The Pennsylvania State University Can research be relevant to Gestalt therapists, or any type of therapists? EAGT La Ville Lumière May 2017 Louis G. Castonguay The Pennsylvania State University

Caveats North American perspective Theoretical and epistemological assumptions CBT and RCT Building on convergences and complementary across theories, domains, expertise Improving effectiveness without always requiring drastic change in practice Improving practice by integrating two types of research: evidence based and practice oriented 2

HOW RESEARCH CAN BE USE TO EXPAND OUR CLINICAL REPERTOIRE Empirically Supported Treatments (EST) and Potentially Harmful Treatments (PHT): First lines of attack (FLA) and warning signals (WS) for some clients - Depression: Good news and bad news Empirically based guidelines: Modifying, expending, and adding to FLA and WS - Principles of change - Psychopathology findings - Process research and outcome research Practice-oriented research: Complementing evidence based practice

Principles of Change: Building on Theoretical connections APA & NASPR Task Force (Castonguay & Beutler 2005) Domains: Client characteristics Relationship variables Techniques variable Problems: Depression Anxiety Personality Disorders Substance Use Disorders

Principles Related to Participant Factors in Treating Anxiety Disorders Newman et coll. (2005) Psychotherapy for anxiety is less likely to be successful if the client experiences high level of functional impairment (e.g., severity, distress, axis I comorbidity, interpersonal problems, social support perceived as critical) Psychotherapy for anxiety is less likely to be successful if the client has negative perceived parenting.

Principles Related to Relationship Variables in Treating Depression Principles Related to Relationship Variables in Treating Depression. Castonguay et coll. (2005) When working with depressed clients, therapist’s use of self disclosure is likely to be helpful. This may be particularly the case for reassuring and supportive self- disclosure, as opposed to challenging self-disclosures. When working with depressed clients, therapists should strive to develop and maintain a positive working alliance with their clients.

Alliance: What do we know Alliance: What do we know? Castonguay, Constantino, & Grosse Holtforth (2006) It predicts outcome across several orientations It is predicted by client’s characteristics and behaviors It correlates with therapist’s characteristics and behaviors It predictive when measured early in therapy It is at least as predictive when measured by the client than when measured by the therapist

Principles Related to Technique in Depression Follette & Greenberg (2005) Challenge cognitive appraisals and behavior with new experience. Increase and diversify the patient's access to reinforcements to increase behavioral activation and decrease avoidant behaviors. Improve the patient's interpersonal social functioning. Improve marital, family, and social environment to reduce the establishment, maintenance, or recurrence of depressive behaviors. Improve awareness, acceptance, and regulation of emotion and promote change in maladaptive emotional responses.

Principles Related to Deterioration Castonguay et al., (2010) Prevent and repair toxic relational and technical processes Help trainee become aware of instances where inflexible adherence to techniques threatens the alliance. He/she should be trained to use potentially helpful interventions in a clinically flexible and sensible way Treatment choice, implementation, and expectation should be adjusted to client Help trainee be aware that clients with high levels of reactance are not likely to benefit from directive forms of therapy, and that clients with low levels of reactance are not likely to benefit from non-directive treatments

Principles Related to Deterioration Castonguay et al., (2010) Some therapists may be better than others Help trainee increase self-awareness of their hostility toward him/herself and potentially steer toward own personal psychotherapy

HOW EVIDENCE BASED RESEARCH CAN EXPAND OUR CLINICAL REPERTOIRE Empirically based guidelines: Modifying, expending, and adding to FLA and WS - Principles of change - Psychopathology findings - Process research and outcome research Practice-oriented research: Complementing evidence based practice

Psychopathology: Building on Connections of Research Domains Psychopathology research can tell us what to change, psychotherapy research can tell us how to change it (Arkowitz, 1990) Clinical implications of research on symptoms, clinical features, epidemiology, course, co-morbidity, and etiology

Integrating Research Domains Psychopathology of Depression Symptomatology: Psychomotor change (Buchwald & Rudick-Davis, 1993) Clinical features: Anger and lack of cooperation (Joiner, 2002) Epidemiology: Prevalence (Seligman, 1989) Gender (Nolen-Hoeksema, 1987)

Principles Related to Technique in Depression Follette & Greenberg (2005) Challenge cognitive appraisals and behavior with new experience. Increase and diversify the patient's access to reinforcements to increase behavioral activation and decrease avoidant behaviors. Improve the patient's interpersonal social functioning. Improve marital, family, and social environment to reduce the establishment, maintenance, or recurrence of depressive behaviors. Improve awareness, acceptance, and regulation of emotion and promote change in maladaptive emotional responses.

Integrating Research Domains Psychopathology of Depression Etiology: Cognitive inhibitions (Joormann et al., 2007) Reappraisal of negative events Emotional disclosure Distraction Parental neglect/abuse and insecure attachment Therapeutic relationship as corrective experience Exploration of early relationship events Stress and stress regulation strategies Interpersonal styles

Integrating Research Domains Psychopathology of BP Risk factors: Medication adherence Depression symptoms Negative life events, perceived low social support, EE Negative cognitive styles Manic symptoms Goal dysregulation Schedule disruption

Integrating Research Domains Psychopathology of BP Principles of change: Improve awareness of symptoms Increase motivation for medication adherenc Increase treatment engagement Reduce risk factors for episodes Promote regulation of sleep and activities Address overly ambitious goals Address maladative thoughts Address interpersonal stress and social isolation

Integrating Research Domains Psychopathology: From Science to Clinical Practice (Castonguay & Oltmanns, 2013)

Integrating Research Domains Pairs of scholars from psychopathology and psychotherapy research Deriving clinical guidelines based on empirical information that can be relevant to most if not all orientations, in terms of assessment, case formulation, and treatment planification

These two lines of research suggest EBP does not have to imply radical change EBP should include RCT EBP should not be restricted to RCT

Other lines of research Psychotherapy: Bringing Psychotherapy Research to Life: Understanding Change through the work of leading clinical researchers (Castonguay, Muran, Angus, Hayes, Ladany, & Anderson, 2010) Visions in Psychotherapy Research and Practice (Strauss, Barber, & Castonguay, 2015) Basic Research: Constantino & Castonguay (2003)