GWYNNE GUZZEAU / CAROL BROCKMON 169

REFERENCES

Azar, F. S., & Asadnia, S. (2013). Efficacy of cognitive behavior therapy and

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Gestalt therapy on poor sleep quality among college female students with
headache. Journal of Education, Psychology and Social Sciences, 1, 15-24.
Bohart, A. E. (2002). Empathy. In J. C. Norcross (Ed.), Psychotherapy relationships
that work (pp. 89-108). New York: Oxford University Press.
Norcross, J. C. (2011). Psychotherapy relationships that work: Evidence-based
responsiveness. New York: Oxford University Press.
Stevens, C., Stringfellow, J., Wakelin, K., & Waring, J. (2011). The UK Gestalt
psychotherapy CORE Research Project: The findings. British Gestalt Journal,
20, 22-27.
Strumpfel, U. (2006). Therapie der Gefuhle–Forschungesbefunde zur
Gestalttherapie [Therapy of emotions-Research findings on Gestalt
therapy]. Bergisch Gladbach, Germany: Verlag Andreas Kohlhage.

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Borderline, Narcissistic, and Schizoid Adaptations: The Pursuit of

Love, Admiration, and Safety by Elinor Greenberg. New York:
Greenbrooke Press, 2016.

Review 1
For a book that sounds deceptively academic, this one is a stimulating
treasure to read, contemplate, and engage with in collegial dialogue. Elinor
Greenberg takes on the tension between the usefulness of diagnosis and the
phenomenology, present centeredness, optimism and relational, dialogic
values, and strategies of Gestalt therapy, and creates a highly useful paradigm
and set of tools for working effectively and respectfully with clients who
present some particular challenges in therapy.
The book reads like a conversation. It refers to and explains technical
terminology but uses almost entirely plain, everyday language. After 40 years
of practice, I found that this book helped me to reorganize what I had already
known and added significantly to my understanding of this class of clients.
What Greenberg has done is to take insights from Masterson, Kohut, and other
Object-Relations and psychoanalytically based theorists and practitioners,
understood and digested them thoroughly, brought them down to their basic
elements, and translated those elements into ordinary language consistent
with Gestalt thinking.
170 CAROL BROCKMON

Some examples of how she does what she does follow. Greenberg uses
the Gestalt concept of figure/ground, the process of figure formation and
destruction, and the notions of unfinished business and fixed Gestalts and

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is able to translate the more static concepts of psychoanalytic language
into the more dynamic, dialogic ideas of Gestalt. We can then talk about
adaptations instead of disorders, and look at the usefulness, in context, that
those adaptations do or did have. She can gear interventions in very concrete
ways toward insights and “aha moments,” toward tiny-named or unnamed
experiments, or hold ground with the empathic reflections that help to make
the therapy bearable. She is specific and concrete.
The issues she defines are humanizing, respectful, and universal. For me,
“a penny dropped” when she says that borderline adaptations center around
love and fears of abandonment and engulfment; narcissistic adaptations
center around admiration, affirmation and status, and fears of humiliation,
shame and valuelessness; and schizoid adaptations center around issues of
safety and fears of annihilation and emptiness. Things that I knew intuitively,
and recognized in practice at least after a while but had not articulated,
suddenly made a clear kind of sense.
Greenberg makes a contribution also in giving clear indications of when
and why not to use ordinary Gestalt interventions—when and why they might
not be useful or bearable for the client—such as reflecting, confronting, “two
chairs work,” or too much of an experiment. Unquestionably, a huge piece
of her wisdom is a way to understand what is bearable for someone with a
particular adaptation at a given time. She is able to articulate that in a way
that makes it accessible.
She also makes it clear just how much one needs to be prepared to spend
time and energy just waiting and reflecting and empathizing; how slow the
process can be; and how much you as therapist have to sub-optimize your
hurry, your own need for affirmation, and your own level of comfort—how
much you need to be prepared for rupture after rupture, and repair after
repair.
Besides her deep understanding of the dynamics and life experience of her
clients, Greenberg has a particular talent for coming up with ways to give
clinicians what I think of as “a hook to hang things on.” She uses humor,
irreverence, creative metaphor, and other strategies that include the notion
of high and low “Splash!” (when clients’ problems impact other people); the
uproar, disorganization, and disruption that follow certain clients around,
along with ways to notice and predict it; ideas like the appropriate song, patron
saint, and emblem for a particular diagnosis; names like “closet narcissist” and
“malignant narcissist,” so that you do not forget or lose a sense of the big
picture. These “hooks,” however, are not dismissive or contemptuous; they
CAROL BROCKMON / GIANNI FRANCESSETI 171

