The integrative attitude–a personal journey

The origins of clinical psychotherapy date from the beginning of last century and the development of broadly four foundational schools–psychoanalytic, cognitive-behavioural, humanistic and transpersonal psychologies. The imperative to integrate these schools, however, is relatively recent and in the last 25 years a professional integration movement has developed, exemplified by the formation of SEPI and the UKAPI, and ‘integrative psychotherapist’ is now the most popular nomenclature used in the profession. This article gives a brief history of the integration movement, reviews some issues raised by developments so far, and discusses the personal dilemma that integration evokes in the would-be integrative practitioner. Using my own journey I espouse an integrative attitude that is based on the nature of integration as an evolving personal process rather than an ideal, fixed, profession-wide position. I describe three interweaving modalities of integration I call constructive, complicit and contiguous integration, which form a developmental framework that aims to encourage the individual activity of questioning, inventing, researching and interrogating the discipline within its philosophical, professional and social context. In concluding, this article exhorts the profession to see integration as a personal journey, as a way of being that is constantly becoming and unfolding in relation with the therapist's training, experience and interaction with peers and clients. The result is indefinable and unnameable, and perhaps represents the soul of integrative psychotherapy.     

Prayer in psychotherapy: a model for its use, ethical considerations, and guidelines for practice

Although few guidelines exist, many therapists use prayer as a part of psychotherapy. The immense variance inherent in prayer behaviors and the paucity of literature on its use beckons the profession to develop a model for its use in therapy, examine the ethical implications for such use, and prepare guidelines for practice. A tripartite model for the conceptualization and localization of prayer in therapy is presented, ethical issues of therapist bias and competence and clients' right to autonomous decision making are considered, and guidelines for employing prayer in psychotherapy are developed.     

Self-assessment in clinical health psychology: a model for ethical expansion of practice

Society expects autonomous professions to ensure the competency of it practitioners, and professions should facilitate the continuing education and training of its members. Given the shift from psychology as a mental health profession to that of a health profession, the authors propose a self-assessment model for the individual practitioner to gauge his or her readiness to provide professional service in expanded areas of practice. This model could also be useful to the American Psychological Association, state psychological associations, and other purveyors of continuing education programs in systematically developing postgraduate experiences. A template for self-assessment that reflects well-accepted core domains of knowledge and skills is presented.     

Counselling and psychotherapy,complementary and alternative medicine and the future of healthcare

The counselling and psychotherapy profession is undergoing considerable change as a result of government intervention in the form of regulation, funding and efficacy research. In this paper we argue that these changes, even though they challenge some of the basic ways of thinking which have come to underpin the profession since its inception, also offer an opportunity to stimulate debate and thought in regard to how the profession might contribute to the development of healthcare systems in the future. We argue that this could be enhanced if therapists can learn from the experience of practitioners in the field of complementary and alternative medicine (CAM), which has been experiencing similar changes in recent years. Indeed, both fields of clinical activity adopt many similar underlying clinical principles and, according to Samuels (2001), have similar political outlooks. With reference to anthroposophic psychotherapy which, as well as being a form of psychotherapy, is also part of a ‘whole systems’ approach to CAM, we will examine those characteristics of psychotherapy and CAM that can inform the thinking of healthcare systems as a whole.     

Concurrent individual and individual-in-a-group psychoanalytic psychotherapy

This paper's thesis is that concurrent individual-in-a-group and individual psychoanalytic psychotherapy can be conducted in conformance with psychoanalytic principles of treatment as well as can individual psychoanalytic psychotherapy alone. American psychoanalysts have shown little interest in group psychotherapy, probably because of earlier criticism that transference is diluted by the greater reality of the therapist in group psychotherapy. This is a misconception extrapolated from the mirror model of dyadic analytic technique. The criticism was formulated during a period when that model was prominent and there was little awareness that the actual personal relationship between patient and analyst played an important facilitating role in the dyadic analytic process, including providing a basis for investiture of transference. Also, the criticism was based on one-session-per-week group psychotherapy, whereas concurrent individual-in-a-group and individual psychoanalytic psychotherapy utilizes two group sessions plus one or two individual sessions per week, enabling a more intensive patient-therapist relationship. Concurrent group and individual psychoanalytic psychotherapy constitutes a contribution to the widening scope of application of psychoanalytic treatment.     

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.     

