The Use of Autobiography in Therapy: A Gestalt-based Approach
by
Jennifer
A. Jilks , B.A., B.Ed., M.Ed.
Faculty of Behavioural
Sciences,
Yorkville University
for
PSYC 6153-07F-C
Psychodynamic
and Humanistic Modalities
Dr. M. A. Munteanu, Professor
[Introduction | Theoretical
Perspectives | Implications for Clients |
Implications for Therapists | Strategies | Conclusions
| References]
Introduction
This paper is an exploration of a Gestalt approach in the therapeutic
process with seniors, as incorporated in the field of autobiography. My work
with seniors (Jilks, 2007a) has led to this avenue of research, which I hope to
apply to future practice. An increasing population of seniors has required that
we rethink the demands made upon the health care system and better prevent
mental health issues, rather than remediate them. Recent research (Canadian
Broadcasting Corporation, 2007), and government policy agenda (LHIN, 2007) in
the area of Aging at Home will mean that with seniors no longer be requiring
Long-Term Care (LTC) homes, require some support to physically, socially and
emotionally manage their lives in their own homes. It is apparent from Canadian
research (Fenton, Cole, Engelsmann, & Mansouri, 1994) that older clients
suffer silently from depression. This paper will present a strategy to combat
the vagaries of old age, allow the senior to taste, embrace and revisit their
lives, and present the benefits of the treatment afforded by a Gestalt-based
autobiographical process.
The benefits of new techniques to utilize a modern concept of autobiography are presented beginning with theoretical perspectives, implications for clients, implications for therapists, and conclusions from the research. I will refer to the therapist using the female gender, the client the male, to simplify this work and make clearer the dance of therapist and client
Theoretical
Perspectives
The early work of psychoanalysts, behaviourists, and Gestalt therapists,
has influenced more recent developments. The field of psychodynamic and
behavioural models of therapy has reformed with new post-modern knowledge,
thought, research and understandings. The Gestalt approach to therapy was
influenced by revolutionary changes in science, philosophy, religion,
psychology, art, literature, and politics (Yontef & Jacobs, 2008). Client-centred
and Gestalt therapy demands that the therapist responds with congruency to the
client, in a team-based approach. The therapist is taken off her pedestal and
the client was removed from the couch, with client-generated data being seen as
valuable and intrinsic to the therapeutic process. This approach has been both
experimental and subjective, something new to the psychological world that had
striven to become more objective, scientific, and accepted in a world peopled
by those who espouse clinically-based experiments to prove their work.
As Yontef said (1993) there are no ŌshouldsÕ in therapy. Gestalt therapy
is a process-based therapy that focuses on perceptions, feelings and action. It
is crucial that a dialogue be created between therapist and client. The
phenomenology in the client-therapist relationship became valued within this
approach. In this dialogic therapeutic relationship the therapist is given
license to feel what the client feels, without losing herself in the process
(Yontef & Jacobs, 2008). The therapist recognizes the client as being
other, but accepting that as the therapist studies the client, she will be
changed in the process. In this respect, the relationship mimics that of the
student and teacher. During this relationship both will be changed and will
learn through the challenges or demands required by a unique individual who
requires individual and unique strategies.
Yontef (1993) states four requirements for therapeutic relationships:
inclusion, presence, commitment to dialogue, and dialogue that is lived. For
those for whom dialogue is difficult, Gestalt techniques can incorporate
various facets of the arts: drama, visual art, music, movement, sand play and
various means by which the therapist engages the client. In Gestalt therapy the
client is encouraged to move towards self-realization using internal and
external senses, to be self-responsive and self-supportive. Existential
therapy, such as the Thematic Apperception Test, the empty chair technique, and
other work designed to focus on the here and now, and on human
interrelationships, focuses work on directly experienced suffering in the
present in an open-ended Gestalt practice (Yontef & Jacobs, 2008).
