Group Work in Gestalt Therapy

Introduction

Group psychotherapy is a type of therapy for psychoanalysis in which multiple therapists can be engaged in treating a group of clients as a collective lot. The group format is adopted in the measure of treating the patients who are encouraged to seek therapy in groups. The types of therapy which can be delivered in this format include cognitive behavioral therapy, interpersonal therapy, gestalt therapy as well as other therapies which seek to explore and examine group interaction and relationship building by individuals under the group process. The objective of group psychotherapy is to determine the psychodynamics pertaining to groups to collective individuals, and the impact group has on the performance of an individual. Some of the aspects of individual performance which are analyzed pertain to anger management, relaxation training, social skills training as well as conducting expressive therapies to increase the social and interaction skills of the group therapy participants.

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The paper discusses one of the group therapies in detail, gestalt therapy. The gestalt therapy theory is elaborated upon in the following sections and the applications of the gestalt theory are explored. The process of Gestalt therapy examines and the principles of the therapy as they apply to the process are discussed. Additionally research conducted in the field of group psychotherapy, as well as Gestalt therapy, are reviewed. The personal development of the patients and participants in Gestalt therapy is also examined along with the benefits of the therapy and its resultant effects. The limitations and multicultural considerations pertaining to the Gestalt theory are also highlighted.

Gestalt Theory

Gestalt therapy is a form of psychotherapy that is still in the experimental stage. The therapy focuses on the momentous experience of the individual undergoing therapy as well as the relationship of the client and the therapist. The environments, as well as the contexts in which the therapy takes place, are also accounted for and the adjustments that the client makes in order to be more comfortable and adapt to the environment are noted in the therapy.

The initiators of the therapy were Perls & Perls and Goodman. They initiated the therapy by experimental technique in California by taking on test subjects in groups.

Gestalt therapy presents the view that human nature is divided into four aspects. The biological field, the entity of the organism, contact, and relationships as well as the whole making capability. The biological field theory depicts that all organisms exist in environments that and therefore have effects on each other. No organism is independent of the other; therefore the degree of reliance on each other on part of the organisms is strong. Similarly, none of the organisms is completely powered from within itself or from an exterior source. Instead, all organisms are coexisting to develop and evolve to sustain themselves. The theory of the organism depicts however that every organism has a goal to seek growth towards the phase of maturity. The organism-based dimension which is highlighted in Gestalt therapy pertains to physical, social, cognitive as well as interpersonal, spiritual, and economic dimensions. The concept of contact therapy provides that contact and relationships are the lifeblood of growth for people. The contacts also allow the organism, or the person to adjust their interaction with the environment and adapt themselves to the changes taking place in the environment. Aside from this the Gestalt therapy also depicts that humans as an entity are whole makers through bodily, perceptual as well as cognitive, and behavioral functions. They tend to change their behavior and learn from the mistakes that they make.

The basic principles of Gestalt therapy theory specifically pertain to the approach human takes for change. This change can occur as a result of contact or even self-regulation. According to the theory, humans crave and live in contact with others. They have an inbuilt obsession with building relationships and being dependent on these relationships through contacts. In the context of the human organism and contact is “the awareness of, and the behavior toward, the assimilable; and the rejection of the unassimilable novelty” (Perls et al., 1951/1994, p.230). To have the opportunity for functional and existential contacts in the field, as well as the strength to repudiate and/or sustain unhealthy contacts, is the quintessence of growth and change.” (Kirchner).

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In relation to contacts, interruptions to contacts also exist which include, confluence, introjection, projection as well as retroflection. These depict false identification on part of the human organism to others, for portraying oneself differently to others, or for hiding the true identity and nature of the human organism. Through self-regulation, however, the human organism controls the equilibrium for contact. Moreover, the Gestalt therapy theory also depicts that humans can adapt to changing environments through self-regulation.

