Introduction to the Main Theories and Key Debates

7/27/2019 Introduction to the Main Theories and Key Debates

1/18

INTRODUCTION TO THE

MAIN THEORIES AND KEY

DEBATES WITHIN THE

INTEGRATIVE APPROACH

Dr George Varvatsoulias


2/18

Theoretical foundations of the

integrative approach (1)

Behavioural therapy, represented by B.F.Skinner and Albert Bandura, focuses on behaviourthat can be observed. BT believes that behaviorsare learned based on conditioning. Normal

behaviours are learned based on reinforcement,whereas less than normal behavior is due to faultylearning. There are many techniques used(reinforcement, desensitization, relaxation,flooding and skills training are just to name a few),

and the questions focus on what, how, andwhen, rather than why. The counselor willutilize contracts and homework with the client topromote action, rather than talk.


3/18



Behavioural therapy holds strong amongsttheories; BT is an action therapy that puts thesteering wheel in control of the client. Theycannot just talk about change, they do it. This

aspect of BT is empowering; clients do the workand they see the results. Clients need to realizetheir maladaptive behaviours and change them tobe more healthy behaviours. With behavioural

therapy, one could integrate the idea that action isneeded in order to change behaviours. Behavioraltherapy may also work hand-in-hand very wellwith cognitive behavioural therapy.


4/18



Cognitive behavioural therapy, led by Albert Ellisand Aaron Beck, focuses on the idea that faultythinking leads to behavioural problems. In order for aclient to meet their goals, new thoughts/thinkingprocess must occur. CBT doesnt focus on the past,rather the present and the future. A client needs tofocus on their irrational thoughts and see the way theirlife is affected by these, and then they can begin tolearn new and effective beliefs. The counselor needsto challenge a clients irrational thinking, and teach

them ways to change those thoughts. CBT is directiveand time limited, with an ore of techniques(homework, role play, imagery, training, and recordkeeping to name a few), all tailored to a client.


5/18



So many people hold themselves back, and arequick to blame their problems on others. CBTopens clients eyes to the reality that it is theirthoughts within themselves that are keeping them

from reaching their goals. I think many peoplehave been there, or know someone that has. Itcan be detrimental to a persons movementtowards they want out of their life to becomeaware of their thoughts and thinking, and how

they affect their current situation, as well as theirbehaviors and feelings. CBT and BT work greattogether to get a person to change their irrationalthoughts and maladaptive behaviours, but a veryempowering theory is existential.


6/18



Existential therapy, known with such leaders asViktor Frankl and Rollo May, puts the clients in aposition where the must own their decisions they havemade, becoming more aware of themselves and

whom they are, and living a life of authenticity.Existentialists believe that people are looking to findmeaning in their life, and their purpose. Throughexistential therapy, a client is challenged to find whatthey want out of life, and through freedom to choose

their fate, their abilities to be self-aware, and takingresponsibility for their choices, they are more apt tolive their life fully. Existential therapy focuses on thepresent, and techniques are not as important as

understanding the client.


7/18



Existential therapy gives the client a lot ofempowerment; thru this therapy, a client realizesthey are in control of their fate. Self-awareness isan on-going process; a person never stops

changing and growing, so it is imperative that we,as humans, remain aware of this and areconstantly aware of our changing thoughts andfeelings. Given the empowerment of being able to

choose ones fate leads way for an eye-openingexperience. People are not victims; they make thedecisions that have led them to where theycurrently are.


8/18

Key debates in Integrative Counselling

(1)

The diversity of approaches to psychology andpsychotherapy has increased exponentially in the past 20-years. The number of theoretical orientations now exceeds100 approaches and the specialties within psychology aredeveloping at such a fast rate that it is hard to keep track of

them. The idea of a unified psychology appears to be more ofa fantasy now than at any time in its history.

The diversity within psychology can draw mixed reactionsfrom both modernism and postmodernism. In many ways, theproliferation of approaches is a product of the specializationinherent in modernism. However, modernism also believed

that eventually science would unify psychology.Postmodernism, on the other hand, embraces thepsychologys pluralism while voicing strong concern aboutattempts to unify psychology. Through its differences,psychology can meet the needs of more people.


