INTEGRATION OF

APPROACHES

Submitted by:
Ruchi Vashist (5680)
Tushita Hora (5675)
An integrated approach to treatment in clinical psychology uses treatment strategies
and techniques from various schools of therapy, sequenced and adapted to the
individual patient.

REASONS FOR GROWTH OF INTEGRATED AND

ECLECTIC APPROACHES
1. No single theory has yet been found that can clearly capture the entire range of
human experiences across the life span
2. Adhering to a single approach reduces therapeutic options due to diversity in
clients with respect to culture, gender, sexual orientation, intelligence, abilities,
interpersonal skills, life experiences, etc.
3. There is availability of training opportunities, case studies and detailed manuals
that give clinicians the opportunity to study, observe and gain experience in a
variety of treatment approaches.
4. Increasing pressure from governmental organisations, consumers and others for
clinicians to determine the most effective and efficient treatment approach for
each client.
5. Clinicans’ increased awareness that common factors among treatment
approacehs, such as the nature of therapeutic alliance are at least as important
in determining treatment success as specific strategies.
CHALLENGES TO INTEGRATED AND ECLECTIC
APPROACHES
• It is difficult to develop expertise in a range of treatment systems. No clinician
can have sufficient knowledge and expertise in the entire range of therapeutic
approaches to treat all clients and all problems.
• Clinicians must ensure that the disparate parts of treatment comprise a seamless
whole in which each intervention is chosen deliberately to accomplish a purpose.
(Coherence, relevance and planning)

BENEFITS OF INTEGRATED AND ECLECTIC

APPROACHES
• Bring flexibility to treatment process so that there is a good fit between treatment
and client.
• Important for clinicians dealing with clients from diverse backgrounds because it can
work with a broader range of people and problems.
• Allow clinicans to adapt standard treatment approaches to their own beliefs about
human grownth and development.
• Facilitate clinician efforts to assume a scientist-practitioner role and combine
theoretical information, empirical research, and practical experience.
NATURE AND TYPES OF INTEGRATED AND ECLECTIC
APPROACHES
Eclectic approach to treatment is not just drawing more than one approaches. There
should be a clear rationale for combining interventions. Lacking a thoughtful and
systematic approach to treatment is termed as syncretism (Providing treatment
without direction).

There are 4 types of eclectic and integrated approaches:

1. Atheoretical eclecticism: It is characterised by combining interventions without an

overriding theory of change development. There is a risk of syncretism.
2. Common factors eclecticism: It hypothesises that certain elements of treatment,
notably a therapeutic alliance that communicates support, empathy and
unconditional positive regard, are primarily resposible for promoting client growth
and change.
3. Technical eclecticism: It provides a framework for combining interventions from
different treatment systems without necessarily subscribing to the theories
associated with those interventions.
4. Theoretical integration: It provides a framework for understanding how people
grow and change, and guidelines for developing treatment plas that reflect that
understanding.
CHARACTERISTICS OF A SOUND INTEGRATED
APPROACH
• Evidence of building on the strengths of
existing theories
• A coherent combination of theories that
creates a unified whole
• An underlying theory of human behaviour
and development
• A philosophy or theory of change
• Logic, guidelines, and procedures for
adapting the approach to a particular
person or problem
• Strategies and interventions, related to
the underlying theories, that facilitate
change
• Inclusion of the commonalities of
effective treatment, such as support,
positive regard, empathy, and client-
clinician collaboration.
TREATMENT PLANNING
Treatment plans provide a road map for both clinicans and clients, indicating how
they will proceed from their starting poing to their destination. It can organise the
disparate elements of various theories into a cohesive whole, clarify sequence of
interventions, and help ensure that treatment strategies address the entire range of
clients’ concerns.
Treatment planning serves the following four purposes (Seligman, 2004a):

1. A carefully developed plan, grounded in research on treatment effectiveness,

provides assurance that counselling or psychotherapy is likely to succeed.

2. A treatment plan specifying goals and strategies helps clinicians and clients to
track progress, determine whether goals are being met, and if not, revise and
improve the plan.

3. Treatment plans provide structure adn driection to the therapeutic process. They
help clinicians and clients to developed shared and realistic expectations for
treatment and promote optimism that treatment will be helpful.

