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The Power of the Immediate Moment in Gestalt Therapy

Article  in  Journal of Contemporary Psychotherapy · March 2007

DOI: 10.1007/s10879-006-9030-0

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1 Article Title The Power of the Immediate Moment in Gestalt Therapy

2 Journal Name Journal of Contemporary Psychotherapy

3 Prefix
4 Family name Yontef
5 Corresponding Author Particle
6 Given name Gary
7 Suffix
8 Degrees

9 Organization Pacific Gestalt Institute

10 Address Los Angeles, CA, USA
11 e-mail gyontef@bigfoot.com

12 Received
13 Schedule Revised
14 Accepted

15 Abstract This article discusses the gestalt therapy concept of the paradoxical theory of change and
a method combining a dialogic relationship with active phenomenological focusing and ex-
perimenting. Fundamental change results from self-acceptance and not attempts to change
based on self-rejection. This is supported by the characteristics of dialogic contact: inclusion,
confirmation, authentic presence, and a commitment to what emerges between therapist and
patient. The patient is taught how to be aware, including awareness of the awareness process,
facilitating autonomous use of the method by the patient. Suggestions and cautions for practice
are discussed.

16 Keywords Gestalt therapy − Self-acceptance − Awareness

separated by ‘-’

17 Footnote information My thanks to Lynne Jacobs for help in writing this article
 J Contemp Psychother
DOI 10.1007/s10879-006-9030-0

18 ORIGINAL PAPER

19 The Power of the Immediate Moment in Gestalt Therapy

21 Gary Yontef

22

C Springer Science+Business Media, LLC 2006

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23 Abstract This article discusses the gestalt therapy concept
of the paradoxical theory of change and a method combining O
Gestalt therapists aim to meet and understand the patient
rather than to move the patient in any particular direction. The
50

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24 51

25 a dialogic relationship with active phenomenological focus- gestalt therapy version focuses more on the immediacy of 52

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26 ing and experimenting. Fundamental change results from how the patient functions moment-to-moment and on what is 53

27 self-acceptance and not attempts to change based on self- happening in each moment between therapist and patient and 54

28

29
rejection. This is supported by the characteristics of dialogic
contact: inclusion, confirmation, authentic presence, and a
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less on content (story, history, reinforcement schedules, etc.). 55

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30 commitment to what emerges between therapist and patient. People do not change by trying to be who they are not 56

31 The patient is taught how to be aware, including awareness

32

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of the awareness process, facilitating autonomous use of the
method by the patient. Suggestions and cautions for practice
are discussed.

T E
This is called the Paradoxical Theory of Change (Beisser,
1970). Trying to be who one is not is a disowning of oneself
or denial of aspects of the self and leads to internal conflict
and prevents wholeness and organismic change. The paradox
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35 Keywords Gestalt therapy . Self-acceptance . Awareness is that the more people try to be who they are not, the more 61

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they stay the same. For example, self-loathing patients who 62

36 Therapists are usually trained to think about how to get pa- spotlight being overweight often try to change their entire 63

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37 tients to be different than they are. Some might say: “Of life, who they are, by dieting without really exploring why 64

38 course. Why else do patients come to us?” From this view- they are self-loathing, the function of overeating, the choices 65

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40

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point, patients come to be “fixed” and the therapy aims to-
ward that fix. In such a model the therapist is expected to
made, and so forth. This usually fails.
But what is the alternative? Of course people come to
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ened this tendency.

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know how to fix and to do so. Current pressures in health care
delivery and attempts at scientific validation have strength-

Humanistic/existential approaches stress something quite

us for change. So how can people grow out of a dysfunc-
tional, stuck position without trying to be what they are not?
How can people move toward their goals and wishes without
rejecting who they are?
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different. They emphasize the importance of an existential
meeting in the here-and-now whereby shared understanding

