Other Therapies for

Psychological Interventions UNIT 4 PSYCHOTHERAPY INTEGRATION

Structure
4.0 Introduction
4.1 Objectives
4.2 Definition of Integrative Psychotherapy
4.3 Historical Overview of the Integrative Movement
4.4 Variables Responsible for Growth of Psychotherapy Integration
4.5 Different Ways to Psychotherapy Integration
4.5.1 Eclecticism
4.5.2 Differences between Eclecticism and Psychotherapy Integration
4.5.3 Theoretical Integration
4.5.4 Assimilative Integration
4.5.5 The Common Factor Approach
4.5.6 Multi Theoretical Approaches
4.5.7 The Trans Theoretical Model
4.5.8 Brooks-Harris’ Multi Theoretical Model
4.5.9 Helping Skills Approach to Integration
4.6 Evidence Based Therapy and Integrative Practice
4.7 Future of Psychotherapy Schools and Therapy Integration
4.8 Let Us Sum Up
4.9 Unit End Questions
4.10 Glossary
4.11 Suggested Readings

4.0 INTRODUCTION
A major emphasis of this unit is on helping you construct your own integrated
approach to psychotherapy. Research has indicated that psychotherapy is moving
toward an integrated approach to therapy. Throughout the world, when you ask a
psychologist or counsellor what his or her theoretical orientation is, the most
frequently given response is integrative or eclectic. It is highly likely that upon
graduation, you will integrate one or more of the theories presented in this block.
This unit explores in detail the integrative approach to therapy. This unit traces
the historical development, variables responsible for, the different models and
future of integrative approach.

4.1 OBJECTIVES
After completing this unit, you will be able to:
• Define and describe the concept of integrative psychotherapy;
• Describe the historical perspective of the integrative movement;
• Explain the variables responsible for growth of psychotherapy integration;
• Analyse the different ways to psychotherapy integration;
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• Explain evidence based therapy and integrative practice; and Psychotherapy Integration

• Analyse the future of psychotherapy schools and therapy integration.

4.2 DEFINITION OF INTEGRATIVE

PSYCHOTHERAPY
Integrative psychotherapy is an attempt to combine concepts and counselling
interventions from more than one theoretical psychotherapy approach. It is not a
particular combination of counselling theories, but rather it consists of a
framework for developing an integration of theories that you find most appealing
and useful for working with clients. According to Norcross (2005):

