W7

Question 1

Why did the integration/ eclecticism of psychotherapy emerge?

Answer 1

It emerged because of a dissatisfaction
with single-school approaches and a naturally associated desire to look across
school boundaries to see how patients can benefit from other ways of conducting
psychotherapy

Ultimate goal: To enhance the efficacy and applicability of psychotherapy by
crosscutting perspectives (by tailoring one’s approach to the
unique needs of the client). Integrative psychotherapy leads by following the client.

The integrative imperative to tailor psychotherapy to the patient can be
misconstrued as an authority figure therapist prescribing a particular form of
psychotherapy for a passive client. The real goal is for an empathic therapist to work toward an optimal relationship that
both enhances collaboration and secures the patient’s sense of safety and
commitment.

Question 2

The Four Primary Routes to Integrated Psychotherapies

Answer 2

Technical eclecticism,
theoretical integration, common factors, and assimilative integration

Question 3

Technical Eclecticism

Answer 3

Seeks to improve our ability to select the best treatment techniques or
procedures for the individual person and their individual problem

This search is guided primarily by research on which methods have worked
best in the past with similar problems and patients with similar characteristics.

Focuses on predicting for whom interventions will work; its foundation is
actuarial (mathematical/statistical) rather than theoretical

Uses Procedures drawn from different therapeutic systems without necessarily
subscribing to the Theories that spawned them.

For technical eclectics, no necessary connection exists between conceptual
foundations and techniques.

[Selects the techniques that have worked best with similar circumstances in the past; without necessarily subscribing to the theories that spawned the techniques]

Question 4

Theoretical Integration

Answer 4

Two or more therapies are united with the hope that the result will be better
than the constituent therapies alone

There is an emphasis on integrating the underlying theories of psychotherapy
as well as the techniques from each.

It involves a commitment to a conceptual or theoretical creation beyond a
technical blend of methods.

Goal: To create a conceptual framework that synthesizes the best elements of
two or more therapies! The aim is an emergent theory that is
more/better than the sum of its parts.

Question 5

Common Factors Approach

Answer 5

An attempt to identify core ingredients shared by different therapies

Goal: Creating more parsimonious and efficacious treatments based on the
commonalities between different successful therapies.

Based on the belief that commonalities are more important in
accounting for therapy success than the unique factors that differentiate
approaches.

Common factors most frequently proposed: Development of a therapeutic
alliance, opportunity for catharsis, acquisition and practice of new behaviors,
and clients’ positive expectancies.

Question 6

Assimilative Integration

Answer 6

A firm grounding in one system of psychotherapy but with a willingness to
selectively incorporate/ assimilate practices from other systems

It combines the advantages of both a single, coherent theoretical system with the
flexibility of a broader range of technical interventions from multiple systems.

Some say it is a realistic way-station on the path to a
more sophisticated integration.

For people who are against it, it is a halfway station of people unwilling to
commit to an approach (both agree that assimilation is a tentative step toward full integration).

Most therapists gradually incorporate parts and methods of other approaches
once they discover the limitations of their original approach and inevitably
integrate new methods into their home theory.

Question 7

Commonalities between Assimilative Integrationists and Technical Eclectics

Answer 7

Assimilative integrationists and technical eclectics both believe that synthesis
(the combination of the parts) should occur at the level of PRACTICE, rather than
theory - by incorporating therapeutic methods from multiple schools.

In some circles, the terms integrative and eclectic have become synonymous
(seen as having the same meaning) and are often viewed ambivalently because of their alleged disorganized and indecisive
nature.

This opposition can be attributed to syncretism (the creation of uncritical and unsystematic
combinations)

Question 8

How do the Authors approach Integrative Practice?

Answer 8

Their approach is broadly characterized as integrative and is specifically labeled
systematic treatment selection (STS) - or prescriptive.

They intentionally blend several of the four paths toward integration (which are not mutually exclusive!)

Attempt to customize psychological treatments and therapeutic relationships to the
specific, varied needs of individual patients.
They do so by drawing on effective methods across theoretical schools (eclecticism),
by matching those methods to particular clients on the basis of evidence-based
principles (treatment selection), and by adhering to an explicit and orderly
(systematic) model [new therapy for each client - that evolves throughout the process along with the client]

Our integrative therapy is expressly designed to transcend the limited applicability of
single-theory or “school-bound” psychotherapies
This is accomplished by emphasizing change principles (or processes) rather than a
closed theory or a limited set of techniques.

