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.
Bristol: 2006
© Pauline Connolly