Thoughts on Integrative Psychotherapy

Ger Murphy

In this brief article I will attempt firstly to give some definition to the much 
muddled term of ‘Integrative’: secondly, to outline a particular perspective which 
I believe can be viewed within the boundaries of an integrative perspective; and 
thirdly, to touch on some of the wider issues which the question of integration
 raises in psychotherapy.

‘Integration’ appears to be defined in three main ways:

1. related to theory; 
2. related to the person of the psychotherapist;
 3. related to the practice tools.


The European Association for Integrative Psychotherapy defines as integrative
 “any methodology and integrative orientation in psychotherapy which exemplifies 
or is developing towards a conceptually coherent, principled, theoretical
 combination of two or more specific approaches, and/or represents a model of
 integration in its own right.”

Secondly, alongside this focus on theoretical integration are those practitioners
 who would look to the person of the psychotherapist and state that integration is
 not of a theory but of a person, both of the psychotherapist and of the client. For
 example, the psychotherapist would be encouraged to work towards the integration
 of their feeling and thinking functions, or their minds and bodies, so that they are 
not overly given to either intellectualization or somatization.

Thirdly, in viewing integration as related to practice tools, psychotherapists focus
 on one factor such as the therapeutic relationship which can be viewed as a 
container for diversity. This is seen particularly in the model advanced by 
Clarkson et al. [1]

It would seem to be generally accepted that although integration is seen from
 various perspectives, there is a clear distinction being made between integration
 and eclecticism in psychotherapy. Integration appears to denote an attempt at
 conceptual synthesis, whether this is purely at a theoretical level or applied to the 
person or the tools of the practice. Eclecticism in contrast appears to be strictly 
speaking related to a theoretical combination of methods. To quote Norcross &
 Napolitano (1986):

“The eclectic selects among several dishes to constitute a meal, the integrationist 
creates new dishes by combining different ingredients.” [2]

The move to a focus on integration and away from separate schools of
 psychotherapy appears to be developing strongly over recent years. This could be 
understood as part of a wider social movement towards the breakdown of
 boundaries eg East-West and EU changes are examples of this trend. However the 
trend can also be explored with reference to factors specific to psychotherapy as
 outlined by Dryden & Norcross [3]. These are outlined by them as follows-

1. Proliferation of therapies.


There are many different systems of psychotherapy in place. This can lead to
 confusion and fragmentation. In the late 1950s, Harper (1959) [4] identified thirty-
six distinct systems of psychotherapy, while Karasu (1986) [5] reported four 
hundred schools of psychotherapy. This shows a huge growth in differentiation 
and the time is coming for a growth in the other polarity – integration. It may also 
be relevant to remember with Kuhn (1970) [6] that before the change from a given 
paradigm, a period of splitting and confusion is experienced. The view has been 
forwarded that psychotherapy may be in such a ‘pre-paradigm-change crisis’ where
 one particular belief in emotional or psychic change as being best may give way to 
new ways of viewing personal change.

2. Inadequacy of single theories.


There exists some disillusionment with rigidly held single theory viewpoints in
 being able either able to fully understand or treat particular symptomatology. For
 example, the slavish pursuit of unconscious motivation or feeling release are 
increasingly seen to be of only partial value by many.

3. Equality of outcomes.


Despite the growth in psychotherapeutic approaches, it is not possible to show that 
one psychotherapeutic approach is clearly superior to another. [7] This has led to 
a focus on the common factors which appear to bring greater success, these have 
often focused on the qualities of the psychotherapist and the alliance with the
 client. This has focused thinking on integrative concepts.

The factors outlined above have led to an exploration of what is common among 
psychotherapies, where usually the differences have been highlighted. Given the
 sense of competition which seems to exist, some theorists have focused on
 common factors. For example, Frank (1982) [8] saw the following as common to
 all forms of psychotherapy:

(i) an emotionally charged, confiding relationship; 
(ii) a healing, safe setting;
 (iii) a rationale;
 (iv) a therapeutic ritual.
 Or again, Garfield (1980) [9] saw common factors as: 
(i) relationship;
 (ii) catharsis;
 (iii) explanation;
 (iv) reinforcement;
 (v) desensitisation; 
(vi) information; 
(vii) time.


