For the friends & clients who have asked for this work & for those who need some hope to keep going…

 

Know that there are always options. A therapist who works with the body and mind can make a huge difference

Please share this post with people that may benefit from an understanding of bodywork, particularly yoga and how it is effective in the treatment of trauma. This article also explains the integrated work of Gestalt Psychotherapy.

 

BECOMING WHOLE AGAIN

TRAUMA, YOGA & PSYCHOTHERAPY

 

 

The momentum for this literature review has grown out of my direct experience of childhood trauma and the deeper transformation that has occurred through my engagement in supported relationships and the somatic practice of yoga. This early experience has taken me on a profound journey personally and professionally, facilitating an interest in the mind and body connection and introducing me to a career as a yoga teacher and Gestalt Psychotherapist. Since embarking on these career paths, I have repeatedly witnessed the healing qualities of yoga. I have also engaged with scholarly research that demonstrates the ways in which yoga has been an effective body process for people with trauma (Caplan, Portillo, & Seely, 2013). This witnessing and research has reminded me of the embodied processes that exist in the foundations of Gestalt methodology. Specifically, the use of the body to access direct experience and raise awareness. My personal and professional engagement with yoga has also increased a curiosity on how Gestalt’s relational approach adds safety for the clients to have new experiences. My personal observation combined with the review of literature has also increased a dissatisfaction of other current treatments and empirical studies in trauma therapy that appear to focus predominantly on “top–down” or “talk” (van der Kolk, 2014, p.3) therapies and pharmacological treatment without the systematic inclusion of body process. This curiosity and dissatisfaction has offered an opportunity to explore the current research on yoga and Gestalt and how it may influence the progression of both fields. Therefore, this review will concentrate on literature that is pertinent to trauma, yoga and its approach to working with trauma. It also highlights Gestalt psychotherapy’s methodology as an effective integrated and embodied approach to working with trauma clients.

This literature review is divided into three sections. The first section defines and describes the meaning of trauma. This includes a discussion on the consequences that trauma has on an individual’s life, including the relational, physiological and somatic responses. The second section describes yoga’s history and philosophy. It explores the embodiment process which is embedded in yoga, followed by an exploration on how yoga supports the work of trauma. The third section emphasises Gestalt therapy as founded on an experiential, phenomenological and relational methodology, paying regard to Gestalt therapy and illuminating the aspects of Gestalt therapy that make it an integrative and body-inclusive therapy. It introduces Gestalt therapy and looks to the phenomenological and contact processes. This section then identifies how Gestalt Therapists work with people who have experienced trauma, through body process work. Finally, this literature review presents a summary on the key components of the literature on Trauma, Yoga and Gestalt Psychotherapy concluding with recommendations for further research.

 

TRAUMA

Human beings are tender creatures. We are born with our hearts open and sometimes our hearts encounter experiences that shatter us. Sometimes we encounter experiences that so violate our sense of safety, order, predictability and right, that we feel utterly overwhelmed – unable to integrate and simply unable to go on as before. Unable to bear reality. We have come to call these shattering experiences trauma. None of us are immune to them. (Stephen Cope as cited in Emerson & Hopper, 2001, p. xiii)

 

 

Psychological trauma refers to the intense experiences of not feeling safe in one’s own body, in relationships and experiencing the world as an inherently unsafe place to live in (Caplan, Portillo, & Seely, 2013; Emerson, 2016; Levine, 1997; Sapriel, 2009; Siegal, 2006; van der Kolk, 2014). Traumatic incidents can occur in isolation as single-event trauma, through a chronic sequence of events, or through abusive relationships (van der Kolk, 2014; Emerson, 2016). Events and circumstances that may contribute to a traumatic response include sexual abuse, terrorism, war, accidents, physical assaults, emotional neglect, illness, death and human services work (Ogden, Minton, & Pain, 2006; van der Kolk, 2014). It is the individual’s response to that particular event, not the event itself that can result in a traumatic response (Levine, 1997). The individual’s history, life stage, context, environment and available supports all influence whether a traumatic response will follow an event (Levine, 2010; van der Kolk; 2014).

