See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/224970562

Psychotherapist development: Integration as a way to autonomy

Article in Psychotherapy Research · May 2012

DOI: 10.1080/10503307.2012.688883 · Source: PubMed

CITATIONS READS
23 614

3 authors:

Tomas Rihacek Ester Danelova

Masaryk University Masaryk University
104 PUBLICATIONS 357 CITATIONS 5 PUBLICATIONS 46 CITATIONS

SEE PROFILE SEE PROFILE

Ivo Cermak
Katolícka univerzita v Ružomberku
50 PUBLICATIONS 432 CITATIONS

SEE PROFILE

All content following this page was uploaded by Tomas Rihacek on 31 May 2014.

The user has requested enhancement of the downloaded file.

This article was downloaded by: [Tomas Rihacek]
On: 17 May 2012, At: 04:13
Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,
37-41 Mortimer Street, London W1T 3JH, UK

Psychotherapy Research
Publication details, including instructions for authors and subscription information:
http://www.tandfonline.com/loi/tpsr20

Psychotherapist development: Integration as a way to

autonomy
a a a
Tomas Rihacek , Ester Danelova & Ivo Cermak
a
Department of Psychology, Masaryk University, Brno, Czech Republic

Available online: 17 May 2012

To cite this article: Tomas Rihacek, Ester Danelova & Ivo Cermak (2012): Psychotherapist development: Integration as a way
to autonomy, Psychotherapy Research, DOI:10.1080/10503307.2012.688883

To link to this article: http://dx.doi.org/10.1080/10503307.2012.688883

PLEASE SCROLL DOWN FOR ARTICLE

Full terms and conditions of use: http://www.tandfonline.com/page/terms-and-conditions

This article may be used for research, teaching, and private study purposes. Any substantial or systematic
reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to
anyone is expressly forbidden.

The publisher does not give any warranty express or implied or make any representation that the contents
will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should
be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims,
proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in
connection with or arising out of the use of this material.
 Psychotherapy Research,
2012, 1
14, iFirst article

Psychotherapist development: Integration as a way to autonomy

TOMAS RIHACEK*, ESTER DANELOVA, & IVO CERMAK

Department of Psychology, Masaryk University, Brno, Czech Republic

(Received 7 December 2012; revised 9 April 2012; accepted 24 April 2012)

Abstract
This study deals with the question of how therapists naturally develop an integrative perspective. A grounded theory analysis
was conducted, based on retrospective interviews with seven experienced therapists (working together in the same training
program). Adoption of an integrative perspective was found to be an unintended consequence of the development towards
an autonomous personal therapeutic approach. This development is directed by two autonomous criteria (congruence and
perceived efficacy) and results in intuitive integration. Complementary to this aspect is a heteronomous line of personal
therapeutic approach development, characterized by two criteria (adherence and legitimization) and leading to
identification. Autonomy and heteronomy are understood as general principles along which a therapist’s development
Downloaded by [Tomas Rihacek] at 04:13 17 May 2012

can be organized.

Keywords: psychotherapy integration; psychotherapist development; autonomy; heteronomy; grounded theory

Integration has been a predominant phenomenon in can be roughly equated with ‘‘theoretical breadth’’
the recent decades of psychotherapy’s evolution (defined as the number of theoretical orientations
(Norcross & Goldfried, 2005). McLeod (2009) reported by the therapists as salient in their current
reviewed several surveys on therapists’ preference of therapeutic approach). The authors found that a
theoretical orientations and concluded that ‘‘the trend therapist’s breadth of theoretical perspective predicts
across all surveys of counselors and psychotherapists the experience of therapeutic work as a healing
has been that some form of eclecticism/integrationism involvement (defined by therapists perceiving them-
has either emerged as the single most popular selves as affirming, invested, accommodating in
approach, or has been a significant source of influence manner, experiencing in-session flow and using con-
even among those therapists who operate mainly structive coping strategies). Orlinsky and Rønnestad
within a single model’’ (pp. 363
364). A vast majority state, with caution, that theoretical breadth may be
(79%) of training directors in Lampropoulos and confounded in their analysis with the level of experi-
Dixon’s (2007) study believed that having been ence, because it tends to increase with seniority.
trained in one therapeutic model is not sufficient for Nevertheless, another study has confirmed this re-
therapists, yet little is known about the process of lationship in several cohorts of junior therapists,
integrative perspective development in an individual which were homogeneous in respect to therapist
therapist. According to our knowledge, previous experience level (Romano, Orlinsky, Wiseman, &
studies on therapist development did not directly Rønnestad, 2009).
address this issue, though some of them dealt with it Using a qualitative design, Skovholt and Rønnestad
tangentially. Therefore, we will briefly summarize (1) (1992) described an eight-stage model of therapist
the relevant empirical literature on therapist profes- development, later condensed into six stages
sional development, (2) studies on a therapist’s choice (Rønnestad & Skovholt, 2003). They found the
of theoretical orientation, and (3) several speculative main course of the development to be from (1) a
models of therapist development towards psychother- conventional and internally driven ‘‘lay helper’’ mode,
apy integration. through (2) the rigid and externally driven mode of
(1) In their extensive study on therapist develop- the training period, to (3) an internal and flexible
ment, Orlinsky and Rønnestad (2009) did not address mode of functioning. While the training period is
psychotherapy integration explicitly. Nevertheless, it characterized by the gradual ‘‘enculturation’’ of a

Correspondence concerning this article should be addressed to Tomas Rihacek, Department of Psychology, Faculty of Social Studies,
Masaryk University, Joštova 10, 602 00 Brno, Czech Republic. Email: [email protected]

ISSN 1050-3307 print/ISSN 1468-4381 online # 2012 Society for Psychotherapy Research
http://dx.doi.org/10.1080/10503307.2012.688883
 2 T. Rihacek et al.

trainee, internalization of concepts and techniques between therapists’ personal beliefs, implicit theories
taught by trainers, imitation of experts and rigidity in and values on the one hand, and the theoretical and
a trainee’s working style, in the post-training period a meta-theoretical assumptions of their psychothera-
trainee explores other possibilities, integrates new peutic orientation on the other. The latter is defined
experience, modifies the professional style imposed as ‘‘the degree of complexity and flexibility that
by trainers, and gradually develops an authentic, characterizes the way therapists think about ontolo-
personalized working style (Rønnestad & Skovholt, gical and epistemological matters’’ (p. 328). Thera-
2003). This naturally opens up a space for the pists, according to Vasco and Dryden, choose their
integration of multiple theoretical perspectives. first orientation mostly on the basis of their personal
A qualitative study, which explored psychoanalytic characteristics (e.g., personal philosophy and va-
trainees’ experience at the beginning of their train- lues), while later in their career they are influenced
ing, during the training and after graduation, was also by their clinical experience. When a state of
conducted by Carlsson, Norberg, Sandell and dissonance occurs, they may either change their
Schubert (2011). While ‘‘search for recognition’’ theoretical orientation, become eclectic, or keep
appeared to be a central theme permeating all three their original perspective at the expense of distorting
of the stages, a trend similar to Rønnestad and facts. Vasco and Dryden have found that the solution
Skovholt’s (2003) study can be traced within their is mediated by a therapist’s epistemological develop-
results: from reliance on external evaluation (con- ment: higher epistemological development naturally
firmation or confrontation), trainees moved into a leads to embracing a more eclectic or integrative
stage of gaining confidence and finding one’s own stance.
Downloaded by [Tomas Rihacek] at 04:13 17 May 2012

