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PART I
INTEGRATION: CONTEXT AND CONCEPTS

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A BRIEF HISTORY OF
INTEGRATION AND SOME
RECENT DEVELOPMENTS

If we were writing a complete history of integration, we would need to devote not

just one chapter but several volumes to the subject, for the history of integration
is the history of psychotherapy itself.We might well begin with Freud, who within
his own developing psychoanalytic frame attempted to integrate influences from his
medical and psychiatric studies, from academic psychology, and from his collaborative work with Joseph Breuer, as well as from his neuropathological lectureship under
Professor Charcot whose work using hypnosis suggested the power of the
unconscious, the phenomena of attachment between patient and doctor and a link
between sexuality and neurosis.We would then go on to describe the works of the
next generation who broke away, diverged, incorporated, yet always in some ways
integrated concepts from and into the structure of psychoanalysis. Even as early as
1932, Thomas Morton French, addressing the American Psychiatric Association,
suggested similarities between the psychoanalytic concept of repression and the
behavioural concept of extinction (French, 1933) and Rosenzweig (1936) was
exploring common factors across various approaches.
By about volume 10, we would still not have done justice to the many and various alternatives that have developed from those early beginnings, converging, competing or reforming neo-Freudian and non-Freudian strands and developments as
they proliferated into the hundreds of approaches that now exist. Needless to say,
therefore, this developmental integration over the century will only be covered generally here, our purpose being to show that integration is not a new phenomenon
and to explore, in its historical context, the more recent thrust of integration which
seems to be of a different order to that of the past.
Within the general development of psychology, psychotherapy and counselling,
there have been, and still are, distinct and separate models of counselling and psychotherapy. These models are based on different theoretical and philosophical

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foundations which are supported and furthered by the respective training organizations
and professional associations to which they belong. The different models are normally divided into three distinct, though often overlapping, schools or traditions of
theoretical approach which have informed the practice of counselling and psychotherapy. The first, already referred to, is the psychodynamic (or psychoanalytic)
school with its roots in the theory and methodology of Freud, characterized by the
unconscious conflict brought about by instinctual drives and repression.The second
is the behavioural tradition with its roots in the experiments of Pavlov and Skinner
and characterized by conditioned learning. The third is the humanistic/existential
tradition with its roots in the works of such pioneers as Moreno, Maslow, Rogers, Perls,
Berne, May, Boss and Binswanger and characterized by a belief in self-actualization and
choice. Recently, some therapists have begun to identify a fourth force of thought
and practice, which has grown in strength perhaps as a response to the ills of the
twentieth century and is characterized by a transpersonal element and a focus on the
spiritual path of human beings. Its forebears are such theorists as Assagioli, Brazier
and Wilbur.
These schools, though claiming a distinction from each other, have spawned a
proliferation of approaches to counselling and psychotherapy not only within their
own school of thought but also across the four schools. These various approaches,
though seemingly unique, can often be traced back to early beginnings in one or
more of the schools. For example, Perls, in his Gestalt therapy, developed across
schools by integrating Gestalt psychology, Freudian psychoanalytic theory, the theories of the interpersonal psychoanalysts such as Fromm, Adler and Rank and
radical analysts such as Reich, as well as existential philosophy, Zen Buddhism, phenomenology, field theory and psychodramatic techniques as developed earlier by
Moreno (see Sills et al., 1995). Transactional analysis, although basically an object
relations theory that integrates elements of cognitive behaviour theory and social
psychology, is considered humanistic because of its philosophy and value system
(see Lapworth et al., 1993). Self-psychology (Kohut, 1971) originally integrated
elements of drive theory and object relations while centralizing the importance of
empathic understanding (traditionally associated with person-centred practice) in
the healing of a damaged self. Intersubjectivity theory (Atwood and Stolorow, 1984)
has developed from a psychoanalytic root, especially the empathic immersion of self
psychology, yet centralizes the co-creativity of experience more usually associated
with Gestalt, person-centred or constructivist approaches. Relational psychotherapy
integrates exploration of unconscious, intrapsychic dynamics whilst prioritizing the
co-created, authentic relationship as the central vehicle for change.
From psychoanalysis there have been many offshoots. Some examples of these are
analytical psychology, ego psychology, object relations theory, self-psychology and, most
recently, intersubjective and relational psychoanalysis.The behavioural school has led to
cognitive behaviour therapy, constructivist theories, assertion trainings, neuro linguistic
programming (NLP), solution focused therapy and dialectic behavioural therapy.Within
the humanistic school, the offshoots have been so plentiful that it is sometimes difficult
to keep track even of the names, let alone their theoretical slant.Among the more established humanistic or existential approaches such as psychodrama, person-centred counselling, existential psychotherapy, Gestalt and transactional analysis, there have been

