Eclectic and Integrative Approaches to Counselling
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Transcript of Eclectic and Integrative Approaches to Counselling
Kenya Association of Professional Counsellors
Higher Diploma in Counselling Studies, 2011
Title:
With reference to relevant literature describe eclectic and integrative
approaches to counselling. (3000 words).
Facilitators: Briggid Muisyo
Beatrice Otieno
Student: Albert Muraya
Date: 15th
July, 2011
Words: 3247
Copy: Final Copy
2
Introduction......................................................................................................................... 3
Development ....................................................................................................................... 4
Technical Eclecticism ......................................................................................................... 5
Differentiating between Eclecticism and Integration ......................................................... 8
How eclecticism and integration influence and shape the therapist ................................. 11
Advantages of Integration................................................................................................. 12
Obstacles to Integration .................................................................................................... 12
Advantages of Eclecticism............................................................................................... 14
Limitations of Eclecticism ................................................................................................ 15
Conclusion ........................................................................................................................ 16
References......................................................................................................................... 17
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Introduction
The impetus towards harmony and away from the previous situation of dominance of
single theories in psychotherapy and the resultant unhelpful competition between them
has been influenced by cultural, economic and social changes. These changes include an
abundance of psychotherapies such that there was confusion from even within the field as
to efficacy of most; therapeutic limitations of single therapy approach as evidenced by
research (Lazarus et. al, 1992); inability to exhibit particular superiority of any one theory
over the others; the identification of common therapeutic factors amongst the different
types of psychotherapy e.g. the central importance of the therapeutic alliance for
successful therapy outcomes; and socio-political and economic changes ranging from a
more demanding and discerning market for therapy services to closer scrutiny by
government, regulators and the health insurance industry who fund treatment.(Norcross, J
C. and Grencavage, L.M., 1989).
There are three main ways in which the various therapies have been brought together,
namely technical eclecticism, theoretical integration and the common factors approach in
which clinical strategies are devised from shared core elements within specified therapy
approaches and brought together seamlessly (Lazarus et al, 1992). In this paper I will
describe the first two approaches and look at the advantages and limitations with both. I
will examine the pathway to integration or eclecticism and explain why there are two
seemingly disparate approaches to this phenomenon, as well as what both mean for the
practitioner and how they may influence the way she works. Finally I will present the
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obstacles to both integration and eclecticism and the advantages and disadvantages for
both as well as presenting a conclusion and a list of references.
Development
The history of psychology has involved the development of different ideas to explain and
understand human behaviour and development. These in turn have promoted the growth
of competing paradigms to help people overcome difficulties and lead more satisfying
lives. These paradigms are known as theories of counselling as they are based on
assumptions and concepts that offer both an insight on human conduct as well as sets of
problem-solving tools and techniques (Palmer and Woolfe, 2010).
The driving force to develop different theories of counselling was that the founders of the
different schools disagreed with the prevailing thinking on human growth and
development. Invariably a spirit of competition and even dogmatism set in amongst their
followers and adherents as they developed their own vocabulary “which only those
committed to their ideas would be likely to understand”, Palmer and Woolfe, (2010)
This movement towards the segregation of schools of psychotherapy was balanced by an
understanding amongst several early practitioners that there were useful and useable
ideas and even concepts from other counselling theories and that the client receiving
therapy was best helped by incorporating such schemes into the originating hypothesis.
(Palmer and Woolfe, 2010). Subsequently, there emerged a drive to harness ideas from
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other orientations, and even blend different orientations together as it was discovered that
no one theory served the best interests of every client all the time (Norcross and
Grencavage, 1989)..
Technical Eclecticism
The dictionary defines eclecticism as ‘selecting ideas or material from a wide range of
sources or authorities’ (Chambers, 2004). Technical Eclecticism in psychotherapy refers
to the borrowing from diverse schools of therapy, techniques to enhance the effectiveness
of a core or basic theory without applying the underlying concepts that spawned them
(Lazarus et al, 1992). According to Lazarus who first coined the term, this approach to
philosophy and psychology has existed since the third century, but took on clinical
significance in the 1930’s (Lazarus et. al, 1992). He felt that a joining together of
theoretical concepts would be futile, but the adoption of techniques from disparate
orientations would be rewarding. Further he stated that the process of selecting
techniques had to be systematic and effective for the range of problems, conditions and
patients for whom they were selected. Given the relative ease of adoption and
assimilation, technical eclecticism experienced rapid growth as well as growing diversity
(Lazarus et. al, 1992).
