What is Integration?

Integrative therapy is a broadly titled approach which can be further broken
down into specific models for practice, some of which being –

➢ Pluralism – working within an individual approach whilst recognising that other approaches have value. Ideally will work closely with other therapists from different orientations and will refer on clients who may benefit from a different approach.

➢ Eclecticism – from the Greek word ‘eklegein’ meaning to ‘select or ‘choose’. Therapists select techniques and practices from a variety of approaches, dependent on the presenting issue.

➢ Integration – An assimilation of theories and philosophies rather than selection of techniques as in an eclectic approach. This can be used in an ‘assimilative’ or ‘accommodative’ approach.

The difference between Integration and Eclecticism is explained beautifully by Andrew M. Pomerantz using the analogy of the difference between a fruit salad and a smoothie.

“A fruit salad includes a variety of ingredients, but each bite brings only one flavour. The fork may stab a strawberry first, a blueberry next, and a pineapple chunk third. Each piece is pure, discrete, and easily distinguished from the others. But in a smoothie made of these ingredients, every sip includes the same combination of ingredients, and the taste of every sip, reflects that unique blend. Mixed together the ingredients create a distinct concoction, with a taste wholly its own.” (Pomerantz, 2016).

The historical growth and development of Integration can be seen from 1983, when the ‘Scientific Establishment for Psychotherapy Integration’ (SEPI) was founded. The ‘Journal of Psychotherapy Integration’ was published from 1997, and ‘The United Kingdom Association for Psychotherapy Integration’ (UKAPI) set up in 1999.

In 2004 the ‘British Journal of Psychotherapy Integration’ began publication, and an APA (American Psychological Association) survey in 2015 found of over 1000 psychotherapists, only 15% indicated that they used only one theoretical orientation in their practice, and the median number of theoretical orientations used in practice was four (Tasca et al., 2015).

In the UK a sample of 300 counsellors discovered 49% were found to be explicitly integrative, with an additional 38% implicitly.
Reasons for these developments can be explained through the recognition of the diversity of therapeutic approaches; which is estimated to be over 400, the limitations of individual approaches achieving successful outcomes for all clients, and the recognition of common features in different modalities.

Eclecticism

Whilst considered an integrational approach, Eclecticism is a method where a practitioner would choose specific skills and approaches to ‘fit’.

Eclecticism can further be reduced by the route in which this is practised.

➢ ‘Technical Eclecticism’ refers to specific techniques, skills and strategies, but not theory. However, these techniques can be extracted from theory and used as necessary.

➢ ‘Haphazard Eclecticism’ – techniques are used randomly without any apparent rationale.

➢ ‘Systematic Eclecticism’ –Practices are concise, with reasoning used for such selection.

Integration

Integration can be further broken down into –

➢ Assimilative integration – Adapts to fit with base theoretical approach.

➢ Accommodative integration – Flexible to changing therapeutic base to accommodate.

➢ Theoretical Integration – Involves building a new approach to therapy which uses theories and techniques from existing approaches.
Relies on framework for creating an approach
Builds a new individual approach, which can lead to the development of research and practices from it frame of reference.

Theoretical integration is about the incorporation of philosophical assumptions and theory, rather than the integration of modalities. This approach ‘seeks an emergent theory that is more than the sum of its parts’ (Norcross & Newman, 1992, p.11-12)

Theoretical Integration

Examples of models are –

➢ ‘Five Relationship Model’ (Clarkson, 2003)

➢ ‘The Relational Integrative Model’ (RIM) (Faris & van Ooijen, 2012)

➢ ‘Integrative Psychotherapy’ (or Relationship-Focused Integrative Psychotherapy (Moursund & Erskine, 2004)

➢ ‘Transtheoretical Model’ (TTM) (Prochaska & Norcross, 2010)

The benefit of these frameworks provide accountability to decision making in practice, structure to the therapy and facilitates boundaries rooted in research.

Whilst these reflections have not been exhaustive, it is hoped that a clearer explanation of the diversity of integrative approaches have been made clearer for those practitioners looking for a better understanding of what is meant by it. Being aware of the importance of framework, and how this can add a basis for practice, can enable us to feel safe in our modality, knowing that it is backed up by tried and tested methods, enabling the client to achieve good outcomes, which are based in robust exploration and research.

References

Clarkson, P. (2003) The Therapeutic Relationship 2nd ed. London; Whurr Publishers

Faris, A. and van Ooijen, E. (2012) Integrative Counselling and Psychotherapy. A Relational Approach London; Sage

Moursand, J. P. and Erskine, R. G. (2004) Integrative Psychotherapy. The Art and Science of Relationship California; Brooks/Cole – Thomson Learning

Norcross, J. C., & Newman, C. (1992). Psychotherapy integration: Setting the context. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration. New York: Basic.
Pomerantz, A. M. (2016). Clinical psychology: Science, practice, and culture. Sage Publications.

Prochaska, J. O. and Norcross, J. C. (2010). Systems of psychotherapy: A transtheoretical analysis (7th ed.). CA: Brooks/Cole.

Tasca, G. A., Sylvestre, J., Balfour, L., Chyurlia, L., Evans, J., Fortin-Langelier, B., … & Joyce, A. S. (2015). What clinicians want: Findings from a psychotherapy practice research network survey. Psychotherapy, 52(1), 1.

 

Article written by Linda Harris.

Contact – Linda Harris Therapy.

 

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