Humanistic Integrative Psychotherapy (Barcelona)

1. Introduction

Version followed: Psicoterapia Integradora Humanista (PIH) as set out by Ana Gimeno-Bayón Cobos and Ramón Rosal Cortés of the Instituto Erich Fromm, Barcelona: the two Desclée de Brouwer manuals (Fundamentos y tratamiento de problemas sensoriales, emocionales y cognitivos, 2nd ed. 2016, phases 1–4; Manual práctico, 2017, phases 5–13), Gimeno-Bayón's process article (2017), her emotion-work article (Revista de Psicoterapia no. 60, c. 2004) and her imagery article (2015), and the 2018 casebook. Only the publishers' previews and the journal articles are drawn on; the full manuals are not.

PIH is a Spanish-origin, methodologically integrative humanistic-existential psychotherapy. Rosal and Gimeno-Bayón founded the institute in Barcelona in 1978 according to Rosal's publisher biography, or in 1979 according to Gimeno-Bayón's [uncertain: sources give different dates]. The model is theoretically unified (holistic-systemic, existential, constructivist) but technically eclectic. It draws verbal, imaginal and psychocorporal techniques from more than 20–25 models: Gestalt, Transactional Analysis (TA), psychodrama, Psychosynthesis, Focusing, bioenergetics, NLP, eidetic and oneiric imagery, and logotherapy [source: edesclee 2016 preview; Siete casos introduction].

How change happens. The person is treated as an open system whose life-flow (fluir vital) moves through a 13-phase cycle of experience, expanded from Perls's seven phases. Distress arises where that flow is blocked (bloqueo), dispersed (dispersión) or distorted (distorsión) at a particular phase; the authors catalogue more than 100 such problems (102 in the 2018 count). Therapy is framed as a problem-solving process set by the client's demand. Through a warm, real relationship and in-session experiential "experiments", the client's cognitive, affective and existential constructs about self, others and life change, freeing the client to live creatively, with greater responsibility, a life project and a sense of meaning [source: Gimeno-Bayón 2017 Dinámica; Gimeno-Bayón c.2004; Siete casos preview].

2. Framework

PIH does not prescribe a closed, fixed sequence of session-numbered phases. Gimeno-Bayón (2017) combines several complementary sequences, summarised below. The macro-stages are an ordering synthesised from her article and from the casebook's chapter template [synthesis of sources].

Stage A: Initial contacts and assessment. The goal is to understand the person as a whole and clarify the demand. The process includes:

the Cuestionario Básico (a pre-therapy questionnaire written by the authors; licensed, so not reproduced here);
a first interview;
directly observed behaviour;
formulation of the therapeutic demand (demanda terapéutica).

Diagnostic hypotheses are written on three parallel axes: DSM (a courtesy for scientific communication), TA (life script) and PIH (which phase or phases of the cycle are blocked, dispersed or distorted, and how). Fuller assessments add an emotional autobiography, imagery exercises, projective drawings, psychometrics and a Millon-style personality description. The client is encouraged toward intuitive self-diagnosis (autodiagnóstico) rather than handed a label [source: Siete casos TOC and introduction; edesclee 2016 preview].

Stage B: Building the relationship and defining goals. The opening is diffuse (Gimeno-Bayón compares it to a morula). Rogers's conditions create a holding "womb". Problems and goals are defined while the bond forms, and the demand may be redefined and prioritised. Partial goals and strategies are then planned. A step from Muriel James's "excavation" applies here: early "chicken soup" gestures sustain the client while the alliance forms [source: Gimeno-Bayón 2017 Dinámica].

Stage C: Working phase, moving from surface to depth.

Following James, work moves from (1) supportive contact, to (2) work on interactions with reasonable challenges that bring early success (calibrated in the manner of Csikszentmihalyi), to (3) work on personality structure and deep roots, done carefully.
Egan's sequence runs in parallel: attention, problem exploration, insight, action programmes.
Entry follows Ware's "doors": begin with the client's most accessible subsystem (thinking, feeling or behaving), then the target subsystem, and only then the blocked one.
Within the cycle, work usually starts at the most basic blocked phase, because higher phases build on lower ones.

Intervention routes are chosen by four "Aristotelian causes": material, efficient, formal and final (see §4). The aim is the most potent option, meaning relevant, lasting change in the least time with the least disruption [source: Gimeno-Bayón 2017 Dinámica; Gimeno-Bayón c.2004].

Detours (desvíos). Emergencies such as a bereavement, job loss or serious illness, or a sudden concentrated motivation in the client, justify pausing the central theme to work on the new event, then returning to it [source: Gimeno-Bayón 2017].

Stage D: Consolidation and termination. Each partial goal achieved is celebrated, then the next problem is taken up. Termination is indicated when the client is connected with their deep "being" pole (Ambrosi) and can leave autonomously. Termination follows Tudor's tasks (see §4) [source: Gimeno-Bayón 2017].

The 13-phase cycle used as the diagnostic map [source: Gimeno-Bayón c.2004; 2017]:

Sensory receptivity
Filtering of sensations 3–4. Cognitive and affective identification (the order varies between people)
Valuation
Implicating decision (decisión implicadora)
Mobilisation of resources
Planning
Execution of the action
Encounter
Consummation
Relaxing-off (relajamiento)
Relaxation

Valuation and decision are the authors' main additions to Perls's cycle. The 2016 manual covers 33 problems in phases 1–4 and the 2017 manual covers 69 problems in phases 5–13; for each problem the manuals give a description, signs (indicios) and in-session and between-session resources [source: infocop; Siete casos preview].

