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Exploring The Influence of Gestalt Therapy Training On Psychiatric Nursing Practice: Stories From The Field
Exploring The Influence of Gestalt Therapy Training On Psychiatric Nursing Practice: Stories From The Field
Exploring The Influence of Gestalt Therapy Training On Psychiatric Nursing Practice: Stories From The Field
Goodman (Yontef & Jacobs 2007). The origins of gestalt 1997, p. 48). In this way, field theory takes into account
therapy were deeply influenced by the philosophical, cul- the total situation (Lewin 1951; Parlett 1991; 2005),
tural, and intellectual trends of the time (Yontef & Jacobs appreciating wholeness, complexity, and context, rather
2007), including existentialism, phenomenology, holism, than reducing a situation to a collection of parts (Joyce &
humanism, gestalt psychology, field theory, interpersonal Sills 2010; Mackewn 1997; Parlett 1991; Yontef & Jacobs
psychoanalysis, and Eastern philosophies (Clarkson & 2007). In gestalt, field theory provides the basis for a
Mackewn 1993; Clarkson 1989; Mackewn 1997; Yontef & holistic, therapeutic approach (Joyce & Sills 2010) that
Jacobs 2007). encompasses the view that ‘people cannot be understood
Contemporary gestalt is an experiential, relational, and without understanding the field, or context, in which they
process-oriented therapy. Its present-centred focus live’ (Yontef & Jacobs 2007, p. 329).
means that rather than looking to the past or imagining
the future, it focuses on the ‘here and now’, thereby Phenomenology
facilitating clarity of a person’s needs, goals, and values Phenomenology is a method of exploring the nature of
(Yontef & Jacobs 2007). Developing awareness and phenomena and of existence (Joyce & Sills 2010; Spinelli
insight is a key focus in gestalt therapy (Hurley et al. 2005). In a therapeutic setting, the phenomenological
2006; Yontef & Simkin 1993). Yontef and Simkin (1993) method has been adapted as a means of exploring the
describe awareness as ‘a form of experience that may be subjective meaning of a client’s experience of ‘himself and
loosely defined as being in touch with one’s own exist- his world’ (Joyce & Sills 2010). The goal of phenomeno-
ence, with what is’ (p. 144). They describe the ‘person logical inquiry is clarity of awareness and insight (Yontef
who is aware’ as one who ‘knows what he does, how he & Jacobs 2007; Yontef & Simkin 1993). From a gestalt
does it, that he has alternatives and that he chooses to be therapeutic perspective, the phenomenological approach
as he is’ (p. 145). involves staying as close as possible to the client’s experi-
Gestalt therapy aims for self-knowledge, acceptance, ence (Joyce & Sills 2010), with an emphasis on descrip-
self-responsibility, authenticity, and personal growth tively exploring and developing the client’s awareness
(Clarkson 1989; Yontef & Jacobs 2007; Yontef & Simkin moment to moment, rather than attempting to explain or
1993). The integration of fragmented parts of the self into interpret his or her behaviour (Joyce & Sills 2010; Yontef
a unique whole in the social and environmental context of & Jacobs 2007). Therefore, the phenomenological
a person’s life is central to the gestalt approach (Clarkson method is as much an attitude of openness and curiosity
1989; Hurley et al. 2006; Yontef & Simkin 1993). Accord- as it is of actual techniques (Joyce & Sills 2010; Mackewn
ing to Clarkson, wholeness is a cornerstone of gestalt 1997).
