Gestalt Family Therapy and Person-Centered Family Therapy: Compare and Contrast by Nina Bingham

Abstract: This article will explore two psychotherapies as applied to family therapy: Family-Centered Therapy (known as Person-Centered Therapy, or Rogerian Therapy), and Gestalt Family Therapy. It will describe the philosophy and goals of the therapies, typical interventions, role of the therapist, and beliefs about family outcomes and change. It will compare and contrast the two psychotherapeutic models, and suggest how I blend these two therapies so they are complimentary.

    While a family is a system comprised of individuals, it is the survival of the family unit which may be threatened when a family presents in therapy. Psycho-therapeutics has, in the past, attempted to emphasize the sum (family unit) over its parts (family members). I propose that perceiving the family as a gestalt unto itself is a “collectivist perspective,” while emphasizing the individuals within the group is a decidedly westernized, individualistic perspective. It seems to me that Family-Centered Therapy (Rogerian Therapy, 1951) is more of a collectivist-oriented modality, wherein the family unit’s good will be weighed, along with the individual member’s needs. Conversely, Gestalt Family Therapy seems to be of the individualistic persuasion. The logic seems to be that if the individual is happy, as a result, the group will be happier. I happen to agree with Gestalt Therapy’s emphasis on drawing out the individual’s needs within the family context. Bott (2001) reminds us that, “Families are made up of people. To use the metaphor of saying a family is LIKE a system as a way of conveying the rich interconnectedness of family members is quite different from the dehumanizing process of treating it AS a system.” Before exploring Gestalt Family Therapy further, let’s assess Family-Centered Therapy in more depth.

    Person-Centered Therapy can be compared in structure to “embodying the perspective view that the presenting symptom or complaint is a “motor for growth,” and argue that the immediate alleviation of symptoms may be antithetical because it can preclude the opportunity for long-term, holistic healing of the self” (Keeney and Sprenkle, 1992). Rogerian therapists traditionally would not be in a rush for change, as they see the therapy process as a journey of self-actualization rather than a “destination.” In assessing the fitness of Rogerian philosophy for family therapy, Minuchin (1974, p. 123) has stressed the importance of empathy, saying, “The therapist should feel the family members pain at being excluded or scapegoated, and his pleasure at being loved.” Although Rogers advised the use of empathetic response, he did not work with couples or families. “However, it can be argued that the core conditions of unconditional positive regard, empathy and congruence (Rogers, 1951) can be the means to model the manner in which family members might more constructively respond to one another.” Roger’s therapeutic philosophy was decidedly humanistic: “The organism has one basic tendency and striving-to actualize, maintain and enhance the organism” (Rogers, 1951). Treacher (Reimers and Treacher, 1995, p. 200) remind us that, “A family therapist who actively works at believing in the potential of her clients from a basically humanistic point of view, can go a long way to overcome the inevitable dislikes that she may have for certain users.” I also share the belief in the “forward-moving tendency of the human organism” (Rogers, 1951, p. 489), and have experienced that when I display unconditional positive regard, empathetic listening and congruence to clients-what Rogers called the “necessary and sufficient conditions” for client change-“the actualizing potential of the client will be released and the client will begin to change and grow” (Mendor and Rogers, 1984, p. 164). However, can a Rogerian approach solve the real-world problems of today’s families?  

    Knight (2007) suggests the dilemma in applying the Rogerian model to family therapy is how to respond directively to the family’s needs for answers without interfering with the client’s focus on his inner experience, which Rogers taught was counterproductive. She suggests there are two windows of opportunity when “active problem solving appears most applicable: during initial contact with the client when specific problems are presented, and later in therapy when the client presents specific problems within the context of the ongoing Person-Centered Therapy approach.” In both cases, it is at the client’s specific invitation that an active problem-solving phase is engaged. The therapist encourages the client to brainstorm as many solutions as the client can think of, and then collaboratively, the client and counselor assess the viability of the possible solutions. “In essence, this approach to problem-solving is one in which the client is invited to generate and attend to multiple doors to resolution, or even to have doors presented by the therapist” (Knight, 2000). When clients take an active role in finding solutions to their problems, they may realize they are more capable of managing them than they first imagined. They also build a stronger sense of self-efficacy and self-confidence in active problem-solving. Now we will take a closer look at Gestalt Family Therapy.

