Gestaltungstherapie (depth-psychological design therapy)

1. Introduction

Version followed: the tiefenpsychologisch fundierte Gestaltungstherapie/Klinische Kunsttherapie (GKT) taught by the Deutscher Arbeitskreis für Gestaltungstherapie/Klinische Kunsttherapie e.V. (DAGTP, Berlin) in its cooperative B.A. with the Katholische Hochschule für Sozialwesen Berlin (KHSB), as set out in the module handbooks of 2017, 2019, 2023 and 2024. This is supplemented by G. Waser's 2005 Lindau lecture on painting dreams in Gestaltende Psychotherapie (the name the Swiss art-therapy association uses for this approach, per Waser) and by Benedetti and Peciccia's progressive mirror drawing, a technique the curriculum names. The classic founding texts, E. Franzke, Der Mensch und sein Gestaltungserleben (Bern: Huber, 1st ed. 1977, 2nd ed. 1983), and G. Schottenloher, Kunst- und Gestaltungstherapie in der pädagogischen Praxis (1983), have no publicly available text, so statements about them come only from citing sources (Waser 2005, Schuster 2009; Menzen's art-therapy textbook, 5th ed. 2021, also cites Franzke 1977 among the depth-psychological sources of Gestaltungstherapie). [uncertain]

Status: confirmed in published sources: the DAGTP's full name and its role as the KHSB's cooperation partner (KHSB 2019, 2023; Knott CV); Franzke's edition dates (Waser 2005 bibliography); Schottenloher's title and date (Schuster 2009); the DFKGT's full name, its Graduierung and its membership of the BAG KT (BAG KT newsletter; Knott CV); the listing of Begleitendes and Begegnendes Malen in the 2019 and 2023 handbooks (Modul 14.2); and the session totals in Waser's published cases. [uncertain]: any step-by-step procedure for Begleitendes or Begegnendes Malen, any official DAGTP phase model, and the role of the BVKT.

What it is: Gestaltungstherapie is a German-language school of clinical art therapy. The DAGTP–KHSB curriculum defines it as "(Psycho-)Therapie mit bildnerischen Mitteln auf tiefenpsychologischer Grundlage", meaning (psycho)therapy with pictorial means on a depth-psychological basis. Its theoretical roots are psychoanalysis (especially ego psychology and object-relations theory), C. G. Jung's analytical psychology and theories of creativity. Later additions are infant research (Stern), attachment theory (Bowlby), mentalisation concepts, and structure-oriented as well as conflict-centred psychodynamic models. [source: KHSB Modulhandbuch 2017/2023/2024] It is a broad clinical method within depth-psychological treatment, used mainly in psychiatry, psychosomatics, child and adolescent psychiatry, chronic illness, palliative care and crisis intervention, and not a single manualised protocol. [source: KHSB Modulhandbuch 2023] Do not confuse it with Gestalttherapie (Perls). The two names are easily mixed up even in medical journalism. [source: Schuster 2009, Ärzteblatt PP]

Core idea of change: the work is made in an intermediate space that Waser takes from Winnicott. Patient, picture and therapist form a "kunsttherapeutische Triade" (art-therapy triad). Making something gives conscious and unconscious material an outer form (Symbolisierung). The picture then works as a transitional object, linking inner and outer reality. Looking at it together, and working with the transference that runs through it, makes the material available for reflection, mentalisation and new experience. [source: KHSB 2024 Bausteine 03.1, 06.2; Waser 2005 pp. 2–3] Waser adds, citing Franzke, that pictures have a "prospektive" effect: they can show new ways of experiencing and acting before these can be put into words. [source: Waser 2005 pp. 7, 14]

2. Framework

No phase manual with fixed session numbers was found. Neither the KHSB handbooks (2017, 2019, 2023, 2024) nor Waser 2005 define phases with session counts. The structure below is the treatment arc as the curriculum's modules teach it. The handbooks' Modul 03.3 lists Anamnese, Zielvereinbarung, Verlaufsplanung, Verlaufsprozess and Ergebnis (history, goal agreement, planning, process, outcome), but these are documentation headings, not a phase model. [source: KHSB 2019/2024 Module 02, 03, 06; uncertain as to any official DAGTP phase model]

Phase A: Initial phase (Initialphase)

