As a global population, we find ourselves in this post-pandemic world attempting to recover from the physical, psychological, and emotional traumas associated with what was an unknown, potentially deadly, possibly long-term illness that resulted in social isolation (sometimes extreme), government restrictions, unexpected deaths, loss of physical and mental function, cessation/interruption of work and school life, and postponed bereavement. In addition to recovering from the global COVID-19 pandemic, multiple nations and cultures are beset by many factors: hate, violence, and severe deprivation of basic needs (resulting from war, government ineffectiveness, incompetence, and corruption), as well as climate change and air and water quality deficits. We are experiencing the consequences of 3,000 years of human technology, development, and warfare, not only on all aspects of humanity, but also on the health of the earth and global ecology, as evidenced in extinction rates, droughts, severe weather, flooding, and famine. And these collective insults are magnified by 24-hour news streams and social media, providing additional sources of stress as well as addictive, dissociative, and abusive behaviors.The clinical disorders already common in current generations prior to the pandemic “desensitization, dependencies, depression, anhedonia, anxiety disorders, the difficulty to relate, eating disorders, the struggle to focus in children” (9) are already associated with a compromised embodied-sense-of-security, as Margherita Spagnuolo Lobb and Pietro Andrea Cavaleri observe in their coauthored chapter in their edited volume, Psychopathology of the Situation in Gestalt Therapy: A Field-Oriented Approach. Combined, this lack of a sense-of-security, the pandemic, environmental and political instabilities, and virtual rather than person-to-person interactions exacerbate many individuals’ already faltering groundedness, relational security, and sensitivity to the other (9–11). Reinforced throughout this volume, however, is the notion that “Gestalt therapy as a radically relational theory and practice can contribute in an age that has a desperate need for a radically relational attitude by government leaders and ordinary citizens” (69). Gestalt theory and practice is uniquely equipped to support individuals, couples, families, and groups to reorient themselves toward health and growth because of its recognition of the relationship among the figure of the suffering, creative adjustment, and the ground of the sociocultural context. Further, its depathologizing stance and focus on relationality, embodiment, and the “ecstatic aesthetic attitude towards the experience of the therapist and the patient” (8) constitute a strengths-based approach.The volume is divided into two parts roughly corresponding to theory (Part I) and practice (Part II). In Part I, “Psychopathology of the Situation,” the various authors share concepts from fields as diverse as neurobiology, epistemology, hermeneutics, sociology, anthropology, culture, and postmodernism. Thus, the reader is oriented to the current global field, modern psychopathological expressions, and current thinking in Gestalt therapy regarding the dynamism between therapist and client. Foci of these chapters include current world crises; lack of groundedness for clinicians and patients; emergent thinking in neuropsychology and neurophenomenology; “Aesthetic Relational Knowing” (ARK), or the “dance” that therapist and client engage in to facilitate healing; and the “Gestalt Clinical Data Sheet” (GCDS), an instrument for standardizing reporting from psychotherapy sessions and supervision. Each chapter in Part II, “Psychopathological Situations in the Clinical Fields of Human Relations,” shares a unique story of suffering and therapeutic change from a depathologizing stance during one of eleven developmental phases of life; each presents unique conditions and concerns, especially within the current milieu. Authors of chapters 6 (Silvia Tosi and Elisabetta Conte), 7 (Paola Canna and Manuela Partinico), 8 (Rosanna Militello), and 10 (Michele Lipani) discuss unique but relatable childhood, pre-adolescent, and adolescent traumas. Antonio Narzisi addresses autism in chapter 9, and his work could influence/support therapists working with other types of neurodivergent clients. Addiction is approached from the perspective of persistent trauma by Giancarlo Pintus and Marialuisa Grech in chapter 11; couples and family conflicts in chapters 12 (Cavaleri) and 13 (Giuseppe Sampognaro); and aging, chronic illness, and bereavement in chapters 14 (Alessandra Merizzi), 15 (Alessandra Vela and Donatella Buscemi), and 16 (Carmen Vázquez Bandín). Each of the case studies in Part II includes accounts of “Aesthetic Relational Knowing” (ARK) and the “Dance of Reciprocity Model” (DRM).The essence of ARK is described by Spagnuolo Lobb in chapters 1 and 2: “In order to be a psychotherapist, one does not need to make ‘the right move’ or blame oneself for not being empathetic or creative no matter what. What is essential is an ecstatic and aesthetic attitude towards the experience of oneself and the patient. It entails having a humble and ethical attitude which does not deny limits and places reciprocity of presence in the foreground” (8). Thus, the therapeutic change