Integrative Approaches of Psychotherapy

Integrating Cognitive Behavioral, Solution Focused and Some Aspects of Person Center Therapies. 

By:- Alazar Kassahun, Teacher at Asella College of Teachers Education.

1.    Introduction

Since  the  late 20th century,  psychotherapy  has  been   described   as  an   important  aspect  in   the  study  of  psychology.  Due to its importance, psychologists  have  been  actively involved  in  the  identification  of  the  critical  approaches  in  counselling and psychotherapy  (Corey 2009).  Psychologists  have  come  up  with  different  theoretical  models of  counselling  that are applicable at different  situations during  psychotherapy. The  application of  these theoretical models of counselling have helped in overcoming  the  impact  of  several emotional as well as psychological difficulties such as stress, depression, anxiety, anger, and other emotional problems. However, despite the universal application in solving similar problems in human beings, these theoretical models of psychotherapy possess distinct differences as well as similarities.

        An  integration   of  the major theoretical models in counselling is therefore critical in understanding  of  various  psychological  problem  from  wide  perspectives  in  inclusive manners  (Corey 2009). For integrating   purposes, the paper has  identified  three  main  modalities:- Cognitive Behavioral Therapy,  Solution focused Therapy  and  some  aspects  of  Persons centered therapies . This paper  will  describe  the underpinning assumptions of each model,  the goals of therapy in relation to each model,  the therapeutic relationship including the role of the counsellor and the client,  the key  techniques of each  model  in relation to  each  particular model. The paper will describe each theoretical model of counselling with the purpose of integrating them and widening the scope of various pathological abnormalities from the view of these three models of psychotherapy theories. 

2.     Over View and My Reflection on the New Integrated Theories of Psychotherapy.

Though integrating theories need to be supported by research findings and in-depth inquiry; before that it’s also good to hypothesize which psychotherapeutic theory will be integrated and used as one model to help client with different problem from various viewpoints of therapeutic process. I believe human have to be defined from the view of as they are capable, abled, and good in nature and factors  of maladjusted behavior arises both from theenvironment , internal self’s, poor knowing of self’s, lack of structured thinking and cognition of outer world and inner self’s.And the pathological aspects of human behaviors will be defined from the view of both internal and external behaviors influences.

      Goal of therapy is also designed by the client and are unique based up on the client. And therapist encourages client to explore well beings, his oneself and make realization of his own emotional and psychological growths. The goals are aimed at finding the root causes, setting future solutions, exploring the clients own self-awareness, training new behaviors, thoughts, belief and norms at all.

The counselor has to give an emphasis for his clients to explore his own self. In addition to that irrational thoughts of the client which needs a rational and logical discussion will have to be blocked and therapist can have a role of encouraging, assessing and challenging theclients’ negative thoughts. When we come to see the applications of therapeutic techniques in this integral model, the therapist is waited to explore both the root causes of problemand future solution with a therapeutic relation of unconditional patterns and accepting genuinely and also settingcriterion,rules, practical techniques like ABCmodel,questioning, giving homework’s, asking what if questions, miracles question and giving continuous tasks. Also change over the client’s problem is determined by their relationships between client and therapist.

The therapeutic relationships between clients and counsellor tends to be collaborative, congruent, opened and clients are active to become aware of what is going on their behavior and cognition after making a self-evaluative tasks.

3.      Historical Foundation of CBT, SFT and PCT Psychotherapy Theory      

CBT, SFT and Person Centered Therapy arethree theoretical models that have been applied in psychotherapy for many years. Despite their some similarities and use in counselling, this three theoretical models hold distinct similarities helps to integrate each other. These differences are realized especially in regard to the assumptions, the goals of each, therapeutic relationship, key techniques of each and limitations.  Being one of the most preferred theoretical models in counselling, CBT has demonstrated explicit justifications as well as definite rates of success in most of the instances where it has been applied .The diversity of its applications in major psychological and emotional problems has also encouraged most psychotherapists to utilize it in therapeutically sessions In contemporary psychotherapy.

Aron Beck, A graduate of Brown University and Yale School of Medicine, Beck initially practiced as a neurologist, but he switched to psychiatry during his residency. Beck is the pioneering figure in cognitive therapy, one of the most influential and empirically validated approaches to psychotherapy. Beck’s conceptual and empirical contributions are considered to be among the most significant in the field of psychiatry and psychotherapy.  Cognitive behavioral therapy has been integrated with other theoretical models due to its multidimensional nature. CBT has been applied in clinical psychology and other psychological therapies on the basis of its premise of the importance of thinking about individual actions and feelings in relation to psychological and emotional health.

