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
Introduction
•Uses
creativity to help clients remain in the moment
•Emphasizes
growth
integration, awareness, and positive
•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
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
12-2
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)
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
12-3
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
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
12-4
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
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
12-5
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
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
12-6
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
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
12-7
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
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
12-8
Clemmen’s Addictive Cycle Model
•Individuals
experience
•3
who abuse substances have an impaired cycle of
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
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
12-9
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
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
12-10
Gestalt Based Techniques
Heightening awareness
Empty chair
Focusing on the body
Dreamwork
Creating experiments
Integration of polar opposites
Elusive client language
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
12-11
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
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
12-12
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
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
12-13
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
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
12-14
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
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
12-15