It is worthwhile to keep revisiting this question. There is some solid evidence - examining 40+ years of outcome research across various disciplines - regarding 'common factors' in psychotherapeutic approaches that constitute key ingredients for efficacy in assisting people to achieve positive change.

Writers I have been particularly drawn to, and often refer my students to, are:

Miller, S. D., Duncan, B. L., & Hubble, M. A. (1997). Escape from Babel: Toward a unifying language for psychotherapy practice. WW Norton & Co.

Thank you Melissa,

I also like this book and the others of these author group. Their work is a really great contribution in this discussion. Do you think common factor approaches are the right way in psychotherapy integration? And why and how?

Regards Thomas

In the Miller, Duncan, & Hubble (1997) text, the 40+ years of outcome research showed evidence for a 4-factor model:

* the importance of the therapeutic relationship to effect change (30% of change attributable to this),

* the importance of hope/placebo (15%),

* the importance of our models/theories (a modest 15%),

* and also to remind our students (and ourselves) that we need to keep in mind the capacity of the client themselves, their environment and other factors in their lives to effect change (40% of change due to 'extra-therapeutic factors') - e.g. getting a job, a partner, a friend, a dog...

I think it's time for psychotherapy integration. You may take a look on the publications enclosed.

Article An integrative model of counseling

Enclosed a cultural approach to psychotherapy Integration.

Article Goethe's Anxieties, Depressive Episodes and (Self-)Therapeut...

Another look on integrative counseling that may be applied to psychotherapy too.

Article [Effectiveness of Integrative Psychotherapeutic Counseling f...

Rainer,

Thanks for your publications. Nice to meet a neighbor on researchgate.

Rergards Thomas

Nice to meet all of you. I am foremost a follower of Carl Rogers (see wikipedia), his student Nat Raskin (also of person-centered work) with Barry Stevens, a Cornellian who began with psychologists of all time (from Jung to Freud to Allport) to working colleagues who are from Tavistock (R.D. Laing, and my colleague David Towell), community psychology (community studies, and John O'Brien of person-centered work), and behavioral psychology (with lifestyle approach, also special educators Rob Horner for 200 refereed articles).

The word integration implies combining into a whole in which the characteristics of a factor are lost. In that case what is the whole into which the integrated factor is combined.

I suggest the word synthesis that has a similar meaning but is, in my opnion, a more appropriate word for the context of this question. A therpist may be trained in one or a few theoretical models. However, the therapist's persona and thinking are filters through which any model or combination of models are used. A therapy strategy is developed based on the problem(s) a client presents and the therapist draws from her/his pool of knowledge, skill and ability to implement the strategy. Therefore the synthesis of models occurs automatically and serially within the framework of the client-therapist relationship and the treatment process.

The best that we appear to know is that some therapies work for some people some of the time none work for all people all the time (explaining the ongoing and irresolvable arguments now extant) and perhaps the so called common factors (i.e. the relationship, charismatic behavior of the professional, a viable story of why the approach works and a large potion of placebo) are the most telling elements held by all of these change efforts.

I believe that if we remove the mythological and mystifying power of the word "therapy" we are left with an education process. A process noted throughout the therapy literature, but not very clearly acknowledged. I am developing this approach now as a potential self educational model that completely demedicalizes the process and looks at it as a problem solving educational procedure about problems in living some of which are very severe.

Psychotherapy can and should be integrated in general practice

Please consider integration with advanced molecular imaging of the brain's neurochemical response to psychotherapy. Very interesting study showing serotonin receptors up-regulate in response to psychotherapy:

Karlsson H, Hirvonen J, Kajander J, Markkula J, Rasi-

Hakala H, Salminen JK, Nagren K, Aalto S, Hietala J

(2010) Research letter: Psychotherapy increases brain

serotonin 5-HT1A receptors in patients with major

depressive disorder. Psychological Medicine 40:523–8

My $0.02 follows. I agree with Thomas Blakely's comment that synthesis better describes the use of multiple techniques and theoretical approaches. I also agree with Tomi Gomori's comment that no one approach works for every patient every time. Thus, the more tools in the armamentarium, the more material one's therapeutic self has to draw upon to meet the patient's need in a particular moment.

I find that many patients appreciate the sense of control, increased self-efficacy, and real progress gained by having specific tasks to accomplish between sessions. Most of the tasks that I use for this purpose come from behavioral, cognitive, mindfulness, and other theoretical models...even if I may be conceptualizing the patient from more of a psychodynamic approach. IMHO, like the blind men describing the elephant, we have many theories that attempt to explain--but fall well short of--describing what it is to be human. A synthesized approach to therapy humbly accepts the shortcomings of any one theory. There is a satisfying empiricism in trying an approach with a patient, observing the patient's reaction and progress, then adjusting one's approach based on that observational data. I learned that from a learned self-psychologist.

I think any approach whether applied as a synthesis of more than one or as used as a whole will have a positive outcome for the client as long as the approach is used with a high level of skill. I've met various therapist who uses only one approach but there skill makes it a natural fit for how they work. I've also met therapist who tries so hard to use one that they think will fit the client but is not neccesarily a good fit for them as a practitioner, These one invariably fail. If effective synthesis can be achieved using more than one approach it needs to be used skillfully and be congruent with the practitioners own natural tendencies and beliefs.

There is a huge difference between the external nature of what is happening between the client and therapist which may be addressed at the higher cortical functions of the client and the internal nature of the way that the client's and the therapist;s autonomic nervous systems are interacting which probably drives actual treatment success. I think an integrated approach really could be taken as meaning both a top down and bottom up awareness on the part of the therapist of first, his or her own state of being and then how that is interacting with that of the client. The goal of therapy to me is to live a fully embodied life, free to feel and love and grow, but no longer controlled by the old and necessary coping strategies, both top down and bottom up, that created the programs for perception of threat and survival and for living that resulted in the dysfunction that is currently presenting itself in therapy. The form the integration takes will be a function of what the practitioner is drawn to learning and hopefully continues to evolve as the practitioner continues to grown in exactly the same directions. No one I know is actually "there" because there really is no "there."

The current state of psychotherapy integration is poor because the current trend emphasizes hard empircal measures and de-emphasizes empathically sensing the subjects' inner state. This works against integration because it excludes dynamically oriented approaches where hard measures have not yet been developed and admits aprpoaches that support hard measurment, the latter being weakly connected with the subject's inner state. The prevailing belief, held almost universally in psychology and psychotherapy that quantification of subjective states is impossible further retards conceptual approaches that support integration because mathematical representation is a fundamental key to integration of concepts in any domain, a thing easily seen in the 'hard' sciences..

Thanks a lot for your answers.

I agree with Rainer, that it is time for integration (or synthesis).

I like the answer of Thomas Blakely , that synthesis is perhaps the better concept. And I agree with Tomi that the mystifying power of the word ‘therapy’ conveys questionable aspects and contributes to mystification.

Terry I am really interested in brain mechanisms or correlates associated with psychotherapy. But I am not sure about the synthetic power of these results because currently it seems to me, that it is technically impossible to discriminate different psychotherapies, approaches or even techniques and effects by brain imaging (perhaps I do not know enough).

I agree with Phyllis, that there is a huge difference between the external nature of what is happening between client and therapist and what happens internally. I also agree that the autonomic nervous system and in the end the body as a whole plays a relevant role.

And I also see, what Anthony stated, that integration is poor because subjective aspects play an important role.

The phenomenon of psychotherapy is really complex. But not trying to synthesize in my opinion will lead to severe problems in e.g. psychotherapy research, institutionalization of psychotherapy, and in training programs.

Human interaction - and most psychotherapy approaches can be understood as a paradigm of human interaction - is not easy to conceptualize. One of the main questions of synthesis or integration is, how interaction influences behavior and experience in a way that therapeutic goals can be realized. It also seems to me that the technical terms, the approach depending languages and concepts (e.g. behavioral, psychodynamic, naturalistic) are not really sufficient, as I think Melissa stated with the recommendation of the book of Miller, Duncan and Hubble (Escape from Babel).

