Becoming an Integrative Psychotherapist

by John Bourke

The process of becoming an integrative psychotherapist has been described as being experienced as a complex, challenging yet rewarding journey that involved coming to an understanding about the meaning of integration and forming an identity as an integrative psychotherapist in a context of uncertainty. (Gordon, McElvaney, Dunne & Walton, 2020:1)

This article summarises the main themes and findings of research completed as part of an MA Psychotherapy entitled ‘Towards Integrative Psychotherapy Practice: an exploration of the process of becoming an Integrative Psychotherapist’.

The term ‘integrative’ has had various attributed meanings across the decades (Gordon, McElvaney, Dunne, & Walton, 2020). For example, in attempting to provide a specifically tailored treatment for each client and their specific issues, the practitioners may take an eclectic approach, integrating different psychotherapeutic modalities as they seek to support the client. Others will use the term ‘integrative’ to refer to a holistic view of a person, a view that sees the person as an integrated whole: affectively, cognitively, behaviourally, physically and spiritually (Lapworth, Sills, & Fish, 2001). For others again, ‘integrative’ refers to the integration of the personal and the professional, and the integration of research and practice (Glibert & Orlans, 2011).

In addition, a number of factors have been identified as influencing the process of becoming an integrative psychotherapist. These include those relating to the therapist’s professional role (base training and subsequent learning and development choices, clinical experience and supervision), those relating to the context of practice (including health policy, trends in psychotherapy provision and practice, changes in theory and advances in neurosciences and psychopharmacology) and those relating to the person/self of the psychotherapist.

So, what does the process of becoming an integrative psychotherapist ‘look like’ in practice? How have seasoned integrative practitioners fared on this journey? Are there common markers along the way that a novice psychotherapist would do well to be aware of? What role and level of influence do all of these factors mentioned above play in the process of becoming a psychotherapist? Are there extra or particular nuances at play for those who practice as integrative psychotherapists? If the therapist is no longer the “blank screen” then what implications does this have for the personal and professional development of the integrative psychotherapist?

Methods

Six psychotherapists, each registered with either IAHIP or IACP for more than 10 years, were initially invited to rate the influence of the various factors mentioned above on their development as an integrative psychotherapist. Following on from this, each participant took part in an hour-long online interview which sought to explore their development as such.

Understanding that each participant of this study will inevitability approach their practice in their own unique way, the study explored not only the range and scope of such practice approaches along with their commonalities and disparities of worldviews, but also such patterns or insights as may emerge in the ‘life-long learning/directions of travel’ of the participant practitioner. The study explored the participants’ descriptions of their integrative practice models. These were ‘snapshots’ of their practice at a particular point in time. Also, the forces or ‘dynamics’ that shape each participants’ practice approach was explored through discussion about the factors (professional, contextual and personal) that contribute to their practice approach. It is this ‘dynamics’ perspective that is the subject of this article.

Results

The study found that practitioners’ approaches to their work reflected a mix of models, including technical or systematic eclecticism (Benito, 2018) and a holistic view of the client and their context (Lapworth, Sills, & Fish, 2001).

Results from the rating exercise carried out by participants indicated that, apart from research, all other factors – namely base training, career development choices (CPD), clinical experience, supervision, various context factors, the ‘self’ of the practitioner and their own experiences of personal therapy were all deemed as ‘very influential’ in terms of their impact on the process of becoming an integrative psychotherapist practitioner.

From a phased reflexive thematic analysis of the dataset, four themes emerged: models of practice were marked by ‘client centricity’ and ‘specialist/ generalists,’ and the practice dynamics of ‘equilibration’ and ‘presencing’.

Practice Dynamics

The two themes described below (‘equilibration’ and ‘presencing’), arise from a process or dynamic perspective.

‘Equilibration’

The process of equilibration (Piaget, 1954) occurs in the context of two ongoing sub-processes in the person’s attempt to make sense of the world. Assimilation is the cognitive process of fitting new information into existing cognitive schemes, perceptions and understanding: one’s overall beliefs and understanding of the world do not change as a result of the new information. Accommodation, on the other hand, refers to the cognitive process of revising existing cognitive schemas, perceptions and understanding so that the new information can be incorporated.

It would appear that these processes are ongoing not only in terms of the therapist making sense of their own world (intrapersonal) but also in their attempts to understand the world of their clients (interpersonal) and to assist their clients to make sense of the same.