For clients, family members and therapists reading and writing autobiographies
have been found to be helpful in understanding issues, and clarifying courses
of therapy (Sommer, 2001). To that end, there are publications that have resource lists
of autobiographies available for those who suffer from mental health issues
(Norcross, Sommer, & Clifford, 1998). Sommer advocates for the sharing
of stories on the part of clients. Stories can offer us consolation for suffering
and, rather than aiming for happy endings, they help us work through our present
reality, as it is shaped by our past. It is an active reconstruction that
integrates past and present to develop optimism for the future. It helps the
client to restore, maintain or enhance a sense of personal meaning and facilitates
two meaning-making processes: transcendence, to rise above a current situation
and to transform, through cognitive restructuring.
Implications
for Clients
Bacigalupe (1996) suggested that fostering written autobiographical
responses by the client is a creative response for institutional, cultural,
ethnic, class and gender discrimination. Rather than the therapist writing
about the client, she can engage the client in a dialogue unfiltered by the
language of academia, and give the client his voice. In post-modern family
therapy, this infuses the therapeutic relationship with more equality, making
the client and therapist co-participants in the process. Some therapists use a
letter writing approach (Bastien,
& Jacobs, 1974; McAllister & Wolff, 2002).
In education it has become tradition, if not expected practice, to
require students to write journals (Jilks, 1998; Jilks, 2005; Jilks, 2006).
Much can arise from journaling in that the writer can open up, with uncensored
freedom, to develop thoughts and reveal emotions in a safe manner, much in the
way that reading a suspense novel is much less scary than viewing a movie in
its raw, bleeding colour. The benefits of journal writing, aside from the
expectation of literacy, provide much in the way of therapy. Adams (1990) found
that self-expression, stress reduction, and stronger relationships could result
from journal writing. In the safety of the client-therapist relationship a
client can pursue issues, create dialogues, freeze-frame emotional events,
explore roads not taken, and imagine goals.
In an exploration of existential predictors of psychological well-being
Fry (2000) explored expressions of well-being with frail seniors. Health
complications of the frail elderly have been the topic of an increasing number
of funding dollars (LHIN, 2007). Prevention of cognitive disabilities includes
keeping the mind alert, as well as physical exercise to keep the body healthy.
The situation of the aged holds a special difficulty for those who have lost
some meaning in their lives: loss of relationships (at work, or the loss of a
spouse), work productivity, financial conditions of retirement and old age, the
inability to be as mobile, as well as physical demands of the aging process,
with a loss of choice of home or activities that results in a frustration that
is palpable in Long-Tern Care group settings. Fry found a significance of an
existential paradigm that incorporated religious activity, private prayer, and
an affirming psychological and spiritual wellbeing.
Implications for Therapists
For some clients for whom face-to-face discussion is difficult, and
social interaction has been an issue, the field of the arts presents a safe
vehicle for an exploration, while helping the therapist better understand the
client. For others, auditory, visual or kinesthetic learners, allowing the
client to rehearse or present their stories on paper, using multi-media or
visual arts, presents an
opportunity to begin a session feeling comfortably prepared.
Stone (n.d.) lists 45 therapies and the 72 methods
of counselling in which one can be trained. There are many choices for the
therapist who wisely keeps a portfolio of choices from which to begin engaging
the client. Traditionally the therapist has spent her time writing about
the client, rather than to or for the purpose of engaging responses. The
purpose of writing has been to prescribe, educate, communicate and clarify
directives, or post-session information for a team or a report. Writing for, to
and with the client holds promise for exploring the clientÕs psychological
well-being.
Over time, before free access to writing materials, humans have told and
retold their stories through myths and legends around campfires. Shamans used
tools and storytelling techniques to help teach and as tools to educate. First
Peoples legends retell stories of their nation (Canadian Museum of
Civilization, 2001). These stories allowed humans to revisit, and restore peace
and harmony to their world, to re-examine and dramatize the human condition.
The telling of an autobiography helps the client find a firmer footing in the
present, as he is able to look back and differentiate between past and present.
It is through keeping meaning in our lives that we find a meaningful
existence. To restore meaning
requires that the therapist find a technique by which we value our existence.
The client and the therapist become pattern-makers (Epston, 1986), changing
from pattern-finders as the view of history helps the client understand his
present. Using this process the therapist need not consider: if a client reads
files and clinical notes, would he understand or appreciate what I have
written? With the client co-writing his story, it becomes more authentic and
transforms the therapeutic relationship, reframing the process.
