GESTALT

THERAPY
 INTRODUCTION
 The word gestalt has no literal English translation.

 It refers to a perceptual whole or configuration of experience.

 People do not perceive in bits and pieces, which are then added up to form an organized perception; instead,

they perceive in patterned wholes.

 Patterns reflect an interrelationship among elements such that the whole cannot be gleaned by a study of

component parts, but only by a study of the relationship of parts to each other and to the whole.

 The leading figures in the development of gestalt psychology were Max Wertheimer, Kurt Koffka, and

Wolfgang Kohler.

 Kurt Lewin extended this work by applying gestalt principles to areas other than simple perceptual psychology

and by explicating the theoretical implications of gestalt psychology.

• He is especially well known for his explication of the field theory philosophy of gestalt psychology.
• In field theory, the world is studied as a systematic web of relationships, continuous in time, and not as discrete or
dichotomous particles.
• In this view, everything is in the process of becoming, and nothing is static.
• Reality in this field view is configured by the relationship between the observer and the observed. “Reality,” then, is a
function of perspective, not a true positivist fact.
• Fritz Perls’s earliest publication was Ego, Hunger and Aggression (1942/1992), the first comprehensive integration of
gestalt therapy system is found in Gestalt Therapy.
• Gestalt therapy pioneered many ideas that have influenced humanistic psychotherapy.
• Gestalt therapy was developed in the 1940s primarily by Frederick Perls, Laura Perls, and Paul Goodman.
• Gestalt therapy is humanistic, holistic, and experiential.
• The goal of treatment is the restoration of awareness, which allows for increased choice and flexibility in all aspects of
living.
GESTALT THERAPY
 Gestalt therapy began as a revision of psychoanalysis and quickly developed as a wholly independent, integrated system .

 Since gestalt therapy is an experiential and humanistic approach, it works with patients’ awareness and awareness skills rather than

using the classic psychoanalytic reliance on the analyst’s interpretation of the unconscious.

 Also, in gestalt therapy the therapist is actively and personally engaged with the patient, rather than fostering transference by remaining

in the analytic role of neutrality.

 The gestalt therapist uses active methods that develop not only patients’ awareness but also their repertoires of awareness and

behavioral tools.

 The active methods and active personal engagement of gestalt therapy are used to increase the awareness, freedom, and self-direction

of the patient, rather than to direct patients toward preset goals as in behavior therapy and encounter groups.

 The gestalt therapy system is truly integrative and includes affective, sensory, cognitive, interpersonal, and behavioral components.

 In gestalt therapy, therapists and patients are encouraged to be creative in doing the awareness work.

 There are no prescribed or proscribed techniques in gestalt therapy.

PHILOSOPHICAL FOUNDATIONS
Gestalt therapy method is guided by three philosophical foundations.
 The first of these is field theory, a concept that comes from physics. The “field” is a dynamic interrelated system, each
part of which influences every other part. Nothing exists in isolation.
 Gestalt therapy is a field theoretical and process-oriented approach, which means the therapist attends to the total field
including content and subject matter, as well as the here-and-now process occurring in the moment.
 This involves things such as the patient’s tone of voice, style of communication and interaction, facial expression,
physical gestures, posture, breathing, sensation, and affect.
 The therapeutic field also includes the patient’s history and current situation, the therapeutic relationship, feelings
experienced by the patient and the therapist, and their mutual impact on one another.
 The second philosophical foundation is phenomenology. The Gestalt therapist attempts to bracket off
preconceived biases, beliefs, theories, and interpretations, and attend as much as possible to what is actually
understandable through the senses, with the focus on the patient’s subjective experience. The therapeutic stance
is one of meeting the patient where he is, and the therapist describing what she observes, rather than explaining or
interpreting. The patient is encouraged to do the same. The therapist also brings her own feelings, sensations, and
awareness into the interaction with the patient when useful for the treatment.

 The third philosophical foundation is dialogue. A dialogic stance requires that the therapist be “present,”
confirm the patient, and be available for an I–Thou way of relating. Presence is the therapist bringing all of
himself to the encounter in the here and now. Confirmation involves seeing and accepting patients for all they are
and all they are capable of being. The I–Thou mode of relating has the qualities of immediacy, directness,
presence, and mutuality. These qualities create a therapeutic relationship that is not hierarchical, and a meeting
between patient and therapist that is in and of itself healing.
 BASIC CONCEPTS
 Gestalt psychology is based on the view that psychological phenomena are organized wholes rather than specific parts.

 Gestalt psychologists principally studied visual and auditory perception and viewed learning as a perceptual problem in

which individuals attempt to discover a correct response in their perceptual field. For example, a student learning
algebra may know formulas, but only when these formulas are brought together is she able to arrive at the solution to the
problem.

 Wallen (1970) cites three kinds of interferences in developing a complete gestalt, or clear figure against the ground.

 First, individuals may have poor perceptual contact with others and with themselves. An example would be looking
away from a friend when one is talking to her.
 Second, a complete gestalt is thwarted when expression of needs is blocked. Wanting to express affection to a friend but
refraining from doing so is an illustration.

