Running head: THE CASE OF SALLY

Oral Comprehensive Report The Case of Sally Faheem Johnson La Salle University

THE CASE OF SALLY

Tentative (5 Axis) Diagnosis & Goals Axis I: 311: Depressive Disorder NOS; 298.8: Brief Psychotic Disorder (w/ marked stressor(s)); 313.82: Identity Problem Axis II: 799.9: Deferred Axis III: 556.9: Colitis, ulcerative Axis IV: Occupational recent job loss; Economic issues w/ family finances; Other psychosocial/environmental problems victim in a bank robbery Axis V: 60-65

For Sallys Axis I diagnoses of clinical syndromes, utilizing all of the information provided in her case narrative, several hypotheses were formulated leading to Sally having multiple diagnoses. The first diagnosis is Depressive Disorder NOS. If this is the case, then some of Sallys symptoms would include: (1) an inability to think clearly or concentrate appropriately (2) exhibit variable symptoms that can cause significant to severe distress or impairment in occupational, or other important areas of functioning, and (3) exhibit episodic depressive features for at least 2 weeks.

THE CASE OF SALLY To illustrate, Sally had recently been laid off from a job she worked for many years. And while

Sally was laid off from this job, a job in which she seemingly loathed, it can be assumed that Sally would not only feel guilty about being laid off, but she would also experience a sense of devastation and disconsolation, especially because she was one of the heads of the household with an income. As indicated in the case description, Sally is definitively worried about her familys finances. An occupational disturbance such as losing a job can cause or increase debilitation of an individuals mental and emotional state, i.e. Sallys professional identity is now in a bleak quandary. That is to say, if Sally was at some point before all of this, quite stable and on the surface she appeared to be a well-adjusted professional adult with little pervasive psychological stressors, then it is not unlikely to propose that Sallys variable depressive features were caused by or stem from a stressful life event such as losing her job. As for Sallys secondary Axis I diagnosis of Brief Psychotic Disorder (w/ marked stressor(s)), Sally reported experiencing seeing a vision of her late mother as she was falling asleep. After Sally had been asleep for an unspecified period of time, she suddenly awoke to another vision, this one perhaps more lucid than the first, of her mother standing in her bedroom gazing at her. In Sallys own words, the experience was very real. Following the event, Sally self-described herself as being discombobulated, ultimately causing her to feel bewildered and incapable of performing normal parenting and household duties. Even further, Sally reported feeling ill at ease and not herself for at least three consecutive days, although each day appeared to get better with time. Brief Psychotic Disorder (w/ marked stressor(s)) is a period of psychosis with a duration that is typically shorter, non-re-occurring, and not caused by another condition. In preparing this secondary diagnosis for Sally, it was assumed that Sally was not of a specific culture where symptomology of a brief psychotic episode is considered culturally appropriate, sanctioned or otherwise normal. Because Sally identified experiencing a pair of visions that her deceased mother was in her presence, describing such experiences as very real, and following these experiences, she felt mentally disoriented for several days,

THE CASE OF SALLY it is likely that Sally experienced hallucinations. Along with the presence of several other symptoms, hallucinations are one of several symptoms that occur in those who suffer a brief psychotic period.

Namely, it is assumed that Sally experienced hallucinations of her mother because both of Sallys visions occurred while she was wakeful, and not while she was asleep and dreaming. For, dreams, while somewhat related, occur while someone is not awake and typically do not involve an active distortion or misinterpretation of reality and real perception. Additionally, Sallys episode of experiencing hallucinations, as well as exhibit grossly disorganized behavior for several days was brief and lasted less than one month (3 days to be exact). More importantly, Sally described the entire experience, while puzzling, as something that eventually got better with time, which is ultimately an eventful return to premorbid levels of functioning. And thirdly, Sallys third and final Axis I diagnosis of Identity Problem was significant enough in her case to receive clinical attention. This diagnosis stems not only from her recent job loss, but mainly from her past history of unfinished business with her then, very strict mother. According to Sallys case description, her mother was a stringent parent who demanded and seemingly pushed Sally into choosing a career that was more profitable and stable rather than support Sally in choosing any career that could allow her both wealth and inner tranquility. Because of her past history, Sally, who is now unemployed is a) anxious about looking for another job, especially because she was quite dissatisfied with accounting work and b) at a crossroad of potentially never finding a job that suits, not only her financial needs, but also suits her efficacious needs as well. Clearly, there is discord and uncertainty related to Sallys overall identity as a person, her career and professional identity as a social being, and her moral value(s) related to whats needed to be done both as a mother and as a wife to continue to support her family structure. For Axis II; personality disorders and mental retardation, there was not enough information provided in Sallys case description to make any diagnostic judgment about an actual Axis II diagnosis; thus, Sally was confidently given a deferred diagnosis on this axis. In contrast, on Axis III; general medical condition(s), per the evidence detailed about Sallys medical history, Sallys colitis or more