Result: More efficient and effective therapy that fits both client and clinician

Question 9

Four weaknesses of single school therapies

Answer 9

The creation of most psychotherapies was more rational than empirical. They
were developed without or with little regard to the research evidence on their
effectiveness. In an era of accountability demanding evidence-based practice
(EBP), psychotherapies without controlled outcome research will not last long.

Single-school therapies tend to favor the strong personal opinions/ pathological conflicts that were of most interest to their originators. Patients suffer from a multitude of specific problems that should
be remedied with a similar multitude of methods.

Most pure-form systems of psychotherapy recommend their
treatment for virtually every patient and problem. The clinical reality is that no single approach to therapy is effective
for all patients and situations, no matter how good it is for some. Evidence-
based practice demands a flexible, if not integrative, perspective.
Psychotherapy should be flexibly tailored to the unique needs and contexts of
the individual client, not applied as if one size fits all.

They largely consist of descriptions of psychopathology and personality rather
than of mechanisms that promote change. They are actually theories of
personality rather than theories of psychotherapy; they offer lots of information
on the content of therapy but little on the process of change.

Question 10

Five Advantages of Integrative Psychotherapies

Answer 10

Tend to be more empirical in creation and more evidence based in revision

Case conceptualization is based more on the actual patient than on an
obscure theory

Therapy is more likely to be adapted or responsive to the unique patient and
the singular situation

Treatment is more focused on the process of change than on the content of
personality

Integration promises more evidence, flexibility, responsiveness, and
effectiveness

Question 11

What is an early example of integrating therapies?

Answer 11

Freud constantly struggled with selection and integration of
diverse methods, and introduced psychoanalytic psychotherapy as an
alternative to classical psychoanalysis; in recognition of the fact that the more rarified
approach lacked universal applicability

These early attempts at integration were largely theory driven and empirically
untested

Question 12

The Grandfather of Eclecticism

Answer 12

Frederick Thorne.

Introduced systematic integration and likened contemporary psychotherapy to a plumber who used only a
screwdriver! Like this plumber, deep-set psychotherapists apply the
same treatment to all people, regardless of individual differences, and
expected the patient to adapt to the therapist/therapy; rather than vice versa.

Question 13

“Prescriptive Psychotherapies”

Answer 13

Written by Goldstein and Stein and outlined treatments
for different people based on the Nature of their problems and on Aspects of
their living situations.

Question 14

Lazarus and Multimodal theory

Answer 14

Arnold Lazarus emerged as a prominent spokesperson for eclecticism in the 1960s. His
multimodal theory inspired a generation of mental-health professionals to
think and behave more broadly.

At the same time, an appreciation of common factors was gaining traction (i.e., therapeutic change resulting from common elements - pioneered in part by Garfield who introduced an eclectic psychotherapy in the 1980s predicated on
common factors )

Question 15

The contributions of Jerome Frank

Answer 15

Wrote “Persuasion and healing” - which argued that all psychotherapeutic methods
are elaborations and variations of age-old procedures of psychological healing

Argued that therapeutic change is predominantly a function of four factors
common to all therapies: [R.R.R.H - relationship, ritual, rationale, healing (setting)]
(1) an emotionally charged, confiding relationship
(2) a healing setting
(3) a rationale or conceptual scheme
(4) a therapeutic ritual

Nonetheless, the features that distinguish psychotherapies from each other receive
special emphasis in the pluralistic, competitive American society. Little glory has
traditionally been accorded to common factors.

Question 16

The contributions of Godfried

Answer 16

Influential article in the American Psychologist calling for the
description of therapeutic change principles

He was a leader of the integration movement

Argued that if therapists from different schools can arrive at common
strategies, they will consist of robust phenomena as they have survived
the distortions of therapist with different theoretical biases!

Question 17

The Contributions of Wachtel

Answer 17

His book began as an effort to portray behaviour therapy as foolish.

Realised that a lot of the concepts were similar to the form of psychotherapy
that he gravitated towards

This experience shows us that isolated theoretical schools perpetuate
caricatures of other schools, thereby foreclosing changes in viewpoint and
preventing expansion in practice.

