On Psychotherapy

Improving Effectiveness with an Integrative Approach to doing Therapy

A few weeks ago I attended an all day workshop on the Integrative Problem Centered Metaframeworks  (IPCM) approach to therapy (1).  This workshop  activated my thinking about how to improve effectiveness in therapy, an issue I have been delving into more fully in the past year. Specifically, the IPCM model offers an approach to therapy which should improve effectiveness because it is problem focused, parsimonious, and utilizes client feedback.

The IPCM model is an integration itself: of Bill Pinsoff’s Integrative Problem Centered Therapy (2) and Doug Breunlin’s, Dick Schwartz’s and Betty Karrer’s Metaframeworks approach (3).  Both Pinsoff and Bruenlin et al have argued that an integrative model, a model which guides therapists on when and how to intervene is the most efficacious approach to therapy.  Rather than arguing for a specific approach to therapy, e.g., my model is the best approach, the IPCM model advocates for a parsimonious and problem focused approach to therapy. Specifically, in the IPCM approach to therapy, the therapist initially utilizes the most straightforward methods and strategies for helping clients solve their problems, and only takes more in-depth and intensive approaches when more straightforward problem focused efforts have not succeed.  For example, if parents present for therapy with a child who is exhibiting a variety of behavior problems the IPCM model would recommend the use of behavioral or family therapy approaches which take a here and now problem focused approached, i.e.,  offer parents specific strategies and assistance on how to more effectively manage and resolve the child’s behavior problems.   Only if these strategies/interventions were not helpful would therapists take more in-depth and expanded approaches, e.g., ranging from addressing family of origin issues to examining the values and beliefs of individual family members.

The IPCM model is also feedback driven and focused on the therapeutic alliance. Therapists routinely solicit and review feedback (rating scales) completed by clients to assess client progress and concerns, and to monitor the therapeutic alliance. Thus, the IPCM model is congruent with the extensive  research of  Scott Miller and his colleagues, Michael Lambert, and John Norcross which stresses the importance of client feedback and the therapeutic alliance as key ingredients for successful therapy.

Finally, the IPCM model is a systems model. The model not only argues that we start by taking a straightforward here and now approach to problems, but that we also try and include the client’s significant others (parents, children, spouses, partners) in the therapy process. The advocates of the IPCM model persuasively argue that by including client’s parents, spouses and family in therapy that we can improve effectiveness. The argument is both theoretical, i.e., that family members will react to changes the client makes and that their support of these changes will help strengthen the client’s effort to change (and ignoring their negative reactions will undermine therapeutic efficacy, including the therapeutic alliance), and research based (the proponents of the IPCM model cite data that support that treatment of individual problems such as anxiety, have better outcomes when family members are involved in the treatment).

Any brief discussion of a complex model, like the IPCM model, cannot do justice to the complexities and richness of the IPCM model.  Rather my goal here is to encourage readers of this blog to consider this model, as its integrative approach appears to offer therapist an organized approach to improving effectiveness.

However, before closing there are some caveats to my recommendation of the IPCM model: (1) its complexity can be daunting; (2) its efforts to be all inclusive are its strength and its weakness; trying to take into account all variables that possibly impact clients from  biological, psychological, familial, societal, and spiritual levels/dimensions could become overwhelming and confusing; (3) to successfully use the model a therapist would need to either be adept in using multiple approaches, and/or being willing to refer to other colleagues who use such approaches; (4) the choice points for when to switch models/approach versus persist with one’s approach, appear to be left more to therapist discretion, which runs the risk of clinicians prematurely abandoning their interventions (or conversely sticking with unsuccessful strategies); and (5) there does not appear to be solid empirical data supporting the efficacy of the IPCM model over other approaches. The last point is particularly critical because of the increasingly consistent data stressing the importance of the therapeutic alliance and client feedback above all other variables in determining therapy outcome. Thus, before a compelling case for using the IPCM or other integrative models can be made there should be more evidence to support their efficacy relative to feedback informed treatment (as it may be that the feedback component is the critical factor and not the other aspects of the IPCM approach).

In closing, I would recommend and encourage therapists to learn about the IPCM model.  Many of its components have been shown to be related to improved efficacy, and it provides a valuable heuristic for thinking about how to be a more effective therapist.

1. Breunlin, D., Pinsof, W., Russell, W., Lebow, J., & Burgoyne, N. Integrative Problem Centered Metaframeworks (IPCM), Illinois Association of Marriage and Family Therapy, March 6, 2015.

(2) Breunlin, D.C., Schwartz, R.C., & MacKune-Karrer, B.M., Metaframeworks: Transcending the models of Family Therapy. Jossey-Bass, San Francisco, 1992.

(3) Pinsof, W.M., Integrative problem centered therapy: A synthesis of biological, individual and family therapies. Basic Books, New York, 1995.