    Gestalt Family Therapy (GFT) is a structural therapy in that, “The therapist works primarily with the nuclear family, and therapy is aimed toward altering the structure of the interactions between various family members” (Hazelrigg, Cooper and Borduin, 1987). The philosophy of Gestalt Family Therapy is to develop each family member’s awareness of: interactional patterns, and becoming responsible for their own feelings, behavior, and needs. The role of the therapist in GFT is to provide therapeutic techniques and experiments which can stimulate positive change. “The family is an intimate system in which the behaviors of family members are connected in a complimentary way. Connections among members may be functional or dysfunctional, depending on the awareness, needs, and behaviors generated through such family networks” (Lawe and Smith, 1986). Goals of GFT are to enable family members to “represent themselves genuinely, and to accept and respect that they are separate and different from each other” (Lawe and Smith, 1986). Other goals include re-establishing contact between family members, and expression of feelings which were suppressed or denied. In Gestalt Therapy, the therapist works to improve individual family member’s self-awareness, and the awareness of the impact the client is having on the family system. In each family member’s quest to meet his needs, the therapist uses techniques and experiments to assist the members in defining their needs, expressing their needs, and improving intimate contact with other family members (Lawe and Smith, 1986). “A general goal for the therapist is to assist members in removing barriers they use to avoid being intimate” (Zinker, 1981). As is typical of Gestalt Therapy, GFT explores the following themes: (a) What feelings, perceptions and awareness do members have towards the family, each other, and themselves? (b) How do members deny taking responsibility and manipulate one another to get what they want? (c) What do members expect from each other? (d) What unresolved conflicts do members have with each other? Techniques which the Gestalt Family Therapist will use include: having all members of the family interact, requesting the members speak directly to each other, to intervene only when the interaction is at an impasse, identifying the dysfunctional relational patterns, role playing and the Empty Chair technique. How does the family know when therapy has been successful? “The resolution of conflict, anxiety and guilt may be seen as a basic goal of Gestalt Therapy. The more family members can clearly articulate their wants, needs, and expectations, as well as to understand, accept and support each other, the more the family is in harmony and balance…positive outcomes of therapy witness the increase in the family member’s ability to be responsive to the needs of its members. Members profit from therapy when they can forgive each other and let go of the past in order to accept and love each other as they are, and not as they think they “should be” (Lawe and Smith, 1986). Therapy is also seen as successful when members take responsibility for their role in family dysfunction, when conflict is resolved and resentments dissolved, and when each member of the family feels safe to “be themselves” rather than trying to live up to expectations of one another.

    Certainly, both of these family therapy approaches have merit. It is easier to see how the two models contrast rather than compare; differences in the two modalities are stark. The Rogerian humanist model is client-paced and relatively unstructured in format. It allows a wide berth for exploration of member’s feelings and concerns. Conversely, Gestalt is more structured and therapist-driven. Gestalt employs techniques and experiments which are introduced throughout crucial points in therapy, especially in moments when the member has reached an impasse. An apt metaphor might be to describe Family-Centered Therapy as more democratic, in that it takes into account the family as a whole, seeking to teach more equality and tolerance among family members. In contrast, Gestalt Family Therapy allows each member freedom of expression, need fulfillment and individualism. Although both therapies are ultimately focused on the well-being of the family unit, Family-Centered Therapy encourages family members to conceptualize themselves as a collectivist unit, while Gestalt Family Therapy conceptualizes the individuals as being a part of a family, while maintaining separateness. In comparing these two therapies, “It may be the case that there are effective components and change mechanisms that are common to various types of family therapy” (Gurman et al, 1986). It seems to me the qualities that the Rogerian model lacks (being therapist-driven and introduction of techniques and experiments) Gestalt Therapy offers. And, the qualities that traditional Gestalt Therapy lacks (such as empathy and conformation of the client) Rogerian Therapy offers. I see these two very different therapies as being complimentary. If a Gestalt Family Therapist is willing to incorporate the relational-building principles of Rogerian Therapy, perhaps she will be more efficacious in her task of uniting a divided family. If the Family-Centered Therapist is willing to introduce techniques or an experiment at those moments of impasse when the family is looking to the therapist for direction, then perhaps these two therapies can be modified just enough to meet the demands of modern family therapy. Finally, what does research show about family therapy?

