Gestalt therapy and Heart-Centered therapies.

Abstract: Heart-Centered therapies utilize several of the basic Gestalt techniques developed by Fritz Perls. One is presentness, making everything very immediate, emphasizing the here and now. Another is concrete attention to detail, rather than abstract conceptualizing, including the importance of somatic and body awareness. Both of these principles lead to heightened emotional intensity of experience, which in turn facilitates greater healing. Gestalt therapists are existentially oriented, framing life as offering exciting choices or opportunities to explore and to discover one's potentials. The hypnotic trance state in HeartCentered therapies maximizes such Gestalt techniques as client focusing and directed awareness (including body awareness), enactment, exaggeration, and guided fantasy. We utilize loosening techniques to assist a client who is stuck in rigid thinking. We use integrating techniques to bring together processes the client doesn't bring together or actively keeps apart. We adhere to the Gestalt principle of balancing client frustration and support. Finally, we discuss the set of skills required to properly facilitate Gestalt-oriented therapy.

Gestalt Therapy 

Gestalt therapy is directed toward experiencing, feeling and expressing rather than interpreting; toward what is being done, thought and felt in this moment rather than on what was, might be, could be, or should be; toward understanding that emotional responses to current life events are faulty, habitual residue patterned after original repressed unresolved events (Levendula, 1963). Fritz Perls (1969a, 1969b, 1970) used several basic premises in his development of Gestalt therapy. One was to make everything very immediate, emphasizing the here and now. His assessment of the importance of presentness was influenced by Karen Horney, who supervised Perls in Berlin and emphasized the "Here and Now, the What and How." When people would start telling him about their lives or their problems, he would stop them, saying, "Do you hear the quality of your voice? Can you hear the fear in it?" or "What is your right foot doing? What would it say to you, if it could talk?" He applied the same insistence on present tense experiencing of plans or worries for the future, dreams or fantasies. This oriented people out of their familiar mood and ways of engaging or resisting, and forced them to attend to their experience in the present. Similarly, Sheldon Kopp (1976, p. 75) speaks of Wilhelm Reich's manner of working with patients: "...he begins by ignoring the content of the patient's complaints in favor of focusing entirely on the style in which they are being presented."

Emphasis on immediate experience meant that awareness was the key to unlock insight and ultimately to bring behavior change. Rather than trying to change something, one might better simply to be aware of it; fully aware, deeply aware. Immediate experience includes whatever a person receives through his senses, i.e., feeling states, proprioceptive (internal) body sensations, movement, and thoughts. Perls referred to this emphasis as the "awareness continuum." Another basic principle of Gestalt therapy is that concrete attention to detail, rather than abstract conceptualizing, facilitates greater awareness. This personal awareness raises the emotional intensity of whatever the individual is saying or thinking about. Used in hypnotherapy, the heightened intensity of experience aides in the depth of the affect or somatic bridge in regressions. Keeping the client's awareness on concrete detail is a constant in hypnotic age regressions, because it promotes presentness emotionally and viscerally.

In Gestalt therapy, there is a recognition that all human experience exists on a continuum with polar opposites, such as passive/aggressive, sad/ happy or humility/ arrogance. It is often useful to understand psychopathology as an imbalance on one or more of these continuums, with the individual stuck at or near one of the polar extremes. Healthy functioning is seen, then, as access to both polarities and the ability to flexibly experience any place in between as the situation calls for. One of the objectives of Gestalt therapy is for individuals to balance their inner polarities, finding a zero-point within. Such a state may be thought of as a form of nonattachment; Fritz Perls referred to this concept as "creative indifference."

