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Journal of Psychotherapy Integration - Vol 27, Iss 3

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Journal of Psychotherapy Integration Journal of Psychotherapy Integration is the official journal of SEPI, the Society for the Exploration of Psychotherapy Integration. The journal is devoted to publishing original peer-reviewed papers that move beyond the confines of single-school or single-theory approaches to psychotherapy and behavior change, and that significantly advance our knoweldge of psychotherapy integration. The journal publishes papers presenting new data, theory, or clinical techniques relevant to psychotherapy integration, as well as papers that review existing work in the area.
Copyright 2017 American Psychological Association
  • Integrative research for integrative practice: A plea for respectful collaboration across clinician and researcher roles.
    In recent decades, the field of psychology has experienced a kind of continental drift, resulting in a widening segregation between subdisciplines and schools of thought. The ever-increasing daily demands of the academic scientist and the practicing clinician provide scarce time for members of one group to maintain exposure to and understanding of the other. As this divide continues to grow, systemic group dynamics can develop, silently creating more distance in the best cases, and fostering unproductive contempt in the worst. In this article, I elaborate on this perceived estrangement and propose ways to reverse the divide between researchers and clinicians, to the possible benefit of both parties. Reducing the current chasm between the worlds of researchers and clinicians is not merely a proposed remedy for the continuous fragmentation of our mutual field, but is also necessary for putting integrated psychotherapy squarely in the center of the public’s consciousness, permitting the consideration of mental health options that go beyond constrained time-limited treatments and medication management. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Contextualized integration as a common playing field for clinicians and researchers: Comment on McWilliams.
    We comment on McWilliams’s (2016) article, “Integrative Research for Integrative Practice: A Plea for Respectful Collaboration Across Clinician and Researcher Roles.” Above all, we appreciate McWilliams’s well-toned plea for considerate collaboration between researchers and clinicians. We also appreciate that obstacles have long made it difficult to meaningfully reduce the scientist–practitioner chasm, and McWilliams shrewdly highlights how some obstacles are becoming even more daunting to traverse. In general, we agreed with most of McWilliams’s points. We also provide some respectful challenges or at least extensions or reframes. For example, to us, the researcher–practitioner divide is more than just an urgent conversation problem; rather, it has potential to do harm to patients. Also, although we too appreciate relational factors in the psychotherapy evidence base, it seems important to refrain from contributing to the artificial relational–specific factor dichotomy. We present a resolution of this divide, which we call content-responsive psychotherapy integration (Constantino, Boswell, Bernecker, & Castonguay, 2013). We also offer possible versions of efficient and immediately translational trainings, arguing against continued self- or peer-nominated experts passing down wisdom in long-form in-services. Similarly, while we champion hearing from “reputable” clinicians about important research topics, we believe that the determination of reputable needs to be based on clinicians’ personal outcomes data. We also argue that it is important to move beyond the 4 established integration pathways by pushing for disruptive integrative innovations. Ultimately, our goal is to help locate the common playing field for researchers and clinicians and the most efficient ways to play together on it. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Trainee perspectives on issues of psychotherapy integration across research and practice: Comment on McWilliams.
    As students of clinical psychology, we comment on McWilliams’s (this issue) article, “Integrative Research for Integrative Practice: A Plea for Respectful Collaboration Across Clinician and Researcher Roles.” McWilliams touches upon a number of contentious areas within the field of clinical psychology with implications for research, practice, and integration as they relate to psychotherapy. We are in agreement with McWilliams across a variety of her concerns, and hope to add to the conversation on contemporary issues in psychotherapy integration by bringing trainee viewpoints to the table. In our commentary, we discuss our thoughts regarding the role graduate training program environments and culture may play in initiating and sustaining issues that divide research and practice. Among other issues, we discuss our concerns related to theoretical orientations and the need for greater emphases on common factors across training programs. Additionally, we comment on the importance of both clinician and researcher understanding of the constraints placed on each other’s respective fields by external pressures (e.g., third-party insurers, research funding), and the lack of information often dispensed at the graduate training level related to these domains. We hope that our comments emphasize considerations that may not have received attention in the field, and are taken in context as only one perspective of many on the state of psychotherapy integration. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Research–practice and practice–research gaps: Commentary on McWilliams’ perspective.
    McWilliams (2016) nicely articulated many of the issues related to the research–practice and practice–research gaps. In this reply, I focus on 2 keys to addressing these gaps. Specifically, I discuss the ways in which we communicate as a community as well as how we communicate with the public. Additionally, I focus on moving into the next generation of technology to enhance the effectiveness of psychotherapy and training with a focus on how we are educated in research methods. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Clinician-researcher collaborations: Making the dream come true. Perspectives from Argentina on McWilliams.
