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ESSAY ON GESTALT THERAPY

 

The writer believes the meaning of the Gestalt approach to therapy is to encourage
the client towards a greater awareness of himself and his environment and to work
with him to reach enlightenment, thus enabling him to be master of his own growth
and development. The creativity needed from the authentic therapist to ‘think on his
feet,’ utilising his own awareness, psychodrama, guided fantasy and body posture, is
exciting and demanding.

“In therapy the aim is to shift the ‘inner conflict;’ that between impulse and counter-
attacking resistance into an open aware conflict” (Gestalt Therapy, Perls et al, p59).
Frederick (Fritz) Perls, a psychiatrist and psychoanalyst, with psychologist wife
Laura, were co founders of Gestalt therapy. Perls moved from the Freudian tradition
towards free will and individuality, focussing on the “here and now” and the
uniqueness of the whole person: mind and body; perceptions and awareness. “Gestalt
is also theoretically an integrative approach to counselling rooted in an existential
orientation which combines pyschoanalitic with procedural inventiveness through
use of three primary devices – relationship, awareness and experiment” (GestaltCounselling In Action, Petrûska Clarkson, p2). The word Gestalt is of German origin and means basically a whole that is something more than, or different from, the sumof its parts. What we perceive is intuitive so it is difficult to explain why individual parts create the total impression in our minds, but people need to give meaning to these perceptions.

Figure and Ground is borrowed from Gestalt psychology. Figure is a pattern or object
which is the focus of attention. Ground is the setting or context. For example, while
writing this essay the writer is aware of a clock ticking in the background. When
focussing sensory awareness to the ticking this becomes the foreground and the
writing slips into the background. Both cannot be perceived at the same time. One
concept of Gestalt is not to set boundaries within our conscious minds. Some people
are only aware of one thing; their problem is so much in figure that everything else is
background.

If the reader could imagine waves breaking on a beach, as one breaks another wells
up behind it to break again, and so forth. Gestalt’s, in the healthy cycle, come to
prominence then dissipate. The organism actualises itself.
The Healthy Gestalt Cycle can be summed up as:-
Sensation:  Hearing telephone ring
Awareness:  Realising it should be answered
Mobilisation:     Deciding to answer it and moving towards it
Action:     Picking receiver up
Engaging:   Having conversation
Final Contact:    Putting receiver down
Satisfaction:     Task has been completed
Withdrawal: Moving into equilibrium: at rest.

This represents the flow of energy around the body which is released into the
environment. “A motor Gestalt which is the beginning pattern of action of something
you want to do” (Gestalt Therapy, Perls et al, p39).

The example above has shown the normal healthy pattern of Gestalt formation and
destruction but interruptions may appear at any stage of the cycle. When a block does
occur this prevents the free flowing motion of the Gestalt from formation to
nothingness. Dysfunction occurs when the organism is not fully in touch with the
environment. As a requirement to completing the “unfinished business” (principle of
closure) tension, frustration and excitement may follow until the need is met. The
client may hinder outward muscle expressions and hold onto himself which for Perls
was a contributory factor in nervous breakdown. The inner sensations have been
repressed in the organism when they should have been expressed on the environment.
It is worth noting that we as human beings limit ourselves and prevent our own
growth. Perls wrote neurosis should be called “growth disorder”.

Throughout a persons life it will not always be possible for Gestalt formation and
destruction to take place in its normal cyclical pattern. This however does not mean
that growth disorders or dis-ease will occur, ie it would not be in the persons best
interest to say precisely what they wanted at a specific time. The basic Gestalt belief
is that the person is generally healthy and is trying to achieve equilibrium. If we are
unfortunate enough to experience situations, traumatic events or repeated stressful
pressures that are perceived in a detrimental manner, dysfunction can occur. If a child
overhears or is told on s regular basis that the household is very short of money and
his education costs a lot and is berated for not achieving good results at school the
child may be embarrassed and fearful to express his true emotions and consequently
feel anxious, self conscious, unsure of himself and disorientated. These events may
be introjected, retroflected and may lead to guilt.

