Frequently asked questions
Patients are the main focus in Gestalt therapy. The Gestalt differs from the traditional therapy as it is a horizontal relationship. Direct experiences and being in the present is the center, the language of present experience is spoken by both the participant and the therapist. Both, the therapist and the client need to show the presence in the moment. This allows the patient to act as an equal who has full access to the data of his own experience so that what the therapist has observed from outside the patient or client can experience from inside.
The ‘I’ in the I-Thou relationship signifies a person, whereas the ‘I’ in an I-It relationship signifies ego and self-interest which dominates a person.
The I-Thou relationship emphasizes the importance of ‘encounter‘, or the process of interacting with the environment, including other people. It emphasizes that by treating others with respect and genuine care and not merely as objects, we can discover our authentic self. After all, according to Martin Buber, “All actual life is encountered” and “All real living is meeting”.
Following are the goals of I-Thou therapy:
Moving from Competition to Collaboration
The whole goal here is to create empowerment of the couple so that they feel capable of choosing direction in their life. Instead of viewing themselves as victims, they come with circular views.
Moving From Magic to Mystery
As the couple shifts to a collaborative mode, they reflect on the history of their relationship with the therapist. This is when old superficial feelings of love may resurface when everything was new and rosy. When two people confront each other in the I - thou mode, in their wholeness, it is then they drive out the ghosts of mutual projection.
Moving from Blame to Empathy
Partners often begin therapy in a blame mode. Each sees the other as responsible for the misery in the relationship. Each may see the self as a victim of the other. With this view, it is inevitable that partners deal with each other in the I-It mode. To help the couple move to a more mutually empathic position, it is important to first understand the dynamics of blame in the relationship. This shift will ultimately enable them to see each other more authentically and to relate in a dialogical mode.
Moving from a Hierarchical to a Generational View of the Family of Origin
A second level of work often emerges at this point - the multigenerational level. For the couple to move beyond blame, it may be necessary to work with each partner to resolve unfinished grievances with their family of origin. It is often the case that blame in the couple is a resonance of old blame toward parents from childhood. When one is stuck in blame with one‘s parents, it is difficult not to be stuck in blame with one‘s spouse or children as well. Accepting limitations of the parents is an important part of this work. This process often involves grieving and coming to terms with the fact that their parents will never be the parents they wanted or needed.
Moving Toward Mutual Empathy and Mutual Empowerment
In helping the couple to develop empathy for each other, this approach facilitates ‘mutuality of care and concern‘ and even mutual protection. Many partners, underneath the fighting and weariness, care deeply for each other and are quite protective of each other.
In the I-Thou mode, the individual is aware of the full, irreducible otherness of the partner in dialogue- logical space that is opened when individuals relate to each other in I-Thou terms. During the deep therapeutic process, the client might have many I-Thou moments, special moments wherein they realize the uniqueness and independence of the other partner.
The I-Thou relationship is a dialogical relationship, wherein one meets the other as who they are rather than what they represent.
According to the Cambridge dictionary, “The quality that involves deep feelings and beliefs of a religious nature, rather than the physical parts of life.”
Spirituality and gestalt
Gestalt theory is based on feeling and experiencing. Dealing with spirituality is the same as it is about the experience, and believing in what you experience is your experience.
Following are some of the other types of mental disorders:
Somatic symptom and related disorders
In somatic symptom and related disorders, mental distortions are manifested in the form of physical symptoms. Now, it is normal to have physical reactions to mental problems, but people with this disorder are greatly disturbed by these symptoms, so much that it takes a toll on their wellbeing, and daily life. These disorders are categorised as:
Conversion disorder
In this disorder, physical symptoms that resemble those of a nervous system disorder are developed.
Factitious disorder
In this disorder, people pretend to have symptoms for no apparent external reason (such as to get time off from work).
Illness anxiety disorder
People with illness anxiety disorder are excessively preoccupied and worried about the possibility of having or getting a serious illness.
Psychological factors affecting other medical conditions
Sometimes attitudes or behaviors can have a negative effect on a medical disorder that a person has.
Somatic symptom disorder
In this disorder, people's symptoms concern and preoccupy them, worry them constantly, and/or drive them to see doctors very frequently.
