What is 'Integration' in Counselling and Psychotherapy?

Summary

Highlights

• Mick Cooper shares insights on what integration actually means in counseling and psychotherapy 💡.
• Integration involves combining different therapeutic theories and practices for holistic therapy 🌀.
• There are no clear boundaries between integrative therapies and pure form therapies as perspectives evolve 📚.
• Four main models of integration are discussed: theoretical, assimilative, common factor approaches, and eclecticism 🔍.
• Theoretical integration involves creating a new therapy model like cognitive analytic therapy 🌟.
• Eclecticism allows trying different methods with different clients but requires careful thought to avoid disorder 🌀.
• Pluralism in therapy highlights the importance of valuing all therapeutic approaches and engaging in collaborative decision-making 📊.
• A coherent integrative approach avoids mishmash and ensures clarity for clients to enhance therapy outcomes 🛤️.

Key Takeaways

• Integration in therapy involves combining multiple therapeutic approaches for a comprehensive practice 🧩.
• There are different models of integration: theoretical, assimilative, common factor approaches, and eclecticism 🎨.
• Theoretical integration creates a new therapeutic model from existing approaches, like cognitive analytic therapy 🔄.
• Assimilative integration allows individual customization within a primary therapeutic model 👓.
• Eclecticism uses a wider range of methods, which may lack an underlying coherent theory but can be coherent if designed thoughtfully 🛠️.
• Pluralism in therapy emphasizes valuing diverse approaches and involves shared decision-making with clients 🤝.
• Understanding and applying integration requires careful thought to avoid a mere patchwork of techniques 🧠.
• Practitioners are encouraged to reflect on their integrative styles and how they incorporate various models and philosophies in therapy 💭.

Overview

Chapters

• 00:00 - 00:30: Introduction to Integration in Psychotherapy The chapter introduces the concept of integration in psychotherapy. Mick Cooper, a professor of counseling psychology, discusses what integration means in the context of counseling and psychotherapy, as well as how it is practiced and conceptualized. He reflects on the frequent mention of integration and integrative approaches within the field, and points out that while the term is often used, there is not always a clear understanding of its meaning or application. Cooper highlights that there has been useful work on this topic that professionals in the field may not always engage with.
• 00:30 - 01:00: Defining Integration in Therapy This chapter discusses the concept of integration in therapy, focusing on the combination of different theories and practices. It includes the merging of two or more approaches, which may include what are known as 'pure form' therapies, 'classical therapies', or 'single modality therapies'.
• 01:00 - 01:30: Historical Context and Evolution of Therapies The chapter explores the evolution and historical context of various therapeutic approaches, focusing on the distinction between integrative and pure form therapies. It highlights that what is considered an integrative therapy can evolve into a pure form over time. Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) are used as examples, initially viewed as integrative, but now often seen as pure forms of therapy. The chapter underscores the fluid nature of these categories and the beauty in their evolution.
• 01:30 - 02:00: Levels and Questions of Integration The chapter delves into the concept of integration in therapeutic practices, focusing on how various established therapies can be combined to form integrative therapies. It raises concerns about the challenges in properly integrating different therapeutic approaches, such as CBT, psychodynamic, and person-centered therapies. The discussion highlights the need for a more thorough exploration of how these different methods can coalesce effectively.
• 02:00 - 02:30: Challenges in Integrating Different Approaches The chapter explores the concept of integration in therapeutic approaches, specifically questioning what constitutes real integration in therapy. It examines whether using different approaches like psychodynamic and CBT with different clients or in different settings can be considered integration. The discussion implies that simple alternation between different therapy styles may not fully qualify as integration.
• 02:30 - 03:00: Models of Integration Overview This chapter discusses different models of integration in therapy. Integration involves using different therapeutic approaches within the same session, such as switching between person-centered and psychodynamic approaches. This method raises important questions about how to decide which theories or practices to use in given situations. It highlights the flexibility and adaptability required in integrative practices to best meet the needs of clients.
