Northern Arizona University From the SelectedWorks of Timothy homason 2010 Existential, Humanistic, and Gestalt Psychotherapy Timothy homason, Northern Arizona University Available at: htp://works.bepress.com/timothy_thomason/39/ Existential, Humanistic, and Gestalt Psychotherapy Timothy C. Thomason Northern Arizona University Author Note: Timothy C. Thomason is a Professor in the Educational Psychology Department at Northern Arizona University in Flagstaff, Arizona. Copyright 2010 by Timothy C. Thomason 2 Existential Philosophy and Psychotherapy Existential psychotherapy grew out of existential philosophy, and focuses on concerns rooted in the person's existence, such as the meaning of life, choice, responsibility, isolation, loneliness, and alienation. Everyone has to address these issues to live authentically. From this perspective, psychotherapy is not different from "life," it is an intensification of life. Key figures in existential philosophy are Dostoyevsky, Kierkegaard, Nietzsche, Heidegger, Sartre, and Buber. The major proponents of existential psychotherapy are Rollo May, Viktor Frankl, and Irvin Yalom. Frankl developed Logotherapy, a term he invented which means "healing through reason." While Freud believed in a person's "will to pleasure," and Adler believed in a "will to power," Frankl believed in a "will to meaning." Frankl developed Logotherapy as a result of his imprisonment in Nazi death camps. He believed that mental and emotional disorders are really symptoms of an underlying sense of meaninglessness or emptiness. The therapy is meant to assist people to detect their own unique meaning and their own unique mission in life. Key concepts of existential philosophy: 1. Humans have the capacity for self-awareness. 2. Because we are free beings, we must accept responsibility for our actions. 3. We have a concern to preserve our uniqueness and identity; we know ourselves in relation to knowing and interacting with other people. 4. The meaning of our existence is never fixed once and for all. 5. We continuously recreate ourselves through our projects. 6. Anxiety is part of the human condition. 7. Death is a fact of life, and awareness of it gives significance to our lives. Therapeutic goals of existential psychotherapy: 1. To help people see that they are free and become aware of their possibilities. 2. To challenge clients to recognize that they are doing something that they formerly thought was happening to them. 3. To recognize factors that block freedom. 3 Clients seek to better understand their own being and to be aware of their own ability to freely and responsibly choose and set goals. Nietzsche said "he who has a why to live for can bear with almost any how." This approach places primary emphasis on understanding the client's current experience, and great importance is placed on the therapeutic relationship. Rollo May said "psychotherapy is the human relationship sought when a person is blocked in some form of his or her psychological and emotional existence." The purpose of therapy is to show clients that there are other ways to be and other choices that can be made. Choosing involves risk, and this dilemma is part of the human condition. Technique, as the standardization of behavior, is abhorrent and antithetical to the broad existential point of view. Existential therapists are not bound by any prescribed procedures and use techniques from many schools of therapy. There is no certain technique for finding the meaning of life, but one path is to enter a dialogue with another person who can serve as a guide. The therapeutic relationship is characterized by empathy. This approach is especially appropriate for clients who are seeking personal growth. Existential therapy stresses self-determination, accepting the personal responsibility that accompanies freedom, and viewing oneself as the author of one's life. Frankl said that "approaching human beings merely in terms of techniques necessarily implies manipulating them . . . and these human beings immediately feel and notice the manipulative quality." Although technique is not emphasized, some existential therapists use free association, interpretation, and confrontation. Paradoxical intention is a strategy that invites clients to do intentionally that which they anticipate fearing doing, or that which they secretly say they wish to do. For example, a client who is anxious and fears a panic attack may be asked to have a panic attack in the safety of the therapy session. It is almost impossible for clients to make themselves have a panic attack when invited to. Freedom is the freedom to choose; if people were not free, they would not experience anxiety. Anxiety can be constructive as well as destructive. Mental health is not living without anxiety, but living without irrational anxiety. Neurosis is the constriction of one's freedom. Therapy transfers the energy that has previously gone into neurotic symptoms into creative activity in love and work. 4 The existential therapist seeks to understand clients and then to show them where, when, and the degree to which they have failed to realize their potential, as well as how they can help themselves to more fully experience their existence. Criticisms of this approach include the fact that some of the basic concepts of existential therapy are vague and abstract, and the fact that the model has not been studied much scientifically. It has limited applicability to lower-functioning clients, clients in extreme crisis who need direction, and clients who are nonverbal. Purpose in Life Test 1. I am usually: completely bored 1 neutral 2 3 exuberant, enthusiastic 4 5 6 7 2. Life to me seems: completely routine 1 2 neutral 3 4 always exciting 5 6 7 3. In life I have: no goals or aims at all 1 2 neutral 3 very clear goals and aims 4 5 6 7 4. My personal existence is: utterly meaningless; neutral very purposeful and without purpose 1 meaningful 2 3 4 5 6 7 5. Every day is: exactly the same 1 neutral 2 3 4 constantly new and different 5 6 7 5 6. If I could choose, I would: prefer never to neutral like nine more lives have been born 1 just like this one 2 3 4 5 6 7 7. After retiring, I would: loaf completely the neutral do some of the things rest of my life 1 I've always wanted to 2 3 4 5 6 7 8. In achieving life goals I have: made no progress neutral progressed to complete whatever 1 fulfillment 2 3 4 5 6 7 9. My life is: empty, filled only neutral running over with with despair 1 exciting good things 2 3 4 5 6 7 10. If I should die today, I would feel that my life has been: completely worthless 1 2 neutral 3 very worthwhile 4 5 6 7 Crumbaugh, J. C., & Maholick, L. T. (1981). Manual of instructions for the Purpose in Life Test. Murfreesboro, TN: Psychometric Affiliates. 6 Humanistic Psychotherapy Humanistic approaches to psychotherapy are attempts to apply existential philosophy in therapy. Humanistic psychology grew out of a dissatisfaction with both psychoanalytic and behavioral approaches, which are deterministic (both view human behavior as controlled by either ids, egos, and complexes, or by reinforcers and punishers). Neither approach gave enough attention to human free will. Humanistic psychology emphasizes freedom, choice, values, growth, self-actualization, spontaneity, creativity, and peak experiences. Humanists believe that each person has a "true self" that contains the potential for optimal growth. Alienation from this true self results from unhealthy socialization. For many people humanistic psychology has served as an ideology rather than a science. It has been compared to religious traditions such as Buddhism, and the state of selfactualization might be seen as somewhat similar to the state of enlightenment. It is assumed that most people will never actually reach the end state, but that everyone can at least progress toward it. Humanism is usually considered highly compatible with the individuality and optimism of American culture. Humanism is essentially atheistic: "there is no place else to turn but inward, to the self, as the locus of values" (Hermann, 1996). A Brief Biography of Carl Rogers Carl Rogers was born in 1902 and grew up on a rural farm estate in Illinois. He described himself as a loner in childhood, and was socially incompetent. The family was fundamentalist Christian, and Rogers said "we did not dance, play cards, attend movies, smoke, drink, or show any sexual interest." Rogers was headed for a career in the ministry when he took a Christian-fellowship trip to China in his senior year in college. His discussions with many people who were less conservative than his parents broadened his perspective. He got married in 1924, and his fundamentalist religious attitudes were further liberalized when he attended Union Theological Seminary in New York. He left the seminary for Columbia University, and studied psychological testing and