Running head: MFT APPROACH RESEARCH 0

Family Counseling Approach Research Paper

Alexander Dolin

Liberty University

MFT APPROACH RESEARCH 1

Family Counseling Approach Research Paper

Integrative Theory

Eclecticism, multi-modal models and integrative theories have all become recently

popular in the field of counseling lately. Jones-Smith (2011, p. 5), found that a high majority

(96%) of counselors do not claim adherence to any single particular theory, instead they

acknowledge the use of integration. Integration is when a counselor uses a collection of tools and

techniques from an array of different counseling theories and models instead of just using

techniques of a single theoretical orientation (Thomas & Sosin, 2011, p. 85).

Historically, counselors have operated from within their own theoretical framework.

Founders of theory stubbornly held to their own point of view to the point of ignoring alternative

conceptualizations and even potentially superior interventions. Despite the fact that no single

theory is comprehensive enough to account for the complexities of human behavior. Human

behavior, in and of itself is quite complex. There is a wide range of clientele types, each with

their own specific problems and environments (Corey, n.d.). Integrative theory is more flexible.

Miller, Sward, Nielsen, & Robertson (2001), blend the theoretical structure of a

humanistic approach with the interventions of a cognitive behavioralism. This combination of

techniques may accelerate client change. With this "made-to-order" theory, a counselor can

better serve the client in a unique way using the best intervention for the given situation. Since

every, single client is different, this theory is applicable to every single case. It can be adapted to

fit every single client's needs (Dolin, 2012, pg.1). Integrative therapy is practical for clients with

a Christian worldview as well as with clients who do not because this treatment can be easily

modified to the unique situation and worldview of the client (Bjorck, 2007).

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It is true in family therapy also. Practicing family therapists prefer to use a number of

techniques from many theories instead of just a few techniques associated with a single theory

(Center for Substance Abuse Treatment). These theories are eclectic, useful, pragmatic and case-

by-case specific to the client (Goldenberg, 2008, pg. 147). Not only is the integrative theory

more pragmatic and helpful for the client in the client's situation but it also makes the counselor

more versatile.

Postmodern Shift

Recently, there has also been a postmodern shift towards eclectic approaches.

Postmodernism says there is no one, absolute, correct way or truth. So for postmodernists, new

theories is a sign of growth and development. In the past twenty years, there has been a plethora

of new theories introduced into the counseling field. Thus, a postmodernism culture embraces

this pluralism in specializations and theories (Hoffman, L. 2006, pg.1). An integrative therapy

has the advantage of being able to draw upon all types of psychotherapies. This advantage is

only realized, however, if the integrative approach utilizes a scheme that enables therapists to

move systematically and smoothly within and among these models.

Integrative problem centered meta-frameworks (IPCM) therapy is in line with the

postmodern perspective. IPCM says that there is no perfect or definitive hypothesis. Instead,

there is a search for "good enough" hypotheses that assists problem resolution. This comes down

to fully understanding the clients, their problems, and the unique context in which both exist.

Two fundamental questions guide the quest to understand solution constraints within any

context: "What are the constraints?" and "where in the system are they located?" (Breunlin,

Pinsof, Russell and Lebow, 2011, 299-301).

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The ‘‘where’’ question looks at all levels of the psychosocial system including the levels

of person, relationships. The ‘‘what’’ question uses eight (Mind, Biology, Spirituality, Culture,

Gender, Development, Organization and Sequence) hypothesizing meta-frameworks. This is

more or less just a brain map to help the client and counselor to organize the client's human

function (Breunlin, Pinsof, Russell and Lebow, 2011, 299-301).

Integrative Behavioral Couples Theory (IBCT) specifically combines a humanistic

outlook with behavioral, hands-on problem-solving techniques. (Goldenberg, 2008, pg. 147).

Larner (2009) suggests that there is a group of "paramodern" therapists who are both modern

and postmodern.. They use approaches and techniques that are most likely to introduce change

and difference, despite the theoretical background (pg. 53).

