Theoretical Considerations

EDPS 602
N I C O L E D A R L I N G T O N , J OA N N E
TA K E N A K A A N D A L I C I A M A R C H I N I

Theoretical Considerations: Overview

Choosing a Theory
Adapting a Theory
Learning to be Responsive to Your Clients
Integrative Psychotherapy

Diagnosis
Coping
Client Preferences & Cultural Considerations
Processes and Therapeutic Relationship
Treatment Planning
Relapse Prevention

Implications to Consider

Adopting a Theory
The importance of identifying a theory that you believe in:

helps you become an effective therapist

helps client and therapist establish a rationale for change based on
the theory

The therapy is not as influential as the therapist is on the

outcome, so its important to commit to continual personal

and professional development

Adopting a Theory
Highly effective therapists involve their personal and

professional values, beliefs, and behaviours as they develop

professionally
An open attitude when it comes to learning is necessary
because therapists with an open attitude
actively explore and learn through lessons
and experiences

Shapes their therapeutic self into a confident,

congruent, and effective therapist, which leads to a
longer and more satisfying career

Choosing a Theoretical Orientation

Caution: Adopting the theoretical orientation of
their mentor or training program may result in an
incongruent or conflicting personal worldview and
theoretical orientation
Choose your own therapeutic system, consistent with your
personal values and views
Therapists who dont adopt a theoretical approach are more
likely to feel ineffective, stagnant, and dissatisfied
When you find your theory, explore the different theorists and
rationales

Find one that you find most appealing

Study it intensely by reading about it, attending workshops, and
joining discussion groups in person or online

Learn From Experience

Ensure that dissonance or crisis leads to growth, rather

than hindrance by keeping an open mind during

learning and experiences and by engaging in self-care
practices
Be flexible in the adaptation of preferred theory and
consider clients worldview

Learn From Experience

Develop referral relationships with other therapists,

particularly therapists who use different theoretical

approaches to psychotherapy
Strive to adapt your personal approach through:

self-reflection and self-care, such as personal therapy

continual education, consultation, and supervision with
experienced therapists

The Well-Seasoned Therapist

A well-seasoned therapist:

understands and appreciates that each theory of

psychotherapy is relatively reliable and valid, without being
definitive
revise their approach through assimilative integration (i.e.,
gradually incorporating change tasks and processes from other
theories into their preferred theory)

Learn to be Responsive to Your Clients

Use your preferred approach as the basis from which to develop

a therapeutic rationale that both you and the client believe in

Be mindful of the assumptions of your preferred theory, consider

the uniqueness of the individual (i.e., diagnosis, gender, religion,
etc.)
Be open to adapting your approach to incorporate your worldview
and the worldview of your client.
Be cautious when identifying the categories to which the individual
belongs

True collaboration within a shared therapeutic rationale can

come from listening and responding closely and empathetically to
each clients view of his or her place in the world (Truscott, 2010,
p. 165)

Learn to be Responsive to Your Clients

Cultural Considerations

Cultural encapsulation: the mistaken assumption of many

therapists that others share their worldview

they believe that they are morally, ethically, and politically neutral

Therapists may assume that clients who are a part of cultures

different from their own are different in the same way

Therapists may impose stereotypical thinking to make
assumptions of the clients worldview
*Hinders therapist from
understanding our clients
actual worldview

Learn to be Responsive to Your Clients

Identify whether the client possesses an empirical,

humanistic, or rational worldview by listening to how the

client describes a problem or goal
To be effective therapists, we must hold on to the
theoretical approach that is consistent with our personal
views while considering the worldview of our client and
being open to revision
This will ultimately allow us to develop a therapeutic
rationale with the client, and it will allow us to better help
our clients

Integrative Psychotherapy
Integrative psychotherapists ask themselves the

following question:

What treatment, by whom, is most effective for this individual

with that specific problem and under which set of
circumstances (Paul, 1967)?
Enhances the efficacy and applicability of psychotherapy

