1.  Scientific paradigm in psychotherapy o Methods of knowing (epistemology) o Psychological components of human nature (philosophy of mind) o Dynamic processes that move humans toward and away from mental health (etiology of health and unhealth) o Professional practice methods of enhancing mental health (applied ethics)  Definition: Integrative psychotherapy refers “to a new and particular form of psychotherapy with a set of theories and clinical practices that synthesizes concepts and methods from two or more schools of psychotherapy” (Stricker & Gold, 2008, p. 390).

2.  The early roots of integrative psychotherapy o Explanatory models of ancient and contemporary folk medicine Etiology Onset Pathophysiology Treatment Prognosis o Integrative practices developed out of the debate over which method is better than others o Three questions posed by integrationists Which therapy to use When to use it With whom to use it

3.  First efforts at psychotherapy integration o Rosenzweig (1936): “Some Implicit Common Factors in Diverse Methods of Psychotherapy” Common factors more important than specific factors Dodo bird – “Everybody has won, and all must have prizes” o First efforts focused on similarities between behaviorism/learning theory and psychoanalysis  Psychotherapy integration and the call for accountability o Focus on establishing an evidence base for treatment techniques, not treatment models o Therapists were demonstrating an allegiance to one treatment model while using techniques from various models (“lazy eclecticism”)

4.  Psychotherapy integration moves beyond eclecticism o Problems with eclecticism Uncritical approach Unsystematic approach o Wachtel (1977) discusses integration as unifying theory and practice in contrast to undisciplined eclecticism o Smith, Glass, and Miller (1980) – meta-analysis that concluded that Psychotherapy is beneficial Surprisingly, different forms of psychotherapy are equally beneficial (“dodo bird effect”) Therefore, focus should be on identifying underlying shared mechanisms of change, not different models of treatment

5.  Psychotherapy integration evolves distinct approaches o Society for the Exploration of Psychotherapy Integration (1988) o Process research needed “which actively focuses on providing an understanding of some of the specific mechanisms of change in different psychotherapeutic episodes [which] could begin to help in the search for explanations of the active ingredients in therapeutic change” (Greenberg, 1986, p. 713) o Common factors have more impact on outcome than unique factors of particular treatment models

6.  Psychotherapy integration evolves distinct approaches (cont.) o Four schools of integration Technical Eclecticism – for whom do techniques work well, not why they work well Common Factors Integration – identifying clinical strategies and change processes shared by different treatment models Assimilative Integration – Incorporating elements of other models into a primary “home” model and reinterpreting the meaning of those elements from the home model’s theory Theoretical Integration – blending theories of psychopathology and therapy techniques into a unified system

7.  Psychotherapy integration and evidence – based practices o Understanding integration concepts o More process and outcome research o Updating training programs to emphasize integration  Psychotherapy integration into the future o More accurate and innovative measures of process and outcome o Accepting inherent subjectivity of studying humans o Adopt operational definitions for psychotherapy constructs (e.g., PQS, CPQ, APQ) o Focus on the Pragmatic Case Study Method – integrative practices do not have to be “proven” by outcome research

8.  Disadvantages of one-size-fits-all treatment model o Diagnostic comorbidity – complex cases o Each treatment model does not show success across all types of patients o Different treatment models are better suited to different problems Cognitive-behavioral--problematic behaviors Psychodynamic--traumatic memories and emotions and buried parts of self Family systems--sequences of action and reaction

9.  Reasons for increase of integrative treatment models o Large increase in treatment models o Lack of single, adequate treatment model o Rise in short-term, problem-focused treatment models o Rise in evidence-based treatment models resulting from the identification of specific treatment effects o Recognition that common factors contribute to outcome  Therapeutic powers of play underlying the model o Proposed common factors across treatment models Therapeutic alliance Goal Task Bond Opportunity for catharsis Acquisition and practice of new behaviors Patient’s positive expectancies

10.  Therapeutic powers of play underlying the model (cont.) o “The curative powers of play become the change mechanism within play” (p. 29) o What are the therapeutic powers of play? Self-expression Access to the unconscious Direct/indirect teaching Abreaction Stress inoculation Counterconditioning of negative affect Positive affect Sublimation Attachment and relationship enhancement Moral judgment Empathy Power/control Competence and self-regulation Accelerated development Creative problem-solving Fantasy compensation Reality testing o Research needed to determine which are effective with specific problems and within blended treatment models

11.  Role of therapist/role of patient o Child directing, therapist following o Therapist directing, child following o Occurring within or across sessions  Clinical applications: “The integrative play therapy model can be utilized across all disorders and developmental levels” (p. 30) o Child-led therapy Build rapport (i.e., therapeutic alliance) Release from traumatic and stressful material o Directive CBT techniques Reduce strong affects (i.e., anger, depression) Awareness of emotional triggers Develop alternative coping skills

12.  Clinical applications (cont.) o Bereavement work Process unresolved grief and loss of father Process unresolved pending grief and loss of mother o Parent-child dyadic therapy Talk about father’s death Talk about mother’s wishes for adoption o Session format First 10-15 minutes – check-in period Second 25-30 minutes – child-led Final 5-10 minutes – clean-up and closing ritual

13.  Challenges in implementing the model o Territoriality of purists o Limited coursework, articles, books, and workshops to learn how to become more flexible and integrative o Lack of common language and contradictory assumptions about personality development, human nature, and the origins of psychopathology o Lack of process and outcome research on integrative treatment models