Intrapersonal

Part of the process for the integrative psychotherapist is the ongoing challenge of assimilating and accommodating their base training into their own internal practice process. In this regard, Nora commented:

I had an early fear of moving beyond one school (Gestalt)… I found the different curricular approaches initially overwhelming… I wondered how does this material speak to me? How does it apply?... It (Gestalt) saved my life…it brought me back to my own process… to a slowing down…

Interpersonal

These processes of assimilation and accommodation are also evident in relation to how the psychotherapist is making sense of the client or assisting the client in this process of sense making. Nora commented:

The client holds the key…but so many doors are closed…I can only meet them at the front door … it is the role of the psychotherapist to help the client make meaning…

Part of my role is to offer challenges to the client… to assist them working with life tasks…

Finally in this regard, Alan commented:

I gear my approach to what I feel will work best for the client, so rather than just working with one modality- it means I can adapt- which I find very helpful with clients- much easier- puts them much more at ease…

‘Presencing’

‘Presencing’ – a blending of the words ‘presence’ and ‘sensing’- has been defined as ‘sensing, tuning into and acting from one’s highest future potential- the future that depends on us to bring it into being being’(Scharmer, 2016; Senge, Scharmer, Jaworski, & Flowers, 2004). In the same way as with the processes of ‘equilibration’, it would appear that ‘presencing’ processes, too, are ongoing not only in terms of the therapist themselves (intrapersonal presencing) but also in their attempts to ‘co- presence’ with their clients (interpersonal presencing) as the client might sense, tune in and begin to act from a fuller sense of themselves.

Intrapersonal Presencing

There was a palpable sense of intrapersonal dynamism and growth for study participants. These are the words that Nora used:

For myself… I see that I am on a spiritual journey… Spiritual pain/pain of life that can’t be healed- leaning into the pain… (I need to) get a handle on Me and my own process and my contact with my environment … (I need) a knowledge of my own process…

This dynamism and growth infuse not only the base training but also those career learning and development choices with which participants continue to engage. Nora commented:

Further training/qualification (in one sense) is a badge to bring into the therapy room- but really it is a license to bring more of me (self) into the room…I’m a (participant used their own first name) psychotherapist … the imperative of personal work…always growing deepening and integrating who we are in the world…

There was a sense that, for some, base training (their original training) was understood in terms of the concept of ‘presence to self’. These are the terms used by Helen:

Being vs Doing (was emphasising) in training… The whole course was practice of ‘presence to self’- knowing what’s going on in the body, mind, feelings … (I like the way this has been described by Wilber) …The Moveable Boundary- (referring to) stages of development…

Supervision, including internal supervision, personal therapy and the commitment to same seem very important resources in terms of the therapist’s own presencing. Nora commented: “Supervision is hugely supportive- to the therapist as person… Continuing personal therapy- the clearer I am about my own processes the better…”

Various comments made by Ian seem to speak into this theme: “We didn’t mention the word ‘soul’ and actually who I am and what my soul is yearning for- being touched in certain ways…”

Interpersonal Presencing- Co Presencing

Nora spoke about a particular client and how she, as a therapist, saw her task in terms of co-presence:

(I was very much) Holding the presence of that young girl…The challenge of meeting resistance to change… I bring all of me into the therapy room… my self- consciousness in the room, the capacity to discern (what’s yours/what’s mine/what’s ours?) …

These are the terms that Helen used, in this regard:

How can I help people become more conscious in this time of change… (they are) looking to steady themselves … Essence is an open-mindedness to resources to inputs … the size of the container, to contain things in a way that is meaningful l… I can feel you feeling me…that is the essence that creates the container for change…

Finally, David alluded to both interpersonal ‘presencing’ and intrapersonal ‘presencing’:

the more present I am- the more I pick up… my capacity to meet them is resourced by me being able to experience what’s happening for me in the present moment with them, present experience of the therapeutic relationship…

Discussion

Equilibration

From an intrapersonal perspective, it is the process of ‘equilibration’ that appears to be key as the practitioner makes career and developmental choices, taking account of the inputs from clinical experience, supervision and their own personal therapy. As Helen noted: “Clinical experience makes you look for what you don’t know…”

This process appears to be central in relation to integration- again quoting Helen: “I have chosen CPD to broaden out…I have gone seeking it…that’s the integrative bit…”

These processes also seem to be important as the practitioner adjusts and develops their practice. In this regard Alan said: “At the beginning (I was told) I was too Rogerian… I had to rethink… now I am constantly developing, constantly growing in the role in work.”

These findings seem to find an echo in the literature as Jennings and Skovholt (1999, p.6) noted that one of the central characteristics of these master therapists is that they “value cognitive complexity and the ambiguity of the human condition”. Wilber (2000b) synthesises many of these developmental theories, referring to them as ‘structure stages’ indicating different ways of making sense of the world. Forman (2010, p.83) underlines the particular strengths of the multiperspectival/integrated structure stage for integrative psychotherapists.

