Wednesday, March 17, 2010

Psychoanalysis and Gestalt: A Corrective to the lineage of psychotherapies

Recently, I found a chart slipped into one of my old psychology books that shows the connections and lineage between psychoanalysis and gestalt therapy largely mediated by Wilhelm Reich. There was a rather petty movement among psychoanalysts to write Reich out of their history after he broke with them, which has made it rather awkward—not to say political—to properly record the history of psychotherapy. For example, in their important textbook, “The Psychiatric Interview in Clinical Practice,” authors Roger MacKinnon and Robert Michels confess not knowing where the approach used in their text came from, and yet that approach—describing each psychiatric disorder in concrete physical and behavioral terms—is precisely the approach that was pioneered by Wilhelm Reich in teaching psychoanalysts in Berlin in early the 1930s. (The institute in New York where MacKinnon and Michels learned this approach was founded by Sandor Rado, who happens to have been Reich’s training analyst.) For many decades, Reich was “he who cannot be named” in terms of his actual positive contributions to psychoanalytic therapy, although it was politic to dismiss him as in an article penned by Richard Sterbe who captiously argued that where Reich was original he was wrong and that where he was right, he was entirely derivative. He gave as an example a paper by Karl Abraham, “A Particular Form of Neurotic Resistance Against the Psycho-Analytic Method,” which Sterbe claims is the entire basis of Reich’s best thought. This paper can be found in “The Psychoanalytic Reader” (edited by Robert Fliess) among other places, but Fliess also includes several of Reich’s early papers, which can be used for comparison. Such a comparison of Abraham and Reich shows that Abraham’s idea of prioritizing the material to be analyzed so that the therapist analyzes the resistance before analyzing the underlying material was so tentative that the tentativeness can be seen in the verbal hedging of his title. Indeed, the idea of prioritizing the material to be analyzed—central to Reich’s character-analytic approach—is so subtly, briefly and tentatively presented in Abraham’s paper that a reader could be forgiven for not noticing it at all. It was certainly not envisioned by Abraham as an approach to be applied systematically to every single resistance. Reich may well have gotten the idea from Abraham, but his development of it was an original contribution.

(Every new idea can be wrestled into submission by arguing that it is derivative. I once heard Thomas Szasz declare that every new idea is invented when its discoverer reads about it in someone else’s work; as an example, he made the case that Freud’s work is derivative of Socrates. Put simply, there are no new ideas under the sun, but this should not prevent us from giving due credit to those who have articulated the obvious when no one else was willing to pay attention to its full implications. This is what Reich did, and he played both a creative and evangelical role in making psychoanalytic-oriented therapy into a relationship between two real human beings rather than a consultation between an immaculately objective specialist and an objectified analysand.)

My overarching interest in my previous life as a student of psychology was—obviously from my chart—the connections between psychoanalysis and gestalt therapy that I found to be too often oversimplified. Yes, Friedrich “Fritz” Perls met Freud and trained as a psychoanalyst, but there is more to it than that. There are too many differences between what one of my psychoanalytic teachers liked to call “full-dress” psychoanalysis and gestalt therapy. In fact, what my teacher was calling attention to was the difference between old-fashioned Freudian analysis and modern psychoanalytic-oriented therapy, which actually shares more in common with the gestalt approach than either shares with Freud’s psychoanalysis.

I have now forgotten who Perls trained with, but I believe he had an unsatisfactory initial analysis followed by a more satisfactory one with an analyst who may have been the one who sent Perls to finish his training with Reich. Perls also attended Reich’s teaching seminars. Thus the psychoanalysis that informed gestalt therapy was already filtered through the Reichian character-analytic approach. In parallel, character analysis played a seminal role in the development of ego psychology’s technique of “defense analysis,” which is essentially character analysis by another name. The chief difference between character analysis and defense analysis is the psycho-somatic approach of the former as opposed to the psychodynamic approach of the latter. This “body-mind” focus of character analysis was brought over into gestalt therapy but was eschewed by ego psychology where Freud’s view of the internal dynamics of the mind were transformed into a different but equally non-somatic theory. (The same could be said of other psychoanalytic-oriented theories such as “object relations.”) Perls, nevertheless, presented a psychodynamic structural model of his own in his writings, even though several critics noted that this model had little if anything to do with the practice of gestalt therapy. That seems to be because Perls was really practicing character analysis while superficially nodding toward psychodynamics.

Reich’s influence on gestalt therapy did not stop with his early mentoring of Perls, however. Perls lost contact with Reich before his former teacher transformed character analysis into orgonomy, an approach that completely subordinated talking therapy to a focus on the somatic manifestations of psychopathology; however, after both Reich and Perls came to the United States, their students, patients and colleagues had cross-fertile contacts. Principally, a patient and student of Reich, Alexander Lowen, took the writer Paul Goodman as a patient, and Goodman was also a student and colleague of Perls, as well as a patient and colleague of Perls’s wife, Lore “Laura” (Posner) Perls. The intellectually acquisitive Goodman taught Laura virtually everything that he had learned in his therapy with Lowen. Goodman, who voraciously read the writings of both Freud and Reich, persuaded Laura to import into gestalt therapy both theory and practice from Reich’s orgonomy, albeit filtered through Lowen’s practice. (Reich, for his part, disavowed Lowen’s work, and, the one time that Goodman met Reich, the poet got nothing more from his hero than Reich’s plea that he “stop writing about me.”)

Obviously the name of gestalt therapy suggests a connection with Gestalt psychology. Both Fritz and Laura Perls were junior colleagues of the psychiatrist Kurt Goldstein, who was influenced by the more purely academic Gestalt theory of Max Wertheimer, who was, in turn, one of three or so proponents of the Gestalt approach to understanding how the human mind processes visual and auditory information. Goldstein developed this idea into the "organismic" notion that the entire range of perception including proprioception as well as internal mental activity can be understood and analyzed in terms of Gestalten or “wholes.” Laura Perls also had worked directly with Wertheimer, and it turns out that her understanding of Gestalt psychology as approach to research psychology that is alien to psychotherapy led her to resist her husband’s decision to call his therapeutic innovation “gestalt therapy.” (German nouns are always capitalized, but I am putting “gestalt therapy” in all lower case because it has become an English language term.)

It should be noted that Kurt Goldstein shared a strong affinity for existentialist philosophy with Fritz Perls, and the two, seemingly independently, later referred to themselves as existentialist therapists.

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