Levels of Gestalt Therapy Treatment Methods

A client who has just started therapy will experience different kind of session as a client who has been with the therapist for a longer period of time. Similarly, clients who experience psychosis would benefit from different style of therapy than clients who have issues based on neurosis. Then there are clients who seek therapy because they are facing really difficult existential issues in their lives. Their therapy would be experienced differently.

Gestalt therapy is known for its multi-variant techniques. However, what is seen as techniques is not Gestalt therapy. Gestalt therapy is the principles that lie under these techniques, within the dialogue between patient and therapists.

Different people, different needs at different times.

Level 1: Being present for the Client

The basis of all good therapy work is work with empathy, listening and validating. Being present, attentive, authentic and connecting with the client and inviting the client to be in contact. Contact work as such is healing, as it works towards reducing anxiety and loneliness that comes with it. Being present is really about the therapist putting aside prejudices, need to help, self-evaluation, analyzing the client or giving advise.  This is very important fundamental attitude for therapists in the session. It is also the most challenging.

This is also the only way to help clients who are psychologically very fragile and fragmented heal.

Irvin Yalom, in his biography, talks about one of his first clients, Sarah B., the wife of a business tycoon who suffered catatonic schizophrenia, who existed in a frozen state, not able to react to stimuli. Being a new in the profession, he was at a loss for what to do. He decided, during his rounds at the hospital ward, to converse with his non-reacting patient. He spent these 15 or so minutes talking to her about his day, the headlines etc. It was not till new neuroleptics came to existence did Sarah B. was able to move again. When she came around, the author mentioned to her of his multitude of doubts that he was of help to her in all those hours. She answered, “but Dr. Yalom, you were my bread and butter.”

Level 2: Phenomenology and Body Awareness

As the therapy progresses, and depending on the client, more work is done on the awareness of the body. This is not bodywork, but the momentarily focus on tension in the muscles and breathing. This is done in a dialogical way.

The more stable client would get sessions that looks like a play of being present. Looking at the phenomenon of the moment. What is going on, how the interaction feels like in the moment. What comes to mind now, etc. is discussed.

Level 3: Use of Creative Media

The use of creative medium, like art and music is useful at this stage for self reflection and sharing one’s internal structure with the therapist.

Further into the course of therapy, the client gets to work on relationships intra-psychic and external. Gestalt therapy is known for it’s two-chair work.

Level 4: Confrontation and Frustration

Very stable, self-sustaining clients who need therapy for self-awareness, who already have months or years of sessions with the therapist, may appreciate the challenge  that involves frustration of resistances, etc. This is done with all the first three levels intact. Gestalt therapy is never without level 1 !

What is being “frustrated” is the clients tendency to deprive him/herself of his/her need. For example, a client feels loneliness and longs to ask a lady for a date. He  is, however, so fearful of being rejected that he keeps to himself rather than calling her. The therapeutic frustration here is the confrontation of his fear of rejection.

At the end of the day, empathy is the most important aspect of therapy. 

Most therapy with clients do not reach the confrontative stage, and most sessions of gestalt therapy do not involve empty chair work. All clients at all stages of therapy are served best at the first level. It is also the most challenging part of the work.