Integrative and Eclectic Therapies
Transtheoretical Therapy
Future of Psychotherapy
Integrative and Eclectic Therapies
Psychotherapy integration is motivated by a desire to look past the confines of a singlesystem approach so that clients may benefit from other approaches.
Why have Integrative and Eclectic approaches become popular?
1. Proliferation of therapies
2. Inadequacy of any single theoretical system for all patients and problems
3. External socioeconomic contingencies
4. Growing popularity of short-term, problem-focused treatments
5. Opportunities for therapists to observe and experiment with various treatments
6. Recognition that therapeutic commonalities play major roles in determining
therapy outcome
7. Identification of specific treatments of choice
8. Development of professional societies for integration
Technical Eclecticism versus Theoretical Integration
See Table 14.2
Technical Eclecticism –
Theoretical Integration –
-
-
Most common combos are
o Cognitive and behavioral
o Humanistic and cognitive
o Psychoanalytic and cognitive
Transtheoretical Therapy
This theory allows the clinician to use different techniques depending on the client’s
stage of change.
1. This therapy draws on the common factors from all therapies as well as the unique
aspects of each.
2. It is based on empirical findings.
3. Accounts for change inside and outside of therapy.
4. Generalizes to a broad range of behavior changes, including physical health
changes.
5. Encourages psychotherapists to become innovators, not just borrowers.
Processes of Change
Covert or overt activities that people engage in to alter emotion, thinking, behavior, or
relationships.
10 Processes of change with the most empirical support:
1. Consciousness Raising
2. Catharsis
3. Self-reevaluation
4. Environmental reevaluation
5. Self-liberation
6. Social liberation
7. Counterconditioning
8. Stimulus Control
9. Contingeny Management
10. Helping relationship
Across the board, most therapies agree on the processes; they most often disagree on the
problem that needs to be changed.
Table 15.1
Consciousness raising is most often used in a variety of therapies.
Client expectation or placebo may account for 10-40% of change.
Stages of Change
1. Precontemplation –
a.
b.
c. “I don’t really have any problems that need changing”
2. Contemplation
a.
b.
c.
d. “I’ve been thinking I might want to change something about myself”
3. Preparation
a.
b.
c.
4. Action
a.
b.
c.
d. “I am really working hard to change”
5. Maintenance
a.
b.
Spiral pattern
Relapse is
Termination
Integration of Stages and Processes
Doing the right thing at the right time. Using insight-oriented techniques for a person not
yet ready to change; using behavior-oriented techniques for the person ready to take
action.
Specific processes work better during specific stages.
Precontemplation
-
consciousness raising
o
o
o
-
catharsis
o
Contemplation
-
consciousness raising
o
-
self-re-evaluation
o
-
environmental re-evaluation
o
Preparation
-
self-liberation
o
Action
-
counterconditioning
-
contingency management
-
stimulus control
Maintenance
- continuing processes that have worked so far
Levels of Change
1. Symptom/situational problems
2. Maladaptive cognitions
3. Current interpersonal conflicts
4. Family/systems conflicts
5. Intrapersonal conflicts
A symptom can be the result of any of the previous levels (or multiple levels). The
deeper, more historical the cause, the more resistant the symptom will be to change.
Therapists should try to explain symptoms using the lowest level of change appropriate.
Three basic strategies
1. Shifting levels:
2. Focus on key levels:
3. Maximum impact:
TTT Relationship
-
Therapist is expert on change.
-
Relationship depends on the stage.
-
Move from nurturing parent to Socratic teacher, experienced coach, consultant.
Future of Psychotherapy
Twelve Emerging Directions
1. Industrialization of Mental Health Care –
a.
2. Practice and Treatment Guidelines –
a.
b.
3. Prescriptive Matching
a.
4. Cultivation and Customization of the Therapeutic Relationship
a.
b.
5. Technological Applications
a. Behavioral e-health –
b. Virtual therapy –
c. Telepsychotherapy –
6. Treatment of Health Behaviors
a. Over
of health costs are due to behaviors
7. Proactive Outreach to Entire Populations
a. Increase the percentage of high-risk people receiving services
b. Getting out into the community, primary care
8. Self-Help Resources
a. Can be used in conjunction with therapy
9. Relapse Prevention
a. Most used with
10. Decline of Personality in Psychotherapy Systems
a. Less focus on _______________________, more focus on
__________________________
11. Incorporation of Spiritual and Religious
a. 92% of Americans are affiliated with a religion
b. 96% profess belief in God or universal spirit
c. Research supports the inclusion of client’s religion
12. Psychotherapy Works!
a. Effect size = .80 (79% of clients are better off than those not seeking tx)