handbook of psychotherapy integration feb 2005

Handbook of Psychotherapy Integration, Second Edition John C. Norcross Marvin R. Goldfried, Editors OXFORD UNIVERSITY PRESS HANDBOOK OF PSYCHOTHERAPY INTEGRATION OXFORD SERIES IN CLINICAL PSYCHOLOGY Editorial Board Larry E. Beutler Bruce Bongar Gerald P. Koocher John C. Norcross Comprehensive Textbook of Psychotherapy: Theory and Practice edited by Bruce Bongar and Larry E. Beutler Clinical Personality Assessment: Practical Approaches, Second Edition edited by James N. Butcher Ethics in Psychology, Second Edition by Gerald P. Koocher and Patricia Keith-Spiegel Oxford Textbook of Psychopathology edited by Theodore Millon, Paul H. Blaney, and Roger D. Davis Child and Adolescent Psychological Disorders: A Comprehensive Textbook edited by Sandra D. Netherton, Deborah Holmes, and C. Eugene Walker Handbook of Psychotherapy Integration, Second Edition edited by John C. Norcross and Marvin R. Goldfried Handbook of Psychotherapy Integration Second Edition Edited by John C. Norcross Marvin R. Goldfried 1 2005 3 Oxford University Press, Inc., publishes works that further Oxford University’s objective of excellence in research, scholarship, and education. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Copyright  2003, 2005 by Oxford University Press, Inc. Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York 10016 www.oup.com First edition published in 1992 by Basic Books Oxford is a registered trademark of Oxford University Press All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data Handbook of psychotherapy integration / John C. Norcross, Marvin R. Goldfried, editors.—2nd ed. p. cm. Includes bibliographical references and index. ISBN-13 978-0-19-516579-1 ISBN 0-19-516579-9 1. Eclectic psychotherapy. I. Norcross, John C., 1957– II. Goldfried, Marvin R. RC489.E24H36 2005 616.89′14—dc22 2004006513 987654321 Printed in the United States of America on acid-free paper Preface From its beginnings, psychotherapy integration ment was small a nd concentrated in the United States.has been characterized by a dissatisfaction with single-school approaches and the concomitant In 2005, psychotherapy integration has en- tered young adulthood, no longer an immaturedesire to look beyond school boundaries to see what can be learned—and how patients can or novel approach to clinical work. Eclecti- cism—or the increasingly favored term, integra-benefit—from other forms of behavior change. Improving the efficacy, efficiency, and applica- tion—is now well established as the modal ori- entation of psychotherapists, and this book isbility of psychotherapy is the raison d’e ˆ tre of integration. now only one of many volumes on the subject. Literally hundreds of books around the globeThe 13 years between publication of the original edition of the Handbook of Psychother- are now published with the term integrative in their titles. Empirical evidence attesting to theapy Integration and this second edition was marked by memorable growth in psychother- effectiveness of integrative psychotherapies is growing. Integration has grown into a matureapy integration. In 1992, psychotherapy inte- gration was relatively new and novel, just en- and international movement. For these and related reasons, the originaltering its pre-teen years. Integration had only recently crystallized into a formal movement. edition of the Handbook of Psychotherapy Inte- gration became dated and incomplete. It wasOur original Handbook was the first compila- tion of the major integrative approaches and time for a new edition. was hailed by one reviewer as “the bible of the integration movement.” Few empirical studies OUR AIM had yet been conducted on the comparative effectiveness of integrative or eclectic approac hes What has not materially changed is the purpose of our book. The aim of this second editionto psychotherapy. The formal integration mo ve- vi Preface continues to be a state-of-the-art, comprehen- Psychotherapy Integration (SEPI). Within the constraints of a printed volume, we have triedsive description of psychotherapy integration and its clinical practices by some of the leading to share some of that excitement by including an actual dialogue on psychotherapy integra-proponents. Along with these integrative ap- proaches, we feature the concepts, history, tion between Paul Wachtel and Marvin Gold- fried.training, research, and future of psychotherapy integration as well. The Handbook is divided into five substan- tive parts. Part I presents the concepts (Nor-The intended audiences are practitioners, students, and researchers. Psychotherapists of cross) and history (Goldfried, Pachankis, & Bell) of psychotherapy integration. Part II fea-all persuasions and professions will be attracted to these premier integrative psychotherapies tures exemplars of each of the movement’s four predominant thrusts: common factors (Beitman,and integrative trea tment s. The first ed ition of the Handbook was widely adopted for courses Soth, & Bumby; Miller, Duncan, & Hubble); technical