Different classifications and terms have been used to categorise the different variations of trauma (van der Kolk, 2014; Emerson, 2016). Interpersonal trauma is the term used to describe the effects that are left by emotional, physical or sexual abuse with either caregivers or other adults, during formative and developing years of childhood and adolescence (Ogden, Minton & Pain, 2006; van der Kolk, 2014). The core experience of interpersonal trauma is a loss of trust in the primary relationship and it is not uncommon for this to be perpetuated in other relationships later in life (van der Kolk, 2014; Emerson, 2016; Kepner, 1995; Taylor, 2014). Post-traumatic stress disorder (PTSD) is the diagnostic term taken from the fifths edition of the Diagnostic and statistical manual of mental disorders (DSM) (American Psychiatric Association, 2013). PSTD is the predominant diagnostic tool from the medical model, and is widely associated with single-event trauma or isolated traumatic incidents that involve threatened death or serious injury (American Psychiatric Association, 2013; Rothschild, 2011; van der Kolk, 2014). As it is one of the only diagnoses of trauma in the DSM, PTSD is the most commonly known form of trauma (van der Kolk, 2014). Clinical practice and recent developments in research (van der Kolk, 2014; Rhodes, 2015) suggest that it is highly likely that interpersonal trauma also underlies the symptoms of PTSD (Taylor, 2014; van der Kolk; 2014).

According to some scholars chronic interpersonal trauma is not recognised by the predominant diagnostic system (van der Kolk, 2014). As a result, practitioners have utilised the adopted term, complex trauma or complex PTSD to support clinical presentations of this type of trauma (Cook et al., 2005; Emerson, 2016; van der Kolk, 2014). Complex Trauma presents as a deeply embedded lack of power in the context of relationships, often with exposure to chronic abuse of a sexual, physical, emotional or neglectful nature (Choi, 2016; Cook et al., 2005; Emerson, 2016). Furthermore, some scholars explain that this manifestation is deeply embedded, self-perpetuating and resistant to healing, associated with devastating and significant problems in affect and impulse regulation (Cozolino, 2006; van der Kolk et al., 2014).

 

Trauma Consequences

The consequences of trauma are physiologically, psychologically and relationally extensive (Emerson, 2015; Taylor, 2014; van der Kolk, 2014). The impact creates splits on multiple levels, leaving traces on an individual’s mind, body, emotions and psyche, and often leading to a sense of disempowerment, and disconnection from self and relationships (Levine, 2010). These splits can also be described as overwhelming experiences that are difficult to be integrated and regulated, contributing to a feeling of intolerable terror, shame or vulnerability (Ogden & Fisher 2015; van der Kolk, 2014). Instead, the individual is most likely to react in a way that perpetuates their sense of worthlessness and belief that they are not a coherent, worthy or unique person (Courtois & Ford, 2009).

Clinical practice suggests that most trauma clients hover somewhat between moments of extreme and uncontrollable arousal, flitting between helplessness, paralysis and collapse and experience’s that are difficult to be integrated (Emerson, 2015; Levine, 2015; Ogden & Fisher, 2015). Such experiences can produce the fight-flight-or-freeze response (Ogden & Fisher, 2015). The flight response evokes the sympathetic nervous system to release adrenaline and switches the senses to hyperalert, allowing the human organism to mistake the event or relational interaction as life-threatening (Ogden & Fisher, 2015; Rothschild, 2011). In this hyperalert state the heart pumps stronger (tachycardia), adrenaline is released and the body begins to shake as oxygen moves towards the muscles and internal organs to keep the body alive (Bonnell, 2016; Emerson, 2015; Ogden & Fisher, 2015). Memories and visual or sensory flashbacks can be accompanying these symptoms (Schore, 2011) making the experience intolerable. (Ogden & Fisher, 2015). In some cases, the flashbacks make it difficult for the individual to differentiate between the past and present (Rhodes et al.2016; van der Kolk, 2014).