Psychotherapy integration is characterised by dissatisfaction with single school

approaches and a concomitant desire to look across school boundaries to see
what can be learned from other ways of conducting psychotherapy. The ultimate
outcome of doing so is to enhance the efficacy, efficiency, and applicability of
psychotherapy.
Within this integrative therapy we have Meaning Therapy which is an integrative
approach. Meaning therapy (MT), also known as meaning centered counseling
and therapy (MCCT), is an integrative, positive existential approach to counseling
and psychotherapy. Originated from logo therapy, MT employs personal meaning
as its central organising construct and assimilates various schools of
psychotherapy to achieve its therapeutic goal. MT focuses on the positive
psychology of making life worth living in spite of sufferings and limitations. It
advocates a psycho educational approach to equip clients with the tools to navigate
the inevitable negatives in human existence and create a preferred future. The
paper first introduces the defining characteristics and assumptions of MT. It then
briefly describes the conceptual frameworks and the major intervention strategies.
In view of MT’s open, flexible and integrative approach, it can be adopted either
as a comprehensive method in its own right or as an adjunct to any system of
psychotherapy.
Integrative psychotherapy offers a safe environment for the exploration of body,
mind, emotion and spirit, and their impact on health, personal fulfilment and
relationships.
Because everyone is unique, my therapeutic approach is shaped according to
your particular needs and wishes. Together we bring your authentic, true self
into focus, calling forth your inner strengths and resiliency while you explore
your vulnerabilities and concerns. We may use insight, mindfulness, an interactive
style of guided imagery, the Work of Byron Katie, solution focused therapy,
EMDR, EFT, and cognitive behavioural therapy, to name a few. EMDR refers to
EMDR stands for Eye Movement Desensitisation Reprocessing, a highly effective
and well-researched therapeutic method developed in 1987 by Dr. Francine
Shapiro, for healing many types of psychological distress including past or recent
trauma, self esteem issues, creativity blocks, complex unresolved grief, being
the victim of a violent crime, combat experiences, and performance anxiety. It is
also used to enhance performance, build self-confidence and inner resiliency.
Our brains can process and integrate most of our experiences without leaving a
lasting negative effect. But research in the area of trauma tells us that when an
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Other Therapies for experience is very intense or threatening, the ability to process the experience
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can get stuck along with negative interpretations or beliefs. EMDR works to
unlock the lodged memories and reengage the brain’s natural ability to integrate
the experience.
EFT refers to Emotional Freedom Technique or EFT for short. It is one of the
most remarkable health innovations in the last 100 years. It is based on impressive
discoveries regarding the bodies’ energy system. It works on just about every
emotional and physical issue you can name. In fact it often works where all else
has failed and can work where conventional medicine has no answers. EFT has
its basis in Chinese acupuncture and psychology but instead of using needles
you simply tap on well established meridian points on the upper body. EFT is a
painless and relaxing method of healing.
EFT is a powerful technique and a potent technique that helps you take control
of your body and your thoughts. This technique was developed by Gary Craig in
1990 and has originated from acupuncture, kinesiology, and psychology. This
wonderful technique has shown amazing results in developing attitude and
behaviour, resolving personal problems, decreasing stress, and restoring life
balance.
Emotional Freedom Technique is an efficient technique offering solutions to
stress related problems and helps in balancing the body’s energy system. This
painless technique effectively deals with any psychological or physiological
problem and shows concrete results within a short time.
EFT aims at returning the mind, body, and emotions of an individual to a balanced
and harmonious state so that he or she is free from negative emotions.
EFT is a gentle method that works by balancing the body’s energy system.
Many a times we are affected by bad relationships, traumas, or losses. Work
related stress, depression, interpersonal problems, and anxieties also affect our
mental health. These negative emotions block the flow of energy in our system
and have a detrimental effect on our health. EFT helps in releasing these negative
emotions and resolving the problem.
EFT involves treating physiological or psychological problems by tapping specific
acupressure points with fingers. It is you who taps yourself. I have no need to
touch you at all. My role is to tell you where to tap and also what to say as you
tap. The procedure can be done over the telephone or the Internet. It is easy to do
and I have never had a client who found it difficult.
EFT helps in Pain Management, Addictions, Allergies, Weight Loss, Headaches,
Asthma, Trauma, Abuse, Depression, Eating Disorders, Blood Pressure, Anorexia,
and many more diseases and maladies.
EFT often works where every other treatment fails. In fact EFT helps with virtually
every physical and emotional problem that one can think of.
Self Assessment Questions
1) What is integrative psychotherapy?
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 Psychotherapy Integration
2) Describe the characteristics of integrative psychotherapy.
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3) What is EMDR? Explain
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4) Elucidate the EFT technique.
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4.3 HISTORICAL OVERVIEW OF THE

INTEGRATIVE MOVEMENT
Integrative therapy draws on some of the oldest techniques of psychotherapy. It
was developed during the 1970s by Richard G Erskine PHD and at The Institute
for Integrative Psychotherapy.
The Integrative psychotherapy model recognises the use of other therapeutic
approaches such as humanistic, cognitive, gestalt and psychodynamic and attempts
to fuse them into a approach that is of benefit to the individual. The facilitation
of a person’s ‘wholeness’ to improve their quality of life.
The movement toward integration of the various schools of psychotherapy has
been in the making for decades. On the whole, however, psychotherapy integration
has been traditionally hampered by rivalry and competition among the various
schools. Such rivalry can be traced to as far back as Freud and the differences
that arose between him and his disciples over what was the appropriate framework
for conceptualising clients problems. From Freud’s Wednesday evening meetings
on psychoanalysis, a number of theories were created, including Adler’s individual
psychology. As each therapist claimed that he had found the one best treatment
approach, heated battles arose between various therapy systems. When
behaviourism was introduced to the field, clashes took place between
psychoanalysts and behaviourists.
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Other Therapies for During the 1940s, 1950s, and 1960s, therapists tended to operate within primarily
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one theoretical school. Dollard and Miller’s (1950) book, Personality and
Therapy, was one of the first attempts to combine learning theory with
psychoanalysis. In 1977, Paul Wachtel published Psychoanalysis and Behaviour
Therapy: Toward an Integration. In 1979, James Prochaska offered a trans
theoretical approach to psychotherapy, which was the first attempt to create a
broad theoretical framework.

