Gestalt therapy importance to psychiatric practice

Feature Article_729 296..304

Exploring the influence of gestalt therapy training on
psychiatric nursing practice: Stories from the field

Teresa Kelly and Linsey Howie
School of Public Health, La Trobe University, Melbourne, Victoria, Australia

ABSTRACT: Psychiatric nurses interested in extending their interpersonal and psychotherapeutic
skills sometimes undertake postgraduate training in gestalt therapy. Little is known about how this
new knowledge and psychotherapeutic skill base informs their practice. This paper presents the
findings of a qualitative study that aimed to explore the influence of gestalt therapy training on
psychiatric nursing practice. Within a framework of narrative inquiry, four psychiatric nurses trained
in gestalt therapy were invited to tell their stories of training in a gestalt approach to therapy, and
recount their experiences of how it influenced their practice. In keeping with narrative analysis
methods, the research findings were presented as a collection of four stories. Eight themes were derived
from a thematic analysis conducted within and across the four stories. The discussion of the themes
encapsulates the similarities and differences across the storied collection, providing a community and
cultural context for understanding the individual stories.

KEY WORDS: gestalt therapy, holism, psychiatric nursing, psychotherapy, qualitative research.

INTRODUCTION

Cognitive behavioural therapies that are validated using
standardized trials, dominate the psychotherapy discourse
in contemporary mental health-care contexts (Hurley
et al. 2006; Yontef & Jacobs 2007). However, standard-
ized trials often do not take into account the interpersonal
nature and ‘whole process of therapy’ (Yontef & Jacobs
2007, p. 354), central to the efficacy of the relational
and experiential psychotherapies, contributing to these
approaches being disadvantaged in the dominant scien-
tific paradigm.

It is timely then to incorporate the art with the
science of mental health care. In psychiatric nursing, the
art lies in the humanistic, interpersonal, and therapeutic
encounter, and the subtle crafts of human-to-human
interconnectedness.

Gestalt therapy is a humanistic, holistic, and relational
psychotherapeutic approach that aligns well with the
humanistic values and interpersonal processes espoused
as central to psychiatric nursing (Chambers 1998; Dziopa
& Ahern 2009; Hurley et al. 2006; Moyles 2003; Peplau
1952; 1962; Welch 2005; Wright 2010).

Psychiatric nurses interested in advancing their psy-
chotherapeutic agency sometimes undertake training
in gestalt therapy. There has, however, been negligible
research into how this training has influenced their
discipline-specific practice. This qualitative study aimed
to explore the influence of gestalt therapy training on the
professional practice of psychiatric nurses.

To begin, an overview of gestalt therapy theory is nec-
essary to provide readers new to the gestalt approach with
a theoretical context to the research findings presented in
this paper.

THEORETICAL OVERVIEW OF
GESTALT THERAPY

Fritz Perls founded gestalt therapy during the 1940s
and 1950s in collaboration with Laura Perls and Paul

Correspondence: Teresa Kelly, Northern Area Mental Health
Service, c/ The Northern Hospital, 185 Cooper Street, Epping, Vic.
3076, Australia. Email: [email protected]

Teresa Kelly, RN, MHN, PGradDip(AdvClinNursMH), MGestTher,
BHIM.

Linsey Howie, PhD, MA, BA, DipOT.
Accepted November 2010.

International Journal of Mental Health Nursing (2011) 20, 296–304 doi: 10.1111/j.1447-0349.2010.00729.x

© 2011 The Authors
International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

Goodman (Yontef & Jacobs 2007). The origins of gestalt
therapy were deeply influenced by the philosophical, cul-
tural, and intellectual trends of the time (Yontef & Jacobs
2007), including existentialism, phenomenology, holism,
humanism, gestalt psychology, field theory, interpersonal
psychoanalysis, and Eastern philosophies (Clarkson &
Mackewn 1993; Clarkson 1989; Mackewn 1997; Yontef &
Jacobs 2007).

Contemporary gestalt is an experiential, relational, and
process-oriented therapy. Its present-centred focus
means that rather than looking to the past or imagining
the future, it focuses on the ‘here and now’, thereby
facilitating clarity of a person’s needs, goals, and values
(Yontef & Jacobs 2007). Developing awareness and
insight is a key focus in gestalt therapy (Hurley et al.
2006; Yontef & Simkin 1993). Yontef and Simkin (1993)
describe awareness as ‘a form of experience that may be
loosely defined as being in touch with one’s own exist-
ence, with what is’ (p. 144). They describe the ‘person
who is aware’ as one who ‘knows what he does, how he
does it, that he has alternatives and that he chooses to be
as he is’ (p. 145).

