Sjoerd Colijn PhD.

History
 Mid- 20th century: divergent development, competing
therapeutic schools
 In the US from 1981 onward: ‘Exploration of
Psychotherapy Integration’
 In the Netherlands from 1995 onward-> ‘integratieve
psychotherapie’
 In the Netherlands from 2006 onward->

One PSYCHOTHERAPY
Dutch textbook for
psychotherapy training
Literature
 Trijsburg, R.W., Colijn, S., & Holmes, J. (2005).
Psychotherapy Integration. In G. Gabbard, J. Beck & J.
Holmes (red.), Oxford Textbook of Psychotherapy (pp.
95-107). Oxford: Oxford University Press.

 Psychotherapy integration, eclective

psychotherapy
 Common factors, nonspecific factors, universal
therapeutic factors
Developments in the field of
psychotherapy: CONVERGENCE
 Attachment
 Cognition and emotion
 Neurobiology
 Evidence-based medicine
 Convergence between therapeutic schools
What is psychotherapy integration?
 Integrating the best of many worlds
 Dominant in psychotherapy practice
 The unique client as starting point

What is it not?
 A new brand of psychotherapy
One psychotherapy
What works in psychotherapy (?)
Evidence-based psychotherapy
- guidelines
 Anxiety disorder: CBT, EMDR (trauma), mindfulness-
based CBT (GAD)
 Depression: CBT, manualized Psychodynamic
psychotherapy, Interpersonal Psychotherapy
 Personality disorders: mentalization-based therapy,
schema-focused therapy, dialectic behavioral
psychotherapy
Limitations in evidence-basedness
 Treatments are effective for 40-70% of the patients
 Most treatments have not been investigated in natural
environments (efficacy-effectiveness)
 There have been only a few cross-cultural replications
 We do not know what the active ingredients are
 Evidence tells us that other factors are (more?)
influential
To the evidence
 Not so much: which treatment works
best?
 But: what works best in treatment for
which patient?
Evidence on differential contribution of
elements

Common
Factors Extratherapeutic
30 % Change
40 %

Techniques
15%
Expectancy
(Placebo effects)
15%

FIGURE 3.1
Percent of Improvement in Psychotherapy Patients as a Function of Therapeutic Factors (Lambert, 1992)
 % of Psychotherapy Outcome Variance
Atrributable to Therapeutic Factors

Inte raction
5%
Individual
The rapist
7%
Tre atme nt
Me thod
8% Une xplaine d
The rapy Variance
Re lationship 45%
10%

Patie nt
Contribution
25%
Universal and specific therapeutic
factors
 Universal and specific therapeutic
factors (Karasu, 1986; Trijsburg, Colijn, Holmes, 2006)

‘Two major contrasts dominate the field of

psychotherapy’:
1. Monism versus Eclecticism
• is one school enough for treating all
pathology?
2. Specificity versus Universality
• Does the major contribution to therapy
outcome come from specific (schoolist)
factors?
Universal therapeutic factors
(Frank)

 A trusting relationship
 Between a client and a socially sanctioned
healer/therapist
 Who provides a rationale for the problems
 And performs procedures/techniques/rituals
accordingly
 In a healing context

 Promoting Hope and Remoralization

Specific factors, for example:
 BT: classical and operant conditioning
 CBT: cognitive restructuring
 CCT: acceptance and exploration in a therapeutic
relationship
 PD: influencing the unconscious dynamics through
clarification and interpretation
 Systemic: Understanding pathology in context,
influencing family structure
 Group: investigating and modifying interpersonal
ways of relating
Universal and specific therapeutic
factors (Karasu, 1986; Trijsburg, 2003)

Universal factors Specific factors

Model: Universality Model: Specificity

Contextual model: Medical model: specific

holistic element
Evidence: Evidence:
Observational studies RCT
Naturalistic studies Experimental studies
Correlational studies
Research evidence
Evidence
 Patient factors
 Therapist factors
 Relationship factors
 Treatment x Aptitude factors
 Context factors
 Universal therapeutic factors
Patient factors
 Extremely important
 In research: multitude
 Demographical variables: no importance
 Motivation
 Active participation
 Interaction therapist and patient factors: ‘therapist
responsiveness’
Therapist factors
• Important
• Demographically: not important, but perceived values
important
• Skill to use procedures
• Relational qualities
• Interaction therapist and patient factors: ‘therapist
responsiveness’
• Training most probably, selection most certainly
important…
Relationship factors
Psychotherapeutic relationship
 4 aspects:
 Real relationship
 Working alliance
 Transference relation
 Primary relation

 Working alliance:
 Bordin: tasks, goals, bond
 Saffran & Muran: alliance ruptures
 Universal aspects of the
therapeutic relationship (Norcross, 2002)
 Proven to be effective: working alliance, cohesion in
group therapy, empathy, agreement and cooperation
on treatment goals
 Most probably influential: positive regard,
genuineness, feedback, repairing relationship
ruptures, self-disclosure, dealing with
countertransference, quality of relational
interpretations
 Customizing the therapeutic relationship
(Norcross, 2002)

 Proven to be effective: : dealing with resistance, taking

functional impairment into account
 Most probably influential: taking copingstyle, phase of
treatment, expectations of patient
 Still insufficient evidence: attachment style, matching
on gender and ethnicity
Conclusion

 Convergence
 Specific ánd universal
 ‘Psychotherapy integration’:

one psychotherapy