THE INTEGRATIVE THERAPIST - President's Column WHAT'S INSIDE
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JUNE 2021 • VOL. 7, ISSUE 2
THE INTEGRATIVE THERAPIST
ARTICLES • INTERVIEWS • COMMENTARIES
ISSN # 2520-2464
ALAN JEREMY
KIAN
EDITOR
FORSYTHE
ASSOCIATE
President's Column
EDITOR ALBERTA POS
Okay, so we are still reeling in relation to COVID-19. We
never imagined that a world of quarantine would still be
WHAT'S going on at this stage of the game. So, I’m glad that we as
INSIDE the SEPI Executives made the early commitment to have a
totally online meeting this year in 2021 – this has made our
process of responding to COVID much smoother. The
President's Column (by
lockdown is being lifted in some countries and is being re-
Alberta Pos) - Pg. 1
established in others, and some folks have been vaccinated
while others still await. We have a long way to go before we
SEPI 37th Annual Meeting
reach a ‘new normal’.
- Pg. 6
SEPI Awards Spot (by Still, SEPI is an international organization with members from
Ioana Podina) - Pg. 7 every continent. Innovative clinical theory, cutting-edge
Continued... research, and warm face to face dialogue have always
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THE INTEGRATIVE THERAPIST VOL. 7, ISSUE 2 • JUNE 2021
Regional Network been cherished by us. We will maintain this. Not being able
Committee News ( b y to meet in person has posed a big challenge for us, but SEPI
Tom Holman) - Pg. 9 members are flexible and innovative, and we continue to do
our best to sustain connections and collaborations in the
Upcoming SEPI Webinar world and around our communities. SEPI can thrive in spite
- Pg. 11
of these difficulties. We continue to inevitably and
intellectually stimulate one another. We commit to having
Communications &
live, in person conferences in the future. We are planning
Publications Committee
Updates ( b y S e l i n a P h a n and hoping to have our next live meeting in Lausanne in
& Lauren Smith) - Pg. 12 2022 (we missed Lausanne this year!). Ueli Kramer has
graciously told us that he will continue as the local chair in
SEPI Featured Members Lausanne. In the following year, we hope to be in
- Stephen M. Diggs ( b y Vancouver, as we have missed that one too. Afterwards, we
Markus Böckle) - Pg. 14
hope to go to Poland and to Istanbul. Fingers crossed!
SEPI Featured Members
This crisis will end, and we will return to having open
- Alberta Pos ( b y M a r k u s
conversations that we all treasure so much. We are also
Böckle) - Pg. 16
learning about advantages to a COVID online world. Most
Bruce Lee and the Tao importantly, we are finding advantages of being more
of Integrative accessible financially and time wise than we have ever been
Psychotherapy ( b y before. Speaking to that point, I want to thank Tracy Prout,
Daniel Millstein) - Pg. 18 our chair of the communications committee at SEPI, and
Tracey Martin, our conference secretary, publicly, for
Making space for dealing with all the little snafus that are part of this learning
relational therapies:
to go online process that we have had this year. Thanks to
Challenging the status
you both for such hard work. We SEPI members are very
quo in a CBT-dominated
grateful to you both. And as far as our soon to arrive (June
environment ( b y V e n e t i a
10-12, 2021) online meeting, it will prove to be a good one!
Leonidaki) - Pg. 22
The theme of this online meeting will be “Working with
Personality Theory is Emotion in Psychotherapy: Clients, Diagnoses, Methods” will
Fascinating ( b y S i g m u n d have plenty of live stream sessions as well as a full library of
Karterud) - Pg. 26 online demand videos for our attendees to watch. We also
have many submitted posters. These will all be available for
Judging Qualities of the
watching by our attendees for 3 full months after the
Therapist from
conference ends. Check out the program at
Segments of
https://www.sepiweb.org/page/37conferenceprogram.
Psychotherapy Sessions
(by Rivian K. Lewin &
Jeffrey S. Berman) - Pg.
28
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THE INTEGRATIVE THERAPIST VOL. 7, ISSUE 2 • JUNE 202
So what is the plan for the year 2021 for SEPI? Well, we have already been able to renew our
website, thanks to Catherine Eubanks. Tracy Prout has also established our presence in our
webinars. Gregg Henriques, who will be our new president in 2022, has just done one in May,
and we did a well attended fireside chat in December on Emotion with Les Greenberg, who is
going to be our keynote speaker at this year’s online meeting, a past SEPI president Rhonda
Goldman and myself, Dr. Pos. We have had offerings also in May from Tony Rousmaniere &
Alexandre Vaz on deliberate practice, and we had two fabulous webinars, one from Catherine
Eubanks and Dr Christopher Muran on alliance ruptures that occurred in April, and another that
provided an overview of psychotherapy Integration, that was presented last July by Paul
Wachtel & Marvin Goldfried. We also had a webinar presented by notable West Coast
clinicians, with Drs. George Silberschatz & David Kealy. All our webinars can be accessed and
watched online. This impressive library of recorded webinars is now available to be viewed on
our new website at https://www.sepiweb.org/page/webinar_recordings.
It is clear that psychotherapy integration is now more than an idea to be mused about in
conversations. Psychotherapy integration is becoming the beacon for research and clinical
work everywhere. Now that we know that no one approach is the ‘best one’ for any disorder,
and now that the Dodo Bird effect (Duncan, 2002) is becoming so well known, we are moving
into a much more serious research and conversation about change (Kazdin, 2007). We are also
at the brink of a true science of change. We know that psychotherapeutic change is most often
about the activation of common factors, or what Marv Goldfried would call therapeutic
principles of change (Goldfried, 2019). This SEPI founding father, Marv Goldfried, has received
the 2018 Gold Medal Award for Life Achievement in the Application of Psychology from the
American Psychological Foundation. He is a true SEPI scientist, always championing the
connection between research and practice. We do this at SEPI and hold this as a solemn
principle and mandate. We keep working tirelessly to continue this legacy. Many champions in
the field are coming around to holding our point of view, both research wise and clinically. We
want to acknowledge the tireless work of those who have made this possible. John Norcross for
example, a past SEPI president, publishes alone, and with other champions of
psychotherapeutic change research, like Drs. Michael Lambert and Bruce Wampold (Norcross &
Lambert, 2019; Norcross & Goldfried, 2019; Norcross & Wampold, 2019). We will continue to
acknowledge the work of many in our field, Paul Wachtel, Gregg Henriques, and many others.
