Integrative and Week 12 Quiz

Question 1

Main Themes

Answer 1

While each of the perspectives discussed throughout the course of this unit share common goals, they differ in their approach to achieving these goals and in the importance placed on feelings, thoughts, and behaviours. They also differ on whether it is the counsellor or the client who takes the more active role in therapy. An integrative approach has the advantage of combining the most useful and appropriate methods to use with each client and adopting a more complete theoretical model to inform therapeutic practice.

The vast majority of practising counsellors now regard themselves as integrative in their approach rather than adhering strictly to the theories and techniques of a single theoretical perspective. Prior to this shift, however, counsellors tended to adopt one approach to the exclusion of all others, oftentimes dogmatically where they would believe their perspective was the best method of personality change and deny the validity and utility of alternative approaches. Such strict adherence to a single theoretical perspective has the potential to act against the client’s best interests in favour of reinforcing the counsellor’s personal position. The recognition that no one theoretical approach can be applied universally to the diverse range of clients that attend counselling assisted in establishing integrative therapy as the preferred approach.

Four common pathways towards integration of different perspectives that each look beyond the restrictions of a single approach are technical integration, theoretical integration, assimilative integration and the common factors approach. Attempt the following activity to match the pathway to the underlying principle.

Technical integration is the…utilisation of the most effective techniques with the specific issues presented.

Assimilative integration is the…adoption of a single theoretical perspective and openness to slsectively incorporating elements from other perspectives.

Theoretical intergration involves…developing a conceptual framework for therapy that incorporates the best aspects from two or more theoretical perspectives.

The common factors approach involves…consideration of common and nonspecific elements from across perspectives, without adherence to one.

Feedback:

A systematic and critical approach to the inclusion of various methods that reflect a clear theoretical rationale is vital to ensure the effectiveness of integrative therapies with individual clients.

All integrative approaches attempt to find a therapeutic framework that fits the specific needs of the client with the view that no one theory can accurately and completely encompass all aspects of human experience. This not only involves utilising an effective method of integrating these different perspectives but also relies on the counsellor being flexible in their approach to each client.

Psychotherapy is recognised to be most effective when a broad range of theoretical perspectives and techniques are incorporated into a consistent framework that can be applied with clients on an individual basis. Increasingly, counsellors that identify themselves with a single approach are expanding their theoretical outlook and incorporating elements from other perspectives to effectively manage clients from diverse backgrounds and situations. While many of these approaches to integration to date have been grounded in theoretical and clinical foundations, it has been suggested that empirical pragmatism, a focus on evidence-based practices and their applications rather than theoretical paradigms, will form the basis of psychotherapy integration into the future.

Of note in modern integrative practice are issues of multiculturalism and spirituality, both of which are necessary to consider when developing treatment plans for specific individuals. Counsellors must be able to assess the unique needs of those they see to work effectively in any clinical setting, which involves understanding their own cultural and spiritual perspective as well as that of their client. An important element of this approach is a non-judgemental investigation and understanding of how the client defines meaning in their life and the particular beliefs and values to which they adhere. Such beliefs, whether they be religious, spiritual or otherwise, can be valuable resources available to the client in addressing their concerns. Beliefs can provide an opportunity to work collaboratively with the client to assist them in identifying what gives their life purpose, particularly in times of crisis, and/or how these unexamined belief systems have influenced their current experience.

Question 2

Techniques

Answer 2

Counsellors that adopt an integrative approach to therapy must first determine what type of relationship style they will use with their clients; what techniques, procedures or interventions will be used; when to use them; and with which clients. In your eText take particular note of the different techniques and applications of the various approaches covered and how each of these need to be considered within the context of the relationship with the client, the type of issues being addressed and their effectiveness in dealing with the specific needs of the client. This provides greater opportunities for therapy to be tailored to individual clients to combine cognitive, affective and behavioural techniques to assist clients to think about their beliefs and assumptions, experience their conflicts and struggles and create a plan to modify their behaviours.

While the beauty of an integrative approach is its level of personalisation, it also opens the doors to a number of key considerations and challenges. Before delving in head first, explore the following to learn more about the issues related to the therapeutic process from an integrative perspective and the subsequent challenges associated with implementing an effective and appropriate integrative approach.

