[ Pobierz całość w formacie PDF ]
.As we have argued elsewhere(Power and Dalgleish 1997), there is no necessary one-to-one correspondence betweentheory and practice in the psychotherapies.Many theories could generate many prac-tices, and many practices could be based on many theories.The differences between thetherapies are in many ways more accidental than deliberate and get over-emphasized forboth political and research-driven reasons.Good practice on the ground does not hon-our these artificial barriers and is not based on textbook simplifications of therapy.Final comments and conclusionsTo conclude that there are no significant differences between the various types of ther-apy is a conclusion that attempts to prove the null hypothesis, which, as any statisticallyminded individual will tell you, is not the way to proceed in research.In fact, the appear-ance of such a conclusion as a consequence of meta-analytic studies or large outcomestudies such as the NIMH Collaborative Depression Study, necessitates a number ofimportant qualifications to the all have won and therefore anybody can do anythingconclusion.One of the most crucial qualifications relates to the therapist s skill in estab-lishing a therapeutic alliance.What little evidence there is suggests that therapists of allpersuasions have particular difficulty with patients who are negative and who expresshostility in therapy; the failure to establish an alliance may be the most important factorthat contributes to negative outcome in therapy, that is, the fact that a proportion ofpatients get worse rather than better.However, it may only be when a therapeutic alli-ance is established that additional effects of specific techniques for specific problems canemerge.Even outcome studies which manualize treatments and assess therapist adher-ence to these treatments do not generally assess factors such as the quality of the allianceor other factors common to all therapies.At a more general level, the Grand Unified Theory of psychological therapies, is, as inphysics, a long way off.Nevertheless, there are positive signs: a broad-based cognitivemodel seems capable of incorporating the strengths of both traditional learningapproaches and psychoanalysis while overcoming some of their limitations.Any such INTEGRATIVE THERAPY FROM A COGNITIVE BEHAVIOURAL PERSPECTIVE | 47cognitive model is substantially different to the current models that underpin CBTapproaches, because of the need to incorporate, for example, both modern learning the-ory and a cognitive version of the dynamic unconscious.The theory also needs to pro-vide a framework in which to view the great diversity and ever-increasing number ofpsychotherapies.Only then will we understand what distinguishes the good underwatermassage therapist from the bad behaviour therapist and vice versa and understandwhy each may be useful in the right place.Finally, it should be noted that in terms of the history of the psychotherapy integra-tion movement, the approach taken here is an example of the common factors and theo-retical integration viewpoint (Norcross 1992).Although many therapists now adopt aso-called technical eclecticism in that they may use techniques and procedures fromdifferent approaches without adopting a particular theory, our approach has been toargue strongly for the possibility of theoretical integration (e.g.Power and Dalgleish1997).As agreed throughout this chapter, the CBT approach already represents an inte-gration of behavioural and cognitive viewpoints which have at times in the past been atwar with each other.Part of this integration has occurred because practitioners came toignore some of the earlier theoretical arguments.Hopefully, the more recent integrativetheories will equal clinical experience in their richness, and offer further hope ofprogress. This page intentionally left blank Chapter 4Integrative therapy from a systemicperspectiveEia AsenIntroductionThe term systemic perspective requires some explanation.A system is any unit struc-tured by and around feedback (Bateson 1972).It is made up of interacting parts whichmutually influence one another, forming patterns of behaviour and communication.When two or more people interact, they are involved in a joint construction of actionsand meanings.This relationship is an evolving one, with each person influencing theother and being in turn influenced by the other s responses and actions.Any action isviewed as a response and any response can be conceptualized as an action.In that sensethere is, like in a circle, no identifiable beginning or end to any interaction: it really isimpossible to say whether chicken or egg came first.Such circularities are characteristicof relationship patterns and these are governed by explicit and implicit rules, establishedover time through the process of constant feedback (Watzlawick et al.1967).The contextwithin which such feedback takes places is of importance: this refers not only to the fam-ily, but also the social and cultural context within which families live.The notion of a systemic perspective entails the idea that there is a whole multi-verse of different per-spectives from which to view a person s specific problems: individual, couple, family,extended family, social setting, cultural and religious context, economic and politicallarger system.This multi-level view of a person s predicament is what can be summa-rized as a systemic perspective.In terms of psychotherapeutic practice, systemic thera-pists will consider interventions that take into account context and the different levels ofthe system.The development of systemic therapiesOne of the major influences for the development of the systemic therapies came from agroup of researchers and clinicians in Palo Alto (Bateson et al.1956) [ Pobierz całość w formacie PDF ]
