‘You cry, I feel pain’.

The emerging, co-created self as the foundation of anthropology, psychopathology and

psychotherapy in Gestalt Therapy.

Gianni Francesetti

1. An exordium

When Jean-Marie asked me to write a chapter on the self, possibly in relation to psychopathology, I was
only too happy and grateful to accept. But I soon realized just how difficult it is to describe something that
at the same time seems so omnipresent in my theoretical work and clinical practice. Paraphrasing Saint
Augustine’s words on time, I, too, might say that I know what the self is, but if you ask me to explain it, I no
longer know! Initially I thought it was just a matter of sitting down and finding the right words, but then I
realized that this ‘elusive’ aspect was indicative not only of a contingent and surmountable limitation that
lies in who does the describing, but it is also a constituent aspect of the object of description: the essential
is always elusive (cfr. Lévinas, 1974; Barison, 1990). A more practical approach to writing this chapter would
come one pleasant evening, thanks to help of a good bottle of Barolo, when Jean-Marie explained that
what he was interested in knowing was if I used the concept of self in my work and, if so, how. This helped
to link the issue to my clinical experience. This chapter is my attempt to answer, provisionally, Jean-Marie’s
query. I am sharing these thoughts in this exordium because I feel that they are relevant. Elusiveness and
anchorage to experience are not just two hiccups along the way to approaching the issue; rather, they
constitute a first insight into the issue itself. An issue that tends to elude verbal definition and which moves
away, just like the horizon, at every step; an issue that I can only begin to grasp by returning to experience
itself. Just as you ‘cannot forcefully grasp the sea and the smile of friends who move far away’ (Yoshimoto,
1999, p. 286), so a verbalization cannot grasp, capture, contain and crystallize the self.
Within these constituent limits, which I cannot transcend in this piece, I will try to explain how the
concept of self underpins my practical work as a Gestalt therapist. This concept, as it is presented in Gestalt
Therapy (Perls, Hefferline, Goodman, 1951; hereinafter PHG), constitutes the anthropological foundation,
psychopathological foundation, and the therapeutic foundation of my clinical work. I will try to explain my
understanding of these three dimensions in the light of the theory of self, and how that theory supports me
in my day-to-day work with clients and in my clinical research. I refer in particular to the theory as it is
presented in the chapter ‘Self, Ego, Id, and Personality’ in PHG (1951) and developed by Spagnuolo Lobb
(2001a, 2002b, 2013), Robine (2006a, 2006b, 2015), Philippson (2009), Vázquez Bandín (2014), Bloom
(2003, 2014), Jacobs (2005), Yontef (2009), Wollants (2008), Wheeler (2000), Parlett (1993) and Staemmler
(1997, 2009). The task I have set myself is to bring to the fore a figure that is constantly present in my
ground—a ground that I rarely think of explicitly, but which underpins and nourishes the emergence of
figures in my theory and practice.

2. What is a human? The anthropological perspective

2.1. The relational foundation

‘The complex system of contacts necessary for adjustment in the difficult field, we call “self”. Self may
be regarded as at the boundary of the organism, but the boundary is not itself isolated from the
environment; it contacts the environment; it belongs to both, environment and organism’ (PHG, 1994, p.
151). The first fundamental element that I wish to stress is that this concept of self shifts the response to
the anthropological question ‘What is a human?’ as it immediately casts us out of an individualistic
paradigm. The minimum descriptive unit of the human being is not the individual (Francesetti, 2015a).
 The response puts us instead in a post-Cartesian and phenomenological universe. Descartes identified
his foundation in the mind as immaterial substance (res cogitans), as opposed to the material substance of
the world (res extensa). ‘What kind of thing am I? I am a thinking thing’ (1990, p. 27). Phenomenology
pivots instead on the self-evident statement that thinking has a thought, and identifies the foundation of
consciousness in the relationship between cogito and cogitatum, between thinking and what is thought. For
Descartes the foundation of consciousness is a substance; in phenomenology, the foundation of
consciousness is a relationship. And the relationship between who thinks and what is thought is called
intentionality. The original relational nature of humans is founded on the intentional nature of
consciousness. This simple move shatters the solipsistic isolationism of the Cartesian world view and
inextricably grounds humans in an original relationship. It is in and from this relationship that the I and the
world emerge as two poles (Husserl, quoted in Wiesing 2014, p. 73). The I and the world are co-original (in
the sense that they emerge together); they are reciprocal (in the sense that there is no subject with the
world and without a subject there is no world); and they are different (in the sense that they are not
identical and they are each defined on the basis of their reciprocal otherness) (Wiesing, 2014).
For the purposes of clarity, it should be noted that in these few lines I have used, following the authors
cited, various linguistic references that belong to different epistemological grounds. The concept of
organism and environment refers to a third-person perspective, of an observer who observes and describes
phenomena in a ‘naturalistic’ and somewhat detached way. The terms ‘I’ and ‘world’ are closer to a
phenomenological description made in the first person. The language of PHG belongs to a semantic field
that is psychoanalytic in kind and the entire text tends to take a post-Cartesian view, using language that is
often Cartesian but which shifts between the two paradigms (Robine, 2006a, 2015; Spagnuolo Lobb, 2013;
Philippson, 2001; Jacobs, Hycner, 2009). Looking beyond the linguistic registers and epistemological
shifting, what is important to remember here is that the foundation of the human being does not lie in an
immaterial substance distinct from the world, but in a relationship. I and the world are co-emergent and
made of the same stuff. Other schools of philosophical thought, besides phenomenology in all its various
derivations, have also posited the foundation of the human being in the relationship rather than the
individual. Of particular importance in Gestalt Therapy literature is the philosophy of Martin Buber and his
concept of Zwischenheit (betweenness) (Buber, 1923; Francesetti, 2008; Jacobs, Hycner, 2009). Another
school of thought that converges on this point and which seems quite fertile to me, although it has been
explored less in our literature, is French personalism, with its concept that the person cannot be reduced to
the individual (Weil, 1947; Mounier, 1949).

