LauraEWagnerMooreDepartmentofPsychologyUniversityofMassachusettsatBostonThisarticlerepresentsamodifiedpaperwrittenforagraduateschoolrequirementattheUniversityofMassachusettsatBostonAssistancew ID: 505643
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GESTALTTHERAPY:PAST,PRESENT,THEORY,ANDRESEARCHLAURAE.WAGNER-MOOREUniversityofMassachusettsatBostonOrthodoxgestalttherapysufferedaratherunfortunatefate;gestalttheoryhasbeenpoorlyarticulated,andgestalttechniqueshavereceivedminimalempiricalvalidation.Theseweaknessesare,inpart,aconsequenceofF.Perlssbiographicalhistory,whichledtoanintegrationofdisparatetheoreticalmodelsthatwereexacerbatedbyF.Perlsshaphazard,idiosyncraticpersonalstyle.However,recentempiricalresearchsuggeststhatthe2-chairtechniqueissuperiortoothertherapeuticinterventionsforconflictsplits,decisionalconflict,maritalconflict,andunfinishedbusinessandthatthe2-chairtechniqueisaseffectiveasRogerianandcognitivebehavioraltherapies.AlthoughF.Perlsstechniquesmayhavebeengeneratedlargelyfromhisidiosyncraticpersonalitycharacteristics,thesetechniqueshavesomevalidityforveryspecificpsychologicaldilemmas.ClassicalGestaltTheoryandPerlssEccentricitiesFritzPerlshasbeensimultaneouslypraisedforhiscreativeexuberanceandcriticizedforaspectsofhisstylethatsimplydefythetermcallyderived.ThePerlsianformofgestalttherapyprimarilyembodiesthehistoryandper-sonalityofPerlshimself,ratherthanascientific,structured,empiricallyderivedortheoreticallyconsistentmodelofpsychotherapy.Gestalttheoryisanintellectuallyfascinating,philosoph-icallycomplexsetofdiversebutpoorlyarticu-latedandpoorlysubstantiatedbeliefs.Conversely,itisinterestingthattheactualtechniquesusedbygestalttherapistshavebeenclearlydelineatedandhavereceivedsomeem-piricalvalidationfortheireffectiveness.Thisdis-junctionbetweentheoryandresearchmakesthestudyofgestalttheoryandtechniquedecidedlyByzantineandperplexing.Thisreviewandcri-tiquepresentsthemostcoherentaspectsofgestalttherapythatarebasedonprinciplesofGestaltpsychologyandprovidesareviewofrecentem-piricalworkongestalttechniques.HistoricalcontextdictatedanomadiclifeforPerls,withmovesfromBerlin(wherehewasheavilyinfluencedbypsychoanalysis)toJohan-nesburgin1933,toNewYorkin1946,andlatertoCalifornia.Geographiclocationseemed,inpart,toinfluencePerlssconceptsandpracticeofpsychotherapy,onthebasisofhisteacherdujour.Asaresult,Perlssapproachtogestalttheoryandtherapywas,atbest,eclectic.Hebor-rowedsomeideasfromhisanalysts,likeReichandHorney(Miller,1974).AsMiller(1974)noted,PerlsintegratedHorneysnotionthatneu-roticbehaviorisbasedonmanipulation,designedtowinlove(p.5-24)andwasattractedtoSar-treanexistentialismsideaofindividualrespon-sibilityandchoice(Miller,1974).InthewakeofthezeitgeistofWorldWarII,whichwassoheav-ilypermeatedbyphenomenologicalandexisten- LauraE.Wagner-Moore,DepartmentofPsychology,Uni-versityofMassachusettsatBoston.Thisarticlerepresentsamodifiedpaperwrittenforagradu-ateschoolrequirementattheUniversityofMassachusettsatBoston.AssistancewasprovidedbyJoanLiem,EsterSha-piro,andDonKalick,UniversityofMassachusettsatBoston.CorrespondenceregardingthisarticleshouldbeaddressedtoLauraE.Wagner-Moore,PhD,whoisnowattheCenterforChildandFamilyHealth,DukeUniversityMedicalCenter,3518WestgateDrive,Suite100,Durham,NC27707.E-mail:Psychotherapy:Theory,Research,Practice,TrainingCopyright2004bytheEducationalPublishingFoundation2004,Vol.41,No.2,1801890033-3204/04/$12.00DOI10.1037/0033-3204.41.2.180 tialthought,Perlsrejectedmuchofhisanalytictraininginfavorofthenewzeitgeist(Yontef&Simkin,1989).FromJanSmuts,theprimemin-isterofSouthAfrica,Perlsborrowedtheideaofholism.Ironically,heinitiallyhadminimalexpo-suretoorunderstandingofGestaltpsychologyitselfandhasbeencriticizedforthisonseveralaccounts(Wheeler,1991).Wheeler(1991)notedthatPerlssearlywork,titledEgo,HungerandwassimplyrevisedandrenamedBeginningsofGestaltTherapy(renamedathisssuggestion)withlittledescriptionofwhatPerlsmeantbyGestaltpsychologyortherapy.PerlshimselfcalledthebookWheelerconvincinglyarguedthatPerlssoriginaltextisfullofvaguephilosophicalmusingsandself-aggrandizementintheFreudianmanner(Wheeler,1991,p.43).Thefateofclassicalgestalttherapyisasadone,whichfindsitselfwithoutaclearsetofbind-ingtheoreticalprinciplesandwithoutaprolificbodyofliteraturededicatedtothecriticalanaly-sisanddialoguethatcouldfurtheritsdevelop-ment.Miller,apracticinggestalttherapistandstudentofPerls,arguedthatgestalthasintoamiddle-ageddeclineandisplaguedbyapersistentintellectualthinness(Miller,1974,p.21).Perlssstrikinganti-intellectualbias(Miller,1974)hasbeentransmittedovertime.HisfamousLoseyourmindandcometoyourbestembodieshispreferenceforacquir-ingknowledgethroughexperiencingandfeelingratherthanthroughempiricallyvalidatedorra-tional,logicalthoughtprocesses.Perlsssimilarpreferencefortheidiographicoverthenomothet-icmakesthesystematicstudyofgestaltquitechallenging.Despitethesedifficulties,neo-gestaltistshavesuccessfullydescribedPerlsiannotionsofgestalttherapylinkedtoclassicalge-staltpsychologicaltheory.Thetwoconceptsex-plainedmostcompletelyinvolve(a)figurebackgroundgestaltformationanddestructionand(b)thecontact/experiencecycle,astheyrelatedtotheetiologyofpsychopathologyingestaltBackgroundGestaltFormationPerls,inkeepingwithotherhumanisticap-proaches,believedintheself-actualizingpoten-tialoftheindividual,whichassumesthatanor-ganismultimatelyknowswhatisbestforitsself-regulationandactualization(Greenberg&Rice,1997).Thisprocessisbestencapsulatedinthenotionoffigurebackgroundgestaltformationanddestruction.Gestaltpsychologysuggeststhatamassofunstructuredindividualdataintheen-vironment(i.e.,)aresubjectivelystructuredbytheperceiverintothathavebothformandstructure(Perls,Hefferline,&Goodman,1951).Thepersonsactualexperienceisdeter-minedbythegestalt,ratherthantherawpiecesofdata.Thewayinwhichmultipledataareshapedisbasedontheindividualsneeds,appetites,andTheseconceptscanbeappliedtotherealmofpsychologicalneedsaswell.Intheory,aneedarisesandbecomesforeground;ifitissatisfied,itbecomesbackgroundasthegestaltiscompleted.Pathologyariseswhenthisprocessisdisrupted.Whengestaltformationisblockedorrigidifiedatanystage,whenneedsarenotrecog-nizedorexpressed,theflexibleharmonyandflowoftheorganism/environmentfieldisdisturbed[and]unmetneedsformincompletegestaltenthatclamorforattention...andinterferewiththeformationofnewgestalten.(Yontef,1969,ascitedinSimkin,1976,pp.223Aneedmaybeblockedbyanunclearsensationoralackofawarenessofonesneeds(Greenberg&Rice,1997).Therapeuticworkfocusesonin-creasingawarenesstobringaboutchange,sothattheemergingneedmaybeidentified,satisfied,andenabledtoretreatintothebackground(Simkin,1976).Awarenessofonesexperienceandneedsisconsideredtheroyalroadtothe(Greenberg&Rice,1997).Experience/ContactCycleTheprocessesunderlyinggestaltformationanddestructionwereobtuselydescribedbyPerlsastheexperience/contact,ormetabolism,cycle.Thecycleconsistsoffourmainphases,includingawareness,excitement,action,andgestalttheory,thetermdoesnotequatewiththepopulardefinitionmeaningGestalttheoryusesthewordasanab-stract,formalconceptthatreferstotheexchangebetweenanindividualpersonandthesurround-ingenvironment(Miller,1994).Iftheboundarybetweentheselfandtheenvironment(orother)becomesunclearorlost,thenthereisadistur-banceofcontactandawareness(Yontef&Simkin,1989).Whenthecycleisfunctioningsmoothly,awarenessofinternalorexternalstimulileadstoexcitement,whichpotentiatesanGestaltTherapy actiontendency;theactiontendencyleadstoneedsatisfaction(optimally)andcontact(Green-berg&Rice,1997).Dysfunctionisconsideredtheinterruptionofthecycleatanystage(Green-berg&Rice,1997),andresistancestocontactaccountforthesedisruptions.Perlsretainedthetraditionalpsychoanalyticnotionofdefensestoexplainadditionaldisrup-tionsinthecontactcycleincludingretroflection,introjection,projection,anddeflection.Forin-stance,abreakinthecyclebetweenexcitementenergyandactioncouldbeaccountedforbyret-roflection,whichoccurswhenasplitwithintheselfandresistanceofaspectsoftheselftakeplace,whereintheselfeither(a)doestooneselfwhatonewantstodotosomeoneelseor(b)doesfortheselfwhatonewantssomeoneelsetodofortheself(e.g.,beingoverlyself-sufficient,re-sultinginisolation).Inbothcases,theselfhasaneedwithenergy,buttheenergyisdivertedawayfromitsnaturalobjectandturnedbackagainstitself(Wheeler,1991).Increasingawarenessisaprimarypsychotherapeutictoolbecausethecyclecanbeinterruptedatthefirststageifaneedisblockedbydullsensationorpoorawareness(Greenberg&Rice,1997).Implicitinthemodel,however,istheassump-tionthatalldisturbancesinthecyclecanbeul-timatelytracedbacktoaproblemwithawarenessitself(Wheeler,1991;Yontef&Simkin,1989).Itfollows,then,thatgestaltpsychotherapyuseshere-and-now(present-centered)experimentsindirectedawarenesstoincreasetheindividualawarenessaswellastheindividualsawarenessoftheprocessofawareness(Yontef&Simkin,1989).Contrarytotraditionalpsychoanalyticmethodsofexcavatingthepast,gestalttherapyfocusesonawarenessandcontactinthepresentmoment,usingmethodsthatultimatelyservetoclarifypresentexperiencing.sexperience-cyclemodelhasbeencriti-cizedbyphilosophersofGestaltpsychologyforitsinsistenceonfocusingonindividualimpulsesordesiresinisolation;significantcontextualis-suesareeitherminimizedorignored.Thisisaprimeexampleofhowgestalttheoryoftenem-bodiesaparticularpenchantofPerlsspersonal-itystructureratherthanapredictableconceptdrivenbytheoreticalconstructs.Thecycle,criticizedbyGoldstein(ascitedinWheeler,1991),hasbeenlabeledThissuggeststhatthemodelrestslargelyontheimmediateneedorimpulsethathasbecomefig-ure,againstabackground,ratherthanfocusingontheentirefield.Second,themodeliscriticizedforassumingcycledisturbancescanalwaysbetracedbacktoaprobleminawarenessitself.Themodelsuggeststhatifanindividualhasaware-nessofagoalandattemptstoactonthatimpulsebutultimatelyfailsinthataction,thefailureisduetomisunderstandingtheneedornotempow-eringtheneedfromtheverybeginning.Wheeler(1991)hasnotedthatfailingtomeetagoalmaynotsolelybeattributedtoaproblemwithaware-ness;instead,theindividualmayhavemisper-ceivedtheoriginalproblemortheindividualmayhavehadclearawarenessbutdifficultyfollowingthroughwithactionsthatwouldleadtoasuccess-fuloutcome.Forinstance,survivorsofposttraumaticstressmayhavedevelopedarelativelyclearawarenessofindividualneedsanddesireswhilesimulta-neouslyhavingcognitivedistortionsorinaccu-rate(oraccurate)perceptionsofenvironmentalthreatthatimpederecovery;inotherwords,con-textualfactorsarequiterelevantindecreasingpersonaldistress.Perlssconceptualizationmakestheindividualundulyresponsibleformeetinghisorherownneedsandsimultaneouslyfailstoaccountforpeculiaritiesintheenviron-mentthatcounteractorconflictwiththeindividu-sneed.squirkybeliefs,pepperedthroughoutge-stalttheory,mayhelpuncoverthemysterybe-hindseveralsignificantsourcesofweaknessandincongruenceinthematchbetweengestalttheoryandtherapeuticpractice.Therearemultipledan-gersinherentinconsideringindividualimpulsesandneedsofprimaryimportance.MillerarguedthatPerlsaggressiveself-expressionbordersonwhatSartrecharacterizedasthatdiligentandalmostsadisticviolenceIcallthefullemploy-mentofoneself(Miller,1974,p.19).Oneofsgreatstrengths,however,washisfocusonindividualpotential,althoughhefailedtorealizehowdestructivethispositioncouldbeinrela-tionalcontexts.Perlsbelievedthatfreeingoneselffromcom-mitmentanddependenceonotherswasessential(Perls,1968).Perlsembodiedthisidealwhen,afterbecomingestablishedinNewYork,helefthiswifeandchildrenanddriftedwestwardtopursuehisowngoals(Miller,1974).Impulsesanddrivesthatarenotmoderatedbyreason,re-straint,andconsiderationofthecanendupinfrenzied,relativelyautistic,andchaoticre- lationshipsthatlackreciprocityandempathy.sfocusonseparatenessandself-reliancearereflectedinthefirstfewlinesofhismantraGestaltTherapyVerbatimIdomything,andyoudoyourthing.Iamnotinthisworldtoliveuptoyourexpectations.Andyouarenotinthisworldtoliveuptomine.YouareyouandIamI,andifbychancewefindeachotheritisbeautiful.Ifnot,itcantbehelped.(Perls,1968,p.4)Unfortunately,althoughclassicalgestalttherapyismorethancapableofpromotingself-relianceandthedrivetowardindividuation,itfailstoac-knowledgethebenefitsinherentinrelationalandintersubjectiveapproachestopsychotherapy.Thesimilaritiesbetweenthegreatestweaknessinge-stalttheoryandPerlssownstylearestrikingandprovideawayofunderstandingthepeculiaritiesofgestalttheory.TheFateofClassicalGestaltTherapyandtheRiseofModernGestaltTherapyAlmost30yearshavepassedsincePerlsdeath,andgestalttherapyhascertainlychanged,movingfromtheoriginalPerlsianemphasisonskillfulfrustrationandself-reliancetoagentler,versionofgestalttherapy.The1960sversionofgestaltincludedpsychodramatechniquesthatcontainedaphilosophythatem-bodiedexistentialprinciplesoffreedomandre-sponsibility,analyticnotionsofdefenses,andge-staltpsychologicalprincipalsofgestaltformationanddestruction.ModerngestalthasretainedmanyofPerlssoriginalideasbuthasalsosoft-enedinmanyrespects.AsPerlsspracticeofgestalttherapypro-gressed,hewrotelessabouttheory;hisseminalGestaltTherapy:ExcitementandGrowthintheHumanPersonality(Perls,Hefferline,&Goodman,1951),wasconsideredoneoftheonlycomprehensivetextswrittenaboutgestalttheory.Thiswork,however,isaratherarcaneandun-successfulattempttoilluminategestaltprin-ciples.JerryKogan,awell-respectedandadmir-ingstudentofPerlssaidthathebeganreadingGestaltTherapythoughtitwasterrible,althoughhefoundPerlshimselfamodelofabrilliantteacherandtherapist(Kogan,1976,p.255).Perlsrarelyreferredtothistextafteritsoriginalprintingandinsteadpreferredtoprinttranscriptsofhiswork(therapyseminars)ratherthanexpositionsexplainingit(Perls,1968).Assfocusontheorydiminished,hisnarcissis-ticstyleledtogimmickytechniquesthatflour-ished.Hewasknowntosprinklehisaudiencesandtraineeswithslogansashemadeupnewonthefly,whichhepresentedasthelatestessenceofGestalttherapy1994).Theory-driven,empiricallyvalidatedtech-niquewasprogressivelyabandonedandsubse-quentlyreplacedbythemethodsgeneratedbysowndramatic,off-the-cuffflare.Modern-daygestalttherapyhasretainedsappliedphenomenologicalapproachandcreativetechniques.ContrarytoPerlssstyle,moderngestaltistsconsidertherelationshipbe-tweenthetherapistandclientoneofthemostimportantaspectsofpsychotherapyanduselessstereotypictechniques(Yontef&Simkin,1989).Yontefarguedthattraditionalgestalttechniquesstressingskillfulfrustration,clientmanipulation,andself-sufficiencyservedtoprovokeshamefulreactionsinpatients(Yontef&Simkin,1989).Yontefandothersarguedthatmoderngestalttherapyislessharsh(Aleksandrov,1997;Yontef&Simkin,1989)andhasturneditsfocustothegenuinecontactbetweenpatientandtherapist(Greenberg&Rice,1997;Yontef&Simkin,1989).Althoughthereareover60gestalttherapyinstitutesthroughouttheworld,nonationalorga-nizationorstandardshavebeenestablishedascriteriaforempiricallyvalidatedgestaltModerngestalthaschangedinseveralrespectsbutstillembodiesthemajorityofPerlssoriginalideasandtherapeutictechniques.DespitePerlslackofrigorousintellectualexplanationofgestalttheory,hisuniqueandcreativestylehasgivenmoderngestalttherapyseveralfascinatingandeffectivetherapeutictechniques.EventhoughPerlsattemptedtoconnectthepuzzlebetweengestalttheoryandhisowntechnique,empiricalvalidationofPerlsstechniquesremainedlargelyunsupporteduntilrecently.GestaltPsychotherapyTechniquesDespitethelooseconnectionbetweengestalttheoryandpractice,thetechniquesofgestalttherapyandPerlssapplicationofthemarecre-ativeandartisticandembodyanunusualcharis-maticandauthenticapproachtotreatment.Re-centresearchbyLeslieGreenbergonthetwo-chairdialogueandtheempty-chairdialogueforconflictsplitsandunfinishedbusinesshashelpedexplainthetwo-chairmethodandhasbroughtaGestaltTherapy