So what can you do as a member of SEPI to encourage the conversation about change not
being the sole domain of any one approach? For sure we must be respectful to individual and
specific schools of change. But we also have to be brave enough to talk about transtheoretical
ideas, and a broader context of change in our client worlds. Encourage others to speak more
inclusively. Remember that we must stop excluding each other from our conversations by using
special ‘club’ language. Encourage plain speak about these topics, not ‘coded’ speech.
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And when you do not understand something, do not assume the reason you do not understand is
because you are the one who is ill informed. It may be that you do not have a special ‘decoder
ring’ needed to understand, and that perhaps the conversation can be reframed in language
we can all access. Encourage people to speak to each other using language that can be
shared. This is because only in shared language can true conversation occur.
And keep noticing the responsive changes this past year SEPI has gone through: a major web
page renovation and a better web presence; an updated homepage with a refreshed new look;
a recognizable brand we can continue to grow; active Facebook page, Twitter, and Instagram
accounts as well. Notice our updated logo, thanks to the work of our past president Shigeru
Iwakabe. The SEPI Webinar Series continues to grow throughout the year until our next meeting
in Lausanne in 2022. Open to all, members and nonmembers, webinars promote SEPI all over
the world. Applaud our Journal of Psychotherapy Integration (JPI) editor Jennifer Callahan for a
very successful year. She responded very quickly to the pandemic with a call for a special issue
on tele-psychotherapy in the age of covid-19. She and her editorial team created an important
special issue that lead our journal to much APA success. APA congratulated our journal of its
success. Keep submitting ideas for special issues and let JPI become the stronghold it should
be. Check out our JPI web presence too at https://www.sepiweb.org/page/JPI.
Finally, in the midst of the pandemic, keep confronting racism and violence with us. Know that
SEPI is an organization that condemns police brutality, violence, and the silencing of the voices
of people of color. SEPI acknowledges the entrenched systemic factors that reify oppression.
Know that we stand up to and wish to stop racial injustice. Our SEPI mission rests on the
importance of dialogue and learning from one another. Let us be ever more aware of how our
various cultures form fundamental contexts within which people grow, flourish, but also suffer.
We can be responsible, as individuals and as an organization, to examine and challenge
ourselves.
Stay strong and healthy in 2021.
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THE INTEGRATIVE THERAPIST VOL. 7, ISSUE 2 • JUNE 2
References
1. Duncan, B. L. (2002). The legacy of Saul Rosenzweig: The profundity of the dodo bird. Journal of
Psychotherapy Integration, 12(1), 32–57. https://doi.org/10.1037/1053-0479.12.1.32
2. Goldfried, M. R. (2019). Obtaining consensus in psychotherapy: What holds us back? American
Psychologist, 74(4), 484–496. https://doi.org/10.1037/amp0000365.
3. Kazdin, A. E. (2007) Annual Review Clinical Psychology 3,1–27 doi:
10.1146/annurev.clinpsy.3.022806.091432.
4. Norcross, J. C., & Lambert, M. J. (2019). (Eds.). Psychotherapy relationships that work. Volume 1:
Evidence-based therapist contributions (3rd ed.). New York: Oxford University Press.
5. Norcross, J. C., & Wampold, B. E. (2019). (Eds.). Psychotherapy relationships that work. Volume 2:
Evidence-based responsiveness (3rd ed.). New York: Oxford University Press.
6. Norcross, J. C., & Goldfried, M. R. (2019). (Eds.). Handbook of psychotherapy integration (3rd ed.).
New York: Oxford University Press.
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SEPI 37th Annual Meeting
JUNE 10-12, 2021 (VIRTUAL)
Conference Theme
Working with Emotion in Psychotherapy: Clients, Diagnoses, Methods
We know that COVID-19 has thrown a wrench into the academic world of conferences and
broader than that, a wrench into the lives of all mankind. It is for this reason that we have
decided to hold a completely online/virtual meeting this year. We are disappointed that we
not be able to join together in Lausanne, Switzerland as planned. But, we believe meeting
online for 2021 is the safest, most inclusive option. We also realize that an online format
will likely facilitate presentations by students who have had financial considerations,
clinicians who have been unable to attend in the past, and those who likely have to or are
unable to come from afar for any number of reasons. This is the potential silver lining of the
COVID pandemic for SEPI. We are looking forward to seeing many of you in this new virtual
format.
For more information on this meeting, including registration, specific themes, guidelines, and
schedules, please click below:
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SEPI Awards Spot
IOANA PODINA
CONGRATULATIONS TO THE SEPI 2021 RESEARCH AWARD WINNERS!
Dear colleagues and SEPI members,
Every year it is traditional for SEPI to award its top early researchers and dissertation
candidates which foster research in psychotherapy integration. This year was no exception
and the SEPI Research Committee selected the best integrative research applicants with
substantial contributions to the field of integrative psychotherapy research. As a result, two
excellent integrative researchers were awarded with the Marvin R. Goldfried SEPI New
Researcher Award and the SEPI Dissertation Award, as detailed below.
THE MARVIN R. GOLDFRIED SEPI NEW RESEARCHER AWARD
This year’s Marvin R. Goldfried SEPI New Researcher Award, supporting excellent early-
career researchers, was awarded to Dr. Andrew McAleavey. Dr. McAleavey is an instructor
of Psychology in Psychiatry at Weill Cornell Medical College. He conducts research on the
psychological effects of trauma as well as general process and outcome of psychotherapy
in large, diverse data sets. He has expertise in cognitive-behavioral therapies, including
prolonged exposure therapy. He is currently an Associate Editor of Psychotherapy Research.
THE SEPI DISSERTATION AWARD
The 2021 winner of the SEPI dissertation award was Alice Coyne. Alice is a doctoral
candidate at the Department of Psychology, University of Massachusetts Amherst. Her
scientific advisor is Dr. Michael Constantino. Alice's research interests include
psychotherapy process, outcome, and integration; common treatment factors; dyadic
analysis of the patient-therapist relationship and psychotherapy process; therapist effects;
psychotherapy training; interpersonal theory and treatment; moderators and mediators of
treatment and process effects.
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We know that this year, as well as 2020, was extremely challenging for researchers and
psychotherapists alike, not to mention for their clients. The excellent research outputs of this
year’s SEPI research awardees are a testimony of their assiduous work and resilience
despite worldwide known hurdles. Therefore, on behalf of the SEPI research committee and
my own, I congratulate the 2021’s SEPI research award winners for their outstanding
achievements!
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THE INTEGRATIVE THERAPIST VOL. 7, ISSUE 2 • JUNE 2021
Regional Network Committee News
TOM HOLMAN
The award for Regional Network of the Year 2020 goes to the Regional Network of Uruguay
whose Coordinator is Margarita Dubourdieu. The Uruguayan RN promotes Integrative
Psychotherapy from a medical, psychological and social perspective. The Uruguayan approach
not only integrates contributions from the different models of Psychotherapy but also from
Medicine, Neurosciences, Sociology and other disciplines. Dr. Dubourdieu directs the
Uruguayan Society of Psycho-Neuro-Immuno-Endocrinology, the Integrative Psychotherapy area
in several countries that are members of the Latin American Federation of Psycho-Neuro-
Immuno-Endocrinology.
The RN conducts postgraduate training in Integrative Psychotherapy for various professionals in
several universities and institutions in Uruguay and Argentina as well as in other Latin American
countries and in Spain. It provides patient care, supervision and training in hospital settings in
psychiatry, oncology, endocrinology and gastroenterology, including pediatric settings and
institutions that support adolescents and families in vulnerable contexts. They also collaborate
with institutions in Spain.
The Uruguayan RN has also established support networks in the face of the pandemic situation.
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THE INTEGRATIVE THERAPIST VOL. 7, ISSUE 2 • JUNE 2021
Members of the Uruguayan RN have given presentations at national congresses and scientific
activities in societies and associations of Biological Psychiatry, the Neurology Society of
Uruguay, at the School of Medicine, and at the Latin American Association of Psychology and
Psychotherapy, Psychology Congresses, and the Congress of Pediatric Oncology in Ecuador,
among others. In addition, they have made live presentations on Instagram, Facebook, and
webinars in various countries. The Uruguay RN has been consistently active and productive for
many years.
SEPI also wants to recognize the efforts of all RNs who have reached out to support people
suffering from issues related to the pandemic. These are documented in the annual reports of
Uruguay, Argentina, Italy, and Turkey. We would love to hear from other RNs who may also have
reached out.
Finally, we will miss Doménica Klinar, who has stepped down from the position of co-
coordinator of the Regional Network Committee. It is impossible to say enough in praise of
Doménica’s insight and efforts for the RN Committee. As we look for another co-chairperson,
please send suggestions (including self-nominations) to Tom Holman at tom@tomholman.com.
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Upcoming SEPI Webinar
WEDNESDAY, JUNE 16, 2021, 6:00 PM - 7:30 PM
EASTERN TIME (NY)
Deliberate Practice for Multicultural Orientation
Many mental health therapists are deeply committed to providing equitable and culturally
relevant care to their clients. However, a common challenge for newer as well as more
experienced therapists is how to translate their multiculturally oriented aspirations into
practice. What does a multiculturally oriented therapist say? When and how do MCO
therapists highlight cultural moments in therapy? How do they incorporate clients’ worldview
and values into therapy sessions?
In this webinar we will introduce attendees to the multicultural orientation (MCO) framework
and the strong empirical literature that supports integrating it into therapy and supervision.
We will discuss how a Deliberate Practice approach can help therapists infuse MCO into
their therapeutic interventions. We also will utilize video examples for practicing
interventions with clients. Additionally, we will focus on understanding therapists’
intersectional identities and how those identities can influence their expression of the three
MCO pillars: Cultural Opportunities, Cultural Comfort, and Cultural Humility.
This free webinar – co-sponsored by SEPI and the Ferkauf Graduate School of Psychology –
is part of a research study. You will be asked to complete several, brief measures (10
minutes) prior to and after the webinar. Upon completion of pre-webinar measures, you will
be able to register for the webinar.
Trainees who attend this webinar will also have the opportunity to participate in free, 4-
week DP for MCO coaching groups that begin in late June.
DR. JESSE OWEN DR. KAREN TAO DR. TRACY PROUT
SEPI | PAGE 11Communications & Publications Committee Updates
THE INTEGRATIVE THERAPIST VOL. 7, ISSUE 2 • JUNE 2021
Many mental health therapists are deeply committed to providing equitable and culturally
relevant care to their clients. However, a common challenge for newer as well as more
experienced therapists is how to translate their multiculturally oriented aspirations into
practice. What does a multiculturally oriented therapist say? When and how do MCO therapists
highlight cultural moments in therapy? How do they incorporate clients’ worldview and values
into therapy sessions?
On June 16th, 2021 from 6:00 to 7:30pm (Eastern Time), a webinar on Deliberate Practice for
the multicultural orientation (MCO) framework will be presented by the developers of MCO
Jesse Owen, Ph.D. & Karen Tao, Ph.D., and moderated by Tracy Prout, Ph.D. This webinar will
introduce attendees to the MCO framework and the strong empirical literature that supports
integrating it into therapy and supervision. Attendees will learn how a Deliberate Practice
approach can help therapists infuse MCO into their therapeutic interventions. Video examples
will be utilized for practicing interventions with clients. Additionally, the presenters will focus
on understanding therapists’ intersectional identities and how those identities can influence
their expression of the three MCO pillars: Cultural Opportunities, Cultural Comfort, and
Cultural Humility.
This free webinar – co-sponsored by SEPI and the Ferkauf Graduate School of Psychology – is
part of a research study. You will be asked to complete several measures prior to and after the
webinar. Upon completion of pre-webinar measures, you will be able to register for the
webinar. Importantly, trainees who attend this webinar will also have the opportunity to
participate in free, 4-week DP for MCO coaching groups that begin in late June. Register here.
