Usuaria:Elena Elías/Psicoterapia integral

La psicoterapia integral es el conjunto de elementos provenientes de distintas escuelas de psicoterapia enfocada en el tratamiento de clientes o pacientes. Del mismo modo, la psicoterapia integral es comprendida como el proceso psicoterapéutico de la integración de la personalidad que "une los sistemas afectivo, cognitivo, conductual y psicosocial en la persona".​

Antecedentes

Inicialmente, Sigmund Freud desarrolló un método basado en la plática llamado psicoanálisis; posteriormente, escribió acerca de este método y lo popularizó. Después de Freud, muchas disciplinas se fueron desprendiendo del psicoanálisis. Algunas de las terapias más conocidas son: psicoterapia psicodinámica, análisis transaccional, terapia cognitivo conductual, terapia Gestalt, psicoterapia corporal, terapia familiar, psicoterapia centrada al cliente y terapia existencial. Cientos de diferentes teorías de psicoterapia siguen siendo practicadas (Norcross, 2005, p. 5).

Cuando una nueva terapia nace, lo hace a través de distintas etapas. Después de ser entrenado en una escuela de psicoterapia en particular, el terapeuta comienza su práctica. Posterior a un entrenamiento en otras escuelas, el terapeuta puede comenzar a combinar distintas teorías como una base para una nueva práctica; de la que pueden escribir e incluso otorgarle un nuevo nombre.

Una perspectiva pragmática o teórica puede ser tomada cuando se combinan diversas escuelas de psicoterapia. Los practicantes de la corriente pragmática combinan diferentes aspectos de diferentes escuelas, así como varias técnicas. Dichos practicantes son llamados psicoterapeutas eclécticos y ellos están interesados en cosas que en realidad funcionan. De otro modo, otros terapeutas se consideran mas teóricos cuando mezclan teorías. Ellos son usualmente llamados psicoterapeutas intergrales, y ellos no solo se preocupan por lo que funciona, sino el porque funciona. (Norcross, 2005, p. 8).

Por ejemplo, un terapeuta ecléctico puede experimentar un cambio en su cliente después de emplear una técnica en particular y estando satisfecho con el resultado. En contraste, un terapeuta integral esta interesado en el porque y como de ese cambio. Un énfasis teórico es importante: por ejemplo, el cliente puede solamente haber intentado complacer al terapeuta y lo que hizo fue adaptarse al terapeuta en lugar de aplicar ese mismo movimiento a si mismos.

Diferentes Rutas de Integración

La mas reciente edición del Manual de Integración Psicoterapeutica Handbook of Psychotherapy Integration (Norcross & Goldfried, 2005) reconoció cuatro reglas generales para la integración: Factores en Común, Eclecticismo Técnico, Integración Teórica e Integración Asimilativa.

Factores en Comun

La primera ruta a la integración es llamada factores en común y busca determinar los ingredientes claves que las diferentes terapias en comun. La ventaja de la perspectiva de los factores en comun es el énfasis de las acciones terapéuticas las cuales han sido comprobadas por su efectividad. La desventaja es que los factores en comun pueden pasar por alto tecnicas especificas las cuales han sido desarrolladas con teorías particulares. Los factores comunes han sido descritos por Jerome Frank (Frank & Frank, 1991), Bruce Wampold (2001), y Miller, Duncan y Hubble (2005). La teoria de los factores en común establece que son precisamente los factores en común a las psicoterapias las que hacen que cualquier psicoterapia sea exitosa.

Algunos psicólogos han acordado en la conclusión de que una variedad de diferentes psicoterapias pueden ser integradas por su habilidad en común de disparar el mecanismo neurológico de la reconsolidacion de memoria de cierto modo que lleva a la desconsolidacion. (Ecker, Ticic & Hulley 2012; Lane et al. 2015; Welling 2012- pero para una muestra del rol de reconsolidacion de memoria en psicoterapia, ver las objeciones en algunos de los comentarios invitados. Lane et al. 2015)

Eclecticismo Tecnico

La segunda ruta de integración es el tecnicismo ecléctico, el cual esta diseñado para incrementar nuestra habilidad para seleccionar el mejor tratamiento para una persona y problema... guiados principalmente por datos de lo que ha funcionado para otros en el pasado. La ventaja del tecnicismo eclectico

The second route to integration is technical eclecticism which is designed "to improve our ability to select the best treatment for the person and the problem…guided primarily by data on what has worked best for others in the past" (Norcross, 2005, p. 8). The advantage of technical eclecticism is that it encourages the use of diverse strategies without being hindered by theoretical differences. A disadvantage is that there may not be a clear conceptual framework describing how techniques drawn from divergent theories might fit together. The most well known model of technical eclectic psychotherapy is Arnold Lazarus' (2005) multimodal therapy. Another model of technical eclecticism is Larry E. Beutler and colleagues' systematic treatment selection (Beutler, Consoli, & Lane, 2005).