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developments presented under names such as focusing, reclaiming your inner child,
rebirthing, primal integration, and many others.
Many psychotherapy and counselling books specialize in some specific approach
and many of the general counselling and therapy textbooks have sections or chapters devoted to individual theoreticians and approaches. Readers of these books,
therefore, may come to the decision that all counsellors and psychotherapists are to
be classified as purists. However, research indicates that many counsellors and
psychotherapists will use and will also have studied a variety of approaches besides
their basic training and would not define themselves as purists at all. Increasing
numbers are identifying themselves as integrative. For example, in 1996, out of 2,334
practitioners listed in the British Association for Counsellings (BAC) Counselling and
Psychotherapy Resources Directory, 499 (21 per cent) identified their theoretical orientation as integrative. By 2008, a search of the BACPs website directory in randomly
chosen regions across the UK showed a range from 30 per cent to 50 per cent of
therapists describing their theoretical approach as integrative.These Figures challenge
the current (2009) moves by the government to categorize therapies according to
specific and discrete skills and competencies a task that is obviously unsuited to the
flexibility of an integrative approach.
In light of the natural evolutionary development of ideas and approaches within
the world of counselling and psychotherapy from its very beginnings a century ago,
the question arises as to what is the difference between this integration and the
movement towards integration that has been happening over the last thirty years.We
suggest that the difference is in the intention of the integration.Whereas it was often
the intention of past developments to invent something new, an innovative package
that could be used as a complete model of counselling and psychotherapy, this is not
necessarily the case with modern integrative developments. Rather, the integrative
challenge of today is to discover overarching frameworks within which compatible
or complementary, tried and tested aspects of various theories and approaches can
be integrated.This involves embracing a meta-perspective of the field of therapy and
taking stock of commonalities within theories and approaches (and the concomitant
differences), as well as utilizing practical techniques from the wealth of such operations offered by the many and different approaches. It is more of a bridge-building
exercise between and within the three schools than the construction of a new orthodoxy. Integrative counselling and psychotherapy seek, therefore, to build philosophical, theoretical and technical networks between compatible, workable and useful
aspects of the various schools.
By and large, up until the l960s, counselling and psychotherapy were restricted to
the wealthy or the insane often both. In the social and cultural revolution of the
1960s in the West, therapy and counselling not only matched the zeal and innovation of that time but were an essential part of it. However, though more accepted as
legitimate means to personal growth, and in that sense normalized, counselling and
psychotherapy were still considered unusual by the wider population.The enormous
expansion in the technology of international and interpersonal communication in
the 1980s has meant an egalitarianism of information, understanding and knowledge
such that counselling and psychotherapy can be offered to and participated in by a
much wider and diverse clientele. During this time, the term counselling reached