Goals: set up the frame (room, time, setting). Make the first work, the Initialgestaltung, and read it for what it expresses consciously and unconsciously. Understand the first contact scenically (szenisches Verstehen). Take the history, agree goals and plan treatment. [source: KHSB 2024 Bausteine 02.1, 02.3; KHSB 2023]
Format: individual or group. The mode (resource-oriented and structure-oriented versus conflict-centred) is chosen from the psychodynamic diagnosis. Diagnostic steps and diagnosis glossaries feed into the treatment goals and the themes set for the work (Gestaltungsthemen). [source: KHSB 2024 Modul 06.1; Bausteine 05.3]
Move on when the frame is held, a working alliance and a shared treatment goal exist, and the patient can make something in the room. [synthesis]

Phase B: Process phase (Prozesssteuerung)

Goals: steer the therapeutic process with interventions in the image and in words. Interventions are chosen by indication, aim and intention and fitted to the patient's ego development, therapy goals and setting. Attention to body experience is part of this. Work with transference and countertransference in the triad, and with symbolisation. [source: KHSB 2024 Bausteine 03.1–03.2, 06.2]
Series work: pictures can be continued, painted over or answered with a new sheet. Dreams, current pictures and earlier pictures are laid side by side so that recurring themes show. [source: Waser 2005 pp. 8, 11–13]
Move on when themes are integrated and new ways of acting appear in the work and in life, and the end is agreed. [synthesis]

Phase C: Ending and evaluation

Goals: document the outcome "in Wort und Bild" (in words and pictures): indication, goal agreement, planning, process and result. Review the series of works. [source: KHSB 2024 Baustein 03.3] No detailed rules for ending are published. [uncertain]

Session count and format. No published source sets a standard number of sessions. Published case lengths vary widely. In Waser's outpatient individual cases, one therapy ran 80 sessions over about two years (40 dreams, 45 pictures) and another 37 sessions (12 dreams, 45 pictures made in the practice). He also describes a single-session crisis intervention. He gives no session frequency or length. [source: Waser 2005 pp. 7, 10, 15] A Swiss case from the related Gestaltungs- und Maltherapie tradition ran 15 outpatient sessions over eight months, after a six-week inpatient stay. [source: Breuer 2016; related Swiss school, not GKT] Treat these figures as examples, not norms. [uncertain]

Gestaltungstherapie appears as one of several offers within psychodynamic inpatient programmes, for example on the Heidelberg Mitscherlich ward, where a "Gestaltungs- und Körpertherapeutin" (design and body therapist) sits alongside individual and interactional group psychotherapy. It also appears as themed group work in a Swiss rehabilitation clinic (ReThur). [source: Heidelberg flyer; ReThur PDF]
One Austrian clinical art therapist (art therapy generally, not GKT specifically) reports 50-minute individual sessions and 90-minute groups of up to four, with a 10–15-minute closing round. [source: Gölles 2023, Prasch interview; secondary]
A typical session arc is a check-in conversation, then making, then talking about the work. [source: Gölles 2023 citing Rössler; secondary]

3. Guiding principles

Therapy, not art lessons. The work serves expression, not skill. Never grade or correct a picture. [source: ReThur PDF; Gölles 2023 citing Obermeier]
The triad is the treatment unit (Patient–Gestaltung–Therapeut). Track three relationships: patient and picture, patient and you, and you and the picture. [source: KHSB 2023/2024 Modul 06.2]
Depth-psychological grounding. Read process and picture through conflict, structure, defence, transference and countertransference. The picture carries unconscious as well as conscious material. [source: KHSB 2024 Bausteine 02.3, 06.2]
Use the intermediate space. Treat the work as a transitional object between inner and outer reality. Let it hold what cannot yet be said. [source: Waser 2005 pp. 2–3; KHSB 2024 Baustein 03.1]
Patient associations first. The main material is the patient's own association. Yours is secondary and offered tentatively. [source: Waser 2005 p. 3]
Personal over archetypal. Waser deliberately moves away from Jungian amplification towards archetypal meaning. Keep the work on the patient's biography and relationships. [source: Waser 2005 p. 3] Other Jungian-influenced GKT trainers may amplify more. [uncertain]
Not-knowing. Pictures "lassen sich nicht einfach als Text lesen" (cannot simply be read like a text). Explore the work together, and let insights come from the patient. [source: Gölles 2023 citing Obermeier 2019; secondary]
Fit intervention to structure. Work resource- and structure-oriented when ego functions are weak, and conflict-centred when structure allows. Choose interventions by indication, aim and ego development. [source: KHSB 2024 Bausteine 03.2, 05.3; Modul 06]
Material is an intervention. Colour and material have sensory, motor, affective and cognitive effects. Choose them on purpose. [source: KHSB 2023/2024 Baustein 02.2]
Look from several perspectives (multiperspektivische Bildbetrachtung). View the work formally, scenically, in terms of relationship and in terms of process. [source: KHSB 2024 Modul 04.2; the breakdown of perspectives is synthesis]
The frame is part of the therapy. Room, time, setting and institutional frame are planned interventions. [source: KHSB 2023/2024 Baustein 02.1]
Prospective function, not prophecy. Read pictures and dreams as signs of possible new ways of experiencing and acting, never as predictions. [source: Waser 2005 p. 14]
The therapist's own personality matters. Franzke (as cited) warns of risks arising from the therapist's personality structure. Training therefore requires extensive depth-psychological self-experience in art and design therapy. [source: Waser 2005 p. 3; KHSB 2024 Modul C]
Document in words and pictures. Keep photographs or the originals, plus process notes, for every session. [source: KHSB 2024 Baustein 03.3]
Artwork is not diagnostic proof. The Initialgestaltung is read for what it expresses. It is not evidence of abuse or of a disorder. No validated diagnostic manual for GKT pictures exists. [synthesis]