Part of the work with clients includes work with their families. As a
caregiver for parents in palliative care, work must be undertaken with this
group of individuals. For seniors with dementia, there is impact on the senior,
as well as the family, who might have to advocate for those who cannot speak
for themselves. Using autobiography can help caregivers engage in reflexive
dialogue, share care planning, and work through the bereavement process to
construct emotional and physical care strategies in a negotiated clinical
response to current life situations (Keady, Ashcroft-Simpson, Halligan, &
Williams, 2007). Reflexive accounts, such as the aforementioned, assist the
client (in this case the daughter as caregiver) to identify issues that concern
professionals involved in the palliative care process. Integrating narrative
approaches helps client and therapist negotiate new ways of working in mental
health care.
Clark (2004) found that early recollections are widely integrated in
personality and innovative directions are being included in investigations into
recollections, cultural differences, and early memory metaphors that all add to
the reference points available to the analyst. OÕReilly and Edgar (1987) offer
a five-phase Therapeutic Memoir Technique to confront and reinterpret mistaken
beliefs and shape the therapeutic process: Introductory, Exploration,
Confrontation, Reinterpretation and Redirection, using photographs from the
formative years to illustrate constructs in early recollections. These
photographs can be used to shape writing practice, or enable those with limited
writing skills, to work with a therapist in a different medium.
Strategies
Using journal prompts (Jilks, 2006) the client can identify issues they
would like to explore. Several writers, including Goldberg (1986, 1990, &
1993), recommend 5 minute timed writings during which time the writer responds
to a prompt until the time is exhausted. This type of writing opens up the mind
to inner feelings and emotions, without censorship or criticism. The client
must be guided to let go of concerns around the mechanics of writing, i.e.,
spelling, penmanship or grammar, to simply produce a free-flowing thought.
While some clients are asked to report and record data to the therapist
(Bacigalupe, 1996), this type of writing, which may be autobiographical in
nature, demands something more from the client. This empowers the client and
gives them ownership of the process.
There are several methods from which to choose, i.e., Epston, 1986. A widely popular text, The Freedom
Writer's Diary
(Gruwell, 1990) demonstrates the beauty and simplicity of sharing our stories
and the therapeutic benefits and the self-confidence that ensues as the facilitator
can accept and better understand life experiences of the writer in a Gestalt
approach. It opens up the inner imaginings to both client and therapist, as
they take their journey together along the path of self-discovery.
Traditionally, writing in the elementary panel has consisted of creative
writing assignments that do little to produce personal narratives. As adults
most of our writing is expository, rather than narrative. Writing about life
experience brings the best of both worlds. Autobiography gives meaning and
place to experiences and firmly guides a process. Blogs have become a frequent
practice for seniors who want to share their life experiences (Garfield, 2007).
The therapist is wise to tap this strategy previously used by the young, to
assist those in their twilight years to share ideas, explore their feelings and
communicate. For this reason, some educators are taking the process further by
the addition of e-portfolios. In projects, such as Ice storm Õ98 (Jilks, 1998), students can write
for a purpose, communicate their feelings, fears, beliefs and experiences in a
safe, supervised environment. The writing process is a monologue that can
illuminate and provide a therapeutic release (Ontario
Ministry of Education, 2002) especially if used in conjunction with
graphics and self-chosen illustrations that give time, colour, and place to our
experiences.
Gutheil and Chernesky (2006) recommend a service-learning partnership between
seniors and students studying geriatrics. Benefits accrued by having young
people develop more positive attitudes and understandings of seniors. Having
these students assist the senior in creating an autobiography as an effective
means of promoting collaboration between the generations.
Conclusions
There is much published in the use of Gestalt-based work in art therapy
(Sterns Books n.d.), psychodrama (Blatner, 2007), music therapy (Ashida, 2000;
Bennett, & Maas, 1988; Lord, & Garner, 1993; Pollack, & Namazi,
1992) as metaphors of experience. It has been twenty-eight years since I last
explored the field of psychology, sociology and the work of the
existentialists. In hindsight, during my work as educator, writer (Jilks,
2007b) and researcher, it is apparent in the field of education that there is a
profound influence in curriculum strategies from these fields. In the 70s we
incorporate work in self-esteem and self-concept as our knowledge increased in
devises methods to allow students to feel confident enough to take risks and
participate thoroughly in the learning process (Canfield & Siccone, 1994).