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a wide audience in the UK and elsewhere through phone-in counselling shows on

television and national and local radio, as well as via programmes presenting counselling and psychotherapy with celebrities or exploring various approaches. Indeed,
radio and TV soaps were often to include the need for therapy for many of their lifebattered characters. Comedy sitcoms have also been attempted which revolve around
therapy and therapy practitioners. The result is that the public has not only been
informed of the existence of counselling and psychotherapy, but also educated in its
terminology, methodology and variety of approaches.
Increasing numbers of people are turning to therapy, therapeutic workshops or
groups to address the stress they experience in their modern-day lives. Many companies and organizations now incorporate counselling services in their employee care
packages.The therapeutic population is slowly becoming more representative of the
general population found in our richly diverse and multicultural societies. Theories
and approaches based upon white, middle-class, often male, Western ideologies and
values no longer suffice to answer the needs of this population with its diversity of
internal and external values, social complexity, differing family patterns and spiritual
and cultural beliefs, as well as limitations of time or finance. To answer this need,
models with a broader scope are required. Developing an integrative or integrating
attitude within counselling and psychotherapy may be part of the answer.
This development towards integration is not confined to the world of counselling
and psychotherapy but is also evident in educational approaches, political and social
reorganization, economic theory and practice, industrial theory, anthropology, psychiatry and medicine. It is evident that while such a trend for integration exists
within these individual areas, there is also room for integration across them. For
example, psychotherapy and counselling may need to take note of and make room
for aspects of social and political change and incorporate new knowledge and discoveries in the world of anthropology and medical science. In other words, integration
is essential to an holistic view of human existence.

SOME DISAGREEMENTS
However, as is often the case where boundaries are being changed, there are some
who do not agree with the developments that have taken place within counselling
and psychotherapy and would argue strongly against any further developments of an
integrative nature. Three major debates have emerged. First, some purist practitioners argue against eclectic or integrative psychotherapy or counselling approaches.
Second, a debate continues between eclectic and integrative counsellors and psychotherapists. The third debate arises between the proponents of different versions
of integrative approaches. Some practitioners identifying themselves with a specific
or purist approach consider that any attempt to combine different approaches will
result in confusion and an inauthenticity of some kind or another because each
specific training is based on different underlying philosophical assumptions. They
hold that, even if there is an overlap of a few of these assumptions, to lift a part of
any whole would result in a distortion of not only that part but also of any other

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whole into which it is intruded/included. Further, they would argue that integration
leads to an undisciplined spirit of translation which loses the subtleties and nuances
of the individual approach.
Among the more purist writers who led the early argument against eclecticism and
integrative approaches was Eysenck (1970) who argues that the only scientific and
sufficiently consistent approach is behaviour therapy and that any integrative or eclectic
therapy is a confusion of models. He criticizes eclectics for their lack of an acceptable
rationale and a shortage of empirical evidence for their approach.Without mincing his
words, he describes eclecticism as a mishmash of theories, a hugger-mugger of procedures, a gallimaufry of therapies and a charivaria of activities having no proper
rationale, and incapable of being tested or evaluated (1970: 1406). From another perspective, the radical critic of psychoanalysis, Szasz (1974) protests against integration by
saying that combinations of theories and practices result in inauthenticity:
The psychotherapist, who claims to practice in a flexible manner, tailoring his therapy
to the needs of his patients, does so by assuming a variety of roles. With one patient
he is a magician who hypnotises; with another, a sympathetic friend who reassures;
with a third, a physician who dispenses tranquillisers; with a fourth, a classical analyst who interprets; and so on. The eclectic psychotherapist is, more often than not,
a role player; he wears a variety of psychotherapeutic mantles, but owns none and is
usually truly comfortable in none. Instead of being skilled in a multiplicity of therapeutic techniques, he suffers from what we may consider, after Erikson, a diffusion
of professional identity. In sum, the therapist who tries to be all things to all people
may be nothing to himself; he is not at one with any particular method of psychotherapy. If he engages in intensive psychotherapy his patient is likely to discover
this. (Szasz, 1974: 41)

