GESTALT THERAPY Slides created by Barbara A Cubic

GESTALT THERAPY Slides created by Barbara A. Cubic, Ph. D. Professor Eastern Virginia Medical School To accompany Current Psychotherapies 10

Learning Objectives n This presentation will focus on: • Overview of Gestalt therapy • History of Gestalt approaches • Applications of Gestalt psychology • Treatment techniques used in gestalt therapy

BASIC CONCEPTS

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

Gestalt Therapy n n n 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 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 GESTALT THERAPY TO OTHER APPROACHES

Comparison of Gestalt Therapy to Other Therapies Most Similar Behavioral Psychoanalytic Most Different Humanistic

Gestalt Therapy Compared to Other Systems “In behavior modification, the patient's behavior is directly changed by 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 selfrealization through here-and-now experiments in directed awareness. ” — Yontef, 1969

Gestalt Therapy, Person-Centered Therapy and REBT Gestalt Person. Centered REBT Focuses on awareness and personal disclosure. Trusts patient’s self report. Confronts patient’s irrational thinking.

Comparison of Gestalt Therapy to Other Therapies n 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 Therapy to Other Therapies n 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 n 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. Psychoanalysis 2. 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 Therapy Gestalt therapy institutes internationally n Virtually every major city in the United States has at least one Gestalt institute. n Association for the Advancement of Gestalt Therapy formed to govern adherence to Gestalt principles. n

Current Status of Gestalt Therapy Four Major Journals: 1. 2. 3. 4. International Gestalt Journal British Gestalt Journal Gestalt Review Australian Gestalt Journal

THEORY OF PERSONALITY

The Field Theory Perspective Underlies the Gestalt phenomenological perspective. n Describes the whole field of which an event is part of rather than classifying it or seeking a causeeffect sequence. n A person constitutes a field. n

The Field Theory Perspective n No action is at a distance. • What has effect must touch that which is affected in time and space. n The phenomenological field is defined by the observer. • Therefore, one must know the observer’s frame of reference. n 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 n 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 n n 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 are brought to forefront through therapy.

Health is an awareness of shifting need states. n Being whole is identification with one’s ongoing, moment-bymoment experience. n Requires being in contact with what is actually occurring. n

Other Gestalt Concepts n People are inclined towards: • Growth • Self-regulation Conditions can impede growth. n People define themselves in relation to others. n

Other Gestalt Concepts n Disturbances at the boundaries • In optimal functioning, when something is taken in, there is contact and awareness. • Experiences that are blocked create isolation. n Creative adjustment • Creative balance between changing the environment and adjusting to current conditions.

Other Gestalt Concepts n Maturity • A good Gestalt describes a perceptual field organized with clarity and good form. • Results from creative adjustment. n Disrupted personality functioning • Mental illness is the inability to form clear figures in the moment.

Other Gestalt Concepts n 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 n Resistance • n 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 n Anxiety • Gestalt therapists are concerned with the process of anxiety, not content of anxiety. • Anxiety results from futurizing and unsupported breathing.

Other Gestalt Concepts n 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. • Mc. Conville 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 n Awareness • Direct experience n Contact • Relationship n 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 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 n 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 n "Stay with it" • Therapist encourages client to follow a report of an awareness with the instruction “stay with it" or “feel it out. " n Enactment • Therapist asks the patient to act out feelings or thoughts. • Enactment is for increasing awareness, not catharsis.

Techniques of Patient Focusing n Exaggeration • A special form of enactment. • Therapist asks the patient to exaggerate some feeling, thought, or movement to feel it more intensely. n Guided fantasy • Therapist encourages visualizing rather than enacting.

Techniques of Patient Focusing n 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 n 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 n 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 n n 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. n An individualized approach is used with each patient.

Applications of Gestalt Therapy n n n 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 n n 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 n n n 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 n n 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 n n n Based on Strumpfel’s meta-analysis, Gestalt therapy shown to be equally effective as CBT. Also noteworthy that Gestalt therapists use CBT and other empiricallysupported approaches in their clinical work. Effectiveness of combining experiential techniques and a good relationship has been robustly demonstrated.

Evidence: Gestalt Therapy n 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 n 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 n 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 n n n 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 n 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.