Handbook of Psychotherapy Integration, Second Edition Part 10 doc

23 A Critical Dialogue on Psychotherapy Integration PAUL L. WACHTEL AND MARVIN R. GOLDFRIED The Society for the Exploration of Psychother- S AFRAN : One of the things I remember about the first SEPI conference in 1985 was theapy Integration (SEPI) is an interdisciplinary organization of professionals interested in inte- dialogue in which Clara Hill interviewed Paul Wachtel and Marv Goldfried about theirgrative and eclectic approaches to psychother- apy. Founded in 1983, SEPI was designed to thinking regarding SEPI and psychotherapy integration [Goldfried & Wachtel, 1987]. Asencourage communication and to serve as a reference group for psychotherapists interested it is nearly two decades since then, I thought it would be meaningful to replicate that kind ofin transcending the limitations of a single theo- retical orientation. SEPI also serves an edu- interview, and see the extent to which their thinking has changed over the years—es-cational function by publishing a journal, by holding an annual conference, publishing a pecially their thoughts and reflections about where SEPI started from and where it’smembership directory, and maintaining a Web site. heading. As I was thinking about this dialogue, I re-The following dialogue, presented as the closing plenary session of the 19th annual membered back to my first experiences with SEPI in 1985. Then, I was a young whipper-meeting of SEPI in New York City, features SEPI’s cofounders in a candid conversation snapper and I remember Paul and Marv as be- ing “old men.” In fact, they were considerablyabout the purposes, status, and future of psy- chotherapy integration. The comments of Dr. younger than I am right now! There are a few memories that stand out about that. One ofMarvin Goldfried and Dr. Paul Wachtel are reproduced faithfully from an audio recording them was that we were in Annapolis, Mary- land, and it was the first time I had tasted soft-of the plenary session, moderated by Dr. Jer- emy Safran. shell crab, and it was delicious. 494 A Critical Dialogue on Psychotherapy Integration 495 So that was one of my most important mem- a rather small group, so there weren’t that many presentations, and there was a lot of time in-ories of SEPI! between sessions. And the hallways were just W ACHTEL : Jeremy has been in psychoanalytic abuzz; I have the feeling that they are still vi- training, and begins with the oral stage. brating. There was just a sense of intense stim- S AFRAN : I also remember meeting Paul for the ulation and possibility. And then we were up first time. I knew Marv, but Paul and I had all night in different people’s rooms talking. It never met before. I traveled down with Les was just the most exciting conference I have Greenberg, and we had dinner with Paul, ever been at. So I think that’s the single pri- Marv, and others. We were staying at a very mary memory that I have. nice hotel and sharing a room, and I was struck G OLDFRIED : I remember very much the same by the fact that they put these chocolates on thing. When people come to a SEPI confer- the pillows. ence for the first time, they may experience the G OLDFRIED : Still at the oral stage. same kind of thing—seeing the people that you’ve read about. Not only seeing them, but S AFRAN : I’ll work my way up. And the maid also having a chance to talk to them, and said to me: “Sir, would you like a turn down?” sometimes even touch them—so there’s a real- And we were speculating what she meant by ity to them. And since it was the first SEPI con- that. ference, there was the reality of a beginning. I W ACHTEL : We just jumped two stages. remember a couple of years earlier when the S AFRAN : My other memory—and we’ll see SEPI Organizing Committee—which later be- how you interpret this one as the analyst of the came the Steering Committee—came to my team—is that Les [Greenberg] and I were giv- apartment to talk about what we should do. I ing a panel on emotion and were involved in recall how nervous I was, preparing coffee and a very intense discussion over lunch with Irene different kinds of teas; I felt everything had to Elkin. As a result, we were 10 minutes late for be just right, as I had this sense that something our panel. We walked in and apologized for important may be happening. being late, and the people said: “We’re just W ACHTEL : I think the other thing that strikes glad you made it.” Now, how do you interpret me, sparked by what Marv is saying, is every- that one? one meeting the people whose work we had W ACHTEL : I’ll leave that one to Marv; it’s each been reading, and a sense of all of us start- about a behavior. ing out on the same ground, just sharing ideas and being truly interested in each other’s ideas. S AFRAN : Anyway, the first question I have for It felt like we got off the right way right from the two of you is what memories stand out for the beginning by making this an organization you about that first conference? that was not a hierarchical organization. I’ve G OLDFRIED : Why don’t you start, as you’re been to conferences where people wear ribbon s much more adept at early memories than I am. that indicate how many presentations they are making or what committees they are on or of-W ACHTEL : Well, my first thought, especially given the way Jeremy has reevoked the experi- fices they hold, and for some “big shots” it looks as if the ribbons will end up sweepingence, is to think of the Bob Dylan song “I Was So Much Older Then, I’m Younger Than the floor there are so many. SEPI has no rib- bons. And it’s not because our dues are lowThat Now.” But I think what I remember most of all is the incredible sense of excitement that and we can’t afford the ribbons. Ribbons aren’t expensive. But hierarchy is costly.virtually everybody at the conference felt. And I remember one thing procedurally that we Marv and I just came from a really exciting session that centered on presentations by somedid. It was partly because it was a smaller group—part of the paradox of success is as it of our students who met together at last year’s SEPI meeting in San Francisco and had fol-gets bigger, it’s harder to manage, but this was 496 Training, Research, and Future Directions lowed up on the dialogue between them that you learned from the audience discussion, you know that one of the goals of SEPI has beenstarted there. The fact that the students could do this, and do it on their own initiative, feels achieved. to me so much the essence of SEPI. SEPI is S AFRAN : Thinking back to the early days, to the only organization I belong to that doesn’t what extent do you think the two of you had a have a president. That’s again part of the aim shared vision of what both SEPI and psycho- of fostering real dialogue. And I think that what therapy integration should be, and to what ex- probably everybody here has found is that you tent do you think there were divergences? can be somebody who’s coming to the first G OLDFRIED : It depends on how far back we meeting, someone who has not published any- go. Are you talking about our lunch meetings thing, someone who isn’t known yet, and peo- or our dinner meetings? During our lunch ple have time for you. It’s not the kind of orga- meetings, we were very much in accord. We nization where there are the important people felt we had to break out of our boxes. This was and everybody else. I think that started at the in the aftermath of an APA symposium pro- very first meeting. posal that was rejected. Was it the 1960s? However successful we may have been in W ACHTEL : Early 1970s. different respects, we were all also, in a certain sense, professional misfits; we were people who G OLDFRIED : We were frustrated about that, and we thought that if they’re not going todidn’t fit easily within the usual boundaries and categories. We were coming together as allow us to talk in front of a group, then at least we can talk with each other At the 1986 NIMHfellow misfits, in some way, and I think that set a tone that I hope has continued (obviously workshop, where a group of us met for 2 days to discuss future directions in psychotherapythose of you that are sitting in the audience are the best judges of that). integration research, I recall telling the group what I would really like to see happen. And G OLDFRIED : And you recall that one of the that was that the field would reach the point debates we had in the Organizing Committee where we no longer functioned according to was whether to have different types of mem- theoretical orientations, but where we had bers—members and fellows. The fellows being some kind of consensus. I had thought that ev- the super-misfits. You’d be a fellow if you wrote eryone would think that this was a great idea, X number of different things or gave so many but recall your saying that you didn’t think that different presentat ions. We decided flatly against was such a good idea. I think this may be a that. So many of the debates across theoretical point of distinction between us that would be orientations had been hierarchical in the past, good to talk about: Your exploration versus my and the notion was: “We are going to have a intervention; your insight versus my action. debate, and the goal of my interaction with someone from another orientation is to prove W ACHTEL : It really is interesting to go through this process because I was actually thinking al-how he or she is wrong.” When each person adopts that same attitude, nobody changes and most exactly the opposite. My recollection is that when we had different views of the waynobody learns. We therefore wanted to create a structure that would be very different, so we our fledgling network might go that I was the one more eager to take the next step of startingdidn’t have a hierarchy of memberships. One of the unique aspects of SEPI meetings an actual organization. I remember when we first had a “virtual SEPI”—it was before theis that we allow time for audience