This paper is an example of a “Research Paper” for Psy 201 General Psychology
STRESS MANAGEMENT
USING
RET AND GESTALT
GROUP THERAPY
BY
Jane Doe
Table of Contents
Table of Contents .......................................................................................................................................... 1
Abstract ......................................................................................................................................................... 2
Introduction ................................................................................................................................................... 2
Definition of Stress ....................................................................................................................................... 2
Gestalt Therapy ............................................................................................................................................. 2
Gestalt Group Therapy .................................................................................................................................. 3
Definition and Theory of RET ...................................................................................................................... 4
RET Group Therapy...................................................................................................................................... 5
Comparison Between RET and Gestalt Therapy .......................................................................................... 5
Contrasting RET to Gestalt ........................................................................................................................... 6
Stress Management With RET ...................................................................................................................... 8
Research ........................................................................................................................................................ 8
Gestalt Techniques and Their Application to Stress Management ............................................................... 8
A Final Word About Gestalt Techniques .................................................................................................... 10
Conclusions ................................................................................................................................................. 10
References ................................................................................................................................................... 12
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Abstract
This paper explores stress management group therapy by presenting two major therapeutic models Rational
Emotive Therapy (RET) and Gestalt Therapy. Stress is defined in both physical and emotional terms. The therapy
theoretical models are described and how these models are used in a group setting are discussed. Examples of how
these therapeutic models and there application to stress management is given. The advantages/disadvantages and
similarities/differences of the two therapy are presented.
Introduction
Stress or “distress” is a causative or contributory factor in an increasing number of illnesses in our society. In the
field of Health and Primary Prevention, the management of stress to reduce the frequency and severity of these
illnesses has become a foremost concern. One method of helping clients control stress is stress management group
therapy. Stress is very difficult to define because a situation might be stressful for one person but the same
situation is not stressful for another. Let’s define stress in general terms.
Definition of Stress
Schafer (1983) defines stress as: “Arousal of mind and body in response to demands placed upon it”. He points out
that stress is all around us and can not be eliminated or avoided but can be contained and managed. Harmful stress
or what Schafer terms “distress”, is defined as: “too great or too little arousal, which is harmful to body or mind”.
Stress is an abstraction. When a person first experiences a stressful situation, defense mechanisms in the body are
activated: The glands release large quantities of adrenaline, cortisone, and other hormones, and coordinated
changes take place in the central nervous system. If exposure to the stressor continues and the body is able to
adapt, resistance to illness ensues. Specific bodily reactions occur to contain the effects of the stressor. But if
exposure to stress is prolonged, the body's defense mechanism gradually wears down until it becomes inadequate
and one of the organs fails to operate properly. This deterioration process can lead to disease in almost any part of
the body. However, no specific cause produces a specific effect. (Kiev, 1979) Emotional stress, if not managed,
can cause dysfunction behavior because the person focuses on the stressor in such a way as to divert energy away
from what is needed to functional in every day life. One therapeutic model that can be used in stress management
is Gestalt Therapy.
Gestalt Therapy
Gestalt therapy is based on the promise that each individual must accept sole responsibility for their behavior.
Setting and achieving of goals is the individual’s free choice. The therapist's view of the person is essentially
phenomenological. Specifically, the gestalt therapist considers perceptions (and this means perceptions of oneself,
feelings, relationships, etc.) in terms of the figure - ground dichotomy. Gestalt therapists believe that a healthy
personality exists when a person's experiences form a meaningful whole, when there is a smooth transition between
those sets of experiences that are immediately in the focus of awareness (what they term the figure) and those that
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are in the background (the ground). According to Paris (1973) “The Basic premise of gestalt psychology is that
human nature is organized into patterns or wholes, that it is experienced by the individual in these terms, and that it
can only be understood as a function of the patterns of wholes of which it is made.” The therapist in a one-to-one
consulting situation is first of all a perceiver and constructor of patterns. As soon as he is informed of a symptom
or a request for change and begins listening to and observing a patient and responding to him, he begins a process
that is called patterning.
