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How Gestalt Therapy Views DepressionGestalt Therapy & Depression

Gestalt Therapy & Depression

What is Gestalt Therapy?

Gestalt Therapy (GT) promotes personal well being by building increased awareness of physical

sensations, mind states and orientation to surroundings. GT has proven very effective for helping

release repressed emotional stress 'stored' characteristically in areas of frequent bodily tension. It

heightens self-awareness and perception. It focuses on understanding emotional aspects of inter-

relational dynamics between people and their social environments.

Introduction

On beginning my research into how GT views depression, I found it quite difficult to gather much

information on depression specifically (or any other DSM-IV categories). Perhaps this is/was due to

the fact that in traditional Perlsian GT the person is viewed holistically and seen as more than a sum

of their individual parts and hence, as such there has been a reluctance to diagnose patients least

we view them as I-it rather than I-thou.

Modern Gestalt therapy argues that diagnosis works well in conjunction with GT, as the I-Thou, I-It

relationship can change quite rapidly during a session and it is useful for the therapist to review the

fixed gestalt patterns week-to-week as well as during the session. (McKeown, 1999)

The therapist can then come up with a plan of interventions and yet be ready to work with the client’s

unfolding process in the here and now. Using field theory we can explore how being diagnosed with

depression has effected the client’s relationship with significant others, in society, their job, both

before they knew what was “wrong” with them (as one client puts it) and after they were diagnosed

by the medical profession.

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As with any interruptions in the Gestalt contact cycle, at one stage in our lives the creative

adjustment served us, (or we would not of survived the traumatic experiences at that time) but now

in our adult lives, they have become fixed rigid gestalts that hinder us, in contact with others and

ourselves. Through assimilating, looking at and expressing our introjects, projections and then

retroflections, we can evaluate what values we own for ourselves and those which no longer serve

us and limit our way of contacting.

How Does Gestalt Therapy View Depression?

Depression is seen in Gestalt as unsatisfied needs. “When expression is overt, there normally is a

release of pent up energy – for instance, the seeming lethargy of depression will if unblocked, be

replaced by what it concealed and held in check: raging or the clonic movements of sobbing.”

(PHG, )

Gesaltists would argue that depression has a meaning for the client and it often suppressed anger

which the client flattens because of introjects or projections.

Depressing emotion is a retroflection, which Gestalt therapy would aim to work with gradually and

carefully to undo as it is seen as a creative adjustment that became a depressive adjustment that

has become a fixed Gestalt. Removing a fixed gestalt suddenly and without integration could lead to

mobilizing the client into the action stage of the contact cycle, which in the case of depression may

lead to suicide etc.

Retroflection

Retroflection is defined as an action that was once directed towards the environment but was turned

back against oneself. (PHG, )

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The Role of Retroflection

There are many contact styles in the clients’ process but the main way people block contact with

depression is through retroflection. The contact style of retroflection is an economical mode of

contact in energetic terms. A person does not give out his energy but turns it back to himself.

Many diagnoses of depression have been made when the person has been hiding abuse, etc. and

the client has recovered once the abuse has been acknowledged and integrated. The client limits his

ability to stay in conscious contact with his environment here-and-now. He is not able to react in

accordance with his actual need but his behaviour and present experiencing are determined by fixed

patterns. He follows a habit, not a conscious choice (Yontef, 1993). Depression is a fixed gestalt.

From a Gestalt perspective symptoms are products of a creative self and display human uniqueness

(Perls, Hefferline & Goodman, 1990). Symptoms such as low mood, suicidal thoughts, increased

tiredness etc. are phenomena that accompany depression. Gestalt therapy focuses more on the

specific generating process of depression (Greenberg, Watson & Goldman, 1998). In Gestalt

therapy the symptoms are viewed not as discrete items but as a narrowed spectrum of functions

(Zinker, 1978).

Interruption of a contact cycle: Typical manifestations of depression

The loss of the creative adjustment manifests in a particular withdrawal of contact. A depressed

person lacks the self-confidence, will and motivation to contact. We can watch the repeating pattern

of an interruption in the contact cycle (Mackewn, 1999).

How does Gestalt therapy treat depression?

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During therapy clients first learn how to accept support from their surroundings and then they create

a system of self-support by themselves. The work centres on a primary task of creating a safe

environment, a safe relational field, in which the patient’s self-healing powers can be activated.