personality 7 adjustment. After graduation he went into clinical work at the Child Study Department of the Society for the Prevention of Cruelty to Children, working with children referred by the courts. After twelve years he moved to Ohio State University, where he wrote Counseling and Psychotherapy in 1942, and then he moved to the University of Chicago in 1945. Early in his career Rogers said that he quickly discovered that he could not change his clients' attitudes or behavior by rational arguments. He felt that rational argument always implies a form of evaluation and judgment. Clients who feel that they are being judged will naturally resist attempts to change their beliefs. Rogers decided that the therapist is not a healer, but rather a facilitator of healing. Helping clients get in touch with their own thoughts and emotions allows them to heal themselves. Rogers felt that Freudian analysis was clearly impractical for his clients, and around this time he also had a personal crisis, feeling unlovable, vulnerable, and inferior. He often cried, and had a craving for a theory of self-acceptance. He described his ideas for his new approach in the 1961 book On Becoming a Person, in which he presented his case for being real, genuine, and non-defensive. One of Rogers' friends, Eugene Gendlin, said that Rogers was a very ordinary person who was not a good conversationalist. He listened with real interest, but did not reveal much about himself in return. He rarely spoke about his own feelings, especially anger. Rogers cared about people, but not about institutions, roles, class, credentials, or positions. He considered diagnostics to be inadequate, prejudicial, and often misused, so he eliminated it from his approach to psychotherapy. Rogers rejected the medical model of mental illness and was against all forms of manipulation within therapy. He changed the designation "patient" to "client," and this change in terminology has been accepted by almost all psychotherapists. He felt that the therapist and client should have an egalitarian relationship, and he eschewed the label of expert or specialist. Rogers never distanced himself from liberal and left-wing activists during the 1960s because he agreed with their goals: authenticity, intimacy, nonjudgmental empathy, and trust in subjective experience. In 1964 Rogers moved to California to work at the Western Behavioral Sciences Institute, and in 1968 he established the Center for the Studies of the Person in La Jolla. 8 For the remainder of his life Rogers wrote, did therapy, lead encounter groups, and traveled widely to consult and teach his approach. His 1970 book Carl Rogers on Encounter Groups solidified his position in the therapy counterculture as the primary advocate of "going with the flow, being open to experience, and getting in touch with one's feelings." Rogers died at the age of 85 in 1987 of a heart attack after surgery for a broken hip. Today about half of the therapists in Europe and Japan are client-centered, and about 20% of American therapists and counselors are client-centered. A 1993 survey of American counselors showed that Carl Rogers was by far the most influential theorist, and his book Client-Centered Therapy was considered the most influential book in all psychology. Carl Rogers' Client-Centered Therapy In Client-Centered psychotherapy the therapist provides unconditional positive regard and supports the client by helping clarify the client's feelings through restatements, summary statements, and clarifications. Advice and interpretations are avoided, since the assumption is that the client has the intuitive knowledge to grow, and simply needs a facilitative environment in which to address barriers and work out problems. Carl Rogers developed nondirective therapy in the 1940s. Later he called it client-centered therapy, and later still he called it person-centered therapy. This approach has been called the first popular system of psychotherapy that has its roots almost exclusively in American psychology (instead of psychiatry, on the one hand, and European sources, on the other). In the 1960s the humanistic psychology of Abraham Maslow, Rollo May, and Carl Rogers was called the "third force" to distinguish it from psychoanalysis and behaviorism. It emphasizes utilizing the client's resources for becoming more self-aware and resolving personal blocks to psychological growth. The client-centered approach is grounded in a positive view of humanity and sees people as innately striving toward becoming "fully functioning" (Rogers' version of Maslow's concept of self-actualization). This approach helps clients focus on fully experiencing the present moment, learning to accept oneself, and deciding on ways to 9 change. Rogers said that "therapy is not a matter of doing something to the individual, or of inducing him to do something about himself. It is instead a matter of freeing him for normal growth and development, and removing obstacles so that he can again move forward." The goal is to facilitate client change through talk, similar to Plato's description of rhetoric as the "art of influencing the soul through words." According to Rogers, the healthy person is congruent, which means their selfconcept and their experience overlap, while the maladjusted person is incongruent, meaning their self-concept and their experience do not overlap sufficiently. In therapy the client's real self changes gradually to become more like their ideal self. The goal is not to change as a by-product of realizing one's true self, as in Gestalt, but to change the self directly. The motive for growth is self-actualization. It is assumed that with the proper social environment, everyone can grow toward self-actualization. Humanists are teleological (future-oriented) rather than deterministic (pastoriented), since they emphasize the goals of behavior rather than the mechanisms by which behavior occurs. The predominant philosophy of science, logical positivism, insists on determinism, that is, explanation in terms of past or present, not future, causes. Many people believe that by its nature humanistic psychology cannot be scientific. Some think that cognitive behaviorism pushes the scientific method as far toward humanism as it is possible to go, without abandoning science. A major goal of client-centered therapy is to provide a climate of safety and trust in the therapeutic setting so that the client can become aware of blocks to growth. Rogers considered the quality of the therapeutic relationship to be the prime determinant of the outcome of therapy. The therapist provides genuineness, non-possessive warmth, accurate empathy, unconditional acceptance of and respect for the client, permissiveness, and caring. The focus in therapy is on feelings, the present, and the therapeutic relationship. The client is expected to translate his or her learning in therapy to outside relationships with other people. Not everyone is fortunate enough to have been raised by ideal, accepting parents who facilitated the child's development. In contrast to therapies based on the medical model, client-centered therapy is a non-coercive approach that honors the client's experience. 10 Rogers considered three conditions as necessary and sufficient for therapeutic progress: unconditional positive regard, congruence, and empathic understanding. Unconditional positive regard, also called prizing, is acceptance that is not contingent on the particular behaviors of the client. Feeling valued by the therapist, the client becomes more self-accepting, and begins to trust personal experience. Congruence refers to the idea that the therapist's behavior should match his or her inner experience. The therapist should be genuine and largely transparent, a real person rather than a mask. Rogers said that if a therapist simply does not like a client, he or she should acknowledge dislike of the client rather than pretend acceptance. Empathic understanding is the ability to understand the experience of the client. Empathy is feeling the client's pain, rather than just intellectually understanding it. Techniques are considered secondary to the quality of the therapeutic relationship. Therapy is more dependent on who the therapist is than what he or she does. The approach minimizes directive techniques, interpretation, questioning, probing, and collecting history. There is little interest in measuring individual differences, and humanistic therapists prefer not to make a diagnosis if possible. There are strategies for building a therapeutic relationship, such as active listening, reflection of feelings, and clarification. The core therapeutic conditions, which are considered necessary and sufficient for client change to occur, include therapist congruence (genuineness), unconditional positive regard (acceptance, respect, caring, and warmth), and accurate empathic understanding. The steps in client-centered therapy include the following: define the situation; encourage free expression; accept and clarify the client's feelings; express positive feelings; recognize the client's positive impulses; facilitate the development of insight; clarify the client's choices; encourage positive actions; increase the client's independence; and decrease the client's need for help. Although Rogers stressed the facilitative or understanding conditions, other proponents of the approach, such as C. H. Patterson, proposed that as the therapeutic relationship progresses, the therapist becomes more active and implements the action conditions, which are self-disclosure, immediacy, and confrontation. As therapy proceeds the relationship becomes more intimate and intense, and the therapist becomes more genuine and spontaneous. Patterson considered specific 11 direction, advice, or guidance to be unnecessary for clients to translate their selfunderstanding into action. When Rogers founded non-directive therapy he declared war against psychoanalysis, and to a great extent he won the war, since today most counselors and psychotherapists use his approach as at least the foundation for their counseling. Rogers eliminated all interpretation, and replaced it with empathy. He used restatements and rephrasings to help understand clients and to help clients identify and refine their feelings. However, it is not meant to be simply parroting or mechanical restatement. In order to train nurses, teachers, and others in his method, Rogers admitted that he oversimplified it so that it became verbal repetition, rather than a way of really sensing the deep meaning of the client's comments. That ended up discrediting the method to some extent. Good listening is hard to learn, and recent training in client-centered therapy is much more exacting. A strength of the person-centered approach is that it stresses the active role and responsibility of the client. It is a positive and optimistic view that makes the therapeutic process relationship-centered rather than technique-centered. Relationship therapy has been called the technique of no technique. From this perspective, it is the therapist's attitudes rather than technical knowledge or skill that leads to client change. Because humanistic psychotherapy deals with relatively vague concepts such as self-actualization, it has been criticized as being too abstract and not offering practical assistance to clients who have concrete problems. Similarly, the human potential movement has been criticized as being naïve and containing a considerable amount of psychobabble and pseudoscience. Rogers took pride in his scientific research and criticized therapists who did not test their theories. In contrast to psychoanalysis, Rogers tape-recorded therapy sessions in order to make the process available for research. Taperecording counseling sessions was another of Rogers' innovations that have become commonplace in counselor training programs today. The model has generated a great deal of clinical research, but like all humanistic psychotherapies, it is closer to philosophy than science, and many of its assumptions are untestable. Many humanistic concepts are hard to define operationally. How can we really know if a person is self-actualized? How can we know whether a person's choices 12 represent a free choice or an escape from freedom? What exactly is unconditional positive regard, and is it desirable in all human relationships? The concepts may have some value in working within a multicultural context, but some people think the stress on the self and individual freedom and choice is a Western or American cultural phenomenon. A similar criticism focuses on the apparent over-emphasis on the individual at the expense of social interest. The concern is that a focus on personal growth may reduce the likelihood of social change. The humanists reply that nothing in the approach argues against social concern, and that people must first develop an awareness of their own choice and responsibility in order to become healthy members of society. The approach is extremely demanding on the therapist, who must be self-aware, congruent, genuine, non-judgmental, warm, respectful, and deeply empathic. Being this way with every client is impossible. Proponents admit that since therapists are imperfect human beings, they are fallible, and cannot be expected to practice all of the qualities all of the time. Another criticism is that the therapist who merely reflects the client's thoughts and feelings is not a real person in the relationship. What if the therapist feels contempt for a certain client? A genuine therapist would have to either express the contempt or suppress it. Another common criticism is that although providing the facilitative conditions is a good goal, and may help very verbal clients work through their feelings, this is not always sufficient to help all clients resolve their concerns. Jeffrey Masson, a well-known critic of psychotherapy, complained that the core conditions of client-centered therapy cannot be implemented in real life. Even if it is possible in the artificial setting of psychotherapy, it is possible only because the therapy is so time-limited. According to Masson, "no real person really does any of the things Rogers prescribes in real life." The therapist is not a real person with the client because if he were, he would have the same reactions he would have with people in his real life, rather than non-judgmentalness and unconditional acceptance. So if a therapist manages to do so in a session, it is merely artifice rather than reality. Masson said that the attitude of unconditional acceptance and empathic understanding is playacting, the very opposite of the genuineness that Rogers said was essential. 13 Another criticism of client-centered therapy is that it is too simplistic. The principles of the approach can be learned in just a few hours, and it appeals to the young, inexperienced therapist because it seems to be easy. It does not require much knowledge of personality diagnosis or dynamics, and it does not require the therapist to be responsible for providing guidance to the client. The therapist simply provides warmth and acceptance and encourages the client to be more fully himself, hoping this leads to self-actualization. Active listening is a sort of generic form of person-centered therapy, and consists of restating, rephrasing, and extending the client's comments in therapy. As a technique, it takes the form "You feel _____ because _____ and you want to _____." As a therapeutic tool, active listening can be very helpful in communicating understanding of the client's feelings and desires, but it can easily become a meaningless formula. The danger is that a therapeutic way of being becomes just another technique in the therapist's bag of tricks. Carl Rogers the therapist reminds some people of Fred Rogers, the sensitive neighbor on children's television. Of course, a therapist can be client-centered without imitating Carl Rogers' interpersonal style. Another criticism is that the humanistic approach is naively optimistic and has not adequately addressed the existence of evil in human beings. Trust in the human organism assumes that people will naturally incline toward the positive and constructive, but obviously there are people who behave negatively and destructively. The humanist response is that violence results from thwarting the self-actualizing tendency, and that even damaged people will grow in positive ways if given certain definable psychological conditions. According to Rollo May, the client-centered therapists' neglect of the evil side of human nature leaves them unprepared to deal adequately with negative emotions, including anger and hostility, in their clients. Rogers' trust in the positive actualizing tendency is so complete that he does not call for any social or religious checks on the individual who is pursuing selfactualization. Client-centered therapy works best with clients who are highly verbal, so it may not be the treatment of choice for many clients. There is also some question as to whether it is culturally appropriate for clients who are not European-American. Clients 14 from collectivist cultures may not place a high priority on the highly individualist approach of client-centered therapy, which emphasizes personal growth and selfactualization. The self of humanistic psychology is subjective, ahistorical, and preoccupied with individualist concerns such as personal choice and self-realization. James Bugental, one of the original humanistic psychologists, said that "human beings must certainly recognize at last that each is the center of a subjective universe. We are God. We can become the creators of what will be." Some late twentieth-century outgrowths of the human potential movement produced a