Gestalt Therapy and Mental Health Care: Part 2.

Gestalt Therapy and Mental Health Care II

I'd like to begin this second part of the article on Gestalt Therapy and Mental Health Care by posing a few questions to encourage interactivity and dialogue and start you thinking about these issues from whatever perspective you bring to this discussion forum.

First, in what way does training in Gestalt therapy advance or add to public mental health work, particularly in terms of current models of case management?

Second, in what way might Gestalt therapy be limited or inappropriate for public mental work?

I'd be interested to hear your perspective.

Do you think that Gestalt therapy is best kept for people of a more psychologically stable nature, and for certain disorders such as anxiety?

Or is the Gestalt approach suitable in working with people who experience psychotic disorders such as schizophrenia?

I have my own thoughts and answers to these questions and as we develop the discussion here on the list I'd like to offer them, along with some stories from my work with people experiencing psychosis, with particular emphasis to the area termed *dual diagnosis*.

I've included here a summary of the Principles of Case Management in mental health, by Joel Kanter (1989). You might like to compare these to the principles of Gestalt therapy to be found in the introductory article by Yontef and Simkin as a starting point.

*Definition of Case Management (Kanter, 1989)*

Clinical case management can be defined as a modality of mental health practice that, in coordination with the traditional psychiatric focus on biological and psychological functioning, addresses the overall maintenance of the mentally ill person's physical and social environment with the goals of facilitating his or her physical survival, personal growth, community participation and recovery from or adaptation to mental illness.

Or to summarise in point form:

a modality of mental health practice

addresses the overall maintenance of the mentally ill person's physical, psychological and social environment

with the goals of facilitating

*PRINCIPLES of Case Management*

1. Continuity of Care. This reflects an appreciation of the person's need for support and treatment/rehabilitation over an extended period of time. This involves an ongoing personal relationship with a case manager who is familiar with the past and present manifestations of their illness, their past and present personal functioning and their social networks.

3. Titrating Support and Structure. Like psychiatrists who adjust medication dosages to reflect the person's fluctuation status, case managers collaborate with clients and social networks in titrating the levels of environmental support and structure needed to facilitate survival, personal development, and adaptation to mental illness.

4. Flexibility. People's changing internal and external worlds require case mangers to flexibly tailor their interventions to accommodate diverse needs of individuals. The frequency, duration and location of interventions should reflect an appreciation of each person's individual needs and situation.

5. Facilitating Patient Resourcefulness. In finding the proper balance between flexibility and firmness, case managers attempt to facilitate the client's personal resourcefulness, helping them manage their own lives.

Kanter, J. (1989) Clinical case management: definition, principles components. Hospital and Community Psychiatry, 40 (4), 361-8.

• Case Management by John Winston Bush, Ph.D., 11/7/96
• In Response to ..Part 2 by John Clark , 11/24/96
  • Working with People Experiencing Psychosis by Brian O'Neill, 12/5/96
• Thank you for sharing by Afonso H Lisboa da Fonseca, 3/6/97