Abstract
Given that therapists are confronted with literally hundreds of techniques or interventions to potentially utilize in their clinical practice — and a growing chasm separating research and practice — how do therapists dispel the confusion that so many of us feel as we confront this fragmented heap of techniques? In short, how do therapists decide which interventions to use with a given client? This question is both epistemological in nature and immediately tied to practice, as epistemologies have concrete clinical consequences. This article classifies nearly 200 therapeutic interventions according to the AQAL model of Integral Psychotherapy, followed by a critical discussion of the clinical utility of such a taxonomy. The author first presents the need for such a classification system and briefly overviews integral theory. The author ends with suggestions for how to use an integral taxonomy of therapeutic interventions with psychotherapy clients, the role and meaning of interventions, an algorithm describing how the interventions were classified, and a caution against the “tyranny of technique.”Introduction
The limitations of practicing within a single counseling approach have begun to outweigh the benefits offered by “pure form” therapies. Moreover, with only a few exceptions, there is very little research that demonstrates the consistent superiority of one single-school approach or intervention over others (Asay & Lambert, 2003). Now that the majority of therapists report practicing eclectically or integratively (Jensen et al., 1990), most of us have an overwhelming number of counseling interventions and techniques to draw from. Confronted with this plethora of counseling interventions — and a growing chasm separating research and practice (Miller, 2004) — how do therapists dispel the confusion that so many of us feel as we confront this fragmented heap of techniques? In short, how do we decide which interventions to use with a given client? This question is both epistemological in nature and immediately tied to practice; after all, epistemologies have concrete clinical consequences (Stolorow et al., 2002).
Although the five main categories of eclectic or integrative practice (eclecticism, common factors, assimilative integration, theoretical integration, and metatheoretical integration) each address the above questions and have contributed to the field, each approach also has noteworthy limitations or drawbacks (i.e., incompleteness, restrictedness, propagation of incongruent sub-therapies, unsuitability for practice, and a high level of abstraction, respectively) (Norcross & Goldried, 2003; Lampropoulos, 2001; Stricker & Gold, 1993). For now, let me suggest that integral theory provides a comprehensive yet parsimonious model and conceptual framework able to accommodate varying and highly divergent therapeutic systems, thus greatly aiding therapists in their decisions of what interventions to use with which clients (Wilber, 1999, 2000a; Marquis, 2007; Marquis, 2008; Marquis & Wilber, 2008).
Given that the primary purpose of this article is to provide a classifying system with which to lend order and coherence to what has been a gargantuan heap of techniques, I want to emphasize how imperative it is to retain a sense of humility when we assess and evaluate the therapeutic impact of our interventions. Our best appraisals remain conjectural. A thorough critique of empirically-supported treatment (EST) and evidence-based practice (EBP) research protocols would fill volumes of this journal (see Marquis & Douthit, 2006). This is not an expression of pessimism or nihilism, but rather an honest realism peering into the human condition, which is tremendously complex, multi-dimensional, and multiply-determined. In the mysterious region where facts and meanings mingle, traditional scientific methods (especially the controlled clinical trials used in EST research) seem to gaze in confusion at the shining surfaces, where they either remain mostly silent or hubristically pretend to know far more about the precise workings within the depths of human change processes than they actually do (Foucault, 1973). It is possible that a logic different than that of the biomedical model alone will be required to understand the workings of the human heart.