2.2. Emerging from the aesthetic dimension

Having established the relational foundation of the human being, let us now look briefly at the
relationship between I and self, understanding these terms from now on in the Gestalt Therapy sense and
in the light of the process by which experience is constituted. The ego function, id function and personality
function are all functions of self. Our conception of self as an emergent phenomenon at the contact
boundary (Philippson, 2009; Spagnuolo Lobb, 2001a), is in line with recent models developed in the
neurosciences. In particular, Damasio, taking his cue from Pessoa, uses the metaphor of the self as an
orchestra conductor who only appears precisely when the orchestra starts playing (Damasio, 2010). This
concept is also found in PHG, for instance, when the authors write that “the self is the figure/background
process in contact-situations […] Self exists where there are the shifting boundaries of contact” (PHG, 1994,
pp. 152–153). What does this imply? It implies that the me I am emerges from the contact process
underway. The roots of my being there transcend me, running deep into a place where me and the other
have yet to be differentiated (for more on this see Francesetti 2012, 2015a). Hence there exists a moment
in the unfolding of the experience, in the cauldron where it all takes shape in the senses, in which me and
the other are still being differentiated. This moment of the aesthetic dimension1 is pre-reflexive and ante-
predicative, in which there is no clear separation between me and what is other-to-me. We see the vestiges

1
We call this dimension aesthetic in that it is sensory; in the ancient Greek aisthesis means sensation and aesthetics thus
constitutes knowledge through the senses (Spagnuolo Lobb, 2013; Francesetti, 2012; 2015a).
of this process in the words subject and object: sub-jectum in the Latin means cast down below, ob-jectum
means cast out there, thus bearing evidence of their not being original essences but the product of the act
of being cast into two different regions of the world.2 The sensorial origin of experience is a vague
perception, one that is confused and affectively pregnant, which in just a matter of milliseconds becomes a
clear and detached figure, as was described by Metzger (1941). In that original moment, we do not
perceive distinct objects yet, but rather an atmosphere, which shapes the subsequent perception,
influencing the emergence of the figure and its qualities, in particular its affective and emotional tone. It is
a moment that generally is not mentalized or verbalized—indeed, it is not really verbalizable as our
linguistic syntax requires a subject and an object that here have yet to be ‘cast’ and defined (Francesetti,
Spagnuolo Lobb, 2013). This process of emergence is implicit in the concept of the id of the situation, and,
as Robine points out (2006a, 2006b, 2015), it is a revolutionary concept in PHG. The id function of the self
does not belong to me alone, but to the situation. It means that the emerging self that in an instant will be
mine and will develop an ego function, and which will exercise choice in the field, originally belongs to the
situation; it transcends me. The ego function exercises choice in the field and for the field (Philippson,
2009); it is the function of choice expressed by the field, i.e., it is the organ through which the field makes
choices. The same can be said of the personality function. There is a personality function of the situation
which, before being my personality, is an emergent function of the field. An important element to note is
that the aesthetic dimension does not disappear once the figure is defined. The definition of the figure
continues and adds to this original sensory level, thus modifying the experience. As many authors who have
worked on development have stressed (Stern, 1985), subsequent stages add to and do not replace the
previous. In therapy, we often need to return to the senses to re-find, re-orient, re-emerge and re-create
ourselves and restore the atmospheric tone of the encounter.
Since it is a ante--predicative and pre-reflexive moment, where subject and object have yet to defined,
the translation of this experiential moment into language cannot be taken for granted. When language
does manage to latch onto this moment, it becomes poetry (PHG, Ch. 7); some specific creative
adjustments witnessed in psychotic experience (delusions and hallucinations) are also attempts to express
what is unspeakable. Madness is thus seen clearly here as the unfortunate relation of poetry (Clemens
Brentano, quoted in Béguin, 1939). Another difficulty encountered in trying to describe this moment is tied
to our own culture. PHG talk about a ‘disease of language’ which permeates modern Western culture (PHG,
1994, p. 155 footnote), which has lost the middle mode, a grammatical structure present in Greek which
describes an experience that falls neither entirely with the subject or the object, but which lies in a middle
realm where the subject and object play and are played with, and which would be able to express the co-
originality and reciprocity of me and the world (Sichera, 2001; Francesetti, 2012, 2015a). This language
disease expresses a cultural disease, of having lost sight of the phenomena that populate the middle realm
and which are not ascribable or reducible to an event that is neither subjective or objective. A verbal form
is lacking to describe its spontaneity, for it is ‘both active and passive […] it is middle in mode, a creative
impartiality’ (PHG, 1994, p. 154). The human being lives in and comes from this dimension, but our culture
does not help us grasp it or convey it. Even for the therapist it is not easy to grasp this dimension. In the
cauldron of the senses where the origin of experience gushes and spouts—the aesthetic cauldron, the task
of the therapist is to grasp the atmosphere generated and that generates, which she co-creates with the
client. In this way she grasps the phenomenological field that is emerging and that shapes the
figure/ground process which is started up in the therapeutic encounter. This task is an aesthetic task.
Aesthetic evaluation is immediate, pre-reflexive and ante-predicative, judging neither oneself nor the other
but what happens and emerges at the contact boundary. The criterion used in making this evaluation is
intrinsic to contact itself, and does not require measurement against an external standard (PHG, Ch. IV, §
13; Bloom, 2003; Robine, 2006b; Spagnuolo Lobb, 2013; Francesetti, 2012; Tellenbach, 2013). It gives the
clinical worker the chance not to evaluate the patient, because what is evaluated is the process of figure
formation, the Gestaltung: this is what we evaluate, this is what we treat. And this is why our approach is
called Gestalt Therapy, because what we support is the formation of the Gestalt at the contact boundary

2
German Berrios notes how the current meaning of ‘object’, as something independent, and subjective, as something mental
and relative to the individual, only developed during the XVII century with the establishment of the scientific method. Before then,
the terms were used to mean the outcomes of a process (Berrios, 2012).
(Francesetti, 2012, 2015a). Perls’ call to ‘go back to your senses’ thus becomes, in this framework, an
invitation to step up to the contact boundary and not descend introspectively into oneself. The place where
we encounter ourselves is at the boundary where me and the other co-emerge: the contact boundary. ‘The
deepest part of ourselves is the skin’ (“Ce qu'il y a de plus profond en l'homme, c'est la peau”, Paul Valéry,
1931).