 Third, repressing feelings or perceptions can prevent the formation of a complete gestalt. Inability to express psychological
hurt after someone has insulted an individual may interfere with the development of a full gestalt experience. Such an individual
is likely to feel anxious, experience some muscular tension in the stomach, or otherwise be unable to complete the gestalt.

Holism and field theory

 Most humanistic theories of personality are holistic.

 Holism asserts that humans are inherently self regulating, that they are growth-oriented, and that persons and their symptoms

cannot be understood apart from their environment.

 Holism and field theory are interrelated in gestalt theory.

 Field theory is a way of understanding how one’s context influences one’s experiencing.

 It represents one of the first attempts to articulate a contextualist view of reality (Philippson, 2001).
• The combination of field theory, holism, and gestalt psychology forms the bedrock for the gestalt theory of personality.
• Fields have certain properties that lead to a specific contextual theory.
• As with all contextual theories, a field is understood to be composed of mutually interdependent elements. But there are
other properties as well.
• For one thing, variables that contribute to shaping a person’s behavior and experience are said to be present in the current
field, and therefore, people cannot be understood without understanding the field, or context, in which they live.
• A patient’s life story cannot tell you what actually happened in his or her past, but it can tell you how the patient
experiences his or her history in the here and now.
• That rendition of history is shaped to some degree by the patient’s current field conditions.
• An event that happened three years ago is not a part of the current field and therefore cannot affect one’s experience.
• What does shape one’s experience is how one holds a memory of the event, and also the fact that an event three years
ago has altered how one may organize one’s perception in the field.
• Another property of the field is that the organization of one’s experience occurs in the here and now and is ongoing
and subject to change based on field conditions.
• Another property is that no one can transcend embeddedness in a field; therefore, all attributions about the nature of
reality are relative to the subject’s position in the field.
• Field theory renounces the belief that anyone, including a therapist, can have an objective perspective on reality.

The Paradoxical Theory of Change is the heart of the gestalt therapy philosophy (Beisser, 1970). The paradox is that
the more one tries to become who one is not, the more one stays the same. Health is largely a matter of being whole, and
healing occurs when one is made whole again. The more one tries to force oneself into a mold that does not fit, the more
one is fragmented rather than whole.
Organismic self-regulation requires knowing and owning—that is, identifying with— what one senses, feels
emotionally, observes, needs or wants, and believes. Gestalt therapy theory holds that people are inherently self-
regulating and motivated to solve their own problems. Needs and desires are organized hierarchically so that one’s most
urgent need takes precedence and claims one’s attention until this need is met. When this need is met, the next need or
interest becomes the center of one’s attention.

Living in the past, worrying about the future, and/or clinging to illusions about what one should be or could have been,
diminishes emotional and conscious awareness and the immediacy of experience that is the key to organismic living and
growth.
Gestalt therapy aims for self-knowledge, acceptance, and growth by immersion in current existence, aligning contact,
awareness, and experimentation with what is actually happening at the moment.

It focuses on the here and now, not on what should be, could be, or was.

From this present-centered focus, one can become clear about one’s needs, wishes, goals, and values.
• The concepts emphasized in gestalt therapy are contact, conscious awareness, and experimentation.

• Contact means being in touch with what is emerging here and now, moment to moment.
• Contact is the lifeblood of growth, means for changing oneself, and one’s experience of the world” (Polster & Polster, 1973,
p. 101).
• Contact differs from fusion, as contact exists when a sense of separateness is maintained.

• In fusion, there is no separateness. Although contact is a quality that occurs with other persons and objects, rarely are people
aware of the contact they have with others.

• With contact can come a sense of self as well as a sense of impingement on a boundary.

• Difficulties in contact are many for children with autism; gestalt therapy can be used to help children develop their contact
with others.

• For Polster and Polster (1973), the challenge for most individuals is how to maintain lively, productive contact with people
Levels of contact have been described by Perls as five layers of neuroses. To become psychologically mature,
individuals must strip off each of the five layers: phony, phobic, impasse, implosive, and explosive. Each layer’s
removal reveals increasingly impactful contact with the environment.

 The phony layer refers to reacting to others in unauthentic or patterned ways. Examples are “How are you?” and
“Have a nice day.” More substantial examples include trying to be nice to someone so they will buy something from
you.

 At the phobic layer is an avoidance of psychological pain. For example, we may not want to admit to ourselves that
an important relationship is over.

 Impasse is the point at which we are afraid to change or move. We may feel very little, only a sense of being stuck.
Perls gives an example of a marriage in which the partners are no longer in love; they have ideas of what the other
should be but no ideas of what the other is really like. They blame each other and are at an impasse. Individuals feel
little internal or external support. This is a particularly significant level for making therapeutic change.
 At the implosive level we experience our feelings, start to become aware of the real self, but may do little about the feelings.

 Contact with the explosive layer is authentic and without pretense. For Perls it was necessary to experience the explosive to
become truly alive and authentic.
CONTACT BOUNDARIES

Contact boundaries are the process of connecting to or separating from other or objects. I-boundaries are those that
distinguish between one person and another, a person and an object, or the person and a quality of the person. I-boundaries
are formed by an individual’s life experiences. Polster and Polster distinguish vantage points from which I-boundaries can
be described: body-boundaries, value-boundaries, familiarity-boundaries, and expressive-boundaries.

