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In this naturalistic study, 262 audiotaped psychotherapy sessions--randomly drawn from 81 individual therapies from eight different psychotherapy approaches--were rated completely on treatment adherence using a newly developed rating manual. In the therapy sessions, a relatively low percentage of treatment specific interventions (ranging from 4.2% to 27.8%) was found for all eight approaches, 50% to 73% of the interventions were nonspecific or common, and approximately 18% to 27% were intervention techniques from other approaches. Different types of psychotherapy differed highly significantly in levels of treatment adherence. There was no statistically significant association between the type of psychotherapy and its outcome, or between the degree of therapists' treatment fidelity and the treatment outcome. However, there were significant associations between therapists' degree of professional experience, clients' initial psychological burden, and treatment response. Clients' severity of psychological problems prior to treatment predicted quality of therapeutic alliance while therapists' treatment adherence was predicted by therapists' professional experience and by the quality of the therapeutic alliance. We discuss the seemingly indirect importance of treatment adherence for psychotherapy outcome that we found in this study in relation to findings from other studies and in the context of the role of schools within psychotherapy.

Objective: The research on psychotherapy for posttraumatic stress disorder (PTSD) stems predominantly from a cognitive-behavioral orientation while other approaches are underrepresented. We evaluated dialogical exposure in trauma therapy (DET), a treatment for PTSD combining cognitive-behavioral elements with an interpersonal, gestalt-based framework., Methods: In this uncontrolled pilot trial, 25 PTSD patients were treated with DET in an outpatient setting and 21 completed therapy., Results: There was a significant reduction in self-rated PTSD symptoms from pre- to posttreatment. Effect sizes were large in the completer sample and moderate to large in the intent-to-treat sample. General psychopathology also decreased significantly. The dropout rate was rather low at 16%., Conclusion: These results show that further research on DET as a treatment for PTSD is warranted.

We offer a view of the nature and role of client-therapist collaboration in experiential psychotherapy, focusing on Gestalt and emotion-focused therapy (EFT). We distinguish between the necessary condition of mutual trust (the emotional bond between client and therapist) and effective collaboration (regarding the goals and tasks of therapy). Using a case study of experiential therapy for social anxiety, we illustrate how the development of collaboration can be both complex and pivotal for therapeutic success, and how it can involve client and therapist encountering one another through taking risks by openly and nonjudgementally disclosing difficult experiences in order to enrich and advance the work., (© 2012 Wiley Periodicals, Inc.)

Topic: Dissociation is believed to be one of the most common underlying psychological processes among children and adolescents receiving mental health treatment, but most of the dissemination of information about dissociation has occurred among psychiatrists and psychologists., Purpose: Modes of treatment for dissociation as it affects children and adolescents are described., Sources Used: Current research and practice scholarly articles on treatment of children and adolescents for dissociation and dissociative symptom disorders were accessed and critically reviewed., Conclusions: Prognosis in children and adolescents can vary widely among patients and between the specific types of dissociation disorder; however, expert clinicians and researchers agree that early, intense treatment offers the greatest possibility of full recovery.

In psychotherapy, the crucial question of indication-and more particularly, the question of differential indication-has, for a long time, not received the attention it deserves. This has been the case both in research and in the training of psychotherapists, and the decisions made by psychotherapists when choosing a type of intervention for a patient (or the patient for an intervention), have scarcely been informed by research results. This state of things is changing due to a series of factors, and the scientific, the clinical, the socio-political, and the legal aspects of the problem gain more and more attention. The fact that a psychoanalysis during five years with four sessions a week (the therapeutic effects of which are not established) takes almost the same therapeutic effort as the treatment of fourty patients receiving a short-term therapy of twenty six sessions during a half year, or of eighty patients having thirteen sessions (these twenty six or thirteen sessions likely to yield quite satisfying therapeutic effects) is something of which everybody begins to be strikingly aware. But differential indication-globally the question: what therapy for what patient?- continues to pose problems. Do we have valuable criteria for choosing, and why don't we use those we have? In this paper we distinguish two types of problems: those at the conceptual and technical level and the problems pertaining to the ethical and professional domain. Their description will be followed by some conclusions and recommendations that might be useful for treatment selection.

A literature review indicated a dearth of research on how dreams are used in therapeutic settings so a questionnaire was sent to a random sample of 500 members of the Florida Psychological Association to assess (a) the extent of dream use in therapy, (b) theoretical approaches applied to dream interpretation, and (c) basis for experience and expertise in dream work. Of the 500 potential clinicians, 228 returned survey forms for a response rate of 46%. Analysis indicated that 83% of the respondents used dream material at least occasionally in their practice and that Freudian and Gestalt approaches were most often used in dream interpretation. Interestingly, most respondents gained their 'experience' in dream work through self-study and continuing education workshops and seminars.