Treating Parents and Children Together

SUMMARY

In this paper I look at two traditions of psychotherapy with children: family therapy {here considered in its common paradigm of systems theory and not in its diversity of approaches) and individual psychodynamically oriented child therapy. The author examines how, in these two modalities of treatment, the real world of the parent-child relationship, which remains mostly a world of women and children, tends to be left out in practice. Many family therapists “exclude” children from their sessions and concentrate on the marital relationship while child therapists “exclude” parents from the core of the therapeutic process. The issues for therapists and the consequences for adults and children in families in this com-partmentalization of services are examined within a feminist framework. The development which is advocated is for therapists to expose themselves fully to the world of the parent-child relationship as a fust step in reexamining their stereotypical views of motherhood and fatherhood which trap women in conflicted and potentially exploitative situations and do not consider that children actively construct their own relationships.     

Psychotherapy and Pharmacotherapy Treatment Outcome Research in Pediatric Populations

Reviewed treatment interventions for pediatric populations involving the combination of pharmacotherapy or psychotherapy or either treatment employed alone. The literature revealed a dearth of psychotherapy and pharmacotherapy outcome studies, with the exception of investigations of children diagnosed with attention-deficit hyperactivity disorder (ADHD). Issues pertaining to design, including sample selection, treatment integrity and comparability, and placebo controls also are reviewed. A potpourri of other issues are noted including parental attitudes toward the use of medication versus psychotherapy, treatment adherence, and patient/provider relationship. For children diagnosed with ADHD, the use of stimulant medication appears to be superior to psychotherapy employed alone in managing the behavior of these children as well as their classroom functioning. Recommendations are made for multimodal trials that examine the combined and individual use of pharmacotherapies and psychotherapies for various developmental and psychiatric disorders that occur in childhood and adolescence. Future studies also need to address the durable effects of these treatment options.     

Social and political perspectives on the psychotherapy and counselling profession: Returning caravelles

The counselling and psychotherapy profession is changing. For the first time in its history, it has begun to receive substantial Government funding in the UK and it also has to contend with the principles of evidence-based practice and the policies of the New Public Management systems in many countries. This paper argues that such recent developments present challenges to the profession’s historical apolitical standpoint. More importantly, it argues that the present social and political climate offers many opportunities such as the possibility of learning from psychosocial practices in other countries. The paper will look, in particular, at what can be learned from Latin America and India where mental health care and psychological therapy have adopted grassroots involvement, health-focused approaches and innovatory therapeutic methods.     

Legislative warriors: American psychiatrists,psychologists, and competing claims over psychotherapy in the 1950s

American psychiatrists and psychologists have long been close colleagues and fierce rivals. There is no better illustration of this polarized relationship than the chronic tug-of-war over psychotherapy. Both groups laid claim to psychotherapy-whatever it was and however it was practiced. Psychiatrists attempted to monopolize psychotherapy despite its ambiguous status as an essential component of the healing arts. After the war, psychologists pressed for a share on the basis of their qualifications and competence, but struggled to overcome the limitations imposed by medical envy. This story lays bare the crucial function of tools and techniques for defining the identity and the boundaries of a science-based profession.     

Strukturbezogene Psychotherapie

Structure-oriented psychotherapy is a variant method of the psychodynamic therapeutic procedure concerned with the therapeutic encouragement of insufficiently available structural abilities of patients, in contrast to realization of conflicts. This form of psychotherapy is based on the definitions of Operationalized Psychodynamic Diagnostics (OPD) and the diagnostic and therapeutic studies carried out with this method in the comprehension of structural functions and levels. The therapeutic approach and the therapeutic attitude were formulated with respect to the developmental psychological aspects of early relationship disorders. The method is indicated where, for example in severe personality disorders the clinical picture is determined by the structural problems of self-regulation and relationship formation. In this case the patient should first be actively stabilized in order to then increasingly transfer responsibility for self-regulation and way of life and to work these out together. The individual stages of the therapeutic process and the special interventions against the background of a development promoting, parental-like therapeutic attitude will be described.     

The function of the therapist's affect in therapeutic conflict in groups

Group psychotherapy theory and technique are presented with the goals of helping group practitioners working with difficult clients: 1) develop a treatment plan; 2) create a therapeutic alliance; 3) foster a responsive group climate; and 4) utilize the therapist's countertransferential reactions in dealing with therapeutic conflict. Historical modifications of the analyst's role in the development of group psychotherapy are noted. Emphasis is give to the recognition of therapist-client identifications in order to separate feelings induced in the therapist from countertransferential reactions, to enable the practitioner to respond appropriately to the affective and inspirational substratum of therapeutic groups.     

