My Journey Through Psychotherapy Integration by Twists and Turns

Stanley B. Messer
Rutgers University
In this article, I describe my evolving engagement with the field of psychotherapy integration over a period of 40 years. It
started with a consideration of the limits of integration based on the very different perspectives on, and visions of, reality
in three major forms of therapy—psychoanalytic, behavioral, and humanistic. My journey took a turn toward an
integrative position as I noted how behavioral and psychodynamic outlooks began moving closer together. This led to my
formulating the concept of assimilative integration, in which techniques or perspectives from other therapies are
incorporated into a “home” therapy. It is related to the philosophical positions of contextualism and pluralism as
advocated by John Stuart Mill. I then apply the four visions of reality—tragic, comic, romantic, and ironic—to a case,
showing how they can be utilized clinically and integratively. Finally, I address how new ways of conducting and
presenting case studies can foster the integration of research and practice, which is an important part of the mission of the
Society for the Exploration of Psychotherapy Integration.

Keywords: psychotherapy integration, visions of reality, assimilative integration, integrating practice and research, case
studies

In a sense, my engagement with psychotherapy integration started with my appointment to

Rutgers University’s PhD clinical psychology program in 1968—yes, exactly 50 years ago— much to my
astonishment. In 1970, I took a partial leave of absence to enter a fellowship program in psychoanalytic
psychotherapy at Hillside Hospital in Glen Oaks, New York. By the time I returned full-time to Rutgers 2
years later, the PhD program had become primarily behavioral with the hiring of Arnold Lazarus, Cyril
Franks, Peter Nathan, and Terry Wilson. I was considered the token psychoanalyst, although
I was not formally certified as such, and my views were frequently challenged by these proponents of the
emerging field of behavior therapy and cognitive-behavioral therapy (CBT). They argued that psychoanalysis
was neither empirical nor scientific, instead relying on theory and case studies, rather than on experiments,
and questionable constructs such as the unconscious.
A few years later, Meir Winokur, who had been a practicing psychologist in Israel, came to Rutgers to obtain
a PsyD. In an effort to learn more about behaviorally informed therapy, we watched Arnold Lazarus
conducting therapy from behind a one-way mirror. We also read Wachtel’s (1977) groundbreaking book that
integrated psychoanalytic and behavior therapy at both the clinical and theoretical levels. These experiences
prompted us to consider why we were psychoanalytically oriented and not behaviorally oriented. We framed
this project interms of the difficulties and limits we saw to the integration of these two types of therapy and
compared them primarily along two dimensions: perspectives on reality and visions of reality (Messer &
Winokur, 1980, 1984).

Perspectives on Reality
Regarding perspectives on reality, we referred to three polarities, namely realism versus idealism,
objectivism versus subjectivism, and extraspection versus introspection. We characterized the behavior
therapist as adopting an orientation that is relatively realistic, objective, and extraspective (i.e., “viewing
from the outside”), in contrast with the more idealistic (i.e., “we create the world we see”), subjective, and
introspective (i.e., “viewing from the inside”) outlook of the psychoanalytic psychotherapist.

Visions of Reality
Although these perspectives refer to the angle from which reality can be viewed, they do not inform us as to
the nature of that reality or the extent of human possibility or limitation that they imply. For this, we turned to
an approach within the literary domain described by the critic Northrup Frye (1957), namely the four mythic
forms characterizing various genres of literature, and to Schafer’s (1976) application of these forms to
psychoanalysis. These are the tragic, comic, romantic, and ironic visions of reality. In the following text, I
describe these literary tropes briefly, as well as how they apply to psychoanalytic, behavioral and humanistic
therapy.

