Gestalt therapy is a humanistic, person-centred approach to therapy that recognises we are more than the sum total of our parts – we are not merely our diagnosis, our jobs or our thoughts. It was once said, somewhere in the depths of a dusty textbook, that gestalt therapy emerged from the ovens of Auschwitz rather than the armchairs of Oxford. These powerful words give some idea of its origins. Both trained in psychoanalysis, the founders of gestalt therapy, Fritz Perls and his wife, Laura Perls, fled Nazi Germany and set about creating a new psychotherapy that helped people move towards their natural instinct for growth, expansion and self-regulation, free from external introjects that may not truly be our own and imposed ideas of how we should be. Over the years, this approach, grounded in the innate wisdom of the client, has developed into a distinct therapy which holds awareness and personal growth at its core. It doesn’t seek to change people, but only to heighten awareness of who we are, rather than focusing on what we’re not…and from this place, change often occurs naturally.
Gestalt therapy essentially traded in the microscope for the magnifying glass and based its approach on viewing a person, not in isolation, but with a wider lens, representing a paradigm shift from the individual to the relational. Underpinning this, stands four theoretical pillars which support its unique methodology – field theory, phenomenology, dialogue, and experiment. Field theory helps us to understand that we are not alone in the world but are instead always in relationship to others and our environment. We are situated – meaning, we each have a context (our family, our social life, our childhood experiences, our geography, our culture, our heritage etc). We are often wounded in relationship – and gestalt therapy offers a relational, safe, and supportive climate to help us heal in relationship. Phenomenology is a philosophy, a theory, and a method that is interested in immediate experience. As a gestalt therapist, I am interested in your here and now experience – your awareness of your thoughts, feelings, and emotions as well as what happens in your body as we sit together in session and explore these different and dynamic aspects of the self. Paying attention to our immediate experience helps ‘get underneath’ our thoughts and endless internal conversations. Dialogue is not just talking! The dialogic approach values the authenticity of the therapist through my genuine presence. I bring my true self to therapy, in service of your journey and through my honesty, can deepen and broaden our work. The quality of our relationship is important. Gestalt therapy believes that the suffering of relationships is the primary cause of human distress, therefore the quality of the therapeutic relationship is critical. Indeed, the quality of the client-therapist relationship has been shown again and again to be the main ingredient in successful therapy, no matter what the modality or approach. In dialogue, I walk beside you as an interested other, not as an expert, teacher, or person with all the answers. We walk together as human beings, as partners. As Rollo May, the existential psychologist once said, the therapist acts as the midwife, bringing forth that which cries out to be born. Experiment is the idea that we need to do something rather than just think about or know something. In other words, being aware of how we do things is not enough. So, gestalt therapy involves seeing what emerges in the moment and learning by doing – or trying something new. This can be an exciting creative process.
Overall, gestalt therapy is a way of working with the whole person – not just the thinking parts or the emotional parts or the behavioural parts – but all the bits and pieces that make up who you are. Nothing is off the table – making this type of therapy spontaneous and capable of facilitating life changing shifts in perspective and awareness.
How Gestalt Therapy can help with PTSD, Vicarious Trauma, Compassion Fatigue, Burnout and Moral Injury.
There is mounting evidence that unidentified trauma is at the root of many mental health problems and gestalt therapy has been increasingly identified as particularly well suited to working with a range of issues including, but not limited to, anxiety, depression, and addiction. It is also well suited to working with PTSD, vicarious trauma, and moral injury (often crossing paths with compassion fatigue and burnout). My interest in working with PTSD, vicarious trauma and the associated issues of compassion fatigue, burnout, and moral injury, arises from my own personal experiences of working in jobs that exposed me to incredibly traumatic materials, including child abuse, child pornography, violence, cruelty, and youth suicide. During my psychotherapy training, I became curious about the predominantly unquestioned prevalence and superiority of the “one size fits all” pharmacological and/or psychiatric and psychological treatments available such as Prolonged Exposure Therapy (PET) or Eye Movement Desensitisation and Reprocessing (EMDR) to help people with diagnoses of PTSD, C-PTSD, and vicarious trauma. As a relational therapist, I felt uncomfortable with the “blanket approach” of using such manualised techniques on complex and unique human beings. While these treatments certainly do produce successful results for some clients, the clinical literature suggests that this narrow focus on rapid symptom reduction and classical conditioning leaves out the important factor of interpersonal dynamics and working through trauma as a process – and not everyone’s nervous system reacts in the same way. Bilateral stimulation (EMDR) can help in memory processing by enhancing left-right brain communication, thereby assisting in integrating traumatic memories and reducing symptoms of stress, however it can also activate and overwhelm the nervous system of a person with PTSD or vicarious trauma. Further, PET and EMDR are not the only methods available to work with these issues.
Relational gestalt therapy creates an atmosphere that is conducive to neural integration. The practice of staying with our immediate experience and describing what is happening for us has a calming effect, inducing a neurobiological feeling of safety. The gestalt therapist utilises a much more natural approach to neural integration, by gently encouraging right-brain sensing, feelings, and emotions to emerge while simultaneously helping the client to use their left-brain language, thereby enhancing the process of left-right brain communication, integration, and memory processing. Basically, talking while sensing!
At Special Counsel Psychotherapy, I also use a phased approach towards trauma – it is trauma-informed because it is safe, it prioritises support before challenge, and it emphasises a rebuilding of the self in order to create a stable ground for the client before diving headfirst into the deep end, which may potentially only serve to retraumatise. Stability is essential in order for the client to be able to slowly tolerate the intensity of processing traumatic memories. It is important we tread lightly and move at a pace that suits the individual.
Overall, there is currently a shift away from these manualised approaches of PET and EMDR towards relational approaches, highlighting the value of gestalt therapy as a primary trauma treatment. This is both because of its flexible approach to specific mental health disorders but also its capacity to work with personal growth, interpersonal effectiveness, and spiritual and psychological expansion.