And in an epistemological perspective the problems are huge too. Therapeutic goals are different, as well as diagnostic foci as well as therapeutic techniques. And concepts are different. Sometimes different concepts refer to comparable phenomena. Sometimes the same words mean different phenomena. And the link between concepts and empirical observations are often weak, confusing or even do not exist or are impossible.

But in my opinion things could develop better when we try to teach the next generation in more than one approach. So one of the keys could perhaps lie in education. By this probably we could support future developments of synthetic approaches.

Additionally, one of the problems of psychotherapy integration / synthesis seems to be the justification pressure of health care systems that supports or prefers specific approaches and by that institutionalize virtual differences (and in a different way in different countries).

Regards Thomas

Zunächst bitte ich um Entschuldigung, dass mein Englisch mir nicht gut genug erscheint, meinen Beitrag in der hier üblichen Form hinzuzufügen -

Um eine allgemeine Psychotherapie, in der alle Schulen ihre Theorien und therapeutischen Strategien einbringen könnten, zu formulieren und damit das inhaltlich zu leisten, was man "Integration" oder "Synthese" nennen mag, müsste nach meiner Überzeugung nicht von der Therapeuten-Perspektive ausgegangen werden, sondern davon, was denn eine erfolgreiche Psychotherapie aus Patienten/Klienten-Sicht charakterisiert.

Aus Pat.-Sicht ist das Ergebnis einer erfolgreichen Psychotherapie so zu beschreiben, dass der/die Pat. in die Lage versetzt wird, seine/ihre Geschichte so zu erzählen, dass alle Fakten darin ihren Platz finden, die Geschichte einen Sinn ergibt und sich daraus neue Möglichkeiten ergeben, im Leben und mit schwierigen Situationen zurecht zu kommen.

Dieses Ziel der gemeinsamen Arbeit aus Patientenperspektive (zu dem es sicher viele, schulenspezifisch unterschiedliche Wege gibt) scheint mir leider in den akademischen Diskussionen über Definition und Verwendung von Begriffen aus dem Blickfeld der Therapeuten verlorenzugehen, was im Denken auf Therapeutenseite vermutlich eher die Konkurrenz als die Wahrnehmung von Gemeinsamkeiten fördern dürfte.

For anyone interested in the topic of psychotherapy integration you will likely find many kindred spirits and very stimulating discussion in the Society for the Exploration of Psychotherapy Integration (http://www.sepiweb.org/). SEPI is an international organization founded some 40 years ago by leading psychotherapy scholars of various theoretical backgrounds.

Man erfindet offenbar grad NLP neu. Und das ist ok. Genau das war die Grundidee: evidenzbasiert ohne Paradigmenscheuklappen das zu verwenden, was funktioniert. Übrigens gehen die wenigen "Studien" zu NLP-Techniken (die es ja "als solche" kaum eigenständig gibt, das wirklich Neue war die offene Herangehensweise an alles Mögliche, da sind uralte schamanische Praktiken dabei, z.B. EMDR/Scheibenwischer) zumeist von unzutreffenden Hypothesen aus, z.B. dass über Augenbewegungsmuster Lügen entlarvt werden könnten. Tun sie nicht, behauptet aber auch niemand. Ich halte es für wissenschaftlich unsinnig, wenn solche komplexen Gebiete von Theoretikern untersucht werden, die keine Ahnung haben, welche Fragen genau sie stellen sollten. Falsche Fragen, falsche Antworten.

Wenn wir die integrative Psychotherapie (oder wie immer man den alten Wein nun neu titulieren mag) als komplexes, aber hervorragendes Werkzeug ansehen, dann müssen wir erkennen, dass ein hervorragendes Werkzeug allein noch nichts tut - man muss auch mit ihm umgehen können. Kaluzas Stresskonzept kann auch der unbegabteste behavioristische Holzhacker lernen, auf dieser platten Oberfläche geht kaum was daneben. Für feinere Werkzeuge wird der gekonnte Umgang immer wichtiger. Fingerspitzengefühl. Kommunikationstechnik.

Und DAS ist eine der Hauptkomponenten, die aber experimentell, soweit ich weiss, bislang nicht kontrolliert wurde. Rubbish in, Rubbish out. Da hilft mechanistisches Starren auf tanzende "p-Werte" (Cumming) auch nix.

