Monday, January 17, 2011

My Review - Integral Psychotherapy: Inside-Out/Outside-In by Elliott Ingersoll & David Zeitler

Integral Psychotherapy: Inside-Out/Outside-In
By Elliott Ingersoll & David Zeitler
SUNY Press, Series in Integral Theory, 2010, 384 pages
$29.95 (paper); $90.00 (cloth)

When I reviewed Mark Forman's A Guide to Integral Psychotherapy: Complexity, Integration, and Spirituality in Practice (SUNY Series in Integral Theory, 2010), I was thrilled to finally have a book on integrally informed psychotherapy for people who actually practice therapy - and more importantly, written by a practicing therapist. Granted, we had already been gifted with Andre Marquis' The Integral Intake (Routledge, 2007), and as useful as that book is, it still did not offer the perspective presented in Mark's book.

My curiosity began back in 2000, when Ken Wilber published the first taste of a truly integral approach to psychology and psychotherapy in his book, Integral Psychology, a cliff-notes version of a much larger textbook that (as far as I know) has never been written or completed. I eagerly awaited that larger volume, but for various reasons, his illness chief among them, it is likely we will never see it published.

As I said, it was great to get Forman's book. But I soon found out that there would be another book, also from SUNY, by Elliott Ingersoll and David Zeitler. I knew of Zeitler as one of the co-founders of the Integral Theory Conference, but I had only seen brief bits of Ingersoll's work. Here are the standard bios from the SUNY page for the book:

R. Elliott Ingersoll is Professor of Counseling and Counseling Psychology at Cleveland State University. His books include Psychopharmacology for Helping Professionals: An Integral Exploration; The Mental Health Desk Reference: A Practice-Based Guide to Diagnosis, Treatment, and Professional Ethics; Becoming a 21st Century Agency Counselor: Personal and Professional Explorations; and Explorations in Counseling and Spirituality: Philosophical, Practical, and Personal Reflections. David M. Zeitler is Assistant Professor at John F. Kennedy University where he teaches in the Integral Theory Program and Integral Psychology Program.

A paper related to the material presented in this book appeared in 2007: PERSPECTIVES AND PSYCHOTHERAPY: APPLYING INTEGRAL THEORY TO PSYCHOTHERAPY PRACTICE;
Journal of Transpersonal Psychology. The link goes to from BNet - it's broekn up over many pages with annoying ads.

Anyway, I was offered a review copy last summer and eagerly accepted. Unfortunately, however, it has taken me far too long to get to the review (mostly because I kept having to put down the book to focus on school and work).

Having already read Forman's book, I wasn't sure what to expect in this one - would they simply be covering the same ground? Fortunately, that is not the case. I can't exactly name the difference, but they are very different books in my opinion.

Here is the table of contents for Integral Psychotherapy:

List of Illustrations

1. Introduction - Ingersoll
2. Perspectives and Psychotherapy - Ingersoll
3. The Self-System and Ego Development - Ingersoll
4. Lines and Levels of Development - Zeitler
5. Types and Styles - Ingersoll
6. States of Consciousness and Psychotherapy - Ingersoll
7. Psychological Address - Ingersoll
8. Spirituality and Integral Psychotherapy - Zeitler & Ingersoll
Appendix: A Case Study - Zeitler

My sense is that Forman's book was more theoretical in its offering the practicing therapist a meta-framework with which to understand and apply integral therapy, while Ingersoll and Zeitler are a bit more in the trenches in their own approach. Because of this essential difference, Forman cites a lot more sources outside of the integral world, while Ingersoll and Zeitler seem to refer back to Wilber more than any other source, and they admit in the Introduction that the book was originally intended for the non-professional. To me, someone who would like to see integral psychology (in particular) move beyond Wilber, this is a weakness - for those who are already fans of Wilber's books, this will no doubt be a strength.

To begin, they offer the following definition of psychotherapy, a painful necessity in a book such as this:

Psychotherapy is the scientific and artistic process of helping clients make aspects of themselves or their lives objects of awareness, helping them identify with and own these objects, and then integrating them through a process of disidentification. (p. 4-5)

Ingersoll (he wrote the Introduction - each chapter names its author, as noted above) goes on to offer the standard outline of Wilber's AQAL integral model as it relates to psychology. Again, this is a necessary evil for those who know the model - but I am sure they (the authors and SUNY Press) are hoping to reach non-experts and those who could not care less about Ken Wilber or the integral enterprise and just want to know how this is useful for them - i.e., psychotherapists. (In my experience, therapists are often folks who look at integral theory and say, "Yeah, so what? I use a bio-psycho-social approach with my clients all the time." Which may be true, but there is more to AQAL than that, which is why this book is important.)

