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by Sheldon Litt, Ph.D.(more info)

listed in headaches, originally published in issue 41 - June 1999

I have seen numerous patients with headaches during the past thirty years, and many of them can actually be helped in a relatively short time with a method that appears simple but has the elegant requirement that the person take an active part in the treatment.

Now as we all know, most people prefer to remain passive and allow the practitioner to do his magic, awaiting a miraculous improvement, but unfortunately, life is not always so easy.

Most people prefer, of course, to simply pop a pill, aspirin, or one of the wide collection of modern pain-killers. They hope for an instant cure. It may work, and again may not. I have also heard about massage therapists who can alleviate the pain of a chilling headache, and both acupuncture and acupressure have their adherents. Methods abound, some more complicated and expensive than others. I am sure there are several esoteric approaches to this symptom that have not yet reached my ears. But one must keep in mind that various treatments have side-effects in addition to the cost factor. Others only seem to help at certain times in certain places. Certainly it is a field fraught with confusion and mystery.

Let me tell you about what Gestalt Therapists do for headaches. I learned this from Fritz Perls, and have often seen it utilised in Group Therapy. It also effective in an individual psychotherapy setting. In my experience it is successful in about 80-90% of the cases, depending on the patient's co-operation and skill in concentration.

First, a word of caution. It is always a good idea when a patient comes in complaining about chronic headaches, to suggest a medical examination. One can never forget the case of American composer George Gershwin who died in his late 30s from a brain tumour. He had been suffering from severe headaches, but at the time it was the trend to visit a psychoanalyst for such problems. His tumour was overlooked in the search for unconscious memories, and 20th century American music lost one of its major figures.

That caveat noted, the next step is to ask the person to pay attention to the headache. (Instead of what is more usual, trying to flee from it.) No, the idea is to concentrate on it, welcome it, I say to them, learn as much as you can about it; it is your headache, experience it and feel it.

The core of the experiment then is to experience the headache as your headache; it is not happening to you, take responsibility for it. So instead of a passive role, greet it and see what is there for you.

Now, this seems an unusual request, to concentrate on the very thing you are trying to avoid so desperately. But this is the fundamental approach which can ultimately solve the headache – a phenomenological mapping of the headache experience. Learn to feel it and experience it in every way.

I ask for a complete experiential description of the headache. Focus on the various dimensions of it – the shape and location of the headache, for example; which side of the head is it on? is it sharp or diffuse? constant or pulsating? size? colour? The boundary between the headache area and the healthy domain surrounding it, etc.. All of these must be minutely concentrated on. (Perls originally planned to call his new therapeutic 'concentration therapy' since a key concept was that bringing greater awareness to whatever on is experiencing results in increased freedom and self actualisation.)

You may be surprised to find, for instance, that after a few seconds of total concentration on the physical dimensions of the headache, that it begins to move. Does it shift to left or right? Up or down? Just be aware of this new development and follow it with an interest wherever it moves. Here we see some confirmation that the headache is under a certain amount of self-induced tension.

This in itself will bring a greater sense of individual responsibility and freedom: it is my headache, I have some control over it.

For Perls, headaches and other psychosomatic symptoms are caused by tensing one's muscles against some impulse. If you turn your awareness on your headache, you may soon discover that you yourself are causing it by squeezing your head. Sometimes you can test this for yourself by making it first more tense, then you feel the headache becoming worse. But remember, if you can go one way, you can also go the other way; so if you have enough control over it to increase the pain, you can most likely go in the other direction to decrease the problem.

The general term for this sort of holding back and punishing oneself is called Retroflection in gestalt therapy. Instead of, for example, giving aggression to your boss or your mother-in-law, you hold it back and turn it against yourself. Voilà, a headache.

To give a concrete example of the undoing of a common headache, here's a brief case study of a man in his 40s who has had intermittent headaches for many years. During one session when he experiences his usual headache, we begin to work on it following the general rule – focus on your headache. It takes a bit of discussion to convince him to try this, but that's all part of the skill of the therapist. Eventually, he agrees to try it for a minute. When asked to describe his headache, he says it is on the left side, intense, a small area, with a diffuse boundary, pulsating slightly. Colour? He'd call it dark red. Asked about motion he now notices it has shifted slightly to the left. Follow it, I request. He now notices it moves further left. Now he realises that there might be something to this little game, he sees that something new is happening! His headache moves! It also changes shape, and the more he concentrates on it, the more diffuse it becomes, until after a few more seconds, it has diminished in intensity. Quite pleased with himself, he breaks off his attention. This is as far as we can go in this session, it is decided. The following week, we continue the process, and the headache is completely banished. He has also tried it out for himself during the week (I often suggest homework assignments and this is a basic one to try) and it has even functioned when he tries it without my guidance.

* In the next issue of Positive Health, we will continue the discussion of headaches.


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About Sheldon Litt, Ph.D.

Dr Sheldon Litt is an American psychologist who trains professionals in modern methods of psychotherapy. He has taught at many universities in northern Europe. He was trained by Fritz Perls at the New York Institute for Gestalt Therapy.S. Litt, Inedalsgatan 25, S-11233 Stockholm, Sweden. Tel: +468 651 2489 Email:

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