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psychotherapy theory research practice training copyright 2004 by the educational publishing foundation 2004 vol 41 no 2 180 189 0033 3204 04 12 00 doi 10 1037 0033 3204 41 ...

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                                           Psychotherapy: Theory, Research, Practice, Training                                                         Copyright 2004 by the Educational Publishing Foundation
                                           2004, Vol. 41, No. 2, 180–189                                                                               0033-3204/04/$12.00     DOI 10.1037/0033-3204.41.2.180
                                                            GESTALTTHERAPY:PAST,PRESENT, THEORY,
                                                                                                        ANDRESEARCH
                                                                                              LAURAE.WAGNER-MOORE
                                                                                            University of Massachusetts at Boston
                                           Orthodox gestalt therapy suffered a                                                   Classical Gestalt Theory and
                                           rather unfortunate fate; gestalt theory                                               Perls’s Eccentricities
                                           has been poorly articulated, and gestalt                                                  Fritz Perls has been simultaneously praised for
                                           techniques have received minimal                                                      his creative exuberance and criticized for aspects
                                           empirical validation. These weaknesses                                                of his style that simply defy the term scientifi-
                                           are, in part, a consequence of F.                                                     cally derived. The “Perlsian” form of gestalt
                                                                                                                                 therapy primarily embodies the history and per-
                                           Perls’s biographical history, which led                                               sonality of Perls himself, rather than a scientific,
                                           to an integration of disparate                                                        structured, empirically derived or theoretically
                                           theoretical models that were                                                          consistent model of psychotherapy. Gestalt
                                           exacerbated by F. Perls’s haphazard,                                                  theory is an intellectually fascinating, philosoph-
                                                                                                                                 ically complex set of diverse but poorly articu-
                                           idiosyncratic personal style. However,                                                lated and poorly substantiated beliefs.
                                           recent empirical research suggests that                                                   Conversely, it is interesting that the actual
                                           the 2-chair technique is superior to                                                  techniques used by gestalt therapists have been
                                           other therapeutic interventions for                                                   clearly delineated and have received some em-
                                           conflict splits, decisional conflict,                                                 pirical validation for their effectiveness. This dis-
                                           marital conflict, and unfinished                                                      junction between theory and research makes the
                                                                                                                                 study of gestalt theory and technique decidedly
                                           business and that the 2-chair technique                                               Byzantine and perplexing. This review and cri-
                                           is as effective as Rogerian and                                                       tique presents the most coherent aspects of gestalt
                                           cognitive–behavioral therapies.                                                       therapy that are based on principles of Gestalt
                                           Although F. Perls’s techniques may                                                    psychology and provides a review of recent em-
                                           have been generated largely from his                                                  pirical work on gestalt techniques.
                                                                                                                                     Historical context dictated a nomadic life for
                                           idiosyncratic personality                                                             Perls, with moves from Berlin (where he was
                                           characteristics, these techniques have                                                heavily influenced by psychoanalysis) to Johan-
                                           some validity for very specific                                                       nesburg in 1933, to New York in 1946, and later
                                           psychological dilemmas.                                                               to California. Geographic location seemed, in
                                                                                                                                 part, to influence Perls’s concepts and practice of
                                                                                                                                 psychotherapy, on the basis of his teacher “du