working style, which was characterized by freeing (3) Concerning therapist development towards
themselves from training requirements, trusting their integrative perspective, literature offers a few spec-
own experience and relying on their own expertise. ulative models, none of which has been, to our
Finally, analyzing retrospective interviews with 12 knowledge, subjected to empirical evaluation. Per-
senior therapists, Rønnestad and Skovholt (2001) haps the most general is Norcross’s (2005) applica-
identified four ‘‘arenas’’ for professional develop- tion of Werner’s theory which conceptualizes
ment: early life experience, cumulative professional development into three phases, where: (1) a therapist
experience, interaction with professional elders has a global, undifferentiated understanding of
and experiences in one’s own personal adult life. psychotherapy theory, (2) a therapist perceives
Besides confirmation of the findings that the thera- differentiation of the whole into parts, but loses
pists developed a style which suited them, the perspective of the whole, (3) a therapist organizes
authors found how early life experiences influence and integrates the parts into a whole at a higher level
one’s working style throughout the entirety of his or and appreciates the complexity of psychotherapy.
her career. Similarly, the internalized influence of Castonguay, Reid, Halperin and Goldfried (2003)
mentors and other professional elders still remains drew a parallel between the growth of a psychother-
very active and profound. apeutic school, and an individual therapist’s devel-
(2) The two following studies on therapists’ opment. In their model, a therapist first experiences
theoretical orientation development (see Arthur, a period of excitement and discouragement, con-
2001, for a review) appear most relevant for the nected with the first achievements and failures in
discussion of the presented findings. A grounded practice. This is followed by a period of confidence
theory study on a sample of marriage and family and rigidity after a therapist solidifies his or her
therapists (Bitar, Bean, & Bermúdez, 2007) identi- personal approach, and finally by a period of
fied 10 categories explaining their theoretical orien- humility and openness for potential contributions
tation development. Bitar et al. divided these from outside the original approach.
categories into two broad contexts: personal and Though not presenting a comprehensive model,
professional. The personal context included the Gold (2005) draws attention to phenomena which,
influence of personality, personal philosophy, family viewed from a psychoanalytic perspective, represent
of origin, own therapy and own marriage. The obstacles in the process of development towards
professional context consisted of undergraduate integration. He understands loyalty to a psychother-
courses, graduate training, clients, professional de- apeutic school or eminent therapist as the manifesta-
velopment and clinical sophistication. tion of ‘‘a more general tendency toward a tribal,
Further, Vasco and Dryden (1994) proposed a ancestral affiliation, hero worship, or brand loyalty’’
model explaining changes in a therapist’s initial (p. 376). It stems from ‘‘the need to identify with and
theoretical orientation. It is based on two con- to be affiliated with an ancestral heroic figure or
cepts*dissonance and epistemological develop- group of elders who prescribe and legitimize what we
ment. The former refers to the discrepancy know and do’’ (p. 376), which inevitably generates
 Integration as a way to autonomy 3
1
an out-group or ‘‘a demonized and devalued Other.’’ tion (Brno, Czech Republic). The team was
According to Gold, these tendencies need to be composed of four men and three women, whose
overcome in the course of developing a relativistic, age varied between 38 and 46 years and with 10 to
integrative perspective. 20 years of therapeutic practice.
Finally, Castonguay (2000; Boswell & Castonguay, Each participant is qualified in multiple ap-
2007) described his model of integrative psychother- proaches. Together, the following psychotherapy
apy training, which can simultaneously stand as a approaches are represented: psychoanalysis and
model of therapist development. It consist of five psychoanalytic psychotherapy (hereafter referred to
stages: (1) preparation (i.e., learning basic clinical and as PA), psychodynamic psychotherapy (PD), Gestalt
interpersonal skills), (2) exploration of the major therapy (GT), Pesso-Boyden system psychomotor
psychotherapy orientations, (3) identification with a (PBSP), person-centered approach (PCA), systemic/
particular orientation, (4) consolidation of this orien- family therapy (SFT), logotherapy and existential
tation, and (5) integration of contributions from other analysis (L&EA), sati therapy (a mindfulness-based
orientations, which begins in an assimilative manner integrative psychotherapy), art therapy and trans-
and gradually becomes more accommodative. personal therapy (Holotropic Breathwork). None of
As has been shown, empirical literature includes the participants has been fully trained in cognitive-
studies on both a psychotherapist’s professional behavioral therapy (CBT), but some of them com-
development in general, and a therapist’s choice of pleted shorter courses on CBT and use it in their
theoretical orientation. Existing models on the clinical practice.
specific topic of a therapist’s integrative perspective In terms of original professions, the participants
Downloaded by [Tomas Rihacek] at 04:13 17 May 2012

development, however, lack empirical support. represent clinical psychology (three), psychiatry
How, then, do therapists naturally develop to- (three) and social pedagogy (one). Gender, with
wards an integrative perspective? Finding an empiri- four male and three female participants, is also
cally grounded answer to this question is the equally distributed. The participants’ characteristics
objective of the present study. Integration is, in the are summarized in Table I (to protect the partici-
context of this study, understood in the broadest pants’ identities, fictional names are used).
sense*as the combining of two or more psychother- It should be mentioned explicitly that the partici-
apy approaches in one’s practice. Developing ‘‘natu- pants were frequently in contact over the last 3 years,
rally’’ is understood here as becoming integrative and therefore partially shared their individual devel-
without necessarily undergoing integrative psy- opments towards integration during the creation of
chotherapy training. the Training in Psychotherapy Integration men-
Corresponding to the explorative character of the tioned above.
research question, the grounded theory approach
(Glaser & Strauss, 1967) has been employed. Rennie, Analysts. The first two authors acted as analysts.
Phillips and Quartaro (1988) argue for grounded The first author is a 33-year-old man with 7 years of
theory as a promising method in psychological part-time therapeutic practice, trained in GT. The
research and it has been established in psychotherapy second author is a 26-year-old woman with her MA
research, as well (e.g., Rennie, 1996). As described by in psychology and her MA in psychotherapeutic
Glaser and Strauss (1967), the method is based on studies, currently attending a GT training. These
inductive generation of a theory through the method two analysts share humanistic/experiential orienta-
of constant comparison. Though the original formu- tion and favor psychotherapy integration. The third
lation of grounded theory methodology reflects the author, a 55-year-old man and professor of psychol-
positivist epistemological tradition, in the present ogy with expertise in qualitative methodology, acted
study it has been employed in accordance with as an auditor analyst in this study.
Charmaz’s (2006) constructivist reformulation, re-
flecting a researcher’s co-constructive role in creating
Procedure
their own theory.
Recruitment. This study is a part of a larger
research project, focused on the Training in Psy-
Method chotherapy Integration. Originally, the main goal was
to provide a reflection on how the individual profes-
Participants
sional development of the trainers might influence
Therapists. This study is based on interviews teaching integration within the newly created training.
with seven experienced therapists, who together Only later did it become clear that it was worth
formed a team of trainers preparing new psychother- developing the analysis into an independent study.
apy training, the Training in Psychotherapy Integra- Therefore, participants were not selected separately
 4 T. Rihacek et al.
Table I. Summary of participants’ characteristics