In an exploratory study, the authors examined the cognitions, affect, and behaviors reported by eight female depressed chronic pain patients during experiential therapy sessions that focused on anger and depression. Subjects appeared to fit previously developed psychologic profiles of patients with chronic pain disorder: they presented as conscientious, compliant, passive, and rule-bound, viewing life and emotional expression as dangerous, avoiding conflict and risk, denying their own emotional needs. Their reports were compared with the self-reported affect behavior and cognitions of eight depressed female patients without chronic pain, under similar therapeutic conditions. Considerable differences in style and content were found. Implications of these findings for clinical practice are discussed.

In Gestalt therapy, transference is viewed as a contact boundary disturbance which impairs the patient's ability to accurately perceive the present therapy situation. The boundary disturbances in Gestalt therapy most closely related to the analytic notion of transference are projection, introjection, and confluence. In Gestalt group psychotherapy, group members interfere with the process of need identification and satisfaction by distorting their contact with each other through projecting, introjecting, and being confluent. The Gestalt group therapist uses interventions directed to individuals and to the group to increase participants' awareness of these boundary disturbances and of the present contact opportunities available to them when these disturbances are resolved. In formulating interventions, the leader is mindful of the function of boundary disturbances to the group-as-a-whole as well as to individuals.

Interviewing behavior of psychiatrists representing the Gestalt, Psychoanalytic, Kleinian and Jungian schools of psychotherapy are rated using the Truax-Carkhuff measures of accurate empathy, nonpossessive warmth and genuineness. Although similarities of behavior were found, there were significant behavioral differences that coincide with the theoretical models.

The incidence of masturbation in males and females as reported by Kinsey was cited as basic data to support Gagnon and Simon's theoretical conceptions of differences in the psychosexual development of males and females. The use of masturbation as treatment in sex therapy was reviewed. An inventory to measure negative attitudes toward masturbation was described, and four research studies supporting its construct validity was summarized. The affective-cognitive structure of masturbation-guilt was posited to inhibit masturbatory behavior and to elicit negative affects such as guilt and disgust as a consequence of masturbation. The use of the inventory measuring negative attitudes toward masturbation was illustrated using the P-LI-SS-IT model. Intensive therapy from a gestalt sex therapy perspective was illustrated as integrating the negative masturbatory schema into self-regulating awareness-expression cycles. A caution to sex therapists alerted them to the importance of awareness of emotions, fantasy, and sociosexual meanings in sex therapy rather than using masturbation as a packaged technique.

This article discusses the theory and operations of Gestalt Therapy from the viewpoint of learning theory. General comparative issues are elaborated as well as the concepts of introjection, retroflextion, confluence, and projection. Principles and techniques of Gestalt Therapy are discussed in terms of learning theory paradigm. Practical implications of the various Gestalt techniques are presented.

The aim is to demonstrate the presence of transference within Gestalt Psychotherapy, opinion not shared by many gestaltists. For this purpose she includes Freud's findings and comments on transference. She also takes into consideration Jung's and Melanie Klein's concepts on transference. The author concludes that transference is in Psychoanalysis a decisive concept in diagnosing and defining a prognosis. She refers to the fact that in Gestalt Psychotherapy the patient projects on the therapist disturbed aspects of his personallity as well as healthy ones, which determines the characteristics of the relationship. In Gestalt Therapy transference is made easy by the self-responsibility the patient has to assume in the process. Within this frame-work some of the techniques which facilitate the use of transference are mentioned: gestual observation, conscience awareness, an alliance with the healthful aspects of the patient, work in the "here-and-now", clarifying projections, switch from environmental support to inner support.

The past decade has seen the emergence of popular "new psychotherapies" such as Gestalt Therapy, Transactional Analysis, and Primal Therapy, each with substantial followings. This paper puts forward a hypothesis about what these divergent systems may possess in common. Certain aspects of these therapy systems, in particular the induction of new patients and trainees, are examined in terms of Paul Tillich's concepts of the universal necessity of a rationale for courage. The significance of Tillich's analysis of courage for various historical movements is reviewed. In each system an element of unconditional commitment to a particular world view is required, as evidenced in the writings of the proponents of these systems, for the patient to be accepted into the particular system. These theoretically divergent systems possess, in common, a factor of an initial commitment to and induction into a collective belief system comparable to what Tillich describes as "the courage to be as a part".

