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Book Review: Integrative Psychotherapy in Action – Richard Erskine and Janet Moursund

Sage Publications, 1988

The idea of an “Integrative Psychotherapy” has been around for some time. It
 usually means the bringing together of affective, cognitive, physiological, systems,
  biodynamic and perhaps behavioural approaches to psychotherapy. Insights to do 
with developmental issues are also important. \The risk in attempting to integrate
 various approaches is that you may end up with a mix (or a mess) and not an 
integration. On the other hand the creative potential of the enterprise is
 obvious. \Many “eclectic” therapists I have met insist that the integration of
 influences takes place at the personal level for each therapist rather than the
 theoretical . If this is so then integrative psychotherapy is a mystery or an infinite 
number of mysteries and not a single clarity. An alternative approach is to view the
 notion of “integrative” not as a destination but as a path or direction, as a way of
 naming a process which is continually re-discovering and re-defining itself. The task 
is to capture that process in theory or in some other way.

This latter description seems to best fit what Erskine and Moursund have
 produced. They make an attempt, in a long introduction, to offer a theoretical
 overview of what they mean by integrative psychotherapy. This consists of an 
excellent summary of Transactional Analysis theory side by side with a sketchy, 
oversimplified piece on Gestalt. Reich’s ideas get two paragraphs and the odd
 mention here and there. Systems and other approaches are mentioned briefly. While
 disappointing this is not surprising. Erskine is described on the dust jacket as having
 won the “Eric Berne Scientific Award for advances in theory of Transactional
 Analysis.” The final sentence of the theoretical introduction seems to suggest the
 author’s own frustration with theory.

“We hope that clients and therapists’ actual words may help to convey some of the
 affective involvement that gives integrative psychotherapy impact.”

Accordingly the remainder of the book is given over to transcripts of 11 individual
sessions, mainly with Richard Erskine as therapist assisted by Rebecca Trautman. 
Each session takes place in a group of 16-20 people on a 10 day therapy residential. A 
large number of interventions and approaches are displayed. Each script is carefully 
annotated – every pause and physical gesture is recorded in brackets – together with 
”running commentaries” from the authors. These commentaries (which do not form 
part of the session itself) serve to explain the therapist’s thinking, how he sees his 
options and what he chooses to avoid at each important stage of the session. The 
important principles behind the therapist’s approach are also set out, for example:

“The fuzziness 
is beginning to clear; the major issue, Jon’s relationship with his father, is moving into the foreground. It is not a matter of the therapist’s zeroing in on a theme, or even of Jon himself deciding what he wants to work on. Rather
 it is like an intricate dance, with each participant contributing to weaving a 
pattern – a pattern that becomes more and more visible as the dance continues.”

These annotated transcripts also manage to convey a sense of timing, of
 connectedness and artistry in the way the therapists “use” themselves and their 
knowledge of various models, within the therapeutic encounter. It is this sense of
 informed inspiration, so difficult to capture in theoretical exegesis, which makes the 
action-based or experiential therapies so compelling. The emphasis in their work is
 often on the quality of contact – on how clients avoid clear contact with the therapist,
 group members and themselves in a variety of ways:

“Emily:(Pause) I find it very difficult to tell her….(her fist is clenching on
 the mat)

Richard: But your hand is talking. There’s tension in that fist.

Emily: My mother was incapable of hearing anything about sex.

Richard: (holding his hand up to her fist so that she can push against it)
 Push here. Push against her instead of you, and say it again to her.”

My overall impression of these 11 sessions is of an effective integration of 
transactional analysis and Gestalt approaches which falls short of even the AUTHORS’
 definition of “integrative psychotherapy”. Nevertheless the form in which they 
produced this material – carefully annotated transcripts with appropriate running 
commentaries – is shown to work exceptionally well in conveying the informed 
inspiration characteristic of this work when done well.

As all good therapy takes place in the immediacy of present time, the test of an 
effective integration of approaches lies more in action than in theory.

ED BOYNE

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