Articles & Book Reviews
What is good therapy?
by Peter Charleston, Psychologist
The intention of all modes of therapy is to develop in consciousness. Traditionally, psychotherapy has focused on the mind, to the exclusion of other aspects of our existence. This emphasis has lead to a generation of partial theories, each one with something to contribute, but none that encompasses the wholeness of our humanity.
Integral psychotherapy attempts to integrate or combine the techniques, research and theories from psychological, spiritual, scientific and medical ‘wisdom’ traditions, known as the perennial philosophy or Great Chain of Being. Matter, body, mind, soul and spirit, together form a hierarchical structure of consciousness, and a way of mapping our potential.
Integral psychotherapists believe that a holistic perspective is essential in order for therapy to be effective. They consider social and cultural influences, and systems factors. Ken Wilber, a leading scholar of integral theory, summarises these factors in what he calls the four quadrants model.
A) interior individual – the intentional
B) exterior individual – behavioural
C) interior collective – cultural
D) exterior collective – social systems
Language is divided into “I” (A & B), “you/we” (C) and “It” (D). These dimensions of reality usually show up in society as art, morals and science. Integral psychotherapy incorporates all three in the one context.
The core belief of integral psychotherapy is that most natural organisms have an inherent capacity for development. In each quadrant there are many developmental lines or threads, including cognitive, moral, psychosexual, spiritual, aesthetic, artistic and creative, social, emotional, and so on. Each element in each quadrant develops at different rates for different people. A person can be highly developed in some areas, and not in others. A pathology or illness can occur in any line, and will manifest in different forms, according to an individual’s stage of development. For example, anxiety (or depression, or lack of confidence) can mean different things to different people, or for the same person at different times of his/her life.
Integral theory also acknowledges that there are different types of knowing, for example masculine and feminine ways of knowing. This suggests that there are different ways of looking at a problem. Ideally, a therapist discerns which interventions or techniques to use, depending on the client’s intentions and aspirations, their circumstances, and their development.
Integral psychotherapy considers the whole individual (mind, body, soul, and spirit), the people he/she interacts with, the society in which they live, and the various cultures in which they belong. An open awareness of these elements and how they weave together to make up each unique person in any given moment, enables the psychotherapist to assist the client with an exploration and conscious integration of his/her fragmented sense of self. This collaborative process can have a profoundly positive impact.
How does Integral Psychotherapy compare with other Therapies?
Some therapists are trained in a specific method informed by an underlying philosophy, such as psychoanalysis or cognitive-behavioural therapy or gestalt. Some therapists like to mix the techniques of a number of methodologies; a practice known as eclecticism. One of the potential dangers of eclecticism is that it can become difficult to locate or identify the underlying philosophy: A unifying philosophical perspective is often lost with this kind of approach. What a therapist believes invariably influences how they practice, but they may not understand how their core beliefs and the techniques they use fit into a unified whole. For me, integral psychotherapy provides this unifying philosophical framework.
Does it focus on the Therapeutic Relationship or on technique/methodology?
There is now research supporting the quality of the therapeutic relationship as more important for a positive outcome than the particular methodology used. I believe this is true and I believe that therapists also need structure. The relationship is not everything. You may get along very well with your therapist, but that doesn’t mean you are growing. Therapists need to know how to build a healthy therapeutic alliance as well as use a sound methodology / unifying philosophy.
Is it directive or non-directive?
Some methods rely on ‘going with the flow’ of the conversation. Others are far more therapist – directed. Without structure, the therapeutic relationship can seem like a boat without a rudder; it may be warm and empathic but lack direction. If too much structure is imposed, the client is denied adequate freedom to explore themselves fully. Because of the complexity of human behaviour, there is no one right way of doing things. A therapist is guided by their intuition and by the client in determining what is best in each session, and for each moment.
Is it challenging or nurturing?
People come to therapy for different reasons. Some prefer to be challenged, others prefer more nurturing. Integral practice says you may need to do both. The skill lies in the timing –what to do and when, depends on an individual’s development and priority of need, and these can change during the course of therapy.
How does it work in practice?
A good doctor would not treat a broken toe without checking whether the whole leg was functioning well, or whether there were any other physical concerns the patient may be facing. An exceptional doctor would also inquire as to how the broken toe became broken, and whether there were any related internal individual, behavioural, cultural or social factors that may need to be addressed as well, especially in order to avoid further injuries. He/she may also give the patient some exercises/stretches to strengthen the toe once it has healed. This is a holistic approach, and the same philosophy applies to integral psychotherapy.
For example, Ian presents to therapy with grief after his father passed away from a terminal illness. Early discussion in therapy may be about coping in relation to Ian’s thoughts, feelings and behaviour; learning ‘coping skills’, and ensuring he seeks the support of those around him.
Therapy may then move beyond coping to more general issues, such as the impact Ian’s father had on his life. This includes talking about the attitudes, values and beliefs Ian adopted from his father, and whether these are helping him achieve his own goals. In discussing the alternatives, Ian may learn more about where he has come from and who he wants to become (in his ongoing development). We may also talk about Ian’s views on death, how this relates to finding purpose and meaning, and whether he has an interest in developing his spirituality.
In addition, if Ian says he values his marriage, but does not spend much time with his partner, we can link this behaviour to a strong work-ethic adopted from his father, and to him repeating his parents’ relational patterns (father was often away from home). I may invite Ian’s wife along for a session or two. I would also invite feedback about Ian from others significant in his life. In being more aware of these influences (and their consequences) Ian can make more conscious decisions about how he is to live in the future. Different topics are emphasized at different stages, and integrated for Ian to understand who he is, what matters to him, and where he is headed.
Integral psychotherapy is in many ways similar to other psychotherapies. The main difference is the way a unified whole is created. By noticing patterns in one’s behaviour and thought, and purposefully observing how the many aspects of one’s life and world link together, a person develops a stronger sense of self and his or her place in the larger scheme of things. The stronger a person becomes, the more they are able to take responsibility for. Self development links to relationship growth, which relates to spiritual unfolding. Therapy expands awareness and opens up new possibilities, potentials become realities, and there is no limit to the exploration of depth and interconnectedness.
1. Wilber, K. (2000). Integral Psychology. Shambhala: Boston. (4 Quadrants adapted from p. 67)
2. Integral Institute
3. Journal of Integrative Psychotherapy.
Peter Charleston © 2006
If you would like to explore Integrative Psychotherapy further, Peter would be happy to hear from you. He can be contacted via email from his profile page (click on his name at the top of the page.) Peter is a psychologist in private practice in Melbourne.