Format and dose.

Individual therapy is the main format described. Group work is also used: emotional-education exercises and group feedback, groups of 12–30 in the authors' studies, and a group protocol for anxiety (Lizeretti) [source: c.2004; 2015; 2017 Experiencia].
No standard session count is given. One published case ran 31 sessions over 15 months, weekly in the first year and fortnightly afterwards [source: Siete casos preview]. Session length is not stated [uncertain].
Not every session is experiential. An experiential session opens with welcome and empathic listening to the here-and-now and then follows Greenberg's sequence: client marker → therapist operation → client performance → in-session change [source: 2017].

Criteria for moving on [source: 2017; c.2004]:

deepen from interaction work to structural work only once the relationship is solid and early challenges have succeeded;
climb the cycle (and Lane and Schwartz's levels of emotional awareness) only once lower phases flow;
close a partial goal when the client values the achievement;
the client decides how far change goes.

3. Guiding principles

[source: Gimeno-Bayón 2017 Dinámica; 2017 Experiencia; c.2004; edesclee 2016 preview; Siete casos introduction]

Holism and systems thinking. Change in one subsystem (body, emotion, cognition, interaction, values) moves the others, so look for where the flow stops rather than treating one channel in isolation.
Anti-reductionism. Do not reduce the problem to cognitions, emotions, behaviour or physiology alone; consider all of them, and the spiritual dimension too, since the person is seen as bio-psycho-socio-spiritual.
Theoretical unity with technical eclecticism. Borrow a technique only if its assumptions are compatible with PIH, and use it without distorting it.
Demand-led problem solving. The client's demand sets the goal; you may invite further growth, but the client chooses how far to go.
Client as protagonist, two experts. You are expert in procedures, the client in their own subjectivity; work as a team and avoid acting as a superior expert.
Maieutic stance. Act as a "midwife": ask so the client discovers what they already hold.
Rogerian conditions plus semi-directivity. Provide acceptance, respect and empathy, but because love alone is not enough (Beck, as cited), actively propose experiments.
Concreteness. Keep the focus on the client's specific distress (Egan).
Here-and-now experience and phenomenology. Describe before explaining; move between the concrete present and the whole life project.
Do not interpret images. Meaning is idiosyncratic, so let the client find it.
The medium is the message. The form of therapy must not contradict its content, which would create a double bind.
Enter by the open door. Respect personality style (Ware) so that the client's defences are not reinforced.
Grade the challenge. Experiments should be completable: neither so easy that they are pointless nor so hard that they force the client.
Do not force pain. Pushing clients into feelings they are not ready for is counterproductive and can harden them emotionally.
Accept all emotions, not all acts. Accept every emotion as part of accepting the person, while teaching safe and socially congruent expression.
Emotions are guides, not infallible. Distinguish authentic emotions from parasitic (substitute) ones.
Use your own reactions diagnostically. Treat your emotional and kinaesthetic responses as data, and know when you soften an intervention out of tact and when out of your own avoidance.
Real relationship over transference. Gently discourage the fantasised relationship and return to the real present one; offer a secure base (Bowlby).
Authenticity and self-disclosure. Share your perception when it adds something new, for example noticing a smile while the client tells something sad. Your own therapy is expected.
Ethical values and meaning matter. Values (the authors list 22) and the client's worldview (atheist, agnostic or religious) are legitimate therapeutic material.
Change the therapist too. If the work is not enriching you, review your practice.

4. Intervention inventory

This inventory lists the procedures named in the PIH texts. The manuals' full catalogue of 102 problems and their specific resources (and the 2020 Baúl de recursos) are not drawn on here, so this list is complete only for what those texts describe [uncertain]. Steps are paraphrased. Where a source names a technique without giving its procedure, the steps follow the originating model's standard form and are tagged [synthesis].

A. Process and assessment procedures

4.1 Pre-therapy questionnaire, first interview and demand clarification

Purpose: Gather a whole-person picture and set a demand-led goal before choosing techniques [source: Siete casos TOC and introduction; Gimeno-Bayón 2017].
Steps:
1. Have the client complete the Cuestionario Básico (the authors' own questionnaire, reproduced in the 2018 casebook; not reproduced here).
2. In the first interview, explore four areas: the client's implicit theory of the symptom and of therapy; their life stage and existential project; any existential vacuum; and their temperament, motivations, history and environmental expectations.
3. Note behaviour observed directly in the room.
4. Write a provisional demand in the client's own terms.
5. Draft three-axis hypotheses (DSM, TA script, PIH cycle location) and invite the client's own intuitive self-diagnosis.
6. Over the first sessions, redefine and prioritise the demand and break it into partial goals.
Example language (illustrative): "What would need to be different for you to say coming here was worth it?" "What's your own sense of where things get stuck?"
Watch for: A demand that is really someone else's. A goal that changes with each crisis (see Detours in §2). Note that "chicken soup" support (Muriel James's term for early sustaining gestures) may be all the client can use at first.

4.2 Locating the problem in the 13-phase cycle

Purpose: Find where the life-flow stops and whether the problem there is a block, a dispersion or a distortion, so that the intervention fits the problem's form [source: Gimeno-Bayón c.2004; 2017].
Steps:
1. Take a concrete recent episode of the problem.
2. Walk the client slowly through the episode: what they sensed, what they attended to, what they thought and felt, how they valued it, whether they decided, mobilised, planned and acted, whether contact with the other happened, whether it was consummated, and whether they let go and rested.
3. Mark the first phase where the flow breaks, and classify the break:
  - block: the phase is absent, for example forbidden emotions;
  - dispersion: competing contents, for example ambivalent emotions;
  - distortion: the content is wrong or displaced, for example somatisation, projecting an unfinished past situation onto the present, loss of control, or a parasitic emotion that substitutes for a forbidden one.
4. Start work at the most basic broken phase.
Example language (illustrative): "Let's slow that moment right down. Just before you walked away, what did you notice in your body?"
Watch for: Phases 3 and 4 (cognitive and affective identification) occur in either order for different people. Note also the authors' own examples of learned substitution patterns: fear standing in for anger in some women, anger standing in for fear in some men.

4.3 Choosing the entry door (Ware)

Purpose: Enter through the subsystem the client can access so that defences are not reinforced [source: Gimeno-Bayón 2017].
Steps:
1. Identify the personality style.
2. Start with its open door, then work the target subsystem, then approach the blocked one. The article's examples:
  - schizoid: behaviour → thinking → feeling;
  - antisocial: behaviour → feeling → thinking;
  - paranoid: thinking → feeling → behaviour;
  - hysteric (histrionic): feeling → thinking → behaviour;
  - obsessive: thinking → feeling → behaviour;
  - passive-aggressive: behaviour → feeling → thinking.
Example language (illustrative), with an obsessive client: "What's your thinking about it?" Then, later: "And as you say that, what's there in terms of feeling?"
Watch for: Intellectualising, flooding or shutting down are signs you entered by the wrong door.

4.4 Choosing the route by the four causes

Purpose: Pick the most potent route by asking what the distress is made of, who authors it, how it is maintained, and what it is for (after Rychlak). Weigh the choice against Paul's matrix of treatment × therapist × client × problem [source: Gimeno-Bayón 2017].
Steps: Ask four questions.
- Material: Is the distress held in the body, in muscular armour or a felt sense? If so, use psychocorporal work or Focusing (4.21, 4.33).
- Efficient: Is the client positioned as a victim of others? If so, use the responsibility sequence (4.34).
- Formal: Where in the cycle does the client get stuck? If so, use cycle-specific work (4.2, 4.36).
- Final: What purpose does the symptom serve? If so, use permissions work (4.35), dialogue with the symptom, or the play and project fantasies.
Watch for: Prefer the route that gives relevant, lasting change in the least time with the least disruption of the client's systems.

4.5 The experiential session (Greenberg structure)

Purpose: Turn an in-session marker into a focused experiment that produces observable in-session change [source: Gimeno-Bayón 2017; 2015; Siete casos TOC].
Steps:
1. Welcome the client and listen empathically to what is present now.
2. Spot a marker, such as a split, a symptom, a stuck feeling or an unfinished situation.
3. Propose an experiment and get the client's agreement.
4. Guide the client's performance of the experiment.
5. Note the in-session change.
6. Close with a brief cognitive review of what happened, which fixes the change and gives it credibility and direction.
Example language (illustrative): "I'd like to propose an experiment. You can stop at any point. Shall we try?"
Watch for: Not every session is experiential; supportive and planning sessions are legitimate. The 2015 and 2018 case analyses use this four-step frame to record change events.

4.6 Graduated experiments (Zinker)

Purpose: Adjust any exercise up or down in difficulty so that the client can complete it [source: c.2004].
Steps:
1. Propose the experiment at an estimated level.
2. If the client sabotages it or complies hollowly, grade it down: imagine instead of enact, write instead of speak, address an object instead of an imagined person.
3. If it is too easy, grade it up toward more disturbing material.
4. Insert protective intermediate steps where needed.
Example language (illustrative): "Speaking to her directly may be too much today. Would writing to her feel more possible?"
Watch for: The goal is completion without submission or sabotage.

B. Awareness and emotional-perception techniques (cycle phases 1–4)

4.7 Exaggeration of gesture and movement (Levitsky and Perls)

Purpose: Bring out the meaning or target of a small involuntary movement when the client is stuck at the level of sensation [source: c.2004].
Steps:
1. Point out the movement, such as a tapping foot or a clenching hand.
2. Ask the client to keep doing it and make it bigger, breathing more deeply.
3. Ask what the movement wants or who it is aimed at.
4. Let the emerging emotion take words or sound.
Example language (illustrative): "Your hand keeps closing. Let it close a little more, and breathe. What does it want to do?"
Watch for: It is working if an emotion or intention surfaces. If the client feels mocked, the timing was wrong.

4.8 Confronting verbal–nonverbal incongruence

Purpose: Expose an internal split or a lack of full commitment [source: c.2004; 2017 Experiencia].
Steps:
1. Describe the mismatch neutrally, as your own perception (self-disclosure), for example a smile while recounting something sad.
2. Ask what each side, the words and the body, is saying.
3. If a split emerges, move to Gestalt dialogue between the two sides (4.15, 4.17).
Example language (illustrative): "I notice you're smiling as you tell me this, and it moves me. What's the smile about?"
Watch for: Deliver this as curiosity, not as catching the client out.

4.9 Perls's five questions

Purpose: Heighten present awareness; also used inside the sculpting exercise (4.14) [source: c.2004; 2017 Experiencia].
Steps: Ask, one at a time and in your own words:
1. What are you doing?
2. What are you feeling?
3. What would you wish to happen?
4. What do you expect will happen?
5. What are you avoiding?
Example language (illustrative): "Right now, what are you doing with your shoulders? … And what are you avoiding?"
Watch for: Answers that are explanations rather than descriptions. Bring the client back to present experience.