 Body-boundaries are those that may restrict sensations or place them off limits. Polster and Polster describe a man with
a complaint of impotence who was at first aware only of head movements and became more and more aware of a
trembling sensation in his legs that led to a sense of peacefulness in his body. Thus, his body-boundary was extended.

 Value-boundaries refer to values we hold that we are resistant to changing. When a man who holds antiabortion values
must deal with the unwanted pregnancy of an unmarried 17-year-old daughter, value boundaries may be challenged,
possibly changed, or possibly reinforced.

 Familiarity-boundaries refer to events that are often repeated but may not be thought about or challenged. Examples
include going to the same job every day, taking the same route to work every day, or interacting in a stereotyped way
with an associate. If an individual loses a job or experiences the rejection of a marriage partner, the challenge to
familiarity-boundaries can be devastating.
CONTACT BOUNDARY DISTURBANCES

Occasionally the boundary between self and others becomes vague, disintegrates, or is otherwise disturbed. Sometimes an
individual keeps out nourishing and helpful aspects of objects or others. In one sense, the individual is out of balance, and
needs are not being met. If the contact with objects or others is resisted, the interaction with the object or other may follow
one of these five patterns: introjection, projection, retroflection, deflection, and confluence.

 Introjection refers to swallowing whole or accepting others’ views without reviewing them. For example, children often
take their parents’ opinions as fact rather than as values. As children grow older, they introject their parents’ views less
frequently. Doing so may be appropriate at sometimes, but not at others. Introjection can be healthy or pathological,
depending on the circumstances.

 Projection refers to the dismissing or disowning of aspects of ourselves by assigning them to others. Often feelings of
guilt or anger may lead individuals to project blame onto someone else. By doing so, the individual may feel better
temporarily, but full contact with others is reduced. In projection, aspects of the self are attributed to others, thus
extending the boundary between self and others. Blaming a professor for failing an exam for which an individual did not
study is an example of projection.
 Retroflection consists of doing to ourselves what we want to do to someone else, or it can refer to doing things for
ourselves that we want others to do for us. The statement “I can do it myself” when we want others to help us is an
example of retroflection. Although this behavior is designed to make us feel self-sufficient, we may feel alone and cut off
from others.

 Deflection refers to varying degrees of avoidance of contact. The person who does not get to the point, who is overly
polite, or talks constantly is deflecting-avoiding contact. Other examples include talking about something rather than
talking to someone or substituting mild emotions for strong ones. Particularly at the beginning of the therapeutic process,
it is common for patients to deflect- to describe their problems abstractly or as if they belong to another person, or to
include irrelevant details. Avoiding physical contact is an example of deflecting contact.
 Confluence occurs when the boundary between one’s self and others becomes muted or lessened.

 In relationships there may be a perception that both individuals have the same feelings and thoughts, when in fact the
individuals have become less aware of their own feelings and values.

 People who feel a strong need to be accepted may experience confluence; they relinquish their true feelings and opinions for
the acceptance of others. Thus, knowing how they truly feel, or think is difficult for them.

 O’Leary (1997) compares confluence with empathy. Healthy confluence can be experienced as empathy toward individuals
or groups.

 Unhealthy confluence may serve to isolate individuals from others, as they agree with others without unconditional positive
regard or understanding. Clients can experience the healthy expression of confluence by therapists as empathic
understanding.

 Gestalt therapists assume that contact is healthy and necessary for satisfactory psychological functioning.

 Introjection, projection, retroflection, deflection, and confluence are ways of diminishing, avoiding, or otherwise resisting
contact.
AWARENESS

• True growth starts with conscious awareness of what is occurring in one’s current existence, including how one is
affected and how one affects others.

• One moves toward wholeness by identifying with ongoing experience, being in contact with what is actually happening,
identifying and trusting what one genuinely feels and wants, and being honest with self and others about what one is
actually able and willing to do—or not willing to do.

• When one knows, senses, and feels one’s self here and now, including the possibilities for change, one can be fully
present, accepting or changing what is not satisfying.

• Awareness of oneself is an important part of gestalt personality theory, referring to contact within individuals
themselves, as well as with others and objects. Awareness refers to what is happening now rather than what is
remembered. To be fully aware is to be in contact with one’s boundaries.
Polster and Polster (1973) identify four types of awareness:

 Awareness of Sensations and Actions pertains to sensing through seeing, hearing, touching, or other senses and then
expressing oneself through movement or vocal expression

 Awareness of Feelings concerns awareness of both emotional feelings and physical feelings such as sweaty palms or
shortness of breath

 Awareness of Wants refers to awareness of desires for future events to take place, such as to graduate from college or to
win the lottery

 Awareness of Values and assessments concerns larger units of experience than those mentioned, including how one
values others, social and spiritual issues, and other assessments of events related to these.
EXPERIMENTATION

It is the act of trying something new in order to increase understanding. The experiment may result in enhanced emotions
or in the realization of something that had been kept from awareness.

Experimentation, trying something new, is an alternative to the purely verbal methods of psychoanalysis and the behavior
control techniques of behavior therapy.

Trying something new, without commitment the adoption of a new pattern, can facilitate organismic growth.