• 03:00 - 03:30: Theoretical Integration Explained The chapter "Theoretical Integration Explained" discusses the decision-making process regarding the selection of therapeutic models. It explores how therapists might choose or switch between different models such as person-centered, psychodynamic, or dialectical behavior therapy depending on the client and the therapist's training. The chapter poses challenging questions about integration in therapy, emphasizing the importance of tailoring the approach to fit the needs of the client and the situation.
• 03:30 - 04:00: Examples of Theoretical Integration The chapter discusses different models of psychotherapy integration. It references the 'Handbook of Psychotherapy Integration', which contains numerous chapters on these integration models. A notable introduction by John Norcross is highlighted as a primer on psychotherapy integration.
• 04:00 - 04:30: Coherent Integration Strategy This chapter provides a comprehensive overview of various models of psychotherapy integration. Emphasizing the importance of understanding different frameworks, it even recommends accessing a library handbook for further exploration. The chapter introduces four primary models of psychotherapy integration, setting the stage for a deeper discussion and additional insights.
• 04:30 - 05:00: Simulative Integration The chapter explores the concept of 'Simulative Integration' in therapeutic practices. It delves into 'theoretical integration', which involves combining two or more pure form approaches to create a new model or form of therapy. The discussion invites readers to consider examples of such theoretical integrations in therapy.
• 05:00 - 05:30: Common Factors in Integration This chapter delves into the integration of various therapeutic methods with a focus on cognitive analytic therapy. This approach was developed by Tony Rail, who combined elements from cognitive therapy and psychodynamic therapy to create a novel therapeutic methodology. The integration highlights the potential for creating innovative practices by blending existing ideas into new formations.
• 05:30 - 06:00: Eclecticism as an Integration Approach The chapter discusses the concept of eclecticism as an integration approach, specifically in the context of cognitive analysis therapy. It emphasizes that the integration is not merely a superficial combination of different therapeutic methods, such as CBT (Cognitive Behavioral Therapy) and psychodynamic approaches. Instead, it involves a deeper and more meaningful synthesis that creates a new perspective on understanding individuals. This approach is particularly important in the context of writing essays or pursuing accreditation as an integrative practitioner.
• 06:00 - 06:30: Challenges of Eclecticism This chapter explores the challenges of integrating eclectic approaches in practice, emphasizing the need for coherence when combining different theoretical perspectives. It discusses how various approaches, such as attachment theory, person-centered methods, and cognitive behavioral therapy (CBT), can be unified. The key challenge identified is demonstrating how person-centered concepts like unconditional positive regard and empathy can complement and cohesively fit with an attachment theory perspective, ensuring a joined approach rather than a disjointed use of separate techniques.
• 06:30 - 07:00: Pluralism in Psychotherapy The chapter discusses the importance of coherent integration in psychotherapy to avoid confusing clients. It touches upon theoretical integration where various therapy models, such as emotional focused therapy, person-centered therapy, and gestalt therapy, are combined. The need for thoughtfully blending different therapeutic approaches is emphasized to ensure clarity and effectiveness.
• 07:00 - 07:30: Pluralism: Philosophy and Practice This chapter discusses the concept of pluralism in therapy, acknowledging the existence of numerous mindfulness-based therapies such as cognitive therapy and existential therapy. These therapies represent various theoretical integrations that form distinct models within themselves. The chapter emphasizes that these integration approaches are not mutually exclusive and can be combined in numerous ways to create unique therapeutic models.
• 07:30 - 08:00: Shared Decision Making in Therapy In this chapter, the concept of shared decision making in therapy is explored with a focus on integrative practices. The key idea is that practitioners often start with a primary therapeutic approach such as person-centered, psychodynamic, or CBT (Cognitive Behavioral Therapy) and then integrate elements from other therapeutic models. This approach allows therapists to tailor their methods to better suit individual client needs, highlighting the flexibility and adaptability required in therapy to achieve effective outcomes.
