Integrative psychotherapy: the integration of therapeutic models

During the last decades the quality and effectiveness of psychological treatments have increased considerablyIn large part because of the growing trend of psychotherapists to integrate different elements of classical psychotherapeutic models.

Integration allows us to develop a more global and holistic vision of the person, his relational world and his social context. In this article we will see what are the characteristics of integrative psychotherapy, And what it is based on.

What is integrative psychotherapy?

Integrative models differ from eclectic models in that the former do not use the techniques in a more or less isolated way, depending on the characteristics and needs of the person, but start from a global vision of the human being that allows to give meaning and consistency. to the different elements as a whole.

Now that this does not mean that there is only one way to approach psychological problemsAs if it were an “absolute truth”, let alone.

It can happen and, in fact, it happens most of the time, that each particular psychotherapist integrates elements in one way or another, which gives more weight to some factors than to others, for example. example to emotions in relation to cognitions or behaviors, etc. It will depend on the general basis or, to put it another way, the integrative model from which the professional starts.

Although elements and techniques from other psychotherapeutic models are still integrated, there is always a more general background that predominates and allows their integration, as an “epistemological umbrella”.

Psychotherapy schools

But … what are the major psychotherapeutic models that generally serve as a basis for the integration of other components and techniques? There are many schools and sub-schools of psychotherapy, Although we can talk, basically, of four major orientations: cognitive-behavioral, psychodynamics, systemic and humanistic.

How can the different models be used in an integrative way? What keys for exploration, analysis and intervention can each of them allow? We will briefly describe the guidelines on which each of these models emphasizes the essential, although with the exception that there are almost never completely “pure” models, because, of one way or another, they all take the other factors into account. , overlap, mix and reflect each other.

Cognitive-behavioral model

The cognitive-behavioral model tends to focus more on learning theories and how stimulus control affects human behavior. Thus, the prism from which the problem that the patient takes is approached is approached from classical conditioning, operative conditioning … directed techniques to reduce or increase, depending on the case, the behaviors with which he is wanted to work ( for example, reducing alcohol abuse or quitting smoking).

The cognitive element, i.e. working with thoughts, Has taken on more and more importance in the face of purely behavioral approaches. Working with the constructions and narratives that people make of their reality (what Watzlawick called “second-order reality”) is fundamental: cognitive patterns, basic assumptions, automatic thoughts, biases and tendencies of automated thinking, etc., are discussed. starting, for example, from cognitive restructuring.

psychodynamic model

The psychodynamic model, strongly influenced by psychoanalysis, he usually pays attention to biographical aspects and to what extent early or past experiences (but not only, as they also focus on the present) influence the present.

From this approach, in which the work with the unconscious is nuclear, the defense mechanisms, the work with the transference and the countertransference, the interpretation and the elaboration of the behaviors of the patients, the awareness takes a particular importance. bonding patterns and relational conflicts, etc. All this allows us to immerse ourselves in the intrapsychic and relational life of the patients.

It is important to say that although psychoanalysis is generally associated with treatments of very long duration, which can last for many years, the truth is that they tend more and more to make brief approaches focusing on specific aspects of a person’s life and which have to do directly with their issues (eg, Malan’s conflict triangles, Horowitz’s relationship models, etc.).

The contributions that psychodynamic approaches can make should not be underestimated, being of great utility, for example, in their conception of relational conflicts and their link with health.

systemic model

The systemic-relational model, in which the person is conceived within a larger system with which he interacts and where there is permanent feedback between his members, attention is generally given to interactions, communication, relationship dynamics and role models, The person’s place in the system (his role, etc.).

An important aspect of this way of working is that attention is paid to how people influence each other and the effects they have on each other in certain situations (for example, how parents and children react so that children find it difficult to mature. and become independent or, as they cope with the illness of a loved one, establish rigid functional roles, etc.).

humanistic models

From humanistic models such as Rogers ‘client-centered therapy or Fritz Perls’ Gestalt therapy, emphasis is placed on awareness and accountability of behaviors and the person’s life.

Client-centered therapy promotes personal development and confidence in one’s potential of each person (it is assumed that, if the appropriate conditions are met, the person will be able to update their potential according to their needs).

For Gestalt therapy, an eminently experiential model, the work must always aim to become aware of why the person does what he does (instead of the why, more typical of psychoanalysis), to work with the emotional and bodily experience in the here and now (which encourages awareness) and self-responsibility for their emotions, thoughts and actions, seeking personal consistency.

Where to start designing the approach?

At the risk of oversimplifying things, one could say that these are the main characteristics of each model and from which they evaluate and treat their customers. But if you want to do real integration work, you have to have a general model, a certain way of understanding the human being, which allows you to do this integration. It is therefore very important to ask the question of where the different guidelines and factors are integrated.

We find relational approaches particularly useful, in which attention is placed, both implicit and explicit, in how people have bonded and what kind of relationships they make with others.

The way people interact and behave, consciously or unconsciously, provides general psychological working keys from which to begin to redefine the problem the person is carrying, as well as how to begin to alter relationship patterns.

Bowlby’s theory of affection and its subsequent developments it can be one of those “epistemological umbrellas” that we spoke about above, because it allows this integration of the psychological factors of different schools.

From postmodern approaches, narrative and discursive therapies have been other general frameworks from which the integration. Some authors have even linked condition theory and narrative therapy in a single model to achieve this integration of psychological techniques. These models challenged the so-called “isolated mind” myth. which in the scientific psychological tradition has prevailed for decades, influenced by positivism.

The context, the group, the culture and the values, the constitutive character of the language, etc. these are elements which have come to enrich and broaden the approaches of current psychotherapies, going beyond the purely individual and intrasubjective approach.

Author: Diego Albarracín Prat Psychologist Psychologists, expert in clinical psychology and psychoanalytic psychotherapy. Higher education in Gestalt Therapy. Sexologist. Mediator.

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