Over 2500 years ago an unhealthy lowering of mood, seen as a disease, was identified (Roubal, 2007). Since then, what is now known as depression has been identified by the World Health Organisation as the fourth most urgent global health problem. Affecting hundreds of millions of people worldwide, depression is believed to effect at least 20% of women and 12% of men during their lifetime and 15% of depressed people end their life by suicide (Akiskal, 2000). Despite the ever increasing use of antidepressants, their efficacy remains unsatisfactory. Roubal (2007) reported that between 15 and 30% of depressed people prescribed antidepressants do not show a response to the medication. However, what studies have shown is that psychotherapy, on its own or in combination with antidepressants, is an effective treatment for depression.
So what is depression… a medical model considers depression and its symptoms to be a disease, something that needs ‘fixing’ often categorised by a person suffering low moods, decreased energy and activity, reduced ability to feel pleasure, withdrawal, poor concentration and increased tiredness and the depth of depression is measured according to a list of criteria (DSM-V). Whilst this kind of description can also be useful for Gestalt therapists it has limitations in that it is static and it does not describe the dynamic nature of the relationship between the person experiencing depression and his, her or their environment.
Depression and Gestalt Therapy
Gestalt therapy defines depression as a process observed in the therapeutic relationship whereby the client is experienced as unable to react flexibly to the present situation and starts organising themselves in a rigid and stereotypical way such as hopeless, powerless and insecure. A client with depression is observed to try to cope with their emotions by withdrawing from contact with others (including the therapist) and by blocking their experiencing. Although a Gestalt therapist does and can make diagnosis and assessments, the manner in which they do this is different to other modalities such as CBT. A Gestalt therapist works closely with clients in a collaborative fashion whereby a relational approach is strongly adopted and the here-and-now; moment by moment interactions are highly regarded with curiosity and awareness. Gestalt therapy views a person holistically and as more than a sum of their individual parts. A Gestalt therapist, presently, with the client watches for interruptions in the Gestalt contact cycle and explores, with the client, how these interrupts may have once been creative adjustment that served them, (or they would not of survived the traumatic experiences at that time) but now how in our adult lives, they have become fixed rigid gestalts that hinder them, in contact with others, their environment and themselves. A Gestalt therapist works with clients through assimilating, looking at and expressing introjects, proflections, projections, deflections and retroflections, to enable the client to evaluate what values they own for themselves and those which no longer serve them and limit their way of contacting. The relationship within Gestalt therapy is of significance and profound importance, it is what is used to develop awareness through relationally working with one another in the here-and-now. Gestalt therapists use the relationship and their own responses during session to identify with the client their processes, how they interrupt contact, how they make contact, how they have their needs met or how they dismiss their needs. When a Gestalt therapist is working with a client who is depressed or is depressively adjusted their interest is in the client’s process, they view the client as dynamic not as static or as a list of criteria. Yontef and Jacobs wrote ‘Gestalt therapy maintains that there is no meaningful way to consider any living organism apart from its interactions with its environment (F. Perls et al., 1951/1994). Psychologically, there is no meaningful way to consider a person apart from interpersonal relations just as there is no meaningful way to perceive the environment except through someone’s perspective.
Akiskal, 2000 Mood disorder: Introduction and Overview. Kaplan, H.I.,
Sadock, B.J. Comprehensive Textbook of Psychiatry. Seventh Edition. Lippincott
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Francesetti, G., & Gecele, M. (2009). A Gestalt therapy perspective on psychopathology and diagnosis. British Gestalt Journal, 18 (2), 5-20.
Greenberg, L. & Watson, J. (2005) Emotion-focused Therapy for Depression. APA Press, Washington D.C.
Greenberg, L., Watson, J. & Goldman, R. (1998) Process Experiential Therapy of Depression. Handbook of Experiential Psychotherapy: Foundations and Differential Treatment. Guildford, New York, 227-248.
Joyce, P., & Sills, C. (2010) Skills in Gestalt: Counselling & Psychotherapy. Sage Publications, London.
Roubal, J. (2004) Gestalt approach in therapy of depression. Konfrontace, 15 (1), 31-36.
Roubal, J. (2005) Depression – A Gestalt Theoretical Perspective. British Gestalt Journal, 16, 1, od s. 35-43, 9 s. ISSN 0961-771. 2007.
Yontef, G. (1993) Awareness, Dialogue and Process. Gestalt Journal Press, Highland, NY.
Yontef, G. (2005). In A. Woldt and S. Toman (Eds.). Gestalt Therapy: History, Theory and Practice. Pp 81-100. Thousand Oaks, California: Sage Publications.
Yontef, G., & Jacobs, L. Gestalt Therapy found. www.gestalttherapy.org/faculty_publications
Zinker, J. (1978) Creative Process in Gestalt Therapy. Vintage Books, NY.
*All definitions can be found in article titled ‘Gestalt Therapy: What is it and what are some common terms used by Gestalt Therapists’.