A Tribute to Laura Perls

(The Therapeutic Support in Gestalt Therapy)

Carmen Vázquez Bandin

Abstract

Laura Perls says: "Contact is possible only to the extent that support for it is available". This phrase and other paragraphs from "Living at the Boundary" by Laura Perls provide the opportunity to relate the therapeutic support to the process of contact according to Perls/Hefferline/Goodman. This paper proposes that the therapeutic support be considered as one function of the field. Then, the author analizes the self-support not only in the patient but in the therapist also. Thi is following by some examples of case studies and finaly the conclusions are presented.

My tribute to Laura

Fritz Perls was and is the relevant figure with which Gestalt is identified. But there is no doubt that the creation of Gestalt Therapy is due, with the same intensity, to Laura (Lore) Perls and to Paul Goodman.

The contribution of Laura Perls isn't usually mentioned, nor that, at the beginning, she was involved in the development of Gestalt Therapy in a decisive way. Laura Perls brought a very concrete and different style to that of her husband.

Laura Perls committed herself specifically to three aspects of Gestalt Therapy: Support, Commitment and the bodily dimension of Gestalt Therapy.

I don't want to talk about Laura Perls' life, I don't think that it would be the best way to pay her a compliment; I think that, being one of us, she'd like to share the time speaking about some of the subjects which where her strength. I want to speak about support and more specifically, about therapeutic support.

But, before focusing on the subject, I wish to emphasize the personal capacity of Laura, the "Grande Dâme de la Gestalt", as Stella Resnick called her, for her support and "commitment", she lived what she believed. I don't want to do it with my own words, but with the personal testimony of those who knew her.

"I felt rather overwhelmed by this small person who radiated tremendous energy particularly through her eyes. Her eyes are alive, aware, searching, curious, smiling, communicating..."

(Yaro Starak)

"I remember her sensuality and her bubbly, unabashed way of showing her excitement. We talk about meditation, her early life, and gossiped about various personalities in the Gestalt community..."

(Steven Hendlin)

"Her curiosity of life and others, her child-like bewilderment, always intrigued me."

(Zelda Schemaille)

"Laura Perls for me, personifies what Buber describes as the high point of I-Thou relating `by the graciousness of her coming, and the solemn sadness of her going'".

(Eileen Abigail Wright)

"Laura was a woman gentle and graceful... with a quiet nod, a certain look, or a simple gesture, Laura supported our strivings."

(Micki Balaban)

Thank you, Laura, for having always been a basic support, essential for the growing and the development of Gestalt Therapy. Gestalt Therapy has taught me that there's not figure without a ground to contain, to sustain amd to support it; you let me really feel and experience this truth: your life was the ground, the sustained and continuous support, so that Fritz and the very Gestalt Therapy could pay their attention to the figure. Thank you for being the strength and the discretion of the continued support.

Warning

The following is a rough copy, an attempt to think aloud about a second phase of my thinking and writing process about the therapeutic support in Gestalt Therapy.

Generalities

It seems that the implicit or explicit concept of support sounds in each of us in a special way. It's one of those words which quickly evokes an emotional answer when we hear it ("I feel supported", "You didn't support me") and includes in it a term that unchains other associations of strong emotional content ("I feel abandoned"; "I need to feel you close to me", etc.)

In my opinion however, it's a concept to which we don't dedicate the attention it deserves, neither in Gestalt Therapy, nor in other therapeutic schools.

In a society like ours, in which the value of autonomy is applied and enhanced, of strength, of independence, of "do it yourself", it seems that the concept of support will become stronger, as a figure that, little by little, will take place in the conscience. And, as it happens with any sharp and clear figure, starts to activate our energies to call our attention and search how to resolve it.

It may be that our structures of personality, strongly narcissistic, are beginning to crumble in front of such auto-requirement, such strength, such dissimulation of emotions. Everywhere, you can hear speaking about the solidarity, the brotherhood, the team, the sharing... and never let to be a veiled form of searching support.

I don't want to speak generalities about the support, but about a concrete form of support: the therapeutic support, and about therapeutic support according to Gestalt Therapy.

In 1953, Laura Perls said, "Contact can be good and creative only to the extent that sufficient and adequate support for it is available".

And in Easter of 1986, she continued, "Contact orientation and manipulation is only possible when appropiate support is available. The most important concepts are boundary, contact and support, but support is the most urgent one".

Indeed, Laura, I agree with you, the support is the most important.

What is the therapeutic support for the Gestalt Therapy?

Generally, when we speak about support in Gestalt Therapy, we refer to the support in contact interruptions, but we forget that the therapeutic support is a main requirement of the field.

