Gestalt Against Depression First part

Link and Integrative Process

By: Jesus Miguel Martnez
- Doctor, Psychiatrist by the Central University of Venezuela.Especialista Dynamics
and Group Psychotherapy for the Institute of Cultural Affaires
CENTURY EPIDEMIC
"... It's like being stuck in a tunnel or a dense forest. Solo. No hopes to get out
someday ... rather thinking it can not get out ... or with the conviction that there is no
output whatsoever, and the absolute assurance that no one can help you. There comes
a time when no longer afraid, no longer causes that keep fighting. You only want to
die and not have the strength to kill you, you just have to want it. "
Thus a patient I described his dramatic experience with this disease that progressively
threat to become one of the worst evils of this century. Depression has been gaining
monstrous dimensions across the world.
Just to give an idea of what previously asserted, I will mention that in 1996 the World
Health Organization (WHO) has hired a team of independent researchers led by Dr.
Dean Jamison, professor of Public Health at the University of California, in Los
Angeles, for a prospective study to identify the major public health problems by
2020. The committee that conducted this study used a measure that emphasizes not
only mortality but also in the quality of life and loss Of the health: "Disease burden
measured in years of life adjusted for disability" (DALY: disability-adjusted life
year), ie the sum of years of potential life lost due to premature mortality and the
years of productive life lost due disability caused by the disease.
In preliminary measurements it determined that by 1990 the main pathologies that
plunged to the individual to a disability affecting the welfare and everyday
performance and killed prematurely, were lower respiratory infections, diarrheal
diseases, perinatal pathological conditions , unipolar major depression, which by that
time occupied the fourth place, ischemic heart disease, cerebrovascular diseases,
tuberculosis, measles, trauma caused by traffic accidents and certain types of
congenital abnormalities.
Projections made by the team of Jamison 2020 indicated that depression threatened to
increase making it the second leading cause of disability worldwide. When the
projections were reviewed by gender, it was determined that to this date the
depression threatened to become the leading cause of disability in women in
developed countries and also the first in the third world countries, above accidents
transit, coronary disease, chronic obstructive lung disease, of cerebrovascular
accidents, tuberculosis, respiratory infections, the consequences of wars, AIDS and
diarrheal diseases were occupying the remaining nine places the list of the ten threats
to the third world.

It is easy to understand why some experts have called depression epidemic century.
According to figures published by the Pan American Health Organization (PAHO) in
September 2001, it is estimated that there are around 25 million people with
depression in Latin America and that could reach 35 million by 2010. Only 15
percent They are diagnosed and receive appropriate treatment.
HELPING THE DEPRESSED: What works?
The role of psychotherapy in the treatment of this disorder is of fundamental
importance. There are three basic ways to approach the treatment of depression. The
first is pharmacological, ie prescribed to patients afflicted by any of the many
antidepressant drugs sold in the market disorder. The second is the application of
certain characteristics of any of the methods of psychotherapy tools, the third is a
combination of the above strategies.
The drug has an important advantage: it is faster, with a good drug treatment
depression symptoms disappear, or at least improve dramatically in an average time
not exceeding four weeks and is sometimes reduced to only a few days, However,
drug treatment is mostly symptomatic, meaning that very often when removing
antidepressants depression symptoms reappear after a few months, the patient
experienced a relapse; They are also more frequent recurrences, the drug does not
prevent the patient sick again from the same box. In psychotherapeutic treatment
relapses are much less frequent and relapses, but the onset of improvement is much
slower than with treatment with antidepressants. Numerous studies indicate that when
both strategies are combined prevail advantages of both, ie with combination therapy
patients are disappearing faster symptoms of depression and are less likely to relapse
or recur when the medication is discontinued.
Psychotherapy has the ability to further improvement of this disorder, which makes
this durable over time and cause changes in the person and his way of approaching
events of their environment, this desminuye notably the possibility of re- sick of a
depressive disorder. But are all effective psychotherapies? Which of the
psychotherapeutic models is most appropriate for the treatment of depression?
There are moments for different theoretical trends about depression and each offers a
particular approach to some aspects in common and some differences. I'll make a
brief mention of which have been considered most relevant.
The best known of these is undoubtedly the psychoanalytic theory that depression
treated as a return aggression towards me in an internalized object that has an
ambivalent subject to the significance of love and hate lies. Based on this view
psychoanalysis explores memory last patient seeking the cause that generates
ambivalence and self-injury, also seeks to strengthen the self that can resist
aggressive impulses of the superego. .