Statt NLP hatte ich eher die OPD Achse I (Krankheitserleben und Behandlungsvoraussetzungen) im Sinn, die in der praktischen Anwendung ja einen Hinweis bzgl. Indikation zur Psychotherapie liefern kann und insofern möglicherweise auch zur Messung von Veränderungen vor vs. nach erfolgter Psychotherapie genutzt werden könnte.

Clinicians often sense intuitively that a certain approach will have a greater likelihood of helping a certain person than others. Research is focusing on personality, motivational, genetic and other variables that may interact with therapeutic approach and make it possible in the future for clinicians and researchers to cooperate in building models matching those needing or wanting psychotherapy with the best approach for them.

Dear Thomas

the common factors are the most important effective factors.

Wampold et al. (2005, p.204) state that "the variance of outcomes due to therapists (8% -9%) is larger than the variability among treatments (0% -1%), the alliance (5%), and the superiority of an empirically supported treatment to a placebo treatment (0-4%). "13% or more of the clarified variance thus result from the treatment (therapist effect, alliance, art, allegiance). They correspond to the constant proven ES of d = 0.8 for psychotherapies.

Historically, the findings on this " therapist effect" are a reconstruction of psychotherapy in terms of a heterodox technique, ie a methodology that adaptively develops focally and goal-oriented and contextually the interaction events between therapist and patient. This is a late- recognized heritage of psychoanalysis in the pedigree of psychotherapy. It is therefore no coincidence that it was a psychoanalyst , that died in 2004 S. Rosenzweig (1936 ) , the "common factors" was the first to become the focus of psychotherapy outcome research in the amazingly young age of 29. B. Duncan , therefore, calls him approvingly the "founder of the common factors" (Duncan et al. 2010, p 3).

" In conclusion, it 'may be said that given Name a therapist who has to effective personality and who Consistently Adheres in his treatment to a system of concepts Which He has mastered and which is significant in one way or another adepted to the problems of a sick personality , then it is of comparatively little consequence what particular method the therapist uses " ( Rosenzweig, 1936 , p 414).

Bio-psycho-social. The ability to bond with an individual (Wampold, 2012) is the first and foremost important step. Once trust is ignited an eclectic facilitation in guiding the client to reach their own answers by drawing on their biological experiences, psychological perspectives and social influences/pressures. Hopefully empowering and building hope along the way. I am not sure of the source (apologies) but a professor told me a while back that research showed, that how much a therapist believed in a treatment was the only significant predictor of therapeutic outcome for treatment type. Highly debatable... but a stimulating thought.

Dear all,

I am probably not even close to your expertise in this field, as a part-time PHD student, but I am pretty interested in this subject.

Apart from integrating the various psychological models, I think integration of psychological and physiological models could be an interesting approach.

If I am not mistaken, this is called psychoneuroimmunology (PNI).

Reading articles such as:

Analyzing the Impact of Stress:

A Comparison Between a F actor Analytic and a Composite Measurement of

Allostatic Load by J.G. Buckwalter et al. and

Psychoneuroimmunology and health psychology:

An integrative model

Susan K. Lutgendorf and Erin S. Costanzo 2002

I think this could be an interesting way to go for various reasons.

One is that in my opinion it somehow fits with the approach of Damasio who demonstrated that the rational and emotional field are intertwined. It also fits with the observation that stress might pop up within the cardio-vasculair domain, but could lead to 'pure' psychological distress as well.

I fully agree with the statement of Phyllis Stein "the higher cortical functions of the client and the internal nature of the way that the client's and the therapist;s autonomic nervous systems are interacting which probably drives actual treatment success"

But now, suppose that the development of biometric solutions of which many are currently developed in Silicon Valley can provide us with better indications of physiological and/or psychological stress resulting from an external stimulus (eg during a psychological intervention) or an internal stimulus (eg by an upcoming thought/ feeling) that might help us to track back the source of the stressor.

In other words: with very refined biometric instruments, we might come to the point that we could measure stress responses from our automatic nervous system and could find the related stimulus.

That could be a way to change the stimulus-response relationship, which in the end is what all therapies are about.

