Integrative Perspective in

Therapy
C6436 Individual Counseling
Theory and Practice
James J. Messina, Ph.D.
Trend Towards Psychotherapy
Integration
 Integration and Eclecticism in Therapy
Models began in the 1980’s
 In 1992 30-50% of therapists called
themselves eclectic or integrative in their
therapeutic approach
 Syncretism: haphazardly picking
techniques without any overall theoretical
rationale as long as it works “by default”
Three Multiple Pathways to
Achieve Integration of Therapy
 Technical eclecticism: focuses on differences,
chooses from many approaches, using
techniques from different schools-without
subscribing to theoretical positions which
developed them
 Theoretical integration: conceptual or theoretical
creation beyond a mere blending of techniques-
producing a conceptual framework synthesizes
best of two or more theoretical approaches
 Common factors: looks across different
theoretical approaches in search of common
elements-find core composed of non-specific
variables common to all therapies
Motives for Integration Trend
1. Proliferation of therapies
2. Inadequacy of a single therapy relevant to all clients &
problems
3. External socioeconomic realities: insurance
reimbursement, HMO, PPO, POS
4. Popularity of short-term, prescriptive, problem focused
therapies
5. Opportunities to observe & experiment with various
therapies
6. Paucity of differential effectiveness among therapies
7. Recognition therapeutic commonalities major role in
therapy outcomes
8. Development of professional societies aimed at
integrating psychotherapies
Integration of multicultural Issues
 Integration of multicultural Issues in
Counseling-through technical eclecticism
 Create techniques to meet the needs of
clients of different cultures
 Be flexible in utilizing diverse therapeutic
strategies across varying cultural groups
 Employ and adapt techniques to fit the
Person-in-the-environment
Integration of Spiritual/Religious
Issues
 Being open to spiritual/religious values results in
change in focus of treatment away from
symptoms relief to general changes in lifestyle
 Spirituality important component of mental
health and inclusion in therapy helps make it
more effective
 To be used in therapeutic process to benefit and
enhance the process
 Force that can help individual make sense of
universe and find purpose in living
 Stay tuned into client’s stories and purpose for
which therapy as sought
Similarities Between Therapy &
Spirituality
 Similar goals
 Emphasize learning to accept oneself, forgive
others & self
 Admitting one’s shortcomings
 Accepting Personal Responsibility
 Letting go of hurts & resentments
 Dealing with guilt
 Learning to let go of self-destructive patterns of
thinking, feeling & acting
Healing Nature of Spirituality
 Shares Themes of: Loving, caring, learning to
listen with compassion, challenging client’s life
assumptions, accepting human imperfection,
going outside of self-oriented interests (social
interest)
 Ponders questions of: Who am I? What is
meaning of life?
 Explores: role of shame & guilt
 Understanding of: difference between blame &
responsibility & power of sharing deeply human
concerns
Spirituality: Implications for
Assessment & Treatment
 Important to understand background of client’s
involvement in religion
 Understand & respect client’s religious beliefs
 Steps in assessment:
4. Include in intake procedure & early phase of
therapy
5. Questions of spirituality relevant to current
problem & role in current life of client
6. How religious beliefs relate to cognitive,
affective & behavioral processes of client
7. Letting client know it is acceptable to talk
about religious & spiritual concerns
Role of Counselor Dealing with
Spirituality
 Be careful not to make decisions for
clients but to let clients how their own
values will guide their behavior
 Guard against indoctrinating clients with a
particular set of spiritual/religious values
 Integrate a spiritual orientation to assist
clients in crisis to have the solace,
comfort, & sustaining power which
spirituality and religious beliefs offer them
Developing Integrative
Perspective
 Beware of mixing theories with incompatible
underlying assumptions about meanings,
origins, development, maintenance, significance
& management of problems
 Clinicians can select techniques from any
discipline without necessarily endorsing any of
the theories that spawned them
 Therapists must be flexible & versatile
 “What works for whom under which particular
circumstances”
 Blending flexible repertoire of relationship styles
with wide range of techniques enhance outcome
Challenges of Integrative Models
 Deliver therapy in
 Brief
 Comprehensive
 Effective
 Flexible way
 Rapidly & systematically
 Identify problems
 Create a collaborative relationship
 Intervene with a range of specific methods
Integrative Perspective
 Systematic integration of underlying
principles & methods common to a range
of therapeutic approaches
 Be thorough conversant with number of
theories
 Open to idea that theories can be unified
 Willing to continually test hypotheses to
determine how well they are working
 Great deal of study, clinical practice,
research & theorizing
 Therapeutic Goals in Integrative
1. Uncovering the unconscious
Perspective
2. Creating social interest
3. Finding meaning in life
4. Curing an emotional disturbance
5. Examining old decisions & making new
choices
6. Developing trust in oneself
7. Becoming more self-actualized
8. Reducing anxiety
9. Shedding maladaptive behaviors & learning
new ones
10. Gaining more effective control of one’s life
Therapist’s Functions & Role in
Integrative Perspective
 How do counselor’s functions change depending
on the stage of the counseling process?
 Does therapist maintain basic role or does role
vary in accordance with characteristic of client?
 How does counselor determine how active &
directive to be?
 How is structuring handled as the course of
therapy progresses?
 What is optimum balance of responsibility in
client/therapist relationship?
 When & how much does counselor self-
disclose?
Client’s Experience in Integrative
Perspective Therapy
 Client’s given situation in environment provides
framework for selecting most appropriate
interventions
 What are client’s expectations?
 What are client’s responsibilities in the process?
 Are there commonalities in diversity of clients?
 Initially clients want expert help & quick fix
 As progress realize must be active in process,
select their own goals & work towards them in
therapy and daily living
Relationship between Client &
Therapist in Integrative Model
 Crucial determinant in therapy in existential,
person-centered & gestalt
 Not ignored, but not central in REBT, CBT, &
behavior therapy
 Honesty, sincerity, acceptance, understanding &
spontaneity are basic ingredients for success
 Therapists’ degree of caring, interest, ability in
helping clients, genuineness are factors
influencing relationship with clients
 Ability to teach a range of coping skills
 Client contribute: motivation, cooperation,
interest, concern, & expectations
Techniques in Integrative
Therapy Perspective
 Effective counseling: proficiency in
combination of cognitive, affective &
behavioral techniques
 Help clients think about their beliefs &
assumptions
 Experience on feeling level conflicts &
struggles
 Translate insights into action programs by
behaving in new ways in daily living
Evaluation of Effectiveness in
Integrative Perspective
 A substantial number of outpatients improve
without formal therapy-use natural helping
systems in environment
 Generally therapeutic treatments are beneficial-
little support for superiority of one school of
therapy over another
 Common factors which help clients: Support,
Learning & Action factors
 Specific techniques can be selected for dealing
with specific problems on basis of their
effectiveness-provides framework to assess
direction & outcomes of therapy