What these transtheoretical and technical eclecticist approaches have in common is that, despite being different ends of the continuum, each represents a partial rather than a complete integration. We see this as an advantage rather than a limitation, as complete integration seems neither possible or desirable Faris and van Ooijen (2012:10).
Drawing from two of the broad approaches that influence the Newport RIM, critically evaluate what makes it possible to integrate aspects of these models.
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‘What these (transtheoretical and technical eclecticist) approaches have in common is that, despite being different ends of the continuum, each represents a partial rather than a complete integration. We see this as an advantage rather than a limitation, as complete integration seems neither possible or desirable’ Faris and van Ooijen (2012:10).
Drawing from two of the broad approaches that influence the Newport RIM, critically evaluate what makes it possible to integrate aspects of these models.
Within this quote, Faris and van Ooijen (2012,p.10) pose a way of integration as either technical eclecticism or transtheoretical. I will begin by considering the continuum of integration and move to explore similarities within approaches which make partial integration possible within the Newport Relational Integrative Model (RIM). As a means to demonstrate this partial integration I will concentrate upon Relational Psychodynamic theory drawing upon the concept of intersubjectivity and further consider Humanistic approaches with a consideration of Person Centred and Gestalt approaches. The similarities in relational aspects and underlying themes within these approaches demonstrate the possibility of partial integration.
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Mahrer’s (1989; cited in Faris and van Ooijen, 2012,p.9) continuum of six options of integration identifies integration and technical eclecticism as the only viable options for integration. Technical eclecticism as defined by Lazarus (1981, cited in Lapworth, Sills and Fish, 2010,p.39) is the use of a considered collection of varying therapeutic techniques chosen from a range of theories without an overarching theoretical perspective binding them. Conversely a transtheoretical approach holds a theoretical framework as an umbrella under which connecting similarities within differing theories can be used concurrently; representing a partial integration of theories, whilst recognising their differences.
Faris and van Ooijen (2012,p.10) alongside Lapworth et al (2010,p.34) assert a complete integration is not possible, and I agree. A complete model attempts to weld ideas together to create one reality of human nature and one model combining all prior theories (Lapworth et al, 2010,p.34). I question whether this is possible. Complete integration forces contradicting concepts together with no conjoining element. In pure form Psychodynamic and Humanistic theories appear conflicting (McLeod, 2009,p.365) asserting contrasting views of human nature which cannot be integrated. This indicates an eclectic use of techniques associated with Psychodynamic and Humanistic theories may be effective without holding a unifying theoretical understanding between them, which does not seem possible. Although with such focus on technique, eclecticism neglects the value of theory in providing an understanding of human nature and concepts which influence practice (McLeod, 2009,p.370).
However, in considering similarities between Relational Psychodynamic and Humanistic theories there are areas which could be integrated when holding an overarching belief or theory. Cooper (2008,p.125) postulates the therapeutic relationship between therapist and client as more valuable and significant for outcome of therapy than theoretical orientation and techniques. In holding an overarching theoretical framework of the intersubjective therapeutic relationship (Lapworth et al, 2010,p.38) as a connective premise within RIM (Faris and van Ooijen, 2012,p.30), we are able to integrate relational aspects of Relational Psychodynamic and Humanistic approaches.
Psychodynamic Theory has undergone a shift in focus from an intra-psychic or one-person position, to intersubjective (Orange et al, 1997; cited in Faris and van Ooijen, 2012,p.44) or two-person interaction with a focus on the reciprocal influence of the relationship between client and therapist (Faris and van Ooijen, 2012,p.30). Gestalt theory holds relational aspects at its theoretical centre (Yontef, 2002; cited in Larson, 2005,p.13) as does Person Centred, with a strong focus on the co-creation of therapeutic relationship ‘between’ therapist and client. Faris and van Ooijen (2012,p.45) consider a common thread of relational psychodynamic theory and contemporary humanistic theory as the co-construction of meaning being between therapist and client.
Faris and van Ooijen (2012,pp.47-58) outline core transtheoretical concepts within RIM which are interwoven theoretically and conceptually, demonstrating partial integration of theories when holding an overarching theoretical framework of the relationship. The core of RIM lies in the therapeutic relationship, viewing this as a microcosm of the clients’ experiences where internal issues and intersubjective dynamics are repeated and explored (Faris and van Ooijen, 2012,p.58). It therefore follows that relationships are vital to experience. The interdependence of human relatedness embeds within relational and societal context in a way which continually alters meanings within the self and thus the intersubjective space of the therapeutic relationship (Faris and van Ooijen, 2012,p.47). Meaning is vital for survival and central to experience (Frankl, [1946]2004; cited by Faris and van Ooijen, 2012,p.67) leading to a constant struggle to create meaning within relational context. Recognising the subjectivities of client and therapist, attending to the intersubjective space in the here and now enables awareness of the connection and construction of meanings.