I realize this is for the future: we are currently at the level that stress indicators such as hart reate and hart rate variability and hormons such as the cortisol level can be neasured, which is certainly not subtle enough.

This might change, though.

Does any of this makes sens?

Regards from the Netherlands,

Mark

Hi all,

Few interesting points to ponder about:

Research reveals that client-therapist relationship is the strongest predictor of positive outcome (Lambert and Ogles 2004) compared to theoretical modality, technique, or years of experience (Christensen and Jacobson 1994).

In respect of what clients are looking for: worldwide survey found that 48% of adults in Australia, 70% in Canada, 75% in France, and 38% in USA use some form of alternative treatment.

And than looking at therapists' practices: a poll which surveyed clinical psychologists, marriage and family therapists, psychiatrists, and social workers has documented that 59% to 72% endorse eclecticism as their preferred approach (Jensen, Bergin, & Greaves, 1990).

In respect of integration there are two aspects to consider:

- Integration of mind-emotion-body-spirit aspects (holistic approach)

- Willingness to incorporate practices and techniques from different schools or orientations.

Different clients would require different treatments and relationships. Research shows that tailoring psychotherapy to patients’ stage of change, preferences, culture, coping style, and religion/spirituality improves the effectiveness of psychotherapy.

Postmodern thinking describes two relevant aspects in relation to psychotherapy integration (Safran, J. & Messer S., 1997) :

1. Contextualism - An event cannot be studied as an isolated element, but only within its setting. Quality is the total meaning of the phenomenon, e.g., "Lemon, sugar, and water are the details of the taste, but the quality of lemonade is such a persistent fusion of these that it is very difficult to analyze out its components" (Pepper, 1942, p.243, after William James).

2. Pluralism - The postmodern notion that there is more than one correct theory or perspective by which to view any phenomenon and the attitude that absolute certainty is attainable. Seeing how other theories get a grip on the world can lead to enhanced understanding and improvement of the theoretical ground on which one stands (Nozick, 1981). Pluralism acknowledges that there are multiple perceptions of truth, each one influenced by the context out of which the perceiver arises in making his or her judgments. In the natural sciences it is recognized that multiple, contradictory theories are necessary to capture different aspects of the underlying phenomenon, and that a given theory captures some of these aspects at the expense of others (Nozick, 1981).

John Stuart Mill (Cohen, 1961), a strong advocate of empirical methods in scientific procedure, argued that a plurality of views is critical for the following reasons:

1. A view which one rejects may be true nevertheless, and to reject it assumes one's own infallibility.

2. A problematic view may contain some portion of the truth since the prevailing view is never the whole truth. It is only by collision with contrary opinions that the remainder of the truth has a chance of being recognized.

3. A point of view that is wholly true, but not subjected to challenge, will be held as a prejudice rather than on a rational basis.

4. Someone holding a particular point of view without considering alternative perspectives will not really understand the meaning of the view he or she holds.

5. Decisive evidence against a perspective only can be articulated once an alternative perspective is advanced. This results from the fact that evidence in the absence of theory is meaningless.

In conclusion, I would agree with Safran J. & Messer S. (1997) that we need atmosphere of confronting and discussing difference and an ongoing dialogue and not an uncritical acceptance of all therapeutic orientations and techniques.

Hi, I am only just graduating but I believe that, with regards to eclecticism, the definition of eclecticism highlights the use of techniques without regard to theory (Hollanders, 1999) but, attempting to improve therapeutic outcomes without creating new theories or models could become convoluted. Therefore, in agreement with McLeod (2009), there must be some basic criteria set in place for aiding the therapist in the decision making process. Perhaps a more pluralistic approach, as advocated by Cooper & McLeod (2011), is more appropriate for tailoring therapy for the individual. This proposed bringing together of the vast wealth of knowledge within counselling and psychotherapy; the development of a new paradigm with a commitment to respect across orientations; full collaboration with service users and; a desire to understand all the ways in which clients can be helped, could help to allow the integrative movement to flourish further, with the most important piece of the jigsaw, that of the therapeutic relationship between client and therapist, firmly in place.

