Personal therapeutic approach in Gestalt therapists working with clients suffering from medically unexplained psychosomatic symptoms

Submitted: March 9, 2021
Accepted: October 20, 2021
Published: December 20, 2021
Abstract Views: 3890
PDF: 1036
Appendix: 78
HTML: 47
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Treatment specificity and adherence to treatment manuals represent essential components of the medical model in psychotherapy. The model assumes that psychotherapists who work with the same type of clients and who identify with the same theoretical approach work very similarly. This study illustrates the shortcomings of that assumption and explores how therapists’ individuality forms and shapes their unique approaches that resonate with their own personalities, inclinations, and worldviews. Semi-structured interviews with eight Gestalt therapists working with clients who experienced medically unexplained physical symptoms were analysed using the grounded theory method. Considerable differences were found among the therapists within four domains of the personal therapeutic approach, namely Case Conceptualization, Therapeutic Task, Therapist’s Position, and Alternative Strategy. However, regardless of the differences, all the therapists endeavoured, either implicitly or explicitly, to convey to the clients what they considered to be healthy functioning. There is considerable diversity in the way therapists work even when they subscribe to the same psychotherapeutic approach and work with the same type of clients. The exploration of psychotherapists’ usual strategies, as well as the alternative strategies they use when their usual strategies do not work, appears helpful for capturing their personal therapeutic approaches.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Balabanovic, J., & Hayton, P. (2019). Engaging patients with ‘medically unexplained symptoms’ in psychological therapy: An integrative and transdiagnostic approach. Psychology and Psychotherapy: Theory, Research and Practice, 1-20. doi:10.1111/papt.12213. DOI: https://doi.org/10.1111/papt.12213
Baldwin, S. A., & Imel, Z. E. (2013). Therapist effects: Findings and methods. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed., pp. 258-297). Hoboken, NJ: John Wiley & Sons.
Barber, P. (2006). Becoming a practitioner researcher, a Gestalt approach to holistic inquiry. London: Middlesex University Press.
Beutler, L. E., & Bergan, J. (1991). Value change in counseling and psychotherapy: A search for scientific credibility. Journal of Counseling Psychology, 38(1), 16-24. doi:10.1037/0022-0167.38.1.16. DOI: https://doi.org/10.1037/0022-0167.38.1.16
Brown, R. J. (2007). Introduction to the special issue on medically unexplained symptoms: Background and future directions. Clinical Psychology Review, 27(7), 769-780. doi:10.1016/j.cpr.2007.07.003. DOI: https://doi.org/10.1016/j.cpr.2007.07.003
Brownell, P. (2008). Handbook for theory, research, and practice in Gestalt therapy. Newcastle: Cambridge Scholars Publishing.
Brownell, P. (2016). Contemporary gestalt therapy. In D. Cain, K. Keenan, & S. Rubin (Eds.), Humanistic psychotherapies: Handbook of research and practice, Second Edition (pp. 219-250). Washington, DC: American Psychological Association. DOI: https://doi.org/10.1037/14775-008
Cabaniss, D. L., Cherry, S., Douglas, C. J., & Schwartz, A. R. (2011). Psychodynamic psychotherapy: A clinical manual. In Psychodynamic psychotherapy: A clinical manual. Hoboken, NJ: Wiley-Blackwell. DOI: https://doi.org/10.1002/9780470711262
Caspi, A., Houts, R. M., Belsky, D. W., Goldman-Mellor, S. J., Harrington, H., Israel, S., … & Moffitt, T. E. (2014). The p factor: One general psychopathology factor in the structure of psychiatric disorders? Clinical Psychological Science, 2(2), 119-137. doi:10.1177/2167702613497473. DOI: https://doi.org/10.1177/2167702613497473
Castonguay, L. G., Janis, R. A., Youn, S. J., Xiao, H., McAleavey, A., Boswell, J. F., … & O’Leary Wiley, M. (2017). Clinicians’ prediction and recall of therapeutic interventions: Practice research network study. Counselling Psychology Quarterly, 30(3), 308-322. doi:10.1080/09515070.2017.1334628. DOI: https://doi.org/10.1080/09515070.2017.1334628
Čevelíček, M., Roubal, J., Hytych, R. & Řiháček, T. (2019). What works in the treatment of medically unexplained physical symptoms? The psychotherapist perspective. Manuscript submitted for publication.
Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage Publications.
Cuijpers, P., Reijnders, M., & Huibers, M. J. H. (2019). The role of common factors in psychotherapy outcomes. Annual Review of Clinical Psychology, 15(1), 207-231. doi:10.1146/annurev-clinpsy-050718-095424. DOI: https://doi.org/10.1146/annurev-clinpsy-050718-095424
Elliott, R. (1998). Editor’s introduction: A guide to the empirically supported treatments controversy. Psychotherapy Research, 8(2), 115-125. DOI: https://doi.org/10.1093/ptr/8.2.115
Fernández-Alvarez, H., Gómez, B., & García, F. (2015). Bridging the gap between research and practice in a clinical and training network: Aigle’s program. Psychotherapy Research, 25, 84-94. doi:10.1080/10503307.2013.856047. DOI: https://doi.org/10.1080/10503307.2013.856047
Francesetti G., Gecele M., & Roubal J. (2013). Gestalt therapy approach to psychopathology. In Francesetti G., Gecele M., Roubal J. (Eds.), Gestalt therapy in clinical practice. From psychopathology to the aesthetics of contact (pp. 59-76). Milano: FrancoAngeli.
Francesetti, G., Gecele, M., & Roubal, J. (2013). Gestalt therapy in clinical practice. From psychopathology to the aesthetics of contact. Milano: FrancoAngeli.
Francesetti, G. (2019). The field perspective in clinical practice. Towards a theory of therapeutic phronesis. In: Brownell P. (Ed.), Handbook for theory, research and practice in gestalt therapy (2nd ed.). Newcastle upon Tyne: Cambridge Scholars Publishing.
Francesetti, G., Alcaro, A., & Settanni, M. (2020). Panic disorder: attack of fear or acute attack of solitude? Convergences between affective neuroscience and phenomenological-Gestalt perspective. Research in Psychotherapy: Psychopathology, Process and Outcome, 23, 77-87. DOI: https://doi.org/10.4081/ripppo.2020.421
Glaser, G. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago, IL: Aldine Publishing Company.
Heijmans, M., olde Hartman, T. C., van Weel-Baumgarten, E., Dowrick, C., Lucassen, P. L. B. J., & van Weel, C. (2011). Experts’ opinions on the management of medically unexplained symptoms in primary care. a qualitative analysis of narrative reviews and scientific editorials. Family Practice, 28(4), 444-455. doi:10.1093/fampra/cmr004. DOI: https://doi.org/10.1093/fampra/cmr004
Hopwood, C. J., Bagby, R. M., Gralnick, T., Ro, E., Ruggero, C., Kotov, R., …& Zimmermann, J. (2019). Integrating psychotherapy with the hierarchical taxonomy of psychopathology (HiTOP). Journal of Psychotherapy Integration. Advance online publication. doi:10.1037/int0000156. DOI: https://doi.org/10.1037/int0000156
Iaculo G. (2007). The psychosomatic disorders in a dependent personality. Gestalt Review, 11(1), 59-73. DOI: https://doi.org/10.5325/gestaltreview.11.1.0059
Jacobs, L., & Hycner, R. (Eds.) (2009). Relational approaches in gestalt therapy. New York: Gestalt Press.
