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Post Psychological Therapies

COGNITIVE BEHAVIORAL THERAPY
A Cognitive Behavioral Therapy (CBT) is a psychotherapy based on modifying cognitions, assumptions, beliefs and behaviors, with the aim of influencing disturbed emotions. The general approach, developed out of behavior modification, Cognitive Therapy and Rational Emotive Behavior Therapy, has become widely used to treat various kinds of neurosis and psychopathology, including mood disorders and anxiety disorders. The particular therapeutic techniques vary according to the particular kind of client or issue, but commonly include keeping a diary of significant events and associated feelings, thoughts and behaviors; questioning and testing cognitions, assumptions, evaluations and beliefs that might be unhelpful and unrealistic; gradually facing activities which may have been avoided; and trying out new ways of behaving and reacting. Relaxation and distraction techniques are also commonly included. CBT is widely accepted as an evidence- and empiricism-based, cost-effective psychotherapy for many disorders and psychological problems. It is sometimes used with groups of people as well as individuals, and the techniques are also commonly adapted for self-help manuals and, increasingly, for self-help software packages.
An example will illustrate the process: Having made a mistake, a person believes, "I'm useless and can't do anything right." This, in turn, worsens the mood, leading to feelings of depression; the problem may be worsened if the individual reacts by avoiding activities and then behaviorally confirming his negative belief to himself. As a result, a successful experience becomes more unlikely, which reinforces the original thought of being "useless." In therapy, the latter example could be identified as a self-fulfilling prophecy or "problem cycle," and the efforts of the therapist and client would be directed at working together to change this. This is done by addressing the way the client thinks and behaves in response to similar situations and by developing more flexible ways to think and respond, including reducing the avoidance of activities. If, as a result, the client escapes the negative thought patterns and destructive behaviors, the feelings of depression may, over time, be relieved. The client may then become more active, succeed more often, and further reduce feelings of depression.
The objectives of CBT typically are to identify irrational or maladaptive thoughts, assumptions and beliefs that are related to debilitating negative emotions and to identify how they are dysfunctional, inaccurate, or simply not helpful. This is done in an effort to reject the distorted cognitions and to replace them with more realistic and self-helping alternatives.
Cognitive behavioral therapy is not an overnight process. Even after patients have learned to recognize when and where their mental processes go awry, it can take months of effort to replace any dysfunctional cognitive-affective-behavioral processes or habit with a more reasonable, salutary one.
The cognitive model especially emphasized in Aaron Beck's cognitive therapy says that a person's core beliefs (often formed in childhood) contribute to 'automatic thoughts' that pop up in every day life in response to situations. Cognitive Therapy practitioners hold that clinical depression is typically associated with negatively biased thinking and irrational thoughts.
Cognitive behavioral therapy is often used in conjunction with mood stabilizing medications to treat bipolar disorder. Its application in treating schizophrenia along with medication and family therapy is recognized by the NICE guidelines (see below) within the British NHS.
Cognitive Behavioral Therapy
CBT can be seen as an umbrella term for many different therapies that share some common elements. While similar views of emotion have existed for millennia, the earliest form of Cognitive Behavior Therapy was developed by Albert Ellis (1913-2007) in the early 1950s. Ellis eventually called his approach Rational Emotive Behavioral Therapy, or REBT, as a reaction against popular psychoanalytic methods at the time. Aaron T. Beck independently developed another CBT approach, called Cognitive Therapy, in the 1960s. Cognitive therapy rapidly became a favorite intervention to study in psychotherapy research in academic settings. In initial studies, it was often contrasted with behavioral treatments to see which was most effective. However, in recent years, cognitive and behavioral techniques have often been combined into cognitive behavioral treatment. This is arguably the primary type of psychological treatment being studied in research today.
Concurrently with the pioneering contributions of Ellis and Beck, starting in the late 1950s and continuing through the 1970s, Arnold A. Lazarus developed what was arguably the first form of "Broad-Spectrum" Cognitive-Behavior Therapy. Indeed, in 1958, Arnold Lazarus was the first person to introduce the terms "behavior therapy" and "behavior therapist" into the professional literature (i.e., Lazarus, A. A. New methods in psychotherapy: a case study. South African Medical Journal, 1958, 32, 660-664).] He later broadened the focus of behavioral treatment to incorporate cognitive aspects (e.g., see Arnold Lazarus' 1971 landmark book "Behavior Therapy and Beyond," perhaps the first clinical text on CBT). When it became clear that optimizing therapy's effectiveness and effecting durable treatment outcomes often required transcending more narrow focused cognitive and behavioral methods, Arnold Lazarus expanded the scope of CBT to include physical sensations (as distinct from emotional states), visual images (as distinct from language-based thinking), interpersonal relationships, and biological factors. The final product of Arnold Lazarus' approach to psychotherapy is called Multimodal Therapy and is, perhaps, the most comprehensive form of CBT in addition to REBT that also shares many of the same assumptions and theorizing.
Cognitive Behavioral Group Therapy (CBGT) is a similar approach in treating mental illnesses, based on the protocol by Richard Heimberg. In this case, clients participate in a group and recognize they are not alone in suffering from their problems.
A sub-field of cognitive behavioral therapy used to treat Obsessive Compulsive Disorder makes use of classical conditioning through extinction (a type of conditioning) and habituation. (The specific technique, Exposure with Response Prevention (ERP) has been demonstrated to be more effective than the use of medication—typically SSRIs—alone). CBT has also been successfully applied to the treatment of Generalized Anxiety Disorder, health anxiety, Social phobia and Panic Disorder. In recent years, CBT has been used to treat symptoms of schizophrenia, such as delusions and hallucinations. This use has been developed in the UK by Douglas Turkington and David Kingdon.
Other types of Cognitive Behavioral Therapy include Dialectical Behavior Therapy, Self-Instructional Training, Schema-Focused Therapy and many others.
CBT has a good evidence base in terms of its effectiveness in reducing symptoms and preventing relapse. It has been clinically demonstrated in over 400 studies to be effective for many psychiatric disorders and medical problems for both children and adolescents. It has been recommended in the UK by the National Institute for Health and Clinical Excellence as a treatment of choice for a number of mental health difficulties, including post-traumatic stress disorder, OCD, bulimia nervosa and clinical depression.
Cognitive Behavioral Therapy most closely allies with the Scientist-Practitioner Model of Clinical Psychology, in which clinical practice and research is informed by a scientific perspective; clear operationalization of the "problem" or "issue;" an emphasis on measurement (and measurable changes in cognition and behavior); and measurable goal-attainment.
Depression
Negative thinking dominates when a person experiences depression. The depressed person can experience negative thoughts as being beyond their control, thereby allowing them to become automatic and self-perpetuating.
Negative thinking can be categorized into a number of common patterns called "cognitive distortions." The cognitive therapist provides techniques to give the client a greater degree of control over negative thinking by correcting these distortions or correcting thinking errors that abet the distortions, in a process called cognitive restructuring.
Causes of depression according to cognitive theory
One etiological theory of depression is the Aaron Beck cognitive theory of depression. His theory is regarded as the most verified psychological theory of depression. His theory states that depressed people think the way they do because their thinking is biased towards negative interpretations. According to Beck’s theory of the etiology of depression, depressed people acquire a negative schema of the world in childhood and adolescence. (Children and adolescents who suffer from depression acquire this negative schema earlier.) Depressed people acquire such schemas through a loss of a parent, rejection of peers, criticism from teachers or parents, the depressive attitude of a parent and other negative events. When the person with such schemas encounter a situation that resembles in some way, even remotely, the conditions in which the original schema was learned, the negative schemas of the person are activated. [7]
Beck also included a negative triad in his theory. A negative triad is made up of the negative schemas and cognitive biases of the person. A cognitive bias is a view of the world. Depressed people, according to this theory, have views such as “I never do a good job.” A negative schema helps give rise to the cognitive bias, and the cognitive bias helps fuel the negative schema. This is the negative triad. Also, Beck proposed that depressed people often have the following cognitive biases: arbitrary inference, selective abstraction, overgeneralization, magnification and minimization. These cognitive biases are quick to make negative, generalized, and personal inferences of the self, thus fueling the negative schema.
Another cognitive theory of depression is the hopelessness theory of depression. This is the latest theory of the helpless/hopeless theories of depression. According to this theory, hopelessness depression is caused by a state of hopelessness. A state of hopelessness is when the person believes that no good outcomes will happen and that bad ones will happen instead. Also, the person feels that he or she has no ability to change the situation so that good things will happen. Stressors (negative life events) are thought to interact with a diathesis (in this case, a predisposing factor to depression) to create a sense of hopelessness.
Some proposed diathesis’s are attributing negative events to stable and global factors, low self-esteem, and a tendency to believe that negative life events will have severe negative consequences. Theses diathesis increase the chance that a person will have hopelessness depression.
Attributional style
An approach to depression based upon attribution theory in social psychology is related to the concept of attributional style. First advanced by Lyn Abramson and her colleagues in 1978, this approach argues that depressives have a typical attributional style —they tend to attribute negative events in their lives to stable and global characteristics of themselves. This theory is sometimes known as a revised version of learned helplessness theory.
In 1989, this theory was challenged by Hopelessness Theory. This theory emphasised attributions to global and stable factors, rather than, as in the original model, internal attributions. Hopelessness Theory also emphasises that beliefs about the consequences of events and rated importance of events may be at least as important in understanding why some people react to negative events with clinical depression as are causal attributions.
The ABCs of Irrational Beliefs
A major aid in cognitive therapy is what Albert Ellis called the ABC Technique of Irrational Beliefs.[3] The first three steps analyze the process by which a person has developed irrational beliefs and may be recorded in a three-column table.
• A - Activating Event or objective situation. The first column records the objective situation, that is, an event that ultimately leads to some type of high emotional response or negative dysfunctional thinking.
• B - Beliefs. In the second column, the client writes down the negative thoughts that occurred to him or her.
• C - Consequence. The third column is for the negative disturbed feelings and dysfunctional behaviors that ensued. The negative thoughts of the second column are seen as a connecting bridge between the situation and the distressing feelings. The third column C is next explained by describing emotions or negative thoughts that the client thinks are caused by A. These could be anger, sorrow, anxiety, etc.
For example, Gina is upset because she got a low mark on a math test. The Activating event, A, is that she failed her test. The Belief, B, is that she must have good grades or she is worthless. The Consequence, C, is that Gina feels depressed.
• Reframing. After irrational beliefs have been identified, the therapist will often work with the client in challenging the negative thoughts on the basis of evidence from the client's experience by reframing it, meaning to re-interpret it in a more realistic light. This helps the client to develop more rational beliefs and healthy coping strategies.
From the example above, a therapist would help Gina realize that there is no evidence that she must have good grades to be worthwhile, or that getting bad grades is awful. She desires good grades, and it would be good to have them, but it hardly makes her worthless. If she realizes that getting bad grades is disappointing, but not awful, and that it means she is currently bad at math or at studying, but not as a person, she will feel sad or frustrated, but not depressed. The sadness and frustration are likely healthy negative emotions and may lead her to study more effectively from then on.
Effectiveness of CBT with or without drugs for depression
A large-scale study in 2000 showed substantially higher results of response and remission (73% for combined therapy vs. 48% for either CBT or antidepressants alone) when a form of cognitive behavior therapy and an anti-depressant drug were combined than when either modality was used alone.
The effectiveness of combination therapy is endorsed by the Australian depressioNet group:
Currently the most effective treatment for major (clinical) depression is considered to be a combination of antidepressant medication and Cognitive Behavioral Therapy.
For more general results confirming that CBT alone can provide lower but nonetheless valuable levels of relief from depression, and result in increased ability for the patient to stay in employment, see The Depression Report, which states:
The typical short-term success rate for CBT is about 50 percent. In other words, if 100 people attend up to sixteen weekly sessions one-on-one lasting one hour each, some will drop out but within four months 50 people will have lost their psychiatric symptoms over and above those who would have done so anyway. After recovery, people who suffered from anxiety are unlikely to relapse. . . . So how much depression can a course of CBT relieve, and how much more work will result? One course of CBT is likely to produce 12 extra months free of depression. This means nearly two months more of work.
The American Psychiatric Association Practice Guidelines (April 2000) indicated that among psychotherapeutic approaches, cognitive behavioral therapy and interpersonal psychotherapy had the best-documented efficacy for treatment of major depressive disorder, although they noted that rigorous evaluative studies had not been published.
CBT with children and adolescents
The use of CBT has been extended to children and adolescents with good results. It is often used to treat depression, anxiety disorders, and symptoms related to trauma and Post Traumatic Stress Disorder. Significant work has been done in this area by Mark Reinecke and his colleagues at Northwestern University in the Clinical Psychology program in Chicago. Paula Barrett and her colleagues have also validated CBT as effective in a group setting for the treatment of youth and child anxiety using the Friends Program she authored. This CBT program has been recognized as best practise for the treatment of anxiety in children by the World Health Organisation.Combining the Biofeedback method with the C.B.T process is very effective.(( cite-book Biofeedback You Are In Control Editor Dr.Yigal Gliksman,)) ((www.lulu.com/content/1800043)) date 2008 . CBT has been used with children and adolescents to treat a variety of conditions with good success.
