Can CBM and therapist-free therapy form part of an integrative approach to counselling and psychotherapy?

Content writing LondonThe term integrative psychotherapist can be loosely banded around these days and can often engender confusion for potential clients when seeking counselling and psychotherapy. Each school of counselling and psychotherapy can be quite precious about their particular approach. Psychoanalysis can be seen as purist as can Rogerian therapy in that they both offer a comprehensive approach to dealing with psychological disturbance that is exclusive and unique.

Integrative therapists can, however, use a multiple range of tools and techniques to meet the needs of their clients, in whatever state or stage they might be. They do not adhere in a rigid manner to one particular philosophical or theoretical approach but often use tools and techniques in a flexible and inclusive way given that clients present with varying needs. Integrative therapists can, for instance, work with the transference but could also employ a range of techniques from the Gestalt school, Transactional Analysis, Person Centred approach, Existential approach or even creative interventions from the Transpersonal school. The underlying theoretical approach of the integrative schools is that clients present in different levels and stages of consciousness and, therefore, therapists need a multi disciplinary range of skills and theory in order to be most effective.

French (1933) was perhaps the first integrative scholar when he proposed an integration between Freudian analysis and Pavlovian conditioning commalities. There have been many scholars since then who have proposed further ideas on integration including Paul Wachtel, Gerard Egan, Kuhn and Rorty. For pluralists such as Cooper and McCleod (2010) therapy should be based on what the client needs, rather than getting them to comply with standardised treatments. Research on the therapeutic alliance indicates that the therapeutic alliance may be a better predictor of outcome than technique or approach.

However, what if the client does not need a one to one and face to face therapist?  What if you could relieve symptoms of emotional ill health by conducting “therapy” on your own with a computer screen?  Does this sound daft?  Read on.

There has been some research, such as that conducted by Norman Schmidt of Florida State University and his colleagues, that suggests that Cognitive-bias modification (CBM) can be effective after a few 15-minute sessions.  The approach involves neither drugs nor the discussion of feelings. You don’t need to even leave your house.  No, this is not online therapy.  The only requirement is to sit in front of a computer screen and use a programme that subtly alters harmful thought patterns.

The theoretical basis of CBM is based on the idea that many psychological problems are caused by automatic, unconscious biases in thinking. The goal of CBM is to alter such biases, and doing so has apparently proved surprisingly easy.

So does it work?  In an era of evidence based psychological interventions research has become even more important. More recent research by Reinout Wiers of the University of Amsterdam suggests that CBM can help alcoholics deal with their addiction. However, one of the pioneers of the approach Professor Colin MacLeod, from UWA’s Elizabeth Rutherford Memorial Centre for the Advancement of Research on Emotion (CARE), and his team suggests that more research is needed to demonstrate its wider effectiveness. His team has already published studies that show how CBM works for anxiety and addictions.

Can CBM form part of an integrative psychotherapeutic approach? There are many purists in counselling and psychotherapy that do not view an integrative approach as forming a coherent theory and skills set in the therapy room. The argument from analysts and Rogerian therapists is that an integrative approach lacks an in-depth insight to any particular theory and the integration approach can be clumsy and hap hazard in its application.  Integrative therapists are, therefore, a kind of jack of all trades and master of none.

Even integrative psychotherapists themselves can fail to properly comprehend the benefits of a cognitive approach and pay only lip service to approaches such as CBT. In the brand wars of counselling and psychotherapy approaches, any cognitive based approach can be viewed at one end of a pendulum with limited use. So, CBM, in the absence of the therapist in the room, would perhaps appal the integrative schools even further. Indeed all face to face “talking therapists” would effectively be put out of business if CBM was to gain more credibility.  But perhaps a truly integrative approach must be liberally holistic and see the potential role of an approach such as CBM as having a part to play for some clients to overcome certain conditions at particular points in their lives.