2. Indirect methods
Often, direct analysis is difficult. Then an indirect method of stimulating the inconscious integration process is used. These methods don't guarantee an easy integration, but accelerate the unconscious intuition. In fact, it is a rapid cycle of inspiration of elementary ideas, and attempts of integration. These attempts never succeed from the first time, but by the next cycles the intuition and inspiration generally are more successful.<i
a) schematizing: as many ideas, suggestions, proposals, as
possible are collected, and one tries to schematize them into "logical" groups. After a certain time a possible underlying system becomes apparent, and each attempt is inspiring for the next cycle. After some cycles, the existence of new categories becomes apparent, even if no ideas are yet available to fit in these categories,
b )matrix method: if one doesn't have yet many ideas about detailed aspects of a system ons tries to develop, but rather variants, one could try to discern some major aspects (e.g. in music: rhythm and harmony), then classify the variants along the major aspects. The ideal form probably is a combination of the several dimensions, each in a maximal developed form. The attempt to classify the available variants along the original aspects probably will help to discover aspects that weren't yet conscious.Example: the "ideal" music, projected out of a classification of the different existent musical styles Example: an ideal school system, projected from several educational systems, as well schools as other systems e.g. youth movementc) corpus method: in this method a complete (as complete as possible...) theoretical logical scheme is developed, outside the traditional schemes of a theory. This implies e.g. that one stops to speak about integrative psychotherapy, but at least about integrative psychology.
At this moment our Corpus of Integrative Psychology has this structure:
1. basic sciences: (a) general systems theory, (b) logics, (c) brain functioning
2. individual psychology: (a) general processes, (b) pathological (= sub-optimal) functioning, (c) optimal functioning
3. group psychology: (a) general processes, (b) pathological social functioning including history, (c) optimal functioning, ideal society The interaction between single theories and the general classification of the corpus is so inspiring and productive, that we decided at an early stage that no new theory or therapeutical method could be developed without situating it critically inside the corpus.
(1) First of all, it is usable for a rapprochement between differing theoretical orientations. This is the most popular meaning of integration, for many the only meaning.
(2) Integration as a way of thinking, the third way after choice and compromise, which are the most frequently used. In this process we discern the stages of retroduction against eduction, synthesis of the kernels of the concept, and recombining. Some important conditions for this process are explained. Kant and Hegel already introduced this process in the 18th century, but its utility was largely disregarded.
(3) Integration as the essential tool in (good) communication processes, hence being the most useful tool to teach in couple, family and group therapy<
(4) Integration as the factor that makes one's life either healthy or pathological. Psychoses and neuroses (and psychopathy) could be explained as ways to avoid integration, and attempts to pursue conscious and unconscious choices.
(5) *Perhaps the most important:* Integration as a means for scientific research. It enables "plausible" scientific research in the field of the alpha and gamma sciences, while exact science never really succeeds in those fields.>
The pre-scientific thinkers, from the ancient Greek and Alexandrian to the Renaissance scientists onwards, intuitively used the integrative method, and consequently even discovered the "exact" scientific method. Modern concepts such as Evidence Based Practice and Qualitative Research are in fact intuitive attempts towards this integrative ideal.
(6) The unconscious application of integration in creativity, and its importance for arts and research. (7) Integration as the way the brain functions, far away from the Cartesian and rational myths.
(8) Integration as the essential process used by cosmic evolution, of which nowadays 9 stages are known, the present psychosocial stage being the ninth. Both Pierre Teilhard de Chardin and Julian Huxley used the notion of "convergence: their word for "integration". Teilhard's most loved motto was "What emerges merges" (Tout ce qui monte converge)
(9) Integration as the central process in the collaboration and synergy of "democratic" groups and societies, enabling peer to peer production and consensus governance. Is the art of integration the most important condition for politics after democracy?