wide variety of bizarre theories, exploitative practices, and spiritual-therapeutic cults, such as the Rajneesh cult, est, and the Polarity Fellowship. Scientific evaluations of client-centered therapy show mixed results. A comprehensive review concluded that "after 25 years of research on Rogers' hypotheses, there is not yet research of the rigor required for drawing conclusions about the validity of this important therapy" (Watson, 1984). Cloninger (2000) stated that "client-centered therapy is effective but not more effective than alternative treatments." Bibliography: Existential and Humanistic Psychotherapy Cloninger, S. C. (2000). Theories of personality. NY: Prentice-Hall. Frankl, V. (1963). Man's search for meaning. Boston: Beacon. Gendlin, E. T. (1988). Carl Rogers. American Psychologist, 43, #2. Hermann, E. (1996). Romance of American psychology. University of California Press. Hoffman, E. (1988). The right to be human: A biography of Abraham Maslow. Los Angeles: Tarcher. Leonard, G. (1983). Abraham Maslow and the new self. Esquire, December, p. 326336. Levant, R. F. & Shlien, J. M. (1984). Client-centered therapy and the person-centered approach. NY: Praeger. Lowry, R. J. (1973). A. H. Maslow: An intellectual portrait. Monterey, CA: Brooks/Cole. Maslow, A. H. (1968). Toward a psychology of being (2nd ed.). NY: Van Nostrand. 15 Maslow, A. H. (1987). Motivation and personality (3rd ed.). NY: Harper & Row. Masson, J. M. (1988). Against therapy. NY: Atheneum. Rogers, C. R. (1951). Counseling and psychotherapy. Boston: Houghton Mifflin. Rogers, C. R. (1961). On becoming a person. Boston: Houghton Mifflin. Wachtel, P. L. (1983). The poverty of affluence. NY: Free Press. Watson, N. (1984). The empirical status of Rogers's hypotheses of the necessary and sufficient conditions for effective psychotherapy. In Levant & Shlien (Eds.), Client-centered therapy and the person-centered approach. NY: Praeger. Yalom, I. (1980). Existential psychotherapy. NY: Basic Books. Study Questions: Existential and Humanistic Psychotherapy 1. Do you agree with the humanistic psychologists that the drive for selfactualization is the highest goal and motive in human beings? Why or why not? 2. Do you believe that most clients have the capacity to understand and resolve their own problems without directive intervention by the therapist? Why or why not? 3. To what extent do you agree with the humanistic psychologists that a therapeutic relationship which provides the core facilitative conditions is necessary and sufficient for client change? If it is not sufficient, what else is needed? 4. According to Rogers, a therapist must be a congruent, integrated, genuine person. The qualities of the therapist are what is important, rather than techniques. Are there any techniques in client-centered therapy, or is it the technique of no techniques? 5. If all that matters are the personal qualities and attitudes of the therapist, what about the issue of training? Is it possible to train someone to be empathic, nonjudgmental, warm, etc.? Suppose someone who has never been trained in counseling is naturally an empathic, non-judgmental, warm person; by what right can the profession say that that person cannot be a counselor? Does the licensing of counselors serve any purpose? 6. How does one know that a therapist does, indeed, possess empathy? Is it possible to measure empathy? If empathy is essential to good therapy, should all therapists be tested on empathy before being allowed to practice therapy? Which schools 16 of psychotherapy believe in the necessity of empathy for good therapy, and which do not? Is there any scientific evidence that empathy is essential for good therapy to occur? 7. Is the lack of attention to evil in human nature the fatal flaw of humanistic psychology? Why or why not? 8. Is active listening simply a watered-down version of Rogerian responding? If it is used as a technique outside a relationship characterized by the core conditions can it still be effective? If so does this contradict Rogers' emphasis on the crucial importance of the therapeutic relationship? 9. Can genuineness, warmth, and respect be faked? How would a client know whether he or she was seeing the real person of the therapist, or simply a good actor? Could the therapy be effective even if the therapist was just pretending to care about the client? 10. Client-centered therapy requires that the therapist be genuine, caring, and warm. What should a client-centered therapist do if he or she feels negatively about a specific client? Would it be more therapeutic for the therapist to be open and honest about his or her negative feelings, or to suppress the negative feelings and pretend to be accepting, caring, warm, and non-judgmental? Or would the therapist have to refer this client to another therapist? 11. How applicable do you think client-centered therapy would be in working with (a) a client who is severely depressed and actively suicidal? (b) A client who is anorexic? (c) An alcoholic? (d) A Navajo adolescent who sniffs glue? (e) A Chinese immigrant who has anxiety attacks? (f) An agoraphobic? (g) A child who is afraid to go to school? 12. Rogers talks about therapy being an equal relationship between two struggling human beings, but of course client-centered therapists charge money for their services, so they are not really in equal positions. Does this in effect make client-centered therapy the professionalization of compassion and the purchase of friendship? Why or why not? 13. Client-centered therapists do not like to do psychological testing or make DSM diagnoses. Is this a viable position in today's world, especially for therapists who work in managed care settings? Can all or most clients be served adequately without any 17 testing or diagnosis? How would you address this issue if you were a client-centered therapist who worked in managed care? 14. What do you consider to be the strengths and the weaknesses of this approach in a multicultural context? 15. To what extent are you interested in practicing client-centered therapy, and why? A Brief Biography of Abraham Maslow Abraham Maslow proposed a humanistic theory of how people grow by progressing from fulfilling basic needs to the highest need, self-actualization. Maslow was born in 1908 in New York and he grew up as the oldest of seven children in the only Jewish family in the neighborhood. He said "With my childhood, it's a wonder I'm not psychotic. . . I grew up in libraries and among books, without friends." At age nine he tried to join a gang for self-defense, but was rejected because he was not able to pass the initiation, which required throwing rocks at cats and at girls on the corner. He faced strong anti-Jewish sentiment among his elementary school teachers. Maslow said "my childhood and boyhood were miserably unhappy . . . I can find no single glimpse of happiness in all my memories." He described his father as emotionally distant, and at a family gathering he once said "Have you ever seen anyone uglier that Abe?" Maslow's mother was cruel, hostile, miserly, and unloving. For example, once when Maslow brought home two stray kittens, his mother seized them and smashed their heads against the wall. She kept the refrigerator bolted shut to prevent him from having snacks; Maslow hated his mother and never reconciled with her. By his early teens, Maslow viewed Judaism, along with other religions, as nonsensical; he said "religion is nothing but a blind, unreasoning faith." However, he came to believe that humans are motivated by transcendent values that lie beyond purely rational knowing. Maslow said that in his adolescence he was intensely shy and "terribly unhappy, lonely, isolated, self-rejecting." In 1923, at the age of 15, Maslow wrote an article predicting atom-powered ships and submarines. Maslow's IQ was measured by Edward L. Thorndike at 195, the second highest he ever encountered. 