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

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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

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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

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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

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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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Pearson

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