5

GESTALT FOUNDATION

ΚΕΝΤΡΟ ΨΥΧΟΘΕΡΑΠΕΙΑΣ & ΕΚΠΑΙΔΕΥΣΕΙΣ

Creative Adjustment
In Therapeutic Relationship

being a dissertation submitted in partial fulfilment of

the requirements for the title of

Gestalt Psychotherapist

in Gestalt Foundation, Athens

by

Joanna Kato
M.Sc. of psychology Catholic University of Lublin
Speech Therapist of University M. Curie-Sklodowska of Lublin

ABSTRACT
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The interest of this dissertation is the presentation of the concept of creative

adjustment in Gestalt therapy and its meaning in a therapeutic relationship
exemplified by cases of the therapist’s practice.
In the beginning a review of the relevant literature is presented regarding a. the
philosophical influence on the concept of creativity and of the creative
therapist, b. the concept of creativity, c. the concept of the creative therapist.
Subsequently the literature review includes a. the concept of adjustment in
Gestalt therapy, b. the understanding of creative adjustment. On the following
pages literature review follows presenting a. the characteristics of the
therapeutic relationship (therapist’s task and responsibilities toward the client,
b. the role of the therapeutic relationship (including the I-thou concept, the
concept of contact, of awareness and of change). Opinions about the place of
therapeutic relations in society are also mentioned. The next part of this
dissertation shows the affiliation between contact and relationship based on a.
the experience of the self and the b. contact boundary. In the final part
examples of creative adjustment in therapeutic relationships are presented as
perceived in the therapist’s practice. Few cases are described and analyzed
according to the factors mentioned in the presented literature.
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ACKNOWLEDGEMENTS

I want to thank my therapist Gianna Giamarelou for guiding me through the

process of education in Gestalt approach and supporting me through all the
years I have been in therapy with her.

I also want to say thank you to all the therapists who were involved in my
training process the last six years, starting from Gianna Giamarellou, Despoina
Baliou, Antonia Konstantinidu and Katia Hatzilakou. I want to thank Harm
Siemens, Dick Lompa, Margarita Spaniuolo-Lobb, Nurit Levi, Peter
Schulthess, Malcolm Parlett, Ken Evans, Joseph Melnick for sharing
knowledge, experience and quality of contact.

I want to say thank you to my supervisor Katia Hatzilakou for supporting me

during the very difficult period of the first years of working as a
psychotherapist and for showing me what flexibility means.

I am saying thank you to my colleagues and friends Bianca Ellinger, Elpida

Kalaitzi, Mariola Kochanowicz for being there for me and listening, for
helping with ideas and advice.

I want to say thank you to all my clients who contributed to this dissertation for
trusting me and sharing their lives with me. Without them this dissertation
would not exist.

I am saying thank you to my sister Izabela Kato for her contribution in reading
and checking my text, picking up the phone and reading my mails every time I
asked her.

I am saying thank you and expressing gratitude to all the members of my

family and to the nanny of my children for supporting my effort.
I am thanking my very close friend for listening complains and still believing
in me, and all my friends who supported me in several ways during the time I
was writing. Without them this task could never be accomplished.

INTRODUCTION

This dissertation is a partial fulfillment of the requirements for the title of

Gestalt psychotherapist. The subject concerns creative adjustment in
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therapeutic relationship. Therapeutic relationship is the very base of therapeutic

work in Gestalt therapy approach. Gestalt therapy is a phenomenological and
existential approach to therapy and concentrates on the phenomenology of the
client and the therapist during their meeting.
The basic theoretical meanings of Gestalt therapy are:
the field theory, the phenomenological perspective, the existential perspective,
dialogue, inclusion, presence, the interdependence: organism/ environment -
the organismic self-regulation.
The therapeutic work in Gestalt therapy is done in the “here and now” during
the meeting between the therapist and the client through the dialogue. In order
for this to happen, both, therapist and client need to adjust (do the best they
can) to each other and to the environment, including date, place, circumstances,
personal history, age, culture, society, goals of therapy etc.
M. Spagnuolo-Lobb(1992) states that “Creativity is one of the basic concepts
of The Gestalt approach, a quality of adaptation in interpersonal relationship. It
includes everything that happens in the field in relation to contact”. It is the
process of giving it a meaning. The task of the therapist is to co-create the
condition of contact. In order to do this the therapist needs some abilities,
knowledge, values and attitudes which he/she acquires through the process of
education, personal therapy and supervision.
The therapeutic relationship is a meeting, it has a role and several tasks. It is
performed every time individually and requires risk taking from both, the
therapist and the client. In order to co-create contact therapist and client need to
meet at the contact boundary, “in between”. This meeting might be analyzed
from the therapist side, the client side, by analizing what happens in the field
and at the contact boundary.
The meaning of creative adjustment emerges several times during supervision.
The field is very different every time and with every client, and even if it
appears obvious, it takes time to understand and feel it, and also gain
awareness of the differences between cases and clients. It is difficult to apply
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the “same” principles of Gestalt therapy to every new client and at the same
time to maintain a flexibility regarding the field with all its components –
culture, life story, language, therapeutic setting etc.
During the process of supervision the very different needs of every “case”
emerge, developmentally, and in life history, as much as at personality level.
Seeing the differences in the dynamic of the therapeutic relations, the
circumstances, the field, the different ways of working, using the methodology
and building ground for therapeutic relationship leads to the process of
creative adjustment.
In this dissertation the subject of creative adjustment is restricted to the
therapeutic relationship, the context of the therapeutic work where it can be
observed, considered the fact that therapeutic relation and its process are the
beginning and the end in Gestalt approach. In therapy client and therapist live
a relation and learn to give a meaning to it by adjusting to whatever emerges in
the process. This is every time a live event and the analyze of it caused interest
in looking closer to what happens to therapist and client during its duration.
Theory and experiences are described on the following pages.
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CHAPTER I
CREATIVITY AND ADJUSTMENT

Creativity in Gestalt therapy is considered to be a quality of spontaneous

adaptation in interpersonal processes, as well as important ingredient of
healthy social living.(A. Sichera, 2003 p93)

The purpose of this chapter is to present the meaning and

understanding of the terms creativity and adjustment in Gestalt therapy and
theory.
The above words have a range of meanings. They are connected with
existential philosophy, Gestalt psychology, developmental psychology, they
also refer to the concept of creativity in philosophy and psychology.
On the following pages references on the subject, those which influence the
process of Gestalt psychotherapy and are connected with the ideas of creativity
and creating will be presented.

Gestalt therapy basic principles

As G. Yontef states in his article (1989) Gestalt therapy was founded by
Frederick and Laura Perls in the 1940s. It is a phenomelogical-existencial
approach to therapy and concentrates on the phenomenology of the client and
the therapist during their meeting. “Patients and therapist in Gestalt therapy
dialogue, that is communicate their phenomenological perspectives.”(G.
Yontef ,1989)
In the Gestalt approach the focus is on process, that is on what is happening
between the therapist and the client. The content, that is the discussed subject,
is considered to be of less importance. It is a sample from the client’s life, on
which therapeutic work can be done. It brings the client in touch with emotions
which accompany an event. Emotions which several times are repressed,
forgotten and reappear in inadequate situations. According to this dissertation
the therapeutic relationship and the process of adjustment are a meeting
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through awareness. As Gestalt literature supports the goal of therapy is for the
client to become aware of his behavior, feelings, believes, attitudes and what
they can do to others. The therapeutic setting is a safe place where new feelings
might be experienced and expressed, new ways of acting and expressing might
be discovered in experiments performed during the therapeutic session. With
the therapist support the client might dare feel and act as he is not permitted in
everyday life and gain awareness of it. The therapeutic work is done in the
“here and now”. Explanations and interpretation are not so important as what is
felt, and perceived.
In the process of therapy clients might discover how and what they can change
about themselves and learn to accept what is not to be changed, or learn to look
at it from a new perspective.
Experiencing differences in perspectives with the therapist, without judging nor
interpreting, is a subject of continuous dialogue, of the process going on
between the client and the therapist.
To realize how all those concept came into light especially the concept of
creativity it is necessary to refer to the philosophical trends of the time Gestalt
therapy was founded.
Two philosophers contributed to the concept of creativity: Salomo
Friedlander with the concept of creative indifference, and Otto Rank and the
concept of creative will.
Salomo Friedlaender/Mynona (1871-1946) a philosopher and a
humorist, influenced by Schopenchauer. His basic concepts are presented in
the book “Creative Indifference” (1918). Those concepts are: indifference and
polar differentiation. According to Friedlaender the indifferent center emerges
from the balance of opposite polars. The indifference is the creative central
dimension of reality, the “immension of all dimensions”. When the polar
opposites are merged, the differentiation is lost. Creative indifference is the
point where differences dissolve. “It is the basic creative dimension of human
existence”. This is the start point for F. Persls “fertile void” or “middle, centre,
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zero-point, naught, void, pre-difference, equilibrium, balance, centering

