Gestalt Therapy
Proponents: Fritz Perls & Laura Perls
*Basic Philosophy
- Gestalt Therapy is a here-and-now
- Individuals naturally seek to become whole,
integrating thinking, feeling and behaving, living
productively
i. Energy-block of energy is manifested by
tension
*Goals
a. Help clients gain awareness of moment to
moment experiencing
b. Expand the capacity to make choices
c. Integration rather than analysis
- Gestaltists are anti-deterministic
*Therapeutic Relationship
Key Concepts
a. Therapist
a.
Rooted
in
existential
philosophy,
phenomenology and field theory (organism must
be on its environment)
o Notice foreground and background
b. Organismic self-regulation
c. Paradoxical theory of change-we can change
when we are aware of what we are
d. Holism-nature is seen as unified and coherent
whole
e. Figure-formation process-how individuals
organizes the environment from moment to
moment
f. Now ethos
* power is in the present
* What and how questions
g. Unfinished business-unresolved issues from
the past
h. Contact and resistance to contact-contact
with the environment is necessary for change
and growth to occur
o Work within I/Thou dialogue
o Pay attention to body language
* Emphasizes relationship between language
patterns and personality;
* Language patterns Gestalt therapist might
focus on:
o It talk - using it instead of I
o You talk - generalized use of you
o Questions - change questions into statements
*Language that denies power - disclaimers or
qualifiers (I can’t)
*Listening to clients’ metaphor - translate
metaphors to manifest content
*Listening for language that uncovers a story pick out a small part to focus on
b. Clients
3 Stage Integration Sequence
Introjection - uncritically accept other’s beliefs
and standards
o Discovery - new realization
Projection - Disown certain aspects of ourselves
o Accommodation
Deflection - distraction
o Assimilation - clients learn how to influence
their environment
Confluence - blurring of self and environment
C. person-to person relationship
*TECHNIQUES
BEHAVIORAL THEORIES
a. Experiment - grow out of interaction between
client and therapist and is aimed at awareness;
cornerstone of experiential learning
Proponent: B.F. Skinner
b.Exercise - ready-made techniques to achieve a
goal
c. Confrontation
*Basic Philosophy
a. Behavior is the product of learning; all
behavior is learned wether the behavior is
maladaptive or adaptive
*Confrontation
b. Applies principles of classical and operant
conditioning
3 Therapy Styles (Frew, 1992)
*KEY CONCEPTS
o Imposing stance - experts who evaluates,
diagnoses, confronts, interprets
a. Person is the producer and the product of his
environment
o Competing stance - negotiate, compromise
b. Action-oriented
o Confirming stance - acknowledge the whole
being of client
10 Key characteristics of Behavior therapy
*based on scientific method
*INTERVENTIONS
c. Deals with current problems
• Internal dialogue exercise
• Learning is the core of therapy
O Top dog – righteous, authoritarian,moralistic,
demanding, bossy,manipulative
• Teach clients skills of self management
o underdog - victim, helpless, apologetic
o Making the round - speak to do something with
each person
• Reversal exercise - client take the plungeinto
the very thing that is fraught witanxiety
* Rehearsal exercise - share internalrehearsals
out loud with therapist
• Assessing overt and covert behavior directly,
identifying the problem and evaluating change
* self-control approach
• Treatment interventions are individually
tailored
• Collaborative partnership between therapist
and client
• Practical applications
* Exaggeration exercise - exaggerate the
movement or gesture repeatedly
• Develop culture-specific procedures
• Staying with the feeling - clients go deeper into
the feeling and behavior they wish to avoid
D. Normal behavior is learned through
reinforcement and imitation. Abnormal behavior
is the result of faulty learning
• Gestalt approach to dreamwork - bring dreams
back to life; dreams are projection of self; clients
make their own interpretations
*GOALS
a. To increase personal choice and create new
conditions for learning
b. To eliminate maladaptive behaviors and learn
more effective behaviors
c. To focus on factors influencing behavior and
find what can be done about problematic
behavior
d. Clients actively set goals and evaluate how the
goals are met
*Therapeutic Relationship
a. Therapist is active and directive
