Gestalt Therapy

Gestalt Therapy

Gestalt therapy was originated about fifty years ago by Frederick ‘Fritz’ Perls (1893-1970) in collaboration with Paul Goodman. A German word, “Gestalt,” points to a main theme of the therapy. It describes the unified nature of a pattern of elements and, in Gestalt therapy practice, refers to our tendency to see and act in unified wholes, instead of parts. Thus, the mind, body, and spirit act as one and are not treated as separate functions. The main limit to Gestalt counselling is the counsellor himself and his or her lack of imagination. The overall aim is, by bringing elements into the open, people are able to identify and integrate the various diverse parts of themselves and thereby achieve an individual gestalt.

The Gestalt Therapy approach encourages individual personal growth through the development of self-awareness and self support to enable creative and spontaneous contact with people and the environment we live in. This process does not conform to preset rules or expectations. A Gestalt therapist encourages clients to explore and find ways to live life in a meaningful way. The learning and application of Gestalt therapy is always experiential with clients being encouraged to experiment between client and therapist as the vehicle for healing. Gestalt Therapy works through the interconnection of concepts. Here are a few that are key:-

  • Present-centered awareness
  • Profound respect
  • Social responsibility
  • Emphasis on experience
  • Creative experiment and discovery
  • Relationship


Preparation of Gestalt Therapy

Gestalt therapy begins with the first contact. There is no separate diagnostic or assessment period. Instead, assessment and screening are done as part of the ongoing relationship between patient and therapist. This assessment includes determining the patient’s willingness and support for work using Gestalt methods, as well as determining the compatibility between the patient and the therapist. Unfortunately, some “encounter groups” led by poorly trained individuals do not provide adequate pre-therapy screening and assessment.

Gestalt therapy is often criticized as being too technique orientated with little research into what actually works. In fact some say no matter what the style or technique used it is the actual counsellor who is the biggest factor as to whether the client moves on or not. Perls  himself was in his later years says this about therapists, One of the objections I have against anyone calling himself a Gestalt Therapist is that he uses a technique. A technique is a gimmick. A gimmick should only be used in the extreme case.



Existential Therapy

Existential Therapy

Existential therapy is based on developing a client’s insight, or self-understanding, and focuses on problems of living such as choice, meaning, responsibility, and death. This therapeutic approach emphasizes “free will,” the ability to make choices that are not dictated by heredity or past conditioning, through which an individual can become the person that he or she wants to be. Existential therapy attempts to restore meaning to life so that the client is inspired to have the courage to make choices that are both rewarding and socially constructive.

Existential therapy is a dynamic type of psychotherapy that can help us to get in touch with these questions and the ultimate concerns that often underlie many of our conflicts, anxieties, and motives. These ultimate concerns include:

  • Awareness of our limited lifespan
  • Our freedom to make choices
  • Awareness of our existence as individuals (separateness)
  • The threat of meaninglessness

Goals of Existential therapy

It is possible for people to face the anxieties of life head-on and embrace the human condition of aloneness, to revel in the freedom to choose and take full responsibility for their choices. They courageously take the helm of their lives and steer in whatever direction they choose; they have the courage to be. One does not need to arrest feelings of meaninglessness, but can choose new meanings for their lives. By building, by loving, and by creating one is able to live life as one’s own adventure. One can accept one’s own mortality and overcome fear of death. Some of the goals of existential therapy are:-

  • Taking responsibility for decisions
  • Finding personal meaning
  • Increasing self-awareness and authentic living

The benefit of existential therapy is that it helps people to clarify and choose among different ways of living, and ultimately lead richer and more meaningful lives.




EFT – Emotional Freedom Techniques


This technique was created by Gary Craig, who studied TFT under Dr. Callahan. EMOTIONAL FREEDOM TECHNIQUE is based on the meridian system, comparative to acupuncture without the use of needles. The process is used to release negative emotional energy stored in the nervous system. It is used in the treatment of trauma, PTSD, phobias, grief, anger, guilt, anxiety, etc.