While diagnosis is a more common term, it has the disadvantage of provoking the analogy of the medical model
and implying that the purpose of the process is arriving at a specific label. A better analogy for the process of
patterning is that of artistic creation, involving sometimes cognitive, sometimes perceptual and intuitive skills in
interaction with the material and demands of the environment. (Fagan, 1970) The role of the therapist changes
when Gestalt is use in a group setting.
Gestalt Group Therapy
The therapist’s goal is to assist the individual in reaching particular and complete subjective fulfillment within his
or her environment (Perls et al., 1951). This goal can be accomplished by integrating it into the group setting.
Shapiro (1978) describes the role of the Gestalt therapist as one of not interpreting or getting personally involved in
the group process, but rather creating a climate in which the participants can experience their feelings in the here
and now and thus facilitate integration. The goal of a Gestalt group is to challenge the participants to become
aware of how they are avoiding responsibility for their awareness and to encourage them to look for internal, rather
than external, support. Moment-to- moment awareness of one's blocks to such experience is seen as therapeutic in
and of itself (Corey, 1985). The Cleveland model of Gestalt Group Therapy, “integrates the principles and
practices of Gestalt Therapy and group dynamics” (Kepner, 1980). The therapist's role is threefold: to facilitate
awareness on an interpersonal, intrapersonal, and a group level. In other words, the therapist “can function as a
therapist for an individual, as a facilitator of interpersonal process, or as a consultant to the group as a system” (Kepner,
1980). Gestalt groups go through three developmental stages: 1) identity and dependence, 2) influence and counter
dependence, and 3) intimacy and Interdependence.
In the first stage, participants cope with questions about self, about others, about the leaders, and about the process.
The primary task of the leader, during this stage, is to set up relationships with and among the members as quickly
as possible.
The second stage, the group struggles with influence, authority, and control. While in the first stage, group
members try to imbue the leader with special power, in the second stage they try to take away that power.
Leadership tasks during this stage include helping members become aware of the norms that are operating in the
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group, encouraging challenge and open expression of differences and dissatisfactions, and differentiating roles
from persons. It is during this phase that group patterns and stereotyping emerge.
The third stage enables and even motivates members to deal with their differences and to struggle with their
conflicts, and members behave interdependently in the sense that they can depend on each other for understanding,
support, and challenge; also the relationships are reciprocal. (Kepner 1980) Applying this theory to stress
management will be discussed later in this paper but lets now take a look at the second type of theory, Rational
Emotive Therapy (RET).
Definition and Theory of RET
According to Corey (1985) RET is based on the assumption that we are born with a potential for both rational,
straight thinking and irrational, crooked thinking. All neurotic behavior results from illogical thinking. “Nothing is
either good or bad, but thinking makes it so.” Irrational beliefs are the cause of our emotional disturbances and
may have been incorporated from external sources. In order to overcome the indoctrination that has resulted in
irrational thinking, RET therapists employ active Directive Techniques and challenge clients to substitute a rational
belief system for an irrational one. The ABC theory of personality and emotional disturbance (Corey, 1985) is
central to RET theory and practice.
The ABC theory maintains that when people have an emotional reaction to a Consequence (C), after some
Activation event, it is not the event itself that causes the emotional state. It is the belief system (B) that creates the
consequence. The belief system is a cognitive process that if irrational thinking is present then a undesirable
consequence will result. Ellis maintains (Corey, 1985) that people have the capacity to significantly change their
beliefs, behaviors, and emotions. People can best accomplish this goal by not preoccupying themselves with
activating events and by not dwelling endlessly on the emotional consequences. They can examine, challenge, and
modify their beliefs. Ellis (Beech, 1982) recognizes seven types of cognitive distortion that occur commonly:
