Integrative Perspective in Therapy

1
Integrative Perspective in Therapy

• C6436 Individual Counseling Theory and Practice
• James J. Messina, Ph.D.

2
Trend Towards Psychotherapy Integration

• Integration and Eclecticism in Therapy Models
  began in the 1980s
• In 1992 30-50 of therapists called themselves
  eclectic or integrative in their therapeutic
  approach
• Syncretism haphazardly picking techniques
  without any overall theoretical rationale as long
  as it works by default

3
Three Multiple Pathways to Achieve Integration of
Therapy

• Technical eclecticism focuses on differences,
  chooses from many approaches, using techniques
  from different schools-without subscribing to
  theoretical positions which developed them
• Theoretical integration conceptual or
  theoretical creation beyond a mere blending of
  techniques-producing a conceptual framework
  synthesizes best of two or more theoretical
  approaches
• Common factors looks across different
  theoretical approaches in search of common
  elements-find core composed of non-specific
  variables common to all therapies

4
Motives for Integration Trend

• Proliferation of therapies
• Inadequacy of a single therapy relevant to all
  clients problems
• External socioeconomic realities insurance
  reimbursement, HMO, PPO, POS
• Popularity of short-term, prescriptive, problem
  focused therapies
• Opportunities to observe experiment with
  various therapies
• Paucity of differential effectiveness among
  therapies
• Recognition therapeutic commonalities major role
  in therapy outcomes
• Development of professional societies aimed at
  integrating psychotherapies

5
Integration of multicultural Issues

• Integration of multicultural Issues in
  Counseling-through technical eclecticism
• Create techniques to meet the needs of clients of
  different cultures
• Be flexible in utilizing diverse therapeutic
  strategies across varying cultural groups
• Employ and adapt techniques to fit the
  Person-in-the-environment

6
Integration of Spiritual/Religious Issues

• Being open to spiritual/religious values results
  in change in focus of treatment away from
  symptoms relief to general changes in lifestyle
• Spirituality important component of mental health
  and inclusion in therapy helps make it more
  effective
• To be used in therapeutic process to benefit and
  enhance the process
• Force that can help individual make sense of
  universe and find purpose in living
• Stay tuned into clients stories and purpose for
  which therapy as sought

7
Similarities Between Therapy Spirituality

• Similar goals
• Emphasize learning to accept oneself, forgive
  others self
• Admitting ones shortcomings
• Accepting Personal Responsibility
• Letting go of hurts resentments
• Dealing with guilt
• Learning to let go of self-destructive patterns
  of thinking, feeling acting

8
Healing Nature of Spirituality

• Shares Themes of Loving, caring, learning to
  listen with compassion, challenging clients life
  assumptions, accepting human imperfection, going
  outside of self-oriented interests (social
  interest)
• Ponders questions of Who am I? What is meaning
  of life?
• Explores role of shame guilt
• Understanding of difference between blame
  responsibility power of sharing deeply human
  concerns

9
Spirituality Implications for Assessment
Treatment

• Important to understand background of clients
  involvement in religion
• Understand respect clients religious beliefs
• Steps in assessment
• Include in intake procedure early phase of
  therapy
• Questions of spirituality relevant to current
  problem role in current life of client
• How religious beliefs relate to cognitive,
  affective behavioral processes of client
• Letting client know it is acceptable to talk
  about religious spiritual concerns

10
Role of Counselor Dealing with Spirituality

• Be careful not to make decisions for clients but
  to let clients how their own values will guide
  their behavior
• Guard against indoctrinating clients with a
  particular set of spiritual/religious values
• Integrate a spiritual orientation to assist
  clients in crisis to have the solace, comfort,
  sustaining power which spirituality and religious
  beliefs offer them

11
Developing Integrative Perspective

• Beware of mixing theories with incompatible
  underlying assumptions about meanings, origins,
  development, maintenance, significance
  management of problems
• Clinicians can select techniques from any
  discipline without necessarily endorsing any of
  the theories that spawned them
• Therapists must be flexible versatile
• What works for whom under which particular
  circumstances
• Blending flexible repertoire of relationship
  styles with wide range of techniques enhance
  outcome

12
Challenges of Integrative Models

• Deliver therapy in
• Brief
• Comprehensive
• Effective
• Flexible way
• Rapidly systematically
• Identify problems
• Create a collaborative relationship
• Intervene with a range of specific methods

13
Integrative Perspective

• Systematic integration of underlying principles
  methods common to a range of therapeutic
  approaches
• Be thorough conversant with number of theories
• Open to idea that theories can be unified
• Willing to continually test hypotheses to
  determine how well they are working
• Great deal of study, clinical practice, research
  theorizing

14
Therapeutic Goals in Integrative Perspective

• Uncovering the unconscious
• Creating social interest
• Finding meaning in life
• Curing an emotional disturbance
• Examining old decisions making new choices
• Developing trust in oneself
• Becoming more self-actualized
• Reducing anxiety
• Shedding maladaptive behaviors learning new
  ones
• Gaining more effective control of ones life

15
Therapists Functions Role in Integrative
Perspective

• How do counselors functions change depending on
  the stage of the counseling process?
• Does therapist maintain basic role or does role
  vary in accordance with characteristic of client?
• How does counselor determine how active
  directive to be?
• How is structuring handled as the course of
  therapy progresses?
• What is optimum balance of responsibility in
  client/therapist relationship?
• When how much does counselor self-disclose?

16
Clients Experience in Integrative Perspective
Therapy

• Clients given situation in environment provides
  framework for selecting most appropriate
  interventions
• What are clients expectations?
• What are clients responsibilities in the
  process?
• Are there commonalities in diversity of clients?
• Initially clients want expert help quick fix
• As progress realize must be active in process,
  select their own goals work towards them in
  therapy and daily living

17
Relationship between Client Therapist in
Integrative Model

• Crucial determinant in therapy in existential,
  person-centered gestalt
• Not ignored, but not central in REBT, CBT,
  behavior therapy
• Honesty, sincerity, acceptance, understanding
  spontaneity are basic ingredients for success
• Therapists degree of caring, interest, ability
  in helping clients, genuineness are factors
  influencing relationship with clients
• Ability to teach a range of coping skills
• Client contribute motivation, cooperation,
  interest, concern, expectations

18
Techniques in Integrative Therapy Perspective

• Effective counseling proficiency in combination
  of cognitive, affective behavioral techniques
• Help clients think about their beliefs
  assumptions
• Experience on feeling level conflicts struggles
• Translate insights into action programs by
  behaving in new ways in daily living

19
Evaluation of Effectiveness in Integrative
Perspective

• A substantial number of outpatients improve
  without formal therapy-use natural helping
  systems in environment
• Generally therapeutic treatments are
  beneficial-little support for superiority of one
  school of therapy over another
• Common factors which help clients Support,
  Learning Action factors
• Specific techniques can be selected for dealing
  with specific problems on basis of their
  effectiveness-provides framework to assess
  direction outcomes of therapy