CBT is also used as a treatment modality for children who have experienced Complex Post Traumatic Stress Disorder, chronic maltreatment, and Post Traumatic Stress Disorder. It would be one component of treatment for children with C-PTSD, along with a variety of other components, which are discussed in the Complex Post Traumatic Stress Disorder article.
Computerized CBT
As the name suggests, this is a computerised form of CBT, in which the user interacts with computer software (either on a PC, or sometimes via a voice-activated phone service), instead of face-to-face with a therapist.
Computerized CBT is not a replacement for face-to-face therapy but can provide an option for patients, especially in light of the fact that there are not always therapists available, or the cost can be prohibitive. Computerized CBT is clinically proven and drug-free. For people who are feeling depressed and withdrawn, the prospect of having to speak to someone about their deepest problems can be off-putting. In this respect, CCBT (especially if delivered online) can be a good option.
It has been proven to be effective in randomized controlled trials, and in February 2006 the UK's National Institute of Health and Clinical Excellence (NICE) recommended that CCBT should be made available for use within the NHS across England and Wales, for patients presenting with mild/moderate depression, rather than immediately opting for medication (i.e. anti-depressant pills).
A new UK government initiative for tackling Mental Health issues has recently been launched by the Care Services Improvement Partnership. This confirms Primary Care Trust (PCT) responsibilities in delivering the NICE Technology Appraisal on CCBT. National Director for Mental Health, Professor Louis Appleby CBE[3] has confirmed that by 31 March 2007 PCTs should have ST Solutions' "FearFighter" and Ultrasis' "Beating the Blues" CCBT products in place and the NICE Guidelines should be met.
Notable Behavioral Theorists
• Albert Bandura
• Ivan Pavlov
• B.F. Skinner
• Edward Thorndike
• John B. Watson
• Joseph Wolpe
GESTALT THERAPY
Gestalt Therapy is an existential and experiential psychotherapy that focuses on the individual's experience in the present moment, the therapist-client relationship, the environmental and social contexts in which these things take place, and the self-regulating adjustments people make as a result of the overall situation. It emphasizes personal responsibility. Gestalt Therapy was co-founded by Fritz Perls, Laura Perls and Paul Goodman in the 1940s–1950s.
Overview of main premises
Edwin Nevis described gestalt therapy as "...a conceptual and methodological base from which helping professionals can craft their practice" (Nevis, E., 2000, p.3). In the same volume Joel Latner asserted that gestalt therapy is built around two central ideas: that the most helpful focus of psychology is the experiential present moment and that everyone is caught in webs of relationships; thus, it is only possible to know ourselves against the background of our relation to other things (Latner, 2000). The historical development (see below) of gestalt therapy shows the influences that have resulted in these two foci. Expanded, they result in the four chief theoretical constructs (see below under the theory and practice section) that comprise gestalt theory and guide the practice and application of gestalt therapy.
Gestalt therapy was forged from various influences in the times and lives of the founders: physics, Eastern religion, existential phenomenology, gestalt psychology, psychoanalysis, theatrical performance, systems and field theory (Mackewn, 1997).
Gestalt therapy rose from its beginnings in the middle of the 20th century to rapid and widespread popularity during the decade of the 1960s and early 1970s. During the 70s and 80s gestalt therapy training centers spread globally, but they were, for the most part, not aligned with formal academic settings. As the cognitive revolution eclipsed gestalt therapy in psychology, many came to believe gestalt was an anachronism. In the hands of gestalt practitioners gestalt therapy became an applied discipline in the fields of psychotherapy, organizational development, social action, and eventually coaching. Until the turn of the century gestalt therapists disdained the positivism underlying what they perceived to be the concern of research, and so, largely, ignored the need to utilize research to further develop gestalt therapy theory and support gestalt therapy practice. That has begun to change.
Gestalt therapy focuses more on process (what is happening) than content (what is being discussed). The emphasis is on what is being done, thought and felt at the moment rather than on what was, might be, could be, or should be.
Gestalt therapy is a method of awareness, by which perceiving, feeling, and acting are understood to be separate from interpreting, explaining and judging using old attitudes. This distinction between direct experience and indirect or secondary interpretation is developed in the process of therapy. The client learns to become aware of what they are doing psychologically and how they can change it. By becoming aware of and transforming their process they develop self acceptance and the ability to experience more in the "now" without so much interference from baggage of the past.
The objective of Gestalt Therapy, in addition to helping the client overcome symptoms, is to enable him or her to become more fully and creatively alive and to be free from the blocks and unfinished issues that may diminish optimum satisfaction, fulfillment, and growth. Thus, it falls in the category of humanistic psychotherapies.
Contemporary Gestalt therapy theory and practice
Gestalt therapy theory rests atop essentially four "load bearing walls:" phenomenological method, dialogical relationship, field-theoretical strategies, and experimental freedom. Although all these tenets are present in the early formulation and practice of gestalt therapy, as described in Perls, F. (1969), Ego, Hunger, and Aggression. and in Gestalt Therapy, Excitement and Growth in the Human Personality (Perls, Hefferline, & Goodman, 1951), the early development of gestalt therapy theory emphasized personal experience and the experiential episodes understood as the "safe emergencies" of experiments; indeed, half of PHG consists of such stylized experiments. Later, through the influence of such people as Erving and Miriam Polster (Polster & Polster, 1973), a second theoretical emphasis emerged: contact between self and other, and ultimately the dialogical relationship between therapist and client. Later still, field theory emerged as an emphasis (Wheeler, 1991). At various times over the decades since gestalt therapy first emerged one or more of these tenets, and the associated constructs that go with them, have captured the imagination of those who have continued developing the contemporary theory of gestalt therapy. Since 1990 the literature focused on gestalt therapy has flourished, including the development of several professional gestalt journals. Along the way, gestalt therapy theory has also been applied in Organizational Development and Coaching work. Thus, currently, gestalt therapy training institutes often offer programs in both clinical and organization tracks.
Phenomenological method
The goal of a phenomenological exploration is awareness (Yontef, 1993). This exploration works systematically to reduce the effects of bias through repeated observations and inquiry (Yontef, 2005).