Another principle of Gestalt therapy is the importance of somatic and body awareness. The body's sensations and movements, when paid attention to, can bring into conscious awareness their concomitant but repressed emotions and impulses. This awareness enhances the person's experience of ownership for the feelings, and permits a richer, more genuine expression of them. Perls was influenced by Wilhelm Reich, who was Perls' analyst in the early 1930s, both in relation to presentness and to the function of the body's motor system as an armor. Reich expanded on the classical psychoanalytic focus (the fundamental rule) on the patient's expression of unconscious tensions and impulses through ideational productions, i.e., associations, fantasies, dreams, memories, slips: "The how of saying things is as important `material' for interpretation as is what the patient says" (Reich, 1949, p. 45). Reich's essential therapeutic aim was that of "penetrating to the energy sources of the symptoms and the neurotic character" (1949, p. 20). Allowing physical expression of the psychic energy held in the body intensifies and clarifies the emotions, and ultimately brings release of blockages and resistances. "Perls's basic assumption was that the body and its total processes are somehow anterior to and bigger than the mind. Gestalt conceives of the mind as an interference, as a way of blocking the total momentum of the organism in some way. Not only that, but the mind is not even the noble part of the organism that we always thought it was. For most people the mind and the creations of the mind work against the body. They work against the best interests of the total person" (Becket, 1993).

Heart-Centered Hypnotherapy combines Reichian energy movement with the Gestalt techniques, reinforcing the belief that the mind often interferes with the truth. We encourage participants to use an "energy release hose" (a tool we learned from Elizabeth Kubler-Ross) in order to release blocked energy from the body. As we encourage the client to move into deeper and deeper levels of release, he/she spontaneously gets down to increasingly powerful layers of their own truth.

A woman named Vana recently had the feeling that she had been sexually abused because whenever her husband touched her sexually, she "felt her skin crawl." This is a somatic experience or body memory. She began by expressing these feelings into the pillow. Just admitting this to herself, experiencing her skin crawling and speaking it aloud is what we would call removing the first layer of body armoring. Then we asked her to regress on the somatic bridge to the childhood experience where the feeling of "touch makes my skin crawl" began. She reported experiencing being a small child and could feel her father's body on top of her. She could smell the familiar smell of his alcoholic breath and the grease on his hair. These are all somatic memories, which are the most reliable aides in heightening the experience for the person. As she expressed her feelings, directly to her father, she began to address the "unfinished business" she had carried with her from so long ago. This unfinished business continues to affect her throughout her life, even into her marriage.

We then encouraged her to use "the energy release hose" to remove the blocked energy of anger that was impossible for the child to express back when the abuse happened. The anger hangs over the person most of their lives and is often projected onto those people closest to them. This anger actually acts like a magnet and attracts people who fit the profile of the original abuser. So it is no coincidence that Vana attracted a husband who is also an alcoholic and sex addict just like her abusive father. In that way, expressing anger at her husband for drinking and going to see nude dancers, she has been able to vent the repressed anger at her father. In the Heart-Centered therapy, she can take that anger back to its source and express it directly to her internalized father. She can thereby reduce the need to project it onto others. This also frees her husband from her need for him to play the role of her abusive father. He, of course, will need to deal with his alcohol and sex addictions, but now without her collaboration in them.

Another way to express this point, in the language of Gestalt Therapy, is that dissatisfaction in life is due to accumulated unfinished business. Latner (1973) refers to unfinished business as "organismic indigestion" that clogs us up, the only-partially digested (and therefore partially undigested) resentments, regrets, worries and repressions. Every experience strives for closure: everything we have repressed wants expression, and contains "stuck" energy until it is. This need for closure results in obsessive attempts to put it to rest, to find peace, i.e., the repetition compulsion. With a significant part of our energy preoccupied elsewhere ("then and there"), we cannot bring enough of ourselves to new situations ("now and here").

This is especially important when someone dies. Often family members have not completed their unfinished business with their deceased relatives, and the resulting regret creates anxiety or depression. A man named Jerome had a long history of abuse with his father. As a child, he was beaten, shamed and often punished by his young father who was trying his best to support his family of six during the Depression years of the 1930s. Jerome held these feelings within himself and during his life used drugs and alcohol to numb his anger and shame. When his father died, Jerome could not attend the funeral and became more depressed. His alcohol abuse increased and he withdrew from his entire family.

Jerome began the hypnotherapy sessions using the deep techniques of Gestalt inner dialogue to begin expressing his hurt, anger and grief to his deceased but internally alive father. After about ten sessions, which included use of the energy release hose to express anger, his depression lifted, he was able to reduce his use of drugs and alcohol and find an inner peace that was previously unknown to him. Jerome was able to finish the previously unfinished business with his father so that they could both "rest in peace."

Latner (1973, pp. 122-123) tells a Japanese Zen story to illustrate the need to resolve unfinished business:

Tanzan and Ekido were once traveling together down a muddy road. A heavy rain was still falling.

Coming around a bend they met a lovely girl in a silk kimono and sash, unable to cross the intersection.

"Come on, girl," said Tanzan at once. Lifting her in his arms, he carried her over the mud.

Ekido did not speak again until that night when they reached a lodging temple. Then he could no longer restrain himself. "We monks don't go near females," he told Tanzan, "especially young and lovely ones. It is dangerous. Why did you do that?"

"I left the girl there," said Tanzan. "Are you still carrying her?"

Gestalt therapists are existentially oriented (Van Dusen, 1960). Perls insisted that people take responsibility for all their actions, an existential approach to psychotherapy based on the idea that life is a series of choices for which we are responsible. "Existentially oriented therapists will always frame life as offering exciting choices or opportunities to explore and to discover one's potentials. An existentially oriented person will tend to feel dissatisfied with sameness or with conventional patterns (Fagen & Shepherd, 1970)" (King & Citrenbaum, 1993, p. 97). If someone had a pain in the neck, Perls would get the person to say, "I am giving myself a pain in the neck," and then go on to get the person to say exactly how they were giving themselves that pain. Taking responsibility often reveals a split in the person; one part gives the pain, the other part receives it. The person's parts are often in conflict. For example, in Perl's terms, a "top dog," manipulating with threats, tries to dominate an "underdog," manipulating with whining and avoidance. The objective is to facilitate a person to get in touch with his or her real self, i.e., the actual self as opposed to the self-image. The person has elements or aspects of both ego states within himself, and is in resistance until he experiences them both, owns them both, and indeed embraces the totality of himself with compassionate self-acceptance. This is what Frankl called the "paradoxical intention," to release dysfunctional aspects of oneself by first fully accepting them.

Gestalt therapy's goals for the individual are similar to those elaborated by traditional psychoanalysis: to dissolve the forces of repression and resistance through systematic interpretation, so that one becomes consciously aware of what was formerly unconscious. Psychoanalysis operates on the twin foundations of interpretation of resistance and the working through of conflicted drives within the transference phenomenon in the therapist-client relationship. To encourage transference, the analyst withholds direct personal expression (no "I" statements) and refrains from gratifying the patient's wishes (the "Rule of Abstinence"). The experiential therapies, especially Gestalt, utilize projective techniques other than the specialized projection of transference. People are encouraged to project their unconscious, or disowned, feelings and behaviors onto representations of people in their life rather than onto the therapist. For example, a client experiencing conflict with a boss at work would be encouraged to put (a representation of) the boss into an empty chair, project his/her expectations of the boss' beliefs and feelings, and then interact with the projected representation in the empty chair. Someone could follow the same projective technique with a part of themselves rather than with another person. The person would alternately be the "top dog" berating the "underdog," and then the "underdog" whining at the "top dog."

   The organism perceives the world as it is trained to perceive it.
   Gestalt tries to cut through this, as I said, by letting people
   discover in practice their own activities in the world, giving
   them back possession of themselves, possession over their own
   motives, finding out what is unconscious to them, what they're
   doing unbeknownst to themselves. That's what I think is the whole
   point of Gestalt: take people who are conditioned and automatic
   and put them in some kind of aegis over themselves (Becker, 1993).

These projective techniques are especially effective in enhancing the intensity of one's experience if the person first utilizes preliminary awareness continuum work. In Heart-Centered therapies, we have the person become aware of the most recent time they had the experience (preliminary awareness continuum work) and then use modified empty chair projective techniques (talking to a relevant person, into a pillow). Intensifying the person's emotional engagement in this way enhances the affect bridge, which leads directly to an age regression to a source experience. The projective techniques are used with the regressed ego states as well to enhance the intensity of emotions and the sense of immediacy.

