W3

Question 1

Gestalt Therapy Summarized

Answer 1

Gestalt is a therapy of contact; founded by Frederick (“Fritz”) Perls, Laura Perls and Paul Goodman. Began as a revision of psychoanalysis and developed into its own wholly independent, integrated system.
Utilizes an experiential and humanistic approach; working to develop patients’ awareness and behavioral skills rather than relying on the analyst’s interpretation of the unconscious.
The therapist is not neutral, and actively and personally engages with the client. The aim is to increase the awareness, freedom, and self-direction of patients, rather than to direct them toward a series of preset goals.
It is an integrative system and includes affective, sensory, cognitive, interpersonal, and behavioral components.
Therapists are encouraged to be creative in its practice, hence it does not feature any prescribed techniques.

Question 2

Holism

Answer 2

The assertion that humans are inherently self-regulating, growth oriented, and cannot be fully understood without a consideration of their environment.

Question 3

Field Theory

Answer 3

A theory about the nature of reality and our relationship to it. Posits that no one can have an objective perspective on reality. Any rendition of history is shaped to some degree by the one’s current field (situational) conditions. All attributions about the nature of reality are relative to the subject’s position in the field. A way of conceptualizing how one’s context influences one’s experiences.

In other words, “reality” is a function of perspective and there may be multiple realities of equal legitimacy.

The Field is a systematic web of relationships, continuous in space and time. Everything is of-the-field, and phenomena are determined by the whole field. The field is a unitary whole; everything in the field affects everything else in the field.

Therapeutic work can therefore be considered a mutual investigation into how the field is organized (parsing out the specifics of the connections).

Question 4

The Paradoxical Theory of Change

Answer 4

The more one tries to become who one is not, the more one stays the same.
The more one tries to force oneself into a mold that does not fit, the more one is fragmented rather than whole.
Knowing and accepting one’s true self is key to growth.

Hence, a therapist should strive to fully accept the patient as they are; to maintain consistency with this theory.

Question 5

Organismic Self-Regulation

Answer 5

People are inherently self-regulating, context sensitive, and motivated to solve problems.
Needs are organized hierarchically (with health at the top). Once a need has been met, the subsequent need can become the new focus of attention.
Knowledge and acceptance of the full self is needed for its functionality.

Question 6

Contact

Answer 6

Being in touch with the emerging here and now.
One’s experience of contact, and contrastingly withdrawal, determine the quality of one’s life; and their capacity for development.

Question 7

Conscious Awareness

Answer 7

Being in touch with what is.

Awareness (focused attention) is a prerequisite for contact. It is vital when higher contact ability is required (i.e., conflict/complex situations, when habitual modes of thinking don’t function and one is not learning from experience).

Awareness more generally requires self-knowledge, knowledge of the environment, responsibility for choices, self-acceptance, and the ability to contact.

Question 8

Experimentation

Answer 8

The act of trying something new to increase understanding.
May result in enhanced emotions or the realization of something that had been kept from awareness. Serves as an alternative to the purely verbal methods of psychoanalysis and the behavior control techniques of behavior therapy.

Question 9

Second Order of Awareness

Answer 9

Awareness of how you interrupt your own awareness (i.e., by blocking awareness the emotional energy of sadness with anger).

Question 10

Distinctions between Classical Freudian Psychoanalysis and Gestalt Therapy

Answer 10

Freudian:
- Patients’ insights deemed unreliable as they exist to disguise deeper unconscious motivations.
- The therapist is governed by the rule of abstinence (gratifying no patient’s wish) and the rule of neutrality (having no preferences in the patient’s conflicts); to avoid countertransference.
- Discussion usually focused on the past.

Gestalt:
- Patient’s awareness/insights are not assumed to be merely a cover for some other deeper motivation. Self-report data is considered real data.
- The therapist and client co-direct the therapeutic process.
- Discussion is focused on the here-and-now.