I wanted to re-raise 2 of Tomi Gomori's really useful points: 'some therapies work for some people some of the time none work for all people all the time' and 'if we remove the mythological and mystifying power of the word "therapy" we are left with an education process'.

I agree that the importance of an educational process is present in the therapy literature, but 'not very clearly acknowledged'.

Excellent to hear of your work Tomi in developing this approach as a self-educational model, using a problem-solving approach.

There is real usefulness and efficacy (and transparency/honesty/trustworthiness) in taking on a problem-solving approach as a core approach (since consumers/clients/patients consistently present with 'problems' as they experience them).

Eclecticism is difficult to argue for.

Many therapists do indeed describe their practice as 'eclectic', but this is typically when they have been practicing for some years and their skill base has become less self-conscious, and further they acknowledge they use different approaches with different clients or the same client at different phases of therapy (a multiplicity of practice approaches).

When you discuss what the therapists predominantly do in therapy though, and what informs this/what they draw on, it typically becomes evident that skilled therapists are not 'eclectic' so much as use 2-3 core knowledge bases and/or core models/approaches in deliberate and applied ways. I think it is important we stay aware of this and acknowledge these in our practice for transparency and rigour.

I think many of integrated modelş have not theorical foundation. But for most clients in the therapy, single approach isn't sufficient. For this reason integration is useful in psychotherapy.

In my opinion, any of integrated approach should be formed to the needs of each patient.

I have work for quite some time in psychotherapy integration and I think that theoretical integration ends up in another theory, maybe more comprehensive, but another clinical model. What are we integrating? Do we need more comprehensive models? However, the question on psychotherapy integration has opened up our minds so we can study and review other approaches that we never used to take into account. The questions leads to a dialogue among models, a dialogue that I think is very important. It is amazing how different models sometimes propose similar things in different words. Maybe clinical models have more in common that we are able to recognize!!

In the realm of technique I really think that every model becomes short and not every therapeutic technique works for every one. And that is something we have to study:What works for whom, not in the sense of what manual works with what pathology but what verbal and non verbal interventions are more effective with whom-The enterprise is big!

Psychotherapy should be integrated into primary care setting. There is new studies suggesting primary care integration can save a lot of money.

It seems to me that the key to psychotherapeutic integration is for the therapist to not superimpose any preconceived, presumptive, exclusive theoretical model on the client, but, instead, to empathically tune into the client's actual experience and dynamically changing feelings, from moment to moment. That lack of complex, divisive, compartmentalized theoretical "baggage," distancing interpretation, and the related process of unmediated direct empathic experiential communion with the client, enables the therapist to view the client in a more holistic, integral manner. Furthermore, the therapist should encourage clients to be open to directly experiencing their own issues and feelings without superimposing any preconceived interpretations, predetermined outcomes, self-control, self-censorship, or partisan value judgments upon themselves. The absence of such distancing preconceived interpretations and partisan value judgments enables clients to integrate and heal their psyche by eliminating the illusory sense of separation, division, or duality between the interpreter and the interpreter, knower and known, controlling value judger and controlled or censored value judged feelings, approved and disapproved feelings, and so on. This process of nonjudgmental, non-abstracting, non-distancing, empathic attunement is the key to developing good communication, experiential understanding, and caring closeness in interpersonal relationships as well as in psychotherapeutic work, as I discuss in my two recently published books (Please see the enclosed attachment and/or my ResearchGate profile for more information about my books, and their relevance to enhancing the effectiveness of psychotherapy, psychological self-help, and developing psychologically healthy personal relationships, with empathic experiential intimacy, genuine deep caring, and good communication.

I agree with Barry that genuine caring and empathic attunement is the most beneficial and healing aspect of psychotherapeutic relationships. Research very much supports the notion that client-therapist relationship is the strongest predictor of positive outcome in psychotherapy (Lambert & Ogles, 2004).

Knowledge of various approaches enhances therapists' capacity for exploration of multiple perceptions that might be even contradictory to his/her own beliefs in order to help clients' understand and deal with complex life issues.

In my view, therapists' willingness to integrate practices and techniques from different orientations, blended with holistic approach and empathic processing elevates psychotherapy from a skill to art, and psychotherapist to an artist.

