Gestalt therapy

Gestalt therapy

History

Precursors

The history of Gestalt therapy starts with the professional development of Fritz Perls and the zeitgeist in which he lived. After acquiring the M.D. degree, Perls went to Frankfurt-am-Main in 1926 as an assistant to Kurt Goldstein at the Institute for Brain Damaged Soldiers. Here he was exposed to Professors Goldstein and Adhemar Gelb and he met his future wife, Laura. At that time Frankfurt-am-Main was a center of intellectual ferment and Perls was directly and indirectly exposed to leading Gestalt psychologists, existential philosophers and psychoanalysts.

Fritz Perls became a psychoanalyst. He was influenced directly by Karen Horney and Wilhelm Reich, and indirectly by Otto Rank and others. Perls was especially influenced by Wilhelm Reich, who was Perls' analyst in the early 1930s, and "who first directed my attention to a most important aspect of psychosomatic medicine -- to the function of the motoric system as an armor" (F. Perls, 1947, p. 3).

Three influences on Perls' intellectual development should be noted. One was the philosopher, Sigmund Friedlander, from whose philosophy Perls incorporated the concepts of differential thinking and creative indifference, spelled out in Perls' first book, Ego, Hunger and Aggression (1947). Perls was also influenced by Jan Smuts, the prime minister of South Africa when Perls moved there with his family (having first escaped from Nazi Germany and then Nazi-occupied Holland). Before becoming prime minister, Smuts had written a major book on holism and evolution that, in effect, examined the broader ecological world from a Gestalt perspective. Smuts coined the word holism. Third, Alfred Korzybski, the semanticist, was an influence on Perls' intellectual development.

Laura Posner Perls was a co-founder of Gestalt therapy. Her influence on Perls was generally known, and she wrote a chapter in Ego, Hunger and Aggression. She was a psychology student at the time she met Perls, receiving the D.Sc. degree from the University of Frankfurt in 1932. She had contact with and was influenced by the existential theologians Martin Buber and Paul Tillich. Much of the Gestalt, phenomenological and existential influences in Gestalt therapy are through her, although credit and influence were limited by how little she wrote under her name (Rosenfeld, 1978).

Although Perls was a training psychoanalyst, he was among those who chafed under the dogmatism of classical Freudian psychoanalysis. The 1920s, 1930s, and 1940s were periods of great ferment and rebellion against Newtonian positivism. This was true in science (for example, Einstein's field theory), theater and dance, philosophy, art, architecture and existentialism. Both Laura and Fritz lived in a zeitgeist permeated by a phenomenological-existential influence that later become interacted into Gestalt therapy (Kogan, 1976). Among these were acknowledgment of responsibility and choice in creating one's personal existence, the primacy of existence over essence, and the existential dialogue.

Gestalt psychology provided Perls with the organizing principle for Gestalt therapy as an integrating framework. Gestalt refers to the configuration or pattern of a set of elements. Gestalt psychologists believe that organisms instinctively perceive whole patterns and not bits and pieces. Whole patterns have characteristics that cannot be gleaned by analyzing parts. Perception is an active process and not a result of passively received stimulation of sense organs. All situations are believed to possess inherent organization. Organisms have the capacity for accurate perception when they use their native ability of immediate experience in the here and now. The task of phenomenological research and therapy is to utilize this capacity to gain insight into the structure of that which is being studied. Because people naturally perceive whole patterns as they occur, actual awareness can be trusted more than interpretation and dogma.

Beginnings

Perls' Ego, Hunger and Aggression was written in 1941-1942. In its first publication in South Africa in 1946 it was subtitled A Revision of Freud's Theory and Method. The subtitle of the book when it appeared in 1966 was changed to The Beginning of Gestalt Therapy. The term "Gestalt therapy" was first used as the title of a book written by Frederick Perls, Ralph Hefferline and Paul Goodman (1951). Shortly after, the New York Institute for Gestalt therapy was organized, headquartered in the apartment of Fritz and Laura Perls in New York City. This apartment was used for seminars, workshops and groups. Among those who studied with Perls at that time were Paul Weisz, Lotte Weidenfeld, Buck Eastman, Paul Goodman, Isadore From, Elliot Shapiro, Leo Chalfen, Iris Sanguilano, James Simkin and Kenneth A. Fisher.

