Training issues in psychotherapy integration: A commentary.

This article is a commentary on A. J. Consoli and C. M. Jester's (see record 2006-01691-002) and J. Gold's (see record 2006-01691-003) eloquent and stimulating reflections on training in psychotherapy integration. Three issues are addressed: (a) the timing of an integrative perspective in training, (b) the potential merits of "hero worshiping" at an early phase of training, and (c) some misconceptions about training in "pure-form" psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Competency in integrative psychotherapy: Perspectives on training and supervision.

Increasingly, many psychotherapists identify with an integrative approach to psychotherapy. In recent years, more attention has been directed toward the operationalization and evaluation of competence in professional psychology and health care service delivery. Aspects of integrative psychotherapy competency may differ from competency in other psychotherapy orientations, although convergence is more often the case. Despite the potential differences, there exist very few formal training programs or guidelines to systematically guide clinicians in developing a competent integrative practice. This paper attempts to distill the essential elements of competent integrative psychotherapy practice and focuses on how these might be developed in training and supervision. We address most of these complex issues from a specific integrative perspective: principle-based assimilative integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Encountering difference in graduate training: Potential for practicum experience.

Psychotherapists attempt to cultivate sensitivity to difference in their work with diverse client populations. Developing therapists may also benefit from theoretical and practical encounters with difference during graduate training. Although graduate students may thrive in training institutions where orientations resonate with their intuitive understandings, valuable opportunities for growth emerge when students obtain practicum experience at sites using alternative approaches to psychotherapy. This article documents the challenges and opportunities met by one graduate student trained in existential, psychodynamic, humanistic, and sociocultural approaches, when she embarked on a practicum experience in a medical setting, where dialectical behavior therapy (DBT) was the treatment of choice. She discusses professional growth, steps toward psychotherapy integration, and implications for graduate training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy integration and integrative psychotherapy: Process or product?

From rather early in the development of the psychotherapy integration movement, there were implicit tensions between alternative understandings of the concept of psychotherapy integration and of its boundaries and aims. These tensions have been healthy and productive rather than divisive, sparking different models and different kinds of integrative efforts, but it is nonetheless important to be clear that they are tensions that persist rather than tensions that have been “resolved.” In this paper, I discuss some of the history of these competing views, some of the ways that they have been given voice, and some of the possible future directions for the psychotherapy integration movement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anxiety, conflict, and resistance in learning an integrative perspective on psychotherapy.

Learning to do psychotherapy is emotionally difficult as well as cognitively challenging. This article addresses some of the intrapsychic conflicts with which beginning therapists are faced and points out some of the ways that novices cope by identifying with psychotherapeutic schools and "heroes." The added emotional burdens of learning an integrated approach are discussed, as are some solutions to these conflicts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy integration as practiced by experts.

Twenty-four psychotherapists who were experts in psychotherapy integration and had a mean of 32 years of clinical experience completed a questionnaire assessing their practice history and fidelity to various psychodynamic, cognitive–behavioral, humanistic, and family systems theories. They then completed the 100-item Psychotherapy Process Q set (Jones, Hall, & Parke, 1991) modified to be a self-report questionnaire, based on a client they had treated using integrative therapy. Most therapists reported some influence of all 4 orientations, but almost three-quarters indicated that only 1 was a salient influence. Principal components factor analysis revealed 4 factors representing 4 integrative practice styles, which were then correlated with prior prototypes of cognitive–behavioral, psychodynamic, and interpersonal therapies. The first factor, accounting for just over half the variance, most resembled cognitive–behavioral therapy. The second factor shared elements of several orientations, whereas the third factor most resembled psychodynamic therapy. The responses of more than half the therapists loaded on more than 1 factor. Findings demonstrate a diversity of theoretical influences and practices among these experts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The future of psychotherapy integration: A roundtable.

This article provides a compilation of forecasts on the future of psychotherapy integration from 22 prominent figures in the integration movement. Contributors succinctly addressed questions on desirable practice, research, theoretical, and training directions for the movement. Contributors also responded to the question, What would you like the field of psychotherapy integration to look like in 25 years? (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Education for Research.

Notes that after reading about a third of the article "Education for Research in Psychology" (Amer. Psychologist, 1959, 14, 167-179; see record 1960-03707-001), I found myself playing a little game (an idiosyncrasy of mine to encourage the reading of psychological journals). Every time the article mentioned education for research, I substituted education for psychotherapy. Once seen in this way, it seemed to me that the implications for training graduate students in research are also quite applicable in training graduate students in psychotherapy or in counseling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Turning ghosts into ancestors: An appreciation of “psychotherapy as a problem in learning theory”.

While once again rereading Shoben’s (1949; see record 1950-01904-001) brilliant and prescient article, the following clinical interaction came to mind. It is one that most psychotherapists will find familiar. It also serves to illustrate the importance of Shoben’s nascent integrative theory for contemporary clinical practice and for the study of psychotherapy integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Leading researchers' consensus on psychotherapy research findings: Implications for the teaching and conduct of psychotherapy.

We examined leading international psychotherapy researchers' views on psychotherapy outcome research. Participants completed a questionnaire on which they rated level of research evidence for or against various assertions about psychotherapy processes and outcomes. Participants rated how confident they were that the assertions were supported by psychotherapy research. Strong, or relatively strong, consensus was achieved on several of the questionnaire items. Areas for which relative uniformity of opinion does or does not exist have potential implications for the teaching and conduct of psychotherapy and for the science-practice interface in psychotherapy. Additionally, consensus about psychotherapy findings can be used as a yardstick by which to measure practicing clinicians' knowledge of the research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the road to psychotherapy integration: A student's journey.

