Why I Am an Integrative Therapist, Stressing the Therapeutic Alliance

In this posting I shall discuss how the great changes over the years in the psychotherapeutic professions  have affected me since I started practicing in the 60’s. I will also discuss why I am an integrative therapist and why, no matter what method I am using, I see therapy as a collaborative venture. This means that I  make primary  the therapeutic alliance and client resources.  In future articles I shall discuss other therapy topics such as the importance of focusing on emotion in therapy and how to do it effectively;  working with sexuality in the therapeutic relationship; common mistakestherapists make; and how to empower helpless-feeling clients who expect to be magically cured by their therapists.

When I first entered the field there were only two major therapeutic methods:  Freudian psychoanalysis (and, for non-analysts,  analytically-oriented therapy), and behavior therapy.  But in the mid-60’s, partly fueled by counter-cultural movements and  existential-humanistic psychology,  a whole host of alternative therapies began to arise.   Although my original training was in Freudian psychodynamic therapy at the University of Michigan, I  began to become  aware while teaching at UCLA and practicing as a clinician that this method was relatively ineffective and didn’t suit my personality.  It required me to be too passive and over-intellectualized.  I went to the Esalen Institute in Big Sur for a week-long workshop with Virginia Satir and met Fritz Perls, the co-founder,  with his wife Laura Perls, of Gestalt Therapy.  I later returned to Esalen for a workshop with Perls, and was very impressed by the power of his work.  I realized  that if I mastered Gestalt Therapy,  I could use my creativity and be much more effective with my own clients than I was with my Freudian approach.  Subsequently, I had several years of training with Jim Simkin, a prominent Gestalt trainer  and helped, with other therapists to form a Gestalt training institute.

In the following years I had intensive training in  neo-Reichian body therapy, Object-relations theory, Psychoanalytic Self Psychology and EMDR.  I also taught Gestalt Therapy and Self Psychology in training institutes throughout the world and in universities.

Each time I embarked on a new personal training regimen because I began to realize that the methods I had been trained in were ineffective  with some clients with specific disorders.  I reasoned I would be more effective with them if I had additional training in methods that seemed to work well with them; for example, object-relations therapy with Borderline clients, EMDR with people who suffered from PTSD.    I also entered personal therapy with an expert practitioner of each school while I was learning about it, reasoning that I would be more efficient and empathic if I experienced the therapy from a client vantage point.  I have always thought that some of the best training is obtained through one’s personal therapy.

Being an integrative therapist allows me to flexibly fit my approach to the disparate needs of my clients rather than forcing them into one therapeutic regimen.  Thus I use a combination of psychodynamic/relational Gestalt with those with attachment disorders and needing and wanting personality change; EMDR for those who have been traumatized and not needing an intensive psychotherapy experience; and supportive therapy with those who are seriously mentally ill and can’t profit from a growth-oriented therapy until they achieve stability.   I also use EMDR intermittently with long-term clients when some unfinished business from the past arises that needs to be worked through.    After exposure to numerous couples therapy methods, I finally feel able to work effectively with this most difficult client population with the aid of Emotional Focused Couples Therapy, which combines elements of various existential-humanistic principles.

No matter which approach I am using, my  foremost emphasis is the therapeutic alliance, which has been shown in an overwhelming amount of research  to be the most important in-therapy factor in successful therapy. But I am also modest enough to realize, also from research, that the most important therapy factor is the strengths and resources clients bring to therapy that enable them to profit and grow from  treatment.    A hard-working, optimistic, client who has a good support system of relatives and friends will be able to profit from even an ineffective therapist.  I help clients  discover their resources and support them in utilizing them in their growth.   With those who lack these resources, I spend much time helping them to develop them.