Applications

Problems

Gestalt therapy is very efficient with any clients the therapist feels easy with. In case the therapist establishes connection with the client, this is possible to use the dialogue principles as well as direct experiencing. With every client, common principles should be adapted to certain clinical situation. If the treatment of the client is made to obey the rules of "Gestalt therapy," it can be unsuccessful or even damaging. To a sociopath, a schizophrenic, a borderline or to an obsessive-compulsive neurotic various approaches are required. Consequently, in order to be competent in Gestalt therapy and to have a successful practice, one needs background also which is not just in Gestalt training. Personality theory, information about diagnosis and psychodynamic theory is required too.

In Gestalt therapy the personal clinician has much discretion. Alterations are made individually by the therapist in accordance with the therapeutic style, diagnostic considerations, and et cetera. The therapist should be responsible to do it. Therapists should have Gestalt training and have a firm ground in psychopathology, personality theory, psychotherapy theories, and sufficient clinical experience. Those who participate in the therapeutic sessions are allowed to experiment with different behavior and later share their cognitive and emotional experience.

Gestalt therapy has been regarded always most successful with "excessively socialized, reserved, constricted personalities" (nervous, perfectionistic, patients with phobia and depression), whose contradictory or controlled functioning is first and foremost a result of "inner restrictions" (Shepherd, 1970, pp. 234-35). Such persons frequently demonstrate just a little satisfaction of living.

Though Shepherd's statement portrays exactly in what way Gestalt therapy is efficient, modern clinical Gestalt therapy practice comprises treatment of a much wider assortment of problems. Gestalt perception is different nowadays.

The workshop "Perlsian" style in Gestalt therapy has limited and narrow application than Gestalt therapy upon the whole (Dublin, 1976; Dolliver, 1981). In discussion of Shepherd concerning restrictions and cautions, she mentions limitations that are relevant to any therapist but should specially be noted in the surroundings of the workshop, also by therapists who did not have good Gestalt training or dealt with disturbed clients.

Sessions with disorganized, psychotic, or seriously disturbed people are harder and require "vigilance, sensitivity and tolerance." Shepherd recommends not doing work of this kind where it is not possible to make a "long-standing commitment" to the client. Disturbed clients necessitate support from the therapist and some faith that it is possible to heal them before they start deep exploration and experience strongly the "devastating pain, hurt, fury and depression" that lie behind the mental processes of disturbed clients (Shepherd, 1970, pp. 234-35).

Work with disturbed persons calls for clinical awareness of ways to balance frustration and support, comprehension of character dynamics, need for supplementary support (for instance, day treatment and medicine) and so on. Certain statements which seem to be reasonable in a workshop encounter are evident nonsense as soon as a wider context is used. Regard for instance, "do your own thing" referring to acting out clients! In this context this is nonsense.

An examination of the Gestalt perception is seen in books about Gestalt such as The Growing Edge of Gestalt Therapy (Smith, 1976), Gestalt Therapy Now (Fagan and Shepherd, 1970), and The Gestalt Journal. These sources will illustrate Gestalt therapy use for crisis intrusion, ghetto adults in a program concerning poverty (Barnwell, 1968), psychotics, interaction groups, family therapy and just about any other possible group. Regrettably books supplies with examples (there are not so many of them) with insufficient explanation of necessary alterations under consideration and not discussing negative outcome.

Gestalt psychotherapy has been effectively engaged in the treatment of a broad variety of "psychosomatic" disorders together with ulcerative colitis, migraine, and spastic back and neck. Gestalt therapists have productively conducted family therapy, with persons who have problems managing authority figures, with a broad assortment of intrapsychic confrontations. Gestalt therapy has always been efficient when dealing with psychotics and stern character disorders.

Due to the influence of Gestalt therapy and the simplicity with which it is possible to obtain strong, normally hidden affective reactions, it is essential to set up shelter islands where the therapist and client can easily return. It is necessary as well for the therapist to be with the client up to the moment he is ready to go back to these shelter islands. For instance, following a particularly emotion laden incident, the client may be urged to create visual, tactile or any other contact with the psychotherapist or with somebody from the group to tell about the experience. Another protection technique is to have the patient move backwards and forwards between establishing contact in the now with the clinician or members of the group and with the emotionally loaded incomplete situation that the client felt then up to the moment all the influence has been discharged and situation which was not completed worked through.