18 In college Maslow studied first law and then psychology. At age 20 he married his childhood sweetheart (and cousin) Bertha; he said "It was a tremendous and profound and total love affair." His first interest in psychology was behaviorism, but later he said "Anyone who's had a baby couldn't be a behaviorist. . . . Behaviorism has done a lot [but] it's useless at home with your kids and wife and friends. It does not generate an [adequate] image of man, a philosophy of life, a conception of human nature. It's not an adequate guide to living, to values, to choices." One of his teachers was Harry Harlow, who did research on attachment in monkeys, and Maslow studied sex and dominance in monkeys for his doctoral dissertation. Maslow learned from several mentors who were in New York then, including Alfred Adler, Erich Fromm, Karen Horney, Margaret Mead, Ruth Benedict, and Max Wertheimer, founder of the European Gestalt school of psychology. Maslow began making notes on these exceptional people, considering them prime examples of people who live up to their potential and are also wonderful human beings. This was the beginning of his thinking about self-actualized people. After reading about psychoanalysis and Gestalt psychology he became a teacher at Columbia University and did ground-breaking research on human sexuality. This was about ten years before the Kinsey Report came out. Maslow thought of himself as a Freudian, and he considered his psychoanalysis in the 1950s as one of the most educational experiences of his life. Maslow moved to Brooklyn College in 1937, where he was a popular teacher, and then to Brandeis University in 1951, where he was a professor and chair of the psychology department. As recreation Maslow enjoyed visiting art museums, shopping, and reading science fiction and the books of J. D. Salinger. Maslow's major books were Motivation and Personality and Toward a Psychology of Being. He said "We shouldn't have 'humanistic psychology;' the adjective should be unnecessary; I'm not antibehaviorist, I'm antidoctrinaire." Late in his life Maslow coined the term "transpersonal psychology" to describe a "fourth force" in psychology beyond psychodynamic, behavioral, and humanistic psychology. Although an atheist, he described his perspective on the psychology of transcendence in his book Religions, Values, and Peak-experiences, and in the anthology Farther Reaches of Human Nature. Throughout his life, Maslow was an advocate of nudism, and he practiced it 19 occasionally. While teaching at Brandeis Maslow brought in Timothy Leary as a guest speaker and got interested in psilocybin as a trigger of peak experiences, but he did not try any of Leary's drugs, saying, "it's too easy; to have a peak experience, you have to sweat." Maslow was a self-proclaimed patriot and a supporter of the Vietnam War in the late 1960s. He called student protesters members of the "Spit-on-Daddy-Club," and he considered them spoiled, undisciplined, and ungrateful. However, many young people in the 1960s used his theory for left-wing purposes, such as his statement "Adjusted to what? To a bad culture? To a dominating parent? What shall we think of as a welladjusted slave? . . . Personality problems may sometimes be loud protests against the crushing of one's psychological bones, of one's true inner nature. What is sick then is not to protest while this crime is being committed." Abbie Hoffman said that "Maslovian theory laid a solid foundation for launching the optimism of the sixties." Maslow called Hoffman "pathological," but he also recognized a degree of kinship with the "nuts, fringe people, and borderline characters" who were seeking the peak experiences he celebrated. Maslow saw his work as part of a third force in psychology, moving beyond Freudian psychology and behaviorism. Along with Rollo May, Carl Rogers, and others, he was a guiding force in starting the Association for Humanistic Psychology, which published the Journal of Humanistic Psychology. Maslow applied his ideas to management, and his theory of "eupsychian management" is described in most books on management theory today. Most of Maslow's professional career was spent developing his theory of human motivation and exploring various facets of humanistic psychology. His view of psychology was influenced by Asian traditions, especially Taoism, and he supported the human potential movement in the 1960s. He gave several workshops at the Esalen Institute, which he called "the world's first growth center" and "potentially the most important educational institution in the world." Fritz Perls attended one of Maslow's workshops, and made many disruptive comments. Apparently he felt that Maslow was being too intellectual rather than experiential. At one point Perls dropped to the floor and began making whining, infantile sounds as he wrapped himself around Maslow's knees. At that point Maslow announced "This begins to look like sickness," and the meeting 20 broke up in confusion. So even humanistic psychologists did not always understand each other. In 1966 Maslow was elected president of the American Psychological Association and was also named Humanist of the Year. In his book The Psychology of Science Maslow argued that "when one wishes knowledge of persons, or of societies, mechanistic science breaks down altogether." The book was widely praised, but B. F. Skinner disagreed with Maslow's attack on positivism, saying "I have had many peak experiences and they have not decreased as I have become more rational or materialistic or mechanical." In spite of his interest in transcendence, Maslow said that hard work, discipline, and lifelong effort are essential for inner growth. He valued Freud and psychoanalysis, and he was concerned about the dangers of excessive interest in mysticism and religion. He considered astrology, tarot cards, the I-Ching, and similar subjects as forms of superstition. In 1967 Maslow felt a sense of urgency to complete his theory, and he was so busy he had few peak experiences. He said "I've become a kind of work-machine, not really having much fun, or even resting. Have pretty well given up really listening to music. These all seem like self-indulgences, and I'm impelled to work." Maslow published close to a hundred articles and books throughout his life. At age 56 he wrote "With my troubles about insomnia and bad back and conflict over my role in psychology and, in a certain sense, needing psychoanalysis, if anyone were to ask me 'Are you a happy man?' I'd say 'yes, yes! Am I lucky? Sitting as high up as a human being ever has? Yes!" He continued his work until he died of a heart attack at the age of 62 in 1970. Abraham Maslow's Theory Maslow postulated a hierarchy of needs, or motives, which consists of five levels: physiological needs, safety needs, love and belonging needs, esteem needs, and selfactualization. Maslow felt that although all newborns have the potential for selfactualization, only a few people ever go on to actualize or fulfill their potential. Maslow said that basic human needs make up an unfolding hierarchy: "It is quite true that man lives by bread alone - where there is no bread. But what happens to man's desires when 21 there is plenty of bread? At once other (and 'higher') needs emerge." The highest inborn need is the need for self-fulfillment, which Maslow called self-actualization. He said "A musician must make music, an artist must paint, a poet must write, if he is to be ultimately at peace with himself. What a man can be, he must be . . . This tendency might be phrased as the desire to become more and more what one is, to become everything that one is capable of becoming." Maslow's theory says that the five needs emerge in a fixed sequence, so we would expect that hunger and poverty would prevent higher functioning, but many contrary examples have been reported. For example, Nazi concentration camps did not cause all prisoners to regress to the lowest levels of human functioning, as Maslow's theory would predict. Some people compromise their safety needs by committing suicide, and soldiers die for political causes. Such examples, and empirical research, suggests to some people that the need hierarchy should be abandoned. However, some research has supported the idea that people attend to their physiological needs before their safety needs, and other studies show that mental health is higher when basic needs are met. According to Maslow, self-actualized people have an efficient perception of reality, are accepting of themselves and other people, behave spontaneously, enjoy solitude, are not self-centered, and have a freshness of appreciation for the wonder of life. Self-actualized people are creative, autonomous, and empathic. As examples of selfactualized people Maslow listed Thomas Jefferson, Abraham Lincoln, Jane Addams, Albert Einstein, William James, Albert Schweitzer, and Eleanor Roosevelt. Maslow said that "self-actualization is not a static, 'perfect' state in which all human problems are transcended. This is empirically not so." Rather, self-actualization is "a development of personality which frees the person from the neurotic problems of life, so that he is able to face, endure, and grapple with the 'real,' [existential] problems of the human condition." Self-actualized people are strongly focused on problems outside of themselves; they have a mission in life, often related to fighting injustice, exploitation, and untruth. They have a keen sense of the false or phony. They sometimes display a mature "childlikeness" and their friendships tend to cut across the dividing lines of class, politics, and ethnic background. They generally limit themselves to a relatively small circle of close friends. 