opposites, poles and polarization.” (Frambach, 2003)
The ability to perceive equally both polarities allows energy to emerge and
create “new” possibilities which have been unnoticed but always existed. In
therapy this means that a person might be able to know who he is first through
the process of polar differentiation and than by finding the “melting of the
opposite polars into polar indifferentiation and state of being”(H. Stevenson,
2004).
Otto Rank (1884-1939) a psychologist and a philosopher. Rank was
interested in volitional psychology, will, artistic creativity. His philosophical
concept refers to polarities and processes.
According to Rank all polarities are grouped around one central life impulse
which he calls creative will. This impulse (will = ego +power) is responsible
for forming the human individuality and his ability to be responsible. The
human ego is being shaped through life, mostly in the person’s relation to the
mother, but is also self shaping by its own strong will. The denial of this will is
the base for neuroses. The identification with it, especially as distinct from the
environment allows a person to fully experience his existence. In therapy the
healer is supposed to provide help into the process of joining and separating
different aspect of the ego, there where both mother and child want and need it.
“Therapists do not heal through means and techniques: nor through simple or
mere expressions of their creativity. They heal through their personality, which
is professionally restrained and at the same time capable of spontaneous
response”. (B. Mueller, 2003 p. 139)
In order to understand better the concepts of adjustment and creativity
in Gestalt theory it is important to refer to the basic concepts of this approach.
One of them is “the field theory” which means “looking at the total situation”
(Lewin, 1952 p.288). In Gestalt therapy it means a holistic perspective towards
a person including environment, the social world, organization, culture.
According to L. Estrup (2000) the basic lenses of Gestalt the therapy are: The
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Field Theory – everything is constantly changing and in flux. Everything is off

the field and cannot be separated from it. The field is our history. The second is
The Phenomenological Perspective – each person’s feeling and understanding
of the field depends on the position he/she has on the field. The third important
lens is Dialogue – where in a relation two people are impacted and responsive
to each other.
The above mentioned terms and concepts will be more analytically discussed
in the following chapters, where their connection to the terms creative
adjustment and therapeutic relationship will also be presented.

A. CREATIVITY

The noun “creativity” has a range beautiful of synonyms such as “originality,

imagination, inspiration, resourcefulness, vision, inventiveness,
ingenuity”(Longman Dictionary of Contemporary English 1987) . All of them
sound positively, might be used to define certain life experiences, qualities of
an artist, maybe a process of creation, the building of something new,
unknown. M. Spagnuolo-Lobb and N. Amendt-Lyon in the preface to
Creative license the art of Gestalt therapy comment that in Gestalt therapy
“creativity” as noun is not defined. It is considered to be all that happens in the
field in relation to contact. In the experience of contact the organism and the
environment create the meeting, give a meaning to it. The meeting occurs
between the human organism who encounters the world by hearing, touching,
smelling, talking, looking at – with senses and abilities the organism contacts
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the environment. Creativity is an attribute of contact. Contact is creative

adjustment. The self helps to find and give meaning to our experiences.
To adjust creatively, according to Gestalt literature means to do the best a
person can within the given situation, considering the circumstances, the age,
the possibilities, the number of available solutions. When for some reasons the
chosen way to adjust becomes a pattern and no longer benefits the person, the
energy involved in this process is trapped and might create various, sometimes
bothering or painful symptoms. Those symptoms still are creative adjustment ,
a creative solution to difficult situation. The therapeutic work is to gain
awareness about the way a person adjusts and if the chosen way is no longer
necessary, no longer the best, redirect the energy to the proper goal. In other
words creative adjustment involves “letting go of chronically dysfunctional
behavior patterns, using one’s perceptual functions and available resources
optimally in the interchange with the given circumstances” (Wertheimer,
1964).

In order to get a larger perspective on the concept of creativity some

remaining concepts related to it will be described, as they are presented in
literature.

A creative way to relate to the environment and a positive ability to adjust is

mentioned by F. and L. Perls in “Ego Hunger and Aggression”. “Dental
aggression” (which includes biting , chewing, destroying what is given to keep
only the needed parts and let go of the rest). is a process of responding to ones
needs and adjusting to the environment using the tools ones has and taking
advantage of the possibilities the environment offers. It also is a big step and
achievement in the childs’ development process.

The meaning of existential, experiential and experimental interventions in

therapeutic work refer to work with the phenomenology of the client and the
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therapist, to work with what client and therapist experience in their bodies, way
of thinking and feeling and finally to create experiments in which a different,
new phenomenology is perceived and felt, sometimes new ways of acting are
performed. (G. Yontef, 1989)

The style of the therapist is a very personal matter. It has not to do with
the therapist’s professional skills, abilities and responsibilities towards the
client but is part of his personality.(J. Zinker, 1977)
Creativity here is the way the therapist assimilates and involves his personal
talents and interest in his therapeutic work.
This means that the style of one Gestalt therapist might be much different from
another Gestalt therapist and also that the style of one therapist might differ
from client to client.

The concept of dialogical relationship in Gestalt psychotherapy , is

Martin Buber’s I – Thou (M. Buber, 1967). This means that both client and
therapist are of the same importance. The relation between them is equal in
terms of respect even if it might be not equal in terms of power. Transference
and countertransfrerence issues are subject of dialogue in the present, during
the client’s therapist meeting. (M. Spagnulo Lobb, 2003).
The next is the concept of polarities, derived from Salomo
Friedlaender’s philosophical theory of creative indifference.
Everybody’s personality consists of many opposites. Some of them are well
known to the person, of some other he has no awareness. That is why some
polarities/opposites are experienced unevenly. In this case poles seem to have
no relation to each other. Creativity means such an exploration of the poles and
the “fertile void” between them that they can both be perceived, noticed and
then integrated in personality
(L. Frambach , 2003).
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The last mentioned is the concept of the creative quality of the ego
function. In psychology and philosophy it is related with Otto’s Rank concept
of creative will. In life all of us have the tendency to identify with certain parts
of the environment and at the same time to alienate from others. The artist who
identifies himself as different and distinct from the environment might
experience the fullness of existence. This creative quality of ego allows him to
create and fully live his life even if he is always aware of death. (N. Amend
Lyon , M. spagnuolo Lobb, 2003).
As described above the concept of creativity emerges as very important
and essential in Gestalt therapy. On the following pages the meaning of the
word creativity for a Gestalt therapists will be presented, with emphasis on its
impact on the therapeutic relationships.
A description of a creative therapist and his work as mentioned in
Gestalt literature will follow.
“Therapy is the task of the self, which discovers and feels, in the dark painful
areas, in danger and in difficulty, that space in which a creative élan is
possible”: (F. Pearls,R. F. Hefferline, P. Goodman, 1951 p.26). Things that had
been blocked, forgotten, that a person was not allowed to feel might be brought
back in therapy. The come back of certain feelings and experiences might be
very painful. It also may allow to gain a new perspective, new feelings,
discover new themes. With the support of the therapeutic relationship the
experience might be integrated by the person. It might become his own. The
therapist and the patient co-create the condition of contact, of the journey they
commit themselves to do together.
In order for this to happen the therapist needs several capacities, abilities and
techniques but also and mainly certain values and attitudes. To represent those
attitudes and values the therapist goes through a long process of discovering
and knowing himself, through his education, therapy and supervision.
The above attitudes and capacities are described very specifically
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by J. Zinker. In “Creative process in Gestalt therapy”(1977) he presents a

creative therapist, an artist in the already mentioned categories.
According to J. Zinker for a Gestalt therapist to be creative, he needs to focus
on his/her values and attitudes as much as concentrate on his/her capacities,
abilities and techniques.
Following Zinker’s thoughts a creative therapist has a rich personal
background and experience in emotional and intellectual development, he had
exposure to a range of experience. He celebrates life, another person’s beauty,
goodness, capacities and future possibilities. He is an aesthetically sensitive
person, has a sense of grace, structure, order and rhythm of life. He loves play
and is aroused by unknown possibilities beneath the surface of human life (J.
Zinker, 1997 pp 38-41)
As much as capacities and abilities are concerned a Gestalt “creative therapist”
is experimental – his attitude is one of using himself, his client and objects in
the environment in the service of inventing novel vision of the person. He has
insights – he encourages articulation of awareness “making the familiar strange
and the strange familiar” (after W. Gordon, 1961 p.42). The personality of the
therapist and the values he considers important are strongly related with his
skills and how he uses them in the therapeutic process. Therapist skills and
beliefs become quality of the process of psychotherapy (G. Giamarelou, 2006).
He also possesses some characteristics related to work, which according to J.
Zinker are essential. He has a good sense of timing, the capacity to detect
where the person can be reached, energized, moved emotionally, he has a
knowledge of where psychological “buttons” are and when to push them, he
has the ability to shift gears – to let go of some things and move on to other,
more lively areas, he has the willingness to push, confront, persuade, energize
the person to get the work done and also he has the wisdom to know when to
let the person stay confused so that he may learn to evolve his own clarity. He
has ability to integrate two modes of consciousness, two modes of being in the
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world – grabbing hold on and being active and living in loose, passive,
receptive wonderment.
As stated in “ Creative Process in Gestalt Therapy” the psychotherapy
situation, which is experimental and safe, gives to the client the possibility to
look at himself from different points of view, like observing himself in various
mirrors. This might happen when the therapist is “imaginative”. When he gains
“an independent perception of his field, when he is specifically involved in the
client’s life experience, when he is able to feel wonderment and surprise and is
a risk taker” (J. Zinker, 1977).
A creative therapist is part of the field in therapy, part of the contact making,
creative adjustment process. Before exploring further the creative adjustment
process in the relation between the client and the therapist a reference to the
understanding of the term adjustment will be presented.
B. ADJUSTMENT
Understanding of creative adjustment in Gestalt literature