Question 11

Distinctions between Client-Centered Therapy/Rational Emotive Behavior Therapy and Gestalt Therapy

Answer 11

Gestalt and Client-Centered both believe:
- In the potential for human growth.
- That growth results from a warm/authentic therapeutic relationship.
- They are phenomenological therapies that work with the patient’s subjective awareness.

But Gestalt:
- Undertakes awareness experiments to clarify the patient’s subjective experience.
- Values therapist subjectivity more; so the therapist is more likely to open-up.

Rational Emotive Behavior Therapy is:
- More confrontational with the patient regarding their dysfunctional ways of thinking (similar to Fritz’s early “boom boom” approach)

Question 12

Martin Buber’s I-Thou Relationship

Answer 12

There is no independent “I”/sense of self, other than the self that exists in relation to others.
There is only the “I” of the “I-Thou”, or the self-with-other/self-in-relation (to the environmental field)

The basis for the patient–therapist relationship in Gestalt, and ties into the belief that it is the contact between humans that dominates the formation and functions of our personalities.

Question 13

Tenets Shared by Modern Psychoanalysis and Relational Gestalt Therapy

Answer 13

• An emphasis on the whole person and sense of self.
• An emphasis on process thinking.
• An emphasis on subjectivity and affect.
• An appreciation of the impact of life events on personality development.
• A belief that people are motivated toward growth and development rather than regression.
• A belief that infants are born with a basic motivation and capacity for personal interaction, attachment, and satisfaction.
• A belief that there is no “self” without an “other” (meaningless to speak of a person in isolation from the relationships that shape/define their life)
• A belief that the structure and contents of the mind are shaped by interactions with others rather than by instinctual urges.

Question 14

Distinctions Between Cognitive Behavior Therapy/REBT and Gestalt Therapy.

Answer 14

Gestalt therapists do not presume to know the truth about what is irrational (i.e., irrational behaviors).

REBT and Gestalt: discuss the creation of guilt through moralistic thinking and unreasonable conditions of worth (“shoulds”).

CBT and Gestalt: stress the role of “futurizing” in creating anxiety.

Question 15

Reich’s Character Armor

Answer 15

Repetitive patterns of experience, behavior, and body posture that keep the individual in fixed, socially determined roles.
Reich argued that how a patient spoke or moved was more important than what they said (valuing the body as a carrier of emotional wisdom)

Question 16

Gestalt

Answer 16

Has no literal English translation. It refers to a perceptual whole or configuration of experience. People do not perceive in bits and pieces, they perceive in patterned wholes.

Question 17

Phenomenology

Answer 17

Assumes reality is formed in the relationship between the observed and the observer. In other words, reality is interpreted.

Phenomenological understanding is achieved by dissecting one’s initial perceptions and separating what is actually experienced – from what is expected or logically derived.

Question 18

Principles of the Dialogic Relationship in Gestalt

Answer 18

[D.I.C]

Disclosure (therapist is transparent/self-disclosing, authentic/congruent)
Inclusion (similar to empathic engagement; imagining the patient’s experience as if it was your own while maintaining a sense of self)
Commitment to the Dialogue (surrendering to what happens between the therapist and client, and therefore not controlling its outcome; therapist changes as well as the patient)

Question 19

Boundaries

Answer 19

Boundaries help to differentiate the field

Question 20

The Contact Boundary

Answer 20

Holds the dual function of both connecting and separating people.

Without emotionally connecting with others, one starves (social/biological/psychological needs not met); without emotional separation, one does not maintain a separate, autonomous identity.

Question 21

Dialogic Contact

Answer 21

Interactions in which two persons each acknowledge the experience of the other with awareness and respect for the needs, feelings, beliefs, and customs of the other. Important for psychological growth.

Question 22

Gestalt (Figure/Ground) Formation

Answer 22

The formation of a figure (or ground) of interest, that is in focus; in contrast from a less distinct background. Its formation means that other aspects of reality become less vivid. One can only perceive one clear figure at a time, although figures may shift rapidly.