Knowledge requirements

Perhaps the greatest challenge to implementing an effective and appropriate integrative approach is the extensive knowledge required of each theoretical perspective and their application in clinical settings, and the time and finesse necessary to integrate these effectively. Many of the theoretical perspectives discussed share no common philosophy or understanding of human development, and their respective assumptions shape how we view the world and the reality we perceive. As such, it is important for counsellors to remain open to different views of human nature and incorporate alternatives selectively into their counselling framework. This not only allows counsellors to adopt an integrative approach that reflects their personal beliefs and identity but also validates and supports those of the client.
No common theoretical base and conflicting underlying assumptions

A key issue in developing an integrative framework is the potential to combine perspectives and techniques with no common theoretical base and conflicting underlying assumptions. Such haphazard blending of ideas can lead to syncretistic confusion as discussed earlier, resulting in inefficient treatment and, potentially, unethical practice. Understanding a broad range of theoretical perspectives can assist the counsellor, particularly those early in their career, to recognise where different theories overlap and how these can be incorporated into a theoretically consistent, but technically integrative, therapeutic framework. This not only allows the counsellor to be more flexible in their approach with any one client, but also provides the basis and the means for selecting appropriate interventions for that client.
Use of time-limited and short-term therapies

The increasing use of time-limited and short-term therapies present additional challenges for counsellors, as these typically require a more integrative approach to deal with a client’s concerns effectively over a minimal space of time. Counsellors must ensure that they are reflective in their practice and can assess both how well their adopted perspectives relate to each other, such as the underlying assumptions or the goals of therapy, and the effectiveness of their treatment from this framework for each client. Again, therapy that is tailored to the specific needs and concerns of the individual client is more likely to result in positive outcomes, but the core strength of integrative approaches is their potential to be taught, replicated and evaluated.

Question 3

Role of Evaluation

Answer 3

A lot of evidence points to the effectiveness of psychotherapy in improving client functioning, however counsellors must always be mindful of how well their approach is working with specific clients. Research suggests that it is the similarities between perspectives, such as the interpersonal, social, and affective factors, that account for the effectiveness of psychotherapy. Importantly, these interventions must be accepted by both the counsellor and the client to be effective, and the client must be at the forefront of directing change. Evaluations of therapy during the course of treatment should be carried out periodically to confirm what is working and what is not, which can be achieved through Feedback-informed treatment (FIT).

FIT involves consistently obtaining feedback from the client to assess the therapeutic relationship and their clinical progress with the understanding that the client is the most important predictor of change. Use of such feedback allows identification of which approach to take, by whom, with which issues, and under which set of circumstances to ensure that the approach taken is the most appropriate for each individual client. In doing so, clients and counsellors can more effectively collaborate on the best treatment plan, enhancing the therapeutic relationship and improving the associated outcomes.

Question 4

Limitations

Answer 4

Now that you have explored this week’s approach and applied it to two case studies, it is time to consider the limitations of integrative perspective. With your essay complete, you should turn your attention to how this theory may fit into your future professional practice.

While evidence-based practice should be employed to assist in determining which interventions to use with which clients, counsellors should also adopt practice-based evidence, whereby client outcomes are consistently monitored and become the primary goal of therapy. To consider only interventions that have a solid empirical base may overlook the individual needs of the client and limit their engagement in the therapeutic relationship. Instead, a focus on the outcomes of therapy through consifistent and systematic assessment of client perceptions provides a simple, practical and meaningful method of documenting therapeutic progress and provides the client with the opportunity to engage in the process to ensure that practice is tailored to their individual needs and characteristics.

Question 5

For decades, counsellors resisted integration, often to the point of denying the validity of alternative theories and of ignoring effective methods from other theoretical schools.

Answer 5

True

Question 6

As the field of psychotherapy has matured, the concept of integration has emerged as a mainstay.

Answer 6

True

Question 7

Syncretism occurs when a practitioner, lacking in knowledge and skill in selecting interventions, looks for anything that seems to work.

Answer 7

True

Question 8

One of the best known forms of technical integration is multidimensional therapy, created by Arnold Lazarus.

