The model muddle

I’ve already written posts on several therapy models (gestalt, Rogerian, Transactional Analysis, Freudian psychoanalytic), so it’s time I examine what models are: their utility, their strengths, and their limitations. First off, models are ways of organizing and framing ideas in a way that serve as a guide. A good model is like a good map: it helps you accomplish something you set out to do, to get where you wanted to go.

But the map is not the territory; it’s merely a helpful representation. I’ve known people who were so dedicated to a model that they couldn’t see its limitations, and were blind to alternative formulations, viewing everything through the lens of their fixed beliefs. No model is perfect and complete. Each one has its flaws and limitations.

I first started thinking about models as a young mental health professional, when I read Miriam Siegler and Humphrey Osmond’s Models of Madness, Models of Medicine, in which they compared the medical model to eight other models related to the care of mentally ill persons. After examining each model (moral, impaired, psychoanalytic, social,  family interaction, etc.), the authors – both MDs – conclude that psychiatry is the only way to go. Holistic, shmolistic..

Psychiatry is the medical model’s approach to treating mental illness, usually with medications. The medical model is a scientific model. In a nutshell, the model starts with the identification of symptoms, which leads to an appropriate diagnosis, which in turn leads to a specific treatment. The medical model is very good at what it’s good at, such as mending broken bones, and doing surgery, and treating many physical ailments. But its self-promotion as the only game in town for the care of the mentally ill has been challenged by many, notably Dr. Thomas Szasz and R.D. Laing.

No model is a perfect fit for all occasions, and many MDs have come around to believing in the benefits of a holistic approach to health care. Although I still believe that psychiatric treatment has its place and can be of benefit to many people with what are known as “psychiatric disorders,” like all models the medical model has its limitations. There are other valid approaches to health care that don’t rely on symptoms > diagnosis > treatment as their primary focus. The medical model is mostly focused on what to do after you exhibit symptoms, not so much on how you got there. Some medical traditions are more focused on wellness than on treating (sometimes preventable) illnesses. No model has all of the answers.

One of the limitations of the medical model as regards the care of mentally ill people is that the criteria for a differential diagnosis were determined by a committee of psychiatrists, to be applied to a unique individual. Unlike most physical disorders, there are no identifiable biological markers to distinguish what we call “schizophrenia” from “schizoaffective disorder” or “bipolar, manic.” Psycho-diagnosis is not rocket science, because mental illness isn’t precisely measurable. At best it’s educated guesses, and many people with an extensive history of psychiatric treatment have been diagnosed with – and treated for – a variety of diagnoses.

A model I’ll be writing about in a future post is the Recovery Model. A lot of mental health professionals initially scoffed at the idea of people “in recovery” from chronic psychiatric disorders. Recovery made sense as a helpful model for “recovering” chronic substance abusers, but did it apply to the chronically mentally ill? I think (hope) that many or most mental health professionals have come to recognize the merits of the recovery model, and there are now recovery centers in some cities that aren’t run on the medical model. You might want to check out <madinamerica.com> to learn more.

Treatment models compete in the marketplace, and there’s money to be made. For instance, the Pentagon has paid millions for training in Positive Psychology. With modern marketing in the mix, we find ourselves in the midst of a model muddle. More about this down the road.

Defense mechanisms

In the classic boomer movie “The Big Chill” Jeff Goldblum’s character asserts that rationalizations are more popular than sex. When his friends look at him questioningly, he asks, “When was the last time you’ve gone a week without a rationalization?”

Many of Sigmund Freud’s psychoanalytic notions have been discarded as the art and science of psychotherapy has evolved, but one of his contributions has, I think, proven valuable over time: defense mechanisms. Dr. Freud and his daughter Anna described specific ways that people defend themselves from frightening or unacceptable thoughts, feelings, or memories. A thought may be unacceptable because it threatens our cherished self image, or because it might open a door we’d rather remained closed. Freud said that to the unconscious mind, a wish is identical to an act. As a therapist I’ve seen many people who had terrible guilt for having had unacceptable thoughts or feelings, although they’d never acted on them, and didn’t want to.

I don’t intend to cover all of the defense mechanisms in this post, but here are some of the things people do to defend themselves against the unacceptable: denial is an extreme form of avoidance. “If it’s not true I don’t have to deal with it.” Confronted with mounting evidence that she’s lost control of her drinking behavior, denial will allow an alcoholic to continue drinking, because the thought of getting and staying sober is terrifying. Denial that a loved one is dead allows you to avoid the pain of mourning.