Question 18

Who introduced the transtheoretical approach in one of the first integrative textbooks?

Answer 18

Transtheoretical approach (across theories) was introduced in a book by Prochaska and DiClemente

The book reviewed different theoretical orientations from the standpoint of
common change principles and the stages of change

The transtheoretical approach in general and the stages of change in particular are among the most extensively researched integrative therapies!

Question 19

Integrative Therapies in the Modern Day

Answer 19

Between one-quarter and one-half of contemporary clinicians prefer the label integrative or eclectic over identifying with a particular school of psychotherapy (with integration being the typical modality in the U.S)

This prevalence is assessed directly by asking whether one endorses the integrative orientation or obtained indirectly by
determining whether one endorses multiple orientations.

International organizations reflect this popularity:
o Society for the Exploration of Psychotherapy Integration (SEPI)
o Society of Psychotherapy Research (SRPR)

Being trained in a single theoretical
orientation does not always result in
clinical competence, but it does reduce clinical complexity and theoretical
confusion. However, there is a growing appreciation that single
orientations are theoretically incomplete and clinically inadequate for the
variety of patients, contexts, and problems they confront in practice (too narrow for real life)

Question 20

Challenges Associated with Integrative Training

Answer 20

Integrative training addresses the daily needs of
clinical practice, satisfies the intellectual quest for an informed
pluralism, and responds to the growing research evidence that different
patients prosper under different treatments and relationships.

On the other hand, integrative training increases the pressure for
students to obtain clinical competence in multiple methods and formats
and, in addition, challenges the faculty to create a coordinated training
enterprise.

Approximately one-third of training directors believe that students should be trained first to be proficient
in one therapeutic system, approx. half believe that students should be trained to be
at least minimally competent in a variety of systems; and the remainder believe that
students should be trained in a specific integrative system from the outset.

Studies show success in training clinicians to recognize cues on which treatment
methods are likely to be most effective for a particular patient.
Online programs have also been developed to guide patients and their therapists in
selecting optimal treatments that are both broad and flexible in applying fundamental
principles of change - the Innerlife STS (which suggests compatible/incompatible treatments, styles etc.,).

Question 21

Evidence-Based Practice

Answer 21

EBP reflects a pragmatic commitment to “what works for
whom”.

EBP lends increased urgency to the task of using the best of research and
experience to tailor psychological treatment to the client. The clear emphasis is on what works, not on what theory applies (in line with an integrative approach and speeding up the breakdown of more traditional schools)

Question 22

Personality and Integrative Therapies

Answer 22

Most psychotherapy systems have consisted primarily
of theories of personality and psychopathology (what to change). This is not true of most integrative therapies, which instead emphasize the
process of change (how to change).

Integrative therapy makes no specific assumptions about how personality and psychopathology
occur. Such determinations are relatively unimportant if one knows which therapy
methods and relationships are likely to evoke a positive response in a specific
patient [a personality-less theory focused instead on immediate change]

The broad and inclusive theories of personality that do exist emphasize that humans are, whether functional or dysfunctional, the
products of a complex interplay of our genetic endowment, learning history,
sociocultural context, and physical environment.

Question 23

Coping Styles

Answer 23

An enduring personality trait - what one does when confronted
with new experience or stress.

Clients habitual behaviour when confronting new or problematic
situations.

Question 24

Tailoring Psychotherapy to the Client’s Personality (integrative)

Answer 24

The integrative therapy approach is concerned with tailoring psychotherapy to
the patients personality, not developing a theory about personality.

The patient’s personality plays a key role as do the therapist’s personality - and their mutual match. Personality traits
are incorporated to the extent that the research evidence has consistently
demonstrated that identifying them contributes to effective psychotherapy.

The patient’s coping style is one such vital personality characteristic to consider when
deciding to conduct insight-oriented or symptom-change methods. The patient may engage in behaviors that disrupt social relationships such as impulsivity,
blaming, and rebellion (externalizing) on the one hand, or behaviors that increase personal distress such as self-blame, withdrawal,
and emotional constriction (internalizing) on the other. Integrative therapy doesn’t attempt to understand why they occur, it just
concentrates on how they impact psychotherapy and improve its success.

Question 25

The Value of Clinical Assessment for Integrative Psychotherapy

Answer 25

Integrative psychotherapy strongly values the guidance that clinical assessment can provide for ensuring treatment effectiveness.

