Introduction

Gestalt therapy is considered one of the most exciting and innovative of all the psychotherapeutic disciplines. The importance it places in the interaction between client and therapist makes it a dynamic, fascinating and highly original practice that deserves far greater prominence and recognition than what it is usually accorded.

We shall begin by considering its philosophical and psychological foundations before focusing on its general principals and techniques. We will then concentrate on where its theory lies in relation to the practice of hypnotherapy before ending with a discussion as to why, through the criticisms of its own practitioners, Gestalt therapy is destined to survive and flourish in the 21st Century.

Philosophical and psychological foundations

Gestalt therapy is a complete, complex and highly developed approach to human psychological functioning. Its theory has at its heart three major influences: Psychoanalysis, with its crucial insights into the inner mind; Existentialism, with its emphasis upon the personal decisions that have to be made in a world that seems without reason and without purpose and Gestalt psychology, which provides a framework for a wide variety of psychological phenomena, processes and applications and insists that any psychology concerning humans is meaningless without the inclusion of human experience. At its centrepiece lies two fundamental ideas. First, that the proper focus of psychology should not be on the unknown, or even the unknowable, but on the "here and now" of living and second, that we are inextricably caught in a web of relationships with all things.

An obviously German word, Gestalt describes the unified nature of a pattern of elements. "The primary focus of the term is that it is used to refer to unified wholes, complete structures, totalities, the nature of which is not revealed by simply analysing the several parts that make it up" (1) In Gestalt therapy, the whole and the integrity of the whole are vitally important. A core Gestalt concept is that we are born whole and full of possibilities and that we create adjustments as a way to cope with adversity. "Gestalt therapy seeks to resolve these "creative adjustments" which have become rigidified, in order to enhance people's creativity, liveliness and presence in the world." (2)

Gestalt therapy emerged from the clinical work of two German psychotherapists, Frederick Saloman "Fritz" Perls (1893 -1970) and his wife Laura (1905 - 1990) an existentialist, philosopher and student of the Gestalt psychologist Max Wertheimer. Fritz Perls had helped Kurt Goldstein, a principle figure in the holistic school of psychology, with his researches into the effects of brain injuries on veterans of the Great War and had studied psychoanalysis with Karen Horney and Wilhelm Reich. Escaping Nazi persecution, Fritz and Laura Perls fled Western Europe in 1933, ran a psychological training institute for many years in Johannesburg, South Africa and finally emigrated to the United States in 1945.(3)

Once settled in New York City, the Perlses gravitated towards its artistic and intellectual centre, then as now based in and around Greenwich Village, where they were thrilled to meet people well versed in philosophy, psychology and the medicines. Indeed, it was in collaboration with members of this group that they formulated the theory, methodology and practice of their new psychological approach leading to the publication, in 1951, of the groundbreaking work: Gestalt Therapy: Excitement and Growth in the Human Personality.

Numerous centres of Gestalt learning were established across the US in the 1950's and in 1960, Fritz Perls moved to California where he taught at the Esalen Institute and became a highly successful practitioner. Many years later, American Gestaltists began to focus on the intellectual depth and long-term usefulness of the theory, dovetailing with the psychotherapeutic movements' interest in finding more inclusive models of practice. As a result, Gestalt therapy is claimed by its followers to be at the forefront of the "new integrative models of psychotherapy" and is now poised for "profound and far-reaching significance" (4)

General principals

Gestaltists believe that we live too much "in our heads." Because of this, we tend to disregard what is going on in our bodies, which is why Gestalt therapists pay so much attention to the client's gestures, mannerisms and body language. To emphasize this, Perls famously suggested that we "/ose our minds and come to our senses".

Practitioners of the Gestalt approach point to a series of assumptions and organising principals as forming a kind of "backbone" to its central theory.

Phenomenology emphasises the point that we can only know that which we actually experience, and focuses on how we can organise meaning and bring forth intention from the background of our lives. Its methodology invites us to cast aside our pre-conceived biases and assumptions and guides us to adopt a posture of what Gestalt therapists term choicefu/ transparency. We cast aside explanation and interpretation and focus more on observation and description. Dialogue concentrates on the interaction between the therapist and client ­the principal of I/Thou - and sees the therapist engaging the client in a real and authentic way, creating a shared language of meaning and self-disclosure that is restricted only by obvious ethical considerations (as an example, the therapist must never violate client boundaries, or work his or her problems into the client's treatment)

The concept of figure/ground is relevant to all functions of the individual, of couples and families and of larger groups such as organisations and, it could be said, even cultures:"As we experience the environment, a primary form or figure stands out and is organised against its background." As a figure emerges from this background, "it draws attention for a varied, though always finite, length of time" (5) When it no longer holds its focus, because of competition from another figure, it recedes into the background where it reintegrates in such a way as to have new meaning. The background includes our past experiences, beliefs and physiologies. The most famous visual example is the image of the vase and two-faces.