develops from the “reciprocity of the mutual being-with of client and therapist” (32). The therapist works on three levels to dialogue with the patient’s reality in the here-and-now, the situation/life circumstances that bring patients to therapy: (1) diagnostic and anamnestic elements known about the patient; (2) observations of the patient’s manner of contacting both environment and relationship with the therapist; and (3) recognition and conscious appreciation of the therapist’s own resonance with the patient’s way of contacting (22), perceived by asking “three ‘magic’ questions”: (1) “What do you feel, as a therapist, in being-with this client?”; (2) “What meaning do you think your ‘feeling’ has in the client’s life?”; (3) “What should change in your experiential approach in order for the client to be more spontaneous?” (36). These elements, and answers to these questions, are integrated into the “Gestalt Clinical Data Sheet” (GCDS) and integral to the “Dance of Reciprocity Model” (DRM).Metaphorically, Spagnuolo Lobb describes this give-and-take between client and therapist as the “Dance of Reciprocity Model” (32). The eight nonsequential “dance steps” in this model can be described in self-reports from therapists and clients at the end of each session to help measure synchrony and reciprocity (32). In the same way that dancing with a partner is an iterative process—beginning with basic steps, building complexity as partners learn more about each other, the music, and the environment, while spirally returning to basic movements in no particular order—this “Dance of Reciprocity” between therapist and client is iterative as well. Spagnuolo Lobb suggests the following eight movements: (1) “Building together the sense of the ground,” (2) “Perceiving one another,” (3) “Acknowledging one another,” (4) “Adjusting to one another,” (5) “Taking bold steps together,” (6) “Having fun,” (7) “Connecting,” (8) “Entrusting oneself to the other/Taking care of the other” (33–36). Woven through these steps is a substrate of deep support for the therapist’s intuition and opportunities for clients to find more trust in their own intuition.Because intuition, relationally, reciprocity, experientially, and spontaneity are not quantitative measures but rather qualitative experiences, and perhaps because the global Gestalt community has not previously accepted a detailed clinical tool, Spagnuolo Lobb, Conte, and Maria Mione have recognized this need (see chapter 5), carefully and critically providing a practical, detailed “Gestalt Clinical Data Sheet” (GCDS) that “can be used as a guideline for the therapist’s diagnostic/clinical work, as a useful teaching instrument in student training, as a record of the practice of supervision, and as a tool for research into individual cases” (81, emphasis in original). The GCDS is a structured baseline for recording therapeutic noticings from a Gestalt perspective, which therapists can add to and modify for their own needs. It is divided into five sections that support the spiral, iterative process of the “Dance of Reciprocity”: (1) Physiological Aspects, (2) Anamnesis, (3) Figure/Ground Formation, (4) Diagnosis, and (5) Clinical Log (277–84). Helpfully (especially for training and supervisory uses), each section’s subheading includes questions and prompts for practical information, thus providing the scaffolding to create habitual and standard note-taking that can be easily reviewed and compared across cases.Clearly, the authors of chapters 6–16 in Part II of the volume found the Gestalt Clinical Data Sheet, the Dance of Reciprocity, and Aesthetic Relational Knowing, robust and useful models for documenting/processing therapeutic change across a wide variety of challenging situations. In chapter 14, “Gestalt Psychotherapy and Ageing,” Merizzi details a poignant example of DRM while working with a client who has Mild Cognitive Impairment: “Norma cries, looking away and covering her eyes. I let her be with her tears and I lean over slightly with my body. She seems to sense my increased proximity and slowly calms down. She makes eye contact with me again” (233). Merizzi later reminds the reader that, as therapists engage in the DRM with their clients, it is important to “explore their own aging stereotypes,” to “be present,” to “become a receptacle for the suffering related to the losses,” and then to “move towards an acceptance of what is no longer available to the client,” and “explore and value the client’s strengths” (234). Of course, this statement is applicable to ARK with all clients by amending “aging stereotypes” with any other stereotype. In chapter 12, “Conflict in Couple Relationships,” Cavaleri offers ARK/DRM questions that he asks himself during couples work. Here are a few: (1) “Are I and the couple present at the contact boundary and open to our senses? What can we ‘do together’ to transform the emerging shared intentionality into a clearly precise action?”; (2) “What are the techniques, the experiments, the metaphors, the games, and the stories that the couple and I can place in the field to develop perception, feeling, intentionality, action, and narrative?” (202, emphasis in original). In chapter 6 on Gestalt psychotherapy and childhood suffering, Tosi and Conte share an example of how the openness and playfulness of the