This article presents the integrative journey of a doctoral student across two continents. The development and aspirations of a student integrationist from the "get go" are outlined, and some thoughts on the future of the integration movement are offered. The role of self-direction, integrative role models, flexible training environments, and the support of the integrative community in one's integrative development are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couples psychotherapy: A psychodynamic model.

Psychoanalytic assumptions and goals need not be viewed or approached from a purely individual analytic perspective. Families and especially marriages offer a unique opportunity for systems-oriented intervention to add therapeutic depth by addressing psychodynamic interactions in vivo. Doing so requires integration in therapy, as well as in theory, of the manner in which individual psychodynamics manifest in primary interpersonal systems. A model is presented which aims at translating and instilling a useful degree of analytic insight in members of marital or family systems. Insight into transferential distortions and behavior is facilitated by introducing the metaphor of unconscious "hopes" and "expectations" in the interactive contexts of conjoint and individual sessions. It is suggested that such an expansion of systems-oriented approaches is a crucial step in adding depth and durability to change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trainee theoretical orientation: Profiles and potential predictors.

The goal of this study was to provide data on the theoretical orientations of a sample of therapists in-training, as well as to investigate constructs that may help to predict identification with a particular theoretical orientation(s). Data on therapist theoretical orientation and personality were gathered from 46 graduate student therapists in 4 APA accredited clinical and counseling psychology programs. Although psychodynamic therapy was the most strongly endorsed single theoretical framework across the sample, the orientation with the highest mean rating was an eclectic/integrative approach. A 2-step cluster analysis was used to create orientation profiles to further explore psychotherapy integration, which produced a 3-cluster solution: (a) humanistic/systems/psychodynamic, (b) psychodynamic, and (c) cognitive–behavioral. A significant main effect for cluster membership and personality factors was found, and a chi-square analysis indicated differential representation across the three “integration clusters” as a function of training program. Implications for psychotherapy integration and training are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating an emotion-focused approach to treatment into psychotherapy integration.

A truly integrative approach to treatment needs to combine methods of working with affect, cognition, and behavior, but established principles of affective change are sorely missing in the literature. Emotion theory and research suggests that emotion awareness, regulation, and transformation are 3 major principles of emotional change. In addition to these principles, 3 general factors that help guide integrative intervention in their use are discussed. Intervention should be guided by the source of the affect involved in the client's distress (amygdala- or prefrontal cortex-generated emotion), the type of affect dysregulation involved (too much or too little emotion), and the type of change process to be used (quick change to improve coping or longer change to restructure character). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting treatment outcome by combining different assessment tools: Toward an integrative model of decision support in psychotherapy.

Different types of evidences must be integrated to derive predictions about the possible outcome of psychotherapeutic interventions. We use the Minnesota Multiphasic Personality Inventory–2 (MMPI–2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) as a tool for gathering assessment data and propose a new method of statistical prediction to apply to psychotherapy. We apply artificial neural network (ANN) technology to a pool of clinical data gathered from the MMPI–2 profiles of 150 patients to derive indications about the outcomes of the interventions. ANNs are nonlinear computational devices, directly inspired by the principles of biological neural computation, that process information to learn patterns as a result of exposure to a set of representative “training cases.” The performance of the paper's ANN in forecasting successful and unsuccessful treatment cases shows a mean rate of correct classification of 81%. This suggests that ANNs may be considered a potentially useful tool for supporting clinical practice and for deriving prognostic indicators for psychotherapy outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Thoughts about journeys to integrative psychotherapy.

What a humbling experience to be invited to offer commentary on the papers of such distinguished contributors to the field of integrative psychotherapy. Even the most junior member of the panel has a record of achievement impressive enough to place him in a competitive position for a tenured faculty position. As we read their stories, we have a wonderful opportunity to get glimpses into two decades of change in the field of psychotherapy as seen through the eyes of four colleagues who have been tremendously influential. In my effort to tie together these moving pieces I have looked for the "common factors" that have played out in the stories of these four clinician-scholars. In the pages that follow, I will review these commonalities, which include the following: (a) the role of personal life experiences on the development of an integrative approach; (b) the critical role of a mentor; (c) the challenge of defining one's approach; (d) views about the essential factors in effective psychotherapy; (e) an appreciation for the relationship between research and clinical practice; (f) a commitment to teaching and supervision; and (g) the significance of SEPI in the past, present, and future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A self-determination theory approach to psychotherapy: The motivational basis for effective change.

The application of self-determination theory (SDT) to psychotherapy is particularly relevant because a central task of therapy is to support the client to autonomously explore, identify, initiate, and sustain a process of change. In this article, the authors discuss the experimental work, field studies, and clinical trials representing the application of SDT to the domain of psychotherapy. Evidence supports the importance of client autonomy for the attainment and maintenance of treatment outcomes. In addition, intervention studies suggest that therapist autonomy support enhances the likelihood that treatment gains will be achieved and maintained. The authors discuss some of the processes involved in enhancing autonomy, including the role of awareness, the importance of exploring and challenging introjects and external regulations, attention to need-related goal contents, and therapist attitudes required for a therapy approach that is process- rather than outcome-focused. (PsycINFO Database Record (c) 2010 APA, all rights reserved)