THE Integrative Therapist

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1 Society for the Exploratio SEPI of Psychotherapy Itegratio Volume 3, Issue 3 July 2017 ISSN # Missio Statemet The Society for the Exploratio of Psychotherapy Itegratio (SEPI) is a iteratioal, iterdiscipliary orgaizatio whose aim is to promote the exploratio ad developmet of approaches to psychotherapy that itegrate across theoretical orietatios, cliical practices, ad diverse methods of iquiry. Jeffery Smith Editor THE Itegrative Therapist A R T I C L E S I N T E R V I E W S C O M M E N T A R I E S A Word From the Editor Dear SEPI members ad frieds, Secret SEPI Issue Jeffery Smith By traditio, the summer issue of The Itegrative Therapist is dedicated to savorig the excitemet ad fermet of the aual coferece. This time, we have goe oe step farther i solicitig ad sharig with you a host of tidbits ad glimpses ito Secret SEPI, the kids of thigs you might ot kow or missed i Dever. SEPI has a lot to offer, yet keeps o growig ad tryig out ew ideas ad iitiatives. After the Presidetial letter, the issue goes right ito Summer i Cassis, Frace Secret SEPI. We prepared a shared documet to be edited i the cloud, ad asked SEPI s officers ad chairpersos to share their best SEPI secrets. Next, Jeifer Davidtz has curated a series of reflectios by attedees o what stood out at the Coferece. More reflectios follow, voluteered by two graduate studets who experieced their first SEPI coferece, Carly Schwartzma ad Brittay Iles from SUNY, Albay. Fially, I take the ext step i the Theoretical Covergece project started i the last issue. Followig the publicatio of Cotiued o page 15 Presidet s Colum Nuo Coceição Jeifer Davidtz Associate Editor I This Issue Secret SEPI: Notes From SEPI Leaders Secret SEPI: Take-Home Notes From Dever Reflectios o SEPI s Dever Coferece..14 Yet? Theoretical Covergece, Part Theoretical Covergece, Part II Dear SEPI members ad frieds, Addig my most formal visual look for this more iformal volume, I am writig my third presidetial message, after havig completed my role as program chair of our 2017 th aual meetig i Dever, Colorado Cliical Decisios That Work: Navigatig the Psychotherapy Itegratio Maze. There we got a appreciatio of how complex the maze is that we re i. For me, it was great to chair the program for this evet, 16 years after I gave my first talk o a SEPI meetig ad 10 years after beig part of the local arragemets committee whe it was held i Lisbo. Despite a slightly lower attedace tha usual, may of the attedats were complimetig the program ad the overall experiece. Due to the lovely work by the local hosts durig the coferece together with our amazig admiistrative officer, I eve allowed myself to experiece the coferece as a participat with sigificat ethusiasm takig a few otes to brig home, although my home is still i reovatio sice last October. Ad how thrillig it was the older geeratio so sharp ad clear coveyig their keyotes! Ad the youger oes so actively ivolved! I wish to thak all of those who cotributed ad participated at our joit evet i Dever! Now seriously, we wished our program reflected eve more itegratio of attetio to patiets social ad cultural cotext ad cocrete life circumstaces, but at least we made it clear this is a dimesio of itegratio that represets a Cotiued o page 13

2 The Itegrative Therapist Volume 3, Issue 3 July 2017 Secret SEPI: Notes From SEPI Leaders Followig the Dever meetig, The Itegrative Therapist asked SEPI s leadership ad committee chairs to share with the membership a collectio of lesser kow features, thoughts ad plas for SEPI s future. We hope you ejoy ad beefit from this trove of SEPI uggets. Presidet: Nuo Coceicao As the presidet of SEPI I hope to have us all workig together i the pursuit of the objectives that help advace SEPI. Together coected, pleoasm purposely icluded, we ca be stroger. Officers/voluteers eed to have a bigger role i the state of affairs i SEPI, ad oly the SEPI should have a greater impact. Therefore we still eed more commuicatio withi committees ad betwee committees ad from these to the EC ad Presidet ad vice-versa. We eed committees to be populated by SEPIANS, active, geerous, commuicative people who mobilize or ask for mobilizatio or deouce lack of it. Otherwise itegratio stalls with lack of commuicatio ad mobilizatio. The Itegrative Therapist oticed uder the Liks tab o the website a list of likig ad collaboratig orgaizatios? We asked what was behid it. This LINKING was my iitiative whe presidetelect... This LINKING was my iitiative whe presidet-elect ad I still add models or approaches to it occasioally. I had just had a few years of experiece at the Regioal Networks Committee, realizig may members were participatig more i tue with their closest i-group approach, while keepig coected to SEPI. It was also iitially meat by me as a mere service to our members to icrease awareess of several relevat* approaches, with their ow books, papers, traiigs ad commuities. The the EC decided to make it a more regulated iitiative obligig the liked etity to also lik with SEPI. I was agaist this, but accepted the challege to egotiate these deals oly to the realize how time cosumig it was ad how hard it was to obtai results, as may istitutes ad societies are quite closed still ad do ot have a policy or a space to lik back. Some seemed eve afraid of loosig their members or at least acted avoidatly or dismissively. So we left it ope, with slightly bigger emphasis for those who lik back to us already. I believe part of the future of SEPI implies some way for us to aggregate the best of what these groups create ad to go o promotig dialogues betwee the ew emergig creatios, be it a cliical approach or a research tool of some kid. Of course, better egotiatios ca occasioally take place i the future. Criteria still eed to be established as to precisely what relevat approaches should mea, but eve if a approach or tool does ot yet have much evidece supportig it, as log as there are a few books, papers, traiigs ad commuities reflectig movemet ad eergy aroud it the it might be worth highlightig. Members should alert SEPI wheever they are aware of some approach that should be listed there, ad the we (the EC) ca assess its eligibility. Members watig some traiig or research (readig or coductig) o this or that approach ca also search via the liks provided. Members ca thik of how to make better use of SEPI s strog muscles, those of dialogue ad curiosity towards similarities ad differeces amog approaches. Presidet Elect: Staley Messer What secret plas are i store for ext year? There will be a special emphasis i ext year s SEPI coferece i NYC o systematic case studies of psychotherapy, especially those combiig qualitative ad quatitative data ad methods. These ca iclude emphasis o process ad/or outcome. This focus relates to oe aspect of the reewed SEPI theme of itegratig research ad practice. I ecourage SEPI members to start plaig ow for their presetatios ext year. I would like to see more diversity i ethic ad racial backgroud i SEPI membership as well as at the coferece. I additio, we should strive for SEPI to have more variety i theoretical orietatio (e.g., more CBT adherets), i professioal backgroud (e.g., more social workers, psychiatrists, child/family therapists) ad more members/participats from abroad. For this to happe, I hope that SEPI members will ivite their frieds ad colleagues who come from Cotiued o page 3 Society for the Exploratio of Psychotherapy Itegratio 2