 

 

The freeze response emerges differently and is usually associated with numbing or disassociation (Emerson & Hopper, 2011; Ogden & Fisher, 2015; Taylor, 2014; van der Kolk et al., 2014). Often a cessation of movement, an activation of the parasympathetic nervous system and a shutdown is evoked preparing the body to feign death (Ogden & Fisher, 2015). Waves of shame and despair, feelings of detachment, isolation and a sense of not me can also accompany the freeze response (Bonnell, 2016; Schore, 2009; van der Kolk, 2014). The freeze response can result in a person losing contact with the awareness of their body (Emerson, 2015; Ogden & Fisher, 2015; van der Kolk, 2014). These responses are replayed and recycled in the sympathetic and parasympathetic nervous system, with a decisive impact on one’s physicality (van der Kolk, 2014).

Extensive somatic consequences can result from unresolved trauma (Emerson, 2015; Kepner, 1987; Taylor, 2014; van der Kolk, 2014). Although, in most cases, the initial wound was predominantly psychological, physiological responses can become physical or somatic if the trauma response is chronically activate in a cyclical way (Emerson, 2015). “At the moment the retraumatization occurs, a cascade of physiological changes can take over a person, preparing them for instinctive action and flooding the body with neurochemicals related to stress such as adrenaline and cortisol” (Taylor, 2014, p. 6). It is the long-term exposure to these neurochemicals that alters the person’s nervous system and body (Emerson, 2015; Taylor, 2014; van der Kolk, 2014). Panic attacks, anxiety, chronic fatigue, skin disorders, digestive problems, endocrine disorders, autoimmune diseases, dissociation testify to clients that have presented with trauma histories (Levine, 2010; Steele & van der Hart, 2013; Taylor, 2014; van der Kolk, 2014). With so many and diverse bodily responses, it is a logical consequence that the body is actively addressed in the treatment of trauma (Kepner, 1995; Totton, 2015; van der Kolk, 2014). Recent studies in yoga and trauma suggest that it is possible to support people in becoming autonomous in regulating their systems (Emerson, 2015).

 

YOGA: The History & Philosophy

Research has started to demonstrate that the somatic approach of yoga has the potential to reduce trauma symptoms (Emerson, 2015; Emerson, 2016; Jindani & Khalsa, 2015; van der Kolk et al., 2014). Yoga is a somatic practice, and system that dates back approximately 5000 years ago and has its philosophical roots in Hinduism and Buddhism (Emerson & Hopper, 2011). Yoga is closely translated from Sanskrit[1] language, meaning “to yoke” or “to make one” and it is an integrated approach that focuses on the physicality and entire life of a person, as well as, probing the mysteries of the mind and consciousness (Desikachar, 1995; Iyengar, 1979; Satchidananda, 2013; Stephens, 2010). The earliest writings of yoga can be found in the Vedas and the Upanishads dating between 5,000 B.C. to 300 A.D, making yoga an ancient system that has survived the test of time (Desikachar, 1995; Feuerstein, 2008). These early writings, arguably written by Patanjali in the book of the Yoga Sutras (Satchidananda, 2014), influenced the first systemised form of yoga (Satchidananda, 2014). Yoga is described as an eight-limbed path in the yoga sutras, that takes a person towards the realisation of their true self (Satchidananda, 2014). The first limb, Yama is considered universal morality, Niyama is observance, Asana is posture practice, Pranayama is breath control, Pratyahara is sense withdrawal, Dharana is focussed concentration, Dhyana is meditation and Samadhi is unified consciousness (Desikachar, 1995; Satchidananda, 2014). Asana, the posture practice, is most commonly recognised in Western culture as a series of mental and physiological practices which help the practitioner reach this awareness about their true nature (Feuerstein, 2008). Whilst traditionally the system of the eight limbs was passed from teacher to student as an oral tradition (Satchidananda, 2013), this has changed through its integration in Western culture. Whilst yoga was traditionally a one on one practice, today it is more common for a teacher to facilitate a yoga class to a number of students (Davies, 2013; Desikachar, 1995). It is through asana, pranayama and meditation that the teacher will guide the class to focus on the body and breath. Attention is directed to how the body reacts or responds to the different asanas in a attentive and nonjudgmental way (Brisbon & Lowery, 2011). This focus on the breath allows for an awareness of the present moment by noticing the transitory nature of one’s momentary experience and it is this nonjudgmental attention to experience that has been shown to facilitate self-regulation (Emerson, 2015; van der Kolk et al., 2014). Regular practitioners of yoga describe a greater sense of connection to their body, heightened perception, intuition and connection to others (Cope, 1999).

