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Gestalt practitioners, like psychotherapists from other disciplines, do well to be informed of the medical models of psychological distress, such as the descriptions of behaviour listed in the D.S.M.1V. This makes for ease of communication with other professionals and patients' patterns of behaviour may be discerned.
However, Gestaltists will regard the disorders so described as processes, rather than things.
Narcissism, the subject of this dissertation, is listed in the D.S.M. as, in its severe form, a disorder: Narcissistic Personality Disorder. Although some disorders in the D.S.M. may be regarded as diseases if they are organically caused and are not treatable by a talking therapy (Alzheimer's, for example), Narcissistic Personality Disorder would not be regarded as a disease but as a behaviour pattern indicative of psychological distress and difficulty and treatable by psychotherapy.
Gestalt psychotherapy is underpinned by a philosophical and theoretical belief that all human beings are inherently relational. The work of Martin Buber has been inspirational to the dialogical Gestaltists frequently referred to above: Gary Yontef, Richard Hycner and Lynne Jacobs.
This view is supported by some psychoanalytical writers whose work has been considered in this thesis. In particular, Symington, Kohut and Hamilton stress this belief. Hamilton acknowledges her debt to the research of John Bowlby and others in developing this perspective.
Narcissism is understood by Gestaltists to be a turning away from relationship and to be a decision which was once a creative adjustment to adverse environmental factors, these often being related to empathic failure by the mother .
Symington shares the Gestalt view that narcissism is a choice, a response to early trauma and environmental failure. This choice is not a once and for all decision but is a process, a continuing choice to be inauthentic and not to face the pain of loss, which true engagement in relationship entails.
All the writers considered above agree healing is possible through various types of 'talking cure', i.e. narcissistis patients can change through engaging in a relationship with a psychotherapist.
There are different emphases and vocabulary, nevertheless there is agreement that patients can benefit from an empathic, understanding other, who is willing to bracket his own concerns and responses if they are unhelpful and to devote himself to the patient's experience and the patient's growth for the duration of the therapy. This would seem in some way - the details of how this works are various - to allow the development that was impossible in infancy and childhood to become possible within this relationship.
Thus, arrogance becomes a healthy enjoyment of achievement, the tendency to use others as objects changes to allow a capacity for intimacy and genuine closeness, a tendency to crippling shame and rage becomes a normal manageable vulnerability to disappointment.
There is some agreement that the tendency of the narcissistic patient to idealise the therapist should be tolerated and that this is gradually worked through to a relationship where the therapist is perceived as a fallible, helpful human being. The disappointments in therapy are important: the expression of rage and pain are permitted, the patient learns that the therapist remains constant and does not abandon him, he learns that no-one is perfect but that help and care can be offered and received.
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