The clinical and technical demands in Gestalt psychotherapy may be summarized as finding and skillfully utilizing ways of increasing the client's full involvement and engagement with his own feelings, thoughts and impulses intrapsychically and in relationships. "Patients move best when they are moved" (Rosen, 1972, p. 102). To that end, hypnotherapy is a powerful tool in a number of ways. It enhances presentness, concrete attention to detail, awareness of somatic experience, and accepting personal responsibility. Levendula (1963, p. 25) comments that a Gestalt therapist

   would be in a more advantageous position if he would combine his
   approach with hypnotic techniques. For example, the Gestalt
   therapist teaches the increasing of awareness through experimental
   exercises. The hypnotherapists can achieve this much more easily by
   directing the patient's attention to become sharply aware of an idea
   or sensation or memory which thereby becomes "a bright Gestalt"
   while the rest of the perceptual field recedes into a background.
   The hypnotic state itself corresponds to the Gestalt-background
   principle, and the Gestalt formation becomes more or less an
   automatic function of it. ... the combination of Gestalt therapeutic
   principles with hypnosis enriches both approaches.

There are, then, a number of specific enhancements of Gestalt techniques when using them within a hypnotherapy context:

1. The boost in intensification of emotions. Current research (Greenberg & Malcolm, 2002) documents that the degree of emotional arousal is a determining factor in the successful outcome of resolving unfinished business using the empty-chair technique.

2. The natural way in which past events are brought into the subject's awareness to be experienced in the present tense. This revivification effect of hypnosis produces more than the cognitive reliving of a facsimile of the original experience, but rather one that resurrects the full nuance of the experience itself, physically as well as emotionally.

3. The natural way in which the subject is brought to viscerally conscious awareness of bodily sensations and responses, through focused attention and access to body memories in age regression.

4. The Gestalt intention to bring client resistances to awareness rather than to circumvent them is enhanced with the use of hypnosis because resistance can be followed to its source in unresolved development in childhood and worked with as a discreet immature ego state. This facilitates the Gestalt therapy aim to bring resistances into the realm of conscious choice.

5. The "completion of a Gestalt" of earlier traumatic experiences, allowing through the revivification unique to hypnosis for deeper resolution of "unfinished business." This is accomplished by means of corrective experiences provided in the regressed ego state in which the state-dependent memory was created.

6. Expansion of the client's awareness of patterns of behavior, to enlarge the Gestalt (the focal point of awareness), i.e., to increase the scope of what can be brought into focused attention to include various experiences over the lifespan. In Levendula's words: "Hypnosis is particularly effective to achieve an integration of newly gained knowledge, and on the basis of corrective emotional experiences, to evolve a new and better philosophy of existence" (1963, p. 25).

7. The enhancement of suspension of disbelief. Hypnotic trance allows the client to experience fantasy, memory and rehearsal as vividly real. Smith (1975, p. 40) states that "the effectiveness of the Gestalt technique is related to the degree of realness of the subjective experience which ensues, or in other words the depth of the altered state of consciousness produced."

In Gestalt therapy, an impasse is a situation in which the client believes he cannot support himself, yet sufficient external support is not forthcoming. The impasse is usually due to the person's strength being divided between impulse and resistance. People most frequently cope with this by attempting to manipulate others, including the therapist. In effective psychotherapy, however, rather than circumventing the impasse and rescuing the client by providing external support, the therapist provides loving contact and encouragement to the client to find self-support deep within. That support may come in the form of a conjured nurturing and capable ego state. For example, we commonly suggest to a client in regression to a young and immature ego state, e.g., a three-year-old being verbally abused and frightened by a caregiver, to bring into the scene his/her adult to create safety, support and nurturing for that overwhelmed child.

