Regents College London 11 – 14 July 1991
It was an encouraging and exciting sight to see about 300 psychotherapists from America (North and South), Europe, Australia and Africa spend four days together in a beautiful old London college discussing the theoretical, clinical and research issues involved in psychotherapy integration. All the main schools of psychotherapy were there: behavioural, analytic, humanistic, cognitive ansd systemic. They were there to see what could and could not be integrated. The Americans seemed to outnumber the rest which is hardly surprising since SEPI has been mainly an American based organisation until the past 2 years. Also with 50% of American psychotherapists now defining themselves as eclectic or integrative, it is obvious that a lot of the energy would be coming from there. (Norcross et all 1989)
However, the fact that the conference was on integration not eclecticism was what gave rise to most interest. (Eclecticism is defined as the technical and theoretical com bination of methods, while integration is more about the search for a conceptual and clinical synthesis of diverse theoretical systems. (Norcross).
The conference took the shape of lectures, workshops and, what for me was the most interesting, practical demonstrations with presenters offering video tapes of their work and exploring their integration of various frameworks through this. For example, we had three practical presentations of working with clients with a similar presenting issue. In this case they dealt with a client presenting with a harsh internal critic or excessive self- criticism. It was in these discussions that the many possibilities of integration and its many difficulties really emerged. The value of using a theoretical and practice frame- work which drew on the treasures of different schools was explored in depth here. Various meta-models for understanding integration were offered and outlined. An example of this was the schema offered by Dr Richard Erskine of the New York School of Integrative Psychotherapy where he explored the different questions focused on by the main schools of psychotherapy and how all of these questions needed to be asked.
Erskine posited that in exploring how to facilitate change it is important to look at all four aspects of the person’s functioning. Through this one would explore a person’s behaviour and what they need to change in it in terms of their dynamic history and structures of meaning, while allowing them to change by the release of feelings through an exploration of how their holding patterns are also structured in their bodies.
Another meta-model offered was one by Dr Petrushka Clarkson of Metanoia, London in her outline of 5 types of therapeutic relationship which a client may need in the course of therapy.
COGNITIVE ANALYTIC – “why” questions (Freud, Ellis)
AFFECTIVE - “how” questions (Rogerian, Gestalt)
BEHAVIOURAL. – “What questions” (Skynner)
PHYSIOLOGICAL – “where” questions (Reicit, Lowen)
This allows one to draw techniques and ways of relating from the various schools of psychotherapy at various times. The relationships she defines as:
1) A working alliance 2) A transference relationship 3) A developmentally needed relationship 4) An I-thou or person to person relationship 5) A transpersonal relationship
Also of great interest was Dr Tony Ryle’s presentation of short-term cognitive-ana lytic therapy lasting a maximum of 18 sessions and designed by him over the past 10 years for use in a health service setting. Furthermore we were treated to presentations on integrating cognitive therapy and Gestalt therapy, Rogerian and Kohutian Analytic Therapy. For good measure there were a number of presentations on Integrative Psychotherapy training from trainees in Belgium, US, and England, as well as research papers on integration practice.
I left the conference tired but excited that this ground-breaking work is well in progress in psychotherapy. Perhaps we will catch up with the physicists some day as they allow light to be a wave and a particle, by allowing our tightened boundaries around schools of psychotherapy to expand. This is not so that we can merge into a structure less morass but so that we can be responsive to the real needs of our clients and no longer do as Abraham Maslow said: “When you hold a hammer you run the risk of treating everything as a nail” and thereby move away from treating all issues and persons only from our own preferred technique base.
The lingering question that I am left with is whether integration is really something to search for through the pursuit of ways to bring together a synthesis of theory and thereby end up with a finished product? Or is integration rather an ongoing process only given life by each meeting of the client and therapist where each is searching for inte gration. If we see psychotherapy as an activity engaged in when our innate urge toward personal integration is blocked or frozen usually out of a fear of disintegration, then we must focus on how each client and therapist copes with disintegration in their meeting. By this I mean the disintegration of character structure, of habit, routine and boundary, and their reformation. We then have to focus also on how both parties can cope with the ambivalence in the relationship between contact and distance, certainty and doubt process and content and being and doing. Perhaps only by facing such ambivalence individually can we cope with the fears that giving up the beliefs that we hold on the truth brings up. For example, I would postulate that each psychotherapist’s choice of theo retical perspective whether behavioural, humanistic, analytic etc., is guided as much by our own character patterns, defence structure and search for personal wholeness as it is by purely intellectual considerations. From this I am left wandering whether the con ference would also have benefited from some form of personal therapeutic group being on offer in order to balance the bias towards the cognitive which was evident.
I will end with a quote from the ending symposium of the conference:
“I admire those who search for the truth, I avoid those who find it.”
There was little to avoid here and much to admire.
The next SEPI International Conference is in San Diego, California in April 1992 and the British branch will hold a conference in July 1992. Further information can be had from the Journal of Psychotherapy Integration, Dept of Psychology, University of Arizona, Tuscon AZ 85721.
Clarkson, Petrushka, “A Multiplicity of Psychotherapeutic Relationships, British Journal of Psychotherapy, Vol 7 No.2 Winter 1990
Norcross & Dryden (Eds), “Eclecticism and Integration in Counselling and Psychotherapy”, Gale Centre Publications 1990
Ryle, Anthony, “Cognitive Analytic Therapy, John Wiley & Sons 1990.