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.     

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.     

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.     

Financial and Ethical Considerations for Professionals in Psychology

The profession of psychology is one of many entities affected by the current economic recession. The question of what to do when clients cannot pay agreed-upon charges will need to be answered. Ethical issues related to setting the fee for psychotherapy, insurance coverage, abandonment, pro bono psychotherapy, and lack of resources are addressed in light of the 2002 American Psychological Association's Ethical Principles of Psychologists and Code of Conduct and other relevant literature. The impact of the Mental Health Parity Act on the financial complexities that professionals in psychology now face is also discussed. Several recommendations are made for psychologists, calling them to be proactive in their communities, to be advocates for their clients, and to critically evaluate their financial practices.     

Where Has All the Psyche Gone? Searching for Treatments That Focus on Psychological Issues

The field of psychotherapy can be aided by adopting an integrative model that follows a comprehensive biopsychosocial perspective. Unfortunately, recent advances in the field of psychopharmacology have appeared to overshadow the gains that can be made through psychotherapy. Psychotherapists need to protect the psyche that lies at the core of their treatment. Psychotherapy can promote changes in cognitive processes that help to reduce psychiatric symptoms and enhance adaptive functioning. Psychotherapists should not neglect the role of biological or social factors in the etiology or treatment of mental illness. Many clients benefit from a comprehensive biopsychosocial model and interdisciplinary collaboration among mental health professionals. Psychotherapists can maintain a strong emphasis on psychological functioning, while colleagues from other fields focus on the biological and social aspects of mental illness. Furthermore, it seems important for psychotherapists to emphasize the unique qualities of psychotherapy that are distinct from the social support that is provided from a close and confiding friendship.     

A pluralistic framework for counselling and psychotherapy: Implications for research

Historically, training, research and practice in counselling and psychotherapy have been dominated by unitary theoretical models. Although integrative and eclectic positions have been developed as alternatives, these have not been successful in generating research and have resulted in a further proliferation of competing models. In this paper we introduce a ‘pluralistic’ framework for counselling and psychotherapy and discuss the implications of this framework for research. The basic principle of this pluralistic framework is that psychological difficulties may have multiple causes and that there is unlikely to be one, ‘right’ therapeutic method that will be appropriate in all situations—different people are helped by different processes at different times. This pluralistic framework operates as a meta‐theory within which it is possible to utilise concepts, strategies and specific interventions from a range of therapeutic orientations. The framework is structured around three domains—goals, task and methods—by which therapeutic processes can be conceptualised, critically examined and empirically investigated. These domains, and the relationships between them, are outlined and the collaborative relationship at the heart of the pluralistic framework is discussed. The pluralistic framework provides a means for empirical research directly to inform practice and potential lines of empirical inquiry are outlined, along with findings from a recent study of counselling in schools.     

Rethinking a Familiar Model: Psychotherapy and the Mental Health of Refugees

This paper examines with a somewhat critical eye the primary role that psychotherapy and other clinic-based services currently play in addressing the mental health needs of political refugees in the industrialized countries. Two factors are considered which suggest that refugee mental health needs might be better served by complementing clinic-based treatments with a variety of community-based interventions. The first factor concerns the pervasiveness of psychological distress within refugee communities, coupled with the reluctance of many refugees to utilize formal psychological and psychiatric services. This calls into question both the adequacy and appropriateness of clinical-based services as cornerstones of our response to the mental health needs of refugees. More precisely, it suggests the need to complement such services with a variety of culturally grounded, community-based strategies that do not require attendance in formal mental health settings. Second, recent findings have shown consistently that a considerable amount of the distress reported by refugees is related not to prior exposure to violent events, but to a constellation of exile-related stressors such as the loss of one's community and social network, the loss of important life projects, changes in socioeconomic status and related concerns about economic survival, the loss of meaningful structure and activity in daily life, and the loss of meaningful social roles. It is suggested that while psychotherapy can play an important adjunctive role in helping people confront these exile-related stressors, they may most effectively be addressed through targeted community-based interventions. Examples of such community-based approaches are briefly described, and suggestions are offered for community-level strategies that might be explored. The paper concludes by emphasizing the complementary nature of clinical and community-based programs, and by suggesting that psychotherapy might best be conceptualized as one component of a more comprehensive approach to addressing the mental health needs of refugee communities.     

Improving Methodologies for the Treatment of Child and Adolescent Disorders: Introduction

This special issue grew out of a workshop sponsored by the National Institute of Mental Health, the MacArthur Foundation, and the Child and Adolescent Psychosocial Interventions Consortium. The goals of the workshop are outlined. The contents of the special issue are then described: definitions of psychotherapy and its mechanisms of action, developmental issues in psychotherapy research, methodologies for the treatment of anxious youth, measurement of change in interventions, predicting the outcome of treatment, and advancing the efficacy and effectiveness of psychosocial treatments. Finally, some areas that need to be addressed in the future are discussed, such as process research, the effects of comorbidity on outcomes, intensity, and duration, and transferability of treatments.     

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.     