Key Concepts of Integrative Psychotherapy

Technical Eclecticism: selects the best treatment

techniques or procedures (but not necessarily the theory)

from diverse approaches to suit the person or problem
Theoretical Integration: unites the techniques and the

theories from two or more approaches to achieve a better

result than utilizing one approach on its own
Assimilative Integration: maintains a firm grounding in

one approach to psychotherapy but selectively assimilate

practices and views from other approaches

What Integrative Psychotherapy Is Not

Syncretism: Highly problematic approach that is

characterized as being disorganized and indecisive

It is an arbitrary method of blending approaches

without a systematic rationale or empirical

verification
When approaches are combined in an uncritical and

unsystematic combination, the result is a

disorganized, haphazard approach

Six Client Characteristics

There are six characteristics that are commonly used to

guide the integrative therapist in identifying a

beneficial fit between the client and the treatment
They are used to guide the process of clinical
assessment and treatment matching
The six characteristics that are commonly used include:

Diagnosis
Stages of Change
Coping Style
Reactance Level
Client Preferences
Culture

Diagnosis
Treatment planning is organized in part around the
disorders as described in the DSM and ICD due to the
following:
Insurance companies want a diagnosis
Outcome research is organized around what is helpful to

specific diagnostic groups

The major symptoms of a diagnosis allow for evaluation of the
effectiveness of treatment
Specialized and manualized treatments have been developed for
many disorders

- Acknowledge that diagnosis alone is insufficient for

treatment planning. Treatment plans must be formulated for
the entire individual not for isolated disorders

Stages of Change
The stages of change represent the clients readiness

to change
The stages of change guide the use of certain
treatment methods and the therapists relational
stance
Five Stages:

Precontemplation
Contemplation
Preparation
Action
Maintenance

Precontemplation
There is no intention to change the behaviour in the foreseeable

future
The individual is unaware or under-aware of his or her problem
Others (family, friends, co-workers) are often well aware of the
problem
The individual will engage in psychotherapy due to pressure or
coercion from others
Key: Resistance to recognizing that a problem exists
Most effective treatment methods: Motivational interviewing,
Strategic family therapy, Psychoanalytic therapy
Most effective relational stance: A nurturing parent

Contemplation
The individual is aware that there is a problem
The individual is seriously thinking about overcoming it

but has not made a commitment to take action that is

necessary
Key: There is serious contemplation of the problem
resolution
Most effective treatment methods:
Analytical therapy and Adlerian
therapy
Most effective relational stance:
A Socratic
teacher

Preparation
The individual intends to take action in the near future

and has unsuccessfully taken action in the past year

Key: The individual has made behavioural changes to
reduce the problem but has not reached a threshold for
effective action
Most effective treatment methods: Existential
therapy, Rational emotive behaviour therapy,
Cognitive therapy, Interpersonal therapy,
Gestalt and Experiential therapy
Most effective relational stance:
An experienced coach

Action
The individual modifies his or her behaviour,

experiences, or environment to overcome the problem

This involves overt behavioural changes and requires a
considerable commitment of both time and energy
Key: The behavioural changes are now the most visible
and externally recognized
Most effective treatment methods: Behaviour
therapy, Solution-focused therapy, EMDR and
exposure
Most effective relational stance:
An experienced coach

Maintenance
The individual is working to prevent relapse and to

consolidate the gains made during the action stage

For some behaviour the maintenance stage can last a
lifetime
Key: To achieve maintenance, the individual must remain
problem free and engage in the new behaviour,
consistently, for more than six months
Most effective treatment method: Behavioral, Exposure,
and Solution focused therapies
Most effective relational stance: A consultant

Coping Style
Coping style is habitual behaviour that occurs when

confronting new or problematic situations

Coping styles fall between two extreme types:
Externalizing coping (impulsive, stimulation
seeking, extroverted)
Internalizing coping (self-critical,
inhibited, introverted)
Externalizing client coping:
Symptom focused and skill building
is most effective

Coping Style
For example: A child that is acting out is best served

by reducing his or her problems through skill

development methods
Internalizing client coping: Insight and awareness
enhancing therapies are most effective
For instance: A child that is
self-critical may engage in exercises
to enhance awareness of feelings

Reactance Level
Reactance level is the variation in behaviours that

are described as resistance

The level of reactance is a reliable marker for the
amount of therapist directiveness that is necessary
High reactance: indicates need to non-directive, selfdirected techniques to improve outcomes
Low reactance: indicates need for more directive
techniques to improve outcomes

Client Preferences
The therapist works diligently in beginning sessions

to identify the clients preferences and to

accommodate them when feasible considering
ethical and clinical variables
By attending to client preferences, research and
clinical experience indicate:

A decrease in misunderstandings
Strengthening of the alliance
A decrease in dropouts

Aides in establishing collaboration

Cultural Considerations
Culture is defined broadly to include ethnicity, race,

gender, sexual orientation, disability status, and age.

Multicultural competence is considered a clinical
necessity
Must not assume that a single or visible culture
defines the clients experience

Assumptions can be as hurtful as ignoring all

together

Respectfully discuss which aspects of

culture are fundamental to tailoring

psychotherapy

Summary of Six Client Characteristics

Integrative Psychotherapists consider six

characteristics in making decisions regarding the best

fit between the client and the treatment:

Diagnosis
Stages of change
Coping style
Reactance level
Client preference
Culture

These characteristics can serve as reliable markers to

systematically adapt psychotherapy to the individual,

the problem and the context

Process of Integrative Psychotherapy

Goal is to establish an optimal therapeutic

relationship
Enhances collaboration
Secures a clients sense of safety and commitment
Nature of therapeutic relationship is determined

by client preferences, culture, and personality

Change occurs through interrelated processes:
Nature of the therapeutic relationship
Treatment plan
Relapse prevention

Therapeutic Relationship
Integrative psychotherapies attempt to customize therapy

techniques and relationship stances to individual clients

Significant reliance on clinical experience and empirical
research on what works

Meta-analyses of studies indicate effectiveness and improvement

in therapeutic success through:

Congruence Self-disclosure
Empathy
Goal consensus
Collaboration
Management of countertransference
Positive regard Collecting real-time feedback
Therapeutic Alliance Repairing breaks in the therapeutic
alliance

Therapeutic Relationship
Proceeds collaboratively in establishing treatment goals,

securing client preferences, and allaying expected distrust

and fear
Therapeutic relationship must be tailored to the individual
client and his/her culture

Treatment Planning
Treatment planning involves interrelated decisions

that consider a number of components:

Treatment setting
Location of treatment
Choice of setting depends primarily on the relative needs of
the client
Treatment format

Interpersonal context within which therapy is conducted

Treatment intensity

Product of the duration of the treatment episode, the length

of a session, and the frequency of contact

Treatment Planning
Pharmacotherapy

Integrative psychotherapies are well suited to the

integration of pharmacotherapy and psychotherapy

Strategies and techniques

Preference is awarded to prescribing change principles

rather than a focus on specific techniques

By integrating procedures from different therapy systems,

treatment can be more effectively tailored to the client

Each client will respond more effectively to a

different configuration of components

Relapse Prevention
Teaching relapse prevention to clients toward the

end of psychotherapy is strongly advisable

Relapse prevention will help a client:
Identify high risks for regression
Make plans for avoiding high risk situations
Builds maintenance skills

Implications to Consider
Culture as the diversity of humanity
Psychotherapy can be adapted to:

Incorporate the cultural values of the client into therapy

Collaborate with indigenous healers
Match clients with therapists of the same culture
Effective practice may entail:

Clarifying expectations
Collaboratively defining a more comfortable role for the client
Augmenting an individualistic position with a collectivist
orientation
Consideration for cultural empathy

References
Corsini, R.J. & Wedding, D. (2014). Current
psychotherapies (10th ed.). Belmont, CA:
Brooks/Cole.
Truscott, D. (2010). Becoming an effective
psychotherapist: Adopting a theory of psychotherapy
thats right for you and your client. Washington, DC:
American Psychological Association.