An example of this is taking Rogers’ core conditions from Person-centred therapy and
applying them in a psychodynamic or other setting. Another is employing the free
association of psychoanalysis within a Cognitive-behavioural framework. This way
precludes embracing the basic underlying assumptions of a given theory which may be
directly contrary to the working theory upon which the therapy is based. In a sense,
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eclecticism is a buffet of several techniques without trying to blend or synthesise a new
method from the constituent theories. (Norcross and Grencavage, 1989)..
An example of technical eclecticism is Lazarus’ own Multi-modal therapy. He advocates
a system of selecting treatment techniques to fit the specific needs of individual clients.
He put forward seven dimensions or modalities of human personality that a helper would
need to address using the most relevant approach to do so. These are known as by their
acronym B.A.S.I.C. I.D which stands for behaviour, affect, sensation, imagery, cognition,
interpersonal, and diet or drugs. The underlying theory is social learning, a derivative of
behaviourism, but Lazarus saw elements of psychodynamics and cognitive emotive
perspectives at play and he incorporated techniques from them accordingly (Okun &
Kantrowitz, 2008).
Lazarus (1989) contends that for eclecticism to be effective it needs to be systematic,
taking into account patient qualities, specific techniques and clinical skills of the
therapist. He differentiates between “eclecticism” and “fusion” or “syncreticism” where
the latter is the ad hoc blending of notions from seemingly disparate orientations based on
clinicians’ inexperience and inadequate training. He suggests dropping of confusing
labels including eclecticism and advocates instead a problem focus. He sees technical
eclecticism as a precursor to an eventual unifying theory. Another example of eclecticism
is Solution-focused Brief Therapy.
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Theoretical Integration
Theoretical integration on the other hand refers to the blending or synthesising of two or
more divergent theories of psychotherapy to form a unified whole which is distinct from
the constituent theories that informed it. There is an expectation that the resultant therapy
will exhibit the strengths of its constituent theories whilst minimising their weaknesses,
(Norcross and Goldfried, 2005). An example is Motivational Enhancement Therapy that
draws primarily from person-centred therapy and cognitive-behavioural therapy with
elements of existentialism. Cognitive-behavioural therapy itself is another example of
theoretical integration. A further example is Egan’s Problem Management Approach.
In Egan’s model, the relationship-building core conditions of the person-centred
approach are combined with a skills emphasis from Cognitive-behavioural therapy
(Jenkins, 2010). It is a staged process with distinctly different things happening in each of
the three stages namely exploration, problem redefinition and action. In each of these are
sub-stages that require different types of involvement for the therapist. It is integrative in
the sense that it provides for the incorporation of different techniques throughout the
process (Jenkins, 2010), from person-centred therapy in establishing a therapeutic
alliance; to cognitive therapy in thinking through potential preferred outcomes as well as
illuminating blind spots that a client may be experiencing; and behaviourism in taking
and maintaining action by goal-setting and behaviour change.
Cognitive-behaviour therapy is another example of integration in psychotherapy. is
comprised of more than twenty methods of therapy that are grouped together as having a
8
common approach to problem solving. These include Rational Emotive Behavioural
therapy postulated by Albert Ellis and Cognitive therapy (CT) by Aaron Beck. They view
human problems as stemming from disturbances in the thought or cognitive processes in
which people are disturbed not by events themselves, but by their view of events.