3 The Itegrative Therapist Volume 3, Issue 3 July the secret pla is to ecourage youg people s iovative ideas ad participatio. these ad other backgrouds ad locatios to joi SEPI ad atted the New York City Coferece o May 31-Jue 2, The Itegrative Therapist would like to add that members should feel free to share the lik to this Newsletter ad previous issues with ay colleagues, list-serves or orgaizatios that might fid it iterestig. The Itegratrive Therapist is oe more vehicle for spreadig the word about SEPI to a wider audiece ad expadig membership. Past Presidet: Beatriz Gómez SEPI has a great potetial based o the coexistece of the sustaied work of the pioeers ad experts i psychotherapy itegratio ad ovice therapists ad studets from all over the world, strogly promotig the dialogue betwee the differet geeratios. It has bee very stimulatig to see the growig ethusiasm of youg people. For me the secret pla is to ecourage youg people s iovative ideas ad participatio, to help expad psychotherapy itegratio. SEPI is committed to aother excitig challege, which is to stregthe the liks betwee practice ad research. Advisory Board: Marvi Goldfried & Paul Wachtel With our chage i goverace, Goldfried ad Wachtel are most pleased with the dedicatio ad hard work of the Executive Coucil (E.C.). Membership Committee: Paul Wachtel The membership had declied for a while, ow we are back to a icreasig membership agai. We are especially cocetratig at this poit o icreasig membership amog three groups whose umbers are smaller tha we wish psychiatrists, social workers, ad members of ethic ad racial miority groups. We are makig efforts to icrease iitiatives to recruit members from those groups, though of course from all groups as well. SEPI s Website: Marvi Goldfried & Tracey Marti The Itegrative Therapist wats members to be aware of the rich collectio of iterviews of leaders ad iovators i psychotherapy, doe by Alexadre Vaz, as well as the excellet research reviews for cliicias by Costatio ad Goldfried s, metioed below. The iterviews are o the website, ad periodic aoucemets are made o the listserv about them. We regularly post ad aouce JPI articles i the series co-edited by Costatio ad Goldfried, reviewig basic research fidigs for the practicig cliicia. The Itegrative Therapist: At preset these treasures ca be foud o the right-had colum of the website uder Featured News. The iterviews are labeled as Persoal Reflectios o Psychotherapy Itegratio ad the rich ad importat research fidigs are uassumigly listed uder Joural. Members are urged to joi this list ad ca use it for aoucemets of traiigs, publicatios, requests for cliical referrals, etc. The Listservs: Tracey Marti Uder the directio of the Commuicatios ad Publicatios Committee, Ms. Marti actually moitors two listserves. Oe is a volutary opt-i list of a subset of members. Members are urged to joi this list ad ca use it for aoucemets of traiigs, publicatios, requests for cliical referrals, etc. To post a aoucemet, or joi, sed a to SEPI@lists.apa.org The other list is a full membership list, maitaied for official commuicatios from SEPI. Tracey is also the go-to perso for this list. Cotiued o page 4 Society for the Exploratio of Psychotherapy Itegratio 3

4 The Itegrative Therapist Volume 3, Issue 3 July 2017 SEPI s Facebook Page: Nuo Coceicao The Facebook page is ot cotrolled by ay oe perso, but bears the stamp of Giacarlo Dimaggio from Italy ad Joaa Fojo Ferreira from Portugal, but it seems ot to be as effective i fulfillig the eed for a discussio forum as hoped. Perhaps the best approach would be to let it grow orgaically with more short cotet to our members. We actually eed a ew iitiative o Commuicatio/Press/News to reach out for people iterested i psychotherapy itegratio. The Itegrative Therapist: The Facebook group ca be accessed at: You ca also just log oto Facebook ad do a search for SEPI. The Fiace Committee: Steve Sobelma SEPI membership is growig each year... Fiaces: SEPI is i pretty good fiacial shape as we maitai as checkig, savigs, ad Morga Staley fiacial portfolio. We have 3 icome streams Dues, Joural, ad Coferece. After the Dubli Coferece last year, which was a big fiacial wier for SEPI, I told the EC that we were i great shape from a fiacial perspective. We added more moey to our fiacial portfolio with Morga Staley from the profits. However, the Dever Coferece did ot go as well, fiacially, with lower attedace tha plaed plus some added expeses. We hope to recover i NYC, which is a risky Coferece (fiacially), sice it is expesive to ru a Coferece i NYC. We will eed to have a Dubli-Like attedace for NYC. I m plaig o 340 people!!! However, the profit from NYC will be lower tha Dubli due to icreased expeses i NYC. Tracey ad I have met with the NYC host committee ad also met with the Hotel staff ad NYC has the potetial to be a terrific Coferece!!! The SEPI membership is growig each year ad we re seeig a icrease i studet membership, too. The Joural is doig well ad supports SEPI s fiacial growth. Dues: The Dues has bee $59 forever!!! I suggested a $10 icrease for Fellow status, which we implemeted ad the it was chaged back about 2 years ago.ot sure why as I was ot o that coferece call. It is risky to icrease dues sice other trade associatios are lookig to may of the same people for their $$$. New Iitiatives: We re lookig for larger icreases i membership. Please ote that we ve earmarked more moey for travel grats ad research. SEPI gives back to the membership, too, but our fiacial positio, at this poit i time, does t warrat ay icreases.ufortuately. The Educatio ad Traiig Committee: Jack Achi The Itegrative Therapist asks: What materials o traiig are available o the website? What are the Committee s future plas?...readig through these syllabi as a collectivity ca i ad of itself be remarkably educative! To facilitate the work of those egaged i teachig ad traiig psychotherapy itegratio, the Educatio ad Traiig Committee has thus far assembled ad posted 20 syllabi that various members of SEPI have developed for formal courses o psychotherapy itegratio, itegratively orieted practica, ad formal courses o the itegratio of sciece ad practice. I additio to detailig the strikig multiplicity of ways i which educators whether i a classroom or practicum settig ca desig formal ad applied educatio i psychotherapy itegratio, readig through these syllabi as a collectivity ca i ad of itself be remarkably educative! I additio, take together these syllabi idetify a vast array of topically orgaized readigs (i.e., articles, chapters, ad books) o psychotherapy itegratio. To access these syllabi, oe eed oly place their cursor o the item Traiig i the meu at the top of SEPI s homepage. A drop dow meu will the appear with the two items Traiig Programs ad Teachig ad Traiig Materials; clickig the latter will brig up a listig of all syllabi, each idetified by course title ad istructor, ad i tur clickig ay give syllabus will brig this up o oe s scree as a PDF. The E&T Committee evisios this as a cotiuously growig list, with the pla beig to put out a call for other members of SEPI to submit their syllabi for potetial postig o this Teachig ad Traiig Materials website page. Curret plaig etails a give syllabus submissio udergoig a peer review procedure, for quality-cotrol purposes, aki to Cotiued o page 5 Society for the Exploratio of Psychotherapy Itegratio 4

