GESTALT THERAPY

Slides created by

Barbara A. Cubic, Ph.D.Professor

Eastern Virginia Medical School

To accompany

Current Psychotherapies 10

Learning Objectives This presentation will focus

on:• Overview of Gestalt therapy• History of Gestalt approaches• Applications of Gestalt

psychology• Treatment techniques used in

gestalt therapy

BASIC BASIC CONCEPTSCONCEPTS

Gestalt Therapy

Gestalt psychotherapy is focused on process (what is happening) rather than on content (what is being discussed).

Gestalt Therapy

Developed by Fritz and Laura Perls. Gestalt comes from the German word

for "whole." Therapy focus on the person’s

experience in the here-and-now. Holism and field theory are

interrelated in Gestalt theory. Organismic self-regulation requires

knowing and owning.

Gestalt Therapy

Phenomenological method Direct perception is considered

more reliable than explanations or interpretations..

Unresolved conflicts are worked out in the therapy session as if they are happening in that moment.

Gestalt Therapy

Clients are taught to be attentive to all parts of themselves. Posture Breathing Methods of movement

Gestalt Therapy

Therapist and client dialogue about their perspectives.

Differences of perspective are the focus of experimentation and further dialogue.

Goal is for the client to have increased awareness of what they do, how they do it and how they can change or accept themselves..

COMPARISON OF COMPARISON OF GESTALT THERAPY TO GESTALT THERAPY TO OTHER APPROACHESOTHER APPROACHES

Comparison of Gestalt Comparison of Gestalt Therapy to Other TherapiesTherapy to Other Therapies

Most Similar Most Different

Behavioral Psychoanalytic Humanistic

Gestalt Therapy Compared to Other Systems

“In behavior modification, the patient's behavior is directly changed by the therapist's manipulation of environmental stimuli. In psychoanalytic theory, behavior is caused by unconscious motivation which becomes manifest in the transference relationship… In gestalt therapy the patient learns to fully use his internal and external senses … Gestalt therapy helps the patient regain the key to this state, the awareness of the process of awareness. Behavior modification conditions [by] using stimulus control, psychoanalysis cures by talking about and discovering the cause of mental illness [the problem], and gestalt therapy brings self-realization through here-and-now experiments in directed awareness.”

— Yontef, 1969

Gestalt Therapy, Person-Centered Therapy and REBT

Gestalt Person-Person-CenteredCentered

REBTREBT

Focuses on Focuses on awareness and awareness and personal personal disclosure.disclosure.

Trusts patient’s Trusts patient’s self report.self report.

Confronts Confronts patient’s patient’s irrational irrational thinking.thinking.

Comparison of Gestalt Comparison of Gestalt Therapy to Other TherapiesTherapy to Other Therapies

Over recent decades, Gestalt Therapy has developed in parallel with psychoanalysis, emphasizing:• Whole person

• Process thinking

• Subjectivity and affect

• Impact of life events on personality

• Viewing people as motivated towards growth

• More integration of impact of interpersonal relations

Comparison of Gestalt Comparison of Gestalt Therapy to Other TherapiesTherapy to Other Therapies Similarities of Gestalt therapy with cognitive

behavioral approaches and REBT include:• Attention to cognition• Encouraging present orientation• Seeing role of focusing on the future on creating

anxiety• Creation of guilt by moralistic and unreasonable

thinking

Major difference is that Gestalt therapists do not assume to know the truth about what is irrational.

History of Gestalt Therapy

History of Gestalt Therapy

Three main influences:1. Psychoanalysis2. Humanistic, holistic,

phenomenological and existential writings

3. Gestalt psychology

History of Gestalt Therapy Frederick “Fritz” Salomon Perls

Trained as a psychiatrist. Worked with Kurt Goldstein, a principal

figure of the holistic school of psychology who studied the effects of brain injuries on WWI veterans.

Trained in psychoanalysis with Karen Homey and Wilhelm Reich.

Lore Perls Trained as a psychologist. Worked with Gestalt psychologist Max

Wertheimer.

History of Gestalt Therapy Because of Nazism, the Perls fled

Western Europe in 1933 to South Africa, where they practiced until 1945.

In 1947, Ego, Hunger and Aggression: A Revision of Psychoanalysis is published in London under F. S. Perls' name. Included text reevaluating the

psychoanalytic view on aggression. At the end of the war, the Perls

emigrated to New York City.

History of Gestalt Therapy

Collaboration began with artists and intellectuals versed in philosophy, psychology, medicine, and education resulting in elaboration of Gestalt theory, therapy and therapists.

In 1951 the Julian Press published Gestalt Therapy: Excitement and Growth in the Human Personality by F. S. Perls, Ralph Hefferline, and Paul Goodman..

Current Status of Gestalt TherapyCurrent Status of Gestalt Therapy

Gestalt therapy institutes internationally

Virtually every major city in the United States has at least one Gestalt institute.

Association for the Advancement of Gestalt Therapy formed to govern adherence to Gestalt principles.

Current Status of Gestalt Therapy

Four Major Journals:Four Major Journals:1.1. International Gestalt JournalInternational Gestalt Journal

2.2. British Gestalt JournalBritish Gestalt Journal

3.3. Gestalt Review Gestalt Review

4.4. Australian Gestalt JournalAustralian Gestalt Journal

THEORY OF PERSONALITY

The Field Theory Perspective

Underlies the Gestalt phenomenological perspective.

Describes the whole field of which an event is part of rather than classifying it or seeking a cause-effect sequence.

A person constitutes a field.

The Field Theory Perspective No action is at a distance.• What has effect must touch that which is

affected in time and space.

The phenomenological field is defined by the observer.• Therefore, one must know the observer’s

frame of reference.

Field approaches are descriptive rather than speculative, interpretive, or classificatory.

Organismic Self-Regulation"There is only one thing that should control: the situation … If you understand the situation you are in and let the situation you are in control actions, then you learn to cope with life."

Fritz Perls

Organismic Self-Regulation Human regulation is either:• Organismic

–Acknowledgment of what is.

–Choosing and learning happen holistically.

–A natural integration of mind and body.

–Requires that the habitual become fully aware as needed.

• Shouldistic –What one thinks should or should not be.

–Cognition reigns.

Gestalt (Figure-Ground) Formation

"Insight is a patterning of the perceptual field in such a way that the significant realities are apparent; it is the formation of a Gestalt in which the relevant factors fall into place with respect to the whole."

Heidbreder, 1933

Consciousness and Unconsciousness

View is radically different from the Freudian view.

Concepts of awareness and unawareness replace the unconscious.

Gestalt theory recognizes that background and forefront change fluidly.

Patient’s conflicts are regulated to background and are brought to forefront through therapy.

Health Health is an awareness of shifting

need states. Being whole is identification with

one’s ongoing, moment-by-moment experience.

Requires being in contact with what is actually occurring.

Other Gestalt Concepts People are inclined towards:• Growth• Self-regulation

Conditions can impede growth. People define themselves in

relation to others.

Other Gestalt Concepts Disturbances at the boundaries • In optimal functioning, when

something is taken in, there is contact and awareness.

• Experiences that are blocked create isolation.

Creative adjustment• Creative balance between changing

the environment and adjusting to current conditions.

Other Gestalt Concepts Maturity• A good Gestalt describes a

perceptual field organized with clarity and good form.

• Results from creative adjustment. Disrupted personality

functioning• Mental illness is the inability to

form clear figures in the moment.

Other Gestalt Concepts Polarities • Health represents ability to shift

between figure and ground (polarities such as life/death, strength/weakness).

• Maladjustment occurs when polarities become rigid and are seen in dichotomies.

Other Gestalt Concepts Resistance• Gestalt therapists see resistance as

the process of opposing the formation of a threatening figure.

Impasse• Terror that occurs when a person’s

supports are not available and new supports have not yet been mobilized.

Other Gestalt Concepts

Anxiety • Gestalt therapists are concerned

with the process of anxiety, not content of anxiety.

• Anxiety results from futurizing and unsupported breathing.

Other Gestalt Concepts Development• Humans are born with capacity for

self-regulation.• Frank (2001) has formulated a theory

of development based on embodiment and relatedness from a Gestalt perspective.

• McConville and Wheeler (2003) have used field theory and relatedness in their theory of child and adolescent development.

Gestalt Therapy: Four Dialogue Characteristics

1. Inclusion• Putting oneself as fully as possible

into the experience of the other without judging, analyzing or interpreting while simultaneously retaining a sense of one's separate, autonomous presence.

• Represents phenomenological trust in immediate experience.

• Provides safe environment for patient and strengthens self-awareness.

Main Gestalt Therapy Principles

Awareness• Direct experience

Contact• Relationship

Experimentation• Phenomenological focusing

Gestalt Therapy: Four Dialogue Characteristics

2. Presence• The Gestalt therapist expresses

observations, preferences, feelings, personal experience and thoughts to the patient.

• Therapist is modeling phenomenological reporting.

• Enhances patient's trust and use of immediate experience to raise awareness.

Gestalt Therapy: Four Dialogue Characteristics

3. Commitment to dialogue •Contact refers to something

that happens in an interaction.

• Therapist allows contact to happen rather than making contact happen.

Gestalt Therapy: Four Dialogue Characteristics

4. Dialogue is lived

• Dialogue is something done.

• "Lived" emphasizes the excitement/immediacy of the

process.

•Mode of dialogue can vary.–Examples might include dance,

song, art, words, movement.

Techniques of Patient Focusing

Patient Focusing Techniques are elaborations of

"What are you aware of (experiencing) now?"

And

"Try this experiment and see what you become aware of (experience) or

learn."

Main Tools of Gestalt Therapy Awareness • Being in touch with one's existence, with

what is.• Gestalt therapy focuses on creation of an

awareness continuum.– What is of primary concern to the organism, the

relationship, the group or society becomes Gestalt and into the foreground.

– Allows primary concerns to be fully faced, worked through, sorted out, changed, eliminated.

– As one becomes aware of/ faces concerns, they become the background — leaving the foreground free for the next Gestalt.

Techniques of Patient Focusing "Stay with it" • Therapist encourages client to

follow a report of an awareness with the instruction “stay with it" or “feel it out."

Enactment • Therapist asks the patient to act out

feelings or thoughts.• Enactment is for increasing

awareness, not catharsis.

Techniques of Patient Focusing Exaggeration • A special form of enactment.• Therapist asks the patient to

exaggerate some feeling, thought, or movement to feel it more intensely.

Guided fantasy• Therapist encourages visualizing

rather than enacting.

Techniques of Patient Focusing Loosening and integrating techniques• Therapist asks patient to imagine the

opposite of whatever is believed.• Integrating techniques bring together

processes patient keeps apart.• Examples:

–Asking a patient to put words to crying– Identifying where in the body one feels an

emotion–Asking patient to express positive and

negative feelings about the same person

Techniques of Patient Focusing Body techniques• Therapist provides ideas about how

the patient can increase awareness of body functioning.

• Examples:– Teaching patient breathing exercises– Teaching patient to hold body in a

certain posture while feeling a certain emotion

Techniques of Patient Focusing Therapist disclosures • Therapist uses "I" statements

judiciously to enhance therapeutic contact and patient's awareness.

• Requires wisdom to know when to self-disclose.

• Therapists may share what they are experiencing in their senses or emotionally.

Applications of Gestalt Therapy Approach can be used with any

patient population. Therapist must have a comfort with

and knowledge of the patient population being treated.• Therapist must be able to relate to the

patient to dialogue.

An individualized approach is used with each patient.

Applications of Gestalt Therapy Gestalt therapy has traditionally been

considered most effective with neurotic disorders (for example anxious, perfection driven, phobic and depressed clients).

The approach is present-focused and increases joy in life.

Gestalt therapy is effective with a wide variety of problems.

Applications of Gestalt Therapy Treating psychotic, disorganized,

Axis II or severely disturbed clients calls for “caution, sensitivity and patience.”

Approach should not be used with this population unless a “long-term commitment” to the patient is possible.

Applications of Gestalt Therapy Gestalt therapy can be used for crisis

intervention, impoverished individuals, groups and couples.

Psychosomatic disorders including migraine, ulcerative colitis and spastic neck and back respond to the approach.

Application of Gestalt therapy in school systems has been promising.

Evidence: Gestalt Therapy Gestalt therapists do not rely much on

formal diagnostic evaluations and research.

RCT is not a suitable research approach for Gestalt therapy.

Gestalt therapists do not believe a statistical approach applies to a specific individual-therapist situation.

Interactions are seen as experiments involving calculated risk-taking.

Evidence: Gestalt Therapy Based on Strumpfel’s meta-analysis,

Gestalt therapy shown to be equally effective as CBT.

Also noteworthy that Gestalt therapists use CBT and other empirically-supported approaches in their clinical work.

Effectiveness of combining experiential techniques and a good relationship has been robustly demonstrated.

Evidence: Gestalt Therapy Process-experiential therapy• Form of contemporary, relational Gestalt

therapy.• Combines client-centered relationship

with Gestalt techniques.• Manual based for the purposes of

research.• Lends support to Gestalt therapy,

although not true to central tenets (i.e. individualized approach used in Gestalt therapy).

Evidence: Gestalt Therapy Meta-analyses also have shown

support for:• Experiential confrontation process as a

strong predictor for positive therapeutic outcome.– Example: Directing attention to the patient’s

experience and behaviors directly activated in the session

• Directive experiential approach shown to be more effective than client-centered approaches and CBT.

Evidence: Gestalt Therapy Support for specific techniques

includes:• Two-chair technique lead to greater

depth of experience than empathic reflection alone.

• Empty-chair dialogue leads to reduction in general distress and a reduction in a sense of unfinished business.

Gestalt Therapy in a Multicultural World

Founders of Gestalt therapy were all cultural and political outsiders.

Encourage people to explore their own life paths.

Establish a process goal: awareness.

Gestalt Therapy in a Multicultural World

Therapist recognizes social, cultural, and political implications.• Helps therapist relativize own

cultural norms with clients.• Awareness of the difference between

the relative insider status of being a professional versus being a client.