4.10 Continuum of awareness and the concentration (raisin or apple) exercise

Purpose: Train graded attention to ongoing experience. The concentration exercise uses slow, full attention to a simple experience such as eating, after Perls (1947, which used an apple) and linked by the authors to mindfulness [source: 2017 Experiencia]. The steps below are not detailed in the source text [synthesis].
Steps:
- Continuum: the client reports moment by moment what they are aware of ("now I am aware of…"), and you gently return them from interpretation to awareness.
- Concentration: the client explores a raisin or apple by sight, touch, smell and taste, eats it slowly, and then reflects on how their way of eating mirrors their personal style.
Example language (illustrative): "Just keep saying 'now I notice…' and let it change as it changes."
Watch for: Habits of rushing, judging or skipping steps. These are useful material about the client's style.

4.11 Emotional self-observation schema (Gimeno-Bayón, 1996)

Purpose: Psychoeducation followed by daily bodily self-observation, for clients cut off from their bodies, such as obsessive or schizoid clients [source: c.2004].
Steps:
1. Give a written explanation of the basic emotions, what typically triggers each, and their healthy forms (the author's schema; paraphrase it in your own handout).
2. As homework, the client notes bodily responses in daily situations and labels them.
3. Review the notes in session.
Example language (illustrative): "This week, just notice what your body does when something matters to you, and jot down what you think the emotion was."
Watch for: Over time, labels should get more precise and differentiated.

4.12 Group nonverbal-feedback exercises

Purpose: Increase awareness of the emotion the client transmits, in a group setting [source: c.2004].
Steps:
- T-shirt game (juego de la camiseta): Each member walks in front of the group. The group agrees on the message conveyed by the member's posture and writes it on the front and back of a drawn T-shirt. The member then receives it and discusses it.
- Hearing one's voice (Stevens): In pairs, partners listen to each other's tone, volume, rhythm and intonation and name the emotion underneath.
- Pass a mask (Stevens): Members make exaggerated facial "masks" with sounds, interact without words, then name the emotions the masks conveyed.
Example language (illustrative): "Write only what his posture tells you, not what you know about him."
Watch for: Feedback that becomes attack. Hold the group's right to non-destructive expression.

4.13 Teaching parasitic (racket) emotions (TA)

Purpose: Cognitive teaching that helps the client distinguish authentic emotions from learned substitutes that cover forbidden emotions and are often used manipulatively [source: c.2004].
Steps:
1. Explain the concept with neutral examples.
2. Explore with the client which emotion was forbidden in their family and which emotion was rewarded instead.
3. Track the substitute emotion in recent episodes.
4. Work on the hidden need behind it (4.15, 4.32).
Example language (illustrative): "When you get sad in these moments, I wonder whether something else is underneath that wasn't allowed at home."
Watch for: Shame at being "caught". Frame the parasitic emotion as an old solution that once made sense.

4.14 Sculpting my emotions (Esculpiendo mis emociones, Gimeno 1985)

Purpose: A group exercise for appropriate expression, especially of anger [source: c.2004].
Steps:
1. Lying down, members recall a recent emotionally charged situation and watch it like a film.
2. They re-enter the situation bodily and notice what changes in the body.
3. They stand and shape the emotion into a body sculpture, while you put the five questions (4.9) to them.
4. They look at others' sculptures and notice which attract and which repel them. They try on the most attractive and the most repellent postures, with the same questions.
5. They form a final sculpture and add sound and then words. They interact with others, then look for wordless ways to obtain what the emotion needs.
6. The exercise ends with group feedback.
Example language (illustrative): "Let your body take the shape of that anger. Exaggerate it. What are you doing right now?"
Watch for: Discharge that becomes destructive. Keep expression symbolic and safe.

C. Dialogue and integration techniques

4.15 Gestalt dialogue with a significant other (empty chair)

Purpose: Express an unexpressed feeling toward someone and test how well that expression fits; also used to understand the other person's side in relationship problems [source: c.2004; 2015].
Steps:
1. The client imagines the person in front of them.
2. The client tries out different ways of expressing the feeling.
3. The client switches seats to become the other person, answers from there, and judges how the expression landed.
4. Continue alternating until something shifts.
5. In a group, members can take turns playing the other. If the client cannot empathise with the other, you may play the role yourself.
6. For relationship problems, start with the interaction itself, then move to the feelings underneath.
Example language (illustrative): "Tell her directly, as if she were here." … "Now come over here and be her. What happens in you as you hear that?"
Watch for: Role-play can carry projection. Pair it with empathic-listening training (4.43). Signs it is working: softening, new understanding of the other, or a clear and freed statement.

4.16 Dialogue with the symptom (Levitsky and Perls)

Purpose: Uncover the hidden emotion and the present function, or positive intention, of a bodily or psychological symptom. It serves the "final cause" route [source: c.2004; 2017; 2015].
Steps:
1. The client locates the symptom, such as a headache or stomach tension, and describes it in detail.
2. The client gives the symptom a voice and speaks as it ("I am your headache; I…").
3. The client answers it from their own position.
4. Alternate until the symptom's intention or need is clear.
5. Negotiate a healthier way to meet that intention.
Example language (illustrative): "Be the tightness for a moment. What are you doing for her?"
Watch for: A shift from fighting the symptom to understanding it, and a reduction in its intensity during the session. With somatic symptoms, rule out medical causes first [synthesis].