5 The Itegrative Therapist Volume 3, Issue 3 July 2017 that used by APA Divisio 2 (see Project Syllabus Descriptio: ). Complemetig this pool of formal syllabi, the Committee plas also iclude developmet of a ogoig collectio of pedagogical methods (e.g., role plays, etc.) that educators have foud useful i fosterig experietial uderstadig of psychotherapy itegratio. It is aticipated that these write-ups will follow a to-be-articulated structured format, submissios will be reviewed for their fidelity to the latter (with revisios requested if warrated), ad accepted, fialized submissios will be posted. As oted above, the drop dow meu uder Traiig also idicates the item Traiig Programs, which will poit to a extesive pdf documet idetifyig ad describig key features of specific programs aroud the world that provide traiig i psychotherapy itegratio. Assembled i 2016 by the SEPI goverace, this project is ow uder the charge of the E&T Committee, ad, as such, a additioal E&T iitiative to be udertake etails updatig this documet. Amog additioal plas ecessitatig the E&T Committee s attetio are (a) developig a process with the potetial to lead to regular periodic iclusio of ivited high-quality educatio-ad-traiig articles i JPI; (b) coductig ad/or cosposorig (e.g., with APA Divisio 29) a webiar focusig o the specific topic of educatio ad traiig i itegrative treatmet; (c) developig ways for studets ad traiees to become more ivolved i E&T Committee activities; (d) ecouragig, to the extet feasible depedig o the topic at had, iclusio of attetio to traiig-related implicatios of material beig preseted i papers, symposia, ad structured discussios at SEPI s Aual Meetig; (e) cotributig to developmet of a structured iterview focusig o educatio for the Fall, 2017 issue of The Itegrative Therapist. The Research Committee: James Boswell The Research Cosultatios have become rather popular evets. Research Cosultatios: With the assistace of the Coferece Program Committee, the Research Committee orgaizes ad moderates the Research Cosultatio Program that takes place durig the aual SEPI Coferece. The Research Cosultatios are ope to ay coferece attedee. It is a opportuity for studets, early career researchers, ad cliicias to cosult with leadig researchers i psychotherapy itegratio. Three to four expert research cosultats participate each year o a voluteer basis ad have bee extremely geerous with their time. Each year, the Research Committee attempts to recruit a team of cosultats represetig diverse methodological approaches (e.g., experimetal ad correlatioal desigs; sigle case desigs; observatioal codig; quatitative ad qualitative), i order to be maximally resposive to potetial cosultee iterests. The Research Cosultatios have become rather popular evets. We had twelve participats i 2016 (Dubli) ad seve participats i 2017 (Dever). The program will cotiue i New York i Awards: The Research Committee admiisters the core of SEPI s Awards Program, which icludes the aual Dissertatio ad Marvi R. Goldfried New Researcher Awards. Depedig o the year, the Research Committee is comprised of seve members. I recet years, due to the umber of submissios/omiatios, we have divided the Dissertatio ad New Research awards reviews amog subgroups of 3-4 raters. Committee members will recuse themselves if there is a potetial coflict of iterest. Furthermore, curret members of the Research Committee are ot eligible to receive a award. The review process is a relatively itesive task. I the case of the Dissertatio Award, committee members review the omiee s full dissertatio proposal, CV, ad at least oe letter of recommedatio from the primary omiator. For the Marvi R. Goldfried New Researcher Award, committee members review the omiee s CV, multiple represetative published empirical articles, ad at least oe letter of recommedatio from the primary omiator. I both cases, reviewers provide quatitative ratigs pertaiig to (a) the quality of the work (proposed project i the case of the Dissertatio Award, or body of work i the case of the Marvi R. Goldfried New Research Award); ad (b) the closeess of fit with the missio of SEPI. These ratigs are the combied ito a total score ad omiees are subsequetly raked based o this total score. Although the Chair of the Research Committee does ot participate i the formal review/ratig process, the Chair reviews all submitted omiee materials ad provides additioal iput as ecessary (e.g., whe there is o clear wier or a sigificat lack of agreemet amog raters). Subsequet to this, the Chair submits a brief report to the SEPI Executive Committee, which must approve the tetative Research Committee recommedatio, ad ca also weigh i with specific suggestios for resolvig a stalemate if ecessary. I additio, the Research Committee oversees the studet travel award program. The review/ratig process is similar with regard to the dimesios of quality ad fit. The primary differeces are that a total of three awards are typically give each year, ad the review process is blid for all itets ad purposes. That is, letters of recommedatio ad CVs, etc., are part of the review process for the other awards; for the studet travel awards, omiee ames ad affiliatios are removed by the Chair prior to the review. Cotiued o page 6 Society for the Exploratio of Psychotherapy Itegratio 5

6 The Itegrative Therapist Volume 3, Issue 3 July 2017 Research Committee Secret : I additio to the stadig Graduate Studet member positio, a special Early Career committee member desigatio/represetative was added to the committee i Secretary: Keeth Critchfield What should members kow about the role of the Secretary? The Secretary is elected for a term of three (3) years. The role ivolves workig closely with the EC, ad Tracey Marti, to safeguard our records, keep ad validate the official miutes of our meetigs, ad so o. The biggest secret of iterest to the membership is that my 3 year term eds as of the ed of We ll soo be sedig out a call for a ew SEPI secretary. SEPI s Awards: James Boswell ad Catherie Eubaks The Itegrative Therapist: Be sure to check the Awards tab o the website for clearly explaied awards. We asked the chairs, Are there ay ew iitiatives or chages o the horizo? The Executive committee will revise the Wachtel Travel grat criteria ad applicatio process to make them clearer for At the Dever coferece, SEPI preseted the first Arkoff & Glass Award for Regioal Network of the Year, amed for Diae Arkoff ad Carol Glass. The award wet to Tahir Özakka ad his Psychotherapy Istitute of Turkey. Tahir fouded the Istitute ad has provided a thorough ad iovative traiig specifically i itegrative psychotherapy. The Istitute uses lectures ad readigs, aalysis of video, a iovative group supervisio format, amog other teachig techiques. Tahir ad his colleagues gave us may impressive programs durig the coferece. The award wet to Tahir O zakkas ad his Psychotherapy Istitute of Turkey. Studet Coferece Travel Awards: Typically 3 awards of $300 each to studet attedees with a first author presetatio that is of high quality ad related to psychotherapy itegratio. The Joural of Psychotherapy Itegratio: Jeifer Callaha... A sciece-practice dialogue will be featured i the 3rd issue of the 2017 volume. It opes with a article by Nacy McWilliams that closely aligs with her pleary address at the 2015 Baltimore SEPI coferece ad is followed by ivited commetary from diverse perspectives (some ew to SEPI, others familiar). We ve begu clusterig accepted submissios ito related groupigs ad publishig them i orgaized special sectios. We have icreased diversity withi the editorial board ad have added a role for studets to cotribute as traslators. Traslated (Chiese, Spaish) titles, abstracts, ad keywords are ow published ad also idexed for searchig withi databases. Traslated (Chiese, Spaish) titles, abstracts, ad keywords are ow published... We have a upcomig special sectio o treatmet of sleep; a commo symptom across a rage of disorders ad a symptom for which psychotherapy is the primary treatmet recommedatio (i.e., ot medicatios). We cotiue the quest for a impact factor. Our applicatio was lost whe Thomso Ruteurs sold the Joural Citatio Report database to Clarivate Aalytics i late We were ot the oly joural impacted; this occurred with several APA-published jourals who had applicatios pedig. The APA busiess developmet team has set up a meetig with a represetative from Clarivate later this moth to discuss the situatio ad get (hopefully) some updates regardig timelies for review ad decisio of our applicatio for a impact factor. Cotiued o page 7 Society for the Exploratio of Psychotherapy Itegratio 6

7 The Itegrative Therapist Volume 3, Issue 3 July 2017 Newsletter: Jeffery Smith & Jeifer Davidtz Jack Achi will collaborate o developig a ew structured iterview focused o traiig for the fall issue. We wat to focus o critical issues i itegrative therapy traiig see from the poits of view of leaders i the field. After that, who kows. Maybe a reader will suggest a great theme for the Jauary Issue. We also wat to recogize that the sigle most cosistet theme that has come up i relatio to the Newsletter is a desire to have better pathways for reader feedback. We are thikig about how to solve that. So far we have tried Survey Mokey ad Letters to the Editor as well as the structured iterview. The Facebook page is aother move i that directio. Ay thoughts are welcome....the sigle most cosistet theme that has come up i relatio to the Newsletter is a desire to have better pathways for reader feedback. Regioal Networks: Tom Holma The web site shows the Regioal Networks (RNs) i four cotiets ad over 15 coutries. May people joi SEPI for the itegrative approaches, the joural, ad the cofereces. SEPI s broad iteratioal membership is somethig of a hidde secret. Imagie that you spet your life learig oly oe theory, ad the you discovered a group of people who are comfortable with, thrive o, a multitude of theories. That is like discoverig SEPI. Now imagie that you spet your life kowig the views of oly oe coutry i oly oe laguage, ad you ot oly discovered SEPI, but also discovered its Regioal Networks ad iteratioal membership. Our curret ad past Presidets are from Portugal ad Argetia, respectively. The web site shows the Regioal Networks (RNs) i four cotiets ad over 15 coutries. There are 4 RNs i the US. At the Dever coferece the RNs were well represeted i a large variety of presetatios. It was excitig to see may people comig from thousads of miles away to share their iterests. They gave us may isights, ad took isights back with them. We see how much iteratioal members cotribute to our uderstadig i ways that are t ofte foud i other professioal groups. A large group from the Turkish Istitute for Psychotherapy preseted several programs, ad their director, Tahir Özakka received the RN of the Year Award. We had other substatial cotributios from Portugal. The RN Coordiators from Frace, Egypt, ad Switzerlad preseted. Japa, Filad, the Turkish Cypriot RN, Caada, Argetia, ad the Czech Republic were represeted as well. The RN Committee icludig RN Coordiators who could atted the coferece held its aual meetig. Much of the committee s discussio ivolved the eed to develop certificatio i itegrative therapy for idividuals ad/or for RNs iteratioally ad i the US. The secret of establishig a RN is to be a SEPI member, ad ask Tom Holma, RN Committee Chair, for the applicatio form. The completed form is reviewed by the RN coordiators, the by the Presidet ad the Executive Committee. Coordiators of the SEPI Regioal Networks: Argetie Network of Itegrative Psychotherapies (Bueos Aires): Beatriz Gomez Argetie Network of Itegrative Psychotherapies. Aiglé Foudatio celebrates its 40th. Aiversary ad has orgaized activities throughout a year. Paul Wachtel participated i the first activity ad Louis Castoguay will participate i the last oe this year. A umber of reowed psychotherapists i the world will also participate i a activity i August etitled 40 years of traiig i psychotherapy. Attedees are professioals ad studets from Argetia ad Lati America, with Larry Beutler, Adrés Cosoli, Melissa Morga Cosoli ad Sergi Corbella are amog the ivited speakers. Cotiued o page 8 Society for the Exploratio of Psychotherapy Itegratio 7

