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Brendan Toohey June 21st, 2005 04:00 AM

Depression Discussion
I had initially attempted to get information on Depression the cheats way maybe, and thought I might get a better return if I put some thoughts out to be commented on by the various Gestalt people that frequent this page.

In writting an essay on what Gestalt has to offer in working with individuals with Depression I have quickly recognised that Gestalt therapy has many developed theories and principles that places this approach in very good stead for working with the key themes that are identified in the area of Depression.

I have in particular identified figure/ground formation becoming potentially fixed and the individual being unable to discriminate between a fantasised perception of self and phenomena in the present that differs from the fixed figure ie "I am hopeless at everthing". This seems to then lead to boundary disturbances such as sensory numbing and a introjected sence of being inherently flawed.
Also being able to work with a fixed label it's self (Depression) and work phenoneologically with each individuals unique experience to emphasis the persons ownership or choice with the illness rather than Depression being a fixed way of being that is un-changeable.

I could say more but thought I would put out some of my peceptions to stimulate others to offer their perspective on where Gestalt seems to merge with the themes within Depression, or for that matter does not!

Brendan Toohey

Phil Brownell June 22nd, 2005 09:19 PM

Re: Depression Discussion
Interesting approach. I like you putting out your ideas.

As Peter Philippson and some others might say, the depressed "self" is an emergent experience, and it emerges through contact in the environment. Thus, even automatic thoughts (of negative valence) do not arise in a vacuum. One can track the experience of self through a phenomenological method, and in the course of that, one can discover how a person depresses him or herself (so to speak). Even depression which is largely genetic and biological in etiology has a way of emerging within a context of life. Working with the field of any given client, a clinician can suggest medications, physical exercise or rehabilitation, nutritional consultation, home health care (especially in the case of elderly depressed people who need help with their activities of daily living), and financial counseling as ways of shifting influential elements affecting the client. These are not mechanical or strictly behavioral interventions when conducted within the perspective of Gestalt therapy's understanding of experiment, field, and especially of dialogue, when the supportive relationship between the therapist and client forms a ground.

Brendan Toohey June 27th, 2005 03:30 AM

Re: Depression Discussion
Thanks for your Reply Phil, nice to get some feedback, and your views.

You touched upon a thread that is of interest to me, that of the organism not being within a vacuum. I am curious about the increase of Depression in society and what potentialy on a societal level phenomenologically could be seen as themes that exist playing a role in the increase. I imagine that the repetative themes from the media to remain active or busy even in the face of cold or flu for example can seem to put a negative light on the phenomenology of being 'low', albeit physically in this example. I notice distinct themes both within myself on occasion and in clients who come to me for counselling, viewing 'being down' described in their words as a type of 'failing' and conversely being always 'up' a sign of success.

The counselling office at times in my view seems to have become in some ways a type of replacement to the Catholic confessional box. People come to release the parts of themselves that have been held back, out of the seeming greater need to be confluent with a pervading view of 'staying up', rather than risk revealing being 'down' out of fear of rejection or withdrawl of love essentially from their environment.
Of course the self has a role in the letting in or the keeping out of these beliefs or messages. I feel firstly though, being able to even notice the existance of an introject that is alien to the self, due to what could be said to be a dominant societal view (but of course not everyones view), is the begining of the forming of a contact boundary.

Paradoxical Theory of change seems to be apt here. The need to embrace the self 'as is' will possibly lead to intergration, and maybe greater flexability in self regulation.

Phil Brownell July 2nd, 2005 11:02 AM

Re: Depression Discussion
I don't relate well to "themes" in therapy. I don't mean to be critical; I just speak for myself. A theme to me is a cognitive symbol, and it is a complex representation that stands for something more real, something that moves with life, feels gritty, smells sweet, or tastes bitter. A theme is a fiction, and it often forms the third point in a triangulation of contact between therapist and client. It's as if they collude with one another to talk about the theme rather than to actually meet one another in the moment. Themes may lend themselves to cognitive manipulations, but they don't facilitate dialogue. Depressed people can be helped by focusing on the way they think and by challenging automatic thoughts, but that has to take place within the context of the therapeutic relationship, which gets us back to such things as contact and the immediate experience of being "with" another person. That's not a representation or a symbol. It has a lot to do with the pre-conceptual flow of one's experience - ie, with phenomenology.

Brendan Toohey July 3rd, 2005 10:06 PM

Re: Depression Discussion
I feel a sense of being a little out of my depth here but never the less I will reply to the last thread. From a student perspective I feel I still struggle to put into words the Gestalt approach but any way I feel that my intention is good so I will continue to have a go! I read your comments about symbols and read it in this way, objectively conversing about a theme can take away potentially from the actual, moment to moment contact. Rather than talk 'about', from a fantasy perspective the so called theme would only have creadability through the veichle of experiment. A theme is akin to a theory, they can well be formed from patterns of experience or insight but unless it is truely lived then it remains a fiction. Yes the theory or theme can say more about the owner than the subject. I will when working with another potentially have times when I move into an 'I-it' way of relating. If as a result I form a fantasy about a theme or theory on what could be occuring for a client, this I would bracket if the moment to moment dialogue did not seem to lend its self to the fantasy. However, I never the less would not ignor the aspect of myself that will form ideas on a fantasy level. To do so I feel would ignor the need to step back from contact 'I-Thou' and explore objectivly for example themes of depressive illness. Of course I will always do my best to honour first and foremost the unique moment to moment contact. The opposite I guess is reducing meeting to having pre-conceptions about the meeting and making the other fit those pre-conceptions, hence a fixed relating style. I would invite further comment to gauge if I have made myself understood this time.