2.3. Intentionality for contact

A third element that I would like to stress, to be able to respond to the anthropological question starting
from a Gestalt Therapy understanding of self, is the concept of intentionality for contact. In PHG, self is the
agent of growth; it is what makes the encounter with novelty, excitement and growth (the three words that
subtitle the book) possible. The foundational text does not provide a clear definition of growth and often it
seems to talk about growth as a phenomenon pertaining solely to the organism (‘An organism preserves
itself only by growing’, PHG, 1994, p. 151). There is one passage, however, which shifts the lens once again
from an individualistic perspective to a field perspective: ‘The field as a whole tends to complete itself, to
reach the simplest equilibrium possible for that level of field. But since the conditions are always changing,
the partial equilibrium achieved is always novel; it must be grown to” (PHG, 1994, p. 151). Here we see that
the organism’s growth is a function of the field: ‘it must be grown to’. The organism, therefore, can and
must grow in relation to the potential of the field—the further away the field is from equilibrium and the
more elements there are that push for change, thus making it pregnant with potential, the more the
organism is called on to grow. The impetus for contact, the drive towards the next, is thus an impetus that
emerges from the field and leads towards the creative realization of the potentiality at play in the field, and
which ultimately results in the growth of the organism and a new equilibrium for the field. Growth is not a
response to an individual urge, but the outcome of a call of the field. The way in which the organism senses
and expresses that call is its ’intentionality for contact. It is an impetus towards contact that arises from the
impetus within the field towards a new equilibrium. The term intentionality comes from the Latin in-
tendere: tuning an instrument, making its strings resonant with the heart. It expresses the impetus that
emerges in me when I am attuned to the drive for change present in the actualizing field. When the ego
function adopts this impetus as its own, intentionality becomes deliberate intention and action, but as it
emerges the intentionality belongs to the id and the personality of the situation, for it is the expression of
the potentiality that pushes for their transformation. But how do we perceive the impetus of potentiality,
the unfolding of the process? How do we sense that a new equilibrium has been reached and that we have
grown to it? The criterion is aesthetic and intrinsic; the task is an aesthetic one (Francesetti, 2012). What
guides the process is the sense that a good Gestalt is being created, that it is going in a good, beautiful,
clear, energetic, bright and fair direction. It is not about avoiding pain or effort; good health is not well-
being (in the sense of being without pain), but presence. The ego function helps us to decide how to
respond creatively to the call that comes from the field, but the elements that mark out the road to be
taken in a given situation are not just subjective. The call comes from the field and it is the intrinsic criterion
that points out the specific way to proceed; it is unique and different for each of us, but it is not subjective
in a relativistic sense—it is a contextual phronēsis . Freedom consists in accepting the call; it is exercised by
becoming engaged with the given situation. To not be engaged is not actually a choice but the
diminishment of presence, and hence the diminishment of integrity and freedom3 (Bloom, 2005).
Understood this way, freedom gives rise to audacity, which is the courage to be fully present. Choice is a
matter concerning how to be present at the moment when we are attuned with the potentiality of the
field. Missing the call is not a choice, it is absence—it is psychopathology. “Self is spontaneous, middle in
mode […] and engaged with its situation” (PHG, 1994, p. 154). In Troubled Sleep by Sartre (1949), at the end
of the story the main character, ineffectual up till that moment, takes the clamorous and audacious

3
That the exercise of freedom should consist in becoming engaged can seem paradoxical in our cultural climate. In Ancient
Greece, by contrast, it was obvious: for Aristotle, the free man is he who is bound; the slave is he who is not bound and therefore
can be bought, sold and transferred. The free man is rooted and bound, and it is precisely because of this that one cannot do as
one would like with him (Benasayag, Schmit, 2006).
decision to defy the Nazi occupation. It is the redemption of his entire life, the response to a call evaded up
till that moment, a decision that is the only choice possible to be present in full and with integrity.4
This perspective puts us in a position to radically critique our consumerist culture of ‘affluence’, where
we are driven to pursue pleasure and avoid pain, on the presumption that all choices are relativistically
equivalent (Bauman, 1999)—to the detriment of presence. The fallacy lies in believing that we must strive
for affluence and that we can be happy and fulfilled by purchasing goods and material beauty 5 thereby
avoiding all pain, as though the latter were some accident of the human condition that can be side-
stepped. Rather, what makes us feel fully alive and with integrity is not being anaesthetised, or diverting6
from pain, nor material beauty, but being fully present. In our world, pain and beauty are channelled into
objects, bearing witness to their absence and to our own absence. Today, it is very often proposed, as
something innovative, that psychotherapy should be committed to preventing suffering and promoting
well-being, but if it is not made clear what kind of well-being we are talking about, we risk merely
contributing to the dominance of a misleading consumerist culture. We need to promote a culture of
presence—which implies effort, loyalty, creativity and pain—rather than a culture of affluence.
The intrinsic criterion is aesthetic in the sense that it in-tends-towards, or leads us towards, emergent
beauty—the beauty that emerges and is co-created at the contact boundary through the process of
figure/ground formation. As I explained in a previous work (Francesetti, 2012; 2015a), the transformation
of absence into presence at the contact boundary can be perceived as emerging beauty. The impetus of the
field is an impetus to tie up loose processes, the unfinished business that awaits the right moment for
completion. Unfinished business does not just belong to the client; it is co-created and actualized at the
contact boundary through the backgrounds of the client and the therapist and through the actual situation
in the encounter. The transformation of absence into presence, of pain into beauty, represents the fulcrum
of the impetus for contact. It is a process that has nothing to do with material beauty, intelligence
quotients, the quality of experience (whether psychotic or neurotic), biological age, learning and culture, or
any other condition. It is solely a function of presence. The degree of potential presence is higher the more
invalidating the person’s experience has been, the more being at the contact boundary has been painful
and hampered, the more they have been marginalised, humiliated or excluded. Here discarded rubble
becomes a cornerstone; here we can appreciate how the ‘small’ and minorities are the bearers of great
truths (Francesetti, 2013). This clinical perspective helps us restore to clients the dignity of their suffering
(Jacobs, 2005). Here aesthetics and ethics take shape together (Bloom, 2005; 2013).

