Integrative psychotherapy

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Integrative psychotherapy is the integration of elements from different schools of psychotherapy in the treatment of a client. Integrative psychotherapy may also refer to the psychotherapeutic process of integrating the personality: uniting the "affective, cognitive, behavioral, and physiological systems within a person". [1]

Contents

Background

Initially, Sigmund Freud developed a talking cure called psychoanalysis; then he wrote about his therapy and popularized psychoanalysis. After Freud, many different disciplines splintered off. Some of the more common therapies include: psychodynamic psychotherapy, transactional analysis, cognitive behavioral therapy, gestalt therapy, body psychotherapy, family systems therapy, person-centered psychotherapy, and existential therapy. Hundreds of different theories of psychotherapy are practiced (Norcross, 2005, p. 5).

A new therapy is born in several stages. After being trained in an existing school of psychotherapy, the therapist begins to practice. Then, after follow up training in other schools, the therapist may combine the different theories as a basis of a new practice. Then, some practitioners write about their new approach and label this approach with a new name.

A pragmatic or a theoretical approach can be taken when fusing schools of psychotherapy. Pragmatic practitioners blend a few strands of theory from a few schools as well as various techniques; such practitioners are sometimes called eclectic psychotherapists and are primarily concerned with what works. Alternatively, other therapists consider themselves to be more theoretically grounded as they blend their theories; they are called integrative psychotherapists and are not only concerned with what works, but why it works (Norcross, 2005, p. 8).

For example, an eclectic therapist might experience a change in their client after administering a particular technique and be satisfied with a positive result. In contrast, an integrative therapist is curious about the "why and how" of the change as well. A theoretical emphasis is important: for example, the client may only have been trying to please the therapist and was adapting to the therapist rather than becoming more fully empowered in themselves.

Different routes to integration

The most recent edition of the Handbook of Psychotherapy Integration (Norcross & Goldfried, 2005) recognized four general routes to integration: common factors, technical eclecticism, theoretical integration, and assimilative integration (Norcross, 2005).

Common factors

The first route to integration is called common factors and "seeks to determine the core ingredients that different therapies share in common" (Norcross, 2005, p. 9). The advantage of a common factors approach is the emphasis on therapeutic actions that have been demonstrated to be effective. The disadvantage is that common factors may overlook specific techniques that have been developed within particular theories. Common factors have been described by Jerome Frank (Frank & Frank, 1991), Bruce Wampold (Wampold & Imel, 2015), and Miller, Duncan and Hubble (2005). Common factors theory asserts it is precisely the factors common to the most psychotherapies that make any psychotherapy successful.

Some psychologists have converged on the conclusion that a wide variety of different psychotherapies can be integrated via their common ability to trigger the neurobiological mechanism of memory reconsolidation in such a way as to lead to deconsolidation (Ecker, Ticic & Hulley 2012; Lane et al. 2015; Welling 2012—but for a more hesitant view of the role of memory reconsolidation in psychotherapy see the objections in some of the invited comments in: Lane et al. 2015).

Technical eclecticism

The second route to integration is technical eclecticism which is designed "to improve our ability to select the best treatment for the person and the problem…guided primarily by data on what has worked best for others in the past" (Norcross, 2005, p. 8). The advantage of technical eclecticism is that it encourages the use of diverse strategies without being hindered by theoretical differences. A disadvantage is that there may not be a clear conceptual framework describing how techniques drawn from divergent theories might fit together. The most well known model of technical eclectic psychotherapy is Arnold Lazarus' (2005) multimodal therapy. Another model of technical eclecticism is Larry E. Beutler and colleagues' systematic treatment selection (Beutler, Consoli, & Lane, 2005).

Theoretical integration

The third route to integration commonly recognized in the literature is theoretical integration in which "two or more therapies are integrated in the hope that the result will be better than the constituent therapies alone" (Norcross, 2005, p. 8). Some models of theoretical integration focus on combining and synthesizing a small number of theories at a deep level, whereas others describe the relationship between several systems of psychotherapy. One prominent example of theoretical synthesis is Paul Wachtel's model of cyclical psychodynamics that integrates psychodynamic, behavioral, and family systems theories (Wachtel, Kruk, & McKinney, 2005). Another example of synthesis is Anthony Ryle's model of cognitive analytic therapy, integrating ideas from psychoanalytic object relations theory and cognitive psychotherapy (Ryle, 2005). Another model of theoretical integration is specifically called integral psychotherapy (Forman, 2010; Ingersoll & Zeitler, 2010). The most notable model describing the relationship between several different theories is the transtheoretical model (Prochaska & DiClemente, 2005).