This relates to the concept of perception as the formation of unified wholes against a background, through the phenomenon of contrast.

Question 23

Awareness-Unawareness

Answer 23

What is typically referred to as consciousness and unconsciousness.

There is fluidity in what is in and outside of awareness from moment to moment (what is in the background/outside of awareness could instantly become the next figure in awareness).

In neurotic patients, some aspect of the phenomenal field is intentionally and regularly relegated to the background. These aspects with permanent background status reflect the patient’s current conflicts. A safe therapeutic relationship can enable these states to brought back into awareness through dialogue.

Question 24

Healthy Organismic Self-Regulation

Answer 24

Occurs when one is aware of shifting need states (i.e., when what is of most importance becomes the figure of one’s awareness).

Healthy functioning involves identifying with one’s ongoing, moment-by-moment experiencing and allowing this identification to guide one’s behavior. It also requires one to be in contact with what is occurring in the person–environment field (i.e., one’s experience in relation to the field)

Question 25

Why is Life Relational?

Answer 25

Because awareness and human relations are inseparable.

Awareness develops through the lens of relations –> Relationships are regulated by how people experience them –> People define themselves by how they experience themselves in relation to others.

Question 26

The Boundary Disturbance of Isolation

Answer 26

Occurs when the experience of connecting with others is blocked repetitively (suboptimal balance between connecting and withdrawal; with an imbalance towards withdrawal)

Question 27

The Boundary Disturbance of Confluence

Answer 27

The blocking of the need to withdraw, resulting in the loss of experiencing a separate identity (suboptimal balance between connecting and withdrawal; with an imbalance towards connecting)

Togetherness without adequate separation; where do the lines start/end – where do you begin, where do I?

Question 28

The Boundary Disturbance of Introjection

Answer 28

Occurs as result of absorption without awareness. Introjects represent concepts that did not have the opportunity to be properly integrated into organismic functioning, because they weren’t analyzed at the point of assimilation.

Question 29

Assimilation

Answer 29

The process of experiencing what is to be taken in/absorbed; deconstructing it, keeping what is useful, and discarding what is not.

Question 30

The Boundary Disturbance of Projection

Answer 30

When a phenomenon that occurs in oneself is falsely attributed to another; in an effort to avoid awareness of one’s own experience.

Question 31

The Boundary Disturbance of Retroflection

Answer 31

When an impulse or desire that required two people is satisfied alone (i.e., caressing oneself when the desire was intimacy with another). Some part of the individual is disowned and not allowed to guide action or behavior.

Question 32

Creative Adjustment

Answer 32

Habits/patterns/belief systems that people create in unhealthy situations in order to survive (i.e., in a loud family you would make the creative adjustment to be loud also; to be heard).

A healthy response to an unhealthy situation, that may no longer be healthy or necessary in the present.

It represents a balance between changing one’s environment and adjusting to current conditions. It is a continual negotiation between oneself and one’s environment.

Question 33

Gestalt Formation Cycle

Answer 33

The process whereby a need becomes a figure, is acted upon, and then recedes to the background to make way for the emergence of a new figure.

This cycle will always require creative adjustment, as the environment must be contacted and adapted to meet the individual’s needs.

Question 34

A Good Gestalt

Answer 34

A perceptual field organized with clarity and good form (i.e., a well-formed figure that stands out clearly from a less distinct background due to clear meaning)

Question 35

Three Issues of Gestalt Formation

Answer 35

[H.I.C]
Hysteria: Figures change too rapidly; preventing need satisfaction.
Impulsivity: Figures do not have a background, or there is a background without a figure/focus.
Compulsivity: Figures change too slowly; such that incoming figures do not have the space to assume dominance.

Question 36

Neurotic Regulation under Gestalt

Answer 36

The result of a creative adjustment that was made in a difficult past situation (e.g., in a field with limited resources), then not readjusted in light of changing field conditions. What was initially a creative adjustment has been hardened into a repetitive character pattern.

