Gestalt Therapy: An Introductionby Gary Yontef, Ph.D.This introductory chapter appears in Awareness, Dialogue, and Process published by The Gestalt Journal Press and was copyright in 1993 by Gary Yontef, Ph.D. Youay download it for your personal use only. !t ay not be copied or distributed by any eans.The boo" is #$% pages long and sells for &3# plus &3.%% '&1(.%% for those wishing airail deli)ery outside *orth +erica,. !t can be ordered fro The Gestalt Journal Press, P. -. .o/ 99%, 0ighland, *Y 1(#(12%99%. 3oice415#26912$19(. 7a/4 $$#2(#5211## 82ail.The boo" is also a)ailable in the following languages.!nforation about the publisher appears under each language heading.GeranGestalttherapie:Awareness - Dialogue - Prozess!9.* 3291%5$152%21 80P '8dition 0uanistische Psychologie, 8: #1 Tel4 %((12#3%5511 7a/4 %((12#3%(%6(Postfach 3( %1 $3, #%$9# ;asilla 1319antiago (9, >hile7a/4%11 '#6(, 351 31%$Tel4 %11 '#6(, (##21311+ Portuguese edition is e/pected in early 199$ fro49uas 8ditorial ?TD@ua >ardoso de +leida, 1(1$%#%132%%1 9ao Paulo, 9P.rasilTel4%11 1$( 33((7a/4 %11 1$( $5$6>oentaryThis paper, coauthored with James S. Simin in !"#!, is pro$a$l% the $est general introduction to Gestalt therap% that & ha'e written. &t was the Gestalt Therap% chapter in the !"#" edition o( )orsini and *edding+s >urrent Psychotherapies ,-th.dition/. &t appears here with the ind permission o( the pu$lisher, 0... Peacoc, Pu$lishers, &nc. o( &tasca, &llinois. &t is a slightl% edited 'ersion o( the !"#- chapterwritten 1ointl% $% Jim Simin and m%sel( (or the third edition o( >urrent Psychotherapies. The !"#- 'ersion was a complete rewriting o( a 'ersion Jim did $% himsel( (or the second edition o( >urrent Psychotherapies. The re'isions & made in the !"#" 'ersion were minor and were made a(ter Jim+s death.OverviewGestalt therapy is a phenoenological2e/istential therapy founded by 7rederic" '7ritA, and ?aura Perls in the 195%s. !t teaches therapists and patients the phenoenological ethod of awareness, in which percei)ing, feeling, and acting are distinguished fro interpreting and reshuffling pree/isting attitudes. 8/planations and interpretations are considered less reliable than what is directly percei)ed and felt. Patients and therapists in Gestalt therapy dialogue, that is, counicate their phenoenological perspecti)es. Differences in perspecti)es becoe the focus of e/perientation and continued dialogue. The goal is for clients to becoe aware of what they are doing, how they are doing it, and how they can change thesel)es, and at the sae tie, to learn to accept and )alue thesel)es.Gestalt therapy focuses ore on process 'what is happening, than content 'what is being discussed,. The ephasis is on what is being done, thought and felt at the oent rather than on what was, ight be, could be, or should be.asic !onceptsThe Phenomenological Perspecti'ePhenoenology is a discipline that helps people stand aside fro their usual way of thin"ing so that they can tell the difference between what is actually being percei)ed and felt in the current situation and what is residue fro the past '!dhe, 19$$,. + Gestalt e/ploration respects, uses and clarifies iediate, Bnai)eB perception Bundebauched by learningB 'Certheier, 195#, p. 331,. Gestalt therapy treats what is BsubDecti)elyB felt in the present, as well as what is BobDecti)elyB obser)ed, as real and iportant data. This contrasts with approaches that treat whatthe patient e/periences as Bere appearancesB and uses interpretation to find Breal eaning.BThe goal of Gestalt phenoenological e/ploration is awareness, or insight. B!nsightis a patterning of the perceptual field in such a way that the significant realities are apparentE it is the foration of a gestalt in which the rele)ant factors fall into place with respect to the wholeB '0eidbreder, 1933, p. 3##,. !n Gestalt therapy insight is clear understanding of the structure of the situation being studied.+wareness without systeatic e/ploration is not ordinarily sufficient to de)elop insight. Therefore, Gestalt therapy uses focused awareness and e/perientation to achie)e insight. 0ow one becoes aware is crucial to any phenoenological in)estigation. The phenoenologist studies not only personal awareness but also the awareness process itself. The patient is to learn how to becoe aware of awareness. 0ow the therapist and the patient e/perience their relationship is of special concern in Gestalt therapy 'Yontef, 19$6, 191(, 1913,.The 0ield Theor% Perspecti'eThe scientific world )iew that underlies the Gestalt phenoenological perspecti)e is field theory. 7ield theory is a ethod of e/ploring that describes the whole field of which the e)ent is currently a part rather than analyAing the e)ent in ters of a class to which it belongs by its BnatureB 'e.g., +ristotelian classification, or a unilinear, historical, cause2effect seFuence 'e.g., *ewtonian echanics,.The field is a whole in which the parts are in iediate relationship and responsi)e to each other and no part is uninfluenced by what goes on elsewhere in the field. The field replaces the notion of discrete, isolated particles. The person in his or her life space constitutes a field.!n field theory no action is at a distanceE that is, what has effect ust touch that which is affected in tie and space. Gestalt therapists wor" in the here and now and are sensiti)e to how the here and now includes residues of the past, such as body posture, habits, and beliefs.The phenoenological field is defined by the obser)er and is eaningful only when one "nows the frae of reference of the obser)er. The obser)er is necessary because what one sees is soewhat a function of how and when one loo"s.7ield approaches are descripti)e rather than speculati)e, interpreti)e, or classificatory. The ephasis is on obser)ing, describing, and e/plicating the e/act structure of whate)er is being studied. !n Gestalt therapy, data una)ailable to directobser)ation by the therapist are studied by phenoenological focusing, e/perienting, reporting of participants, and dialogue 'Yontef, 191(, 1913,.The .2istential Perspecti'e8/istentialis is based on the phenoenological ethod. 8/istential phenoenologists focus on peopleGs e/istence, relations with each other, Doys and suffering, etc., as directly e/perienced.:ost people operate in an unstated conte/t of con)entional thought that obscures or a)oids ac"nowledging how the world is. This is especially true of oneGs relationsin the world and oneGs choices. 9elf2deception is the basis of inauthenticity4 li)ing that is not based on the truth of oneself in the world leads to feelings of dread, guiltand an/iety. Gestalt therapy pro)ides a way of being authentic and eaningfully responsible for oneself. .y becoing aware, one becoes able to choose andHor organiAe oneGs own e/istence in a eaningful anner 'Jacobs, 19$1E Yontef, 191(, 1913,.The e/istential )iew holds that people are endlessly rea"ing or disco)ering thesel)es. There is no essence of huan nature to be disco)ered Bonce and for all.B There are always new horiAons, new probles and new opportunities.DialogueThe relationship between the therapist and the client is the ost iportant aspect of psychotherapy. 8/istential dialogue is an essential part of Gestalt therapyGs ethodology and is a anifestation of the e/istential perspecti)e on relationship.@elationship grows out of contact. Through contact people grow and for identities. >ontact is the e/perience of boundary between BeB and Bnot2e.B !t is the e/perience of interacting with the not2e while aintaining a self2identity separate fro the not2e. :artin .uber states that the person 'B!B, has eaning only in relation to others, in the !2Thou dialogue or in !2!t anipulati)e contact. Gestalt therapists prefer e/periencing the patient in dialogue to using therapeutic anipulation '!2!t,.Gestalt therapy helps clients de)elop their own support for desired contact or withdrawal '?. Perls, 19$6, 19$1,. 9upport refers to anything that a"es contact orwithdrawal possible4 energy, body support, breathing, inforation, concern for others, language, and so forth. 9upport obiliAes resources for contact or withdrawal. 7or e/aple, to support the e/citeent accopanying contact, a person ust ta"e in enough o/ygen.The Gestalt therapist wor"s by engaging in dialogue rather than by anipulating the patient toward soe therapeutic goal. 9uch contact is ar"ed by straightforward caring, warth, acceptance and self2responsibility. Chen therapistso)e patients toward soe goal, the patients cannot be in charge of their own growth and self2support. Dialogue is based on e/periencing the other person as he or she really is and showing the true self, sharing phenoenological awareness. The Gestalt therapist says what he or she eans and encourages the patient to do the sae. Gestalt dialogue ebodies authenticity and responsibility.The therapeutic relationship in Gestalt therapy ephasiAes four characteristics of dialogue41. &nclusion. This is putting oneself as fully as possible into the e/perience of the other without Dudging, analyAing or interpreting while siultaneously retaining a sense of oneGs separate, autonoous presence. This is an e/istential and interpersonal application of the phenoenological trust in iediate e/perience. !nclusion pro)ides an en)ironent of safety for the patientGs phenoenological wor" and, by counicating an understanding of the patientGs e/perience, helps sharpen the patientGs self2awareness.(. Presence. The Gestalt therapist e/presses herself to the patient. @egularly, Dudiciously, and with discriination she e/presses obser)ations, preferences, feelings, personal e/perience and thoughts. Thus, the therapist shares her perspecti)e by odeling phenoenological reporting, which aids the patientGs learning about trust and use of iediate e/perience to raise awareness. !f the therapist relies on theory2deri)ed interpretation, rather than personal presence, she leads the patient into relying on phenoena not in his own iediate e/perience as the tool for raising awareness. !n Gestalt therapy the therapist does not use presence to anipulate the patient to confor to preestablished goals, but rather encourages patients to regulate thesel)es autonoously.3. )ommitment to dialogue. >ontact is ore than soething two people do to each other. >ontact is soething that happens between people, soething that arises fro the interaction between the. The Gestalt therapist surrenders herself to this interpersonal process. This is allowing contact to happen rather than anipulating, maing contact, and controlling the outcoe.5. Dialogue is li'ed. Dialogue is soething done rather than tal"ed about. B?i)edB ephasiAes the e/citeent and iediacy of doing. The ode of dialogue can be dancing, song, words, or any odality that e/presses and o)es the energy between or aong the participants. +n iportant contribution of Gestalt therapy to phenoenological e/perientation is enlarging the paraeters to include e/plication of e/perience by non)erbal e/pressions. 