gestalt therapy: an introduction

Ecological Interdependence: The Organism/Environment Field

A person exists by differentiating self from other and by connecting self and other. These are the two functions of a boundary. To make good contact with one's world, it is necessary to risk reaching out and discovering one's own boundaries. Effective self-regulation includes contact in which one is aware of novelty in the environment that is potentially nourishing or toxic. That which is nourishing is assimilated and all else is rejected. This kind of differentiated contact inevitably leads to growth (Polster and Polster, 1973, p. 101).

Responsibility

People, according to Gestalt therapy, are responsible (response-able); that is, they are the primary agents in determining their own behavior. When people confuse responsibility with blaming and shoulds, they pressure and manipulate themselves; they "try" and are not integrated and spontaneous. In such instances their true wants, needs and responses to the environment and choices in the situation are ignored and they overcomply or rebel against shoulds. Gestalt therapists believe in the importance of a clear distinction between what one chooses and what is given. People are responsible for what they choose to do. For example, people are responsible for their actions on behalf of the environment. Blaming outside forces (e.g., genetics or parents) for what one chooses is self-deception. Taking responsibility for what one did not choose, a typical shame reaction, is also a deception. People are responsible for moral choices. Gestalt therapy helps patients discover what is moral according to their own choice and values. Far from advocating "anything goes," Gestalt therapy places a most serious obligation on each person: choosing and valuing.

Awareness

Awareness and dialogue are the two primary therapeutic tools in Gestalt therapy. Awareness is a form of experience that may be loosely defined as being in touch with one's own existence, with what is. Laura Perls states: The aim of Gestalt therapy is the awareness continuum, the freely ongoing Gestalt formation where what is of greatest concern and interest to the organism, the relationship, the group or society becomes Gestalt, comes into the foreground where it can be fully experienced and coped with (acknowledged, worked through, sorted out, changed, disposed of, etc.) so that then it can melt into the background (be forgotten or assimilated and integrated) and leave the foreground free for the next relevant Gestalt. (1973, p. 2) Full awareness is the process of being in vigilant contact with the most important events in the individual/environment field with full sensorimotor, emotional, cognitive and energetic support. Insight, a form of awareness, is an immediate grasp of the obvious unity of disparate elements in the field. Aware contact creates new, meaningful wholes and thus is in itself an integration of a problem. Effective awareness is grounded in and energized by the dominant present need of the organism. It involves not only self-knowledge, but a direct knowing of the current situation and how the self is in that situation. Any denial of the situation and its demands or of one's wants and chosen response is a disturbance of awareness. Meaningful awareness is of a self in the world, in dialogue with the world, and with awareness of Other -- it is not an inwardly focused introspection. Awareness is accompanied by owning, that is, the process of knowing one's control over, choice of, and responsibility for one's own behavior and feelings. Without this, the person may be vigilant to experience and life space, but not to what power he or she has and does not have. Awareness is cognitive, sensory and affective. The person who verbally acknowledges his situation but does not really see it, know it, react to it and feel in response to it is not fully aware and is not in full contact. The person who is aware knows what he does, how he does it, that he has alternatives and that he chooses to be as he is. The act of awareness is always here and now, although the content of awareness may be distant. The act of remembering is now; what is remembered is not now. When the situation calls for an awareness of the past or anticipation of the future, effective awareness takes this into account. For example: P: [Looking more tense than usual] I don't know what to work on. T: What are you aware of right now? P: I am glad to see you, but I'm tense about a meeting tonight with my boss. I have rehearsed and prepared and I've tried to support myself as I wait. T: What do you need right now? P: I thought of putting her in the empty chair and talking to her. But I am so tense I need to do something more physical. I need to move, breathe, make noise. T: [Looking but remaining silent] P: It's up to me, huh? [Pause. Patient gets up, starts stretching, yawning. The movements and sounds become more vigorous. After a few minutes he sits down, looking more soft and alive.] Now I'm ready. T: You look more alive. P: Now I am ready to explore what had me so uptight about tonight. Self-rejection and full awareness are mutually exclusive. Rejection of self is a distortion of awareness because it is a denial of who one is. Self-rejection is simultaneously a confusion of who "I am" and a self-deception, or "bad faith" attitude of being above that which is ostensibly being acknowledged (Sartre, 1966). Saying "I am" as if it were an observation of another person, or as if the "I" were not chosen, or without knowing how one creates and perpetuates that "I am" is bad faith rather than insightful awareness.

to be continued...

a sort of loneliness-among-others

How the Legal and Medical Systems failed Patricia and Ryan Stallings.

