Thursday, October 25, 2007

Chapter 10 Gestalt Therapy - Updated 3/21/06

Current Psychotherapies.
Chapter 10.
Gestalt Therapy.
Gary Yontef and Lynne Jacobs.
Instructor: Jeff Garrett Ph.D.



Founders of Gestalt Therapy.
Fritz Perls and Laura Perls.

Three founders of Gestalt Psychology.
Max Wertheimer.
Kurt Koffka.
Wolfgang Kohler.

"Gestalt" is a German word that means "whole" (shape or form).
"Gestalt" - A physical, biological, psychological, or symbolic configuration or pattern of elements so unified as a whole that its properties cannot be derived from a simple summation of its parts.

Tension between Gestalt Psychology and Gestalt Therapy
"Perls’s Gestalt therapy should not be considered a clinical application or the development of Gestalt psychology." (p.254 History and Systems of Psychology. David Hothersall).

Field Theory
Kurt Lewin (1890-1947) adopted a Gestalt approach in developing an innovative field theory which addressed ….
Child development.
Industrial management.
Social Psychology.

Comparison of Gestalt Therapy to Other Therapies.

Most Different = Behavioral Therapies

Most Similar = Humanistic Theories


Comparison to Other Therapies.
Although similar in some ways to rational emotive behavior therapy (REBT) and cognitive therapy (CT), a gestalt therapist does not imply that they know the rational way to think.

In contrast to psychoanalysis, gestalt therapy emphasized the potential of the here and now.

History.
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 Horney and Wilhelm Reich.

Laura Perls.
Trained as a psychologist.
Worked with Gestalt psychologist Max Wethheimer.

The Perls.
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 was published in London under F.S. Perls’ name and included text reevaluating the psychoanalytical view on aggression
At the end of the war, the Perls emigrated to New York City.
Collaboration began with artists and intellectuals versed in philosophy, psychology, medicine, and education resulting in elaboration of Gestalt Theory, Gestalt Therapy and Gestalt Therapist.
In 1951 Julian Press published Gestalt Therapy: Excitement and Growth in the Human Personality by F.S. Perls, Ralph Hefferline, and Paul Goodman.

Current Status.
Gestalt Therapy Institutes internationally.
Virtually every major city in the U.S. has at least one Gestalt Institute.
Association for the Advancement of Gestalt Therapy formed to govern adherence to gestalt principles.
International Gestalt Therapy Association newly formed.
Four Major Journals.
International Gestalt Journal.
British Gestalt Journal.
Gestalt Review.
Australian Gestalt Journal.

Some Basic Principles of Gestalt Therapy Theory.

Focused on process (what is happening) rather than on content (what is being discussed).
"Gestalt" comes from the German word for "whole".
Focused 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.

Holism.
All of nature is seen as a unified whole. The whole is different from the sum of its parts.
We can only be understood to the extent that we consider all the dimensions of human functioning.
No superior value is place on any one aspect of the individual. Gestalt therapy attends to clients’ thoughts, feelings, behaviors, body, relationships, and dreams.

Field Theory.
Field - A set of mutually interdependent elements.
The organism must be seen in its environment (context), as part of the constantly changing field.
Everything is relational, in flux, interrelated, and in process.
Gestalt therapists pay attention to what is occurring at the boundary between the person and the environment.
The purpose of a boundary is to separate and connect us to others
Lewin thought of an individual as a complex energy field, a dynamic system of needs and tensions that directs perceptions and actions. Behavior (B) is a function (f) of a person (P) interacting with an environment (E).
B = f(P,E)

Basic Concepts (Continued).

Phenomenological.
The phenomenological perspective asserts that all reality is subjectively interpreted.
Objective reality, as defined by a gestalt therapist, is non-existent.

