Response to "Schema Therapy:
A Gestalt-Oriented Overview"

Iris Fodor

New York University

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)

Home

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 response to Kellogg and Young's paper on schema therapy and its use of gestalt therapy. It summarizes the Kellogg and Young article from the perspective of someone who has been at the work of integrating cognitive-behavioral and gestalt therapy for many years.

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Cognitive behavior therapy is now the major psychotherapeutic modality worldwide. Drawing on scientific psychology and developing research strategies, CBT has demonstrated the effacy of its treatments to a variety of clinical problems and is in the forefront of the development of empirically validated psychotherapy procedures. While, CBT has developed few new innovations in the past twenty years, more and more CBT practioners, writers and researchers are culling the experiential therapies for ideas and techniques to integrate with CBT theory and practice. In particular, many cognitive behavior therapists have looked toward gestalt and other experiential therapies for areas to integrate. For example, what’s new in CBT is mindfulness training (focused awareness and meditative practice) for a variety of disorders such as depression, borderline personality, substance abuse, etc.(Linehan 1993, Segel and Teasdale, 2001, Marlott, 2004). These treatments feature in addition to the standard CBT, focused awareness training, attending to process and meditation. While CBT has espoused change as central, leading behavior and cognitive behavior therapists are now espousing acceptance therapy, and developing research strategies to support this view (Hayes, Follette and Linehan, 2004). Many CBT practitioners in work on self-control from a CBT framework have also utilized the two-chair technique. This author, a gestalt and cognitive therapist, has additionally proposed integrating some of the relational interpersonal facets of gestalt to CBT and incorporates cognitive features into gestalt (Fodor, 1987,1996a,b, 1998).

Following this integrative trend in CBT, Kellogg and Young present in this paper a comprehensive overview of schema-based cognitive therapy and their newer adaptation schema mode therapy. Young has been a pioneer in adapting aspects of Beck’s cognitive therapy into a schema model, which is relational and developmental and is considered cutting edge CT. With Kellogg, who has trained in gestalt, they propose that the newer adaptation of schema therapy, which they call schema mode therapy, is an integration of CBT and GT and moves closer to the gestalt world.

In describing their integrative therapeutic work within the newer model, Kellogg and Young stress the need to assess the core maladaptive schemas, the developmental issues and coping strategies through the use of imaginal imagery and two-chair dialogue. Their integrative therapy is designed to assess and to work on change in the internal schema, using imagery and/or two-chair work. Keeping within the tradition of cognitive therapy, in their description of their therapy, there is much emphasis on the identification of self-talk and inner dialogue. Through the imagery and two-chair work, the client experiences the voices of the different parts of the schema, which facilitates integration for the client. 

However, while Kellogg and Young propose their work as an integration of gestalt and cognitive therapy, their integration in many respects is not yet fully in the spirit of gestalt therapy. I have written elsewhere of the problems of trying to integrate cognitive and gestalt therapy (Fodor, 1966a). Cognitive therapy with its focus on change, learning new behaviors and a directive stance by the therapist, is in contrast to the process oriented, dialogical experiential gestalt approach. Any combination undermines the basic underpinnings of the therapy. Kellogg and Young, mindful of this problem, talk of the therarapeutic relation as one of “empathic confrontation or empathic reality testing." “This means a sense of understanding that patients have typically been through difficult struggles and there are reasons why they feel and behave the way they do." However, The therapist is still working with them to help them change. Also they speak of “limited reparenting." The therapist takes on the role of protector and nurturer. In the relationship, “the therapist, using the schema as a guide attempts to provide the patient with that which the parent or caregiver did not.” In the mode therapy, the focus is on those modes that are currently active for an individual.” using the analogy of attending to figure. In mode therapy, the modes divided into three groups, child, and parent, coping. (This seems to incorporate TA). Thus, the therapist is still the director of the therapy and adheres to the role of change agent.

The major strength of the Kellogg and Young paper is their comprehensive presentation for a gestalt audience of schema theory and the approach developed by Young for a schema based cognitive therapy for personality disorders. They also review the relevant research literature. Schema theory is now in the mainstream of CBT and there is a growing research literature on its efficacy for the treatment of personality and other disorders.

However, Kellogg and Young have a way to go in working out a seamless integration of CT and GT. Marsha Linehan’s application of CBT for borderline personality disorders, which does incorporate many features of both schema theory and GT in her work with borderline personality disorder is a model of the seamless integration of an experiential, process oriented CBT. The current comprehensive review in this issue is a good first attempt at presenting the theory and the possibilities for developing a comprehensive integration, not only of CT and GT, but also of TA, narrative therapy, bringing in a developmental perspective, as well as the use of metaphors, that have a Jungian flavor. The case illustration by Bamber of schema mode therapy is interesting and appears to combine schema mode therapy, a form of narrative therapy, with the client using imagery and metaphoric names for aspects of his struggles, but, it is not clear how that case discussion contributes to a GT/CT integration.

This paper in general, is a map, laying out possibilities for further exploration, but not yet a framework for a fuller theoretical integration. In arguing for the integration of CBT and GT, Kellogg and Young highlight meaning making. However, reading this from a gestalt perspective, their presentation is still too heady. In their second phase of treatment, schema mode change, they appear to be using cognitive templates or preformed categories as the basis for treatment. Too often their descriptions look more like an interpretative as opposed to a process therapy.

Furthermore, Kellogg and Young in their discussion of GT appear to be using an older model of GT. They speak of Pearls, top dog, underdog concepts, but do not bring in the newer process oriented (Resnick, 1995) or relational GT writings of Jacobs (1996) or Wheeler (2001). There are some questions to ask: In applying an integrative gestalt model one needs to slow down, to see freshly the schemas from the client’s perspective? How does the imagery and two-chair work facilitate awareness? Where is the dialogue between the therapist and client that facilitates the clients awareness of what is happening and how does that relationship affect the process. In general, the work is still more CT than GT.

In summary, this is a very packed paper that covers a lot of ground. For a gestalt audience, exposure to schema theory and the newer schema mode therapy is one of the strong points of the paper. However, the therapy is still too cognitive, despite the addition of the experiential component. There is still too much explaining and not enough focus on process and on the contact between the therapist and client that facilities the awareness process.

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Fodor, I. G. (1996a).  A cognitive perspective for Gestalt therapy.  British Gestalt
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Fodor, I. G. (1996b).  A woman and her body: The cycles of pride and shame.  In G.
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