C6436 12th Integrative
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Integrative Perspective in Therapy C6436 Individual Counseling Theory and Practice James J. Messina, Ph.D.
Trend Towards Psychotherapy Integration
Integration and Eclecticism in Therapy Models began in the 1980’s In 1992 30-50% of therapists called themselves eclectic or integrative in their therapeutic approach Syncretism: haphazardly picking techniques without any overall theoretical rationale as long as it works “by default”
Three Multiple Pathways to Achieve Integration of Therapy
Technical eclecticism: focuses on differences, chooses from many approaches, using techniques from different schools-without subscribing to theoretical positions which developed them Theoretical integration: conceptual or theoretical creation beyond a mere blending of techniquesproducing a conceptual framework synthesizes best of two or more theoretical approaches Common factors: looks across different theoretical approaches in search of common elements-find core composed of non-specific variables common to all therapies
Motives for Integration Trend 1. 2. 3. 4. 5. 6. 7. 8.
Proliferation of therapies Inadequacy of a single therapy relevant to all clients & problems External socioeconomic realities: insurance reimbursement, HMO, PPO, POS Popularity of short-term, prescriptive, problem focused therapies Opportunities to observe & experiment with various therapies Paucity of differential effectiveness among therapies Recognition therapeutic commonalities major role in therapy outcomes Development of professional societies aimed at integrating psychotherapies
Integration of multicultural Issues
Integration of multicultural Issues in Counseling-through technical eclecticism Create techniques to meet the needs of clients of different cultures Be flexible in utilizing diverse therapeutic strategies across varying cultural groups Employ and adapt techniques to fit the Person-in-the-environment
Integration of Spiritual/Religious Issues
Being open to spiritual/religious values results in change in focus of treatment away from symptoms relief to general changes in lifestyle Spirituality important component of mental health and inclusion in therapy helps make it more effective To be used in therapeutic process to benefit and enhance the process Force that can help individual make sense of universe and find purpose in living Stay tuned into client’s stories and purpose for which therapy as sought
Similarities Between Therapy & Spirituality
Similar goals Emphasize learning to accept oneself, forgive others & self Admitting one’s shortcomings Accepting Personal Responsibility Letting go of hurts & resentments Dealing with guilt Learning to let go of self-destructive patterns of thinking, feeling & acting
Healing Nature of Spirituality
Shares Themes of: Loving, caring, learning to listen with compassion, challenging client’s life assumptions, accepting human imperfection, going outside of self-oriented interests (social interest) Ponders questions of: Who am I? What is meaning of life? Explores: role of shame & guilt Understanding of: difference between blame & responsibility & power of sharing deeply human concerns
Spirituality: Implications for Assessment & Treatment 4. 5. 6. 7.
Important to understand background of client’s involvement in religion Understand & respect client’s religious beliefs Steps in assessment: Include in intake procedure & early phase of therapy Questions of spirituality relevant to current problem & role in current life of client How religious beliefs relate to cognitive, affective & behavioral processes of client Letting client know it is acceptable to talk about religious & spiritual concerns
Role of Counselor Dealing with Spirituality
Be careful not to make decisions for clients but to let clients how their own values will guide their behavior Guard against indoctrinating clients with a particular set of spiritual/religious values Integrate a spiritual orientation to assist clients in crisis to have the solace, comfort, & sustaining power which spirituality and religious beliefs offer them
Developing Integrative Perspective
Beware of mixing theories with incompatible underlying assumptions about meanings, origins, development, maintenance, significance & management of problems Clinicians can select techniques from any discipline without necessarily endorsing any of the theories that spawned them Therapists must be flexible & versatile “What works for whom under which particular circumstances” Blending flexible repertoire of relationship styles with wide range of techniques enhance outcome
Challenges of Integrative Models
Deliver therapy in
Brief Comprehensive Effective Flexible way
Rapidly & systematically
Identify problems Create a collaborative relationship Intervene with a range of specific methods
Integrative Perspective
Systematic integration of underlying principles & methods common to a range of therapeutic approaches Be thorough conversant with number of theories Open to idea that theories can be unified Willing to continually test hypotheses to determine how well they are working Great deal of study, clinical practice, research & theorizing
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Therapeutic Goals in Integrative Perspective Uncovering the unconscious Creating social interest Finding meaning in life Curing an emotional disturbance Examining old decisions & making new choices Developing trust in oneself Becoming more self-actualized Reducing anxiety Shedding maladaptive behaviors & learning new ones Gaining more effective control of one’s life
Therapist’s Functions & Role in Integrative Perspective
How do counselor’s functions change depending on the stage of the counseling process? Does therapist maintain basic role or does role vary in accordance with characteristic of client? How does counselor determine how active & directive to be? How is structuring handled as the course of therapy progresses? What is optimum balance of responsibility in client/therapist relationship? When & how much does counselor selfdisclose?
