Gestalt Therapy

Definition

Gestalt therapy is a humanistic therapy technique that focuses on gaining an awareness of emotions and behaviors in the present rather than in the past. The therapist does not interpret experiences for the patient. Instead, the therapist and patient work together to help the patient understand him/herself. This type of therapy focuses on experiencing the present situation rather than talking about what occurred in the past. Patients are encouraged to become aware of immediate needs, meet them, and let them recede into the background. The well-adjusted person is seen as someone who has a constant flow of needs and is able to satisfy those needs.

Purpose

In Gestalt therapy (from the German word meaning form ), the major goal is self-awareness. Patients work on uncovering and resolving interpersonal issues during therapy. Unresolved issues are unable to fade into the background of consciousness because the needs they represent are never met. In Gestalt therapy, the goal is to discover people connected with a patient's unresolved issues and try to engage those people (or images of those people) in interactions that can lead to a resolution. Gestalt therapy is most useful for patients open to working on self-awareness.

Precautions

The choice of a therapist is crucial. Some people who call themselves "therapists" have limited training in Gestalt therapy. It is important that the therapist be a licensed mental health professional. Additionally, some individuals may not be able to tolerate the intensity of this type of therapy.

Description

Gestalt therapy has developed into a form of therapy that emphasizes medium to large groups, although many Gestalt techniques can be used in one-on-one therapy. Gestalt therapy probably has a greater range of formats than any other therapy technique. It is practiced in individual, couples, and family therapies, as well as in therapy with children.

Ideally, the patient identifies current sensations and emotions, particularly ones that are painful or disruptive. Patients are confronted with their unconscious feelings and needs, and are assisted to accept and assert those repressed parts of themselves.

The most powerful techniques involve role-playing. For example, the patient talks to an empty chair as they imagine that a person associated with an unresolved issue is sitting in the chair. As the patient talks to the "person" in the chair, the patient imagines that the person responds to the expressed feelings. Although this technique may sound artificial and might make some people feel self-conscious, it can be a powerful way to approach buried feelings and gain new insight into them.

Sometimes patients use battacca bats, padded sticks that can be used to hit chairs or sofas. Using a battacca bat can help a patient safely express anger. A patient may also experience a Gestalt therapy marathon, where the participants and one or more facilitators have nonstop group therapy over a weekend. The effects of the intense emotion and the lack of sleep can eliminate many psychological defenses and allow significant progress to be made in a short time. This is true only if the patient has adequate psychological strength for a marathon and is carefully monitored by the therapist.

Preparation

Gestalt therapy begins with the first contact. There is no separate diagnostic or assessment period. Instead, assessment and screening are done as part of the ongoing relationship between patient and therapist. This assessment includes determining the patient's willingness and support for work using Gestalt methods, as well as determining the compatibility between the patient and the therapist. Unfortunately, some "encounter groups" led by poorly trained individuals do not provide adequate pre-therapy screening and assessment.

Aftercare

Sessions are usually held once a week. Frequency of sessions held is based on how long the patient can go between sessions without losing the momentum from the previous session. Patients and therapists discuss when to start sessions, when to stop sessions, and what kind of activities to use during a session. However, the patient is encouraged and required to make choices.

Risks

Disturbed people with severe mental illness may not be suitable candidates for Gestalt therapy. Facilities that provide Gestalt therapy and train Gestalt therapists vary. Since there are no national standards for these Gestalt facilities, there are no set national standards for Gestalt therapy or Gestalt therapists.

Normal results

Scientific documentation on the effectiveness of Gestalt therapy is limited. Evidence suggests that this type of therapy may not be reliably effective.

Abnormal results

This approach can be anti-intellectual and can discount thoughts, thought patterns, and beliefs. In the hands of an ineffective therapist, Gestalt procedures can become a series of mechanical exercises, allowing the therapist as a person to stay hidden. Moreover, there is a potential for the therapist to manipulate the patient with powerful techniques, especially in therapy marathons where fatigue may make a patient vulnerable.