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of a patient’s life situation emerges from the interaction be-
tween therapist and patient. This existential meeting is the
Efforts to change based on self-recognition and accep-
tance of the self-as-a-person differ from efforts to change
based on a pejorative attitude about the self-as-a-person.
Change occurs with self-recognition, self-acceptance, own-
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49 vehicle for improving patient functioning and satisfaction. ing, and healthy interpersonal contact. If a person identifies 76

with how he/she actually is, including internal conflicts and 77

My thanks to Lynne Jacobs for help in writing this article dysfunctional behavior, in an attitude of self-love and self- 78

respect, a fundamental change is much more likely to happen. 79

G. Yontef (
)
The Paradoxical Theory of Change makes the therapeutic re- 80
Pacific Gestalt Institute,
Los Angeles, CA, USA lationship central because the therapist’s acceptance of the 81

e-mail: gyontef@bigfoot.com patient’s moment-by-moment experiencing—including the 82

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 J Contemp Psychother

83 patient’s struggles and conflicts—is a primary support for ing how to learn that is a natural process of living. The in- 132

84 the patient’s self-recognition and self-acceptance. terruption serves, or served, a function. What is the function 133

of the self-interruption? What drives the self-interruption? 134

85 People learn from experience It is definitely not helpful if the therapist gets frustrated, 135

confronts, asks “why” questions that the patient experiences 136

86 Ordinarily people change their thoughts and behavior by as judgmental. Some confrontive versions of gestalt therapy 137

87 learning what works and what does not work. Spontaneous publicized by Fritz Perls in the 1960s erred in this direction. 138

88 reinforcement and insight guide this natural growth. This is This is not true of contemporary gestalt therapy. 139

89 not a disowning of self-as-a-whole but an expansion of self. When patients identify with what is interrupted and also 140

90 When a person does not learn from experience, therapy is with the interrupting process itself, stalled growth is reacti- 141

91 indicated. vated. When people fully identify with what they think, feel, 142

desire, choose, and how they behave, the stuckness of self- 143

92 Learning how to learn rejection and denial are replaced by a new felt sense (Gendlin, 144

1981) of responsibility, possibility, expanded awareness and 145

93 Usually the pattern of not learning from experience will greater capacity for learning from their experience. They can 146

also manifest itself directly in therapy. For example, a pa- be who they are—and who they are becoming – by increased

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94 147

95 tient complaining of worry and anxiety reacted at each mo- awareness and by increased honest and respectful contact 148

ment by speculating on “why” and “what if” and did not with the therapist and others in their lives.

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96 149

97 gain grounding or new insight by noticing what he felt and In the following example the patient was helped to identify 150

wanted, his body sensations, a more detailed description of her actual experience.

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98 151

99 his experience, etc. Each obsessive question in the session

P: What if he does not come back? What if. . .(P. esca- 152

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100 was a doubting or denying of himself that blocked learn-
lated her pitch and pace in a series of ‘what if’ questions 153
101 ing, and increased worry and anxiety. This was his pattern

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about her husband in Iraq). 154
102 in life and it happened in sessions. He did not need me to
T: What are you feeling emotionally right now at this 155
103 ask “why” but needed questions such as: “What do you ex-
moment? 156

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104 perience right now?” What do you sense right now in your
P: (Pause). I don’t know. 157
105 body?” “What do you need right at this moment?” “What
T: Try an experiment. Take several long, slow

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158
106 were you thinking or feeling the second before you started
breathes, and on the exhale let your jaw drop. 159
107 to doubt yourself?” From this kind of focusing, he learned

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P: (Does the experiment, tension decreases, and the 160
108 more about his actual experience and learned to recog-
patient cries deeply). God how I miss him. I was getting 161
nize when he was interrupting some important awareness—

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so wound up in my worries that I did not realize that I 162
110 and then learned to interrupt that interruption. This helped
miss him so much that it is painful—and that worrying 163

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111 him learn how he interfered with reaching his own
does not lessen my fear or increase his safety.
112 goals. 164

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113 Another example is a patient who did not use her power
114 and her “response-ability” to set boundaries at work and in

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115 her personal life. The resultant turmoil and difficulty in her The phenomenological attitude and method in therapy 165

116 life was also present in therapy. From moment-to-moment

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117 this patient felt helpless to do anything for herself and she The soil that makes restoration of learning-by-living possible 166

118 pulled on me to be the provider of both truth and also basic in the gestalt model is composed of: (1) phenomenological 167

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comfort. She believed I was a source of omnipotent knowl-
edge and infinite provisions. In a variety of ways I commu-
nicated to her that although I cared about her, I did not wish
to—nor could I—take care of her. I held firm to the position
focusing and experimentation to increase awareness, and: (2)
a relationship based on dialogic contact. This combination
(both discussed below) fosters self-recognition skills, self-
respect, the patient’s experience of being guided by working
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123 that the best I could do was support her to find her own way with a person who understands him/her and treats him/her her 172

124 in life. By refusing to try to meet such elevated expectations, with love and kindness, and the use of active techniques (ex- 173

125 two things happened. First, the patient learned that she had periments). The therapist’s attitude toward the patient and the 174

126 more resources for self-care and support than she had known quality of the contact between them, especially when there 175

127 before, and second, she did not fall into a rage that would are ruptures in the relationship, and the kind of interventions 176

128 likely have followed from her disappointment had I tried and that the therapist uses, largely determine the outcome of the 177

129 failed to support her idealizations of me. (Yontef, 1993). therapeutic process. 178

130 It is important to respect the necessity of the patient’s The chief tools in a phenomenological approach are de- 179

131 self-interruption process, even though it subverts the learn- scription rather than theory-driven interpretations or strate- 180

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181 gies aimed at preset goals such as symptom removal. In the T: Do you feel crazy or think you are crazy? 233

182 phenomenological method the therapist puts aside (“brack- P: No. I am confused and angry. But when I get 234

183 ets”) assumptions, preconceived ideas, and fixed attitudes emotional, my husband thinks I am crazy. 235

184 about what is real, about self and the world, in order to T: And you don’t know yet how I will react to you 236

185 sense, describe, and clarify what is actually experienced in when you show your emotions. 237

186 this very moment. Using a phenomenological method gets P: That’s right. Maybe I should trust you—you are a 238

187 to a deeper, more textured understanding by focusing, by therapist. 239

188 experience-near clarifications, and by experimenting rather T: I think you have to find out if I can be trusted and 240

189 than explaining. The phenomenological therapist is curious it makes sense not to assume that I am trustworthy until 241

190 and wants to understand what the other person experiences you know me better. 242

191 and does not take the role of a change agent, judge, or arbiter
192 of truth. Such a stance seems to enable patients to become Experiments 243

193 less-critical and more interested in their experiential world.

194 One result is that so-called “symptoms” come to be under- Experiential focusing can be extended by using active 244

195 stood as integral dimensions of their self-functioning, for techniques—such as experiments. Experimenting can be as 245

example as signals to them about what is vital to them (e.g. simple as suggesting that the patient take a few slow, deep

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196 246

197 a symptom of profound isolation might protect one’s sensed diaphragmatic breathes with a long exhale. Possibilities are 247

fragility from becoming overburdened). At the point when only limited by imagination and creativity. The experiment

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198 248

199 symptoms are appreciated for the function they serve, new might involve an expanded dialogue in which the therapist 249

learning may take place that expands a patient’s range of gives voice to what he actually experiences with the patient,

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200 250

201 responding to life’s challenges. e.g., “I don’t think you are stupid. In fact, you make a lot of 251

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202 The patient who is frightened in the session might be sense.” That dialogue would be an experiment for both the 252

203 asked questions such as “How do you experience this mo- patient and the therapist. 253

204

205
ment?” “What am I doing that frightens you?” “What do
you experience in your body?” “What do you want and not
P
Experiments in gestalt therapy are cooperative efforts of
the therapist and patient to understand more deeply and to
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206 want?” The answer might be something like “I am afraid explore alternate possibilities. Experiments are an attempt 256

207 that you will think I am stupid,” “I don’t know what I expe- to explore and understand and not attempts to move toward 257

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210
rience and that leaves me feeling chaotic and ashamed,” “I
am afraid you will tell me I have to. . .,” or “I feel hopeless

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and desperate,” or “You look so stern,” or a number of other
responses that can be followed by the therapist accepting the
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pre-established goals. It is assumed that both the patient’s
and therapist’s experience are valid data. The data from the
experiments might be that regardless of what the therapist
believes and affirms, that the patient’s affective reality con-
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211 261

212 patient’s experience as valid and continuing the exploration tinues to be that he is stupid. This might open the door to 262

