Laima Sapezinskiene; - PowerPoint Presentation

Laima Sapezinskiene; Lina Jurkstaite-Pacesiene and Kaylyn Kretschmer Lithuanian University of Health Sciences, Behavioural Medicine Institute, Laboratory of Psychosomatic Research The analysis of metaphors for exploring power relations in Gestalt psychotherapy

AgendaTerm ‘psychotherapy’.Notion of power relations in psychotherapy.Notion of metaphor.Research of power relations, applying metaphor analysis.

HistoryAn individual in psychotherapy was encouraged to adapt to the social pressure (social conformism) Health was understood as the fulfillment of the psychotherapist’s order to adjust to the social normsGestalt therapy “made its debut” in 1951 and became a new branch of psychotherapy, replacing a traditional, rather authoritarian form of psychotherapy

Definition of “psychotherapy”Treatment by conversation, where a psychotherapist becomes a doctor of a person’s internal problems When two people sit down to talk with each other about the subjective experience of one of them Any form of treatment, applying verbal or non-verbal communication, as a professional relationship between the client/patient and the therapist

Term “psychotherapy"Made of two Greek words “psyche“ and “therapeuo“ Psyche means ‘a human being’, ‘soul’, ‘spirit’Therapeuo means ‘to treat’ or ‘treatment ’ This word combination also defines the proces s during which the soul is treated

The psychotherapeutic process Between patient and therapist Intra- and inter-subjective processes that translate into interaction and production of affective signalizations, psychic productions and mental representations, and/or speech productionBoth processes work simultaneously, interact and influence each other, with the possibility of producing change from one axis to the other

Psychotherapy and counseling ‘Therapy’ and ‘therapy enterprise’ is used to describe the institutions, personnel, and discourses of therapyEmpowerment is at the heart of therapyThe ability of an individual to change his/her personal circumstances through therapy is dictated, limited, or moulded by ‘social power’Therapy socially controls through its direct and indirect contribution to the ‘sick role ’

Psychotherapy and power relationsClients enter therapy assuming a “powerless” positionTherapists are viewed as possessing “expert power” and the ability to solve/manage the clients’ personal problemsClients can develop reliance on this power dynamic

Power and powerlessnessPower - an individual’s ability to affect others or the potential to influence or control others, the ability to control the available resources or the consequences of eventsPowerlessness - lack of control potential, inefficiency in handling the available resources or the consequences of events Power protects us psychologically from other people’s influence Power is not an amulet that is transmitted from one person to another, it is a characteristics resulting from human interaction

Power-powerlessness scaleRespondents with a low estimates of powerlessness were more likely to depend on those who were “powerful” and vice versa:Those who were “powerful” and provided services were more likely to influence others, limit and control their behavior R espondents who felt “powerful” (i.e., had high power estimates) were “immune ” to the pressure of the situation and were able to better control their internal psychological processes as compared with those who felt “powerless ”

Power in social dynamicsPower can be used to influence and control others as well as provide liberation from the effects of external forces Social constraints or pressure is needed for people to develop the ability to think and express themselves clearly (verbally and in actions) But not limiting others through influence of power

Vertical and horizontal position in spaceLakoff and Johnson (1980) state that space and power are related by two aspects, namely vertical size and vertical positionSchwartz et al. (1982) determined that a person in a vertical position was considered as being more powerful ( high power estimate ) than the one in a horizontal position ( low power estimate )

Traditional arrangements of power in psychotherapyIndividuals having a high power estimate are subjected to less external resistance and act according to their personal beliefs and attitudes Can result in being trapped deep in their feelings C an create inharmonious situations when they start to express themselves competitively or not in accordance with personal resources Those who have a lower power estimate are subjected to more external resistance After empowerment process individuals tend to be open and act according to their specific relationship with the social environment

Metaphor as a measure of power relationsMetaphorology was introduced by Hans Blumenberg (1920–1996)The works of Blumenberg fall generally within the category of the hermeneutics of metaphorAccording to Blumenberg, metaphors are a kind of reality model, the work of human imagination Metaphors are used in Gestalt therapy

Analysis of metaphorsAccording to Foucault, the discourse of psychotherapy not only reveals but also conceals certain intentions, motivations and desires Therefore, need to explore the interactions between the client/patient and the psychotherapist and the therapeutic alliance Analysis of power and powerlessness through use of metaphors

Research contextGelso and Carters – the psychotherapeutic relationship contains feelings and attitudes that are experienced and expressed by the client and therapist Differentiate psychological categories for defining and analyzing the psychotherapeutic relationshipFeelingsAttitudesExpression of feelings/attitudes

Research challengesLack of instruments for measuring the efficacy and quality of Gestalt therapyLack of qualitative methodologies to explore interpersonal relationships (e.g., client/therapist)

Research questionsWhat is the relationship between individual power and social power in the context of psychotherapy?In particular, will a person empowered by therapy (i.e., strengthened their personal power) be able to acquire more social power (i.e., become influential to others in their environment)?