0owe)er, the interaction is liited by ethics, appropriateness, therapeutic tas", and so on.Other "yste#sYontef notes that4The theoretical distinction between Gestalt therapy, beha)ior odification and psychoanalysis is clear. !n beha)ior odification, the patientGs beha)ior is directly changed by the therapistGs anipulation of en)ironental stiuli. !n psychoanalytic theory, beha)ior is caused by unconscious oti)ation which becoes anifest in the transference relationship. .y analyAing the transference the repression is lifted, the unconscious becoes conscious. !n Gestalt therapy the patient learns to fully use his internal and e/ternal senses so he can be self2responsible and self2supporti)e. Gestalt therapy helps the patient regain the "ey to this state, the awareness of the process of awareness. .eha)ior odification conditions IbyJ using stiulus control, psychoanalysis cures by tal"ing about and disco)ering the cause of ental illness Ithe probleJ, and Gestalt therapy brings self2realiAation through here2and2now e/perients in directed awareness. '1969, pp. 33235,.eha)ior odification and other therapies that priarily try to direct control o)er syptos 'for e/aple, cheotherapy, 8>T, hypnosis, etc., contrast with both Gestalt therapy and psychodynaic therapies in that the latter systes foster change priarily by the patientGs learning to understand hiself or herself in the world through insight.The ethodology of Gestalt and psychodynaic therapy uses an accepting relationship and a technology to help the patient change )ia eotional and cogniti)e self2understanding. !n psychoanalysis the basic patient beha)ior is free associationE the chief tool of the analyst is interpretation. To encourage transference, the analyst withholds any direct e/pression of personhood 'no B!B stateents, and practices the B@ule of +bstinenceBE that is, the therapist does not gratify any of the patientGs wishes. This approach is true of all psychodynaic schools4 classical, obDect relations, ego psychological, ;ohutian, Jungian. The psychodynaic therapist isolates his or her person in order to encourage a relationship based e/plicitly on transference 'rather than contact,.Gestalt therapy wor"s for understanding by using the acti)e, healing presence of the therapist and the patient in a relationship based on true contact. Transference, e/plored and wor"ed through as it arises, is not encouraged by the Gestalt therapist'Polster, 1961,. >haracterological issues are e2plicitl% dealt with in Gestalt therap% )ia the dialogic and phenoenological ethod.!n Gestalt therapy the iediate e/perience of the patient is acti)ely used. @ather than free associate while passi)ely awaiting the therapistGs interpretation and subseFuent change, the patient is seen as a collaborator who is to learn how to self2heal. The patient Bwor"sB rather than free associates. BChat can ! do to wor" on thisKB is a freFuent Fuestion in Gestalt therapy and freFuently there is an answer. 7or e/aple, a couple with se/ual difficulties ight be as"ed to practice sensate focusing.:ore than any other therapy, Gestalt therapy ephasiAes that whate)er e/ists is here and now and that e/perience is ore reliable than interpretation. The patient istaught the difference between taling a$outwhat occurred fi)e inutes ago 'or last night or (% years ago, and e2periencing what is now.+pplebau, a psychoanalyst, obser)es that!n Gestalt therapy the patient Fuic"ly learns to a"e the discriination between ideas and ideation, between well2worn obsessional pathways and new thoughts, between a stateent of e/perience and a stateent of a stateent. The Gestalt goalof pursuing e/perience and insight which eerges as the Gestalt eerges is ore potent than insight gi)en by the therapist, does help the patient and the therapist draw and aintain these iportant distinctions. '19$6, p. $#$,Therapies such as beha)ior odification, reality therapy and rational eoti)e therapy do not wor" with the patient+s e/perience enough to do this. !n @ogerian therapy the passi)ity iposed on the therapist se)erely narrows the range or power of the therapy to teach these distinctions.The practice of ost therapy systes encourages intellectualiAing4 tal"ing about the irrationality of patient beliefs, tal"ing about the beha)ior changes the therapist belie)es that the patient should a"e, and so forth. The Gestalt therapy ethodology utiliAes acti)e techniFues that clarify e/perience. Gestalt therapists will often e/perient by trying soething new in the therapy hour. Lnli"e ost other therapies, in Gestalt therapy the process of disco)ery through e/perientation is the end point rather than the feeling or idea or content.The psychoanalyst can only use interpretation. The @ogerian can only reflect and clarify. Gestalt therapists ay use any techniFues or ethods as long as 'a, they are aied toward increasing awareness, 'b, they eerge out of dialogue and phenoenologic wor", and 'c, they are within the paraeters of ethical practice.The power and responsibility for the present are in the hands of the patient. !n the past the patient was psychologically in utual interaction with the en)ironent and not a passi)e recipient of traua. Thus the patient ay ha)e recei)ed shaing essages fro his parents, but swallowing the essage and coping by self2blae were his own, as was the continuation of the shaing internally fro then until now. This point of )iew is at )ariance with psychodynaic attitudes, but consonantwith +dlerGs and 8llisGs )iews.This )iewpoint enables patients to be ore responsible for their own e/istence, including their therapy. Chen the therapist belie)es that the past causes the present and that patients are controlled by unconscious oti)ation not readily a)ailable to the, they are encouraged to rely on the therapistGs interpretations rather than their own autonoy.!n therapies in which the therapist underta"es to directly odify the patientGs beha)ior, the iediate e/perience of the patient and therapist are not honored. This separates Gestalt therapy fro ost other therapies. + resentful patient ay increase awareness by e/pressing resentent. !f the therapist suggests this as a eans of catharsis, it is not the phenoenological focusing of Gestalt therapy.!n Gestalt therapy there are no Bshoulds.B !nstead of ephasiAing what should be, Gestalt therapy stresses awareness of what is. *hat is, is. This contrasts with any therapist who B"nowsB what the patient BshouldB do. 7or e/aple, cogniti)e beha)ior odification, rational2eoti)e therapy and reality therapy all try to odify patient attitudes the therapist Dudges to be irrational, irresponsible or unreal.8)en though Gestalt therapy discourages interrupting the organisic assiilating process by focusing on cogniti)e e/planatory intellectualiAations, Gestalt therapistsdo wor" with belief systes. >larifying thin"ing, e/plicating beliefs, and utually deciding what fits for the patient are all part of Gestalt therapy. Gestalt therapy deephasiAes thin"ing that a)oids e/perience 'obsessing, and encourages thin"ing that supports e/perience. Gestalt therapy e/cludes the therapistGs narcissistically teaching the patient rather than being contactful and e/pediting the patientGs self2disco)ery.:any persons clai they practice BT+ Itransactional analysisJ and Gestalt.B Lsually these people use the T+ theor% and soe Gestalt therapy techni3ues. TechniFues are not the iportant aspect of Gestalt therapy. Chen used in an analytic, cogniti)e style, these techniFues are not Gestalt therapyM 9uch a cobination often aborts, pre)ents or neutraliAes the organisic awareness wor" of the phenoenological2e/istential ethod. + better cobination would be integrating concepts of T+ into a Gestalt fraewor". Thus the parent, adult, and child ego states, crossed transactions, and life scripts can be translated into Gestalt process language and wor"ed with e/perientally and dialogically.+nother difference fro other therapies is Gestalt therapyGs genuine regard for holis and ultidiensionality. People anifest their distress in how they beha)e,thin" and feel. BGestalt therapy )iews the entire biopsychosocial field, including organisHen)ironent, as iportant. Gestalt therapy acti)ely uses physiological, sociological, cogniti)e, oti)ational )ariables. *o rele)ant diension is e/cluded in the basic theoryB 'Yontef, 1969, pp. 33235,.$istoryPrecursorsThe history of Gestalt therapy starts with the professional de)elopent of 7ritA Perls and the Aeitgeist in which he li)ed. +fter acFuiring the :.D. degree, Perls went to 7ran"furt2a2:ain in 19(6 as an assistant to ;urt Goldstein at the !nstitutefor .rain Daaged 9oldiers. 0ere he was e/posed to Professors Goldstein and +dhear Gelb and he et his future wife, ?aura. +t that tie 7ran"furt2a2:ain was a center of intellectual ferent and Perls was directly and indirectly e/posed to leading Gestalt psychologists, e/istential philosophers and psychoanalysts.7ritA Perls becae a psychoanalyst. 0e was influenced directly by ;aren 0orney and Cilhel @eich, and indirectly by -tto @an" and others. Perls was especially influenced by Cilhel @eich, who was PerlsG analyst in the early 193%s, and Bwho first directed y attention to a ost iportant aspect of psychosoatic edicine 22to the function of the otoric syste as an arorB '7. Perls, 195$, p. 3,.Three influences on PerlsG intellectual de)elopent should be noted. -ne was the philosopher, 9igund 7riedlander, fro whose philosophy Perls incorporated the concepts of differential thin"ing and creati)e indifference, spelled out in PerlsG firstboo", .go, 4unger and Aggression '195$,. Perls was also influenced by Jan 9uts, the prie inister of 9outh +frica when Perls o)ed there with his faily 'ha)ing first escaped fro *aAi Gerany and then *aAi2occupied 0olland,. .eforebecoing prie inister, 9uts had written a aDor boo" on holis and e)olutionthat, in effect, e/ained the broader ecological world fro a Gestalt perspecti)e. 9uts coined the word holism. Third, +lfred ;orAybs"i, the seanticist, was an influence on PerlsG intellectual de)elopent.?aura Posner Perls was a cofounder of Gestalt therapy. 0er influence on Perls was generally "nown, and she wrote a chapter in .go, 4unger and Aggression. 9he wasa psychology student at the tie she et Perls, recei)ing the D.9c. degree fro theLni)ersity of 7ran"furt in 193(. 9he had contact with and was influenced by the e/istential theologians :artin .uber and Paul Tillich. :uch of the Gestalt, phenoenological and e/istential influences in Gestalt therapy are through her, although credit and influence were liited by how little she wrote under her nae '@osenfeld, 19$1,.