The Therapist’s Intuition and Responsiveness: What Makes the Difference between Expert and in Training Gestalt Psychotherapists

Abstract

This study aims to investigate the presence of intuition and responsiveness in early students and in experienced students and psychotherapists, which is understood as the ability to integrate bodily sensitivity and cognition of what is experienced with the patient (aesthetic relational knowing—ARK). The study compares how the therapist’s felt sense of the phenomenological intersubjective field and aesthetic relational competence differs between a group of experienced students and psychotherapists and a group of beginners. The sample consisted of 128 participants (20 M; 108 F), finally divided into two groups: “experienced students and psychotherapists” and “beginners”. The Aesthetic Relational Knowledge Scale (ARKS), a questionnaire consisting of 58 items targeting three factors (empathy, body awareness, and resonance), was administered. Statistical analyses were conducted to assess (i) differences between the two groups (through Student’s t and Cohen’s d for effect sizes), (ii) the influence of the level of training for each ARK factor using analyses of covariance for testing the possible influence of demographic variables, and (iii) logistic regressions to compare the influence of the three factors of the ARK model on the group variable with groups as a categorical variable. Significant differences between the two groups were found in body awareness and resonance. Body awareness was found to be the variable best discriminating between the beginners and the experienced students and psychotherapists. Despite being non-significant, there is a tendency suggesting that empathy appears more relevant at the beginning of training. The study shows the importance of training for the development of the therapist’s intuition and responsiveness, especially in the factors of body awareness and resonance. The results indicate the importance of assessing and supporting the aesthetic and field resonance of therapists in training, increasing quality and depth of the therapist’s responsiveness. This study is limited by a correlational design using self-report and on a limited sample, but it shows that the ARKS can monitor the effectiveness of training related to Gestalt therapeutic competencies.

The assessment of therapist responsiveness in psychotherapy research: a systematic review

“…Concerning the definition of TR, 55% of included studies referred to the definition provided by Stiles et al (1998) (Kivlighan et al, 2017;Kramer et al, 2014;Kramer et al, 2016;Meystre et al, 2014;Richards et al, 2013;Spagnuolo Lobb et al, 2022), while in the remaining studies, in 27%, the authors used the conceptualization by Hatcher (2015) (Snyder & Aafjes-van Doorn, 2016;Snyder & Silberschatz, 2016;Zalaznik et al, 2021), and in 18%, the one by Elkin et al (2014) (Culina et al, 2022;Elkin et al, 2014).…”

“…In relation to instruments employed to assess TR, in 55% of the included studies (Culina et al, 2022;Elkin et al, 2014;Richards et al, 2013;Snyder & Aafjes-van Doorn, 2016;Snyder & Silberschatz, 2016;Zalaznik et al, 2021) the authors adopted tools aimed at directly measure TR [i.e., the therapist responsiveness scale (TRS), the patient's experience of attunement and responsiveness (PEAR) scale, and the adherence responsiveness measure], while in the remaining 45%, TR was assessed indirectly, through: i) the use of instruments to measure related constructs [e.g., aesthetic relational knowledge scale (ARKS) or processing-content-relationship scale] ( Kramer et al, 2016;Spagnuolo Lobb et al, 2022); ii) the integration of different constructs and methodologies, as in the case of discrepancy between working alliance inventory short form and real relationship inventory, or in the case of co-presence of the comprehensive psychotherapeutic interventions rating scale (C-PIRS) and the assimilation of problematic experiences scale (APES) (Kivlighan et al, 2017;Meystre et al, 2014); iii) the adoption of an atheoretical approach (i.e., the motive-oriented therapeutic relationship) (Kramer et al, 2014). Among the included studies, the only instruments used in more than one article were the PEAR scale (27%) (Snyder & Aafjes-van Doorn, 2016;Snyder & Silberschatz, 2016;Zalaznik et al, 2021) and the TRS (18%) (Culina et al, 2022;Elkin et al, 2014).…”

“…Regarding the sources of information, 55% of the included studies were based on self-reported instruments. In 9% of these, instruments were administered only to therapists (Spagnuolo Lobb et al, 2022); in 9%, only to patients (Meystre et al, 2014); and in 37%, to both therapists and patients (Kivlighan et al, 2017;Snyder & Aafjes-van Doorn, 2016;Snyder & Silberschatz, 2016;Zalaznik et al, 2021). In 45% of included studies, measurement was based on observer-rated tools; in particular, 36% of the included studies used videotapes (Culina et al, 2022;Elkin et al, 2014;Kramer et al, 2016;Richards et al, 2013), and 9% analyzed transcripts of sessions (Kramer et al, 2014).…”

“…Referring to the associated constructs, in 45% of the articles, TR has been related to the outcome (i.e., symptom relief of panic disorders, depression, and personality disorders), finding a positive association in all studies (Kramer et al, 2014;Kramer et al, 2016;Richards et al, 2013;Snyder & Silberschatz, 2016;Zalaznik et al, 2021). In the remaining studies, TR has been related to therapist expertise in training (Spagnuolo Lobb et al, 2022), quality session evaluation (Kivlighan et al, 2017), assimilation of problematic experiences (Meystre et al, 2014), and patient feedback (Snyder & Aafjes-van Doorn, 2016). Lastly, TR was also found to be positively associated with WA (Culina et al, 2022) and early patient engagement (Elkin et al, 2014).…”

“…The second trend, found in the remaining 45% of studies, indirectly assessed TR. The ARKS is a self-report measure composed of 58 items evaluating empathy, resonance, and bodily awareness that can be administered only to therapists (Spagnuolo Lobb et al, 2022). Participants are asked to respond on a 7-point Likert scale ranging from 1 (extremely disagree) to 7 (extremely agree).…”