4. Intervention inventory

Professional frame (read first).

In Germany, art and design therapy is not a state-regulated health profession. "Kunsttherapeut/in" is not a legally protected title. Since 2020 the umbrella body BAG KT (Bundesarbeitsgemeinschaft Künstlerische Therapien e.V.) has run a working group seeking a legal framework and outpatient billing. This differs from the UK's HCPC registration for art therapists. [source: BAG KT newsletter] Training is run by associations and universities. For GKT this is the DAGTP, here in a part-time seven-semester B.A. (210 credits) with the KHSB that teaches in Berlin, Stuttgart and Dresden. [source: KHSB Modulhandbuch 2023; therapie.de institute list]
That training requires a completed depth-psychological self-experience in art and design therapy, in individual and group settings (Modul C, 20 credits; no hours are given). It also requires supervision (2 SWS individual and 4 SWS group supervision in the 2023 handbook) and practice alongside study. [source: KHSB 2023/2024]
Practising heilkundlich (treating illness) on one's own account falls under the Heilpraktikergesetz, the "Gesetz über die berufsmäßige Ausübung der Heilkunde ohne Bestallung", unless one holds a licence such as approbation as a psychotherapist or physician. [source: KHSB 2023 Modul 12.3; the legal reading is synthesis, so check current law]
Professional association and credential: the Deutscher Fachverband für Kunst- und Gestaltungstherapie (DFKGT) is a member of the BAG KT. It awards a Graduierung through its Graduierungskommission, and the head of the DAGTP institute holds this graduation. The DAGTP and its institute are founding members of the DFKGT. [source: BAG KT newsletter; Knott CV; AHPGS accreditation report 2024] The 2024 accreditation report states that the B.A. grew in 2011 out of a certified further-education course run with the DAGTP since 2002, that the programme follows a depth-psychological approach while bringing in behavioural, systemic, body and movement approaches, and that graduates may work in their own practice only within the applicable legal requirements; it names no protected title or state licence. [source: AHPGS accreditation report 2024] The criteria for DFKGT graduation and the role of the BVKT are unconfirmed. [uncertain]
Outside Germany, use your national art-therapy registration route (for example HCPC/BAAT in the UK, AATA/ATCB in the US, OdA ARTECURA in Switzerland [source: Breuer 2016]).
A licensed psychotherapist can use simple making-and-talking tasks within their own competence. The depth-psychological technique that works through the picture in transference (4.10–4.13), and work with psychosis, should not be done without GKT or equivalent art-therapy training and supervision. [synthesis]

Materials and physical safety [synthesis unless tagged]

Use non-toxic, water-based paints. Avoid solvents and spray fixatives indoors.
Clay: wet-clean surfaces rather than sweeping, because dry clay dust contains silica. Never sand dry clay.
Plaster with wire and plaster bandage are named as clinical materials [source: Gölles 2023, Prasch]. Plaster heats as it sets, so never cast body parts in bulk plaster. Mix it in a ventilated space and keep it away from eyes.
Scissors, craft knives, wire and soapstone tools: count them out and back in. Use blunt-tipped scissors with people at risk of self-harm, or in acute psychiatric settings.
Fingerpaint and wet media: provide aprons and washing facilities, and check for allergies such as latex or nickel.
Keep storage and the drying of works secure and confidential. Patients' works are clinical material.