Against this purist attitude, integrationists and eclectics suggest that the similarities
between approaches are so fundamental that the using of ideas from different
approaches will enrich an approach rather than confuse it. Though a confirmed
eclectic rather than an integrationist, Lazarus (in Norcross, 1986) in writing of his
multimodal therapy presents an argument which is in direct opposition to Szaszs by
stating that there is no one way to approach peoples problems and that individuality
and flexibility are the key to good practice. He says:If a number of clinicians, unfamiliar with me or my therapeutic orientation, were to observe me with different
clients, their views and conclusions about my methods and school identification
would differ considerably. He goes on to suggest that one observer might see a
Gestalt therapist, another a behaviourist, another a Rogerian, yet another a psychoanalytic therapist, and so on. He maintains that technical eclecticism (see the procedural integration strategy in Chapter 3 and Lazaruss multimodal therapy in
Chapter 8) draws on all and any effective technique without necessarily subscribing
to the theories or systems that gave rise to them (1974: 82) His emphasis rests on
a flexibility of style and specificity of intervention designed to fit each clients individual and idiosyncratic needs and expectancies, rather than attempting to fit the
client into one particular approach or methodology.Wachtel certainly supports this
view when he writes:

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there is no single way to conduct psychotherapy. When I think of the many different
ways in which I have engaged with my patients over the years, I am struck by the
incredible variety of things that I have done or said in the name of psychotherapy and
by the ways that different patients have seemed to need or to be helped by different
ways of being with them or interacting with them. Whatever rules may guide our
work, perhaps the most important rule is not to take those rules too seriously (cf.
Hoffman, 1998). By this I do not mean take them lightly. The responsibility we assume
as psychotherapists is a weighty one. But every patient teaches us something new
about what people need. The day we think we know all we need to know in order to
help people is probably the day we cease to be able to help at all. (2008: 303)

The second debate between those using eclectic methods and those using an integrating framework involves, among other things, the belief that integrative approaches
require a greater academic and theoretical discipline than that required by any form of
eclecticism. In the 1960s the term eclectic was more popular than it is today. An eclectic approach to therapy is perceived as one that involves a practitioner assessing the
needs of his client and choosing from a range of approaches the intervention which
seems to best suit the situation, as described above in terms of Lazaruss multimodal
approach. Integration, however, involves a therapist bringing together disparate theories and techniques and modelling/moulding them into a new theory. In this second
debate the integrationists would argue that their form of transformation results in a
more authentic and consolidated approach than that of an eclectic random selection.
Some theorists would claim a distinction between eclecticism and integration;
others say that integration is only one form of eclecticism and yet others that the
situation is the reverse. It is our view, however, that this debate is often one of semantics. For this reason, we have chosen to stay out of the argument between the two
sides by presenting two strategies which we believe deal with each respectively.We
have called these the Framework Strategy and the Procedural Strategy. We continue to use the term integration here because not only does it appear to be the
term of choice among practitioners today but more so because it also describes a
wholeness of approach which best matches our own philosophical attitude to counselling and psychotherapy.
The third debate concerns the effectiveness of different types of integrative
approaches. Here again, we find the debate not only fruitless and unnecessary, but
also continuing the mine is better than yours competition that has somewhat undermined the credibility of counselling and psychotherapy in the past.These claims are
unfounded within both purist and integrative approaches.
Research findings (for example, Lambert et al., 1986; Luborsky et al., 2002;
Wampold, 2001) suggest no evidence that one psychotherapeutic approach is more
effective than another. What is important in terms of effectiveness has little to do
with the chosen approach and much to do with the relationship between therapist
and client. It is also interesting to note that these studies have found greater commonalities between experienced practitioners from differing schools than between
senior practitioners and trainees within the same school. Such findings suggest that
there are certain important therapeutic elements which are common to most
psychotherapeutic approaches rather than particular approaches to counselling and