      The foundation of SFT goes back to the 1980s with the enthusiast De Shazer collaborated with a number of therapists, who each wrote extensively about solution-focused therapy and started their own solution-focused training institutes. De Shazer (1988, 1991) suggests that it is not necessary to know the cause of a problem to solve it and that there is no necessary relationship between the causes of problems and their solutions.

Person-Centered Therapy was developed by Carl Rogers in the 1940's, and has been a critical theoretical model in counselling. This theory of counselling developed in three different phases. In the first phase, the theory "focused on how the nondirective counsellor's conduct differed from that of more "directive" psychotherapists such as psychoanalysts and behavior therapists. 

The second phase focused "away from the counsellor and firmly onto the client as a responsible agent whose nature provided the rationale for the counsellor's therapeutic conduct" . The third phase emerged when the theory included past counselling philosophies which formed major requirements of conventional psychology.

4.     Key Concepts

Beck contends that people with emotional difficulties tend to commit characteristic “logical errors” that tilt objective reality in the direction of self-deprecation. The following are some of basic concepts which explained as a source of distortion and behavioural maladjustment.

• Arbitrary inferences: - Refer to making conclusions without supporting and relevant evidence. This includes “catastrophizing,” or thinking of the absolute worst scenario and outcomes for most situations.

• Selective abstraction: - Consists of forming conclusions based on an isolated detail of an event. In this process other information is ignored, and the significance of the total context is missed. The assumption is that the events that matter are those dealing with failure and deprivation.

• Overgeneralization: -Is a process of holding extreme beliefs on the basis of a single incident and applying them inappropriately to dissimilar events or settings.

      In solution-focused therapy(SFT) focus on what is possible, and they have little or no interest in gaining an understanding of the problem. De Shazer (1988, 1991) suggests that it is not necessary to know the cause of a problem to solve it and that there is no necessary relationship between the causes of problems and their solutions.

Therapy tends to be brief and addresses the present and the future. The person is not the problem; the problem is the problem. The emphasis is on externalizing the problem and looking for exceptions to the problem. Therapy consists of a collaborative dialogue in which the therapist and the client co-create solutions.

5.      Psycho-pathology

The  underlying assumption of my integrative therapy is built up on the paralogues that human being have  the ability to resolve the challenges life bring ,  influenced by external  faulty cognition of  own  self and world  yet at times we  may  lose our sense of direction or awareness of our competencies. My integrative model requires a therapist who believe in philosophical stance of accepting people where they are and assisting them in creating solutions rather than spending much time exploring the pathological history.

The emphasis is on how clients act in their world with others, how they can move forward in constructive directions, and how they can successfully encounter obstacles (both from within themselves and outside of themselves) that are blocking their growth. Therapist encourage their clients to make changes that will lead to living fully and authentically

6.     Basic Assumptions of CBT, SFT and PCT

Cognitive Behavioral Therapy (CBT), Solution focused therapy and Person- Centered Therapy havedifferingunderpinning assumptions that make each therapy integrate. CBT assumes that the occurrence of behavioral and emotional problems in most individuals is due to the nature of people incorporating faulty thinking (Dryden & Bond 2000). Also assumes that the manner in which individuals perform and believe is determined andinfluenced by individualcognition. The counselling is therefore focused towards the cognition and behavior of the individual.  During CBT, the importance of decision making, thought, questioning and action is stressed. CBT assumes that counselling is a process that entails learning, acquisition of novel talents as well as learning new coping mechanisms for common psychological and emotional problems (Corey 2009,).

SFTas a model that explains how people changeand how they can reach their goals. And view Individuals who come to therapy do have the capability of behaving effectively, even though this effectiveness may be temporarily blocked by negative cognitions.  Problem-focused thinking prevents people from recognizing effective ways they have dealt with problems.

      In PCT, it is assumed that humans are positive and due to this positivity, they tend to be inclined towards the achievement of complete functionality of both their bodies and minds.  In applying this model in counselling, it is assumed that the immediate experiences in an individual have occurred due to lack of past awareness about the problems. The theory has it that after therapy, the individual will possess actualization that will impact on his or her potential to move from being unaware to being aware of his or her feelings, and will have self-trust and think positively in relation to his or her life (Rennie 1998).

Therefore when I try to combine the assumption of those three theories of psychotherapy as an integrative approaches its good to think human nature from the humanistic aspects. Human have to be defined from the view  as they are capable, able, and good in nature and factors  of maladjusted behavior may arises both from the  environment , internal self’s, poor knowing of self’s, lack of structured thinking and cognition of outer world and inner self’s.

7.     Goals of Therapy

CBT challenges individuals to face the behaviors, norms, and beliefs that affect their psychological and emotional health (Dryden & Bond 2000). CBT also encourages clients to be more aware of their thoughts therefore encouraging clients to change their feelings.

