integration: turn, or logical consequence in development? © zbyněk vybíral, 2007 department of...

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Integration: turn, or logical consequence in development? © Zbyněk Vybíral, 2007 Department of Psychology Faculty of Social Studies, Brno

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Integration: turn, or logical consequence in development?

© Zbyněk Vybíral, 2007Department of Psychology

Faculty of Social Studies, Brno

Introduction paper for Invited Symposium

“Is psychotherapy taken a integrative turn?”

at Xth European Congress of Psychology,

Prague, 3 – 6 July 2007

Some inspirations and current questions regarding integration in psychotherapy

What we know

• There are three perspectives now:– Attempts to build a new theoretical integration– “Common factors” approach– “Technical eclecticism” without constructing a

new particular theory

• But note that so called eclectic PST changed very rapidly into systematic eclectic PST

What we know, as well (one reminder)

• In third Delphi Poll “on the future of PST” conducted in 2001 62 experts predicted changes and trends in orientations in rank order of 29 approaches. They forecasted the state in 2010:

• Increase of both technical eclecticism (rank 5) and theoretical integration (rank 6)

• Rank 1: CBT, rank 2: culture-sensitive / multicultural th., rank 3: Beckian therapy (…), rank 27 TA, 28 implosive th., 29 PA

• (See: Norcross, 2002)

What should be noted, as well

• To me, there are three diverse movements:• 1 Integration of parts of traditional schools

(techniques) and blending of fundamental convictions (guidelines) from different “clusters” of theories – leading to systematic eclecticism

• 2 Integration of different ways within modalities (e.g. from different historical stages – e.g. in family/systemic therapy, or Gestalt therapy, or CBT)

• 3 Establishing of new schools (e.g. “Strength-centered therapy”, CAT)

What we already have

• [Outcome of the second way:] We can use fruits of integrative work in systemic schools – see Anderson (), Jones (), Asen (2002) – we live in the era of modern Gestalt therapy, modern PA, modern CBT, modern FT. (Or postmodern?)

• [Outcome of the third way:] Therapists created and do have and use CAT, DBT, S-CT (based on positive psy and SC), etc.

Who was and is contributing in the field?

• Bergin, Beutler, Castonguay, Clarkin, Frank, Garfield (†2004) , Goldfried, Grawe (†2005) , Knobloch, Kratochvil (CZ), Lambert, Lazarus, Luborsky, Marmor, Norcross, Prochaska, Sloane, Stiles, Strupp, Wachtel and many others

From other view of point

• In one article regarding integration in PST with subtitle “Goal or utopia” outlined two Utrecht’s authors another three ways in integrative movement:

• “empirical strategy” focused on research • “conceptual strategy” trying to theorize on

psychotherapy concepts• and “linguistic strategy”

• Lemmens; de Ridder and van Lieshout (1994)

Go on… Acronyms mean references to texts

as follows: • CAST: Castonguay, Louis G. (2006).

– Personal Pathways in Psychotherapy Integration. Journal of Psychotherapy Integration 16(1): 36-58

• ARK: Arkowitz, Hal (2003). – Integrative Theories of Therapy. In Freedheim, Donald K. (Ed.) (1992;

2003). History of Psychotherapy. Washington: APA, pp. 261-303.

• GOLD/CAST: Goldfried, M.R., Castonguay, Louis (1992). – The Future of Psychotherapy Integration. Psychotherapy 29(1): 4-10.

• ASE: Asen, Eia (2002). – Integrative therapy from a systemic perspective. In Holmes, J. &

Bateman, A. Integration in Psychotherapy, pp 49-67

Some fundamental statements

• Integration was gaining popularity in the field since 1970s and (as ARK stated):

• Beginning around 1980, interest in PI grew dramatically.

