Gestalt therapy

Gestalt therapy is an existential and experiential psychotherapy that focuses on the individual's experience in the present moment, the therapist-client relationship, the environmental and social contexts in which these things take place, and the self-regulating adjustments people make as a result of the overall situation. It emphasizes personal responsibility. Gestalt therapy was co-founded by Fritz Perls, Laura Perls and Paul Goodman in the 1940s–1950s.

Overview of main premises

Edwin Nevis described Gestalt therapy as "...a conceptual and methodological base from which helping professionals can craft their practice" (Nevis, E., 2000, p.3). In the same volume Joel Latner asserted that Gestalt therapy is built around two central ideas: that the most helpful focus of psychology is the experiential present moment and that everyone is caught in webs of relationships; thus, it is only possible to know ourselves against the background of our relation to other things (Latner, 2000). The historical development (see below) of Gestalt therapy shows the influences that have resulted in these two foci. Expanded, they result in the four chief theoretical constructs (see below under the theory and practice section) that comprise Gestalt theory and guide the practice and application of Gestalt therapy.

Gestalt therapy was forged from various influences in the times and lives of the founders: physics, Eastern religion, existential phenomenology, Gestalt psychology, psychoanalysis, theatrical performance, systems and field theory (Mackewn, 1997).

Gestalt therapy rose from its beginnings in the middle of the 20th century to rapid and widespread popularity during the decade of the 1960s and early 1970s. During the 70s and 80s Gestalt therapy training centers spread globally, but they were, for the most part, not aligned with formal academic settings. As the cognitive revolution eclipsed Gestalt therapy in psychology, many came to believe Gestalt was an anachronism. In the hands of Gestalt practitioners, Gestalt therapy became an applied discipline in the fields of psychotherapy, organizational development, social action, and eventually coaching. Until the turn of the century Gestalt therapists disdained the positivism underlying what they perceived to be the concern of research, and so, largely, ignored the need to utilize research to further develop Gestalt therapy theory and support Gestalt therapy practice. That has begun to change.
Gestalt therapy focuses more on process (what is happening) than content (what is being discussed). The emphasis is on what is being done, thought and felt at the moment rather than on what was, might be, could be, or should be.

Gestalt therapy is a method of awareness, by which perceiving, feeling, and acting are understood to be separate from interpreting, explaining and judging using old attitudes. This distinction between direct experience and indirect or secondary interpretation is developed in the process of therapy. The client learns to become aware of what they are doing psychologically and how they can change it. By becoming aware of and transforming their process they develop self acceptance and the ability to experience more in the "now" without so much interference from baggage of the past.

The objective of Gestalt therapy, in addition to helping the client overcome symptoms, is to enable him or her to become more fully and creatively alive and to be free from the blocks and unfinished issues that may diminish optimum satisfaction, fulfillment, and growth. Thus, it falls in the category of humanistic psychotherapies.

Contemporary theory and practice

Gestalt therapy theory rests atop essentially four "load bearing walls:" phenomenological method, dialogical relationship, field-theoretical strategies, and experimental freedom – Brownell, P. (ed.) (2008), Handbook for Theory, Research, and Practice in Gestalt Therapy, UK: Cambridge Scholars Publishing. Although all these tenets are present in the early formulation and practice of Gestalt therapy, as described in Perls, F. (1969), Ego, Hunger, and Aggression. and in Gestalt Therapy, Excitement and Growth in the Human Personality (Perls, Hefferline, & Goodman, 1951), the early development of Gestalt therapy theory emphasized personal experience and the experiential episodes understood as the "safe emergencies" of experiments; indeed, half of Perls, Hefferline, and Goodman (1951) consists of such stylized experiments. Later, through the influence of such people as Erving and Miriam Polster (Polster & Polster, 1973), a second theoretical emphasis emerged: contact between self and other, and ultimately the dialogical relationship between therapist and client. Later still, field theory emerged as an emphasis (Wheeler, 1991). At various times over the decades since Gestalt therapy first emerged one or more of these tenets, and the associated constructs that go with them, have captured the imagination of those who have continued developing the contemporary theory of Gestalt therapy. Since 1990 the literature focused on Gestalt therapy has flourished, including the development of several professional Gestalt journals. Along the way, Gestalt therapy theory has also been applied in Organizational Development and Coaching work. Thus, currently, Gestalt therapy training institutes often offer programs in both clinical and organization tracks.