The phenomenological method is comprised of three steps: (1) the rule of epoché, (2) the rule of description, and (3) the rule of horizontalization (Spinelli, 2005). In the rule of epoché one sets aside his or her initial biases and prejudices in order to suspend expectations and assumptions. In the rule of description, one occupies him or herself with describing instead of explaining. In the rule of horizontalization one treats each item of description as having equal value or significance. The rule of epoché sets aside any initial theories with regard to what is presented in the meeting between therapist and client. Second rule implies immediate and specific observations, abstaining from interpretations or explanations, especially those formed from the application of a clinical theory superimposed over the circumstances of experience. Third rule avoids any hierarchical assignment of importance such that the data of experience become prioritized and categorized as they are received. A gestalt therapist utilizing the phenomenological method might find him or herself typically saying something like, “I notice a slight tension at the corners of your mouth when I say that, and I see you shifting on the couch and folding your arms across your chest … and now I see you rolling your eyes back.” All this is not to say that the therapist never makes clinically relevant evaluations, but that he or she, when applying the phenomenological method, temporarily suspends the need for that (Brownell, in press).
Dialogical relationship
To create the conditions under which a dialogic moment might occur, the therapist attends to his or her own presence, creates the space for the client to enter in and become present as well (called inclusion), and commits him or herself to the dialogic process, surrendering to what takes place between them as opposed to attempting to control it. In presence, the therapist “shows up” as the whole and authentic person he or she is (Yontef, 1993) instead of assuming a role, false self, or persona. To practice inclusion is to accept however the client chooses to be present, and that may be in a defensive and obnoxious stance as well as an overly sweet but superficially cooperative one. To practice inclusion is to support the presentation of the client, including his or her resistance, not as a gimmick but in full realization that that is how the client is present. Finally, the gestalt therapist is committed to the process, trusts in that process, and does not attempt to save him or herself from it (Brownell, in press).
Field-theoretical strategies
“The field” can be considered in two ways. There are ontological dimensions and there are phenomenological dimensions to one’s field. The ontological dimensions are all those physical and environmental contexts in which we live and move. They are the office in which one works, the house in which one lives, the city and country of which one is a citizen, and so forth. The ontological field is the objective reality that supports our physical existence. The phenomenological dimensions are all mental and physical dynamics that contribute to a person’s sense of self, one’s subjective experience, but are not merely elements of the environmental context. This could be the memory of an uncle’s inappropriate affection, one’s color blindness, one’s sense of the social matrix in operation at the office in which one works, and so forth. It is in the way that gestalt therapists choose to work with field dynamics that makes what they do strategic (Brownell, in press).
Experimental freedom
In the moving to action, away from mere talk therapy, gestalt therapy has distinguished itself for many people. Gestalt is considered an experiential approach (Crocker, 1999). Through experiments, the therapist supports the client’s direct experience of something new instead of the mere talking about the possibility of something new. Indeed, the entire therapeutic relationship could be considered experimental, because at one level it is the provision of corrective, relational experience for many clients, and it is the "safe emergency" that is free to turn this way and that. An experiment can also be conceived of as a teaching method that creates an experience in which a client might learn something as part of their growth (Melnick & Nevis, 2005).
Notable issues
Self
In field theory, self is a phenomenological concept, and is a comparison with 'other'. Without other there is no self, and how I experience other is inseparable from how I experience self. The continuity of selfhood (personality functioning) is something achieved rather than something inherent "inside" the person, and has its advantages and disadvantages. At one end of the spectrum, there is not enough self-continuity to be able to make meaningful relationships or to have a workable sense of who I am. In the middle, personality is a loose set of ways of being that work for me, commitments to relationships, work, culture and outlook, always open to change where I need to adapt to new circumstances, or just want to try something new. At the other end, it is a rigid defensive denial of the new and spontaneous. I act in stereotyped ways, and either induct other people to act in particular and fixed ways towards me; or I redefine their actions to fit with the fixed stereotypes.
In Gestalt therapy then, the approach is not the self of the client being helped or healed by the fixed self of the therapist, but the exploration of the co-creation of self and other in the here-and-now of the therapy. There is not the assumption that the client will act in all other circumstances as he or she does in the therapy situation. However, the areas that cause problems will be either the lack of self definition leading to chaotic or psychotic behaviour, or the rigid self definition in some area of functioning that denies spontaneity and makes dealing with particular situations impossible. Both of these show very clearly in the therapy, and can be worked with in the relationship with the therapist.
The experience of the therapist is also very much part of the therapy: since we are co-creating our self-other experiences, the way I experience being with the client is significant information about how the client experiences themselves. The proviso here is that I as therapist am not operating from my own fixed responses, and this is why Gestalt therapists are required to undertake significant therapy of their own during training.
From the perspective of this theory of self, the theory of neurosis can be seen as fixed predictability, and the theory of therapy can be seen as the ability to facilitate the client to become unpredictable. Thus, if the therapist is working from some theory of how the client should end up, this defeats the aim of the therapy.

Change
In what has now become a "classic" of gestalt therapy literature, Arnold Beisser (1970) described gestalt's paradoxical theory of change. The paradox is that the more one attempts to be who one is not, the more one remains the same (Yontef, 2005). Conversely, when people identify with their current experience, the conditions of wholeness and growth support change. Put another way, change comes about as a result of "full acceptance of what is, rather than a striving to be different" (Houston, 2003).
The Polsters
Erv and Miriam Polster started a training center in La Jolla, which also became very well known; the Polsters became well known through the publishing of their book, Gestalt Integrated, in the 1970s.
They had an influential role in advancing the concept of contact. A disturbance described by Miriam and Erv Polster was deflection: referring to a means of avoiding contact by jumping around from one thing to another and never staying in the same place for very long. All the instances of the disturbance have a pathological and a non-pathological aspect. It is appropriate for the infant and mother to become confluent, for example, or two lovers, but inappropriate for client and therapist. When the latter pair becomes confluent, there can be no growth because there is no boundary at which the one can contact the other; the client will not be able to learn anything new because the therapist is simply an extension of the client, so to speak.
Psychoanalysis
Gestalt therapy was influenced by psychoanalysis. It was part of a continuum moving from the early work of Freud, to the later Freudian ego analysis, to Wilhelm Reich and his notion of character armor, where they gave attention to nonverbal behavior (This was consonant with Laura Perls' background in dance and movement therapy). To this was added the insights of academic gestalt psychology about perception, gestalt formation and the tendency of organisms to complete the incomplete gestalt, to form "wholes" in experience.