+lthough Perls was a training psychoanalyst, he was aong those who chafed under the dogatis of classical 7reudian psychoanalysis. The 19(%s, 193%s, and 195%s were periods of great ferent and rebellion against *ewtonian positi)is. This was true in science 'for e/aple, 8insteinGs field theory,, theater and dance, philosophy, art, architecture and e/istentialis. .oth ?aura and 7ritA li)ed in a Aeitgeist pereated by a phenoenological2e/istential influence that later becoe interacted into Gestalt therapy ';ogan, 19$6,. +ong these were ac"nowledgent of responsibility and choice in creating oneGs personal e/istence, the priacy of e/istence o)er essence, and the e/istential dialogue.Gestalt psychology pro)ided Perls with the organiAing principle for Gestalt therapyas an integrating fraewor". Gestalt refers to the configuration or pattern of a set of eleents. Gestalt psychologists belie)e that organiss instincti)ely percei)e whole patterns and not bits and pieces. Chole patterns ha)e characteristics that cannot be gleaned by analyAing parts. Perception is an acti)e process and not a result of passi)ely recei)ed stiulation of sense organs. +ll situations are belie)ed to possess inherent organiAation. -rganiss ha)e the capacity for accurate perception when they use their nati)e ability of iediate e/perience in the here and now. The tas" of phenoenological research and therapy is to utiliAe this capacity to gain insight into the structure of that which is being studied. .ecause people naturally percei)e whole patterns as they occur, actual awareness can be trusted ore than interpretation and doga.e%innin%sPerlsG .go, 4unger and Aggression was written in 19512195(. !n its first publication in 9outh +frica in 1956 it was subtitled A 5e'ision o( 0reud+s Theor% and 6ethod. The subtitle of the boo" when it appeared in 1966 was changed to The 7eginning o( Gestalt Therap%. The ter BGestalt therapyB was first used as the title of a boo" written by 7rederic" Perls, @alph 0efferline and Paul Goodan '19#1,. 9hortly after, the *ew Yor" !nstitute for Gestalt therapy was organiAed, headFuartered in the apartent of 7ritA and ?aura Perls in *ew Yor" >ity. This apartent was used for seinars, wor"shops and groups. +ong those who studied with Perls at that tie were Paul CeisA, ?otte Ceidenfeld, .uc" 8astan, Paul Goodan, !sadore 7ro, 8lliot 9hapiro, ?eo >halfen, !ris 9anguilano, Jaes 9i"in and ;enneth +. 7isher.During the 19#%s, intensi)e wor"shops and study groups were established throughout the country. .efore the +erican Psychological +ssociation >on)ention held in *ew Yor" >ity in 19#5, a special intensi)e wor"shop liited to1# Fualified psychologists was gi)en o)er a three2day period. 9iilar wor"shops were held in >le)eland, :iai and ?os +ngeles. !n 19## the >le)eland study group fored the Gestalt !nstitute of >le)eland.7ritA Perls o)ed to the Cest >oast in 196%, at which tie 9i"in arranged a Gestalt therapy wor"shop for hi. Perls, Calter ;epler and Jaes 9i"in offered the first Gestalt therapy training wor"shops at the 8salen !nstitute during the suer of 1965. These training wor"shops continued under the leadership of Perls and 9i"in through 1961. +fter Perls o)ed to >anada, 9i"in, along with !ra 9hepherd, @obert C. @esnic", @obert ?. :artin, Jac" Downing and John 8nright, continued to offer Gestalt therapy training at 8salen through 19$%.During this beginning period Gestalt therapy pioneered any ideas subseFuently accepted into eclectic psychotherapy practice. The e/citeent of direct contact between therapist and patient, the ephasis on direct e/perience, the use of acti)e e/perientation, the ephasis on the here and now, the responsibility of the patientfor hiself or herself, the awareness principle, the trust in organisic self2regulation, the ecological interdependence of person and en)ironent, the principle of assiilation, and other such concepts were new, e/citing and shoc"ing to a conser)ati)e establishent. !n this period the practice of psychotherapy was dichotoiAed between the older, traditional approach of psychoanalytic dri)e theory and the ideas pioneered largely by Gestalt therapy. This was a period of e/pansion, with integration of the principles with each other and the elucidation and enucleation of the principles left for the future. Thus, for e/aple, Gestalt therapy pioneered the use of the acti)e presence of the therapist in a contactful relationship but did not consider in detail what constituted a healing dialogic presence.!urrent "tatusThere are at least 6( Gestalt therapy institutes throughout the world, and the list continues to grow. 3irtually e)ery aDor city in the Lnited 9tates has at least one Gestalt institute.*o national organiAation has been established. +s a result, there are no established standards for institutes, trainers and trainees. 8ach institute has its own criteria for training, ebership selection, and so on. +ttepts in the recent past to organiAe anationwide conference for establishing standards for trainers ha)e not been successful. There are no agreed2upon standards for what constitutes good Gestalt therapy or a good Gestalt therapist. Therefore, it is incubent on Gestalt therapy consuers to carefully e)aluate the educational, clinical, and training bac"ground of people who call thesel)es Gestalt therapists or gi)e training in Gestalt therapy 'see Yontef, 1911a, 1911b,.The Gestalt Journal is de)oted priarily to articles on Gestalt therapy. Gestalt Theor% publishes articles on Gestalt psychology, including soe on Gestalt therapy. .ibliographic inforation can be obtained fro ;ogan '191%,, @osenfeld '1911,, and Cysong '1916,.+s e/perience in doing Gestalt therapy has grown, earlier therapeutic practices ha)e been altered. 7or e/aple, earlier Gestalt therapy practice often stressed the clinical use of frustration, a confusion of self2sufficiency with self2support, and an abrasi)e attitude if the patient was interpreted by the therapist as anipulati)e. This approach tended to enhance the shae of shae2oriented patients. There has been a o)eent toward ore softness in Gestalt therapy practice, ore direct self2e/pression by the therapist, ore of a dialogic ephasis, decreased use of stereotypic techniFues, increased ephasis on description of character structure 'with utiliAation of psychoanalytic forulations,, and increased use of group process.Thus a patient is ore li"ely to encounter, aong Gestalt therapists who are in)ol)ed in the newer ode, an ephasis on self2acceptance, a softer deeanor by the therapist, ore trust of the patientGs phenoenology, and ore e/plicit wor" with psychodynaic thees. There has also been an increase in ephasis on groupprocess, including relation between group ebers, and a decrease in foral, one2to2one wor" in groups. There is also an increased attention to theoretical instruction, theoretical e/position, and wor" with cognition in general.PersonalityTheory of Personality.cological &nterdependence: The 8rganism9.n'ironment 0ield+ person e/ists by differentiating self fro other and by connecting self and other. These are the two functions of a boundary. To a"e good contact with oneGs world,it is necessary to ris" reaching out and disco)ering oneGs own boundaries. 8ffecti)eself2regulation includes contact in which one is aware of no)elty in the en)ironent that is potentially nourishing or to/ic. That which is nourishing is assiilated and all else is reDected. This "ind of differentiated contact ine)itably leads to growth 'Polster and Polster, 19$3, p. 1%1,.6ental 6eta$olism!n Gestalt therapy, etabolis is used as a etaphor for psychological functioning.People grow through biting off an appropriate2siAed piece 'be this food or ideas or relationships,, chewing it 'considering,, and disco)ering whether it is nourishing orto/ic. !f nourishing, the organis assiilates it and a"es it part of itself. !f to/ic, the organis spits it out 'reDects it,. This reFuires people to be willing to trust their taste and Dudgent. Discriination reFuires acti'el% sensing outside stiuli and processing these e/terocepti)e stiuli along with interocepti)e data.5egulation o( the 7oundar%The boundary between self and en)ironent ust be "ept pereable to allow e/changes, yet fir enough for autonoy. The en)ironent includes to/ins to be screened out. 8)en what is nourishing needs to be discriinated according to the doinant needs. :etabolic processes are go)erned by the laws of hoeostasis. !deally, the ost urgent need energiAes the organis until it is et or is supersededby a ore )ital need. ?i)ing is a progression of needs, et and unet, achie)ing hoeostatic balance and going on to the ne/t oent and new need.Distur$ances o( the )ontact 7oundar%Chen the boundary between self and other becoes unclear, lost or ipereable, this results in a disturbance of the distinction between self and other, a disturbance of both contact and awareness 'see Perls, 19$3E Polster and Polster, 19$3,. !n good boundary functioning, people alternate between connecting and separating, between being in contact with the current en)ironent and withdrawal of attention fro the en)ironent. The contact boundary is lost in polar opposite ways in confluence and isolation. !n con(luence 'fusion,, the separation and distinction between self and other becoes so unclear that the boundary is lost. !n isolation, the boundary becoes so ipereable that connectedness is lost, i.e., the iportance of others for the self is lost fro awareness.5etro(lection is a split within the self, a resisting of aspects of the self by the self. This substitutes self for en)ironent, as in doing to self what one wants to do to soeone else or doing for self what one wants soeone else to do for self. This echanis leads to isolation. The illusion of self2sufficiency is one e/aple of retroflection as it substitutes self for en)ironent. +lthough one can do oneGs own breathing and chewing, the air and food ust coe fro the en)ironent. !ntrospection is a for of retroflection that can be pathological or healthy. 7or e/aple, resisting the ipulse to e/press anger ay ser)e to cope with a dangerous en)ironent. !n such a situation, biting oneGs lip ay be ore functionalthan saying soething biting.Through intro1ection, foreign aterial is absorbed without discriinating or assiilating. 9wallowing whole creates an Bas ifB personality and rigid character. !ntroDected )alues and beha)ior are iposed on self. +s in all contact boundary disturbances, swallowing whole can be healthy or pathological, depending on the circustances and degree of awareness. 7or e/aple, students ta"ing a lecture course ay, with full awareness that they are doing so, copy, eoriAe and regurgitate aterial without full Bdigestion.BPro1ection is a confusion of self and other that results fro attributing to the outside soething that is truly self. +n e/aple of healthy proDection is art. Pathological proDection results fro not being aware of and accepting responsibility for that which is proDected.De(lection is the a)oidance of contact or of awareness by turning aside, as when one is polite instead of direct. Deflection can be accoplished by not e/pressing directly or by not recei)ing. !n the latter case, the person usually feels BuntouchedBEin the forer case, the person is often ineffecti)e and baffled about not getting what is wanted. Deflection can be useful where, with awareness, it eets the needsof the situation 'e.g., where the situation needs cooling down,. -ther e/aples of deflection include not loo"ing at a person, )erbosity, )agueness, understating and tal"ing a$out rather than to 'Polster and Polster, 19$3, pp. 1929(,.8rganismic Sel(-5egulation0uan regulation is to )arying degrees either 'a, organisic, that is, based on a relati)ely full and accurate ac"nowledgent of what is, or 'b, Bshouldistic,B based on the arbitrary iposition of what soe controller thin"s should or should not be. This applies to intrapsychic regulation, to the regulation of interpersonal relations and to the regulation of social groups.BThere is only one thing that should control4 the situation. if you understand the situation you are in and let the situation you are in control our actions, then you learn to cope with lifeB '7. Perls, 19$6, p. 33,. Perls e/plicated the abo)e with an e/aple of dri)ing a car. !nstead of a preplanned progra, B! want to dri)e 6# iles per hour,B a person cogniAant of the situation will dri)e at different speed at night or differently when in traffic, or still differently when tired, and so on. 0ere Perls a"es it clear that Blet the situation controlB eans regulating through awareness of the conteporary conte/t, including oneGs wants, rather than through what was thought BshouldB happen.!n organisic self2regulation, choosing and learning happen holistically, with a natural integration of ind and body, thought and feeling, spontaneity and deliberateness. !n shouldistic regulation, cognition reigns and there is no felt, holistic sense.