In 1979, Marvin Goldfried, Paul Wachtel, and Hans Strupp organised an

association, the Society for the Exploration of Psychotherapy Integration (SEPI),
for clinicians and academicians interested in integration in psychotherapy
(Goldfried, Pachankis, & Bell, 2005). Shortly thereafter in 1982, The International
Journal of Eclectic Psychotherapy was published, and it later changed its name
to the Journal of Integrative and Eclectic Psychotherapy. By 1991, it began
publishing the Journal of Psychotherapy Integration. As the field of
psychotherapy has developed over the past several decades, there has been a
decline in the ideological cold war among the various schools of psychotherapy
(Goldfried, Pachankis, & Bell, 2005).

Integrative therapy is different from eclectic therapy. Integration is like choosing

raw ingredients to make a balanced and nutritious meal, from a recipe to be used
again, whilst eclecticism is like visiting the salad bar to select prepared food for
just that meal, equally nutritious, and a different selection can be made next
time.

It is this considered, methodical attempt to bring theories and practices together

that sets the integrationists apart from the eclectics.

Paul Wachtel, a central figure in the integrative movement since the seventies,
says that eclecticism tends to focus on “what works,” and relies heavily on
empiricism and statistical analysis to discover what seems to work. For Wachtel,
it is this lack of theory that distinguishes the eclectics from the more theoretically
grounded integrationists, who should be able to say not only what works, but
why it works.

Tullio Carere, a committed integrationist, sketches the history of psychotherapy

integration in several phases ([Link]/[Link]). The first, the
“latency” phase, began in the early 1930’s but was not a well defined area of
interest, he says. The 1970’s saw the more clear delineation of integration as a
concern, with more concerted efforts being made at rapprochement across the
boundaries. An interim phase, he says, was marked by the launch of the Society
for the Exploration of Psychotherapy Integration (Sepi) in 1983 and the growing
concern with a range of themes in integration and common theoretical and clinical
languages.

The third phase, he suggests, is beginning with the new century, and, if successful,
will see integrative psychotherapy moving from an area of interest to a scientific
discipline.

Psychotherapy integration is not a new school, but there are new schools which,
while integrative, are discrete new schools which draw on and systematically
integrate the most useful ideas they can find from other schools.
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A typical integrative brand of therapy is Eye Movement Desensitisation and Psychotherapy Integration
Reprocessing, (EMDR). But the history of EMDR is illustrative of the emergence
of discrete new schools.

The history of EMDR has been dogged by controversy which makes other, more
traditional modality wars look tame by comparison. Those opposed to the method
have slated the lack of evidence and theoretical grounds for its claimed efficacy
(see page 16 of this edition). In response, its proponents have scrambled for
more research-based evidence of its value and recruited thousands of practitioners
as trainees and advocates of the method.

To be truly integrative then, means to largely abandon one’s religious favour

about any particular method, including any discrete approaches or philosophies
which are themselves integrative of other approaches. Sound like a difficult
balancing act? Well, why do you think it has taken integrationism 70 years to get
integrated into our psychotherapeutic repertoires?

4.4 VARIABLES RESPONSIBLE FOR GROWTH OF

PSYCHOTHERAPY INTEGRATION
Norcross and Newman (1992) have summarized the integrative movement in
psychology by identifying eight different variables that promoted the growth of
the psychotherapy integration trend in counselling and psychotherapy.

