What's an integrationist? A study of self-identified integrative and (occasionally) eclectic psychologists.
ABSTRACT We examined the views and practices of self-identified eclectic and integrative psychologists, particularly in the context of historical changes since 1977 and 1988. Results from 187 eclectic clinical psychologists indicated that 50% previously adhered to another theoretical orientation, the majority preferred the term integrative to eclectic, and 85% conceptualized eclecticism/integration as the endorsement of a broader orientation. The most common paths toward integration were theoretical integration, common factors, and assimilative integration, as opposed to technical eclecticism. The most frequent theoretical contributor to integrative practice was cognitive therapy.
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ABSTRACT: In this paper, an approach to clinical supervision, entitled the Contextual-Functional Meta-Framework (CFM), is developed and articulated, based on a consideration of current literature and the author’s extensive practice experience. First, the context for the development of the CFM, and its formative influences, are examined, followed by a review of its six main components: the administrative context in which supervision takes place; the culture infused supervisory working alliance; nine supervisory functions; the supervisor’s and supervisee’s theory of change; the service delivery system; and the phase of counsellor development. Finally, future avenues for the model’s ongoing development and evaluation are discussed. As a meta-framework for the development of one’s personal approach to supervision, rather than a model of supervision, the CFM provides a transtheoretical heuristic for clinical supervisors to develop their personal approach the supervision.International Journal for the Advancement of Counselling 06/2012; 35(2).
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ABSTRACT: Progress monitoring (PM) consists of using standardized measure to follow client progress and give clinicians feedback about response to treatment. PM systems have shown great promise in helping therapists identify when clients are not progressing, which improves both retention and client outcomes, but only if therapists use them. This article traces the story of the author's halting and sceptical adoption of PM and the questions that were raised along the way. Beginning at the point of seeing PM as a good thing for others, the author presents a series of questions that centre around the issue of how PM fits with a therapeutic philosophy that values conversation over numbers. Case vignettes illustrate some of the challenges and things learned along the way. Rather than diminishing the importance of therapeutic conversation as a vehicle for change, PM data have opened up new conversations and presented opportunities to broaden and deepen therapy sessions. The author suggests that working with a new kind of data in practice has developed her identity as a scientist–practitioner and increased her appreciation of how practitioners can contribute to the development of knowledge in our field.Canadian Psychology-psychologie Canadienne - CAN PSYCHOL-PSYCHOL CAN. 01/2012; 53(2):75-81.
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ABSTRACT: A busca por tratamentos com base empírica para o jogo patológico está em sua infância, havendo relativamente poucos ensaios clínicos e uma ausência de estudos naturalísticos. A adesão dos jogadores ao tratamento tem sido um problema, sendo que o tratamento cognitivo-comportamental e os estudos farmacoterápicos relatam índices particularmente altos de aban-dono. As abordagens psicodinâmicas, com sua ênfase na relação terapêutica e no significado dos comportamentos autodestrutivos e aparentemente irracionais, e nos obstáculos à capacidade de se perdoar, poderiam melhorar o desfecho. Método: Após uma descrição da psicoterapia psicodinâmica, foi feita uma revisão da literatura que investigou a eficácia de tratamentos psicoterápicos de curto e longo prazo para uma série de transtornos. Com relação ao jogo patológico, foi feito um resumo da literatura psicana-lítica inicial (1914-1970) e a seguir foi revisada a literatura mais recente sobre a utilização da psicoterapia psicodinâmica no jogo patológico. Resultados: A pesquisa da literatura recente sobre psicoterapia psicodinâmica não revelou nenhum estudo contro-lado aleatorizado sobre a eficácia ou efetividade desse tratamento. No entanto, há oito estudos com desfechos positivos descritos como ecléticos multimodais; a metade destes parece utilizar abordagens psicodinâmicas. São