In therapy I’ve described avoidance  as being a surefire drug that always works to eliminate here-and-now anxiety, and therefore can become an addictive habit. Take the case of someone who’s been unfaithful to his lover on one occasion, and knows he has to admit it, because it will eventually come out anyway. So he promises himself he’ll tell his lover about the one night stand by the end of the weekend. He puts it off until Sunday, and as the day goes on his anxiety mounts. Will his confession wreck the relationship? As midnight approaches, he decides to postpone his confession (a kind of avoidance), and immediately experiences a reduction in here-and-now anxiety – as if he’d taken an anti-anxiety medication that works instantly. That immediate relief from anxiety is “reinforcing” and increases the likelihood that he’ll resort to avoidance again. In this manner, defense mechanisms can become habitual.

Habitual avoidance can perpetuate dysfunctional or irrational behaviors. If your response to a deep-seated fear of flying is to never fly, your avoidance reinforces your irrational fear. You may want to travel to Europe and may understand intellectually that air travel is statistically safer than driving, but the prospect of giving up all control and entrusting your life to the pilot may seem intolerable. Fear of a real threat is a reasonable response, but phobias (irrational fears) only serve to limit our options in life.

The only effective way to overcome phobia-based avoidant behaviors is what cognitive behavioral therapists call “exposure.” To get over your fear of drowning, you have to (eventually) swim in the deep end of the pool. Only by facing the thing feared can you grasp that the fear was irrational. This principle also pertains to regaining confidence in something you were good at, but now avoid because of a bad experience. We all know what you’re supposed to do if you’re afraid to mount any horse because another horse threw you; but that doesn’t make it easy. You either get back in the saddle, or you avoid horseback riding.

Having started with rationalizations, I’ll conclude this post with some thoughts on that defense mechanism, also known as intellectualization. I’ve found that highly intelligent people who have risen above the “more primitive” defenses of denial and avoidance have found rationalization as their anti-anxiety drug of choice. The essence of rationalization is,  “I don’t have to deal with it if I can explain (rationalize) why I don’t have to deal with it.” Or “I’m not responsible because I have an explanation.” Or “I didn’t want that, anyway.” The fox in the Aesop fable about the fox and the grapes is a classic representation of an intellectualizer in popular literature. When he couldn’t reach the grapes, he concluded that they were probably sour.

Like denial and avoidance, intellectualization gives a temporary respite from unwelcome thoughts and feelings, but like the other defense mechanisms it can perpetuate dysfunctional behaviors. Defense mechanisms are often barriers to insight and personal growth. I’ll write more about them later.

 

Communication and metacommunication

This post will explore some of the basics of Dr. Eric Berne’s Transactional Analysis (TA), one of the popular theories in the humanistic psychology movement, and will also briefly cover “metacommunication” as a principle in communication theory. Eric Berne is perhaps best known for his book The Games People Play, which popularized some of his concepts regarding TA – a psychoanalytic theory. Another popular book about TA was I’m OK, You’re OK, by Thomas Harris.

Communication theory posits that every statement made within a relationship works on two levels: the content of the statement, and as a statement about the nature of the relationship. So I’ll start with some thoughts on what a relationship is and the different kinds of transactions that occur in relationships. A relationship can be a casual ongoing series of social transactions, such as your relationship with your postal carrier or a store clerk whom you see from time to time, or it can be something deeper. Dr. Berne listed the kinds of transactions that occur in relationships, from the superficial to the intimate.

The most basic transactions are what Berne called rituals, polite exchanges that superficially acknowledge a relationship, but contain no real, meaningful content. “How are you doing?” “Oh, I’m  fine. Hot enough for you?” The next level of transactions is pastimes, where two or more acquaintances pass the time together, watching TV or playing a game, with no sharing of meaningful content. After that is activities, where people get together to engage in purposeful pursuits, with a goal in mind, without getting past superficial interpersonal exchanges. In the next level of transactions, games, there’s an effort to connect and share meaningful communications, but the people involved engage in inauthentic manipulations. It was this level of transactions that Berne primarily focused on in The Games People Play.  A popular song borrowed its title: “Oh the games people play now/ Every night and every day now/Never meanin’ what they say now/Never sayin’ what they mean.”

