Psychotherapy Integration Research Articles

Introduction to In Session special issue: Psychotherapy for complex PTSD.

Complex Posttraumatic Stress Disorder (CPTSD) is a condition resulting from exposure to chronic, interpersonal traumatic events, in which some form of control or power dynamics existed. Its clinical picture includes the main symptom clusters of posttraumatic stress disorder, accompanied by dysregulated emotion, problems in interpersonal relationships, and difficulties in identity integration. In addition, both clinical work and research have shown CPTSD to include highly distressing and complicated psychological phenomena, such as identification with the aggressor, various forms of dissociation, self-harmand self-destructive behaviors, and more. Due to this highly complex and multilayered clinical picture, the treatment of CPTSD poses a significant clinical challenge to therapists. In this special issue of In Session, we present a series of case studies, each representing a different therapeutic approach to CPTSD (e.g., skills training for affective and interpersonal regulation, Eye Movement Desensitization and Reprocessing, psychodynamic, integrative psychotherapy). These cases also represent a wide variety of patient populations, as well as different types of underlying traumatic events. Together, they reveal the breadth of clinical possibilities currently available to trauma therapists encountering cases of CPTSD. They also highlight the challenges and dilemmas that clinicians often face when treating this condition, as well as ways to overcome those.

SPECIAL ISSUE: The ACT of Biofeedback—Training for Psychological Flexibility

This paper examines the innovative integration of acceptance and commitment therapy (ACT) principles with biofeedback methodologies, presenting a novel approach to psychophysiological therapy. This paper uses Kevin Polk’s structured ACT matrix approach to elucidate how biofeedback can augment ACT processes, including acceptance, cognitive defusion, and present-moment awareness. The paper explicates practical techniques such as the “Hook Words Exercise” and “Verbal Aikido,” demonstrating their application within a biofeedback-enhanced therapeutic context. This integrative approach represents a significant advancement in psychophysiological interventions, offering a comprehensive framework for deepening interoceptive awareness and fostering psychological flexibility and value-aligned living while bridging the gap between cognitive processes and physiological responses. By exemplifying assimilative integration in psychotherapy, this approach offers a promising avenue for advancing both clinical practice and research in psychophysiological interventions, potentially improving therapeutic outcomes and client engagement.

Partners in crime: Integrating forensic psychotherapy into criminological discourse

This article advocates for the integration of forensic psychotherapy into criminology to deepen our understanding of criminal behaviour, particularly serious youth violence. Despite historical interest in psychoanalytic explanations for criminal behaviour, the exploration of unconscious motivations has been marginalised. Our article emphasises the need to consider both inner psyche and external social factors by drawing on contemporary theorising in the field of psychosocial criminology and forensic psychotherapy. By presenting the case study of Rob, a young person with a history of violence, we highlight the role of forensic psychotherapy in better understanding the motivations behind an individual's violent behaviour. By adopting a case study approach, we highlight the limitations of solely attributing offending behaviour to structural inequalities. This article therefore calls for a broader consideration of forensic psychotherapeutic modalities in criminological thinking to offer more comprehensive explanations for serious youth violence. This shift towards a more holistic understanding holds promise for more effective prevention and rehabilitation strategies in the field of youth justice.

The heart of healing: Echoes of Sándor Ferenczi's legacy in Jeremy Safran's relational commitments.

In this duet of two voices honoring Jeremy Safran's legacy, the authors celebrate some points of resonance between Sándor Ferenczi's groundbreaking relational interventions and Safran's approach to the therapeutic relationship as the heart of healing. Karen Starr first highlights Ferenczi's now well-knowncreative experimentation with technique and his emphasis on and care for the relational dimension of psychoanalytic treatment. Jill Bresler then links Safran's career-long dedication to the therapeutic alliance to Starr's introductory remarks, honoring Safran and Ferenczi's shared dedication to expanding options in clinical practice through focus on the relationship. Recalling Safran's naming Ferenczi as a key figure in psychotherapy integration's origin story, Bresler reflects on her own learning from Safran's groundbreaking transtheoretical research into the mutative aspects of psychotherapy and his translating apsychoanalytic focus on the therapeutic relationship to CBT researchers and practitioners.

Remembering Jeremy Safran: continuing the conversation.

This introduction provides an overview to this special issue honoring the work and legacy of Jeremy D. Safran. Born of the Jeremy Safran Memorial Conference, held on April 2nd, 2023, this issue features a wide range of contributions from leaders in the field, former students, and early career professionals whose work engages and develops central ideas from Safran's work and reflects on his impact on their own clinical work and scholarship. Themes center around the three domains of Safran's major contributions: pedagogy; psychotherapy integration; and Buddhism, spirituality, and psychoanalysis. We observe among the contributions an experiential reconnecting with the deeply relational commitments of our friend and colleague.

Intake Characteristics as Predictors of Psychotherapy Outcome in a Practice Research Network in Argentina

There are few studies exploring intake diagnostic characteristics as predictors of change in integrative naturalistic settings. The aim of this study is to explore baseline variables at the intake process and establish the predictive value of the individual trajectories of the patients. We recruited 259 patients undergoing an integrative psychotherapy network of psychotherapists from Buenos Aires, Argentina. Every therapist completed the intake form of each patient involved in the routine outcome monitoring. Thereafter step-wise regressions based on forward selection strategies were used, in order to identify meaningful baseline predictors of patients’ clinical evolution, derived from the intake process. The selected predictors were social support network, subjective distress, the initial measure of clinical distress, unemployment, sociocultural status and reactance. When including those six variables in a multilevel model, the results indicate that social support network, subjective distress, and the initial measure of clinical distress were significant predictors of the trajectories of OQ-30, whereas unemployment, sociocultural status and reactance were not significant. The results regarding social support network are in line with the literature, while results of socioeconomic status (unemployment and sociocultural level) move in an opposite direction in comparison to the available evidence. Moreover, the mental health findings (initial OQ-30 and subjective distress) confirm the contradictory body of literature produced in this domain. Finally, reactance seems to be a significant predictor in previous study in contradiction of our results. Overall, this endeavor constitutes important but preliminary evidence to enhance the production of bottom-up science within practice research networks in the global south.

Methodological bases of integration of Positive Psychotherapy with modern directions of psychotherapeutic assistance

Methodological bases of integration of Positive Psychotherapy with modern directions of psychotherapeutic assistance

Integrating behavioral, psychodynamic, recovery-oriented, and trauma-informed principles to decrease aggressive behavior in inpatient care.

Positive behavioral support plans have been employed since the 1980s in the service of those with developmental disabilities and in school systems and show efficacy for decreasing challenging behaviors and facilitating skill building. Recent years have seen an increased use of positive behavior support (PBS) technology with adults who experience serious mental illness. Inpatient psychiatric units can be traumatizing places as a consequence of the acuity of units and their use of containment methods to address challenging behaviors, such as aggression against others and self-injury. This has resulted in socially just movements from coercive measures in inpatient care, informed by psychotherapeutic, trauma-informed, and recovery-oriented principles that emphasize safety, person-centered values, and developing a life of meaning while ensuring trustworthiness, collaboration, and empowerment. This article describes the effectiveness of a trauma-informed and recovery-oriented PBS approach, informed by psychotherapeutic principles, in the treatment of individuals with serious mental illness on an inpatient unit in decreasing the frequency and intensity of challenging behaviors. The PBS approach is also founded on the ideals of social justice that all individuals have the right to equity and to the pursuit of a meaningful life in society. This is especially true of persons who experience the most marginalization, such as those who are involuntarily hospitalized and who face coercive measures, and who deserve interventions to help them live a life of meaning. Findings suggest that this psychotherapy integration approach leads to significant decreases in aggressive behaviors while decreasing the likelihood of exposure to traumatic experiences for patients and staff alike. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

How Does Individual Psychotherapy Promote Recovery for Persons with Psychosis? A Systematic Review of Qualitative Studies to Understand the Patient's Experience.

