“I would like to invite you to move to this chair and I would like you to speak from your heart and speak from your pain. (Giving Voice)
“I sense that holding this secret inside for so long has been a terrible burden. If you are willing, I’d like you to move to this chair and tell me the story of what happened.” (Telling the Story)
“You seem to be of two minds about the project. I wonder if you would be willing to go to this chair and speak from the part that wants to go forward with it and then to this chair and speak from the part that is having second thoughts.” (Internal Dialogues)
“I can sense that you are still very stuck–even though the relationship ended two years ago. I would like to work with this, if I may. I’d like you to imagine her sitting in this chair and I would like you to talk to her and tell her what you are feeling.” (Relationships and Encounters)
In 2001, I discovered the astonishing power and beauty of Gestalt Chairwork. Originally one of Dr. Jacob Moreno’s Psychodrama techniques from the 1950s,1 it was further developed and made famous in the 1960s by Dr. Frederick “Fritz” Perls, the creator of Gestalt Therapy.2
In the classic West Coast Gestalt formulation, the technique begins with two chairs, facing each other. The patient sits in one and speaks to the empty chair, imagining a family member, colleague, or even another part of themselves in the chair. The patient may then switch chairs and imagine how that person would react to their words, and respond. This technique is especially helpful at resolving “unfinished business”—relationships with family members who’ve passed away, for instance. This two chair technique is also used to allow people to resolve inner conflicts and make decisions about their lives.
The first of these orienting principles is multiplicity of self, which means that it is clinically useful to understand people as containing different parts, modes, voices, or selves. The second is that it is healing and transformative for people to give voice to these different parts. The third is that it is also healing and transformative for people to enact or re-enact scenes from the past, the present, or the future. The fourth is that the ultimate goal of Chairwork—and all psychotherapy for that matter—is the strengthening of what has been variously called the Ego, the Healthy Adult Mode, or the Inner Leader.
The Four Dialogues
Chairwork is based in techniques of dialogue. There are four major styles used in my therapeutic model:
The first dialogue structure is called Giving Voice. This involves asking a patient to move to a specific chair and give voice to a feeling that they may be experiencing or speak from a part that has come into their awareness. The process may also include interviewing that part to better understand its history and purpose in the person’s life.
One part that’s often found is the Inner Critic—a part of yourself that judges and criticizes you harshly in an attempt to hurt you or protect you from failure—depending on its specific nature. One intervention that I have found to be effective is to create a “suffering chair” and invite the patient to move to that chair and express the pain and anguish that they may be experiencing. All of these strategies are rooted in the Paradoxical Theory of Change,4 which emphasizes that the way to change is to more deeply engage with and experience what you are already feeling.
The second dialogue structure is Telling the Story. Reflecting the centrality of narrative in clinical work, Roberts and Holmes5 wrote: “At the heart of any therapeutic encounter there is always a story.” I typically work with problematic or difficult stories in two ways. In the first, I ask the patient to sit in a chair and, to the degree that they are willing, to tell the painful and traumatic story. I then ask them to shake it off, sit down, and tell the story again. If possible, I will take them through this process two or three more times. While this can be quite challenging, when it works well, the narrative starts to become more detailed which indicates that memory integration is taking place and that healing is occurring.
Another approach to therapeutic storytelling involves imagery rescripting. Here the patient is asked to close their eyes and bring up a difficult memory—often from their childhood. They are then asked to go into the memory image as their adult self and to change the situation by taking whatever actions are necessary and by bringing in whatever metaphorical resources are needed to help both their child and adult selves feel safe and empowered. This can include using their voice, building walls, wielding weapons, fighting off malevolent figures, and/or bringing in the police or the military. Patients may also want to enlist the aid of historical, fictional, or spiritual figures to help defend themselves.
The third structure is called Internal Dialogues. In this approach, which uses multiple chairs, different parts are invited to speak. For example, when seeking creative solutions to life challenges, one chair can represent the desire for financial prosperity and the other chair can represent the desire to be with and care for one’s family; this process can be helpful because creativity often emerges out of the juxtaposition of different forces.
Another common use is for decision making. One chair can represent the part that wants to take a new job while the other chair embodies the part that wants to maintain the status quo. The goal of this dialogue is to help the patient clarify the forces within and, using that information, make a clear decision and choose a course of action.
Cognitive Behavioral Therapy has emphasized the centrality of thoughts and interpretations in emotional health and illness.6 From this perspective, experiences of depression and anxiety stem from the active presence of cognitive distortions in the person’s thinking. Using the Internal Dialogues approach, the patient can give voice to a distorted or problematic thought in one chair (“All dogs are dangerous and I must stay away from them at all costs.”) and to a healthy or more adaptive alternative in the other (“While some dogs are dangerous, the vast majority are not. I can use caution and a sense of discretion, but I do not need to be so frightened.”)
Along those lines, but perhaps at a deeper level, many patients report being tortured by an Inner Critic voice. These voices can be counterbalanced in the other chair through the empowerment of the Inner Leader or the Healthy Adult Mode—which can take a more affirming, humanistic, and compassionate approach to the person and the situation.
The fourth and final dialogue structure is Relationships and Encounters—or the world of interpersonal dialogues. In this technique, the patient sits in one chair and imagines a person from their past, their present, or their future in the opposite chair. Here they can express their feelings of love, anger, fear, and grief, and they can, potentially, work though any “unfinished business” that they have with that person. This structure can also be used to help them develop their capacity for assertiveness, which will help enable them to engage in difficult conversations, make requests of others, and develop the capacity to say yes and to say no.
Chairwork can be thought of as a psychotherapeutic art form that has three core creative processes. The first is the understanding that a central goal of the work is for the patient to be able to speak from each part with clarity, force, and simplicity. The second component is the Deepening Techniques. These are methods for increasing emotional intensity and they usually involve repetition, increasing and decreasing the volume, using more extreme statement formulations, and placing a central emphasis on simple language and fewer words.
