Theory of Psychotherapy
Goal of Therapy
There is only one aim in Gestalt - awareness. This comprises more awareness in a certain area and also more ability for the client to take automatic habits into awareness as necessary. In its previous sense awareness is understood as content, in the later sense awareness is a process. Two notions (of awareness as content and as process) develop to more profound levels as the therapy progresses. Awareness embraces knowing the surroundings, responsibility for decisions, knowledge of self, acceptance of self, and the capability to contact.
In the beginning clients are mostly concerned with finding solution to the problems. Gestalt therapist is looking for the answer to the question how clients support themselves when they solve problems. Gestalt therapy makes problem easier getting rid of it by means of improved self-regulation and client’s self-support. As therapy continues, both parties pay more attention to common personality problems. By the closing stage of therapy with the desired effect the client does the work in large part and can assimilate problems solving, relationship and characterological issues with the therapist, and ways to control the awareness.
Gestalt therapy is of special value for clients ready to work with self-awareness and those who wish to master the awareness process. In spite of the fact that some people declare they want to modify their behavior, the majority of people on the lookout for psychotherapy just want liberation from feeling of uneasiness. They can complain of widespread sickness, particular discomforts, or unsatisfactory relationships. Clients frequently anticipate that relief will follow after therapist's work more than from their own hard work.
Psychotherapy suits for people who are anxious and depressed because they are rejecting themselves, pushing aspects of themselves away, and misleading themselves. In other words, people not knowing how to stop being unhappy are main candidates on condition that they are ready to work over awareness, for the most part awareness of self-regulation. This kind of therapy is good for those who are aware about themselves but do not grow.
If the person just wants symptom relief not including awareness work, then medication, biofeedback, or behavior modification and some other ways will probably work better. The Gestalt therapy direct methods make it easier for the clients to come to this decision on an early stage of therapy. Nevertheless, if the patients have problems with awareness work or contact, it does not mean that they are unwilling to work. Respect for the total personality gives Gestalt therapist an opportunity to assist to clarify the difference between notions "can't" and "won't" and to learn the way internal obstacles or resistance, for instance, prior learning, nervousness, shame and being subjected to narcissistic injury, hamper awareness work.
Gestalt therapy does not comprise "shoulds". Independence and the determination of self for the patient are more important than different values in Gestalt therapy. This is no such connotation the one “should” has. It is rather a preference. The no-should ethic is a priority over the goals the therapist set for the client and passes to the patient the responsibility approving his behavior (the restrictions and requirements of society are certainly not regarded here only because the person is in Gestalt therapy).
How Is the Therapy Done?
Gestalt therapy is an examination more than modification of behavior directly. The objective is development and self-sufficiency by means of consciousness growth. Rather than establishing distance and interpretation, the therapist in Gestalt meets clients and conducts energetic awareness work. The presence of therapist is active and energized (therefore warm), sincere and direct as clients can see, hear and converse the experience, feelings. They see the personality in therapist. Development is the result of contact between real people. Clients learn the way they are perceived, that their awareness process is incomplete, not mainly by discussing the problems, but by the way the contact with the therapist happen.
Focusing starts from plain inclusions or understanding to exercises, that occur generally from the phenomenology of the therapist while with the client. Everything is less important than direct experience of two sides.
The Gestalt therapy common approach is to make the exploration easier and maximize the development even after the therapy session and when the therapist is not present. It is as if the patient is left with a task. The process in not finished after the session is over. It can be compared with a roast that goes on preparing even when it is taken out of the oven. This explains the way Gestalt therapy can be intensive even with the fewer sessions a week. We collaborate and this brings to growth without us; we start the required process. We only launch something that is needed to encourage patient to improve. We make growth possible rather than finish healing process.
Fritz Perls considers that the final purpose of psychotherapy was the reaching that degree of integration which makes own development attainable (1948). An illustration of this type of facilitation is the likeness to a little hole made in the accumulation of snow. As soon as the draining process starts, it is hard to stop enlargement and it continues by itself.
Psychotherapy bringing to positive result reaches integration. Integration needs identification with all crucial functions – not just some of the ideas, feelings and actions of the client. Any refusal from one's own ideas, feelings or actions brings to alienation. Reowning lets the individuality to be whole. So the assignment in therapy is to let the patient learn about formerly separated parts and experience them, think about them and incorporate them in case they are ego-syntonic or refuse from them if they happen to be ego-alien. Simkin (1968) has employed the image of a cake to encourage patients to reown their parts which were considered harmful or improper: though such products as the oil, flour and baking powder are not tasty by themselves, they are essential to make the whole cake tasty.
The I-Thou Relation
Gestalt psychotherapy concentrates on the patient, just as any other therapy. Nevertheless, the horizontal relationship became the main difference from what existed in the traditional therapy at that time. The therapist and the client in Gestalt therapy find understanding as the speech is on the same language of current centeredness, stressing experience of direct communication of two sides. Therapists in Gestalt psychotherapy confirm their complete presence just the same way as clients do.