Gestalt therapy aims for self-knowledge, acceptance,
self-responsibility, authenticity, and personal growth
(Clarkson 1989; Yontef & Jacobs 2007; Yontef & Simkin
1993). The integration of fragmented parts of the self into
a unique whole in the social and environmental context of
a person’s life is central to the gestalt approach (Clarkson
1989; Hurley et al. 2006; Yontef & Simkin 1993). Accord-
ing to Clarkson, wholeness is a cornerstone of gestalt
therapy, emphasizing wholeness of the person and their
experiences. In gestalt theory, the wholeness of human
experience is understood through the perceptual prin-
ciple of figure and ground (Clarkson 1989; Mackewn
1997). This principle, conceptualized as the cycle of expe-
rience (Clarkson 1989; Joyce & Sills 2010; Mackewn
1997), provides a metaphor for understanding the aware-
ness process (Joyce & Sills 2010) and extends throughout
much of gestalt therapy theory and practice. Fundamen-
tal theoretical perspectives in a gestalt approach include
field theory, phenomenology, dialogue, and the paradoxi-
cal theory of change.

Field theory
Field theory provides a holistic perspective that appreci-
ates the interrelationship of the person with the environ-
ment (Lewin 1951; Mackewn 1997; Melnick 1997; Parlett
1991; Yontef & Simkin 1993). In gestalt therapy the
‘individual–environment entity is known as the field,
where the field consists of all complex interactive phenom-
ena of individuals and their environment’ (Mackewn

1997, p. 48). In this way, field theory takes into account
the total situation (Lewin 1951; Parlett 1991; 2005),
appreciating wholeness, complexity, and context, rather
than reducing a situation to a collection of parts (Joyce &
Sills 2010; Mackewn 1997; Parlett 1991; Yontef & Jacobs
2007). In gestalt, field theory provides the basis for a
holistic, therapeutic approach (Joyce & Sills 2010) that
encompasses the view that ‘people cannot be understood
without understanding the field, or context, in which they
live’ (Yontef & Jacobs 2007, p. 329).

Phenomenology
Phenomenology is a method of exploring the nature of
phenomena and of existence (Joyce & Sills 2010; Spinelli
2005). In a therapeutic setting, the phenomenological
method has been adapted as a means of exploring the
subjective meaning of a client’s experience of ‘himself and
his world’ (Joyce & Sills 2010). The goal of phenomeno-
logical inquiry is clarity of awareness and insight (Yontef
& Jacobs 2007; Yontef & Simkin 1993). From a gestalt
therapeutic perspective, the phenomenological approach
involves staying as close as possible to the client’s experi-
ence (Joyce & Sills 2010), with an emphasis on descrip-
tively exploring and developing the client’s awareness
moment to moment, rather than attempting to explain or
interpret his or her behaviour (Joyce & Sills 2010; Yontef
& Jacobs 2007). Therefore, the phenomenological
method is as much an attitude of openness and curiosity
as it is of actual techniques (Joyce & Sills 2010; Mackewn
1997).

Dialogic relationship
A central focus of a gestalt approach to therapy is
the relationship between the therapist and the client
(Hycner & Jacobs 1995; Yontef & Jacobs 2007; Yontef &
Simkin 1993). In gestalt, the therapeutic relationship is
referred to as the dialogic relationship (Hycner & Jacobs
1995; Joyce & Sills 2010). It is based on an existential
encounter between two people that is non-hierarchical
and has an ‘emphasis on full and genuine engagement
between patient and therapist’ (Hycner & Jacobs 1995,
p. 52). Gestalt theory identifies the potential for change
and self-development as emerging through this exis-
tential encounter between the client and the therapist
(Mackewn 1997).

Paradoxical theory of change
The paradoxical theory of change (Bessier 1970) is
another central concept in gestalt therapy (Joyce & Sills
2010; Yontef & Jacobs 2007). In this theory, Bessier

GESTALT THERAPY AND PSYCHIATRIC NURSING 297

© 2011 The Authors
International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

proposed that ‘change occurs when one becomes what he
is, not when he tries to become what he is not’ (Bessier
1970, p. 77). Contemporary gestalt theorists and thera-
pists embrace this concept, recognizing that in therapy
and in life, people change only when they fully accept and
become who they are in the present moment (Joyce &
Sills 2010; Mackewn 1997; Yontef & Jacobs 2007).

METHODS

Aim
The aim of this qualitative research study was to explore
the influence of gestalt therapy training on psychiatric
nurses’ practice.

