Beyond Integration

In contrast, the second, theoretical integration, as the name implies, refers to efforts aimed at synthesizing the underlying theories of different approaches (Saltzman & Norcross, 1990). Here, the focus is more theoretical than pragmatic. The best aspects of different approaches are combined into a superordinate theory that hopefully, ‘leads to new directions for practice and research ’ (p. 12, Norcross & Newman, 1992). The third and final approach to integration is called the common factors. Dating back to 1936 and the work of Saul Rozenzweig, this perspective might rightly be considered the earliest attempt at psychotherapy integration. Emphasis is placed on identifying the core ingredients ‘shared by all effective therapies’ (p. 7, Hubble, Duncan, & Miller, 1999a). While definitions of the three dominant approaches are straightforward, since the formation of the Society for the Exploration of Psychotherapy Integration (SEPI) nearly two decades ago, one finds little reason to be sanguine. As Norcross (1997) noted with open distress, ‘psychotherapy integration has stalled...the meaning... remains diffuse, its commitment typically philosophical rather than empirical, and its training idiosyncratic and unreliable’ (p. 86). More troubling, available evidence calls the validity of the entire project into question. In 1990, Jensen, Bergin, & Greaves concluded that the integration movement ‘will have been wasted unless it can be shown that specific combinations of techniques produces superior outcomes with given disorders’ (p.129). On this score, consider the data on technical eclecticism. The pragmatic blending of various approaches remains the most popular clinical orientation among practicing therapists despite the fact that the research clearly shows no therapist is truly eclectic (Jensen, Bergin, & Greaves, 1990; Norcross, 1997; Smith, 1982; Watkins, Lopez, Campbell, & Himmel, 1986). As it is, the modal ‘eclectic’ therapist uses only 4 of the existing 250-1000 (depending on how one counts) different treatment models and techniques. Those used frequently have a strong family resemblance (i.e. the combination of techniques from solution-focused and narrative approaches) or are applied in accidental, hit or miss combinations. This practice hardly qualifies as eclecticism! Though not for lack of trying, no evidence of differential effectiveness exists for the perspective. For instance, significant attempts have been made to identify, ‘what kind of therapy, or elements thereof, benefits what kind of client’ (p.219, Shoham-Salomon & Hannah, 1991). Beyond complaints that the resulting ‘matching matrices’ are either too simplistic or too complex to be of much value in modern clinical work, comparative, component (e.g. dismantling), and person by treatment interaction studies have failed to provide any consistent or compelling empirical support (Ahn & Wampold, 2002; Baker ‘The proof of the pudding is in the eating’. Cervantes, Don Quixote (IV. 10, p. 322)