The task of the therapist is to be authentically present whilst attending to material and meaning co-created within the intersubjective field between client and counsellor. Authenticity is vital to the relationship and ability to empathise (Faris and van Ooijen, 2012,p.51), sensing the client’s experiences of emotions and meanings at each moment (Rogers, 1961,p.62) and communicating this understanding. Combined with unconditional acceptance and prizing of the client, Rogers (1961,p.64) saw these ‘core conditions’ as enough to facilitate healing and growth. Relational Psychodynamic and Gestalt theories explore this connection in an ‘I-Thou’ relationship (Buber, 1958; cited in Faris and van Ooijen, 2012,p.51) in which client and counsellor relate with mutual reciprocity in acceptance, openness and engagement
An intention of therapy is for the client to be authentic within themselves (Faris and van Ooijen, 2012,p.51), recognising their internal and intersubjective processes. Relational Depth describes a ‘feeling of profound contact and engagement with the client’ (Mearns and Cooper, 2005,p.36) in which there exists an authentic communication of a high degree of empathy and acceptance which the client is experienced as recognising and felt as wholly congruent (Mearns and Cooper, 2005,p.36). Mearns and Cooper (2005,p.36) consider Rogers’ (1961,pp.62-64) core conditions as facets of an interacting whole, relational depth. An authentic or real encounter as described within relational depth potentially enables the client to relate to themselves and others with authenticity (Faris and van Ooijen, 2012,p.51).
However, attachments are formed to past relationships, events, beliefs and wounds which only heal when we release them (Wahl, 2001; cited in Faris and van Ooijen, 2012,p.51). The desire for growth is strained by attachments to past experiences and fear of letting go, leading to a sense of ambivalence (Faris and van Ooijen, 2012,p.51) which can permeate throughout the therapeutic process but explored within the co-created relationship.
Within Relational Psychodynamic theory, intersubjectivity is considered a dialogic endeavour of two people or subjectivities to understand and explore their intersubjective experience (Orange, 1995,p.5) in the space between them. Similarly, Humanistic Gestalt approaches dialogically explore the ‘between’ of a relationship where interpersonal connection is held (Faris and van Ooijen, 2012,p.45), co-created between therapist and client.
To encourage exploration of this intersubjective space, the therapist must embody qualities of genuineness (Kahn, 2001,p.166) and empathy. Kohut’s (1977, cited in Orange 1995,p.17) concept of ‘vicarious introspection’ describes being intensely attuned to another’s subjective reality both emotionally and cognitively, similar to authenticity and empathy within Person Centred Theory. The relational aspects within this description of intersubjectivity demonstrate the importance of working within the relationship (Larson, 2005). Such an empathic awareness and reciprocity of relationship (Kahn, 2001,p.166) allows an awareness of transferences within therapy, the clients’ unconscious (Corey, 2001,p.89) repetition of historical patterns of relating (Jacobs, 2010,p.17), re-experienced within present relationships.
Transference can emerge as a re-experiencing of intense conflicts or a seeking for positive feelings of past significant relationships attributed to the counsellor (Corey, 2001,p.89). Relational depth demonstrates a relational encounter which may function in a corrective manner, fulfilling a unmet childhood desire for human contact (Jordan, 1991; cited in Mearns and Cooper, 2005,p.48). I wonder whether within the co-created relationship, the sense of profound contact may be, with some clients, a form of positive transference and counter-transference.
Both Relational Psychodynamic and Humanistic Theories refer to childhood experiences influencing how we relate in adult life. Intersubjective theory acknowledges the significance for development of the meeting of subjectivities in relationship in the context of relational reciprocity (Mitchell, 2000; cited in Faris and van Ooijen, 2012,p.34).
