Psychotherapy offers a range of treatments to help clients deal with issues impacting their mental health and disrupting their lives.
Choosing “the most effective psychotherapy for each mental disorder is complicated by the existence of over 400 varieties of psychotherapy approaches” (Zarbo et al., 2016, p. 1).
Fortunately, there is another way.
The integrative approach to therapy attempts to bridge the divisions in psychology by selecting and using theories and techniques from different models and creating a framework that prioritizes dialog between each one.
Let’s explore integrative therapy and review several techniques that can be used with clients.
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Some academics argue that psychology and psychotherapy are essentially fragmented. They believe treatment suffers due to our insistence on defining ourselves as coming from specific modalities and setting up “false dichotomies when, in practice, we routinely straddle multiple approaches” (Finlay, 2015, p. 19).
“Integration” suggests bringing together.
When working with clients, it points to “adapting to both client needs and context by blending different theoretical frameworks and their methods” (Finlay, 2015, p. 22).
Humans are complex, bringing unique needs, hopes, and challenges to therapy. It is unlikely that any single specific therapeutic approach and treatment is adequate for all clients in all situations.
The challenge for therapists attempting to create a truly integrative therapy that blends different philosophical commitments, values, and assumptions is that not all theories and practices are compatible (Finlay, 2015).
Therefore, integrative therapists treating a client must consider what, how, and when to integrate, typically involving one of four potential approaches (Zarbo et al., 2016):
Theoretical integration
Transcending individual models by creating a single model
Technical eclecticism
Combining effective ingredients from various approaches
Assimilative integration
Working predominantly in one model while integrating aspects of others when needed
Common factors
Focusing on the effective practices and elements of all approaches
Definition
“Integrative therapy is a unifying approach that brings together physiological, affective, cognitive, contextual and behavioral systems, creating a multi-dimensional relational framework that can be created anew for each individual case” (Gilbert & Orlans, 2011, p. 2).
In a 2016 article, researchers suggested that the integrative perspective “indicates a generally flexible and inclusive attitude toward the different psychotherapeutic models” and aims “to see what can be learned and introduced from various perspectives in
practice” (Zarbo et al., 2016, p. 1).
History and origin
Interest in therapeutic integration goes back as far as Freud and his contemporaries in the early 1900s. A 1933 paper by Hungarian-born relational psychoanalyst Sándor Ferenczi argues that we should take our cue from the patient rather than stick too rigidly to preferred techniques and adopt the best approach at the right time (Gilbert & Orlans, 2011).
In 1991, Aaron Beck claimed Cognitive-Behavioral Therapy (CBT) to be the integrative therapy, saying that “in view of its integration of theory from the broad sweep of psychology and its integration of diverse technical procedures, I claim that cognitive therapy is the integrative therapy” (Beck, 1991, p. 191).
While we can challenge Beck’s claim, CBT is an example of complexity whereby two or more approaches are combined. In this case, an awareness that changes in the client’s belief system can enhance the therapist’s work on behavioral change (Gilbert & Orlans, 2011).
Techniques and Examples of Integrative Therapy
Ultimately, like other psychotherapies, integrative therapy is a process that relies on a robust therapeutic alliance and a therapist skilled in multiple techniques (Gilbert & Orlans, 2011).
The following is a short list of techniques, strategies, and examples taken from such a combined approach (Gilbert & Orlans, 2011):
Empathic attunement
The ability of the therapist to attune to their client empathically is vital for the therapeutic alliance and the client’s successful outcome.
As a result, the therapist must be confident that their body-based (and vocal) responses will be picked up as showing empathy to the client.
Students wishing to learn how to empathize with clients will benefit from working in pairs and practicing nonverbal responses, allowing themselves to feel what happens in a session and responding with a gesture or a sound.
Questions and phenomenological inquiry Questioning is essential at the beginning of and throughout therapy to identify initial needs, understand progress, and uncover additional information.
During the assessment, the following questions can help reveal what brought the client to their first session:
What brings you here today? Can you tell me a little about your background and current situation? Have you been to therapy before? If so, how did you find the experience? What are your goals? Or, what would you like to achieve from therapy?
Phenomenological inquiry can open up areas of experience that the client may not have previously been conscious of (Gilbert & Orlans, 2011, p. 196).
What do you experience as you say that to me? Where in your body are you feeling tense? Does any image come to mind as you tell me of this experience?
Working with the script
Children build scripts or narratives to make sense of the events in their lives. A script formed under traumatic circumstances may continue to influence the person well into adulthood, potentially negatively.
As an integrative therapist, it is vital to identify and understand the client’s script as it emerges during therapy and recognize it as their version of their life story, potentially changing events to fit.
Working with the client to create a new narrative can help free them “from limiting beliefs, fixed repetitive behaviors, and survival strategies from the past that have long outlasted their usefulness” (Gilbert & Orlans, 2011, p. 205).
Working with dissociation
The gradual and ongoing reintegration of feelings, memories, and sensations can help the client create a coherent dialogue of the most significant events in their lives.