• 08:00 - 08:30: Conclusion and Reflection on Integration The chapter discusses the process of developing a personalized approach to integration in therapy. It begins with training in person-centered therapy and later incorporates elements from gestalt therapy and creative techniques. Therapists are encouraged to create their own unique methods, contributing to a personal approach to integration. This individualized style is an essential aspect for therapists who embrace this tailored method in their practice.

What is 'Integration' in Counselling and Psychotherapy? Transcription

• 00:00 - 00:30 hi my name is mick cooper i'm a professor of counseling psychology at the university of roehampton and i just wanted to do a a little talk about integration in psychotherapy because i guess you know a lot of the time in counseling and psychotherapy we talk about integration and integrative approaches or practicing integratively but what does it actually mean you know what is integration uh and and how how do we do it how do we think about it and there's been some useful work that i think often people uh in the in the therapy field aren't
• 00:30 - 01:00 that familiar with so i wanted to talk a little bit about that when we think about integration we can think about it as the putting together of different theories and practices it's combining uh two or more approaches and i guess we can talk about combining two or more what we might call pure form therapies or or kind of um classical therapies or or a single modality therapies we might refer to so we're talking they're about
• 01:00 - 01:30 person-centered psychodynamics cbt gestalt but of course what's a kind of an integrative therapy and what's a pure form therapy changes over time for instance you know cbt in many ways is an integration of cognitive and behavioral approaches but these days we tend to think about it as a pure form therapy something like emdr you might say is integrative but now we think about that as a pure form therapy so there's no clear distinction but beautiful
• 01:30 - 02:00 therapies tend to be the more established ones and integrative therapies are when we bring those established ones together into a different combination but there's lots of different questions here and uh you know again i i hear often students on integrative courses talking about the way that these issues aren't really kind of unpacked sometimes you're given one approach and then another approach and then you know you learn a bit of cbt you learn a bit psychodynamic then a bit of person-centered but then how do they actually come together
• 02:00 - 02:30 what do we do one of the questions for instance is is when we think about integration like what level of integration are we thinking about are we talking about say if you've got different placements like you do psychodynamic of one cbt at the other is that integration probably not isn't it it doesn't quite feel like integration what about between different clients so with one client if you you know assuming you have the skills and the training you do cbt another client you do psychodynamic another one you do back to cbt again is that integration
• 02:30 - 03:00 probably not quite i mean if you're working like using different approaches in different sessions that feels probably more like integration and being an integrative practitioner and certainly if within the session you were moving between person-centered and maybe psychodynamic then that might be what we think about as more kind of an integrative approach but it also raises the question you know about how do we decide which theories or practice to use
• 03:00 - 03:30 like how do we choose our integrity model when for instance might we switch from a person-centered to a psychodynamic way of working or when would we with a particular client for instance start using dialectical behavior therapy if that's our training so again there's some quite challenging questions really around integration uh that kind of need working out and uh and it partly depends on which particular model of
• 03:30 - 04:00 integration that we're talking about because integration means quite specific things and that's mainly what i wanted to look at in this talk is about these different models of integration there's a fantastic book it's bloody expensive unfortunately but it is a fantastic book called the handbook of psychotherapy integration and that has a lot of chapters about different models of psychotherapy integration there's a brilliant introduction there from a colleague of mine john norcross about which is a primer on psychotherapy integration and if you can get hold of that you
• 04:00 - 04:30 might need to do it through a library that gives you such a really solid introduction to the different models of integration out there that i'm going to talk through and add a little bit to so do try and if you've got library access do you try and get a hold of that uh handbook uh to find out more about these different models so in that chapter and more generally people tend to talk about four main models of psychotherapy
• 04:30 - 05:00 or counselling integration now the first one is what's called theoretical integration and theoretical integration is where people bring together two or more approaches pure form approaches to create a new kind of therapy a new model a new form of therapeutic practice so you might think for instance of can you think of any what would be a form of theoretical
