Psychotherapy Integration Research Articles

Client preferences for religious/spiritual integration and matching in psychotherapy.

Client preferences for religious/spiritual integration and matching in psychotherapy.

Integrative psychotherapy in stress management of cervical cancer patients at RSUD Dr. Moewardi Surakarta: A case study

Integrative psychotherapy in stress management of cervical cancer patients at RSUD Dr. Moewardi Surakarta: A case study

Verification of Game-Based Psychotherapy Intervention Model for Elderly with Memory Disorder Using Expert Review Approach

Game interventions have been demonstrated to have significant effects in terms of increasing treatment adherence and accessibility in the health profession. The use of game has a great therapeutic influence on the experience when doing recovery workouts. Due to its strengths, a game-based intervention model for elderly with memory disorder is proposed. The proposed model consists of both exogenous and instantaneous factors as its main components. Nine exogenous factors are attitude, emotion, skill, belief; support, attractive, fun, reminiscence, complexity. Six instantaneous factors are perceived focus, enjoyment, motivation, comfortability, perceived control, and boredom. To ensure its correctness, verification procedure has been carried out by using an expert review approach involving five experts from three different domains. Qualitative and quantitative feedbacks from the experts are used in refining the proposed model. Our works can be extended by incorporating other related theories to strengthen the model such as reminiscence and flow theories. The improved model is significant in providing a guideline of game-based intervention to other related domains. Our works are believed as effective in improving cognition among elderly, the interesting and positive findings can be attributed to the integration of digital game and psychotherapy for elderly, particularly those with memory disorder symptoms.

Integration of Clinical Neuroscience Into Psychotherapy: A Narrative Review of Neuroscience-Informed Psychotherapy Models for the Treatment of Depression and Anxiety Disorders

The development of neuroscience-informed psychotherapy models that attempt to refine existing psychotherapy models, especially for the treatment of depression and anxiety disorders, is a current topic in psychotherapy research. This narrative review appraised the existing literature on neuroscience-informed psychotherapy models to understand the extent to which the integration of neuroscience can advance the practice of psychotherapy for the treatment of depression and anxiety disorders. The literature search on online databases identified 21 articles that report five different neuroscience-informed psychotherapy models specifically designed to overcome the limitations of top-down-focused cognitive behavioural therapy (CBT) models for depression and anxiety disorders, such as inconsistent treatment effects. Unlike conventional top-down-focused CBT models, which primarily focus on promoting top-down regulation of the brain by improving the cognitive functioning regulated by the higher brain system, the models reviewed commonly focus on promoting bottom-up regulation of the brain by improving the emotional and physiological functioning regulated by the lower brain system with a diverse combination of techniques. However, most reviewed neuroscience-informed psychotherapy models lack research evidence from clinical trials that support the efficacy of these models. The development of a neuroscience-informed psychotherapeutic model is still in its infancy. Future neuroscience-informed therapeutic models will need to be continuously modified, adjusted, and developed by integrating the latest psychotherapy and neuroscientific knowledge and feedback from clinical trials and case studies. Such research may promote the credibility and effectiveness of neuroscience-informed therapeutic models.

Clinical effectiveness of an integrative psychotherapy technique for the treatment of trauma: A phase I investigation of Heart Assisted Therapy

There is a need for more effective clinical interventions to assist individuals in healing from lingering negative and traumatic experiences. Furthermore, healing from such experiences and coping with residual symptoms are conceptionally separate yet important outcomes in psychotherapy. This report describes a Phase I investigation that evaluates an innovative integrative psychotherapy technique that promotes healing in addition to providing a method of coping while treatment is in progress. 43 patients were treated by 2 separate psychologists using Heart Assisted Therapy (HAT) in their private practices. There was a total of 81 specific upsetting and/or traumatic life events treated. All patients completed a standardized form to rate their degree of distress before and after HAT for each life event. Follow-up data were also collected ranging from 3 months to over 18 months post-treatment. Data analysis revealed the average number of HAT sessions for a treated incident was 3 – 4. The mean distress level was 7.55 before HAT and 0.00 after HAT for an exploratory study (n=13; p < .0000001), and 8.31 before HAT and 0.02 after HAT for a confirmatory study (n = 30; p < .0000001). These improvements were replicated across therapists, gender, and veteran status. The combined findings suggest that the integrative Heart Assisted Therapy model has important practical as well as theoretical significance. Future Phase II and Phase III studies can be performed to confirm the large magnitude of the patients perceived clinical effects and evaluate potential moderating variables such as expectancy.