This assessment is conducted:
- Early in psychotherapy to select treatment methods and therapy
relationships that are most likely to be effective,
- Throughout therapy to monitor the patient’s response and to make
midcourse adjustments as needed
- Toward the end of psychotherapy to evaluate the outcomes of the
entire enterprise

Assessment is continuous, collaborative, and invaluable.

Question 26

Typical Clinical Assessment Vs. Clinical Assessment in Integrative Practice

Answer 26

A clinical assessment interview entails collecting information on presenting
problems, relevant histories, and treatment expectations and goals, as well as
building a working alliance.

Typically, formal psychological testing is used as a
means of securing additional data and identifying DSM or International
Classification of Diseases (ICD) disorders. The authors recommend both symptomatic rating forms (e.g., Beck Depression
Inventory II, Symptom Checklist–90R) and broader measures of pathology
and personality (e.g., Minnesota Multiphasic Personality Inventory-II).

Assessment in integrative therapy differs from other therapies as it collects information from the outset on multiple patient characteristics that guide treatment selection! These characteristics are largely transdiagnostic (cut across
diagnoses rather than being specific to any particular disorder). This can include coping styles, stage of readiness to change, and therapy preferences.

The Innerlife STS Web-based assessments can be used to acquire information on these client transdiagnostic characteristics.

Identifying these patient characteristics and finding a match with corresponding treatment qualities will improve outcomes.

Question 27

The 6 Primary Transdiagnostic Characteristics For Determining a Well-Fitting Integrative Therapy

Answer 27

[Really - Patient - C - Does - So - Class]

Diagnosis.

Stages of Change.

Coping Style.

Reactance Level.

Patient Preferences.

Culture (related to the above)

Patient characteristics serve as reliable markers to systematically adapt
psychotherapy to the individual patient, problem, and context. These are but a few of the patient and therapist qualities that constitute a good fit. It is also important to combine several dimensions of “fit” and organize them
into a coordinated treatment. Doing so increases effectiveness.

Question 28

Diagnosis in Treatment Planning

Answer 28

Diagnosis is relevant to treatment planning, but it is severely insufficient on its own. Such an approach would neglect patients’ strengths.

There is extensive heterogeneity (differing presentations/manifestations) in diagnostic groups. Diagnoses can shift, are often not very reliable and patients frequently suffer from comorbidity.

Diagnoses have their limitations as a guiding principle, and therefore one should formulate treatment plans for entire
individuals, not for isolated disorders.

Indeed, most tested psychotherapies work equally well for most mental disorders once
we account for the researcher’s theoretical allegiance and patient severity. Only a handful of mental disorders are treated more effectively with one
psychotherapy than another.

Of all the patient characteristics, it has the least evidence of differential treatment
effects (although exposure seems best for trauma
disorders).

Question 29

Stages of Change in Treatment Planning

Answer 29

Represent a person’s readiness to change.

It can be defined as a period of time
(as well as a set of tasks needed for movement to the next stage). It is not an enduring personality trait and can be assessed with the Stages of Change questionnaire.

The Stages: [P.C - P.A.M]
> Precontemplation: Stage at which there is no intention to change behavior in
the foreseeable future
> Contemplation: Stage in which people are aware that a problem exists and
are seriously thinking about overcoming it but have not yet made a
commitment to do so
> Preparation: Combines intention and behavioral criteria. Individuals in this stage intend to take action in the near future and
report small behavioral changes (i.e., drinking less or contacting G.P)
> Action: Stage in which individuals modify their behavior, experiences, or
environment to overcome their problems
> Maintenance: Stage in which people work to prevent relapse and consolidate
the gains attained during action! For addictive behaviors, this stage extends from six months to an
indeterminate period past the initial action

A patient’s stage of change recommends the use of certain treatment methods:
> Methods associated with psychoanalytic/ insight-oriented psychotherapies are
most useful during the earlier P.C stages
> Existential, cognitive, and interpersonal therapies are particularly well suited to the P. A stages
> Behavioral, exposure, and solution-focused therapies are most useful during A. M stages.

Question 30

The Therapist’s Relational Stance at each of the Stages of Change

Answer 30

The therapist’s relational stance is matched to the patient’s stage of change.

