8 Psychotherapy8.6 Other therapeutic and skills-based approaches
8.6 Other therapeutic approaches
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Written by Resident Doctor Committee · Published
Gestalt therapy
Core ideas
Fritz and Laura Perls and Paul Goodman developed Gestalt therapy from the 1940s. It works with present experience: feelings, bodily sensations and contact with others.
Figure and ground describe how a need becomes the focus of attention and then recedes once it is met.
Unfinished business is an unresolved experience, such as unexpressed grief or anger, that keeps returning to awareness.
Contact boundary disturbances
Disturbance | What happens |
|---|---|
Introjection | Another person's values are swallowed whole, untested against one's own experience |
Projection | One's own feeling is attributed to someone else |
Retroflection | An outward feeling turns back on oneself, as unexpressed anger becomes self-directed |
Confluence | Self and other merge, so a separate need cannot register |
Techniques
The empty chair technique is the hallmark of Gestalt therapy: a here-and-now experiment in which the patient voices unresolved feelings towards an imagined person, then takes that person's seat.
Two-chair work uses the same method for an internal conflict or disowned feeling, with the patient swapping chairs to speak for each side.
The therapist describes observed posture, tone or movement and asks "what" and "how" questions rather than offering interpretations.
Use and safety
Patients are chosen for suitability for experiential work, not by diagnosis, such as those with unresolved loss or recurring internal conflict.
Chair experiments intensify emotion, so they need an alliance, consent and pacing; acute illness, dissociation or recent trauma may need stabilisation first.
The trial base is limited, and chair work also features in emotion-focused therapy.
Person centred therapy
Origins and model
Carl Rogers developed client-centred therapy, later renamed person-centred therapy, as a non-directive therapy.
Rogers is told apart from Maslow, whose contribution was a theory of motivation.
The actualising tendency is a drive towards growth that an accepting relationship lets work.
Incongruence is the gap between experience and the self-concept, produced when acceptance depends on meeting others' expectations (conditions of worth).
The core conditions
Rogers' three core therapist conditions are the active ingredient of change specific to person-centred therapy.
Condition | Meaning | Not the same as |
|---|---|---|
Congruence | The therapist is genuine and integrated | Hiding behind a professional facade |
Unconditional positive regard | Accepting the person with no conditions attached | Approving of what they do |
Empathic (accurate) understanding | Sensing the client's internal frame of reference "as if" it were your own | Sympathy, which is feeling for the person |
In 1957 Rogers called six conditions necessary and sufficient for change: these three plus psychological contact, client incongruence and the client perceiving the regard and empathy.
Uses and limits
The approach can suit bereavement, adjustment or demoralisation when someone prefers less structured work.
Non-directive does not mean passive: what the therapist reflects back still shapes the session.
Acute risk, obsessive-compulsive disorder, specific phobia, anorexia nervosa and psychosis need active treatment beyond following the client.
Transactional analysis
Origin and core constructs
Eric Berne developed transactional analysis in the late 1950s, in Transactional Analysis in Psychotherapy (1961) and Games People Play (1964).
Its core constructs are ego states, transactions and games.
Ego states
Ego states are patterns of thinking, feeling and behaving that can shift within one conversation. They are not fixed personality types.
Ego state | What it consists of | How it shows |
|---|---|---|
Parent | Learned parental responses, critical or nurturing | An admonishing "You should have known better" |
Adult | Appraisal of current reality | Checking facts and weighing options |
Child | Responses rooted in childhood, free or adapted | Delight, sulking, appeasement or defiance |
Unlike Freud's agencies, all three ego states are observable in the room and in contact with reality.
Transactions
A transaction is an interpersonal stimulus and response, read through the ego states involved.
Type | What happens |
|---|---|
Complementary | The state addressed replies to the sender's state |
Crossed | The reply comes from a different state and derails the exchange |
Ulterior | An overt message carries a covert one |
Games, strokes and scripts
A game is a recurring sequence that carries a concealed psychological message and ends in a familiar feeling, such as "why don't you, yes but".
A stroke is a unit of recognition.
Karpman's drama triangle (1968) describes shifts between Persecutor, Rescuer and Victim.
A script is an early life plan built from parental messages and the child's own conclusions.
Evidence
The research base is small, and much of it is uncontrolled.