Jadaszewski, S. (2017). Ethically problematic value change as an outcome of psychotherapeutic interventions. Ethics and Behavior, 27(4), 297-312. doi:10.1080/10508422.2016.1195739. DOI: https://doi.org/10.1080/10508422.2016.1195739
Kelly, T. A. (1990). The role of values in psychotherapy: A critical review of process and outcome effects. Clinical Psychology Review, 10(2), 171-186. doi:10.1016/0272-7358(90)90056-G. DOI: https://doi.org/10.1016/0272-7358(90)90056-G
Kelly, T. A., & Strupp, H. H. (1992). Patient and therapist values in psychotherapy: Percieved changes, assimilation, similarity, and outcomes. Journal of Consulting and Clinical Psychology, 60(1), 34-40. doi: 10.1037/0022-006X.60.1.34 DOI: https://doi.org/10.1037/0022-006X.60.1.34
Kepner J.I. (1993), Body process. Working with the body in psychotherapy. Jossey-Bass Publishers, San Francisco CA.
Kleinstäuber, M., Witthöft, M., & Hiller, W. (2011). Efficacy of short-term psychotherapy for multiple medically unexplained physical symptoms: a meta-analysis. Clinical Psychology Review, 31(1), 146-160. DOI: https://doi.org/10.1016/j.cpr.2010.09.001
Lini, C., & Bertrando, P. (2019). Finding one’s place: emotions and positioning in systemic‐dialogical therapy. Journal of Family Therapy, 1-2. doi:10.1111/1467-6427.12267. DOI: https://doi.org/10.1111/1467-6427.12267
Luca, M. (2011). A qualitative study of psychodynamic and cognitive behavioural therapists’ conceptualisations of medically unexplained symptoms in their clients. Counselling & Psychotherapy Research, 11(4), 291-299. doi:10.1080/14733145.2010.528007. DOI: https://doi.org/10.1080/14733145.2010.528007
Luca, M. (2012). Therapeutic activities and psychological interventions by cognitive behavioural and psychodynamic therapists working with medically unexplained symptoms: a qualitative study. Counselling and Psychotherapy Research, 12(2), 118-127. doi:10.1080/14733145.2011.605455. DOI: https://doi.org/10.1080/14733145.2011.605455
Maruniaková, L., & Řiháček, T. (2018). How beginning cognitive behavioural therapists develop professional confidence. The Cognitive Behaviour Therapist, 11(e5), 1-19. DOI: https://doi.org/10.1017/S1754470X1800003X
Maruniaková, L., Řiháček, T., & Roubal, J. (2017). How beginning counselors learn: The interaction of personal and professional experiences in counselors with an experiential orientation. Counselling Psychology Quarterly, 30(1), 48-66. DOI: https://doi.org/10.1080/09515070.2016.1148013
Nemirinskiy, O. (2013). Gestalt approach to psychosomatic disorders. In Francesetti, G., Gecele, M., Roubal, J. (Eds.), Gestalt therapy in clinical practice. from psychopathology to the aesthetics of contact (pp. 573-587). Milano: FrancoAngeli.
Norcross, J. C., & Wampold, B. E. (2018). A new therapy for each patient: Evidence ‐ based relationships and responsiveness. Journal of Clinical Psychology, 74(11), 1-18. doi:10.1002/jclp.22678. DOI: https://doi.org/10.1002/jclp.22678
Orlinsky, D. E., & Rønnestad, M. H. (Eds.) (2005). How therapists develop: a study of therapeutic work and professional growth. Washington, DC: American Psychological Association. DOI: https://doi.org/10.1037/11157-000
Perls, F. Hefferline, R., & Goodman, P. (1951). Gestalt therapy. Excitement and growth in the human personality. Highland, NY: Gestalt Journal Press.
Philippson, P. (2009). The emergent self. An existential-gestalt approach. London: Karnac Books.