EFT (Emotional Freedom Techniques) is becoming known to many amazed users as a modern miracle. It can dramatically relieve emotional disturbances along with many physical symptoms. It often works in minutes, its results are usually long lasting, and side effects are almost always positive.

EFT is versatile and has been used confidently by hundreds of therapists on thousands of clients with successes on even the most difficult problems, by relieving imbalances in their clients’ energy systems. Phillip and Jane Mountrose have been using it personally and with clients and class participants for over 5 years, with consistent success.


How EFT – Emotional Freedom Techniques Works?

EFT is a very effective yet gentle method of directly balancing the body’s energy system for the feelings that you want to change. It’s a bit like clearing a log that’s blocking a stream where the log represents a stuck emotion in your stream of energy. You don’t have to believe in the theory though, just as you don’t need to know how a car works under the bonnet to drive one. Some people do like to find out more about the theory, while others are happy simply to have their problem resolved.


EFT Step What’s Involved in Each Step Time Taken
The Setup Massage a tender area of lymph nodes in your upper chest and repeat a specially-worded statement of your problem. 10 sec
Tap with the pads of your fingers on a series of acupressure points to stimulate energy flow through the meridian system. 20 sec
9-Gamut Procedure Tap one acupressure point on the back of your hand; do 9 brain-connecting actions with eye movements, humming and words. 10 sec
Again, tap with pads of your fingers on the same acupressure points to stimulate energy flow through the meridian system. 20 sec

Total EFT Treatment Time = about 60 seconds

EFT is a form of psychological acupressure, based on the same energy meridians used in traditional acupuncture to treat physical and emotional ailments for over five thousand years, but without the invasiveness of needles. Instead, simple tapping with the fingertips is used to input kinetic energy onto specific meridians on the head and chest while you think about your specific problem – whether it is a traumatic event, an addiction, pain, etc. — and voice positive affirmations.

Most energetic imbalances may be partially or completely relieved within a short time using this process. Others may be relieved through repetition of the process. Some examples of energetic patterns that have been successfully cleared using EFT:

  • Fears related to performance like public speaking, concentration, sports, etc.
  • Phobias like the fear of heights, flying, enclosed spaces, driving, etc.
  • Emotional trauma from war experiences, physical abuse, etc.
  • Disturbing emotions like depression and anger.
  • Emotions related to addictive patterns like eating and smoking
  • Insomnia
  • Emotions related to physical conditions.



Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT)

The term ‘dialectical’ is derived from classical philosophy. Dialectical Behavior Therapy (DBT) was originally developed by Marsha Linehan for treating borderline personality disorder, and has subsequently been adapted for binge eating disorder. Typically clients with BPD, as defined in DSM-IV, are notoriously difficult to treat (Linehan 1993a). They often do not attend regularly, frequently fail to respond to therapeutic efforts and make considerable demands on the emotional resources of the therapist (particularly when suicidal and parasuicidal behaviors are prominent). The effectiveness of DBT has been demonstrated in many controlled studies across different research groups. Because of this success and due to similar behavior patterns, DBT is now being used in many settings as a viable therapy for the treatment of bipolar disorder.

How it works

Dialectical Behavioral Therapy (DBT) consists of two parts:

  1. Once-weekly psychotherapy sessions in which a particular problematic behavior or event from the past week is explored in detail, beginning with the chain of events leading up to it, going through alternative solutions that might have been used, and examining what kept the client from using more adaptive solutions to the problem:
    Both between and during sessions, the therapist actively teaches and reinforces adaptive behaviors, especially as they occur within the therapeutic relationship. . . the emphasis is on teaching patients how to manage emotional trauma rather than reducing or taking them out of crises. . . . Telephone contact with the individual therapist between sessions is part of DBT procedures.
    (Linehan, 1991) DBT targets behaviors in a descending hierarchy:

    • decreasing high-risk suicidal behaviors
    • decreasing responses or behaviors (by either therapist or patient) that interfere with therapy
    • decreasing behaviors that interfere with/reduce quality of life
    • decreasing and dealing with post-traumatic stress responses
    • enhancing respect for self
    • acquisition of the behavioral skills taught in group
    • additional goals set by patient
  2. Weekly 2.5-hour group therapy sessions in which interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills are taught (see summaries of sample worksheets). Group therapists are not available over the phone between sessions; they refer patients in crisis to the individual therapist.