Participants
The participants were four psychiatric nurses trained in
gestalt therapy. The small sample size was consistent with
qualitative research where the richness of the data and
their capacity to encompass the dimensions of the topic of
inquiry was more important than the number of partici-
pants (Rice & Ezzy 2001; Whitehead & Annells 2007).
Snowball sampling (Patton 2002; Whitehead & Annells
2007) was employed to recruit six potential participants:
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 &
Howie 2007).

At the time of the study, the four participants were
working as registered psychiatric nurses in Victoria, Aus-
tralia. Their practice settings included adolescent mental
health; a specialist mental health service; education and
professional development; and private practice (Kelly &
Howie 2007).

Ethical considerations
The study was approved by the La Trobe University
Faculty of Health Sciences Ethics Committee. All partici-
pants provided informed consent. To assure confidential-
ity, a pseudonym was applied to each participant at the
data collection phase, and any potentially identifying data
evident in the transcripts were omitted or changed early
in the data analysis process (Kelly & Howie 2007).

Data collection
Qualitative data were collected through semistructured,
individual narrative interviews. The narrative interview
techniques were employed with the specific intent of
eliciting narrative responses from the research partici-
pant (Kelly & Howie 2007; Rice & Ezzy 2001; Riessman

1993). Each narrative interview was audiotaped and
transcribed.

Data analysis
A narrative analysis type of narrative inquiry was
employed in this qualitative study (see Emden 1998a,b;
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
outcome (Kelly & Howie 2007; Polkinghorne 1995). The
product of the narrative analysis employed in this study
was a collection of four stories. Because the researchers
were interested in exploring the stories of the partici-
pants as individuals and as members of a community of
gestalt-trained psychiatric nurses, they conducted a the-
matic analysis across the storied database. This involved
the systematic, rigorous, and careful examination of
the plots and subplots common to all stories to identify
common elements and experiences across the stories,
and the synthesis of these to inform eight emerging
themes (Kelly & Howie 2007). This process encom-
passed the emplotment reasoning of Polkinghorne
(1995), while utilizing procedures described by Emden
(1998b) for examining plots, subplots, and themes across
all four core stories.

RESULTS AND DISCUSSION

The comprehensive across-story analysis conducted
across the storied collection identified eight themes:
‘growing professionally in fertile ground’, ‘resonating with
the gestalt potential’, ‘emerging gestalt potential in psy-
chiatric nursing settings’, ‘gestalt learning: the self in
process’, ‘bringing gestalt into psychiatric nursing prac-
tice’, ‘expressing the multidimensional influence of gestalt
therapy on advanced psychiatric nursing practice’, ‘inte-
grating and assimilating gestalt’, and ‘making sense’.

Mapping the themes to the gestalt
experience cycle
Faithful to the narrative methodology underpinning this
study, the themes were located within a temporal frame-
work that encompassed the participants’ experiences of
their personal and professional transitions (Polsters 1987).
In this way, the themes are part of a collective ‘temporal
gestalt’ (Polkinghorne 1995, p. 18) or whole, reflecting the
storied experience of all the participants.

Conceptualizing the themes as a ‘temporal gestalt’ was
useful in this study, as it incorporated the understand-
ings inherent in narrative analysis, while lending itself
to being understood within a gestalt therapy theoretical

298 T. KELLY AND L. HOWIE

© 2011 The Authors
International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

framework’. In gestalt theory, a temporal gestalt can be
understood as the cycle of gestalt formation and destruc-
tion: the temporal process of experience evolving through
stages (Clarkson 1989).

In the literature, while some gestalt theorists have rep-
resented the process of experience as a circle (Clarkson
1989; Joyce & Sills 2010; Sills et al. 1996), others have
represented it as an open-ended wave (Gaffney 2009;
Mackewn 1997; Zinker 1977). Inspired by Clarkson
(1989) and Joyce and Sills (2010), we refer to the process
of experience as the ‘gestalt experience cycle’, and repre-
sent it diagrammatically as a circle for the purpose of
emphasizing the temporal, cyclical, and whole nature of
experience (Clarkson 1989; Sills et al. 1996). Figure 1 dia-
grammatically maps the eight themes identified in this
study to the gestalt experience cycle.

In the gestalt experience cycle, a ‘dominant figure
emerges from a background, claims attention and fades
into the background again as a new compelling figure
emerges’ (Clarkson 1989, p. 27). For example, a woman
browsing in a bookshop gazes upon a book. As she reads

its dust cover, the other books fade into the background.
Then another book catches her eye and it becomes
figural, and so on.

Cycles of experience can be microscopic, such as the
process of breathing in and out. They can also be macro-
scopic and take many years, such as studying for a degree,
raising a child, or a person’s lifetime (Clarkson 1989;
Mackewn 1997). Smaller cycles can occur within larger
cycles. They are like stories within stories.