    In a meta-analysis of 20 studies by Hazelrigg, Cooper and Borduin (1987), the results showed that family therapy had a positive effect on clients compared with no therapy and alternative treatments. “The family therapy approaches used in the studies included structural, strategic, and behavioral family therapies, and parent training in client-centered Rogerian methods. Because of the lack of complete information about the type of family therapy used, no conclusions can be drawn about differential effects for different types of therapies.” Certainly, more research is needed in order to establish the overall comparative effectiveness of family therapies. I will next briefly apply both models of therapy to the sub-system of Helen’s family in the movie, Parenthood (1989).

    A Person-Centered approach would work well for this family who have suppressed and internalized a great deal of anger and resentment towards their absent father, and in the case of the daughter Julie, seems to be projecting that onto their single mother. For the therapist to model empathy, unconditional positive regard and congruency would allow them each the opportunity to express their feelings, while looking to the therapist for a role model in inter-family communication skills. The gentler approach which Rogerian Therapy offers would soothe and sympathize with Helen’s plight, and also draw out her reclusive son. Todd has dropped out of school, and a Person-Centered approach might work well to prompt him to problem-solve both his dilemma of being a new husband and what to do with his future. However, in the case of Julie, Gestalt techniques might provide a powerful intervention for her, since she is at least expressing her true feelings of anger. She lacks self-awareness, as she does not understand the impact her rebellion and decisions have had on the family system. Her feelings of rejection and abandonment could be redirected from her mother to the appropriate place: her absent father. Perhaps she could use the Empty Chair to dialogue with her father, to express how his decision to leave their family to have an affair has impacted her life and their family. Family therapy would “take the heat off” of mother Helen in a number of ways: it would allow her to express the suppressed grief over the affair and divorce, and ask for her children’s support in beginning to date again. It also would allow her to make meaningful contact with her withdrawn son, and to establish healthier communications with Julie. With this volatile family sub-system, I would utilize Family-Centered Therapy initially, and gradually introduce Gestalt Therapy techniques to resolve inter-personal resentments, and draw out from each of the family members what they expect from one another and what their individual needs are. I feel using a combination of these two approaches would be a successful way to direct this fractured family sub-system.

    In conclusion, while Family-Centered Therapy and Gestalt Family Therapy have not been considered the mainstay of family therapy models, when utilized together, perhaps they will produce a workable solution for family therapists who are willing to combine the best features of each modality. Therapists who are seeking a humanist, existential philosophical framework from which to build a relationally stable, yet flexible model of family therapy would do well to reconsider how these two “opposing” approaches can work together.

References:

Rogers, C. R. (1951). Client-centered therapy: Its current practice, implications and theory: London, Constable.

Bott, D. (2001). Towards a family-centered therapy. Postmodern developments in family therapy and the person-centered contribution. Counselling Psychology Quarterly, Vol 14(2), pp. 111-118.

 Keeney, B. P., Sprenkle, D. H. (1992). In: The restoration of dialogue: Readings in the philosophy of clinical psychology. Miller, Ronald B. (Ed.); Washington, DC, US: American Psychological Association, 1992. pp. 477-495.

Minuchin, S., (1976). Families and Family Therapy. Cambridge, MA: Harvard University Press.

Reimers, S., Treacher, A. (1995). Introducing User-Friendly Family Therapy. London: Routledge.

Mendor, B.D., Rogers, C.R. (1984). Person-centered therapy. In R.J. Corsin, Current psychotherapies (3rd ed.). Itasca, IL: F.E. Peacock.

Knight, T.A. (2007). Showing clients the doors. Active problem-solving in person-centered psychotherapy. Journal of Psychotherapy Integration, Vol 17(1). Special issue: The Integration of Concrete Operating Procedures. pp. 111-124.

Hazelrigg, M.D., Cooper, H.M., Borduin, C.M. (1987). Evaluating the effectiveness of family therapies. An integrated review and analysis. Psychological bulletin, 101 (3), pp. 428- 442.

Law, C.F., Smith, E.W. (1986). Gestalt processes and family therapy. Individual Psychology. Journal of Adlerian Theory, Research & Practice, 42(4), pp. 537-544.

Zinker, J. (1981). Lies in intimate systems. Newsletter, Gestalt Institute of Cleveland, 1,2,1-4.

Gurmin, A.S., Kniskarn, D.P., Pinsof, W.M. (1986). Research on the process and outcome of marital and family therapy. Insl.

Garfield & A.E. Bergin, Handbook of Psychotherapy and Behavior Change (pp. 565-624). New York: Wiley.