In case or repeated experience of limiting, threatening or misusing environment the person cannot

acquire the whole spectrum of self-functions. He needs to create them during the process of ongoing

therapeutical relationship (Zinker, 1978).

Gestalt Therapy looks at the overall field of the client and views the client as a whole rather than just

a sum of his parts. We would not say the client is depressed but is depressing in our contact with

them within the therapeutic setting as well as outside the therapy room in his interactions with

others. The therapist when treating depression as the presenting problem, can benefit greatly from

knowing the medical diagnostics of the symptoms of depression but should be mindful not to label

the client as being depressed and therefore, not seeing the person as a human being. In therapy, we

would ask the client to explore what it means for them to be diagnosed with depression or to feel

depressed.

In the starting stages, it is useful to take the client’s history to get an overall picture of their

environmental field and the part society has played as well as psychological and biological factors.

As in the case of x, whom after speaking of his sickness and the ‘bad’ part of him, he mentioned he

found it beneficial to break from his old peer group as “they still occasionally took drugs”. This then

led me to wonder if the drugs played their part in tipping the balance of his moods during withdrawal,

as well as the many other influences in his life.

Working with Depression – Undoing the Retroflections

Interventions during the first session are to bring the clients awareness to how he interacts with me,

as this can be a microcosm of how he relates to people outside the session, as in lack of eye

contact, looking around the room and shifting about on the chair. Focusing on just one of the many

retroflected behaviours or bringing some awareness to them, can get the client into some contact

with his body and how limits his contact.

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Even the breath can be held, swallowed or constrained in a retroflected way to avoid fully feeling or

allowing excitement to rise and this leads to anxiety which is seen as excitement unsupported by

breath. Retroflection is usually the result of doing to oneself that which one wanted to do to others

but held it back and this is evident in the client’s musculature. Often when there wasn’t full

expression or the movement was limited early on, there can be an equal force of antagonistic and

agonistic forces holding the muscle equally in opposite directions. He abandons any attempts to

influence his environment. He becomes a separate and self-sufficient unit. Energy becomes

interpersonal and he limits traffic between himself and environment. Polster & Polster. Pg.70.

We would also look to bring the clients awareness to the introjects (messages they took in from

youth, etc) on why they are unable let go of tensions, i.e., “women shouldn’t be angry”. Then over

time, look at the projections, “they wont except me if I really tell them how I feel”, and then to notice

the tensions in the client’s body as they say these things and bring their attention to their body.

Dialoguing between the different body parts and describing them or getting the client to use ‘I’

statements can all help in experiencing this tension, or staying in the impasse and agitating it by

staying in the not knowing for long enough will eventually create enough tension in the body (which

cannot be held forever in awareness) until the body starts to implode and then explode, as a healthy

organism will eventually return to homeostasis.

Attention to physical behaviour to see where the battle is taking place during the retroflected activity

can be achieved by examining posture – gestures and movement. Polster & Polster.

After any experiment in raising awareness such as working on the body through dialogue, fantasy, or

psychodrama, it is important to get the client to repeat key phrases or bring the client into awareness

further by asking them what they learnt from the experiment and what it meant for them. The

therapist’s task is to enable the client, even in the most incremental way, to express the energy,

which he experiences within himself (Zinker, 1978). Work with developing expressive movement

requires a base of awareness, relationship to the therapist, and a well-managed therapeutic context.

(Mckeown, 1999)

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Effectiveness of Gestalt Therapy When Working With Depression

Problems

The problems in working specifically with depression as a separate condition in Gestalt are listed

below:

There is currently a lack of literature or research into the effectiveness of Gestalt with working

with depression.

A lack of diagnostic tools and training giving to practitioners.

Insufficient medical experience or collaboration with the medical profession.

The uncertainty around the issue of whether depression is caused by nature or nurture and

how to work holistically with the client rather than label them.

Conclusion

Gestalt therapy is finding its place in clinical practice. There is still little research into the Gestalt

therapy of depression. It seems that the effectiveness of Gestalt therapy is comparable with the

other therapeutical methods, for example with Cognitive Behavioural therapy (Rosner, Frick &

Beutler, 1999, Beutler, Engle & Shoham-Salomon, 1991). The effect of a therapy based on a

supportive therapeutic relationship may be increased by the use of specific interventions focused on

emotions in ways that are typify Gestalt therapy (Greenberg, Watson & Goldman, 1998).

