Treatment of addictions from the Gestalt therapy model PDF

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The following work was based on the lessons learned during a professional practice carried out in a Gestalt association in the province. This practice, chosen from the offer of internships available at the University, was developed under the modality, characteristic of the Gestalt school, of theoret...

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Treatment of addictions from the Gestalt therapy model The following work was based on the lessons learned during a professional practice carried out in a Gestalt association in the province. This practice, chosen from the offer of internships available at the University, was developed under the modality, characteristic of the Gestalt school, of theoretical-experiential learning and, in this particular case, within the clinical area. During the professional practice, the interns were trained in patient admission processes, group supervision of professionals, and attended meetings and training provided by the different departments of the association, such as the adult department, community assistance, addiction and of groups, also participating in activities such as the coexistence training process carried out by the institution as a specialized postgraduate course. In this case, and exclusively during the internship, they participated in the 1st and 4th Gestalt Congress, attending conferences, workshops and lectures, as well as collaborating with administrative and organizational issues of the Congress. Also as an exception, a specific course of perspective was taught, At the end of the internship and as a result of the training received on diagnosis and treatment, especially in the case of addictions, a growing interest was born in inquiring about the treatment of addiction problems from the Gestalt perspective and how, from this model and Under a theoretical-experiential modality, a renewed and different possibility of change is provided to the patient, taking him from homeostasis to autopoiesis.

1. goals

1.1. General purpose To analyze the approach and the descriptions made by the therapists of a Gestalt association about their interventions in the treatment of patients with addictions at the individual and group level. 1.2. Specific objectives 1.2.1. Analyze the descriptions made by therapists of a Gestalt association about the approach in the treatment of patients with addictions. 1.2.2. To analyze the descriptions made by the therapists of a Gestalt association about their interventions in the treatment of patients with addictions at the individual level. 1.2.3. To analyze the descriptions made by the therapists of a Gestalt association about their interventions in the treatment of patients with addictions at a group level.

2. Theoretical framework 2.1. Historical development and theoretical influences of Gestalt therapy A brief historical development regarding the emergence of Gestalt therapy is attempted below, together with an approach to the theoretical foundations on which the approach is based. 2.1.1.

Brief historical development of Gestalt therapy

According to Yontef (1995) Gestalt therapy was born from the hand of Friedrich Salomon Perls (Fritz Perls) and his wife Lore Possner in the 1940s. Gestalt therapy had its main influences on the studies carried out by Gestalt psychology that they posited perception as the primary process of all mental activity and not a secondary derivative of sensory states or mental processing (Carterette and Friedman, 1982). In addition to gestalt psychology, the influences of psychoanalysis, with which Perls differed, of phenomenology and existentialist philosophy stood out. Perls' play Ego, Hunger and Aggression

written between 1941-1942 marked the beginning of the current Gestalt therapy that offered a theoretical-practical review of Freudian psychoanalysis. During the 1950s, several intensive Gestalt workshops and study groups developed in the United States (Yontef, 1995). Perls was born in a Jewish ghetto in Berlin, Germany, in June 1893. In her early years she shared a motherly passion for the theater. After the First World War in 1920 he received a medical degree specializing in psychiatry and joined his two passions, health and theater. Later he began his analysis with the German psychoanalyst Karen Horney and this encouraged him to approach psychoanalysis, and then he continued his analysis with Wilhelm Reich, both figures of profound relevance to him and the creation of his approach. In 1933 with the arrival of fascism at the hand of Hitler, Perls and his family moved to South Africa, where he founded his first psychoanalytic center (Peñarrubia, 1998). In 1952 Fritz and Laura Perls founded the Gestalt Therapy Institute in New York and later the one in Cleveland. Laura remained as director of both institutes and Perls dedicated herself to directing group workshops throughout the country (Peñarrubia, 1998). In 1960 Fritz Perls, now separated from Laura, moved to the west coast where, together with Walter Kempler and James Simkin, they gave the first Gestalt therapy training workshop at the Esalen Institute, California, in the summer of 1964. These workshops were held in the The development of Gestalt formation continued under the leadership of Perls and Simkin until 1968 (Yontef, 1995). At the regional level, from the 1970s on, Claudio Naranjo and Adriana Schnake, both prominent figures of the gestalt, brought the Gestalt approach to Latin America. From the beginning his work contributed greatly to the momentum of the Gestalt therapy movement, where the Gestalt Psychotherapy Center was created. On the other hand, Salama founded the Gestalt Psychotherapy Institute (IPG) in 1983, which would later become a University dedicated to the dissemination and academic development of the approach. Later, in 2013, the Mexican Association for Gestalt Therapy was created. Gestalt therapy is represented mainly in cities and states such as Brasilia, Florianópolis, Rio de Janeiro and Goiania. In the latter the Revista da Abordagem Gestaltica is published.

