resistance has been used differently than in Gestalt therapy. resistance to contact with emerging processes of the self and. Contact with others. The method of that it establishes an authoritarian relationship between therapist and clicnt. The emphasis is on the quality of the therapist–client relationship and Therapy aims not at analysis or introspection but at awareness and contact with the In fact, a number of Gestalt therapy writers propose that the term “resistance” is. relativity, is a theory about the nature of reality and our relationship to r",Mity. . The concepts emphasized in Gestalt therapy are contact) conscious . patient to know something about tbe analyst was interpreted as resistance, and any ideas.
Integration refers to how these parts fit together and how the individual integrates into the environment. Often people who come to therapy do not have these parts fitting together in their environment, Gestalt Therapy is about facilitating clients to integrate themselves as whole persons and help restore balance in their environment.
There are two main causes lacking awareness: There are three ways people may achieve awareness through therapy: Contact with the environment: This is through looking, listening, touching, talking, moving, smelling, and tasting. This enables the individual to grow in his or her environment through reacting to the environment and changing.
This is the individual living in and being conscious at the present moment rather than worrying about the past or the future. This refers to the individual taking responsibility for his or her own life rather than blaming others.
Energy and blocks to energy: Gestalt Therapists often focus on where energy is in the body, how it is used, and how it may be causing a blockage Corey, Blocked energy is a form of resistance, for example, tension in a part of the body, not breathing deeply, or avoiding eye contact. Gestalt Therapy is about finding and releasing the blockages that may be inhibiting awareness. Growth disorders refer to emotional problems that are caused by people who lack awareness and do not interact with their environment completely.
In doing so, people are unable to cope with the changes in their lives successfully and, instead deal with the problems in a defensive manner Seligman, People with unfinished business often resent the past and because of this are unable to focus on the here and now. One of the major goals of Gestalt Therapy is to help people work through their unfinished business and bring about closure.
General Ideas about Personality Development Gestalt Therapy deems that people cannot be considered as separate from their environment or from interpersonal relations. The individual is seen as being self-regulating and is able to motivate oneself to solve problems. Individuals are able to work towards growth and develop as their environments allow.
This will therefore allow them to rectify issues affecting his or her life. In order to do this, clients must first accept responsibility for choosing their present situations. Language plays a big part in accepting responsibility. Both avoidance responses and projection of traits attempt to displace ownership and responsibility onto an external cause. In fact, the nonverbal communication is seen to provide more information about the real essence of the person.
Gestalt Therapists use the technique of experiments or learning experiences with their clients. An example of this technique is with a man who feels insecure in social situations. He has a work function to go to in two weeks time so the therapist gives him the experiment of starting a conversation at the function with someone he does not normally speak to.
Conversely, they will be strongly influenced by success in their career area, and events like being fired, jobless or retired, could trigger a crisis. The problem in identifying with a limited number of aspects of ourselves is that the we do not use much of our potential. By assuming we lack of inner resources we look for external support, creating dependencies.
Perls uses this distinction of figure-ground to establish a principle of human need. He conceived that needs are part of a continuum. The most pronounced need manifests as a figure until its resolution. This type of Gestalt is called a Gestalt controller since it guides the mental process.
An extreme example of the mental function of this mechanism is the case of a toothache. When we have a toothache, our whole world revolves round the pain. We do not care about other concerns. Until we solve our problem of pain, we can not attend to any other affairs with clarity. With psychological needs something similar happens; a need is considered in this plane to be like an unresolved situation or an unclosed gestalt.
This is manifest as thoughts that seize the mind most of the time in involuntary ways. For example our conscience may compulsively dialogue with us over an issue. Or it may manifest as a filter that makes us blind to certain information in our environment. For example, someone who has had a history of abuse in childhood might fail to observe issues of power and abuse in relationships in the present day. The formation process and Gestalt closing is a natural process that works without human intervention or the control of our will.
We go through Gestalt processes everyday that form and close naturally in time. Nevertheless, situations sometimes occur which do not get resolved as they are supposed to, sometimes to a point that we forget the original problem exists or we believe that it has been resolved. This class of perpetuatal problem can cause psychological difficulties. The Gestalt psychotherapist works with this unfinished mental content or filter forms.