From the very start, Gestalt therapy was focused on the patient's experience in addition to observation of the therapist who determines what is not present in the awareness of the client. This lets the patient be an equal participant of the process with complete access to the information of his experience therefore he is able to experience directly from inside what the therapist observes from outside. Not having theological basis for the interpretation, the client is an amateur and does not have knowledge in an interpretive system. It is supposed that the significant inner data are beyond the consciousness, and this data is not experienced.
The matter of responsibility is an essential aspect of the Gestalt therapy relationship. In Gestalt therapy both parties of the process are self-responsible. There is an emphasis on it. In the situations while therapists consider that they bear responsibility for patients, this brings to the outcome when the client does have self-responsibility and manipulation becomes inevitable because of the client’s inability to support himself. Nevertheless, it is not sufficient for the therapist to be in charge of self and for the client to be in charge of self – there is a union of client and therapist that should be always and knowledgeably attended to.
Therapists are in charge of the quality and quantity of their own presence, for information about themselves and the client, for preserving a nondefensive posture, and for maintaining their awareness as well as making contact comprehensible for the client. The patients answer for the outcomes of their behavior and for creation of the therapeutic atmosphere and maintaining it.
The Awareness of What and How
There is always accent in Gestalt therapy on such aspects as what the client does and how. What does the client encounter and how does he choose? Does the client self-support or on the contrary resist? Being an instrument, direct experience is stretched out further than what one experienced in the beginning, so deeper and broader focus is obtained. The techniques of Gestalt therapy consist of experimental assignments. They are the tools of enlarging direct experience. They are not meant to get the client somewhere, to alter the feelings of the client, to recondition, or to promote catharsis.
Here and Now
"Now" begins in a phenomenological therapy with the current awareness of the client. What takes place initially is not childhood period, but the period of current experience or now. Awareness comes right now. Previous happenings may be the items of current awareness, but the process of awareness (for instance, remembering) is right now.
Now I am able to contact the surrounding, or now I have the ability to contact recollections or hopes. Without being aware of the present, not keeping in memory, or not expecting are all troubles. The present is a transition point between the past period and the future. Clients are not always aware about their behavior at the present moment. Sometimes they live the way they do not have past. The majority lives in the future. These things present interruptions of time awareness.
"Now" is applied to the present moment. During the therapy hour the clients think of lives from the position of the current hour, or before in the hour, which is not now. Gestalt therapy is more focused on the now than in some different psychotherapy form. Experiences, received in the last minutes of the past, days, or years and even decades are especially important. We try to progress from speaking about to experiencing directly. For instance, this more resembles the situation which is closer to speaking to an individual who is not present physically activates more direct experience of sensations than speaking about the person.
I and Thou in Gestalt therapy is just like “what and how” notions, “here and now” methodology is often applied to grow characterological and developmental psychodynamics.
For instance, a woman, who is 30 years old, is in the group therapy, on some middle stage. She shares that she is cross with a man from the group. Often and legitimate approach of Gestalt psychology is "Inform him." Instead, the therapist follows another way:
T: You feel more than just angry.
P: [looks with attention]
T: It seems that you are furious – the way you look and sound.
P: This is right, I am ready to kill him.
T: You have a feeling of impotency as it seems.
P: I do.
T: Impotence typically goes together with rage. What causes your impotency?
P: He does not acknowledge me and I can’t do anything about it.
T: [the observations of therapist verify this] You can’t accept it.
T: Your rage is stronger than the situation requires.
P: [the person nods and makes a pause]
T: What do you feel now?
P: There were many people in my life before who caused the same situation.
T: Your dad for instance? [this is the result of previous work with client and not just a guess. The client starts to reexperience the narcissistic injury received from father, who was not receptive to her]
Process of Psychotherapy
Gestalt psychotherapy almost certainly has a lot of styles and modalities, more than in any other structure. It is experienced in personality therapy, workshops, family therapy, group therapy and is also good for couples. Its practice takes place in clinics, hospitals, growth centers and others. Family therapy is practiced as a rule in family service agencies and private practices. The styles can be different in every modality on many characteristics: level and sort of structure; amount and worth of techniques used; regularity of sessions; accent on body, cognition, lack abrasiveness; sensations, interpersonal contact; knowledge of psychodynamic themes and work with them; level of individual encountering, and so on.
Gestalt psychotherapy modalities and styles resemble general principles discussed by us: prominence on direct experience and phenomenology (experimenting), direct contact use and individual presence (the sign of dialogic existentialism), and accent on concepts of field theory, such as “what and how” for example, or “here and now”. In the boundaries of these dimentions, intrusions are modeled in accordance with the context and the individualities of the therapist and the client.
The core of the methodology is the accent on the discrepancy between work activity and different activities, "speaking about" in particular. Occupation can mean two things. It can refer to a purposeful, intentional and closely controlled obligation to apply awareness, which is phenomenologically accented in order to be able to see the life clearly. When the process in transferred from speaking about a difficulty or spending time with person in a universal way to thorough studying the activity, particularly knowing of somebody’s awareness, the person is working. Secondly, in a group, work denotes being the major focus of the therapist's or the group's attention.
Different approaches in techniques are not of big importance, though the value of therapeutic contact and its type and a connection between the manner and accent of the therapist and the client's needs are essential. Techniques are not as important, they are just techniques: the general method, bond, and outlooks are the fundamental aspects.