Research on Integrative Theory

The effectiveness of integrative family therapy has piqued interest from other disciplines

besides family therapists. On one hand, family therapists have access to a range of evidence-

based psychological theories that already work. So some family therapists do not see the need for

an integrative approach. On the other hand, there is some indication from the research literature

that integrating systemic family therapy with cognitive therapy is effective for depressed

adolescents. Larner does point out that any therapeutic work with adolescents requires an

engaging, creative and collaborative therapeutic relationship. There needs to be therapeutic space

for the young person's voice to be heard (Larner, 2009, pg. 53).

Integrative Marital Intensive Therapy (IMIT) shows some signs of effectiveness. After

three months of IMIT, there were no divorces. After six months, about 98% of 141 couples were

still married,. After twelve months, still around 95% of 129 couples were still married. And after

twenty-four months 84.5% of 71 couples were still married. Also a statistically significant

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finding, all four intervals (3, 6, 12 and 24 months) there were increases in marriage satisfaction

(Burbee, Sparks, Paul and Arnzen, 2011, 47).

Integrative therapies share common factors with other empirically proven models (Davis,

2007, pg. 345). In all of the successful theories, the therapist is familiar with how the

dysfunction comes about, offers a clear definition of health and has a understandable plan to get

the client from the dysfunction to health. Also the counselor helps the client's discouragement

and estrangement by instituting a strong therapeutic relationship. The counselor is a beacon of

hope and expectations through-out the therapy. The counselor offers new learning experiences

and facilitates emotional arousal and reprocessing. The counselor facilitates a sense of mastery

or self-efficacy; and offers opportunities for the client to practice new behaviors (pg. 359).

Common factors for successful treatment is really important to address, as this is the key

research that is guiding the direction of integrative therapy. Essentially integrative therapy wants

to know what works and what does not work. These common factors are what works. According

to Christensen (the founder of IBCT), Johnson, Lebow and Chamber (other pioneers in

integrative therapy) the common factors include the generation of hope in the context of

discouragement, a systemic viewpoint, adapting to client phase/session of change and a mix of

intervention strategies that work with emotion, cognition, and behavior. Research is still very

new and an on-going process evaluating the effectiveness of integrative versus traditional

therapies ( Christensen, Johnson, Lebow and Chamber, 2012, pg.158).

Christensen, Johnson, Lebow and Chamber tested IBCT against traditional behavioral

couple therapy (TBCT). Following treatment termination, couples showed an immediate drop in

satisfaction but then a gradual rise in satisfaction and, for couples who stayed together,

considerable maintenance of that higher level of satisfaction. The authors suggest that the initial

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slump in satisfaction after treatment termination might be a natural result of ending the regular

scheduled focus on the relationship that therapy provides. Both treatments showed significant

effect sizes on relationship satisfaction at post-treatment and at 5 years after treatment

termination. At termination, 70.4% of IBCT couples and 60.6% of TBCT couples showed

clinically significant improvement (reliable improvement or recovery). At 5-year follow-up, 50%

of IBCT couples and 46% of TBCT couples showed clinically significant improvement. At 5-

year follow-up, 25.7% of IBCT couples and 27.9% of TBCT couples were divorced or legally

separated (pg. 150). In the long run, IBCT can offer more hope and give the clients more tools to

use in their marriages and improve more marriages.

Goals

Ideally, families are democratic systems that include healthy boundaries, not bound by

gender roles or hierarchies. Ideally, family members care about the happiness of others rather

than being self-absorbed . The ideal is not always possible. Things like birth order, favoritism,

gender, blended families, and the presence of family challenges, such as illnesses, all affect the

family system. Part of the theorists job is to assess these conditions. It is also important to

understand the ways family members interpret these circumstances also. Obviously, most

families are not without some dysfunction.

