Gestalt group therapy pdf

In view of this, it makes sense to involve the relatives who visit. The contact in the group provides a different space and experience in which to relate to each other in a qualitative person-centred way further enriching the quality of the relative-resident relationships, which may be burdened by the dementia and by the fact that the elderly person lives in a residential home. Increasingly, a greater integration between interventions for caregivers and intervention for people with dementia is being seen today.

Themes from the data were elicited and discussed. Case study generally constitutes a qualitative, interpretive approach to understanding the experiences, features, behaviours, and processes of one bounded unit. For this research, our aim is to gather a deeper understanding of the experience of elders suffering from dementia, along with their relative and the care giver at the residential home through a gestalt reminiscence group therapy over a period of time. A number of other aspects of a case study must then be explored, related to the sampling and selection of participants cases , the unit s of analysis, methods and types of data collection, data analysis and interpretation, and the writing up of the report e.

In order to do this, it was necessary to consider screening and selection issues by thinking of the common characteristics that we hoped would bring the group together. Such characteristics included having as much of a homogenous group of elderly persons as possible, meaning that the elderly persons all had mild to moderate dementia. The aim was for each of the elderly group members to be able to participate in the group at the same level and for us, co-therapists, to try our best to move at and maintain the same pace for all the group members.

Another common characteristic was that the relatives who participated in the group each had a caring role with the elderly person outside the group. This was based on the belief that attending the group would give them the opportunity to have some quality time together, without needing to fully engage in the caring role. The members of the group were thus identified in a way that we hoped would foster the development of relationships amongst the triad.

As the selection of the group members took place, an initial letter was written for the members of the group in order to provide all the information related to the group members and their relatives. This served to ensure that whoever was going to participate in the group was aware of what the group sessions consist of and was informed well enough to choose whether to participate or not.

We began with an initial meeting, followed by a total of 8 sessions and closed off the experience with a final evaluative meeting. We would begin one session at 9. This was also the time in which group members had the opportunity to socialise and to get to know each other. The break was also beneficial for the relatives who used this time to vent out their feelings and to find support in each other. The next session began at till am, after which the group members left the group for lunch.

This schedule happened twice weekly, meaning that the whole intense brief-intervention was completed within three weeks. The materials used included pictures, photo-language and personal photos in order to tap into the visual memory; food, for olfactory and taste sensory stimulation; music for auditory; art and clay for tactile, kinetic, motor-sensory and cognitive stimulation; and costumes and props for acting out role plays and addressing the senses holistically.

The residential care context The residential home within which the groups were held is a government home sub- contracted to a private service that runs it. Large windows allow natural light to enter the wide corridors and speakers around the house allow for soft music to be played.

The welcoming reception area is at the heart of the building, with sofas and chairs where most elderly persons sit and chat, also close to the big dining room which links to the adjacent Day Centre. Residents and non-residents make regular use of the day centre and can partake in all activities organised there.

Apart from being close to the village centre, a zebra crossing with lights, parking spaces and a bus- stop right outside the home allows for easier access to and from the home.

The group was carried out in an easily accessible multi-sensory room, within the residential home. This provided a familiar, safe and confidential space, separate from the busy environment of the home. During this meeting, the manager explained that the number of residents in the home is There are 80 members of staff of whom 2 are part-time nurses and 45 are health care workers. Whilst the members of staff attempt to run the home in the best way possible, the limited number of staff often limits contact with the residents, puts pressure on the workers and at times leads to burnout.

In view of this, the idea of holding a reminiscence group and involving some of the staff was welcomed as an opportunity to increase person-centred contact with the elders in the group.

The participants The elders were 4 females and 1 male, their ages ranging from 60 to 94 years. All names have been changed. He enjoys socialising with other residents and has an enjoyable sense of humour. The couple attended all sessions together. Both her daughters took it in turns to attend the group sessions. She is 76 years old and enjoys participating in activities organised by the residential home.

She has no relatives who come to visit her and none attended the group. She finds it difficult to accept that she is in a residential home yet calms down when her son visits her every afternoon. Her son managed to provide us with valuable information about his mother during the initial meeting however was unable to attend other sessions due to work commitments.

At times she becomes disoriented claiming that she is going home and requiring assistance to find her room in the residence. The idea was to support the initial creation of a supportive ground for the group. We wanted to create a safe space in which they could feel comfortable and free to share information about themselves. In practice, we began by using a ball of string which was passed from person to person whereby each introduced themselves. Towards the end of this exercise a cobweb-like design emerged.

We processed this, eliciting the idea that together, we are creating a network of communication amongst the group members.

A big map of Malta was put up, and members were encouraged to speak about the towns or villages that they came from. This brought smiles and comments and was the beginning of reminiscing, particularly when some members realised that they grew up in the same areas.