According to the Longman dictionary of Contemporary English (1987) to

adjust means: to change slightly, especially in order to make right or make
suitable for a particular purpose or situation. The word is being compared to
the word adapt –that is : to make or become suitable for new needs, different
conditions.
The terms adjustment, self regulation, and creativity appear in Gestalt
literature as synonymous or related to each other.
Creative adjustment is a developmental capacity of doing “the best I can” or
an organismic self-regulation process. When a creative way of acting becomes
fixed and is no longer suitable or becomes an obstacle in the developmental
process of a person it is called “a fixed Gestalt”. Other term which are used in
Gestalt literature connected with “creative adjustment” are “resistance”, and
also “polarities”
e.g. adjustment versus creativity. To adjust creatively is a part
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of a growth and destruction process, the organization of phenomenal field into

figure and ground, or the process of figure and ground formation/destruction
(G. Yontef, 1989).
People adapt to difficult situation and circumstances when growing up and in
society, following rules, doing the best they can at the very moment. This way
of acting, at the time creatively, allows them to survive and move on with their
lives. Sometimes what was creative adjustment becomes a fixed way of acting.
Then people might no longer know what they feel. In other cases they might
not be able to name their feelings. Some other people aware of what they feel
and still do not know how to act. “What is common to all of us is that we have
done the best we could in an imperfect world: we made what Gestalt calls a
creative adjustment” (A. Fookes, 2002).
The terms self – regulation and homeostasis were introduced to Gestalt
therapy by F. Perls, who state that “the homeostatic process is the process by
which the organism maintains its equilibrium, therefore its health under
varying conditions. Homeostasis is the process by which the organism satisfies
its needs” (F. Perls, 1973, p.4).
This means that the organism tries to maintain a steady state when the
environment changes. To satisfy its need the organism has to also to approach
and hold of new things and let go what is no more needed. This is the”
aggression and destruction” process described as part of contact making, part
of the process of creative adjustment.
“Creativity and the organism/environment adjustment are polar: one
cannot exist without the other. No adjustment would be possible by the self-
regulation alone; contact must be a creative transformation”. (F. Perls , R. F.
Hefferline , P. Goodman P, 1972, p. 406).
The term creative adjustment replaces the term “resistance” in the vocabulary
of Gestalt therapy. Resistance means an opposition to change, means that the
client is not willing to accept the therapist guidelines. Accepting guidelines
from the therapist might suspend the therapeutic process and open the
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resistance below it. In the “here and now” the resistance is a healthy, protective
process. It allows to avoid pain, real or imaginary which cannot be taken. In
psychology, generally, therapists try to overcome resistance, in order the client
to change. The client should stop being resistant. In Gestalt therapy the
therapist stays with the resistance (H. Siemens, 2004). The resistance is
creative adjustment. It is the way the client is in the world. During the process
of life gives the possibility to survive, to solve a present problem. The way of
“resisting” stops sometimes to work developmentally. This is why Gestalt
therapy explores resistances, brings them into awareness, works with conflicts
between them so they can be reintegrated as new meaning making wholes.
“In Gestalt therapy every symptom or defense is viewed as an attempt
to solve a problem through creative adjustment”
(J. Melnick, 2004).
When these adjustments, at first bringing profit in a person’s development are
no longer helpful and become rigid, the natural figure/ground process of
formation/destruction is blocked. The distortion of this process called also
resistances to contact, includes: projection, retroflection, introjection,
confluence, deflection and proflection (Polsters E, M,1973 ).
Herb Stevenson (2004) mentions the following understanding of resistances:
introjection – swallowing the whole experience without chewing, projection –
attributing my own feelings or needs to another person, deflection – avoiding
contact by paying suddenly attention to something else, not related with the
subject, using humor, confluence – lack the ability to distinguish myself from
the other, agree always with other’s opinion, desentization – avoiding physical
or emotional awareness: (more details in Appendix 1).
S. Ginger (1995) presents a picture of resistance which include
organism, the contact boundary and the environment: in confluence the
organism and the environment cross the contact boundary back and forth
without noticing where each begins and ends. In introjection all the energy
goes back to the organism, in projection energy is directed only outside the
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organism to the environment. Retroflection works as a u turn back inside the

organism, deflection turns energy elsewhere in relation to contact, inside or
out. Proflection is a mixture of projection and retroflection where I project my
retroflected need to somebody else, ask somebody else to fulfill my need, and
finally egotism is the state where I know and I am aware but still I avoid
contact. (the graphic representation of the above in Appendix 2).
In common language the term resistance brings sometimes negative
associations. The synonyms are opposition, battle, conflict , struggle, hostility
(Longman Dictionary of Contemporary English, 1987). In psychology, G.
Wheeler (1991) introduced a positive meaning to the understanding of
resistances. He presents resistances as “the dimension or function of the contact
process” which means resistances might be perceived as creative, positive,
components to contact styles. Contact styles are placed on a continuum and are
dysfunctional whenever move to one of the extremes of it. The pairs are the
following : confluence vs. differentiation, projection vs. retention, literalness,
introjection vs. chewing, destruction, retroflection vs. exchange and encounter,
desentization (or egotism) vs. merging, deflection vs. focusing and
concentration (Appendix 3).
Those mechanisms of avoiding contact might be placed in the
subsequent phases of the “contact withdraw cycle”(called also the awareness
cycle, the cycle of experience, the cycle of Gestalt formation and destruction,
the need and satisfaction cycle), (P. Clarckson , 2000; Delisle G, 1999). In
Gestalt therapy there is no contact without withdraw. The therapeutic process
includes both – the “when” and “how” of the contact – withdraw cycle is the
creative part.
In the contact withdraw cycle the base is a need of being autonomous and of
belonging to. The point is to find such a way to adjust not to loose oneself –
this means take what I need and reject what I don’t need. The contact withdraw
process is a healthy process. The boundary between the organism and the
environment should be flexible. Every single moment a figure (the strongest
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need) emerges and the rest becomes background. This is the forecontact phase,
where the experience is the sensation. Interruption of contact in this phase is
confluence. It has to do with the Id function. After this phase orientation
follows, taking note of feelings, needs, ideas. This is the awareness phase, still
in forecontact. The next step is a mobilization of energy, which might be put on
hold or expressed. Here the interruptions of contact have to do with the loss of
ego function (projection, introjection, deflection, retroflection). Subsequently
the contact phase arrives, where we make a choice, followed by action. This is
the final contact, with self, with the others. Our choices and way of making
contact have to do with the personality function, with who I am. The last is the
post –contact, withdrawal or rest phase, where we back off in relation to self or
to the environment (J. Zinker, 1977) see (Appendix 4).
The understanding of resistances including a creative component is important
for the process of therapy, for staying with the resistance and gaining
awareness of it. In the therapeutic process methodology itself helps the
therapist to be creative. Making contact is very important at the beginning of
the therapeutic relation/process. Gaining awareness of the resistance and
staying with it, gives to possibility to make contact, to proceed into the
therapeutic relation.
Graphic representation of the contact withdraw cycle is attached
in Appendix 4.
Developmentally, we satisfy our needs in contact with the environment. By
contacting we organize the way we exist in the field. For everyone of us, in
every situation the adjustment is a unique, individual, creative process. It is
unique for every person in an individual situation, under specific
circumstances. It does not follow general rules. The process of adjustment is
every time creative and unique, it is the best solution in the given conditions.
“The process of adjustment is mutual. In creative adjustment, our achievements
and solutions are made by us and given to us both in the give and take of our
creative partnership with the rest of the field”
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(N. Amend-Lyon, 1992). A further and important analyses of the concept of

the concept of creative adjustment is presented in “Creative Adjustment as
field based psychotherapy”. M. Parlett presents five dimensions of creative
adjustment: the first is called Responding – it is described as a way of
responding to situations and as an ability to respond and take responsibility.
The second, called Interrelating –is defined as ability to relate to others. The
third, named Self-Recognizing is presented as being aware of one’s position in
the field, having direction and experiencing a sense of coherence and
continuity. The fourth called Embodying –includes a full bodily participation
in life– somatic, sensory, with thoughts and attitudes. Finally the fifth,
described as Experimenting- is the ability to appreciate the present situation
and also invent possibilities, take creative decisions, risk the unusual, and be
able to let go- when necessary – of what we have become dependent on or
attached to (M. Parlett, 2000 pp.19-24).
The role of the self and the field process are very important here. We influence
the field and the field influences us. Bringing changes to the field means
change in our selves, changes done in order to survive, adjust and develop. M.
Parlett believes that learning and practicing various ways of adjusting
creatively and performing abilities to adjust is beneficiary to our wellbeing, in
today’s complex world with its social requirements. A field oriented therapy,
like Gestalt therapy is, might consider it a serious task to be achieved (M.
Parlett, 2000).
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CHAPTER II

