Chapter Thirteen: Integrative Theories of Counseling and Psychotherapy

Context for the Development of Integrative Theories –Contradictions –Need for diversity –Need for integration

Foundations of Theoretical Diversity  Individuality  Cultural specificity  Human conflict

Historical and Theoretical Trends  Ideological Purity  Theoretical Integration  Common Factors  Technical Eclecticism

The Practice of Specific Eclectic or Integrative Therapies  Preparing yourself  Preparing your client  Assessment Issues and Procedures

Specific Therapies  Multimodal Therapy  Eye Movement Desensitization Reprocessing  Interpersonal Psychotherapy  Process-Experiential Psychotherapy  Dialectical Behavior Therapy

Specific Therapies (continued)  Acceptance and Commitment Therapy  Cognitive-Constructivist Psychotherapy

The Transtheoretical Change Model  Change Processes  Stages of Change  Levels of Change

The Last Best Therapy Dialectic  Seek relationships between theory and technique  Yin and Yang of counseling and psychotherapy

Concluding Comment  Seek wisdom  Seek balance  Don’t give up on theory—but recognize it is an evolving process.

Student Review Assignments  Critical corner  Reviewing key terms  Review questions

Critical Corner  The most anyone should expect of practicing mental health professionals is that they try to listen and help people with problems. Theory is like philosophy—nice but irrelevant in the day-to-day world. What would help is more guidance on what to do when, not on explaining how people get into the messes they get into.

Critical Corner (continued)  People who come for help don’t really care about your theoretical orientation. In fact, they are unlikely to even get the gist of what you are talking about. After all, they haven’t been to graduate school and suffered through a theories class, and they are in some kind of pain. It is unethical to take up their time trying to explain yourself to them.

Critical Corner (continued)  This emphasis on empirical outcomes and scientifically matching techniques with problems is just a good way to get grant money. Humans are too complex to ever respond the same way enough to guarantee that a given technique is the right one to use with a certain problem. Problems are unique to each individual, and therefore, what helps one person might make another person worse.

Critical Corner (continued)  Choose one of the following:  · The safest thing to do is just pick a theory and stick with it. There’s no way to know enough otherwise. The simpler the theory, the better.  · The safest thing to do is forget theories and just do techniques that you believe in yourself. If all else fails, just listen and nod.  · The safest thing to do is just work with one kind of problem, and refer everyone who doesn’t have that problem to someone else.  · The safest thing to do is give good advice and have a generous supply of self-help books.

Review Key Terms  Individuality  Cultural specificity  Human conflict  Technical Eclecticism  Syncretism  Ideological purism

Key Terms (continued)  Theoretical integration  Common factors  Multimodal Therapy  Eye Movement Desensitization and Reprocessing  Dialectical Behavioral Therapy  Interpersonal Psychotherapy

Key Terms (continued)  Interpersonal Psychotherapy  Process-Experiential Therapy  Acceptance and Commitment Therapy  Cognitive-Constructivist  Transtheoretical Change Model

Key Terms (continued)  Fading  Aversive conditioning  Progressive muscle relaxation  Exposure treatment  Imaginal and in-vivo exposure  Massed vs. spaced exposure  Virtual reality exposure  Interoceptive exposure

Review Questions  What are the three proposed sources of theoretical and practical diversity noted in this chapter?  What are the four paths often taken by therapists to try to deal with the inconsistency and ambiguity inherent in psychological theory and therapy?  Describe the basic concept of corrective emotional experience.

Review Questions  What are J. Frank’s ingredients common to all forms of therapy?  What are some of the problems or pitfalls of manualized therapies?  Discuss A. Lazarus’s view of the authentic chameleon.  What is the general explanation for the effectiveness of EMDR? How would you explain its apparent effectiveness?

Review Questions  Which form of treatment described in this chapter is derived from a medical model and which completely rejects the medical- disease model of psychopathology?  What two theoretical perspectives underlie process-experiential psychotherapy?  Explain the main dialectics in dialectic behavior therapy.