Gestalt therapy in the prevention of mental disorders. Gestalt therapy

To understand the essence of Gestalt therapy, consider the basic principles, which, unlike other principles of this kind, are not a collection of rigid, directive instructions. They only provide preliminary directions for behavior and conditions that are conducive or not to the expansion of awareness of the situation and the most full contact with the environment and with oneself.

The principle of "now" or "here and now". The principle of "now", or concentration on the present moment, is perhaps the most important principle gestalt therapy. It originates in the traditions of Zen Buddhism and a number of other Eastern practices, which, with the thoroughness and thoroughness inherent in Perls, were studied by him. The essence of this principle is that during the session the therapist often asks to determine what the patient is currently doing, feels what is happening to him and around him in this minute. In the event that material appears in the course of work related to any important aspects of the personality, efforts are made by the therapist to transfer this material to the present. For example, if the patient talks about some events of the past, then he can be asked to transfer the action to the present with the help of fantasy and describe the events as if they happened in this moment. In such cases it is often revealed how many people avoid contact with their present and tend to delve into memories of the past and fantasies about the future.

The principle of "me and you" reflects the desire for open and direct contact between people. Patients very often send their statements regarding others to the wrong address, thereby revealing their fears and unwillingness to speak directly and unambiguously.

Fear of contact, its avoidance, superficial or distorted communication with others support the patient's sense of isolation and loneliness. Therefore, during the session, the therapist encourages participants to make attempts at direct contact and communication, insisting on addressing specific statements to specific individuals whom they concern already in the first phase of work. At the same time, immediate situations are organized aimed at establishing contact between individuals through a series of short verbal and non-verbal exercises in pairs and threes.

The principle of subjectivization of statements. This principle is associated with the responsibility and involvement of the patient in what is happening. Quite often, people talk about their own body, feelings, thoughts and behavior from a certain distance, being, as it were, on the sidelines. For example: “It prevents me from making a career”, “They have been bothering me for a long time.” Often in such a situation, the therapist uses the suggestion to the patient to replace the form of the statement with a more objective one, for example, “I can’t do it myself,” “I’m preventing myself from solving this problem.” That is, the patient's conflict is artificially created with the problems that are essential for him of avoiding responsibility for his own decision, and ultimately for himself. Paying attention to the form of the utterance can help the patient to see himself as a subject, rather than a passive object that is distant or alienated from himself, with which various things that do not belong to him are “done” or “happened”.

Continuity of awareness. Awareness as the basis of therapeutic work means deliberate concentration on the spontaneous flow of the content of experiences, complete control over what and how is happening at a given moment. This method leads the individual to own experience and the rejection of endless verbalizations, clarifications and interpretations of the situation. Awareness of feelings, bodily sensations and observations are the most definite part of our knowledge, which creates the basis for the orientation of a person in his inner world and in the connections of the "I" with the environment.

Using awareness helps shift the focus from the question of "why" to the question of "what" and "how" happens. Since each action can have many causes, the clarification of all these causes leads further and further away from understanding the essence of the action itself.

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Such an introjected (essentially programmed) person, if he says “I”, then he means “THEY”. Those. does not live his own life, and often such a life of a loser.

Unfinished Gestalt and "Projection"

When projecting, a person shifts responsibility for what is happening to the environment. Often, he attributes all his hidden, unconscious negative qualities to other people. Including life problems and misfortunes.

When such a person says "THEY", one must understand - "I".

With the help of the Gestalt approach, he can realize and solve his problems.

The Unfinished Gestalt and "The Confluence"

When merging, a person's contact boundaries are so blurred that he is not able to distinguish his thoughts, feelings and actions from the thoughts, feelings and actions of other people.

When such a person says "WE", then it can be both "THEY" and "I".

Unfinished Gestalt and "Retroflection"

With retroflection (turning back), a person transfers emotions and actions intended for others.

He draws a contact boundary in the middle of himself, as if dividing into two personalities.

Such a person uses the pronouns: “himself”, “himself”, as if we are talking about two different people.