Ingersoll's explanations of Wilber's model hold pretty close to the original, but he offers highly useful clinical examples that explicate and expand the theory. There are two things I really appreciate about the chapters written by Ingersoll - 1) he has a good sense of humor and he uses it in his writing; 2) his use of case examples to illustrate what he is talking about at several points brings the model down from the abstract into the consulting room (something that could have been done more in Forman's book).

Likewise, the chapters Zeitler writes or to which he contributes are theoretically interesting - his chapter on Lines and Levels of Development is essential, even for those well-versed in integral psychology. He examines one of the primary ideas in Wilber's Integral Psychology that captured interest - the integral psychograph.

Zeitler breaks it down into 3 variations - 1) theoretical, 2) clinical, and 3) empirical. The theoretical version is the one Wilber writes about, but it is also the one we do not have at our disposal. Its use would require two things - first, that we prove the existence of lines of development, and second, that we find a reliable and verifiable way to measure them. We are a long way from this being a possibility.

The clinical psychograph accepts lines of development as a metaphor, at the very least, that can be useful with clients for making sense of their situation. Finally, the empirical psychograph is that which we do not have, an empirically validated measure of the reliably consistent (from person to person) developmental lines. This will not be a reality any time soon - especially since there are not likely to be any psychometric experts working in this realm until integral psychology becomes an accepted field in the academic world.

[To illustrate how far we are from an integral psychometric battery, in my recent psychometrics class, taught by a relative expert in the field (he's been doing this for 25+ years), he had never heard of Loevinger's Washington Sentence Completion Test. He uses projective measures in his own work, especially with criminals and psychotics, but he dismisses sentence completion tests in general as TOO subjective and lacking inter-rater reliability. Since this and the revisions by Cook-Greuter may be the most well-known integral measures, we have a long way to go.]

Anyway, Zeitler breaks his chapter up into sections:
  • A history of developmental lines
  • The sloppiness of development (it's not linear)
  • Five research questions in lines of development
  • A series of principals for organizing lines of development
  • The implications for therapists in taking developmental lines as valid
In my opinion, this is one of the most intellectual rigorous chapters in the book. However, I must take issue with the assertion that Freud's psychosexual line is one of those having empirical support - Freud's psychosexual stages are based on drive theory, which has been dismissed and discredited even by psychoanalytic therapists. The Freudian stages (oral, anal, phallic, latency, genital) have been reframed within Eriksonian stages and/or other models. As a simple example, Freud's phallic/Oedipal stage, based on the case of Little Hans, is one of the most poorly handled and misinterpreted cases in the annals of psychology (see Ken Corbett's Boyhood: Rethinking Masculinities, 2009, for a detailed explanation of how Freud's psychosexual model crumbles in this particular case).

Issues such as these have to be addressed if integral psychology is to be taken seriously. Be that as it may, if integral psychology is to move forward as an empirical discipline, the questions posed in this chapter must be addressed.

One of the sections, brief as it is, that was of particular interest to me is in the following chapter on Types and Styles, written by Ingersoll. In one section of this chapter, he looks at "Masculine and Feminine Approaches to Type," and he begins the section with a discussion of the sex (biology) and gender (social construct) terminology and the widely popular Bem Sex Role Inventory (BSRI). There are a lot of problems with the BSRI, not least of which is that its dominance in the field has likely resulted in a concretization of traditional gender roles rather than the relaxing of them for which Bem had hoped.

While there is little in this section that is new or offers an alternative to modern gender studies, Ingersoll does present a very useful "Quadratic heuristic of sex-typing constructs" at the end of the section. This one piece is more useful than the discussion around it. Ingersoll concludes the chapter with the observation that most typologies are (in my own words) little more valid than online personality tests. They provide useful information as long as we hold them lightly.

I could keep going, but I hope that this will provide a useful overview of the book. This really is a wonderful addition to the integral field. I appreciate that the authors are skeptical of Wilber's claims where appropriate, and that they elucidate the details as much as is possible at this stage.

I hope that we will see more books from these authors, both of whom are the next generation of integral leaders, on their work an on the finer points of integral psychotherapy. As wonderful as this book is, alongside Forman's and Marquis', we need to move from theoretical overview into a more specific approach to various psychological issues - for example, depression and anxiety (mood disorders), eating disorders, treating trauma, or Axis II personality disorders.

I'm looking forward to that happening in the near future.

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