Psychotherapy Integration

21st Century Psychotherapy

• Makes use of wisdom from various disciplines and traditions.

• Focuses on moments of change and how they happen.

• Recognizes multiple change mechanisms and therapeutic tasks.

• Adapts and mixes techniques for effectiveness and safety.

Today's therapists, at least half of them, mix techniques and theories from multiple sources. Pragmatism has overcome misgivings as clinicians, faced with the challenge of helping people change, have gone outside the limits of their initial training and learned from each other. While purist schools have taught that it couldn't be done, real world therapists and patients have benefited from what is now known as psychotherapy integration.

My own experience, starting with a psychodynamic foundation then moving to the challenges of early life trauma and addictions, led me to reevaluate what I had been taught. With trauma, I learned that being positively supportive actually enhanced progress. Working with people suffering from addictions, I became aware that it was not only OK, but sometimes necessary to spell out advice. As I delved into techniques and theories from cognitive, behavioral and experiential traditions, I discovered a century of thoughtful observation and rigor.

The question for me, moved from why to why not integrate psychotherapy techniques. However, what was still missing was a satisfying way to understand what was happening. Curiously, the weakest part of each of the major theoretical traditions has been how therapy actually works. Behaviorists say that we help people change skewed learning. Cognitive therapists say that therapy corrects erroneous ideas and values. Psychodynamic therapists talk about conflicting wishes and fantasies but bank on work done in the therapeutic relationship. How can we make sense of all of these so very different-sounding conceptualizations?

This course is the result of my own quest, stretching over a third of a century, to make sense of all that I saw and learned. The key insight is the realization that, while the different schools have each tried to find the one true route to change, there are actually several (about five, depending on how you count) basic change mechanisms. In my work, I found that I was focusing on specific tasks involving one or at most two of these mechanisms. With this specificity, rather than following a set of rules or prescriptions and waiting, I sought the most effective way to do the job at hand. Being able to identify and track change processes led to increasing open mindedness about adapting and mixing techniques according to their ability to foster observable changes.

A second insight was just as important. Along with a growing number of therapists and researchers, I began to realize that actual change often takes place in a few seconds. A large part of therapy is laying groundwork for these moments of change. As this has become clear, bridges have begun to form between neurophysiology and the traditions of psychotherapy. At last, we can begin to glimpse how, through talk and human relationship, we are able to reach precisely into the brain to catalyze important and lasting changes.

The aim of this course is to give the reader a practical and intellectually satisfying foundation for integrated psychotherapy in the 21st Century.

DISCLAIMER: I have attempted to make this material brief and simple, but it is NOT a beginning course in psychotherapy. Psychotherapy is a powerful tool that should be learned by direct interaction with a supervisor who has experience. Substantial training is required to do psychotherapy and to bring new ideas into practice with safety. These ideas are intended to stimulate thought, not to tell anyone what to do or to substitute for professional judgment. The ideas presented here should not be applied blindly or by inexperienced therapists without consultation or supervision