Length of Development of theoretical orientation

Name Gender Age practice Profession Trainings (chronologically) conceptualized into phases

Andrew Male 38 15 Psychiatrist GT, PBSP He found the GT approach very fitting for
himself and subsequent PBSP training only
confirmed this orientation. Phases: (1)
identification with one approach, (2) emphasis
on creating his own therapeutic style, and (3)
explicit interest in integration.
Chris Male 41 18 Psychiatrist Psychoanalysis and Phases: (1) identification with PA perspective,
psychoanalytic psychotherapy and (2) broadening of his personal therapeutic
approach to techniques originating in other
therapeutic approaches (while maintaining his
PA identity).
Claire Female 39 13 Psychiatrist and SFT, couple and family The SFT approach generally satisfies her, but
psychologist psychoanalytic therapy she felt a need to also add individual
perspective to her clinical work. Phases: (1)
identification with one approach, (2) partial
identification with the second approach, and
(3) filling up her capacity and being grounded
in her personal integrative approach.
George Male 38 10 Clinical Sati therapy, psychoanalytic He inclined to PA from the beginning but was
psychologist psychotherapy not admitted to a training he applied for. Then
Downloaded by [Tomas Rihacek] at 04:13 17 May 2012

he started his training in sati therapy but

during it he also entered a PA training. Phases:
(1) identification with one approach (PA), and
(2) broadening his identity; autonomy in
relation to therapeutic approaches.
Judith Female 46 18 Clinical Holotropic Breathwork, shorter Phases: (1) congruence-based choice of an
psychologist, CBT courses, GT combined with approach (transpersonal therapy), (2) efficacy-
lawyer psychosynthesis based choice of an approach (CBT), (3)
becoming grounded in an approach that met
both criteria (GT), and (4) reflected
assimilative integration.
Noel Male 45 20 Social Art therapy, shorter CBT-oriented While being mostly grounded in the PD
pedagogue courses, PD and SFT approach, he does not fully identify himself
with any of the approaches he has been trained
in. Phases: (1) building his own therapeutic
approach gradually, and (2) identification with
integrative perspective.
Sarah Female 43 17 Clinical PD, PCA, SFT and L&EA One of the reasons why she found her
psychologist identification approach only in the last training
may be the fact that her previous trainings were
incomplete for various reasons (missing
theory, personal experience or supervision,
etc.). Phases: (1) searching for a fitting
approach, (2) identification with a particular
approach, (3) apostasy and feeling guilty, and
(4) legitimization of integrative approach.

for this study, according to any pre-established participant. At the time of the interviews, the
criteria, and thus the method can be formally classi- interviewer was already familiar with previously
fied as convenience sampling (Patton, 2002) with post collected data on the participants’ individual ap-
hoc checks for representativeness in respect of the proach to psychotherapy and on their commonal-
phenomena under study. ities, as well as differences within the trainers’ team.
The therapists were asked via email to participate Each interview began with a uniform question:
and all of them agreed. Informed consent was ‘‘What was your personal path to psychotherapy
obtained from all participants in written form. integration and what does integration in psychother-
Therapists were paid 75 USD for their participation. apy mean for you today?’’ Then the interviewer
followed the participant’s line of thought and each
Data creation. The second author conducted an interview developed in a unique way. During these
individual unstructured in-depth interview with each interviews participants also reflected on the process
 Integration as a way to autonomy 5

of creation of the training. This part of the data, rich description of several significant cases, and
however, was not included in this analysis. Each therefore encourages researchers to collect data of
interview lasted from 60 to 90 minutes. highly idiographic nature. The goal of the grounded
After analysis, participants were sent additional theory method, on the other hand, is to develop a
questions via email, the number of which ranged general model or theory, and hence requires data
between one and 15. These questions were designed that are more comparable and progressively focused
individually to further develop selected categories on the central phenomenon emerging during analy-
which appeared to be important during analysis or to sis. Therefore, the data obtained from unstructured
add some missing information. The additional interviews were supplemented by the additional
questions were focused mainly on the choices the questions described above. In this study, the authors
participants made in respect of psychotherapy train- accepted Glaser’s (1978) approach to connecting
ing during their professional development (in case categories in a theoretical system which is more
this information was missing): why they chose a flexible and, according to the authors, more appro-
particular approach, what they gained from that priate in this case than Strauss and Corbin’s (1990)
training, in which ways they experienced the training axial coding paradigm, which is more rigid and did
to be insufficient, in what way (if at all) they not fit the data of this study.
identified with the particular approach represented Preliminary data analysis was conducted after each
by the training and how they integrated it into their interview; thorough analysis followed after all data
current practice. had been collected. The logic of theoretical sam-
Afterwards, seven individual stories of the partici- pling, which is an inherent part of grounded theory
Downloaded by [Tomas Rihacek] at 04:13 17 May 2012

pants’ development towards integration based on the methodology, was not followed here, but is planned
data were created by the first two authors using to be utilized in further development of this initial
the preliminary analytic categories as a framework study. Transcribed data were analyzed using the
while still preserving the participants’ own language Atlas.ti software (version 5.2.0).
where possible. This step was deemed necessary
because the authors felt that a narrative form would Credibility checks. Several steps were made to
be more suitable to capture the developmental ensure credibility of the results: (1) two analysts
character of the data. The participants were then conducted the analysis simultaneously and discussed
asked to validate their stories and their comments their results until a consensus was reached on every
were incorporated into the texts, extending them level of analysis; (2) analyses of the individual cases
considerably in some cases. These stories were in were validated by the participants; (3) an auditor,
turn used to refine the analysis and small parts of whose role was to check the groundedness as well as
them will be presented within the description of the the logical consistency of the model, was employed
model (as they are more informative than quotations after the analysis was finished. Items (1) and (3)
of raw data). reflect the principle of consensuality advocated by
When sending the stories to the participants, the Hill et al. (2005).
authors also asked them questions directed so as to
develop one of the categories that was considered
important (Congruence). The participants were also Results
given opportunity to comment on the resultant The main finding of the study is that the develop-
model (this opportunity was used by only one of ment towards integration was an unintended con-
them). Their answers were then analyzed. sequence of the participants’ endeavor to develop an
autonomous Personal Therapeutic Approach. It is,
Analysis. Initially, the study was designed as a according to the data, conceptualized as an approach
multiple case study (Stake, 2006) with the intention conforming to the criteria of Congruence (i.e., how
of describing the individual participants’ paths appealing and fitting to a therapist’s preferences
towards integration. It soon became apparent, how- a certain theory, model or technique is) and
ever, that it is hardly possible to present several case Perceived Efficacy (i.e., how useful for the everyday
analyses in sufficient detail within the extent of an practice a therapist finds it). Forming such a
article. Furthermore, the interviews evinced consid- personal style spontaneously led to Intuitive
erable overlap of resulting themes and catego- Integration in the participants.
ries. Therefore, the grounded theory approach Besides this autonomous aspect of development,
(Charmaz, 2006; Glaser & Strauss, 1967) has been there was a complementary heteronomous aspect
chosen for analysis instead, which led to the for- traceable in the participants’ accounts which, de-
mulation of a general model. The multiple case study pending on the circumstances, could either support
approach aims to provide a detailed and contextually or hinder the autonomous development of an
 6 T. Rihacek et al.