• 05:00 - 05:30 integration uh classic one is cognitive analytic therapy so that's where tony rail brought together ideas from cognitive therapy ideas from psycho dynamic therapy but also created his own kind of brand new uh approach you know fantastic approach if you get a chance to read about it which uses some cognitive ideas some psychodynamic ideas kind of mixed together into a new combination
• 05:30 - 06:00 that integrates them and what you see in cognitive analysis therapy is that there's a really deep rich integration it's not just a question of uh kind of slapping these two things together let's do a bit of cbt here let's do a bit psychodynamic there there's a whole new way of thinking about the person that draws on these ideas and particularly when we're talking about integration and if you're writing about integration for for instance an essay or or applying as an integrative practitioner uh for an accreditation then it's really
• 06:00 - 06:30 important to be able to show how these different approaches come together so you're not just saying well i do a bit of attachment theory but then i also like person-centered approach and a bit of cbt here you know like if you if you if you're holding an attachment theory perspective then how do person-centered ideas of unconditional positive regard or empathy come into that how does it all fit together uh you need to show that there's something coherent there joining them together and you've really
• 06:30 - 07:00 thought through these issues so that you're not just doing one thing and then another with a client as you feel like it which you know for some clients certainly it can be very uh has a potential to be kind of confusing like why are they doing this why they're doing that so there needs to be a coherent integration so theoretical integration are these these models of therapy that have been developed other ones might be emotional focused therapy which brings together person-centered therapy engaged out therapy or you know there's
• 07:00 - 07:30 there's millions mindfulness-based cognitive therapy mindfulness-based uh existential therapy you can think there's so many different combinations that you can have but they're kind of particular models in themselves that form these theoretical integrations what you have then is then and each of these different approaches to integration the different kind of kinds of integration if you like they're not and they're not mutually exclusive in any way you know you can you can combine them in lots of
• 07:30 - 08:00 different ways although as a practitioner you might kind of identify more with one than the other a simulative integration is more of an individual level it's great it's not a particular model it's more where you start with a particular form of practice say person-centered or psychodynamic and this would be true for a lot of us as therapists who identify as integrative but we start with one of these models and then we bring into it theories and practices from other models so we might start for instance with cbt
• 08:00 - 08:30 uh or person-centered therapy and that we do a training in that for a couple of years and then after a while we start bringing maybe bigger style therapy and some of the ideas from gushed out therapy or some of the methods or maybe some creative techniques so that we develop a kind of unique individual style our own particular approach and and you know there's people who've written about and developed what they would call is a kind of personal approach to integration which is which which is kind of rooted around the
• 08:30 - 09:00 individual and the individual person the individual the person is the practitioner but assimilative integration means that there is that kind of drawing together and again like theoretical integration is it's coherent in integration it's not just putting things together there's a coherence to how we draw these things together and why and and why and when we applied one and and and perhaps not the other but the difference is this is an individual model whereas theoretical integration is more
• 09:00 - 09:30 a particular form of practice that is out there that some people might say and of course we might assimilate into our integrative position uh particular forms of theoretical integration you know i might i might do i might integrate some ideas from cat cognitive analytic therapy for instance so as i say these approaches aren't mutually exclusive what we come on to then is a third form which is what's called the common factor approach which again is a different slant on theoretical or sorry on integration
• 09:30 - 10:00 and ones with common factors is that people have written about this and this particularly comes from a kind of research base often the people who've developed it have got more of a research perspective is that it's trying to get away perhaps from particular schools particular approaches pure form or even a kind of integrative theoretical integrations i'm more thinking about what are the underlying factors across lots of different approaches that are the the kind of driving factors
• 10:00 - 10:30 of changed so this is you can see here for instance an example from mike lambert one of the world's leading psychotherapy researchers and he wrote a number of years ago now about this idea that if you look at changes it's around 40 and half of what drives changes the client factors like involvement and engagement and motivation then you've got the relationship and nearly all the common factor models put the relationship really central then you've got hope the kind of placebo effect of clients just believing change is
