Gestalt Therapy and Mental Health Care.
Early research to develop a working model for community mental health care and uncover principles of care which would be efficacious was developed by Stein and Test (1980) in Madison, Wisconsin. This model was replicated at other sites around the world such as Sydney, Australia (Hoult, 1986). This provided a blueprint for a comprehensive system of mental health care which integrated hospital and community components of care, provided a single point of entry to the service and used a case management approach which fostered collaborative ways of working with consumers, families and community agencies to achieve an integrated network of care.
Two robust models of case management are those of Kanter (1989) and Onyett (1992) both of which link philosophy, principle and practice of case management into a comprehensive model.
Both these models stress a strong consumer or service user orientation, where mental health care practice is done in collaboration with consumers and their families. They both stress an initial phase of case management involving engagement and relationship building as a foundation for all other future interventions. This is a shift from previous models of mental health care (particularly institutional) which provided mental health care to the patient without a need for consultation and collaboration with the mentally ill and their families.
My work in Australia has involved training health professionals in gestalt therapy through the Illawarra Gestalt Centre and teaching Case Management to mental health workers across the continent through the Postgraduate Mental Health Program at the University of Wollongong. I have found not only has my training and experience in one area helped me in working in the other, but I see each approach as speaking to the same issues and frequently only the words are changed, depending on the audience I am talking too.
Now of course training in gestalt therapy does not prepare one for working as a mental health worker and vis versa. In fact there is very little gestalt therapy literature on how to work with psychotic disorders, and most mental health workers' view of gestalt therapy is that it is supiciously too emotive and confronting to be of use in working with the mentally ill.
Over the next few days and weeks, I will offer a series of brief articles here discussing the use and application of Gestalt Therapy to in working with the people experiencing serious mental illness, paying particular attention to the tremendous overlap between these two frequently seperate fields of literature.
While both Kanter and Onyett see a place for counselling and psychotherapy as part of a comprehensive case management approach, and list it as a component of *Individual Interventions*, I believe one of the most useful applications of gestalt therapy to mental health practice is in the initial phases of case management - engagement and relationship building. Kantor and Onyett offer the relationship itself as the foundation for all other work in case management. If you read the Introduction to Gestalt Therapy by Yontef and Simkin, you will notice the importance placed on what Martin Buber called the I-Thou relationship. If you haven't read the introductory article already, please do so and I'd like to then launch us into one thread of this forum that is of particular interest to me... the application of the gestalt approach to working within current best practice models of mental health care.
Hoult, J. (1986) Community care of the acutely mentally ill, British Journal of Psychiatry, 149, 137-44
Kanter, J. (1989) Clinical case management: definition, principles components. Hospital and Community Psychiatry, 40 (4), 361-8.
Stein, L.I. and Test, M.A. (1980) Alternative to mental hospital treatment I. Archives of General Pyshciatry, 37, 392-7.
Onyett, S. (1992) Case Management in Mental Health, Chapman & Hall, London.