Integration as a scientific method
We discovered at an early stage that the method of integration is an excellent tool to enhance the quality of theories and therapies. We are confronted with the fact that the traditional scientific method, so successful in natural sciences, is practically of no use in psychological, social, political and philosophical domains. We were hoping during two centuries or more that "our" psychology would become "scientific" one day, but we are still frustrated. Apart from "measuring" that patients feel better when exposed to certain therapeutical methods, and the "measuring" of symptoms including depression and anxiety, there isn't much available that is accepted by the majority of professionals. Even the results of comparison between different approaches is poor, and correlations are more present between result and personality traits of the therapist, than with aspects of the method. Moreover we will try to explain why most of those comparisons are senseless.
Of course, dualistic notions as exact/inexact, true/false, proof/falsification, very popular and apparently fundamental in traditional exact science, have to be replaced by more relative notions as more/less probable.
Let's refer here to the approach of Larry Laudan , who tried to solve the conflict of Kuhn's and Popper's approach to scientific method. Popper stated that the discovery one "counterexample" was enough to immediately reject a theory, Kuhn, Lakatos and Laudan are more careful, and plead for nuance.
It is our hypothesis that if a greater number of divergent theories and visions are integrated, the probability of the integrative theory based upon them, is higher. Therefore, we looked for safeguards that would secure the integration process. Five factors seemed essential;
1) All available partial theories, or at least as many as possibe, have to be intregrated into the integrative approach. Of course, each partial theory itself has to be maximally secured, where possible with traditional "exact" scientific methods, if applicable.
2) Deductions have to be made with fundamental sciences including General Systems Theory, Logics and Brainscience, including the Psychopharmacological theories.
3) Even hypotheses out from non-scientific approaches of human sciences, e.g. literature, popular wisdom, can be taken into account
4) Every theory and technioque has to be situated within de Corpus of Integrative Psychology. During this operation, as well the theory and its components, as the corpus itself will probably be adapted and refined.
5) Every theory that was utilized to develop the integrative theory, has to be reconstructed by reduction from the integrative theory, the reduction consisting in dropping or limiting the value of factors that are not relevant in certain cases. The mnemonic word alfunocore can be used for easily remembering those 5 conditions.
In our case, the integrative corpus, still in development, is published since many years (in Dutch) on psy.cc/0000.html,
An integrative theory is acceptable and highly probable, if these five conditions are met.
Scientific publications are to be built on the same conditions. A traditional publication with a few pages and some statistically proved graphs and a lot of references to authors that say the same, is not sufficient. In fact, an integrative scientific publication has always to be situated within a corpus of integrated theories. It gets its justification from that corpus, and renders this integrative corpus more probable, the links with reality being the results of each practical theory and treatment. All traditional references concerning experimental applications and referral to other publications are present, but much more is needed to be a true integrative scientific publication. Sticking to the level of traditional academic science could hamper us to develop an integrative psychotherapy and resolve the fragmentation of psychotherapy schools.
Due to the same reason short communications on scientific meetings are rather difficult, at least if one wants to use the integrative scientific method.
A comparison with the traditional "exact" scientific method
In fact each theory is developed through 3 stages: (1) collecting related data, (2) generating one of more hypotheses to explain the observations, and (3) proving or rejecting these hyptheses by testing their applications against experiences and experiments.<
By using the "exact", mainly mathematical tool, traditional science was able to reduce its attention to the third stage. The most important stage, the generation of hypotheses, could be left to the genius of some "discoverers" and "scientists", to the point that this moment even didn't seem to exist. All scientific exercices begin with the sentence "given a=b+c, how can we prove or refute it", as if all hypotheses could be chosen from a wide collection of available theories. Also the first stage, the collection of data, could be highly selective: just picking the data that are useful for the theory. In scientific research e.g. the publication of failures, that could contradict popular theories, is very rare.
As in psychology and psychiatry the possibilities for exact measuring the emotional and mental processes we are describing is very limited, if any, our general deceiving feeling that our knowledge is not very scientific, and that we have to wait till other sciences, perhaps neurology, will fill the scientific gap, is not justified. The integrative approach can strengthen the first two stages of the scientific process, most often neglected by traditional science: collecting the data by including all fragmented theories into the integration, and consciously elaborating integrative hypotheses. These two stages are so important that a weeker application of the third stage, is acceptable because it largely compensates. And don't forget that all traditional scientific data are always included in the integrative hypotheses. Integrative science doesn't replace exact science, it completes it. From a historical point of view, it is interesting to remember that the pre-renaissancistic science worked exactly the same way as we describe here, because they generally lacked the measuring tools we have. And nevertheless, they did a great job! They even invented exact science...
