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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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Latina/o adolescents’ family undocumented-status disclosures directed at school counselors: A latent transition analysis. - April 19, 2018
For adolescents from undocumented families, school counselors may serve as a resource to draw upon for support should the adolescents decide to disclose their family status. In this study, we identified psychological factors that were associated with adolescents’ decisions to disclose (or not) their own or a family member’s undocumented status to a counselor and examined corresponding mental health implications. Utilizing latent transition analyses with a sample of 410 Latina/o immigrant high school students, four profiles emerged in Wave 1: (1) indifferent nondisclosers, (2) concerned revealers, (3) anxious revealers, and (4) secure revealers. By Wave 2, we identified the same profiles, except anxious revealers were no longer present, and anxious nondisclosers emerged as a new profile. At Wave 3, we only identified three profiles: (1) indifferent nondisclosers (2), concerned revealers, and (3) anxious revealers. As Latina/o immigrant students experienced greater fear of deportation in the middle and end of the year, they were more likely to be concerned revealers (i.e., reporting moderate perceived risk of disclosing, low communication efficacy, and moderate levels of disclosure) compared with most profiles. Anxious revealers reported higher levels of depressive symptoms than several other profiles in the beginning of the year, and concerned revealers reported higher levels of depressive symptoms than several other profiles in the middle and end of the year. This study emphasizes the importance of considering the diverse experiences of family undocumented adolescents, and it sheds light on the extent to which family undocumented adolescents confide in a counselor. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
An examination of the Psychology of Working Theory with racially and ethnically diverse employed adults. - April 19, 2018
The present study tested key tenets of the Psychology of Working Theory (PWT) in a sample of 526 racially and ethnically diverse employed adults. The authors investigated how economic resources and marginalization predicted decent work through experiences of work volition and career adaptability. Support for the hypotheses was mixed. There was a direct, negative relation between marginalization and decent work; a direct, positive relation between economic resources and work volition; and a direct, negative relation between marginalization and work volition. There was a positive relation between work volition and career adaptability as well as with decent work. Work volition was also found to significantly mediate the relations between marginalization and economic resources to decent work. These results suggest that the primary reason why greater economic resources and lower experiences of marginalization predict engaging in decent work is attributable to an increased sense of choice in one’s career decision making. Results suggest the need for further investigation using the PWT to understand how racially and ethnically diverse employed adults secure decent work. Practical implications are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Testing the predictions of the existential constructivist theory of suicide in a college student sample. - April 19, 2018
There is a lack of empirically supported theories explaining suicidal ideation and few theories describe how suicidal ideation can be prevented in the context of normative human development. Rogers (2001) proposed an existential constructivist theory of suicide (ECTS) wherein existential distress and the inability to reconstruct meaning from adverse life events contribute to suicidal ideation. The ECTS includes a distinct focus on meaning reconstruction from adverse life events, which is congruent with existing research on college students and developmental frameworks used by counseling psychologists. Thus, in the present study, we tested the predictions of the ECTS in a college student sample. We collected data online from 195 college students (i.e., ages 18–25) attending a large, Midwestern university and analyzed the data using structural equation modeling. Findings provided partial support for the original ECTS. Post hoc analyses of an alternate ECTS model indicated that existential distress mediated the negative association between meaning reconstruction and suicidal ideation. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Transgender people of color’s experiences of sexual objectification: Locating sexual objectification within a matrix of domination. - April 19, 2018
The purpose of this grounded theory study was to investigate transgender people of color’s (TPOC’s) sexual objectification experiences (SOEs). Fifteen TPOC were interviewed about their experiences with sexual objectification. Using intersectionality and objectification theories as our research paradigms, results suggested that participants’ SOEs were shaped by the intersections of cissexism, sexism, and racism, and that participants experienced various levels of privilege and oppression based on their specific identities. Results revealed similarities with previous sexual objectification research as well as unique sexual objectification experiences for TPOC, including racialized sexual objectification, fetishization, genital- and gender transition-based comments, and body policing. Results also suggested that self-objectification may manifest as a desire to affirm one’s gender identity and result in physical safety anxiety. TPOC may engage in body surveillance to achieve transgender congruence and reduce potential victimization experiences. Mental health practitioners are encouraged to attend to how intersections of cissexism, sexism, and racism may encourage SOEs, and the ways in which such experiences may impact TPOC. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Predicting PTSD severity from experiences of trauma and heterosexism in lesbian and bisexual women: A longitudinal study of cognitive mediators. - April 19, 2018
Sexual minority women (SMW) are at high risk of trauma exposure and, subsequently, the development of posttraumatic stress disorder (PTSD). The authors extended a theoretical model explaining the higher risk of mental disorders in minority populations to the maintenance and exacerbation of PTSD symptoms among young adult SMW specifically. This study used observational longitudinal data from a sample of 348 trauma-exposed 18- to 25-year-old individuals assigned female sex at birth who identified as either bisexual (60.1%) or lesbian (39.9%) and met screening criteria for PTSD. Participants identified as White (82.8%), Hispanic/Latina (12.4%), American Indian/Alaska Native (13.5%), Black/African American (13.8%), and/or Asian/Asian American (4.9%). The authors investigated whether distal stressors (i.e., criterion A traumatic events, daily experiences of heterosexism) produced proximal stressors (i.e., trauma-related cognitions, internalized heterosexism) that maintained or exacerbated PTSD symptoms. Findings indicated that daily heterosexism longitudinally predicted trauma-related cognitions (i.e., cognitions related to the self, world, and self-blame). Internalized heterosexism and cognitions about the self longitudinally predicted PTSD symptom severity. In addition, a significant indirect effect was identified between daily heterosexism and PTSD symptoms via self-related posttraumatic cognitions. These findings suggest that exposure to minority-specific distal stressors appears to promote nonminority-specific cognitive processes that, in turn, may maintain or exacerbate PTSD among young adult SMW exposed to trauma. Clinicians should consider addressing daily heterosexism in young adult SMW presenting with PTSD and evaluate how these experiences might promote clients’ global, negative views regarding themselves. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

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