Negative punishment - reinforcing stimulu is
removed following the behavior to decrease the
frequency of behavior
C. Functional assessment model (Miltenberger,
2004)
d. Systematic desensitization(Wolpe,1990) imagine successively more anxiety arousing
situations at the same time engage in a behavior
that competes with anxiety
b. Function of therapist
e. Relaxation methods(Jacobson,1938) muscle
and mental relaxation
o teacher or trainer
f. Exposure Therapies
o consultant
In vivo desensitization - clients are exposed to
actual feared situations in the hierarchy
o problem solvers
o model
c. Client must be active
d. A quality client-therapist relationship is
essential
for
implementing
behavioral
procedures, it is now viewed as sufficient
*TECHNIQUES
a. Behavioral assessment-record of client’s
complaints, frequency and intensity of
occurrences
b. Operant conditioning techniques
o Positive reinforcements - adding of something
of value to the individual
o Negative reinforcement - escape from aversive
stimuli
Extinction - with holding reinforcement from a
previously reinforced response
Positive punishment - aversive stimuli is added
after aversive behavior to decrease the
frequency of behavior
Flooding - exposure to anxiety-evoking stimuli
for a prolonged period
g. Eye movement and
reprocessing (Shapiro, 2001)
desensitization
h. Assertion and social skills training
i. Self-management programs and self-directed
behavior
j. Multimodal Therapy (Lazarus)
Technical Eclecticism(Classical, operant, social
cognitive)
*The BASIC ID (7 major areas of functioning)
1. Behavior
2. Affective responses
3. Sensations
4. Images
5. Cognitions
6. Interpersonal relationships
7. Drugs, biological functions, nutrition and
exercise
COGNITIVE BEHAVIOR THERAPY
c. Homework/assignments
Proponent: Albert Ellis & Aaron Beck
d. Gathering data on assumptions
*PHILOSOPY
e. Keeping a record of activities
1. Individuals tend to incorporate faulty thinking
that leads to emotional and behavioral
disturbance
f. Forming alternative interpretations
2. Therapy is primarily oriented toward cognition
and behavior
3. Reorganization of one’s self-statements will
result in a corresponding organization of one’s
behavior
g. Learning new coping skills
h. Changing one’s language and thinking
patterns
i. Role playing
j. Imagery
k. Confronting faulty beliefs
4. Psychoeducational model
*KEY CONCEPTS
a. A person’s belief is a primary cause of
disorders
b. Internal dialogue plays a central role in one’s
behavior
REALITY THERAPY
c. Faulty assumptions and misconceptions are
replaced with effective beliefs
*BASIC PHILOSOPY
*KEY CONCEPTS
a. A person’s belief is a primary cause of
disorders
b. Internal dialogue plays a central role in one’s
behavior
c. Faulty assumptions and misconceptions are
replaced with effective beliefs
*THERAPEUTIC RELATIONSHIP
a. Therapist: teacher
Client : student
Proponent: William Glasser
a. Humans are social creatures, and we need
quality relationships to be happy
b. Psychological problems exist because of our
attempt to control others and our resistance to
be controlled by others
✓Power or achievement
✓Freedom or independence
✓Fun
C. Quality world-world we would like to live in if
we could
b. Therapist is highly directive
d. Total Behavior(components of behavior)behaviors that get them what they want
*TECHNIQUES
*KEY CONCEPTS
a. Socratic dialogue
a. Evaluate present actions if they are working or
not
b. Debating irrational beliefs
b. People are mainly motivated to satisfy their
needs:
✓ Survival
✓ Love and belonging(primary need)
✓ Power of achievement
✓ Freedom or independence
✓ Fun
c. Quality world - world we would like to live in if
we could
d. Total behavior :(components of behavior)behaviors that get them what they want
✓ Acting
✓ Thinking
✓ Feeling
✓ Physiology
e. Rejects the following:
*THERAPEUTIC RELATIONSHIP
a. Create good relationship with the client to
engage client to evaluate their relationship
b. Therapist- client’s advocate, teacher, model
and confrontational
*TECHNIQUES (Active, Directive & Didactic)
a. Cycle of Counseling
✓ Creating the counseling environment
✓ Implementing specific procedures that lead to
changes in behavior
b. WDEP System
WANTS - explore client’s wants, needs,
perceptions
DIRECTION&DOING - explore the current
behavior of clients
EVALUATION - evaluate present behavior and
direction this is taking clients
PLANNING & ACTION - identify specific ways to
fulfill clients’ wants and needs