newunderstandingtotheeffectivenessofPerlsGestalttherapistsoftencreateexperimentsthathelpclientsincreaseawarenessbyuncoveringas-pectsoftheirexperience;thesetherapistsmaysharehunchesaboutwhatisoccurringormayteachclientswaysinwhichtheyareinterruptingoravoidingtheirownexperience(Greenberg&Rice,1997).Acorebeliefisthatclientswillmorefullyunderstandtheirownemotionsandneedsthroughaprocessofdiscovery,ratherthanthroughinsightorinterpretation.Inmanyin-stances,theclientmaydiscoveraconflictbe-tweenaspectsofexperienceorconflictswithintheself(Greenberg&Rice,1997).Theconfron-tationbetweentheseconflictingaspectsofexpe-riencecanbefacilitatedbytechniquessuchasthetwo-chairorempty-chairdialogue.Two-ChairDialogue:TheoryandEmpiricalResearchThetwo-chairtechniqueisoneofthemostpowerfulandwidelyusedofthegestalttech-niques.Orthodoxgestalttherapistsmayfeelfrus-tratedwithtraditionalgestalttherapybeingbro-kendownintoparts(e.g.,usinggestalttechniqueswithoutbeingguidedbygestalttheory).Yet,oneofthegreatestadvancesinboththeoryandre-searchforgestalttherapyhascomefromtheworkofLeslieGreenbergandcolleagues.Theirsystematicpresentationoftheeffectivenessoftwo-chairworkandtheirrigorousempiricalanalysesoftwo-chairworkhassignificantlyen-hancedtheconfidenceinandapplicabilityofge-stalttherapy.sunfortunatefateofreceivingminimaltheoreticalandempiricalvalidationhasbegunacriticalchange.Greenbergandcolleagueshavebothmodifiedandclarifiedthearcaneorthodoxgestaltideasintheirprocess-experientialap-whichcombinesRogerianhumanismwithPerlsiantechniques.Greenbergsmarriageofthetwoorientationshasresultedinthebirthofawell-definedandwell-researchedintegratedtherapeuticorientation.Two-ChairWorkforConflictSplitssformalanalysesofgestaltthera-pistssuggestthattwo-chairworkismostoftenusedwhentheclientexpressesa(Clarke&Greenberg,1988;Elliott&Greenberg,1995).Asplitisadivisionoftheselfprocessintopartialaspectsoftheself(Clarke&Greenberg,1988,p.5-19).Greenberghasidentifiedthreetypesofsplits:conflictsplit,subjectobjectsplit,andat-tributionsplits(Greenberg,Elliot,&Lietaer,1994).Anexampleofaconflictsplitoccurswhenanindividualwishesforadesiredgoal,suchastobemarried,butsimultaneouslyfeelsthatheorsheshouldremainsingletopreservehisorherindependence(Greenberg,Rice,&Elliott,1993).Inthissplit,therearetwothatopposeeachother,resultinginasenseofstruggle.Greenberghasfoundthatthistypeofsplitusuallyinvolvesaconflictbetweenanindividualsprinciplesandfundamentalemotionalneedsandwants(Green-bergetal.,1993).Duringtwo-chairwork,thepartoftheselfthatprimarilyembodiesneeds,wants,andgut-levelemotionsiscalledtheperiencingself;thepartoftheselfthatembod-ieseitherIshouldbeabletobe),negativeevaluationsoftheself(e.g.,mjustworthless),orsocietalstandardsorval-uesiscalledtheinternalcritic(Clarke&Green-berg,1988).Thegoalfortwo-chairworkistobringtheexperiencingselfandtheinternalcriticintocontactwitheachother,fortheclienttoat-tendtobothsides,forcovertinternaldialoguetobemadeovert,andforchangetoresultastheclientincreasesself-acceptanceanddevelopsnewcognitiveschemas(Greenbergetal.,1993,p.191).Althoughthetwo-chairtechniquecanlookrelativelysimplewhenappliedbyanexpert,thetaskactuallyrequiresextensiveskill,includingdetailedknowledgeofpotentialtechniques,sen-sitivitytononverbalcues,andtheabilitytodealandtotrackprocess(Faganetal.,1974).Thistechniquerequiresthatthethera-pistandclientmakeanagreementtoworkonasplit(Faganetal.,1974)andthattheclientde-velopsbothsidesoftheconflictthroughdialogue(Greenbergetal.,1993).Greenbergnotedthatmanyclientsbeginwiththeharsh,self-critical,partofthemselves(Greenbergetal.,1993).Then,thetwo-chairsareusedtofurtherdistinguishandseparateouttheconflictingas-pectsoftheself(Greenbergetal.,1993).Researchhasshownthetwochairscanbede-scribedastheexperiencingchairandtheandthatthemetaphoricalindividualspres-entinthetwochairsundergodifferenttransfor-mationsduringtherapy.Duringthework,theex-periencingchairdeepensindepthofexperiencingandinnerexplorationandusesanexpressive voice(Clarke&Greenberg,1988),whiletheotherchairisfilledwiththepersonnegativeselfstatementsandattributionsusesanexternalizingandlecturingvoice(Clarke&Greenberg,1988).Aprimarygoalforthetherapistduringtwo-chairworkistohelptheclientkeepthepartialaspectsoftheselfseparated,whichcanaidinconflictresolutionandintegration(Clarke&Greenberg,1988).Thetherapistsdirectioncanimprovetheclientsattentiontoinnerprocessesandmayhelpraisetheclientsawarenessofwhatheorsheisexperiencinginthemoment.Forexample,thetherapistmayasktheclienttofocusonaparticularnonverbalbehaviorthatisinter-ruptingtheexperienceormayasktheclienttoexaggeratestatementsorvoiceinflectiontoin-tensifyaffectiveexperiencing(Daldrup,Beutler,Engle,&Greenberg,1988).Insummary,theprinciplesthatguidethetherapistsworkinclude(a)clearlyseparatingoutpartialaspectsofthesself,(b)encouragingclientattentiontoandheighteningofemotionalexperiencingandexpression,and(c)assessingthetwo-chairworkandcognitiveandemotionalchangeswiththeclient(Daldrupetal.,1988).Faganetal.