3. What is suffering? The psychopathological perspective

There are many diverse and varying views of psychopathology. One view, prevalent in the medical
world, considers psychopathological disorders to be cerebral dysfunctions; another considers mental illness
to be a social construct. Others seek to be consistent with a bio-psycho-social world view (Civita, 1999; Gelo
et al., 2014). In some previous works, we sought to develop a psychopathological perspective consistent
with the principles of Gestalt Therapy in both theory and practice (for more on this see Francesetti, Gecele,
2009; Francesetti, Gecele, Roubal, 2013; Francesetti 2012, 2015a). This perspective takes a holistic
approach, and hence is bio-psycho-social; it is a field approach, and hence radically relational; it is
deconstructive, and so takes into account the nosology so as to transcend it; and it is aesthetic because it
considers suffering to be co-created in the here and now of the encounter and actualized through absence
at the contact boundary. Here I want to focus in particular on how the conception of self that we find in
PHG underpins the development of a perspective of this kind. The foundational text explores and presents
a view of neurosis that is innovative compared to psychoanalysis. It outlines the social and biological
motives, the clinical phenomenology and the treatment for it, both working with and breaking with
psychoanalysis and, more indirectly, with the medical models of the time. It does not, however, develop a

4
“The choosing makes the individual, rather than the individual making the choice!” (Philippson, 2009, p. 7).
5
‘Material beauty’ is beauty collapsed in objects, as opposed to emergent beauty, which arises at the contact boundary and is
fleeting.
6
From the Latin, di-vertere, “to turn apart “(Oxford English Dictionary).
systematic understanding of psychopathology or deal with psychotic or sociopathic experience, except in a
tangential way.
Given the premises set out in §2, it can be said that psychopathological suffering emerges from the field
and is actualized as absence at the contact boundary. It is a simple statement to make, but one full of
important consequences. The individual expresses through the self a suffering that comes from the field
and preserves its evolutionary impetus. This leads him to actualize the suffering in his relationships and to
seek opportunities to transform it in the encounter. To preserve so as to transform: this is the faithful and
creative task of the sufferer. But the sufferer does not necessarily feel in a subjective way that he is
suffering. If suffering is absence, and hence anaesthetization, it can happen that the suffering present in the
field is only perceived by others. The partner of a man with narcissistic experience may feel the suffering of
his absence without him perceiving it at all. His therapist may feel inadequate or, in self-defence, consider
the patient to be inadequate, and maybe even humiliate him. In a field perspective, in the therapy situation
we do not focus on the fact that the client is vulnerable to humiliation; rather we feel that in the field that
together we co-create there is a vulnerability to humiliation which may emerge in him or in me. The
suffering lies in the psychopathological field that is co-created and emerges in various ways in the subjects
that co-create it. This perspective helps us become aware of the suffering that actualizes and circulates in
the field, and helps us to avoid playing on it in a confluent way by being self-defensive and attributing it
entirely to the client.
We said that the psychopathological field is an experiential field that conveys absence in the encounter,
an anaesthetization at the contact boundary. This field is actualized in the here and now of the encounter
as an ecstasy7 of the situation, and hence of the lived bodies in the here and now of the situation. The field
emerges as an atmosphere—here I use the term with the connotations given to it by Hermann Schmitz, the
founding author of New Phenomenology in philosophy (Schmitz, 2011; Böhme, 2010; Griffero, 2014).
Atmosphere is a phenomenon that is neither subjective or objective, which occupies the diffuse,
surfaceless space between and around subjects. It is discontinuous in time, it changes. For Schmitz,
atmospheres, like the phenomena of the lived body, are half-entities, as their status cannot be reduced to
either subject or object; they exist in the betweenness. Psychopathological fields appear atmospherically in
different ways. For instance, in a depressive field, the phenomena that emerge are attuned to the
experience of the unreachableness of the other; in a field marked by trauma, the phenomena that emerge
are attuned to multiple dissociations.
To embrace such a conception, the therapist needs to be open to considering in what way he himself
contributes to creating the suffering encountered. It is a perspective that requires the therapist to be
willing to question himself in every encounter and to have the humility to become part of the very fabric he
is called upon to heal. Here I refer to humility not only in an ethical sense, but also in its literal meaning—
humble (from the Latin humus, ‘soil’) describes a person who is close to the ground, where roots sprout
and are embedded. The fundamental task of grasping an emerging absence, and hence the characteristics
of a psychopathological field, is an aesthetic task. Considered this way, psychopathology is deconstructive,
and the suffering expressed by the individual finds a pathway to return to the field to which it belongs. For
this to happen, the pathway passes through the contact boundary—it is here that suffering is actualized in
the therapeutic encounter and it is here that therapy takes place.
Only a conception of self that allows us to transcend the individual, to firmly ground her in the
relationship and to take on a radical field perspective can help us develop a psychopathology specifically
rooted in Gestalt Therapy.
This epistemology also enables us to develop an understanding of severe suffering which the
foundational text does not explore: psychotic experience (for more on this see Francesetti, Spagnuolo Lobb,
2013; Burley, 20158; Francesetti, 2015b) and sociopathic experience (Francesetti, 2012).
In §2.2 we said that the subject is a product of a process of emergence from an undifferentiated ground.
This process implies the plotting of boundaries between subjectiveness and otherness, which serve the dual
function of distinguishing and connecting. In this way, the subject emerges and instinctively feels distinct

