Gestalt Therapy and The Path to Wholeness

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Gestalt Therapy and The Path to Wholeness

THC Editorial Team June 10, 2021
Thomas Cole, The Voyage of Life, Youth, 1842, National Gallery of Art (article on gestalt therapy)
The Voyage of Life, Youth, Thomas Cole, 1842, Courtesy National Gallery of Art, Washington

Contents

What Is Gestalt Therapy?

Gestalt therapy is an integrative, client-centered, present-focused, embodied, and relational form of psychotherapy that aims to help clients increase their levels of awareness; claim responsibility for and accept the consequences of their actions; generate confidence in their abilities to make healthy choices; and release negative emotions, feelings, and life patterns.1,2

On a broader scale, this form of therapy is focused on the notion of perception and seeks to help people understand how they give meaning to and make sense of their lives in the present moment.3 Today, numerous gestalt institutes exist around the world.

What Is the History of Gestalt Therapy?

In the early 20th century, a group of academic researchers from Berlin, Germany, were the first practitioners of the gestalt school. This group sought to reimagine the prevailing views and explanations of the human experience, which they saw as limited.4 They intended to “fill in that gap between environmental stimulus and behavioral response with clear principles” using an empirical, lab-based approach.Their research demonstrated the prominence of selective and integrative mental processes concerning human behavior, and this integrative, holistic approach laid the groundwork for gestalt psychology, and later, gestalt therapy. Kurt Lewin, a founder of social psychology and organizational psychology and a gestalt psychologist, is credited with translating gestalt theory from the research lab to the real world.4

In the 1940s, gestalt therapy was born from the work of psychologists Fritz Perls, Laura Perls, and Paul Goodman, who synthesized psychoanalytical theory, gestalt philosophy, and such disciplines as existentialism, phenomenology, field theory, and Eastern philosophies to create gestalt therapy.2 F. Perls, Goodman, and Ralph Hefferline first introduced gestalt therapy in their seminal text, Gestalt Therapy: Excitement and Growth in the Human Personality, in 1951.2

Key Principles of Gestalt Therapy

“Gestalt” is roughly translated from German to English as “whole,” which informs an underlying principle of gestalt therapy: Each person is considered a unified entity and is approached in their totality—as a full integration of mental, physical, emotional, sensorial, and spiritual dimensions that are experienced in the present moment.3,5,6 According to F. Perls, this form of therapy aims to avoid treating the individual fragments or aspects of a person in isolation. Instead, it seeks to integrate the “dispersed and disowned parts of the self and make the person whole again.”2

In general, the goals of gestalt therapy include cultivating greater social and emotional awareness and presence, increased internal fulfillment, and richer relationships with other people and the world around us.4 This form of therapy particularly emphasizes the interconnectedness of relationships between all things in existence. This web of interconnectedness—referred to by practitioners as the “field” or the “experiential field”—forms the basis of field theory, developed by Kurt Lewin. “Many links have been made between findings in quantum physics that show that we cannot study one specific thing in isolation (Philippson, 2009), as there is no specific isolated thing in existence. There are only interrelated fields of energy, and these principles support gestalt’s field perspective.”2

A core gestalt therapy principle pertains to “contact,” or the process of experiencing and interacting with the relational field that exists between us and the world around us.4 Healthy contact involves creative adjustment and “the ability to be fully present with all aspects of ourselves—our sensing, emotional, intellectual, behavioral, sexual and spiritual being.”2 It is facilitated by a sense of openness, curiosity, and awareness. This includes contact with painful experiences and the ability to remain with them in the here and now.

Gestalt therapy also focuses on the power of innate human capacity and potential. The gestalt therapy model presupposes that human nature involves “lifelong growth, which can be defined as the capacity to integrate ever-increasing complexity of response and meaning-making in relationship with our world.”4

This type of therapy draws on the paradoxical theory of change. Gestalt therapists believe that real change can occur only when clients fully accept their “whole personhood,” including parts of themselves they may wish to avoid, resist, or deny.2

How Does Gestalt Therapy Work?