The solution-focused therapist believes people have the ability to define meaningful personal goals and that they have the resources required to solve their problems. Goals are unique to each client and are constructed by the client to create a richer future (Prochaska& Norcross, 2007).

 Person-Centered therapy aims at providing individuals with an environment that is safe and favorable for exploring their wellbeing (Rennie 1998). By encouraging clients to explore wellbeing, Person-centered therapy ensures that clients recognize all the challenges that they have faced in their emotional and psychological growth. Further,this therapy enables clients to realize aspects of self-worthiness that had been imprecise during their past.

Therefore goal of therapy for the integrative model of these therapy can also designed by the clients and are unique based up on the client. And therapist encourages clients to explore well beings, his oneself and make realization of his own emotional and psychological growths. The goals are aimed at finding the root causes, setting future solutions, exploring the clients own self-awareness, training new behaviors,  thoughts, belief and norms at all.

8.     Therapeutic Relationship and Process

The therapeutic relationship in cognitive behavioral therapy, resembles the relationship between a teacher and a student. The therapist acts as the teacher and the client as the student. In relation to therapeutic relationship, the role of the counsellor and client becomes critical in ensuring that the outcome of the therapy is desirable.

The role of the therapist is to give therapeutically instructions to the client who listens and does what the counsellor says. In this relationship, the counsellor employs directive structures to direct clients on behavior changes.  In this case, the counsellor acts as the focal point since he impacts much on the cognitive and behavioral changes in the client. However, for desirable results, collaboration is ensured during therapy.  The counsellor utilizes the Socratic dialogue that is critical in supporting clients in tenets such as the identification of the beliefs, norms and values that have impacted on the psychological and emotional functionality.  Further, the counsellor encourages the client to change these beliefs as well as identify an unconventional rule for present and future living. In this case, the counsellor helps in promoting the adoption of remedial skills of learning. 

In this relationship, the client always gets new insights in relation to the problems he/she is experiencing and therefore decides on efficient and effective means of acquiring change.

      In solution focused therapy counsellors must create a climate of mutual respect, dialogue, inquiry, and affirmation in which clients are free to create, explore, and co-author their evolving stories.  The main therapeutic task consists of helping clients imagine how they would like things to be different and what it will take to bring about these changes. And also the attitudes of the therapist are crucial to the effectiveness of the therapeutic process. It is essential to create a sense of trust so clients will return for further sessions and will follow through on homework suggestions.

Beside the person centered therapy, the therapeutic relationship is distinct from CBT and SFT. In PCT, the relationship between client and counsellor is crucial because therapy is centered towards the client as the client is the focal point of the therapy. Due to this, the counsellor must ensure that respect, genuineness, and empathy towards the client are maintained. Further, communication is also critical in this model especially between the client and the therapist. The relationship must equal as it is crucial in aiding behavior change in the client.

     Finally the therapeutic relationships between clients and counsellor tends to be collaborative, congruent, opened and clients are active for a changes, well prepared to learn new behavior and cognition by active engagement in the therapy process and tasks.

9.     Roles of Counselor

The first step of CBT therapist duties   are disputing clients’ irrational beliefs and encourages clients to engage in activities that will counter their self-defeating beliefs and to replace their rigid “musts” with preferences.  A second step in the therapeutic process is to demonstrate how clients are keeping their emotional disturbances active by continuing to think illogically and unrealistically.  To get beyond mere recognition of irrational thoughts, the therapist takes a third step—helping clients modify their thinking and minimize their irrational ideas. Although the therapist confronts clients with the beliefs they originally unquestioningly accepted and demonstrates how they are continuing to indoctrinate themselves with unexamined assumptions. The fourth step in the therapeutic process is to challenge clients to develop a rational philosophy of life so that in the future they can avoid becoming the victim of other irrational beliefs. Tackling only specific problems or symptoms can give no assurance that new illogical fears will not emerge. It is desirable, then, for the therapist to dispute the core of the irrational thinking and to teach clients how to substitute rational beliefs and behaviours for irrational ones.

The solution focused model casts the role and function of a therapist in quite a different light from traditionally oriented therapists who view themselves as experts in assessment and treatment. Therapists have expertise in the process of change,but clients are the experts on what they want changed. The therapist’s task is topoint clients in the direction of change without dictating what to change.