Eating disorders
Eating disorders are psychological conditions that cause unhealthy eating habits to develop. They generally begin with an obsession with food, body weight, body shape, or body image. If left untreated, eating disorders can become severe and even life threatening. There are 6 common types of eating disorders:
Anorexia nervosa
People with anorexia tend to restrict their food intake in order to lose weight, but they are already underweight. They have a distorted body image, and also denial of being underweight.
Bulimia nervosa
People with bulimia tend to binge eat foods that they would normally avoid, to a point where they are painfully full. They seem to lose control of themselves while eating. This erratic episode is generally followed by forced vomiting, taking laxative, or fasting to relieve oneself of the guilt caused by binge eating.
Binge eating disorder
Binge eating disorder consists of uncontrollable consumption of food in a short period of time followed by excessive guilt, but no compensating behaviours unlike bulimia nervosa.
Pica
Individuals with pica feel an urge for consuming culturally and socially inedible substances, like chalk, dust, soil, paper, hair, cloth, etc. this disorder is usually seen in children, pregnant women, or mentally disturbed patients.
Rumination disorder
Rumination disorder can affect people of all ages. People with this condition generally regurgitate the food they’ve recently swallowed. Then, they chew it again and either swallow it or spit it out.
Avoidant/restrictive food intake disorder
Individuals with this disorder experience disturbed eating either due to a lack of interest in eating or distaste for certain smells, tastes, colors, textures, or temperatures.
Psychosis
Psychosis is a mental disorder that may be a side effect of a psychiatric illness such as schizophrenia. In other cases, it may be caused by a health condition, medication or drug use.
Generally, symptoms of psychosis include delusions, hallucinations, talking incoherently and agitation. The person with the condition is usually unaware of his or her behaviour.
Common psychotic disorders
Some of the common psychotic disorders are: schizophrenia, schizophreniform disorder, schizoaffective disorder, brief psychotic disorder, delusional disorder, etc.
PTSD
Post traumatic stress disorder is characterised by inability to recover after experiencing or witnessing a traumatic event. Intense emotional and physical reactions are noted after certain triggers that cause flashbacks.
Depression
Depression is a mental disorder categorised by persistent low mood, loss of interest in daily activities, resulting in impaired daily functioning.
Anxiety
Anxiety disorders are categorised by symptoms of strong feelings of worry, anxiousness or stress, that interferes with one’s day-to-day activities, about the future.
Substance use disorder
Substance use disorder occurs when a person’s consumption of alcohol or abuse of drugs leads to health problems and problems at school, home, and/or work.
Gestalt and abnormal psychology
Gestalt therapy understands individual symptoms and human suffering as phenomena emerging from a wider relational field and can offer an original key to understanding, staying with and supporting people who suffer.
Personality disorders are classified into three clusters: cluster A, cluster B, and cluster C based on the similarities between disorders.
Cluster A
Cluster A disorders have symptoms that others see as bizarre. Sometimes, even strangers can notice these symptoms in people with Cluster A disorders. The disorders in this cluster are:
Paranoid
This disorder causes people to feel constantly suspicious of others for no apparent reason. They believe that the people around them are somehow working against them. Due to this paranoia, they may resist forming meaningful relationships, opening up to others, or forgiving perceived slights.
Schizoid
People with this disorder feel little to no desire to have relationships with others, including sexual relationships, friendships, or close relationships with family. These patients find it difficult to note social cues, express emotions, or find joy in activities that include socialising.
Schizotypal
People often notice that those with this disorder have strange ways of talking, acting, and emoting. They may hear voices, believe that everyday things leave hidden messages for them, and believe that their thoughts are magical. People with schizotypal personality disorder have trouble forming relationships as they are always suspicious of others.
Cluster B
Those who fall under this cluster of personality disorders are perceived to be dramatic, erratic, and unpredictable by others. The disorders in this cluster are:
Histrionic
This condition causes patients to have dramatic, unpredictable outbursts. However, the distinctive feature of histrionic personality disorder is that people have these episodes as a way to seek attention. People with this disorder may also feel like their relationships are intense, even when the other person believes the relationship is shallow. Their emotions shift rapidly and dramatically, and the people around them greatly influence their behaviors.