We are also looking to scheduling future webinars. If you are interested in hosting a SEPI
webinar, please contact Dr. Shigeru Iwakabe (shigeru.iwakabe@gmail.com). We welcome topics
that highlight psychotherapy integration and incorporate practice and research (in all its
forms).
Our new Featured Members section is a unique way to introduce and connect SEPI members.
There are spotlights and interesting interviews on each featured member, allowing SEPI
members to learn about others in the SEPI community. If you are interested in being a future
Featured Member, or if you would like to nominate another SEPI member to be a future
Featured Member, we encourage you to email Communications and Publications Committee
member Markus Böckle (markus.boeckle@gmail.com).
You can stay up-to-date with SEPI through our social media platforms! (See above)
SEPI | PAGE 13THE INTEGRATIVE THERAPIST VOL. 7, ISSUE 2 • JUNE 2021
Spotlight:
SEPI Featured Members
MARKUS BÖCKLE
Stephen M. Diggs
FEATURED MEMBER
Markus : Tell us about your work.
Stephen : Treatment of personality disorder has been
languishing for years. Why? Effective methods are isolated
from each other in schools of practice. The Nysa Therapy
maxim is this: everyone is right about something, no one is
right about everything. By taking the best from
psychoanalysis, solution focused, DBT, relational therapy,
etc., we are fully committed to integrating a method that
heals personality disorder.
Markus : What do you see as the future of psychotherapy
integration?
Stephen : For 100 years, psychotherapy developed and
innovated effectively in isolated "schools". That ended
about 20 years ago, and since then innovation has
occurred primarily through integration. I believe it's not so
much what is the future of psychotherapy integration, as it
SEPI | PAGE 14THE INTEGRATIVE THERAPIST VOL. 7, ISSUE 2 • JUNE 2021
is integration is the future of psychotherapy.
Markus : How has SEPI influenced your career?
Stephen : In the past, conference presentation proposals of my organization, Nysa Therapy,
were rejected. The first time we submitted to SEPI, two of our proposals were accepted. We
are thrilled to have found truly like-minded researchers and practitioners. I have learned a
great deal from the SEPI journal about the state of the art of integrative practices.
Markus : Tell us a fun fact about you.
Stephen : I play jazz guitar. And for all you guitar geeks, I just got a 1952 Gibson single-
pickup ES-175. Whoo! I haven't yet discovered her name.
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Spotlight:
SEPI Featured Members
MARKUS BÖCKLE
Alberta Pos
FEATURED MEMBER
Markus : Tell us about your work.
Alberta : I do, or I’m interested in doing a lot of predictions
of long-term outcomes for depression, if we are to know
how people change long-term that will help us know more
about the science of change. I know that is hard to do in
research because we don’t have control over time, but I
think we have to do that more.
Markus : What do you see as the future of psychotherapy
integration?
Alberta : I think the future is to be able to talk more
intelligently about science, and how research and practice
need each other. We need researchers to help us and we
need clinicians to point researchers in the right direction.
Markus : How has SEPI influenced your career?
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Alberta : I get to meet a lot of folks that I normally wouldn’t and I think that has been a
really big part of my tenure as a member. I met Art Bohart, I met George Silberschatz, I met
David Barlow and also David Orlinsky. I think it has really taught me how to be open to
those folks and to know how to talk to them. I think it has also harbored in me a great deal
of respect for alternate approaches such as behavioral and CBT for Borderline Personality
Disorder, the whole idea of transference and the importance of alliance ruptures like
Jeremy Safran and Chris Muran and Catherine Eubanks have been focused on in New York,
as well as the concepts of individuation and complementarity that Loran Benjamin talks
about.
Markus : Tell us a fun fact about you.
Alex : I'll do anything. I'm a bit daring that way. I even walked behind a cheetah once. I like
to try new things. I guess that's why I'm in SEPI.
SEPI | PAGE 17THE INTEGRATIVE THERAPIST VOL. 7, ISSUE 2 • JUNE 2021
Bruce Lee and the Tao of
Integrative Psychotherapy
DANIEL MILLSTEIN
POSTDOCTORAL FELLOW, ROCHESTER, NY
So begins Bruce Lee’s long-awaited
“This book is dedicated to book project that found its way into
the free, creative eager martial artists’ hands in 1975. Lee
martial artist: ‘Research had suffered a back injury while training
your own experience; absorb in 1970, and while confined to bed-rest
what is useful, reject what focused his energy on describing many
is useless, and add what is of his views on martial arts, philosophy,
essentially your own.’” spirituality, and training. Though he had
Bruce Lee, planned to finish what would eventually
The Tao of Jeet Kune Do
become The Tao of Jeet Kune Do in 1971,
the project did not materialize until
1975 after he had passed away. Jeet
Kune Do, or “the way of the intercepting fist,” was an evolving approach to martial arts Lee
developed over his lifespan. The name reflects his efforts to dissolve the more fixed
“offense/defense” way of viewing techniques and highlight how one could evade and attack
simultaneously. In the fifty years since its intended publication, The Tao of Jeet Kune Do,
along with Lee’s larger teachings on self-expression, hold several important lessons for the
contemporary integrative psychotherapist.
In what ways could this cultural icon’s work be relevant to psychotherapists in 2021? While a
complete overview of Lee’s life (Polly, 2019) and work (Lee 2018) are outside the scope of
this piece, a few points bear clarifying. A keen student of philosophy and personal growth,
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many of Lee’s sources match those of today’s therapists, particularly those practicing
experiential approaches. Interspersed within his writings on martial arts are reflections on Alan
Watts, Jiddu Krishnamurti, Carl Rogers, Abraham Maslow, and Fritz Perls. He studied deeply,
adapted others’ teachings to fit his needs, and often shared the resulting aphorisms in his
teaching. At his core, Lee was deeply relational, whether in martial arts, acting, or with family.
As he once put it, “to know oneself is to study oneself in action with another person (Lee,
1975).”
