Gestalt and Behavior Therapy

Gestalt Therapy

      

   Gestalt Prayer

“I do my thing and you do your thing.

I am not in this world to live up to your expectations,

And you are not in this world to live up to mine.

You are you, and I am I, and if by chance we find each other, it's beautiful.

If not, it can't be helped.”

(Fritz Perls, 1969)

The founder of Gestalt therapy was Frederick S. (“Fritz”) Perls.  He was a German‐born psychiatrist. He had the reputation of being a bit faddish but in all reality he was a serious professional.  Laura Posner Perls also made contributions to Gestalt Therapy.  Fritz and Laura were married in 1930 and made their life work Gestalt therapy.

Key Concepts

Gestalt therapy stressed that clients need to grow up, stand on their own two feet, and deal with their life problems themselves.  Perls’ goal was to assist the client in being self-supportive and to work back in the parts of the personality the client disowned.  His approach was very confrontational and he often intentionally made clients frustrated to increase their awareness.  Present time Gesalt Therapy techniques and or principles are as follows:

•             Holism – interested in the whole person.  This principle focuses on the client’s thoughts, feelings, behaviors, body, memories, and dreams.  Cues such as physical gestures, tone of voice, demeanor, and other nonverbal content are observed.  This gives the therapist a look into how the client fits together with the environment. 
•        Field Theory – Therapist must see clients in their environment and they believe that everything relates to each other.
•       The Figure-Formation Process – How the client organizes their experiences from moment to moment.  This process tracks how some part of the environment emerges from the background and becomes the focal point of the client’s attention.
•       Organismic Self-Regulation – This principle is intertwined with the figure-formation process.  Balance is disturbed when there is a need, a sensation, or an interest.  Clients will do their best to regulate themselves with the resources and the capabilities that they have.  Clients can take action that will restore balance.
•       The Now – “Power is in the present.”  Therapists ask “what” and “how” questions to help the client be in the present moment.  Phenomenological inquiry pays attention to now and suspends any preconceived assumptions about the client’s experience.  Sadness, pain, and confusion are not talked about in the past.  The therapist asks the client to experience the present sadness, pain, and confusion.  When the past does creep back in into the present the therapist believes it is because there is a lack of completion of the past experience.  When the past is spoken about the therapist asks the client to talk about the experience as though it is in the present. 
•        Unfinished Business – When feelings are not completed or resolved.  Unfinished business can manifest in feelings such as resentment, rage, hatred, pain, anxiety, grief, guilt, and abandonment.  When feelings are not dealt with it results in them being carried into present day experiences.  These incomplete feelings seek completion the client experiences compulsive behavior, wariness, oppressive energy and self defeating behavior.  Unexpressed feelings can also result in physical sensations or problems.  There is also an impasse, or stuck point, when there is not external support or the way that the client has always behaved doesn’t work anymore.  The therapist’s job is to help the client experience the impasse and not rescue or frustrate the client.
•       Contact and Resistances to Contact – Contact is made by seeing, hearing, smelling, touching, and moving.  To contact effectively the client should be able to interact with nature and others and lose their individuality.  There are five kinds of resistances (contact boundary phenomena): Introjection – incorporates what the environment provides rather than identify what the person wants or needs.  Projection – disown certain aspects of ourselves by assigning them to the environment.  Retroflection – directing aggression inward out of fear or embarrassment, guilt, and resentment.  Deflection – the process of veering off with overuse of humor, abstract generalizations, and questions rather than statements.  Confluence – Blending in and getting along with everyone.  This results in absence of conflicts, slowness to anger, and a belief that all parties experience the same feelings and thoughts we do.
•       Energy and Blocks of Energy – Attention is given to where energy is located, how it is used, and how it can be blocked.  Blocked energy can be manifested by tension in the body, by posture, by the body being tight and closed, not breathing deeply, looking away to avoid eye contact, by speaking with a restricted voice, etc.  Clients might not be aware of blocked energy so the therapist assists them in recognizing it.

Therapeutic Goals

•        Assist the client to attain greater awareness and greater choice.
•     Assume ownership of their experience.
•     Develop skills and acquire values that will allow them to satisfy their needs without violating the rights of others. 
•     Become more aware of all of their senses.
•     Learn to accept responsibility for their actions.  This includes accepting the consequences of their actions. 
•     Be able to ask for, get help, and give help to others. 