Management of therapist directiveness in integrative psychotherapy: A corpus-assisted discourse study

Healthcare practitioners often face the dilemma of whether to provide advice during medical consultations due to concerns around affecting patients’ autonomy in decision making. Healthcare practitioners’ directiveness in patient–practitioner interactions may influence the success of medical consultations. Research has revealed that healthcare practitioners employ various communicative strategies and linguistic patterns to manage directiveness in medical consultations, such as the notions of likelihood and uncertainty, use of information, and politeness. Nonetheless, few scholars have examined how psychotherapists manage directiveness in counseling or psychotherapy sessions. Directives are inevitable speech acts in counseling or psychotherapy. Therapists may encounter challenges when producing directives, such as preventing clients from seeking their own solutions or clients becoming excessively dependent on therapists’ suggestions. Drawing upon the systems of mood and modality in systemic functional linguistics, this article employs a corpus-assisted approach to investigate therapists’ directives in terms of phraseological patterns, use of modality, and corresponding interpersonal meanings. Results reveal that therapists tend to manage directiveness by forming indicative directives and using low-value modulation modality. This article is the first corpus-assisted study to contribute to an understanding of therapist directiveness in psychotherapy from a lexico-grammatical perspective.

Patient personality characteristics and therapeutic integration: treating borderline personality and emotionally dysregulated-dysphoric personality features.

This study examines the relationship between patient personality characteristics and therapeutic integration. Within a sample of patients (N=93) receiving outpatient psychodynamically- oriented psychotherapy, we assessed patient Borderline and Emotionally Dysregulated personality features through the Shedler-Westen Assessment Procedure (SWAP-200), and therapeutic technique using the Comparative Psychotherapy Process Scale (CPPS) during an early treatment session. We examined personality dimensionally, psychotherapy interventions across different theoretical orientations, as well as psychotherapy integration. These analyses revealed an overlap between the Borderline Clinical Prototype and the Emotionally Dysregulated-Dysphoric Q-factor, with the former associated with higher use of integration and the latter associated with higher use of either psychodynamicinterpersonal or cognitive-behavioural interventions. Secondary analyses also indicated the greater presence of interventions oriented towards emotional exploration and to the didactic instruction of effective symptom coping techniques across both of these personality subtypes early in treatment. The key differences between these personality types, as well as the theoretical, empirical, and clinical implications of these findings are discussed.

Premature dropout from psychotherapy: Prevalence, perceived reasons and consequences as rated by clinicians

Why clients discontinue their psychotherapies has attracted more attention recently as it is a major problem for many healthcare services. Studies suggest that dropout rates may be affected by the mode of therapy, low-quality therapeutic alliance, low SES, and by conditions such personality disorders or substance abuse. The aims of the study were to investigate what happens in therapies which end in a dropout, and to estimate how common dropout is as reported by practicing clinicians. An online questionnaire was developed and completed by 116 therapists working in clinical settings. They were recruited via social media (Facebook and different online psychotherapy groups) in Sweden and worked with Cognitive Behavioural Therapy (CBT), Psychodynamic Therapy (PDT), Interpersonal Psychotherapy (IPT) and Integrative Psychotherapy (IP). Psychotherapists rated the frequency of premature dropout in psychotherapy to be on average 8.89% (MD = 5, SD = 8.34, Range = 0-50%). The most common reasons for a dropout, as stated by the therapists, were that clients were not satisfied with the type of intervention offered, or that clients did not benefit from the treatment as they had expected. The most common feeling following a dropout was self-doubt. In conclusion, premature dropout is common in clinical practice and has negative emotional consequences for therapists. Premature dropout may lead to feelings of self-doubt and powerlessness among therapists. The therapeutic alliance was mostly rated as good in dropout therapies. Further research is needed to validate the findings with data on the prevalence and subjective reasons behind a dropout from point of view of clients.

