COUNSELLING
Introduction
In the last decade, there has been increased interest and use of assimilative approaches in various disciplines, such as theology, philosophy, and other sciences. In psychotherapy, various scholars have highlighted the importance of incorporating varying ideologies to achieve better outcomes. As a result, there has been a steady movement from isolationism to integration, as demonstrated by the scholars’ and clinicians’ willingness to cross sectarian lines and open up a dialogue between various psychotherapy schools. Ziv‐Beiman and Shahar (2014) hold that the overarching goal of integration has been to develop more effective forms of therapy by synthesizing the best methods and concepts into new theories and systems of treatment (Ziv‐Beiman & Shahar, 2014).
Psychotherapy integration goes beyond a single theory to incorporate different techniques. With the recent upsurge of integrative works and the sustained discussion on their advantages, it is important to study how psychotherapy has morphed and become more fluid to accommodate divergent views and ideologies. Besides, there have been a lot of discussions between proponents and opponents, which attests to the evolving maturity. The relevance, efficacy, and history of psychotherapy integration are briefly described, and so the developments in the past ten years, especially those that pertain to research and scholarly work. The paper then describes the assimilative integration and common factors models.
Literature Review
Psychotherapy integration is an approach that incorporates single-school approaches with other perspectives. The approach unifies the cognitive, behavioral, physiological, and affective levels of human functioning to address the various dimensions of life. Therefore, the essence of psychotherapy signals the idea that there is a lot more to be learned from other counseling perspectives. Further, it is characterized by the openness to embrace diverse psychotherapy theories and techniques. The counselor uses the rationale of efficiency to the contrast between technique and theory. Overall, there are three main types of integration, which are Theoretical integration, Assimilative Integration, and Common Factors. The three domains present a different paradigm from the eclectic approach to psychotherapy.
According to Ziv‐Beiman and Shahar (2014), most therapists in Europe and the United States identify and perceive themselves as eclecticists or integrationists. They also acknowledge that the psychotherapy field is continually evolving and developing, which indicates trends that assimilative integration is the most preferred model of integration compared to other models. Similarly, the authors reckon that the cognitive approach is the most dominant approach that is applied in the assimilative integration models (Ziv‐Beiman & Shahar, 2014). Overall, there is consensus among most scholars that the term “integration” has a clearer predilection over “eclecticism.”
Integration is becoming a key and influential movement in psychotherapy practice, as reflected by the many practitioners who currently identify as integrative. Some scholars, such as Castonguay et al. (2015), reckon that so far, integration has not had any significant impact on psychotherapy research and that there are new frontiers that have not yet been explored to strengthen the integration movement and its role in the psychotherapy field. Further, the authors reckon that it is vital to consider the perspectives of integrationists on such areas as training, practice-oriented, therapists’ effects, and harmful effects. The article suggests that there should be more collaboration between psychotherapy researchers and integrationists, which would help create a unified body of actionable knowledge that will advance the field and benefit all the participants (Castonguay et al., 2015).
According to empirical evidence and the existing breadth of knowledge, integrative psychotherapy upholds the general requirements of counseling. These include the application of a specific technique to a problem and the choice of treatment approach based on the characteristics and presenting problems of the patient. Various scholars agree that integrative psychotherapeutic models do not conform to the development of protocols and manuals because they are not premised on randomized clinical trials.
Psychotherapy integration has been applied in diverse ways.
Assimilative integration
Assimilative integration posits that counselors should stick to their preferred theoretical paradigm even while blending various aspects from other psychotherapy models. The approach presents a middle ground between the unified theory and the technical eclecticism, which brings forth clinical and theoretical challenges.
Assimilative Integration
Assimilative integration, and its variant, technical eclecticism, are commonly used by eclectic practitioners. The therapists are grounded in a particular theoretical approach and an incorporation of techniques borrowed from other approaches, effectively demonstrating the diversity of techniques.
