Gestalt Theory: 5 Phases of Therapeutic Change

This five phases of change is also termed as five levels of neurosis. Whatever the terminology, it describes a process by which a client goes through when lasting and cathartic change happens.

 

There are several terminologies for these phases, however for this article we shall use the terms:  Fixation, Differentiation, Diffusion, Vacuum (impasse) and Integration.

Phase 1: Fixation (Cliche Role-playing)

At this level what is noticed in the client is a stiffness, being stuck in ideas / conclusions / habits / patterns, feeling trapped, in other words desperation.  The reason for therapy usually describes this condition. The client is stuck in roles, routines that do not serve him. It causes stress and conflicts in his daily life. The client is often also not aware of this point of what he really needs, because these needs are forgotten or relegated to the unconscious. This feeling of “stuckness” in repeating patterns has become part of his way of life and he cannot imagine things being different. He is however affected negatively by it at the present time.

An example :

Mr D addresses his problem of having long term relationships with women. He says that after a while he gets bored with them and wants to move on. He feels empty and lonely, and expresses this to his therapist.

During therapy a picture of the stagnation in the client’s life is formed. There is now awareness about this. The client can decide if and how he would like to proceed.

Phase 2: Differentiation

With the experiencing of the needs (as in the above case), or the feelings of anxiety, avoidance impulses. The client’s attention to the present moment is distracted by memories of the past or hopes for the future. He escapes into chains of thought, ideas and gets into debates and intellectualization.

This roundabout thoughts and decision making is a sign of unfinished business, which the client cannot complete and there is too much anxiety / anxiety of pain involved for the client to face up to the unfinished situation.

At this point, the therapist’s work is to support the client to stay in the moment. Providing a secure environment to face the anxiety — to relive conflicts, the tension between what he/she needs, emotions, impulses to move forward and its resistance, the blockages to act.

When the client is able to see his polarities, he can come to terms with taking responsibility for which direction he decides to move towards.

Mr D’s talk with his therapist has led Mr D to the knowledge of himself– that he is able to share only superficial parts of himself to the other person. In turn, he gets to know only superficial parts of the other. This superficiality is colorless and gets boring very quickly. When this happens, his impulse is to leave the present relationship for another. 

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Phase 3: Diffusion

This is a phase of acceptance. Acceptance of the Situation without avoidance of the issues. The existing situation is no longer working for the client, but alternatives are elusive to him/her. Usually when clients decide to have therapy, they are open to this phase. It is the phase of acceptance. The client accepts his/her responsibility for his/her situation, and realizes that he/she has the resource to work through the situation. This usually happens after an alliance with therapist is grounded.

Mr. D realizes that it is not that the girl(s) are boring, or that he is more interesting. He takes the viewpoint that since this is his experience with every relationship he faces (even non-romantic relationships), something in his way of connecting with others, has something to do with his own psychic defenses. 

Phase 4: Vacuum

At this stage, the client experiences confusion (not knowing how to react). It would be counter-productive at this phase for the therapist to step in and provide analysis of the situation– even if the answers are glaringly clear. The therapist is advised to wait, and allow the client to assimilate this rather uncomfortable phase. Any solutions-orientated premature direction provided by the therapist would compromise the clients’ healing process. Such intervention by the therapist could lead the client to be fixated on the opposite pole of the problem.

For example, the same client Mr D talks to the therapist who realizes that in their own relationship in the here-and-now, the client avoids deeper communication by answering with the words “”I don’t know” or “I feel bored”. The therapist may have the need to either ignore the “I don’t know” and thereby moving away from the stalemate, or the therapist may “unbore” the session by doing /saying something to fix the situation. This is an example of rescuing the client from the vacuum. 

The client will benefit more if he/she is allowed to endure this momentarily discomfort. Being in a vacuum does not last more than a couple of seconds. The client can be trusted to creatively adjust to the situation and find his/her own solutions. All he/she needs is support to stay in the vacuum long enough for movement to take place.

In this vacuum stage, the client experiences the push and pull of both poles of the problem. He/she feels “stuck in the middle”. The polarities surface from the background of his/her awareness and become clear to him/her.  Through this clarity, the client can make decisions to swing between the poles and not get unconsciously stuck at any extreme. There is freedom of choice.

Phase 5: Integration

A person who is able to stay in the momentary state of emptiness in a vacuum, in confusion, in not knowing which way to turn, eventually reaches an “ah-ha” moment. Fritz Perls (1976) mentions this in his writings often. The problem with us most of the time is that we are afraid of this vacuum. Almost always we bail out by finding solutions, distracting ourselves from the situation, forgetting, being clueless, or deadening our experiences.

In the therapy session, a safe environment is provided for the client to sit into the emptiness long enough to gain valuable “ah-ha” insight / understanding and experiences. The greatest difficulty is abstaining from intellectualizing, and making meaning of what’s going on while in this state of “stuckness”.  This requires the trust of client.

What usually happens is when the client is held by the therapist to stay in position of emptiness, the client does not use his/her old patterns of escaping the problems.  This is an opportunity for the client to reach into past unfinished experiences and experience the needs and feelings involved in these experiences. Here is where enlightenment is achieved.

Mr. D, in sitting with the therapist, and feeling bored, and needing to “flee” the encounter, realizes his anxiety of being seen. He recounts how as a child he was always doted upon by adults, and part of this attention brought also criticism of his emotions, usually negative emotions. He felt lots of expectations on him to be the happy child. 

This is a simple example of how integration of the past experiences to the present takes place. The client sees how his unease with connecting with another person is linked to how he lived as a child.

For the rest of the therapy sessions, Mr. D experiments with being authentic in the presence of the therapist. He is also encouraged to attend group therapy and work through interaction with a group.

Bibliography

Voitsmeier-Röhr, A., Wulf, R. (2017). GestalttherapieErnst Reinhart Verlag: Munich. p. 143-148.

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