THE THERAPEUTIC RELATIONSHIP

“In the beginning is the relation “ M. Buber (1958,p.18)

This chapter is a review of literature concerning the definition and meaning of

therapeutic relationship in Gestalt Therapy. The characteristics and the role of
a therapeutic relationship, including its philosophical and ethical aspects will
be presented on the following pages.

According to Lynne Jacobs (1995) the nature of a therapeutic relationship can

be described in two aspects: one is the role of the relationship – how curative
and important is the relation itself in therapy, and the second refers to the
characteristics of the relationship – the structure of the relation and the
allowed therapists behaviors.

In this chapter both aspects will be presented starting with the characteristics.
Reflections regarding the role of the relationship will be presented afterwards
since this subject is strictly related with the material presented in chapter III.

The characteristics of the therapeutic relationship

The therapeutic relationship is both a technique and a transcendence of
techniques (L. Jacobs, 1995).

On the pages of “The Healing Relationship in Gestalt therapy” (1995)

the therapist’s task are presented and analyzed: those tasks are patterning,
control, potency, humanness and commitment.

Diagnose is a process, which starts during the first client-therapist

meeting and goes on during therapy.

In Gestalt therapy, according to the authors the emphasis is on the

process of interaction itself. It includes clients skills and patterns of

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behavior, risk taking in interaction, blocking contact and change.

The therapy situation may become a model of several situations in

the outside world. The way we interact in therapy we also do
outside. The therapy process allows testing new skills in a safe
environment.
Control – by control Gestalt therapy understands that the context of the
therapy process has to be controlled by the therapist. It is the therapist’s job to
involve the patient in the process of therapy. “In essence, it becomes the
therapist responsibility to establish the conditions for dialogue”

(M. Friedman, 1976).

The next characteristic is potency - the potency of the therapist means that it is
the therapist that should be able to follow the client’s needs at his pace. He has
to be able to assist the client where he is expected to and at the same time
provoke changes which help the process of maturing and growing.

Humanness means that the therapist cares about his client, supports him in
difficulties, recognizes his effort and commitment to the process of therapy. He
also sincerely shares his emotional responses and experiences. He is be able to
choose when and how much to share so it will be profitable for his client. He is
himself committed to the process of his own growth so it can be a model for
the client.

Finally commitment. The therapist commits himself to the process of therapy,

to every individual client, to continue the self growth process which includes
training, therapy, supervision, research etc.

“Commitment is the continuing involvement and acceptance of assumed

responsibilities”. (J. Fagan , 1970). Commitment means to be there for the
client according to the made contract, to respect client’s phenomenology, to
discuss therapist’s themes during supervision, to work on self development in
psychotherapy and in psychotherapy training, to know therapist’s limitations –
 2

including working with patients the therapist is able to work with. Commitment
also means staying in therapy process with all its difficulties and “teach the
client how to learn about himself” (H. Siemens , 2003).

Apart from the above mentioned characteristics it is important to stress the

Gestalt therapist responsibilities toward the clients.

Those have been carefully described by F. Perls (1951). According to Perls

the therapist is responsible for both, knowing himself and the client, for the
quality of his presence in therapy, for being open to the client and being able to
keep this openness. The therapist is also responsible for creating and sustaining
a therapeutic atmosphere which will motivate the client to work. In Perls’
understanding the experiences, awareness and perceptions of the therapist, are
the background of the therapy process, while and the client’s reaction and
aquatinted awareness form the foreground.

It is therapist ‘s responsibility to share his perceptions, reactions and thoughts

regarding the client, while they emerge in the process of therapy. The most
important part of therapy is the dialogic relationship, techniques per se are not
important.

“Techniques are not the issue; rather the therapist’s attitudes and behavior and
the relationship that is established are what really count”. (F. Perls, 1951 p.236)
. Some techniques (such as exaggerating) intensify and clarify current
experience, others focus on the evolving awareness process. A technique
should not become a way “to make something happen” but should be part of a
dialogic attitude (L. Jacobs, 1989).

A technique might be used after establishing ground and as a part of

experimenting, when an experiment is appropriate in the therapy process.
Techniques need to become a quality of contact. “The important thing is that
…techniques emerge organically from the ongoing dialogue” ()Polster and
Polster, 1973, p.239).
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Gestalt literature often mentions that the therapeutic setting is an experimental,

model situation, a micro-world where all the social rules might be applied as in
the macro-world we live. Social relation are very important to us, in social
relation we live our lives.

E. Doubrawa (2001) presents how therapeutic relations are connected with

society and how society influences the therapeutic relations. According to his
article “the client therapist relationship cannot sustain the I-Thou relationship
to the last consequence”. In therapy during the horizontal meeting “souls
touch”. This process is encouraged by the therapist. At the same time, during
this meeting one person is asking for help and the other is a helping profession
representative. One person pays for the meeting and the other is being paid for
it. This is the part of the relation which remains instrumental. The therapist is
paid, so in this aspect the client is the “instrument” which permits him to earn a
living. From the client’s point of view, the therapist is the “instrument” which
allows him to “find a way out”. Following Doubrawa’s reflection it is
important to notice, that both, client and therapist, are to learn from both, the
dialogic and the instrumental part of this relation. In the same kind of relations
we are involved everyday. Several times it is in our hands to contribute in
building a healthy society, where meeting would not be only instrumental.
Taking results of therapy in the outside world is the most difficult part of the
therapy process but also its most powerful factor.
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The role of the therapeutic relationship

In Gestalt therapy the role of the relationship is basic. Developmentally
the emphasis was first on awareness (Perls, Heffeline, Goodman) and on
contact (I. Fromm and the Polsters). Nowadays the
relationship is the base of the therapeutic work, of contact making, of healing.
It is the bridge between the two who meet. It is a process, it is dialogue. It
includes every aspect of the client’s and the therapist’s field. Content itself is
not so important. The content might become a creative aspect of therapy when
is included in the process. Using the Gestalt methodology allows to put the
content into the dialogue. This is why dialogue becomes content and process.
Methodologically this is done by using words. Putting in words “who I am “
and “what I say” and also “how do I say it” allows to create a process which is
a dialogue.
The therapist – client relationship is horizontal. Client and therapist have their
history and phenomenology. The relationship is supposed to be lived “here and
now”. Therapist respects the client as an expert of his own experiences. He has
to understand and accept the client’s history, not to change it. The only
judgment the therapist makes, is what to disclose and deep on in the meeting.
The therapist needs to support “as much as necessary and as little as possible”
quoting “What’s behind the empty chair” (L. Estrup,) 2000
Gestalt therapy is also called “dialogic method”. “Dialogue is used to
make contact, to move towards the other, to establish a relation-ship. Dialogue
is also the therapist’s instrument to build a relation and help the client to restore
his awareness and his ability to make contact” (G. Yontef, 1993). The
therapeutic dialogue has a goal. The goal is the unique therapeutic relationship
which allows the client to gain a different perspective of what he has
experienced in other words a different point of view or also to acquaint a new
experience in addition to what he has experienced so far in his social life.
The theoretical concept of dialogue in therapeutic relationship comes from the
existentialist M. Buber(1878-1965). “ All real living is a meeting” stated M.
 2

