An Outsider's Perspective on Psychotherapy Integration

This article offers those who are identified with progress in psychotherapy integration an outsider's perspective on progress in the field. The author argues for a contextual study of psychotherapy and psychotherapy integration, noting that the social psychology of psychotherapy may be an overlooked dimension in the study of psychotherapy integration. He suggests that perceptions of progress in psychotherapy integration may be exaggerated due to the lack of such a perspective.     

My Perspective on Psychotherapy Integration: An Outsider Who's Out of It

My rejoinder is a response to two commentaries on my SEPI keynote in 1997: commentaries written by Goldfried and Cullari. Instead of grappling with the ideas I presented, both respondents were distracted by my satirical beginning. In my talk I proposed a method for studying psychotherapy integration. I am not pessimistic about the potential for integration, nor am I pessimistic about psychotherapy. But I am a skeptic, and science is driven—and indeed advance—by skepticism. In fact, psychotherapy integration requires that its advocates be skeptics. I still do not know what psychotherapy integration is, and remain confused. I can only conclude that I am not only an outsider, but out of it.     

Pragmatism, Pluralism, and Psychotherapy Relationships: An Interview with John C. Norcross, Ph.D.

John C. Norcross has made significant contributions in the areas of the transtheoretical model of change, psychotherapy integration, and empirically supported psychotherapy relationships. This interview explores the contributions of pragmatic philosophy and his personal upbringing to his work as a psychotherapy researcher and practitioner. Dr. Norcross discusses the status of the psychotherapy integration movement, the work of the Task Force on Empirically Supported Psychotherapy Relationships, and future trends in psychotherapy over the next 25 years. He emphasizes the importance of a methodological rigor that recognizes the unique characteristics of the psychotherapy relationship. He describes his current interest in the psychotherapy of psychotherapists, illustrating it with his personal challenges in balancing work and home.     

An Overview of Directions in Psychotherapy Integration Research

In general, empirical research in psychotherapy integration has lagged behind the growing theoretical and clinical interest in the field. Even though many of the theoretically integrative treatment models currently available are based on empirical findings and clinical observations, the models themselves remain, for the most part, untested. Rigorous examination of integrative psychological theories and therapeutic programs is a necessary and useful way to increase our understanding of the process of psychotherapy and establish the efficacy and effectiveness of integrative therapies. The present article explores five different research areas in the field of psychotherapy integration, discussing several published studies in each area. The utility of this research for practicing clinicians is also discussed. Additional investigations in these areas and others are encouraged, with the goals of greater understanding of psychotherapy, as well as the further development and acceptance of integrative approaches.     

Does Every Good Behaviorist Deserve Favor? A Reply to Neil Jacobson

This is a response to Dr. NeilJacobson's article, An Outsider's Perspective on Psychotherapy Integration, which appears in this issue. It addresses the issue of the differences between eclecticism and psychotherapy integration as well as the possible advantages integration holds over a one-model therapy system. This article suggests that virtually all psychotherapy systems operate under an integrated three paradigm model, and offers some concrete examples of this explanation. It also suggests that the use of psychotherapy integration may lead to a better paradigm match between client and therapist, and ultimately to better outcome. This article concludes that psychotherapy integration possibly offers the best alternative in terms of reducing the biases of one's underlying treatment oaradiem.     

The Clinical Challenges of Assimilative Integration

S. B. Messer (1992) introduced the notion of assimilative integration in psychotherapy, theorizing that integrative practitioners adhere to their preferred theoretical paradigms while judiciously blending aspects from other models. His assimilative approach offers a conceptual and clinical middle ground between technical eclecticism and a grand, unified theory of psychotherapy. However, the practice of competent assimilative integration is fraught with many challenges, both theoretical and clinical. The goal of the present paper is to explore the challenges of implementing assimilative integration. First, the theoretical and clinical barriers to assimilative approaches are considered. Second, the use of assimilative integration to avoid therapeutic failures is discussed. Finally, a case example is presented to illustrate the author's attempt to assimilate narrative, interpretive interventions within his preferred cognitive–behavioral treatment paradigm.     

