The People's Therapist

On my private practice website it says, right after my name, “Integrative Psychotherapy.” A number of people have asked me what the heck that means. Good question.

There’s room for argument, but so far as I’m concerned, there are two chief meanings.

The first is a bit technical.  It means I integrate the two leading schools of psychotherapy – psychodynamic and cognitive-behavioral – into one eclectic approach.

Huh?

You can think of the two schools as vertical versus horizontal.

Psychodynamic work is vertical.  It involves digging down into your past, looking for the root sources of your behaviors.  When I work psychodynamically, I’m wondering when you started thinking or feeling a certain way.  I want to make you aware of how the environment in which you grew up shaped the person you are.

If you always seem to expect honesty to be received with punishment, and so avoid telling people what you really think, I’ll wonder where that pattern started.  Maybe you had a punishing parent, who responded harshly to being told the truth because she had trouble tolerating the reality of a situation.  You may have observed that response to you when you were a kid, spotted a feedback loop of sorts (telling truth = bad response), and formed expectations.  These expectations let you to adapt a strategy for survival (avoid telling truth = avoid bad response.)  These sorts of strategies – learned behaviors – may continue to take over unconsciously today and lead you to sabotage your conscious goals in life.  To address that situation, you need to understand where and when they started, so you can decide if you’d like to abandon learned behaviors which have become maladaptive to your life as an adult.

Cognitive-behavioral work, in contrast,  is horizontal.  I’m not so worried about the source of the behavior – I’m dealing with the here and now, trying to make you more conscious of your current thoughts and how they’re controlling your actions.

If you have a phobia about flying in airplanes, I will likely employ cognitive-behavioral techniques to make you conscious of the thoughts – predictions – that are frightening you.  These thoughts are like tapes that play in your head – if you become aware of them, you can turn them off, and play another tape that will soothe you instead of freaking you out.

You might have a fear of plunging from a great height if a plane crashes.  Once you understand that thought, you can reality-test it.  Yes, it could happen that you would plunge in a plane accident, but it is exceedingly unlikely, since you’d most likely die quickly or fall unconscious – and in any case, it might be a risk worth taking, once you balance the enormous benefits of air travel against the very small risks of a crash.   You could learn to formulate counter-messages to address frightening thoughts, perhaps something like “I’ve chosen to take a tiny risk because I want to see the world.  I’m okay with that small risk, and can relax now and accept that I cannot control everything, and there is risk involved in all aspects of life – risk that need not lock me up in fear.”

Some psychotherapists – especially in the past – fought over the superiority of psychodynamic versus cognitive-behavioral approaches.  That’s mostly old-hat at this point.  The two techniques are considered tools in a toolbox – options for treatment, depending on what the therapist thinks is most likely to be effective and useful for the individual client in question.  They are often complementary – two great psychotherapeutic approaches that taste great together.

Modern psychotherapy at its best is integrative, and eager to accept diverse, worthy approaches.  Speaking for myself – I’ll use anything that works and helps my clients.

The second meaning of “integrative” with regard to psychotherapy refers to the greater purpose of the entire exercise – to integrate the unconscious into the conscious ego.

Huh?

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