Instead of being himself he may
compensate or de-sensitize himself from those feelings, thus leading to emotional
problems. His growth has been blocked. Thoughts and feelings are energy. Energy
has not been released onto the people/person it was generated for. The energy is then
trapped causing a blockage of emotional fluency or the free flowing pattern of
Gestalt in the organism.

He may later suffer from anxiety attacks.
Perls said “anxiety is the tension between the now and the later” and added
“excitement without creative expression causes anxiety,” and as such is to be
avoided. So it would follow that when excitement occurs the organism will control
itself, but the perspective client tries to control it as he is fearful of losing control.
When excitement occurs the metabolic process attempts to process more food to
maintain the required energy levels, which increases the oxygen requirements. The
prospective client will attempt to control the excitement by suppressing this urge for
oxygen, which he hopes will give the outward impression that he is in complete
control. This is a vicious circle as it will cause more excitement and block the healthy
Gestalt cycle.
When a client presents himself for counselling the Gestalt therapist may wish to find
out where the disturbance at the contact boundary has taken place – at what stage did
the Gestalt fail to be completed? There are a number of ways to do this.

Desensitisation may reflect neglect or abuse. Workaholics or heavy drinkers, schizoid
and passive aggressive personalities divert attention from what they really need, thus
minimising sensations.

Deflection. The person may not pay attention and deliberately divert what is really
needed for their growth. They reduce awareness.

Introjection. Taking in other peoples negative beliefs and comments. Perls used
analogies with food to express his views. “Physical food properly digested and
assimilated becomes part of the organism; but food which rests ‘heavy on the
stomach’ is an introject. You are aware of it but want to throw it up. If you do so, you
get it ‘out of your system’ “ (Gestalt Therapy. Perls et al, p189). Clients may suffer
from anxiety which is an excessive mobilisation of energies, or depression which is
an insufficient movement of energies. They have lost touch with their true organismic
promptings.

Projection. Ones own attitude, referred to others but mirroring the feelings for
oneself. Obsessions are a way of dealing with the inner anxiety by repeating a
specific behavioural action, or by thoughts that preoccupy a mind to an abnormal
degree, to alleviate the inner torment. At its most extreme this can become paranoia.
“An extremely important and dangerous class of projections is prejudice; race-
prejudice class-prejudice, snobbery, anti-semitism and misogyny, etc. In every such
case, along with other factors, the following projection is operating; to the vilified
groups are attributed traits which really belong to the prejudiced person, but which he
represses from awareness” (Gestalt Therapy, Perls et al, p214).

Retroflection. To turn back on oneself. Doing to self what you would like to do to
others thus stopping energies from flowing into to the environment. They flow
inwardly against self. He is the “doer” and the “done to”. Possibly as a child when
releasing energies he met with punishment. He lost, gave up and the organism is now
holding back his natural responses. The unconscious – “at-this-moment-unaware” –
which Gestalt emphasises – right-hemispheric, non-linear thinking has been trained to
act accordingly and without the person being aware of this he has a repression. When
this internal conflict is released back into the environment the organisms energies are
discharged as the impulse, which has been blocked, is released. Growth can take
place. Excessive daydreaming. habits, feelings of victimisation, avoiding
relationships, or  psychosomatic illness may be the sign of retroflection.

Egotism; as with retroflection this may occur at any stage of the cycle. The client
may not be able to enjoy the full pleasure of experience. Narcissistic personality
traits; one may commentate on oneself but will feel empty inside as they have lost
touch with the physical self. Subsequently many people are unable to achieve
orgasm.
Confluence. Client may be unwilling to let go of their false sense of belief,
relationships and work, and will externalise on some task to avoid themselves, and
may show traits of sulking, becoming withdrawn or hostile. All boundary
disturbances have a purpose. Empathy between partners is of benefit in some
circumstances, but when taken to extremes problems will arise. Some therapists may
find it difficult to disassociate from their work and encounter difficulties in their
private life. Disillusionment and despair may follow. “It is only where confluence is
maintained as a means of preventing contact that it is unhealthy” (Gestalt Therapy,
Perls et al, p118).

