Final Report: Gestalt therapy of Three Case Studies

INTRODUCTION
Gestalt therapy is an existential form of psychotherapy that emphasizes personal
responsibility and focuses on the individual’s experience in the present moment. This client
centred approach enables clients to be more creatively alive as this therapy encourages focus
on the now (what is actually happening) over content (what is being talked about).

Gestalt therapy is also a method of awareness practice ("mindfulness") for both

therapist and patients, by which perceiving, feeling, and acting are understood to be
conducive to interpreting, explaining, and conceptualizing. Explanations and interpretations
are considered less reliable than what is directly perceived and felt. Patients and therapists in
Gestalt therapy dialogue, communicate their phenomenological perspectives. Differences in
perspectives become the focus of experimentation and continued dialogue.

The objective of Gestalt therapy is to enable the client to become more fully and
creatively alive and to become free from the blocks and unfinished business that may
diminish satisfaction, fulfilment, and growth, and to experiment with new ways of being.
Another goal is for clients to become aware of what they are doing, how they are doing it,
and how they can change themselves, and at the same time, to learn to accept and value
themselves.

Gestalt therapy can be used to help clients overcome anxiety, depression, negative
emotions, self-esteem and relationship difficulties. This form of therapy can also alleviate
physical issues including migraines, ulcerative colitis and back spasms.

HISTORY OF GESTALT THERAPY

Gestalt Therapy has been an acknowledged therapeutic practice since the early 1950s. It
was founded in the socio-cultural context of humanistic psychotherapies by Frederick and
Laura Perls. Theoretical and practical insights were further developed by a group of
American intellectuals with a deep knowledge of psychoanalysis. Gestalt Therapy has
integrated psychoanalytic (Freud, Reich, Rank), gestalt theoretical and field theoretical
(Wertheimer, von Ehrenfels, Koffka, Lewin, Zeigarnik, Goldstein and Gelb), holistic
(Smuts), philosophical (Tillich, Friedlaender, Buber), phenomenological, zen buddhistic as
well as psychodramatic (Moreno) influences into its theory. Currently, this form of therapy is
being used worldwide.

THEORY OF GESTALT THERAPY

Gestalt therapy focuses on the experiential and the experimental techniques which
provides opportunities for the unique personality, skills and background of the therapist to
influence the flavour of its practice. Gestalt theory is a philosophically complex set of diverse
substantiated beliefs. Gestalt theory contains a philosophy that embodied existential
principles of freedom and responsibility, analytic notions of defences, and gestalt
psychological principals of gestalt formation and destruction. It is also a present centred
psychotherapy that directs an individual’s awareness and the process of awareness. Gestalt
therapy theory suggest that people make contact (meet needs) through a characteristic style of

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interacting with the environment established through experience. Gestalt therapy theory
asserts that contactful interactions with the environment promotes individual psychological
health.

LITERATURE REVIEW

In order to identify the disorder of my patients according to their symptoms, I

referenced the ‘Diagnostic and Statistical Manual of Mental Disorders’ (DSM) by the
American Psychiatric Association. It provides clear, highly detailed definitions of mental
health and brain-related conditions. It also provides details and examples of the signs and
symptoms of those conditions. In fact, providing diagnoses are challenging even with the
manual, as practice and experiences are crucial to better interact with the patients that
lead to better judgement. Besides, customs, culture differences, and religious belief also
affect the diagnosis. For example, people with a strong religious faith easily connect their
problem to spiritual matters as guided by their respective religions. Therefore, there is a
gap between the scientific perspective of the therapist and the spiritual perspective of the
patient. I reflected on my sessions with my patients and learnt that I must learn to accept
their way of thinking, try to understand them and identify their problem in a more
effective way.
My case studies display similar patterns mentioned in the book ‘Breaking Negative
Thinking Pattern,’ despite vast cultural differences between the Western, which the book
is based on, and Asian cultures. Though many values in kid’s education observed in my
case studies are very different from the book, I came across a Japanese lady where I
found out that she was in the ‘Punitive Coping Parent Mode’. However, the therapy and
method of treatment suggested in the book is unlikely to work on her as most of these are
against the Japanese culture of strong discipline and respect to their parents. The attempt
to suggest the treatment itself will affect the trust and bond between the therapist and the
patient. I believed that some adjustment must be done by the therapist to suit each patient
based on their culture, educational background, and religious beliefs. Hence, it is
important to clearly understand the Ethic Standards of Malaysia and make efforts to
provide the best therapy to our patients.