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213 and dialogue. exploring how the patient learned that he is stupid (or silly, 263

214 In years past, many gestalt therapists tended to see such or absurd, or undesirable, etc.). Or the experiments might 264

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215 patient fear as something that resided within and emerged involve homework, role-playing, sensory experiments, jour- 265

216 from the patient’s self-organization. In the now outdated ver- naling, use of art, music, or movement, fantasy experiments, 266

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sion of gestalt therapy publicized by Fritz Perls in the 1960s,
the intervention to these traits of the person was often the-
and so forth.
The exploration brings into focal awareness aspects of the
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atrical, abrasive, confrontational, and/or organized around
cathartic experiments. Contemporary gestalt therapists lean
more on our grounding in Buber’s philosophy of dialogue
and on phenomenological field theory to stress—as in the
patient’s experience that had been kept in the background,
e.g., longing or disgust. When these shameful aspects are
brought into vivid, visceral awareness in the context of an ac-
cepting relationship with the therapist, spontaneous change
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example questions above—that this patient’s fear is an emer-
gent property of the immediate situation, which includes the

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therapist’s participation.
In the example below with a new patient, the therapist
often results. The patient “gets better.” This is the paradox-
ical theory of change. Embracing your current existence,
including your conflicts and shame, reinstates the learning
that is a natural aspect of living and makes growth possible.
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276

227 begins as follows: Patients’ resilience in the face of anxiety becomes enhanced 277

by their more nuanced awareness of their self-process, and 278

228 T: What are you experiencing right now?
their decreased shame and isolation as they come to trust 279
229 P: I am afraid to speak.
in the therapist’s genuine respect for their life choices on a 280
230 T: Are you afraid of something right here in the room
moment-by-moment basis. 281
231 with me?
The new awareness also points to avenues of exploration. 282
232 P: You will think I am crazy and put me in a hospital.
For example, a patient with an impoverished romantic life 283

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284 discovered a previously denied longing for connection. This can occur even if the therapist is not at all aware that he or 334

285 led to an awareness of an even more intense terror at the she is triggering this reaction. 335

286 prospect of either success or failure with women. He became The phenomenological attitude, focusing and experiment- 336

287 aware that his lack of a romantic life came from his isolating ing can contribute to any therapy, behavior therapy, psy- 337

288 defenses and not from women rejecting him. This also put choanalytic therapy, or an existential experiential therapy 338

289 his emotionally isolating behavior in the therapy sessions such as gestalt therapy. Our interest in, and methodology 339

290 into a meaningful context. for, accentuating and expanding here-and-now awareness 340

can vivify and increase the specificity of the therapeu- 341

291 P: I am aware now that my life is without romance
tic process whether one is focused on a particular symp- 342
292 mostly because I isolate myself.
tom or on the broader questions of enduring life themes. 343
293 T: Sometimes I experience that happening right here
The other central aspect of this approach is the dialogic 344
294 between us.
relationship. 345
295 P: Really? How?
296 T: Sometimes you seem in your own world and
297 when I try to connect, I feel a barrier, like I am shut The dialogic relationship 346
298 out.
299 There are moments in which patients become sharply
aware, with great emotion, of the value of their self- F
Psychotherapy in the gestalt therapy model is “healing
through meeting” (Jacobs, 1995). In a dialogic relationship
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301 interruptions. One isolating patient had such a moment: “I the therapist “meets” or contacts the patient rather than aim- 349

won’t be vulnerable and let someone hurt me again!” As ing to get the patient to be different. The therapist wants 350

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303 he became aware that this defense keeps him from a new to experience what the patient experiences; the therapist is 351

authentically present and willing to be emotionally affected

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304 connection, he also became aware that this attitude was a 352

305 healthy response to adverse conditions in his past, but now by the patient. 353

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307
doomed him to reliving the trauma. He then started experi-
menting with contacting rather than isolating. The therapist
P
Therapeutic effectiveness is largely determined by the
nature and quality of the therapeutic relationship. If the ther-
apist tries to effect a specific the outcome, the patient is en-
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308 facilitated this by identifying the thoughts and feelings as 356

309 they emerged moment-to-moment, by formulating the theme couraged to conform rather than grow through engagement. 357

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310 emerging from these moments, and respecting the patient’s The emergence of spontaneous and self-directed change is 358

311 core emotions and his defenses. inhibited as the expectation of cure by the therapist is re- 359

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Example: Tom was a 45-year-old man proud of his self-

& Jacobs, 2005, p. 328).

