Gestalt Therapy
Gestalt Therapy
Definition
Gestalt therapy is a form of psychotherapy that helps the client focus on the here and now rather than on the past. Gestalt therapy stresses the development of client self-awareness and personal responsibility.
Purpose
The goal of Gestalt therapy is to raise clients’ awareness regarding how they function in their environment; with family, at work or school, and with friends. The focus of therapy is more on what is happening (the moment-to-moment process) than what is being discussed (the content). Awareness is being alert to the most important events in one’s life and environment with full sensorimotor, emotional, cognitive, and energy support. Support is defined as anything that makes contact with or withdrawal from the environment possible, including energy, body support, breathing, information, concern for others, and language, for example.
In therapy, clients become aware of what they are doing, how they are doing it, and how they can change themselves, and at the same time, they learn to accept and value themselves. According to this approach, individuals define, develop, and learn about themselves in relationship to others, and they are constantly changing.
Gestalt therapy is “unpredictable” in that the therapist and client follow moment-to-moment experience and neither knows exactly where this will take them. Gestalt therapy is complex and intuitive, but it is based on the following principles:
- Holism. Gestalt therapy takes into account the whole person including thoughts, feelings, behavior, body sensations, and dreams. The focus is on integration, that is, how the many parts of the person fit together, and how the client makes contact (interacts) with the environment.
- Field theory. According to this theory, everything is related, in flux, interrelated, and in process. The therapist focuses on how the client makes contact with the environment (family, work, school, friends, authority figures).
- The figure-formation process describes how individuals organize or manipulate their environment from moment to moment.
- Organismic self-regulation is the creative adjustment the organism (person) makes in relation to the environment. The person’s equilibrium with his or her environment is “disturbed” by the emergence of a client need, sensation, or interest and is related to the figure-formation process in that the need of the person organizes the field. For example, if an individual wants coffee, this coffee need is what comes out of the diffuse background and becomes “figural” (comes to the forefront of the client’s environment or field) and when the individual enters a room, the figural will be related to the coffee need. The therapist is interested in what is figural for a person because it may provide insight into the person’s need (s).
- The Now. The concept of the here and now is what is being done, thought, and felt at the moment, and not in the past or the future.
- Unfinished business is defined as the unexpressed feelings that are associated with distinct memories and fantasies. These feelings may be resentment, rage, hatred, pain, anxiety, grief, guilt, and/or abandonment that are not fully experienced in awareness and linger on in the background. The feelings are carried into the present life and cause preoccupations, compulsive behaviors, wariness, and other self-defeating behaviors. Unfinished business will persist until the person faces and deals with these denied or alienated feelings.
The current practice of Gestalt therapy includes treatment of a wide range of problems and has been successfully used to address a wide range of “psychosomatic” disorders including migraine, ulcerative colitis, and spastic neck and back. Therapists work with couples and families, and with individuals who have difficulties coping with authority figures. In addition, Gestalt therapy has been used for brief crisis intervention , to help persons with post-traumatic stress disorders, alcohol and drug abuse, depression , or anxiety disorders; with adults in a poverty program; with seriously mentally ill individuals with psychotic disorders; and those with borderline personality disorders.
Description
The relationship between the therapist and the client is the most important aspect of psychotherapy in Gestalt therapy. In Gestalt therapy, the interaction between therapist and client is an ever-changing dialogue marked by straightforward caring, warmth, acceptance, and self-responsibility. There are four characteristics of dialogue:
- inclusion, in which the therapist puts him- or herself, as much as is possible, into the experience of the client. The therapist does not judge, analyze, or interpret what he or she observes.
- presence refers to the therapist expressing his or her observations, preferences, feelings, personal experience, and thoughts to the client.
- commitment to dialogue allows a feeling of connection, or contact, between the therapist and the client.
- dialogue is active and can be nonverbal as well as verbal. It can be dancing, song, words, or any modality that expresses and moves the energy between the therapist and the client.
Gestalt therapy holds the view that people are endlessly remaking or discovering themselves; therefore, individuals are always in constant transformation. The therapist’s approach is to help clients: increase or deepen their awareness of themselves and their relationships with others, by attending and engaging with the client; to explore the client’s experience; and to describe what is perceived. All techniques used within the therapeutic relationship help clients to work through and move beyond painful emotional blocks. This allows the client to explore new behavior, first in the context of the therapeutic relationship and then, as appropriate, in the outside world.
