Psychiatric Annals

Integrative Psychotherapy 

Integrative Psychotherapy: Collaborative Aspects of Behavioral and Psychodynamic Therapies

Henry H Babcock, MD

Abstract

It is generally agreed that behavior therapy as a new clinical entity made its first appearance in the early 1950s. Its birth has not been as dramatic or sudden as that of Athena who sprang fullarmored from the head of Zeus, but perhaps the modern day infant was just as ready for battle as the ancient goddess. In the case of behavior therapy the armor might be seen as its claim to be rooted in the science of behaviorism and in the precision of laboratory research rather than in metaphysical theories. Whether or not behavior therapy during those early years owed its survival to this protective shield, there eventually did come a time when disarmament could take place.

The overall theme for the cluster of articles published in this issue of Psychiatric Annals is how this new discipline, now fully grown, has become a collaborating partner with its former rival, psychodynamic psychotherapy, in the fashioning of a more comprehensive approach to the treatment of psychological disorders.

In the leading paper Dr. London and Ms Palmer give an incisive account of the historical development of behavior therapy. The account is perforce a complex one because of the need to deal with the rivalries encountered by this new discipline vis-a-vis the other schools of therapy that marked the early years. The accusations and invectives that were exchanged, especially between the newcomers and the psychoanalysts, are graphically described. Through London and Palmer's portrayal these struggles seem in retrospect no less than Olympian in nature, as entertaining at times as the juvenile embroilment of the gods.

Only after competition gave way to mutual acceptance and co-existence could reciprocal understanding and collaboration take place. The authors contribute not just a chronicle of these historical interactions but add their own assessments about how well the marriage of the two disciplines has worked thus far and what the future holds for further integration on both theoretical and practical levels.

In contrast with the macroscopic and historical portrayal by London and Palmer, Dr. Rhoads devotes much of his paper to considering the two major therapies from the standpoint of their actual working relationship with one another.

It is interesting to note that many firm supporters of behavior therapy come from the ranks of psychiatrists and psychologists who were trained in the institutes of psychoanalysis. Most have incorporated this second discipline without lessening their adherence to the first. Dr. Rhoads represents an example of that double tracking and his contribution to this issue reflects the ease and versatility with which he utilizes the tools and methods of both orientations. Illustrations from his own practice show how these two approaches can merge on a functional level regardless of the lack of a theoretically based integration.

Perhaps only the theorists need to await an integration on that level while practitioners, whatever their primary professional labels, should try to broaden their clinical horizons.

With even more emphasis on illustrative clinical material, Dr. Powell presents several cases in detail. His approach to the issue of integration between the two disciplines focuses on the spontaneous insight which is aroused occasionally by the conduct of behavioral techniques when practiced alone or in an overlapping or sequential relation to psychodynamic therapy. The emergence of this insight takes place entirely without the intention or anticipation of the behavior therapist who has, by tradition, confined his sights to the external and measurable aspects of human functioning. The fact that members of this discipline are now concerned with insight, an intangible recently branded by them and their predecessors as heretical, speaks for the rapidity of the movement toward synthesis…

It is generally agreed that behavior therapy as a new clinical entity made its first appearance in the early 1950s. Its birth has not been as dramatic or sudden as that of Athena who sprang fullarmored from the head of Zeus, but perhaps the modern day infant was just as ready for battle as the ancient goddess. In the case of behavior therapy the armor might be seen as its claim to be rooted in the science of behaviorism and in the precision of laboratory research rather than in metaphysical theories. Whether or not behavior therapy during those early years owed its survival to this protective shield, there eventually did come a time when disarmament could take place.

The overall theme for the cluster of articles published in this issue of Psychiatric Annals is how this new discipline, now fully grown, has become a collaborating partner with its former rival, psychodynamic psychotherapy, in the fashioning of a more comprehensive approach to the treatment of psychological disorders.

In the leading paper Dr. London and Ms Palmer give an incisive account of the historical development of behavior therapy. The account is perforce a complex one because of the need to deal with the rivalries encountered by this new discipline vis-a-vis the other schools of therapy that marked the early years. The accusations and invectives that were exchanged, especially between the newcomers and the psychoanalysts, are graphically described. Through London and Palmer's portrayal these struggles seem in retrospect no less than Olympian in nature, as entertaining at times as the juvenile embroilment of the gods.

Only after competition gave way to mutual acceptance and co-existence could reciprocal understanding and collaboration take place. The authors contribute not just a chronicle of these historical interactions but add their own assessments about how well the marriage of the two disciplines has worked thus far and what the future holds for further integration on both theoretical and practical levels.

In contrast with the macroscopic and historical portrayal by London and Palmer, Dr. Rhoads devotes much of his paper to considering the two major therapies from the standpoint of their actual working relationship with one another.

It is interesting to note that many firm supporters of behavior therapy come from the ranks of psychiatrists and psychologists who were trained in the institutes of psychoanalysis. Most have incorporated this second discipline without lessening their adherence to the first. Dr. Rhoads represents an example of that double tracking and his contribution to this issue reflects the ease and versatility with which he utilizes the tools and methods of both orientations. Illustrations from his own practice show how these two approaches can merge on a functional level regardless of the lack of a theoretically based integration.

Perhaps only the theorists need to await an integration on that level while practitioners, whatever their primary professional labels, should try to broaden their clinical horizons.

With even more emphasis on illustrative clinical material, Dr. Powell presents several cases in detail. His approach to the issue of integration between the two disciplines focuses on the spontaneous insight which is aroused occasionally by the conduct of behavioral techniques when practiced alone or in an overlapping or sequential relation to psychodynamic therapy. The emergence of this insight takes place entirely without the intention or anticipation of the behavior therapist who has, by tradition, confined his sights to the external and measurable aspects of human functioning. The fact that members of this discipline are now concerned with insight, an intangible recently branded by them and their predecessors as heretical, speaks for the rapidity of the movement toward synthesis of outlooks.

Powell also explores the release of emotional side effects during the practice of behavior therapy. After speculating on the origin of these two classes of occurrence he hypothesizes a cause which may be common to both. In this way he contributes to our conceptual thinking about the functional relation between behavioral and psychodynamic therapies, especially when they serve to complement each other in clinical practice.

Dr. Birk's paper represents the culmination of many years of clinical research. Drawing on his own earlier work in the fields of individual, couples, family, and group therapies, he has originated a methodology for the treatment of marital problems based on a strategic integration of these approaches which he finds to be briefer and more efficacious than has been the case with any less comprehensive use of these component modalities.

This method is described as creating an overlap of natural and artificial systems. The former consists of individual couples within a larger group. Each of these couples has progressed through the preliminary stages of individual and couple counseling before entering the larger couples group. Family-of-origin counseling can usually be arranged and takes place principally after each couple has joined the larger group. It is this larger couples group that Birk describes as artificial, partly because of its ever-changing composition as it interacts with the dynamics of each couple in turn.

Birk has made a unique contribution to a firmer integration between psychodynamic and behavioral therapy. The latter is signalled not only by the techniques which it lends to the working of the group, but also by the artificial changes it makes to the environment (group structure).

10.3928/0048-5713-19880501-05

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