ANDIt’s difficult to find a concrete definition. It is defined as the way of doing therapy created by (a neuropsychiatrist and psychoanalyst) and his wife. The (APA) defines it as one of the three especially relevant types of humanistic therapy, based on «organismic holism», the importance of being aware of the here-and-now and that each person accepts responsibility for their own actions.
It has a very eclectic theoretical base that draws from Eastern philosophy, psychoanalysis, psychodrama, the theory of S. Friedlander (human behavior is a process of balance between two opposite poles, the health of the organism and its potential being defined. creator as its ability to reach the “zero point”), the (the body has a muscular armor and that there are different zones of emotions or rings in which energy accumulates and stagnates, producing pathologies), existential philosophy, the existential phenomenological approaches and the (technique based on psychoanalysis and dynamic relaxation that according to its defenders allows for the solution to psychological blockages and creates a transformation process thanks to the symbology of dreams).
Gestalt thinking as such has its origin in the figure of Fritz Perls, at the end of the 40s, and focuses on a holistic perspective where they claim to integrate the multiple dimensions of the human being; sensory, intellectual, emotional, social and spiritual. Therapy focused on the here and now, where the importance of awareness and different aspects such as integration, self-realization and the development of human potential stand out. Its defenders say that it is a therapy that helps people consider their existential position in their lives, seeking to promote an attitude of honesty, responsibility and respect and promote a value of meaning about life and oneself.
What do studies tell us about gestalt therapy?
There is no doubt about the boom that this way of understanding and doing therapy is having. There are many psychologists who practice it and who defend their vision. However, do we have proof of its effectiveness? When analyzing the evidence available up to this point, we find that efficacy studies are scarce and of low methodological quality. Let’s see:
There are very few randomized controlled trials (RCTs) on the effectiveness of gestalt therapy and these are of very low quality.
For example, only 2 RCTs were found in one: The first compared 21 patients with depression, to whom support and expression therapy was applied in a group (manualized version of Gestalt therapy), versus a control group that received cognitive behavioral therapy. (CBT) They measured the nature and intensity of emotions, with a 20-week follow-up. They found no significant differences in the occurrence of anger emotions compared to CBT. As we see, the sample is small and the authors only highlight the differences in one measure. What happened to the others?
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In the second by Cook (2000), the sample size is unknown and focuses on adolescent women who “consider themselves depressed.” The treatment consists of a brief group intervention and a 5-week follow-up period compared to a control group on a waiting list. The gestalt therapy group showed a reduction in depression and anxiety scales and higher scores on self-concept scales than in the control group.
When analyzing the evidence available up to this point, we find that efficacy studies are scarce and of low methodological quality.
Another more current study (2016) reviews the levels of evidence of gestalt therapy within the humanistic current, between the years 1990 and 2016. In total, they analyzed 172 studies with different levels of evidence, from meta-analysis of controlled studies and randomized to cohort studies. They found 7 meta-analyses, 20 literature reviews and numerous controlled, randomized, cohort and comparative studies.
Of all these meta-analyses, there is only one published in German, whose results support the effectiveness of Gestalt therapy but warn: “a definitive statement cannot be made about the significant differences, the configuration of the individual therapy or the long-term measures. .” That is, the results are not superior to doing nothing. On the other hand, Elliot et al () made a meta-analysis of humanistic psychotherapies from the years 1978 to 2001, and from 2001 to 2013 and observed that CBT produces superior effects to Gestalt therapy, although the differences, they say, disappear when They take into account the effects of therapeutic adherence and directive alternative treatments.
Literary reviews are based on qualitative measures and case studies, being more optimistic in their results.
carries out an analysis of 27 literary reviews that analyze gestalt therapy as: “a means toward the recovery of mental and somatic function.” They found positive results in the treatment of mental disorders such as depression (; ), anxiety and post-traumatic stress (; ; ; ), phobia ( ), borderline personality disorder () and schizoid and paranoid personality disorder ().It also points to a beneficial effect of gestalt therapy in physical conditions, such as chronic diseases including high blood pressure (HTN) (), heart disease, cancer, chronic back pain and rheumatoid arthritis (Imes et al, 2002), whiplash () and chronic Stonnington headache ().
