Unit on Integration and Eclecticism, Theories of Counseling and Psychotherapy

Slide 1: Pulling it all together

Beginning to make choices...

Slide 2: Facilitating change...

• …[I]t is the client more than the therapist who implements the change process.  If the client does not absorb, utilize, and follow through on the facilitative efforts of the therapist, then nothing happens (Bergin & Garfield, 1994, pp. 825-826).

• ...[T]he client, not the therapist, is the engine that drives the therapy.  The therapist provides structure, tools and a good working atmosphere.  The most important variable in therapy is not client diagnosis or therapist intervention, but client participation.  Clients who are openly involved and willing to participate will be much more likely to change than clients who are not... [I]nterventions have no power in themselves (Bohart, 2001, p. 237).

Slide 3: What can we do to facilitate client involvement?

• Respect the client and client's strengths and efforts
• Work where the client is
• Work on client's goals
• Choose methods that client finds palatable
• Use client's language and metaphors
• Collaborate with the client on treatment

Slide 4: Seeing cooperation rather than only resistance

What most therapists mean by client collaboration is really client compliance with the therapist's treatment regimen.  If clients do not comply, they are labeled treatment resistant… Then the therapist must "treat" the resistance.  None of this language portrays therapy as a genuine collaboration between two intelligent beings in dialogue with one another (Bohart, 2001, p. 238).

Slide 5: Stages of change (Prochaska & Norcross, 1994)

• Precontemplation.  Has not identified the same thing as a problem that you do.
• What is the client willing to work on?
• Contemplation. Identification of problem, but ambivalence about change.
• Action. Actively changing.
• Maintenance. Working to continue change made.
• Relapse. Back to full blown syndrome.
• Lapse. A slip, also a learning opportunity.

Slide 6: Why theories rather than just one?

• To provide an overview of the field
• To help you communicate with people with disparate viewpoints
• To give you multiple views of “stuck points”
• To help you choose a comfortable viewpoint knowledgeably

Slide 7: Should we choose just one theory?

• Pro:
• Therapist develops expertise
• Improved outcomes
• Con:
• Clients must fit the theory rather than vice versa -- Procrustean bed
Do you want to be treated the same as everyone else???

Slide 8: But...

• Everyone has a personal theory about the world
• We may not notice our theory -- it’s "normal," the way it should be

Slide 9: Syncreticism

Mixing, without a rationale or theoretical explanation

Slide 10: Technical eclecticism

• What therapy, by whom, is most effective for this client with that specific problem, under which set of circumstances? (Paul, 1967)
• What data supports your decision?

Slide 11: How should we choose interventions?

• The nature of problem
• Client's goals
• Client's preferences
• Client's readiness to change
• Our theoretical viewpoint

Slide 12: Integration

• The synthetic combination of two theories to create something new
• More theoretical than empirical

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URL= http://psy1.clarion.edu/jms/cptintegrationpp.html
Last modified November 3, 2001.