Last updated on 23rd January 2012
Here's my brand new "two-seven-two" model of integrative psychotherapy. How do I know it's so fresh off the press? Well I just came up with it lying warmly in bed an hour or so ago. It's "serious" in the sense that I have been mulling over what I actually do as a therapist, and how I might categorise the different methods that I use. I certainly qualify as "experienced". My first work in "psychotherapy" (if you could call it that) was co-facilitating drop-in encounter groups while I was still a medical student in 1974. That gives me about 38 years in the field, so I guess I've seen a fair amount. The popularity of specific psychotherapy approaches sometimes seems to come and go a bit like a slowed version of changes in hemline fashion. My core approach is cognitive-behavioural because that's currently where there's the most solid evidence base. Times change though. CBT evolves and other psychotherapy methods are increasingly getting their research hats on and showing that they too have good interventions to offer. I am integrative, as CBT itself is becoming. I think there are good reasons for encouraging this kind of diversification - see, for example, my post "Orlinsky & Ronnestad's 'How psychotherapists develop': three key recommendations for maintaining effectiveness".
So what's the "two-seven-two" model? The initial two is the combination of an overall problem-solving approach and a deep valuing of the therapeutic alliance. These two components intertwine. I see the therapeutic/working alliance as involving Horvath's triad of agreement on the goals of therapy, agreement on what feel effective methods to use to reach these goals, and being good fellow-travellers - in tune and relating with warmth & respect. John Norcross's recent overview of "The therapeutic relationship" in the multi-authored, 2010 edition of "The heart & soul of change: delivering what works in therapy" underlines the importance of the alliance. The problem-solving diagram I put together from what the client tells me at our initial session(s) ensures that the therapeutic goals that they personally choose remain centre stage in our work. To elicit these goals I often ask questions like "Let's imagine that we see each other over several sessions and that you're really pleased with how things have gone. What would you want to have achieved? What changes, what improvements would you most want to have made?"
If you look at a PDF of the problem-solving diagram I most typically use, you'll see that there is space on the lower half of the page for a variety of therapeutic approaches to be jotted down. Here's where the "seven" section of of the "two-seven-two" model comes in. Three of these therapeutic approaches are probably common to many therapists; four of them are maybe less routinely used. The three more usual components could be described as outer (current) problem solving, inner (current) problem solving, and tackling the "ball & chain". So, often a client presents with a particular life difficulty - maybe a relationship that is going wrong, or a conflict at work, or a feeling of being depressed, or some other experience that they want to change. I will typically explore with them what they could do to tackle the outer situation better and whether they also would benefit from working on their possibly somewhat dysfunctional internal responses. The outer work might - for example - involve couple therapy, or job hunting, or behavioural activation, while the inner work might - for example - involve reappraisal methods, or mindfulness training, or a focus on developing self-compassion. The "ball & chain" focus would be used if it seemed that the effects of past experiences - possibly childhood or other trauma - needed to be addressed to allow the client to move forward adequately in their current life situation.
I'll write the second half of this "two-seven-two" integrative model post tomorrow.