Buber ( 1963). Gestalt therapy theory includes many of Buber’s ideas. One of
the most important is- the I- Thou concept and the distinction between the I- It
and I- Thou.
The I –it relation is the one, where we are interested in the outcome. Its
meaning is close to manipulation.
The I-Thou relation is a meeting, where we don’t know the other. In order to
meet the other person we need to enter the meeting taking the risk of feeling
lost. Referring to Gestalt terms, the closure or the completion of a gestalt in not
possible during this meeting. The only available figure in the I-Thou meeting is
openness.
“In otherness this openness is the ground from which we offer ourselves to the
meeting.”(S. Schoch De Neuforn, 2001,p.155).
The distinction between the I-Thou process and the I- Thou moment. Is
analyzed by R. Hycner (1995) . The I-Thou moment is a special moment. The
experience of it proves to the person, that he can restore his relation to the
world. It is the experience of reintegration, of making a new meaningful entity.
It is what Polster and Polster (1973) call “a contact episode”.
The I-Thou process is established in dialogue. R. Hycner calls it also
“dialogical” or “dialogic”. The form of dialogue is contact.
Contact/dialogue is according to M. Buber’s principals a transcendental
process. “Contacting is in the form of dialogue, the contacting process
becomes itself an evolving, spiraling, developmental process”. (L.Jacobs, 1997
p60).
During the development of Gestalt therapy as an approach G. Yontef related
Buber’s principals to the process of Gestalt therapy and suggested a list of
skills that a therapist needs in order to build a relationship, using dialogue. In
H. Siemen’s article: “Dialogue and Awarenes…” the following reflections
above those skills are presented: At first Inclusion - this term means that the
therapist should be able to see the world through the eyes of the client. He
needs to accept the client without judgment or criticism. He needs to do
 3

something to come closer to the world of the client and then pull back. The
next comments are on Presence . Showing presence means pointing out chosen
aspects of the phenomenology. The therapist should know when to show
presence, how to enter into the world of the client and at the same time, keep
enough distance not to be completely absorbed by it. Therapist should be
aware of both his own, and his client’s phenomenology. Showing presence
should have a function in dialogue with the client. The very base of the
relationship is Dialogue - the I- Thou meeting. “The therapist needs to use
dialogue professionally, as a therapeutic instrument” in the process of therapy.
Dialogue is not just a technique. Although the above are considered to be skills
which a therapist requires, they also are existential meeting qualities.
The next mention therapist skill, but also a quality of the process of meeting is
awareness . Awareness in both, a method and a tool in therapy. “Awareness
can be restored through new experience”
(H. Siemens, 1996). This experience might be co-created by therapist and
client in the process of therapy, through experiments and dialogue. The client
might gain a different phenomenology than he was familiar with. What the
therapist does is “to lovingly serve the awareness process of the client”
(Vernon van de Riet, after R. Jarosewith, 1995). Awareness is a continuum –
the first step of it is the awareness of the outside world (noises, smells etc. )
with which we are in contact through our senses. The second step is the is
awareness inside the body, the reaction of our body to the impulse and the
emotional connection with the experience inside the body. The third step
concerns the fantasies we make and includes consciously reflecting ourselves
(P. Schulthess 2006) .
Another important component of the process between the client and the
therapist is change.- “Change occurs with supported awareness of it” (R.
Hycner, L. Jacobs , 1995). Gestalt therapy no more takes awareness as a goal,
but rather dialogue and relationship. A person is able to be present in the
relationship when he/she has awareness of it. The process of awareness allows
 3

to respond to a situation according to one’s needs and the given possibilities.

“When one is aware, one does not alienate aspects of one’s existence; one is a
whole” (G. Yontef, 1976,p.67)
Change arrives when one invests in the present experience with no judgment
nor demand to change. The acceptance of the I-Thou relation is the acceptance
of what is. This means surrender to what emerges in the dialogue, between the
therapist and the patient. It also means that the therapist is changed by the
interaction as well as the patient. The interdependence between a person and
the environment concerns also the process of meeting in Gestalt therapy (L.
Estrup, 2000). The “how” two people meet and change during this continuous
process of interdependence is the creative part.
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CHAPTER III

CREATIVE ADJUSTMENT IN THERAPEUTIC RELATIONSHIP

“Relationship means to contact and help people to discover how they can help
themselves. In the place where they can meet and be aware of who they are”.
(J. Melnick)

In this chapter the links between creative adjustment and the therapeutic
relationship will be presented according to how as they are discussed in
Gestalt literature.
An important affiliation between contact and relationship is mentioned
in Gestalt psychotherapy theory.
The process of creativity is an aspect of relationship, existing between the self
end the environment.
The self is the ability of the human organism to be in contact, and contact is
one of the basic roles of the therapeutic relationship – in the therapeutic
relationship the therapist helps the client to restore the ability to function
spontaneously, to adjust to the new aspects of the present situation in order not
to repeat stereotypes, which might be no longer helpful. “Being spontaneous
means to develop the process of contact-withdrawal”
(M. Spagnuolo Lobb, 2001, p.58) This process concerns the whole human
being and might be analyzed on thee different levels: Those levels consist of
the experience of the self . Self is a function. This is a novelty referred by M.
Spagnuolo Lobb, Gestalt therapy deals with the fullness that comes from
staying with the experience. The therapist co creates the ability to fully
experience the “here and now”. At clinical level “self” means that the therapist
helps to restore the ability to function spontaneously, adjusting to the novelty
of the current situation, instead of repeating a stereotyped schema. Therapist
goes to the positive resources in one’s self.
 3

The Ed, Ego and Personality are “special structures” of experience which the
self creates for special purposes.
1) The experience of the self

On the Id level this is the ability to identify physiological needs and

needs inside the skin, and also experiences which are related to our body. It
refers to sensory and motor learning, breathing, first learning in life.
When there is a distortion on this level the person does not feel the difference
between id and not id, that is what is and what is not related to the body
experience. He/she does not have a clear perception of boundaries. This is the
case of psychotic patients. A psychotic patient has an enormous need for
environment, for confluence ,does not differentiate between himself and
boundaries. Psychotic patients do not perceive themselves as different. They
fear to be dangerous for others and carry a sense of huge responsibility in front
of the world. They have no fear to damage themselves. A Gestalt therapist in
such cases works on creating ground, through rules, therapeutic setting,
dialogue and experience. Creating new healthy environment is the goal of
Gestalt therapy on this level.
The experience of the self on ego level, it is the ability to use will, take
decisions, identify or alienate with parts of the environment. On this level one
is able to make decision and identify with choices or alienate from them. If the
environment is healthy, a person at this level achieves the ability recognize
his/her needs and to take an action to fulfill them. If choices are healthy a
person acquires this ability. When action in not related with the persons needs
the therapist needs to deal with the loss of ego function. The creative work of
the Gestalt therapist is to allow experience of action making and give attention
to action that works well for the client.
On the personality level the experience of the self has to do with the ability to
answer the question “who am I”? and “how I define myself”? in relation with
the environment and my life experience. The creative work of the Gestalt
 3

therapist on this level is organizing experience in meaningful wholes, to give

meaning to the persons’ experience in the existential process of life.
Following again M. Spagnulo Lobb reflections “the self is never passive and
never active. It is always both. In contact, it is in the space between – not in
you and not in me. It is the middle mode”
(M. Spagnuolo Lobb, 2002).
An interesting analyze of three boundaries which in themselves and in the
relationship between them make up the experience of the self is presented by P.
Philipson (2001).
The first is the organism/environment boundary (the It/not It
boundary) which separates and links the processes inside and outside my skin.
The second is the self/other (the ego, the I/not I) boundary –
responsible for the sense of self and other, what is my experience and what is
not my experience. On this boundary, the interaction is contact.
The third is the personality boundary (me/not me) –responsible for
alienating or identifying with some aspects of functioning. The personality
functioning includes memory and stable environment. The processes here are
making choices, not making choices or neurotics.
Making choices includes: life choices, commitments, values and ethics,
culture. Neurotics is connected with polarities – uneven perception and
experience of polarities, fixed gestalt and introjections.
Creativity takes place in the dynamic between the individual and the
environment “where the self meets the other” (J. Melnick, S. Nevis, 2003). In
this understanding the creative process occurs in a relationship, in this case in a
therapeutic relationship, in the process of contact between the self and the
environment.
N. Amend-Lyon states that the creative processes (eg creative adjustment) “are
triggered in no man’s land, at the contact boundary” (N. Amend-Lyon, 2003).

