Introduction to the Special Issue: “Psychotherapy Integration” and Cognitive Psychotherapy

Abstract

There has been much recent attention and debate over the possibility of unified or "integrative" approaches to psychotherapy. Cognitive therapy stands at the center of this important controversy. Its unifying nature has been recently highlighted (Alford & Norcross, 1991; Beck, 1991; Lyddon, 1993), and Arnkoff and Glass (1992) comprehensively document how " . . . cognitive therapy has fostered the movement to the integration of psychotherapies." Reflecting this increased attention, a new journal (Journal of Psychotherapy Integration) and two major edited volumes (Norcross & Goldfried, 1992; Strieker & Gold, 1993) have appeared, and a new professional organization has been formed, the Society for the Exploration of Psychotherapy Integration (SEPI). The three areas or foci of integration include technical eclecticism, atheoretical integration, and the identification of common factors (Arkowitz, 1991). Briefly, eclecticism refers to the relatively atheoretical selection of clinical treatments on the basis of predicted efficacy rather than theoretical considerations (Beutler, 1983; Lazarus, 1989). By contrast, integration refers to the conceptual synthesis of diverse theoretical systems as exemplified by the work of Wachtel (1977, 1987). The third approach, common factors, seeks to identify the core ingredients different therapies have in common, with the goal of developing more efficacious treatments based on these components (e.g., Frank, 1973; Garfield, 1980). It should also be noted that-in addition to the three areas cited by Arkowitz (1991)-a fourth (and probably the most important) approach to integration seeks to refine cognitive therapy through the integration of basic psychological science into clinical practice (Alford et al., 1994; Beck, 1991). In seeking consensus and unification, advocates of integration have vigorously promoted the value of diversity in clinical approaches to treatment of psychopathology. Other core values include openness to other perspectives, equality among psychotherapy systems, and a zealous drive to move "beyond the confines" of the contemporary scientific systems of psychotherapy and behavior change (cf. Arkowitz, 1991). Integrationists are emphatic regarding such values, as can be seen in the following comments: (1) It has been the hallmark of those involved in SEPI to remain distant from any signs of conceptual imperialism . . . we would hope that those involved in the pursuit of psychotherapy integration adopt the following French motto: I admire those who search for the truth. I avoid those who find it (Goldfried, Castonguay, & Safran, 1992, p. 611). (2) Psychotherapy integration is not for rigid, ideological clinicians who put their professional narcissism before their client's welfare (J.Norcross, quoted in Dryden, 1991, p. 5). At the same time, there has been much debate regarding whether greater consensus and agreement is possible. For example, A. A. Lazarus concludes that, as a result of psychotherapy integration, "a state of even greater chaos now prevails. Instead of seeking unification, different schools of eclectic and integrative therapies seem to be proliferating" (Lazarus & Messer, 1991, p. 144). However, this may be neither surprising, nor undesirable. Competition among theories is at the heart of the scientific enterprise. Indeed, integrationists themselves would appear to agree on this point. For example, Goldfried (1991) describes the aim of integrationism as follows: "The ultimate goal for research in psychotherapy integration is to develop empirically based procedures . . . which are then demonstrated to be more effective than current pureform therapies" (emphasis added) (p. 21). There now exists a large body of work addressing clinical, experimental, and theoretical issues in the cognitive therapies. Consistent with Goldfried's (1991) point regarding the quest for effectiveness, most of the published work to date has been designed to extend the cognitive approach to the various clinical disorders, thus broadening the scope and empirical support for cognitive therapy. …