Sunday, March 10, 2013

Clinical Technique: I statements and rebus

A few years ago I read a Gestalt Therapy Verbatim. Perls analyzed some dreams by having the person talk as if they were one of the things in the dream. I think one was an old license plate in a lake and one was a woman's dress, or something. Anyway, I thought that some of the communications felt like they could be profound, but I felt like a lot of people would feel that it's ridiculous to talk as if were a license plate. So, I modified this by asking for a person to give me a few adjectives to describe a thing or person in the dream. For example, one patient noted the ledge of a building outside her window and when I asked her to describe it she said it was slippery, dangerous, ... and then I asked her to turn it into I statements and see how it felt. She said the words and said they felt right and then went on to tell me about some of her sexual relationships.

It's often surprising how anthropomorphic the descriptions of inanimate objects can be. Very rarely do I have to leave out an adjective when I ask the person to turn them into I statements.

Of course, this also works with people who appear in dreams (she's "petty, a bitch, lazy..."). It seems important to use the words as he or she says them and to not let the patient defend by arguing that one doesn't really apply. This doesn't mean to argue with them but to re-direct them to the words they feel connected with and go from there.  

There is a strong divide between egoistic and altruistic patients. Those who seem to be more egoistic it's often better to look for a rebus in the dream and break down some of the words they use into smaller words or ask the patient about the word in a new context.

For example, one patient had a dream of an anaconda snake and I asked her what came to mind when I said an-a-con-da. She said an a con dad and began to tell me about how her step-dad tricked her and her mom. He was nice when he began dating her mother but when he moved in he was mean. Another patient turned Mississippi into 'Mrs. sleepy' a nickname she received and which reinforced her self-reproaches for not working hard enough. Another egoist told me of a dream in which she opened the door for her mom and said 'after you'. I asked her how she felt about the idea of her mom being out of the picture or gone and it strongly resonated with her.

I like to approach therapy as experiments that the patient and I try out. If you follow emotions or get a sense for the patient talking about new things that he or she hasn't brought up before then you can't go wrong. However, if the patient is too regressed then he or she won't be able to make these spontaneous connections or asking them to do so is too intrusive. The horizontal split of psychic bisexuality and the vertical line of development must be considered with each patient you are working with.

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