Cognitive therapy, developed by Aaron Beck model and has placed great emphasis on
the experimental demonstration of the results, suggests that depression is a cognitive
distortion, in which the patient suffers as a result of an experience of loss sustained in
a time of patient's life that this could not work it properly. This event causes a change
in the self-evaluation of the subject, the way it interprets its environment and
assessing their ability to manage in the future (aspects Beck called cognitive triad). In
a person high and rigid targets set failures in achieving such objectives are understood
as a profound and unsurpassed themselves default, this will add a feeling of deep
sadness and acute and relentless self-criticism which are characteristic of depression.
Beck argues that depression is an emotional but no cognitive impairment.
Seligman (1974) he proposed another way of understanding depression, according to
which this was caused by a feeling of inadequacy learned [1] , in which the patient is
perceived incompetent to avoid situations of suffering or to control and promote those
that produce gratification and therefore it blames himself. This proposal is known as
the theory of learned helplessness.
From the standpoint of behavioral theory Ferster, Lazarus and Lewinshon, they
raised that depression was the result of a three reinforcement behavioral phenomena:
first, insufficient reinforcement of some behaviors that foster satisfaction and
increase the likelihood of achieving specific goals, second the limited availability of
adequate backup environment and ultimately the loss of effectiveness of
reinforcements available.
Mathews depression considered as a failure of self-regulation that occurs when a
sequence of behavior does not get adequate success in a specific situation, then
individuals spend on phased self-review, self-assessment and self-reinforcing.
Depressed subjects, for certain reasons Mathews insufficiently clear, have a
predisposition to be evaluated as inflexible and thus make autorrefuerzos inadequate
so that spontaneous self-regulation of the subject is lost.
The inefficiency in the establishment of certain relationships was adduced
by Salzman Y Coyne who claimed that depression was because people felt they
had lost the esteem and affection of some very important figures in their environment.
These perfectionists and rigid subjects resorted to a series of mechanisms of coercion
as the request, the despotic demands, manipulation or emotional blackmail to force
people to reintegrate significant affection that they assumed lost.
Finally I will mention the approach of Benton who claimed that depression was both
an attempt to protect the patient from threatening or traumatic experiences as a
mechanism to re-experience the loss to resolve.
When a thorough study is found that all these theories have in common with the
approach that makes the Gestalt psychotherapy around depression. For example, the
interaction between the rigid superego and threatening and some aspects of self that
proposes psychoanalysis in some ways resembles the polarized relationship "top dog"

and "Underdog" posed by Perls. The notion of unfinished gestalt raises similar to
those reported by Beck when talking about the traumatic event of loss not elaborate
mechanisms, a situation that was also proposed by Benton and behavioral authors.
And needless to mention how close you are Gestalt psychotherapy approaches made
by Mathews as the concept of self-regulation bill Organismic is Gestalt. However,
despite the obvious conceptual coincidences about the etiological origin of depression
we have with them many divergent points that will be presented later in this paper.
The most important thing is to note that there are different perspectives on the origin
of depression, many of these approaches have succeeded in reducing depression, but
they have gained greater effectiveness are those that include correcting cognitive
distortions, modification patterns of social interaction and the experiencing and / or
expression of emotions. Gestalt therapists can say that the integration of the
personality, which is the ultimate goal of Gestalt therapy, amply covers all these
components, and this is precisely why the effectiveness of this model on mood
disorders among them Depression is in its various manifestations.
DEPRESSION FROM THE POINT OF VIEW GESTALT
From a Gestalt perspective depression is seen as the product of a conflict between
two segments of the personality that have been disrupted and these two polarized
components of personality were called by Perls as "top dog" and "Underdog."
Actually these two components are a set of introjects and beliefs that have been
incorporated by the patient probably since childhood and which by their nature and
come from people who have a great influence on him, such as his parents or who
made the sometimes they have been incorporated into the personality unchallenged at
any time.
The top dog is a series of elements that constitute a severe consciousness coming
from the outside that was internalized and now part of the patient's personality, these
elements were introjected under the pressure of emotions such as guilt, shame and
fear of being be severely punished or abandoned emotionally and have the function of
caring for the person to do and think "right," "what to" severely punish and make a
self-criticism as a transgression of these rigid standards, is a kind of police punitive.
Meanwhile the dog below embodies a set of attitudes and beliefs used to manipulate
others and they do see the patient as a helpless, inadequate and incompetent to be in
need of compassion and protection of others and constantly receives attacks Dog
above.
Unconsciously the depressed patient splits his personality in these two segments that
show what the person wants to do and what you think you should do, manipulative
embody the victim and the victimizer punitive. The depressed patient breaks contact
with certain elements or people or environment field, with some aspects of himself or
some of the emotions you feel. The way to interrupt this contact is through specific

