How To Use Gestalt Therapy To Diagnose Personality Disorders? What people need, want, and fear reveals their diagnosis.
Written By: Elinor Greenberg
- People with personality disorders are still preoccupied with their unmet interpersonal needs and problems from childhood.
- They unconsciously project these desires, fears, and needs onto their current adult relationships.
- The Interpersonal Gestalt describes what people notice and what they ignore in interpersonal situations.
One of the difficulties that clients face when looking for a psychotherapist to diagnose and treat their personality disorder is that so few therapists actually have the necessary training to do so. This is mainly because the traditional methods of teaching this topic involve many years of study with difficult-to-understand experts who write in obscure professional jargon.
In an effort to encourage more psychotherapists to learn about the differential diagnosis of borderline, narcissistic, and schizoid disorders, I have developed a simplified way to make these diagnoses that is based on the Gestalt therapy theory. It is easy to understand and can also be used informally by observant non-mental health professionals. I call it “The Interpersonal Gestalt” (1999).
This method has its limitations because it relies on what can be observed across multiple interpersonal interactions and on the awareness of the observer. However, I have taught it to many psychotherapists who find it a useful introduction to a difficult subject. It can be supplemented by using more conventional diagnostic systems if the need arises.
What Is The Interpersonal Gestalt?
My concept of the Interpersonal Gestalt is based on the Gestalt Psychology theory of Figure/Ground formation (Wagemans, Elder, Kubovy, et al, 2012). This basically states that at any point in time, there is more data available to our mind and senses than we can possibly process. Therefore, we automatically prioritize certain types of data over other types. In interpersonal encounters, we tend to make an organized whole—a figure—out of cues that relate to our current desires, needs, and fears. Everything else becomes part of the invisible background.
Gestalt is a German word that refers to an organized whole that is more (or different) than simply the sum of its parts. For example, a melody is perceived as an organized whole and not just a series of musical notes. Its effect on us emotionally cannot be predicted simply from the individual notes.
How Does This Relate To Diagnosis?
If we had a good enough childhood, most of us are able to relate to other people in a fairly spontaneous, flexible way. We are open to the actual person and situation in front of us. However, if we have a personality disorder, we tend to automatically and unconsciously project our old unmet needs and fears from our childhood onto the new situation. We may misread the current situation and the other person’s intentions because most of what we are noticing is based on our past. Other potentially important interpersonal cues become part of the unseen background.
As a result, we can distinguish the three major personality disorders—borderline, narcissist, and schizoid—from each other by what the person repeatedly notices or ignores during interpersonal encounters. As you can see below, the primary desires and fears of people with borderline, narcissistic, or schizoid disorders are quite different from one another.
1) Borderline Interpersonal Gestalt –
Unconditional love, nurturing and reparenting.
Abandonment, rejection as unlovable, or engulfment by the emotional needs of the other person.
2) Narcissistic Interpersonal Gestalt
Self-esteem enhancement, admiration, attention, increase in social status.
Loss of self-esteem, being exposed as imperfect, public humiliation, and diminished status.
3) Schizoid Interpersonal Gestalt
Safe intimacy, independence, predictability, and control over interpersonal distance.
Loss of autonomy, intrusiveness, loss of the ability to connect, existential dread.