Answer 8

False

Question 9

Psychotherapy integration stresses tailoring of interventions to the individual client, rather than to an overarching theory.

Answer 9

True

Question 10

Although clients’ spiritual and religious beliefs may be important to them, it is ethically inappropriate for clinicians to address these beliefs in the context of therapy.

Answer 10

False

Question 11

Most forms of short-term psychotherapy are active in nature, collaborative in relationship, and integrative in orientation.

Answer 11

True

Question 12

Therapeutic goals should always be specific, concrete, and short term.

Answer 12

False

Question 13

Evaluating how well psychotherapy works is relatively simple.

Answer 13

False

Question 14

Significant empirical research on effectiveness has been produced for all of the major models covered in this book.

Answer 14

False

Question 15

___________________ is best characterised by attempts to look beyond and across the confines of single-school approaches to see what can be learned from other perspectives.

Answer 15

Psychotherapy integration

Question 16

Which of the following is not one of the four most common pathways toward the integration of psychotherapies?

Answer 16

Symbolic integration.

Question 17

Which path calls for using techniques from different schools without necessarily subscribing to the theoretical positions that spawned them:

Answer 17

Technical integration

Question 18

All of the following therapies synthesise the best aspects of two or more theoretical approaches except:

Answer 18

Acceptance behavior therapy

Question 19

The _________________________ approach is grounded in a particular school of psychotherapy, along with an openness to selectively incorporate practices from other therapeutic approaches.

Answer 19

assimilative integration

Question 20

Support, warmth, feedback, empathic listening, and developing a working alliance are considered __________________ that have empirically shown to be curative

Answer 20

common factors

Question 21

______________________ will increasingly become the organising force for integration.

Answer 21

Evidence-based practice

Question 22

One aspect of integration that is particularly well-suited to taking cultural factors into account is:

Answer 22

therapeutic flexibility.

Question 23

Sydney, a grief counsellor, mentioned to his colleagues in a peer supervision group that he is open to discussing his clients’ spiritual and religious beliefs with them. What should he say to his colleagues who are skeptical about this practice?

Answer 23

“My clients’ spiritual and religious beliefs are a major sustaining power that supports them when all else fails. I think it would be unethical for me to overlook this.”

Question 24

Cognitive behavior therapists frequently design __________ to assist clients in practicing new behavior outside therapy sessions.

Answer 24

homework assignments

Question 25

What would both cognitive behavior therapists and reality therapists be inclined to say to their clients?

Answer 25

“What do you think about trying out the new behaviors we discussed today during the week?

Question 26

Which of the following approaches does not emphasise the personal relationship as the crucial determinant of treatment outcomes?

Answer 26

The behavioural approach

Question 27

Eliza considers herself an Adlerian therapist, Julie regards herself as a feminist therapist, and Kyle specialises in cognitive behavioral therapy. All three therapists, regardless of their theoretical orientation, must do all the following except:

Answer 27

Decide to use all techniques with all clients.

Question 28

Most outcome studies in counselling have been conducted by researchers affiliated with:

Answer 28

behaviour and cognitive therapy and person-centered therapy.

Question 29

Research evidence from meta-analyses has demonstrated that psychotherapy is:

Answer 29

highly effective.