By Rhonda Riglesberger.

In July of 1989, life seemed perfect and complete for the Stallings family who had just moved from St. Louis to a pretty little white house overlooking Lake Wauwanoka, a large, beautiful, private lake surrounded by a variety of modestly priced and expensive homes. Patricia and David Stallings had moved into their tiny, white, dream house approximately a month before their son Ryan became ill and was hospitalized. Patricia says, "He had my hair and David's face. He had huge dimples and big blue eyes." She went on to say, "That was the happiest time of my life. Everything was perfect, everything. A new house, a healthy and happy baby, I mean, what could be wrong?"

Everything was about to change for Patricia. On the evening of July 7, 1989, a Friday, Stallings says that she gave Ryan his evening bottle before she put him to bed. Ryan threw up immediately after he drank it. On Saturday, the baby seemed to be feeling better so Patricia left Ryan with her husband and went swimming at her sister's house. She did not become alarmed about Ryan's condition until Sunday morning when she discovered that he had become lethargic, could not keep his food down and his breathing grew labored. Patricia called Children's hospital and made arrangements to meet a Doctor there. She bundled up Ryan and placed him in his car seat. Patricia said that she got lost trying to find Children's hospital and end ended up at Cardinal Glennon Hospital instead.

On July 12, 1989, after a series of tests had been performed on Ryan, the emergency room physician read the test results. Ryan's blood tests reportedly showed extremely high levels of ethylene glycol (found in antifreeze). The pediatrician Dr. Robert Lynch called in the Missouri Division of Family Services and signed an affidavit saying that he believed the child might have been poisoned. The Missouri Division of Family Services immediately took custody of Ryan. On July 17, 1989, Ryan was discharged from the hospital and placed in a foster home. Foster care for Ryan continued throughout the rest of the summer. Patricia visited her son on September 1, 1989. During her short supervised visitation period, Patricia fed her baby a bottle. On September 4, 1989, Ryan was hospitalized again. The next day Patricia was handcuffed and arrested at her home. She did not know that Ryan died until after she reached the police station.

"It happened real fast," Patricia stated, "I kept thinking this would get straightened out, I thought somebody would figure this out, they'd say oops, and we'd all go home." She went on to say, "I don't think I believed it. I just went around that entire day, saying no, no, no ... I had just seen him; I had just spent the night with him, I was mad at everybody, the whole thing just seemed so absurd." Patricia Stallings was arrested and charged for the murder of her son because the authorities said that she had poisoned Ryan during her last visit. They said that traces of ethylene glycol were found on Ryan's baby bottle, the same bottle that she had used to feed him on September 1st. Patricia spent the next seven months in jail.

Although, she did not know it at the time of her arrest, Patricia Stallings was pregnant with the couple's second child. This child would be the key to proving Patricia's innocence. The newly appointed Prosecuting Attorney, George B. McElroy III, felt he had enough evidence to convict Patricia Stallings. As he immersed himself in the Stallings' case, he interviewed all the witnesses himself. He talked to all the experts involved and reviewed their findings. They found a gallon of antifreeze in the basement of the couple's home. In the Prosecuting Attorney's mind, all the evidence pointed to Stallings' guilt. McElroy grew disturbed by news reports that Patricia's second baby suffered from a rare metabolic disease called Methylmalonic Acidemia, commonly referred to in the medical field as (MMA.) Two major pieces of medical evidence seemed to positively indicate that Ryan's mother had poisoned him. The first was the finding of ethylene glycol in the infant's body by two independent laboratories. McElroy, consulted with a couple of "experts," who wrongly advised him that even if Ryan suffered from the rare metabolic disease (MMA) that it still would not account for the high levels of ethylene glycol found in the baby's blood. The second disturbing piece of evidence was the finding of crystals in Ryan's brain that the experts concluded were positive signs of ethylene glycol poisoning.

