Gestalt therapy: how it works

It's common for past problems to follow us into the present. But without working on them or coming to a resolution, there is no guarantee past issues won't follow you into the future. That, say its proponents, is where gestalt therapy can be helpful. 

Gestalt therapy is a so-called experiential therapy—a technique that involves activities such as role-playing or acting. It helps people to work on unresolved past experiences in the present by looking at what's happening in the "here and now."

Guided by clinicians, the gestalt approach promotes personal growth by focusing on one's needs, sensations, and desires. 

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Gestalt is a German word for “shape” or “form.” In the context of gestalt therapy, it means to represent a person in their entirety instead of their different attributes (Mann, 2010). Gestalt therapy combines and builds on various aspects of psychology such as psychoanalysis, developmental psychology, field theory, existentialism, and bodily awareness. 

Although inspired in part by gestalt psychology, gestalt therapy and gestalt psychology are entirely different theories. Gestalt therapy is an experiential approach to psychotherapy, whereas gestalt psychology focuses on perception and cognition (Henle, 1978).

Husband and wife psychotherapist duo Fritz Perls, M.D., and Laura Perls, Ph.D., developed gestalt therapy in the 1940s after fleeing Nazi Germany. The Perls first lived in South Africa and later moved to New York City. There, they founded the Gestalt Institute in 1952 (Clarkson, 1993). 

The Perls' travels and historical events such as the rise of fascism and World War II influenced gestalt theory. Initially, the couple wanted to name gestalt therapy existential therapy. However,  they felt the term had too strong a connection to French philosopher Jean-Paul Sarte and nihilism—the belief that life is meaningless (Sommers-Flanagan, 2018). 

As part of their work defining gestalt theory, the Perls wrote Ego, Hunger, and Aggression: A Revision of Freud's Theory and Method and Gestalt Therapy, Excitement, and Growth in collaboration with psychologist Ralph Hefferline, Ph.D. and Paul Goodman, a writer interested in psychoanalytic modalities.

The practice of gestalt therapy is a physical-mental-emotional one. In addition to listening to you speak, gestalt therapists also consider your body language and how those movements relate to the emotions you convey (Yontef, 2005).  

Gestalt therapy sessions focus on building a dialogue-based relationship built on your own experiences, becoming aware of physical and emotional sensations, and "here and now" or present moment experiments. Gestalt therapy focuses on the present because there is no changing the past. Gestalt therapy aims to bring past problems into the present since the present is what can actively change. This process occurs through the client-therapist dialogic relationship and gestalt exercises (Mann, 2010). 

One of Fritz Perls' most famous descriptions of gestalt therapy was "lose your mind and come to your senses." Indeed, gestalt therapy focuses more on sensations and experiences than analysis (Yontef, 2005).

Gestalt therapy techniques include:

• Staying with your feelings

• Taking personal responsibility

• Playing the projection

• The exaggeration experiment

• The empty chair technique

• Dream work

Though feelings can be unpleasant, therapists encourage addressing your feelings instead of avoiding them. Therapists may ask you to voice your emotions, act out your feelings, or personify certain sensations (i.e., if your anxiety could talk, what would it say?) Staying with your feelings is thought to bring on "aha" moments and promote personal discovery. 

With playing the projection and exaggeration, the therapist asks you to act out a feeling or scenario. For example, if you say your partner acts insensitively, your therapist may ask you to act out that behavior. Acting out exaggerations requires mimicking nonverbal behaviors exaggeratedly.  Let's say your therapist notices you play with your hair when you get nervous. They may ask you to twirl your hair exaggeratedly and share how you feel. This observation aims to help you recognize the behavior, give you more autonomy over it, and improve self-esteem (Sommers-Flanagan, 2018).

One of the most popular gestalt exercises is the empty-chair dialogue (Glass, 2010). This experiment uses two chairs to represent two polarities of an internal conflict. After establishing the two opposing viewpoints, you act out what a conversation would be like if those two chairs could talk to one another. This enactment allows you to be both the top dog and the underdog (Greenberg, 2002).

The top dog is the Freudian superego or your conscience. The underdog is the voice that comes up with reasons that negate the righteous or top dog thing to do. This role-playing helps eliminate the back and forth self-torture that happens when these conversations occur in the confinement of our minds. It also brings the conflict into the present, allowing you to resolve unfinished business (Greenberg, 2002). 

The empty-chair exercise can also help resolve an external conflict between two parties. Instead of switching from chair to chair, you stay seated in one chair and pretend the other seat is the person you're arguing with. Again, in this scenario, you provide both parts of the conversation, noting your feelings throughout. 

Dreamwork is another way of improving your understanding of yourself, according to gestalt therapy. During dreamwork, you relay your dream to your therapist in the present tense by setting it up as though it were a movie. You then act it out and become each character. This exercise allows you to interpret your dream and what it means to you in the broader context of your life (Mann, 2010).  

Another frequently utilized exercise is mindfulness. Mindful grounding can help you stay in the present moment by focusing on your breathing and how you hold yourself in your current space (Joyce, 2018). 

Gestalt therapy is best suited for those who want to improve their self-awareness and can be open to their role in their problems. Gestalt therapy can help treat anxiety and depression, and improve body image (Hander, 2001). Gestalt exercises like the empty chair dialogue can also help couples work through their problems. A small study of people with unresolved feelings related to a significant other found that those who completed the therapy reported less distress and improved problem-solving following therapy. These benefits lasted four months post-treatment (Paivio, 1995).

In addition to helping those with mental health conditions, gestalt therapy may also benefit people with physical illnesses. A small study compared three groups of women with migraines; one group received gestalt therapy, another cognitive-behavioral therapy (CBT), and the last no treatment. Both the gestalt and CBT groups showed improvements compared to those that didn't receive therapy (Sepehrian Azar, 2013). Another small study found that gestalt therapy helped people cope with chronic lower back pain (Ellegaard, 2012).

Gestalt therapy has its limitations. Because it values personal experience, it doesn't always translate well for people or cultures that put less value on individualism. Critics have called the effectiveness of gestalt therapy into question due to limited empirical evidence that it works. Of all of its practices, the empty chair dialogues show the most benefit (Sommers-Flanagan, 2018). 

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Current version

June 17, 2021

Written by

Jordan Davidson

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.