Rather than adhering to a fixed, step-by-step protocol, gestalt therapists follow the core principles of gestalt therapy about how the human condition works.4

Within sessions, gestalt therapists generally use the following four tactics to interact with clients in what they call the “therapist–client relational field”:1

  • Follow the dynamic experience of the client through a phenomenological method or a first-person perspective.
  • Relate to the client through dialogue.
  • Address critical aspects of the felt experiential field.
  • Suggest experiments that will lead the client to higher levels of exposure, experience, awareness, and creativity.

The Therapist–Client Relationship in Gestalt Therapy

The therapeutic relationship between client and therapist in gestalt therapy is characterized as dialogical—based on dialogue. However, practitioners tend to note that the relationship cultivated within gestalt therapy is often deeper and more profound than what many people think when they hear the word “dialogue.” Philosopher Martin Buber, whose work influenced gestalt therapy cofounder Laura Perls,2 explained that the root of dialogical interaction is a form of “I-Thou” practice, which is “characterized by a desire to genuinely meet with the other with openness, respect, acceptance and presence in a fluidly inclusive way.”2

According to some gestalt therapists, clients are healed within the therapeutic process not by a therapist’s practical advice but by the therapist’s embodied presence and ability to relate to the client with the fullness of their being.7 In this perspective, therapist–client interaction itself—relating to and knowing a person and being known by someone else in ways that are transparent, authentic, and present—is healing.1

Experiments: Gestalt Therapy Techniques

Experimentation is a core practice in the gestalt therapy approach that aims to increase the client’s and therapist’s awareness of how the client reacts in certain enacted situations. This understanding can help clients proactively address unhealthy patterns of thought, response, and action. These experiments can be planned and formal or dynamic and spontaneously suggested.Crucially, before experimentation, it is imperative that the groundwork for a sufficient sense of safety and support has been developed in the therapist–client relationship.

Gestalt experiments help clients by creating opportunities for generating insights, observing dysfunctional patterns, gaining exposure to new sensations in a safe environment, cultivating greater awareness, and expanding the range of choice in clients’ lives.Additionally, clients benefit from the therapist’s experience, knowledge, empathy, and presence throughout the experiments.

Examples of experiments include the following:

Empty Chair Experiment

This classic gestalt technique usually involves a therapist asking a client to sit in a chair. The therapist will then place an empty chair across from the client and ask the client to imagine an individual from their present or past sitting in the chair. The therapist will then invite the client to engage in dialogue with the imagined person in the present moment. This experiment helps the client and therapist witness the client’s potential denied and repressed features projected onto the imagined individual and observe how the client may not be claiming their healthy power.2 When an individual accepts and claims these traits as parts of themselves, they have the opportunity to proactively work with and change them from within.

Two-Chair Work

This technique is a variation of the empty chair experiment. In it, the therapist and client identify two opposing viewpoints in a dilemma the client faces, and the client takes turns sitting in each chair to voice and embody each opposing viewpoint.4 This allows the client to become better acquainted with these aspects by giving them a voice and responding to them.

Spontaneous Experiments

Spontaneous, or dynamic, experiments can be simple and highly effective and may include the following methods:2

  • supporting the client to feel and stay with an uncomfortable feeling
  • asking the client to experiment with a different posture
  • using bodywork techniques, such as breath awareness, to assist the client in staying present in their body

Potential Benefits of Gestalt Therapy

According to several research studies, evidence suggests that gestalt therapy may offer the following benefits:1,8