Tragic Vision
• Conflict is endemic in life, and there is no escaping it. It can only be confronted with the hope of some
alleviation.
• Choices made are irreversible. Going down one road in life often precludes another.
• Losses are irreplaceable, which is an unfortunate feature of the human condition.
• Possibilities for change are limited and are imposed by the nature of human existence, such as childhood
dependency and early experience.
External circumstances contribute to tragedy, but often the principal cause lies in the person— what is known
as the tragic flaw. This vision leads to a therapy that is focused on internal struggles and coming to grips with
the limitations of life and of oneself: That is, it focuses on self-knowledge. Most would agree that
psychoanalysis, among the therapies, falls most strongly within this vision.

Comic Vision
This does not mean “comic” in the sense of “funny or frivolous,” but it refers to the structure of dramatic
comedy.
• Conflict is centered in situations, not in character flaws, and these can be ameliorated by effective problem
solving and action.
• It emphasizes the familiar, the controllable, and the predictable aspects of life.
• Endings are happy, free from anxiety and guilt.
• Comfort and worldly success are achieved.
Comic dramatists are interested in their characters from the outside. Frye (1965) said that what a comic
character acquires is not an introverted knowledge, but a sense of proportion and of social reality, that is, an
increased capacity to perform social roles more adequately. The comic vision, which in certain ways is
opposite to the tragic vision, is consonant with a therapy that is action-oriented rather than reflective.
Behavior therapy, by emphasizing learning through modeling and reinforcement and the personal control of
environmental contingencies, allows for greater optimism regarding people’s ability to change.
Similarly, cognitive therapists, in focusing on the correction of irrational cognitive constructions and
attributions, imply a malleable and readily improvable subject. The client is helped to change his or her
behaviors or thoughts rather than to reach an inner reconciliation based on self-knowledge as in
psychoanalytic therapy. In other words, behavioral and cognitive therapists are decidedly more optimistic
about human possibility.

Romantic Vision
• Life is a series of quests, be it for adventure, fulfillment, or the Holy Grail. Uncertainty and the irrational are
valued (not just that which is certain and rational).
• There is an attitude of curiosity and openness to the unexpected: That is, you do not know what one will face
around the corner.
The romantic vision corresponds more to the world as we would like it to be than as it actually is. According
to Jean-Jacques Rousseau, who developed the romantic view, human nature unadulterated by civilization is
intrinsically good. After originally focusing on psychoanalytic and behavior therapy, Winokur and I applied
these literary forms to the humanistic therapies (Messer & Winokur, 1986). We saw these as falling squarely
within the romantic vision in so far as they emphasized people’s inherent goodness, potential for growth,
willingness to take risks, ability to be spontaneous and to selfactualize.