• PI becomes more a part of the mainstream (GOLD/CAST)

• What therapists do in therapy is often different than what their theories predict and suggest. (GOLD/CAST)

Other fundamental claims

• Rosenzweig’s slogan (Dodo bird verdict: Everybody has won so all shall have prizes) used in 1936 was still confirmed (see e.g. Luborsky et al., 2003)– BUT ALSO many therapists always argue that

• “…different PST-s work differently… Factors such as cognitive changes and accurate interpretation might be important in certain treatments but not in others.” (Andrusyna in PR, October 2006)

Marvin R. Goldfried wrote in 1980:

• There is a growing discontent among therapists of varying orientations… [They are] starting to raise serious questions about the limits of their respective approaches and are becoming more open to contributions from other paradigms.

What can we see today? Does go on [discontent]?

• To me, unfortunately we are at the same stage of development as in 1980’s.

• The rigid positions of pure schools are stronger than we thought.

• In ASEN’s words said free: single-schools offered (offer always) their models often reduced to some banal principles to provide safe certainty in therapists; they lead them to adopting the state “I know all”

Goldfried and Castonguay anticipated in 1992

• It would not surprise us if we saw future generations of therapists choosing to be trained in one particular traditional orientation, while at the same time showing a greater openness toward the […] contributions of the other approaches.

Who is the new generation?

• Who is the new generation of therapists according predicting view from 1992 mentioned above?

• Are we the new generation, or are we the old one?

What does mean PI?

• Paradigm-breaking activity [CAST], or ground-breaking steps [GOLD/CAST]

• “Thinking outside the box” [CAST]• PI is characterized by dissatisfaction with

single-school approaches and with desire to look across and beyond school boundaries to see what can be learned from other ways of thinking about P, P and change.

Raise questions:

• Does “be integrative” mean more “state of mind”?

• Or rather “being more willing to try / to learn / to experiment other “methods of practicing and thinking”?

• Where remains a consistency?• Where begins and ends a chaos and state of

confusion?• Does it mean – “to become heretic” in

broadening the originally “pure way”?• Or does it mean something different?

One question more: Why to integrate?

• Bateson asked in Mind and Nature what benefit do we gain if we would combine information from two perspectives:

• "What bonus or increment of knowing follows from combining information from two or more sources?" (see Chapter 3)

Bateson’s answer looks:

• “we may say that epistemology is the bonus from combining insights form all these separate […disciplines…]

• GB added, that “epistemology is always and inevitably personal”

So, why to think and practice integrative?

• Integrative therapy is not only superior to a waiting list but appears to compare favorably with traditional cognitive therapy [CAST]

• Related to Bateson: Why not to adopt a more open epistemology?

What is strong linking with Main Theories may become

• rigid

• ineffective in certain circumstances

• more limited and closed than open

Conclusions

• PI has gained increasing interest during the past three decades

• Integrationist is in a state of safe uncertainty (according to ASE),

• he/she have to improvise • he/she is better prepared to complexity of

clients needs, wishes, prejudices and (maybe also) in treating of ruptures in therapeutic alliance

References (1)

• Castonguay, Louis G. (2006). Personal Pathways in Psychotherapy Integration. Journal of Psychotherapy Integration 16(1): 36-58

• Goldfried, Marvin R. (1980). Toward the Delineation of Therapeutic Change Principles. American Psychologist 35(11): 991-999

• Goldfried, M.R., Castonguay, L. (1992). The Future of Psychotherapy Integration. Psychotherapy 29(1): 4-10.

• Arkowitz, Hal (2003). Integrative Theories of Therapy. In Freedheim, Donald K. (Ed.) (1992; 5. vyd. 2003). History of Psychotherapy. Washington: APA, s. 261-303.

• Asen, E. (2002). Integrative therapy from a systemic perspective. In Holmes, J. & Bateman, A. Integration in Psychotherapy. Oxford UniPress – s. 49-67.

References (2)

• Lemmens, F.; de Ridder and van Lieshout (1994). The integration of psychotherapy: Goal or utopia. Journal of Contemporary Psychotherapy 24(4): 245-257

• Andrusyna, T. et al. (2006). The mechanisms of sudden gains in Supportive-Expressive therapy for depression. Psychotherapy Research 16(5):526-535

• Luborsky, L., Rosenthal, R. et al. (2003). Are Some Psychotherapies Much More Effective Than Others? Journal of Applied Psychoanalytic Studies, Vol. 5, No. 4, 455-460.