Integrative psychotherapy is not a new psychotherapy approach. It marks its beginning in the 1980s. In 1983 the Society for the Exploration of Psychotherapy Integration (SEPI) was created, which is an active organization today as well. SEPI is an international, interdisciplinary organization which aims to promote the development of psychotherapies that integrate theoretical orientations, clinical practices, and diverse methods of inquiry.
First, integrative psychotherapy unites an aggregation of specific relations in one specialized approach towards the person. The main focus of this therapy is to respond to the person’s needs on a few divergent but not entirely differentiated levels: emotional, cognitive, spiritual, behavioral and body levels. The purpose is to facilitate the integration of approaches in such a way that the quality of a person’s life in its interpsychological and interpersonal dimension to be satisfied to its highest extent, in accordance with his personal abilities and his external limitations.
The basic understanding of integrative psychotherapy postulates that there is not one psychotherapeutic approach which is the best and most adequate for all cases, people and situations. Nowadays this is a holistic problem that requires complex interaction and cooperation on many levels.
Integrative psychotherapy affirms the flexibility of different methods in order to solve a person’s problem. It stresses different strategies, techniques, and theoretical constructs in order to resolve the problematic situation corresponding to the individuality of the client and assisting him to solve his problems in a satisfactory manner. In this way, it affirms the facilitation of one protective and supportive environment, where the healing can happen in the intersubjective space, created between the therapist and the client. The integrative therapists are encouraged to communicate with colleagues from different theoretical orientations in order to be flexible in regards to their personal development in different psychotherapy approaches.
What integrative psychotherapy means?
- Personality integration.
This the integration of the nine (9) psychological axes:
- Transgenerative/ familial;
- Transpersonal and spiritual;
- Neurobiological/body axes;
- Cultural and social-historical axes;
This integration can be demonstrated by accepting the “shadow” or what we deny in ourselves; understanding our defense mechanisms and lessening their influence, supporting the spontaneity and flexibility when resolving different problems in one dynamic and a quickly changing social-cultural environment. The integration includes the affective, behavioral, emotional, cognitive, and the bodily level of the individual whereas does not neglect the spiritual and social dimensions of life. The integrative process of the personality as a whole includes the unresolved aspects of the Self. The individual, in its gradual development, will be able to stand up in front itself and the world, without relying on its defenses, prejudices, the opinions of his closest friends and relatives, relationships and expectations of the world. The integrative psychotherapy is flexible in regards to the client’s needs and sensitive in regards to the therapeutic union. This is a unifying psychotherapy that effectively responds to the individual’s needs to live at his best in accordance with the “reality principle” and “the pleasure principle”.
(In Freudian and Neoreichian psychology the reality principle is the ability of the mind to assess the reality of the external world and to act upon it accordingly, as opposed to acting on the pleasure principle. The pleasure principle is the driving force of the Self that seeks immediate gratification of all needs, wants, and urges. Sometimes referred to as the pleasure-pain principle, this motivating force helps drive behavior but it also wants instant satisfaction.)
2. Theoretical integration.
Flexible and adaptive behavior towards different psychotherapy modalities. There are over 400 psychotherapy approaches that can be classified and defined in accordance with different criteria: Г
- In accordance with their theoretical model: behavioral, systematic, cognitive, psychodynamic, body psychotherapy.
- According to its format: group, individual, family therapy;
- In accordance with the length and frequency of the sessions, as well as a combination of them (Garfield and Bergin, 1994). Because of their differences, the dialogue between them in the past decades was limited. In order to create a bridge between all these historical separations, some specialists in the field propose an integrative approach in psychotherapy which, since the 1990s of the last century is becoming more and more popular (Norcross and Goldfried, 2005). SEPI is an example of such an organization and its members are increasing every year and include some world leaders in psychotherapy practice and research.
