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Time in Gestalt Therapist Work


Back to the future

Part 1

Reflections on working with time in gestalt therapy


Like a bird in the air,
Like fish in the ocean,
Like a worm in the moisture of earth,
Like a salamander in flames,
So is a man in time…
(V. Khodasyevich, 1920)


Time is like air. We might not notice it but, while we are alive, we can't avoid being in a relationship with time. 

As the Queen in Through the Looking Glass, and What Alice Found There/Chapter 2 put it, "it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that!" 

Andrey Tarkovsky says in his article “Captured time” that the person goes to the cinema ‘to obtain time’, lost or not yet obtained; she or he goes there “for experiences in life” [18].
In this sense, I think, the motivation of a psychotherapist's client is like the motivation of the cinema-goer as Tarkovsky understands it. 
А client goes to a psychotherapist 'in search of lost time', in order to either 'catch' something in the past – events that didn't happen, were interrupted or went awry – or to catch up with something that did happen to us that we weren’t prepared  for:  so there was no chance for us to experience or live it properly.   As a consequence of our 'quarrels with time', which can happen for any number of reasons, we lose the opportunity to be fully present in our own lives.
For such presence to be possible, a person needs to be be in contact both with her(him)self – in other words, to be aware of her or his own feelings and wants:  and also in contact with the world, including people around her (him). One should be able to hear people and emphathise with them. When this contact is interrupted, what happens is a disruption in time, a tiny shift, sometimes barely noticeable.

No matter what she or he is doing, the person steps aside from line of travel. They might be having endless tea, like the Mad Hatter and the March Hare, or singing Hakuna Matata, like the Lion King, but, in any case, something has gone wrong – a person has become lost. In any case, if the client has come to the psychotherapist, this means she (he) has had enough of tea, and Hakuna Matata has turned into f... it all. Most likely, the client, searching for yet another clean cup, has already tried to find a better place at the table many times. She (he) has already discovered that all of the cups are dirty, - in other words, she (he) has exhausted their own resources in attempts to come to terms with time. 

The aim of the psychotherapist is to help their client to 'repair her/his relationship with time, so that the person can regain her/his presence in her/his own life. 

In gestalt-therapy, we work on the premise that our movement in time is a result of our interaction with the world around us.
F. Perls [11]  believes that psychotherapeutic work should take place in the present because extrapolations from it either to the past or the future lead to neurotic experience. 
However, the past, the present and the future are intertwined in the now. “The present moment contains an inherent future [avenir inherent], an orientation, and a direction” (J.-M. Robine, 2008) [13]. Referring to the past (or to the future) happens exactly here and now and is specifically related to these. Not only does the past influence the now but it is also present in the now. According to Spagnuolo Lobb (2015), “the remembered ‘terrible state’ is the way to speak of the actual one” [17].
The future is also present in the now. For instance, my vision, fears and dreams of myself at the age of 80 are affecting me now. Our future (more exactly, our notion of it) gives sense to our present and has an effect on it, importantly, in the process of therapy as well as in real life. While we can't change our past, during the therapy here and now in an unmediated contact with the surrounding world, we can encounter those moments in our past when we lost our way. We can set the halted experience back in motion properly so as to be able to move into our future unencumbered (Spagnuolo Lobb, 2013) [16].
When a client and a psychotherapist meet, what begins is an exciting juggling with 'there and then' and 'here and now' so that the present and the past become alive and existing. And in this 'dance' of the client's temporal contexts, in her / his interaction with the therapist, it becomes possible to reestablish the client's connection with their personal time, with their own life. This happens thanks to the restoration of the client's ability to feel and experience life. This dance takes place in the present because 'experience' is the process of interacting with the world now. 'It is a holistic on-going experience… a holistic process of on-going interactions with the world' (Nemerinsky, 2017) [10]. Experience is a thread ensuring the continuity of personal time. The past, the present and the future are divided but, at the same time, interconnected by our living through the past experiences and future prospects: now.
The perception of time changes in a variety of specific conditions, including particular psychopathological states, schizophrenia, depression, burnout syndrome; and also in stressful situations. It also changes after a trauma or when we are grieving. (Vasilyuk [3]; Vazquez-Bandin [4]; Vidakovic [5]; Polster E., Polster M. [12]). If a situation has not been lived through, a person wants to restore the lost past. Time halts – freezes – one can't move on. One goes back to the past, without being able to look forward to the future. What is more, if a person undergoes retraumatisation, the past can catch up with her / him in the totality of bodily sensations – which can be totally incongruent with the situation. Thus the therapeutic aim of at least the first few sessions with a client who is grieving is to 'synchronise subjective time with objective, social time' [4]