are closely followed by a discussion of the woundedness and reasons for these
defense systems.
A big leftover question for me, because I do a large proportion of couples

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work, has to do with working with these adaptations in the context of a
couple or other system. All of the strategies a therapist can tolerate for an
hour at a time are hard to manage in a system with an equally vulnerable and
impacted other co-creating a relationship—maybe with as much dysfunction.
I can extrapolate a little from the discussions of group therapy, but that could
be fleshed out as well.
The strategies, tools, and ideas which Elinor Greenberg offers are valuable.
If they are not right for you, they are still good thought starters. This book has
been entirely useful to me. I highly recommend it.

Carol Brockmon, LCSW, PCC

[email protected]

Review 2
In her interesting and needed book, Borderline, Narcissistic, and
Schizoid Adaptations: The Pursuit of Love, Admiration, and Safety, Elinor
Greenberg explores the named adaptations in order to provide a key for
their understanding, and to offer pathways for helping people who suffer
from them. The author uses the term “adaptations” to avoid the negative
and pathologizing connotations of “disorders.” The volume is divided into
five parts: the first is an overview of these ways of experiencing and living;
the following three parts are each dedicated to one of the adaptations;
and the fifth and final part is a useful Glossary, where Greenberg provides
explanations of the more specific terms she uses.
The book is a key reference work for any Gestalt therapist seeking to
understand these sufferings and to work clinically with people with these
adaptations. The story that led Greenberg to write this book is not just
relevant for the author’s personal experience, but it is also testimony to a
development in the field of psychotherapy and of Gestalt therapy, as Peter
Philippson underlines in his Foreword. To work with people suffering from
“personality disorders” requires an understanding of the ways in which they
organize the field, experience life, and are impacted by their background.
I fully agree with Greenberg when she states that, without that support,
the risk of being unable to help those individuals and or of re-traumatizing
them is high. This is true for all clinical suffering, not only for “personality
disorders,” and for why a solid preparation in psychopathology is needed for
psychotherapists. Some forty years ago, it became clear that more was needed
so that relationally-oriented psychoanalysts, especially, could understand
172 GIANNI FRANCESSETI

borderline and narcissistic adaptations in psychoanalysis. Humanistic therapists

generally stayed well away from that movement, following the historical and
ethical principle of not labelling and pathologizing people. Greenberg had to