In the traditional case, the psychotherapists chose one theoretical model and apply that model in their practice in a flexible and integrative way. In the last few decades though, an increasing number of psychotherapists prefer not to identify themselves with only one approach and define themselves as integrative or eclectic (Feixas and Botella, 2004). In recent research with over 1000 psychotherapists, only 15% said that they use only one theoretical orientation in their practice and the average number of theoretical approaches is four (Tasca et al., 2015). In accordance with the integrative psychotherapy movement, the new research approaches target the seeking of common goals, choice of theories and techniques within psychotherapy models and the development of a new field of integrative and cooperative methods. The integrative model does not target to combine all psychotherapy models in one, but its purpose is to develop a new frame for a dialogue between the different psychotherapy approaches. (Feixas and Botella, 2004). The purpose is to find out what can be studied and used in a different practical perspective.
The integration in psychotherapy includes four different approaches: theoretical integration (i.e. transcending different models in the creation of one, but completely different model), technical eclectism (i.e. using different techniques from different modalities), assimilative integration (i.e. working primarily with one model, but integrating aspects of others, when necessary), and the approach of common factors (i.e. focusing on effective psychotherapy practices that are common for all modalities) (Kozarić-Kovacić, 2008; Castonguay et al., 2015).
- Integration of the psychotherapist as a person.
In the process of education, the integrative psychotherapist will develop his own style of practicing psychotherapy and he will be encouraged to be creative and flexible, to communicate and interact with colleagues from other psychotherapy orientations, developing himself as a psychotherapist. The main accent is on the individual approach towards every different and unique client, in every different psychotherapeutic situation. This happens through the means of individual and group psychotherapy, simulation of the psychotherapy process, participation in educational seminars of other psychotherapy schools in the field of integrative psychotherapy, and continuing education. The purpose, besides the development of basic psychotherapy skills, is to create a unique psychotherapy approach in which to integrate his own theoretical and practical knowledge.
Why integrative psychotherapy works?
The integrative psychotherapy services different clients and problems, in a different context. An increasing number of psychotherapists and researchers agree that there isn’t one psychotherapy approach that will be effective for all clients, problems, and situations. Every already existing psychotherapy model appears inadequate or not useful to some individuals (Norcross and Goldfried, 2005). The scientific research demonstrates that the psychotherapy approaches, that are integrative in their nature (for example interpersonal therapy, Schema терапия, cognitive analytical psychotherapy ) is possible to be effective for a wide range of psychological problems (i.e.. depression, postpartum depression, social anxiety, personality disorders, dissociative identity disorder) (Reay et al., 2003; Kellett, 2005; Hamidpour et al., 2011; Stangier et al., 2011; Masley et al., 2012; Roediger and Dieckmann, 2012; Clarke et al., 2013; Miniati et al., 2014).
In the heart of psychotherapy integration stays the important scientific discovery that regardless of the different theoretical approaches of different psychotherapy schools, they yield similar results (Barth et al., 2013). What have made psychotherapists integrate different psychotherapy models is the proof that some of the common factors approach within the different psychotherapy models (i.e. psychotherapy alliance, clients expectations, therapist empathy) are most likely the reason for different results, and not the special effects attributed to different psychotherapy approaches (i.e. the interpretation of in psychodynamic therapies or cognitive restructuring in cognitive-behavioral therapies) (Wampold and Imel, 2015). The specific psychotherapy techniques contribute to only 7% of the results in therapy, while the common factors approach contributes to 20% of variance results in psychotherapy. (Lambert and Bergin, 1992). In the past decades, clinical workers and researchers have a growing consensus on the fact that there are existing common factors, shared by different psychotherapy approaches (Norcross and Goldfried, 1992; Wampold and Imel, 2015). The common factors in psychotherapy schools, that are considered associated with positive results and changes in the therapy include the therapist’s ability to give hope and provide alternative and more credible point of view of the person and the world, the ability to give his clients a corrective emotional experience that can help them overcome previous traumatic experiences, psychotherapy alliance, a positive change of the expectations and some therapist’s qualities like attention, empathy and positivism (Stricker and Gold, 2001; Feixas and Botella, 2004; Norcross and Goldfried, 2005; Constantino et al., 2011; Horvath et al., 2011). In other words, we treat not exactly with the method we provide, but with our qualities as psychotherapists. From the above mentioned common factors, the psychotherapy alliance is the biggest predictor of change in the client (Feixas and Botella, 2004).