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.     

Experiential personal construct therapeutic artistry: The therapy relationship and the timing of interventions

Abstract

Experiential personal construct psychotherapy focuses on the intimate, interconnected, and evolving relationship between the therapist and the client as vital to therapeutic growth. Great creativity is demanded of the therapist who aspires to connect with clients in life‐changing psychotherapy. This article first describes the essential nature of the therapy relationship with its implicit and explicit demands for therapist creativity. These principles then are illustrated through a discussion of the critical issue of timing therapeutic interventions.     

The Influence of Retention,Turnover, and Alliance on Process and Outcomes in Rolling Group Psychotherapy for Cocaine Disorder

A longitudinal repeated measures design was used to investigate the influence of treatment retention, and membership turnover on individual outcomes, and the relationship between individual-level and group-level therapeutic alliance in rolling group psychotherapy for individuals with cocaine abuse disorder. Eighteen patients were studied; data were collected prior to therapy and then monthly for 24 months. Patient outcomes and process were assessed. Improvements in symptoms and psychological functioning were associated with retention in psychotherapy. Membership turnover had a negative influence on symptoms. Development of an individual alliance was affected by the development of group-level therapeutic alliance, but not by time spent in therapy.     

Theorietreue und Variationen

Interventional techniques can be integrated into inpatient group psychotherapy. Our approach is not meant to be a wild eclecticism but an empirically founded interventional repertoire that contains psychoanalytical, depth psychological, behavioral and hypnotic therapeutic interventions. A “uniform solution” for an integrative therapy is not possible. A tension between theory conformity and variations remains inherent to psychotherapy for a multitude of reasons. An interventional repertoire is illustrated by case examples which use operationalized psychodynamic diagnostics (OPD). The results must be appraised within the time frame of inpatient treatment. The conception in guideline psychotherapy that the individual approaches cannot be mixed because they would lose their effectiveness, does not correspond to our experiences. The chances and risks of switching interventions must be considered.     

Towards a relationally-orientated approach to therapy: empirical support and analysis

Drawing on contemporary evidence in the counselling and psychotherapy research field, this paper argues that there is growing support for a relationship-orientated approach to therapeutic practice. The paper reviews findings from a range of meta-analytical and individual studies which provide strong evidence for the centrality of relational factors to the successfulness of therapy, and then goes on to examine the specific variables that appear to be linked to positive therapeutic change. Having considered some of the empirical evidence that challenges this position and highlighted the importance of individual differences, the paper concludes by arguing that we need to develop and expand our understanding of the kind of relational factors and processes that most facilitate therapeutic change.     

The Hope,Promise, and Possibility of Psychotherapy

In this paper, five values—diversity, science, education, practice, and spirit—(a) are examined within the professional context of psychotherapy, (b) are presented as forming the foundation of much if not all that is psychotherapy, and (c) are considered as binding values that join us as a community of practicing, theorizing, and researching psychotherapists. Some of the positives of each value are reviewed. Diversity has heightened our sensitivity to and respect for individual and cultural differences. Science has kept us focused on empirically challenging and empirically informing our practice. Education has maintained emphasis on providing solid training/supervision in psychotherapy and transmitting its culture. Practice has provided us with opportunities to increasingly implement and expand on our role as helpers and healers. Spirit has been the guiding light—the heart and soul—that supports, infuses and informs all of our therapeutic endeavors and gives them meaning. What follows is a celebration of sorts—(a) capturing some of what we have done and are doing right in psychotherapy, (b) reflecting some of the weight of those “right” efforts, and (c) conveying some of the inherent hope, promise, and possibility that forever guide us in our work.     

Existential psychotherapy and the therapeutics of activism*

This paper considers the socio-political perspectives of Sartre, de Beauvoir and Fanon and their relationship to existential psychotherapy practice. It argues that their existential analyses of oppression must play a greater part in informing existential psychotherapeutic practice and pedagogy. In this current neo-liberal political age, in which therapy is increasingly being utilised as a form of psychological coercion and mystification, an understanding of the structures and systems of alienation and oppression that construct experience must translate to a broadening therapeutic concern beyond individual to social change. The author suggests that engaging with a politics of alienation and actively responding to the oppressive social conditions which generate distress and marginalisation should be intrinsic to existential psychotherapy practitioners and their representing institutions.