Gestalt Therapy in Psychological Practice
IN THIS ARTICLE
Gestalt therapy is an empowering and germane framework for psychotherapy. It is uplifting for both practitioners and patients. Its objective is to bring about new awareness so that transition and problem-solving is possible. Clients are immediately equipped and responsible for doing real work, inspired and motivated to reach their own solutions. This approach entails moving in creativity from talk to action and experience (Corey, 2009). The theory looks to growth and enhancement as therapy, and reflects an early Gestalt motto: “You don’t have to be sick to get better” (Corey, 2009, p. 225). Because of its many demonstrated benefits, Gestalt therapy should be utilized by more practicing psychologists. It is a science that continues to advance the field of psychology.
“Psychology is a very unsatisfactory science,” Kurt Koffka, a German psychologist, wrote in 1935 (Koffka, 1935, p. 18). On one side, he noted, there are the objective facts; on the other, hypotheses, theories, and “pure products of mind” (Koffka, 1935, p. 1).
In psychology, a theory is a fact-based and tested framework that helps to categorize a phenomenon and predict future behavior. Theories are used to provide models for understanding and interpreting human thoughts, actions, and emotions (Cherry, 2011). Today, copious therapeutic theories exist. Many psychological theories approach the patient as a subject, something to be altered. Numerous psychologists claim they are “Adlerian” or “behaviorist” or “Freudian.” But Gestalt therapists have a different objective. Zinker (1977) contends that Gestalt therapy is “not so much to change [a] sense of being [one]self as to exercise it” (p. 21). A key tenet of Gestalt theory is “increased and enriched awareness,” which “by itself is seen as curative” (Corey, 2009, p. 206). The central idea is that individuals are already striving to improve and “self-actualize,” and that if they are more aware of themselves, they can continue to grow and change.
This text aims to explain the Gestalt approach to psychotherapy. It also argues for Gestalt therapy as an established and sound framework from which more psychologists should work within their practice.
What is Gestalt Psychology?
The concept of gestalt should be described since it is the basis of this framework. First, the word is pronounced “GESH- tawlt.” It is a German word meaning “form” or “shape” (keithyates.com, 2001). Simply put, gestalt is the idea that a whole is comprised of parts, and all those parts are necessary to achieve the whole. In addition, the effect of the whole form cannot be achieved by simply describing the individual parts it holds (keithyates.com, 2001).
James Pomerantz, a professor at Rice University, concedes that translating this word into scientific terms is difficult and elusive. But he explains gestalts as “patterns or higher order features that emerge when two or more perceptual elements are placed in close spatial or temporal proximity to one another, patterns… that do not arise when only a single element is present” (Pomeranz, 2006, p. 620). Pomerantz (2006) contends that the whole is perceived before its parts and that the human mind uses a “preattentive” process to literally see the forest before the trees (p. 621).
This vital formula fits well within the science of psychology: Gestaltists approach patients as whole products that are the result of various interacting systems, some evident and some not. For example, practitioners could consider aspects like temperament, personality, family history, beliefs, education, and cognitive processes of a particular patient and how those systems influence the whole that is seen.
A Note on Field Theory
This therapy is based on the assumption that individuals can only be understood within the context of their continued relationship with the environment, an idea also known as field theory (Corey, 2009). This scientific method rejects compartmentalization and unilinear, historical, cause-effect sequence (Yontef, 1993). The client’s life is regarded as an entire field, and events and relationships are parts of the field that are related to and responsive to each other. The field consists of a foreground and background, and the elements in those parts indicate their importance or noteworthiness in the client’s life.
The notion of the field replaces the concept of discrete, isolated particles (Yontef, 1993). Gerald Corey, Ph.D., (2009) author of Theory and Practice of Counseling and Psychotherapy, maintains that, to the Gestalt therapist, everything is dynamic, and the field is the entire situation, a place that is constantly changing. Everything affects time and space in some way. Further, what the patient directly sees and feels is considered more reliable for therapy than interpretation (Yontef, 1993). Corey (2009) explains that field theory tracks some aspect of the environmental field as it emerges from the field’s background and becomes the focal point of the individual’s attention or interest.
Gestalt Versus More Traditional Theories
How does this concept in psychology differ from other theories in psychological practice, such as behaviorism? Yontef (1993) claims:
“In behavior modification, the patient's behavior is directly changed by the therapist's manipulation of environmental stimuli. In psychoanalytic theory, behavior is caused by unconscious motivation which becomes manifest in the transference relationship. By analyzing the transference the repression is lifted, the unconscious becomes conscious. In Gestalt therapy the patient learns to fully use his internal and external senses so he can be self-responsible and self-supportive” (p. 5).
