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Higher Diploma in Counselling Studies, 2011
With reference to relevant literature describe eclectic and integrative approaches to counselling. (3000 words).
15th July, 2011
................................................................................ 11 Advantages of Integration............................................................................................................................................................................................................................................................................................................................................................................ 5 Differentiating between Eclecticism and Integration ........................................ 12 Obstacles to Integration ........................................................ 8 How eclecticism and integration influence and shape the therapist .............. 4 Technical Eclecticism ........ 15 Conclusion .................................................. 16 References............................................................................................................................................................................................................................................................................... 17 2 ..... 12 Advantages of Eclecticism.............................................................................................. 3 Development ....Introduction......................................... 14 Limitations of Eclecticism ......................................
g. In this paper I will describe the first two approaches and look at the advantages and limitations with both. 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. 1989).. I will examine the pathway to integration or eclecticism and explain why there are two seemingly disparate approaches to this phenomenon. Finally I will present the 3 . al. and socio-political and economic changes ranging from a more demanding and discerning market for therapy services to closer scrutiny by government. the central importance of the therapeutic alliance for successful therapy outcomes. L. 1992). therapeutic limitations of single therapy approach as evidenced by research (Lazarus et. 1992). J C. economic and social changes. the identification of common therapeutic factors amongst the different types of psychotherapy e. namely technical eclecticism. There are three main ways in which the various therapies have been brought together.(Norcross. and Grencavage.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. These changes include an abundance of psychotherapies such that there was confusion from even within the field as to efficacy of most.M. regulators and the health insurance industry who fund treatment. as well as what both mean for the practitioner and how they may influence the way she works. inability to exhibit particular superiority of any one theory over the others.
(Palmer and Woolfe. 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. Subsequently. 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. (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. 2010). Palmer and Woolfe. Development The history of psychology has involved the development of different ideas to explain and understand human behaviour and development. there emerged a drive to harness ideas from 4 . 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”.obstacles to both integration and eclecticism and the advantages and disadvantages for both as well as presenting a conclusion and a list of references. These in turn have promoted the growth of competing paradigms to help people overcome difficulties and lead more satisfying lives. 2010).
. 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. Technical Eclecticism The dictionary defines eclecticism as ‘selecting ideas or material from a wide range of sources or authorities’ (Chambers. conditions and patients for whom they were selected. He felt that a joining together of theoretical concepts would be futile. 1992). this approach to philosophy and psychology has existed since the third century. Technical Eclecticism in psychotherapy refers to the borrowing from diverse schools of therapy.other orientations. 5 . but took on clinical significance in the 1930’s (Lazarus et. al. Given the relative ease of adoption and assimilation. In a sense. 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. Further he stated that the process of selecting techniques had to be systematic and effective for the range of problems. technical eclecticism experienced rapid growth as well as growing diversity (Lazarus et. 2004). techniques to enhance the effectiveness of a core or basic theory without applying the underlying concepts that spawned them (Lazarus et al. An example of this is taking Rogers’ core conditions from Person-centred therapy and applying them in a psychodynamic or other setting. 1992). Another is employing the free association of psychoanalysis within a Cognitive-behavioural framework. but the adoption of techniques from disparate orientations would be rewarding. 1989). According to Lazarus who first coined the term. al. 1992).
These are known as by their acronym B. specific techniques and clinical skills of the therapist. 2008). He sees technical eclecticism as a precursor to an eventual unifying theory. 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. taking into account patient qualities. imagery. The underlying theory is social learning. Lazarus (1989) contends that for eclecticism to be effective it needs to be systematic. and diet or drugs. but Lazarus saw elements of psychodynamics and cognitive emotive perspectives at play and he incorporated techniques from them accordingly (Okun & Kantrowitz. 6 . I. (Norcross and Grencavage. affect..A.D which stands for behaviour. interpersonal. An example of technical eclecticism is Lazarus’ own Multi-modal therapy. 1989). He suggests dropping of confusing labels including eclecticism and advocates instead a problem focus. cognition.I. He advocates a system of selecting treatment techniques to fit the specific needs of individual clients. a derivative of behaviourism. sensation.eclecticism is a buffet of several techniques without trying to blend or synthesise a new method from the constituent theories. 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.S. Another example of eclecticism is Solution-focused Brief Therapy.C.