The third component is Existential Language. This is drawn directly from the work of Fritz Perls. In the Chairwork dialogues, I work with patients to use the language of power and responsibility: “I want”; “I am deciding to”; “I am choosing to”; “I will”; or “I will not”. I do not want them to use disempowering language, or in existential terms, language that disavows their personal ontological authority. This includes phrases like “I must”; “I should”; “I need to”; or “I can’t”.
This is a fascinating process because when they use the language of personal authority, a striking energy shift often takes place within them. When they resist doing this, a great deal may be revealed—often pertaining to fears, trauma, or “rules” that they learned growing up that are still active within them. Either way, the work with language can be transformative.
A Clinical Vignette
As a way of demonstrating how Chairwork and the Four Dialogues can be used for healing and therapeutic change, while protecting the confidentiality of my patients, I like to use published accounts of suffering and difficulty as a vehicle to explore how I might approach the treatment of these individuals if they were my patients. In his memoir, My Cross to Bear,7 the late Gregg Allman, one of the founders of The Allman Brothers Band, wrote about a very painful experience he had with his brother, Duane—an experience which haunted him for much of his life.
In 1971, when they were both addicted to heroin, Gregg gave his brother $100 to get him some heroin. When Duane came back, the money was gone, and Duane told Gregg that another musician had used up the heroin. This was an untruth, as Duane had, in fact, taken the drugs for himself. Gregg was very upset about this and spent the night drinking and ruminating about the situation. The next day, he went to Duane’s house and entered his bedroom while Duane was sleeping. He saw the drugs there and took them back.
When Duane woke up and realized that the drugs were missing, he called Gregg and accused him of stealing them. Gregg lied and denied that he had done that. Duane apologized, told him that he loved him, and hung up. Tragically, that would be the last time that they spoke as Duane died in a motorcycle accident shortly after that.
This experience tormented Gregg for the rest of his life. He wrote: “I have thought of that lie every day of my life, and I just keep recrucifying myself for it. I know that’s not what he would want—well, not for long, anyway. I know he lied to me about the blow in the first place, but the thing is, I never got the chance to tell him the truth.”
If he had been my patient, I would have seen this case as having two core components. First, there is a strong Inner Critic at work. To address this, I would begin by asking Gregg to sit in a chair and “be” or embody the Inner Critic; I would then interview this part to understand its history and its function in Gregg’s life. One of my goals would be to get a more specific sense of what it perceived as the “moral violation” and why it was persecuting him so relentlessly (Giving Voice).
Next, I would bring over another chair and ask Gregg to move there and embody his Inner Leader or Healthy Adult Mode. Here we could work together to create a counterscript that could be based on such truths as: (1) he and Duane loved each other profoundly; (2) he had always been honest with Duane and this was an aberration; (3) Duane had lied first and the critic is using a double-standard—forgiving Duane and punishing Gregg; (4) if the roles were reversed, he would never have wanted Duane to suffer the way that he had; and (5) the reality is that terrible things happen when people are addicted or are using drugs heavily.89 A central theme here is to re-envision the story so that it is a tragedy and not a crime.
After creating this counterscript, I would have the Inner Critic and the Healthy Adult/Inner Leader chairs face each other and I would encourage him to go back and forth between the two chairs giving voice to each perspective:
“I lied to my brother and I stole his drugs and I should be punished.”
“I loved my brother and I would do anything for him. This was a tragic event that took place because we were addicted. He would never want me to suffer like this.”
We would alternate between these two perspectives many times.
The last step would be for him to stand in the middle between the two chairs and ask him to look inside of himself and get a sense of what the balance was between these two perspectives—50:50? 60:40? 90:10? With cases like these, patients often report that their sense of badness was nearly 100% when they walked into the office. With enough intensity, this kind of dialogue work can begin to shift the balance. Perhaps it would be 70% bad and 30% tragic after the first session and 60% bad and 40% tragic after a second Chairwork session on this topic. It is certainly a process and not an event, but each round can help to reduce the suffering of the patient and help them live with greater freedom in this world.
The second component to the treatment would involve grief work. It would begin by putting a chair in front of Gregg, asking him to imagine that Duane was in the chair, and inviting him to speak with him (Relationships and Encounters). Gregg would be asked to speak from love, from anger, from guilt, and from grief. Ideally, he would also speak of and share some of the good experiences that he and his brother had shared together.
The next phase would involve asking him to switch chairs to “become” Duane, to “channel” him. I would then speak with Duane directly and tell him that Gregg has been suffering terribly about the stolen drugs and the lie; I would then ask him if wanted Gregg to be in this kind of pain. Since Duane loved him deeply, he would very likely say no. Duane would then be encouraged to speak to Gregg in the “Gregg chair” and to give him this message of forgiveness clearly and forcefully so that Gregg would have a better chance of accepting and integrating it. We would do this several times for emphasis.
Before bringing this “channeling” section to an end, I would ask him to express his love for Gregg and his own sense of grief about their parting. I would also ask Duane whether he thought Gregg should live a free and healthy life; if so, I would encourage him to tell that to Gregg as well. The final step would for Gregg to switch chairs and become “Gregg” again. Ideally, he would close his eyes for a minute so that he could take in what his brother had told him. He could then say goodbye to Duane, at least for now, and we could move the chairs and debrief the experience.
In actual practice, these kinds of inner critic and grief dialogues can be incredibly profound. I am deeply and repeatedly impressed by how much healing can occur in only one session. It is also my hope that from this imaginary treatment, the reader can get a sense of the incredible power and potential that lies at the heart of the practice of Chairwork.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
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