Also by Pauline Connolly:
Trust in the
actualizing tendency
The 'as if' quality of empathy
The Here
and Now in Gestalt therapy
Pauline
Connolly
This essay will include ‘something of the essence’ of Gestalt Therapy; focusing
primarily upon awareness – as a goal and process, and the therapeutic
relationship, including some aspects of the therapist’s role.
Gestalt therapy – as an existential/phenomenological approach – teaches
individuals the phenomenological method of awareness of perceiving, feeling and
acting (Yontef and Simkin, 1989). Focusing on the client’s perception of
reality, it considers direct experience to be more reliable than explanation;
and emphasizes individual responsibility for thoughts, actions and immediate
experience – the ‘now’, ‘what and how’, and the ‘I-Thou’ relationship
(Patterson, 1980).
Central to the approach is the ‘continuum of awareness’, and learning to
appreciate and fully experience/live in the moment (Litt, 1996). For
Gestaltists, the ‘power is in the present’ (Polster and Polster,1973, cited in Corey, 2001); it is only in the here-and-now
that experience, awareness, responsibility, and growth can take place.
The goal of therapy is “to bring the client’s awareness back to actuality, to
the now, where he can face himself and take responsibility for his actions”
(Litt, 1996, p. 7). Focus on the present does not imply that the past and/or
future are ignored, but rather that they are rooted in the now, and experienced
only in the immediate present. When/if the past or future bear significantly
upon one’s present attitudes or behaviour, it is dealt with by bringing it into
the present as much as possible (Corey, 2001). Since at least some re-structuring/organization
of the life script[1] is required in facilitating
organismic balance, the past can not be overlooked. Thus, while references to
experiences outside the session occur, the therapist – sensitive to how the
here-and-now includes residues of the past (including Reich’s ‘body armor’, etc)[2] – is likely to enquire about their significance, by
asking ‘what?’ and ‘how?’ questions; as opposed to ‘why?’ questions; which
according to Perls, lead to rationalizations, self-deceptions, and away from
the immediacy of experiencing (ibid).
Given that for most individuals“… the mind and the creations of the mind work
against the body … against the best interests of the person” (Becker, 1970,
p.1), ‘thinking’[3] rather than integrative, “creative
synthetic knowing” (Bohart & Todd, 1988, p.162) is discouraged. Gestalt
therapy, however, is not anti-intellectual; it simply recognizes
intellectualizing /theorizing as just one dimension of our cognitive capacity.
And since direct awareness is often more important – in terms of organismic
self-regulation – it disesteems exclusive focus on one aspect of our total
processes; not thinking, abstracting, symbolizing, etc, per se.[4]
Fundamentally, gestalt therapy helps the client develop the choice and
disciplined ability to focus his attention either intellectually, or in direct
awareness depending on forming gestalts, i.e. enhance healthy boundary
functioning and alternate between ‘contact’ and ‘withdrawal’ mode, rather than
unwittingly become lost in his intellect (Daniels, 2002, p.1). Accordingly,
Perls advocates that we “lose our mind and come to our senses”, and thus become
liberated from the maya. This loss of mind implies a shift from future-oriented
thinking and theorizing to a present-centered sensory awareness (Corey, 2001).
From an existential perspective, the focus is the individual’s existence –
relations, joy, suffering, etc – as directly experienced. Most of us, through
self-defeating self regulation (deception) are unable to face reality, and be
authentic, including in our relationships and choices. Full awareness, implying
sensory, cognitive and emotional contact with self/environment field, better
enables us to choose and organize our life more meaningfully – become
self-governing/ responsible (Yontef and Simkin, 1989). However, in terms of
addressing the fundamental anxieties and givens of the human condition,
including the ‘existential paradox’, gestalt therapy (or more accurately Perls)
has been accused of overlooking, rather than explaining or helping to resolve
such dilemmas. Becker (1970, p.6), for example, (along with Laura Perls[5] and others) remarks that “…there’s a sense in which
Perls himself was limited. I don’t think he had this awareness … he tended to
overlook the haunting anxieties of the human condition …Where are you going to
get support for your painful self-consciousness? … answer
the question of the mystery of your life? … get the
equanimity to face your own death? …”
Gestalt therapists aim to establish a contact-orientated relationship (creating
a ‘safe emergency’ within the therapeutic encounter), which supports and
promotes clients’ exploration in immediate experience. Within this dialogic
relationship, characterized as an ‘I-Thou’, person-to-person encounter, direct
experience of both participants, as well as, therapist’s observations[6]
of what is not in the clients awareness, (‘advanced empathy’, or ‘depth
reflection’) are emphasized. As Corey (2001) notes, “The therapist’s
experiences, awareness and perceptions provide the back-ground of the
therapeutic process, and the client’s awareness and reactions constitute the
foreground” (p.236). This ‘I-Thou’ dialogue, embodying authenticity,
acceptance, warmth, self-responsibility, etc, helps the client to “ de-automize the blocks” (L.Perls in Rosenfeld, 1978,p.8)
and develop his own support for desired contact or withdrawal. Yontef and
Simkin, (1989) emphasize four characteristics of such dialogue: inclusion,
presence, commitment to dialogue and dialogue is lived. Inclusion[7] implies
putting oneself as fully as possible into the other’s experience “without
judging, interpreting or analyzing while simultaneously retaining a sense of
one’s separate autonomous presence” (p.3). This is almost identical to
Through dialogue and awareness – Gestalt’s primary therapeutic tools – the core
life scripts that determine the client’s significant interpersonal experiences
are uncovered, explored and reorganized (Erskine,1995).
Rather than avoiding the present through inauthentic games or roles (‘the
phony’), or ways of relating such as ‘talking about’ feelings (rehearsing),
clients experience them directly. By attending to the continuum of awareness,
it is not necessary to dig up the past (as in psychoanalysis); important
incomplete gestalts emerge and can be dealt with in an experiential and
experimental manner (Yontef and Simkin, 1989). “Forget Freud’s archaeological
seeking of past memories; by being aware from second to second of what is going
on, by concentrating on the immediate present, major concerns are brought up
and confronted” (Litt, 1996, p.2). Such awareness allows clients to work on the
healthy gestalt principle: that unfinished business will always emerge and can
be resolved. A healthy/good gestalt describes a clearly organized perceptual
field, with a well-formed figure (dominant need) standing out against a less
distinct ground (context/field) (Yontef and Simkin, 1989). According to
Gestalt’s ‘holistic principle’, individuals are unified organisms (i.e. mind
and body function as a totality), fundamentally, striving for balance; a
process whereby needs are satisfied, and equilibrium constantly upset and
restored.[9] This unitary concept of motivation,
recognition that interests/needs emerge as they take priority in the process of
actualization, is almost identical with that of Rogers.[10]
Although organism
and environment exist in a dialectical relationship (the point of interaction
being the ‘contact boundary’), individuals are often unaware of self and
environment; loosing touch with reality, and relinquishing authentic
self-control/support for self-esteem. In an attempt to escape reality, the real
self, and thus avoid facing the ‘holes’ and disowned aspects of self, the
individual resorts to game and role playing, i.e. acting ‘as if’ he were
someone he is not, in order to receive (conditional) love and environmental
support.
Full awareness – being ‘in touch’ with self/others, involves ‘owning’, i.e.
“the process of knowing one’s control over, choice of and responsibility for
one’s behaviour and feelings” (Yontef & Simkin, 1989, p.11). Responsibility
(Response-ablity) means that the individual is autonomous,
self-supporting/directed, and “the spontaneous source of his own activity”
(Becker, 1970, p.3). Far from being individualistic, narcissistic, etc, this
way of being entails ‘creative adjustment’: a social, ethical responsibility
for the ecological balance between self and others/environment (Yontef and
Simkin, 1989). Accordingly, therapists – recognizing the moral
implications/obligations inherent in choosing and valuing – help clients to
discover their own sense of morality (rely on their own ‘locus of evaluation’).
“A psychotherapy
that only led people to impose themselves on the world without considering
others would engender pathological narcissim and a world-denying realization of
self isolated from the world” (ibid, p.12).
Becoming self
responsible and fully functioning, however, is only likely if the individual
tries to be ‘what he is’. According to Beisser’s (1970) ‘paradoxical theory of
change’ (Yontef and Simkin, 1989), the more he tries to be something other than
he is, or when he denies his true/real self, the more he stays the same.
Organismic self-regulation, thus requires an
integration - knowledge and acceptance - of the polarities within oneself. Lack
of integration (incongruence), creates ‘splits’ or ‘defensive
contact-interrupting processes’ (Erskine, 1995) and retards growth. Through
direct experience and experimenting, dialogue, and therapist’s ‘attuned
presence’ (ibid), internal interruptions to contact can be
dissolved/diminished; “dichotomies such as self-ideal and needy self, social
requirements and personal needs can be healed by integrating into a whole
differentiated into natural polarities” (Perls, 1947, cited in Yontef and
Simkin, 1989p.14).
Gestalt therapy encourages clients to break through the self-protective phony
layer of existence (maya); and not allow their ‘rehearsals’, ‘stage fright’,
‘shoulds’, etc, to distract them from their true nature, and preclude them
transcending from environmental to self-support (Prochaska and Norcross, 1994).
Such liberation however, can be a painful experience. While clients may wish to
be ‘free’ – authentic, self-supporting, etc, they may (succumbing to ‘stage
fright’) be less ready/ able to risk confronting and moving beyond the various
layers of neurosis (e.g. the phony, phobic, impasse, implosive, and explosive
layer); relinquish script beliefs, or ‘ego-defense mechanisms’(Corey, 2001) –
resistances to ontact.[11] Yet, suffering/ endurance, and courage are necessary
in order to ‘grow up’. As Perls, (cited in Patterson,1980,
p.443) remarks, “the awareness of, and ability to endure, unwanted emotions are
the condition sine qua non for a successful cure.” Therapists will, thus, be
“looking for the person’s ability to free up some of the blocks – to take a risk” (L.Perls, see Rosenfeld, 1978, p.6).
In raising consciousness, and working with resistance[12], the therapist
‘frustrates’ the client’s demands for support/help so that he can discover,
within himself, the resources (including how he is blocking his strengths) for
resolving his own conflicts, i.e. recognize his own expert status.[13] This is
done, “in such a way that he is forced to find his own way, discover his own
possibilities, his own potential, and discover that what he expects from the
therapist, he can do just as well himself” (Perls, cited in Patterson,1980,
p.447). Energy then expended trying to secure environmental support (including
therapist), and actualize a self-image, can be more beneficially used to
actualize the self. Without frustration the client has less need/reason
to mobilize his resources, and face his ‘holes’ and disowned parts of his
personality, and thus more likely to remain ‘stuck’ in his pseudosocial (rather
than natural) existence (Prochaska and Norcross, 1994).
Despite theoretical
emphasis on an egalitarian relationship and onus upon clients to make their own
meaning/interpretations,[14] the therapist – notably, the Perlsian type –
in practice does function as an ‘expert’ and conveys this to ‘patients’;
directing attention, verbalizations and activities (Patterson, 1980). (In
successful therapy, however, much/most of the work is client-directed). Indeed,
Perls himself functioned very much as an active, process-director; “…an expert
directing the process by which the patient comes to the impasse, breaks it, and
then achieves awareness and independence” (ibid, P.445).[15] It is, however,
possible to practice Gestalt therapy in such a way that it appears almost
unrelated to Perls’s approach. Mearns (2003), for example, notes how Laura
Perls’(‘New York’ school) practice is virtually identical to Person-Centred
therapy; remarking how she is “particularly strong in emphasizing the
timeliness of interventions in relation to the client’s process and a highly
relational empathy as the only real way of sensing that timeliness”(p.3). Thus,
individual therapists can be process-oriented but behave quite differently
depending upon the timeliness of interventions in relation to client’s
immediate process.
Traditionally, Gestalt therapy has been considered most effective with “overly
socialized, restrained … constricted individuals”, i.e. anxious,
perfectionistic, phobic and depressed clients[16] (Shepherd, 1970 cited in
Yontef and Simkin, 1989, p.243). Current practice, however, extends to a much
wider range of problems. Yontef and Simkin
(1989), for example, have noted its effective employment in the treatment of a
broad range of ‘psychosomatic’ and severe character disorders. Particular
client groups, however, may require different approaches, alterations in focus,
etc, thus, modifications are made by therapists according to personality,
therapeutic style, experience, diagnostic considerations, etc. (ibid).
The ‘Perlsian’
workshop style, however, has a more limited application, and work with severely
disturbed individuals can become “a risky proposition” and “with some even
contraindicated” (Shepherd, 1976 cited in Prochaska and Norcross, 1994, p.186).
(Particularly, if therapist long term commitment and auxiliary support are not
feasible; ibid). Thus, general restrictions/cautions,
are especially pertinent to therapists lacking adequate training and/or
experience with such client populations.
Notwithstanding,
Yontef and Simkin (1989), are keen to point out that Gestalt therapy can be
used with any group that the therapist feels comfortable with, i.e.
psychological contact and/or therapist attunement/empathy is possible. If the therapist
can relate to the client, the central Gestalt principles of dialogue, contact,
trust in organismic self-regulation, and direct experiencing can be applied.
With each client “general principles must be adapted to the particular clinical
situation” (ibid, p.23); in order to be effective and ethical. “Thus, the
competent practice of Gestalt therapy requires a background in more than
Gestalt therapy” (ibid, p.24); including knowledge of personality,
psychodynamic theory, psychopathology, diagnosis, theories and applications of
therapy, etc.
Regarding a
different client group, although for similar reasons, L. Perls (see Rosenfeld,
1978, p.7) concedes that therapist’s awareness, experience and knowledge extend
beyond (that of clients and) their ‘professional stuff’;[17] so that when
working with well educated, erudite clients, their ‘lack of background’, does
not result in their floundering/not copying.
Gestalt exercises and experiments, help to make internal conflicts actual
experiences/processes, i.e. ‘they bring struggles to life’(Corey,
2001), and are designed to expand awareness and flexibility with new modes of
thought/ behaviour. Exercises e.g. top dog/underdog or empty-chair techniques,
guided fantasy, dream work – ‘the royal road to integration’, exaggeration,
responsibility giving, reversals, ‘may I feed you a sentence?’ etc, encourage
clients to externalize interjects and experience conflict more fully. According
to Greenberg and Dompierre (1981, cited in Prochaska and Norcross, 1994),Gestalt empty chair intervention achieved greater depth of
experiencing, conflict resolution, and awareness than Rogerian empathic
reflections. This enactive dimension is designed to help clients become aware
of the phony roles and games they play; and learn how and what is interfering with their ability to be present-centered.
Emerging from phenomenological work (dialogue), and thus spontaneous, not
predetermined, techniques/experiments, therapist disclosure/feedback, by
focusing on specific actions, verbalizations, feelings, etc, are all directed
toward greater integration between internal polarities, (resolution of splits,
or boundary disturbances) and ultimately greater self-acceptance and autonomy.
Central to this work is the quality/type of contact, and resonance between the
therapist’s attitude, enquiry/focus and the client’s needs (level of
functioning).A careful balance between risk and support is necessary so that
clients are “neither blasted into experiences that are too threatening nor
allowed to stay in a safe but infertile territory”(Corey, 2001p.238). The role
of frustrator and enquirer, nevertheless, implies an inconsistency between
theory and practice; “It is not easy”, Perls (1969) recognized, “to find the
way through this inconsistency, but once the therapist has resolved the
psychotherapeutic paradox of working with support and frustration, both his
procedures will fall correctly into place” (cited in Patterson, 1980, p.469).
Many (e.g. Patterson, Corey, etc), however, doubt that he ever did resolve this
paradox.
Contemporary gestalt work has moved beyond what Yontef (1993, cited in Corey,
2001, p.240) refers to as the Perlsian style “boom-boom-boom therapy”, with
greater emphasis on therapist attunement, involvement, or presence, dialogue,
etc; and less emphasis on techniques divorced from the relationship.
“Certainly, techniques are still important in gestalt practice, yet they must
always be a phenomenological part of the therapeutic encounter”(Corey, 2001).
Ethical practice is dependant upon the level of training and supervision; with
the most effective application of gestalt techniques resulting from personal
experiences gained in professional training (workshops) with competent
therapists and supervisors (Passons, 1975). In addition to personally experiencing
techniques and sound supervision, an appreciation of the theoretical framework
underlying the approach/techniques, and an awareness of one’s own limitations,
or ‘boundaries of one’s competence’ (Corey, 2001, p.253) is crucial. Typically
active and directive therapists are also encouraged to have the characteristics
mentioned by Zinker (1978, cited in Corey, 2001) e.g. sensitivity, timing,
empathy, acceptance[18] respect for client, etc; and
reiterated by the BACP.
Fundamentally, one
could say that the most immediate limitation of Gestalt therapy is the
training, skill, resourcefulness, experience, wisdom/judgment, etc, of the
therapist (rather than the approach per se.); i.e. that it “has been simplified
and falsified and distorted and misrepresented” (L. Perls, see Rosenfeld, 1978,
p.10).
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[1] Perls (1967, cited in Erskine, 1995) used the concept of the life script,
focusing on how individuals use fantasy, ‘catastrophic expectations’,
‘shoulds’, fixated defensive reactions, and others to reinforce the script.
[2] In some cases, the script beliefs – which function as a cognitive defense
against awareness/contact in relationships – are manifested as
(psychosomatic)‘physical reactions’, e.g. headaches, stomach tensions, etc
(Erskine, 1995).
[3]I.e. Ruminations, analytical dissection, etc, which interrupt the organismic
assimilating process.
[4] In fact, growth occurs through accurate symbolization and abstraction; they
constitute “natural self-regulatory functions” which can ,
“help organize and integrate experience”(Bohart & Todd, 1988, p.166).
[5] L.Perls makes the ‘existential paradox’ central to her work; see Rosenfield
(1978); Becker (1970).
[6] Particularly of body language and verbal-nonverbal incongruities, blind
spots, etc.[7] According to Buber (1962, cited in
Schmid, 2001b, p.5) inclusion transcends empathy, and is a way of perception
that means to be existentially touched/affected.
[8] Even empathy is
‘process directive’. While not guiding clients in terms of making particular
decisions, taking actions, etc, Rogerian therapists, by emphasizing certain
utterances, etc, invite clients to reflect/focus in some way (Mearns,
2003).
[9] Concept of ‘organismic balance/homeostasis’.
[10] The single ‘life force’/ ‘actualizing tendency’ – the crux of the PCA.
[11] E.g. confluence, projection, introjection, etc.
[12] In respectful inquiry, confrontation/challenge, the therapist acknowledges
how the script beliefs or resistance, helps the client maintain – albeit
ineffectively – psychological homeostasis, i.e. they value his attempt at
self-support/ management (Erskine, 1995)
[13] I.e. the locus of evaluation/responsibility lie with him.
[14] Despite the ‘no interpretation’ rule, in ‘Three Approaches to
Psychotherapy: Gloria (interview), I felt Perls’ ‘feedback’ was akin to
interpretation (‘one-upmanship’). Moreover, his presence, ‘I-Thou’ dialogue was
somewhat absent.
[15] Criticized as
always playing Top dog, and in no way demonstrating ‘I’[in
the ‘I-Thou’ context], ‘impersonal’ Perls has been called a puppeteer,
manipulator, director… (Templer,1973 in Patterson,
1980)
[16] Essentially
‘normal’ but inhibited, intellectually controlled. The ‘patients’ with whom
Perls mainly (successfully) worked.
[17] In part a manifestation of therapist self-responsibilty/support.
[18] Perls never accepted the Rogerian concept of UPR; viewed as collusion -
rescuing or infantilizing on the therapist’s part.