8 The Itegrative Therapist Volume 3, Issue 3 July 2017 Turkish Cypriot SEPI Regioal Network (Nicosia-Lefkosa): Erdem Akgu Dear SEPI RN members, I am workig as a itegrative psychotherapist i Turkey ad Cyprus. I am also the coordiator of the Turkish Cypriot SEPI RN. There are a 16 uiversities i Turkish Cyprus ad I have preseted at all of them to itroduce SEPI ad discuss the topic, What is itegratio? Italia SEPI Regioal Network (Bergamo-Milao): Agelo Compare I Italy, we have the followig iitiatives: Workshop o Itegrative Psychotherapy with Paul Wachtel o Oct 13-14, 2017 (Mila) i collaboratio with the Uiversity of Milao-Bicocca ad Scuola di Psicoterapia Itegrata e di Comuità (SPIC-ACOF). Iteratioal Workshop o Meta-Aalysis i cliical psychology, o Dec 14-15, 2017.(Bergamo, Uiversity of Bergamo). Research psychotherapy as drive for psychotherapy itegratio i collaboratio with Italia Post doc - Master degree i Multidimesioal Psychological Assessmet ad Psychological Therapeutic Techiques, at Uiversity of Bergamo i collaboratio with Hogrefe. Studets will be traied, withi a paradigm of psychotherapy itegratio, to combie therapeutic techiques o the base of multidimesioal psychological assessmet durig itervetio with patiets. Portuguese Group for Psychotherapy Itegratio (Lisbo): Atóio Braco Vasco, Joaa Fojo Ferreira Members of the Group are soo publishig two chapters o psychotherapy itegratio ad the first book o psychotherapy itegratio, ever, i Portugal. Psychotherapy Istitute of Turkey (Darıca): Tahir Özakkas... I Turkey, we are orgaizig the 1st Natioal Itegrative Psychotherapy Cogress o Sept ad Oct 1, Over 40 pael sessios plaed i 3 days, with more tha 400 participats expected. Itegratio may be quite commo i daily practice, but theoretical discussios are quite youg i Turkey. So the first year s theme is Itegratig Psychotherapies Society for the Exploratio of Psychotherapy Itegratio 8

9 The Itegrative Therapist Volume 3, Issue 3 July 2017 Secret SEPI: Take-Home Notes From Dever Curated by Jeifer Davidtz Alexadre Vaz I her mii-workshop Beyod the Words Kristi Osbor beautifully tapped ito two crucial ad uderresearched topics: the codig of paraverbal commuicatio i videotaped sessios, ad payig special attetio to the therapist s ow cotributio ad iteral processes. Her passioate, relatioal stace i therapy is somethig all of us should joyfully steal for our ow beefit! Havig bee traied through watchig tos of videotaped sessios, I admit some jealousy ad lack of surprise (ad total ethusiasm!) towards her high perceptual skills, makig the co-costructed therapy dace a lot more uderstadable to a outside observer. Well, ot everyoe has the luck of havig Leigh McCullough as a metor! Ayway, it would be woderful to see more systematic process research o the impact of therapist s overbals o the quality of the therapeutic relatioship ad, ultimately, therapy outcomes. Could the deliberate practice of accurate paraverbal commuicatio be o the meu of future itegratioists? Oe ca hope! Not everyoe has the luck of havig Leigh McCullough as a metor. I had ot cosidered the idea of gettig too close to a cliet ad the dager i becomig too itimate icludig icreased fatasies for cliets. Sapa Patel I reflectig o what struck me from the SEPI Coferece i Dever, I walked away thikig about what Jerrold Lee Shapiro had said regardig persoal reactivity ad errors i a existetial case. I had ot cosidered the idea of gettig too close to a cliet ad the dager i becomig too itimate icludig icreased fatasies for cliets. I am a doctoral studet ad am ofte taught to icrease cotact ad closeess through the relatioship. I have ofte reflected o exactly this issue of whether there is a limit o the level of closeess, attachmet ad itimacy, icludig the dagers i becomig too close. Hearig Dr. Shapiro speak of the challeges he faced i becomig more a part of the room was fasciatig to me, icludig the ways i which he foud himself reactig as he became the focus of coversatio. I ejoyed the way he shared his pitfalls, ad shared his reactios, as well as the way i which he chose to hadle the situatio ad retur it to the work at had. I ejoyed his hoesty, ad humility, i speakig about his mistakes ad valued his isights i what he would have doe differetly. Jay Eihor The opeig keyote address was by Marvi R. Goldfried, PhD, of Stoy Brook Uiversity, o Itegrative Themes i Psychotherapy: Searchig for Uiversal Priciples to Guide our Cliical Work. Goldfried is a fouder of SEPI, & he touched o importat themes i his address. He observed that psychotherapy was a ifat sciece, ad oted 3 themes: 1. Lack of itegratio of ew iformatio with past cotributios. We seem to have amesia as a professio ad field about developmets i the past. 2. We have differet schools of thought, sometimes movig o parallel paths with little icetive to itegrate or talk to oe aother. Eve i CBT, which is Marvi s field, there is a lot of this kid of fragmetatio. 3. There is a lack of itegratio of research ad practice, which should ot just be about research tellig practitioers what they should do as is typically the case but also practitioers iformig researchers about what eeds to be studied so that research ca be more relevat to practice. (My thought: there are critically importat dyamics i therapy that the ifat sciece does t kow how to study yet. For example, trust; the cliet s trust i the therapist, the therapist s trust i the cliet, the iteractio of their trust.) There are similarities ad differeces betwee physical ad social scieces, Goldfried observed. At the cuttig edge of Cotiued o page 10 Society for the Exploratio of Psychotherapy Itegratio 9