This study was concerned with the macroscopic expe-
rience cycle relevant to the participants’ experiences of
the influence gestalt therapy training on their psychiatric
nursing practice. In this way, the cycle encompasses the
participants’ journeys into and through gestalt training
and their experiences of how the training influenced
their practice and their professional lives as psychiatric
nurses.

The following discussion of the eight themes encapsu-
lates the similarities and differences across the storied
collection, and provides a community and cultural context
for understanding the individual stories.

FIG. 1: Mapping the themes to the gestalt
experience cycle (adapted from Clarkson
1989).

GESTALT THERAPY AND PSYCHIATRIC NURSING 299

© 2011 The Authors
International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

Growing professionally in fertile ground
This theme relates to the ‘the fertile void’ (Perls 1969, p.
57): a period of rest and calmness that occurs between the
completion of one gestalt and the emergence of a new
one. It is described as a space rich with limitless possibili-
ties (Clarkson 1989; Joyce & Sills 2010; Mackewn 1997;
Sills et al. 1996).

‘Growing professionally in fertile ground’ describes
the background features of the participants’ lives prior to
the commencement of their gestalt therapy journey.
This theme provides the context for the imminent emer-
gence of their interest in gestalt therapy. Common to
the background or ‘ground’ of all the participants was
their unique features, their professional environments,
and their energetic involvement in professional develop-
ment pursuits.

Mary’s ground was one of creativity. Even before she
began gestalt training, she was working creatively with
people who had long-term mental illness. Cathy’s ground
included an enduring desire to ‘practice holistically’.
Sally’s ground was one of change and professional chal-
lenge, and Peta’s was very much structured around her
professional experience and expertise. The professional
environments of all four participants, although varied with
regard to the type, nature, and even location in time, were
all rich in terms of experience and possibilities.

Resonating with the gestalt potential
This theme relates to the sensation phase of the gestalt
experience cycle. It is when raw sensory information
begins to register for the individual, but is ‘before these
possibilities come fully into meaningful awareness’
(Clarkson 1989, p. 32). It is here that the participants’
interest in gestalt therapy began to emerge as a new figure
from a previously undifferentiated ground.

‘Resonating with the gestalt potential’ is about the par-
ticipants sensitizing and attuning themselves to the field
and the context of their current environment. Across the
stories, this theme encompasses a kaleidoscope of influ-
encing factors that oscillate in the fields of the participants
as individuals. In this theme, the field is alive with stir-
rings, influences, and possibilities. It captures what it was
about the participants’ professional and personal contexts
that contributed to and heightened their interest in gestalt
therapy, and its potential scope in relation to their psychi-
atric nursing practice. An unmistakable openness to influ-
ences and practice possibilities outside of the more
traditional ‘medical model’ psychiatric nursing role was
common across the participants’ stories. Each participant
was in professional contact with colleagues skilled in psy-
chotherapeutic modalities or group work, and had some

exposure to exploring practice possibilities lateral to more
medically-orientated psychiatric nursing practice.

Emerging gestalt potential in psychiatric
nursing settings
This theme relates to the awareness phase of the gestalt
experience cycle. In this phase, the new figure that started
to form in the earlier phase begins to impinge on an
individual’s awareness and becomes the point of interest
for the individual (Clarkson 1989). In ‘emerging potential
in psychiatric nursing settings’, the emerging interest in
gestalt training sharpened for the participants. The par-
ticipants became more attuned to their field, as they
began to see the potential application of their gestalt
therapy knowledge and skills to their psychiatric nursing
practice within their respective practice settings.

Gestalt learning: the self in process
‘Gestalt learning: the self in process’ encompasses the
self-learning, personal growth, and self-awareness inher-
ent in gestalt therapy training and the impact of this on
the participants’ professional lives. Throughout this
theme, the participants were more fully engaging in the
awareness phase of the gestalt experience cycle through
deepening their awareness of their own personal process.
This theme encompasses the concept of the ‘self as chang-
ing process and self as enduring identity . . .’ (Mackewn
1997, p. 76), in that the participants developed personal
insights, awareness, and understandings, and integrated
these into their personal and professional lives. Peta’s
reflections on her choice of career provided an exquisite
example of the integration of such self insights:

Someone commented that one of my functions in my
gestalt training group was to make the group feel safe.
This was interesting feedback, given my choice of career,
which is about containing people and making people feel
safe. It hadn’t occurred to me that I would do that in
another setting.

