MSc Integrative Psychotherapy

What is Integrative Psychotherapy?

Integrative Psychotherapy is composed of a collection of developmentally-based and relationally-focused concepts about the practice of psychotherapy. The theories and methods of Integrative Psychotherapy serve as a blueprint for the psychotherapist to facilitate clients’ internal integration of physiological sensations, feelings, thoughts, and actions. In short, integration means becoming whole, with full access to all that one is and may become. The term integrative refers to the full synthesis of affective, behavioural, cognitive, and physiological theory and methods of psychotherapy as well as the outcome of psychotherapy – the integration or assimilation within the client of the fragmented or fixated aspects of the personality.

The original and primary meaning of “integrative psychotherapy” was composed by Dr. Richard G. Erskine in 1972 while he was a professor at the University of Illinois. Integrative Psychotherapy is about the process of integrating the personality. It involves the psychotherapist facilitating clients‘ development of a comprehensive and congruent narrative of their sense of self; replacing archaic means of self-protection with mature forms of self-stabilization and self-regulation; and, becoming aware of unconscious relational patterns so that the person can learn and grow from each experience in life.

Integrative Psychotherapy involves the process of making whole: taking disowned, unaware, unresolved or fragmented aspects of the self and integrating them within a cohesive entity. Through integration, it becomes possible for people to engage the world with full contact and to have the courage to face each moment openly and freshly, without the protection of a preformed opinion, position, attitude, or expectation. An objective of Integrative Psychotherapy includes having each person assume personal awareness and responsibility so that their behaviour is by choice in the current situation and not stimulated by compulsion, fear, or conditioning. This is accomplished in part through the use of the therapist-client relationship — the ability to create full interpersonal contact in the present as a stepping stone to healthier relationships with other people and a satisfying sense of self.

The word “Integrative” of Integrative Psychotherapy also refers to the integration of theory, the bringing together of affective, cognitive, behavioural and physiological dimensions of human functioning, within a relational system. The concepts are utilized within a perspective of human development in which each phase of life presents heightened developmental tasks, need sensitivities, crises, and opportunities for new learning. The quality of the therapist to client relationship is viewed as the central factor in the success of psychotherapy.

Child development research and literature provide a variety of insights into how children grow and learn, how relational disruptions and the resulting internal distress are accommodated and compensated at each developmental age. To implement an in-depth Integrative Psychotherapy, it is essential to work from a developmental perspective. The literature on human development also leads to the premise that the sense of self and self-esteem emerge out of contact-in-relationship. Developmental concepts provide the basis for developmental attunement, forming developmental images, phenomenological inquiry, and therapeutic inferences that allow implicit and procedural memory to be expressed in a therapeutic narrative.

Even though Integrative Psychotherapy makes use of concepts from several schools of psychotherapy it is not eclectic because the various theories of personality and therapeutic methods are based on the central organizing principle that people are inherently relationship-seeking and that psychological distress and dysfunction are the result of accumulated relational disruptions. For a theory to be integrative it must also separate concepts and ideas that are not theoretically consistent, in order to shape a cohesive theoretical core with constructs that inform and guide the psychotherapeutic process.

Unlike an “eclectic’ approach, the theories of Integrative Psychotherapy are coherent; each of the theories of motivation, personality, or methods emerges from a basic and clearly defined set of concepts about the nature of human relationships. The concepts of Integrative Psychotherapy incorporate only those aspects of other theories and approaches that fit within a consistent and comprehensive theoretical framework and that have proven to be clinically useful.

The theoretical models in Integrative Psychotherapy are structured to provide the internal consistency and cohesion necessary in a comprehensive paradigm of psychotherapy, thereby qualifying as a distinct school of psychotherapy. The concepts, theories, sub-theories, and interrelated ideas are organized into three classes: a theory of motivation; theories of personality; and, a theory of methods. Recognizing the importance of sound theory building, Erskine (2015) wrote:

Theories of motivation provide a metaperspective that encompasses theories of personality. A theory of motivation determines which theories of personality can be integrated and which are conceptually inconsistent and do not integrate into a unified, comprehensive theory of human functioning. When theories of motivation and personality have an internal validity and consistency, they work together as a conceptual organization for a unified theory of method.