10 The Itegrative Therapist Volume 3, Issue 3 July 2017 both, there is just as much disagreemet about what is relevat. But the physical scieces have a core ad agree o certai pheomea, eve with disagreemet o the cuttig edge. I our field, there is o core of agreemet. So the system is built i such a way that we ai t goig owhere, ad we ll have a very old ifat i the future. Why is this happeig? What are the obstacles that exist i comig up with a agreed-o core? There are critically importat dyamics i therapy that the ifat sciece does t kow how to study yet. Goldfried cosidered is the tedecy to forget & devalue the learig of the past & overvalue the importace of what s ew. Oe obstacle is the gap betwee researchers ad cliicias, which appears to be structural. Laguage barriers are aother issue, whe members of oe school of therapy are too ucomfortable with laguage of aother. Paul Wachtel spoke about X-rated cocepts i therapy schools years ago. Whe Has Strupp, havig bee ivited to speak to a behavioral group, used words like ego ad warded off, people fidgeted ad walked out. Whe Goldfried edited I Sessio, he would t allow writers to use jargo. Chagig research methodology is the ext issue. I the 1980s, NIMH chaged its research priority from lookig at problems-i-livig to focusig o DSM criteria. Recetly that s chaged agai to look at the biological/geetic/biochemical compoets associated with differet psychological disorders. (My thought: I woder what all that research has produced? What if there was a book etitled, NIMH Over the Years: What Have We Really Leared? ) The ext issue Goldfried cosidered is the tedecy to forget & devalue the learig of the past & overvalue the importace of what s ew. There are structural reiforcers for both cliicias ad researchers to do that. (My thought: this gives the impressio of progress while actually udermiig it.) The ext issue Goldfried cosidered is that of the orms of sciece. Referece groups withi sciece compete with each other ad selectively choose or exclude citatios. You do t get research moey to study commoalities. Scietists are ofte doig all they ca do to advace their ow careers ad reputatios, eve at the expese of advacig the field. Takig a cocept ad chagig the cocept s ame ad callig it ew cocept is oe example of a problem. (My thought: this happes i the cliical field all the time.) Careers are made by makig history, ot kowig history. Three itegrative themes Goldfried emphasized i psychotherapy are the itegratio of ew iformatio with past cotributios, a itegrative perspective across orietatios, ad itegratio of research ad practice. If we thik about therapy theoretically we wo t get cosesus, or will we if we thik about the hudreds of differet techiques. Referrig to a coversatio betwee Albert Eistei ad Neils Bohr, Eistei said, Alas, our theory is too poor for experiece. Neil s Bohr said, No, o! Experiece is too rich for our theory! Goldfried ext cosidered the challege of Depictig Levels of Abstractio for Coceptualizig Psychotherapy. At the highest level of abstractio, this would be psychodyamic, experietial, ad behavioral. But at a observable cliical level, there are iterpretatio, reflectio ad self-moitorig, across these three approaches. Somewhere betwee the upper ad lower levels of abstractio there is the geeral priciple, which is icreasig awareess; all three approaches try to icrease awareess, i differet ways, ad that is a uifyig priciple, said Goldfried. Goldfried the cosidered commo priciples for therapeutic chage, across therapeutic methods, icludig: 1. Expectatio that therapy will help, motivatio. 2. Presece of a optimal therapeutic alliace. (Goldfried commeted that although may CBT people thik that techiques, ot relatioship, are importat, he uses the aalogy of aesthetic ad surgery, with the relatioship i the role of aesthetic. (My thought: This is the oly commet I would disagree with, sice the relatioship itself is a therapeutic dyamic, ulike aesthetic i surgery.) 3. Helpig patiets become better aware of themselves ad their world. Sulliva wrote about selective iattetio, the iability to lear from experiece because experiece is t recogized. Goldfried sees this as a part of executive fuctio. Reflective fuctio, de-ceterig, midfuless, self-uderstadig, witessig, gettig the cliet to step back ad observe oeself plays itself out i so may differet schools of thought. Gettig the perso to do this selfobservatio sometimes produces chage i itself. 4. Ecouragig corrective experieces. CBT people call this exposure. I psychodyamic therapy, the corrective experiece is i the relatioship with the therapist. I CBT it is expected to take place betwee sessios, but it could be happeig i the sessio if the CBT therapist is payig attetio. 5. Facilitatig ogoig reality testig. First patiets start thikig, actig, feelig differetly, ad the become aware Cotiued o page 11 Society for the Exploratio of Psychotherapy Itegratio 10

11 The Itegrative Therapist Volume 3, Issue 3 July 2017 that they are. Because these chages may be icosistet with the self-schema (which may be excessively ad urealistically self-critical), the ew behaviors may be ot perceived, or miimized ( it s just luck, it s just because you re helpig me ). Somewhere betwee the upper ad lower levels of abstractio there is the geeral priciple, which is icreasig awareess. Goldfried the told a joke to illustrate how we may ot be aware of what is right i frot of us. A ma is leavig a highly secure costructio site with a wheelbarrow full of sawdust. The guard is suspicious ad searches the sawdust to see what the ma is stealig, but fids othig, ad lets the ma go. This is repeated several times, ad evetually the guard asks the ma, promisig ot to tell, what he is stealig sice the guard kows that the ma is stealig somethig ad the ma says that he is stealig wheelbarrows. (This has exactly the same structure as a Mulla Nasrudi joke, except the Mulla was stealig dokeys.) Goldfried referred to his Rorschach traiig as a studet, i which there was o evidece for the assertios about what Rorschach resposes meat. Our schools of thought keep us from thikig thigs that we should be thikig, as therapists. Goldfried is cocered about how people i each camp cliicias, researchers deigrate ad dismiss the other. Research has teded to be a oe-way street, from research to practitioer. Goldfried thiks this should be reciprocal. Good cliical research depeds o the researcher eedig to kow somethig about the cliical pheomeo. There is a website at Stoybrook about buildig a two way bridge betwee research ad practice: Goldfried said this site has surveys published to date o paic disorder, social axiety, geeral axiety disorder, ad OCD, showig that protocols that are evidece-based i research do t work i the cliical settig. A key issue ot looked at i research is duratio of the symptoms or problem (prior to treatmet). Severity is looked at, duratio is ot, but duratio is a key factor to outcome of treatmet. Now here is Jay Eihor s ow secret SEPI: Below is the title slide from my presetatio, Iclusive Psychodyamic ad Cogitive-Behavioral Cosultatio: Overview ad Demostratio. I thik it s cute, with the Gustav Klimt paitig for psychodyamic therapy, ad the cogitive-behavioral diagram for CBT: Cotiued o page 12 Society for the Exploratio of Psychotherapy Itegratio 11

12 The Itegrative Therapist Volume 3, Issue 3 July 2017 Here s a slide from that presetatio, Freudia ad Skieria Silos : Scott Browig, Chestut Hill College While I foud may of the talks woderful, the most ifluetial momet was from Paul Wachtel s pleary. Whe he said that, push come to shove, he would idetify himself as a Itegratioist, rather tha psychodyamic, I foud that be both timely ad eeded to propel the missio of SEPI. Douglas Heig A SEPI 1 st timer s take-home poits from opeig ad closig plearies by Goldfried & Wachtel, respectively, ad Utilizig Geograms... Psychodyamic Thikig, by Scott Browig & Rachel Hull. 1. Chagig perceptio is ofte key to idividual s metal health. Differet theoretical perspectives o psychological issues helps us see a more complete picture: a. Better equipped i assistig cliet(s) adjustmet to ew ormal as i PTSD, vs tryig to retur to previous stages. b. Likely to see thigs ot see before, to discover ew aveues to improvemet c. Promotes humility, which is essetial to the therapeutic relatioship. 2. Uderstadig historical developmet of beliefs/assumptios lead to more sophisticated views ad uderstad that curret thikig is part of a developmetal process. Stadig o the shoulders of past explorers, makes sese of how we arrived, ad ecourages us to remai ope to ew thikig. Others will refie our thikig, keepig some thigs, discardig others. Itegratio allows each etity to maitai its distictiveess while cotributig to the richess of the whole. Cotiued o page 13 Society for the Exploratio of Psychotherapy Itegratio 12