The participants also told of the challenge inherent in
the personal growth and self-awareness aspects of gestalt
training. Mary’s metaphor of gestalt training being like a
washing machine captures the challenge inherent in the
personal growth process:

The influence of gestalt therapy training on my life
and . . . my work as a psychiatric nurse is like a washing
machine. It’s washed me clean. I feel spun dry and ready.
Being spun about in a washing machine is a ‘bloody awful’
thing. It’s also very cleansing, if you can hack it. . . . (Kelly
& Howie 2007, p. 142)

300 T. KELLY AND L. HOWIE

© 2011 The Authors
International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

Cathy’s story captures the rawness of her experience
and the paradox of this challenge becoming a source of
valuable learning:

The first year . . . was very experiential and involved
intense personal work. It was quite traumatic for me. The
process of increased self-awareness had quite a destabi-
lizing effect on me . . . Yet at the same time, this experi-
ence was quite useful. It helped me to become aware of
my ‘own stuff’ so that I could hold it and be more able to
work therapeutically with my clients. As I progressed in
my gestalt training, I developed confidence and ability to
just be with my clients in their distress and discomfort.

Bringing gestalt into psychiatric nursing practice
This theme relates to the mobilization and action phases
of the experience cycle. In the mobilization phase, the
emerging figure becomes sharper and generates energy
(Clarkson 1989). The person begins to respond to the
sharpening figure, makes sense of it, and prepares to act
(Sills et al. 1996). In the action phase, the person experi-
ments with different courses of action, as they progress
towards achieving their goal (Sills et al. 1996).

‘Bringing gestalt into psychiatric nursing practice’ is
descriptive of how the participants began to connect with
gestalt theory and apply it actively to their psychiatric
nursing practice. The participants experimented with
bringing aspects of gestalt to their psychiatric nursing
practice, making flexible adaptations to gestalt interven-
tions to ensure the appropriateness of the intervention to
the specific needs of their clients (see Yontef & Jacobs
2007). The influence of the participants’ gestalt training
became progressively evident, as it began to inform their
individual and group interventions with clients. Collec-
tively, the participants’ stories were replete with many
practical examples of how they applied their gestalt
knowledge and skills to their psychiatric nursing practice
during their training years. Mary recalled a rich and poi-
gnant story of her application of her gestalt learning to her
work with a man with long-term mental illness:

One of my clients . . . was psychotically depressed and
frequently attempted suicide . . . Following a gestalt
training session on projection, I was working with this
man in my office. My hat trunk was open. He picked up a
hat and put it on his head and I put one on my head. We
began playing characters. These hats helped us talk about
his mental illness and his thoughts about suicide . . . This
story speaks to me about the power of the creativity of
gestalt. I tried to go with where my client was; with
his energy. Paradoxically, we got back to his illness, which
is what did need to be talked about. It was through

projective work that this client and I engaged and then
moved on to deeper and more meaningful work. (Kelly &
Howie 2007, p. 142)

Cathy’s description of the influence of her gestalt train-
ing on her work as psychiatric nurse–therapist captures
the development of a much more ‘dialogic’ and relational
therapeutic style:

Prior to gestalt training, I had shied away from thinking
about my impact on the client, my relationship with them,
and what happens between the client and me. During my
training, I started to think about my relationship with my
client. I also began to take more responsibility for the
impact I had on my client. I moved from being focused on
the content of my client’s story to encouraging them to
think about what we were actually doing together in the
therapy sessions.

Peta’s story of a ‘relationship group’ provides a descrip-
tion of her application of gestalt theory and practice to her
group work as a psychiatric nurse in adolescent mental
health. Peta identified her interventions in this group as
being primarily sensitive to the needs of the young people
yet very much informed by her gestalt learning:

One of the groups was about pre-existing relationships. In
this group, we sat in a circle, pretending to be around a
campfire, and told stories of our family and of our ances-
tors. I encouraged each participant to respond to the
young person who told the story: ‘What was it like for you
when you heard that?’ In this way, I was able to gently
support these emotionally and socially-disabled young
people to support each other. This helped the sense of
cohesion and altruism in the group. My intervention was
framed by what I learnt in my gestalt training. It was
about supporting the young people in sharing an emo-
tional response and being in relationship. It was about
connection.

Expressing the multidimensional influence
of gestalt therapy on advanced psychiatric
nursing practice
This theme relates to the contact phase of the gestalt
experience cycle. In this phase, there is energy, excite-
ment, interest, and engagement (Clarkson 1989; Sills
et al. 1996). Expression in this sense is compatible with
achieving full contact with the figure of interest of the
gestalt experience cycle (Clarkson 1989; Mackewn 1997;
Wheeler 1991).

