The Necessity of Vitality
Lately I have been thinking about the role of vitality in psychotherapeutic practice. Particularly relevant (to my mind) in relational and existential approaches, it often feels like one of the things we are trying to do in the work is bring people back to life. I don’t intend the use of this phrase to be interpreted in a simplistic way, in which, for example, the bringing back to life means something like the rehabilitation of the severely depressed individual who is bedridden and nearly catatonic. I mean to suggest something more like bringing someone back into their life. It is well understood that in a clinical sense diagnoses and disorders are meant to describe interruptions to processes of daily living and “functioning”. But the particular hue imparted by the word functioning misrepresents and covers over something essential in this process. Living isn’t merely about the alignment or accumulation of a series of effectively organized and simultaneously running functions. This kind of rigid metaphysical thinking, even at its most sophisticated, significantly distorts the experience of what it means to be a human being and what it means—to borrow a phrase from the DBT literature—to live a “life worth living”.
Though you could fairly say that each school of psychotherapy probably has some way of conceptually organizing what it would mean to help someone become more vital, the Gestalt school seems to me the one that most maintains it as a critical outcome of a successful therapy, concerning itself primarily and for the most part with what it means to help someone feel more enlivened and aroused in the living of their life. [Quick aside that might not be so quick: it is truly a shame that the word “arouse” has been generally sequestered to the world of sex and sexuality, because it so perfectly captures I think some of what it is I am trying to get at in this piece…it’s actually hard not to wonder how much it’s having been so assigned is both a cause and consequence of some of the hindrances that affect people's sense of their own liveliness]. Gestalt’s insistence on this element of the work, and its dense vocabulary for exploring it, is certainly what has kept me interested in the Gestalt literature, placing it on a sort of second-tier level of importance in my own hierarchy of preferred methods—with the obvious Psychoanalytic and existential schools being those on the first-tier.
Gestalt catches a lot of flak these days. I think for a couple reasons. The first is the general lack of interest by Gestaltists themselves for doing any sort of vigorous research on the model. That’s not to say that there probably aren’t Gestalt practitioners who concern themselves with that sort of thing. However, it's more or less akin to the reputation of psychoanalysis and other disciplines primarily concerned with the relationship and less interested in operationalizing and universalizing their approach.
The other piece is seemingly the diminished reputation of its founder Fritz Perls in the years following his death. Perls, for reasons probably having to do with his own psychology, seems to loom over the Gestalt approach more than any other theoretician does for their respective school of thought, including Freud within psychoanalysis. My sense is it is pretty well-known that at the time he was working he was not a popular person to be around amongst his more established peers. From a clinical sense, most anyone who has taken a course on the theories of psychotherapy, even at the undergraduate level, has seen the video of Perls working with the patient “Gloria”. For those who haven’t seen it, the clip is easily located on YouTube. Perls doesn’t do any favors in endearing the uninitiated to his approach. He jeers, mocks, and literally squawks at the woman he is assigned to work with over a 30-minute session.
Upon first glance, the session can be incredibly jarring and, I think especially as a model for students in undergraduate courses or their first years of training, easily comes across as “bad” or at least undesirable therapy. I also think the sensibilities of most practitioners cause it to be taught in that way. I suspect this is largely due to the increasing narrow scope with which we view “good” therapy. We’ve been so indoctrinated in the Rogerian principles of warmth, empathy, and positive regard and/or the rigidity of managed-care and medicalized models for treatment where training programs do things like film your work and then criticize any twitch of the muscle or reflective response that might dare reveal that you are thinking or feeling something about your client. It’s sometimes hard to imagine encouraging a scope of practice beyond these principles.
And yet, every time I go back to watch this session I walk away thinking it is one of the most astonishing pieces of therapy I’ve ever witnessed. Yes, the session can be ugly at times, but Perls’ confrontational style evokes things out of Gloria that the others in the video, Carl Rogers and Albert Ellis respectively, simply do not. Gloria is so clearly “in it” throughout the session. She’s aware, she’s engaged, she’s obviously curious at times about what Perls is trying to get at. There are moments when he says or does things that you can see land with Gloria in a profound and moving way. And for all the criticism I have heard about the way Perls “treats” Gloria in the session, I actually get the sense he would tell you he has a tremendous amount of respect for her and that much of his prodding is meant to galvanize in her a sense of wanting to have respect for herself and a sense of her own agency and purposefulness. And if you watch closely enough, I think you’d be inclined to believe him.