Phenomenological method

The goal of a phenomenological exploration is awareness (Yontef, 1993). This exploration works systematically to reduce the effects of bias through repeated observations and inquiry (Yontef, 2005).

The phenomenological method comprises three steps: (1) the rule of epoché, (2) the rule of description, and (3) the rule of horizontalization (Spinelli, 2005). In the rule of epoché one sets aside one's initial biases and prejudices in order to suspend expectations and assumptions. In the rule of description, one occupies oneself with describing instead of explaining. In the rule of horizontalization one treats each item of description as having equal value or significance. The rule of epoché sets aside any initial theories with regard to what is presented in the meeting between therapist and client. The second rule implies immediate and specific observations, abstaining from interpretations or explanations, especially those formed from the application of a clinical theory superimposed over the circumstances of experience. The third rule avoids any hierarchical assignment of importance such that the data of experience become prioritized and categorized as they are received. A Gestalt therapist utilizing the phenomenological method might find him or herself typically saying something like, “I notice a slight tension at the corners of your mouth when I say that, and I see you shifting on the couch and folding your arms across your chest … and now I see you rolling your eyes back.” All this is not to say that the therapist never makes clinically relevant evaluations, but that he or she, when applying the phenomenological method, temporarily suspends the need for that (Brownell, in press, 2009, 2008).

Dialogical relationship

To create the conditions under which a dialogic moment might occur, the therapist attends to his or her own presence, creates the space for the client to enter in and become present as well (called inclusion), and commits him or herself to the dialogic process, surrendering to what takes place between them as opposed to attempting to control it. In presence, the therapist “shows up” as the whole and authentic person he or she is (Yontef, 1993) instead of assuming a role, false self, or persona. To practice inclusion is to accept however the client chooses to be present, and that may be in a defensive and obnoxious stance as well as an overly sweet but superficially cooperative one. To practice inclusion is to support the presentation of the client, including his or her resistance, not as a gimmick but in full realization that that is how the client is present. Finally, the Gestalt therapist is committed to the process, trusts in that process, and does not attempt to save him or herself from it (Brownell, in press, 2009, 2008)). It should be noted that since Gestalt therapy is an experiential therapy, it is extremely difficult to encapsulate it in the concepts used above, which Perls would probably have referred to as "elephant shit." From the above description one would be hard put to envision what a Gestalt therapist really does or what a session would look like!

Field-theoretical strategies

“The field” can be considered in two ways. There are ontological dimensions and there are phenomenological dimensions to one’s field. The ontological dimensions are all those physical and environmental contexts in which we live and move. They are the office in which one works, the house in which one lives, the city and country of which one is a citizen, and so forth. The ontological field is the objective reality that supports our physical existence. The phenomenological dimensions are all mental and physical dynamics that contribute to a person’s sense of self, one’s subjective experience, but are not merely elements of the environmental context. This could be the memory of an uncle’s inappropriate affection, one’s color blindness, one’s sense of the social matrix in operation at the office in which one works, and so forth. It is in the way that Gestalt therapists choose to work with field dynamics that makes what they do strategic (Brownell, in press, 2009, 2008)). Gestalt therapy focuses on the character structure; according to Gestalt theory, the character structure is dynamic rather than fixed in nature. To look into ones character structure, the focus would be on the phenomenological dimensions rather than the ontological dimensions.