Excitement and growth die away as the person moves from one
event to another. He avoids himself. Prolonged bereavement and difficulty leaving
therapy are more examples of confluence. Energy interweaves within itself.
These interruptions can also occur in therapy. The meeting, greeting and seating of a
client and the observations and awareness of the therapist may begin to help him
formulate a treatment plan. All the things that are not said can indicate so much

“Gestalt is always fundamentally based in what the counsellor can see, hear, feel and
smell about the client, rather than what the counsellor thinks, interprets or
understands about the client” (Gestalt Counselling in Action, Petrûska clarkson,
p60).

Confluence could mean lack of eye contact, nervousness, lack of confidence:

Retroflection; arms folded, blocking emotions or “holding on:” introjection; shallow
breathing, hyperventilation, anxiety, eye lids flickering or sudden movement when
something of significance is said.

From the initial contact with the client through to actually meeting with him it is
important for the therapist to be clear and concise and to establish therapeutic goals
and a working relationship with the client. An emphasis placed on the “response-
ability” of the client on playing an active part in his life and recovery may be
necessary. Many clients may well be unwilling to take this responsibility as possibly
their only experience regarding matters of health will have been in a passive role
with their General Practitioner . The therapist can help the client becoming more
aware of body sensations and the environment.

As the body will heal a cut so too the
organism as a whole will self actualise, integrate and assimilate its experiences into
harmony. “The emphasis is on the person finding his own goals within his own life
and discovering his potential to meet those goals.” (Individual Therapy, Malcolm
Parlett & Faye Page, p185). Everything is possible and the Gestalt therapist must be
flexible, willing to share his feelings and thoughts, encouraging frustrations into the
here and now, removing blockages to awareness with such phrases as ‘what is
happening’, ‘what are you aware of’ ‘can you sense it’ ‘focus on that frustration’ ‘shake
your fist again’ ‘put a voice to it, what does it say’ .

The therapist should avoid using
the word ‘why’ and keep intellectualisation to a minimum. “Lose your mind; listen to
your senses.” As memories come to the fore the client may censor or avoid, look
away or change the subject. The therapist can draw the client’s attention to this and
ask him how he felt, or alternatively state ‘I felt nothing when you said that.’ Above
all, the therapist must keep his theories out.
These therapeutic methods can be used in hypnotherapy. As therapy continues the
therapist will work through the cliché-layer or outer layer; this consists of small talk –
the weather and such. The role-layer is the clients superficial belief system which
dictates phoney behaviour. The impasse-later where the client may feel resistant and
confused.

This is a good sign as the two opposing forces healthy and unhealthy are in
conflict – battling for expression. The implosive-layer where the client may take an
even tighter grip on himself as he gets closer and closer to catharsis. Anxiety may
increase but will only be tolerated for so long. Catharsis, explosive/authentic-layer.

The client may dramatically release anger, grief, orgasm, joy as he feels and fully
expresses these and releases the blocks to awareness, and therefore completes the
unfinished flow of energy. Of course, therapy must be followed up integrating the re-
found awareness and health into relationships, situations and the workplace.”It is
very important for the counsellor to support and encourage the acceptance and
exploration of the withdrawal and isolation which a necessary part of the transition
process.” (Gestalt Counselling in Action. Petrûska Clarkson, p133).

Ultimately, Fritz Perls, like the psychiatrist Jakob Moreno, believed in the client
being his own author-ity on therapy and life drama. The therapist too must continue
to grow and remain vibrant and open to all possibilities and solutions, and his task is
to produce the best therapeutic encounter for the person. This may include
psychodrama, where the therapist and client can re-enact, with the use of props (ie
cushions or clay work), situations most relevant to the client.
Although Gestalt techniques can be used in hypnotherapy, the writer is aware of the
disapproval Gestaltists have for their techniques being used in isolation. A hypnotic
induction incorporating a bright light in the distance and the client visualising
himself walking towards it would increase the significance of the use of figure of
ground, ie ‘as you approach the bright light, so you will have an overwhelming desire
to let the problem merge into the light, and as you walk through the light and
experience calmness and relaxation, the light fades into the distance behind you
taking your problems with it.

These feelings of calmness and relaxations you are now
experiencing will assume greater proportions on a day to day basis and these feelings
of calmness and relaxation will stay with you,” and the therapist may add a
associative post-hypnotic suggestion utilising figure and thumb and two slow deep
breaths. A progressive relaxation induction would make excellent use of Gestalt body
awareness and avoid introspection  – ie ‘being aware of rays of relaxation flowing
through your body, and becoming much more aware of tensions and stresses.’

“Almost all persons in our society have lost the proprioception of large areas of their
body” (Gestalt Therapy, Perls et al, p85).
A client who appears to lack in body awareness and visualisation skills may be de-
sensitizing himself. The therapist may ask him to do some homework using creative

visualisation, ie looking at flower or a pen for a few moments each day and trying to
imagine it in his mind’s eye, thereby comparing his external image with his internal
image. He may then be asked to progress to something else in the environment such
as a tree swaying or watching himself in front of a mirror doing various expressions,
and then asked to feel, touch, taste, or smell other things in the environment, thus

utilising his five senses and enabling the induction of hypnosis to be more effective.
If not used before hypnosis, Perls “top-dog / under-dog” theory of intrapsychic
conflict between introjected messages and organismic needs, could be used in
hypnosis with the client visualising the top-dog (introjected rules) in one chair having
a conversation with the under-dog (the victim) in another. This would help solve any
dilemma the client would have and the therapist could then incorporate the positive
points as suggestion from the “two-chair” work. A deviation on this theme may to ask
the client to imagine a twin image of himself, one representing the downtrodden, low
self-esteem side, and the other representing the positive unafraid confident side. This
would help the client become more aware of the part that had held him back with his
current problem, in comparison with his true self with which he has lost touch. The
client will then be asked to concentrate on the more positive side and build on it.

By using the diagnostic scan (counting backwards from the client’s current age with
each number representing a year in his life and asking the I.M.R. to identify a
specific year where something of significance happened which is still affecting him),
and pinpointing the problem area, it would be possible to ask the unconscious to
bring all the unfinished business into the here and now, so that in an adults mind it
can be dealt with in a far more appropriate way. When the client is completing an
abreaction a cinema technique can be used for the client to step into the screen “and
comfort the younger you back then and tell then it’s going to be all right in the future,
and giving them a kiss and cuddle if necessary.”

Guided fantasy, where the client utilises his own imaginative resources, may be
carefully used in the treatment of pain with their Doctor’s permission. Petrûska
Clarkson describes an exercise in imagination about a client suffering from
leukaemia where she encouraged the client to imagine white blood cells fighting the
cancer cells with ray guns so that the client became involved with their own healing
process.

If a client presented himself with recurring nightmares it may be useful for the
therapist to incorporate Gestalt dream work using hypnotherapy. Asking the client to
be one of the characters in the nightmare, or dream, would be useful in integrating
the different parts of the personality which may have become ‘disowned.’ By asking
him to visualise himself as a character in the dream and  then asking him what that
part of the dream means. If unable to do this the client could visualise the character
in the here and now so that the therapist could have a conversation with it. Thus it
may well follow that the dream and its meaning will become to have a ‘real’ and
spontaneous outcome.

For Perls, dreams were the ‘Royal Road to Integration.’ The
therapist should also be aware of the client who at consultation may go into an
altered state as the therapist asks specific questions. If the therapist has knowledge of
eye-accessing-cues (ie if his eyes go the top left that is visual remembered) it may be
useful for the therapist to say “I ‘see’ what you mean,” and also to be aware of any
spontaneous regression. Pacing the client’s breathing in hypnosis, and ‘anchoring’ the
client’s experiences, will have a greater effect of rapport.

The writer is of the opinion that Gestalt techniques can enable the client to attain an
even greater awareness of himself and his difficulties, thus removing the blockages
which are inhibiting his growth. When used in conjunction with hypnotherapy the
process is enhanced considerably.

 

Robin Thorburn