Narcissistic
This disorder makes people believe that they are more important than others. As such, they may think less of or even fail to notice the needs of others. People with narcissistic personality disorder expect constant praise from those around them and may exaggerate their credentials. They may fantasize about holding more power and envy those with higher statuses. People describe them as arrogant.
Borderline
People with borderline personality disorder are gripped by an overwhelming fear of being abandoned or left alone. This often leads to signs like impulse behaviors, including gambling, unsafe sex, and binge eating. They often have fragile self-worth and unstable relationships. When interpersonal conflict is high, people with borderline personality disorder have paranoia and outbursts of anger.
Anti-social
Media portrayals and casual conversations often use the term “sociopath,” to describe people with this condition. One of the hallmark symptoms of antisocial personality disorder is the inability to care about other people’s needs and feelings. This leads people with this disorder to violate people’s rights, steal, cheat, and con others. They often have trouble with the law and can act violently. People with this disorder feel little to no remorse for their actions because they cannot understand how they hurt someone else.
Cluster C
Cluster C personality disorders cause interpersonal friction due to the person’s inability to face certain fears. The conditions in this cluster are:
Dependent
They rely on others to make decisions for them and take care of all their needs. They are afraid to take care of themselves. As such, people with this disorder are at risk for being abused and staying in those situations, even when they have options for leaving.
Avoidant
People with this disorder are afraid of any criticism or rejection. In order to avoid these experiences, they may go through extreme measures to avoid contacting people at work or attending social events.
OCPD
People with this disorder fear that if they do not carry out certain tasks or stick to rigid rules, something horrific will happen. As such, they obsess over orderliness, rules, and cleanliness. This inflexibility can hurt their relationships.
Personality is a set of behaviours, cognitions, and emotional patterns that are born out of our biological and environmental patterns. A personality disorder is a persistent way of thinking, feeling, and behaving that is away from the norm according to social standards.
Schizophrenia is a mental disorder that affects a person’s cognition, behavioural patterns, and emotions. It may involve a certain (negligible or highly persistent) level of hallucinations, delusions, lack of interest, lack of initiative taking, flat affect, very little or absence of speech. This disorder can become manageable through treatment, but it cannot be cured.
The two major types of mood disorders are depressive disorders and bipolar disorders
Depressive disorders
Depressive disorders are characterised by periods of extreme sadness, hopelessness, despair, worthlessness, along with several physical and cognitive symptoms.
Bipolar disorders
Bipolar disorders are classified as:
Bipolar I
Previously known as “manic depressive” disorder, bipolar I involves alternating cycles of mania and depression. Mania is characterised by euphoric mood, hyper energy, and/or irritable moods and aggression.
Bipolar II
People with bipolar II disorder show signs of hypomania alternating with depression. Hypomania is simply a less severe form of mania.
Mood disorders are characterised by a severe shift in a person’s mood from time to time which disrupts his/her daily activities.
The different types of dissociative disorders are Dissociative identity disorder, Dissociative amnesia, Depersonalization/derealization disorder.
Dissociative identity disorder.
Dissociative identity disorder is categorised by overwhelming experiences, traumatic events and/or abuse that faced in childhood. Dissociative identity disorder was previously referred to as multiple personality disorder.
Dissociative amnesia.
Dissociative amnesia involves not being able to recall information about oneself (not normal forgetting). This amnesia is usually related to a traumatic or stressful event
Depersonalization/derealization disorder.
Depersonalization/derealization disorder involves significant ongoing or recurring experience of one or both conditions:
Depersonalization – experiences of unreality or detachment from one’s mind, self or body. People may feel as if they are outside their bodies and watching events happening to them.
Derealization – experiences of unreality or detachment from one’s surroundings. People may feel as if things and people in the world around them are not real.
Dissociative disorders are mental disorders that involve experiencing a disconnection and lack of continuity between thoughts, memories, surroundings, actions and identity. People with dissociative disorders escape reality in ways that are involuntary and unhealthy and cause problems with functioning in everyday life.
The 6 major types of anxiety disorders are: separation anxiety disorder, specific phobia, social anxiety disorder, panic disorder, agoraphobia, generalised anxiety disorder.