-b)iously, e)erything rele)ant to boundary regulation cannot be in full awareness. :ost transactions are handled by autoatic, habitual odes, with inial awareness. -rganisic self2regulation reFuires that the habitual becoe fully aware as needed. Chen awareness does not eerge as needed andHor does not organiAe the necessary otor acti)ity, psychotherapy is a ethod of increasing awareness and gaining eaningful choice and responsibility.Awareness+wareness and dialogue are the two priary therapeutic tools in Gestalt therapy. +wareness is a for of e/perience that ay be loosely defined as being in touch with oneGs own e/istence, with what is.?aura Perls states4The ai of Gestalt therapy is the awareness continuum, the freely ongoing Gestalt foration where what is of greatest concern and interest to the organis, the relationship, the group or society becoes Gestalt, coes into the foreground where it can be fully e/perienced and coped with 'ac"nowledged, wor"ed through, sorted out, changed, disposed of, etc., so that then it can elt into the bac"ground 'be forgotten or assiilated and integrated, and lea)e the foreground free for the ne/t rele)ant Gestalt. '19$3, p. (,7ull awareness is the process of being in )igilant contact with the ost iportant e)ents in the indi)idualHen)ironent field with full sensoriotor, eotional, cogniti)e and energetic support. !nsight, a for of awareness, is an iediate grasp of the ob)ious unity of disparate eleents in the field. +ware contact creates new, eaningful wholes and thus is in itself an integration of a proble.8ffecti)e awareness is grounded in and energiAed by the doinant present need of the organis. !t in)ol)es not only self2"nowledge, but a direct "nowing of the current situation and how the self is in that situation. +ny denial of the situation and its deands or of oneGs wants and chosen response is a disturbance of awareness. :eaningful awareness is of a self in the world, in dialogue with the world, and with awareness of -ther 22 it is not an inwardly focused introspection. +wareness is accopanied by owning, that is, the process of "nowing oneGs controlo)er, choice of, and responsibility for oneGs own beha)ior and feelings. Cithout this, the person ay be )igilant to e/perience and life space, but not to what powerhe or she has and does not ha)e. +wareness is cogniti)e, sensory and affecti)e. Theperson who )erbally ac"nowledges his situation but does not really see it, now it, react to it and (eel in response to it is not fully aware and is not in full contact. The person who is aware "nows what he does, how he does it, that he has alternati)es and that he chooses to be as he is.The act of awareness is always here and now, although the content of awareness ay be distant. The act of reebering is nowE what is reebered is not now. Chen the situation calls for an awareness of the past or anticipation of the future, effecti)e awareness ta"es this into account. 7or e/aple4P4 I:ooing more tense than usualJ ! donGt "now what to wor" on.T4 Chat are you aware of right nowKP4 ! a glad to see you, but !G tense about a eeting tonight with y boss. ! ha)e rehearsed and prepared and !G)e tried to support yself as ! wait.T4 Chat do you need right nowKP4 ! thought of putting her in the epty chair and tal"ing to her. .ut ! a so tense ! need to do soething ore physical. ! need to o)e, breathe, a"e noise.T4 I:ooing $ut remaining silentJP4 !tGs up to e, huhK IPause. Patient gets up, starts stretching, %awning. The mo'ements and sounds $ecome more 'igorous. A(ter a (ew minutes he sits down, looing more so(t and ali'e.J *ow !G ready.T4 You loo" ore ali)e.P4 *ow ! a ready to e/plore what had e so uptight about tonight.9elf2reDection and full awareness are utually e/clusi)e. @eDection of self is a distortion of awareness because it is a denial of who one is. 9elf2reDection is siultaneously a confusion of who B! aB and a self2deception, or Bbad faithB attitude of being abo)e that which is ostensibly being ac"nowledged '9artre, 1966,.9aying B! aB as if it were an obser)ation of another person, or as if the B!B were not chosen, or without "nowing how one creates and perpetuates that B! aB is bad faith rather than insightful awareness.5esponsi$ilit%People, according to Gestalt therapy, are responsible 'response2able,E that is, they are the priary agents in deterining their own beha)ior. Chen people confuse responsibility with blaing and shoulds, they pressure and anipulate thesel)esE they BtryB and are not integrated and spontaneous. !n such instances their true wants, needs and responses to the en)ironent and choices in the situation are ignored and they o)ercoply or rebel against shoulds.Gestalt therapists belie)e in the iportance of a clear distinction between what onechooses and what is gi)en. People are responsible for what they choose to do. 7or e/aple, people are responsible for their actions on behalf of the en)ironent. .laing outside forces 'e.g., genetics or parents, for what one chooses is self2deception. Ta"ing responsibility for what one did not choose, a typical shae reaction, is also a deception.People are responsible for oral choices. Gestalt therapy helps patients disco)er what is oral according to their own choice and )alues. 7ar fro ad)ocating Banything goes,B Gestalt therapy places a ost serious obligation on each person4 choosing and )aluing.;ariet% o( )onceptsGestalt therapy personality theory has e)ol)ed priarily out of clinical e/perience. The focus has been a theory of personality that supports our tas" as psychotherapists rather than an o)erall theory of personality. The constructs of Gestalt therapy theory are field theoretical rather than genetic and phenoenological rather than conceptual.+lthough Gestalt therapy is phenoenological, it also deals with the unconscious, that is, with what does not enter into awareness when needed. !n Gestalt therapy, awareness is concei)ed of as being in touch and unawareness as being out of touch.Lnawareness can be e/plained by a )ariety of phenoena, including learning whatto attend to, repression, cogniti)e set, character and style. 9i"in '19$6, copared personality to a floating ball 22 at any gi)en oent only a portion is e/posed while the rest is suberged. Lnawareness is the result of the organisGs not being in touch with its e/ternal en)ironent due to its being ostly suberged in its owninternal en)ironent or fantasies, or not being in touch with its inner life due to fi/ation on the e/ternal.Gestalt Therap% Theor% o( )hange>hildren swallow whole 'introDect, ideas and beha)ior. This results in an enforced orality rather than an organisically copatible orality. +s a result, people freFuently feel guilt when they beha)e in accordance with their wants as opposed to their shoulds. 9oe people in)est an enorous aount of energy in aintainingthe split between shoulds and wants 22 the resolution of which reFuires a recognition of their own orality as opposed to an introDected one. 9houlds sabotage such people, and the ore they push to be what they are not, the ore resistance is set up, and no change occurs..eisser ad)anced the theory that change does not happen through a Bcoerci)e attept by the indi)idual or by another person to change hi,B but does happen if the person puts in the tie and effort to be Bwhat he is,B Bto be fully in his current positionB '19$%, p. $%,. Chen the therapist reDects the change agent role, change that is orderly and also eaningful is possible.The Gestalt therapy notion is that awareness 'including owning, choice, and responsibility, and contact bring natural and spontaneous change. 7orced change isan attept to actualiAe an iage rather than to actualiAe the self. Cith awareness self2acceptance, and the right to e/ist as is, the organis can grow. 7orced inter)ention retards this process.The Gestalt psychology principle of PrShouldsBThere are no BshouldsB in Gestalt therapy. !n Gestalt therapy a higher )alue is placed on the autonoy and the self2deterination for the patient than on other )alues. This is not a should, but a preference. The no2should ethic ta"es precedenceo)er the therapistGs goals for the patient and lea)es the responsibility and sanctioning of the patientGs beha)ior to the patient 'of course, the inDunctions and reFuireents of society are not suspended Dust because the patient is in Gestalt therapy,.4ow &s the Therap% Done?Gestalt therapy is an e/ploration rather than a direct odification of beha)ior. The goal is growth and autonoy through an increase in consciousness. @ather than aintaining distance and interpreting, the Gestalt therapist eets patients and guides acti)e awareness wor". The therapistGs acti)e presence is ali)e and e/cited 'hence war,, honest and direct. Patients can see, hear and be told how they are e/perienced, what is seen, how the therapist feels, what the therapist is li"e as a person. Growth occurs fro real contact between real people. Patients learn how they are seen and how their awareness process is liited, not priarily by tal"ing about their probles, but by how they and the therapist engage each other.7ocusing runs the range fro siple inclusions or epathy to e/ercises arising ostly fro the therapistGs phenoenology while with the patient. 8)erything is secondary to the direct e/perience of both participants.The general approach of Gestalt therapy is to facilitate e/ploring in ways that a/iiAe what continues to de)elop after the session and without the therapist. The patient is often left unfinished but thoughtful or Bopened up,B or with an assignent. This is li"e a roast that continues to coo" after being reo)ed fro theo)en. This is in part how Gestalt therapy can be so intensi)e on fewer sessions per wee". Ce cooperate with growth occurring without usE we initiate where needed. Ce gi)e the degree of facilitation necessary to foster patient self2ipro)eent. Ce facilitate growth rather than coplete a cure process.Perls belie)ed that the ultiate goal of psychotherapy was the achie)eent of Bthataount of integration which facilitates its own de)elopentB '1951,. +n e/aple of this "ind of facilitation is the analogy of a sall hole cut into an accuulation ofsnow. -nce the draining process begins, the base that began as a sall hole enlarges by itself.9uccessful psychotherapy achie)es integration. !ntegration reFuires identification with all )ital functions 22 not with only some of the patientGs ideas, eotions and actions. +ny reDection of oneGs own ideas, eotions or actions results in alienation. @eowning allows the person to be whole. The tas", then, in therapy is to ha)e the person becoe aware of pre)iously alienated parts and taste the, consider the and assiilate the if they are ego2syntonic or reDect the if they pro)e to be ego2alien. 