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From: Jerry Gold
Subject: SEPI influences in psychotherapy integration

Here's a question borrowed from Ed Zuckerman, Ph.D. and which appeared originally on the PSYUSA list:
What are the books and articles that each of us feels as having been centrally influential in defining the ways that we think about and practice psychotherapy? In particular, are there any writings that opened the possibility of integration as a real one. For example, my vision was changed forever by Paul Wachtel's Psychoanalysis and Behavior Therapy, an experience that I'm sure is/was shared by many? Anyone care to contribute a bibliography of such influences? Brief annotations might be fun too.
Jerry




From: Sliepack

Brazier, D. (1995). Zen therapy: Transcending the sorrows of the human mind. New York:Wiley.
Captures my ideas about the process and practice of therapy better than any other book I've read...by far! In my mind a must read for all therapists.




From: "George Bouklas"

I am sure this is something many of us can relate to, but books never captured the essence of integration for me. I think this says something about the written word's inability to impart much about the therapy process. Ros and Lenny Schwartz trained us here in NY and in a two year period brought in people from the behavioral, psychoanalytic, psychodynamic movements and more, for marathon sessions. After we had Ellis, we sat with someone from Esalen, then a Jungian, then a neo-Freudian. Ros and Lenny continually asked the integrating questions, stitching together what seemed at first disparate and contradictory. Then I had the pleasure of observing Arnold Lazarus who brilliantly pulled together a number of approaches. Underlying his behavioral system was a psychoanalytic sensibility that was impossible to miss, and this came through in a particular form of compassion for those suffering with emotional problems. He told a story about a patient who was criticizing herself over a certain symptom and at one point he had exhausted behavioral remedies. But when he joined her dystonically, that did the trick. I loved Lazarus for telling that story, because he showed us how to merge behaviorism with psychoanalysis, right there. Spotnitz accommodated to every kind of technique and suggested an integrative underpinning to all our work. You had to have the "right feelings" for the patient. The technique was secondary. I think in this way the modern psychoanalytic movement has attracted folks with all kinds of training, because it hunts down those ineffables, or therapist variables that account for about half the "action" in therapy. Probably "the book" that has most influenced my integrative interest is "The Book," by Alan Watts. Again, it gets at universal underpinnings that shed light on symptoms, suffering and growth.




From: Gerald Davison

My votes are for the following:
London, P. (1964). Modes and morals of psychotherapy
Dollard & Miller (1950). Personality and psychotherapy (Out of Stock)

Lazarus (1971). Behavior therapy and beyond
and of course
Wachtel (1977). Psychoanalysis and behavior therapy
(which I have assigned in my graduate course on psychological intervention every year since it appeared; this semester I'm using his expanded 1997 edition.)
-- Jerry Davison



From: Pio Scilligo

Here are some of the books that have had an important influence on me:
Wachtel, P. (1997). Psychoanalysis, behavior, and the relational world. Washington: APA.
Lazarus, A. (1997). Brief but comprehensive psychotherapy: The multimodal way. New York: Springer
(and Lazarus's 1989 book)
Horowitz, M. J. (ed.) (1991). Person schemas and maladaptive interpersonal patterns. Chicago: The University of Chicago Press.
Benjamin, Lorna, S. (1996). Interpersonal diagnosis and treatment of personality disorders. New York: Guilford Press (especially her interpersonal model).

I am adopting all these volumes at the Graduate School for Clinical Psychologists of the Salesian University in Rome and Horowitz at the Second Graduate School of Clinical Psychology of the Unversity of Rome "La Sapienza". Of course, books are just stimuli, they are no substitute to the creativness of the psychotherapist!
Pio Scilligo, Ph. D.
Professor of Psychology
University of Rome "La Sapienza"
Faculty of Psychology




From: Graz Kowszun

I would like briefly to introduce myself before responding. I am a humanistic integrative psychotherapist practicing in the unfashionable south-easterly corner of London. My caseload is multi-cultural and of diverse sexualities, and I offer both short-term contracts and longer term opportunities. I have practiced as a counsellor and psyhotherapist for some 15 years and was delighted when convergence between analytic and humanistic schools began to take off, and integrative trainings appeared in England:

