PSY 245

CLINICAL PSYCHOLOGY-II

• Assoc. Prof. Dr. BAHAR BAŞTUĞ

• Clinical Psychologist
 Welcome
• This week’s focus is on Gestalt theory and
therapy.

• Gestalt theory and therapy were originally

developed by Fritz and Laura Perls.
Fritz Perls (1893-1970) and Laura Perls (1905-
1990)
• It is a highly experiential therapy. Perls (1969)
wrote:
– ‘‘Lose your mind and come to your senses.’’ (p.
69)

• This statement shows the physical and

experiential nature of Gestalt therapy.
• Gestalt Therapy isn’t to talk about one’s
experiences. Every moment of therapy is an
experience to confront. It’s goal is self-
awareness.
 Biographical Information: Fritz Perls
• Fritz was born in Berlin. He was a Jewish. His
older sister was killed by the Nazis.
• Because he failed the school, he had to leave
it. For a short time, he worked, then he
returned to school. He decided to study
medicine. During the world war I, he served as
a medical corpsman. He specialized in
psychiatry.
 Biographical Information: Fritz Perls
• In the 1920s, he began to psychoanalysis with
analysists, O. Fenichel, W. Reich and K.
Horney.

• He described psychoanalysis experience as

useless.
Biographical Information: Laura Posner
Perls

Laura was born to a wealthy German family. She

was fantastically bright and ambitious. She was
interested in modern dance, concert pianist,
obtained a doctorate degree in Gestalt
psychology and studied Existential psychology
with Buber.
 Biographical Information: Fritz Perls
and Laura Posner Perls
• Fritz and Lore met while working in Kurt
Goldstein’s lab in 1926.

• They were married in 1929.

• Together they formed a union. They produced

one of the most provocative personal change
strategies.
 Biographical Information: Fritz Perls
and Laura Posner Perls

• Not long after their marriage they fled the

Nazis with the clothes on their backs and
about $25, moving briefly to Amsterdam, then
to South Africa.
 Historical Context
Wilhelm Reich was the first analyst of Fritz.

• Reich’s psychotherapy focused on observing clients’

facial expressions and body positions.

• For Reich, libido was seen as a positive force or energy

characterized by excitement.
 Historical Context
• Fritz and Laura in South Africa for about 12
years.
– Fritz had a meeting with Freud that freed him
from the dogma of psychoanalytic thinking.
– During the South Africa days, Laura had two
daughters. She observed the children eating and
chewing behaviors.
 Historical Context
• Chewing, eating and digesting became
important themes in Gestalt theory.

• When people eat, they bite off what they can

chew. When they’re exposed to ideas, they
mentally chew it to digest the ideas. Mental
metabolism
 Historical Context
• The Gestalt Therapy Bible
– Gestalt Therapy: Excitement and Growth of the
Human Personality (1951)

• Fascism and World War II

Gestalt therapy was developed in the beginning
of World War II. Gestalt therapy has anarchistic roots.
– The anti-establishment or anti-authoritarian position
of Gestalt seems natural within the fascist context.
 Historical Context
• Due to the Apartheid regime in South Africa,
Fritz and Laura moved to NY City.

• They conducted workshops.

• Fritz fled from the increasing fascist trends in

the USA. He established a communal utopian
anarchy in Cowichan. He died in 1970.
• Laura Posner Perls wrote several chapters of F.
Perls’s first major work and introduced him to
Gestalt psychology. But she never received
much credit, her name didn’t appear on many
publications.
• At the 25th anniversary of the NY Institute for
Gestalt Therapy, she stated that:

«without the constant support from his friends,

and from me, without the encouragement and
collaboration, Fritz would never have written a
line.»
 Historical Context
• Gestalt Therapy’s Roots and Branches
– Gestalt therapy is an integration of several different
intellectual and historical forces:
• Psychoanalysis
• Developmental psychology
• Gestalt psychology
• Field theory
• Existential philosophy
• World War II, fascism, and anarchist rebellion
• Reich’s focus on body awareness
• Experiential learning during workshops and demonstrations
• Gestalt theory and therapy are a combination,
an integration, a human encounter, etc.

• It continues to develop: Yontef’s Relational

Gestalt Therapy (2010) and Emotion-Focused
Therapy (Watson, Goldman and Greenberg,
2011).
 Theoretical Principles

• Gestalt theoretical principles are praised and

criticized.
 Theoretical Principles
• Existential/humanistic and Gestalt Psychology
Foundations

– Individuals have self-actualizing potential.

– Experiences can activate this potential.