9i"in '1961, has used the siile of a ca"e in encouraging patients to reownthe parts of thesel)es that they ha)e considered no/ious or otherwise unacceptable4 although the oil, or flour, or ba"ing powder by thesel)es can be distasteful, they are indispensable to the success of the whole ca"e.The &-Thou 5elationGestalt therapy focuses on the patient, as any therapy does. 0owe)er, the relationship is horiAontal, thus differing fro the traditional therapy relationship. !nGestalt therapy the therapist and patient spea" the sae language, the language of present centeredness, ephasiAing direct e/perience of both participants. Therapists as well as patients in Gestalt therapy show their full presence.9ince its beginning, Gestalt therapy has ephasiAed the patientGs e/perience as well as the therapistGs o$ser'ation of what is not in the patientGs awareness. This allows the patient to act as an eFual who has full access to the data of his own e/perience so he can directly e/perience fro inside what is o$ser'ed by the therapist fro outside. !n an interpreti)e syste the patient is an aateur and does not ha)e the theoretical foundation for the interpretation. !t is assued that the iportant internal data are unconscious and not e/perienced.+n iportant aspect of the Gestalt therapy relationship is the Fuestion of responsibility. Gestalt therapy ephasiAes that both the therapist and the patient areself2responsible. Chen therapists regard thesel)es as responsible for patients, they collude with patientsG not feeling self2responsible and thereby reinforce the necessity for anipulation due to the belief that patients are unable to support and regulate thesel)es. 0owe)er, it is not enough (or the therapist to $e responsi$le (or sel( and (or the patient to $e responsi$le (or sel( 22 there is also an alliance of patient and therapist that ust be carefully constantly, and copetently attended to.Therapists are responsible for the Fuality and Fuantity of their presence, for "nowledge about thesel)es and the patient, for aintaining a nondefensi)e posture, and for "eeping their awareness and contact processes clear and atched to the patient. They are responsible for the conseFuences of their own beha)ior andfor establishing and aintaining the therapeutic atosphere.The Awareness o( *hat and 4ow!n Gestalt therapy there is a constant and careful ephasis on what the patient doesand how it is done. Chat does the patient faceK 0ow does the patient a"e choicesK Does the patient self2support or resistK Direct e/perience is the tool, and itis e/panded beyond what is at first e/perienced by continuing to focus deeper and broader. The techni3ues o( Gestalt therap% are e2perimental tass. The% are the means o( e2panding direct e2perience. These are not designed to get the patient somewhere, to change the patient+s (eelings, to recondition, or to (oster catharsis.4ere and =ow!n a phenoenological therapy BnowB starts with the present awareness of the patient. Chat happens first is not childhood, but what is e/perienced now. +wareness ta"es place now. Prior e)ents ay be the obDect of present awareness, but the awareness process 'e.g., reebering, is now.=ow ! can contact the world around e, or now ! can contact eories or e/pectations. *ot "nowing the present, not reebering, or not anticipating are alldisturbances. The present is an e)er2o)ing transition between the past and future. 7reFuently patients do not "now their current beha)ior !n soe cases patients li)e in the present as if they had no past. :ost patients li)e in the future as if it were now. +ll these are disturbances of tie awareness.B*owB refers to this moment. !n the therapy hour, when the patients refer to their li)es out of the hour, or earlier in the hour, that is not now. !n Gestalt therapy we orient ore to the now than in any other for of psychotherapy. 8/periences of thepast few inutes, days, years or decades that are of present iportance are dealt with. Ce attept to o)e fro tal"ing about to directly e/periencing. 7or e/aple, tal"ing to a person who is not physically present rather than tal"ing a$out that person obiliAes ore direct e/perience of feelings.!n Gestalt therapy this ! and Thou, what and how, here and now ethodology is freFuently used to wor" on characterological and de)elopental psychodynaics.7or e/aple, a 3%2year2old feale patient is in group therapy. 9he is in the iddle phase of therapy. 9he says she is )ery angry at a an in the group. -ne legitiate and freFuent Gestalt approach is B9ay it to hi.B !nstead, the therapist ta"es a different tac"4T4 You sound not only angry but soething ore.P4 Iloos interestedJT4 You sound and loo" li"e you are enraged.P4 ! a, ! would li"e to "ill hi.T4 You see to feel ipotent.P4 ! a.T4 !potence usually accopanies rage. Chat are you ipotent aboutKP4 ! canGt get hi to ac"nowledge e.T4 Ithe therapist+s o$ser'ations o( her pre'ious encounters with the man agree withthat statementJ and you donGt accept that.P4 *o.T4 +nd there is an intensity to your rage that sees to be greater than the situation calls for.P4 Inods and pausesJT4 Chat are you e/periencingKP4 + lot of en in y life who ha)e been li"e that.T4 ?i"e your fatherK Ithis comes (rom prior wor with patient and isn+t a shot in thedar. The wor proceeds into a ree2periencing the narcissistic in1ur% (rom her (ather, who was ne'er responsi'e to herJProcess of PsychotherapyGestalt therapy probably has a greater range of styles and odalities than any othersyste. !t is practiced in indi)idual therapy, groups, wor"shops, couples, failies, and with children. !t is practiced in clinics, faily ser)ice agencies, hospitals, pri)ate practices, growth centers, and so on. The styles in each odality )ary drastically on any diensions4 degree and type of structureE Fuantity and Fuality of techniFues usedE freFuency of sessionsE abrasi)eness2ease of relatingE focus on body, cognition, feelings, interpersonal contactE "nowledge of and wor" with psychodynaic theesE degree of personal encountering, and so forth.+ll styles and odalities of Gestalt therapy ha)e in coon the general principles we ha)e been discussing4 ephasis on direct e/perience and e/perienting 'phenoenology,, use of direct contact and personal presence 'dialogic e/istentialis,, and ephasis on the field concepts of what and how and here and now. Cithin these paraeters, inter)entions are patterned according to the conte/t and the personalities of the therapist and the patient.+t the heart of the ethodology is the ephasis on the difference between Bwor"B and other acti)ities, especially Btal"ing about.B Cor" has two eanings. 7irst, it refers to a deliberate, )oluntary and disciplined coitent to use phenoenologically focused awareness to increase the scope and clarity of oneGs life. Chen one o)es fro tal"ing about a proble or being with soeone in a general way to studying what one is doing, especially being aware of how one is aware, one is wor"ing. 9econd, in a group, wor" eans being the priary focus of the therapistGs andHor the groupGs attention.Differences in techniFues are not iportant, although the Fuality and type of therapeutic contact and a fit between the attitude and ephasis of the therapist and the patientGs needs are iportant. TechniFues are Dust techniFues4 the o)erall ethod, relationship, and attitude are the )ital aspects.*e)ertheless a discussion of soe techniFues or tactics ight elucidate the o)erall ethodology. These are only illustrati)e of what is possible.Techni3ues o( Patient 0ocusing+ll techniFues of patient focusing are elaborations of the Fuestion, BChat are you aware of 'e/periencing, nowKB and the instruction, BTry this e/perient and see what you becoe aware of 'e/perience, or learn.B :any inter)entions are as siple as as"ing what the patient is aware of, or ore narrowly, BChat are you feelingKB or BChat are you thin"ingKBBSta% with it.B + freFuent techniFue is to follow an awareness report with the instruction4 B9tay with itB or B7eel it out.BB9tay with itB encourages the patient to continue with the feeling that is being reported, which builds the patientGs capacity to deepen and wor" a feeling through to copletion. 7or e/aple4P4 Iloos sadJT4 Chat are you aware ofKP4 ! a sad.T4 9tay with it.P4 Itears well up. Then the patient tightens and loos awa% and starts to loo thought(ulJT4 ! see you are tightening. Chat are you aware ofKP4 ! donGt want to stay with the sadness.T4 9tay with the not wanting to. Put words to the not wanting to. Ithis inter'ention is liel% to $ring awareness o( the patient+s resistance to melting. The patient mightrespond: >& won+t cr% here -- & don+t trust %ou,> or >& am ashamed,> or >& am angr% and don+t want to admit & miss himBJ.nactment. 0ere the patient is as"ed to put feelings or thoughts into action. 7or e/aple, the therapist ay encourage the patient to Bsay it to the personB 'if present, or use soe "ind of role playing 'such as spea"ing to an epty chair if theperson is not present,. BPut words to itB is another e/aple. The patient with tears in his eyes ight be as"ed to Bput words to it.B 8nactent is intended as a way of increasing awareness, not as a for of catharsis. !t is not a uni)ersal reedy..2aggeration is a special for of enactent. + person is as"ed to e/aggerate soe feeling, thought, o)eent, etc., in order to feel the ore intense 'albeit artificial, enacted or fantasied )ision. 8nactent into o)eent, sound, art, poetry, etc., can both stiulate creati)ity and be therapeutic. 7or instance, a an who had been tal"ing about his other without showing any special eotion was as"ed to describe her. -ut of his description cae the suggestion to o)e li"e her. +s the patient adopted her posture and o)eent, intense feelings cae bac" into his awareness.Guided (antas%. 9oeties a patient can bring an e/perience into the here and nowore efficiently by )isualiAing than by enacting4P4 ! was with y girlfriend last night. ! donGt "now how it happened but ! was ipotent. Ipatient gi'es more detail and some histor%JT4 >lose your eyes. !agine it is last night and you are with your girlfriend. 9ay out lout what you e/perience at each oent.P4 ! a sitting on the couch. :y friend sits ne/t to e and ! get e/cited. Then ! go soft.T4 ?etGs go through that again in slow otion, in ore detail. .e sensiti)e to e)ery thought or sense ipression.P4 ! a sitting on the couch. 