9/18


(2)

A Postmodernism Response to Special izat ionPostmodernism, in many ways, favours the continued

development of new specializations through its acceptance ofmultiple approaches to investigation. It is not threatened by theincreasing of number of specialties within psychology.Postmodernism does, however, believe that it is important for these

different approaches to be in dialogue with each other.As the different specialties dialogue, it is important that each

subject open to being influenced by the other. For example, whenexperts in quantitative and qualitative research dialogue, it isimportant for both sides to remain open to recognizing thelimitations of their approach and the benefits of the other.

Additionally, they should seek to learn how they can improve theirown approach through the ideas of the other. Similarly, whenpsychodynamic therapists dialogue with neuropsychology, it isimportant for both sides to remain open.In the modern area, it would be easy to say that the quantitativeresearchers and the neuropsychologists held the trump cards andwere in the position to educate the lesser psychodynamic therapist

and qualitative researchers. Postmodernism has pointed out theerrors of this approach to dialogue.


10/18


(3)

A Postmodern Response to th e Divers i ty o f Theoret ical Orientat ions

Modernist epistemology is the root of one of psychologys most embarrassing

public debates. Until the last several years, one of the most intense disagreements

among psychotherapists was regarding which approach to therapy (i.e., theoretical

orientation) was the best. This debate continues in some circles of psychotherapists.

In the light of postmodernism, such debates seem irrelevant and futile.

Since different approaches to psychotherapy have different inherentepistemologies, the way to measure their effectiveness will vary in accordance with

their epistemological beliefs. Each therapy will likely emerge with more positive

outcomes than the competitors when measured in accordance with its

epistemology and an appropriately-related methodology. Additionally, different

approaches to therapy have different ideas of the good life. While some purport

happiness or symptom relief represents the good life; others suggest that a self-

aware life, a free life, or a virtuous life is a better sought after outcome.

The best example of this problem relates to the empirically supported

treatment debate which ravaged so heatedly in the 1990s and early 2000s (Hoffman,

2005). A modernist epistemology still reigned supreme in psychology and a narrowly

defined empirical approach (i.e., quantitative research) was seen as the supreme

way to evaluate therapy. As this fit with the epistemology of cognitive-behaviour,

rational-emotive, and behavioural therapy, these approaches tended to fair betterthan many of the depth psychotherapies.


11/18


(4)

Postmodern helped level the playing field by pointing out theepistemological errors associated with attempting to prove the superiority ofany one approach to therapy through empirical means. New approaches toevaluating the efficacy of psychotherapy incorporate an epistemologicalpluralism (i.e., evidence based practice) which allows for multipleapproaches to evaluating the effectiveness of therapy to be recognized asvalid (see Levant, 2005). Additionally, more consideration is given tocommon factors, such as the therapy relationship, which facilitate positivetherapy outcomes regardless of the therapeutic orientation.

The most important change, however, is the consideration given tothe clients values and desired outcome of therapy. It is important fortherapists to be aware of the different approaches to therapy and what theycan help the client accomplish. For example, various approaches to therapycan help clients understand how their unresolved childhood issues impact

their present relationships; however, the psychodynamic approaches aremore effective at accomplishing this. Conversely, cognitive approachestend to be a better fit for client who desire quick relief from difficultemotional issues, particularly if the client is not interested in increasing self-awareness. In other words, it is more important to match the client with thetype of therapy and therapist who best meets their needs. This is asignificant improvement from the petty, egocentric battles over which

approach to therapy is best.


12/18


(5)

The Move from Eclect ic to Integrat ive TherapyThe ideas of eclectic and integrative therapy are both distinctly

postmodern in many ways. Eclectic therapy acknowledges that differenttherapies work better for different people. Thus, a pragmatic approach isutilized in which whatever approach works with a client is used. While theeclectic approach was popular for a while, it has more recently fallen into illrepute.

The problem with the eclectic approach was a lack of depth. It takesmany years to become an expert at any one approach to therapy; toassume anyone could become an expert at many different approaches totherapy is unreasonable. Eclectic therapy became a bag of tricksapproach to therapy that often was inconsistent with itself and applied bytherapists who had never become skilled or experts in any singularapproach to therapy.

The integrative viewpoint is a much more sophisticated approach totherapy. It differs from the eclectic approach in that it suggests a foundationor center of practice. For example, Schneider proposed an existential-integrative therapy. In this approach, existential theory forms the foundationof practice; however, it integrates from other theories in order to broadenand strengthen its practice. This creates a flexibility in which existentialtherapy can be adapted to meet the needs of more clients while expanding

its theoretical basis.