Ironic Vision
• Within this vision, there is a readiness to seek out contradictions, ambiguities, and paradoxes.
• It aims at detachment, spotting the antithesis to any thesis.
• It stresses the independence of the way things are from the way we would like them to be.
As is readily discernable, the ironic vision is antithetical to the romantic vision. Perhaps some of the family
therapies partake of irony in noting double binds in family communication, in using techniques such as
paradoxical intention, or in their no-nonsense, reality-oriented approach. In truth, I have not explored this
possibility in any depth: However, I can say that the ironic posture is more typical of psychoanalytic than it is
of the behavioral or humanistic therapies. For example, it leads one to look for hidden agendas and the
meaning underlying dreams or symptoms. Ambiguity and the possibility of multiple meanings are valued and
are seen as intrinsic to human functioning. The upshot of our analysis was to emphasize the limits of
psychotherapy integration because the therapies have such different underlying visions. Following these
articles, Arkowitz and I coedited a book titled Psychoanalytic Therapy and Behavior Therapy: Is Integration
Possible? (Arkowitz & Messer, 1984). In answer to this question there were pro and con views presented by
Gill (1984), Kazdin (1984), Mahoney (1984), Messer and Winokur (1984), and Wachtel (1984), among
others.
Combining Psychoanalytic and Behavioral Perspectives
Around this time, I was beginning to discern a trend in the psychotherapy literature, which was bringing the
therapies closer together. Here is where I began to twist and even turn. I give just one example or two from an
article I wrote titled “Behavioral and Psychoanalytic Perspectives at Therapeutic Choice Points (Messer,
1986). In it, I compared possible behavioral interventions with psychoanalytic interventions at choice points
in therapy as applied to a case that I was supervising. I discussed the rationale for each of these very different
interventions along with suggestions for the psychoanalytic therapist and behavior therapist who were
inclined to incorporate perspectives or attitudes of the other. The first of each of the following
dichotomies was the more usual behavioral approach, and the second, the psychoanalytic: (1) goal
determination set by the client versus by the therapist; (2) the promotion of action versus the exploration of
mental content; (3) challenging versus understanding irrational cognitions; (4) modifying cognitive schemata
versus elaborating unconscious fantasies; (5) dissipating versus releasing emotions; and (6) the therapeutic
relationship—is it real or projected? In addressing these seeming dichotomies, I tried to show that the
therapies were not as far apart in these respects as they once were and that there were ways to draw on both
sides, such as introspective and extraspective vantage points, to the advantage of each. I then drew out the
implications of this rapprochement for the perspectives and visions of each type of therapy. For example,
regarding the therapeutic relationship, I recommended to behavior therapists that, in addition to striving for a
positive relationship with clients, they should be on the lookout for hidden, ambivalent and negative reactions
that clients may have to them or that they themselves may have to their clients. These observations could be
invaluable in alerting them to the way their clients perceive and respond to others, as well as in helping
therapists to overcome client resistance when progress is not evident. For psychoanalytic therapists, I
recommended that they allow their human qualities to shine through as advocated by humanistic and
cognitive-behavioral therapists, particularly their caring for and support of the client. They should keep in
mind, I wrote, the real relationship and its impact on the client in trying to discern the transferential elements
of the relationship— that is, that the relationship is not pure projection.

Assimilative Integration
Once I had begun to see the advantages of at least some degree of eclecticism or integration, I proposed
(Messer, 1992) a new twist in a form of integration, which I termed assimilative integration (the other major