Consensus has been arrived at that assimilative integration is a middle ground between technical eclecticism and theoretical integration and is the channel towards fuller integration. It is advantageous because it gives therapists the latitude to practice within the comfort of their preferred theoretical approaches while allowing them the latitude to draw from perspectives and techniques from other modalities, effectively broadening their repertoire. This concept is supported by empirical evidence, which shows that out of those therapists who considered themselves integrative psychotherapists, 27% were applying assimilative integration compared to the 19% who preferred technical eclecticism (Castonguay et al., (2015).
The overarching claim of assimilative integration is that practitioners have a home base in a particular theory. Messer (2019) cites a study that was done on psychotherapy integration experts who were asked how often they felt influenced by family systems, humanistic, psychodynamic, and cognitive-behavioral theories. 75 % of the subjects affirmed that they were only influenced by one theory (Messer, 2019). Therefore, even though practitioners have different theoretical persuasions, the tendency is to anchor one’s preferred theory and to borrow from some aspects of other theories.
Recent literature also suggests that other fields are borrowing from the principles of assimilative integration. For example, clinicians are incorporating the practice to improve the quality and effectiveness of patient care. A clinician may choose psychodynamic therapy as the home base but may also ask the patient to do some homework, a technique used in cognitive-behavioral therapy. As a result, assimilative psychodynamic therapy theories have been used to treat patients suffering from substance use disorders. Messer (2019) makes reference to a situation where psychodynamic clinical psychology learners applied CBT to patients with substance abuse disorders and achieved positive results from the assimilative fashion. They affirmed that using a CBT as the home base, and combining it with process-experiential therapy, yielded optimal emotional deepening (Messer, 2019).
The efficacy of assimilative integration is well-documented. Some therapists found that incorporating behavioral and psychodynamic techniques into family therapy yielded positive outcomes for married couples. Therefore, assimilative integration principles are a solid framework within which practitioners can leverage multiple system theories and still maintain a base in their preferred main theory. The implications are that there is seamless quality in interventions, creating a consistent treatment, such that the patient does not feel that there is any integration taking place.
There is strong evidence that the practical underpinning of assimilative integration is that there is no single one-size-fits-all psychotherapy approach. Therefore, it is imperative that therapy is tailored to individual patients by understanding their problems and needs. Assimilative integration is, therefore, widely lauded because it facilitates the understanding of the patient’s needs, and by using different approaches, the therapist can make tailored treatment because they have a better understanding.
The common factors approach
Researchers and scholars agree that there are common factors among different psychotherapeutic approaches. According to Zarbo et al. (2016), common factors are responsible for about 20% of outcome variances, while therapeutic techniques are responsible for 7% of outcome variance (Zarbo 2016). Zarbo’s findings are corroborated by Watkins (2017), who underscores that the various schools of psychotherapy produce similar outcomes, their varying theoretical underpinnings and approaches notwithstanding (Watkins, 2017). Therefore, there is a consensus that
The premise of the common factors approach is drawn from the fact that there is a uniformity of factors in all psychotherapy approaches. In response, psychotherapists have integrated all the psychotherapy approaches. These factors include client expectations, therapeutic alliance, therapist empathy and are associated with positive outcomes, such as the therapist inspiring hope and providing alternatives to their client. Other benefits include the therapist’s ability to inspire the client to have a more plausible perception of themselves and the world, their effectiveness in providing a corrective emotional experience that is necessary to remedy the traumatic impact of their previous experiences, and positive therapist qualities, such as attention, respect, positive regard, and empathy.
There has been a section of researchers who feel that clinical researchers have ignored common factors as they design research-based interventions that are effective for therapeutic change. However, Hofman & Barlow (2014) underscore that clinical researchers have been studying the impact of the common factors for decades in an effort to develop empirically supported interventions and treatments. Further, they argue that these factors are contributory and do not suffice to yield maximum effects. Besides, their efficacy differs significantly from one disorder to another depending on the type and manifestation of the disorders.