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.As we have argued elsewhere(Power and Dalgleish 1997), there is no necessary one-to-one correspondence betweentheory and practice in the psychotherapies.Many theories could generate many prac-tices, and many practices could be based on many theories.The differences between thetherapies are in many ways more accidental than deliberate and get over-emphasized forboth political and research-driven reasons.Good practice on the ground does not hon-our these artificial barriers and is not based on textbook simplifications of therapy.Final comments and conclusionsTo conclude that there are no significant differences between the various types of ther-apy is a conclusion that attempts to prove the null hypothesis, which, as any statisticallyminded individual will tell you, is not the way to proceed in research.In fact, the appear-ance of such a conclusion as a consequence of meta-analytic studies or large outcomestudies such as the NIMH Collaborative Depression Study, necessitates a number ofimportant qualifications to the all have won and therefore anybody can do anythingconclusion.One of the most crucial qualifications relates to the therapist s skill in estab-lishing a therapeutic alliance.What little evidence there is suggests that therapists of allpersuasions have particular difficulty with patients who are negative and who expresshostility in therapy; the failure to establish an alliance may be the most important factorthat contributes to negative outcome in therapy, that is, the fact that a proportion ofpatients get worse rather than better.However, it may only be when a therapeutic alli-ance is established that additional effects of specific techniques for specific problems canemerge.Even outcome studies which manualize treatments and assess therapist adher-ence to these treatments do not generally assess factors such as the quality of the allianceor other factors common to all therapies.At a more general level, the Grand Unified Theory of psychological therapies, is, as inphysics, a long way off.Nevertheless, there are positive signs: a broad-based cognitivemodel seems capable of incorporating the strengths of both traditional learningapproaches and psychoanalysis while overcoming some of their limitations.Any such INTEGRATIVE THERAPY FROM A COGNITIVE BEHAVIOURAL PERSPECTIVE | 47cognitive model is substantially different to the current models that underpin CBTapproaches, because of the need to incorporate, for example, both modern learning the-ory and a cognitive version of the dynamic unconscious.The theory also needs to pro-vide a framework in which to view the great diversity and ever-increasing number ofpsychotherapies.Only then will we understand what distinguishes the good underwatermassage therapist from the bad behaviour therapist and vice versa and understandwhy each may be useful in the right place.Finally, it should be noted that in terms of the history of the psychotherapy integra-tion movement, the approach taken here is an example of the common factors and theo-retical integration viewpoint (Norcross 1992).Although many therapists now adopt aso-called technical eclecticism in that they may use techniques and procedures fromdifferent approaches without adopting a particular theory, our approach has been toargue strongly for the possibility of theoretical integration (e.g.Power and Dalgleish1997).As agreed throughout this chapter, the CBT approach already represents an inte-gration of behavioural and cognitive viewpoints which have at times in the past been atwar with each other.Part of this integration has occurred because practitioners came toignore some of the earlier theoretical arguments.Hopefully, the more recent integrativetheories will equal clinical experience in their richness, and offer further hope ofprogress. This page intentionally left blank Chapter 4Integrative therapy from a systemicperspectiveEia AsenIntroductionThe term systemic perspective requires some explanation.A system is any unit struc-tured by and around feedback (Bateson 1972).It is made up of interacting parts whichmutually influence one another, forming patterns of behaviour and communication.When two or more people interact, they are involved in a joint construction of actionsand meanings.This relationship is an evolving one, with each person influencing theother and being in turn influenced by the other s responses and actions.Any action isviewed as a response and any response can be conceptualized as an action.In that sensethere is, like in a circle, no identifiable beginning or end to any interaction: it really isimpossible to say whether chicken or egg came first.Such circularities are characteristicof relationship patterns and these are governed by explicit and implicit rules, establishedover time through the process of constant feedback (Watzlawick et al.1967).The contextwithin which such feedback takes places is of importance: this refers not only to the fam-ily, but also the social and cultural context within which families live.The notion of a systemic perspective entails the idea that there is a whole multi-verse of different per-spectives from which to view a person s specific problems: individual, couple, family,extended family, social setting, cultural and religious context, economic and politicallarger system.This multi-level view of a person s predicament is what can be summa-rized as a systemic perspective.In terms of psychotherapeutic practice, systemic thera-pists will consider interventions that take into account context and the different levels ofthe system.The development of systemic therapiesOne of the major influences for the development of the systemic therapies came from agroup of researchers and clinicians in Palo Alto (Bateson et al.1956) [ Pobierz całość w formacie PDF ]