This project is designed as a clinical trials investigation of the effectiveness of a focused form of experiential psychotherapy based on principles of Gestalt therapy. The project objectives are to demonstrate the efficacy of this treatment procedure as applied to a clinical population which has been characteristically difficult to treat. Sixty patients presenting both depression and psychogenic pain syndrome will be subclassified into two groups, relative to their characteristic method of coping with angry and resentful feelings. Subgroups of emotionally overcontrolled and emotionally undercontrolled individuals will be randomly assigned to two treatment protocols, one emphasizing a highly focused Gestalt/experiential treatment and the other an educative/control treatment. Treatment will be initiated following a two week drug wash out period and will proceed through 15 to 20 sessions. A six month follow-up will also be obtained. Changes in patients' status will be assessed in the areas of (1) medical and pain condition, (2) depression and psychological state, (3) emotional expressiveness, and (4) involvement in the psychotherapy process. We anticipate that the Gestalt treatment will be more effective than the educative one, especially for those who are emotionally overcontrolled. We further anticipate that emotional and physiological arousal in treatment will be related both to pain relief and to diminuation of depressive symptoms. Finally, we anticipate that treatment gains will be maintained longer for individuals in the experiential treatment condition.