4. Treatment plans, in conjunction with post-treatment evaluations, allow clinicians

to determine and demonstrate their effectiveness. They also can provide a sound
defense in the event of allegations of malpractice.
DO A CLIENT MAP
The most widely accepted model of treatment planning is DO A CLIENT MAP (Seligman
& Reichenberg, 2007). The 12 steps in this comprehensive treatment process include:

1. Diagnosis: Accurate dagnosis of a person’s problems using multiaxial assessment

format and diagnostic terminology.

2. Objectives of treatment: Client and clinician collaborate in establishing written

objectives of treatment that address diagnosis.

3. Assessments: Clinicians use assessment tools to enhance their efforts to make

accurate diagnoses, establish worthwhile objectives, and measure progress.

4. Clinician: Variables that characterise the sort of clinician likely to work well with a
given client are specified.

5. Location of treatment: This item specifies whether treatment should be inpatient,

outpatient, or an alternative such as a day treatment program.

6. Interventions: The specific theories that will be combined in treatment and how
they will be integrated is specified. These strategies along with objectives are listed.
7. Emphasis: Outlines how the theoretical approach identified in the interventions
section will be adapted to meet the needs of a particular person.

8. Number of people seen in treatment: This section specifies whether individual,

family, or group therapy will be the primary model of intervention.

9. Timing: This part encompasses the length of each session, the frequency of
sessions, the duration of treatment, and the pacing of the treatment process.

10. Medication : Clinicians may collaborate with psychiatrists for an evaluation if cilents
exhibit loss of contact with reality, mania, disorientation, severe depression, or
other problems that can benefit from medication.

11. Adjunct services: These are sources of helo, support, and information that
contribute to the effetiveness of treatment and help people progress towards their
goals.

12. Prognosis: This step specifies the likelihood of clients achieving the specified
objectives according to the treatment plan.
 THEORIES OF INTEGRATED
APPROACHES
MULTI MODAL THERAPY
 MMT is based on the assumption that most psychological problems are
multifaceted, multidetermined and multilayered, and that comprehensive therapy
calls for a careful assessment of seven dimensions or “modalities” in which
individuals operate – Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal
relationships and Biological processes.
 The first letters of the foregoing dimensions yield the convenient acronym BASIC
I.D. This results in broad-based assessment and treatment foci. It may be stated
that a specific MMT theory is that the reciprocal reactions among and between
the seven modalities comprise the essence of human temperament and
personality, and point the way to rapid and durable therapeutic tactics and
strategies.
 Multimodal therapy is technically but not theoretically eclectic. It makes effective
use of methods from diverse sources without relinquishing its social learning and
cognitive theoretical underpinnings. Fitting the requisite treatment to the specific
client (and not vice versa) is an essential goal.
THEORETICAL BASIS
A. Social Learning Theory
• MMT is based on the principles and procedures of experimental
psychology, most notably social and cognitive learning theory. Social
learning theory states that all behaviors (normal and abnormal) are
created, maintained, and modified through environmental events.

• CBT is based on the finding that cognitive processes determine the

influence of external events, and can in turn be affected by the social and
environmental consequences of behavior. As such, the main focus is on
the constant reciprocity between personal actions and environmental
consequences.
 B. Technical Eclecticism

An essential concept in MMT is that of technical eclecticism. An increasing number

of therapists have become aware that no one theory can possibly provide all the
answers. Therefore they are willing to incorporate different methods and
procedures into their practice.
It should be noted, however, that there are several alternate ways in which
different methods may be combined, including:
(a) utilizing several techniques within a given approach (e.g., exposure, response
prevention, and participant modeling from a behavioral perspective),
(b) combining techniques from different disciplines (especially when confronted
by a seemingly intractable patient or problem),
(c) using medication in conjunction with psychosocial therapies,
(d) treating certain clients with a combination of individual, family and group
therapy, or
(e) looking to other disciplines (e.g., social work in the case of vocational
rehabilitation)
DEVELOPMENTAL AND COUNSELING THERAPY