                                                                                                                                 jour.” As a result, Perls’s approach to gestalt
                                               Laura E. Wagner-Moore, Department of Psychology, Uni-                             theory and therapy was, at best, eclectic. He bor-
                                           versity of Massachusetts at Boston.                                                   rowed some ideas from his analysts, like Reich
                                               This article represents a modified paper written for a gradu-                     and Horney (Miller, 1974). As Miller (1974)
                                           ate school requirement at the University of Massachusetts at                          noted, Perls integrated Horney’s notion that “neu-
                                           Boston. Assistance was provided by Joan Liem, Ester Sha-                              rotic behavior is based on manipulation, designed
                                           piro, and Don Kalick, University of Massachusetts at Boston.                          to win love” (p. 5-24) and was attracted to “Sar-
                                               Correspondence regarding this article should be addressed                         trean” existentialism’s idea of individual respon-
                                           to Laura E. Wagner-Moore, PhD, whoisnowattheCenterfor                                 sibility and choice (Miller, 1974). In the wake of
                                           Child and Family Health, Duke University Medical Center,
                                           3518 Westgate Drive, Suite 100, Durham, NC 27707. E-mail:                             the zeitgeist of World War II, which was so heav-
                                           wagne032@mc.duke.edu                                                                  ily permeated by phenomenological and existen-
                                           180
                                                                                                                  Gestalt Therapy
                           tial thought, Perls rejected much of his analytic     1997). This process is best encapsulated in the
                           training in favor of the new zeitgeist (Yontef &      notion of figure–background gestalt formation
                           Simkin, 1989). From Jan Smuts, the prime min-         and destruction. Gestalt psychology suggests that
                           ister of South Africa, Perls borrowed the idea of     a mass of unstructured individual data in the en-
                           holism. Ironically, he initially had minimal expo-    vironment (i.e., parts) are subjectively structured
                           sure to or understanding of Gestalt psychology        by the perceiver into wholes that have both form
                           itself and has been criticized for this on several    and structure (Perls, Hefferline, & Goodman,
                           accounts (Wheeler, 1991). Wheeler (1991) noted        1951). The person’s actual experience is deter-
                           that Perls’s early work, titled Ego, Hunger and       minedbythegestalt, rather than the raw pieces of
                           Aggression, was simply revised and renamed The        data. The way in which multiple data are shaped
                           Beginnings of Gestalt Therapy (renamed at his         is based on the individual’s needs, appetites, and
                           wife’s suggestion) with little description of what    impulses.
                           Perls meant by Gestalt psychology or therapy.            These concepts can be applied to the realm of
                           Perls himself called the book “sketchy,” and          psychological needs as well. In theory, a need
                           WheelerconvincinglyarguedthatPerls’soriginal          arises and becomes foreground; if it is satisfied, it
                           text is full of “vague philosophical musings and      becomes background as the gestalt is completed.
                           self-aggrandizement in the Freudian manner”           Pathology arises when this process is disrupted.
                           (Wheeler, 1991, p. 43).                               When gestalt formation is
                              The fate of classical gestalt therapy is a sad     blocked or rigidified at any stage, when needs are not recog-
                           one, which finds itself without a clear set of bind-  nized or expressed, the flexible harmony and flow of the
                           ing theoretical principles and without a prolific     organism/environment field is disturbed [and] unmet needs
                           body of literature dedicated to the critical analy-   form incomplete gestalten that clamor for attention . . . and
                           sis and dialogue that could further its develop-      interfere with the formation of new gestalten. (Yontef, 1969,
                           ment. Miller, a practicing gestalt therapist and      as cited in Simkin, 1976, pp. 223–234)
                           student of Perls, argued that gestalt has “slipped    Aneed may be blocked by an unclear sensation
                           into a middle-aged decline” and is plagued by         or a lack of awareness of one’s needs (Greenberg
                           “a persistent intellectual thinness” (Miller, 1974,   &Rice, 1997). Therapeutic work focuses on in-
                           p. 21). Perls’s striking “anti-intellectual bias”     creasing awareness to bring about change, so that
                           (Miller, 1974) has been transmitted over time.        the emerging need may be identified, satisfied,
                           His famous “Lose your mind and come to your           and enabled to retreat into the background
                           senses” best embodies his preference for acquir-      (Simkin, 1976). Awareness of one’s experience
                           ing knowledge through experiencing and feeling        and needs is considered the “royal road to the
                           rather than through empirically validated or ra-      cure” (Greenberg & Rice, 1997).
