current conditions and externally working to change the environment, when such change is possible and appropriate (Yontef & Jacobs, 2000). Creative adjustment occurs when individuals are aware of their own organismic functioning such that they attend to the hierarchical needs / desires that emerge in new situations and make the appropriate internal and external adjustments. For bereaved individuals, "creative adjustment during mourning means adapting to 'what is,' changing oneself and reorganizing one's environment to fit the new reality of the deceased person no longer being physically present" (Sabar, p. 161). This description clearly parallels the DPM.

Another strong connection between DPM and Gestalt theory is the attention given by both to dualism and oscillation. According to Gestalt theory, life is marked by polarities (Yontef & Jacobs, 2000), and each figure stands against an opposite ground. For healthy functioning, both poles of each dichotomy must be allowed to become figures, and the constantly shifting balance between the poles is critical to the process of creative adjustment. As connected with the DPM, bereaved individuals have a dichotomy with regard to loss- and restoration-oriented coping, and both poles must be allowed to rise as figures and be addressed as hierarchically required by the organismic functioning of the individual. After a loss, bereaved individuals need to self-regulate both the pace and intensity of their grief, following a comfortable rhythm of avoidance of and attention to the pain so that they become neither overwhelmed nor numb (Sabar, 2000). Based on her clinical work with the bereaved, Clark (1982) took this notion of rhythm even further and defined times within the mourning process as either periods of connecting or separating. The similarity between her descriptions of these periods and the loss and restoration orientations of DPM is striking. More specifically, Clark explained that during connecting times, "people were involved in their life activities, making plans, doing everyday tasks, exploring and experimenting" (p. 59). In contrast, when in a time of separating, peoples attention centered on the impact of their loss. Thus, in a wave-like rhythm, "therapy flows back and forth during transition times between awareness of separating and awareness of connecting, between times of 'living' and times of 'dying'" (p. 61).

Just as Stroebe and Schut (1999,2001) described complicated grief as a disturbance in the oscillation, Gestalt theory suggests that neurotic regulation occurs when some aspects of one's mental background are not allowed to become figures, that is, when the polarities are not fluid, but rather become hardened dichotomies (Yontef & JacoDs, 2000). The recommendation for mental health counselors with regard to both approaches is to foster the acknowledgement and expression of both dimensions, loss and restoration, thereby encouraging clients toward balance.
- Servaty-Seib, Heather L.; Connections Between Counseling Theories and Current Theories of Grief and Mourning; Journal of Mental Health Counseling, Apr2004, Vol. 26 Issue 2
The article above contains foundational information. Articles below contain optional updates.

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Personal Reflection Exercise #4
The preceding section contained information about integrating Gestalt techniques into grief and mourning work.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 18
What is the definition of the Gestalt term "creative adjustment"? Record the letter of the correct answer the CEU Answer Booklet.