The author schematically describes the three predominating themes in the development of the psychotherapies: dynamic, behavioral, and experiential. These themes represent different conceptualizations of the fundamental nature of man and his ills, therapeutic processes or change agents, the basic nature of the physician-patient relationship, and the primary techniques and methods used. Although there appears to be some unifying thread connecting the four different areas within each theme, a comparable bond does not exist across the three themes. The author questions the potential unification of the psychotherapies and poses specific dimensions for further exploration.

The aim of this study was to discover whether client-centered, Gestalt, and rational-emotive psychotherapy interviews could be described and differentiated on the basis of quantitative measurement of their speech rhythms. These measures were taken from the sound portion of a film showing interviews by Carl Rogers, Frederick Perls, and Albert Ellis. The variables used were total session and percentage of speaking times, speaking turns, vocalizations, interruptions, inside and switching pauses, and speaking rates. The three types of interview had very distinctive patterns of speech-rhythm variables. These patterns suggested that Rogers's Client-centered therapy interview was patient dominated, that Ellis's rational-emotive therapy interview was therapist dominated, and that Perls's Gestalt therapy interview was neither therapist nor patient dominated.

This paper examines the psychoanalytic concepts of interpretation, resistance, and transference as manifest in gestalt therapy. Although these concepts are de-emphasized, criticized, and disavowed in gestalt theoretical writings, they are actually fundamental to the underlying or "deep" structure of gestalt therapy. Examples of gestalt interventions are described and indications for their use suggested.

Based upon assumptions of Gestalt Therapy, an objective, reliable scoring system for analyzing a specific aspect of verbal behavior, avoidant verbalization, was developed. Verbal samples were elicited from 30 female college students who previously had been rank ordered on the Neuroticism scale of the Maudsley Personality Inventory. The expectation that psychologically stressful questions would result in a significantly greater number of avoidant verbalizations was confirmed. Contrary to another expectation, no significant correlation between neuroticism as measured by the MPI and total number of avoidant verbalizations uttered by the Ss was found. Results were interpreted on the basis of the Gestalt Therapy theory of personality.

Using clinical psychoanalytic theory as a unifying concept, an attempt is made to observe, interpret, and integrate the therapeutic process in a wide variety of psychotherapies. All psychotherapy, regardless of specific form or technique, is viewed as an interpersonal or intrapersonal process, and should be understandable from a psychoanalytic perspective. Ten common factors are selected: structure of the therapeutic situation; the therapeutic relationship; management of anxiety; drives and their derivatives; mechanisms of defense; identification; regression; catharsis and abbreaction; external reinforcement; structural change. The various psychotherapies are compared regarding each of the ten factors.

This article describes the application of Gestalt therapy concepts to the treatment of stuttering. Within this framework stuttering is seen as an organized self-system rather than a symptom. This self-system is maintained and reinforced by the stutter's experience of this physical self, self-expectancies, self-messages, projections on others, and total viewing of self as a limited and inadequate person. The individual enmeshes himself or herself into this system and restricts himself to familiar behaviors, in this case stuttering, because he has no framework for other ways of functioning. The Gestalt therapeutic framework as a basis of unlocking the individual's limited style of functioning is explored.

People can express their suffering voicing it, complaining with their body, with gestures, movements; for alerts eyes it is even more comprehensive and true than words. Complaints that human beings are capable of expressing are not so many, there are only a handful, and this work intends to be exhaustive in its exposition. It is possible to complain against third persons. It is also possible to do so against oneself assuming either the intransigent attitude of a father who judges a son who does not fulfill his expectancies, or as a son who resents the paternal demands which he feels he cannot comply. Other kind of complaints include physical symptoms, either isolated (cephalea, dysnea, urticaria) or constituting syndromes or illnesses. Losses suffered are also a source of complaints, whatever the lost object might be (person, situation, material things or a part of oneself). It can be mourned because of its absence, or else by feeling guilty of the real or imaginary damage inflicted or else by feeling indisolubly linked to it with a phantom tie. Other types of complaints are the feeling of dependancy towards something oppressive, be it a substance, such as alcohol, smoking, drugs or overeating, or it may be a person or a situation. In view of the compulsive addiction characteristics with which the subject lives, it is possible to assimilate this dependancy and the feeling of oppression and damage to the link with a toxic.

