Running Head: INTEGRALLY-INFORMED PRAGMATIC PSYCHOTHERAPY

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INTEGRALLY-INFORMED PSYCHOTHERAPY

Running Head: INTEGRALLY-INFORMED PRAGMATIC PSYCHOTHERAPY

Toward an Integrally-informed pragmatic psychotherapy

Durwin Foster

Department of Educational and Counselling Psychology, and Special Education

University of British Columbia

Vancouver, Canada

Address for Correspondence: Durwin Foster, 4525 Summerside Lane, North Vancouver, BC V7G 1H4. Telephone: 604-929-1988. E-mail:
Abstract

This paper describes the theory and practice of an Integrally-informed pragmatic approach to psychotherapy. Integrally-informed pragmatic psychotherapy is presented as a viable, innovative approach to psychotherapy based on the assimilative integration of elements of Duncan et al.’s common factors (2004) and Lazarus (2005, 2008) technically-eclectic approaches within the theoretical framework provided by Wilber’s (1986; 1995; 1997; 2000a-b; 2003a-b; 2005a-c ) Integral theory. This integration is seen as valid and useful because it unites the theoretical strengths of the Integral model with the practical strengths of common factors and technically-eclectic schools. The sections cover all the major elements of a complete theory of psychotherapy put forward in standard psychotherapy texts, including historical background, concept of personality, psychological health and pathology, process of clinical assessment, practice of therapy, therapeutic relationship, curative factors, treatment applicability and ethical considerations.

Key words: psychotherapy integration, assimilative integration, Integral psychology, common factors, technical eclecticism

Author Bio

An integral educator and counsellor, Durwin is currently completing a Ph.D. in Counselling Psychology at the University of British Columbia, Vancouver, Canada.

He has published scholarly articles in Counseling and Values, Constructivism in the Human Sciences, and AQAL: Journal of Integral Theory and Practice (forthcoming). Durwin lives in Vancouver with his life partner Wendy and two daughters, who Durwin unabashedly proclaims are as adorable as can be.

Toward an Integrally-informed pragmatic psychotherapy

Stricker and Gold (1996) distinguish three major options that those moving beyond adherence to a single theory approach have at their disposal: technical eclecticism (clinically-based), theoretical integration (rationally-based), and common factors (empirically-based) approaches. They go on to make a useful further distinction within the broader domain of theoretical integration with the notion of assimilative integration. Assimilative integration refers to the incorporation of key techniques from a system of therapy into the theoretical framework of a second system. For example, Stricker & Gold’s own model of psychotherapy integration incorporates techniques from the cognitive-behavioral paradigm into a psychodynamic interpretive framework. Consistent with postmodern understandings of contextualism, Stricker & Gold impart how changing the context for a given intervention changes what that intervention means and does within psychotherapy.

The model that I present here lies within the theoretical integration domain, and can also be categorized as a type of assimilative theoretical integration. However, in this case, the assimilative integration occurs between an already-given theoretical integration, that of Integral psychotherapy, and procedures drawn from the pragmatic, even a-theoretical common factors school. By “Integrally-informed”, I mean that the model draws heavily on Ken Wilber’s Integral Psychology meta-theory (1986; 1995; 1997; 2000a-b; 2003a-b; 2004; 2005a-d), while “pragmatic” refers to the incorporation of elements drawn from common factors (Duncan et al., 2004) and technically-eclectic (Lazarus, 2005, 2008) approaches.

The explication of the model is structured according to the framework for comparative study set forth in Chapter 1 of Gurman and Messer’s Essential psychotherapies: Theory and practice, 2nd Edn. (2003). This framework for theory explication includes the following sections: historical background, concept of personality, psychological health and pathology, process of clinical assessment, practice of therapy, therapeutic relationship and stance of the therapist, curative factors or mechanisms of change, treatment applicability and ethical considerations and case illustration. Because of space constraints, I have not included a case illustration in this initial article. I do attempt to infuse research support wherever possible, throughout the presentation.

You will note that I am referencing individual therapy, as opposed to couples, family or group therapy. Individual therapy still appears to be the prototypical context in which therapy is envisioned, and so remains my preferred context for the purposes of explicating a basic theory. However, my decision to focus on individual therapy is in no way meant to reflect a disinterest in couples, family or group therapy.