• 10:30 - 11:00 going to happen and then mike talks about some of the variance being about the specific model that's taken and for instance where there's maybe phobias then an exposure approach might be more helpful for uh more clients at different particular points in time so the common factors approach isn't talking about a particular combination it's more going into therapy maybe less orientation specifically more more holding that
• 11:00 - 11:30 a particular relational stance patricia's class and for instance her relational model looks at different kinds of relationships across different therapies uh the work of people like scott miller barry duncan their common factors model is based around the idea particularly using feedback i mean they would suggest doesn't matter too much where you start you know you can have any any particular starting point what's important is you listen to the feedback check how the work is going with the client in terms of outcomes in terms of are they valuing the work or not and
• 11:30 - 12:00 then if they aren't great keep on doing it if they're not then maybe you need to do something different so it's kind of integrative thinking maybe and an inspirative practice around these common factors that again could be you know your starting point could be according to analytic therapy but you're kind of assuming that these cognitive factors have changed rather than maybe a more schoolist beautiful perspective but we see the changes being down to
• 12:00 - 12:30 the particular model that's being used now the fourth approach that is classically talked about is eclecticism and it's kind of got a bit of a bad press um and i guess the reason for that is that in eclecticism the different practices are kind of more spread out as the diagram kind of suggests that rather than having this this kind of tight coherent underlying rationale um theory if you like that you'd have in
• 12:30 - 13:00 theoretical integration or simulative integration with eclecticism uh it's more the kind of toolbox image trying one thing with one client another approach with another client without necessarily bringing them together you know the attachment theory we're going to work with this one from an attachment theory perspective but this client we're going to work with a uh a more cbt perspective for instance and i mean having said that probably the best known form of eclectic practice was on lazarus's
• 13:00 - 13:30 technical eclecticism and his approach was called multimodal therapy and brilliant if you get a chance to read about it multimodal therapy it's a fascinating approach which you know which was based around a kind of what he did is to have this coherent assessment called basic id that looks at these kind of biological and effective different components and then you use that as a way of working out what method that you might use and the techniques might
• 13:30 - 14:00 be uh it might be chair work uh it might be like your education might involve listening you can basically use anything obviously you have to be a very experienced practitioner to be able to use such a wide berth of different techniques but it was a very coherent approach but it just didn't worry too much about the theoretical integration and i guess the challenge there is that you know you have to be careful if you're doing an assignment or go for accreditation about describing yourself as eclectic because
• 14:00 - 14:30 it doesn't have to be but it can be that not having a theoretical integration is is kind of an excuse for not having to think about some of these complex issues like how does person sense and psychodynamic sit together which is why assessors accreditors tend to be a bit wary about it because it can be a kind of standing for not thinking through things or what's called syncretism syncretism is a word that means just kind of mishmash of stuff just chucked together and you
• 14:30 - 15:00 you want to avoid that you want to avoid that because uh for clients that can feel quite chaotic but eclecticism absolutely doesn't need to be like that and actually i think that these eclectic approaches often do have very coherent uh rationales behind them now i just wanted to talk about two more and this relates to the work that i've done with john mcleod and dryden and many other colleagues on pluralism that you can find out more at pluralisticpractice.com and these are kind of there's two ways that we thought
• 15:00 - 15:30 about pluralism it doesn't help stuff really it makes it more complicated um but they do link into how we think about integration and we've talked about the difference between pluralism as a philosophy and pluralism as a particular practice pluralism is philosophy and and one of the things about pluralism is that it comes out really from a person-centered humanistic existential worldview one which is particularly about
• 15:30 - 16:00 kind of valuing and valuing different if you think about person-centered values about unconditional positive regard it's about really valuing different ways of doing things and also about valuing differences across people recognizing that people are different and people have different ways of doing things so pluralism is a philosophy it's kind of a meta stance on therapies as a whole we're not talking about a particular practice here and in that sense it's different from these other forms of integration that are specifically about practice and again
• 16:00 - 16:30 it's not mutually exclusive you can have a pluralistic philosophy within which an integrative practice and i'll talk about that in a sec but pluralism as a philosophy is is holding that valuing of the different approaches and recognizing that there isn't one best therapy uh pluralism in the philosophy really was a kind of response or reaction to schoolism and the dogmatism of this is the right approach or that's the right approach and trying to say well actually lots of different therapies can be helpful certainly the evidence would