References:

Lambert, M. J., & Ogles, B. M. (2004). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.), Handbook of psychotherapy and behavior change (5th ed.). New York: John Wiley & Sons.

The Challenge seems to be the Balance between common theoretical models on one hand and the individual, personal understanding and relationship between patient and therapist on the other.

I agree with Eva, managing that challenge is key.

Love is not enough. Lambert's numbers are not to be taken literally. The relationship is important, to the degree of being necessary to deliver effective treatments, but all of the findings are with bona fide treatments. And many of the numbers are from CBT style therapies, most of the studies included in Wampold 97 are CBT style. Often one will find that the suggestion that there is low variance explained by therapy type is due to low variance of therapies in the studies (they are in general all short-term and structured). One cannot just do anything and hope that it works.

I agree with many of the points on integration and eclectisism above. At the same time there is much common ground between a lot of theories. E.g. Beck's cbt's pathology model, due to his training as a psychoanalyst, is clearly part of that tradition.

My favorite example is Tom Borkovec's approach to treatment of GAD. In his conglomerate apporach he incorporates Jacobson's relaxation, Beck's CBT, and lately mindfulness and interpersonal psychology. The important thing is that the model is empirically tested, compared to the lone therapist making an eclectic or integrative mix in random sessions. While the treatment is more effective than Öst's relaxation alone, it would seem that it does not increase in effectiveness automatically as a function of including many effective modules. Recent research suggests that the Dugas et al Intolerance of Uncertainty and especially Wells MCT may be more effective. Maybe there are some benefits of integration; I would still recommend attempting to find the pathogenic processes, and attempt to provide specific methods to treat them.

To whatever degree identifying a "pathogenic process" may be worthwhile in a given situation, I don't understand how this could be done absent consideration of pertinent theoretical models i.e. the imputed process will be appreciated in terms that are consistent with one or another- or of several models- and the thoughtful application of any theoretical approach and attendant methods will entail consideration of the similarities, differences and potential relationships between explanatory frameworks that may contribute to a holistic appreciation of the clinical opportunity. No?

Any theoretical model that provides an explanation for the problem, that is new and plausible in the eyes of the patient (what I think is at a great deal a matter of the kind of relationship between therapist and the client - maximum with placebo!) may serve to create new solutions. And any solution may turn into a variation of the problem, if applied too often ...

At the recent meeting of the Society for the Exploration of Psychotherapy Integration held in Baltimore last month, I participated in a structured discussion organized by Sarah Bloch-Elkouby & entitled "Shall the Twain Ever Meet?"  The participants also included Stan Messer, Paul Wachtel, George Stricker, Louis Castonguay, Golan Shahar, & Catherine Eubanks.  One thing that emerged in the discussion was the recognition of a generational difference: The senior guard of Messer, Wachtel, & Stricker became integrationists during the course of their careers, while the others were identified with & trained as integrationists from the start.  There seemed to be agreement that integration has mainstreamed or boundaries have so permeable & indistinguishable that it nearly impossible to identify anything as discrete or pure.  Food for thought... 

Therapy integration is a thing that should take place because any one modality will tend to see an aspect of the total process not seen by all the others.  Forming the sum of all modalities would be facilitated by invoking mathematics for a number of reasons.  For one, it represents form and, in any one case, gives rise to testable hypotheses. For another, it is inherent in the mathematics of any one model for it to define what other models it can be merged with in an internally consistent way. This is the way the 'hard' sciences build their models and a significant obstacle to this taking place in a 'soft' science such as psychology is the false belief that psychological concepts cannot be represented mathematically.  This is not about using statistics, which is about data analysis and not about representing form.  It is about using pre-existing disciplines such as topology, algebra and the calculus, all of which emerged in efforts to represent various phenomena in nature.

If I understand the question correctly, I would say that we need to understand what are the differences in the essence of therapy approaches, and then to decide whether and why we may need their integration. As a post-modern therapist, I am open to colleagues who follow different approaches than myself, but I know that other therapists (post-modern or not) are not that open. Similarly, I am thinking of medical doctors who are trained the "traditional" way who may or may not accept holistic medicine or homeopathy. Do they need integration or not? and why?

