Gestalt therapy and cognitive therapy seem like vastly different approaches to psychotherapy; and they are. It is interesting to note, however, that they do have a few aspects in common. Both approaches focus on the client’s present state or the here-and-now. Gestalt and cognitive theories do not avoid the past but only view it as it relates to the present. Both approaches also emphasize self-awareness as a means of therapeutic change (Beck & Emery, 1985; Perls, 1973). Another shared aspect is the use of imagery and psychodrama.
Gestalt therapy’s empty chair technique and cognitive therapy’s use of goal rehearsal are both good examples of this (Beck & Emery, 1985; Perls, 1969). That being said, there are a number of important distinctions between gestalt and cognitive therapies. The most notable is the contrast in organization style. Cognitive therapy is highly structured; gestalt is very unstructured. The cognitive approach is also intentionally un-mysterious, emphasizing the importance of educating and informing the client about the approach and the theories behind it (Beck, 1995; Clarkson, 2004).
Gestalt therapy, on the other hand, especially as practiced by Perls, has a more philosophical bent and an air of mystery (Clarkson, 2004; Perls, 1969). Due to its high level of organization, cognitive therapy has an extensive library of tested techniques and available data on how and when to use them appropriately (Beck & Emery, 1985). Gestalt therapy, on the other hand, shuns “techniques” in the formal sense of the word and encourages each practitioner to develop his or her own creative ways of implementing the gestalt concepts (Clarkson, 2004; Perls, 1969).
Sharon’s case will be explored through both the gestalt and cognitive perspectives. Areas of focus will be case diagnosis, issues addressed in therapy, techniques used, relevant research and strengths and weaknesses of each therapeutic approach. One approach will be presented as the best to treat Sharon’s case and one as the best fit for the author as a therapist. Gestalt Therapy Conceptualization Gestalt: Diagnosis Although Sharon meets the criteria in the DSM-IV for Generalized Anxiety Disorder (GAD), this would have little meaning or relevance in a gestalt therapy environment.
From the gestalt perspective, labeling is seen as de-humanizing and represents a fragmenting of the whole person: To label people “anal-retentive” or “manic-depressive” can be to strip them of the unique ways in which they have chosen to give meaning to their existence in their historical context. (Clarkson, 2004, p. 27) Using a gestalt diagnosis, the therapist might say that Sharon’s true needs are not being recognized and expressed thus creating an incomplete gestalt. These unrecognized and unmet needs have become foreground and with therapy will become background as the gestalt is completed (Greenberg & Rice, 1997).
Although Sharon’s unmet needs may be from her past, they are being experienced in the present and are preventing her from living in the here and now. Perls might say that Sharon is a “neurotic” which by his definition is a person who “chronically engages in self-interruption and whose psychological state is unbalanced” (Perls, 1973, p. 63). The goal of therapy then, would be to help Sharon resolve the conflict of her unmet needs and unfinished business. This would stop her self-interruption so that she may become and remain fully aware and whole.
Self-support is the means to wholeness and is achieved by “dealing with oneself” and becoming truly aware (Perls, 1973, p. 4). Once Sharon develops her awareness, she will be able to see that she is interrupting her self. Gestalt: Issues Addressed Some of the issues addressed in Sharon’s gestalt therapy sessions would be ways to start living in the here and now, the ways in which Sharon is interrupting her self, the contact boundaries that have developed and her unfinished business. All of these issues are important because they are preventing contact and awareness and thus preventing Sharon from becoming self-realized.
The cause of Sharon’s anxiety may be that she is not living with awareness in the here and now (Perls, 1973). She is preoccupied with a future that she is viewing through the lens of her past. In her past, Sharon set rigid goals for herself, ideas of how her life “should” be by a certain age. She has to abide by goals set in the past so that it has become very difficult for Sharon to be present in the here and now. This is causing her to be anxious. Living in the here and now may affectively reduce Sharon’s anxiety: If you are in the now, you can’t be anxious, because the excitement flows immediately into ongoing spontaneous activity.
If you are in the now, you are creative, you are inventive. If you have your senses ready, if you have your eyes and ears open, like every small child, you find a solution. (Perls, 1969 p. 3) Through the gestalt theoretical perspective, it is apparent that Sharon has developed several contact boundary disturbances. These are mechanisms that interrupt the self and prevent an individual from making real contact. Is Sharon’s idea of how her life should be really hers? Are the goals that she set for herself really her goals?
Perhaps, but exploring these ideas might lead us to the knowledge that these examples are manifestations of the boundary disturbance of introjection (Perls, 1973). Sharon’s mother’s controlling nature may be a driving force behind the introjection. Perhaps she is concerned because Sharon’s lifestyle conflicts with her own values. Sharon may have adopted her mother’s views without really examining whether or not they were her views. Breaking up with her boyfriend and minimizing interaction with her mother can all be seen as examples of deflection. Deflection is an indirect means of avoidance of contact (Clarkson, 2004).