 The study of human development has had a significant impact on Ivey’s ideas
about culture. Ivey has drawn from Piaget, Erickson, and Freud to apply
developmental concepts directly into counseling in developing developmental
counseling and therapy (DCT).
 In 1991, Ivey elaborated the cultural emphasis in developmental counseling to
underline the notion of multicultural development. He proposed that therapists
should facilitate clients’ movement through different stages of cultural identity
development. Ivey believes that therapists help clients move through stages
related to conformity, dissonance, resistance and immersion, introspection, and
synergistic awareness by focusing on culture in counseling.
 In this developmental approach, Ivey and his colleagues expanded the definition of
culture to include race and ethnicity, gender, religion, economic status, nationality,
physical capacity, and sexual orientation. Clients are encouraged to share their
stories in ways that promote movement through different types of development.
This process may result in both expanded awareness and congruent social action.
 TRANSTHEORETICAL MODEL
• The Transtheoretical Model (also called the Stages of Change Model), developed
by Prochaska and DiClemente in the late 1970s, evolved through studies
examining the experiences of smokers who quit on their own with those
requiring further treatment to understand why some people were capable of
quitting on their own. It was determined that people quit smoking if they were
ready to do so.

• Thus, the Transtheoretical Model (TTM) focuses on the decision-making of the

individual and is a model of intentional change. The TTM operates on the
assumption that people do not change behaviors quickly and decisively. Rather,
change in behavior, especially habitual behavior, occurs continuously through a
cyclical process.

• The TTM posits that individuals move through six stages of change:
precontemplation, contemplation, preparation, action, maintenance, and
termination. For each stage of change, different intervention strategies are most
effective at moving the person to the next stage of change and subsequently
through the model to maintenance, the ideal stage of behavior.
 ADAPTIVE AND COUNSELING THERAPY

 An integrative model for determining the sequence of therapist styles as

clients move through developmental stages during the course of
counseling and psychotherapy. The ACT approach is compared with other
integrative models that suggest an eclectic practice of therapy, as does
ACT, and similarities and differences are noted.

 ACT is intended to be used by practitioners in case conceptualization and

in the application of effective treatment planning and has potential as a
training device for therapists.

 ACT is a rich heuristic device for counseling practice, research, and

supervision.
 3 STAGE INTEGRATED MODEL OF HELPING

 In Helping Skills in Practice: A Three-Stage Model, Dr. Clara E. Hill

demonstrates her three-stage model of helping clients.

 The first stage, exploration, involves helping the client examine his or her
thoughts and feelings. The second stage, insight, helps clients understand
the reasons for these thoughts and feelings. The third stage, action,
involves the client making changes. The model builds on itself, such that
exploration builds the foundation for insight, which sets the stage for
action.

 The goal in the insight stage is to help clients understand their problems at
a deeper level. Insight means seeing things in a new way, gaining a new
perspective, or making connections.
COMMON FACTOR MODELS
 Common factors theory, a theory guiding some research in clinical
psychology and counseling psychology, proposes that different approaches and
evidence-based practices in psychotherapy and counseling share common
factors that account for much of the effectiveness of a psychological
treatment.

 There are many models of common factors in successful psychotherapy

process and outcome. In 1990, Grencavage and Norcross identified 89
common factors in a literature review, which showed the diversity of models of
common factors.To be useful for purposes of psychotherapy practice and
training, most models reduce the number of common factors to a handful,
typically around five.

 Joel Weinberger and Cristina Rasco listed five common factors in 2007 and
reviewed the empirical support for each factor: the therapeutic relationship,
expectations of treatment effectiveness, confronting or facing the problem
(exposure), mastery or control experiences, and patients' attributions of
successful outcome to internal or external causes.
REFERENCES
Hill & O-Brien. (1999), Three-Stage Integrated Model. Retrieved from
https://www.apa.org/pubs/videos/4310868?tab=1

Howard, G. S., Nance, D. W., & Myers, P. (1991). Adaptive counseling and therapy: An
integrative, eclectic model. Retrieved from
https://psycnet.apa.org/record/1987-28793-001

Ivey-Ivey, Simek M.(1997) Developmental Counseling and Therapy.

Retrieved from
https://psychology.iresearchnet.com/counseling-psychology/counseling-therapy/develo
pmental-counseling-and-therapy/

Lazarus, (1976) Multimodal Therapy. Retrieved from

https://www.zurinstitute.com/multimodal-therapy/

Prochaska & DiClemente(1986) Transtheoretical Model of Change.

Retrieved from
http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/Behavior
alChangeTheories6.html

Reichenberg, L.W. & Seligman, M. (2014) Theories of counselling and