During the 1950s, intensive workshops and study groups were established throughout the country. Before the American Psychological Association Convention held in New York City in 1954, a special intensive workshop limited to 15 qualified psychologists was given over a three-day period. Similar workshops were held in Cleveland, Miami and Los Angeles. In 1955 the Cleveland study group formed the Gestalt Institute of Cleveland.

Fritz Perls moved to the West Coast in 1960, at which time Simkin arranged a Gestalt therapy workshop for him. Perls, Walter Kempler and James Simkin offered the first Gestalt therapy training workshops at the Esalen Institute during the summer of 1964. These training workshops continued under the leadership of Perls and Simkin through 1968. After Perls moved to Canada, Simkin, along with Irma Shepherd, Robert W. Resnick, Robert L. Martin, Jack Downing and John Enright, continued to offer Gestalt therapy training at Esalen through 1970.

During this beginning period Gestalt therapy pioneered many ideas subsequently accepted into eclectic psychotherapy practice. The excitement of direct contact between therapist and patient, the emphasis on direct experience, the use of active experimentation, the emphasis on the here and now, the responsibility of the patient for himself or herself, the awareness principle, the trust in organismic self-regulation, the ecological interdependence of person and environment, the principle of assimilation, and other such concepts were new, exciting and shocking to a conservative establishment. In this period the practice of psychotherapy was dichotomized between the older, traditional approach of psychoanalytic drive theory and the ideas pioneered largely by Gestalt therapy. This was a period of expansion, with integration of the principles with each other and the elucidation and enucleation of the principles left for the future. Thus, for example, Gestalt therapy pioneered the use of the active presence of the therapist in a contactful relationship but did not consider in detail what constituted a healing dialogic presence.

Current Status

There are at least 62 Gestalt therapy institutes throughout the world, and the list continues to grow. Virtually every major city in the United States has at least one Gestalt institute.

No national organization has been established. As a result, there are no established standards for institutes, trainers and trainees. Each institute has its own criteria for training, membership selection, and so on. Attempts in the recent past to organize a nationwide conference for establishing standards for trainers have not been successful. There are no agreed-upon standards for what constitutes good Gestalt therapy or a good Gestalt therapist. Therefore, it is incumbent on Gestalt therapy consumers to carefully evaluate the educational, clinical, and training background of people who call themselves Gestalt therapists or give training in Gestalt therapy (see Yontef, 1981a, 1981b).

The Gestalt Journal is devoted primarily to articles on Gestalt therapy. Gestalt Theory publishes articles on Gestalt psychology, including some on Gestalt therapy. Bibliographic information can be obtained from Kogan (1980), Rosenfeld (1981), and Wysong (1986).

As experience in doing Gestalt therapy has grown, earlier therapeutic practices have been altered. For example, earlier Gestalt therapy practice often stressed the clinical use of frustration, a confusion of self-sufficiency with self-support, and an abrasive attitude if the patient was interpreted by the therapist as manipulative. This approach tended to enhance the shame of shame-oriented patients. There has been a movement toward more softness in Gestalt therapy practice, more direct self-expression by the therapist, more of a dialogic emphasis, decreased use of stereotypic techniques, increased emphasis on description of character structure (with utilization of psychoanalytic formulations), and increased use of group process.

Thus a patient is more likely to encounter, among Gestalt therapists who are involved in the newer mode, an emphasis on self-acceptance, a softer demeanor by the therapist, more trust of the patient's phenomenology, and more explicit work with psychodynamic themes. There has also been an increase in emphasis on group process, including relation between group members, and a decrease in formal, one-to-one work in groups. There is also an increased attention to theoretical instruction, theoretical exposition, and work with cognition in general.

Goal of Therapy

In Gestalt, the only goal is awareness. This includes greater awareness in a particular area and also greater ability for the patient to bring automatic habits into awareness as needed. In the former sense awareness is a content, in the latter sense it is a process. Both awareness as content and awareness as process progress to deeper levels as the therapy proceeds. Awareness includes knowing the environment, responsibility for choices, self-knowledge, and self-acceptance, and the ability to contact.