The ability to respond with awareness to the current self-in-field problem has been eroded.

Question 37

A Safe Emergency

Answer 37

A recreation of an emergency in the therapeutic environment which contains some elements reminiscent of the emergency but also contains health facilitating elements (like the therapist’s calming presence).

It can promote the creation of a new, more flexible and responsive creative adjustment.

Question 38

Polarities and Neurotic Regulation

Answer 38

In neurotic regulation, some aspects of the ground must be kept out of awareness (e.g., unbearable loneliness), and polarities can lose their fluidity and become hardened into oppositional dichotomies (where one thing can exist but not the other)

For example, strength may be readily embraced by a neurotic patient while vulnerability is disavowed.

Question 39

Resistance

Answer 39

Opposing the formation of a figure (i.e., a thought, feeling, impulse, need etc.). Or, the imposition of the therapist’s figure (or agenda) threatening to emerge in a dangerous context (e.g., choking back tears because of fear of ridicule).

In Gestalt theory, resistance is an awkward but crucially important expression of an organism’s integrity. One can forget making these resistant adjustments, and therefore remain unaware of their existence. Even when one is aware, they may not be comfortable changing the adjustment for fear that the current context has not changed sufficiently.

Question 40

Mental Illness within Gestalt

Answer 40

The inability to form clear figures of interest, to identify with one’s moment-by-moment experience, or to respond to what one is aware of.

Question 41

Emotions in Gestalt

Answer 41

Key signals that can provide insight to an individual on their relationship to the current field, and the relative urgency of an emerging figure.

Question 42

Support in Gestalt

Answer 42

Support refers to anything and everything that facilitates assimilation and integration in the client. It can consist of both self-support and environmental support; and Gestalt therapy seeks to strike a balance between these two.
Contact is possible only when support is available.

Question 43

Anxiety/Futurizing

Answer 43

Anxiety is created cognitively through a failure to remain centered in the present (“futurizing” – focusing one’s awareness on something that is not yet present), or through unsupported breathing habits (rapid breathing without sufficient exhalation such that carbon dioxide is not fully expelled and oxygenated blood cannot reach the alveoli).

Question 44

Impasse

Answer 44

The freeze in flight, fight, or freeze. Experienced when a person’s customary supports are not available and new supports have not yet been created/mobilized.

Manifests as terror. Going back is not an option, but the individual does not know whether they can survive going forward. When support is not mobilized to work through the impasse, the person falls back on old and maladaptive behaviors.

Question 45

Gestalt’s Perspective on Childhood Development

Answer 45

Infants are born with the capacity for self-regulation, the development and refinement of self-regulatory skills is contingent on mutual regulation between caretaker and infant, the contact between caretaker and infant must be attuned to the child’s emotional states for self-regulation to develop best, and children seek relatedness through emotionally attuned mutual regulation.

Question 46

What is The Goal of Gestalt Therapy?

Answer 46

In one word, awareness.

Facilitating greater awareness in particular areas (awareness of content) and improving the ability to bring automatic habits into awareness (awareness of process).

Awareness of how they avoid learning from experience, of how their self-regulatory processes may be closed ended rather than open ended, and of how inhibitions in the area of contact limit access to the experience necessary to broaden awareness.

The focus is not on “curing”, but on helping patients to gain the self-support necessary to solve problems independently. As lived experience is central to growth, it takes precedence over explanation. Gestalt is therefore more of an exploration than an attempt to change behavior. The process/dialogue is emphasized over diagnosis.

Question 47

Time Disturbance

Answer 47

Occurs when an individual is not primarily centered in the present; or cannot contact the past; or cannot plan for the future (e.g., living in the past, or living in the present like you never had a past and didn’t learn from it).

The most common time disturbance is living in anticipation of what could happen in the future (as though the future was the now).

Question 48

The ‘What and How, Here and Now’ Method

Answer 48

Gestalt holds the dual focus of what the patient does, and how it is done (as well as a focus on the interactions between therapist/patient).