There are four modules in DBT group skills training:

  • Core Mindfulness Skills – These are derived from Buddhist meditation techniques to enable the client to become aware of the different aspects of experience and to develop the ability to stay with that experience in the present moment.
  • Interpersonal Effectiveness Skills – These focus on effective ways of achieving one’s objectives with other people: to ask for what one wants effectively, to say no and be taken seriously, to maintain relationships and to maintain self-esteem in interactions with other people (comparable to assertiveness training).
  • Emotion Modulation Skills – These skills are ways of coping with intense emotional experiences and their causes. They also allow for an adaptive experience and expression of intense emotions.
  • Distress Tolerance Skills – These include techniques for putting up with, finding meaning for, and accepting distressing situations if there is no conceivable solution at present.

DBT for Binge Eating Disorder Techniques

  1. Mindfulness training: Learning to fully experience thoughts, emotions, and action urges without attempting to suppress them or judge them, and without experiencing secondary emotions such as guilt or shame.
  2. Identifying the antecedents and consequences of emotions.
  3. Becoming aware of the bodily responses that accompany negative emotions.
  4. Understanding the relationship between cognitions and emotions, and modifying cognitions that evoke negative emotions.
  5. Learning adaptive methods of coping with negative emotions: relaxing, taking walks, socializing, taking a warm bath, listening to soothing music.
  6. Getting adequate sleep and reducing excessive exercise and the use of drugs and alcohol.
  7. Reducing negative emotions, for example by facing rather than avoiding feared situations, and by revealing rather than hiding feelings of shame.



Cognitive Behavioral Therapy

Cognitive Behavioral Therapy

Cognitive therapy is fairly new to the mental health field, but we can actually trace its development back in time 2,600 years to the Buddha and the great emphasis his followers place on watching – and eventually taming – one’s thoughts. There, the goal is eventual enlightenment. Here, we are speaking in relatively more modest terms of saving one’s own life – of watching how you think in certain situations, and making the appropriate adjustments.

What is CBT?

Cognitive-behavioral therapy is an action-oriented form of psychosocial therapy that assumes that maladaptive, or faulty, thinking patterns cause maladaptive behavior and “negative” emotions. (Maladaptive behavior is behavior that is counter-productive or interferes with everyday living.) The treatment focuses on changing an individual’s thoughts (cognitive patterns) in order to change his or her behavior and emotional state.

Cognitive therapy is a well-researched method of psychological treatment that can be effective for dealing with emotional and behavioral problems. It is a way of talking about:

  • How you think about yourself, the world and other people
  • How what you do affects your thoughts and feelings.

CBT can help you to change how you think (“Cognitive”) and what you do (“Behaviour)”. These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the “here and now” problems and difficulties. Instead of focussing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.

It has been found to be helpful in:

  • Anxiety
  • Depression
  • Panic
  • Agoraphobia and other phobias
  • Social phobia
  • Bulimia
  • Obsessive compulsive disorder
  • Post traumatic stress disorder
  • Schizophrenia

How effective is CBT?

CBT has been shown in clinical trials to help ease symptoms of various health problems. For example, research studies have shown that a course of CBT is just as effective as medication in treating depression and certain anxiety disorders. There may be long-term benefits of CBT as the techniques to combat these problems can be used for the rest of your life to help to keep symptoms away. So, for example, depression or anxiety are less likely to recur in the future. There is good research evidence too to show that CBT can help to improve symptoms of some physical conditions such as rheumatoid arthritis.


Cognitive-behavioral therapy does not suit everyone and it is not helpful for all conditions. You need to be committed and persistent in tackling and improving your health problem with the help of the therapist. Those who don’t have a specific behavioral issue they wish to address and whose goals for therapy are to gain insight into the past may be better served by psychodynamic therapy. Patients must also be willing to take a very active role in the treatment process.

