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.     

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.     

Treatment of Excessive Interpersonal Dependency: A Cognitive-Behavioral Model

Clients with excessive dependency often seek treatment for an Axis I anxiety or mood disorder. Simply providing treatment for the Axis I disorder may fail to address the long-standing personality factors that may underlie the acute anxiety and depression. A four-stage model has been proposed for the treatment of excessive interpersonal dependency. This model describes strategic ways therapy content and style should change over the course of treatment. Despite the apparent utility of the four-stage treatment model, it may be difficult to apply in many sites that now emphasize short-term approaches to treatment. In many cases, therapy can be designed to address themes that are relevant to both dependency and the Axis I syndrome. Therapy can be focused around helping clients make improvements in stabilizing emotional reactions, enhancing views of the self, and improving social functioning. Treatment focused on stabilizing emotional reactions can help clients confront and develop tolerance for feelings of depression and anxiety. Treatment focused on enhancing views of the self can help clients improve their self-esteem, self-reinforcement and reduce self-criticism. Treatment focused on improving social functioning can enhance social skills, reduce social anxiety and challenge feelings of loneliness. In addition, treatment can focus on reducing specific aspects of interpersonal dependency and confronting developmental antecedents that may underlie the dependency.     

Cognitive-Behavioral and Personal Construct Therapies for Depression in Women with Fibromyalgia: A Randomized Controlled Trial

Background/ObjectiveFibromyalgia is a chronic pain syndrome that depressive symptoms can aggravate. The aim of the present study was to test the efficacy of Personal Construct Therapy (PCT), an approach that emphasizes identity features and interpersonal meanings as the focus of the treatment of depressive symptoms, in women with fibromyalgia.MethodWe compared PCT with Cognitive Behavioral Therapy (CBT) in a multicenter parallel randomized trial. Women with fibromyalgia and depressive symptoms (n = 106) were randomly allocated to CBT (n = 55) or PCT (n = 51) in individual and modular formats to adjust to their needs. Analysis was by linear mixed-effects models.ResultsParticipants in both conditions had significantly reduced depressive symptoms, and we found no significant difference when comparing groups both post-treatment (β = -0.47, t = -0.49, p = .63) and at follow-up (β = -1.12, t = -1.09, p = .28). Results were similar between conditions for anxiety, fibromyalgia's impact, and the distribution of clinically significant changes in depressive symptoms and pain.ConclusionsPCT and CBT seem to be equally effective in the treatment of depressive symptoms, making PCT a viable alternative treatment.     

Family-Based Cognitive-Behavioral Treatments for Suicidal Adolescents and Their Integration With Individual Treatment

A considerable research base underscores the importance of family functioning in the risk for and treatment of adolescent suicidal thoughts and behaviors. This paper reviews the extant empirical literature documenting associations between features of the family context and adolescent suicidal thoughts and behaviors. A case example is provided to illustrate how family factors may guide case conceptualization and treatment planning for suicidal adolescents. In light of the growing support for treatment approaches predicated on the principles of cognitive-behavioral therapy (CBT), the paper focuses on many of the common family treatment elements, notably interventions with parents across treatment studies with adolescent suicidal populations. A specific treatment known as CBT for Suicide Prevention (CBT-SP; Stanley et al., 2009) serves as an exemplar for how interventions with parents may be applied in the context of an integrated intervention for teen suicide. The paper reviews issues salient to the implementation of key components of treatment with parents and addresses specific treatment considerations and challenges.     

Adapting Cognitive-Behavioral Therapy for Depressed Adolescents Exposed to Interpersonal Trauma: A Case Study With Two Teens

A substantial body of evidence indicates that interpersonal trauma increases risk for adolescent and adult depression. Findings from 4 clinical trials for adolescent depression show poorer response to standard cognitive-behavioral therapy (CBT) among depressed adolescents with a trauma history than youth without such a history. This paper reports on the development of a modified CBT (mCBT) protocol that has been adapted for treating depressed adolescents who have been exposed to traumatic interpersonal events (physical/sexual abuse or witnessing domestic violence). First, we provide an empirical rationale for targeting executive function deficits and trauma-related cognitions in the mCBT protocol. Second, we present promising results from 2 community clinic cases.     

Medical Decision-Making: An Argument for Narrative and Metaphor

This study examines the processes ofdecision-making used by intensive care(critical care) specialists. Ninety-ninespecialists completed a questionnaire involvingthree clinical cases, using a novel methodologyinvestigating the role of uncertainty andtemporal-related factors, and exploring a rangeof ethical issues. Validation and triangulationof the results was done via a comparison studywith a medically lay, but highly informed groupof 37 law students. For both study groups,constructing reasons for a decision was largelyan interpretative and imaginative exercise thatwent beyond the data (as presented), commonlyresulting in different reasons supporting thesame conclusions and similar reasons supportingopposite conclusions. The skills of ethicalimagination and interpretation were related toan individual's prior lived experience,construed in the broadest sense. Application ofthese skills of ethical imagination andinterpretation always occurred, to some degree,in a state of uncertainty and almost alwaysinvolved temporal relationships.Using these results, a theory of ethicaldecision-making is proffered. Three levels ortypes of reasoning processes may be present.Type I decision-making involves the applicationof rules, usually in a deductive fashion. TypeII decision-making is characterised by aprocess where a plurality of reasons arebalanced, weighed and sifted with each other.Type III decision-making is intimately linkedwith respondents lived experiences and `crafts'the content of type I and II reasoningprocesses, via the application of ethicalimagination and interpretation. Relationshipsbetween these three types of reasoningprocesses, and with narrative ethics, are alsodiscussed.     

