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.     

Between the street and the consulting room: The role of therapeutic frame in working with homeless clients

This paper explores the context of psychotherapy with people who are homeless and the kinds of dynamics and challenges that typically arise in this work. The paper specifically considers the process of therapy as it takes place with clients who have been recurrently homeless and who have difficulties with sustaining shelter that has its roots in deficits in early containment. Clinical case material from psychotherapy conducted with two homeless men is presented and the implications of the approach adopted are explored both in relation to policies around the provision of services for homeless people and the more specific issue of psychotherapy intervention.

It is argued that a clear, well-articulated set of expectations has to be developed around this work in order to protect it and to provide it with the greatest opportunity for providing the kind of safety that is required for the development of this work. It is argued that the most important issue here relates to the provision of a consistent therapeutic framework and a care around the development of the specific psychotherapeutic frame within, and in relation to, the other frames present in the person's life.     

Issues in using interpreters in therapeutic work with refugees. What is not being expressed?

‘Interpreting’ could be thought about as a legal equal opportunities or human rights issue. Whereas interpreters are likely to focus on the linguistic issues, and will be aware of the technical complexities of their work. Clinicians may worry about the impact on the therapeutic relationship of the interpreter's presence, how this will be managed and how it may depend on the match or mismatch of such factors as the client's gender, age and first or other language. This paper considers the issue on each of these levels to reveal the complexities and dilemmas of effective clinical work with interpreters, but also what can be achieved: the multiple layers of meaning concerning the client's experience and communication which can be elicited through effective working between interpreter and clinician.     

Integrating different types of knowledge in supervision

The present article examines ways to integrate two, often contradictory, types of knowledge in supervision, which are sometimes represented either by supervisors or supervisees, and sometimes by different parts in the supervisee. These types of knowledge are in a dialectic relationship: they may define each other and at the same time influence and shape each other, yet remain two separate sources for understanding the therapeutic experience. One type is the primary, vague, and intuitive knowledge about patients and therapist–patient interactions, derived from actual participation in the therapeutic relationship. The other type is knowledge derived from theory, experience acquired mainly outside of the specific therapy, and dialog with colleagues.     

Intentional attention switching in dichotic listening: Exploring the efficiency of nonspatial and spatial selection

Using an auditory variant of task switching, we examined the ability to intentionally switch attention in a dichotic-listening task. In our study, participants responded selectively to one of two simultaneously presented auditory number words (spoken by a female and a male, one for each ear) by categorizing its numerical magnitude. The mapping of gender (female vs. male) and ear (left vs. right) was unpredictable. The to-be-attended feature for gender or ear, respectively, was indicated by a visual selection cue prior to auditory stimulus onset. In Experiment 1, explicitly cued switches of the relevant feature dimension (e.g., from gender to ear) and switches of the relevant feature within a dimension (e.g., from male to female) occurred in an unpredictable manner. We found large performance costs when the relevant feature switched, but switches of the relevant feature dimension incurred only small additional costs. The feature-switch costs were larger in ear-relevant than in gender-relevant trials. In Experiment 2, we replicated these findings using a simplified design (i.e., only within-dimension switches with blocked dimensions). In Experiment 3, we examined preparation effects by manipulating the cueing interval and found a preparation benefit only when ear was cued. Together, our data suggest that the large part of attentional switch costs arises from reconfiguration at the level of relevant auditory features (e.g., left vs. right) rather than feature dimensions (ear vs. gender). Additionally, our findings suggest that ear-based target selection benefits more from preparation time (i.e., time to direct attention to one ear) than gender-based target selection.     

Attention and action: The role of response mappings in auditory attention switching

Switching auditory attention incurs a performance decrement (i.e. auditory attention-switch costs). Using an auditory attention-switching paradigm, we aimed to generalise these across different response mappings. In all three experiments, two number words, spoken by a female and male speaker, were presented dichotically via headphones. A visual cue indicated the gender of the to-be-attended speaker in each trial. The task was a magnitude judgement of the relevant number word (i.e. smaller vs. larger than 5). We additionally varied the interval between cue onset and auditory stimulus onset (cue-stimulus interval) to explore cue-based preparatory effects. In Experiment 1, attention switching was more costly with direct-verbal responses (e.g. ‘smaller’) than in the shadowing task (e.g. ‘three’). In Experiment 2, performance was largely similar for direct-verbal responses and abstract-verbal responses (e.g. ‘left’). In Experiment 3, performance was generally worse with abstract-verbal responses than with abstract-manual responses (e.g. left key press) and auditory attention-switch costs were similar for both response mappings. Overall, auditory switch costs occurred more or less invariably across response mappings in categorical (magnitude) judgements suggesting a minor role of the response mapping in auditory attention switching. Furthermore, verbal identity-based judgements (i.e. shadowing) generally seem to benefit from ideomotor compatibility.     

Humor and Its Contributions to Mental Health

Self control assistance includes steady doses of humorous comment and reflection. Getting past the perfect person syndrome en route to an emotionally healthier existence can be done by the appreciation of use of humor. Distinguishing between commercialized and rational humor allows for more permanent long range happiness and survival. To be able to laugh and learn at the same time are two bull's-eyes that promote more optimal emotional well-being. Humor ignites thirty-seven listed provisions in the service of emotional health. Fifteen precise dimensions of mental health that humor can pave the way toward are reviewed. Twenty-nine irrational beliefs about humor are fleshed out followed by nine types of rational humor. Stories and stormy anecdotes from the wiles of the author's practice of psychotherapy and parenting misdemeanors further document the topic under consideration.     

Therapist responses to requests for disclosure of therapeutic records: An introductory study

This paper describes a questionnaire survey of therapists in the UK who have been subject to requests for disclosure of client records as part of a legal process. Therapist responses are outlined in terms of the perceived effect of such disclosure on the client, therapist and the therapeutic relationship. Negative effects included the experience of exposure of sensitive client material in an adversarial legal system, of powerful emotional responses by therapists, and a sense of feeling professionally de‐skilled in an unfamiliar and often challenging legal environment. Positive effects for the client included the achievement of valued outcomes such as compensation, and, for the therapist, the facilitation of support for the client in this process. These findings are discussed in terms of a contrast between therapist perceptions of consensual and contested disclosure. In the former, therapist and client are in agreement about the restorative value and outcome of disclosure. In contested disclosure, the process is experienced as disrupting therapeutic privacy, undermining professional self‐confidence and introducing an unwelcome element of critical re‐evaluation of client motives for undertaking therapy.     

The Therapeutic Community Sing: Music Therapy Inpatient Group Process

Early psychoanalytic authors and music educators in both Europe and the United States pointed to the contemporary use of music therapy as a powerful modality in an inpatient psychiatric unit. The inpatient community sing is discussed in its capacity to address both individual and group goals. A clinical vignette from such a group is presented and discussed.