Finally the boom in psychotherapy and the growth in insurance funding for
 treatment has brought further focus on finding a clear approach which is not simply 
based on one aspect of the person and can be cogently sold in the market place.

These factors outlined above give some view as to why a focus on integration is so 
rapidly growing in the area of psychotherapy. I will now turn to focusing on one
 such integrative model in brief. This model aims to integrate body-oriented 
psychotherapy, object relations theory, Lacanian perspectives from psychoanalysis 
and a gestalt perspective. Simply put, this framework sees the work of 
psychotherapy to be about coming to grips with the possibilities of Life, and the 
limitations of Death, and doing this in the present moment. (See my article in
 Inside Out, Winter 1997, on Loneliness.) I see body psychotherapy as offering
 conceptual and technical routes to explore one relationship to Life through the
 body. [10] For example, how the individual has allowed themselves to grow, and
 the history which is stored in the body of blocked emotion, etc. Such a
 psychotherapy perspective is based on allowing the Life to be experienced and 
asserted. In contrast, one could say, that Object Relations Theory and Lacanian
 Perspectives valuably focus us on coming to terms with limitation, our own and 
others, from the limitation of parental powers and the necessity of loss and
 separation, to the ultimate blow to our own narcissism of our own death. [11] We 
can view the participating factors which draw us to engage in psychotherapy as
 coming from an inability to deal either with taking on our own Life or in 
surrendering to our own Death. The exploration of these themes can only have real 
potency, I would argue, if undertaken not in a discursive, abstract fashion, but
 experientially in the Now of a relationship between therapist and client. Gestalt 
psychotherapy has much to offer in exploring and working with this Now in the
 therapeutic relationship, as do body psychotherapy and object relations and Lacan.
 This model focuses on integration as being to do with the processes necessary to 
the development of the person as they go through the life cycle.

One could question the necessity for such an integration and argue that these 
psychotherapeutic perspectives are wholly valid on their own. I disagree. I see 
body psychotherapy as being an excellent perspective for offering clients contact
 with their unconscious through bodily experience. Such a contact with the 
unconscious comes through the body unveiling its stored experience without 
external interpretation – it is thus empowering. Body psychotherapy does not have 
a well-developed structure for dealing with the psychotherapy relationship as
 Object Relations does. Object Relations has a model of exploring and
 understanding the splits in the ego and the defences used in relating to others that 
complement well the body psychotherapy focus on splits and relating to one’s 
body. Gestalt psychotherapy with its primary focus on here and now experiencing 
brings a freshness and immediacy to the perspective which is useful. It also offers
 a model of change – a paradoxical one ‘to change, to become more who you are
 now.’ This is valuable in complementing the other two perspectives (Body and
 Object Relations), which are powerful tools for knowing who you are now, both 
psychically and somatically. The value of such an integration comes, I believe,
 from the fact that each theory appears to focus on one aspect of the individual’s
 life. Body psychotherapy, I suggest, focuses on harnessing the life force within the 
person to overcome limitations, such as poverty of self-concept or fear/guilt of disturbing others in the task of taking up one’s life in the world, while
 psychoanalytic perspectives can focus on surrendering to limitations of self and 
others and corning to some acceptance of such limits. This would alert us to the
 dangers of offering body psychotherapy alone to an already grandiose or 
omnipotent individual, and of offering a psychoanalytic treatment only to the self-
abasing/negating individual who may need a certain grandiosity or narcissism to 
enable them to conquer the obstacles to living. Such an integration is needed to do 
justice to the complexity which is called for in living a life. To grasp the paradox
 of life necessitates holding the paradox in psychotherapy. The paradox in life 
means that we must believe that we are invincible while knowing that we are frail
 and mortal, believe that we have free choice while knowing that we live out our 
destiny. As T.S. Eliot states:

“Here and there does not matter.
 We must be still and still moving 
Into another intensity
 For a further union, a deeper communion
 Through the dark cold and the empty desolation,
 The wave cry, the wind cry, the vast waters
 Of the petrel and the porpoise.
 In the end is my beginning.” 
[The Four Quartets]

