Integral Psychotherapy

A Unifying Approach

Andre Marquis

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781317308492
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

Integral Psychotherapy lays out a conceptual framework for understanding and applying the wide range of psychotherapeutic approaches. The unifying model presented here addresses the dynamics of healthy human development, the assessment process, techniques and processes of therapeutic change, and much, much more. Beginning as well as experienced mental health practitioners will find the integral approach to be an exquisitely parsimonious model, one that allows practitioners and researchers to retain their own style and preferences, while simultaneously organizing ideas within a more comprehensive framework for understanding human beings and the psychotherapeutic process.

PART I

Unifying Psychotherapy

Context and Theory

CHAPTER 1
Setting the Context

From Single Schools, Eclecticism, and Integration to Unification¹

Introduction

In order to contextualize the emergence of integral psychotherapy (iPT),² I will provide a brief primer on the evolution of psychotherapy—from the many decades of single-system (“pure-form”) approaches, to the emergence of eclecticism and integration, and, finally, unified approaches to psychotherapy. Until the latter part of the twentieth century, most psychotherapists were “purists” who practiced a single-therapy system, such as psychoanalysis, behaviorism, or person-centered therapy. In fact, rivalry and sectarianism characterized the different single-school psychotherapies for most of their history (Norcross, 2005a).³ Given that differing schools of psychotherapy commonly incorporated knowledge and methods from diverse disciplines such as medicine, the natural and social sciences, and even philosophy and literature, it is particularly ironic that most therapists were ignorant of, or even hostile to, alternative psychotherapeutic systems. Gradually, a growing dissatisfaction with single-school approaches led many to begin seeing how they could enhance their effectiveness and efficiency by learning from other approaches (Norcross, 2005a), and indeed there are many different approaches to learn from.

Jumping to the present, there are now more than 1000 differently named psychotherapies (Garfield, 2006), but the majority of these are more variations on a handful of themes than genuinely novel approaches (Magnavita & Anchin, 2014). Of significance, very little research demonstrates the consistent superiority of one single-school approach or intervention over the others; examples to the contrary— such as the superiority of exposure approaches for specific phobias—are far more the exception than the norm.⁴ Given this situation, and because they perceive the limits and drawbacks of practicing solely within the parochial confines of any of those single school approaches to outweigh the benefits that such “pure form” therapies have to offer, the majority of English-speaking therapists have reported practicing eclectically or integratively for the last three decades. A review of a dozen recent studies in the United States revealed that eclecticism/integration is the most common therapeutic orientation (Norcross, 2005b), with some studies reporting 90% of therapists espousing an eclectic or integrative position (Norcross, Karpiak, & Sanotoro, 2005; Marquis, Tursi, & Hudson, 2010). Many current students of counseling and psychotherapy find it hard to believe how intolerant the preceding generations of therapists were of theories and interventions of approaches other than their own.

Context: From Single Schools, Eclecticism, and Integration to Unification

In 1950, John Dollard and Neal Miller significantly moved psychotherapy beyond single-system thinking by recasting psychoanalytic therapies in the concepts and language of behaviorism, which resulted in modifying traditional psychoanalytic technique. Frederick Thorne’s work in the late 1950s is often considered the inauguration of eclecticism in counseling and psychotherapy, and a decade later Arnold Lazarus articulated a comparatively comprehensive technical eclecticism. In the early 1970s, Jerome Frank initiated what would become the common factors approach with his classic Persuasion and Healing; in it, he argued that change in psychotherapy involves a healing setting in which a special form of a trusting, safe, emotionally charged relationship is cultivated in which therapeutic rituals, which are based upon a sound theoretical rationale, occur. A few years later, Paul Wachtel authored the classic theoretical integration of psychoanalysis and behaviorism. In 1980, Sol Garfield and Marvin Goldfried published key integrative works (Norcross & Beutler, 2007). A thorough account of the developmental history of eclectic and integrative thinking can be found in Goldfried (2005).

