Integrative psychotherapy: the integration of therapeutic models

How do psychologists approach all facets of the human being in a holistic way?

In recent decades the quality and efficiency of psychological treatments has increased considerably, largely due to the increasinglyIn recent decades, the quality and efficiency of psychological treatments have increased considerably, largely due to the increasingly widespread tendency of psychotherapists to integrate different elements of classical psychotherapeutic models.

Integration makes it possible to elaborate a more integral and holistic vision of the person, his or her relational world and social context. In this article we will see what the characteristics of integrative psychotherapy areand what it is based on.

What is integrative psychotherapy?

Integrative models differ from eclectic models in that the former do not use techniques in a more or less isolated manner, according to the characteristics and needs of the person, but are based on an integral vision of the human being that allows meaning and coherence to be given to the different elements as a whole.

However, this does not does not mean that there is only one way of approaching psychological problems, as if there were an "absolute truth".as if it were an "absolute truth", far from it.

It can happen, and in fact it happens most of the time, that each particular psychotherapist integrates elements in one way or another, that gives more weight to some factors over others, for example, to emotions over cognitions or behaviors, etc. It will depend on the general basis or, to put it another way, on the integrative model from which the professional starts.

Although elements and techniques from other psychotherapeutic models are integrated, there is always a more general background that predominates and allows them to be integrated, as an "epistemological umbrella".

Psychotherapeutic schools

But... what are the major psychotherapeutic models that usually serve as a basis for the integration of other components and techniques? There are many psychotherapeutic schools and sub-schoolsHowever, we could basically speak of four major orientations: cognitive-behavioral, psychodynamic, systemic and humanistic.

How can the different models be used in an integrative way? What keys of exploration, analysis and intervention can each of them allow? We will give a brief description of the guidelines that each of these models mainly emphasizes, although with the caveat that there are almost never completely "pure" models, since, in one way or another, all of them contemplate the other factors, overlapping, intermingling and mutually feeding back on each other.

Cognitive-behavioral model

The cognitive-behavioral model tends to focus more on theories of learning and how stimulus control affects how stimulus control affects human behavior.. Thus, the prism from which the problem brought by the patient is approached is based on classical conditioning, operant conditioning... techniques aimed at reducing or increasing, depending on the case, the behaviors with which we want to work (for example, reducing alcohol abuse or quitting smoking).

The cognitive element, i.e., working with thoughtshas been gaining more and more prominence over purely behavioral approaches. Working with the constructions and narratives that people make of their reality (what Watzlawick has called "second-order reality") is basic: cognitive schemas, basic assumptions, automatic thoughts, biases and automated thinking tendencies, etc., are approached from, for example, cognitive restructuring.

Psychodynamic model

The psychodynamic model, heavily influenced by psychoanalysis, usually focuses on biographical aspects and how early or past experiences and how early or past experiences (although not only, as they also focus on the present) are influencing the present.

From this approach, in which the work with the unconscious is the core, the defense mechanisms, the work with transference and countertransference, the interpretation and elaboration of the patients' behaviors, the awareness of automated bonding models and relational conflicts, etc., take on special relevance. All this allows us to go deeper into the intrapsychic and relational life of the patients.

It is important to say that, although psychoanalysis is usually associated with treatments of very long duration, which can last for many years, the fact is that increasingly there is a tendency to make brief approaches focused on specific aspects of the person's life and that have to do directly with his or her and which are directly related to their problems (e.g. Malan's conflict triangles, Horowitz's relationship models, etc.).

The contributions that psychodynamic approaches can make should not be disregarded, being very useful, for example, their conception of relational conflicts and their link with health.

Systemic model

From the systemic-relational model, in which the person is conceived within a larger system with which he/she interacts and where there is permanent feedback among its members, the focus is usually on interactions, communication, relational dynamics and patterns, on the place that the person has in the system, and on the role that the person plays in the system.The focus is usually on interactions, communication, relational dynamics and patterns, the place the person has within the system (his/her role, etc.).

An important aspect of this way of working is that attention is paid to how people influence each other and what effects they have on each other in certain situations (for example, how parents and children feed back to make it difficult for the children to mature and become independent, or how they behave when faced with the illness of a family member, establishing rigid roles of functioning, etc.).

Humanistic models

From the humanistic models such as, for example, Rogers' client-centered therapy or Fritz Perls' Gestalt therapy, the emphasis is on awareness and taking responsibility for the person's own behavior and life. and for the person's own life.

Client-centered therapy promotes personal development and confidence in one's own potential. (the assumption is that, if the right conditions are provided, the person will be able to actualize his or her potentialities according to his or her needs).

For Gestalt therapy, an eminently experiential model, the work must always be directed towards the awareness of why the person does what he/she does (instead of why, more typical of psychoanalysis), the work with the emotional and bodily experience in the here and now (which promotes awareness) and the self-responsibility of their emotions, thoughts and actions, seeking personal coherence.

From where to start designing the approach?

At the risk of oversimplifying things, we could say that these are the main characteristics of each model and from which they evaluate and treat their clients. But if you want to do a real integrative work, it is necessary to have a general model, a certain way of understanding the human being, which allows this integration. It is therefore very important to ask oneself the question of where the different patterns and factors are being integrated.

We find relational approaches particularly useful, in which attention is paid, both implicitly and explicitly, to the ways in which people have constructed their lives. the ways in which people have constructed their attachments and what kind of relationships they establish with others..

How people relate and how they behave, whether consciously or unconsciously, offers general psychological keys from which to begin to redefine the problem that the person brings, as well as how to begin to introduce changes in relational patterns.

Bowlby's attachment theory and its later developments can be one of those "epistemological umbrellas" mentioned above, as it allows the integration of psychological factors from different schools.

From postmodern approaches, narrative and discursive therapies have been other general frameworks from which to make the integration. Some authors have even linked attachment theory and narrative therapy in a single model to achieve this integration of psychological techniques. These models have challenged the so-called myth of "the isolated mind", which in the scientific psychological tradition has been the basis for the integration of psychological techniques. which in the scientific psychological tradition has prevailed for decades, influenced by positivism.

The context, the group, culture and values, the constitutive character of language, etc. are elements that have come to enrich and broaden the approaches in current psychotherapies, going beyond the merely individual and intrasubjective approach.

Author: Diego Albarracín Psychologist at El Prado Psicólogos, expert in Clinical Psychology and Psychoanalytic Psychotherapy. Higher training in Gestalt Therapy. Sexologist. Mediator.