The theme provides a clear description of the partici-
pants’ full engagement with gestalt theory and practice
and how it relates to their multifaceted, advanced psychi-
atric nursing roles. Specifically, this theme identifies
the dialogic, phenomenological, and field theoretical

GESTALT THERAPY AND PSYCHIATRIC NURSING 301

© 2011 The Authors
International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

influences in the professional practice areas of nursing
professional development, management, nursing educa-
tion, clinical supervision, and individual and group
therapy.

Cathy articulated her ‘interest in the experiential
aspects of gestalt’. Her description of working in the
moment with clients provides an example of the evolving
and mature gestalt influence on her psychotherapeutic
work with clients following her training years:

I work with the individual clients in the group to capture
some confidence or self-esteem and encourage them to
fully experience what it feels like to experience confi-
dence or self-esteem in the moment that it happens. Not
just talking: actually being in there doing it, and talking
about it too.

Sally’s story about sharing her gestalt knowledge and
skills with her work team provides a snapshot of the
vibrancy, energy, excitement, and expression that is ‘final
contact’ (See Clarkson 1989, pp. 33–34). Her story dem-
onstrates her full engagement with bringing her gestalt
knowledge into her psychiatric nursing practice and to her
work team:

What stands out for me is the interest and curiosity about
gestalt among the staff. They wanted to run groups with
me and to learn about gestalt . . . Together, we explored
lots of questions: ‘How might a situation be understood
from a gestalt point of view?’ ‘What might be a gestalt
understanding of the person’s experience?’ . . . We
explored a person’s field, rather than just thinking about
their history and genogram.

Sally identified that, as a manager, gestalt helped her to
‘be more attentive to the different skills within the staff
group’ and to ‘think differently about management issues’.
Sally’s example of dealing with ‘scapegoating’ in a work
team provides a description of how gestalt influenced her
work as a manager:

I think about what purpose scapegoating might serve in
the team . . . what’s happening in the context of the field?
I consider what might be happening for that individual
with those people around them, and what’s leading to
things being the way they are. Gestalt has given me a
broader way of looking at situations. It has also given me
more scope and more ways of dealing with things.

Integrating and assimilating gestalt
This theme relates to the phase of the gestalt experience
cycle that involves ‘satisfaction and gestalt completion’
(Clarkson 1989, p. 35). This phase occurs on the comple-
tion of a life experience and reaching a point of reflecting
on its meaningfulness in relation to one’s past and present

life. ‘Integrating and assimilating gestalt’ encompasses
how gestalt became integrated and assimilated into the
participants’ psychiatric nursing practice and professional
ways of being subsequent to their gestalt training years.
The influence of gestalt therapy is evident in the partici-
pants’ more reflective and confident professional styles
that are mindful of the importance of relationship and the
impact of phenomenological and field theoretical influ-
ences across their spectrum of practice. Mary reflected:

I hardly think about myself as a gestalt psychiatric nurse,
but I am. It’s integral to who I am. I’m very phenomeno-
logical and really curious. I am interested in how nurses
and patients view their world . . . My understanding of
field theory and my living of it helps me see what’s going
on. I’m incredibly observant. I’m mindful of the big
picture and the interrelated parts. Relationship is impor-
tant. How I meet you and show myself to you is the crux.
It can mean that we get done what we need to get done or
not. To me, relationship is everything. Gestalt’s given me
that. I live gestalt. I do it well as a psychiatric nurse. (Kelly
& Howie 2007, p. 142)

This theme is descriptive of the integration of the con-
fidence developed during their gestalt training years into
the participants’ professional ways of being. Sally said:

I gained confidence through gestalt training and that has
impacted on me professionally. I’m not afraid to try some-
thing new, and sometimes in a bit of a quirky way. I’m also
more likely to take a risk and have bit of a go at something
or to challenge and explore why I won’t. I like the idea of
challenge. I think that’s connected to my gestalt training,
because often I learned things in quite unexpected ways.

Making sense
This theme relates to the later satisfaction phase and early
withdrawal phase of the gestalt experience cycle. It is
about the ‘figure’ – gestalt therapy training – becoming
‘ground’ again. ‘Making sense’ provides insight into how
the participants understand and give meaning to their
gestalt training in relation to their professional sense of
themselves as psychiatric nurses trained in the gestalt
approach. Looking back over their training in gestalt
therapy, the participants reflected on their experiences of
the blending of gestalt with psychiatric nursing. In doing
so, they considered the impact of their gestalt experience
on their conceptual appreciation of psychiatric nursing
theories concerning interpersonal relations and the thera-
peutic relationship.