participa- tion. Some of the best meetings I’ve attended days of the computer, so it was through the post office—but there was a list of about 100are when I’ve learned just as much or more from the audience as I did from those present- people and we would contact them. The ques- tion was “Should we actually develop an orga-ing. And in those instances where you’re pre- senting and where you come out knowing nization?” I think I was a little more eager to than Marv was, as I recall.more than when you went in because of what A Critical Dialogue on Psychotherapy Integration 497 As we moved ahead, one of the dialectical achieve, but I now believe that it will never achieve that—at least on its own.pulls for SEPI has been on the one hand, em- phasizing what we’re all committed to: keeping W ACHTEL : I don’t know whether it wil l achieve the sense of openness, not developing some that. I think we share the need to go beyond new orthodoxy, even if it’s an “integrative” or- theories A, B, C, D, and E and then integrate. thodoxy. On the other hand, there’s been an We need to develop, elaborate, explore, and increasing interest for many members in mov- investigate really integrative ways of thinking ing forward to develop guidelines for integra- from the beginning. I think that, rather than tive practice and in describing what practicing thinking of it as a manual oriented toward spe- integratively is like and not just what the pro- cific disorders, for me it would be the develop- cess of integrating entails. I think particularly ment of both an integrative theory and a re- as SEPI has become more and more interna- lated integrative set of principles that will be tional, people in different countries have at applied differently with different patients. The times had different goals from the members in skeleton wouldn’t be so much The Merck Man- North America. There is more and more inter- ual as the conceptual framework est among members in other parts of the world G OLDFRIED : I would certainly be delighted to especially in developing a coherent integrative see that. I don’t ascribe to using the DSM model approach to psychotherapy, in moving from for treatment, namely if it’s panic it must be the exploration of psychotherapy integration to this book on the shelf and if it’s depression it’s integrative psychotherapies. My sense has been this other book. However, I think we need to that most of us have been interested in the dia- have some structure, but not structure that is lectic between these two visions see the value based on theory. There are too many political, in both, but that we’ve differed in where we economic, and social factors that cause us to place the emphasis. It’s been my sense that I’ve maintain our theories and our institutes. I been somewhat more eager to move it to devel- know there are people in the audience that oping integrative psychotherapies and that you have institutes, and realize I am saying some- represented more the thing that is not politically correct. However, this is not going to happen very fast, but some- G OLDFRIED : We may end up learning some- time in the future it would really be nice if we thing from each other. One of the reservations achieved some consensus. I don’t like the way that I had was that there would be a prolifera- [American Psychological Association] Division tion of even more therapies than already existed 12 has gone about trying to get a consensus by to confuse the field, as there now would also coming up with a list of empirically supported be different kinds of integrative therapies. I therapies. Still, consensus is in the wind. Jer- think that has happened. That was always a emy, are we dealing with your questions? fear of mine. In my pre-SEPI publication on S AFRAN : That’s okay. Don’t worry about me. psychotherapy rapprochement [Goldfried, 1980], I’ll just sit here in the dark. I ended the paper by saying that I would like to envision—more of a hope than a predic- G OLDFRIED : I think where SEPI has been in- credibly successful is in changing the zeitgeist.tion—the textbook of the future that would be different from textbooks of the present. Current There’s no question whatsoever about that. If SEPI were to get royalties from book publish-books have theory A, B, C, D and so forth, with the final chapter perhaps being an integration ers every time the term integration was used in the title, we’d be a very wealthy organization.of all of these. I would rather see the textbooks of the future that describe various kinds of clin- Integration is no longer something that one can only talk about late at night after a confer-ical problems and issues, together with ways in which one may intervene. More like a Merck ence. I think another part of the zeitgeist that isManual, reflecting a consensus in the field. That was something that I hoped SEPI would starting to happen is the notion of empirically 498 Training, Research, and Future Directions supported or evidence-based treatments. That