Paper figures, representing each group member were stuck onto the Map. We began by laying out galletti, bigilla, fazola, stuffed olives, almond biscuits and other typical Maltese food on the table. The group members truly enjoyed this part of the session. While eating, they socialized with each other. We supported the emergence of a discussion about the different types of food that existed in their childhood.

They spoke about soups, different traditional plates, recipes and memories which they associated with such food. This not only provided us facilitators with further information about the group members but also supported the staff member and relatives to get to know more narratives about each member of the group, supporting more depth, connectedness and richness within the group.

In order to cover the wide age range, prior to the session, we prepared various songs from the years to and played them at the start of the session. Pictures of Maltese scenes including traditional food, labour, art, religious ornaments and landscapes were laid out on a table. The participants looked at these images and chose those which they were drawn to.

They then organised the chosen pictures onto a chart, together with the personal photos which they brought. At the end of this session, each of the members showed and presented their charts to each other and we attached them to a wall on another side of the room. Several powerful memories were brought to the present through this work.

These were main events that emerged in previous sessions. Members of the group participated in each others role play bringing a sense of joy, laughter, and significant memories into the present experience.

It was a beautiful experience of re-enactment in the company of each other. The participants were given clay in order to sculpt, concretize and shape this experience. The aim was for their chosen experience to symbolically defy time, living on in the present. An exercise using motor movement through drawing was carried out in order to emphasise closure. Prior to the session, we drew a picture on a chart that combined aspects of the 5 narratives which had been role played.

The picture was cut up in the form of a jigsaw puzzle with a piece per person. The session consisted of colouring in their piece. Each part was later brought together to form a whole picture representing each and every member.

Participants were then invited to share any significant moments, experienced throughout the sessions, which they would like to remember. Prior to this session, we had also prepared some clay baskets with flowers in them, along with special personalized cards for each of the participants with a message and with the photos taken during the role-plays. These were handed out as a form of closure. Semi-structured questions were prepared in order to elicit information about the various aspects of our intervention.

Themes were elicited form the interview and will be discussed below embedded in the evaluation. Participant's own quotes were also included. Evaluation Following each group session, we engaged in a self-reflexive exercise, whereby process notes were written, discussed and themes elicited. General overview Intervening from a person-centred conceptual framework encouraged the participants to share personal memories and past significant events with the other group members, giving value to their unique narratives, life stories and personhood.

This happened whilst simultaneously enriching their personal relationships with their relatives and widening their social network by getting to know other elders and having the opportunity for better and more meaningful contact with the staff who participated. All participants spoke positively about the group experience. I said to myself I never saw things like this! Asked whether they would change or add anything, they suggested: reading some stories, using paint, sharing past memorised stories such as fairytales and legends, and speaking more about war.

One relative also wished for more space for self expression. The group process seems to have empowered the triad to move beyond their typical roles and into an I-thou, person-to-person relationship. And very much, very much. Pauline and her daughter also moved beyond their usual carer-dependent roles. As Pauline added pictures of Rabat, her hometown, her daughter flicked through an album and carefully selected photos, which held significance for both of them.

This process brought back memories of special occasions, such as being on television, birthdays, parties and so on, aiding Pauline to recall more and more experiences. The daughter actually felt the need to share how meaningful the experience was for her and that more such sessions should be organised. The nurse in the group also experienced a shift in relating to the residents. She felt that she got to know Katerin in a more personal way. Even though in the past she had attempted to converse with Katerin she found that her unclear memory prevented getting to know her.

Through the multi-sensory reminiscence sessions, Katerin and her son shared some stories and information about her background. The nurse felt that such information aided in understanding Katerin better and in making their previously rather limited conversations richer and more meaningful. She also shared that the opportunity to be in the sessions allowed her to spend quality time with a number of the residents and to get to know them better.

I was shy of them, of the others. When I could, I spoke to you! However as she began to feel more comfortable she started to communicate more. Reminiscing and sharing their personal life stories provided them with the opportunity to get to know each other better. For example, Cettina attached photos of her family, a photo of herself with the village priest and stuck pictures of village statues and saints. Ines stuck pictures of little chickens, rabbits and farmers and put some photos, which she had of herself with a horse and a friend.

Katerin stuck pictures of windmills, farmers, animals, sewing needles and thread. Victor attached pictures of Valletta, the city in which he grew up.

He described his experience as a DJ playing music in parties and spoke of his work, driving trucks in the desert and working locally at the shipyard. His wife selected significant photos and recounted experiences, aiding Victor to gradually recall such memories.

I realized that they still have a lot to offer. Similar to what Zauszniewski et al. One exercise focusing on their childhood was particularly helpful for the group members since it assisted them towards remembering a number of childhood details which they were unable to recall in the initial meeting, including for example how many siblings they had and what they did when they were younger, in terms of a job or helping out at home.