The therapeutic process begins at the first contact between client and therapist. Assessment and screening are usually done as part of the ongoing relationship with the client and not as a separate period of diagnostic testing and history taking. Assessment information is obtained by beginning the therapeutic work and includes the client’s willingness and support for work in the Gestalt therapy framework, the match between the client and the therapist, diagnostic and personality information, the decision regarding the frequency of sessions, the need for adjunctive treatment (such as day treatment or biofeedback training), and the need for medication and medical consultation.
Gestalt therapists now make use of the traditional diagnostic categories to obtain necessary information to help patients with serious mental illnesses (such as psychotic disorders and borderline disorders) and because of administrative and insurance reimbursement procedures. Despite these changes, it is believed that Gestalt therapy assessment techniques will continue to be varied since Gestalt therapists draw on other therapeutic systems.
In therapy, the Gestalt therapist is active and sessions are lively and characterized by warmth, acceptance, caring, and self-responsibility and promote direct experiencing of a situation or event rather than passively talking about the event. Events recalled from the past are explored and felt in the here and now of the therapy session. Clients receive input from the therapists in many ways: they can see and hear the therapists react; the therapists can tell them how they are seen and what is seen; therapists may share their own feelings and reveal personal information about themselves; and therapists can discuss how client awareness is limited by how the client and therapist interact with or engage each other—that is, make contact.
The Gestalt therapist has a wide range of active interventions (cognitive and behavioral) at his or her disposal and may use any techniques or methods as long as they are (a) aimed toward increasing awareness, (b) arise out of the dialogue and the therapist’s perception of what is going on with the client (sensing, feeling, thinking) in the immediate therapy session, and (c) within the parameters of ethical practice.
Exercises and experiments
Many therapeutic interventions called exercises and experiments have been developed to enhance awareness and bring about client change. Exercises are defined as ready-made techniques that are sometimes used to evoke certain emotions (such as the expression of anger) in clients. Experiments, on the other hand, grow out of the immediate interaction (dialogue) between client and therapist. They are spontaneous, one-of-a-kind, and relevant to a particular moment and the particular development of an emerging issue such as the client’s reports of a need, dream, fantasy, and body awareness. Experiments are done with full participation and collaboration with clients and are designed to expand clients’ awareness and to help them to try out new ways of behaving rather than to achieve a particular result. These experiments may take many forms. According to Gerald Corey, some are: “imagining a threatening future event; setting up a dialogue between a client and some significant person in his and her life; dramatizing the memory of a painful event; reliving a particularly profound early experience in the present; assuming the identity of one’s mother or father through role-playing; focusing on gestures, posture, and other nonverbal signs of inner expression; carrying on a dialogue between two conflicting aspects within the person.”
While participating in experiments, clients actually experience the feelings associated with their conflicts or issues. Experiments are tailored to each individual client and used in a timely manner; they are to be carried out in a context that offers safety and support while encouraging the client to risk trying out new behavior. The Gestalt therapy focus is on the entire person and all parts—verbal and nonverbal behaviors, emotional feelings—all are attended to.
Gestalt therapists are said to rely on spontaneity, inventiveness, “present-centeredness,” and a range of possible therapeutic encounters, interactions that lead to exercises, and experiments are potentially infinite but can be categorized as follows.
USING STATEMENTS AND QUESTIONS TO FOCUS AWARENESS
Many interventions have to do with simply asking what the client is aware of experiencing or asking simple and direct questions as, “What are you feeling?” and “What are you thinking?” The client may be instructed to start a sentence with “Now, I am aware …” or asked to repeat a behavior, as in, “Please wring your hands together again.” A frequent technique is to follow the client’s awareness report with the instruction, “Stay with it!” or “Feel it out!”
CLIENT’S VERBAL BEHAVIOR OR LANGUAGE
Awareness can be enhanced and emphasized through the client’s verbal behavior or language since client speech patterns are considered to be an expression of their feelings, thoughts, and attitudes. Some aspects of language that might indicate the clients’ avoidance of strong emotions or of self-responsibility are the general pronouns such as “it” and “you.” Clients are instructed to substitute, when appropriate, the personal pronoun “I” for these pronouns to assume a sense of responsibility for his or her feelings or thoughts (ownership). Sometimes clients may be asked to change their questions into direct statements in order to assume responsibility for what they say. Other examples of helping clients to be more in control using language are to have them omit qualifiers and disclaimers such as “maybe,” “perhaps,” or “I guess” from their language patterns. This changes ambivalent and weak statements into more clear and direct statements; to substitute “I won’t” for “I can’t” because often “can’t” gives the feeling of being unable to do something. It may be more accurate to say “I won’t” meaning “I choose not to do this for any of various reasons,” or use the word, “want” instead of “need” which is considered an indication of urgency and anxiety, and is less accurate. Other changes might be to change “should” and “ought” to “I choose to” or “I want to” increasing the clients’ power and control of their lives.