A major premise of Integrative Psychotherapy is that contact constitutes the primary motivating experience of human behaviour. Contact is simultaneously internal and external: it involves the full awareness of sensations, feelings, needs, sensorimotor activity, thought, and memories that occur within the individual, and a shift to full awareness of external events as registered by each of the sensory organs. With full internal and external contact, experiences are continually integrated. To the degree that the individual is involved in full contact, needs will arise, be experienced, and be acted upon in relation to the environment in a way that is organically healthy.

When a need arises and is met the person moves on to the next experience. When contact is disrupted, however, needs are not met. If the experience of need arousal is not closed naturally, it must find an artificial closure. These artificial closures are the substance of physiological survival reactions, implicit conclusions, or explicit decisions that may become fixated and adversely influence a person’s life for many years. They are evident in the disavowal of affect, habitual behaviour patterns, neurological inhibitions within the body, and the beliefs that limit spontaneity and flexibility in problem solving, health maintenance, and relating to people. Each habitual interruption to contact impedes full awareness. It is the fixation of interruptions in contact, internally and externally, that is the concern of Integrative Psychotherapy.

Contact also refers to the quality of the transactions between two people: the full awareness of both one’s self and the other, a sensitive meeting of the other and an authentic acknowledgement of one’s self. Relationships between people are built on contact. Both internal and interpersonal contact are necessary for establishing and maintaining relationships. The single most consistent concept in the psychology and psychotherapy literature is that of relationship.

Eight philosophical principles form the foundation of the theory and methods articulated in a relationship-focused and developmentally-based Integrative Psychotherapy. These principles reflect the value system and attitudes toward the practice of psychotherapy.

• All people are equally valuable: It is a therapeutic responsibility to find ways to value every client even if their behaviour or what motivates them is not understood. This involves respecting their vulnerability, as well as their attempts at being invulnerable, while maintaining a therapeutic relationship that fosters a sense of security.
• All human experience is organized physiologically, affectively and/or cognitively: Our biological imperatives require that we make meaning of our phenomenological experiences and that we share those meanings with others in relationship.
• All human behaviour has meaning in some context: All problematic behaviours serve some psychological function such as reparation, prediction, identity, continuity, stability, or enhancement. Before focusing on behavioural change in therapy, it is essential to know and appreciate the client’s phenomenological experiences and to inquire about the various psychological functions that their behaviours serve.
• Internal and external contact is essential for human functioning: In Integrative Psychotherapy, one of the definitions of psychological health is the ability of an individual to be aware of both internal and external processes.
• All people are relationship-seeking and interdependent throughout life: Interpersonal relationships are essential throughout the entire life cycle; they are the manifestation of a biological imperative that provides a basic motivation for human behaviour.
• Humans have an innate thrust to grow. There is a natural force within people to grow, heal, and explore; to express the human capacity to be all that one can be.
• Humans suffer from relational disruptions: A developmentally-based, relationally-focused Integrative Psychotherapy emphasizes a non-pathological perspective in understanding people’s behaviour.
• The intersubjective process of psychotherapy is more important than the content of the psychotherapy: Intersubjectivity refers to the synthesis of two people sharing an experience together; each is influenced by the other. The therapy process is co-created. Therefore, no two psychotherapists will ever do the same psychotherapy — each psychotherapist is idiosyncratic in how they interact with their clients. The therapist’s attitudes and demeanour, the quality of interpersonal relationship and involvement, are just as important, sometimes even more so, than any specific theory or method.