As they spoke about their parents, fond memories began returning, and they recounted significant episodes in their lives. One cannot ignore the reality however, that bringing back past memories included experiences of trauma, grief and sadness.

Ines explained that she still recalls being a little girl and hearing the bombs coming down during the war. Somehow, trust in the group seems to be greater than trust in the therapist — in spite of all so-called transference confidence.

In Stevens, ed. It is the task of the therapist to keep the level of group awareness high enough to allow for this clear-sightedness to develop, and not be concealed by the social niceties and interlocking defensive pairings. What the individual does is done in the matrix of the group situation; and the group can pick up and amplify what is importantly unfinished for one of its members.

Therefore, any exploration would typically involve a continual movement between these levels, rather than staying with one group member, or conversely with the whole group. I even make clear that the restrictions I place on sexual activity and violence in the group are meant to allow for an exploration of sexuality and aggression while preventing the most dangerous consequences of an unrestricted exploration , rather than to hide it away. Thus all restrictions are overt and for a specific therapeutic purpose rather than to make the group more comfortable.

A particular norm that I have found it very useful to question is the identification of a group with a circle of people sitting down and speaking one at a time to the whole group. A Gestalt model of groups Leading from the last consideration, we at Manchester Gestalt Centre are now defining a group as any collection of people who have a perceived ability to communicate.

This is a very wide definition, and would include very disparate, and sometimes not very interesting, collections of people. However, it makes the question of who does or does not communicate a significant part of the group process, and also allows for an exploration of processes within situations that are very common but not covered by the idea of a group as a circle.

For example, the processes within a multi- site organisation raise questions of who does communicate with whom, interface between different sites, movement from one site to another. The formation of subgroups and the interaction and fluidity between them become statements of whole-group process, especially where the group is allowed to move about, and not required to do only one thing at a time.

It is important to recognise that, holding this wide definition of groups, conventional models of group functioning, e. More widely, our ideas are underpinned by ideas from non-linear dynamics, chaos and complexity theory Gleick, ; Waldrop, These ideas are beyond the scope of the present chapter, but I would like to point to two findings from this theory.

The first is that the structure emergent from a non-linear system i. Further, there is evidence that too much feedback prevents the emergence of new levels of organisation. So an approach which does not rely on everyone being constantly connected to everyone else can actually work more effectively.

Meaning in this approach is multi-layered, so the same event could have a meaning on all levels: individual, interpersonal and whole-group. It could also be a statement of something the member has picked up from others. These are of course not mutually exclusive: it is often difficult to warm to someone who isolates themselves and sees criticism in every interaction. On a whole-group level, it raises challenges about safety and honesty: can I not like other group members, will I be able to stay if I am not liked, what is my responsibility for the way others feel?

What change has been signalled by this statement? As the group discovers the power of this phenomenological attitude, they become able to tolerate what would in other situations be very shaming statements.

I think I want to frighten you. Are there words for it? And it is not just the interchanges between the two people, but the effect on others, the way they look at the people, what they feel, what they then voice. It restores contact where contact has been habitually lost. And in the Gestalt Therapy model, growth occurs through contact and assimilation from otherness, not from introspection. Questioning group norms A second task of the therapist is in relation to group norms and rules.

Some rules are important for the functioning of the group, for example those relating to attendance, violence and sexual activity. It is part of the role of the therapist to uphold such rules. Some norms help the group to be therapeutic: I have given the example of the phenomenological attitude.

The therapist needs to encourage those, mainly by example. A third group of norms that develop are those that are specific to a particular group, its personality boundary, so to speak. These can, like the individual personality boundary, either support the deepening of contact or be defensive rules that limit what can be explored or make invisible processes, e.

It is the task of the therapist to be aware of and question such norms. I am curious about this. It seems that people are only willing to say things about themselves if invited. Could we maybe experiment with banning questions for a time and make only statements? We could see what happens. This does not mean the therapist engaging actively in every process. Often there is usefulness in silently validating what group members are achieving together. Sometimes there is a need to engage more actively with one person or an interpersonal engagement, providing a holding of the process.

We emphasise that the therapist has a psychotherapy contract with each group member, and is not just a facilitator of the whole group. Membership themes We run our ongoing groups continuously, with new members joining when there are vacancies and leaving when they have done what they need or wish to do.

We ask for a minimum five week commitment to get over the initial strangeness of the environment. Group members are given the name of potential members to check if they have a prior relationship that might mean the person would be better not joining. John Bernard Harris and myself have run one such group continuously for 20 years! This model fits with our theory of groups. Advertisement Hide. Creative Processes in Gestalt Group Therapy.

Authors Authors and affiliations Carl Hodges. This process is experimental and the keywords may be updated as the learning algorithm improves. This is a preview of subscription content, log in to check access. Agazarian Y Systems-centered therapy for groups. Cox M, Theilgard A Mutative metaphors in psychotherapy. Tavistock Publications, London Google Scholar.