“Gestalt therapy defines treatment as the support that allows the individual to regain his/her capacity to live spontaneously and to spontaneously make contact with others,” observes the theorist and practitioner Margherita Spagnuolo Lobb. “Herein lies the key to individual integrity and harmony—in other words to health itself. The therapist establishes a context in which the patient can develop his/her own integrity. This context is established by means of a kind of ‘dance’ between therapist and patient. Therapy is not, therefore, just a technique that an expert implements upon a patient who has asked for help. It is rather the co-creation of an [ongoing encounter] within which values, personalities and personal attitudes towards life play a fundamental role. Two people work together to find a new way of realizing interrupted intentionalities. This is the elaborate dance that the therapist, with all his/her skills and humanity, and the patient, with all his/her suffering and desire to get better, create.”

I am struck by how clearly this formulation speaks to my understanding of clinical practice based on insights derived from improvisation in music. It is a truism among jazz musicians that theoretical considerations, at least on a conscious level, are mostly “out the window” in a moment of genuinely spontaneous creative expression, which is a mutually responsive fusion of all the voices involved into a completely unpredictable stream of new ideas.

What this entails (at least in the context of our culture) is a pretty unconventional understanding of what it means to “know what one is doing.” Given all the training and self-examination that most therapists (like jazz players) put themselves through, it is typical for a practitioner to enter each new engagement with an embarrassment of riches in terms of concepts, organizing principles, and the exhaustively mined memories of his or her previous successes and failures. Yet all of these resources must remain both ready to hand and very much in the background so that the direct encounter with “the other” can take unimpeded precedence, and the total “beings” of each of the participants involved can act on each other without the interference of limiting preconceptions of any kind. The therapist’s willingness to engage with the client in this manner facilitates a degree of “attunement” which can be supplemented by technical understanding but for which such understanding can never be an adequate substitute. The therapist, as Erving and Miriam Polster wrote some forty years ago, “plays from his own feelings, like the artist, using his own psychological state as an instrument of therapy. Naturally, just as the artist painting a tree has to be affected by that particular tree, so also must the psychotherapist be tuned in to the specific person with whom he is in touch. It is as if the therapist becomes a resonating chamber for what is going on between himself and the patient. He receives and reverberates to what happens in this interaction and he amplifies it so that it becomes part of the dynamic of the therapy…. All of [his] reactions say something about both the patient and the therapist and they comprise much of the vital data of the therapy experience.”

That today is an interesting time to be practicing Gestalt therapy is due in part to the fact that many of its foundational intuitions are now finding confirmation in the broader therapeutic field, primarily as a result of advances (a) in neuroscience, and (b) in related developmental research, particularly in studies focusing on the interactional processes characteristic of the mother-infant dyad. Many Gestaltists’ exposure to relevant issues in the latter category comes by way of the writings of the late Daniel Stern. Stern, a psychiatrist, came from a non-Gestalt background, and belonged to a lineage traceable more directly to Freud and the American psychoanalytic movement. As a result of their medical backgrounds, professional affiliations and concrete research interests, Stern and his colleagues in the so-called Boston Change Process Study Group (BCPSG) found themselves with greater access to research funding, and greater public credibility in general, than Gestalt therapists have typically enjoyed (or wanted, for the most part).

To some Gestaltists it may seem ironic that concepts characterized by Fritz and Laura Perls and Paul Goodman more than sixty years ago as representating a radical departure from psychoanalysis have more recently begun to find their way into contemporary psychoanalysis through the formulations of practitioners like Stern and his colleagues, who have put forward what amount to radical alterations to the psychoanalytic paradigm without having formally rejected it as an overarching framework. Yet their ideas, which are so consonant with the Gestalt approach, are not borrowed from Gestalt, but were arrived at by a completely different route; and because the “motivating issues” underlying the development of their approach are different from the concerns that gave rise to Gestalt therapy earlier in the twentieth century, their conclusions line up with Gestalt theory in slightly out-of-register ways, highlighting its core principles from unexpected angles.