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psychotherapy which are more effective than others. These generic elements will
be discussed in the next chapter.
It is our hope that these particular debates will fade and that between and within
various schools of thought a co-operative discussion and sharing of ideas may lead
to a clearer understanding and discovery for what is, after all, our common task as
practitioners, that of the improvement of the service we offer to our clients be it
in terms of healing, change, insight or actualization.
In just such a quest, in 1983 the Society for the Exploration of Psychotherapy
Integration (SEPI) was formed. Its aim was to bring together practitioners representing diverse approaches who shared a common interest in investigating the ways
in which various forms of psychotherapy could be integrated. Some of these practitioners are professionals who clearly identify themselves with a particular theoretical
framework but openly acknowledge that other schools have something to offer. Some
are people interested in finding commonalities among therapies and some would like
to find a way to integrate existing approaches. Many members would hope eventually to find integrative approaches based on research findings or are interested in
developing clearer guidelines that are more consistent with their clinical experience
(Goldfried and Newman in Norcross, 1986: 55).Though there is much healthy debate
within this society, it is refreshing that there is a willingness to self-evaluate, to investigate other approaches and to search for methods of integration across approaches
and a greater openness to co-operation, mutual exploration and shared endeavour.
In the late 1980s, the United Kingdom Council for Psychotherapy (UKCP) was
set up to unite the psychotherapy profession and provide some regulation for the
public benefit with its move towards statutory regulation and its first register of
psychotherapists in 1993. Its eight sections represent the whole range of approaches
to psychotherapy. As most integration of approaches was taking place within the
humanistic realm at the time of the UKCPs inauguration, a section was designated as
Humanistic and Integrative Psychotherapy. Given that integration is increasingly
occurring within and between several other sections, perhaps it is time for this to be
reflected in the designation of a separate and distinct integrative section.The description given in the Humanistic and Integrative Psychotherapy section flag statement
concerning the integrative aspects of this group could probably stand as a convincing
flag statement for a discreet integrative section:
This section includes different psychotherapies which approach the individual as a whole
person including body, feelings, mind and spirit. Members welcome interdisciplinary dialogue and an exploration of different psychological processes with particular emphasis
on integration within the section. Integrative Psychotherapy can be distinguished from
eclecticism by its determination to show there are significant connections between different therapies which may be unrecognised by their exclusive proponents. While
remaining respectful to each approach, integrative psychotherapy draws from many
sources in the belief that no one approach has all the truth. The therapeutic relationship
is the vehicle for experience, growth and change. It aims to hold together the dual forces
of disintegration and integration, as presented by the psychologically distressed and disabled. The integrative therapeutic experience leads towards a greater toleration of lifes
experiences and an increase of creativity and service. (UKCP, 1999: xiv)

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In similar vein, with its aim of fostering the development of integrative psychotherapy
in the UK, the United Kingdom Association for Psychotherapy Integration (UKAPI)
was established in 1999.The association (www.ukapi.com) organizes conferences on
the theme of integration, publishes The British Journal of Psychotherapy Integration and
provides continuing professional development for practitioners exploring an
integrative approach.
It is in this same spirit that we have written this book.We hope to provide guidelines and templates that will help practitioners and students to develop their own integrative approaches to working with clients rather than impose one prescriptive theory
or methodology. It is our belief that there are not one but many integrative and integrating approaches to counselling and psychotherapy and that these depend upon several variables which need to be taken into consideration. Such variables will include
the experience and training of the practitioners, their professional and personal style
of relating and creating, their life experience and the stories (sometimes called theories) they have evolved to make meaning of their lives and the lives of others.Their
work setting may have some influence on the type, frequency and duration of the
therapy and their choice of client population will also affect the development of their
approach. These same variables will apply equally to their clients. Such respect for
individuality, difference and idiosyncratic preference, when held alongside an appreciation of commonalities, the similarity of needs and the shared experience of being
human gives hope, as the first decade of this new millennium draws to a close, for the
lessening of segregation and the development of integration in our field.

RECENT DEVELOPMENTS
As we have said in the Introduction, it is our aim in this book to discuss and demonstrate the use of frameworks and procedures for integration in order to encourage
practitioners to develop their own personal, integrative models. However, we will
mention here three of the many integrative models that have been developed in
recent years as useful examples of how different, innovative and effective integrations
can be developed whilst drawing from a similar range of concepts and approaches.
These are necessarily much abbreviated descriptions and cannot do justice either to
the theory or practice of these models.We would urge readers to refer to the original
sources for more comprehensive descriptions and discussions. The reader interested
in descriptions of several other integrative models is recommended to read Integrative
and Eclectic Counselling and Psychotherapy (Palmer and Woolfe, 1999).