First, they pointed out that there was simply a proliferation of separate counselling
theories and approaches. The integrative psychotherapy movement represented
a shift away from what was the prevailing atmosphere of factionalism and
competition amongst the psychotherapies and a step toward dialogue and
cooperation.
Second, they noted that practitioners increasingly recognised the inadequacy of
a single theory that is responsive to all clients and their varying problems. No
single therapy or group of therapies had demonstrated remarkable superior efficacy
in comparison to any other theory.
Third, there was the correlated lack of success of any one theory to explain
adequately and predict pathology, personality, or behavioural change.
Fourth, the growth in number and importance of shorter-term, focused
psychotherapies was another factor spearheading the integrative psychotherapy
movement.
Fifth, both clinicians and academicians began to engage in greater communication
with each other that had the net effect of increasing their willingness to conduct
collaborative experiments.
Sixth, clinicians had to come to terms with the intrusion into therapy with the
realities of limited socioeconomic support by third parties for traditional, long-
term psychotherapies. Increasingly, there was a demand for therapist
accountability and documentation of the effectiveness of all medical and
psychological therapies. Hence, the integration trend in psychotherapy has also
been fuelled by external realities, such as insurance reimbursement and the
popularity of short-term, prescriptive, and problem-focused therapists.
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Other Therapies for Seventh, researchers identification of common factors related to successful therapy
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outcome influenced clinician’s tendency toward psychotherapy integration.
Increasingly, therapists began to recognise there were common factors that cut
across the various therapeutic schools.

Eighth, the development of professional organisations such as SEPI, professional

network developments, conferences, and journals dedicated to the discussion
and study of psychotherapy integration also contributed to the growth of the
movement. The helping profession has definitely moved in the direction of
theoretical integration rather than allegiance to a single therapeutic approach.
There has been a concerted movement toward integration of the various theories.
Self Assessment Questions
1) Present the historical overview of integrative psychotherapy movement.
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2) Elucidate the variable responsible for the growth of integrated
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4.5 DIFFERENT WAYS TO PSYCHOTHERAPY

INTEGRATION
This section provides an overview of how theorists and practitioners have tried
to integrate the various theoretical approaches to therapy. Perhaps in examining
how others have integrated their therapy with different concepts and techniques,
we might feel more comfortable in thinking about how we might pursue this
same avenue. Clinicians have used a number of ways to integrate the various
counselling theories or psychotherapy, including technical eclecticism, theoretical
integration, assimilative integration, common factors, multitheoretical
psychotherapy, and helping skills integration.

4.5.1 Eclecticism
Eclecticism may be defined as an approach to thought that does not hold rigidly
to any single paradigm or any single set of assumptions, but rather draws upon
multiple theories to gain insight into phenomena. Eclectics are sometimes
criticized for lack of consistency in their thinking. For instance, many
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psychologists accept some features of behaviourism, yet they do not attempt to Psychotherapy Integration
use the theory to explain all aspects of client behaviour. Eclecticism in psychology
has been caused by the belief that many factors influence human behaviour;
therefore, it is important to examine a client from a number of theoretical
perspectives.

4.5.2 Differences between Eclecticism and Psychotherapy

Integration
Typically, eclectic therapists do not need or have a theoretical basis for either
understanding or using a specific technique. They chose a counselling technique
because of its efficacy, because it works. For instance, an eclectic therapist might
experience a positive change in a client after using a specified counselling
technique, yet not investigate any further why the positive change occurred. In
contrast, an integrative therapist would investigate the how and why of client
change. Did the client change because she was trying to please the therapist or
was she instead becoming more self-directed and empowered?

Integrative and eclectic therapists also differ in the extent to which they adhere
to a set of guiding, theoretical principles and view therapy change. Practitioners
who call themselves eclectic appear to have little in common, and they do not
seem to subscribe to any common set of principles. In contrast, integrationists
are concerned not only with what works but why it works. Moreover, clinicians
who say they are eclectic tend to be older and more experienced than those who
describe themselves as integrationists. This difference is fast disappearing because
some graduate schools are beginning to train psychologists to be integrationists.

4.5.3 Theoretical Integration

Theoretical integration is perhaps the most difficult and sophisticated of the three
types of psychotherapy integration because it involves bringing together
theoretical concepts from disparate theoretical approaches, some of which may
present contrasting worldviews. The goal is to integrate not just therapy techniques
but also the psychotherapeutic theories involved as Dollard and Miller (1950)
did with psychoanalysis and behaviour therapy. Proponents of theoretical
integration maintain that it offers new perspectives at the levels of theory and
practice because it entails a synthesis of different models of personality
functioning, psychopathology, and psychological change.