Instead of trying to make meaningful contact with her boyfriend of two years, Sharon ended the relationship with him. Deflection is also evident in Sharon’s interaction with her mother. The way Sharon has typically deal with her mother’s controlling ways was “minimizing contact with her. ” It could be argued that Sharon’s mother remarrying and moving to a location that is only half an hour from her is acting as a trigger for some of her behavior. The negative contact with her mother has increased as Sharon feels obligated to spend more time with her.
Her mother is already involved in the introjection and deflection disturbances and may also be playing a key role in the contact boundary disturbance of confluence. Due to the change in the type and amount of interaction with her mother, the separation of her self and her mother may have become unclear to Sharon. Sharon may be having a difficult time distinguishing between her own perceptions and values and those of her mother (Perls, 1973). The formation of these boundary disturbances is an indicator that Sharon may have some ‘unfinished business’ with her mother (Perls, 1973).
This may be one reason that Sharon has tried to limit her interaction with her mother. Based on her mother’s recent marriage, we know that her parents are divorced or her father has died. Sharon’s unfinished business with one or both of her parents may be around the issue of their divorce. Perhaps Sharon is still angry with her parents for divorcing and never recognizing how hard it was on her. The mother getting remarried may be what has brought this unfinished business to the surface thus impacting Sharon’s life in such drastic ways.
All of these issues are part of a much larger issue that would be addressed in Sharon’s gestalt sessions. Sharon’s boundary disturbances, unfinished business, feelings of anxiety and lack of satisfaction with life are a direct result of her lack of awareness and contact. There are a few gestalt activities that could be used to help Sharon establish contact and become a self-realized person. Gestalt: Techniques Compared to other therapeutic approaches, such as cognitive therapy, gestalt is less structured and more philosophical.
There are not standardized gestalt techniques, in the traditional sense of the word. As a matter of fact, Perls is quoted as saying “One of the objections I have against anyone calling himself a Gestalt Therapist is that he uses technique. A technique is a gimmick” (Perls, 1969, p. 1). Gestalt therapists are encouraged to invent their own means of getting the client to experience awareness and meaningful contact with the self and others. Although they would be executed differently depending on the practitioner using them, two of the more widely used “techniques” of gestalt therapy will be explored.
The first gestalt technique that might be used in Sharon’s treatment is development of awareness. Sharon would have her attention drawn to her breathing, gestures, movement, and her voice. The intention of this focusing is to allow Sharon to develop awareness and to be in the here and now. By really focusing on what she is doing, Sharon is building awareness. This awareness may help Sharon see how she is interrupting her self (Perls, 1973). One of the more well-known gestalt techniques is the use of the empty chair. This is a useful way to address unfinished business.
In Sharon’s case, it may be used to address the unfinished business she may have with her mother. The therapist would ask Sharon to imagine her mother sitting in an empty chair that is in the room. Sharon would be asked by her therapist to address her mother directly via the empty chair. Sharon would be encouraged to be direct and honest with her mother and to tell her all of the things she has withheld through the years. By finally releasing these emotions and addressing her mother honestly and directly, Sharon may resolve the past conflict with her mother.
She is no longer being held to the past by her unfinished business. She is free to live in the here and now and make real contact (Perls, 1973). Gestalt: Relevant Research It makes sense that an approach that emphasizes experimentation and even encourages each practitioner to come up with his or her own version of gestalt therapy, would shun the scientific approach. Understandably, gestalt does not always lend itself well to the scientific environment and thus there is limited empirical research regarding gestalt therapy. What research there is however, is relatively favorable.
Wagner-Moore (2004) noted the efficacy of the empty chair technique in treating indecision and interpersonal conflict and increasing awareness. Watson, Gordon, Stermac, Kalogerakos and Steckley’s (2003) study offered some more supportive results. They found greater interpersonal functioning improvement with process-experiential therapy using gestalt techniques when compared to cognitive behavioral therapy. This was attributed to the efficacy of the empty chair technique, which was considered a strong tool for successful conflict resolution.
This is particularly interesting in considering Sharon’s case. At this point in her life, her interpersonal relationships, especially with her mother, seem unhealthy. She is lacking awareness and true contact with others. This study gives some evidence that the empty chair technique would be effective in addressing unfinished business with her mother. In a study treating depression, Watson and Greenberg (1996) found the empty chair effective for increasing self-acceptance, self-esteem, separation from significant others and for treating cognitive-affective problems.
Gestalt: Strengths and Weaknesses The strengths of using gestalt therapy in Sharon’s treatment would be the use of awareness and the empty chair technique. From what little we know of Sharon, it seems that her anxiety revolves around her preoccupation with the way her life should be and her relationship with her mother. Awareness enhancing techniques would help focus Sharon on the present state of her life and the empty chair would help her resolve the conflicts regarding her mother. The weaknesses of gestalt therapy in treating Sharon lie in its unorganized nature and direct approach.
