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Gestalt therapy, developed by Frederick (Fritz) and Laura Perls, is a variation of
humanistic psychology. Like person-centered methods, Gestalt therapy aims at
enhancing clients’ self-awareness in order to free them to grow in their own
consciously guided ways. More specifically, the Gestalt therapist seeks to
reestablish clients’ stalled growth processes by helping them (a) become aware of
feelings they have disowned but that are a genuine part of them, and (b) recognize
feelings and values they think are a genuine part of themselves but in fact, are
borrowed from other people.
One of the key differences between person-centered therapy and Gestalt therapy is
that Gestalt therapists are much more active and dramatic. Through a variety of
therapeutic techniques, the client is encouraged to assimilate or “re-own” the
genuine aspects of self that have been rejected and to reject the “phony” features
that do not belong. Ideally, when clients assimilate and integrate all aspects of their
personality (both the desirable and the undesirable), they start taking responsibility
for themselves as they really are instead of being attached to and defensive of a
partially phony, internally conflicted self-image.
Focus on the Here and Now
Gestalt therapists believe that therapeutic progress is made by keeping clients in
belief in a conceptual equation where now = experience = awareness = reality
(Perls, 1970). Any attempt by the client to recount the past or anticipate the future
obstructs therapy goals. It is an escape from reality. So instead of reflecting (as a
Rogerian might) the client’s nostalgia for the past or thoughts about the future, a
Gestalt therapist will point out the avoidance and insist that it be terminated.
Through role-playing or part-taking, clients explore inner conflicts and experience
the symptoms, interpersonal games, and psychological defenses they have
developed to keep those conflicts—and various other aspects of their genuine
selves—out of awareness. By asking clients to “become” their resistance to
change, for example, Gestalt therapists help them toward an experiential awareness
of what the resistance is doing for and to them.
Gestalt therapists also turn role-playing into extended “conversations” between
various parts of the client, including between the client’s superego (what Perls
called “top dog”) and the part that is suppressed by “should” and “ought’s” (the
“underdog”). Using the empty chair technique, therapists encourage clients to
“talk” to someone they imagine to be seated in a nearby chair. The person may be a
parent, child, spouse, or even an internalized aspect of the self. The client is asked
to talk to the imagined person and to express—perhaps for the first time— true
feelings about him or her and about events or conflicts in which that person played
a part. The client may even respond to the imagined person.
Clients may also be asked to clarify and release feelings toward significant people
in their lives via the unmailed letter technique: They write—but do not send—a
letter in which they express important but previously unspoken feelings.
Role-played reversals also are used to enhance awareness of genuine feelings. So
the client who conveys an image of cool self-sufficiency and denies feelings of
tenderness toward others might be asked to play a warm, loving person. In the
process, this client may get in touch with some feelings that have been suppressed
for many years.
Use of Nonverbal Cues
Gestalt therapists pay special attention to what clients do as they speak because the
nonverbal channel often contradicts the client’s words. For example, if a client
says that she is nervous and clasps her hands, the therapist might wonder what the
clasped hands meant. So instead of asking why the client clasped them, the
therapist might ask her to repeat and exaggerate the handclasp and to concentrate
on the associated feelings. Once the client expressed these feelings, she would be
asked to elaborate on them.
Frustrating the Client
Because it is not always this easy for clients to become aware of hidden feelings,
Gestalt therapists use many other methods for self-exploration. To help clients give
up their maladaptive interpersonal roles and games, for example, Perls deliberately
set out to frustrate their efforts to relate to him as they normally would to others.
During individual or group therapy, he put his clients on what he called the “hot
seat,” where all attention was focused on the client and where his or her symptoms,
games, and resistances were pointed out and explored.
Suppose that a client begins a session by saying, “I’ve really been looking forward
to having this session. I hope you can help me.” Instead of reflecting on this feeling
or asking why the client feels this way, a Gestalt therapist would focus on the
manipulative aspect of the statement, which seems to contain the message, “I
expect you to help me without my having to do much.” The therapist might say,
“How do you think I could help you?” The client (perhaps taken aback) might
respond, “Well, I was hoping you could help me understand why
I’m so unhappy.” From here, the therapist would continue to frustrate the client’s
attempt to get the therapist to take responsibility for solving the client’s problems
and, in the process, would help the client recognize how he avoids responsibility
for improving. The therapist might also help the client recognize the unrealistic
wish that the therapist would have a magic cure.
