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Copyright J.D.Middleton. 2nd October 1996.
I will outline what I consider to be the Gestalt approach to therapy, drawing on the historical background of it's birth, it's originators and innovators. I shall discuss how it is used by purists from the gestalt school and how I might use some of the techniques in my work. In other words what specific techniques I might draw on with my personal psychodynamic approach, and which I would find inappropriate.
The basis of the school of psychology known as Gestalt, is that we perceive a pattern in things that we see rather than the individual parts which make up that pattern. For example when we look at a television screen we see the picture rather that the thousands of points of light of which that picture is composed.
This grew up in Germany towards the end of the nineteenth century and the name Gestalt comes from a German word which means form or pattern. it was led by Max Wertheimer (1880-1943), Kurt Koffka (1886-1941) and Wolfgang Kohler (1887-1967).
They held that components of a perceptual field are synthesised by the mind into a pattern or a Gestalt i.e., that the whole perception is more than the sum of the individual parts. They concluded that there were four basic principles of Gestalt psychology;
'Figure and ground', 'segregation and differentiation', 'closure' and 'good Gestalt' or 'Pragnanz'. The roots were also determined by the philosophy of Existentialism. I think, therefore I am. In order to be, I simply am, I don't have to understand anything. Perls coined a phrase to illustrate this;
"A rose is a rose is a rose ."
Beyond such simplistic a statement are the springboard of the approach. What grew from the psychology of early Gestalt was a type of therapy employing these ideas. Fritz Perls ((1893-1970), the German born psychoanalyst was one of the main founders of Gestalt therapy. His inspiration was to give the concept relevance to psychotherapy and use it as a hook on which to hang a number of therapeutic concerns. He saw the task of psychotherapy as one of enhancing the figure-ground differentiation of those Gestalten which reflect the patient's needs. The needs of a healthy person organise the field of experience into well differentiated Gestalten which command the appropriate response. So for example, a fluid-depleted person experiences the complex of perceptions which emerge into awareness as the Gestalt of thirst, and he gets himself a drink.
An affronted person who is aware of his anger has a choice of responses; a person who is unaware or incompletely aware , on the other hand, may repress his anger and get a headache instead, The neurotic is continually interfering with the process of Gestalt formation. He is unable to deal effectively with certain needs because he interrupts and avoids the formation of the relevant Gestalten.
Let us look at a definition of Gestalt therapy. The Oxford companion of the Mind defines Gestalt Therapy as;
A non-interpretative psychotherapy which emphasizes awareness and personal responsibility and adopts a holistic approach, giving equal emphasis to mind and body.
It began to achieve prominence toward the end of the 1960's. It is now one of the leading psychotherapies in the United States and is developing strongly in the United Kingdom. It is one of the several alternative therapies that comprise the Humanistic Psychologies of the Human Potential movement. It exists more as a style of practice than as a theoretical framework, its ideas are drawn from many sources and the precise boundary between Gestalt therapy and it's neighbours is not always clear, and many practitioners use it in conjunction with other approaches.
Gestalt therapy deals with the whole person but particularly the emotional side of human nature. Much emphasis is placed on the figure/background relationship. The background being the context or environment and the figure being the entity or object, element or need.
For example, the gestalt might be a need such as a drink. If this is satisfied with a drink the need dies away, it is met, it is complete; there is no more energy bound up in the need (thirst). If this need is unsatisfied, a drink is not taken, energy is still holding down the need, it is incomplete, unsatisfied and energy to do other activities is blocked. This is an incomplete gestalt.
Much of Gestalt therapies approach is to help complete the unfinished gestalts, which we all carry with us. One of the principal means of doing this is to generate 'awareness' in the patient. In Gestalt terms, awareness is an active process that moves towards the construction of meaningful organised wholes (Gestalts). These wholes are between the organism and it's environment. I shall come back to a more expansive explanation of awareness when I outline the therapeutic assumptions which Gestalt therapists base their work on.