manipulations. Manipulates people and himself intoned projecting other polarities top
dog and the underdog, the projection does not allow the feeling and expression of
emotions that these parties disintegrated personality will generate so the gestalt It
never ends and the conflict remains unresolved.
Field-Environment Agency
The conception of man's own Gestalt psychotherapy suggests that humans, like all
living organisms are inextricably linked to the environment in which they live and
develop. As suggested by the French Gestalt Jean-Marie Robine we can not refer to
the man without reference to the air you breathe or the gravity that holds together the
ground, or an angry person without being implicitly referring to the obstacles in its
path.
Humans then we body-intone fields, units of influence and permanent transformation
linked interdependently the environment in which origin is given to certain types of
experiences from meeting basic needs to complex brain functions such as learning the
mind, the self, health and disease. On the border of contact between the organism and
its environment the process of organismic self-regulation occurs, whether this occurs
in an efficient manner the subject gives satisfaction to your needs, complete its
Gestalt, if the organismic self-regulation is interrupted by the appearance of some of
the contact resistance mechanisms will take place different diseases, including
depression.
This notion of human beings as a field has its origins in the work of psychologist Kurt
Lewin who develop field theory from the theories of physicists Michael Faraday and
James Maxwell who described the behavior of electromagnetic fields. Lewin found
useful aspects of this physical theory to describe the behavior of human beings in
relation to their environment.
Depression occurs for an interruption or blockage of organismic self-regulation in the
limit contact between the organism and its environment which are part of a unified
field of mutual influence.
Depression in Cycle SRO-Organismic
To understand the dynamics by which it appears, is expressed and depression is
treated according to the Gestalt model is necessary to refer to the cycle of organismic
self-regulation. It is a sequence of events that occur when the individual attempts to
satisfy their needs or desires. Gestalt psychotherapy studies and contact addresses,
that is, the complex relationships that occur on the border between the organism and
its environment, all contact is a process of organismic self-regulation, that is, an
adjustment between organism and environment. In this process the experience is the

process done in the field and the field is created, and then removed from contact with
the border that unites and separates the organism and its environment.
The head of the experience is the excitation energy. The excitement makes the
experience flowing through the cycle of self-regulation. This flow may be hampered
by bygone events or present life of the individual which generate emotions and carry
blockages in the flow of excitation through experience cycle. Some of these blocks
that disrupt the contact are responsible for depression.
The way humans tend to meet your needs from the simplest as a physiological need
to complex, a desire, an attraction, an instinct, an emotion or an unfinished situation
requires an energy we call excitement mobilizes through a series of steps in the cycle
of self-regulation. I will use as an example the resolution of a physiological need as
thirst and you know that this can it happen with the satisfaction of sexual desire, with
the treatment of a phobia of heights, developing a grieving the loss of a loved one or
the emergence and treatment of depression, of course each with its peculiarities and
complexities. A person at rest or perhaps engaged in other activities like reading a
book or having a business conversation perceived as a need arises, initially it's just a
confused, vague, vague feeling but it attracts attention and disturbed rest or other
activity, that is the stage of feeling.
Like: Surge, gradually or suddenly emerges a figure that stands out from the
undifferentiated background. This figure can be a periodic pulse requiring satisfaction
of a part of the environment as hunger or thirst sexual desire; or perhaps a nonperiodic stress related more to the body internally as a digestive upset or a toothache;
also an emotional need as love or disorders caused by changes in the environment as
lost or affective labor problems, perhaps physiological adjustments in response to
changes in the organism-environment field ranging from temperature variations to the
recovery of a cerebrovascular accident vascular.
The feeling becomes more precise and definite and is identified by the individual
stage entirely realize how thirsty, then it is recognized as a body belonging to own
need.
Realize: The picture that emerges becomes the focal point of interest in the
individual's conscious experience in the here and now. It is characterized by an
intense sensory, volitional, behavioral, emotional and cognitive experience and a
strong sense of belonging, is no longer a desire, feeling or need, it is my desire, my
feeling or my need.
This need and disturbance generated differ in the subject an amount of excitement
that will be aimed at meeting the need, is the stage of mobilization of energy, in
which the subject defines strategy and mobilizes volitional elements that need to meet
the thirst.
Energy mobilization: Active self excitation resources, the needs are completely
defined generated images will energy and possibilities of satisfaction, the motor

system is activated and senses open to information on the environment in search of