Gestalt therapy theory also focuses on exploring phenomenology which, in terms of philosophy, is the direct and instantaneous response of an individual to stimuli in the environment. The presence of the clients in the Gestalt therapy theory is not important; instead what is important is the awareness of their process. Awareness is the core function of the Gestalt therapy theory. “Awareness is always intentional and occurs in the organism-environment field. Characterized by contact, sensing, excitement, and Gestalt formation it is a subjective experience, a being in touch with one’s own existence inclusive of all senses at a given moment. It is more than the pure thought of a problem but is integrative, implying wholeness, allowing for appropriate responses to a given situation in accordance with one’s needs and the possibilities of the environment. Different awareness can come to the foreground at different times. It is the person’s awareness of his/her complexity within and inclusive of the field that manifests itself in uninterrupted organismic self-regulation, meaningful growth, and long-term change. Consequently, awareness is integral to dialogical relations.” (Kirchner) Other principles on which the Gestalt Therapy Theory is based include the principle of dialogue, through which individuals communicate and establish contact with each other, the here and now focus which separates the bearings of past and future for the human organisms and allows them to make sense of the world. Another principle that is the basis of the Gestalt therapy theory is the concept of self whereby it is treated as a process that is an agent of growth, dynamicity as well as experiences of different relations.

The objective of the therapy is to enable an individual to be able to regulate and control their repose to the environment and manage the interactions he/ she may have with other human organisms in the environment. “The ultimate aim of Gestalt therapy is to assist the client in restoring (or discovering) his/her own natural ability to self-regulate as an organism and have successful and fulfilling contact with others (environmental others), as well as with disowned aspects of oneself (internal others). That allows one to be able to cope creatively with the events of one’s life and to pursue those goals which seem good and desirable to oneself. Through awareness of and experimentation with bodily sensations, emotional responses, desires, and cognitive assumptions, the clients’ range of choices about how they live their lives, especially how they engage with others and themselves, will be enhanced. The question of foremost interest is HOW a person is creating his/her life in a certain way not WHY they came to be as they are. Accepting someone’s experiential validity is key rather than manipulating occurrences and outcome.” (Kirchner)

Essentially the Gestalt therapy is focused on what is happening with a human organism as opposed to what should be happening. The investigation of the matter in psychotherapy is for the instantaneous reactions of the client, emphasizing what effect the contact with relations and stimuli in the environment has on the human organism. The process of Gestalt therapy is that of awareness through which perception feelings and actions are comprehended and analyzed. These elements are forcefully regarded as separate from the elements of interpretation, explanation, and judgment based on previous or old attitudes. The goal of Gestalt therapy as mentioned above is to enable to client to realize what he/ she is doing and become aware of how they can influence the environment, regulate themselves to change their actions. As a result, the decisions they make are based on the current status of the environment and the situation, instead of the history which leads up to the action being taken by the client. This is an advantageous technique for drug abuse, alcohol abuse, and couples counseling.

Methods of Gestalt Therapy and Research on the Approach

The goal of Gestalt therapy is identified as bringing about change in the people. This change is mainly brought about by employing contact between the environment and the clients. Almost all Gestalt theory-based therapists take the approach of contact to bring change in the client’s behavior and actions. The method however in which the therapy is imparted to the clients is divided into five categories. These include the therapeutic relationships, the phenomenological method, employing an experimental technique, cognition as well as a wilder field of operation.

In the therapeutic relationship technique, the therapist aims to bring change in the willingness and the capability of the client through the creation of a relationship of dialogue. The therapist notes the verbal as well as the nonverbal behavior of the client in the setting as a component of the experiences, awareness, and beliefs of the client. The phenomenological method tends to assess the attitude of the client with the therapist encouraging the client to what they are and how they operate and fit into the world. IN the experiment technique, the therapist provides the client with a customized situation that is focused on enhancing the experience of the client in the here and now. The process encourages the client to live through an event, instead of simply talk about it to the therapist. The work with cognition method involves encouraging the client to identify and verbalize the errors and the faults in them, or any distortion or ambiguity that they face in life. The input is used by the therapist to determine the direct impact on the person’s experience, through patterns as well as contact relations and beliefs.

