You decide to start therapy, look for a psychologist and run into an alphabet soup of acronyms and schools: CBT, EMDR, ACT, systemic, humanistic, psychodynamic. And on many profiles, one phrase keeps coming up: "integrative approach". Is it just another therapy? A bit of everything? Better or worse than a "pure" therapy?

Combining approaches is in fact the norm among psychotherapists, although it is rarely explained. This guide covers what integrative therapy is, how it differs from mixing techniques at random, what research says about why it works, what a session is like and how to choose a good professional with this approach.

What is integrative therapy?

There are more than 400 varieties of psychotherapy, according to an article by Zarbo, Tasca, Cattafi and Compare published in Frontiers in Psychology. They differ in their theoretical model (behavioural, cognitive, systemic, psychodynamic and so on), their format (individual, family or group) and their length. For decades, each school worked within fairly rigid boundaries and with little dialogue with the others. If you would like an overview of each one, see Types of psychological therapy: what they are and how to choose.

Integrative psychotherapy arose partly to build bridges. It does not try to merge every model into one, but to make use of what works in each and adapt it to the person in front of you. It has gained wide acceptance since the 1990s, and today combining approaches is the norm: in a survey of more than a thousand psychotherapists cited by these authors, only 15% said they used a single theoretical orientation, and the median number was four.

The four ways to integrate

Integration does not mean the same thing to everyone. Zarbo and colleagues describe four ways of doing it:

  • Theoretical integration: creating a new model from concepts drawn from several schools.
  • Technical eclecticism: using effective techniques from different approaches.
  • Assimilative integration: working mainly within one model, for example cognitive behavioural therapy, and bringing in elements of others when a case calls for it.
  • Common factors: focusing on what works across all therapies, such as the alliance with the therapist, empathy or expectations of change.

In practice, many professionals combine several of these.

Integrative does not mean "a bit of everything"

That is the most common criticism, and it has a point when integration is done badly. The same authors sum it up in a motto: be integrative, not eclectic. An eclectic therapist chooses a technique because it might work, without much concern for its theoretical basis or the evidence. Integration, by contrast, looks at the link between what is done, the theory that explains it and the data that support it.

It also fits the American Psychological Association's definition of evidence-based practice, which combines three elements: research evidence, clinical judgement and each patient's characteristics and preferences.

Why it works: the common factors

One of the most influential findings in psychotherapy is that approaches with very different theories achieve similar results. The obvious question is what they have in common. The idea is not new (Rosenzweig raised it in 1936), but Wampold updated the evidence in a review published in World Psychiatry and concluded that common factors are important for producing the benefits of psychotherapy. They include:

  • The therapeutic alliance: the bond with the therapist and agreement on the goals and on how to work towards them.
  • Empathy on the part of the professional.
  • Expectations: that the person understands the explanation of what is happening to them and trusts that the treatment can help.
  • Cultural adaptation: that the explanation and the tasks fit with each patient's beliefs.
  • Therapist differences: some therapists achieve better results than others using the same method.

The alliance is the most researched factor. A meta-analysis by Flückiger and colleagues, covering 295 studies and more than 30,000 patients, found a robust positive relationship between the alliance and therapy outcome, consistent across treatment approaches, patient characteristics and countries. And a classic estimate by Lambert and Bergin, from 1992, attributed about 20% of the differences in outcomes to common factors and around 7% to specific techniques.

That does not mean techniques do not matter. For some problems there are well-studied treatments, such as cognitive behavioural therapy for anxiety or EMDR for trauma, and good integrative therapy includes them when they are called for; we explain this in Cognitive behavioural therapy: what it is, how it works and what it treats. In addition, several therapies that are integrative in nature, such as interpersonal therapy and schema therapy, have shown effectiveness for problems such as depression, social anxiety and personality disorders.

What an integrative therapy session is like

There is no single script, and that is precisely the point. Therapy usually begins by understanding what is happening to you, since when, what you have tried and what you want to achieve. With that information, the psychologist proposes a plan, chooses the tools that suit you best and adjusts them as you go. Zarbo and colleagues describe it as an individualised approach that pays attention to what the person feels, does, thinks and notices in their body, and in which the client takes an active part rather than passively receiving a technique.

An example: someone comes in because of anxiety attacks and, as they talk, very low self-esteem and memories of a relationship that hurt them come to light. Integrative therapy might start with cognitive behavioural techniques to manage the anxiety, move on to work on self-esteem and emotional regulation, and use EMDR for the memories that still hurt. All within the same process and with the same professional.

To check whether things are on track, it helps to review your goals from time to time; we give you some pointers in How to know whether therapy is working (and what to do if it is not).

Who integrative therapy is for

According to Zarbo and colleagues, there is growing agreement that no single approach is effective and appropriate for every person, problem and context. That is why an integrative approach is especially well suited when:

  • Several problems are mixed together, such as anxiety, low mood and relationship difficulties.
  • A previous therapy with a single approach did not quite work for you.
  • You want a process tailored to you, not a fixed protocol.
  • What you are going through does not fit a clear label.

And if your problem has a recommended treatment, an integrative therapist should use it. Integrating does not mean giving up what works.

How to choose an integrative psychologist

Like any label, "integrative" can be used well or badly. These checks help you tell the difference:

  • Licensing and registration. This is the first thing to check, whatever the approach.
  • Specific training in each tool they use. Practising EMDR or schema therapy requires specific training.
  • They explain why they do what they do. A good integrative therapist can tell you what they combine and on what basis.
  • They involve you. Your preferences and goals are part of the plan.
  • You feel comfortable with them. Given everything that is known about the alliance, feeling heard and able to trust them is no small detail.

If you are still not sure what is going on, a questionnaire from the psychological tests catalogue can help you sort it out before your first session.

Does integrative therapy work online?

Yes. In Flückiger's meta-analysis, the relationship between alliance and outcome in internet-based therapy was almost exactly the same as in face-to-face therapy. What matters is the bond, and that bond can be built over video call too.

Man in an online integrative therapy session by video call with his psychologist from home

A psychologist with an integrative approach

At MyPsicoTest we recommend Xènia Capel Salcedo, a licensed clinical psychologist (COPC 14982) with a master's degree in Clinical Psychology and Psychotherapy. On her website she explains that this training allows her to deal with a wide range of problems through an integrative, evidence-based approach, tailoring each process to the person ("no two therapies are alike"), and that the therapeutic relationship is the foundation of any process of change, which is exactly what research says. She combines scientifically validated techniques with a warm, non-judgemental manner, and her aim is not for you to depend on therapy but to leave it with practical tools.

She works with adults, children and teenagers on anxiety and depression, self-esteem, emotional dependency, emotional regulation, grief, trauma (with EMDR), eating disorders and neurodivergence such as autism or ADHD. She sees clients in Igualada and Sant Sadurní d'Anoia and also offers online therapy, in English, Spanish or Catalan. The first contact is a free, no-commitment information session by phone to answer your questions, and therapy sessions last an hour.

If your result worries you or you want a professional assessment, you can talk to Xènia Capel Salcedo, a licensed psychologist (COPC reg. 14982), who offers a free first consultation call and online therapy from anywhere.

MyPsicoTest team · Updated: