Understanding Esther's Case Using Gestalt Approach: Principles, Goals, And Techniques

Case study Esther is a woman aged in her 50s who comes to you because she has been unemployed for six months after she was made redundant. She has described feeling down in recent weeks as her job search has dragged on. She said she used to be someone who looked forward to work and who had felt really proud of her achievements. Esther said she that whilst initially she really enjoyed having more free time, she was now becoming increasingly anxious that she would never find work again. She said she is beginning to doubt her capabilities and is afraid that she will be “left on the scrap heap”. She has noticed that she is thinking negatively of herself and her situation. Her main goal in therapy is to reduce her anxiety and maintain her self-confidence. She has come to you because she has heard that counselling can help people feel good about themselves, and this is something she feels she needs help with. She says “I need to get back my enthusiasm for my life and I need to start liking myself again, rather than criticising myself and everything around me all the time”.

• an overview of the principles and goals of Gestalt approach .
• an explanation of how Esther could be understood from the perspective of gestalt  approach
• a description of how a counsellor might work with Esther using gestalt approach ( the empty chair technique)
• examples of questions or dialogue that might be involved in taking gestalt approach
• an evaluation of the advantages and disadvantages of taking gestalt approach with Esther
• reference to relevant literature, linking your ideas to theory discussed in the unit

An overview of the principles and goals of Gestalt approach

Gestalt therapy is a counselling approach that focuses on the client as a whole, interconnecting with the environment and his or her experiences. The approach puts more emphasis on the “here” and “now” instead of “what was” or “might be.” The main objective of this approach is to help the client understand what the counsellor is doing and how he or she is doing it.

Gestalt practitioners always affirm that the key values of every human being are encountered between two situational matters, both of which risk themselves in the dialogue of a proper healing process. The primary focus is usually the step by step moment process of the association between a client and a counsellor. In this association, the primary objective is a completely authentic meeting between the two individuals.

Wholeness: This can be viewed as the foundation of the Gestalt approach which emphasizes the wholeness of an individual during the counselling relationship. The association is not just about intrapsychic or mere interpersonal dimensions. During the counselling process, various aspects of an individual might be viewed in different ways. This often includes symbolic, Behavioral, effective as well as spiritual aspects of the client’s life (Crocker, 2013).However, the counsellor will always play the guiding principle that integrates all the multiple facets and the unique individual. Acceptance and celebration of such multifaceted wholeness are often goals for the client.

Self-regulation: In gestalt ,  an  individual   is  viewed  as   having   either  natural  or   organismic   tendencies   when  they  are regulating  themselves . Wagner-Moore, (2004) considered  that   the  self    is usually  a function  of   facing   or   having  contact with   the   real   transient    beings  and  separate  them  from   ego, and   individual  personality  as  separate   partial  structures  of the  self,   often  mistaken with  the   entire  function of  the self.

The attitude of the counsellor: To practice Gestalt theory, it means the counsellor puts himself actively in the experience of the other individuals. It is more of a way that is prescribed by the approach. Gestalt is characterized by the willingness of the counsellor to take an active position in order to effectively intervene. The idea is based on the presumption that treating the client with responsibility and intelligence is most likely to invite the client into autonomy and self-healing.

It is more of a way that is perceived to set the methods for proper counselling. The   Gestalt concept is often associated with the idea of the willingness of the counsellor’s side in order to remain active and as a person to intervene in the entire relationship. This is usually based on the postulation that handling the client as a normal individual with unique responsibilities and nominal decisions at any time of their lives is most probable to offer the client an opportunity for autonomy and self- healing (Sterner,2012).

Explanation of how Esther could be understood from the perspective of gestalt approach

In this case, the counsellor and the Esther have spent the first moment of the session establishing the key issues as well as the themes that are associated with the client's states of depression. To diagnose the Client, as a counsellor it is essential to follow Esther's lead, providing her with the opportunity to process with no precise agenda in mind. The primary goal, in this case, is to listen closely to   Esther as she unfolds her recent experiences of being unemployed and assist her in identifying what is bothering her so much. This will also allow proper processing of the emotional style of the client. In order to understand the clients properly, it would be great to utilize guided validation, exploration to communicate and understand the client (Welling, 2012). During this time, the counsellor could clearly highlight key issues and start developing an agreement   with Esther regarding the matter at hand and help her explore more

As indicated in the key concepts of Gestalt, a strong association often involve d the attitude of the therapist as it allows an agreement on the goals of treatment as well as a shared bond is important to the overall success of such an emotion-driven therapy.Yontef, (2007) add that , it should be understood that the main objective of the gestalt therapy is not facilitating direct exchange with the client through a strategized approach,  but instead to facilitate the understanding of the client and insight in herself applying creative measures(Tschacher, Junghan,& Pfammatter,2014).) Specifically, from Esther’s perspective, the primary objective is to assist her to become aware of her subject experiences as much as possible.