 

 

A helpful step to understanding yoga is to consider the role of Embodiment (Emerson, 2015). Embodiment is a bodily way of being in the world, it is the sensate experience of the body in relation to others and the world around us. (Clemmens, 2012; Emerson, 2015). Living human bodies are fluid and constantly adapting to the environment (Emerson, 2015; Emerson, 2016). Embodiment has often been implicated as the embedded process of yoga, with many teachers interpreting the ancient texts as it being the objective of yoga (Desikachar, 1995; Iyengar, 1979; Satchidananda, 2008). In The Yoga Sutras of Patanjali, Patanjali describes this through the sutra: “Tadartha eva drsyasatma,” translated in English to, “The seen exists only for the sake of the Seer” (Satchidananda, 2014, p. 105). This sutra means that we are all individuals that have different perspectives through our embodiment (Satchidananda, 2014). In Asana, Pranayama, Mudra and Bandha, Swami Satyananda Saraswati (2008) describes the physical asanas as placing the body in positions that cultivate awareness, relaxation, concentration and altering electrochemical activity in the nervous system, inducing an embodied state. Swami Saraswati’s description is re-iterated by Deschikachar (1995) and expanded in the book The Heart of Yoga when he explains that the more yoga is practiced, the more one becomes aware of the holistic nature of our being, realizing that we are made of body, breath, mind and more.

 

Yoga & Trauma

The embodied process embedded in yoga has become increasingly pertinent in the treatment of trauma (Caplan, Portillo, & Seely, 2013; Clark et al., 2014; Davies, 2013; Emerson, 2015; van der Kolk, 2014; Levine, 2015). Yoga research has grown significantly in the past 10 years and has, for example, seen the formation of the Trauma Centre Trauma Sensitive Yoga or TSY (Emerson, 2015). TSY was founded in 2014 by the Trauma centre in Boston, America (Emerson, 2015). TSY is a stand-alone or adjunct clinical intervention and methodology for developmental, complex trauma and PTSD (van der Kolk, 2014; Emerson, 2015; Bonnell, 2016). Theoretical underpinnings of TSY look to Neuroscience, Attachment theory, Yoga, and the work of Bessel van der Kolk and Judith Herman’s trauma work (Emerson, 2016). The TSY model supports inner awareness on the mat or in the therapy chair (Emerson, 2015). Attention is given to awareness in the present moment and invitatory language of the clinician is used (Emerson, 2016; van der Kolk, 2014). In particular, TSY research reflects interoceptive changes for those impacted by trauma (Rhodes, 2015).

Recent studies on trauma sensitive yoga reflect that the overarching experience of yoga is becoming aware of one’s embodiment through interoception (Emerson, 2015; Impett, Daubenmeir, & Hirschman, 2016; Costin & Kelly, 2016; Rhodes, 2015). Interoception is the experience of our sentient self (Emerson, 2015; Rhodes, 2015). It is being aware of what is going on within the boundary of our own skin, the visceral experience of feeling something within the body, maybe a muscle contracting or stomach growling or the affect of our mood and emotions. It is awareness and a sense of being “me” (Emerson, 2015; Fowler, 2002; Tsakiris, Jajadura-Jimenez, & Constantine, 2011).

 

 

One particular yoga study on 60 women experiencing treatment resistant complex PTSD and TSY reflected improved interoception (Rhodes, 2015). This study revealed participants experienced a reintegration of a regulated nervous system, an improvement in self-regulation, feelings of self worth and an overall core sense of peaceful embodiment (Rhodes, 2015). Through TSY, participants were able to leave their historical trauma narrative behind and instead create a new narrative and sense of self in the present moment (Rhodes, 2015). They were also able to attend to a particular quality of body awareness characterised by nonjudgmental and nonelaborative awareness with an orientation of curiosity, acceptance and experiential openness (Emerson; 2015; Mehling et al., 2011; Rhodes, 2015; Rhodes, Spinazzola, & van der Kolk, 2016). This particular body awareness was made possible by working directly with present phenomena in the body and the use of clinician invitatory language (e.g., “If you like” or “when you feel ready,” “notice” or, “notice how it feels in your lower spine when you lean forward” (Emerson, 2015, p. 50). The women described an increased ability to tolerate physical and sensory experiences associated with fear, helplessness, shame and depression, which supported an increase in their ability of self-regulation (Emerson, 2016; Rhodes, 2015). The research indicates that the interoceptive and embodied states of yoga were responsible for the changes (Costin & Kelly; 2016; Rhodes et al., 2016).