In addition, the martial arts world Lee encountered had themes sometimes experienced in
psychotherapy. It was colored by ideological, nationalistic, and stylistic splits, such as Eastern
and Western, “hard style” and “soft styles,” grappling and striking, sport and street-fighting, to
name but a few. As mental healthcare providers, we too find ourselves facing such systemic
splits such as psychodynamic/behavioral, scientist/practitioner, and biomedical/psychosocial,
among others. Lee’s approach to the splits speaks to his larger systemic view of his field. When
asked about his "style" he responded in a 1971 interview (Rothery, 1994):
…I do not believe in styles anymore. I mean, I do not believe that there is such thing as like ‘the Chinese way
of fighting’, or, ‘the Japanese way of fighting’, or whatever ‘way of fighting’, because unless human beings
have three arms and four legs, we will have a different form of fighting. But basically, we have only two
hands and two feet. So, styles tend to not only separate men, you know, because they have their own
doctrines, and then the doctrine became the gospel truth that you cannot change! But, if you do not have
styles, you just say, ‘Well, here I am as a human being: how can I express myself totally and completely?’
Practically, Lee was focused on finding and testing the most efficient means of training and
delivering principles of fighting. He strongly believed that any new approach he developed
needed testing against a resisting opponent. At a time when many martial artists primarily
trained within their form or system, Lee looked to develop and test techniques across systems.
He also went outside of traditional training methods entirely, incorporating modern methods
such as running and resistance training into his routines. He recorded his practices, their
outcomes, studied film of experts, and was evolving new methods until his death. His approach
to study and practice is consistent with the ways psychotherapists might conduct “dismantling”
or “deliberate practice” research. That is, he approached training marital arts as a living,
empirical process rather than a set of rotely repeated techniques.
Though Lee faced opposition from within the more traditional martial arts community for his
innovations (Lee, 2015), he encountered larger, systemic barriers to integration. Hollywood in
the 1960s routinely placed Asian actors/actresses into subservient roles conforming to racial
stereotypes, or cast white actors/actresses in their places. Unfortunately, these practices
persist today. Lee routinely pushed to have his character developed beyond that of “kung-fu”
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sidekick. He lobbied to get Kato more lines in “The Green Hornet” and fought with studio
executives to have his philosophies on combat included in “Enter the Dragon.” When executives
turned him down for the lead role in the series that would eventually become “Kung-Fu,” Lee
returned to Hong Kong to launch his now iconic film career. Even there he and his family faced
discrimination from those who looked down on his “Americanized” ways (Anthony & Nguyen,
2020.) In some ways, the ethnocentrism he faced in both cultures correlates with tensions
within psychotherapy. Many psychotherapists were initially skeptical of practices from Eastern
spirituality (e.g. mindfulness) while some Eastern spiritual teachers were reluctant to consider a
role for psychotherapy in helping their students (Safran, 2003). Just as more culturally
integrated and competent approaches are increasingly common in psychotherapy, Lee’s
teachings continue to inspire people of all cultures to study martial arts and self-actualization.
In this sense, he has remained an icon for cross-cultural integration many years after his death
(Polly, 2019).
One of the greatest ironies of Bruce Lee’s
iconic status was his emphasis on developing a
unique means of personal expression. For Lee,
the highest ideal was integration within
oneself. He relentlessly stressed an embodied,
authentic “self-actualization” over a
conceptually-driven, imitative “self-image
actualization” (Lee, 2015). Part of the reason
why The Tao of Jeet Kune Do was not published
during his lifetime was his fear that others
might uncritically copy his techniques while
missing the larger purpose of his work. As Lee’s
character on the television series Longstreet
said “I cannot teach you, only help you to
explore yourself.” Psychotherapists, encounter a
number of teachers, supervisors, and patients.
For our work to be effective, we need to remain
open to all of these influences while
encouraging our own and our patients’ truest
identities to emerge.
Ultimately Bruce Lee would likely be critical of practitioners trying to be like him instead of
trying to be like themselves. He would potentially be concerned over the proliferation of
different styles, rule systems, and tribalism within the martial arts world. As integrative
psychotherapists, we can resonate with these problems in terms of therapy models, professional
organizations, and a healthcare system marked by a profound lack of integration.
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THE INTEGRATIVE THERAPIST VOL. 7, ISSUE 2 • JUNE 202
This is perhaps a fine concluding lesson
for integrative psychotherapists. Rather
than trying to “do a model” or practice
like its founder, can we find within
ourselves the capacity look critically at
our methods, go outside of them when
necessary, and add what is uniquely our
own? Can we remain firmly backed by
solid, scientific principles while
transcending orientations as needed.
Can we work within our own culture and
system while going beyond it? And can
we find ways of encouraging these
same growth points in others? As
someone who ultimately sought
authentic human development, Bruce
Lee would invite us, our patients, and
students to aim for such ideals. As the
headstone of his grave in Seattle’s
Lakeview Cemetery reads: “Your
inspiration continues to guide us
towards our personal liberation.”
References
1. Anthony, J. (Producer) & Nguyen, B. (Director). (2020) Be Water [Motion picture] USA: ESPN.
2. Lee, B. (2018). Bruce Lee Artist of Life: Inspiration and Insights from the World's Greatest Martial Artist
(Vol. 6). Tuttle Publishing.
3. Lee, B. (2015). Bruce Lee striking thoughts: Bruce Lee's wisdom for daily living. Tuttle Publishing.
4. Lee, B. (2015). Bruce Lee: The Art of Expressing the Human Body (Vol. 4). Tuttle Publishing.
5. Lee, B. (2011). Tao of Jeet Kune Do: new expanded edition. Black Belt Communications.
6. Polly, M. (2019). Bruce Lee: a life. Simon & Schuster.
7. Rothery, Michael (Director). (1994). Bruce Lee: The lost interview [Motion picture]. Canada: CCH-TV.
8. Safran, J. D. (Ed.). (2003). Psychoanalysis and Buddhism: An unfolding dialogue. Simon and Schuster.
9. Siliphant, S. (Writer) & McDougall, D. (Director). (1971) The way of the intercepting fist [Television
series episode]. In Rogosin, J. Longstreet. Los Angeles, CA: Paramount Studios.
SEPI | PAGE 21THE INTEGRATIVE THERAPIST VOL. 7, ISSUE 2 • JUNE 2021
Less than 20%
of the IAPT
workforce is
trained in non-
CBT
approaches.
