Integrative Theories

3 dimensional model of multicultural counseling

1. Level of acculturation (high or low) 2. Location of problem (internal or external) 3. Intervention needed (remediation or prevention)

Atheoretical eclecticism

Combining interventions without an overriding theory of change or development (may be confusing and lack direction, may lead to treatment failure)

Theoretical integration

Offers conceptual guidelines for combining two or more treatment approaches to provide a clearer understanding of clients and a more effective ways to help them. Hill's three stage integration model, discussed later in this chapter is an example of theoretical integration

First person to truly integrate two separate theoretical orientations

Paul Wachtel combined psychodynamic therapy with behavioral therapy to create cyclical psychodynamic behavior therapy. His work was an example of technical eclecticism

5 stages of change of TTM

Precontemplation, contemplation, preparation, action, maintenance

Transtheoretical model (TTM)

Prochaska and others, provides a theory of behavior change that incorporates elements from many different theoretical perspectives. Used with mental health and behavioral problems (smoking etc) Links interventions and the targe of change efforts to the person's stage of change.

Bridging and Tracking

Two useful techniques associated with MMT. With bridging clinicians initially relate to clients through the clients dominant modality to build connection and rapport and then branch off into other dimensions that are likely to promote new skills and ways of responding. Tracking is processing of using interventions in the same sequence as the person's preferred firing order

Application of MMT steps

Use Basic ID, identify three or four focal concerns with client, refer for a medication and physical examination if needed, use empirically validated treatment modalities and interventions to address the client's focal concerns

Syncretism

without a logic or structure, eclecticism can lead to treatment that is haphazard and inconsistent, lacking in direction and coherence (Eysenck 1970)

Basic I.D. Of MMT

An assessment that delineates seven basic categories of basic functioning, represented by the acronym BASIC I.D. (Behavior, affect, sensations, images, cognitions, interpersonal relations, drugs and biology)

Four types of Eclecticism

Atheoretical eclecticism, Common Factors eclecticism, technical eclecticism, theoretical integration

Multimodal therapy (MMT)

Best known of the technical eclectic approaches, is a system for integrating theories and interventions, rather than a self- contained treatment approach. Grounded in behaviorism and empathizing outcomes, it also draws heavily on cognitive therapy as well as social learning theory. Has a humanist component and values the uniqueness and self- determination of each individual.. Also pays attention to context (Developed by Arnold Lazarus)

Second order analysis of Basic ID

Clients identifying changes they would like to make in each of the 7 modalities

Termination of treatment

Clinicians choice, clients choice, mutual agreement

10 processes of change of TTM

Determination of a person's stage of change is tuned to identify strategies and interventions that are likely to be successful.

Hill's three stage integrated model

Exploration, insight and understanding, action

According to Lazarus's, treatment that reflects technical eclecticism is:

Grounded in a theory of the clinicians choice, enhanced by interventions associated with compatible approaches to treatment, focused on interventions that have had their value substantiated by research

Evaluation of MMT

Lack of cohesive theory to unify this model. Can be poorly organized in hands of bad clinician,, lacks concept of human development, theory of change and explanation of why people develop problems. All the structure puts more demands on the counselor. Strengths: flexible, holistic, individualized, goal oriented, clear direction and structure. Studies show 75% of people treated achieved major treatment goals.

Therapeutic alliance of MMT

Lazarus says to be authentic chameleons, as you consider the clients needs and preferences. Adjust therapeutic style to fit the expectations or preferences of the client

Main reason for integrative and electic treatment

No single theory has yet been found that can clearly capture an entire range of human experiences across the life span

Application of MMT

Requires that clients have some self-awareness and are motivated and reliable informants, and capable of a moderate level of planning, organizing and self monitoring. People with common of different concerns (anxiety, time management, etc) might be particularly responsible to this therapy.

Common factors eclecticism

Says that certain elements of treatment, notably a therapeutic alliance that communicates support, empathy and unconditional positive regard are primary responsible for promoting client growth and change. Specific interventions are linked to these common factors rather than to a specific theory

technical eclecticism

Seek out most effective techniques available for a client's specific problems. Thought of as a organized collection of interventions rather than an integration of ideas. lacks a coherent model for human development and growth. Lazarus's multimodal therapy exemplifies this type of eclecticism

Common factors model

Some eclectic treatments have a unifying basis, ground in common factors that make treatment effective. (Diagnosis, reactance (or level of resistance), client preferences, client copying styles)

MMT Assessment Instruments

Structural Profile Inventory- helps identify a person's preferred modalities. This forms asks people to indicate on a scale of 1 to 7 how important each of the seven ares of functioning is in their lives. Also with BASICID look at the person's modality firing order, to see sequence of reactions of stressors

5 levels of change in TTM

Symptom/situational problems. Maladaptive cognitions. Current interpersonal conflicts. Family/systems conflicts/ Intrapersonal conflicts