Beginning patients are chiefly concerned with the solution of problems. The issue for the Gestalt therapist is how patients support themselves in solving problems. Gestalt therapy facilitates problem solving through increased self-regulation and self-support by the patient. As therapy goes on, the patient and the therapist turn more attention to general personality issues. By the end of successful therapy the patient directs much of the work and is able to integrate problem solving, characterological themes, relationship issues with the therapist, and means of regulating his or her own awareness.

Gestalt therapy is most useful for patients open to working on self-awareness and for those who want natural mastery of their awareness process. Although some people claim they are interested in changing their behavior, most people seeking psychotherapy mainly want relief from discomfort. Their complaint may be generalized malaise, specific discomforts, or dissatisfaction in relationships. Patients often expect that relief will result from their therapist's doing the work rather than from their own efforts.

Psychotherapy is most appropriate for persons who create anxiety, depression, and so forth by rejecting themselves, alienating aspects of themselves, and deceiving themselves. In short, people who do not know how they further their own unhappiness are prime candidates, providing they are open to awareness work, especially awareness of self-regulation. Gestalt therapy is especially appropriate for those who know intellectually about themselves and yet don't grow.

Those who want symptom relief without doing awareness work may be better candidates for behavior modification, medication, biofeedback, and so on. The direct methods of Gestalt therapy facilitate patients' making this choice early in the therapy. However, patients' difficulty in doing the contact or awareness work should not automatically be interpreted as meaning that they do not want to work. Respect for the total person enables a Gestalt therapist to help the patients become clear about the differences between "can't" and "won't" and to know how internal barriers or resistance, such as prior learning, anxiety, shame and sensitivity to narcissistic injury, inhibit awareness work.

No "Shoulds"

There are no "shoulds" in Gestalt therapy. In Gestalt therapy a higher value is placed on the autonomy and the self-determination for the patient than on other values. This is not a should, but a preference. The no-should ethic takes precedence over the therapist's goals for the patient and leaves the responsibility and sanctioning of the patient's behavior to the patient (of course, the injunctions and requirements of society are not suspended just because the patient is in Gestalt therapy).

How Is the Therapy Done?

Gestalt therapy is an exploration rather than a direct modification of behavior. The goal is growth and autonomy through an increase in consciousness. Rather than maintaining distance and interpreting, the Gestalt therapist meets patients and guides active awareness work. The therapist's active presence is alive and excited (hence warm), honest and direct. Patients can see, hear and be told how they are experienced, what is seen, how the therapist feels, what the therapist is like as a person. Growth occurs from real contact between real people. Patients learn how they are seen and how their awareness process is limited, not primarily by talking about their problems, but by how they and the therapist engage each other.

Focusing runs the range from simple inclusions or empathy to exercises arising mostly from the therapist's phenomenology while with the patient. Everything is secondary to the direct experience of both participants.

The general approach of Gestalt therapy is to facilitate exploring in ways that maximize what continues to develop after the session and without the therapist. The patient is often left unfinished but thoughtful or "opened up," or with an assignment. This is like a roast that continues to cook after being removed from the oven. This is in part how Gestalt therapy can be so intensive on fewer sessions per week. We cooperate with growth occurring without us; we initiate where needed. We give the degree of facilitation necessary to foster patient self-improvement. We facilitate growth rather than complete a cure process.

Perls believed that the ultimate goal of psychotherapy was the achievement of "that amount of integration which facilitates its own development" (1948). An example of this kind of facilitation is the analogy of a small hole cut into an accumulation of snow. Once the draining process begins, the base that began as a small hole enlarges by itself.

Successful psychotherapy achieves integration. Integration requires identification with all vital functions -- not with only some of the patient's ideas, emotions and actions. Any rejection of one's own ideas, emotions or actions results in alienation. Reowning allows the person to be whole. The task, then, in therapy is to have the person become aware of previously alienated parts and taste them, consider them and assimilate them if they are ego-syntonic or reject them if they prove to be ego-alien. Simkin (1968) has used the simile of a cake in encouraging patients to reown the parts of themselves that they have considered noxious or otherwise unacceptable: although the oil, or flour, or baking powder by themselves can be distasteful, they are indispensable to the success of the whole cake.

