Gestalt Therapy Interventions Peter Schulthess Paris EAGT Research Conference 2017

Project team PAP-S Volker Tschuschke, University of Cologne Agnes von Wyl, University of Applied Sciences, Zurich Margit Koemeda, Swiss Charter for Psychotherapy Aureliano Crameri, University of Applied Sciences, Zurich Peter Schulthess, Swiss Charter for Psychotherapy

How to describe, what therapists really do in their practice? PAP-S (Naturalistic Practice Study in Switzerland including 10 distinct modalities) PAP-S-RM: Rating Manual for the Objective Evaluation of Interventions Usually research projects neglects checking real therapeutic interventions Existing manuals mainly influenced by CBT A broader oriented manual was needed Aim: evaluating therapists‘ treatment adherence with their prescribed treatment concept

Development of the Manual Experts Consultation from modalities. Each modality contributed 7-10 specific interventions. In total: 100 different interventions resulted - Gestalt Therapy - Psycho Analysis and Dephth Psychology - Jungian - Client Centered - Systemic - CBT - Existential Analysis - Art and Expression Oriented Psychotherapy - Integrative Body Psychotherapy - Process work - Logotherapy and Existential Analysis - Bioenergetic Analysis and Therapy - Transactional Analysis - Non specific (general) interventions

How do You recognize that this is a Gestalt Therpist working? What are typical Gestalt interventions? Listing the 10 most important specific interventions (taken from previous research of B. Fliegener in Germany and supplemented) Consulting Experts in Teaching Gestalt Therapy Revision Final list presented to the manual construing researchers Discussion about expressions and language for those who are not Gestalt Therapists Transfering theoretical descriptions to phenomenological descriptive ones (defining operationalizations of the theoretically described intervention techniques)

Structure of Manual Definition (Name of the intervention) Operational definition (descriptive) Differentiation (to distinguish from other –similar - interventions) Typical examples 100 different interventions have been described

Training of Raters and Interrater Reliability Raters have been trained over 100 hours in identifying these 100 interventions in tape recorded sessions Blind for approach Interrater reliability: 0.61 (in Cologne) and 0.68 (in Zurich) (Cohen‘s Kappa)

Discussion Is Gestalt Therapy measurable by identifying Interventions? Who defines what is Gestalt Therapy? Symplification, but better then not measuring at all

Results on Treatment Adherence

54 therapies 165 sessions 6 x 3 7 x 3 6 x 3 8 2 x 1 4 x 3 2 x 5 7 12 1 x 2 11 x 3 54 therapies 165 sessions

SGTA Transactional Analysis FG-POP Process Oriented Therapy IGEAP Personal Existential Analysis SVG Gestalt Therapy SGBAT Bioenergetic Therapy ISIS Art and Expression Oriented Therapy IBP Integrated Body Therapy Psa + SGAP Psychoanalysis and Analytical Psychology

Gestalt Therapists Interventions 8 % modality specific interventions 70 % general interventions 22 % Interventions from other modalities

Interventions from Other Concepts (Percentage of total other concept interventions, percentage of most preferred other concept, and mostly used other concept intervention category) Process oriented IBP Logotherapie Expressive Arts Therapy Psa Jung Bioenergetic Therapy Gestalt TA 32,7 28,9 23,7 30,9 14,1 30,3 22,1 31,3 1. CCT 16,0 Verbalization of emotional experience 1. Psa 26,9 Interpretation 1. CCT 50,8 1. Psa 35,1 Confrontation 1. CCT 46,7 1. Psa 46,4 1. Psa 40,6 1. Psa 31,5 2. Psa 14,6 2. CCT 15,1 2. Psa 33,8 2. Systemic 14,9 Metaphor work 2. SGAP 20,0 Working with complex episodes 2. CCT 19,1 2. CCT 25,2 Systemic 19,1 Reframing 2. SGBAT 14,6 Focussing on body impulses 3. SGAP 11,7 Imagination 3. SGAP 4,6 Search for sense and meaning 3. Behavior Therapy 12,0 Reinforcement 3. SVG 17,8 Focussing on actual emotion Systemic 14,8 Systemic 11,4 3. ILE 13,1

Treatment adherence and outcome Dodo Bird Verdict: Everybody wins a price. Because therapists from all modalities use more then 50 % general interventions? Treatment adherence does not seem to be a predictor for outcome The same therapists show with different patients a different amount of typical interventions

OQ-Total Scores and Treatment Fidelity and techniques from other concepts 11 therapies more severely disturbed patients (1:3:7) therapists less experienced (Mean = 6.8) 53 therapies less severely disturbed patients (15:9:22) therapists more experienced (Mean = 12.5)

Conclusions Across modalities we identified and operationalized a wide variety of intervention categories. They range from “intitiative towards behavioural interaction” to “recommending imaginative work”, from “direct assignment” to “free floating attention”. There is a spectrum of overlapping categories: “Nonspecific” or „essential but not unique“. Therapists predominantly work with these (50% - 70%). „Essential and unique“ interventions across all modalities amount to less than 20%. Techniques from other concepts are being used to an approximate extent of 10% - 35%. Most of these latter intervention techniques („other concepts“) come from Psychoanalysis and Client-Centered Therapy. However, treatments are successful on average. Thus, it can be speculated that the outcome equivalence paradox in psychotherapy is due to the relatively high proportion of unspecific interventions which are seemingly shared by all psychotherapists. So far we find a trend that intervention specificity seems to be higher (> 30%) with less experienced therapists, and only moderate (10% - 30%) with more experienced therapists. Further data analysis may reveal if specific disorders, the severity of patients‘ distress, additional therapist variables or certain phases of therapy are related to high versus low intervention specificity.

Literature Tschuschke V, Koemeda-Lutz M, Schlegel M (2015): PAP-S-Rating Manual (PAP-S-RM). Zurich, Swiss Charter for Psychotherapy (free download from our website) www.psychotherapieforschung.ch Many publications are available in English, German and French