Assimilative integration

Assimilative integration is the fourth route and acknowledges that most psychotherapists select a theoretical orientation that serves as their foundation but, with experience, incorporate ideas and strategies from other sources into their practice. "This mode of integration favors a firm grounding in any one system of psychotherapy, but with a willingness to incorporate or assimilate, in a considered fashion, perspectives or practices from other schools" (Messer, 1992, p. 151). Some counselors may prefer the security of one foundational theory as they begin the process of integrative exploration. Formal models of assimilative integration have been described based on a psychodynamic foundation (Frank, 1999; Stricker & Gold, 2005) and based on cognitive behavioral therapy (Castonguay, Newman, Borkovec, Holtforth, & Maramba, 2005).

Govrin (2015) pointed out a form of integration, which he called "integration by conversion", whereby theorists import into their own system of psychotherapy a foreign and quite alien concept, but they give the concept a new meaning that allows them to claim that the newly imported concept was really an integral part of their original system of psychotherapy, even if the imported concept significantly changes the original system. Govrin gave as two examples Heinz Kohut's novel emphasis on empathy in psychoanalysis in the 1970s and the novel emphasis on mindfulness and acceptance in "third-wave" cognitive behavioral therapy in the 1990s to 2000s.

Other models that combine routes

In addition to well-established approaches that fit into the five routes mentioned above, there are newer models that combine aspects of the traditional routes.

Clara E. Hill's (2014) three-stage model of helping skills encourages counselors to emphasize skills from different theories during different stages of helping. Hill's model might be considered a combination of theoretical integration and technical eclecticism. The first stage is the exploration stage. This is based on client-centered therapy. The second stage is entitled insight. Interventions used in this stage are based on psychoanalytic therapy. The last stage, the action stage, is based on behavioral therapy.

Good and Beitman (2006) described an integrative approach highlighting both core components of effective therapy and specific techniques designed to target clients' particular areas of concern. This approach can be described as an integration of common factors and technical eclecticism.

Multitheoretical psychotherapy (Brooks-Harris, 2008) is an integrative model that combines elements of technical eclecticism and theoretical integration. Therapists are encouraged to make intentional choices about combining theories and intervention strategies.

An approach called integral psychotherapy (Forman, 2010; Ingersoll & Zeitler, 2010) is grounded in the work of theoretical psychologist and philosopher Ken Wilber (2000), who integrates insights from contemplative and meditative traditions. Integral theory is a meta-theory that recognizes that reality can be organized from four major perspectives: subjective, intersubjective, objective, and interobjective. Various psychotherapies typically ground themselves in one these four foundational perspectives, often minimizing the others. Integral psychotherapy includes all four. For example, psychotherapeutic integration using this model would include subjective approaches (cognitive, existential), intersubjective approaches (interpersonal, object relations, multicultural), objective approaches (behavioral, pharmacological), and interobjective approaches (systems science). By understanding that each of these four basic perspectives all simultaneously co-occur, each can be seen as essential to a comprehensive view of the life of the client. Integral theory also includes a stage model that suggests that various psychotherapies seek to address issues arising from different stages of psychological development (Wilber, 2000).

The generic term, integrative psychotherapy, can be used to describe any multi-modal approach which combines therapies. For example, an effective form of treatment for some clients is psychodynamic psychotherapy combined with hypnotherapy. Kraft & Kraft (2007) gave a detailed account of this treatment with a 54-year-old female client with refractory IBS in a setting of a phobic anxiety state. The client made a full recovery and this was maintained at the follow-up a year later.

Comparison with eclecticism

In Integrative and Eclectic Counselling and Psychotherapy (Woolfe & Palmer, 2000, pp. 55, 256), the authors make clear the distinction between integrative and eclectic psychotherapy approaches: "Integration suggests that the elements are part of one combined approach to theory and practice, as opposed to eclecticism which draws ad hoc from several approaches in the approach to a particular case." Psychotherapy's eclectic practitioners are not bound by the theories, dogma, conventions or methodology of any one particular school. Instead, they may use what they believe or feel or experience tells them will work best, either in general or suiting the often immediate needs of individual clients; and working within their own preferences and capabilities as practitioners (Norcross & Goldfried, 2005, pp. 3–23).

See also

Notes

  1. "The Association: Definition of 'Integrative'". International Integrative Psychotherapy Association. Archived from the original on 2016-10-11. Retrieved 2009-06-05.

Related Research Articles

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction with adults, to help a person change behavior and overcome problems in desired ways. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. There is also a range of psychotherapies designed for children and adolescents, which typically involve play, such as sandplay. Certain psychotherapies are considered evidence-based for treating some diagnosed mental disorders. Others have been criticized as pseudoscience.

Clinical psychology is an integration of science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment, clinical formulation, and psychotherapy, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration. In many countries, clinical psychology is a regulated mental health profession.

Counseling psychology is a psychological specialty that encompasses research and applied work in several broad domains: counseling process and outcome; supervision and training; career development and counseling; and prevention and health. Some unifying themes among counseling psychologists include a focus on assets and strengths, person–environment interactions, educational and career development, brief interactions, and a focus on intact personalities.