The I-Thou Relation

Gestalt therapy focuses on the patient, as any therapy does. However, the relationship is horizontal, thus differing from the traditional therapy relationship. In Gestalt therapy the therapist and patient speak the same language, the language of present centeredness, emphasizing direct experience of both participants. Therapists as well as patients in Gestalt therapy show their full presence.

Since its beginning, Gestalt therapy has emphasized the patient's experience as well as the therapist's observation of what is not in the patient's awareness. This allows the patient to act as an equal who has full access to the data of his own experience so he can directly experience from inside what is observedby the therapist from outside. In an interpretive system the patient is an amateur and does not have the theoretical foundation for the interpretation. It is assumed that the important internal data are unconscious and not experienced.

An important aspect of the Gestalt therapy relationship is the question of responsibility. Gestalt therapy emphasizes that both the therapist and the patient are self-responsible. When therapists regard themselves as responsible for patients, they collude with patients' not feeling self-responsible and thereby reinforce the necessity for manipulation due to the belief that patients are unable to support and regulate themselves. However, it is not enough for the therapist to be responsible for self and for the patient to be responsible for self -- there is also an alliance of patient and therapist that must be carefully constantly, and competently attended to.

Therapists are responsible for the quality and quantity of their presence, for knowledge about themselves and the patient, for maintaining a nondefensive posture, and for keeping their awareness and contact processes clear and matched to the patient. They are responsible for the consequences of their own behavior and for establishing and maintaining the therapeutic atmosphere.

The Awareness of What and How

In Gestalt therapy there is a constant and careful emphasis on what the patient does and how it is done. What does the patient face? How does the patient make choices? Does the patient self-support or resist? Direct experience is the tool, and it is expanded beyond what is at first experienced by continuing to focus deeper and broader. The techniques of Gestalt therapy are experimental tasks. They are the means of expanding direct experience. These are not designed to get the patient somewhere, to change the patient's feelings, to recondition, or to foster catharsis.

Here and Now

In a phenomenological therapy "now" starts with the present awareness of the patient. What happens first is not childhood, but what is experienced now. Awareness takes place now. Prior events may be the object of present awareness, but the awareness process (e.g., remembering) is now.

Now I can contact the world around me, or now I can contact memories or expectations. Not knowing the present, not remembering, or not anticipating are all disturbances. The present is an ever-moving transition between the past and future. Frequently patients do not know their current behavior In some cases patients live in the present as if they had no past. Most patients live in the future as if it were now. All these are disturbances of time awareness.

"Now" refers to this moment. In the therapy hour, when the patients refer to their lives out of the hour, or earlier in the hour, that is not now. In Gestalt therapy we orient more to the now than in any other form of psychotherapy. Experiences of the past few minutes, days, years or decades that are of present importance are dealt with. We attempt to move from talking about to directly experiencing. For example, talking to a person who is not physically present rather than talking about that person mobilizes more direct experience of feelings.

In Gestalt therapy this I and Thou, what and how, here and now methodology is frequently used to work on characterological and developmental psychodynamics.

For example, a 30-year-old female patient is in group therapy. 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." Instead, the therapist takes a different tack:

T: You sound not only angry but something more.

P: [looks interested]

T: You sound and look like you are enraged.

P: I am, I would like to kill him.

T: You seem to feel impotent.

P: I am.

T: Impotence usually accompanies rage. What are you impotent about?

P: I can't get him to acknowledge me.

T: [the therapist's observations of her previous encounters with the man agree with that statement] and you don't accept that.

P: No.

T: And there is an intensity to your rage that seems to be greater than the situation calls for.

P: [nods and pauses]

T: What are you experiencing?

P: A lot of men in my life who have been like that.