13 The Itegrative Therapist Volume 3, Issue 3 July 2017 Ahmed Rady It s a great pleasure to share my experiece of the last SEPI coferece i Dever. The program was scietifically very rich ad ispirig, with highlights shed o ew treds i itegrative therapeutic models, ad a ispirig atmosphere. Though I really ejoyed all atteded sessios, I would like to share themes from two particularly iterestig workshops that ispired critical ad costructive thikig. I the pre-coferece workshop titled Iterpersoal Recostructive Therapy IRT: help to decide what to do for whom, whe ad how, Lora Bejami, PhD preseted a iovative approach to resistat cases. She suggested redefiig the role the symptom serves, ad emphasized the eed to uderstad resistace i a way that allows us to validate it as a reactio that makes sese withi the cotextual model of the primitive brai i fight or flight mode, that blocks the higher cortical logic reasoig. She discussed the value of structural aalysis of symptoms to overcome resistace before gettig back to CBT or DBT. I liked so much that the model was explaied first, the followed by a magificet case presetatio. I also atteded two cosecutive workshops tacklig two of the most difficult persoality disorders to treat i cliical practice Pheomeology, Diagosis ad treatmet of Borderlie persoality disorder & Diagosis ad treatmet of Narcissistic persoality disorder preseted by woderful preseters from the Masterso Istitute of Psychotherapy, highlightig challegig poits i diagosis ad treatmet from a practical perspective, ad offerig a simplified ad clear model to approach those persoality disorders startig with the ego repair stage focusig o ways to cofrot maladaptive defese mechaisms, followed by the work through stage. I liked so much that the model was explaied first, the followed by a magificet case presetatio that traslated the model ito practice ad helped a lot i brigig theory ito cliical practice uderstadig. I was happy to be amog SEPI colleagues i a ispirig ad friedly atmosphere, schedule timig was strict ad orgaizatio just great. Attedig SEPI cofereces is a amazig experiece that I do recommed for colleagues i the psychotherapy field. Thaks to the scietific committee ad the orgaizig committee for their great effort to keep the high level of cotet i a friedly collegial atmosphere. See you i New York. Presidet s Colum, cotiued from page 1...I eve allowed myself to experiece the coferece as a participat... importat frotier i psychotherapy itegratio to be further developed i future programs. We wished our program had more time for discussio ad for rest, but the schedule was tight for such diversity, which also characterizes SEPI ad its dialogues. We also wished our program had bee eve more thematic tha it was, but i some sessios it was already quite excitig to sese the atmosphere where decisios ad choice poits figured tetatively, as fuctioally relevat objects, as explaatorily relevat etities i the field of psychotherapy itegratio. A therapist s decisio is ot oly the locus of operatios ad processes guided by approaches or frameworks. A therapist s decisio also operates as a itegrated whole ad egages its eviromet causally i ways that require that it be treated as a object of iquiry! After the usual break followig such a evet, I will remai curious to see what work will build up with such a fiegraied focus o Cliical Decisios that Work. If our steady progress over the last three decades ca rest for a little while, it is however ot meat to stop. Every semester we are gettig a bit better orgaized ad we are takig advatage of makig thigs happe with the ivolvemet of three geeratios. Now more tha ever we are i a good positio to go o cultivatig both the uity ad diversity i psychotherapy practice, research ad traiig ragig from diversity of topics worked o/researched/taught to diversity of people doig the cliical work/research/teachig ad what coects these parties or roles together. All this, i a cotext of work that sustais ad maitais. We ihabit a culture that privileges productivity ad efficiecy as ovelty ad growth over the cyclical ad the regeerative, but we do see maiteace ad care as productive ad efficiet i the same way. Now more tha ever, all cotiets eed to stay uited ad committed to creatively challege ecoomic pressures, so that they do ot costitute a serious impedimet to cliical ad scietific progress i psychotherapy i geeral ad i psychotherapy itegratio i particular. Challeges related to scarcity of fudig will probably also require us to pay attetio to the activities we as a orgaizatio do to focus o our impact - the broad or loger-term effects of our orgaizatio s work (i.e. the differece we make). This ca iclude effects o our members who are direct users of SEPI s Cotiued o page 21 Society for the Exploratio of Psychotherapy Itegratio 13

14 The Itegrative Therapist Volume 3, Issue 3 July 2017 Reflectios o SEPI s Dever Coferece The expasive sites ad beauty of the surroudig ature ecouraged opemided thought ad curiosity... Aother topic of iterest to us was routie outcome moitorig i cojuctio with therapist effectiveess. As our secod year approaches, durig which we will begi therapy with our ow patiets, the axiety has gradually icreased. Carly M. Schwartzma & Brittay R. Iles Uiversity at Albay, State Uiversity of New York The 2017 Society for the Exploratio of Psychotherapy Itegratio (SEPI) Coferece was our first attedace at a SEPI coferece. This was a icredibly eye-opeig ad thought-provokig experiece, which ispired us to cosider deeply the researchers ad psychotherapists we both hope to be. Dever, Colorado was the perfect settig for the coferece to take place a stuig city with a view of the Rocky Moutais i the distace. The expasive sites ad beauty of the surroudig ature ecouraged ope-mided thought ad curiosity, ad remided us to appreciate the gestalt ad perhaps disregard the mior details that serve to divide us. With hopes of learig more about itegrative therapy ad our ow idetities as psychotherapists, we etered the ballroom for opeig remarks with excitemet, woderig where the series of symposia ad research would guide us over the ext few days. Throughout the weeked, there were a umber of otable themes ad topics discussed that stood out. A topic that seemed to be prevalet throughout the coferece was that of traiig psychotherapists, which was fasciatig to us as curret studets i a doctoral program. Specifically, durig studet Alexadre Vaz s presetatio, he discussed whether stregth of perceptio ad ituitio i a psychotherapist ca be taught, or if this is more of a iheret quality. After persoal reflectio, we feel that this is a skill that ca be stregtheed with effortful practice ad experiece, ad is a tool we hope to improve i ourselves whe we meet with our ow cliets this Fall. Additioally, we ejoyed the Traiig Cliical Judgmet mii-workshop demostratig the APA PsycTHERAPY video streamig service. The service allows traiees to view videos of therapists treatig real cliets usig differet theoretical approaches. These videos could be uiquely helpful i exhibitig to traiees various therapeutic techiques ad the sequece of evets that take place durig a authetic therapy sessio, allowig the traiee to discer which approaches resoate with him/her. Aother topic of iterest to us was routie outcome moitorig i cojuctio with therapist effectiveess. Durig a symposium o the topic of Therapist Effects, preseters discussed the high variability i therapist effectiveess, as well as research that foud that a majority of surveyed outpatiets would like access to therapist effectiveess iformatio to aid them i fidig a cliicia they are cofidet ca be of help. This led us to woder how we ca icrease our kowledge about our effectiveess i treatmet, ad cosider if we as a field are egagig i the effort eeded to esure effective treatmet for the populatios we are so passioate about servig. This the led us to ask aother questio: if we do choose to egage i routie outcome moitorig to track ad esure effectiveess with cliets, are we usig a valid ad reliable measuremet tools to do so? I Dr. Jeifer Callaha s pael o New Directios i Psychotherapy Itegratio, she stated that some of the existet routie outcome moitorig istrumets do ot measure the specific costructs we are actively targetig i therapy. Therefore, she proposed a ew measure that icludes those costructs, as well as icorporates the dimesios that the Natioal Istitute of Metal Health has declared importat i the RDoC. With the iclusio of these dimesios, this ew istrumet may be a more viable tool to use i research, with potetial greater fudig opportuity. As first-year graduate studets, we have leared of ad practiced a umber of differet therapeutic techiques ad skills, ad have bee taught to idetify cotexts i which such skills would be most appropriate. However, we have also leared that it is ot always obvious whe certai techiques would be most helpful, thus geeratig a strog sese of fear of makig a mistake with a real cliet. As our secod year approaches, durig which we will begi therapy with our ow patiets, the axiety has gradually icreased. However, oe (perhaps, stragely) comfortig message that we took from this coferece was that mistakes will happe i therapy, ad eve the best therapists regret certai decisios they have made i sessio. This message was particularly saliet durig the Friday morig pael, To Err is Huma; To lear from Mistakes... Therapeutic: Seior Psychotherapists Describe Therapeutic Errors ad Recovery. Dr. Jerrold Cotiued o page 15 Society for the Exploratio of Psychotherapy Itegratio 14