9he coes o)er and sits ne/t to e. 9he touches y nec". !t feels so war and soft, ! get e/cited 22 you "now, hard. 9he stro"es y ar, and ! lo)e it. Ipause, loos startledJ Then ! thought, ! had such a tense day, aybe ! wonGt be able to get it up.This patient becae aware of how he created his own an/iety and ipotence. This fantasy was recreating an e)ent that happened in order to get in better touch with it.The fantasy could be of an e/pected e)ent, a etaphorical e)ent, and so forth.!n another case, a patient wor"ing on shae and self2reDection is as"ed to iagine a other who says and eans B! lo)e you Dust the way you are.B +s the fantasy is gi)en detail, the patient attends to her e/perience. This fantasy helps the patient becoe aware for the possibility of good self2othering and can ser)e as a transition to integrate good self2parenting. The iage can be used to wor" between sessions or as a editation. !t also raises feelings about e/periences with abandonent, loss and bad parenting.:oosening and integrating techni3ues. -ften the patient is so fettered by the bonds of the usual ways of thin"ing that alternati)e possibilities are not allowed into awareness. This includes traditional echaniss, such as denial or repression, but also cultural and learning factors affecting the patientGs way of thin"ing. -ne techniFue is Dust to as" the patient to iagine the opposite of whate)er is belie)ed to be true.!ntegrating techniFues bring together processes the patient doesnGt bring together oracti)ely "eeps apart 'splitting,. The patient ight be as"ed to put words to a negati)e process, such as tensing, crying or twitching. -r when the patient )erballyreports a feeling, that is, an eotion, she ight be as"ed to locate it in her body. +nother e/aple is as"ing a patient to e/press positi)e and negati)e feelings aboutthe sae person.7od% techni3ues. These include any techniFue that brings patientsG awareness to their body functioning or helps the to be aware of how they can use their bodies to support e/citeent, awareness and contact. 7or e/aple4P4 Iis tear(ul and clamping 1aw tightJT4 Could you be willing to try an e/perientKP4 Ipatient nodsJT4 Ta"e soe deep, deep breaths and each tie you e/hale, let your Daw loosely o)e down.P4 I$reathes deepl%, lets 1aw drop on the e2haleJT4 9tay with it.P4 Istarts melting, cr%ing, then so$$ingJTherapist DisclosuresThe Gestalt therapist is encouraged to a"e B!B stateents. 9uch stateents facilitate both the therapeutic contact and the patientGs focusing and are to be ade discriinatingly and Dudiciously. Lsing the B!B to facilitate therapeutic wor" reFuires technical s"ill, personal wisdo and self2awareness on the therapistGs part.Therapists ay share what they see, hear or sell. They can share how they are affected. 7acts of which the therapist is aware and the patient is not are shared, especially if the inforation is unli"ely to be spontaneously disco)ered in the phenoenological wor" during the hour, yet is belie)ed to be iportant to the patient.&echanis#s of Psychotherapy8ld De(icits, =ew StrengthsThe child needs a parental relationship with a nurturant, organisicHen)ironental,ecological balance. 7or e/aple, a other ust see that a childGs needs are et andthat the de)elopent of its potentialities are facilitated. + child needs this war, nurturing "ind of irroring. +nd a child also needs roo to struggle, to be frustrated, and to fail. + child also needs liits to e/perience the conseFuences of beha)ior. Chen parents cannot eet these needs because they need a dependent child or lac" sufficient inner resources, the child de)elops distorted contact boundaries, awareness and lowered self2estee.Lnfortunately, children are often shaped to eet the appro)al of parents on their own needs. +s a result, the spontaneous personality is superseded by an artificial one. -ther children coe to belie)e they can ha)e their own needs et by others without consideration for the autonoy of others. This results in the foration of ipulsi)ity rather than spontaneity.Patients need a therapist who will relate in a healthy, contactful anner, neither losing self by indulgent the patient at the e/pense of e/ploration and wor"ing through nor creating e/cessi)e an/iety, shae and frustration by not being respectful, war, recepti)e, direct and honest.Patients who enter psychotherapy with decreased awareness of their needs and strengths, resisting rather than supporting their organisic self, are in pain. They try to get the therapist to do for the what they belie)e they cannot do for thesel)es. Chen therapists go along with this, patients do not reown and integratetheir lost or ne)er2de)eloped potential. Therefore they still cannot operate with organisic self2regulation, being responsible for thesel)es. They do not find out if they ha)e the strength to e/ist autonoously because the therapist eets their needs without strengthening their awareness and ego boundaries 'see @esnic", 19$%,.+s Gestalt therapy proceeds and patients learn to be aware and responsible and contactful, their ego functioning ipro)es. +s a result, they gain tools for deeper e/ploration. The childhood e/periences of the forati)e years can then be e/ploredwithout the regression and o)erdependency necessary in regressi)e treatent and without the teporary loss of copetence that a transference neurosis entails. >hildhood e/periences are brought into present awareness without the assuption that patients are deterined by past e)ents. Patients acti)ely proDect transference aterial on the Gestalt therapist, thereby gi)ing opportunities for deeper e/ploration.The following two e/aples show patients with different defenses, needing different treatent, but with siilar underlying issues.To was a 5#2year2old an proud of his intelligence, self2sufficiency and independence. 0e was not aware that he had unet dependency needs and resentent. This affected his arriage in that his wife felt unneeded and inferior because she was in touch with needing and showed it. This anGs self2sufficiency reFuired respect 22 it et a need, was in part constructi)e and was the basis of his self2estee.P4 Iwith prideJ Chen ! was a little "id y o was so busy ! Dust had to learn to rely on yself.T4 ! appreciate your strength, and when ! thin" of you as such a self2reliant "id ! want to stro"e you and gi)e you soe parenting.P4 Itearing a littleJ *o one has been able to do that for e.T4 You see sad.P4 ! a reebering when ! was a "id.... Ie2ploration led to awareness o( a shamereaction to una'aila$le parents and a compensator% sel(-relianceJ.ob was a 5#2year2old an who felt shae and isolated hiself in reaction to any interaction that was not totally positi)e. 0e was consistently reluctant to e/perient with self2nourishent.P4 Iwhin% 'oiceJ ! donGt "now what to do today.T4 Iloos and does not talJP4 ! could tal" about y wee". Iloos 3uestioningl% at therapistJT4 ! feel pulled on by you right now. ! iagine you want e to direct you.P4 Yes. ChatGs wrong with thatKT4 *othing. ! prefer not to direct you right now.P4 Chy notKT4 You can direct yourself. ! belie)e you are directing us away fro your inner selfright now. ! donGt want to cooperate with that. IsilenceJP4 ! feel lost.T4 Iloos and does not talJP4 You are not going to direct e, are youKT4 *o.P4 Cell, letGs wor" on y belie)ing ! canGt ta"e care of yself. Ipatient directs a (ruit(ul piece o( wor that leads to awareness o( a$andonment an2iet% and (eelings o( shame in response to una'aila$le parentsJ0rustration and SupportGestalt therapy balances frustration and support. The therapist e/plores rather than gratifies the patientGs wishes 22 and this is frustrating for the patient. Pro)iding contact is supporti)e, although honest contact frustrates anipulation. The Gestalt therapist e/presses self and ephasiAes e/ploring, including e/ploring desire, frustration and indulgence. The therapist responds to anipulations by the patient without rein(orcing them,without Dudging and without being purposely frustrating. + balance of warth and firness is iportant.The Parado2ical Theor% o( )hangeThe parado/ is that the ore one tries to be who one is not, the ore one stays the sae '.eisser, 19$%,. :any patients focus on what they Bshould beB and at the sae tie resist these shoulds.The Gestalt therapist attepts to wor" toward integration by as"ing the client to identify with each conflicting role. The client is as"ed what he or she e/periences at each oent. Chen the client can be aware of both roles, integrating techniFuesare used to transcend the dichotoy.There are two a/ios in Gestalt therapy4 BChat is, is,B and B-ne thing leads to anotherB 'Polster and Polster, 19$3,. The ediu of change is a relationship with atherapist who a"es contact based on showing who he or she truly is and who understands and accepts the patient.+wareness of Bwhat isB leads to spontaneous change. Chen the person anipulating for support finds a therapist who is contactful and accepting and who does not collude with the anipulation, he ay becoe aware of what he is doing. This Aha@ is a new gestalt, a new outloo", a taste of new possibility4 B! can be with soeone and not anipulate or be anipulated.B Chen such a person eets BtherapeuticB collusion, derision, ind gaes, gae busting and so on, this increase in awareness is unli"ely to happen.+t each and e)ery point along the way this new Aha@ can occur. +s long as the therapist or the patient can see new possibilities and the patient wants to learn, new Aha@+s are possible and with the, growth. +wareness wor" can start anywhere the patient is willing, if the therapist is aware and connects it to the whole. The ensuing process in Gestalt therapy leads to changes e)erywhere in the field. The ore thorough the in)estigation, the ore intense the reorganiAation. 9oe changes can only be appreciated years later.Patients in Gestalt therapy are in charge of their li)es. The therapist facilitates attention to opening restricted awareness and areas of constricted contact boundariesE the therapist brings firness and liits to areas with poor boundaries. +s sensing increases in accuracy and )i)idness, as breathing becoes fuller and ore rela/ed and as patients a"e better contact, they bring the s"ills of therapy into their li)es. 9oeties intiacy and Dob ipro)eents follow Gestalt wor" li"e an act of grace, without the patientGs connecting the increase to the wor" done in therapy. .ut the organis does grow with awareness and contact. -ne thing does lead to another.ApplicationsPro$lemsGestalt therapy can be used effecti)ely with any patient population that the therapist understands and feels cofortable with. !f the therapist can relate to the patient, the Gestalt therapy principles of dialogue and direct e/periencing can be applied. Cith each patient, general principles must $e adapted to the particular clinical situation. !f the patientGs treatent is ade to confor to BGestalt therapy,Bit can be ineffecti)e or harful. + schiAophrenic, a sociopath, a borderline and an obsessi)e2copulsi)e neurotic ay all need different approaches. Thus, the competent practice o( Gestalt therap% re3uires a $acground in more than Gestalt therap%. + "nowledge of diagnosis, personality theory and psychodynaic theory is also needed.The indi)idual clinician has a great deal of discretion in Gestalt therapy. :odifications are ade by the indi)idual therapist according to the therapeutic style, personality, diagnostic considerations, and so on. This encourages and reFuires indi)idual responsibility by the therapist. Gestalt therapists are encouragedto ha)e a fir grounding in personality theory, psychopathology and theories and applications of psychotherapy, as well as adeFuate clinical e/perience. Participants in the therapeutic encounter are encouraged to e/perient with new beha)ior and then share cogniti)ely and eotionally what the e/perience was li"e.Gestalt therapy has traditionally been considered ost effecti)e with Bo)erly socialiAed, restrained, constricted indi)idualsB 'an/ious, perfectionistic, phobic anddepressed clients,, whose inconsistent or restricted functioning is priarily a result of Binternal restrictionsB '9hepherd, 19$%, pp. (3523#,. 