The techniques of Gestalt therapy are experimental tasks, intended to expand the client's direct experience. They are not designed to move the client somewhere, to change the client's feelings or behavior, to recondition, or to foster catharsis. Gestalt-oriented therapists use many active techniques to facilitate client focusing and directed awareness in order to clarify their experience. All of the techniques are elaborations of the question, "What are you aware of (experiencing) now?" or "What are you feeling?" and the instruction, "Try this experiment, or pay attention to that, and see what you become aware of (experience) or learn." Enactment is a technique in which the patient is asked to put feelings or thoughts into action. For example, the therapist may encourage the patient to "say it directly to the person" (such as speaking to an empty chair or into a pillow). "Put words to it" or "Give it a voice" is another example when the individual becomes aware of a somatic experience. Enactment is intended as a way of increasing awareness, not as a form of catharsis. Exaggeration is a special form of enactment in which a person is asked to exaggerate some feeling, thought, movement, etc., in order to feel it more intensely. Sometimes a client can bring an experience into the here and now more efficiently by visualizing than by enacting, and the therapist suggests guided fantasy. Loosening techniques can assist the client who is so fettered by the bonds of the usual ways of thinking that alternative possibilities are not allowed into awareness. One example is just to ask the client to imagine or consider the opposite of whatever is believed to be true. Integrating techniques bring together processes the client doesn't bring together or actively keeps apart (splitting). For example, when the client verbally reports an emotion, she might be asked to locate it in her body. Another example is asking a patient to express positive and negative feelings about the same person. Taking back externalizations (projections) is an integrating technique in which the client is able to acknowledge and "own" some personal attribute that has previously been denied and unconsciously projected onto others. Body awareness techniques include any technique that brings clients' awareness to their body functioning or helps them to be aware of how they can use their bodies to support excitement, awareness and contact. For example, the therapist might remind the client to take some deep breaths, or to open the mouth wide rather than yelling through clenched teeth. The Gestalt therapist balances client frustration and support. The therapist explores rather than gratifies the client's wishes, even though this is frustrating for the patient, and provides a balance of warmth and firmness. The therapist responds to manipulations by the client without indulging (and thus reinforcing) them, without judging and without being purposely frustrating.

Of course, as we have seen, these techniques are usually enhanced when utilized within the context of hypnosis or hypnotherapy.

The skill set to facilitate Gestalt-oriented Heart- Centered therapies

Beahrs and Humiston (1974) discuss the set of skills required to properly facilitate Gestalt therapy: the ability to carefully discern in a client where the energy is, how he is dealing with the energy, where his strengths and weaknesses are, when his defenses are healthy and when pathological, and how much anxiety the client can tolerate at a given moment. "Most important for the therapist is a skill which can only be cultivated but not taught: the ability to see through his senses where a patient is, and the willingness to flow with him" (p. 14). We have discovered and agree with Lavendula that all these skills can best be developed when Gestalt is combined with hypnotherapy.

The Gestalt-oriented therapeutic relationship emphasizes a very real and mutual dialogue between therapist and client, incorporating four primary characteristics (Yontef, 1993):

1. Inclusion. This is a high degree of empathy, putting oneself as fully as possible into the experience of the other without judging, analyzing or interpreting while simultaneously retaining a sense of one's separate, autonomous presence. This is crucial in regression and altered-state modalities, providing validation to the client, and thus safety to explore and greater self-awareness.

2. Presence. The Gestalt-oriented therapist acknowledges that the interaction is a dialogue, expressing his/her observations, preferences, feelings, personal experience and thoughts to the client. This develops trust and models the valuing of immediate experience. It is vitally important that the therapist has done his/her own personal work so that their presence is clear and not a projection of the therapist's own issues.

3. Commitment to dialogue. The Gestalt-oriented therapist surrenders to the interpersonal process, allowing contact to happen rather than manipulating, making contact, and controlling the outcome.

4. Dialogue is lived. Dialogue is "lived" rather than looked at or talked about. The therapeutic relationship is one of sharing energetic interaction, emphasizing excitement and acceptance of the immediacy of the experience. In hypnotherapy the dialogue is "lived" also because the client is actually dialoguing with living parts of themselves or internalized others.