1. Over generalization - individual draws conclusion as a result of one or a few episodes.
2. Selective abstraction - look at details out of context.
3. Arbitrary inference — specific inference in the absence of evidence to support the conclusion.
4. Magnification — grossly magnify an important event.
5. Minimization — distort significance by grossly playing down the importance of the event.
6. Dichotomous thinking — all experiences are placed in one of two categories: imperfect or defective brilliant.
7. Personalization — associate external events to self when there is no rational basis for judgment
To demonstrate arbitrary inference lets look at an example. An example of a cognitive distortion would be a self -
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statement as a manifestation of anxiety “my presentation must be dreadful and lacking interest. so many people are
leaving.” This self statement evokes anxiety, panic and becomes a self fulfilling prophecy. It is self defeating, self
deprecating, anxiety generating and often an irrational pattern of thinking. Ellis defines irrational as any thought,
emotional state or behavior which leads to self defeating or self destructive consequences which significantly interferes
with the adaptive functioning of the individual. These evaluative cognitive patterns are frequently ruminative in nature
and unproductive. They can lead to loss of self esteem, demoralization and mood states such as depression and anger.
To overcome self defeating beliefs, RET therapists use active - directive techniques such as audiovisual presentations
and other teaching techniques, bibliotherapy, imagery and behavioral rehearsal, desensitization, homework, skill
training, replaying and modeling, and group feedback and support. The primary emphasis is the therapist’s skill and/or
the group’s skill and willingness to challenge, confront, suggest, probe, or convince the client to accept and practice a
new response. RET Therapy is used in a group setting to enhance and reinforce rational thinking. RET lends itself to
group oriented procedures.
RET Group Therapy
The group is seen as offering the participants excellent opportunities for challenging self-destructive thinking and for
rehearsing different behaviors. Ellis's therapy process based on the D-E theory works well in groups. D-E stands
for Disputing and Experiencing. In Disputing, the therapist argues, attack and aggressively deprograms the client's
irrational beliefs. In Experiencing (E), the client experiences the irrationality by repeating exposures to the
situation. The group becomes very useful in this Disputing process by asking what the evidence for the client’s
conclusion is. Are there other explanations? The goals of the RET group leader, according to Corey (1985), are to
teach the clients how to separately evaluate their behavior and their self, and accept themselves in spite of their
imperfections. He shows them how they have created their own misery and teaches them how to challenge their
own assumptions. Group members help support one another in learning these endeavors. They also play a
powerful role in challenging the individual’s crooked thinking. The group also serves as an environment in which
the new behavior can be directly observed in action. It also provides rich examples for learning and applying RET
principles and allows the group members to learn that their thoughts and reactions are not unique and can better see
themselves as other see them. They can also become empowered by changes in others. RET and Gestalt Therapy
has some similarities and some major differences. Lets look at some similarities first.
Comparison Between RET and Gestalt Therapy
Both RET and Gestalt have been described as existential, phenomenological therapies. Ellis maintains that, “many
who call themselves existential therapists, are rather anti-intellectual, prejudiced against the technology of therapy,
and confusingly non-directive, while RET makes much use of incisive logical analysis, clear-cut techniques, and a
great deal of directiveness and teaching by the therapist.” (Cors 1984). The similarities between RET and Gestalt
Therapy are:
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1. Both Peris and Ellis stress “tyranny of the should". (Wessler, 1980, pg 247)
2. Gestalt prayer, “you do your thing and I'll do mine” could be part of RET session, except the RET therapist
would add “sometimes my doing your thing is in my best interest”.
3. A message of client responsibility and client independence is common in both.
4. It is the vision of both therapists to be intentionally persuasive.
5. Both RET and Gestalt are borrowed from the Jacob Moreno process and psychodrama movement.
6. Therapists in both styles has to be active and directive initially to keep the group on track.
7. Ellis has come to appreciate that image formation is essential for comprehensive therapy and benefits of using
rational emotive imagery, and Gestalt uses of fantasy.