Childhood depression: A place for psychotherapy

Pharmacotherapy and psychotherapy are the two dominant mental health treatment modalities, but they are often taught and practised very separately leading to polarisation which may fragment treatment delivery. This paper presents results from a small qualitative study of interfaces between these modalities as described by medical and non-medical professionals practising in the National Health Service (NHS) and explores whether this polarisation maps to the Kleinian ‘P/S’ (paranoid/schizoid) and ‘D’ (depressive) positions, the ‘P/S’ position of omnipotence and dominance of one model over the other shifting the attention away from a more realistic ‘D’ position of integration and concern for the patient. The challenges to the integration of pharmacology and psychotherapy are examined in reference to cultural, organisational, relational and intrapsychic issues. Finally, clinical implications of an integrative approach are considered.     

Increasingly informed consent: discussing distinct aspects of psychotherapy at different points in time

Psychologists are ethically obligated to obtain informed consent to psychotherapy "as early as is feasible" (American Psychological Association, 2002, p.1072). However, the range of topics to be addressed includes both information that may be immediately and uniformly applicable to most clients via policy or rule, as well as information that is not immediately presentable because it varies widely across clients or emerges over time. In this study, licensed psychologists were surveyed regarding the earliest feasible point at which they could provide information regarding specific aspects of psychotherapy. Results indicate that, although psychologists believe that they are capable of presenting some information, such as payment and confidentiality policies, at the outset, they believe that a discussion of more substantive issues, such as psychotherapy duration, goals, orientation, and activities, can take place only after some therapy has transpired. Implications are discussed regarding the process and event models of informed consent.     

Attitudes about psychotherapy: A qualitative study of introductory psychology students who have never been in psychotherapy and the influence of attachment style

Design: Interviews about attitudes about psychotherapy with 12 undergraduate students who had never been in psychotherapy were analysed using consensual qualitative research. Results: Participants believed that the client role is to disclose, be receptive, and be motivated; that the therapist role is to listen, support, and give advice; and that the therapeutic relationship should be close and personal. Participants had ideas about the benefits (a healing therapeutic relationship, personal and interpersonal changes) and the barriers (self‐stigma and public stigma, difficulty revealing, need to solve problems on own, cost) associated with seeking therapy, and they disliked the idea of being diagnosed. In contrast with participants who were securely attached, those who were insecurely attached more often wanted a professional therapeutic relationship, wanted the therapist to ask questions, mentioned fewer benefits to therapy, and thought that they would have difficulty disclosing to a therapist. Discussion: Implications for changing attitudes about psychotherapy and improving training programs for practitioners are discussed.     

Race,racism and systemic supervision

The idea of ‘race’ and the social reality of racism have gained increasing attention in family and systemic psychotherapy. This article seeks to extend this attention by focusing upon the influence of race and racism in the supervision of family and systemic psychotherapy. The way in which the idea of race might be conceptualized is discussed, before looking at how race and racism have been addressed in the field. Attention is then turned to systemic supervision, focusing upon the ideas generated about how supervisors might position themselves in relation to these issues, the implications this might have for the supervisory relationship and the relationships between supervisees and client families. It is proposed that by virtue of the supervisor's position of power over the supervisee, it is the supervisor's responsibility to initiate conversations about race and racism. A proposal for this task is outlined, which recognizes that these conversations are ongoing. A concluding assertion is made that such conversations should form part of the evaluative process for trainee supervisors.     

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.     

Chaos, Group Psychotherapy, and the Future of Uncertainty and Uniqueness

This paper explores the application of chaos theory, a new non-linear dynamical theory, to the understanding of psychotherapy groups. Two features of psychotherapy groups that have been insufficiently described or explained, uncertainty and uniqueness, are considered in the light of the chaos theory notion that groups proceed through periods of order and disorder. The recommendation is made that chaos theory be explored further as the field moves into the millennium and a hundred years of its own existence.     

Integrative Therapy and Training: A Commentary

The authors in this series present innovative training programs in integrative psychotherapy. Although they approach integration from different starting points, they converge in their emphasis on principle-based thinking as it applies to understanding the process of change and the selection of interventions. What is not made as clear is how to conceptualize clients' problems from this principle-based level of abstraction. In this paper, the strategy of pattern identification is discussed as one approach. Together, these approaches to training teach clinicians to think at a level of abstraction that provides a structure for integrating theory and technique from a constantly evolving knowledge base so that a wide variety of clinical problems can be addressed.     

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.     

Internal cohesion psychotherapy: The nature,principles and application

Psychotherapy is widely used to treat different mental health disorders and emotional difficulties. The main objective of psychotherapy is to help clients become aware of and have control over their thoughts, moods, feelings and behaviours, as well as create healthy strategies to respond to challenging situations. Since the existing psychotherapy approaches and other methods of treatment are not always effective in treating mental health disorders, there is still space for new approaches to fill this gap. In this paper, we provide information about internal cohesion psychotherapy, which is a new integrative approach. This paper presents a new approach to eclectic psychotherapy, focussing on four detrimental aspects of human functioning through different time perspectives.