4.1 Setting up the frame (Raum, Zeit, Setting)

Purpose / when: at the start of every treatment, and again when the setting changes. In GKT, the room, the time frame and the institutional frame are treated as part of the therapy. [source: KHSB 2023/2024 Baustein 02.1]
Steps:
1. Prepare a stable room with a work table and a wall or easel for standing work, materials laid out openly, and a place to view finished works.
2. State the time frame, including when making stops and talking begins.
3. Explain confidentiality, who keeps the works, how they are photographed and documented, and that the works stay in the therapy until the end.
4. Explain that no artistic skill is needed. [synthesis on the step order]
Example language (illustrative): "We have 50 minutes. For most of it you can work with whatever materials you like. In the last 15 minutes we'll look at what came about together. It's not about making something beautiful."
Watch for: reactions to the frame, such as lateness, asking for exact instructions, or refusing to touch materials. These are already scenic material (szenisches Verstehen of the first contact). [source: KHSB 2023, Initialphase; interpretation is synthesis]

4.2 Initialgestaltung (initial work)

Purpose / when: first or second session, for treatment planning. The first work made in therapy is "i. S. einer Initialgestaltung" (as an initial work) viewed for its conscious and unconscious expressive content. [source: KHSB 2024 Baustein 02.3]
Steps:
1. Offer a broad, open invitation, or a light theme if the patient needs structure.
2. Observe the process: approach, material choice, pace, hesitations, use of space and pressure, and what the patient says while working.
3. Look at the work together (see 4.6).
4. Note your countertransference.
5. Document the work and your hypotheses on conflict, structure and resources. Use them to agree goals and themes for later work.
6. Keep the work, so that later works can be compared with it. [source: KHSB 2023/2024; steps 2–6 are synthesis on the curriculum headings]
Example language (illustrative): "Use this first meeting to make something on paper or in clay, whatever wants to come. Afterwards we'll look at it together."
Watch for: do not over-interpret one picture. Hold hypotheses lightly and test them over the series. Never treat the initial work as diagnostic evidence. [synthesis]

4.3 Free (spontaneous) making

Purpose / when: to let unconscious material and the patient's own themes emerge, with patients whose structure is sufficient. Spontaneous drawing is the starting point both in Waser's practice and in progressive mirror drawing. [source: Waser 2005 p. 8; Peciccia 2014]
Steps:
1. Give the open invitation.
2. Stay present and do not direct. You may sit nearby, work at a distance, or move between patients in a group.
3. Signal the time shortly before the end of the making.
4. Move to viewing the work (4.6). [synthesis; Gölles 2023 citing Prasch on moving between patients]
Example language (illustrative): "There's no task today. See what draws you, a colour, a material, and begin there."
Watch for: blank-page anxiety, or flooding (see section 5). If the patient freezes, offer structure (4.4 or 4.5) rather than pushing on.

4.4 Themed making (Gestaltungsthema)

Purpose / when: for focus, containment or a specific conflict. Diagnosis informs the treatment goals and the choice of Gestaltungsthemen. Clinic groups work on set themes. [source: KHSB 2024 Modul 06.1; ReThur PDF]
Steps:
1. Choose a theme from the treatment focus, for example self and others, resources, or a current conflict.
2. Phrase it openly and symbolically, not as a demand for a literal depiction.
3. Offer a fitting material.
4. Make the work.
5. Talk about it (4.6).
Example published in a secondary (educational) source: a collage "as a symbol of yourself before a fitting background", made by tearing images intuitively over about 60 minutes. Follow-up questions ask what the person did, what their symbol looks like and what they take away with them. [source: Gölles 2023 citing Obermeier 2019; secondary]
Example language (illustrative): "Today's theme is 'a place where I feel safe'. It can be quite abstract, just colours or shapes."
Watch for: themes that open too much too soon, for example trauma themes with patients whose structure is weak. Prefer resource themes in that case (4.15). [synthesis]

4.5 Material choice as intervention (Materialkunde)

Purpose / when: material and colour have sensory, motor, affective and cognitive meaning, so choosing them is itself an intervention. [source: KHSB 2023/2024 Baustein 02.2]
Clinical observations reported in a secondary source [source: Gölles 2023, Prasch interview]:
- Clay and soapstone demand letting go, because they are hard to undo.
- Fingerpaint suits perfectionists, because it does not allow precise lines.
- Wire with plaster can engage men who avoid painting.
- Collage gives structure.
- Waser additionally uses watercolour, pastel and oil crayons, pencil, charcoal, coloured pencils and squared paper. [source: Waser 2005 pp. 16–17]
Steps:
1. Notice what the patient habitually chooses.
2. Offer either a material that steadies (structured, controllable: pencil, collage, clay forms) or one that loosens (wet, fluid, large format), depending on what the patient needs.
3. Explore the experience of working with it. [synthesis]
Example language (illustrative): "You always reach for the fine pencils. Would you be willing to try the thick crayons for ten minutes and notice how that feels?"
Watch for: regression with fluid materials in fragile patients. Keep a structuring material within reach. [synthesis]

4.6 Viewing the work together (Bildbetrachtung / Bildgespräch)

Purpose / when: after each making phase. Talking afterwards makes visible the change that took place in the making. [source: KHSB 2024 Modul 04.2; Gölles 2023 citing Obermeier 2019]
Steps:
1. Place the work where both of you can look at it, at a little distance, for example propped or on the wall.
2. Look at it in silence for a moment.
3. Ask the patient to describe what they see, then how making it was.
4. Invite associations. Waser treats the patient's associations as the main material. [source: Waser 2005 p. 3]
5. Explore details from several perspectives: form and colour, the scene, the relationships among the elements, and changes from earlier works.
6. Only then, and tentatively, offer your own observation or link. Waser does give interpretive statements in his case material. [source: Waser 2005 p. 12]
7. Ask what the patient takes with them. [Steps 1–3 and 5 are synthesis on the curriculum's "multiperspektivische Bildbetrachtung"; 7 is from Gölles/Obermeier]
Example language (illustrative): "What do you notice first?" "How was it making this part here?" "What comes to mind when you look at the dark corner?" "I notice the two figures don't touch. Does that say anything to you?"
Watch for: answers being imposed ("what does it mean?"). Hold the not-knowing stance. [source: Gölles 2023 citing Obermeier] It is working when the patient discovers something themselves, for example a link to a relationship or a feeling that becomes namable.

4.7 Intervening in the image: continuing, painting over, new sheet

Purpose / when: to work on in the medium rather than only in words. The curriculum distinguishes image-based from verbal interventions. Waser has pictures developed further by painting over them, continuing them or adding a new sheet. [source: KHSB 2024 Baustein 03.2; Waser 2005 p. 8]
Steps:
1. After viewing, ask whether something in the work wants to change, continue or be answered.
2. Offer the options: work on it, paint over it, add a sheet next to it, or make a response picture.
3. View the work again and compare the two states. [synthesis on the order]
Example language (illustrative): "If this picture could go one step further, what would happen? Would you like to try it on a new sheet next to it?"
Watch for: destructive over-painting that wipes out a vulnerable part of the picture. Photograph the work first, and explore what the destroying means. [synthesis]

4.8 Series review (Bildreihe)

Purpose / when: periodically, and at the end. Placing dream, picture and earlier pictures side by side shows recurring themes and the course of the process. [source: Waser 2005 pp. 11–13; KHSB 2024 Baustein 03.3]
Steps:
1. Lay out the works in order.
2. Ask the patient to walk along them and say what repeats and what changes.
3. Link them to the treatment goals.
4. Document the review. [synthesis]
Example language (illustrative): "Here are your pictures from the last two months side by side. What do you see when you look at them like this?"
Watch for: devaluation of earlier works, or shame. It is working when the patient recognises their own development (the prospective function).

4.9 Painting dreams (Träume malend gestalten)

Purpose / when: to deepen dream work and lower the threshold of dream recall. Franzke, as Waser cites him, notes that drawing stimulates recall. Waser uses this with personality disorders, post-traumatic and psychosomatic disorders, and as an adjunct in addiction, affective disorders and schizophrenia. [source: Waser 2005 pp. 3, 6]
Steps (reconstructed from Waser's case material, not a protocol he published):
1. The patient writes the dream down. Following Moser and von Zeppelin, Waser has it retold in the present tense, without narrative padding. [source: Waser 2005 p. 5]
2. The patient paints the dream, at home or in the practice, before, during or after the session. The picture may show the dream directly or only relate to it indirectly. [source: Waser 2005 p. 8]
3. Gather the patient's associations to the dream and to the picture.
4. Develop the picture further if needed: paint over it, continue it, or add a new sheet.
5. Lay the dream and the picture beside earlier pictures to find recurring themes. [source: Waser 2005 pp. 8, 11–13]
Example language (illustrative): "Tell me the dream again as if it's happening now. Then choose the moment that stays with you most and paint just that."
Watch for: reading dreams as prophecy. Waser explicitly rejects this. [source: Waser 2005 p. 14] With suicidal patients, Waser describes pictures helping to externalise death wishes and work them through. [source: Waser 2005 p. 8] This never replaces a structured suicide risk assessment and safety planning (see section 5). [synthesis]

4.10 Working with transference and countertransference in the triad

Purpose / when: throughout. Transference, countertransference and the intermediate space are core curriculum content. Patients may literally place the therapist in the picture. Waser treats his own countertransference, including his own dream about a patient, as material. [source: KHSB 2023/2024 Modul 06.2; Waser 2005 pp. 12, 15–16]
Steps:
1. Notice how you are cast in the process (helper, judge, intruder) and how the picture addresses you.
2. Register your bodily and emotional response to the work.
3. Note it, and take it to supervision.
4. Bring the relationship theme in through the picture before naming the transference directly.
5. Interpret the transference directly only where the patient's structure allows it. [synthesis on the order]
Example language (illustrative): "There's a small figure at the edge watching the scene. If that were someone in this room, who might it be?"
Watch for: your own aesthetic preferences shaping the patient's work, or a wish to "improve" pictures. Franzke, as cited, warns of risks from the therapist's personality structure. [source: Waser 2005 p. 3]

4.11 Progressive therapeutic mirror image / progressive mirror drawing (Progressiv therapeutisches Spiegelbild)

Origin: developed by Gaetano Benedetti (1920–2013) and Maurizio Peciccia for the psychoanalytic psychotherapy of psychosis. The GKT curriculum names it as a method centred on shared action in the triad. [source: Peciccia 2014 abstract; Benedetti & Peciccia 2000 (title only); KHSB 2024 Modul 06.2]
Purpose / when: with patients in psychotic states, to open a non-verbal communication that had been inaccessible. Peciccia distinguishes it from Winnicott's squiggle game. [source: Peciccia 2014]
Steps (as far as the abstract gives them):
1. Patient and therapist each draw a spontaneous picture at the same time, on separate sheets.
2. They swap. Each completes and transforms the other's drawing.
3. Over repeated rounds, the therapist takes up and develops the patient's hand gestures and graphic forms, so that a graphic dialogue arises. [source: Peciccia 2014]
- Detailed rules (for example how many rounds, how mirroring is paced, and how the drawings are discussed) are not publicly available. [uncertain]
Example language (illustrative): "Let's both draw something, each on our own sheet. Then we'll swap and each carry the other's drawing on a little."
Watch for: this is specialist work. Use it only with training in psychosis psychotherapy and supervision, within a psychiatric treatment plan. [synthesis] Watch for the patient experiencing your additions as intrusion or as merger. Keep your additions close to the patient's own forms. [synthesis]

4.12 Begleitendes Malen (accompanying painting)

What the sources say: the curriculum names it, together with the progressive mirror image, among methods that put shared action at the centre of the art-therapy relationship (Modul 06.2). The 2019 and 2023 handbooks (Modul 14.2) list "Begleitendes Malen", "Begegnendes Malen" and the progressive mirror image as special GKT methods that put the shaping of the relationship "auch von Seiten des/der Therapeuten/in" (from the therapist's side as well) at the centre. Students practise them in application. [source: KHSB 2019/2023 Modul 06.2, 14.2] This implies the therapist takes an active part in the making, but no source says who paints what, or when. [uncertain]
Steps / language: no published procedure exists; the KHSB handbooks (2017, 2019, 2023, 2024) only name it. Do not use it from this guide. Learn it in GKT training. [uncertain]

4.13 Begegnendes Malen (encounter painting)

What the sources say: the 2019 and 2023 module handbooks (Modul 14.2) name it as a GKT method, alongside Begleitendes Malen and the progressive mirror image. It belongs to the group of methods that put the relationship at the centre from the therapist's side as well. No description is given. [source: KHSB 2019/2023 Modul 14.2] It is not named in the 2024 handbook excerpt read in the first pass. [uncertain]
Steps / language: no published procedure exists. Do not use it from this guide. Learn it in GKT training. [uncertain]