The desired results is that Esther becomes more authentic as an individual.  In such a case it would be easy for her to shed what disturbs her and make up her life in a new way. In such a way the client will be able to make better choices that would eventually lead to a better life, and develop the ability to grow herself as an individual without searching for any employment (Nevis, 2013).Moreover, Esther will become more integrated with her present self as well as the environment. Through such enhance awareness of herself, she will be able to gain total self-acceptance and take full responsibility for her current situations which in turn translates to her being in charge of her destiny.

 The empty chair approach would effectively be applied in Esther’s case. One part of self would be directed to express negative self-statements which in turn would evoke emotional reaction by Esther towards the criticism. Such a reaction would include feeling hopeless, shame. They would later be transformed by evaluating the alternatives which are more primary such as feeling sad or loss. Such feeling would be assessed emphasizing on Esther’s primary emotions and   articulation of needs (Watson, 2010).This would eventually lead to Esther softening of the harsh feelings about herself and negotiate through her desperate aspects of self.

How a counsellor might work with Esther using gestalt approach (the empty chair technique)

The Gestalt approach works effectively through unfinished business which usually involved the expression of previously suppressed emotions such as disgust to the imaginary significant other in the chair. This results to the client expressing the unmet needs. At this point Esther would take the standpoint of other people in the conversation, thus leading to access to a new opinion of the other (Boritz, et.al.2011). Resolutions are often viewed to involve the assertion of self as well as a proper understanding of the other by letting go and affirming individual responsibility for her actions. For Esther, Empty chair approach was utilized to address her uncompleted business stopping from her being unemployed (Jacinto,& Edwards,2011).Empathic response from the counsellor would be a fundamental approach to assist Esther to understand  her experiences, symbolize them and process them to ensure that they do not overwhelm her. The overall objective through the entire therapy would involve resolving Esther’s internal conflict about being unemployed at the age of 50.

Mackewn, (2006) indicates that transformation in any uncompleted business often occurs through the expression of emotions and the associated needs. Through such a process there develops a consolidation of self and the client would now be able to address some of the previously salient issues and often focus on the positive aspects of the others. The process of giving a voice to Esther’s emotions can help in strengthening her sense of legitimacy in needing to be employed again. As a result, the client would easily develop compassion for her struggles in her life.

Esther  would describe    her  emotional changes  that  she would have  made   by  the end  of the  counselling   with the ability to  view things  in a  positive  standpoint  and   not  always  focusing on  negative  feelings . By  the   end  of  the  session   her  feeling of  despair  would  have  already  gone .Through  a  dialog  she  can be able  to  mention  some   issues   that  she  has  observed

Counsellor: How  do  you  feel  about  yourself   in  most  cases.Do  you  feel Like  you’ve lost  it all ?

.Esther: Like in most cases, I would feel like I do not want to see anybody because   I felt disgusted about everyone. Now when I see people, I do not feel disgusted. Before, if I showed up at any job interview, which was not that often, I felt bad, you know.   I  thought  to  myself “will  I  even  get  this  job?” I ensure everyone in the room heard it.

This shows that at the start of the therapy Esther had already internalized a strong sense of failure especially of her being employed again. At post-therapy change, Esther can be expected to say.

Counselor: What are you aware of right now?

Esther: I understand now that I am not irresponsible, and not a failure. I now understand that.

Counselor: What are you  thinking?

Esther: For  an inordinate length of time, if  something  goes  wide of the mark  in my life, I  would  involve  a proper  thought  process “Oh yeah, am not a loser

This phenological approach assists in exploring and becoming aware of who the client is from the inside, through her direct experience in the entire process. Esther has to keep an open mind and being genuinely understanding of how she can be able to surpass her ordeals, at every level of her being.

In such dialogues, as a counsellor, it is easy to experience anger, anxiety from the client that can further be hypothesized as repressed by the client. Becoming familiar with Jacob’s in text reference theoretical framework for appreciative psychosomatic sequelae as being the events as well as the disruptions of the previous subjective experiences. (Jacobs,2007).  Parlett ,& Lee,(2005) adds that the hallmarks of being depressed or the parts being experienced in the present often triggers the client into organizing her world around survival. The predominant feeling through such a dialogue would be despair, and dread thus reflecting the weight of her anguish of existing in a world that has fallen apart that had accumulated over the years. At this juncture, Esther would feel that she is already a trash to the world. It is agreeable at this position it would be much easier to support her position in order for her to feel supported. This   is entire based on the Gestalt approach.

Gestalt theory would be   very helpful in unravelling Esther’s enigma of hope and desolation with her being unemployed, and understanding the transferral of the situation. Greenberg, (2010) discusses countertransference responses between the counsellor and the client as affecting the body of the counsellor. He  adds  that   clients   are  often  generated  into  distressed situations   by  the   prevailing   circumstances  which  frequently  reflect  the  themes of  the history. It is common for the counsellor to take the repressed feelings to supervision to be agreed upon and worked through as a result of her having a symbolic representation of her feelings.

