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.     

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.     

Neurodynamics inside therapeutic interaction: a case study with simultaneous EEG recording / La neurodinámica en el contexto de la interacción terapéutica: un estudio de caso con una grabación simultánea de EEG

Recent research on processes of psychotherapy has focused on the study of patient-therapist regulation. Evidence concerning verbal and nonverbal coordination as predictors of therapeutic alliance and outcome in psychotherapy has been cumulating. These, along with others results in the field of social neuroscience, suggest that behavioural coordination may have neurophysiological correlates, which play a role in the regulatory process in psychotherapy. Here we introduce an observational paradigm and analytic method to assess the joint neurodynamic activity of patient and therapist. Additionally we report results from ongoing psychotherapy sessions. Our work highlights the involvement of brain activity in the psychotherapeutic process and provides novel insights on how psychotherapy works, in order to further the understanding of the embodied characteristic of the therapeutic interaction.     

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.     

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.     

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.     

From Interpretation to Commentary: Truth and Meaning in Psychotherapy

Some of the epistemological consequences of adopting the narrative point of view in psychotherapy are explored. Attempts to apply principles and norms from the philosophy of science to psychotherapy are criticized, since psychotherapy is not a science, but a technique. In addition, those models, related to the acquisition of knowledge, that consider that knowledge could increase by apposition without transforming the subject who is knowing are discussed. Natural science and hermeneutic metaphors are not suitable for understanding the practice of psychotherapy. Traditionally, the interpretation of symptoms or problems to solve has been the main instrument in therapy. In other words, the therapist tries to look for the truth hidden under the symptom, which then becomes a sign. Our proposition is to substitute these metaphors for the paradigm of text commentary. Text commentary, instead of providing a unique truth, provides a set of meanings suggested by a commentary. Characteristics that allow one to distinguish a good and a bad commentary, and implications of the paradigm described for the training of psychotherapists, are discussed.     

Using client feedback in training of future counseling psychologists: An evidence-based and social justice practice

Training in counseling psychology has evolved to emphasize both evidence-based practice (EBP) and social justice, though these two dimensions have often seemed disconnected, or even at odds in the practice of psychotherapy. The Partners for Change Outcome Management System (PCOMS), an EBP that monitors treatment outcomes and the therapeutic alliance across treatment (often called “client feedback”), may offer a means to connect evidence-based and socially just practices. The purpose of this article was to outline how the use of PCOMS in psychotherapy and supervision can serve as a useful training tool that is a form of EBP and also promotes a socially just paradigm in psychotherapy. We also offer an implementation example from a counseling psychology doctoral program to demonstrate how PCOMS can be used with clients in psychotherapy and included within the supervisory process.     

Three modes of psychotherapy and their requisite core skills

The field of psychotherapy suffers from the lack of an integrative meta‐perspective on the large variety of existing psychotherapies and on the therapeutic skills involved. In the present paper, it is suggested that the development of a more comprehensive view of this field may be facilitated if we differentiate between three modes of psychotherapy, which require different therapeutic core skills: (a) an educational mode, which requires teaching skills; (b) a reparative mode, which requires analytic‐conceptualising skills to identify some kind of disordered functioning, in combination with specific relational‐technical skills to repair this dysfunction; and (c) a developmental mode, which involves engaging in a therapeutic relationship with patients to facilitate their personal growth, and which requires non‐directivity skills. In addition, some therapeutic skills (e.g., awareness and communication skills) may be more or less important in all modes of treatment. Concrete manifestations of the three different modes of psychotherapy are discussed in terms of five different theoretical perspectives on psychotherapy: the common factors, the humanistic‐experiential mindfulness cognitive‐behavioural (CBT) and psychodynamic perspective. The common factors model is criticised as being insufficient in several respects. Finally, it is argued that if personal therapeutic skills are essential to the effects of psychotherapy, then empirical research on psychotherapy needs to be re‐oriented towards a person‐oriented study of therapist skills in action, in the context of a study of the interaction between therapist and patient.     

Emotion-Focused Therapy: An Interview with Leslie Greenberg

Over the past 30 years Leslie Greenberg has developed and refined the Emotion-Focused Therapy (EFT) approach. This therapy model stands apart from other, humanistic-based approaches in its focus on empiricism. In addition, EFT is one of the few therapy models that is truly integrative in nature, combining client-centered, gestalt, and cognitive principles. This paper includes a recent interview with Greenberg in which he describes the development of EFT and his views regarding future directions of EFT, as well as his views on the field of psychotherapy more generally.     