Gestalt therapy: methods, techniques and exercises

Using the methods, techniques and exercises of gestalt therapy, transference and countertransference, in incomplete situations, an emotional outburst and completion of the gestalt (situation) is possible, i.e. restoration of the contact boundary and getting rid of neurotic mechanisms.

Gestalt therapy method "Cleaning the bulb"

By the method of "cleaning the bulb" a person is gradually freed from neurosis, psychological, emotional problems. With the help of the therapist's questions and the client's answers, one problem after another, appearing in the form of "Figures", is gradually removed into the "Background".

The ultimate goal of therapy is for the client to gain the ability to manage their own psychological problems, and did not depend on the Gestalt therapist.

Gestalt Therapy "Here and Now"

Psychotherapy "here and now" helps to get rid of today's difficulties, regardless of when they arose.

The current solution of problems frees the future from these problems.

Gestalt Therapy Shuttle Approach

"Shuttle movement" consists in a phased experience by the client of an event with a return (if necessary) from the next stage to the previous one.

The experience takes place in the style of "psychodrama", i.e. the client visualizes the traumatic situation and lives through it, thus completing the "unfinished situation".

Gestalt Therapy Exercises for Self Use

Gestalt Prayer by Fritz Perls:

I am me.
And you are you.
I am not in this world to live up to your expectations.
And you are not to live according to mine.
I am who I am.
And you are you
Amen.

The techniques used in Gestalt therapy are grouped around two main areas of work. They are called principles and games. The principles are introduced on initial stage therapy, and there are not too many of them, the number of games is not limited. The principles indicate the preferred directions of behavior and conditions that favor the expansion of awareness and the most complete contact with the environment and oneself.

The main principles of Gestalt therapy are as follows:
1. The principle of "now". "Now" is a functional concept of what and how the individual is doing at the moment. For example, the act of remembering a distant past is part of the "now", and what happened a few minutes ago is not "now".
2. The principle "I - you". Expresses the desire for open and direct contact between people. Often members of the psychotherapeutic group send their statements not to the address - a specific participant, but to the side or into the air, which reveals their fears of speaking directly and frankly. The therapist encourages group members to communicate directly.
3. The principle of subjectivization of statements. The psychotherapist suggests that the patient replace the objectified forms ("something presses in the chest") with subjectivized ones ("I suppress myself").
4. Continuum of consciousness. It is an integral part of all technical procedures, but can also be used as a separate method. This is the concentration on the spontaneous flow of the content of experiences, the method of leading the individual to direct experience and the rejection of verbalizations and interpretations, one of the central concepts. Awareness of feelings, bodily sensations and observation of body movements contribute to the orientation of a person in himself and in his connections with the environment.

Technical procedures are called Gestalt games. These are various actions performed by patients at the suggestion of a psychotherapist, which contribute to a more direct confrontation with meaningful content and experiences. These games provide an opportunity to experiment with yourself and other members of the group. During the games, the group members "try on" different roles, enter into different images, identify with significant feelings and experiences, alienated parts of the personality and introjects. The purpose of the experimental games is to achieve emotional and intellectual clarification, leading to the integration of the personality. Emotional awareness ("aha-experience") is such a moment of self-realization when a person says: "Aha!". According to F. Perls, "aha" is what happens when something snaps into place; every time the gestalt "closes" this click "sounds". As the facts of emotional clarification accumulate, intellectual clarification comes.

The number of games is not limited, since each psychotherapist, using the principles of Gestalt therapy, can create new games or modify already known ones.