Central to Fritz and Laura Perls' modifications of psychoanalysis was the concept of "dental or oral aggression". In "Ego, Hunger and Aggression" (1944), Fritz Perl's first book, to which Laura Perls contributed[1], the Perls suggested that when the infant develops teeth, he/she has the capacity to chew, to break apart food, and by analogy experience, to taste, accept, reject, assimilate. This was opposed to Freud's notion that only introjection takes place in early experience. Thus the Perls made "assimilation", as opposed to "introjection", a focal theme in their work, and the prime means by which growth occurs in therapy.
In contrast to the psychoanalytic stance in which the "patient" introjects the (presumably more healthy) attitudes/interpretations of the analyst, in Gestalt Therapy the client must "taste" his/her experience, and either accept or reject, but not introject, or "swallow whole". Hence, the emphasis is on avoiding interpretation and encouraging discovery. This is the key point in the divergance of GT from traditional psychoanalysis — growth occurs through gradual assimilation of experience in a natural way, rather than by accepting the interpretations of the analyst; thus, the therapist should not interpret, but lead the client to discover for him or herself.
The Gestalt therapist contrives experiments that lead the client to greater awareness and fuller experience of his/her possibilities. Experiments can be focussed on undoing projections or retroflections. They can work to help the client with closure of unfinished gestalts ("unfinished business" such as unexpressed emotions towards somebody in the client's life). There are many kinds of experiments that might be therapeutic. But the essence of the work is that it is experiential rather than interpretive, and in this way distinguishes itself from the psychoanalytic.
Current status
Gestalt Therapy reached a zenith in the late 1970s and early 1980s. Since then its influence has spread out into other fields like organisational development and teaching. Its contributions have also become assimilated into current schools of therapy, sometimes in unlikely places. For example, Acceptance and Commitment Therapy (ACT) shares much from Gestalt Therapy yet is considered to be a cognitive behavioral approach. Also, mindfulness is a buzzword as of 2006, yet much of mindfulness work is connected to Gestalt Therapy's emphasis on the flow of experience and awareness.
Dan Rosenblatt led Gestalt training groups in Japan for 7 years and Stewart Kiritz followed with public workshops and training workshops in Tokyo from 1997 through 2005. Rosenblatt (b. 1925) was part of the early group around Laura. A Harvard-trained psychologist and intellectual, he practiced Gestalt therapy for over 35 years in Manhattan, seeing 30 patients a week in individual therapy and doing groups almost every evening. He did training workshops in Germany, the Netherlands, Japan, New Zealand, Italy for many years. Rosenblatt, who also wrote several books on Gestalt therapy, exemplifies the Gestalt therapist as practicing clinician, rather than would-be guru.
All of these therapists had their own distinctive styles, but always with Gestalt Therapy's focus on immediate experience as a central theme. And unlike Fritz Perls, whom Isadore From persisted in calling Frederick Perls, these first generation Gestalt therapists maintained thriving therapy practices, mostly in one location, for many years. Gestalt Therapy is a very useful process for therapists-in-training of any persuasion because of its focus on the person of the therapist, barriers to full contact with others, self-awareness. And graduate students still seem to seek it out, even though it is not as recognized by the establishment as it once was.
PSYCHOANALYSIS
Today psychoanalysis comprises several interlocking theories concerning the functioning of the mind. The term also refers to a specific type of treatment in which the "analysand" (analytic patient) brings up material, including free associations, fantasies, and dreams, from which the patient with the assistance of the analyst attempts to infer the unconscious basis for the patient's symptoms and character problems and to use this insight to resolve the problems. Unconscious functioning was first described by Sigmund Freud, who modified his theories several times over a period of almost 50 years (1889-1939) of attempting to treat patients who suffered with mental problems. In the past 70 years or so, infant and child research, and new discoveries in adults have led to further modification of theory. During psychoanalytic treatment, the patient tells the analyst various thoughts and feelings. The analyst listens carefully, formulates, then intervenes to attempt to help the patient develop insight into unconscious factors causing the problems. The specifics of the analyst's interventions typically include confronting and clarifying the patient's pathological defenses, wishes and guilt. Through the analysis of resistance (unconscious barriers to treatment), and transference to the analyst of expectations, psychoanalysis aims to unearth wishes and emotions from prior unresolved conflicts, in order to help the patient perceive and resolve lingering problems.
Theories
The predominant psychoanalytic theories include
Conflict Theory, which theorizes that emotional symptoms and character traits are complex solutions to intrapsychic conflict. See Brenner (2006), Psychoanalysis: Mind and Meaning, New York: Psychoanalytic Quarterly Press. This revision of Freud's structural theory (Freud, 1923, 1926) dispenses with the concepts of a fixed id, ego and superego, and instead posits unconscious and conscious conflict among wishes (dependant, controlling, sexual, and aggressive), guilt and shame, emotions (especially anxiety and depressive affect), and defensive operations that shut off from consciousness some aspect of the others. Moreover, healthy functioning (adaptive) is also determined, to a great extent, by resolutions of conflict. A major goal of modern conflict theorist analysts is to attempt to change the balance of conflict through making aspects of the less adaptive solutions (also called compromise formations) conscious so that they can be rethought, and more adaptive solutions found. Current theoreticians following Brenner's many suggestions (see especially Brenner's 1982 book, "The Mind in Conflict") include Sandor Abend, MD (Abend, Porder, & Willick, (1983), Borderline Patients: Clinical Perspectives), Jacob Arlow (Arlow and Brenner (1964), Psychoanalytic Concepts and the Structural Theory), and Jerome Blackman (2003), 101 Defenses: How the Mind Shields Itself). Conflict theory is the prevalent analytic theory taught in psychoanalytic institutes, throughout the United States, accredited by the American Psychoanalytic Association.