❑ Medical Model
❑ Transference
❑ Unconscious
❑ Dwelling on one’s past
RATIONAL EMOTIVE BEHAVIOR THERAPY
Proponent: Albert Ellis
*GOALS OF THERAPY
*BASIC PHILOSOPHY
a. Help people become effective in meeting their
need
- People contribute to their own psychological
problems and symptoms by the way they
interpret events
b. Enables client to reconnect with people they
have chosen to be in their quality world
c. Teach clients choice theory
- Emotions stem from beliefs, evaluations, and
reactions to life situations
- Works on thinking and acting
- Therapy is seen as an educational process
*KEY CONCEPTS
❑ Behavioral
- Showing people, they can change the irrational
beliefs that directly “cause” their disturbed
emotional consequences is the heart of
REBT(Ellis, 1999; Ellis& Dryden, 1997; Ellis et all.,
1997; Ellis & Harper, 1997
➢ Operant Conditioning
➢ Systematic Dysensitization
➢ Modeling/skills training
*GOALS
➢ To assist people in minimizing emotional
disturbances,
decreasing
self-defeating
behaviors and become more self actualized
➢ To accept
imperfections
➢ Self-management
themselves
despite
➢ Behavioral homework
their
*THERAPEUTIC RELATIONSHIP
➢ Therapist show, demonstrate, modify and
challenge (teacher); unconditional
➢ Client: learner & doer
*TECHNIQUES
❑ Cognitive
➢ Coping Self-Statements
➢ Cost-benefit analysis
➢ Psychoeducational method
➢Teaching others
➢ Problem Solving
❑ Emotive
➢ Rational-emotive imagery
➢ Role playing
➢ Shame-attacking exercises
➢ Forceful self-statements
➢ Forceful self-dialogue
FAMILY THERAPY
▪ Family systems perspective holds that
individuals are best understood through
assessing the interactions between and among
family members
▪ Eight lenses in family systems therapy:
Teleological, organization, developmental,
multicultural, gender, process, sequences and
internal
*BASIC PHILOSOPHIES
O Adlerian FT (Adler, Dreikurs)- enable parents
as leaders, promotion of effective parenting
O Multigenerational FT (Bowen)- differentiate
the self; change the individual within the context
of the system
O Human Validation Process Model (Satir)promote
self-growth,
self-esteem
and
connection; help family reach congruent
communication and interaction
O Experiential/Symbolic FT (Whitaker) promote
spontaneity, creativity, autonomy and ability to
play
O Structural FT- (Minuchin) restructure family
organization; change dysfunctional transactional
patterns
O Strategic FT- (Haley & Madanes)-eliminates
presenting problems; interrupt sequence,
change dysfunctional patterns
*KEY CONCEPTS
❑ Focus is on communication patterns within a
family, both verbal and non-verbal
❑ Problems are likely to be passed from one
generation to the next.
❑ The present is more important than exploring
past experiences
*GOALS OF THERAPY
O Help family members gain awareness of
patterns of relationship that are ineffective.
O Create a new ways of interacting to relieve
distress.
*THERAPEUTIC RELATIONSHIP
O Therapist acts as teacher, coach, model, and
consultant. They are concerned with process of
family
interaction
and
patterns
of
communication.
FEMINIST THERAPY
Proponent: Miller, Brown
o Central concept of the feminist therapy is the
psychological oppression of women and the
constraint imposed by the sociopolitical status to
which women have been relegated
o Most clients and psychotherapy are women,
thus the need for theory that evolves from the
thoughts and experiences of women seemed
evident.
*BASIC PHILOSOPHIES
Feminists' theoretical orientations:
o Liberal feminist -help individual women
overcome constraint of their socialization
patterns;
*Goals include personal empowerment, dignity,
self fulfillment and equality
o Radical Feminist -focused on oppression and
seek change through activism
*Goal is to transform gender relationships, social
institutions and increase women’s sexual and
proactive determination
o Cultural feminists -oppression stems from
society’s devaluation of women’s Strengths
o An integrative model of family counseling and
therapy moves from forming a relationship,
conducting assessment
*Goal is through infusion of feminine values into
the culture
o Hypothesizing and sharing meaning and
facilitating change.
o Socialist Feminist - focus on multiple
oppressions including class, race, economics,
and history
*TECHNIQUES
•
•
•
•
Genograms
Setting boundaries
Family mapping
Enacment
*Goals is transformed social relationships and
institutions
*VIEW OF HUMAN NATURE
a.