The individual approach is a key element in the integrative psychotherapy (Norcross and Goldfried, 2005) and particularly aims not to be included in any psychotherapy paradigm. The goal of the integrative psychotherapy approach is to respond to a person’s needs with special attention on affective, behavioral, cognitive, and physiological levels of his functioning and his spiritual beliefs. It allows a better psychotherapy adaptation towards the significant characteristics and needs of every single client, allowing the therapist to apply his knowledge of scientific proven approaches and healing.
The main emphasis in integrative psychotherapy, as in many other modalities is on the individual characteristics of the client and the psychotherapy alliance, which are considered key elements of the psychotherapy change (Feixas and Botella, 2004), as well as the motivation of the client. This approach is in accordance with the requirements of the American Psychological Association (APA), based on scientifically proven practices. (American Psychological Association, 2006). The requirements for “scientifically proven factors” are defined as research-proven, clinically justifiable, and client factors. In accordance with this definition, integrative psychotherapy is not a technique, applied to a passive client but the client is approached as an active participant in the therapy and the therapist adjusts its approach in accordance with the client’s characteristics, its needs, and preferences. The changes will happen within the frames of the therapeutic relationship and the clients can most benefit from one caring and empathetic therapist. (Feixas and Botella, 2004).
Psychotherapists in general practice use different types of psychotherapy integration applying the “common factors” approach, as well as assimilative or theoretical integration. The common factors approach seems to diminish the significance of specific effects or techniques in psychotherapy (i.e the two-chairs technique, exposure, Socrates questions, etc.) in favor of the common factors which are proven to bring positive results (therapeutic connection, empathy, client’s expectations etc.); (Norcross and Goldfried, 2005)
From another point of view and assimilation integration includes a dedication to primarily one psychotherapy model (for example cognitive-behavioral psychotherapy), but also includes methods and techniques from other psychotherapy approaches depending on the client and the context (for example interpretation of transfer; Stricker and Gold, 2001). Finally, the theoretical integration aims to find a current application also of other concepts of different theoretical approaches and to develop a “grand unified theory” of psychotherapy (Stricker and Gold, 2001).
The psychological integration movement underlines that this is not just a process of mechanical use of a few techniques from different psychotherapy modalities and their application, when necessary (i..e technical eclectism). This includes also focusing on the connection between theory, proof, and techniques (Norcross and Goldfried, 2005). In other words, integrative psychotherapy is different from technical eclectism. The eclectic therapist chooses one technique because this technique probably is working and is effective, without dealing with theoretical concepts or research evidence. If the client of this eclectic therapist receives a positive result after trying this specific technique, the therapist does not research why exactly that positive change happened in order to develop some generalized model of treatment. In contrast, psychotherapy integration is focused also on the connection between effective practice and its theoretical and empirical basis (Norcross and Goldfried, 2005). For example, scientifically proven psychotherapy client-therapist relationship practices (therapeutic relationship, therapist empathy, positive regard, congruency, etc. ), which are integrative in their nature and are based on common factors, are the main focus of research in many psychological organizations.
American Psychological Association (2006). Evidence-based practice in psychology. Am. Psychol. 61, 271–285. 10.1037/0003-066X.61.4.271 [PubMed] [Cross Ref]
Barth J., Munder T., Gerger H., Nüesch E., Trelle S., Znoj H., et al. . (2013). Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. PLoS Med. 10:e1001454. 10.1371/journal.pmed.1001454 [PMC free article] [PubMed] [Cross Ref]
Castonguay L. G., Eubanks C. F., Goldfried M. R., Muran J. C., Lutz W. (2015). Research on psychotherapy integration: building on the past, looking to the future. Psychother. Res. 25, 365–382. 10.1080/10503307.2015.1014010 [PubMed] [Cross Ref]
Clarke S., Thomas P., James K. (2013). Cognitive analytic therapy for personality disorder: randomised controlled trial. Br. J. Psychiatry 202, 129–134. 10.1192/bjp.bp.112.108670 [PubMed] [Cross Ref]
Constantino M. J., Arnkoff D. B., Glass C. R., Ametrano R. M., Smith J. Z. (2011). Expectations. J. Clin. Psychol. 67, 184–192. 10.1002/jclp.20754 [PubMed] [Cross Ref]
Feixas G., Botella L. (2004). Psychotherapy integration: reflections and contributions from a constructivist epistemology. J. Psychother. Integr. 142, 192–222. 10.1037/1053-0418.104.22.168 [Cross Ref]
Garfield S., Bergin A. (1994). Introduction and historical overview, in Handbook of Psychotherapy and Behaviour Change, eds Bergin A., Garfield S., editors. (Chichester: Wiley; ), 3–18.
Greben D. H. (2004). Integrative dimensions of psychotherapy training. Can. J. Psychiatry 49, 238–248. [PubMed]
Hamidpour H., Dolatshai B., Shahbaz A. P., Dadkhah A. (2011). The efficacy of schema therapy in treating women’s generalized anxiety disorder. Iran. J. Psychiatry Clin. Psychol. 16, 420–431.
Horvath A. O., Del Re A. C., Flückiger C., Symonds D. (2011). Alliance in individual psychotherapy. Psychotherapy (Chic). 48, 9–16. 10.1037/a0022186 [PubMed] [Cross Ref]
Kellett S. (2005). The treatment of dissociative identity disorder with cognitive analytic therapy: experimental evidence of sudden gains. J. Trauma Dissociation 6, 55–81. 10.1300/J229v06n03_03 [PubMed] [Cross Ref]
Kozarić-Kovacić D. (2008). Integrative psychotherapy. Psychiatr. Danub. 20, 352–363. [PubMed]
Lambert M. J., Bergin A. E. (1992). Achievements and limitations of psychotherapy research, in History of Psychotherapy: A Century of Change, ed Freedheim D. K., editor. (Washington, DC: American Psychological Association; ), 360–390.
Masley S. A., Gillanders D. T., Simpson S. G., Taylor M. A. (2012). A systematic review of the evidence base for Schema Therapy. Cogn. Behav. Ther. 41, 185–202. 10.1080/16506073.2011.614274 [PubMed] [Cross Ref]
Miniati M., Callari A., Calugi S., Rucci P., Savino M., Mauri M., et al. . (2014). Interpersonal psychotherapy for postpartum depression: a systematic review. Arch. Women’s Ment. Health 17, 257–268. 10.1007/s00737-014-0442-7 [PubMed] [Cross Ref]
Norcross J. C., editor. (ed.). (2011). Psychotherapy Relationships that Work: Evidence-Based Responsiveness. Oxford: Oxford University Press.
Norcross J. C., Goldfried M. R. (1992). Handbook of Psychotherapy Integration. New York, NY: Basic Books.
Norcross J. C., Goldfried M. R. (2005). Handbook of Psychotherapy Integration, 2nd Edn. Oxford: Oxford University Press.
Reay R., Stuart S., Owen C. (2003). Implementation and effectiveness of interpersonal psychotherapy in a community mental health service. Aus. Psychiatry 11, 284–289. 10.1046/j.1440-1665.2003.00574.x [Cross Ref]
Roediger E., Dieckmann E. (2012). Schema therapy: an integrative approach for personality disorders. Psychother. Psychosom. Med. Psychol. 62, 142–148. 10.1055/s-0032-1304615 [PubMed] [Cross Ref]
Stangier U., Schramm E., Heidenreich T., Berger M., Clark D. M. (2011). Cognitive therapy vs interpersonal psychotherapy in social anxiety disorder: a randomized controlled trial. Arch. Gen. Psychiatry 68, 692–700. 10.1001/archgenpsychiatry.2011.67 [PubMed] [Cross Ref]
Stricker G., Gold J. R. (2001). An introduction to psychotherapy integration. Psychiatr. Times 28. Available online at: http://www.psychiatrictimes.com/articles/introduction-psychotherapy-integration
Tasca G. A., Sylvestre J., Balfour L., Chyurlia L., Evans J., Fortin-Langelier B., et al. . (2015). What clinicians want: findings from a psychotherapy practice research network survey. Psychotherapy (Chic). 52, 1–11. 10.1037/a0038252 [PubMed] [Cross Ref]
Wampold B. E., Imel Z. E. (2015). The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work. London: Routledge.