Since the founding of the Society for the Exploration of Psychotherapy Integration in 1983, five different integrative approaches—each with numerous different subtypes—have been developed and are now well-established: eclecticism, common factors, theoretical integration, assimilative integration, and metatheoretical integration (the latter is involved with unified psychotherapies); these will be described in more detail subsequently. Integrative therapies consist of a broad range of approaches that are not confined by single-therapy systems. Although the variety of integrative psychotherapies is quite diverse, all of them share a similar goal—that of transcending a “one size fits all” mentality and incorporating manifold ways of conceptualizing and intervening so that the applicability, effectiveness, and efficiency of psychotherapy is enhanced (Norcross, 2005a). Reflecting the steady growth of scholarly conceptual, clinical, and empirical work on integrative treatment approaches, the International Journal of Eclectic Psychotherapy was published from 1982 to 1986 and then changed its name to the Journal of Integrative and Eclectic Psychotherapy (published from 1987 to the present); the Journal of Psychotherapy Integration has been published from 1991 to the present; and the Journal of Unified Psychotherapy and Clinical Science has been published from 2012 to the present.

Eclecticism

Eclecticism, a common form of integration, includes technical eclecticism and systematic eclecticism. The eclectic practitioner attempts to provide a specifically tailored treatment for each individual and her specific issues. The determination of the treatment approach is guided not by theory, but by research and/or what has been beneficial in previous work with similar patients with similar problems; for this reason, its foundation has been described as “actuarial,” rather than theoretical (Norcross, 2005a). Technical and systematic eclecticism evolved as a response to concerns pertaining to the haphazard nature of unsystematic eclecticism (or syncretism); the former involves utilizing techniques derived from a theory other than one’s own guiding theory, which affords the therapist an expanded and flexible technical repertoire that is drawn from the empirical literature. A limitation of eclectic approaches is their failure to provide a coherent (theoretical) rationale for why one uses specific treatments in one case but not in another, which is why they are considered more “actuarial” than “theoretical.” Exemplars of eclecticism include the respective psychotherapeutic systems developed by Lazarus (2003), Norcross (1986), and Beutler and Clarkin (1990).

Common Factors

Followers of the common factors approach, the “commonians,” argue that a significant percentage of the effectiveness of the different counseling approaches is due to what those diverse approaches have in common with one another, in contrast to their unique, specific differences. This position is corroborated by numerous meta-analyses of psychotherapy outcome studies that demonstrate that as little as 10–15% of patients’ improvement is due to the specific interventions or single-school approaches to which many therapists hold allegiance (Asay & Lambert, 2003; Norcross, 2011). Some of the common factors that appear to be therapeutic to patients are: empathy; warmth; congruence; receiving feedback from the therapist; being helped to understand their problems; being encouraged to practice facing those things that disturb them; having the opportunity to speak to an understanding person; being helped to understand themselves; the personhood of the therapist; and the Hawthorne effect (people often improve due to having special attention devoted to them). Overall, the commonians believe that the most helpful forms of therapy will emphasize those elements that are common to all, or most, forms of psychotherapy—while also acknowledging and implementing theory-specific, unique interventions as needed. Limitations of the common factors approach include its failure to adequately answer the following questions: How does one systematically organize patients’ reports and conceptualize patients’ dynamics? How does one identify the specific goals of therapy? And what aspects of patients (thinking, feeling, behaving, relationships, culture, systems, etc.) should therapists emphasize? Moreover, like eclectic approaches, common factorists lack a systematic rationale for their counseling different individuals differently. Exemplars of common factors approaches to psychotherapy integration include the various therapeutic systems developed by Frank (1982), Garfield (2003), Beitman (2003), Wampold (2001), and Hubble et al. (1999).

Theoretical Integration

Theoretical integration has been characterized as both the most important and sophisticated integrative approach as well as overly ambitious; the latter is asserted because most theoretical approaches contain philosophical assumptions that are incompatible with other approaches. The theoretical integrationist attempts to synergistically integrate the theories of two or more single-system psychotherapeutic approaches, along with their associated interventions. Although it is usually impossible to integrate the totality of different systems, essential components of different theories can be synthesized into a new, internally consistent, coherent structure that differs from either of its constituent parts. The primary limitation of theoretical integration is that it tends to integrate only two or three of the multitude of approaches, many of which appear impossible to theoretically integrate due to incompatible philosophical assumptions. Exemplars of theoretical integration include the respective therapeutic approaches of Wachtel (1977) and Ryle (1990).

