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Integrative Perspective inTherapy

C6436 Individual CounselingTheory and Practice

James J. Messina, Ph.D.

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Trend Towards PsychotherapyIntegration

Integration and Eclecticism in TherapyModels began in the 1980s

In 1992 30-50% of therapists calledthemselves eclectic or integrative in their therapeutic approach

Syncretism: haphazardly pickingtechniques without any overall theoreticalrationale as long as it works by default

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Three Multiple Pathways toAchieve Integration of Therapy

Technical eclecticism: focuses on differences,chooses from many approaches, usingtechniques from different schools-without

subscribing to theoretical positions whichdeveloped themTheoretical integration : conceptual or theoreticalcreation beyond a mere blending of techniques-

producing a conceptual framework synthesizesbest of two or more theoretical approachesCommon factors: looks across differenttheoretical approaches in search of common

elements-find core composed of non-specificvariables common to all thera ies

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Motives for Integration Trend1. Proliferation of therapies2. Inadequacy of a single therapy relevant to all clients &

problems3. External socioeconomic realities: insurance

reimbursement, HMO, PPO, POS4. Popularity of short-term, prescriptive, problem focused

therapies5. Opportunities to observe & experiment with various

therapies6. Paucity of differential effectiveness among therapies7. Recognition therapeutic commonalities major role in

therapy outcomes

8. Development of professional societies aimed atintegrating psychotherapies

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Integration of multicultural Issues

Integration of multicultural Issues inCounseling-through technical eclecticism

Create techniques to meet the needs of clients of different culturesBe flexible in utilizing diverse therapeutic

strategies across varying cultural groupsEmploy and adapt techniques to fit thePerson-in-the-environment

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Integration of Spiritual/ReligiousIssues

Being open to spiritual/religious values results inchange in focus of treatment away fromsymptoms relief to general changes in lifestyle

Spirituality important component of mentalhealth and inclusion in therapy helps make itmore effectiveTo be used in therapeutic process to benefit andenhance the processForce that can help individual make sense of universe and find purpose in livingStay tuned into clients stories and purpose for which therapy as sought

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Similarities Between Therapy &Spirituality

Similar goalsEmphasize learning to accept oneself, forgive

others & self Admitting ones shortcomingsAccepting Personal ResponsibilityLetting go of hurts & resentmentsDealing with guiltLearning to let go of self-destructive patterns of thinking, feeling & acting

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Healing Nature of Spirituality

Shares Themes of: Loving, caring, learning tolisten with compassion, challenging clients lifeassumptions, accepting human imperfection,going outside of self-oriented interests (socialinterest)Ponders questions of: Who am I? What ismeaning of life?Explores: role of shame & guiltUnderstanding of: difference between blame &responsibility & power of sharing deeply human

concerns

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Spirituality: Implications for Assessment & Treatment

Important to understand background of clientsinvolvement in religionUnderstand & respect clients religious beliefs

Steps in assessment:4. Include in intake procedure & early phase of

therapy5. Questions of spirituality relevant to current

problem & role in current life of client6. How religious beliefs relate to cognitive,

affective & behavioral processes of client

7. Letting client know it is acceptable to talkabout religious & spiritual concerns

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Role of Counselor Dealing withSpirituality

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 aparticular set of spiritual/religious values

Integrate a spiritual orientation to assistclients in crisis to have the solace,comfort, & sustaining power which

spirituality and religious beliefs offer them

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Developing IntegrativePerspective

Beware of mixing theories with incompatibleunderlying assumptions about meanings,origins, development, maintenance, significance

& management of problemsClinicians can select techniques from anydiscipline without necessarily endorsing any of the theories that spawned them

Therapists must be flexible & versatileWhat works for whom under which particular circumstancesBlending flexible repertoire of relationship styleswith wide range of techniques enhance outcome

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Challenges of Integrative Models

Deliver therapy inBrief

ComprehensiveEffectiveFlexible way

Rapidly & systematicallyIdentify problemsCreate a collaborative relationship

Intervene with a range of specific methods

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Integrative Perspective

Systematic integration of underlyingprinciples & methods common to a range

of therapeutic approachesBe thorough conversant with number of theoriesOpen to idea that theories can be unifiedWilling to continually test hypotheses todetermine how well they are workingGreat deal of study, clinical practice,research & theorizing

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Therapeutic Goals in IntegrativePerspective

1. Uncovering the unconscious2. Creating social interest3. Finding meaning in life4. Curing an emotional disturbance5. Examining old decisions & making new

choices6. Developing trust in oneself

7. Becoming more self-actualized8. Reducing anxiety9. Shedding maladaptive behaviors & learning

new ones10. Gaining more effective control of ones life

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Therapists Functions & Role inIntegrative Perspective

How do counselors functions change dependingon the stage of the counseling process?Does therapist maintain basic role or does rolevary 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 inclient/therapist relationship?

When & how much does counselor self-disclose?

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Clients Experience in IntegrativePerspective Therapy

Clients given situation in environment providesframework for selecting most appropriateinterventionsWhat are clients expectations?What are clients responsibilities in the process?Are there commonalities in diversity of clients?

Initially clients want expert help & quick fixAs progress realize must be active in process,select their own goals & work towards them intherapy and daily living

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Relationship between Client &Therapist in Integrative Model

Crucial determinant in therapy in existential,person-centered & gestaltNot ignored, but not central in REBT, CBT, &

behavior therapyHonesty, sincerity, acceptance, understanding &spontaneity are basic ingredients for successTherapists degree of caring, interest, ability inhelping clients, genuineness are factorsinfluencing relationship with clientsAbility to teach a range of coping skillsClient contribute: motivation, cooperation,interest, concern, & expectations

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Techniques in IntegrativeTherapy Perspective

Effective counseling: proficiency incombination of cognitive, affective &

behavioral techniquesHelp clients think about their beliefs &assumptions

Experience on feeling level conflicts &strugglesTranslate insights into action programs by

behaving in new ways in daily living

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Evaluation of Effectiveness inIntegrative Perspective

A substantial number of outpatients improvewithout formal therapy-use natural helpingsystems in environment

Generally therapeutic treatments are beneficial-little support for superiority of one school of therapy over another Common factors which help clients: Support,

Learning & Action factorsSpecific techniques can be selected for dealingwith specific problems on basis of their effectiveness-provides framework to assess

direction & outcomes of therapy