Gestalt Psychotherapy

Background

Gestalt therapy began as a revision of psychoanalysis (F. Perls, 1942/1992) and quickly developed as a wholly independent, integrated system (F. Perls, Hefferline, & Goodman, 1951/1994). Since gestalt therapy is an experiential and humanistic approach, it works with patients’ awareness and awareness skills rather than using the classic psychoanalytic reliance on the analyst’s interpretation of the unconscious. Also, in gestalt therapy the therapist is actively and personally engaged with the patient, rather than fostering transference by remaining in the analytic role of neutrality. 

In gestalt therapy theory, a process-based postmodern field theory replaced the mechanistic, simplistic, Newtonian system of classical psychoanalysis. The gestalt therapist uses active methods that develop not only patients’ awareness but also their repertoires of awareness and behavioral tools. The active methods and active personal engagement of gestalt therapy are used to increase the awareness, freedom, and self-direction of the patient, rather than to direct patients toward preset goals as in behavior therapy and encounter groups. 

The gestalt therapy system is truly integrative and includes affective, sensory, cognitive, interpersonal, and behavioral components. In gestalt therapy, therapists and patients are encouraged to be creative in doing the awareness work. There are no prescribed or proscribed techniques in gestalt therapy. 

Holism and Field Theory 

Most humanistic theories of personality are holistic. Holism asserts that humans are inherently self-regulating, that they are growth-oriented, and that persons and their symptoms cannot be understood apart from their environment. Holism and field theory are interrelated in gestalt theory. Field theory is a way of understanding how one’s context influences one’s experiencing.  

Variables that contribute to shaping a person’s behavior and experience are said to be present in the current field, and therefore, people cannot be understood without understanding the field, or context, in which they live. A patient’s life story cannot tell you what actually happened in his or her past, but it can tell you how the patient experiences his or her history in the here and now. That rendition of history is shaped to some degree by the patient’s current field conditions. 

An event that happened three years ago is not a part of the current field and therefore cannot affect one’s experience. What does shape one’s experience is how one holds a memory of the event, and also the fact that an event three years ago has altered how one may organize one’s perception in the field. Another property of the field is that the organization of one’s experience occurs in the here and now and is ongoing and subject to change based on field conditions. Another property is that no one can transcend embeddedness in a field; therefore, all attributions about the nature of reality are relative to the subject’s position in the field. Field theory renounces the belief that anyone, including a therapist, can have an objective perspective on reality. 

The Paradoxical Theory of Change is the heart of the gestalt therapy philosophy (Beisser, 1970). The paradox is that the more one tries to become who one is not, the more one stays the same. Health is largely a matter of being whole, and healing occurs when one is made whole again. The more one tries to force oneself into a mold that does not fit, the more one is fragmented rather than whole. Organismic self-regulation requires knowing and owning—that is, identifying with— what one senses, feels emotionally, observes, needs or wants, and believes. True growth starts with conscious awareness of what is occurring in one’s current existence, including how one is affected and how one affects others. One moves toward wholeness by identifying with ongoing experience, being in contact with what is actually happening, identifying and trusting what one genuinely feels and wants, and being honest with self and others about what one is actually able and willing to do—or not willing to do. When one knows, senses, and feels one’s self here and now, including the possibilities for change, one can be fully present, accepting or changing what is not satisfying  

Living in the past, worrying about the future, and/or clinging to illusions about what one should be or could have been, diminishes emotional and conscious awareness and the immediacy of experience that is the key to organismic living and growth. Gestalt therapy aims for self-knowledge, acceptance, and growth by immersion in current existence, aligning contact, awareness, and experimentation with what is actually happening at the moment. It focuses on the here and now, not on what should be, could be, or was. From this present-centered focus, one can become clear about one’s needs, wishes, goals, and values. 

The concepts emphasized in gestalt therapy are contact, conscious awareness, and experimentation. Each concept is described below. Contact means being in touch with what is emerging here and now, moment to moment. 

Conscious awareness is a focusing of attention on what one is in touch with in situations requiring such attention. Awareness, or focused attention, is needed in situations that require higher contact ability, situations involving complexity or conflict, and situations in which habitual modes of thinking and acting are not working and in which one does not learn from experience. For example, in a situation that produces numbness, one can focus on the experience of numbness, and cognitive clarity can emerge. 

Experimentation is the act of trying something new in order to increase understanding. The experiment may result in enhanced emotions or in the realization of something that had been kept from awareness. Experimentation, trying something new, is an alternative to the purely verbal methods of psychoanalysis and the behavior control techniques of behavior therapy. 

Gestalt therapy starts with the therapist making contact with the patient by getting in touch with what the patient is experiencing and doing. The therapist helps the patient focus on and clarify what he or she is in contact with and deepens the exploration by helping focus the patient’s awareness. 

Awareness Process 

Gestalt therapy focuses on the awareness process—in other words, on the continuum of one’s flow of awareness. People have patterned processes of awareness that become foci for the work of therapy. This focus enables the patient to become clear about what he or she thinks, feels, and decides in the current moment—and about how he or she does it. This includes a focus on what does not come to awareness. Careful attention to the sequence of the patient’s continuum of awareness and observation of nonverbal behavior can help a patient recognize interruptions of contact and become aware of what has been kept out of awareness.  

Awareness of awareness can empower by helping the patient gain greater access to himself or herself and clarify processes that had been confusing, improving the accuracy of perception and unblocking previously blocked emotional energy.  The gestalt therapist focuses on the patient’s awareness and contact processes with respect, compassion, and commitment to the validity of the patient’s subjective reality. The therapist models the process by disclosing his or her own awareness and experience. The therapist is present in as mutual a way as possible in the therapeutic relationship and takes responsibility for his or her own behavior and feelings. In this way, the therapist can be active and make suggestions but also can fully accept the patient in a manner consistent with the paradoxical theory of change.