Other research indicates the Gestalt approach is especially effective in the therapies of internalizing

clients who deal with depression in intrapunitive ways (Beutler, Engle & Shoham-Salomon, 1991).

I believe that by learning more about the DSM-IV diagnostic criteria of disorders, that Gestalt can

work in tandem with the medical profession and this knowledge will actually assist the therapist in

working with clients that are referred on by doctor’s etc with various mood disorders.

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http://irishphoenix.hubpages.com/hub/How-Gestalt-Therapy-Views-Depression

Gestalt Therapy 

Gestalt therapy focuses on here-and-now experience and personal responsibility. It was develped by

Fritz Perls, Laura Perls, and Paul Goodman. The objective, in addition to overcoming symptoms, is to

become more alive, creative, and free from the blocks of unfinished issues which may diminish

optimum satisfaction, fulfillment, and growth. Gestalt therapy relies heavily on the interpersonal

relationship between client and therapist that is developed and nurtured over the course of therapy.

This technique is also classified as an experiential approach to psychotherapy because it involves

actions that are both intentional and experimental to facilitate change.

Foundational Principles of Gestalt Therapy

Focus on "Here and Now"

Benefits of Gestalt Therapy

Resources Related to Gestalt Therapy

Foundational Principles of Gestalt Therapy

Gestalt therapy has at its core two key principals. The first maintains that experiencing the present

moment in its entirety is at the heart of psychology, unlike techniques that give significance to the

unknown or imagined. Second, each and every person is linked and connected to all things. Without

acknowledging that we are in relationship with all things, we can never truly understand who we are.

These two principals of present state and relational theory form the foundation of Gestalt therapy. By

using a formation of ideas that outline the premise of life in a relational way, this therapy provides a

unique and profound perspective on life as we experience it with its peaks and valleys. This technique

provides insight into ways in which we can alleviate our current distress and also aspire to our

maximum potential.

 

Focus on "Here and Now"

Gestalt therapy places emphasis on the current content of a situation in addition to the process of the

circumstance as it unfolds. Rather than forming conjectures or assumptions as to the unknown, this

method involves staying in the present and becoming aware of the feelings and emotions associated

with the moment. Gestalt therapy teaches the client how to define what is truly being experienced

versus what is merely an interpretation of the events. When the client becomes fully aware of this

difference, he or she is able to identify the patterns and behaviors that need to be changed.

 

Benefits of Gestalt Therapy

Gestalt therapy helps clients gain a better understanding of how their emotional and physical bodies

are connected. Understanding the internal self is the key to understanding actions, reactions and

behaviors. Gestalt therapy helps a client take the first step into this awareness so that they can

acknowledge and accept these patterns. Through a journey of self-discovery, this form of therapy also

empowers a client with the skills necessary to face stressful situations. The answers lie within us all,

and this wisdom helps each of us become more accepting of ourselves and others, which carries over

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into our communication, decisions and relationships. People who participate in gestalt therapy feel

more self-confident, calm and at peace. Gestalt therapy is an effective approach for managing tension,

depression, anxiety, addiction, post-traumatic stress and other psychological challenges that prevent

people from achieving a free and fulfilling life.

http://www.goodtherapy.org/Gestalt_Therapy.html

Basic ConceptsThe Phenomenological PerspectivePhenomenology is a subject which assists people to keep away from the ordinary way thinking, therefore it is possible to distinguish between the actual perception, feelings and the previous experience residue (Idhe, 1977). A Gestalt examination values, employs and makes clear instant and "naive" perception and this perception is "undebauched by learning". (Wertheimer, 1945, p.331.) Gestalt therapy regards what is felt "subjectively" at the moment and objective observation too as actual and essential data. This is different from the approaches considering what the person experiences as "mere appearances" and interpretation is used by them to discover "real meaning."

Gestalt phenomenological exploration is aimed at awareness, or insight. Insight is a creation of patterns of perceptual field in this way that the important realities are apparent; it is a creation of a gestalt when the essential factors begin to make sense with reference to the whole" (Heidbreder, 1933, p. 355). As for the Gestalt therapy, insight here is complete understanding of the structure of the situation under observation.