Practitioners in the “relational psychoanalytic” paradigm that has increasingly intersected with the Gestalt prospectus in recent years have made productive use of these ideas and adapted them for their own purposes. Given the emphasis on relational considerations in contemporary Gestalt theory, my intention here is simply to allude to some of the relevant concepts in broad outline and to note their utility as supplements to the foundational elements of the Gestalt approach. Their significance to my own practice arises from their emphasis on the improvisational dimension of psychotherapy mentioned above—on the dance-like flexibility and responsiveness that therapy, like infant care, often requires. A primary orienting principle from the developmental literature is that this improvisational dimension is contextualized by a rhythmic framework of recurring expectancies, frustrations, surprises and resolutions—again, both in early development (in the form of sleep and feeding schedules and increasingly patterned cognitive-emotional interactions requiring “moments of meeting” at specific developmental junctures) and in the remedial or transformative processes of psychotherapy as it is encountered later in life. It is the caregiver’s attention to and regulation of this naturally arising framework in time that makes it possible for each party to improvise between the orderly and the chaotic, the familiar and the unconceived, the constrained and the liberated, the old and the new as the dyad (whether developmental or therapeutic) negotiates the ongoing processes of growth, integration and individuation in a fluid condition of contactful relationship.

It is thus in their approach to time that Gestalt therapy and approaches derived from dyadic infant-caregiver interactions reveal their most fundamental commonalities. Relational processes are not only dialogical; they are temporal—embedded in and unfolding over time. As is explicitly stated or tacitly implied in just about everything Fritz Perls and Paul Goodman wrote, Freud’s inattention to this “process dimension” of human experience and the therapeutic encounter is what accounts for the absence, in classical psychoanalysis, of a phenomenological orientation, and for its excavatory focus on the client’s past, which in effect sacrifices the present moment as a “locus” of examination, treatment and healing on the altar of “depth” and “meaning.” Stern and his colleagues (beginning with the psychiatrist and pioneering developmental researcher Louis Sander) have sought to remedy this deficiency by suggesting conceptual and practical revisions to psychoanalytic therapy that are uncannily consistent with the Gestalt approach. (Perhaps in another paper I will explore the relevant points of correspondence in greater detail.) One of Stern’s most fascinating contributions is his exhaustive phenomenological exploration of “the present moment” from a psychological research perspective (inclusive of but not confined to the findings of contemporary neuroscience) and his analysis of the applicability of his conclusions to relationally oriented therapeutic practice (see The Present Moment in Psychotherapy and Everyday Life).

The last thing I will attempt here is to indicate in slightly greater detail how I have found these ideas relevant to my own practice. I have mentioned above the notion, intrinsic both to early developmental processes and the therapeutic processes encountered by clients later in life, of a “rhythmic framework of recurring expectancies, frustrations, surprises and resolutions.” As an improviser in a field—music—whose “process” is also relational but whose “content” is somewhat more abstract, I find that I am particularly sensitive to phenomena associated with temporal frameworks, and that I tend to experience them in a particular way. Moreover, there is a musical component to the way I work as a therapist which sometimes facilitates a clear intuitive experience of those rhythmically recurrent configurations of “expectancies, frustrations, surprises and resolutions” that, as a result of early experiences in the mother-infant dyad, have helped to constitute a client’s unique relational patterns and idiosyncratic manner of self-regulation. Stern and his colleagues think of this complex of creative adjustments as a dynamic personal epistemology, described in their system as implicit relational knowing—i.e., a learned and/or habituated “knowing how to be with” another. Meanwhile, of course, I, too, have my own complex of creative adjustments and self-regulatory schemes, and as in any relationship these two systems of “implicit relational knowing”—the client’s and mine—sooner or later arrive at a dynamic equilibrium uniquely characteristic of the larger dyadic system (a.k.a. “our relationship”) which together they comprise.

This, to me, connotes a broader dimension of the therapeutic “frame,” which is typically understood as a set of conventions designed to establish the practical parameters of the therapeutic “working relationship.” That definition is fine as far as it goes; what I am further suggesting is (a) that, in a manner more consistent with the notion of an improvised dance, the two participants figure out a way to move and grow together in time and space, and (b) that such patterns of dyadic rhythms and recurrences—in effect, dyadic structures in time—are no less constitutive of the therapeutic process than they are of developmental processes or, for that matter, of human relational processes in general.