7
Being put out of place, from Late Latin extasis, from Greek ekstasis, from eksta- stem of existanai put out of place, formed as
ex- + histanai to place (Oxford English Dictionary).
8
See Todd Burley et al., in the Gestalt Review issue dedicated to schizophrenia (2015, vol. 19, no 1).
from the world, but at the same time feels it has a place in, and belongs to, the world. The disturbance of
this process, and the resulting alteration of the functions of the boundary, is what characterises psychotic
experience. If the disturbance chiefly concerns the function of distinguishing the self from the other,
experience will be situated in the schizophrenic spectrum. If it is chiefly the function of connection that is
disturbed, experience will belong to the depressive and manic spectrum. If both functions are disturbed,
the mixed experience of schizoaffective psychosis will emerge (Francesetti, Spagnuolo Lobb, 2013;
Francesetti, 2015b). An understanding that focuses on the co-creation of this boundary disorder opens up
important roads for therapy, which enable the therapist not to dissociate herself from the psychotic field
(with all the iatrogenic risks that would entail) and to grasp the message of relational truth that it holds.
Even sociopathic experiences, which represent one of the toughest challenges for the psychotherapist,
find meaning within a field perspective. A person with sociopathic experience bears a field of suffering that
she cannot feel firsthand, and to actualize it needs another person, the victim. To paraphrase Simone Weil
(1947), the victim feels in himself that pain that the executioner cannot feel. Through the victim, the
executioner brings out the suffering that she bears. In a field that expresses sociopathic suffering, this
drama is reactualized; in therapy, the anaesthetization towards one’s own suffering and the impetus to
bring it out through the other often permeates the encounter. The therapist often can slip easily into this
mechanism and may feel a desire to make the other person suffer, with the risk of naively believing that
this experience is a good direction for therapy to take. Naturally, we might agree on the fact that an
objective of therapy might be for the client suffering from sociopathy to be able to feel pain, but it is a step
fraught with danger. The therapist himself risks instigating the suffering that characterises the field (which
he, if not self-aware, will attribute solely to the client), so that it will be the other who suffers.
Focusing on the field rather than the individual also helps give us a clearer understanding of phenomena
of mass sociopathy. Studies of single individuals who have participated in criminal social movements
usually do not find any evidence of psychopathology in a classical sense. This is the banality of evil as
Hannah Arendt (1963) spoke of it, as she noted, dumbfounded, how ferocious Nazis were also, for instance,
caring fathers, or the ‘Lucifer Effect’ of Zimbardo’s studies (2008), which look at how perfectly ‘well-
adapted’ people in normal situations can become, in other contexts, so surprisingly violent and indifferent
towards the evil inflicted on others. If we look at the individual we cannot understand this behaviour; all we
can do is put it down to some generic anthropological tendency for humans to be evil. This certainly helps
to put us on guard and know that we, too, can be evil in certain conditions. A field perspective, however,
can help take us a step further. It is not really the individual taken on her own that can help us understand
how evil emerges. There is a broader and more fundamental dimension from which evil emerges, where
the field in which the individual is immersed makes him suffer—it is a field of pathos, in the etymological
sense (sharing a root with passive and passion). If he is not sufficiently aware and audacious enough to
differentiate himself, the individual expresses the evil present in the co-created field. The more the social
field is full of passion, the more individuals passively suffer from it. And the more audacious the individual
has to be to differentiate himself. The aesthetic task is to grasp the climate, the atmosphere, of what
happens in the social field before certain events actually take place. Perhaps it was this instinct that led
Fritz Perls and his wife Laura to flee Germany in 1933, first for the Netherlands, and then South Africa, thus
saving themselves from the death camps (Bocian, 2012). It is possible that it sharpened Fritz Perls’s
aversion to confluence in general, and to attunement to what emerges in the field, which is a central
element of therapy. He had experienced firsthand the risks of non-differentiation, which led him to adopt a
stance of early differentiation in therapy (Robine, 2006a) and a style that could be more confrontational
than empathetic (Yontef, 2009).
A field perspective lets us view the phenomena of suffering as being co-created in each therapy session,
and hence not as fixed and crystallized. By focusing on the process of co-creation, the therapist, therefore,
has some margin for intervention—a margin at least as big as her own contribution to the
psychopathological field that is actualized.
4. What is therapy? The therapeutic perspective

What are the therapeutic consequences of this approach to understanding psychopathology? If we take
the object of psychopathology to be the field, not the individual, “this shifts the epistemological ground of
psychopathology itself, in the definition, understanding and treatment of suffering. Thus I assert that it is
not in the client that we should locate suffering, but rather we should regard it as an emergent
phenomenon at the contact-boundary. Accordingly, if psychopathology is an absence at the boundary and
the boundary is a co-created phenomenon, there can be no psychopathology of the isolated individual or
mind. As a consequence, the therapist does not ‘work on the client’, but in the field that is actualized
between the therapist and client. Given that this field is co-created, the therapist works primarily on
himself and on modulating his presence and absence at the contact-boundary” (Francesetti, 2015a, p. 7).
With a client with depressive experience, for instance, the field perspective enables the therapist to
move from the question ‘What can I do for such a depressed client?’ to ‘How are we depressing together
right now?’ (Roubal, 2007; Francesetti, Roubal, 2013; Francesetti, 2015a). It is precisely the element of co-
creation that gives the therapist margin for therapy, as minimal as it can sometimes be. Since the therapist
himself is part of the id and the personality of the situation (Robine, 2006a), he will always be able to effect
a choice (ego function) that is rooted in the here and now of the situation and is an expression of the
intentionalities at play in the field.
The task of the therapist is to be present as absence is actualized in the encounter. Being present
means: grasping the way the absence is co-created also by her, herself; echoing in her own lived body, and
hence feeling, the pain that the absence implies (and has implied and will imply) for the client; feeling the
fatigue of having had to sustain the absence and how much pain and deprivation it has provoked in her
own life and for those who are close to her; grasping the broader background—the social and
transgenerational relational fabric—from which the suffering comes (Francesetti, 2016); grasping the way
the absence has contributed to making that life possible and to the development of specifically unique and
excellent qualities; grasping how bearing the suffering up to this point is a form of loyalty to the relational
fabric of the life that is now asking to be transformed, finally; and feeling how the suffering belongs to a
possibility of being in the world, to which the therapist herself is no stranger. To do all this, the therapist
relies on her aesthetic sense (Robine, 2006b; Francesetti, 2012, 2015a; Spagnuolo Lobb, 2013), on her
capacity for kinaesthetic resounding (Frank, 2001), for inclusion (Yontef, 2009), for cultivating uncertainty
(Staemmler, 1997), and for attunement (Stern, 2010).
Being present does not, therefore, entail changing the client9 or working on him. It means modulating
one’s presence to be present as the absence is actualized. What emerges from the quality of presence is
the intentionality for contact borne within the suffering itself, which the client has never wanted to
abandon. The call to contact can now take shape and will find unique ways to emerge that depend on the
situation and the characteristics of the therapist and the client. Here a new relational experience emerges,
one anticipated ever since the intentionality for contact could find no relational outlet and was
encapsulated in suffering—a suffering that bears witness to defeat but also to perseverance. The new
experience is an embodied one, where the body actively participates and is vibrant, and may be conveyed
through a glance, a word, or a gesture. Presence becomes living body. The Gestalt Therapy approach
enables experiential form to be given to the act of being present as absence emerges and as intentionality
for contact emerges. Working on the lost and refound gesture, which embodies and frees the
intentionalities for contact in play, is built on this previous act of being present as absence emerges.
Without this attunement to the potentiality and call of the field that is actualized, without this pregnant
moment, the experiment risks being an empty or artificial technique.
When the therapist is present as the absence is actualized, the absence becomes present, and in that
moment it is no longer absence, enabling intentionality to emerge and time to become fertile for new