the possibilities in this to satisfy the desires or needs
The mobilized energy is transformed into action, environmental resources that are
considered adequate to meet the need and the subject moves into them are selected.
At this time the subject gets up and heads for the nearest source of drinking water.
Action: To choose and implement appropriate action, perceptual, behavioral and
emotional activity is organized, the obstacles are evaluated and the action that must
be responsible for resolving the tension generated by the need is undertaken.
The Agency contacts with elements of the chosen field as adequate to satisfy the
need, thirst in this example, then take the water poured into the glass and swallowed
Contact: Our sensory and motor functions facilitate contact with environmental
elements of the field whether these objects or people, or personal items such as field
memories, images or other aspects of self to meet the need. All contact occurs at the
boundary between the self and the environment.
After the final phase of the contact contact occurs, when the subject appropriates or
field elements that satisfy the specific need, water is assimilated satisfying thirst.
Final touch: A part of the environment has been incorporated into self with both the
self and the environment are transformed to generate a momentary disruption in the
organism-environment field is modified. For a moment the figure becomes the only
gestalt in existence, joins perception, movement and emotion experience intensely
expressed in the body either satisfaction, joy, sadness or sexual climax.
Then the stage of satisfaction that the subject is clear of the field with the embedded
element and assimilates the experience occurs. Thirst is gone.
Satisfaction: Characterized by a sense of satisfaction and relief at the disappearance
of stress, reflection on the importance of the implemented resources, learning and
assimilation of experience. The excitement comes to an end and the figure is
weakened. Intone self and now have a new configuration have been changed.
The subject content is removed again enters the resting stage or fertile vacuum
pending the next need.
Between each of these steps in the sequence blockages caused by different
mechanisms of resistance as mentioned some may lead to the occurrence of a
depressive disorders can occur.
Observation and clinical experience have shown us that different mental pathologies
disrupt or impede the flow of excitation or energy through organismic self-regulation
cycle (also known as cycle or cycle gestalt experience). Several authors have tried to
find a clear correlation between the specific point in the cycle in which the flow of
excitation is interrupted and various diseases and even more between the diseases and
the mechanism by which the interrupt occurs, has also been tried,
linking

mechanisms of resistance to particular times of the cycle of self-regulation. These

attempts have some few coincidences and numerous disagreements. But what is
phenomenologically evident is that there is a relationship between interruptions and
pathologies, from a clinical point of view, it has been amply demonstrated that the
techniques that restore the flow of energy through the cycle and helping the patient
eliminate contact resistance mechanisms associated with the interruption produce
improvement or disappearance of the pathological picture transient or permanent. The
clinical picture is also related to the resistance mechanism used to promote the
interruption.
Severe depression, according to the hypothesis of agreement should consist of a break
between the withdrawal and the new sensation through the mechanism of repression
or energy between mobilization and action through retroflection. However, the reality
is more complex and less ideal than these authors has glimpsed. As pointed out by the
French Gestalt Anne and Serge Ginger and British Petruska Clarkson, experience
reveals that most of the mechanisms of avoidance (introjection, projection,
retroflexion, confluence, etc.) usually occur at different times of the cycle of
organismic self-regulation. And it has also become apparent that a condition can be
determined by various resistance mechanisms that exert their effect at various times
in the cycle.
Depression can be so deep that the subject hampered their ability to have experiences
of himself and the environment, is isolated in his bed, he sleeps hold and lose the
ability to feel pleasure in things you once liked them, even to not perceive hunger
signals your body sends you; in this situation the avoidance or resistance mechanism
is known as desensitization interrupting the feeling that this is the first step of the
cycle of self-regulation. At other times the deflection mechanism through which
direct contact with their own experiences or the environment interrupts the full
realization, the patient can then say phrases like "okay I was orphaned, but it actually
prevents it orphan're born alone and always alone "thus does not establish a full
contact with the pain of loss but is able to perceive his presence.
Other patients achieve adequate notice of the loss and pain that this causes, but are
unable to mobilize their energies to establish contact with environmental resources in
these situations is common that some beliefs introjected prevent the mobilization of
energy or contact with the environment is needed for the resolution of the gestalt,
they were heard saying "... if it really hurts that has left me but I will not talk to her to
fix anything, if humbled me worse." The contact can also be interrupted by
retroflexion of emotions such as anger, then the patient begins to make himself what
he would do to others and initiates a series of autorecriminaciones and even
physically attack each other in various ways. It looks like depression may be
mediated by disruption of the cycle of experience at different times and by different
avoidance mechanisms.

DISTINCTIVE ASPECTS OF GESTALT

General features
The gestalt psychotherapy has some features that differentiate it from other
psychotherapeutic models and in which much of its effectiveness lies. There are
certain fundamental aspects that together make it very different from other models.
First you are given much more importance to the phenomenological experience of
subjective experience, that is what the patient experiences in a given situation and as
experienced; in the psychotherapeutic context it is emphasized bodily sensations,
gestures, postures, facial features, blush, involuntary trembling, etcetera. The verbal
speech and intellectual understanding, but are also considered to have a less
prominent place to the feelings, emotions and how these are manifested; We
understand that experience is the main way of learning and change.
The second aspect is to work in present time, with the patient's experience in the
"here and now". This does not mean that the relevance of past declines in the genesis
of diseases or trends patient to act in one way or another to their conflicts; it is
considered that past events like souvenirs or any unfinished business and future
situation as a fear or expectation, affect the present moment the subject generating
emotions, thoughts or volitions which have to be addressed in its current meaning in
the current therapeutic process.
The gestalt psychotherapy takes man holistically, as an integrated unit, we see no
difference between psyche and soma, between mind and body. The human being is
inserted to their environment in close and interrelated way, so do not think that the
distinction between diseases of the mind and the body has diseases meaningless, like
the distinction between organic and functional disorders or endogenous and
exogenous depressions . These distinctions are supported by a narrow view, restricted
by theoretical dogmas or lack of information from the limitations of the diagnostic
methods. The human being is unbalanced, it disrupts globally, as a whole, where
what happens emotionally affects the body and vice versa.
Living beings are self-regulatory organizations in the homeostasis plays an endless
series of actions to stop bleeding from a wound, to develop emotional grieving a loss.
The psychological mechanism of homeostasis is known as organismic self Gestalt
psychotherapy. This is for all living things tend to bond with your environment more
harmonious way that is permitted, he performs with his environment a creative
adjustment that leads to give you the best satisfy their needs. In this conception as
symptoms and disease entities they can not be considered only as failed attempts at
self-regulation, or what is the same maladaptive to interact with the environment to
meet their wants and needs forms. It follows that the therapeutic job is not to fight