This reality
has remained Making space for relational
unchanged as therapies: Challenging the
the IAPT status quo in a CBT-
programme dominated environment
has evolved VENETIA LEONIDAKI
over the years, CLINICAL PSYCHOLOGIST, LONDON, ENGLAND
despite the A game-changing but controversial service model of
original frontline psychological therapy in
longstanding debates, deeply rooted in the global field of
England has sparked
promise that psychotherapy. Over 12 years ago, the Improving Access to
the programme Psychological Therapies (IAPT) programme was rolled out
would offer a and funded by the English government.
response to the increased rates of depression and anxiety
It formed a
range of and was delivered to the wider community via the National
therapies and Health Service. This is perhaps the largest and most
clients would
expensive public health programme of psychological
therapy in the world. It has influenced programmes in other
be given a countries including Norway, Australia, New Zealand, and
choice. Canada. IAPT adopts a stepped-care programme with
people receiving more intense interventions at higher steps.
Here, I focus on clients with common mental health
problems who see a qualified psychotherapist for brief
therapy, typically not lasting more than 16 sessions.
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Cognitive behavioural therapy (CBT) is recommended for all the diagnostic presentations
treated in IAPT. It is the only recommended therapy for anxiety disorders and the first choice
treatment for depression and post-traumatic stress disorder. CBT here refers to protocol-
based, specific-disorder CBT, such as a CBT manual for treating panic disorder. These manuals
are the starting point for any CBT interventions offered in the programme. A range of other
therapies, such as interpersonal therapy (IPT) or brief psychodynamic therapy or counselling are
also offered in IAPT, but their provision is scarce. Almost 70% of clients are offered CBT, with
IPT and brief psychodynamic therapy combined representing less than 1% of the treatment
provision. Less than 20% of the IAPT workforce is trained in non-CBT approaches. This reality
has remained unchanged as the IAPT programme has evolved over the years, despite the
original promise that the programme would offer a range of therapies and clients would be
given a choice.
The dominance of protocol-based, specific-disorder CBT is the product of the three pillars of
IAPT: the medical model, the outcome research paradigm, and the National Institute for Health
and Clinical Excellence (NICE) guidelines. In IAPT, evidence-based therapy primarily draws on
treatments tailored to specific diagnostic categories, evaluated in bona fide randomised
controlled trials (RCTs). NICE guidelines, produced by the Department of Health, draw upon the
RCT literature to make prescriptive recommendations about what therapy to use for each
diagnosis. The CBT-dominated environment of IAPT presents a puzzling picture and some
scholars in the UK have hinted at political motives. Regardless of the reasons behind it, the
hegemony of CBT in IAPT raises valid questions about how well ‘one-size therapy’ fits all. Here, I
summarise the reasons that highlight the need to integrate other modalities in IAPT and present
an initiative for embedding a relational therapies pathway, which I developed and clinically led
in an IAPT service.
CBT in IAPT epistemologically embodies a view of therapy as a prescribed drug for symptom
relief. However, in my seven years of working in IAPT, I came across many clients who sought
help with increasing satisfaction with relationships or improving their quality of life in the
context of adverse life circumstances or while dealing with oppressive cultural beliefs. For such
clients, the notion of therapy as a dialogue that generates new perspectives in a safe
interpersonal environment seems more pertinent. Further, NICE has been criticised for its over-
reliance on RCTs, which are widely viewed as the golden-standard methodology but
nevertheless suffer from limited external validity due to their specific selection criteria. Not all
IAPT clients fit neatly into diagnostic categories, while many meet criteria for two or more
diagnoses. NICE guidelines for depression have also been criticised for not accurately
classifying and disfavouring research for psychodynamic treatment. They also do not reflect
that CBT, despite being the treatment with the largest body of evidence, has not been found to
be superior to other treatments and that not all clients respond positively to CBT.
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Another major principle at the core of the IAPT model is the emphasis on technical
competences and adherence to protocols, underlying the hegemony of CBT. However, this
notion fails to integrate relevant research bodies that highlight the impact of therapist- or
client-related factors on treatment outcomes. The first omission is that of the therapist effect,
which accounts for a greater variability in treatment outcomes than a model itself and is more
relevant when a client’s level of severity is heightened. IAPT has mainly employed therapists
trained in the delivery of CBT protocols, thus ostracising therapists trained in other treatment
approaches who perhaps have qualities and strengths that could promote a client’s recovery.
The second omission concerns the role of client preference and positive expectations about
treatment on therapy effectiveness and completion. A client’s own beliefs about their problem
and anticipated therapeutic action appear relevant to the outcome, and clients offered their
preferred therapy are likely to do better. Finally, the latest research indicating that adapting
therapy to a client’s transdiagnostic characteristics improves treatment effectiveness is left out
from NICE guidelines. This research clearly highlights the value of integrative practice and
moving beyond rigid adherence to protocols based solely on client’s diagnosis.
Thus, the above points offer a clear
rationale for expanding the treatment
provision in IAPT beyond a single model. In
the IAPT setting where I previously worked,
the conditions favoured the development of
a treatment pathway for relational
therapies, which are not typically found in
IAPT. Historical and clinical factors in the
service had set the scene for this innovative
pathway.
Part of the workforce, employed on the site prior to the arrival of the IAPT model, was trained in
a range of modalities. Further, the current service faced the additional challenge of serving a
culturally diverse and socio-economically deprived population, where clinical presentations are
inseparable from social inequalities and cultural challenges and treatment adaptation is often
necessary.
The relational therapies pathway adopted in this particular IAPT setting consisted of
psychodynamic and relational integrative therapy. Both therapies recognise the self-regulatory
function of relationships, view distress as a result of impaired relationships, focus on
developmental and affective themes, and treat the therapeutic relationship as a vehicle for
change. While psychodynamic therapy focuses on unconscious material and defences,
relational integrative therapy melds concepts and techniques from humanistic, attachment-
SEPI | PAGE 24THE INTEGRATIVE THERAPIST VOL. 7, ISSUE 2 • JUNE 2021
based and schema therapy, among other models. In the spirit of a NICE-compliant framework,
relational therapies were offered to clients who presented with mild to moderate depression or
unclear diagnostic presentations, declined CBT, had previously had CBT and did not recover, or
expressed a clear relational focus instead of symptom management. These criteria were
developed so they did not contradict but complemented NICE guidelines, and thus were more
readily acceptable to commissioners.
