Çarşamba, Haziran 08, 2011

Integration of Psychotherapies

Since the time when the first pleas for psychotherapy integration were voiced, it has taken a full century to accumulate the technical and theoretical knowledge that would lead to the phase of unification. In the meantime, the number of techniques to be used in the session room has significantly increased, converging the therapy forms leaning on different theories. This current state has been tempting therapists to explore the opportunities of integration. The realm of psychotherapy, on the one hand, appears to have a fragmentary nature, and on the other hand, witnesses common and similar techniques, even the same techniques under different names. This appearance indicates that the psychotherapy integration is a natural course rather than an adventure taken up by a handful of over-daring men.

In the past, each different school of therapy was like a secret cult where they would strive to use a different language canonized by its followers, and if a known technique was to be included in the theory, it would definitely be given a different name, the reason of which is quite understandable because that technique gains a different nature within that framework. However, this trend continuing for a century has both created a richness and also a seeming apparent chaos. Could anyone claim that this situation makes things easier for novice therapists who are at the beginning of their career?

The efforts for psychotherapy integration necessitate addressing “human” as an open system, not a frozen structure, nor a closed and restricted system. Relation should be emphasized over technique. According to Ferenczi, the main ingredient of change is the quality of the therapeutical relationship. According to Sullivan, self is located in the “relational field” rather than in the patient’s mind. This new perspective builds pathology on the interrelationship instead of the disturbed constructs within the individual.

An integration to be built on a relational common ground according to the principles of the “general systems theory” sounds highly exciting in terms of the opportunities it offers because this perspective is open to such approaches as personality theory and developmental psychopathology already utilized by the therapist while also embracing the rapidly advancing fields of our era like affective and cognitive neuroscience, ecology and cultural anthropology. This approach, thus, seems to be much more promising as it is more outward-oriented (environmental), educative, supportive, relational, and open to the cultural as well as taking along the orthodox science and progressing at peace with the academic community.

Countless scientific data to be obtained from these fields can be adopted for maturation of diagnostic categories and transformed into interventions that we utilize in clinical practice. This way, “the art of psychotherapy” prepares to take its place in the classification of sciences, no longer being a solely speculative field, thanks to the data based on scientific evidence, for which the field has been starving for long years. In order to keep such a great variety of interdisciplinary perspectives, this field surely needs to have a robust evidence base.

The greatest resistance against the unification of psychotherapies arises from the theories’ desire of sterility because theories canonize the boundaries and are often built on irreconcilable principles. Therefore, theoretical orientation may regard integration as impossible. The fundamental point here is;

We have perfectly working theories, and our problem is that we are not able to apply them in the session room with competency and excellence, is this the case?

Or, are the theories linear and reductionist constructs desperately trying to anticipate the “relationship” which actually occurs in the room mostly through nonverbal communication and affects?

If we think without taking a sectarian attitude, i.e. neither canonizing the form in an Apollonian way nor inclining to an amorphous Dionysian freedom, we can say that integration is a natural consequence of the latter approach.

Ahmet Corak, M.D., PhD.

Written as an introductory paper for the 2-days workshop of Jeffrey Magnavita on unified psychotherapy, held in Istanbul, June 4,5, 2011

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