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 the respect to the whole" Heidbreder, 1933


Gestalt Theory recognizes that background and forefront change fluidly
Patient’s conflicts are regulated to background and are brought to forefront through therapy

Describes how the individual organizes the environment from moment to moment.
The undifferentiated field is called the background (or ground), and the emerging focus of attention is called the figure.
The figure-formation process tracks how some aspect of the environmental field emerges from the background and becomes the focal point of the individual’s attention.
The dominant needs of an individual at a given moment influence this process.

Holism
The idea that individuals are growth oriented, self-regulating and only understandable within the context of their environment

Gestalt Therapy is best considered as a form of existential therapy
The focus is on the …
what and how of behavior (not why).
here-and-now.
integrating fragmented parts of the
personality.
unfinished business from the past.

Boundaries.
Disturbances at the Boundaries.
Experiences that are blocked creates isolation.

Creative Adjustment.
Creative balance between changing the environment and adjusting to current conditions
According to Gestalt therapy psychological adjustment requires an awareness of our need states Achieving a balance between individual needs and the environment reflects creative adjustment.

Maturity.
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.
Polarities
Maladjustment occurs when polarities become rigid and are seen in dichotomies.
Positive mental health is seen as the ability for an individual to shift between figure and ground, in other words to be able to deal with competing concepts like life and death which are considered polarities.

Resistance
Gestalt Therapists see resistance as the process of opposing the formation of a threatening figure.
A gestalt therapist would view resistance as an attempt to maintain psychological integrity

The impasse is the point in therapy at which clients:
avoid experiencing threatening feelings.
experience a sense of "being stuck."
imagine something terrible will happen.
When a client remains stuck in nonfunctional ways of thinking and behaving a gestalt therapist would say the client is experiencing impasse.

People are inclined to towards growth and self regulation.
Conditions can impede growth.
People define themselves in relation to others.

The essential nature of the individual’s relationship with the environment is interdependence, not independence.
Individuals have the capacity to self-regulate in their environment.
Individuals can reown the parts of themselves they have disowned.

View of human nature is rooted in
- existential philosophy.
- phenomenology.
- field theory.

Gestalt Therapy’s Theory of Personality
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
Human regulation is either organismic or shouldistic.
Organismic.
Acknowledgement of what is.
Choosing and learning happen holistically
A natural integration of mind and body
Shouldistic
What one things should or should not be
Cognition reigns
Gestalt Therapy’s Theory of Personality

Consciousness and Unconsciousness
View is radically different from Freudian view
In gestalt therapy, the concept of unconscious is replaced by the concepts of awareness and unawareness
Concepts of awareness and unawareness replace the unconscious

Gestalt Therapy
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

The Figure-Formation Process
The figure-formation process tracks how some aspect of the environmental field emerges from the background and becomes the focal point of the individual’s attention.
The dominant needs of an individual at a given moment influence this process.

The Now
Initial goal is for clients to gain awareness of what they are experiencing and doing now
Promotes direct experiencing rather than the abstractness of talking about situations
Therapist directs clients to "bring the fantasy here"
Rather than talk about a childhood trauma the client is encouraged to become the hurt child
Ask "what" and "how" instead of "why"
Our "power is in the present"
Nothing exists except the "now"
The past is gone and the future has not yet arrived
For many people, the power of the present is lost
They may focus on their past mistakes or engage in endless resolutions and plans for the future

Unfinished Business
Feelings about the past are unexpressed
These feelings are associated with distinct memories and fantasies
Feelings not fully experienced linger in the background and interfere with effective contact
Pay attention on the bodily experience because if feelings are unexpressed they tend to result in physical symptom
Result:
Preoccupation, compulsive behavior, wariness oppressive energy and self-defeating behavior
Solution: get in touch with the stuck point (impasse).