The issues raised by the CBT-dominated environment of IAPT and the attempt to remedy this via
the introduction of relational therapies in the current service are far from unique. In fact, the
IAPT framework extends beyond a service model to represent a certain paradigm of therapy
delivery, emphasising diagnosis and technical manuals. This paradigm is not only adopted by
IAPT commissioners in England but is popular with commissioners in many countries. However, it
poses the danger of breeding a generation of therapists trained to work mechanistically with
certain diagnostic presentations, stripped away from the curiosity about what works for whom
and the benefits of integrative practice. In contrast, relational therapies, as described here,
place the client, the therapist, and an individualised treatment approach at the heart of
therapy and are in line with second-generation therapies moving beyond diagnoses.
Making a case for the inclusion of relational therapies in IAPT goes beyond their unfair
exclusion. It calls for renegotiation of core psychotherapy dialectics, including technical
knowledge versus a common factor approach and diagnostically-driven versus individually-
tailored treatments. Of course, in an ideal world, the value of making the full range of
evidence-based modalities easily accessible would be obvious and the focus would be on
studying therapeutic change beyond the borders of specific treatment models. However, we
are not there yet. The example of this service innovation and how core dialectics were
negotiated to help relational therapies survive in a public health setting in England offers food
for thought to the international psychotherapeutic community facing similar challenges. A full
reference list can be found in my published work (Leonidaki, 2021), where I expand further on
the above discussion.
References
1. Leonidaki, V. (2021). Moving beyond a single-model philosophy: Integrating relational therapies in
front-line psychological therapy services in England. Journal of Psychotherapy Integration, 31(1), 70–
85. https://doi.org/10.1037/int0000192
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Personality Theory is Fascinating
SIGMUND KARTERUD
PSYCHIATRIST, OSLO, NORWAY
Most clients usually come with some kind of personality issues, smaller or larger, and the roads
to personality development and integration are manifold. There are good arguments for
pragmatic practices, a tailoring of psychotherapy according to the uniqueness and individuality
of the client and his/her sociocultural context. What is the role of personality theory in this
process? I have recently (2020) discussed this question in an article with my Danish colleague
Mickey Kongerslev: “Psychotherapy of personality disorders needs an integrative theory of
personality”. We point to the fact that several of the so-called evidence-based treatments
(e.g., mentalization-based treatment, dialectic behavioral treatment, transference-focused
treatment and good psychiatric management) for borderline personality disorder seem to be
approximately equally effective in spite of different “techniques” and different theories where
the proponents emphasize different problems and competencies, e.g. deficit social cognition,
deficit emotion regulation, excessive aggression, and interpersonal hypersensitivity. We ask if
there exists any unifying theory that might assemble these diverse aspects of personality
functioning.
The grand master Otto Kernberg is a likely author of such a theory, and he has in fact published
a much-cited article on “What is personality” (Kernberg, 2016). Through a detailed discussion of
Kernberg’s text we conclude that despite important merits, it contains both deficits as well as
unsupported claims. A major problem, in our opinion, is a reluctance in fully accepting a
modern theory of emotions, e.g., ad modum Jaak Panksepp (2012). Such a reluctance is
accompanied with a reluctance to take evolution seriously. The cost of neglecting evolution is,
in our opinion, a flawed drive theory, a neglect of human prosociality, problems with the
concept of the self, and a lack of understanding the (evolutionary) origins of self-
consciousness (mentalizing).
SEPI | PAGE 26THE INTEGRATIVE THERAPIST VOL. 7, ISSUE 2 • JUNE 2021
In our view, symptoms are undigested emotions
that cause confused and confusing cognition
with behavioral consequences.
We argue that the principal components of personality are 1) Temperament (mainly primary
emotions), 2) Attachment (interpersonal relations), and 3) Mentalizing (self-consciousness), and
label this constellation the TAM theory of personality. These components contain elements
(different emotional styles and awareness, different attachment patterns and different levels
and style of mentalizing) that might paint a nuanced and dynamic picture of the individual,
being helpful for psychotherapists with different backgrounds. The picture might be helpful for
early case formulations, e.g., in which way, exactly, is this client hampered by his personality
makeup in dealing with this specific relational and/or sociocultural situation? And it helps by
providing a bridge between so-called symptom and personality disorders. What are symptoms,
really? In our view, symptoms are undigested emotions that cause confused and confusing
cognition with behavioral consequences. Symptoms may be approached by different means,
but they should be understood from a personality perspective. When we as therapists work with
emotion consciousness, we work with symptoms and personality at the same time.
What we particularly like with this theory, besides its usefulness, is its potential for integrating
natural sciences and hermeneutics (Karterud & Kongerslev, 2019). Emotions require natural
sciences. We need to know the neurobiology of emotions, their sites in the brain, their
pathways, neurotransmitters, how they engage the autonomous nerve systems, etc. In addition,
we need to know how they can be mentalized, i.e. acquire significance and meaning in a
universe of signs and symbols and meaningful social relations. We have come a long way where
we can understand when and how Homo sapiens made this leap from being an emotional
creature to being able to reflect upon and civilize his/her emotional responses. On a daily
basis, we can observe a similar process in our consulting room. It is fascinating.
References
1. Karterud, S. & Kongerslev, M. T. (2019). A Temperament, Attachment and Mentalization-based (TAM)
theory of personality and its disorders. Frontiers in Psychology, doi: 10.3389/fpsyg.2019.00518
2. Karterud, S., & Kongerslev, M. T. (2020). Psychotherapy of personality disorders needs an integrative
theory of personality. Journal of Psychotherapy Integration. Advance online publication.
https://doi.org/10.1037/int0000196
3. Kernberg, O. (2016). What is personality? Journal of personality disorders, 30: 145-156.
4. Panksepp, J. & Biven, L. (2012). The archaeology of mind. Neuroevolutionary origins of human
emotions. New York, NY: Norton.