integrative perspective. In this respect, the analysis techniques, concepts, philosophies or attitudes*
revealed another two criteria that influence the either embracing and assimilating them, or rejecting
creation of Personal Therapeutic Approach: Adherence them. In this way, their Personal Therapeutic Approach
(i.e., a therapist’s compliance with prescribed pro- became gradually grounded (or ‘‘anchored’’) in one
cedures) and Legitimization (i.e., affirmative influ- or more psychotherapy approaches (or theoretical
ence of a particular reference group). orientations in a broader sense). The participants’
The dimension of Heteronomy-Autonomy repre- decisions (deliberate or unintentional) whether to
sents a higher level of abstraction, which is used to incorporate a technique, concept or attitude into
organize the criteria and processes into the resultant their Personal Therapeutic Approach followed certain
model. Though the concepts of Heteronomy and criteria which may, in principle, be classified as
Autonomy may be conceived as successive develop- autonomous or heteronomous.
mental phases, they are used here in the sense of two
complementary principles, which probably operate
at any stage of therapist development. The categories Autonomy
and their relationships are depicted in Figure 1. In the participants’ stories, integration was found an
unintended, yet natural consequence of their devel-
opment of an autonomous Personal Therapeutic
Personal Therapeutic Approach
Approach. The Autonomy principle refers to criteria
The data suggest that forming one’s own Personal exclusively connected to the therapist’s own judg-
Therapeutic Approach is the ultimate goal of the ment. The participants described it as reliance upon
Downloaded by [Tomas Rihacek] at 04:13 17 May 2012

participant therapists’ development. Though they their own experience and perspective, rather than
were not aware of this process at the beginning of prescriptions of a certain psychotherapy approach. It
their career, all respondents view it retrospectively as is connected both with intuition, in the sense that the
an inevitable aspect of their professional develop- participants rely on their own feelings and hunches
ment. In their own words, they strive to create a in making their decisions, and with reflection, in the
working style that would fit both themselves and sense that they are aware of this process and are able
their clients*Personal Therapeutic Approach, covering to learn from their own experience. For all partici-
both the more apparent (behavioral) component of pants, their Personal Therapeutic Approach was only
therapists’ work and the less accessible conceptual satisfactory providing that it met two crucial condi-
(cognitive) component of their activity. tions: Congruence and Perceived Efficacy. Until these
In the course of their professional development, two conditions were met, therapists kept searching
the participants encountered various therapeutic for more suitable resources to draw from.

Principle HETERONOMY AUTONOMY

Goal PERSONAL THERAPEUTIC APPROACH

Identification Apostasy Intuitive

Processes
Integration

Perceived Congruence
Criteria Legitimization Adherence
Efficacy

SOURCES OF KNOWLEDGE AND EXPERIENCE

Figure 1. Criteria and processes in the development of Personal Therapeutic Approach.
 Integration as a way to autonomy 7

Congruence. Congruence reflects the level of Intuitive Integration. Following the criteria of
accordance between a specific concept, technique, Congruence and Perceived Efficacy led the participants
or a whole therapeutic approach a therapist comes to actively consider methods and concepts different
into contact with on the one hand, and personal from their own approach, to get inspired by them,
characteristics of a therapist (preferences, beliefs, experiment with them, and finally to accept, adjust
implicit theories, etc.) on the other. In the inter- or dismiss them. They engaged in discussions with
views, Congruence was usually expressed in a form their colleagues (either out of pure interest, or
of simple phrases such as ‘‘this fits me’’ (Noel, because of the necessity to communicate about a
Andrew), ‘‘that corresponds to my inner disposi- client in a team), trying to translate the other’s
tion’’ (Chris), ‘‘it helps me in my daily life theoretical stance into their own language and
situations’’ or ‘‘I like it very much’’ (Sarah), ‘‘it possibly accommodating their own conceptual sys-
interests me most’’ (George), and in enumerating tem.
attributes of a psychotherapy approach which
correspond with a person’s worldview. Statements Andrew appreciates dialogue with his colleagues as
usually reflect respondents’ enthusiasm to new a valuable place for the potential emergence of
idea, method or technique they come in contact new qualities, e.g. in discussions with PD-oriented
with. colleagues he created his own way of dealing with
his clients’ history within the framework of GT.
Sarah decided to enter training in PCA because Sarah mentioned that following her discussions
she valued qualities such as humanity, responsive- with GT-oriented colleagues, she started to con-
Downloaded by [Tomas Rihacek] at 04:13 17 May 2012

ness and sensitivity, which she associated with this sider incorporating the ‘‘here and now’’ principle
approach. During this training, she felt the need and self-disclosure in her mostly L&EA-based
for a more directive approach and was frustrated practice.
by its lack. Finally, she became grounded in
L&EA, because this approach was even more In the process of Intuitive Integration various
suited to her personal values and offered her the incoming stimuli are ‘‘metabolized’’ into a coherent
structure she needed. conceptual and interventional working style. The
metaphor of metabolization is used here to empha-
In delineating the boundaries of their Personal size not only the idiosyncratic selectivity (embodied
Therapeutic Approach, the participants also used in the categories of Congruence and Perceived
negative statements, such as ‘‘it’s not my home, I Efficacy), but also adjusting and appropriating these
feel myself more somewhere else’’ (Noel), and ‘‘I incoming concepts and techniques to fit both the
don’t feel well in this’’ (George). therapist and the client.

This aspect is especially apparent in Andrew, who

Perceived Efficacy. Perceived Efficacy means spoke about the need to withdraw from sources of
perceiving oneself as an effective therapist, i.e., one new inspiration from time to time and to con-
who is able to help his or her clients. According to solidate already-attained material into a coherent
the data, integration of techniques and theories form of Personal Therapeutic Approach.
originating in various therapeutic orientations was,
on the individual level, motivated primarily by a This process of active selection and transforma-
perceived ineffectiveness of a participant’s current tion (‘‘metabolization’’) has several direct implica-
approach in certain situations and by an effort to tions concerning integration. The participants often
meet particular clients’ needs and conditions. spoke about discovering general principles and
dimensions lying beyond distinct psychotherapy
For George, perceiving his therapeutic work as approaches and schools and conceived the distinc-
effective is the most important criterion of a tion between approaches as unnecessary or irrele-
satisfactory Personal Therapeutic Approach. He vant. It may be said that the therapists formulated
adopted this view after abandoning Adherence as their own idiosyncratic sets of common factors that
a primary criterion for assessing his work. Sarah helped them organize their clinical experience into
also described this personal shift. Chris and Judith meaningful schemas.
both speak about the need to adjust their approach
to the level of the client’s disturbance. More Judith, e.g., asks questions about how much a
severely disturbed clients may need more support therapist’s directivity or how much self-disclosure
and behavioral training, while less severely dis- is functional in a therapeutic relationship, irre-
turbed clients may only require reaching insight. spective of specific approaches.
 8 T. Rihacek et al.