close relationships and friendships all around the world, with people from other countries,has occurred parallel to psychotherapy integra- tion, and it would be nice to integrate these who have become very important in my own life. That has been a bonus that I didn’t antici-two themes, especially since most of the work that has been done on evidenced-based ther- pate but now, in retrospect, seems absolutely essential.apy has involved theoretically pure interven- tions—cognitive-behavioral or otherwise. As a result, I believe that the starting points for the G OLDFRIED : Without using the fantasy con- cept—I think of it more as belief systems I hadevidence-based trials have been flawed to be- gin with. It would nice if SEPI could somehow early on, some of which were realistic and oth- ers unrealistic—I similarly did not anticipateinfluence that, but we are avowedly apolitical in our mission. Individual members of SEPI that SEPI would provide me with a good home base. I think I missed only one SEPI meetingcan be political, but it’s not clear that SEPI will serve in that role. Still, I’m in favor of over the years and have always looked forward to the meetings and seeing the people in-changing the name of our organization to the Society for the Evolution of Psychotherapy In- volved. So, from a personal point of view, it has been very gratifying, even though that was nottegration, which would involve more than just exploring. one of my original motives. Rather, I was look- ing at what was going on in the field and being S AFRAN : Think back to the inception of SEPI very frustrated in seeing all the work, time, and and try to remember your fantasies, hopes and energy that was being put in by cognitive- expectations of where it would be 20 years into behavior therapists who were being totally ig- the future. nored by psychodynamic and experiential ther- apists. Indeed, everyone was being ignored byW ACHTEL : Well, it certainly didn’t include me sitting in front of a bunch of people sharing everyone else, but everyon e was presumably put- ting in all their time and en ergy toward the goalmy fantasies. One of the places where my fan- tasies have centered, and have been partly real- of improving how we work with patients. I saw this lack of communication as a f o lly, and thatized and partly not, was that SEPI would be a home for people who think integratively and something needed to be done to address this folly. Although I didn’t think I’d get the personalthat the identity as an integrative therapist or an integrative thinker about therapy would be benefit, I’m very gratified that I have. The unrealistic belief I had was that weas compelling and real and “filling one up” as the identity of psychoanalyst, cognitive behav- could achieve a consensus. Maybe it still can happen, but I have not yet seen it happen. I’mior thera pist, family therapist, and s o on. I t seem s to me that those [single-theory] identities still not referring to a consensus on a grand the- ory—I don’t think that is possible—but ratherare stronger in many ways even among most of us at SEPI. Partly because it’s my child, I on some things more specific. For example, finding agreement on a given case. We’ve gonewould say that SEPI is the single most impor- tant organization for me personally. In terms of through such an exercise several times. I was recently listening to the tapes of the weekendpeople identifying me or in terms of living my professional life, there are other more psycho- workshop we had in San Francisco in 1982, where several of us—Sol Garfield, Mardi Hor-analytic organizations that play a very powerful role too. I know that kind of dual identity is owitz, Stan Imber, Phil Kendall, Hans Strupp, Paul Wachtel, Barry Wolfe, and me—tried totrue for almost all of us here. But SEPI still has been and is a place where I can feel especially determine if we could agree on anything. Talk about obsessiveness! We spent 2 hours tryingintensely like I’m among my brethren, so to speak. to agree on the goals of a particular case, and were unable to do so. I think we could get aThe other thing that has been wonderful and unanticipated was the degree to which little bit further some 20 years later, but I don’t think we are where I would hope we’d be.SEPI has been a means for developing really A Critical Dialogue on Psychotherapy Integration 499 S AFRAN : Just to make sure that I understand, it tention to what has been overlooked, new inte- grative ways of thinking would emerge. I usesounds like both of you had the fantasy, belief system, or expectation that SEPI would move the word ways plural intent ional ly. I don’t know that we can ever achieve a single theory, but Itoward some kind of consensus, although you might have had somewhat different ideas as to do think we want to move more and more in that direction so long as the theorizing iswhat the nature of that consensus would be. Paul, your idea was that it would involve more rooted in observations