Mary identified the therapeutic ‘use of self’ to be a
quality intrinsic to gestalt therapy and psychiatric nursing.
In her story, Mary not only captured the across-discipline

302 T. KELLY AND L. HOWIE

© 2011 The Authors
International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

relevance of this concept, but also located herself among
a community of other gestalt-trained psychiatric nurses.
She observed:

I always wondered about the use of self in psychiatric
nursing . . . The use of self was the art of psychiatric
nursing. This notion lends itself well to gestalt . . . As a
gestaltist, you use who you are both for your own growth
and for the growth of others. It doesn’t surprise me that I
went from psychiatric nursing to gestalt therapy training.
Many psychiatric nurses are gestaltists. (Kelly & Howie
2007, p. 142)

Evident in this theme is the grounding of the partici-
pants’ gestalt experiences in their enduring sense of them-
selves as psychiatric nurses. Peta reflected:

When I work therapeutically with a client, there’s a whole
cake full of experience . . . Twenty years of psychiatric
nursing experience: all those people I’ve seen and all
those clinicians I’ve worked with. Then there’s the icing:
the very lovely interplay of gestalt therapy with my clinical
practice.

FUTURE RESEARCH DIRECTIONS

This study heralds the opportunity for further research
that evaluates gestalt therapy and other experiential and
relational psychotherapeutic approaches, as applied to
clinical practice in contemporary mental health services.
It also illuminates possibilities for research that explores
consumers’ experiences of these therapies. Importantly,
future studies must employ research designs that are valid
for these psychotherapeutic approaches and congruent
with their philosophical underpinnings. Specifically,
research designs must first incorporate the therapeutic
relationship; second, not limit interventions to ‘achieve
scientific precision’ (Yontef & Jacobs 2007, p. 356); and
third, include holistic measures of recovery.

The challenge, however, is to advance research that is
valid for the holistic, process-orientated psychotherapeu-
tic approaches, but sufficiently robust to demonstrate effi-
cacy in the contemporary mental health-care context.

LIMITATIONS

Although not considered relevant to the aim of the study,
the participants were all women. The inclusion of men
might have influenced the findings (Kelly & Howie 2007).
Further, the sample was limited to nurses working in
Victoria, Australia, and therefore, the findings might not
be applicable outside of this context.

CONCLUSION

This qualitative study aimed to explore the influence of
gestalt therapy training on psychiatric nursing practice.
Utilizing narrative inquiry, a small group of psychiatric
nurses, who were also trained in gestalt therapy, were
invited to tell their stories of how training in gestalt influ-
enced their practice as psychiatric nurses. A systematic
analysis of the transcripts employing narrative analysis
methods resulted in a collection of four individual stories.
Eight themes were derived from an across-story thematic
analysis. Mapping the themes to the gestalt experience
cycle facilitated the researchers to conceptualize the par-
ticipants’ journeys into and through gestalt therapy train-
ing, and their experience of how the training influenced
their practice as psychiatric nurses.

In this study, the stories articulate the experience of
the participants as individuals, while providing a cultural
context and sense of community to psychiatric nurses who
are trained in the gestalt approach (Kelly & Howie 2007).
Importantly, this study communicates the philosophical
congruence of gestalt therapy with core psychiatric
nursing values (Hurley et al. 2006), and describes the
valuable contribution of gestalt therapy training to holistic
person-centred, psychiatric nursing practice.

ACKNOWLEDGEMENTS

We would like to thank our scholarly readers Ms Joan
Steieret, Dr Elizabeth Crock, Ms Dianne Woods, Ms
Wanda Bennetts, and Ms Finbar Hopkins. We would also
like to acknowledge Ms Fiona Lacy for her valued theo-
retical contribution to the thematic analysis, and Ms
Colleen Kelly for preparing the graphics.

REFERENCES
Bessier, A. R. (1970). The paradoxical theory of change. In: J.

Fagan & I. Shepherd (Eds). Gestalt Therapy Now: Theory,
Techniques, Applications. (pp. 77–80). Palo Alto, CA:
Science and Behaviour.

Chambers, M. (1998). Interpersonal mental health nursing:
Research issues and challenges. Journal of Psychiatric and
Mental Health Nursing, 5, 203–211.

Clarkson, P. (1989). Gestalt Counselling in Action. London:
Sage Publications.

Clarkson, P. & Mackewn, J. (1993). Fritz Perls. London: Sage
Publications.

Dziopa, F. & Ahern, K. (2009). Three different ways mental
health nurses develop quality therapeutic relationships.
Issues in Mental Health Nursing, 30, 14–22.

GESTALT THERAPY AND PSYCHIATRIC NURSING 303

© 2011 The Authors
International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

Emden, C. (1998a). Theoretical perspectives on narrative
inquiry. Collegian, 5, 30–35.

Emden, C. (1998b). Conducting a narrative analysis. Collegian,
5, 34–39.