T: Like your father? [this comes from prior work with patient and isn't a shot in the dark. The work proceeds into a reexperiencing the narcissistic injury from her father, who was never responsive to her]

GESTALT THERAPY: OVERVIEW AND KEY CONCEPTS

 “I do my thing and you do your thing.
I am not in this world to live up to your expectations
And you are not in this world to live up to mine.
You are you and I am I,
And if by chance we find each other, it’s beautiful.
If not, it cannot be helped.” (Fritz Perls, 1969, in Gladding, 2000)

Gestalt Therapy was developed in the 1940’s by Fritz and Laura Perls and further influenced by the likes of Kurt Lewin and Kurt Goldstein (Corsini & Wedding, 2000). It was developed as a revision to psychoanalysis and focuses on an experiential and humanistic approach rather than analysis of the unconscious which was one of the main therapeutic tools at the time Gestalt Therapy was employed.

Gestalt Therapy rejects the dualities of mind and body, body and soul, thinking and feeling, and feeling and action. According to Perls, people are not made up of separate components, this is, mind, body and soul, rather human beings function as a whole. In doing so, one defines who one is (sense of self) by choice of responses to environmental interactions (boundaries). The word “Gestalt” (of German origin) refers to a “whole, configuration, integration, pattern or form” (Patterson, 1986).

The form of Gestalt Therapy practiced today utilises ideas, data and interventions from multiple sources, as well as some of the original techniques known to be ‘Gestalt Therapy techniques’. It is noted that Gestalt Therapy has a history of being an approach which creates or borrows specific techniques that are focused on assisting the client to take the next step in their personal growth and development.

Key Concepts

Several key concepts underlie Gestalt Therapy, many of which are similar to that of person-centred and existential therapy. However, what does differentiate Gestalt Therapy from these therapies are some of the ideas added by Perls and associates as well as distinctive therapeutic techniques that will be covered further down (Seligman, 2006). The following are the key concepts of Gestalt Therapy:

Wholeness and Integration: Wholeness refers to the whole person or the individual’s mind and body as a unit rather than as separate parts (Seligman, 2006). 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.

Awareness: Awareness is one of the most important elements in Gestalt Therapy as it is seen as a “hallmark of the healthy person and a goal of treatment” (Seligman, 2006). When individuals are “aware”, they are able to self-regulate in their environment.

There are two main causes lacking awareness:

1. Preoccupation with one’s past, fantasies, flaws and strengths that the individual becomes unaware of the whole picture.
2. Low self-esteem.

There are three ways people may achieve awareness through therapy:

1. 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.
2. Here and now: This is the individual living in and being conscious at the present moment rather than worrying about the past or the future.
3. Responsibility: 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, 2005). 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: 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, 2006).

Unfinished business: Unfinished business refers to people who do not finish things in their lives and is often related to people with a “growth disorder” (Seligman, 2006). 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.

A psychologically healthy person is someone who is self-regulating through the changes in life and has developed a sense of “wholeness” between mind and body (Corsini & Wedding, (2000).

Therapeutic Techniques & Methods of Working

The most important goal of Gestalt Therapy is that Gestalt Therapists do not aim to change their clients. The therapist’s role is to assist clients in developing their own self-awareness of how they are in the present moment. This will therefore allow them to rectify issues affecting his or her life.

“The therapist’s job is to invite clients into an active partnership where they can learn about themselves by adopting an experiential attitude toward life in which they try out new behaviours and notice what happens” (Perls, Hefferline and Goodman, 1954, in Corey, 2005).

A focus of developing awareness is that of clients’ awareness of their own realities. In order to do this, clients must first accept responsibility for choosing their present situations. Language plays a big part in accepting responsibility. The client may attempt to use avoidance responses or project individual traits onto other people or external causes, for example “She makes me so angry”; “It’s his fault”. Both avoidance responses and projection of traits attempt to displace ownership and responsibility onto an external cause.

Another goal of Gestalt Therapy is that therapists should work to create an “I-thou” relationship with clients in which both the therapist and client are present in the here-and-now rather than focusing on the past or future (Seligman, 2006).

Also, an understanding of the whole of the client’s experience is required by the therapist. This involves considering the client’s verbal and non-verbal communication. In fact, the nonverbal communication is seen to provide more information about the real essence of the person.