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sufficiency and unaware of unmet dependency needs (Yontef
inforced. This issue is relevant to any kind of therapy.This
does not mean that the therapist ignores the urgency of a
patient’s suffering. But our acceptance of the meaningful-
ness of their difficulties seems to help patients move from
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315 P: [With pride.] When I was a little kid my mom was a position of shame and self-loathing for having problems, 364
316 so busy I just had to learn to rely on myself. to one of compassion and interest about what their prob-

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317 T: I appreciate your strength, but when I think of you lems say about important life themes and what they can do 366
as such a self-reliant kid, I want to stroke you and give

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318
about it. This also becomes the foundation for new learning, 367
319 you some parenting. experimenting with alternate coping tools, and exploration 368
P: [Tearing a little]. No one ever did that for me.

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of avenues for solving the problems that are now accepted 369
321 T: You seem sad. without shame and self-loathing. 370
P: I’m remembering when I was a kid. . .

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When the therapist attempts to organize or change pa- 371

323 These interactions created new satisfactions, a new sense tients, or has an attitude of “knowing how the patient ought 372

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of hope, and also new material for exploration, e.g., reexam-
ining core belief system. If the same experiments are sug-

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gested by the therapist as a way to get the patient to behave
better, the spirit of the venture is very different. Often pa-
to be,” the patients get a message that they are not OK as
they are and that the therapist knows better than they what
is true, how they should be, and what they should do. If the
therapist takes charge, the client would not be encouraged to
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328 tients then will experience that they must succeed and please clarify and trust his or her own felt sense of reality and would 377

329 the therapist or fail and disappoint the therapist. The exper- instead defer to the superiority of the therapist. This is rel- 378

330 iments then become something to pass or fail rather than to evant to both behavioral approaches and also to insight and 379

331 learn something. Pleasing or frustrating the therapist can then experiential explorations. In a dialogic relationship change 380

332 become the organizing principle rather than a felt sense of is an emergent phenomenon of the shared wisdom of the 381

333 curiosity, excitement, spontaneity, and self-expansion. This patient and the therapist. 382

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383 Characteristics of dialogic contact in psychotherapy Inclusion as practiced in gestalt therapy focuses not only 435

on what the patient is experiencing, but also on the experienc- 436

384 Martin Buber suggested there were a few essential elements ing process (Jacobs, 1995). Although presence and inclusion 437

385 of dialogue. Using his language, they are: presence, inclu- are necessary for optimal therapy practice, explicating the 438

386 sion, confirmation and commitment to “the between.” experiencing process itself also requires skill at directing 439

387 Presence. In a dialogic relationship the therapist reveals phenomenological experimentation and the guidance of a 440

388 him/herself truthfully rather than seeming or pretending in good professional background. 441

389 order to be seen as he/she would like to be seen. Congru- Confirmation. An existential meeting in which the thera- 442

390 ence comprises one aspect of presence, but it is more than pist experiences the actuality of the patient’s existence con- 443

391 congruence with what is visible; it is a commitment to be as firms the patient’s being and becoming. Whereas “affirma- 444

392 visible to the patient as the therapeutic task and conditions tion” might refer to validating the patient’s current experi- 445

393 warrant. ence, confirmation includes both the present reality and what 446

394 In gestalt therapy the therapist engages in a full range the patient can become. Confirmation is an inherent aspect 447

395 of behaviors and emotions. This presence is manifest ver- of inclusion. 448

396 bally and/or nonverbally; it is revealed by word, gesture Commitment to “the between.” The therapist trusts and 449

or movement; it is demonstrated in all of the ways that a surrenders to what emerges in the interaction. The therapist’s

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397 450

398 person’s emotions and sentiments are revealed to others. “truth” is not privileged, is not considered objective, and 451

When the therapist feels powerless in the face of the patient’s is subject to change in the interaction. What the therapist

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399 452

400 pain or powerless in the face of the patient’s needs and de- believes to be fact, real, including his or her self-beliefs are 453

sires, presence might include sharing the therapist’s affective “put in brackets” – subject to modification in the dialogue.