As we begin to re-experience a visceral reconnection with the needs of our bodies, there is a brand new capacity to warmly love the self. We experience a new quality of authenticity in our caring, which redirects our attention to our health, our diets, our energy, our time management. This enhanced care for the self arises spontaneously and naturally, not as a responsible should. We are able to have an immediate and intrinsic pleasure in self-care. (Cope, as cited in van der Kolk, 2014, p. 265)

Furthermore, The TSY model also assumes that most trauma victims have suffered trauma in the context of relationships and therefore aims to empower the survivor through attending to relationships (Emerson, 2016).  As a result, current research is starting to reflect that the integration of TSY with ongoing psychotherapy allows for a synthesis of top-down and bottom–up processing in the relationship (Emerson, 2015). It is for this reason that Gestalt psychotherapy and its relational application encompasses an integrative synthesis of bottom-up and top-down approaches, inclusive of a nonprescritive somatic and awareness-building methodology, making it an effective approach to working with trauma (Jacobs & Hycner, 2009; Kepner, 2003; Taylor, 2014; Yontef & Schultz, 2016).

 

GESTALT PSYCHOTHERAPY

Gestalt psychotherapy was founded in the 1950’s by Fritz Perls, a psychiatrist and psychoanalyst and by Laura Perls, a psychologist with a previous career in dance and movement (Brownwell, 2010; Melnick & Nevis, 2009). Following in the work of Max Wertheimer, Wolfgang Kohler and Kurt Koffer’s Gestalt psychology, Gestalt therapy’s emergence contested Freudian theory and the inherent reductionism within its methodology (Melnick & Nevis, 2009; Sabor, 2013; Yontef, 1988; Yontef, 1993). Gestalt psychology’s work focussed on visual perception, cognition, memory and the subjective field of individuals (Sabor, 2013). Gestalt therapy, instead looked to a more holistic approach, with influences from the Gestalt psychologists, psychoanalysts, Jan Smuts holism, existentialism, Zen Buddhism and Wilhelm Reich’s somatic therapy (Brownwell, 2010; Melnick & Nevis, 2009; Sabor, 2013). Today Gestalt methodology rests on four foundational pillars (Joyce & Sills, 2010; Yontef, 1993; Wollants, 2012). The first pillar, known as field theory, is a scientific proposal adapted to a psychological theory by Kurt Lewin (Brownell, 2010). In its application to Gestalt therapy, field theory proposes that all parts effect the field, including the entire situation of the therapist, the client and all that goes on between them (Brownwell, 2010; Yontef, 1993). The second pillar, phenomenology searches for understanding through careful attention to immediate and obvious experience in the here and now (Mann, 2010; Yontef & Schultz, 2016). The phenomenological method takes into account the embodiment of the therapist and client (Clemmens, 2012). The third pillar, dialogue, refers to the relational contact that emerges between the therapist and the client (Spagnuolo Lobb, 2009). Dialogue acknowledges that the client and therapist are being affected not only by conversing, but also by the interaction of their bodies (Clemmens, 2012; Spagnuolo Lobb; 2009). A Gestalt therapist also practices the dialogical principles of inclusion and authentic presence to support the interaction of contact (Yontef, 1993). The fourth pillar, experimentation, is a way of using active, in the moment, experiential responses to support awareness and understanding of experience (Yontef & Schultz, 2016). Often, experiment may also include investigation of body awareness (Clemmens & Bursztyn, 2003).

