By the late 1980s, the National Center for Post-Traumatic Stress Disorder at the Menlo Park Veterans’ Administration Hospital was regarded by our capricious government as the Clinical Laboratory and Educational Center for organizations involved in the treatment of PTSD. This state-of-the-art facility and model program—nicknamed “Club Fed” by its intimates—was directed by Fred Gusman, an MSW in clinical and administrative social work with “a lot of on-the-job training.” Although a veteran of the Air Force, Gusman never served in Vietnam.
“The treatment here is to take a look at the person’s total life and understand how the trauma interacts with both pre- and post-trauma experiences,” Gusman explained. “There was ‘another person’ prior to the trauma and in order to understand who was affected by the trauma, you have to know who that other person was.” Gusman went on to point out that “nobody ever gets what they think they should get, or even knows what they should get. What we do know is that if a person does not follow up with outpatient treatment, and if they do not have a supportive environment, they fail. And that’s true wherever you go in the country, no matter what program you talk to.”
“They put you in a controlled environment and attempt to stabilize you,” Gary told me in reference to his own treatment at Club Fed. “But what they don’t do is follow through. A lot of vets go back to the same inappropriate behavior when they leave because they haven’t gotten rid of the feelings of guilt and trauma, and they’re back trying to stay alive on the street. When the program people hear that they say, ‘Well, he just didn’t learn anything here. He’s just not working his program.’”
Dr. Michael Cohen, who often referred veterans to the National Center for PTSD, reported that their reviews of Gusman’s treatment were mixed. “There are people who really feel that it’s turned their whole life around, and then there are those who feel it’s a total waste of time.”
Gestalting: Confrontational Therapy Redefined
Pete settles down, lights his next cigarette from the glowing butt of the last, and continues to tell me the story of his military career and subsequent downward spiral. It is like listening to the sound of a dam slowly breaking apart. A veteran of the I-Corp Combined Action Program in 1968, Pete was no stranger to unfavorable odds and extreme measures. Of the 5000 Marines who served in the backcountry CAP units, fewer than half survived. The other half had to live with the memory of what they had done to stay alive. To fend off his personal demons, Pete chose the needle
In 1987, recovering from heroin addiction at a VA Hospital in Phoenix, Pete applied to the Menlo Park program. Shortly after being admitted, he was interviewed by a nurse who assured him the answers to her probing questions would be held in strict confidence. The following morning, Pete was introduced to Gusman’s second in command, a social worker with first-hand experience in The Family, a Synanon-style “attack-therapy” drug rehab group, and his weapon of choice—a technique he called “gestalting.”
Fritz Perls’ Gestalt Therapy became popular in the United States during the 1960s. Defined as “a non-interpretative psychotherapy, which emphasizes awareness and personal responsibility,”[i] it has its underpinnings in German gestalt psychology, developed in the early 1900s by Max Wertheimer. Irma Lee Shepherd, one of Gestalts’ leading proponents, pointed out the dangers involved when inexperienced therapists use its powerfully confrontational techniques to “open up” unstable people with vulnerable personalities. Such people need time, support, and long-term commitment from their therapists, she insists.[ii]
“When we started the program in ‘78,” Gusman explained, “we did a number of things that were derived from a treatment modality called “Creative Gestalt.” Basically, what we do is similar to any drug and alcohol program. When a new patient comes in, the whole community has a chance to meet this person. The actual technique of Gestalt is using a creative, animated, experiential way of getting people to do self-disclosure. It’s sort of a confrontation process. We review a person’s chart, what the people who interviewed them wrote; we have a lot of data. There are some people that you have to handle differently based on who they are.”
“We had to sit on this red park bench,” Pete tells me, “and all the way around in a big ‘U’ are the other guys who’ve already had this done to them. When you got in, to take away your identity, any facial hair had to come off. You wore green pajamas for the first three to six weeks and then you had to have your big brother sponsor you to come out of pajamas. So here you are sitting on this bench, a hundred guys all around, giving you the look. [The second in command] then starts the questioning and he’s got on his clipboard the ‘confidential’ interview you did with the nurse.”
Pete pauses and stares at the glowing ember at the end of his cigarette, at a memory that still burns in his mind. “There were men who had come in there severely f***ed up, who’d molested children and gone through a treatment program, and he’d get them up there and force them to tell the entire community. I saw people faint, black out, run out the door, or somehow manage to hold it together, and as soon as they were allowed to go to their rooms, pack and run that night. Anything you’ve said to anybody, they stand up and tell in Gestalt.”
[i] The Oxford Companion to the Mind, (Oxford: Oxford University Press, 1987).
[ii] Shepherd, I.L. "Limitations and Caution in the Gestalt Approach," Gestalt Therapy Now, (eds.) Fagan, J. and Shepherd, I. L., (New York: 1970)
Continued in Part V
You can read the article in its entirety in Beyond Trauma: Conversations on Traumatic Incident Reduction. See http://www.BeyondTrauma.com
