Abstract
The invitation to contribute to this issue on integrative and eclectic psychotherapies gives me an opportunity to reflect on a topic that has hovered unexamined over my clinical practice for a long time. I realize now that I have not attempted to formulate these answers before because they create some anxiety, the reasons for which will become apparent as I continue. At the same time, as I think about the questions this topic raises, I am coming to understand more about my relationship to theory and its use in my clinical work. Surely the ability to tolerate anxiety and explore its sources is the premise of good clinical work? In this last sentence, I am clearly identifying myself as a psychodynamic clinician. The anxiety creeps in when I ask myself to what extent I also practice in an integrative or eclectic fashion. I am uncomfortable with the label eclectic; the word suggests post facto explanations for clinical work that has not been fully thought through. Indeed, I am embarrassed by the memory of a much younger me being asked by a senior clinician, I had met socially, what kind of psychotherapist I was. Even as the words came out of my mouth, I realized that saying ‘‘eclectic’’ was a cop out because I could not articulate my approach at that time in my career. Integrative, on the other hand, suggests knowledge of several different modalities and different theories of mind, recognition of the overlap between them, and an attempt to include those aspects of one that might move clinical work forward; an integrative approach amounts to informed flexibility. Rational as this explanation sounds, the notion of flexibility challenges the different orthodoxies to which I have been exposed at different times in my training, the orthodoxies to which most of us are inevitably exposed during our training. Graduate schools and training institutes rarely teach integrated approaches, faculty members are selected because they represent a particular theory, supervisors because they can oversee clinical work that defines a particular way of practicing, marking them and, consequently their supervisees, as insiders. Orthodoxy is a function of the need to establish an identity. It is not only the need for a unifying theory that can render integrative approaches suspect. Clinicians who combine different psychotherapeutic approaches frequently come under attack. In November 2009, the Washington Post accused therapists of being ‘‘behind the times’’ because, unlike well trained physicians, they do not use the latest scientific findings to guide their technique. Psychologists are singled out for behaving like kids in a candy store: ‘‘They look around, maybe sample a bit, and choose what they like, whatever feels good to them.’’ (Mischel 2009) Although Mischel is targeting psychologists because their graduate training is supposed to follow the Boulder scientist-practitioner model, his comments apply to all mental health professionals who do not adhere strictly to evidence based treatment. Questions about integrative and eclectic choices are anathema to this kind of thinking: Mischel would argue that they encourage the candy store approach. As an undergraduate I would have endorsed Mischel’s criticism enthusiastically. A philosophy major, I felt as if the scales had fallen from my eyes when I was introduced to the British Empiricists. Here were straightforward ways to make sense of human experience that seamlessly transferred to the behavioral psychology to which I was also exposed. In the early nineteen seventies, Social Learning Theory was in its heyday and I was hooked by its simplicity and universality. But when it came to accepting G. Boulanger (&) 242 West 101 Street, New York, NY 10025, USA e-mail: ghislaine242@gmail.com
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