I agree that live experiences more than books encouraged me to consider integration. Nonetheless the goodies for me include:-
Kahn, M. (1991) Between Therapist and Client, New York: W.H. Freeman
Erskine, R. & Moursand, J. (1988) Integrative Psychotherapy in Action: Sage
Also an article:-
Erskine, Richard, G. (April, 1994) Shame and Self-Righteousness: Transactional Analysis Perspectives and Clinical Interventions, in Transactional Analysis Journal, Vol 24, No. 2.
Kepner, J. (1995) Healing Tasks: Psychotherapy with Adult Survivors of Childhood Abuse, San Francisco: Gestalt Institute of Cleveland
Kaufman, G. (1989) The Psychology of Shame, London: Routledge.
Whitmore, D. (1991) Psychosynthesis Counselling in Action, London: Sage

These are mainly practice based examples of integrative models that include what is dear to me. Recognising the impact of shame and how approaches to therapy can humiliate rather than heal was a turning point in my understanding and practice. Developing the sense of self (and a self operating on interdependent levels)as an integrative tool means a lot to me also.
A brilliant question / topic - could you please send the biblio when it is collated?
Thanks and best wishes,
- -- Graz Kowszun




From: Stanley Messer

In addition to Paul Wachtel's book, which was a key influence in my own work, two other volumes come to mind. One is by Stephen Appelbaum, called Out in Inner Space: A Psychoanalyst Explores the New therapies. It is his account of what he learned visiting centers where the new therapies of the 70's (such as rolfing, biofeedback, bioenergetics, macrobiotic dieting, transcendental meditation) were being practiced, and what he could incorporate into psychoanalytic practice. The other was Perry London's book about the modes and morals of psychotherapy in which he looked at the insight oriented and action-oriented therapies within a broad, socicultural context.

Stanley Messer




From: "P. Abrego"

I'm beginning to see some of my favorite books appearing on this list. I would like to add two more of Wachtel's books, Therapeutic Communication (Guilford, l993) and Family Dynamics in Individual Psychotherapy (Wachtel & Wachtel, l986). Also, I like Lorna Benjamin's writings on interpersonal psychotherapy, Interpersonal diagnosis and treatment of personality disorders (New York, l996) and writings by Daniel Wile, After the Fight (l993, Guilford) and After the Honeymoon (Wiley,l988) for couples therapy. By way of introduction, I am a psychologist in private practice in Seattle and am affiliated with the Univ. of WA.
I like this dialogue! Phil




From: "david gilbert"

I am struck that in this discussion very little influence has been attributed to basic psychological science (e.g., learning, memory, information processing, neuroscience, cognition, socail, recent work on affect and cognitive-affective interactions). Modern psychological science has offered me a great deal and provides conceptual frameworks and heuristic guides for therapy integration. I find it useful to look for common mechanisms of psychological and behavioral change across therapies and in life and behavior in general. I believe that basic science has a lot to offer clinicians if they bother to integrate their theories within broader frameworks.
David Gilbert




From: Gerald Davison

Dear Dr. Gilbert,
Thank you for reminding me that an aspect of SEPI is, or should be (in my view), a concern for linking therapeutic interventions with basic psychological science. One way to do this is to work from principles of change to innovative applications. This is the rhetoric of behavior therapy, where my own primary identification lies. Another way is to try to validate the efficacy and effectiveness of existing therapies in controlled studies. This is reflected in the Empirically Supported Treatments work of Division 12, recent information on which was just posted on another network I am on.

The books mentioned as influential so far, including those I suggested, are not particularly noted for their empirical underpinnings. Instead, they reflect primarily the clinical impressions of creative clinicians, and these too are important to advancing psychotherapy and encouraging discussion and collaboration across school lines. But what has begun to concern me about SEPI is that this is where the interests and energies of most SEPI members seem exclusively to lie, or at least that is how it appears to me.

As Arnold Lazarus and I have argued in a couple of recent publications, advances in clinical work depend on both creative, heuristically fertile hypotheses -- and I use the word "hypotheses" intentionally -- and on systematic study that is informed by what we know in general about human behavior in a more scientific sense than holds the interest of many practicing clinicians.