Contact and Resistances to Contact
CONTACT – The gestalt term describing an individual's ability to focus on the here and now
Interacting with nature and with other people without losing one’s individuality
Contact (connect) and Withdrawal (separate)
RESISTANCE TO CONTACT – the defenses we develop to prevent us from experiencing the present fully

Five major channels of resistance:
1. Introjection: uncritically accept others’ belief and standards without thinking whether they are congruent with who we are
2. Projection: the reverse of introjection; we disown certain aspect of ourselves by assigning them to the environment
3. Retroflection: turning back to ourselves what we would like to do to someone else
Directing aggression inward that we are fearful to directing toward others.
4. Deflection: The process of distraction, or fleeting awareness that makes it difficult to maintain sustained contact. A way of avoiding contact and awareness by being vague or indirect.
e.g., overuse of humor
5. Confluence: less differentiation between the self and the environment.
e.g., a need to be accepted---to stay safe by going alone with other and not expressing one’s true feeling and opinions.
e.g., A parent and a child become so enmeshed that the child can no longer experience a sense of separate identity.

Clients are encouraged to become increasingly aware of their dominant style of blocking contact

Energy and blocks to energy
Pay attention to where energy is located, how it is used, and how it can be blocked
Blocked energy (resistance):
Tension some part of the body; numbing feelings, looking away from people when speaking, speaking with a restricted voice
Recognize how their resistance is being expressed in their body
Exaggerate their tension and tightness in order to discover themselves

Gestalt psychotherapy is focused on process rather than on content

Main Gestalt Therapy Principles
Awareness
Direct experience
Contact
Relationship
Experimentation
Phenomenological focusing

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 a safe environment and strengthens the client’s self-awareness

2. Presence
The Gestalt Therapist expresses their observations, preferences, feelings, personal experience and thoughts to the client
Therapist is modeling phenomenological reporting
Enhances client’s trust and use of immediate experience to raise awareness

3. Commitment to dialogue
Contact refers to something that happens in an interaction
Therapist allows contact to happen rather than making contact happen

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

Techniques of Client Focusing elaborations of …
"What are you aware of (experiencing) now? And "Try this experiment and see what you become aware of (experience) or learn."
The Gestalt therapist pays attention to the client's nonverbal language.

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 where what is of primary concern and interest to the organism, the relationship, the group or society becomes the gestalt and into the foreground
Primary concerns are fully faced, worked through, sorted out, changed, or eliminated
As one becomes aware of and faces concerns they can become the background which leaves the foreground free for the next primary gestalt

Stay with it
Therapist encourages client to follow a report of awareness with the instruction: "Stay with it" or "Feel it out"

Enactment
Therapist asks the client to act out feelings or thoughts to increase awareness
Gestalt therapy's empty chair technique, in which a patient is encouraged to express feelings to others or themselves in a symbolic manner enactment

Exaggeration
A special form of enactment where the therapist asks the client to exaggerate some feeling, thought, or movement to feel it more intensely
Main Tools of Gestalt Therapy

Loosening and Integrating
Therapist asks the client to imagine the opposite of whatever is believed to be true
Integrating techniques bring together processes – the client keeps alert
Examples might include asking a client to put words to crying; identifying where in the body one feels an emotion; Or asking a client to express positive and negative feelings about the same person

Guided Fantasy
Therapist encourages visualizing rather than enacting

Body Techniques
Therapist provides ideas about how the client can increase awareness of their body functioning
Examples would be teaching the client breathing exercises or to hold the body in a certain posture while feeling a certain emotion

Therapist Disclosures
Therapist uses "I" statements judiciously to enhance therapeutic contact and the client’s awareness
Requires wisdom to know when to self disclose
Therapists may share what they are experiencing in their senses or emotions
In most types of therapy, the therapist may not reveal considerable amounts of information about themselves. In gestalt therapy, therapist disclosure is considered appropriate if done judiciously

Reversal technique
A Gestalt technique that is most useful when a person attempts to deny an aspect of his or her personality (such as tenderness)

The Gestalt approach to dreams
Ask the client to become all parts of his or her own dream. The client interprets and discovers the meaning of the dream for himself or herself.

Therapeutic Goals
The basic goal of Gestalt therapy is attaining awareness, and with it greater choice.
Awareness includes knowing the environment, knowing oneself, accepting oneself, and being able to make contact.
Stay with their awareness, unfinished business will emerge.

