International Themes in Psychotherapy Integration

Interest in psychotherapy integration has steadily expanded over the past decades, reaching most continents of the world and more mental health professionals than ever. Nevertheless, a country’s cultural and historical background significantly influences the nurturance or hindrance of integrative endeavors. This chapter seeks to explicate the current climate of psychotherapy integration in different continents and specific countries. With the aid of local integrative scholars, brief descriptions are presented on integrative practice, training, and research, as well as on cultural and sociopolitical issues that have shaped this movement’s impact around the world.

Integrating Research and Practice

This chapter reviews efforts to integrate psychotherapy research and practice through collaboration and information-sharing within naturalistic clinical settings. Specifically, the chapter focuses on three types of practice-oriented research that capitalize on the bidirectional partnership between researchers and practitioners: (1) patient-focused, (2) practice-based, and (3) practice-research networks. The authors provide examples of each type of integration, highlighting the ways in which the research is different, yet complementary to more traditional studies conducted in controlled settings. They submit that the researcher–practitioner partnership in an ecologically valid treatment context represents an optimal means to reduce the pervasive research–practice chasm and to promote genuine integration for enhancing the effectiveness and personalization of psychotherapy. The chapter also discusses future directions in this vein.

Integrative Psychotherapy for Generalized Anxiety Disorder

This chapter describes an integrative therapy for generalized anxiety disorder (GAD) that responsively assimilates motivational interviewing (MI) into cognitive-behavioral therapy (CBT). MI is a person-centered method that helps clients increase their intrinsic drive to change by identifying and working through their intrapsychic ambivalence about or interpersonal resistance to change, which are common negative process markers for clients with GAD. The MI spirit can also facilitate CBT outside of these markers by forestalling such processes that, even in small doses, correlate with poor outcomes. The authors also present assessment methods (especially for the markers of change ambivalence and resistance); summarize the application and structure of MI interventions; describe the processes of change, therapeutic relationship, and core techniques in MI + CBT; consider diversity elements; and provide a case example. The chapter concludes by reviewing the outcome research for this integrative therapy and by highlighting future practice, research, and training directions.

Assimilative Psychodynamic Psychotherapy

Assimilative psychodynamic psychotherapy maintains a relational psychodynamic focus and methodology but assimilates interventions from other orientations seamlessly when it might help to facilitate treatment for the patient. In order to understand the potential value of these interventions drawn from other orientations, accommodation is necessary. This is done by means of an expanded three-tier model. The importance of the therapeutic relationship, particularly with regard to providing a corrective emotional experience, and the value of self-understanding is stressed. An illustrative case is presented, research summarizing the equivalent efficacy of psychodynamic psychotherapy is presented, and directions for future development are suggested.

Cyclical Psychodynamics and Integrative Relational Psychotherapy

This chapter covers an integrative psychotherapy known as cyclical psychodynamics and features its origins, applicability, assessment, treatment, therapy relationship, case example, outcome research, and future directions. Cyclical psychodynamics is an approach to theory and therapy that centers on the repetitive interaction cycles that maintain adaptive and maladaptive patterns of living. Employing concepts and methods from psychodynamic, behavioral, cognitive-behavioral, systemic, and humanistic-experiential perspectives, the aim is to interrupt these cycles to enable the person not only to be relieved of distressing symptoms but to live more fully and richly. A key focus is on how the person unwittingly recruits “accomplices” in the maintenance of the pattern through the behaviors his actions evoke in others. Also central is attention to the ways that early attachment experiences lead some of our thoughts, wishes, and feelings to be cast into the background, rendered difficult to access consciously or to draw upon adaptively in one’s life. The therapy proceeds integratively, attending both to the expansion of subjective experience and to more adaptive daily behavior, as well as to how each promotes the other.

A Principle-Based Approach to Psychotherapy Integration

A principle-based approach to integration provides a framework for identifying common change processes that may exist among different theoretical orientations. This chapter identifies five change principles that are common across orientations and are supported by outcome research: fostering the patient’s hope, positive expectations, and motivation; facilitating the therapeutic alliance; increasing the patient’s awareness and insight; encouraging corrective experiences; and emphasizing ongoing reality testing. By focusing on these change principles, therapists have the flexibility to select a variety of techniques that are responsive to the client’s individual needs and preferences. The chapter also provides examples of techniques that support each principle and illustrates principle-based psychotherapy with a case example. The authors concludes by reviewing the research evidence and suggesting future directions for this approach.

Integration of Common Factors and Specific Ingredients

This chapter presents the theoretical framework and research evidence of the contextual model, which integrates common factors and specific ingredients in psychotherapy. In working with clients, the specific ingredients and common factors of various therapy approaches are not mutually exclusive but work together to make psychotherapy effective. The benefits of psychotherapy accrue through three pathways: the real relationship, expectations created through explanation for distress and a cogent treatment plan, and the specific actions enacted in treatment. It is suggested that the outcome of psychotherapy can be improved by the deliberate practice of particular skills that characterize effective therapists. The chapter concludes with case examples, diversity considerations, and future directions.

Integrating Self-Help and Psychotherapy

Psychotherapy integration typically refers to the synthesis of diverse methods and schools of psychotherapy. This chapter expands that definition to consider the combination of psychotherapy with self-help materials. Clinicians frequently desire to integrate self-help into psychotherapy but question how and what to do with clients. The authors address types of self-help resources, their effectiveness with and without psychotherapy, and ways to seamlessly integrate them into formal treatment. The chapter considers a variety of self-help (e.g., self-help books, websites, mobile apps, commercial films). The clinician’s behavior can significantly enhance the effectiveness of recommended self-help and can produce a broader integration of effective change methods.

Integrative Psychotherapy with Culturally Diverse Clients

When multiple cultural influences are acknowledged, all psychotherapy clients are recognized as culturally unique. Cultural assessment involves understanding the intersecting impact of race/ethnicity, gender, sexual orientation, socioeconomic status, disabilities, and other influences on clients. Case formulation often involves understanding the process of identity development related to important cultural identities. Processes of change include consciousness-raising, catharsis, choosing, and social justice. The therapy relationship can be adapted to the cultural expectations of clients, and differences can be discussed to reduce unintended therapy microaggressions and to repair ruptures. Four types of cultural methods and techniques are presented. In the integrative tradition, psychotherapists are encouraged to think about when to focus on group membership and when to explore the individual meaning of cultural influences.

The Transtheoretical Approach

The transtheoretical model outlines important dimensions of intentional behavior change from an integrative perspective. Stages describe the motivational and temporal dimension and the critical multidimensional tasks involved in creating sustained change. Processes are an eclectic set of cognitive/experiential and behavioral coping activities that act as mechanisms or engines of change that drive completion of stage tasks. The chapter summarizes the origins of the approach, its applicability and structure, therapeutic relationship, and diversity considerations. A case example illustrates its assessment and treatment foundations. The transtheoretical approach has demonstrated utility in tailoring treatment and predicting outcomes across a variety of health, mental health, and addictive behaviors.