Project

Emotion Focused Therapy; Psychotherapy; Integration; Psychological Therapy

Lead
Psychotherapeuten arbeiten zunehmend integrativ: Sie sind meist in einer bestimmten Richtung (wie Freudsche Psychoanalyse oder Verhaltenstherapie) ausgebildet, eignen sich aber später auch Elemente anderer Richtungen an und werden damit konzeptuell und technisch flexibler.
Lay summary
Heutzutage entwickeln sich Psychotherapeuten kaum weiter, indem sie von einem psychotherapeutischen Ansatz, in dessen Erlernen sie viel Zeit und Geld investiert haben, gänzlich zu einem anderen wechseln. Eher integrieren sie Elemente eines neuen, als nützlich erkannten Ansatzes, in ihren bestehenden Ansatz. Was aber spielt sich ab, wenn Psychotherapeuten eine solche Integration vornehmen? Welche Auswirkungen hat die Integration auf die Ergebnisse solcher Therapien, welche Auswirkungen auf den Prozess, die Art und Weise, in der therapeutische Veränderungen stattfinden? Gibt es Friktionen, wenn Neues zum Alten kommt, und wenn ja, wie gehen Therapeuten damit um? Geht durch das Hinzukommen von Neuem auch Altbewährtes verloren? Gibt es Patienten, die besser vom alten und solche, die besser vom neuen, integrierten Ansatz profitieren? Solchen Fragen wird in einer experimentellen Untersuchung an der Psychotherapeutischen Praxisstelle der Universität Bern nachgegangen, in der exemplarisch treatment as usual (TAU; eine bereits recht integrative Form von Kognitiver Verhaltenstherapie) verglichen wird mit TAU, in das wichtige Elemente der Emotionsfokussierten Therapie nach Greenberg integriert werden. Die 130 vorgesehenen Patienten (mit Diagnosen Depression, Ängste und Anpassungsstörungen) werden von gut 40 Therapeuten über rund 25 Sitzungen behandelt.

Direct link to Lay Summary

Last update: 28.07.2015

Active participation

Number	Title	Start	Funding scheme

As recent evidence shows, a big part if not a majority of psychotherapists adopt a rather integrative stance. Trained in one approach, they seek complements in other approaches when they find conceptual and practical weaknesses of their original approach. There is, however, little research on the effects of such an “assimilative integration”, in our view mainly due to the difficulty of doing valid research on this question. Whereas there is more research on the effects of “pure” approaches, most practitioners use these approaches only in adapted forms. This leads to a dissatisfactory state where much of the available evidence does not tell us much about prevailing practice. While it is impossible to include all variants of psychotherapy integration in one study it would be a major step forward if a common form of integration of concepts and specific interventions into an established treatment could be studied in an exemplary way. This is at the heart of the project proposed here. With the term “General Psychotherapy” Grawe (2004) has postulated an ongoing process of including all interventions and concepts relevant for a domain, be they from other approaches to psychotherapy or concepts from basic science. As all these are ever changing and developing, General Psychotherapy is rather a process, an ideal to strive at, than a state that can ever be reached. “Psychological Therapy” (PT) is a therapeutic approach largely corresponding to the ideas of General Psychotherapy. It draws mainly on empirically validated interventions from Cognitive Behavior Therapy (CBT) and is based on concepts with a strong basis in academic psychology and neigh¬boring fields. With an emphasis on explicit individual case conceptualizations, reference to general therapeutic factors, and an explicit prescriptive concept for building and maintaining the therapeutic relationship, PT has a major influence in the field.The range of emotion-related interventions commonly used in PT is, however, limited when compared with an approach like Emotion Focused Therapy (EFT; Greenberg, 2010). EFT appears thus as a suitable complement and enrichment to PT as commonly practiced. In various places therapists have indeed begun to combine CBT with EFT. There is increa-sing evidence for the effectiveness of the latter, it fulfills the APA criteria of an empirically validated treatment for depression and couples therapy, and evidence for more diagnoses has been published. However, effects of integrating EFT-based interventions in a way that is close to common integrative practice have not yet been studied.The goal of this project is to compare PT as usual (PT-TAU) with PT with integrated EFT elements (PT-EFT). 130 patients out of the routine practice of the Bernese psychotherapy outpatient clinic, suffering from depressive, anxiety or adjustment disorders, are to be treated by 20 therapists in each treatment condition. While the competency and adhe-rence to the respective condition will be checked, therapists will vary in general therapy experience and extent of trai-ning, which will allow evaluating the influence of these variables. To secure balance regarding the amount of training and supervision for the project, PS-TAU will be supplemented with additional units elaborating on some elements that are already part of PT. The assessment will cover standard self-report questionnaires common for this kind of research, Goal Attainment Sca-ling, standardized diagnostic interviews, symptom ratings by clinicians, and implicit assessment of motivation. Further assessments each with small parts of the sample will use ambulatory assessment via smartphones to more validly cap-ture behavior changes in real life, and recordings of EEG responses in individually meaningful and emotionally challen-ging situations to assess neurobiological processes associated with therapeutic change processes. The main questions are whether the integration of central EFT elements leads to deeper and more lasting effects compared to the commonly practiced version of PT, and whether there are negative side effects of the integration due to less attention and time de-dicated to more traditional elements and procedures. Differential effects, moderators and mediators will be analyzed.The project is important if psychotherapy research is to cover “real practice” in an endeavor to reduce the much bemoa-ned science-practice gap. We believe that the applicants together with colleagues employed in the department and their practical and methodological skills, therapists in our postgraduate training, master and doctoral students to be engaged in evaluations, and a suitable infrastructure offers uniquely favorable conditions for conducting such a project.