Intelligent-Design Theory: An Argument for Biotic Laws

A central thesis of intelligent‐design theorists is that physical and chemical laws and chance are insufficient to account for irreducibly complex biological structures and that intelligent design is necessary to account for such phenomena. This assertion, however, still implies a reductionist ontology. We need to recognize that reality displays multiple modes of being beyond simply chemical and physical modes of being, each of which is governed by laws for that mode of being. This essay argues for an alternate framework for understanding life phenomena that is neither philosophical materialism nor intelligent‐design theory.     

An Epistemic Argument for Conservatism

‘Epistemic’ arguments for conservatism typically claim that given the limits of human reason, we are better off accepting some particular social practice or institution rather than trying to consciously improve it. I critically examine and defend here one such argument, claiming that there are some domains of social life in which, given the limits of our knowledge and the complexity of the social world, we ought to defer to those institutions that have robustly endured in a wide variety of circumstances in the past while not being correlated with intolerable outcomes. These are domains of social life in which our ignorance of optimal institutions is radical, and there is uncertainty (rather than quantifiable risk) about the costs of error. This is an argument for the preservation of particular institutions, not particular policies or outcomes, and it specifically identifies these with the institutions that John Rawls called ‘the basic structure of society.’ The argument further implies that to the extent that there is any reason to change these institutions, changes should be calculated as far as possible to increase their ‘epistemic power.’     

Patriotism and Human Rights: An Argument for Unpatriotic Patriotism

This paper centres on the question as to whether human rights can be reconciled with patriotism. It lays out the more conventional arguments which perceive them as incommensurable concepts. A central aspect of this incommensurability relates to the close historical tie between patriotism and the state. One further dimension of this argument is then articulated, namely, the contention that patriotism is an explicitly political concept. The implicit antagonism between, on the one hand, the state, politics and patriotism, and, on the other hand, human rights, is illustrated via the work of Carl Schmitt. However, in the last few decades there has been a resurgence of interest in patriotism and an attempt to formulate a more moderate form, which tries to reconcile itself with universal ethical themes. Some of these arguments are briefly summarised; the discussion then focuses on Jürgen Habermas’s understanding of constitutional patriotism. This is seen to provide an effective response to Schmitt’s arguments. There are weaknesses in the constitutional patriotic argument which relate to its limited understanding of both the state and politics. This leads me to formulate my own argument for “unpatriotic patriotism.” The discussion then examines and responds to certain potential criticisms of this argument.     

Depression and the Emotions: An Argument for Cultivating Cheerfulness

In this paper, I offer an argument for cultivating cheerfulness as a remedy to sadness and other emotions, which, in turn, can provide some relief to certain cases of depression. My thesis has two tasks: first, to establish the link between cheerfulness and sadness, and second, to establish the link between sadness and depression. In the course of accomplishing the first task, I show that a remedy of cultivating cheerfulness to counter sadness is supported by philosophers as diverse as Thomas Aquinas, Baruch Spinoza, and David Hume in their writings on the passions. I also show that my argument can generalize to promote the cultivation of other emotions. In the course of accomplishing the second task, I consider different models of depression and how the emotions are related to depression. The purpose of this paper is to offer conceptual, philosophical support that is consistent with the most current empirical data on depression.     

Eclecticism and integration in counselling: Implications for training

The multiplicity of approaches in the field of counselling, together with a growing interest in eclecticism and integration amongst practitioners, present a challenge for counsellor trainers. One way in which this challenge is being met is by the development of training programmes that purport to be integrative. The development of such programmes, however, presents a further challenge to trainers, since sophisticated integration is rare. Some of the issues needing careful consideration by trainers involved in integrative programmes are explored under the headings of 11 key statements.     

Attachment,Contemporary Interpersonal Theory and IPT: An Integration of Theoretical,Clinical, and Empirical Perspectives

Interpersonal Psychotherapy (IPT) is an effective, pragmatic treatment for depression but interpersonal explanations of its effectiveness are not fully developed. This paper presents an integration of aspects of attachment theory and contemporary interpersonal theory which explains how interpersonal interactions contribute to a clinical understanding of depression and its treatment through IPT. We test hypotheses of interpersonal change in a case series of depressed patients treated with IPT. The results demonstrate that both attachment insecurity and interpersonal problems improve significantly over a 16 week course of treatment. Further research into the interpersonal processes that alleviate depression is needed.