Separation anxiety disorder
A person is said to have separation anxiety disorder when he/ she shows symptoms of excessive fear or anxiety concerning those to whom the individual is attached, especially excessive given their age and level of cognition.
Specific phobia
Anxiety of a particular stimulus or situation is known as a phobic stimulus. There is marked fear or anxiety about a specific object or situation and intensity varies depending on proximity with the object or situation.
Social anxiety disorder
Intense fear or anxiety of social situations in which individuals may be negatively evaluated by others. Social situations almost always evoke anxiety, hence these situations are actively avoided.
Panic disorder
A panic disorder is an abrupt surge of intense fear or discomfort that reaches its peak within minutes leading to physical or cognitive symptoms. Panic disorder is the fear of having these panic attacks.
Agoraphobia
Agoraphobia is the fear or extreme anxiety of being in crowded spaces with seemingly no escape.
Generalised anxiety disorder
Generalised anxiety disorder is characterised by excessive worry and anxiety about daily activities, with little to no control on the worry.
Anxiety disorders are categorised by symptoms of strong feelings of worry, anxiousness or stress, that interferes with one’s day-to-day activities, about the future.
The 5 categories of abnormal psychology are anxiety disorders, dissociative disorders, mood disorders, schizophrenia, and personality disorders.
Psychopathology is the scientific study of mental disorders.Psychopathology is the scientific study of mental disorders.
Abnormal behavior may be defined as behavior that is disturbing (socially unacceptable), distressing, maladaptive (or self‐defeating), and often the result of distorted thoughts (cognitions).
Abnormal psychology is the branch of psychology that studies abnormal behaviour, cognition, and emotions in a clinical setting.
Following are the five core techniques used in psychodrama:
Soliloquy
Soliloquy is a technique brought by Moreno directly from the field of classic theatre. It is used because of its purpose to be cathartic and it results in knowing oneself. The aim of this technique is for the individual to externalise their hidden feelings, thoughts and reveal deeper levels of the interpersonal world. It allows correcting any misinterpretation of the scene and provides the therapist with insight to the patient's thoughts.
Mirror
The purpose of this technique is to promote awareness of the patient and their behaviour in different situations. It is used when the patient does not perceive their behaviour, and the image they transmit to others differs from the image they have for themselves.
Role reversal
Role reversal is one of the foundations of Moreno‘s therapy. The client is asked to portray another person while a second actor portrays the client in the particular scene. This not only prompts the client to think as the other person, but also has some of the benefits of mirroring, as the client sees him- or herself as portrayed by the second actor.
Resistance interpolation
The therapist asks the auxiliary ego to act in a completely different way than what the protagonist would expect.
Double
The job of the ‘double’ is to make conscious any thoughts or feelings that another person is unable to express whether it is because of shyness, guilt, inhibition, politeness, fear, anger, etc. In many cases the person is unaware of these thoughts or at least is unable to form the words to express how they are feeling. Therefore, the ‘double’ attempts to make conscious and give form to the unconscious and/or under expressed material. The person being doubled has the full right to disown any of the ‘double’s’ statements and to correct them as necessary. In this way, doubling itself can never be wrong.
The technique of psychodrama was established by Jacob Levy Moreno in 1889- 1974. The essential goal of psychodrama is to have a greater insight and to comprehend human relationships, behaviour as well as emotions.
Psychodrama is an action method, often used as psychotherapy, in which clients use spontaneous dramatization, role playing, and dramatic self-presentation to investigate and gain insight into their lives.
Being able to forgive someone involves letting go of the past and coming to terms with the present circumstances, as well as expanding your love above and beyond towards those who wronged you; thus forgiving someone or yourself is a skill.
The path towards forgiveness comes from acceptance. Accepting that whatever happened, happened for a reason, and leaving it in the past is the only way to be aware of the present, helps to forgive those who have wronged us.
Letting go of past hurt frees the forgiver from its weight, and it also frees the person who caused hurt, thus both parties can move on. Hence, forgiveness can indeed lead to healing.
In forgiving, we free ourselves from attachments to the past, and we clear obstructions that constrict our heart and accelerate the aging process.