Historical background: Integral and pragmatic traditions

Integral counselling is a recent development, but with roots stretching back to pre-modernity. It is based on the synthetic work of theoretical psychologist Ken Wilber (1986; 1995; 1997; 2000a-b; 2003a-b; 2004; 2005a-d). For the past thirty years, Wilber has been developing an integrated meta-theory spanning multiple domains of human inquiry -- including psychology, philosophy, spirituality/religion, anthropology, and sociology -- as well as multiple periods in history: postmodern, modern, and premodern.

The socio-historical background out of which Wilber and Integral psychology arise is important to understanding this work. Integral psychology developed out of the “progressive” movements that occurred in the1960’s and 1970’s, most importantly the rise of interest in Eastern philosophies such as Buddhism. Within psychology, Integral theory is most closely-linked with the humanistic and transpersonal forces. Since 1983, however, Wilber has called his work integrative or Integral, rather than humanistic or transpersonal, since he feels that what he has developed includes conventional psychology in a way that transpersonal or humanistic psychology has been unable to. That is, Integral psychology could be seen to include but potentially transcend the four forces in psychology of psychoanalytic, behaviouristic, humanistic and transpersonal (K. Wilber, 2005d).

As an integrated theory of consciousness and self, Integral psychology is sophisticated and comprehensive. For example, Dr. Larry Dossey asserts that Wilber has produced the “first truly comprehensive map of the human mind” (K. Wilber, 2000b, cover material). As a framework to guide clinical practice and as a model of the process of change in psychotherapy, integral psychology’s usefulness is now being actively explored (______,2007). This theory employs Integral psychology as its overarching framework, while attempting to infuse Integral psychology with the empirical research generated by the common factors approach, and the pragmatic emphasis of Ericksonian-based clinical practice.

A counterpoint to Integral psychology’s theoretical sophistication is the practical wisdom embodied in the Ericksonian tradition. Milton Erickson is widely regarded as one of the most effective psychotherapists of all time (Duncan et al., 2004). Some of his work with clients seemed to produce extraordinary change in relatively short periods of time. Yet Erickson maintained a strongly a-theoretical stance: “I think any theoretically-based psychotherapy is mistaken because each person is different” (Zeig, 1980,p.131). The uniqueness of Erickson’s approach has vexed those who have sought to further his pragmatic approach to therapy. For example, Steve de Shazer and colleagues sorted as many Erickson case reports as they could find according to patterns in Erickson’s interventions (de Shazer, 1994), coming up with five piles. Unfortunately, the largest pile was the sixth, containing cases that were unclassifiable. That is, most of Erickson’s cases showed no distinct pattern that the researchers could use to build a theory of Erickson’s approach. Thus, the focus of those working within the “Ericksonian tradition” (my term) has been on what works as derived empirically and clinically, rather than as deduced through a rational-theoretic process. The dialectical tension which drives my approach, then, is that between the view from 50,000 feet (Wilber, 2005a) offered by integral psychology, and the view from five feet, representing the distance between the chairs of client and therapist in a small counselling office. To assist me in formulating the view from five feet, I draw most notably on the work of Duncan, Miller & associates (Duncan et al., 2004) who have been working from the bottom up (empirically, clinically) to determine the common factors of “what works in therapy” (Hubble et al., 1999,title).

One way to think of an Integral approach to any topic is via the principles of partial truth claims and nonexclusion (Wilber, 2003a). The notion of partial truth claims is the idea that no human system of thought or set of practices is 100% incorrect. Thinking in terms of counselling, then, this principle means that in building an integrated approach, the goal must be to include the partial truths of all major systems, such as psychodynamic, behavioural, humanistic and pragmatic. Closely related to the idea of partial truths is the guiding principle of nonexclusion: because all systems or perspectives contain at least some truth, we cannot exclude any of them. My goal, then, is to attempt to bring together the theoretical insights of Integral psychology with some aspects of the practical wisdom of the Ericksonian tradition.

Consistent with action theory, I believe good theory and practice evolve out of an effective balance of experience or evidence based on action in the world and reflection upon that experience within the interior space of mind (Foster, 2003). In integral terms, these correspond to the left-hand and right-hand quadrants (see below). Broadly-speaking, the Ericksonian tradition could be viewed as having evolved out of the discipline of clinical experience. Integral psychology, on the other hand, has evolved out of a process of disciplined reflection and contemplation. It seems to me that the uniting of action and experience (exoteric approach) with reflection and contemplation (esoteric approach) is essential to the development of integrated approaches, and so it is with this guiding intention that I hope to unite these seemingly disparate approaches to helping others change. I believe there can be no clinical action taken without the presence of a guiding theory, operating implicitly if not made explicit. On the other hand, neither can there be a process of reflection undertaken without there simultaneously occurring some behaviour in the world. This is, in fact, a strong hypothesis of the integral model, which posits the mutual arising of subjective or esoteric and objective or exoteric aspects of reality (Wilber, 2003).