The most famous are the following games.
1. Dialogue between parts of the self. When a patient has a fragmentation of personality, the psychotherapist suggests an experiment: to conduct a dialogue between significant fragments of the personality - between aggressive and passive, "attacking" and "defending". This can be a dialogue with one's own feelings (for example, with anxiety, fear), and with individual parts or organs of one's own body, and with an imaginary person significant to the patient. The technique of the game is as follows: in front of the chair occupied by the patient ("hot chair"), there is an empty chair, on which an imaginary "interlocutor" is "seated". The patient alternately changes chairs, replaying the dialogue, trying to identify himself as much as possible with various parts of his personality.
2. Making circles. The patient is invited to go around the circle and address each participant with a question that concerns him, for example, to find out how others evaluate him, what they think of him, or express own feelings towards group members.
3. Unfinished business. Any unfinished gestalt is unfinished business that needs to be completed. Essentially, all Gestalt therapy is about completing unfinished business. Most people have a lot of unresolved issues related to their relatives, parents, and so on. Most often, these are unspoken complaints and claims. The patient is invited to use the empty chair technique to express his feelings to an imaginary interlocutor or to address directly to that member of the psychotherapeutic group who is related to the unfinished business.
Gestalt psychotherapists have noticed that the most frequent and significant feeling is a feeling of resentment. It is with this feeling that they work in the game, which begins with the words: "I am offended.".
4. Projective play. When the patient states that another person has some feeling or character trait, he is asked to check whether this is his projection. The patient is asked to "play a projection", i.e. try on yourself this feeling or trait. Thus, a patient who states, "I feel sorry for you" is asked to act out the role of the pitiable person by approaching and interacting with each member of the group. Gradually entering the role, a person reveals himself, while integration of previously rejected aspects of the personality can occur.
5. Revealing the opposite (reversion). The patient's overt behavior is often defensive in nature, hiding opposing tendencies. For the patient to realize hidden desires and conflicting needs, he is invited to play a role opposite to that which he demonstrates in the group. For example, a patient with "darling" mannerisms is asked to play the role of an aggressive, arrogant, hurtful woman. This technique allows you to achieve a more complete contact with those aspects of your personality that were previously hidden.

6. Imagination exercises. Illustrate the projection process and help group members identify with the rejected aspects of the personality. Among these exercises, the game "Old Abandoned Store" is the most popular. The patient is asked to close his eyes, relax, then imagine walking down a small street late at night past an old, abandoned shop. Its windows are dirty, but if you look, you can see some object. The patient is asked to carefully consider it, and then move away from the abandoned store and describe the object found outside the window. Further, he is invited to imagine himself as this object and, speaking in the first person, describe his feelings, answer the question why he was left in the store, what his existence as this object looks like. By identifying with these objects, patients project some of their personal problems onto them.

In Gestalt Therapy great attention is devoted to working with the dreams of patients. Paraphrasing Z. Freud, F. Perls said that "sleep is the royal road to personality integration." Unlike psychoanalysis, dreams are not interpreted in Gestalt therapy, they are used to integrate the personality. The author believed that the various parts of sleep are fragments of our personality. In order to achieve integration, it is necessary to combine them, to re-acknowledge these projected, alienated parts of our personality as our own and to recognize as our own the hidden tendencies that appear in a dream. By playing the objects of a dream, its individual fragments, the hidden content of the dream can be revealed through its experience, and not through its analysis.

Gestalt therapy is a form of therapy that incorporates and generalizes various psychotherapeutic methods of treatment. Translated from German language the word "gestalt" means "figure", "form". Gestalt therapy is based on a holistic approach to a person and his problem, taking into account bodily, spiritual, social aspects. The focus is not on finding the causes of the problem, but on trying to understand the momentary feelings of a person, what he feels at the moment and how something can be changed for the better.

The founder of Gestalt therapy is the German psychoanalyst Fritz (Frederick Solomon) Perls, who finally formulated the principles of therapy in his work in 1951. main goal of the new method of treatment, Perls designated the achievement of a “healthy personality” (German gute gestalt) - hence the name Gestalt therapy appeared.

Currently, the followers of Perls are trying to further improve the methods of Gestalt therapy used to treat mental illnesses, for example, schizophrenia, schizoid neurosis.

Key points

Gestalt therapy is based on the ability of the human psyche to self-regulate and adapt to changing conditions. external environment. A person must be aware of the consequences for his own actions, goals, desires. The psychotherapist focuses the patient's attention on understanding and evaluating the sensations that the patient feels "here and now".

It is very important that the patient himself realizes his true needs. For example, if a patient has alcohol or drug addiction, he must realize that alcohol or drugs are not the true need of his body, there is something more significant. For such an understanding, positive practical experience of interaction with environment, for example, new interesting hobby. The main goal is the perception of something new, development creative thinking, motivation for growth, personal development. Helps to identify the true needs of the patient experimental analysis.

