In Part 1 of this series on forming an integrative model of child psychotherapy, I gave the example of The Red shoes metaphor. In the story multiple pieces of material are lovingly handcrafted into forming the complete, unique pair of shoes. This metaphor I believe is useful to us in terms of how we approach the idea of many different theories coming together to form our integrative framework.
There are many different theories of integration in psychotherapy. For example, The Journal of Psychotherapy Integration published by the American Psychological Association, states that it, ‘publishes original peer-reviewed papers consistent with 5 major pathways associated with psychotherapy integration’:-
- common factors (core elements to effective psychotherapy that transcend a specific orientation)
- technical eclecticism (application of the best treatment for a specific population and problem)
- theoretical integration (combining two or more theories and their associated techniques)
- assimilative integration (theoretical grounding in a single orientation with value-added techniques drawn from other orientations)
- unification (meta-theoretical approaches that place theories, techniques, and principles into holistic frameworks)
Often when we begin training we may think we are questing after the ‘holy grail’ of a theory of unification. I however question the possibility of Unification as a form of integration and my reason for this is not only is it an absolutely arduous task requiring more knowledge than we can have early in our career, but also more importantly, I take a postmodernist perspective which challenges the assumption that there is one truth seeking to be found or one unified theory, which Unification as a form of integration asserts. This philosophical assertion may suddenly seem an intrusion here, but there have been calls for psychotherapy trainings to focus more with students upon the philosophical foundations underpinning their practice (See Ross 2014). Being clear on our philosophical foundations about what it means to be human, how we view human development, what is knowledge and what can be known and how are all essential to forming our integrative framework. I feel a postmodernist approach is advantageous to the integrative child psychotherapist for it asserts the necessity of pluralism and contextualism :
‘While contextualism notes that context often determines which of many possible interpretations or meanings we give to an event, pluralism acknowledges that there are multiple perceptions of the truth, each one influenced by the context out of which the perceiver arises in making his or her judgments.’ (Hauke, C 2000 p20)
Contextualism converges with relational psychotherapy’s belief in seeing the client in context and thus a marrying up of the intrapsychic with the interpsychic (Orbach 2014). Pluralism I feel as has been argued by Samuels, offers a range of theories or perceptions of truth to reflect the pluralistic nature of the human psyche in all its complexity (Samuels 1989 ). What pluralism as opposed to a perfectly unified integrative model offers us, is that not all of our model has to add up seamlessly by a smoothing over the edges or the cracks where different theories do not perfectly align. This is not a return to eclecticism but rather is about creating a model which can be coherently argued, where differences are acknowledged, accepted and valued. A postmodernist approach to integration provides a way out of trying to develop one ‘grand theory’ of unification applicable to all children and all their therapists in all contexts. Instead, I favour what Hauke (2000) refers to as the postmodernist valuing of lots of ‘local truths’. We will each have our own integrative model, each with its own truths applicable to the therapist we are, in the context in which we are working and with the particular child we are seeing and these local truths do not all have to add up neatly (see also Nelson-Jones 2006).
Crittenden, P (2012) puts the case well when she says that psychological treatments are like theories:
‘…none is best. Each is the right solution to some (interpersonal) problem and none is the right solution to everyproblem.’ (bold included by me)
I also value Samuels thinking on pluralism as it can be applied to the broader issue of how integrative child psychotherapy as a profession takes its place alongside other schools or modalities. How do we relate to our psychoanalytic child psychotherapy colleagues? Our arts therapies and counselling colleagues? Our colleagues in the wider field of child well-being?
I concur with Feyerbend’s plea:
‘From a postmodern perspective one of the most important functions that psychotherapy integrative movement can serve is to help theorists and practitioners move beyond the attitude of superiority, contempt, and aversion that frequently arises from the confrontation of adjoining therapeutic cultures towards a sense of surprise and eagerness to learn, which is also a natural human response to difference.’ (cited in Bresler and Starr 2015, p20)
References
Bresler, J and Starr, K (2015) Relational Psychoanalysis and Psychotherapy Integration: An evolving synergy. Routledge.
P, Crittenden (2012) BPS Annual Conference. Youtube https://www.youtube.com/watch?v=XvK35ocdytw&t=2497s
Hauke, C (2000) Jung and the Postmodern: The Interpretation of Realities. London: Routledge
The Child Psychotherapist 