rather than just ideologi- cal. I should let Marv respond to it but thenof a theoretical consensus, whereas your think- ing Marv was that the consensus would be I want to come back to why I used the word observations, because there are issues for memore about practice and some principles of change. with words like evidence-based and empirical. S AFRAN : Before Marv responds, I’d like to G OLDFRIED : Jeremy, your Rogerian training heighten things a little bit. My view of your has held up. ultimate goal is somewhat more pluralistic W ACHTEL : I think that it’s true that a good than Marv’s. Is that right? part of my interest was in a theoretical direc- W ACHTEL : I don’t think I would say that. I tion, but it was not necessarily seeking a con- wouldn’t even say it is in opposition to Marv’s. sensus on a theory. Consensus would not be The way I would articulate my own view, I the word that would primarily characterize my don’t think I’d use the word pluralistic, be- hope. It was really more about figure/ground cause pluralism for me entails separation. I differences; I don’t think I’d be saying anything want something that’s more interactive. I want Marv would disagree with but there would be a constant evolution. That’s why the word evo- figure/ground differences in emphasis. lution would be a very congenial one. An evo- G OLDFRIED : Is that a challenge? lution that continues to move toward synthesis W ACHTEL : We’ll see. I was trying to make it and then discovering what’s been left out and impossible for Marv to disagree. trying to work it in. There will probably be more than one way to work it in, but it’s not G OLDFRIED : I recognized that, which is why I pluralism. It’s not “live and let live.” It’s “let’s made that comment! live together, and let’s change each other.” W ACHTEL : When you have two clinicians up G OLDFRIED : Let’s see if we can operationalize here and they’re savvy toward each other, it’s a this. Part of my role is to make things concrete. bit rough. What I am hoping for and still am What would the table of contents of your fanta- is, first of all, dialogue. I think one of the things sized textbook be in 100 years from now? that struck me was that there was very little dia- logue among theoretical orientations. I think W ACHTEL : It would probably be written in Chinese. More readers.SEPI has been very successful, but there’s still a lot of separate worlds that don’t hear each G OLDFRIED : Let’s assume we could have it other, that don’t know about each other, that translated into English. don’t take each other seriously, and most of all W ACHTEL : I don’t know what it would be like don’t learn from each other. So most of all I 100 years from now. I can say a little bit about saw SEPI as a venue for that. what it would be like today. But I also saw it as a force for changing each G OLDFRIED : I know that! of the separate schools of psycho thera py. Chang- ing them in the sense that part of what was W ACHTEL : I don’t know. What I would hope is that the result of 100 years of SEPI would bewrong with psychoanalysis, part of what was wrong with cognitive-behavior therapy, part of that it would produce the table of contents that we can’t imagine right now. What would emergewhat was wrong with family systems therapy, was that they were so exclusive and so unable would be new concepts and new ways of orga- nizing and coordinating the observations, andto see that there were important things in the other realm. My hope was that, by paying at- it would generate new observations as a result, 500 Training, Research, and Future Directions leading to concepts that really would be differ- plied to this type of problem. The intervention would be implemented in various ways, de-ent. For example, one of my objections to the DSM is that it feels to me like debating pending on the nature of the client. There would be leeway for clinical judgment withinwhether this patient is earth, air, fire, or water. It seems to me no matter how well you refine that, but there would be guidelines that some- how give direction. The chapter would providethat, it’s not a set of concepts that will last. guidelines, not straightjackets. G OLDFRIED : We don’t disagree on that. W ACHTEL : I think part of what we’re getting W ACHTEL : I think it’s true probably of all the at here is that we’re approaching it with a concepts we’re working with, that the spirit of somewhat different cognitive style. In order to what we’re up to is that they will lead, hope- answer your question of what the table of con- fully, to our learning new concepts. tents would look like in 100 years, I would G OLDFRIED : I agree. Let me refine the ques- have to be entering into your cognitive style, tion a bit, because I agree that the concepts which I would try to do if you were my patient, will hopefully grow out of some kind of con- but you’re not. It’s one of the nice things about sensus that would emerge if this [integration] someone being a friend instead of a patient. movement