GESTALT THERAPY

GESTALT THERAPY
Frederick (fritz) Perls 1893-1970
-originator and developer of Gestalt
-In 1916 he joined the German Army and served as a medic in World
War I.
-After the war Perls worked with Kurt Goldstein at the Goldstein
Institute for Brain-Damaged Soldiers in Frankfurt.
-he met wife, Laura, who was earning her PhD with Goldstein.
-Perls and several of his colleagues established the New York Institute
for Gestalt Therapy in 1952.
Laura Perls (1905-90)
-was born in Pforzheim, Germany, the daughter of well-to-
do parents.
-Laura already had a rich background when she met Fritz in
1926 and they began their collaboration, which resulted in
the theoretical foundations of Gestalt therapy.
-Laura made significant contributions to the development
and maintenance of the Gestalt therapy
- Gestalt is an approach that focuses on the here and now,
the what and how, and the I/Thou of relating.
- holistic approach
- examines the present situation
- focuses on process
- lively promotes direct experiencing
 Key Concepts
View of Human Nature

- Rooted in existential philosophy, phenomenology and field

theory (organism must be seen in its environment)
- Authentic change occurs more from being who we are
than from trying to be who are not --- paradoxical theory of
change
Some Principles of Gestalt Therapy Theory

Holism
All nature is seen as a unified and coherent whole
Field Theory
Asserts that the organism must be seen in its environment,
or in its context, as part of the constantly changing field.
The Figure-Formation Process
It describes how the individual organizes experience from
moment to moment.
The Now

Phenomenological inquiry involves paying attention to what

is occurring now.

-”What is happening now?” “What is going on now?” “What

are you experiencing as you sit there and attempt to talk?”
“What is your awareness at this moment?”

Gestalt therapists recognize that the past will make regular

appearances in the present moment.
Unfinished Business

Are manifested in unexpressed feelings such as resentment,

rage, hatred, pain, anxiety, grief, guilt and abandonment.

Contact and Resistances to Contact

Effective contact means interacting with nature and with

other people without losing one's sense of individuality.
Polster and Polster (1973) describe five different kinds of contact
boundary disturbances:

Introjection is the tendency to uncritically accept others’

beliefs and standards without assimilating them to make them
congruent with who we are.

Projection disown certain aspects of ourselves by assigning

them to the environment.
 Retroflection consists of turning back onto ourselves what
we would like to do to someone else or doing to ourselves what
we would like someone else to do to or for us.

Deflection is the process of distraction or veering off so that

it is hard to maintain a sustained sense of contact.

Confluence involves blurring the differentiation between

the self and the environment.
 The Therapeutic Process
Therapeutic Goals

Assisting the client to attain greater awareness, and with it,

great choice.
Through a creative involvement in Gestalt process, Zinker
(1978) expects clients will do the following:

- Move toward increased awareness of themselves

- Gradually assume ownership of their experience
- Develop skills and acquire values that will allow them to
satisfy their needs without violating the rights of others.
- Become more aware of all of their senses
- Learn to accept responsibility for what they do, including
accepting the consequences of their actions.
- Be able to ask for and get help from others and be able to
give to othersa
Therapeutic Function and Role

The therapist’s job is to invite clients into an active

partnership where they can learn about themselves by adopting
an experimental attitude toward life in which they try out new
behaviors and notice what happens.

Gestalt therapists focuses on paying attention to client’s

body language. Moreover, on the relationship between language
patterns and personality.
 Here are some examples of aspects of language that Gestalt
therapists might focus on:

“It” talk. When clients say “it” instead of “I,” they are using
depersonalizing language.

Questions. Gestalt counselors often ask clients to change

their questions into statements.
 Language that denies power. Some clients have a tendency to deny
personal power by adding qualifiers (e.g., “maybe,” “perhaps,” “sort of,” “I
guess,” “possibly,” and “I suppose” or disclaimers to their statements.

Listening to clients’ metaphors. Examples are, “It’s hard for me to

spill my guts in here.” “I feel like I have a hole in my soul.” “I need to be
prepared, in case someone blasts me.”

Listening for language that uncovers a story. Polster (1995) reports

that clients often use language that is elusive yet gives significant clues to a
story that illustrates their life struggles.
Client’s Experience in Therapy

1. Discovery. Clients are likely to reach a new realization

about themselves.

2. Accommodation. Involves clients’ recognizing that they

have a choice.

3. Assimilation. Involves clients’ learning how to influence

their environment.
 THERAPEUTIC TECHNIQUES AND
PROCEDURES
The Experiment in Gestalt Therapy

Experiments - grow out of the interaction between client

and therapist, and they emerge within this dialogic process.
- experimentation in Gestalt therapy is a collaborative
process with full participation of the client. Clients test an
experiment to determine what does and does not fit for them
through their own awareness
Client’s Experience in Therapy

1. Discovery. Clients are likely to reach a new realization

about themselves.

2. Accommodation. Involves clients’ recognizing that they

have a choice.

3. Assimilation. Involves clients’ learning how to influence

their environment.
The Role of Confrontation

Confrontation can be done in such a way that clients

cooperate, especially when they are invited to examine their
behaviors, attitudes, and thoughts.
Gestalt Therapy Interventions

The Internal Dialogue Exercise

Top dog is righteous, authoritarian, moralistic, demanding,
bossy, and manipulative. (badgers with shoulds and oughts)

Underdog manipultes by playing the role of victim: by being

defensive, apologetic, helpless, and weak and by feigning
powerlessness.
Empty-chair technique. Using two chairs, the therapist asks
the client to sit in one chair and be fully the top dog and then
shift to the other chair and become the underdog.

Making the Rounds. Involves asking a person in a group to go

up to others in the group and either speak to do something
with each other.
The Reversal Exercise. Example, the Therapist could ask a
person who claims to suffer from severe inhibitions and
excessive timidity to play the role of an exhibitionist.

The Rehearsal Exercise. When clients share their rehearsals

out loud with a therapist, they become more aware of the
many preparatory means they use in bolstering their social
roles.
Limitations and Criticism of Gestalt Therapy

- place more attention on using techniques to confront

clients and getting them experience their feelings
- there is a danger that therapists who are inadequately
trained will be primarily concerned with impressing
clients.
BEHAVIOR THERAPY
 BEHAVIOR THERAPY
B.F. Skinner (1904–1990)
- he was first interested in music and literature. However, he
did not became successful in his writing career.
- He received his PhD in psychology from Harvard University
in 1931
- but again he faced another identity crises (the project
pigeon and the baby tender)
- Skinner wrote Walden Two
- considered as the father of the behavioral approach to
psychology
- received an unprecedented Citation for Outstanding
Lifetime Contribution to Psychology
- on August 18, 1990, he died of Leukemia
Albert Bandura (b. 1925)
- Born in Mundare, Canada
- Bandura spent his elementary and high school in town,
which was short of teachers.
- he earned his PhD in clinical psychology from the University
of Iowa in 1952
- Bobo doll experiment in 1950's
- He became a faculty member at Stanford University in 1953
- received National Medal of Science in a ceremony held at
the White House on May 19, 2016
 Behavior is the product of learning; all behavior
is learned whether the behavior is maladaptive or
adaptive
Classical conditioning (respondent conditioning) refers to what
happens prior to learning that creates a response through pairing.
Operant Conditioning involves a type of learning in which
behaviors are influenced mainly by the consequences that follow
them.
 Key Concepts
Modern behavior therapy is grounded on a scientific view of
human that accommodates a systematic and structured approach
to counseling.

Its current view is that the person is the producer and the
product of his or her environment.
Basic Characteristics and Assumptions

1.Behavior therapy is based on the principles and procedures

of the scientific method.

2. Behavior therapy deals with the client’s current problems

and the factors influencing them.

3. Clients involved in behavior therapy are expected to assume

an active role by engaging in specific actions to deal with their
problems.
4. This approach assumes that change can take place without
insight into underlying dynamics.

5. The focus is on assessing overt and covert behavior directly,

identifying the problem, and evaluating change.

6. Behavioral treatment interventions are individually tailored

to specific problems experienced by clients.
 The Therapeutic Process
Therapeutic Goals
 To increase personal choice and create new conditions for
learning
 To eliminate maladaptive behaviors and learn more effective
behaviors
 To focus on factors influencing behavior and find what can be
done about problematic behavior
 Clients actively set goals and evaluate how the goals are met
Therapeutic Function and Role

 Therapist is active and directive

 Functions of therapist: teacher or trainer; consultant; problem
solvers; model
 Clients must be active
 A quality client-therapist relationship is essential for
implementing behavioral procedures
 THERAPEUTIC TECHNIQUES AND
PROCEDURES
Operant Conditioning Techniques

Behaviorists believe we respond in predictable ways

because of the gains we experience (positive reinforcement) or
because of the need to escape or avoid unpleasant
consequences (negative reinforcement).
Positive reinforcement involves the addition of something of
value to the individual (such as praise, attention, money, or food)
as a consequence of certain behavior.

Negative reinforcement involves the escape from or the

avoidance of aversive (unpleasant) stimuli.

Extinction, which refers to withholding reinforcement from a

previously reinforced response
Punishment, sometimes referred to as aversive control, in which
the consequences of a certain behavior result in a decrease of that
behavior.

Positive punishment an aversive stimulus is added after the

behavior to decrease the frequency of a behavior
In negative punishment a reinforcing stimulus is removed
following the behavior to decrease the frequency of a target
behavior
Relaxation Methods
It is aimed at achieving muscle and mental relaxation and is
easily learned.

Systematic Desensitization
Clients imagine successively more anxiety-arousing
situations at the same time that they engage in a behavior that
competes with anxiety.
In Vivo Exposure and Flooding

Exposure therapies are designed to treat fears and other negative

emotional responses by introducing clients, under carefully
controlled conditions, to the situations that contributed to such
problems.

In vivo exposure involves client exposure to the actual anxiety-

evoking events rather than simply imagining these situations.
Flooding, which refers to either in vivo or imaginal exposure to
anxiety-evoking stimuli for a prolonged period of time.

In vivo flooding consists of intense and prolonged exposure to the

actual anxiety-producing stimuli.
Eye movement desensitization and reprocessing (EMDR)

is a form of exposure therapy that involves imaginal flooding,

cognitive restructuring, and the use of rapid, rhythmic eye
movements and other bilateral stimulation to treat clients
who have experienced traumatic stress.
Social Skills Training
A broad category that deals with an individual’s ability to
interact effectively with others in various social situations; it is
used to correct deficits clients have in interpersonal
competencies.

Assertion training
is that people have the right (but not the obligation) to
express themselves.
Self-Modification Programs and Self-Directed Behaviors
Self-modification strategies include self-monitoring, self-
reward, self contracting, stimulus control, and self-as-model.

Multimodal Therapy
Multimodal therapy is an open system that encourages
technical eclecticism. New techniques are constantly being
introduced and existing techniques refined, but they are never
used in a shotgun manner.
Multicultural Implications

a. Focus on behavior is compatible with many cultures

b. Behavioral changes may not be valued by family
Contribution
- Assessment and evaluation techniques
- Self-directed programs
Limitations and Criticisms
1. May change behaviors, but it does not change feelings.
2. Ignores the important relational factors in therapy
3. Does not provide insight.
4. Treats symptoms rather than causes.
5. Involves control and manipulation by the therapist.
COGNITIVE THERAPY
 COGNITIVE THERAPY
Aaron Temkin Beck (b. 1921)

- was born in Providence, Rhode Island.

- his early schooling was interrupted by a life-threatening
illness
- Throughout his life he struggled with a variety of fears
- A graduate of Brown University and Yale School of Medicine
- Beck joined the Department of Psychiatry of the University of
Pennsylvania in 1954
-He is the founder of the Beck Institute
Aaron Beck’s Cognitive Therapy

Cognitive therapy is based on the theoretical rationale that

the way people feel and behave is determined by how they
perceive and structure their experience.

- reasoning that lead to faulty assumptions and

misconceptions, which are termed cognitive distortions.
Arbitrary inferences refer to making conclusions without
supporting and relevant evidence

Selective abstraction consists of forming conclusions based on an

isolated detail of an event.

Overgeneralization is a process of holding extreme beliefs on the

basis of a single incident and applying them inappropriately to
dissimilar events or settings.

Magnification and minimization consist of perceiving a case or

situation in a greater or lesser light than it truly deserves.
Personalization is a tendency for individuals to relate external
events to themselves, even when there is no basis for making this
connection.

Labeling and mislabeling involve portraying one’s identity on the

basis of imperfections and mistakes made in the past and allowing
them to define one’s true identity.

Dichotomous thinking involves categorizing experiences in either-

or extremes.
Limitations and Criticisms

- Focusing too much on the power of positive thinking;

being too superficial and simplistic;
- denying the importance of the client’s past; being too
technique oriented;
- failing to use the therapeutic relationship;
- working only on eliminating symptoms, but failing to
explore the underlying causes of difficulties;
- ignoring the role of unconscious factors; and neglecting the
role of feelings
COGNITIVE BEHAVIORAL
THERAPY
 COGNITIVE BEHAVIOR MODIFICATION
Donnald Meichenbaum
- raised in New York City.
- received his undergraduate degree in psychology from City College
of New York, then moved to Illinois to pursue graduate studies at the
University of Illinois
- In 1977 Dr. Meichenbaum published Cognitive-behavior
Modification
- These days, Dr. Meichenbaum is a distinguished professor emeritus
(retired) but is still "very much associated with the University of
Waterloo."
- focuses on changing the client’s self-verbalizations.
- self-statements affect a person’s behavior in much the
same way as statements made by another person.
- basic premise of CBM is that clients, as a prerequisite to
behavior change, must notice how they think, feel, and
behave and the impact they have on others
- self-instructional training focuses more on helping clients
become aware of their self-talk.
How Behavior Changes

Meichenbaum (1977) proposes that “behavior change

occurs through a sequence of mediating processes involving the
interaction of inner speech, cognitive structures, and behaviors
and their resultant outcomes”

Phase 1: Self-observation. The beginning step in the change

process consists of clients learning how to observe their own
behavior.
 Phase 2: Starting a new internal dialogue. As a result of the
early client–therapist contacts, clients learn to notice their
maladaptive behaviors, and they begin to see opportunities for
adaptive behavioral alternatives.