Techniques Used

•        Experiments – The client “tries on” a new behavior.
•     Confrontation – sustained empathic inquiry with crisp, clear, and relevant awareness.
•     Exercises – Internal Dialogue Exercise—acceptance of aspects of one’s personality that has been denied.  A main division is between the “top dog” and the “underdog,” and therapy often focuses on the war between the two.  Making Rounds---This involves asking a person in a group to go up to others in the group and either speak to or do something with each person.  The Reversal Exercise---Clients take the plunge into the very thing that is fraught with anxiety and make contact with those parts of themselves that have been submerged and denied.  The Rehearsal Exercise---Internal rehearsal inhibits willingness to experiment with new behavior.  The client becomes more aware of how they try to please others by meeting their expectations.  The Exaggeration Exercise---The client is asked to exaggerate movements and gestures.  This normally intensifies the feelings that go with the behavior.  Once the client is exaggerating the movement the therapist will ask the client to put words to the movement.  Staying with the feeling---When a client is talking about a feeling that they want to ignore or avoid the therapist will encourage the client to stay with the feeling.  The Gestalt Approach to Dream Work---Dreams are brought back to life and they are relived like they are happening in present moment. 

Here are some fun brain stuff, Gestalt images, and backgrounds:

http://www.gestalt-institute.com/fun.html

References

Corey, G. (2012). Theory and Practice of Counseling and Psychotherapy (9^th ed.). Belmont, CA: Brooks/Cole.

(Frederick Salomon) Fritz Perls. (2011). Hutchinson's Biography Database, 1.

Fritz Perls Quotes. (2012). Retrieved from http://www.fritzperls.com/quotes/

Behavior Therapy

Society attacks early, when the individual is helpless. 

~ B.F. Skinner

•     B.F. Skinner (1904-1990) is considered the father of the behavioral approach to psychology. 
•     Albert Bandura (b. 1925) broadened the scope of behavior therapy by exploring the inner cognitive affected forces that motivate human behavior. 
•     Arnold A. Lazarus (b.1932) he is a pioneer in clinical behavior therapy and he developed multimodal therapy.  Multimodal therapy is a comprehensive, systematic, holistic approach to behavior therapy.

Key Concepts

•        Seven key characteristics of behavior therapy:

1.     Principles of learning are applied to assist clients to change behaviors.  Treatment goals are stated in clear-cut terms so that they can be replicated easily.  Evaluations are used to measure the effectiveness of the assessment and the treatment.  Revisions are made as needed.

2.     Behavior is not defined as actions that can be observed.  Behaviors can also include cognitions, images, beliefs, and emotions.

3.     Behavior therapy deals with current issues and why the issues are occurring.  Current environment is considered more than historical determinants.  Behavior therapy sees the importance of the client, their environment, and the way in which the client interacts with their environment. 

4.     Clients are expected to be active in dealing with their problems.  Simply talking about change is not enough.  Clients have to be willing to do something to make the change in behavior occur. 

5.     Change can happen without knowing the underlying dynamics and without understanding where the psychological problem originated.

6.     Assessment informs the treatment process.  Culture is taken into consideration when doing the assessment.  The assessment and evaluation includes the interventions used to determine whether the behavior change resulted from the procedure.

7.     Treatment interventions are specific to the client. 

Therapeutic Goals

•     To increase personal choice.
•     To create new conditions for learning.
•     The therapist assists the client in defining specific goals. 
•        Formal assessment takes place prior to treatment to determine behaviors that are targets of          change.
•     Continual assessment determines whether the goals are being met.
•     Clients are active in deciding on their treatment.
•      Goals must be clear, concrete, understood, and agreed on by the client and the therapist.