becomes successful some time in For me, the relevant question isn’t what would the future. What would the organization of the that look like. For me the question is how will chapters be like? Would they talk about princi- we get there. How will we go about arriving at ples of change? Would they talk about clinical what is now unimaginable? issues? Would it talk about disorders? As I see G OLDFRIED : Okay. But it’s not unimaginable myself as immortal, I’m preparing my syllabus for me. for my intervention class at Stony Brook 100 years from now, and I want to know what text- W ACHTEL : I know. book to use for beginning students. G OLDFRIED : But it’s unimaginable for you. S AFRAN : What about you, Marv? Do you have W ACHTEL : I hope it is. In other words, if I can any idea about what the table of contents imagine it now, that would mean it wasn’t a might look like? very exciting 100 years. G OLDFRIED : Well, I kind of hinted at it be- G OLDFRIED : I think we have different philo- fore. I would hope there would be some over- sophical styles, and mine is certainly much arching principles of change, and that these more functional. principles would be spelled out in the context W ACHTEL : Mine is dysfunctional. of different kinds of clinical problems—how these principles get implemented clinically. In G OLDFRIED : Functional in a learning sense. addition, it would include the evidence. W ACHTEL : I understand; I’m just playing. Evidence-based therapy means not only how well an intervention has fared in a clinical G OLDFRIED : Not in a psychological sense. trial. I think the findings of clinical trials are of S AFRAN : I know that the two of you are in the interest, but I don’t think they have informed midst of something, but rather than being my us as much as other kinds of research might client-centered self, I’m going to be an analyst inform us. Evidence-based also means that we and end this part of the session on time and know something about different kinds of clini- give the audience a chance to be part of this cal problems. For example, we know that if a dialogue. person has had a series of losses and is experi- encing various kinds of emotions, thoughts and A UDIENCE Q UESTION : You say that SEPI has influenced therapists to think more integra-behaviors, then they probably are having some difficulty in overcoming these losses. There tively. However, my sense is that psychoana- lytic organizations have not changed all thatwould then be certain general principles of change that would be modified so as to be ap- much over the years with regard to psychother- A Critical Dialogue on Psychotherapy Integration 501 apy integration. What are your thoughts about had they put their names on—or whether somebody is willing to say this in print—is an-that? other story. W ACHTEL : There are very great differences between people in their participation and their A UDIENCE Q UESTION : Dr. Goldfried, do you think that cognitive-behavior therapists, your-identities within organizations and as individu- als in their own practices. In other words, I self included, take an integrative approach to intervention?think that you’re absolutely right that orga- nized psychoanalysis, for example, has been G OLDFRIED : I think there are individual dif- very unreceptive to integration. But what al- ferences. I would say that with regard to how I ways surprises me is that when I speak to indi- practice integratively, cognit ive-behavior therapy vidual analysts, they are often receptive. There is dominant, and everything else is integrated. are taboo ideas in public that are very common But that is simply a function of cognitive- in private. One of the things that strikes me is behavior therapy being my primary orientation that very, very often I get calls from well-known and not what I believe is the mission of SEPI. analysts either asking for some input about how It’s where we are at this point in time that leads they might actually use a cognitive-behavioral us to this. intervention or looking for a referral for a pa- In listening to some of my graduate students tient of theirs even if they won’t integrate it talk about how they do clinical work, they directly. That was not true 20 years ago, but it’s sounded very integrative. What is of particular quite common now. And this includes people interest is that they label themselves as “inte- that you wouldn’t think that about if you see grative,” even though I continue to label my- their positions in the psychoanalytic organiza- self as “cognitive-behavioral.” We are talking tions. But I think that you’re absolutely right here about the difference between behavior that in the psychoanalytic literature and in and identity. [American Psychological Association] Division 39, it hasn’t yet officially emerged. But there A UDIENCE Q UESTION : It seems that the two of you have been focusing more on either pro-is something happening underneath that’s also interesting to be aware of. cess or outcome. Thinking