Gestalt Therapy Research Articles

Therapy Alone and in Combination With Cognitive-Behavioral Therapy on Hope and Pain Intensity in Women With Breast Cancer

Background: The breast is a sensitive organ for women. In addition to pain, breast cancer can cause many psychological problems for the patient. The aim of this study was to compare the effectiveness of gestalt therapy (GT) alone and combined with cognitive-behavioral therapy (CBT) [GT-CBT] on the hope and pain intensity of women with breast cancer. Methods: This quasi-experimental study had a pre-test and post-test design with a control group. Out of 96 available patients with breast cancer who were referred to Imam Khomeini Hospital Cancer Clinic in Tehran, Iran, 60 cases were selected based on the inclusion criteria and randomly assigned to the control (n=20), GT (n=20), and GT-CBT (n=20) groups. Patients in the intervention groups received weekly online sessions (90 minutes) of GT or GT-CBT during eight weeks of training using the Zoom app. The data were collected through the miller hope scale (MHS) and hayes & peterson visual analog scale (VAS) and analyzed using descriptive (Mean±SD) and inferential (analysis of covariance) statistics by SPSS software version 20. The significance level was set at 0.05. Results: The results indicated that both GT and GT-CBT significantly increased hope and decreased pain intensity scores (eta=0.73, F(51, 2)=70.06, P<0.001). GT-CBT showed significantly higher effectiveness than GT (P<0.05). Conclusion: According to the results, it is suggested to use integrated methods, such as GT-CBT to enhance hope and manage the pain intensity of patients with breast cancer.

Psychogenic overeating: problems of classification, diagnosis, approaches to psychotherapy (literature review)

In the article, we analyze the diagnosis of psychogenic overeating (ICD-10), consider the problem of its diagnostic criteria, similarities and differences with the diagnosis of binge-eating disorder (DSM-V), which complicate the work of researchers. We are looking at the need to differentiate the different types of binge eating disorder. The role of psychogenic overeating is noted as a pathogenetic factor that triggers the process of gaining excess weight. We describe in detail the biological (gender and hereditary predisposition), psychological (individual psychological personality traits, adaptive and compensatory resources) and sociocultural (style of family education, social ideas about the reference body image, features of communicative behavior, etc.) groups of factors involved in the formation of psychogenic overeating. The article emphasizes the role of psychological triggers of the disease associated with the emotional-volitional sphere, the specificity of reactions to stressful influences, psychological defenses and perception of the image of one’s body. The article also raises the problem of the lack of adapted and standardized psychodiagnostic tools aimed at studying psychogenic overeating, which complicates the formulation of an accurate diagnosis and the choice of methods of its treatment. The article also discusses such therapeutic approaches to the treatment of the described nosology, such as psychoanalysis, positive psychotherapy, gestalt therapy, transactional analysis, body-oriented therapy. Particular attention is paid to the cognitive-behavioral approach, which has shown high efficiency when working with patients with eating disorders. It is noted, that it is promising to develop algorithms for diagnostics and therapy of the described nosology, the feasibility of identifying individual targets of psychotherapeutic interventions to create personalized complex programs that increase the effectiveness of therapy in relation to immediate and long-term results.

Beauty and Uncertainty as Transformative Factors: A Free Energy Principle Account of Aesthetic Diagnosis and Intervention in Gestalt Psychotherapy.

Drawing from field theory, Gestalt therapy conceives psychological suffering and psychotherapy as two intentional field phenomena, where unprocessed and chaotic experiences seek the opportunity to emerge and be assimilated through the contact between the patient and the therapist (i.e., the intentionality of contacting). This therapeutic approach is based on the therapist’s aesthetic experience of his/her embodied presence in the flow of the healing process because (1) the perception of beauty can provide the therapist with feedback on the assimilation of unprocessed experiences; (2) the therapist’s attentional focus on intrinsic aesthetic diagnostic criteria can facilitate the modification of rigid psychopathological fields by supporting the openness to novel experiences. The aim of the present manuscript is to review recent evidence from psychophysiology, neuroaesthetic research, and neurocomputational models of cognition, such as the free energy principle (FEP), which support the notion of the therapeutic potential of aesthetic sensibility in Gestalt psychotherapy. Drawing from neuroimaging data, psychophysiology and recent neurocognitive accounts of aesthetic perception, we propose a novel interpretation of the sense of beauty as a self-generated reward motivating us to assimilate an ever-greater spectrum of sensory and affective states in our predictive representation of ourselves and the world and supporting the intentionality of contact. Expecting beauty, in the psychotherapeutic encounter, can help therapists tolerate uncertainty avoiding impulsive behaviours and to stay tuned to the process of change.