Pourová, M., Klocek, A., Řiháček, T., & Čevelíček, M. (2020). Therapeutic change mechanisms in adults with medically unexplained physical symptoms: a systematic review. Journal of Psychosomatic Research, 134. DOI: https://doi.org/10.1016/j.jpsychores.2020.110124
Řiháček, T., & Čevelíček, M. (2019). Common therapeutic strategies in psychological treatments for medically unexplained somatic symptoms. Psychotherapy Research. Advanced online publication. doi:10.1080/10503307.2019.1645370. DOI: https://doi.org/10.1080/10503307.2019.1645370
Řiháček, T., & Roubal, J. (2017). Personal therapeutic approach: concept and implications. Journal of Psychotherapy Integration, 27(4), 548-560. doi:10.1037/int0000082. DOI: https://doi.org/10.1037/int0000082
Roubal, J., Francesetti, G., Brownell, P., Melnick, J., Zeleskov-Djoric, J. (2016). Bridging practice and research in gestalt therapy. In Roubal, J. (Ed.), Towards a research tradition in Gestalt therapy (pp. 1-17). Newcastle upon Tyne: Cambridge Scholars Publishing.
Roubal J., Francesetti G., & Gecele M. (2017). Aesthetic diagnosis in Gestalt therapy. Behavioral Sciences, Basel, Switzerland: MDPI AG, 7(4). doi:10.3390/bs7040070. DOI: https://doi.org/10.3390/bs7040070
Salkovskis, P. M., Gregory, J. D., Sedgwick-Taylor, A., White, J., Opher, S., & Ólafsdóttir, S. (2016). Extending cognitive-behavioural theory and therapy to medically unexplained symptoms and long-term physical conditions: a hybrid transdiagnostic/problem specific approach. Behaviour Change, 33(4), 172-192. doi:10.1017/bec.2016.8. DOI: https://doi.org/10.1017/bec.2016.8
Santa Ana, E. J., Martino, S., Ball, S. A., Nich, C., Frankforter, T. L., & Carroll, K. M. (2008). What is usual about ‘treatment-as-usual’? Data from two multisite effectiveness trials. Journal of Substance Abuse Treatment, 35(4), 369-379. doi:10.1016/j.jsat.2008.01.003. DOI: https://doi.org/10.1016/j.jsat.2008.01.003
Sichera, A. (2001). A confronto con Gadamer: Per una epistemologia ermeneutica della Gestalt. In Spagnuolo Lobb, M. (Ed.), Psicoterapia della Gestalt. Ermeneutica e clínica (pp. 17-41). Milano: FrancoAngeli.
Strümpfel, U., & Goldman, R. (2001). Contacting gestalt therapy. In D. Cain & J. Seeman (Eds.), Humanistic psychotherapies: handbook on research and practice (pp. 189-219). Washington, American Psychological Associationß. DOI: https://doi.org/10.1037/10439-006
Strümpfel, U. (2006). Therapie der Gefühle. Forschungsbefunde zur Gestalttherapie. Bergisch Gladbach; EHP.
van Dessel, N., den Boeft, M., van der Wouden, J. C., Kleinstäuber, M., Leone, S., Terluin, B., Numans, M., … & van Marwijk, H. (2014). Non-pharmacological interventions for somatoform disorders and medically-unexplained physical symptoms (MUPS) in adults (Protocol). Cochrane Database Syst Rev, 11(6), CD011142. DOI: https://doi.org/10.1002/14651858.CD011142
Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270-277. doi:10.1002/wps.20238. DOI: https://doi.org/10.1002/wps.20238
Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). New York, NY: Routledge. DOI: https://doi.org/10.4324/9780203582015
Williams, D. C., & Levitt, H. M. (2007). A qualitative investigation of eminent therapists’ values within psychotherapy: Developing integrative principles for moment-to-moment psychotherapy practice. Journal of Psychotherapy Integration, 17(2), 159-184. doi:10.1037/1053-0479.17.2.159. DOI: https://doi.org/10.1037/1053-0479.17.2.159

How to Cite

Roubal, J., Hytych, R., Čevelíček, M. ., & Řiháček, T. (2021). Personal therapeutic approach in Gestalt therapists working with clients suffering from medically unexplained psychosomatic symptoms. Research in Psychotherapy: Psychopathology, Process and Outcome, 24(3). https://doi.org/10.4081/ripppo.2021.535

List of Cited By :

Crossref logo