from person-centred therapy in establishing a therapeutic alliance. (Norcross and Goldfried. problem redefinition and action. is comprised of more than twenty methods of therapy that are grouped together as having a 7 . and behaviourism in taking and maintaining action by goal-setting and behaviour change. Cognitive-behaviour therapy is another example of integration in psychotherapy. A further example is Egan’s Problem Management Approach. It is integrative in the sense that it provides for the incorporation of different techniques throughout the process (Jenkins. 2010). 2010). In Egan’s model. In each of these are sub-stages that require different types of involvement for the therapist. There is an expectation that the resultant therapy will exhibit the strengths of its constituent theories whilst minimising their weaknesses. 2005). An example is Motivational Enhancement Therapy that draws primarily from person-centred therapy and cognitive-behavioural therapy with elements of existentialism.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. the relationship-building core conditions of the person-centred approach are combined with a skills emphasis from Cognitive-behavioural therapy (Jenkins. Cognitive-behavioural therapy itself is another example of theoretical integration. It is a staged process with distinctly different things happening in each of the three stages namely exploration. to cognitive therapy in thinking through potential preferred outcomes as well as illuminating blind spots that a client may be experiencing.
They view human problems as stemming from disturbances in the thought or cognitive processes in which people are disturbed not by events themselves. feelings and behaviour. an explanation of the perpetuation of functional and dysfunctional thoughts. evaluations. but by their view of events. feelings and behaviour. for modifying thoughts. and consequently how we behave or the actions we take (Corey. an explanation of the acquisition of functional and dysfunctional thoughts. interpretations and reactions to life situations and events. 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. and fourthly a framework consistent with the preceding. feelings and behaviour.common approach to problem solving. Emotions are derived from our beliefs. These include Rational Emotive Behavioural therapy postulated by Albert Ellis and Cognitive therapy (CT) by Aaron Beck. acquisitions and perpetuation) and the theory of change. He views any given theory including any hybrid as having four sub-components: basic assumptions. 2005). Horizontal integration is where there is a consistency and coherence between the 8 . and that changing these will lead to a change in how we feel about things. 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.
focus on interventions – changing the nomenclature from being theory of origin-specific to more generalised language. a concept of self and personal agency or responsibility. focussing on skills and choices . 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.to build self-reliance. 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”. 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. Further he postulates that there will be different extents of eclecticism depending on the degree of convergence or divergence between theory and practice. and his own “Personal Responsibility Counselling and Therapy” . accessible language that supports self-help. developmental and self-help focus. These are: a balanced emphasis on thoughts. In this context then.merging of psychodynamic and existential methods and concepts. Nelson-Jones gave as examples Existential Psychotherapy . feelings and behaviour. a remedial. psychodynamic. accounting for all areas of functioning . humanistic. he views eclecticism as occurring where the practice and the theory are not consistent as being from different orientations.existential.theory (of the person) and the practice (of behaviour change). 9 . cognitive and behavioural theories.not just relationships.
An example is Motivational Enhancement Therapy that emerged from a painstaking research project carried out to test and assess how people change (Prochaska et. 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. 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 summary. al. This would reveal the drivers for therapeutic change and the 10 . 1992). Thus it is necessary for the counsellor to stick to a systematic approach to building up an eclectic method. 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. 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 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. However there are established eclectic and integrated approaches that have come about through exhaustive research available for use by the multi-modal therapist.
maintenance of that change allowing the practitioner to establish a basis for choice of either technique or theory. and Grencavage. they are forced to keep up with innovations and the latest thinking. and Grencavage. 2010). However it offers the possibility of permanently shifting the therapist to being more accepting of the unfamiliar and willingness to grow (Palmer and Woolfe. In order for the therapist to engage in integration and eclecticism they need to question the assumptions and techniques of their established theoretical school. to greater flexibility. 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. 1989). 1989). This in turn creates a necessity to refresh themselves with training courses and other opportunities for continual growth and development (Norcross. 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. 11 . and away from custom. preference and convenience (Norcross. Systematic eclecticism requires the counsellor to become familiar with changes in the field. It requires them to move from a rigid reliance on a narrow range of strategies to meet the client’s needs. This can be challenging for the counsellor as previous assumptions are questioned.