This naturally leads to blurring the definite participants, it was described as a natural but
borders of therapeutic approaches, which are subse- abandoned stage of therapist development.
quently viewed from the point of their similarities
and unique contributions. Gaining multi- and trans- Noel expressed the idea that before therapists can
theoretical perspectives coincides with deviating create styles which best fit them, they have to go
from one’s original approach on the practical level through drill phase, during which they need to
(adopting techniques of various origins and theore- practice even those techniques or attitudes in
tical ‘‘affiliations’’), and thus broadening one’s ther- which they manifest poor performance. Only after
apeutic scope. In the case of the participants, this doing so are they able to truly reject those
process tended to function very naturally and with- techniques or attitudes as incongruent.
out reflection until the participants became familiar
with the concept of psychotherapy integration. Only in Chris’s case was the need for Adherence
Therefore, the process was termed Intuitive still active and it had a negative impact on his ability
Integration. (or willingness) to immerse himself more deeply into
integration.
For George, the process of integration often goes
on intuitively and it lends itself to reflection only in Chris, while still being engaged in his training
retrospective analysis. George trusts his intuition analysis, could not adopt a detached stance
and relies on it. towards his PA orientation and viewed this as an
obstacle in integration.
Downloaded by [Tomas Rihacek] at 04:13 17 May 2012

Heteronomy In the form of ‘‘required Adherence,’’ the category

The heteronomous aspect of Personal Therapeutic was most densely represented in one participant’s
Approach development was less obvious in the data account of her experience as a supervisee, and she
and its relation to developing an integrative perspec- perceived it as a pivotal moment in her professional
tive was less straightforward, in comparison to the development.
autonomous criteria. The Heteronomy principle refers
to criteria connected with external influences, namely During her supervision in L&EA, Sarah’s super-
therapeutic approaches (formulated in manuals, visor classified any deviation from this approach as
books and articles) and individuals or social groups a mistake. Sarah perceived this supervision as
mediating the relationship between a therapist and negatively restrictive because, after having com-
various aspects of psychotherapy approaches. In the pleted three other psychotherapy trainings before,
present analysis, the heteronomous criteria have been she already felt considerably confident in her
conceptualized as Adherence and Legitimization. personal working style. Sarah felt relieved after
the supervision had concluded. Nevertheless, it
led her to judge her own work as ‘‘impure.’’
Adherence. In the model, Adherence refers either
to a therapist’s own need to follow prescribed Not conforming to required Adherence was con-
procedures (i.e., ‘‘need for Adherence’’), or to a nected with an experience of Apostasy. Apostasy thus
therapist’s conformity with prescriptions imposed appears to be a consequence of tension between the
by a particular professional group (i.e., ‘‘required autonomous tendency to create one’s own Personal
Adherence’’). Both aspects were united into the single Therapeutic Approach (meeting the already men-
category of Adherence, since they both imply that a tioned criteria of Congruence and Perceived Efficacy),
therapist judges his or her working style according to and the heteronomous tendency to follow a pre-
some kind of external criteria. Theoretically, these scribed method or to keep contacts with a valued
prescriptions may be founded either in a ‘‘pure professional group.
school’’ of psychotherapy or in one of the established
integrative approaches, though the latter possibility Sarah knew she did not adhere to the approach she
was not represented in our data. had been taught, though she felt considerable
In the form of ‘‘need for Adherence,’’ this category identification with it. She felt as if she was
was only rarely mentioned by the participants, and betraying the L&EA approach. Even during her
almost exclusively with a negative connotation: as a interview, she still wondered how therapeutic
limitation or as an indicator of a therapist’s insecurity ‘‘purists’’ would judge her work. A similar account
(George), and as an external and negatively experi- on Apostasy was conveyed by George, but in his
enced demand or as an obsolete criterion for case, it was also connected with experiencing a loss
evaluating one’s therapeutic work (Sarah). By some or weakening of relationships with his close
 Integration as a way to autonomy 9

colleagues. Currently, Apostasy is not connected assuring each other in their project) and the large
with anxiety and does not threaten his professional community of integrative therapists (legitimizing
identity. George understands it now as a necessary integration as such).
condition of integration.
Judith emphasizes the role of the trainers’ team in
It may be concluded that in both its forms, providing her with a sense of stability. She
Adherence represents a restrictive influence on appreciates mutual tolerance, respect, a non-
Personal Therapeutic Approach and was seen by the condemning attitude, the ability to listen to others,
participants as an obstacle in their paths towards an inquisitiveness and tolerance for anxiety. She also
integrative therapeutic style, though it might have an thinks that the participants share a tendency to
important place in the beginning of their professional question stable structures and an inclination
development or at times when they wanted to learn a towards heresy.
new technique or theory.
Identification. The process through which het-
Legitimization. In contrast to the restrictive eronomous criteria exert their influence was con-
influence of required Adherence, Legitimization gen- ceptualized as Identification. It consists of defining
erally refers to an affirmative or acknowledging oneself through a relation to external sources of
influence of a particular reference group or a guidance (a particular therapeutic school or a
therapeutic approach, as such. professional reference group). In contrast to the
blurring and metabolizing character of Intuitive
Downloaded by [Tomas Rihacek] at 04:13 17 May 2012

GT was a fitting approach for Andrew because it Integration, the nature of Identification is to define
legitimized his existing personal qualities of in- borders and, within these borders, to accept the
tuitive working and improvisation. given techniques, concepts or attitudes without
selection, elaboration or modification. A weaker
Legitimization became especially visible when the form of Identification can be referred to as ‘‘loyalty.’’
participants spoke about the creation of the new Identification leads to a sense of therapeutic
Training in Psychotherapy Integration. Here, they identity, which is conceived here, in accordance
opened themselves to a never-ending dialogue with the data, as a manifestation of one’s sense of
(which itself is seen as an expression of their belonging to a certain psychotherapeutic school or
therapeutic Autonomy), at the same time striving relating to a theoretical system or to a particular
for the support and approval (i.e., Legitimization) form of integration. It is often expressed in state-
provided by the group. ments, such as ‘‘I am a gestalt therapist’’ or ‘‘I am an
assimilative integrationist.’’ Therapeutic identity,
For Sarah, claiming allegiance to an integrative being essentially heteronomous, seems to serve the
perspective brought Legitimization of her actually purpose of creating and maintaining stability and a
integrative (‘‘impure’’) practice. Thanks to this sense of safety (cf. Gold, 2005). Though it plays a
Legitimization, her feelings of guilt and betrayal diminishing role in the professional life of most of the
diminished. For Noel, naming his personal ap- participants, it still maintains a certain importance,
proach ‘‘integrative’’ gave a sense of legitimacy to as they may often be expected by others to define
the way he had been intuitively doing psychother- themselves in terms of theoretical orientations (as
apy from the very beginning of his career. The they were asked to do, e.g., by the interviewer). Yet,
concept of integration gave him an opportunity to as shown below in Noel’s account, even after 20
newly define and defend his approach, which had years of practice, the heteronomous need for
been difficult before. Identification can be influential and may even support
integration.
Legitimization was an important aspect of the
participants’ joint meetings and communication Before being asked to participate in the creation of
during the preparation of the new training and the Training in Psychotherapy Integration, Noel
provided them with a sense of justification and never thought of himself as an integrative thera-
vindication, in turn giving them permission to pist, nor had he been identified with any particular
continue their apostatic practice (and thereby over- orientation. Even though he feels himself
come their feelings of Apostasy). It was also con- grounded mostly in the PD approach and has
nected with reflection on their actual integrative internalized many of its concepts, on the level of
practice and with studying literature on integration. identity he distances himself from any approach in
In this case, the particular reference group was both particular. Although in various contexts, he could
the group of participants themselves (mutually identify with SFT, PD or art therapy, he feels that
 10 T. Rihacek et al.