Cognitive-behavioral intervention may be inappropriate for some severely psychotic patients and for cognitively impaired patients (for example, patients with organic brain disease or a traumatic brain injury), depending on their level of functioning.



Clinical Depression (Major Depression)

Clinical Depression

Clinical depression is also know as major depression, it is the most severe category of depression. It is normal for people to feel depressed when something bad happens, such as the death of a loved one. This type of depression normally goes away after a couple of weeks; but sometimes it persists. It can last for periods of six months or more, and then it is classified as clinical depression. Without treatment, symptoms of clinical depression can last for weeks, months, or years. Appropriate treatment for clinical depression, however, can help most people who suffer from clinical depression.

Signs and Symptoms of Clinical depression

In a clinical depression, more of the symptoms of depression are present, and they are usually more intense or severe. However, each individual may experience symptoms differently. Symptoms may include:

  • Inability to experience pleasure
  • Hopeless about the future, excessive pessimistic feelings
  • Insomnia or excessive sleeping
  • Fatigue or loss of energy nearly every day
  • Drug or alcohol abuse
  • Thoughts of suicide
  • Feelings of guilt, worthlessness, helplessness
  • Significant weight loss or gain

What are the Causes of Clinical Depression?

Current theory suggests those clinical depression results from complex interactions between brain chemicals and hormones that influence a person’s energy level, feelings, sleeping and eating habits. These chemical interactions are linked to many complex causes–a person’s family history of illness, biochemical and psychological make-up, prolonged stress, and traumatic life crisis such as death of a loved one, job loss, or divorce. Sometimes no identifiable cause triggers an episode of clinical depression; usually one or more stresses are involved. Medical research has found that people who suffer from clinical depression have changes in important brain chemicals, such as serotonin and norepinephrine. New medications are available that restore these brain chemicals to their proper balance and relieve symptoms of clinical depression.


Major depression can profoundly alter social, family, and occupational functioning. However, suicide is the most serious complication of major depression, resulting when the patient’s feelings of worthlessness, guilt, and hopelessness are so overwhelming that he no longer considers life worth living.

Note: If specific plans for suicide are uncovered or if significant risk factors exist (previous history, profound hopelessness, concurrent medical illness. substance abuse, social isolation), refer the patient to a mental health specialist for immediate care. Nearly 15% of patients with untreated depression commit suicide, and most of these patients sought help from a doctor within 1 month of their deaths.

Diagnostic criteria

A patient is diagnosed with a major depressive episode when he fulfills the criteria documented in the DSM-IV.

  • At least five of the following symptoms must have been present during the same 2-week period and represent a change from previous functioning; one of these symptoms must be either depressed mood or loss of interest in previously pleasurable activities (Don’t include symptoms that are due to a general medical condition, delusions, or hallucinations):

– depressed mood (irritable mood in children and adolescents) most of the day. nearly every day, as indicated by either subjective account or observation by others

– a markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

-significant weight loss or weight gain (greater than 5% of the patient’s body weight in a month) when not dieting or a change in appetite nearly every day

– insomnia or hypersomnia nearly every day

– psychomotor agitation or retardation nearly every day

– fatigue or loss of energy nearly every day

– feelings of worthlessness and excessive or inappro­priate guilt nearly every day

– diminished ability to think or concentrate or indecisiveness, nearly every day

– recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or suicide attempt or a specific plan for committing suicide.

  • The symptoms aren’t due to a mixed episode.
  • The symptoms aren’t due to a medical condition (such as hypothyroidism) or the effects of a medication or other substance (drug abuse, for example).
  • The symptoms aren’t better accounted for by bereavement (for example, symptoms persist for more than 2 months after a loved one’s death or are characterized by marked functional impairment, morbid thoughts of worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation).

Psychological tests such as the Beck Depression Inventory can be used to determine the onset, severity, duration, and progression of depressive symptoms. The dexamethasone suppression test may show a failure to suppress cortisol secretion; however, this test has a high false-negative rate. Toxicology screening may suggest a drug-induced depression.

