Running head: EXPLORING THE THERAPEUTIC VALUE OF GESTALT THERAPY 1

Exploring the therapeutic value of Gestalt therapy in contemporary psychiatric nursing

Trina Skinner

Stenberg College

0312 PSYN 201-3: Introduction to Counselling

May 17, 2013

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Exploring the Therapeutic Value of Gestalt Therapy in Contemporary Psychiatric Nursing

For the purpose of this essay, I chose to examine the therapeutic value of the Gestalt

approach to counselling and psychotherapy in concert with presenting my explanation of how

and why this treatment modality resonates with me so deeply. I am thrilled to have the

opportunity to express my passion for the use of Gestalt therapy in psychiatric nursing and how I

plan to incorporate into my future practice as a psychiatric nurse.

The aspect of Gestalt therapy that is so appealing to me is the emphasis on holistic health

and healing that underpins the base of our education as contemporary psychiatric nursing

students. This is the single most approach to counseling and psychotherapy that I find mirrors the

principles and philosophy on which contemporary mental health nursing is predicated on.

Harman (1974) considers that the “basic assumption of the theory of Gestalt therapy is that the

normal, healthy person responds to situations as an integrated, whole organism” (p. 178).

It is common knowledge in the discipline of psychology that cognitive behavioral

approaches to therapy “dominate the psychotherapy discourse in contemporary mental health-

care” (Kelly & Howie, 2011, p. 297). I uphold the belief presented by Kelly & Howie (2011),

when they proclaim that due to a lack of consideration for the interpersonal nature in current

standardized trials, it is due time “to incorporate the art of the science in mental health care. In

psychiatric nursing, the art lies in the humanistic, interpersonal therapeutic encounter, and the

subtle crafts of human-to-human interconnectedness” (p. 297).

Gestalt therapy was originally founded in the 1940’s by psychoanalysts and

psychotherapists Fredrick (Fritz) and Laura Perls, and continues to develop in the context of

psychiatric nursing, particularly in regard to the focus on the holistic health care model emerging

in contemporary mental health care that parallels the underlying philosophy of Gestalt therapy.

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In order for Gestalt therapy to be effective it is imperative that both the client and the therapist

focus on their immediate perceptual and sensory experience (Palmer, 2011, p. 83). The most

relative element of the Gestalt approach for me is the parallels drawn between the philosophical

underpinnings of this form of therapy and my own personal faith grounded in Yogic philosophy.

Yoga is defined as ‘the cessation of thought waves in the mind’, “the aim being union with the

Universal Consciousness through the realization of one’s true nature” (SSCY, 2011).

The referred material offers a distinction between classical Gestalt therapy, focused

primarily on the development of self-awareness, and contemporary Gestalt therapy that is more

conscious of ‘contact’, one’s relationship with themselves, others and the universe, (Palmer,

2001, p. 83), although the terminology and language differs, these fundamental principles uphold

the underpinning philosophy of both Yoga and the Gestalt approach . More specifically Kelly &

Howie (2011), expand on the subject, describing the basis of contemporary Gestalt therapy as

being more ‘person-centered’, reflecting the necessity of experiencing the present moment,

maintaining focus on the ‘here and now’ rather than aspects of the past or the future. Learning to

live in the present thereby facilitates clarification of one’s core beliefs and values, assisting in the

establishment of realistic goals cultivated in that present moment (p. 300).

Gestalt therapy aims to develop “self knowledge, acceptance, self-responsibility,

authenticity, and personal growth” (Clarkson, 1989; Yontef & Jacobs 2007; Yontef 7 Simkin,

1993, as cited in Kelly & Howie, 2011, p. 300). The founder of the Mount Madonna (Saanta

Cruz, CA.) and Salt Spring centre for Yoga (Salt Spring island, B.C.), the Sri Ram orphanage

(Northern India), renowned author and my personal Guru (spiritual teacher), Baba Hari Dass,

carries this message to the world on the topic of ‘binding thoughts & liberation’, “Liberation is

not attained in the past or future. It is attained in the present. Any binding thought should be

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replaced by a liberating thought” (Dass,, 1992). The language and context may differ, however,

the principles and underlying philosophy of the Gestalt approach to therapy and Yoga are closely

intertwined, as the above examples imply.