4.17 Two-cushion dialogue between conflicting emotions

Purpose: Resolve emotional dispersion, that is, ambivalence or agitation produced by two competing emotions [source: c.2004; 2017].
Steps:
1. Assign each emotion its own cushion.
2. The client sits on one cushion and speaks as that emotion to the other.
3. The client switches cushions and replies.
4. Continue until the two emotions understand each other or reconcile.
Example language (illustrative): "From the fear's cushion, tell the anger what you're worried it will do."
Watch for: One side may dominate. Slow the dialogue down and give voice to the weaker side.

4.18 Integration of conflicting emotions (NLP, Andreas and Andreas)

Purpose: An imaginal and kinaesthetic alternative to 4.17 [source: c.2004].
Steps:
1. The client places one emotion in each hand and visualises it.
2. The client finds each emotion's positive intention and thanks each part.
3. The two parts dialogue with each other.
4. The hands slowly come together and the result is integrated, with a gesture toward the chest.
Example language (illustrative): "What is this part trying to do for you? … Let the hands come together only as fast as feels right."
Watch for: Rushing the hands together before the parts feel heard.

4.19 Synthesis of opposites (Psychosynthesis, Ferrucci)

Purpose: Integrate polar emotions through drawing [source: c.2004].
Steps:
1. The client draws each polar emotion on opposite sides of a sheet.
2. On further sheets, the client draws how the two emotions interact and change, until they fuse.
3. Put the process into words and link it to daily life.
Example language (illustrative): "Don't plan the next drawing; let your hand show what happens between them."
Watch for: A final image that is a forced compromise rather than a felt fusion.

4.20 Staying with the sensation and process questions

Purpose: Help the client tolerate ambiguity rather than rushing into discharge or explanation, so that complex feelings can unfold [source: c.2004].
Steps:
1. Keep the client's attention on the bodily sensation.
2. Move back and forth between sensation, naming it, and the movement it invites.
3. Use questions of this type (paraphrased from the article): If the sensation had a voice, what would it say? Where is it inviting you to go? What emotion is it?
Example language (illustrative): "No need to know yet. Stay with it a moment longer."
Watch for: Rationalising, verbal flooding, agitation or mutism. These are defences against emotion that has not yet surfaced.

4.21 Focusing (Gendlin)

Purpose: Contact the bodily felt sense. Uses include judging the client's readiness for a theme, finding an aspect that abstract thinking has missed, and "clearing a space" to separate the self from problems before imagery work [source: c.2004; 2015; 2017].
Steps: Follow the six steps as listed by Gimeno-Bayón (2017), using Gendlin's procedure:
1. Clear a space: set each concern down at a distance.
2. Felt sense: let a whole-body sense of one concern form.
3. Handle: find a word or image that fits it.
4. Resonate: check the handle against the felt sense.
5. Ask: ask the felt sense what it needs or what is the worst of it.
6. Receive: welcome whatever shift comes.
Example language (illustrative): "Let's put each worry down beside you for now … Now, which one asks for attention? What's the feel of the whole of it in your body?"
Watch for: A bodily felt shift, such as a breath or a release, is the sign it is working.

D. Imagery (fantasy) work

4.22 Guided fantasy: general method

Purpose: Evoke or reorganise emotion and meaning through imagery. Imagery integrates image, bodily reaction and meaning (after Ahsen), and these multifactorial methods induce emotion most strongly [source: 2015; c.2004].
Steps:
1. Prepare the client: lying down or seated, with dim light and slow relaxation, and if needed clearing a space first.
2. Use a slow, warm voice and rich sensory detail.
3. Have the client breathe consciously while holding the image; this deepens involvement.
4. Use NLP submodalities (size, colour, distance, volume) to turn the vividness down for overwhelming images or up for flat ones. Time lines can be used to order past, present and future spatially.
5. Let the client choose the content of the symbols; do not supply symbol meanings, as rigid use of Desoille's guided daydream would.
6. Return the client slowly to the room.
7. Process the experience by asking the client what it meant to them. Do not interpret the images for them.
Example language (illustrative): "Notice what's on the path; it's yours to discover … If the image is too close, you can let it move further away."
Watch for: Obsessive clients may disdain or struggle with fantasy. Give them time, help them relearn imagery, and support tolerance of ambiguity. Downward movement in a fantasy tends toward low mood or anxiety, upward movement toward energy (Desoille, as cited).

4.23 Releasing past burdens (case illustration, 2015)

Purpose: For a client who confuses past and present feelings. This is an individual fantasy reported in a single case of generalised anxiety, not a standard protocol [source: 2015].
Steps (as described in the case):
1. The client lies down relaxed in a dim room and imagines climbing a mountain path carrying a backpack of past burdens.
2. The client lays out the symbolic objects, discards some and keeps others.
3. The client reaches a viewpoint, accompanied by a significant person, and watches the sunset.
4. Process the experience afterwards.
Example language (illustrative): "Take each object out and decide what you still need to carry."
Watch for: Afterwards the client should stop mixing past feelings with present concerns, as happened in the reported case.

4.24 Encounter and walk with an ideal Nurturing Parent

Purpose: Intensify and provide reparative nurturing emotion. The fantasy text is in the 2016 manual's appendix, which is not drawn on here [source: c.2004; edesclee preview TOC; uncertain].
Steps:
1. After relaxation, the client meets an ideal caring parent figure and walks with them.
2. The client receives what was missing.
3. Debrief. Detailed steps are [synthesis].
Example language (illustrative): "Let this figure be exactly the parent you needed. What do they say to you?"
Watch for: Grief may surface at the contrast with the client's real parents. Allow it.

