Gestalt Therapy Essay, Research Paper
Gestalt Therapy
I. Summary and Integration of Major Concepts
Founded by Frederick (Fritz) and Laura Perls in the 1940’s, Gestalt therapy is a phenomenological – existential methodology which emphasizes experience and experimentation. Gestalt is a German term that means a “complete pattern or configuration” (p. 112). Though there are many modalities and styles in Gestalt therapy, it is holistic in its approach uniting mind, body, and feeling (p. 112). Some concepts at the core of Gestalt therapy are “the organism as a whole”, emphasis on the “here and now”, and “awareness” (pp. 223-225).
Perls believed that “human beings are unified organisms” (p.223) and that mind and body were not separate entities. It was important that to understand the person as a whole, one must consider all dimensions of the person such as physical functioning, thoughts, emotions, culture, etc., in a unified manner. All of these aspects were viable expressions of the individual.
Gestalt therapy also places a great deal of emphasis on the “here and now”, however, it does not imply that the past and the future are not important. Past-unfinished business can interfere with a person’s current and future existence. For this reason, finishing
unfinished business is a significant aspect of Gestalt therapy (p. 112). It is thought that these unfinished situations will naturally emerge when the person is focused on what is being done, thought, and felt at the moment (p.224). Focusing on the “here and now” allows the individual to be in touch with the self and his/her environment which in turn enables the individual to realize his/her needs (p.224).
Awareness and acknowledgement of experiences are key elements to the completion of a gestalt. Awareness is grounded in the present needs of the individual. Completion is dependent upon the individual taking responsibility for his/her own feelings and behavior. It is through this increased awareness that the health (or mental health) of the individual is restored.
II. Breakthroughs and Steps in Learning
Practicing Client Centered therapy helped me get over most of my fear and apprehension about performing as therapist and client in front of my classmates. So, as we (the class) began our first session in Gestalt I initially felt less nervous about participating, in fact, I volunteered to be the first client in my group during the first demonstration. Just like client centered therapy, I had again been in a group that was assigned to Dr. Fiebert and I felt fortunate to have him demonstrate because I knew that I would learn a great deal given his years of experience. I had learned through the reading and class lecture that this was a therapy that called for the therapist to be creative in getting the client to express emotions and feelings. I was anxious to see what creative techniques Dr. Fiebert would employ.
He began the session by asking me what I was aware of and I told him that I was feeling some tension in my neck and shoulders. He then asked me to describe the tension, rate the level of tension on a scale of 1-10, increase the tension and relate it to and experience or incident in my life. I linked to a recent situation I had experienced with my mother, whom he then brought in to the empty chair to begin the external dialogue. My immediate reaction was to put up a defense by holding back but I knew if I was going to truly learn anything I had to freely allow myself to experience this process.
In the third stage we had identified and labeled my internal polarities – Independent and Neglected. After a couple of minutes in to this stage I was uncomfortable with the depth of emotion that we were exploring and again put up my defenses but trying to keep it at a superficial level. Sensing this, Dr. Fiebert had me stand up and stomp my foot while repeating a line that expressed my anger and frustration, and exercise that was aimed at getting me in touch with my feeling. When my session ended I felt a sense of relief not only because I was no longer on the spot but also because I was able to explore some difficult issued and understand them a little better. As Dr Fiebert continued working with the other students, I carefully observed the different techniques he used in each of the stages, from fantasy work in stage 1 to the physical expression in stages 2 and 3, and finally the creative ways in which he had the client label his/her internal polarities. He didn’t repeat these techniques as he worked with each one of us so it gave us the opportunity to observe a variety of approaches that we could use later. Overall, the session demonstrated how quickly emotions could be evoked and how powerful a therapy it was.