(1974)cautionedunskilled,un-trainedtherapistsabouttheuseofthistechnique.Neitherthetherapistnortheclientknowswhatmayunfoldduringthework,anditoftenincludestheexpressionofdeeplyfelt,painfulemotions(Faganetal.,1974).Faganetal.(1974)wiselysuggestedthattherapistsshould(a)notusethetechniqueunlesstheyhavehadpersonalexperi-encewiththetechnique,(b)bereadyforsionsorstrongemotionalresponses,and(c)knowtheirpatientswellenoughtoknowhowtoprovidefollow-upsupport;notresolvinganin-tenseconflictcanbedamagingforfragilepa-tients.Thesecautionsarerarelycitedinthecur-rentliteraturebutareabsolutelyessentialpointsthatneedtobemade.Asatraumatherapist,Icautiontheuseofthesetechniqueswithtraumasurvivorswhocanhaveprimitive,visceralemotionaleruptionsthatcanleadtoregression,retraumatization,ordissocia-tiveepisodes.Itisnotalwaystheinitialaccessingofrepressedemotionthatisdangerousbutratherthetherapistsencouragementtoheightenandin-tensifythefeltemotionandtheexpressionofthatemotionthatmayleadtovolatilesituations.Theuseofclinicaljudgment,preparationofthepa-tient,titrationofpatientexposuretointenseaf-fectivestates,andtheconstantuseofcautionandduecareintheapplicationofthesetechniquescannotbeemphasizedenough.Thisworkcallsforexceptionalfortitudeonthepartofthethera-pistandmaycontributetosecondarytraumatiza-tion,confusingcountertransferentialresponses,andunexpectedtransferencedynamicsforneophytetherapistsortherapistswhohavepoorpsychologicalboundaries.Inad-dition,gestalttechniquesmaybecontraindicatedforpatientswithorganicconditions,severecog-nitivedisorders(inwhichlooseningemotionalexpressionresultsinchaoticratherthanstruc-turedthoughtprocesses),impulsecontroldifficulty,severepersonalitydisorders,socio-paths,andpsychoticpatients(Saltzman,1989)orforthosewhoneedcrisisintervention(Elliott&Greenberg,1995).Thetechniquesobviouslyhavelimitedapplicabilityandarevulnerabletoiatrogenicharmifnotusedcarefully.Despitethedangersinvolvedinusingthesetechniques,recentempiricalworksuggeststhattheyprovetobequiteusefulinfacilitatingdeeperemotionalexperiencesandinreducingvariousTwo-ChairDialogue:EmpiricalFindingsThetwo-chairtechniquehasbeencomparedwithseveralothertherapeuticorientationsandhasreceivedsomeempiricalvalidationforthereductionofconflictsplits,indecision,maritalconflict,andinterpersonaldifficulty.Analogueandexperimentalstudiesconductedthusfarhavecomparedtwo-chairworkwithclient-centered,behavioral(e.g.,problemsolving),andexperiential(e.g.,focusing)methods.Thesestud-iesdidnotcomparetheeffectivenessofthege-staltapproachversusanotherapproachbutin-steadinvestigatedthespecificefficacyofthetwo-chairapproachversusothermethodsforaspecificproblem(e.g.,conflictsplitordecisionalconflict).(Foranoverallcomparisonofgestalttherapytootherorientations,seeGreenbergetal.,1994,whichprovidesameta-analyticreviewof37studies.)Inthe1980s,Greenbergcomparedtwo-chairdialoguewithclient-centeredempathicrespond-ingforresolvingaconflictsplitincollegestu-dents(16;Clarke&Greenberg,1988;Greenberg&Rice,1981).Empathicreflectionswereusedasacomparisonbecausetheorysug-geststhatempathicresponsesalsoincreaseclientGestaltTherapy experiencing(Clarke&Greenberg,1988).sanaloguestudyshowedthetwo-chairtechniqueledtogreaterdepthofexperienc-ingandgreaterchangeofawarenessthantheem-pathictechniques(Greenbergetal.,1994).Thesestudieswerenotwellcontrolledandweredonewithcollegestudentswithrelativelybenignprob-lems;theresultshavelimitedexternalvalidityandmaynotgeneralizetoseverelydisturbedpsy-chiatricpopulations.TheresultsofthisstudywerereplicatedandexpandedbyGreenbergandDompierre(1981,ascitedinGreenbergetal.,1994;16,subjectsusedasowncontrols).Thisstudyusedanoutpa-tientpopulationandimplementedtwoexperi-mentaltreatmentsessionsincludingeithertwo-chairorempathicresponding(eachpatientre-ceivedeitherempathicrespondingorgestaltfirstandthenreceivedthecomplementarytechniquesecond).Participantsinthetwo-chairtreatmentconditionreportedgreaterdepthofexperiencingandmoreshiftsinawareness;two-chairpartici-pantsalsoreportedgreaterconflictresolutionim-mediatelyafterthetreatmentandatthe1-weekfollow-up(Greenbergetal.,1994).Intermsofbehavioralchange,thegestaltgroupreportedgreaterchangeandgoalattainmentthanthecom-parisongroup;participantsreportednodifferenceindiscomfortinthetwogroups(Clarke&Green-berg,1988).Thereplicationofpreviousfindingstoanoutpatientpopulationslightlyimprovestheexternalvalidityoftheresults.However,there-sultsofthelatterstudyaresuspectbecausetheparticipantswerereceivingadditionaltreatments(atleasteightpriorsessions)thatwerenotpartoftheexperimentaldesign.Thereisnowaytoknowifthesubjectsinthegestalttreatmentgroupweresignificantlydifferentfromtheothertreatmentgroupfromthebeginning;theuseofstatisticalcovariates(e.g.,pretest)werenotusedtoresolvethisuncertainty.Atleastthreestudiesconsistentlyfoundthatthetwo-chairtechniquewassuperiortoempathicrespondingforincreasingdepthofexperienceandshiftsinawareness(Greenberg&Clarke,1979;Greenberg&Rice,1981;andGreenberg&Dompierre,1981,allascitedinClarke&Green-berg,1988).Greenbergandhiscolleaguesbegantohypothesizethatthemoreactivecomponentofthegestaltworkwaslargelyresponsibleforthegroupdifferences.GreenbergandHiggins(1980,ascitedinClarke&Greenberg,1988)decidedtocomparethetwo-chairtechniquewithrespondingplusfocusingtechniques.GreenbergandClarkealsoreasonedthattheuseofanotherdirective,engagingtechniquewouldservetocon-troltherapistsexpectancyeffects(Clarke&Greenberg,1988).Whenthetwo-chairmethodwascomparedwithfocusingplusempathy,re-sultsshowedthatthetwo-chairtechnique,ap-pliedtoasplit,producedsignificantlygreaterdepthofexperiencingthanfocusingplusempa-thy(Clarke&Greenberg,1988).Thetwo-chairandtheempathyplusfocusingresultedingreatersymptomreductionandshiftsinawarenessintheexperimentalsubjectsversustheno-treatmentcontrols(Clarke&Greenberg,1988).Theseearlystudies,comparinggestalttoempathicmodali-ties,arelargelyanalogue,haverelativelysmallsamplesizes,andaremostappropriatelyconsid-eredinitialpilotstudiesinthefield,giventhattheyhavemethodologicalflaws.Subsequentexperimentalresearchhascon-trastedthetwo-chairapproachwithcognitivebehavioralmodalities(Clarke&Greenberg,1986;Johnson&Greenberg,1985).Theresultsofthesetwowell-controlled,methodologicallyimprovedstudiesindicatethatthetwo-chairtech-niqueisusefulforreducingindecisionandim-provesintimacyandmaritaladjustmentwhilere-ducingsymptomatology.Boththetwo-chairandbehavioralmethodsappeartobesupe-riortowait-listcontrolgroupsforreducinginde-cisionandimprovingmaritalconflict(Clarke&Greenberg,1986;Johnson&Greenberg,1985).TheprimarygoalofClarkeandGreenberg(1986)studywastodeterminewhetherthegestaltmethod,whichfocusesonaffectiveexperience,wasaseffectiveascognitivebehavioralap-proaches,whichfocuslessonaffectandmoreoncognitiveprocesses.Forty-eightsubjectswerepretested,posttested,andrandomlyassignedtothreegroups:1.cognitivebehavioralproblem-solving2.two-chairdialoguegroup3.no-treatment,wait-listcontrolgroup.Thedependentmeasureswerescalesmeasur-ingdegreeofundecidedness(modifiedScaleofVocationalIndecision;Osipow,Carney,&Barak,1976,ascitedinClarke&Greenberg,1986)andascalemeasuringchangesinsubjectsdecision-makingstage(modifiedAssessmentofCareerDecisionMaking;Harren,1979,ascited inClarke&Greenberg,1986).Thetargetprob-lemforallparticipantswaskeptconstantandinvolvedanemotionallymeaningfulsonalconflictrelatedtoa[career]decision(Clarke&Greenberg,1986,p.12).Thetherapistsresponsibleforthetreatmentconditionsweretrained,doctoral-levelpsychologists;thethera-pistsweretrainedonlyinthetreatmenttheyad-ministered(theywerealsomatchedtothetreat-menttheytypicallypracticed)andfollowedcleartreatmentprotocols(Clarke&Greenberg,1986).Inaddition,blindratersreviewedaudiotapesofthesessionstocheckforfidelityoftreatmentimplementation;allratersagreedonthedeliveryofthespecifiedtreatment(Clarke&Greenberg,1986).Anadvantageofthisstudywasitsdelib-erateattempttoguardagainsttreatmentbiasesandtoensuretheeffectivenessofthetreatmentResultsofthestudyshowedthetwo-chairtechniquewasmoreeffectivethanproblemsolv-ingornotreatment,forreducingindecision(Clarke&Greenberg,1986).Thisfindingisuniqueinthatitshowsamaineffectfortreatmentonadirectmeasureofindecision,ratherthanonmeasuresthatindirectlycorrelatewithindecision(Clarke&Greenberg,1986).Similarly,there-sultsareimpressiveinthattheproblem-solvingapproachisspecificallydesignedforameliorat-ingindecisionbyhavingtheclientfocusontheproblemtobesolved,ratherthanattendingtounderlyingemotions(Clarke&Greenberg,1986).Theproblem-solvingapproachwasindeedbetterthanthecontrolgroup,yetthegestalttwo-chairinterventionresultedinoverallgreaterThisisanimpressiveempiricalstudy,within-terestingresultsandonlyminormethodologicalflaws.Theresultshavebeenreplicatedinatleastoneotherstudy(Clarke&Greenberg,1988).Thestudylacksgeneralizability,owingtosamplecharacteristics;outof48subjects,37werefemaleandonly11weremale.Givengenderdifferencesinemotionalexpression,itispossiblethattwo-chairworkismoreeffectiveforwomenthanmen.Perhapsthegreatestcaveatinthisworkisthatresearchersdonotknowifincreasesinde-cisivenesscorrelatewithdecisionimplementa-tionorbehavioralchange(Clarke&Greenberg,1986).Peoplemayself-reportgreaterdecisive-nessbutmaystillbelackingessentialcommuni-cationandnegotiationskillsnecessaryforsuc-cessfulchange.ClarkeandGreenberg(1986)be-lievedthattheproblem-solvingapproachcouldbemostusefultheclienthadexploredtheaffectstatesunderlyinghisorherindecision;thisremainsanempiricalquestion.AstudywithanidenticalgoalwasconductedbyJohnsonandGreenberg(1985),comparingtheeffectivenessofproblem-solvingskills(consid-eredacognitivebehavioralapproach)andexpe-rientialtreatmentinterventions(consideredacombinationofthegestalttwo-chairandRog-erianempathytechniques)inresolvingmaritalconflict.Forty-fivecoupleswererandomlyas-signedtoeitherawait-listcontrolgrouporoneofthetwotreatments.Sixtrainedtherapists,withanaverageof4yearsofexperience,conductedeight1-hourexperimentaltreatmentsessions.Treat-mentvaliditywasensuredwithclearprotocolsandfrequenttreatmentmonitoringandrating(Johnson&Greenberg,1985).Dependentmea-suresincludedtestsofemotionalstyles(usedtocheckforgroupequivalence),couplesallianceintherapy(e.g.,measureofbondbetweentherapistandclient,agreementwiththerapytasks),maritaladjustment(includesaffectionateexpression,co-hesion,satisfaction,etc.),targetcomplaints(sub-jectsrateamountofchangeonthepresentingproblem),degreeofgoalattainment(clientre-portshowwellpreviouslyspecifiedgoalsweremet,e.g.,worsethanexpected,lessthanex-pected,etc.),andrelationalintimacy(e.g.,emo-tional,social,sexual,intellectualintimacy).Resultsindicatedthatthestrengthofthework-ingalliancebetweenthetherapistsandcouplesandtherapistseffectivenesswereequivalentforthetwotreatmentgroups(Johnson&Greenberg,1985).Thetwotreatmentgroupsscoredsignifi-cantlybetterthancontrolsonmeasuresofgoalattainment,maritaladjustment,intimacylevels,andtarget-complaintreduction(Johnson&Greenberg,1985).However,theemotion-focusedtreatmentwassuperiortothecognitivebehavioraltreatmentonmeasuresofmaritalad-justment,intimacy,andtarget-complaintlevel;thesedifferencesremainedatthe8-weekfollow-up(Johnson&Greenberg,1985).Theseresultssuggestthatemotion-focusedworkcanbeameansofpositivelytransformingdyadicrelation-ships(Johnson&Greenberg,1985).Thisstudysstrengthsincluderandomassign-menttotreatments,checksontreatmentimple-mentation,andconsistentleveloftherapeutical-lianceacrossgroups.Combined,thesefactorssuggestthattheresultsareduetothetreatmentGestaltTherapy manipulationratherthanspuriousvariables.Re-searchonthetwo-chairtechniquesuggeststhatithaspromisebutthatadditionalresearchisneededtoclarifytheapplicabilityofthetechnique.Itisimportanttoconsiderthatthetechniquehasbeenempiricallysupportedlargelyforamelioratingconflictsplits.Theseareusefuldatathathelpsupportthetheorybehindthetechniques.Inan-othersense,researchersknowthattwo-chairworkisspecificallydesignedforconflictsplitsbutdonotknowifithasgreaterapplicability.ClarkeandGreenbergs(1986)studycomparinggestalttoacognitivebehavioralapproachforde-cisionalconflictrepresentsastepinthisdirec-tion,becausetheycomparedtheefficacyofthetwoapproachesforaproblemtypicallytargetedby,anddesignedfor,cognitivebehavioraltech-niques.Futureresearchshouldpursuetheques-tionofhowapplicabletwo-chairworkcanbeforadditionalclinicalproblems.Themostrecentempiricalresearchhasinves-tigatedthegestaltempty-chairtechniqueforfinishedbusiness.Thistechniquefacilitatestheexpressionofunresolvedfeelingstowardasig-nificantother.Theclientisencouragedtodirectunresolvedemotions,suchasanger,towardanappropriatetarget;forinstance,thiscouldinvolvehavingtheclientredirectinternalizedangerto-wardthepersonwithwhomheorsheisangry.Throughthisprocess,theclientisabletoexpresspreviouslyinterruptedfeelingsmorefullyandisabletoidentifysuppressedneeds(Greenbergetal.,1994).Resolutionisachievedwhentheclienthasintensifiedemotion,expressedhisorherneeds,andshiftedhisorherviewofthesignifi-cantother(e.g.,eitherholdingtheotheraccount-ableorhavingmoreunderstandingoftheotherpointofview;Beutler,Engle,Oro-Beutler,&Daldrup,1986).Asmallnumberofstudiessupporttheefficacyofempty-chairworkforunfinishedbusiness.Beutlerandcolleaguesconstructedabiologicalmodelthatsuggestedthattheinabilitytoexpressintenseaffectsputspeopleatriskforbothdepres-sionandchronicpain(Beutleretal.,1986).Theyfoundempty-chairworkforangerledtothere-ductionofangerandadecreaseinsubjectivelyreportedphysicalpain(Beutleretal.,1986)andthatemptychairworkwasaseffectiveasanedu-cationgroupforthereductionofdepressionandchronicpain(Beutler,1988,ascitedinGreen-bergetal.,1994).Conoley,Conoley,McConnell,andKimzey(1983)andcolleaguesfoundsimilarresultsinananaloguestudy;theycomparedtheeffectivenessofrationalemotivetherapyandtheempty-chairtechniqueforangerreductionincollegewomen(measuredwithbothself-reportandphysiologi-calexamination).Theyfoundbothtreatmenttechniquesreducedsystolicbloodpressureandself-reportofangerascomparedwithcontrols(Conoley,Conoley,McConnell,&Kimzey,1983).Therationalemotivegrouphadatrendtowardbeingmoreeffectivethantheempty-chairgroupontheself-reportmeasure(Conoleyetal.,1983).However,researchbyPaivioandGreen-berg(1995)demonstratedthattheemptychairdialogueledtogreaterresolutionofunfinishedbusinessascomparedwithapsychoeducationalAtthispoint,thedataontheempty-chairtech-niqueforangerreductionandunfinishedbusinessareinconclusive.Althoughsomestudiessuggestthattwo-chairworkissuperiortoothertech-niques,otherstudiessuggestthatthereisnodif-ferencebetweentwo-chairworkandothertech-niques.Thereplicationofexistingstudiesandagreatervolumeofresearchinthefieldwillhelpclarifytheefficacyofthesetechniques.Conclusion:CurrentStatusofGestaltTherapyTheeraofPerlssclinicalartistryhaspassed,andgestaltstechniqueshavebeendemystifiedbyrecentempiricalinvestigations.Despitetheal-luringnatureofPerlsswork,ithistoricallyhasfailedtopresenteitheracoherenttheoreticalmodelordatasupportingitasanempiricallyvali-datedtreatment.Thisflawintheoryandresearchhashaddetrimentalconsequences.Today,gestaltjournals,gestalttherapists,andPerlssonlytextongestalttheoryarenearlyimpossibletofindandrelativelyfewgraduate-levelinstitutionshaveasystematicmethodforteachinggestaltpsychotherapyintheircurriculum.Gestalttherapyremains,atitsverybest,mar-ginalizedintheeyesofpractitionersofothertheoreticallyeloquentandempiricallyvalidatedtreatmentprotocols.WithPerlssdeath,therewasalossofvaluabletechniquesthatareindeeduse-fulpsychotherapeuticinterventions.Withoutscontinuousadvocationforgestalttherapy,therewerefewindividualsabletopropagateandteachtheeffectiveaspectsofgestalttherapy,namely,apinchoftheeclecticmixofvarious intellectuals(theanalysts,theexistentialists,theZenBuddhists,thetheologians),andaheavydoseofPerlshischaracter,hisintellect,andeccentricpersonalitystyle.WithoutPerlsscre-ative,self-righteouscertitudepropagatinggestaltideology,otherinvestigatorshave,outofneces-sityandperhapsfaith,turnedtotherealmofem-piricalinvestigation.Fortunately,someaspectsofrecentempiricalresearchsuggestthatPerlssdistinctiveblendofcharisma,arrogance,andcreative,yethaphazard,styledidyieldenduringlyvaluableinnovationsintechnique.Whenused,asdescribedabove,inconjunctionwithrelationalapproaches,andwithduerespectforthepowerofthesetechniques,therapistsandresearcherslearnthatthegestaltworkPerlsdidhisclients,despitehismanyflaws,wasefficaciousandhaspromiseforeventhemostskeptical,evidence-based,contem-poraryclinicians.,A.A.(1997).Combiningpsychodynamicandphenomenologicalapproachesinpsychotherapy:Waystoimproveeffectiveness.InternationalJournalofMentalHealth,26,,L.E.,E,D.,O,M.E.,&DR.(1986).Inabilitytoexpressintenseaffect:Acommonlinkbetweendepressionandpain?JournalofConsultingandClinicalPsychology,54,,K.M.,&G,L.S.(1986).Differentialef-fectsoftheGestalttwo-chairinterventionandproblemsolvinginresolvingdecisionalconflict.JournalofCoun-selingPsychology,33(1),,K.M.,&G,L.S.(1988).ClinicalresearchonGestaltmethods.InF.N.Watts(Ed.),Newdevelop-mentsinclinicalpsychology(Vol.II,pp.519).NewYork:WileyandtheBritishPsychologicalSociety.,C.W.,C,J.C.,M,J.A.,&,C.E.(1983).TheeffectoftheABCsofrationalemotivetherapyandtheemptychairtechniqueofGestalttherapyonangerreduction.Psychotherapy:Theory,Re-search,andPractice,20,,R.J.,B,L.E.,E,D.,&GL.S.(1988).Focusedexpressivepsychotherapy:Freeingtheovercontrolledpatient.NewYork:GuilfordPress.,R.,&G,L.S.(1995).Experientialtherapyinpractice:Theprocess-experientialapproach.InB.Bon-gar&L.E.Beutler(Eds.),Comprehensivetextbookof(pp.123139).Oxford,UnitedKingdom:OxfordUniversityPress.,J.,L,D.,S,S.,D,S.,K,M.,&,E.(1974).Criticalincidentsintheemptychair.CounselingPsychologist,4,,L.,E,R.,&L,G.(1994).Researchonexperientialtherapies.InA.Bergin&S.Garfield,Handbookofpsychotherapyandbehaviorchange539).NewYork:Wiley.,L.S.,&R,L.N.(1981).ThespecificeffectsofaGestaltintervention.Psychotherapy:Theory,Re-search,andPractice,18,,L.S.,&R,L.N.(1997).Humanisticap-proachestopsychotherapy.InP.L.Wachtel&S.B.Messer(Eds.),Theoriesofpsychotherapy:Originsand(pp.97129).Washington,DC:AmericanPsy-chologicalAssociation.,L.S.,R,L.N.,&E,R.(1993).itatingemotionalchange:Themoment-by-momentprocessNewYork:GuilfordPress.,S.M.,&G,L.S.(1985).Differentialeffectsofexperientialandproblem-solvinginterventionsinresolvingmaritalconflict.JournalofConsultingandClini-calPsychology,53,,J.(1976).Thegenesisofgestalttherapy.InC.HatcherandP.Himelstein(Eds.),Thehandbookofge-stalttherapy(pp.235258).NewYork:Aronson.,M.V.(1974).NewintroductiontogestalttherapyTheGestaltJournal,12(1),,M.V.(1994).IntroductiontoGestalttherapy.InF.S.Perls,R.F.Hefferline,&P.Goodman(Eds.),therapy:ExcitementandgrowthinthehumanpersonalityNewYork:GestaltJournalPress.,S.,&G,L.S.(1995).Resolving:Efficacyofexperientialtherapyusingemptychairdialogue.JournalofConsultingandClinicalPsychology,63,,F.(1968).Gestalttherapyverbatim.Moab,UT:RealPeoplePress.,F.,H,R.F.,&G,P.(1951).therapy:ExcitementandgrowthinthehumanpersonalityNewYork:GestaltJournalPress.,N.(1989).Integratingintenselyemotionalmeth-odswithpsychodynamic,gestalt,cognitiveandbehavioraltherapeuticelements:I.Emotionalfreedomversusemo-tionalcontrol.PsychotherapyinPrivatePractice,7(1),,J.S.(1976).ThedevelopmentofGestalttherapy.InHatcher&Himelstein(Eds.),ThehandbookofGestalt(pp.223234).NewYork:Aronson.,G.(1991).Gestaltreconsidered:Anewapproachtocontactandresistance.NewYork:GestaltInstituteofClevelandPress.,G.M.,&S,J.S.(1989).Gestalttherapy.InR.J.Corsini&D.Wedding(Eds.),Currentpsychothera-(pp.323361).NewYork:Peacock.GestaltTherapy