therapy, emphasizing wholeness of the person and their
experiences. In gestalt theory, the wholeness of human
Dialogic relationship
experience is understood through the perceptual prin-
ciple of figure and ground (Clarkson 1989; Mackewn A central focus of a gestalt approach to therapy is
1997). This principle, conceptualized as the cycle of expe- the relationship between the therapist and the client
rience (Clarkson 1989; Joyce & Sills 2010; Mackewn (Hycner & Jacobs 1995; Yontef & Jacobs 2007; Yontef &
1997), provides a metaphor for understanding the aware- Simkin 1993). In gestalt, the therapeutic relationship is
ness process (Joyce & Sills 2010) and extends throughout referred to as the dialogic relationship (Hycner & Jacobs
much of gestalt therapy theory and practice. Fundamen- 1995; Joyce & Sills 2010). It is based on an existential
tal theoretical perspectives in a gestalt approach include encounter between two people that is non-hierarchical
field theory, phenomenology, dialogue, and the paradoxi- and has an ‘emphasis on full and genuine engagement
cal theory of change. between patient and therapist’ (Hycner & Jacobs 1995,
p. 52). Gestalt theory identifies the potential for change
Field theory and self-development as emerging through this exis-
Field theory provides a holistic perspective that appreci- tential encounter between the client and the therapist
ates the interrelationship of the person with the environ- (Mackewn 1997).
ment (Lewin 1951; Mackewn 1997; Melnick 1997; Parlett
1991; Yontef & Simkin 1993). In gestalt therapy the Paradoxical theory of change
‘individual–environment entity is known as the field, The paradoxical theory of change (Bessier 1970) is
where the field consists of all complex interactive phenom- another central concept in gestalt therapy (Joyce & Sills
ena of individuals and their environment’ (Mackewn 2010; Yontef & Jacobs 2007). In this theory, Bessier
proposed that ‘change occurs when one becomes what he 1993). Each narrative interview was audiotaped and
is, not when he tries to become what he is not’ (Bessier transcribed.
1970, p. 77). Contemporary gestalt theorists and thera-
pists embrace this concept, recognizing that in therapy Data analysis
and in life, people change only when they fully accept and A narrative analysis type of narrative inquiry was
become who they are in the present moment (Joyce & employed in this qualitative study (see Emden 1998a,b;
Sills 2010; Mackewn 1997; Yontef & Jacobs 2007). Polkinghorne 1995). In this type of narrative inquiry,
data analysis involves reduction, synthesis, and recon-
figuration of the data to produce stories as the research
METHODS outcome (Kelly & Howie 2007; Polkinghorne 1995). The
product of the narrative analysis employed in this study
Aim was a collection of four stories. Because the researchers
The aim of this qualitative research study was to explore were interested in exploring the stories of the partici-
the influence of gestalt therapy training on psychiatric pants as individuals and as members of a community of
nurses’ practice. gestalt-trained psychiatric nurses, they conducted a the-
matic analysis across the storied database. This involved
Participants the systematic, rigorous, and careful examination of
The participants were four psychiatric nurses trained in the plots and subplots common to all stories to identify
gestalt therapy. The small sample size was consistent with common elements and experiences across the stories,
qualitative research where the richness of the data and and the synthesis of these to inform eight emerging
their capacity to encompass the dimensions of the topic of themes (Kelly & Howie 2007). This process encom-
inquiry was more important than the number of partici- passed the emplotment reasoning of Polkinghorne
pants (Rice & Ezzy 2001; Whitehead & Annells 2007). (1995), while utilizing procedures described by Emden
Snowball sampling (Patton 2002; Whitehead & Annells (1998b) for examining plots, subplots, and themes across
2007) was employed to recruit six potential participants: all four core stories.
two men and four women. Both men chose not to partici-
pate in the study. The researchers did not consider sex
balance to be important to the research topic (Kelly & RESULTS AND DISCUSSION
Howie 2007). The comprehensive across-story analysis conducted
At the time of the study, the four participants were across the storied collection identified eight themes:
working as registered psychiatric nurses in Victoria, Aus- ‘growing professionally in fertile ground’, ‘resonating with
tralia. Their practice settings included adolescent mental the gestalt potential’, ‘emerging gestalt potential in psy-
health; a specialist mental health service; education and chiatric nursing settings’, ‘gestalt learning: the self in
professional development; and private practice (Kelly & process’, ‘bringing gestalt into psychiatric nursing prac-
Howie 2007). tice’, ‘expressing the multidimensional influence of gestalt
therapy on advanced psychiatric nursing practice’, ‘inte-
Ethical considerations grating and assimilating gestalt’, and ‘making sense’.