In his contribution to Creative License: The Art of Gestalt Therapy, Stern writes:

“We see [any given moment in therapy as part of] what we call the moving-along…. This moving-along is a fascinating process, because what it really amounts to is that [once] the client says something…the therapist really doesn’t know what [either party is going to say or do next until it actually happens]…. This means that you’ve got two people who are constantly improvising together…. [They are] co-creating where they are going to move. What one person says becomes the context that will determine in part what the other person says.

“One very interesting feature about this improvisation is its enormous creativity. The reason it’s so creative is that [improvisation] is very sloppy. You didn’t quite understand that right, or you were thinking something while you [spoke which gave your words] a different color. So there are constant derailments. And we see these derailments as an opportunity and not as an error. This is very true in mother-infant relationships [and it is equally] true in therapy relationships, because [in either case, every] error is an opportunity to learn a way to be together [arising from the process of repairing “mistakes”]. With babies, we see that every time there is an error in this moving-along process, it is a chance for the baby to learn coping mechanisms, and for the mother, too. In psychotherapy situations, [similarly,] we see these errors or derailments as creative opportunities to take a slightly different path. This is why we call the process sloppy…[and in] thinking about the improvisation, sloppiness, and creativity [involved in] this kind of process, we have found it very useful to consider dynamic system theory…. It turns out that [when] any system that is extremely complicated, with thousands of variables…tries to organize itself, [it] creates what we call emergent properties, which you can never fully explain…. In that sense, it’s unpredictable. That’s why you don’t know what you’re going to say until you say it.”

As I see it, what is co-created by the client-therapist dyad is a differently structured way of being with another in time than either party has experienced before. (This speaks to the developmental dimension characteristic of both the ontogenetic and therapeutic contexts.) What is distinctive about the therapeutic relationship—at least under ideal circumstances—is that the new “unilateral” structures generated by it are more fluid, creative and spontaneous than those the parties came in with, so that each is able to exit with both a more authentic and functional relational style and a more highly developed capacity to form such equally functional new styles as future events and relationships may necessitate. Ultimately, then (at least from this perspective), learning to improvise is what it’s all about.

* * *

I append below some relevant passages from Erving and Miriam Polster’s classic Gestalt Therapy Integrated: Contours of Theory and Practice. ~

Since the search for meaning is accorded a central [role] in gestalt theory, the real question boils down to ascertaining its rightful place. [Specifically, we] want to hear the story first and let the meaning unfold, rather than to be present with expectations of a certain significance into which all behavior is then fitted. Though the search for meaning is a human reflex, the compulsion to meaning frequently drowns out experience itself. Meaning evolves out of the sequentiality of life and the natural rhythms between experience and the attribution of meaning. In psychotherapy, [accordingly,] the symbol is most powerful when its meaningfulness arises out of experiences which exist first for their own sake and then project themselves into a natural and evident meaningfulness which helps [the patient to tie his] experiences together. In this process, the patient participates as an equal, [situating each new experience] in a new context and [among] new applications of his own [choosing], uniquely transcending the therapeutic present [and its stereotypical] search for causes, history, and meaning, meaning, meaning. This emphasis on experience itself rather than on the interpretation of experience reflects [a] spirit of protest against [the kind of] authoritarianism that entitles one person, who presumably knows more, to put something over on another person, who presumably knows less. Instead of playing intellectual guessing games, we prefer that a patient get inside his own experience, trusting that when he gets a clear sense of what is happening inside him, his own directionalism will propel him into whatever experience is next for him. His internal dynamic [only requires] recognition and re-awakening. Usually, people are only tangentially aware of what supports or adds to the richness of their own existence…. Yet [when they] are able to describe, or at least be in touch with, their own experience, [their conversations automatically] take a turn upward toward increased absorption. [It is only because such awarenesses are considered either private or trivial that we are so] frequently left with flat interactions. These interactions are flat because the personal and human [details have] been omitted or covered up…. If [these elements] were to be revealed, we would hear such remarks as “I’m scared by your question” instead of [the client] ignoring it or lying; “I’m awed by your knowledge” instead of playing one-upmanship; or even, “I’m thrilled that you like me!” instead of playing it cool. ~