THE CASE OF SALLY formally, ulcerative colitis was recognized here. This specific medical condition is a form inflammatory bowel disease that primarily affects an individuals colon and rectum. According to medical literature,

there is seemingly no direct cause for colitis; however, stress and genetics are regular postulations formed about the disease. As for Axis IV and in accordance with the evidence in Sallys case description, the psychosocial and environmental factors that are likely catalysts in the ebb and flow of Sallys diagnostic symptoms include: recent job loss, issues with family finances, and her recent exposure to the violent and traumatic event of being held at gunpoint in a bank robbery. Lastly, for Sallys Axis V diagnosis (Global Assessment of Functioning), Sallys overall level of current functioning reflects that she falls in between the ranges of 60-65. Despite Sallys secondary Axis I diagnosis of Brief Psychotic Disorder, which occurred nearly two months ago, Sallys current level of functioning displays that she may exhibit some mild symptoms of depressed mood, as well as display some difficulty occupationally due to her joblessness. Conversely though, if it is assumed that Sally is generally functioning well and trying to maintain some of her duties and commitments as both a wife and a mother balancing meaningful interpersonal relationships, then her GAF score of 60-65 is appropriate for her current diagnoses. As for confirming or rejecting Sallys tentative multiaxial diagnosis, it is essential that the therapist review current symptoms of depression using the DSM-IV-TR criteria, inquiring about each symptom and about any past history of depression. It is also imperative for the therapist to take advantage of peer consultation. It is also essential that Sally is referred to a psychiatrist for further medical and diagnostic assessment. All the same, Sally and the therapist need to explore Sallys family history as extensively as possible to determine whether or not mental illness and/or addiction are unfortunate contributors that have influenced Sallys family generationally. One specific, as well as therapeutic method to collect Sallys familial history is to collaborate on completing a genogram. Unlike a conventional family tree, completing a genogram with Sally provides a pictorial display of possible hereditary patterns and psychological factors that have or still punctuate Sallys family dynamic.

THE CASE OF SALLY In preparing to work with Sally, it should be noted that the therapists approach would embody several elements and characteristics to its method. To be general at best, the core or foundation of the therapists aim is humanistic in nature and attempts to adopt a more holistic sense to Sallys individual experience as a human being. In essence, this approach would not be practiced in an attempt to solve any one of Sallys particular issues. Rather, the approach would more so identify with supporting Sallys individual growth so that she becomes better at managing both present and future issues in a more integrative manner. At the most basic level, the therapists overarching goal would be to facilitate empathic engagement with Sally in order to establish, overtime, both a congruent and genuine therapeutic relationship. That is also to say, with as much collaboration as possible, it would be important as Sallys

therapist to reduce the potentiality of her having emotional discomfort in therapy, foster a general sense of insight from Sally about herself, and encourage Sally to try and experience cathartic freedom or express her emotions as freely as possible and as much as she can in session. To illustrate, for Sallys first Axis I diagnosis of Depressive Disorder NOS, because Sally (in accordance with her condensed case description), does not appear to exhibit any one particular depressive feature, one of the first goals in working with her would be to tap into her understanding of her diagnosis phenomenologically or in the here-and-now so to speak. In other words, the therapist will not look to disprove Sallys own interpretation of her experience itself and the potential meaning it can have to her. For, theoretical and behavioral interpretations cannot impugn first-hand experience(s) of any client without first understanding a clients subjective experience. Nevertheless, general psychoeducation and providing new information about diagnoses can, and is, vital in working with any client, but specifically speaking, in working with Sally, so that her self-awareness has a starting point in fostering what might or might not be expected with having such diagnoses.