4.5.4 Assimilative Integration

The assimilative integration approach to psychotherapy involves grounding
oneself in one system of psychotherapy but with a view toward selectively
incorporating (assimilating) practices and views from other systems. Assimilative
integrationists use a single, coherent theoretical system as its core, but they borrow
from a broad range of technical interventions from multiple systems. Practitioners
who have labelled themselves as assimilative integrationists are: (1) Gold (1996),
who proposed assimilative psychodynamic therapy; (2) Castonguay et al. (2004),
who have advocated cognitive-behavioural assimilative therapy; and (3) Safran,
who has proposed interpersonal and cognitive assimilative therapy (Safran &
Segal, 1990).
Assimilative integrationists believe integration should take place at the practice
level rather than at the theory level. Most therapists have been trained in a single
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Other Therapies for theoretical approach, and over time many gradually incorporate techniques and
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methods of other approaches. Typically, therapists do not totally eliminate the
theoretical framework in which they were trained. Instead, they tend to add
techniques and different ways of viewing individuals.

4.5.5 The Common Factor Approach

The common factors approach has been influenced by the research and
scholarships of such renowned leaders in psychotherapy as Jerome Frank (1973,
1974) and Carl Rogers (1951, 1957). Clearly, Rogers’s contributions to common
factors research has become so accepted by clinicians throughout the world that
his core conditions (or necessary and sufficient conditions to effect change in
clients) have become part of the early training of most helping professionals.
Researchers and theorists have transformed Rogers’s necessary and sufficient
conditions into a broader concept that has become known as “therapeutic alliance”
(Hubble, Duncan, & Miller, 1999). The therapeutic alliance is important across
the various counselling theory schools; it is the glue that keeps the person coming
to therapy week after week. Currently, more than 1,000 studies have been reported
on the therapeutic alliance (Hubble, Duncan, & Miller, 1999).

The common factors approach seeks to determine the core ingredients that
different therapies share in common, with the eventual goal of creating more
parsimonious and efficacious treatments based on their commonalities. This
search is predicated on the belief that commonalities are more important in
accounting for therapy outcome than the unique factors that differentiate among
them.

There is no standard list of common factors, but if a list were to be constructed,

it surely would include:
• A therapeutic alliance established between the patient and the therapist.
• Exposure of the patient to prior difficulties, either in imagination or in reality.
• A new corrective emotional experience that allows the patient to experience
past problems in new and more benign ways.
• Expectations by both the therapist and the patient that positive change will
result from the treatment.
• Therapist qualities, such as attention, empathy, and positive regard, that are
facilitative of change in treatment.
• The provision by the therapist to the patient of a reason for the problems
that are being experienced.
Irrespective of the type of therapy that is practiced, each of these common factors
is present. It is difficult to imagine a treatment that does not begin with the
establishment of a constructive and positive therapeutic alliance. The therapist
and the patient agree to work together and they both feel committed to a process
of change occurring in the patient. Within every approach to treatment, the second
of the common factors, the exposure of the patient to prior difficulties, is present.
In some instances the exposure is in vivo (occurs in real life), and the patient will
be asked directly to confront the source of the difficulties. In many cases, the
exposure is verbal and in imagination. However, in every case, the patient must
express those difficulties in some manner and, by doing so, re-experiences those
68 difficulties through this exposure.
In successful treatment, the exposure usually is followed by a new corrective Psychotherapy Integration
emotional experience. The corrective emotional experience refers to a situation
in which an old difficulty is re-experienced in a new and more positive way. As
the patient re-experiences the problem in a new way, that problem can be mastered
and the patient can move on to a more successful adjustment.
Having established a therapeutic alliance and being exposed to the problem in a
new and more positive context, both the therapist and the patient always expect
positive change to occur. This faith and hope is a common factor that is an
integral part of successful therapy. Without this hope and expectation of change,
it is unlikely that the therapist can do anything that will be useful, and if the
patient does not expect to change, it is unlikely that he or she will experience any
positive benefit from the treatment.
The therapist must possess some essential qualities, such as paying attention to
the patient, being empathic with the patient, and making his positive regard for
the patient clear in the relationship. Finally, the patient must be provided with a
credible reason for the problems that he or she is undergoing. This reason is
based in the therapist’s theory of personality and change. The same patient going
to different therapists may be given different reasons for the same problem. It is
interesting to speculate as to whether the reason must be an accurate one or
whether it is sufficient that it be credible to the patient and not remarkably at
variance with reality. As long as the reason is credible and the patient has a way
of understanding what previously had been incomprehensible, that may be
sufficient for change to occur.