But when we have to centre the subject, in a way to show it with more clearness, different concepts appears to me that I had to differentiate: support for interrupted contact, support the client and support the therapist... Where does the one begin and the other finish? Are they all the same? In what way are they different?

I think that support in general is the joining of them all, but the different support concepts are at the same time nuances of that general one.

I will give an example from the Gestalt Therapy theory.

If we want to plant trees, beet or flowers or something else that needs to germinate and to grow, it's necessary to fulfil some of their basic requirements. These requirements are part of the field and correspond to these two main requirements: the seed and the earth. The seed must fulfil its own functions: remain alive, prepare itself to sprout, and so on; this corresponds to the support of the therapist. Earth and seed joined together, make the field in which the seed will grow. Both elements are essential to made the growing and the changing of the seed possible; each of them have to fulfil determinate conditions and complete determinate functions during this process. As the book of Perls, Hefferline and Goodman says: these two elements are joined, with the weight of their differences (this is the contact) ("an organism lives in its environment by maintaining its difference") will let the seed survive and the consequence of it will be the growing. And Laura Perls expresses this same idea when she says, "Contact is the recognition of, and the coping with the other, the different, the new, the strange. It is not a state, but an activity". Even if the seed is very alive, it needs the earth to sprout, the earth must receive it for having the whole development, so that it can begin to sprout on its own but without the earth it cannot complete its process. It will be received by the earth with a determinate condition and a genuine intention, this is what I consider, in therapy, the therapeutic support.

I see the therapeutic support like this, a genuine acceptance of the client; to be a privileged and safe environment where the client can take risks.

In the therapeutic process, the aim of the therapy is support the interruptions of contact, in the here and now of the session, in a way that contact can be re-established, as Laura Perls says, "the objective of therapy is to develop sufficient support for the reorganisation and rechanneling of energy". Contact isn't possible if there is no therapeutic support, indeed it is not possible to build a house if you don't count with the soil and the ground for building it.

Each therapeutic session will have its own peculiarities to allow, to strengthen and to re-establish the contact. It is necessary that the first step is support. That is what both, the therapist and the client bring in the interactive field with a series of conditions. Generally the support is all the conditions of the field, all the functions of the field. For that, the therapeutic support IS a requirement of the field, IS a function of the field. "Support is the total background against which the present experience stands out (exists) and forms a meaningful Gestalt". It's something shared, it's something the therapist must bring and something different, that the client has to bring on their own.

A journey for the self-support

Lets made a "didactic" division in a way to continue my explanation. Knowing that already the gestaltic field is "the `whole" configurations" and "is an abstraction", we can speak about three nuances of the support: the support of the client, the support of the therapist and the therapeutic support.

What is the contribution of the client and of the therapist? In a general level, the first requirement on the client's side is their necessity to grow, their motivation to "sprout", but both, client and therapist, must "be able to take risks"; also if in each session, if we follow Laura Perls, she says, "The most important function for (self) support is breathing", further down, in chapter 12, she says "(Self)support is everything that facilitates the ongoing assimilation and integration for a person, a relationship, or a society: primary physiology (like breathing and digestion), upright posture and coordination, sensitivity and mobility, language, habits and customs, social manners and relationships, and anything else that we have learned and experienced during our lifetime".

But it's obvious, that there's no equal relation, generally, the client is not able to support himself, neither in a physical, nor in a psychological way.

"I put myself in your hands"

Our basis is that the reason why the client asks for a therapy is because he/she has a problem. In my opinion, this is not the main reason. The client, actually, has a problem, but, the reason for coming to therapy is that he/she is not able to solve it on his own. He must learn to solve his conflicts. He has exhausted his possibilities and is asking for help. In this asking for help and in how to solve his problems is the key of the therapeutic process. It's the interaction of the relationship between client and therapist, in the here and now of the situation, which will make a powerful spreading possible, with the power invested in this moment to solve his conflicts in his daily interpersonal relationships. (Remember that there is no human, or personal problem, that isn't in an organism/environment field. "Let us remember that no matter how we theorise about impulses, drives, etc., it is always to such an interacting field that we are referring, the `organism/environment field', and not to an isolated animal"). This will show to the therapist, how he makes relationships, what he does to satisfy his needs, what he does to obtain from his environment all he needs, and it will show him how he fails to do this.

But when he comes to therapy, in some way, he is conscious of his fallings, of his incapacity to give an account of what he needs or for knowing how to obtain it, his self-esteem is on the ground. Not only his introjects, but also his daily incapacity to satisfy his needs (needs of recognising, intimacy, bravery,...) has reduced the faith in himself. His daily dissatisfaction produces doubts in himself.