2) The contact boundary

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The relation between the patient and the therapist includes two modalities – the
content and the context of both the therapist and the patient. “Therapist and
patient both interact in the process and are in the process. The focus, or the
figure, change during the process of dialogue” (M. Denes, 1980).
The process of change and transformation of the self in contact with the
environment is creative adjustment (J. Melnick, S. Nevis, 2003).
The process of psychotherapy is a contact withdraw process where both
therapist and client are involved. Creative adjustment occurs on the contact
boundary, in “no man’s land” between them. Therapist and client might
communicate from their common experience. They find the boundaries from
the differences between them.
In clinical practice, according to J. M. Robin (2001) contact in Gestalt therapy
is following the movements towards differentiation and towards integration in
the field. Therapist either helps to open to clients’ experience options towards
the integration of the field or towards the differentiation of it. All the work is
concentrated on the balance between them.
According to P. Philippson (2001) reflections about meeting for the
first time a client on the mentioned three boundaries levels, a therapist should
concentrate on the following:
At the Id boundary:
Does the client allow himself the moment of not knowing, of not making
figure?
Does he allow himself to see what emerges or does he have a kind of
stereotyped figure (fixed Gestalt) he uses?
If he allows Id then he has to become creative in that moment – he has freedom
with the anxiety of that freedom, he has also to be aware of his freedom and the
confusion it brings so he can acknowledge his free will.
Same questions and processes concern the therapist.
Therapist has to be able to look without attaching anything, since the meaning
of what happens in the process has to be created together
 3

At the ego (self/other ) boundary the questions are:

What kind of choices does the client make? What does he expect from me?
How does he express that? How is the self/other process between us? And from
the therapist part: How do I experience myself wanting him to be? What do I
like and what I don’t like? How open am I to different aspects of his life?
At the personality boundary – is the client’s personality supportive and open to
changes through new experiences or is it rather a range of fixed behaviours and
introjects? Do those introject permit the client to experiment with new
behaviours? Or is he committed to the old attitudes which do not allow him
effective functioning today?

The contact boundary is made up of contact functions. The functioning

of a client can be observed by the therapist upon the use of contact functions.
“In therapy we observe the appearance, verbal, auditory, movement and
touching contact functions” (G. Delisle , 1999).
In the contact cycle dysfunctions might be observed in the phases of sensation,
awareness, mobilization, action, final contact and withdrawal. The
dysfunctions are maintained through resistance and adjustment to contact and
also by not making appropriate use of one’s support system (cognitive, emotive
and behavioural see appendix 8).
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CHAPTER IV

EXEMPLIFICATION FROM CASE STUDIES

The therapist “has to love the client on a very basic level, in a very simple
manner. The therapist should love the human being before him ” (J. Zinker,
1997).

Gestalt therapy from the beginning and in its history was very much
based on awareness. Social condition and changes contributed to changes in
Gestalt therapy approach. Nowadays it is much more concentrated on contact
and process. Contact making is a primary concern. The therapist should be
aware of contact making, observe what the contact does to the other person,
find the strength and vulnerabilities of the therapeutic situation. This is part of
the process of therapy.
In this chapter examples of creative adjustment in therapeutic relationship as
experienced in Gestalt therapy practice will be presented.

The first case which will be presented and discussed comes from
therapy with a 5 year old girl, with mental and speech retardation and
behaviour problems. She poorly communicates verbally, pronounces very few
words and communicates miming things and situations. Mother comes to
therapy asking for speech improvement. The girl does not want to come, gives
parents difficult time twice a week when is time to go to therapy. When she
does not obtain what she wants she screams and bites. She behaves like
described also at home, at family friends during visiting, in super market
creating situation where parents are at big discomfort and manipulating them.
Her perception of boundary is vague she does not feel other people personal
space.
 3

She does not have the ability to identify her needs, she has no sense of skin
boundaries. Her touch is heavy and she does not respond well to guiding by
touch. She often steps on other people coming to close, she walks unbendingly,
her movements are stiff, her body is very tense. She has no sense of her body
strength. She actually is very strong for her age and misuses the strength.
Contact making with A. was a challenge since she had negative reaction to
every trial to start an activity, no matter if it was related to speech , behaviour
or play. The girl is in therapy for over two years now and she starts perceiving
and respecting rules of the therapeutic setting. In this case it means
working/playing for about 40 minutes with the therapist without calling her
mother, leaving the office without screaming and taking some objects with her,
playing with one toy or one activity at the time and communicating her needs
without pulling the therapist hair nor hitting her. The creative adjustment in
this relation from the therapist part was establishing physical boundaries –
sessions where the main impact was on the physical place client and therapist
occupied during the session “this is my pillow and this is yours” ,”this is your
book for today and this is mine”. “I write on my paper – this is my paper and
this is yours”. “today we will play in this room only”.
Parallel parts of the therapeutic intervention were sessions with the mother of
the child, during A.’s therapy hours. Mother would meet a therapist colleague
every 15 days and work on issues related to the girls’ behaviour and mothers
feeling about it. Possible intervention to be done outside therapy sessions were
discussed there as much as the need of a full developmental diagnose. Another
part of creative adjusting procedure in this case was doing social work and
research in order to find an appropriate school place for the girl. This included
calling schools and making appointment with the girls mother.
Contact making with this client is still an issue. Improvement in
boundary perception is visible, the girls cuddles up to therapist instead of
pulling hair or hand. She stars being aware of her physical strength. She comes
to session regularly and works doing speech exercises for about 10, 15 minutes
 3

every time, reacting to what therapist asks her. Two visits on three the girl
comes and leaves quietly without anger outburst which therapist and parent
agreed to ignore.
The development of personality of this girl is stuck at the negation level and
this does not allow her to experiment with new behaviors. Her “no“ attitude
stops also the child’s development procedure. Adjusting to this pattern
creatively included commitment to work again and again on the same issues
introducing rules in and out of therapy, like “session duration is 45 minutes and
then you leave” or “we will play with dough for 15 minutes and then we will
do speech exercises for 5 minutes in front of the mirror”. In case she still did
not want to work, therapist would do exercises as a demo and ask the girl every
time to repeat, even if she wouldn’t listen.
The girl was also allowed to take home with her one chosen object, usually a
toy, of her choice which she would bring back on the next session. This system
required the parents cooperation and involvement. Every session which went
well was rewarded by therapist and parents by very good words, sometimes
stickers the girls collects or small toys.
The most difficult part of adjusting to contact making for the therapist here was
dealing with the feeling of anger to the client and disappointment when
therapeutic intervention brought no result. Creative in this case meant
introducing one by one rules of behaviour, and repeating them again and again
until they were perceived and accepted by the client.

The second case which will be presented here is the case of a 40 year
old man who came to therapy because of feeling depressed. During the first
weeks of therapy he continued feeling worse so he was referred to a colleague
psychiatrist (was diagnosed bipolar maniac depressive disorder) and started
taking medications. Psychotherapy during this period was concentrated on
support. The creative part here was involving in therapy the clients wife (she
started psychotherapy with a colleague psychologist). Other creative
 4

interventions were couple session with two therapist so a holistic approach to

the case was possible. Important part of this therapeutic setting was also
consulting the case with the psychiatrist on regular bases.
During therapy after a phase when things were going well and client seemed to
be ready to work on personal themes in therapy he suddenly got very depressed
again, stopped working, stopped going out of the house. He called therapist to
tell he is not going out of the house and will not attend therapy sessions for a
while.
A creative intervention at that time was going out of the regular therapeutic
setting and rules and calling the client at home. A transcript of the phone
conversation follows:
Therapist : “Hi M., this is Joanna. I called to ask how are you doing?”
Client: “ things are really bad. I don`t go out almost at all. I stay in the house
moving from the bed to the couch. I cannot think clearly. It is very heavy and
stressful. I don’t answer my cell phone because I’m afraid it is a client. And I
cannot work right now. I don’t answer the phone also. I picked it up because
my wife told me she will call at 18.30 so I thought it was her.”
Therapist: “I can hear also in your voice you are not well. I want to ask you if
you would like to move our session to your place until you feel better. I could
visit you in your house for a session. How do you feel about that?”
Client:” no, I don’t think this is a good idea”
Therapist:” would you like to think about it….?”
Client: “No, I don’t want to. I will come to see you when I am ready. I will call
you”.
Therapist:” Ok M. If you change your mind or need anything you can call me. I
will be waiting to hear from you. “
In this case where the client does not exploit very much his support system (he
has knowledge about his medical condition, knows the prognoses for it, has
discussed with psychiatrist the consequences of stopping medical treatment or
continuing for preventing depressive episodes. He could not use this
 4

knowledge at that time, he could not accept his condition. His environment was
very supportive. He could see it but could not feel for them. Client would not
experiment with new solution nor new behaviours even when therapist was
very directive and his attitudes would not allow him to function in everyday
life (could not work, help in the house nor going out).
The client’s choice was to come to therapy and then wait for changes to happen
“I will tell you about it when I feel a little better” or “we will discuss this
another time now I don’t have the strength”. At the ego boundary the process
of therapy was stuck at a vague support level and both therapist and client were
waiting for some result of medical treatment to start therapy. Client when
depressed was closing up to any contact with outside world and after the
antidepressant started working was so high that was involved only with his
work at a very fast pace.
Therapist experienced herself wanting the client to fight a little bit more for his
improvement which was accompanied with a feeling of disappointment.
At the id level client had a fixed Gestalt on reacting to situation of taking
responsibility for his feelings. He often referred feeling strong fears which did
not allow him to go out of bed into the world. He could not specify what he
fears. Following the movement toward integration and toward differentiation
in the field was extremely difficult in this case.