Клініко-терапевтичні особливості пацієнтів із шизотиповим розладом з обсесивно-компульсивною симптоматикою

Introduction. The prevalence of obsessive-compulsive symptoms in modern conditions of high stress and the lack of detailed recommendations for this category of patients determine the relevance of this publication. The emergence of suffering at a young age forms insufficiently adaptive behaviors and complicates the socialization of such persons. And the emergence of these symptoms within different etiological disorders requires the development of differentiated diagnostic and therapeutic approaches. Materials and methods. The study involved 69 outpatients with leading obsessive-compulsive disorder within schizotypal disorder (F21). The following methods were used: clinical-psychopathological, psychodiagnostic, clinical-follow-up and mathematical statistics. Patients were examined using psychodiagnostic techniques: clinical scale of obsessions and Yel-Brown compulsions (Y-BOCS - Obsessive-compulsive Scale); hospital anxiety and depression scale (HADS); quality of life scale (Chaban OS, 2008); multidimensional scale of perception of social support ("MSPSS" D. Zimet); questionnaire "Lifestyle Index" ("LSI" by R. Plutchik - G. Kellerman - H. R. Conte), method "Psychological diagnosis of coping behavior strategy" by R. Lazarus. Results. The clinical typology of these symptoms: type of avoidance, type of ambivalence and type of accumulation was studied by processing the clinical scale of obsessions and Yel-Brown compulsions (Y-BOCS) in patients with schizotypal disorder (F21). It was found that these symptoms were accompanied by anxiety and depressive symptoms only at the subclinical level, which indicates a lack of criticism of one’s condition. In patients with the leading obsessive-compulsive symptoms in schizotypal disorder, not quite mature variants of the protective structure are actualized, namely, substitution (62.3%), displacement (60.9%), regression (58%) and denial (26.1%). The leading coping strategies of such individuals are self-control (73.9%) and escape-avoidance (55.1%), which differs significantly from the strategies more often used by patients with ACS at the neurotic level. We have proposed a program of comprehensive treatment of this group of patients. Patients were divided into 2 groups, the first of which received a combined (differentiated psychopharmacological interventions and psychotherapy) option of therapy, and the second – only differentiated psychopharmacotherapy. The psychotherapeutic formulation was determined by different focus targets depending on the type of obsessive-compulsive symptoms and consisted of a combination of techniques of cognitive-behavioral therapy (CBT) and gestalt therapy (GT). The results of the follow-up study indicate the effective impact of the developed treatment and rehabilitation program on all components of the mental state and social functioning of patients with all types of obsessive-compulsive symptoms of subpsychotic level. Conclusions. The leading types of ACS in schizotypal disorder and features of psychosocial functioning in patients have been identified, which allowed to create a differentiated approach to the formation of a program of their comprehensive treatment and rehabilitation. Such persons need mandatory psychopharmacotherapy and differentiated psychotherapeutic intervention. The application of the program made it possible to improve the mental state and quality of life and achieve the optimal level of adaptation of patients in various spheres of life, increase periods of remission and prevent recurrence of the disorder.

Psychological consulting of patients with anxiety phenomena using the gestalt therapy method in the conditions of the open psychiatric hospital

The main principals of the psychological consultation of the patients with the anxious phenomenons with the use of gestalt therapy are outlined in this article. The main therapeutic principals of this method are described. The work is done in the Research and Clinical Center for Neuropsychiatry of Moscow Healthcare Department.