What is the End Point of Psychotherapy Integration? A Commentary

This commentary on six papers about assimilative integration considers the place assimilative integration, as defined by Messer, ought to have in the discussion on psychotherapy integration. After briefly summarizing the contribution of each paper, with particular attention to whether the paper takes a position on the end point of psychotherapy integration, the author compares the relative benefits of assimilative integration to those of a unified grand theory. He argues that assimilative integration, as an end point, is preferable to a unified grand theory because it has a more generative influence on both theory evolution and clinical practice.     

Coming together and remaining a part: Development of a group-as-a-whole compass. Part II

Group-as-a-whole theory is an attempt to explain the collaboration and synergy that results when patients share their care. The art and science of treating individuals within psychotherapy groups is enriched by an understanding of the unique mediums ³ through which a group comes into being and the more general domains within which it comes to be known. This paper continues the development of a group-as-a-whole compass, as an integration of extant models and theories (Ettin, 1996). The focus shifts from conceptual and spatial models to an exploration of the cultural and relational processes that make up whole-group functioning. The paper comes full circle with hypotheses drawn about how a psychotherapy group, as a holistic phenomenon, is composed and maintained.Private practice, East Brunswick, New Jersey.     

Attitudes about psychotherapy: A qualitative study of introductory psychology students who have never been in psychotherapy and the influence of attachment style

Design: Interviews about attitudes about psychotherapy with 12 undergraduate students who had never been in psychotherapy were analysed using consensual qualitative research. Results: Participants believed that the client role is to disclose, be receptive, and be motivated; that the therapist role is to listen, support, and give advice; and that the therapeutic relationship should be close and personal. Participants had ideas about the benefits (a healing therapeutic relationship, personal and interpersonal changes) and the barriers (self‐stigma and public stigma, difficulty revealing, need to solve problems on own, cost) associated with seeking therapy, and they disliked the idea of being diagnosed. In contrast with participants who were securely attached, those who were insecurely attached more often wanted a professional therapeutic relationship, wanted the therapist to ask questions, mentioned fewer benefits to therapy, and thought that they would have difficulty disclosing to a therapist. Discussion: Implications for changing attitudes about psychotherapy and improving training programs for practitioners are discussed.     

Working Through Physical Disability in Psychoanalytic Psychotherapy With an Adolescent Boy

The narcissistic injury that may be caused by physical disability in infancy and the possible familial traumatization may block the integration of the infant's body and self-image, and can consequently hinder the child's identity formation. This article presents how an adolescent boy with cerebral palsy in short-term psychoanalytic psychotherapy works through the mental impact of his physical disability using a story. Transference and countertransference reactions are discussed. The positive impact of short-term psychoanalytic psychotherapy highlights the importance of caring for the mental health of children with physical impairments.     

Complexity science: A framework for psychotherapy integration

The paradigm of complexity science provides a new way to address the problem of psychotherapy integration and allows us to bypass the various shortcomings of the linear-interventionist perspective. Nine criteria are outlined, which should be satisfied by any integrative approach to psychotherapy: (a) the use of complexity science to provide a meta-theoretical and generic understanding of change processes (from neuronal to social system levels); (b) a comprehensive and formalised modelling of change processes and personality development; (c) an integrative method of case formulation; (d) the ability to understand a variety of techniques in terms of basic change principles; (e) criteria to guide microdecisions; (f) the application of data-driven feedback and real-time monitoring of change dynamics; (g) standardised assessment of outcomes in naturalistic settings; (h) guidelines for training; and (i) strategies that are well-suited to science–practice integration. Using these criteria as a framework for evaluation, one may grasp the potential of complexity science to drive innovation in the pursuit of psychotherapy integration.     

