In the last decades the quality and efficiency of psychological treatments has increased notably , in good measure due to the increasingly generalised tendency of psychotherapists to integrate different elements of the classic psychotherapeutic models.
Integration allows us to develop a more integral and holistic vision of the person, their relational world and their social context. In this article we will see what the characteristics of integrative psychotherapy are , and on what it is based.
What is integrative psychotherapy?
Integrative models differ from eclectic ones in that the former do not use techniques in a more or less isolated way, according to the characteristics and needs of the person, but rather start from an integral vision of the human being that allows for giving meaning and coherence to the different elements as a whole.
Now, this does not mean that there is only one way to deal with psychological problems , as if it were an “absolute truth”, far from it.
It is possible, and in fact it is most often the case, that each individual psychotherapist integrates elements in one way or another, giving more weight to some factors than others, for example, emotions versus cognitions or behaviours, etc. It will depend on the general basis or, to put it another way, on the integrative model from which the professional departs.
Even if elements and techniques from other psychotherapeutic models are integrated, there is always a more general background model that predominates and allows them to be integrated, as an “epistemological umbrella”.
But… what are the major psychotherapeutic models that usually serve as a basis for an integration of other components and techniques? There are many psychotherapeutic schools and sub-schools , although we could basically speak of four major orientations: cognitive-behavioral, psychodynamic, systemic and humanist.
How can the different models be used in an integrated way, and what are the keys to exploration, analysis and intervention that each one can allow? We are going to make a brief description of the guidelines that each one of these models emphasizes in a main way, although making the exception that there are almost never completely “pure” models, since, in one way or another, they all contemplate the other factors, overlapping, intermingling and feeding back to each other.
The cognitive-behavioral model tends to focus more on the theories of learning and how stimulus control affects human behavior . Thus, the prism from which the problem brought by the patient is approached from the classical conditioning, operant conditioning… techniques aimed at reducing or increasing, depending on the case, the behaviours with which one wants to work (for example, reducing alcohol abuse or quitting smoking).
The cognitive element, that is, working with thoughts , has been acquiring an increasingly greater role in comparison with merely behavioural approaches. Working with the constructions and narratives that people make of their reality (what Watzlawick has called “second-order reality”) is basic: cognitive schemes, basic assumptions, automatic thoughts, biases and automated thinking tendencies, etc., are approached from, for example, cognitive restructuring.
The psychodynamic model, highly influenced by psychoanalysis, usually focuses on biographical aspects and how early or past experiences (although not only, as they also focus on the present) are influencing the present.
From this approach, in which the work with the unconscious is the core, the defence mechanisms, the work with transference and countertransference, the interpretation and elaboration of the patients’ behaviours, the awareness of automated linkage models and relational conflicts, etc. take on special relevance. All this allows us to go deeper into the intrapsychic and relational life of the patients.
It is important to say that, although psychoanalysis is usually associated with very long treatments, which can last for many years, the truth is that there is an increasing tendency to make short approaches focused on specific aspects of the person’s life and directly related to their problems (for example, the Malan conflict triangles, Horowitz’s relationship models, etc.).
The contributions that psychodynamic approaches can make should not be disregarded, being of great use, for example, their conception of relational conflicts and their link with health.
From the systemic-relational model, in which the person is conceived within a larger system with which he/she interacts and where there is permanent feedback between its members, attention is usually placed on interactions, communication, relational dynamics and patterns , on the place that the person has within the system (his/her role, etc.).
An important aspect of this way of working is that attention is paid to how people influence each other and what effects they have on each other in certain situations (for example, how parents and children feed back on each other to make it difficult for children to mature and become independent, or how they behave in the face of a family member’s illness, establishing rigid functioning roles, etc.).
From humanist models such as Rogers’ client-centred therapy or Fritz Perls’ Gestalt therapy, the emphasis is on awareness and responsibility for behaviour and for the person’s own life.
Client-centred therapy promotes personal development and confidence in the potentialities of each person (it is assumed that, if the right conditions are provided, the person will be able to update his or her potentialities according to his or her needs).
For Gestalt therapy, an eminently experiential model, the work must always be aimed at the awareness of why the person does what he does (instead of why, more typical of psychoanalysis), working with the emotional and bodily experience in the here and now (which encourages awareness) and the self-responsibility of his emotions, thoughts and actions, seeking personal coherence.
Where to start designing the approach?
At the risk of oversimplifying things, we could say that these are the main characteristics of each model and from which they evaluate and treat their clients. But if you want to do a real integrative work, it is necessary to have a general model, a certain way of understanding the human being, that allows to do this integration. So it is very important to ask the question from where the different patterns and factors are being integrated.
We find particularly useful relational approaches, in which attention is paid, both implicitly and explicitly, to the ways in which people have built their bonds and what kind of relationships they establish with others .
How people relate to each other and how they behave, whether consciously or unconsciously, offers general psychological clues from which to begin redefining the problem a person brings with him or her, as well as how to begin introducing changes in relationship patterns.
Bowlby’s attachment theory and its subsequent developments may be one of those “epistemological umbrellas” we talked about above, since it allows for this integration of psychological factors from different schools.
Since post-modern approaches, narrative and discursive therapies have been other general frameworks from which to make integration. Some authors have even linked attachment theory and narrative therapy into a single model to achieve this integration of psychological techniques. These models have questioned the so-called myth of “the isolated mind” that has prevailed in the scientific psychological tradition for decades, influenced by positivism.
The context, the group, the culture and the values, the constitutive character of the language, etc. are elements that have come to enrich and to extend the approaches in the current psychotherapies, going beyond the merely individual and intrasubjective approach.
Author: Diego Albarracín
El Prado Psychologists, expert in Clinical Psychology and Psychoanalytic Psychotherapy. Superior training in Gestalt Therapy. Sexologist. Mediator.