 Self-Actualization and Self-Regulation

Instead of self-actualization of existential/humanists,

Gestalt theory focuses on self-regulation.
– Self-regulation is based on self-awareness, and the
process looks like this:
• An initial state of equilibrium
• Disruption of equilibrium through emergence of a need,
sensation or desire: dis- equilibrium
• Development of awareness of the need, sensation or desire
• Taking actions
• Return to equilibrium
 An initial
state of
equilibrium

Taking dis-
actions equilibrium

awareness
of the
need,
sensation
 The Whole, Self-Regulating Person

The goal of treatment is to help the individual

become aware of entire self. All rejected or
undervalued parts are integrated into the
whole person. Gestalt therapy enhances
awareness.
• Therapist’s primary role is to help clients
become aware of their needs, sensations and
desires.
 Theoretical Principles III
• The Gestalt
– Gestalt is a German word. It means the unified
whole or complete form.

“THE WHOLE IS DIFFERENT OR GREATER THAN THE SUM OF

ITS PARTS.”

This idea goes back to Aristotle.

 Theoretical Principles
– Holism. Gestalt theory views mind-body as an
inseparable whole.

– It is a physical-mental-emotional theory. Gestalt

therapists comment on their clients’ physical
positions, postures, and gestures. Motor
movements represent emotional and cognitive
events.
 Theoretical Principles
• Phenomenology

– Gestalt therapists are interested in direct

experiencing in therapy. Clients are encouraged to
drop their baggage and biases and report their
direct experiences. Direct experiencing and
authenticity in therapy and life facilitates growth.
 Theoretical Principles
• Field Theory was described by K. Lewin.
– Individuals and the environment are together
within a field of constant interaction.

• Therapist is not separated from the field.

• The field is organized so the therapist and client explore
it together.
• Gestalt therapists work in the immediate, present, and
here-and-now field.
 Theoretical Principles
• The Figure-Ground Formation Process

– Everyone constantly shifts their cognitive or

perceptual focus. In Gestalt therapy, this is referred to
as the figure-formation process.

– This process is under your voluntary control. You may

choose to do something or you may choose to do
another one. You can’t have it both ways because
something has to be figure and something has to be
ground.
 Theoretical Principles
• I and Thou, Here and Now, What and How

These nine words briefly describe Gestalt

therapy (Yontef, 2010).
 Theoretical Principles
• I and Thou
– An authentic therapist-client relationship. They
work to develop and refine client self-awareness.
The therapist is an expert on the Gestalt change
process; the client is an expert on his or her own
experience. They are independent and responsible
for therapy process and success.
 Theoretical Principles
• Here and Now
– Immediacy or being present in the here and now.

– For Perls, the individual always brings everything

into the room- past, present and future. It’s all
accessible in the Now. The past can only be
accessed in the Now. The past is over and
unchangeable.
 Theoretical Principles
• What and How
– An emphasis on process over content; moment-
to-moment examination of what is happening and
how it’s happening.

– Gestalt therapists avoid using the question

«WHY». Question «Why» is viewed as promoting
intellectualization.
 Theoretical Principles
• Contact and Resistance to Contact

– The exchange of information between I-ness and

otherness.

– This is a perceptual process. We’ve made contact

through our senses.
 Theory of Psychopathology

– Healthy functioning is characterized by contact, full

awareness, full sensory functioning and
spontaneity. Psychological health is characterized
by a healthy boundary between self and
environment. A healthy boundary is one with both
permeability and firmness.
 Theory of Psychopathology
– Psychopathology can be viewed as a contact or
boundary disturbance. Symptoms arise because of
dysregulation in the boundary between self and
environment.
• It occurs when natural processes of contact,
excitement, self-regulation, and new learning are
disturbed.

• There are five different types of boundary disturbances.

 Theoretical Principles
• Boundary Disturbance Types
– Introjection
– Projection
– Retroflection
– Deflection
– Confluence
• Introjection : uncritical acceptance of other’s beliefs
and standards. A contact occurs and whatever
values and standards are associated with contact are
swallowed whole.
• Projection: one person projects his or her emotions
or traits onto others.
• Retroflection: someone turns back on him/herself
something s/he would like to do to another person.
• Deflection: a distraction designed to diffuse or
reduce contact or avoidance of contact.
Avoiding physical contact, using humor
excessively, talking about others instead of the
self.
• Confluence: there is a merging boundaries.
Not really knowing where one person stops
and the other begins.
 The Practice of Gestalt Therapy
• Polster identified three specific therapeutic
devices or processes:

1. Encounter

2. Awareness

3. Experiment
 The Practice of Gestalt Therapy
• Assessment Procedures and Training Guidelines
– Gestalt therapy approaches have historically
underused assessment and diagnostic processes
because:
• Existential-humanistic therapists typically avoid
assessments.
• Gestalt therapy was modeled by Fritz Perls during
workshops and retreats.
• There’s a focus on pushing people forward toward
growth.
• There’s a facilitation of self-assessment.
 The Practice of Gestalt Therapy
• Emphasizing Collaboration
– Recent developments in Gestalt therapy have
emphasized collaboration and the I-Thou
relationship.

