Working from an integrative theoretical approach in psychotherapy

Integrative psychotherapy should include all states of being, that is what it means to work from a holistic perspective, as well as all major theoretical traditions, this is what it means to be integrative.  If human beings exist on at least five levels, namely body, feelings, intellect, soul and spirit, then we have to work on all five of those levels in order to realise human potential. 

In practising as an integrative psychotherapist, one can integrate different theoretical models using different relational maps. One such map is offered by Petruska Clarkson in ‘Systemic Integrative Psychotherapeutic Model’. For Clarkson, there are five ways in which the therapist and client relate:

  • the working alliance;
  • the transferential and countertransferential;
  • the reparative or reparenting;
  • the person to person (Martin Buber’s ‘I/Thou’);
  • the transpersonal.

Whilst acknowledging the possible transpersonal aspects of the therapeutic relationship, I would argue that it is important not to be premature to focus on it to the detriment of the other four. Clarkson’s model might be better used as a fluid and flexible way of working, not as a hierarchical map. Added to Clarkson’s five relationships, it is also important to recognise further levels that widen one’s understanding of the context of the client’s existence. These can include the integration of the chakras and the integration of different brain functions.

Kahn (1997) seeks to bring together insights into the therapeutic relationship from Humanist, Psychodynamic (Object Relations), and Self Psychology sources.  Whereas Clarkson sees a multiplicity of relationships, Kahn sees the therapeutic relationship as singular, though having different facets to it. Kahn invites us to draw out the integrative aspects of Freud, Rogers, Gill and Kohut. Both Clarkson and Kahn do not, however, make reference to the kind of relationship likely to be fostered in the technique orientated cognitive behavioural approaches. This element is addressed by Gold (1996) and Power (2002) who offer a more comprehensive integrative model by incorporating cognitive and behavioural theories.

It is important that behaviour change techniques, such as anti-procrastination exercises and cognitive change techniques, such as verbal disputing (and using Beck’s ABC Model) have their role to play in effective integrative psychotherapeutic practice. CBT can often be downgraded in the psychotherapeutic brand wars but I believe that the successful engagement of clients in the process of therapy, can be facilitated by goal setting, especially in short term counselling.  Indeed, Bordin (1979), usefully conceptualized the working alliance as consisting of three parts: tasks, goals, and bond. Tasks can be understood  as what the therapist and client agree need to be done to reach the client’s goals. Goals are what the client hopes to gain from the process of therapy, based on the presenting issues. The bond forms from trust and confidence that the tasks will bring the client closer to his or her goals.



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