Basic therapeutic skills in Gestalt Therapy

A review of the qualities that allow a good therapist-patient communication.

Thinking back to the different interventions I have been able to do in different workshops and therapeutic processes, in particular those that dealt with the establishment of roles, I would like to reflect on the important role of therapeutic listening, in particular the gestalt listening.

Observations and analysis that have brought me many conclusions about the role it plays in that double direction about the self that every therapist seeks: inward and outward.

Learn more: "Gestalt Therapy: what it is and what principles it is based on".

Clarifying some concepts

Inner listening

The inner listeningas the ability to question oneself from self-observation, is nothing more than the virtue of looking inward, of allowing us to become aware of ourselves and to pay attention to those processes that are awakened in the established communication.

Although "being available to the other does not mean forgetting about ourselves" (Peñarrubia, 2012), the harsh self-criticism that arises from "keeping up appearances" in therapy -such as the attention to the self in the experiential process-, forgets that gestalt therapists not only attend to what is happening to the other, but must also be aware (be conscious) of what is happening to them at that very moment (in the here and now).

Inner listening

This inner listeningwhich at the beginning we thought was a burden for the patient's mindfulness, gives way to a friendlier version, exemplifying the excellence of its method as accompaniment, without having to interfere in the attention of our interlocutor.

Paraphrasing J.B. Enright (1973) we exemplify this new vision and awareness of what is alluded to here: "To carry out a suitable clinical task, mental health professionals need to have access to the flow of their inner experience. The first and most subtle clue to understanding the distress, the hostility...of the other, is awareness of some similar or complementary state in oneself."

External listening

With regard to external listeningIn external listening, it is forgotten that more important than listening to what is said, is to decipher how it is said. It is common to observe, then, how listening to verbal content is important (showing our ability to listen once again with the repetition of what we have attended to with maximum fidelity: words and textual topics transmitted), but even more important is listening to non-verbal content.

In my experience in group dynamics, although we develop attention and concentration on words and topics, we relegate gestures, voice tones, body posture, which, more than words, provide us with more sincere information than their narration in sentences.

Undoubtedly, this shows that a good therapist should not only limit himself to a passive listening of what is presented, but should also must actively pay attention to the sound of the voice, its tones, the rhythm of the musicality in his words, because, in short, verbal communication is not just a matter of listening passively.because, in short, verbal communication is nothing more than a lie (Peñarrubia, 2006).

My experience in congruence with the above has allowed me to understand that in addition to listening to the words, we must pay attention in a more conscious way to what the voice tells us, what the movements, posture, facial expression, psychosomatic language narrate; in short, and in the words of Fritz Perls himself (1974): "it's all there, if you allow the content of the sentences to play second fiddle".

Keys and benefits of therapeutic listening

Therapeutic listening should be seen as an attitude: availability, attention, interest for the other... If we materialize it in two inseparable operational lines (listening to content and perception of form) we will understand the purpose of the training that every good therapist must attend to:

• Listening to the content (what the other says), retain and reproduce it literally; it is a test of attention. Considering the purely theoretical character of its explanation, we find that, almost permanently, what is forgotten, what has been changed, corresponds to or points to conflictive areas of the therapist, referring us to unfinished business and alluding to the therapist's own inner world. We could conclude that memory is therefore selective and that both what is rescued and what is discarded allude to the therapist's neurosis.

• Listening to the non-verbal requires the therapist to be a good observer, a capacity and perception that transcends the therapist's neurosis.This is a capacity and perception that transcends words. The attention of the how over the what, betting on the nonverbal in case of dissonance.

Communication in Gestalt Therapy

We have spoken of the attitude of gestalt listening, which inevitably leads us to speak also of a certain attitude of communication (communication in Gestalt). It is already common in the workshops, the correction in several colleagues, among which I find myself, of forms of expression that distort the rules of communication in Gestalt.

Here are some examples of the most common ones (Peñarrubia, 2006):

• Talking in the third person and in the past/future tense is perhaps the most frequent correction during therapeutic processes. The theoretical basis that sustains this correction of the tutor that forces us to "speak in the first person and in the present tense", states that impersonal language dilutes the responsibility of what is being said. Speaking in the present tense (even when talking about the past) facilitates the experience, making the emotional content of the narrated experience accessible and available.

• Not taking responsibility for the expressionThe patient is recommended to incorporate it as the discourse progresses, with the introduction of phrases (that facilitate taking charge of what is being narrated). Examples of these experiences in real sessions are: expressions about "I feel that my neck is tense", being able to make the patient responsible for this experience in a more committed way from "I am feeling tense".

• Use of the conjunction "but" instead of "and" and the interrogation "why" instead of "how".. It is common in the clinic to ask questions about the "why" trying to get some rationalization or explanation, having to exercise the devolution of that relational dynamic. This will never lead us to a global understanding and that if we switch to the "how" we will look at what is happening, observe the structure of the process and it will give us perspective and orientation. Likewise, with the use of "and" instead of "but" we will avoid the dichotomy of language, integrating instead of dissociating.

Gestalt Therapy and the therapeutic relationship

To conclude and going back to the origins of Gestalt Therapy, we are indebted (either by position or by opposition) to Freud and his psychoanalysis (Rocamora, 2014) :" what a relationship damages in its origin or infancy, another can heal it- psychotherapy", allowing when speaking of therapeutic relationship, to detect certain models of patient-therapist relationship. Relationship that when speaking of gestalt listening, highlights the peculiarity that in relation to its fundamental principle of "awareness", points to an interaction where the therapist (the self) is used as a map of reference or experience with his patient (gestalt balance).

What attitude should we then maintain: "to hear? or to listen? If listening is something that is done intentionally and hearing is something independent of the will, in Gestalt Therapy the former is the priority. This, in congruence with the objective of the therapy (focused more on processes than on contents), emphasizes what is happening, what is being thought and felt at the moment, rather than what could have been.over what might have been or could have been. Listening in a global way, as we are shown in the workshop (verbal and non-verbal), is therefore the key to the success of a therapeutic process.