The Humanistic Psychologist

The Humanistic Psychologist
A Measure for Psychotherapist’s Intuition: Construction, Development, and

Pilot Study of the Aesthetic Relational Knowledge Scale (ARKS)
Margherita Spagnuolo Lobb, Federica Sciacca, Serena Iacono Isidoro, and Zira Hichy
Online First Publication, February 17, 2022. http://dx.doi.org/10.1037/hum0000278
CITATION
Spagnuolo Lobb, M., Sciacca, F., Iacono Isidoro, S., & Hichy, Z. (2022, February 17). A Measure for Psychotherapist’s
Intuition: Construction, Development, and Pilot Study of the Aesthetic Relational Knowledge Scale (ARKS). The Humanistic
Psychologist. Advance online publication. http://dx.doi.org/10.1037/hum0000278
The Humanistic Psychologist
© 2022 American Psychological Association
ISSN: 0887-3267 https://doi.org/10.1037/hum0000278
A Measure for Psychotherapist’s Intuition: Construction,

Development, and Pilot Study of the Aesthetic Relational
Knowledge Scale (ARKS)
Margherita Spagnuolo Lobb1, Federica Sciacca2,

Serena Iacono Isidoro3, and Zira Hichy2
1
Postgraduate School of Psychotherapy, Istituto di Gestalt HCC Italy, Syracuse, Italy
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
2
Department of Educational Science, University of Catania
This document is copyrighted by the American Psychological Association or one of its allied publishers.
3
Istituto di Gestalt HCC Italy, Palermo, Italy
This study has explored the construct of aesthetic relational knowledge (ARK) as the intui-
tive experience of the therapist that emerges from the phenomenological field created in a
meeting between therapist and client. A scale to measure this construct has been built and
validated. The concept of ARK has been examined in literature and a questionnaire has
been developed, composed of 58 items. A sample of 94 Italian Gestalt psychotherapists
(Mage = 40.19, SD = 8.15) has completed an online protocol containing the Basic Empathy
Scale, the Multidimensional Assessment of Interoceptive Awareness, and a series of ques-
tions created ad hoc for the assessment of resonance. Two exploratory two- and three-
latent-factor analyses were conducted to identify the variables that best explain ARK. The
results have shown that ARK is described by three factors: empathy, resonance, and bodily
awareness. They show the best saturation values and the best comparison with the theoreti-
cal reference model. Cronbach’s alpha is .844. The ARK can be defined as a three-dimen-
sional construct that supports the positive use of counter-transferential feelings in terms of
Margherita Spagnuolo Lobb https://orcid.org/0000-0003-3867-0563

Federica Sciacca https://orcid.org/0000-0001-8653-7818
Serena Iacono Isidoro https://orcid.org/0000-0002-6181-8477
Zira Hichy https://orcid.org/0000-0002-4038-0605
The study has been approved by the review board of the Istituto di Gestalt HCC Italy (accredited by the
Italian Minister for Universities) and complies with the Helsinki Declaration of 2013 and with American
Psychological Association ethical standards in the treatment of our sample. All participants were adequately
informed about the study before taking part in the research and have consented to the use of the data in
anonymous form with respect for privacy. The authors declare that the research was conducted in the absence of
any commercial or financial relationships that could be construed as a potential conflict of interest. The authors
wish to thank Prof. Santo Di Nuovo, University of Catania, and Wolfgang Tschacher, University of Bern, for the
exchange and inspiration.
Margherita Spagnuolo Lobb conceived the theoretical reflections and the study, collected data, and
contributed to interpretation of data, drafting of the article, and critical revisions of the article. Federica Sciacca
conceived the study, was responsible for collection of all data and for organizing the database, contributed to the
interpretation of the data, and performed the statistical analysis. Serena Iacono Isidoro contributed to critical
revisions of the article. Zira Hichy performed the statistical analysis and contributed to interpretation of data. All
authors actively discussed the subject, revised the article, and provided final approval.
Correspondence concerning this article should be addressed to Margherita Spagnuolo Lobb, Istituto di
Gestalt HCC Italy, Postgraduate School of Psychotherapy, Via S. Sebastiano 38, 96100 Siracusa, Italy. Email:
[email protected]
1
2 SPAGNUOLO LOBB, SCIACCA, IACONO ISIDORO, AND HICHY
aesthetic knowledge of the phenomenological field of the therapeutic situation. The ARK
can be measured by the Aesthetic Relational Knowledge Scale, suitable for training pur-
poses, supervision, and research.
Keywords: phenomenological field, therapeutic intuition, humanistic psychotherapy, process