The study was approved by the La Trobe University
Faculty of Health Sciences Ethics Committee. All partici- Mapping the themes to the gestalt
pants provided informed consent. To assure confidential- experience cycle
ity, a pseudonym was applied to each participant at the Faithful to the narrative methodology underpinning this
data collection phase, and any potentially identifying data study, the themes were located within a temporal frame-
evident in the transcripts were omitted or changed early work that encompassed the participants’ experiences of
in the data analysis process (Kelly & Howie 2007). their personal and professional transitions (Polsters 1987).
In this way, the themes are part of a collective ‘temporal
Data collection gestalt’ (Polkinghorne 1995, p. 18) or whole, reflecting the
Qualitative data were collected through semistructured, storied experience of all the participants.
individual narrative interviews. The narrative interview Conceptualizing the themes as a ‘temporal gestalt’ was
techniques were employed with the specific intent of useful in this study, as it incorporated the understand-
eliciting narrative responses from the research partici- ings inherent in narrative analysis, while lending itself
pant (Kelly & Howie 2007; Rice & Ezzy 2001; Riessman to being understood within a gestalt therapy theoretical
framework’. In gestalt theory, a temporal gestalt can be its dust cover, the other books fade into the background.
understood as the cycle of gestalt formation and destruc- Then another book catches her eye and it becomes
tion: the temporal process of experience evolving through figural, and so on.
stages (Clarkson 1989). Cycles of experience can be microscopic, such as the
In the literature, while some gestalt theorists have rep- process of breathing in and out. They can also be macro-
resented the process of experience as a circle (Clarkson scopic and take many years, such as studying for a degree,
1989; Joyce & Sills 2010; Sills et al. 1996), others have raising a child, or a person’s lifetime (Clarkson 1989;
represented it as an open-ended wave (Gaffney 2009; Mackewn 1997). Smaller cycles can occur within larger
Mackewn 1997; Zinker 1977). Inspired by Clarkson cycles. They are like stories within stories.
(1989) and Joyce and Sills (2010), we refer to the process This study was concerned with the macroscopic expe-
of experience as the ‘gestalt experience cycle’, and repre- rience cycle relevant to the participants’ experiences of
sent it diagrammatically as a circle for the purpose of the influence gestalt therapy training on their psychiatric
emphasizing the temporal, cyclical, and whole nature of nursing practice. In this way, the cycle encompasses the
experience (Clarkson 1989; Sills et al. 1996). Figure 1 dia- participants’ journeys into and through gestalt training
grammatically maps the eight themes identified in this and their experiences of how the training influenced
study to the gestalt experience cycle. their practice and their professional lives as psychiatric
In the gestalt experience cycle, a ‘dominant figure nurses.
emerges from a background, claims attention and fades The following discussion of the eight themes encapsu-
into the background again as a new compelling figure lates the similarities and differences across the storied
emerges’ (Clarkson 1989, p. 27). For example, a woman collection, and provides a community and cultural context
browsing in a bookshop gazes upon a book. As she reads for understanding the individual stories.
Growing professionally in fertile ground exposure to exploring practice possibilities lateral to more
This theme relates to the ‘the fertile void’ (Perls 1969, p. medically-orientated psychiatric nursing practice.
57): a period of rest and calmness that occurs between the
completion of one gestalt and the emergence of a new Emerging gestalt potential in psychiatric
one. It is described as a space rich with limitless possibili- nursing settings
ties (Clarkson 1989; Joyce & Sills 2010; Mackewn 1997; This theme relates to the awareness phase of the gestalt
Sills et al. 1996). experience cycle. In this phase, the new figure that started
‘Growing professionally in fertile ground’ describes to form in the earlier phase begins to impinge on an
the background features of the participants’ lives prior to individual’s awareness and becomes the point of interest
the commencement of their gestalt therapy journey. for the individual (Clarkson 1989). In ‘emerging potential
This theme provides the context for the imminent emer- in psychiatric nursing settings’, the emerging interest in
gence of their interest in gestalt therapy. Common to gestalt training sharpened for the participants. The par-
the background or ‘ground’ of all the participants was ticipants became more attuned to their field, as they
their unique features, their professional environments, began to see the potential application of their gestalt
and their energetic involvement in professional develop- therapy knowledge and skills to their psychiatric nursing
ment pursuits. practice within their respective practice settings.