    The article comments on Nancy McWillams’s paper on a plea for collaboration between clinicians and researchers. It highlights the contributions of an expert psychotherapist in raising awareness of the obstacles that hinder the interaction of clinicians and researchers for mutual benefit. It presents an overview of clinicians’ and researchers’ roles in Argentina, the efforts to overcome the researcher–clinician divide, and the proposal of the Aiglé Project to bridge the gap. A brief outline of Society for the Exploration of Psychotherapy Integration (SEPI)’s mission to contribute in this direction is presented. The commentary finalizes with a brief summary of the ways to promote two-way communication. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Response to McWilliams: Commentary from a practicing therapist.
    McWilliams addresses many of the problems that psychologists face in practice and in research. She emphasizes the importance of integrating evidence from research in practice, but expresses caution about the strict use of clinical treatment guidelines. While agreeing with her concern, this commentary examines, from the perspective of a clinician, underlying epistemological factors implicit in her article. It uses an example from the author’s practice to illustrate and underscore the importance of understanding underlying cognitive assumptions in order to provide care that is consistent with the best research has to offer. It also expresses its own cautions about the interpretation and application of research in practice. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Neutrality revisited: On the value of being neutral within an empathic atmosphere.
    Using psychoanalysis as a starting point, we explore the value of therapeutic neutrality in psychotherapies that seek to foster self-understanding, experiencing, and insight. Contrary to much of the current zeitgeist, therapist neutrality is posited to be a key element of effective psychotherapy in such approaches. We suggest 5 meanings of effective therapeutic neutrality: The therapist (a) takes, at least in part, an observer position in the relationship; (b) refrains from taking sides in the patient’s inner struggles; (c) also does not take sides in the patient’s relational struggles; (d) refrains from manipulating the patient into emotional expression; and (e) follows some guidelines about when to directly gratify the patient’s dependency and affectional needs/demands. Rules of thumb are presented about the conditions under which direct gratification is called for. However, as a bottom line, if neutrality is to be an effective stance in any psychotherapy, it must be carried out in the context of empathy, caring, and affirmation. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • The ambiguities of neutrality: Comment on Gelso and Kanninen (2017).
    This article reexamines the concepts of neutrality and abstinence in light of Gelso and Kanninen’s advocacy of a return to greater focus on these factors in the practice of psychotherapy. In considering Gelso and Kanninen’s arguments, it finds them to be too strongly weighed toward consideration of the ways departing from neutrality impedes the therapeutic process and insufficiently attentive to the at least equally significant problems in adhering to the neutral, abstinent stance. The article also considers the ways in which their framing therapy in terms of neutrality and abstinence generates a problematic tendency to view patients as making “demands” for inappropriate “gratifications.” An alternative understanding is introduced in which a broader range of ways of engaging the patient is permitted, with some patients at some times being most helped by the stance Gelso and Kanninen advocate but many others thriving in response to quite different ways of participating in the therapeutic relationship. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • The emotion-focused therapeutic relationship: Genuineness, warmth, and acceptance are not neutral: Comment on Gelso and Kanninen (2017).
    A commentary is offered in response to Gelso and Kanninen’s “Neutrality Revisited: On the Value of Being Neutral within an Empathic Atmosphere.” Adopting an emotion-focused relational framework, it is argued that the core relational conditions of genuineness, unconditional acceptance, and empathy, together with a strong therapeutic presence, are active states that to some extent run counter to the psychodynamic concept of analytic neutrality. The author examines the many different facets of analytic neutrality that are offered by Gelso and Kanninen and considers whether they are consistent with or provide additional support for humanistic–experiential, emotion-focused therapy. It is concluded that the client-centered relational conditions, the basis of the emotion-focused relationship, are essential and amply guide therapists in providing a strong therapeutic relationship that is associated with positive outcome. Together with the emotion-focused change principles, the relational conditions offer strong rules of thumb that guide therapists to create the relational atmosphere necessary to promote emotional change. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Understandings and misunderstandings about neutrality in an empathic context: Reply to Wachtel (2017) and Goldman (2017).
    Paul Wachtel (2017) and Rhonda Goldman (2017) have provided thoughtful critiques of our concept of the importance of therapist neutrality within an empathic context. Although there are many points of agreement, our reply highlights our disagreements with these reactions. When accompanied by flexible guidelines, not conflated with uncaring indifference, and offered in a context of what we term an empathic atmosphere, neutrality is a highly effective therapeutic stance. In contrast to Wachtel, we conclude that the therapist can indeed get far in neutral, so long as it is a benevolent neutrality that is marked by therapist empathy, caring, and affirmation. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Psychological flexibility, attachment style, and personality organization: Correlations between constructs of differing approaches.