descritos dois programas entre os que obtiveram maior êxito. Conclusões: Uma observação sobre os desfechos mais gerais da psicoterapia psicodinâmica na literatura demonstra eficácia suficiente para uma variedade de transtornos que justificam um ensaio clínico sobre o jogo patoló-gico. A psicoterapia psicodinâmica de curto prazo, com seu foco em questões nucleares, pode ser particularmente aplicável à necessidade dos jogadores patológicos de evitar ou escapar de efeitos e problemas intoleráveis. Terapias de mais longo prazo podem ser necessárias para modificar um padrão evitativo de comportamento e defesas psicodinâmicas. Descritores: Jogo patológico; Psicoterapia psicodinâmica; Terapia combinada; Formulação dinâmica; Resultado de tratamento A b s t r a c t Objective: The search for empirically based treatments for pathological gambling is in its infancy, with relatively few clinical trials and an absence of naturalistic studies. Treatment retention of gamblers has been a problem; cognitive-behavioral treatment and pharmacotherapy studies report especially high dropout rates. Psychodynamic approaches, with their emphasis on the therapeutic relationship, and the meaning of the patient's self-destructive and seemingly irrational behaviors, and on obstacles to self-forgiveness, might improve outcome. Method: After a description of psychodynamic psychotherapy, the literature on both short-term and longer therapies is reviewed regarding their efficacy for a variety of disorders. With regard to pathological gambling, the author summarizes the early (1914-1970) psychoanalytic literature then reviews the more recent psychodynamic psychotherapy literature on pathological gambling. Results: A review of the recent psychodynamic psychotherapy literature on pathological gambling failed to disclose a single randomized controlled study of treatment efficacy or effectiveness. However, there are eight positive outcome studies described as multi-modal eclectic; half of those seem to utilize psychodynamic approaches. Two of the more successful programs are described. Conclusions: A review of the outcomes literature for psychodynamic psychotherapy demonstrates efficacy for a variety of disorders sufficient to justify a clinical trial for pathological gambling. Short-term psychodynamic psychotherapy, with its focus on core issues, may be particularly applicable to the pathological gambler's need to avoid or escape intolerable affects and problems. Longer therapies may be needed to modify an avoidant coping style and defenses.
B R I E F R E P O R T
John C. Norcross, Christie P. Karpiak, and Kelly M. Lister
University of Scranton
We examined the views and practices of self-identified eclectic and inte-
grative psychologists, particularly in the context of historical changes since
1977 and 1988. Results from 187 eclectic clinical psychologists indi-
cated that 50% previously adhered to another theoretical orientation, the
majority preferred the term integrative to eclectic, and 85% conceptual-
ized eclecticism/integration as the endorsement of a broader orientation.
The most common paths toward integration were theoretical integration,
common factors, and assimilative integration, as opposed to technical
eclecticism. The most frequent theoretical contributor to integrative prac-
tice was cognitive therapy. © 2005 Wiley Periodicals, Inc. J Clin Psychol
61: 1587–1594, 2005.
psychotherapists; theoretical orientation
Between one-quarter and one-third of contemporary American psychologists identify
themselves as eclectic or integrative, making eclecticism the modal theoretical orienta-
tion (Norcross, 2005). Dozens of specific systems of eclectic/integrative psychotherapy
have appeared (Lebow, 2003; Norcross & Goldfried, 2005), and literally hundreds of
books proclaim themselves as integrative in their subtitles or dust jackets.Yet, our empir-
ical knowledge of eclectic and integrative psychotherapists is meager indeed (Jensen,
Bergin, & Greaves, 1990). The research on eclectic and integrative psychotherapists has
lagged far behind clinical practice (Schottenbauer, Glass, & Arnkoff, 2005).
An earlier version of this article was presented at the 75th annual meeting of the Eastern Psychological Asso-
ciation, Washington, DC.
The authors gratefully acknowledge the participation of the 187 psychologists, the technical assistance of
Ms. Shannon O. Santoro, and the editorial contributions of Stanley B. Messer.
Correspondence concerning this article should be addressed to: John C. Norcross, Department of Psychology,
University of Scranton, Scranton, PA 18510-4596; e-mail firstname.lastname@example.org.
JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 61(12), 1587–1594 (2005)
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jclp.20203
© 2005 Wiley Periodicals, Inc.
In 1977, Garfield and Kurtz published the first study on the views of 154 self-
identified eclectic psychologists (achieving a 66% response rate to their survey). The
eclectics were bound together by dissatisfaction with one orientation and concurrent
selection from two or more theories, believing that no single theory could be used to
treat all clients effectively. There was considerable variability among the theoretical
orientations, with the synthesis of psychoanalytic theory and learning theory the most
frequent at that time.
In 1988, Norcross and Prochaska revisited Garfield and Kurtz’s study on eclectic
views. Of the 113 self-designated eclectic clinical psychologists (77% response rate),
58% previously adhered to a specific theoretical orientation, typically psychodynamic
(44%) or behavioral (27%). The results demonstrated that the majority preferred the label
integrative in describing their theoretical orientation. Although the integrative/eclectic
orientation continued to be the modal orientation among American psychotherapists, the
frequency of theoretical contributions was changing. Whereas the most frequent combi-
nation in the 1970s was psychoanalytic and behavioral, in the 1980s the most common
combinations were cognitive and behavioral and then humanistic and cognitive. The
authors observed that “integration by design is steadily replacing eclecticism by default”
The present study was designed to update the earlier studies in order to investigate
the views and practices of self-identified eclectic and integrative psychologists in the
Participants were recruited and eclectic/integrative psychologists were identified by the
same procedures used in the previous studies. The initial subject pool consisted of 1,500
randomly selected members of Division 12 (Clinical Psychology) of the American Psy-
chologicalAssociation (APA), the same organization employed in the previous two stud-
ies. In August 2003, we mailed the questionnaire, a cover letter, and a prepaid return
envelope to 1,500 randomly selected members and fellows of APA Division 12 living in
the United States. Six weeks later, we sent a follow-up letter and another questionnaire to
500 randomly selected nonrespondents. The U.S. postal service returned 7 questionnaires
as undeliverable; of the remaining 1,493 questionnaires, 694 were returned for a total
response rate of 46.5%. However, 40 of the questionnaires were not usable for various
reasons, primarily because of retirement (n ? 36). The final sample, therefore, consisted
of 654 clinical psychologists affiliated with Division 12, a usable response rate of 43.8%.
(Results pertaining to the demographic characteristics, educational experiences, theoret-
ical orientations, and professional activities of all 654 clinical psychologists are reported
in Norcross, Karpiak, & Santoro, 2005).
integrative as their primary theoretical orientation. Fully 29% of the respondents did so;
those 187 psychologists composed the sample for the present study.
The section contained six items: three items from Garfield and Kurtz’s (1977) orig-
inal study, two items from Norcross and Prochaska’s (1988) study, and one new item. The
first item asked respondents whether they had previously adhered to a specific theoretical
orientation and, if so, asked them to indicate that orientation. The second item asked
which term, eclectic or integrative, was preferred. The third item asked whether respon-
dents considered eclecticism/integration the absence of a theoretical orientation or the
endorsement of a broader one. The new item asked psychologists to choose the one type
of integration/eclecticism that best represented their practice: theoretical integration
Journal of Clinical Psychology, December 2005
(synthesis of multiple theories), technical eclecticism (use of various techniques without
regard to the theory that spawned them), common factors (synthesis of robust common-
alities across the psychotherapies), or assimilative integration (selective incorporation of
techniques and concepts from different orientations into a single, preferred theory). Next,
we asked for a frequency rating of theoretical orientations (behavioral, cognitive, human-
istic, interpersonal, psychoanalytic, systems, and other) in their eclectic/integrative prac-
tices (on a 5-point, Likert-type scale in which 1 ? no use, 3 ? occasional use, and 5 ?
repeated use). The final question asked respondents to define or explain their eclectic
view and provided blank space in which to respond.
