Integrative Therapy

100 Key Points and Techniques

Maria Gilbert, Vanja Orlans

• Publisher: Routledge
• Year: 2010
• ISBN:
  9781136876820
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Integrative Therapy is a unifying approach that brings together physiological, affective, cognitive, contextual and behavioural systems, creating a multi-dimensional relational framework that can be created anew for each individual case.

Integrative Therapy: 100 Key Points and Techniques provides a concise and accessible guide that allows professionals and students to look beyond specific approaches in order to draw upon ideas and techniques that will best help the client.

Divided into helpful sections, areas of discussion include:

• 
  
  

• the case for an integrative approach to therapy
• the centrality of relationship and dimensions of self development
• the process of integrative therapy
• techniques and strategies

This book will be essential reading for all psychotherapists and counsellors, both in practice and training, who want to expand their perspectives and learn more about an integrative approach.

Part 1
THE CASE FOR AN INTEGRATIVE APPROACH TO PSYCHOTHERAPY

1
The current professional context

We are writing this book at an interesting time in the context of the therapeutic professions as a whole. Statutory regulation is currently underway, having started in 2009 for psychologists and with pending regulation for psychotherapists at present under heated debate. The UK Department of Health has favoured the extension of its Health Professions Council (HPC) as the statutory body to regulate the helping professions and is also supporting the development of National Occupational Standards (NOS) and the identification of competencies for different therapeutic modalities. At present these modalities include cognitive behavioural therapy (CBT), family and systemic therapy, psychodynamic and psychoanalytic therapy, and humanistic therapy. The NOS identified for each of these named modalities have so far been field tested to ascertain applicability. A further category termed ‘cross-modality NOS’ has been proposed to bring together some of the key competencies as highlighted in the context of research on specific modalities (Skills for Health, 2008). While we value the idea of transparency and precision in our work, our view is that doing psychotherapy successfully goes beyond any simplistic use of a set of competencies. In this book our interest is in the articulation of a ‘cross-modality’ focus based in a reflexive approach to therapeutic work, and promoting a form of psychotherapy that will always be contextually informed by the person of the therapist, the person of the client, and the broader social frame in which problems are presented. We also highlight the process-based nature of this activity and aim to articulate how it plays out in practice.

Recent developments on the political front include the publication of The Depression Report (Layard et al., 2007), which highlights the economic implications of depression and the claim that the situation can be alleviated by the implementation of brief, CBT-based therapeutic interventions, thus favouring one particular modality over the others. While brief therapeutic responses of this kind form a part of our integrative frame of reference we do not support the rather reductionist position of promoting only one form of therapeutic response for any presenting issue, and we are not alone in taking such a view. Darien Leader, for example, presents a cogently argued analysis of these developments as representative of the search for ‘a quick fix for the soul’ involving an emphasis on a market-driven view of the human psyche (Leader, 2008). Craig Newnes is also sceptical of the claims in this report, with its focus on getting people back to work. He states:

The Depression Report isn’t about people feeling better, moving on, self actualising or the rest. It’s about claiming to get people back to work and off benefits. Someone with a potentially life-changing spell of madness or mortifying sense of anomie will be funnelled into a job with the kind of pay and conditions of service the therapist left behind long ago. Therapists in Layard’s brave new world become an arm of the state-serving bourgeoisie in a far more explicit way than before. In effect, they are paid by the State to make sure people remain cogs in the machine rather than giving them a collective voice on the parlous state of modern society.

(Newnes, 2007:227)

We can discern in these debates the rather grave existential issues embedded in our society and currently being expressed through economic and legislative mechanisms. We are also aware of the effects of the economic and environmental challenges that are being faced on a global scale.

In these changing political and social times there is in many ways a pull back towards ‘schoolism’ and away from the integrative project, at least as expressed through the current development of modality-specific competencies and the identification of national occupational standards. At the same time we discern in the different literatures, as well as in practice, a move towards a more integrated stance in the different ‘schools’ of psychotherapy. This is echoed by Colin Feltham who refers to practitioners ‘who report practising integratively based on professional experience, clinical wisdom and responses to client needs in busy and diverse practice settings’ (Feltham, 2007:17). There appears to be an increasing recognition that human beings are complex with multilevel aspects to their experience and their social interactions. There is recognition also of the relational needs of the individual and the limitations of a one-person psychology in arriving at an understanding of psychological difficulties as well as a recognition of the variety of ways that we might think about and deal with presenting distress (e.g. Greenberg and Mitchell, 1983; Yelland and Midence, 2007; Willock, 2007). Key figures such as Martin Seligman have launched a considered critique on reductionism, arguing for a more broadly and phenomenologically based approach to psychotherapy (Seligman, 1995).

If we look back over the history of psychotherapy, however, we can see that an interest in integration has been alive and well for quite a considerable period of time, dating back to Freud and his contemporaries. For example, Ferenczi, in a paper written in 1933, points to the limitations of schoolism in a review of clinical approaches in psychoanalysis to early relational trauma. He highlights the need to revise technique and to take the lead from the patient. He refers to ‘patients who taught me that we are more willing to adhere rigidly to certain theoretical constructions and to leave unnoticed facts on one side that would injure our complacency and authority’ (Ferenczi, 1994: 160). Reflections such as these point to the political nature of separate modality constructions rather than considerations about what may be best for the patient. When we look into the different traditions reflected in the history of psychotherapy we can see that there is much interweaving between them; for example, both Albert Ellis and Aaron Beck, who were original founders of the cognitive behaviour therapy movement, had a background in psychoanalysis, as did Fritz Perls who developed gestalt psychotherapy within the humanistic tradition (Orlans and Van Scoyoc, 2009).