Several research studies have shown that the quality of the therapeutic relationship is the essential factor in behaviour change and psychological growth. For a psychotherapeutic relationship to be effective the psychotherapist must be committed to the positive life change of their clients and must be guided by respect for their integrity. Through respect, kindness, and contact, the constant presence allows an interpersonal relationship that affirms clients’ integrity to emerge. Such a therapeutic relationship:

• enhances each client’s understanding of his or her history and inner experience;
• furnishes each client with a sense that his or her behaviour has an important psychological function;
• fosters the capacity for full internal and external contact;
• provides the opportunity for each client to experience being seen as a unique and valuable human being;
• explores creative options and outlets; and,
• nourishes the possibility of pleasure in relationships.

Within this framework it is recognized that integration is a process to which therapists also need to commit themselves. Thus, there is a focus on the personal integration of therapists. However, while a focus on personal growth in the therapist is essential, there also needs to be a commitment to the pursuit of knowledge in the area of psychotherapy and its related fields. There is an ethical obligation for integrative psychotherapists to seek supervision, to dialogue with colleagues of diverse orientations, and to remain informed of developments in the field.

The focus of the therapeutic work is on the primary dimensions of human functioning: affective, cognitive, behavioural, and physiological — each within a relational system. A major focus of this developmentally-based, relationally-focused Integrative Psychotherapy includes assessing whether each of these domains is open or closed to contact and applying methods that enhance full contact.

The relational methods of Integrative Psychotherapy distinguish it as a unique school of psychotherapy and provide a major contribution to the entire field of psychotherapy. In a developmentally-based, relationally-focused Integrative Psychotherapy the theory of methods can be encapsulated in one sentence: the healing of the physical and emotional effects of stress, repeated relational disruptions, cumulative neglect, or traumas occurs through a contactful therapeutic relationship.  The methods are composed of the therapeutic skills of inquiry, attunement, and involvement; the essence of a successful therapeutic relationship. With careful inquiry, sensitive attunement, and authentic involvement, the therapist will be experienced as dependable, consistent, and trustworthy.

1. INQUIRY. Inquiry is the process by which the therapist invites the client to explore his or her experiencing It begins with respectful questions about the client’s internal experience. But inquiry is not only with questions; it may include a statement, a tone of voice, a gesture, or a lift of an eyebrow — each of these is a part of therapeutic inquiry. It begins with the assumption that the therapist knows nothing about the client’s experience and therefore must continually strive to understand the subjective meaning of the client’s behaviour and intrapsychic process. Through respectful investigation of the client’s phenomenological experience the client becomes increasingly aware of current and archaic needs, feelings, and behaviour.

Inquiry begins with a genuine interest in the client’s subjective experiences and construction of meanings. It proceeds with questions from the psychotherapist as to what the client is feeling, how he experiences both himself and others (including the psychotherapist) and what conclusions and decisions the client may have made. The process of inquiring is as important, if not more so, than the content. The therapist’s inquiry must be empathetic with the client’s subjective experience to be effective in discovering and revealing the internal phenomena (physical sensations, feelings, thoughts, meanings, beliefs, decisions, hopes, and memories) and uncovering the internal and external interruptions to contact. A contact-oriented relational therapy requires that the therapist be attuned to these relational-needs and be involved, through empathetic validation of feelings and needs and by providing safety and support.

2. ATTUNEMENT. Attunement is a two-part process. It begins with empathy — that is, being sensitive to and identifying with the other person's sensations, needs, or feelings - and the communication of that sensitivity to the other person. More than just understanding or vicarious introspection, attunement is a kinesthetic and emotional sensing of the other - knowing his or her rhythm, affect, and experience by metaphorically being in his or her skin, thus going beyond empathy to provide a reciprocal affect and/or resonating response. Attunement is more than empathy: it is a process of communion and unity of interpersonal contact. Effective attunement also requires that the psychotherapist simultaneously remain aware of the boundary between client and therapist as well as his or her own internal processes. Attunement is facilitated by the therapist's capacity to anticipate and observe the effects of his or her behaviour on the client and to decenter from his or her own experience to extensively focus on the client's process.