                           tional, logical thought processes. Perls’s similar
                           preference for the idiographic over the nomothet-     Experience/Contact Cycle
                           ic makes the systematic study of gestalt quite           The processes underlying gestalt formation
                           challenging. Despite these difficulties, neo-         and destruction were obtusely described by Perls
                           gestaltists have successfully described Perlsian      as the experience/contact, or metabolism, cycle.
                           notions of gestalt therapy linked to classical ge-    Thecycle consists of four main phases, including
                           stalt psychological theory. The two concepts ex-      awareness, excitement, action, and contact. In
                           plained most completely involve (a) figure–           gestalt theory, the term contact does not equate
                           background gestalt formation and destruction and      with the popular definition meaning closeness.
                           (b) the contact/experience cycle, as they related     Gestalt theory uses the word contact as an ab-
                           to the etiology of psychopathology in gestalt         stract, formal concept that refers to the exchange
                           theory.                                               between an individual person and the surround-
                           Figure–Background Gestalt Formation                   ing environment (Miller, 1994). If the boundary
                                                                                 between the self and the environment (or other)
                              Perls, in keeping with other humanistic ap-        becomes unclear or lost, then there is a distur-
                           proaches, believed in the self-actualizing poten-     bance of contact and awareness (Yontef &
                           tial of the individual, which assumes that an or-     Simkin, 1989). When the cycle is functioning
                           ganism ultimately knows what is best for its self-    smoothly, awareness of internal or external
                           regulation and actualization (Greenberg & Rice,       stimuli leads to excitement, which potentiates an
                                                                                                                              181
                             Wagner-Moore
                             action tendency; the action tendency leads to             ure, against a background, rather than focusing
                             need satisfaction (optimally) and contact (Green-         ontheentire field. Second, the model is criticized
                             berg & Rice, 1997). Dysfunction is considered             for assuming cycle disturbances can always be
                             the interruption of the cycle at any stage (Green-        traced back to a problem in awareness itself. The
                             berg & Rice, 1997), and resistances to contact            model suggests that if an individual has aware-
                             account for these disruptions.                            ness of a goal and attempts to act on that impulse
                                Perls retained the traditional psychoanalytic          but ultimately fails in that action, the failure is
                             notion of defenses to explain additional disrup-          due to misunderstanding the need or not empow-
                             tions in the contact cycle including retroflection,       ering the need from the very beginning. Wheeler
                             introjection, projection, and deflection. For in-         (1991) has noted that failing to meet a goal may
                             stance, a break in the cycle between excitement           not solely be attributed to a problem with aware-
                             energy and action could be accounted for by ret-          ness; instead, the individual may have misper-
                             roflection, which occurs when a split within the          ceived the original problem or the individual may
                             self and resistance of aspects of the self take           have had clear awareness but difficulty following
                             place, wherein the self either (a) does to oneself        through with actions that would lead to a success-
                             what one wants to do to someone else or (b) does          ful outcome.
                             for the self what one wants someone else to do               For instance, survivors of posttraumatic stress
                             for the self (e.g., being overly self-sufficient, re-     may have developed a relatively clear awareness
                             sulting in isolation). In both cases, the self has a      of individual needs and desires while simulta-
                             need with energy, but the energy is diverted away         neously having cognitive distortions or inaccu-
                             from its natural object and turned back against           rate (or accurate) perceptions of environmental
                             itself (Wheeler, 1991). Increasing awareness is a         threat that impede recovery; in other words, con-
                             primary psychotherapeutic tool because the cycle          textual factors are quite relevant in decreasing
                             can be interrupted at the first stage if a need is        personal distress. Perls’s conceptualization
                             blocked by dull sensation or poor awareness               makes the individual unduly responsible for
                             (Greenberg & Rice, 1997).                                 meeting his or her own needs and simultaneously
                                Implicit in the model, however, is the assump-         fails to account for peculiarities in the environ-
                             tion that all disturbances in the cycle can be ul-        mentthatcounteract or conflict with the individu-
                             timately traced back to a problem with awareness          al’s need.