For example, patients often repeat stories of unhappy events without giving any evidence of having achieved increased
clarity or relief. In this situation, a gestalt therapist might suggest that the patient express affect directly to the person
involved (either in person or through role playing).

This often results in the patient experiencing relief and in the emergence of other feelings, such as sadness or appreciation.
THE PRESENT

• Prior and future events are seen through the present. The present is also important because only here can an individual’s
bodily and sensory systems be seen.

• Yontef (2007) sees many advantages of focusing on the immediate moment so that the patient can experience self-
acceptance, feel awareness of the moment, and a commitment to what emerges.

• When a patient talks about an event, the individual is distanced from the event and is not in the present.

• Although the present is most important, past history and future plans are also considered.
• Gestalt therapists often assess ways in which the past and future are stated in the present.
• One way of examining how the past affects the present is through the concept of unfinished business.
• This refers to feelings from the past that have been unexpressed but are dealt with in the present.
Eg- A six-year-old child is molested by her uncle, who comes into her room at night, violates her trust, and intimidates her
into silence. She swallows her fear and experiences a loss of power. When she is an adult, she may not even remember the
experience because she has repressed it, but she may have difficulty experiencing intimate relationships with men because of
the unfinished business related to her molestation as a child.
The feelings may be of anger, hatred, guilt, fear, and so forth, or they may be memories or fantasies that are still within
the individual.
Sometimes unfinished business may take the form of an obsession with money, sex, or some other issue. By working
through unfinished business, individuals are completing a gestalt.
When closure has been accomplished, the preoccupation with the past is completed.
 THEORY OF GESTALT PSYCHOTHERAPY

 Gestalt therapy has as its basic goal the development of growth and personal integration through awareness. This is
done through the establishment of a good therapeutic relationship.

 The therapeutic role is different from that in other therapies, with an emphasis on the present and utilization of awareness.

 In gestalt therapy, much assessment is through the therapist’s moment-to-moment observation of the patient. Many
observations provide a useful overview of the problem for both patient and therapist.

 Resulting from this assessment are procedures to enhance the patient’s awareness, both verbal and nonverbal.

 Integrating approaches to awareness takes creativity and experience.

• Goals of Therapy

• Perls stated that the goal of therapy is to help individuals mature and grow.

• The emphasis is on self-responsibility, helping patients depend on themselves rather than on others.

• Therapy should assist patients in seeing that they can do much more than they think they can. Thus, patients become
more self-aware and move toward self-actualization.

• Implicit in the goal of maturity and growth is that of achieving integration.

• Integration implies that a person’s feelings, perceptions, thoughts, and body processes are part of a larger whole.

• When a person is not fully integrated, there are voids and the individual is likely to experience contact boundary
disturbances.

• Perls (1948) believed that the integration of previously alienated parts was an extremely important goal of
psychotherapy.
• Basic to maturity, growth, and integration is the development of awareness. Perls believed that with full
awareness the organism or individual would regulate itself and function optimally.

• Fully aware individuals are aware of their environment, are responsible for their choices, and accept themselves.

Zinker outlines in more detail the ways in which gestalt therapy helps individuals become more fully aware of
themselves and their environment.

 Individuals develop fuller awareness of their bodies, feelings, and environment.

 Individuals own their own experiences rather than projecting them onto others.

 Individuals learn to be aware of their own needs and skills in order to satisfy themselves without violating the
rights of others.

 Fuller contact with sensations (smelling, tasting, touching, hearing, and seeing) allows individuals to savor all
aspects of themselves.
 Rather than whining, blaming, or guilt making, individuals experience their power and ability to support themselves.
 Individuals become sensitive to their surroundings yet are able to protect themselves from those parts of the environment
that may be dangerous.
 Responsibility for actions and consequences is a part of greater awareness.

• As therapy progresses individuals gradually feel more comfortable in experiencing their own energy and using it in a
productive and complete way.
These are general goals of gestalt therapy.
By feeding back observations and encouraging the client to become more aware, the therapist helps clients achieve their
goals.
Gestalt therapy is particularly appropriate for individuals who are inhibited. Examples are people who are overly socialized or
feel restrained or constricted in some way.
Those who are perfectionistic, phobic, or feel depressed may be inhibiting their awareness of themselves and others.
The Therapeutic Relationship
• For gestalt therapy to be effective, a good therapeutic relationship is important.
• Gestalt therapists have been influenced by the work of Carl Rogers, Martin Buber, and more recently, the concepts found in
intersubjectivity theory, an approach related to self-psychology.
• All of these focus on ways to understand the client and to communicate this understanding to the client.
• Gestalt interventions are used within the context of the client–therapist relationship.
• Gestalt therapists agree with Rogers’s emphasis on empathy. Being genuine and showing the client that you understand is
an important aspect of therapy.
• The empathic responding of the therapist provides continuing support to the client. Additionally, clients support themselves
through their own motivation for therapy, intelligence, and commitment to therapy.
• To bring about growth through awareness, a meaningful relationship with the therapist is essential.
• Buber’s (1965) discussion of the I–thou relationship has been important in understanding the gestalt view of a dialogic
relationship.
• The dialogue exists to meet or understand the other person, not to do something to the person.
• In this dialogue, the individual becomes fully aware of the other person while still being aware of his or her own separate
existence. The dialogue occurs; it is not directed toward an outcome.
• In the dialogue the therapist is genuine yet focused on the patient’s needs
Assessment in Gestalt Psychotherapy
Traditionally, gestalt therapy has not addressed itself in a systematic way to diagnosis or assessment.
Typically, gestalt therapists are attending to moments in therapy that include patients’ bodily movements, feelings,
sensations, or other content.
Joyce and Sills (2001) recommend a diagnostic approach to gestalt therapy in which client and therapist work to identify
problems that can be addressed.
They have designed a brief “client assessment sheet” that assesses broad units of patients’ awareness and disturbances of
contact boundaries.
Yontef (1988) states that gestalt therapy by itself does not provide sufficient diagnostic information to help patients with
serious problems such as narcissistic or borderline disorders.
He believes that developmental insights drawn from object relations provide a background that can be integrated with the
application of gestalt therapeutic processes.
Gestalt therapists can use a cyclical approach to assessment.
Melnick and Nevis (1998) explain how the experiencing cycle can be used to diagnose types of disorders by attending to
five phases: sensation/awareness, mobilization, contact, resolution/closure, and withdrawal.