One-half of the 187 self-identified eclectic/integrative psychologists adhered to a spe-
cific theoretical orientation before they became eclectics or integrationists. This 50% is
similar to the findings of the two earlier studies, in which 58% (Norcross & Prochaska,
1988) and 49% (Garfield & Kurtz, 1977) had previously adhered to a single orientation.
The previous theoretical orientations were varied but principally psychodynamic/
psychoanalytic (46% of respondents), cognitive (20%), and behavioral (11%). Other pre-
vious orientations were systems/family systems (8%), person-centered (6%), humanistic/
existential (4%), and others (5%). Thus, as with the earlier findings, the largest shift
continues to occur from the psychodynamic and psychoanalytic persuasions and the next
largest from the cognitive and behavioral traditions.
The majority of psychologists preferred the term integrative to eclectic. Specifically, 23%
strongly preferred integrative, 36% preferred integrative, 21% expressed no preference,
15% preferred eclectic, and the remaining 5% strongly preferred eclectic. This semantic
preference is generally consistent with the findings in Norcross and Prochaska’s (1988)
investigation except that the preference for integrative has grown from 40% to 59%.
Indeed, in the present study, only 20% preferred the label eclectic.
When asked whether they considered eclecticism/integration the absence of a theo-
retical orientation or the endorsement of a broader one in its own right (or both), the vast
majority of psychologists (85%) conceptualized it as the endorsement of a broader ori-
entation. Only 3% indicated it represented an absence of an orientation and 12% responded
that it represented both. The 85% constitutes a rise from the 66% found in the 1988 study;
the discrepancy seems to be in the reduced percentage of psychologists answering both—
from 27% in 1988 to 12% in 2003. For better or for worse, integration/eclecticism is now
largely seen as a distinct system of psychotherapy, as opposed to the absence of a tradi-
tional pure-form system.
In a new item, psychologists selected one of the four paths toward eclecticism/
integration they preferred. Theoretical integration, common factors, and assimilative
integration were preferred by 27.5%, 27.5%, and 26% of the sample, respectively. These
for technical eclecticism corresponds with the low preference for the label of eclectic.
What’s an Integrationist?
Psychologists rated the frequency of their use of six major theories in eclectic/integrative
practice. As a first step, to permit historical comparisons with the earlier studies, we
examined the individual ratings to determine the most widely used combinations of two
theories. We were able to do so for 115 of the 178 psychologists who completed these
ratings. We could not reliably decipher the remaining psychologists’ intent regarding
their two most prominent theories.
The most frequent combinations of theoretical orientations constituting eclectic/
integrative practice are summarized in Table 1. All 15 possible combinations of the six
theories presented were endorsed by at least one self-identified eclectic/integrationist.
Cognitive therapy predominated; in combination with another therapy system, it occu-
pies the first 5 of the 15 combinations and accounts for 42% of the combinations. Put
differently, cognitive therapy was the most frequently and most heavily used contributor
to an eclectic or integrative practice.
Over time, the behavioral and psychoanalytic combination as well as the behavioral
and humanistic combination have slipped considerably. They have gradually dropped
from the 1st and 3rd most frequently combined theories in 1977 to the 9th and 4th in 1988
to 13th and 14th in 2003. The behavioral and psychoanalytic hybrid—accounting for
25% of the combinations in the 1970s and only 1% in the 2000s—has been firmly replaced
by a cognitive hybrid.
As a second step, we entered the ratings of the 178 psychologists into a K-means
cluster analysis. Inspection of solutions ranging from 6 to 12 clusters led us to select the
nine-cluster solution, on the basis of the clinical relevance of the resulting clusters and
adequate distances between cluster centers. In this nine-cluster solution (and in all the
Most Frequent Combinations of Theoretical Orientations
(N ? 145)a
(N ? 113)
(N ? 115)
Behavioral and cognitive
Cognitive and humanistic
Cognitive and psychoanalytic
Cognitive and interpersonal
Cognitive and systems
Humanistic and interpersonal
Interpersonal and systems
Psychoanalytic and systems
Interpersonal and psychoanalytic
Behavioral and interpersonal
Behavioral and systems
Humanistic and psychoanalytic
Behavioral and humanistic
Behavioral and psychoanalytic
Humanistic and systems
aPercentages and ranks were not reported for all combinations in Garfield & Kurtz, 1977. NR ? not reported.