the I Gestalt Therapy Congress. The humanist-existential approach is today distributed in a diverse set of groups and organizations throughout the continent (Fernández Álvarez, 2017). Today there is a strong presence of Gestalt institutions in 12 countries with the highest representation (Correia, Correia, Cooper and Berdondini, 2014). 2.1.2. Theoretical foundations of Gestalt therapy The theoretical influences that support the Gestalt approach and therapy are multiple and diverse. These range from the philosophical, psychological to the theoretical. A brief approach to these fundamentals is attempted below. The first theoretical foundation of Gestalt therapy came from the experiments conducted by Gestalt psychology on visual perception that resulted in the psychology of form. The psychologists who proposed the theory of form discovered that the human being perceived organized wholes that appeared in the direct experience of the individual. Wertheimer (18801943), Köhler (1887-1967) and Koffka (1886-1941) were the forerunners of this school, contrary to the traditional point of view of ancient psychology that was represented by both functionalism and structuralism. Gestalt psychologists were opposed to the fact that human behavior could be studied by analyzing it from the sensation of separate elements since, according to gestalt theory, studying the elements separately destroys the unity of the studied phenomena. At first Gestalt psychology focused its studies on perception, then it spread to other areas such as learning, behavior and thinking. Gestalt psychology was born in 1912 by Wertheimer, Köhler and Koffka as a result of experiments carried out on the perception of movement. Wertheimer created the socalled phi phenomenon that consisted of visually presenting two foci in series and then presenting a third interstimulus, and as a result the first appeared to be in motion. Köhler for his part proposed that the learning process was a secondary process to that of perception,

Perls, creator of Gestalt therapy, established his model, more than in the psychology of form, in his questioning of Freudian psychoanalytic theory and technique, placing emphasis on movement, body language and emotion, and not only on the word , thus proposing a more active and involved therapist role (Peñarrubia, 1998). Psychoanalysis was Perls's first therapeutic influence on the path to the creation of Gestalt therapy. In 1926 Perls began his psychoanalytic training with Karen Horney in Berlin and later in Frankfurt with Clara Appel, in 1927 in Vienna with Edward Hitschmann and Helen Deutsch and later, in 1928, he returned to Berlin where he continued his training with Eugene Harnik and began there to exercise psychoanalytic practice. During 1933 his clinic was supervised by Otto Fenichel and began to be discussed with Wilhelm Reich, who introduced him to the importance of gestures and body language. He traveled to Holland and exercised his psychoanalytic practice in Amsterdam. Then in 1934 as a consequence of fascism, he traveled to South Africa and founded a psychoanalytic institute in Johannesburg. By 1942 he finished his book Ego, For Chevreux (2007) another great influence of Gestalt therapy was the training received by Fritz Perls in theater during his youth. He had a great influence on his psychotherapy, especially in terms of the expressive and corporal. In this branch, Jacob Levy Moreno, father of Psychodrama, was also strongly influenced. Fritz Perls was influenced by his technique since Moreno proposed activity and experience as diagnostic-therapeutic tools to the detriment of the exclusive use of the “spoken word; or, in the words attributed to Moreno, don't tell it, act it up ”. On the other hand, Moreno was also the creator of the famous technique of the empty chair, a resource that Perls would use extensively throughout his entire Gestalt practice (Peñarrubia, 1998). When referring to the philosophical influences of Gestalt therapy, the thought of the philosopher Edmund Husserl and his phenomenology can be highlighted. Husserl basically argued that knowledge is accessed by experience rather than imagination, that is, of what could or should be. And that is why Gestalt therapy work is not focused on revealing unconscious truths through the word but on experiencing what is happening in the here and now, the why of the obvious is sought instead of the why of reason ( De Casso, 2003). Yontef (1995) also proposes the existentialist influences of Kierkegaard and Nietzsche where