The essence of Gestalt therapy is to give the patient the ability to concentrate on a new positive experience, to realize its significance on the bodily, intellectual and emotional levels, to understand that there is a choice in life. You can change your lifestyle in accordance with new sensations obtained as a result of practical experience of interacting with those elements of the world around you that were not previously given due importance.

Gestalt Therapy Techniques

The main techniques of Gestalt therapy can be divided into two main parts: principles and games. Principles are aids by which the patient is able to put his thoughts and feelings in order and play by the rules.

Principles of Gestalt Therapy:

• The first principle is understanding the present. It is important that the patient is aware of what is happening at a particular moment. He must be able to abstract from the past and the future.
• The second principle is "I" and "you". The patient does not just speak to someone, but addresses his words to a specific person sitting opposite, whom he must call by name.
• The third principle is that the patient must "reincarnate" and speak not on his own behalf, but on behalf of the image in which he "reincarnated". The patient does not say, "My hand is trembling," but says, "I am trembling."
• The fourth principle is the use of the stream of consciousness. The patient should talk about his emotions and show what he is experiencing, for example, visualize fear.
• The fifth principle is that the patient is forbidden to talk about other people nearby, but he must address them directly.
• The sixth principle relies on the patient's questions. The therapist tries to separate important questions from minor ones.

Games

Gestalt therapy uses many different games. For example, the game "I will be responsible for this" is used in group therapy sessions to create a certain mood. At the same time, the patient must add to each thought expressed by him: "... and I will be responsible for this." Other games are “Monologue” (an expanded statement from the first person), “Circle” (the patient must frankly tell each member of the group how he feels for him), “I have a secret” (the patient tells how others would react if they knew the secret that he wants to keep), "Advice to the spouses" (during the game, the spouses must engage in a frank dialogue). Gestalt therapy uses other similar games. In addition, the therapist can come up with new games that match the problems of patients and their life situations.

Gestalt therapy exercises

• Hot chair - all group members sit on chairs in a circle. In the center of the circle is another chair, which is called "hot". One of the group members sits on a hot chair, and at will. The person sitting in the hot chair begins to talk about his problems, the others ask him questions, which must be answered frankly. A person in a hot chair should feel warmth, understand that someone cares about his problems, become self-confident, realize that his problems are surmountable.
• Associations - the therapist or one member of the group names a concept or term that causes negative emotions, for example, "fear", and the other selects a positive association for it, for example, "overcome fear."
• Incomplete phrases - tell other group members what you think of them. Your phrases should begin with the words: I like that you ..., makes me angry that you ..., I'm surprised that you ..., etc.
• Missing Person - The participant closes their eyes and imagines a person they have missed in the past, such as an older brother or a mentor. Then the participant tells the group about how this person could influence or prevent the problem.
• Reverse emotions - the participant expresses in words his feelings and emotions that he experienced when listening to the problems of other participants. Then he tries to portray the opposite emotion and explores new sensations.
• Reversion is a game of opposites. For example, the right girl is offered to be a bitch, and the believer is offered to be a sinner.
• For and against - after listening to the problem of one of the participants, the group is divided into those who criticize and those who defend. Each group gives its own arguments, discussion and debate are welcome.
• Shuttle - this exercise Gestalt therapy can be done independently at home. You will need two chairs - "hot" and "empty". The bottom line is that a person sits in a “hot” chair and tells a fictional interlocutor in an empty chair about his problem. Then he sits on an empty chair, tries to listen to what was said and perceive from the listener, give advice, ask a clarifying question. Then back to the "hot" chair, back to the empty one, and so on.

Taking part in various games the patient must understand that real life- this is the same game in which real people take part, and that some of these games are acceptable to him, while others are not. Therapy should teach people to change their unsatisfactory game and not be afraid to change themselves so that life becomes full. A person must get rid of complexes and learn to be free from prejudices imposed by society. In addition, during therapy, a person learns to accept their loved ones as they are, and not try to change them.

Paradoxically, Gestalt therapy is recognized by some part of society, both professionals and non-specialists, for some techniques that are not specific to the Gestalt method, and sometimes even not at all consistent and generally little or not used by modern Gestalt therapists. For example, the technique of dialogue with one or more empty chairs representing various characters in the subject's life is essentially a technique borrowed by Perls from Moreno's psychodrama.