Techniques Used

•   Positive reinforcement – adding something of value to the client for a certain behavior.
•   Negative reinforcement – the escape or avoidance of unpleasant stimuli.
•   Extinction – withholding reinforcement from a previously reinforced response.
•   Punishment – the consequences of a certain behavior result in a decrease of that behavior.
•   Positive punishment – a stimulus is added after the behavior to decrease the frequency of a behavior.
• Negative punishment – a stimulus is removed after the behavior to decrease the frequency of a behavior.
• Progressive Muscle Relaxation – it achieves muscle and mental relaxation and is easily learned.
• Exposure therapies – designed to treat fears and other negative emotional responses.  It involves confrontation with a feared stimulus.
• Vivo Exposure – Clients are exposed to the actual events as opposed to imagining the situation.
• Vivo Flooding – Intense and Prolonged exposure to actual anxiety producing stimuli.
• Eye Movement Desensitization and Reprocessing – assessment, preparation, imaginal flooding, and cognitive restructuring the treatment of people wit traumatic memories.  The use of rapid, rhythmic eye movements and other bilateral stimulation to treat clients who have experienced traumatic stress.
• Social Skills Training – Deals with how the client is able to interact with others in different social situations.  Social skills is being able to communicate both effectively and appropriately.
• Assertion training – To teach people how to be assertive in different social situations.
• Self-management – This includes self-monitoring, self-reward, self-contracting, and stimulus control. 

References

Corey, G. (2012). Theory and Practice of Counseling and Psychotherapy (9^th ed.). Belmont, CA: Brooks/Cole.

B.F. Skinner Quotes (2012). Retrieved from: http://www.brainyquote.com/quotes/authors/b/b_f_skinner.html

Test your knowledge of behavioral therapy.  Take the quiz now:

http://www.selectsmart.com/FREE/test/tq.php?kqid=6071&kq=9

Existential Therapy

Recall how often in human history the saint and the rebel have been the same person. ~ Rollo May  

There was no one founder or group that started the existential therapy movement.  Many psychologists and psychiatrists were involved.  The key figures to this movement was Soren Kierkegaard 91813-1855), Friedrich Nietzsche (1844-1900), Martin, Heidegger (1889-1976), Martin Buber (1878-1965), Ludwig Binswanger (1881-1966), Medard Boss (1903-1991), Jean-Paul Sartre (1905-1980), Viktor Frankl (1905-1997), Rollo May (1909-1994), James Bugental (1915-2008), Irvin Yalom (1931- ).  Other contributors were Kirk Schneider, Orah Drug, David Elkins, and Ken Bradford.

Key Concepts

Existential Therapy does not follow a set of techniques but instead is based on understanding what it means to be human.  The movement focuses on respect for the individual, exploring new aspects of human behavior, and for different methods of understanding the individual.

The basic dimensions of the human condition include:

Ø  The Capacity for Self-Awareness-Freedom, choice, and responsibility make up this proposition.  The more aware that a person is the freer they are.  This proposition means that we are both free to be creative but limited by social and environmental constraints.  Increasing self-awareness is an aim of counseling.  It is stressed that there is a price to pay for self-awareness.  The more aware we become it will be more difficult to return to thought patterns and behaviors.  In self-awareness there may be turmoil but there is also fulfillment.

Ø  Freedom and Responsibility-People are free to choose their path, which will shape their own future.  There are three values that existential therapy embraces: the freedom to become within the context of natural and self-imposed limitations; the capacity to reflect o the meaning of our choices; and the capacity to act on the choices we make.  We didn’t have a choice to be born but we do have a choice on the way we live.  An individual can make excuses by speaking about “bad faith.”  They can blame their future on the fact that they were born a certain way or grew up in a dysfunctional family but the fact remains that they choose their path.

Ø  Striving for Identity and Relationship to Others-People want to relate to others but also to be unique and be centered in self.  Individuals have a desire to be on a path of self-discovery and to authenticate themselves.  Existential writers talk about up rootedness, alienation, and loneliness that can be seen as a failure to connect to others and to nature.  Another problem that individuals have is failure to connect to self.  People often take directions, answers, values, and beliefs from significant people in their lives instead of trusting self.

Ø  The Search for Meaning-The reason that people seek counseling and therapy are centered in these existential questions: “Why am I here?”  “What do I want from life?”  “What gives my life purpose?”  “Where is the source of meaning for me in life?”  Existential therapy helps clients challenge the meaning in their lives.  People will often get rid of traditional values and not create new ones.  This therapeutic process helps clients create a value system that is based on a way of life that is consistent with the client’s way of being.  The therapist’s trust is important in helping clients create a new value system.