4.5.6 Multi Theoretical Approaches

Recently, therapists have developed multi theoretical approaches to therapy.
Multitheoretical frameworks do not attempt to synthesise two or more theories
at the theoretical level. Instead, there is an effort to “bring some order to the
chaotic diversity in the field of psychotherapy and “preserve the valuable insights
of major systems of psychotherapy” (Prochaska & DiClemente, 2005, p. 148).
The goal of multi theoretical approaches is to provide a framework that one can
use for using two or more theories. Two examples of multi theoretical frameworks
are (1) the trans theoretical approach by Prochaska and DiClemente, and (2)
multi theoretical therapy by Brooks-Harris.

4.5.7 The Trans Theoretical Model

The most widely recognised model using a multi theoretical framework has been
the trans theoretical model developed by Prochaska and DiClemente (1984, 2005).
The trans theoretical model is a model of behavioural change, which has been
the basis for developing effective interventions to promote healthy behaviour
change. Key constructs are integrated from other counselling theories. The model
describes how clients modify problem behaviour or how they develop a positive
behaviour. The central organising construct of the model is the stages of change.
The theorists maintain that change takes place through five basic stages: (1) pre
contemplation, (2) contemplation, (3) preparation, (4) action, and (5) maintenance.
In the pre contemplation stage, people are not intending to take action in the
foreseeable future, usually measured as the next 6 months. During the
contemplation stage, people are intending to change within the next 6 months.
In the preparation stage, clients are intending to take action in the immediate
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Other Therapies for future, usually measured as the next month. Clients in the action stage have
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made specific overt modifications in their life styles within the past 6 months.
During the maintenance stage, clients work to prevent relapse, a stage which is
estimated to last from 6 months to about 5 years. The termination stage of change
contains clients who have zero temptation and 100% self-efficacy. They are
confident they will not return to their old unhealthy habit as a way of coping.
The trans theoretical model also proposes 10 processes of change, which are the
covert and overt activities that people use to progress through the stages. The
first 5 processes involve experiential processes of change, while the last 5 are
labelled behavioural processes, and these are used primarily for later-stage
transitions. For instance, during the experiential processes of change, people
experience consciousness rising and social liberation. The 5 behavioural processes
of change range from stimulus control to counter-conditioning to self-liberation.
The trans theoretical model does not make assumptions about how ready clients
are for change in their lives. The model proposes that different individuals will
be in different stages and that appropriate interventions must be developed for
clients based on their stages of development.
The trans theoretical model assumes that the different systems of psychotherapy
are complementary and that different theories emphasise different stages and
levels of change.

4.5.8 Brooks-Harris’ Multi Theoretical Model

The most recent multi theoretical model for psychotherapy comes from Brooks-
Harris, who provides a framework that describes how different psychotherapy
systems come together. Brooks-Harris (2008) begins with the premise that
thoughts, actions, and feelings interact with one another and that they are
influenced by biological, interpersonal, systemic, and cultural contexts.
Given this overarching premise, he integrates the following theoretical
approaches: (1) cognitive, (2) behavioural, (3) experiential, (4) bio psychosocial,
(5) psychodynamic, (6) systemic, and (7) multicultural. A brief explanation of
each of these areas is provided below (table 6.5.2). His framework emphasises
at what point a therapist might consider using elements of psychodynamic theory
or multicultural theory. A major umbrella in multicultural psychotherapy consists
of the focal dimensions for therapy and key strategies.
MULTI THEORETICAL PSYCHOTHERAPY
Cognitive strategies deal with the focal dimension of clients’ functional
and dysfunctional thoughts.
Behavioural skills–focal dimension of actions encourage effective client
actions to deal with challenges.
Experiential interventions result in adaptive feelings.
Bio psychosocial strategies emphasise biology and adaptive health practices.
Psychodynamic – interpersonal skills are used to explore clients’
interpersonal patterns and promote undistorted perceptions.
Systemic – constructivist interventions examine the impact of social
systems and support adaptive personal narratives.
Multicultural – feminist strategies explore the cultural contexts of clients’
issues.
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Brooks-Harris presents five principles for psychotherapy integration, which Psychotherapy Integration
include
1) Intentional integration,
2) Multidimensional integration,
3) Multi theoretical integration,
4) Strategy-based integration, and
5) Relational integration.
The first principle says that psychotherapy integration should be based on
intentional choices. The therapist’s intentionality guides his or her focus,
conceptualisation, and intervention strategies.