2
Philosophy, values and ethics supporting an integrative framework for practice

Integrative psychotherapy has its roots in a number of different traditions which have come together in the nineteenth and twentieth centuries, but which are based on much earlier philosophical ideas. In this movement we can see the origins of the humanistic challenge to positivistic psychology, a challenge that has been supported by philosophical developments through Kant, Hegel and nineteenth-century writers within the phenomenological and existentialist traditions. Kant (1724–1804) in particular drew attention to the relationship between the perception of an object and the object itself, claiming that the object itself, the noumenon, could not be known, and that knowledge therefore resided only in the object as it appeared to us, the phenomenon. These ideas place a particular focus on the nature of perceptual reality, and importantly for psychotherapy, on the nature and role of the perceiver. From such a starting point, any one theoretical perspective as a potential ‘truth’ within the psychological therapies becomes impossible. These early humanistic ideas paved the way for further thinking that has a direct relevance to the practice of psychotherapy and which is highlighted through developments in the phenomenological tradition. Of particular importance to later thinking and practice within the field of psychotherapy was the notion of the co-creation between observer and observed, an idea that lies at the heart of the phenomenological position, and that forms the basis of our integrative stance on the co-creation of all relationships, and the inseparable nature of figure and ground.

Integrative psychotherapy, as a specialist training pathway within the humanistic tradition, takes as its fundamental starting point the philosophical position that there can be no one truth. Taking this starting point seriously requires the development of a capacity to work at the meta level, to claim an interest in holding ambiguities and different starting points, to be willing and able to articulate the fundamental philosophical starting points of different therapeutic conceptualisations, and to commit to finding a transparent way through these which creates a coherent form in itself. In this enterprise we do not support unaware eclecticism and related fragmented technique. Nor do we favour ‘opinion’ over research-based strategies. What we highlight, however, is the continuing need for clinical judgement and therapist/client interaction in the understanding and management of presenting issues—the therapist needs to work from a coherently organized reflexive philosophical and theoretical position within a relational framework, informed by a humanistic approach. This standpoint involves a commitment to collaboration with the client on client needs, treatment possibilities and agreement about outcomes, as well as rigorous analysis of the therapist’s own conscious and unconscious position. Such a perspective on the therapeutic endeavour requires constant critical analysis, the careful comparison of emerging ideas and theories, and the translation of this process into a coherent set of clinical skills and related process. The commitment to such a meta-perspective is demanding for trainers and students alike, as well as for mature practitioners. However, such a meta-perspective ensures constant evaluation of emerging theories and practices, literally a commitment to ‘integrity’ within the developing professional setting, as well as ongoing critical evaluation of research findings that speak to the potential appropriateness and excellence of service delivery.

3
Criticisms of integration

While we aim to support the development of an integrative framework for practice, we are concerned also to consider the different criticisms that might be levelled at an integrative approach to psychotherapy. Below are some keys themes that emerge:

1 Integration could be viewed as superficial and skimming the surface without reaching any depth of conceptualization or depth of treatment as a result of its superficiality.

2 Integration tries ‘to be all things to all people’ and is not really effective with anyone because of its lack of in-depth diagnostic capacity.

3 Integration is grandiose in its claims that it can help anyone with any problem; in other words, that it has a range to reach anyone in trouble.

4 Integrative psychotherapists lack the in-depth knowledge of the psychotherapy process that comes from immersion in a ‘pure-form’ approach; they risk getting lost in too many options and lack the clarity that comes from one focus.

We believe that there is some validity in all of these criticisms which can apply in certain cases, with certain clinicians, and in trainings where there may be insufficient grounding in basic psychotherapeutic principles. It is important that a training is rigorous and covers concepts in depth as well as providing a firm grounding in the application of technique and space to consider tensions and conflicts between different approaches. Above all, it is vital that all therapists, integrative therapists equally, know the limits of their competence at each developmental stage and do not make claims that are unrealistic and grandiose. We know that in a training where integration is taught from the start, students do have to meet the challenge of there being no ‘true’ or ‘fixed’ answers to questions or to ways of intervening with clients. They are challenged to conceptualize at a meta level from the start and to evaluate differential intervention options since there is no one ‘given’ way of intervening and no manual to fall back upon. This is a challenging process and requires the development of sophisticated reflective functioning.

There are two areas of challenge outlined in the literature on integration that we wish to support (Eubanks-Carter et al., 2005). We do believe that there needs to be greater attention to common factors and the principles of the change process in practice, theory and research. We also see that there is a need to bridge the gap between practice and research to make research more useful to practising clinicians by addressing questions that have relevance to clinical practice. However, we would also wish to highlight the developing reflexive self of the trainee and the effects of the gradual development of the reflective functioning of the therapist brought about by the training setting, the effects of the involvement in therapeutic work with clients with the support of competent supervisors, and the development of sensitivity and insight brought about by significant experience of personal psychotherapy.

4
Competencies for an integrative psychotherapy

We are highlighting here the importance of the psychotherapist having a good grounding in key concepts within the psychot...

Table of contents

• 100 Key Points
• Contents
• Acknowledgements
• Part 1 THE CASE FOR AN INTEGRATIVE APPROACH TO PSYCHOTHERAPY
• Part 2 A REVIEW OF THE LITERATURE ON INTEGRATION
• Part 3 THE CENTRALITY OF RELATIONSHIP FROM THE TIME OF INFANCY
• Part 4 DIMENSIONS OF SELF DEVELOPMENT
• Part 5 PROBLEM FORMULATION FOR THE INTEGRATIVE PSYCHOTHERAPIST
• Part 6 THE PROCESS OF INTEGRATIVE PSYCHOTHERAPY
• Part 7 TECHNIQUES AND STRATEGIES FOR THE INTEGRATIVE PSYCHOTHERAPIST
• Part 8 ETHICS AND PROFESSIONAL PRACTICE
• References