9
Thinking that it is the client who has to change inevitably implies the judgement that the client himself or his way of being is
inadequate, which raises a number of risks, as it can be a source of shame for the client (Robine, 2013; Lee, Wheeler, 1996; Yontef,
2009), but it can also be a way for the therapist to avoid confronting his own inadequacies, offloading them onto the client and
shaping an abusive field in which what is adequate is attributed to him and what is inadequate is attributed to the client.
experience. The paradoxical theory of change (Beisser, 1970) is not longer paradoxical when seen in this
light.
We can also observe that the reach of therapy transcends the single individual. Changing a
psychopathological field means treating the actualization of an absence, which will have a vertical,
generational fallout. Fields of suffering are actualized and transmitted from generation to generation.
Modifying a psychopathological field means mending part of the relational fabric of the world passed down
by history and by previous generations, and lightening the load for future generations. Research into the
intergenerational transmission of traumas suggests that what is not transformed is transmitted (Mucci,
2014; Francesetti, 2016).
Therapy is thus an arena for social change and investment in the future (Francesetti, 2012; Robine,
2015).

5. ‘You cry, I feel pain’. A clinical example

I will now present the transcript of the first part of a session within a training group. My aim is to
illustrate a way of working based on an aesthetic approach and a field perspective, in which individual
experiences are considered co-created and their meaning attributed in the light of the emerging field.
Intentionalities for contact are gradually revealed and a journey is experienced which, by actualizing
absence and by being present as absence emerges, leads to presence. This kind of perspective is possible
thanks to the conception of self described in PHG. In this chapter I have sought to show how it underpins
my understanding of human beings, of psychopathology and of therapy; with this example, I hope to
anchor it a little more to clinical experience.
In a workshop in Ukraine, Elèna asks for personal work.
As soon as we sit down in front of each other, a sort of anaesthesia pervades me. I feel both turned to
stone and lightweight at the same time. Or I could say absent and cold. Elèna observes me, without moving
herself, apparently without intentionality. Between us everything is immobile. Not heavy, like in a
depressive field, just immobile; I feel we are absent with each other. I look for some possible movement,
but I have no direction.
I lean on the emergent sense of the situation:
G. ‘Elèna, what drove you to ask for work?’
E. ‘Um… I find it impossible to stay with the group… to pay attention… be present.’
As she says this I sense all of her and my own absence. Our bodies seem to be frozen, without resonance
or emotion, they are not attuned.
I stop and look at Elèna and try to sense whether in the desolate and cold landscape of my body
something resounds. I do not seem to find anything.
We look at each other in silence.
The seconds pass. They have no weight, they do not count, they do not unfold.
All of a sudden something in her eyes seems to flash, and a hint of tenderness is sparked in me.
G. ‘Something happened with your eyes…’ I feel my voice soften almost imperceptibly and I am
somewhat surprised at this, albeit slight, affective resonance in me.
E. ‘I don’t know…’
Elèna does not seem very interested in what I said.
G. ‘Now your eyes are moist…’
E. ‘I don’t know…’
A few tears begin to stream down Elèna’s face. They simply fall, without any expression or change in her
breathing.
G. ‘Tears are falling down your face…’
E. ‘…ah… yes, perhaps…’ Elèna continues to show no interest in what is happening. My interest instead
grows.
G. ‘What do you feel?’
E. ‘Um…nothing…’
 As Elèna pronounces this gaunt, yet penetrating word, nothing, a small but sharp pain awakens in my
chest. Then slowly it spreads and I gradually recognise it as sadness. A still but profoundly deep sadness,
like the dark water of a well.
G. ‘…Your cry, I feel pain…’
Someone in the group is touched. My sadness becomes more mobile.
E.‘…I don’t understand.’
G. ‘…Your cry, I feel pain…’
E. ‘I haven’t cried all year. I don’t know why I’m crying now…’
I feel attuned (together with the group) to a pain that Elèna still cannot feel, but through my feeling she
can begin to express it.
G. ‘What’s happened this year?’
E. ‘I’ve been constantly on the move, hyperactive I think. Ever since the war made me and my family
flee… ever since we lost our home and our belongings… ever since we’ve been separated and displaced…
Now, my son, my husband and I no longer have a home to see each other in… we are displaced.’
My pain finds a meaningful horizon. My sadness is no longer immobile, but moves and warms up. It
moves me intensely.
E. ‘Now I feel sadness…’ says Elèna.
Many in the group are crying.
From an individualistic perspective we could say that Elèna is suffering dissociation and that the
therapist should help her to feel her dissociated experiences. As a perspective it is obviously quite
legitimate and could underpin therapy.
But let’s shift to a field perspective, where the self and the other co-emerge. From this point of view, we
can consider the dissociation as an emergent phenomenon in the therapeutic field which I also co-create. I
would not say that it is Elèna who is dissociated in the session, but rather that we both are experiencing the
phenomena of dissociation that we co-create together. My surprise at hearing my voice soften reveals to
me just how anaesthetized I also was, and how I, too, contributed to keeping dissociation in the field. My
position as therapist then allowed me not to remain imprisoned within our absences and to sense the
presence of absence. In this horizon, the focus of therapy is different. I do not need to change Elèna but
remain present as absence emerges and I grasp it. This means letting her be, feeling the pain of the
absence, of the effort made to hold onto it, the pain that could not be perceived because of a lack of
support. In this way I open up the way for the intentionality for contact to emerge, which is how our being
present is expressed. Elèna does not have to change; in a sense this is a side-effect of the process. It is the
field pregnant with anaesthetized pain seeking a way to be actualized that has to deliver this feeling. My
task as therapist is to be aware of this impetus, to let it be between us, to embody it myself and to support
its transformation. To enable the field to actualize and transform, first and foremost through me.
The therapist, therefore, modulates his presence to manage to be present in a field characterised, in this
case, by a dissociative anaesthetization. He moves to be present as absence emerges, without wanting to
modify it. Once it becomes present, it is no longer absence. Something happens there, and those involved
in the situation feel their presence grow and an ephemeral, yet unperishing, beauty flutters by.

