‘Meeting the Client Where They Are Rather Than Where I'm At’: A Qualitative Survey Exploring CBT and Psychodynamic Therapist Perceptions of Psychotherapy Integration

Abstract

This qualitative study explored therapists' attitudes towards psychotherapy integration. Twenty-nine psychoanalytic/psychodynamic and cognitive-behavioural therapy (CBT) therapists completed an open-ended survey that focused on their personal understanding of psychotherapy integration, examples from their own practice and reflections on improving integrative therapy. Participants were also encouraged to share attitudes and perceptions towards the other therapeutic paradigm (CBT towards psychoanalysis, and vice versa). Thematic analysis revealed three main themes: (1) Positive perceptions and benefits of psychotherapy integration, (2) Negative perceptions and challenges of psychotherapy integration and (3) Proposals for strengthening integration in clinical practice. While most participants had a strong allegiance to their modality, they recognised the need for flexibility and additional techniques from other paradigms to address individual client needs. However, participants raised concerns about the level of knowledge required for integrative work and the epistemological compatibility between CBT and psychoanalysis. Some responses reflected the ongoing ‘turf wars’ between the two paradigms, with some referring to ‘outdated’ psychoanalytic ideas and ‘dogmatic’ evidence-based hierarchies. Suggestions were made for further development of psychotherapy integration during the training and post-qualification. The study reflects a generally positive outlook towards integration while recognising the challenges as well as the continuing resistances between CBT and psychoanalytic paradigms.