 Sensation/awareness involves taking in experience through the senses. Patients with a borderline disorder often have
difficulty maintaining relationships because of distorted intake of sensations.

 Mobilization refers to moving from awareness to forming a desire or want. Individuals with phobias and other anxieties
may avoid actions or events rather than move toward an action.

 Contact produces emotional arousal and implies contact with self and others. The individual who functions
histrionically may be very emotional but may not be aware of his feelings or be able to relate well emotionally to others.
He may need to slow down and become more aware of not just raw feelings but also feelings about self and others.

 Resolution/closure takes place as individuals disengage from an experience. Individuals with posttraumatic stress
disorder have difficulty moving from a traumatic event (such as a robbery or a rape) to other events. Gestalt therapists
help such individuals acknowledge that they must resolve the problem and find ways to express feelings about the
problem to develop closure.
 Withdrawal takes place as the experiencing cycle draws to a close and moves toward other contact experiences. In a sense,
it is the end of the resolution/closure phase. Just as those with posttraumatic stress are likely to have difficulty with
resolution/closure, so are they apt to experience difficulty with withdrawal. It is difficult for such individuals to move on
to other experiences.

Because many gestalt therapists use other therapeutic systems such as relational forms of psychoanalysis as part of the
assessment process, assessment techniques of gestalt therapists are likely to be varied.
Therapeutic Change

• In gestalt therapy, both patient and therapist are fully present, allowing for the development of a fully functioning I–thou
relationship.

• The therapist’s non-defensive posture and awareness of self and of the patient provide an atmosphere for change. Change
occurs by exploring the patient’s wishes.

• If there is frustration, the therapist investigates it. If a patient is reluctant to follow a suggestion for exploration by the
therapist, the therapist gently explores the reluctance rather than pushing the patient to follow the therapist’s instructions.

• When patients reach an impasse in therapy and have difficulty changing, Perls (1969b) has suggested that the patient be
stuck and stay with the feeling of no progress.

• Perls believed that some people are unable to make progress in therapy because they are afraid of what might happen. A
patient might say, “If I really look at my friendship with Harry, there won’t be any friendship, and I won’t have any friends.”

• The gestalt therapist helps the patient to experience the blockage and to experiment with, or fantasize about, what will
happen if the patient explores his relationship with Harry.

• Working through such an impasse is an important part of the change process in gestalt therapy.
The change process can be further articulated by examining Miriam Polster’s (1987) description of a three-stage sequence
of integration.

 In the first stage, discovery, patients may get a new view of themselves or of an old problem or situation.

 In the second stage, accommodation, patients learn that they have choices and can try out different behaviors. In this
process, therapeutic support is particularly important.

• In the third stage, assimilation, patients progress from choosing and trying out new behaviors to learning how to make
changes in their environment.
At this point they are apt to act assertively in obtaining what they want from others. Although patients do not move neatly
through these three stages, and some may not fully experience each stage, Polster’s model for client growth does provide an
overview of the change process.
TECHNIQUES
Enhancing Awareness

 Gestalt therapists may use techniques such as cognitive and behavioral methods, but they are used as an experiment
to help the patient learn by doing something different.

 In focusing on the goal of achieving patient awareness, gestalt therapists have developed many exercises and
experiments to bring about client growth.

 Exercises are specific techniques that are used in group or individual counseling.

 Experiments are innovations of the therapist that grow out of the struggles patients have when they encounter an
impasse or have difficulty in achieving awareness.

 When applied in therapy, exercises become experiments as the client learns new ways of learning or of achieving
awareness.
 Some methods are relatively simple, involving commenting on or emphasizing awareness.

 Others involve enhancing awareness through verbal or nonverbal behaviors.

 The dialogue with oneself, often using another chair, is a means of becoming aware of different parts
of oneself.

 Enacting—that is, playing out parts of oneself or others—can be a dramatic gestalt experiment to
bring about change.

 Gestalt therapists have been creative in how they deal with dreams as a means of furthering awareness.
Gestalt therapists also make use of homework to encourage growing awareness throughout the
patient’s life, not just in the therapeutic session.
Awareness Statements and Questions

• Sometimes awareness can be enhanced by relatively straightforward questions.