A hindrance in the family system manifests itself when a member has a feeling that

he/she is losing the courage to face daily living. This discouragement always reflects an ambition

that is deemed unreachable. The goal of family therapy is reorientation of the environment,

system roles and of the belief about the dysfunction . The counselor needs to get the family on

the same page. Everyone needs to know the purpose of the family system itself, as well as the

strengths and resources of unity. In a safe environment, there is encouragement. Counselors

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should help the clients break dysfunctional patterns in behavior. Therapeutic treatment and

interventions must address the unique needs of the clientele to whom they are applied. While

Gestalt or Adlerian therapy may provide a bird's eye view framework for counseling for wide

range of problems, treatment plans can be enhanced by the inclusion of concepts and methods

borrowed from other approaches to therapy (Carlson and Robey, 2011, 232,-233). This is the

application of integration theory.

Summary

Integrative family therapy is still a very relatively new idea. The idea behind the theory is

to help clients with the strategies that work best for their specific context and particular

circumstance. It is born out of the postmodern mindset, that says that there is not one correct

theory, instead it may be useful to draw upon many theories to find a technique that is useful in a

particular therapeutic relationship that also will help with the client's situation. It is getting away

from finding a theoretical orientation that will solve everyone's problems, because there is no

one-size-fits-all theory.

Research on these approaches are hopeful but still fresh. It is obvious that one could error

by going too far in the postmodern movement and trying too hard to learn every single theory or

by completely ignoring all theories all together and just talk to clients randomly. Both if these

ideas are negative and not what this theory is about. Instead Integrative therapy, does challenge

the counselor to do his/her research and have a good knowledge-base in theory but ultimately has

a good understanding of the factors that make family therapy successful. These factors, are in all

successful therapy despite the theoretical orientation: a strong therapeutic relationship, hope and

a strategy to get from dysfunction to health again. It actually is simple and freeing. A therapists

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is not chained to any orientation but is free to pick and choose form techniques that are

empirically-sound for the client's particular situation.

Reflection

An integrative approach is useful to me. It is sort of the "best of the best" techniques. I

also really appreciate these integrative theories because I use an integrative approach in

individual therapy also. What I appreciate the most, personally, is the inter-changeability of

techniques despite the theoretical framework. The usefulness of integrative therapy, is that it is

flexible and editable for any situation. The idea for this integrative approach is that clinicians can

pick and choose from theories, combining discrete parts that work best in any situation,

crossing theoretical boundaries (Goldneberg, 2008, pg. 147).

Eclecticism is very useful for all clinicians, no matter what worldview or theoretical

background they favor. Above all, studies have shown that the therapeutic relationship is the

most vital aspect of the therapy (Hoisington, 2003). Clients are not likely to recall what their

counselor's theoretical orientation was, they might remember some of the interventions in

treatment and they may not remember everything they learned, although they will remember the

counselor cared, listened and respected them (Hatchett, 2008, p. 215). Eclecticism helps put the

spotlight off of the theory and back on the client and that therapeutic relationship.

I am glad that integrative therapy is taking off. I desire to learn more and more

interventions to become more comprehensive in my approach and be able to use a larger variety

of techniques. I still have a lot to learn about which interventions work best in any given

situation. Ultimately what this theory comes down to is a simple query: “What treatment, by

whom, is the most effective for this individual with that specific problem and under which set of

circumstances?” (Corey, 2009, p. 238). This is the loaded question counselors need to think

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about at all stages of the therapy. The focus is off of the counselor and counselor's preference and

it is back on the client and the client's needs.

A key that I learned through doing this research is that one of the common factors found

in successful Integrative and all successful theories is that the counselor brings hope to the

sessions. In Hope Focused Counseling, as the name implies, is focused on hope. There is hope

for change and hope that the marriage will be saved and strengthened (Worthington, 1991, pg.

23). Hope-Focused Counseling may not be considered an integrative theory, but it also is not a

tradition theory either. It is a brief, solution-focused one. In any case, Worthington is a great

source to draw techniques from that can be used in integrative therapy with couples.

According to Worthington there are nine target areas: central values and beliefs, core

vision of the marriage, confession and forgiveness, communication, conflict resolution, cognition

about the marriage, closeness/intimacy, complicating problems and commitment (pg. 37).

Worthington suggests to target just one of these target areas (pg.42). The truth is that it would be

very difficult to plan and form an strategy for all areas. Plus each of the nine areas are very

inter-related. If change occurs in one of these areas, it will have an impact on the other areas too.

