1. Gestalt Therapy Interventions
Peter Schulthess
Paris EAGT Research Conference 2017

2. 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

3. 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

4. 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

5. 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)

8. 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

12. 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)

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

14. Results on Treatment Adherence

15. 54 therapies 165 sessions 6 x 3 7 x 3 6 x 3 8 2 x 1 4 x 3 2 x 5 712
1 x 2
11 x 3
54 therapies 165 sessions

16. 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

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

18. 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 ,0
Verbalization
of emotional
experience
1. Psa ,9
Interpretation
1. CCT ,8
1. Psa ,1
Confrontation
1. CCT ,7
1. Psa ,4
1. Psa ,6
1. Psa ,5
2. Psa ,6
2. CCT ,1
2. Psa ,8 2.
Systemic 14,9
Metaphor work
2. SGAP 20,0
Working with complex episodes
2. CCT ,1
2. CCT ,2
Systemic ,1
Reframing
2. SGBAT ,6
Focussing on body impulses
3. SGAP 11,7
Imagination
3. SGAP ,6
Search for sense and meaning 3.
Behavior
Therapy 12,0
Reinforcement
3. SVG ,8
Focussing on actual emotion
Systemic 14,8
Systemic 11,4
3. ILE ,1

19. 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

20. 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)

21. 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.

22. 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) Many publications are available in English, German and French