At the next group session it was our turn to act as therapist and since it was the first time I knew I would clumsily muddle through it and I was comfortable with that – it was part of the learning process. I was far more reluctant about being a client because I felt that had no control and was going to have to face my demons whether I liked it or not. Again I volunteered to be the first client, mainly to conquer my fear but also to view someone else’s technique before attempting it myself. Although we only focused on stages 1 and 2, most of us in the group had difficulty as therapist’s and relied heavily on the facilitator. At the end of our session we discussed what we thought our individual difficulties were and the on we all had in common was the fear of making our client break down. We had all witnessed on or more of our classmates cry in the previous session and none of us wanted to be the cause of such a breakdown. While we all realized that we could not be the “true” cause of such a reaction, we still found the possibility unsettling and felt a sense of responsibility for our clients. The facilitator assured us that as we proceeded we would be able to handle such a situation.
Initially I thought I would have difficulty remembering the structure and rules of Gestalt therapy, but it was utilizing the various techniques to elicit the clients feelings that I had trouble with. I found it particularly difficult to determine which technique was appropriate to use in each stage, especially in stage 1. As the therapist in the third class session, I was tempted to use fantasy work very early on, but the facilitator reminded me that it should be used as a last resort. Instead she instructed me to explore the clients physical and emotional awareness and link it to a situation and person that is significant to the client. I also found it difficult to transition from state to stage, particularly from stage 2 to 3. I explained the transition from external to internal polarities in textbook terms rather than in plain English. With a little coaching I was able to guide my client through the three stages pretty well. By this time I had proven to be skillful at moving the client between chairs and picking up on verbal and non-verbal expressions.
After this session I decided to view the tapes at the library again so I could observe how to properly transition between stages. I also had a practice session with a classmate where we coached each other through the three stages. This practice session was a great learning experience because our strengths were in different areas. She was better at transitioning between stages and I was better at guiding the client when in the stages. However, we both struggled with the first stage and focused a lot of our attention there until we felt fairly comfortable with our technique. Here I learned not to take the easy out and rush into fantasy work but to take my time with the client’s physical state, emotions, thoughts and feelings.
In the fourth session we ran out of time and I didn’t get a turn as therapist. But, I was able to watch and learn from my classmates as they were introduced and guided through stage 4 (the integration stage). While I had always been aware of the changes that took place in the client as he/she progressed through the stages, I was so enthralled in learning the technique of the therapy tat I had focused most of my attention on the therapist’s chair. I found myself concentrating mostly on the clients during this session. I clearly saw how each client responded in the various stages of Gestalt and how the whole process unfolded. Those students who were not afraid to be open and expressive specifically moved me. I was also intrigued at how effortless it seemed to employ the two chairs with these clients and how they automatically took on the appropriate posture and behavior of each chair.
The fifth session was where I was able to implement all four stages in Gestalt therapy for the first time. I tended to rely a little to heavily on the facilitator to help me through the stages partly because I didn’t yet trust my ability and also I hadn’t been able to rid myself of the nervousness I experienced when being observed. At the end of the session the facilitator assured me that I was doing fine and would probably only need one more practice session to hone my skills.
The next class meeting was devoted to a Gestalt workshop for those of us who had not worked with a guest yet. The workshop was designed to explore probable scenarios and to supply us with general guidelines for working with a guest. One of the more important things I got from the workshop was how to work with a resistant client, or a client who feels silly doing some of the experiments. This information would prove useful when I did work with a guest. After the workshop I had one more practice session with a classmate and it went fairly well. I was relaxed and comfortable in the role of therapist, which in turn made the client, feel more at ease. I transitioned through to stage 3 smoothly but discovered that I still had some trouble transitioning to stage 4. Luckily I was scheduled to meet with some classmates to videotape a therapy session prior to working with a guest. Things went a little smoother during this session and after viewing the videotape I felt fairly confident that I would be able to do a good job with the guest.