4.14 Group Gestaltungstherapie

Purpose / when: the group is a space for corrective emotional and social experience. The curriculum teaches group models from several schools. In clinics, groups often work on set themes. [source: KHSB 2024 Modul 03; ReThur PDF]
Steps:
1. Brief check-in round.
2. Introduce a theme or a free task.
3. Individual making in parallel. The therapist moves between participants. [source: Gölles 2023, Prasch]
4. Group viewing: each person shows their work if they want to. The maker speaks first, then others offer resonances (what they see and feel, not interpretations).
5. Closing round of 10–15 minutes. [source: Gölles 2023]
6. Works can remain in the room to show continuity. [source: Gölles 2023] [steps 1, 2 and 4 are synthesis]
- No joint-picture or partner-picture formats are published for GKT groups. [uncertain]
Example language (illustrative): "Before anyone says what they think it means, tell Anna what you see in her picture and what it does to you."
Watch for: comparison and envy over 'good' pictures, scapegoating, and exposure of a picture someone did not want to show. Showing is always voluntary. [synthesis]

4.15 Resource- and structure-oriented versus conflict-centred work

Purpose / when: set the mode from the psychodynamic diagnosis. The curriculum teaches the two orientations side by side, together with mentalisation concepts. [source: KHSB 2024 Baustein 05.3; Modul 06] Making a picture involves decisions, and this integrative process is described as strengthening ego functions. [source: Gölles 2023 citing Leutkart 2003; secondary]
Steps (structure/resource mode) [synthesis on the curriculum headings]:
1. Use clear frames, defined formats, controllable materials and resource themes.
2. Name the patient's decisions and skills in the making.
3. Mentalise the picture (what might the figure feel or want?) rather than uncovering it.
4. End with an orienting, stabilising piece of work.
Steps (conflict mode) [synthesis]: use more open tasks, explore ambivalence in the picture, link it to biography and relationship patterns, and work with the transference (4.10).
Example language (illustrative): "You decided to put a frame around the whole thing. How did that feel?"
Watch for: switching to conflict work when the patient becomes disorganised, regresses or dissociates. Return to structure (section 5).

4.16 Documentation in words and pictures

Purpose / when: every session, and at the end. Documentation covers indication, goal agreement, planning, process and outcome. [source: KHSB 2024 Baustein 03.3]
Steps:
1. Photograph each work with the date. Store the photos as part of the clinical record.
2. Write a short note covering the process, the patient's words, associations, your countertransference and your hypotheses.
3. Agree with the patient what happens to the originals at the end. [synthesis]
Watch for: confidentiality of the images, which are identifiable clinical data. Get consent before any use in teaching or publication. [synthesis]

4.17 Children and adolescents

The curriculum names child and adolescent psychiatry as a field of practice and includes infant research and attachment theory. [source: KHSB 2023/2024]
No specific GKT procedures for children are published. [uncertain]
Practice points [synthesis]:
- Obtain parental consent and the child's own assent.
- Tell the child at the start what you have to pass on if they are in danger.
- Know your local safeguarding and reporting procedures (in Germany, § 8a SGB VIII and the KKG; in the UK, local safeguarding partnership procedures).
- Never take a drawing as proof of abuse. If a picture or a remark raises concern, document it factually and follow the safeguarding procedure.
- Involve parents in review sessions without showing them works the child has not agreed to share.
- Use more play-like media, shorter sessions and more structure for younger children.

5. Handling problems

The published sources give only scattered guidance here, chiefly the principle of fitting interventions to ego structure, Waser's points on suicidality and on the therapist's personality, and the not-knowing stance. Most of what follows is therefore marked [synthesis].