8. Use of behavior techniques like relaxation, imagery.
9. De-emphasize warm therapeutic relationship.
10. Active and directive techniques.
11. Insight level — RET goes on step further emphasizing the necessity of doing something.
12. Both use role play as a technique for group therapy.
13. Therapist is confrontative, avoids impasse, and sometimes places their values system on client.
14. They both work well with clients of at least average intelligence.
15. Neither is a cure all. It does not cure psychosis. Success depends on cooperation of the client, it will not help
uncooperative clients.
16. Neither RET or Gestalt makes no claim that the person was victim of her or his parents, society, or past passive
conditioning. Clients who wish to become undisturbed, rather than discovering on whom to place blame for
disturbance, benefit most quickly. (Ellis, 1987)
The use of both therapies in a group setting have evolved from individual client-therapist theory. Many of the
similarities have come the integration of the theory into the group dynamics. Let’s look at the differences between
the two.
Contrasting RET to Gestalt
In contrasting RET and Gestalt therapy, Simkins and Yontef, say that Gestalt stresses awareness and “what is”;
RET disputes irrational attitudes and beliefs, with the therapist judging what is irrational; Gestalt explores beliefs
and attitude with the therapist and the client deciding what “fits” for the client (Corsini, 1984). Some RET and
Gestalt differences are:
1. Gestalt therapy resembles RET less than any other popular approach to therapy. Gestalt takes an anti-intellectual
stance, while RET takes a rational position.
2. Peris holds that if people can increase their awareness and become integrated, they will no longer experience
disturbing emotions while RET assumes philosophical changes and realistic thinking.
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3. A high degree of cohesiveness and intimacy is not necessarily sought in RET groups but is sought in Gestalt
groups.
4. RET emphasizes thinking, judging, deciding and doing whereas Gestalt is concerned with feeling. (Freeman,
1983)
5. Gestalt groups are intrapersonal — the interactions are between the leader and one member. Success is measured
by the relationship of the members to the therapist. RET groups are interpersonal - the group interactions are
between members. The leader serves as an orchestrator. Success is measured by the RET groups ability to exist
without the leader. (Shapiro, 1978)
6. RET emphasizes the didactic side of the therapeutic process. Therapy is viewed as intellectual and educational.
(Richardson, 1976) Gestalt therapy ignores thought.
7. RET groups are oriented to problem solving. (Corsini, 1984)
8. Both share techniques but different ones: RET tries to overcome self-defeating beliefs. RET therapists use
active, directive techniques such as teaching, suggestion, persuasion, and homework assignments and challenge
clients to substitute rational belief systems for irrational ones.
9. Wessler says Gestalt therapy resembles RET less than any other popular approach to therapy. (Corsini, 1984)
Ideal outcome is to have RET groups function well without therapist, some groups become self-help groups.
11. Common problems in RET include: a) delving into too much detail. b) unbalanced participation by members.
c) therapist responsibility for initiating challenge and exposing norms d) giving advice and, group process can be
used for therapeutic advantage if group members react against the person who breaks the norms.
12. Ellis says his approach is didactic, Gestalts is not. (Lazarus, 1976)
13. Ellis defines irrational as any thought, emotional state or behavior that leads to self-defeating or self-destructive
consequences which significantly interfere with the adaptive functioning of the individual. Gestalt does not
determine whether something is Irrational or not (Beech, 1982)
14. RET uses the ABCDE analytical model where as Gestalt use a “wholeness” model.
15. RET emphasizes thinking, judging, deciding and doing. Gestalt deals with feeling. (Corey, 1986)
16. RET does not consider the nature of a relationship between therapist and client as vitally important to the
therapeutic process.
17. RET emphasizes cognitive restructuring.
18. RET is viewed as emotional, intellectual reeducation.
19. Ellis says he can work with large groups of 50-100 or small groups 10-13. Gestalt is used with smaller groups.
20. RET group members can remind one another of the desirability of accepting reality and work together in
groups to bring positive change. Gestalt groups watch more.