To understand the reaction of the therapist in Esther's cases, it is important to refer to the bodily signs that are often familiar to such kind of clients.  This is often a creative way that relates to the suggestions of the client until a therapist gets a clear insight a time to offer the client with the best remedy. One might how Esther has lived with such levels of despair for such a long period. Mendes, et.al (2010) posits   that “ a sense of  astonishment  allows  psychotherapists  to  feel  the   distinctive  qualities  of a  client .” He suggests that “by remaining in the situation, irrespective of how many aspects that might arise.” the role of  a innovative therapist is tracking the various themes presented by the client in order to establish the thematic direction and at the same time avoid being overwhelmed by the despair of the client.

In Esther's case, the role of the therapist is to have confidence in the interpersonal procedure in order to develop a strong consciousness that there are guiding processes   in place that protect both of them. It is through such a method that it is easy to become overwhelmed by despair triggered by the counsellor’s empathy while engaging in the client's account of depression and get off it more quickly in order to be more available for the client (Diamond, Rochman, & Amir,2010).

It is important to note that the Gestalt approach can be confrontational in some cases. The present moment interaction between the client and the therapist allows the client to be creative, and question the counsellor’s way of thinking and get themselves out of her negative view of herself. Even though the Gestalt approach is important in Esther’s case, the approach might cause her to be anxious at the beginning of the process. Therefore it might not be the most effective way of dealing with depression.

Conclusion:

Esther’s cases is an excellent instance of the innovative process possible during the application of a gestalt approach while at the same time demonstrating the path through vicarious despair. By following Esther’s procedure,   the present and what is    however grim, it is easy to develop a sense of hope. Through the analysis, it is easy to establish a moment of the relationship that offers an intuition of a puzzle in any therapist’s exercise. When a counsellor is working in cases like that of Esther, it is essential to understand that there is also hope in the field.  Matching between hope and desolation with those of the clients allows a counsellor to remain more present with her. Esther would be able to utilize the created environment to admit more of her own feelings and relate properly with the setting and so to as have her need accomplished. The more a therapist is conscious of the needs of the client to organize their lives around desolation and persistence, the more he or she is capable of understanding their process. When Esther's coping facades are lowered due to her age, it would see how her original problem compounded with her present. In an attempt to go through the complex strategies of engaging the client empathetically   following a considerable period of traumatization, it would be easier to understand the link between the implicit and the combination of emotional states which translate to desolation.

Reference:

Boritz, T. Z., Angus, L., Monette, G., Hollis-Walker, L., & Warwar, S. (2011). Narrative and emotion integration in psychotherapy: Investigating the relationship between autobiographical memory specificity and expressed emotional arousal in brief emotion-focused and client-centred treatments of depression. Psychotherapy Research, 21(1), 16-26.

Crocker, S. F. (2013). A well-lived life: Essays in Gestalt therapy. Gestalt Press.

Jacobs, L. (2007). Pacific Gestalt Institute’s winter retreat lecture. Santa Barbara:(Audiotape).

Diamond, G. M., Rochman, D., & Amir, O. (2010). Arousing primary vulnerable emotions in the context of unresolved anger:“Speaking about” versus “speaking to”. Journal of counseling psychology, 57(4), 402.

Greenberg, L. S. (2010). Emotion-focused therapy: A clinical synthesis. Focus, 8(1), 32-42.

Jacinto, G. A., & Edwards, B. L. (2011). Therapeutic stages of forgiveness and self-forgiveness. Journal of Human Behavior in the Social Environment, 21(4), 423-437.

Mackewn, J. (2006). Working with embodiment, energy and resistance. In Developing Gestalt counselling (pp. 157-175). London, England: SAGE Publications.

Mendes, I., Ribeiro, A. P., Angus, L., Greenberg, L. S., Sousa, I., & Gonçalves, M. M. (2010). Narrative change in emotion-focused therapy: How is change constructed through the lens of the innovative moments coding system?. Psychotherapy Research, 20(6), 692-701.

Nevis, E. C. (2013). Organizational consulting: A Gestalt approach. Gestalt Press.

Parlett, M., & Lee, R. G. (2005). Contemporary gestalt therapy: Field theory. Gestalt therapy: History, theory and practice, 41-65.

Sterner, W. R. (2012). Integrating existentialism and Super's life?span, life?space approach. The Career Development Quarterly, 60(2), 152-162.

Tschacher, W., Junghan, U. M., & Pfammatter, M. (2014). Towards a taxonomy of common factors in psychotherapy—results of an expert survey. Clinical psychology & psychotherapy, 21(1), 82-96.

Watson, J. C. (2010). Case formulation in EFT. Journal of Psychotherapy Integration, 20(1), 89.

Welling, H. (2012). Transformative emotional sequence: Towards a common principle of change. Journal of Psychotherapy Integration, 22(2), 109.

Wagner-Moore, L. E. (2004). Gestalt Therapy: Past, Present, Theory, and Research. Psychotherapy: Theory, Research, Practice, Training, 41(2), 180. https://dx.doi.org/10.1037/0033-3204.41.2.180

Yontef, G. (2007). The power of the immediate moment in Gestalt therapy. Journal of Contemporary Psychotherapy, 37, 17-23. https://dx.doi.org/10.1007/s10879-006-9030-0