Question 30

Textbook Notes

Answer 30

Some therapies focus on experiencing feelings, others stress identifying cognitive patterns and still others concentrate on actual behaviour. The field of psychotherapy is characterised by a diverse range of specialised models. Since the early 1980s, psychotherapy integration has developed into a clearly delineated field. In the 1983, is an international organisation whose members are professional working toward the development of therapeutic approaches that transcend single theoretical orientations.
The movement toward psychotherapy integration – a large number of therapists identify themselves as eclectic and this category covers a broad range of practice. At its worst, eclectic practice consists of haphazardly picking techniques without any overall theoretical rationale. This is know as syncretism where in the practitioner, lacking in knowledge and skill in selecting interventions, looks for anything that seems to work, often making little attempt to determine whether the therapeutic procedures are indeed effective.
Pathways toward psychotherapy integration – is best characterised by attempts to look beyond and across the confines of single school approaches to see what can be learned from other perspectives and how clients can benefit from a variety of ways of conducting therapy. In a 2007, only 4.2% of respondents identified themselves as being aligned with one therapy model exclusively. The remaining 95.8% claimed to be integrative, meaning they combined a variety of methods or approaches in their couseling practice. The integrative approach is characterised by openness to various ways of integration diverse theories and techniques. Norcross and Beurler 2019 – and Stricker 2010 describe 4 of the most common pathways toward the integration of psychotherapies; technical integration, theoretical integration, assimilative integration and common factors approach. Technical intetgration – aims at selecting the best treatment techniques for the individual and the problem. It tends to focus on differences, choose from any approaches and is a collection of techniques. technical eclecticism is the basis of multimodal therapy. Theoretical Integration -refers to a conceptual or theoretical creation beyond a mere blending of techniques. This route has the goal of producing a conceptual framework that synthesises the best aspect of 2 or more theoretical approaches under the assumption that the outcome will be richer than either theory alone. EG dialectical behaviour therapy, acceptance and commitment therapy, emotion focused therapy. Assimilative Integration – approach is grounded in a particular school of psychotherapy, along with an openness to selectively incorporate practices from other therapeutic approvals. EG – mindfulness based cognitive therapy. The common factors approach – searching for common elements across different theoretical systems. Some of the common factors include empathic listening, support, warmth, developing a working alliance, opportunity for catharsis etc… The importance of the therapeutic alliance s a well established critical component of effective therapy. Research confirms that the client-therapist relationship is central to therapeutic change and is a significant predictor of both effectiveness and retention of therapy outcomes.
Advantages – enables practitioners to make sense of the many aspects of the therapy process and provides a map giving direction to what practitioners do and say. These growing recognition that psychotherapy can be most effective when contributions from various approaches are integrated. Empirical pragmatism not theory, will be the integrative theme of the 21st century. Practitionesr who are open to an integrative perspective will find that several theories play a crucial role in their personal counselling approach. Each theory has its unique contributions and its own domain of expertise. Developing an integrative perspective is a lifelong endevour that is refind with clinical experiences, reflection, reading and discourse with colleagues.
The challenge – A survey of approaches to counselling and psychotherapy reveals that no common philosophy unifies them. We perceive and they direct our attention to the variabkes that we are set to see. Despite these divergences in the various theories, creative syntheses among some models are possible. In developing a personal integrative perspective, it is important to be alert to the problem of attempting to mix theories with incompatible underlying assumptions. Difficult to deliver brief services – time limited brief therapy refers to a variety of time sensitive goal directed, efficiency-oriented methods. An integrative perspective at its best entails a systematic integration of underlying principles and methods common to a range of therapeutic approaches.
Issues in Multicultural counselling – clients can be harmed if they are expected to fit all the specifications of a given theory, whether or not the values espoused by the theory are consistent with their own cultural values. Comas Diaz believes that cultural competence enables counsellors to work effectively in most clinical settings. Being an effective couselor involves reflecting on how your own culture influences you and your interventions in your counselling practice.
Integration of Spirituality and Religion in Counseling – Worthington asserts that the increasing openness of therapists to clients spiritual and religious concerns and interests has been fueled by the multicultural evolution. Johnson 2013 – views spirituality informed therapy as a form of multicultural therapy. Clients who are experiencing a crisis situation may find a sources of comfort, support, and strength in drawing upon their spiritual resources. Other clients value spirituality yet do not have any ties to a formal religion. Other clients may be affected by depression and a sense of worthlessness due to guilt, anger or sadness create by their unexamined acceptance of spiritual or religious dogma.
Common Goals – spiritual goals have a major part to play in human life and struggles. Exploring these values has a great deal to do with providing solutions for clients struggles.