SEPI | PAGE 27THE INTEGRATIVE THERAPIST VOL. 7, ISSUE 2 • JUNE 2021
Judging Qualities of the
Therapist from Segments
of Psychotherapy Sessions
RIVIAN K. LEWIN & JEFFREY S. BERMAN
UNIVERSITY OF MEMPHIS, MEMPHIS, TN
The observation of psychotherapy sessions has long
been a common practice in both research studies as
well as clinical supervision (e.g., Wittenborn, 1984;
Gonsalvez et al., 2016). Evaluations of the therapist,
client, and therapy interaction are often made after
viewing or listening to differing lengths of treatment. A
considerable body of literature demonstrates that
judgments made from viewing brief interactions correlate highly with assessments derived from
longer segments or the full interaction (Ambady, Bernieri, & Richeson, 2000). In psychotherapy
research, associations between short and long segments have yielded mixed findings, with
some suggesting short segments can be used in place of longer ones (Caperton, Atkins, & Imel,
2018), whereas others have shown that at least for some variables, observations from shorter
portions of treatment may not correspond highly with evaluations based on viewing a full
therapy session (Mintz & Luborsky, 1971). A drawback with the use of full-session ratings in a
therapy study is that the process is necessarily time-consuming and may result in limiting the
size of samples that can be studied.
The aim of our study was to assess whether it is feasible for observers to evaluate therapeutic
qualities from the observation of short segments of video-recorded therapy sessions. We used
48 video-recorded psychotherapy sessions featuring expert therapists practicing various
therapy approaches (e.g., cognitive-behavioral, person-centered, integrative, etc.) and
addressing diverse client concerns (e.g., anxiety, depression, substance use, trauma, etc.). A
team of observers viewed varying lengths (1-min, 5-min, 5-min, full session) of video-recorded
psychotherapy interactions and then rated these interactions in terms of therapeutic alliance,
therapist empathy, treatment expectations, and the basic semantic dimensions of evaluation,
potency, and activity.
SEPI | PAGE 28THE INTEGRATIVE THERAPIST VOL. 7, ISSUE 2 • JUNE 2021
We then examined how well judgments of these
What is striking in qualities based on segments of the treatment
our results is that
session predicted ratings of the variables from
observing the full session.
there did not seem
to be a systematic Our results revealed that evaluations of
advantage to psychotherapy from observation of session
evaluations based segments generally correlated only modestly with
on longer portions judgments from viewing the entire session.
of a therapy Moreover, with the exception of therapeutic
session. alliance, there was little evidence that ratings
from longer segments were more predictive of
evaluations based on the entire session.
There are several possible reasons therapeutic alliance may have yielded a different pattern
than the other variables. First, therapeutic alliance is the only dyadic variable, requiring the
observers to gauge information from the client to make their judgments. It is possible that
clients exhibited greater variability in a session than therapists, therefore making shorter
segments less associated with the full session. Second, shorter segments may not capture a
rupture; whereas longer segments may show a rupture and therefore the opportunity for
therapist repair. Research suggests the way a therapist handles a rupture may distinguish
between therapists who rise to the occasion and those who struggle under the pressure (e.g.,
Muran & Eubanks, 2020).
What is striking in our results is that there did not seem to be a systematic advantage to
evaluations based on longer portions of a therapy session. With the exception of therapeutic
alliance, ratings from the viewing of longer segments were no better at predicting full-session
judgments than were ratings from shorter segments, which challenges the idea that basing
judgments on longer periods of the interaction will always be better. It is possible that, for
certain variables that fluctuate during a session, viewing longer portions could pose a
challenge. For example, many researchers have emphasized the importance of peak or
significant moments (e.g., Gonçalves et al., 2012; Levitt & Bonin, 2011; Levitt, Butler, & Hill,
2006) in evaluating sessions. Overall, our study reveals—at least for judgments of therapeutic
qualities such as alliance, empathy and credibility—that ratings from viewing a longer portion
of a treatment session may not necessarily be any better than evaluations based on the
observation of shorter segments.
SEPI | PAGE 29THE INTEGRATIVE THERAPIST VOL. 7, ISSUE 2 • JUNE 2021
References
1. Ambady, N., Bernieri, F. J., & Richeson, J. A. (2000). Toward a histology of social behavior:
Judgmental accuracy from thin slices of the behavioral stream. In M. P. Zanna (Ed.), Advances in
experimental social psychology (pp. 201–271). San Diego, CA: Academic Press. doi: 10.1016/S0065-
2601(00)80006-4
2. Caperton, D. D., Atkins, D. C., & Imel, Z. E. (2018). Rating motivational interviewing fidelity from thin
slices. Psychology of Addictive Behaviors, 32(4), 434–441. https://doi.org/10.1037/adb0000359
3. Gonçalves, M. M., Mendes, I., Cruz, G., Ribeiro, A. P., Sousa, L., & Greenberg, L. S. (2012).
Innovative moments and change in client-centered therapy. Psychotherapy Research, 22, 389–401.
doi: 10.1080/10503307.2012.662605
4. Gonsalvez, C., Brockman, R., & Hill, H. (2016). Video feedback in CBT supervision: Review and
illustration of two specific techniques. The Cognitive Behaviour Therapist, 9, E24. doi:
10.1017/S1754470X1500029X
5. Levitt, H. M. & Piazza-Bonin, E. (2011). Therapists’ and clients’ significant experiences underlying
psychotherapy discourse. Psychotherapy Research, 21, 349–357. doi: 10.1080/10503307.2010.518634
6. Levitt, H. M., Butler, M., & Hill, T. (2006). What clients find helpful in psychotherapy: Developing
principles for facilitating moment-to-moment change. Journal of Counseling Psychology, 53, 314–
324. doi: 10.1037/0022-0167.53.3.314
7. Mintz, J., & Luborsky, L. (1971). Segments versus whole sessions: Which is the better unit for
psychotherapy process research? Journal of Abnormal Psychology, 78, 180–191. doi: 10.1037/h0031969
8. Muran, J. C., & Eubanks, C. F. (2020). Therapist performance under pressure: Negotiating emotion,
difference, and rupture. American Psychological Association. https://doi.org/10.1037/0000182-000
9. Wittenborn, J. R. (1984). Observer ratings. In M. Hersen & A. S. Bellack (Eds.), Issues in
psychotherapy research (pp. 97–131). Boston, MA: Springer. doi: 10.1007/978-1-4899-2283-0_4
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