The therapist works with the client to identify and understand existing dissociations (disconnections between feelings, memories, and a sense of identity) and focus awareness on different parts of the body “so that the client can recover dissociated experiences in a ‘felt’ sense” (Gilbert & Orlans, 2011, p. 206).
Reconnecting with a dissociated state and reexperiencing trauma can be a challenging yet vital aspect of successful treatment through integrative therapy.
Ultimately, through identifying and combining tools and techniques from multiple models and approaches, the integrative therapist has a vast toolset to choose from.
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Advantages and Disadvantages
Integrative therapy’s disadvantage (or challenge) is its most significant advantage: combining multiple therapeutic stances to put the client’s needs first (Finlay, 2015; Gilbert & Orlans, 2011).
Disadvantages
Critics point out several disadvantages of the integrative therapy approach, yet they can more correctly be seen as challenges associated with the process. Some of those challenges include the following (Gilbert & Orlans, 2011; Finlay, 2015).
Integration can be shallow and superficial, and the treatment may not achieve the required depth.
“Integration tries ‘to be all things to all people’ and is not effective with everyone because of its lack of in-depth diagnostic capacity” (Gilbert & Orlans, 2011, p. 21).
Integrative psychotherapists risk becoming lost in too many techniques, tools, and methods, failing to achieve clarity and focus.
Therapeutic approaches are often fundamentally different. It is not possible to ignore such differences or transplant an idea from one approach to another. For example, the humanistic stance involves staying in the “here and now,” while from a Gestalt and phenomenological perspective, the past is always present.
The role of the analyst varies across therapies. For example, “client-centered precepts concerning being non-directive contrast with the more directive interventional styles of systemic and cognitive-behavioral practitioners” (Finlay, 2015, p. 26). Integrative therapists will need to adopt a style based on the therapeutic perspectives they favor.
Gilbert and Orlans (2011), proponents of an integrative approach to therapy, accept some of the validity of these arguments but argue that the answer is providing therapists with an appropriate grounding in all the psychotherapeutic principles that apply.
Advantages
There are many and varied advantages to the integrative approach to therapy and “the bringing together of affective, cognitive, behavioral, physiological, and systems approaches to psychotherapy” (Moursund & Erskine, 2011, p. 33).
Is powerful and far reaching, working with different patients, problems, and contexts
Keeps a focus on the common factors proven vital in therapy, including the therapeutic alliance, the client’s expectations, and the therapist’s degree of empathy
Is flexible to the needs of the therapist’s patients and sensitive to the therapeutic alliance
Recognizes clients as the most critical common factor in change — their capacity for self-healing enables them to move forward
Places treatment within the perspective of human development and includes development tasks, need sensitivities, and opportunities for growth and new learning
Integrative Therapy Training Programs
There are multiple integrative therapy training options for becoming skilled as an integrative therapist (or other mental health professional); therefore, reviewing the options and considering costs, timing, and flexibility before deciding is vital.
The following is a small sample of three very different options available.
Institute for Integrative Psychotherapy
The institute is an international academy providing ongoing training in integrative therapy since 1976.
Training includes most of Europe and is typically residential.
Integrative Focusing Therapy offers an integrative approach to therapy that manifests at several levels. They approach integration from the perspective of the client’s capacity to integrate experiences into their lives and how to integrate multiple therapy modalities.
At this institute, training is available for psychiatrists, psychologists, physicians, naturopaths, and psychotherapists in the form of an integrative psychiatry fellowship.
Ninety-five percent (95%) is live virtual learning with a telesummit to kick off the training. The aim is to help health professionals deliver the best treatment to clients, particularly those who never fully recover or are resistant to treatment.
Holistic Therapy and Integrative Therapy Partnerships
Combining holistic therapy and integrative therapy has proven both valuable and effective in palliative care, helping individuals with pain, discomfort, and fear and anguish concerning the present and what lies ahead (Matzo et al., 2015).
When traditionally Western medicine cannot help the chronically ill, complementary treatments such as sense therapies, imagery, meditation, etc., combined with psychotherapy, offer hope for many in need of peace and calm as they near the end of their lives (Matzo et al., 2015).
Other holistic approaches combined with integrated psychotherapies explore the importance of spirituality, theology, religion, and existential concerns.
A review of the literature suggests that while “the ongoing, dynamic process of collaborating with patients in interweaving their spiritual beliefs, values, and context within psychotherapy is challenging” (Captari et al., 2022, p. 316), its consideration is likely to promote mental wellbeing and flourishing.
3 Fascinating Books for Therapists
Despite integrative therapy being discussed in the literature for several decades, there are limited comprehensive therapy books on the subject.
The following three are a must for anyone wishing to adopt a more integrative approach to treating their clients.
1. Relational Integrative Psychotherapy: Engaging Process and Theory in Practice – Linda Finlay
This refreshing and engaging read from Linda Finlay draws on her vast knowledge and experience of a wide variety of therapies.
Clinical vignettes are used throughout to guide and entertain the reader, helping them understand her embodied approach to treating clients.