eclecticism (Lazarus; Beutler, Con-and seminars on psychotherapy integra tion, and we anticipa te that the second edition wil l soli, & Lane); t heore tical integratio n (Prochaska & DiClemente; Wachtel, Kruk, & McKinney;again serve this purpose. The contribu tors’ use of the chapter guidelin es (see belo w) and Ryle); and assimilative integration (Stricker & Gold; Castonguay, Newman, Borkovec, Holt-our addit ion of a summary outline (next sec- tion) will faci litat e a systematic and compar- forth, & Maramba). Part III presents integrative psychotherapies for specific disorders and pop-ative analysis of the integrative approaches. We worked hard t o maintain the delicate bal- ulations—anxiety (Wolfe), chronic depression (McCullough), borderline personality disorderance between authors’ individual preferences and readers’ de sire f or uni formi ty in c hapte r (Heard & Linehan), and culturally diverse cli- ents (Ivey & Brooks-Harris). Part IV featurescon tent a nd format. A nd research ers wi ll find that each chapter summarizes the empirical integrative treatme nt modalities, specifically, dif- ferential therapeut ics (C larki n), combini ng the r-evidence assoc iated with that particular ap - proach. apy formats (Feldman & Feldman), integrative problem-centered therapy (Pinsof), integrat- ing spirituality into psychotherapy (Sollod), and blending pharmacotherapy and psycho-CONTENT AND ORGANIZATION therapy (Beitman & Saveanu). Part V con- cludes the volume by addressing clinical train-The contents of this second edition reflect both the evolution of psychotherapy integra- ing (Norcross & Halgin), outcome research (Schottenbauer, Glass, & Arnkoff), and futuretion and the continuation of our original goals. We have deleted several dated chapters that ap- directions (Eubanks-Carter, Burchell, & Gold- fried) in integration.peared in the original edition, and all remain- ing chapters have been revised and updated. No single volume—even a hefty one like this—can canvass all important topics or clini-We added new chapters on outcome-informed clinical work, cognitive-analytic therapy, cogni- cal situations. One regrettable gap in our cov- erage is the absence of a chapter on integrativetive-behavioral analysis system of psychother- apy, integrative psychotherapy with culturally therapy with children and adolescents. We could not readi ly identify a conceptually advanceddiverse clients, integrative problem-centered therapy, and blending spirituality with psycho- and empirically supported integrative therapy for children. Moreover, space considerations re-therapy. An entirely new section (with two chapters) features assimilative integration. We stricted us to four examples of integrative thera- pies for specific disorders and populations. Inhave also tried to convey more about the pro- cess of integrative dialogue itself—the lively making the precarious choices of which mate- rial would receive coverage and which wouldand dynamic exchanges that often occur in in- tegrative meetings, particularly the annual con- be passed over, we opted to keep the book clin- ically useful and student accessible.ferences of the Society for the Exploration of Preface vii CHAPTER GUIDELINES Applicability and Structure Aim: To describe those situations and patients for which the approach are particularlyContributors to Part II (Integrative Psychother- apy Models) and Part III (Integrative Psycho- relevant. • For which types of patients (e.g., diagnos-therapies for Specific Disorders and Popula- tions) were asked to address a list of central tic types, client characteristics) is the ap- proach relevant?topics in their chapters. Chapter guidelines were designed to facilitate comparative analy- • For which types of patients is the ap- proach not appropriate or of uncertainses and to ensure comprehensiveness. As ex- pected, the authors did not always use the sug- relevance? • For what situations (e.g., clinical settings,gested headings; all of the requested topics were addressed in the respective chapters, but time limitations) is/is not the approach relevant?we did not insist on identical formats. • What are the clinical settings for the ap- The Integrative Approach proach? Are there any contraindicated Aim: To outline the historical development settings? and guiding principles of the approach. • What is the typical frequency and length • What were the primary influences that of sessions? contributed to the development of the ap- • Is the therapy typically time-limited or proach (e.g., people, experiences, re- unlimited? What is the typical duration search, books, conferences)? of therapy (mean number and range of • What were the direct antecedents of the sessions)? approach? • Are combined therapy formats used (e.g., • What are the guiding principles and cen- individual therapy plus family therapy)? tral tenets of your approach? • Where does psychotropic medications fit • Are some theoretical orientations more into the approach? prominent contributors to your approach than others? Processes