22 Maslow's goal was to study positive human experience. He said the issue was not "What makes for a genius like Beethoven?" but "Why aren't we all Beethovens?" His answer was that each of us has an innate human nature of vast potential that usually becomes blocked or thwarted through the deprivation of lower needs. "Certainly a visitor from Mars descending upon a colony of birth-injured cripples, dwarfs, and hunchbacks . . . could not deduce what they should have been. But then let us not study cripples, but the closest thing we can get to whole, healthy men. . . In a certain sense, only the saints are mankind. All the rest are cripples." Maslow said that "every baby has possibilities for self-actualization, but most get it knocked out of them . . . I think of the self-actualizing man not as an ordinary man with something added, but rather as the ordinary man with nothing taken away." Self-actualized people are far more likely than others to have peak experiences, which are mystical experiences of ecstasy, wonder, and joy. Maslow said "Peak experiences come from love and sex, from aesthetic moments, from bursts of creativity, from moments of insight and discovery, or from fusion with nature." Maslow described his own peak experiences as listening to classical music, bird-watching on nature walks, and making love with his wife. Not all self-actualized people have peak experiences, and some people who are not self-actualized may have occasional peak experiences. Maslow estimated that only a fraction of one percent of the population is self-actualized. He saw them as an elite, which he called "good specimens, good choosers, winners." In his journal he wrote "I vote in favor of making life better for the ones I call "good students" and letting the others go hang. . . . The taste or judgment of one superior can and should outweigh 1000 or a million blind ones." It is probably safe to assume that Maslow considered himself self-actualized. Prior to Maslow human motivation was generally treated in terms of tension reduction, but Maslow said this was true only in the realm of the lower needs. The growth needs can be pleasurable rather than simply relieving tension. Freud said that he had never had a transcendent (peak) experience, and he considered the "oceanic feeling" as merely infantile regression. Maslow made the study of such experiences more legitimate in psychology. As an atheist, he discussed transcendent experiences in a secular, psychological context, instead of a religious context. 23 Late in his life Maslow developed his idea of the plateau experience, an extended period of serenity which, in contrast to peak experiences, could be achieved through conscious, diligent effort. He proposed that the true self-actualized person goes beyond occasional intense moments of joy to long periods of serenity or rapture. He tried to develop exercises to help people reach the plateau experience, such as gazing at a flower with full attention, or looking at a friend while pretending they will die soon. He felt that such methods can break our habits of perception and help us see the world freshly. Many aspects of Maslow's theory were applied in the human potential movement, in psychotherapy, at growth centers, in the workplace, and in education. Critics have noted that Maslow's theory was appealing to American psychologists because only societies with an abundance of material needs are likely to produce self-actualized people. The idea that people are the products of their choices and the sole creators of their own destiny could be used as a rationale for cutting back on welfare and other forms of assistance to the needy. Maslow believed that what is good for the development and well-being of the individual is also good for the development and well-being of the society. He viewed neurosis as a deficiency disease; in American society many people lack adequate food, shelter, safety, belongingness, love, and esteem. These lacks or "holes" in the development of a person cause mental illness. Paul Wachtel criticized Maslow's theory on the grounds that it fails to recognize the degree to which we depend on each other for our well-being. Self-actualizing people are depicted as autonomous and self-directed, with a special liking for privacy, detachment, and meditativeness. Their perception of other people is based on "desirelessness" and "choiceless awareness." This detatchment would hardly be pleasant in a spouse or friend. Wachtel also said that the hierarchy of human needs is fallacious. The needs for belongingness and love relations are considered lower, deficiency needs which produce dependency on other people. Maslow seemed to assume that the lower needs are filled once and for all, that one satisfies them and moves on. But lower needs will continue to be satisfied only if the conditions for their satisfaction continues. The person who decides he has love, respect, and community, and goes on to pursue selfactualization, may discover that meanwhile he or she has lost some love and respect from others. 24 George Leonard has said that in its basic optimism, Maslow's thinking was as American as apple pie. He did more to change our view of human nature and human possibilities than any other American psychologist in the past century. Gestalt Psychology and Psychotherapy The German word "gestalt" has no exact English equivalent, but roughly means "a form or shape exposed to the eye." Gestalt psychology began in 1912 with a study presented by Koffka, Kohler, and Wertheimer. Wertheimer was a friend of Freud, who had published six books by 1912. The Gestalt psychologists proposed that "the whole is different from the sum of the parts." They emphasized the difference between sensation and perception. For example, we see a design of two-dimensional lines drawn on paper as a cube; the figure arises from our subconscious mind. We see not objective reality but rather our subjective interpretation of objective reality, which is greatly influenced by what we are prepared to see and by what we are interested in seeing or motivated to see. Perception is thus an interaction of both objective reality and the individual's needs. This is different from the approach of Watson, whose Conductism (or Behaviorism) focused on objective reality. A Brief Biography of Fritz Perls Fritz Perls, the founder of Gestalt Therapy, was born in 1893 in a Jewish ghetto in Berlin, Germany. He grew up in a conflictual household. Perls was a rebellious child and often fought his father. He was expelled from school, got in trouble for peeking up women's skirts, and was often severely punished by his parents. He had his first sexual experience at age 13, and was preoccupied with sexuality throughout his life. His first career goal was to be a theater director, but in World War I he enlisted in the Zeppelin Corps and served as a medic. He was wounded in the head and exposed to mustard gas, and he saw many atrocities. He developed what today would be called a post-traumatic stress disorder and was depressed and apathetic for several years after the war. 25 At the age of 27 Perls graduated from school with a medical degree, but spent most of his time hanging our in cafes with the anarchist intellectual crowd. He had a torrid affair with an older woman, Lucy, who was bisexual and was a distant relative. Then he went into psychoanalysis with Karen Horney. He broke up with Lucy, moved to Frankfurt, met with the early Gestalt psychologists, and had an affair with a 21-year old graduate student named Laura. The he moved to Berlin, married Laura, became a psychoanalyst, saw patients, and analyzed himself for a year and a half, five times a week. Then he went into analysis with Wilhelm Reich. As described in his book The Function of the Orgasm, Reich, a maverick analyst, believed that healthy, full body orgasms harmonize one's "orgone energy." While orthodox psychoanalysts rarely spoke to the patient, Reich not only spoke but touched and massaged his patients to work with their muscular armor. He called this "active analysis." Later he developed the "Orgone Box" to collect and focus orgone energy, and was arrested for fraud for promoting this unproven invention. In 1933 Perls and his wife fled Hitler to Holland, where they had a daughter, and then to South Africa, where Perls had an active orthodox analytic practice and founded a training institute. He had two children and became rich and famous, but he began to detach himself from his family. He tried to meet with Freud, but Freud refused to see him for more than a few minutes, and Perls wrote a book contradicting many of Freud's ideas called Ego, Hunger, and Aggression. Perls proclaimed the importance of the present, the need for genuine contact with the patient, the need to pay attention to incomplete emotions, and the importance of the body and sensations. In World War II Perls served as a psychiatrist for the South African Navy for four years. During this period he neglected his work, had many sexual affairs, and was very strict and punitive with his children, just as his father had been with him. In 1946 Perls moved to New York City without his family, but was not well received by the psychoanalytic establishment, who thought his ideas were provocative and rebellious. However, Perls had a busy analytic practice, and still used the couch. He loved the bohemian culture of New York, which valued the direct expression of feelings in the here and now. He openly had many affairs. He got interested in group therapy, formed a group with like-minded colleagues, and published the book Gestalt Therapy in 26 1951. Other titles he considered for the book included Existential Psychoanalysis, Integral Therapy, and Experiential Therapy. Perls proposed that in Gestalt Therapy the patient confronts an open gestalt, which is an unfinished situation. The patient has to concentrate on the here and now, feelings, and physical sensations (not the free association of ideas as in psychoanalysis). The publication of this book marked the official birth of Gestalt Therapy. Perls founded Gestalt institutes in New York and Cleveland and traveled widely to promote his approach, but by 1955 he was tired and depressed, and had heart problems. He moved to Florida, lead some groups, and, at age 65, fell in love with a 32 year old married woman named Marty, who was also one of his patients at the time. During a two-year affair they tried to break as many sexual taboos as possible, and they also used LSD and hallucinogenic mushrooms in a search for cosmic consciousness. When Marty broke up with him, Perls moved to Los Angeles, where he met Jim Simkin, who became a well-known proponent of Gestalt Therapy. In 1962, at age 69, Perls made a trip around the world, during which he visited a kibbutz in Israel and a Zen monastery in Japan, where he learned to meditate. Back in California, in 1963, Perls met Michael Murphy, founder of the Esalen Institute in Big Sur, a human potential training center which attracted many well-known psychologists and thinkers, including Alexander Lowen (bioenergetics); Virginia Satir (family therapy); Eric Berne (Transactional Analysis); Gregory Bateson (philosophy of the mind); John Lilly (sensory isolation); Alan Watts (Zen and Taoism); Will Schutz (encounter groups); and Stan Grof (transpersonal psychology). Perls was Rolfed by Ida Rolf, and he liked Esalen so much he moved there, built a house on the property, and taught regular seminars on Gestalt Therapy. He wrote his memoirs, which were published under the title In and Out of the Garbage Pail. This was the late 1960s, and Perls became one of the most popular stars of the human potential movement. In 1969 Perls moved to Lake Cowichan, Canada, bought an old motel, and founded a Gestalt kibbutz where he lead workshops and groups. Six months later Perls died at age 76 of pancreatic cancer and heart disease. Perls is still considered one of the greatest innovators of the twentieth century in psychotherapy. Never a modest person, he himself said "I accomplished the next step after Freud in the history of psychiatry." 27 Today there are almost a hundred Gestalt training institutes all over the world, with the three main centers of activity in the United States being New York, Cleveland, and California. Gestalt Therapy is used with people with a wide variety of disorders and concerns, and especially in marriage counseling and family therapy. Other major proponents of Gestalt Therapy include Ralph Hefferline and Erving and Mariam Polster. The Theory and Technique of Gestalt Therapy If the first great school of psychotherapy was Psychoanalysis, and the second was Behaviorism, then the third force was Humanistic Psychology, part of which developed into the Human Potential Movement. This approach was based on existential philosophy, and its goal was to restore dignity to human beings, validate emotional expression, and emphasize the uniqueness of all individuals and their right to pursue fulfillment. Major proponents of humanistic psychotherapy included Abraham Maslow, Rollo May, Carl Rogers, and Fritz Perls. Proponents of this approach were not very interested in psychopathology or medical-model diagnosis, and they saw humanistic psychotherapy as a way for any person, healthy or unhealthy, to promote self-development. Perls said that "Gestalt therapy is too effective to save it just for the sick." In developing Gestalt therapy, Perls was influenced by several philosophies. From phenomenology he took the emphasis on the what and the how, rather than the why; corporal perception of the immediate experience; and the focus on here and now feelings. From existentialism Perls took the idea of the priority of actual experience over abstractions and the idea that each person is responsible for their existential project. In Gestalt, responsibility is freedom, the ability to make choices and respond to a situation in a variety of ways ("response-ability"). From Zen Buddhism and Taoism Perls borrowed the emphasis on experiencing life in the here and now; the recognition of the Tao (the way of things; the flow of nature); the importance of spontaneity; and the idea that all change starts by accepting who you are. Zen emphasizes that enlightenment comes not from intellectual understanding but from alert waiting, detatchment without purpose, and intuitive realization. Perls said that neurosis results from a series of unfinished (unsatisfied) 28 needs, and he approached the unconscious through the body, sensations, and feelings rather than through intellectual talk about the past. He defined psychological health as equilibrium. Whereas Carl Rogers believed that therapy can help clients work toward selfactualization, Gestalt therapists believe that therapy is the process of becoming aware of what one is, rather than a process of striving to become something else. Awareness brings about the integration of the individual into one whole. Unintegrated clients are considered to be "phony," and therapy can help them become authentic. Early Gestalt practice stressed the use of confrontation, even intentionally frustrating clients at times, but more recently there has been a movement toward more gentleness. Gestalt Therapy works in the here and now and emphasizes the sensations. The goal is awareness; clients become aware of how they prevent themselves from fulfilling their needs and closing their gestalts (unfinished situations). Awareness of what is going on in the present can lead to change. The past is a memory and the future is a fantasy. Anxiety is the gap between the now and the then; if you are in the now, you cannot be anxious. Neurotics obsess about either the past or the future, rather than living in the now. The use of techniques to promote awareness is a bit paradoxical in an approach that values here and now experiencing, genuineness, and spontaneity. Perls called techniques "gimmicks," and said that although they can be useful tools, they should be used only in extreme cases. Nevertheless, several techniques are commonly used in Gestalt Therapy. The main technique is facilitating awareness by asking the client questions, such as: "What are you doing? What do you feel right now? What are you trying to avoid at this moment? What do you want or expect from me?" Questions that promote awareness may uncover resistance, which is seen as blocking maturity and growth. Since some resistance can be normal and healthy, one goal is for clients to become aware of how they resist feeling their feelings. Then they can make a more conscious choice about how to proceed. Attention to the client's body language also promotes awareness of feelings and blockages in feelings. In the use of paradoxical intention the client is instructed to engage in and exaggerate the behaviors of concern. Guided imagery and fantasy may be 29 used to recreate problematic life situations, while the client verbalizes whatever comes to mind. In another technique, the Empty Chair, the client speaks to a significant person as if they are there in the room in an empty chair, and then changes chairs and speaks as the other person. The empty chair technique allows the client to address the Top-dog and Underdog perspectives. The Top-dog represents the client's desires, needs, and potentials, while the Underdog identifies the excuses and obstacles the client puts in their own way. In the Monodrama technique the client plays different characters from an unfinished situation in life or speaks from the perspective of bodily organs or feelings. Amplification and exaggeration is a technique in which the client is asked to repeat, continue, or exaggerate a word, phrase, gesture or movement (which increases the client's perception of mechanisms used to block sensations and feelings). Direct honest communication is encouraged; clients speak in the first person active voice, stating feelings without judgment, instead of in the passive voice. Mind reading (projecting your feelings or fears onto someone else) is discouraged. First-person speech emphasizes that individuals are responsible for their own acts, thoughts, and feelings. In Gestalt dream analysis the client acts out the dream to discover what is being avoided, or speaks from the perspective of each element in the dream. The dream is seen as a disguised message, and the elements in the dream have a personalized meaning for the dreamer. The following are suggestions for working with your dreams: 1. Tell the dream in first person and present tense, as if you were dreaming it now. 2. What part of the dream is less like you? Which part is it hardest to identify yourself with? 3. Go back to the dream and speak as that part, in first person and present tense. 