The proponents of the common factors approach to identify the effective components of any cluster of therapies and explore how certain psychotherapeutic interactions and interventions can promote those ingredients. The common factors approach to psychotherapy integration arose from the assumption that all psychotherapy approaches share some critical and curative factors, albeit in varying degrees.
There is consensus among scholars that the common factors approach is important and viable.
The common factors integrative approach has been reinforced through cross-sectional studies that have yielded a consensus that integrative therapies are structured around the objective of optimizing the patient’s exposure to an exclusive blend of therapeutic factors that will yield the best outcomes for their problems. Some researchers have attempted to clinically and empirically identify the exact sufficient and necessary factors for therapeutic growth. Consequently, the findings have affirmed that accurate empathy, self-congruence, unconditional positive regard, demoralization of stressed patients, coupled with offering hope, are central to psychological relationships. Thus, the common inference has been that there are common effective ingredients of therapy.
Overall, scholars have come to similar conclusions that most therapeutic approaches share common curative ingredients. Therefore, it is logical to approach integrative therapy from the angle of the relational and supportive common factors so as to improve therapy outcomes. The overarching justification that has been widely accepted is that since each facet subdivision of psychotherapy is anchored and capitalizes in certain common effective factors while excluding or neglecting others, then the common factors integration is superior because it combines and increases the unique and common factors, exposing the client to better therapy outcomes.
However, despite the strides that have been made, there are gaps in psychotherapy integration. For example, some surveys show that many clients do not receive empirically supported treatment because most therapists do not update their knowledge of recent research. According to Gyani et al. (2014), most therapists prefer using clinical experience and not research findings to upgrade their knowledge and improve their practice. Such attitudes have a profound impact on working practices and could be reversing the gains that have been made in the profession (Gyani et al., 2014).
Psychotherapy integration is widely acclaimed if the number of journals, publications, and professional society interested in the frontier is anything to go by. It is, therefore, apparent that psychotherapy integration has matured. The growth has been attributed to different variables. These include the increase in the number of disparate psychotherapies, the appreciation of the inherent limitations of each therapy coupled with their failure to present remarkable efficacy, and the inability of any theory to sufficiently explain or predict personality, pathology, or behavioral change. Other variables include the rise in the number and relevance of psychotherapies that are short-term focused and improved communication between scholars and clinicians, which has presented an opportunity for increased therapeutic experimentation. Scholars and practitioners have also appreciated the common factors in various therapy approaches, which yield related and successful outcomes. As a result, there has been an increase in the number of professional organizations, published journals, networks, and conferences that are dedicated to studying and discussing psychotherapy integration. The limited socioeconomic support for the traditional and long-term psychotherapies has increased the need to document the efficacy of psychological therapies.
References
- Watkins Jr, C. E. (2017). Convergence in psychotherapy supervision: A common factors, common processes, common practices perspective. Journal of Psychotherapy Integration, 27(2), 140.
- Ziv‐Beiman, S., & Shahar, G. (2014). Psychotherapy integration. The encyclopedia of clinical psychology, 1-6.
- Castonguay, L. G., Eubanks, C. F., Goldfried, M. R., Muran, J. C., & Lutz, W. (2015). Research on psychotherapy integration: Building on the past, looking to the future. Psychotherapy Research, 25(3), 365-382.
- Messer, S. B. (2019). My journey through psychotherapy integration by twists and turns. Journal of Psychotherapy Integration, 29(2), 73.
- Zarbo, C., Tasca, G. A., Cattafi, F., & Compare, A. (2016). Integrative psychotherapy works. Frontiers in psychology, 6, 2021.
- Hofmann, S. G., & Barlow, D. H. (2014). Evidence-based psychological interventions and the common factors approach: The beginnings of a rapprochement?.
- Gyani, A., Shafran, R., Myles, P., & Rose, S. (2014). The gap between science and practice: How therapists make their clinical decisions. Behavior Therapy, 45(2), 199-211.