• 16:30 - 17:00 suggest that lots of different therapies tend to work and the different clients need different approaches at different points in time now that is not to say that we can do all 450 different kinds of therapy uh you know we can only be trained in certain approaches and and develop and and we want to develop skills in in specific things it might be a preference might just be a limitation of our training uh nobody can develop skills skills and everything so it's not saying we can do everything but a pluralistic philosophy is about
• 17:00 - 17:30 valuing and holding that value for therapy a and therapy b for different models of theoretical integration uh for these different common factors and and recognizing that they all have the potential to have a place rather than getting into my therapies better than your therapy and the different clients can benefit from different things at different points of time so that's pluralism as a philosophy and that of course can include as we can see here you know an appreciation of common facts
• 17:30 - 18:00 as appreciation of different forms of theoretical integration and an appreciation of different simulative integrative uh models and then we have pluralism as a practice which is kind of applying that same pluralistic thinking pluralism doesn't start with psychotherapy pluralism it's a philosophy that goes back to questions of ontology what exists epistemology how do we know things are there pluralism is there in religion uh pluralistic attitudes to religion but it's always
• 18:00 - 18:30 about valuing difference in diversity so pluralism is a philosophy of therapies about valuing the therapy field as a whole pluralism as a practice and if you hold a pluralistic philosophy so if you practice in a pluralistic way you need to hold a pluralistic philosophy but if you hold a pluralistic philosophy it doesn't necessarily mean you will then practice in a pluralistic way you might be a person-centered practitioner and just hold that valuing of lots of different approaches and you know recognize that some clients won't
• 18:30 - 19:00 need persons endothermic and wants it and value it some clients other times don't and you know you might refer on but there is also a pluralism of practice which is valuing there's different approaches although of course we can only be trained in a certain number so it might be using approach a and approach b but at the heart of pluralism as a practice is shared decision making with clients what that means is that it's about valuing the different perspectives on therapy not just assuming that our
• 19:00 - 19:30 our perspective as the therapist is the right one that we should dialogue and collaborate and work with clients to work out what's best for them that's not about just saying to clients look you know you decide it's it's really about the dialogue it's about finding that meeting place between a paternalistic therapist-led approach and a more kind of hands-off client directed approach where we just give the power to the client it's about using our understanding our knowledge our skills
• 19:30 - 20:00 but also how much clients want to contribute and that can really vary some clients really want to be involved in shared decision-making sometimes not so much and of course being pluralistic means being responsive to that and recognizing that different clients just as they want and can value different approaches at different times so that they can value different levels of shared decision making at different points in time and but that shared decision making on that that attempt to share decisions
• 20:00 - 20:30 is what makes pluralism as a practice unique and somewhat different from other forms of their integration particularly simulative integration now some people would say i mean colleen and john norcross would say that uh you know when we talk about integris integration as a practice we're talking about personalization we're talking about shared decision making we don't need another term for it uh you know and you know it doesn't matter so much what we call it in a sense what's important is what we do uh from a
• 20:30 - 21:00 pluralistic standpoint you know we wanted to kind of really emphasize that collaborative element and we think that's a useful term if it's not useful then the important bit is how we work with clients so i hope that's given you some idea of the how people think about these different forms of integration uh you might want to think for yourself about you know if you identify as an integrity practice what kind of integrative practitioner are you uh are you similar to integrative uh probably you are in some format but
• 21:00 - 21:30 how much does pluralism as a philosophy lie behind that how much is your work around shared decision making would you see yourself as a pluralistic in practice uh and then how much do you believe in common factors how much do you ever kind of model specific approach or how much do you believe that common factors like the relationship like empathy are the driving factors of change and uh you know how coherent is it how much do you think it's important to have a coherent
• 21:30 - 22:00 theory underlying it or how eclectic are you and you know there's no right answer here there's no right or wrong but i hope this talk has helped you think about some of these questions and uh and reflect on some of the issues there so thanks for listening