    Psychological flexibility is a theoretical construct associated with acceptance and commitment therapy, a “third wave” cognitive–behavioral therapy treatment focusing on mindfulness and acceptance of aversive internal events. Psychological flexibility has been thoroughly investigated in clinical and nonclinical populations. However, very little research has been done pertaining to the possible relationships between psychological flexibility and attachment style. Similarly, there is no research investigating the potential link between psychological flexibility and constructs associated with a psychodynamic formulation of personality organization, particularly identity integration and defensive operations. We hypothesized that psychological flexibility would be negatively correlated with attachment anxiety and attachment avoidance, as well as being negatively correlated with primitive defenses and identity diffusion. Our hypotheses were largely confirmed, with several significant correlations found. Psychological flexibility was negatively correlated with attachment anxiety, as well as being negatively correlated with primitive defenses and identity diffusion. We discuss these findings in terms of clinical practice and directions for future research. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Therapist use of specific and nonspecific strategies across two affect-focused psychotherapies for depression: Role of adherence monitoring.
    Psychotherapists routinely use both specific and nonspecific strategies to deliver empirically supported treatments (ESTs). Psychotherapy adherence monitoring has traditionally focused on assessing therapist use of EST-specific strategies (to distinguish between ESTs), paying less attention to nonspecific techniques common to multiple psychotherapies. This study used the Collaborative Study Psychotherapy Rating Scale (CSPRS) to evaluate therapist use of both specific and nonspecific techniques in 2 affect-focused ESTs for depression. Blinded raters evaluated 180 recorded sessions of interpersonal psychotherapy (IPT) and brief supportive psychotherapy (BSP). Because IPT and BSP both emphasize attention to affective states and developing a warm therapy relationship, we expected overlap across scales measuring therapist warmth, empathy, and focus on feelings. In contrast, we expected differences in scales measuring therapist directiveness, as well as IPT- and BSP-specific interventions. Results showed raters displayed good interrater reliability on primary subscales and could discriminate between 2 treatments with considerable overlap. Both IPT and BSP therapists used similarly high levels of nonspecific, facilitative interventions. Expectedly, IPT therapists were more directive and used more IPT-specific strategies, while BSP therapists utilized more nondirective, supportive strategies. Unexpectedly, BSP therapists showed greater focus on feelings than IPT therapists. Exploratory analyses suggested that greater focus on feelings in early sessions was associated with greater depressive symptom reduction in the first 8 weeks of treatment for both ESTs. Additional treatment adherence research is needed to investigate both shared and distinctive features of ESTs, as well as the effect of the relative use of specific versus nonspecific interventions on psychotherapy outcomes. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Divergence and convergence: An examination of cognitive–behavioral and dynamic therapies, theoretical and clinical perspectives.
    Meta-analytic research has highlighted the clinical similarity in outcome between psychodynamic and cognitive–behavioral therapies (Leichsenring, 2001; Stiles, Barkham, Mellor-Clark, & Connell, 2008), yet patients’ understanding of the 2 therapies is qualitatively different (Nilsson, Svensson, Sandell, & Clinton, 2007). Through common mechanistic factors exemplified in the pioneering works of Aaron Beck, Steven Hayes, Keith Dobson, Hanna Segal, Peter Fonagy, and Donald Winnicott, among others, this article discusses the theoretical convergence of cognitive and psychodynamic therapy through the aid of illuminative clinical material that will contrast the mechanistic similarities and differences between the 2 therapies. A central aim of this article is to better inform early career trainee therapists of the structural overlap and divergence between the 2 theoretical orientations that are often seen as squarely oppositional in function and practice. Four theoretical platforms will be presented that identify both common factors between the 2 therapies, as well as sharp divergent models of change, with direct clinical relevance and case examples: absolutism versus multiplicity, the “healthy” dissociation, “self as change” (modeled through top-down vs. bottom-up processing routes), and developmental considerations. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Wise additions bridge the gap between social psychology and clinical practice: Cognitive-behavioral therapy as an exemplar.
    Progress in clinical science, theory, and practice requires the integration of advances from multiple fields of psychology, but much integration remains to be done. The current article seeks to address the specific gap that exists between basic social psychological theories and the implementation of related therapeutic techniques. We propose several “wise additions,” based upon the principles outlined by Walton (2014), intended to bridge current social psychological research with clinical psychological therapeutic practice using cognitive-behavioral therapy as an example. We consider how recent advances in social psychological theories can inform the development and implementation of wise additions in clinical case conceptualization and interventions. We specifically focus on self and identity, self-affirmation, transference, social identity, and embodied cognition—5 dominant areas of interest in the field that have clear clinical applications. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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