Treatments for Clinical Depression

The first step to getting appropriate treatments for clinical depression is a physical examination by a physician. If a physical cause for the clinical depression is ruled out, a psychological evaluation should be done by referral to a psychologist or psychiatrist. Physical treatments have several options including antidepressant medication therapy, psychotherapy or electroconvulsive therapy or ECT.

  1. Antidepressant medication therapy, it takes about 5 or 6 weeks to find out if that antidepressant medication is appropriate – that is it is working and does not have untoward side effects – and then it takes 6 months or more of continuation treatment to ensure that the medication remains effective.
  2. Psychotherapy – most often cognitive-behavioral and/or interpersonal therapy) for the individual. Cognitive-behavioral focused on the negative thinking and behavioral patterns associated with depression, and teaches the individual to recognize and target the self-defeating behavioral patterns that contribute to their depression.
  3. Electroconvulsive therapy (or ECT). This usually involves 8 to 10 treatments over a 3 to 4 week period. One can consider ongoing treatment once every 2 weeks to once every 4 weeks over a several month period if this treatment has been successful. (ECT)

The effectiveness of treatment often depends on factors such as the amount of optimism and hope the sufferer is able to maintain, the control he or she has over stressors, the severity of symptoms, the amount of time the sufferer has been depressed, the results of previous treatments, and the degree of support of family, friends, and significant others.

While treatment is generally effective, there are some cases where the condition fails to respond. Treatment-resistant depression requires a full assessment which may lead to the addition of psychotherapy, higher medication doses, changes of medication or combination therapy, a trial of ECT /electroshock, or even a change in the diagnosis with subsequent treatment changes. Although this process helps many, some people’s symptoms continue unabated.



Bulimia Nervosa

bulimia nervosa

Bulimia (buh-LEE -me-ah) nervosa, typically called bulimia, is a type of eating disorder. The essential features of bulimia nervosa include eating binges followed by feelings of guilt, humiliation, and self-deprecation. These feelings precipitate the patient’s engaging in self-induced vomiting. the use of laxatives or diuretics, or strict dieting or fasting to overcome the effects of the binges. Unless the patient devotes an excessive amount of time to binging and purging, bulimia nervosa seldom is incapacitating.

Most people with bulimia nervosa are females, ranging in age from the teens to early 20s, who are preoccupied with their weight and body image. Bulimia nervosa affects all races, but is most often diagnosed in Caucasian women.


The exact cause of bulimia is unknown, but various psychosocial factors are thought to contribute to its development. Such factors include family disturbance or conflict, sexual abuse, maladaptive learned behavior, struggle for control or self-identity, cultural overemphasis on physical appearance, and parental obesity. Bulimia nervosa is strongly associated with depression.

Signs and symptoms

  • self-induced vomiting (usually secretive)
  • depression
  • inappropriate use of diuretics or laxatives
  • overachieving behavior
  • persistent preoccupation with eating and an irresistible craving for food.
  • anxiety


Treatment of bulimia nervosa may continue for several years. Interrelated physical and psychological symptoms must be treated simultaneously. Merely promoting weight gain isn’t sufficient to guarantee long-term recovery. A patient whose physical status is severely compromised by inadequate or chaotic eating patterns is difficult to engage in the psychotherapeutic process.

Psychotherapy focuses on breaking the binge-purge cycle and helping the patient regain control over eating behavior. Treatment may occur in either an inpatient or outpatient setting. It includes behavior modification therapy, possibly in highly structured psychoeducational group meetings. Individual psychotherapy and family therapy, which address the eating disorder as a symptom of unresolved conflict, may help the patient understand the basis of her behavior and teach her self­control strategies. Antidepressant drugs such as imipramine may be used to supplement psychotherapy.

The patient also may benefit from participation in self-help groups such as Overeaters Anonymous or in a drug rehabilitation program if she has a concurrent substance abuse problem.


Preventive measures to reduce the incidence of bulimia are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the process of normal growth and development, and improve the quality of life experienced by adolescents with bulimia. Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful.