Integrative Perspective in Therapy

1. Integrative Perspective in Therapy Theoretical Foundations The University of Oklahoma

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

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 client’s stories and purpose for which therapy as sought

7. Similarities Between Therapy & Spirituality • Similar goals • Emphasize learning to accept oneself, forgive others & self • Admitting one’s shortcomings • Accepting Personal Responsibility • Letting go of hurts & resentments • Dealing with guilt • Learning to let go of self-destructive patterns of thinking, feeling & acting

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

9. Spirituality: Implications for Assessment & Treatment • Important to understand background of client’s involvement in religion • Understand & respect client’s 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 one’s life

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

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

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