Attunement involves sensitivity to, and resonance with, whatever is going on for the client. Sensitivity and resonance can be maintained only if the therapist is fully present, aware of his or her own internal process as well as that of the client, involved in the relationship, and open to being moved and affected by it. The communication of attunement validates the client’s needs and feelings and lays the foundation for repairing the failures of previous relationships. Attunement is demonstrated by what we say, such as “That hurt” “You seemed frightened,” or “You needed someone to be there with you.” It is more frequently communicated by the therapist’s facial or body movements that signal to the client that his affect exists, is perceived by the psychotherapist, that it is significant, and that it makes an impact on the therapist.

3. INVOLVEMENT. Involvement is best understood through the client’s perception — a sense that the therapist is contactful. It evolves from the therapist’s empathetic inquiry into the client’s experience and is developed through the therapist’s attunement with the client’s affect and validation of his or her needs. Involvement is the result of the therapist being fully present, with and for the person, in a way that is appropriate to the client’s developmental level of functioning. It includes a genuine interest in the client’s intrapsychic and interpersonal world and a communication of that interest through attentiveness, inquiry, and patience. Therapeutic involvement that emphasizes acknowledgement, validation, normalization, and presence diminishes the internal discounting that is part of an archaic self-protective process.

Acknowledgement indicates to clients that what they have said has been heard and is meaningful, that the psychotherapist is attentive to what they are saying, and that they exist.

Validation indicates the significance of cause and effect. Validation diminishes the possibility of the client internally discounting the significance of affect, physical sensation, memory, or dreams. Validation helps the client claim his own phenomenological experience.

Normalization means to depathologize the client’s definition of their own internal experience. It diminishes destructive internal criticism and indicates to the client that the self-protective reactions were normal, not pathological.

Presence is provided through the psychotherapist’s sustained empathetic responses to both the verbal and nonverbal expressions of the client. Presence includes the therapist’s receptivity to the client’s affect — to be impacted and moved by his emotions. It communicates the psychotherapist’s responsibility, dependability, and reliability. Presence includes judicious intersubjective sharing of perspectives, ways of thinking, and experiences.

These relational methods and their interconnections are graphically represented in the "Keyhole" diagram that depicts the fundamental premise of Integrative Psychotherapy: “Healing occurs through a contactful therapeutic relationship”. The "keyhole" represents, in some sense, the progress of therapy through time, the movement from one level of contact-making to another. The "keyhole" is an attempt to show all the facets of a therapy of contact-in-relationship together, in dynamic relationship.

Analysis of clients’ experiences of Integrative Psychotherapy revealed six categories of helpful aspects of therapeutic relationship: (1) the therapist’s empathic attunement, (2) the therapist’s acceptance, (3) the match between the client and the therapist, (4) feelings of trust and safety, (5) feeling of connection, and (6) experience of a new relational experience.

The interrelatedness of these six helpful aspects of the therapeutic relationship is evidence of the therapist’s contribution to a healing therapeutic relationship.

Integrative Psychotherapy bases its theories and methods on scientific research that has proved their effectiveness. Currently, there is a joint research project that has been launched by several universities to validate the essential elements of this therapeutic model. Among them are the following:

• The University of Ljubljana, Faculty of Arts, Department of Psychology, Slovenia, led by Gregor Žvelc, PhD.
• The Kocaeli University, Institute of Health Sciences, Trauma Studies and Mental Health in Disasters, Turkey, led by Şafak Ebru Toksoy.
• Deusto University, "Clinical evaluation and health" team, led by Dr. Ioseba Iraurgui, recently accredited by the Basque Government

In summary, Integrative Psychotherapy philosophical principles, theories, and methods form a comprehensive and coherent system. This intricate system of the theories of motivation, personality, and methods provides an understanding of human functioning. It provides a conceptual basis for establishing a contactful therapeutic relationship − the cornerstone of this psychotherapy − which allows the client to integrate their affect, physiology, cognition, and behaviour into a cohesive sense of self so that behaviour is by choice in the current situation and not stimulated by fear, compulsion, or conditioning.

Reference:
International Integrative Psychotherapy Association (IIPA)
https://integrativeassociation.com/what-is-integrative-psychotherapy/