of Change • What is the basis for selecting therapy in- Aim: To identify the mechanisms or processes terventions (e.g., proven efficacy, theoreti- that produce changes in therapy and to cal considerations, clinical experience)? assess their relative impact. • What is the role of insight and under-Assessment and Formulation Aim: To describe the methods used to under- standing in change, distinguishing be- tween historical-genetic insight and inter-stand patient functioning, to construct a case formulation, and to prioritize treat- actional insight? • What is the relative importance of in-ment goals. • What are the formal and informal systems sight/awareness, skill/action acquisition, transference analysis, and the therapeuticfor diagnosing or typing patients? • Do you employ tests or questionnaires in alliance in the approach? • What are the relative contributions ofyour assessment? • What major client and/or environmental “common” factors to outcome? • Does the therapist’s personality and psy-variables are assessed? • At which levels (e.g., individual, dyadic, chological health play an important role? • What other therapist factors influence thesystem) are the assessments made? • How do you integrate assessment and course and outcome of therapy? • Which patient variables enhance or limittreatment? • What role does case formulation play in the probability of successful treatment? the approach? • How do you select and prioritize treat- Therapy Relationship Aim: To depict the therapeutic relationshipment goals? viii Preface valued in the approach and the therapist Cases in Part III will pertain, of course, to the specific disorder discussed in thebehaviors contributing to it. • How do you view the therapeutic rela- respective chapters. tionship (e.g., a s a precon ditio n of ch ange, Empirical Research as a mechanism of change, as content to Aim: To summarize the empirical research on be changed)? the approach. • What are the most important ingredients • What research has been conducted on of the therapy relationship in the ap- the conceptual framework of the approach? proach? • What empirical evidence exists for the • On what grounds is the therapy relation- efficacy and effectiveness o f the approach? ship adjusted or tailored to the individual • What are the percentages of dropouts and patient? negative outcomes? • Does the therapist’s role change as ther- apy progresses? Future Directions Aim: To explicate the future directions and Methods and Techniques needs of the approach. Aim: To delineate the methods and tech- • What further work (clinical, research, niques frequently employed in the ap- theoretical, training) is required to ad- proach. vance your approach? • What are some of the interventions used • In what directions is your approach head- to engage patients? ing in the next decade? • What is the therapist’s work in treatment? What is the client’s work in treatment? ACKNOWLEDGMENTS • What therapy methods are typically em- ployed? Which would typically not be A large and integrative volume of this nature used? requires considerable collaboration. Our efforts • How do you deal with resistances and have been aided immeasurably by our families blocks in treatment? and our SEPI colleagues; the former giving us • What are the most common and the most time and inspiration, the latter providing intel- serious technical errors a therapist can lectual stimulation and professional affirma- make when operating within your ap- tion. proach? We are truly indebted to the contributors. • How active and directive is the therapist Most of them are SEPI members, and all are in the approach? eminent psychotherapists in their own right. • How are maintenance sessions and re- They are “beyond category”—a phrase that lapse preventi on addressed in th e approach? Duke Ellington used as a high form of praise for artists who transcend the normal theoretical Case Example boundaries. We are pleased to be in their com- Aim: To illustrate the initiation, process, and pany and to privilege their integrative work. outcome of the integrative approach with Finally, we reciprocally acknowledge each a single case example. other for the pleasure and success of our edito- • To maintain comparability among the ex- rial collaboration. We have a long history of amples, the cases in Part II should deal collaborating on various projects and consider with the treatment of a client with gen- ourselves fortunate to continue to do so. eral anxiety and unipolar depression (psy- chological distress). The case example John C. Norcross should illustrate and discuss the initiation Clarks Summit, PA of treatment, patient assessment, case for- mulation, treatment methods, therapy Marvin R. Goldfried Stony Brook, NYrelationship, termination, and outcome. Contents Summary Outline xiii About the Editors xv Contributors xvii Part I: Conceptual and Historical Perspectives 1. A Primer on Psychotherapy Integration 3 John C. Norcross 2. A History of Psychotherapy Integration 24 Marvin R. Goldfried, John E. Pachankis, and Alissa C. Bell Part II: Integrative Psychotherapy Models A. Common Factors 3. The Future as an Integrating Force Through the Schools of Psychotherapy 65 Bernard D. Beitman, Angela M. Soth, and Nancy A. Bumby 4. Outcome-Informed Clinical Work 84 Scott D. Miller, Barry L. Duncan, and Mark A. Hubble [...]