Thus, an important function of the Gestalt Therapist is paying attention to the client’s body language such as the client’s posture, movements, gestures, voice, and hesitations as the body language is considered to be reflective of what the client is going through at that point in time.

Experiments: Gestalt Therapists use the technique of experiments or learning experiences with their clients. The experiments are designed for the individual and take the form of an enactment, role play, homework, or other activity which promotes the individual’s self-awareness (Seligman, 2006).

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. Spending time thinking about what he might say promotes self-awareness and the experiment itself gives him more confidence in social situations.

Use of Language: Gestalt Therapists choose language that will encourage change in the client. The following are ways that this can be accomplished (Seligman, 2006):

1. Emphasis on statements rather than questions to highlight a collaborative client-therapist relationship.
2. “What” and “How” questions (when questions are used) to keep the client in the present and promote integration.
3. “I” statements are used to promote clients ownership of feelings rather than placing blame on others.
4. The present tense is used so the focus is on the present rather than the past.
5. Encouraging responsibility for clients of their words, emotions, thoughts, and behaviours so they recognize and accept what they are feeling.

Empty Chair: The empty chair technique is a “method of facilitating the role-taking dialogue between the patient and others or between parts of the patient’s personality. It is generally used in a group situation” (Patterson, 1986). Two chairs are placed facing each other: one represents the patient or one aspect of the patient’s personality, and the other represents another person or the opposing part of the personality. As the patient alternates the role, he or she sits in one or the other chair.

The therapist may simply observe as the dialogue progresses or may instruct the patient when to change chairs, suggest sentences to say, call the patient’s attention to what has been said, or ask the patient to repeat or exaggerate words or actions.

In the process, emotions and conflicts are evoked, impasses may be brought about and resolved, and awareness and integration of polarities may develop — polarities or splits within the patient, between the patient and other persons, or between the patient’s wants and the social norms (Patterson, 1986).

Topdog — Underdog: A commonly utilised Gestalt technique is that of the topdog-underdog dialogue. This technique is used when the therapist notices two opposing opinions/attitudes within the client. The therapist encourages the client to distinguish between these two parts and play the role of each in a dialogue between them (Patterson, 1986).

The tyrannical ‘topdog’ demands that things be a particular way whilst the ‘underdog’ plays the role of disobedient child. The individual becomes split between the two sides struggling for control.

Dreams: Dreams are used to bring about integration by the client. The focus of a client’s dream is not on the unconscious, rather on projections or aspects of the dreamer (Seligman, 2006). The therapist would get clients to talk about their dream/s in terms of the significance of each role in the dream and this allows clients to take responsibility for the dreams and increase awareness of their thoughts and emotions.

Fantasy: Fantasy is used in Gestalt Therapy to increase clients’ self-awareness of their thoughts and emotions and to bring about closure to unfinished business (Seligman, 2006). Therapists use guided imagery techniques (fantasy) to encourage clients to imagine situations such as what they would do in a certain situation or by projecting themselves into different roles.

The Body as a Vehicle of Communication: Gestalt Therapy sees that not only are thoughts and emotions important to creating a feeling of “wholeness” for the client, the physical sensations are also important. Seligman (2006) has identified three strategies to help with focusing attention on the physical sensations:

Identification: Gestalt Therapists should be able to recognise physical signs of their clients. For example, a client might be tapping their feet on the ground. The therapist may say “Become your leg and give it a voice?” This creates awareness of the client’s physical sensations and emotions.

Locating emotions in the body: Gestalt Therapists may ask clients where they are experiencing the emotion in their body. For example, a client may say they are feeling nervous about something. The therapist may ask where this is coming from in the body and the response from the client may be that the feeling is butterflies in the stomach. This helps the client to bring about more awareness into sensations and their emotions.

Repetition and exaggeration: If there is repetition such as the example of the client tapping their feet on the ground, the therapist would get them to exaggerate the movement and talk about feelings that come up. This in turn focuses on the emotion and should help to release the blocked awareness.

Confusion: The technique of dealing with confusion of the client is about drawing attention to the client’s hesitation in talking about something unpleasant. The hesitation can be shown through avoidance, blanking out, verbalism and fantasy (Patterson, 1986). By drawing attention to the hesitation, it creates self-awareness for the client and allows the client to work through the issue.