Principle two (multidimensional) proposes that therapists should recognise the

rich interaction between multiple dimensions.

The third principle asserts that therapists take into consideration diverse theories
to understand their clients and guide their interventions.

The fourth strategy based principle states that therapists combine specific
strategies from different theories. Strategy-based integration uses a pragmatic
philosophy. Underlying theories do not have to be reconciled.

The fifth or relational principle proposes that the first four principles must be
enacted within an effective therapeutic relationship.

Brooks-Harris’ (2008) model offers a good plan for therapists seeking to

implement an integrative multitheoretical approach. He outlines strategies for
each of the seven core areas. For instance, cognitive strategies should encourage
functional thoughts that are rational and that promote healthy adaptation to the
environment. In addition, he enumerates a catalogue of 15 key cognitive strategies,
which include identifying thoughts, clarifying the impact of thoughts, challenging
irrational thoughts, providing psychoeducation, and supporting bibliotherapy.

To integrate behavioural therapy into one’s practice, he suggests some of the

following catalogue of key strategies: assigning homework, constructing a
hierarchy, providing training and rehearsal, determining baselines, and schedules
of reinforcement.

4.5.9 Helping Skills Approach to Integration

Clara Hill (2004) has provided a helping skills model to therapy integration. Her
model describes three stages of the helping process that are based on different
therapy schools.

The first stage of helping is labelled exploration. Using Rogers’ client-centered

therapy as the therapy school of choice, Hill (2004) emphasises the counselling
skills of attending, listening, and reflection of feelings.

The second stage is termed insight, and this stage is based on psychoanalytic
theory; therefore, such skills as interpreting and dealing with transference are
stressed.

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Other Therapies for The third stage is termed the action stage, and this stage is based largely on
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cognitive-behavioural techniques. Using the helping skills model, training would
focus on teaching graduate students techniques associated with each of these
three therapeutic schools.

Self Assessment Questions

1) What are the ways to integrate psychotherapy?
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2) Differentiate between eclectic therapy and integrative therapy.
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3) What is meant by assimilating integrations?
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4) Explain common factor approach in Integrated Psychotherapy.
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5) Discuss multi theoretical approach.
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6) Explain Brooke Harris Multi theoretical approach to integrative
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4.6 EVIDENCE BASED THERAPY AND

INTEGRATIVE PRACTICE
Regardless of whether a therapist uses an integrative approach or one based on a
single therapy school, he or she will have to take into consideration whether or
not empirical support exists for a chosen treatment approach. Evidence based
practice (EBP) is a combination of learning what treatments work based on the
best available research and taking into account clients culture and treatment issues.

The American Psychological Association (2006, p. 273) conceptualises evidence

based practice as “the integration of the best available research with clinical
expertise in the context of patient characteristics, culture and preferences.”
Evidence based practice emphasises the results of experimental comparisons to
document the efficacy of treatments against untreated control groups, against
other treatments, or both.
The arguments in favour of EBP are reasonable.
First, clients have a right to treatments that have been proven to be effective.
Second, managed care requires counsellor accountability in choosing a method
of treatment.
Increasingly, counsellors may have to consult with research studies to determine
which approach is the most efficacious with what mental health disorder. Helping
professionals may be required to answer for using a therapeutic approach with a
specific disorder.

How does a therapist implement EBP in practice? The therapist must gather
research that informs him or her about what works in psychotherapy. Such
information should be obtained before treatment is begun.

There are several major resources for evidence-based practice. For instance, the
Cochrane Collaboration ([Link] sets standards for reviews
of medical, health, and mental health treatments and provides “systematic
reviews” of related research by disorder. Cochrane Reviews are designed to help
providers, practitioners, and patients make informed decisions about health care
and are the most comprehensive, reliable, and relevant source of evidence on
which to base these decisions. Moreover, the United States government also
offers treatment guidelines based on EBP principles at the National Guideline
Clearinghouse ([Link] This site contains very good
information on medication.
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Other Therapies for Other online resources for EBP and treatment guidelines include the American
Psychological Interventions
Psychiatric Association (APA), which offers practice guidelines for mental health
([Link]

4.7 FUTURE OF PSYCHOTHERAPY SCHOOLS

AND THERAPY INTEGRATION
What does the future look like for psychotherapy schools? Norcross, Hedges,
and Prochaska (2002) used a Delphi poll to predict the future of psychotherapy
over the next decade. The experts who served as participants in the poll predicted
that the following theoretical schools would increase the most: cognitive-
behaviour therapy, culture-sensitive multicultural counselling, Beck’s cognitive
therapy, interpersonal therapy, family systems therapy, behaviour therapy,
technical eclecticism, solution-focused therapy, and exposure therapies.