A Systems Approach to Behavioral Neurobiology: Integrating Psychodynamics and Neuroscience in a Psychiatric Curriculum

In the practice of medicine, an understanding of the biological functioning of organs and organ systems is the basis for theories of pathology and clinical practice. If psychoanalysis is to be accepted by the medical and psychiatric community, it must be based on a sophisticated understanding of the organ from which mental and emotional experiences emanate and use scientifically acceptable language. Each approach to psychotherapy has its own vocabulary for describing neuropsychological processes. Neurobiological vocabulary provides the various factions "neutral ground" upon which to carry on a multidisciplinary integrative dialogue. An understanding of behavioral neuroscience allows the therapist to look beyond the labels that spawn division and identify unifying biological principles that are described in a variety of ways in a multitude of theories. We contend that the neural network/representational approach to neurobiology views human mental experience as the result of multiple complex integrated systems, and is therefore holistic and antireductionistic in its perspective. Such a biologically informed psychotherapy facilitates integration of skill sets and flexibility in technique. With these principles in mind, the therapist can base his or her approach to the patient based on these principles rather than on devotion to one particular "school" or another. Because behavioral neuroscience supports many of the basic tenets of psychoanalytic theory, such an integrative psychotherapy would be psychody-namically informed. In this paper, we outline some of the ideas we present in our neuroscience course and how we relate biological concepts with some core principles of psychodynamics and psychotherapy.

Helpful and hindering events in an integrative psychotherapy training.

Helpful and hindering events in an integrative psychotherapy training.

A Microchange Process of Activation–Contract–Processing (ACP) Across Treatment Models: A Common Process in Clinical Social Work Practice

ABSTRACT Training social workers to provide competent professional practice is of utmost importance. However, there have been ongoing dilemmas in enhancing practice competence in clinical social work, such as the challenges of selecting treatment approaches among numerous empirically supported approaches. Increasingly, common factors and common elements approaches are incorporated into clinical social work practice to address these issues, yet there is still a gap in addressing how to foster skill building in clinical social work. Using theories of psychotherapy integration and corrective experiences as a transformative change mechanism, we propose a microchange process, Activation–Contract–Processing (ACP), within sessions across various treatment approaches. This common process was developed based on both literatures and widely circulated master-tapes of therapy sessions from four empirically supported treatment models—cognitive therapy, behavioral activation, emotion-focused therapy, and interpersonal therapy. To guide social work students and clinicians, we elaborate on each step in ACP with illustrative examples around therapeutic proceedings, while incorporating core aspects of clinical social work, including but not limited to: person-in-environment perspectives, relationship, social justice and diversity, and evidence-based practice. We conclude by sharing the implications of the proposed common process to clinical social work practice, training, and research.

The alliance construct in psychotherapies: from evolution to revolution in theory and research

The alliance construct in psychotherapies: from evolution to revolution in theory and research

Integrative-strategic approach in orgasm disorder - case study

Objectives: This paper addresses the disorder of orgasm in women, from an integrative-strategic point of view. Through this paper we summarize the impact of various aspects of individual life on sexuality, taking into account a multitude of variables related to self and self-construction, such as biological, behavioral, cognitive, existential, emotional, spiritual or psychodynamic. We are specifically interested in whether certain aspects of the individual's life affect sexual dysfunction. Method: The case study presents the case of a patient who requested psychotherapy stating that she does not have an orgasm. The psychotherapeutic model used was the integrative-strategic one, structured on the six psychological axes, in the approach of each axis specific therapeutic interventions learned in the training of the psychotherapist at the Association for Research, Counseling and Integrative Psychotherapy were applied. The working period was from August 2020 to December 2021. Results: The orgasm disorder may persist, being affected by the couple's life, family history, parental patterns, body image, self-esteem and various coping mechanisms. Conclusions: It is necessary to have several approaches and the continuation of psychotherapy, both individually and as a couple, in order to observe favorable results in disturbing the patient's orgasm. Keywords: sexual dysfunction, orgasm disorder, psychotherapy, integrative-strategic.