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There is limited research and material available on Gestalt therapy and theory as the researchers claim the therapy is highly complex and diverse for them to conduct explorative and detailed research. However, the research which is available indicates that the Gestalt therapy approach is still in the experimental stages despite being launched in the 1940s. “Simkin (1978) reported that Gestalt therapy was not even recognized by the Psychological Abstracts as separate from Gestalt psychology until 1973, and Harman’s (1984) conclusion of a review of Gestalt therapy research literature confirmed the scarcity of quality research in the field. A growing, yet still small number of practicing Gestalt psychotherapists and theoreticians started to counteract this state of the affair but the published research in support of the Gestalt approach remains far from being competitive.” (Kirchner) & “Recent work by Paivio and Greenberg (1995), Greenberg, Rice and Elliot (1993), and Greenberg, Elliot, and Lietaer (1994) are moderate beginnings of outcome studies that show the effectiveness of Gestalt therapy. Additional findings reported Gestalt therapy bringing about significant positive changes in body image (Clance, Thompson, Simerly, & Weiss, 1994), the effectiveness of the empty-chair dialogue versus desensitization processes (Johnson & Smith, 1997), favorable Gestalt therapy outcome compared to psycho-education of unfinished business (Paivio & Greenberg, 1995), and the efficacy of Gestalt therapy with ‘hard-core’ criminals (Serok & Levi, 1993).” (Kirchner).

Comprehensively, the research indicates that the Gestalt therapy theory can be used by the therapists to aid the clients by changing and modifying their negative and erroneous behavior through a specific target strategy. Moreover, the therapy can be used to launch the clients into taking actions that enable them to seek closure for unfinished businesses that have a profound effect on their psychics.

Application of Gestalt Theory

Gestalt therapy has been mentioned in literature as being effective but complex for the therapists as well as the clients. To practice the therapy, the therapists are reduced to practice on themselves due to the lack of volunteers available. Moreover, the complexity of the technique has also led to the therapy becoming obsolete amongst the therapists. Despite the complexity, the effectiveness of the technique has provided some significant venues for us to target human behavior through Gestalt therapy. “Although the Gestalt school fell out of favor due to its descriptive rather than explanatory nature, it permanently changed our understanding of perception. For the radiologist, such fundamental Gestalt concepts as figure-ground relationships and a variety of “grouping principles” (the laws of closure, proximity, similarity, common region, continuity, and symmetry) are ubiquitous in daily work, not to mention in art and personal life. By considering the applications of these principles and the stereotypical ways in which humans perceive visual stimuli, a radiology learner may incur fewer errors of diagnosis.” (Koontz & Gunderman, 2008).

Gestalt therapy has been used by therapists on terminally ill patients and their families to limit their psychological distortion and target the specific actions which aggravate their suffering. “Gestalt therapy, a particular type of psychotherapy, draws on existential and various Eastern philosophies and aims to enable the individual to seek his or her own solutions to personal problems. Literally translated as ‘whole’, Gestalt focuses the individual to appreciate and experience the present.” (Jones, 1992) In another study, one conducted by Nelson and Groman on the neurotic verbalizations and the exploration of the Gestalt therapy assumption, a scoring system was developed. This scoring system was made reliable, objective as well as focused on specific verbal behaviors to target behaviors of the clients subject to avoidance. For the purpose of the experiment verbal samples were attained for a sample population of thirty college students of the female gender. These females were previously ranked in the order f the neuroticism scale as set by Maudsley. Through the study “the expectation that psychologically stressful questions would result in a significantly greater number of avoidant verbalizations was confirmed. Contrary to another expectation, no significant correlation between neuroticism as measured by the MPI and the total number of avoidant verbalizations uttered by the Ss was found. Results were interpreted on the basis of the Gestalt Therapy theory of personality.” (Nelson & Groman, 1975).