Theoretical integration

The third route to integration commonly recognized in the literature is theoretical integration in which "two or more therapies are integrated in the hope that the result will be better than the constituent therapies alone" (Norcross, 2005, p. 8). Some models of theoretical integration focus on combining and synthesizing a small number of theories at a deep level, whereas others describe the relationship between several systems of psychotherapy. One prominent example of theoretical synthesis is Paul Wachtel's model of cyclical psychodynamics that integrates psychodynamic, behavioral, and family systems theories (Wachtel, Kruk, & McKinney, 2005). Another example of synthesis is Anthony Ryle's model of cognitive analytic therapy, integrating ideas from psychoanalytic object relations theory and cognitive psychotherapy (Ryle, 2005). Another model of theoretical integration is specifically called integral psychotherapy (Forman, 2010; Ingersoll & Zeitler, 2010). The most notable model describing the relationship between several different theories is the transtheoretical model (Prochaska & DiClemente, 2005).

Assimilative integration

Assimilative integration is the fourth route and acknowledges that most psychotherapists select a theoretical orientation that serves as their foundation but, with experience, incorporate ideas and strategies from other sources into their practice. "This mode of integration favors a firm grounding in any one system of psychotherapy, but with a willingness to incorporate or assimilate, in a considered fashion, perspectives or practices from other schools" (Messer, 1992, p. 151). Increasingly, integrationists are acknowledging that most counselors will prefer the security of one foundational theory as they begin the process of integrative exploration. Formal models of assimilative integration have been described based on a psychodynamic foundation (Frank, 1999; Stricker & Gold, 2005) and based on cognitive behavioral therapy (Castonguay, Newman, Borkovec, Holtforth, & Maramba, 2005).

Other models that combine routes

In addition to well-established approaches that fit into the four routes mentioned above, there are newer models that combine aspects of the traditional routes.

Clara E. Hill's (2014) three-stage model of helping skills encourages counselors to emphasize skills from different theories during different stages of helping. Hill's model might be considered a combination of theoretical integration and technical eclecticism. The first stage is the exploration stage. This is based on client-centered therapy. The second stage is entitled insight. Interventions used in this stage are based on psychoanalytic therapy. The last stage, the action stage, is based on behavioral therapy.

Good and Beitman (2006) described an integrative approach highlighting both core components of effective therapy and specific techniques designed to target clients' particular areas of concern. This approach can be described as an integration of common factors and technical eclecticism.

Multitheoretical psychotherapy (Brooks-Harris, 2008) is a new integrative model that combines elements of technical eclecticism and theoretical integration. Therapists are encouraged to make intentional choices about combining theories and intervention strategies.

An approach called integral psychotherapy (Forman, 2010; Ingersoll & Zeitler, 2010) is grounded in the work of theoretical psychologist and philosopher Ken Wilber (2000), who integrates insights from contemplative and meditative traditions. Integral theory is a meta-theory that recognizes that reality can be organized from four major perspectives: subjective, intersubjective, objective, and interobjective. Various psychotherapies typically ground themselves in one these four foundational perspectives, often minimizing the others. Integral psychotherapy includes all four. For example, psychotherapeutic integration using this model would include subjective approaches (cognitive, existential), intersubjective approaches (interpersonal, object relations, multicultural), objective approaches (behavioral, pharmacological), and interobjective approaches (systems science). By understanding that each of these four basic perspectives all simultaneously co-occur, each can be seen as essential to a comprehensive view of the life of the client. Integral theory also includes a stage model that suggests that various psychotherapies seek to address issues arising from different stages of psychological development (Wilber, 2000).

The generic term, integrative psychotherapy, can be used to describe any multi-modal approach which combines therapies. For example, an effective form of treatment for some clients is psychodynamic psychotherapy combined with hypnotherapy. Kraft & Kraft (2007) gave a detailed account of this treatment with a 54-year-old female client with refractory IBS in a setting of a phobic anxiety state. The client made a full recovery and this was maintained at the follow-up a year later.

Comparison with eclecticism

In Integrative and Eclectic Counselling and Psychotherapy (Woolfe & Palmer, 2000, pp. 55, 256), the authors make clear the distinction between integrative and eclectic psychotherapy approaches: "Integration suggests that the elements are part of one combined approach to theory and practice, as opposed to eclecticism which draws ad hoc from several approaches in the approach to a particular case." Psychotherapy's eclectic practitioners are not bound by the theories, dogma, conventions or methodology of any one particular school. Instead, they may use what they believe or feel or experience tells them will work best, either in general or suiting the often immediate needs of individual clients; and working within their own preferences and capabilities as practitioners (Norcross & Goldfried, 2005, pp. 3–23).