9uch indi)iduals usually show only a inial enDoyent of li)ing.+lthough 9hepherdGs stateent accurately delineates a population Gestalt therapy is effecti)e with, current clinical practice of Gestalt therapy includes treatent of a uch wider range of probles.Gestalt therapy in the BPerlsianB wor"shop style is of ore liited application thanGestalt therapy in general 'Dolli)er, 1911E Dublin, 19$6,. !n 9hepherdGs discussion of liitations and cautions, she notes restrictions that apply to any therapist but should especially be noted in a wor"shop setting, as well as by therapists not well trained or e/perienced with disturbed patient populations.Cor" with psychotic, disorganiAed, or otherwise se)erely disturbed people is ore difficult and calls for Bcaution, sensiti)ity and patience.B 9hepherd ad)ises against doing such wor" where it is not feasible to a"e a Blong2ter coitentB to the patient. Disturbed patients need support fro the therapist and at least a inial aount of faith in their own natural healing capacity before they can e/plore deeply and e/perience intensely the Bo)erwheling pain, hurt, rage and despairB that underlie the psychological processes of disturbed patients '9hepherd, 19$%, pp.(3523#,.Cor"ing with ore disturbed populations reFuires clinical "nowledge of how to balance support and frustration, "nowledge of character dynaics, need for au/iliary support 'such as day treatent and edication, and so forth. 9oe stateents which see to a"e sense in a wor"shop encounter are ob)ious nonsense when applied in a broader conte/t. >onsider for e/aple, Bdo your own thingB in the conte/t of treatent with acting out patientsM+ perusal of the Gestalt therapy literature such as Gestalt Therap% =ow '7agan and9hepherd, 19$%,, The Growing .dge o( Gestalt Therap% '9ith, 19$6, and The Gestalt Journal, will show that Gestalt therapy is used for crisis inter)ention, ghetto adults in a po)erty progra '.arnwell, 1961,, interaction groups, psychoticsand alost any group iaginable. Lnfortunately the literature pro)ides e/aples 'and a sall nuber at that, without sufficient e/plication of necessary alterations in focus and without discussing negati)e results.Gestalt therapy has been successfully eployed in the treatent of a wide range of BpsychosoaticB disorders including igraine, ulcerati)e colitis and spastic nec" and bac". Gestalt therapists ha)e successfully wor"ed with couples, with indi)iduals ha)ing difficulties coping with authority figures and with a wide range of intrapsychic conflicts. Gestalt therapy has been effecti)ely eployed with psychotics and se)ere character disorders..ecause of the ipact of Gestalt therapy and the ease with which strong, freFuently buried affecti)e reactions can be reached, it is necessary to establish safety islands to which both the therapist and patient can cofortably return. !t is also iperati)e for the therapist to stay with the patient until he or she is ready to return to these safety islands. 7or e/aple, after an especially eotion laden e/perience, the patient ay be encouraged to a"e )isual, tactile or other contact with the therapist or with one or ore group ebers and report the e/perience. +nother safety techniFue is to ha)e the patient shuttle bac" and forth between a"ing contact in the now with the therapist or group ebers and with the eotionally laden unfinished situation that the patient was e/periencing then until all of the affect has been discharged and the unfinished situation wor"ed through.The Gestalt therapy ephasis on personal responsibility, interpersonal contact and increased clarity of awareness of what is, could be of great )alue in eeting the probles of the present. -ne e/aple is application of Gestalt therapy in schools '.rown, 19$%E ?ederan, 19$%,..'aluationGestalt therapists are singularly unipressed with foral psychodiagnostic e)aluation and noothetic research ethodology. *o statistical approach can tell the indi)idual patient or therapist what wor"s for hi or her. Chat is shown to wor" for ost does not always wor" for a particular indi)idual. This does not eanthat Gestalt therapists are not in fa)or of researchE in fact, the Gestalt Therapy !nstitute of ?os +ngeles has offered grants to subsidiAe research. Perls offered no Fuantified, statistical e)idence that Gestalt therapy wor"s. 0e did say, Bwe present nothing that you cannot )erify for yourself in ters of your own beha)iorB '7. Perlset al., 19#1, p. $,. !n the publication Gestalt Therap%, a series of e/perients are pro)ided that can be used to test for oneself the )alidity of Gestalt therapy.8ach session is seen as an e/perient, an e/istential encounter in which both the therapist and the patient engage in calculated ris" ta"ing 'e/perients, in)ol)ing e/ploration of heretofore un"nown or forbidden territories. The patient is aided in using phenoenological focusing s"ills and dialogic contact to e)aluate what is and is not wor"ing. Thus, constant idiographic research ta"es place. Gestalt therapyhas Bsacrificed e/act )erification for the )alue in ideographic e/periental psychotherapyB 'Yontef, 1969, p. ($,.0aran '1915, re)iewed Gestalt research literature and found Fuality research on Gestalt therapy sparse. 0e did find studies that showed increased self2actualiAation and positi)e self2concept following Gestalt therapy groups '7oulds and 0annigan, 19$6E Giunan and 7oulds, 19$%,.+ series of studies conducted by ?eslie Greenberg and associates 'Greenberg, 1916, addressed the lac" of attention to conte/t in psychotherapy research and the unfortunate separation of process and outcoe studies. The Greenberg studies related specific acts and change processes in therapy with particular outcoes. Their research distinguished three types of outcoe 'iediate, interediate and final, and three le)els of process 'speech act, episode and relationship,. They studied speech in the conte/t of the type of episodes in which it appears, and they studied the episodes in the conte/t of the relationships in which they occur.!n one study Greenberg e/ained the use of the two2chair techniFue to resol)e splits. 0e defined a split as Ba )erbal perforance pattern in which a client reports a di)ision of the self process into two partial aspects of the self or tendencies.B 0e concludes that Btwo2chair operations conducted according to the principles Iof his studyJ ha)e been found to facilitate an increase in the Depth of 8/periencing and inde/ of producti)e psychotherapy...and to lead to resolutions of splits with populations see"ing counselingB '19$9, p. 3(3,.+ study called the B8ffects of Two2>hair Dialogues and 7ocusing on >onflict @esolutionB by ?. 9. Greenberg and 0. :. 0iggins found that BTwo2chair dialogue appeared to produce a ore direct e/perience of conflict IsplitJ and encouraged theclient in a for of self2confrontation that helped create a resolution to the conflictB '191%, p. ((5,.0aran '1915, found a nuber of studies that copared the beha)ior of Gestalt therapists with that of other therapists. .runnin" and 9chroeder copared e/pert psychoanalysts, beha)ior therapists and Gestalt therapists and found the Gestalt therapists Bpro)ided ore direct guidance, less )erbal facilitation, less focus on theclient, ore self2disclosure, greater initiati)e and less eotional support.B They also found that the Binter)iewB content of Gestalt therapists tended to reflect a ore e/periential or subDecti)e approach to therapyB '19$9, p. #$(,.*o clai is ade in the Gestalt therapy literature that Gestalt therapy is deonstrated to be the Bbest.B There is theoretically no reason why Gestalt therapy should be ore generally effecti)e than therapies under other naes that follow theprinciples of good psychotherapy. General outcoe research ay yield less useful results than process research loo"ing at beha)ior, attitudes and conseFuences. +n e/aple of this is 9i"inGs assessent of the effecti)eness of Gestalt therapy in wor"shops 'Bassed learningB, as contrasted with BspacedB wee"ly therapy sessions. 0e found e)idence for the superiority of assed learning '9i"in, 19$6,.9oe Gestalt therapy )iewpoints on what constitutes good therapy are supported by general research. The research on e/periencing within the @ogerian tradition deonstrated the effecti)eness of an ephasis on direct e/perience by any therapist. !n Gestalt therapy there is also an ephasis on personal relating, presence and e/perience. Lnfortunately, soe therapists regularly and blatantly )iolate the principles of good psychotherapy according to the Gestalt therapy odel, but still call thesel)es Gestalt therapists '?ieberan, Yalo and :iles, 19$3,.Treat#ent8ngoing &ndi'idual Gestalt Therap%+lthough Gestalt therapy has acFuired a reputation for being priarily applicable to groups, its ainstay is actually indi)idual treatent. 9e)eral e/aples can be found in Gestalt Therap% =ow '7agan and 9hepherd, 19$%,. +n annotated bibliography of case readings can be found in 9i"in '19$9, p. (99,.Gestalt therapy begins with the first contact. -rdinarily, assessent and screening are done as a part of the ongoing relationship rather than in a separate period of diagnostic testing and social history ta"ing. The data for the assessent are obtained by beginning the wor", for e/aple, by therapeutic encounter. This assessent includes the patientGs willingness and support for wor" within the Gestalt therapy fraewor", the atch of patient and therapist, the usual professional diagnostic and characterological discriinations, decisions on freFuency of sessions, the need for adDuncti)e treatent and the need for edical consultation.+n a)erage freFuency for sessions is once per wee". Lsing the Gestalt ethodology, an intensity eFui)alent to psychoanalysis can often be achie)ed at this freFuency. -ften indi)idual therapy is cobined with group therapy, wor"shops, conDoint or faily therapy, o)eent therapy, editation, or biofeedbac" training. 9oeties patients can utiliAe ore freFuent sessions, but often they need the inter)al to digest aterial and ore freFuent sessions ay result in o)erreliance on the therapist. 7reFuency of sessions depends on how long the patient can go between sessions without loss of continuity, decopensation, or lesser fors of relapse. 7reFuency of sessions )aries fro fi)e ties per wee" to e)ery other wee". :eeting less freFuently than e)ery wee" ob)iously diinishes intensity unless the patient attends a wee"ly group with the sae therapist. :ore than twice a wee" is ordinarily not indicated, e/cept with psychotics, and is definitely contraindicated with borderline personality disorders.