Emerging Trends in Psychotherapy: Integration

If there is one constant in life, it’s change. The important field of psychotherapy is certainly no exception. As our world becomes ever more advanced, the problems we face both as a society and as individuals become correspondingly more complex and difficult to resolve. One way to adapt and thrive in such an environment is to realize the connections that often exist between different components of a subject. This integration process helps to reduce the total number of pieces involved in mentally processing the problem and thus makes it easier to understand and develop effective measures for.

How is the field of psychotherapy moving toward integration? Dr. Gelso, in his article entitled: “Emerging and Continuing Trends in Psychotherapy: Views From an Editor’s Eye” lays out various ways he has seen the industry evolve over the last several decades.  We will examine some of these below.

Acceptance of Opposing Worldviews to Counseling

The first of these is bringing together the technical and relational aspects of this field. According to Dr. Gelso, there are two prominent worldviews that are the primary drivers of change in psychotherapy. The technical side, which focuses on the methods used, is concerned with only using treatments that are empirically supported. According to this approach:

“Individual differences among therapists are controlled through the use of treatment manuals, and patients are carefully selected to fit a single diagnostic group.”

Its conclusions are reached through properly conducted experiments and made available through various studies.
The opposing vision concerns itself fundamentally with the patient-therapist relationship. Proponents of this view are primarily concerned with relational variables within the treatment process. To offer validation of their position, they:

“…point to evidence that relational factors seem to account for more outcome variance than techniques and methods, and that relational factors cutting across diverse treatments seem key to successful treatment.”

Put another way, the relational side is more attuned to the manner in which treatment methods are employed, rather than the actual treatment method itself.

However, even though these divergent approaches have historically been at odds, the trend that is emerging is one of a greater valuation and employment of both. What is now being realized and more accepted is that it is really the interplay of the two strategies in tackling therapeutic problems that really matters most. As Dr. Gelso states it:

“Indeed, each is indelibly embedded in the other, and the effect of each is profoundly dependent on the other.”

Merging of Theoretical Orientations

During the 1950s, 1960s, and 1970s there were many new schools of counseling theory that arose. Each of these schools had their devoted adherents and sought to distinguish themselves as superior to the others. The psychotherapy practitioner of that time was expected to pick a school and follow it exclusively. Any sort of drawing ideas or techniques from other theories was considered taboo and assigned the derogatory moniker of Eclecticism.
However, as the number of different schools continued to proliferate, it became increasingly difficult to choose just one. As Dr. Gelso states it:

“This proliferation melded with other theoretical, empirical, social, and economic forces (Norcross, 2005) to foster the currently powerful movement toward integrating theories in one’s psychotherapy practice.”

Presently, the movement to integrate theories within psychotherapy has reached such a level of prominence in the industry that it is now appears to be the dominant paradigm. It has become so prevalent, in fact, that it is even possible to designate different types of integration, such as:

“Common Factors (integration of factors common to all approaches), Assimilative Integration (commitment to one approach but willing to use techniques of others), Theoretical Integration (integration of theoretical concepts from different approaches) and Technical Eclecticism (choice of techniques that best fit case).”

Improved Research-Practice Integration

A long-standing problem within the field of psychotherapy has been the disconnection between its research and practice. Practitioners complain that research is not relevant to their practice, and researchers lament that practitioners do not implement their findings.

There are likely many factors that contribute to this problem, but a few of these might be:

1. Empirical research, by its very nature, typically reduces the whole down to its parts and focuses on these independent of the whole; whereas in practice, these parts have little meaning separate from the whole in which they actually occur.

2. The topics that researchers pursue are often not perceived by practitioners as relevant to them.

3. The way in which research findings are communicated to practitioners is often not particularly helpful to them, especially as the qualitative analysis becomes ever more sophisticated and specialized.

Some ways in which the industry is changing in order to create a more collaborative approach is by redefining what constitutes acceptable scientific methodology.  According to Dr. Gelso:

“A wide range of methodological approaches is now seen as acceptable, and some of these approaches rank high on clinical relevance. An example of such an approach is qualitative research…Such research typically uses small samples and seeks to study these samples intensively, probing therapists’ and patients’ views of their experience.”

An organization that has taken it upon themselves to help propagate this approach within the industry is the Practice Research Network (PRN). It is constituted of both experienced clinicians and psychotherapy researchers and seeks to find ways to make research meaningful to practitioners.

Another way in which the industry is responding to this issue is by publishing its research findings in more clinician-friendly formats. Dr. Gelso’s own newsletter was created in 1983 “with the aim of providing research synopses to practitioners” by reviewing relevant scientific journals and summarizing their conclusions. Since then, many other articles and case-studies have been published with a similar end in view.

More Specific, Integrative Reviews

As the amount of knowledge in psychotherapy rapidly increases, so does the number of journals and research studies. This trend, of course, makes it ever more difficult for those in the industry to keep up with and apply what is learned. How the industry has been responding is by producing more integrative reviews of this knowledge. While such reviews are not new, the focus has shifted now to more specific topics within psychotherapy. There is also a tendency to make these more qualitatively based.

An example that Dr. Gelso gives is Norcross’ (2002) Psychotherapy Relationships that Work:

“In this extensive work, a number of relationship ingredients and therapist-offered relationship conditions are reviewed in terms of their relation to treatment outcomes. Each chapter contains an integrative review on a specific ingredient. Notably, in the second edition of this book (Norcross, 2011), each chapter contains one or more meta-analyses of the relation of a given relationship ingredient to treatment outcome. This is the most striking example of the trend toward quantifying the integrative review. Dovetailing with the trend toward integrating research and practice, however, each chapter contains a section on implications of the findings for psychotherapy practice.”

Integration of Neuroscience and Biological Understanding

As the volume of knowledge in psychotherapy increases, so does the number of valuable connections made between our behaviors and the neurobiology that underlies them. What influences our feelings and actions are no longer considered within the views of either nature or nurture, but rather as a composite of these factors examined together.

Quoting Cappas, Divino & Moore, Dr. Gelso states:

“The newest neurobiological evidence not only demonstrates how neurobiology affects intrapsychic events and behavior, but how experiences, including the psychotherapy relationship, affect and change the structure of the brain.”

Adam Gerbman in his online article: “Mental Health Trends To Watch In 2017” also supports Dr. Gelso’s conclusion when he discusses the “Mind-Body Connection.” In this article, he states that:

“Having a healthy mind can lead to a healthy body and having a healthy body can lead to a healthy mind. It’s true. Just ask that stomach ulcer that keeps coming around every time your boss adds more work to your already full load. Or what about the feelings of anxiety that appear when the in-laws come over for Sunday lunch? Your brain needs to be healthy so it can handle life stressors appropriately.

Doctors will use the mind-body connection to heal patients by incorporating the entire lifestyle of the patient into the treatment plan. Psychiatrists can work with your doctors, social workers, and family members to discover the areas that may be contributing to your mental health disorders.”

It should be clear now that examining topics within the field of psychotherapy in a manner isolated from the others these are naturally associated with may no longer be the best strategy for resolving the complex issues that challenge the industry today. Based on the current research and industry trends, what appears to be needed now is an integrative approach that examines and accounts for as many diverse, but related, factors as possible. Hopefully, as this trend continues to gain acceptance and prominence in our industry, the results achieved will likewise prove positive.

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