As a student of Baba Hari Dass and graduate of his yoga teacher training program, words

cannot express the incredible transformation I have witnessed in other people as well as

experienced in establishing a connection with my ‘authentic self’. I am not claiming that spiritual

pathways such as Yoga are magical or there is some divine secret revealed to those who immerse

themselves in a spiritual lifestyle/practice such as Yoga. Quite the contrary, in fact, the message

that is conveyed through Yogic philosophy is very simplistic. Teachings revolve around

identification and integration of various elements of self; ego, authenticity, awareness, etc.. In

this respect, one has the opportunity to draw upon the unprecedented parallels as they

intermingle with Gestalt therapy’s emphasis on the ‘paradoxical theory of change’. The

paradoxical theory of change, a central concept to Gestalt therapy, operates on the proposition

that “change occurs when a person becomes who they are, not when they try to become what

they are not” (Palmer, 2011, p. 86).

Spirituality and Gestalt therapy share one similarity that is critical to the development and

maintenance of a therapeutic relationship between the client and psychiatric nurse, the

unwavering belief that human beings are innately good and given the right conditions have the

propensity to change their perceived reality and present life experience as it occurs in this

moment. I am a strong proponent of the Gestalt approach to therapy as it correlates with my

personal perspective on the world. Palmer (2011), identifies the Gestalt approach has the

potential to be beneficial to a “wide range of client groups” (p. 90).

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Where the discipline of psychiatric nursing is concerned, it is crucial that the

nurse/therapist maintain a genuine belief that clients living with mental health issues have the

ability to improve their health status and quality of life by actively participating in the

therapeutic process, taking the initiative to implement change in order to support a holistic state

of health and well being. I maintain the view that the Gestalt approach to therapy strongly

upholds the objectives presented above.

The following case study is a representation of an actual application of the Gestalt

therapy approach imparted on a fellow peer how has been experiencing disturbed psychological

health and feelings of hopelessness as a result of a recently experienced situational crisis. I felt

that the Gestalt approach to counseling and psychotherapy appropriate in relation to the life

challenges experienced by my peer, who willingly consented to my therapeutic intervention and

will be referred to as J.T. in an effort to preserve this individual’s right to confidentiality.

J.T. expressed to me that she has been experiencing increased feelings of hopelessness

and decreased motivation as a result of circumstances regarding her professional life over the

course of the past year. I have witnessed her mood and demeanor shift drastically to one of a

pessimistic nature following termination from her original position at the place of employment

that she had aspired to secure a position for years prior to being hired. In fact it is this position

that prompted her to study cosmetology in the first place. Following what she believed to be

unjust dismissal from this company, J.T. began to express feelings of displaced anger and

frustration, blaming the company for her termination, rather than acknowledging how her own

actions may have resulted in this unfortunate circumstance. J.T.’s attitude of resentment toward

her previous employers resulted in an overinflated sense of egoism and entitlement in regards to

procuring a new, more favorable position. After many attempts to attain a new position that

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suited her expectations, J.T. eventually landed a part-time job in an upscale skin care boutique,

which provided minimal hours, a decrease in pay, as well as hindered her ability to provide

professional make up application as she was originally trained for. J.T. often complained about

this job, however when her peers suggested possible job opportunities outside the realm of her

general profession, she repeatedly displayed an attitude of helplessness, complaining constantly

of her distaste for working a retail position, all the while unwilling to make necessary changes to

improve her professional situation.

J.T. continued to dwell on past events that led to her current situational crisis and shifting

blame onto other persons and factors in her life, as opposed to taking action to improve the

situation in the present context. As described earlier in this paper, the Gestalt approach supports

the notion that “past is past and the future unknowable, therefore the focus of counseling

attention should be the present moment” (Burnard, 2005, p. 51). Keeping this perspective in

mind, it became evident that J.T. may benefit from Gestalt therapy in terms of redirecting focus

on the present, developing a deeper sense of self awareness, and the ability to take responsibility

and accountability for her own action and subsequent effects of this action.

In the time that I have been acquainted with J.T. she has demonstrated a history of

placing blame on other people and circumstances in an effort to omit herself from any

wrongdoing which would require proactive resolution of perceived problems on her part.

Gilbert (2010), explains that in regards to personal responsibility clients who would

benefit most from Gestalt approach to therapy tend to “assume no responsibility for what, they

are, and it seems to them that there is nothing they can do about their situation other than accept

it. They do not see themselves as having input into or control of their lives” (p. 85). J.T.

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accurately fits the above presented description, hence my argument for the Gestalt approach to

therapy as relevant to this clients current life situation.

When I first sat down with this client, J.T. was reluctant to acknowledge that she

possessed the power to change her current situation regarding her professional life. For the better

part of our interaction, J.T. complained incessantly, explaining the various reasons as she

perceived them for her current plight, unwilling to offer an opportunity for me to interject and

offer some advice. As out time together continued, I began to suggest various options for

resolving the stress harbored by her perceived inability to maintain a job favorable to her and

somewhat jaded attitude that the world was inflicting this hardship upon her. I came to realize

that for every suggestion I posed, before even considering, J.T. would respond with a reason why

my suggestions were not feasible.

J.T. consistently referred to “life being unfair”, it being “to difficult to get ahead, or

secure a good job in Vancouver” (J.T, 2013), as well as statements of blame, for example, if her

current employer did not terminate her unjustly she would not be in this predicament. After

careful consideration of what J.T. was communicating to me I began to implement some of the

strategies outlined in the Gestalt approach to therapy, for example changing “they” statements to

“I” and bring about some awareness that her narrow-mindedness was limiting her ability to

regain control of her own life and initiate the steps to secure a position, that may not be her

desired profession, but will promote financial security that will allow her more freedom to

pursue the career she is most passionate about. Each time she explained how “hopeless” the

situation was, I challenged this by encouraging her to state certain actions she could take to

initiate change, in perception and eventual action.

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I was careful to implore techniques that reinforced the therapeutic relationship and

process, as without such techniques, the therapist (in this case me) may manipulate changes in

the client that would benefit myself or society as a whole (Gilbert, 2011, p.87). By engaging in

active listening and a genuine desire to help, J.T. began to flirt with the effectiveness of some of

the techniques I acted on, such as encouraging her to express her true feelings, and how the

situation was affected if J.T. focused on her own self awareness and began making more

empowering statements, such as “I suppose there are other options that I haven’t considered or

explored because I have been so down about the situation and dwelling in anger towards others”

(J.T., 2013) which I helped J.T. to realize that she is expending energy on these feelings of

resentment, rather than on improving the financial and professional issues at hand.

The NANDA nursing diagnosis that I feel is most applicable to J.T.’s current situation is

Ineffective Coping, defined as an “Inability to form a valid appraisal of the stressors, inadequate

choices of practiced responses, and/or inability to use available resources” (Townsend, 2011, p.

35). Possible etiologies include, situational crisis (job loss), inadequate coping strategies

(expressing anger and lack of motivation to leave house and seek out employment), as evidenced

by: Inability to meet [age-appropriate] role expectations; Inadequate problem solving; Poor

concentration; Unable to delay gratification; Oppositional and defiant responses to adult requests

or rules (which has ultimately resulted in termination of two jobs in the past year), (Townsend,

2011, p. 37). The treatment plan based on this diagnosis will consist of discussion and exercises

related to developing/enhancing self awareness, as well as restructuring J.T.’s relationship with

herself, others, and the universe. Exploring and implementing strategies for stress reduction,

favorable and effective for J.T. will be a critical element of the treatment plan as well. Finally,

brainstorming and developing a list of goals associated with increased self awareness,

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accountability, and identification and implementation of strategies that will enhance the

likelihood of obtaining an employment position that J.T. feels passionate about and is able to

perform duties expected of her successfully.

In conclusion, the outcomes I would hope to see as a result of utilizing the Gestalt

approach to therapy would include, increased motivation/positive attitude, ability to take

personal responsibility and accountability for her actions and the consequences of inaction,

increased effort to broaden scope in terms of employment sought, and finally, a more integrated

sense of self and relationship with others and the universe.

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References

Dass, B. H. (1992). Essays on the search for peace in daily life: Binding Thoughts and

Liberation. Santa Cruz, CA.: Sri Ram publishing.

Gilbert, M., & Evans, K. (2011). Gestalt counselling and psychotherapy. In S. Palmer (Ed.),

Introduction to Counselling and Psychotherapy the Essential Guide. 83-96. London,

England: Sage publications.

Harman, R. L. (1975). Goals of Gestalt therapy. Professional Psychology, 5(2), 178-184.

Retrieved from http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=1975-21533-

001

J.T. (2013, May 15). Personal Communication. Vancouver, B.C., Canada

Kelly, T., & Howie, L. (2011). Exploring the influence of gestalt therapy training on psychiatric

nursing practice: Stories from the field. International Journal of Mental Health Nursing,

20(4): 296-304. http://dx.doi.org/10.1111/j.1447-0349.2010.00729.x

Townsend, M. (2011). Disorders Usually First Diagnosed in Infancy, childhood, or adolescence:

Ineffective coping. Nursing Diagnoses in Psychiatric Nursing: Care Plans and

Psychotropic Medications.8th ed. F.A. Davis Company. Philadelphia.