ahead to the future, what orientation do you think is likely to G OLDFRIED : I certainly can’t speak for the emerge as the superordinate one? psychoanalytic community, but I have had similar experiences in interactions with indi- W ACHTEL : Two different thoughts are stimu- lated by that comment. One goes back to theviduals who are psychoanalytically oriented and know that they are much more open. I earlier question. I think, for example, in the vision of many analysts, some version of psy-know more about the cognitive-behavioral world, which has showed increasing openness. choanalysis is the superordinate theory. But there are two different spirits in which that canWe have representatives at this conference from that world, and the very fact that they are be approached. One is a problematic one, which is the defensive, “we’re the best.” It washere and interested in this is an indication that there has been a change. once dominant, and it can’t abide the fact that it no longer is. And I think psychoanalysis isLes Greenberg once presented at the Associ- ation for Advancement of Behavior Therapy really struggling with that. So that’s one atti- tude.[AABT] convention on emotion and experien- tial therapy. We were sharing a room together, But a second variant is one that reflects one of the very important advances in our under-and the evaluations of his workshop were there for me to look at. They were rave reviews. That standing of what’s going on process-wise in in- tegration—Stan Messer’s [1992] introductionwas certainly an indication of the receptivity that cognitive-behavior therapists have to inte- of the idea of assimilative integration. I mean, if I look at myself, even though I’m so power-gration. Now, these were done anonymously, and whether they would have been as good fully committed to integration, I’ve realized 502 Training, Research, and Future Directions ever since Stan introduced that term that I’m from now is of a certain sort, but that will re- quire a lot of work and a lot of action. We areengaged in an assimilative integration in that it’s not equally, say cognitive-behavioral or psy- not at the action stage. We have gone from pre- contemplation to contemplation as a field andchoanalytic. The psychoanalytic perspective is clearly the organizing configuration for me, SEPI as an organization, and it’s going to take a while before we get to action [Prochaska &but not necessarily because it’s better, but just because it’s what my root thinking is, and I’m DiClemente, 1992]. As I indicated earlier, I think we must pay attention to evidence, butconstantly looking to examine and question it and to bring new things in from outside. So I the evidence must be informed in a sophisti- cated way by clinical practice. It is essential forthink those are two different spirits of doing that same thing. practitioners to be involved in any kind of con- sensus that is evidence based.SEPI is an organization of people who, al- most by the very nature of being active in this S AFRAN : Because of time limitations, I’m organization, are not true believers. It becomes afraid that we’re going to have to stop here. difficult and contradictory to be a true believer I would like to thank everybody for partici- in not being a true believer, so we do not have pating in this dialogue. I would like to thank the same kind of zeal, or at least we have a Marv for sharing his verbal behavior with us different kind of zeal. I think it’s a kind of zeal and Paul for sharing his instinctual deriva- that makes it harder for us to be exclusionary. tives. It’s not “I’m integrative, you are not.” It’s “I’m integrative, join me, and let us learn from each other.” And that’s different from the other orga- References nizations, but it makes for a less aggressive identity and in a way one that is less defined. Goldfried, M. R. (1980). Toward the delineation of therapeutic change principles. American Psy- G OLDFRIED : I have thought a lot about that. Indeed, I’ve struggled with these issues, as I’ve chologist, 35, 991–999. Goldfried, M. R., & Wachtel, P. L. (1987). Clinical felt a certain amount of disappointment. How- ever, I think it is no small accomplishment to and conceptual issues in psychotherapy inte- gration: A dialogue. Journal of Integrative and change a zeitgeist, and SEPI has been very suc- cessful in changing it. Within the context of a Eclectic Psychotherapy, 6, 131–144. Messer, S. B. (1992). A critical examination of belief new zeitgeist, there is much work that needs to be done. Although we can use the metaphor structures in integrative and eclectic psycho- therapy (pp. 130–165). In J. C. Norcross & of outcome versus process research, people who do therapy research talk about the “big O” M. R. Goldfried (Eds.), Handbook of psycho- therapy integration. New York: Basic Books. and the “little o.” The former is the ultimate outcome and the latter the interim outcomes, Prochaska, J. O., & DiClemente, C. C. (1992). The transtheoretical approach (pp. 300–334). In the subgoals that eventually lead to the ulti- mate goal. J. C. Norcross & M. R. Goldfried (Eds.), Hand- book of psychotherapy integration. New York: My fantasy—excuse me, my expectation, a “behavioral slip”—about the textbook 100 years Basic Books. [...]