disorders or remove disease, but to help patients increase their resources and potential
to find themselves the path towards freedom, self-determination and health.
Gestalt psychotherapy as was raised by Yontef It is an existential dialogical
relationship based on the particular form of communication that characterizes the
gestalt dialogue and backed by the statements of Buber's I-Thou relationship. This
relationship model argues that there are several people (patients and therapist) that are
equally important and different functions in the therapeutic situation, and that both
are responsible for developing the process and generating the new experience of
reality that has come to call health.
And finally in psychotherapy gestalt great importance is given to the patient's body,
the body expresses emotions, conveys important information about the individual
personality and its disorders and is also an important vehicle for the integration of
dispersed aspects of personality.
On the Nature of Emotions
Mentioned under the previous title has the consequence that the Gestalt have a
particular way of understanding emotions. In classical psychological literature on
emotions he has dominated a focus on the grief and sadness that has made a huge
emphasis on loss and significant in explaining the emergence of feelings of sadness
and mourning separations. However, separations and losses are part of the daily
experience of everyone, every day we experience losses and in many situations
without realizing it.
The aging, the growth of our children, the development of our relationships makes us
go from one stage to another losing much of what is related to the previous one, job
changes, academics, family and the crowd and changes occurring in our environment.
They represent a number of missed, gestalts that are destroyed to make room for the
formation of others. Any change means the destruction of our organism-environment
field to allow the formation of a different giving us the opportunity to evolve and
perfect. We got married, broke up, our children are born and then grow up and move,
change jobs, move our friends and make new friends, get older, our parents die and
nothing to change.
Sadness is an inherent excitement to the occurrence of are lost and these
transcendental or daily, meaning that sadness is inherent to the occurrence of
changes, the process of formation and destruction of gestalts. When not welcome
moments of grief and sorrow when a habit becomes evade, retroflection mechanism
leading to depression rather than the physiological duel starts.
We live in a hedonistic society that favors triumphant initiation and disqualifies lost.
Many people feel ashamed of situations that are natural to human existence.
Retirement, aging, divorce, the departure of the children, menopause, failures, and so
they are no longer opportunities to learn or passages of a life to another state and have

become sources of shame that people want to hide. When the formation of gestalts on
the destruction of these is privileged, you live in the future without assuming the
present or the past complete. People fail to complete their getalts evasively. The result
is the accumulation of unfinished end. And the inconclusive end inevitably lead to
distorted early neurosis that fill the existence of these subjects.
Some important conclusions are to be stated about the nature of emotions to properly
orient the work of depressive in the light of the knowledge of Gestalt psychotherapy
disorders. First. Emotions are neither positive nor negative or destructive, neither
good nor bad as so widely held; Most of our emotions are part of the genetics that
come into the world and are at the service of the survival mechanisms in this regard
are useful, which can be rated as good or bad is what we do with them, but these our
actions are not our emotions.
Secondly emotions have purpose and meaning, they are useful for something, anger
prepares our body to fight; Fear triggers a series of physiological mechanisms that
facilitate a quick escape; love is responsible for that emotional ties are established to
ensure the survival of the offspring and sadness provides the repetitive thought and
contemplation enough to reflect on the causes that originated and pretty causing
discomfort to learn to do something useful with such reflections; emotions arise in us
as an effect to events in the environment, an effect that generates a series of faster
than thought itself, in circumstances where reflection can be slow and
counterproductive behaviors; when humanists say that man is wiser than the intellect,
there is concern that the choices we need to handle more information than what gives
us our conscious part, is where the emotions, when, how involved and who we fled,
who attack or who we fall in love, they are not conscious decisions that are actively
involved in emotions.
Moreover, it is important to remember that emotions can not be controlled or
suppressed, control or suppress what is consciousness or expression of emotion;
control of emotional expression is a form of disruption in the cycle of experience and
a way to not take responsibility for certain actions. A very important aspect of Gestalt
psychotherapy is that people can turn to express their emotions in a constructive way
and this is the most suitable to do with them as catharsis does not eliminate or drains
emotion.

