Current Issues in the Practice of Integrative Couple and Family Therapy

• Date: 01 September 2019
• Published date: 01 September 2019
• DOI: http://doi.org/10.1111/famp.12473
• Author: Jay L. Lebow

Current Issues in the Practice of Integrative Couple

and Family Therapy

JAY L. LEBOW*

This paper provides an overview of current issues in integration in couple and family

therapy. It summarizes the evolution of integration in couple and family therapy, the vari-

ous traditions in integration, the strengths of integrative approach, and the possible pit-

falls involved. It highlights the extent to which most couple and family therapy is now

integrative practice. It concludes with a consideration of an emerging trend towar d meth-

ods of practice centered on modules of intervention that have been identified as effective

with certain presenting phenomena. The example of therapy for high conflict divorce is uti-

lized to illustrate how various components can be brought together to create a maximally

effective intervention.

Keywords: Couple Therapy; Family Therapy; Integrative Therapy; Therapy High Conflict

Divorce

Fam Proc 58:610–628, 2019

Many speak of integrative couple and family therapy, but what does this mean in the

context of couple and family therapy as practiced today? The thesis of this paper is

that the meaning of integration in couple and family therapy has evolved as couple and

family have evolved. In what follows, the diverse ways the term “integration” has been uti-

lized are summarized, present challenges are highlighted, and directions for integrative

practice in couple and family therapy are described.

A BRIEF HISTORY OF INTEGRATION IN COUPLE AND FAMILY THERAPY

The term “integration” entered the discourse in couple and family therapy as early fam-

ily therapies congealed into readily identified schools of therapy such as structural (Min-

uchin, 1974), strategic (Watzlawick, Weakland, & Fisch, 1974), and Bowenian (Bowe n,

1978). In this context, integration spoke to combining concepts and intervention strategies

from different schools of therapy. For example, structural family therapy might be aug-

mented by exploration of the impact of family of origin or one person’s internal process.

Following such pathways, in the 1970s and 1980s pioneers such as Gurman (1992),

Kaplan (1974), Kramer (1980), Pinsof (1983), and Sager (1976) developed ways of combin-

ing therapies into new hybrids.

Yet, even this simple idea contained within it considerable complexity. First, early fam-

ily therapy was dominated by a charismatic set of brilliant therapists who ranged widely

in how they conceptualized family process and what they did in therapy. For Carl Whi-

taker, Salvador Minuchin, Murray Bowen, and their compatriots, whatever they might

emphasize in writing and presentations was clearly supplemented in their actual sessions

*Family Institute at Northwestern University, Evanston, IL.

Correspondence concerning this article should be addressed to Jay L. Lebow, Family Institute at North-

western, 618 Library Place, Evanston, IL 60201. E-mail: jaylebow@comcast.net.

610

Family Process, Vol. 58, No. 3, 2019 ©2019 Family Process Institute

doi: 10.1111/famp.12473

of couple and family therapy; this point was explicitly highlighted in their prominent

demonstrations of their therapies. Second, even the official version (what now would be

called the “treatment manual”) of those original methods of couple and family therapy

included what already was an integration of at least one theory of what constitutes the

crucial factors in human experience (such as psychodynamics or behavior contingen cies)

and systems theory. Indeed, some integration with systems theory is a defining character-

istic of all couple and family therapy (Lebow, 2014; Sprenkle, Davis, & Lebow, 2009).

Thus, while the emphasis of different schools of individual intervention such as psycho -

analysis or behavior therapy had little overlap, comparable couple and family therapies

shared a considerable common base in systems theory. Third, while some of the first-gen-

eration couple and family therapies were fairly simple in their focus and limited in their

range of intervention, most contained what already were complex amalgamations of con-

cepts and interventions drawn from several existent individual therapy approaches (e.g.,

developing insight or deepening feeling) as well as newly developed couple and family

methods (e.g., using genograms or reframing). For example, Bowen therapy includes some

concepts that are much like psychoanalytic concepts, others that are highly experiential,

and others that now might be most appropriately named as cognitive therapy techniques.

As time passed, further complexity emerged as the dominant therapies in couple and

family evolved. In the early years of couple and family therapy, the most frequen tly

encountered approaches were structural (Minuchin, 1974) , strategic (Watzlawick et al.,

1974), Bowen (Bowen, 1978), and psychoanalytic (Framo, 1992). Today, the most widely

practiced family therapies are functional family therapy (Robbins, Alexander, Turner, &

Hollimon, 2016), psychoeducation-based family therapies (McFarlane, 2016a,b), narrative

and other postmodern therapies (Tarragona, 2008), cognitive-behavioral therapies with

an emphasis on parenting (Forgatch & Patterson, 2010), multidimensional family therapy

(Liddle, 2016), attachment-based family therapy (Diamond, Russon, & Levy, 2016), multi-

systemic therapy (Henggeler & Schaeffer, 2019), Maudsley family therapy (Eisler, Le

Grange, & Lock, 2016), solution oriented therapy (De Shazer, 1982), and narrative and

other poststructural methods (White & Epston, 1989). The most widely practiced couple

therapies are emotionally focused couple therapy (Greenberg & Johnson, 1988; Johnson,

2015), Gottman therapy (Gottman & Gottman, 2015), narrative and other postmodern

approaches (Freedman & Combs, 2002), cognitive-behavioral therapy (Baucom, Epstein,

Kirby, & LaTaillade, 2015), and third wave behavioral therapies such as integrative

behavioral couple therapy (Christensen, Dimidjian, & Martell, 2015). A consequence of

this change has been that the therapies which integrate now largely bring together a

much different set of therapies than in earlier eras. Of special note is that most of these

newer dominant therapies were themselves the product of integration from earlier thera-

pies and other influences, and thus integrative therapies now emerging are integrations

of what already are integrations.

As integrative therapy has evolved, it also has become more difficult to identify what is

an integrative therapy. Therapies might be called integrative in which there was very lit-

tle integration involved (see the description of assimilative integration below), whereas

other therapies that clearly were among the best representations of integration are not so

identified. For example, most feminist therapies (Goldner, Penn, Sheinberg, & Walker,

1990) are often not recognized as integrative. Further, some developers of integrative

therapies highlight that label in identifying their treatments (e.g., integrative systemic

therapy: Pinsof et al., 2018; or the therapeutic palette: Fraenkel, 2009), whereas others

who developed integrations do not.

This problem in identifying what is integrative practice becomes even more complex at

the level of the individual therapist: those who incorporate multiple theories or interven-

tion strategies in their own methods of practice as opposed to intending their treatment

Fam. Proc., Vol. 58, September, 2019

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