Minority stress and the inner critic/oppressive sociocultural schema mode among sexual and gender minorities

Several adverse psychological outcomes among sexual and gender minorities (SGM) are well documented in the literature. Notwithstanding the emergence of these data, SGM still receive little attention regarding psychological interventions, which include Schema Therapy (ST), an emerging integrative psychotherapy approach. Even though revisions have been proposed to expand ST’s understanding of emotional needs, schemas, domains, and schema modes, there is a gap in our understanding of SGM. Based on that, the main goal of this theoretical essay is to propose a specific ST intervention for SGM, addressing sociocultural aspects aiming at promoting a healthy functioning that can interpose oppression and internalized prejudice. To this end, we will present (a) the minority stress theoretical framework; (b) the ST model applying to SGM clients; and (c) a few strategies of ST intervention for SGM clients, highlighting the need for strengthening individuals’ healthy schema mode. It should be noted that, despite clinical work being relevant, there are social variables supporting and maintaining maladaptive structures. We hope the therapeutic interventions proposed promote dialogue on this subject and encouraging positive societal changes.

The Predicted Future of Psychotherapy: A Decennial e-Delphi Poll.

Whither psychotherapy in the 2030s? Following a decennial tradition, the authors conducted an e-Delphi poll on the future of psychotherapy in the United States. A panel of 56 psychotherapy experts participated in two rounds of predictions and achieved consensus on most items. The experts forecast multicultural, mindfulness, and cognitive-behavior therapies to increase the most, whereas classical psychoanalysis, reality therapy, and gestalt therapy to decrease the most. Technological, relationship-building, strength-oriented, skill-building, and self-change interventions were expected to rise. Master-level clinicians of multiple professions were projected to expand while psychiatrists to decline in the proportion of psychotherapy rendered. Therapy platforms with the highest likelihood of flourishing were videoconferencing, texting, smartphone applications, and multiple or flexible platforms. Short-term therapy, crisis intervention, and very short-term therapy were predicted to increase the most. Forecast scenarios with the highest likelihood were therapy personalization, treatment of health problems, requirement of evidence-based practices for insurance reimbursement, and integration of psychotherapy into primary care. Limitations of the Delphi methodology are elucidated, and practice implications for health-service psychologists are advanced.

Tracking Sequences of Patient-Therapist Dialogues by Coding Responses During Integrative Psychotherapy

Objective: The Assimilation of Problematic Experiences Scale (APES) to code the client’s responses and the Process Focused Conversation Analysis (PFCA) to code the therapist’s responses were applied to transcripts of a successful case of integrative psychotherapy of depression. Methods: The method used for the present research was a case study. Dialogues (150 conversations between therapist-client on the basis of meaning) between a therapist and a client in one case with a good outcome were coded and analyzed by two different systems of APES and PFCA. Results: The data revealed that combining the results of APES and PFCA is a suitable coding system for drawing a client’s change equation. In a pyramid of therapeutic change, questions, skills, and techniques applied by the therapist are located in the base, center, and high level, respectively. Meanwhile, higher APES levels are located at the top of the pyramid. The efficient intervention has to be delineated on the spot and is appropriate for a situation in which the client is at one particular moment. Case improvement has demonstrated that at high levels of APES, level 4 is the critical one. Conclusion: Setbacks and stagnations are common within psychotherapy and are generally affected by the main topic of the therapeutic conversation.

Integration of trauma in music therapy: A qualitative study.