Behaviorism merely seeks to alter a surface behavior and doesn’t consider the thoughts or motivations behind an action. Gestalt psychology deems an action as only part of the whole—that certain factors were necessary in order to produce the visible result. Gestalt therapy aims to help patients gain awareness of certain behaviors in order to change them and their outlook on life, whereas behaviorism focuses on observable behavior and changing that alone (Corey, 2009).
History and Influences
Christian von Ehrenfels published his book On Gestalt Qualities in 1890 and used the term gestalt to describe a theory of perception within the field of psychology (Woldt and Toman, 2005). In 1912, Max Wertheimer discussed his concepts of perceptual grouping and perception of movement consistent with the established gestalt tradition (Woldt and Toman, 2005). Woldt and Toman (2005) note that, together with Wertheimer, psychology professors like Wolfgang Köhler and Kurt Koffka made their contributions to the discipline in the 1920s through their research and publications.
Academics Fritz Perls and his wife Laura made a significant impact on Gestalt therapy starting in the 1940s (Wikipedia, 2011). The Perls’ seminal work, co-authored by Paul Goodman and Ralph Hefferline and published in 1951, was called Gestalt Therapy: Excitement and Growth in the Human Personality (Wikipedia, 2011). 1952 saw the founding of the first Gestalt Institute: Fritz and Laura ran it out of their Manhattan apartment (Wikipedia, 2011).
In the 50s and 60s, personal growth and human potential were emphasized within this framework (Wikipedia, 2011).
Existential phenomenology, Gestalt psychology, experiments, and other concepts have contributed to the development of Gestalt therapy. It rose from its early stages in the 1940s to flourishing popularity during the 1960s and early 1970s (Wikipedia, 2011). Later on, the cognitive revolution and developments in behaviorism overshadowed Gestalt practices in psychology.
Traditionally, Gestalt therapists have spurned the demand for research to demonstrate the benefits of Gestaltism, and they have discounted the need to develop Gestalt theory and practice (Wikipedia, 2011). However, many practitioners have renewed their interest in the implications for the application of Gestalt therapy.
Concepts Unique to Gestalt Therapy
What other characteristics and techniques achieve the gestalt of Gestalt therapy? Though not all ideas will be mentioned, the more significant concepts unique to Gestalt therapy will be discussed.
The Gestalt approach holds that dwelling on the past and fantasizing about the future can be ways to avoid the present, and that there is power in facing the present (Corey, 2009). In order to help the patient become more aware of the present moment, Gestalt therapists ask “what” and “how” questions (Corey, 2009). For example, these questions are typical of a Gestalt therapy session: “What are you doing with your feet now?” or “Are you aware of your smile?” (Dolliver, 1991).
Gestalt therapy has roots in existential philosophy, which attempts to address the condition of being human. Existential therapy is applied to help people resolve dilemmas of contemporary life, to confront common feelings such as isolation, meaninglessness, confusion, uncertainty, or embarrassment (Corey, 2009).
Existential practice attempts to reconcile the limits and tragic elements of human existence with the possibilities and opportunities of human life (Corey, 2009). Gestalt therapy, because it is existential in nature, is based on an understanding of what it means to be human (Corey, 2009).
Humans, then, are seen as self-aware beings, able to make choices. Patients have freedom, but they are also assigned responsibility for actions and thoughts. They are challenged to take responsibility for how they choose to be now in the current moment (Corey, 2009). Exploration of the subject’s specific reality is valued, while diagnosis and prognosis are mostly ignored (Corey, 2009).
In psychology, a “phenomenological” or “experiential” approach refers to the patient’s experience—how he or she experiences things. Phenomenology is a discipline that helps patients stand aside from their usual way of thinking so that they can distinguish the difference between what is actually perceived and felt in the current situation and what is due to past events (Yontef, 1993). Therapy that is both existential and phenomenological focuses on people's existence—relations with others, joys and suffering, and so on—as they are directly experienced.
In fact, Gestalt therapy treats feelings in the present and what is observed as palpable and pertinent data (Yontef, 1993). Therapists may ask questions like, “Is my experience the same as yours?” in order to get patients to question their perceptions. Description is valued.
Phenomenological inquiry is a method that focuses on what occurs in “the now” or the present moment (Corey, 2009). To help the client gain self-awareness, Gestalt therapists ask questions like “What is happening now?” or “What are you experiencing as you sit there and talk to me?” or “How are you experiencing your anxiety?” (Corey, 2009, p. 202). If the discussion is about a dream the patient had, the therapist might suggest, “Tell me the dream as though you were having it now” (Corey, 2009, p. 203).
