Let’s say you’re writing a case study or essay for an integrative or pluralistic course on counselling, psychotherapy, or counselling psychology. You’re using a range of different therapeutic methods and theories—for instance, person-centred practices with attachment-based ideas and some mindfulness techniques—and you have an intuitive sense that it all goes together somehow. But how do you put that down on paper? That is, how do you explain a range of different ideas and practices in a way that is coherent and gives a deeper sense of integration in what you are thinking and doing?
My recent book Integrating counselling & psychotherapy: Directionality, synergy, & social change (Sage, 2019) is an attempt to provide a framework for doing just that (you can find an open-access summary here). And the framework is less of a new theory, and more a way of trying to articulate the implicit assumptions and understandings that many of us have about our work.
The framework starts with the idea that human beings are essentially directional. What that means, drawing on humanistic and existential ethics, is that we are always moving towards something in our lives: always purpose-oriented, always agentic. We’re not blank sheets that get written on (or, at least, not only that), and neither are we machine- or computer-like beings that are determined to act in certain ways. Rather, we act towards our worlds, try to make sense of things, try to do things rather than just being done to. A directional understanding of human beings is pretty much common to all our therapeutic approaches—whether the person-centred actualising tendency, psychodynamic desires, or CBT goals and drives—and is way of understanding our clients that expresses a deep respect for who and how they have come to be: something we would all want to do as the basis for our work.
From a directional standpoint, clients come to us because they are struggling to move forward in their lives. There’s things that they want—whether relatedness, self-worth, inner peace, or more happiness—and in some way, and for some reason, they’re not able to get there. Whatever theories or methods we use, what makes our work coherent is that these are all ways of trying to to help our clients get from where they are to where they want to be.
That’s why many of us are naturally integrative: because we have a sense that there are different ways, from a range of different therapeutic approaches, that can help in that process. For those of us at the pluralistic end of the spectrum, we’re also interested in talking to clients about how they, themselves, think that they can get there: because we want to draw on the wisdom and resources of the client, as well as bringing our own into the mix.
This integration, however, goes deeper than just wanting to help. The directional framework suggests three basic reasons why things can go wrong with people, and hence three ways in which we might try to make it right.
Finding Synergies
The first is that people sometimes struggle to move forward in their lives because there’s other parts of them wanting to go in different directions. For instance, a client wants to deepen their trust and love for their partner, but there’s also part of them holding back: scared of letting go and allowing themselves to be fully in their relationship. Or a client wants to feel better about who they are, but there’s a ‘driver’ or a ‘critic’ part of them that is pushing them to be strong, or more successful—saying that they are never good enough. All the time as therapists we work with these conflicts, and what we do, whatever orientation we are from, is to help clients find more synergetic ways of meeting their needs. What that means is that we try and help clients to find ways in which they can get, for instance, the love that they want, but also feel safe in the relationship; or to feel good about themselves, but also to allow themselves to push forward. Synergetic means ‘win-win’ between our different wants and needs: it means getting A and B, rather than A or B. Our roles, as therapists, is not to take sides in these internal disputes, but to help the client find their own positive reconfigurations. And there’s many, many ways we can do that. So, for instance, our person-centred, listening work might be about providing a client with the space to lay out all the different things they want, but then psychodynamic interpretations might add in some ideas about what they are really striving for and how they go about doing that. For instance:
I can really hear how scared you are of trusting your partner, and I guess that might link to the hurt and rejection you experienced as a child. You knew what it was like to be abandoned, you knew how painful that was, and I can totally see why you would want to protect yourself now. But I guess the cost of it is that you’re finding it difficult to let your partner in.
There’s other idea and practices that we might bring in to support this process of reconfiguration, given the appropriate skills and training. For instance, we might encourage the client’s trusting and distrusting parts to have a dialogue using two-chair work from Gestalt therapy; or we might use creative methods like artwork to help the client express other feelings and strivings. Behind it all, though, is a desire to provide clients with a space to explore their ways of doing things and to help them find better possibilities: more rewarding and more satisfying ways of living, where they are getting more of what they most fundamentally want more of the time.
Being Effective
Sometimes, people just don’t have the best ways of getting to where they want to be. For instance, they want to overcome their anxiety but they do it by drinking or being promiscuous; or they want to improve their relationship but they do it by criticising their partner. Of course, ‘best’ here isn’t some judgement from an external standpoint, and there’s no one best thing for all clients all of the time: some people, for instance, might find promiscuity really helps with their anxieties. But it’s just that, for ourselves, and by our own standards, we don’t always do things in the ways that are going to help us most. So, from the directional framework, the second thing that a therapists can do is to help clients learn more effective ways of getting to where they want to be.
Just to reiterate, as a person-centred-ish therapist, I do hate to use the word ‘better’. I know it can seen really judgmental and inconsistent with the idea of a person as an actualising being. But it depends a lot on how we understand actualisation. From a directional standpoint, we do always understand people as striving to maintain and enhance themselves (as Carl Rogers would say), and there’s a strong sense of the person as an ever-growing and evolving organism. But, as even most person-centred therapists I’m sure would acknowledge, the fact that we are always striving to do our best doesn’t mean that what we are doing is, genuinely, the best thing for us. Indeed, if it was, there wouldn’t be any point to therapy at all.
So, as integrative or pluralistic therapists, there’s various ways in which we might help clients find better ways of doing things. And this might range from very client-centred ways (for instance, providing the client with a space to talk and reflect), to more therapist-led and psychoeducational ways: for instance, suggesting mindfulness exercises or coping strategies. This is where CBT methods and techniques can come in as particular helpful. And although such practices might seem diametrically opposed to person-centred approaches; from a directional standpoint they’re simply different ways of helping clients to ‘find better’. Just like if we were learning a new language: some of the learning comes from outside (discovering, for instance, new Spanish words for things), but also time to process internally and to make sense of things ourselves.
Social Change
The third reason we don’t always get what we want, in the directional framework, is less something we can do about as therapists, but nonetheless important to acknowledge. Sometimes, clients don’t get where they want to be because of social impediments. For instance, a woman wants to feel successful at work but actually there’s a ‘glass ceiling’ that stops her from being able to reach the level she should. Or a black person feels unsafe walking around the streets because of the very real racism that is out there in the world. As therapists, we can help clients work out what is best for them to do within these limitations, and we might also help them feel more personally empowered. But, to a greater or lesser extent, what these problems call for may be wider social, political, and economic action—and that’s perhaps something we can only facilitate from outside of our therapeutic role.
Conclusion
Sometimes integrative and pluralistic practices can feel fragmented, and we’re not always clear why we’re doing what we’re doing. That can be particularly hard if we have to explain (or justify) it to someone else. The point of this blog is not to create some new account of integrative practices that therapists can hang on to. Rather, it’s to try and dig down and to articulate what some of our implicit assumptions and practices might be if we’re working integratively or pluralistically. Some of the language of the directional framework is a bit technical (‘synergies’, ‘directionality’, etc), but the basic idea is very simple: that all of us, as therapists, are trying to help clients get from where they are to where they want to be, and when we’re integrating we’re drawing on different ideas and methods to try and do that as best as we possibly can.
Reference
You can reference this blog post as:
Cooper, M. (2021, April 10). How to explain integrative practices: A directional account. https://mick-cooper.squarespace.com/new-blog/2021/4/10/how-to-explain-integrative-practices-a-directional-account
[Photo by Stephen Hocking on Unsplash]