Integrative Approaches to Counselling

Integrative Approaches to Counselling

Introduction

In spite of the extensive acknowledgement that theories are essential to successful counseling (Castonguay et al., 2005), there is limited evidence that one counseling approach is better than another. Faced with over 400 types of psychotherapy/counselling to choose from (Corey, 2012), and an expanding rift between practice and research (Norcross, 2005), counselors, along with other mental health professional, frequently face a dilemma  regarding the most effective approach to use (Castonguay et al., 2005). The single-school theoretical approaches to counselling have been competing for dominance but this has not prevented mental health professionals from combining these (Norcross, 2005). Eclecticism and integrative approaches are two of the approaches that have found wide application in counselling.

Integrative Counseling

An integrative approach to psychotherapy and counselling involves looking past the single-school theoretical approaches with the aim of examining what might be gained from other perspectives, and how this could be of benefit to clients (Norcross & Beutler, 2008). Corey (2001) contends that integrative counseling entails identifying methods and concepts from different systems. The integrative approach could be viewed as a creative unification of the distinctive contributions of different abstract alignments, dynamic techniques and concepts that meet the practitioner’s uniqueness in terms of style and personality.

Over the past three decades, the field of psychotherapy has witnessed swift developments towards the integration of approaches to counselling. Such a movement towards integration hinges on combining the best divergent perspectives in order to articulate the more complete hypothetical theories (Ingersoll & Zeitler, 2010). This enables counselors to develop more efficient treatments. A key explanation for the movement towards integrating counselling is the realisation that we do not have a single theory that can exhaustively explain the complex nature of human behaviour, particularly after accounting for the diverse nature of clients, along with their specific issues.  Seeing as no single theory is comprehensive on its own, and since no one set of counseling methods has been found to be effective when applied to clients with differing health needs (Norcross, 2005), some counsellors, scholars, and mental health professionals view it as making sense to cross the current boundaries by designing integrative approaches as the foundation for future counseling sessions.

Integration encompasses diverse perspectives and attitudes. In literature the terms ‘Eclectic’ and ‘Integrative’ are usually used correspondingly (Norcross & Goldfried, 2005). Upon drawing a distinction between the two terms, however, eclecticism mainly involves techniques, while integration mainly involves theories. Therefore, the systematic eclectic shall on the one hand endevour to integrate several techniques to form a coherent whole without the need for taking into account the theory of origin. In contrast, the integrationist will endevour to integrate various theories into a novel theory that is all-inclusive compared to the other theories undertaken individually. Palmer (2000) opines that eclecticism entails adjusting treatment for an individual patient to suit his/her definite issues, under the guidance of what has been identified as being beneficial in previous work, be it empirical research or experience, as opposed to theoretical principles.

Forms of Integrative Approaches

Overall, there are four main forms of integrative approach to counselling:

Technical integration

In technical integration, the counselor utilises techniques drawn from various schools but is not restricted in approving of the hypothetical positions that they derive from (Woolfe & Palmer, 2000). Put simply, the techniques that the therapist draws from the various schools need not share a connection between the conceptual foundation and techniques.

Theoretical integration

This approach endevours to develop a hypothetical construction that combines the best components of two or more hypothetical approaches based on the supposition that this will yield better results compared to those of a single approach when used in isolation (Stricker & Gold, 2005). In other words, the theoretical approach is concerned with the assimilation of theories and the associated techniques. Some models of theoretical integration centre of integrating and combining a few theories albeit at an in-depth level, even as other models outline the link between various systems of psychotherapy. The cyclical psychodynamics model as postulated by Paul Watchel represents a key example of hypothetical synthesis. This particular model combines behavioural, psychodynamic, as well as family systems theories (Watchel, Kruk & McKinney, 2005). Elsewhere, the cognitive analytic therapy model as proposed by Anthony Ryle, integrates diverse ideas from both cognitive psychotherapy and the psychoanalytic object relations theory (Ryle, 2005).  Integral psychotherapy is yet another example of a theoretical integration model (Ingersoll & Zeitler, 2010).

Common factors approach

Weinberger (1995) describe common factors as the components of psychotherapy that can be found in virtually all the different approaches to therapy. Such an integration of familiar and valuable techniques intersects all hypothetical lines and can be found in virtually all the psychotherapeutic events.  This form of integration searches for familiar aspects among various hypothetical orientations since these elements (for example, catharsis, positive client expectations, and therapeutic alliance) are also viewed as being   essential in deciding therapeutic outcomes (Corey, 2012). Each of the aforementioned aspects is present in nearly all form of therapy in practice. One cannot fathom a treatment that does involve the therapist first trying to develop a therapeutic alliance with the client.

