What is eclecticism & integration * Can mean anything that is not adherence to a specific school (schoolism) * Plenty of variation within different approaches anyway * Creative response to individual client * Therapist applying own version of theory * Different levels: * Formal eclecticism – menu choice * Integrated model of therapy or training * Tension between the empirical and the theoretical * Focus can be on client, or theory, or condition treated or combinations Approaches to eclecticism & integration * Forms of eclecticism * technical integration * common factors - necessary & sufficient? * theoretical integration * Manualisation * stages of change – more of a rationale for integration than a form of integration * Specificity of treatments * Creating a pharmacy style matrix of treatment of choice on an evidence-based model * Pragmatic client focus * focus on a specific condition / client group Integrated models and stages of change * Stages of change well recognised in some conditions, implies integrated model? * eg. * Grief and loss, multi-stage models by Kubler-Ross and others * Denial, anger, bargaining, depression, acceptance * Prochaska & DiClemente, stages of change, eg. in smoking * Pre-contemplation, Contemplation, Action, Maintenance, relapse The Kübler-Ross grief cycle * Shock stage: Initial paralysis at hearing the bad news. * Denial stage: Trying to avoid the inevitable. * Anger stage: Frustrated outpouring of bottled-up emotion. * Bargaining stage: Seeking in vain for a way out. * Depression stage: Final realization of the inevitable. * Testing stage: Seeking realistic solutions. * Acceptance stage: Finally finding a way forward. Prochaska & DiClemente: Stages of change model * Precontemplation: Has no intention to take action within the next 6 months * Contemplation: Intends to take action within the next 6 months. * Preparation: Intends to take action within the next 30 days and has taken some behavioral steps in this direction. * Action: Has changed overt behavior for less than 6 months * Maintenance: Has changed overt behavior for more than 6 months. * Termination: Overt behavior will never return, and there is complete confidence that you can cope without fear of relapse. The stages of change model evaluated * A highly influential idea * But is there evidence that the model relates to experience? Technical eclecticism * Meta-theoretical attempts to offer systematic routes through the maze of approaches. Eg Lazarus, multi-modal therapy. * Frameworks not entirely a-theoretical (sometimes behavioural as with Lazarus) * Standard assessment leads to guided selection from menu * Version of matrix response? Manualised training: Egan model * Egan model very influential * An a-theoretical model widely used in general counselling training * Emphasis on practical helping skills, no grounding in theory or psychology required * Can be seen as beginning with behavioural interpretation of humanistic core qualities moving towards cognitive and behavioural focus in a multi-stage process Egan model continued * Empathy translated as skilled behaviour, as a reflection response * Skills developed through micro-skills training, very detailed ‘Exercises in helping skills’ manual accompanies textbook * Humanistic emphasis on relationship first and then specifying goals and tasks * Fits well with therapeutic alliance Common Factors * Based on the idea that outcomes are equivalent because common factors in therapy are the real agents of change * Broadly 2 groups * Warm involvement * Communication of new perspective * Frank (1973) all change is brought about by social influence * Frank & Frank (1991) re-formulated as re-moralisation * Rogerian core factors * Warmth, empathy, genuiness * Therapeutic alliance * Bonds, goals, tasks Theoretical integration * Attempts to combine the insights of psychoanalysis with behavioural theory date back 60 years * Feather & Rhoads (1972) psychodynamic behaviour therapy aims to use insights of one to target the other – case 1 is interesting. * Feather; B. W. and Rhoads. J. M. (1972). Psychodynamic behaviour therapy. Arch Gen Psychiatry. 26: 496-511. * But probably now unavailable