NONVERBAL BEHAVIOR
Awareness can also be enhanced by focusing on nonverbal behavior and may include any technique that makes the clients more aware of their body functioning or helps them to be see how they can use their bodies to support excitement, awareness, and contact. The parts of the body that therapists may attend to include the mouth, jaw, eyes, nose, neck, shoulders, arms, hands, torso, legs, and feet, or the entire body. The therapist, for example, may point out to and explore with the client how he or she is smiling while at the same time expressing anger.
SELF-DIALOGUE
Self-dialogue by clients is an intervention used by Gestalt therapists that allows clients to get in touch with feelings that they may be unaware of and, therefore, increase the integration of different parts of clients that do not match or conflicts in clients. Examples of some common conflicts include: “the parent inside versus the child inside,” “the responsible one versus the impulsive one,” “the puritanical side versus the sexual side,” “the good side versus the bad side,” “the aggressive self versus the passive self,” “the autonomous side versus the resentful side,” and “the hard worker versus the goof-off.” The client is assisted in accepting and learning to live with his or her polarities and not necessarily getting rid of any one part or trait.
The client is engaged in the self-dialogue by using what is called the empty-chair technique. Using two chairs, the client is asked to take one role (the parent inside, for example) in one chair and then play the other role (the child inside) in the second chair. As the client changes roles and the dialogue continues between both sides of the client he or she moves back and forth between the two chairs. Other examples of situations in which dialogues can be used, according to Corey, include “one part of the body versus the other (one hand versus the other), between a client and another person, or between the self and object such as a building or an accomplishment.”
ENACTMENT AND DRAMATIZATION
Enactment increases awareness through the dramatizing of some part of the client’s existence by asking him or her to put his or her feelings or thoughts into action, such as instructing the client to “Say it to the person” (when in group therapy ), or to role-play using the empty chair technique. Exaggeration is a form of enactment in which clients are instructed to exaggerate a feeling, thought, or movement in order to provide more intensity of feelings. Enactment can be therapeutic and give rise to creativity.
GUIDED FANTASY
Guided fantasy (visualization) is a technique some clients are able to use more effectively than using enactment to bring an experience into the here and now. Clients are asked to close their eyes and, with the guidance of the therapist, slowly imagine a scene of the past or future event. More and more details are used to describe the event with all senses and thoughts.
DREAM WORK
Dream work is most important in Gestalt therapy. Working with clients’ dreams requires developing a list of all the details of the dream, remembering each person, event, and mood in it and then becoming each of these parts through role-playing and inventing dialogue. Each part of the dream is thought to represent the clients’ own contradictory and inconsistent sides. Dialogue between these opposing sides leads clients toward gradual insight into the range of their feelings and important themes in their lives.
AWARENESS OF SELF AND OTHERS
An example of how this technique is used by the Gestalt therapist would be asking the client to “become” another person such as asking the client to be his mother and say what his mother would say if the client came in at 2:00 A.M. This provides more insight for the client rather just asking what the client thinks his mother would say if he came home at 2:00 A.M.
AVOIDANCE BEHAVIORS
Awareness of and the reintegration the client’s avoidance behaviors are assisted by the interventions used to increase and enhance awareness of feelings, thoughts, and behaviors.
HOMEWORK
Homework assignments between therapy sessions may include asking clients to write dialogues between parts of themselves or between parts of their bodies, gather information, or do other tasks that are related to and fit with what is going on in the therapy process. Homework may become more difficult as the awareness develops.
Therapy sessions are generally scheduled once a week and individual therapy is often combined with group therapy, marital or family therapy , movement therapy, meditation , or biofeedback training. Sessions can be scheduled anywhere from once every other week to five times a week and depends on how long the client can go between sessions without loss of continuity or relapsing. Meetings less frequent than once a week are thought to diminish the intensity of the therapy unless the client attends a weekly group with the same therapist. More than twice a week is not usually indicated except with clients who have psychotic disorders, and is contraindicated with those who have a borderline personality disorder.
Weekly group therapy may vary from one and one-half hours to three hours in length, with the average length being two hours. A typical group is composed of ten members and usually balanced between males and females. Any age is thought to be appropriate for Gestalt therapy. There are groups for children as well.