They help the individual to recognise them and work towards the closing of the Gestalt using various techniques suggested by the psychotherapist. Contact boundaries The human being establishes a relationship with his or her surrounding environment; this relationship defines a boundary. This boundary is what allows a distinction to be made between self and non self, but it is also the area where contact takes place.
In Gestalt therapy, it is defined as the ego boundary or the contact boundary. In Gestalt therapy it is considered that the relationships with other people are made at this boundary. When it happens in a healthy manner, then the boundary is flexible, which means that we are capable of distinguishing I from you, but also of forming a we. We are capable of coordinating the appropriate needs with those that surround us and we can see each other as a complete person, and not only as a function of our needs and wishes.
Generally, in a relationship with another person, we are each subject to number of conflicts of interest. In most cases, the individual-societal conflict faces us with a conflict between our needs and the demands of others.
Concepts of obligations like must do transform themselves into ideals as to what we must do in a particular situation. We then create rigid formulae for relationships which correspond to these must do obligations. In time these become more and more rigid.
She is in the middle phase of therapy. She says she is very angry at a man in the group. One legitimate and frequent Gestalt approach is "Say it to him. You sound not only angry but something more. You sound and look like you are enraged. I am, I would like to kill him.
- Gestalt Therapy: Overview and Key Concepts
- The Experiment in Gestalt Therapy
- Gestalt therapy
You seem to feel impotent. Impotence usually accompanies rage. What are you impotent about? I can't get him to acknowledge me. And there is an intensity to your rage that seems to be greater than the situation calls for. What are you experiencing? A lot of men in my life who have been like that. The work proceeds into a reexperiencing the narcissistic injury from her father, who was never responsive to her] Process of Psychotherapy Gestalt therapy probably has a greater range of styles and modalities than any other system.
It is practiced in individual therapy, groups, workshops, couples, families, and with children. It is practiced in clinics, family service agencies, hospitals, private practices, growth centers, and so on. The styles in each modality vary drastically on many dimensions: All styles and modalities of Gestalt therapy have in common the general principles we have been discussing: Within these parameters, interventions are patterned according to the context and the personalities of the therapist and the patient.
At the heart of the methodology is the emphasis on the difference between "work" and other activities, especially "talking about. First, it refers to a deliberate, voluntary and disciplined commitment to use phenomenologically focused awareness to increase the scope and clarity of one's life. When one moves from talking about a problem or being with someone in a general way to studying what one is doing, especially being aware of how one is aware, one is working.
Differences in techniques are not important, although the quality and type of therapeutic contact and a fit between the attitude and emphasis of the therapist and the patient's needs are important. Techniques are just techniques: Nevertheless a discussion of some techniques or tactics might elucidate the overall methodology. These are only illustrative of what is possible. Techniques of Patient Focusing All techniques of patient focusing are elaborations of the question, "What are you aware of experiencing now?
What are you aware of? Then the patient tightens and looks away and starts to look thoughtful] T: I see you are tightening. I don't want to stay with the sadness.
Stay with the not wanting to. Put words to the not wanting to. The patient might respond: Here the patient is asked to put feelings or thoughts into action. For example, the therapist may encourage the patient to "say it to the person" if present or use some kind of role playing such as speaking to an empty chair if the person is not present.
The patient with tears in his eyes might be asked to "put words to it. It is not a universal remedy. Exaggeration is a special form of enactment. A person is asked to exaggerate some feeling, thought, movement, etc. Enactment into movement, sound, art, poetry, etc. For instance, a man who had been talking about his mother without showing any special emotion was asked to describe her. Out of his description came the suggestion to move like her.
As the patient adopted her posture and movement, intense feelings came back into his awareness. Sometimes a patient can bring an experience into the here and now more efficiently by visualizing than by enacting: I was with my girlfriend last night. I don't know how it happened but I was impotent.
Imagine it is last night and you are with your girlfriend. Say out lout what you experience at each moment. I am sitting on the couch. My friend sits next to me and I get excited.
Then I go soft. Let's go through that again in slow motion, in more detail. Be sensitive to every thought or sense impression. She comes over and sits next to me. She touches my neck. It feels so warm and soft, I get excited -- you know, hard. She strokes my arm, and I love it. This patient became aware of how he created his own anxiety and impotence. This fantasy was recreating an event that happened in order to get in better touch with it.
The fantasy could be of an expected event, a metaphorical event, and so forth. In another case, a patient working on shame and self-rejection is asked to imagine a mother who says and means "I love you just the way you are.
This fantasy helps the patient become aware for the possibility of good self-mothering and can serve as a transition to integrate good self-parenting.
The image can be used to work between sessions or as a meditation. It also raises feelings about experiences with abandonment, loss and bad parenting. Loosening and integrating techniques. Often the patient is so fettered by the bonds of the usual ways of thinking that alternative possibilities are not allowed into awareness.
This includes traditional mechanisms, such as denial or repression, but also cultural and learning factors affecting the patient's way of thinking.
One technique is just to ask the patient to imagine the opposite of whatever is believed to be true. Integrating techniques bring together processes the patient doesn't bring together or actively keeps apart splitting.
The patient might be asked to put words to a negative process, such as tensing, crying or twitching. Or when the patient verbally reports a feeling, that is, an emotion, she might be asked to locate it in her body. Another example is asking a patient to express positive and negative feelings about the same person. These include any technique that brings patients' awareness to their body functioning or helps them to be aware of how they can use their bodies to support excitement, awareness and contact.
Would you be willing to try an experiment? Take some deep, deep breaths and each time you exhale, let your jaw loosely move down. Such statements facilitate both the therapeutic contact and the patient's focusing and are to be made discriminatingly and judiciously.
Using the "I" to facilitate therapeutic work requires technical skill, personal wisdom and self-awareness on the therapist's part. Therapists may share what they see, hear or smell. They can share how they are affected.
Facts of which the therapist is aware and the patient is not are shared, especially if the information is unlikely to be spontaneously discovered in the phenomenological work during the hour, yet is believed to be important to the patient. For example, a mother must see that a child's needs are met and that the development of its potentialities are facilitated. A child needs this warm, nurturing kind of mirroring.
And a child also needs room to struggle, to be frustrated, and to fail. A child also needs limits to experience the consequences of behavior. When parents cannot meet these needs because they need a dependent child or lack sufficient inner resources, the child develops distorted contact boundaries, awareness and lowered self-esteem.
Unfortunately, children are often shaped to meet the approval of parents on their own needs. As a result, the spontaneous personality is superseded by an artificial one. Other children come to believe they can have their own needs met by others without consideration for the autonomy of others. This results in the formation of impulsivity rather than spontaneity. Patients need a therapist who will relate in a healthy, contactful manner, neither losing self by indulgent the patient at the expense of exploration and working through nor creating excessive anxiety, shame and frustration by not being respectful, warm, receptive, direct and honest.
Patients who enter psychotherapy with decreased awareness of their needs and strengths, resisting rather than supporting their organismic self, are in pain. They try to get the therapist to do for them what they believe they cannot do for themselves.
When therapists go along with this, patients do not reown and integrate their lost or never-developed potential. Therefore they still cannot operate with organismic self-regulation, being responsible for themselves. They do not find out if they have the strength to exist autonomously because the therapist meets their needs without strengthening their awareness and ego boundaries see Resnick, As Gestalt therapy proceeds and patients learn to be aware and responsible and contactful, their ego functioning improves.
As a result, they gain tools for deeper exploration. The childhood experiences of the formative years can then be explored without the regression and overdependency necessary in regressive treatment and without the temporary loss of competence that a transference neurosis entails. Childhood experiences are brought into present awareness without the assumption that patients are determined by past events.
Patients actively project transference material on the Gestalt therapist, thereby giving opportunities for deeper exploration. The following two examples show patients with different defenses, needing different treatment, but with similar underlying issues. Tom was a year-old man proud of his intelligence, self-sufficiency and independence.
He was not aware that he had unmet dependency needs and resentment. This affected his marriage in that his wife felt unneeded and inferior because she was in touch with needing and showed it. This man's self-sufficiency required respect -- it met a need, was in part constructive and was the basis of his self-esteem.
I appreciate your strength, and when I think of you as such a self-reliant kid I want to stroke you and give you some parenting. I am remembering when I was a kid He was consistently reluctant to experiment with self-nourishment. I could talk about my week. I feel pulled on by you right now. I imagine you want me to direct you.
What's wrong with that? I prefer not to direct you right now. You can direct yourself. I believe you are directing us away from your inner self right now. I don't want to cooperate with that. You are not going to direct me, are you? Well, let's work on my believing I can't take care of myself. The therapist explores rather than gratifies the patient's wishes -- and this is frustrating for the patient.
Providing contact is supportive, although honest contact frustrates manipulation. The Gestalt therapist expresses self and emphasizes exploring, including exploring desire, frustration and indulgence.
The therapist responds to manipulations by the patient without reinforcing them,without judging and without being purposely frustrating. A balance of warmth and firmness is important.
The Paradoxical Theory of Change The paradox is that the more one tries to be who one is not, the more one stays the same Beisser, Many patients focus on what they "should be" and at the same time resist these shoulds. The Gestalt therapist attempts to work toward integration by asking the client to identify with each conflicting role. The client is asked what he or she experiences at each moment. When the client can be aware of both roles, integrating techniques are used to transcend the dichotomy.
There are two axioms in Gestalt therapy: The medium of change is a relationship with a therapist who makes contact based on showing who he or she truly is and who understands and accepts the patient. Awareness of "what is" leads to spontaneous change. When the person manipulating for support finds a therapist who is contactful and accepting and who does not collude with the manipulation, he may become aware of what he is doing.
At each and every point along the way this new Aha! As long as the therapist or the patient can see new possibilities and the patient wants to learn, new Aha! Awareness work can start anywhere the patient is willing, if the therapist is aware and connects it to the whole. The ensuing process in Gestalt therapy leads to changes everywhere in the field. The more thorough the investigation, the more intense the reorganization. Some changes can only be appreciated years later.
Patients in Gestalt therapy are in charge of their lives. The therapist facilitates attention to opening restricted awareness and areas of constricted contact boundaries; the therapist brings firmness and limits to areas with poor boundaries.
As sensing increases in accuracy and vividness, as breathing becomes fuller and more relaxed and as patients make better contact, they bring the skills of therapy into their lives. Sometimes intimacy and job improvements follow Gestalt work like an act of grace, without the patient's connecting the increase to the work done in therapy.
But the organism does grow with awareness and contact. One thing does lead to another. Applications Problems Gestalt therapy can be used effectively with any patient population that the therapist understands and feels comfortable with. If the therapist can relate to the patient, the Gestalt therapy principles of dialogue and direct experiencing can be applied. With each patient, general principles must be adapted to the particular clinical situation.
If the patient's treatment is made to conform to "Gestalt therapy," it can be ineffective or harmful. A schizophrenic, a sociopath, a borderline and an obsessive-compulsive neurotic may all need different approaches. Thus, the competent practice of Gestalt therapy requires a background in more than Gestalt therapy. A knowledge of diagnosis, personality theory and psychodynamic theory is also needed.
The individual clinician has a great deal of discretion in Gestalt therapy. Modifications are made by the individual therapist according to the therapeutic style, personality, diagnostic considerations, and so on.
This encourages and requires individual responsibility by the therapist. Gestalt therapists are encouraged to have a firm grounding in personality theory, psychopathology and theories and applications of psychotherapy, as well as adequate clinical experience.
Participants in the therapeutic encounter are encouraged to experiment with new behavior and then share cognitively and emotionally what the experience was like. Gestalt therapy has traditionally been considered most effective with "overly socialized, restrained, constricted individuals" anxious, perfectionistic, phobic and depressed clientswhose inconsistent or restricted functioning is primarily a result of "internal restrictions" Shepherd,pp. Such individuals usually show only a minimal enjoyment of living.
Although Shepherd's statement accurately delineates a population Gestalt therapy is effective with, current clinical practice of Gestalt therapy includes treatment of a much wider range of problems. Gestalt therapy in the "Perlsian" workshop style is of more limited application than Gestalt therapy in general Dolliver, ; Dublin, In Shepherd's discussion of limitations and cautions, she notes restrictions that apply to any therapist but should especially be noted in a workshop setting, as well as by therapists not well trained or experienced with disturbed patient populations.
Work with psychotic, disorganized, or otherwise severely disturbed people is more difficult and calls for "caution, sensitivity and patience. Disturbed patients need support from the therapist and at least a minimal amount of faith in their own natural healing capacity before they can explore deeply and experience intensely the "overwhelming pain, hurt, rage and despair" that underlie the psychological processes of disturbed patients Shepherd,pp.
Working with more disturbed populations requires clinical knowledge of how to balance support and frustration, knowledge of character dynamics, need for auxiliary support such as day treatment and medication and so forth.
Some statements which seem to make sense in a workshop encounter are obvious nonsense when applied in a broader context. Consider for example, "do your own thing" in the context of treatment with acting out patients! A perusal of the Gestalt therapy literature such as Gestalt Therapy Now Fagan and Shepherd,The Growing Edge of Gestalt Therapy Smith, and The Gestalt Journal, will show that Gestalt therapy is used for crisis intervention, ghetto adults in a poverty program Barnwell,interaction groups, psychotics and almost any group imaginable.
Unfortunately the literature provides examples and a small number at that without sufficient explication of necessary alterations in focus and without discussing negative results.
Gestalt therapy has been successfully employed in the treatment of a wide range of "psychosomatic" disorders including migraine, ulcerative colitis and spastic neck and back. Gestalt therapists have successfully worked with couples, with individuals having difficulties coping with authority figures and with a wide range of intrapsychic conflicts.
Gestalt therapy has been effectively employed with psychotics and severe character disorders. Because of the impact of Gestalt therapy and the ease with which strong, frequently buried affective reactions can be reached, it is necessary to establish safety islands to which both the therapist and patient can comfortably return. It is also imperative for the therapist to stay with the patient until he or she is ready to return to these safety islands.
For example, after an especially emotion laden experience, the patient may be encouraged to make visual, tactile or other contact with the therapist or with one or more group members and report the experience. Another safety technique is to have the patient shuttle back and forth between making contact in the now with the therapist or group members and with the emotionally laden unfinished situation that the patient was experiencing then until all of the affect has been discharged and the unfinished situation worked through.
The Gestalt therapy emphasis on personal responsibility, interpersonal contact and increased clarity of awareness of what is, could be of great value in meeting the problems of the present. One example is application of Gestalt therapy in schools Brown, ; Lederman, Evaluation Gestalt therapists are singularly unimpressed with formal psychodiagnostic evaluation and nomothetic research methodology.
No statistical approach can tell the individual patient or therapist what works for him or her. What is shown to work for most does not always work for a particular individual. This does not mean that Gestalt therapists are not in favor of research; in fact, the Gestalt Therapy Institute of Los Angeles has offered grants to subsidize research. Perls offered no quantified, statistical evidence that Gestalt therapy works. He did say, "we present nothing that you cannot verify for yourself in terms of your own behavior" F.
In the publication Gestalt Therapy, a series of experiments are provided that can be used to test for oneself the validity of Gestalt therapy. Each session is seen as an experiment, an existential encounter in which both the therapist and the patient engage in calculated risk taking experiments involving exploration of heretofore unknown or forbidden territories.
The patient is aided in using phenomenological focusing skills and dialogic contact to evaluate what is and is not working. Thus, constant idiographic research takes place. Gestalt therapy has "sacrificed exact verification for the value in ideographic experimental psychotherapy" Yontef,p. Harman reviewed Gestalt research literature and found quality research on Gestalt therapy sparse.
He did find studies that showed increased self-actualization and positive self-concept following Gestalt therapy groups Foulds and Hannigan, ; Giunan and Foulds, A series of studies conducted by Leslie Greenberg and associates Greenberg, addressed the lack of attention to context in psychotherapy research and the unfortunate separation of process and outcome studies.
The Greenberg studies related specific acts and change processes in therapy with particular outcomes.
The Experiment in Gestalt Therapy
Their research distinguished three types of outcome immediate, intermediate and final and three levels of process speech act, episode and relationship. They studied speech in the context of the type of episodes in which it appears, and they studied the episodes in the context of the relationships in which they occur. In one study Greenberg examined the use of the two-chair technique to resolve splits. He defined a split as "a verbal performance pattern in which a client reports a division of the self process into two partial aspects of the self or tendencies.
Higgins found that "Two-chair dialogue appeared to produce a more direct experience of conflict [split] and encouraged the client in a form of self-confrontation that helped create a resolution to the conflict"p. Harman found a number of studies that compared the behavior of Gestalt therapists with that of other therapists.
Brunnink and Schroeder compared expert psychoanalysts, behavior therapists and Gestalt therapists and found the Gestalt therapists "provided more direct guidance, less verbal facilitation, less focus on the client, more self-disclosure, greater initiative and less emotional support.
No claim is made in the Gestalt therapy literature that Gestalt therapy is demonstrated to be the "best. General outcome research may yield less useful results than process research looking at behavior, attitudes and consequences.
An example of this is Simkin's assessment of the effectiveness of Gestalt therapy in workshops "massed learning" as contrasted with "spaced" weekly therapy sessions. He found evidence for the superiority of massed learning Simkin, Some Gestalt therapy viewpoints on what constitutes good therapy are supported by general research.
The research on experiencing within the Rogerian tradition demonstrated the effectiveness of an emphasis on direct experience by any therapist. In Gestalt therapy there is also an emphasis on personal relating, presence and experience. Unfortunately, some therapists regularly and blatantly violate the principles of good psychotherapy according to the Gestalt therapy model, but still call themselves Gestalt therapists Lieberman, Yalom and Miles, Treatment Ongoing Individual Gestalt Therapy Although Gestalt therapy has acquired a reputation for being primarily applicable to groups, its mainstay is actually individual treatment.
An annotated bibliography of case readings can be found in Simkinp. Gestalt therapy begins with the first contact. Ordinarily, assessment and screening are done as a part of the ongoing relationship rather than in a separate period of diagnostic testing and social history taking. The data for the assessment are obtained by beginning the work, for example, by therapeutic encounter. This assessment includes the patient's willingness and support for work within the Gestalt therapy framework, the match of patient and therapist, the usual professional diagnostic and characterological discriminations, decisions on frequency of sessions, the need for adjunctive treatment and the need for medical consultation.
An average frequency for sessions is once per week. Using the Gestalt methodology, an intensity equivalent to psychoanalysis can often be achieved at this frequency. Often individual therapy is combined with group therapy, workshops, conjoint or family therapy, movement therapy, meditation, or biofeedback training.
Sometimes patients can utilize more frequent sessions, but often they need the interval to digest material and more frequent sessions may result in overreliance on the therapist. Frequency of sessions depends on how long the patient can go between sessions without loss of continuity, decompensation, or lesser forms of relapse.
Frequency of sessions varies from five times per week to every other week. Meeting less frequently than every week obviously diminishes intensity unless the patient attends a weekly group with the same therapist. More than twice a week is ordinarily not indicated, except with psychotics, and is definitely contraindicated with borderline personality disorders.
All through the therapy patients are encouraged and aided in doing the decision making for themselves.
When to start and stop, whether to do an exercise, what adjunctive therapies to use, and the like are all discussed with the therapist, but the competence and ultimate necessity for the patient to make these choices is supported. Group Models Gestalt therapy groups vary from one and one-half to three hours in length, with an average length of two hours.
A typical two-hour group has up to 10 participants. Gestalt therapists usually experience maximal involvement with heterogeneous groups, with a balance of men and women.
Participants need to be screened. Any age is appropriate for Gestalt therapy, but an ongoing private practice group would typically range from ages 20 to 65 with the average between 30 and Some Gestalt therapists follow Perls' lead in doing one-on-one therapy in the group setting and use the "hot seat" structure.
The focus is then on the extended interaction between patient and group leader I and Thou " Levitsky and Simkin,p. One-on-one episodes average 20 minutes, but range from a couple of minutes to 45 minutes. During the one-on-one work, the other members remain silent. After the work, they give feedback on how they were affected, what they observed, and how their own experiences are similar to those the patient worked on.
In recent years the one-on-one work has been expanded to include awareness work that is not focused around a particular problem. In the early s Perls wrote a paper in which he said: