A basic assumption of Gestalt therapy is that an individual’s own existing inner resources are adequate to cone with his Problems and conflicts once these are utilized and brought into effective action This therapeutic approach, then, relies on the existing potentials within the patient at the time he seeks therapy. The therapeutic process is directed at freeing the patient’s energies and capacities so that these are more available to him in his present, on-going adjustment processes. The therapist does this, in mart by helping the patient AWARE OF HOW he uses his resource or energies in ineffective ways; HC’R he blocks his own potentials and by what mechanisms he does this.
In contrast to most psychotherapeutic approaches, this method focuses on the here and now. It directs the patient towards awareness of his present behavior Pattern and his interaction with other people in his immediate life-situations. It provides the patient with insight and awareness about his behavior patterns in tens of “that” he dons and “how” hr goes about doing it. The “why” questions, which involve the laborious searching into the life history of the patient for the causes and motivations of a behavior pattern and tracing its roots to childhood, are considered- unimportant for the therapeutic process. It is assumed that all behavior patterns were learned earlier and that the patient continues to manifest these early behavior patterns and attitudes to the present.
The rationale for minimizing the time spent on understanding the patient’s developmental patterns and life history is that such insight is not therapeutic and does not help him to overcome these long standing Patterns he now wishes to change. The validity of various theories of developmental psychology is acknowledged: however, this approach does deny their therapeutic value per se.
In the therapeutic situation terms such as “neurotic” or “sick” are irrelevant and indeed often provide a convenient excuse for the patient to avoid responsibility for himself. Lack of love, economic hardships, broken homes, neurotic parents, etc., may all be valid explanations about “why” a person became the way he is but these factors have no therapeutic value for the patient in his process of adjustment. He Still must face the reality that if he wants to live a fuller and more rewardinq life he will have to accent the responsibility for himself in reaching no for these goals. Further, the patient is made aware that adjustment is an on going process and is meaningful only as it is experienced by the person in the here and now. Preoccupation with one’s past, in therapy or otherwise, actually preserves and may even enhance existing maladjustments and undesirable behavior patterns.
The attitude towards the patient follows the same philosophy in the treatment program itself. The patient is not asked to commit himself to a program of therapv of a certain duration and frequency. This tends to relieve the patient of direct responsibility for himself and encourages the patient to let the doctor take over because he is “getting help”. Instead, the patient is encouraged to evaluate for himself the on goinq experience of his therapy hours. He is asked to continuously decide if the awareness and insight he gains from the therapeutic experience is sufficiently meaningful and valuable to him. The method itself is such that the patient quickly sees what the therapist has to offer. There are no preambles or “uncovering” necessary before the patient is considered capable of deciding if he wants to continue. Each hour is a unit and considered to be a complete therapeutic experience in and of it self simply in terms of what the patient learned or became aware of about him self during the hour. There is no need for continuity from session to session since the present is always the focus. There is no such thing as “starting all over” if a patient discontinues. Therapy hours need not follow any pattern of frequency or regularity.
In the therapeutic situation the focus is on the most obvious behavior patterns of the patient. I begin by asking myself what I observe most readily and what is most apparent about the patient’s behavior and manner. This is based on my direct and immediate -perceptions of him -how he looks, sounds, moves, etc. These are then developed -‘y calling attention to the parson of these behavior Patterns so that he becomes more aware of them. From this we often establish important behavior patterns which the patient then begins to understand are crucial aspects of his everyday functioning in all kinds of situation.
As an example I shall quote the dialogue between a patient and me during the initial session. The patient is a twenty-six year old married man with two children who works as an engineer in a large aircraft company. He was referred by his fairly physician because of functional gastro-intestinal symptoms including a spastic colon.
The patient began the interview talking about the distress and embarrassment he experienced about his symptoms and how reluctant he felt to consider them partly psychogenic. He touched on various other aspects of his present life-situation and made a few remarks about his childhood and family. This continued about fifteen minutes during which he smiled almost continuously as he talked irregardless of the subject matter. At this point the dialogue began with my comment as follows:
Therapist: “I notice that as you talk about these things, some of which seem to be upsetting, you smile almost continuously.
Patient: (obviously embarrassed but smiling still) “Yes, people have mentioned this to me. I’ve done it for years…. habit I guess.”
T: “Do you really feel like smiling or laughing as if you had heard a Funny joke?”
P: ” Oh no! It just comes on … it’s embarrassing … it often makes me
T: “I notice you refer to your smile as ‘it’. Would you repeat your last sentence using ‘I’ instead of ´it’.”
P: “…my smile just comes on? I am embarrassed by my smile… I often make myself uncomfortable by smiling …”
T: “Do you experience any difference when you restated your comments in the first person?”
P: “Yes, I became more uncomfortable … like you were making me face something that I wanted to avoid…”
T: “Very well … then would you make up a case telling how you need your smile to be comfortable and how it serves a useful purpose for you? Just verbalize your thoughts about this as they come.”
P: “That’s hard to do … I am not very good at these things (smiles continuously) ?O.K?.I need my smile to be uncomfortable I mean I would he even more uncomfortable not smiling right now I’m trying not to smile but it won’t go away. Now I am not smiling (patient strains to keep a straight face) … I’m afraid you’ll think I’m angry at you.” (smiles again)
T: “What’s your objection to being angry at me?”
P: “I want you to like me … If I get mad at you, you won’t like me … you’ll be mad at me.”
T: “And then? …”
P: “You won’t help me.”
T: “And then? …”
P: “I came here to be helped. I want to be helped with my problems or I wouldn’t be here.”
T: “You’re telling me that the only way I’ll help you is if you are always nice and friendly and smiling and avoid being unpleasant or angry?”
P: “Yes, of course.”
T: “Then you have to be this way with everyone if you want or need something_ from them?”
P: “Yes, I’ve always been told that the mature person controls his anger, that a smile is what people like and if I am unpleasant or angry they won’t like me or want to have anything to do with me.”
T: “So you swallow your anger instead and keep it inside you where it builds pressure. With this in mind can you fantasize what your colon might be saying by means of your so-called symptoms?”
P: “This is really embarrassing s. patient blushing and smiling and seems delighted) … I see what you mean. … “(laughs explosively).
The remainder of the hour flowed easily from this awareness of the hiding of anger and resentments behind his smile and the patient began to see some of the meaning of his symptoms.
Awareness is the fundamental instrument of psychotherapy. It is the key to the utilization of the patient’s full potentials. A person functions best when he is aware of the present reality of himself and his environment. He is then most able to respond to his own needs and goals and to be most aware of the on going process of interaction and “feedback” in his relations with other people.Philosophy and Techniques of Gestalt Therapy