All of which brings to mind O. H. Mowrer's two 1960 volumes on learning theory and clinically relevant speculations. I read these in graduate school over thirty years ago and commend them to anyone who is interested in how a brilliant experimental psychologist extrapolated from basic S-R, mostly animal-based theory and research to proposals that can enhance our understanding of complex human behavior, cognition, and affect.
Cheers,
Jerry Davison




From: "Jerry Gold"

The discussion about the relationship of psychological science to practice reminded me that I've been heavily influenced by works such as Ferster and Skinner's Schedules of Reinforcement, Mahoney's Cognition and Behavior Modification, and the writings of Tolman, Hull and Spence. Yet, these ideas don't spring to mind immediately as clinical influences, but remain (dare I say it about such authors?) unconscious influences (Or is it introjects?). Clinical writers tend to influence me clinically, as does of course, clinical experience and modeling of other experienced clinicians. This discussion is reminiscent of some of Hans Strupp's views on the indirect relationship between science and practice and also of George Stricker's publications on the local clinical scientist.
George has a new book (with Steven Trierweiler) just out on this topic, The Scientific Practice of Professional Psychology.
I wonder if colleagues who came to SEPI from a psychodynamic background, like myself, are less likely to look to basic psychological science as a foundation?
Some other seminal writings:
Beier, The Silent Language of Psychotherapy (An integration of Freud & Skinner);
Feather & Rhodes on Psychodynamic behavior therapy;
Franz Alexander on the Therapist as a reinforcer.
Jerry Gold




From: Paolo Migone

I would like to make briefly few comments about the "important books" one has in mind on psychotherapy integration. I agree on the importance of Wachtel's work (beside his books already mentioned in the list, I refer, for example, to such contributions as his attempt at linking Freud's concept of transference with Piaget's concept of coreggible schemas).

But I would like to add that, to me, psychotherapy integration can be only at the theoretical level. "Clinical" integration is meaningless, because it does not exist, so to speak: when me try to describe clinical interventions or approaches, we always do theory, otherwise we could not even talk about what we do. We always use concepts.

It is for this reason that, for example, one of the books that I found important is Lawrence Friedman's book "Anatomy of Psychotherapy" (1988): the author tries to review and understand various approaches, to see them historically, to compare them, to see how and why they work, what are the premises, etc.
In my opinion it is at this level that "psychotherapy integration" really makes sense.
Paolo Migone, M.D.




From: Hilde Rapp
I appreciate the contributions people are making towards constucting a reading list of what's hot and helpful in psychotherapy integration and I hope that the final product will be published in the Journal for the benefit of those members who are not on email.
To add my penny's worth to the existing list which of course contains some of my favorites already:
Roth, T. and Fonagy P. (1996) What Works for Whom, New York: Guildford Press.

I find this a very sensitive and sensible, tightly argued book which covers many of the debates stimulated within Sepi about the need to meet client need through innovative and hence integrative practice while at the same time endeavouring to work in ways which are open to intellectual, ethical, scientific and pragmatic scrutiny. Pages 44 onwards cover Sepi ( and SPR) territory well, for instance.

Also, I want to add Marv Goldfried's series "In Session" which addresses our need as busy clinicians to form a quick overview of what has been reported to work for whom in a clear and accessible way. From a UK perspective there is perhaps a wish to see more European contributions, but maybe there need to be different series for different service contexts.

M.R. Goldfried (Editor in Chief)In Session. Psychotherapy in Practice.Published Quarterly by John Wiley and Sons.

I also really like Susan Heitler's description of psychotherapy integration as 'Fitting together the Pieces of the Puzzle'. It's not a new book, but its modest style is, to my mind, characteristic of the best of SEPI, especially where she looks at the relationship between 'treatment focus', 'treatment philosophy' and some relevant 'treatment techniques' in a simple client or patient centred way ( pp190 ff, Bill Pinsoff,John Clarkin, and Arnold Lazarus of course do the same thing within more tightly formulated, and more highly articulated theoretical and methodological frameworks, but I am supposing that most of us know that already...):

Heitler. S (1990) From Conflict to Resolution. Skill and Strategies for Individual, Couple and Family Therapy.

Colin Feltham's (1997) Which Psychotherapy?Leading Exponents Explain Their Differences. London: Sage, raises important issues in the ever necessary debate about which approach, framework, technique might not marry at all well with which other one and why, because, at bottom, there are fundamental clashes between values.

