A Responsive Commentary on
"Schema Therapy: A Gestalt-Oriented Overview"

Philip Brownell

Director, Gestalt Training Institute of Bermuda

Gestalt!
Volume 10; Number 1
2009
Published by
Gestalt Global Corporation and the Gestalt Training Institute of Bermuda

Consult also:
Gestalt! Discussions for continued dialogue on issues of interest arising from articles in the journal

Stuff2Know for news of events and announcements of interest to gestalt therapists, consultants, and coaches.

Contents of 10(1)

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Schema Therapy: A Gestalt-Oriented Overview

Response to Schema Therapy... from Dan Bloom

Response to Schema Therapy from Iris Fodor

Response to Schema Therapy from Philip Brownell

Kellogg Response to Bloom, Fodor, and Brownell

GO TO DISCUSSION BOARD FOR THE CONTINUED DIALOGUE AND TO JOIN IN THE DISCUSSION YOURSELVES

Working Corner

Initial information about Continuity and Change: Gestalt Therapy Now

ABSTRACT

This is a responsive commentary to Scott Kellogg's overview of schema therapy. This response focuses on the role of consilience in psychotherapy integration, offers three kinds of integration, and identifies the integration employed by Kellogg and Young in their adoption of gestalt therapy techniques. It closes with suggestions for possible future development of integrational bridges between these two clinical approaches.

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Scott Kellogg clearly stated the purpose of his paper and its contents:

The goal of this paper is to provide an introduction to and overview of schema therapy … within the context of a journal dedicated to gestalt therapy. Schema therapy is an integrative psychotherapy that draws very deeply from the gestalt and experiential traditions. The areas to be covered include the history of the approach, an overview of the schema model, an introduction to both schema-focused and schema mode therapies, a case example of mode therapy, and points of connection between schema therapy and gestalt therapy

Both Dan Bloom and Iris Fodor have responded to various points, indicating, among other things, that gestalt therapy is not a technique driven therapy, even though many other modalities utilize gestalt experiments that have become formalized. This is something Kellogg and Young actually point out as well, and I appreciated reading that in their article. However, I agree with both Dan and Iris that the version of gestalt therapy Kellogg and Young seem most conversant with reflects a more primitive phase in the development of gestalt therapy theory.

What shall I say in response to this article by Scott Kellogg and Jeffrey Young?

First, I think the article is well written, and it certainly provides gestalt therapists a view into this other modality. That said, however, I wonder if there actually exist points of consilience between the two approaches. I can see how Kellogg and Young offer a pragmatic consideration: Schema therapy adapts gestalt therapy, and in return gestalt therapy benefits from the research on schema therapy.

Second, reading the section on schema therapy, I was reminded of recovery literature focused on co-dependency. Whereas the recovery-oriented therapist might explain that as a child the client had to set aside being a child to take care of the needs of the parent(s), and that the child developed a "coping strategy" to survive the chaos of a dysfunctional family, the schema therapist might go a step further to identify components of that coping style and provide a diagnostic label that becomes almost like a hologram that stands in the place of the client's life. I find no consilience there, because the gestalt therapist attempts to remain experience near while the schema therapist leaves the ongoing experience of the client to relate to the client through the grid of the schemas he or she has assigned. The person seems to become the diagnosed schema(s), but in gestalt therapy the person remains the person who is now doing this or that, has more or less a sense of the past in the present, and is more or less aware of what he or she is doing at any given moment.

In an important paragraph, Kellogg and Young stated:

Schemas are assessed in a variety of ways. This is a particularly important issue because the coping modes may obscure the underlying schemas. While patients may present with a similar style, be it anger or disengagement, the underlying schema structure can be different. In addition, patients who have been through similar experiences may, nonetheless, have different schema structures, or if they have the similar schema structures they may use different coping modes. Ultimately, the healing process takes place in the connection to and work with the schema, not the coping style.

This is also a departure from gestalt therapy because in gestalt therapy the focus is on the what and the how of a client's experience–what one does and how one does that. If I understand Kellogg and Young correctly, they claim that healing takes place in connection to the what, at which point they leave behind the how of the coping style or mode. This is a significant loss of consilience because gestalt therapy is largely a therapy of process, and it is the process of how the given person embodies his or her being, as dasein (being there in the midst of other beings), which is a matter of contacting.

The contacting can be, in a sense, "in touch" with oneself, knowing and being aware of oneself as situated, and it can be knowing and being aware (or being unaware as the case may be) of other (i.e., other persons or other things in one's physical-social-ecological and environmental situation). Actually, these two types of contact are aspects of the same thing. In gestalt therapy this is the main focus: how a person is losing or interrupting contact on the one hand and how that person is establishing and/or maintaining contact on the other (with all the relationship ramifications concomitant to these considerations).