THE CASE OF SALLY As for explaining why these general goals were selected or are preferred for Sallys therapeutic experience, the answer is rather simple: effective therapy requires healthy collaboration between the client (Sally in this specific case), and the therapist. Essentially, there is a certain quality and strength to allowing the therapeutic process be-come collaborative. An effective and empathic alliance between the

therapist and the client reliably shows that the process of therapy can maintain a healthy positive balance, which in turn, can generate positive outcomes in therapy and promote the facilitation of therapeutic change. As a result, the therapist and Sally will both facilitate an active role in her treatment process; thus, prognostically, as a client, Sally will understand that her course of treatment with the therapist will most centrally involve heightening her expectancy or capacity to change. Simply translated, this active collaboration between Sally and the therapist will in no way guarantee that Sally will never experience any of her diagnostic symptoms again, but rather, Sally and the therapist will work together to foster the belief that the therapeutic process in and of itself promotes an expectancy of improvement upon Sallys major problems and issues she seems to be experiencing. Theoretical Orientation & Case Conceptualization Because there is no one fully acceptable or advantageous theoretical model of therapy and the fundamentals of effective counseling seem to be proportionately similar (i.e. encouraging client catharsis, presenting new knowledge and information to a client, and raising a clients level of probability of change), the therapists basic theoretical approach to counseling is to work from an eclectic model of therapy. Subjectively, that is to say, certain types of psychotherapies are better suited for certain types of individuals and issues. As well, despite preferring to work from an eclectic approach, generally speaking, effective therapy from any discipline has more so to do with the connection between the client and the therapist and the maturation of their therapeutic alliance than it has to do with subscribing to specific theoretical orientations. Thus, in the same light of Arnold Lazaruss unifying manner toward the overall practice of counseling, the goal of therapy, then, is uniquely multidimensional and encompasses a holistic influence on the individual client while working on a few problem areas of focus.

THE CASE OF SALLY Specifically however, in the case of Sally, the two primary theoretical orientations that will be presented to further conceptualize her issues are: Person-Centered Therapy and Gestalt Therapy. In essence, both of these therapies, when integrated dynamically, yield the most congruence when it specifically pertains to (1) the therapists views of human nature, (2) the influential roles of the clienttherapist relationship, (3) the development of maladaptive behavior, and (4) treatment goals of therapy. For example, according to Rogers (1980a, p. 117), fully functioning persons are increasingly

open to experience, increasingly accepting of their own feelings, and capable of living in the present from moment to moment. In other words, individuals are progressively free to make their own choices and act on them as they please. As well, they are able to trust themselves and human nature while still being able to balance sensible expressions of various emotions such as intimacy and aggression. Hence, one of the main goals of person-centered therapy is to do the therapeutic work that promotes moving toward a truer self, rather than move toward a self one is not. In the same way, one of the primary tenets of Gestalt therapy is to assist clients to become more fully aware, that is, achieve a healthy stability of satisfaction and balance. For, Gestaltists view humans as having the capability to become fully aware in spite of their maladaptive behaviors and characteristics. Moreover, awareness is whats considered right for all individuals, especially clients. Consequently, being fully aware allows for there to be a sense of inner direction and inspiration to being who we really are. Therefore, according to Perls, all needs stem from, and are grounded in, this basic need to actualize oneself, to become whole (Perls, 1969a). Even further, Gestalt therapy and person-centered therapy both focus on the here-and-now approach and stress positive objectives and goals of living. Indeed, these two unique modalities personify their own unique characteristics; however, like many of the broad therapeutic orientations, some of their most general beliefs about effective therapy overlap with one another. Again, because it is the therapists preferred methodology to utilize an eclectic approach to counseling, Sallys case will be conceptualized from both a Person-Centered modality and Gestalt

THE CASE OF SALLY modality of psychotherapy. In the eyes of the therapist, both of these paradigms encompass the most