 
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The development and validation of the Contemporary Critical Consciousness Measure II. - August 30, 2018
Critical consciousness (CC) has been heralded as an antidote to oppression. Developed by the Brazilian educator, Paulo Freire, CC represents the process by which individuals gain awareness of societal inequities and subsequently take action to dismantle the systems and institutions that sustain them. Empirically supported instruments intended to assess this important construct have only been recently introduced to the literature and have focused specifically on racism, classism, and heterosexism. The purpose of this project was to develop a psychometrically sound measure of CC that expands assessment into sexism, cissexism (genderism/transphobia), and ableism. Two studies with a total of 569 observations provided initial reliability and validity evidence on the Contemporary Critical Consciousness Measure II (CCCMII). Results from exploratory and confirmatory factor analyses suggest that the final 37-item CCCMII provides a general index of CC as well as assesses CC associated with sexism and ableism above and beyond the general factor. Results support the internal consistency and factor structure of the measure. Expected relationships between the CCCMII and existing measures of sexism, cissexism, and ableism provide evidence for the validity of the instrument. Limitations, future directions for research, and counseling implications are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Gendered Racism Scales for Asian American Men: Scale development and psychometric properties. - July 23, 2018
The Gendered Racism Scales for Asian American Men (GRSAM) was developed to assess the frequency and stress level of gendered racism perceived by Asian American men. The development of the new measure was grounded in the Intersectional Fusion Paradigm. This paradigm explains individuals’ experiences of discrimination based on unique combinations of multiple interlocking identities that individuals experience simultaneously. In mixed samples of college students and community adults, GRSAM’s factor structure as well as evidence of convergent validity, criterion-related validity, discriminant validity, incremental validity, internal consistency, and test–retest reliability was examined. Exploratory factor analyses revealed three dimensions of GRSAM: Psychological Emasculation, Perceived Undesirable Partner, and Perceived Lack of Leadership. Confirmatory factor analyses demonstrated that a bifactor model was a better fit to the data than a correlated three-factor model and a higher-order model. Results of correlation and regression analyses further provided evidence for different aspects of construct validity and internal consistency. Both the Frequency and Stress versions of GRSAM positively predicted psychological distress and somatic symptoms above and beyond the effects of general racism experienced by Asian Americans and masculine gender role stress. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Gendered Racial Microaggressions Scale for Asian American Women: Development and initial validation. - July 30, 2018
Asian American women’s (AAW’s) mental health issues have received growing public attention; recent statistics suggest alarmingly high suicide rates among AAW. Yet, little research has examined the nuanced oppression that AAW face and the daily effects of compounded racism and sexism contributing to their mental health issues. Applying the intersectionality and microaggressions framework, we developed the Gendered Racial Microaggressions Scale for Asian American Women (GRMSAAW) using data collected from 564 AAW. Items were developed via literature review, focus group, and expert review. Exploratory (N = 304) and confirmatory (N = 260) factor analyses suggested a 4-factor structure and produced 22-item scales of frequency and stress appraisal with the following subscales: (a) Ascription of Submissiveness, (b) Assumption of Universal Appearance, (c) Asian Fetishism, and (d) Media Invalidation. Internal consistency estimates were .80 and above for frequency and stress appraisal scales, and the scales accounted for 52% and 60% of variance, respectively. Examination of a bifactor model containing one general factor and four group factors suggested that GRMSAAW could be represented unidimensionally (total scale score) for the purpose of applied measurement. Initial construct validity was established as GRMSAAW scores were associated with sexism, racial microaggressions, depressive symptoms, and internalized racism in ways consistent with theory. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Experiences of transmasculine spectrum people who report nonsuicidal self-injury: A qualitative investigation. - August 02, 2018
Transgender populations experience mental and physical health disparities compared to nontransgender populations, including nonsuicidal self-injury (NSSI). Guided by the minority stress theory and Nock’s model of NSSI, this study explored perspectives of transmasculine spectrum people (i.e., people with a gender identity that is man, male, transgender man, genderqueer, or nonbinary and who were assigned female at birth) who engage in NSSI. Qualitative interviews were conducted with transmasculine spectrum people (N = 18) who reported a history of NSSI. Their mean age was 24.9 years old (SD = 5.43, range = 17–38). Participants reported that NSSI was influenced by a variety of factors including stress from gender nonconformity in childhood and adolescence. Stigma related to minority status and identity as well as proximal minority stress processes of concealment and expectations of rejection were identified as contributing to NSSI. Transgender identity development tasks such as coming out and identity exploration also appeared to affect NSSI. Finding a community of peers who engage in NSSI was helpful in mitigating social isolation, but at times reinforced NSSI. We discuss clinical implications at the individual and family levels. Interventions to reduce NSSI among transmasculine-spectrum people should include facilitating connections with gender minority peers and providing individual support and family interventions to facilitate transgender identity development. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
The relative importance of parent–child dynamics and minority stress on the psychological adjustment of LGBs in China. - July 12, 2018
This cross-sectional study examined how minority stress (i.e., internalized homonegativity, self-concealment, and rejection sensitivity) and positive parent–child relationship dynamics (i.e., respect for parents and perceived parental support for sexual orientation) were associated with the psychological adjustment of lesbian, gay, and bisexual (LGB) individuals in China. Based on survey responses from 277 self-identified Chinese LGB young adults, results from structural equation modeling showed that minority stress was not a significant predictor of psychological maladjustment, whereas respect for parents and perceived parental support for sexual orientation were associated with positive psychological adjustment. Tests of gender differences partially confirmed whether Confucian traditions may burden sexual minority men more than women. Gender differences were found in the correlations between minority stress and each measure of positive parent–child relationship dynamics. However, the associations between independent variables and psychological maladjustment were not different between men and women in the sample. Our results suggest that culture-specific variables, such as parent–child factors within the context of China, may be especially important when working with LGB individuals in research and clinical practice. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

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