How Does Gestalt Therapy Compare with Cognitive Behavioural Therapy?


This discussion considers the main differences between Gestalt Therapy and Cognitive Behavioural Therapy (CBT). The main differences are that:


There are many different ways in which CBT is practiced. For this discussion we use the example of Rational Emotive Therapy (RET).

Rational Emotive Therapy

Rational Emotive Therapy (RET), also known as Rational Emotive Behaviour (REBT) therapy, was developed in 1955 by Albert Ellis, and is considered to be one of a variety of Cognitive Behavioural Therapies (CBT) (Dryden, 2001 p. 33).

Rational emotive behaviour therapy focuses on uncovering irrational beliefs which may lead to unhealthy negative emotions and replacing them with more productive rational alternatives. The therapy is based on a framework consisting of: activating events (A); our beliefs about them (B); and the cognitive, emotional or behavioural consequences of our beliefs (C). This is referred to as the 'ABC framework'. (Dryden, 1990, p. 242). Therapeutic interventions consist of identification of irrational beliefs, interpretation and disputation of those beliefs by the therapist, and assigning homework assignments to the client to reinforce the alternative belief and behavioural change.

There are six consecutive queries employed in RET therapy: (Ellis, 1974)

1. What self-defeating irrational belief do I want to dispute and surrender?

2. Can I rationally support this belief?

3. What evidence exists of the falseness of this belief?

4. Does any evidence exist of the truth of this belief?

5. What are the worst things that could actually happen to me if I don’t get what my belief tells me I must get(or do get what I think I must not get)?

6. What good things could I make happen if I don’t get what my belief tells me I must get (or do get what I think I must not get)?

This contrasts markedly with Gestalt therapy which is based on the Paradoxical Theory of Change.

Gestalt therapy and the Paradoxical Theory of Change.

Beisser states that: “change occurs when one becomes what he is, not when he tries to become what he is not. Change does not take place through a coercive attempt by the individual or by another person to change him, but it does take place if one takes the time and effort to be what he is -- to be fully invested in his current positions.” (Beisser, 1970 http://www.gestalt.org/arnie.htm), and “The only way to get rid of an unwanted thought or feeling is first to accept it and then to allow it expression.” (Smith, 1977, p. 34). Although Beisser’s theory was not formulated at the time, Perls, the founder and exponent of Gestalt therapy, states “As long as you fight a symptom, it will become worse […] the very moment you get in touch with yourself – growth begins, integration begins” (Perls, 1969 p. 193) and again “As soon as you say ‘I want to change’ […] a counter-force is created that prevents you from change”

By rejecting the role of change agent, Gestalt therapists make meaningful and orderly change possible (Beisser, 1970 http://www.gestalt.org/arnie.htm). Gestalt therapists…assist the patient, paradoxically, to be more fully where (how) he is, in order to develop organismic, bodily experienced awareness” (Dublin, in Smith, 1977 p 138)

“The practice of most therapy systems encourages intellectualizing: talking about the irrationality of patient beliefs, talking about the behaviour changes the therapist believes that the patient should make “(Yontef, 1993).

“Forced change is an attempt to actualize an image rather than to actualize the self. With awareness self-acceptance, and the right to exist as is, the organism can grow. Forced intervention retards this process.” (Yontef, 1993).

PHG states that “the whole crusade for ‘control of the emotions’ […] does not eliminate ‘undesirable’ emotions from the person, for it cannot repeal the way nature designed organisms to function. What it does succeed in doing is to complicate the already intricate organism/environment field by setting up a great number of situations which, unless avoided, are immensely emotion-arousing” (Perls Hefferline & Goodman, 1951 p.97).

Yontef states that “The theoretical distinction between Gestalt therapy [and] behavior modification [,…]. In behavior modification, the patient's behavior is directly changed by the therapist's manipulation of environmental stimuli. […]. In Gestalt therapy the patient learns to fully use his internal and external senses so he can be self-responsible and self-supportive. Gestalt therapy helps the patient regain the key to this state, the awareness of the process of awareness.” (Yontef 1969, pp. 33-34)

Bugental (1987) views intellectualising as a form of resistance to experiencing, and that the main aspect of effective psychotherapy is to help the client to identify the ways in which they set up resistances to experience, and further, experiencing rather than analysing that resistance is the way through the impasse (Bugental 1987, p. 173-183)

It is clear from the forgoing that Gestalt therapists facilitate changes in client awareness without assuming the role of change agent per se, but via facilitating growth in their clients’ own awareness.

The CBT/RET therapeutic model maintains that desirable emotions and actions proceed from a “rational” cognitive approach. An RET therapist assists the client to recognise faulty cognitive, belief and behavioural patterns.

