Gestalt Therapy and Depression

Gestalt Therapy

Trained in Psychoanalysis, Fritz Perls broke away from the tradition and moved to the United States in the 1940s, setting up shop in the fabled Esalen Institute on the west coast in Big Sur, California. Dynamic, charismatic, and generally characterized as being a man prone to confrontations, Perls developed a new theory of psychotherapy with a particular interest in the body’s role in psychology.

Gestalt is a German word that loosely means that structure and meaning are created by ‘pieces coming together as a whole’; the structure and meaning are greater than the sum-total of the pieces. Is this tough to understand? It doesn’t translate well, which is why the word Gestalt is used in almost all languages instead of a translation.

Gestalt therapy is an experiential therapy as opposed to an analytic therapy. This means that there is less emphasis on why things are the way they are, and more on experiencing the fullness of the range of emotions. Insight is still relevant to Gestalt therapists.

What You Can Expect in Gestalt Therapy

Gestalt therapists place high value on a warm therapeutic relationship with clients, and that relationship forms the foundation that clients explore emotional content from. This foundation is a place of mutual trust.

Gestalt Therapy and Depression | northbyseven.comIn that environment, clients are encouraged to become aware of how they experience emotions on a body level. If you are anxious, how do you know that are you anxious? Where do you feel the anxiety in your body? Is there a part of your body that feels more anxious than another part? These questions heighten awareness of sensations we have learned to tune out or quiet.

A practical every-day example of how your body does this is with your socks. You slip them on in the morning, are aware of how they feel on your feet and ankles for maybe fifteen seconds, and then you don’t ‘feel them‘ for the rest of the day.

Our body is good at tuning out uncomfortable feelings and sensations, up to a point. The grace here is that we can focus on something else, with the implicit understanding that once we relax again, we can address what was tuned out. This is why anxiety can feel worse right before bed.

By bringing these feelings and sensations up in therapy, they can be worked with and resolved, instead of ignored yet still persistent. Keeping those sensations out of awareness takes energy, and we only have limited amounts of energy to work with. Suppressing discomfort makes us less productive than we could be. Therapy can therefore consciously address and create an environment for these concerns and their associated mental content to be resolved. This frees up energy to be productive again.

In general, Gestalt therapists view diagnosis as unhelpful. They view the act of labeling as preventing the re-integration of suppressed self-functions like anger and anxiety; labels can become part of your identity and stand in the way of you viewing yourself as capable of healing and being healthy. Labels can as objectify you, and make you less capable of relating in a full capacity. Clients that have been labeled with a diagnosis are encouraged in Gestalt therapy to explore their diagnosis and how they relate to themselves in light of their diagnosis.

Gestalt places a high value on relating in all forms. Following the work of Martin Buber, a German psychologist, Gestalt sees two main ways of relating – the I/It relationship, and the I/Thou relationship, which may be more appropriately called the I/You relationship. An I/It relationship is the relationship a person has with an object, like a tool, tree, or couch. The I/Thou relationship, on the other hand, is where a person relates to another person in a symbolic/spiritual way. The capitalization of the Thou (or You) emphasizes the essential nature of the connection.

According to Buber, the ultimate I/Thou relationship is the I’s relationship with the divine Thou/You, which for many clients is God. A person can be related to both as an It and as a You. The Divine cannot be used as a tool since there is no material substance to the Divine.

For this reason, Gestalt therapists dislike diagnosis; diagnosis have a way of turning satisfying I/Thou relationships into I/It relationships. The Gestalt therapist is not eager to refer to you as a depressed person; they are interested in getting to know You, as a whole person.

Gestalt Therapy and Depression

According to Gestalt Therapy, depression is viewed as unsatisfied needs in a Need-Satisfaction Cycle. Depression has meaning for each client, and it is often–but not always–associated with anger. This anger is uncomfortable and then suppressed by either introjects (blindly accepting beliefs and values without critically examining them) or projections (seeing specific issues in others that you refuse to see in yourself, whether or not the others actually have these issues).

Anger that leads to depression is termed as the resistance of retroflection, which is the turning of energetic anger back at yourself as the only appropriate outlet and not the environment or people nearby. This happens between gaining the energy (becoming angry), and putting the energy to work.

It is in the relative safety of the therapeutic relationship that depression can be addressed, and new self-management skills can be learned. In the case of anger, how the client relates to their depression or anger can be experienced, and explored. A healthy way of putting their anger to action can be uncovered without any of the normal limitations coming in to stop the process. No judgement, shame, or hurt feelings step in the way of you processing what you need to in order to engage with others again in a way that feels responsible and in your control.

Since Gestalt is so focused on relationships between parts and the whole, the Gestalt therapist’s goal is to show a client how their modes of relating (with defenses like retroflection) specifically reduce their contact with both themselves and others, such as the therapist. Body awareness and lack thereof is how this gets highlighted. When the client becomes aware of the tension associated with retroflection, and the energy involved in maintaining that tension in their muscles, they can then address the problem and allow the tension to resolve.

Gestalt therapists may ask a client to symbolically ‘be’ a part of their body where they feel tension to further increase their awareness of it, and to ‘speak’ as that part to another part of their body with a similar but slightly different state of tension. The increased awareness can be uncomfortable, and the brain desires a comfortable neutral place; the increased discomfort can trigger an automatic releasing of the muscles that were held tight unconsciously. This symbolic psychological shortcut is a way for the brain to recruit nerves without each one being commanded specifically to do something; it’s really hard to ‘tell’ yourself to relax. It’s as if your brain goes, “Oh yeah, wow, this is uncomfortable and I completely forgot about that. Let’s let go now.”

Body psychology can have a remarkable impact on a person’s posture and health, as the mind has a powerful influence over the muscles consciously and unconsciously, and muscles furthermore hold bones in certain positions. I have personally benefited from body-conscious psychotherapy (though not through Gestalt specifically), and have heard testimony from both a chiropractor and a massage therapist about the changes that came after therapy.

Consider how your body feels next time you get angry. You may notice your jaw being tight, your legs and hands tensed, for starters.

Have you ever noticed how your body responds to different emotions? How it literally feels with certain ‘feelings’? Do you see a particular physical tension pattern that could emerge from depression?

This is part two in a three part series:
Psychodynamic Therapy and Depression
Gestalt Therapy and Depression
Cognitive-Behavioral Therapy and Depression

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