1. Dr Matt Bambling THE RESEARCH PARADIGM AND GESTALT

2. AIMS Briefly review the history of psychotherapy research to illustrate the major approaches Define the nature of research models and observed phenomena Discuss implications for Gestalt

3. The scientific paradigm The scientific method is good at defining phenomenon and classifying effects It has limitations as it cannot explain all mechanisms in therapy It can not fully explain why therapy works or the subjective meaning attached to the experience of therapy

4. The scientific method and psychotherapy history The first research methods in psychotherapy were observational and inclusive; psychoanalysis, neo-offshoots, and psychodynamic approaches. Outcomes were assessed both subjectively and objectively, how a person felt, functioned and weather they had resolved core conflicts

5. It was not enough to have target symptom reduction as an outcome, the undying problem must have been identified and worked through to count as an effective treatment The method was case study, observation and classification. This method built up clinical theory and diagnostic and treatment nosology as well as elucidating psychodynamic principles, and finally classifications and systems of diagnosis and treatment. So method and process of therapy research were one. The model reflected the definition of phenomena.

6. The second wave Paradigm shift into behavioural models with mechanistic assumptions led to easily quantifiable symptom measure and treatment dose equations. Behaviour was devoid of feeling and cognition. Later cognitive approaches reintroduced thinking and meaning operationalising these as defined constructs that could be measure in the same way. The methods reflected the model.

7. Pieces of the picture These approaches were polarised until the late 80s when humanistic, psychosocial and other models appeared in force. Outcome became more holistic again including global function and quality of life, not just symptoms. Qualitative and phenomenological methods were seen as positive ways to engage with the impact of the conditions for therapy and its broad benefits Meaning making research paradigms gained popularity such as qualitative measures, communication models, and therapy process analysis. The dual approach lead to the important discovery of process variables in treatment outcome.

8. Our most prized mythologies about research Efficacy Vs effectiveness studies are the 2 biggest stars in the therapy research world Novel designs include Single session models Case studies Feedback and dose dependent treatment tracking Process analysis Content analysis Contemporary trend towards mixed models

9. Example of treatment tracking over time: 2 group model

10. What research has proven and the myths of research One of the most enduring findings is that common factors and relationship variables are more important than approach; kruppnik. No one approach is superior, they work because of process factors; what about effect sizes?

11. So can we forget models of therapy? It is more about therapist and client variables and not skills; really, what about skilfulness? Has led to extreme claims that technique and skill doesn’t matter; not true Feedback research has proven the notion of therapist factors in outcome, and also a procedure for increasing skilfulness and outcome. More than just providing immediate client feedback, works one level up in supervision and client outcome. So we can conclude that they are 2 sides to the one coin, and privileging one over the other in research is myopic and cloud identification of key mechanisms.

12. The state of Gestalt therapy Wagner states: Orthodox gestalt therapy suffered a rather unfortunate fate; gestalt theory has been poorly articulated, and gestalt techniques have received minimal empirical validation. However, recent empirical research suggests that the 2-chair technique is superior to other therapeutic interventions for conflict splits, decisional conflict, marital conflict, and unfinished business and that the 2-chair technique is as effective as Rogerian and cognitive- behavioural therapies.

13. This is optimistic Research is scant, mainly qualitative-subjectivist investigations. But this is needed as a starting point. Much theoretical discussion In the race for an evidence base it must be concluded Gestalt therapy is loosing. The good news is that it is an unexplored territory and badly needed. Best way forward as a starting point is to focus on treatment effectiveness Manualised brief treatment approach and trials Need to develop a standardised approach and a agreed set of theoretical principles

14. Gestalt as a modality and scientific method, process vs mechanisms Gestalt is a complex therapy that relies on technique and process to effect outcomes. It has the richness of psychodynamic models and is multi level. It can be engaged with through nearly any paradigm of research to examine features, but will be to the exclusion of others. E.g. symptom outcome A Gestalt research paradigm has potential to be inclusive and examine multiple areas. It could be back to the future

15. Potential approaches Treatment tracking to measure dose dependent response Clinical change Impact of individual sessions, this could make an excellent primary effectiveness study Analysis of process and interactions in sessions; including Gestalt specific constructs Working alliance Qualitative experience and evaluation Or any combination of these would make a fine PhD As Gestalt therapists would know, any of these are good, but combining these approaches are likely to give a more complete picture of the impact of treatment and mechanisms of change.

16. Finish Thanks for listening and good luck with research