by Jen L’Insalata
When working with a diverse client population it is important to acknowledge varying ideological concepts between demographic groups. In other words, a diverse population of clients requires a therapist to utilize a diverse repertoire of treatment approaches. Elements such as race, gender, age, religion, and sexual orientation impact the client’s response to particular therapeutic approaches. A therapist must recognize and utilize the best fit and appropriate approach for each individual client. Often when working with diverse population, it becomes necessary to integrate elements from varying psychotherapeutic approaches. Such integration allows for the necessary flexibility in clinical treatment that yields evidence based best practice results.
Methods of Integrating Psychotherapies
The integration of psychotherapeutic treatments can be as diverse as the theories themselves. However integration often takes the form of one of four main pathways. Each pathway allows a therapist to customize and blend psychotherapeutic treatments and modalities to best fit a particular client’s receptiveness and needs (Wedding, & Corsini, 2014).
Technical eclecticism is a research specific approach to integrating psychotherapeutic theories. This integration style allows unrelated concepts of varying therapeutic theories to be integrates and combined. Technical eclecticism draws on research which compares effective treatments to particular problems and client characteristics and utilizes concepts and techniques from varying theories (Wedding, & Corsini, 2014).
Theoretical integration includes multiple therapies which are combined to achieve the best result. The overarching concept blends together multiple theoretical approaches in order to create a more effective conceptual framework for treatment. Integration of psychodynamic and interpersonal, cognitive and behavioral, or systems, and humanistic are most widely used in combination (Wedding, & Corsini, 2014).
Combining treatments based on common factors is an integrative approach that identifies core similarities of varying treatment modalities. Treatment techniques are then developed based on key combinations of commonalities. Combining common factors focuses on the effective commonalities in theoretical concepts of treatment processes rather than the individual theoretical differences (Wedding, & Corsini, 2014).
Assimilative integration is an integrative technique that utilizes one primary therapeutic theory as a foundation. It then selects specific elements of other theoretical approaches to assimilate into a single treatment modality. This combinations allows a foundation in one coherent system of treatment with the ability to interject a broader range of treatment techniques (Wedding, & Corsini, 2014).
Empirical and evidence based research shows that the integration of theoretical approaches provides advantages from a variety of therapeutic modalities. Integrative therapies tend to focus on the clients individual circumstance and experiences rather than an overarching or abstruse theory (Ponterotto, 2013). Studies show that by integrating psychotherapeutic modalities for individual clients, the client attains the best possible outcome.
It is possible to conduct quantitative research without understanding epistemology however qualitative research relies on awareness of philosophical perspectives among client sub cultures. Qualitative research recognizes the sociocultural compounds of expression and experiences within a various populations and accounts for their voice or cultural input in the effectiveness. Qualitative research accounts for social, cultural, and economic realities for clients that impacts the structure and relationship of the therapeutic process (Ponterotto, 2013).
Mahrer’s 1989 Study
The Mahrer’1989 study investigated the integration of various psychotherapeutic techniques with concrete operating procedures. Mahrer utilized videotapes and transcripts to identify therapist’s behaviors that promoted client change. He believed that particular behaviors could be utilized and integrated into a range of options to achieve therapeutic goals. (Richert, 2007).
Concrete operations is describes as a set of ordered behaviors that a therapist would perform in sequence in order to elicit particular behaviors from a client. A therapist would utilize activities such as s Socratic questioning, teaching disputation, and the recording of automatic thoughts to implement a broader range of cognitive problem solving. Four specific theoretical orientations were selected for the integration into concrete operations procedures; humanistic and existential, cognitive and constructivist, analytic and dynamic, and interpersonal. (Richert, 2007).
According to Mahrer’s study, a constructivist therapeutic approach integrated most effectively with concrete operational procedures. Constructivist approach integrates unconditional positive regard, transference-counter transference while utilizing empathic reflections, two-chair dialog exercises, metacommunication or therapist self-disclosure, and dream work. Mahrer believed that a constructivist approaches proved favorable for integration due to emphasizing meaning-based practice, disputing irrational beliefs and self-monitoring procedure adapted from REBT and CBT (Richert, 2007).
Changing demographics in the United States calls for the continued development and integration of psychotherapy approaches. The ethnic and cultural diversity in which a clinician sees in their clients is increasing. More people from ethnicities who previously did not seek treatment are turning to therapist and clinicians with traumatic histories. Often these immigrant populations are underserved, under insureds, and receive treatment that is ineffective (Cook, & Tedeschi, 2007).
It is important to remember that when working with culturally diverse clients a therapist enters and experiences a foreign world and mindset. Empathy, respect and understanding of differences is imperative. A therapist must be able to suspend any preconceived concepts or stereotypes surrounding a particular population. (Ponterotto, 2013).
Blended elements from varying psychotherapeutic theories are effective when working with diverse populations. It is important for the therapist to keep an open mind about integrating treatments in the same manner as the must to toward each individual client. An effective integrative therapist recognizes the individual needs and limitations to therapy and creates a personalized therapeutic plan for each individual.
Wedding, D., & Corsini, R. J. (Eds.). (2014). Current psychotherapies (10th ed.). Belmont, CA: Brooks/Cole. ISBN: 9781285083711.
Ponterotto, J. G. (2013). Qualitative research in multicultural psychology: Philosophical underpinnings, popular approaches, and ethical considerations. Qualitative Psychology, 1(S), 19-32. doi:10.1037/2326-3598.1.S.19
Richert, A. J. (2007). Concepts, processes and procedures: An introduction to the special issue on integration of concrete operating procedures. Journal Of Psychotherapy Integration, 17(1), 1-9. doi:10.1037/1053-04220.127.116.11
Cook, J. R., & Tedeschi, R. G. (2007). Systems of care and the integrative clinician: A look into the future of psychotherapy.Journal Of Psychotherapy Integration, 17(2), 139-158. doi:10.1037/1053-0418.104.22.168