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Psychotherapy Integration 101
by George Stricker, Ph.D.
Learning Objectives
- Learn the significance of
the common factors to therapy
- Learn the significance of
the most frequently practiced approach to integration
- Learn the significance of
what is involved in the Grand Unified Theory
- Learn the significance of
integrating techniques from different therapeutic approaches
Psychotherapy integration
has been defined as an approach to psychotherapy that includes a variety
of attempts to look beyond the confines of single-school approaches in
order to see what can be learned from other perspectives. It is characterized
by an openness to various ways of integrating diverse theories and techniques.
The term psychotherapy integration has been used in four different ways:
Common Factors, Technical Integration, Theoretical Integration, and Assimilative
Integration.
COMMON FACTORS
Common Factors refers to aspects
of psychotherapy that are present in most, if not all, approaches to therapy.
These characteristics of treatment occur across all theoretical lines
and are present in all psychotherapeutic activities, resulting in the
name Common Factors. There is no fixed list of common factors, but such
a list might include the following: a therapeutic alliance established
between the patient and the therapist; exposure of the patient to prior
difficulties, either in imagination or in reality; a new corrective emotional
experience that allows the patient to experience past problems in new
and more benign ways; expectations by both the therapist and the patient
that positive change will result from the treatment; therapist qualities,
such as attention, empathy, and positive regard, that are facilitative
of change in treatment; and the provision by the therapist to the patient
of a reason for the problems that are being experienced.
TECHNICAL ECLECTICISM
Technical eclecticism is similar
to what often is described as eclectic. In Technical Eclecticism, the
therapist relies on previous experience and on knowledge of the theoretical
and research literature to choose interventions that are appropriate for
the patient. However, there is no unifying theoretical understanding that
underlies the approach. It probably is the most frequently practiced of
all the approaches to psychotherapy integration. Aside from the relatively
hit or miss interventions of many practitioners, there also are several
carefully developed systems that rely on this approach.
THEORETICAL INTEGRATION
The third approach to psychotherapy
integration is called Theoretical Integration. This is the most difficult
level at which to achieve integration because it requires integrating
theoretical concepts from different approaches, and these approaches may
differ in their fundamental philosophy about human behavior. Theoretical
Integration tries to bring together those theoretical approaches and then
to develop what in physics is referred to as a Grand Unified Theory.
Neither psychotherapists nor
physicists have been successful to date in producing a Grand Unified Theory.
It is difficult to imagine a theory that really can combine an approach
that has one philosophical understanding with a different approach that
has a different philosophical understanding. For example, a psychodynamic
approachis based on the belief that an early difficulty leads to a pattern
of behavior that is repetitive, destructive, and nearly impossible to
resolve. In contrast, behavior therapy views problems as much more amenable
to change. This difference may represent a basic incompatibility between
the two theories. Therefore, theoretical integration would be faced with
the task of integrating a theory about the stability of behavior with
a theory about the ready changeability of behavior, and unless this obstacle
can be overcome, Theoretical Integration, in the grand sense, will not
be achieved. However, there have been several successful attempts to combine
the best of two theories, and these may point the way to future achievements.
ASSIMILATIVE INTEGRATION
The final approach to psychotherapy
integration is Assimilative Integration. Assimilative Integration is an
approach in which the therapist has a commitment to one theoretical approach
but also is willing to use techniques from other therapeutic approaches.
For example, a therapist may try to understand patients in terms of psychodynamic
theory, because he or she finds this most helpful in understanding what
is going on in the course of the treatment.
However, the therapist may
also recognize that there are techniques that are not suggested by psychodynamic
theory that work very well, and these may then be used in the treatment
plan. The psychodynamic therapist can occasionally use cognitive-behavioral
techniques such as homework, and may occasionally use humanistic approaches,
such as a two-chair technique, but always retains a consistent psychodynamic
understanding. The treatment can take place in a way that is beneficial
to the patient and is not bound by the restrictions of the therapist's
favorite way of intervening. Although the patient may not be aware that
integration is taking place, he or she does feel that a consistent approach
is being maintained.
Inherent in psychotherapy
integration is the conviction that there is no one approach to therapy
that is suitable to every patient. In making the treatment suitable for
the individual patient, the therapist must understand the patient, and
that establishes a place for theory. Assimilative Integration is particularly
useful in that theory helps in the understanding of the needs of the patient,
but then several different approaches to technique can help to design
a treatment that fits that particular understanding. The treatment plan
then must undergo continuous revision as the the therapists understanding
of the patient becomes fuller and deeper over the course of the treatment.
CONCLUSIONS
Two of these approaches, Assimilative
Integration and Theoretical Integration, recognize the value of theory
to psychotherapy integration, whether the theory deals with the way integration
works (Theoretical Integration) or provides the framework that governs
the choice of interventions (Assimilative Integration). The other two
approaches, Common Factors and Technical Eclecticism, are not concerned
with theory, but also view the benefit of the patient to be of more significance
than adherence to any single school of treatment.
For those who are interested
in learning more about psychotherapy integration, there are two major
handbooks that have been published. In addition, there is a journal, the
Journal of Psychotherapy Integration, that regularly publishes relevant
articles. It is available as a benefit of membership in the Society for
the Exploration of Psychotherapy Integration (SEPI). Information about
SEPI can be obtained by writing to me (stricker@adelphi.edu).
AUTHOR
George Stricker, Ph.D., is
a Distinguished Research Professor at Adelphi University and a member
of the National Register Board of Directors.
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