Gaffney, S. (2009). The cycle of experience re-cycled: Then,
now . . . next? Gestalt Review, 13, 7–23.

Hurley, J., Barrett, P. & Reet, P. (2006). ‘Let a hundred flowers
blossom, let a hundred schools of thought contend’: A case
for therapeutic pluralism in mental health nursing. Journal of
Psychiatric and Mental Health Nursing, 13, 173–179.

Hycner, R. & Jacobs, L. (1995). The Healing Relationship in
Gestalt Therapy: A Dialogic/Self Psychology Approach. New
York: The Gestalt Journal Press.

Joyce, P. & Sills, C. (2010). Skills in Gestalt Counselling and
Psychotherapy, 2nd edn. London: Sage Publications.

Kelly, T. & Howie, L. (2007). Working with stories in nursing
research: Procedures used in narrative analysis. International
Journal of Mental Health Nursing, 16, 136–144.

Lewin, K. (1951). Field Theory in Social Science. New York:
Harper & Row.

Mackewn, J. (1997). Developing Gestalt Counselling. London:
Sage Publications.

Melnick, J. (1997). Welcome to the gestalt review. An editorial.
Gestalt Review, 1, 1–8.

Moyles, W. (2003). Nurse–patient relationship: A dichotomy of
expectations. International Journal of Mental Health
Nursing, 12, 103–109.

Parlett, M. (1991). Reflections on field theory. The British
Gestalt Journal, 1, 69–81.

Parlett, M. (2005). Contemporary gestalt therapy: Field theory.
In: A. L. Woldt & S. M. Toman (Eds). Gestalt Therapy:
History, Theory and, Practice. (pp. 41–64). Thousand Oaks,
CA: Sage Publications.

Patton, M. Q. (2002). Qualitative Research and Evaluation
Methods, 3rd edn. Thousand Oaks, CA: Sage Publications.

Peplau, H. (1952). Interpersonal Relations in Nursing. New
York: G.P. Putman & Sons.

Peplau, H. (1962). Interpersonal techniques: The crux of psy-
chiatric nursing. American Journal of Nursing, 62, 50–54.

Perls, F. S. (1969). Gestalt Therapy Verbatim. Moab, UT: Real
People Press.

Polkinghorne, D. E. (1995). Narrative configuration in qualita-
tive analysis. In: J. A. Hatch & R. Wisniewski (Eds). Life
History and Narrative. (pp. 5–23). London: The Falmer
Press.

Polsters, E. (1987). Every Person’s Life is Worth a Novel. New
York: W. W. Norton & Company.

Rice, P. L. & Ezzy, D. (2001). Qualitative Research Methods: A
Health Focus. Victoria: Oxford University Press.

Riessman, C. K. (1993). Narrative Analysis. Newbury Park,
California: Sage Publications.

Sills, C., Fish, S. & Lapworth, P. (1996). Gestalt Counselling.
London: Winslow.

Spinelli, E. (2005). The Interpreted World: An Introduction to
Phenomenological Psychology, 2nd edn. London: Sage Pub-
lications.

Welch, M. (2005). Pivotal moments in the therapeutic relation-
ship. International Journal of Mental Health Nursing, 14,
161–165.

Wheeler, G. (1991). Gestalt Reconsidered: A New Approach to
Contact and Resistance. New York: Gardner.

Whitehead, D. & Annells, M. (2007). Sampling data and data
collection in qualitative research. In: Z. Schneider, D. White-
head & D. Elliot (Eds). Nursing and Midwifery Research:
Methods and Appraisal for Evidence-Based Practice, 3rd
edn. (pp. 122–137). Sydney: Elsevier.

Wright, K. M. (2010). Therapeutic relationship: Developing a
new understanding for nurses and care workers within an
eating disorder unit. International Journal of Mental Health
Nursing, 19, 154–161.

Yontef, G. M. & Jacobs, L. (2007). Gestalt therapy. In: R. J.
Corsini & D. Wedding (Eds). Current Psychotherapies, 8th
edn. (pp. 328–367). Belmont, CA: Thomson Brooks/Cole.

Yontef, G. M. & Simkin, J. S. (1993). Gestalt therapy. In: G. M.
Yontef (Ed.). Awareness, Dialogue and Process: Essays on
Gestalt Therapy. (pp. 128–180). New York: The Gestalt
Journal Press.

Zinker, J. (1977). Creative Processes in Gestalt Therapy. New
York: Vintage.

304 T. KELLY AND L. HOWIE

© 2011 The Authors
International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

Copyright of International Journal of Mental Health Nursing is the property of Wiley-Blackwell and its content

may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express

written permission. However, users may print, download, or email articles for individual use.