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Therapy

New Ways Forward in Psychotherapy Integration

Two new ways to approach psychotherapy integration can help advance the field.

Key points

  • Psychotherapy consists of a jungle of different approaches.
  • Psychotherapy integration systematically explores the relationship between different schools of thought.
  • The common core refers to the central problems, processes, mechanisms, and principles that frame the work.
  • Unification refers to a metatheoretical map of the schools of thought and their interrelations.

This blog was co-authored with Dr. Andre Marquis, associate professor at the University of Rochester.

The world of psychotherapy is characterized by many different approaches and schools of thought. Consider, for example, that an APA video and book series on theories of psychotherapy includes over 20 different bona fide approaches. Some more fine-grained analyses have documented that more than 1000 different approaches to therapy have been developed. It was in large part because of this “jungle” of fragmentation and unhelpful competition between the schools of thought that Drs. Paul Wachtel and Marvin Goldfried co-founded the Society for the Exploration of Psychotherapy Integration (SEPI) back in the 1980s. As they recount in this podcast, the goal of the society was to foster communication between the different schools of thought and explore different paths toward a more integrated field.

The endeavor was productive and by 1992 the first edition of the Handbook of Psychotherapy Integration was generated. That book outlined four main “pathways” to psychotherapy integration. The most general approach was called common factors, and it focused on the shared features of the healing relationship, including establishing hope and encouraging clients to face things they tend to avoid. Technical eclecticism focused on blending empirically supported techniques from different approaches to be applied when appropriate. Assimilative integration focused on maintaining one’s grounding in a specific school, but pulling in concepts or techniques from other approaches (e.g., a psychodynamic therapist might consider cognitive techniques as a way to build a client’s ego strength). Finally, theoretical integration was the fourth pathway and it looked to synthesize underlying theories to generate a more adequate explanatory model for human behavior (e.g., exploring how principles of reinforcement from the behavioral tradition connect with principles of repression from the psychodynamic tradition).

We believe these four pathways have provided highly useful insights and practices for the field. However, recently two additional frames on integration have emerged that have the potential to bring greater clarity and coherence to the jungled landscape of psychotherapy.

One development is called the common core. The common core extends the common factors view and systematizes it into the domains of: (a) the problems that psychotherapy treats, defined as entrenched maladaptive patterns; (b) the processes of change that are associated with successful outcomes (e.g., cultivating a good relationship that can foster awareness, acceptance and change); (c) the core learning and neuroscience mechanisms that enable deep, longstanding change; and (d) the principles that facilitate or undermine good therapeutic outcomes. The goal here is to create a foundational core on which the vast majority of psychotherapists can agree. It is a goal that SEPI co-founder Dr. Marv Goldfried identifies as one of the central tasks of the integrative psychotherapy movement. As current President Elect of SEPI, I (Henriques) have worked with Dr. Goldfried and others (see here), and have made the common core my presidential theme for SEPI this year.

The other development is unification. Earlier this year, an article in the Journal of Contemporary Psychotherapy delineated how unification can be effectively framed as a “fifth pathway” toward psychotherapy integration. It specified that the central, defining feature of unification was that it adopts a metatheoretical perspective on the field. To obtain a clear understanding of how this is a novel view, think of each school of thought in psychotherapy as being represented by a mountain. The other four pathways to psychotherapy integration have explored the territory between the mountains, and considered how concepts, techniques, and theories might be shared among them. Unification is different; it zooms out and affords us a view of the schools of thought as a whole mountain range.

The combination of a common core and a unified view of the landscape of psychotherapy affords us a new way to frame the “jungle” of different approaches. The common core frames the central aspects of the field, whereas the unified view affords a view of the whole landscape. Framed as such, we can then place the specific schools of thought, kinds of problems, and the particular domains of expertise that more advanced practitioners develop. Hopefully the consequence of these advances will be such that we will be able to shift the field of psychotherapy from its current jungled state of fragmented pluralism into one that can be better characterized as a coherent, integrated pluralism.

Gregg Henriques
Source: Gregg Henriques
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