TA is a psychoanalytic theory because it re-casts Freud’s superego, ego and id as parent, adult and child, and analyzes games in relationships within that framework. I’ll write about games and crossed transactions in a later post. For now I’ll just say that the highest level of transactions in TA is intimacy: non-manipulative, authentic relating.

Having said that relationships can range from superficial to intimate, now I’ll elaborate on communication and metacommunication. On one level, any statement within a relationship is characterized by its content, whether it’s a “How ya doin?” communication that simply affirms that a relationship exists, or whether it contains more meaningful content. But on another level, metacommunication, the statement is a comment on the nature of the relationship. It’s as if every statement within a relationship were preceded by, “We have the kind of relationship in which I can say to you ______.” If you have no problem with the statement, then you and the person who said it agree on the nature of your relationship. If you find the statement creepy or inappropriate or offensive, there’s a disagreement about the nature of your relationship.

Take the example of a newly-single mother,  the night after Dad – who used to be the sole parental disciplinarian – moved out.  With Dad gone, Mom has had to take on that role. The first time Mom (in Dad’s absence) tells Junior it’s time for bed, she’s saying. “We have the kind of relationship where I can order you to go to bed.” If Junior complies, putting on his pajamas and brushing his teeth, he’s affirmed Mom’s new role. If he replies, “I’m not ready to go to bed yet,” he’s attempting to reject Mom’s new definition of their relationship, implying, “I don’t have to do the things you tell me to do if I don’t want to.” If Mom lets Junior stay up, she’s let him define the relationship. If she says, “Nine o’clock is your bedtime. If you’re not in your pajamas with your teeth brushed in ten minutes, no TV or video games tomorrow,” she’s asserting that she is the parent and gets to define the relationship.

Another example involves a woman who has just taken a job in an office managed by a lecherous boss. If, on her first day of work, he tells her “You look hot in that dress” and she doesn’t object, she’s  communicating that she accepts his understanding that “We have the kind of relationship where I can comment on your body and make suggestive remarks.” If she doesn’t want this kind of treatment to persist, she needs to reject his assertion as to the nature of this new relationship. “Mr. Smith, I know you meant that as a compliment, but I really don’t feel comfortable with you talking to me like that.” In saying that, she’s asserting that the relationship is professional, not personal, in nature.

I’ve found this principle of metacommunication to be very helpful in making sense of the complexities of human interactions. (Or, as Eric Berne would have it, “analyzing transactions.”)  You already know intuitively, from your own experience, the essence of what I’ve written about in this post; I’ve just given you the principle behind what you  know,  and given it a name. The term has another meaning that I’ll get into in a later post: within a relationship, metacommunicating means communicating about how we communicate, talking about how we talk together.

 

Client-centered therapy and active listening

Dr. Carl Rogers’ client-centered therapy was one of the major therapies within the human potential movement. I had the good fortune to meet him briefly when he was the keynote speaker at a convocation of the Association for Humanistic Education, held at West Georgia College (now the University of West Georgia) in 1976. I’d just listened to his address and then joined my ex-wife, Doris, who was selling her hand-crafted jewelry from a blanket on the lawn outside the education building. Dr. Rogers came out of the building and Doris’ display caught his eye. He was being escorted by a faculty member, but stopped to look. I can’t remember anything that was said between the three of us, but I was in awe of the man and couldn’t believe I was actually talking to him. He bought a piece of Doris’ jewelry as a gift, so I’ve subsequently made the claim that Carl Rogers helped put me through grad school.

Rogerian therapists don’t make analytic interpretations, or provoke authentic responses, or recommend goals to the client. Goals are established by the client, who does a lot more talking than listening in therapy sessions. A good Rogerian therapist is an active listener, who strives to understand the client’s sense of self, interpersonal boundaries, and experience of being-in-the-world by carefully listening to his words. The therapist might ask clarifying questions, but mostly listens. Actively.

