 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to the next episode of The Therapy Show behind closed doors with the wonderful Mr Bob Cook and myself Jackie Jones and we're going to follow on from the last episode where we spoke about relational psychotherapy and we're going to be talking about integrative psychotherapy. Yeah sure. What number are we up to now then Jackie? 122. Good gosh. I know. 122. Absolutely. It's amazing isn't it? It is. Now this is one of my favourite subjects of all time because I could talk for very long time about this but I know I'm limited so I'll start away. In my career clinically and I'll be interested in yours as well but I can count on my hand probably the clients that are interested or even ask questions in the psychotherapy model that I use. Now if I'm teaching transaction analysis then I'll tell them and I'll teach them the parent adult child model but this is counting the assessments as well by the way. Very few clients are interested really in what model I use unless I teach them how to say TA for example as part of the educative therapy process but most of them just see psychotherapy as a bit different from counseling the past effects the present and helping people get new coping mechanisms off the ground. I sort of wanted to say that because I know we're going to do, we are going to do, we are talking about integrative psychotherapy as a model but I do want to emphasise that actually clients never ask me what question about what I was trained in so I might have read about it on the website really they're more interested in getting better, they know therapies about how the past effects are present and they've used to be recommended anyway so I don't get asked about this sort of nuances of the different models. So I wanted to sort of say that because I think it's quite important. Okay so I trained in transaxonosis for a very long time and then I went on to do another 11 years in integrative psychotherapy so I'm conversing very much in those two models. So the model of integrative psychotherapy I trained in was the model taught by Richard Erskine who is an integrative psychotherapist in his model course and he was a founder of the IIPA which is the International Integrative Psychotherapy Association but I think it was 1998, might have been 20. Anyway so why that is important because if you put a group of psychotherapists around say 20 of them and they are all calling themselves integrative psychotherapists their view on integrative psychotherapy would be different according to the model they were trained in. So when somebody says they're an integrative psychotherapist the question is what type of model and the model will be according to the model they were trained in. So many different integrative psychotherapists when they say the term integrative psychotherapy they actually mean different things. Yeah because I googled this I think and I got a bit confused as to what integrative was because it came up that integrative is when you know a counsellor or a psychotherapist uses lots of different modalities. So do you know what I mean they might do a bit of CBT or a bit of NLP and transactional analysis and they integrate it all together for the good of the client is what they want. In 1985 when I first went oh sorry let's go back a bit 1984 when I had a TA therapist for myself so long way back I was 34 35 and then I went on to training and I did a counselling training and what is now called integrative psychotherapy the way you have just explained it back then 40 odd years ago it was called eclectic eclecticism and what that means is what you just explained. So if you put eclectic I don't know eclectic therapy into Google you get that same definition. But is that what you're talking about now when you're talking about integrative psychotherapy? No and yes which I'll just add in a minute because when I 45 years ago integrative psychotherapy terminology wasn't around but what was around was the term eclectic or eclecticism which means what you have just said yeah which is taking tools from different modalities if you like yeah yeah okay that's important because you know I often ask people especially on my supervision groups what was your first training and you get four or five six people will say an integrative psychotherapy if you question them what does that mean they'll give usually a majority of them the definition you've just given. Yeah right okay so that is important. Just to clarify it for the listeners on what we're actually talking about. Yeah most of them will give that answer. They use eclectic integrative because they're training which teaches them the influences and tools different modalities and then they call themselves integrative psychotherapists. Yeah it might go a bit further and look at concepts such as transference which could be occupied through all the different models so it could have a whole training on the over what over reaching concepts that cover all these different modalities and that's what they'll call themselves if they say integrative psychotherapists. Yeah right it's not what I'm talking about though so this is another version that's why I wanted to put this clear yeah I was trained in Richard Erskine's version of integrative psychotherapy which has a different take on this. Yeah. One yes what you have just said so in his version of integrative psychotherapy that the therapist will be influenced by many different fathers of different models Gestalt psychotherapy Fritz Pearls. Yeah. Transaction analysis Eric Byrne. Yeah. Psych analysis Freud Young we could go on. Yeah. Psychodynamic psychotherapy we could go on. So all these different influences are in the remit of the integrative psychotherapy I'm talking about and in a training if you train to be an integrative psychotherapy in the way I'm talking about you will get training modules on how all those different influences of effect is today but the bigger aspect of integrative psychotherapy provided Erskine is this is the integration is the cure integration of the self. Yeah. In an holistic way is the curative goal. Yeah. And towards that end the theory that human beings especially in response to trauma will cut off parts of themselves to so disown parts of themselves. Yeah. Okay. Yeah. And in integrative psychotherapy what it will be big thrust is helping the person take