Dialogue b/w client and therapist is stressed.
The therapist has no agenda, no desire to get anywhere)
The therapist understands that the essential nature of the individuals relationship with the environment is interdependent, not independent.
Therapy is a spontaneous; here and now experience

Therapist’s function and Role
Increase clients’ awareness
Pay attention to the present moment
Pay attention to clients’ body language, nonverbal language, and inconsistence b/w verbal and nonverbal message (e.g., anger and smile)
"I" message
Therapist’s function and Role
Pay attention to language patterns.
Language can both describe and conceal

Examples of the aspects of language that Gestalt therapist might focus on.
1. "It" talk – "it" instead of "I"
(depersonalizing language) e.g., "It is difficult to make friends" instead of "I have difficulty making friends"
2. "You" talk – "you" instead of "I" (global and impersonal)
3. Questions - keep the questioner hidden, safe, and unknown.
4. Language that denies power – qualifiers and disclaimers such as "perhaps", "sort of", "I guess", "possibly", "I suppose"
5. "I can’t " talk – instead of "I won’t"
6. Listening to metaphors
- It’s hard for me to spill my guts
- I don’t have a leg to stand on
- I feel like a have a hole in my soul
- I feel ripped to shreds
- I feel like I’ve been put through a
meat grinder
6. Listening to metaphors
Seek to translate the meaning of these metaphors into manifest content so that it can be dealt with in therapy.
e.g., "What is your experience of being ground meat?" "Who is doing the grinding"
7. Listening to language that uncovers the story (fleshing out the flash).
Clients often use language that is elusive yet significant clues to a story that illustrate their life struggles. Clients slide over pregnant phrases but alert therapist can help flesh out their story line.

Client’s Experience in Therapy
General orientation is dialogue
Therapist à no interpretation that explain why they are acting in certain ways.
Client à making their own interpretation
Three-stage (Polster, 1987)
Discovery (increasing awareness)
Accommodation (recognizing that they have a choice)
Assimilation (influencing their environment)

Relationship Between Therapist and Client

Person-to-person
The quality of therapist-client relationship
Therapists knowing themselves
Therapists share their experience to clients in the here-and-now

Therapist's Use of self in therapy
Therapeutic techniques and procedures
The experiential work
Use experiential work in therapy to work through the stuck points and get new insights

Preparing client for experiential work
Get permission from clients
Be sensitive to the cultural difference (e.g., Asian cultural value: emotional control). Know when to leave the client alone.

Respect resistance
Therapeutic techniques and procedures
Increase awareness about the incongruence between mind and body (verbal and nonverbal expression)

Therapeutic techniques and procedures

1. The internal dialogue exercise – Pay close attention to splits in personality function.
Top dog - is righteous, authoritarian, moralistic, demanding, bossy. The critical parent that badgers w/ "shoulds" &"oughts"
Underdog – manipulates by playing the role of a victim: defensive, apologetic, helpless, weak, and feigning powerlessness.
The top dog demands thus-and-so while the underdog defiantly plays the role of disobedient child.
As a result of this struggle for control, the individual becomes fragmented into controller and controlled.
The conflict between top dog and underdog is rooted in the mechanism of introjection which involves incorporating aspects of others, usually parents, into one’s ego system.
It is essential that clients become aware of toxic introjects that poison the system and prevent personality integration.

The empty chair – is one way of getting the client to externalize introjects.
Use two empty chairs. Ask the client to sit in one chair and be fully the top dog and then shift to the other chair and become the underdog.
As introjects surface the client can experience the conflict more fully. The conflict can be resolved by the clients acceptance and integration of both sides.
This technique helps clients get in touch with a feeling or a side of themselves that they may be denying.
Rather than talking about the conflicted feeling, they intensify the feeling and experience it fully. Further, by helping the clients realize that the feeling is a very real part of themselves, the intervention discourages them from disassociating the feeling.
The goal of this exercise is to promote a higher level of integration between the polarities and conflicts that exist in everyone.
The aim is not to ride oneself of certain traits but to learn to accept and live with the polarities.