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turn to psychoanalysis—specifically to James Masterson’s approach—in order
to find support for her clinical work with clients with borderline, narcissistic,
and schizoid adaptations.
Greenberg’s book can be seen as being the result of the successful integration
of the author’s studies at the Masterson’s Institute with the Gestalt therapy
approach cherished at the New York Institute for Gestalt Therapy, to which
she belongs. Many Gestalt therapists have followed, and continue to follow,
that same path. Over the years, it has enriched Gestalt therapy with new ideas
and experiences from other theoretical and clinical approaches. In some cases,
it has produced developments in line with Gestalt therapy theory; in others,
it has produced eclectic juxtapositions built on rather inconsistent theoretical
grounds. A lack of firm grounding is a sign that new additions are not
sufficiently rooted in Gestalt therapy theory, with the risk that practical work
will lack clarity and resist critical reflection. However, tackling clinical issues
that others before us have tackled is not only a source of fertile contamination
with new ideas but also a stimulus for developing the potentiality that our
approach has yet to express. The study of these adaptations can in fact give
rise to a specifically Gestalt way of understanding and working with sufferers,
i.e., a specifically Gestalt psychopathology that supports the therapist with a
perspective that is both consistent with the theoretical bases of the approach
and original by pointing to new pathways in clinical work. This book strikes
me as a good example of both of these possibilities. On the one hand, it
represents a development in Gestalt therapy theory and practice based on the
author’s experience at the Masterson’s Institute and, on the other, it offers
readers original insights specifically within the framework of Gestalt therapy.
It falls within, and provides a major contribution to, one of the fundamental
contemporary areas of development in Gestalt therapy: the exploration and
creation of a specifically Gestalt psychopathology. The movement is a work in
progress, giving rise to new clinical insights that are of extraordinary interest
not only to Gestalt therapists but also to therapists from other approaches.
Greenberg belongs to this movement, and her contribution to it is highly
original.
The book provides readers with an excellent description of the
characteristics of borderline, narcissistic, and schizoid adaptations, enriched
and accompanied by a great number of highly insightful clinical examples.
Readers are guided in understanding the patient’s experience and their own
experience of the therapeutic relationship through outstanding descriptions
of countertransference and practical advice on how to recognise such reactions
GIANNI FRANCESETTI 173

and use them in therapy. Readers also learn how to approach patients with
these types of suffering, the risks they run, and the potential developments
they can expect to encounter. A central and specifically Gestalt concept in

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Greenberg’s approach which I find useful and original is that of Interpersonal
Gestalt: “the way we are organizing our interpersonal field at any moment:
what becomes figure for us out of many interpersonal possibilities, and what
becomes ground” (p. 349). The author differentiates the three adaptations
discussed on the basis of the interpersonal Gestalt that emerges. For
borderline patients, the experience is organized around the pursuit of, or
struggle for, love; for the narcissist, around the pursuit of admiration; for
schizoid patients, around the pursuit of safety. These are descriptions of the
figure/ground creation process that unfolds in the therapeutic encounter and
shapes the field of therapeutic possibilities. The therapist supports awareness
of the process triggered, and encourages the exploration of new ways of
creating figures and grounds by sustaining the emergence of new experiential
attractors.
The book focuses on one of the most controversial fields of research:
personality adaptations, a field subject to changes in perspective depending
on the author and clinical developments. That is why I believe it can help
offer readers insights from a divergent point of view in order to enable a
broader perspective on the field. Besides the preferred terminology of choice,
the very possibility of categorically distinguishing one personality disorder (or
adaptation) from another is a matter of widespread debate. For many authors
(who were influential in the proposal of the alternative diagnostic system for
personality disorders in the DSM 5), it is useful to consider these personality
organizations as dimensions rather than categories. A categorical approach
considers, on the basis of explicit criteria, whether the patient’s personality
is borderline or narcissistic or schizoid, etc. A dimensional approach looks at
the extent to which the patient’s personality is borderline and narcissistic
and schizoid, etc. Greenberg chooses a helpful approach that is widely
used in psychopathology, which is neither categorical nor dimensional but
typological. That is, she describes the essential characteristics of a certain
type of adaptation, so that clinicians can then compare their clients with
the description and check whether they correspond or not. Greenberg’s
descriptions are clear and simple, and hence didactically effective, and can
be understood in either a more categorical or a more dimensional way. It is
important to underscore that the descriptions can be viewed within a more
categorical or a more dimensional framework. I find it more useful to view
them from a dimensional perspective, according to which each of us potentially
possesses all the dimensions of various personality disorders or adaptations
that can change (i.e., I can be more or less borderline, narcissistic, or schizoid)
174 GIANNI FRANCESSETI

depending on the situation and circumstances. This helps us understand

why many of the clinical situations we come across are never quite “pure,”
but rather exhibit aspects of different adaptations at the same time or in

