Gestalt Therapy

“Don't push the river it will flow by itself” (author unknown)

•  Introduction

•  Basic focus and founders – Fritz Perls, and more recently Erving and Miriam Polster. Approach is an experiential therapy that stresses the here and now awareness and integration of the fragmented parts of the personality. It focuses on the “what” and “how” of behavior not on the why. It looks for the role of unfinished business from the past and the effects this business has on present functioning.

•  Perls – Fritz Perls is the name associated primary with gestalt therapy. Described himself as a lower middle class Jewish boy who became a mediocre psychoanalyst to a creator of a “new” method of treatment. (p. 1-2 In and out of garbage pail). Born in Germany , joined the German Army and served in WWI as a medic. Had 2 sisters, - Grete with whom he was close and Else, eldest sister, whom he did not like. She died in a concentration camp. He got his parents out of Germany and into the US .

•  Reactions to Perls was mixed. He is said to be an unusual man who was skilled in his ability to perceive and influence behavior. He was a wanderer, and did not claim his titles or liked to be labeled. He is credited for bringing Gestalt psychology to the clinical arena, but he did not originate gestalt thinking.

•  “There is nothing in Gestalt Therapy that can be considered original. All its theoretical considerations can be found throughout man's written history. Furthermore, there is nothing in its activity that has not been done by someone else, somewhere else, sometime. The most that can be said for it is that it represents an updated language, and recommendations for behavior that hopefully apply more effectively knowledge which man has known for a long time.” Kempler, p. 251.

•  Background information (handouts from psych)

•  Gestalt means whole or configuration. Gestalt principles states that we are more than the sum of our parts – the whole is greater (holism). The whole picture (the Gestalt) gives a pattern or form that you couldn't see if you broke the picture into individual units. We also like to organize our world into meaningful patterns. We want to see things as meaningful and make sense of them. Figure-formation or figure-ground says that we make sense of our world by organizing it from moment to moment – those things that are the focus of attention is called the figure and those that are undifferentiated are the ground. (Related to this is the concept of Grouping – we like things grouped by similarity – perceiving objects that are similar as belonging together; proximity – the tendency to group things that are near each other as belonging together; continuity – tendency to see series of figures or objects along a smooth or continuous path or pattern; closure – tendency to perceive a complete or whole figure even when there are gaps in sensory input. We also see what we expect to see – this is called Perceptual set – predisposition to perceive things in a particular way because of past experience or expectations. )

•  Gestalt therapy is rooted in existentialism and phenomenology. Stresses unity of mind, body and feelings. Basic assumption is that individuals are responsible for their own behavior and experiencing. Designed to help people experience the present moment more fully and gain awareness of what they are doing.

•  Approach is experiential in that clients come to grips with what they are thinking, feeling, and doing as they interact with the therapist.

•  Growth occurs through personal contact. Clients have the capacity to do their own seeing, feeling, sensing, and interpreting, and it is not the therapist's job to do that for them. Clients are autonomous and active in therapy.

•  Key concepts

•  View of human nature – rooted in existential philosophy, phenomenology and field theory. Humans have the capacity to “self-regulate” in their environment if they are willing to be fully aware of what is happening. To be fully alive we must be present in the now – not try to change, but be aware of what we are. It is by being fully aware that we change. Perls believed that people need to become self-reliant and to reintegrate the parts of their personality that they have disowned. While Perls was confrontational, more modern Gestalt approaches stress dialog and equality within the therapeutic relationship.

•  The Now or Awareness – form of experience that is defined as being in touch with one's own existence, with what is. Involves self-knowledge, a knowing of the current situation and knowledge of self in the situation. Accepting, not denying the situation. Awareness is accompanied by owning, i.e. the process of knowing one's control over, choice of, and responsibility for one's own behavior and feelings. Awareness is cognitive, sensory and affective. The act of remembering is now, what is remembered is not now. It is taking what is in the past or the future and dealing with it in the present. In therapy people tend to talk about feelings in a detached way, and Gestalt therapy gets people to experience feelings. Look at “what” and “how”, not “why”. Bring the past into the present – how do you feel NOW about the event – experience the feeling in the moment. Our past influences our present behavior usually because of some unfinished business or lack of completion of that experience.

•  Field theory – must see organism within its environment – we cannot separate ourselves from our context. Everything is relational, in flux, constantly changing and interrelated (Chaos theory).

•  Organismic self-regulation – we self-regulate or shift our attention and resources according to what gets our attention (figure) at the moment. We try to keep ourselves in balance – try to maintain a sense of equilibrium.