supportive and complementary evidence into the potential causes of and the current maintenance of some of Sallys issues. To begin with, if the causes of Sallys problems were to be looked at developmentally, it could be said that Sallys development, in relation to her early environment, was neither promoting nor domestically satisfying. To explicate this developmental point more clearly, half of it will be discussed from a Gestaltist view of early development and the other half will be framed from a Person-Centered point of view. That is to say, in Sallys social stage, her development in the infancy period included depending on both of her parents for everything and having little to no awareness of herself, which is considered normal. However, when it was time for Sally to move past the social stage of development to the psychophysical stage of development where an individual becomes more aware of their self and selfimage through their relation to receiving acknowledgement and support, Sally was imperceptively without a father in her life. This is critical to assume due to fact that Sallys mother and father divorced when Sally was 5 years-old. Even further, this critical assumption is also important to note due in part to Sallys mother being described as very strict. It is likely that Sallys mother was more stoical than warm in her emotional attendance and availability to her daughter. Therefore, Sally is likely to have gone on in life adopting those same characteristics that her mother embodied, and unknowingly applied them to her own life and interpersonal relationships. Because of this, Sally is at a current stage in life where she is less than fulfilled existentially and is used to insecurely sheltering herself emotionally from others. Most uniquely, it is mentioned by Kempler (1975) that very few people reach what Perls identified as the third stage of development, which is the spiritual stage where one moves from awareness that is sensory sensing to awareness that is extrasensory sensing. If this were the case, Sallys recent episode of experiencing a hallucinatory vision of seeing her deceased mother gaze at her one night can be looked at as Sallys inner self attempting to move from sensory-based awareness, which is (physical) to that of an extrasensory awareness, which is more (mental). And while Sally experienced discombobulating after

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effects of this episode, these experiences have brought Sally to therapy to find out what she experienced and does this experience have any correlation to her lack of fulfillment career-wise; thus, further exacerbating her anxiety about finding something new to do with her life. By the same token, from a Rogerian or Person-Centered perspective, if it were the case that Sally did not grow up in favorable conditions, then Sally is likely to have not been granted the chance to flourish. In other words, after Sallys parents divorced, Sally had to be raised by her mother, who possessed the natural inability to promote and support Sallys self-growth. Rogers recognized, of course, that human beings can perpetuate great evil that they are capable of deceit, hatred, and cruelty but he believed that these propensities are the result of negative conditions of worth imposed on children by family and society (Moreiera, 1993). In summary, Sallys dateless disposition of non-specific depressive features has resulted in her becoming more externally preoccupied, rather than internally oriented. In other words, if Sally is considered to have had a long-lasting lack of passion for herself and continuously found herself tempted to distort her own feelings in order to meet the needs of others, it is clear to see how Sallys maladaptive behaviors could have manifested over time. In beginning therapeutic work with Sally, some of the most fundamental elements of counseling would be advocated as identified earlier in the Goals section of the paper such as: promoting an expectancy for change to occur, utilize the nature of the therapeutic relationship to reduce Sallys potential for emotional discomfort, foster insight and self-examination, encourage catharsis, and provide Sally with a different perspective of her issues so that they can be thought of as more solvable. However, to speak in terms of technicality, the therapist would apply specific methods and techniques from the Gestalt model, and if needed, attempt to support such therapeutic efforts utilizing fundamentals from the Person-Centered approach to therapy. To illustrate, the overarching goal in Sallys case is to relinquish her potential psychological pain and maladjustment (or resistances to contact), by becoming more aware; thus, helping Sally learn how to

THE CASE OF SALLY enhance her entire self so that she can become more integrated internally rather than continue to

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ineffectively preoccupy herself with external forces outside of her responsibility and control. Because the Gestalt model functions primarily by using experiential work to help clients gain new insights while improving their issues, it is vital that the therapist first prepare Sally for such therapeutic work. Hence, Sally would have to first grant the therapist full permission to begin Gestalt therapy with her. As well, if it were the case that Sally had any potential cultural concerns about the work, such concerns would be explored and therefore treated sensitively by the therapist. As a result, the therapist and Sally will develop a communicative partnership between equals talk with, rather than at each other while remaining centered in the here-and-now. Also, there will be resistance during the experiential process. Sally would become more aware of that as therapy unfolds. It is predictable, especially provided Sallys early background and her current perpetuation of not being in the present moment, that certain elements of her emotions will not be moved easily and that she may experience a fear of losing control; however, provided that Sally wants to do the work, eventually, this resistance shall wane. Furthermore, the nature of language during the sessions would be another central focus to explore, as Sally would be encouraged to take more responsibility by phrasing what she means and how she feels using I statements rather than you or it statements. Subsequently, in conjunction with the experiential aspect of the Gestalt helping process, Sally would be encouraged to fully engage in expression work, such as performing the internal dialogue exercise and therefore staying with the feeling of this expression work in order to go deeper into her feelings that she tends to avoid. For example, the therapist would encourage Sally to engage in Topdog vs. Underdog dialogue (in this case critical mother vs. victim), either by using the empty-chair technique or by role playing with Sally and becoming her mother in the present. If it were the case that Sally preferred the empty-chair method, with the guidance of the therapist, Sally would be encouraged to take on both sides of the discussion; not only being herself, but also being her mother as well. In general, this particular method allows Sally further exploration into the nature of the relationship she had with her mother, while at the same time grant her some new insight