Ø  Anxiety as a Condition of Living-Existential anxiety is the unavoidable outcome of being confronted with the “givens of existence” – death, freedom,, choice, isolation, and meaningless.  Anxiety arises as the realities of our mortality is recognized, pain and suffering is confronted, and the need to struggle for survival.  There is a difference between normal and neurotic anxiety.  Anxiety can be a source of growth.  Normal anxiety is appropriate and is a response to a particular event being faced.  Neurotic anxiety is anxiety that is not appropriate for the given situation.  This kind of anxiety tends to immobilize the person.  Anxiety must be faced and viewed as part of the adventure.  A new life might sometimes mean new anxiety.  Self-confidence lessens the expectation for a catastrophe to happen.

Ø  Awareness of Death and Nonbeing-If we view life as being significant than it is necessary to view death as significant.  Death is not a threat but motivation for the individual to take advantage of the present moment.  Death should be the force that makes the individual live life to the fullest extent.  The fear of death bubbles inside of an individual and haunts them throughout their life.  Confronting the fear of death can assist in transforming the individual’s life into an authentic one.  A person that fears death also fears life.  When the reality of death is accepted the individual realizes that actions count, they do have choices, and they must accept responsibility for their actions.

Therapeutic Goals

Ø  To help the client become more present to both themselves and others.

Ø  To assist the client in identifying ways they block themselves from fuller presence.

Ø  To challenge clients to assume responsibility for designing their present lives,

Ø  To encourage clients to choose more expanded ways of being in their daily lives.

Techniques Used

Existential therapy is not technique oriented.  Therapists may use techniques from other models but the main goal is to understand the world of the client.  The therapist prefers description, understanding, and exploration of the client’s reality, as opposed to diagnosis, treatment, and prognosis.  Therapists prefer not to be though of as repair psyches but rather as philosophical companions.  Existential therapists should adapt their interventions to their own personality and style.

The following link is movies that reflect many existential themes:

http://www.existential-therapy.com/Arts/Movies.htm

References

Corey, G. (2012). Theory and Practice of Counseling and Psychotherapy (9^th ed.). Belmont, CA: Brooks/Cole.

Existential Therapy. (2012). Retrieved from: http://www.existential-therapy.com/Existential_Quotes.html

Person-Centered Therapy

The only person who is educated is the one who has learned how to learn and change. ~ Carl Rogers

Carl Rogers (1902-1987) founder and a “quiet revolutionary” who continues to contributed to the development and whose influence continues to shape counseling practice today. 

Abraham Maslow (1908-1970) helped to further the understanding of self-actualizing individuals.  Many of Carl Rogers ideas are built on Maslow’s basic philosophy.

Key Concepts

Ø  Rogers believed that people are trustworthy, resourceful, capable of self-understanding and self-direction, able to make constructive changes, and able to live effective and productive lives. 

Ø  When therapists are real with the client and able to support, care, and understand them then that is when significant change will occur. 

Ø  Three therapist characteristics create an environment in which the client can grow.  Those three characteristics are congruence, unconditional positive regard, and accurate empathic understanding.

Ø  The therapist is not the authority while the client sits passively following the beliefs of the therapist.

Ø  This approach focuses on how the client interacts with others, how they can constructively move forward, and how they deal with obstacles.

Therapeutic Goals

Ø  The client’s goal is to achieve more independence and integration.

Ø  The person is the focus.  Not the person’s problems.  The client is assisted in their growth process and how the client can better deal with problems.

Ø  The client chooses the goals.

Techniques Used

The therapist is focused in their ways of being and attitudes.  Techniques to get the client to “do something” are avoided.  Attitude of the therapist is more important than techniques, knowledge, and theories.  The therapist is the instrument of change.  The therapeutic climate is set by the therapist’s attitude and belief in the inner resources of the client.  The therapist has a real relationship with the client.

The following video is what a person-centered therapy session might look like: 

References

Carl Rogers Quotes. (2012). Retrieved from:  
            http://psychology.about.com/od/psychologyquotes/a/rogersquotes.htm

Corey, G. (2012). Theory and Practice of Counseling and Psychotherapy (9^th ed.). Belmont, CA: Brooks/Cole.

Existential Therapy. (2012). Retrieved from: http://www.existentialtherapy.com/Existential_Quotes.html