Case Study 2: Gestalt therapy with a cancer patient

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Name : Luciana

Gender: Female

Chronological Age: 60 years

Student’s Name: EMY

Number of Sessions: 5

Dates of Assessment/Session Date of Report : 18/8/2023

Background Information

Current Concern

● Divorced with the husband in 2016

● Found a lump on the left breast and was diagnosed with cancer.

● She is worried but unclear with her own feelings.

Medical & Development History

● Breast cancer stage 2, diagnosed on 2/8/2023. Surgery of removal of the left breast is

recommended.

Family & Social History

● She grew up in a big family with 10 siblings. The father was a typical Chinese man

who has preference of boys to girls.

● She had been working very hard since young and even after she got married. The

husband was 7 years old younger than her and the in-laws were not happy with the

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 age difference. She had to work hard to please the in-law family and at the same time
to earn money to support the family as the husband was not working.

● She went through a divorce in 2016. At the same time, as her son quit university and

gave up the scholarship he received, she had to pay back a large amount of money to
the scholarship agency, she had many financial and mental stress.

● She is a loyal employee who worked for the same company for nearly 35 years until

she retired during the pandemic, she is very capable and was trusted by her boss.

● She has a group of close friends whom she knows since childhood. She lives a simple

live and now started to spend more time with her only son who has started working.

Behaviour Observation

She is very kind and caring.

1. Subjective Observation

● She is reliable, capable, kind and caring.

● She is not familiar with her own emotions and does not speak much about herself.

2. Objective Observation

● She tend to make unnecessary scarification to please others and ended up

accumulating stress.

● She is always thinking how to make people feel comfortable and sometimes forgot to
take care of herself.

● She is not used to request help from others and tries to do everything on her own
without troubling others.

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 3. Assessment
a. The core childhood need of safety was unmet.
b. Schema: "Subjugation" schema. The Subjugation schema is characterized by
an excessive focus on meeting the needs of others while ignoring one's own
needs and desires. It often stems from childhood experiences where
individuals were taught to prioritize others' needs and feelings above their
own.
c. Coping Modes:
Overcompensation

4. Plan (Intervention/Recommendations)

Steps taken:

1. Sandtray therapy (31/7/2023):

Explanation of the sandtray:

1. She mentioned that she is the Sun, shining everyone around her. (I have shared the
“good enough” idea for her and to treasure her own emotions as well.)
2. The dolphin jumping out from the sea is her cancer, when I asked her to become the
dolphin, she shouted: “Get me out of here!” She mentioned that the dolphin represents
her hatred toward the husband and the regret she had when she had to sacrifice
everything to the husband and the family.
3. She admitted that her world is packed of things and people since young, with little
space for herself.

Changes and improvement:

1. She started to share about her history which she never mentioned before. We clearly
see that the sandtray became a channel for her to access toward her emotions and
feelings.

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 2. After the session, she said that she is ready to accept the treatment and to spend
meaningful time with her son and family members. She opened up to the son and the
son decided to take off from work to accompany the mother during her surgery.

Session 2 (16/8/2023):

1. I am the Pegasus, no more as the sun.

2. The world is separated into heaven and man-living world. People is suffering in the
world.

Further Plan:

1. Chair dialogues (to allow the vulnerable child to defend herself)

2. Continue to work on the first sandtray art.

3. Do memory rescripting to rewrite her memory with her ex-husband.