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401 454

402 reaction. Interpretations are tentative and held lightly. The therapist 455

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403 A requirement of dialogic contact is the therapist’s will- learns from the phenomenological exploration and dialogic 456

404 ingness to be “genuine and unreserved” by honestly revealing interactions. 457

405

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anything that the therapist believes will enable the ongoing
dialogue. Presence is shaped and limited by the needs of the
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407 clinical situation and by the creativity of the therapist. The Suggestions for practice 458

408 style of the therapist in this approach can be as varied as the

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personalities of the therapists. Zinker refers to gestalt therapy
as “permission to be creative (Zinker, 1977).”

shows and what the therapist actually feels. Presence re-

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Ideally there is congruence between what the therapist E
Consider your primary task to contact the patient

Enlarge your own awareness to include the patient’s expe-

rience rather than trying to find a causal explanation or to
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412 461

413 quires the therapist to recognize, feel, understand, accept, change the patient. “Start where the patient is.” Consider the 462

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414 and take responsibility for his/her feelings in the therapeutic patient’s “reality” as valid. What does the patient experience 463

415 contact. However, it is of crucial importance that therapists and how does he or she experience it? Try to understand 464

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416 be able to make discerning judgments about whether or not patients from their own frame of reference. Instead of asking 465

417 they are speaking in order to further the therapeutic dia- “why,” ask questions like “how do you experience that?” 466

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logue, or whether they are reacting impulsively to their own
emotional impulses or urgencies. This suggests the need for Use discrimination 467

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psychotherapy and supervision for the therapist in training
and periodically over the lifetime?
Inclusion is the process of the therapist putting him/herself
so thoroughly into the patient’s perspective—as if the thera-
Too often patients experience the message, with or with-
out full awareness, that their experience, existence, feelings,
longings, despair are too painful, disgusting, frightening or
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pist could feel it in his/her own body—while simultaneously
maintaining a separate sense of self. By practicing inclusion,

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often referred to as empathy, the therapist imagines the re-
ality of the patient, thereby clarifying the patient’s reality
shameful to be shared. Usually patients hunger to be met by
a therapist who does not recoil. But for some patients their
fear, shame, and self-loathing, threaten to engulf them when
the therapist engages with their feelings.
471

472

473

474

428 and confirming the existence of the patient as experienced While ordinarily inclusion is a healing balm, with cer- 475

429 by the patient. When the therapist shows this kind of grasp tain patients, practicing inclusion with their despair and self- 476

430 of the patient’s reality, the patient usually feels understood loathing will be taken as a confirmation of the accuracy of the 477

431 and cared for but also understands him/herself better. Pa- patient’s self-picture, i.e., that indeed they are unworthy of 478

432 tients have a sense that they are not alone in the world, that being in human contact and that there is no hope. For at risk 479

433 at least one person recognizes, cares, respects them, and can patients, such as borderline patients, this can exacerbate sui- 480

434 feel something like what they feel. cidal urges or trigger suicidal attempts (Yontef, 1993).With 481

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482 these patients it is very important to hold and express the Choice of intervention 530

483 polarity of the therapist’s experience and the patient’s. The

484 therapist can say, “I feel very differently about you and your Of course the therapist does something besides just “relate.” 531

485 future than you do–but I want to sit with you and share your The therapist can experiment in a variety of ways: construct 532

486 experience.” reinforcement schedules, construct step-by-step behavioral 533

sequences, can offer guesses about the patient’s experiential 534

487 Be curious about the patient’s actual experience process, or can use phenomenological focusing and phe- 535

nomenological experimentation. Phenomenological meth- 536

488 Be curious. What is it about the patient’s life circumstances ods have decided advantages. Patients not only gain more 537

489 and way of thinking, that makes sense out of the fixed and knowledge through focusing, experimenting, and homework, 538

490 recurrent pattern in which the patient is stuck? How can we but also learn tools they can use on their own. 539

491 understand the patient’s incongruence? What is it like to be When you have a choice, use a method that the patient 540

492 this patient at this time? can fruitfully adopt. Theory-driven interpretations, interpre- 541