rational-emotive and cognitive therapy – that spawned it (Norcross. 1989). 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. 1989). there are ongoing impediments to a wider adoption of the same. and Grencavage. then integration will enable the optimal framework for the skills of the counsellor to shine through for the good of the client (Egan. and Grencavage. Integration of the different concepts will facilitate outcome research in a way not currently possible as like for like is not being compared. 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. and whilst there are clear advantages to clients 12 . It is richer than the various theoretical orientations – behaviourism. An example of this is Cognitive behavioural therapy which has evolved over time and its coherence at the conceptual level is clear. Obstacles to Integration Research amongst practicing psychotherapists has revealed that despite the advantages of integration.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. It will allow for more accurate analysis of what works in psychotherapy and inform the training of future counsellors (Norcross.
of a blended (or collectivist) approach to treatment. Many therapists would prefer to remain in their single-theory approach rather than bridge this gap. 1989). Currently most psychotherapists practicing integrated counselling are essentially self-taught. and Grencavage. This is slowing the uptake of this perspective in psychotherapy (Norcross. Given that counselling theories are primarily views of human personality. whilst person-centred therapy believes the person is basically good and will strive for self-actualisation or optimisation given a nurturing environment. 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. 1989). often the opportunity cost of leaving ones established single theory approach is too high (Norcross. it becomes difficult to square the opposing views of human nature that alternative approaches may have. The third factor impeding the uptake of integration more widely is the apparent contradiction between the different schools of psychotherapy. For instance psychoanalysis states that the human being is the product of hidden drives developed in childhood and is therefore essentially flawed. and Grencavage. there is a certain comfort from remaining in the known despite the potential advantages of embracing a new blended approach (Norcross. and Grencavage. 1989). to the extent of the integration of their practice. 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 13 .
and Grencavage. Advantages of Eclecticism As eclecticism involves choosing many techniques from diverse theories.objective basis for determining whether to take up an integrated approach at the expense of a single theory. 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). Further. a common framework of understanding would have to be established so that direct comparisons and referencing could be made (Norcross. 1992). it can just as easily discard whatever technique is no longer useful. without the basic constituent theory changing in any way (Lazarus et al. ‘negative self-statements’ (Beck’s cognitive therapy). psychology draws heavily on technical terms. 1992). 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. It also complicates the choice of combination of concepts and strategies as there is little to go by. and ‘poor self-image’ (Rogerian person-centred) – these may or may not refer to the same thing. 14 . 1989). This in turn impedes the uptake of an integrated approach. This again discourages the potential integrationist (Lazarus et al. A gulf grows where elements of different theories become inaccessible to adherents of other persuasions. as a science.
Eclecticism is flexible and it is easy to use. 1992). and not from the notion of eclecticism itself. Recent developments have devised problem specific treatment formats for complex mental illnesses previously in the exclusive of domain of medical practitioners. Techniques that are inappropriate can be dropped and replaced by other more appropriate ones. methods subjectively based on personal appeal happens when there is neither validation nor rationale for the methods employed (Lazarus et al. 1992). As a result there are more and more manualised treatments emerging for the treatment of specified conditions. Eclectic approaches are comprised of prescriptive treatments based on needs of the patient and are therefore appropriate and timely and quite specific. 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. Treatments of choice for specific ailments or conditions are becoming the norm and these are facilitated by an eclectic approach (Lazarus et al. 15 . Limitations of Eclecticism The disadvantages of eclecticism stem from the way it is practiced. The possibility of a haphazard incorporation of ideas. made possible by taking an eclectic approach. This augurs for better and more effective treatments.
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. 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. This itself will facilitate accurate outcome research further sharpening the skills of practitioners and shedding more light on what constitutes effective therapy. 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. 16 . methods and strategies. It is clear however that both practices are stops on the journey to a unifying theory from which will emerge complimentary techniques. 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. I have presented some of the emergent thinking into the ways in which this movement is taking place.
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