the human being is in a continuum in which he is continuously remaking and discovering himself. 2.2. Central theoretical concepts of Gestalt therapy The concepts that are relevant to understanding the theoretical foundation of Gestalt therapy will be briefly developed below. These are: the here and now, awareness, responsibility and the cycle of experience (Perls and Baumgardner, 1978). 2.2.1. The here and now: focus on the present Phenomenology is one of the foundations of Gestalt therapy, therefore everything that the patient deals with in the therapeutic space must be framed within the phenomenon that occurs at that time and place, that is, in the here and now. From phenomenology there is nothing else beyond the present phenomenon, therefore, as far as Gestalt therapy is concerned, the past will only be a context since the only thing accessible to the individual, the only thing existing at this moment and this place is this here and now that will be the only setting for the other pillars of change to unfold within the therapeutic environment. The realization will only be possible in what is, what exists in this moment and place. We will also be responsible for what is experienced at this time and place. By definition, the cycle of continuous experience cannot be at any other time or place than where and when that experience is taking place. The patient's past is anecdote, the future is not yet. Only this moment will provide all the information and experience necessary for a real learning to be possible (Perls, 1996). For Castanedo (1995), a therapy that does not take into account the present moment, the here and now, would only focus on the patient's anxieties, since all questions about the future would be formulated on an event that has not yet occurred. This type of questioning only leads to the endless representation of a role, what in gestalt is called panic to the scene. All therapy can only take place in the now. Any other method only constitutes an interruption, since it only allows us to access consciousness in the present moment, the now in this place and stay in it (Naranjo, 1994). According to Vásquez (2000), psychotherapeutic schools have shown an evolution in terms of temporality from the first epochs of psychoanalysis to psychotherapies

contemporary. The importance that has been given to time within each therapeutic technique has varied according to the evolution of the schools. At first the focus was on the experiences of the past as it was in the case of classical psychoanalysis, later the present took on greater relevance with behaviorism and finally time was concentrated on the immediate moment as is the case of humanist therapies like gestalt, in which the conception of man is based on his immediate experience, in the here and now, with an emphasis on feeling, experiencing, discovering and exploring. For Salama (1988), psychoanalytic therapy consists of a permanent search in the patient's past and it is in this past that the causes of his current conflicts reside, while Gestalt therapy is a therapeutic system that is based on the experiences of here and the now while taking into account the past. This is evidenced in practice when the patient comes to treatment with a strong desire to look back. The here and now refers to being in a continuous present state experiencing experiences, sensations, thoughts in that present moment (Sinay & Blasberg, 1997). For a therapy to function as an efficient treatment method, it must comprehensively address the individual in a gestalt, an integration that must take place in the here and now of each of the therapeutic experiences, at the moment the patient feels the emotion. It does not matter if this is an emotion or thought corresponding to the past or the future, the organism, as a whole, thinks and feels it in the present, in an existential here and now. The ultimate objective of Gestalt therapy is to focus on the needs and desires that the patient has to express their feelings in the here and now, thus learning to face their situations and unfinished griefs, since both situations will demand closure. Once closed, the subject will be able to face new situations, new experiences that focus, that are emerging, with all the energy that these new situations require, without dissipating this energy in what has already been or has not yet been (Castanedo, 1985 ). 2.2.2. The realization The realization (also known as awareness, original term used by Perls in English) is the axis of the Gestalt approach, since phenomenology is the primary step and