Client’s Experience in Integrative Perspective Therapy
Client’s given situation in environment provides framework for selecting most appropriate interventions What are client’s expectations? What are client’s responsibilities in the process? Are there commonalities in diversity of clients? Initially clients want expert help & quick fix As progress realize must be active in process, select their own goals & work towards them in therapy and daily living
Relationship between Client & Therapist in Integrative Model
Crucial determinant in therapy in existential, person-centered & gestalt Not ignored, but not central in REBT, CBT, & behavior therapy Honesty, sincerity, acceptance, understanding & spontaneity are basic ingredients for success Therapists’ degree of caring, interest, ability in helping clients, genuineness are factors influencing relationship with clients Ability to teach a range of coping skills Client contribute: motivation, cooperation, interest, concern, & expectations
Techniques in Integrative Therapy Perspective
Effective counseling: proficiency in combination of cognitive, affective & behavioral techniques Help clients think about their beliefs & assumptions Experience on feeling level conflicts & struggles Translate insights into action programs by behaving in new ways in daily living
Evaluation of Effectiveness in Integrative Perspective
A substantial number of outpatients improve without formal therapy-use natural helping systems in environment Generally therapeutic treatments are beneficiallittle support for superiority of one school of therapy over another Common factors which help clients: Support, Learning & Action factors Specific techniques can be selected for dealing with specific problems on basis of their effectiveness-provides framework to assess direction & outcomes of therapy
Trend Towards Psychotherapy Integration
Integration and Eclecticism in Therapy Models began in the 1980’s In 1992 30-50% of therapists called themselves eclectic or integrative in their therapeutic approach Syncretism: haphazardly picking techniques without any overall theoretical rationale as long as it works “by default”
Three Multiple Pathways to Achieve Integration of Therapy
Technical eclecticism: focuses on differences, chooses from many approaches, using techniques from different schools-without subscribing to theoretical positions which developed them Theoretical integration: conceptual or theoretical creation beyond a mere blending of techniquesproducing a conceptual framework synthesizes best of two or more theoretical approaches Common factors: looks across different theoretical approaches in search of common elements-find core composed of non-specific variables common to all therapies
Motives for Integration Trend 1. 2. 3. 4. 5. 6. 7. 8.
Proliferation of therapies Inadequacy of a single therapy relevant to all clients & problems External socioeconomic realities: insurance reimbursement, HMO, PPO, POS Popularity of short-term, prescriptive, problem focused therapies Opportunities to observe & experiment with various therapies Paucity of differential effectiveness among therapies Recognition therapeutic commonalities major role in therapy outcomes Development of professional societies aimed at integrating psychotherapies
Integration of multicultural Issues
Integration of multicultural Issues in Counseling-through technical eclecticism Create techniques to meet the needs of clients of different cultures Be flexible in utilizing diverse therapeutic strategies across varying cultural groups Employ and adapt techniques to fit the Person-in-the-environment
Integration of Spiritual/Religious Issues
Being open to spiritual/religious values results in change in focus of treatment away from symptoms relief to general changes in lifestyle Spirituality important component of mental health and inclusion in therapy helps make it more effective To be used in therapeutic process to benefit and enhance the process Force that can help individual make sense of universe and find purpose in living Stay tuned into client’s stories and purpose for which therapy as sought
Similarities Between Therapy & Spirituality
Similar goals Emphasize learning to accept oneself, forgive others & self Admitting one’s shortcomings Accepting Personal Responsibility Letting go of hurts & resentments Dealing with guilt Learning to let go of self-destructive patterns of thinking, feeling & acting
Healing Nature of Spirituality
Shares Themes of: Loving, caring, learning to listen with compassion, challenging client’s life assumptions, accepting human imperfection, going outside of self-oriented interests (social interest) Ponders questions of: Who am I? What is meaning of life? Explores: role of shame & guilt Understanding of: difference between blame & responsibility & power of sharing deeply human concerns
Spirituality: Implications for Assessment & Treatment 4. 5. 6. 7.