With precontemplators, often the therapist’s stance is like that of a nurturing parent
joining with a resistant youngster who is both drawn to and repelled by the prospect
of independence.

With contemplators, the therapist’s role is akin to that of a philosophical teacher who
encourages clients to develop their own insights and motivations.

With clients who are preparing for action, the therapist is like an experienced coach
who has been through many crucial matches and can provide skill training and
review the person’s own action plan.

With clients who are progressing into maintenance, the integrative psychotherapist
becomes more of a consultant who is available to provide expert advice and support
when progress is not smooth.

Question 31

The Two Primary Coping Styles and Their Implications for Integrative Therapy

Answer 31

Patients tend to adopt a style of coping that places them somewhere between
two extreme but relatively stable types:

Externalizing coping (Impulsive, stimulation seeking, extroverted) - [better outcomes with symptom-focused and skill-building therapies]

Internalizing coping (Self-critical, inhibited, extroverted) - [better outcomes with insight and awareness-enhancing therapies: with broader thematic objectives]

Question 32

Reactance and Integrative Therapy

Answer 32

Patient reactance: Behaviors that are often described as resistance.

A reactant patient is easily provoked and usually opposes external
demands (i.e., those of the therapist)

The tendency to engage in reactance is a reliable marker for the amount of
therapist directiveness!:
> High reactance = the need for nondirective, self-directed, or
paradoxical techniques (improved outcomes)
> Low client reactance = more directive and structured techniques
(i.e., cognitive
restructuring, advice, etc.,)

High patient reactance is consistently associated with poorer therapy
outcomes.

Question 33

Patient Preferences and Integrative Therapy

Answer 33

When ethically and clinically appropriate, we accommodate a client’s
preferences in psychotherapy (with preferences being influenced by the client’s personality, values, attachment style, previous experiences etc.,)

The client may have preferences as to what kind of therapist they get (age, gender, ethnicity, sexual
orientation), the therapeutic relationship (how warm or tepid, how active or
passive), therapy methods (preference for or against homework, dream
analysis, two-chair dialogues), or treatment formats (refusing group therapy or
medication).

Strong
preferences should be identified in the early sessions and accommodated where feasible. This can decrease misunderstandings,
strengthen the alliance, decreases dropouts, and establishes
collaboration—improving therapy success.

Patients do not always know what they want/
what is best for them. But having respect for their often accurate sense of how they can best be served, might result in fewer relational
mismatches.

Client preferences are often direct indicators of the best therapeutic method and
healing relationship for that person - when matched to their preference clients are a third less likely to drop out.

Question 34

Culture and Integrative Psychotherapy

Answer 34

Related to patient preferences and includes ethnicity, race, gender, sexual orientation, disability status, and age.

Treatment methods and healing relationships are fit to the patient’s culture just
as they are to the patient’s stage of change, coping style, and reactance level.

Therapy can be culturally adapted by Incorporating cultural content and values,
using the client’s preferred language, and matching therapists of similar ethnicity. We do not assume
that a single or visible culture defines the person’s experience but we do discuss with the client which cultures—or intersections of
cultures—are fundamental to tailoring psychotherapy to them.

Gender or ethnicity or sexual
orientation should not be the primary determinant of treatment selection, but it should not be ignored.

Question 35

How would an Integrative Therapist interpret frequent client resistance?

Answer 35

If a client frequently resists, then the therapist considers whether she is
promoting something that the client finds incompatible (preferences), whether
the client is not ready to make changes (stage of change), or whether the
client is uncomfortable with a directive style (reactance).

Question 36

What are the processes through which change takes place in Integrative Psychotherapy?

Answer 36

Change takes place through interrelated processes:

• The nature of the patient– therapist relationship
• The treatments that are used
• The way the patient avoids relapse

Question 37

The Therapeutic Relationship in Integrative Psychotherapy

Answer 37

Empirically speaking, therapy success can best be predicted by the properties
of the patient and of the therapy relationship. Less than 10% of the outcome is generally accounted for by any particular
treatment method!

What do clinical experience and
empirical research say works?
> Therapeutic alliance which is characterised by empathy, goal consensus, collaboration, support,
congruence, modest self-disclosure, and management of
countertransference.
> Collecting real-time feedback from the client about his or her progress
throughout psychotherapy and repairing ruptures in the alliance.

The client needs to feel safe, connected and
secure.