Awareness should go with systematic exploration otherwise it is not usually sufficient to reach insight. This is the reason why Gestalt therapy makes use of focused awareness in addition to experimentation to reach the goal and develop insight. The way the patient becomes aware is decisive to every phenomenological investigation. It is not just personal awareness the phenomenologist studies but the process of awareness itself as well. The patient should understand how to be aware of awareness. The way the therapist and the client experience their relationship is of particular importance (Yontef, 1976, 1982, 1983).

The Field Theory PerspectiveThe scientists think that Gestalt phenomenological perspective is based on field theory. Field theory is an exploration method describing the entire field and the event being its piece rather than evaluating the event expressing the concept of a class, one belongs to by nature (Aristotelian classification can be an example of it) or a historical and cause-effect sequence (for instance, Newtonian mechanics).

Being a whole, the field consists of such parts as immediate relationship and they influence each other with all parts involved. The field becomes a substitute for separate constituents' notions. The person in somebody's life space is a part of a field.

There is no act in field theory, which is at a distance; this means that everything having effect must involve things affected in space and time. Gestalt therapists make effort in "the here and now" and are perceptive to the way "the here and now" comprise things left from the past, like behavior, principles, lifestyle and body posture.

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The phenomenological field is characterized by the one observing it and it is significant just when the person is aware of the observer's frame of reference. The observer is needed since what is seen by him is a function to some extent of how and when the person looks.

Field approaches more describe than speculate, interpret, or classify. The stress is on looking, describing, and clarifying the accurate structure of the thing being studied. If there is no access to facts by means of therapist's direct observation in Gestalt therapy, then they are studied by means of phenomenological focusing, experiments, participants' reporting and dialogue (Yontef, 1982, 1983).

The Existential PerspectiveExistentialism has the phenomenological method in its basis. Existential phenomenologists bring into focus existence of people, their relations with other people, happiness and pain, and so on, as experienced directly.

The majority operates in the context of conventional thought which distorts or keeps away from acknowledging how the world is. This is particularly true of person's relations in the world and choices made. Self-delusion is the reason for inauthenticity: living not based on the real facts about oneself in the world brings to feelings of fear, guilt and concern. Gestalt therapy gives the patient authenticity and meaningful responsibility. Becoming aware, the person can choose and arrange his existence with a meaningful approach (Jacobs, 1978; Yontef, 1982, 1983).

The existential view is that every person continually discovering and remaking themselves. Human nature is not discovered once and forever. All the time new horizons, new challenges and new possibilities appear.

DialogueThe relationship of the therapist and the patient is one of the most significant matters of psychotherapy. Existential dialogue is an important part of methodology in Gestalt therapy. It demonstrates the existential perspective on relationship.

Relationship develops out of contact. Every person grows and forms identity through contact. During contact the boundary is defined between "me" and "not-me." Contact appears when one deals with the "not-me" (in this case "the other person") while keeping a self-identity apart from the "not-me". Martin Buber affirms that one ("I") has meaning barely with regard to others, in the dialogue "I-Thou" or in contact of manipulative kind "I-It". Gestalt therapists like the dialogue scheme better experiencing the client than "I-It" scheme - therapeutic manipulation.

Gestalt therapy assists patients to build up their support for preferred contact or withdrawal (L. Perls, 1976, 1978). Support means anything making contact or withdrawal achievable, such as energy, support of body, breathing, data, interest in others, language, and et cetera. Support activates means for either contact or withdrawal. For instance, to support the enthusiasm coming with contact, one should have sufficient oxygen.

The Gestalt therapist is occupied with involving the client into dialogue rather than by means of manipulation aimed to reach certain therapeutic goal. The signs of this contact are simple caring, warm attitude, approval and self-responsibility. As therapists lead patients to certain aim, the clients cannot be responsible for their development and self-support. Dialogue is founded on experiencing the individual to make him reveal the real self and share this way

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phenomenological awareness. The Gestalt therapist explains what the person means and persuades the client to act the same way. Gestalt dialogue is based on genuineness and responsibility.

In Gestalt therapy the therapeutic relationship accentuates 4 attributes of dialogue:

1. Inclusion. This is immersion into the experience of the person without judgment, analysis or interpretation while maintaining a sense of one's detached, independent presence at the same time. The phenomenological trust in direct experience is revealed here through interpersonal and existential application. Inclusion grants an environment of protection for the client's phenomenological work and, in the course of communication the understanding of the client's experience, contributes to sharpening of the client's the self-awareness.