Concept of personality

I reason that because Erickson was focused on a pragmatic or exoteric approach, he described what he did as a-theoretical and therefore his work does not provide a coherent theory of the interior reality of the personality or self. Therefore, for this aspect of a complete approach to therapy, we need to rely mostly on the Integral approach. Self is a more appropriate term in the context of integral psychology than is personality, because self better encapsulates both subjective and objective aspects of the psyche. Considered from the subjective point-of-view, an individual experiences a self-sense; from an objective or exterior point-of-view, a social scientist can describe a self-system (K. Wilber, 2000c).

Each of us experiences some feeling of I-ness, a basic subjectivity or awareness, as well as some sense of me-ness, objective or descriptive aspects that we know about ourselves, such as being a shy or outgoing person (K. Wilber, 2000c). The personality, felt or sensed from the inside, is our “I-ness”. However, when we look at ourselves from a 3rd person perspective, as if from the outside, we see a “me”. In first person mode, I experience uncomfortable sensations of fear; in third-person mode, I reflect that I am an anxious person sometimes (I know this about me). Wilber terms these the proximal (close to us) and distal (farther away) selves. Also important to the Integral notion of self is the transcendental Self, or pure Witness. We might call this the antecedent self or I-I, the pure “I” that witnesses the relative “I”, since it is radically prior to all other senses of self. The antecedent self is sensed in counselling during moments when awareness opens to some larger sense of spaciousness, clarity or well-being.

Wilber asserts that proximal, distal and antecedent selves are all components of the sensation of being alive. The healthy self, then, can be illustrated as a continuum in awareness, as follows:

I-I …..I…..I/me…..me/mine

where the proximal self is situated somewhere between I and I/me, the distal self is the me/mine, and the I-I represents the antecedent self (Ingersoll & Cook-Greuter, 2007).

Functions of the self-system

The self has important functional capacities. Wilber (1986) outlines the six most important of these, as follows: identification, organization, will, defense, metabolism and navigation. Identification is the process that brings forth the senses of self as outlined above: I-I ….. I…..I/me..…me/mine. Identification processes are vital to understanding pathology, as well, since “only the self represses, only the self will idealize. The self is where all the action is “ (K. Wilber, 2005a,p.7). Pathology is taken up in greater detail in the next section.

The process of self-organization is also crucial, for with it the self is involved in ordering, cohering or making sense of all its own aspects as well its relationship with its environment. To make sense of, in this context, does not refer only to symbolic processing, as in language or “thinking”, but rather refers to an activity of the self that encompasses physical, emotional, symbolic and potentially post-symbolic[1] (i.e. spiritual) dimensions. In simpler terms, the self has to make sense of itself at all levels, in all domains. The self, in this sense, is “an independent organizing principle, a ‘frame of reference’ against which to measure the activities or states of these [psychological] substructures” (Brandt, 1980). The capacity and need of the self for self-organization in this model is close to that put forward within constructivist psychotherapy (Mahoney, 1991, 2003).

The function of will suggests the capacity of the self for free choice, “within the limits set by the basic structures of its current level of adaptation” (K. Wilber et al., 1986, p.79), as well as within the limits set by its couplings with the environment. Closely related to will and thus included here under the same general heading are two other important capacities of the self: valence and power (Mahoney, 1991). Valence refers to the self’s motivation. The self must answer the question: “In which direction am I moving?” Power is related to the idea of self-efficacy or agency – the ability of the self to influence or control its contexts, to achieve its goals.

The function or process of defense is also a crucial characteristic of the self. Within integral psychology, defense mechanisms develop and transform hierarchically in a manner consistent with that outlined in psychodynamic literature (and correlatively to the basic structures, outlined below). Thus, defences are viewed as progressing from psychotic to immature to neurotic to mature (Vaillant, 1992). Defences themselves are considered normal functions of a self at any given level of development. Pathology only occurs when defences are under or over-employed (K. Wilber et al., 1986), suggesting a difficulty with an individual’s ability to maintain appropriate boundaries.