Ego Psychology, which has a long history. Begun by Freud in Inhibitions, Symptoms and Anxiety (1926), the theory was refined by Hartmann, Loewenstein, and Kris in a series of papers and books from 1939 through the late 1960s. Leo Bellak picked up the work from there. This series of constructs, parallelling some of cognitive theory, includes the notions of autonomous ego functions: mental functions not dependant, at least in origin, on intrapsychic conflict. Such functions include: sensory perception, motor control, symbolic thought, logical thought, speech, abstraction, integration (synthesis), orientation, concentration, judgment about danger, reality testing, adaptive ability, executive decision-making, hygiene, and self-preservation. Freud noted inhibition as a way the mind may interfere with any of these functions to avoid painful emotions. Hartmann (1950s) pointed out that there may be delays or deficits in such functions. Frosch (1964) described differences in those people who demonstrated damage to their relationship to reality, but who seemed able to test it. Deficits in the capacity to organize thought are sometimes referred to as blocking or loose associations (Bleuler), and are characteristic of the schizophrenias. Deficits in abstraction ability and self-preservation also suggest psychosis in adults. Deficits in orientation and sensorium are often indicative of a medical illness affecting the brain (and therefore, autonomous ego functions). Deficits in certain ego functions are routinely found in severely sexually or physically abused children, where powerful affects generated throughout childhood seem to have eroded some functional development. Ego strengths, later described by Kernberg (1975), include the capacities to control oral, sexual and destructive impulses; to tolerate painful affects without falling apart; and to prevent the eruption into consciousness of bizarre symbolic fantasy. Defensive activity, which shuts certain conflictual thoughts, fantasies, and sensations out of consciousness, is also sometimes included here, although defensive operations are different from autonomous functions. Nevertheless, the term "ego defense" has become common.
Object relations theory, which attempts to explain vicissitudes of human relationships through a study of how internal representations of self and of others are structured. The clinical problems that suggest object relations problems (usually developmental delays throughout life) include disturbances in an individual's capacity to feel warmth, empathy, trust, sense of security, identity stability, consistent emotional closeness, and stability in relationships with chosen other human beings. (It is not suggested that one should trust everyone, for example). Concepts regarding internal representations (also sometimes termed, "introjects," "self and object representations," or "internalizations of self and other") although often attributed to Melanie Klein, were actually first mentioned by Sigmund Freud in his early concepts of drive theory (1905, Three Essays on the Theory of Sexuality). Freud's 1917 paper "Mourning and Melancholia", for example, hypothesized that unresolved grief was caused by the survivor's internalized image of the deceased becoming fused with that of the survivor, and then the survivor shifting unacceptable anger toward the deceased onto the now complex self image. Vamik Volkan, in "Linking Objects and Linking Phenomena," expanded on Freud's thoughts on this, describing the syndromes of "Established pathological mourning" vs. "reactive depression" based on similar dynamics. Melanie Klein's hypotheses regarding internalizations during the first year of life, leading to paranoid and depressive positions, were later challenged by Rene Spitz (e.g., The First Year of Life, 1965), who divided the first year of life into a coenesthetic phase of the first six months, and then a diacritic phase for the second six months. Margaret Mahler (Mahler, Fine, and Bergman (1975), "The Psychological Birth of the Human Infant") and her group, first in New York, then in Philadelphia, described distinct phases and subphases of child development leading to "separation-individuation" during the first three years of life, stressing the importance of constancy of parental figures, in the face of the child's destructive aggression, to the child's internalizations, stability of affect management, and ability to develop healthy autonomy. Later developers of the theory of self and object constancy as it affects adult psychiatric problems such as psychosis and borderline states have been John Frosch, Otto Kernberg, and Salman Akhtar. Peter Blos described (1960, in a book called "On Adolescence) how similar separation-individuation struggles occur during adolescence, of course with a different outcome from the first three years of life: the teen usually, eventually, leaves the parents' house (this varies with the culture). During adolescence, Erik Erikson (1950, 1960s) described the "identity crisis," that involves identity-diffusion anxiety. In order for an adult to be able to experience "Warm-ETHICS" (warmth, empathy, trust, holding environment (Winnicott), identity, closeness, and stability) in relationships (see Blackman (2003), 101 Defenses: How the Mind Shields Itself), the teenager must resolve the problems with identity and redevelop self and object constancy.
Structural Theory, which breaks the mind up into the id, the ego, and the superego. Actually, in German, the word for id is "es," which means "it." The word ego was coined by Freud's translators; Freud used the term, "ich" meaning "I" in English. Freud called the superego the "Über-ich." The id was designated as the repository of sexual and aggressive wishes, which Freud called "drives." The ego was composed of those forces that opposed the drives -- defensive operations. The superego was Freud's term for the conscience -- values and ideals, shame and guilt. One problem Brenner (2006) later found with this theory (see above) was that Freud also suggested that forgotten thoughts ("the repressed") were also "located" in the id. However, Freud here realized that drives could be conscious or unconscious, and that consciousness vs. unconsciousness was a quality of any mental operation or any mental conflict. Forgetting things could be done on purpose, or not. People could be aware of guilt, or not aware.
Self psychology, which emphasizes the development of a stable sense of self through mutually empathic contacts with other humans, was developed originally by Heinz Kohut, and has been elucidated by the Ornsteins and Arnold Goldberg. Marian Tolpin explicated the need for "transmuting internalizations" (1971) during treatment, to correct what Kohut referred to as a disturbance in the "self-object" internalizations from parents.
Lacanian psychoanalysis, which integrates psychoanalysis with semiotics and Hegelian philosophy, is popular in France.
Feminist theory of psychoanalysis, articulated mainly by Julia Kristeva, Luce Irigaray and Bracha Ettinger, is informed both by Freud, Lacan and the Object relations theory.
Analytical psychology, which has a more spiritual approach, founded by Carl Jung
Interpersonal psychoanalysis, which accents the nuances of interpersonal interactions, was first introduced by Harry Stack Sullivan, MD, and developed further by Frieda Fromm-Reichmann. It is the primary theory, still taught, at the William Alanson White Center.
Relational psychoanalysis, which combines interpersonal psychoanalysis with object-relations theory as critical for mental health, was introduced by Stephen Mitchell. Relational psychoanalysis emphasizes how the individual's personality is shaped by both real and imagined relationships with others, and how these relationship patterns are re-enacted in the interactions between analyst and patient. Fonagy and Target, in London, have propounded their view of the necessity of helping certain detached, isolated patients, develop the capacity for "mentalization" associated with thinking about relationships and themselves.
Modern psychoanalysis, a body of theoretical and clinical knowledge developed by Hyman Spotnitz and his colleagues, extended Freud's theories so as to make them applicable to the full spectrum of emotional disorders. Modern psychoanalytic interventions are primarily intended to provide an emotional-maturational communication to the patient, rather than to promote intellectual insight.
Although these theoretical "schools" differ, most of them continue to stress the strong influence of unconscious elements affecting people's mental lives. There has also been considerable work done on consolidating elements of conflicting theory (cf. the work of Theodore Dorpat, B. Killingmo, and S. Akhtar). As in all fields of medicine (for example, , there are some persistent conflicts regarding specific causes of some syndromes, and disputes regarding the best treatment techniques.