these identities are only partial and artificial, and autonomous therapeutic development and an ex-
do not express the width and organization of his pression of Autonomy itself. This is in accordance
Personal Therapeutic Approach. Not having fully with Rønnestad and Skovholt’s finding that profes-
identified with any of these approaches, Noel felt a sional development is growth toward professional
sense of homelessness. Only after he started to individuation (Rønnestad & Skovholt, 2003;
engage himself in the preparation of the integrative Skovholt & Rønnestad, 1992). A similar tendency
training and became familiar with the concept of of a development towards an individualized working
integration did he identify with an integrative style has been described by Carlsson et al. (2011) as
perspective and find his ‘‘home’’ here. In this well. It should be noted that the participants’
context, integration for him represents mainly the concept of integration was one of openness, toler-
freedom of an unrestricted identity. ance, a searching attitude, an ever-continuing pro-
cess, flexibility, permission to experiment, freedom,
For the sake of clarification, Identification needs to non-restrictedness and defying authority. While the
be distinguished from Grounding (an aspect of participants find themselves closest to the assimila-
Personal Therapeutic Approach introduced above). tive approach to integration (Lampropoulos, 2001;
While Identification refers to defining oneself in Messer, 2003), some of the listed attributes are, in
relation to an external system, Grounding just repre- essence, characteristics of Autonomy. According to
sents the fact that the participants ‘‘anchor’’ their Carere-Comes (2001), the assimilative principle
clinical work in one or more psychotherapy ap- itself represents the very movement towards emanci-
proaches (which does not automatically mean adopt- pation (i.e., Autonomy). The participants’ emphasis
Downloaded by [Tomas Rihacek] at 04:13 17 May 2012

ing them as such, but may include selective on Autonomy can be thus explained by the current
processing as embodied in the metabolizing nature stage of a participant’s professional development:
of Intuitive Integration). These two concepts overlap individuation (Skovholt & Rønnestad, 1992) or
only partially, as can be seen from the following experienced professional phase (Rønnestad &
examples: Andrew is grounded in GT, yet his Skovholt, 2003).
identification encompasses a broader field of psy- At the same time, heteronomous influences were
chotherapy as such; Sarah identifies herself with found to provide an important background, against
L&EA, but is grounded in a much broader field; which autonomous development can take place.
Noel is grounded mostly in the PD approach, yet Without enough heteronomous support (conceptua-
does not like to be restricted by any identification. lized here as Legitimization), autonomous integration
This leads to a conclusion that Identification and can lead to an uncomfortable experience of Apostasy.
Grounding serve different purposes and should not be This finding goes beyond simply ordering
confused: while Identification (or identity, which Heteronomy and Autonomy as developmental stages
represents a static result of the process of and stating that therapists become more and more
Identification) can be understood as a reflection of autonomous during their career (as suggested by
the way one relates to theoretical systems and social Skovholt & Rønnestad, 1992, or Carlsson et al.,
groups and seems to serve the purpose of joining or 2011). Instead, it shows that even in later stages of
distancing on the level of self-concept, Grounding professional development, both Autonomy and
expresses the mere fact that one’s Personal Therapeu- Heteronomy play important roles, though these roles
tic Approach draws on established therapeutic ap- may change qualitatively in the course of the devel-
proaches and the therapist does not even need to be opment. In the participants’ accounts, both princi-
fully aware of these roots or consider them important ples are concurrently present and interwoven. Except
enough to build his or her therapeutic identity upon for Noel, all participants relate to at least one
them. theoretical orientation as their home orientation,
even though the relationship is not always strong
During her training in L&EA, Sarah identified enough for them to call it Identification. Noel, who
herself with this approach, yet in supervision she does not affiliate himself very strongly with any
often received feedback that her style is actually orientation, experiences this situation as ‘‘home-
more psychodynamic. lessness.’’ The role of Heteronomy is also clearly
visible in the moment when the participants met to
create the new Training in Psychotherapy Integra-
Discussion
tion. Although they basically define their concept of
The main finding of this study is that an integrative integration as synonymous to Autonomy, they needed
perspective served the purpose of developing parti- mutual support, assurance and Legitimization of their
cipants’ autonomous working styles*integration concept to be able to bear the burden of their
was found to be a natural consequence of their collective Apostasy. Therefore, Autonomy and
 Integration as a way to autonomy 11

Heteronomy are not considered synonyms for thera- particular clients or diagnoses, and that their own
pist maturity and immaturity, but rather equivalently sense of successfulness (efficacy) in conducting
important principles in therapist development. The therapy is an important clue. The name of this
roles of the Heteronomy and Autonomy principles in category was intentionally designed to refer to
various stages of psychotherapist development de- Bandura’s concept of self-efficacy (e.g., Bandura,
serve further attention. For example, it may be 1995, 1997).
hypothesized that the degree of therapists’ The heteronomous criterion of Adherence basically
Autonomy predicts the kind of resolution which corresponds to its traditional meaning as the extent
therapists choose in a state of dissonance between to which a therapist complies with a manual (e.g.,
their personal beliefs and the core tenets of their Strupp, 1986). Furthermore, it received here either a
theoretical orientation (cf., Vasco & Dryden, 1994). connotation of a therapist’s ‘‘emotional dependence’’
The two autonomous criteria, Congruence and on this external criterion (in the case of a therapist’s
Perceived Efficacy, are highly consistent with a grow- own ‘‘need for Adherence’’), or a connotation of ‘‘an
ing body of research on the development of psy- inner rebellion’’ against an externally imposed de-
chotherapists’ theoretical orientation. The suitability mand (in the case of ‘‘required Adherence’’).
of the term Congruence was questioned in the While Adherence seems, in the participants’ ac-
presented study, as it coincides with the term Rogers counts, to be currently almost abandoned as a
(1980) coined in PCA but, finally, it was accepted criterion for evaluating their therapeutic practice,
because it is used in other studies on the theoretical Legitimization still continues to be an active and
orientation of therapists, as well (Arthur, 2001; Bitar important source of reassurance for the participants.
Downloaded by [Tomas Rihacek] at 04:13 17 May 2012