– Informed consent is very important.

 Clinical Training Guidelines Based on
Goodness of Fit
• Goodness of fit between client and therapy is a strong
predictor of positive treatment outcome.

• The following clients may be poorly suited to Gestalt

therapy:

– Clients with depressive symptoms who are also highly

reactive or sensitive to feedback.
– Clients with depressive symptoms who also have
tendencies to externalize their problems (e.g., these clients
blame others or their environment for their depressive
symptoms).

– Clients who exhibit observable deterioration when

engaging in an expressive-experiential, emotionally
activating treatment.
Encounter: The Dialogic Relationship in
Gestalt Therapy
– The interaction between patient and therapist in a
present moment.

– Relational psychoanalysis and relational Gestalt

therapy hold a common view; both the therapist and
the client bring subjectivity into therapy, and neither
subjective view is considered inherently
authoritative.
• Gestalt therapists encourage clients to attend
to their moment-to-moment experiences in
session. The therapists creates a safe
therapeutic environment, so clients can
explore their experiences, enhance their
awareness, and engage in Gestalt
experiments.
 The Practice of Gestalt Therapy
• Awareness is Polster’s 2nd phase of Gestalt
therapy.
⁻ In Gestalt therapy self-awareness is fostered through
techniques requiring phenomenological articulation of
self-experience.
– Client’s resistance to contact was manifest physically or
muscularly.
– Gestalt therapists attend closely to client physical
movements, gestures, flushing, and other physical
manifestations of emotional and psychological processes.
 The Practice of Gestalt Therapy
• Body Feedback
– Gestalt therapists notice client’s nonverbal
behavior
• Tightness in a client’s jaw
• Repeated opening and closing fits
• The movement of one hand to the neck several times
• Grimacing or puckering of the lips
• Redness or flushing of the neck beginning to emerge
 The Practice of Gestalt Therapy
• Gestalt therapists attend closely to client’s
Language and Voice Quality
– Moving client from using “it” or “you” to “I.”
«When you are talking about yourself it can be
helpful to use the word «I». Are you willing to try
that on?»
– Moving clients from talking in past tense to
present. When client ‘s talking about a story
happened in the past, client is encouraged to
speak as if the event is happening right now.
The Practice of Gestalt Therapy
– Having clients transform their questions into
statements.
«I want to do.....» instead of «Would you mind....?»
– Noticing when clients use passive language.
« I don’t know.», «Maybe».....
– Noticing client voice tone and quality. The changes
in client voice may reflect unfinished business or
any emotions.
 The Practice of Gestalt Therapy
• Unfinished Business
– Gestalt therapy is a here-and-now therapy that’s all
about there and then. The whole point is to get
clients to bring their baggage or unfinished business
out of their old cupboard and into the present
moment. When that happens, change is possible.
 Specific Gestalt Experiments

– The third phase of Gestalt therapy involves

application of Gestalt therapy experiments: a
device that creates new opportunities for acting in
a safely structured situation.

– The Gestalt experiments are useful treatment

method. But, they can be abused.
 Specific Gestalt Experiments
– Gestalt threapy is not technique-driven.
– Techniques are devices to facilitate awareness and
personal growth in the long run.

– Techniques, inappropriately used, can be fake and

antitherapeutic.

– They should be used within the context of an

I-Thou relationship.
 Specific Gestalt Experiments
• Staying with the Feeling
• I Take Responsibility For. . .
• Playing the Projection
• The Reversal Technique
• The Exaggeration Experiment
 Staying with the Feeling

• Gestalt therapy emphasizes on immediate

feelings. Feelings are to be faced and confronted,
not avoided. Therapist encourages clients to stay
with feelings they’re avoiding. Techniques:
 Staying with the Feeling
– Therapists repeatedly ask questions: “What are
you aware of now?” or “What are you noticing
inside yourself right now?”