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different moments. The dimensional perspective also aids in avoiding the risk
of objectifying and labelling patients, which inevitably comes with diagnosis.
Moreover, it allows us to remember that every adaptation emerges from a
creative adjustment to a particular situation; that it is not an immutable,
constituent datum of fact; and that it is relatively subject to change as the
situation changes. This is important because, in dealing with personality
disorders, the risk of crystallizing what makes a person suffer is as high as
ever—precisely because it is crystallized.
I would also like to offer some critical considerations which I hope will
encourage a more rewarding engagement between reader and author
and pave the way for further contributions to the debates this book quite
brilliantly opens up.
Firstly, Greenberg certainly achieves the goal she sets herself at the start
of the book, that of being clear, which greatly facilitates the understanding
of these complex issues. This choice, however, leaves less space for the
problematics of the issues addressed, and for additional reference to the vast
existing literature, including Gestalt therapy contributions that, though not
abundant, are certainly significant. Although consistent with Greenberg’s
chiefly pragmatic aims, it is nevertheless a shame that she does not cite the
full bibliography of works from which she draws. Secondly, in some passages
I found that concepts deriving from different conceptual fields are used
without a discussion of their relationship with the epistemology of Gestalt
therapy. For example, Winnicott’s concept of “false self” and “true self,” a
concept grounded in a theory of self vastly different from that of Gestalt
therapy, is used without explaining the relationship and the differences
between the two theories.
Thirdly, the perspective of phenomenological fields in psychopathology and
in the therapeutic encounter could be further developed within Greenberg’s
approach. This perspective highlights the fact that a borderline, narcissistic,
or schizoid adaptation emerges in the patient’s history from a relational field.
This view is amply described in the book, with many references made to the
interpersonal relations and potential traumas experienced by patients. I feel,
however, that more development is needed from a perspective that considers
the phenomenological field as the effect of co-creation in the therapeutic
encounter. From this point of view, the suffering that the therapist encounters
in the session is co-created: borderline, narcissistic, and schizoid fields are co-
created in the here and now at the contact boundary. It is not the patient
who is borderline; rather, what happens in the session is the emergence
GIANNI FRANCESSETI / NANCY HARDAWAY 175

of a borderline field that is co-created by both therapist and patient. This

perspective shifts our focus in therapy: from working on the patient in an
effort to change him or her, to working on the therapist’s experience, which

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will change the field and, as a consequence, the patient’s experience in the
therapy session. Let us take, for example, a narcissistic field: rather than
working to change the patient’s sense of shame, or his tendency to exclude
from the emerging figure everything he considers negative, the therapist
works on her own experience of inadequacy and shame; and on how, in the
session, she experiences the need for admiration and her tendency not to let
what she considers negative emerge. The field perspective in the therapeutic
encounter places the emphasis on the therapist’s presence rather than on
change in the patient.
To conclude: all Gestalt and other therapists who intend to work with
these adaptations should read this book. I thank Elinor Greenberg for
having so generously shared with us her clinical experience and theoretical
considerations. I am certain that the work will support the development of
further research and insight into a clinical field of great complexity.

Gianni Francesetti, MD
[email protected]

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Expanding Your Leadership: A Journey Towards Building Character

by Dagrun Dvergsdal. Oslo: Abstrat forlag AS, 2014

I love this book describing the design and implementation of a leadership

development program, but I may not be entirely impartial. First, I know, like,
and respect the author, Dagrun Dvergsdal, having encountered her during my
years at the Gestalt International Study Center (GISC), both as participant in
programs and as CEO of the organization. Second, I subscribe to and use the
Gestalt approach to leadership development that underpins the book and the
program described by the author. Even without those connections, however,
I believe I would have valued this text because it is unusual in describing a
whole process of design and implementation, and it is well structured and
well written. It can be a useful resource for a wide audience.
The author includes the business rationale behind program development
and program outcomes, examples of program modules, succinct participant