Patricia's Attorney, Rathbone, who took the case as a favor to the Stallings family and "Because no one else would take it," had a hard time finding any witnesses who would testify that the infant had likely died of a rare inborn metabolic disorder. "The problem is that there was no one who would back me up on it," Rathbone said. Rathbone says that he extensively researched the subject and consulted with a nationally known expert on metabolic diseases. That expert, Rathbone said, told him there was no way that any metabolic byproducts of MMA could be mistaken for ethylene glycol in lab tests.

Rathbone, who said that he has a degree in biochemistry, stated that he had also looked at the test results and had determined "on his own" that there was no reason to question their findings. When the trial began Rathbone had subpoenaed no expert witnesses to testify for Patricia. He did not believe that there were any experts who would support his theory. Rathbone decided to try to introduce his theory to the jury. Because Rathbone had no solid evidence to support his defense theory, the Judge did not allow him to present it to the jury. Records show that Judge Kramer reprimanded Rathbone during the Stallings trial by gruffly remarking, "You have to prepare and subpoena the evidence necessary to prove your theory!" Who could blame the Judge? After all, if an Attorney shows up unprepared and tries to introduce an inadequate defense strategy, what choice did the Judge have?

The jury convicted Patricia Stallings of first-degree murder and sentenced her to spend the rest of her life in prison. Patricia was devastated by the verdict. Who Says All Prosecuting Attorneys have no heart? Six months after the Stallings trial, Prosecutor McElroy set a groundbreaking precedent when he wrote a motion to Judge Kramer asking for a new trial for Patricia; where he acknowledged that Rathbone's defense of Stallings was woefully inadequate. Judge Kramer stated, "This is the first time I have ever known this to happen. It's unheard of for a prosecutor to acknowledge ineffective counsel." Based on McElroy's motion Judge Kramer decided to grant Stallings a new trial.

Doubts about whether Stallings had actually poisoned her son began to show as early as April of 1990, a full nine months before Patricia's original trial. As previously stated, after the birth of Patricia's second son, David, Jr., press reports grew disturbing to McElroy. The media introduced the fact that the second child suffered from a rare genetic metabolic disease called Methylmalonic Acidemia, commonly referred to in the medical field as (MMA.) There was a one in four chance that Ryan had suffered from the same rare genetic disorder. "I had heard enough to be concerned," McElroy later stated.

Doctor Christopher Long, the head of the St. Louis University's toxicology laboratory, one of the testing facilities that had previously found ethylene glycol in Ryan's blood, miraculously agreed to turn over a tiny bit of Ryan's blood serum to Dr. James Shoemaker, who had just set up a genetic disorder testing laboratory at the same University. Shoemaker received approximately one tenth of a teaspoon of Ryan's blood serum. Using a test designed to detect MMA in urine, Shoemaker discovered on April 21, 1990 that Ryan Stallings actually suffered from MMA. Shoemaker also discovered a trace of ethylene glycol in the baby's blood, but he believed that it was not highly concentrated enough to have killed the little boy. This groundbreaking discovery went no further because of the following. Shoemaker reported his findings to his superiors and held a meeting with some of the university's senior staff. Most agreed that Ryan likely had MMA, but could not agree on whether or not Ryan had died of the disease. The senior staff members believed that some of the ethylene glycol that had been in the child's blood could have dissipated with time and storage. Most of the senior staff members still came to the conclusion that Ryan had been poisoned. Since Shoemaker was not a senior staff member, his findings weren't considered credible and therefore the evidence he had discovered couldn't be used to help Patricia prove her innocence.

Shortly before Patricia's trial, the prosecutor's office called Shoemaker. This was the first time that Shoemaker reported his findings to McElroy, who then reported the same findings to Patricia's Attorney. Rathbone says that had he known that Shoemaker had only found a trace of ethylene glycol in Ryan's blood that he would have pursued it. Rathbone never contacted Shoemaker because he said, "that he didn't need another witness to say that Ryan had probably been poisoned." The media continued to report on the Stallings' case and "Unsolved Mysteries" aired her story. This story alone proved helpful to ending Patricia's long ordeal. Dr. William S. Sly, professor and chairman of the Department of Biochemistry and Molecular Biology at St. Louis University, happened to watch the program and instantly realized that no other tests had been performed on Ryan's blood. He ordered additional testing on the blood sample, which Dr. Shoemaker performed. The results stunned everyone there and Doctor Sly proceeded to write a letter to another university official. This official in turn relayed the letter to McElroy.

In his letter Dr. Sly reached three important conclusions: 1.) They confirmed the absence of ethylene glycol in blood tests performed before Ryan Stallings' untimely death.

2.) They confirmed abnormal elevations of organic acids in Ryan's blood serum, which made the diagnosis of MMA virtually certain.

3.) Dr. Sly confirmed that one of the compounds in Ryan's blood, which are elevated by MMA could be confused with ethylene glycol when the older gas chromatographic testing techniques were used.

McElroy grew intrigued with Shoemaker's findings, but he wasn't entirely convinced that Patricia Stallings was innocent. The question of Patricia's innocence nagged upon the mind of the prosecutor and he decided to investigate the university's findings. McElroy consulted with Dr. Piero Rinaldo, a young, world renowned genetics expert from Yale University and when Dr. Rinaldo concurred with Dr. Sly's findings that the young prosecuting attorney realized that Ryan had likely died of MMA and not ethylene glycol poisoning.

Rinaldo was highly critical of the original tests performed on Ryan's blood serum. "The quality of the tests was highly unacceptable. "They were unbelievably out of this world." Rinaldo further stated: "I was astonished, I couldn't believe that somebody would let this go through a criminal trial unchallenged." Rinaldo performed his own tests on the baby bottle that Patricia had used to feed Ryan on September 1st; and concluded that no traces of ethylene glycol were found on it. Rinaldo shocked both the medical and legal worlds when he further stated that the treatment that Ryan received at Cardinal Glennon Hospital was inappropriate for a child with MMA. Because the hospital staff believed that Ryan had ethylene glycol poisoning, the proposed treatment actually helped end Ryan's life.

McElroy, more uncertain now about Patricia's conviction questioned Dr. Rinaldo further. Ryan's autopsy had shown high concentrations of brain crystals, which were consistent with ethylene glycol poisoning. Dr. Rinaldo explained that there was a high likelihood the crystallization had come about as a direct result of the ethanol drip the hospital used to treat Ryan for ethylene glycol poisoning. Their faulty treatment caused the death of little Ryan Stallings. "Dr. Rinaldo was very persuasive," McElroy later stated, "I was persuaded that Patricia did not murder her son. My charge as a prosecutor is to seek justice, and justice for Patricia Stallings required that I seek a dismissal."

After Patricia Stallings was released from Prison, she and her husband David had their hands full between coping with the death of one son and trying to manage the illness of their second son. MMA is difficult to treat and manage; and the struggle to keep David Jr. alive would be a difficult task. The couple filed a wrongful death lawsuit against Cardinal Glennon Hospital, St Louis University laboratory and SmithKline Beecham Clinical Laboratories and against several Doctors who participated in Ryan's care.

Prosecutor McElroy says, "It will be impossible to make restitution for what happened to Patricia Stallings." He went on to say, "As sad as it is that she had to suffer what she has suffered, I think the final outcome shows real strength in our system of Justice." McElroy also states, "It's difficult at any time to step up and say that a mistake has been made, but my gosh, there's a time when it has to be done."

Author's note: The authorities based Patricia's case on the theory that she suffered from Munchausen's Syndrome by Proxy. Every parent who is advocating for a seriously ill child is in imminent danger of being wrongly accused of participating in Munchausen's by proxy. Is Munchausen's by Proxy a threat to children? The answer is yes, this dangerous disorder can and has caused children to undergo unnecessary medical procedures, which in turn have led to the deaths of many innocent children by the hands of their parents or those entrusted to care for them. There are no simple answers for the caretakers or the caregivers in this situation. We have all heard horror stories about the crimes perpetrated against innocent children by their own parents. Several parents have been rightfully diagnosed with this disorder; and thankfully, the laws are in place to protect the innocent children from the perpetrators. In the Stallings case, however, the authorities used the excuse that it was better to err on the side of the child. This is a classic example of a time when the authorities erred at the expense of an innocent mother and her baby, Ryan Stallings died because those in authority failed him.

