When we look into the world of counselling and psychotherapy the buzzword these days appears to be `Integrative Counselling and psychotherapy`. The phrase is tossed into conversations and the written word like the bread thrown to the ducks in the park. But what exactly isIntegrative Counselling and psychotherapy and how does it work?
We all know that there are many different approaches (or methods) to counselling and psychotherapy which are built on a wide range of ideas and theories. These include Psychodynamic, Gestalt, Behavioural (CBT), Humanistic (Person Centred) Psychosynthesis and Existential.
The advantage of the Integrative Counselling Model is that it draws from all these major orientations and includes them in a counselling method which treats the person as a whole. This wider view is in contrast to some Psychodynamic purists who will generally look towards the client’s younger years and symbolism like dreams and Freudian slips to attempt to unravel the person’s unconscious.
Behavioural therapies such as CBT will be concerned with the here and now and look at unhelpful aspects of a person’s thinking such as Negative Automatic Thoughts (NATs). Here the CBT therapist will communicate very little Empathy, instead concentrating on how the client is affected right now by their problems and issues.
Humanistic counselling which includes the work of Carl Rogers and his Person Centred approach leans heavily on the relationship between client and therapist and the communication to the client by the therapist of what Rogers called the `core conditions`. While Psychosynthesis itself and other Existential approaches relate more to the `unexplainable` and has a spiritual side or edge to it. Therefore we in Integrative Counselling see it’s possible to have one’s gateau and eat it in as far as treating the client as a whole and also having the benefits of the major orientations.
It is said that Integrative counselling is the growing approach within psychotherapy which links it nicely to another buzzword of `postmodernism`. Postmodernism captures the trend and mood that we see in the decline of purist approaches. In many walks of life we witness the move to more flexible and pragmatic solutions to problems that were tackled in a more rigid fashion in times past.
So who’s responsible for Integrative counselling theory that supports Integrative counselling and the surge of interest that it has caused? One of the leaders has been Dr Petruska Clarkson, who with almost 30 years international experience and 150 publications to her name was the designer of the first MSc level Integrative psychotherapy course in the UK. Her Integrative counselling framework has been used in various colleges to provide a sound qualification for recipients to embark upon a career in counselling.
Clarkson’s Integrative counselling framework includes the Five Relationships between therapist and client of Working Alliance, Tranferential, Reparative, I-you and Transpersonal. Also present are the Seven Levels of Functioning of Physiological, Emotional, Normative, Nominative, Rational, Theoretical, and Transpersonal.
For those still wondering what Integrative Counselling is, it’s clear that the Integrative approach to counselling is different than eclecticism. Eclecticism is said to be about the process of `selecting out` and also more about taking something apart while Integration is more about `bringing together`. So the Integrative approach to counselling is a bringing together of different approaches to form a new orientation that stands in it’s own right.
The following case study is a fictitious and is unlikely to occur in real life, however it’s useful to explain a little of Integrative counselling theory. `Mrs Smith` arrives at her counsellor’s for her first session of Integrative counselling. While presenting her problem to the therapist she appears to be shaking slightly while wrapping her arms around herself. The therapist views this Physiological level of his client. Is she cold, is she frightened or is there some other reason for her shaking? Maybe chemical? This is discussed with the client.
While the client talks, she becomes upset and starts to cry, the client’s Emotional level is clear for the therapist to see and work can be done on this. Feeling a little better now, Mrs Smith talks of the fact that she has not seen her grown up children for fifteen years – she shows no emotion and appears to see nothing strange in this – this is her Normative level – what is normal to her, her bench mark and her frame of reference to judge the goings on in her external world.
Mrs Smith now talks of her neighbour who she alleges runs a black magic cult in his garden every other Thursday evening. She calls him “the evil one”. The therapist notices that this is the name she has nominated for him – this name brands him and links him to how she sees him and his activities. This is her Nominative level. As mentioned before this is a fictional tale and it’s unlikely that all aspects of the 7 levels of functioning would be witnessed in one single session. However it does help to explain the question `What is Integrative Counselling?` and what is behind Integrative Counselling Theory.
Now back to Mrs Smith;
Although seemingly unhappy about the exploits of her Satanist neighbour, Mrs Smith surprises her therapist by declaring that he’s not really hurting anyone and everyone needs a hobby, as did her late husband Mr Smith, who was an avid collector of eggcups. The therapist notes down her Rational level of functioning.
Moving on, Mrs Smith talks again of her late husband and his hobby of eggcup collecting. She theorises as to why he did it – poor upbringing, he didn’t have much, nasty father, very mean. I think eggcups was a safe place to be, gave him something he never had as a child. The therapist jotted down her Theoretical level.
With 10 minutes to go the therapist tells Mrs Smith that they are near the end of their time together and begins to summarise their session. Although not a good time to start with anything new, Mrs Smith mentions that she often feels her late husband’s presence, especially in times of worry and stress.
The therapist asks her to try to hold that thought and the feeling that goes with it and they can let it unfold in their next session together. The therapist makes a mental note of the Transpersonal experience that Mrs Smith has mentioned.
Within Dr Petruska Clarkson’s framework are the Five Relationships that are identified as being between the client and the practitioner, these are the Working Alliance, Transferential, Reparative, the I-You and Transpersonal.
By its very nature the Working Alliance is common to all approaches found within counselling and psychotherapy. For many practitioners the working alliance is the crucial and sometimes only relationship necessary for effective therapy. Central to this process are the core conditions of empathy, unconditional positive regard and congruence. The Working Alliance centres around the contract between the adult of both the practitioner and the client.
The Transferential relationship has its roots in the Psychodynamic and Gestalt approachs. I believe transference is everywhere and will almost certainly appear at some point in most orientations, even if the chosen approach has not got Psychodynamic roots. Transference itself is the past manifested in the present. So an example might be the client unconsciously seeing the practitioner as a figure of authority from their childhood.
The Reparative relationship draws from Psychodynamic, Gestalt or TA. Maintaining the core conditions is a general way of offering the client a reparative relationship, with support from the counsellor in the present, the client experiences the relationship they lacked at a past time.
The I-You relationship is an authentic and real relationship requiring the counsellor not to be hiding behind their role as a counsellor or expert with the associated imbalance of power that can result. The I-You relationship draws on the Person Centred approach and is all about the relationship between client and counsellor.
The Transpersonal relationship which has its roots in Psychosynthesis, Existential and Gestalt therapy and has a spiritual identity is a hard one to identify. Based on research I did at a specialist counselling section in a local Somerset hospital, where patients with serious medical conditions can talk about their fears and concerns to a trained counsellor. It seems likely that people with life-threatening illnesses may well enter a Transpersonal relationship with their counsellor as they maybe contemplate death, the hereafter and the meaning of their existence.
So, to summarise briefly, we see the post modernist trend seems to lean towards Integration in Counselling and psychotherapy with its advantage of flexibility in the way therapy can be adapted to the meet the wide range of client’s issues and problems. This is reinforced by the growing realisation that `one size does not fit all` and the benefits the client gains from being treated as a whole i.e. mind, body, behaviour and emotions.