BASIC PRINCIPLES OF WORKING WITH DREAMS IN GESTALT THERAPY

The article discusses the main principles of working with dreams of the founder of gestalt therapy F.S. Perls, which consist in achieving the integrity of a person’s personality by «acting out» a dream by a dreamer. The stages of working with dreams in the Perls technique are highlighted and characterized.

Grieving the Child That Never Was: Treatment of Ambiguous Loss in Parents of Children with Down Syndrome

Many parents raising a child with Down syndrome (DS) express feelings of grief, sadness, disappointment, anger, and frustration related to the child's diagnosis (Sheehan & Guerin, 2017). Although previous authors have not directly used the concept of ambiguous loss when treating parents raising a child with a developmental disability, parents' thoughts and emotions align with ambiguous loss. There is also a cascade of losses for parents while raising a child with DS, such as developmental milestones or never seeing a child graduate. The empty‐chair technique (ECH) is used to increase emotional processing and expression of unmet desires (Tsvieli & Diamond, 2018). This article proposes the use of the ECH for parents raising a child with DS for processing the grief of ambiguous loss.

Taking (white) space: reflections from a queer-of-colour Gestalt therapy trainer

In this paper, the author, a queer-of-colour professor of Gestalt therapy, reflects on how race and racism emerged and was explored during a training workshop at the Norwegian Gestalt Institute. The student group, as is quite often the case in the Gestalt world, was majority white. The exploration became heated, but there was also movement through the crises. The author makes sense of the experience by reflecting on racism as a field phenomenon, the need to increase awareness of power and privilege, and the importance and difficulty of balancing challenge and support in these situations. The paper ends with a short reflection on the importance of self-care and a joyful poem. Keywords racism, microaggressions, BIPOC, Gestalt therapy training, group experiment, online

Atmospheres as media of transgenerational transmission. ‘Children and pet dogs understand everything, especially that which is not spoken.’ (Dolto, 1988)

Over the last two decades, the exploration of transgenerational phenomena has been supported by studies on infant development, epigenetics and trauma. In clinical work it is important, at times essential, to consider more than two generations in order to give meaning to what is happening to us and to our clients as well as to support the therapeutic process. We know that what happened to previous generations is transmitted to subsequent ones, but we need a better understanding of how transgenerational legacies are passed on and how they emerge in therapeutic processes. Building on a phenomenological and Gestalt perspective, and so on a conception of the self as an emergent process and on field theory, in this paper the author proposes the concept of atmosphere as a useful element of support for clinicians in being aware of, and working with, a transgenerational perspective. Atmospheres can be considered media of transgenerational transmission. In therapy, they can be useful for relating what is happening in the here and now with the history of previous generations, and thus supporting the therapist in being aware of therapeutic processes, intentionalities and transformations. Keywords atmosphere, transgenerational transmission and phenomena, emergent self, field theory, psychopathology, Gestalt therapy.

Writing evocative case studies: applying autoethnography as a research methodology for the psychotherapist

This is an introduction to the application of autoethnography, a qualitative research method, an aesthetic inquiry into the psychotherapy process. The method engages the practitioner as researcherautoethnographer who enters a field, which is their client’s therapy process. The aim is to derive insights and deepen the understanding of process, theory and diagnostics from psychotherapy sessions in practice. The therapist creates a reflexive account of their experiences, recording this in their session notes, which are also the field notes and the data. As an autoethnographer, the therapist begins therefrom a process of creative writing. The writing process is reflexive, and aesthetic. Integral to the research method, the act of writing forms a hermeneutic circle where new insights of the phenomenon of therapy happen for the researcher. The writing is created as an art form, usually a story or poetry. The result of this method is a written, evocative, aesthetic representation of the therapy process, based on the phenomenological experience of the practitioner. Demonstrating this method, a single case study of an online Gestalt therapy session of a male client diagnosed with depression and borderline personality disorder is featured in this article. The outcome of this form of aesthetic inquiry is the embodiment of psychotherapy theory through the aesthetic sensibility of the therapist-researcher. Keywords autoethnography, psychotherapy case studies, psychotherapy process research, Gestalt therapy, aesthetic inquiry

Wampold’s Contextual Model for Psychotherapy: thoughts about consequences for Gestalt therapy