Confrontation: In Gestalt Therapy, confrontation means ‘to challenge or frustrate the client’. The client is challenged with sensitivity and empathy on the part of the therapist to face the issues important to them. It is an invaluable tool for bringing clients into clear awareness of their realities, when used appropriately. However, confrontation is not a technique that can be used with all clients.

Applications

Originally Gestalt Therapy was predominantly used to treat individuals who were anxious and/or depressed and who were not showing serious pathological symptoms. Although still used in the treatment of anxiety and depression, Gestalt Therapy has been effective in treating clients with personality disorders such as borderline personality disorder.

Gestalt Therapy is also effective in counselling groups, couples, and families (Corsini & Wedding, 2000).

Strengths

1. There is empirical research to support Gestalt Therapy and its techniques (Corsini & Wedding, 2000). Specifically,
2. Gestalt Therapy is equal to or greater than other therapies in treating various disorders, Gestalt Therapy has a beneficial impact with personality disorders, and the effects of therapy are stable.
3. Works with the past by making it relevant to the present (Corey, 2005).
4. Versatile and flexible in its approach to therapy. It has many techniques and may be applied to different therapeutic issues.

Weaknesses

1. For Gestalt Therapy to be effective, the therapist must have a high level of personal development (Corey, 2005).
2. Effectiveness of the confronting and theatrical techniques of Gestalt Therapy is limited and has not been well established.
3. It has been considered to be a self-centred approach which is concerned with just individual development.
4. Potential danger for therapists to abuse the power they have with clients (Corey, 2005).
5. Lacks a strong theoretical base.
6. Deals only with the here and now.
7. Does not deal with diagnosis and testing.

Conclusion

Gestalt Therapy focuses on the integration between the “whole” person and his or her environment. This therapy sees a healthy individual as being someone who has awareness in his or her life and lives in the here and now rather than focusing on the past or future. Gestalt Therapy has a number of successful techniques that are applicable in therapy today and may be utilised across a broad spectrum of emotional issues.

Theory of Psychopathology

A pathological person is stuck in a growth disorder (alternative word to neurosis).  Perls (Founder of Gestalt Therapy) believed there were 5 stages of psychopathology: the phony; the phobic; the impasse; the implosive; and the explosive.

The phony layer consists of the roles that we play, such as the leader who is in actuality shy, or the coworker who believes she is a big shot; instead of actualizing our true selves, we try to actualize a concept and try to be something else because we don’t like what we are.  This defensive mechanism provides us with a phony character to play, allowing us to shield ourselves from the rejection of showing our true selves.  Phony existence polarizes one of our polarities, if we choose to be saintly and unconditionally complimentary, we are trying to hide our criticism and individuality.  Perl called these polar opposites Top Dog and Under Dog.  Top Dog represents our consciousness that drives our overt actions and therefore insists on being right.  Underneath, the Under Dog acts as passive resistance by being lazy, procrastinating, and acting inept.

The phobic layer is our fear of rejection and/or pain that is consequence of being dissatisfied with our true selves.  It contains all our catastrophic expectations from childhood, helping us to avoid what is hurting on the inside.

Impasse represents the most critical layer of psychopathology.  Most people are stuck at impasse for fear of moving to a new point where the familiar environmental and social support are absent.  It is inherently easier to remain at an impasse, where resources can be manipulated to comfort the client.

Many of those who come to psychotherapy attempt to explain their existence as an implosive layer: the deadness of our lives.  The daily habitual existence (popularly called as the cubicle life) may be safe, but it provides no energy to our lives, thus we are theoretically dead.  To change our lives we must be able to accept our death, and move on to be rebirth.

By literally “exploding” our energy that was being used to defend the phony, phobic, impasse, and implosive layers, we experience the explosive layer of our growth disorder.  In order to experience rebirth, we must be able to explode with orgasm, anger, grief, and joy.  This explosion marks our departure from the impasse, moving on towards a bright future filled with the joy of a new existence, as well as the responsibility that goes with it.