It is my contention that only with full experiential awareness (bodily, emotional and cognitive) can a person begin to change. And then it happens automatically, and not by trying.

Both Gestalt and RET are effective.

It is manifestly clear that both Gestalt and RET are effective therapies in their own spheres of activity. If this was not the case, the therapies would not endure and would soon be disregarded. RET has demonstrated effectiveness in areas such as family troubles, unsatisfying work, early childhood traumas and interpersonal relationships. (Ellis, 1994). Gestalt Therapy’s aim is increased awareness. PHG states “The basic endeavour is to assist you to become aware of how you are now functioning as an organism and as a person” (PHG 1951, p. 17). Since this is a broad statement of functional psychological health, Gestalt operates broadly to facilitate psychological health through increased awareness.

Gestalt Therapy compared to RET with regard to the Paradoxical Theory of Change


RET therapeutic intervention places the therapist as a direct change agent, actively identifying, challenging and disputing the client’s faulty cognitive processes and beliefs.

“The RET counsellor may take a very directive role, actively disputing the client's irrational beliefs, […] overcome their irrational beliefs, and in general 'pushing' the client to challenge themselves and to accept the discomfort which may accompany the change process.” (http://counsellingresource.com/types/rational-emotive/)


This approach places the therapist as a direct change agent, as somehow more knowledgeable and aware of the client’s behaviours and experience than the client. It is not at all necessary according to RET, for clients to accept or fully experience their current position. The emphasis of the therapy is on prescribing the appropriate cognitive regimen that will ‘fix’ the ‘faulty’ client. This approach is at odds with the Paradoxical Theory of Change, in the following ways:



Holism

Holism is a concept developed by Jan Smuts which “extends to a radical acceptance of body-mind which is not based on any notion of causality”…“An holistic approach to the person embraces and affirms complexity, inclusion and diversity and resists reductionism” (Clarkson, 1989, p. 8).

"Gestalt therapy views the entire biopsychosocial field, including organism/environ­ment, as important. " (Yontef, 1969, pp. 33-34).

Gestalt explicitly embraces holism and RET views only cognitive and behavioural aspects of the whole person as relevant to psychotherapy. RET is therefore philosophically non-holistic.

RET places the therapist as an expert and the client as holding “irrational beliefs” and “unhealthy negative beliefs”. The decisions as to which beliefs are unhealthy and irrational are made by the therapist and may or may not be accepted by the client. This paints a picture which is very different from “an […] acceptance of body-mind which is not based on […] causality” (Clarkson, 1989, p. 8). For these reasons, I contend that RET is not a therapy that is based on, or even acknowledges holism. The fact that the RET therapist identifies faulty and unhealthy beliefs held by the client will reinforce any idea held by the client that there is something wrong with him or her, setting up still more intrapsychic conflict.

Both therapies depend on skilled and effective therapists to be effective

“Although emphasizing the same 'core conditions' as person-centred counselling -- namely, empathy, unconditional positive regard, and counsellor genuineness -- in the counselling relationship, REBT views these conditions as neither necessary nor sufficient for therapeutic change to occur” ( http://counsellingresource.com/types/rational-emotive/). Thus, RET clearly embraces the role of therapist as authentic, empathetic and respectful, but views these attributes as optional in the context of therapeutic effectiveness.

Gestalt takes the view of therapeutic relationship as involving an ‘I/Thou’ relationship which is characterised by a “genuine relationship between two unique people in which both respect the essential humanity of the other” (Buber, 1958, quoted in Clarkson, 1989, p. 16). The goal of the relationship is full and complete authentic meeting between these two people. (Clarkson, 1989, p. 16).


Gestalt, therefore, places the therapeutic relationship as more central and essential component than RET does, however this does not negate the skill and effectiveness required of the therapist to be effective in either modality. If, for example, the client perceives that their RET therapist is shaming them into adopting alternate behaviours, I do not believe that the therapy will have any lasting effectiveness; furthermore, I believe that such an approach could be harmful. It is my contention that an RET therapist who operates from an inappropriate role will not assist their clients therapeutic change, but will merely set up more intrapsychic problems for their client. Furthermore, an approach to RET that bypasses the client’s awareness of their patterns will not facilitate lasting therapeutic change.


Differences between Gestalt and RET

Philosophical origins

RET philosophy is most frequently attributed to the philosophy of Stoicism, based on the teachings of Epictetus (2nd century AD), which essentially state that “human beings can control some things and cannot control others”, and “human emotion is consonant with the natural order of things as long as it is joined with reason” (Bard, 1980 p. 223). There is a strong philosophical linkage to Aristotle’s concept of mind/body dualism and subject/object dualism, as well as to Descartes philosophical tenet “I think therefore I am”. The word “reason” itself implies a cognitive process, which thereby depends on mind/body and subject/object duality. RET is therefore philosophically dualistic and non-holistic.