Phil Brownell July 4th, 2005 05:34 PM

Re: Depression Discussion
Makes sense to me. I think we're on the same page.

I just want to say that it's also not always about "dialogue;" sometimes it's just very useful to finely slice the encounter with a phenomenological method. Becoming a patient but careful observer (and resisting the temptation to theorize, make sense, move toward a goal, etc) and staying with the process in the moment can become both a therapist's life preserver and an incredibly sharp therapeutic strategy. It rests upon faith in the paradoxical theory of change.

Brian O'Neill July 13th, 2005 01:54 AM

Re: Depression Discussion
I don't view the term theme the same as you do Phil... no more than using the term "depression" or 'emergent self" or any other term here... another term as well as theme that suits me in this way is "pattern"... and there is much in our literature which speaks of theme (Polsters) and patterning etc.

I do agree, and like what Brendan has said, that any cognitising has the possibility to be detraction from the actual meeting, however I believe that words, movement, sound, tone, and all other forms of contact are a rich mode for each person to meet the other in counselling. Each is part of us as being whole.

I see this more as a balance between imagined and immediate realities and that as long as each are available for the therapist and client then a full meeting will happen...however once we spend too much time in one at the diminishing of the other we (cleint and counsellor) will experience less livelieness and fullness of contact.... the depressive self may even emerge as a theme, dare I say :-)

Maurice Nicholls talks of the visible and invisible reality of when we meet as people. How much of what we are is actually invisible, our hopes and dreams and love and wisdom. Yet this may manifest in the sense based reality of the physical world. The physicist David Bohm calls this implicate and explicate reality. I hear you favour not mistaking one for the other Phil (ie the construct of "theme" to replace the actual meeting in explicate reality)?

In quantum and post quantum physics this is the same as the classical world of our sense based experiences being different from the mathematics and experience of the quantum world, and Bohm notes that awareness and consciousness are a bridging process between quantum reality (invisible) and classical Newtownian reality (visible).

Some aspects of classical reality fall apart in the quatum world which is seen to go against common sense and intuition. Hence neither world or reality has the "inside track".

As Einstein said, for the time being we are stuck with two realities, matter and field. Or immediate and immagined, visible and invisble. Or talk of "theme" versus the direct experience of the other?

I like the dance between the two.


Brian O'Neill July 13th, 2005 09:07 AM

Re: Depression Discussion
And now talking about depression... I always liked the very simple idea in Gestalt therapy, which I know Sylvia Crocker has also advocated in our discussions, to experiment with turning nouns into verbs....Fromm's "To have and to be"... so that instead of "having" depression I notice how am I might I depress my self....what am I might I depress another...

This is not to take away the other phenomena which are part of this experience that we call for example, the above experiment can easily become unknowingly one of victim blaming....of not allowing for the wider field.... such as post natal depression, bi polar I, and the plight of third generation unemployed, to name a few domains where the organism/environment field is clearly a mix of forces at play and not simply the "individualistic" self responsibility of the Gestalt Prayer....

once again I believe there is a dance between the two...matter and field, self and other, to do justice to any phenomenon in an organism/environemnt field


Brendan Toohey August 4th, 2005 12:26 AM

Re: Depression Discussion
I like the balance of what you said in your last post Brian. What interests me as a flow on is working with both the individual and the field that they emerge from. I feel to work in a phenomenological sense using the five questions for example is powerful in seeing how one sculpts thier reality. Then the field of course is inseperable like in the example that you give of long term unemployment. I am thinking of Gestalt writters like Tobin who from memory aspouse to the idea of not collaborating with the client to deaden themselves in any way. This if I am right is a beautiful notion but I wonder about its practicality. Meaning, to me the field seems to present individuals with some fixed issues that they may well be able to percieve differently but not shift on a society level in one life time. Are there some inherent problems within the field that cause the odds to be very slim, in that there structure which one is embeded within, will likely threaten the ability to overcome depression, rather just be a case of managing for example a mild ongoing version of. This I guess relates to creative adjustments and to be in a free flowing authentic state seems to be a massive challenge as long as the field threatens that existance. Is this cynical or practical I'm not sure? Invite your comment.

Brian O'Neill August 13th, 2005 02:46 AM

Re: Depression Discussion
Hi Brendan

What comes to mind on reading your last post is your attempt to somehow split the causation of depression between the person and the field (or not just your attempt but that such perspectives exist in research and various modailities).

Some would argue that you cannot seperate out the person NOR the field as it is the whole phenomenon we are dealing with. This is similar to what Bohr argued for with quantum physics... we can only deal with the whole quantum phenomenon and not the individual parts.

At the same time there are sub fields and these effect each individual differently. This is evidenced in the research on indentical twins reared apart. Fifty percent of indentical twins reared apart have both twins develop schizophrenia but in the other fifty percent only one twin does. Hence the different sub fields of each twin makes a difference.

I am also reminded of the text book " A Hundred Years of Psychotherapy and Nothings Changed" in reference to your sense that perhaps you are being cynical... I think this is not a cynical perspective I hear but a challenging perspective and this is needed, particularly in psychotherapy.

Finally I am reminded of the Buddha and suffering... its not that suffering changes as we become aware or enlightened its more our perspective changes (I would argue both change!)

So here are some initial thoughts to your comments...


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