2. Presence. The Gestalt therapist opens herself to the patient. Remarks, fondness, feelings, private experience and opinions are expressed on a regular basis, sensibly, and with discrimination. The therapist shares with the client her perspective. This way the therapist forms phenomenological reporting, which contributes to client's learning of trust and application of immediate experience to increase awareness. If the therapist counts on interpretation which is derived from theory more than relying on personal presence, she makes the patient trust the phenomena not thanks to his own direct experience as the instrument for increasing awareness. The therapist does not utilize presence in Gestalt therapy to influence the patient by means of manipulation to comply with the goals set before, but rather induces clients to control themselves on their own.

3. Commitment to dialogue. Contact means something deeper than just something two persons do to each other. Contact is a process, which takes place between people. Contact arises from the communication between them. The Gestalt therapist is involved in this interpersonal procedure. This is closer to letting contact occur than making contact, manipulating, and calculating the effect.

4. Dialogue is lived. Dialogue is closer to action rather than words. "Lived" stresses the enthusiasm and closeness of doing. The dialogue can have various modes, such as dancing, words, songs, or any method expressing and moving the energy between the parties. A significant input of Gestalt theory to phenomenological experimentation is expanding the parameters in order to embrace explanation of experience in nonverbal way. On the other hand, the interaction is restricted by such aspects as ethics, correctness, therapeutic assignment, and et cetera.

Gestalt Personality TheoryTheory of Personality

Ecological Interdependence: The Organism/Environment FieldThe existence of the person is accompanied with differentiating self from other or with connecting self and other. The boundary has the two functions. To establish good contact with the world of the other person, it is required to try to reach out and discover own boundaries. Successful self-regulation embraces contact in which the person understands the novelty of the

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environment that is possibly nourishing or on the contrary toxic. It can be assimilated or refused. This type of differentiated contact undoubtedly brings growth (Polster and Polster, 1973, p. 101).

Mental MetabolismThe term "metabolism" is referred to in Gestalt therapy when it is employed as a metaphor for psychological functioning. People develop through biting off pieces of proper size (this can be applied not only to food but relationships and ideas too), then the phase of chewing comes (the same as consideration), and determining if it is nourishing or vice versa toxic. When it is nourishing, it is assimilated by the organism and it becomes the part of it. In case of toxic variant, it is rejected by the organism. This makes people rely on their taste and decision. Discrimination needs actively sensing without the stimuli and exteroceptive stimuli processing together with interoceptive data.

Regulation of the BoundaryThe boundary set between person and environment should be penetrable to let exchanges, yet rather strong to be autonomous. One should be able to exclude toxins in the environment. But nourishing also should be discriminated in accordance with dominant needs. Metabolic processes are managed by the laws of homeostasis. The most vital need activates the organism until it is satisfied or is replaced by a more crucial need. Living is a succession of needs, either met or unmet, reaching homeostatic balance and moving to the new moment and next need.

Disturbances of the Contact BoundaryIn case the boundary is unclear, gone or impassable, this leads to a disorder of the distinction between self and other, and then contact and awareness are disturbed too (see Perls, 1973; Polster and Polster, 1973). When boundary functions well, people change connecting and separating, and alternate between withdrawal from the environment and being in contact with it. The boundary of contact is gone in absolutely contradictory ways in joining together and separation. In fusion the isolation and distinction between self and other becomes uncertain then the boundary disappears. In isolation, the boundary turns solid that coherence is lost, that means that significance of others for the self is replaced from awareness.

Retroflection is a division within the self, a preventing the aspects of the self with the self. This replaces self for environment, like in doing to self what is desired to do to the other one or doing for self what is desired to do by the other one for self. This scheme brings to separation. The illusion of self-sufficiency is a sample of retroflection as it substitutes self for environment. Though one can breathe and chew for oneself, the air and food is provided by environment. Introspection is a type of retroflection which is either pathological or healthy. For instance, refusing to accept the impulse to convey anger can help to manage hazardous environment. Under the circumstances, biting one's lip can be more practical than biting words.

Via introjection foreign material is taken in without discriminating or assimilating. Swallowing whole contributes to creation of an "as if" personality and inflexible character. Introjected principles and actions are acquired in an imposing manner. Like in all disturbances of this kind (contact boundary), swallowing whole is at times normal or pathological, in accordance with the situation and level of awareness. For instance, students studying something on lectures, with complete awareness what they are doing, make a copy, remember and repeat the material without complete "digestion" or understanding.