REFLECTIONS
In a way, the books I like most ( and there could be lots of others which there isn't room to mention) locate our need to integrate different ways of thinking and working at the interface between an individual therapist and an individual client ( family, group, organisation) regarding a particular issue at a particular time. As Saul Raw ( following Shakespeare's adage 'readiness is all'?) maintains ( see latest issue of JIP), sensitive timing, and pacing, and recognising the solution, which is at that moment within the grasp and the resources of the client/therapist pair engaged in a dialogic relationship, is the best we can ever hope to manage in practice. It is a real boon if we can talk with colleagues about what happened in those momemts where things moved on in intelligent and intelligible ways. Better still if we can write about it so that it helps all of to us to develop a shared language . This makes it easier to recognise where we're headed, and to preview what we might need to prepare for...

I am always looking for frameworks which help me to formulate quite precise questions about how one may flexibly combine differential therapeutics. I suppose the focus, for instance by Jacquie Persons ( Cognitive Behavioural), Tony Ryle ( Cognitive Analytic), Peter Fonagy ( Psychoanalytic and Psychodynamic) on labouring away to arrive at a reasonable, sensitive, clear, and comprehensive formulation of the clients difficulties is the same activity at the level of integrative practice as the one I am advocating here at the level of conceptualising the field of psychotherapy integration.

At this higher level, I expect the construction of such frameworks to be underpinned by cumulated observations and conceptual debates: Has the author wrestled with such questions such as:> what do we collectively already know about what values, objectives, aims, go together with what other ones?> what have we collectively found out about what helps or hinders (!!)whom in which context? or, as Marv puts it: do we know anything about which therapist behaviours are most likely to facilitate the beneficial workings of common therapeutic factors? On optimistic days I think we know quite a lot, on bad days I wonder how much, what we do know, actually helps me to stay with this client now...

Regards

Hilde




From: Mary Coombs

I have enjoyed reading what others are interested in and recommended readings. To introduce myself, although my background has been predominantly clinical, I am currently doing post-doctoral work at U. of Ca. - Berkeley in mental health research. One of the areas that I have been working on is that of the role of emotion in psychotherapeutic change, and am looking in depth at the various major schools of psychotherapy, including research, theory, and clinical practice and their distinctive views of emotion, its etiology, purpose, and how it relates to psychotherapeutic change. I am particularly interested in the contrast between the psychodynamic, cognitive and behavioral approaches and their handling of the element of client emotion. In my review of the existing measures of emotion in psychotherapy, I am struck by the fact that existing measures of emotion in psychotherapy (i.e. the Experiencing Scale (M. Klein et al.), Wilma Bucci's Referential Analysis, Enrico Jones' Psychotherapy Process Q-sort) are orthogonal in certain research studies and find that this raises very interesting questions about what actual aspect of emotion in sessions is being measured, and how experienced clinician/researchers can view the same case in opposite ways in terms of what is considered to be positive psychotherapeutic change with respect to client emotion. Grist for the mill. In this regard, I would add to the list of helpful integrative material, some of the works by Leslie Greenberg (such as Greenberg and Paivio (1997) Working with Emotions in Psychotherapy and Greenberg (1993) " Emotion and Change Processes in Psychotherapy" in Handbook of Emotions edited by Michael Lewis and Jeannette Haviland). These works make a major contribution, in bringing the focus of emotion more clearly into the examination of psychotherapeutic process. Greenberg's points about the different kinds of emotional experiencing (i.e. what he refers to as "primary and "secondary" emotion) offers a potential basis upon which to view psychodynamic and cognitive/behavioral approaches to handling emotion in psychotherapy and their potentially complementary contributions given that each has superior methods for handling certain kinds of emotion. Lorna Benjamin also has written a key piece about the therapeutic and counter-therapeutic handling of client anger in sessions. Benjamin, L.S. (1990) "Interpersonal analysis of the cathartic model" in Plutchik Robert, and Henry Kellerman (Eds.) Emotion: Theory, Research, and Experience. These writings offer a grounded and integrated look at multiple theoretical perspectives on what occurs commonly before the eyes of the clinician.