The next case to be analyzed is the 20 years old E. coming from a

different country. Her mother language is different from the language of the
therapist but they share common culture background and experience. This
factor was very helpful in building a relationship between client and therapist.
Creative adjustment in this relation included finding the best possible verbal
way to communicate. Therapist and client agreed on experimenting speaking in
different languages and finding the way which clients feels at ease and
therapist is able to understand well.
 4

Client:” I though we could speak Greek from now on because I’m taking
lessons and it will also help me socially:
Therapist:” Ok, I’m fine with both languages. We could experiment for today’s
session and see how we both feel with that. How does that sound to you?”
Client: “I’m ok, let’s try it for today”
After a few sessions E. asks:
Client:” I thought I could speak my own language so I can express myself
better and you could speak yours. (Our mother languages are indeed similar
enough and with some practice this could be done)
Therapist: “I’m a little bit hesitant about that….. But still we can try it. Let’s
start our session as you say and see how it goes…”
And after sometime during the same session:
Therapist: “I’m sorry I cannot do it this way. I’m to much concentrated on
trying to understand the words and I cannot see nor feel anything else. Could
we switch back to English or Greek?”
Client:” It’s a pity. Let’s try back in Greek then”.
After a few more session we found a satisfactory model to communicate. We
speak basically Greek. If one of us misses something we get help from other
languages including body language.
In this case the client makes a very good use of the cognitive support system.
Knowledge helps to maintain contact and adjust to new situation. The usage of
the system is no rigid, changes according to clients and therapist’s needs.
Client’s personality is open to changes and experimenting. She expects from
me help in issues concerning her adjustment to new environment and a new life
style. She also expects support, understanding and advice from a person who is
not connected with her everyday social cycle. She expresses that verbally
asking “I want to ask you about that dinner I arranged. When you tell me how
you feel about what I describe it helps me to understand better. I feel more
respect for my actions”… “I need from you to ask me more question because
 4

sometimes you ask about thinks I could not find searching by myself…so
question help me to look in other areas that I had in mind so far”.
In this therapeutic relation therapist feels the process very intensely. Relation
was build fast during crises. Therapist experiences herself wanting the client
“to make it” in a new environment, new life style, new and difficult love
relationship, new job and in therapy with a new therapist.
At the id level – client allows herself the moment of not knowing even though
some stereotypes, especially concerning self esteem and respect often emerge
during the process of therapy. In therapy she allows the uncertainty to emerge
and is open to experimenting new behaviours.

The case which follows comes from a very different therapeutic setting
which is detention unit for illegal aliens. There the purpose of the psychologist
presence is crisis intervention and support. Relations are build quickly and are
quite intense. Intervention is fast and might be the only time therapist and
client see each other. Contact making is a challenge since sometimes a
translator is needed, other times contact has to be done without speaking.
From the therapist part creative is adjusting to all the setting included open
doors and a guard outside sometimes listening, interruption of every kind
during a meeting with a client, talking about wanting to die with a translator,
forgetting about the right of confidentiality because of circumstances.
Creativity here means mainly finding a way to make contact and communicate
immediately. In the case of H. it was trying to pronounce some words in
Arabic, which was his native language.
H. has been in prison for several years before he has been transferred to the
detention unit. The time he would stay in the unit could not be defined since his
deportation was impossible (his country is at war).He started suffering from
bad insomnia except his health problem. H. is a caring person he would
persuade inmates to come to see the doctor if they were not feeling well and
 4

translate for them when there was need. He would understand what people who
were arrested go through and was a fatherly figure. He is 52 years old.
Creative intervention from the therapist part in this case was calling Ahmed in
the doctor’s office every time a translation from Arabic was needed. Another
part of it was asking H. to keep an eye at other patient during afternoon and
sometimes night hours. Involving Ahmed in taking care of others helped him to
feel better. His presence was very helpful for therapist during session with
other patients since a relation of trust has partially already been built between
H., who was the translator, and the other patient. The issue of insomnia
reappeared and H. disclosed that he was doing drugs in the past. He was
abused by them. Here is the conversation which followed:
Therapist : “so…how long have you been doing drugs?”
Client : “for many years….after that I went to prison …but I’ m clean now”
Therapist: “You understand that starting medicine for improving your sleep
might bring you back to abuse, don’t you?”
Client: “I know that. I’m very tired. I need to get some sleep. I promise you I
will not take more than one pill at night, the one which the doctor will
prescribe”
Therapist: “It is your decision. I trust you. I also appreciate very much what
you are doing here. I’m just worried you might go back to a condition which
will not be good for you”.
Client: “Thank you for caring about me….”
In this case the goal of therapy is making a contact which by itself will be
supportive in a difficult life situation, when circumstances cannot be changed.
Her therapist perceives herself wanting the client to take care and protect
himself. During the session she passes using humor. Client responds to this
kind of contact making.
At the same time therapist finds difficult to be open to aspect of client’s life
which have to do with his being prisoner and doing drugs, especially since the
reason of being arrested was never mentioned. Therapist has a difficult time
 4

dealing with her own stereotypes of “a prisoner” and respecting the fact H.
would not talk about his past experience related to that.
Client is aware of his needs and of rules of contact making in the detention
unit’s doctor’s office. His ability to organize past experience allows him to
adjust to everyday reality and also help other people.
 4

CONCLUSION

The concept of creative adjustment is very significant in Gestalt therapy

theory and practice. It also is described as an essential factor in development
and in the way a person can function, communicate and meet or avoid contact
in his/her environment. Every kind of reaction is creative adjustment, at least
at its beginning, when it serves a specific purpose. It stops being efficient
when becomes a “fixed gestalt” no longer serving the best interest of the
person. The process of creative adjustment concerns both, the therapist and the
client and is a crucial part of the therapeutic relationship.
Creative adjustment occurs in the space” in between”, where the therapist and
the client meet, and requires from both parts: commitment, openness, ability to
respond, trust. The therapist is responsible for acting according to his
knowledge, code of ethics in the best interest of the client. The therapist and
the client are both responsible for the process of therapy, for the meeting at the
contact boundary where they both change in the process of creative adjustment.
In the first and second chapter the literature review concerning the concept of
creative adjustment and therapeutic relationship was presented. In chapter
three the connection between creative adjustment and therapeutic relationship
is described, specifically exposing the experience of the self and on the contact
boundary.
In the last chapter cases from therapist’s practice illustrating the process of
creating adjustment in therapeutic relationship are presented. In all the
described cases the need of adjustment concerned both – the therapist and the
client, on behavioral, cognitive and emotional level. This includes knowledge,
experience in ways of making interventions, awareness of the self and the
process. In therapist’s understanding the most helpful in contact making is
commitment, trust in the process and sharing of the “here and now” experience.
Empathy and common experience with the client is also helpful, when therapist
is aware of it. The most difficult and at the same time, the most efficient is
 4

sharing the obvious and the simple in a way, that can meet and benefit both
persons involved in the relationship.
 4

SUMMARY

Joanna Kato “Creative Adjustment in Therapeutic Relationship”

Being partial fulfilment of the requirements for the title of Gestalt
Psychotherapist in Gestalt Foundation, Athens

The purpose of this dissertation was to present the concept of creative

adjustment and therapeutic relationship with emphasis on affiliation between
those two concepts as published in Gestalt literature as well as show samples of
creative adjustment in a relation between patient and therapist as experienced
in Gestalt psychotherapy practice.
In the first chapter what Gestalt therapy is including its basic meanings
and key words is briefly described. The description is followed by a literature
review on the meaning of creativity, a portrayal of a creative therapist, a review
of the understanding of the terms “adjustment” and “creative adjustment” in
Gestalt therapy. The philosophical trends which had impact on the mentioned
above terms have also been presented.
Chapter two contains information about the role and the characteristics
of the therapeutic relationship including the I- Thou concept, the description of
contact and awareness as it is understood in Gestalt therapy. In this chapter the
therapist’s task and responsibilities towards the client and the influences the
society might have on a therapeutic relationship have been described.
In chapter three the affiliation between contact and relationship have
been presented and are followed by the description and the experience of the
self formation. Its relation to the contact boundary as referred in Gestalt
literature is also mentioned.
Finally in chapter four an illustration of creative adjustment in therapeutic
relationship is presented. The described examples come from therapist’s
experience. The descriptions are based on notes from therapeutic sessions.
4
 5

Appendix 1

UNDERSTANDING OF RESISTANCES - Herb Stevenson (2004)

Resistances

Introjection Taking in or swallowing an experience "whole." Not

filtering experiences for what resonates with personal
truth. Being naïve or gullible; e.g. parental guidance of
how to safely walk across the street is a positive
introjection.