Mary’s ground was one of creativity. Even before she
began gestalt training, she was working creatively with Gestalt learning: the self in process
people who had long-term mental illness. Cathy’s ground ‘Gestalt learning: the self in process’ encompasses the
included an enduring desire to ‘practice holistically’. self-learning, personal growth, and self-awareness inher-
Sally’s ground was one of change and professional chal- ent in gestalt therapy training and the impact of this on
lenge, and Peta’s was very much structured around her the participants’ professional lives. Throughout this
professional experience and expertise. The professional theme, the participants were more fully engaging in the
environments of all four participants, although varied with awareness phase of the gestalt experience cycle through
regard to the type, nature, and even location in time, were deepening their awareness of their own personal process.
all rich in terms of experience and possibilities. This theme encompasses the concept of the ‘self as chang-
Resonating with the gestalt potential ing process and self as enduring identity. . .’ (Mackewn
1997, p. 76), in that the participants developed personal
This theme relates to the sensation phase of the gestalt
insights, awareness, and understandings, and integrated
experience cycle. It is when raw sensory information
these into their personal and professional lives. Peta’s
begins to register for the individual, but is ‘before these
reflections on her choice of career provided an exquisite
possibilities come fully into meaningful awareness’
example of the integration of such self insights:
(Clarkson 1989, p. 32). It is here that the participants’
interest in gestalt therapy began to emerge as a new figure Someone commented that one of my functions in my
from a previously undifferentiated ground. gestalt training group was to make the group feel safe.
‘Resonating with the gestalt potential’ is about the par- This was interesting feedback, given my choice of career,
ticipants sensitizing and attuning themselves to the field which is about containing people and making people feel
and the context of their current environment. Across the safe. It hadn’t occurred to me that I would do that in
stories, this theme encompasses a kaleidoscope of influ- another setting.
encing factors that oscillate in the fields of the participants
as individuals. In this theme, the field is alive with stir- The participants also told of the challenge inherent in
rings, influences, and possibilities. It captures what it was the personal growth and self-awareness aspects of gestalt
about the participants’ professional and personal contexts training. Mary’s metaphor of gestalt training being like a
that contributed to and heightened their interest in gestalt washing machine captures the challenge inherent in the
therapy, and its potential scope in relation to their psychi- personal growth process:
atric nursing practice. An unmistakable openness to influ- The influence of gestalt therapy training on my life
ences and practice possibilities outside of the more and . . . my work as a psychiatric nurse is like a washing
traditional ‘medical model’ psychiatric nursing role was machine. It’s washed me clean. I feel spun dry and ready.
common across the participants’ stories. Each participant Being spun about in a washing machine is a ‘bloody awful’
was in professional contact with colleagues skilled in psy- thing. It’s also very cleansing, if you can hack it. . . . (Kelly
chotherapeutic modalities or group work, and had some & Howie 2007, p. 142)
Cathy’s story captures the rawness of her experience projective work that this client and I engaged and then
and the paradox of this challenge becoming a source of moved on to deeper and more meaningful work. (Kelly &
valuable learning: Howie 2007, p. 142)
influences in the professional practice areas of nursing life. ‘Integrating and assimilating gestalt’ encompasses
professional development, management, nursing educa- how gestalt became integrated and assimilated into the
tion, clinical supervision, and individual and group participants’ psychiatric nursing practice and professional
therapy. ways of being subsequent to their gestalt training years.