In our co-authored article, "Healing Emotional Pain and Relationship Pain", my late father and co-author, Dr. Max Hammer, and I, discuss the process of integrating the individual psyche, or restoring the psyche's natural wholeness, by embracing previously estranged feelings and experiential states, and by connecting in a caring way to other individuals. The article can be accessed either by using the following URL link, or by using the enclosed file attachment:

https://www.academia.edu/12371857/HEALING_OUR_EMOTIONAL_PAIN_AND_RELATIONSHIP_PAIN

Here, below, is an excerpt from the article which summarizes our view of psychotherapeutic integration:

"We have an innate urge to restore our natural wholeness of being by reunifying with formerly estranged, disturbed, self-conflicted, aspects of ourselves. When we stop struggling against, distancing, identifying with, taking a judgmental partisan stance for or against, or being overly dominated by emotional negativity or conflicted, disturbing aspects of our energy, then our energy is thereby liberated from self-division and self-conflict, which makes our energy, feelings, and behavior less tense, less negative, and produces greater inner relaxed peace, fulfillment, and wholeness of being. That inner wholeness is also our natural psychotherapeutic healing, health, happiness, wholesomeness, and holiness, not an idealized perfectionistic holiness, but attunement to what is naturally easeful, harmonious, regenerative, sacred, precious, beautiful, truly good, and life-affirming in ourselves and others. Dr. Max Hammer’s psychotherapeutic dictum, 'Wholeness heals!' reflects this view that compassionately embracing and reunifying with uncomfortable, turbulent feelings, energies, and experiential states in ourselves, is the key to restoring our natural wholeness and wellbeing, as well as similarly healing or constructively resolving unnecessary discord and experiential distancing or estrangement in our interpersonal relationships by empathically embracing or nonjudgmentally, compassionately, intimately or non-dualistically contacting the experiential wholeness of other individuals, including their experiential negativity."

Georgios:I agree that we really do need to look at the components of treatment to see what works. The homeopathy stuff, however, is just "wooo", with no evidence at all to support it. So I wouldn't be too quick to accept those sorts of ideas.

Barry: your approach sounds fascinating, and (with some changes in language) very similar to many of the mindfulness based approaches such as ACT. There is a growing awareness, with increasing data to support it, that helping the client to accept the transitory quality of  thoughts and feelings, and not get caught up in the "trueness" of them is very useful. I find the danger of such approaches to be the slipperiness of boundaries, and the ease with which one can move from clear, well defined concepts, to more vague and amorphous ideas, difficult to actually do research on.

Psychotherapy is essentially a conversation between two people in a positive relationship, one of whom has a knowledge base of human behavior and the other a need to know how and why adaptation and social functioning have been affected by negative experiences especially those with the primary caretaker. These experiences create neural pathways that are stored in the emotional center of the brain. They contribute to the internalization of a negative self. They continue to seek expression and are responsible for dysfunctional behavior. The goal of psychotherapy is for the therapist to use the knowledge base to teach realistic thinking about erroneous  interpretation about developmental events that have generated negative feelings. As self-awareness increases through thinking, changes in behavior and improved adaptation and social functioning will occur.

Some thoughts on various understandings of psychotherapy integration discusssed in this thread.

It is useful I think to consider that integration or synthesis of evidence into a coherent theoretical framework is a fundamental process in the sciences including the social sciences. In this sense then e.g. failing to discriminate different effects or models via brain imaging would not be an impediment but a "clue".

A second, distinct and important but perhaps derivitive question relating to psychotherapy integration is how an evidence informed integrative psychotherapeutic orientation is effectively implemented in applied settings. Different - perhaps more specific sorts of heuristic process models may prove to be more useful than overarching theory for practicing clinicians in a given domain of practice.

Some of the comments in this thread are pertinent to integration as a therapeutic process rather than to the topic of psychotherapy integration per se.

On another point (by Tomi Gomory), yes psychotherapy does involve education or shared learning but, in my view, the cultural context in which it occurs meaningfully distinguishes it from "mere" education. Demystifying psychotherapy, to the degree that that may be desirable - it seems to me, can more usefully occur through appropriate discrimination of the differences not by obscuring them.