Experimental freedom

Gestalt therapy has distinguished itself by moving to action, away from mere talk therapy, and is considered an experiential approach (Crocker, 1999). Through experiments, the therapist supports the client’s direct experience of something new instead of the mere talking about the possibility of something new. Indeed, the entire therapeutic relationship could be considered experimental, because at one level it is the provision of corrective, relational experience for many clients, and it is the "safe emergency" that is free to turn this way and that. An experiment can also be conceived of as a teaching method that creates an experience in which a client might learn something as part of their growth (Melnick & Nevis, 2005). Examples: (1) rather than talking about one's critical father, a Gestalt therapist might ask the patient/client to imagine the parent was present, or that the therapist was the parent, and talk to that parent in this fashion; (2) If a client/patient is struggling with how to be assertive, a Gestalt therapist could either (a) have the patient say some assertive things to members of a therapy group, or (b) give a talk on how one should never be assertive; (3) A Gestalt therapist might notice something about the non-verbal behavior or tone of voice of the client; the therapist might have the client exaggerate the non-verbal behavior and pay attention to his/her experience while doing so; (4) a Gestalt therapist might work with the breathing or posture of the client, and changes in these when the client talks about different content. Through all these means the Gestalt therapist is working with process rather than content, the How rather than the What.



Self

In field theory, self is a phenomenological concept, and is a comparison with 'other'. Without other there is no self, and how I experience other is inseparable from how I experience self. The continuity of selfhood (personality functioning) is something achieved rather than something inherent "inside" the person, and has its advantages and disadvantages. At one end of the spectrum, there is not enough self-continuity to be able to make meaningful relationships or to have a workable sense of who I am. In the middle, personality is a loose set of ways of being that work for me, commitments to relationships, work, culture and outlook, always open to change where I need to adapt to new circumstances, or just want to try something new. At the other end, it is a rigid defensive denial of the new and spontaneous. I act in stereotyped ways, and either induct other people to act in particular and fixed ways towards me; or I redefine their actions to fit with the fixed stereotypes.

In Gestalt therapy then, the approach is not the self of the client being helped or healed by the fixed self of the therapist, but the exploration of the co-creation of self and other in the here-and-now of the therapy. There is not the assumption that the client will act in all other circumstances as he or she does in the therapy situation. However, the areas that cause problems will be either the lack of self definition leading to chaotic or psychotic behaviour, or the rigid self definition in some area of functioning that denies spontaneity and makes dealing with particular situations impossible. Both of these show very clearly in the therapy, and can be worked with in the relationship with the therapist.

The experience of the therapist is also very much part of the therapy: since we are co-creating our self-other experiences, the way I experience being with the client is significant information about how the client experiences themselves. The proviso here is that I as therapist am not operating from my own fixed responses, and this is why Gestalt therapists are required to undertake significant therapy of their own during training.
From the perspective of this theory of self, neurosis can be seen as fixed predictability—a fixed Gestalt, and the process of therapy can be seen as facilitating the client to become unpredictable, really, more responsive to what is in the client's present environment, rather than responding in a stuck way to past introjects or other learning. If the therapist is working from some theory of how the client should end up, this defeats the aim of the therapy.

Change

In what has now become a "classic" of Gestalt therapy literature, Arnold Beisser (1970) described Gestalt's paradoxical theory of change. The paradox is that the more one attempts to be who one is not, the more one remains the same (Yontef, 2005). Conversely, when people identify with their current experience, the conditions of wholeness and growth support change. Put another way, change comes about as a result of "full acceptance of what is, rather than a striving to be different" (Houston, 2003).

Notable examples

Gestalt therapy had a variety of psychological and philosophical influences, and in addition was a response to the social forces of its day. It is a therapeutic approach that is holistic (mind/body/culture) present-centered, and related to existential therapy in its emphasis on personal responsibility for action, and on the valuing of the I-thou relationship in therapy. (In fact, its creators considered calling Gestalt therapy existential-phenomenological therapy.) "The I and thou in the Here and Now," was one Gestalt therapist's semi-humorous mantra.

Both Perls were students and admirers of the neurologist Kurt Goldstein. Gestalt therapy was based on Goldstein's understanding called "Organismic theory". Goldstein viewed a person in a situation in terms of a holistic and unified experience. He encouraged a big picture perspective, taking in to account the context of a person's experience. The word Gestalt means whole, or contextual. Goldstein taught the Perls that self actualization could only be achieved by self transcendence, that is, viewing the self as part of a greater whole. Laura Perls, in an interview denotes the "Organismic theory" as the base of Gestalt therapy.

There were additional influences from existentialism, particularly the I-thou relationship as it applies to therapy, and the notion of personal choice and responsibility.

The late 1950s–1960s movement toward personal growth and the human potential movement fed into and was itself influenced by Gestalt therapy.