Techniques are techniques that allow you to implement fundamental method. In some cases, techniques that appear in other approaches can find their place in the "tool box" (M. Foucault's expression) of the Gestalt therapist, so long as they are compatible with the method and adapted to the ongoing experience. Recall that the Gestalt method focuses on the work of becoming aware of the phenomena that occur at the contact boundary, so that the ability to make creative adjustment in contact with the environment can be restored (Perls, 1969; Rudestam, 1990; Naranjo, 1995).

Whether it is a dyadic or group relationship, the situation is determined primarily by the establishment of a therapeutic context: the scope, the conditions of the meetings, the frequency and duration of the sessions, the fee, etc. All these conditions of the context can actually be considered experimental because they must be adapted to to every patient. In any case, if the goal of the therapeutic project is to restore plasticity in the construction of gestalts, and the therapeutic situation were determined by the invariable rules that each individual patient must obey, there would be a contradiction.

In fact, the forms that therapy can take may change with each new patient, just as they may change with the sensitivity and personal experience of each therapist - with some patients the connection will be mainly verbal, with others it may turn to expressive forms and non-verbal communication, such as: drawing, movement, modeling, sound, etc.

Gestalt therapy techniques can be divided into two large groups. On the one hand, these are the techniques of dialogue that take place on the borderline of contact between the therapist and the client. This work requires the full-blooded personal presence of the therapist in the dialogue; it is said about this form of work that the therapist "works by himself", uses his experience, his experiences. On the other hand, these are projective techniques, such as working with images, dreams, imaginary dialogue; at the same time, the therapist supports the client's manifestation and awareness of his experiences. Techniques are not an end in themselves, but only designate different approaches and ways of experimentation.

Experimentation, being the core of the method, creates the originality of the Gestalt way of working. In the course of therapy, the subject is encouraged not to limit himself to a story, but to turn his words into actions that unfold in the situation “here and now”. This experimentation is a kind of structure imposed by the therapist. It makes sense only if it is fully consistent with the experience that the patient is reproducing. Experimentation manipulates various parameters in order to find novelty in contact, restored possibilities of identification and rejection, creative adaptation through the expansion of the field. Some therapists are willing to turn, especially in a group, to the arsenal of pre-arranged exercises they offer regardless of the evolution of each patient. It goes without saying that the client will always be able to discover something about himself in these exercises when confronted with this safe situation, but this has little to do with therapeutic experimentation, which is directly related to the acute situations and unfinished situations of each patient.

These experiments can be of a different order, for example: a) the experiment can be focused on the growth of the conscious, when the therapist suggests, for example, to be aware of one's breathing or one or another part of the body (Rudestam, 1990; Enright; 1994, Kerpeg, 1987); b) the experiment may allow for exploration of a topic presented by the client in an implicit manner, for example, when the therapist proposes to put into action the metaphor he has just used ("I feel that my chest is in a vise!", "He makes me want to handle him like a dog”) (Rudestam, 1990; Polster, Polster, 1997).

This exploration can go through the amplification and emphasis of the words and gestures used (“Can you try to repeat this to me by amplifying the gesture that you are subtly making?”). In experimentation, model conditions can be found to provide information about what will happen in certain situations, which are difficult or impossible to model in action. Some form of projection is then invoked to explore fantasies, catastrophic expectations, unfinished or "frozen" situations that seem impossible to resolve.

Experimentation also provides opportunities for exploration different types the boundaries of one's own "I" and contact: the limits of manifestation of oneself, the boundaries of self-expression, habits, thresholds of sensations and bodily movements, values, etc. The use of fantasy allows you to expand the areas of experiment, try out new behavior in safe conditions (Rudestam, 1990; Polster, 1999 ).

One of the most well-known tools of Gestalt therapy is the "empty chair" experiment. By organizing a dialogue between two different parts of the personality, the therapist maintains the expression of various feelings until the integration of the opposite, conflicting, so to speak, irreconcilable sides of the person's personality occurs.