13/18


(6)

Integrative therapy does create some limitations as compared to theeclectic approach. Whereas eclectic pulls from theories veryliberally and quickly adapts to new ideas, the integrative approachincorporate new ideas or techniques more thoughtfully. Forexample, in the existential-integrative theory, all that is integrated istested against the foundation of existential theory. If what is beingintegrated does not fit, then one of two things must happen:adjustments must be made to existential theory or the proposedidea needs to be discarded.

As is illustrated in this discussion, the key differencesbetween an eclectic and an integrative approach is the foundation

and the concern for internal consistency. Therapists will providebetter services if their theory is consistent with their beliefs or valuesand if it remains internally consistent. From a postmodernperspective, two red flags can be noted in this discussion of theintegrative approach.


14/18


(7)

First, postmodernism is opposed to the foundational approaches toknowledge that dominated in modern and pre-modern times. Although thisis a valid concern, it is more a limitation in language. The idea of having afoundation in the integrative approach is not to say that there is an base ofUltimate Truth which everything should be tested against; rather, it is used

to indicate that a theory should be internally consistent.Second, by indicating an approach to therapy should be consistentwith the therapists values, this could be interpreted as suggesting thesevalues are then imposed on clients. To a degree this is true; however, it isno more true than of any other approach to therapy. Therapists always willinadvertently impose their values on their clients at times. This occurs moreoften if therapists are unaware of their values or the values implicit in theirapproach to therapy. In other words, the integrative psychotherapies seekto decrease the imposition of values by encouraging therapists to criticallythink through the values associated with their therapeutic orientation. Bybeing aware of their values, they can better avoid imposing them on clients.


15/18


(8)

A final concern with the integrative psychotherapiespertains to what clients are appropriate for a therapistto work with. Through developing a niche, therapistsare focusing on a more narrowly defined clientele, orat least it seems that way. To a degree, this is true,particularly early on in a therapists career. However,this is also not completely true.

The integrative psychotherapies encourageclients to become well-grounded in a particular theoryin order to develop expertise in that approach to

therapy. Initially, this may limit their clientele. However,as they begin to learn how to adapt this theory andintegrate aspects of other orientations, they are betterable to meet the needs of a wide range of clientswhere they are at in a manner consistent with their

values.


16/18


(9)

Eclect ic to Integrat ive: An Il lustrat ion of the Developmentof Postmodern ism

A valid early critique of postmodernism is that itfocused primarily, if not exclusively, on deconstructingmodernism and essentially promoting a rather an over-

simplistic relativism. However, over time, postmodernismbegan to develop a more sophisticated and constructiveperspectives such as epistemological pluralism andontological holism.

The move from eclectic to integrative psychotherapiesmimics this progression. Eclecticism, as an initial attempt to

utilize postmodern sensitivities in the inter-theory dialogue,took a more relativistic and over-simplistic approach.However, the integrative approach demonstrates postmodernideas with increasing depth and sophistication of thought.Integrative approaches draw from multiple approaches whilerecognizing the need for internal consistency.


17/18

Notions and validity in counselling

research (1)

Validityrefers to whether there is objective

evidence to support a diagnosis. Conceptual

val idi tyis whether a diagnostic category is

conceptually separate from others. Predict iveval idi tyis whether diagnosis can predict the

outcome of an illness. Reliabi l i tyrelates to

whether it is a stable diagnosis (would different

people reach the same diagnosis, and wouldthe patient be diagnosed the same at different

points in time?).


18/18

Notions and validity in counselling

research (2)

Conceptual val id i typroblems are also seen withinspecific diagnoses. For example, schizophrenia is adisjunctive concept: two patients with the diagnosismay have no symptoms in common. Whilst reliabilitycan be improved by psychiatrists being trained

carefully in the use of common symptom checklists(such as those in the DSM), reliability is not the sameas validity and it is possible to consistently use a labelwhich is still not valid. Predictive validity is particularlyimperfect in psychiatry, because human behaviour (of

any sort) is difficult to predict accurately. Theseproblems with the validity and reliability of psychiatricdiagnoses have led some to argue that mentaldisorder is very difficult to measure and that thedividing line between the normal and abnormal is

fuzzy.

Introduction to the Main Theories and Key Debates

Documents