A question I would like to see tossed around is that of "eclectic" and "integrative" psychotherapeutic approaches. Are they one and the same, or do these terms have different meanings? I have heard some interesting arguments about the impossibility of actually doing effective "eclectic" psychotherapy (i.e. each major school is too complex, requiring great skill etc. too much to mix and match--pick one and do it well vs. eclectic (or integrative) is what really allows the therapist to meet the patient where they are and to offer an effective intervention as it is needed and as the psychotherapeutic process unfolds...).

Mary Coombs, Ph.D.
NIMH Post-doctoral Research Fellow
School of Social Welfare
120 Haviland Hall
University of California
Berkeley, CA 94720-7400
phone: 510- 643-6532
e-mail: coombs@uclink4.berkeley.edu





From: ABOHART@DHVX20.CSUDH.EDU

I was going to send my own comments on the things that influenced me the most anyway, but they dovetailed with the recent comment by Mary Coombs on emotion, and that finally mobilized me to take keyboard in hand. My biggest influences were not in psychology, but in philosophy and literature: the writings of the existential philosophers, and writers like James Joyce and Lawrence Durrell, both of whom created "integrative models" in literature, models which continue to influence me. Within psychology, the single most influential thing I ever read was Eugene Gendlin's article "The experiential response" in a 1968 book edited by Emmanual Hammer called Use of Interpretation in Treatment. That article quite literally turned me into a good therapist overnight (the next day I had a session; my supervisor was watching through a one-way mirror and told me afterwards: "You've finally got it!"). Furthermore it a) made sense for me of Carl Rogers' formulations, which up to that point had seemed too nebulous to be helpful (what do you do while you're being warm, empathic, and genuine?), and b) provided the first integrative model in psychology for doing therapy that I was aware of. Basically Gendlin (there and in subsequent writings) argued that can use any intervention or any idea from any therapy if it is tuned to the "experiential track" of the client in the moment, and he then and since has continued to argue that we should try to accumulate good ideas from all approaches to use.

Which brings me to Mary Coombs' interest in emotion. She notes that measures of "emotion" are orthogonal, and includes in that the Experiencing Scale. But it is no surprise that the Experiencing Scale may be orthogonal to other measures of emotion because it is NOT a measure of emotion! The experiencing scale is based on Gendlin's work, and Gendlin carefully distinguishes between experiencing and emotion. Experiencing has an affective component, but is more a meaning-making process. The problem is that it is not a meaning-making process in our typical western cognitivist way of looking at things. Rather, it is not dealing with "ideas" and "beliefs," but rather "bodily felt meaning", closer to what cognitive scientists such as Lakoff and Johnson describe as the basis of all knowing: preconceptual bodily experience. In fact, the experiencing scale, congruent with this, correlates more highly with cognitive measures than with affective measures (at least in some studies). As I tried to clarify in my 1993 Journal of Psychotherapy Integration article, our theories tend to dichotomize the world into Cognition and Emotion, and then have a hard time classifying experiencing, which kind of lies in between. In any case, I salute Mary's interest in clarifying what it means to say that something is an emotion.

Art Bohart
Department of Psychology
California State University Dominguez Hills
Carson, CA 90747





From: Hilde Rapp wrote:
Dear Sepi online colleagues
I really appreciate Gerald Davidson's reminding us of the importance of taking account of research in general psychology. I would add sociology and anthropology as well. In many ways, therapeutic approaches which aim to repair earlier damage or which aim to make up environmental deficits must base their interventions on what practitioners would normally help people to achieve certain developmental tasks throughout the life span. Increasingly we can back up these beliefs with findings from research into normal social, cognitive and emotional developmental processes.Both research outcomes and paradigms relevant to infant- parent atunenement and attachment ( cf Wilma Bucci) are informing psychoanalytic theories about the therapeutic relationship between the therapist/analyst and the adult client/patient. Similarly, Gerald Davison might agree, cognitive behavioural approaches are more or less constructed on the back of research into learning, memory and skill aquisition.(Incidentally, this makes these therapies particularly amenable to process and outcome research, because there is not really any paradigm clash).