Kellogg and Young asserted that the first step in schema therapy is to identify and label the schemas. That brings them more clearly into awareness and provides a conceptual framework for the therapy. However, this too is out of step with gestalt therapy, for such a thing shifts the focus away from the client and onto a theoretical system whereas gestalt therapy utilizes a phenomenological method that remains focused on what the client presents and brackets (as much as possible), the therapist's theories about why the client does any particular thing. The gestalt therapist strives to explore contact with the client rather than to focus on theories about the client. This is not to say that a gestalt therapist never conceptualizes the case or arrives at diagnostic conclusions, but these things are not the first step. They are not even the second step.

The first step in gestalt therapy is to establish the client-therapist dyad (or field) and that requires that the gestalt therapist be present, make room for the client, and accept however the client chooses to enter into the crucible of contact; gestalt therapists call this a dialogical attitude, and the use of the term "attitude" is not haphazard.

Attitude is very important in gestalt therapy. It is an aspect of intentionality that is at the core of gestalt therapy:

…our interest, what gestalt therapists call a figure, is illuminated with an attitude. What is this attitude? It is the filtered light that drops through the canopy of a rain forest. Without that, the ground would remain in shadow or even undetected, and certainly it would go unappreciated and lost to one's attention. However, in this attitude, a subject can attend to this figure or that, but each one will be lit up by the same light cast upon other figures, and all these figures would be understood as in some way fitting together in one attitude.

Gestalt therapists understand the background of a person's life to be the ground of current experience. Thus, when a person is in a particular attitude, it is that attitude that lights up various aspects of the person's ground. This is not a plodding sequence of logical determination; this is more the automatic sparkle that catches a person's attention pre-reflectively. Portions of a person's overall ground are lit up selectively, but instantaneously, by the situated attitude in which a person moves at any given moment. (Brownell, in press)

Thus, if I walk through a shopping mall in a baker's attitude, then I am smelling the aroma of cinnamon buns in one corner, cookies being sold in another, and pies on display in another, and I might drift to thinking about specific versions I've made of those things on occasion. However, if I walk through the same mall in a shopper's attitude, then my eye is caught by signs indicating a store is having a sale, and I might be thinking of going all the way to the end of the mall to compare prices on some particular item. In the second case, the shoppers' attitude precludes the same sensory perceptions detected in the baker's attitude; it's not that those stimuli are not available (as if they stopped baking cinnamon buns, cookies, and pies on the second day); it's that the light shining down on the ground does not illuminate them.

Thus, for a gestalt therapist to adopt a dialogical attitude, the therapist is keyed into what makes for dialogue, and the therapist is keen to work in a dialogical fashion. At that moment, the emphasis of work is dialogical instead of phenomenological, even though phenomenological tracking may also be going on, and even though there would be many factors affecting the overall situation. Thus, gestalt therapy is complex, even while comprising a unified praxis, and it is artificial to extract "techniques" from its unity. At any given moment the therapist might be in a dialogical attitude, a phenomenological attitude, a field-theoretical attitude, or an experimental attitude, but all the while all these elements in the unified praxis would still be going on. You cannot extract bits and pieces of gestalt therapy and truthfully be said to be practicing gestalt therapy.

Kellogg and Young come close to gestalt therapy when they shift to discussing schema mode therapy: 

Mode therapy involves listening to patients speak about their lives and experiences and watching their emotions, energy, language, and position shift. This is probably closely related to the gestalt approach of listening for what is figure for a patient. In the schema model, the shifts will be given names.

From a gestalt perspective I would respond by saying, "This is close." However, gestalt therapy is not just listening and watching the client's emotions and such. It is not just about the figures that clients have. Gestalt therapy is more about observing and describing the way of the client, in which "observing" is more than watching. It is being with. It is paradoxical in this respect: the therapist is not attempting to be the change agent; the therapist is attempting to remain as close to the experience of the client as possible with a view to describing what he or she observes while contacting the client. What the client does with that is entirely unpredictable, but whatever that is, the therapist remains descriptively observant. This approach is based on faith. The therapist trusts that (l) people are inherently oriented toward self actualization/health, (2) the field will provide what is necessary for growth and change, (3) the client will become what he or she is not by being what she or he is in the current moment.

This faith approach is at odds with a medical model of linear cause-and-effect. Schema therapy seems to have been built around that medical model, and so here again is a loss of consilience.