This article presents Wampold’s Contextual Model for psychotherapy. This model emphasizes the general impact factors of psychotherapy that render its effectiveness, regardless of a particular therapeutic orientation. In contrast, there is the Medical Model, which stands for the scientific understanding of medicine and is all about RCT study designs, specific factors, and manuals. This overview is a short summary of Wampold's work and considers possible implications for Gestalt therapy in theory and practice. Keywords contextual model, general impact factors, psychotherapy research

Field Theory in Contemporary Gestalt Therapy Part Two: Paradoxical Theory of Change Reconsidered

ABSTRACTConceptualization of change processes presents a significant source of therapist’s self-support in demanding clinical situations. Three perspectives on understanding the process of change used in Gestalt therapy are set forth in a systematic way: mono-personal, bi-personal, and field theory. Changes in psychotherapy in clinical practice, conceptualized from a field theory perspective, are addressed in order to support both the growing edge of contemporary Gestalt therapy and to add a Gestalt therapy contribution to the current emphasis on field theory in psychotherapy. The Paradoxical Theory of Change, as the leading theoretical concept for Gestalt therapy theory of change, is reconsidered from a field theory perspective, and the consequences for clinical work are addressed.

Case Formulation in Gestalt Therapy

ABSTRACTCase formulation is a frequently used therapeutic tool that helps the therapist develop a better understanding of the client’s situation. Core concepts are strategies applied when sorting information about a client, assessing the importance of specific areas and taking appropriate actions in the therapeutic process. Although the area of case formulation has been explored in many other therapeutic approaches, there is a lack of deeper evidence on its use in the Gestalt approach. This article presents a qualitative research study that uses grounded theory for analyzing interviews with eleven Gestalt therapists. The resulting process model represents a theoretical conclusion about Gestalt therapists’ procedures in formulating clients’ cases. The research findings are discussed with the existing findings about the process of case formulation within Gestalt therapy and other therapeutic approaches. The outcome case formulation model can be helpful for practice, training, and supervision.

Affective Facilitation: A Framework for Surfacing Lived Experiences and Harnessing Creativity in Focus Group Research

In this article, we introduce the framework of Affective Facilitation to the practice of focus group research. In this context, Affective Facilitation is defined as a framework that helps researchers (1) surface and deeply understand participants’ lived experiences, bearing in mind their individual differences, (2) make space for exploring common ground across their diverse backgrounds, and (3) connect with participants through empathy and compassion using active and reflective listening skills. Conceptually, the framework draws on the theoretical and philosophical strands of phenomenology, existential dialogue, holism, and Gestalt therapy. In practice, it employs graphic facilitation as a technique for fostering group learning and connection while creating a visual memory of the dialogue. We explain the implementation of this actionable framework through a case study of facilitated conversations with parents who share their lived experiences, providing insight into their perceptions, beliefs, and concerns regarding childhood vaccination. This study contributes to a growing body of work on creative, participatory, and arts-based research methods.

Violet Oaklander, PhD (1927–2021)

Violet Oaklander, PhD (1927–2021)

The Secret Longing: A Relational Compass in a Field Perspective

ABSTRACT From the perspective of relational and field Gestalt therapy, the authors shed light on the phenomenology of clinical intervention by showing that the therapist’s main activity consists in adjusting his or her own resonance to the movement toward contact—to the impulse—which informs the therapeutic encounter itself. The therapist “positions” himself in order to “hear” better. And it is this change in the therapist that leads toward change in the patient. A clinical example illustrates the different moments in this process. By designating the intentionality at work in the encounter as a secret longing, the authors introduce a new concept, offering practitioners a sensitive compass that allows them to orientate themselves and persevere in their efforts to adjust to patients and maintain their aim of reaching them.

Being a Gestalt Psychotherapist During the Global Pandemic: Some Thoughts

ABSTRACTThe Global Pandemic has brought with it a shift in our normality. As Gestalt therapists, we had to change our way of being, our way of working, and move to online therapy. This reflective article explores the aspects and relevance of Gestalt therapy during the pandemic. The personal and the professional being of the Gestalt therapist during this chaotic and uncertain time is discussed. The aesthetic dimension of the therapeutic encounter is explored, however briefly, through the framework of theories of embodied simulation and embodied metaphors. This special focus on embodiment is then taken as meaning-making through the use of poetry as metaphor. Finally, the therapeutic value of poetry is discussed, along with its application during Gestalt group training.