Gestalt therapy somehow became a "coherent Gestalt", which is the Gestalt psychologists' term for a perceptual unit that holds together and forms a unified form.

Psychoanalysis

Gestalt therapy was influenced by psychoanalysis. It was part of a continuum moving from the early work of Freud, to the later Freudian ego analysis, to Wilhelm Reich and his notion of character armor, where they gave attention to nonverbal behavior (This was consonant with Laura Perls' background in dance and movement therapy). To this was added the insights of academic Gestalt psychology about perception, Gestalt formation and the tendency of organisms to complete the incomplete Gestalt, to form "wholes" in experience.

Central to Fritz and Laura Perls' modifications of psychoanalysis was the concept of "dental or oral aggression". In Ego, Hunger and Aggression (1944), Fritz Perl's first book, to which Laura Perls contributed[1], the Perls suggested that when the infant develops teeth, he/she has the capacity to chew, to break apart food, and by analogy experience, to taste, accept, reject, assimilate. This was opposed to Freud's notion that only introjection takes place in early experience. Thus the Perls made "assimilation", as opposed to "introjection", a focal theme in their work, and the prime means by which growth occurs in therapy.

In contrast to the psychoanalytic stance in which the "patient" introjects the (presumably more healthy) attitudes/interpretations of the analyst, in Gestalt therapy the client must "taste" his/her experience, and either accept or reject, but not introject, or "swallow whole". Hence, the emphasis is on avoiding interpretation and encouraging discovery. This is the key point in the divergance of GT from traditional psychoanalysis — growth occurs through gradual assimilation of experience in a natural way, rather than by accepting the interpretations of the analyst; thus, the therapist should not interpret, but lead the client to discover for him or herself.

The Gestalt therapist contrives experiments that lead the client to greater awareness and fuller experience of his/her possibilities. Experiments can be focussed on undoing projections or retroflections. They can work to help the client with closure of unfinished Gestalts ("unfinished business" such as unexpressed emotions towards somebody in the client's life). There are many kinds of experiments that might be therapeutic. But the essence of the work is that it is experiential rather than interpretive, and in this way distinguishes itself from the psychoanalytic.


Principal influences: A summary list

•    Otto Rank's invention of "here-and-now" therapy and Rank's post-Freudian book Art and Artist (1932), both of which strongly influenced Paul Goodman.
•    Wilhelm Reich's psychoanalytic developments, especially the concept of character armor and its focus on the body.
•    Jacob Moreno's Psychodrama, principally the development of enactment techniques for the resolution of psychological conflicts
•    Kurt Goldstein's holistic theory of the organism, based on Gestalt theory.
•    Martin Buber's philosophy of relationship and dialogue ("I - Thou")
•    Kurt Lewin's field theory as applied to the social sciences and group dynamics
•    European phenomenology of Franz Brentano, Edmund Husserl, Martin Heidegger, and Maurice Merleau-Ponty
•    The existentialism of Kierkegaard over that of Sartre, rejecting nihilism
•    Carl Jung's psychology, particularly the polarities concept
•    Some elements from Zen Buddhism
•    Differention between thing and concept from Zen and the works of Alfred Korzybski
•    American pragmatism of William James, George Herbert Mead, and John Dewey

