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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 scientific future of counseling psychology: Five specific areas of predictions. - June 29, 2017
To honor the 125th anniversary of the American Psychological Association, the scientific future of counseling psychology is highlighted in this special section. Five areas of research growth are covered: three in psychotherapy (research relative to sexual and gender minorities, the importance of the client perspective, and applications of machine learning), one in the application of the cultural lens approach, and one on aspects of privilege. Each of these areas has specific, testable hypotheses that can serve as stimuli for future research. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
White male power and privilege: The relationship between White supremacy and social class. - June 29, 2017
Counseling psychologists have studied privilege as an individual behavior, belief, and attitude related to an individual’s privileged identity such as masculinity, Whiteness, or Christianity. Conceptualizing individual privileged identities in this way means that privileged identities may exist alongside marginalized intersectional identities. However, in this article, the author defines privilege as a multi-identity act that is facilitated and supported by institutions and organizations (e.g., banks, law enforcement, and schools). These institutions are defined as power-governors that regulate access to scaffolds of privilege afforded to the affluent and wealthy. The author posits that power-governors were created to support an ideology of White supremacy and to organize actors within the system to perpetuate and legitimize the status quo. The author describes the ways in which White wealthy men use privilege as a means to access and gain power while White men in lower- and working-classes use privilege to build relationships and legitimize inequality. The author also discusses the proxy privilege of White women and people of color and how this privilege is in fact restricted to specific physical spaces and is limited due to their overt marginalized identities. Recommendations for privilege research are provided. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
The future of counseling psychology research viewed through the cultural lens approach. - June 29, 2017
In this article, we address the need for the future of counseling psychology research to adequately address issues of relevance and application of our theories across cultural groups. We bring the cultural lens approach (CLA; Hardin, Robitschek, Flores, Navarro, & Ashton, 2014) home to its roots in counseling psychology and address the approach’s application specifically within counseling psychology theory. First we provide a brief description of the CLA. Then we offer an in-depth example of how to apply the CLA to a specific theory, using Super’s (1953, 1957) Life-Span, Life-Space Theory of Career Development, and more specifically, the self-concept as an example. Importantly, we articulate how the CLA yields specific, testable hypotheses, providing multiple examples. We conclude with implications of the CLA for implementation of counseling psychology values, evaluating psychological theory, and research training. Adopting the CLA in future counseling psychology research will increase the cultural sensitivity of our work and widen the relevance and applicability of our findings. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Client-focused psychotherapy research. - June 29, 2017
Although the field of professional psychology has definitive evidence that therapy is effective, we do not yet have a good understanding of how therapy works or what makes it so effective. Although hundreds of research studies have been conducted on various aspects of psychotherapy, including client factors and outcome, in the current paper we argue that a key component of the psychotherapy enterprise that warrants additional empirical attention is the client. We readily acknowledge the need for researchers to continue to examine other aspects of psychotherapy, such as therapist factors, the therapy relationship, and the effectiveness of certain therapies or interventions for specific psychological conditions and problems. However, we believe that by pursuing research questions from the perspective of the client that we might be able to better understand clients’ experience in therapy and ways to tailor therapies and interventions to clients, uncover evidence about what actually engages and motivates the client, and gain a broader perspective about the nature of the therapy relationship. In the current paper we highlight fruitful areas for client-focused research, and within each area, we propose research questions that might stimulate further thinking and future empirical inquiries. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Improving the lives of sexual and gender minorities: The promise of psychotherapy research. - June 29, 2017
Current psychotherapy research with sexual and gender minorities (SGMs) is inadequate to address the health disparities in this population. Psychotherapy can benefit from research demonstrating the unique experiences of SGMs with respect to behavioral health, internalized stigma, coping, and resilience. This article describes research approaches, questions, and measurement that can be employed to study psychotherapy. Given the impact of minority stress and microaggressions on SGM individuals, many of the recommendations provided in this article focus on how these components should be infused throughout a diverse range of psychotherapy interventions. Namely, we provide recommendations for researchers focusing on SGM populations in randomized controlled trials and psychotherapy process research. We also provide 7 specific recommendations that focus on psychotherapy research measurement with SGM populations and how researchers can focus their efforts to reduce disparities for SGM individuals. Finally, we identify additional constructs to consider for future intervention research with SGM individuals. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

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