research, psychotherapist training/supervision development
This article helps to describe and measure some complex aspects of the intuitive capacity of
the psychotherapist. The construct of aesthetic relational knowledge (ARK) has been described
as a phenomenological and aesthetic tool able to support therapeutic intuition and clinical use
of countertransference, drawing on a field/relational perspective. The concept of aesthetic rela-
tional knowing captures something that is very hard to describe and very important to the clini-
cal process since the beginning of psychotherapy. The construct of ARK integrates this topic
with what we are learning from neuroscience and with the contemporary relational movement.
The scale, here presented allows to measure the three-dimensional construct of ARK, therefore
the intuitive capacities in psychotherapists’ training, in supervision, and offers an instrument to
research on different populations of psychotherapists.
As evidenced by the current literature, the therapist plays an active role in clinical work
with patients. The therapist’s personal involvement was first recognized by Sigmund Freud,
who introduced the term “countertransference” to refer to an analyst’s unaware transference of
emotional aspects to the patient (Freud et al., 1910). Further, the concept was expanded to
include the therapist’s entire emotional response to the patient (Gabbard, 2014). Theodor Reik
(Arnold, 2006), for instance, urged therapists to pay attention to the images in their mind as
they sat with a suffering person and to take in the whole experience, perceptually and emotion-
ally as well as intellectually. In this new vision, countertransference was no longer considered
as an obstacle to be overcome but as the main road to clinical knowledge. This is because the
feelings that patients induce in their therapist communicate something important about their
inner world (Fromm-Reichmann, 1939; Greenberg, 2001; Heimann, 1950; Winnicott, 1949).
Today, most psychotherapeutic approaches have recognized the clinical relevance of the
therapist’s emotional reactions and attribute to the intersubjective affective environment the
main role in determining the course of clinical outcomes (Flückiger et al., 2018; Heinonen &
Nissen-Lie, 2020; Lingiardi et al., 2018; McWilliams & Spagnuolo Lobb, 2017; Stern et al.,
1998, 2003). According to these studies, an essential part of the psychotherapist’s clinical work
has to do with the process of managing the feelings evoked by the relationship with the patient.
Zilcha-Mano et al. (2021) have shown how patients’ attachment orientation toward significant
others predicts their implicit and explicit expectations from the therapist. The therapist should,
therefore, try to raise the patient’s awareness of what is happening in the here and now of inter-
personal relationships (Stern, 2005) since, as we know, those feelings of which we are not
aware can uncontrollably lead to a negative therapeutic outcome (Dahl et al., 2012).
Although emotional aspects of the therapists have been largely studied, both in terms of
therapeutic alliance (Ardito & Rabellino, 2011; Iwakabe et al., 2000), empathy (cfr. Gal-
lagher, 2012; Merleau-Ponty, 1962; Ratcliffe, 2012; Zahavi, 2010), and intersubjective rela-
tionship (Dosamantes, 1992; Dosamantes-Beaudry, 2007; Stern, 2005), the aesthetic feelings
of the therapist have not been studied enough, especially in the frame of phenomenological
field theory (Bloom, 2009; Macaluso, 2020a, 2020b; Parlett, 1991, 2000, 2003, 2005; Parlett
& Spagnuolo Lobb,2018). This study on the Aesthetic Relational Knowledge Scale (ARKS)
provides a theoretical and clinical ground for the intuition of the therapist (cfr. Tenschert,
2016).
AESTHETIC RELATIONAL KNOWLEDGE SCALE 3
What Is Aesthetic Relational Knowledge?

Previous studies have shown the importance of the therapist’s presence in aesthetic terms
(Polster, 1987, 2021; Zinker, 1987). ARK is a contemporary evolution of the concept of inter-
subjective awareness (or countertransference) defined as the way in which a psychotherapist,
via their senses, uses the tools of both embodied empathy and resonance to understand the cli-
ent’s situation (Spagnuolo Lobb, 2013, 2017a, 2017b, 2018, 2020a, 2020b).
While we find many studies about “embodied empathy”—the capacity to feel at a
bodily level what the other feels—especially by neuroscientists (see Gallese et al.,
2007; Gallese & Sinigaglia, 2011; Schore, 2011; Schore & Schore, 2014) and phenom-
enologists (see “Empathy” below), the concept of resonance is less studied (see “Reso-
nance” below). We have chosen to study it referring to the epistemology of Gestalt
psychotherapy theory. As stated by its founders, “It is meaningless to define a breather
without air” (Perls et al., 1994, p. 35). We can say, “It is meaningless to define the
patient without the therapist.” The therapist’s and the patient’s perceptions during the
session are considered not as isolated perceptions but as individual ones that, insofar
as they are part of a situation, have something in common; they contribute to create a
shared reality. As a matter of fact, we know from previous studies that the same patient
can activate different reactions with different therapists.
With a rather speculative interest, we might explore the concept of isomorphism (Koffka,
1935; Köhler, 1940; Luchins & Luchins, 1999; Wertheimer, 1945) as a bridge that connects
Gestalt theory, the implications of the discovery of mirror neurons, and the specific relational
approach of Gestalt psychotherapy. These three concepts endorse the fact that what “resides”
in our brain is the capability to creatively adjust to the other/environment, inferring their
intentional movements (Spagnuolo Lobb, 2016).
ARK is a construct that supports the therapist to understand the patient’s suffering in the
field perspective, thanks to their isomorphic and aesthetic capacity. Using their own aesthetic
experience, the therapist experiences a “vibration” at the presence of the patient that informs
them of the relational field that is “habitual” for the patient and therefore of the reciprocal
movements that they activate in the experiential field where the suffering has been cocreated.
It also tells the therapist which relational resources are now present in the actual therapeutic
field (cfr. Spagnuolo Lobb, 2019).
Using their ARK, and taking into account what their own body senses, the therapist is
fully immersed in the “situation” of the patient (see Wollants, 2012) and offers them the pos-
sibility of “rewriting history” through experimentation.
Therefore, the therapist’s act of sensing/perceiving is not only empathy, an identification

with the client’s experience, but also resonance, a personal and sensitive reaction to the
field in the presence of the client. It is the “other side of the moon” of the client’s experi-
ence. With it, the therapist can see the beauty, the harmony and grace, with which the client
has faced life’s difficult situations, all the while maintaining the intentionality of contact
with significant others and the reactions of others—“the resonance of the field.” (Spagnuolo
Lobb, 2018, pp. 50–68)
ARK, in other words, is the “sensory intelligence” of the shared phenomenological field.
Factors Related to Aesthetic Relational Knowledge

