Integrative approaches to counselling
Published 3 December 2021. Written by Chris Worfolk.
Many practitioners use an integrative approach to psychotherapy, using more than one school of therapy in their approach to helping clients. In this article, we will discuss the types of integration and the practical issues around using them.
What integrative is not
First, let's consider what to avoid when using an integrative approach.
Whenever we learn about a new modality, we are often excited about the benefits it will bring and it can be tempting to pick clients at random and try the techniques out on them. But it is important to remember that our clients are not guinea pigs. We need to consider what is best for them, not what we have just learnt and are excited about.
Integrative is also not about mashing techniques together at random and seeing what works. It is important to take the time to consider how we are going to integrative two or more techniques and whether it is appropriate to do so. It is something we should decide in the middle of a therapy session to suddenly include.
A single framework is usually a complete package designed to be delivered together. Therefore, extending this to bring in new ideas should only be done after careful consideration. If in doubt, your supervisor is an excellent person with which to discuss your plans.
Many practitioners are technically using an integrative approach even if they are working in a single modality, thanks to theoretical integration. This is where two or more modalities are combined to provide a new modality.
For example, cognitive behavioural therapy is a theoretical integration of cognitive therapy and behavioural therapy. Similarly, mindfulness-based cognitive therapy is a theoretical integration between cognitive and mindfulness.
The advantage of these models is that we get the advantage of the wisdom of multiple approaches but already combined into a single approach for us to use off the shelf as it were. The new modality provides a unified model for how therapy works while bringing in ideas from both.
Some practitioners are trained in multiple schools of therapy and may use a different approach with each client. For example, someone trained in person-centred and solution-focused may decide to use person-centred with client A and solution-focused with client B.
This approach allows a range of different approaches to be used without the confusion of having to fit them together. The practitioner simply chooses which modality to work in and sticks to that throughout the relationship. This approach is known as eclecticism.
While popular, Arnold Lazarus suggested that eclecticism on its own was not enough. It was too easy for the therapist to decide what to use based on what they were most interested in at the moment.
Therefore, Lazarus put forward the idea of technical eclecticism in which a practitioner must carry out a careful assessment with the client to identify what type of therapy would be most helpful to them. This cautious approach in which no technique is selected until after the assessment helps ensure that the decision is based on the client's needs.
The assimilative approach is not a model in itself but the concept that as a counsellor continues their education, they assimilate new knowledge into their practice.
This may involve working in a single modality but allowing the wisdom of other schools of psychotherapy to influence the way you deliver your primary approach. In short, the idea is that learning more is usually a good thing.
Many types of therapy converge on certain ideas. For example, both person-centred and solution-focused advocate a client-led approach. Similarly, acceptance and commitment therapy's defusion concept is very similar to metacognitive therapy's detached mindfulness approach. As we learn and grow, we see common ideas emerge and new ways to utilise them.
Advantages to integrative
Using an integrative approach gives us a wider range of options to help clients. Some clients may respond better to a certain approach and having the flexibility to deliver therapy in that manner may suit them better.
Of course, if they are looking for a specific modality and we cannot deliver that, we must make an ethical referral to someone suitability qualified. But if it does fall within our remit, we can capitalise on the existing therapeutic alliance that we have built with the client.
It is unlikely that there is a single truth in one school of therapy and more likely that each contains many truths. Combining these may present us with the closest alternative to a single best approach.
Disadvantages of integrative
While integrative seems attractive, the disadvantages are also numerous.
It requires a lot of training. Learning one modality is hard enough but to learn several and understand how each one works and best to apply it is a significant challenge.
We also need to ask ourselves to what standard we can deliver multiple modalities. Sticking with one school allows us to get very good at that approach whereas if we divide our time between multiple approaches we may find ourselves a jack of all trades and a master of none.
Different models may present conflicting ideas about why difficulties arise, how we should deal with them and even how we manage the therapist-client relationship. How do we reconcile these conflicting ideas?
A single therapy gives us a framework to work within and a common language to explore the problem. This may be lost when using multiple approaches. Finally, it can also create difficulties in supervision for the same reason: are you and your supervisor able to communicate ideas clearly to each other without a common framework?
Integrating multiple approaches to counselling is popular with practitioners and can provide clients with a greater range of options to suit their needs.
However, integrative techniques should not be used without carefully considering the client's needs as well as the method of integration.