– Clients are instructed to give voice to their feelings

and sensations (e.g., “Let your anxiety have a
voice and let it speak for a while”).
 Staying with the Feeling

• They are encouraged to act out their feelings in the

here-and-now. Gestalt therapists use pillow for this
reason. They often had clients pull on and “stretch”
the pillows when they felt inner tension and conflict.
Perls believed that by acting out their feelings
outside of themselves, his clients would be able to
identify and reintegrate their uncomfortable feelings.
 I Take Responsibility For. . .

– «I’m bored and I take responsibility for my

boredom.»

– This technique is especially useful when clients are

externalizing symptoms.
 Playing the Projection
– Group therapy

– In a group, if one member thought another group

member was too critical of other members,
therapist might say, «Try that on. Stand up and be
critical of everyone here. Go around the room and
criticize everyone.»
 The Reversal Technique
is designed to get clients in touch with parts of
themselves they deny or ignore. To help clients
save their complete selves, this technique is
used.

This tecnique is often employed in group

therapy.
The Exaggeration Experiment
Exaggerate subtle nonverbal behaviors.

Exaggerating subtle nonverbal behaviors helps

clients reclaim their entire self. It can increase
the meaning of behaviors that may have been
outside awareness.

«Make that motion again, only make it bigger.

What are you aware of now?»
The Empty Chair Technique or
Dialogue Experiment
is the best known of all the Gestalt experiments.
There are two different ways to use the empty-
chair dialogue in therapy:

1. Working out an internal conflict

2. Working out interpersonal conflict

1. Working out an internal conflict: switch seats
when playing two different parts of self. The
client is instructed to play two different parts of
self. Typically, this approach to the empty chair
results in the client taking on the “top dog” and
“underdog” polarities.
The dialogue emerges from an inner conflict.
 The Empty Chair Technique or
Dialogue Experiment

According to Perls, one of the most frequent

splits in the human personality is the topdog-
underdog split. The topdog is known as the
superego or the conscience. The topdog is
righteous. The topdog always says you should
and it threatens.
• The underdog looks for the different method.
The underdog says, I promise, or I agree, if
only I could. The underdog is a very good
frustrator. The top-dog is an early parent
figure, under-dog is the child.
 The Empty Chair Technique or
Dialogue Experiment
The purpose of the empty-chair technique is to
help clients break out of being trapped. As the
empty-chair dialogue proceeds, polarization
occurs, but a new approach is used to move
toward an internal resolution. The conflict
represents unfinished business. By bringing the
unfinished business into the here and now, the
empty-chair experiment provides an
opportunity to move toward resolution and to
finish the unfinished business.
The Empty Chair Technique or
Dialogue Experiment

2. Working out interpersonal conflict:

clients act out a contemporary life
conflicts. The dialogue emerges from an
external conflict.
The focus is on monitoring, reflecting and
coming to terms with the client’s
emotional experiences.
 The Gestalt Approach to Dream Work
For Perls, the dream is an existential message.
He believed that the dream is the royal road
to integration.

Dreams are to be experienced, not interpreted.

The dreamer is 100% responsible for all dream
images. If your client dreams of a monster
murdering an innocent victim, both the
monster and the victim are considered
manifestations of the dreamer.
There are four main steps to Gestalt dream work:
• The dreamer tells the story of the dream.
• The dreamer “revives” the dream by changing the
language: past tense to present tense.
• The dreamer becomes a director and organizes the
dream as a play, moving around, setting the stage,
and describing where everyone is and where every
object is.
• The dreamer then acts out the dream, always using
the personal pronoun “I” to enhance identification
with each object and character in the dream.
• The dreamer owns the dream, whether he
wants to or not.

• The therapist doesn’t interpret. Interpretation

is the job of the client.
 Cultural and Gender Considerations
• Can be compatible with multicultural work.

• Empty chair technique might help bicultural and

culturally diverse clients living in the White-
dominant culture deepen their self-awareness
and live more authentically.

• But the emotional focus can be inconsistent with

collectivist cultural values and with cultural rules
about emotional expression.
 Cultural and Gender Considerations

• Gestalt therapy may be easier for women than

men. Female clients may be more interested
in and comfortable with an intense emotions.
 Evidence-Based Status
• Perls was against research.

• Old research shows Gestalt therapy has a

moderately positive effect.

• Research suggests Gestalt therapy is less

effective than cognitive and behavioral
treatments.
 Concluding Comments

• Gestalt therapy is about much more than just

isolating sexual and aggressive impulses, or
altering reward schedules or errant cognitions.
Gestalt therapy is about living life to the
fullest.