Journal of Clinical Psychology, December 2005
solutions we inspected), cognitive therapy was the defining theory for the vast majority
Table 2 shows the final cluster centers for the nine-cluster solution. The first cluster
represented broad cognitive-behavioral therapy, as the 19 psychologists endorsed pri-
marily cognitive and behavioral orientations (ratings of 4) and moderate to small use of
interpersonal, humanistic, psychodynamic, and systems orientations (ratings of 3 and 2).
Cluster 2, interpersonal-humanistic, was marked by full endorsement of humanistic and
interpersonal orientations (ratings of 5 on each), as well as strong endorsement of psy-
chodynamic and cognitive orientations (ratings of 4). We labeled cluster 3 the ubercog-
nitive group because these 21 eclectics/integrationists rated the use of cognitive therapy
(5) over and above all other therapies. This cluster stands in small contrast to the tradi-
tional cognitive-behavioral cluster 4 because both cognitive and behavioral therapies
were rated equally and strongly in that cluster.
Psychologists in the next two clusters indicated that they used all of the listed ther-
apies frequently and, in addition, distinctively indicated routine use of an “other” therapy.
Cluster 5 might be termed moderate eclecticism (all ratings of 3 and 4) and cluster 6
extreme eclecticism (all ratings of 4 and 5).
Cluster 7, consisting of only six psychologists, contained the uncommitted or nay-
sayers in the sample. They accorded all of the listed therapies as no to low use in practice.
The multimodal group in cluster 8 privileged cognitive and behavioral therapies
(ratings of 5) above the others but gave the other brand-name therapies a robust rating
of 4. This pattern reminded of us Lazarus’s (1997) multimodal therapy, a form of tech-
nical eclecticism that draws from all therapies but most heavily from the cognitive-
behavioral traditions. Finally, the 35 psychologists in cluster 9 were characterized by a
cognitive-analytic orientation, as indicated by the two highest ratings in cognitive and
psychodynamic. It is clear from these results that psychotherapists who describe them-
selves as integrative/eclectic are a very heterogeneous group.
Definition and Explanation
In the original 1977 study by Garfield and Kurtz, clinical psychologists were asked to
define and explain their eclectic view. The question was repeated in the 1988 study and
Eclectic/Integrationists’Ratings of Theoretical Orientations by Clusters
N ? 19
Note. Data are mean cluster loadings from participant frequency-of-use ratings for six orientations plus “other.” Each orienta-
tion was rated on a 5-point, Likert-type scale (1 ? No Use, 3 ? Occasional Use, and 5 ? Repeated Use).
What’s an Integrationist?
again in this one. Two trained undergraduates independently coded all of the responses
according to Garfield and Kurtz’s original five-part scheme (including an “other” cat-
egory). They agreed on their ratings in 153 of the 187 responses, a reliability coefficient
of .82, and subsequently reviewed and agreed on the responses in initial disagreement.
Table 3 summarizes the major categories into which the ratings fell. As seen there,
the explanation of using whatever theory or methods seems best for the client continues
as the predominant rationale, with 34% of responses. One psychologist wrote, “People
are different and have different diagnoses and needs as well as viewing therapy differ-
ently. Therefore, I suit the therapy to the patient.” Another indicated, “I will use tech-
niques from various orientations to match patient problems. Some patients only need
brief cognitive interventions, whereas some seem more appropriate for insight-oriented
Integration as the amalgamation of theories or aspects of theories was next, with 25%
of responses. This explanation appears to be steadily rising over the years: from 14% of
lem oriented/cognitive techniques to increase logical thinking style with some supportive
techniques at first” and “I tend to view behavior dynamically in terms of underlying emo-
tions and motivations, but work primarily with cognitions and behaviors using cognitive-
behavioral therapy (CBT) techniques.”