 

Gestalt Psychotherapy & Trauma

Gestalt psychotherapy is an embodied, phenomenological and relational methodology, making it an integrated and effective approach to working with trauma (Brownwell, 2010; Kepner, 1995; Taylor, 2014; Sapriel, 2012; Yontef, 1993). It is a non-pathologising and humanistic modality that pays regard to the person and their wider world (Brownwell, 2010; Taylor, 2014). Despite the many developments in Gestalt theory and practice (Brownwell, 2010), there is limited literature directly addressing Gestalt therapy and trauma (Taylor, 2014). Nevertheless, there is much that is intrinsic through the four pillars that compliments Gestalt methodology as an effective and integrative approach to working with traumatised clients (Kepner, 1995; Sapriel, 2012; Taylor, 2014). Specifically, Gestalt therapy values growth and intrinsically supports that the human organism is constantly moving toward wholeness (Perls, Hefferline, & Goodman, 1951). As trauma clients have often learnt from their environment that full contact with their emotions, arousal and action are dangerous (Sapriel, 2012; Taylor, 2014), they have created fixed protective mechanisms and relational patterns that require splitting and disconnecting, from the bodily self as an adjustment, and hindering their growth in the process (Kepner, 1987). In working towards re-integration of their wholeness, Gestalt therapy first supports a traumatised client in establishing safety and support through the relationship and their wider environment (Kepner, 2003). By initiating and working on safety first, this supplies the necessary conditions for growth to emerge (Kepner, 2003; Sapriel, 2012). Once safety is in place, the Gestalt therapist applies a field theory attitude and works towards heightening awareness, using the phenomenological method (Taylor, 2014; Kepner, 1995), differentiation through contact and relationship (Taylor, 2014) and body awareness through the safe embodied relationship and phenomenological experimentation (Kepner, 1995).

 

 

The phenomenological method is a nonjudgmental approach that recognises, uses and clarifies immediate experience to support insight and to raise awareness in the present moment (Bar-Yoseph Levine & Levin, 2009; Husserl & Cairns, 1960; Yontef, 2012). The phenomenological method focuses on immediate experience to increase awareness as opposed to directly encouraging change (Beisser, 1970). This nondirective approach raises awareness around the client’s process and direct experience by tracking the moment by moment experiences in the therapy room (Clarkson & Cavicchia, 2013). Through immediate experience, clients learn to differentiate between what is habitually assumed, guessed or interpreted residue from past relationships (Taylor, 2014). This approach is particularly important when working with trauma clients as it is not uncommon for them to generalise associations from everyday situations to their past trauma (Kepner, 1995; Taylor, 2014). Additionally, by working phenomenologically, a therapist ensures an open nonjudgmental attitude (Taylor, 2014). The therapist remains, as much as possible, free from interpretation and assumption (Brownell, 2010). Bracketing or epoche,horizontalism and description (Brownwell, 2010; Mann, 2010; Yontef & Schultz, 2016) are the processes that allow for a suspension of prejudices and former understandings, whilst attending with equal relevance to what unfolds presently in the therapeutic setting (Staemmler, 2009). It is the combination of bracketing, hortizontalism, description and field theory that allows for the therapist and client to experience the whole field (Mann, 2010). The application of these processes necessitates everything to be of potential significance, from the words spoken or unspoken, to how the body moves, to the process that emerges as a result of the therapist and client interacting (Clemmens, 2012; Kepner, 1987). Questions are able to move away from a “why” to a “how, where and when” (Kepner, 1987; Perls, 1947; Yontef, 1993). Furthermore, this nonjudgmental approach supports clients to build rapport, trust and alleviate fears, creating a specific type of contact in the therapeutic relationship (Perls 1947; Kepner, 1995; Taylor, 2014; Yontef, 2012).