Therapists have unique responsibilities when it comes to application of Gestalt psychology. Because of its existential nature, the relationship is equal and person-to-person (Corey, 2009). The therapist’s presence is very important for this therapy, as opposed to having a set of technical skills to be used in sessions. Laura Perls noted that the ideas of person and presence are more important than using techniques, and argued the client and therapist invent and create their relationship (Corey, 2009). The therapist is responsible for facilitating the client’s personal process of self-discovery (Corey, 2009).
The client-therapist relationship, according to Corey (2009), must be established before therapy commences, so that the client trusts the therapist. Trust is of paramount importance. Then, Corey (2009) notes, the client is likely to be able to achieve higher levels of awareness.
Corey (2009) suggests that therapists are charged with maintaining a therapeutic atmosphere, one that encourages mental work on the client’s part (210). Therapists also need to be willing to express their reactions and observations as they occur, much like the patient is expected to do. They provide helpful feedback. They are willing to explore existential episodes like fears and expectations with their clients (Corey, 2009). Therapists are also viewed as artistic participants in the creative process (Corey, 2009).
Confrontation is a part of the client-therapist relationship in the Gestalt framework. Yontef advocates for an “empathic inquiry” focused on awareness when this method is used (Corey, 2009, p. 215). Though the term sounds intimidating, confrontation is not an attack. It can be an invitation for clients to examine their behaviors, attitudes, and thoughts, and to notice incongruities between their verbal and nonverbal expressions (Corey, 2009). Using this technique can be a chance for patients to learn more about themselves. Using it during therapy might be as simple as making an observation, or saying something like, “You say [this], but your face is telling me that you really feel [this].”
Joseph Zinker (1977), a noted Gestalt therapist and author of Creative Process in Gestalt Therapy, emphasized creative undertakings like writing, drawing, painting, etc. as therapy. He urged therapists to “treat the whole” of life, to foster the creative process, noting that “each creation is the expressed, behavioral outcome of a multitude of images, fantasies, musings, and thoughts” (Zinker, 1977, p. 4). Themes that come up during these expressions are to be experienced in the here and now. The creative process, according to Zinker (1977), is a chance for growth. It is a problem-solving process. Art and creativity are opportunities to develop novel concepts out of one’s own sense of daring (Zinker, 1977).
When figures emerge from the background but are not completed or resolved, Gestalt therapists suspect that a person is left with unfinished business. This is essentially unacknowledged or unvoiced feelings. They can manifest as grief, anxiety, guilt, anger, abandonment, and a host of other emotions. Because the client is not fully acknowledging what he or she experienced, the unfinished business lingers in the background and prevents the client from being fully self-aware. Gestaltists maintain that many times, when a person has unfinished business, unexpressed feelings result in some physical manifestation— nervous ticks or fidgeting, for instance (Corey, 2009).
It is the therapist’s task to guide the client through this unfinished business in the here and now. Without frustrating or rescuing the patient, the therapist can present situations that evoke similar emotions, and then guide the person through them.
The Gestalt therapist works by engaging in dialogue; contact with the client is straightforward but caring, warm, and accepting (Yontef, 1993). Authenticity and candor between both parties is crucial. Dialogue is lived: it is something “done rather than talked about” (Yontef, 1993, p. 4).
Awareness, New Patterns, and Making Changes
In Gestalt therapy, the patient learns the difference between “well-worn obsessional pathways and new thoughts, between a statement of experience and a statement of a statement” (Yontef, 1993, p.6). Gestalt therapy, Yontef (1993) says, uses active techniques that clarify experience, and responsibility for the present is assigned to the patient. When new patterns of thinking are introduced and practiced, healthy changes are possible.
The Empty Chair
One exercise used in Gestalt therapy involves the client’s use of two chairs in role playing. The therapist asks the client to sit in one chair and play one “part” of his or her problem, and then switch to the other chair to play the role of the “other” in order to further understand the struggle. With the empty chair method, clients may locate a feeling or a side of themselves they had previously been denying; Corey (2009) notes that, rather than just talking about a conflicted feeling, clients are able to intensify the feeling and experience it wholly. The goal of this technique is acceptance of polarities and acknowledgment of conflicts that exist in everyone (Corey, 2009).
Attention to Body Language
Body language is thought to be a subtle indicator of intense emotions. Corey (2009) says, “movements, postures, and gestures may communicate significant meanings” (p. 218). When body language is noticed in sessions, many times the therapist asks the client to exaggerate a movement or tick. This is believed to intensify the feeling attached to the behavior, bring elucidation as to the inner meaning (Corey, 2009). For instance, clenched fists, tight frowning, grimacing, crossed arms, or shaking hands may be highlighted in therapy. A therapist might ask, “What is this gesture saying? What are you saying with this movement? What is your expression saying right now?”
