Integrative Psychotherapy: The Integration Of Therapeutic Models
In the last decades The quality and efficiency of psychological treatments has increased significantly largely due to the increasingly widespread tendency of psychotherapists to integrate different elements of classic psychotherapeutic models.
Integration allows us to develop a more comprehensive and holistic vision of the person, their relational world and their social context. In this article we will see What are the characteristics of integrative psychotherapy and what it is based on.
Integrative models differ from eclectic models in that the former do not use techniques in a more or less isolated manner, depending on the characteristics and needs of the person, but rather start from a comprehensive vision of the human being that allows giving meaning and coherence to the different elements as a whole.
Now this It does not mean that there is only one way to address psychological problems as if it were an “absolute truth”, far from it.
It can happen, and, in fact, happens most of the time, that each particular psychotherapist integrates elements in one way or another, giving more weight to some factors over others, for example, emotions over cognitions or behaviors, etc. It will depend on the general base or, to put it another way, the integrative model from which the professional starts.
Although elements and techniques from other psychotherapeutic models are integrated, there is always a more general underlying one that predominates and allows them to be integrated, as an “epistemological umbrella.”
Psychotherapeutic schools
But… what are the major psychotherapeutic models that usually serve as a basis for an integration of other components and techniques? There are many psychotherapeutic schools and sub-schools although we could basically talk about four major orientations: the cognitive-behavioral, the psychodynamic, the systemic and the humanistic.
How can the different models be used in an integrative way? What keys to exploration, analysis and intervention can each of them allow? We are going to make a brief description of the guidelines that each of these models mainly emphasizes, although making the reservation that there are almost never completely “pure” models, since, in one way or another, they all consider the other factors, overlapping. , intermingling and feeding each other.
The cognitive-behavioral model usually focuses more on theories of learning and How stimulus control affects human behavior Thus, the prism from which the problem that the patient brings is approached is approached from classical conditioning, operant conditioning… techniques aimed at reducing or increasing, depending on the case, the behaviors with which you want to work (for example , reduce alcohol abuse or quit smoking).
The cognitive element, that is, working with thoughts, has been acquiring increasing prominence compared to purely behavioral approaches. Working with the constructions and narratives that people make of their reality (what Watzlawick has called “second-order reality”) is basic: cognitive schemes, basic assumptions, automatic thoughts, biases and automated thinking tendencies, etc., They are addressed from, for example, cognitive restructuring.
Psychodynamic model
The psychodynamic model, highly influenced by psychoanalysis, usually pays attention to biographical aspects and how early or past experiences (although not only, as they also focus on the present) are influencing the present.
From this approach, in which work with the unconscious is central, defense mechanisms, work with transference and countertransference, the interpretation and elaboration of patients’ behaviors, the awareness of models, take special relevance. automated linking and relational conflicts, etc. All of this allows us to delve deeper into the intrapsychic and relational life of patients.
It is important to say that, although psychoanalysis is usually associated with very long-term treatments, which can last for many years, the truth is that Increasingly, there is a tendency to make brief approaches focused on specific aspects of the person’s life and that have directly to do with their problems (for example, Malan’s conflict triangles, Horowitz’s relationship models, etc.).
The contributions that psychodynamic approaches can make should not be neglected, being very useful, for example, the conception they have of relational conflicts and their connection with health.
Systemic model
From the systemic-relational model, in which the person is conceived within a larger system with which he or she interacts and where permanent feedback is given between its members, The focus is usually placed on interactions, communication, and relational dynamics and patterns in the place that the person has within the system (their role, etc.).
An important aspect of this way of working is that the focus is on how people influence each other and what effects they have on each other in certain situations (for example, how parents and children provide feedback to each other to make it difficult for children to mature). and becoming independent or, how they behave in the face of a family member’s illness, establishing rigid functioning roles, etc.).
Humanistic models
From humanistic models such as, for example, Rogers’ client-centered therapy or Fritz Perls’ Gestalt therapy, The emphasis is on raising awareness and taking responsibility for behaviors and the person’s own life.
Client-centered therapy encourages personal development and confidence in potential of each person (it is assumed that, if the appropriate conditions are provided, the person will be able to update their potential according to their needs).
For Gestalt therapy, an eminently experiential model, the work must always be aimed at becoming aware of why the person does what they do (instead of the why, more typical of psychoanalysis), working with the emotional experience and body in the here and now (which encourages awareness) and self-responsibility for their emotions, thoughts and actions, seeking personal coherence.
Where to start designing the approach?
At the risk of oversimplifying things, we could say that these are the main characteristics of each model and from which they evaluate and treat their clients. But if you want to do true integrative work, it is necessary to have a general model, a certain way of understanding the human being, that allows this integration to be carried out. Therefore, it is very important to ask the question from where the different guidelines and factors are being integrated.
We find relational approaches especially useful, in which attention is paid, both implicitly and explicitly, to the ways in which people have built their ties and what types of relationships they establish with others
How people relate and how they behave, whether consciously or unconsciously, offers general psychological work keys from which to begin to redefine the problem that the person brings, as well as how to begin to introduce changes in relationship patterns.
Bowlby’s attachment theory and its later developments It may be one of those “epistemological umbrellas” that we talked about above, since it allows the integration of psychological factors from different schools.
From postmodern approaches, narrative and discursive therapies have been other general frameworks from which to do integration. Some authors have even linked attachment theory and narrative therapy in a single model to carry out this integration of psychological techniques. These models have questioned the so-called myth of “the isolated mind.” which in the scientific psychological tradition has prevailed for decades, influenced by positivism.
The context, the group, the culture and values, the constitutive nature of the language, etc. They are elements that have come to enrich and expand the approaches in current psychotherapies, going beyond the merely individual and intrasubjective approach.
Author: Diego Albarracín Psychologist from El Prado Psychologists, expert in Clinical Psychology and Psychoanalytic Psychotherapy. Higher training in Gestalt Therapy. Sexologist. Mediator.
