Update on Gestalt Therapy

Educational Objectives

The goal of this program is to improve understanding of the principles of Gestalt therapy. After hearing and assimilating this program, the clinician will be better able to:

1. Distinguish Gestalt therapy from traditional psychodynamic therapy.
2. Discuss the five layers of neurosis as conceptualized in Gestalt therapy.
3. Describe interventions and strategies of Gestalt therapy.

Summary

Gestalt psychology: theory of perception that is part of learning theory; different from, but key underpinning of, Gestalt therapy; Fritz Perls assigned emotional motivation to Gestalt psychology’s concept of learning process and applied it to Gestalt therapy; concept of unfinished business — Gestalt psychology recognizes person’s need to make “wholes” out of things; unfinished business presses for being finished until it is finished; similar to concept of unmet needs; needs may shift in importance; physiologic need may interrupt need to finish other task (eg, fixing car); Gestalt is formed based on need; individual scans environment to look for ways to finish business or meet need; met need or finished Gestalt no longer has power to interrupt other activities

Definition of Gestalt: German word generally translated as “whole,” or sometimes “form”

Gestalt therapy vs traditional psychodynamic therapy: Gestalt therapy more interactive, including greater contact between therapist and client; term “client” preferred to “patient” because therapy not based on medical model; client experiences interaction on equal basis with therapist; therapist not healer or fixer, but acts as guide with client; diagnoses used as guide when individuals interrupt their Gestalts or themselves from finishing business; example of art therapy — non-Gestalt therapist might ask client to draw something, then interpret drawing; in Gestalt therapy, as characterized by Oaklander, art therapy uses colors, lines, and shapes as language for clients to express themselves

Basic principles of Gestalt therapy: holistic approach; phenomenological (ie, interested in process of what is happening) and present-centered; relational (ie, everything has meaning within context of how it is communicated)

Five layers of neurosis: part of seminal writings of Perls; phony — superficial presentation of self, as at cocktail party; phobic — “there’s something about me that I don’t want other people to know”; may lead to deflection of what others say or to phobic actions to cover paranoia; impasse — “fertile void”; individual knows he or she cannot return to phony or phobic layer; fear of moving forward (leads to implosive layer); implosive — seeing self in negative light; “hiding what I don’t want to be known”; explosive — explosion or release, as into grief, anger, joy, orgasm

Relationship between therapist and client: “I-thou” relationship; therapist not expert in what client says or does, but rather guides client; therapist communicates with client about what is happening at any given moment; therapist present-centered and gives client opportunity to experience possibility of change with full awareness (full sensory, motor, energetic, and emotional experience)

Empty chair technique: way for clients to create dialogue with disowned parts of themselves; therapist uses clues from client, and clients move from one chair to another to experience parts of themselves that they have been disowning; client integrates experience into making new choices for change

Art therapy: communicating or creating dialogue through use of colors, lines, and shapes (eg, client chooses color to represent anger); useful in children; colors can become “empty chair” or vehicle for communicating to help find disowned parts of client to complete Gestalt

Gestalt therapy for couples: important to focus on communication between individuals rather than taking sides and assigning blame to one or another; therapist works with couple to reach equality in relationship and communication with each other in present; therapist guides communication (encourages clients to, eg, speak in present tense and start sentences with “I” instead of “You” to avoid assigning blame)

Role of nonverbal communication: always important to consider body language (eg, legs crossed, arms folded); breath work — helpful for patients with anxiety; anxiety can interfere with breathing, especially effective exhalation of carbon dioxide; seated, clients should place feet flat on ground to feel fully supported by floor, then inhale through nostrils and exhale as if blowing out candle; repeat; clients often have difficulty exhaling (making sound or using voice helpful); important to address physiologic elements of anxiety to make changes

Gestalt therapy for treating psychosis and personality disorders: must be judicious in deciding whether to use Gestalt therapy to work with psychotic individuals or clients with personality disorders; clients with borderline or narcissistic personality disorder often have difficulty performing tasks (eg, talking to empty chair) outside realm of their normal experiences; important to proceed one step at time

Status of Gestalt therapy: not as popular in United States as in Europe (may be partly attributable to increased use of mindfulness and somatic experiencing)

Gestalt therapy for growth and change: relationship between client and therapist becomes laboratory for clients to relate to themselves and to others; therapist guides client to explore and experience what is happening in present to allow change to occur; therapist helps clients ground themselves in holistic approach

Readings

Brown P, Brown M: Pastoral group counselling at a high security prison in Israel: Integrating Pierre Janet’s psychological analysis with Fritz Perls’ Gestalt therapy. J Pastoral Care Counsel. 2015 Mar;69(1):40-5; Fahrutdinova LR, Nugmanova DR: Dynamics of psychological crisis experience with psychological consulting by gestalt therapy methods. Glob J Health Sci. 2015 Jan 1;7(4):130-5; Field NP, Horowitz MJ: Applying an empty-chair monologue paradigm to examine unresolved grief. Psychiatry. 1998 Winter;61(4):279-87; Henle M: Gestalt psychology and Gestalt therapy. J Hist Behav Sci. 1978 Jan;14(1):23-32; Jones A: Gestalt therapy: theory and practice. Nurs Stand. 1992 Jun 10-16;6(38):31-4; Knez R et al: Gestalt psychotherapy in the outpatient treatment of borderline personality disorder: a case report. Afr J Psychiatry (Johannesbg). 2013 Jan;16(1):52-3; Leung GS et al: An outcome study of gestalt-oriented growth workshops. Int J Group Psychother. 2013 Jan;63(1):117-25; Tonnesvang J et al: Gestalt therapy and cognitive therapy — contrasts or complementarities? Psychotherapy (Chic). 2010 Dec;47(4):586-602.

Disclosures

For this program, members of the faculty and planning committee reported nothing to disclose.

Acknowledgements

Ms. Godfrey and Norra MacReady were recorded onsite in Glendale, CA. The Audio Digest Foundation thanks the speakers and the sponsors for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

PG070801

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

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