493 The initial disclosure by patients is limited by how tations that are not close to actual experience, only lead the 542

494 skillful they are at sensing deeply held affect and beliefs. patient to speculate about themselves rather than sense and 543

Self-acceptance is only as meaningful as the depth of that feel. This is not useful. If you make interpretations, make

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495 544

496 self-reflection. The fog of denial and the learned storm of interpretations that are close to the patient’s experience, that 545

self-loathing obscure an accurate sense of self. While we you consider tentative and subject to the patient’s sense of

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497 546

498 start with what the patient reports experiencing, the therapist things, and that emerge from inclusion and dialogue. This 547

needs to be curious about the awareness that may emerge kind of interpretation can aid the patient’s focusing skills

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499 548

500 from the therapeutic work. Use your curiosity and your and experienced sense of self whereas theory-driven inter- 549

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501 knowledge of how to focus to guide the patient to discover pretations leave the therapist as the expert with access to 550

502 more about self, to go beyond the fixed beliefs constructed truth and the patient to speculate or believe the expert rather 551

503

504
to cope with experiences in earlier times but not freely ad-
justing to the immediate field. By doing so, you find out
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than deciding for him/herself. 552

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505 more about the patient and the patient finds out more about Focus on actual experience 553

506 him/herself and also how to be more aware. The accuracy

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509
and fullness of the awareness is judged by the patient’s grasp
of the experience – not by the therapist’s analysis.

a wonderful asset; but fixed notions about the patient are

T
Therapists’ curiosity about patients’ actual experience is E
When the therapist uses focusing or experience-near inter-
pretations, patients can learn to differentiate observation
from inference, thought from feeling, and what could be
from what is. Using methods of focusing enables patients
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555

556

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510 557

511 not. Curiosity can guide the therapist and patient to inquire to get clearer about their situation and experience. From 558

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512 and acquire a deeper understanding. Fixed notions, whether an emotional morass, a patient might distinguish a long- 559

513 driven by theory, premature conclusion, or outright bias, are ing and despair, or uncover a desire long hidden in a mode 560

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514 a hindrance to an accurate understanding, the therapeutic re- of self-protection. If a therapist focuses experientially on 561

515 lationship, the development of autonomy and self-awareness the unfolding of directly felt sense and emotion rather than 562

516

517

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by the patient, and growth based on self-recognition and
self-acceptance. The therapist’s curiosity and open attitude
theory-driven interpretation, patients can learn to observe
and feel rather than speculate on why they do what they do.
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518

519

520 Inner conflicts

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can also help stimulate patients’ curiosity and open attitude
about themselves and the people in their lives.
This observational focusing approach strengthens patients’
ability to know and accept themselves and experiment to find
out what is possible for them.
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521

522

523
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Most patients come to therapy with conflicts that are soon

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revealed. Often they want something but there is a conflict
between what they want and feelings fear, guilt, or shame
Give attention to interruptions and resistance

Notice how energy (interest, excitement, animation, affect)

emerges and develops. What is the pattern? Does the energy
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569

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524 that oppose the basic desire. Or, they want things that are flow from initial awareness, through a building of excitement, 571

525 mutually inconsistent. Or, they want things to be different into action or expression, and then resolution? Are there signs 572

526 and do not want to give up what they are doing that is part of anger, joy, sexuality, sadness, or other feelings that start 573

527 of the undesired outcome. Be curious about and open to the to show and then are stopped? Or if allowed into expression, 574

528 validity of all sides of conflicts. Be curious about the function does it transform into action? How does the patient prevent 575

529 of any “resistance,” e.g. self-interruption. resolution? 576

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 J Contemp Psychother

577 The forces of interruption are as real and functional as the P: (Role playing, looks disgusted, rolls her eyes to- 624

578 forces of the primary affect. We may call them resistances, ward the ceiling, and frowns. She does not say anything. 625

579 which means resisting affect, as opposed to resisting the T: What did you experience at that moment? In the 626

580 therapist or the therapy, but this resistance is not unhealthy. role play I experienced being exposed and ashamed. 627

581 It is best explicated, understood, respected, and directly ex- P: I thought: “What is wrong with him that he finds 628