Equally, in the interpersonal space- the therapeutic relationship- these processes are also evident helping the client make sense of their world. Similarly, it was Helen who noted:

The systemic thing is very important – whole families/communities/nature…making sense of that… there is so much burnout and distress…clients not tuned into the wider system… climate change… so without, so within …

It would appear that these metacognitive processes of equilibration are key dynamics fueling the adaptation that is such a hallmark of the practice model of the integrative psychotherapist.

Presencing

The second theme that has emerged in practice dynamics is that of ‘presencing’. Skovholt (2012, p.125) emphasises the important role of metacognitive skills that underpin the therapist’s capacity not only for ‘empathetic presence’ with the client, but also for ‘empathetic presence’ with their own self. Within the Gestalt tradition, for example, ‘presence’ is recognised as an important aspect of being a Gestalt practitioner (Joyce & Sills, 2018).

However, there appears to be less psychotherapy literature relating to the processes of ‘presencing’. Based on the philosophical assumptions of field theory and phenomenology, Scharmer (2016, p. 7/8) defines ‘presencing’ as “the process of sensing, tuning in and acting from one’s highest future potential- the future that depends on us to bring it into being”. These processes and sensitivities are seen as pertaining to particular realms or states of consciousness (Wilber K. , 2019, p. 612).

Scharmer’s definition also appears to assume realities that are less static and more ‘a process of coming into being’ (p. 104). From this perspective, the definitional elements of ‘sensing and tuning in’ capture an important dynamic supporting the process of becoming an integrative psychotherapist. As with the processes of ‘equilibration’, ‘presencing’ is operational in both the intrapersonal and interpersonal domains. For the therapist themselves, for example, Nora states:

(I need to) get a handle on me and my own process and my contact with my environment … (I need) a knowledge of my own process.

Supervision, including internal supervision, and a commitment to personal therapy seem to be important resources in terms of the therapist’s own ‘presencing’. These same factors appear to support the processes of ‘presencing’ as proceeding in the interpersonal domain.

The final part of Scharmer’s definition of ‘presencing’, however, “…acting from one’s highest future potential- the future that depends on us to bring it into being…” points to a transpersonal quality in the processes of ‘presencing’. While this quality does appear to be included in the Psychosynthesis approach to psychotherapy, it is unclear as to whether this meaning finds an echo in the humanistic- Existential, Gestalt or Psychodynamic traditions.

There is another aspect of the processes of ‘presencing’ that deserves mention. Scharmer (2016) alludes to ‘presencing’ as enabling a conscious relationship with the ‘deeper source level’ from which practitioners act. This helps them notice the invisible roots of dysfunctional social patterns and systems, to acknowledge and relinquish them and to co-create new pathways and structures that may aid transformation (Bockler, 2021). May (1994, p. 55).

Finally, there is a complementarity between the process of ‘equilibration’ and of ‘presencing’. We have mentioned earlier that equilibration has to do with the ‘structure-stages’ or different levels of perspectives of the integrative practitioners. ‘Presencing’, on the other hand, refers to ‘states’ of consciousness. Wilber (2019, p. 121) combines these two aspects of consciousness in the Wilber- Combs Lattice. The ongoing work of equilibration by the therapist, focused not only on the client but also on themselves, points to the ongoing development ‘structure stage’ work. This work allows for a different sense to be made of the world, of relationships and of pathology. The ongoing work of ‘presencing’ is focused on different states of being. As such the attainment of states of being as facilitated by ‘presencing’ allows for different ways of feeling and being in the world.

Conclusion

The findings of this study then point to two key complementary processes underpinning the ongoing process of becoming an integrative psychotherapist - ‘equilibration’ and ‘presencing’ - and there is a complementarity between these processes.

Equilibration has to do with the ‘structure- stages’ or different levels of perspectives of the integrative practitioners. The ongoing work of equilibration by the therapist, focused not only on the client but also on themselves, points to the ongoing development ‘structure stage’ work. This work allows for a different sense to be made of the world, of relationships and of pathology.

‘Presencing’, on the other hand, refers to ‘states’ of consciousness. The ongoing work of ‘presencing’ is focused on different states of being, and as such the attainment of states of being as facilitated by ‘presencing’ allows for different ways of feeling and being in the world. In particular, given that its definition includes a transpersonal element, the concept of ‘presencing’ may provide a useful focus for future research in this regard.

John Bourke is a qualified humanistic and integrative psychotherapist and is a Certified Associate of IAHIP, working as a psychotherapist with Mind and Body Works Dundrum and with City Therapy in Rathmines. John is also a pharmacist and continues to work in the pharmacy sector.

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