15 The Itegrative Therapist Volume 3, Issue 3 July 2017 How do we wat to label ourselves if, or whe, we are asked by cliets, peers, ad future itership or job sites? Shapiro discussed how he persoally reacted to a false persoal accusatio made by a cliet, ad Dr. Rhoda Goldma, through a recorded video sessio, highlighted a error as miute as askig a questio at a potetially iappropriate time. Fortuately, each preseter described the ways i which they attempted to correct the situatio, ad the lessos they each leared from their mistakes. After solicitig advice from a fellow therapist, Dr. Shapiro, for example, decided to alleviate the situatio by settig aside his ow reactios ad askig the cliet about her egative reactio to the rumor, which the improved both the therapeutic alliace as well as his uderstadig of the cliet s pathology. With these presetatios, we ot oly saw that mistakes are ievitable for all therapists, but also that the cosequeces of such errors may ot be as catastrophic as we thik, ad are ofte easily repairable. Although we may ot realize that we have made mistakes util later i treatmet, the importat message is to attempt to fix them oce they are realized, ad to lear from them. Fially, a theme that was apparet at both the ope ad coclusio of the coferece weeked was that of self-idetificatio with respect to therapeutic orietatio. Dr. Marvi Goldfried bega the coferece with a keyote presetatio about itegrative decisio-makig, durig which he idetified himself as a CBT therapist. A audiece member proceeded to ask why he idetifies as cogitive-behaviorally orieted while practicig itegratively why ot idetify as a itegrative therapist? This was a iterestig ad very saliet questio for us as we will soo begi therapy with our ow patiets. How do we wat to label ourselves if, or whe, we are asked by cliets, peers, ad future itership or job sites about our therapeutic approach? We believe that itegrative therapy results i more idividualized ad successful therapy for cliets ad will most certaily practice i this way. However, will we do so i a more assimilative way i which we work from a base orietatio, such as CBT, ad occasioally utilize techiques typical of other orietatios? If so, perhaps it makes sese to idetify as a CBT therapist, ad may also explai why Dr. Goldfried idetified himself as such. Alteratively, will our approach be more techically eclectic? Ultimately, we wat to use evidecedbased techiques that work for the problems our cliets seek help for, which may ot always coicide with a sigle, specific theoretical orietatio. However, this presetatio ad the etire coferece weeked motivated us to cosider how we wat to idetify ad preset ourselves to others, especially i relatio to how we pla to practice. Our experiece as first-time SEPI attedees was thought-provokig, iformative, ad ecouragig. It was ispirig to participate i a coferece that promotes cuttig through tribes ad steadfast loyalties to specific orietatios, to istead come together with the uited goal of providig the best treatmet for our cliets. We very much look forward to attedig ad presetig at future SEPI cofereces! Society for the Exploratio SEPI of Psychotherapy Itegratio A Word From the Editor, cotiued from page 1 reactios to our structured iterview, that issue preseted a set of te priciples outliig a possible itegrative theoretical framework. Readers were ivited to take a olie survey ratig their respose to each of the te items ad givig specific reactios ad suggestios. I this issue we preset ew iteratio of the te priciples, modified i respose to readers commets. The title is, Are We There Yet, Part I. Followig presetatio of this ew versio, your editor proposes a Affect Avoidace Model, a eve more cohesive way to coceptualize psychotherapy ad help ew therapists avigate the territory while remaiig faithful to the basic foudatios of all cotemporary orietatios. Readers are urged to commet o both Part I ad Part II, through letters to the editor for iclusio i the ext issue. Jeffery Smith Society for the Exploratio of Psychotherapy Itegratio 15

16 The Itegrative Therapist Volume 3, Issue 3 July 2017 Are We There, Yet? Theoretical Covergece, Part I Jeffery Smith Itroductio Fid the simplest set of costructs compatible with all schools ad havig the power to explai etiology, maiteace ad cure... I the last issue of The Itegrative Therapist, we published resposes by leaders i the field to a structured iterview focused o key issues related to a uified theory of psychotherapy, takig ito accout recet discoveries about biological mechaisms of chage such as recosolidatio, ad their relatioship to differet theories of psychotherapy. Based o those resposes, The Itegrative Therapist developed a set of priciples formig the outlie of a proposed theoretical framework. Followig the publicatio of that issue, the priciples were published o the web as a olie survey, askig readers to rate each priciple ad offer commets ad discussio. Today, we publish a revised versio of the priciples, based o commets ad reservatios expressed i the 22 resposes received. I may cases, objectios were the result of assumig that terms like iformatio ad avoidace were beig used i a arrow sese. I this versio we have tried to improve clarity ad respod to objectios while remaiig faithful to the goals of the exercise. The goals remai: 1. Build a theoretical framework withi which the wisdom of all schools ad orietatios ca be valued ad accommodated. 2. Fid the simplest set of costructs compatible with all schools ad havig the power to explai etiology, maiteace ad cure of those psychological pathologies that are ameable to psychotherapy. 3. Make the sciece of psychotherapy upwardly compatible with the theoretical umbrella of biological sciece ad evolutio. 4. Icorporate more recet fidigs about the eurobiology of memory ad chage processes. 5. Use plai laguage ad avoid termiology specific to ay oe school. I am pleased to report some early positive resposes from idividuals particularly well qualified i the area of uifyig theory: Jack Achi: I thik that collectively the 10 priciples do succeed i meetig the challege of achievig the five goals idetified at the outset of the documet. Gregg Heriques: Psychotherapy is at a crossroads ad the time for a more systematic, itegrated approach is here. These 10 priciples are a excellet start i buildig cosesus toward a shared uderstadig of psychological problems ad the eterprise of psychotherapy. Richard Lae: Oe thig that I got out of the SEPI symposium that we did together was to come away with a clearer sese of what might be achieved here. I used the aalogy of a automobile it has a fuctio ad works a certai way. But there are a potetially ifiite umber of makes ad models. I do t thik we wat to have everyoe drive the same car. I thik what you are tryig to do is defie the basics, but ot everyoe will say that the descriptio captures exactly what they do or thik, which I thik is OK. Cotiued o page 17 Society for the Exploratio of Psychotherapy Itegratio 16

17 The Itegrative Therapist Volume 3, Issue 3 July 2017 Te Theoretical Priciples:...we lay the groudwork for placig a theory of psychotherapy withi the overall scietific framework of biological sciece... A umber of respodets to the survey foud the priciples reductioistic....both healthy ad maladaptive resposes are motivated ad that motivatio is closely related to emotio. P1: The huma cetral ervous system evolved uder the ifluece of atural selectio. This history, favorig survival ad procreatio i a social cotext, is reflected i its orgaizatio ad fuctioig as a orga of appraisal of opportuities ad dagers ad geeratio of adaptive resposes. (See also, Heriques Behavioral Ivestmet Theory, 2011) The majority of iformatio processig takes place outside of cosciousess. Discussio: I this priciple, we lay the groudwork for placig a theory of psychotherapy withi the overall scietific framework of biological sciece, built o the foudatio of evolutio. I additio, we ackowledge the importace of iformatio processig takig place outside of cosciousess, which is cetral i psychodyamic theory, but is also icreasigly recogized i other theoretical orietatios. P2: Iputs to the huma brai (from without ad from withi) are eormously varied ad complex. Processig of iformatio is oliear ad is iflueced by the history of the species, the idividual, ad, idirectly, the commuity. Outputs iclude thoughts, feeligs, behaviors, ad impulses to act, as well as physiological adjustmets. (See also, Achi, J.C., 2008) Discussio: We cotiue to build a basis for joiig a biological, iformatio processig perspective with the richess of cotet familiar to every therapist. I doig so, we itroduce the idea that the mid/brai produces outputs, which will iclude those that tur out to be maladaptive. P3: While the huma mid ca be described as processig ad storig iformatio i its broadest sese, the subtlety ad idividual uiqueess of huma experiece shared betwee humas defies reductio ad makes psychotherapy a art as well as a sciece. Processig of iformatio ca be schematized as appraisalà emotioà motivatioà respose, however, i reality, this complex processig is simultaeous ad oliear. Discussio: A umber of respodets to the survey foud the priciples reductioistic. I o way was this iteded. This revisio reiforces that, eve if we recogize biological priciples icorporated ito the orgaizatio ad fuctioig of the mid, its cotets have a iescapable uiqueess ad complexity that make psychotherapy the excitig ad challegig edeavor it is. We use this priciple as a place to emphasize the oliear ature of the mid s iformatio processig. P4: Curretly, uderstadig of the emotioal ad motivatioal liks mediatig appraisal ad the productio of coscious ad/or observable resposes is i a early stage. A cosesus exists that emotio ad motivatio are closely liked ad ca be see schematically as stadig betwee appraisal ad respose. Furthermore, emotio ad motivatio, ted to be orgaized aroud positive ad egative valeces associated with approach ad avoidace behaviors. (for further discussio, see LeDoux, 2012, Paksepp, et al., 2016) Discussio: The importace of this item is that both healthy ad maladaptive resposes are motivated ad that motivatio is closely related to emotio. Resposes are shaped i complex ad importat ways by may factors, but motivatio is a commo deomiator that potetially offers a uifyig cetral theme to our uderstadig ad approach to pathologies ragig from the early, overbal schemas of persoality disorders all the way to itrapsychic coflict ad addictios. P5: For ow, a useful model is to cosider the valece ad itesity of emotios as the mid s proxy for adaptive advatage. I this way, what the mid appraises as opportuity or dager (both i their broadest seses) is tagged or associated with positive or egative emotio, which promotes adaptive reactio ad settig of goals. Success or failure i pursuig goals, i tur, geerates additioal positive or egative emotios. Cotiued o page 18 Society for the Exploratio of Psychotherapy Itegratio 17

