Psychotherapy Integration

  • Integration is combining concepts and techniques from various approaches
  • Key is to find ways to integrate features from different approaches to help clients on all 3 levels of human experience- thinking feeling behaving
  • Some theories are better at explain various aspects of thinking, feeling and behaving than compared to other theories- e.g. CBT best at explaining cognition, behavioural therapy good at explaining behaviour etc.
  • For decades therapists resisted integration – battle of ‘what theory is the best’
  • At the theoretical level there is no one truth when it comes to the different schools of psychotherapeutic thought.
  • Different therapeutic modalities have greater or lesser relevance depending upon he individual and what they are hoping to achieve through therapy
  • An integrative therapist does not offer a one size fits all approach Different people will need a different approach at different times.
  • Therapists who take a medical model orientation to mental health have less empathy for their clients and clients who take a medical model orientation to mental health will have less empathy for themselves.

 

Eclectic vs. integrative

  • Eclectic: imply a random, non-systematic selection of techniques without any theoretical rationale.
  • This is called
  • One week to the next changing type of techniques used without integration
  • Integrative therapy is characterized by looking at a variety of perspectives and how clients could best benefit.
  • 8% of therapists prefer some form of integration- meaning they combine a variety of methods or techniques into their counseling practice.
  • The risk is being a ‘Jack of all trades and master of none’.
  • Goal: enhance efficiency and applicability of psychotherapy.

 

Pathways to integration

 

 

Technical Integration             • Selecting best techniques for the individual and the problem, without having to subscribe to that particular theoretical perspective.

  • Must be systematic and must have a rational to explain the reason for this choice of technique.

Theoretical Integration          • Far more challenging

  • More than just blending a few techniques
  • Takes a lot of knowledge to produce a framework that synthesises the best aspects of two or more theoretical approaches.

Assimilative approach            • This is remaining grounded to a particular theoretical perspective but using a variety of interventions from multiple systems

  • g. MBCT

Common factors     • Identifies the common elements across the different theoretical perspectives approach      • Common factors accounts for the general equivalence of diverse therapeutic

styles

  • Some common factors include empathic listening, support, warmth, feedback, reassurance, and client’s motivation.
  • Therapeutic relationship is central to effective therapy

 

Advantages of integration

  • No one single theory is enough- there are efficiencies in all of the theories
  • Can tailor individual needs to individual clients
  • Can fit a more diverse population of clients
  • Can be a more effective therapist
  • Not realistic to integrate all of the theories
  • Integration of some aspects of some theories is more realistic

 

How to deliver in brief, flexible, thorough ways

  • One of the big limitations is that medicare only funds 10 sessions per year.
  • More pressure to deliver therapy in a time-limited way.
  • Most therapy is brief, most people only have a handful of sessions, and this is not only related to pressure, it’s often to do with client factors
  • 5 average counselling sessions in Australia

 

What is counselling/therapy?

  • A relationship- more intimate than the standard doctor patient relationship
  • Based on collaboration
  • A repertoire of skills
  • Emphasises self help
  • Emphasises choice
  • A process
  • Provides additional skills
  • Its creative

 

Effective counsellors

  • Develop a sense of humour     Open to change and authentic
  • Strong sense of identity and self     Make mistakes and willing to accept them
  • Willing to become a more therapeutic person         Derive meaning
  • Strong interpersonal skills Show genuine interact and care for client
  • Respect and appreciate themselves Able to be in the present
  • Understands the influence of culture

 

Other treatments that are not ‘counselling approaches’

  • Biofeedback and neuro-feedback
  • The use of electronic monitoring of a normally automatic bodily function in order to train someone to acquire voluntary control of that function.
  • Good for those who don’t have insight into how stressed they are.
  • Eye movement desensitisation and reprocessing (for PTSD) Transracial direct current stimulation (tDCS) helping for depression
  • Other things that help:
  • Yoga
  • Attending religious services
  • Going to catholic confessional
  • Engaging with social supports
  • Exercise plus diet

 

The factors that matter in counselling

  • The therapeutic relationship (30%)
  • Connection, rapport, trust
  • There is a shared understanding of the problem
  • The client feels understand
  • Client’s expectations (15%) Placebo effect?
  • External factors (40%)
  • The factors we cannot measure- something else has occurred in the client’s life so they feel better
  • Interventions/techniques used (15%)
  • It’s not just 15%- it is more complicated
  • The treatment approach you use will impact the therapeutic relationship
  • Choosing the right approach will be based on how to best connect with the client
  • Credibility is important for a therapeutic relationship
  • The therapeutic relationship mediated the effectiveness of the technique.
  • For example, some parts of CBT use diagrams of the brain to explain concepts. This increases credibility, thereby improving trust in the therapeutic relationship, thereby meaning clients will be more likely to apply techniques, thereby improving symptoms

 

Spirituality and religion

  • Not our role to incorporate religious or spiritual issues into sessions, unless specifically relevant.
  • Never impose your own religious beliefs
  • Have a sense of your own spiritual perspective
  • Clients should determine their own values that they may want to retain or give up or modify
  • If a religious belief is harming a client, should we attempt to change it? Dangerous area to go into

 

Biblical counselling vs. CBT

 

 

Termination

 

  • There are many reasons clients decide to end therapy
  • Sometimes the therapist is ready to cease sessions but client is not ready
  • Important for both parties to overt it sooner rather than later
  • Not therapeutic to stop therapy abruptly, should be a process.
  • Talk about it in person
  • Be honest
  • Communicate clearly
  • Should be an action plain for maintaining what has been learnt
  • Relapse prevention- who to call?
  • Some kind of evaluation is really important
  • Readiness and reasons for ending therapy
  • Termination is as important as the initial phase
  • Where to from here- maybe a group therapy?
  • Termination of therapy doesn’t mean the door is not always open down he track for sessions in the future.