I also want to respond to Mary Coombs contribution, which I think points us to the importance of looking for integrative themes along particular axes of enquiry: In Mary's case this axis co-ordinates the different ways in which different approaches and researchers like Lorna Benjamin, Enrico Jones, Leslie Greenberg, etc, construct concepts of emotion, and hence diferrences in how the importance of particilar emotions in the genesis and treatment of psychological difficulties is theorised, and how technical approaches follow from that. What I find exciting is the increasing specificity in our enquiries, looking quite precisely and minuteltely at which differences and which similarities might matter in relation to what issues. So, the orthogonality of certain kinds of emotions is interesting in this regard. (There is also some relevant work, for instance by Charles Spielberger in Florida and by Stephen Palmer in the UK).

Wouldn't it make an exciting panel plus co-ordinated workshop at a future sepi conference to get these colleagues together to compare and contrast their concepts and methodologies?!

Also, the perennial question raised by you, Mary (Coombs) as well as by other contributors to this 'poly'-logue, concerning the difference between integration and eclecticism could perhaps be asked more pointedly if we look to philosophy. Perhaps we could argue that integrative approaches are constructed along lines of enquiry where a particular 'pattern that connects' (to quote Bateson), allied to certain fundamental values and models of (wo)man inform the theoretical perspective as well as a set of compatible practices?

> Integration vs Eclecticism
At the same time, there probably are 'problems' for which such a sustained alignment is not necessary and an ad hoc 'eclectic' combination of ways of achieving a particular objective are the optimal fast and flexible response? But, perhaps even within an integrated approach we may need to preserve the freedom to be innovative by making ad hoc choices with particular clients at particular times...? I believe, incidentally that contemporary work in philosophy , especially philosophy of mind,language, science, ethics and aesthetics is grappling with questions which are highly relevant to our work. Perhaps we could learn from, and we should contribute, more fully to these discourses?

Thank you Jerry and Carrol, for making this free flowing sharing of thoughts, questions and exchanges of experience possible.

Hilde Rapp
( Chair, British Institute of Integrative Psychotherapy, Network co-ordinator, SEPI, UK )
21 Priory Terrace
London NW6 4DG
Tel 44 (0)171 625 4287
Fax 44 (0)171 813 4718
email: rapp.biip@cableinet.co.uk





From: "J. Russell Ramsay"
Greetings to all,

First, to introduce myself, I am a psychologist with the Center for Cognitive Therapy of the University of Pennsylvania. I completed a two-year postdoctoral fellowship before being named clinical director of the Center's first satellite office, which is located in Bucks County, PA. I am active in clinical service, supervision of postdocs, and writing/research.

Second, I'd like to offer a short list of books I found to be influential. First is Mahoney's (1991) "Human Change Processes" for his coherent integration of a vast amount of scientific literature regarding behavior, personal meaning-making, and change processes. This book, along with a special issue of the Journal of Clinical and Consulting Psychology (1993) devoted to cognitive and constructivist therapises solidified my then growing interest in the congruence of these two models. Wegner and Pennebaker's (Eds., 1993) "Handbook of Mental Control" is an interesting collection of contributions regarding various aspect of human experience, cognitive/emotional processing and how we "make sense" of things. Finally, the "Evolution of Psychotherapy" series (Zeig, Ed., 1987, 1992, 1997) provides a forum to listen in as master clinicians share with one another their theories, practices, and meta-frameworks. In striving to provide empirically-supported treatment, I find it vital to integrate transtheoretical phenomena such as learned helplessness, social learning, social psychology, emotional intelligence, cognitive heuristics, etc.

