Two risks and a third way: what research for GT?
This article has been first published in the British Gestalt Journal Vol 29, n°1 - The author wrote this article while he was chairing the EAGT Research Committee in a controversial context about research and on request of the editor.
His recognition goes to Florence Belasco for her support, and with whom he has maintained a long and mutual companionship on this theme of clinical research for almost ten years.
In this article the author explains the possible future for Gestalt therapy in view of the evolution of the regulatory context and the appearance of the contextual model resulting from the evolution of research in psychotherapy. This future oscillates between marginalisation or even outright disappearance and dissolution into a vast, integrative, outcome-based current.
The author argues that both the values inspiring the Gestalt therapeutic posture and the mode of intervention based on the therapist’s affective resonance are worth defending and even disseminating more widely than today. He then draws the outlines of a Gestalt research that allows Gestalt therapy to be legitimised by being recognised as offering evidence-based treatments and to continue to develop as an original and innovative modality.
Table of contents
I - Regulatory Pressure and the Risk of Marginality
II - The Contextual Model and the Risk of Identity Loss
..........II-1 Wampold’s Contextual Model
..........II-2 EAP Policy
III - The need and interest in inventing our future: the third way
IV - Elements for a Gestalt Therapy Research Policy
..........IV-1 The medical model: a controversial model
..........IV-2 Efficiency research - Methodologies compatible with our anthropology
..........IV-3 Research Questions Relevant to Gestalt Therapy
V - What policy, then, for the EAGT?
..........V-1 A bit of history
..........V-2 The Future
Chair of the EAGT Research Committee, convening international conferences on Gestalt therapy research in Paris (2017) and Hamburg (2021), co-founder of the French Research Committee, former member of the AAGT Research Task Force, and member of the Research Committee of the EAGT since 2013. Co-editor with Florence Belasco of the book La recherche en Gestalt-thérapie (2018), member of the editorial board of the Gestalt Therapy Book Series, and member of the reading committee of the Revue Gestalt for ten years. He has written more than thirty articles on Gestalt therapy in various French and English- speaking journals and translated many others. Co-founder of the IDeT (Institute for the Development of the Therapist) in Paris, France. He is currently a member of the SPR (Society for Psychotherapy Research) and the NYIGT (New York Institute for Gestalt Therapy).
From 1985 to 1992 he was a statistician and researcher at the ORS PACA (Observatoire Régional de la Santé de Provence Alpes Côtes d’Azur), France.
This article was published in British Gestalt Journal 29.1. To read the full issue, please visit the British Gestalt Journal website.
The second element we need to take into account is the state of research and what the future holds for the profession of psychotherapists. Although the debate between cognitive-behavioural scientists and those who belong to humanistic and psychoanalytic approaches is not over, it has become clear that differences in effectiveness between modalities are marginal (Luborsky & Luborsky, 1975; Luborsky & al., 2002). Currently, there is a growing consensus that effectiveness depends mainly on factors that are common to all modalities, i.e., mainly on the therapeutic relationship and its components. Thus, the quality of the therapeutic alliance is today the best predictor of the outcomes of a therapy (Orlinsky & al., 2004, Norcross & Wampold, 2011).
Moreover, there are therapists who systematically and significantly have better results than their colleagues, regardless of the modalities and perhaps even the types of patients they receive (Castonguay & Hill, 2017). This means that the therapist is ultimately more important than the treatment (Belasco & Castonguay, 2017).
These two statements, taken together, can profoundly transform the landscape of psychotherapy. Bruce Wampold, a renowned American researcher, has drawn conclusions from these achievements, which are no longer hardly contested today, and he has proposed the contextual model (Wampold, 2015) as an alternative to the medical model. In particular, he argues that since modalities have less impact on outcomes than the individual therapist, it is the therapist - not the modality or treatment - who must prove its effectiveness. It is moreover on this clinical basis of regular evaluation that the therapist will be able to improve his efficiency and measure his evolution; it will no longer be enough to apply a treatment based on evidence (Briffault, 2018).
It is therefore a model that departs from the medical model currently advocated by CBT and is beginning to compete with it. However, it leads to a weakening of therapeutic modalities, including Gestalt therapy (Briffault, 2018). Indeed, if they are still necessary to give the practitioner a form of conceptual framework and assurance, they are no longer justified by anything other than the therapist’s personal preference alone. Thus, in the long run, modalities may disappear in favour of a therapy guided essentially by the result. What lies in wait is to lose our gestalt specificity and to have to melt into a globalizing and eclectic supra-modality.