Sydney Banks once stated: “If we can forgive everyone, regardless of what he or she may have done, we nourish the soul and allow our whole being to feel good. To hold a grudge against anyone is like carrying the devil on your shoulders. It is our willingness to forgive and forget that casts away such a burden and brings light into our hearts, freeing us from many ill feelings against our fellow human beings”
Forgiveness can be defined as a subjective, internal process of intentionally letting go of anger, hurt, bitterness, grudges, and retribution towards others or ourselves.
Words and feelings are the two dialogues in a communication:
Words
Merely expressing oneself through words does not include emotions, for e.g., saying “I’m fine” when asked “How are you?”. ‘Fine’ does not express your emotional state.
Feelings
Expressing oneself more deeply is possible by expressing one’s feelings, for e.g., to the above question, responding with “I’m so happy today!”, or “I feel lost right now”, or “I am not feeling great today”.
Communication occurs when one person expresses an emotion or a feeling, creates an idea, or senses the need to communicate. The communication process is triggered when the person makes a conscious or an unconscious decision to share the message with another person.
Webster’s dictionary defines communication as: “a process by which information is exchanged between individuals through a common system of symbols, signs, or behavior”.
Low resolution/ limited discrimination, difficulty in processing fine detail; tendency to overgeneralize, especially in the early stages of learning; prone to inappropriate responses in certain situations; prone to ‘fixity’ in the form of set expectations or set responses in certain situation; tendency to respond in an ‘all or nothing’ manner; relatively slow learning (reactive and context dependent); unable to delay responses; limited to responding to immediate goals (as distinct from temporally remote goals); unable to deal with delayed error signals (delayed feedback/consequences); limited spontaneity (reactive to circumstances, reactive will rather than initiating-will) In principle, the weaknesses of the unconscious mind can be compensated for by the ‘strengths’ of the conscious mind, and in that sense the unconscious mind and the conscious mind can be regarded as fulfilling complementary roles.
Processes information rapidly; is anticipatory/ predictive; implicit; permanent memory; holistic processing; unifying; emphasises sameness; imitative; inclusive; collective; associative; intuitive problem solving; empathic.
If the conscious mind represents the tip of the iceberg, it is the unconscious mind that makes up the massive bulk that lies beneath. Memories and emotions that are too painful, embarrassing, shameful, or distressing to consciously face stored in the enormous reservoir that makes up the unconscious mind.
The three levels of the awareness of mind, according to Sigmund Freud, are:
The preconscious
The preconscious consists of anything that could potentially be brought into the conscious mind.
The conscious
The conscious mind contains all of the thoughts, memories, feelings, and wishes of which we are aware at any given moment. This is the aspect of our mental processing that we can think and talk about rationally. This also includes our memory, which is not always part of consciousness but can be retrieved easily and brought into awareness.
The unconscious
The unconscious mind is a reservoir of feelings, thoughts, urges, and memories that are outside of our conscious awareness. Most of the contents of the unconscious are unacceptable or unpleasant, such as feelings of pain, anxiety, or conflict.
Fritz Perls viewed the unfolding of adult personality as the peeling of an onion. The layers of adult personality according to him are phony, phobic, impasse, implosive, and explosive.
Phony layer
As the name suggests, the phony layer is a construct built by others that we live in. we live up to other’s beliefs, standards, and understandings of the world and of us, thus straying far away from self actualisation. This layer of our personality is stereotypical and inauthentic.
Phobic layer
The phobic layer is made up of our immature beliefs about being rejected by society or our loved ones for leading an authentic life. This is the layer of our personality that prefers to run away from hurt and dissatisfaction about ourselves, which thus keeps us away from seeing our true selves.
Impasse layer
The impasse is a point where we realise that we are at a dead end, that there is no way forward, but we do not show it to the world. Instead, we continue to manipulate our surroundings which include the people in it as part of our game. We tend to give up our power at this stage.
Implosive layer
This is the layer where we have acknowledged the deadness of parts of our ‘self’. We develop a rigid system that keeps us going and makes us feel safe, but habitual parts of our ‘self’ are dead. We fully experience this deadness.
