The Problem of Psychotherapy Integration

Tullio Carere 

The history of psychotherapy integration can be divided into three phases. The first was a phase of latency. The theme ran through the literature, starting in the early 1930s, but was not yet a well defined area of interest. The delineation of such an area characterized the second phase, that began in the 1970s, when interest in a rapprochement across the psychotherapies increased dramatically. In 1983 the SEPI was founded. The recurrent themes in a rapidly growing body of literature were (Goldfried & Newman, 1986):

  • The potential for divergent modes of therapy to complement each other
  • The advantages of focusing on the interactions of cognitions, behaviour, and affect in clients/patients
  • The desire for therapeutic procedures to be guided by empirical findings
  • The importance of a common theoretical language
  • The need to organize communalities into a universal "meta-theoretical" set of principles of therapeutic change

It seems that now, at the turn of the century, a third phase is beginning. On the one hand we could say that the integrationist movement has never been as successful as it is today. Approximately half of all psychotherapists, all over the world, define themselves eclectic or integrative, and their number is growing, as is the number of schools that label themselves in the same way. On the other hand the term "integrative", diffuse, ill-defined and inflated, has come to occupy nearly the same semantic area, and to be seen almost with the same suspicion, as the term "eclectic". Anybody can come up with a brand-new "integrative model", especially those who have difficulties in integrating themselves in any of the hundreds of existing schools, argue the anti-integrationists. Is an integrative therapist an open-minded one who has gone beyond sectarianism and parochialism, or an omnipotent one who cannot submit to the rules and the limits of any given school? There may be some truth in both answers.

What does it mean to be an integrative psychotherapist today? But before confronting that question: what does it mean to be a psychotherapist at all? Is psychotherapy a "robust phenomenon", or just a conventional container for a host of heterogeneous and incompatible practices? Some refuse such questions as too "philosophical". Philosophy will give us no answers, they maintain: empirical research is all we need now. But is the definition of our field still so poor because too much, or too little philosophical work has been done so far? The fate of psychotherapeutic integration depends on the answer we can give to the above question (is psychotherapy a robust phenomenon or a conventional container): whether it will evolve from an area of interest (second phase) to a scientific discipline (third phase), or it will fade away and finally disappear, leaving the field to circumscribed orientations and to research in manualized treatments. The minimum requirement for a discipline to be scientific is that the object of study exists: there can be no science of a conventional container. The outcome is open, as there are signs pointing in both directions.

The perspective of a world in which every DSM-disorder will have to be treated with a corresponding Empirically Validated Psychological Intervention may be so alarming to some (as it may be attractive to others), to stimulate the greatest efforts to avoid it. A small but meaningful contribution in this direction may be a web area of documents, in which the relevant issues of the present phase of psychotherapeutic integration are discussed. We shall post three categories of documents:
1. Permanent articles (papers by distinguished Authors of the integrative field).
2. Temporary articles (papers that can be posted only for a limited time before their publication on the Journal of Psychotherapy Integration).
3. Reports of discussions on the SEPI mailing list.