Even if the targets are not related, accomplishing one of these targets instills hope in the clients

and excites them as they are one step closer to their goals (pg. 71). Ultimately, I think having a

solution-focused framework will do well in many cases. Although, in other cases, it will not. It is

still good to have the knowledge and techniques available.

Since integrative therapy is so flexible brief and solution-focused therapies, like

Worthington's, can easily be integrated into integrative therapy. While a lot of Christian

counseling theories are brief and solution focused, this means that they too are easily integrated.

Even, more extensive and lengthier Christian therapies are easily integrated into integrative

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family therapy because there is no preferred or recognized theoretical framework for integrative

theory. The counselor can just as easily use techniques and goals from a Christian therapy as

he/she can from a secular approach or model.

I really appreciate Integrative Behavioral Couples Theory (IBCT) specifically because it

combines a humanistic outlook with behavioral, hands-on problem-solving techniques

(Goldenberg, 2008, pg. 147). This is my preferred orientation for individual therapy and I

imagine it would also work really well in couples counseling. IBCT embraces features of

cognitive-behavioral strategies but also takes into account private experience such as emotions.

IBCT evaluates the broad themes in partners’ concerns and places a high emphasis on a

functional analysis of behavior (Christensen, Johnson, Lebow and Chambers, 2012, pg. 149)..

One technique I take from these researchers is this analysis of behavior. The counselor

helps the couple to become aware of the difficult behavioral patterns in the relationship but

allows for emotional space for analysis and feedback. This emotional distance is helpful and

allows clients to view their own objectively (Christensen, Johnson, Lebow and Chambers, 2012,

pg. 149).

I also really appreciate Integrative Marital Intensive Therapy (IMIT) as it was developed

by Christians. It follows theoretically very similar to IBCT, except it is set in the Christian

worldview. Burbee, Sparks, Pau, & Arnzen (2011), state that the only limitation of IMIT is that

of the therapist's imagination (pg. 44). I sense a deeper responsibility as the therapy is only

limited by my own creativity. Part of me hates the disorganized, unstructured ideals of this "in

the moment" type of therapy. Although, the majority of my thoughts absolutely love the idea of

being liberated and free to create and use whatever technique I think will fit best. This is the

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artist in me coming out. There is a lot of benefits to integrative therapy. I plan on taking aspects

of these prominent integrative theories and use them in practice in couples and family therapy.

part 2 requires 4 pages, not 3.

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References

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Bjorck, J. P. (2007). A Christian Application of Multimodal Therapy. Journal of Psychology and

Christianity., 26(2), 140-150.

Breunlin, Pinsof, Russell, & Lebow. (2011). Integrative Problem-Centered Metaframeworks

Therapy I: Core Concepts and Hypothesizing. Family Process , Vol. 50, 299-301

Burbee, Sparks, Pau, & Arnzen. (2011). Integrative Marital Intensive Therapy: A Strategy for

Marriages in Severe Distress. Journal of Psychology and Christianity, Vol. 30, No. 1, 37-

50.

Your journal citations should look like this:

Kogan, L.R., Granger B.P., Fitchett, J.A., Helmer K.A., & Young, K.J. (1999). The human-

animal team approach for children with emotional disorders: Two case studies. Child and

Youth Care Forum, 28 (2), 105-121.

Carlson and Robey. (2001). Integrative Alderian Approach. The Journal of Individual

Psychology, Vol. 67, No. 3, pg. 232-

Center for Substance Abuse Treatment. Substance Abuse Treatment and Family Therapy.

Rockville (MD): Substance Abuse and Mental Health Services Administration (US);

2004. (Treatment Improvement Protocol (TIP) Series, No. 39.) Chapter 4 Integrated

Models for Treating Family Members. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK64266/

Christensen, A., Johnson, S., Lebow, J., and Chambers, A. (2012). Research on the Treatment of

Couple Distress. Journal of Marital and Family Therapy, Vol. 38, No. 1, pp. 145–168.

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Corey, G. (2009). Theory and practice of counseling and psychotherapy(8th ed.) Belmont,          

CA: Brooks/Cole-Thomson Learning.