Projection Attributing one's own feelings or actions to another.

Blaming. For example, unable to acknowledge that white
is a form of race and looking to define race via people of
colour, instead of in deathly looking to understand what it
means to be white by looking at the larger population as
well as one’s life.

Deflection Avoiding direct contact with another person. For example,

using jokes to block the seriousness of a situation or to
ignore a compliment.

Confluence The inability to differentiate oneself. For example,

merging with others' opinions to avoid having to take a
position, often perceived as a “yes” person with no
personal opinion.

Desensitization Numbing sensations. For example, avoiding awareness

physically, emotionally or mentally. Dissociating.
 5

Appendix 2

RESISTANCES IN GESTALT - S. Ginger (1995)

Co Intr Pro Ret Defl Pro Ego

nflu ojec ject rofl ectio flec tis
enc tion ion ecti n tion m
e on

Others
(environment)

contact
boundary

me (organism)
 5

Appendix 3

CONTACT STYLES - G. Wheeler (1991)

Confluence Vs. Differentiation

Projection Vs. Retention, literalness

Introjection vs. Chewing, destructuring

Retroflection vs. Exchange, encounter
Desensitization (or vs. Merging, yielding
Egoism)
Deflection vs. Focusing, concentration
 5

Appendix 4

THE CONTACT WITHDRAWAL CYCLE (P. Clarkson)

THE CYCLE OF GESTALT FORMATION AND DESTRUCCTION

The awareness cycle
The contact and withdrawal cycle
The need and satisfaction cycle

choice and implementation full and vibrant

of
appropriate ACTION phase FINAL CONTACT

of contact

MOBILIZATION SELF SATISFACTION

and excitement or post-contact
phase of contact and gestalt completion

WITHDRAWAL
AWARENESS or organism at rest
of emerging
social o biological need
fore-contact phase SENSATION
fore-contac

ENVIRONMENT

Appendix 5
THE ORGANISM/ENVIRONMENT BOUNDARY
 5

(THE IT/NOT IT BOUNDARY) – Philippson P, (2001) Three Boundaries of

Self-Formation. Contact and Relationship in a Field Perspective. GTin,
l’exprimerie, Bordeaux

Organism/environment boundary: it/not it

Field

boundary process = interaction

experience
Not my experience
 5

Appendix 6

THE SELF/OTHER BOUNDARY (THE EGO, THE I/NOT I

BOUNDARY) Philippson P, (2001) Three Boundaries of Self-Formation.
Contact and Relationship in a Field Perspective. GTin, l’exprimerie, Bordeaux

Ego
Self/other boundary:
boundary or I/not I

Other(figure)

Other Self
(ground)

boundary process = contact

 5

Appendix 7
THE PERSONALITY BOUNDARY (ME/NOT ME)
Philippson P, (2001) Three Boundaries of Self-Formation. Contact and
Relationship in a Field Perspective. GTin, l’exprimerie, Bordeaux

Personality boundary: me/ not me

Memory
Stable environment
Will
Autonomy
Not me

Me

Boundary processes
Choiceful Neurotic
Safe choices Polarities
Commitments Splittings
Values/ethics Fixed gestalts
Culture ? Introjects
Appendix 8 “Support systems”: Delisle G, (1999) Personality Disorders.
CIG Press, Ottawa
The Biological Support System:
 5

Bone structures – bones might be used as levers and way toput strain on them
can result in injury.
The muscular system, - can be used to establish contact with the environment
or to retroflect.
The respiratory system – the dispenser of energy. Holding breath interferes
with the circulation of energy, prevents excitement and transforms into anxiety.
The Cognitive Support System
This mode is the locus for assigning a meaning to something. Think, reflect,
plan, analize or remember. Therapy concentrates on how thought can influence
the mobilization and channeling of energy. Therapist uses thoughts for
cognitive reframing and restructuring.
The Emotive Support System
This mode consist of the range of feelings we are capable of experiencing: fear,
joy, sadness, anger. Our capacity to reason lucidly may be diminished or
restricted depending on whether the feelings with which we approach a given
situation are more or less recent or significant.
The Behavioral Support System
This is a set of contact functions. The behavioral pole is another representation
of the contact boundary.
The Interpersonal Support System
This is a network of friends or acquaintances. The quality of this network is
frequently an indicator of the individual self esteem and opinion about himself.
 5

REFERENCES
Amendt-Lyon N, (1992) The Theory of Gestalt Therapy. In Nevis E, C
Ed: Gestalt Therapy Perspectives and Applications.
Gestalt Institute of Cleveland

Arthur Mc T, (1987) Longman dictionary of Contemporary English.

Longman Group UK Limited

Clarkson P, (2000) Gestalt Psychotherapy. Sage Publication Ltd

Beisser A, (1970) The Paradoxical Theory of Change. In Fagan , Sheperd

Gestalt Therapy Now, Harper Colophon Book

Buber M, (1967) The knowledge of Man, George Allan & Unwin Ltd

Buber M, (1967) Between Man and Man. The Macmillian Comp., N.Y.

Dass R, (1974) The Only Dance There Is. New York: Achor Books

Delisle G, (1999) Personality Disorders. CIG Press, Ottawa

Denes M, (1980) The Gestalt Journal Vol.3 No 1

Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR,

(2000) American Psychiatric Association

Doubrawa E, (2001) The Gestalt Journal (Spring)

Estrup L, (1995) LivEstrup@aol.com

Estrup L, (2000) What s Behind The Empty Chair, SA

Fagan J, (1970) Gestalt Therapy Now. Harper Colophon Books

Friedman M, (1976) Healing trough meeting: a dialogical approach to

psychotherapy and family therapy. In E. Smith (Ed.)
Psychiatry and the humanities (vol. 1). New Haven. Yale
University Press

Giamarelou Gianna, (2006) open discussion

Gilbert M. C, Evans K, (2004) superwizja w psychoterapii. Gdanskie

Wydawnicwto Psychologiczne
 5

Ginger S, (2004) Gestalt Sztuka kontaktu. Polish edition

Jacek Santorski &Co

Gordon W J J, (1961) Synecticts. New York. Macmillan

Hycner H, Jacobs L, (1995) the Healing Relationship in Gestalt Therapy.

Gestalt Journal Press, USA (Highbud) NY

Jarosewith R, (1995) Gestalt Dialogue No 2, May

Melnick J, (2004)About Gestalt. Gestalt Review, Vol.8 No. 1

Oaklander V, Windows to Our Children, 1978 Real People Press

Parlett M, (2000) Creative Adjustment and the Global Field. British

Gestalt Journal Vol. 9 No. 1

Perls F, Hefferline R F, Goodman P, (1951) Gestalt Therapy. London.

Souvenir Press

Perls F, Hefferline R, Goodman P, (1972) Gestalt Therapy Excitement

and Growth in the Human
Personality.
Great Britain Souvenir Press Ltd.

Philippson P, (2001) Three Boundaries of Self-Formation. Contact and

Relationship in a Field Perspective. GTin, l’exprimerie,
Bordeaux

Philippson P, (2001) Self in Relation, The Gestalt South Press

Polster E, Polster M, (1973) Gestalt therapy integrated: Contours of

theory and practice. New York: Brunner/Mazel

Schoch De Neuforn S, (2001) Gestalt Review 5(2), The Analityc Press

Schulthess P, (2006) Lecture “Living Gestalt: How Gestalt principles

can guide our everyday life” Pilio, Greece

Siemens H, (1996) Dialogue and Awareness Two essential elements of

contact in Gestalt therapy. Nederlandse Stichting Gestalt
Educational Department, Amsterdam
 6

Siemens H, (2003) Lecture. Thessaloniki ΧΕΝ

Siemens H, (2004) Training & Supervision Program for Advanced

Gestalt Therapists. Thessaloniki

Spagnuolo Lobb M, Amendt-Lyon N(eds.) (2003) Creative Licence The

Art of Gestalt Therapy.
Spinger-Verlag
Wien New York

Spagnuolo Lobb M, (2001) Contact and Relationship in a Field

Perspective. GTin, l’exprimerie, Bordeaux

Wertheimer M, (1964) Produktives Denken. Kramer, Frankfurt a. M

Wheeler G, (1998) A Gestalt developmental model.

British Gestalt Journal 7 (2):

Yalom I. D, (2003) Dar terapii. Instytut Pychologii Zdrowia. PTP

Warszawa

Yontef, G, Simkins J.S, (1989)Current Psychotherpies.

Corsini & Wedding

Yontef G, (1993) Awarness, Dialogue and Process. Essays in Gestalt

Therapy. Heighland: Gestalt Journal Press

Zinker J, (1977) Creative process in Gestalt Therapy. Random House,

Inc. New York