In the attempt to describe the construct of ARK, we have considered three basic concepts:
empathy, resonance, and bodily awareness.
Empathy
Empathy is a heterogeneous construct that has received considerable attention in recent
years (Decety & Svetlova, 2012). The way it was conceived has changed considerably since
the early studies of Lipps (1903/1979), Titchener (1909), and Rogers (1951), who defined
empathy as the concept of “as if.” Today, it has recently been assigned, for instance, an im-
portant role for issues related to social cognition (Clark et al., 2008; Haker & Rössler, 2009;
Marshall & Marshall, 2011; Mehrabian, 1997; Schulte-Rüther et al., 2011; Thoma et al.,
2011). Most of all, a conception of empathy has emerged based on two components: an affec-
tive and a cognitive component (Davis, 1980, 1983, 1994; Deutsch & Madle, 1975; Hoffman,
1977; Hogan, 1969; Jolliffe & Farrington, 2006; Lawrence et al., 2004; Mehrabian & Epstein,
1972). The empathic response requires the recognition of one’s own emotion and that of other
people, the ability to share and replicate the emotional states of other people and, at the same
time, be aware that these emotions are not one’s own (affective reactivity), and the ability to
adopt another perspective while preserving the distinction between oneself and the other
(emotional perspective). Motor and cognitive functions therefore play an important role in the
arousal and modulation of empathy. In the cognitive domain, the ability to deliberately adopt
the perspective of others and imagine their feelings, even without direct observation, can be
an equally powerful trigger of affective responses (Jackson et al., 2006; Lamm et al., 2007)
and consequent prosocial behaviors (Hein et al., 2010, 2011). More recently, a perspective
has developed that sees empathy as consisting of three factors (Decety, 2011; Decety &
Michalska, 2010). The first is emotional contagion, which corresponds to the automatic iden-
tification of another person’s emotions (Iacoboni & Dapretto, 2006; Lipps, 1903/1979); the
second is cognitive empathy, defined as the ability to understand and mentalize the feelings of
another (Decety, 2011; Hoffman, 1977); and the third is emotional disconnection, defined as
a regulatory factor involving self-protection from distress and pain (Batson et al., 1987;
Lamm et al., 2007). In a previous study, we investigated the wish to help in people who are
exposed to visual images of pain (Spagnuolo Lobb et al., 2020), testing that it increases in
those who have a higher capacity of empathy and at the same time can detach from their own
bodily feelings. Neuropsychological studies also support the three-component perspective by
indicating how emotional contagion involves subcortical structures such as the limbic lobe,
known for processing emotions (Hariri et al., 2002; Phillips et al., 2003); cognitive empathy
involves activation of the insular cortex, which promotes emotional awareness; and the ven-
tromedial and medial prefrontal cortex, which are responsible for emotional understanding
(Decety, 2011; Decety & Svetlova, 2012), and emotional disconnection, which allows for the
regulation of emotions, are related to top-down executive functions of the orbitofrontal,
medial, and dorsolateral prefrontal cortex and anterior cingulate cortex (Decety, 2011; Decety
& Michalska, 2010). Interesting studies in the neurological basis of empathy have been con-
ducted, in particular on the role of sensorimotor neural circuits in the relationships between
empathic and aesthetic contexts. Gallese (2009) has described the concept of embodied simu-
lation, and Singer et al. (2004) observed that empathy recruited neural networks similar to the
direct experience of the emotional one, confirming the hypothesis of Wicker et al. (2003)
who showed that the anterior insular cortex and the anterior cingulate cortex were activated
during the observation of the pain of others. In other words, we are able to understand and
share the emotions of others by processing them (partially) with our own emotional systems.
Resonance
In physics, resonance is a vibration between two elements, such as the prolonga-
tion of a sound, a bell, or a musical tone that allows them to energetically drag,
synchronize, and act in a sudden new harmony. Since there were initially no literature
studies that addressed the theme of resonance in the human sciences, as well as in
mathematics and physics, neuroscientists took a cue from physics and have begun to
speak of empathy as states of reverberant empathic resonance to describe the underly-
ing mechanism that allows humans to indirectly learn what another animal is experi-
encing (Keysers, 2009; Rizzolatti & Craighero, 2004). As mammals, our survival
depends on our ability to be aware of and respond to the nonverbal messages of
others. In other words, the neuron tends to “mirror” the acted or observed behavior of
the other animal, apparently as if the observer were doing the action. Our limbic brain
is central to this process. Resonance was thus confused with empathy for a long time,
while today it is seen as the direct experience of temporarily entering the perceptive,
sensory, cognitive, and relational world of another. It is a phenomenon that includes
within it concepts of empathy, mirroring, tuning, intuition, and kinesthetic perception
(McConnell, 2011), but it does not overlap with the concept of empathy. Over time,
several authors have become interested in the concept of resonance. Prendergast

(2007) spoke of empathic resonance or attunement with another as “mutual attune-

ment to a shared field,” which includes the sharing of somatic thoughts and sensa-
tions. The resonance is therefore experienced between two people when they both
touch the essential qualities within their body by experiencing a deep contact with
each other (see also Hart, 2000, and Blackstone, 2007).
Watkins (1978, 2009) similarly described resonance as the complete experience of com-
mon moments of intimacy between therapist and client, the experience of entering the
patient’s world so fully that one temporarily abandons one’s self and becomes the other.
Finally, according to Siegel (2007), resonance is
the alignment of two autonomous beings into an interdependent and functional whole since each
person influences the internal state of the other. Our heart rates align, breathing becomes
synchronized, nonverbal signals emerge in parallel waves and . . . changes in EEG results and
heart rate variability occur simultaneously . . . Resonance reveals the profound reality that we are
part of a greater whole . . . that we are created by the dance going on within, between us. (p. 159)
He describes the neurobiology of a resonance circuit that awareness can exploit by