The relationship among therapeutically induced affective arousal, depressive symptoms, pain and beta-endorphin levels were explored on 6 patients with chronic, active rheumatoid arthritis. An ABA, n of 1 study methodology was utilized, replicated 5 times. This procedure allowed the analysis of individualized changes across time in response to the therapeutic regimen. The results indicated that the treatment regimen activated the beta-endorphin system, particularly during the early and late phases of treatment. However, beta-endorphin response had little effect on reports of subjective pain. Depressive symptoms were affected positively by the treatment but were not strongly correlated to the beta-endorphin response. The results suggest that pain and depression represent independent systems and that beta-endorphin levels serve more as stress markers than analgesics in chronic, organic pain.

This study investigated preferences for behavioural, analytic and gestalt psychotherapy among a sample of 40 SES class III and IV adult females and 67 college freshmen who had never been actual therapy patients. A scaled survey assessed general preference, preference given an imagined long-standing depressive disorder, preference given an imagined specific phobia, and preference for the therapist-patient relationship. Three audio tapes were designed, each describing one of the modalities. High inter-rater reliability and agreement were determined by three independent judges. Results showed that young females had a general preference for gestalt therapy. Young and old females, but not young males, significantly preferred behavioural therapy for a specific phobia. Under forced-choice conditions the group as a whole significantly preferred gestalt therapy. No differences were found for the relationship or preference given a depressive disorder. Preference was hypothesized as a cognitive structure with potential use in therapist-client matching.

Gestalt therapy extends considerably psychoanalysis. 1. Transfer in psychoanalysis allows to work on the disturbed relations which the patient transfers onto his analyst, relations created by the parents and repeated now. The extended transfer in a therapeutic group of life allows to work on the fact that the patient recreates here and now the difficulties he encounters in life. 2. The game of the analyst and the encounter show that beyond transfer and projection, a real encounter may take place, a precious means to create life here and now. 3. The difference between individual therapy and group-therapy is about this: the former is centered on illness, the latter on life; the former helps to understand, the latter to live; the individual talks about facts from the past and from elsewhere and the group lives "here and now", which allows to test feelings, a powerful source of life. 4. A session of group-therapy, as developed here, allows to see how one can find a response to a need or avoid to find a response to it. 5. A comparison-table between psycho-analysis and gestalt shows the difference of method, diagnosis, therapeutic process, therapeutist's attitude and of the position of the patient. 6. Psycho-analysis is perhaps a relay after religion? Several elements make us believe this: tension in contacts, ritual, authority, protection, neutrality, guilty making. 7. To contest or contest one-self has helped me to compare the contester with the psycho-analyst: both contest society, but they don't change their behavior. The gestalt-therapeutist is in a way like a hippie: though contesting society, he brings a change to his way of life, while being closer to life.

This paper presents a taxonomy of verbal response modes and applies that taxonomy to the verbal behavior of psychotherapists of three contrasting schools: client-centered, gestalt, and psychoanalytic. The taxonomy consists of a theoretically based set of classificatory principles that define a mutually exclusive and exhaustive set of modes. Its purpose is to describe dyadic verbal interaction comprehensively and quantitatively. Such description is a necessary first step in investigating the therapeutic effectiveness of different interaction styles.

The couple with a sex dysfunction is at an impasse. The natural process of sexual self-regulation is interrupted by the self. Growth requires experimenting with new solutions for unsolved problems. The gestalt experiment is a major modality of treatment applicable to sex therapy. To experiment is to invent and discover solutions and to find and make meanings. In posing an experiment, the therapist attempts to create a safe emergency in which risk and support are balanced, permitting the person to stay with the mounting excitement and coming solution. An atmosphere of playfulness and creativity invites experimentation. Thorough familiarity with modes and methods of experimenting permits the therapist's creativity to emerge. Applications of sexual metaphors and sex dysfunction as a nightmare are presented which use methods drawn from gestalt dream work. The use of gestalt experiments are illustrated in a client-therapist dialogue.

This is a report on death therapy with a 36-year-old cancer patient. Gestalt therapy and creative media (clay, poetry, and colors) were used to facilitate an integration of life and to give the person a sense of balance with life. The author tries to communicate his thoughts and feelings as they were during the course of the therapy, to show that counseling the dying means walking along a stretch of the path together. The companion-therapist cannot avoid his own perplexity and confusion by simply falling back on his professional role. Once he has become involved in an interpersonal relationship, he does not treat the patient as some kind of object. With the aid of transcripts taken from tape recordings, the integrating effect of using gestalt dialogue, and fantasy work becomes evident.