forms being common factors, technical eclecticism, theoretical integration and, as proposed somewhat later, a
unified view of psychotherapy).1 What is assimilative integration? It is a mode of conducting psychotherapy
in which a technique, concept or perspective is incorporated into one’s home or preferred therapeutic
approach from another form of therapy (Messer, 2015a). One might, for example, incorporate behavioral
activation or social skills training— that is, behavioral techniques— into a psychodynamic or person-centered
therapy or include in CBT special attention to the therapeutic relationship as described in person-centered
therapy. To help control anxiety, the psychodynamic therapist may give patients a relaxation tape or advise
them to learn meditation or yoga. Assimilative psychotherapy integration recognizes that although most
therapists are trained in and practice from within one theoretical model, as they gain experience therapists are
very likely to include some features of another approach that have been demonstrated to help therapy progress
more effectively and/or efficiently. By integrating new methods and outlooks, therapists build on, and hence
modify, the theoretical modality to which they have primary allegiance. In so doing, they often modify the
theory as well (Wolfe, 2001), which is the accommodative counterpart to assimilative integration.
Assimilative integration has been referred to variously as a middle ground between theoretical integration and
technical eclecticism, as a minitheoretical integration, and as a way station to a fuller integration
(Lampropoulos, 2001). It has the advantage of allowing therapists to practice within the comfort zone of their
favored theoretical approach, even while broadening their repertoire to include techniques or perspectives
from other modalities. Supporting this concept, a survey by Norcross, Karpiak, and Lister (2005) found that
roughly 27% of those who regarded themselves as integrative or eclectic described themselves as preferring
assimilative integration, theoretical integration, or common factors, whereas technical eclecticism lagged
behind at 19%. In another study by Hickman, Arnkoff, Glass, and Schottenbauer (2009), those identified as
experts in psychotherapy integration were asked to assess the extent to which they were influenced by
psychodynamic, cognitive-behavioral, humanistic, and family systems theories. Threequarters indicated that
only one was a salient influence, supporting a major claim of assimilative integration—namely, that
practitioners tend to have a home base in one theory. The concept has been picked up by clinicians of various
theoretical persuasions as reported in the recent literature. For example, with a home base in psychodynamic
therapy, Stricker (2013) will ask a patient to do homework, which is a cognitive-behavioral technique, with a
psychodynamic twist—namely, to write a poem about his or her therapeutic experience, which Stricker then
works with much as he would with a dream. Gottdiener (2013) has used an assimilative psychodynamic
therapy for the treatment of those with substance use disorder. Trub and Levy (2017) trained psychodynamic
clinical psychology students to apply CBT to substance abuse clients; the students then expressed positive
attitudes toward practicing in an assimilative fashion. Castonguay, Newman, Borkovec, Grosse Holtforth, and
Maramba (2005) have described assimilative integration with a CBT home base, in which they include
aspects of other therapies such as facilitating emotional deepening from process-experiential therapy.
Likewise, Pitta (2015) incorporates a variety of psychodynamic and behavioral techniques into a family
systems assimilative therapy. Fraenkel (2018) has presented an assimilative approach to couples therapy in
regard to couples’ better use of time; and Fraenkel and Pinsoff (2001) have shown how “the tenets of
assimilative integration provide a framework for introducing students to multiple systemic theories and
techniques while allowing them to maintain a secure base in one main theory” (p. 59). Regarding how
interventions, which pertain to the therapy relationship can be assimilated into a homebase, see Messer and
Fishman (2018).