Sincerely,
Russ Ramsay


from kathleen adams

I feel a bit like a fish out of water reading everyone's comments. I owe my entire writing career to Wachtel for his article From the Surface to the Depths. I got so ramped up after reading about his concerns about 'depth' that I took off three weeks and just began writing about what I knew best: depth. Articles ensued and a book is in progress, the main theme of which is "FALLING FOREVER." I trained as a child psychologist originally,working several years in long term child and adolescent inpatient settings, which I think opened my mind to the impact of early childhood trauma. My favorite book on working with children is Boston and Szur's Psychotherapy with Severely Deprived Children. The population I specialize in appears superficially to be highly functional (and indeed are, except for their level of terror and dread and vulnerabiity to fragmentation) but come from backgrounds of profound abuse and/or neglect. They all have disorganized attachment as an underlay to one of the varieties of insecure attachment. I work in long term combined group and individual modalities. For many years I worked with dissociative disorders, and these patients have similar dynamics without the DID. These are some of the influences which shaped me:
(1) Depth. In my consultation groups with other therapists I steadfastly focus upon facilitating depth of emotional experience in the therapeutic hour, defusing therapistsí discomfort with primitive states, and cultivate therapistsí capacity to meet patients fearlessly at the edge of the unknown. We read Ogden's The Primitive Edge; all of Winnicott and Christopher Bollas and Lawrence Hedges and Michael Eigen; Grotstein's Do I Dare Disturb the Universe, Corrigan & Gordon's The Mind Object. Favorite Journals: Contemporary Psychoanalysis, Psych Dialogues, Psychoanalytic Review.
(2) Dissociation and psychoanalysis. I observed my growing capacity to recognize subtle dissociative defenses against annihilation anxieties within my own high functioning private practice patients. This shift in emphasis within my own practice of psychotherapy represented a culmination and synthesis of thirty years of work with primitive states and profound pathology. Books: Bromberg's Standing in the Spaces, Awakening the Dreamer,Nijenhuis and Steele's The Haunted Mind. Favorite article: Chefetz and Bromberg's Talking with Me and Not-Me,
(3) Layers of chronic shock in the body: A convoluted personal journey involving chronic pain and somatic dysfunction (fallout from a serious childhood accident) and manypatientswith somatic complaints folowing car wrecks or other traumata catalyzed a renewed interest in the relationship between somatoform dissociation and unbearable affects. Books: Levine's Waking the Tiger, Ogden's Building Somatic Resources: Sensorimotor Psychotherapy, Gendlin's Focusing, Nijenhuis' Somatoform Dissociation, Rothschild's The Body Remembers.
(4) Unmentalized experience, pathological organizations and attachment. Within the context of teaching private practice therapists in study groups, I became intrigued with the work of Judith Mitrani's Ordinary People, Extraordinary Defenses and other followers of Frances Tustin, with their emphasis on unmentalized experience, the role of the second skin, the autistic-contiguous position and autistic enclaves. At this same time the concepts of attachment styles and disorganized attachment were gaining attention in psychoanalytic circles and illuminated my understanding of traumatic attachment in my patients: Solomon $ George's Attachment Disorganization, Goodwin &Attias' Splintered Reflections, Susan Johnson's Emotionally Focused Couples Therapy with Trauma Survivors, Fosha's The Transforming Power of Affect.
(5) The interweaving of neuroscience with trauma theory. Neuroscience has been breaking new ground in the understanding of self-states, early childhood experience and emotional regulation. The school of interpersonal neurobiology was founded by Siegel: The Developing Mind; affective neuroscience's leader is Alan Schore's books about Affect Regulation. Sternís The Present Moment opened up both group and individual therapy to lived experience in the here and now. Cozzolino's The Neuroscience of Psychotherapy and Badenoch's Being a Brain-WIse Therapist integrate all the above.
(6) Spirituality. Explorations of human suffering invariably open a doorway to soul-searching about meaning and meaninglessness. Contemplatives of fall traditions emphasize the powerof love and compassion to transform suffering into an acceptance of what is, to allow for life in the present. Trauma has long been known as one of the portals to trnsformation and spiritual awareness. Fear is used all too often as an excuse not to risk, to act, to embrace life, and to perpetuate the malignancy of a contracted heart. When we are forced to confront circumstances beyond our capacity, we always have a choice about utilizing the crisis for stagnation or transformation. John Rowan's posted question about how come we integrationists don't talk about transpersonal psychology was on point. Books: Eigen's The Psychoanalytic Mystic, Moore's Dark Night of the Soul, Spezzano's Soul on the Couch, Moody & Carrols's Five Stages of the Soul, Muller's Spiritual Gifts of a Painful Childhood, Chittister's Scarred by Struggle, Transformed by Hope; favorite article K. Steel's Sitting with the Shattered Soul.
So, although there isn't much behavior therapy, CBT or DBT in my pedigree, I still consider myself a loyal psychotherapy integrationist.

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