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Getting Our Act Together –

The Challenge of Integration in the Psychological Therapies.

Now that the Iron Mill has been providing education and training in the field of Counselling/Psychotherapy and related areas for 30 years, I think it is an interesting time to take a look again at the issue of integration in our professional world.


We are moving into the second decade of the second century of Psychotherapy, yet our field is still a fragmented one, divided into various schools and approaches, such as the Humanistic, the Psychodynamic, the Cognitive-Behavioural etc.

Even these broad schools are further sub-divided. Within the Humanistic camp can be found the Person-Centred approach, Gestalt Therapy etc. Some Cognitive-Behavioural therapists see themselves as primarily in the Rational Emotive Behavioural (Albert Ellis) camp, others lean more towards Cognitive Therapy (Aaron Beck), and so on. Not only that, Psychological Therapy of various kinds is often provided by other helping professionals apart from Counsellors and Psychotherapists, for example Clinical Psychologists, Psychiatrists, Psychiatric Nurses, Addiction Key Workers, Life Coaches, etc…

And of course there is no sign of agreement as to what the difference is between Counselling and Psychotherapy, if there is any…

This is confusing for those entering the helping professions, for those working in them, for the general public, and especially for prospective clients in need of help.

Statutory Regulation, whenever it comes, may help to clarify some of this confusion, but in the meantime I believe that we in the Counselling & Psychotherapy field need to put our own profession on a firmer footing, while also building solider links to allied professions.

What I believe would help clients, when they seek help for their life issues and mental health problems, would be if they met a more integrated set of options, and found themselves as quickly as possible working with the professional who can best help them (availability of resources is also an issue here, of course, but that is another story).

Whatever picture emerges, it will need to encompass a range of interventions (including psychological, pharmaceutical, and social) which can be applied to a range of problems, in a variety of circumstances, with a variety of personality types and developmental stages.

With regard to putting Counselling & Psychotherapy on a firmer footing, I would predict that when a more integrated picture does emerge, the principles and practices that become established will include only some of the elements of each of the schools of Psychological Therapy. Many aspects of each school will also have to be dropped, if they are not supported by scientific evidence and best practice guidelines.

With regard to building solider links to allied professions, it seems to me that the important distinction is not between such territories as Counselling, Psychotherapy, Psychiatry, Coaching, etc, but between what works reliably well in particular circumstances and what works less reliably well. For the moment, the process of defining such professions probably needs to continue, as a necessary stage in a process, but in the long term we may be more likely to see a softening of boundaries and more overlapping of these professions, rather than increasing distinctions.

In practice, this means that useful interventions should not be seen as all coming as a complete package, which is then given the name of Cognitive Behavioural Therapist, or Life Coach, or Psychoanalyst (with the accompanying training package). For the sake of clients, training in useful interventions should be provided, to the necessary level, to any helping professionals who can make use of them in the setting in which they work. These helping professionals could be psychiatric nurses, counsellors in private practice, GPs, residential addiction treatment staff (including, but not solely, addiction counsellors). Part of the emerging picture is that, along with general principles of good helping, different interventions are being found to work best for different problems, rather than generic solutions being the order of the day. This means that the distinction between areas of specialisation (addiction, relationship problems, sexual abuse, etc) may in the long-term be a more real and enduring one than that between Psychological Therapy professions and schools.

Some useful principles I would suggest, which might help to guide us, are as follows:
 

  • Inclusiveness/pluralism; accepting that there are many approaches through which people in distress can be helped
  • Interdisciplinary and inter-school cooperation
  • Choice, through the provision of as many options as possible for those who look for help
  • Broad (not territorial) education of clients as to the options available
  • Broad (not purist) education of students of the helping professions
  • Encouraging self-help wherever possible
  • Sound professional ethics
  • Multicultural perspectives
  • Evidence-Based Practice, where possible, as one of the available options
  • Mutual referral/cooperation arrangements between a variety of disciplines/schools/settings/specialities in the area of helping.

The contribution of the Iron Mill to this integration in the British context has been significant.

Our BACP Accredited Advanced Diploma in Integrative Counselling is one of the most integrative in the country, including an introduction to all the main schools, as well as looking at various aspects of psychology (Abnormal & Developmental), and providing students with options for studying specific areas such as Substance Addiction and Sexual Abuse/Dysfunction. Our students come from a variety of professional backgrounds, and our CPD programmes in particular are designed to be of relevance to practitioners from many helping professions.

We plan to continue to be at the forefront of the move towards greater integration over our second 30 years – it promises to be an exciting time in the world of the Psychological Therapies!

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