As you might imagine, therapeutic techniques that use confrontation and deliberate
frustration can be powerful motivators, but they can also drive clients away if the
techniques are not implemented properly and carefully. Lilienfeld (2007) found
that there is some risk of negative therapy outcomes with Gestalt therapy. For this
reason, Sommers-Flanagan and Sommers-Flanagan (2012) caution that therapists,
especially relatively inexperienced ones, use caution in applying these techniques.
Motivational Interviewing and Emotion-Focused Therapy
Motivational interviewing and emotion-focused therapy are treatment approaches
derived explicitly from person-centered therapy (Sommers-Flanagan & SommersFlanagan, 2012). In motivational interviewing, therapists use reflective listening
techniques to call clients’ attention to their choices and values. Often used in
substance abuse counseling or in other situations where clients may be resistant to
treatment or distrustful of authority, motivational interviewing seeks to meet
resistance with reflection rather than with confrontation. The assumption is that if
clinicians express empathy and accurately reflect clients’ thoughts and feelings,
clients will become less defensive. They may also become more aware of
discrepancies between their behavior and their deeper values, and that the
responsibility for resolving such discrepancies lies with them. The following brief
vignettes from Miller and Rollnick (1998) illustrate this approach.
I’m trying! If my probation officer would just get off my back, I could focus on
getting my life in order.
It’s frustrating to have a probation officer looking over your shoulder.
Who are you to be giving me advice? What do you know about drugs? You’ve
probably never even smoked a joint!
It’s hard to imagine how I could possibly understand.
The similarities between reflective responding in client-centered therapy and in
motivational interviewing are obvious—both are designed to help clients to see
themselves more clearly. But motivational interviewers are inclined to diverge
from straight reflection, sometimes purposely overstating or siding with only one
side of a client’s ambivalence. The purpose of these elaborations is to gently guide
the client toward certain problems (i.e., to be subtly directive rather than
As its name implies, emotion-focused therapy emphasizes the role of emotion in
the human experience. A prominent example is process-experiential emotionfocused therapy (PE-EFT; Greenberg, Rice, & Elliott, 1993). This approach views
psychological difficulties as coming from emotional schemes—people’s organized
patterns of emotional responses. Therapists seek to provide a warm, empathic, and
supportive relationship in which clients are better able to fully experience their
emotions, particularly emotions of vulnerability. But they are also likely to use a
variety of specific tasks to facilitate emotion and emotional integration (Watson,
Goldman, & Greenberg, 2011). Emotion regulation is also a focus of the therapy,
and so therapists work with clients to become aware of, label, accept, reflect upon,
and modify their emotions.
The Current Status of Humanistic Psychotherapy
Humanistic psychotherapists such as Carl Rogers are often rated by clinicians as
highly influential, yet relatively few therapists identify themselves as humanistic
(person-centered, Gestalt, existential, etc.). One reason for the discrepancy may be
that humanistic psychotherapy revolves around an insistence on not
“pathologizing” clients. It assumes that even bizarre behavior is understandable
from the client’s point of view. But if clients do not have a “problem,” “deficit,”
“conflict,” “illness,” or “pathology,” and if therapists are not expected to identify,
understand, and find solutions to a problem, what is there for the therapist to do?
They can passively support clients’ efforts to gain the self-awareness presumed
necessary to create change, but to many therapists, humanistic approaches do not
give them the kind of more active therapeutic role they prefer.
Humanistic approaches may lack appeal also because, generally speaking,
empirical support for them is not as strong as it is for other, more popular,
therapies. This is not to suggest that humanistic approaches are inherently
unscientific. Indeed, Carl Rogers was among the first to recognize the need for
scientific research to substantiate the alleged value of any treatment technique,
including his own. He was the first to record therapy sessions, and he conducted
some of the first empirical research on the relationship between treatment outcome
and therapist characteristics such as empathy and warmth. In fact, he was arguably
the first modern scientist-practitioner. But person-centered therapy and related
phenomenological treatments can be difficult to study because treatment goals and
methods are not clearly articulated ahead of time. Rather, they emerge from the
two-person field. It is not surprising that such approaches do not fare as well in
empirical outcome studies as highly specified interventions focused on specifically
targeted symptoms in targeted populations. Perhaps this is why variations on
humanistic therapy that more closely approximate this kind of focus (e.g.,
motivational interviewing in substance abuse treatment) generally have more
Despite its shortcomings and apparent lack of popularity, no approach to
psychotherapy has done more than the humanistic one to highlight the importance
of the therapeutic relationship.