Emotions are derived from our beliefs, evaluations, interpretations and reactions to life
situations and events, and that changing these will lead to a change in how we feel about
things, and consequently how we behave or the actions we take (Corey, 2005). Overtime
these have evolved into distinct concept of psychotherapy whereby it is not easy to
distinguish between the constituent orientations (Palmer & Woolfe, 2010)
Differentiating between Eclecticism and Integration
Nelson-Jones (1985) has put forward a framework for defining extents of integration and
eclecticism in which the possibility of integration within a single theory is possible. He
views any given theory including any hybrid as having four sub-components: basic
assumptions; an explanation of the acquisition of functional and dysfunctional thoughts,
feelings and behaviour; an explanation of the perpetuation of functional and
dysfunctional thoughts, feelings and behaviour; and fourthly a framework consistent with
the preceding, for modifying thoughts, feelings and behaviour.
Further he went on to define “horizontal” and “vertical” integration by differentiating the
extent of connectedness between the sub-components or elements of a theory as above –
the theory of the person (assumptions, acquisitions and perpetuation) and the theory of
change. Horizontal integration is where there is a consistency and coherence between the
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theory (of the person) and the practice (of behaviour change). In this context then, he
views eclecticism as occurring where the practice and the theory are not consistent as
being from different orientations. Further he postulates that there will be different extents
of eclecticism depending on the degree of convergence or divergence between theory and
practice. Finally he defines integration as occurring when there is consistency between
theory and practice where ideas from different schools are merged in a coherent way.
Nelson-Jones gave as examples Existential Psychotherapy - merging of psychodynamic
and existential methods and concepts; and his own “Personal Responsibility Counselling
and Therapy” - existential, humanistic, psychodynamic, cognitive and behavioural
theories.
Nelson-Jones (1985) introduces the idea of “comprehensiveness” to distinguish between
the completely vertically integrated therapies as above and the horizontally integrated
single theory which whilst coherent lacks the broadness of the combined one. He states
that whilst no ‘widely subscribed comprehensive theory exists’ there were dimensions
which any theory needed to be gauged against to establish its “comprehensiveness”.
These are: a balanced emphasis on thoughts, feelings and behaviour; a concept of self and
personal agency or responsibility; accounting for all areas of functioning - not just
relationships; a remedial, developmental and self-help focus; accessible language that
supports self-help; focussing on skills and choices - to build self-reliance; focus on
interventions – changing the nomenclature from being theory of origin-specific to more
generalised language.
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In summary, Nelson-Jones (1985) view of integration is that there needs to be a
transcending of methods and concepts beyond a mechanical fusion to a completely new
paradigm with different language and ambitions from the traditional theories and their
objectives.
In order to move from a single theory approach to a more inclusive multi-theory stance
whether at the conceptual level or the technical level requires a mindset that appreciates
the relative strengths and merits of other systems. This presupposes that the practitioner is
conversant with the elements of other theories and has the confidence to blend those
aspects they find usable or attractive. This implies several years of experience in order to
have a basis to do so.
There is a temptation for the budding integrationist to pick in a haphazard way a
potpourri of techniques or even create a mashup of concepts. However there are
established eclectic and integrated approaches that have come about through exhaustive
research available for use by the multi-modal therapist. An example is Motivational
Enhancement Therapy that emerged from a painstaking research project carried out to
test and assess how people change (Prochaska et. al, 1992). Thus it is necessary for the
counsellor to stick to a systematic approach to building up an eclectic method.
For a psychotherapist to devise an integrated approach there would be an advantage in
referring to research to establish the best mix of technique and strategy and therapist
attitudes and approaches. This would reveal the drivers for therapeutic change and the
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maintenance of that change allowing the practitioner to establish a basis for choice of
either technique or theory.
How eclecticism and integration influence and shape the therapist
The opportunity of integration creates a challenge for the clinician to embrace a more
open and inclusive stance to their use of technique. It requires them to move from a rigid
reliance on a narrow range of strategies to meet the client’s needs, to greater flexibility.
This can be challenging for the counsellor as previous assumptions are questioned.
However it offers the possibility of permanently shifting the therapist to being more
accepting of the unfamiliar and willingness to grow (Palmer and Woolfe, 2010).
Systematic eclecticism requires the counsellor to become familiar with changes in the
field; they are forced to keep up with innovations and the latest thinking. This in turn
creates a necessity to refresh themselves with training courses and other opportunities for
continual growth and development (Norcross, and Grencavage, 1989).