4.25 Saying goodbye to the past (Despidiéndose del pasado)

Purpose: Emotional closure of a past stage or situation [source: c.2004]. The steps are not given in the source text [uncertain; synthesis].
Steps:
1. The client revisits a scene from the past stage.
2. The client says what remained unsaid.
3. The client says goodbye and turns toward the present.
Example language (illustrative): "What do you need to say before you leave this place?"
Watch for: Premature goodbyes that skip anger or sorrow.

4.26 The worst day of childhood (McNeel, TA)

Purpose: Intensify emotion linked to early script decisions, as preparation for redecision [source: c.2004]. The procedure is not detailed in the source text [uncertain].
Steps:
1. The client evokes the scene in the first person and present tense.
2. The client identifies the feeling and the conclusion drawn about self or life.
3. Move to the adult and nurturing resources (4.39) [synthesis].
Example language (illustrative): "You're six, it's that day. Where are you? What do you decide about yourself right then?"
Watch for: Traumatic material. Grade down (4.6) and check that the client is stable before using it (see §5).

4.27 The Project fantasy (Psychosynthesis, Ferrucci)

Purpose: Evoke hope and motivation, and clarify the life project and the purpose of change (final cause) [source: c.2004; 2017].
Steps:
1. The client imagines a future achievement in sensory detail.
2. The client notices the emotion and the steps that led there.
3. The client brings one step back to the present [synthesis].
Example language (illustrative): "Picture the day this is accomplished. Where are you, who is with you, what do you feel?"
Watch for: Fantasies that are grandiose or set by others' expectations.

4.28 Fantasy of the play of one's life, with epitaph (Berne)

Purpose: Reveal the life script as a play with characters, roles and an ending [source: 2017; 2017 Experiencia; 2015].
Steps:
1. The client imagines their life as a play: its title, characters and acts, and how the last act ends.
2. Analyse the epitaph the client would write for themselves and the one others would write.
3. Contrast the scripted ending with the ending the client wants.
Example language (illustrative): "If your life were a play, what would it be called, and how does the final act end?"
Watch for: Bleak endings point to script themes to explore. Assess suicide risk if the ending involves death or despair (see §5).

4.29 Favourite childhood tale (Karpman), animal story and character archetypes

Purpose: Access the dominant life narrative through an early story, an invented animal story, or the archetypal characters the client identifies with [source: 2017 Experiencia; 2015].
Steps:
1. The client recounts the favourite tale or invents an animal story.
2. The client identifies the character they relate to and that character's role.
3. Explore the parallels with their own life roles and relationships, without interpreting for them.
Example language (illustrative): "Which character were you drawn to? What happens to them?"
Watch for: Drama-triangle roles (persecutor, rescuer, victim) [synthesis from TA].

E. Cognitive-emotional regulation

4.30 Life positions and the "Five windows for viewing life"

Purpose: Break emotional and cognitive rigidity by teaching the client to tell a euphoric stance, a depressive stance and a realistic stance apart [source: c.2004]. The five-window tool comes from Gimeno-Bayón and Rosal (2002); its content is not drawn on here [uncertain].
Steps:
1. Teach the TA life positions.
2. Take one situation the client brings and look at it from each stance in turn.
3. Help the client choose the realistic view [synthesis].
Example language (illustrative): "Let's look at the same situation through a different window. What would a realistic view see?"
Watch for: The realistic view is not forced positivity.

4.31 Strokes and the stroke profile (cariciograma, TA)

Purpose: Create or intensify emotion through attention to thought, and monitor the client's daily pattern of giving, receiving, asking for and refusing recognition ("strokes") [source: c.2004].
Steps:
1. The client charts their strokes over a period.
2. Identify the patterns.
3. Set small experiments, such as accepting a compliment or asking for recognition.
Example language (illustrative): "This week, notice each time someone recognises you, and what you do with it."
Watch for: Discounting of positive strokes.

4.32 Working with a parasitic or favourite unpleasant feeling

Purpose: Use this when the client clings to an unpleasant feeling, for example from a "victim" role in the life script [source: c.2004].
Steps:
1. Analyse what the feeling does for the client.
2. Name it as parasitic.
3. Find the hidden need behind it, using symptom dialogue, bodily work, psychodrama of the originating scene or TA game analysis.
4. Hold a farewell ritual with the feeling, such as Gestalt grieving or drawings.
5. Protect the client's sense of identity while a new, wider self consolidates.
Example language (illustrative): "This feeling has been with you a long time. Before you let it go, what would you like to thank it for?"
Watch for: Strangeness or loss of identity after letting the feeling go. This is expected; support the client through it.

4.33 Body-oriented work and symbolic discharge

Purpose: Release emotion held in the body and work on the material cause [source: c.2004; 2017].
Methods: Bioenergetics (Lowen): unblocking muscular armour, work on voice and throat, grounding. Biosynthesis is also used.
Steps:
1. Check consent and physical safety.
2. Offer safe symbolic discharge, such as crying, shouting, or striking a cushion.
3. Teach when such expression is safe and when it is destructive.
4. Integrate verbally afterwards.
Example language (illustrative): "You can let that out into the cushion. Your voice too, if it wants."
Watch for: Re-traumatisation, dissociation and medical contraindications [synthesis]. For emotion that is not yet overwhelming, prefer gentler, more cognitive work that dilutes its intensity.