The range of interaction within which the therapist’s experience is pertinent—even indispensable—to full [therapeutic] engagement is very large…. However, the advantage of utilizing the therapist’s own experience goes beyond the additive quality of including everything available in the therapy encounter. When the therapist [participates freely], he is not only making available to the patient something which already exists, he is also taking a hand in making new experiences happen which are based on himself as well as on the patient. That is to say, he becomes not only a responder and a feedback-giver, but also an artistic participant in the creation of new life. He is more than a catalyst which, [while effecting a] chemical transformation, does not itself change. The therapist does change; he becomes more open to the range of experiences which he can know firsthand, discovering with the patient what it is like to engage in the many ways which become open to them…. [Thus] it is important for the therapist to work freely [in the sense that he otherwise] risks dulling his prime instrument—himself…. [Yet at the same time, spontaneity] is no guarantee of excellence, although it is one of its hallmarks. Taste and talent are needed to work out the resolution of flow between patient and therapist which gives [full recognition to their respective] purposes and continuing interests…[because free] expression attains its fullest meaning primarily within the [context of] behavior which accepts responsibility for what follows. Whatever we do, there is always a next moment. Evading responsibility for the next moment is a way of depersonalizing. Although it allows a surface freedom, it also puts up a wall through lack of genuine concern between any two people and certainly between patient and therapist…[whereas making choices freely while remaining in contact] with the consequent concatenation of new developments…is the way to discover how one creates his own life. ~

If we are to loosen up the current system of intercommunication and return to a more native process than is presently acceptable, there are two contingencies we have to take into account. One is that the time required for good communication must be extended drastically—not an easy requirement in the time-bound culture we all know. In a culture where time, every moment of it, is at a premium, we wind up speaking in symbols and formulae which condense large hunks of experience…. The second element is that we are phobic about chaos. The movement from chaos to clarity is inherent in creativity. Chaos is frightening, though, beause there is no assurance that completion of any theme will follow. The prospect of anything which requires completion remaining incomplete is natively frustrating and painful. Furthermore, in the absence of controls, there is no telling what threatening words or acts might occur during the chaotic phase. This is also a serious source of threat to those people who are [in one form or another currently] engaged. Chaos is disruptive of any system which is already set. It reaches beyond current moral standards, beyond the familiar means of coping, and invites new solutions, new configurations and new viewpoints. When people are struggling to get out of their old bags, chaos can sometimes provide the opening, even though it is scary…. In psychotherapy…the tolerance for chaos can be greater than in any other institutional form of communication, except perhaps in art forms. Through the reintroduction of chaos it is possible to restore the individual to a more free relationship between figure and ground than a blocked and programmed person may allow himself. ~

The process of moving from moment to moment reflects the existential view that whatever exists, exists only now. Flux is basic to experience, so if one can allow each experience the reality it seeks, it will fade into the background in its turn, to be replaced by whatever next has the force to appear in the foreground. Only psychological hanging on can maintain the semblance of sameness in life…. Each figural moment contributes only its share in the whole experiential process, much as a single film clip contributes one fleeting image to the uninterrupted flow of a moving picture. If the film is stopped, even though the figure is sharply in focus, the quality of liveliness disappears and we are left with a stagnant version of what might have been a vital process. The restoration of this movement through time is a pervasive theme of [Gestalt] therapy. Where this movement has gaps or when it is interrupted, life becomes awkward, disconnected or meaningless because one has lost the support of the constantly rejuvenating cycle of development and fruition which is native to the ongoing life process. [It is with this in mind that the] gestalt perspective puts a premium on novelty and change, not a pushy premium, but a faith-filled expectation that the existence and recognition of novelty are inevitable if we stay with our own experiences as they actually form. [This has been described] as a paradoxical theory of change because of the fact that change rests on the full, albeit temporary, acceptance of the status quo. Paradoxical games are not easy to play since they require profoundly artful discrimination. In accepting the status quo, that is, staying with the experience as it unfolds in its own way, the individual runs the risk of hanging on to the status quo. This is the poison inhaled by those who don’t sense when to let go and let the native process of change take over. If the letting-go process is forced, we abort the continuity which each moment naturally has with its next moment; if the letting-go process is delayed, we are interrupting this continuity. ~