Gestalt Against Depression Second part

Link and Integrative Process
By: Jesus Miguel Martnez
- Doctor, Psychiatrist by the Central University of Venezuela.Especialista Dynamics
and Group Psychotherapy for the Institute of Cultural Affaires

THE PURPOSE OF DEPRESSION

Mentioned in the previous section what is the purpose of sadness, now I'll do the
same in relation to depression by the clarification that there is the same phenomenon.
Sadness is a healthy, functional emotion while depression is sadness dysfunctional
and its purpose is far from help or protect us but the reality is that it has that intention.
Depression as a way to manipulate relationships. Depression often, in many cases, be
an attempt to manage relations with interpersonal issues that are significant to the
patient. Usually with close relatives. With its symptoms the person has obtained
power over the family, makes everything revolves around your depression, you get
the centrality and relevance that may have lost or can not otherwise obtain. Another
common dynamics in a family member is depressed to prevent somebody else to
collapse, leading to a strong position because this would have to take care of look
after him.
Depression as a form of loyalty to the significant links
A frequent observation in depressed patients is the relationship between depression
and some very traumatic events suffered by people very close such as the rape of a
family member, an accident or illness that caused the invalidity of any of them,
suicides of parents or siblings, mothers who die in childbirth of the patient, family
members or die premature deaths shocking and so on. In this case patients surviving
loved ones lost trying to repair such offering his health, his happiness or his life in
sacrifice, to make an unconscious repair depressed, give up what others can not reach.
Depression as a form of self-harm
It is the defense mechanism proposed in psychoanalysis as aggression turned against
the self, and is known as retroflection in Gestalt psychotherapy. In certain situations
people are confronted with impotence and can not externalize distress, at other times
feel anger toward someone or something and instead of expressing the repressed. In
such cases it is common for the rage that no action be against the patient in the form
of self-harm. The self is divided into an aggressor and attacked, and the person begins
the endless accusations and insults to himself that are characteristic of depressive
disorders. Gestalt Psychotherapy for depression is a form of communication that tells

us something about how the patient structure their reality, a way and a consequence
of break contact and more than a disease, is the best way that a person has to adapt to
their circumstances. If dispusiese a more appropriate way would use.

Pattern depression and treatment strategies

Ann Clark (1982) published in an article setting out his observations about the
psychotherapeutic work with depressed patients, the sadness had argued that a kind of
pattern and that happened in three stages or phases: the phase of withdrawal,
emotional response and existential acceptance of these three phases have different
characteristics and also imply that the therapist's work and approach the guy who
carries out their depressed patients must be different in each of these three
different moments.
Phase Withdrawal
This is the first stage of depression when the person becomes aware that an imminent
or inevitable change is coming, this is a moment of paralysis the person remains in a
state of apathy and apathy is unable to take adequate or perhaps unable decisions take
any decision, this makes it extremely difficult to contact and do not feel able
to influence the, organismic self-regulation fails and the individual is removed from
the field to the self, the body contact limit thickens environment defensively . The
patient is removed, breaks contact
This does not always have a negative meaning, sometimes this withdrawal is a way to
slow the impact of changes to assimilate as progressive, so that the resources that
then can be scarce or poorly suited for the challenge that faces are not overwhelmed.
In this circumstance insist that the patient Face the reality or insist on the realization
can be very inappropriate, we can make the resources of the person who is in a time
of great vulnerability collapse leaving even more helpless. It is time to observe, to
rely on self-regulation of the patient, letting him accompany being aware of what is
capable of realizing. The best therapeutic approach in the period of withdrawal may
be broach such withdrawal, explore the mechanisms of resistance without fighting
them. This reluctance to embrace change is the expression of the will to live the self
clings to a form of existence that is threatened by change.
The reluctance to accept change is the affirmation of life (Ann Clark 82)
Later in this stage when you are past the initial time the patient's resources are
overwhelmed by the impact of changing the therapist trying to promote some
concrete actions that put the patient in a position to start scanning the organismenvironment field and resources that may exist to address this situation and, if
possible, encourage the exploration of such resources in the therapeutic context. This