back or take ownership of the fragmented cut off disowned parts of the self. Yeah. So you get a holistic integrated self. Yeah. That was my understanding of integrative psychotherapy but then when I googled it before this it came up with something completely different. So I thought we better clarify. Yeah. Yeah. And so that's that is more of a rarity if you like in the world of integrative psychotherapy and I've known Richard Erskine for a very long time the founder of integrative psychotherapy and I said to him way back when he was talking about his model he was developing. And also the ideas of a conference that he's going to stop putting back I think 1998 or something I said Richard why did you call your model that you've developed integrative psychotherapy. And this is personal communication but it's not confidential. And he said back to me well actually I wanted to call my model relational integrative psychotherapy but I was persuaded by the board of the organization called integrative psychotherapy because it would sell better and it would be people understand it more. Now if we go now to 2023 and we look back in hindsight I completely disagree because if it had kept it at relational integrative I think he wanted relational developmental integrative psychotherapy that would have differentiated his model. Yeah. And the current of models which are inter with so-called integrative psychotherapy which many people in the UK trained in. Yeah. So the model of integrating psychotherapy I trained in isn't taught in the United Kingdom for example. It's taught in many parts of Europe but not in the United Kingdom. So it's a different type of integrative psychotherapy but integration I think with all the different models really is the major security factor. But in the model I was trained in a really important focus would be looking at the fragmented self and helping the person take back the fragmented disowned parts of the self so that the energy which had been taken up in coping the split parts of themselves will now be free in terms of the security factor. Yeah. Which is usually linked with trauma. Yeah. You could always say that you could start off with most births of course are fairly traumatic and when the when the and of course there's degrees of trauma here but when the human comes into the world by definition the in terms of psychological terms anyway we can start talking about a split and a fragmentation. Now there's that part of it but the other part of it is the more trauma that a person has to cope because they don't want to usually deal with the trauma in its essence they cut part of that off. Yeah. And develop coping working mechanisms so they don't have to visit that trauma. Yeah. Yeah. Which is it's an ingenious sensible thing that we do as human beings really isn't it? Well it's how we cope and how we survive. Detective mechanism. Yeah. Absolutely. Yeah. And if it's not a problem I won't see those people through my door. However, if we think of the human organism as energetic model okay. Yeah. And it takes a lot of energy to keep those cut off parts of the self the best if you like. Yeah. So if you think of a a honeycomb and I know you do a lot of walking and I've seen some of your videos that crime therapy and in forest and goodness knows what but if you picked up your honeycomb perhaps and looked at it you would see lots of different compartments. Yeah. And if we use this as a metaphor for a moment for trauma what happens with trauma is just is that we cut off and put into compartment just like one of those compartments in honeycomb that I talked about. Yeah. We shut the door. Yeah. And we spend a lot of energy keeping those compartments shut. Yeah. So that we don't so that we can get on with our lives and cope and we don't have to visit the horrific traumatic processes. Now if those coping mechanisms work well enough then the person will come to the door but if those coping mechanisms which you know you carry on for quite a few years you know are and are often quite fragile if they're outdated and the compartment doors start coming open a bit and those coping mechanisms aren't helping then psychological time and real time start coming together a bit. Yeah. The flashbacks in terms of uncomfortable feelings in terms of dysregulation of emotion in terms of living the trauma out in the present day. Yeah. And perhaps the coping mechanisms keeping those compartments aren't working very well. So we need to start visiting the different compartments and fragmentations of the self help the person heal and then they take ownership of them of the whole in an integrated fashion. Yeah. So that's a long process I would imagine. Yes. And also of course with Clive's they only may I'll explain if they may decide only to deal with certain traumas they may not yeah you know stay long enough to deal with perhaps other traumas that came up in the therapeutic process. Yeah. Must they may or may not know was there in the first place. So how does or does like derealisation and depersonalisation does that fit into this? Yes because in order to those are things that I abandoned around even clients will talk to me and say I suffer from this and they've kind of self-diagnosed. Yeah. Okay. So let's put this in real terms for people everyone me you all human race one of the major coping mechanisms is what you just talked about here dissociation. Yeah. Dissociation simply means a movement away from the self. Yeah. So one side of a continuum we have daydreaming which I do a lot by the way. And you know because you know there's lots going on in my day and sometimes I get a bit overwhelmed with all the things so it's very pleasant to daydream and move away from myself for a bit. Yeah. So we all do that and that's not that's not unhealthy any form of shape. However at the end of the continuum is when we cut off part of our self for such a long time we lose part of our self. Yeah. And there's a huge variations in all these this continuum. Yeah. Health I'm talking about here. So if somebody's been a real traumatic episode for example you know they to survive they may have cut part of themselves off so deeply or intensely that they lose they lose touch of that part of themselves. Yeah. Okay. So the mechanism to do that is called dissociation. Yeah. So in a very extreme example someone's been sexually abused for example