Living with Uncertainty Without Anxiety
Gestalt’s concept of anxiety as conceptualised by Laura Perls
Often we treat anxiety as something to be reduced, managed, or eliminated—a problem to be solved through identifying irrational thoughts, confronting feared situations, or adjusting brain chemistry. Gestalt therapy takes a fundamentally different stance. Rather than viewing anxiety as an enemy to be conquered, it understands anxiety as meaningful information about how we're organising ourselves at the boundary between ourself and the world, and the question instead might be, “what does the anxiety know?”. This perspective, particularly grounded in the work of Gestalt therapy’s often overlooked co-founder Laura Perls offers a distinctive and often profoundly effective approach to working with anxiety.
Working with What Is, Not What Should Be
The first distinctive feature of the Gestalt approach is its commitment to working with present experience rather than interpretations about what "should" be happening. Laura Perls emphasised that Gestalt therapy is "existential, experiential, and experimental," taking its bearings from what is, not from what has been or what should be. When an anxious client enters the therapy room, the Gestalt therapist might not begin by gathering a detailed history of anxiety triggers and instead attend to what's happening right now: How is the client breathing? Where is tension held in the body? What's the quality of their voice, their eye contact, their posture?...
This focus on the "obvious", what Perls called working with what is "right in front of you, right in your way" reveals anxiety as a whole-body, relational phenomenon rather than merely a cognitive or emotional problem. The therapist might notice that a client holds their breath while describing their worries, or that their shoulders rise toward their ears when discussing certain topics. Rather than interpreting these observations, the therapist brings them into awareness: "I notice you've stopped breathing. What happens if you exhale?" This simple intervention can address anxiety at its physiological root; the lack of oxygen support that transforms what could be excitement into panic.
Understanding Anxiety as Relational, Not Individual
Gestalt therapy understands anxiety not as an individual pathology but as something that emerges at the contact boundary, or meeting point, between a person and their environment. Laura Perls' insight that anxiety arises when confluence (a merged, undifferentiated state) is threatened offers a radically different framework from viewing anxiety as irrational fear or chemical imbalance. An anxious person isn't suffering from faulty thinking; they're experiencing the distress of being caught between merger and contact, lacking the orientation and support needed to navigate this relational transition. They have "inadequate, half-orientation", a dim awareness that something's wrong, but insufficient information to cope.
This relational understanding changes everything about how therapy proceeds. The therapist doesn't try to fix the anxious client but instead may explore how anxiety serves the person at the boundary. A client who rigidly controls every aspect of their life, for instance, may be attempting to prevent the terrifying break of confluence, the moment when they'd have to stand as a separate self with their own needs and desires. The anxiety isn't irrational; it's protecting them from an existential threat they're not yet equipped to handle. The therapeutic work involves developing the support and contact functions that would make differentiation tolerable rather than trying to convince the client their anxiety is unfounded.
Staying with the Impasse
Gestalt therapy's willingness to stay with anxiety rather than rushing to eliminate it represents another distinctive feature. Laura Perls spoke of "de-automatising secondary automatisms", in layperson's terms that means staying with seemingly insoluble conflicts and exploring every available detail rather than quickly applying techniques to make anxiety disappear. When a client reaches an impasse, frozen between the safety of old patterns and the terror of change, many therapeutic approaches may intervene to move them past this stuck point as quickly as possible.
Gestalt however, recognises the impasse as precisely where the most important work happens. By exploring the muscular tensions, the held breath, the desensitisation, the rationalisations, and the investment in the status quo, the client gradually develops awareness of how they're maintaining their own paralysis. This isn't done through interpretation but through experiments: "Stay with that tension in your chest. What does it want to do? What would happen if you let yourself breathe fully?" With increasing awareness comes resensitisation and remobilisation. Alternatives become possible. The impasse transforms into a present problem the client can take responsibility for and work with.
The Therapeutic Relationship as Experiment in Contact
Rather than the therapist remaining a neutral observer or expert diagnostician, Gestalt therapy recognises the therapeutic relationship itself as the primary vehicle for change. The therapist meets the client at the contact boundary, using their own awareness and bodily experience as information about the field. When a therapist notices their chest tightening or a sense of caution arising while with an anxious client, this awareness becomes part of understanding what's happening between them.
This authentic contact provides something crucial: a relationship where the client can experiment with leaving confluence without catastrophic consequences. For example a Gestalt therapist working with an obsessive-compulsive client might gradually introduce the experience of not knowing what would happen next in therapy. Through playful experimentation the client might learn experientially that uncertainty can be tolerated, even enjoyed. The therapy sessions themselves became experiments in what Laura Perls called "living with uncertainty without anxiety."
Supporting the Growing Edge
The ultimate goal of Gestalt therapy with anxiety isn't symptom elimination but the development of what Perls called "that degree of integration that facilitates its own development." The client learns to recognise anxiety as a signal that they're at the growing edge, the place where one foot stands on familiar ground and the other reaches into the unknown. Perls spoke openly about learning to maintain excitement while wobbling at this edge, acknowledging the awkwardness and embarrassment while trusting that these feelings signal creative possibility rather than danger.
This reframing can be profound, anxiety isn't pathology to be cured but a developmental signal indicating that confluence is breaking and real contact is becoming possible. The therapeutic work provides the support, through breathing, awareness, and relationship, that allows the person to tolerate this transition. As support increases, anxiety transforms. What was paralysing anxiety becomes manageable discomfort, then curious excitement, then the energised engagement that characterises genuine contact with life.
What makes Gestalt therapy distinctive in working with anxiety is its refusal to treat anxiety as simply something wrong that needs fixing. By understanding anxiety as meaningful information about boundary organisation, staying with present experience rather than rushing to interpretation, using the therapeutic relationship as a ground for experimenting with contact, and supporting the development of orientation and awareness rather than merely eliminating symptoms, Gestalt therapy offers a path toward transformation rather than just management. The goal isn't an anxiety-free life, an impossible and perhaps undesirable aim but the development of sufficient support and contact functions that anxiety no longer paralyses but instead signals the creative edge where growth becomes possible.
Further Reading
Perls, L. (1992). Living at the Boundary: Collected Works of Laura Perls (J. Wysong, Ed.). Highland, NY: Gestalt Journal Press.