While Gestalt therapy is one of the group psychoanalytical therapy, it tends to offer a unique proposition of results that is significantly different from those offered by the traditional techniques for group psychotherapy. A study was conducted by Shuger and Bebout which analyzed the differences which were present between the samples for the Gestalt technique and the traditional psychoanalytical technique. The differences were examined in terms of the background, attitude, and the values of the samples as well as the experience they had. A total of 32 clients were incorporated into each phase segmented by the nature of the technique. “First, there were no significant differences on any dependent measure between the beginning and advanced clients of either school. Second, gestalt and psychoanalytic clients differed significantly from each other on all but 2 of our 14 dependent measures when time-samples were combined. Gestalt and psychoanalytic clients were different in experiential focusing style, impulse-affect expression, and in symptoms, but these differences existed from the very beginning of therapy.” (Shuger & Bebout, 1980) The results depicted that clients tend to prefer the therapy process which is best suited to their personality and their style of living. As a result, the interaction in their choice of therapy is mutually reinforced. The results, therefore, provided that specific types of techniques could be used to target problems of psychosis in different types of people based on their personalities and lifestyles.

Frew comprehensively summarizes the nature of the Gestalt therapy theory by stating that “in Gestalt therapy, transference is viewed as a contact boundary disturbance which impairs the patient’s ability to accurately perceive the present therapy situation. The boundary disturbances in Gestalt therapy most closely related to the analytic notion of transference are projection, introjection, and confluence. In Gestalt group psychotherapy, group members interfere with the process of need identification and satisfaction by distorting their contact with each other through projecting, introjecting, and being confluent. The Gestalt group therapist uses interventions directed to individuals and to the group to increase participants’ awareness of these boundary disturbances and the present contact opportunities available to them when these disturbances are resolved. In formulating interventions, the leader is mindful of the function of boundary disturbances to the group-as-a-whole as well as to individuals.” (Frew, 1990).

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When it comes to Gestalt therapy theory the therapists tend to have discretion on their hands for the experiment, in terms of how it should be conducted and which of the diverse techniques available can be utilized. The therapists have it as their choice to modify the treatments to make them more customized to suit the clients and patients being entertained with the Gestalt techniques. Through the choice option, the therapist is made responsible for the treatment he imparts on his clients which makes it crucial for the therapists to have a sound background in psychotherapy. Moreover, even the participants are encouraged by the therapists to experiment with new Gestalt techniques to explore which suits them best. “Gestalt therapy can be used effectively with any patient population that the therapist understands and feels comfortable with. If the therapist can relate to the patient, the Gestalt therapy principles of dialogue and direct experiencing can be applied. With each patient, general principles must be adapted to the particular clinical situation. If the patient’s treatment is made to conform to “Gestalt therapy,” it can be ineffective or harmful. A schizophrenic, a sociopath, a borderline, and an obsessive-compulsive neurotic may all need different approaches. Thus, the competent practice of Gestalt therapy requires a background in more than Gestalt therapy. Knowledge of diagnosis, personality theory, and psychodynamic theory is also needed.” (Yontef, 1993).

It has also been observed that Gestalt therapy is most successful with clients who are overly socialized or depict traits of being restrained or constricted. More specifically anxious, phobic well as obsessive-compulsive and depressed patients are best treated through Gestalt theory therapy. “Gestalt therapy has been successfully employed in the treatment of a wide range of “psychosomatic” disorders including migraine, ulcerative colitis, and spastic neck and back. Gestalt therapists have successfully worked with couples, with individuals having difficulties coping with authority figures and with a wide range of intra-psychic conflicts. Gestalt therapy has been effectively employed with psychotics and severe character disorders.” (Yontef, 1993) Literature is also available on research pertaining to the use of Gestalt group therapy on clients suffering from alcohol abuse problems. “The Gestalt approach with alcoholics is different from other, traditional approaches. Its emphasis on growth, awareness, and self-support is aided through some simple guides. Several guides are suggested which have been used with this population and specific examples from therapy are provided to show how they were used and what the effects maybe.” (Boylin, 1975) Similarly, post-traumatic stress is also being targeted through the approach of Gestalt therapy. In this case, the EMDR technique which is the desensitization of the eye movement and its reprocessing is used. Capps in his “article reports three case studies of couples in which EMDR is combined with Gestalt therapy in a single session to resolve relational trauma effects, increase empathy and awareness in the supportive partner and deepen intimacy within the couple” (Capps, 2006).

