Psychotherapy Integration: Personal Journey

By Elizabeth Dickson, LCSW

 

Personal Journey

 

Introduction

    

“…One begins without understanding the parts or the whole very well. Only the whole gives the parts their roles and meanings. But of course we arrive at an understanding of the whole only part by part. A better grasp of any part can change the sense of the whole…The meaning of the parts is not fixed; they must grow in meaning…” ~ Eugene Gendlin, as quoted by Lynn Preston and Ellen Shumsky in “Toward An Integrative Sensibility: A Post Postmodern Challenge”

 

The above quote offers a helpful way to conceptualize what is happening to psychotherapists as we attempt to integrate different theories and approaches. Even for those therapists who maintain one home base, any assimilation of something new is likely to influence the “whole”, which, in turn, gives new meaning to the “parts”; and each of the parts also evolves, leaving the system in constant motion. And because we always take in new information in our work with clients, we can expect our systems to continue to adjust and grow.

It would be interesting to survey therapists about how they relate to this quote. Do we identify with certain key theories or schools as “parts”, and why do we believe that we have emphasized certain ones over others? Does it feel like the parts coalesce to form something that could be called a whole? Was there a point when things started to come together and the system became more stable? Have there been “perturbations” that disrupted everything and forced us to reconfigure? And, of course, much of our evolution is undoubtedly influenced by the success of the different parts in our practice. Which parts have withstood the test of time and strengthened, and which have not provided the results we had hoped for, failed to sustain us, or otherwise failed to fit into our family of ideas and approaches?

 

My Experience of Bringing the Parts Together

Undoubtedly many of us could tell stories about how our values (both implicit and explicit) and personalities led us to choose certain theories and approaches, and how our process of integrating these different parts is also closely tied to our own personal integration and growth as people with complex and often conflicting value systems. In my case, my journey as a therapist is impossible to separate from my own personal journey of integration. Much of what has made my journey both challenging and fulfilling is that I have been attempting to integrate a range of theories and approaches that represent different “polarities” of my own personality.

On the one hand, I could never just be a cognitive therapist; I am far too enamored of the emotional as well as the mysterious and magical side of life that feels so much bigger and more complex than anything we can pin down or understand. Having the opportunity to live and explore that aspect of life as a therapist is the main reason that I do this work. On the other hand, I am also very much of a “scientist” and love to recognize and understand complex patterns and develop and explore psychological theories and concepts. As a former public policy analyst and, later, bond analyst on Wall Street, my evolution as a therapist has also reflected that side of me and has included a long phase where I was adding to and refining the parts of my system that expanded my knowledge base in more concrete ways and gave me specific tools for working with clients.

One way to conceptualize my training is to think of the key parts as including a psychoanalytic part, a spirituality and psychotherapy part, a Cognitive and Schema Therapy part, a Focusing part, a couples therapy part, and a part that includes all the other pro-active approaches that I have studied, including guided imagery, approaches for working with anxiety and OCD (Obsessive Compulsive Disorder), mode work and EMDR. It has taken much of my 20 years as a therapist to have created an approach where each of the various parts have what generally feels like the right level of emphasis and where, as the Gendlin quote suggests, the whole gives the parts their roles and meanings in a way that feels harmonious most of the time.

And of course this process is tied to the integration of my own personal “polarities” and values, since the two processes go hand in hand. My integration as a therapist has given me a way to allow my analytic and conceptual side to flourish (in part, by emphasizing couples therapy, which benefits from a pro-active style and ability to spot interpersonal dynamics) while at the same time giving ultimate priority to the infinite possibilities of what can unfold in any given moment. At least I feel that I have come closer to that ideal.

 

My Search for a Unifying Concept

A related question is whether we have developed a philosophy about what produces healing and growth—do we have a framework for understanding or predicting how we grow and change? My guess would be that most therapists could provide some answer to this question, but the answer may not be very precise. This is not due to a lack of precision in the way that therapists think, but rather to the difficulty of finding a broad enough framework for explaining and capturing all the ways that we have witnessed change, development and healing in our work with clients.

In my case, a framework for understanding change has been something I have been searching for for years, although not always on a conscious level. At earlier points in my career, I have focused on certain concepts for understanding change that have helped ground me in my work. These include the concept of the therapist serving as a healing self-object for the client, helping the client to get the needs of their wounded child parts met, or helping the client break out of self-defeating “lifetraps” or “schemas” (similar, in some respects, to Paul Wachtel’s circular psycho-dynamics perspective). While these concepts continue to be of primary importance in my work, I find that over time I have stepped back further to find a concept that feels even more inclusive.

The way I think of it now is that I focus on the experiential aspect of therapy, even as I use multiple approaches, including Cognitive and Behavioral Therapy. My goal is for the client to feel touched in the process in a way that contributes to healing and growth. This reflects my belief that meaningful change happens at the experiential level and involves something “emerging” from within the client that I help to facilitate, whether this is brought about through exploration, through the psychotherapy relationship, through a cognitive or behavioral approach or by another type of pro-active approach (such as guided imagery). Eugene Gendlin has referred to this process as “facilitating emergence”. For me, any idea that is more specific than this has the problem of not being inclusive enough of the infinite forms that healing can take. This comes closest for me as a concept that can begin to unite or pull together my sense of the integration process.

Coming to understand the power of Gendlin’s concepts of felt sense and forward movement has helped me to achieve a feeling of “wholeness” as a therapist. Perhaps this is because facilitating emergence is “a different kind of concept,” as Gendlin says. It is not an abstraction in the same way as the others, but rather a way of remembering to see possibilities in any particular direction and always in the present moment with a client. Holding this idea in mind provides balance, since most theories and concepts are more like “things”, while Gendlin’s philosophy is more about how we make use of the potential for aliveness and forward movement in each moment, in the “now”. It is a philosophy about the nature of the change process that helps direct my attention without establishing any preconceptions as to the type of change that will occur or exactly how it will be brought about.

Ultimately each therapist will have their own subjective view as to whether a philosophy of change is desirable or achievable and, if so, what form it will take. While the search for such a framework might be a valuable undertaking, it can also be a somewhat elusive or frustrating one. An alternative way of looking at it is that the value of a philosophy of change for therapists may not be so much in its explanatory or predictive power, but more as a touchstone, a way to remember what is most important or as a source of inspiration. It may be of value to have something at the center of it all that resonates for us, and that knowing it or believing it provides a subtle grounding that helps position us in the work we do. We might ask, “Is there something that feels like the heart or soul of our integration system?”

      

The Ultimate Integration: Learning From Our Clients

While any life career can be expected to teach and shape us as people, being therapists gives us a unique vantage point on life and offers a wonderful, if sometimes humbling, way to learn from our experience with clients. So just as we choose the parts or theories that reflect our beliefs and values, we in turn have the opportunity to adjust our theories (and influence the balance of our underlying values as well) based upon what we find is most productive and fulfilling for our clients (and also for ourselves) in our day to day working lives. And this adjusting that we do as therapists is not only at a conscious level, but also at an implicit level, as we allow our experiences to perform much of the professional (as well as personal) integration process for us.

So the process is reciprocal—our values and passions influence how we work, but our experience with our clients over time very much influences our values and passions. If we are fortunate we have allowed our work to bring us greater wisdom.