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Book Forum: Psychotherapy   |    
Integration in Psychotherapy: Models and Methods
RICHARD B. MAKOVER, M.D.
Am J Psychiatry 2003;160:1195-a-1196. doi:10.1176/appi.ajp.160.6.1195-a
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Edited by Jeremy Holmes and Anthony Bateman. Oxford, U.K., Oxford University Press, 2002, 214 pp., $45.00 (paper).

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Modern mental health care is increasingly focused on medication and patient management, but solid evidence supports the value of "talking therapies," and several contributors to this compact volume observe that their number now exceeds 400. Are they all distinct treatments or merely variations on a few core modalities? Is the structure of each only an epiphenomenon that conceals a common unifying principle? The psychologists who contributed to this book argue that innovative therapies combine two or more disciplines to form worthwhile new entities. For example, Power compares the multiplicity of therapies to diversity in linguistics: although several thousand languages exist, and each is "impenetrable" to those who speak a different tongue, they all share a common framework of grammatical rules. By analogy, all therapies are based on a common foundation—the therapeutic alliance and other nonspecific factors—to which each approach adds its own particular methodology. The value of integrative therapies may be their application to areas not previously accessible as well as the augmentation of separate approaches when used in concert with others.

The editors define integration as "the welding together of different strands into a new and coherent whole," and they and the other contributors are at pains to distinguish between the integrative approach and the pick-and-choose method of eclecticism by which one therapist applies different kinds of therapy to the multiple problems of a single patient. The first section examines the theory of integrative therapy, using psychoanalytic, cognitive behavior, systemic (the family in its social and cultural setting), and group perspectives to show how integration has developed over time within these fields and what benefits and problems have resulted.

The remainder of the book examines six therapy models and how they are practiced. Denman reviews cognitive analytic therapy and its application to borderline personality disorder. Margison discusses psychodynamic-interpersonal therapy and the need to balance responsiveness to and detachment from the patient, and Gillies focuses on interpersonal therapy. Heard outlines dialectical behavior therapy, an amalgam of behavior therapy and the principles of Zen Buddhism. Norton and Haigh discuss the therapeutic community as integrative therapy. Van Marle and Holmes supply a solid rationale for the use of supportive therapy with the chronically ill patient. The "models and methods" sections of these chapters are necessarily brief, but anyone who wishes to explore further will benefit from the extensive references.

Two particular strengths of these presentations are the emphasis on the need for validation of results by evidence-based research and the attention paid to teaching others how to practice the therapy described with growing and measurable competence. Integration in Psychotherapy makes a solid contribution to the theoretical exploration of new trends in this burgeoning field.

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