The therapist strives to develop a working alliance and demonstrates
empathy for the client’s experiences and concerns. They proceed collaboratively in establishing treatment goals, securing the
patient’s preferences, allaying the initially expected distrust and fear, and
presenting themselves as caring and supportive. The relationship should of course be matched to the client.

Question 38

Treatment Planning in Integrative Psychotherapy

Answer 38

Involves interrelated decisions about setting, format, intensity,
pharmacotherapy, and strategies and technique.

Each client will respond best to a different configuration or mix of components.

Should not assume that treatment will automatically be outpatient
individual therapy on a weekly basis.

Setting Considerations: Choice of setting depends primarily on the relative need for restricting vs.
supporting the patient given the severity of psychopathology and the support
in their environment. The optimal setting, for example, is partially determined by symptomatic
impairment and partially reflects reactance level.
Most impaired and resistant clients have the greatest need for
a restrictive environment (but outpatient treatment is the typically preferred approach).

Format Considerations: The interpersonal context within which the therapy is conducted. The typical treatment formats—individual, group, couples, and family—are
determined largely by the number and identities of the participants. A multiperson format is indicated if social support systems are low and if one
or more of the major problems involves another person.

Intensity Considerations: The duration of the treatment episode, the length of a session,
and the frequency of contact. Should be gauged as a function of problem complexity and severity, also
taking into account the patient’s resources.

Question 39

The Integrative Perspective on Pharmacotherapy

Answer 39

Psychotropic medications are most effective for more severe and chronic
disorders, but psychotherapy is generally as effective as medications in treating
nonpsychotic disorders, especially when patient-rated measures and long-
term follow-ups are considered. Research suggests there is often no stronger medicine than
psychotherapy.

While the pluralistic stance opens the practice up to the integration of pharmacotherapy, medication alone is not an integrative treatment.

Question 40

Preventing Relapse from an Integrative Approach

Answer 40

Relapse is the rule rather than the
exception in many behavioral disorders, particularly addictive, mood, and
psychotic disorders.

Relapse prevention helps clients identify high risks for regression, makes
plans for avoiding such situations, and builds maintenance skills.

Patient and therapist examine the environment in which the patient lives,
works, and pinpoints those “people, places, and things” that provoke dysfunction. This is coupled with teaching the patient to identify cues of a response.

Maintenance sessions may be needed if:
- The patient is highly impaired and a personality disorder is present.
- When the course of treatment is erratic
- When symptom resolution is not consistently obtained within a period
of 6 months.
[These features are strong indicators of a tendency to relapse]

Question 41

Individualized Mechanisms Of Change

Answer 41

Integrative psychotherapies do not presume single or universal change
mechanisms.

The mechanism of action tends to prove quite different for each individual,
even though all patients may manifest similar symptoms. For an individual who is defensive, the mechanism may be the
benevolent, corrective modeling of trust and collaboration offered by an
empathic therapist. For an individual who is trusting and self-reflective, the mechanism of
action may be insight and reconceptualization.

The change mechanism for helping an anxious patient may be
exposure to feared events and skill training. There are multiple pathways to change.

Question 42

The Nine Change Processes/ Mechanisms of Action

Answer 42

Consciousness raising (increased awareness about self), self-reevaluation, emotional arousal (experiencing and expressing feelings about problems), social liberation (increasing one’s healthy environment alternatives - advocacy), self-liberation, counterconditioing (substituting healthy for maladaptive), environmental control (restructuring one’s environment), contingency management (rewards for changes), and helping relationships (being validated, supported, empathized with by a significant other).

Most used: Consciousness raising and the helping relationship.
Least frequently used: Environmental control and social liberation. The former is seen by some therapists as unduly emphasizing the power of
the environment, and the latter as improperly bordering on political advocacy.

Unlike many therapists from single-school approaches, integrative
therapists have at their disposal the full range of these change processes and
are ready to choose among them, depending on the specific situation (e.g., building skills and implementing environmental control (avoiding environmental triggers) for an addict)

Question 43

The Differential effects of Change Processes at different Stages of Change

Answer 43

Change processes are effective at different stages of change.

[P.C - E.P] Change processes traditionally associated with the experiential and
psychoanalytic persuasions are most useful during the earlier
precontemplation and contemplation stages.