  • increased reflexivity, or thoughtfulness and self-awareness9
  • increased fellowship and participation in community matters9
  • decrease in anxiety10,11,12
  • decrease in depression10,11
  • improvements in individuals with phobias13
  • decreased generalized anxiety and test anxiety14
  • improved sleep quality15
  • reduced nightmare frequency15
  • enhanced mindfulness12
  • less avoidance of inner experiences12
  • increased self-kindness12
  • improved self-efficacy, or a person’s belief in their ability to be successful16
  • improvements in overall functioning10
  • improvements in social interaction10
  • improved interpersonal relationships17
  • improved conflict resolution17
  • improved interpersonal problem-solving17
  • reduced harsh self-criticism17
  • decrease in dysthymic disorders and their intensity18
  • reduced aggression directly after and 6 months after therapy19
  • greater emotional well-being11
  • greater sense of hope11
  • self-development20
  • potential improvements in interpersonal and psychotherapeutic skills of caring professionals (e.g., nursing professionals)21
  • potential assistance in navigating a new stage of life (e.g., older age)10

Effectiveness of Gestalt Therapy

Although psychologists have issued calls to increase research on the effectiveness of gestalt therapy, some studies have illustrated its efficacy and have demonstrated that it is comparable or, in some cases, superior to other well-researched, evidence-based mental health treatments.1,4,8,17

For example, in 2007, UK-based therapists Stevens, Stringfellow, Wakelin, and Waring undertook a 3-year study to assess the effectiveness of gestalt therapy. They used the Clinical Outcomes in Routine Evaluation (CORE) system, a well-established outcome measure for psychological therapies, to collect data about the work of gestalt therapists compared to therapists conducting other forms of therapy. The CORE National Research Database currently holds data for about 50,000 clients. Using complete data sets for 180 clients who received gestalt therapy, they concluded that clinical outcomes for these clients showed considerable recovery and clinical improvements, in line with other forms of evidence-based therapies, including cognitive behavioral therapy.22

In 2011–2012, researchers Farahzadi and Masafi compared the effectiveness of gestalt therapy and cognitive behavioral play therapy in Iranian children with dysthymic disorder. The researchers found that both modalities reduced dysthymic disorders and their intensity.18

In yet another study, in 2011, researcher Drăghici assessed whether experiential psychotherapy, inclusive of gestalt methods, can produce benefits for geriatric clients with depressive and anxious disorders. This study found that gestalt and expressive-creative methods for treating small groups of geriatric clients led to a reduction in depression and anxiety symptoms and may have had other positive impacts in clients navigating older age.10