Over the years it has become acceptable and laudable for educators to do work
with students in the areas of self-concept, self-esteem (Ontario Ministry of
Education, 2004). My work with a Reading Buddies Program (Jilks, 2004) provided
some basis for this type of work. It is possible to apply this knowledge and
research to the seniorÕs population and integrate a holistic approach to case
management. More work is required in issues such as the abuse of the elderly
(Canadian Broadcasting Corporation, 2007). My premise is that autobiographical
work can prevent, work through, or diagnose such issues.
One could take this process further using multimedia (Jilks, 2007a;
Kadjer, 2003) to create an autobiography based on scanned photographs, creating
movies with music, poetry and other personally meaningful artifacts, to
redefine the present self. Recently, life-changing events, such as funerals and
weddings, have included slideshows with family photographs. It would seem more
logical to celebrate oneÕs life before the time of bereavement to celebrate a
life well-lived.
Further research is required to further refine and develop this
process-a topic for another paper. As humans take part in their quest for
meaning, therapists can faciliate a process, created for individual clients, to
ensure that healthy seniors may improve their quality of life. I have learned
much in the course of this research and laud the opportunity to further develop
my knowledge base.
References
Adams, K. (1990).
Journal to the self: Twenty-two paths to personal growth - open the door to
self-understanding by reading, writing, and creating a journal. New York: Warner
Books.
Ashida,
S. (2000). The effect of
reminiscence music therapy sessions on changes in depressive symptoms in
elderly persons with dementia. Journal
of Music Therapy, 37, 170-182.
Bacigalupe,
G. (1996). Writing in therapy: A participatory approach. Journal of Family
Therapy, 18(4),
361–373.
Bastien,
S., & Jacobs, A. (1974). Dear Sheila: An experimental study of the effectiveness
of written communication as a form of psychotherapy. Journal of Consulting
and Clinical Psychology, 42, 151-162.
Bennett,
S. L., & Maas, F. (1988). The
effect of music-based life review on the life satisfaction and ego integrity of
elderly people. British Journal
of Occupational Therapy, 5, 433-436.
Blatner,
A. (1997). Psychodrama: The state of the art. The Arts in Psychotherapy, 24, 23-30.
Canadian
Museum of Civilization (2001). Storytelling: The art of knowledge. Retrieved December 15, 2007, from www.civilization.ca/aborig/storytel/introeng.html
Canfield,
F., & Siccone, F. (1994). 101 ways to enhance student self-esteem. USA: Allyn & Bacon.
Canadian
Broadcasting Corporation (2007). The Sunday edition podcast, October 28, 2007. Retrieved
October 29, 2007, from www.cbc.ca/podcasting
Epston,
D. (1986). Writing your biography.
Family Therapy Case Studies, 1, 13-18.
Fakouri,
M. E., & Hafner, J. L. (1984). Early recollections of first-borns. Journal
of Clinical Psychology, 40, 209-213.
Fenton,
F. R., Cole, M. G., Engelsmann, F., & Mansouri, I. (1994). Depression in
older medical inpatients. International Journal of Geriatric Psychiatry, 9, 279-284.
Fry,
P.S. (1991). Individual differences in reminiscence among older adults: Predictors
of frequency and pleasantness ratings of reminiscence activity. International
Journal of Aging and Human Development, 33, 311-326.
Fry,
P. S. (2000). Religious involvement, spirituality and personal meaning for
life: Existential predictors of psychological wellbeing in community-residing
and institutional care elders. Aging & Mental Health, 4(4), 375-387.
Garfield, M. (2007). My momÕs blog. Retrieved December 8, 2007 from http://mymomsblog.blogspot.com/
Goldberg, N. (1986). Writing
down the bones: Freeing the writer within, Boston: Shambhala.
Goldberg, N. (1990). Wildmind: Living the writerÕs life. New York: Bantam Books.