et al., 2007; Heffler & Sandell, 2009; Ogunfowora & It can be hypothesized that heteronomous factors
Drapeau, 2008; Sumari, Mohamad, & Ping, 2009; not only play a major role at the beginning of one’s
Taubner, Kächele, Visbeck, Rapp & Sandell, 2011). psychotherapeutic career, but also become more
Some variables and categories from other studies important every time a change occurs in one’s
can easily be used to enrich the category of theoretical orientation. The data support this hy-
Congruence: personal philosophy and values (Bitar pothesis in the sense that the participants sought and
et al., 2007; Vasco & Dryden, 1994), epistemological valued their mutual support in their movement
orientation (Arthur, 2001), and epistemological de- towards reflected integration and in incorporating
velopment (Vasco & Dryden, 1994) or clinical this aspect into their therapeutic identities. Thus,
sophistication (Bitar et al., 2007). As Bitar et al. heteronomous support may be necessary for an
point out, the influence of personal philosophy can be autonomous change. This finding corresponds to
two-fold: Either a theoretical orientation is selected Goldfried’s (2005) conclusion that ‘‘[a therapist’s]
because it is congruent with personal philosophy, or a change process (. . .) closely parallels the ways in
theory basically resonates with the personal philoso- which clients change during the course of therapy:
phy and becomes its integral part in a more dynamic Within a supportive interpersonal context, the per-
process of interplay between the two. Bitar et al. have son becomes aware of things in one’s life that are
also identified the need for a match between the remnants of the past and do not necessarily work in
clinical sophistication of a therapist and the level of the current situation’’ (p. 326).
sophistication required by the theory. According to
Vasco and Dryden (1994), a higher level of episte-
mological development (i.e., complexity and flexibi- Methodological Considerations
lity of a therapist’s thinking with respect to episte- The resultant model represents a general framework
mology) naturally leads to eclecticism or integration. which can easily absorb new categories. The general-
Thus, it can be hypothesized that a certain level of izability of the findings is constrained, however, by
epistemological development is necessary for thera- several facts. While the sample is reasonably hetero-
pists to be able to integrate because they need to deal geneous with respect to psychotherapy approach,
with a plurality of theoretical perspectives and their profession, gender and years of practice, it is fairly
respective philosophical foundations. small. Furthermore, it neither represents therapists
The criterion of Perceived Efficacy to a large extent who would be trained in integration from the very
corresponds to Vasco and Dryden’s (1994) ‘‘clinical beginning of their career, nor does it represent all
experience,’’ Bitar et al.’s (2007) ‘‘influence of major routes to psychotherapy integration embraced
clients,’’ and Rønnestad and Skovholt’s (2003) by practitioners (cf. Norcross, Karpiak, & Lister,
‘‘clients as primary teachers.’’ All these categories 2005).
express the same idea that in the selection process of Another limitation of the study is a rather broad
their theoretical orientation (or decisions to change scope of the stories. Individual interviews were
it) therapists follow their own experience with performed in an unstructured way, which means
 12 T. Rihacek et al.

that different topics were explored with different trained in integration from the beginning of their
participants. Although some methodologists prefer career, as well as those having developed toward
to maintain a similar structure in all interviews to integration naturally during their career. Care also
obtain comparable data (e.g., Hill et al., 2005), the needs to be taken to employ therapists of all main
authors of this study preferred to get data of a theoretical orientations, as the development towards
more idiosyncratic nature which corresponded to the integration may take different forms depending on
original idea of multiple case study design (Stake, one’s home orientation.
2006). The subsequent questions sent via email were Another possibility is to focus on the way thera-
partially designed to homogenize the data. pists use various external influences and resources to
This study, unlike e.g., Rønnestad and Skovholt’s create their Personal Therapeutic Approach, explore
(2003) longitudinal study, is based solely on retro- the dimensions of this concept and connect it to
spection. Participants spoke about how they perceive specific clinical cases. Several authors also call for a
and understand their development from the perspec- longitudinal design to explore therapists’ develop-
tive of well-educated therapists, trying to give their
ment prospectively (Arthur, 2001; Taubner et al.,
narrations a coherent form, deliberately or uninten-
2001). Nevertheless, even before more comprehen-
tionally. No attempt was made to triangulate the data
sive results are achieved, the existing categories and
by, for instance, having participants check their
themes can provide tools for trainees’ reflection on
training notes, diaries or other documents to give
how and why they choose their theoretical orienta-
accounts that would be closer to what they really
experienced in various stages of their professional tions (Arthur, 2001; Bitar et al., 2007), make them
Downloaded by [Tomas Rihacek] at 04:13 17 May 2012

development. With respect to Orlinsky and aware of the fact that distressing dissonance may
Rønnestad’s (2009) taxonomy of the methodological arise during their career (Vasco & Dryden, 1994)
perspectives on development, it can be classified as and help them reflect how they approach the existing
reflexive (relying on therapists’ own experience as a plurality of therapeutic perspectives.
data source) and extended (capturing development If psychotherapy trainers find the hypothesis that
throughout the whole career). all therapists develop their own Personal Therapeutic
Similarities in the participants’ accounts should be Approach (which may be more or less grounded in
considered with caution as they may be, at least one psychotherapy approach) plausible and if they
partially, a product of their 3-year cooperation appreciate the role heteronomous influences play
during the preparation of the training and can thus within this process, they may be encouraged to find
reflect shared meanings attributed to their develop- ways to support this individuation process rather
ment and practice. The advantages, on the other than requiring uniform Adherence to a pure-school
hand, are that it enabled us to explore the hetero- approach. Practitioners who incline towards integra-
nomous aspect of the participants’ development in tion may use the presented model as an incentive to
more depth and it gave the participants an excellent reflect on what actually makes them experience a
opportunity for systematic reflection on their inte- technique or a theory as congruent with their
grative perspective. personality and/or efficacious in their practice, and
it may help them to shed light on their intuitive
process of integration.
Future Directions
Further directions open up as possible continuations Acknowledgements
of this study. One is to follow the developmental lines
of therapists’ narratives and explore the reasons for This study was supported by the Czech Science
their choices of various trainings and other thera- Foundation Grant GAP407/11/0141. The authors
peutic activities in more depth. Manifestations of the thank Zbyněk Vybı́ral for valuable comments on an
Autonomy and Heteronomy principles in various earlier version of the article and the participants for
stages of the development can be explored. This sharing their stories of professional development.
would presumably lead to an elaboration of the
presented model, especially with respect to its Note
developmental aspect, which remains only implicit 1
This study was conducted during the preparatory phase of the
so far. Regarding the sampling strategy, future training and during the first year of its first period. The Training
studies should include therapists at various stages in Psychotherapy Integration is a 5-year training based on the
of their professional development, therapists repre- concept of ‘‘helping skills’’ (Hill, 2009) and common factors
senting all main routes to integration, and therapists approach to psychotherapy integration (Goldfried, 1995).
 Integration as a way to autonomy 13

References programs. Journal of Psychotherapy Integration, 17(2), 185
208.