... E (2000) A prescriptive eclectic approach to psychotherapy training Journal of Psychotherapy Integration, 10, 247–261 Norcross, J C., Glass, C R., Arnkoff, D B., & Lambert, M J (1993) Research directions for psychotherapy integration: A roundtable Journal of Psychotherapy Integration, 3, 91–131 Norcross, J C., & Goldfried, M R (Eds.) (2005) Handbook of psychotherapy integration (2nd ed.) New York:... in psychotherapy integration: A roundtable Journal of Psychotherapy Integration Norcross, J C., Hedges, M., & Castle, P H (2002) Psychologists conducting psychotherapy in 2001: A study of the Division 29 Membership Psychotherapy: Theory, Research, Practice, and Training, 39, 97 102 Norcross, J C., Hedges, M., & Prochaska, J O (2002) The face of 2 010: A Delphi poll on the future of psychotherapy Professional... 51(1), 3–16 Elkin, I (1991) Varieties of psychotherapy integration research Journal of Psychotherapy Integration, 1, 27–33 Frances, A., Docherty, J P., & Kahn, D A (1996) The expert consensus guideline series: Treatment of bipolar disorder [Special issue] The Journal of Clinical Psychiatry, 57(12A) Frank, J D (1961) Persuasion and healing: A comparative study of psychotherapy Oxford, UK: Johns Hopkins... principles of psychotherapy integration: Call for a consensus conference Journal of Psychotherapy Integration, 4, 203–228 Beutler, L E (1998) Identifying empirically supported treatments: What if we didn’t? Journal of Consulting and Clinical Psychology, 66, 113– 120 Beutler, L E., & Consoli, A J (1992) Systematic eclectic psychotherapy In J C Norcross & M R Goldfried (Eds.), Handbook of psychotherapy. .. scientifically rigorous psychotherapy research Clinical Psychology: Science & Practice, 8, 155–167 Castonguay, L G (1993) “Common factors” and “nonspecific variables”: Clarification of the two concepts and recommendations for research Journal of Psychotherapy Integration, 3, 267– 286 Castonguay, L G (2000) A common factors approach to psychotherapy training Journal of Psychotherapy Integration, 10, 263–282 Chambless,... relational treatment guide New York: Guilford Press Schacht, T E (1991) Can psychotherapy education advance psychotherapy integration? Journal of Psychotherapy Integration, 1, 305–320 Schottenbauer, M S., Glass, C R., & Arnkoff, D B (2005) Outcome research on psychotherapy integration In J C Norcross & M R Goldfried (Eds.), Handbook of psychotherapy integration (2nd ed., pp 461–495) New York: Oxford University... failure of the field to develop or commit to an organized action plan As a result of this hesitation to act, the integration movement has not produced a number of changes that many sought One of the initial goals of the psychotherapy integration movement was that the competition among various schools of psychotherapy and their respective rival treatments would eventually be replaced with a sense of cooperation... intuition of skilled clinicians is often years ahead of our research findings But the tools of research can help us to access clinical wisdom in a systematic way Instead of allowing the most forceful personalities to dominate the discussion, we can use systematic reviews of the literature (e.g., Grencavage & Norcross, 1990), surveys of experts (Frances, Docherty, & Kahn, 1996), and studies of master... implicit common factors in diverse methods of psychotherapy American Journal of Orthopsychiatry, 6, 412–415 Ryle, A (2001) Cognitive analytic therapy In W J Livesley (Ed.), Handbook of personality disorders: Theory, research, and treatment (pp 400– 413) New York: Guilford Press Ryle, A (2005) Cognitive analytic therapy In J C Norcross & M R Goldfried (Eds.), Handbook of psychotherapy integration (2nd ed.,... guidelines, some form of guidelines may be inevitable A panel of 62 psychotherapy experts, asked to forecast psychotherapy trends for the next decade, predicted that practice guidelines would become a standard part of daily psychotherapy (Norcross, Hedges, & Prochaska, 2002), perhaps because health care companies and governmental agencies are increasing demands for accountability Instead of waiting for external . know that! of the separate schools of psycho thera py. Chang- ing them in the sense that part of what was W ACHTEL : I don’t know. What I would hope is that the result of 100 years of SEPI would. a this. Part of my role is to make things concrete. bit rough. What I am hoping for and still am What would the table of contents of your fanta- is, first of all, dialogue. I think one of the things sized. number of perspectives,Mr. P may remind you of clients you have seen. In some ways, he may also remind you we will gain a richer understanding of how the field should proceed .of the history of the psychotherapy