In sessions, clients often reenact what is happening to them in real life. Attention to how the client is living during a session, how she or he is feeling, including their bodily self-perception at any particular moment of time, not only gives good opportunities for the understanding of their experiences, meanings and needs but also helps to find ways of treating them.
Client Boris, 54, came to see the therapist because his daughter was pushing him to get treatment. ‘Dunno why she’s worrying’, ‘like, she isn’t happy I’m staying in… that I don’t want to go to our dacha’.
The following is a short extract from Session 6:
B: “I think it it's all hopeless (Boris is sitting hunching a bit, and glancing at me sullenly).  It's only going to be worse. She (daughter) is just sick and tired of me. My time's gone, that's it. 'No country for old men'”
T: “Are you feeling out of place here as well?”
B: “I feel out of place in life… And here, too. Perhaps, if I had come twenty years ago… (he’s smiling lopsidedly).
T: “How does it feel – being out of place now?”

Boris is covering his face with his hand, looking at me through his fingers. He's hunching himself further forward, as if wanting to curl up.  As I notice his positioning of himself, I ask what he would like me to overlook. Boris finds it difficult to articulate this, so I suggest that he say a phrase starting with the words 'I don't want you to notice that…' After work with breath and support, Boris utters,
B: “I don’t want you to see that I’m old. The bags under my eyes… they don’t matter… but it’s all passed so quickly… now others are ruling… my time’s over…”
T: “We’ve got another 35 min”
B: “35 minutes…”
T: “Yes. This time isn’t over yet. Now it’s 34”.

Boris is stunned. Suddenly we have got this time which we can decide how to use. I am looking at Boris, finding him very interesting. His face is attractive. I think I can see weariness and confusion in his eyes. I like him. And (oh, dear!) he seems to be peering at me! Now he will see my wrinkles… indicating I'm not young…

B: What’s funny? (B. misinterprets my smile which is supposed to conceal my embarrassment).
T: No, I just thought you could see my wrinkles, and that I'm not 30…

We are looking at each other attentively. The feel is warm and embarrassing. The rest of the session and a few following ones were dedicated to the experiencing of embarrassment in the here and now, to losses and gains of the past experience and to the need for and risk of being seen.

When the client proposes various versions of 'problems with time' as the theme for work, the time of a session may be used by the therapist metaphorically, to engourage both the understanding of the situation and finding ways of creative adjustment.
The client's attitude towards time in therapy amounts to her / his message to the world, which the therapist is part of. This message can vary from sympathy to passive aggression. In any case, it is useful to decipher and legalise it and then to understand how the therapist responds to it.
Not infrequently, at the beginning of therapy the client is regularly late for a session. This may have to do with:
  • a typical problem of the client's life: “I'm always late, never on time”; “I can’t evaluate time”; “I take on too much”;
  • therapy as such or a certain stage of it: “I don’t understand how this happens… ‘cos I left home in advance”; “actually, I don’t like to be late – I never am… except for here”.

Here is an example.

Client Nina, 28 y.o., came to the therapist because of her complicated relationships at work. 
Since graduation, which was half a year before she came to me, she had already changed four jobs. Every time she found herself in conflict with somebody.
To me, Nina seemed soft and agreeable. She lives with her parents and a younger sister. In her large close-knit family (grandmothers, grandfather, two sisters, aunt, two uncles and their kids) mutual help and support are highly appreciated, and all of them take part in each other's lives.
Nina doesn't have time to get bored. “Yesterday my favourite niece had a concert in her music school; today I’m seeing Granny – she’s fallen ill, and after that I’ll need to go and check on my sister – she’s having her flat redecorated and wants me to help her choose floor tiles; and tomorrow is my mum’s friend’s birthday – we’ll be writing a birthday card for her all together…”
In her family everything was just great but at work… Personally, I found Nina a very nice person. I tried to gain insight into the meaning of her conflicts with her workmates but it kept eluding me. My attempts at finding out what, in her view, were reasons for them were not successful either. In her last job, which Nina “liked so much”, everything was just fine, and there was an older colleague, K., who was appointed as Nina’s senior in the line. K. cared for her, she was really helpful. However, Nina “managed to have a huge argument with her… and, consequently, had to resign.”
As soon as a mother figure emerged in the therapy (a kind and a helpful one, and at the same time one that expected to be cared for and helped in return for her kindness), Nina began to be late for sessions. At one session, she said that she could see how I was taking care of her and that made her panic. As the meaning of her panic remained unclear, we decided to discuss the matter in the next session. However, next time, Nina was half an hour late.
“Ooops, didn't make it earlier”, she stated happily. After that, for another few sessions, Nina was regularly late, and every time she would say something with joy, as if it were a funny joke. 'I wasn't able! Just wasn't able!”; “My fault again!” I asked what was so funny. “Nothing at all”, she answered, smiling widely and stamping her feet very lightly.
I felt baffled, annoyed and curious. Sitting in front of me, Nina was making small, hardly noticeable, dancing movements. I suggested that she should follow the small movements of her body while trying to breathe and enlarging their amplitude.
Indeed, she began dancing, nodding and shaking her head, and sticking out her tongue a little bit. I suggested sticking it out openly and also asked her which words could touch me if they had been on the tip of her tongue. 'I can have my own plans, I can be busy, too', uttered Nina. 'Even though I care for you?' My irritation gave way to warmth. Nina hid her face in her hands. 'Yes', she said in a very low voice. 'You've got your own plans, you're really busy, and I'm sure this is important'. Nina was weeping, 'I want her to respect this'.

