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.     

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.     

Resistance as a Problem for Practice and Theory

Resistance is one of the most problematic and potentially counterproductive concepts in the entire field of psychotherapy. It is at the same time one of the most crucial, pointing toward perhaps the single most important factor—or, more accurately, set of factors—in determining the success or failure of the therapeutic enterprise. Drawing on the articles by Davis and Hollon, Prochaska and Prochaska, Reid, and Eagle in this issue, as well as on the author's own perspective, this paper explores this seeming contradiction in order to point toward an integrative resolution of the differing perspectives on resistance and related phenomena.     

Psychotherapy Process Measure Research and the Evaluation of Psychotherapy Orientation: A Narrative Analysis

This article discusses the need for a systematic method that enables researchers to evaluate integrative therapy approaches using a range of therapy process measures. The Narrative System Process Coding (NPCS; Angus, Hardtke, & Levitt, 1996) is proposed as such a method, and is applied with the Experiencing Scale (Klein, Mathieu, Gendlin, & Keisler, 1970) and the Levels of Client Perceptual Processing (LCPP; Toukmanian, 1986) to three brief good outcome integrative therapy modalities to illustrate this need. The study found higher Experiencing Scale scores to be most strongly related to an experiential approach to therapy and to the NPCS internal narrative processes. Higher LCPP scores were most strongly related to the NPCS reflexive narrative process and to a perceptual-processing approach. The discussion initiates a discourse on the importance of explicating process measures' origins when comparing different therapy approaches in order to allow for the meaningful consolidation of process research findings.     

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.     

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.     

A Common Factors Approach to Psychotherapy Training

This article addresses training in psychotherapy integration from the perspective of common factors. Problems related to this training perspective are first reviewed. As an attempt to deal with such problems, current teaching and supervision efforts by the author are briefly described. Based on a developmental model of clinical learning, a sketch of a more comprehensive program of integrative psychotherapy training is advanced.     

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。     

A Participant-Observer's Perspective on Psychotherapy Integration

Jacobson has raised a number of issues about the usefulness of psychotherapy integration. Some of his concerns stem from his doubt that people are capable of change, and some that appear to be the result of a misinterpretation of what constitutes psychotherapy integration. This article attempts to clarify some of these misunderstandings, which seem to be the result of equating psychotherapy integration with the integration of theories. Comments are also made about the research underpinings related to work in this area.     

Bridging Technical Eclecticism and Theoretical Integration: Assimilative Integration

Assimilative integration is a new type of psychotherapy integration introduced by Messer in 1992. This paper explains the where, what, when, and how of this integrative route, outlines its advantages and weaknesses, and discusses areas for potential assimilative practice in various models of therapy. Following a brief review of the current status of psychotherapy integration and its practices, assimilative integration is conceptualized as a mini theoretical integration and as theoretical eclecticism it is offered as a bridge between theoretical integration and technical eclecticism. Assimilative integration is proposed as the best theoretically and empirically based integrative approach available at this time, particularly for therapists who have been trained in a single mode of therapy before they became integrationists.     

Toward an Integrative Theoretical Basis for Training Psychotherapists

The purpose of this paper is to describe a training program for integrative psychotherapy that is based on an as-yet-nonexistent integrative theory of psychotherapy. It is therefore to be considered a thought experiment. A partially integrative theory of psychotherapy is presented—a work in progress—which is used as the basis for planning a 3-year postdoctoral training program for advanced psychotherapists. The curriculum would include (1) several courses on specific pure-form therapies, (2) core courses in the integrative theory, (3) courses on the application of the integrative theory to a number of different classes of mental disorder, (4) a year of practicum during which the student therapist applies the integrative treatment to a substantial number of patients under supervision, and (5) a year-long internship-like experience during which the treatment will be applied to a much larger base of patients. Students would also attend a therapy-like group to explore feelings regarding the conduct of this therapy and a second case conference group to discuss their cases.     

Group-Based Psychotherapy Integration in Theory and Practice: Therapeutic Community Revisited

A group-based theoretical integration model presented in this journal (F. Knobloch, 1996) is elaborated in practice. The core aspects of the group-based system are described and illustrated with clinical examples as they apply to a modified therapeutic community: (a) the creation of the therapeutic world to represent real life and its multiple realities; (b) the group schema model as a context for problem identification and exploration; (c) the collaboration between therapists and group members; (d) the exploration and experimentation of problems through individual and group tasks; and (e) the transfer of new behaviors to real life situations and (f) the systematic application of major psychotherapy theories and techniques.     

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.     

Clinical Exchange: The Architectural Failure

The Clinical Exchange invites eminent clinicians of diverse persuasions to share, in ordinary language, their clinical formulations and treatment plans of the same psychotherapy patient—one not selected or nominated by those therapists—and then to discuss points of convergence and contention in their recommendations. This Exchange concerns a Mr. L, a 47-year-old, married man presenting for outpatient individual psychotherapy with chief complaints of depression, anxiety, and a lengthy history of vocational underachievement. Drs. Herbert Fensterheim, Leslie Greenberg, and Leigh McCullough, who anchor their practices in the cognitive-behavioral, experiential, and psychodynamic orientations, respectively, are the featured commentators. Finally, Dr. Jerold Gold, the case contributor and Mr. L's psychotherapist, provides a few closing comments.     

Trainee psychotherapy effectiveness at a psychodynamic training clinic: a practice-based study

The degree to which clinical experience is a significant factor in predicting positive psychotherapeutic outcomes is an open question. Empirical studies comparing experienced and beginning practitioners on differences in client outcomes have yielded mixed results. While multiple sources have indicated that trainees are generally effective therapists, few of these studies have examined the effectiveness of graduate-level therapists in a psychodynamic training program. In this study, conducted in the United States, we use a practice-based research approach to examine the outcomes of clients working with trainees at a community mental health clinic in the northeast United States. The theoretical orientation identified by the clinic and training program is psychodynamic with an interpersonal and/or relational emphasis. Results indicated that clients working with trainees at this clinic demonstrated improvement across several indicators of symptoms and psychosocial functioning over the time they received treatment. Implications for training and service reimbursement are discussed.     

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.     

Time-limited group psychotherapy: Has cinderella found her prince?

The time-limited group psychotherapy treatment format is in demand in a healthcare delivery system that is increasingly concerned with effective and efficient methods for treating acute mental health problems and maintaining patients in the community. The empirical literature provides strong support for the positive outcome of relatively brief treatment. A larger service delivery system ensures a flow of patients who can be managed in a variety of types of groups. This will require the group clinician to become comfortable working in conjunction with a larger system and knowledgably delivering different types of treatment while continuing to use the group itself as a major source of therapeutic power.