Contact is the medium for change and learning differentiation in relationship (Bar-Yoseph Levine & Levin, 2009; Jacobs, 1989; Polster & Polster, 1973). Gestalt therapy intrinsically holds that examining and investing in differentiation leads to more contact and growth in relationships (Levin & Bar-Yoseph Levine, 2012). A Gestalt therapist proposes that the self only exists in contact with the other (Ginger, 2007; Levin & Bar-Yoseph Levine, 2009; Perls, Hefferline, & Goodman, 1951), and that we grow through specific contact with others.  “Contact is implicitly incompatible with remaining the same” (Polster & Polster, 1973, p. 101). Gestalt therapy, therefore, looks at how a person either interrupts or mobilises their energy at the contact boundary (Clarkson, 2004; Polster & Polster, 1973). The contact boundary refers to how a client meets their environment or the therapist in a therapeutic exchange (Perls et al., 1951; Polster & Polster, 1973; Spagnuolo Lobb, 2009; Stawman, 2009). It is the place where a client or therapist expresses capability to come into contact (connect) with the environment or to withdraw (separate) from it (Levin & Bar- Yoseph Levine, 2009; Spagnuolo Lobb, 2009). The experience of withdrawing and contact is essential for awareness of differentiation (Levin & Bar-Yoseph Levine, 2009; Spagnuolo Lobb, 2009). It is at the contact boundary where the client experiences differentiation (Polster & Polster, 1973).

The framework highlighting how a person makes contact at the contact boundary is the contact cycle (Clarkson, 2004; Kepner, 1987; Mann, 2010; Polster & Polster, 1973; Taylor, 2014). Many different stages comprise the contact cycle, including raw sensation (data), awareness, mobilization, action, contact, satisfaction, assimilation and withdrawal (Clarkson, 2004; Polster & Polster, 1973). Gestalt therapy proposes that clients can interrupt fulfilling the contact cycle through individual creative adjustments, such as introjection, projection, retroflection, deflection, desensitization, egotism and confluence at the contact boundary (Polster & Polster, 1973; Mann, 2010; Yontef, 2012). As such, the Gestalt therapist works with the client toward raising awareness of the disruptions to contact (Ginger, 2007). Additionally, it is not uncommon for there to be a risk of deterioration at the contact boundary for trauma clients (Phillipson, 2005). Often they are extremely sensitive to contact and withdrawal due to past boundary violations, creating a need to disassociate or split at the contact boundary (Taylor, 2014). Therefore, it is imperative that safety is established first in their environment and that the contact cycle is not mechanically worked with by the therapist (Wheeler, & Axelsson, 2015). Moreover, it is the embodied therapeutic relationship that provides a safe vehicle for trauma clients to experiment with one’s contact style (Clemmens, 2012; Sapriel, 2012).

 

Body Process & Gestalt

Experiment and phenomenological enquiry are the Gestalt pillars that support therapists to use their own body in the therapy room, creating safety for clients to have emerging embodied experiences (Clemmens, 2012; Malfait & Wollants, 2009; Yontef & Schultz, 2016). A Gestalt therapist applies self as an instrument in the therapeutic process through attunement, resonance and embodiment (Clemmens, 2012). The therapist uses experimental phenomenological attunement, a receptive opening or reaching out with the senses, to any shifts that occur at the contact boundary (Clemmens, 2012; Sapriel, 2012; Yontef & Schultz, 2016). The use of the therapist’s own phenomenological experience, for example, breathing, movement or posture, supports the therapist attune to what is being created in the therapy room in a nuanced way (Clemmens, 2012). The therapist also uses their bodily sensations to feel resonance, a way of being able to stay near the client’s emerging experience and figure (Clemmens, 2012; Kepner, 2003). Where the therapist provides consistent attuning to clients, historical unmet needs will emerge and provide an opportunity at the contact boundary for a new experience to unfold (Clemmens, 2012; Kepner, 1987; Taylor, 2014). It is here that the client learns to experiment in a number of ways, gain clarity around their process and when the conditions are safe enough, the cycle of contact, assimilation and growth move towards being processed through the body (Kepner, 1987; Perls, 1992). “What is being felt cannot be denied or distanced, it exists. It is seen, heard and said” (Malfait & Wollants, 2009, p. 23). Through heightened body awareness, embodied thoughts can become completed and new insights are able to emerge (Malfait & Wollants, 2009).

