Psychotherapeutic integrationism refers to a movement among therapists and researchers appreciative of the fact that no one treatment works for all people at all times, and that some issues are more responsive to some treatments than others. The goal of psychotherapeutic integrationism is thus to shift therapist’s work with patients from dependence on a single therapeutic framework to a pluralistic approach that draws on multiple empirically validated theories and techniques.
The Argument for Psychotherapeutic Integration
The argument for psychotherapeutic integration is far more robust than its relative obscurity would suggest. First, different psychotherapies are likely to help somewhat different sets of people given the evidence that matching treatment and patient can increase outcome success (e.g., Beutler et al., 2012). As I wrote with my coauthors:
“Just as each psychopharmacological intervention is found to help some patients but not others, and different people are helped differently by different medications owing to neurochemical and biological individuality, so too human psychological individuality entails that different psychotherapeutic treatments are likely to be successful with different people.” (2020, p. 238)
Second, studies of combined or sequential treatments often support integrative treatments over monotheoretical ones (Geisen-Boo et al., 2006; Crow et al., 2013). Although there are not, as yet, any randomized controlled trials (RCTs) for integrative approaches, this shouldn’t distract from the obvious and commonsensical point that even if someone is not responsive to one treatment, they may be responsive to another. This is taken as an established and commonsensical point in physical medicine and no RCT is needed to conclude that when an initial medication fails, prescribing a different medication may yet work.
Third, and I believe most substantively, different psychotherapeutic models focuses on distinct aspects of psychological functioning and so, while one treatment or technique may work at one level it may be ineffective at another level and multiple levels may be implicated in any particular issue. Cognitive theories, for example, which focus on learned helplessness and automatic thoughts, have been shown to be effective in treating depression, however psychodynamic therapies emphasizing attachment problems and unconscious schemas have been shown to be successful at similar rates (Fonagy, 2015; Leichsenring et al., 2015; Shedler 2010; Steinert et al., 2016) and may address aspects of depressive conditions that do not yield to cognitive theories. These models are thus not in competition, as many practitioners assume, but are complementary approaches.
Why isn’t Psychotherapeutic Integration More Common?
Although it may seem obvious that therapists should use what works regardless of its theoretical authorship, in practice psychotherapeutic education is often monotheoretic and clinicians tend to stick with what they know. There are, unfortunately, incentives for these theoretic loyalties. Developing a broad facility in a variety of psychotherapeutic treatments is challenging, time-consuming, and costly. And, while a broad array of skills might create better results for patients, it does not always confer the prestige among peers that a strong and publicly identifiable theoretical specialty does.
While it might offer good career prospects, it is scientifically and ethically indefensible to assume the universal validity of any single psychotherapeutic model. Instead of attempting to fit every problem into the Procrustean bed of one theory, clinicians need a varied toolkit that allows them to fit their approach to the client's problems at each stage of treatment.
References
Beutler, L. E., Forrester, B., Gallagher-Thompson, D., Thompson, L., & Tomlins, J. B. (2012). Common, specific, and treatment fit variables in psychotherapy outcome. Journal of Psychotherapy Integration, 22(3), 255–281.
Fonagy, P. (2015). The effectiveness of psychodynamic psychotherapies: An update. World Psychiatry, 14(2), 137–150.
Geisen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., et al. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schemafocused therapy vs transference-focused psychotherapy. Archives of General Psychiatry, 63, 649–658.
Leichsenring, F., Luyten, P., Hilsenroth, M. J., Abbass, A., Barber, J. P., Keefe, J. R., et al. (2015). Psychodynamic therapy meets evidence-based medicine: A systematic review using updated criteria. Lancet Psychiatry, 2(7), 648–660.
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109.
Steinert, C., Schauenburg, H., Dinger, U., & Leichsenring, F. (2016). Short-term psychodynamic therapy in depression: An evidence- based unified protocol. Psychotherapie, Psychosomatik, Medizinische Psychologie, 66(1), 9–20.
Wakefield, J. C., Baer, J. C., & Conrad, J. A. (2020). Levels of meaning, and the need for psychotherapy integration. Clinical Social Work Journal, 48, 236-256.