As mentioned earlier, the Gestalt therapy approach can be used by therapists to decrease anxiety amongst clients. An application of Gestalt therapy for anxiety control and reduction was apparent in a study conducted Shraga by in which the clients taken in were students. The study pertained to aiding and assisting the students to organize and handle their levels of stress in different situations. The students were taught to reduce body stress by exercising and relaxing through different breathing and body movements. Similarly, they were also taught to differentiate the dimensions of time and realize which things are important for them to focus on in a short period of time.

Effect of Gestalt process on Personal Development

The Gestalt therapy process is specifically used by therapists to change the behavior of people, by making them aware of their attitudes, and actions. The Gestalt therapy process is very complex for the clients to understand, as a result, there is a limited number of volunteer clients who subject themselves to this therapy. The therapists are therefore forced to conduct the Gestalt therapy on themselves in the initial phase of their careers to master the practice of the therapy analyze the analogies and discrepancies they might be facing in their life as well. This is the reason why Gestalt therapy is said to enforce personal development on the client or participants. “Gestalt therapy integrates the body and mind factors, by stressing awareness and integration. Integration of behaving, feeling, and thinking is the main goal in Gestalt therapy. Client’s are viewed as having the ability to recognize how earlier life influences may have changed their lives. The client is made aware of personal responsibility, how to avoid problems, to finish unfinished matters, to experience things in a positive light, and in the awareness of now.” (Gestalt Therapy).

The effects of the gestalt therapy were apparent on the participants in a study conducted by O’Leary, Sheedy, O’Sullivan, and Thoresen. “The study investigated the effects of a gestalt therapy group with older adults. A total of 43 adults, 65 years or older, were randomized into treatment and assessment control groups of 22 and 21 respectively. ANCOVA results indicated that group therapy participants reported less anger control and more overall expression of anger than the control participants. In addition, they were significantly more agreeable and less hostile and more clear-headed, and less confused at the end of the group. These findings were supported by reported emotional changes. Younger group participants were significantly more composed and less anxious than younger control group members. Qualitative results further illustrated this reduction in anxiety. Participants significantly increased their level of clear-headedness and were less confused. Qualitative evidence also illustrated their clear-headedness and agreeableness. The exploratory analysis illustrated substantial learning about oneself by group participants.” (O’Leary et. al, 2003).

The self principle in the Gestalt theory provides for the analysis of oneself amongst the clients that enable them to identify the errors in oneself and the discrepancies which might be present in one’s personality in the form of obsessive-compulsiveness, strange and damaging behavior as well as addictions. “Gestalt therapy, by contrast, regards self-criticism as an aspect of the self which must be recognized and then integrated with other parts of the self. In this therapy, the values of emotional experiencing, subjectivity, and the complexity of personality are paramount.” (Safran & Messer).

The therapeutic counseling of Gestalt is aimed at completing the unfinished business of the clients by exploring the present experience. The here and now principle tends to analyze the momentous experience of the clients which focuses on the current problems of the individual instead of the past ones. This results in a more accurate personal development for the clients.

Aside from this the Gestalt therapy addresses, many different issues which faced the clients in the form of mind, intelligence, body as well spirit of the client.

Gestalt therapy is applicable to anyone and can be sought by clients who suffer from a crisis at any point in their life. The therapy therefore can be used as a tool for the personal development of the clients. The emphasis present in the therapy is to encourage the clients to be aware of their feelings, thoughts as well as behaviors that affect them on a momentous basis. This provides room for the personal development of the client by portraying to them the specific problems that they may be facing which affect their behavior. The clients can then take action in terms of removing these elements which influence their behavior in a negative manner and develop their personality. Personal development is applicable for both the client as well as the therapist.

“Gestalt Therapy regards the personal development of trainers as quintessential to the practical application of its theory. This principle is evident in all reputable Gestalt training programs (GANZ), placing personal development as central importance within their curriculums. Gestalt therapy is quite unique in this respect; with the therapist having to ‘walk the talk’ of self-awareness and authenticity.” (‘What is Gestalt Therapy’).