Corey, G. (n.d.). Designing an Integrative Approach to Counseling Practice. VISTAS Online,

Retrieved August 6, 2012, from

http://www.counseling.org/Resources/Library/VISTAS/vistas04/29.pdf

Davis, S. D. (2007). What Clients of Couple Therapy Model Developers and their Former

Students say about Change. Journal of Marital and Family Therapy, Vol. 33, No. 3, pp.

344–363.

Dolin, A. (2012). Accommodation Design Theory: In partial fulfillment of COUN 510 for

Liberty University coursework.

Goldenberg. (2008). Family Therapy: An Overview (7th Edition). Belmont, CA: Brooks/Cole

Hatchett, G. T. (2008). A One-Size Relationship Stance Does Not Fit All: customization of the

Counseling Relationship. Australian Journal of Guidance & Counseling , 18(2), 210-218.

Hoffman, L. (2006). Understanding Psychology's Diversity in a Postmodern Perspective

Theoretical Orientations, Specialties and the Role of Dialogue. Postmodernism &

Psychology's Diversity. Accessed from

http://www.postmodernpsychology.com/Topics/Postmodernism_Psychologys_Diversity.

html

Hoisington, W. D. (2003, February). Eclecticism, Counseling and Accommodation Design for

Persons with Cognitive Disabilities. Retrieved August 10, 2012, from

http://www.sacredhealingnow.com/Other_Papers/Eclec&Accom.pdf

Jones-Smith, E. (2011). Theories of Counseling and Psychotherapy: An Integrative Approach.

Thousand Oaks, CA: SAGE.

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Larner, G. Integrative Family Therapy With Childhood Chronic Illness :An Ethics of Practice.

The Australian and New Zealand Journal of Family Therap. Vol. 30: 1pp. 51-65

Miller, A. M., Sward, J. M., Nielsen, R. C., & Robertson, S. N. (2001). Theoretical integration of

humanistic and cognitive/behavioral approaches in counseling. Retrieved August 10,

2012, from Theoretical integration of humanistic and cognitive/behavioral approaches in

counseling.

Thomas, J. C., & Sosin, L. (2011). Therapeutic Expedition: Equipping the Christian Counselor

for the Journey. Nashville, TN: B&H Academic Publishing Group.

Worthington Jr, Everett. (1991). Hope - Focused Marriage Counseling. Downers Grove, Il:

Intervarsity Press.

This grading scale is taken directly from the instructions

Element Points Points

received

Readability and APA Style (6th ed.)

APA style 11111 11111 11111 11111 1 Spell/punc/indents/num/abbr/spaces/grammar 1111

30 5

Organization

Clear, logical flow of ideas Major points are stated clearly Major points are supported by one or more of the following

1. Goldenberg & Goldenberg text is okay2. Other scholarly sources (12 total)3. Thoughtful analysis of themes (considering implications, identifying

assumptions, etc.)

37 37

I liked

what you

did here

Part I Content (6 pages)

Identified approach to family counseling Identified leading figures, historical and present events, assumptions, development

of the theory, concepts, techniques, etc. Noted similarities/dissimilarities between your chosen theory and other leading

theories.

45 45

Good

work

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Identification of key things learned that you did not know prior to doing this paperPart II Content (4 pages)

How your faith or world view coincides with your theory Integration principles and techniques within your counseling theory Your Christian worldview or personal worldview of family, pathology, cure How your views interact with your counseling theory First person is okay in this section

30 22

Logistics of Paper

Acceptable page length (minimum 10 pages-NOT counting title/ref pp.) minimum of 12 sources

8

8

Total Points for FTRP

(5 point deduction per day late)

150

possible

117

Good content, but you need to make sure you do spell /grammar/punctuation check, and make sure you work on your APA formatting, especially in your citations and references. Please take advantage of the Online Writing Center that is there to help you with papers and learn appropriate style. also, three pages on part 2 cannot adequately cover the questions required. I pray that you will be blessed in your future endeavors, and that you will continue to work hard. It was a blessing having you in the class!