In addition to observing the client's relationship with time, it seems important to notice how the therapist manages time in the context of their work with a particular client. Does the therapist handle the setting successfully? Does it feel easy to start and finish sessions on time? With some clients, it sometimes seems impossible to do so, or, by contrast, the therapist tends to finish sessions a bit earlier. If this happens regularly, it is a good idea to pay particular attention to this aspect of their relationship with the client. And if the meaning of this phenomenon remains unclear, the therapist should consult the supervisor.
What can varying perceptions of time by both the client and the therapist during the session tell the therapist? Sometimes we can deal with a tiny episode of the client's life whereas, at other times, with a period as long as half of her/his life. Sometimes the session seems to swoosh in the blink of an eye but at other times it seems to be lasting forever.
Let me try to consider this issue from the point of view of the main types of contact modality.  
Contact modifications / moderations are types of behaviour each of which once worked as our creative adjustment to the ongoing situation but later lost its adaptive and began to lead to shifts from one's timeline. Here I will have a look at retroflection, confluence, introjection, projection, and also egotism and deflection.
Each of these is connected with altered perception of time. It may be stretching / elongation (we freeze, stop breathing, come to a halt, without being able to move on, as in retroflection) or compression (we rush forward, without understanding if we really want this, as in confluence, when we lose the flow of our own lives). Or we might be moving in the wrong direction – just because somebody has told us that the road is here; however, we haven't had a chance to understand if it has anything to do with our lives, as in introjection. Finally, we could delegate our feelings to other people – without recognising that these are our own feelings – and behave accordingly, thus missing important turns in our lives, as in projection.
Noticed through their manifestations, сontact modifications can be undersood as diagnostic signs and help improve the therapeutic process.
If the therapist is feeling that the session is lasting endlessly, most likely, we are failing to be with the client, wholly present in the now.  In this case, the main way of contacting (between the therapist and the client) is probably retroflection. Time feels impeded and the therapist might want to accelerate the session so that something meaningful happens or the session itself is brought to an appropriate endpoint. If the therapist manages to understand and express what is being held back so painfully, time will of course accelerate – more precisely, it will be experienced as moving faster.
In confluence, the general feeling is opposite. Everything is happening too fast. The client's speech is fluent, she or he is speaking and moving too quickly. The therapist might want to slow the client down; and if the therapist ignores this want and thus finds her/himself too close to the client too soon, this may result in the feeling that the session has passed but nothing important has happened. Too close a distance may lead to the sensation of awkwardness or inappropriateness. Ignored feelings do not allow for the experiencing of the fullness of time.
In egotism, there emerges the feeling that session time is being wasted. “Happiness has been possible… but... What a nuisance”. 
Similar feelings seem to take place in deflection: something appears to have happened, but it doesn't feel right. Again, it seems that time has been wasted.
In introjection time is experienced in accordance with ‘an externally imposed clock', so to say. As mentioned above, we are following a path because somebody has told us that it is ours. At the beginning of this journey it might seem that time goes as it should. But if the path is not ours, there will emerge an unavoidable sensation of 'lost time' ('I live a life which is not mine', 'I've got lost') along with feelings of confusion and sadness. The client comes to the therapist because she or he has become less sure that she/he has been on the right path, and as a result, one may notice that the pace of the session appears to be slowing down.
Even if in the session there is no sensation of time changing pace or it is not strong, only enough to make the situation of choice possible, the therapist slows it even more in order to facilitate the client's increasing awareness of options and their ability to make choices.