Cognitive-analytic therapy (CAT)

The CAT model was originated and developed by Anthony Ryle and described in
Cognitive-analytic Therapy: Active Participation in Change: A New Integration in Brief
Psychotherapy (1990). It is an example of an approach which started as an integration
of theories and methods and then solidified into a recognized model with its own
name, training courses, and so on.

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CAT has been applied largely within the British National Health Service where
conditions require time-limited work. Usually clients are offered 16 sessions, though
sometimes 8 or 12 sessions have proved to be helpful. It incorporates essential elements of personal construct and cognitive theories such as identifying and challenging
distorted meanings and inferences and the ensuing emotions, challenging negative
self-evaluations and catastrophic fantasies, helping with the choice of appropriate
plans and evaluating their consequences, as well as behavioural techniques such as
graded exposure, modelling and the practice of new skills. In addition, psychoanalytic
theory has incorporated, in particular, the main ego defences of denial, repression,
dissociation, reaction formation and symptom formation.
Ryle based his integrative theory on what he termed the Procedural Sequence
Model concerned with intentional, aim-directed activity. This theory draws upon
both psychoanalytic theory, especially object relations theory, and the developmental psychology of Vygotsky (Wertsch, 1985). Learning and the development and
growth of human personality are seen as taking place through the process of internalization. The early, unique, interpersonal experiences of childhood (particularly
with parents and other adults) become transformed into intrapsychic experiences
through which we acquire a second voice in an internal conversation.The external
dialogue becomes an internal dialogue with the possibility of life-enhancing or
life-restricting conversations. Ryle sees psychotherapy as analogous to the early
adultchild learning process and the therapeutic relationship as the arena in which
the learning process may be utilized to acquire new attitudes and skills, recognizing
and modifying the ways in which a client may avoid or distort this relationship
through transference.
Ryle (1990) identifies three main ways in which people will fail to modify ineffective procedures:
1. Traps: these are circular self-reinforcing processes where a negative belief leads
to action which has consequences serving to confirm the original negative belief
(a classic CBT technique).
2. Dilemmas: possible means are considered but only as narrow, polarized alternatives. One pole tends to be repeated through fear of the consequences of the
perceived only alternative polarity (based on the notion of the defense mechanism).
3. Snags: here appropriate aims are abandoned due to the prediction of negative
external consequences (e.g. disapproval) or internal consequences (e.g. guilt)
(arises from ego psychology).

These tendencies are taken into account when reformulating the Target Problem
Procedures of the client.
In the practice of CAT, reformulation is the essential feature. This represents the
description of the clients difficulties, focusing on the procedures in need of change
and on how the client is actively responsible for maintaining these procedures.This
is usually completed within the first four sessions, with clients vitally playing an
active part in the process by working towards an accurate and fully understood
description which is recorded in writing. Much of this will be based upon the
clients clinical history and their behaviour in relation to the therapist in the early
sessions. However, supplementary devices such as the Psychotherapy File may be

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used. Here clients identify with descriptions they see as applying to themselves and
can use the file to rate various aspects of their moods, feelings, thoughts, behaviours
and patterns.All this is discussed and elaborated upon and finally written down.The
first part is in the form of a letter in the first person. Both therapist and client will
have a copy of this. As Ryle says, The emotional impact of this letter is often profound; as patients feel that their experience has been understood and validated they
often become silent or may cry and this moment often cements the working
alliance (in Dryden, 1992a).The second part of the reformulation lists current target problems (TPs) and target problem procedures (TPPs) by which the client is
actively maintaining their difficulties by means of traps, dilemmas and snags. The
effects of this rigorous reformulation process are threefold. First, the active involvement of clients enhances a sense of ability and efficacy and engenders an active and
co-operative role in the psychotherapy. Second, activities ranging from unstructured
talking to specific homework tasks will tend to reveal how a clients particular difficulties are provoked by and manifested in the therapeutic situation (such transference and countertransferential issues being anticipated by the earlier exploration of
problematic personal procedures). Third, and crucially, reformulation requires considerable thought and sensitivity on the part of the therapist. Ryle states: The fact
that the results are written down is daunting but the fact that what is written down
is discussed and modified with the patient means that, once completed, the reformulation provides a firm shared basis upon which the rest of the therapeutic work
can be built (in Dryden, 1992a).
Change often occurs during the reformulation process itself. Once completed, the
task is for the client to recognize and begin to modify these problematic procedures
and loops. Diaries are kept to record repetitions of target procedures which are
discussed and explored within the sessions, with an additional reference to how these
may be being enacted within the therapeutic relationship.This is a process of bringing awareness to what previously has been performed automatically. This awareness
is heightened by a sessional rating by the client of how far they have been controlled
by their TPPs or have employed alternative modes.
The end of the therapy is marked by an exchange of goodbye letters, acknowledging the pain of loss as well as the gains to be taken away, which serves to continue the therapy and aids in an internalization of the therapist for the period
between termination and the follow-up (usually three months later). Ryle points out
that no therapy can make up for the damage or deficits of childhood, but it can provide a pilot guide and a tool kit.The therapist is internalized, not as the all-powerful
carer of the needy child within the patient but as a caring and coping bearer of
understanding and initiator of change.

Integrative psychodynamic therapy

Integrative psychodynamic therapy was developed by Paul Wachtel (Wachtel, 1987;
Wachtel and McKinney, 1992; Wachtel and Wachtel, 1986) and further developed
from a relational perpective in Wachtel (2008). We have chosen this model as our

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second example of integration because it demonstrates a marked similarity to the

CAT approach while differing in its overall style. It too is an integration of
psychodynamic and behavioural approaches and some of the components will be
seen to be almost identical (for example, Ryles traps and Wachtels vicious
cycles) while presenting a differing emphasis. It is this similar yet different aspect
of models of integration that we find both exciting and reassuring. Here we present the bare outline of this integrative psychodynamic therapy to give a flavour of
its integration and recommend the interested reader to explore the model further
in the original sources as referenced. Integrative psychodynamic therapy is a synthesis of key facets of psychodynamic, behavioural and family systems theory and
has its theoretical base in cyclical psychodynamics. This theory reflects both the
cyclical nature of causal processes in human interactions and experiences and the
unconscious motives, fantasies and conflicts we maintain in our everyday lives. In
Wachtels words:
The events that have a causal impact on our behaviour are very frequently themselves
a function of our behaviour as well By choosing to be in certain situations and not
others, by selectively perceiving the nature of those situations and thereby altering their
psychological impact, and by influencing the behaviour of others as a result of our own
way of interacting, we are likely to create for ourselves the same situation again and
again. (Wachtel in Norcross and Goldfried, 1992: 3445, emphasis in original)

From this perspective Wachtel saw that active intervention methods from the
behavioural school (and others) could enhance the change potential of more psychodynamic approaches and be logically and consistently employed within a
modified psychodynamic context whereby transference reactions are conceptualized as the individuals idiosyncratic way of construing and reacting to experiences, rooted in past experiences, but always influenced as well by what is really
going on. In this way, the emphasis is as much on understanding reactions to current situations (including the impact of the relationship with the therapist and the
therapists responses) as on past influences that might explain why such reactions
may arise.
Cyclical psychodynamics endeavours to develop a theoretical structure which
is coherent and clinically practical by selecting those aspects of competing perspectives which can be integrated. It is influenced, as the name suggests, by psychodynamic theory with its emphasis on unconscious processes, inner conflict
and understanding the relationship between therapist and client, yet places the
primary emphasis not on past events but upon the vicious cycles (in particular
self-fulfilling prophecies) persisting in the present and set in motion by those
past events. The cultural and social context, the how, where and when of the
clients neurotic patterns, are addressed by behavioural and family systems perspectives. Thus, cyclical dynamics integrates the exploration of warded-off experiences and inclinations with direct and active efforts at promoting change. Both
internal and external realities, defining and redefining each other, are crucial to
this integrative approach.

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INTEGRATION IN COUNSELLING & PSYCHOTHERAPY

THE RELATIONSHIP AND RELATIONALITY

The fundamental human need for relationship and its centrality in counselling and
psychotherapy is discussed throughout this book. We also devote Chapter 7 to
exploring the several aspects of the therapeutic relationship as a framework for
integration. The relationship and how we use it have been central to the therapeutic encounter since the beginnings of psychotherapy. However, we mention it
here in this historical overview because a markedly new focus on relationality has
been on the ascendant in recent years. Aided and informed by the research implications of neuroscience and infant studies and the development of intersubjectivity
theory, the relational emphasis seems to us to be having an integrating influence
across various approaches.
There has been a marked surge in the number of counselling and psychotherapy
books in the last decade or so that have employed the word relational in the title.
What is more noteworthy is that, whilst for the most part still adhering to a particular approach in their titles (be it psychoanalysis, transactional analysis, attachment
theory, EMDR or existential theory, to name but a few), the common relational
theme contained within many of the books is implicitly, sometimes explicitly, acting
as a catalyst for the integration of concepts across a range of disciplines and promoting
a dialogue between the proponents of different approaches. Discussion and argument
about relational concepts on psychotherapy website forums between differing schools
of psychotherapy are rife.
In the UK, in 2002, a group of psychoanalysts and psychotherapists from various
schools of thought came together to form a relational movement that has evolved
into The Relational School (www.therelationalschool.org). Its aim is to further the
development of relational thinking in clinical practice and to develop an understanding of the co-created, intersubjective, therapeutic space. Most relevant to the
integrative endeavour, and most heartening to us, is the Relational Schools explicit
creation of forums for further conversations around relationality coming from a variety
of therapeutic disciplines as well as a formal association to disseminate the work (our
emphasis). At the February 2008 Conference, the Relational School was officially
launched, attended by practitioners representing the range of humanistic, psychodynamic and behavioural approaches. We view this as a positive indication of a more
open and inclusive attitude towards the sharing of ideas and theories from diverse
theoretical perspectives and to taking a more integrative stance.
What is apparent from this development is that practitioners are searching not for
a neat package of integrated theories (a one size fits all meta-theory) but for concepts and theories that may be integrated within the individual approaches, philosophies and personal styles they find effective in their work with clients.This said, there
is a very human tendency to want a Truth, a definitive Answer, in most walks of life
and therapy is no exception. In our recent work with students from various integrative institutes and courses across the UK, we have noticed with some dismay a
distinct leaning towards a particular set of theories as being the integrative truth. In
some instances, it seems to have become a case of if your integrated theories do not
include (insert favoured theory), its not integrative. At the beginning of training

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A BRIEF HISTORY AND RECENT DEVELOPMENTS

especially, this may be a retreat into the safety of a set integration and a need to identify
with others, to have a sense of belonging through shared structures.This may also be
a natural reflection of the integrative approach of the tutors which is to some extent
inevitable and understandable. However, as many integrative students will have
already graduated in their own particular approaches, and will have read widely
across other modalities and experienced personal therapy from a variety of practitioners, we do not see why their additional knowledge and experience should be
side-lined or even ignored.As we state in the preface of this book, our own position
on integration is that, by taking the individuals personality, temperament, experience, skills and knowledge into account, there will be as many integrative psychotherapies as there are integrative psychotherapists. In our view, what is sought is
not a shared, definitive integration but the shared values of openness, exploration and
experiment contained within the ongoing integrative process.
Though an in-depth exploration of the development of integration from Freud to
the present day would make for interesting and lengthy reading, such an endeavour lies
outside the remit of our book. However, in this chapter we hope to have highlighted
some of the more prominent aspects of the evolution of integrative counselling and
psychotherapy and to have made clear the distinctive thrust of the modern integrative
movement towards a more individual and personal approach to integration.

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