Some successful achievements of integrative research
1. Integrative classification of therapeutical schools by intervention level
2. An integrative concept of depression
3. An integrative approach to psychopathologies
1. An integrative classification of psychotherapeutical schools by level of intervention
Several methods were already used to realize an integration between the dozens of psychotherapeutical schools and approaches available nowadays: the research on non-specific, general and common factors, the translation of the concepts of one school into the wordings of the other school(s), etc.
We propose a complimentary kind of approach. In the process of psychotherapy we could distinguish 4 well defined levels of psychic functioning: (1) observable symptoms, (2) interactive roles, (3) personality frames, and (4) the ability to autonomously influence/transform the functioning of one's personality, which we call the autonomy of the person. In this model, it appears that the several psychotherapeutic approaches just focus and target one level: level (1) behavior therapy, (2) system, communication therapy and family therapies, (3) psychoanalysis, CBT, TA, Rogerian Approach, focusing, and (4) personality training and "growing" groups. Also remarkable is that the "organic" treatments aim at the same levels: (1) tranquillizers and incisive neuroleptics, (2) -not yet available apart from drugs and alcohol-, (3) antidepressants and socializing antipsychotics, but also meditation and ECT, (4) some modern antidepressants including the revolutionary tianeptine, amineptine.<
It appears that the so-called fragmentation of psychotherapeutic schools is much less intriguing and confusing than generally accepted. With this scheme, the "mystery" of these conflicting ways of thinking largely disappears, and combinations -a step towards real integration, clinical as well as scientific- become obvious, taking also into account that each one-level therapy inevitably influences the processes on related lower and higher levels. It also shows that medication and other organic treatments, when properly handled, don't conflict at all with psychological therapies, but are rather synergistic ways for improving treatment.
Moreover, this model suggests why comparison between the different psychotherapeutical models isn't very important, because they are working on different levels
This scheme is also a very practical guide for integrative psychtherapy as it is practiced at our centers: one starts at the symptom level if necessary, e.g. with symptom oriented behavior therapy, switching progessively from negative mental experiences (classical behavior therapy) to positive autosuggestions (in autogenous training style). Sometimes the client is already partially conscious of the nature of his problems, and the treatment can start at level 2 or 3. Progressively one goes to a deeper level, as long as cooperation and motivation are adequate, ideally to conclude with personality training in group, where autonomy techniques are tought.
2. An integrative concept of depression
By bringing together a number of observations from different related psychological, neurological, psychopharmacological, genetic fields, we were able to develop a novel theory on the nature of depression, with useful implications for therapy.
Some of the observational data (this list isn't complete here):
- after more than two weeks of dream deprivation, e.g. by barbiturates, depressive symptoms appear. One of the two important functions of dreaming, apart from memory conservation, clearly seems to be the processing and recovery from frustrations
- there is still the mystery of the time lag in the effect of antidepressants: minimal 2 weeks. Sometimes biochemical explanations are proposed, but they aren't very convincing
- stopping antidepressant treatment too early provokes a depressive relapse after (more or less) 2 weeks
- even if the anidepressive effect of an antidepressant isn't observable in the first weeks of the treatment, the patient very often reports changes in his dreams from the first days on, as well as increased irritation and agressiveness
- the temperament circuits described by Cloninger are also operated by neurotransmitters, as by coincidence by the same as the famous three from the monoamine theories: DA, NA and Ser.
- the great majority of depressions are masked depressions, i.e. depression with week or without sadness. The percentage is still higher in endogenous depressions
- on psychological tests including the MMPI, a lowered energy level (9. Ma) is the most striking scale deviation, often more than depressiveness (2, D)
- in mammals, including rodents, there is no typical animal model for depression, which makes research on animals more difficult, in contrast with the studies on tranquillizers and neuroleptics, where it is easy to find animal analogies for human symptomatology. Only in the SDS-test (social defeat stress) we observe that after 2 weeks of different levels of anxiety, depression-like symptoms appear.