F. Responsibility, script and existential work

4.34 From victim to author: the efficient-cause sequence (after Erskine)

Purpose: Move the client from blaming life or parents to ownership and power [source: 2017].
Steps: Follow the five steps in order:
1. Helpless victim: acknowledge the client's position of blaming life.
2. Rage to sadness: allow rage at the parents to turn into sadness over unmet childhood needs.
3. Own choice: help the client recognise that they themselves reacted and chose.
4. Responsibility and power: the client assumes responsibility and moves from passive to active.
5. Farewell to the parents: a symbolic goodbye, with forgiving and asking for forgiveness.
Example language (illustrative): "You were a child and it wasn't your fault. And as an adult, what do you choose to do with it now?"
Watch for: Rushing step 3 shames the client. Forgiveness is never demanded; one casebook chapter is titled after a client's own wish to forgive her mother.

4.35 Permissions ladder (after Allen and Allen)

Purpose: Address the final cause by working on the lowest missing internal permission [source: 2017].
Steps:
1. Assess which permission is missing, in ascending order: to exist; to have one's own sensations; to feel; to think; to be close and in contact; to be oneself; to be one's own age; to live a meaningful life.
2. Start at the lowest missing rung.
3. Use imagery, nurturing fantasy (4.24) or redecision (4.39) to grant and internalise it.
Example language (illustrative): "It seems you never quite got permission to feel. What would it be like to have it?"
Watch for: If the permission to exist is missing, assess suicide risk (§5).

4.36 Valuation and decision work (cycle phases 5–6)

Purpose: Address distorted valuation by working on moral conscience (drawing on Kohlberg, Gilligan and neuroethics), and blocked decision by working toward lucid, free and responsible decision-making. These are the model's distinctive phases [source: 2017; Siete casos introduction]. The detailed procedures are in the 2017 manual, which is not drawn on here [uncertain].
Steps [synthesis]:
1. Make the values at stake explicit.
2. Explore their origin: introjected or chosen.
3. Check the competing values against the client's own ethical framework and worldview.
4. Have the client voice the decision in the first person, along with what it costs.
Example language (illustrative): "Whose voice says this matters? Do you agree with it?"
Watch for: Imposing your own values. Make values explicit without prescribing them.

4.37 Graduated grief sequence

Purpose: Approach avoided grief through protective steps [source: c.2004].
Steps:
1. Visualise the deceased, using a photo or object.
2. The client writes an unsent letter.
3. The client imagines the reply and writes it from the other's perspective.
4. The client reads both letters aloud.
5. Move to direct dialogue (4.15).
Example language (illustrative): "Write what you didn't get to say. Then let him answer, in his words."
Watch for: Stop at the step the client can complete; resume later.

4.38 Working through the layers of neurosis (Perls)

Purpose: Accompany the client through the phobic layer and the impasse into pain and then the "explosion" of vitality. This can take one session or years [source: 2017].
Steps:
1. Notice when avoidance or feeling stuck appears.
2. Stay with the impasse rather than rescuing the client.
3. Support contact with the pain beneath it.
4. Welcome the emerging energy.
Example language (illustrative): "This is the place you usually turn back. Can we stay here together a moment?"
Watch for: Holding the impasse is not forcing the client (see the principles in §3).

4.39 Redecision (Goulding) and self-reparenting (James)

Purpose: Revise script decisions made in childhood, and build an inner nurturing parent figure [source: 2017 Experiencia]. The steps are not given in the source texts [uncertain; synthesis from TA].
Steps:
1. Re-enter an early scene.
2. Identify the early decision.
3. From present resources, make a new decision in the scene.
4. For self-reparenting, have the client design and practise the caring inner parent figure.
Example language (illustrative): "Back then you decided it was safer not to need anyone. What do you decide now?"
Watch for: Redecisions that are compliance with the therapist.

4.40 Psychodrama of scenes

Purpose: Dramatise memories or traumatic scenes to reach the needs hidden behind parasitic emotions [source: c.2004; 2015]. The procedure is not detailed in the source texts [uncertain].
Steps [synthesis]:
1. Set the scene.
2. Cast roles (group members, or chairs in individual work).
3. Enact the scene.
4. Role-reverse.
5. Share.
Watch for: Overwhelm. Use the grading in 4.6.

4.41 Existential meaning, values and transpersonal work

Purpose: Work on meaning, self-transcendence and the life project, drawing on Frankl's logotherapy (including his distinction between psychogenic and noogenic neurosis) and Assagioli's personal and transpersonal psychosynthesis. Make explicit the ethical values present in the therapy room [source: 2017 Experiencia; 2017; Gimeno-Bayón 2020 editorial].
Steps [synthesis]:
1. Explore the client's existential vacuum and what matters to them.
2. Identify their values and worldview.
3. Link the therapy goals to the life project.
Example language (illustrative): "What would make this stretch of your life worth living, by your own measure?"
Watch for: Respect the client's worldview, whether atheist, agnostic or religious.

G. Group and relational procedures

4.42 Enactment and feedback in the group

Purpose: Members act out and examine their interactions in the group itself rather than only describing them; feedback shows each member how others perceive them and detects parasitic or suppressed emotions (after Schutz and Rogers) [source: 2017 Experiencia; c.2004].
Example language (illustrative): "Rather than tell us about it, show us. Who here reminds you of him?"
Watch for: Hold both the client's right to express and the group's right to non-destructive expression.

4.43 Empathic-listening training

Purpose: For clients who have difficulty reading others' emotions; used as a counterweight to role-play, which can produce projection [source: c.2004].
Steps [synthesis]:
1. The client reflects the other's feeling.
2. The client checks the reflection with the other person.
3. The client adjusts it.