[B.E.C - A.M] Change processes traditionally associated with the existential, cognitive, and behavioral traditions, by contrast, are most useful during action and
maintenance.

Once a patient’s stage of change is
evident, the integrative psychotherapist knows which change processes to help that patient progress to the next stage of change - using them in a systematic and effective
way (as opposed to a haphazard trial-and-error approach)

It is not enough simply to declare that multiple change processes operate in
psychotherapy; we must know how they can be selected and sequenced in
ways that accelerate and enhance psychotherapy

Question 44

Mismatches and Change Processes/Stages of Change

Answer 44

1. Some therapists rely primarily on change processes most indicated for the
   contemplation stage, such as consciousness-raising and self-reevaluation,
   when clients are moving into the action stage. They try to modify behaviour indirectly, by helping clients become more
   aware.
   > Common criticism of psychoanalysis: Insight alone doesn’t bring
   about behaviour change.
2. Other therapists rely primarily on change processes most indicated for the
   action stage, such as contingency management, environmental control, and
   counterconditioning, when clients are still in the precontemplation or
   contemplation stage. They try to modify behavior by pushing clients into action
   without the requisite awareness and commitment.
   > Common criticism of behaviorism: Overt action without insight is
   likely to lead only to temporary change.

Question 45

For whom is integrative psychotherapy most effective?

Answer 45

Complex problems require complex treatments; most clients desire both insight and action - seeking awareness into
themselves and their problems, as well as reduction of their distressing
symptoms (I.P can address these multiple goals)

Integrative psychotherapy is particularly indicated for:
o Complex patients and presentations such as clients with multiple
diagnoses and comorbid disorders
o Disorders that have not historically responded favorably to
conventional, pure-form psychotherapies such as personality disorders,
eating disorders, PTSD, and chronic mental illness
o Disorders for which the treatment outcome research is limited
o Clients for whom pure-form therapies have failed or have been only
partially successful

Integrative therapists can simultaneously tackle improvement in several
domains of a client’s life: symptoms, cognitions, emotions, relationships, and
intrapsychic conflicts. Change in one domain or on a single level nearly always generates
synergistic change in another.

Question 46

The multiple meanings of the term Integration

Answer 46

The synthesis of multiple systems of psychotherapy.

The combination of therapy formats—individual, couples, family, and group.

The combination of medication and psychotherapy, also known as combined
treatment.

The integration of practice and research

Question 47

Specific Therapies supported by Integrative Research

Answer 47

Review of integrative therapies determined substantial empirical support for:

o Acceptance and commitment therapy
o Cognitive analytic therapy
o Dialectical behavior therapy
o Emotionally focused couple therapy
o Eye movement desensitization and reprocessing (EMDR)
o Mindfulness-based cognitive therapy
o Systematic treatment selection
o Transtheoretical psychotherapy (stages of change)

Integrative therapists can use these treatments for a particular patient or they can
use parts of these treatments for many patients.

(some self-identified integrative therapies have gained some empirical support
(between one and four randomized control studies)- Behavioral family
systems therapy, integrative cognitive therapy, emotion-focused therapy, and
Lazarus’s multimodal therapy)

Question 48

Cultural Empathy

Answer 48

Learned ability to accurately understand the client’s
experience with another culture and express that understanding back to the
client (required in culturally sensitive relationships)

Question 49

Integrative Psychotherapy and multiculturalism

Answer 49

Single school therapies, particularly those born of a dominant “father” and
rooted in a culture-bound theory of personality tend to subtly maintain white,
male-centred, Western European, heterosexual norms. Many of the single school “universal” principles are now seen as cultural
imperialism!

Integrative therapies, by contrast, rely on neither a particular founder nor a
theory of personality. Their sole “universal” principle is that people and cultures differ and should be
treated as such.

Incorporating cultural values should be informed by research evidence. It is particularly effective to orient treatment to a specific cultural
group (instead of a variety of cultural backgrounds) and conduct therapy in
the client’s native language. Avoid translators in sessions whenever possible because their use is
associated with weak alliances, more misdiagnoses (usually more severe
than necessary) and higher dropout rates.

An effective practice, especially for historically marginalized populations, is to
acquaint beginning clients with the respective roles of patient and therapist. An individualistic position can be augmented with a
collectivistic orientation to clinical work (as some cultures center around community support)

Different strokes for different folks!