Gestalt therapists are responsible for maintaining a consistently high quality of presence, for knowledge about themselves and the patient, for maintaining a nondefensive posture, and for keeping their awareness and contact processes clear and matched to the client. They are responsible for the consequences of their own behavior and for establishing and maintaining the therapeutic atmosphere as safe and growthful.

The effective therapist must be willing to engage aggression, his own and that of the client. Bach and Goldberg (1974) recognize that inhibited clients who continue to suppress anger and aggression cannot achieve true authenticity. And clearly, if the therapist is intimidated by her own anger and aggression, she cannot effectively facilitate her client's exploration of his anger and aggression. Learning to express anger in a contained and healthy way is of primary importance for the therapist in preventing countertransference of either misdirected repressed anger or inhibited unexpressed anger.

Another skill, or approach to therapy, characteristic of the Gestalt therapist is a willingness to proceed into relationship with the client without first assessing a diagnosis. In other words, client assessment is performed moment by moment through the intimate and honest relating with the other person rather than through more formal procedures.

Also, the effective therapist must have the courage to be bold, willing to engage in free-wheeling and mischievous responsiveness, to be a "trickster-healer" (Kopp, 1976). Through our own spontaneity and wit, we access the intuition necessary to truly "be with" another in their experience, and to model authenticity for them.

References

Bach, G., & Goldberg, H. (1974). Creative Aggression. Garden City, NY: Doubleday and Co.

Beahrs, J. O., & Humiston, K. E. (1974). Dynamics of experiential therapy. American Journal of Clinical Hypnosis, 17(1), 1-14.

Becker, E. (Fall, 1993). Growing up rugged: Fritz Perls and Gestalt therapy. The Gestalt Journal, 16(2). [available at http://www.gestalt.org/becker.htm]

Fagen, J., & Shepherd, I. (1970). Gestalt Therapy Now. Palo Alto, CA: Science & Behavior Books.

Greenberg, L. S., & Malcolm, W. (2002). Resolving unfinished business: Relating process to outcome. Journal of Consulting and Clinical Psychology, 70(2), 406-416.

King, M. E., & Citrenbaum, C. M. (1993). Existential Hypnotherapy. New York: The Guilford Press.

Kopp, S. (1976). The trickster-healer. In E. W. L. Smith (Ed.), The Growing Edge of Gestalt Therapy. New York: Brunner/Mazel.

Latner, J. (1973). The Gestalt Therapy Book. New York: Bantam Book.

Levendula, D. (1963). Principles of Gestalt Therapy in relation to hypnotherapy. American Journal of Clinical Hypnosis, 6(1), 22-26.

Perls, F. S. (1969a). Gestalt Therapy Verbatim. Lafayette, CA: Real People Press.

Perls, F. S. (1969b). In and Out the Garbage Pail. Lafayette, CA: Real People Press.

Perls, F. S. (1970). Four lectures. In J. Fagen & I. Shepherd (Eds.), Gestalt Therapy Now. Palo Alto, CA: Science and Behavior Books.

Reich, W. (1949). Character Analysis. New York: Orgone Institute Press.

Rosen, S. (1972). Recent experiences with Gestalt, encounter and hypnotic techniques. American Journal of Psychoanalysis, 32, 90-105.

Smith, E. W. L. (1975). Altered states of consciousness in Gestalt therapy. Journal of Contemporary Psychotherapy, 7(1), 35-40.

Van Dusen, W. (1960). Existential analytic psychotherapy. American Journal of Psychoanalysis, 20, 310-322.

Yontef, G. (1993). Gestalt therapy: An introduction. In Awareness, Dialogue, and Process published by The Gestalt Journal Press. Available online at http://www.gestalt.org/yontef.htm.

Diane Zimberoff, M.A. and David Hartman, MSW *

* The Wellness Institute, 3716 - 274th Avenue SE, Issaquah, WA 98029 USA 425-391-9716