THE CASE OF SALLY into herself. It can be predicted that this particular method will take place over the course of several sessions due in part to Sallys immediate inability to self-adjust to creative expression As well, superimposed by deep feelings about her past (unfinished business), it is likely that a few sessions will also have to transpire in order for Sally and the therapist to identify some of her specific defenses that may resist engaging in such creative action. This brief example of experiential work or rather, expression work is to again, promote the

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maintenance of responsibility as therapy progresses. If Sally and the therapist are successful in their initial attempts at promoting expression, Sally is likely to be able to engage in techniques that lead to the differentiation and affirmation process of Gestalt therapy. To be clearer, Sally would be able to differentiate the most unsettling parts of her inner conflict (e.g. working in a less than fulfilling industry because of someone elses desires) by, for example, exaggerating some of her body movements or facial expressions in so doing, she may become more aware of the sadder part (introjection) or angrier part (retroflection) about herself. During the affirmation process of therapy, Sally would then be encouraged to identify with or relate to all the emerging parts of herself that are now metamorphosing into her awareness rather than maintain their resistances to contact. Namely, this process in therapy allows Sally to finally experience a sense of catharsis, releasing pent-up emotions that have left her stuck for quite some time. In what is to be considered the final process of Gestalt therapy, Sally and the therapist are left to explore choice and integration. As Perls (1976, p. 79) put it, responsibility is really response-ability, the ability to choose ones reactions. This final process for Sally can only come about once she is able to carefully abandon some her major defenses of being, and allow herself to be-come more aware of her true feelings and potentially discover what some of her inner motivations are in life. Hence, acquiring internal peace while undoing the past so that it is possible to live more fully in the present is the central goal here, and for, Sallys entire therapeutic journey. Assessment & Ethnic and Gender Issues

THE CASE OF SALLY As for the relevancy and role of assessment in Sallys treatment, there are in fact several assessment measures that would be utilized in this case. First, the therapist would administer the

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Symptom Checklist-90-R or the (SCL-90-R). This relatively brief psychometric instrument is a self-report questionnaire. The measure is designed to assess a broad range of psychological problems and symptoms of psychopathology. By administering the assessment in session, both the therapist and Sally would gain further insight into both of her major Axis I diagnoses of Depressive Disorder NOS and Brief Psychotic Disorder. Therefore, the reliable results of Sallys SCL-90-R will indicate the potential progress and possible outcomes in therapy. Even further, the Career Beliefs Inventory (CBI) and the Strong Interest Inventory (SII) are two complementary measures that the therapist would employ to further explore Sallys tertiary diagnosis of Identity Problem. Often used in career assessment, both measures are counseling instruments used to provide measurable insight into a persons interests, identifying beliefs, and their potential career pursuits based on the data collected from the assessments. By administering these three assessments, the therapist not only stays true to his eclectic dogma, but he also displays a dynamic level of flexibility and resourcefulness in his counseling Sally, who is likely to appreciate the therapists ability to tailor therapy specifically to her needs. In considering possible ethnic issues, if it were the case that Sally distinctively identified herself ethnically, it would be essential for the therapist to understand Sallys meaning of ethnic identity. Furthermore, even if Sally does not identify ethnicity as being an important influence on her life, as a therapist, it is still obligatory that ethnic and cultural meanings are collected from Sallys perspective. Succinctly, it will be assumed that thus far in therapy, Sally has yet to openly present any one particular issue in relation to her own ethnic identity or that of her therapist. However, if an ethnic issue or conversation is presented during session, it can and will receive significant focus in relation to the course of her treatment in therapy. As for some gender issues, more so than some ethnic issues, Sally is likely to generate some discussion about her gender and what it means to her to be a woman in the world. Because of this, the therapist could actively inquire about Sallys thoughts and feelings regarding gender

THE CASE OF SALLY membership or gender role in her family. It is easy to see how these particular constructs could have meant something different to Sally, especially as a younger woman. Now that Sally is approaching 40 years old and is currently married with her own family, it is safe to assume that gender constructs are