21. RET group members can challenge individual, crooked thinking. Gestalt groups don't interact that much.
22. Informative giving and problem solving strategies come from group work in RET.
23. Cognitive evaluation of feelings and beliefs.
24. The Gestalt-interpersonal leader - isolates the individual. Success is measured by relationship of member to
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himself, and working through their relationship with the leader RET interpersonal leader.
Stress Management with RET
Leaders need to discuss with the group that intense fear reactions leading to arousal and mobilization for flight may
once have served a useful purpose in a dangerous environment — but are dysfunctional in society. The onset of
anxiety may signal to the person that he faces some problem or conflict of which he is unaware. (Allen, 1982)
Continual anxiety is unnecessary if he is to “stop and think” and find a solution to the problem at hand, or change
his goals. Therapeutic intervention is designed to help the client identify dysfunctional cognitive patterns, generate
alternative, more reality-based cognitive patterns, generate alternative, more reality-based cognitions and apply to
anxiety situations. Dr. Larry Wolfe, a Marriage-Family-Child Counselor, believes that RET is most effective with
feeling type people. In a personal interview he said: “It works very well with feeling type people because they are
not used to looking at the cognitive part of stress and it allows them to look at the irrational and replace it with
rational statements. It doesn't work as well with cognitive types. They are so tight with their thoughts that they are
difficult to penetrate. RET works better than any other style of treatment with phobic people because it allows
clients with stress problems and phobia to look at their self statements.” Dr. Wolfe has found that group RET
works best if he first teaches the client RET therapy first, then uses the group to support the RET principles.
Research
Ellis found in non comparison outcome studies (DI Giuseppe, 1977) that 60% patients receiving orthodox
psychoanalysis showed little improvement, 37% showed some improvement and 13% showed considerable
improvement. Clients treated with RET showed the greatest improvement with 10%, 46% and 44% respectively.
A study by Jennie and Wollershein compared cognitive therapy based on RET with stress management training in
the treatment of Type A behavior patterns. Cognitive therapy proved more effective in altering this behavior
pattern. (Ellis and Greiger, 1977) Other studies done in the 1970's — (Jacobs 1971), (Trexier and Karst 1972),
(Staatmeyer and Watkins 1974), (Knaus and Boxor 1975), suggest that RET therapy is extremely effective in
reducing test anxiety, public speaking anxiety and hypersensitivity to criticism and opinion. Comparative studies
were also done in the 1970's comparing RET to behavioral therapy, Clients-centered therapy but none have been
done comparing RET to Gestalt according to DiGiuseppe. A review paper presented in 1976 by Glass and Smith
that examined 375 psychotherapy outcome studies, found that RET ranked second among ten types of therapy.
Gestalt Techniques and their Application to Stress Management
The Gestalt group would address stress by helping participants become aware of and experience what they are
“sensing, feeling, thinking and fantasizing in the present” and “discovering how they are functioning in the world”.
(Corey 1985). This awareness and experiencing in the “here and now” would be facilitated by a number of Gestalt
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/
techniques.
Gestalt therapy maintains that we block certain aspect of our personalities, which become expressed in non-verbal
language; our movements, our posture, our facial expression, our tone of voice, and our mannerisms. (Corey 1985).
A technique used in Gestalt groups to explore non-verbal expressions and increase awareness of what is being
experienced in the moment, is to have members exaggerate their somatic language, and tell the group what it is
saying about them.
For example, a member who responds to stress with tense shoulder muscles, might be invited by the leader to
“become” his tight shoulders and address the group about the meaning of this. The participant might say
something like, “I am my tight shoulders and what I'm telling you is that I'm tense and ready to react,if I think you
are getting too close to me or expecting too much of me.”
Another technique for increasing awareness of and integrating denied or disowned feelings or parts of our
personalities, is the “two chair dialogue.” In using this technique a participant experiencing stress headaches might
be invited to “talk to” his headache. The member would sit in one chair facing another chair and address his
headache, then switching chairs, he would “become” his headache and respond. The participant would continue
switching chairs and roles as the dialogue unfolds. The technique allows the participant to become aware of what
feelings are being denied and expressed through his headaches and facilitates integration of those feelings.