After listening to a detailed account of a client’s issues with her dominating mother, the therapist doesn’t respond with an interpretation, but reflects on his understanding of her experience. “It sounds like every time you’re around your mother you end up feeling angry and worthless. I also heard you say that you keep having intrusive thoughts about your mother dying in an accident, and you feel terribly guilty about having these thoughts.” If the therapist has accurately and non-judgmentally reflected the essence of what the client was trying to express, this usually promotes increased trust and a fuller disclosure on the subject at hand. When the therapist is on the mark, the client knows that the therapist cares, listens carefully, doesn’t judge him, and seems to understand. If the therapist misses the mark, the client will usually let him know right away.

Often in everyday life we only give part of our attention to what others tell us, or are distracted by our own thoughts or reactions. Listening is often a passive act. Active listening means giving our full attention to what we’re being told, without allowing our thoughts to distract us. It’s a kind of mindfulness. In a different arena, music appreciation, certain kinds of music demand more of the listener than others. To fully appreciate chamber music, or a sitar raga, or jazz by Coltrane, you have to quiet your own thoughts and give your full attention to the music. In the interpersonal arena, sometimes we need someone who cares enough to listen actively when we have something important to say, whether that person is a therapist, a pastor, a spouse, a family member, or a trusted friend.

Active listening is a learnable skill. I started learning it in grad school. Even when I was working in a therapeutic mode other than client-centered therapy, I was an active listener. I’ve always believed that I owed it to each client to give them my full attention. Sometimes I’d do a brief meditation between clients, to clear my head. Like most things, you learn active listening by practicing it. You have to learn to suspend your own thoughts, and you do that by simply noticing any thought that intrudes on your active listening. Like a stray cat, if you don’t feed it, it goes away. Focus on listening without judging. You can practice listening actively to classical music or jazz, too. Learning to listen actively to complex music is its own reward. Active listening gets easier with practice.

When a parent would come in complaining that their child used to confide in them, but stopped, I’d coach them in active listening and non-judgmental reflection. When a child feels understood and validated, she develops higher levels of  trust and is more willing to talk about what’s important in her life. Learning to be an active listener will give you a tool that some therapists use to establish trust and encourage disclosure. It will make you a better parent, friend or spouse. When you listen carefully and reflect back what you’ve heard accurately and non-judgmentally, the person you’ve been listening to knows that (1) you care enough to (2) really hear them (3) without judging them and (4) you seem to understand and accept what they’re going through. Everyone (other than sociopaths) wants to be understood and validated, and you can help people you care about feel accepted as the unique person they are. In terms of personal growth, Carl Rogers  taught that self-acceptance is the fertile ground in which the seeds of growth can flourish.

Freedom of attitude

Viktor Frankl’s book Man’s Search for Meaning is one of the most important books I’ve ever read. I’ve recommended it, as “bibliotherapy,” to clients in my clinical practice more than any other book, by far. I recommend it too you as a book of useful philosophy. Its conclusions resonate with cognitive therapy, Buddhism and the Serenity Prayer.

Dr. Viktor Frankl was an Austrian psychotherapist and a survivor of a Nazi death camp. The first part of the book isn’t an easy read, as it recounts the hellish circumstances of daily life in a death camp and the heartbreaking choices people were sometimes forced to make. Frankl had studied to be a doctor before he and his wife were arrested for the crime of being Jewish, and sent by train to separate death camps. He never saw her again.

In his book he separates his fellow prisoners into two categories: those who continued to fight for survival, and those who lost the will to live. There were many ways to die in a death camp. Just refusing an order from a brutal guard could get you beaten to death. Giving away your bread to others would hasten death by starvation. Some chose death over life in Hell.

A philosopher by nature, Frankl sought to determine what made the difference for those who fought to live, rather than surrendering to circumstance. His conclusion was that those who lost the will to live were those who could no longer find meaning in their suffering. Frankl found meaning in hope for survival and of possible reunion with his wife. His love for her was alive, as well as his hope. He knew he had something to live for, even if he couldn’t specify what it was, even if there were no guarantees.

Viktor Frankl asserted that we have a choice that nobody can take away from us, regardless of our circumstances. We are always free to choose our attitude toward whatever situation we find ourselves in. If I’d heard this from someone else I might not have given it much weight, but I learned it from Viktor Frankl. I’m unlikely to ever find myself in a situation nearly as dire as what Frankl lived through. If he could apply this wisdom in a Nazi death camp, surely I can apply it to any circumstance I find myself in.