Finally the day to work with a guest came and again I felt nervous about being observed and evaluated. As I sate in the observation room waiting for my client I went over the technique in my head and tried to forget about the facilitators. As I began working with my guest I quickly forgot about the fact that I was being observed and focused all my attention on the client. We spent quite a bit of time in state 1 and after exhausting all possible alternatives I had to use fantasy as away to bring an issue or feeling into awareness. I guided him through the computer screen fantasy and his mother popped up. Finally we had something, or so I thought. When this happened he immediately displayed resistance by intellectualizing the relationship between he and his mother. Nevertheless, we moved on to the second stage and brought his mother in to the empty chair for the external dialogue. This stage started out rather slow and I still felt he was holding something back. I had reassured him that it was a safe environment where he could say anything he wanted without fear. He finally stated that he didn’t like the way his mother still treated him like a child. After a couple of passes between the chairs, I still sensed he was holding back and asked to declare his dislike of being treated like a child again with more force. I then asked him to stomp his foot as he said this, but I could tell he felt very self-conscious about doing this so I stomped my foot and noticed he seemed more at ease. As we progressed to stage 3, the client began to open up a little more and we successfully identified and labeled his internal polarities. In stage 4 I sensed that the client was anxious to leave so I took that as my cure to wrap things up. Because I gave up control too easily I ended the session to abruptly. The facilitator came in after the client left to let me know how I did. She told me I had done and excellent job when in the stages, but my transitions were still a little “rocky”, and I had in fact ended the session too quickly. She said overall I did really well and had nothing to worry about. Personally, if felt that I could have done better by finding more creative ways to elicit some deeper feelings, but hindsight is always 20/20.
III. Case Study
Description of the client: Paula is 5’5 tall, slightly plump, and very attractive 33-year-old female Caucasian. She has medium length blonde hair, hazel eyes and dresses very neatly. Paula is somewhat shy and a little timid, but very warm, friendly, and polite. She I and introvert who enjoys staying home and watching movies, listening to music, reading, and gardening. She goes out with her friends on occasion and likes to entertain small groups of people in her home from time to time. Paula is also a very intelligent and sensitive woman who constantly strives to improve her life.
*** The issues presented, relevant behavior during the session, and application of interview techniques are illustrated in the detailed account of the clients progress through the major stages in Gestalt therapy.
Stage 1 – Emergence of the Problem:
When I asked Paula what she was experiencing she responded by stating she felt tense and stressed. I then asked her to pinpoint, on her body, where she felt this tension and stress and she reported feeling a great deal of tension in her shoulders, neck, and head, particularly around the temples and forehead. She described the tension in her shoulders and neck as several large tight knots and the tension in her head felt like there was a vice clamped around her skull maintaining the pressure. I asked her to rate the tension on a scale of 1-10, 10 being the worst, and she rated it at an 8. I then requested that she show me how it felt by shrugging her shoulders tightly and squeezing her eyes tightly shut. After this, I asked her to intensify the tension to a 9 or 10 and as she held this position for a few seconds I then asked her to remember the last time she felt this way. She began to tell me of an incident she had with her mother a couple of day’s prior when she took her mother to dinner for her birthday. The evening started out with some small talk where Paula told her mother how great her job was going and that she would be getting a promotion and a sizeable pay raise very soon. Her mother ignored this news and instead asked Paula if she had met anyone yet, meaning a man. Paula was angered by this but resolved not to let it get to her and instead continued on with the conversation. She later told her mother that she had just joined a gym to get in better shape. With that information the mother quickly replied “are you sure you want to eat that then?” Paula was hurt and angered by the fact her mother wasn’t being supportive in the least, but was instead being critical, although not overtly. Paula equated these instances to a “hit and run” – she’d take her jab at me and move on to the next subject “. When asked how her mother’s criticisms made her feel, she reiterated the hurt and anger she felt that evening. Now that these significant feelings were brought into the present, we were ready to proceed on to stage 2.