18 The Itegrative Therapist Volume 3, Issue 3 July 2017 Discussio: This item attempts to schematize how evolutio has programmed the mid/brai to geerate reactios, both adaptive ad maladaptive, usig emotio as a commo currecy that drives motivatio ad determies which goals take precedece. I particular, it idetifies the most etreched maladaptive resposes as motivated primarily to miimize egative emotios. The importace of coscious experiece related to activatio of eural etworks is a importat observatio yet to be fully explored. P6: A major source of cliical pathology cosists of reactios that ca be viewed as origiatig from the mid s atural avoidace of paiful, ucomfortable, or overwhelmig emotios, more tha from pursuit of the positive. Maladaptive reactios i adulthood ca be due to some combiatio of chage i coditios sice the time of their origi, immature developmet at the time of origial stress, ad exposure to uhealthy modelig. A secod major source of problems ad potetial therapeutic gai is the absece of opportuities to lear from positive iteractio durig developmet. Discussio: Buildig o the previous two priciples, this item brigs ito focus the problems that psychotherapy aims to resolve ad looks at their causatio. It idetifies a commo deomiator as the mid s attempts to adapt, drive by emotio. I particular, it idetifies the most etreched maladaptive resposes as motivated primarily to miimize egative emotios. The item also recogizes that ot havig leared more adaptive resposes is aother importat source of trouble ad gives the therapist opportuities to foster ew learig ad positive experieces. P7: Those maladaptive patters of appraisal ad reactio that are resolvable i psychotherapy are held i memory structures kow as eural etworks. These iclude procedural, episodic ad sematic memory. While Psychotherapy ca ad does affect biological parameters such as hormoe productio ad gee expressio, it is primarily directed at addig to or modifyig iformatio (i its broadest sese) stored i eural etworks. Discussio: Here we lay the groudwork to joi the latest sciece about memory ad its modificatio together with what we already kow about therapeutic actio. Chage i syapses is the fial commo pathway for psychotherapeutic actio as described below: P8: Studies of therapeutic chage i those forms of stored iformatio represetig maladaptive resposes have so far show that two coditios must be met for chage. First, the relevat memory structure must be i a state of activatio, ad secod, corrective iformatio (i its broadest sese) must simultaeously be preseted. This fidig applies, so far, to the kow chage mechaisms of recosolidatio ad extictio. (See Lae, et al, 2015) May examples of therapeutic chage are too subtle ad gradual for the mechaism to be idetified, but may represet a quieter, more icremetal versio of the same processes. I humas, activatio of emotio, allowig chage to take place, is usually idetified with the coscious, visceral experiece of affect. Discussio: We have tried to brig to bear what is kow, while ackowledgig what is ot kow at preset. The importace of coscious experiece related to activatio of eural etworks is a importat observatio yet to be fully explored. It is, however, cosistet with much of cliical wisdom about the importace of coscious awareess. P9: Active maiteace of maladaptive patters is ofte observed i psychotherapy. A frequet cotributor to this tedecy is the atural reactio of avoidig aticipated egative emotioal experiece i some way associated (cosciously or ucosciously) with positive chage. A additioal source of maiteace of maladaptive patters is the iertia of habit. Discussio: Here we address the persistece of maladaptive behaviors, sometimes referred to as resistace, meaig a ocoscious, o-willful reluctace to accept chage. Habit is a term commoly recogized, ad cliically distict from active resistace, but ot yet well uderstood or scietifically defied. P10: Amog primary objectives of Psychotherapy are: 1) The activatio of memory structures associated with maladaptive emotio, thought, ad behavior, 2) The simultaeous provisio of corrective Cotiued o page 19 Society for the Exploratio of Psychotherapy Itegratio 18

19 The Itegrative Therapist Volume 3, Issue 3 July 2017 Nuo ad may others have expressed how importat it would be for SEPI to develop a discussio forum for member commet....such a coceptualizatio is a logical extesio of the te priciples above ad offers advatages to cliicias ad traiees. iformatio, ad 3) The assimilatio of ew ad healthier approaches to life. I practice, these objectives ca rage from explicit chage to subtle, slow growth resultig from positive huma iteractio. Additioal therapeutic objectives, which may derive from the primary oes listed above, iclude developmet of a ew life arrative, ecouragemet of coscious awareess of emotios ad other aspects of metal life, the use of the therapeutic relatioship to create a corrective cotext, ad the practicig of ovel behaviors i a maer that simultaeously activates memory structures ad provides ew iformatio. Discussio: Most respodets were comfortable with this broad formulatio, based o a europhysiological iterpretatio of the corrective emotioal experiece. We have attempted to leave room for modificatio of maladaptive patters ad ew learig, as well as detoxificatio of egative affects. The additioal objectives ca be iterpreted withi the framework outlied i earlier priciples, but room is left for them to tur out to have uique mechaisms or aspects. Where to go from here? Eve without the modificatios ad clarificatios of this third iteratio, the overall score for the origial survey was 68% positive, 14% eutral, ad 18% egative. The chages i this third iteratio are iteded to address most of the egative resposes, hopefully satisfactorily. The questio of where to go from here highlights a importat umet eed withi SEPI. Nuo ad may others have expressed how importat it would be for SEPI to develop a discussio forum for member commet. The Editor would like to ivite readers to share their commets as well as suggestios about where to where to go from here i the form of letters to the editor via at: jsmd@howtherapyworks.com. As much as possible, they will be icluded i the ext issue of The Itegrative Therapist. Refereces: Achi, J.C. (2008). Pursuig a uifyig paradigm for psychotherapy: Tasks, dialectical cosideratios, ad biopsychosocial systems metatheory. Joural of Psychotherapy Itegratio, 18, Heriques, G. (2011) A New Uified Theory of Psychology, Spriger Sciece. Richard D. Lae, Lee Rya, Ly Nadel & Leslie Greeberg (2015) Memory recosolidatio, emotioal arousal, ad the process of chage i psychotherapy: New isights from brai sciece. Behavioral ad Brai Scieces 38:1-80 Joseph LeDoux, Rethikig The Emotioal Brai, Neuro Feb 23; 73(4): Paksepp, J, Solms, M, Lae, R, Smith, R. Recocilig cogitive ad affective eurosciece perspectives o the brai basis of emotioal experiece. Neurosciece & Biobehavioral Reviews, September Full Text o Researchgate.et. Are We There, Yet? Theoretical Covergece, Part II Jeffery Smith The oe aspect of the Structured iterview that gave respodets the most trouble was seeig affect avoidace as a uiversal aspect of the may forms of pathology that are the targets of psychotherapy. At the Dever coferece, I argued for a Affect Avoidace Model, but foud that the idea was still hard for may to accept as uiversal. Here I will briefly show why I believe that such a coceptualizatio is a logical extesio of the te priciples above ad offers advatages to cliicias ad traiees. This further step from the te priciples is based o the idea that maladaptive behaviors start out as the mid s attempts to adapt or cope with life, ad that, these reactios, at least the oes that become etreched as maladaptive Cotiued o page 20 Society for the Exploratio of Psychotherapy Itegratio 19