Goldberg, N. (1993). Long quiet highway. New York: Bantam Books.
Goldberg, N. (2002). Top of my lungs: Poems and paintings. New York: Overlook Press.
Gutheil, I. A., & Chernesky, R. H. (2006). Influencing student
attitudes toward older adults: Results of a service-learning collaboration. Educational
Gerontology, 32,
771-784.
Gruwell, E. (1999). The freedom writerÕs diary. New York: Broadway Books.
Hester,
R. L. (2004). Early memory and narrative therapy. Journal of Individual
Psychology, 60(4),
338-347.
Jilks, J. (1998). Ice storm Õ98. Retrieved December 8, 2007 from www.jilks.com/icestorm.html
Jilks,
J. (2004). Reading buddies: 2003/4. Retrieved December 16, 2007, from www.jilks.com/articles/ReadingBuddies.htm
Jilks, J. (2005). Literacy and technology infusion: Multimedia
projects for teachers and students. Retrieved December 8, 2007 from www.aace.org/newdl/index.cfm?fuseaction=Reader.ViewAbstract&paper_id=20087.
Jilks, J. (2006). Literacy strategies. Retrieved December 8, 2007 from www.jilks.com/portfolio/Literacy.html
Jilks, J. (2007a). Aging at home project strategy. Retrieved November 30,
2007 from www.jilks.com/Aging
Jilks, J. (2007b). Article publication list. Retrieved December 15,
2007, from www.jilks.com/articles.html
Kajder,
S. (2003). The tech savvy English classroom. Portland, ME: Stenhouse.
Keady,
J., Ashcroft-Simpson, S., Halligan, K., & Williams, S. (2007). Admiral
nursing and the family care of a parent with dementia: using autobiographical
narrative as grounding for negotiated clinical practice and decision-making. Scandinavian Journal of Caring Science,
21, 345-353.
LHIN
(2007). North Simcoe Muskoka Local Health Integration Network: Aging at home
project. Retrieved December 5, 2007, from www.nsmlhin.on.ca/Page.aspx?id=1536&ekmensel=e2f22c9a_72_256_btnlink
Lord,
T. R., & Garner, J. E. (1993). Effects of music on AlzheimerÕs patients. Perceptual and Motor Skills, 76, 451-455.
McAllister,
C. H., & Wolff, M. C. (2002). Letters never sent: Tending to unfinished
business. Journal of Poetry Therapy, 15 (4), 187-193.
Ontario
Ministry of Education. (2004). Me read? No way! A practical guide to improving
boyÕs literacy skills. Retrieved December 15, 2007, from www.edu.gov.on.ca/eng/document/brochure/meread/meread.pdf
Norcross, J. C., Sommer, R., & Clifford, J. S. (1998). A
bibliography of mental patients autobiographies. American Journal of
Psychiatry, 55,
1261-1264.
O'Reilly,
B., & Edgar, T. (1987). Therapeutic memoir technique. Individual
Psychology: The Journal of Adlerian Theory, Research & Practice, 43(2), 148-159.
Pollack,
N. J., & Namazi, K. H. (1992). The effects of music participation on the
social behaviour of AlzheimerÕs disease patients. Journal of Music Therapy, 29, 54-67.
Sommer,
R. (2001). The use of autobiography in Psychotherapy. Conference paper of the
American Psychological Association. August 24-28, 2001. ERIC Document
Reproduction Service No. ED458455
Sterns
Books. (n.d.) Art therapy resource book list. Retrieved December 3, 2007, from www.sternsbooks.com/art.therapy.pdf
Stone, J. D. (n.d.). I am university. Retrieved December 8, 2007, from www.iamuniversity.ch/Counseling-Manual-Intro?artpage=3
Yontef, G., & Jacobs, L. (2008). Gestalt therapy. In R. J. Corsini & D. Wedding (Eds.), Current
psychotherapies (8th
edition) (pp. 328-367). Belmont, CA: Brooks/Cole – Thomson Learning.
Yontef, G. (1993). Gestalt therapy: An introduction. Retrieved December 8, 2008, from www.gestalt.org/yontef.htm
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