Psychotherapy Integration (Theories of Psychotherapy) by George Stricker

Author:George Stricker
Language: eng
Format: mobi
ISBN: 9781433807206
Publisher: American Psychological Association
Published: 2012-06-18T21:00:00+00:00

Client-Directed Psychotherapy

This approach may be the one most likely to be added to the current classification scheme. In this approach, the preferences of the client drive the therapeutic course, rather than the preferences of the therapist or the dictates of theory. The case of Richard is an example of what Gold refers to as client-initiated integration (Gold, 2006) and is an example of this approach as practiced by a prominent integrationist with a clear psychodynamic bent.

“Richard was a White single man in his mid-20s who sought therapy for what he described as mild but chronic depression, a variety of anxiety symptoms that he did not initially specify, and difficulties in sustaining intimate relationships with women” (p. 255). He was a schoolteacher in a suburban area where his family also lived. He recently had become engaged to Patricia, and she encouraged him to seek treatment because of his depression.

Richard was sufficiently sophisticated about psychology that he asked for and received a referral for twice weekly therapy with a psychodynamic practitioner. It had a relatively uneventful course in which insight was gained and led to a relief of the depression and an improved relationship with Patricia. It also moved his anxiety to the forefront, and he discussed several near-phobic experiences and performance anxiety in several areas, including sexual. This changed the nature of the therapy, as a positive working relationship seemed to worsen. When this topic was introduced, Richard indicated that insight was not as helpful with anxiety as it had been with depression, and he raised the possibility of cognitive–behavioral therapy as a possible alternative.

Richard’s initial reluctance to raise the issue of therapeutic approach with his therapist until it was invited was linked to his relationship with a father who did not tolerate disagreement. However, rather than follow this transferential lead, Gold chose to shift to a more cognitive–behavioral mode of treatment. Some of the techniques were familiar to Richard, who attempted to use them on the basis of his reading, but he had not succeeded. However, with the therapist’s support and a reinstitution of the positive therapeutic relationship, the techniques became more helpful and progress was made with the anxiety symptoms.

Therapy then proceeded with shifts between psychodynamic and cognitive–behavioral interventions, with the flow dictated by the client. Interestingly, at one point Richard suggested the use of an experiential intervention, chair work for his relationship with his father, and then berated the therapist for not thinking of it first. Rather than behaving defensively or interpretively, Gold acknowledged the countertransference inherent in his failure to take the lead, and the subsequent sessions proved very productive, both in dealing with the parental relationship and repairing and solidifying the therapeutic alliance.

The final stages of therapy were concerned with Richard’s performance anxiety, particularly as it related to sexual functioning. The therapist thought that Richard’s unacknowledged anger toward Patricia was central, whereas he was more interested in specific technical interventions. Finally, Gold complied and referred Richard and Patricia to a sex therapist to work on the problem, as Richard had requested.

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