Resources

ORGANIZATIONS

Association for the Advancement of Gestalt Therapy. 400 East 58th St., New York, NY 10022. (212) 486-1581. 〈http://www.aagt.org〉.

Gestalt Therapy

BIBLIOGRAPHY

Gestalt therapy is a therapeutic approach in psychology that helped foster the humanistic theories of the 1950s and 1960s and that was, in turn, influenced by them. In Gestalt philosophy, the patient is seen as having better insight into himself or herself than the therapist does. Thus, the therapist guides the person on a self-directed path to awareness and refrains from interpreting the patient’s behaviors. Awareness comprises recognition of one’s responsibility for choices, self-knowledge, and ability to solve problems.

Its originators, Frederick S. (Fritz) Perls (1893–1970) and Laura Perls (born Lore Posner, 1905–1990), were born in Germany and studied psychology there. They fled Germany during the Nazi regime, moving to South Africa and then to New York City. They were both initially influenced by Sigmund Freud’s psychoanalytic approaches and by Wilhelm Reich’s Orgonomic psychotherapy. Their later ideas on Gestalt therapy broke with the psychoanalytic tradition, moving toward existentialism and, ultimately, humanism.

In New York City the Perls founded the Gestalt Therapy Institute in 1952. Their novel technique in therapy was to face the patient, in contrast to the typical Freudian technique of sitting behind a reclining person. The face-to-face positioning permitted the therapist to direct the patient’s attention to movements, gestures, and postures so the patient could strive to gain a fuller awareness of his or her immediate behaviors and environment. Another well-known approach introduced in Gestalt therapy is the so-called “empty chair technique,” in which a person sits across from and talks to an empty chair, envisioning a significant person (or object) associated with psychological tensions.

By using these techniques, the Perls believed, the patient would be able to gain insight into how thoughts and behaviors are used to deflect attention from important psychological issues and would learn to recognize the presence of issues from the past that affect current behavior. The aim was for the patient to experience feelings, not to gain insight into the reasons for them, as psychoanalysts favored.

In the evolution of their therapy, Laura and Fritz Perls differed in some of their approaches. Laura emphasized more direct, physical contact and movement than Fritz did, and the contact favored by Fritz Perls was more symbolic than physical.

Gestalt therapy took its name from the school of academic psychology called Gestalt psychology. Perls asserted that Gestalt psychology had influenced the development of his ideas, but the Gestaltists claimed that there was no connection between the two. Later scholars suggested a common substrate linking the academic Gestalt psychology of Max Wertheimer (1880–1943), Wolfgang Köhler (1887–1967), and Kurt Koffka (1886–1941) and the Gestalt therapy of the Perls and their collaborators Ralph Hefferline (1910–1974) and Paul Goodman (1911–1972). This commonality involved appreciation of the whole rather than a reductionistic approach to understanding psychological phenomena and behavior.

Gestalt therapy took form in the 1950s and 1960s, when humanism first flourished. The optimistic theory promulgated by the Perls was quite compatible with the ideas of other humanistically oriented psychologists such as Carl Rogers (1902–1987). Its influence has waned since the 1980s, although current therapies have been influenced by the humanistic and optimistic outlook of the theory and by some of the interactive techniques developed by the Perls and their followers.

BIBLIOGRAPHY

Levitsky, Abraham, and Frederick S. Perls. 1982. The Rules and Games of Gestalt Therapy. In The Essential Psychotherapies: Theory and Practice by the Masters, eds. Daniel Goleman and Kathleen Riordan Speeth, 143–154. New York: New American Library.

Perls, Frederick S., Ralph F. Hefferline, and Paul Goodman. 1951. Gestalt Therapy: Excitement and Growth in the Human Personality. New York: Dell.

Reisman, John M. 1991. A History of Clinical Psychology. 2nd ed. New York: Hemisphere Publishing.

Bernard C. Beins