Research questions (continued)What key features of the social world immunize individuals from the dominating influence of the situations?How and where does the power of a single individual, influencing the situation, reduces another individual’s thinking and verbal expression?Are individuals having higher power less vulnerable to the influence of the social environment and are less stressed (under the effect of social tension) than those individuals who have less power (or no power at all) ?

Research objectivesTo determine how various metaphors are related to interpersonal power relations and effectiveness (outcomes) of psychotherapyTo explore the dynamics of interpersonal power relations between the client/patient and the therapist in Gestalt therapy session through the analysis of metaphors.

MethodsWithin psychotherapy, the expression of relationship is diverse and includes not only words, but also a variety of non-verbal expressions, metaphors, symbols “Theory-of-life” methodologyExamines an individuals‘ experience by determining what they did and why they did it Methods for qualitative analysis of metaphors E.g., Dialogue between client and therapist is analysed for content and metaphors are categorized by vertical dimensional scale This scale measures high/low estimates of power

Metaphors in Gestalt therapyMarkers of psychotherapeutic change (e.g., self-disclosure)Reveal the “here and now” and prevent it from being “imprisoned”Symbols contain encrypted information and serve several functionsSymptomatic – diagnostic, detecting internal conflictsTherapeutic – reconstructive, harmonizing Powers of change existing as positive and negative forces in time and space

Metaphors in Gestalt therapy (continued)Gestalt therapy is more effective when clients are empowered in the course of therapy to provide more positive metaphors and are able to adapt/integrate the therapists metaphors into their language Importance of emotional touch of content (positive vs. negative)Researchers analyze content and assess level of power according to vertical scale

Metaphors in Gestalt therapy (continued)Metaphors have different meanings and expressionsFreud (1949) expressed them through the metaphors of id, ego and superegoWinnicot (1958) used the notions of true and false selfPerls (1971) mentioned topdog and underdog

Metaphors in Gestalt therapy (continued)In Gestalt therapy, metaphors are called figuresThey allow for the establishment of contact Between the past, the present and the future and by becoming aware of the current existence Between the topdog and the underdog B etween the client/patient and the therapist .

Study methodsThe research covers 4 stages:The measurement of vertical (high “1” or low “2”) levels of the power and powerlessness The identification of metaphors during the psychotherapy sessions of the therapist and the client Analysis of metaphors Selection of therapeutic alliance and self disclosure variables Note: consent of the patient/client of psychotherapy is received for participation in the research

Methods of analysisQualitative research design uses language of client/patient and therapist during gestalt therapy session Content analysis of language is done distinguishing metaphors in vertical dimension scale of power and powerlessness

ConclusionsDifferent models of metaphors have a holistic nature and affect feelings, behaviour, cognitive interpretations and actions It is important to distinguish the levels of power and powerlessness, as it allows greater efficacy of psychotherapy

ConclusionsInfluence of the therapist’s metaphors on the clientMetaphors used by the therapist have an impact on clients’ feelings, experiences and insights and can be used to trigger changesE.g., moving from suffering and to fully realization of their lives R e -establishing memories about what has been overlooked or forgotten

Conclusions – hypothetical statementsRelationship: This concerns the relational qualities of the working alliance, and it relates directly to the gestalt therapy concepts inherent to dialogue—presence, inclusion, commitment to dialogue, and the creation of conditions permissive and conducive to dialogue

Conclusions – hypothetical statementsAnalysis of metaphors not only provides the client and therapist with reflective subject matter, but also serves to demonstrate the acceptance or non-acceptance of new interpersonal power situations and of self- and external perceptions.

Methodological conclusion: why qualitative methods and analysis of metaphors should be applied in measuring the efficacy of psychotherapy L. S. Greenberg and J. C. Watson argue that the research of psychotherapy shall be extended, by testing and reviewing theoretical presumptions and technical factors of specific psychotherapeutic treatment, so that researchers could identify the factors of active changes (Stiles et al., 2012). To do this effectively, generalized efficacy research is not enough, and it is necessary to prove the psychotherapist’s contribution, the client/patient’s contribution, and their interaction (Stiles et al., 2012).

ConclusionsThe question of whether psychotherapy worksIf something “works,” then it attains an expected effect or outcome (i.e., it functions in a desired fashion)A water bucket with holes Evidence-based practice and practice-based evidence

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