 

 

Gestalt places an emphasis on the importance of body process in its methodology and practice, making it an authentic embodied approach (Kepner, 2003; Sapriel, 2012; Clemmens, 2012; Malfait & Wollants, 2009). Gestalt therapists take a field theory approach, and propose that a client’s embodiment is a representation of their experiences and of contact with their environment (Kepner, 2003). From this perspective, “the client is always embodying the situation and their history, carrying important information in their bodies” (Malfait & Wollants, 2009, p. 23). Gestalt therapists work with the whole person, being aware that what has happened to the client is connected to interactions from their wider field (Perls, Hefferline & Goodman, 1951). Furthermore, Gestalt proposes that it is the body that supports an opening to the totality of that experience (Malfait & Wollants, 2009; Perls, Hefferline & Goodman, 1951), and that it is through our embodiment that we understand the other (Clemmens, 2012; Yontef & Schultz, 2016). “We cannot relate, think, struggle, feel, know, live, other than as embodied beings” (Kepner, 2003, p.11). It is the embodied approach and the safety of the therapeutic alliance that makes Gestalt’s methodology an effective, integrative modality to support trauma clients’ risk and grow (Clemmens; 2012; Sapriel, 2012).

 

SUMMARY & CONCLUSION

The motivation for this literature review was to further my understanding of how the fields of trauma, yoga and psychotherapy interrelate. Specifically, I was curious to see how the literature may support Yoga and Gestalt therapy as effective methodologies to working with trauma. I first offered definitions and descriptions of trauma and then expanded into the multifaceted consequences of trauma, namely, the psychological, relational and physical. I explained that chronic trauma responses often result in somatic and embodied illnesses and that the logical consequence would be the body utilised in treatment. I emphasized that trauma responses most often have a relational component contributing to its development. In the next section I introduced Yoga’s history and philosophy. I noted that yoga is over 5000 years old and has survived the test of time. In this section a reflection of the embedded embodiment process as part of Yoga’s system is offered. I then introduced Yoga and its work with trauma, emphasising TSY as an evidence-based effective treatment that can be used as a stand-alone or adjunct treatment in trauma work. This section showed research suggesting that TSY supported trauma clients with heightened interoceptive awareness and a core experience of peaceful embodiment. Additionally, TSY research emphasized the relationship as being important for further integration and synthesis. I then introduced Gestalt psychotherapy as an effective integrative modality for working with trauma. An introduction to Gestalt and the four pillars was first explored. This expanded in to a brief overview on the limited literature of Gestalt and trauma. An explanation followed the overview on how Gestalt’s intrinsic methodology is an effective approach in the work of trauma. It started with safety been prefaced as the most important aspect and lead in to awareness building capabilities of the phenomenological method. I then noted that phenomenology, in its application, supports awareness of immediate experience. Particularly,  reflecting how immediate experience supports differentiation from past residue as being important for trauma clients.  Following on from phenomenology, I introduced contact as the next theoretical aspect. I noted that contact is the medium for exploring differentiation in relationship through the contact boundary. This lead in to an examination on body process and Gestalt. Here I emphasized Gestalts embodied approach and how it supports the therapist using their own body in therapy to attune to the client. I noted that through this process the client’s awareness can be heightened and the client is able to experiment with a new way of being.

This literature review has been an insightful experience, interweaving trauma, Yoga and Gestalt psychotherapy, illuminating the progressions in each field and how they interrelate. Specifically, it has reflected a plethora of literature on trauma, the devastating consequences and the increasingly obvious need for inclusion of body process work. The knowledge I gained from reviewing the literature has informed and solidified Gestalts foundational idea on the significance of using the body in treatment with trauma clients and the importance of the therapeutic relationship for further safety. Gestalt has a solid theoretical foundation that is present moment, non pathologising and integrative approach to working with trauma. Yoga also represents a present moment and non pathologising approach. My hope is to see more collaborative projects and potential research studies that synchronise Yoga and Gestalt therapy. I would also like to see further expansive literature that directly correlates Gestalt as an effective approach to working with  the body and in the work of trauma.

 

  

REFERENCES

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American psychiatric publication

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[1] Sanskrit is the ancient Indian language in which the ancient texts such as the Upanishads and Yedas were written (Desikachar, 1995)

 

 

ARTICLE WRITTEN BY KATE SCHUBERT