Today psychoanalytic ideas are embedded in the culture, especially in childcare, education, literary criticism, and in psychiatry, particularly medical and non-medical psychotherapy. Though there is a mainstream of evolved analytic ideas, there are groups who more specifically follow the precepts of one or more of the later theoreticians. It also plays a role in literary analysis. See Archetypal literary criticism.
Psychopathology (mental disturbances)
The various psychoses involve deficits in the autonomous ego functions (see above) of integration (organization) of thought, in abstraction ability, in relationship to reality and in reality testing. In depressions with psychotic features, the self-preservation function may also be damaged (sometimes by overwhelming depressive affect). Because of the integrative deficits (often causing what general psychiatrists call "loose associations," "blocking," "flight of ideas," "verbigeration," and "thought withdrawal"), the development of self and object representations is also impaired. Clinically, therefore, psychotic individuals manifest limitations in warmth, empathy, trust, identity, closeness and/or stability in relationships (due to problems with self-object fusion anxiety) as well.
In patients whose autonomous ego functions are more intact, but who still show problems with object relations, the diagnosis often falls into the category known as "borderline." Borderline patients also show deficits, often in controlling impulses, affects, or fantasies -- but their ability to test reality remains more or less intact.
Those adults who do not experience guilt and shame, and who indulge in criminal behavior, are usually diagnosed as psychopaths, or, using DSM-IV-TR, antisocial personality disorder.
Panic, phobias, conversions, obsessions, compulsions and depressions (analysts call these "neurotic symptoms") are not usually caused by deficits in functions. Instead, they are caused by intrapsychic conflicts. The conflicts are generally among sexual and hostile-aggressive wishes, guilt and shame, and reality factors. The conflicts may be conscious or unconscious, but create anxiety, depressive affect, and anger. Finally, the various elements are managed by defensive operations -- essentially shut-off brain mechanisms that make people unaware of that element of conflict. "Repression" is the term given to the mechanism that shuts thoughts out of consciousness. "Isolation of affect" is the term used for the mechanism that shuts sensations out of consciousness. Neurotic symptoms may occur with or without deficits in ego functions, object relations, and ego strengths. Therefore, it is not uncommon to encounter obsessive-compulsive schizophrenics, panic patients who also suffer with borderline personality disorder, etc.
Furthermore, we know that many adult problems can trace their origins to unresolved conflicts from certain phases of childhood and adolescence. Freud, based on the data gathered from his patients early in his career, suspected that neurotic disturbances occurred when children were sexually abused in childhood (the so-called seduction theory). Later, Freud came to realize that, although child abuse occurs, that not all neurotic symptoms were associated with this. He realized that neurotic people often had unconscious conflicts that involved incestuous fantasies deriving from different stages of development. He found the stage from about three to six years of age (preschool years, today called the "first genital stage") to be filled with fantasies about marriage with both parents. Although arguments were generated in turn-of-the-(20th)century Vienna about whether adult seduction of children was the basis of neurotic illness, there is virtually no argument about this problem in the 21st century.
Many psychoanalysts who work with children have studied the actual effects of child abuse, which include ego and object relations deficits and severe neurotic conflicts. Much research has been done on these types of trauma in childhood, and the adult sequelae of those. On the other hand, many adults with symptom neuroses and character pathology have no history of childhood sexual or physical abuse.
In studying the childhood factors that start neurotic symptom development, Freud found a constellation of factors that, for literary reasons, he termed the Oedipus complex (based on the play by Sophocles, Oedipus Rex, where the protagonist unwittingly kills his father Laius and marries his mother Jocasta). The shorthand term, "oedipal," (later explicated by Joseph Sandler, 1960, in "On the Concept Superego" and modified by Charles Brenner (1982) in "The Mind in Conflict") refers to the powerful attachments that children make to their parents in the preschool years. These attachments involve fantasies of marriage to either (or both) parent, and, therefore, competitive fantasies toward either (or both) parents. Humberto Nagera (1975) has been particularly helpful in clarifying many of the complexities of the child through these years.
The terms 'positive' and 'negative' oedipal conflicts have been attached to the heterosexual and homosexual aspects, respectively. Both seem to occur in development of most children. Eventually, the developing child's concessions to reality (that they will neither marry one parent nor eliminate the other) lead to identifications with parental values. These identifications generally create a new set of mental operations regarding values and guilt, subsumed under the term "superego." Besides superego development, children "resolve" their preschool oedipal conflicts through channeling wishes into something their parents approve of ("sublimations") and the development, during the school-age years ("latency") of age-appropriate obsessive-compulsive defensive maneuvers (rules, repetitive games).
When there is disturbance in the family during the first genital phase (such as death of a parent or divorce), unusual magnification of anxieties in the child may occur. This sets the stage for problems during latency and adolescence. Later in life, under certain circumstances, a recrudescence of symptoms may occur during periods that are either stressful or symbolic -- such as marriage, having children, or graduating from school.
Controversies regarding infantile sexuality and the oedipus complex are prevalent within and without psychoanalytic circles.
Indications and contraindications for analytic treatment
Using the various analytic theories to assess mental problems, several particular constellations of problems are particularly suited for analytic techniques (see below) whereas other problems respond better to medicines and different interpersonal interventions.
To be treated with psychoanalysis, whatever the presenting problem, the person requesting help must demonstrate
1. good capacity to organize thought (integrative function)
2. good abstraction ability
3. reasonable ability to observe self and others
4. some capacity for trust and empathy
5. some ability to control emotion and urges, and
6. good contact with reality (excludes most psychotic patients)
7. some guilt and shame (excludes most criminals)
8. reasonable self-preservation ability (excludes severely suicidal patients)
If any of the above are faulty, then modifications of techniques, or completely different treatment approaches, must be instituted. The more there are deficits of serious magnitude in any of the above mental operations (1-8), the more psychoanalysis as treatment is contraindicated, and the more medication and supportive approaches are indicated. In non-psychotic first-degree criminals, any treatment is often contraindicated.
The problems treatable with analysis include: phobias, conversions, compulsions, obsessions, anxiety attacks, depressions, sexual dysfunctions, a wide variety of relationship problems (dating and marital strife, e.g.), and a wide variety of character problems (e.g., painful shyness, meanness, obnoxiousness, workaholism, hyperseductiveness, hyperemotionality, hyperfastidiousness). The fact that many of such patients also demonstrate deficits in numbers 1-8 above makes diagnosis and treatment selection difficult.