The basic function of the therapy is to re-establish the faith in himself, the faith in his own capacities to obtain in a satisfying way his own needs. In one word, to trust in the self-regulation of the organism. So, the client will learn how to learn, especially to obtain satisfaction for his needs, learn to keep in contact with the help of the support from the therapist in every contact interruption.

Recover the faith in himself, recover the faith in his own capacities is only possible with good therapeutic support. The therapist must be able to take care of the "details" in the field. The question is not to manage or solve the client's problems, not to counsel or tell what he has to do; this will increase his lack of faith in his own means. Remember the therapy lies within his learning. To take care of the "details" means to believe in the own capacity of the client, to enhance the effort of the client, to enjoy his company, to be enthusiastic with his contributions, to see always the good and "creativeness" of his acts, accepted or not, to give power to his means, to give him limits. To support the client is to let him feel that, in the here and now of each session, "he is the only one in the world for you and you are the only one in the world for him". Afterwards everybody will go back to their daily business, to the interpersonal relationships, feeling foolish, feeling that, after all, it'll be worth to remain alive and have relationships, because after all, you'll feel loved and welcome.

The therapeutic support is for what the person is, not for what the person has, in a way to respect the purpose of Gestalt Therapy, it means, "... to train the ego, the various functions, until the sense is spontaneously revived that `it is I who am thinking, perceiving, feeling, and doing this'.".

Laura continued, "the strengthening and expansion of the support functions mobilizes the alienated emotions and potentialities for contact and makes formerly repressed depth material easily accessible".

The therapist is the therapeutic support

What specific must the therapist bring to the field of the therapeutic relationship? His own support, and the capacity to give the client the possibility to establish an adequate contact.

"Support for making contact comes from what has been assimilated and integrated". Laura continued saying, "Only what is completely assimilated and integrated into the total functioning of the organism can become support... posture, language, manners, techniques, etc...".

The therapist, like essential "earth" for the possibility to establish the contact must, on one part be able to self-support himself, believe in it and be able to give and to receive.

"The feeling of wothiness is given only by one's adequacy in an activity that is going on or in the relaxation after a completed situation... but the sentiment of one's worthiness cannot be given by explanations nor by comparison with an extrinsic standard".

When, in chapter V of Gestalt Therapy, Perls and Goodman speaks about inadequate opposition of "Infantile/Mature", I think they want to postulate in a decisive way the personal characteristics that the therapist must have: "attitude to `biding one's time', it means, "he has an organic equilibrating technique for the tension"; "attitude to hallucination", it means, living "the core of the real is the action", and capacity to change the "responsability" in "earnest", always reminding that Goodman's seriousness "is the activity to which one is committed and cannot leave off, because the self as a closer whole involved in completing a situation that involves the actuality". I want to quote textual words of Perls, Hefferline and Goodman, that seems especially beautiful to me, "... And the relationship of contact is not so much taken on as duty, as a development of the feeling for symmetry... With the stage of becoming an authority, a teacher, a parent, the field has altered again: for the independent person is now less on his own, since others spontaneously attach themselves to or depend on him simply because he has ability, and they give him in turn occasions for new outgoing acts. It is a rare person who grows as mature as this: to advise, guide, and care for without embarrassment, domination, etc.... but simply noblesse oblige, giving up his independent interests as really less interesting".

And Laura further defines these concepts and concretize this "relation of symmetry" saying that, "Give and Take... Between them they comprise the whole range of the social process, the aim of which is the balance of the social field, while growth continues".

The therapist, if he's earnest, according to Goodman's sense, "if he means to be in earnest, then he attends to the actuality of the object and his relation (the cursive is mine) to it and this is a motion of growth. An irresponsible person is one who is not in earnest about what is necessary. A dilettante plays capriciously with an art, he is pleasing himself but has no responsibility for the results; an amateur plays earnestly with the art, he is responsible to the art but he need not engage in it; an artist is earnest with the art, he is committed to it".

What can the therapist do specifically?

1st. He must be able to self-support, accept and love himself, without depending of the answer from the patient. His self-support must be "corruptionproof".

2nd. He must "let be impressed" himself by the genuine in each human being.

3rd. He must be polite: greet in a cordial way, know how to thank,...

4th. He must be able to enhance the value of the client and to keep him, give him limits in an adequate way.

5th. He must be able "to see details": let a warm smile come out, say an amiable word, let the other one feel comfortable and in confidence.