This is a valuable book on integrative therapy that will benefit the student or the seasoned therapist enormously.
2. Integrative Therapy (100 Key Points) – Maria Gilbert and Vanja Orlans
This is an essential read for students and experienced therapists wishing to understand a unifying approach to psychotherapy that combines physiological, affective, cognitive, contextual, and behavioral systems.
The reader learns how to take such an approach, create a multi-dimensional relational framework tailored for each client, and consider the centrality of relationship and dimensions of self-development and the process, techniques, and strategies involved.
3. Integrative Psychotherapy in Action – Richard G. Erskine and Janet P. Moursund
Richard Erskine and Janet Moursund are experienced psychotherapists passionate about sharing their deep insights and understanding of integrative therapy and its potential to help clients toward a successful treatment outcome.
The readers are introduced in detail to 11 case studies, each presenting a vital aspect of their approach to integrative therapy and the theory behind it.
We have many resources from a wide variety of psychological approaches available for therapists wishing to adopt a more integrative approach to psychotherapy.
Two of our many free resources include the following:
Radical Acceptance of a Distressing Situation
The therapist can combine these 11 questions with other interventions to help clients look at a distressing situation differently.
Stress as a Stimulus for Change
The client can use this worksheet to capture what they wish to change in their lives using stress as a stimulus.
Creating Quiet Time
We can all benefit from some quiet time, which we can easily combine with other positive psychotherapeutic practices.
Try out the following steps:
Step one – Schedule quiet time each day for the week ahead.
Step two – After your quiet time each day, reflect and write down how it felt.
Step three – At the end of the week, think about how you found the exercise.
Was it easy or difficult to integrate quiet time into your life? How tough was it to be silent and spend time alone?
Finding Silver Linings
When going through a difficult time, we may forget all that is good and lose sight of the positive events and relationships we experience.
This tool helps clients change their outlook by looking on the bright side and can be integrated into any treatment.
Step one – List things that make you feel like your life is enjoyable.
Step two – Identify a recent difficulty.
Step three – What negatives came out of this difficulty?
Step four – Now, looking on the bright side, capture three positives from this difficulty.
A Take-Home Message
Integrative therapy offers a powerful and flexible approach to psychotherapy, addressing each client’s complex and unique needs.
It aims to create a comprehensive framework that prioritizes effective dialogue between various approaches by blending theories and techniques from different psychological models.
As such, integrative therapists are challenged to determine what, how, and when to integrate different theories and practices. They must either attempt to combine them into a single theoretical model or focus on common factors shared by all therapeutic approaches at a practical level.
Ultimately, integrative therapists have a vast toolset at their disposal, providing the opportunity to help clients based on their specific needs and goals.
While integrative therapy is not straightforward, this innovative approach allows therapists to work with various patients, problems, and contexts and emphasize the importance of the therapeutic alliance and the client’s self-healing capacity.
Overall, integrative therapy offers a comprehensive and inclusive approach to psychotherapy. It creates opportunities for change and new learning by considering human development and growth and promoting positive outcomes in the therapeutic process.
Integrative therapy is also referred to as psychotherapy integration.
What are the different approaches to integrative therapy?
The number of approaches to integrative therapy is seemingly unlimited. It combines the most appropriate models, tools, and exercises from various psychotherapeutic approaches to meet the client’s needs, goals, and context.
How does integrative therapy work?
Integrative therapy is a unifying approach that blends different theories and techniques from various psychological models to address the complex needs of each client.
Who can benefit the most from integrative therapy?
While integrative therapy can help treat all clients, it is particularly valuable for those who previously found single-therapy treatments unsuccessful.
References
Beck, A. T. (1991). Cognitive therapy as the integrative therapy. Journal of Psychotherapy Integration, 1(3), 191–198.
Captari, L. E., Sandage, S. J., & Vandiver, R. A. (2022). Spiritually integrated psychotherapies in real-world clinical practice: Synthesizing the literature to identify best practices and future research directions. Psychotherapy, 59(3), 307–320.
Finlay, L. (2015). Relational integrative psychotherapy: Engaging process and theory in practice (1st ed.). John Wiley & Sons.
Gilbert, M., & Orlans, V. (2011). Integrative therapy: 100 key points & techniques. Routledge.
Matzo, M., Sherman, D. W., & Ayello, E. A. (Eds.). (2015). Palliative care nursing: Quality care to the end of life (4th ed.). Springer.
Moursund, J., & Erskine, R. G. (2011). Integrative psychotherapy in action. Routledge.
Zarbo, C., Tasca, G. A., Cattafi, F., & Compare, A. (2016). Integrative psychotherapy works. Frontiers in Psychology, 6, 2021.
About the author
Jeremy Sutton, Ph.D., is a writer and researcher studying the human capacity to push physical and mental limits. His work always remains true to the science beneath, his real-world background in technology, his role as a husband and parent, and his passion as an ultra-marathoner.
Psychotherapy offers a range of treatments to help clients deal with issues impacting their mental health and disrupting their lives.
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