Implications for assessment and treatment – traditionally when clients come to a therapist with a problem, the therapist explores all the factors that contributed to the development of the problem. A background of involvement in religion can be part of a clients history and thus it can be a part of the intake assessment and can be explored in counselling sessions.
Your Role as a Counselor – it is critical that counsellors not be judgemental when it comes to their clients beliefs and that counsellors create an inviting and safe climate for clients to explore their values and beliefs. By conducting a thorough assessment on a clients background you will obtain many clues regarding personal themes for potential exploration. Ethical and Clinical consideratations are equally important when providing therapy for clients who are nonreligious.
Therapeutic Goals:
- Restructuring the personality
- Uncovering the unconscious
- Creating social interest
- Finding meaning in life
- Curing an emotional disturbance
- Examining old decisions and making new ones
- Developing trust in oneself
- Becoming more self-actualising
- Reducing maladaptive behaviour and learning adaptive patterns
- Becoming grounded in the present moment
- Managing intense emotions such as anxiety
- Gaining more effective control of ones life
- Reauthiring the storys of ones life.
Role and Function – how do counsellors functions change depending on the stage of the counselling process. CBT and Reality therapists, operate within a present-centered directive, didactic, structured and psychoeducational context. In person-centered therapy operate with a much loose and less defined structure. Solution focused and narrative therapists vi the client as the expert on his or her own life. They assist the client in reflection outside of the session that might result in self-directed change.
Clients Experience in therapy – their complaints often relate to these existential issues: a sense of emptiness, meaninglessness in life, routine ways of living, unsatisfying personal relationships, anxiety over uncertainty, a lack of intense feelings and a loss of their sense of self. the initial expectation of many clients is that results will come quickly. They often have great hope for major changes in their life and rely on direction from the therapist. Most clients, will need to do some work in the 3 dimensions – feelings, thoughts and behaviours because these dimension are interrelated.
Relationships between therapist and client – counselling is a personal matter that involves a personal relationship and evidence indicates that honesty, sincerity, acceptance, understanding and spontaneity are basic ingredients for successful outcomes. Therapists can become more ffective by developing their personal qualities and their interpersonal abilities. As you think about developing you personal conselling perspective, give consideration to the issue of the match between client and counsellor. Although you do not have to be like your clients or have experienced the same problems to be effective with them, it is critical that you be able to understand their world and respsect them.
Drawing on Techniques from various approaches – effective therapists incorporate a wide range of procedures in their therapeutic style. Much depends on the purpose of therapy, the setting, the personality and style of the therapist, the qualities of the particular client, and the problems and style of the therapists, the qualities of the particular client and the problems selected for intervention. It is critical to be aware of how clients cultural backgrouns contribute to their perceptions of their problems. The clients responsiveness to certain techniques is a critical barometer in judging the effectiveness of these methods. Effective counselling involves proficiency in a combination of cognitive, affective and behavioural techniques. Such a combination is necessary to help clients think about their beliefs and assumptions, to experience on a feeling level their conflicts and struggles and to translate their insights into action programs by behaving in new ways in day to day living.
Evaluating the Effectiveness of Counseling and Therapy – mental health providers must be accountable and be able to demonstrate the efficacy of their services. In the era of manged care, it is essential for practitioners to demonstrate the degree of which their interventions are both clinically sound and cost-effective. Evaluating how well psychotherapy works is far for simple. Therapeutic systems are applied by practitioners who have unique individual characteristic and clients themselves have much to do with therapeutic outcomes. A summary of the research data shows little or no differences in out come between specific therapeutic approaches. Although it is clear therapy works, there are no simple explanations of how ti works. The various therapy approaches and techniques work equally well because they shrea the most important ingredient accounting for change.
Feedback Informed Treatment – is designed to evaluate and to improve the quality and effectiveness of counselling services. FIT is an evidence based practice that monitors client change and identifies modifications needed to enhance the therapeutic endeavor. Monitoring outcome and adjusting accordingly on the basis of feedback from the client must become routine practice. The outcome rating scale assesses the clients therapeutic progress through ratings of clients personal experience of well being in his or her individual, interpersonal and social functioning. The session rating sale measures a client perception of the quality of the therapeutic relationship, which includes the relational bond with the therapist, the perceived collaboration around the specific tasks in therapy, and agreement on goals, methods, and client preferences. Feedback from clients regarding the therapeutic alliance and outcomes increases the effect of treatment, cuts dropout rates in half, and decreases the risk of deterioration. Arguing for practices based evidence rather than evidence based practices. Ongoing client feedback provides practitioners with a simple, practical, and meaningful method for documenting the usefulness of treatment.