• For example, if a patient is talking about her phone conversation with her mother, the therapist may simply say, “What are
you aware of now?” to focus on what is happening to the patient in the present.

• Sometimes the therapist may focus the awareness a little more closely, as in “Mel, can you be aware of what you are doing
when you are sitting in this chair?” or the therapist may go a step further and use a statement that starts with “I am aware that
you”; thus, “Mel, I’m aware that as you sit in the chair you’re looking at your knees.”

• Sometimes it may be appropriate to ask the patient to use a sentence such as “Now I am aware” to bring about more
awareness; for example, “Mel, as you sit there looking at your knees, could you use the phrase, ‘Now I am aware that’ and
finish it and go right into another phrase, such as ‘Now I’m aware of the dictionary on your desk, now I am aware of the
lamp behind you’?” and so forth.

• Such statements and questions can be used relatively easily in the course of therapeutic work.
Emphasizing Awareness

• Sometimes it is helpful simply to ask a client to repeat a behavior, as in “Please wring your hands together again.”

• In gestalt terms, this makes the figure clearer and more separate from the ground.

• Similarly, requesting that the patient “stay with” the feeling he is experiencing may sharpen awareness by bringing the
figure to the foreground.

• Exaggeration of a behavior also emphasizes the patient’s present awareness.

• For example, it may be appropriate to ask a son who is being critical of his mother to emphasize the critical tone in his
voice, thus making him more in touch with the critical quality within his voice.

• Reversal is a similar but opposite approach from exaggeration in increasing awareness.

• In this technique, a patient who is usually soft-spoken might be asked to increase the loudness of her voice and to sound
brash. In this manner, awareness of her soft-spokenness is enhanced.
Enhancing Awareness Through Language

Words that are likely to give the patient responsibility for himself and his growth are to be preferred over indirect and vague
words. For example, changing pronouns such as it and you to I brings responsibility for the situation to the individual.
Passons gives the following example.

[Patient:] I didn’t have very many dates this year. Next year it will be different.
[Therapist:] It will be different? Who are you talking about?
[Patient:] Me, I’ll be different.
[Therapist:] What will you do differently?

In this situation, the therapist helps the patient take responsibility for getting dates rather than waiting for dates to happen.
Some verbs distract from the patient’s ability to increase awareness and responsibility.
Passon gives three common examples of these:

 “Can’t versus won’t”

Often the use of can’t gives the patient the feeling that he is unable to do something, when it is more accurate to
say “I won’t,” meaning, “I choose not to do this for any of various reasons.”

 “Need versus want”

Usually a list of wants is much longer than a list of needs. It is helpful to use the word want, as in “I want to be
popular,” rather than “I need to be popular.” The former is more accurate, less urgent, and less anxiety provoking.

 “Have to versus choose to”

Like need, have to implies an urgency, demand, and anxiety that choose to does not. Choose to give the patient
responsibility for the choice.
Just as experimenting with different verbs can be helpful, changing questions to statements is often useful in emphasizing
the responsibility of the patient. Some questions are really declarations rather than questions. They diminish patient
responsibility, thus limiting patient awareness.

[Patient:] You know me, don’t you think I’d be better off if I didn’t go to school next year?
[Therapist:] You may have given your own answer. Change that question around to a statement and let’s see what you
have to say.
[Patient:] Going to school next year is not right for me. Not now, anyhow.

These are some of the more common examples of language that diminishes awareness and responsibility. When appropriate,
gestalt therapists may help patients develop self-awareness by listening carefully to language usage.
Awareness Through Nonverbal Behavior

Attending to nonverbal behavior can be particularly helpful for the gestalt therapist. Passons gives four reasons for attending to
nonverbal behaviors in therapy.

 First, each behavior is an expression of a person at a given moment.

 Second, people generally are more attuned to listening to what they are saying rather than noticing what they are doing
with their bodies.

 Third, nonverbal behaviors are usually spontaneous, whereas verbal behaviors are often thought out in advance.

 Fourth, nonverbal and verbal expressions match in individuals who function in an integrated way. Parts of the body that
therapists may respond to include mouth, jaw, voice, eyes, nose, neck, shoulders, arms, hands, torso, legs, feet, and the
entire body.
 Client:] The pressure is really on for getting into college. It seems like there’s nothing I can do without college.
[Therapist:] And how do you respond to all this pressure?
[Client:] I’m not as excited about college as everyone else is, so I’m not doing much about it. (Folds arms across chest.)
[Therapist:] Jo Anne, could you concentrate on your arms and hold them there?
[Client:] O.K.
[Therapist:] What do you feel in them?
[Client:] They’re kind of tight … sort of like I’m holding on.
[Therapist:] Holding onto what?
[Client:] To me. If I don’t, they’ll shove me all over the place. They don’t know how I can hold on.

Passons (1975) comments that Jo Anne is resisting pressures for fear others will point her in a direction that may not be
right for her. As she becomes more aware of her investment in her resistance, she may find out why she is objecting to
going to college. A clearer decision between going to college and not going to college may result.
Awareness of Self and Others

Sometimes individuals can understand themselves and others by “becoming” the other person.