Explosive layer
This is the layer where we let go of our phony layers and fully embrace joy, sadness, and the maturity that comes along with everything. This is the part where we let go of our inauthentic self and accept a personality that is raw, real, and more human.
Gestalt views individuals as being a part of their surroundings. According to Gestalt theory of personality, people cannot be considered to be separate from their environment or even from their interpersonal relationships. Individuals are seen as self-regulating and they are able to motivate themselves to overcome their problems.
This personality inventory was developed by Goldberg in 1993 to measure the five dimensions of the Big Five personality framework.
Openness
Insight, imagination, dynamic personality, wide range of interests are a few traits that people who score high on Openness possess.
Conscientiousness
Important traits include goal oriented nature, organizational skills, mindfulness to detail, determined and careful.
Extraversion/ Introversion
Extroverts are highly energetic, enthusiastic and easily visible to people around them. Opposite to extraversion is introversion. Introverts like to keep to themselves. They do not like to be a part of the social world. They love solitude, tend to be low-key and get bored and exhausted whenever they have to socialize.
Agreeableness
Those who score high on agreeableness are affectionate, kind, full of empathy for others and extremely trustable, helpful, generous and considerate.
Neuroticism
The important characteristics of neuroticism are emotional instability, sulkiness, unhappiness, irritable mood and frequent bouts of anxiety, sadness and mood swings.
According to the OCEAN Model, there are five main components of an individual’s personality. These five components are Openness, Consciousness, Extraversion, Agreeableness and Neuroticism (OCEAN).
Eysenck's theory of personality is based on three dimensions: introversion vs. extroversion, neuroticism vs. stability, and psychoticism vs. socialization.
Cattell (1957) identified 16 factors or dimensions of personality: warmth, reasoning, emotional stability, dominance, liveliness, rule-consciousness, social boldness, sensitivity, vigilance, abstractedness, privateness, apprehension, openness to change, self-reliance, perfectionism, and tension.
Psychologist Gordon Allport found that the english language dictionary alone holds more than 4000 words that describe different personality traits. He categorised these traits into 3 levels:
Cardinal
Cardinal traits usually develop later in life. They are rare and dominate most of the other traits. They tend to define a person, sometimes becoming synonymous with their names. For example, someone who is too self absorbed may be known as Mr. Narcissism.
Central
These are the next traits in the hierarchy and are general characteristics found in varying degrees in every person (such as loyalty, kindness, agreeableness, friendliness, sneakiness, wildness, or grouchiness). These are the basic building blocks that shape most of our behavior.
Secondary
These traits exist at the bottom of the hierarchy and are not quite as obvious or consistent as central traits. They are plentiful but are only present under specific circumstances; they include things like preferences and attitudes. These traits explain why a person may at times exhibit behaviors that seem incongruent with their usual behaviors.
A trait is a genetically determined characteristic or a distinguishing quality of a person.the trait theory of personality suggests that human behaviour, cognition, and emotional pattern are determined by these characteristics unique to each individual.
Psychoanalytic or humanistic perspectives on personality focus on the similarities between individuals, whereas the trait theory argues that it is the differences between each individual that should be studied. Thus, trait theory focuses on identifying and measuring these individual personality characteristics.
The libido is activated once again due to the onset of puberty. Freud suggested that during this stage, the individual develops a strong sexual interest towards the opposite sex. This is the stage where an individual develops the quality of catering to the needs of others and not just themselves.
During this stage, the id’s energies are subdued, while at the same time the superego keeps developing. Children develop social skills, values and relationships with peers and adults outside of the family. This stage of calm is majorly attributed to the development of the ego and superego, as the child enters a world outside of his/her family life.
The term Electra complex has been used to describe a similar set of feelings experienced by young girls. In Freud’s opinion, female children possess ‘penis envy’ in place of ‘castration anxiety’.
Freud suggested that boys begin to view their fathers as a rival for the mother’s affections. The Oedipus complex consists of a male child’s desire of wanting to possess the mother and replace the father. However, the child also fears ‘castration anxiety’, which is the fear that he will be punished by the father for having these feelings.
Freud suggested that during the phallic stage, the main focus of the libido or sex drive is on the genitals. At this age, children also begin to discover the differences between men and women.