CHAPTER 19 Integrative Psychotherapy Constructing Your Own Integrative Approach to Therapy INTRODUCTION_______________ integrative approach to therapy. After studying each of the various theories of psychotherapy pre- A major emphasis of this book has been on help- sented in this book, it may be difficult for you to ing you construct your own integrated approach to decide which approach seems to match best with psychotherapy. Research has indicated that psycho- your own personality, therapeutic style, and your therapy is moving toward an integrated approach methods of conceptualizing the many different to therapy (Norcross, 2005b). Throughout the types of life challenges people bring to therapy. world, when you ask a psychologist or counselor How do you go about integrating or combining what his or her theoretical orientation is, the most the best of several counseling theories? To help you frequently given response is integrative or eclectic. with this task, I present a number of questions that It is highly likely that upon graduation from your you might ask yourself in constructing your own training program, you will integrate one or more of integrated counseling approach. the theories presented in this book. In fact, my own While constructing your own integrative professional journey has resulted in my adoption approach to therapy is a very important profes- of an integrated psychotherapy framework. This sional step, you must also get a vision of what you chapter explores in detail the integrative approach have to do to become an effective therapist. I believe to therapy. that every therapist who becomes an effective pro- The first part of this chapter traces psychology’s fessional has to learn how to reflect on his or her historical development from emphasizing a single therapy experiences. It’s when we are alone in our approach to therapy to the current integrative offices thinking about a client with whom we been psychotherapy movement. In particular, I direct working who appears to be struggling with therapy your attention toward multitheoretical approaches and himself that we begin to grow and mature as to psychotherapy integration. Jeff Brooks-Harris’ therapists. We reflect on what we did or did not do (2008) multitheoretical psychotherapy framework and what we might do in the next session. is presented as a potential framework you might The final section of this chapter contains an consider either using or modifying to develop your integrative psychotherapy plan for Justin, the own integrated approach to therapy. young student who has served as a case study at the After providing a foundation for an integra- end of each theory chapter. In writing the integra- tive approach that is multitheoretical, I then move tive treatment plan, I use Jeff Brooks-Harris’ (2008) toward helping you construct your own personal multitheoretical framework. 585 Brief_Historical_Overview_of_the_ the various schools of psychotherapy (Goldfried, Pachankis, & Bell, 2005). Integrative_Movement Norcross and Newman (1992) have summa- The movement toward integration of the various rized the integrative movement in psychology by schools of psychotherapy has been in the making identifying eight different variables that promoted for decades. On the whole, however, psychotherapy the growth of the psychotherapy integration trend integration has been traditionally hampered by in counseling and psychotherapy. First, they point rivalry and competition among the various schools. out that there was simply a proliferation of separate Such rivalry can be traced to as far back as Freud counseling theories and approaches. The integra- and the differences that arose between him and his tive psychotherapy movement represented a shift disciples over what was the appropriate framework away from what was the prevailing atmosphere for conceptualizing clients’ problems. From Freud’s of factionalism and competition amongst the Wednesday evening meetings on psychoanalysis, a psychotherapies and a step toward dialogue and number of theories were created, including Adler’s cooperation. Second, they note that practitioners individual psychology. As each therapist claimed increasingly recognized the inadequacy of a single that he had found the one best treatment approach, theory that is responsive to all clients and their heated battles arose between various therapy sys- varying problems. No single therapy or group of tems. When behaviorism was introduced to the therapies had demonstrated remarkable superior field, clashes took place between psychoanalysts efficacy in comparison to any other theory. Third, and behaviorists. there was the correlated lack of success of any one During the 1940s, 1950s, and 1960s, thera- theory to explain adequately and predict pathology, pists tended to operate within primarily one personality, or behavioral change. theoretical school. Dollard and Miller’s (1950) Fourth, the growth in number and impor- book, Personality and Therapy, was one of the tance of shorter-term, focused psychotherapies first attempts to combine learning theory with was another factor spearheading the integrative psychoanalysis. In 1977, Paul Wachtel published psychotherapy movement. Fifth, both clinicians Psychoanalysis and Behavior Therapy: Toward an and academicians began to engage in greater com- Integration. In 1979, James Prochaska offered a munication with each other that had the net effect transtheoretical approach to psychotherapy, which of increasing their willingness to conduct collab- was the first attempt to create a broad theoretical orative experiments (Norcross & Newman, 1992). framework. Sixth, clinicians had to come to terms with the In 1979, Marvin Goldfried, Paul Wachtel, and intrusion into therapy with the realities of limited Hans Strupp (Strupp & Binder, 1984) organized socioeconomic support by third parties for tradi- an association, the Society for the Exploration tional, long-term psychotherapies. Increasingly, of Psychotherapy Integration (SEPI), for clini- there was a demand for therapist accountability cians and academicians interested in integration and documentation of the effectiveness of all medi- in psychotherapy (Goldfried, Pachankis, & Bell, cal and psychological therapies. Hence, the integra- 2005). Shortly thereafter in 1982, The International tion trend in psychotherapy has also been fueled by Journal of Eclectic Psychotherapy was published, external realities, such as insurance reimbursement and it later changed its name to the Journal of and the popularity of short-term, prescriptive, and Integrative and Eclectic Psychotherapy. By 1991, problem-focused therapists. it began publishing the Journal of Psychotherapy Seventh, researchers’ identification of com- Integration. As the field of psychotherapy has mon factors related to successful therapy outcome developed over the past several decades, there has influenced clinicians’ tendency toward psycho- been a decline in the ideological cold war among therapy integration. Increasingly, therapists began 586 PART IV THE FOURTH FORCE IN PSYCHOTHERAPY to recognize there were common factors that cut the various counseling theories or psychotherapy, across the various therapeutic schools. Eighth, the including technical eclecticism, theoretical inte- development of professional organizations such as gration, assimilative integration, common factors, SEPI, professional network developments, confer- multitheoretical psychotherapy, and helping skills ences, and journals dedicated to the discussion and integration (Norcross & Goldfried, 2005). study of psychotherapy integration also contrib- uted to the growth of the movement. The helping profession has definitely moved in the direction of Definition_of_Eclecticism theoretical integration rather than allegiance to a Eclecticism may be defined as an approach to thought single therapeutic approach. There has been a con- that does not hold rigidly to any single paradigm or certed movement toward integration of the various any single set of assumptions, but rather draws upon theories (Prochaska & Norcross, 2010). multiple theories to gain insight into phe- Inner Reflections Definition_of_Integrative_ nomena. Eclectics are sometimes criticized Key Points in the Psychotherapy for lack of consistency Integrative Movement As noted in Chapter 1, integrative psychotherapy in their thinking. For What key developments is an attempt to combine concepts and counsel- instance, many psy- chologists accept stand out in your ing interventions from more than one theoretical mind about the psychotherapy approach (Stricker, 2001). It is not a some features of behaviorism, yet they integrative movement in particular combination of counseling theories, but psychotherapy? rather it consists of a framework for developing an do not attempt to use integration of theories that you find most appeal- the theory to explain Thoughts about theory ing and useful for working with clients. According all aspects of client integration date back to to Norcross (2005b): behavior. Eclecticism the 1930s and 1940s. In in psychology has your opinion, what took so Psychotherapy integration is characterized by been caused by the long for the movement to dissatisfaction with single-school approaches and a belief that many fac- reach its current status? concomitant desire to look across school boundaries tors influence human to see what can be learned from other ways of behavior; therefore, it conducting psychotherapy. The ultimate outcome is important to examine a client from a number