The Predicted Future of Psychotherapy: A Decennial e-Delphi Poll.

Whither psychotherapy in the 2030s? Following a decennial tradition, the authors conducted an e-Delphi poll on the future of psychotherapy in the United States. A panel of 56 psychotherapy experts participated in two rounds of predictions and achieved consensus on most items. The experts forecast multicultural, mindfulness, and cognitive-behavior therapies to increase the most, whereas classical psychoanalysis, reality therapy, and gestalt therapy to decrease the most. Technological, relationship-building, strength-oriented, skill-building, and self-change interventions were expected to rise. Master-level clinicians of multiple professions were projected to expand while psychiatrists to decline in the proportion of psychotherapy rendered. Therapy platforms with the highest likelihood of flourishing were videoconferencing, texting, smartphone applications, and multiple or flexible platforms. Short-term therapy, crisis intervention, and very short-term therapy were predicted to increase the most. Forecast scenarios with the highest likelihood were therapy personalization, treatment of health problems, requirement of evidence-based practices for insurance reimbursement, and integration of psychotherapy into primary care. Limitations of the Delphi methodology are elucidated, and practice implications for health-service psychologists are advanced.

A Single-Case Design Investigation for Measuring the Efficacy of Gestalt Therapy to Treat Depression in Older Adults with Dementia in Italy and in Mexico: A Research Protocol.

Psychotherapy is one of the evidence-based clinical interventions for the treatment of depression in older adults with dementia. Randomised controlled trials are often the first methodological choice to gain evidence, yet they are not applicable to a wide range of humanistic psychotherapies. Amongst all, the efficacy of the Gestalt therapy (GT) is under-investigated. The purpose of this paper is to present a research protocol, aiming to assess the effects of a GT-based intervention on people with dementia (PWD) and indirect influence on their family carers. The study implements the single-case experimental design with time series analysis that will be carried out in Italy and Mexico. Six people in each country, who received a diagnosis of dementia and present depressive symptoms, will be recruited. Eight or more GT sessions will be provided, whose fidelity will be assessed by the GT fidelity scale. Quantitative outcome measures are foreseen for monitoring participants’ depression, anxiety, quality of life, loneliness, carers’ burden, and the caregiving dyad mutuality at baseline and follow-up. The advantages and limitations of the research design are considered. If GT will effectively result in the treatment of depression in PWD, it could enrich the range of evidence-based interventions provided by healthcare services.

The Effectiveness of Cognitive Behavioral Therapy Including Updating the Early Life Experiences and Images with the Empty Chair Technique on Social Anxiety

Specific memories of early negative life experiences (ENLE) and images play an important role in the cause and persistence of social anxiety. In this study, we aimed to investigate the effectiveness of individual Cognitive Behavior Therapy (iCBT), which includes updating a specific memory of ENLE and related images using the empty chair technique, on the social anxiety of university students. In addition to this, how iCBT applied affects the students’ general self-efficacy and psychological well-being is also examined. The current study was carried out with a total of eight university students, six female and two male. Participants attended iCBT sessions for 12 weeks. Changes in participants were evaluated with Liebowitz Social Anxiety Scale (LSAS), General Self-Efficacy Scale (GSES), and Flourishing Scale (FS) before iCBT, and one week, three months and six months after iCBT ended. The findings show that participants’ social anxiety decreased both statistically and clinically in post-tests and follow-up measures. There were statistically and clinically significant increases in general self-efficacy and psychological well-being. In addition, the changes in the participants’ social anxiety, general self-efficacy and psychological well-being post-test and follow-up measures have a large effect size. This study shows that iCBT, which includes updating of specific memories of ENLE and images, is effective in reducing social anxiety and increasing general self-efficacy and psychological well-being. These findings show that iCBT, which includes updating a specific memory of ENLE and related images, using the empty chair technique is an effective method reducing for university students’ social anxiety.