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 3: Gestalt therapy with a patient with PTSD

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Name : Durian

Gender: Male

Chronological Age: 11 years

Student’s Name: EMYs

Number of Sessions: 3

Dates of Assessment/Session Date of Report : 15/6/2023, 20/7/2023,12/8/2023

Background Information

Current Concern

● Durian, 11 years old.

● He is gets irritated very easily and will injure his friends and become very aggressive

in his words and actions. Many of his friends got injured and one of the parents is
thinking to report to the police as their son’s neck was bleeding (Mid of August).

● He tells lies when he stole someone’s pen. He later explained that he is afraid of his

mother getting mad at him.

Medical & Development History

● None.

Family & Social History

● The parents divorced when he was 5 years old, the mother experienced serious DV at

home. Durian used to see the father hitting the mother since young. The mother
decided to divorce the husband when he tried to hit her until she lost her
consciousness.

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 ● The mother works hard as a single mother to make ends meet and seldom spend time

with him. He is sent to tuition and art classes and his school results is improving this
year.

● Since young, he does things according to his own will and always cause many

troubles at school. He easily gets irritated and will cry, break things, shout until the
adults try to oblige him.

Behaviour Observation

Home

● He spends most of his time alone and will blame the mother for not spending time

with him.

● Once a while, the mother will confiscate his phone when he is too addicted to the

phone.

● When he gets angry, he will lose his temper and break things at home. It is very

difficult to calm him down.

Outside

● He tries to kind to his good friends. However, when someone is mean or sarcastic to

him or his friend, he will become aggressive. He cannot hold back his anger when he
feels that someone is trying to harm him or his friends and will try his best to protect
or fight back. His overreaction always cause serious injury on his opponents.

● He is not able to concentrate on things that he is not interested for a long period of

time. He is talented in drawing black and white patterns.

● School teachers always contact the mother on his many problems at school: fighting

with classmates, stealing people’s things, telling lies, do not complete his homework
etc.
1. Subjective Observation

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 ● He gets distracted easily and is not aware of his own emotions. He always has the

feeling of frustration and anger in him in which he is not aware (reflection after the
sandtray).

● He has a strong desire to protect and this is one of the reason of him becoming very
aggressive when his friend is being teased by others.

● He tries to not mix around with people whom he is not familiar with to avoid conflict,

but he still gets himself into trouble easily. His friends seem cannot understand his
intention and will think that he is trying to harm them.
2. Objective Observation
 During the first few sessions, he shows no interest in talking to me.
 He gets distracted easily and refuses to cooperate when he is no interested in the
conversation.

● He likes to have body contact with the mother. Especially when his intention is not

understood properly, he tends to hit the mother or touch the mother.

3. Assessment
● He was traumatized when he saw his father harming his mother when he was a kid
and will. Suspected with PTSD (DSM-5: 309.81).

● Scheme mode: Overcompensatory Mode

4. Plan (Intervention/Recommendations)

 Sandplay therapy on the 2nd session.

Explanation:
1. The angel is his rational thinking mind, the dragon is the angry self. He hid the dragon
under the clouds in Fig 1 and Fig 3. When the viruses (Fig 2: stimuli of his
anger=friends who trigger his anger) invade his territory, the dragon will lose control
and release the fire balls (words and actions when he is angry) which will cause a big
damage to the surroundings.

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 2. After he released his anger, the environment will be damaged and his friends will leave
him. He feels lonely but the dragon is always hiding under the cloud and the anger can
never disappear even though he is under control. He mentioned: “I feel very boring
and lonely after I released my anger.”

Reflection:
1. At first, he was completely unconscious about his own emotions and his actions. It is
interesting to see how he could express his emotions through the sandtray session. The
mother was amazed as well and for the first time he could access to his own anger and
observe himself in a calm manner.
2. He realized that the angel (calm him) is not able to control the dragon (angry him). We
came to a conclusion that there can be another way to release the anger.

Further plans:
1. Concrete plan and homework for Durian to manage his anger.
2. Concrete plan for the mother to manage her time to spend more time with Durian.