involving mirror neurons, the insula and superior temporal regions, as well as aspects of the
prefrontal cortex. A similar aspect that has been studied by Tschacher et al. (2014) is the pro-
cess of synchronicity that happens in therapeutic interactions.
Resonance is therefore the direct therapeutic experience of “welcoming you into me” and
implies that the sensations emerge within the intersubjective field of the therapeutic relation-
ship. To resonate with someone means to serve as a mirror to them and to be identified so
closely that you feel the experience of them (Silverberg, 1988). Inside the method of Gestalt
therapy, for Ruella Frank (2016), kinesthetic resonance is the relational feel of our relational-
ity. As I move, you feel and see me move, and then you almost simultaneously move in
response. You experience my movements “as if” they live within you, and vice versa.
Besides these descriptions, we need to add that the concept of resonance that we want to
explore here includes an experience of the whole field and therefore also the possibility to feel
what the meaningful other, with whom the experience has been cocreated, feels in that situation.
The therapist feels part of the patient’s experiential field and uses his own resonance to know
the “other side of the moon” of the patient’s suffering. In other words, the resonance in the
field allows him to reactivate the way in which the meaningful other typically resonated in
contact with the patient. (Spagnuolo Lobb, 2018, pp. 27–28)
Bodily Awareness
Within the theoretical framework of ARK, the concept of bodily awareness is an indis-
pensable prerequisite for the therapist to use their perception as a resonance of the experiential
field cocreated with the patient. It implies being fully present with their senses in the process
of contacting the patient and the situation. Various definitions of bodily awareness (synony-
mous with somatic awareness or interoceptive awareness) are found in different fields, such
as medicine, psychology, neuroscience, anthropology, and philosophy, and they can differ in
terms of meaning. According to medicine, the neuroscientific and physiological understand-
ing of bodily awareness would imply proprioceptive and interoceptive awareness; the first
refers to the conscious perception of muscular tension, movement, posture, and balance (Las-
kowski et al., 2000), and the second refers to the conscious perception of sensations within
the body such as heartbeat, breathing, satiety, and feelings of the autonomic nervous system
related to emotions (Barrett et al., 2004; Cameron, 2001; Craig, 2002; Vaitl, 1996). There are
several studies that show that the link between interoceptive awareness and physical sensa-
tions is a fundamental element for the regulation of affects (Dunn et al., 2010; Sze et al.,
2010), for decision-making (Dunn et al., 2010; Kirk et al., 2011), and for the sense of self
(Cameron, 2002; Damasio, 1999, 2003; Herbert & Pollatos, 2012).
Interoceptive awareness is a product of conscious perception, and as such, it is a psychobio-
logical process that is modified by complex functions that are influenced by evaluation, beliefs,
past experiences, expectations, and contexts. In recent years, a more complex and multidimen-
sional vision of bodily awareness has emerged that distinguishes the different ways of paying
attention such as thinking about the body (interpreting, evaluating, and ruminating physical
symptoms) and presence at the body (perceptive capacity within the body, often labeled aware-
ness; Arch & Craske, 2006; Bishop et al., 2004). Mehling et al. (2009) defined bodily aware-
ness as sensory awareness that originates from physiological states of the body, from sensory
processes including pain and emotion, and from actions including movement and that functions
as an interactive process that includes the evaluation of a person, and it is shaped by attitudes,
beliefs, and experience in its social and cultural context. In this study, when we talk about body
awareness, we refer to the different ways of focusing attention on the body (interpreting and
evaluating physical symptoms) and the ability to consciously perceive muscle tension, move-
ment, posture, heartbeat, breathing, satiety, and feelings of the autonomic nervous system
related to emotions. In fact, in Gestalt psychotherapy, “awareness is characterized by contact,
by sensing (feeling/perception), by excitement, and by Gestalt formation. Its adequate function-
ing is the realm of normal psychology” (Perls et al., 1994, p. xxv).
“Contact,” “sensing,” “excitement” are words that explain awareness in terms of being fully pres-
ent with senses open in a given situation . . . The therapist’s awareness is immediate experience
developing with, and as part of, an ongoing organism–environment transaction in the present. . . .
It includes thinking and feeling, it is always based on current perceptions of the current situation;
it includes some intention and directionality of the self toward the world. . . . The therapist’s
awareness is a quality of the way in which he establishes contact with the client, the way in which
he is present (awake) at the contact boundary, more or less open toward the risk in a meaningful
and intentioned experience. (Spagnuolo Lobb, 2018, pp. 56–57)
Objective
Starting from these theoretical premises, we have made a pilot study of the ARKS. We
have considered the following dimensions: empathy (including emotional contagion,
emotional disconnection, and cognitive empathy), bodily awareness (interoceptive ability to

recognize the emotional-bodily activation), and resonance (experiencing the “other side of the
moon” of the patient’s feeling).
Method
Participants
Participants were 94 Italian Gestalt Psychotherapist (13 men and 81 women) born and liv-
ing in Italy, aged between 28 and 64 years (Mage = 40.19, SD = 8.15). They had been working
for an average of 9.44 years (SD = 9.29). Six therapists had their degree in medicine and 88
in psychology. Participants filled out an online questionnaire on the Google Forms platform,
with the link sent by email. They were informed that their responses would remain confiden-
tial. Ethical approval for this research was granted by the principal investigator’s institution.
Design and Procedures

The ARKS is part of a wider research project of Istituto di Gestalt HCC Italy that aims to
study the process of change in psychotherapy considering the flow of reciprocity between
therapist and client, both in terms of time sequence and reciprocal intentional movements
(cfr. Molinari & Cavaleri, 2015; Maggio, 2016; Sampognaro, 2020; Spagnuolo Lobb, 2017a,
2017b, 2018, 2020). The present research aimed to validate the ARKS in order to use it for
training, research, and clinical purposes; to measure the development of the intuitive capacity
of psychotherapists in long-term (4-year) programs (see Alcaro et al., 2020); to provide vali-
dated feedback on therapeutic situations; to research the development of ARK in different
psychotherapy modalities; and to research ARK with different populations of patients or with
different populations of psychotherapists.
Construction Process of the ARKS

Selection of items for the ARKS was divided into four phases:
1. Analysis of the scientific literature on the area of investigation

2. Choice and definition of the content areas to be explored in the questionnaire (em-
pathy, bodily awareness, and resonance)
3. Choice of the questionnaires to be used
4. Arrangement of items in an appropriate order to create the scale
For each item, participants indicated their level of agreement on a 7-point scale ranging from
1 (strongly disagree) to 7 (strongly agree), with 4 meaning neither agree nor disagree.
Questionnaires Used
The initial version of the scale consisted of two questionnaires present in the literature
(Basic Empathy Scale [BES] for the evaluation of empathy and Multidimensional Assess-
ment of Interoceptive Awareness [MAIA] for the evaluation of bodily awareness), 28 ad hoc
items on resonance, and a series of sociodemographic questions. After the evaluation of a
group of Gestalt psychotherapists, ad hoc items for the evaluation of resonance were reduced
to 11. The final questionnaire we administered was composed of 63 items. The administration
took place in the following order: first the BES was administered, then the MAIA, and finally
the questions on resonance.
Basic Empathy Scale. The BES (Jolliffe & Farrington, 2006) is a tool that evaluates empa-
thy based on three components: emotional contagion from another person’s emotion,
emotional disconnection, and cognitive empathy. The BES consists of 20 questions
with a 5-point Likert response scale ranging from strongly disagree to strongly agree
and is divided into three subscales: emotional contagion, emotional disconnection, and
cognitive empathy.
Multidimensional Assessment of Interoceptive Awareness. The MAIA (Mehling et al.,
2012) is a self-report questionnaire for the assessment of emotional-bodily activation and
interoceptive awareness. It consists of 32 questions and eight subscales: noticing, which eval-
uates the ability to detect and distinguish uncomfortable, comfortable, and neutral body feel-
ings; not-distracting, which measures the tendency not to ignore or distract from feelings of
pain or discomfort; not-worrying, which evaluates the tendency not to react with anxiety or
worry to feelings of pain or discomfort; attention regulation, which measures the ability to
support and control attention to bodily sensations; emotional awareness, for the assessment of
awareness of the connection between bodily sensations and emotional states; self-regulation,
for the ability to regulate psychological distress through attention to bodily sensations; body
listening, to measure the ability to actively listen to the body to understand; and trusting, to
evaluate the ability to experience one’s body as safe and reliable.
Questions About Resonance. Twenty-eight questions were formulated ad hoc (14 positive
and 14 negative) to evaluate the concept of resonance, following studies and reflections con-
ducted with Gestalt psychotherapists adequately trained on the subject (Borino, 2013; Conte
& Tosi, 2016; Macaluso, 2020a, 2020b; Maggio, 2016; Mione, 2019; Rubino & Spagnuolo
Lobb, 2015; Sampognaro, 2020; Spagnuolo Lobb, 2012, 2013, 2018, 2019).
These questions investigated some main aspects such as the therapist’s intuition about
what was happening in the patient’s relationships in which the suffering arose, ability of the
therapist to approach the patient’s suffering considering their own previous experiences and
bodily processes, the therapist’s ability to take distance from their personal experience when
meeting the patient’s suffering, ability of the therapist to empathically understand what care-
givers or other meaningful people who enter into a relationship with the patient feel, ability of
the therapist to understand what the patient was missing from the significant other, and intero-
ceptive perception of the therapist. The psychotherapists who answered the questionnaire
responded on a 5-point Likert scale ranging from strongly disagree to strongly agree. The
questions were written in a way that is as clear and understandable as possible for the target
audience. Once the first draft of the questionnaire was prepared, it was tested on people
belonging to the reference target but external to the project. This first check was aimed at
identifying the presence of confusing or unclear questions, testing the length of the question-
naire, and detecting whether the purposes of the questionnaire were sufficiently described and
clarified. The list of questions was administered to 10 Gestalt psychotherapists adequately
trained on the subject, who rated the adequacy of the items on a scale from 1 (unclear) to 5
(very clear). Seventeen questions were eliminated because they were found to be unclear or
inconsistent. The final questionnaire about resonance consisted of 11 questions.
Sociodemographic Questions. A series of sociodemographic questions such as gender,
age, education (degree in medicine or degree in psychology), and province of residence was
included.
Psychometric Validation of the Measure. The psychometric validation of the ARKS was
provided for the verification of dimensionality through the principal components analysis,
with the aim of analyzing the presence of one or more factors underlying the scale. Subse-
quently, the reliability of the instrument was calculated using Cronbach’s alpha.
Table 1
Factor Loadings of the Aesthetic Relational Knowledge Scale (ARKS) Conducted by Matrix of
Rotated Components Analysis With Varimax Rotation
Body
Item awareness Resonance Empathy
1. After being with a friend who is sad about something, I usually feel
sad. 0.455
2. I can understand the happiness of my friends when they do some-
thing right. 0.427
3. I get scared when I look at the characters in a good scary movie. 0.663
4. I am easily involved in the feelings of others. 0.741
5. I find it hard to tell when my friends are scared. 0.500
6. I don’t get sad when I see other people cry. 0.615
7. Other people’s feelings don’t bother me at all. 0.327
8. When someone feels “down” I can usually understand how they feel. 0.456
9. I usually understand when my friends are afraid. 0.645
10. I often get sad when I watch sad things on TV or in movies. 0.592
11. I often understand how people feel even before they tell me. 0.470
12. Seeing an angry person has no effect on my feelings. 0.602

13. I can usually tell when people are happy. 0.437
14. I tend to feel scared when I’m with friends who are afraid. 0.431
15. I can usually tell quickly when a friend is angry. 0.584
16. I am often caught up in the feelings of my friends. 0.616
17. My friend’s unhappiness makes me feel nothing. 0.315
18. I’m usually not aware of my friends’ feelings. 0.400
19. I have a hard time knowing when my friends are happy. 0.362
20. When I am tense, I notice where the tension is located in my body. 0.564
21. I notice when I’m uncomfortable in my body. 0.634
22. I notice the places on my body where I feel comfortable. 0.585
23. I notice changes in my breathing, for example if it slows down or
speeds up. 0.645
24. I don’t notice the physical tension or discomfort until it becomes
more serious. 0.308
25. I distract myself from the feelings of discomfort. 0.306
26. I can pay attention to my breathing without getting distracted by the
things going on around me. 0.672
27. I can maintain awareness of my inner physical sensations even
though many things are happening around me. 0.642
28. When I’m having a conversation with someone, I can pay attention
to my posture. 0.627
29. I can regain awareness of my body if I am distracted. 0.625
30. I can redirect attention from the act of thinking to the act of perceiv-
ing my body. 0.772
31. I can maintain awareness of my whole body even when part of me is
sore or uncomfortable. 0.558
32. I am able to intentionally focus on my body as a whole. 0.620
33. I notice how my body changes when I’m angry. 0.712
34. When something goes wrong in my life, I can feel it in my body. 0.649
35. I notice that my body feels different after a peaceful experience. 0.642
36. I notice that my breathing becomes free and easy when I feel
comfortable. 0.649
37. I notice how my body changes when I feel happy/joyful. 0.696
38. When I feel overwhelmed, I can find a quiet place within me. 0.344
39. When I turn awareness to my body, I feel a sense of calm. 0.638
40. I can use my breath to reduce tension. 0.541
41. When thoughts assail me, I can calm my mind by focusing on my
body/breath. 0.576
42. I listen to information from my body regarding my emotional states. 0.715
43. When I’m agitated, I take the time to investigate how my body is
doing. 0.632
44. I listen to my body to know what to do. 0.648
45. In my body I feel at home. 0.520
(table continues)
Table 1 (Continued)
Body
Item awareness Resonance Empathy
46. I feel like my body is a safe place. 0.572

47. I trust the sensations in my body. 0.603
48. I can feel what people who enter into a relationship with the patient
feel. 0.526
49. I am unable to imagine the patient and the people related to him in
his past. 0.416
50. I am able to guess what was going on in my patient’s relationships
where suffering arose. 0.440
51. I have a hard time feeling empathy towards the patient’s caregivers. 0.417
52. When I listen to the patient I happen to imagine the situations of the
past in which the unpleasant things he tells were happening. 0.391
53. I can imagine the relationship the patient had with the reference
figures. 0.463
54. When I listen to the patient I can guess what the caregivers felt about
him. 0.472
55. Generally I do not think about what relational lack has generated suf-
fering in the patient. 0.462
56. I hardly guess what happened in the patient’s relationships in which
the suffering was born. 0.621
57. It is difficult for me to empathize with the patient’s significant other. 0.499
58. Generally I don’t wonder what happened around the patient in the
significant episodes of his life. 0.492
Results
The principal components analysis was performed with the aim of analyzing the dimen-
sionality of the scale. Three dominant components were identified. The initial version of the
scale consisted of 63 items (20 of the BES, 32 of the MAIA, and 11 questions on the reso-
nance). In the first factorial analysis, five items that did not saturate in any factor or that satu-
rated in several factors at the same time were eliminated. The final version of the ARKS
consists of 58 items. Factor structure of the ARKS was conducted by matrix of rotated com-
ponents analysis with varimax rotation, shown in Table 1. Table 2 shows the item analysis of
the ARKS. Cronbach’s alpha was .730 for resonance, .921 for body awareness, and .672 for
empathy; moreover, the alpha coefficient for the total scale was .873. Table 3 shows the factor
structure of the ARKS.
Discussion
This study aimed to explore theoretical dimensions of the construct of ARK as the intui-
tive experience of the therapist that emerges from the phenomenological field created in a
meeting between therapist and client and to build and conduct the validation of a question-
naire to evaluate ARK.
Two exploratory two- and three-latent-factor analyses were conducted to identify the vari-
ables that best explain ARK. The results have shown that ARK, originally defined as a two-
factor concept (embodied empathy and resonance), is instead described by three factors: em-
pathy, resonance, and bodily awareness. In fact, the three-factor solution appears to be the
best both from the point of view of saturation values and from the comparison with the theo-
retical reference model from the literature. The final version of the ARKS consists of 58 items
representing three factors: empathy (11 items) as the therapist’s ability to identify, understand,
Table 2
Item Analysis of the Aesthetic Relational Knowledge Scale (ARKS)
Item M SD Skewness Kurtosis
1. After being with a friend who is sad about something,

I usually feel sad. 3.36 .960 .032 .649
2. I can understand the happiness of my friends when they do
something right. 4.14 1.053 1.185 .653
3. I get scared when I look at the characters in a good scary
movie. 3.60 1.347 .762 .607
4. I am easily involved in the feelings of others. 3.83 .969 .882 .822
5. I find it hard to tell when my friends are scared. 1.48 .617 1.202 1.790
6. I don't get sad when I see other people cry. 1.97 .848 .494 .482
7. Other people's feelings don't bother me at all. 2.13 1.229 .746 .606
8. When someone feels “down” I can usually understand how
they feel. 4.31 .734 .893 .589
9. I usually understand when my friends are afraid. 4.31 .734 .726 .179
10. I often get sad when I watch sad things on TV or in
movies. 3.59 1.072 .280 .753

11. I often understand how people feel even before they tell
me. 3.89 .886 .547 .151
12. Seeing an angry person has no effect on my feelings. 1.77 .860 .993 .353
13. I can usually tell when people are happy. 4.50 .582 .669 .512
14. I tend to feel scared when I'm with friends who are afraid. 2.70 .982 .077 .318
15. I can usually tell quickly when a friend is angry. 4.44 .614 .604 .545
16. I am often caught up in the feelings of my friends. 3.27 .845 .005 .755
17. My friend's unhappiness makes me feel nothing. 1.36 .565 1.298 .749
18. I'm usually not aware of my friends' feelings. 1.37 .548 1.126 .293
19. I have a hard time knowing when my friends are happy. 1.27 .512 1.788 2.421
20. When I am tense, I notice where the tension is located in
my body. 2.94 .787 .697 1.224
21. I notice when I'm uncomfortable in my body. 3.33 .739 1.433 3.832
22. I notice the places on my body where I feel comfortable. 2.79 .949 .715 .376
23. I notice changes in my breathing, for example if it slows
down or speeds up. 3.15 .775 .690 .199
24. I don't notice the physical tension or discomfort until it
becomes more serious. 1.52 1.075 .315 .655
25. I distract myself from the feelings of discomfort. 1.55 .923 .159 .777
26. I can pay attention to my breathing without getting dis-
tracted by the things going on around me. 2.47 .912 .381 .036
27. I can maintain awareness of my inner physical sensations
even though many things are happening around me. 2.54 .863 .493 .472
28. When I'm having a conversation with someone, I can pay
attention to my posture. 2.45 .923 .511 .180
29. I can regain awareness of my body if I am distracted. 2.61 1.060 .424 .413
30. I can redirect attention from the act of thinking to the act of
perceiving my body. 2.89 .898 .881 1.109
31. I can maintain awareness of my whole body even when
part of me is sore or uncomfortable. 2.49 1.024 .247 .367
32. I am able to intentionally focus on my body as a whole. 2.86 .911 .853 .922
33. I notice how my body changes when I'm angry. 3.02 .855 .991 1.296
34. When something goes wrong in my life, I can feel it in my
body. 3.19 .820 1.087 1.716
35. I notice that my body feels different after a peaceful
experience. 3.30 .840 1.392 2.328
36. I notice that my breathing becomes free and easy when I
feel comfortable. 3.33 .860 1.527 2.555
37. I notice how my body changes when I feel happy/joyful. 3.23 .873 1.172 1.384
38. When I feel overwhelmed, I can find a quiet place within
me. 2.28 .885 .197 .634
39. When I turn awareness to my body, I feel a sense of calm. 2.57 .956 .481 .112
40. I can use my breath to reduce tension. 2.86 .824 .795 1.055
41. When thoughts assail me, I can calm my mind by focusing
on my body/breath. 2.76 .729 .437 .233
(table continues)
Table 2 (Continued)
Item M SD Skewness Kurtosis
42. I listen to information from my body regarding my emo-

tional states. 3.10 .777 1.012 2.140
43. When I'm agitated, I take the time to investigate how my
body is doing. 2.64 .801 .273 .381
44. I listen to my body to know what to do. 2.69 .916 .371 .209
45. In my body I feel at home. 2.96 .926 .329 .997
46. I feel like my body is a safe place. 2.98 .927 .453 .788
47. I trust the sensations in my body. 3.46 .667 .842 .395
48. I can feel what people who enter into a relationship with
the patient feel. 3.60 .872 .500 .509
49. I am unable to imagine the patient and the people related to
him in his past. 1.83 .851 .765 .132
50. I am able to guess what was going on in my patient's rela-
tionships where suffering arose. 3.87 .845 .734 .782
51. I have a hard time feeling empathy towards the patient's
caregivers. 2.06 .959 .617 .186