- when an animal. living in a herd, doesn't get enough reinforcement strokes from the group, after 2 weeks it switches to a low-profile behavior, to avoid being dumped by the group, which would make it too vulnerable to predators
- disorders as ADHD, ADD, ASS, Asperger, etc. react very well to antidepressants, often better than to amphetamines and (for ASS and Asp) to neuroleptics. This medication of course doesn't address the primary neurological cause, but apparently a secondary, masked depression has installed itself, and progressively becomes a more important cause for the primary disorder.
These facts inspired us, in the course of some years, to develop an integrative theory of depression:
As a mammal, humans also have the low profile instinct to protect themselves. This instinct is switched on, if a lack of strokes and social reinforcement occurs during more than two weeks. If partial redeeming is possible in the meanwhile, this frustration period can be extended, but two weeks is the minimum. When antidepressants are administered, the temperament is restored to its normal state and balance, and dreams in the subconscious restart to recover from this state, by processing the frustration e.g. with more aggressive dreams. After two weeks (at least), the low profile instinct can be switched off.
When the biological low profile state continues, a secondary neurotic reaction installs itself, comparable to learned helplessness (LH), strong in humans, but also present in other mammals.
At several points in therapy, these notions can help the therapist, not only for psycho-education, but also to use more frequently antidepressants, to tackle the resistance of many patients against "these artificial and chemical drugs", and to check the pharamceutical response long before depression disappears.
3. An integrative approach to psychopathologies
Far from the behavioristic maze of the DSM, and more in harmony with the intuitions of psychotherapists, we developed an integrative scheme for psychopathology.
Two major categories:
1. Pure psychological pathology: with only psychological symptoms
2. Complex psychopathology: complicated by somatic symptoms and causes (but organic and biochemical factors are included in the "pure"). The pure psychological pathologies: acute: for some days or weeks, or 1-3 months.
chronic: generally lasting more than 3-6 months. Very often, but not always, a process of neurotization leads to chronification
Level 1 (fusional, psychotic, i.e. leaving reality):
acute: psychosis, intoxication, decompensation of manic and depressive peaks, extreme agressiveness, murder, suicide including suicidal aggressiveness
chronic: schizophrenia, paranoia, chronic delusional and hallucinatory psychoses, identity psychoses
Level 1/2: borderline psychotic decompensations
Level 2 (oral)
acute : anxiety and panic attacks, beginning (months) of depression
chronic: depressive neurosis, hysteria, phobia, anxiety neurosis, hypochondria
Level 2/3: Oedipal conflicts
Level 3 (anal)
acute: agressiveness, decompensation of genital-hysterical neurosis
chronic: obsessions, OCD
Level 3-4: psychopathy
Level 4 (narcissistic)
chronic: narcissistic and phallic personality disorders
Level 4/5: pseudogenital personality: fakes genital functioning with narcissistic drives
Level 5 (genital) -- no problems: hamonious relationships, happiness
The complex psychopathologies
- neurovegetative stress symptoms
- psychosomatic diseases
- body function disorders: toxicomania, alcoholism, anorexia-obesity, sexual disorders
- Minimal Brain Damage: ADHD, ADD, ASS, Asp
- Intelligence disorders
-- Congenital: oligophrenia, low IQ
--Acquired: posttraumatic, psycho-organic
The advantages of this classification are mainly for psychotherapeutic intervention at the personality level. It shows which are the different levels that are to be transited, e.g. in a mourning process.
REFERENCES / LINKS
A corpus of integrative psychology, Kris Roose (in Dutch, since 1980) psy.cc
Kris Roose, psychiatrist, psychotherapist, ECP. firstname.lastname@example.orgFounder (1978) of the Academy for Integrative Psychology, Gent, Belgium.President of the Belgian-Dutch Society for Integrative Psychology and Psychotherapy