Important to understand background of client’s involvement in religion Understand & respect client’s religious beliefs Steps in assessment: Include in intake procedure & early phase of therapy Questions of spirituality relevant to current problem & role in current life of client How religious beliefs relate to cognitive, affective & behavioral processes of client Letting client know it is acceptable to talk about religious & spiritual concerns
Role of Counselor Dealing with Spirituality
Be careful not to make decisions for clients but to let clients how their own values will guide their behavior Guard against indoctrinating clients with a particular set of spiritual/religious values Integrate a spiritual orientation to assist clients in crisis to have the solace, comfort, & sustaining power which spirituality and religious beliefs offer them
Developing Integrative Perspective
Beware of mixing theories with incompatible underlying assumptions about meanings, origins, development, maintenance, significance & management of problems Clinicians can select techniques from any discipline without necessarily endorsing any of the theories that spawned them Therapists must be flexible & versatile “What works for whom under which particular circumstances” Blending flexible repertoire of relationship styles with wide range of techniques enhance outcome
Challenges of Integrative Models
Deliver therapy in
Brief Comprehensive Effective Flexible way
Rapidly & systematically
Identify problems Create a collaborative relationship Intervene with a range of specific methods
Integrative Perspective
Systematic integration of underlying principles & methods common to a range of therapeutic approaches Be thorough conversant with number of theories Open to idea that theories can be unified Willing to continually test hypotheses to determine how well they are working Great deal of study, clinical practice, research & theorizing
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Therapeutic Goals in Integrative Perspective Uncovering the unconscious Creating social interest Finding meaning in life Curing an emotional disturbance Examining old decisions & making new choices Developing trust in oneself Becoming more self-actualized Reducing anxiety Shedding maladaptive behaviors & learning new ones Gaining more effective control of one’s life
Therapist’s Functions & Role in Integrative Perspective
How do counselor’s functions change depending on the stage of the counseling process? Does therapist maintain basic role or does role vary in accordance with characteristic of client? How does counselor determine how active & directive to be? How is structuring handled as the course of therapy progresses? What is optimum balance of responsibility in client/therapist relationship? When & how much does counselor selfdisclose?
Client’s Experience in Integrative Perspective Therapy
Client’s given situation in environment provides framework for selecting most appropriate interventions What are client’s expectations? What are client’s responsibilities in the process? Are there commonalities in diversity of clients? Initially clients want expert help & quick fix As progress realize must be active in process, select their own goals & work towards them in therapy and daily living
Relationship between Client & Therapist in Integrative Model
Crucial determinant in therapy in existential, person-centered & gestalt Not ignored, but not central in REBT, CBT, & behavior therapy Honesty, sincerity, acceptance, understanding & spontaneity are basic ingredients for success Therapists’ degree of caring, interest, ability in helping clients, genuineness are factors influencing relationship with clients Ability to teach a range of coping skills Client contribute: motivation, cooperation, interest, concern, & expectations
Techniques in Integrative Therapy Perspective
Effective counseling: proficiency in combination of cognitive, affective & behavioral techniques Help clients think about their beliefs & assumptions Experience on feeling level conflicts & struggles Translate insights into action programs by behaving in new ways in daily living
Evaluation of Effectiveness in Integrative Perspective
A substantial number of outpatients improve without formal therapy-use natural helping systems in environment Generally therapeutic treatments are beneficiallittle support for superiority of one school of therapy over another Common factors which help clients: Support, Learning & Action factors Specific techniques can be selected for dealing with specific problems on basis of their effectiveness-provides framework to assess direction & outcomes of therapy
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