time to build together with the patient a bridge from the defensive retreat to the
grieving process.
The therapeutic work during this stage is then to allow time for the healing of the
insulation component first, then encourage the individual to perform less isolated and
that are meaningful in the sense of bringing the patient to contact activities and
maintained throughout the process connected with the person in isolation. For this,
the therapist must use certain personal resources such as sensitivity, timing and time
and a very efficient capacity personal contact. As Ann Clark says the therapist should
notice the power balance between passive withdrawal and active energy indicates the
arrival of the stage of emotional response. The end of this stage is marked by change,
by the acceptance of the loss and body-scanning intone to overcome field. The end of
isolation is the beginning of the match.
Emotional Response Phase
We are facing people who have lost a part of your life means, which is to say that
they have lost a part of the self. They feel incomplete and overwhelmed by intense
emotions. It is common to depression and sadness associated this is the emotion most
frequently addressed in psychotherapy but there are other emotions that overwhelm
the patient throughout the process that must not be neglected by the therapist and no
time. Fear of the future almost permanently accompanies those who have had
significant losses, a fear that can inhibit experimentation and hinders all contact from
the wetted to the contact with their own emotions and resources. The therapist will
have to build trust and encourage the patient to regain the self-confidence by helping
you contact the agency resources-environment field. All this must be done without
pressure on the patient and not lose sight of that fear is not an enemy, rather it is a
source of caution and prudence that the patient may need a lot in this vulnerable
state.
Another frequent and intense emotion at this stage is anger. Unlike what curre with
the fear that is dispersed in various degrees and shades throughout the period, rabies
is usually episodic and alternate with sadness in polar form. Arguably rage and
sorrow are the emotional response of contact and withdrawal. It expresses deep
sorrow unhappiness loss, dissolution of the self that has been expressed anger and
frustration and helplessness before the inevitable loss but also guide the individual
towards new activities and new commitments.
Ann Clark argues that there are three areas in which this polarity is expressed anger
and sadness. The first is related to the unfinished gestalt of the individual's history,
recent losses are added to the burden of grief that come from previous injuries or
losses that may belong from a very early life stages until recently, psychological
defenses individual unfinished business decreased by these allow the sum of the
burden of grief so that the current frame be much more dramatic, or a loss that could

have caused only a period of no pathological mourning turns into a deep depression.
The second area is that of the other immediate experiences other than the loss in
which no emotional conflict, it is important and conflicting relations contained are
made during periods of severe loss due to the contact surface of the individual with
others their environment is disturbed by the previous withdrawal or improper
handling of anger or for fear of losing then other relationships that are significant, the
depressed person can project the anger of the lost of their loved ones or turn into
excess applicant before the fear of losing.
Finally we found the area where existential anger and sadness as alternate losses and
changes make the person is deslazada outside their safety zones. Rabies is usually
aimed at impersonal entities such as God, life or the universe, sadness is strongly
linked to the knowledge that our lives will never be the same, losses require us to
rethink who we are, what is the meaning of life or for serving our existence, then we
confront the unknown and we are powerless to control.
The appropriate therapeutic approach in the period of emotional response is crucial as
this depends on the resolution of depression to take place in the next stage. Chronic
and recurrent depression, treatment resistance and relapse often fixings at this stage to
make the patient close in a vicious cycle of recurring rage and sadness. The
therapeutic work will be to guide the patient in a process that has to reach first realize
the different emotions that are seizing, will differentiate the anger and sorrow of the
other emotional responses of affliction; also you must be able to distinguish between
emotions unleashed by the unfinished gestalt, those caused by conflict and those due
to present their insecurities and existential dilemmas.
The therapist must be able to support the emotional expressions from the crying, the
moodiness and even explosive anger, also the irrational fear that usually occurs in this
period and that during the deep experiences of emotional discharge limits are lost
between the self and the environment and the patient is frightened at the prospect of
losing control of their emotions "... I do not want to mourn because if I start I do not
stop ever," they say. It is important to stress that the work of the therapist is not to
force a situation, it is allowed, facilitates and supports the expression of emotions but
not forced in any way. It is very important to help the development of emotions such
as fear, shame, guilt, hopelessness, envy, frustration and many other emotional
components that are present in this period.
Blame deserves special attention because it is extremely common for depressed
patients responsible for their losses accrues and guilt is unconsciously linked with the
notion of punishment and penance and this can lead to attempts to punish through
retroflexivas that self-harm should be avoided. In this period the therapist must be
able to tolerate the emotional response without forcing and without anxiety at the
violence of expression. A common mistake of therapists in this period is trying to