... the growth of psychotherapy integration, after which I review four predominant routes to integration This segues into a brief consideration of the varieties of integration, which includes summaries of recent studies on the prevalence and subtypes of eclectic/integrative therapies The chapter concludes with a discussion of recurrent obstacles to psychotherapy integration WHY INTEGRATION NOW? Integration. .. Therapy to Psychotherapy Integration, and How Therapists Change Dr Goldfried is cofounder of the Society for the Exploration of Psychotherapy Integration (SEPI) and founder of AFFIRM: Psychologists Affirming Their Gay, Lesbian, and Bisexual Family xv This page intentionally left blank Contributors DIANE B ARNKOFF Department of Psychology Catholic University of America NANCY A BUMBY Department of Psychiatry... psychotherapy is progressing toward integration in the zeitgeist of informed pluralism PLAN OF THE CHAPTER This chapter explicates the broad context of psychotherapy integration and sets the stage for the subsequent chapters in the volume As the chapter title indicates, I offer a primer on integration: in the dual sense of a primer (soft i) as a small introduction to the subject and of a primer (hard i) as a... and Systems of Psychotherapy: A Transtheoretical Analysis (with James O Prochaska) He is President of the International Society of Clinical Psychology, past-President of the APA Division of Psychotherapy, and Council Representative of the American Psychological Association (APA) Dr Norcross is also editor of Journal of Clinical Psychology: In Session and has been on the editorial boards of a dozen journals... Parameters of Integration By common decree, technical eclecticism, common factors, theoretical integration, and assimilative integration are all assuredly part of the integration movement However, where are the lines to be drawn, if drawn at all, concerning the boundaries of psychotherapy integration? What about the combination of therapy formats—individual, couples, family, group—and the combination of medication... LINEHAN Department of Psychology University of Washington CAROL R GLASS Department of Psychology Catholic University of America GLORIA G MARAMBA Department of Psychology Pennsylvania State University JERRY GOLD Department of Psychology Adelphi University MARVIN R GOLDFRIED Department of Psychology State University of New York at Stony Brook RICHARD P HALGIN Department of Psychology University of Massachusetts... Psychotherapists now acknowledge the inadequacies of any one theoretical system and the potential value of others What is distinctive of the present era is tolerance for and assimilation of formulations that were once viewed as deviant Indeed, many young students of psychotherapy express surprise when apprised of the ideological cold war of the preceding generations Psychotherapy integration has crystallized into... heavily contribute to outcome 7 Identification of specific therapy effects and evidence-based treatments 8 Development of a professional network for integration 5 The sheer proliferation of diverse schools has been one important reason for the surge of integration The field of psychotherapy has been staggered by over-choice and fragmented by future shock Which of 400-plus therapies should be studied, taught,... problemfocused psychotherapy (Austad et al., 1991) A fifth factor in the promotion of psychotherapy integration has been clinicians of diverse orientations observing and experimenting with diverse treatments (Arkowitz, 1992) The establishment of specialized clinics for the treatment of specific disorders have afforded exposure to other theories and therapies These clinics are often staffed by professionals of different... and Historical Perspectives ald the final dismantling of traditional theoretical categories and will yield a new metatheory of therapy (Smith, 1999) Finally, the development of a professional network has been both a consequence and cause of interest in psychotherapy integration In 1983, the interdisciplinary Society for the Exploration of Psychotherapy Integration (SEPI) was formed to bring together those . Handbook of Psychotherapy Integration, Second Edition John C. Norcross Marvin R. Goldfried, Editors OXFORD UNIVERSITY PRESS HANDBOOK OF PSYCHOTHERAPY INTEGRATION OXFORD SERIES. Deborah Holmes, and C. Eugene Walker Handbook of Psychotherapy Integration, Second Edition edited by John C. Norcross and Marvin R. Goldfried Handbook of Psychotherapy Integration Second Edition Edited. d’e ˆ tre of integration. now only one of many volumes on the subject. Literally hundreds of books around the globeThe 13 years between publication of the original edition of the Handbook of Psychother-