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Projection is a process when self and other are confused that is caused by ascribing to the outside something which is actually self. Art can be a model of healthy projection. But when the person does not have awareness and admits responsibility for something projected then pathological projection appears.

Deflection is the evasion of awareness and contact turning aside. It is similar to the situation when somebody is well-mannered instead of being direct. Deviation can be achieved by not telling directly or by refuse to receive. The person frequently feels either "untouched" or ineffective and puzzled as he does not obtain what is desired by him. Deflection can be of use where, with awareness, it answers the requirements in the current situation (for example, when cooling down is needed). Different samples of deflection involve methods of not looking at a person, wordiness, elusiveness, understating and speaking about more than to (Polster and Polster, 1973, pp. 89-92).

Organismic Self-RegulationIndividual regulation can be (a) organismic - founded on a comparatively complete and accurate acknowledgment of what is, or (b) "shouldistic," founded on the accidental imposition of what one considers should be or not. This refers to intrapsychic regulation, to the regulation of social groups and interpersonal relations.

Fritz Perls wrote that there was just one thing that needed control: the situation. The main thing is to understand the situation and allow it to control the behavior. If one is able to do it, then he can learn to manage life." (F. Perls, 1976, p. 33). Perls explained it with the help of "driving car" example. As a substitute for a program planned ahead, "The person wants to drive at a speed - 65 miles per hour," a person aware of the current situation will do it in a different way: at lower speed at night and when there is much traffic. He will act in a different way when he is tired. Perls explains that "allow it to control" denotes regulating via awareness of the present-day background, together with one's wishes rather than something that "should" occur.

When self-regulation is organismic, choosing and learning occur holistically, with a normal integration of body and mind, consideration and feeling, impulsiveness and deliberateness. In shouldistic regulation, cognition rules and there is no holistic felt sense.

Apparently, everything applicable to boundary regulation cannot be accompanied with complete awareness. The majority of business transactions are conducted in an automatic, habitual way and minimal awareness is employed at that. Organismic self-regulation calls makes it necessary for the habitual to become completely aware as required. In case awareness does not come forward as necessary and does not display the needed motor activity, psychotherapy can be of help here and contribute to increasing awareness and making important choice and taking responsibility.

AwarenessAwareness and dialogue are among the most important therapeutic instruments of Gestalt therapy. Such form of understanding as awareness can be freely characterized as being connected with the existence of the person, with something that answers what is - question.

Laura Perls affirms:

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The goal of Gestalt therapy - awareness continuum, the freely continuing Gestalt formation where what is of furthermost concern and importance to the organism, the connection, the grouping or society gets Gestalt, comes to the forefront to be experienced freely and managed (accepted, worked through, selected, altered, solved, and so on) so in this way it can be dissolved on the background (disregarded, assimilated and integrated) and free foreground from the following significant Gestalt. (1973, p. 2)

Full awareness can be considered as the procedure of being vigilant contact with the important things in the environment field with full cognitive, sensorimotor, emotional and energetic sustain. Insight as a form of awareness is an instant understanding of evident union of different parts in the field. When the contacts are aware, then new significant wholes appear and this way the problem is integrated.

Effective awareness is explained and activated by the prevailing necessity of the organism at the present moment. This way not just self-knowledge is involved, but knowing directly the situation at the moment and the way the self is under the circumstances. Any rejection of the state of affairs and its requests or of one's wants and chosen response is a disturbance of awareness. Meaningful awareness is of a self in the world, in dialogue with the world, and with awareness of other -- it is not an inwardly focused introspection. Awareness is accompanied by owning, that is, the process of knowing one's control over, choice of, and responsibility for one's own behavior and feelings. Without this, the person may be vigilant to experience and life space, but not to what power he or she has and does not have. Awareness is cognitive, sensory and affective. The person who verbally acknowledges his situation but does not really see it, know it, react to it and feel in response to it not being fully aware and is not in full contact. The person who is aware knows what he does, how he does it, that he has alternatives and that he chooses to be as he is.

The awareness act is at all times here and now, even though the content of awareness can be distant. The act of memorizing is at this moment; what is memorized is not at this moment. When the state of affairs requires an awareness of the past or expectation of the future, efficient awareness regards this. For instance:

P: [Looking more stressed than normally] I do not know what I should work over.