Therapy orientations that were predicted to decrease the most included classical
psychoanalysis, implosive therapy, Jungian therapy, transactional analysis,
humanistic therapies, and Adlerian therapy.

The poll also showed how psychotherapy is changing. The consensus is that
psychotherapy will become more directive, psychoeducational, technological,
problem-focused, and briefer in the next decade. Concomitantly, relatively
unstructured, historically oriented, and long-term approaches are predicted to
decrease i.e. Short term is in, and long term on its way out.

4.8 LET US SUM UP

Psychotherapy integration is defined as an approach to psychotherapy that includes
a variety of attempts to look beyond the confines of single-school approaches in
order to see what can be learned from other perspectives. It is characterised by
openness to various ways of integrating diverse theories and techniques.
The movement toward integration of the various schools of psychotherapy has
been in the making for decades. On the whole, however, psychotherapy integration
has been traditionally hampered by rivalry and competition among the various
schools. Such rivalry can be traced to as far back as Freud and the differences
that arose between him and his disciples over what was the appropriate framework
for conceptualising clients’ problems.
Norcross and Newman (1992) have summarized the integrative movement in
psychology by identifying eight different variables that promoted the growth of
the psychotherapy integration trend in counselling and psychotherapy.
Clinicians have used a number of ways to integrate the various counselling theories
or psychotherapy, including technical eclecticism, theoretical integration,
assimilative integration, common factors, multitheoretical psychotherapy, and
helping skills integration.
Regardless of whether a therapist uses an integrative approach or one based on a
single therapy school, he or she will have to take into consideration whether or
not empirical support exists for a chosen treatment approach. Evidence-based
practice (EBP) is a combination of learning what treatments work based on the
best available research and taking into account clients’ culture and treatment issues.
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 Psychotherapy Integration
4.9 UNIT END QUESTIONS
1) Define the term integrative psychotherapy. Trace the historical overview of
integrative psychotherapy movement.
2) Explain the common factors approach to psychotherapy integration.
3. Discuss the difference between technical eclecticism and assimilative
integration.
4) What are the possible ways of integrating psychotherapy?
5) What are the arguments in favour of evidence based psychotherapy in
practice?
6) What does future hold for psychotherapy schools?

4.10 GLOSSARY
Common Factors : This term is used when the techniques are
common to all approaches to psychotherapy.
Assimilative Integration : It is an approach in which the therapist has a
commitment to one theoretical approach but
also is willing to use techniques from other
therapeutic approaches.
Technical Eclecticism : In this approach, diversity of techniques is
displayed but there is no unifying theoretical
understanding that underlies the approach.
Theoretical Integration : This model requires integrating theoretical
concepts from different approaches, and
these approaches may differ in their
fundamental philosophy about human
behaviour.
Multitheoretical Approaches : These approaches provide a framework that
one can use for using two or more theories.
Evidence-based Practice(EBP): It is a combination of learning what
treatments work based on the best available
research and taking into account clients’
culture and treatment issues.

4.11 SUGGESTED READINGS

Corsini, Raymond J., Wedding, Danny. (2008). Current Psychotherapies. USA:
Brooks/Cole.
Messer, S. B. “A critical examination of belief structures in interpretive and
eclectic psychotherapy.” In Handbook of Psychotherapy Integration,edited by J.
C. Norcross and M. R. Goldfried. New York: Basic Books, 1992: 130-165.
Sommers-Flanagan, John., Sommers-Flanagan, Rita. (2004). Counseling and
psychotherapy theories in context and practice: Skills, strategies, and techniques.
Hoboken, New Jersey: John Wiley & Sons, Inc.
Stricker, G., and J. Gold. (Eds.) Comprehensive handbook of psychotherapy
integration. New York: Plenum, 1993. 75