Gestalt draws it’s philosophical base from a wide range, including Zen and Taoism, Holism, and Existentialism, each of which challenges or disputes dualistic concepts. Perls is quoted as saying “To come together again he has to heal the dualism of his person, of his thinking, of his language” (PHG, 1951, P. viii).

Zen philosophy is somewhat more difficult to pin down, but the following quote makes clear “As long as there is a dualistic way of looking at things, there is no emancipation. Light stands against darkness; the passions stand against enlightenment” (Hui Neng, quoted in Suzuki, 1949).

Existentialism

“The existential view holds that people are endlessly remaking or discovering themselves. There is no essence of human nature to be discovered "once and for all." There are always new horizons, new problems and new opportunities.” (Yontef, 1993)

“Taoism and Gestalt have much in common. Both aim at balancing the forces within the individual […] Both recognise that with this centering there is an improved perspective and increased awareness. Both believe in the wisdom of the organism, as opposed to rational intelligence. Both believe in being in the ‘here and now’” (Gagarin, in Smith 1977 p. 213).

This contrasts sharply with the rational philosophical underpinnings of RET. Aristotle’s, Descarte’s and Epictetus’ philosophies are strongly dualistic, and Gestalt’s are strongly non-dualistic.

Body Process

In Gestalt therapy, body process an important dimension of the therapy, in keeping with Gestalt’s holistic philosophy. Kepner states that “the sense of being one’s self is difficult to experience when body work occurs at one time and psychological work occurs at another. ” (Kepner 1987, p. 3) By way of contrast, RET places no emphasis on body work at all, primarily because I believe that the clients somatic symptoms are not available to the RET practitioner and that the entire cognitive therapy field does not view the body as part of the therapeutic situation (RET is non-holistic). This is to be expected of a cognitive behavioural approach, which is by definition addressing thoughts and behaviours and not the whole person in Gestalt terms.

Dreamwork

“I believe that every part of the dream is a part of yourself – not just the person, but every item, every mood, anything that comes across” (Polsters 1977, p. 266). Thus, dreamwork provides Gestalt therapy with a rich source of experience and awareness. RET places no emphasis on dreamwork, I believe because dreams cannot be disputed or interpreted in cognitive terms. Again, this, I believe, limits RET to cognitive and behavioural domains, by contrast to Gestalt that includes the whole person.


Conclusion and summary

RET places the therapist as a direct change agent, unlike Gestalt Therapy which explicitly rejects this role, in favour of change arising in the client through increased awareness of their current situation.

The RET practitioner assumes the role of expert and prescribes behaviour modifications designed to correct faulty cognitive and behavioural activities.

The Gestalt therapist assists their clients to become more aware of their current situation, without ascribing pathology or assuming expertise in regard to the client’s life situation. According to the Paradoxical Theory of Change, this increase in awareness facilitates meaningful change in the client’s situation. Gestalt Therapy views the role of explicit change agent as counterproductive and ineffective.

References

Ellis, A. (1974) Techniques for Disputing Irrational Beliefs (DIBS). New York: Albert Ellis Institute. Revised 2001.

Kepner (1987) Body Process : A Gestalt Approach to Working With the Body in Psychotherapy. Cleveland: Gestalt Institute of Cleveland Press

Perls, Hefferline and Goodman (1951) Gestalt Therapy – Excitement and growth in the human personality. London: Souvenir Press

Polster, G Polster E (1973) Gestalt therapy Integrated. New York: Random House

Smith, Edward W. L. (1977) The growing edge of Gestalt therapy. Secaucus,NY: Citadel Press

Perls, F, (1969) Gestalt Therapy verbatim. Moab, Utah : Real People Press

Clarkson, P (1989) Gestalt counselling in action. London: Sage Publications

Yontef, G (1993) Gestalt therapy: An introduction. Excerpted from Awareness, Dialogue, and Process. New York The Gestalt Journal Press in http://www.gestalt.org/yontef.htm

Dryden, W (2001) How rational am I – Self help using Rational Emotive Behaviour therapy in Embodied Theories London Continuum Books

Dryden, W (1990) Rational Emotive Counselling In Action London: Sage Publications

Bard, J. A (1980) Rational Emotive Therapy in Practice. Illinois: Research Press

Wilber, K (1997) The Eye of Spirit. Boston: Shambhala Publications

Bugental, J.F.T. (1987) The Art of the Psychotherapist. New York: W. W. Norton and Company

Suzuki, D.T. (1969) The Zen Doctrine of No Mind, London: Ryder & Co.



© Alex Whittle 2005