4.44 Intensifying emotion (multifactorial induction)

Purpose: Use when emotion is flat or the client functions at low levels of emotional awareness (Lane and Schwartz): combine several channels, such as gesture exaggeration, breathwork, guided fantasy of an intense past or future moment, voice, dim light, sensory detail, photos, objects and drawings [source: c.2004].
Watch for: Work at the client's usual level first, then climb. Add higher levels when lower ones are insufficient or the problem is urgent.

4.45 Termination (after Tudor)

Purpose: End therapy in a way that consolidates gains [source: 2017].
Steps:
1. Recall the agreed end and its link to the goals.
2. Accept the feelings about ending and handle unfinished themes.
3. Confront tricks for prolonging therapy.
4. Keep contact available so that beliefs about abandonment are not confirmed.
5. Consolidate gains in the life project and revisit the original demand.
6. Affirm the achievements.
7. Say goodbye, possibly with a physical gesture and a symbolic gift.
Example language (illustrative): "Looking back at what you came with, what has changed, and what will you take with you?"
Watch for: Signs of a good ending: the client values the achievements and leaves autonomously. In the 2015 case, therapy ended early by mutual agreement, with a booster session available.

5. Handling problems

The sources used address resistance mainly through the emotion-work article (c.2004) and the process article (2017). Items marked [synthesis] are my own guidance and are not found in PIH texts.

Defences in session (verbal flooding, agitation, extreme mutism, rationalising).
- Read these as emotion that has not yet surfaced, not as opposition.
- Respond by slowing down, returning to sensation (4.20), and checking whether you entered through the wrong door (4.3) [source: c.2004; 2017].
Client avoids unpleasant feelings.
- Grade the work down (4.6) and add protective intermediate steps (4.37).
- Aim for completion without either sabotage or submission [source: c.2004].
Forcing and overwhelm.
- The authors warn that pushing clients into pain before they are ready is counterproductive cruelty. Over long periods, especially in groups, it can harden clients emotionally.
- If a client is overwhelmed: stop the experiment; reduce submodality vividness (move the image further away, make it smaller, turn the sound down); move to gentler, more cognitive work that dilutes the intensity; ground the client in the room [source: c.2004; 2015].
- For people with trauma, dissociation, psychosis or severe personality pathology, assess stability before using regressive fantasies (4.26), body discharge (4.33) or psychodrama. Prefer supportive, interaction-level work first, following James's surface-to-depth order [synthesis; consistent with 2017].
The surprise factor. Some Gestalt experiments confront clients with frightening aspects of themselves. Time them so the client does not withdraw or defend, and announce the experiment and get consent first (4.5) [source: c.2004].
Therapist avoidance. Ask yourself whether you are softening an intervention out of sensitivity to the client or out of your own fear of unpleasant feelings. Take this to supervision or your own therapy [source: c.2004; 2017 Experiencia].
Stuck or plateaued process.
- Re-locate the break in the cycle (4.2). The problem may sit at a more basic phase than you assumed.
- Re-examine the route by the four causes (4.4) and the door (4.3).
- Redefine or reprioritise the demand [source: 2017].
- At a genuine impasse, stay with it rather than rescue (4.38).
Emergencies and detours. Pause the central theme for bereavement, job loss, illness or a sudden concentrated motivation, then return to it explicitly [source: 2017].
Imagery resistance (obsessive clients). Give the client time to accept the method, help them relearn imagery, and support tolerance of ambiguity. Alternatively, enter through thinking and use drawing or writing instead [source: 2015].
Loss of identity after change. When a long-held unpleasant feeling is dropped, protect the client's sense of self and normalise the strangeness (4.32) [source: c.2004].
Transference intensity. Gently discourage the fantasised relationship and return to the real present relationship; offer a secure base [source: Siete casos introduction].
Ruptures (alliance strain, the client feeling pushed or misunderstood). Not specifically addressed in the sources used [uncertain]. Suggested responses [synthesis]:
- Name what you noticed using your own perception (self-disclosure is consistent with PIH).
- Own your part.
- Return to Rogerian acceptance and to the client's demand.
- Re-contract any experiment the client experienced as imposed.
- The principle that the medium is the message means a coercive repair would repeat the problem.
Non-adherence with between-session tasks (self-observation, stroke chart, letters) [synthesis]:
- Treat non-completion as information about the cycle; for example, a block at mobilisation or planning (phases 7–8) or a parasitic compliance pattern.
- Shrink the task.
- Let the client design it.
Clinging to therapy at the end. Confront tricks for prolonging therapy while keeping contact available (4.45) [source: 2017].
Suicide and self-harm. Not addressed in the source texts [uncertain]. Suggested practice [synthesis]:
- When a missing permission to exist (4.35), a death-ending life play (4.28) or a despairing epitaph emerges, carry out a standard structured risk assessment: ideation, intent, plan, history, protective factors.
- Make a collaborative safety plan, and use lethal-means counselling focused on safe storage or removal.
- Pause deep regressive or script work until the client is stable.
- Liaise with medical or crisis services as local protocols require.
Values conflicts and worldview. Because PIH makes ethical values explicit, guard against imposing your own values. Work within the client's worldview, whether atheist, agnostic or religious [source: Siete casos introduction; synthesis].
Group-specific difficulties. Protect members from destructive feedback and from enactment that escalates into aggression. Discharge must be symbolic and safe (cushion, not person) [source: c.2004].

Sources

Sources: