Randy Dellosa: Gestalt Therapy in the Philippines: January 2012

An Introduction to Gestalt Therapy

Based on Yontef, G. & Jacobs, J. (2011). Gestalt Therapy.

In Corsini, R., and Wedding, D. (Eds.). Current Psychotherapies, 9th Edition, Chapter 10. Belmont, CA: Brooks/Cole-Thompson Learning. pp 342-379.

What is Gestalt Therapy?

Gestalt therapy is a humanistic, existential, experiential, contextual, and process-oriented approach to psychotherapy. It was developed by Frederick “Fritz” Perls, Laura Perls, and Paul Goodman in the 1940’s and 1950’s.

Initially, Gestalt therapy was meant to be a revision of psychoanalysis and an alternative to behaviourism. Over time, it evolved into a totally independent and integrated system of psychotherapy.

Gestalt therapy is truly holistic since it deals with the cognitive, emotional, sensory, interpersonal, and behavioural aspects of an individual’s personality.

Generally, people don’t need psychotherapy because they are able to learn and grow from their experiences in life. It is when people are stuck in repetitive, maladaptive ways that psychotherapy is needed. Psychotherapy is primarily a relationship between a client and therapist.

The Gestalt therapist creates a healing experience by being open, alive, honest, sincere, and warm as he engages with the client. In this relationship, the Gestalt therapist gives clients a chance to unlearn maladaptive patterns, to learn how they avoid learning new and creative ways of coping, and to learn how they can keep on learning.

The Gestalt therapist is one who gets actively, creatively, and personally engaged with the client. By using active and creative methods, the Gestalt therapist facilitates in the client a deeper awareness of oneself and of one’s life. With deeper awareness comes the greater freedom and power of choice, resulting in more opportunities for living a self-directed and meaningful life.

Gestalt therapy does not focus on “fixing” people or on curing disease. Gestalt therapy is an exploration rather than a direct attempt to change behavior. The goal of Gestalt therapy is growth and autonomy through conscious awareness and self-support.

What are the foundational bases of the Gestalt therapy?

Holism emphasizes the positive qualities of human beings: firstly, that people are growth-oriented and are inclined to develop as fully as their environmental conditions will allow; and secondly, that people have the inherent capacity at self-regulation. They have the capacity to prioritize their needs hierarchically and then meet those needs which are most urgent.

Field Theory asserts that an individual can only be understood from the context (or field) within which that individual is currently situated and embedded.

An individual is embedded in his environmental field. Hence, the individual never has a “solitary self,” but always a “self-in-relation” to his environment. And since the environmental field is inhabited by other human beings, individuals are better understood by observing the quality and patterns of how they interact and relate to each other.

According to Gestalt therapy’s Field Theory, no one can have a totally objective perspective of reality. An individual’s perception of reality is never absolute since his perceptions are constantly being affected and influenced by elements in the environmental field.

Gestalt Psychology explains that individuals will interpret their experiences to makes it sensical, meaningful, or relevant for themselves.

“Gestalt formation” refers to the emergence of a figure (i.e., whatever our attention focuses on) contrasted against a ground (i.e., everything else that gets set aside into the background). Only one clear figure can be focused on at any given moment. However, figures and grounds may shift very rapidly.

What is the Paradoxical Theory of Change?

This theory asserts that the more one tries to become someone he is not, the more fragmented his personality becomes and the more he stays the same.

What are 3 concepts emphasized in Gestalt therapy?

Contact is the maintenance of attention and connection with an experience, whether it be a mental, emotional, or physical experience. It is “being in touch” or “staying with” the experience rather than ignoring, belittling, suppressing, or denying it.

“Contact” is what the Gestalt therapist does by paying close attention to what the client is experiencing or doing in the session and to what is happening in the therapist-client relationship.

Awareness is a process of focusing on and attending to a current experience.

Unawareness occurs when an individual purposefully, unintentionally, regularly, or permanently sets aside some aspect of his experience to the background. Unawareness generally reflects an internal conflict within the individual. The Gestalt therapist’s task is to observe the client’s awareness process, even helping the client become aware of his “unawareness.”

“Awareness of awareness” is also known as “conscious awareness.” It is being mindful or observant of one's own awareness processes and patterns.

Experimentation is the act of doing something different. In a session, both therapist and client can creatively experiment with different ways of thinking and doing. In the process of doing experiments, repressed emotions may surface, suppressed feelings may find fuller expression, and insights commonly emerge.

Experimentation is done in accordance with the Paradoxical Theory of Change: the purpose of experimentation is not to change the client, but to help the client gain increased self-awareness, deeper self-understanding, and stable self-support.

What are some of the other concepts and principles of Gestalt therapy?

Disturbances at the Boundary

Healthy boundaries allow people to maintain individuality despite the contact and connection with others. Healthy boundaries allow people to acknowledge and respect each other’s differences. Disturbances at the boundary will result in any of the following:

@ Isolation is the failure to allow close contact to occur.

@ Confluence is an enmeshment resulting in the loss of a separate identity.

@ Introjection is acceptance without discrimination or awareness.

@ Assimilation is the deconstruction of an experience, keeping what is meaningful or useful to oneself and rejecting what is not.

@ Projection is falsely attributing to another person something that actually comes from oneself.

@ Retroflection is turning a shared experience into a solitary one.

Creative Adjustment

Gestalt therapists believe that people are growth-oriented and will create solutions to their problems in the best way they can or know how.

Creative adjustment is the process of solving a problem by making full use of one’s resources, by making full use of resources from the environment, by making modifications in the environment, and by adjusting to that which cannot be changed in the environment.

Neurotic Self-Regulation

Neurotic self-regulation is the result of a creative adjustment done in the past that has become an outmoded repetitive character pattern.

The Gestalt therapist helps the client develop new and flexible creative adjustments in response to the client’s current field conditions.

Polarities

The healthy individual is able to adjust creatively to the polar themes of life: comfort and hardships, strength and weakness, love and hate, life and death. In neurotic self-regulation however, the individual is unable to adjust to such polar themes.

The Gestalt therapist may use integrating techniques to join positive and negative poles of a polarity together.

Resistance

Resistance occurs when an individual opposes a thought, feeling, impulse, or need (stemming from oneself or from another person) in a context wherein the individual feels unsafe.

Anxiety

Anxiety can be created cognitively with irrational beliefs, negative misinterpretations, or from “futurizing,” that is, making ominous predictions. Anxiety can also be created physiologically through poor breathing habits.

Gestalt therapists are more concerned with the process of anxiety (i.e., how one becomes anxious) rather than the content of anxiety (i.e., what one is anxious about). Gestalt therapy is ideal for the treatment of anxiety because it has a cognitive and body-oriented focus.

Impasse

An impasse is a paralysis resulting from not wanting to return to a previous state, yet not being able to move forward to a new one. This paralysis happens because the individual does not possess enough support (both self support and environmental support) to move forward.

People often describe this experience as a darkness, an emptiness, or being caught in a whirlpool. By “staying with” the impasse rather than setting it aside, people paradoxically cross over to a more authentic, creative, lively, self-supportive, and meaningful existence.

Here and Now; What and How

The Gestalt therapist has a dual focus during a session. The first focus is on the patient’s awareness process- what the patient does and how he or she is doing it. The second focus is on the personal relationship between therapist and client.

Of all other types of therapy, it is Gestalt therapy which strongly emphasizes the “here and now” and “what and how.” This is essential because most people either live in the past, live as if they had no past, or live in fear of the future.

The primary focus of Gestalt therapy is the “here and now” experience. Even in exploring the past, Gestalt therapy uses creative experiments and techniques to transform the client’s past into a present experience.

Inclusion

“Inclusion,” according to Martin Buber, refers to the process of deeply feeling another person’s experience as if it were his own. The Gestalt therapist considers the client’s perception of reality as real and valid as anyone else’s and immerses into the client’s experience as deeply as possible.

By responding to the client’s perception of reality with empathy, honesty, compassion, and respect, the Gestalt therapist creates a venue wherein the client’s innermost thoughts and emotions can safely surface and be expressed.

Dialogue and Self-Disclosure

The Gestalt therapy relationship is based on dialogue- the verbal interaction between two individuals on a horizontal plane. With the client, the Gestalt therapist surrenders to the interaction and is open to be changed by what transpires in the session.

Occasionally and as appropriately called for, the Gestalt therapist will disclose his personal experiences and reactions, making the dialogue between therapist and client a mutual phenomenological exploration.

What are some techniques used in Gestalt therapy?

Gestalt therapy discourages a cookbook style of applying experiments or techniques on clients. The choice and application of interventions must be tailored to the client’s unique needs. During the session, the Gestalt therapist creatively comes up with interventions (also called “experiments”) that aim to deepen awareness. Some of these Gestalt therapy techniques include the following:

Focusing

The Gestalt therapist’s standard question is, “What are you aware of, or experiencing, at this very moment?” The client is then invited to “stay with” the thought, feeling, or body sensation experienced during that moment in the session.

Enactment

Enactment is done by asking the client to put feelings or thoughts into action. The client may also be asked to exaggerate whatever action the client does.

Enactment may also come in the form of creative expression through art, poetry, dance, or vocalization.

Guided Visualization

The Gestalt therapist can invite the client to engage in mental experiments such as guided imagery exercises or by making the client imagine that a past situation is happening at the present moment.

Guided visualizations and fantasy-based interventions have a “loosening” effect on people with rigid mindsets.

Body Awareness

Gestalt therapy has a special interest in the client’s movements, physical sensations, and breathing patterns. At times, the therapist may ask the client to locate the area where feelings reside (or are intensely felt) in the body.

What do research studies say about Gestalt therapy?

Uwe Strumpfel (2006) conducted a meta-analysis of 74 published research studies on psychotherapy and confirmed the following findings:

@ Gestalt therapy was effective in a variety of clinical problems such as psychotic disorders, mood disorders, anxiety disorders, psychosomatic disorders, substance dependence, personality disorders.

@ Gestalt therapy produced stable long-term effects.

@ Clients who underwent Gestalt therapy evaluated it as very helpful.