American Asociation for the Advancement of Science. TLC Discovery Channel's Innocence Files. Justice: Denied -- The Magazine for the Wrongly Convicted.

i have a dream

In 1950's America, the equality of man envisioned by the Declaration of Independence was far from a reality. People of color, blacks, Hispanics, Orientals, were discriminated against in many ways, both overt and covert. The 1950's were a turbulent time in America, when racial barriers began to come down due to Supreme Court decisions, like Brown v. Board of Education; and due to an increase in the activism of blacks, fighting for equal rights.

Martin Luther King, Jr., a Baptist minister, was a driving force in the push for racial equality in the 1950's and the 1960's. In 1963, King and his staff focused on Birmingham, Alabama. They marched and protested non-violently, raising the ire of local officials who sicced water cannon and police dogs on the marchers, whose ranks included teenagers and children. The bad publicity and break-down of business forced the white leaders of Birmingham to concede to some anti-segregation demands.

Thrust into the national spotlight in Birmingham, where he was arrested and jailed, King organized a massive march on Washington, DC, on August 28, 1963. On the steps of the Lincoln Memorial, he evoked the name of Lincoln in his "I Have a Dream" speech, which is credited with mobilizing supporters of desegregation and prompted the 1964 Civil Rights Act. The next year, King was awarded the Nobel Peace Prize.

The following is the exact text of the spoken speech, transcribed from recordings.

I am happy to join with you today in what will go down in history as the greatest demonstration for freedom in the history of our nation.

Five score years ago, a great American, in whose symbolic shadow we stand today, signed the Emancipation Proclamation. This momentous decree came as a great beacon light of hope to millions of Negro slaves who had been seared in the flames of withering injustice. It came as a

joyous daybreak to end the long night of their captivity.

But one hundred years later, the Negro still is not free. One hundred years later, the life of the Negro is still sadly crippled by the manacles of segregation and the chains of discrimination. One hundred years later, the Negro lives on a lonely island of poverty in the midst of a vast ocean of material prosperity. One hundred years later, the Negro is still languishing in the corners of American society and finds himself an exile in his own land. So we have come here today to dramatize a shameful condition.

In a sense we have come to our nation's capital to cash a check. When the architects of our republic wrote the magnificent words of the Constitution and the Declaration of Independence, they were signing a promissory note to which every American was to fall heir. This note was a promise that all men, yes, black men as well as white men, would be guaranteed the unalienable rights of life, liberty, and the pursuit of happiness.

It is obvious today that America has defaulted on this promissory note insofar as her citizens of color are concerned. Instead of honoring this sacred obligation, America has given the Negro people a bad check, a check which has come back marked "insufficient funds." But we refuse to believe that the bank of justice is bankrupt. We refuse to believe that there are insufficient funds in the great vaults of opportunity of this nation. So we have come to cash this check -- a check that will give us upon demand the riches of freedom and the security of justice. We have also come to this hallowed spot to remind America of the fierce urgency of now. This is no time to engage in the luxury of cooling off or to take the tranquilizing drug of gradualism. Now is the time to make real the promises of democracy. Now is the time to rise from the dark and desolate valley of segregation to the sunlit path of racial justice. Now is the time to lift our nation from the quick sands of racial injustice to the solid rock of brotherhood. Now is the time to make justice a reality for all of God's children.

It would be fatal for the nation to overlook the urgency of the moment. This sweltering summer of the Negro's legitimate discontent will not pass until there is an invigorating autumn of freedom and equality. Nineteen sixty-three is not an end, but a beginning. Those who hope that the Negro needed to blow off steam and will now be content will have a rude awakening if the nation returns to business as usual. There will be neither rest nor tranquility in America until the Negro is granted his citizenship rights. The whirlwinds of revolt will continue to shake the foundations of our nation until the bright day of justice emerges.

But there is something that I must say to my people who stand on the warm threshold which leads into the palace of justice. In the process of gaining our rightful place we must not be guilty of wrongful deeds. Let us not seek to satisfy our thirst for freedom by drinking from the cup of bitterness and hatred.

