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.     

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.     

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.     

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.     

Special Series Introduction: Confronting the Challenge of Clinical Decision Making in Evidence-Based Practice

This special series addresses the often ignored problem that many clients seen by practicing clinicians do not benefit from empirically-based practices as neatly as research may suggest. The authors in this series have considered the process of decision making in evidence-based practice, looking from differing viewpoints, and considering treatment setting and ethical issues. They present suggestions for clinicians to adapt treatment to the needs of clients while adhering to the robust research on psychotherapy processes and cognitive behavioral therapy.     

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.     

Psyche and System: On Progress in the Integration of Individual Psychotherapy and Family Psychotherapy

This article addresses the frequency with which the same group of patients utilizes individual and family therapies, and at the same time do not constitute actual integration. The conditions under which such serial or concurrent utilization of the two forms of psychotherapy may be considered to be integrative are discussed.     

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.     

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.     

Eclecticism and Integration: A Personal Retrospective View

As indicated in the title, this article presents a personal retrospective account of the development of the author's eclectic and integrative views of psychotherapy. Although this period covers more than 50 years, I have tried my best to recall events as accurately as possible.     

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.     

Introduction to the Special Issue on Assimilative Integration

This issue of Journal of Psychotherapy Integration includes a set of articles that explore and apply the concept of assimilative integration. They do so from different theoretical perspectives, including psychodynamic, cognitive–behavioral, family systems, and Yogic/Buddhist, as well as from broad conceptual standpoints. The articles are followed by 3 commentaries that offer an appreciation and critique of assimilative integration and recommendations for its further development.     

Assimilative and Accommodative Integration: The Basic Dialectics

Two basic styles in psychotherapy integration can be described, in which respectively the assimilative or the accommodative mode of proceeding preponderate. The first is chosen by those who wish to keep a firm grounding in any one theoretical system, into which they incorporate perspectives or practices from other schools, reinterpreted and reformulated in their own terms. The second is favored by those who prefer to practice eclectically, without worrying too much about the contradictions and incompatibilities among the different approaches. The latter therapists can remain at this purely eclectic level, or move on towards a proper integration. In this case the integration does not usually happen on the base of a preferred system, as in theoretical integration, but rather follows the line of the common factors approach. This integration mode has a prevalent accommodative character. It points to a basic structure that is common to the different methods, and becomes clearer the more the relation is freed of the constriction of theoretical models. An attempt is made to show the substantial complementarity and the dialectical relation that links the two fundamental modes of psychotherapy integration.     

Commentary: Further Thoughts About Assimilative Integration

The models for assimilative integration presented in this issue are considered. It is concluded that some grounding theories may be too structured, or one's interpretation of them too rigid, stifling psychotherapeutic flexibility and creativity by excluding potentially useful interventions. Alternatively, models may be too unstructured, or one's interpretation of them too loose, leading to treatment forms lacking specificity, direction, and coherence. As noted originally by Messer, assimilative integration operates most beneficially when practitioners address the limitations of their therapeutic models, or tap their models' progressive implications in ways that respect the fundamentals of their shared clinical theories. Practiced in this balanced way, assimilative integration can offer a useful, flexible way of navigating a creative yet disciplined psychotherapeutic course between unbridled technical eclecticism and technical and theoretical rigidity. The author also examines and extends some of the integrative ideas put forth in this issue, from a two-person or intersubjective perspective based on a relational psychodynamic treatment model.     

The promise of EMDR in family and systemic psychotherapy: a clinical complement to Field and Cottrell

Annalisa Field and David Cottrell's careful and balanced summary of the current state of evidence of the effectiveness of eye movement desensitization and reprocessing (EMDR) with children and adolescents is to be welcomed. They conclude that there is, despite an overall lack of good quality studies, some encouraging emerging evidence. They set out a future scenario for development in which these hopeful indications may be sufficient to convince clinicians to train and consider using EMDR in practice. That may in turn lead to more people publishing the results of their nascent practice, and greater availability of therapists would enable larger scale randomized controlled studies to be designed and carried out. In this clinical addendum I seek to complement Field and Cottrell's sense of promise by setting out ways in which EMDR has become incorporated in my systemic psychotherapy practice during the last 3 years.     

Definitional and Research Issues in the Common Factors Approach to Psychotherapy Integration: Misconceptions, Clarifications, and Proposals

This paper focuses on two common misconceptions of common factors in therapy. The first misconception entails the confusion between common factors and therapeutic factors, and thus the inappropriate and misleading use of the term therapeutic common factors in various situations. The second misconception is the mixing of commonalities of different kinds and levels in proposed lists and studies of common factors. These areas are discussed and clarified, and recommendations designed to facilitate conceptual and methodological improvements relative to each misconception are offered. The selection of best levels and kinds of common factors to be studied are further explored (i.e., the study of client change events and antecedent therapist behaviors across different therapies), and specific proposals for their research are outlined.     

Outsight: Radical Behaviorism and Psychotherapy

Clinical experience suggests that a variety of neurotic and personality disorders are effectively treated by an approach to therapy that is relatively passive in appearance and is directed towards the development of self-knowledge. Behavior theory provides an economical, naturalistic analysis of the therapeutic effects of this approach. Punishment, a common method of controlling forbidden behavior, can result in pathologic avoidance and deficient awareness of one's own behavior and its relation to the environment. Traditional methods of psychoanalysis and behavior therapy provide circumstances that help the patient to observe acts and feelings and their relation to elements of the environment that are otherwise avoided. These procedures may work best when self-observation is (1) not selectively reinforced by the therapist, and (2) supplemented by explicit training in behavior analysis. These elements are combined in a treatment approach for generating observations of one's own behavior and its functional significance in the natural environment.