Contact is not just togetherness or joining. It can only happen between separate beings, always requiring independence and always risking capture in the union. At the moment of union, one’s fullest sense of [one’s] person is swept along into a new creation. I am no longer only me, but me and thee make we. Although me and thee become we in name only, through this naming we gamble with the dissolution of either me or thee. Unless I am experienced in knowing full contact, when I meet you full-eyed, full-bodied, and full-minded, you may become irresistible and engulfing. In contacting you, I wager my independent existence, but only through the contact function can the realization of our identities develop. ~

Contact is not a quality which we are aware of any more than we are aware of the sense of gravity when walking or standing. As we sit and talk to each other, we would be aware of what we are saying or seeing or hearing, but it is unlikely that we would think of ourselves as exercising contactfulness. Our sensory and motor functions are potentially the functions through which contact is made, but it is important to remember that, just as the whole is more than merely a sum of its parts, contact is more than the sum of all the possible functions which might go into it. Seeing or hearing are no guarantee of good contact, it is rather how one sees or hears that determines good contact. Furthermore, contact extends into interaction with inanimate as well as animate objects; to see a tree or a sunset or to hear a waterfall or a cave’s silence is contact. Contact can also be made with memories and images, experiencing them sharply and fully. What distinguishes contact from togetherness or joining is that contact occurs at a boundary where a sense of separateness is maintained so that union does not threaten to overwhelm the person…. The [contact boundary, so called,] is a permeable, pulsating locus of energy…. [It] is the point at which one experiences the “me” in relation to that which is not “me,” and [at which,] through this contact, both are more clearly experienced…. [Contact thus] involves not only a sense of one’s self, but also the sense of what [looms or] impinges at this boundary, [or] even merges into it. Skill at discriminating the universe into self and not-self transforms this paradox into an exciting, choice-making experience. Customary rules are out, and artful decisions become a necessity. Do I affect a friend or let him swim in his own freedom? If, through considerations like these, we become punctilious about invading another’s psychological space, we leave them and ourselves to stew in our own juice. [Insisting on the right of the] individual to do his own thing [may leave him without an awareness of the power of his] own creative objections to the forces which will undoubtedly press in [upon him]. If one person’s freedom depends exclusively on another person’s allowing it, he loses his own sense of the power he must exercise in protecting and defining his own psychological space from natural incursions on it. Envisioning a world where freedom to act is bestowed or guaranteed rather than achieved is, regrettably, wishful thinking, utopian and non-contactful. Mastery occurs in actual contact and produces liveliness. Contact, however, inherently involves the risk of loss of identity or separateness. In this lies the adventure and the art of contact. ~

[Contact] is a dynamic relationship occurring only at the boundaries of two compellingly attractive but clearly differentiated figures of interest. The differentiation can distinguish between one organism and another…an organism and some inanimate object in its environment, or an organism and some novel quality of itself. Whatever the two differentiated entities may be, they each possess a sense of boundedness, or they could not become figural and contactable…. The boundaries of the [individual human being, his so-called] I-boundaries, are determined by the [established spectrum] of his experiences in life and by his built-in capacities for assimilating new or intensified experience. [In other words, the individual’s I-boundary represents] what for him is permissible contactfulness. It is composed of a whole range of contact boundaries [defining] those actions, ideas, people, values, settings, images, memories, and so on [with] which he is willing and comparatively free to engage [both in the context of] the world outside himself and [with respect to] the reverberations within himself that [such engagements] may awaken. It includes also the sense of what risks [the individual is willing to take, i.e., in situations where] the opportunities for personal enhancement are great [but the consequences of engaging them entail] new personal requirements which he may or may not be up to. Some people are exquisitely [attuned to the challenges and benefits of risk] because they seem to live always at what [may be] called the growing edge of their lives. For most people, [however,] the need to be able to predict the results of their actions prevents them from easily reaching beyond [their existing forms of behavior to those places] where the greatest opportunities are present. If they were to venture into unfamiliar territory, while they might gain an increased sense of excitement and power, they might lose their easy understanding and feel unprepared and alien. If confusion is impermissible, they may choose to be less venturesome; you don’t get something for nothing. ~