Suggested reading

•    Beisser, A. (1970) The paradoxical theory of change, in J.Fagan & I Shepherd (eds) Gestalt Therapy Now: Theory, Techniques, Applications. Palo Alto, CA: Science and Behavior Books.
•    Brownell, P. (2009) Gestalt therapy in The Professional Counselor's Desk Reference, Mark A. Stebnicki, Ph.D. and Irmo Marini, Ph.D. (eds.), New York, NY: Springer Publishing Company.
•    Brownell, P., ed.(2008) Handbook for Theory, Research, and Practice in Gestalt Therapy, Newcastle upon Tyne, UK: Cambridge Scholars Publishing.
•    Brownell, P. (in press) Gestalt Therapy: A Guidebook for Mental Health Professionals, New York, NY: Springer Publishing Company.
•    Crocker, S. (1999) A well-lived life, essays in Gestalt therapy. Cambridge, MA: Gestalt Press.
•    Doubrawa, E. (2006) Touching the Soul in Gestalt Therapy: Stories and more. Wuppertal, Germany: Peter Hammer.
•    Ginger, S. (2007) Gestalt Therapy, The Art of Contact. London, UK: Karnac Books.
•    Houston, G. (2003) Brief Gestalt Therapy. London, UK: Sage Publications.
•    Latner, J. (2000) The Theory of Gestalt Therapy, in Gestalt therapy: Perspectives and Applications, Edwin Nevis (ed.). Cambridge, MA: Gestalt Press.
•    Mackewn, J. (1997) Developing Gestalt Counselling. London, UK: Sage publications.
•    Melnick, J., March Nevis, S. (2005) Gestalt Therapy Methodology in Gestalt Therapy, History, Theory, and Practice. Ansel Woldt & Sarah Toman (eds). London, UK: Sage Publications
•    Nevis, E. (2000) Introduction, in Gestalt therapy: Perspectives and Applications. Edwin Nevis (ed.). Cambridge, MA: Gestalt Press.
•    Perls, F. (1969) Ego, Hunger, and Aggression: the Beginning of Gestalt Therapy. New York, NY: Random House (originally published in 1947)
•    Perls, F., Hefferline, R., & Goodman, P. (1951) Gestalt therapy: Excitement and growth in the human personality. New York, NY: Julian.
•    Polster, E. & Polster, M. (1973) Gestalt therapy integrated: Contours of theory and practice. New York, NY: Brunner—Mazel.
•    Spinelli, E. (2005) The interpreted world, an introduction to phenomenological psychology, 2nd edition. London, UK: Sage Publications.
•    Woldt, A. (2005) Pre-text: Gestalt pedagogy: Creating the field for teaching and learning, in Ansel Woldt & Sarah Toman (eds), Gestalt Therapy, History, Theory, and Practice. London, UK: Sage Publications.
•    Wheeler, G. (1991) Gestalt reconsidered: A new approach to contact and resistance. New York, NY: Gardner.
•    Yontef, G. (1993) Awareness, Dialogue, and Process, essays on Gestalt therapy. Highland, NY: The Gestalt Journal Press, Inc.
•    Yontef, G. (2005) Gestalt Therapy Theory of Change, in Gestalt Therapy, History, Theory, and Practice. Ansel Woldt & Sarah Toman (eds). London, UK: Sage Publications
•    Handbook for Theory, Research, and Practice in Gestalt Therapy — Philip Brownell (ed)
•    Gestalt Therapy: History, Theory and Practice — Ansel Woldt and Sarah Toman (eds)
•    A Well-Lived Life, Essays in Gestalt Therapy — Sylvia Fleming Crocker
•    Awareness, Dialogue, and Process, Essays on Gestalt Therapy — Gary Yontef
•    The Healing Relationship in Gestalt Therapy — Richard Hycner and Lynne Jacobs
•    Gestalt Therapy: Excitement and Growth in the Human Personality — Frederick Perls, Ralph F. Hefferline, Paul Goodman
•    Gestalt Therapy Verbatim — Frederick S. Perls
•    Ego, Hunger and Aggression — Frederick S. Perls
•    Gestalt Therapy Integrated — Erving and Miriam Polster
•    Gestalt Therapy, The Art of Contact - Serge Ginger
•    Gestalt Reconsidered — Gordon Wheeler
•    Developing Gestalt Counselling — Jennifer Mackewn
•    Brief Gestalt Therapy — Gaie Houston
•    Living at the Boundary — Laura Perls
•    Growing Up Absurd — Paul Goodman
•    Communitas — Paul and Percival Goodman
•    Nature Heals — Paul Goodman
•    Here, Now, Next: Paul Goodman and the Origins of Gestalt Therapy — Taylor Stoehr
•    The Growing Edge of Gestalt Therapy — Edward Smith
•    Gestalt Therapy: The Attitude & Practice of an Atheoretical Experientialism — Claudio Naranjo
•    The Gestalt Therapy Book: A Holistic Guide to the Theory, Principles, and Techniques of Gestalt Therapy — Joel Latner
•    Self in Relation - Peter Philippson
•    Tales of a Wounded Healer - Mariah Fenton Gladis

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