However, a debate about strategy or techniques might explain the methodology on the whole. They just demonstrate what can be achieved.
Techniques of Patient Focusing
The techniques of the client who is concentrated on explanation are around the following questions: "What are you experiencing at the moment?" and the recommendation, "Make this experiment and you will become aware of (experience) or learn." Numerous tactics are as easy as just asking about the awareness of the person, or ask more definite questions: "What are your sensations?" or "What are your thoughts?"
"Remain with it." A common technique is to go after an awareness statement with the following rules: "Go on with with it" or "Sense it out."
"Go on with it" helps the person to carry on with the emotion of the thing reported, which makes the capacity of the client grow deeper and work a sensation through to finishing point. For instance:
P: [looks sad]
T: What do you feel?
T: Remain with it.
P: [tears in the eyes. Then the patient calms down looking away in a thoughtful way]
T: I note your tightening. What is that you aware of at the moment?
P: I have no wish to remain with the sadness.
T: Remain with the not wishing it. Put your lack of wish into words. [this can lead to awareness of the client's struggle with melting. The client might reply: "I will not show my tears as I don't believe you," or "I am embarrassed," or "I am irritated and don't wish to confess that I miss him"]
Enactment. The client is asked to turn sensations or thoughts into acts. For instance, the therapist may give the encouragement to the client to do it "tell the person about it" (if this is now) or employ role playing (for example, saying an empty chair if there is no person). "Put it into words" is a different sample. Crying client might be invited to "put it into words." Performance is given as a means of growing awareness, not as a type of catharsis. This remedy is not common.
Exaggeration is a particular form of performance. A person exaggerates certain sensations, actions, thought, etc., by demand to feel the stronger (though simulated) enacted vision or fantasy. Enactment turned into doings, art, sounds, poetry, etc., can boost creativity and have therapeutic effect. For example, a man told about his mother without any emotions therefore the client was asked to give a description of his mother. Once saying it, the realization of the fact came to his mind and this entailed warmer attitude which was forgotten already. As the client accepted her position and progress, powerful feelings returned to his awareness.
Guided fantasy. The client can bring an experience at times into the here and now with bigger effect by imagining than by performing:
P: Yesterday night I happened to be impotent with my girlfriend and do not understand the reason for it. [client explains his story in detail]
T: Shut your eyes. Visualize last night and your girlfriend and explain the way you feel and the way your sensations change.
P: I am thrilled as my girlfriends sits close to me on the sofa, but I go soft after it.
T: Let us look at every stage together in detail. Do not miss any thought or anything in your perception.
P: I am on the sofa. She approaches and sits beside me, strokes my neck. It is soft and pleasant, I go hard as I am excited. She touches my arms, and this is excellent. [then he makes a pause, looks anxious] Then it occurred to me, that there was a stressed day, perhaps I will not cope with it.
This client got awareness what the reason for anxiety and weakness was. The recreation of event let him receive complete understanding why it happened to him. The vision might be of an anticipated event, or a metaphorical one, and et cetera.
In the next case, a patient, trying to cope with shame and self-rejection problem, is asked to visualize his mother saying with words and actions "I love you as you are." As the vision is described in detail, the client follows attentively her experience. This vision helps the person obtain awareness of the opportunity of fine self-mothering and can serve as a conversion to integrate fine self-parenting. The imagination is used to conduct work between sessions. It increases sensations about experiences with leaving, loss and awful parenting.
Loosening and integrating techniques. Frequently the patient is so confined with the bonds of the typical ways of thinking that different possibilities cannot be accepted in his awareness. This comprises long-established mechanisms, for instance, denial or repression, but cultural factors as well as learning influence the way of thinking of every person. One of the ways is to ask only the client to visualize the contrary of what it seems to be right.
Integrating techniques helps to bring processes together the client doesn't put together or vigorously separates them. On inquiry of the therapists he puts negative process into words through crying and being tense. Verbal form explains the feeling, emotion. Or a different sample when patient is asked to communicate positive and negative emotions about the similar person.
Body techniques. These comprises all techniques that lead to awareness of the client to the body functioning or contributes to their understanding how they are able to use their bodies for excitement support, and for awareness and contact. For instance:
P: [in tears and with a tight jaw with tension]
T: Would you like to make an experiment?
P: [client nods]
T: Breathe deeply and with every exhale, try to relax your jaw to move it down loosely.
P: [takes deep breaths and lets jaw go down as he exhales]
T: Remain with it.
P: [tears appear and patient begins to sob]
The Gestalt therapist is urged to have "I" statements as they make the therapeutic contact easier and the patient's focusing and should be made discerningly and with caution. It is necessary for a therapist to have Gestalt training, to be skilled technically and be wise and have self-awareness to make use of "I" statements to make the work easier. Therapists should share with patients what they see, what they hear or what they smell. They should say how it influenced them. Details, the therapist is aware of, while the patient is not, should be given, particularly if the data is not likely to be suddenly discovered in the process of phenomenological work during the gestalt psychotherapy session, yet it should be believed to be significant to the patient.