T: What is that are you aware of at this very moment?

P: I am pleased to meet you, but I'm nervous about my meeting with my director in the evening. I have practiced much to get ready and I've made efforts to support myself while I anticipate it.

T: What is necessary for you just now?

P: It came to my mind to offer the chair for her at first, and then have a talk. However I am so nervous that some physical activity is needed: to breathe, move and create noise.

T: [Looking but keeping silence]

P: Isn't it up to me? [Silence. Then the client rises, begins stretching and yawns. There is more energy in his behavior. Some minutes later the client sits on the chair, looking calmer and more active.] Let us start.

T: Now you seem to be more energetic.

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P: I have prepared to study what made me so bothered about meeting in the evening.

Self-rejection excludes full awareness and vice versa. Self-rejection is a deformation of awareness as this is a refuse from who one is. Self-rejection is at the same time bewilderment of who "I am" and a self-cheating, or "bad faith" attitude of being higher than that which is apparently being admitted (Sartre, 1966). When person says "I am" as if he observes different person, or like the "I" were not selected, or not knowing the way one makes and keeps that "I am" is more bad faith than insightful awareness.

ResponsibilityPeople, in accordance with Gestalt therapy, are in charge or "response able" - that means, they can determine the way to behave. Confusing accountability with shoulds and blaming, they force and manipulate; they make efforts and are not impulsive and integrated. At these moments their actual wants, responses and needs of the environment and options in the situation are neglected and they either comply with "shoulds" or reject them.

Gestalt therapists consider that it is essential to make a distinction clearly between one's wants and what is given to the person. People are in charge of their behavior. For instance, people are in charge oftheir behavior and protection of the environment. When you blame something outside yourself, you deceive yourself. You can blame genetics, for instance or parents. Taking responsibility for what one did not choose, a typical shame reaction, is also a deception.

Every person is in charge of the moral choice he makes. Gestalt therapy can help the person to understand what can be considered moral and what not. Gestalt therapy gives person an opportunity to choose and value.

Variety of ConceptsPersonality theory of Gestalt therapy has developed initially out of clinical experience. The emphasis has been made on a theory of personality that sustains the task of psychotherapists more than a general theory of personality. The concepts of theory of Gestalt therapy are more field theoretical than genetic and more phenomenological than conceptual ones.

Gestalt psychotherapy, in spite of being phenomenological, has to do with the unconscious - with something that has nothing to do with awareness. In Gestalt therapy, awareness is understood as being in touch and unawareness is understood as being out of touch and can be made clear by various phenomena, together with learning which is better to attend to, by suppression, character, cognitive set and style. Simkin in 1976 made a comparison of personality with the floating ball - just a part of it appears above water any time and the remaining part is underwater. Unawareness is the consequence of the situation when the organism was not in contact with outside environment because of being frequently involved in his own fantasies or the inner environment or on the contrary was fixed upon the outer environment and neglect inner life.

Gestalt Therapy Theory of ChangeChildren introject ideas as well as behavior. Therefore they are more inclined to enforced morality than an organismically compatible. Consequently, people often feel guilty as they act the way the wish and neglect what they should. Some of them direct much energy in maintaining the division between "should" and "want" -- the choice depends upon the morality of the person

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contrasting to an introjected one. "Shoulds" interferes with people of this type. More often they try to be what they are not, the bigger the resistance, and changes do not follow.

Beisser developed the theory according to which alterations do not occur via a "forced effort by the person or by different personality to alter him," but it does not take place when the person makes attempts to be "what he is," "to be completely in his present position" (1970, p. 70). Once the therapist refuses from the role of change agent, orderly change is possible as well as meaningful change.

The Gestalt therapy concept is that awareness in addition to owning, choosing, responsibility, and contact leads to expected and unplanned change. Compulsory change is an effort to realize an image more than oneself. With awareness the acceptance of self, and with the right to exist as is, the organism is able to grow. Mandatory intervention holds back the process.

The principle of Pragnanz in Gestalt psychology affirms that the field will structure itself into the finest Gestalt that overall circumstances will let. So Gestalt therapists consider too that people have an instinctive drive to health. This predisposition is natural, and every person is a part of nature. Awareness of the evident, the awareness continuum, is an instrument for the person to use intentionally to direct this natural drive for healthy condition.