Any fortunate circumstance can be sullied by a negative attitude, and any unfortunate circumstance will inevitably be made worse by negative thinking and expectations. A positive attitude, on the other hand, can make good situations even better, and a positive attitude opens the possibility that an otherwise intolerable situation can be made bearable. We find – or create – the meaning of our life circumstances by our choice of attitude. A negative attitude cannot improve anything.

Frankl called his approach to psychotherapy “logotherapy,” from the Greek word for meaning. In his professional practice, he tried to help his patients discover or create meanings that helped them in their struggles. Exercising your freedom of attitude allows you to re-frame your experience. What does it mean? Are you suffering because that’s what you deserve? Or is your suffering a test, an ordeal from which you can emerge, a better person? Nobody can decide the meaning of your life experiences but you.

 

 

The paradox of identity, Part 2

“Authenticity” is one of the most important words in the lexicon of gestalt therapy, and it’s an essential component of intimacy. I’ve described intimacy as “emotional nakedness” with another person, but that doesn’t imply a sexual relationship. Sexual intimacy is just one kind of intimacy. People in authentic relationships don’t put on acts with one another. They aren’t afraid to be seen as they are, warts and all.  Unfortunately, authentic relationships are hardly ever modeled by characters in TV dramas and soap operas and sitcoms, because it doesn’t make for good drama – which relies on conflict to keep things entertaining.

Dr. Fritz Perls, the reigning guru of gestalt therapy when I was in grad school, wrote a lot about how we’re socialized to be “phony,” in the guise of politeness. He said that it was the job of the gestalt therapist “not to let go unchallenged” any inauthentic expressions by a client in a therapy session. The client of a skilled gestalt therapist often finds himself “sitting on the hot seat,” even in individual therapy. There are some highly effective gestalt techniques that disarm the client’s typical, often reflexive, defenses, leaving him to experience his own “unedited,” authentic here-and-now feelings. Perls said that past and future are fictions; we live our lives in the here-and-now.

If a client started to relate a past unpleasant experience, the gestalt therapist would ask her to relate it in the present tense, to bring it into the here-and-now of her experience. If the client made a statement couched in generalized terms, i.e.”You know how it is when someone gets on your case…” the therapist would ask her to make it an I-statement, i.e. “When somebody gets on my case I ____.” The therapist might interrupt a rationalized response to a question about a thorny issue and say, “Are you aware that you’re  clenching your fists?” This call to be present in her body in the here-and-now disarms the client’s intellectualizing.

When a client “protesteth too much” an inauthentic feeling or response, i.e. “It really doesn’t bother me anymore when my father tells me I’m stupid.” the therapist might say, “Say the opposite. Tell me that it really bothers you when your father calls you stupid.” “But it doesn’t!” “Say it anyway.” Having the client repeat the opposite statement – usually more than once – often produces an authentic emotional response (sometimes tears or rage) and a moment of insight. Probably the best known gestalt technique is the “empty chair,” where you have the client face an empty chair and visualize her father (mother, boss, lover, molester, etc.) sitting in that chair. “Now I want you to tell him what you just told me.” “But he’d never let me!” “He has to listen. He can’t interrupt. Tell him what you’ve always wanted to tell him.” This technique often elicits powerful, authentic responses that the client has typically repressed.

In my last post I wrote about people pleasers and their phony (inauthentic) behaviors. Another mindset that engenders phony behavior is that of the “con,” the bullshitter. Like the people pleaser, the con tries to read you and puts on an act; but unlike the people pleaser, the con wants to get something you have. If he wants you  to like him, it’s only a means to an end. A con is always onstage, performing. Cons and people pleasers pay the same price: they deprive themselves of the opportunity to have an authentic identity. Most of us want to be liked for who we truly are. People who can’t or won’t be authentic in relationships can never know who they truly are. If someone seems to like or admire them, is it really them they hold in esteem, or their act? They can’t come to know the real person behind the masks they habitually wear. It can be scary to enter into a truly intimate relationship, whether with a therapist, a new friend, or a lover. But the more intimate relationships we have in our lives, the better we know who we uniquely are.

“Autonomy” is another important word in the gestalt lexicon, and increased autonomy is a frequent goal of therapy. In my experience, the best marriages and friendships are characterized by intimacy and a mutual respect for one another’s autonomy. This ideal of intimate relating is captured in Fritz Perls’ “Gestalt Prayer,” which was a very popular poster back in the days of hippies and encounter groups:

“I do my thing and you do your thing. I am not in this world to live up to your expectations, and you are not in this world to live up to mine. You are you and I am I, and if by chance we find each other, it’s beautiful.”