6th. His function personality must be rich and serve the therapy (not the therapy serve his vanity). Laura said, "Upright posture is the main support. Anything acquired, really learned, is support. Anything stuffed in is not".

There are three dangers in it, on the side of the therapist:

1st. To feign: due to a lack of personal support, not to be able to accept in a genuine way the other one as an "unique and unrepeatable", fascinating and attractive being. Laura said, "the sacrificer lacks self-esteem and tries to force it from the receiver, i.e., he inflates whatever he is giving or doing... As he has projected his own unrealized need for wholeness on receiver...".

2nd. To exceed and leave to be her/himself, gratifiying continuously the client. As Laura says, "Contact is the recognition of 'otherness', the awareness of difference. It is the boundary experience of 'I and the other'. I would differentiate between 'being in contact' and 'making contact'. Being in contact indicates a continuing state, which gradually tends toward indifference (confluence). Making contact is a foreground function, alert, awake, etc."

3rd. To be rigid in an excessive way, cool and authoritarian, giving advice and marking always the outdistance and the differences. Generating unequally and shame.

Gordon Wheeler says that the failure of support from the environment has shame as a consequence. In my opinion, and following this reasoning, we can say that, if there is enough adequate support from the environment, each human being obtains self-esteem as result. Autoesteem is the final product of esteem, accepting and enhancing the value of the environment. It should be a concrete application of the gestalt principle, that "thanks to contact we survive and the consequence of surviving is growing"(PHG).

"I feel abandoned by you"

Above everything support is a relation of equality. If the ground does not exist, the earth can hardly sustain me, neither can I walk, thinking always that if I haven't a skeleton, or if my muscular tone failed... I couldn't even stand up.

What is more important, the earth or my possibilities? Both are equally necessary.

The client, most part of the time, eager for support and not believing in his possibilities, react clinging himself to the therapist, try clamping to him like on the only available source of support. Reproducing an archaic way of support, the relation between carer/child.

It's the therapist who must foment the awareness process of the client, help him to commit his own capacity of self-support, to give potential to his autonomy.

Unfortunately, on many occassions, the therapist forgets this function. He forgets this relation of equality, he forgets the own capacity of the client to support himself, and move with his own unsatisfied necessities, he projects in him his abandonment and creates the relation of inequality. In this moment, the client stops being a person for the therapist and begins to be "his object". He had lost the possibility to share and to grow. Like a possessive "mother" stuffs him not with real meal, but with advices, norms, suggestions.

Some examples

It isn't simple to give specific examples of the therapeutic support, because most part of the time, these are non verbal details, which are difficult to describe and that lose their contextual qualities, but I want to talk about a very significant one that happened on a psychiatric hospital and had a specific therapeutic label.

Pilar is a clinical helper and a Gestalt therapist. She takes dinner to patient rooms. On one occasion after she left the dinner for a patient she asked the patient how she was feeling, she continued to talk to her kindly. Then the patient looked at her astonished and said: "You should not treat me like this, I am not used to it, I do not know how to cope with this."

Another example. In the first session, a client told me that her small son, Javier, had a cold. The week after, when she had her session, I asked about her son Javier, she answers that he's fine and smiles. Some time later, she told me that when she came the second time and I asked about her son, and also remembered so kindly the name, she felt moved and thought, "If she remembered my son and his name and asks me so kindly and with so much interest about him, she must feel interest and be kind also with me. I want to continue with her".

Conclusion

I would like to write more about the therapeutic support and its basic utility in the therapeutic process. But I must continue organising and giving a shape to the ideas, which come to me every day about this subject. I consider that it is a fundamental subject and I feel especially moved by it.

On this occasion, I wish to let emphasise some ideas:

- that in general support is all the functions of the therapeutic field;

- that therapeutic support is a function of the therapist/client field;

- that without support there's not contact;

- that the quality of the therapeutic support depends on the qualities of the therapist as a person like Goodman understands it.

I can't finish this paper without some words from Laura Perls as a colophon. "If we want to help our patients to realise themselves more fully as true human beings, we ourselves must have the courage to risk the dangers of being human".

Thank you.

References

- SAINT-EXUPERY, Antoine: The Little Prince, A. Dell/ Eleanor Priede, New York, 1989

- PERLS, F., HEFFERLINE, R. and GOODMAN, O.: Gestalt Therapy: Excitement and Growth in the Human Personality, The Gestalt Journal Press, Highland, 1994.

- PERLS, Laura: Living at the Boundary, The Gestalt Journal Press, Highland, 1992.

- Laura Posner Perls: at Memoriam, Website from The Gestalt Journal Press.