Now refers to this exact moment and starts with the current awareness of the patient. Exploring past experiences is anchored in the present (e.g., by determining what in the present field triggers this particular memory). Methods that bring the old experience directly into the present (rather than just recounting it) are preferrable.

Gestalt therapy orients more to the Now than any other form of psychotherapy.

Question 49

Awareness as a Continuum

Answer 49

Gestalt distinguishes between merely knowing about something, and owning what one is doing.

Merely knowing about something is the beginning of the continuum (i.e., the transition between something being out of awareness and then in focal awareness). For full awareness to be achieved, more detailed descriptive awareness must be allowed to affect the patient—and they have to be able to own it and respond in a relevant way; to know what is going on and how it is happening.

Awareness continuum is also sometimes used to refer to the flow of awareness from one moment to the next.

Question 50

Nonverbal Subtext in Gestalt

Answer 50

The information communicated by posture, tone of voice, syntax, and interest level.

Question 51

Experiment

Answer 51

The introduction of experiments can add to a patient’s feelings of inadequacy/self-rejection. Trying to get a patient to feel better may be interpreted by them as evidence that they are only acceptable when they feel good. The therapist should therefore make it clear that the experiments are merely experiments in awareness, and not criticisms of the patient’s current state.
Indeed, the patient’s knowledge and acceptance of self is a vital mode of change.

Question 52

Self-Disclosure

Answer 52

In Gestalt, therapists are both permitted and encouraged to disclose their personal experiences. Indeed, the therapeutic process is one of mutual phenomenological exploration.

Sometimes opening up and giving information about oneself as a therapist can help a client to feel more at ease in the therapeutic environment (i.e., sharing that you’re gay to a female client who has been sexually assaulted)

The therapist also surrenders to the interaction, to what emerges from it, and to the possibility of being changed by it. This sometimes requires the therapist to acknowledge having been wrong.

Question 53

The Breadth of Gestalt Therapy

Answer 53

Gestalt therapy probably has a greater range of styles/modalities within it than any other therapeutic system. It can be short or long-term, done with individuals or a group (typically group therapy is complementary to individual/couples therapy), or have any of a series of foci.

The commonalities are an emphasis on direct experience and experimenting, use of direct contact/active engagement and personal presence, and the “what and how, here and now”.

Question 54

Stages of Gestalt Therapy

Answer 54

E.F.S - Every Fool Sees

First Contact (focus on what is happening now, and what is needed now)
Sharpening Awareness (therapist helps patients to understand what feelings/needs are emerging when they tell a story; via reflective statements/guiding questions).
Evaluating the Client (therapist assesses the patient’s strengths and weaknesses, personality style, and self-support [robust vs. precarious]; and the therapeutic process is adapted to fit their needs)

Question 55

Focusing as a Mechanism of Psychotherapy

Answer 55

A typical intervention/experiment of focus would be “What are you aware of, or experiencing, right here and now?”

Sometimes patients interrupt ongoing awareness before it is completed, and a therapist may be able to identify this (signs include holding one’s breath or gritting teeth; or a change in expression angry look changing to a sad one without the new emotion being verbalized). The therapist may ask a client to “stay with it” and put words to the difficult emotion, or the feeling of wanting to run from it.

Question 56

Enactment as a Mechanism of Psychotherapy

Answer 56

Putting feelings into action, in the literal sense in couple’s therapy perhaps, or through role-play or the empty-chair technique.

Creative expression through journaling, art, movement etc., is a form of enactment used particularly with children.

Question 57

Mental Experiments, Guided Fantasy, and Imagery

Answer 57

Visualizing a past experience in the here and now can heighten awareness, sometimes more effectively than enacting can.

Imagery techniques can also be used to expand the patient’s self-supportive techniques (i.e., imagining a supportive mother when one does not have one). It can also be used to explore or express an emotion that might be difficult to verbalize.

Question 58

Loosening Techniques

Answer 58

Loosening techniques such as fantasy, imagination, or mentally experimenting with the opposite of what is believed can help to break down rigid patterns of thinking; to enable a consideration of alternatives approaches.

Question 59

Integrating Techniques

Answer 59

Integrating techniques call upon the patient to bring together cognitive processes that they don’t typically bring together or actively keep apart (splitting). An example would be joining the positive and negative poles of a polarity (“I love him, and I hate 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.

Question 60

Differing Models of Gestalt Group Therapy

Answer 60

Typically, such therapy starts with rounds/a check-in.

Model One: Participants work one-on-one with the therapist, while the other participants remain relatively quiet and work vicariously through them. This work is then followed by feedback and interaction with other participants, with an emphasis on how people are affected by what they witnessed.

Model Two: Participants talk with one another with emphasis on direct here-and-now communication between group members. This is similar to Yalom’s model for existential group therapy.

Model Three: These two activities are mixed amongst the group. The group and the therapist strike a balance between interaction and the one-on-one focus.

Question 61

Principles of Couples’ Gestalt Therapy

Answer 61

The participating couple usually begins by complaining and blaming each other. Hence, the focus is on calling attention to this dynamic, and highlighting alternate methods of communication.

What is behind the blaming will also be explored. Typically, one individual believes they are being shamed and blames the other to defend against the shame: without an awareness of its defensive function.

Circular causality (where one partner triggers a negative response in the other and so on) is a frequent pattern in unhappy couples. Blaming trigger shames –> shame triggers defense.

Embracing one’s actual experience is the first step towards being able to properly hear the other person and heal. Experiments to facilitate this including looking at one another and articulating one’s awareness, or completing sentences like “I resent you for…”.
The restoration of dialogue between the two is a sign of progression.

Question 62

The Complex Relationship between Gestalt and Research

Answer 62

One concern about the integration of Gestalt into research is that nomothetic/group data will be valued above the individual perspective (i.e., a person’s values, capacities, preferences, and experiences in a particular patient–therapist pair). Some researchers have noted how randomized controlled trials decontextualize the patient/individual, and bear no resemblance to the clinical reality of practicing Gestalt.

However, research models are continually being developed that are sensitive to the complexities of clinical work and can obtain evidence, especially of the medium- and long-term effects of clinical practice.

Question 63

Research’s Findings on the Therapist’s Impact

Answer 63

Repeated research has found that the particular therapeutic orientation of the practitioner is relatively insignificant compared with their experience, skill, and personhood (and that greater comfort within an orientation is associated with more positive outcomes).

Furthermore, in meta-analyses, researchers tend to find significant positive effects for the orientation that most closely matches their own allegiances.

Question 64

Common Factors of Successful Outcomes that Appear to Stretch Across Therapies

Answer 64

The most productive research endeavors typically are those which seek to identify the discipline’s “empirically supported principles of change”; and more specifically, core processes that apply to all forms of psychotherapy.

• Therapist acceptance.
• Therapist warmth.
• Therapist genuineness.
• High Quality Therapeutic Relationship (as/more predictive than method)
• Collaborative Communication [for developing organismic self-regulation] (Lyons-Ruth, 2006)
• Valuing the Here and Now (and the inseparability of emotion and thought)

Question 65

Laura Perls’ Relational Perspective

Answer 65

The therapist should present themself as an individual, not a therapist, to avoiding making the client fall into a certain role (i.e., that of the patient).

A relational foundation should be established, while keeping an eye out for client withdrawal.

“Therapy is about baby steps” – Silverman.

Question 66

Contact Styles

Answer 66

Styles of making connections with others.

Question 67

Deflection

Answer 67

Avoiding difficult topics by flitting to another.
This could occasionally be beneficial for connection because maybe you aren’t ready to deal with that topic yet/it’s too much for you at present.

Question 68

Egotism

Answer 68

A sense of being above; dismissing concerns through making oneself feel big and strong.

“Can’t be touched, Can’t be hurt”