Looking at Psychotherapy Integration From the Bottom Up
It has been challenging to train psychotherapists in a way that responds to the needs of the eclectic or integrative therapist. This website is an attempt to demystify the process by suggesting some framework or language that might help ground this effort.
Defining Psychotherapy Integration
Current definitions of psychotherapy integration often include three key dimensions: 1) assimilative integration, where a therapist has “a commitment to one theoretical approach” but also uses techniques from other approaches; 2) theoretical integration, which requires integrating theoretical concepts from potentially conflicting philosophical approaches to produce one grand system; and 3) technical eclecticism, where different techniques are used but with “no unifying theoretical understanding”.
None of the above definitions captures the essence of what I believe integrative therapists actually do in practice. Most therapists today do not commit to one theoretical approach, and theoretical integration as defined above is considered impossible. And the problem with the term “eclectic” is that it implies a need to escape from theory, which does not describe the typical therapist.
I would suggest a fourth dimension called “integration in practice” where we as therapists welcome the challenge of holding sometimes conflicting theories and approaches simultaneously. This can be a worthy goal; we do not need to choose only one theoretical orientation, neatly resolve conflicting theories into one grand system, or ignore theories altogether.
What Therapists Actually Do: Starting With the Navigation System
Since we cannot create one grand integrative approach that will tell us what to do and when (everyone pretty much acknowledges that this is simply not possible), why not take a phenomenological approach and step back and look at what actually happens when a psychotherapist sits down with a client. At the core of our framework is the concept that we are guided by a kind of felt sense navigation system that incorporates all the various inputs in the psychotherapy process and ends up determining how we proceed during the psychotherapy hour.
Our navigation systems take into account the infinite complexity of the moment that we find ourselves in with our client, including tone, body language, our history with this client, our hopes, fears, personal idiosyncrasies, etc. And since our conceptual brains cannot process all of this information, much of the processing is done unconsciously.
Theories and Concepts as Inputs
When we think of our theories and approaches as inputs to our navigation systems, it becomes clear that no one theory is acting alone, but instead is part of a much larger context—and this is the context in which we integrate our various theoretical orientations and approaches and make the necessary tradeoffs. Ideally our theories and concepts can feel like “good mothers” in this process rather than like punitive parents or warring siblings.
Implicit Values as Inputs
Much has been written about how our counter-transference influences our choices as therapists, but there has been little attention paid to how our values (often implicit rather than explicit) can affect our choices and behavior. Our values include not only what we find most meaningful in life, but also what we most want to avoid doing (or being) as therapists. And of course our values influence which theories or schools we are attracted to as well as how much priority we give to any one theory or approach.
The Importance of Knowing What Works
Given that we no longer believe that any one theory or approach represents the ultimate truth, we must of necessity fall back on something more pragmatic to guide us—and this comes down to what works for the client. Yet our training does not tend to focus directly on this concept of “what works”. What are some criteria that we might use to determine whether our interventions are working?
One Way to Define What Works: The Experience of Felt Meaning
To explore this further we introduce the ideas of philosopher and psychotherapist Eugene Gendlin who has devoted much of his career to exploring the experiential dimension of psychotherapy. Gendlin’s approach to what works is based upon his understanding of “felt meaning”—when something becomes meaningful to us, not just in an intellectual way, but more as if our whole being senses that something is meaningful. We know when we have found it because we can feel the shift. Gendlin calls this the forward movement of a felt sense.
Utilizing Multiple Theories and Approaches: How Do We Find Our Way?
Gendlin explains how therapists can incorporate a wide range of orientations and methods (including cognitive therapy, role play, dream interpretation, imagery, emotional catharsis, action steps, working with the body, etc.) while maintaining an approach where direct experiencing remains central. And it is all predicated on the therapist’s ability to read and take into account the client’s responses to their interventions. Any theory we are holding is only a hypothesis to be tested and, if necessary, discarded. The bottom line for Gendlin is that therapists “can check each move they make, to see if it carries the felt sense forward or not”. When clients are touching in to the felt sense, thoughts, feelings, images and reactions emerge out of the lived experience of the therapy process.
Observing The Psychotherapy Relationship to See What Works
And we are not just observing the client in isolation; we are observing the client in relationship to us. At any given moment we can become aware of how the relationship feels. What is the sense of the “us” in any given moment and how might that determine the decisions we make as therapists?
For a more detailed discussion, visit Creating a Framework for Psychotherapy Integration and also Psychotherapy Integration: Knowing What Works.