Gestalt therapy stresses taking responsibility for our thoughts, feelings and actions and avoiding blaming others for
what we are experiencing. Often group members will blame others for their feelings, saying that the group is
making them feel something. (Corey 1985).
A group member might say that the group is making them tense, or the subject under discussion is making them
feel stressed. The group leader might suggest that the member make direct statements to the group, taking
responsibility for these feelings. For example, “I feel tense in this group, and I take responsibility for this feeling"
or “when unemployment is discussed, I feel stressed, and I take responsibility for this feeling.” The participant
stops delegating control to others and takes charge of his own life. (Corey 1985)
Another Gestalt technique that might be useful in stress management is “rehearsal”. Ports believed that much of
our thinking is rehearsal for roles we think we are expected to play, and worrying about whether we will say the
right thing or behave properly. This kind of internal rehearsing inhibits our spontaneity. In the rehearsal
technique, members are invited to say out loud what they are thinking. (Corey 1985)
In stress management this technique could be used when a member anticipates a future event, such as a job
9
interview, which he thinks will be stressful. The member is asked to fantasize the situation, picture himself in the
situation, and verbalize his feelings in the present. Thus the participant becomes aware of the role he plays in the
situation and his feelings about the situation and is able to make choices about continuing that role.
The thrust of a Gestalt stress management group is becoming aware of one’s responses to stress, taking
responsibility for those responses, and making choices about changing in those responses.
Gestalt groups would be effective in reducing stress for several reasons. The following are cited by (Serok and
Bar, 1984) “(1) When individuals reject the stereotypical norms to which they compare themselves, then
frustration and inferiority feelings diminish. (2) Gestalt accepts individuals where they are, and attitude that builds
self acceptance.
If frustration and inferiority feelings are diminished, one feels more at home in his world, with a resultant decrease
in the manifestations of stress which are experienced. With an attitude of self acceptance, one is less concerned
about how one “should” feel, “should” think, or “ought” to behave, and is less stressed about handling situations
and relationships that he is faced with in his everyday life.
A Final Word About Gestalt Techniques
If a leader over uses techniques, members may become dependent upon the leader to take responsibility for
creating experiments instead of coming up with their own.
Harman (1984), in addressing this issue, says “skilled Gestalt group therapists will build on what is happening
naturally in the group, instead of manipulating the process by presenting structured group exercises. At issue here
is the question, “who supplies the energy?” the leader or the group members? Structured exercises, while building
confidence among group members in the leader’s ability, imply that it is all right for the members to “do nothing”,
rather then wait for the leader to energize them, to liven thing up. As a result it becomes difficult for group
members to move into issues that concern them, since they have become dependent on the leader to supply all the
fuel.”
This dependence on the group leader goes against the basic Gestalt concept of the individual’s responsibility for his
own sensing, feeling, thinking, and behaving. If stress is to be contained and managed, the individual member
needs to become aware of it and take responsibility for the manifestations of his own feelings.
Conclusions
There is no doubt that both RET and Gestalt group therapy has gone beyond the “hot seat” or one-to-one style of
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working. Many therapists are interested in group dynamics and the group as a whole. Gestalt or RET group
therapy does not have to be a choice between working with a collection of individuals or working with a group. It
is, or at least it can be, both. At times the emergent rational thinking or gestalt is an individual, at other times it is
the group.
How the therapeutic dance between the individual and the group is executed depends on the members and the style
and preference of the leader. Some leaders may choose to direct this spirit to choreographing exercises designed to
enliven and to mobilize the group, while others use their energy to help the group focus on what is happening,
allowing for vibrant energy and rich themes or rationalizes to develop from that clear focus.
The use of RET and Gestalt in a stress management group has been shown to work very well. Gestalt works better
for cognitive group members while RET works better with emotional group members. The pre-group screening
could be used to select group members that match the therapy method best suited for the therapist.
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