                             itself (Wheeler, 1991; Yontef & Simkin, 1989). It            Perls’s quirky beliefs, peppered throughout ge-
                             follows, then, that gestalt psychotherapy uses            stalt theory, may help uncover the mystery be-
                             here-and-now (present-centered) experiments in            hind several significant sources of weakness and
                             directed awareness to increase the individual’s           incongruence in the match between gestalt theory
                             awareness as well as the individual’s awareness           and therapeutic practice. There are multiple dan-
                             of the process of awareness (Yontef & Simkin,             gers inherent in considering individual impulses
                             1989). Contrary to traditional psychoanalytic             and needs of primary importance. Miller argued
                             methods of excavating the past, gestalt therapy           that Perls’s “aggressive self-expression borders
                             focuses on awareness and contact in the present           on what Sartre characterized as ‘that diligent and
                             moment, using methods that ultimately serve to            almost sadistic violence I call the full employ-
                             clarify present experiencing.                             ment of oneself”’(Miller, 1974, p. 19). One of
                                Perls’s experience-cycle model has been criti-         Perls’s great strengths, however, was his focus on
                             cized by philosophers of Gestalt psychology for           individual potential, although he failed to realize
                             its insistence on focusing on individual impulses         how destructive this position could be in rela-
                             or desires in isolation; significant contextual is-       tional contexts.
                             sues are either minimized or ignored. This is a              Perls believed that freeing oneself from com-
                             prime example of how gestalt theory often em-             mitment and dependence on others was essential
                             bodies a particular penchant of Perls’s personal-         (Perls, 1968). Perls embodied this ideal when,
                             ity structure rather than a predictable concept           after becoming established in New York, he left
                             driven by theoretical constructs.                         his wife and children and drifted westward to
                                The cycle, criticized by Goldstein (as cited in        pursue his own goals (Miller, 1974). Impulses
                             Wheeler,1991),hasbeenlabeled“figure-bound.”               and drives that are not moderated by reason, re-
                             This suggests that the model rests largely on the         straint, and consideration of the “other” can end
                             immediate need or impulse that has become fig-            up in frenzied, relatively autistic, and chaotic re-
                             182
                                                                                                                                           Gestalt Therapy
                                 lationships that lack reciprocity and empathy.                    tic style led to gimmicky techniques that flour-
                                 Perls’s focus on separateness and self-reliance                   ished. He was known to “sprinkle his audiences
                                 are reflected in the first few lines of his mantra                and trainees with slogans” as he made up new
                                 from Gestalt Therapy Verbatim:                                    techniques “on the fly,” which he presented as
                                 I do my thing, and you do your thing. I am not in this world      “the latest essence of Gestalt therapy” (Miller,
                                 to live up to your expectations. And you are not in this world    1994). Theory-driven, empirically validated tech-
                                 to live up to mine. You are you and I am I, and if by chance      nique was progressively abandoned and subse-
                                 we find each other it is beautiful. If not, it can’t be helped.   quently replaced by the methods generated by
                                 (Perls, 1968, p. 4)                                               Perls’s own dramatic, off-the-cuff flare.
                                 Unfortunately, although classical gestalt therapy                    Modern-day gestalt therapy has retained
                                 is more than capable of promoting self-reliance                   Perls’s applied phenomenological approach and
                                 and the drive toward individuation, it fails to ac-               creative techniques. Contrary to Perls’s style,
                                 knowledge the benefits inherent in relational and                 modern gestaltists consider the relationship be-
                                 intersubjective approaches to psychotherapy. The                  tween the therapist and client one of the most
                                 similarities between the greatest weakness in ge-                 important aspects of psychotherapy and use less
                                 stalt theory and Perls’s own style are striking and               stereotypic techniques (Yontef & Simkin, 1989).
                                 provide a way of understanding the peculiarities                  Yontef argued that traditional gestalt techniques
                                 of gestalt theory.                                                stressing skillful frustration, client manipulation,
                                                                                                   and self-sufficiency served to provoke shameful
                                 The Fate of Classical Gestalt Therapy and                         reactions in patients (Yontef & Simkin, 1989).