By the use of awareness, we are able to create for ourselves our sense of identity in the world we inhabit. Bray and Philippson (1988) see awareness not as being "in" the person, but as being "a relationship between the person and his/her environment - a function of the contact boundary" (6) The way of picturing where this awareness fits into our relationship with our environment is the cycle of awareness. The first stage of the cycle, sensation, is where our senses register some stimulus. One example is the act of eating. When hungry, we experience the sensation of our stomachs "rumbling". We give this as meaning that we are hungry. We then energise ourselves to move into an action (preparing a sandwich, for example), assimilate the sandwich into ourselves (contact) achieve satisfaction and then withdraw from the eating mode to the next cycle.

The field theory of Gestalt is our primary way of looking at the world. Its premise is that everything is dependant upon the environmental context. "We are all part of and related to everything else, that is, the field" (7) All the parts of the field (meaning, desire, sickness etc.) interconnect with, overlap, and influence one another. We are therefore constantly creating what we perceive to be our own realities.

Techniques
 
The role of the Gestalt therapist is to provide a safe, non-judgemental environment that enables the client to explain his feelings, fears, anxieties and worries without any embarrassment or fear. The client is encouraged to explore his emotional, cognitive and physical responses to the matter that is being discussed with the therapist, and creates within himself the courage to make what he deems to be satisfying choices that lead to an inner­confidence that he can cope with anything that is (metaphorically) thrown at him. In "partnership" with the therapist, he learns how events from the past may still be impacting on present circumstances and works to change his situation whilst, at the same time, devising new patterns of response that will give him more satisfying results.

To help foster awareness in the client, the therapist may utilise a number of techniques. Nelson-Jones (2001) sees Gestalt Therapy as an "experimental rather than a verbal or interpretive approach" (8) It certainly has a greater range of formats than any other therapeutic technique, and we mention just a few of them here.

Perhaps the most well known of Gestalt therapy's numerous techniques is psychodrama, which involves the client facing an empty chair or space and speaking to another "person" whom they have unresolved issues with. Top Dog (controller) and Underdog (controlled) dialogues are the dramatic features of this technique, which is also referred to as shuttling.

Dream-work is another Gestaltian practice, founded on the principal that every part of the dream represents a different part of the dreamer's personality. "The aim of dream-work is to help the individual become aware of these different parts" which is achieved by the therapist asking the client to very slowly recall each segment of the dream in as much detail as possible, whilst focusing on those parts that are the most fascinating. "This is where the energy is; asking the dreamer to become or enact each part of the dream" (9)

Sympathy/frustration is another technique that has as its premise the supposition that clients must be frustrated in their efforts to control the therapist by neurotic manipulation and instead "learn to use their power of manipulation to meet their real needs (10) Bodywork focuses on making the client become aware that his physical behaviour is a reflection of his repressed emotions, encouraging him to maintain or even exaggerate his movements (frowning, grimacing, fidgeting and clenching of fists are but a few examples of such physical manifestations) in order to eventually gain release from such emotions.

Ultimately, differences in technique are not, according to Yontef (1993) particularly important. "Techniques are just techniques - the overall method of relationships and attitude are the vital aspects of Gestalt therapy" (11)

Gestalt hypnotherapy

Given the exciting potential of its application in modern therapeutic practice, it is perhaps surprising that so little has actually been written on Gestalt hypnotherapy. The closest Perls, Hefferline and Goodman (1951) come to addressing the issue is when discussing the hypnagogic state in relation to creative visualization: "when so-called hypnagogic images appear, they will be of a schizophrenic, incoherent nature. Yet (despite) this senselessness, they can be a bridge to the recovery of one's ability to visualize and remember" (12) Hammond (1990) describes Edelstien's (1981) technique, where the client visualizes two different individuals responding in opposite ways to a situation, and then visualizes these two persons merging into one, with the integrated person having the best characteristics of each. "This technique is very similar to the Gestalt therapy method of the integration of polarities" (13)

There is little doubt that Gestalt hypnotherapy is becoming more and more accepted. Boyne (1999) argues that "Gestalt dialogue and sentence stemming is the natural development of hypnotic regression therapy" (14) and uses the term "transforming (trance-forming) therapy" to describe the process. McHugh (2001) states that, although Gestalt is a "non-trance" therapy, it is based on the same assumptions as hypnotherapy. He suggests that "our apparent outer world is really only a reflection of our inner world" and points to regression therapy as one example where "the use of metaphors within the soul and subconscious mind act as symbols for the healing of trauma and unfinished business (15)

Levendula (1963) saw Gestalt hypnotherapy as a crucial ingredient to the therapeutic process: " A Gestalt therapist would be in a more advantageous position if he would combine his approach with hypnotic techniques" (16) Zimberoff and Hartman (2003) identify a number of specific "enhancements" of such techniques when used within a hypnotherapeutic context:

1. The intensification of emotions as a direct result of hypnotic "intervention".
2. The natural way in which past events are brought into the client's awareness ­allowing the client to experience these in the present tense.
3. The natural way in which the client becomes consciously aware of bodily sensations and responses through focused attention and access to memories in age regression.
4. The "completion of Gestalt" of earlier traumatic experiences, allowing, through the "revivication unique to hypnosis", for the deeper resolution of unfinished business.
5. The expansion of the client's awareness of patterns of behaviour - increasing the scope of what can be brought into focused attention to include various experiences from the client's history.(17)

Classic Gestalt images:

Vase or two faces?
Old or glamorous woman?