This focus on the differences between psychotherapies relates strongly to what 
Messer [12] calls the different underlying visions of reality that underpin various
 approaches. In this article, Messer focuses on different visions which underlie 
different therapies. He sees that the Humanistic Psychotherapy of Rogers (1961) 
[13] and Maslow (1971) [14] view life as primarily an adventuresome quest which 
emphasises people’s potential for psychological growth. This outlook he terms a 
romantic one. In contrast, psychoanalytic approaches he views as holding more to 
an ironic or tragic vision. The ironic vision can be seen as the flip side of the 
romantic vision where the romantic illusions about ourselves are challenged. This 
is allied to the tragic vision which distrusts the possibility of happy endings and 
focuses on the acceptance of the past, and the belief that man’s nature cannot be 
radically perfected. The metaphor used by Nina Coltart in her book, The Baby and
 the Bathwater [15], is useful here. The therapy process can be seen as two
 processes – one of growing the baby and the other of jettisoning the bathwater. She
 writes:

“There is a way of thinking about every therapy as a long, slow jettisoning of a
 lifetime’s bathwater, allowing the emerging baby to come to know herself, her 
inner selves, her false selves, and grow into a truer and happier self.”

Such a knowing needs both an optimism and a realism, embodied in the different 
perspectives that go into making up an integrative framework.

An integrative perspective needs, I believe, to incorporate these different visions of
 life in order to offer the best chance at helping the individual to assert themselves 
but with a healthy self-suspicion. Such a perspective will aim to emphasise the power of the ego to triumph through the curative powers of the therapeutic 
relationship alongside the sobering aspects of self knowledge and acceptance
 through interpretation.

Integrative perspectives offer sturdy challenges in practice, and much of this work 
has not yet been undertaken in depth, although organisations such as the Society
 for Psychotherapy Integration (SEPI) organise excellent conferences to explore
 such issues. Of particular relevance are such questions as the effects on the
therapeutic relationship of an integrative approach. For example, self disclosure,
 congruence and touch of the humanistic approaches have effects on the 
transference as seen from psychoanalytic perspectives. Thus the kind of 
relationship fostered from different viewpoints may at times be seen as mutually 
exclusive.

Finally although there are difficulties in coming to an integrative perspective, such 
a move is indeed in motion. This movement is further fostered by the coming of
 the European Certificate in Psychotherapy which prescribes that all trainings need 
to incorporate a knowledge and understanding of other approaches. Perhaps such 
pragmatic needs rather than any pure notions of scientific completeness may 
ensure that integration is indeed a force which has come to stay in psychotherapy.

Notes:

1. Clarkson in The Handbook of Psychotherapy, edited by Petrushka Clarkson &
 Michael Pokorny, Routledge 1994.

2. Norcross & Napolitano, International Journal of Eclectic Psychotherapy, Vol 5 
1986.

3. Dryden & Norcross, Eclecticism and Integration in Counselling and
 Psychotherapy, Gale 1990.

4. Harper, R.A., Psychoanalytic Psychotherapy, Prentice Hall 1959.

5. Karasu, T.B., ‘Psychotherapies – an Overview’ in American Journal of 
Psychiatry, Vol 134 1977.

6. Kuhn, T.S., The Structure of Scientific Revolutions, Uni of Chicago Press 1970.

7. Smith et al, The Benefits of Psychotherapy, Johns Hopkins Uni Press 1980;
 Longman & Dawes – American Psychologist, Vol 37 1982.

8. Frank in Psychotherapy Research and Behaviour Change, edited by Harvey & 
Park, American Psychological Association 1982.

9. Garfield S.L. Psychotherapy – an Eclectic Approach, Wiley NY 1980

10. Smith, B., The Body in Psychotherapy.

11. Symmington, N., A New theory of Narcissism, Karnac Books 1996

12. Messer and Winokur, The American Psychologist Vol 35 1980

13. Rogers, C., On Becoming a Person, Houghton & Mifflin 1961

14. Maslow, A., The further Reaches of Human Nature, Viking 1971

15. Coltart, Nina. The Baby and the Bathwater, Karnac Books 1996

Ger Murphy works as a psychotherapist supervisor and trainer at the Institute of Creative Counselling and Psychotherapy, 
Dun Laoghaire.