Philosophical Considerations: Contextualism and Pluralism

The next twist in my journey came in an article titled Psychotherapy Integration: A Postmodern
Critique (Safran & Messer, 1997). In this philosophically oriented paper, Safran and I looked at the prospects
for integration from the viewpoint of contextualism and pluralism. A contextualist position asserts that
psychotherapeutic concepts and interventions can be understood only within the linguistic, theoretical, and
ideological frameworks in which they are embedded; therefore, they take on new meanings when extracted
from their original context and incorporated into an integrative or eclectic therapy. For example, I treated a
young, professional who had experienced anxiety bordering on panic in his work setting since graduating
from law school (Messer, 1992). Although I conducted a largely psychodynamically oriented therapy to help
him deal with his problematic relationship to a highly critical and demanding father, I found that the client
was nevertheless having trouble focusing on his work. In line with cognitive therapy, I pointed out his
selective negative focus on the most problematic aspects of his work, magnification of them, and
catastrophizing about them. Together, we came up with other cognitive strategies to help him get through the
day, such as reminding himself that he had succeeded in similar situations in the past and that he was
expecting too much of himself as a novice professional. Because he tended to be dependent in his stance
toward older men, the challenge for him was not to become overly dependent on me in the transference, and
for me it was not to take up the countertransference role of the powerful, rescuing parent. Returning to my
more typical psychodynamic role, I interpreted this pattern to him to good effect. Turning to pluralism, it is
the postmodern doctrine that there is always more than one correct theory or perspective by which to view
any phenomenon. It is an antidote to parochialism and the attitude that absolute certainty is attainable. Our
position was pluralistic insofar as we argued that there is no single integrative system toward which the field
is seen as evolving, and no one methodological approach considered preeminent, be it experimental,
correlational, case study-based, or interpretive. In other words, we argued that the field would never achieve a
once-and-for-all general relativity theory or periodic table of elements for psychotherapy, neither in content
nor in method. Undoubtedly, others would disagree with that statement (e.g., Anchin (2012), Henriques
(2003), Magnavita (2008), and Marquis (2013) who have creatively pursued that goal). Our position was
dialogic in that truth was seen as emerging from an ongoing debate between alternatives, which, incidentally,
would include pluralism versus unified theory. We cited John Stuart Mill (Cohen, 1961), a strong advocate of
empirical methods in scientific procedure in the 19th century, who argued that a plurality of views is needed
in science— and, we argued, in psychotherapy integration as well. The following are just a few of Mill’s
propositions:
• An alternative view may contain some portion of the truth. Moreover, because the prevailing view is never
the whole truth, it is only by collision with contrary opinions that the remainder of the truth has a chance of
being recognized.
• A point of view that is wholly true, but not subjected to challenge, will be held as a prejudice rather than as
derived from a rational basis.
• Someone holding a particular point of view without considering alternative perspectives cannot really
understand the meaning of the view he or she holds.
For these reasons and others, we must entertain more than one viewpoint on therapy and must train students in
more than one therapeutic model. On the unfortunate narrowing of theoretical orientations in clinical
psychology training, see, for example, Heatherington et al. (2012) and Levy and Anderson (2013).
Integrating the Visions of Reality in a Case
Moving along to the 21st century, there are two other types of integration that are worthy of attention: (a)
applying the visions of reality to a single case and (b) integrating research and practice. Regarding the first,
with many journeys one ends up back at the starting point but with a new emphasis or outlook. I began to
realize that it is both possible and desirable to keep in mind each of the visions in treating the same client in
order to fully appreciate his or her complexity. The visions can be usefully brought to bear in therapy, either
to highlight the many dimensions of an individual’s experience, or to consider how each vision may be best
applied to different clients or specific circumstances. This demonstrates how my outlook has changed over
time from one in which I saw the therapies as largely differentiated by the visions to seeing them as
potentially broadening the perspective of any integratively inclined therapist (Messer, 2006). One may regard
this as both a twist and a turn in my personal journey. How might the perspectives and visions of reality be
integratively applied in a clinical situation, reflecting a way in which I think about my clients? When David
came to see me, he was a single, 19-year-old college student who had recently spent 2 weeks in a psychiatric
hospital following a severe manic episode. Among other irrational and dangerous behaviors, he had been
driving on a highway at breakneck speed and was subsequently apprehended by the police and hospitalized.
He had to drop out of his out-of-state college and move home. He subsequently registered at a university
closer to home and closer to where I practice. The therapy I conducted was an integration of psychodynamic
exploration with supportive and cognitive-behavioral features. How do the visions apply? The tragic vision
highlights the irreversible features of David’s life. He is stuck with a mental illness that, though amenable to
management, usually afflicts the bearer throughout life, at times with dire consequences. David often