The paradox of identity, Part 1

This post begins with my approximation of one of my “standard raps” (talks) as a leader of psycho-educational therapy groups – my examination of the concept of identity: “We think of identity as that which is unique to us, that which characterizes us as the singular person we are, But there’s a riddle embedded in the concept. How do we know who we really are? Think of Robinson Crusoe, or Tom Hanks’ character in “Cast Away,” alone on an island for a long time. As time goes on without human contact, how can he know who he is? How can he know if he’s kind or sensitive, or if he’s kept his sense of humor? Only when he meets Friday can Robinson Crusoe begin to reconstruct an identity.

The paradox of identity is that it relies on relationships with others to define it, and doesn’t exist in a social vacuum. No one person is the absolute authority on your identity – but neither are you, because you can’t be objective about yourself. The person your intimates know you as might not always validate your Cherished Self Image. (We all have one.) I remember one of the first times I was with my divorced first wife, Doris, in the company of my then-girlfriend Maria – my wife of twenty-seven years. (We all remain close friends.) When I made some reference to myself as a laid-back person, they both laughed loud and long.

I’m not a laid-back person by nature; that was just part of my Cherished Self Image. People who know me well know that I’m an intense person, with lots of energy. That doesn’t mean I can’t ever be laid back, just that it’s not my default mode.”

In my career as a psychotherapist I came across a number of folks who were people pleasers. I was good at spotting the insecurities that go along with being a people pleaser, because I used to be one, myself. People pleasers want to be liked by everyone – even people they don’t like. Some people in therapy with me had, or developed, insight into their compulsion to please others, even at their own expense, and made it a goal of therapy to get over their “phony” people pleasing ways. The opposite of phony-ness is “authenticity,” which can be learned with attention and practice.

As a young man, just out of four years in the Army, I felt like everybody  in the psychology program knew more than me. I hadn’t developed a secure sense of who I was. I’d gotten over some bad habits of my youth, but I had a lot of self-doubt about my fitness to be a psychotherapist. What I recognized was that when I met new people – especially if I liked or respected them – I tried to come across as the person I thought they might want me to be. I sought their approval by trying to please them. I said things I didn’t really mean, and did favors it wasn’t in my heart to do. I monitored others for signs of disapproval, so I could improve my act.

I knew I couldn’t be an effective therapist unless I stopped being phony with others. Providence supplied my mentor in this process, in the form of my gestalt therapy professor. Dr. Fred Axelberd was known for a frankness in personal encounters that some saw as brutal, but he became my primary role model for being authentic. As an example: If a grad student asked him after class, “Hey, do you want to go have a beer and finish this conversation?” and he didn’t want to , he’d simply say, “No.” and walk away. No context, no explanation, no excuse. If the student felt hurt or rejected, that was on him. Fred didn’t feel like he had to justify his social decisions to others. One day Fred looked me in the eye and asked me, “You want everyone to like you, don’t you?” I couldn’t deny it, and resolved to change.

People pleasers are excessively “polite” and have to justify any “no” they might express. They say polite/phony things rather than simply expressing their wishes. “Sorry, I’d like to stay but I can’t. I’ve got to ______.” Recognizing my own need to seek approval from everyone, I set about emulating Fred and not making excuses for my decisions about what I wanted to do with whom, when. It’s a cognitive behavioral therapy technique called “exposure,” where you confront your fear of drowning by getting in the water. I taught myself over time that if I said or did something authentic, and someone didn’t like me or disapproved as a result, it wasn’t the end of the world. I could survive someone’s disapproval.

Fred Axelberd’s “Gestalt Man” course provided fertile ground for my personal growth, as well as experiences that trained me to do therapy in the gestalt mode. One of the course requirements was being videotaped in front of the class, both as the client in a gestalt session, and as the therapist. I spent time in what gestalt therapists call “the hot seat,” and got a taste of the vulnerability that psychotherapy clients can feel. After each session, we’d all watch the videotape, which could be stopped at any point if Fred or a classmate had an observation or suggestion. It felt like being examined naked in public, but I learned a lot about myself in the process. There’ll be more about identity – and gestalt therapy – in my next post.