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Integrative psychotherapy is an attempt to combine concepts and counselling interventions from more than one theoretical psychotherapy approach. • It consists of a framework for developing an integration of theories that you find most appealing and useful for working with clients.
History • Dollard and Miller’s (1950) book, Personality and Therapy, was one of the first attempts to combine learning theory with psychoanalysis • In 1977, Paul Wachtel published Psychoanalysis and Behaviour Therapy: Toward an Integration. • In 1979, James Prochaska offered a transtheoretical approach to psychotherapy, which was the first attempt to create a broad theoretical framework.
Prochaska’s transtheoretical approach examines many theories, selecting concepts, techniques, and other factors that effective psychotherapeutic approaches have in common. Cyclical psychodynamics and the transtheoretical approach use a model called theoretical integration. Theoretical integration combines the personality theory concepts and techniques of two or more theories. Assimilative integrative approach, in which the personality theory and the psychotherapeutic techniques of one theory are the major approach and one or more other theories are used to supplement it.
In technical eclecticism, one personality theory is selected and techniques may be used from any theory, but they are used in a way that is consistent with the personality theory that has been selected. • In multimodal therapy, a social learning view of personality is the focus (Stricker & Gold, 2005). It influences the use of many treatment techniques, which have been drawn from many theoretical orientations
WACHTEL’S CYCLICAL PSYCHODYNAMIC THEORY • Combination of behavioral and psychoanalytic ideas and techniques with conceptualizations and methods from some other theories. • Recognizing that anxiety is common to disorders treated by these methods, Wachtel has developed cyclical psychodynamics, a term that comes from his belief that psychological conflicts within oneself create problems in behavior and that problems in behavior create problems within oneself. • eg: intrapersonal conflict creates behavioral problems, and the behavioral problems create further intrapersonal problems.
Behavioral treatments include relaxation, desensitization, and exposure to anxiety. Psychodynamic treatment includes helping the patient understand past and present unconscious conflicts and how they influence each other.
Unconscious processes emerge as the end product of anxiety. • Unconscious conflicts may cause problems or be the result of problem. • Expose the client to anxiety, through interpreting and confronting unconscious processes.
Therapeutic Relationship Therapist as collaborating with the client to make use of interpretations and not feel discouraged by them. In doing this, the therapist attends not just to the client’s discussion of past events but also to the reactions and interactions that occur in the present between client and therapist. Change in therapy is seen as being due in part to the effectiveness of the therapeutic relationship.
PROCHASKA AND COLLEAGUES’ TRANSTHEORETICAL APPROACH • The developers of this transtheoretical model wanted an approach that would go beyond specific theoretical constructs and would encourage therapists to create new, innovative techniques by drawing the most effective ones from other therapies. • They pick and choose constructs and therapeutic techniques from theories they wish to make into their own theory.
Therapeutic Change Five stages of readiness for change: • Precontemplation: the client may have thoughts about changing but is not willing to do so. • Contemplation : the client is seriously considering change, but not committed.- • Preparation: the client intends to change and shows some behavioral changes. • Action: the commitment is clear, with the client showing consistent change over a period of time. • Maintenance: the client works to continue change and to prevent relapse. These stages of change are not independent, and clients may experience problems at several stages at any time.
Levels of Psychological Problems Symptom: problems might include a phobia of snakes. Maladaptive thoughts : Negative beliefs such as “I am a terrible person.” Interpersonal conflicts: Not getting along with individuals in one’s life, such as colleagues at work. Family conflicts: often more complex because the relationships are more intimate. Intrapersonal conflicts: Indecision and disagreements within oneself and may include intense anger or narcissism.
Therapies for different Psychological Problems: Symptoms/situational: Behavior therapy, solution-focused therapy. Maladaptive cognitions: Adlerian therapy, REBT, cognitive therapy. Interpersonal conflicts: Family therapy (general),Interpersonal therapy, reality therapy, psychodrama. Family systems/conflicts: Bowenian, structural, strategic, experiential, and humanistic family system therapies. Intrapersonal conflicts: Psychoanalytic therapy, Jungian therapy, existential therapy, gestalt therapy, narrative therapy, creative arts therapy.
Process of Change • Consciousness raising. This refers to interventions that help clients to become more aware of both the causes and consequences of their actions as well as ways to feel better. • Dramatic relief or catharsis. Such experiences are emotional or affective. Expressing the problem to the therapist can lead. • Environmental reevaluation. By looking at a problem in a wider context, an individual takes a different perspective.
Self-reevaluation. In the process of self-reevaluation, an individual assesses what she needs to do to overcome a significant problem. This involves affective, cognitive, and behavioral changes. Self-liberation. Clients choose to address their problems and to make changes. Clients can choose new alternatives in addressing their problems. Social liberation. Sometimes problems require making small or large social changes. For example, if a woman is being sexually harassed at work by her boss, the therapist may help her develop a strategy or plan for dealing with the problem at work.
Contingency management. Reinforcement of behavior, Systematic and in vivo desensitization are other ways to manage behaviors. Use of this process often includes conducting a behavioral functional analysis. Counterconditioning. By changing the way they respond to problems or stimuli, clients can make positive changes in their lives. Stimulus control. By controlling the environment, individuals can control the way they deal with difficult situations. Stimulus control. By controlling the environment, individuals can control the way they deal with difficult situations.
Different processes of change (techniques) can be used depending on how ready the client is to make change. To move from the contemplation to the preparation stage, clients must self reevaluate. When clients move into the action stage, they then are ready to make use of action-oriented processes