•  Unfinished business – feelings that weren't experienced or left unexpressed linger in present, causing us to be pre-occupied, compulsive, and self-defeating. Often show as energy blockage in the body. Therapist helps draw awareness to tension that shows in the body – posture, yawning, looking away, etc. An impasse or stuck point is when we find that the usual ways of being are not working and we need to get in touch with our frustration, work through it, and get past the point of being stuck. Just like with Person-centered, Gestalt therapists believe that individuals strive towards self actualization and when we can accept all aspects of ourselves without judging we can begin to think, act and feel differently.

•  Contact and resistances to contact

• i. Contact refers to the interaction we make with nature and other people, without losing touch with one's individuality. We have boundaries between self and environment, and a good boundary is one allows for flexibility, connection and disconnection. In a good boundary we can alternate between connecting and separating, being in contact and withdrawing. We resist contact in 1 of 5 ways: (p. 204-205 of text)

•  introjection – uncritically accepting other's beliefs and standards; passive incorporation of what is around us. Example – taking the values of others without examining them.

•  projection – disown parts of ourselves by attributing aspects to others, outside world.

•  retroflection – directing feelings towards others inward – what we want to do to someone else we do to ourselves, such as aggression, hostility.

•  Deflection – distraction, speaking in generalities, avoiding real contact with others. Can be useful like ignoring a comment, or unhealthy like not looking at someone, being vague.

•  Confluence – blending self-other boundary. Inability to distinguish what is felt from what others are feeling.

•  Therapeutic process

•  Goal of Gestalt therapy is to create awareness and through that, choice. Become more aware of feelings, thoughts, actions; find ways to satisfy self without violating rights of others; become more responsible; ask for help when needed but have strong internal support.

•  Relationship is important in Gestalt, but to be in active partnership (as opposed to Rogers who was more passive). Therapist is directive, active, suggesting experiments to try. Can use a variety of techniques, but must be real, not just a bag of tricks. The relationship is a dialogue within an I/Thou (person to person) relationship. Language is important (p. 208 of text) – change “it” and “you” talk to “I” talk. Challenge questions and other attempts to avoid personal power such as “I guess, sort of” and help the client accept responsibility for self – I won't instead of I can't. Listen to metaphors client uses and have the client experience the metaphor – ex. From text: I feel like I've been through a meat grinder. Who is doing the grinding? Experience the grinding – what is that like? Listen to what is said as well as what is not said – what do the pauses tell you?

•  Use of techniques to help client achieve awareness. Challenges client to stay in the process, experience things in the present.

•  Polster talks about 3-stage integration sequence. Discovery – acquire new view of old situation, learn something about themselves; Accommodation – client's recognition of choice, trying new behaviors within and outside of therapy; assimilation – the learning process influences the environment; can deal with change, new situations.

•  Techniques/exercises, experiments. Exercises are ready-made techniques that are sometimes used to make something happen in a therapy session or to achieve a goal. Experiments grow out of the interaction between client and therapist. They are more spontaneous and unique to the moment. One doesn't just use an exercise or experiment without preparing the client. There must be a good relationship with the client and a willingness to cooperate. If met with resistance, it is important to look at what that resistance means. Since experiments and exercises are designed to increase awareness and try new behaviors, look at the reluctance from the idea that there is a resistance to change. Be respectful of client and of their cultural background. Make an exercise or experiment that are not too advanced and at which the client can succeed. Confrontation is an invitation to examine behaviors, thoughts and attitudes, not a harsh attack. Review techniques that are in your book. Examples of interventions: ( p. 216-217 of text)

•  Staying with the feeling – encourages client to continue with the feelings being reported

•  Internal dialogue – sometimes used with empty chair – person expresses both sides of argument that is going on internally.

•  Making the rounds – used in groups – have member speak do or do something with each person in group.

•  Exaggeration – to increase intensity of a behavior, movement or gesture. Put words to the part of the body that is moving.

•  Guided fantasy – visualizing a situation to bring it to the present.

•  Reversal – to take on the opposite of a symptom or impulse.

•  Rehearsal – say out loud the things saying in head. Sometimes used with empty chair.

•  Dream work – becoming parts of the dream.

•  Gestalt is good for people who know about themselves intellectually but don't seem to grow. It helps people distinguish between can't and won't, and to come to know internal barriers. It is an exploration of behavior rather than a modification. Successful therapy is becoming aware of all vital functions; it is becoming aware of alienated parts, tasting them and accepting or rejecting them. Limitations if therapist is just a bag of tricks and does not try to integrate the techniques into the actual needs of the client. Can be abusive – opening someone up and then not helping them bring closure. Culturally it may be difficult for some cultures to be so expressive.

Video – Perls video

Homework – Design a Self-management program for a particular behavior (one that you are willing to share in class). See page 110 of Student Manual.

Back to lectures