The Gestalt therapy stresses the importance of interpersonal contact, personal responsibility, and bigger clearness of awareness of what is most important or could be of big worth when difficulties of the present are solved. One pattern is Gestalt therapy use in schools (Lederman, 1970; Brown, 1970).

Evaluation

Gestalt therapists feel oddly no interest in official psychodiagnostic assessment and methodology of nomothetic research. Statistics will never inform the particular client or therapist what exactly is efficient. What is good for the majority is not at all times effective for individual person. This does not denote that Gestalt therapists do not like research; actually, the Los Angeles Gestalt Therapy Institute has proposed grants to support financially research. Fritz Perls proposed no quantified, statistical verification that Gestalt therapy is efficient. He said, "we offer nothing that you cannot confirm for yourself referring to your own behavior" (F. Perls et al., 1951, p. 7). In Gestalt Therapy publication a range of experiments are given that can be applied to test for yourself the power of Gestalt therapy.

Each encounter is regarded as an experiment, an existential meeting in which both sides: the therapist and the patient are involved in deliberate risk exploring something unknown before or prohibited territories. The client obtains help in use of phenomenological skills and learns to apply dialogic contact to understand what is effective and what not. Consequently, regular idiographic research is conducted. Gestalt phychotherapy has "sacrificed precise confirmation for the worth of ideographic psychotherapy of experimental kind" (Yontef, 1969, p. 27).

Harman (1984) made a review of Gestalt research books and could hardly discover quality research on Gestalt phychotherapy. He has not discovered studies that demonstrated improved self-actualization and stated self-concept which was the outcome of Gestalt therapy groups (Giunan and Foulds, 1970; Foulds and Hannigan, 1976).

A number of studies made by Leslie Greenberg together with associates (Greenberg, 1986) were directed to the lack of interest in context during psychotherapy research and the bad separation of procedure and result studies. The Greenberg explorations referred to definite acts and alteration processes in psychotherapy with definite outcomes. The research of them differentiated three kinds of outcome (such as intermediate, immediate and final) and three stages of procedure (verbal communication act, episode and connection). They explored verbal communication in the context of the kinds of episodes when it appears, and they explored the episodes in the context of the connection with the others or relationships where they appear.

In a particular study Greenberg explored the use of the 2-chair technique to decide upon splits. He made a definition of a split as "of pattern of verbal performance when a patient says about a separation of the self procedure into two fractional parts of the self or tendencies." He makes a conclusion that "two-chair operations fulfilled in accordance with the principles [of his examination] have been discovered to make easier a development in the Depth of Experiencing and index of dynamic psychotherapy...and to direct to resolutions of splits with patients looking for counseling" (1979, p. 323).

A study of L. S. Greenberg and H. M. Higginsí work of the "Effects of 2-Chair Dialogues and Concentrating on Conflict Resolution" discovered that 2-chair dialogue happened to generate a more direct experience of split and urged the patient in a self-confrontation form that assisted to create a resolution to the split or conflict" (1980, p. 224).

Harman (1984) discovered a range of studies that evaluated the Gestalt therapistsí behavior and the behavior of other therapists. Brunnink and Schroeder made the comparison of behavior therapists, psychoanalysts, and Gestalt therapists and came to conclusion that the Gestalt therapists "gave more direct control, not so much verbal facilitation, less centering on the patient, more disclosure of self, more initiative and less emotional sustain." They also discovered that the "interview" used by Gestalt therapists showed more experiential approach to therapy and subjective as well " (1979, p. 572).

It is not claimed anywhere in the literature dedicated to the Gestalt therapy that it is the "best." It is never explained theoretically why this kind of therapy should be more efficient than any other therapies which are based on different psychotherapy principles. The research of the results may produce not so practical results than research of procedure studying behavior, manners, mind-set and consequences. A sample of this is Simkin's evaluation of the efficiency of Gestalt therapy in workshops which was called "massed learning" in comparison with the "spaced" psychotherapy sessions every week. He discovered verification of the advantage of massed learning (Simkin, 1976).

Some Gestalt therapy points of view on constituents of good therapy are sustained by common research. The study on experiencing within the frames of the Rogerian tradition showed the efficiency of an accent on direct experience by the therapist. In Gestalt therapy personal relating is also stressed as well as presence and experience. This is sad but some therapists frequently and deliberately break the principles of excellent therapy in accordance with the model of Gestalt therapy, but continue to mane themselves Gestalt specialists (Yalom and Miles, Lieberman, 1973).