Psychotherapy for individuals with psychosis is an effective treatment that promotes recovery in various ways. While there is strong quantitative evidence across modalities, less is known from the patient's perspective. There are many varied forms of psychotherapy, and gaining the patient's perspective can improve understanding of salient elements of psychotherapy and increase engagement, ultimately improving recovery rates. The purpose of this review is to identify and integrate data from published studies of patient perspectives of psychotherapy for psychosis to understand essential elements across approaches, differences between approaches, and how psychotherapy impacts recovery. We aimed to understand further: what are the perceptions about individual psychotherapy from the perspective of individuals with psychosis? The current study was a systematic review using PRISMA guidelines of studies that included qualitative interviews with persons with experiences of psychosis who participated in psychotherapy. All three authors participated in the literature search using Pubmed, APA PsycInfo, and Psychiatry Online. We identified N = 33 studies. Studies included cognitive therapies, acceptance and mindfulness approaches, trauma therapies, metacognitive therapy, and music therapy. All studies reported participants' perceived benefit with the therapeutic relationship as especially salient. Participants described diverse aspects of objective (e.g., symptoms, functioning) and subjective (e.g., self-experience or quality of life) recovery improvements, with perceived mechanisms of change, and with music therapy having some unique benefits. Participants also reported challenges and suggestions for improvement. Study findings highlight the salient aspects of psychotherapy identified by patients that may help therapists to individualize and improve approaches to psychotherapy when working with individuals experiencing psychosis. Overall, findings support the potential for integrative psychotherapy approaches for maximal treatment personalization.

Responding to Key Process Markers as a Focus of Psychotherapy Training and Practice.

Historically, evidence-based psychotherapy training has favored the standardized application of discrete treatment packages, with key outcomes being the therapist's adherence to and competent delivery of theory-prescribed ingredients. However, this model often fails to align with the priorities and values of clinicians, and research casts doubt on the notion that a therapist's faithful application of treatment protocols is a valid index of clinical expertise. Considering this, training and practice models that emphasize evidence-based clinician flexibility and patient-centered tailoring of interventions are receiving increased attention. In this article, we outline one such model informed by the context-responsive psychotherapy integration (CRPI) framework. Consistent with CRPI principles, we describe several "if this/then try that" marker-response sequences that could become a centerpiece of a more nuanced, clinically representative, and evidence-based psychotherapy training paradigm. Finally, we offer several recommendations for future work on CRPI.

Four Versions of Transtheoretical Stances, and the Bernese View.

A brief characterization of transtheoretical stances to which existing approaches can be allocated is followed by a description of the "Bernese view", that is, what Klaus Grawe and his colleagues, including the authors of this article have developed: the origins, a model of the multiple constraint satisfaction construction of therapist action, a discussion of psychotherapy integration, the crucial role of supervisors in an integrative multiple constraint satisfaction approach, and a discussion of when and how trainees should be introduced to a transtheoretical stance.

A Recovery-Oriented Approach: Application of Metacognitive Reflection and Insight Therapy (MERIT) for Youth with Clinical High Risk (CHR) for Psychosis.

Clinical High Risk for psychosis (CHR) refers to a phase of heightened risk for developing overt psychosis. CHR often emerges during adolescence or early adulthood. CHR has been identified as a group to target for intervention, with the hope that early intervention can both stave off prolonged suffering and intervene before mental health challenges become part of an individual's identity. However, there are few treatment modalities that can address some of the specific needs of CHR. Metacognitive Reflection and Insight Therapy (MERIT) is an integrative psychotherapy that can be applied to the CHR population. MERIT offers unique advantages to working with the CHR population as it aims to improve self-direction and recovery through stimulation of metacognitive capacity, a phenomenon that has been associated with recovery. This paper explores unique aspects of the CHR population and how MERIT can address barriers to recovery for individuals experiencing psychosis-like symptoms. Several case examples and a clinical vignette using MERIT to support patients with CHR are offered to exemplify this approach. MERIT offers a way to assist persons with CHR to address barriers to their personal recovery and to develop nuanced understandings of ways to master challenges.