Bibliography
Arendt H. (1963). Eichmann in Jerusalem: A Report on the Banality of Evil. New York: Viking Press; New
York: Penguin Books, 2006.
Barison F. (1990). La psichiatria tra ermeneutica ed epistemologia. Comprendre, 5: 27-35.
Bauman Z. (1999). La società dell’incertezza. Bologna: Il Mulino.
Béguin A. (1939). L’âme romantique et le rêve [The Romantic Soul and the Dream]. Paris: José Corti.
Beisser A.R. (1970). The Paradoxical Theory of Change. In: Fagan J., Shepherd I., eds., Gestalt Therapy Now:
Theory, Techniques, and Applications. Palo Alto, CA: Science and Behavior Books, pp. 77-80.
Benasayag M., Schmit G. (2006). Les passions tristes: souffrance psychiatrique et crise sociale. Paris: Editions
La Découverte.
Bloom D. (2003).“Tiger! Tiger! Burning Bright”: Aesthetic Values as Clinical Values in Gestalt Therapy. In:
Spagnuolo Lobb M., Amendt-Lyon N., eds., Creative License. The Art of Gestalt Therapy. Milano:
FrancoAngeli.
Bloom D. (2005). Celebrating Laura Perls: The Aesthetic of Committment. British Gestalt Journal, 14,2: 81-
90.
Bloom D. (2013). Situated Ethics and the Ethical World of Gestalt Therapy. In: Francesetti G., Gecele M.,
Roubal J., eds., Gestalt Therapy in Clinical Practice. From Psychopathology to the Aesthetics of Contact.
Milano: FrancoAngeli, pp. 131-148.
Bloom D. (2014). Sensing Animals/Knowing Persons: A Challenge to Some Basic Ideas in Gestalt Therapy. In:
Bloom D., O’Neill B., eds., The New York Institute for Gestalt Therapy in the 21st century. An Anthology of
Published Writings since 2000. Peregian Beach (Australia): Ravenwood Press.
Bocian B. (2012). Fritz Perls a Berlino 1893-1933. Espressionismo, psicoanalisi, ebraismo. Milano:
FrancoAngeli.
Böhme G. (2010). Atmosfere, estasi, messe in scena. L’estetica come teoria generale della percezione.
Milano: Marinotti (or. ed. Aisthetik. Vorlesungen über Ästhetik als allgemeine Wahrnehmungslehre.
München: Wilhelm Fink Verlag, 2001).
Buber M. (1923). I and Thou. New York: Touchstone, 1996.
Civita A. (1999). Psicopatologia. Un’introduzione storica. Roma: Carocci.
Damasio A. (2010). Self Comes to Mind. Constructing the Conscious Brain. New York: Pantheon Books.
Descartes R. (1641). Meditations on First Philosophy [or Metaphysical Meditations]. Cambridge, UK:
Cambridge University Press, 1996 (it. trans. Meditazioni metafisiche. Roma: Laterza, 1990).
Francesetti G. (2008). La sofferenza della Zwischenheit. Una lettura gestaltica di “Colpa e sensi di colpa”. In:
Buber M., Colpa e sensi di colpa, ed. by L. Bertolino. Milano: Apogeo (sp. trans.: El sufrimento del
“entre”. Una lectura gestáltica de Colpa e sensi di colpa de Martin Buber, Figura Fondo 2015, 37: 17-38).
Francesetti G. (2012). Pain and Beauty. From Psychopathology to the Aesthetics of Contact. British Gestalt
Journal, 21, 2: 4-18.
Francesetti G. (2013). The Emergent Suffering. Field Perspective on Psychopathology in Gestalt Therapy. In:
Klaren G., Levi N., Vidakovic I., Yes, We Care! Social, Political and Cultural Relationships as Therapy’s
Ground. A Gestalt Perspective. The Netherlands: EAGT, chapter 6.
Francesetti G. (2015a). From Individual Symptoms to Psychopathological Fields. Towards a Field Perspective
on Clinical Human Suffering. British Gestalt Journal, 24, 1: 5-19.
Francesetti G. (2015b). “Absence Is the Bridge Between Us”. Gestalt Therapy Perspective on Depressive
Experiences. Siracusa: Istituto di Gestalt HCC Italy.
Francesetti G. (2016). Transmission and Transformation of Psychpathological Fields Across Generations. In:
Spagnuolo Lobb M., Levi N., Williams A., eds., Gestalt Therapy with Children: From Epistemology to
Clinical Practice. Siracusa: Istituto di Gestalt HCC Italy, forthcoming.
Francesetti G., Gecele M. (2009). A Gestalt Therapy Perspective on Psychopathology and Diagnosis. British
Gestalt Journal, 18,2: 5-20.
Francesetti G., Gecele M., Roubal J., eds. (2013). Gestalt Therapy in Clinical Practice. From Psychopathology
to the Aesthetics of Contact. Milano: FrancoAngeli.
Francesetti G., Roubal J. (2013). Gestalt Therapy Approach to Depressive Experiences. In: Francesetti G.,
Gecele M., Roubal J., eds., Gestalt Therapy in Clinical Practice. From Psychopathology to the Aesthetics
of Contact. Milano: FrancoAngeli, pp. 433-461.
Francesetti G., Spagnuolo Lobb M. (2013). Beyond the Pillars of Hercules. A Gestalt Therapy Perspective of
Pychotic Experiences. In: Francesetti G., Gecele M., Roubal J., eds., Gestalt Therapy in Clinical Practice.
From Psychopathology to the Aesthetics of Contact. Milano: FrancoAngeli.
Frank R. (2001). Body of Awareness. A Somatic and Developmental Approach to Psychotherapy. Cambridge,
MA: Gestalt Press.
Gelo O.C., Vilel A., Maddux J.E., Gennaro A. (2014). Psychopathology as Social Construction: The Case of
Anorexia Nervosa. Journal of Constructivist Psychology, 28, 2: 105-125.
Griffero T. (2014). Atmospheres: Aesthetics of Emotional Spaces. Farnham: Ashgate.
Jacobs L. (2005). The Inevitable Intersubjectivity of Selfhood. International Gestalt Journal, 28, 1: 43-70.
Jacobs L., Hycner R., eds. (2009). Relational Approaches in Gestalt Therapy. New York: Routledge, Taylor &
Francis Group (1st ed.: New York: A Gestalt Press Book).
Lee R., Wheeler G., eds. (1996). The Voice of Shame. Silence and Connection in Psychotherapy. San
Francisco, CA: Jossey-Bass.