Mearns and Thorne (2007,pp.24-28) extended the Person Centred view of human nature in which self concept develops in dialogue between self actualisation and social mediation. Negative childhood experiences rupture this dialogue, repressing internal processes developing ‘ego-syntonic’ self-preserving withdrawal of emotional attachment (Mearns and Thorne, 2007,p.26). Differing parts of the self develop, each encompassing thoughts, feelings and behaviours characterising an aspect of self (Mearns and Thorne, 2007,pp.33-35). Likewise in Relational Psychodynamics, Object Relations theory depicts a multiplicity of selves of unconscious internalised past relationships exuding varying emotions and thoughts (Jacobs, 2010,p.11). Gestalt therapy employs here and now techniques which enable the client to explore and open a dialogue between these parts of self, to identify and address unresolved issues (Hough, 2002,p.84) integrating parts of self.
Here we can begin to see how differing approaches can be woven together. In attending to the therapeutic relationship it is possible to consider similarities between concepts and views of human nature which enable partial integration of theory and practice.
Furthermore, it could be possible for an overarching approach and eclecticism to co-exist (Lapworth et al 2001,p.32). In attending to the overarching approach of the therapeutic relationship, it could be possible to borrow techniques (Lapworth et al, 2001,p.32) from the wider theories which may not be as compatible, but can support a richness of understanding.
My experience of the richness of working relationally within the co-created relationship comes in working with a client who I will refer to as ‘Carol’ to maintain anonymity. Carol repeatedly experienced a sense of feeling stuck, within her marriage but also in a difficulty with emotional expression leading her to “swallow” anger and sadness through binge eating. Initially I noticed in myself a feeling of boredom. I was quite disturbed by this and wanted to ignore it, believing I was preoccupied. But then Carol expressed feeling she was “wasting” my time. Together we explored her ambivalence towards change and fear of letting go. Reflecting upon this encounter I can see a strong element of counter-transference. My boredom was a reflective feeling of Carol’s ambivalence towards letting go of past behaviours and hurts. If I encounter this sense of consistent boredom or withdrawal again, it may be helpful to “notice” this and “wonder” about her sense in the here and now, considering the intersubjective field between us, which with Carol was rife with ambivalence and resulting withdrawal. Thereafter Carol was able to engage within therapy and I no longer felt bored.
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My sense of Carol was that she was an emotive and warm person able to explore and express emotions, often tearful whilst seeking understanding and meaning. However when considering her marital relationship she identified a coldness. She was keeping her husband distant because of her own self hatred, unable to express this through fear he would leave. Carol would come to see this as a repeating pattern in her relationships, an internalised childhood sense of being encouraged to stifle emotions in relationship to her parents. In noticing differences in these parts of herself and exploring these within the intersubjectivity between us, she began to work on combining these parts of herself as a whole. She described our relationship as “safe”, a place where she could feel emotional and be real without fearing judgement. I sensed a feeling of intense connectedness to Carol and realness in my responses and curiosities. I felt emotionally alongside her, encouraging exploration of what was happening between us in relationship and with her husband. I felt she was able to be fully congruent in this exploration. This experience may be considered relational depth. Working relationally in this way appeared to enable Carol to identify positive feelings around expressing emotions and consequently talked to her husband. Carol was thereafter able to express her emotions and not stifle or “swallow them down”, she didn’t binge eat.
In practice, the integrated theoretical concepts of RIM nurture the relationship as the core by which curiosity of the co-created relationship enables a richness of understanding in noticing and exploring ways of relating. Within this experience I was able to see the importance of a transparent real relationship within which the exploration of intersubjectivity or ‘between’ of the therapist and client relatedness nourishes an empathic understanding of the client’s experience. The intersubjective relationship is the centre by which noticing of ways of relating enables the therapist to draw in other integrative theoretical understandings and techniques supporting exploration of a deeper understanding. I have a growing awareness of the importance of my own internal processes in relation to the client. I am beginning to see the importance of ‘being with’ the client (Rogers, 1951; cited in Faris and van Ooijen, 2012,p.82), recognising my internal processes and my felt sense of the other as nourished by intersubjectivity and reflecting on these in the here and now.
In conclusion, partial integration is made possible by holding an overarching approach of the therapeutic relationship in which the similarities of Relational Psychodynamic and Humanistic theories can combine. The underpinning connection of the RIM holds intersubjectivity as the core of the relationship and draws on the impact of early relational experiences within transferential repeating patterns of relating and the readiness of the therapist to connect with the client with authenticity, empathic understanding of the clients’ subjective experience and a curiosity of the intersubjective space. I believe it is not possible or desirable to create a complete integration due to complexities and contrasting ideas within purist approaches. However, partial integration is possible and can provide a rich environment for understanding and growth.
References
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