Cathy articulated her ‘interest in the experiential The influence of gestalt therapy is evident in the partici-
aspects of gestalt’. Her description of working in the pants’ more reflective and confident professional styles
moment with clients provides an example of the evolving that are mindful of the importance of relationship and the
and mature gestalt influence on her psychotherapeutic impact of phenomenological and field theoretical influ-
work with clients following her training years: ences across their spectrum of practice. Mary reflected:
I work with the individual clients in the group to capture I hardly think about myself as a gestalt psychiatric nurse,
some confidence or self-esteem and encourage them to but I am. It’s integral to who I am. I’m very phenomeno-
fully experience what it feels like to experience confi- logical and really curious. I am interested in how nurses
dence or self-esteem in the moment that it happens. Not and patients view their world . . . My understanding of
just talking: actually being in there doing it, and talking field theory and my living of it helps me see what’s going
about it too. on. I’m incredibly observant. I’m mindful of the big
picture and the interrelated parts. Relationship is impor-
Sally’s story about sharing her gestalt knowledge and
tant. How I meet you and show myself to you is the crux.
skills with her work team provides a snapshot of the
It can mean that we get done what we need to get done or
vibrancy, energy, excitement, and expression that is ‘final not. To me, relationship is everything. Gestalt’s given me
contact’ (See Clarkson 1989, pp. 33–34). Her story dem- that. I live gestalt. I do it well as a psychiatric nurse. (Kelly
onstrates her full engagement with bringing her gestalt & Howie 2007, p. 142)
knowledge into her psychiatric nursing practice and to her
work team: This theme is descriptive of the integration of the con-
fidence developed during their gestalt training years into
What stands out for me is the interest and curiosity about
the participants’ professional ways of being. Sally said:
gestalt among the staff. They wanted to run groups with
me and to learn about gestalt . . . Together, we explored I gained confidence through gestalt training and that has
lots of questions: ‘How might a situation be understood impacted on me professionally. I’m not afraid to try some-
from a gestalt point of view?’ ‘What might be a gestalt thing new, and sometimes in a bit of a quirky way. I’m also
understanding of the person’s experience?’ . . . We more likely to take a risk and have bit of a go at something
explored a person’s field, rather than just thinking about or to challenge and explore why I won’t. I like the idea of
their history and genogram. challenge. I think that’s connected to my gestalt training,
Sally identified that, as a manager, gestalt helped her to because often I learned things in quite unexpected ways.
‘be more attentive to the different skills within the staff
group’ and to ‘think differently about management issues’. Making sense
Sally’s example of dealing with ‘scapegoating’ in a work This theme relates to the later satisfaction phase and early
team provides a description of how gestalt influenced her withdrawal phase of the gestalt experience cycle. It is
work as a manager: about the ‘figure’ – gestalt therapy training – becoming
‘ground’ again. ‘Making sense’ provides insight into how
I think about what purpose scapegoating might serve in
the participants understand and give meaning to their
the team . . . what’s happening in the context of the field?
I consider what might be happening for that individual
gestalt training in relation to their professional sense of
with those people around them, and what’s leading to themselves as psychiatric nurses trained in the gestalt
things being the way they are. Gestalt has given me a approach. Looking back over their training in gestalt
broader way of looking at situations. It has also given me therapy, the participants reflected on their experiences of
more scope and more ways of dealing with things. the blending of gestalt with psychiatric nursing. In doing
so, they considered the impact of their gestalt experience
Integrating and assimilating gestalt on their conceptual appreciation of psychiatric nursing
This theme relates to the phase of the gestalt experience theories concerning interpersonal relations and the thera-
cycle that involves ‘satisfaction and gestalt completion’ peutic relationship.
(Clarkson 1989, p. 35). This phase occurs on the comple- Mary identified the therapeutic ‘use of self’ to be a
tion of a life experience and reaching a point of reflecting quality intrinsic to gestalt therapy and psychiatric nursing.
on its meaningfulness in relation to one’s past and present In her story, Mary not only captured the across-discipline
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