Phase 3: Learning new skills. The third phase of the modifi

cation process consist of teaching clients more effective coping
skills, which are practiced in real-life situations.
Coping Skills Pogram

• Exposing clients to anxiety-provoking situations by means of role

playing and imagery
• Requiring clients to evaluate their anxiety level
• Teaching clients to become aware of the anxiety-provoking
cognitions they experience in stressful situations
• Helping clients examine these thoughts by reevaluating their
self-statements
• Having clients note the level of anxiety following this
reevaluation
 Stress inoculation training (SIT) consists of a combination of
information giving, Socratic discussion, cognitive restructuring,
problem solving, relaxation training, behavioral rehearsals, self-
monitoring, self-instruction, self-reinforcement, and modifying
environmental situations.
 Meichenbaum (1985, 2003) has designed a three-stage
model for stress inoculation training:
1. Conceptual-educational phase, the primary focus is on creating
a working relationship with clients.
2. Skills acquisition, consolidation, and rehearsal phase, the focus
is on giving clients a variety of behavioral and cognitive coping
techniques to apply to stressful situations.
3. Application and follow-through phase, the focus is on carefully
arranging for transfer and maintenance of change from the
therapeutic situation to everyday life.
Constructivist narrative perspective (CNP), which focuses on the
stories people tell about themselves and others regarding signifi
cant events in their lives. This approach begins with the
assumption that there are multiple realities.
Shortcomings
Exploring values and core beliefs plays an important role in all of
the cognitive behavioral approaches, and it is crucial for therapists
to have some understanding of the cultural background of clients
and to be sensitive to their struggles.

Limitations and Criticisms

Is directly teaching the client the most effective approach?
We cannot assume that learning occurs only by teaching. It
is a mistake to conclude that therapy is mainly a cognitive process.
Experiential therapies stress that learning also involves emotions
and self-discovery.
REALITY THERAPY
 REALITY THERAPY
William Glasser (b.1925)
- Glasser was married to Naomi for 47 years, and she was very
involved with the William Glasser Institute until her death in
1992. In 1995 Glasser married Carleen, who is an instructor at
the Institute.
- attended Case Western Reserve University in Cleveland,
where he studied clinical psychology, earning his BS and MA,
and finally his MD in psychiatry in 1953
- Glasser was the president and founder of the William Glasser
Institute designed to teach people choice theory
 Reality therapists believe the underlying problem of most
clients is the same: They are either involved in a present
unsatisfying relationship or lack what could even be called a
relationship.

Reality therapists recognize that clients choose their

behaviors as a way to deal with the frustrations caused by
unsatisfying relationships.
 Choice theory posits that we are not born blank slates
waiting to be externally motivated by forces in the world around
us.

Five genetically encoded needs—survival, love and

belonging, power or achievement, freedom or independence, and
fun.

We store information inside our minds and build a file of

wants, called our quality world, which is at the core of our lives.
It is completely based on our wants and needs, but unlike the
needs, which are general, it is very specific.
Choice Theory Explanation of Behavior

Choice theory explains that all we ever do from birth to

death is behave and, with rare exceptions, everything we do is
chosen.

Total behavior teaches that all behavior is made up of

four inseparable but distinct components— acting, thinking,
feeling, and physiology—that necessarily accompany all of our
actions, thoughts, and feelings.
Characteristics of Reality Therapy

1.Emphasize choice and responsibility

2.Reject transference
3.Keep the therapy in the present
4.Avoid focusing on symptoms
5. Challenge traditional views of mental illness
 Goals of Therapy
a. Help people become effective in meeting their need
b. Enable clients to reconnect with people they have chosen to
be in their quality world
c. Teach clients choice theory

Therapeutic Relationship

a. Create good relationship with the client to engage client to

evaluate their relationship
b. Therapist: client’s advocate, teacher, model and
confrontational
Cycle of Counseling

(1)creating the counseling environment and

(2)implementing specific procedures that lead to changes in
behavior.
WDEP System
• WANTS – explores client’s wants, needs, perceptions
• DIRECTION AND DOING – explores the current behavior
• EVALUATION – evaluate present behavior and direction this
is taking clients
• PLANNING AND ACTION – identify specific ways to fulfill
client’s wants and needs
Limitations and Criticisms

Reality therapy is that it does not give adequate emphasis

to the role of these aspects of the counseling process: the
unconscious, the power of the past and the effect of traumatic
experiences in early childhood, the therapeutic value of dreams,
and the place of transference.

This can erroneously be viewed as a simple approach that

does not require a high level of competence.