[SIZE="2"]Technique[/SIZE]
The basic method of psychoanalysis is interpretation of the analysand's unconscious conflicts that are interfering with current-day functioning -- conflicts that are causing painful symptoms such as phobias, anxiety, depression, and compulsions. Strachey (1936) stressed that figuring out ways the patient distorted perceptions about the analyst led to understanding what may have been forgotten (also see Freud's paper "Repeating, Remembering, and Working Through"). In particular, unconscious hostile feelings toward the analyst could be found in symbolic, negative reactions to what Robert Langs later called the "frame" of the therapy -- the setup that included times of the sessions, payment of fees, and necessity of talking. In patients who made mistakes, forgot, or showed other peculiarities regarding time, fees, and talking, the analyst can usually find various unconscious "resistances" to the flow of thoughts (sometimes called free association).
When the patient reclines on a couch with the analyst out of view, the patient tends to remember more, experience more resistance and transference, and be able to reorganize thoughts after the development of insight -- through the interpretive work of the analyst. Although fantasy life can be understood through the examination of dreams, masturbation fantasies (cf. Marcus, I. and Francis, J. (1975), Masturbation from Infancy to Senescence) are also important. The analyst is interested in how the patient reacts to and avoids such fantasies (cf. Paul Gray (1995), The Ego and the Analysis of Defense). Various memories of early life are generally distorted -- Freud called them "screen memories" -- and in any case, very early experiences (before age two) -- can not be remembered (See the child studies of Eleanor Galenson on "evocative memory").
Variations in technique
There is what is known among psychoanalysts as "classical technique," although Freud throughout his writings deviated from this considerably, depending on the problems of any given patient. Classical technique was best summarized by Allan Compton, MD, as comprising:
1. instructions (telling the patient to try to say what's on their mind, including interferences)
2. exploration (asking questions)
3. clarification (rephrasing and summarizing what the patient has been describing)
4. confrontation (bringing an aspect of functioning, usually a defense, to the patient's attention)
5. dynamic interpretation (explaining how being too nice guards against guilt, e.g. - defense vs. affect)
6. genetic interpretation (explaining how a past event is influencing the present)
7. resistance interpretation (showing the patient how they are avoiding their problems)
8. transference interpretation (showing the patient ways old conflicts arise in current relationships, including that with the analyst)
9. dream interpretation (obtaining the patient's thoughts about their dreams and connecting this with their current problems)
10. reconstruction (estimating what may have happened in the past that created some current day difficulty)
Clearly, these techniques are primarily based on conflict theory (see above). As object relations theory evolved, supplemented by the work of Bowlby, Ainsorth, and Beebe, techniques with patients who had more severe problems with basic trust (Erikson, 1950) and a history of maternal deprivation (see the works of Augusta Alpert) led to new techniques with adults. These have sometimes been called interpersonal, intersubjective (cf. Stolorow), relational, or corrective object relations techniques. These techniques include:
1. expressing an experienced empathic attunement to the patient
2. expressing a certain dosage of warmth
3. exposing a bit of the analyst's personal life or attitudes to the patient
4. allowing the patient autonomy in the form of disagreement with the analyst (cf. I.H. Paul, Letters to Simon.)
5. explanations of the motivations of others which the patient misperceives
Finally, ego psychological concepts of deficit in functioning led to refinements in supportive therapy. These techniques are particularly applicable to psychotic and near-psychotic (cf., Eric Marcus, "Psychosis and Near-psychosis") patients. These supportive therapy techniques include:
1. discussions of reality
2. encouragement to stay alive (including hospitalization)
3. psychotropic medicines to relieve overwhelming depressive affect
4. psychotropic medicines to relieve overwhelming fantasies (hallucinations and delusions)
5. advice about the meanings of things (to counter abstraction failures)
The notion of the "silent analyst" has been made into negative propaganda against analysis. Actually, the analyst listens in a special way (see Arlow's paper on "The Genesis of Interpretation"). Much active intervention is necessary by the analyst to interpret resistances, defenses creating pathology, and fantasies that are being displaced into the current day inappropriately. Silence and non-responsiveness was actually a technique promulgated by Carl Rogers, in his development of so-called "Client Centered Therapy" -- and is not a technique of psychoanalysis (also see the studies and opinion papers of Owen Renik, MD).
"Analytic Neutrality" is a concept that does not mean the analyst is silent. It refers to the analyst's position of not taking sides in the internal struggles of the patient. For example, if a patient feels guilty, the analyst might explore what the patient has been doing or thinking that causes the guilt, but not reassure the patient not to feel guilty. The analyst might also explore the identifications with parents and others that led to the guilt.
Although single-client sessions remain the norm, psychoanalytic theory has been used to develop other types of psychological treatment. Psychoanalytic group therapy was pioneered by Trigant Burrow, Joseph Pratt, Paul F. Schilder, Samuel R. Slavson, Harry Stack Sullivan, and Wolfe. Child-centered counseling for parents was instituted early in analytic history by Freud, and was later further developed by Irwin Marcus, Edith Schulhofer, and Gilbert Kliman. Psychoanalytically based couples therapy has been promulgated and explicated by Fred Sander, MD.
Psychodrama
Psychodrama is a form of drama therapy which explores, through action, the problems of people. It is a group working method, in which each person becomes a therapeutic agent for others in the psychodrama group. Developed by Jacob L. Moreno, psychodrama has strong elements of theater, often conducted on a stage with props.
Psychological uses
In psychodrama, participants explore internal conflicts through acting out their emotions and interpersonal interactions on stage. A given psychodrama session (typically 90 minutes to 2 hours) focuses principally on a single participant, known as the protagonist. Protagonists examine their relationships by interacting with the other actors and the leader, known as the director. This is done using specific techniques, including doubling, role reversals, mirrors, soliloquy, and sociometry.
Psychodrama attempts to create an internal restructuring of dysfunctional mindsets with other people, and it challenges the participants to discover new answers to some situations and become more spontaneous and independent. There are over 10,000 practitioners internationally.
Although a primary application of psychodrama has traditionally been as a form of group psychotherapy, and psychodrama often gets defined as "a method of group psychotherapy," this does a disservice to the many other uses or functions of the method. More accurately psychodrama is defined as "a method of communication in which the communicator[s] expresses him/her/themselves in action." The psychodramatic method is an important source of the role-playing widely used in business and industry. Psychodrama offers a powerful approach to teaching and learning, as well as to training interrelationship skills. The action techniques of psychodrama also offer a means of discovering and communicating information concerning events and situations in which the communicator has been involved.
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Sarfraz Mayo
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