In a section of their article aimed at showing the integration of gestalt therapy and schema therapy, Kellogg and Young state:

Hopefully, the extensive use of gestalt and experiential techniques by schema therapists has been made clear. The ones discussed here have been imagery, chairwork, and letter-writing. Awareness interventions were not discussed, but they are used to a lesser degree. Of central importance, however, is the understanding that the use of gestalt techniques is not random or intuitive; they are used within the context of a strong conceptual base. This distinguishes schema therapy from other therapies that use these interventions in a less or non-systematic way…

This is the crux of the issue upon which I would like to elaborate and comment further. Kellogg and Young have made "use" of techniques associated with gestalt therapy and they believe they have done so, not in a randomly eclectic fashion, but in accord with a "strong conceptual base." I believe they have done just that, but is that what integration is?

In an interview with Leslie Greenberg (Greenberg and Brownell, 1997), in the first issue of Gestalt!, three forms of integration were identified: (1) a grand theoretical integration, (2) a synthesis by adding two things together, and (3) a technical eclecticism gained by patching together different interventions from different schools. Regardless of whether one is seeking a theoretical fusion, a synthesis of the praxis, or the use of one school's interventions by another, there must be points of convergence, overlaps, or pragmatic opportunity that guide the actual integration. I have come to understand these points as matters of consilience.

Consilience is said to exist when a good theory unifies empirical data and laws from different domains; "…the paradigm case of such 'consilience' was the successful unification of Kepler's laws and Galileo's laws by means of Newton's theory." (Niiniluoto, 2007)  Stated in another way, "… by finding a cause shared by phenomena in different sub-kinds, we are able to colligate all the facts about these kinds into a more general causal law. Whewell claimed that 'when the theory, by the concurrences of two indications…has included a new range of phenomena, we have, in fact, a new induction of a more general kind, to which the inductions formerly obtained are subordinate, as particular cases to a general population…'"(Snyder, 2006)  Thus, I find consilience between CBT's use of mindfulness and gestalt therapy's mindful attention to awareness, acceptance, and the present moment due to their common source in Buddhist thought. I find consilience among Martin Buber's interpersonal philosophy, relational psychodynamic psychotherapy's intersubjective methodology, and gestalt therapy's theory of dialogue because of the commonalities they exhibit in respect to alterity and two-person field dynamics.

Where is the consilience between the gestalt methods of "imagery," etc, and schema therapy's use of such methods? I see no fusion in common theory. I do see consilience among schema therapy, transactional analysis, Jungian therapy (archetypes), recovery-oriented intergenerational family dynamics, and attachment theory.

So, what form of integration exists between schema therapy and gestalt therapy? To me, it is the third type identified by Leslie Greenberg: a technical eclecticism gained by patching together different interventions from different schools. To be sure, there is a reason why Kellogg and Young have adopted gestalt techniques, and they do adopt and make use of some rudimentary gestalt therapy ideas, such as polarities, but what does this imply? Is there a theoretical convergence behind such adoption? Is there a point of consilience not yet explicated? There may be, and if so, that would be worth uncovering.

What would I like to see developed in the future between these two forms of therapy? I would like to see schema therapy display a more updated knowledge of gestalt therapy. The bi-polar split between east and west coast gestalt is dead. Gestalt therapy theory and practice has advanced significantly in the last couple of decades. Gestalt therapists have developed and elucidated what was rough in the seminal texts; gestalt therapy is now much more about dialogue, alterity, emergent but non-reductive self, field, and community. So, I believe that it may indeed be possible for one modality to scratch the other's back, and vice-versa, but perhaps it might run in this direction:  schema therapy to adopt gestalt theory of contact, self in relation, and creative experiment, while gestalt therapists engage in research comparing the two approaches and exploring the potential consilience between fixed gestalts and schemas.

Resources:

Brownell, P. (in press) Intentional spirituality, in J. Harold Ellens (ed.) The Healing Power of Spirituality: How Religion Helps. Westport, CT: Praeger/Greenwood

Greenberg, L. and Brownell, P. (1997) Validating gestalt: An interview with researcher, writer, and psychotherapist, Leslie Greenberg. Gestalt!, 1(1), downloaded March 29, 2009 from http://www.g-gej.org/1-1/greenberg.htm.

Niinuluoto, I. (2007) Scientific progress, in The Stanford Encyclopedia of Philosophy, Edward N. Zalta, (ed). Downloaded March 29, 2009 from http://plato.standford.edu/entries/scientific-progress

Snyder, L. (2006) William Whewell, in The Stanford Encyclopedia of Philosophy, Edward N. Zalta, (ed). Downloaded March 29, 2009 from http://plato.standford.edu/entries/whewell