Stage 2 – Working with External Polarities:
In stage 2 we brought Paula’s mother, Virginia, into the empty chair. Paula described her mother as a neatly kept, petite older woman who was extremely judgmental of others and quite opinionated. She also felt her mother was emotionally unavailable and not very affectionate. Paula also claimed that her mother would probably be a little annoyed about being in therapy. “Appearances are very important to her and we should appear to be the perfect family”, Paula said wryly. The dialogue began by Paula stating her dislike of her mother’s criticisms and how she wished her mother would be more supportive. When she switched chairs to respond, she claimed that these criticisms were meant to help her daughter improve herself. This type of exchange went on for a few minutes and proved to be uneventful. I sensed Paula was holding back some deeper feelings because she was not used to confronting her mother in this fashion. I asked Paula to say something to her mother that she always wanted to but never could. After thinking for few seconds she came up with “I hate you for making me feel so inadequate”. She was barely audible as she said this and I noticed she also looked down at the floor and gripped the arms of the chair tightly, indicating resistance. I brought these non-verbal cues to her attention and asked that she repeated her statement and back it up with the felt sentiment. She repeated it a couple of times with slightly more intensity, but she was still holding back. I then asked her to engage in an experiment and instructed her to take a thick pillow from the sofa, place it on her lap and pound it as she repeated the same line “I hate you for making me feel so inadequate”. There was significant increase in the intensity of her expression and by the third repetition, she began to cry. I offered her a tissue and asked that she switch so that Virginia (the mother) could respond, plus I didn’t want to lose the momentum. She took a few seconds to regroup before taking the seat opposite her. She responded as Virginia, by stating she was sorry that her daughter felt that way, but she was only trying to help and felt the criticism was constructive and something that Paula needed to hear. This dialogue ran on for a few more minutes and by this time I felt I had a grasp on the internal polarities. Before we concluded stage 2, I asked Paula to come up with a “desired solution” to this conflict. She simply stated that she wanted her mother to “back off” and be more accepting.
Stage 3 – Working with Internal Polarities
Before we proceeded to this stage, I made it clear that we were letting her mother go and continued by explaining that the external conflict she just experienced was actually a manifestation of internal conflict (of course, I used simpler language). I shared with her what I believed to be her internal polarities. Paula represented the part of her that wanted to be accepted as is but was too insecure to demand it. Virginia represented the more assertive side who was very harsh and judgmental of Paula. Without much hesitation, she agreed that these were accurate observations. I asked the longing to be accepted, insecure Paula to physically identify with this polarity by taking on her supposed posture. She immediately responded by slumping in her chair, folding her arms in her lap, and staring down at her shoes. I then asked her what her motto would be and she replied, “Love me for who I am”. I had her switch chairs and take on the posture of the assertive, harsh, and judgmental Paula, she then sat up very straight with both feet firmly planted on the ground and her hands resting on the arms of the chair. She appeared as if she were ready to pounce on someone at any instant. Her motto was, “I tell it like it is”. Paula was now keenly aware of her two polarities. I had these polarities engage in dialogue as in stage 2. Paula did this with little effort or resistance, and automatically assumed the posture and attitude of each polarity when in their respective chairs. Through this dialogue we found that the assertive, harsh, and judgmental side of Paula was the more dominant polarity. However, the harsh and judgmental side of Paula is what fueled her insecurity and made it a dominant force in her life as well.
Stage 4 – Integration:
The integration stage occurred spontaneously and with little guidance from me. In fact there was no clear break between stages 3 and 4, they simply blended together. During the dialogue, Paula was aware of how her polarities worked with and against each other and was able to detect the pros and cons of each side. As I continued to guide the dialogue, Paula expressed that while she appreciated the assertive, harsh, and judgmental side of her for being the driving force behind some of the more successful aspects of her life and her desire to want to improve herself, she was unhappy with how it fed her insecurities. She felt her assertiveness should be redirected a t individuals who judged her harshly, like her mother, which, in turn, would help her demand that she be accepted for who she is. I could tell Paula was feeling considerably less tense by this point so I decided to wrap up the session. I started by recalling how high she had rated her level of tension at the beginning of the session and had her re-rate it at this point. She claimed that her tension had diminished to a 3 and that she felt much better. I ended the session by summarizing the various events and complimenting her on her courage and willingness to explore these difficult issued and her ability to accept them as part of her. She thanked me for helping her through it and then we chatted for a while before I went home.
Because I had worked with Paula previously in Client Centered therapy, we had already developed a rapport and a foundation of trust. She was a far more open and willing participant this time around which made my job much easier. Overall, I felt that the session, which lasted 82 minutes, went very well, and I truly felt that I had helped Paula.