CHAPTER 12: Gestalt Therapy in the Treatment of Substance Abuse and Addiction

1. CHAPTER 12: Gestalt Therapy in the Treatment of Substance Abuse and Addiction Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory First Edition Todd F. Lewis Developed by Katie A. Wachtel, University of North Carolina at Greensboro

2. Introduction • Uses creativity to help clients remain in the moment • Emphasizes integration, awareness, and positive growth • Focuses on holism to identify inconsistencies between verbal and nonverbal reports • This chapter outlines the main principles of Gestalt therapy, discusses the application of Gestalt therapy with substance abuse populations, and identifies techniques consistent with Gestalt therapy

3. Major Tenets of Gestalt Therapy • Major goals include awareness, growth, maturation and integration of feelings, perceptions, thoughts and behaviors • Figure/Ground • Figure: What stands out in the moment upon which focus is placed • Ground: The backdrop which surrounds the figure. Made up of context, environment, past experiences, and relationships • Contact • Healthy contact is a balance between contact with self and others • I-boundaries • Contact functions (looking/seeing, listening, touching, talking, moving, smelling, and tasting)

4. Major Tenets of Gestalt Therapy Continued • Interruptions to healthy contact • Result from cognitive distortions or inconsistencies between internal wants, desires, and needs, and outward expression • Types: • Introjection • Projection • Confluence • Retroflection • Egotism • Deflection

5. Major Tenets of Gestalt Therapy Continued • Gestalt Cycle of Experience • Individuals consistently respond to internal sensations and the environment • Captures the main processes involved between the person-environment contact • Awareness • The uninterrupted process for “keeping-up-to-date with one’s self”—thoughts, feelings, and actions • Here and Now • Focusing on the present moment and how clients emerge, grow and develop in the immediacy of therapy

6. Major Tenets of Gestalt Therapy Continued • The Creative Stance and the Role of the Gestalt Clinician • Clinician must be open to possibilities in the moment • Client and clinician improvise ways to help the client live a more productive life • Clinician should avoid interpretation and diagnosis • Help clients rely less on external support and more on internal support • Paradoxical Principle of Change • The more one tries to be something one is not, the more one stays the same, thus clients will not change until they accept it

7. Major Tenets of Gestalt Therapy Continued • Criteria for Effective Counseling Outcomes • Completion of unfinished business • Greater awareness of resistance to contact and restoration of healthy contact • Greater awareness of sensations, actions, feelings, wants, and values • Integration of disparate parts of the self • Increased ability to experiment with new behaviors in the counseling session and generalize them to other areas of life

8. Application of Gestalt Therapy with Substance Abuse Problems • Gestalt theory views substance abuse as: • --Distorted retroflection and other contact processes • --Disruptions in the contact cycle manifesting as diminished sensation, diminishing new figures, and unfinished business • --Limited self-awareness and inability to engage in the natural flow of figure/ground processes • Awareness is key: Increased awareness slows down the experience which decreases impulsivity • Substance abuse is a form of creative adjustment

9. Clemmen’s Addictive Cycle Model • Individuals who abuse substances have an impaired cycle of experience • 3 developmental stages of recovery: • Stage 1: Early recovery • Tasks: maintain abstinence, learn how to retroflect, assist in bringing sensations to awareness • Stage 2: Middle recovery • Tasks: helping the client to develop a complementary relationship with the world, redefine self-other boundaries, and develop interpersonal skills • Stage 3: Later recovery • Tasks: reflection, contemplation, and transcendence

10. Working with the Person-Drug Relationship • A model of substance abuse that is based on contact boundary disturbances, fixed figures, and unfinished business that impairs healthy movement through the cycle of experience • Stage 1: Sensing and building ground (precontemplation) • Stage 2: Clarifying the figure (contemplation) • Stage 3: Encouraging awareness (decision) • Stage 4: Mobilizing energy (action) • Stage 5: Contacting and withdrawing (maintenance) • Multiphasic Transformation Process • Examines the cycle of experience as it relates to growth and change, and how this process becomes dysfunctional, leading to addiction

11. Gestalt Based Techniques • Heightening awareness • Empty chair • Focusing on the body • Dreamwork • Creating experiments • Integration of polar opposites • Elusive client language

12. Gestalt Therapy in the Treatment of Diverse Populations • Difficult to study empirically due to its creative stance, but many believe it to have potential to be effective with diverse populations • The emphasis on client unique experiences and the focus on awareness can help clients be more in tune with their cultural background • May be particularly helpful with biracial clients • Connecting with emotions may not be effective with all cultures and the focus on individualism may not be relevant with more collectivist cultures

13. Running Case Study: Michael • The clinician helps Michael to remain in the here and now to help him become more aware of his feelings of anger • Clinician points out discrepancies between verbal report and nonverbal behavior, processes feelings in the body, assesses for unfinished business, and uses the empty chair technique to help Michael address his feelings toward his father • Michael gained deeper awareness into his experience of feelings

14. Strengths, Limitations, and Ethical Issues Related to Gestalt Therapy • Strengths • Can be used in individual or group formats • Focuses on personal responsibility, awareness, contact, and choice • Solid theoretical base and techniques • Focus on the here and now • Assists with affective expression

15. Strengths, Limitations, and Ethical Issues Related to Gestalt Therapy Continued • Limitations • May not be suited for all clients • Takes practice and training • Does not focus on cognitive processes • Does not have a well-developed empirical base • Ethical Issues • Takes considerable skill and understanding to implement ethically • Encouraging clients to re-experience drug using behavior without competent application can cause ethical concern • Rejects many traditional addiction concepts