doi: 10.1037/1053-0479.17.2.185.
Arthur, A.R. (2001). Personality, epistemology and psychothera- McLeod, J. (2009). An introduction to counselling (4th ed). New
pists’ choice of theoretical model: a review and analysis. The York, NY: Open University Press.
European Journal of Psychotherapy, Counselling & Health, 4(1), Messer, S.B. (2003). A critical examination of belief structures in
45
64. doi: 10.1080/1364253011004008 2. integrative and eclectic psychotherapy. In J.C. Norcross &
Bandura, A. (1995). Exercise of personal and collective efficacy in M.R. Goldfried (Eds.), Handbook of psychotherapy integration
changing societies. In A. Bandura (Ed.), Self-efficacy in chan- (pp. 130
165). New York, NY: Oxford University Press.
ging societies (pp. 1
45). New York, NY: Cambridge University Norcross, J.C. (2005). A primer on psychotherapy integration. In
Press. J.C. Norcross & M.R. Goldfried (Eds.), Handbook of psy-
Bandura, A. (1997). Self-efficacy: The exercise of control. New York,
chotherapy integration (pp. 3
23). Oxford: Oxford University
NY: W.H. Freeman.
Press.
Bitar, G.W., Bean, R.A., & Bermúdez, J.M. (2007). Influences
Norcross, J.C., & Goldfried, M.R. (Eds.) (2005). Handbook of
and processes in theoretical orientation development: a
psychotherapy integration (2nd ed.). Oxford: Oxford University
grounded theory pilot study. The American Journal of Family
Press.
Therapy, 35, 109
121. doi: 10.1080/01926180600553407.
Norcross, J.C., Karpiak, C.P., & Lister, K.M. (2005). What’s an
Boswell, J.F., & Castonguay, L.G. (2007). Psychotherapy training:
integrationist? A study of self-identified integrative and (occa-
Suggestions for core ingredients and future research.
sionally) eclectic psychologists. Journal of Clinical Psychology,
Psychotherapy: Theory, Research, Practice, Training, 44(4),
61(12), 1587
1594. doi: 10.1002/jclp.20203.
378
383. doi: 10.1037/0033-3204.44.4.378.
Ogunfowora, B., & Drapeau, M. (2008). Comparing counseling
Carere-Comes, T. (2001). Assimilative and accommodative
and clinical psychology practicioners: similarities and differ-
integration: the basic dialectics. Journal of Psychotherapy
ences on theoretical orientations revisited. International Journal
Integration, 11(1), 105
115. doi: 10.1023/A:1026633125774.
for the Advancement of Counselling, 30, 93
103. doi: 10.1007/
Carlsson, J., Norberg, J., Sandell, R., & Schubert, J. (2011).
s10447-008-9048-y.
Downloaded by [Tomas Rihacek] at 04:13 17 May 2012

Searching for recognition: the professional development of

Orlinsky, D.E., & Rønnestad, M.H. (Eds.) (2009). How psy-
psychodynamic psychotherapists during training and the first
chotherapists develop: A study of therapeutic work and professional
few years after it. Psychotherapy Research, 21(2), 141
153. doi:
growth. Washington DC: American Psychological Association.
10.1080/10503307.2010.506894.
Patton, M.Q. (2002). Qualitative research & evaluation methods
Castonguay, L.G. (2000). A common factors approach to
psychotherapy training. Journal of Psychotherapy Integration, (3rd ed.). Thousand Oaks, CA: Sage.
10(3), 263
282. Rennie, D.L. (1996). Fifteen years of doing qualitative research
Castonguay, L.G., Reid, J.J., Halperin, G.S., & Goldfried, M.R. on psychotherapy. British Journal of Guidance and Counseling,
(2003). Psychotherapy integration. In G. Stricker, T.A. 24(3), 317
327. doi: 10.1080/03069889608253016.
Widiger, & I.B. Weiner (Eds.), Handbook of psychology: Clinical Rennie, D.L., Phillips, J.R., & Quartaro, G.K. (1988). Grounded
psychology (pp. 327
346). Hoboken, NJ: John Wiley & Sons. theory: A promising approach to conceptualization in psycho-
Charmaz, K. (2006). Constructing grounded theory: A practical guide logy? Canadian Psychology, 29(2), 139
150. doi: 10.1037/
through qualitative analysis. Los Angeles, CA: Sage. h0079765
Glaser, B.G. (1978). Theoretical sensitivity: Advances in the Rogers, C.R. (1980). A way of being. New York, NY: Houghton
methodology of grounded theory. San Francisco, CA: University Mifflin Company.
of California. Romano, V., Orlinsky, D.E., Wiseman, H., & Rønnestad, H.
Glaser, B.G., & Strauss, A.L. (1967). The discovery of grounded (2009, October). Theoretical breadth early in the psychotherapist’s
theory: Strategies for qualitative research. Chicago, IL: Aldine. career: help or hindrance? Paper presented at Canadian con-
Gold, J. (2005). Anxiety, conflict, and resistance in learning an ference of the Society for Psychotherapy Research (SPR),
integrative perspective on psychotherapy. Journal of Psycho- Montreal, Canada.
therapy Integration, 15(4), 374
383. doi: 10.1037/1053- Rønnestad, M.H., & Skovholt, T.M. (2001). Learning arenas for
0479.15.4.374. professional development: retrospective accounts of senior
Goldfried, M.R. (1995). Toward a common language for case psychotherapists. Professional Psychology: Research and Practice,
formulation. Journal for Psychotherapy Integration, 5(3), 32(2), 181
187. doi: 10.1037//0735-7028.32.2.181
221
224. Rønnestad, M.H., & Skovholt, T.M. (2003). The journey of the
Goldfried, M.R. (Ed.) (2005). How therapists change: Personal and counselor and therapist: research findings and perspectives on
professional reflections. Washington DC: American Psychological professional development. Journal of Career and Development,
Association. 30(1), 5
44. doi: 10.1177/089484530303000102.
Heffler, B., & Sandell, R. (2009). The role of learning style in Skovholt, T.M., & Rønnestad, M.H. (1992). Themes in therapist
choosing one’s therapeutic orientation. Psychotherapy Research, and counselor development. Journal of Counseling & Development,
19(3), 283
292. doi: 10.1080/10503300902806673. 70, 505
515. doi: 10.1002/j.1556-6676.1992.tb01646.x.
Hill, C.E. (2009). Helping skills: Facilitating exploration, insight, and Stake, R.E. (2006). Multiple case study analysis. New York, NY:
action. Washington DC: American Psychological Association. The Guilford Press.
Hill, C.E., Knox, S., Thompson, B.J., Nutt Williams, E., Hess, Strauss, A.L., & Corbin, J. (1990). Basics of qualitative research:
S.A., & Ladany, N. (2005). Consensual qualitative research: Grounded theory procedures and techniques. Newbury Park, CA:
An update. Journal of Counseling Psychology, 52(2), 196
205. Sage.
doi: 10.1037/0022-0167.52.2.196. Strupp, H.H. (1986). Psychotherapy: Research, practice, and
Lampropoulos, G.K. (2001). Bridging technical eclecticism public policy (how to avoid dead ends). American Psychologist,
and theoretical integration: assimilative integration. Journal 41(2), 120
130.
of Psychotherapy Integration, 11(1), 5
19. doi: 10.1023/ Sumari, M., Mohamad, S.M.A., & Ping, C.L. (2009). Personality
A:1026672807119. types and choice of counseling orientations among counseling
Lampropoulos, G.K., & Dixon, D.N. (2007). Psychotherapy students/trainees in Malaysian higher education institutions.
integration in internships and counseling psychology doctoral The International Journal of Research and Review, 3, 1
8.
 14 T. Rihacek et al.
Taubner, S., Kächele, H., Visbeck, A., Rapp, A., & Sandell, R. Vasco, A.B., & Dryden, W. (1994). The development of psy-
(2011). Therapeutic attitudes and practice patterns among chotherapists’ theoretical orientation and clinical practice.
psychotherapy trainees in Germany. European Journal of British Journal of Guidance & Counselling, 22(3), 327
341.
Psychotherapy and Counselling, 12(4), 361
381. doi: 10.1080/ doi: 10.1080/03069889408253678.
13642537.2010.530085.
Downloaded by [Tomas Rihacek] at 04:13 17 May 2012

View publication stats