"I can't draw" / blank-page block. Restate that skill is irrelevant. [source: ReThur PDF] Reduce the demand: use a small format, a single colour or material, a time limit, or a structuring task such as a shape to fill or collage (4.4, 4.5). Offer to begin with a mark or a scribble the patient then takes over. [synthesis]
Stuck: repetitive, stereotyped pictures. Treat the repetition as meaningful and look at the series (4.8). Vary only one parameter (material, format, standing at the wall) to shift perspective. Standing painting at the wall is reported as a way of bringing movement and a change of perspective. [source: Gölles 2023, Prasch] Explore what changing the picture would cost the patient. [synthesis]
Resistance to talking about the work. Accept that the making itself works, since change happens in the creative process [source: Gölles 2023 citing Obermeier]. Talk about the experience of making rather than the meaning, or let the picture "speak" (what would it say?). Name the reluctance tentatively as part of the relationship (4.10). [synthesis]
Over-intellectualising or hunting for 'the meaning'. Bring the patient back to describing what they actually see, and to their own associations. Decline to give a key-type interpretation. [source: Waser 2005 p. 3; Gölles 2023 citing Obermeier; the application is synthesis]
Overwhelm, flooding or regression during making (for example with wet media, or with trauma or dream themes).
- Stop the making phase. Move the work out of direct view, or turn it over.
- Ground the patient: feet, breath, the room, naming the time.
- Switch to a structuring material, a frame, or a resource image (4.15).
- Contain the work: the picture stays in the therapy room.
- Afterwards, reduce the openness of tasks and review the indication with the treatment team. [synthesis]
Dissociation. Orient the patient to the here and now. Have them handle a physical object such as clay or a stone, use their name, and avoid continuing the theme. Afterwards, discuss early warning signs and agree a stop signal. [synthesis]
Psychotic patients.
- Fluid, unstructured media and open themes can disorganise. Prefer clear formats and structuring media.
- Use the specialist techniques (4.11) only with training, and in coordination with the psychiatric team. [synthesis; Benedetti/Peciccia's technique exists specifically for psychosis, per Peciccia 2014]
- Waser lists schizophrenia only as a supportive (adjunct) indication. [source: Waser 2005 p. 3]
Suicidal or self-harm content in the picture. Take it seriously as communication. Waser describes pictures helping to externalise and work through death wishes. [source: Waser 2005 p. 8] Ask directly about suicidal thoughts, plans and intent. Follow current structured risk assessment and safety planning, including lethal-means counselling (safe storage and removal) and liaison with the medical team or crisis services. Never treat the artwork as a substitute for direct enquiry. Count sharp tools back in. [synthesis]
Destroying the work (tearing, painting over, wanting to throw it away). Photograph it first if possible. Explore what the destruction means before it happens: who or what is being destroyed? Agree that works are kept until the end. Let the patient decide if they insist, and document. [synthesis]
Non-adherence (missed sessions, refusing homework pictures). Waser's dream pictures are partly made at home, but home work is optional. [source: Waser 2005 p. 8] Do not make home pictures a requirement. Explore missed sessions as material while keeping the frame consistent. [synthesis]
Ruptures (the patient feels judged, exposed or misread through an interpretation). Acknowledge it explicitly. Take back or soften the interpretation and return to the patient's own reading. Repair through the picture as well, for example by offering a response picture. In supervision, check whether your own aesthetic or interpretive needs drove the rupture. Franzke, as cited, warns of the therapist's personality as a risk factor. [source: Waser 2005 p. 3; the rest is synthesis]
Shame about the product, or comparison in groups. Ban evaluative comments. Make showing voluntary, have the maker speak first, and give resonance rather than judgement (4.14). [synthesis]
Over-reading pictures diagnostically (by staff or referrers). Explain that GKT reads pictures within the process and relationship. Initial pictures are hypotheses, not proof of trauma, abuse or diagnosis. [synthesis] No published reliability or validity data exist for GKT picture reading. [uncertain]
Physical safety incidents (cuts, plaster burns, allergies, clay dust). Follow your first-aid and incident procedures. Review the material choice for that patient. [synthesis]
Confusion with Gestalt therapy, or with esoteric 'painting therapy'. Clarify the depth-psychological basis and the training route to patients and referrers. A secondary source cites Kraus as separating art therapy from esoteric self-experience. [source: Schuster 2009; Gölles 2023 citing Kraus 2012]

Sources

Web sources:

[uncertain]: content published only on the DAGTP's own website (dagtp.de) is not reflected in this guide, and Franzke (1977/1983) and Schottenloher (1983) have no legitimate public text or preview.

Books cited through the sources above [uncertain]:

Franzke, E. (1977; 2nd ed. 1983). Der Mensch und sein Gestaltungserleben: Psychotherapeutische Nutzung kreativer Arbeitsweisen. Bern: Huber. The edition dates are from Waser 2005's bibliography; the subtitle is not verified. Waser cites pp. 63, 224 and 254 f.
Schottenloher, G. (1983). Kunst- und Gestaltungstherapie in der pädagogischen Praxis. Cited by Schuster 2009; the publisher is not verified.
Moser, U. & von Zeppelin, I. (dream-coding rules, as cited by Waser 2005).
Obermeier (2019), Leutkart (2003), Kraus (2012), Rössler (2013) (as cited by Gölles 2023).

← Previous · VIII-013Anthroposophic art therapy and painting therapy Next · VIII-015 →Expressive painting and the Malort closed studio (Arno Stern)