This approach is often used in racial relations workshops in which people of different races may be asked to play each
other’s roles.

Asking a patient to be his mother and say what his mother would say if the patient came in at 2 in the morning is often
more helpful than asking the patient, “What would your mother think if you came in at 2:00 A.M.?”

In this way the patient develops a fuller awareness of the differentiation between himself and others.

Sometimes it is also helpful for patients to be more aware of parts of themselves, such as feelings or nonverbal behavior.
For example, a patient may say, “Sometimes I can be so cold to Marcie.”

The therapist may reply, “Be that cold self with coldness in your voice and talk to Marcie as if she were here.”
Sometimes a therapist may wish to employ a similar technique with a body part.

For example, a client who is pointing his finger at the therapist while he talks to her may hear from the therapist, “Let me
hear what that finger has to say. It’s pointing at me vigorously. Please put some words to it, if you can.”

In a vast variety of situations like these, therapists may choose to have clients split off a part of themselves or become
someone else in order to become more aware of themselves.

Enhancing Awareness of Feelings

Attending to emotions in gestalt therapy is particularly important because emotions provide energy to mobilize a person
and provide an orientation to those aspects of the environment that are important to the person. Although gestalt
therapists may respond empathically to expressed feelings, they have also developed exercises they frequently use to
further the expression of feelings.
Awareness Through Self-Dialogue

Because integrated functioning is an important goal of gestalt therapy, gestalt therapists attend to those aspects of the
individual that are not integrated.

Polster and Polster see each individual as a “never-ending sequence of polarities”.

Conflict in polarities often results from introjection.

For example, if a person introjects parental religious values that are different from religious values that she identifies as her
own, it is often useful to project the parental values outward so that they can be dealt with.

By having dialogues between opposite tendencies, increased integration results and patient self-criticism is likely to decrease.

The conflict between the top dog and the underdog is that between the righteous, moralistic, and demanding person, often
seen as the “critical parent,” versus the helpless, weak, and passive side of the individual.
• These two parts of us struggle constantly for control.

• The top dog tells us what we should do, and the underdog procrastinates and puts off doing.

• The underdog can be more powerful than the top dog because it can interfere with achieving therapeutic change. Such
conflicts lend themselves to dialogues within oneself.

• Self-dialogues can be done by having an individual take each role of the polarity and express it from her chair.
However, it is more common to use the two-chair method. Used either in individual or group therapy, the individual
takes one role in one chair (for example, the top dog) and plays the other role (for example, the underdog) in another
chair.

• As the individual changes roles, she moves to the other chair. The therapist may call attention to what has been said or
how it was said.

• In this way the therapist helps the patient get in touch with the feeling that she may have been denying. Aspects of the
patient are experienced rather than talked about.

• Dialogues can be used in diverse situations such as one part of the body versus the other (one hand versus the other), or
a dialogue can be between a patient and another person or between the self and an object such as a building or an
Awareness Through Enactment

Dramatizing some part of the patient’s existence is the basis of enactment. A patient who says that he feels like a wimpy
little dog might be asked to act like a wimpy little dog, to whine, to paw at the therapist, and to lower his head.

Enactment may be of a previous experience or of a characteristic, like wimpy. When done in groups, the enactment may
involve several group members.

Enactment is a bold approach to awareness and must be done in a way that helps patients become more aware of
characteristics or unfinished business, not to embarrass them.
Awareness Through Dreams

For Perls, dream work was one of the best ways to promote personal integration. Perls (1970) saw the dream as possibly the
most spontaneous expression of an individual.

Perls’s method was not to interpret the dream but to have the patient relive the dream in the present and to play various parts
of it.

By playing the various persons and objects in the dream, the patient is identifying with parts of the self that have been
alienated.

Perls would often use the two-chair technique to have the patient play out parts of the dream, which would then have a
dialogue with each other.

Enright gives the example of a restless, manipulative woman who dreamed of walking down a crooked path in a forest of
straight trees. He asked her to become one of these trees. This made her feel more serene and deeply rooted. She was able to
take these feelings back into her current life and experience the lack of them and the possibilities of accomplishing them.
When she became the crooked path, she became teary-eyed and experienced the crookedness in her own life and the
possibilities of straightening out, if she chose.
Another creative approach to dream work is taken by Zinker. Rather than have an individual play objects or people in a dream,
he has group members do so.

This method has the individual first work through the dream, and then a group experiment is devised so that other members of
the group as well as the dreamer can profit from playing parts in the dream.

Members of the group act out themes that may be particularly appropriate to them.

The dreamer experiences the process and progress of the dream, changing action in the dream when appropriate.

The dreamer may serve as a director or coach at times or experiment with different outcomes.

In Perls’s method, the audience participates mainly through observation (and occasional participation), whereas in Zinker’s
approach the entire group is active in the dream interpretation.
Awareness Outside of Therapy: Homework

Homework can be assigned that puts individuals in a position of confronting areas that are blocking their emerging
awareness. In some cases, individuals are asked to write dialogues between parts of themselves or between parts of
their body. Others may be asked to find information or do a specific task that fits congruently with the therapeutic
process. As individuals’ awareness develops in therapy, they may be ready for more difficult assignments that may help
them in becoming more aware of themselves and others, which in turn can provide more material for therapeutic work.