The systemic-family-individual approach: The heritage and continuation of Mara Selvini Palazzoli's work in integrative psychotherapy.

Since the birth of family therapy, the Milan approach has been known as a foundational systemic model. Nevertheless, following the dissolution of the Milan group, Mara Selvini, alongside Matteo Selvini, Stefano Cirillo, and Anna Maria Sorrentino, began a new trajectory of clinical development, insufficiently examined within the American panorama. After her death, in 1999, the Selvini group continued to adapt and refine her systemic approach which is known today as the systemic-family-individual (SFI) approach. In this article, we delve into the constituents that constitute the SFI approach, elucidating how it furnishes therapists with a structured framework to guide clinical decision-making and the application of integrated theoretical concepts. Ultimately, the article exemplifies the SFI approach's practical application via a clinical case study, showcasing its efficacious navigation.

Relational Integrative Psychotherapy and the Discipline of Authentic Movement

Relational Integrative Psychotherapy and the Discipline of Authentic Movement

Creating a Space to Feel: An Integrative Therapy Approach with an Adolescent Diagnosed with Dissociative Motor Disorder.

The dissociative motor disorder is one of the most commonly diagnosed forms of dissociative disorder in the Indian population, especially among adolescents. However, there is a dearth of literature on effective psychotherapy practices in the Indian setting. This article details the unique process of employing an integrative psychotherapy approach with a 16-year-old adolescent girl diagnosed with dissociative motor disorder who presented with complaints of headache, deviation of mouth, multiple somatic complaints, inability to move her legs, episodes of loss of consciousness with jerking of upper limbs and a non-pervasive low mood. A detailed evaluation highlighted significant disruptions in attachment with caregivers, complicated grief, significant anger towards her family which did not find a space for expression, unhealthy coping mechanisms in the background of a slow-to-warm-up temperament and sociocultural stressors. The case formulation drew elements from the psychodynamic perspective, family systems approach, biosocial theory and the cognitive behavioural perspective. The intervention from the first session until termination is delineated in different phases which outline the significant themes that emerged along with the techniques used, challenges faced and therapist reflections. The role of the therapeutic alliance, working through transference, systemic work, primary and secondary gains and the importance of defences along with the aftermath of losing them becomes especially salient as the psychotherapy progresses in this case. The implications of the therapy process that can hold relevance to the management of dissociation disorder in the clinical setting are also discussed.

‘Meeting the Client Where They Are Rather Than Where I'm At’: A Qualitative Survey Exploring CBT and Psychodynamic Therapist Perceptions of Psychotherapy Integration

This qualitative study explored therapists' attitudes towards psychotherapy integration. Twenty‐nine psychoanalytic/psychodynamic and cognitive‐behavioural therapy (CBT) therapists completed an open‐ended survey that focused on their personal understanding of psychotherapy integration, examples from their own practice and reflections on improving integrative therapy. Participants were also encouraged to share attitudes and perceptions towards the other therapeutic paradigm (CBT towards psychoanalysis, and vice versa). Thematic analysis revealed three main themes: (1) Positive perceptions and benefits of psychotherapy integration, (2) Negative perceptions and challenges of psychotherapy integration and (3) Proposals for strengthening integration in clinical practice. While most participants had a strong allegiance to their modality, they recognised the need for flexibility and additional techniques from other paradigms to address individual client needs. However, participants raised concerns about the level of knowledge required for integrative work and the epistemological compatibility between CBT and psychoanalysis. Some responses reflected the ongoing ‘turf wars’ between the two paradigms, with some referring to ‘outdated’ psychoanalytic ideas and ‘dogmatic’ evidence‐based hierarchies. Suggestions were made for further development of psychotherapy integration during the training and post‐qualification. The study reflects a generally positive outlook towards integration while recognising the challenges as well as the continuing resistances between CBT and psychoanalytic paradigms.