Gestalt therapy is considered to have a greater range of styles and modalities than any other therapeutic system, and is practiced in individual therapy, groups, workshops, couples, families, with children, and in agencies such as clinics, family service agencies, hospitals, private practice, growth centers. According to Corey, “The therapeutic style of therapists in each modality vary drastically on many dimensions including degree and type of structure; quantity and quality of techniques used; frequency of sessions, abrasiveness and ease of relating, focus on body, cognitions, feelings; interpersonal contact; knowledge of work within psychodynamic themes; and degree of personal encountering.”
Risks
Gestalt therapy is considered to have pioneered the development of many useful and creative innovations in psychotherapy theory and practice. However, there is some concern regarding the abuse of power by the therapist, as well as the high-intensity interaction involved. Therapists who use other techniques can become enchanted with using the techniques of Gestalt therapy without having the appropriate training in Gestalt therapy theory. Gestalt therapists are very active and directive within the therapy session and, therefore, care must be taken that they have characteristics that include sensitivity, timing, inventiveness, empathy, and respect for the client. These characteristics, are dependent on the skill, training, experience, ethics, and judgment of the therapist. In addition, the intensity of the therapy might not be suitable for all patients, and even disruptive for some, despite the competence of the therapist.
Normal results
Gestalt therapists expect that as a result of their involvement in the Gestalt process clients will: have increased awareness of themselves; assume ownership of their experience rather than making others responsible for what they are thinking, feeling, or doing; develop skills and acquire values that will allow them to satisfy their needs without violating the rights of others; become aware of all their senses (smelling, tasting, touching, hearing, and seeing); accept responsibility for their actions and the resulting consequences; move from expectations for external support toward internal self-support; to be able to ask for and get help from others and be able to give to others.
Resources
BOOKS
Blom, Rinda. The Handbook of Gestalt Play Therapy: Practical Guidelines for Child Therapists. London: Jessica Kingsley Publishers, 2006.
Corey, Gerald. “Gestalt Therapy.” Theory and Practice of Counseling and Psychotherapy. 7th.ed. Belmont, CA: Thomson/Brooks/Cole, 2005.
O’Leary, Eleanor. “Breathing and Awareness: The Integrating Mechanisms of Cognitive-Behavioural Gestalt Therapy in Working with Cardiac Patients.” In New Approaches to Integration in Psychotherapy. Ed. Eleanor O’Leary, and Mike Murphy. New York: Routledge/Taylor and Francis Group, 2006.
VandenBos, Gary R., ed. APA Dictionary of Psychology. Washington, D.C.: American Psychological Association, 2006.
Woldt, Ansel L., and Sarah M. Toman. Gestalt Therapy: History, Theory, and Practice. Thousand Oaks, CA: Sage, 2005.
PERIODICALS
Bowman, Deborah, and Tricia A. Leakey. “The Power of Gestalt Therapy in Accessing the Transpersonal: Working with Physical Difference and Disability.” Gestalt Review 10.1 (2006): 42–59.
Kitzler, Richard. “The Ontology of Action: A Place on Which to Stand for Modern Gestalt Therapy Theory.” International Gestalt Journal 29.1 (Spring 2006): 43-100.
Miller, Michael Vincent. “Presenting the Present.” International Gestalt Journal 29.1 (Spring 2006): 135–43.
Wheeler, Gordon. “New Directions in Gestalt Theory and Practice: Psychology and Psychotherapy in the Age of Complexity.” International Gestalt Journal 29.1 (Spring 2006): 9–41.
Williams, Lynn. “Spirituality and Gestalt: A Gestalt-Trans-personal Perspective.” Gestalt Review 101 (2006): 6–21.
ORGANIZATIONS
American Psychological Association. 750 First Street, N.E., Washington, DC 20002. Telephone: (202) 336-5800. Web site: <http://helping.apa.org>.
The Association for the Advancement of Gestalt Therapy. 7861 Spring Avenue, Elkins Park, PA 19027. Telephone: (215) 782-1484. Web site: <http://www.aagt.org>.
National Institute of Mental Health. 6001 Executive Boulevard, RM 8184, MSC 9663, Bethesda, MD 20892-9663. Telephone: (301) 443-4513. Web site: <http://www.nimh.nih.gov>.
National Mental Health Association. 1021 Prince Street, Alexandria, VA 22314-2971. Telephone: (703) 684-7722. Web site: <http://www.nmha.org>.
Janice Van Buren, PhD
Ruth A. Wienclaw, PhD