Clinicians often talk about the importance of “confronting” in therapy. However, where oftentimes cognitive and behavioral modalities talk about confronting in the sense of wanting to confront the client with something they are doing, Perls shows in this video something about how to confront the client with their own being by bringing them into the energy and spiritedness of a genuine human experience. You're not confronting them with them. You’re confronting them with you. He doesn’t just use experience distance language pertaining to Gloria (“you’re avoiding the issue”) but shows and describes—and invites Gloria to describe along with him—with a richness of language the ways in which she is avoiding right now. It’s a powerful move and one that is difficult to do and especially difficult to do well, and I would be willing to hear and probably agree in some regards with the idea that Perls himself had a long way to go in refining that technique into something that could be done without feeling so deliberately shaming. And that’s to say nothing of Perls’ lack of any consideration of the power imbalances and dynamics of role and gender involved in some of what might have been happening in the session, though that is consistent with what I think early Gestalt theory would have seen as a “there-and-then” thing as opposed to a “here-and-now” concern, as ideas about feminism—Perls likely would have argued—are an out there thing and have nothing to with the here of whatever is currently happening. Those kinds of considerations are a way to dismiss, avoid, or interfere with the contact.
Fortunately, Gestalt theory and practice has continued to challenge and refine its principles. Along with the sea change in psychoanalysis towards a more dynamic understanding of the kind of “theory” that gets discussed in philosophical circles, Gestalt therapy has taken on a deeper interest in the interpersonal and relational components of what happens in the therapeutic encounter. Practitioners like Erving and Miriam Polster, Lynne Jacobs, Gary Yontef, and more have continued to move more richly into cultivating increased awareness towards what it means to “encounter” someone and the complexities that enter into every interaction. Some elements of what might feel like “there-and-then” are very much “here-and-now” in the same way that Gestalt thinking does not merely dismiss notions of past or present, but recontextualizes them (much in the way Heidegger did) as temporal phenomena with some basis in the experience of what is happening. Good theorists in the tradition have helped those approaching from this model to understand that it is too simple to say that talking about societal structures undermines attempts to move deeper into the encounter given that the structurally oppressive nature of these forces on the individual is a contributing factor into the aspects of someone’s life that can leave them feeling devitalized and significantly structure their understanding of what contact even looks like.
Vitality is about a commitment to being. And being can mean a lot of different things in a lot of different contexts. Gloria says something really interesting in the closing moments of the session that I don’t think can be overlooked. In reviewing the sessions she remarks, without any sense of uncertainty about it, that she actually thinks Perls would be the best therapist for her at this point in her therapeutic journey. She remarks that she essentially felt something really interesting in the time she sat with him that she senses needs further exploring. But just moments before that she says (I think quite beautifully) something about her experience with Perls and Rogers and notes that if she could blend them together stylistically it would be the perfect combination, noting that Rogers helped her feel comfortable and safe, but that when her time with Perls came to an end she “wanted more” and “felt unfinished”. In Perls’ language we might say he left her feeling hungry. This speaks to the fundamental Gestalt concept of therapy being a “safe emergency”, though I think maybe the justified criticism could be that Perls oftentimes created emergencies and left it to his clients to figure out whether or not it was safe.
What Gestalt understands especially well—and what I think has been most prominently borrowed from it by other disciplines—is the very obvious and frightening notion that in order to get another to commit to their own existence in our presence, we must ultimately be willing to commit to our own existence in front of them. Psychotherapy done well cannot be sterile and completely safe. No meaningful relationship can. But we have to first discover a willingness to move into what feels risky (which by the way, might not always mean leaning in, but also knowing when it is constructive to hold back). I recently was revisiting a journal of mine and stumbled upon a passage I had copied from the psychoanalyst Edgar Levenson that I think sums up part of what it is I am trying to say. In concluding his 1993 paper “Shoot the Messenger”, in which he explores the unconscious interpersonal dynamics of the therapeutic process, and interpretation in particular, Levenson states, “[O]ne must allow space and time for the patient to discover his/her own resources—to recapture what he/she has always known. Ultimately, the patient doesn’t learn from us how to deal with the world. The patient learns to deal with us in order to better deal with the world.”
And what could be more vital than that?