Awareness of Avoidance

When feelings are present in a person, yet the person is not aware of them, the individual is in the process of avoiding
them. Avoidance is an active process, not a passive one. An individual may be expending energy to avoid feelings such
as happiness, loneliness, fear, or sadness.

Expression of feelings is often viewed as doing, whereas avoiding may be seen as not doing by non-gestalt therapists.
From a gestalt point of view, an individual who is avoiding is working to adjust herself.
Helping patients own their feelings and experience awareness regarding a number of issues may help in reintegrating
avoided feelings. Approaches such as emphasizing awareness, enhancing awareness through language or nonverbal
behavior, and self-dialogues can be helpful in assisting people to become aware of their avoidance behaviors
Mental Experiments, Guided Fantasy, and Imagery
Sometimes visualizing an experience here and now increases awareness more effectively than enacting it, as is illustrated
in the following brief vignette (P = Patient; T = Therapist).
P: I was with my girlfriend last night. I don’t know how it happened but I was impotent. [Patient gives more details and
history.]
T: Close your eyes. Imagine it is last night and you are with your girlfriend. Say out loud what you experience at each
moment.
P: I am sitting on the couch. My friend sits next to me and I get excited. Then I go soft.
T: Let’s go through that again in slow motion, and in more detail. Be sensitive to every thought or sense impression.
P: I am sitting on the couch. She comes over and sits next to me. She touches my neck. It feels so warm and soft. I get
excited—you know, hard. She strokes my arm and I love it. [Pause. Looks startled.] Then I thought, I had such a tense
day, maybe I won’t be able to get it up.
One can use imagery to explore and express an emotion that does not lend itself to simple linear verbalization. For
example, a patient might imagine being alone on a desert, being eaten alive by insects, being sucked in by a whirlpool,
and so forth. There are infinite possible images that can be drawn from dreams, waking fantasy, and the creative use of
fantasy.
The gestalt therapist might suggest that the patient imagine the experience happening right now, rather than simply discussing it.
“Imagine you are actually in that desert, right now. What do you experience?” This is often followed by some version of “Stay
with it.”

An image may arise spontaneously in the patient’s awareness as a here-and-now experience, or it may be consciously created by
the patient and/or therapist. The patient might suddenly report, “Just now I feel cold, like I’m alone in outer space.”

This might indicate something about what is happening between the therapist and the patient at that moment; perhaps the
patient is experiencing the therapist as not being emotionally present.

Imagery techniques can also be used to expand the patient’s self-supportive techniques.

For example, in working with patients who have strong shame issues, at times it is helpful for them to imagine a Metaphorical
Good Mother, one who is fully present and loving and accepts and loves the patient just as he or she is (Yontef, 1993).
Meditative techniques, many of which are borrowed from Asian psychotherapies, can also be very helpful experiments.
Body Awareness
Awareness of body activity is an important aspect of gestalt therapy, and there are specific gestalt therapy methodologies for
working with body awareness (Kepner, 1987; Frank, 2001).
The gestalt therapist is especially interested in patterns of breathing. For example, when a person is breathing in a manner
that does not support centering and feeling, he or she will often experience anxiety.
Usually the breathing of the anxious patient involves rapid inhalation and a failure to fully exhale. One can work with
experiments in breathing in the context of an ordinary therapy session.
One can also practice a thoroughly body-oriented gestalt therapy (Frank, 2001; Kepner, 1987).

Loosening and Integrating Techniques

Some patients are so rigid in their thinking—a characteristic derived from either cultural or psychological factors—that they
do not even consider alternative possibilities.
Loosening techniques such as fantasy, imagination, or mentally experimenting with the opposite of what is believed can
help break down this rigidity so that alternatives can at least be considered.
Integrating techniques bring together processes that the patient either just doesn’t bring together or actively keeps apart
(splitting). Asking the patient to join the positive and negative poles of a polarity can be very integrating (“I love him and I
abhor his flippant attitude”).
Putting words to sensations and finding the sensations that accompany words (“See if you can locate it in your body”) are
other important integrating techniques.
 RISKS
 Just as gestalt therapy can bring about powerful change through awareness, it also can be misused. George Brown, a prominent gestalt

therapist, warns about therapists being enchanted by the techniques of gestalt therapy without being skeptical of themselves and without
having a clear grasp of gestalt theory. Attending to ethics and ethical issues is an important aspect of gestalt therapy.

 Yontef (1987) worried about the use of “gestalt therapy and,” referring to therapists who use portions of gestalt therapy with other

theories of therapy without grounding their work in the theory of gestalt therapy. To avoid misuse of gestalt therapy, preparation is
paramount.

 Resnick (1984) believes therapists should have three parts to their training: personal therapy, academic preparation, and supervision.

The therapy should be intensive enough to form a relationship between the beginning therapist (the patient) and the therapist, with self-
dialogue an important part of the therapy.

 The academic preparation should include study of personality theories, theories of psychotherapy, and diagnosis.

 Supervision should include cognitive and experiential supervision by several gestalt therapists. Such training helps ensure that the

therapist is experienced, well grounded in theory, and ethical.