The importance of integration in psychotherapy is a growing area of research, theory, and practice, especially regarding traumatic events. Although research relates to integration in the context of music therapy with trauma survivors, it has rarely been the main focus of research. The current study investigates which principles and techniques guide music therapists to facilitate integration of trauma survivors. Using the phenomenological approach, analysis of semistructured interviews with 41 experienced music therapists working with traumatized populations was conducted to identify themes regarding their perception on integration. The findings yielded three different ways of integration. Body integration entails the ability of active music playing to serve as a sensorial stimulus that bypasses linguistic and logical mediation and enables clients to live in peace with their body and feel whole. Event integration relates to a process by which a repressed traumatic event reemerges into consciousness through music and leads to emotional and cognitive integration of that event. Lastly, life story integration relates to the ability to perceive a life story as a whole. The process includes embedding a trauma into the natural flow of a life story through music and achieving emotional and cognitive integration. These three ways of integration are conceptualized as a progression of three consecutive levels of integration which may assist music therapists in their work with trauma survivors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PATER: An integrative psychotherapy program for socio-economically deprived people in Argentina.

PATER: An integrative psychotherapy program for socio-economically deprived people in Argentina.

Updated cost-effectiveness of MDMA-assisted therapy for the treatment of posttraumatic stress disorder in the United States: Findings from a phase 3 trial.

Severe posttraumatic stress disorder (PTSD) is a prevalent and debilitating condition in the United States. and globally. Using pooled efficacy data from six phase 2 trials, therapy using 3,4-methylenedioxymethamphetamine (MDMA) appeared cost-saving from a payer's perspective. This study updates the cost-effectiveness analysis of this novel therapy using data from a new phase 3 trial, including the incremental cost-effectiveness of the more intensive phase 3 regimen compared with the shorter phase 2 regimen. We adapted a previously-published Markov model to portray the costs and health benefits of providing MDMA-assisted therapy (MDMA-AT) to patients with chronic, severe, or extreme PTSD in a recent phase 3 trial, compared with standard care. Inputs were based on trial results and published literature. The trial treated 90 patients with a clinician administered PTSD scale (CAPS-5) total severity score of 35 or greater at baseline, and duration of PTSD symptoms of 6 months or longer. The primary outcome was assessed 8 weeks after the final experimental session. Patients received three 90-minute preparatory psychotherapy sessions, three 8-hour active MDMA or placebo sessions, and nine 90-minute integrative psychotherapy sessions. Our model calculates the per-patient cost of MDMA-AT, net all-cause medical costs, mortality, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). We reported results from the U.S. health care payer's perspective for multiple analytic time horizons, (base-case is 30 years), and conducted extensive sensitivity analyses. Costs and QALYs were discounted by 3% annually. Costs were adjusted to 2020 U.S. dollars according to the medical component of the U.S. Bureau of Labor Statistics' Consumer Price Index (CPI). MDMA-AT as conducted in the phase 3 trial costs $11,537 per patient. Compared to standard of care for 1,000 patients, MDMA-AT generates discounted net health care savings of $132.9 million over 30 years, accruing 4,856 QALYs, and averting 61.4 premature deaths. MDMA-AT breaks even on cost at 3.8 years while delivering 887 QALYs. A third MDMA session generates additional medical savings and health benefits compared with a two-session regimen. Hypothetically assuming no savings in health care costs, MDMA-AT has an ICER of $2,384 per QALY gained. MDMA-AT provided to patients with severe or extreme chronic PTSD is cost-saving from a payer's perspective, while delivering substantial clinical benefit.

Effects of an Integrated Treatment Program on Grief and Distress Among Parentally Bereaved Young Adults.

This study examined the effectiveness of an 18-session manualized integrative group psychotherapy intervention for parentally bereaved young adults with grief complications. Participants, 63 young adults aged 20-27years, completed questionnaires assessing symptoms of prolonged grief, PTSD, depression and anxiety prior to and following treatment. Treatment effectiveness was assessed by comparing outcomes for the intervention group to a waitlist comparison group. Results revealed a statistically significant reduction in symptoms of grief (large effects size), PTSD (medium effect sizes), and depression (medium effect size). The treatment did not result in a significant reduction in anxiety symptoms. The study provided preliminary support for this intervention for parentally bereaved young adults.