References

  1. Brownell, P. (2016). Contemporary gestalt therapy. In D. J. Cain, K. Keenan, & S. Rubin (Eds.), Humanistic psychotherapies: Handbook of research and practice (pp. 219–250). American Psychological Association.
    https://doi.org/10.1037/14775-008
  2. Mann, D. (2010). Gestalt therapy: 100 key points and techniques. Routledge.
  3. Brownell, P. (2010). Gestalt therapy: A guide to contemporary practice. Springer.
  4. Wheeler, G., & Axelsson, L. (2015). Introduction. In G. Wheeler & L. Axelsson, Gestalt therapy (pp. 3–7). American Psychological Association.
    https://doi.org/10.1037/14527-001
  5. González-Ramírez, E., Carrillo-Montoya, T., García-Vega, M. L., Hart, C. E., Zavala-Norzagaray, A. A., & Ley-Quinónez, C. P. (2017). Effectiveness of hypnosis therapy and gestalt therapy as depression treatments. Clínica y Salud, 28(1), 33–37.
    https://doi.org/10.1016/j.clysa.2016.11.001
  6. Glass, T. A. (2010). Gestalt therapy. In The Corsini Encyclopedia of Psychology.
    https://doi.org/10.1002/9780470479216.corpsy0387
  7. Clemmens, M. C. (2011). The interactive field: Gestalt therapy as an embodied relational dialogue. In T. B. Levine (Ed.), Gestalt therapy: Advances in theory and practice (pp. 39–48). Routledge.
    https://doi.org/10.4324/9780203157763
  8. Raffagnino, R. (2019). Gestalt therapy effectiveness: A systematic review of empirical evidence. Open Journal of Social Sciences, 7(6), 66–83.
    https://doi.org/10.4236/jss.2019.76005
  9. Gonzalez-Hidalgo, M. (2017). The politics of reflexivity: Subjectivities, activism, environmental conflict and gestalt therapy in southern Chiapas. Emotion, Space and Society, 25, 54–62.
    https://doi.org/10.1016/j.emospa.2017.05.003
  10. Drăghici, R. (2011). Experiential psychotherapy in geriatric groups. Procedia—Social and Behavioral Science, 33, 979–983.
    https://doi.org/10.1016/j.sbspro.2012.01.268
  11. Man Leung, G. S., Ki Leung, T. Y., & Tuen Ng, M. L. (2013). An outcome study of gestalt-oriented growth workshops. International Journal of Group Psychotherapy, 63, 117–125.
    http://dx.doi.org/10.1521/ijgp.2013.63.1.117
  12. Leung, G. S. M., & Khor, S. H. (2017). Gestalt intervention groups for anxious parents in Hong Kong: A quasi-experimental design. Journal of Evidence-Informed Social Work, 14, 183–200.
    https://doi.org/10.1080/23761407.2017.1311814
  13. Martinez, M. (2002). Effectiveness of operationalized gestalt therapy role-playing in the treatment of phobic behaviors. Gestalt Review, 6(2), 148–167.
    https://doi.org/10.5325/gestaltreview.6.2.0148
  14. Keshavarz, H., Mansoreh, H. H., & Somayeh, G. (2016). The effect of gestalt therapy on generalized anxiety disorder and test anxiety in students. Counseling Culture and Psychotherapy, 7(28), 85–102.
  15. Holzinger, B., Klosch, G., & Saletu, B. (2015). Studies with lucid dreaming as add-on therapy to gestalt therapy. Acta Neurologica Scandinavica, 131, 355–363.
    https://doi.org/10.1111/ane.12362
  16. Saadati, H., & Lashani, L. (2013). Effectiveness of gestalt therapy on self-efficacy of divorced women. Procedia—Social and Behavioral Sciences, 84, 1171–1174.
    https://doi.org/10.1016/j.sbspro.2013.06.721
  17. Strümpfel, U. (2006). Therapie der gefühle—Forschungsbefunde zur gestalttherapie [Therapy of emotions—Research findings on gestalt therapy]. Verlag Andreas Kohlhage.
  18. Farahzadi, M., & Masafi, S. (2013). Effectiveness of gestalt and cognitive-behavioural play therapy in decreasing dysthymic disorder. Procedia—Social and Behavioral Sciences, 84, 1642–1645.
    https://doi.org/10.1016/j.sbspro.2013.07.007
  19. Yousefi, N., Etemadi, O., Bahrami, F., Fatehizadeh, M. A., Ahmadi, S. A., Mavarani, A. A., Esanezhad, O., & Botlani, S. (2009). Efficacy of logo therapy and gestalt therapy in treating anxiety, depression and aggression. Journal of Iranian Psychologists, 5(19), 251–259.
  20. Arip, M. A. S. M., Bakar, R. B. A., Ahmad, A. B., & Jais, S. Md. (2013). The development of a group guidance module for student self-development based on gestalt theory. Procedia—Social and Behavioral Sciences, 84, 131.
    https://doi.org/10.1016/j.sbspro.2013.06.748
  21. Kelly, T., & Howie, L. (2011). Exploring the influence of gestalt therapy training on psychiatric nursing practice: Stories from the field. International Journal of Mental Health Nursing, 20, 296–304.
    https://doi.org/10.1111/j.1447-0349.2010.00729.x
  22. Stevens, C., Stringfellow, J., Wakelin, K., & Waring, J. (2011). The UK gestalt psychotherapy CORE research project: The findings. British Gestalt Journal, 20(2), 22–27.
    https://www.britishgestaltjournal.com/features/2014/10/24/core

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