DRM might work with children who are digital natives: “We see Nino’s space (his room and other corners of the house, his toys and puppets, his dog) as resources; in addition, the video call and all the potential offered by technology become part of the therapeutic relationship (e.g. short videos, photos, emoticons, chats)” (114). In chapter 11, “Addiction as Persistent Trauma of the Ground Experience: Neuroscience and Gestalt Psychotherapy,” Pintus and Grech summarize the restorative value of the DRM/ARK in relation to the treatment of addictions: “In a thousand ways . . . the reciprocity between therapist and patient, and the aesthetic and phenomenological gaze of the therapist, turned towards capturing and supporting the awkward harmony and withheld vitality that emerges in the relational process, Gestalt psychotherapy becomes a fertile approach” (187). And decidedly, based on the depth and scope of case studies in Part II of this volume, in the treatment of so many afflictions that plague modern civilizations.Foundational to this approach is a depathologizing stance that focuses on understanding pathological behavior as an attempt to alleviate suffering rather than diagnosing these creative adaptations using the symptom-based Diagnostic and Statistical Manual of Mental Disorders. For example, Tosi and Conte state: “We have considered the symptom as an expression of, not an individual, but as a relational suffering” (114). They go on to consider the connection with parents, whether the ground “allows sufficient corporeal and relational rootedness” (114), and encourage re-sensitization and counteracting desensitization. In chapter 9, Narzisi describes the difference between therapeutic work that focuses on modifying “pathological” behavior of people with autism and that which offers “the possibility of new experiences at the contact barrier” (155). The former risks “continuing to support a ‘desensitized’ and asynchronous organism/environment mode of contact,” while the latter would take into account the individual processing patterns of the person with autism and support new operating patterns that would allow meeting the other at the contact barrier (155). What we notice in each of these clinical case studies is that “perceptive and emotional desensitization” (99) happens when, as Spagnuolo Lobb and Rubino (2015, 35) state elsewhere, “the environment is perceived as threatening or confusing, or the contact experience becomes painful and unsustainable, the contact occurs anyway, but loses the quality of awareness and spontaneity, the contact experience is characterised by anxiety. This implies desensitisation of the contact boundary: it is necessary to put part of the sensitivity to sleep in the here-and-now of the contact with the environment” (see also Tosi and Conte in this volume, note 2, 115). Awareness of the creative adaptations that support these desensitizations, and then supporting the client to create relationality, groundedness, and embodiment, are integral aspects of this depathologizing stance.Pre-pandemic, Spagnuolo Lobb and Cavaleri began this project to celebrate the seventieth anniversary of Gestalt psychotherapy and to update foundational concepts to reflect a field-oriented, more modern approach. Post-pandemic, they asked their colleagues to come together to share examples of alleviation of contemporary experiences of suffering in the therapeutic setting through “relational co-creation of a sense of security in patients’ ground experience” (7), and exemplified by using ARK and DRM. Thus, this volume is dedicated to illuminating the “shift in Gestalt thinking from its more classically understood ‘client-centered’ foundation toward a focusing on the encounter itself as the primary ground for psychotherapeutic understanding and change” (xv), while recognizing the extreme challenges of our twenty-first century. Because, as Tosi and Conte emphasize: “The complexity of current society (globalisation, migratory movements, work insecurity, climate change, terrorism, environmental disasters, pandemics) has certainly created a ground characterized by insecurity, anxiety, destabilisation, danger and loss that cannot not have an impact on individuals and families” (99).Among the key concepts developed, the following stand out: (1) defining the situation/sociocultural context, (2) focusing on relationally, (3) depathologizing orientation, (4) developmental overlay, (5) dynamism of the interactions between therapist and client, (6) embodiment, and (7) support for the therapist’s intuition. Clearly, much is owed to Perls, Hefferline, and Goodman (1994), but also to the editors of this volume. Almost every chapter cites multiple publications, most often from Spagnuolo Lobb (2013) and Cavaleri. Finally, the authors and editors call on Gestalt therapists “to be agents of change, capable of promoting and supporting new potentiality and human forms”—all those things that “can be” but “are not yet” (63). And, by discussing and describing these updated approaches to current psychopathological presentations, they locate the venerable traditions and insights of Perls, Hefferline, and Goodman firmly in the twenty-first century, presenting valuable and valid updates to Gestalt therapy and to psychotherapy in general.
Hochman et al. (Wed,) studied this question.