Therapist orientation,supervisor match,and therapeutic interventions: Implications for session quality in a psychotherapy training PRN

Background: Theoretical orientation is a multifaceted construct that is integral to the process of psychotherapy and psychotherapy training. While some research has been conducted on personal identification with particular schools of psychotherapy, techniques used in psychotherapy sessions, and match between trainees and supervisors in training, there is insufficient information regarding how these may interact with one another. Aim: This study, conducted in a practice research network of trainee therapists, was designed to test whether these variables may be related to one another in predicting session quality. Method: The sample comprised 328 sessions from 26 clients and 11 therapists, with the clients completing session quality measures and therapists completing measures of technique immediately post‐session. Results: Using multilevel linear modelling, the data showed varied results. For behavioural therapy and person‐centred therapy, techniques and orientation were unrelated to session quality in the sample. However, process‐experiential, psychodynamic, and cognitive therapy techniques were all involved in interactions with therapist and/or supervisor orientations. Conclusions: These results suggest that the impact of specific psychotherapy techniques sometimes depends on the orientation of the therapist and/or supervisor. For instance, sessions high in cognitive therapy techniques were only associated with positive outcome when both the therapist and supervisor were highly cognitively oriented. Though preliminary, these results suggest that orientation may be an important variable to consider in training and supervision, especially in the context of other variables.     

Some Thoughts on the Integration of Narrative and Humanistic/Existential Approaches to Psychotherapy

Although humanistic and narrative approaches to psychotherapy make some different assumptions about the nature of the human condition and emphasize different aspects of human functioning in their therapeutic endeavors, I argue here that the underlying assumptions of these two approaches reflect a common view of humanness, thus making these two approaches candidates for attempts at integration. Four areas of commonality are discussed in detail: (a) life as a process of continual development, (b) the nature of experience and the process of meaning creation, (c) the nature of psychological dysfunction, and (d) the nature and importance of human relationships. The implications of these commonalities for the practice of therapy from an integrated perspective are explored in an extended case example.     

后现代视野中的心理治疗及其思考

现代心理治疗与后现代心理治疗在关于认识论、知识的性质、标准、构造以及语言的作用等方面存在诸多差异。前者是对客观与理性的探寻．后者是对主观建构的追求。尽管人们对后现代心理治疗尚有诸多争论,但却能引发人们在扩展对心理治疗性质之认识、推进心理治疗本土化、克服心理治疗中的非人格化倾向等方面的有益思考。     

Halachic Judaism's Influence on the Practice of Psychotherapy

This paper enumerates and discusses some halachic principles and values which are exerting increasing influence on the practice of psychotherapy. This trend is linked to the resurgence of spiritual values and content in mainstream psychology and therapy, and to the changing concepts of the philosophy of science. The cultural roots of psychotherapy, specifically the contrast between the Greek and Jewish approaches to freedom are also briefly analyzed. The Jewish stand is viewed as imposing a set of values which has as its core enormous respect for the person and his/her ability to choose. Another factor regarded as pivotal is that Jewish teachings foster esteem for objectivity as opposed to the rampant subjectivity seen in some contemporary psychotherapeutic methods. An additional factor discussed is the relation of character traits to therapy. Finally, some facets of the unconscious are analyzed as to their relation to psychotherapy and Judaism.     

文化心理学视域下的心理治疗

近年来,心理治疗的文化取向日益为心理学界所关注。在概要分析文化心理学理论取向和传统心理治疗特点的基础上,重点对文化心理学取向下的心理病因观、医患关系、心理治疗方法、心理治疗效果评价观做了相应分析,并对未来文化取向下的心理治疗理论进行了展望,希望对我国心理治疗理论和实践有所帮助。     

具身心理治疗:原理与技术

具身心理治疗是以身体心理治疗、舞动治疗为代表的,理论上契合具身认知观点、实践中注重身体作用的一种当代心理治疗取向。它将“身体”与“躯体”区分开来,赋予身体解剖学的、感觉运动的、认知的与嵌入环境等不同层面的意义。当前,已有不少研究证实身体有助于改善治疗关系,促进来访者认知、情绪的改变,并发展出一系列注重身体内外感知、姿势或运动的非言语治疗技术。具身心理治疗重构了身体在治疗过程中的概念与角色,发展了新的技术,是传统心理治疗的有益补充; 但也存在实证证据不足、理论框架尚未完全整合、容易过分强调身体作用等问题。今后需自觉整合其他治疗流派、开发独特的核心技术,推进循证的具身心理治疗的发展。