582 pressed. me attractive, but he is probably is lying. I felt disgust 629

and shut him down.” 630

583 The time dimension T: You had a strong impact. Did it get you what you 631

want? 632

584 Pay careful attention to each moment. As patients talk about P: No. 633

585 their present or past life, give special attention to what T: OK. Let’s explore what else you could have done. 634

586 is present in the room at the very moment. What does

587 the patient feel while telling of his or her story? What is
588 the quality of contact between therapist and patient while The marriage of dialogic relating and active 635

589 the story is being told? Does the demonstrated affect match interventions 636

the story? How are you affected emotionally? The here-and-

F
590

591 now in the therapy session often mirrors or exemplifies a The most effective therapy can only happen when the thera- 637

general characterological pattern and presents an opportu- pist uses both discrimination and creativity in making contact

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592 638

593 nity to work on the general theme first hand. with the patient by directing the focusing, and by devis- 639

ing experiments that carry the work into new dimensions of

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640

594 The task and the situation awareness and action. 641

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Techniques and experiments are also relational events. 642

595 How the therapist contacts the patient and the choice of They can emerge as reactions to the therapist’s frustrations, 643

596

597
intervention must be in service to the context and task. The
context includes the setting (agency) and the limitations of
P
or in a spirit of cooperative exploration that is very helpful for
the patient and actually builds the relationship. When they
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645

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598 the service provided. The figure organizing the therapist’s emerge as a creative response to the temper of the moment, 646

599 interventions must be related to the specific patterns of the the results are usually a surprising enrichment of the thera- 647

600

601

602
patient’s personality organization, life context, and level of
awareness. The therapist has to recognize not only what the
patient is doing and experiencing contemporaneously, but
how specific moments represent larger patterns. The task
T E
peutic dialogue and the patient’s awareness of possibilities.
Without empathic contact, therapeutic effectiveness is very
limited; but empathic contact without creativity in actively
engaging in the learning process is also limited.
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603 651

604 requires the therapist to recognize openings and learn the

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605 sequence of what must come before what.
606 Example: References 652

607

608

609 made you angry.

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P: (Reports a story of a man being hostile to her).
T: It sounds like he was being a jerk and this time it

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P: Yes. I did not feel embarrassed or afraid, as in the
Beisser, A. (1970). The paradoxical theory of change. In J. Fagan &
I. Shepherd (Eds.), Gestalt therapy now (pp. 77–80). New York:
Harper. Download at: http://www.gestalttherapy.org.
Gendlin, E. (1981). Focusing. New York: Bantam Books. “Six
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655

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611 past, but angry. Steps,” a very useful excerpt, can be downloaded at 657

http://www.focusing.org/sixsteps.html. 658
T: That is an improvement, isn’t it? Are you inter-

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Jacobs, L. (1995). Dialogue in Gestalt theory & therapy. In R. Hycner 659
613 ested in seeing what part you may have played in that & L. Jacobs (Eds.). The healing relationship in gestalt therapy 660

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614 interaction? (pp. 51–84). Highland, NY: The Gestalt Journal Press. 661

615 P: Of course, that could be useful. Yontef, G. (1993). Awareness, dialogue and process: Essay in Gestalt 662
therapy. Highland, NY: The Gestalt Journal Press.

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663
616 T: OK. Let’s go over the interaction from the begin- Yontef, G. (1995). Gestalt therapy. In A. Gurman & S. Messer (Eds.), 664
617 ning. How did it start? Essential psychotherapies: Theory and practice (pp. 261–303 at 665

618 (Patient goes over the story in detail and the therapist pp. 268–269). New York: Guilford Publications. 666

619 helps clarify). Yontef, G., & Jacobs, L. (2005). Gestalt therapy. In R. Corsini & 667

D. Wedding (Eds.), Current psychotherapies, 7th Edition, Chap- 668

620 T: Let’s role play the moment when he said he was ter 10 (pp. 299–336). Belmont, CA: Brooks/Cole—Thompson 669
621 attracted to you. I’ll play him. I want to feel how I Learning. 670

622 am affected by your response. (Role plays what she Zinker, J. (1977). Creative process in gestalt therapy. New York: Brun- 671

623 reported the man saying). ner/Mazel. 672

Springer

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