Asmall number of responses essentially communicated that no single theory or ther-
apy is adequate, frequently adding the corollary that some therapies are better for some
purposes. For example, “No single approach seems to work with all patients; [it is] nec-
essary to have training and experiences with a wider variety of useful techniques.”
The integrative/eclectic orientation consistently remains the most popular orientation
among clinical and counseling psychologists in the United States (Bechtoldt, Norcross,
Wyckoff, Pokrywa, & Campbell, 2001), but its constituent parts and even its label con-
tinue to evolve. Since the earlier studies conducted on theAPADivision 12 membership,
three principal changes are evident: a clear preference for the term and process of inte-
gration as opposed to eclecticism, the definite emergence of assimilative integration as
another path to integration, and the encroaching dominance of cognitive therapy in inte-
Response Classification of “Define and Explain Your Eclectic View”
(N ? 154)
(N ? 94)
(N ? 187)
Use whatever theory or method seems best for client.
Select procedures according to client and/or problem.
Basically use and combine two or three theories in therapy.
Amalgamation of theories or aspects of theories.
No theory is adequate—some are better for some purposes.
Journal of Clinical Psychology, December 2005
In both word and (self-reported) deed, practitioners are routinely favoring integra-
tion over eclecticism. Fully 59% preferred the term integrative (compared to 20% who
favored eclecticism), and 54% embraced theoretical integration or assimilative integra-
tion (compared to the 19% who embraced technical eclecticism).
Our results numerically confirm the prominence of assimilation as one path toward
integration. Assimilative integration entails a firm grounding in one system of psycho-
therapy, but with a willingness to incorporate (assimilate) practices and views from other
systems selectively (Messer, 1992). In doing so, assimilative integration combines the
advantages of a single, coherent theoretical system with the flexibility of a broader range
of technical interventions from multiple systems.Abehavior therapist, for example, might
use the Gestalt two-chair dialogue in an otherwise behavioral course of treatment (for
fuller explication and case examples, see Messer, 2001).
To its proponents, assimilative integration is a realistic way station to a sophisticated
integration; to its detractors, it is more of a waste station of people unwilling to commit
themselves to an evidence-based eclecticism. Both camps agree that assimilation is a
tentative step toward full integration: Most therapists have been and continue to be trained
in a single approach, and most therapists gradually incorporate parts and methods of
other approaches once they discover the limitations of their original approach (Goldfried,
2001; Wachtel, 1997).
Our results also underscore the dominance of cognitive and cognitive-behavioral
therapies in the integrative marketplace. Cognitive therapy rivaled integration/eclecticism
as the modal theoretical orientation, dominated the frequent theoretical combinations,
and defined most of the practice clusters.This finding is not surprising because cognitive-
behavioral therapy has dominated the training orientations of clinical psychology for the
past 15 years (Nevid, Lavi, & Primavera, 1986; Robins, Gosling, & Craik, 1999). In fact,
a 2004 study of APA-accredited clinical psychology programs found that the cognitive-
behavioral orientation accounted for one-half of the theoretical orientations of the faculty
members (33% of faculty in Psy.D. programs, 49% in practice-oriented Ph.D. programs,
and 64% in research-oriented Ph.D. programs; Norcross, Castle, Sayette, & Mayne, 2004).
Of course, the current results are based entirely onAmerican psychologists and even
further on Division 12 psychologists. The ascendance of cognitive therapies and the
decline of psychodynamic and humanistic approaches may be specific to Division 12
psychologists. Studies conducted on other APA divisions and other mental health disci-
plines may well produce different results. Although our methods of recruiting and iden-
tifying eclectic/integrative psychologists were identical to those used in the previous
studies, it is important to note that the Division 12 membership has obviously evolved
over the years and now includes, for example, a larger proportion of women and cogni-
tive therapists than in previous years (Norcross, Karpiak, & Santoro, 2005).
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