Gender-fair,
flexible-multicultural,
interactionist and life-span oriented
b. Chodorow (1978) proposed that identity is
formed from their relationship with their
mothers, who are the primary caretakers who
raise their children
c. Giligan (1977) believed that women’s sense of
self and morality is based in issues of
responsibility for and care of other people
d. Bem’s gender schema theory proposed that
children learn society’s view on gender and apply
it to themselves
e. Principles of FT
social
identities
4. Feminist therapist use an integrated analysis
of oppression
5. The counseling relationship is egalitarian
6. Women’s perspectives are valued
*GOALS OF THE THERAPY
•
•
•
•
•
•
•
Develop a sense of personal and social
power
Recognize the power of relationships
and connectedness
Trust their own experience and
institution
*THE THERAPEUTIC RELATIONSHIP
•
Based
on
empowerment
and
egalitarianism
Counselor is relational expert striving to
develop a collaborative relationship with
the client
are
3. Definition of distress and mental illness are
reformulated
•
•
•
1. The personal is political
2. Personal and
interdependent
•
Become aware of one’s gender-role
socialization process
Identify internalized messages and
replace them with self-enhancing beliefs
Understand how sexist and oppressive
societal beliefs and practices influence
them in negative ways
Acquire skills to bring about change in
the environment
Restructure institutions to rid them of
discriminatory practices
Develop a wide range of behaviors that
are freely chosen
Evaluate the impact of societal factors in
one’s life
*TECHNIQUES
❑ Empowerment - emphasize client’s equal
participation in the relationship
❑ Self-disclosure -promotes equalizing and
normalizing women’s collective experiences
❑ Gender role analysis - explore gender role
expectations on client's well-being and distress
❑ Gender-role intervention -placing the client’s
issue in the context of society’s role and
expectations
❑ Power analysis and power intervention similar to gender role analysis and intervention
❑ Social action -suggest volunteering at social
action centers to empower them and reinforce
the intervention used
SOLUTION-FOCUSED BRIEF THERAPY
-
de Shazer, Kim Berg
- Eschew the past in favor of the present and the
future
- No interest in understanding the problem and
focused on what is possible
- Little intention is given to diagnosis, history
taking or problem exploration
3. They are structured in the here and now
4. They are attainable, concrete and
specific
5. They are controlled by the client
Concentrate on small, realistic, achievable
changes that may lead to additional positive
outcomes to signal the beginning of change
*THERAPEUTIC RELATIONSHIP
*BASIC PRINCIPLES
•
•
•
•
There are advantages to a positive focus
on solutions and on the future
Individuals who come to therapy have
the capability of behaving effectively,
even they are temporarily blocked by
negative conditions
There are exceptions to every problem.
Everyone is unique, so too is each
solution
*KEY CONCEPTS
➢ Positive Orientation - People are healthy and
competent and could construct solutions that
can enhance their lives
➢ Looking for what is Working - Therapist assist
people in paying attention to the exemptions to
their problem patterns from their stories
The therapist and client collaborate to construct
solutions, where therapist accept people where
they are and trust their intention to solve their
own problems.
*Three Kinds of Relationship
1. Costumer - client and therapist jointly identify
a problem and a solution to work toward
2. Complainant – client describes a problem but
is not able or willing to assume a role in
constructing a solution
3. Visitor - client who comes to therapy because
someone else thinks he/she has a problem
*TECHNIQUES
•
•
*GOAL OF THERAPY
Goals are unique to each client and are
constructed by the client to create a richer future
•
1. Goals are stated in the positive in the
client’s language
2. They are process or action-oriented
•
Pre-therapy change - what have you
done before the appointment that has
made a difference in your problem?
Exception Question - Were there times in
your life when the situation was not
problematic? What must happen for
these exceptions to occur more often?
Miracle Question - If a miracle happened
and the problems was solved overnight,
how would you know it was solved? How
would things be different.
Scaling question - On a scale of 1 to 10...
•
•
Formula first session task – homework
Feedback to clients - compliment-bridge,
suggest task
*Techniques
•
•
•
NARRATIVE THERAPY
(White & Epston, 1990)
•
•
▪ There are multiple realities and multiple truths
in the situation.
▪ Individuals construct the meaning of life in
interpretative stories
▪ Create solutions in the present and in the
future
*KEY CONCEPTS
•
•
•
Focus of Therapy
The Role of Stories
Listening with an open mind
*GOALS OF THE THERAPY
•
•
Describe one’s experience in a new and
fresh language
Become aware of the impact of various
aspects of dominant culture on human
life
*THERAPEUTIC RELATIONSHIP
•
•
Great importance on the qualities a
therapist brings in the therapeutic
relationship
Relationship is co-authoring or shared
authority. Clients are viewed as experts
of their own life.
Questions - circular or relational, seeking
to empower clients in new ways
Externalization and deconstruction - the
problem is the problem
Search for unique outcomes - similar to
exception questions
Alternative stories and-re- authoring today is the first day of your life
Documenting the evidence - write
letters chronicling changes