Differentiation of the Field: Polarities versus DichotomiesA dichotomy is a division by which the field is regarded not the whole adapted to fit in diverse and interconnected parts, but more as a range of opposing and forces without connection to each other. Dichotomous thinking is in the way of organismic self-regulation. Dichotomous thinking is inclined to subdue diversity among people and of contradictory things about one personality.

Organismic self-regulation integrates parts into total that includes parts. The field is frequently separated into polarities: opposite parts that add or clarify each other. The opposite poles of an electrical field (positive and negative) present a typical example of a field theoretical differentiation. The notion of polarities interprets opposite parts as elements of the whole, similar to yin and yang.

With this polar view of the field, distinctions are admitted and assimilated. Lack of genuine integration creates splits, such as body-mind, self-external, infantile-mature, biological-cultural, and unconscious-conscious. Through dialogue there can be an integration of parts, into a new whole in which there is a differentiated unity. Dichotomies like the self-ideal and the needy self, reflection and impulse, and public requirements and individual needs can be removed by integrating into a whole which consists of natural polarities (Perls, 1947).

Definition of Health I: The Good Gestalt as PolarityThe good Gestalt gives a description of a perceptual field structured well and clearly. A well-formed figure is noticeable on a not so distinct background. Both elements (the figure against the background) are related to each other with meaning. The meaning is understandable in the good Gestalt. The good Gestalt provides a content-free description of health.

In health, the figure alters is necessary, which means that it is moved to different focus when the requirement is met or surpassed by a more pressing need. It does not transform so quickly as to thwart satisfaction (like in hysteria) or so unhurriedly that latest figures have no opportunity to undertake organismic dominance (like in compulsivity). During the dichotomy of figure and

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ground, one remains out of context with a figure or with a context without focus (F. Perls et al., 1951). In health, awareness in particular presents the main requirement of the entire field. Requirement is a function of outside factors (such as, a physical formation of the field, political movement, natural phenomena, and so forth) and inner factors (for instance, famine, tiredness, curiosity, experience of the past, and so on).

Definition of Health II: The Polarity of Creative AdjustmentNotion of healthy functioning comprises creative adjustment in the Gestalt therapy. A psychotherapy that just assists patients to adjust contributes to conformity and stereotypy. A psychotherapy that made people impose themselves on the surrounding world without taking into consideration others would provoke pathological narcissism and separated from the world-denying realization of self.

A person showing creative interaction is responsible for the natural balance between self and surrounding world.

Within this theoretical context (F. Perls et al., 1951) some apparently individualistic statements of Gestalt therapy and even anarchistic are considered in the most though way. The individual presents a polarity against environment. The option is made between organismic regulation and arbitrary, but not between the personality and society.

Being a polarity, resistance consists of an impulse and resistant to that impulse. Considered like a dichotomy, resistance is frequently referred to as "bad" and, in this context, regularly grows into just personal dictates of the client and not the therapist's. Taken as a polarity, it is as integral to health as the trait is being resisted.

Gestalt therapists deal with consciousness: its working process of and its resistance process. Various Gestalt keep away from the word resistance on account of its pejorative dichotomized nuance, which makes the process a battle between therapist and client more than the client's self-conflict that requires integration into a self, which is harmoniously differentiated.

ImpasseAn impasse is a state of affairs when external support is not following and the individual considers that he is not able to support himself. This is so because the strength of personality splits between resistance and impulse. The most common method of overcoming this is manipulation.

An organismically self-regulating person is responsible for things made for self, things made by others for self, and things made by self for others. The person makes exchange with the surroundings, but the main support to regulate the existence is performed by self. As the person is not aware of this, external support becomes a substitute of self-support more than a nourishment source for the self.

In psychotherapy generally therapist can get around the impasse with the help of external support, and the patient thinks that self-support is not enough. In Gestalt therapy, clients can cope with the impasse thanks to the accent on loving contact without doing something for the patient, without coming to rescue or support of infantilism.

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Gestalt PsychotherapyTheory of Psychotherapy

Goal of TherapyThere 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.

No "Shoulds"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

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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 RelationGestalt 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.

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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 HowThere 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

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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.

P: No.

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 PsychotherapyGestalt 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.

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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 FocusingThe 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?

P: Sadness.

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.

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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.

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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]

Therapist DisclosuresThe 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.

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