Integrating Individual and Family Systems Psychotherapy to Treat Borderline Personality Disorder

This paper focuses on two areas. The first is the framework for psychotherapy integration used by Unified Therapy, a psychotherapy approach that is an integration of psychodynamic, cognitive–behavioral, and family systems therapy. The second is the use of this treatment paradigm in the psychotherapy of adults with borderline personality disorder. The theory posits that continuing and recurrent interpersonal behavior patterns within the patient's family of origin serve as behavioral triggers to typical acting-out behaviors. Therapy is geared toward planning strategies to alter these destructive patterns. A case example is presented to demonstrate the use of the therapy's theories and techniques.     

Assimilation from the East and the Spectrum of Consciousness

Beginning with an eastern concept of human beings rooted in the Buddhist and Yogic traditions, this paper describes a theoretical assimilation of western models and therapies into the eastern paradigm. It traces the beginning of the east–west psychotherapy dialogue in the United States, citing early examples of Buddhist and yogic practices in the west. Ken Wilber's spectrum of consciousness model is presented and its unifying value for psychotherapy is explored. An integrative model of wholistic therapy, developed by a group of eastern and western practitioners, is then described. The paper concludes with an exploration of the issues and implications for psychotherapy integration raised by this model.     

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.     

Changes of attachment status among women with personality disorders undergoing inpatient treatment

Background: Attachment has increasingly received attention in psychotherapy and has been used as a predictor of process and outcome. Studies investigating changes of attachment styles during psychotherapy are very rare. Method: Forty women with either borderline (BPD) or avoidant personality disorders (AVPD), treated as inpatients, were investigated using an attachment interview (interpersonal relations assessment (IRA)), and questionnaires to determine therapy outcome at the beginning and after seven weeks of therapy. The IRA uses similar questions as the adult attachment interview (AAI) and is used as the basis for the adult attachment prototype rating (AAPR), a procedure to assign individuals to prototypical categories of attachment. Results: The study showed that the therapy in general was effective. In contrast to other studies, we did not find many women classified as secure at the end of their therapy. Comparisons of pre‐post‐ratings revealed instead that clients within both subgroups received higher ratings for the avoidant prototypes at the end of therapy, indicating deactivation of attachment. Changes from ambivalent to avoidant attachment were linked with better outcome among women with borderline personality disorder (BPD). Conclusions: This study adds further evidence to the result that attachment styles do not change dramatically during a time‐limited psychological treatment of personality disorder. Instead, the study showed that features of preoccupied/ambivalent attachment were less significant after seven weeks of therapy. For women with BPD, these changes were linked with a more favourable outcome which might reflect a more structured and deactivated attachment status as a result of inpatient therapy.     

What Revolution Would You Like to See In the Field of Psychotherapy? Introduction

Contributors to a theme issue were invited to address two questions: (a) What revolution would you like to see in the field of psychotherapy? (b) What makes it revolutionary? That is, how and why is it revolutionary? In a spirit of helping contributors do their job, an attempt is made to clarify the meaning of a revolutionary new idea in the field of psychotherapy by identifying components that do not especially belong, and by proposing components that can be thought of as defining the proposed meaning.     

Rational-Emotive Behavior Therapy: An Interview with Albert Ellis

Over the past 50~years, Rational-Emotive Behavior Therapy (REBT) has been developed and refined by Albert Ellis. REBT provides a framework for therapy that appears useful for many therapists and most clients. This paper includes a recent interview with Dr. Ellis, examining issues related to the development, application, and ongoing refinement of REBT as a useful and effective approach to psychotherapy.     

A call for dialogue: psychotherapists and psychologists specialising in psychotherapy

The development of psychotherapy as an independent discipline in many countries in Europe has stimulated debate within the field of psychology as to what constitutes psychotherapy as a specialism of psychology. The authors, both clinical psychologists who pursued further training in psychotherapy, offer a reflection in this paper on the historical battle between psychiatry and psychology for ‘ownership’ of psychotherapy, describe recent developments in Europe to clarify this specialism within psychology and discuss the distinctive contributions that psychologists offer in developing psychotherapy as a specialism within the discipline. The aim of the paper is to begin a dialogue both within the profession of psychology and outside the profession, with our psychotherapy colleagues, that can develop into an interdisciplinary discourse and a more mutually respectful professional environment.     

Considering methodological integrity in counselling and psychotherapy research

Within the field of counselling and psychotherapy research, qualitative methods have been a longstanding tradition of inquiry due to the mutual interest of therapists and researchers in both internal experiences and intersubjective processes. Methodological integrity is a conceptual framework that has been advanced to increase the rigor of these methods. In this paper, we consider the value of this concept for counselling and psychotherapy researchers and reviewers. This framework guides investigators and reviewers to consider how procedures can be adapted to meet the goals of specific studies, given their characteristics and approach to inquiry. In this brief article, we exemplify the relevance and application of this concept to this field by describing the decision‐making process within the designing of a qualitative research project to investigate clients' needs within rape crisis counselling. Through this exemplar, we also provide guidance to counselling and psychotherapy researchers on considerations during the process of research review and reporting.