Case Study: George
George is a 40 year old senior executive in a large company, a position he has only recently taken up. He was referred to counseling by his general practitioner to explore his mood swings. He has been married for nearly 5 years to a ‘warm and wonderful person’. There were no children yet, and the couple was wondering about the right time for having children. This has been an area of disagreement between George and his wife and has led to a number of heated arguments between the two of them.
George described himself as fairly conservative and not a risk taker, and said that sometimes he couldn’t believe he had accepted a job in such a large company. On questioning, George said that he sometimes felt OK and reasonably good about himself, but that these good feelings frequently gave way to incredible doubts and feelings of hopelessness, that he often felt ‘not good enough’ and ‘not worthy’. He had experienced these feelings before, but he felt they were more intense and more frequent since moving to his current position. He commented, “I’m not the person I thought I would turn out to be” and “I’m disappointed in myself”.
He reports being able to keep it together at work and that his work in not suffering at this stage. He has become more restless and irritable with people, especially in social situations which he describes as excruciating and pointless.
There are a number of potentially valuable therapies that vie for attention as possible curative options for George and his symptoms. However, gestalt therapy and REBT are the two approaches that I have decided to implement here. I will give a very brief synopsis of each approach before offering in-session therapeutic techniques that I will apply with George. In closing I will discuss some of the differences between the two chosen approaches, as well as offering a justification for a preferred approach for treating George.
The gestalt approach is a psychological approach that studies the organization of experience into patterns or configurations (Yontef & Jacobs, 2008). Gestalt psychologists believe that the whole is greater than the sum of its parts and study, among other issues, the relationship of a figure (the part of the field that stands out) to its background. One goal of gestalt therapy is primarily to become aware of the elements that make up the various parts of a field, so that one becomes able to choose and/or organize one’s own existence in a meaningful manner (Jacobs, 1992; Yontef, 1982, 1983). An awareness of the relational field is a way of understanding how one’s context influences one’s experience.
Gestalt theory suggests that people define themselves by how they experience themselves in their field in relation to others. Yontef & Jacobs (2008, p. 340) argue that this is an identity boundary that needs to be permeable enough to allow for connection to others but also to preserve autonomy by separation. They claim that an incessant fluctuation of connecting to and separating from relationships with others is necessary for effective self-regulation.
The gestalt approach has a strong emphasis on experiential learning and focusing on what is actually happening in the ‘here-and-now’ (Yontef & Jacobs, 2008, p. 346). It is not concerned with past events per se, but rather how the past (or an anticipated future event) is experienced in the present. The most conspicuous feature of gestalt therapy is the importance of raising client-awareness and finding self-acceptance by developing awareness skills (Yontef & Jacobs, 2008). Gestalt therapy is a collaborative approach that involves the therapist and the client to make sense of the relational field of the client, and the shared field with the therapist, as manifested during the therapeutic hour.
The other form of therapy that I recommend for treating George is REBT. The fundamental premise of REBT is that nearly all emotions and behaviours are caused by what...
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