commented on how it was bad luck that he ended up with his disorder and complained about the fact that it
has made life much harder for him. For example, in the past he has gotten into trouble by acting in a high-
handed way, a characteristic that may accompany this diagnosis. In his case, the disorder also came with a
high degree of social anxiety, irritability, and obsessive–compulsive traits, such as a strong compulsion for
neatness, structure and order, and a frequent need to check that he had not left the stove on or the water
running before leaving his home. From the point of view of process and technique, the tragic view calls for
exploration and reflection, which are particular elements of both psychoanalytic and humanistic therapies. In
terms of outcomes, the tragic vision stresses the limitations brought on by his mental illness. One can expect
occasional exacerbations or even reversals, which David experienced, and ongoing struggle with his issues,
although to a lesser degree. One cannot expect a straight line forward or a complete cure, nor in fact had there
been one. As I have gained experience as a therapist, I have come to accept limitations in my ability to bring
about thoroughgoing change and transformation in the face of certain psychiatric disorders. I believe that
David has accepted some of his limitations as well. However, keeping in mind the comic and romantic visions
of reality can give one a more hopeful outlook than that offered by the tragic vision alone. From a comic
perspective, the content of David’s problems might be seen as changeable through direct action. Moving
forward a number of years (this was long-term therapy), David was now successfully married with children
and gainfully employed. His tendency at work, however, was to isolate himself from his fellow employees, a
manifestation of his social anxiety. At home, because of his obsessive–compulsive personality style and
ongoing anxieties, he tended to be overly critical of his wife for not keeping the house sufficiently tidy,
despite her having a full-time job and young children to help raise. How can the comic vision help here?
With respect to technique, one can approach David’s problems with a sense of optimism and can-do. For one
thing, his mood can be, and has been, stabilized through the use of medication. Regarding his tendency to
isolate himself at work and to be critical of his fellow employees, I coached him on the importance of his
being friendlier and viewing his fellow employees more sympathetically, if for no other reason than to keep
his job and advance in it. This was handled through direct advice and reframing rather than deeper exploration
alone. And indeed, it helped him relate better to others. Regarding his obsession with the tidiness of his home,
I helped him to realize the pressures that his wife was under and how he should not expect her to keep the
house in immaculate condition. Although this did not eliminate his obsessive–compulsive symptoms, it did
help him to control them. One can also see in this example the application of assimilative integration. With
respect to outcomes, within the comic vision there is an ability to perform social roles more adequately, and
David is now doing so with both fellow employees and with his wife. Happy endings are viewed as the norm
within the comic vision in so far as problems are not merely explored and illuminated, but they are directly
ameliorated through action. This helped David maintain both his job and his marriage in a relatively
harmonious and satisfactory state. In these ways, the comic vision is an antidote to the tragic elements in his
life. As for the romantic vision in David’s therapy, I am careful not to neglect the interests and strengths that
patients have in spheres such as art, music, sports, religion, spirituality, reading, travel, and the more creative
aspects of their work and recreational pursuits. The romantic vision keeps these arenas of the client’s life on
the therapist’s radar, as they can be considerable sources of satisfaction in life as well as wellsprings of
strength to combat the deleterious effects of mental illness. In terms of therapeutic technique, I help clients
delve into their wishes, fantasies and daydreams so that they may see themselves as interesting, multifaceted
and multidimensional human beings who are not defined solely by their mental illness or current life
difficulties. In David’s case, and in terms of the process of therapy, I encouraged his own inclinations to
develop his vocational interests in a creative direction, which currently gives him considerable satisfaction
and that has led to a sense of pride and authenticity in his vocational strivings. Self-fulfillment is an outcome
consonant with the romantic vision. The ironic vision provides a corrective to the romantic vision. The
process or technique of therapy within the ironic perspective calls for therapists to be skeptical of all that they
hear from clients. The grandiosity that David sometimes displayed, which I referred to in therapy as his
highhandedness, masked an underlying sense of inadequacy. In contrast to his typical view of himself as
smart, knowledgeable, and quite special, he was anxious about speaking, eating, or dancing in public.
At times he would feel that his speech was indistinct or his eyesight impaired, leading him to see physicians
unnecessarily, which I interpreted as indicators of a fear of being inadequate. I explored these contrasts in a
psychodynamic fashion and tried to reassure him that I noticed nothing unusual about his speech or manner.
One goal of irony is to see oneself as honestly as possible, free from illusion. For example, David came to
recognize that he may not be quite as superior as he first imagined (although he is very bright and able), but
neither was he as inadequate as he had feared. The ironic vision also predisposes the therapist to keep the four
visions in balance. (See Messer, 2015b for an expanded version of this case).

Integrating Research and Practice

The mission of the Society for the Exploration of Psychotherapy Integration (SEPI) includes not only the
exploration of psychotherapy integration, but also the integration of research and practice. For me, this was a
turn in a new integrative direction. I wrote about this most recently in the January 2018 issue of SEPI’s
newsletter, The Integrative Therapist. Those of us who have been in the field for some time grew up with the
idea that the randomized controlled trial (RCT) was the gold standard in conducting psychotherapy research.
Although it still retains preeminence because it allows one to maximize internal validity and make causal
inferences about the value of a particular approach, the field now recognizes that it falls short of being
optimally useful to the practitioner (Messer, 2016). What do we have available to augment the results of
RCTs? Along with Fishman (2013) and McLeod (2010) among others, I would argue that case study research
has come of age and provides an excellent bridge between research and practice, supplementing what we
learn from traditional RCTs. Research has shown that practitioners, regardless of their theoretical orientation,
are more influenced by cases than by data from RCTs (Stewart & Chambless, 2010). There are also mixed
methods that incorporate RCTs and single case comparisons, which include quantitative and qualitative data.
McLeod has focused on the various ways to conduct rigorous case study research, showing how cases can be
presented in such a way as to provide reliable and valid evidence rather than being purely anecdotal or
illustrative. He emphasized four factors that make case studies relevant for building a solid psychotherapy
knowledge base: (1) a narrative way of knowing; (2) complexity, that is, “thick” description; (3) a fuller
context for the variables of interest; and (4) being able to observe practical expertise in action.
What are some of the ways that have been developed to conduct rigorous case study research? To briefly
mention a few, these are known as the pragmatic case study method (Fishman, 2013); n _ 1 time series case
analysis (Kazdin, 1982; Morgan & Morgan, 2009); the hermeneutic (or adjudicational) single case efficacy
design (Bohart & Humphreys, 2000; Elliott, 2001); the theory building case study (Stiles, 2007); narrative
case research (Etherington, 2000); and the team-based case study method to enable practitioners and students
to conduct systematic case studies (McLeod, 2010). These are works in progress, each with its own
advantages and drawbacks. To get a good sense of how cases can help in practice and in research, see
McLeod (2010) and the online journal Pragmatic Case Studies in Psychotherapy
(https://pcsp.libraries.rutgers.edu/). In a book edited by Fishman, Messer, Edwards, and Dattilio (2017), four
RCTs of different kinds of therapy are presented, each with two or three cases from the RCTs—usually a
success case and a failure case. Each case is presented in narrative form but is enhanced by the quantitative
data that were collected as part of the RCT. Whereas the RCT group results are not able to describe how, or
explain why, some clients are successful and others not, the case comparisons do exactly that. This is known
as the mixed-methods model, as it makes use of both quantitative and qualitative data. What do case studies
add to what is learned from an RCT? In a review of the Fishman et al. (2017) volume, Bohart (2017)
summarized some relevant points made by the editors, chapter authors and commentators about the
advantages of case studies. These are as follows:
• identifying therapist and client factors that may help determine success or failure
• identifying extratherapeutic factors, such as the role of parents
• examining how mismatches between client and therapy can affect outcome
• determining the role of culture
• examining how the process of a specific therapy works
In addition to SEPI’s traditional role of studying commonalities and differences among theoretical and
clinical positions, I believe that it has an important role to play in narrowing the gap between research and
practice, as Goldfried (2018) and McWilliams (2017), each in their own ways, have advocated. Systematic
and rigorous single case studies are one very promising vehicle toward achieving this goal.

Conclusions
To conclude this description of my journey through psychotherapy integration, here are a few take-away
points:
1. We can engage with psychotherapy integration at different levels of discourse. It is not all about
techniques. I have illustrated a few of these levels through my own work, which included the following:
• the metatheoretical (i.e., perspectives on reality and visions of reality)
• the philosophical (the relevance of contextualism and pluralism for integration)
• the clinical (assimilative integration)
2. I view psychotherapy integration as a process and dialectic with no particular endpoint. It is valuable to be
exposed to other viewpoints, to learn from them, and then to further the dialogue and apply what we learn to
our practices and research.
3. I believe that many if not most practitioners have a home base in which they are comfortable and secure.
Gradually they tend to branch out to incorporate other perspectives and techniques in an assimilative manner.
We tend to get attached to one theory early on, but then we are able to expand our horizons in an integrative
way. The attachment is due, perhaps, to the primary theoretical orientation of the doctoral program one tended
and that of one’s own therapist, or to a reflective versus action-oriented personality disposition.
This might help explain why many practitioners prefer to maintain one theoretical and therapeutic outlook
with its accompanying perspective and vision of reality. What might counter this more parochial inclination is
a broadening of our training programs to include more than one theory and therapy.
4. Finally, there is progress being made in the realm of integrating research and practice. Enhanced interest in
the rigorous and systematic case study and in applying multiple methods in our research show promise for
leading to a better understanding of what makes psychotherapy work in general and to what might be the
advantages of psychotherapy integration in particular.