+ll through the therapy patients are encouraged and aided in doing the decision a"ing for thesel)es. Chen to start and stop, whether to do an e/ercise, what adDuncti)e therapies to use, and the li"e are all discussed with the therapist, but the copetence and ultiate necessity for the patient to a"e these choices is supported.Group 6odelsGestalt therapy groups )ary fro one and one2half to three hours in length, with ana)erage length of two hours. + typical two2hour group has up to 1% participants. Gestalt therapists usually e/perience a/ial in)ol)eent with heterogeneous groups, with a balance of en and woen. Participants need to be screened. +ny age is appropriate for Gestalt therapy, but an ongoing pri)ate practice group would typically range fro ages (% to 6# with the a)erage between 3% and #%.9oe Gestalt therapists follow PerlsG lead in doing one2on2one therapy in the groupsetting and use the Bhot seatB structure. B+ccording to this ethod, an indi)idual e/presses to the therapist his interest in dealing with a particular proble. The focus is then on the e/tended interaction between patient and group leader '! and Thou,B '?e)its"y and 9i"in, 19$(, p. (5%,. -ne2on2one episodes a)erage (% inutes, but range fro a couple of inutes to 5# inutes. During the one2on2one wor", the other ebers reain silent. +fter the wor", they gi)e feedbac" on how they were affected, what they obser)ed, and how their own e/periences are siilar to those the patient wor"ed on. !n recent years the one2on2one wor" has been e/panded to include awareness wor" that is not focused around a particular proble.!n the early 196%s Perls wrote a paper in which he said4?ately, howe)er, ! ha)e eliinated indi)idual sessions altogether e/cept for eergency cases. +s a atter of fact, ! ha)e coe to consider that all indi)idual therapy is obsolete and should be replaced by wor"shops in Gestalt therapy. !n y wor"shops ! now integrate indi)idual and group wor". '196$, p. 3%6,This opinion was not then shared by ost Gestalt therapists, and is not currently recogniAed Gestalt theory or practice.9oe obser)ers ha)e described the Gestalt therapistGs style of group wor" as doing indi)idual therapy in a group setting. This stateent is )alid for those Gestalt therapists who use the odel Dust discussed and do not ephasiAe or deal with group dynaics or stri)e for group cohesi)eness. 0owe)er, this is only one style ofGestalt therapy 22 any Gestalt therapists do ephasiAe group dynaics.Greater use of the group is certainly within the Gestalt ethodology and is increasingly used in Gestalt therapy '8nright, 19$#E 7eder and @onall, 191%E Nin"er, 19$$,. This includes greater in)ol)eent of group ebers when an indi)idual is doing one2on2one wor", wor"ing on indi)idual thees by e)eryone inthe group, ephasis on interrelationships 'contact, in the group, and wor"ing with group processes per se. The )aried degree and type of structure pro)ided by the leader include structured group e/ercises or no structured group e/ercises, obser)ing the groupGs e)ol)ing to its own structure, encouraging one2on2one wor", and so on. -ften Gestalt groups begin with soe e/ercise to help participants a"ethe transition into wor"ing by sharing here2and2now e/perience.+ freFuently used odel is one that encourages both increased awareness through focus on contact between group ebers and one2on2one wor" in the group 'with other ebers encouraged to participate during the wor",. This encourages greaterfluidity and fle/ibility.*orshop St%le9oe Gestalt therapy and a good deal of training in Gestalt therapy is conducted inwor"shops, which are scheduled for a finite period, soe for as short as one day. Cee"end wor"shops ay ranged fro 1% to (% or ore hours. ?onger wor"shops range fro a wee" through se)eral onths in duration. + typical wee"end wor"shop ebership consists of one Gestalt therapist and 1( to 16 people. Gi)enlonger periods 'ranging fro one wee" up to a onth or longer,, as any as (% people can be seen by one therapist. Lsually if the group is larger than 16 participants, co2therapists are used..ecause wor"shops ha)e a finite life and because Dust so any hours are a)ailable to the participants, there is usually high oti)ation to Bwor".B 9oeties, rules areestablished so that no one can wor" a second tie until e)ery other participant has had an opportunity to wor" once. +t other ties, no such rules are set. Thus, depending on their willingness, audacity and dri)e, soe people ay get intense therapeutic attention se)eral ties during a wor"shop.+lthough soe wor"shops are arranged with established groups, ost asseble people for the first tie. +s in ongoing groups, the ideal practice is to screen patients before the wor"shop. +n unscreened wor"shop reFuires a clinician e/perienced with the range of se)ere pathology and careful protection for possibly )ulnerable group ebers. >onfronti)e or charisatic Gestalt styles are particularly li"ely to e/acerbate e/isting ental illness in soe participants '?ieberan et al., 19$3,.8ther Treatment 6odalitiesThe application of Gestalt therapy to wor"ing with failies has been ost e/tensi)ely elaborated by Calter ;epler '19$3, pp. (#1216,. The ost coplete description of ;eplerGs wor" appears in hisPrinciples o( Gestalt 0amil% Therap% '19$5,.Gestalt therapy has also been used in short2ter crisis inter)ention '-G>onnell, 19$%,, as an adDunct treatent for )isual probles '@osanes2.erret, 19$%,, for awareness training of ental health professionals '8nright, 19$%,, for children withbeha)ior probles '?ederan, 19$%,, to train staff for a day2care center '8nnis and:itchell, 19$%,, to teach creati)ity to teachers and others '.rown, 19$%,, with a dying person 'Nin"er and 7in", 1966,, and in organiAation de)elopent '0eran, 19$(,.6anagement>ase anageent by a Gestalt therapist tends to be Fuite practical and guided by the goal of supporting the person2to2person relationship. +ppointents are usually arranged o)er the telephone by the therapist. -ffice decor reflects the personality and style of the therapist and is not purposely neutral. The offices are designed and furnished to be cofortable and to a)oid a des" or table between therapist and patient. Typically the physical arrangeent lea)es roo for o)eent and e/perientation. The therapistGs dress and anner are usually Fuite inforal.+rrangeent of fees )aries with the indi)idual, and there is no particular Gestalt style, e/cept straightforwardness. 7ees are discussed directly with the patient and usually collected by the therapist.>larity of boundaries is stressed, with both the patient and the therapist responsiblefor attending to the tas" at hand. The Bwor",B or therapy, starts fro the first oent. *o notes are ta"en during the session because it interferes with contact. The therapist ta"es personal responsibility for note ta"ing after the session, if needed, and for safeguarding notes, )ideo or tape recordings and other clinical aterial. The therapist sets down conditions of payent, cancellation policy, and so forth. 3iolations or obDections are directly discussed. Decisions are ade together and agreeents are e/pected to be "ept by both. The therapist arranges theoffice to protect it fro in)asion, and where possible, soundproofs the office.The e)aluation process occurs as part of the therapy and is utual. 9oe of the considerations in)ol)ed in the e)aluation process include deciding on indi)idual andHor group therapy, estiating the therapistGs capacity to establish a trusting, caring relationship, and letting the patient decide after an adeFuate saple if the therapist and the therapy are suitable.Probles arising in the relationship are discussed directly, both in ters of dealing with the concrete proble and in ters of e/ploring any related characterological life2styles or relationship processes that would be fruitful for the patient to e/plore.+lways the needs, wishes and direct e/perience of both participants guide the e/ploration and proble sol)ing.)ase .2amplePeg was originally seen in a Gestalt training wor"shop, where she wor"ed on the grief and anger she felt toward her husband, who had coitted suicide. 0is deathleft her with the full responsibility for raising their children and beginning a career outside the hoe to support herself and her faily. 9he was in her late 3%s at the tie.Cith considerable courage and initiati)e, Peg had organiAed a crisis clinic sponsored by a proinent ser)ice organiAation in the large 9outhern >alifornia cityin which she resided. 9he was one of 11 people who participated in a"ing a Gestalt therapy training fil with 9i"in '1969,. The following is e/cerpted fro the fil, &n the =ow4Peg4 ! ha)e a ...recurring drea. !G standing on the ground, up by >ap Pendleton. ThereGs an open, rolling countryside. Cide dirt roads crisscrossing all o)er it. + series of hills and )alleys and hills and )alleys....+nd off to y right ! seea tan", li"e in the ary 22 arine tan"s with the big trac"s...and thereGs a series of the and theyGre all closed tight and theyGre rubling o)er these hills and )alleys ina line, all closed up. +nd !G standing beside this road and !G holding a platter of Tollhouse coo"ies. +nd theyGre hot coo"ies. +nd they are Dust on the platter 22 !G Dust standing there, and ! see these tan"s coing by one at a tie. +nd as the tan"s coe past, ! stand there and ! watch the tan"s. +nd as ! loo" to y right ! see one 22 and thereGs a pair of shiny blac" shoes, running along between the treads of the tan" as it coes o)er the hill. +nd Dust as it gets in front of e...the an bends down and the tan" goes on, and he coes o)er toward e and itGs y best friendGs husband. +nd ! always wa"e up. ! always stop y drea...and ! laughed. !t doesnGt see so funny anyore.Ji4 True. Chat are you doingKPeg4 Trying to stop y teeth fro chattering.Ji4 ChatGs your obDectionKPeg4 ! donGt li"e the feeling of an/iety and fear ! ha)e now.Ji4 Chat do you iagineKPeg4 @idicule.Ji4 -"ay. 9tart ridiculing.Peg4 Peg, youGre ridiculous. YouGre fat...youGre laAy. YouGre Dust coic. YouGre pretending to be grown up and youGre not. 8)erybody loo"ing "nows that youGre a "id inside, asFuerading as a 392year2old woan and...itGs a ridiculous disguise. You ha)enGt any business being 39. + ridiculous age. YouGre coic. You ha)e a Dob you donGt ha)e the reotest idea how to do. YouGre a"ing all "inds of grandiose plans that you ha)enGt brains enough to carry through and people are going to be laughing at you.Ji4 -"ay, now please loo" around and note how people are laughing at you.Peg4 !G scared to. I:oos around, slowl%J They appear to be ta"ing e Fuite seriously.Ji4 9o who is laughing at youKPeg4 ! guess...only y fantasy...y...Ji4 Cho creates your fantasyKPeg4 ! do.Ji4 9o whoGs laughing at youKPeg4 Yeah. ThatGs so. !...!G really laughing at whatGs not funny. !G not so daned incopetent. IpauseJJi4 Chat are you really good atKPeg4 !G good with people. !G not Dudgental. !G good at "eeping house. !G a good seastress, good ba"er, !...Ji4 :aybe youGll a"e soebody a good wife.Peg4 ! did.Ji4 :aybe youGll a"e soebody a good wife again.Peg4 ! donGt "now.Ji4 9o say that sentence. B! donGt "now if !Gll e)er a"e soebody a good wife again.BPeg4 ! donGt "now if !Gll e)er a"e soeone a good wife again.Ji4 9ay that to e)ery an here.Peg4 ! donGt "now if !Gll a"e s