References

• Beutler, L. E., Consoli, A. J. & Lane, G. (2005). Systematic treatment selection and prescriptive psychotherapy: an integrative eclectic approach. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 121–143). New York: Oxford.
• Brooks-Harris, J. E. (2008). Integrative Multitheoretical Psychotherapy. Boston: Houghton-Mifflin.
• Castonguay, L. G., Newman, M. G., Borkovec, T. D., Holtforth, M. G. & Maramba, G. G. (2005). Cognitive-behavioral assimilative integration. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 241–260). New York: Oxford.
• Ecker, B., Ticic, R., Hulley, L. (2012). Unlocking the Emotional Brain: Eliminating Symptoms at Their Roots Using Memory Reconsolidation. New York: Routledge.
• Forman, M. D. (2010). A Guide to Integral Psychotherapy: Complexity, Integration, and Spirituality in Practice. Albany, NY: SUNY Press.
• Frank, J. D. & Frank, J. B. (1991). Persuasion and Healing: A Comparative Study of Psychotherapy (3rd ed.). Baltimore, MD: Johns Hopkins University.
• Frank, K. A. (1999). Psychoanalytic Participation: Action, Interaction, and Integration. Mahwah, NJ: Analytic Press.
• Good, G. E. & Beitman, B. D. (2006). Counseling and Psychotherapy Essentials: Integrating Theories, Skills, and Practices. New York: W. W. Norton.
• Hill, C. E. (2014). Helping Skills: Facilitating Exploration, Insight, and Action (4th ed.). Washington, DC: American Psychological Association.
• Ingersoll, E. & Zeitler, D. (2010). Integral Psychotherapy: Inside Out/Outside In. Albany, NY: SUNY Press.
• Kraft T. & Kraft D. (2007). Irritable bowel syndrome: symptomatic treatment approaches versus integrative psychotherapy. Contemporary Hypnosis, 24(4): 161–177.
• Lane, R. D., Ryan, L., Nadel, L., Greenberg, L. S. (2015). Memory reconsolidation, emotional arousal and the process of change in psychotherapy: new insights from brain science. Behavioral and Brain Sciences, 38: e1.
• Lazarus, A. A. (2005). Multimodal therapy. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 105–120). New York: Oxford.
• Messer, S. B. (1992). A critical examination of belief structures in integrative and eclectic psychotherapy. In J. C. Norcross, & M. R. Goldfried, (Eds.), Handbook of Psychotherapy Integration (pp. 130–165). New York: Basic Books.
• Miller, S. D., Duncan, B. L., & Hubble, M. A. (2005). Outcome-informed clinical work. In J. C. Norcross, & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 84–102). New York: Oxford.
• Norcross, J. C. (2005). A primer on psychotherapy integration. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 3–23). New York: Oxford.
• Norcross, J. C. & Goldfried, M. R. (Eds.) (2005). Handbook of Psychotherapy Integration (2nd ed.). New York: Oxford.
• Prochaska, J. O. & DiClemente, C. C. (2005). The transtheoretical approach. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 147–171). New York: Oxford.
• Ryle, A. (2005). Cognitive analytic therapy. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 196–217). New York: Oxford.
• Stricker, G. & Gold, J. (2005). Assimilative psychodynamic psychotherapy. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 221–240). New York: Oxford.
• Wachtel, P. L., Kruk, J. C., & McKinney, M. K. (2005). Cyclical psychodynamics and integrative relational psychotherapy. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 172–195). New York: Oxford.
• Wampold, B. E. (2001). The Great Psychotherapy Debate: Models, Methods, and Findings. Mahwah, NJ: Lawrence Erlbaum.
• Welling, H. (June 2012). Transformative emotional sequence: towards a common principle of change. Journal of Psychotherapy Integration, 22(2): 109–136.
• Wilber, K. (2000). Integral Psychology: Consciousness, Spirit, Psychology, Therapy. Boston: Shambhala.
• Woolfe, R. & Palmer, S. (2000). Integrative and Eclectic Counselling and Psychotherapy. London; Thousand Oaks, CA: Sage Publications.

Further reading

• Fromme, D. K. (2011). Systems of Psychotherapy: Dialectical Tensions and Integration. New York: Springer.
• Magnavita, J. J. & Anchin, J. C. (2014). Unifying Psychotherapy: Principles, Methods, and Evidence from Clinical Science. New York: Springer.
• Scaturo, D. J. (2005). Clinical Dilemmas in Psychotherapy: a Transtheoretical Approach to Psychotherapy Integration. Washington, DC: American Psychological Association.
• Schneider, K. J. (Ed.) (2008). Existential-Integrative Psychotherapy: Guideposts to the Core of Practice. New York: Routledge.
• Schneider, K. J. & Krug, O.T. (2010). Existential-Humanistic Therapy. Washington, DC: American Psychological Association.
• Stricker, G. & Gold, J. R. (2006). A Casebook of Psychotherapy Integration. Washington, DC: American Psychological Association.
• Urban, W. J. (1978) Integrative Therapy: Foundations of Holistic and Self Healing. Los Angeles: Guild of Tutors Press.

External links

• The Problem of Psychotherapy Integration by Tullio Carere
• The Rise of Integrative Psychotherapy by John Söderlund
• Society for the Exploration of Psychotherapy Integration
• International Integrative Psychotherapy Association
• Institute for Integrative Psychotherapy and Counselling, Ljubljana
• International Journal of Integrative Psychotherapy