In order for the therapist to engage in integration and eclecticism they need to question
the assumptions and techniques of their established theoretical school. This questioning
attitude will become ingrained in respect of all therapy methods, and as they evolve into
more discerning clinicians their choice of strategies will naturally become more
appropriate to the needs of the client, and away from custom, preference and convenience
(Norcross, and Grencavage, 1989).
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Advantages of Integration
Integration of concepts allows for the personality of the therapist to be reflected in the
practice and given that psychotherapy is about a facilitative relationship, then integration
will enable the optimal framework for the skills of the counsellor to shine through for the
good of the client (Egan, 2005)
Integration facilitates a seamless merging of different concepts in a coherent manner
allowing for the organising of the core ideas from each source theory to produce a more
useable and relevant end-product. An example of this is Cognitive behavioural therapy
which has evolved over time and its coherence at the conceptual level is clear. It is richer
than the various theoretical orientations – behaviourism, rational-emotive and cognitive
therapy – that spawned it (Norcross, and Grencavage, 1989).
Integration of the different concepts will facilitate outcome research in a way not
currently possible as like for like is not being compared. It will allow for more accurate
analysis of what works in psychotherapy and inform the training of future counsellors
(Norcross, and Grencavage, 1989).
Obstacles to Integration
Research amongst practicing psychotherapists has revealed that despite the advantages of
integration, there are ongoing impediments to a wider adoption of the same. The first is
that a great deal of professional as well as personal integrity and reputation has been
invested in a particular school of thought, and whilst there are clear advantages to clients
13
of a blended (or collectivist) approach to treatment, often the opportunity cost of leaving
ones established single theory approach is too high (Norcross, and Grencavage, 1989).
The second reason is the paucity of training opportunities for integrated therapists as
traditional methods and institutions for training psychotherapists have been single theory
schools. Currently most psychotherapists practicing integrated counselling are essentially
self-taught, to the extent of the integration of their practice. This is slowing the uptake of
this perspective in psychotherapy (Norcross, and Grencavage, 1989).
The third factor impeding the uptake of integration more widely is the apparent
contradiction between the different schools of psychotherapy. Given that counselling
theories are primarily views of human personality, it becomes difficult to square the
opposing views of human nature that alternative approaches may have. For instance
psychoanalysis states that the human being is the product of hidden drives developed in
childhood and is therefore essentially flawed, whilst person-centred therapy believes the
person is basically good and will strive for self-actualisation or optimisation given a
nurturing environment. Many therapists would prefer to remain in their single-theory
approach rather than bridge this gap; there is a certain comfort from remaining in the
known despite the potential advantages of embracing a new blended approach (Norcross,
and Grencavage, 1989).
A fourth obstacle slowing down the up embracing of integration in psychotherapy is the
dearth of outcome research for integrated therapy methods as there then lacks an
14
objective basis for determining whether to take up an integrated approach at the expense
of a single theory. It also complicates the choice of combination of concepts and
strategies as there is little to go by. This again discourages the potential integrationist
(Lazarus et al, 1992).
Further, as a science, psychology draws heavily on technical terms; each theory has
grown its own nomenclature and this has acted as an impediment to mutual
understanding – there have evolved multiple ways of saying the same thing with the
potential for subtle differences in meaning and usage creating confusion and erecting
barriers to transference of concepts from one theory to another. A gulf grows where
elements of different theories become inaccessible to adherents of other persuasions. This
in turn impedes the uptake of an integrated approach. An example of this would be how
the three main schools of psychotherapy refer to source of conflicts in the psyche:
‘punitive superego’ (Freudian psychoanalysis), ‘negative self-statements’ (Beck’s
cognitive therapy), and ‘poor self-image’ (Rogerian person-centred) – these may or may
not refer to the same thing; a common framework of understanding would have to be
established so that direct comparisons and referencing could be made (Norcross, and
Grencavage, 1989).
Advantages of Eclecticism
As eclecticism involves choosing many techniques from diverse theories, it can just as
easily discard whatever technique is no longer useful, without the basic constituent theory
changing in any way (Lazarus et al, 1992).
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Eclecticism is flexible and it is easy to use. Techniques that are inappropriate can be
dropped and replaced by other more appropriate ones. As a result there are more and
more manualised treatments emerging for the treatment of specified conditions, made
possible by taking an eclectic approach.
Eclectic approaches are comprised of prescriptive treatments based on needs of the
patient and are therefore appropriate and timely and quite specific. This augurs for better
and more effective treatments. Treatments of choice for specific ailments or conditions
are becoming the norm and these are facilitated by an eclectic approach (Lazarus et al,
1992). Recent developments have devised problem specific treatment formats for
complex mental illnesses previously in the exclusive of domain of medical practitioners.
Limitations of Eclecticism
The disadvantages of eclecticism stem from the way it is practiced, and not from the
notion of eclecticism itself. The possibility of a haphazard incorporation of ideas,
methods subjectively based on personal appeal happens when there is neither validation
nor rationale for the methods employed (Lazarus et al, 1992). As mentioned above there
needs to be a systematic framework for choosing which methods and techniques to
choose for which clients and sets of problems.
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Conclusion
Integration and eclecticism are the natural products of the movement in psychotherapy
that takes into account all aspects of the human personality towards a unified superior
theory that draws ideas and persuasion from the current distinct ways of looking at and
understanding human behaviour. I have presented some of the emergent thinking into the
ways in which this movement is taking place.
The plurality in the move towards merging different orientations is itself evidence of
democracy in the intellectual arena that is psychology and psychotherapy. It is confusing
that many authors and practitioners have used these terms interchangeably and a great
debate has been spawned by this; one that mirrors the great ideological divide that
characterised the major schools of psychotherapy and gave rise to the integration/eclectic
movement in the first place.
It is clear however that both practices are stops on the journey to a unifying theory from
which will emerge complimentary techniques, methods and strategies. This itself will
facilitate accurate outcome research further sharpening the skills of practitioners and
shedding more light on what constitutes effective therapy.
It is refreshing to know that the field of psychotherapy is dynamic and growing and
hopefully we will come to the holy grail of a unified theory in my lifetime.
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References
1. “Chambers Concise Dictionary”, 2004, Edinburgh: Chambers Harrap Publishers
Ltd
2. Corey, G (2005; 2009), “Theory and Practice of Counselling and
Psychotherapy”, 7th
, 8th
ed, Belmont: Brooks|Cole.
3. Egan, G (2005), “The Skilled Helper”, 7th
ed, Pacific Grove: Brooks|Cole
4. Hough, M (2002) “A Practical Approach To Counselling” 2nd
ed, Harlow:
Pearson
5. Jenkins, P (2000) Gerard Egan’s Skilled Helper Model. In S. Palmer and J Woolfe
(eds) Integrative and Eclectic Counselling and Psychotherapy, London: Sage
6. Lazarus, A (1989) “Why I am an eclectic (Not an integrationist)”, British Journal
of Guidance & Counselling, Vol17:3,248 — 258
7. Lazarus, A, Beutler. L.E. and Norcross J.C., “The Future of Technical
Eclecticism”, Psychotherapy: Theory, Research, Practice, Training, Vol 29(1),
Spr 1992, 11-20.
8. Nelson-Jones, R (1985) “Eclecticism, integration and comprehensiveness in
counselling theory and practice”, British Journal of Guidance &
Counselling,13:2,129 — 138
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9. Norcross, J C. and Grencavage, L.M., 1989 “Eclecticism and integration in
counselling and psychotherapy: Major themes and obstacles”, British Journal of
Guidance & Counselling,17:3,227 — 247
10. Norcross, J.C. & M. R. Goldfried (Eds.), (2005) Handbook of psychotherapy
integration (2nd ed., pp. 241–260). New York: Oxford
11. Okun B.F. & Kantrowitz, R.E., 2008 “Effective Helping”, 7th
Ed, Belmont:
Brooks|Cole
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Psychotherapy”, London: Sage
13. Prochaska, J.O.; DiClemente, C.C.; and Norcross, J.C. 1992, Journal of American
Psychology. 1992 Sep; 47(9):1102-14.