2. Making the rounds
The purpose is to confront, to risk, to disclose the self, to experiment with new behavior, and to grow and change.
Is most useful when a person attempts to deny an aspect of his or her personality (such as tenderness)
Therapeutic techniques and procedures

Example – A group member does not participate. Experiment - Go around to each person and say "What makes it hard for me trust you is……" OR "I’d like to make contact with you but I’m afraid of being rejected [or accepted]"

3. Rehearsal exercise
Reverse the typical style (e.g., a pessimist is directed to act like an optimist, a critical negative client is directed to act positive)
Plunge into the very thing that is fraught with anxiety and make contact with those parts of themselves that have been denied.
Goal – e.g., accept positive and negative side.
May get stuck when rehearsing silently or internally
Share the rehearsals out load with a therapist

4. Exaggeration exercise
Helps client become aware of the subtle signals and cues they are sending through body language.
Exaggerate a gesture or movement repeatedly, which usually intensified the feelings attached to the behavior and makes the inner meaning clearer.

4. Exaggeration exercise
Movements, postures, and gestures may communicate significant meanings, yet the cues may be incomplete. So the client is asked to exaggerate the movement or gesture repeatedly, which usually intensifies the feeling attached to the behaviors and makes the meaning clearer.
e.g., trembling (shaking hands, legs), slouched posture, clenched fists, tight frowning, crossed arms, etc. Then the therapist asks the client to put words to the movements.

5. Staying with the feeling
Clients may want to avoid unpleasant feelings.
At key moments when the client attempt to flee from the feeling the therapist may ask the client to stay with the feeling they wish to avoid.
Go deeper into the feelings they wish to avoid
Facing, confronting, and experiencing feelings not only takes courage but is also a mark of a willingness to endure the pain necessary for unblocking and making way for newer levels of growth.


6. The Gestalt approach to dream work
Not interpret or analyze dreams
Bring dream back to life as though they were happening now
The dream is acted out in the present to become different parts of the dream
Projection: every person or object in the dream represents a projected aspect of the dreamer.
Royal road to integration
Dreams serve as an excellent way to discover personality
No remember-à refuse to face what it is at that time

From a multicultural perspective
Must work with clients from their cultural perspectives

Limitations
Focus on "affect"
Asian cultural value: emotional control
Prohibiting to directly express the negative feelings to their parents.

A contribution of this therapeutic approach is that
it enables intense experiencing to occur quickly.
it can be a relatively brief therapy.
it stresses doing and experiencing, as opposed to talking about problems.

Summary and Evaluation

Gestalt therapy encourages clients to
experience feelings intensely.
stay in the here-and-now.
work through the impasse.
pay attention to their own nonverbal messages.

According to Gestalt theory, people use avoidance in order to:
keep themselves from facing unfinished business.
keep from feeling uncomfortable emotions.
keep from having to change.

In Gestalt therapy, the relationship between client and counselor is seen as
A joint venture
An existential encounter
An I/Thou interaction

Limitations of Gestalt Therapy
Clients who have been culturally conditioned to be emotionally reserved might not see value in experiential techniques.
Clients may be "put off" by a focus on catharsis.
Clients may believe that to show one's vulnerability is to be weak.
Ineffective therapists may manipulate the clients with powerful experiential work.

Some people may need psycho-education.

Application
Anxiety
Depression
Perfection driven
Phobic
Crisis intervention
Groups
Couples

Psychosomatic disorders including migraine, spastic neck and back pain
Does not rely heavily on formal diagnostic evaluations and research methodology
Gestalt Therapists do not believe that a statistical approach can tell the individual client or therapist what works for him or her
All interactions are seen as experiments involving calculated risk taking
Caution when attempting to treat psychotic, disorganized, personality disorders, or severe mental illness. Should not be used with these disorders unless a long-term commitment is possible

2 comments:

Luisa Elberg said...

Thank you, Jeff Garrett!!

LeaMikhaela said...

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

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