      Finally when I come to my reflection   with the integrative roles of therapist in combining the three counselling theories as one therapy; can helps better in understanding the client’sproblem. I believe   counselor has to give an emphasis for his clients to explore his own self.  And simultaneously when the client faces an irrational thoughts which needs a rational and logical discussion its must to encourage clients engage in activities that will assess and challenge the clients’ negative thoughts using different methods or tools and sequential tasks

10.  Key Techniques

There are different techniques applicable in this three models of counselling described in this paper and integrated as one therapeutic model. CBT utilizes techniques aimed at personal counselling. The theory utilizes the Socratic model that entails several questions to be answered by the client. Corey (2009) denotes that "therapists utilize a variety of cognitive, emotive, and behavioral techniques; diverse methods are tailored to suit individual clients. Specifically  techniques like De-catastrophizing asking a patient to ponder "what if" scenarios about feared consequences is known as De-catastrophizingreattribution ,  alternative explanations systematically explained Redefining help client define the problem differently e.g., “Nobody ever talks to me” becomes “I need to try to initiate conversations so other people become interested in me. However, the client is also allowed to ask the counsellor some questions. Further, the theory employs the aspect of homework that encourages the clients to practice the skills learnt. Therefore the majortechnique of CBT is the ABC technique that utilizes the Socratic model. It is important that therapists actually believe that their clients are the true experts on their own lives. 

All of the techniques discussed here are about SFTand must be implemented from the foundation of a collaborative working relationship.

1.      Exception questions

Solution-focused therapists ask exception questions to direct clients to times when the problem did not exist, or when the problem was not as intense.  The therapist asks clients what has to happen for these exceptions to occur more often. In solution-focused vocabulary, this is called change-talk..

2.      The miracle question

Thetherapists asks, “If a miracle happened and the problem you have was solvedovernight, how would you know it was solved, and what would be different?”Clients are then encouraged to enact “what would be different” in spite of perceivedproblems. This process of considering hypothetical solutions reflects the perceived problem changes the problem.

3.      Formula first session tasks

Is a form of homework a therapist might give clients to complete between their first and second sessions.This kind of assignment offers clients hope that change is inevitable. It is not a matter of if change will occur, but when it will happen.  It is important that clients feel understood before they are directed to make changes.

4.      Therapist feedback for a clients

Solution-focused practitioners generally take a break of 5 to 10 minutes toward the end of each session to compose a summary message for clients. Finally the above all techniques will be applied as an integral parts of assumption to help clients who comes with various psychological problems.

      In general when I try to combine or integrate the applications of therapeutic techniques in this integral model the therapist is waited to explore both the background problem and future solution with a therapeutic relation of   unconditional patterns and accepting genuinely and also setting criterion, rules, practical techniques like ABC model, questioning, giving homework’s, asking what if questions, miracles question and giving continuous tasks. The change over the client’s problem is determined by the relationships between client and therapist.

11.  My Integrative Therapy Applicability and its Contribution to Multicultural settings

There are several strengths of my integrative approaches from a diversityperspective. In this integral therapy the therapist needs to understand the core values of their culturally diverse clients, they can help clients explore these values and gain a full awareness of their conflicting feelings.

Here also in this approach client and therapist can work together to modify selected beliefs and practices.By focusingon breaking cultural barriers and facilitating open dialogue among diverse cultural populations. Main strengths are respect for clients’ values, therapist need to makes every effort to enlist clients’ active cooperation and participation, welcoming of differences, understanding, willingness to allow clients to determine what will be explored in sessions, and prizing cultural pluralism are the major things that have to be considered in the integral models of psychotherapy.

12.       Conclusion

This paper has described three theoretical models including CBT, SFT and PCT. The paper has explored the underpinning assumptions of each model and try to combine as one integrative model of psychotherapy. It has also identified the goals of each therapy aswell as the therapeutic relationships. The paper has also combine the key techniques, role of counselor, goal of therapy, relationships between client and counselor, utilized in the three models.

13.       Reference

COREY, G. (2009). Theory and practice of counselling and psychotherapy (8th ed.). Belmont, CA: Thomson Brooks/Cole.

COREY, G. (2008). Theory and practice of group counselling (7th ed.). Belmont, CA: Brooks/Cole.

RENNIE, D. L. (1998). Person-centered counselling: An experiential approach. London: Sage.

WATSON, J. C. (Ed.). (2003). Client-centered and experiential psychotherapy: Advances in theory research, and practice. Ross-on-Wye: PCCS ;Books.

DRYDEN, W. & BOND, T. (2000). Rational emotive behaviourtherapy. In W. Dryden (Ed.), Handbook of individualtherapy(4th ed., pp. 347–372). London: Sage

DE SHAZER, S. (1988). Clues: Investigating solutions in brief therapy. New York: Norton.

PROCHASKA, J. O., & NORCROSS, J. C. (2007). Systems of psychotherapy: A trans theoreticalAnalysis (6th ed.). Belmont, CA: Brooks/ Cole.

GUTERMAN, J. T. (2006). Mastering the art of solution-focused counselling. Alexandria, VA:American Counselling Association.

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