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indeed influential factors in Sallys everyday cultural worldview. For instance, it is empirically reaffirmed that typical patterns of psychopathology are likely to affect some women more than some men (e.g. internalizing disorders such as anxiety and depression). Because of this, it is likely that at some point in therapy, Sally may want to evaluate and discuss particular aspects about her gender in relation to her diagnoses. In all, exploring such unique topics in therapy with Sally will not only potentially indicate her progress therapeutically, but this type of exploration will also indicate that the therapist can be sensitive and is willing to explore various cultural facets about Sally whether they are on a deeply personal level or whether they are on a macro or more cultural level. Consultation, Ethical Issues, & Assessing Outcomes Putting the practical side of counseling to the forefront of ones therapeutic thinking can be difficult at times, especially while a therapist is actually conducting a therapy session. However, it is imperative that a therapist seek regular consultation. In Sallys case, as in most cases, the therapist here would seek regular consultation in the form of peer consultation. For, an essential professional activity for any wise counselor is regular consultation with peers or consultants. In general, consultation serves a number of purposes, such as, but not limited to, reviewing cases, accepting advice, and discovering ones own potential blind spots. As for ending or terminating therapy with Sally, the therapist would follow sound clinical reasoning and abide by clear ethical standard when it became reasonably evident that Sally no longer needed the service, while at the same time honoring the fact that Sally also has a say in her termination of treatment and that the therapeutic relationship with her has always been, and still is, a mutual relationship. As for how the therapist would terminate therapy with Sally, it would first be done face-to-face, as most

THE CASE OF SALLY psychotherapy is done face-to-face. As well, in that final face-to-face interaction (maintaining the

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assumption that Sally and the therapist have experienced a positive relationship), the therapist would not only honor his therapeutic relationship with Sally, but the therapist would also acknowledge Sallys individual growth and recognize her vigorous determination to work through the majority of her issues in order to achieve goals she might have only thought she could achieve and quite possibly discover things about herself that she never knew were there. In general, terminating any type of relationship is difficult to do. And although the word suggests an ending, termination is actually the start of a new beginning for clients. After all, in Sallys case, therapy was always about providing Sally a collaborative atmosphere that promoted growth and self-awareness. Indeed, Sallys final session marks another stage or transition in her life that she is likely to embrace if she so chooses. Perhaps the most ostensible ethical principle relevant in Sallys particular case is ethical principle 2.01 Boundaries of Competence as identified in the American Psychological Association's (APA) Ethics Code (2002). Because Sally has both the rights to be informed and provided access to alternative forms of therapy, it is important that as Sallys therapist, she is continuously provided services in areas only within the boundaries of the therapists competence based on education, training, supervised experience, and/or consultation. Specifically speaking, because the therapist in Sallys case prefers more of an eclectic approach to counseling, and in this case, applied specific methods of the Gestalt discipline to help treat and address Sallys issues, for effective implementation of these services, it is assumed that the therapist obtained the proper training, experience, consultation or supervision necessary to ensure competence in such a therapeutic discipline of knowledge. Because there seems to be a compulsory trend toward outcome measurement in psychotherapy, and it is believed that measuring outcomes is likely to improve the connection between clinical research and the effectiveness of actual clinical practice, the therapist in Sallys case would track outcomes of therapy by using the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS). Both of these complementary outcome measures help Sallys therapist (a) become a better therapist, (b) resist the push

THE CASE OF SALLY towards accountability and embrace its many benefits, and (c) justify Sallys right to know about the treatment she is getting and if the treatment is or will ever help her.

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References American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060-1073. Kempler, W. (1973). Gestalt therapy. In R. Corsini (Ed.), Current psychotherapies (pp. 251-286). Itasca, IL: F. E. Peacock. Lazarus, A. A. (1981). The practice of multimodel therapy: Systemic, comprehensive, and effective psychotherapy. New York: McGraw-Hill. Moreira, V. (1993). Beyond the person: Merleau-Pontys concept of flesh as (re)defining Carl Rogers person-centered theory. Humanistic Psychologist, 21, 138-157. Perls, F. S. (1969a). Gestalt therapy verbatim. Moab, UT: Real People Press. Perls, F. S. (1976). The Gestalt approach and eye witness to therapy. New York: Bantam Books. Rogers, C.R. (1980a). A way of being. Boston: Houghton Mifflin.

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