4. Is the dream giving you a message? Is there anything about the dream that you recognize in yourself? 5. Once the dream has communicated its message to you, put it in the "empty chair" and express your gratitude to it. If there is anything else you want to say to it, do so. In psychoanalysis the goal is to solve a problem (a trauma) in the past, but in Gestalt the goal is to make clients aware of how their resistance and avoidance creates a continuing problem here and now. The therapist facilitates the client's self-support (awareness of verbal, physical, and fantasized actions). Client talk about the past is discouraged, so as not to let past attitudes and influences determine present attitudes. 30 Questions take the place of interpretations. For example, the therapist may ask a client "Are you aware of how your voice changes when you talk about your spouse?" "Why" questions are avoided, since they lead to explanations, justification, and interpretations. There is no end point of Gestalt therapy, since integration is never completed and maturation is a continuous, lifelong process. In a Gestalt group, group members who ask questions are asked to change the question into a statement. Generalizations are also avoided, such as it, one, we, you, they, society, parents, the world, etc. Substituting the word "I" results in increased responsibility. Clients who use the word "can't" are asked to change it to "won't." Clients are asked to speak directly to someone rather than about them (an empty chair can be used for an absent person). In therapy clients experiment with taking responsibility for all their thoughts, feelings, sensations, and actions. Perls said that most clients get into therapy not to get better, but to maintain the status quo or improve their neurosis. We manipulate other people by using tricks such as playing helpless, playing stupid, playing the tough guy, and so on. Part of the problem is that people pursue an idealized image of how they think they should be, rather than accepting that they are who they are. In therapy the satori (enlightenment) comes when the client realizes that he or she is pursuing a fantasy, rather than living in reality. According to Perls, insanity is when we take the fantasy for the real. The crazy person says "I am Abraham Lincoln," and the neurotic says "I wish I were Abraham Lincoln," while the healthy person says "I am I, and you are you." It is assumed that awareness of feelings is essential for self-acceptance. Selfsupport is the process by which clients find their own resources and solutions. Therapy does not change the client; as Arnold Beisser said, "Change comes about when you become what you are, not when you try to become what you are not." Nobody teaches a plant to grow; if you water it, it grows on its own. According to Perls, we cannot deliberately change ourselves or other people. Instead of trying to live up to expectations, we should actualize ourselves (be who we are). Gestalt Therapy emphasizes the present. Abe Maslow said that an essential part of any creative act is "losing oneself in the present." Creativity is seeing the possibilities in a situation and selecting from among the choices the most satisfactory one. Joseph 31 Zinker, author of Creative Process in Gestalt Therapy, said that "freedom is the consequence of letting yourself be. Gestalt Therapy is a permit for being creative, a permit for our playing with our most beautiful possibilities during our short life." Zinker described several potential blocks to creativity in therapists, including fear of failure, reluctance to play; resource myopia; over-certainty; frustration avoidance; fear of the unknown; reluctance to let go; and sensory dullness. The first step in becoming more creative is to recognize one's own blocks to creativity. Spontaneous change results from awareness, rather than from effort, will, or intention. Gestalt therapy is sometimes criticized as emphasizing emotion too much and cognition too little, although current practitioners pay more attention to thoughts. Some Gestalt techniques may be too confrontational for fragile clients. A common criticism of the existential and humanistic psychotherapies is that they promote narcissism and selfishness. However, Perls himself said that the self is merely the locus of change, and that the concept of self only makes sense through contrast with otherness. Self-actualization refers to the idea that an individual actualizes (makes real) his or her potential. Since each person is a unique individual, each person will, if selfactualized, be and appear different from everyone else. Fritz Perls' Gestalt prayer, with which he began his group sessions, went as follows: I do my thing, and you do your thing. I am not in this world to live up to your expectations And you are not in this world to live up to mine. You are you and I am I, And if by chance we find each other, it's beautiful. If not, it can't be helped. Claudio Naranjo described several Gestalt precepts: 1. Live now. Concern yourself with the present before the past or the future. 2. Live here. Devote yourself to what is present before what is absent. 3. Stop imagining things. Experiment with what is real. 4. Stop thinking unnecessary things. Instead, taste and look. 5. Express instead of manipulating, explaining, justifying, or judging. 6. Surrender yourself to distress and pain in the same way that you surrender to 32 pleasure. Do not limit your consciousness. 7. Accept no "you must" or "you should" other than the ones that you impose on yourself. Do not adore any idol. 8. Accept being as you are. Bibliography: Gestalt Therapy Gaines, J. (1979). Fritz Perls here and now. Millbrae, CA: Celestial Arts. Latner, J. (1986). The Gestalt Therapy book. Highland, NY: Gestalt Journal. Marcus, E. H. (1979). Gestalt Therapy and beyond. Cupertino, CA: Meta Pubs. Perls, F. S. (1969). Gestalt therapy verbatim. Lafayette, CA: Real People Press. Perls, F. S. (1969). In and out of the garbage pail. Lafayette, CA: Real People Press. Shepard, M. (1975). Fritz. NY: E. P. Dutton & Co. Sinay, S. (1998), Gestalt for beginners. NY: Writers and Readers Publishing. Stevens, J. (1975). Gestalt is. Moab, UT: Real People Press. Zinker, J. (1977). Creative process in Gestalt Therapy. NY: Random House. Study Questions: Gestalt Therapy 1. Speculate about how two or three specific aspects of Fritz Perls' life story contributed to his development of Gestalt Therapy. 2. Perls began as an orthodox psychoanalyst and ended as a humanistic psychotherapist. Describe several psychodynamic ideas that are present in his approach to Gestalt Therapy. 3. In therapy Perls was often confrontational with clients, since he saw his job as frustrating the client's attempts to escape from the here and now. Is this a valid and useful form of confrontation, and is it something you might want to do as a therapist? 4. Fritz Perls was a unique personality and lived a tumultuous, uninhibited life. To what extent is it possible for us to learn from his ideas and methods, without having a similar personality or living a similar life? 33 5. People think that Perls was effective in therapy because of what he did, but maybe he was effective because of who he was. What is the difference? 6. Which aspects of Gestalt Therapy appeal you, and which do not? 7. Would you like to be a client in therapy with Fritz Perls? Why or why not? 8. The development of Gestalt Therapy has continued since the death of Perls. Do some reading on contemporary approaches to Gestalt Therapy and describe how the newer developments are similar to and different from Perls' ideas. 9. If you took seriously Perls' idea that you should actualize yourself as a therapist, then rather than try to be like Perls or anyone else, your approach to therapy would reflect your unique personality. In what ways does what you do as a therapist reflect how you actualize your unique self? 10. What practical ideas or techniques have you learned from your study of Gestalt Therapy that you plan to include in your therapeutic work in the future?