Sometimes, for example in projection, the pace of the session can remain even, and time may feel either a little accelerated (though to a far lesser extent than in confluence) or a little impeded (though not as much as in retroflection). This depends on the content of the experience being projected. When the client attributes her (his) own experience or the characteristics of figures important in her (his) life to the therapist, this forms conditions for them to become close too quickly and in too straightforward a way; or, conversely, conditions in which excessive caution and fear might thrive. In either case, the therapist stops the client for a moment in order to draw their attention to where exactly the contact interruption takes place. 
Concerning 'slowing down' the pace of a session, it seems that the therapist tends to apply it in any type of contact modification, excluding retroflection. In the latter, the therapist uses both the slowing down and acceleration of the processes taking place during the session. Slowing down while drawing the client's attention to her (his) as well as their own bodily phenomena; whereas acceleration while suggesting that the client amplify her (his) bodily manifestations, realising, at the same time, their own bodily phenomena and daring to express their retroflected experience before the client.
In addition to the fact that the sensations of time accelerating or, conversely, slowing down may be diagnostic features, handling time can be used as a therapeutic tool.
Devices used by the therapist affect the experiencing of time during the session: for example, slowing down (we often ask the client to say a certain phrase or repeat a gesture slowly), acceleration, repetition (we ask the client to repeat what they have said,once or several times), amplification (we ask the client to clarify or strengthen various manifestations: intonation, pitch, loud or, vice versa, low voice, the amplitude of movement, posture), retardation (in some cases it may be appropriate to suggest that the client lingers on events and related feelings and bodily sensations which preceded the event which she or he considers the main (possibly traumatic) one, storyboarding (the therapist may ask the client to tell their story 'in episodes' if it seems that the client does not realise how their experience is changing and what is affecting this).
At first glance, it might seem that the therapist only slows time down when she or he refers to bodily phenomena, for instance, when she or he suggests that the client be in contact with their breathing or asks her or him to repeat a movement slower, as described above. I assume this notion is connected with the fact that both the emerging of resonance between the client and the therapist and also the forming of a field in which the client's change is possible might take time. In addition, the recovering of the sense of time, distorted because of grieving, trauma, depression and other conditions which require therapy, also takes time. “Only the client's going through the slow process of assimilation together with the development of their ability to encounter hard experiences will help them realise and express these” (Vidakovic [5]).
Thus, both the client and the therapists’ attitudes towards time may have not only diagnostic but also therapeutic significance. The attention to the phenomenon of time helps the therapist: 
  • perceive various meanings of the client's relationship with time in therapy; 
  • feel how time is flowing in the session; 
  • realise if there is enough time for the emerging of resonance between the client and the therapist; 
  • indicate the best moment for intervention.

'Slowing down' the session time is not something that always happens, nor is it the only result of the therapist's interventions. On the contrary, sometimes what seemed frozen, unable to thaw and come to life, can happen in the here and now of the session.   
And if the therapist succeeds in being the one who enables the client to discover her or his part in the ‘film’ they have brought to therapy, then the client may remember who she or he is, in the way Simba does in The Lion King.  And as a result, according to the Paradoxical Theory of Change suggested by Arnold Beisser the client can set off, along the line of time, into their future, and enter the stream of their authentic life and remain present in it.


References


  1. Bolotova A. K. (2006). Psychology of time management. Moscow
  2. Vasilyuk F.E. (2009). Chronotope model of psychotherapy // Moscow psychotherapeutic journal (current name: Counseling Psychology and Psychotherapy), no. 4
  3. Vasilyuk F.E. (2000). Survive the grief // Psychologies
  4. Vazquez-Bandin C. (2017). Loss and grief. When the death of one person makes the whole existence meaningless. Moscow // Gestalt therapy in clinical practice, pp. 269-285 
  5. Vidakovic I. (2017). Ability to move on. Gestalt approach in the treatment of traumatic experience. Moscow // Gestalt therapy in clinical practice, pp. 287-299
  6. Zimina S.V. Perception of human time. Medical and biological aspects. Available at: http://www.chronos.msu.ru/old/RREPORTS/zimina_vospriyatie.pdf 
  7. Merzlyakova D. R. (2012).  Perception features of internal time rhythm in depression and burnout syndrome // Science vector of TSU, no. 2 (9). pp. 189-192
  8. Michalsky A.V. (2016). Moscow, Psychology of time 
  9. Nemirinsky O. V. The thoughts about theory of gestalt therapy
  10. Nemirinsky O. V. (2017). Gestalt therapy in clinical practice. Preface to the edition in the Russian language. Moscow
  11. Perls F. (1995). In and Out the Garbage Pail
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