There are a range of therapeutic assumptions which Gestalt therapists use. The image of a person (self image) is that the body and mind are inseparable and interrelated. Gestaltists hold that an individual is capable of being aware of this. They consider; 'we have far more control over our total being than we realise.' A further assumption is that interaction with the environment is necessary for growth. In other words it is not possible or desirable to change in isolation from the outside world. The person needs the environment outside to respond to and learn from.
Every individual has but one goal, in Gestaltist theory, and that one goal is 'self actualisation' . Below this we have a range of other needs but none are as important as this. A person is who/what or how he is at this moment in time, not good or bad, so you can only live in the present, and can only think, feel, respond to the here and now. According to their approach, change can only occur in the present, based on the here and now. Thus some of their techniques are based on promoting this perception and understanding of the need to only live, work, think, feel in the here and now. What is in the future is irrelevant and unnecessary for fully coping effectively with the present, as is what happened in the past.
Much of the focus is to try and bring future fears and past concerns into the present and work with them from this standpoint. In this way they do not discount future fears or past traumas, they simply replace the focus to the present and work with it in this way. This can tend to make a therapy session very immediate and confrontative, and necessarily on occasion, painful; which might discourage some help seekers.
The Gestaltists concept of psychological health and disturbance is based on the whole organism. Every organism, they consider, aims towards a balanced state , in other words homeostasis. Left to it's own devices this is what the individual strives to do.
They consider the biggest cause of ill health and sickness to be the many roles we believe we have to play. I.e., the good parent, the efficient worker, the best student, the best musician, the Professional Therapist.
We invest so much energy in trying to be what we think we 'ought' to or 'should' be that we are left with very little energy to simply enjoy who we are, responding to life as it happens. They believe this stifles spontaneity and the joy of simply being and living.
Part of their work is thus focused in helping the individual strip away these artificial coverings to allow the 'real' individual to shine through. This approach helps us to begin dismantling our fear of the future and how it 'ought' to turn out.
Contact is another important therapeutic assumption, that it is very important to have contact with the environment, so that we can assimilate what is good for us and reject that which is not. In order to do this we need 'awareness'.
Here there are three areas which need to be considered. First, awareness of oneself. Second, awareness of the environment. Third, awareness of the intermediate zone- the interface between the self and the world. The last is considered the most important. Generating an awareness of how we interact with the environment. When we are healthy we interface well, (in other words, allow the Gestalt to come up, and be completed.) For instance if we want lunch, we have lunch and the Gestalt is dealt with, it is complete. If we have not dealt with it, it is 'unfinished business' and is bound up in or with emotion which needs releasing.
Goals of Gestalt therapy have been honed down to a basic set of four.
Firstly 'Maturation'. This is to help the individual away from environmental support to self support. In other words to become less dependant on others and this includes the therapist. It includes learning to drop the many roles and games we play with ourself and others.
Secondly, 'Integration'. This means integrating the individual as a whole person. It can involve helping the person to discover the splits in himself, learning to accept and integrate them. For example we might have a part of us which never allows us to be or feel angry. Therapy will help us to recognise this split, express our anger appropriately and learn that this part is of us and needs to be as it is, neither good nor bad. Simply another part which makes us 'whole'.
Thirdly, 'Awareness', which has already been mentioned. Here the therapist will help encourage the person to recognise parts of themselves that they don't think they have, or have not been aware of.
Fourthly, 'Responsibility' . Here the person is encouraged to take responsibility for their own actions. It can involve simply not blaming the therapist for the outcome of trying some particular therapeutic manoeuvre or technique. Learning that ultimately it is our responsibility to change and grow.
Obviously these goals often merge.
There are a range of ground-rules which the Gestalt therapist sets up at the start of therapy so that the patient knows what is expected from him, as such they could also constitute some of the techniques used.
Awareness- the patient knows that this is what he is working for. The 'here and now' - all Gestalt therapy is carried on in the 'here and now'.
Statements instead of questions. To encourage clients to use statements rather than questions.
No gossiping. Patient might like to talk about their Father, Mother, Wife etc., but in Gestalt therapy they must talk about them as though they were there in the room, in the here and now. One of the techniques used to do this is called the empty chair technique. I shall explain this later.
Patients must not use 'I can't' statements. They must instead use 'I won't'. For example, they must say 'I won't stop smoking' rather than 'I can't stop smoking'. This encourages facing up and taking responsibility for self rather than blaming others.
Responsibility - the patient must accept responsibility for whatever he does, especially if he agrees with the therapist to try something.
The use of 'I' language. I.e.. 'I feel this', 'I don't want to do this'. It means working on the self and accepting the self.
'I' and 'thou', in the therapy session the therapist insists the patient looks him straight in the eyes and talks at the therapist and uses your name. Both direct eye contact and using the therapists name is encouraged and it can be a very confrontative approach to do therapy.
There are four major ways the Gestalt school believe disturbance and interference in good functioning occur.
These are Introjection, Projection, Retroflection and Confluence (Perls 1973).
Briefly; introjection is the uncritical acceptance of significant others beliefs, ideas, and morals. Rather than assimilating what might be useful, the individual accepts all concepts wholeheartedly, in their development, and many of these may be inappropriate and unhealthy now.
Projection is where the individual denies parts of themselves and places those qualities on others. Thus avoiding taking responsibility for their own feelings.
Retroflection is where the person cannot direct their behaviour outwards and directs it at self. I.e. if angry, hitting themselves, if needing love and friendship, hugging themselves.
Confluence is where the person feels no boundary between themselves and the environment. They cannot make good contact with others, nor withdraw from them. They either acquiesce to others or attempt to change the other person to be like themselves by bribery, persuasion, or force. There is a demand for likeness to 'self', and an intolerance of that which is 'not self'.
How might the Gestalt techniques be incorporated into the work of a hypnotherapist?
Perls (1973) believed that a person's dreams, were that person; every detail of the dream is a part of them and an expression of them in the here and now. Using hypnosis it would be simple to help the individual recall the dream and thus place it in the 'here and now', 'as if' it were happening now. Rather than making an attempt to analyse the dream, the therapist could simply help the patient explore various aspects of it. This could be done in a number of ways using hypnosis. The idea is to help the patient integrate lost aspects of themselves.
The patient could try being a number of different parts of the dream and say how it felt being that part. For some people this might be much easier to facilitate in hypnosis, with the loss of critical analysis and the need to conform and behave in a certain way. As we know inhibitions are reduced in hypnosis, and it could be easier and more comfortable to try this in hypnosis than if wide awake. The patient might be encouraged to talk as one part in the dream to another part to discover lost aspects of themselves and integrate the emotions accompanying them.
Working with dreams in this way might help where other analytical techniques simply provide further frustration and inability to express underlying feelings. Emotional control is less apparent in hypnosis and the Gestalt approach here may make the expression of uncomfortable feelings easier and less fearful.
Working in the 'here and now' is a very useful concept which can be adopted using hypnosis. It is a very immediate way of helping the patient focus on what is important now and getting away from the 'headstuff' of intellectualisation and into the task of dealing with feelings. For example if using regression in hypnosis, having allowed an incident or event to be made consciously aware, using a Gestalt approach it is possible to place the event in the present. This is a way of enabling the patient to complete any 'unfinished business'.
For instance if an event arose where the patient was angry with his father for something which happened in the past; using Gestalt the patient could be encouraged to say what he would have liked to say then to his father, and to say it now, along with the feelings of frustration or sadness or anger which he did not express back then. The reason that the patient has recalled that particular event is probably because it is still unresolved.
By working in the 'here and now' it becomes very difficult for the patient to avoid what unresolved feeling there may be, to feel them, express, release and 'integrate' them. For the hypnotherapist using the focus on the 'here and now', it is possible to continually bring the patient back to the present to work on the feelings related to what comes up.
Feelings are an important part of Gestalt therapy, and the hypnotherapist can help the patient 'stay with the feeling'. In a state of hypnosis it is easier to follow what is being suggested that to 'opt out' and avoid what might be uncomfortable and painful. So if using hypnosis the therapist has an advantage over the therapist who is not. The business of therapy is to help someone change, and anything which makes it easier for the patient not to avoid working on and through material is a bonus.
Hypnosis is just such a tool. So for example if the patient is complaining of a sudden pain in a part of his body such as his back or stomach, he is encouraged to experience the feeling fully, the hypnotherapist might suggest that the feeling increase or get bigger or stronger. In this way it is then possible to help the patient discover what that part of his body is telling him and so resolve the issue.
Perhaps he might be encouraged to become the 'part' and speak as his back or stomach to discover what it has to say. The hypnotherapist is able to encourage the emotional content behind the pain or discomfort to 'come out', be expressed, released and so integrated.
For some people it might be easier to let go of pain and anguish whilst in the hypnotic state than while wide awake. Hypnosis has the ability to help us 'disassociate' to some extent, initially allowing us to experience a feeling without being overwhelmed and having to 'escape and run away from' it. This can greatly facilitate the progress of contacting and releasing feelings and pain.
Awareness is one of the key tenets of Gestalt therapy. The unblocking of awareness and drawing the attention to awareness is involved in many of the methods employed by Gestalt therapists. Awareness allows choices; it is not a 'should' or 'must'. If a person is not aware, then their choices and responses are limited. Hypnotherapists can make use of this technique. Perhaps by encouraging the patient while in hypnosis to be aware of feelings and sensations.
Using hypnosis is a more effective way initially of training the patient in awareness. Because of the 'withdrawn' nature of the hypnotic state, where senses such as sight, sound and touch are not so acute, and also are subject to manipulation in deep trance subjects, it is not difficult to help a patient refocus on very small and subtle sensations. Because outside distractions are perceived as minor in the hypnotic state, very small changes in feelings and sensations can be noticed if encouraged by the use of appropriate hypnotic suggestion.
This technique which the hypnotherapist might choose to use, can be accentuated by accurate observation of the patient. For example, the therapist might notice a very small clenching of the fingers or jaw, or perhaps a tightening of the neck muscles. The hypnotherapist can then help the patient be made aware of the movement and can be encouraged to be more aware of the feelings of that part of them. This can be used as a focus to help the patient get in touch with the feelings and emotions which might be behind the movement or sensation. This is a technique I employ frequently and it is a very effective way of 'drawing out' held emotions, and assisting them to be expressed and released.
The hypnotherapist using suggestion can also accentuate the feeling or movement by suggestion. This could be viewed as using the Gestalt process of exaggeration, and repetition of something, either a phrase or movement. From the patient's point of view, hypnosis is the ideal state to be assisted in becoming more aware of small changes in body posture or muscle tension or of course, thought processes.
All of these 'awareness' techniques seem to be more powerful in my experience, actually within the hypnotic state. They make an excellent bridge for helping the awareness process to become more conscious, so that they transfer to the awake state more readily.
In summary, there are a range of Gestalt techniques which the hypnotherapist can profitably employ. There are a number of important tools which haven't been explored due to lack of space, for instance' the empty chair' technique, the taking of responsibility, reversals, offering a sentence, owning a projection.
There is such a wealth of processes and techniques for the hypnotherapist to draw from, that the difficulty is not in deciding which ones to employ, but in deciding which ones to leave out and not work with.
Having tried over a number of years some of these myself, I can attest to their value, and I feel it is no accident that Perls work was one of the major therapies from which Bandler and Grinder extrapolated and developed Neuro Linguistic Programming. N.L.P. in itself requiring several years study to understand and appreciate.
Individual Therapy in Britain Windy Dryden 1984
Gestalt Therapy Perls, Hefferline, Goodman 1976
Gestalt Therapy Verbatim Frederick Perls 1976
Oxford companion to the mind Richard Gregory 1987
References Freud for beginners R. Appignanesi
A textbook of psychology Radford and Govier
The road less travelled M.Scott Peck
Freud Richard Wollheim
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