It seems that the lack of organization in the theory and the personal and experimental techniques may yield unpredictable results (Wagner-Moore, 2004). Also, the direct and sometimes confrontational approach of gestalt could actually do more harm than good in some situations. As mentioned previously, we do not have a significant amount of information regarding Sharon’s case, but it seems possible that she could be fragile enough to be harmed by gestalt therapy. Cognitive Therapy Conceptualization
Cognitive: Cognitive Distortions, Schemas and Automatic Thoughts A cognitive therapist would look at Sharon’s situation and try to understand the combination of social, environmental and biological factors that are causing her anxiety. The therapist would focus on Sharon’s cognitive distortions, cognitive schemas and automatic thoughts. The goal of therapy would be to work with Sharon to remove her distortions in thinking and change her cognitive schema so that she may function in a more effective, reality-based manner (Beck, Emery, 1985). A cognitive therapist may say that Sharon has a maladaptive cognitive schema.
This means that Sharon’s thoughts and beliefs about herself, other people, and her future are negative and unhealthy. Negative early childhood experiences may have formed Sharon’s current schema (Beck, 1995). Based on the information we have about Sharon, an example could have been some negative interaction with her mother. Perhaps Sharon’s mother was controlling and critical and Sharon internalized the criticisms. Through the cognitive perspective, Sharon is supporting this maladaptive cognitive schema with a system of cognitive distortions.
Sharon believes that if she does not have children and a husband by the age of 40, she is a failure. This is an example of “all or nothing” thinking (Beck & Emery, 1985). In her mind, either she has children and a particular type of man as a husband by the age of 40 or she has achieved nothing. Sharon is also using the cognitive distortion of catastrophizing (Clark & Beck, 2010). She is worried that her life is turning out to be a “disaster” and that “the clock is running out. ” Such dramatic language is a negative exaggeration and a distortion of reality.
Based on the information that we have about Sharon, it is interesting to note that although her human resources career has advanced at a faster pace than normal, she is still not satisfied with her performance and sees herself as incompetent. Sharon may be using overgeneralization to come to this distorted conclusion (Beck & Emery, 1985). Perhaps she made one or two mistakes at work due to her lack of sleep and is generalizing her job performance based on those mistakes rather than the other things she does well.
The activation of Sharon’s cognitive schema has more than likely led to automatic thoughts, which are also helping to sustain her anxiety (Beck, 1995). These involuntary, distorted cognitions are contributing to her dysfunctional self-view and anxiety regarding her future (Beck & Emery, 1985). We have no way of knowing exactly what they are, but some examples of possible automatic thoughts that Sharon may be having are: “I am going to end up alone,” “No one wants to be with me” and “I’ll probably be fired for this mistake. It is easy to see how these automatic thoughts might contribute to Sharon’s’ anxiety. With such negative thoughts popping into one’s mind, it is hard to remain positive about the future. Cognitive: Issues Addressed Sharon’s case of GAD seems rather debilitating. For this reason, the first issue addressed might be her presenting complaints (Beck & Emery, 1985). She might tell the cognitive therapist of her sleeplessness, her inability to concentrate and her fear that her life is turning out to be a failure. The therapist might then explain to Sharon that she is experiencing common symptoms of anxiety.
The therapist might also frame anxiety as a natural, evolutionary reaction to threatening circumstances. This rational and educational approach to a client’s condition often puts a client at ease rather quickly. In order for Sharon to effectively take control of her cognitions surrounding her anxiety, she must clearly understand the symptoms and nature of anxiety and how they affect her (Beck & Emery, 1985). Once Sharon’s immediate anxiety is lowered, her automatic thoughts might be brought to her attention.
The cognitive therapist may help her to recognize, evaluate, and change her thoughts so that she may reduce and perhaps eliminate her symptoms (Beck, 1995). The next issue to focus on would be the beliefs behind Sharon’s dysfunctional thoughts. These underlying beliefs would be evaluated and modified during the course of treatment. This would create great positive change for Sharon. If she is able to change her beliefs about her life and her perceptions of it, modifying her thoughts in a healthy way will be much easier and will reduce the risk of a relapse in the future (Beck, 2010).
The link between negative feelings and negative thoughts is an important part of cognitive therapy (Beck, Rush, Shaw, & Emery, 1987). For this reason, being aware of feelings and mood is important and an issue that is likely to be addressed. Sharon’s therapist may use some mood checks to get information on her mood and emotional state. These checks may be subjective surveys like asking Sharon to rate her mood or state of anxiety on a scale of 0-100 or more formal, objective self-report questionnaires such as the Beck Anxiety Inventory (Beck, 1995).