The purpose of addressing dreams in Gestalt therapy is to bring dreams back to life and live them in the here and now. Each part is presumed to be a projection of the self; the patient invents scripts for encounters between characters or parts (Corey, 2009). Since clients can act out a conflict between opposing sides, eventually they can accept their inner differences (Corey, 2009). Gestaltists believe that dreams are spontaneous expressions of the self, that they represent unfinished situations and contain existential messages about personal struggles (Corey, 2009).
Goals for Gestalt Therapists
As one might suspect, Gestalt therapy does not ascribe to a series of set goals in therapeutic application. Although it is not focused on predetermined goals for patients, Gestalt therapists definitely attend to a basic goal—that of assisting clients in achieving greater awareness. As noted previously, increased awareness in itself is highly beneficial.
Patients have the ability to monitor and regulate behavior when they have full awareness of what is happening in and around them. With higher awareness comes the presentation of new and varied choices, as well as responsibility for actions and possible consequences (Corey, 2009). Over the course of therapy, patients gradually assume ownership of their own experiences. They are to develop skills that will help them change within their fields, and try new patterns of being and behaving (Corey, 2009).
Gestalt Therapy in Action
What does Gestalt therapy look like in action? This video will help to expound upon some of the concepts unique to Gestalt therapy and its application in psychotherapy: http://www.youtube.com/watch?v=ZbOAdMdMLdI
Studies Utilizing Gestalt Therapy
Though psychologists previously did not demonstrate exhaustive empirical research on the benefits of Gestalt therapy, future research looks promising (Corey, 2009). Recent studies have advanced the theory and practice of Gestalt therapy: it has a beneficial impact with those who exhibit personality disorders, psychosomatic problems, and substance addictions (Corey, 2009). Outcome studies have proven that Gestalt therapy is equal to or better than other therapies in treating various psychological disorders (Corey, 2009).
Greenberg & Clarke (1986) found empty-chair dialogues to be helpful in reducing intrapersonal conflicts and in making decisions (Greenberg & Webster, 1982). Subjects within the high-affect Gestalt dialogues were very likely to confirm that Gestalt treatment was helpful for them when also participating in comparative procedures (Tyson & Range, 1987).
Gestalt therapy is effective (Coven, 1977; Greenberg & Clarke, 1986; Greenberg & Webster, 1982; Corey, 2009). It is a positive, humanistic therapy. It helps adherents (both clients and therapists) to become responsible for their own experiences and to experiment with new ways of behaving and thinking. It helps them practice—and fully experience—key moments and emotions in life (Corey, 2009). Awareness of key themes or patterns encourages practitioners and clients alike to become more genuine, and more open to transition or change.
Yontef (1993) proffers that Gestalt therapy has founded many useful and creative innovations for psychotherapy theory and practice. Kohler (1959) affirms this. He notes that the enthusiasm and undertakings of early Gestalt psychologists were virtues because they produced new revelations and observations. Further, Yontef (1993) says that many of these discoveries and techniques have been integrated into general practice, many times without credit. Even so, Gestalt techniques and methods form a good model for psychotherapy and should continue to be applied and developed (Yontef, 1993). Gestalt ideas and concepts should thus be embraced and researched by more psychologists because of its many positive contributions to the field of psychology.
Although Koffka lamented psychology as a discipline at the beginning of this text, he also affirmed it. He asserted that it is science because it is founded on both facts and data on one side, and on the other side, hypotheses, emotions, and hunches. Sometimes it is difficult to consolidate psychology into cold, hard facts, but it is a human science, one that examines the mind, behavior, and the human condition. It is a comprehensive and an exclusive science in many ways, one that is fluid and always being refined.
Psychology in itself is inherently gestalt in its qualities; it studies entire worlds—the human mind and thoughts, human behavior, interactions with the environment, human existence. Because of its experimental nature and benefits, Gestalt psychology is very suitable for further practice and study.
Kohler (1959) makes the case for Gestalt psychology quite well in his article titled Gestalt Psychology Today:
“Are we allowed to impose on perception an extreme simplicity which… it may not possess [in the name of science]?... Skepticism… prevent[s] new work… Our wish to use only perfect methods and clear concepts has led to Methodological Behaviorism… [but] the Behaviorist cannot, without giving more particular reasons, reject reference to other individual experiences… since an understanding of relations is essential to all cognitive achievements, the same applies to the whole field… [The Behaviorist misses] the point not only important in human experience but also to what he regards as true science” (p. 727-734).
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