Gestalt Therapy provides advantages for the therapists as well as the client in terms of the results delivered. The therapy sessions are easy to set up in individual session forms as well as in the form of a group session. The appointment times for the therapy can be kept flexible by the therapist and the client makings it convenient for both. Similarly, the payment for the therapy can be negotiated by the therapist and the client while the space required for the therapy is usually not very large. Aside from this the first-time clients to a Gestalt Therapy session are less intimidated as they still consider the therapist as a stranger. For more experienced clients however the sessions can be very intimidating.

Gestalt therapy is one of the pioneer techniques which involve innovative development of psychotherapy theory to aid and change the behavior of human organisms. However, despite the success of the theory and the therapy, there are significant risks that are associated with Gestalt therapy. These risks pertain to abuse of power on part of the therapist. The therapist is highly involved in the sessions with the clients and therefore can abuse the power he holds over the client for material, power, or personal gain. Aside from this increased responsibility falls on the therapists due to their position in the therapy which requires, them to be adequately learned, trained, and experienced in the technique. “Gestalt therapists are very active and directive within the therapy session and therefore, care must be taken that they have characteristics that include sensitivity, timing, inventiveness, empathy, and respect for the client. These characteristics, along with the ethical practice, are dependent on the skill, training, experience, and judgment of the therapist. The intensity of the therapy might not be suitable for all patients, and even disruptive for some, despite the competence of the therapist. In addition, there is a lack of monitored, scientific research evidence supporting the effectiveness of Gestalt therapy” (Kirchner). In some cases however the patients are scared of venturing into Gestalt therapy due to the high levels of intensity and involvement which are required.

Limitations of Gestalt Therapy

The limitations that are presented by Gestalt therapy include the fact that the therapy does not have a clearly defined role and theory for the development of human organisms. There is limited research and development conducted on the topic which tends to put a constraint on the application and the utilization of the theory. “Knowledge of conditions that are necessary for healthy development could be expanded to how human development accounts for contact change over the entire life of the human organism. Not having those constructs available leaves the therapist theoretically unsupported of what is most effective in the therapeutic process with clients who are afflicted by certain kinds of developmental damage and/or deficiencies. There have been modest attempts undertaken by Gestalt therapists to change this, and they point towards promising future additions.” (Kirchner) Aside from this the critical also argue that the Gestalt theory is limited in terms of its relation to psychoanalytical disorders of a much serious nature. It can be rendered useless when faced with personality disorders, as well as a psychological dysfunction. Moreover, in acute cases where mind alternating and modifying agents might be required in the treatment of the patients, Gestalt therapy is rendered impotent for use by the therapists. Another limitation that exists against Gestalt Therapy is that the Therapist has excessive control over the session, and has the power to abuse this responsibility. They can involve personal issues in the therapy sessions which can affect the results of the session in a negative manner for the clients.

One of the main aspects of the Gestalt theory is that it takes into account the effects that the environment has on a human organism. This can turn against the therapy as multicultural considerations have to be taken into account by the therapists. The lives of the clients are impacted by many elements both internal and external in nature. These elements have to be accounted for. Moreover, since the therapist assumes a non-judgmental role in the therapy session pertaining to Gestalt theory, the client is the one who decides the results and the effectiveness of the therapy sessions. This can be ambiguous and overwhelming for the client who is inexperienced with Gestalt therapy. Moreover, each client has unique contacts, social interactions, and interfaces with the environment. This results in a unique and customized session for each separate type of client which requires extensive experience and knowledge on part of the therapist.

Conclusion

It has been established that very little research and explorative studies are present on the subject of Gestalt Theory due to the nature of the theory and the expertise required for the research to be undertaken. However, the research which was available has revealed that Gestalt therapy theory is unique in terms of its application, its use in context with psychoanalysis. The therapy can be employed by therapists to enforce the clients to foray into themselves and identify the problems which are affecting their actions and behavior negatively/. These problems like addition, disengagement, and depression can be solved by personal development initiated on part of the client.

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