indispensable to begin to know everything that can be known. Without this awareness, learning is unable to be present (Perls, 1975). As Gestalt therapy is a phenomenological-existential therapy, it teaches both therapists and patients that the method is phenomenological, that is, it implies awareness. It becomes evident that perceiving, feeling and acting are different when interpreting and repeating preexisting patterns and attitudes. Therefore explanations and interpretations will be less reliable than that which is accessible to us by direct perception and sensation. The dialogue between patients and therapists in Gestalt therapy becomes a round trip of the different phenomenological perspectives and it is precisely this difference in perspectives that becomes the focus of the experience, thus making patients realize what is happening. happening, what they are doing, how they are doing it and how they can change, in a continuous acceptance and appreciation of the phenomenon and of themselves. In line with what we have said about the concept of here and now, in Gestalt therapy the process will be centered on the experience rather than on what is being discussed, since by emphasizing what is being done, what one is thinking or feeling in the present moment, what was or can or should be loses shape. But the objective of this phenomenological modality of therapy is not only to become aware of the patient, but it is also crucial that he learns to become aware of how he is aware, to study not only personal awareness, but also the process of realizing bill. That is, the way in which the therapist and the patient experience this awareness. This is a point of great importance in Gestalt therapy. This dialogue is based on experiencing the other person as he is, showing his true being and sharing the phenomenological in this dialogue (Yontef, 1995). When we refer to awareness in psychotherapy, we also refer to the formation of new figures which conclude in a novel creation, in a creative problem solving. The cure is a reaction similar to the one that in physics would be produced in a catalyst, that is, in the process of realizing the patient and his environment generate a different, novel and specific reaction, in this case the cure, which is not understood as a finished result of the therapeutic process, but rather what is sought is that the patient learns what is necessary to face their own problems (Naranjo, 1994).

2.2.3. The responsability In general, only images related to our life problems, immediate organismic needs or unfinished situations, added to our ideals and resistances, appear in our mind, and even in waking consciousness none of these is recognized by us as an image brought To consciously consciously, we must be willing to take full responsibility for the work our mind does. We can understand these images in principle as resistances of another primary need. But even in this case we must take responsibility for the images that appear in our minds. Avoiding responsibility and avoiding taking responsibility for the creations of our mind are closely related. Responsibility is often linked to guilt, shame and punishment, By assuming responsibility for his actions, the patient becomes the protagonist of his own life. Gestalt therapy from its existentialist roots calls the patient to take responsibility for their own feelings, acts and thoughts (Salama, 2008). Responsibility in Gestalt therapy involves both the patient and the therapist. By showing the therapist as he is, he shows his true self leaving appearances aside, and being here and now present and allowing himself to take responsibility for his being allows the patient to display his true being with responsibility. Therefore, in therapists as well as in patients, it is a condition of Gestalt therapy that both give account of their own processes before the encounter and take responsibility for what they think, feel and do (Yontef, 1995). 2.2.4. The experience cycle A concept closely linked to the concept of awareness is organismic self-regulation. From the Gestalt theory, every living organism primarily attends to questions related to survival. This process is called organismic self-regulation, for which this organism needs to interact with its environment. To achieve this, it is essential that the subject realizes himself, his needs and the environment that surrounds him at the present moment. For Perls this process is valid for both organic and non-organic

organic and postulates that this awareness will be the subjective while the objective will be the content of this awareness process. We know that we are not realizing when we are focusing on content, realizing is not having knowledge of something but realizing what we are. This appears spontaneously when paying particular attention to that border region of contact between the subject, the organism and its object or environment. It is about the individual realizing what he feels and thinks, everything that is accessible to him through the senses, and in this way he can discover the ways in which his process is interrupted (Burga, 1981). The contact cycle model, also called the organismic self-regulation cycle or cycle of experience, is a way of describing the modes or processes of adjustment that an organism puts into play at the moment of satisfying a need both of a purely biological nature as well as psychological and the way in which it interact...