52. When I listen to the patient I happen to imagine the situa-

tions of the past in which the unpleasant things he tells were
happening. 4.27 .792 1.179 2.159
53. I can imagine the relationship the patient had with the refer-
ence figures. 4.16 .708 .981 3.022
54. When I listen to the patient I can guess what the caregivers
felt about him. 3.59 .782 .082 .346
55. Generally I do not think about what relational lack has gen-
erated suffering in the patient. 1.53 .813 1.431 1.204
56. I hardly guess what happened in the patient's relationships
in which the suffering was born. 1.78 .764 .700 .008
57. It is difficult for me to empathize with the patient's signifi-
cant other. 1.91 .799 .414 .620
58. Generally I don't wonder what happened around the patient
in the significant episodes of his life. 1.40 .723 1.824 2.781
and mentalize the patient’s emotions; resonance (19 items) as the therapist’s ability to experi-
ence “the other side of the moon” of the patient’s feeling; and bodily awareness (28 items) as
the therapist’s interoceptive ability to recognize the emotional-bodily activation in their own
body. The ARKS showed good reliability (a = .873).
More thoroughly, the results showed that some items about empathy (6, 9, 10, 12, 14, 16,
19, 20) that belong to the BES scale (Carré et al., 2013) saturated well with the resonance fac-
tor and not with that of empathy. In particular, these items belong to the factor called cogni-
tive empathy. According to the study of Carré et al. (2013), cognitive empathy concerns the
ability to understand and mentalize the emotions of other people; in our case, it can be config-
ured as an aesthetic sensitivity to the field.
This view supports the idea that cognitive empathy has to do with what in the con-
cept of ARK is called resonance, that is, the therapist’s ability to experience “the other
side of the moon” of the patient’s feeling, which originates from an aesthetic sensitivity
to the field (the therapist “vibrates” in front of some aspects of the patient’s presence)
and is defined as a contextualization (i.e., a particular form of mentalization) of the feel-
ing of reciprocity felt by the therapist in the field. In this sense, our study has expanded
the previous studies on empathy, approaching the concept of resonance in more detail.
In particular, it led to an unexpected result: the description of resonance in terms of cog-
nitive empathy, closely correlated with emotional (or embodied) empathy. This result
confirms the statement, “The quality of resonance depends on the degree of embodied
empathy” (Spagnuolo Lobb et al., 2020, p. 26).
Table 3
Factor Structure of Aesthetic Relational Knowledge Scale (ARKS)
Correlation
Factors M SD 1 2 3 4
1. Resonance 4.22 0.334 1
2. Empathy 3.52 0.481 0.06 1
3. Bodily awareness 2.78 0.497 .299** 0.011 1
4. ARKS 3.39 0.307 .610** .313** .884** 1
** p , .001.
Conclusion
In conclusion, this research allowed us to validate the ARK as a construct that expresses
the therapist’s ability to identify with the patient’s body feeling and to resonate with field ele-
ments that allow a broader sensitivity not only on the patient’s experience but also, above all,
on the field from which that experience emerged (Macaluso, 2020a, 2020b; Parlett, 1991,
2000, 2003, 2005, 2018; Spagnuolo Lobb, 2020a, 2020b). Moreover, this study allowed us to
validate the ARKS as a scale useful to evaluate the ARK. In fact, this scale appears to be a
reliable measurement tool to monitor the therapist’s ability within the setting with the patient.
The ARKS can measure the degree by which the therapist can immerse themself in the
phenomenological field that is cocreated with the patient (Husserl, 1965). This measure pro-
vides useful information for them to intervene therapeutically by providing the relational sup-
port that is needed by the patient in their relational field. Moreover, this measure can provide
basic information on the process of learning of students during psychotherapy trainings and
interesting data for different populations of patients or therapists.
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Author Note
Margherita Spagnuolo Lobb, PsyD, Gestalt psychotherapist, director since 1979 of the
Istituto di Gestalt HCC Italy (Siracusa, Palermo, Milano), post-graduate School of
Psychotherapy accredited by the Italian Minister for Universities; she leads International
Training Programs on Gestalt Development and Psychopathology and for Supervisors. Full
Member: NYIGT, SPR, GTA. Past-President: EAGT, FISIG, SIPG, FIAP. She has authored
more than 250 scientific publications, has edited 9 books and has written The now for next in
psychotherapy. Gestalt therapy recounted in post-modern society (2013), translated into 8 lan-
guages. She is editor of the Journal Quaderni di Gestalt (since 1985), and of the Gestalt
Therapy Book Series (Routledge). She has received the Lifelong Achievement Award from
the Association for the Advancement of Gestalt Therapy (AAGT) (Toronto, Canada, 2018)
and from the Regional Council of Psychologists of Sicily.
Federica Sciacca obtained her master’s degree from University of Catania in Psychology;
Currently, Phd student at the Department of Educational Sciences, University of Catania,
Italy. Her specializations include drug and new addiction theory and practice, health psychol-
ogy and psychotherapy, and social psychology theory. Her current research interests are in
gullibility theory, conspiracy’s theory, personality and religious orientations.
Serena Iacono Isidoro, PsyD, Gestalt psychotherapist. She works in private practice with
adults, couples, and adolescents, in-person and online. From 2012 to 2017 she worked at the
Institute of Biomedicine and Molecular Immunology (IBIM) of the National Research
Council (CNR). In 2014 she was Tutor at the post graduate Master "Phenomenology of
Violence in Intimate Relationships", organized by the Catholic University of Sacred Heart of

Milan in collaboration with Istituto di Gestalt HCC Italy. Since 2018 she teaches
Psychotherapy Research at the Istituto di Gestalt HCC Italy and she is Editorial Assistant of
the Journal Quaderni di Gestalt. Since 2020 she coordinates the online service at the Clinical
and Research Center HCC Italy.
Zira Hichy obtained the PhD from the University of Padua (Italy) in social and personality
psychology. She is currently an associate professor of Social Psychology at Department of
Educational Sciences, University of Catania, Italy. Her specializations include intergroup rela-
tions, prejudice and acculturation processes. Her current research interests concern psychol-
ogy of religion and psychology of politics.
Received October 5, 2021
Accepted December 5, 2021 n

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The Humanistic Psychologist

A Measure for Psychotherapist’s Intuition: Construction, Development, and

A Measure for Psychotherapist’s Intuition: Construction,

Margherita Spagnuolo Lobb1, Federica Sciacca2,

Margherita Spagnuolo Lobb https://orcid.org/0000-0003-3867-0563

Keywords: phenomenological field, therapeutic intuition, humanistic psychotherapy, process

What Is Aesthetic Relational Knowledge?

Therefore, the therapist’s act of sensing/perceiving is not only empathy, an identiﬁcation

Factors Related to Aesthetic Relational Knowledge

several authors have become interested in the concept of resonance. Prendergast

(2007) spoke of empathic resonance or attunement with another as “mutual attune-

He describes the neurobiology of a resonance circuit that awareness can exploit by

emotional disconnection, and cognitive empathy), bodily awareness (interoceptive ability to

Design and Procedures

Construction Process of the ARKS

1. Analysis of the scientiﬁc literature on the area of investigation

12. Seeing an angry person has no effect on my feelings. 0.602

46. I feel like my body is a safe place. 0.572

1. After being with a friend who is sad about something,

movies. 3.59 1.072 .280 .753

42. I listen to information from my body regarding my emo-

caregivers. 2.06 .959 .617 .186

52. When I listen to the patient I happen to imagine the situa-

Gabbard, G. O. (2014). Psychodynamic psychiatry in clinical practice. American Psychiatric Asso-

40(4), 525–543. https://doi.org/10.1111/j.1467-6494.1972.tb00078.x

Merleau-Ponty, M. (1962). Phenomenology of perception. Routledge and Kegan Paul.

Violence in Intimate Relationships", organized by the Catholic University of Sacred Heart of

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