Assimilative integration

This approach permits counselors to position themselves in a particular system but also selectively integrate different interventions drawn from other theoretical systems (Corey. 2009). Integrationists are increasingly recognizing that most counselors will usually opt of a single approach that they are most familiar with to act as their foundational theory, even as they endeavour to embrace the integrative approach. So far, the psychodynamic foundation has acted as a basis for various formal model of the assimilative approach (Stricker & Gold, 2005), while other forms the basis of cognitive behavioural therapy (Castonguay et al. 2005).

Norcross and Beutler (2008) are of the view that “psychotherapy should be flexibly tailored to the unique needs and contexts of the individual client, not universally applied as one-size-fits-all” (p. 485). What this means is that different therapeutic approaches are suited for different clients. Accordingly, practitioners should ensure that they identify therapeutic techniques and styles that are suited for not just the client’s needs, but also to the therapist’s professional needs as well.

Similarities and Differences between Eclectic and Integrative Approaches

Both integrative and eclectic therapies are uniquely postmodern in more ways than one. Eclectic approach recognises that certain therapies are more effective on certain people than others. However, eclectic approach has been accused of lacking depth (Woolfe & Palmer, 2000). For example, it takes years for one to become an expert in a given approach to therapy. It is rather unreasonable therefore to assume that an individual will become an expert in diverse approaches. On the other hand, the integrative approach tends to be a lot more sophisticated that eclectic therapy.

The main distinctions between integrative and eclectic approach is the concern and internal foundation for internal consistency. Therapists are more likely to offer better services in case their theory is in harmony with their values and beliefs.  In trying to make a distinction between eclectic and integrative counselling, Woolfe and Palmer (2000) note that even as eclecticism draws from various approaches in dealing with a specific case, integration seems to indicate that the components constitutes a single collective approach top practice and theory.  Elsewhere, Norcross and Goldfried (2005) contend that eclectic practitioners in the field of psychotherapy are not constrained by the principle, methodology, theories, or conventions of a specific school of thought. Rather, they utilise what they feel, experience, or believe to work best for them, be it collectively or in fulfilling the immediate needs of an individual client (Norcross & Goldfried, 2005).

Another distinction between these two approaches is that eclectic therapy suggests a center or foundation of practice. Schneider (2008) has for example suggested an existential-integrative approach in which existential theory acts as the basis of practice; nonetheless, it combines with other theories with the goal of widening and augmenting its practice. This establishes a certain level of flexibility that permits the adaptation of existential therapy to meet the needs of various clients while also widening its theoretical foundation.

Integrative approach is also characterised by certain limitations, relative to the eclectic approach. For example, even though eclectic therapy exhibits a high level of liberalism while pulling from theories and quickly embraces novel ideas, conversely, the integrative approach has been shown to adapt novel techniques or ideas more carefully. For instance, the existential-integrative theory tests all what is added to it using existential theory as the basis. Should what is being added fail to fit, it may be necessary to make adjustments to existential theory. Alternatively, it may be necessary to discard the proposed idea.

Arguments for and against the Integrative Approach

Corey (2012) opines that it is unnecessarily limiting to put into practice several techniques from one theory to majority of the clients. Many therapists now opt to include diverse procedures in their therapeutic styles. Nonetheless, it is almost impossible to develop a true synthesis unless one has an in-depth and accurate knowledge of theories. In other words, a therapist cannot integrate what they are not familiar with (Norcross & Beutler 2011).

Formulating an integrative model is characterised by certain limitations in comparison with opting to test a single theory. According to Corey (2012), choosing eclecticism without an in-depth understanding of what the theory entails could backfire and expose the therapist’s lack of knowledge on the theories they have integrated. For this reason, therapists should avoid falling into the trap of implementing non-fused theories put together haphazardly. Norcross (2005) opines that describes haphazard eclecticism as an offshoot of insufficient and training and pet techniques, and a random mix of methods. Corey (2012) maintains that psychotherapy integration hinges on the premise that different clients need various techniques; however, it is important to ensure that this blending of methods and concepts is accomplished in a systematic manner.

Nonetheless, a key benefit of an integrative approach to counseling is that it affords the therapist the flexibility needed to fulfil the needs of a dissimilar client base (Hoffman et al., 2009). On the other hand, only a handful of graduate program offer training in integrative approach, even though there is every indication that the education system will embrace such an approach in an effort to equip graduates with the theoretical knowledge and  skills needed to implement such an approach.  As the field of counselling heads towards evidence-based practice, the onus will be on practitioners to implement an integrated approach to counseling with a view to adhering to ethical guidelines that demands the existence of a suitable standard of care in dealing with a diverse client base.