Person-centered therapy, also known as person-centered psychotherapy, person-centered counseling, client-centered therapy and Rogerian psychotherapy, is a form of psychotherapy developed by psychologist Carl Rogers beginning in the 1940s and extending into the 1980s. Person-centered therapy seeks to facilitate a client's self-actualizing tendency, "an inbuilt proclivity toward growth and fulfillment", via acceptance, therapist congruence (genuineness), and empathic understanding.

Psychodynamic psychotherapy or psychoanalytic psychotherapy is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension.

Les Greenberg is a Canadian psychologist born in Johannesburg, South Africa, and is one of the originators and primary developers of Emotion-Focused Therapy for individuals and couples. He is a professor emeritus of psychology at York University in Toronto, and also director of the Emotion-Focused Therapy Clinic in Toronto. His research has addressed questions regarding empathy, psychotherapy process, the therapeutic alliance, and emotion in human functioning.

Multitheoretical psychotherapy (MTP) is a new approach to integrative psychotherapy developed by Jeff E. Brooks-Harris and his colleagues at the University of Hawaii at Manoa. MTP is organized around five principles for integration:

  1. Intentional
  2. Multidimensional
  3. Multitheoretical
  4. Strategy-based
  5. Relational

Emotionally focused therapy and emotion-focused therapy (EFT) are a family of related approaches to psychotherapy with individuals, couples, or families. EFT approaches include elements of experiential therapy, systemic therapy, and attachment theory. EFT is usually a short-term treatment. EFT approaches are based on the premise that human emotions are connected to human needs, and therefore emotions have an innately adaptive potential that, if activated and worked through, can help people change problematic emotional states and interpersonal relationships. Emotion-focused therapy for individuals was originally known as process-experiential therapy, and it is still sometimes called by that name.

Functional analytic psychotherapy (FAP) is a psychotherapeutic approach based on clinical behavior analysis (CBA) that focuses on the therapeutic relationship as a means to maximize client change. Specifically, FAP suggests that in-session contingent responding to client target behaviors leads to significant therapeutic improvements.

A clinical formulation, also known as case formulation and problem formulation, is a theoretically-based explanation or conceptualisation of the information obtained from a clinical assessment. It offers a hypothesis about the cause and nature of the presenting problems and is considered an adjunct or alternative approach to the more categorical approach of psychiatric diagnosis. In clinical practice, formulations are used to communicate a hypothesis and provide framework for developing the most suitable treatment approach. It is most commonly used by clinical psychologists and psychiatrists and is deemed to be a core component of these professions. Mental health nurses and social workers may also use formulations.

Common factors theory, a theory guiding some research in clinical psychology and counseling psychology, proposes that different approaches and evidence-based practices in psychotherapy and counseling share common factors that account for much of the effectiveness of a psychological treatment. This is in contrast to the view that the effectiveness of psychotherapy and counseling is best explained by specific or unique factors that are suited to treatment of particular problems. According to one review, "it is widely recognized that the debate between common and unique factors in psychotherapy represents a false dichotomy, and these factors must be integrated to maximize effectiveness". In other words, "therapists must engage in specific forms of therapy for common factors to have a medium through which to operate". Common factors is one route by which psychotherapy researchers have attempted to integrate psychotherapies.

Family therapy, also referred to as couple and family therapy, marriage and family therapy, family systems therapy, and family counseling, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members.

Paradox psychology is an approach that aims to advance the general field of psychology and treatment. These advances include: An approach that specifically addresses a 'hard-to-treat' or resistant client; A scientific understanding that supports a process for 'spontaneous change'; Unifying behavioral, cognitive, and psychodynamic orientations under a single umbrella theory; A science-based model showing how treating secondary non-criminogenic behaviors will impact primary targeted (volatile) criminogenic behaviors

John C. Norcross is an American professor, board-certified clinical psychologist, and author in psychotherapy, behavior change, and self-help.

Reality testing is the psychotherapeutic function by which the objective or real world and one's relationship to it are reflected on and evaluated by the observer. This process of distinguishing the internal world of thoughts and feelings from the external world is a technique commonly used in psychoanalysis and behavior therapy, and was originally devised by Sigmund Freud.

Developmental Eclecticism or Systematic Eclecticism was founded by Gerard Egan in the 1970s. This approach, which is also referred to as the "Skilled Helper" model, is founded on the eclectic framework oriented toward problem management approach in the area of counselling and psychotherapy.

Vittorio Filippo Guidano was an Italian neuropsychiatrist, creator of the cognitive procedural systemic model and contributor to post-rationalist constructivist cognitive psychotherapy. His cognitive post-rationalist model was influenced by attachment theory, evolutionary epistemology, complex systems theory, and the prevalence of abstract mental processes proposed by Friedrich Hayek. Guidano conceived the personal system as a self-organized entity, in constant development.

Eclectic psychotherapy is a form of psychotherapy in which the clinician uses more than one theoretical approach, or multiple sets of techniques, to help with clients' needs. The use of different therapeutic approaches will be based on the effectiveness in resolving the patient's problems, rather than the theory behind each therapy.

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