Lévinas E. (1974). Autrement qu’être ou Au-delà de l’essence. La Haye: Nijhoff; Paris: LGF, 1990 (eng. trans.:
Otherwise than Being or Beyond Essence. Dordrecht and Boston, MA: Kluwer Academic Press, 1978;
Pittsburgh, PA: Duquesne University Press, 1987).
Markova I.S., Berrios G.E. (2009). Epistemology of mental symptoms, Psychopatology, 42, 6: 343-9.
Markova I.S., Berrios G.E. (2012). Epistemology of psychiatry. Psychopathology, 45, 4: 220-7.
Metzger W. (1941). I fondamenti della psicologia della Gestalt. Firenze: Giunti Barbera, 1971 (or. ed.: Die
Entwicklung ihrer Grundannahmen seit der Einführung des Experiments. Darmstadt: Dietrich Steinkopff
Verlag, 1941).
Mounier E. (1949). Le Personnalisme. Paris: PUF (eng. trans.: Personalism. London: Routledge & Kegan Paul,
1952).
Mucci C. (2014). Trauma e perdono. Una prospettiva psicoanalitica intergenerazionale. Milano: Raffaello
Cortina Editore.
Parlett M. (1993). Towards a More Lewinian Gestalt. British Gestalt Journal, 2, 2: 115-120.
Perls F., Hefferline R.F., Goodman P. (1951). Gestalt Therapy. Excitement and Growth in the Human
Personality. Highland, NY: Gestalt Journal Press; Gouldsboro, ME: Gestalt Journal Press, 1994.
Philippson P. (2001). Self in Relation. Highland NY: Gestalt Journal Press; London: Karnac Books.
Philippson P. (2009). The Emergent Self. An Existential-Gestalt Approach. London: Karnac Books.
Robine J.-M. (2006a). Il rivelarsi del sé nel contatto. Studi di psicoterapia della Gestalt. Milano: FrancoAngeli
(or. ed.: Plis et Deplis du Self. Bordeaux: Institut Français de Gestalt-thérapie, 1977; 2004).
Robine J.-M. (2006b). La psychothérapie comme esthétique. Bordeaux: L’Exprimerie.
Robine J.-M. (2013). Shame. In: Francesetti G., Gecele M., Roubal J., eds., Gestalt Therapy in Clinical
Practice. From Psychopathology to the Aesthetics of Contact. Milano: FrancoAngeli, pp. 251-262.
Robine J.-M. (2015). Social Change Begins with Two. Siracusa: Istituto di Gestalt HCC Italy.
Roubal J. (2007). Depression. A Gestalt Theoretical Perspective. British Gestalt Journal, 16,1: 35-43.
Sartre J.-P. (1949). La mort dans l’âme. Paris: Gallimard (eng. trans.: Troubled Sleep. New York: Vintage,
1992; first trans.: Iron in the Soul. London: Hamish Hamilton, 1950).
Schmitz H. (2011). Nuova fenomenologia. Un’introduzione. Milano: Marinotti.
Sichera A. (2001). A confronto con Gadamer: per una epistemologia ermeneutica della Gestalt. In:
Spagnuolo Lobb M., ed., Psicoterapia della Gestalt. Ermeneutica e clinica. Milano: FrancoAngeli, pp. 17-
41.
Spagnuolo Lobb M. (2001a). La teoria del sé in psicoterapia della Gestalt. In: Spagnuolo Lobb M., ed.,
Psicoterapia della Gestalt. Ermeneutica e clinica. Milano: FrancoAngeli.
Spagnuolo Lobb, M. (2001b). The Theory of Self in Gestalt Therapy. A Restatement of Some Aspects. Gestalt
Review, 4, 276-288.
Spagnuolo Lobb M. (2013). The Now-for-Next in Psychotherapy. Gestalt Therapy Recounted in Post-Modern
Society. Milano: FrancoAngeli.
Staemmler F.-M. (1997). On Cultivating Uncertainty: an Attitude for Gestalt Therapists. British Gestalt
Journal, 6, 1.
Staemmler F.-M. (2009). Aggression, Time, and Understanding: Contributions to the Evolution of Gestalt
Therapy. Cambridge, MA: Gestalt Press.
Stern D.N. (1985). The Interpersonal World of the Infant. A View from Psychoanalysis and Developmental
Psychology. New York: Basic Books.
Stern D.N. (2010). Forms of Vitality. Exploring Dynamic Experience in Psychology and the Arts. New York:
Oxford University Press USA.
Tellenbach H. (2013). L’aroma del mondo. Gusto, olfatto e atmosfere. Milano: Christian Marinotti.
Valéry P. (1931). L’idée fixe. In: Oeuvres, vol. 2. Paris: Gallimard, 1960.
Vázquez Bandín C. (2014). Sin tí no puedo ser yo. Pensando según la terapia Gestalt. Madrid: Los Libros del
CTP.
Weil S. (1947). La pesanteur et la grâce. Paris: Plon (eng. trans.: Gravity and Grace. London-New York:
Routledge, 2002; Taylor & Francis e-Library, 2003).
Wheeler G. (2000). Beyond Individualism: Toward a New Understanding of Self, Relationship and
Experience. Hillsdale, NJ: The Analytic Press/Gestalt Press.
Wiesing L. (2014). The Philosophy of Perception. Phenomenology and Image Theory. London: Bloomsbury.
Wollants G. (2008). Gestalt Therapy. Therapy of the Situation. London: Sage.
Yontef G.M. (2009). The Relational Attitude in Gestalt Therapy. In: Jacobs L., Hycner R., eds., Relational
Approaches in Gestalt Therapy. New York: Routledge, Taylor & Francis Group.
Yoshimoto B. (1999). Amrita. Milano: Feltrinelli (eng. trans.: New York: Grove Press, 1997).
Zimbardo P.G. (2008). The Lucifer Effect. Understanding How Good People Turn Evil. London: Random
House Trade.

Gianni Francesetti, Gestalt therapist, psychiatrist, international trainer and

supervisor. Coordinator of the International Training Program and Director of the
Master on Gestalt Therapy Approach to Psychopathology (Istituto di Gestalt HCC
Italy). President of the European Association for Psychotherapy, Past President of the
Italian Federation of Psychotherapy Associations and of the Italian Society for Gestalt
Therapy, member of the New York Institute for Gestalt Therapy, of the Association
for the Advancement of Gestalt Therapy and of the Society for Psychotherapy
Research. He lives and works in Turin (Italy) as psychotherapist, psychiatrist and
supervisor. [email protected]