The > Uncommon < Factor in Psychotherapy and the Role of Negative Skills: Why and How Psychoanalysis Offers an Important Contribution for Mental Health Practice Today

Psychoanalysis brings some specific aspects of treatment technique to the field of mental health practice today, such as highlighting the dynamics within therapeutic relationship (especially regarding emotional and unconscious elements), the role of defense mechanisms etc. Moreover, by means of taking a particular therapeutic stance, psychoanalysis offers some shared mental space for patients. The present paper argues that this stance is characterized by the capacity to “not act”, that is: by passive receptivity. To view this as some specific “negative skill” in psychotherapy in general means to align common elements of effective psychotherapy with the capacity to explore the uncommon, unfamiliar or unforeseen in particular psychotherapeutic processes. The paper sketches how this can be employed in psychotherapy training as well as in psychotherapy integration.

표현예술치료와 통합예술치료의 융합을 위한 비교 연구

The purpose of this study is to convergence of Expressive Arts Therapy and Integrative Arts Therapy. As a research method, first looked at the similarities and differences between the two treatment methods through literature review, and then analyzed the phenomenon of convergent application of the two treatment methods in medical and educational settings. The results of this study are as follows. First, Expressive Arts Therapy and Integrative Arts Therapy treatments include each other in terminology, implementation contents and orientation. Second, the 'Five Stages of Integrative Arts Psychotherapy', which is officially implemented in medical and educational settings within the NCMH(in South Korea), is the integration of psychotherapy and therapeutic education, and the convergence of techniques between Expressive Arts Therapy and Integrative Arts Therapy, and It represents the integration between traditional arts media and practical arts forms. Third, the stages and structure of Int egrative Arts Psychotherapy were proposed.

“I’m a fish!” Deepening receptivity to neurodiversity: a neuroscientifically informed integration of psychoanalytic psychotherapy, reciprocal prediction, and mindfulness

ABSTRACT Receptivity to our patients’ experience is a vital aspect of the psychoanalytic endeavor. As we receive incoming transmissions, we resonate with what is active in the patient. We hope to then jointly metabolize the experience. When we meet neurodiversity, realms of experience emerge that may elude us. Precipitously formulated ideas in the therapist, based on a neurotypical frame of reference, can impinge upon the discovery of our patients’ authentic world. How do we open ourselves to receive their true experience? This clinical narrative tracks the psychoanalytic travels of an individual who identifies as neurodivergent, who helped the therapist learn to deepen receptivity by dipping into a less differentiated place to follow the here-and-now experience from the bottom up. Throughout the journey, interweaving neuroscientific and psychoanalytic perspectives offered a powerful matrix from which an enriched understanding of our process could emerge. Psychoanalytic concepts including evenly suspended attention, unconscious-to-unconscious communication, alpha function, reverie, and negative capability are explored alongside neuroscientific insights into the stress response, mirror neurons, and the default mode network. A predictive coding lens introduced a view of the therapeutic exchange as a continuous reciprocal prediction, evoking the hypothesis that deepening receptivity required opening awareness to incoming signals and lessening the hold of prior predictions. To bring greater therapist awareness to the present moment and lessen the influence of self-referential evaluation, neuroscientifically-informed reflections also inspired the practice of mindfulness. Subsequent developments suggest that these approaches helped deepen receptivity to the experiences being communicated, leading to new understandings with transformative potential.

Common Mental Disorders: Integration of Psychotherapy as a Treatment in Addition to the Use of Psychotropic Drugs

Evolution has always been present in the life of the human being, nowadays we see an acceleration of this evolution, linked to the advancement of science and technologies, the human being sees himself in the need to learn, adapt, and deal with various demands that are often exhausting, with this, the consequences arise. The first decades of the twenty-first century have been marked by the large number of diagnoses of mental disorders, and consequently the use of psychotropic drugs, the side effects of these medications are known, so the discussion about other types of treatment such as psychotherapy arises, since the causes for most of these diagnoses are social and not necessarily biological. The absence of public policies in basic issues such as work, education and security indirectly interferes with the mental health of the population, and the population seeks to solve the problem as quickly as possible.