Assimilative Integration

Assimilative integration involves therapists who—while being firmly grounded in a single, preferred psychotherapy approach—include and incorporate (assimilate) interventions or perspectives from other approaches (provided that they do not contradict the premises and intentions of one’s “home theory”) into their preferred mode of theory and practice. If you recall Piaget’s descriptions of assimilation and accommodation, you will recognize that this approach does not require therapists to fundamentally alter the theoretical conceptualizations of their “home theory”; this represents the primary limitation to this approach: “few have discussed the modifications in one’s home theory that are made necessary by the successful application of techniques generated by another therapy orientation … The examples of assimilative integration thus far published have tended to reinforce one’s commitment to one’s flawed home theory” (Wolfe, 2001, pp. 126–127). Exemplars of assimilative integration include the respective psychotherapeutic systems developed by Messer (2003), Safran (1998), and Stricker and Gold (1996).

Metatheoretical Integration

Metatheoretical integration is the most appropriate category for approaches such as transtheoretical therapy, integral psychotherapy, developmental constructivism, and the approaches of Henriques (2011) and Magnavita and Anchin (2014); although integral psychotherapy and developmental constructivism were once categorized as integrative, they are more properly conceived of as unified approaches (it is worth noting that metatheoretical integration and unification are not completely synonymous; technically, the former is a method for achieving unification). In simplest terms, a metatheory is a theory about theory (Magnavita & Anchin, 2014). “Meta” refers to that which is beyond, transcending, or more comprehensive. Thus, metatheories are theoretical frameworks of a more comprehensive order—at a higher level of abstraction—than traditional single theories. A key advantage of this higher level of abstraction is that, unlike single-system theories that necessarily disagree with or contradict other single-system theories on key points, metatheories operate from a conceptual space beyond the single-system theories such that relativism is transcended by conceptual frameworks that can unify the spectrum of psychotherapies. These approaches also allow utilizing, and capitalizing on, the strengths of both single-school approaches and integrative approaches. Unified psychotherapies—of which there are many—have in common the utilization of a metatheoretical framework that takes into account all (or as many as possible) levels of the human and its various ecological systems, as well as their complex interactions. A primary limitation of metatheoretical unification is that—precisely because it operates from a higher level of abstraction and attempts to be comprehensive—it is sometimes perceived as overwhelming, and thus those new to it are often unclear regarding its immediate clinical application; striving to be comprehensively unified also exerts quite a burden on the therapist to be knowledgeable and competent in domains as varied as neuroscience and cultural meaning-making systems. Exemplars of unified psychotherapies include the respective psychotherapeutic systems developed by Magnavita and Anchin (2014), Henriques (2011), Mahoney (2003), Brooks-Harris (2007), and Marquis (2008).

Is Unification the “Next Wave”?

Many psychotherapy scholars view unifying psychotherapies as the leading edge of the field of psychotherapy, and—after the evolution from single-system approaches and the rapprochement that characterized early eclecticism to the maturation of psychotherapy integration—as the fourth developmental wave in the history of psychotherapy (Magnavita & Anchin, 2014; Henriques, 2011; Wolfe, 2008; Millon & Grossman, 2008). This emerging trend is also apparent in the increasing number of books that demonstrate unified conceptions of personality, assessment, research, psychopathology, and psychotherapy; these books provide a metaframework with which to assess and organize the multidimensional and interconnected domains of humans and their systems and from which to provide psychotherapy (Allen, 2006; Mahoney, 2003; Magnavita & Anchin, 2014; Henriques, 2011; Marquis, 2008; Ingersoll & Marquis, 2014; Brooks-Harris, 2007; Singer, 2005). Two of these books in particular—Henriques’ A New Unified Theory of Psychology (2011) and Magnavita and Anchin’s Unifying Psychotherapy: Principles, Methods, and Evidence from Clinical Science (2014)—clearly reveal how unifying approaches represent the leading edge of psychology an...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Foreword
• Preface
• Acknowledgments
• Part I. Unifying Psychotherapy: Context and Theory
• Part II. Treatment
• Part III. The Role of Research and Conclusion
• Appendix: Integral Culture, Spirituality, and a Category Error
• References
• Index