                                 the Rise of Modern Gestalt Therapy                                Yontef and others argued that modern gestalt
                                                                                                   therapy is less harsh (Aleksandrov, 1997; Yontef
                                    Almost 30 years have passed since Perls’s                      &Simkin, 1989) and has turned its focus to the
                                 death, and gestalt therapy has certainly changed,                 genuine contact between patient and therapist
                                 moving from the original Perlsian emphasis on                     (Greenberg & Rice, 1997; Yontef & Simkin,
                                 skillful frustration and self-reliance to a gentler,              1989). Although there are over 60 gestalt therapy
                                 “Rogerian-ized” version of gestalt therapy. The                   institutes throughout the world, no national orga-
                                 1960s version of gestalt included psychodrama                     nization or standards have been established
                                 techniques that contained a philosophy that em-                   as criteria for empirically validated gestalt
                                 bodied existential principles of freedom and re-                  treatments.
                                 sponsibility, analytic notions of defenses, and ge-                  Moderngestalt has changed in several respects
                                 stalt psychological principals of gestalt formation               but still embodies the majority of Perls’s original
                                 and destruction. Modern gestalt has retained                      ideas and therapeutic techniques. Despite Perls’s
                                 many of Perls’s original ideas but has also soft-                 lack of rigorous intellectual explanation of gestalt
                                 ened in many respects.                                            theory, his unique and creative style has given
                                    As Perls’s practice of gestalt therapy pro-                    modern gestalt therapy several fascinating and
                                 gressed, he wrote less about theory; his seminal                  effective therapeutic techniques. Even though
                                 work, Gestalt Therapy: Excitement and Growth                      Perls attempted to connect the puzzle between
                                 in the Human Personality (Perls, Hefferline, &                    gestalt theory and his own technique, empirical
                                 Goodman, 1951), was considered one of the only                    validation of Perls’s techniques remained largely
                                 comprehensive texts written about gestalt theory.                 unsupported until recently.
                                 This work, however, is a rather arcane and un-
                                 successful attempt to illuminate gestalt prin-                    Gestalt Psychotherapy Techniques
                                 ciples. Jerry Kogan, a well-respected and admir-
                                 ing student of Perls said that he began reading                      Despite the loose connection between gestalt
                                 Gestalt Therapy and “thought it was terrible,”                    theory and practice, the techniques of gestalt
                                 although he found Perls himself “a model of a                     therapy and Perls’s application of them are cre-
                                 brilliant teacher and therapist” (Kogan, 1976,                    ative and artistic and embody an unusual charis-
                                 p. 255). Perls rarely referred to this text after its             matic and authentic approach to treatment. Re-
                                 original printing and instead preferred to print                  cent research by Leslie Greenberg on the two-
                                 transcripts of his work (therapy seminars) rather                 chair dialogue and the empty-chair dialogue for
                                 than expositions explaining it (Perls, 1968). As                  conflict splits and unfinished business has helped
                                 Perls’s focus on theory diminished, his narcissis-                explain the two-chair method and has brought a
                                                                                                                                                          183
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...Psychotherapy theory research practice training copyright by the educational publishing foundation vol no doi gestalttherapy past present andresearch laurae wagner moore university of massachusetts at boston orthodox gestalt therapy suffered a classical and rather unfortunate fate perls s eccentricities has been poorly articulated fritz simultaneously praised for techniques have received minimal his creative exuberance criticized aspects empirical validation these weaknesses style that simply defy term scientifi are in part consequence f cally derived perlsian form primarily embodies history per biographical which led sonality himself than scientific to an integration disparate structured empirically or theoretically theoretical models were consistent model exacerbated haphazard is intellectually fascinating philosoph ically complex set diverse but articu idiosyncratic personal however lated substantiated beliefs recent suggests conversely it interesting actual chair technique superior...

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