In all these disorders, it is highlighted that: “gestalt techniques create a favorable climate for self-care techniques,” and aspects of the gestalt therapist’s work with respect to the body are highlighted in the review, such as: “recognizing blocked areas of the self, making intelligible the messages from the physical body expressed through somatic symptoms and restore the self-regulation imbalances that exist in the body, having previously identified its needs” (Mendieta, 2016). You can also access another summary of the meta-analysis done by in which it is stated that person-centered therapies, including gestalt therapy, are highly effective. Providing evidence to support such a statement is another matter.
What conclusions can we draw from the studies and bibliography?
So far and taking into account the available evidence, gestalt therapy has not been proven to be effective for any problem, disorder or psychological condition for several reasons:
- The studies present important limitations in their methodological quality: low sample sizes (in some cases even unknown), poor or no randomization processes and use of control groups, and little or no specificity in the therapeutic methods used.
- Inability to assess the work methodology used. It is very complicated since the available articles sometimes include global humanistic approaches, and other times a specific gestalt technique, there being a tremendous variation in the gestalt technique or methodology applied: expressive and supportive group therapy, brief group therapy, dialogue with the person, group activities, person-centered group work, etc.
- Absence of a unified and solid theoretical basis in the gestalt therapy model. Its therapeutic model lacks real clinical validity, a lack of rigor and coordination in the application of its therapeutic methods.
Why isn’t there better evidence on gestalt therapy?
There are authors who argue that Gestalt therapy arose from the need to address aspects such as altered states of consciousness and humanistic and experiential aspects that behave in ways that are not very controllable and predictable. For them, their work cannot be covered by current scientific methodology: “they work with experiences and states of consciousness in which a fixed work model at a therapeutic level is not useful” (Naranjo, 1990). Assuming this is dangerous because it leaves too much room for interpretation, ambiguity, bias, and improvisation by the therapist. It is common to observe this way of thinking, especially in therapists from humanistic branches who tend to make a collage what they call integrative therapy, assuming that it enriches without understanding that many aspects that they try to unite are incompatible or incoherent with each other.
It lacks real clinical validity, a lack of rigor and coordination in the application of its therapeutic methods.
Some Gestalt authors defend themselves by saying that the evidence-based psychology model applies criteria influenced by the CBT model to evaluate the effectiveness of a psychological technique. This is not the case, it is simply the orientation that has been most concerned about carrying out studies. They also argue that “such an approach imposes an oversimplification of the gestalt system, and that although it can provide valuable information, it cannot validate or invalidate the effectiveness of a gestalt therapeutic practice” (Yontef and Jacobs, 2008). This could be so, if it were not for the fact that the criteria of (1998), those recommended by the APA to designate the level of evidence, are quite lax. Even so, they do not even reach the minimum.
Reflections:
Gestalt therapy does not have any type of evidence for any psychological problem or disorder. The studies carried out are scarce and their methodological quality is poor. The difficulty in studying the benefits of an intervention due to its lack of specificity, systematicity, absence of intervention protocols and mixture of theoretical concepts and clinical interventions make it very difficult to know what works and what does not.
We could affirm without a doubt that gestalt therapy is a form of pseudotherapy for several reasons:
- It presents a non-specific, incoherent and ambiguous theoretical model. Based on theories of human behavior that have not been demonstrated or directly rejected by the scientific community (such as , , ). It mixes theoretical assumptions of psychoanalysis (Ferenczi, W. Reich, K. Horney) with psychodrama and Eastern philosophical approaches (such as Taoism or Zen Buddhism), existential phenomenological, . However, in its social presentation it is shown as a scientific therapy, defender of a paradigm at the “avant-garde” of science. Here all kinds of concepts and apparently scientific terminology are appropriated, such as those related to (not gestalt therapy, it is not the same), evolutionism, Kurt Lewin and of course , among others. The result is a hodgepodge of ideas that try to make them sound scientific, but that the model fails to integrate (and it tries) in a coherent or consistent way and that confuse the user. The gestalt is so open to interpretation, so…