because it's so horrific you know that invasion they may well dissociate and that means move away from the self so they don't have to experience the trauma while it's happening. Yeah. In the moment. In the moment. While it's happening. While it's happening. Yeah. Yeah. And that's a very healthy tool. Yes. Yeah. So for examples you don't want to have a surgeon. I had hard hard operation recently. I didn't want to have a surgeon who dissociates a lot and cuts off from the moment. Yeah. Yeah. So I don't want to dissociate a surgeon thank you. No. In terms of what we're talking about here in terms of you know coping with the trauma it's a very important cope mechanism to survive. Yeah. So that's so the dissociation is the tool to move away from the self. Yeah. In traumatic situations. Yeah. We may do that for daydream but as what I'm talking about here is trauma intense trauma where to survive we cut off. Yes. Yeah. So people who suffer post-traumatic stress disorder whether they've been in the Falklands whether they've been in Iraq where whatever it is they may experience many real traumatic moments and later on when they come back from their tour of duty usually before they go back into civilian life or somewhere else in the armed forces they do a debrief to help people hear from that process. But even so you see here many stories of people who say they look walk you know they're Southern PTSD and that they're walking down the road and they hear a bang I say I don't know a car backfires or something like that and straight away they can go back to where that trauma was. Yeah. So we trigger back again. Yeah. So the dissociation has not worked so well. Yeah. When you're saying that I'm imagining when you were saying about it takes a lot of energy to keep that door shut. Certainly does. When we take our eye off the ball if you're just mousing down the high street and the car backfires you're kind of not concentrating on keeping the door shut. So like you said you get triggers. Yes. And as I say if these coping mechanisms dissociation cutting off of myself putting the trauma in compartments if that's worked and the person functions well they might not come to therapy. Yeah. However usually the coping mechanisms become outdated or creaking a bit so the trauma starts to leak out. Yeah. Now that then becomes or usually provides a lot of discomfort for the person and that's when they might come to therapy. Yeah. The job of the therapist then and you're right it's a slow process. This isn't an event. You need to help the person go back to the developmental stage or place where those traumas were. Heal there. Take ownership of those parts of the self back again so they're coming from a hole rather than a fragmented part of themselves. Yeah. Which I would imagine I can't imagine how that would be for somebody but you know if they've kept it in a box for an awful long time to then go back and revisit and open that box up you know it's it's I don't want to say it's going to be retraumatising but it is going to be bringing a lot of things up. Yeah well it might be slightly traumatising but the difference this time round is they're doing it with the therapist. Yeah. Yeah. It's not a process as an event so you might dip yourself or again touch with some of the trauma and then stop and debrief that with the therapist and then may or may not go back again so it's a process. Yeah. The important thing is you're with protective healthy other which is the therapist here which can which can help you and protect you. Yeah. In a way that wasn't there before. Yeah and like you said they can dip in and dip out you know what I mean and have that debrief you know and that grounding before they go back out and just bits at a time rather than unearthing everything. Yeah. So really really important what you've just said there that this is a process not an event. If the person doesn't deal with their trauma by the way they 9 times out of 10 will be driven in the here and now by the unconscious process of the trauma. Interesting. So let's take sexual abuse which is the one I mentioned right at the beginning. If that's not dealt with the trauma of that invasion the consequences of that are one level to protect yourself. Yes that's that's really really important. However if you know I know several years later in a relationship with your partner or people that are healthy you're having sex or you haven't even possibly even got that level of intimacy and you start having flashbacks and you aren't able to have an intimate relationship with a partner then part of I don't like the word normal but I'm going to put it here normal relationships is missing for you. Yeah. So what happens you see is that if the trauma is not sorted out you may relive the trauma in the present as if it was happening in the here and now. Yeah. Rather than 10 years ago. Yeah and again I would imagine that it's something like that that will bring somebody to therapy when that starts to happen that the the door is slightly ajar and it's leaking out like you said earlier. Yeah they get triggered. Yeah yeah. And they may get cognitive flashbacks or they may get somatic flashbacks without the cognition whether you feel uncomfortable. But either way it doesn't help healthy relationships because you end up being triggered back to the original trauma or can do. So is it possible for somebody to to have the you know the splitting off and these honeycomb sections and never go back there. It isn't quite a lot of people do that Jackie and and they live their life depressed on medication. They may live their life very paranoid. They may live their life feeling a lack of purpose. They may live their life feeling very anxious. They may live their life not allowing themselves ever to go in a relationship again. They may live their life not trusting anyone at all. And from that position they're only living half or quarter of the life. Yeah it's a really interesting subject Bob. Yeah but you see I think I think it's I picked sexual abuse there but I can think of many other types of trauma you know from the dysfunctional families where the significant other people have been humanively neglectful or they've been physically violent or we could think of many traumatic poses that are going on. So the child dissociates, cut off, moves away from the thing of disowns herself or whatever it is puts all those traumas in a box and carries on in life when they go off to university or whatever it is. Yeah but of course unless they deal with that there's always going to be part of themselves missing. Yeah absolutely and I can remember one of the one in particular looked after child that we had you know he went to camps and they kept encouraging him to talk about things and he was adamant he didn't want to go back there do you know what I mean and I can remember at the time thinking because I was going through my psychotherapy training that do we always need to go back and you know replay the past in order to heal or can we just put it in a box and leave it there and be okay. Well the response to that is you can put it in a box put in put the trauma in compartment the next bit though the question is will you be okay now that's a different discussion. Yeah and what is okay if functioning like you said yeah all things I've just said and if it gets to a place where the discomfort and the disquiet is so high and the cost of living in a fragmented world is so high that people will come to therapy. Yeah very interesting. Yeah and I think it's it's a really important so integrative psychotherapy going back to the the aspect of this podcast is about helping the person take back take ownership of the fragmented cut-off parts of the self so that they can take back the energetic part of themselves in a whole way so they can have a different type of life. Yeah that's integrative psychotherapy. Yeah now integrative psychotherapy in the model I was training had parent-adult child as the major personality model and they borrowed heavily from TA in terms of scripts and different aspects of transaction as is but also looked at whole set of concepts called relational needs as well so there's other types of theory in what I would call the integrative psychotherapy but TA was their major model. Yeah and however I like to look at this in terms of what I've just said in terms of integration. Yeah I very much think that way by the way so people who come to me for assessments I'm always looking at things like how are they moving away from contact in the real world because if we look at it just as that level in and see integration as the cure then what we are then talking about is how we can help a person maintain contact in the here and now with themselves and other people. Yeah and when you say contact you're not talking physical contact you're just talking connect. Oh no so I'm talking about eye contact particularly yeah I'm talking about what you said verbal contact withdrawal or the opposite I'm not talking about physical contact well somebody's I have a quite a big assessment room but if they it's an interesting one what you said there because they may choose to sit very far away from you. Yeah. Yeah I'm not going to do I'm not going to yeah I move them onto therapy so it's not my job to point out to the person but it's in my head. Yeah yeah So integration is the cure taking back parts of the self helping them develop you know more energy promoting the healing process so they can take charge of their own destiny that's integrative psychotherapies I see it. That's brilliant Paul. Does that that's quite clear I think isn't it? Yeah Yeah absolutely and I think you've cleared up you know what what integrative means not necessarily you know as well as how we do it but what it actually means whether it's integrating using lots of different methods or integrating the parts of the self and the honeycomb bit I love that because that's a visual thing and you know we do put things in boxes and try and shut the lid I think we all do it and you know the derealisation I think that's something that you know I can all my hand up and say there have been times where I've done that. Yeah dissociation derealisation they're both coping mechanisms and they're both built on a movement away from the self but as soon as that happens which of course has occurred for survival reasons yeah then part of themselves can be lost and once that has happened then they're living quite a fragmented world and when that happens not only they're disconnected from themselves but they'll be disconnected in relationships and they can present like I said before with depression, high withdrawal and isolation, high anxiety, imposter syndrome, acute paranoia and certainly come from a place where they won't trust anyone again. Yeah those are the sort of you know consequences of what we're talking about here. Okay Bob on that note. Oh okay I could talk a lot more but you can see I've quite a lot of passion for this subject and having been a therapist thinking the way I do and with those principles for such a long time I'm very proud to have been the therapist I have been and I still am in therapy groups but it's been a honor for me to work in the ways I've just talked about with people. Yeah I'm to train with Richard Erskine who kind of devised this as well. This model yeah oh it's wonderful meeting him of course and we're still in touch and I still go to the conferences and teach what I'm talking to you about now. Yeah yeah I think that's one of the things that I love about transactional analysis you know what I mean that people come up with new things all the time you know pulling in from past learnings and everything and come up with something new and then that then moves forward if that makes sense. Yeah that means that makes complete sense to me. I've got a couple of books in my head that I would like to write and I've got some time one is the psychotherapy cookbook and the other one is integrative psychotherapy past present and future. Yeah I hopefully I'll get around to write hopefully I'll get around to writing one of them. You need to get started really then Bob. I'll buy the first copy a signed copy. Oh definitely a signed copy. Definitely right okay until next time where we're going to be talking about empowerment and self agency in goals in the therapy process. Well of course you know the more whole we are the more integrated we are the more empowered we will be. So it leads on very nicely from this one. Yes very much so. Until next time Bob. Bye. Bye bye. You've been listening to the therapy show behind closed doors podcast. We hope you enjoyed the show don't forget to subscribe and leave us a review. We'll be back next week with another episode.