We must forever conduct our struggle on the high plane of dignity and discipline. We must not allow our creative protest to degenerate into physical violence. Again and again we must rise to the majestic heights of meeting physical force with soul force. The marvelous new militancy which has engulfed the Negro community must not lead us to distrust of all white people, for many of our white brothers, as evidenced by their presence here today, have come to realize that their destiny is tied up with our destiny and their freedom is inextricably bound to our freedom. We cannot walk alone.

As we walk, we must make the pledge that we shall march ahead. We cannot turn back. There are those who are asking the devotees of civil rights, "When will you be satisfied?" We can never be satisfied as long as the Negro is the victim of the unspeakable horrors of police brutality. We can never be satisfied, as long as our bodies, heavy with the fatigue of travel, cannot gain lodging in the motels of the highways and the hotels of the cities. We can never be satisfied as long as a Negro in Mississippi cannot vote and a Negro in New York believes he has nothing for which to vote. No, no, we are not satisfied, and we will not be satisfied until justice rolls down like waters and righteousness like a mighty stream.

I am not unmindful that some of you have come here out of great trials and tribulations. Some of you have come fresh from narrow jail cells. Some of you have come from areas where your quest for freedom left you battered by the storms of persecution and staggered by the winds of police brutality. You have been the veterans of creative suffering. Continue to work with the faith that unearned suffering is redemptive.

Go back to Mississippi, go back to Alabama, go back to South Carolina, go back to Georgia, go back to Louisiana, go back to the slums and ghettos of our northern cities, knowing that somehow this situation can and will be changed. Let us not wallow in the valley of despair.

I say to you today, my friends, so even though we face the difficulties of today and tomorrow, I still have a dream. It is a dream deeply rooted in the American dream.

I have a dream that one day this nation will rise up and live out the true meaning of its creed: "We hold these truths to be self-evident: that all men are created equal."

I have a dream that one day on the red hills of Georgia the sons of former slaves and the sons of former slave owners will be able to sit down together at the table of brotherhood.

I have a dream that one day even the state of Mississippi, a state sweltering with the heat of injustice, sweltering with the heat of oppression, will be transformed into an oasis of freedom and justice. I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character.

I have a dream today.

I have a dream that one day, down in Alabama, with its vicious racists, with its governor having his lips dripping with the words of interposition and nullification; one day right there in Alabama, little black boys and black girls will be able to join hands with little white boys and white girls as sisters and brothers.

I have a dream today.

I have a dream that one day every valley shall be exalted, every hill and mountain shall be made low, the rough places will be made plain, and the crooked places will be made straight, and the glory of the Lord shall be revealed, and all flesh shall see it together.

This is our hope. This is the faith that I go back to the South with. With this faith we will be able to hew out of the mountain of despair a stone of hope. With this faith we will be able to transform the jangling discords of our nation into a beautiful symphony of brotherhood. With this faith we will be able to work together, to pray together, to struggle together, to go to jail together, to stand up for freedom together, knowing that we will be free one day.

This will be the day when all of God's children will be able to sing with a new meaning, "My country, 'tis of thee, sweet land of liberty, of thee I sing. Land where my fathers died, land of the pilgrim's pride, from every mountainside, let freedom ring."

And if America is to be a great nation this must become true. So let freedom ring from the prodigious hilltops of New Hampshire. Let freedom ring from the mighty mountains of New York. Let freedom ring from the heightening Alleghenies of Pennsylvania!

Let freedom ring from the snowcapped Rockies of Colorado!

Let freedom ring from the curvaceous slopes of California!

But not only that; let freedom ring from Stone Mountain of Georgia!

Let freedom ring from Lookout Mountain of Tennessee!

Let freedom ring from every hill and molehill of Mississippi. From every mountainside, let freedom ring.

And when this happens, When we allow freedom to ring, when we let it ring from every village and every hamlet, from every state and every city, we will be able to speed up that day when all of God's children, black men and white men, Jews and Gentiles, Protestants and Catholics, will be able to join hands and sing in the words of the old Negro spiritual, "Free at last! free at last! thank God Almighty, we are free at last!"