delete, forward or cushion the impact of emotional shock. This phase ends with the
disappearance of tears and anger.
Existential Phase Acceptance
At this point the person makes a reassessment of his life in the light of the events for
which he has gone through. What began as an emotional response begins to integrate
with the cognitive components of that experience and earlier. The patient tells his
story repeatedly reliving the loss repeatedly, and on each occasion is assigning and
reassigning meaning to the experience until the result seems appropriate since
emotionally and cognitively, then understanding and learning that do arise Copper
sense that the experience and would constitute a present experience able to reassure
and define the future. Existential anger and sadness are integrated with cognitive
experiences causing the patient to explore their responsibility for the events,
questions why did this happen to me? and why it happened to me right now? They are
more than one complaint, are a close contact with the mistakes, carelessness and
incompetence of the past, these questions now demand a coherent response which
becomes a tool to guard in the future. a dramatic and emotional negotiation with
existence, with God and with himself, consistent proposals appear to face similar
situations and alternatives are explored in an almost obsessive way, "If I had done ..."
"If I had said it begins ..." They are leading a multitude of alternative proposals.
These proposals represent a strong commitment to change.
The hopelessness caused by current loss experience and any earlier due to therapeutic
interventions begins to give way to acceptance and learning, self integrity is restored.
The integration of polarities weakness / strength, guilt / responsibility, virtues / flaws,
efficiency / consistency inability to confer self and this is manifested by an efficient
interaction of cognitive, emotional and behavioral components of the individual's
existence. But at the same time people learn to manage in a world where there's
uncertainty and ambiguity
In this period the therapist must take an active part in the integration of polarities and
the use of suppressive techniques to stop attempts to stop the increasing contact of the
individual and the body's resources-environment field. If the therapist self-conscious
at the intensity of some emotional expressions or before the drama of some cognitive
constructions may hinder the emergence of gaining acceptance only an attitude of sad
resignation. The therapist does not explain, comfort, tackles acute and consciously to
promote the integration experience of loss.
Techniques used in Gestalt Psychotherapy
Perhaps the best known systematization of intervention techniques used in Gestalt
psychotherapy is the one made by Claudio Naranjo. These techniques aim to develop
in the patient a triple attitude that consists of an ability to become conscious personal

experience, an ability to live in the present and the ability to take over their
responsibilities without incurring games and manipulations. Gestalt techniques are
grouped into three categories.
Expressive consisting ask the patient to repeat a gesture, a posture, a movement or a
cry or that exaggerate with the intention that the patient comes into contact with
repressed emotion, or a hidden belief.
Suppressive techniques that aim to lead the patient to take responsibility for their
existence, by improving the way they express the facts that makes the emotions and
thoughts and housing; To do this, the patient is encouraged to delete a series of verbal
expressions intended to shift out of it the burden of what happens to him, we prefer
that patients talk to who have difficulties to talk about them, although it should be
done through the strategy of the empty chair, the story is not important, but the
emotion and impulses that move with direct communication person to person.
Moreover, when someone talks about what is happening it tends to make judgments,
to try to explain intellectualizing and away from the feelings that this will occur. This
is what gestalt known as the scientific game.
Patients are also encouraged to avoid clichs such as "I feel good," to mention the
excitement you feel, "I am happy" or "I feel calm, calm "they are much more
expressive and help people to be explored in search of their emotions. Diagnostic
philosophical explanations and games are avoided. The "debesmos" or religious
games are also rejected in the gestalt model of communication as they serve
predominantly for manipulating, inciting others in the emergence of emotions like
shame and guilt. "I must" or "have to" are changed to "want" or "prefer". People
make more decisions that actually agree to take and a lot of times seek to blame
others, or circumstances, the decisions they make.
The technical integration of the elements disintegrated personality, seeking to
integrate these components of personality that have polarized or never merged, it is
done through a strategy that is one of the cornerstones of psychotherapy gestalt, it is a
of the best known and successful integration tools: Empty chair the call. This is a
physical space (chair, sofa, cushion, etc.) in the therapeutic practice, intended to
accommodate the disintegrated parts, opposing parts of the personality of the patients,
which act as opposing forces in a specific situation in life East. It can also be
occupied by the internal representation that a person has of those who interact with
real people in their daily lives. Through the empty chair is conducted a dialogue
between the parties of personality emerge negotiations and integrate and reconcile the
scattered and conflicting aspects. Patients placed in the chair in front of him to part
with it will interact and changing seats, all parties acting as a theatrical performance
full of emotional nuances.
In Gestalt also working with dreams in Gestalt conception dreams they must be
interpreted by the dreamer with the assistance of a psychotherapist. Each element of
the dream represents a segment of the personality of the dreamer. So if someone

dreams, for example, which is in a desolate house talking to his grandmother, each of
the elements of this dream represents a part of himself that conveys a valuable insight
into his unconscious attempts to find solutions to the difficulties, which the individual
goes through in her life watching, consciously or unconsciously. In therapy gestalt is
not a unilateral interpretation of dreams is made, counting as a past history. It is as if
reliving a fact that is happening in the present, each component act, interpret for each
person to be involved in their sleep and reinstate all the personality of the
segments represent.
To conclude
Gestalt psychotherapy is not an impromptu invention, it is a current scientifically
substantiated by a method, a philosophy and a structured research that makes it closer
to the social sciences body. Heir of psychoanalysis, Gestalt psychology,
Psychotherapy Existential, Phenomenology and Humanistic Psychology among other
influences. Has years of tradition, experience and a growing body of research that
supports the methodology and results presented in this paper.
Gestalt Psychotherapy is among the six most effective current professionals with
more research, formed through the world and more demand from patients.
This work aims to show how we understand and how we deal with one of the diseases
that plague humans in this century. Also as we learn from our experience and we let
go of the dogmas, to be in resonance with the challenges of ensuring balance, wellbeing and mental health of our patients and help them recover them when necessary.

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