Nevertheless, counselors cannot arbitrarily put together bits of theories and claim to have created an integrated approach to therapy. Developing such an approach calls for a systematic process and critical thinking.  According to Corey (2009), “developing an integrative perspective is a lifelong endeavour that is refined with clinical experience, reflection, reading, and discourse with colleagues.” (p. 450). On the whole, developing an integrative approach to counseling is a tall order but it is definitely worth the effort and time, as it enables counselor to make positive and meaningful change in addressing the needs of a diverse client base.

Conclusion

Integrative approaches to counselling are based on the premise that no single theory can exhaustively explain the complex nature of human behaviour, and hence the need to combine various aspects and techniques from different approaches to counselling. This is aimed at enabling counsellors to meet the diverse needs of the client population.    There are four forms of integrative approach namely, technical approach, theoretical approach, assimilative approach, and common factors approach. These forms of integrative approaches enable counsellors to ground their treatment on the techniques, methodologies and theories that are most appropriate to the client’s problem.  The terms eclectic and integrative are used interchangeably in counselling, though integrative is more in-depth and sophisticated that eclecticism.  A key argument for the use of integrative approach to counselling is that it gives the counsellor the munch-needed flexibility to attend to the diverse needs of their clients. However, developing an integrative approach to counselling requires that the counsellor adopts a systematic approach, in addition to demonstrating critical thinking skills. In implementing the integrative approach, counsellors will also be required to observe evidence-based practice in keeping with the ethical guidelines demanded of them while attending to clients.

References

Castonguay, L. G., Newman, M. G., Borkovec, T. D., Holtforth, M. G. & Maramba, G. G.

(2005). Cognitive-behavioral assimilative integration. In J. C. Norcross & M. R.

Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 241–260).

New York: OUP.

Corey, G. (2009). Theory and practice of counseling and psychotherapy (8^th ed.). Belmont,

CA: Brooks & Cole Cengage Learning.

Corey, G. (2012). Case Approach to Counseling and Psychotherapy. Stamford, Mass.:

Cengage Learning.

Corey, G. (2012). The Art of Integrative Counseling. Stamford, Mass.: Cengage Learning.

Hoffman, L., Yang, M., Kaklauskas, F., & Chan, A. (2009). Existential

psychology East-West.  Colorado Springs, CO: University of the Rockies Press.

Ingersoll, E. & Zeitler, D. (2010). Integral Psychotherapy: Inside Out/Outside In. Albany,

NY: SUNY Press.

Norcross, J. C. (2005). A primer on psychotherapy integration. In J. C. Norcross & M. R.

Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 3–23). New

York: Oxford.

Norcross, J. C. & Goldfried, M. R. (Eds.) (2005). Handbook of Psychotherapy

Integration (2nd ed.). New York: Oxford.

Norcross, J. & Beutler, L. (2008) Integrative psychotherapies. In R.J. Corsini & D. Wedding

(Eds.), Current psychotherapies (8^th ed., p.481-511). Belmont, CA: Brooks & Cole

Cengage Learning.

Palmer, S. (2000). Integrative and Eclectic Counselling and Psychotherapy. London:  SAGE

Publications Ltd.

Ryle, A. (2005). Cognitive analytic therapy. In J. C. Norcross & M. R. Goldfried

(Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 196–217). New York:

Oxford.

Schneider, K.J. (2008).  Existential-integrative psychotherapy: Guideposts to the core of

practice. New York: Routledge.

Stricker, G. & Gold, J. (2005). Assimilative psychodynamic psychotherapy. In J. C. Norcross

& M. R. Goldfried (Eds.),Handbook of Psychotherapy Integration (2nd ed., pp. 221

240). New York: Oxford.

Wachtel, P. L., Kruk, J. C., & McKinney, M. K. (2005). Cyclical psychodynamics and

integrative relational psychotherapy. In J. C. Norcross & M. R. Goldfried

(Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 172–195). New York:

Oxford.

Weinberger J (1995), Common factors aren’t so common: the common factors dilemma.

Clinical Psychology: Science and Practice, 2, 45-69.

Woolfe, R. & Palmer, S. (2000). Integrative and Eclectic Counselling and Psychotherapy.

London; Thousand Oaks, CA: Sage Publications.