Clinical Work . Coloniality

Thoughts on Integration from a Decolonial Perspective

On March 30, 2021 by sarmientoverano

By: Lucia Sarmiento Verano

As the end of my training program draws near, and given that our humanistic training involves three different modalities, more emphasis is given to integration models to help us draw a coherent picture of the way we practice.

I’ve recently had to write an essay on the matter of integration, to demonstrate that I am aware and have reflected on my way to practice and of course, to make sure I am a safe and theoretically sound practitioner. However, I have my own thoughts on integration and I’d like to share some of them today. They are still in process of forming and I expect my reflections to keep evolving with time.

The thing is, I don’t see integration as something needing to be defined. I realised this as I tried to write my essay and felt uncomfortable with the answers I needed to give. In fact, I felt uncomfortable with the questions. Here are some of the thoughts I had while writing my latest essay and afterwards.

A question of world views

Before joining the profession, I had no idea that purist views still existed. I had worked only with integrative therapists in my personal therapy. Now, with the advent of certain popular integration models, we are hearing voices that present integration as more open minded, more able to adapt to the client’s needs, or less rigid. I’d like to go beyond that perception and talk about what integration means for ontological perspectives.

Psychotherapy theory is essentially an ontological and epistemological endeavour, because it fundamentally speaks of the nature of being, becoming and our reality as humans. It presupposes certain assumptions about our world and what it means to be human.

At the heart of every modality or theoretical framework there is a specific world view. A way of seeing the person, the world and the process of change, as well as assumptions on life, the psyche, the self, etc. Choosing one model also means choosing one of these world views, one way of working, or one true way of articulating different models, in the case of an integration model.

Coming from a specific perspective, the theories developed within a certain modality do not describe truths or facts, they provide one possible way of interpreting the reality of our human processes, corresponding to one specific set of life assumptions. Thus, depending on our own personal perspective and social location, we may feel more drawn or in tune with a certain modality which may better fit our personal philosophy.

Different ontological perspectives underly different therapeutic modalities. The difference is more marked between psychodynamic, humanistic and behavioural modalities. However, I also believe fundamental assumptions about being human and about the world differ between humanistic modalities such as Person-Centred, Transactional Analysis or Gestalt and this even if most practitioners now ascribe to the therapeutic relationship as being the most important factor for healing and change.

Different fundamental ontological perspectives are generally mutually exclusive and they need to be held as truths in order to allow us to build our worlds views and theories from them, as explained by Kuhn’s theory of the incommensurability of paradigms (Kuhn, 1970, cited in Safran, 2006).

Seeing it this way it is easy to understand why purists simply tend to see other modalities as wrong interpretations of reality, and also why integrative practitioners see purists as limited in their thinking.

What’s more, the more I learn about integration models and their intricacies (eclecticism, assimilation, pluralism, common factors approach for example) the more I have the feeling that they are not so different from single modality perspectives. Ultimately, the practitioner is choosing a position and a mode of work (whether this includes one or several modalities) and comfortably applying that formula to their work, relating to every client and presenting issues from that same perspective which carries the therapist fundamental life assumptions, their personal ontology. 

Integration models as eurocentric colonial processes

Let’s consider what happens when integration is done in the way I have just described, by integrating paradigms or world views. When a therapist’s personal model of integration is a way to help them make the fundamental assumptions of the models they’re using fit their own personal life assumptions, so they can work with them.

First of all, I would spend some time reflecting on the need to do this. I wonder if this comes from a person’s need for certainty as a way to maintain safety. Moreover, is it possible to maintain this when working with a diversity of clients? Is it even ethical? It could be argued that putting ourselves in a position so as not to have our life assumptions shaken may bring more issues in the long run, for the profession and for our clients. I will discuss this further at the end of this article.

I have previously mentioned Person-centred, Gestalt and Transactional Analysis, because these are the three modalities of my training. The more I understand them and what they imply about human processes and human relationship with the world, the more I see the contradictions between each of those three sets of ontological perspectives, despite their common grounding in humanism. I can see how making a decision on how I will integrate those three modalities with my own world view can contribute to my comfort and sense of security. I know from personal experience that holding contradictory perspectives can be very uncomfortable. It is not impossible however, and learning to do that is benefitting my practice.

Seen in this way, theoretical integration models make it more comfortable for individual practitioners to navigate a mind map of modalities, use their theories and techniques, without having to question their own ontological perspectives. This, while actually doing a disservice to the depth of these theoretical frameworks.

Because of this, I believe integration models are designed for mental comfort by maintaining the coherence of theories within our own particular life philosophy. Coherence and cohesion allow us to feel safe within our world view, but in doing so, the scope and depth of these theories are lost in order to build a harmonious whole.

Perhaps this way of seeing things comes from personal experience. I have to admit that words like integration, assimilation, acculturation ring alarm bells for me. Red flags meaning negation and invisibilisation of important aspects of what is being integrated. This also seems to be a markedly Eurocentric and Colonial ways of operating, in its need to adopt one particular point of view and make all other perspectives fit that paradigm. It makes me want to pay special attention to what being is cast aside, missed, buried alive in the movement towards integration. This is true for cultural identities, for languages, for world views, politics and also, for therapeutic modalities and their fundamental ontologies and epistemologies.

The following diagrams is an illustration of what I’m trying to convey.

These diagrams are an oversimplification of how I see theoretical modalities fitting the practitioner’s personal ontological perspective in the case of single modality practice and integrative practice. The green circle representing the limits of the therapist’s world view, themselves positioned at the middle of it. The blue circles encompass the theoretical view of different modalities, the limit on what they can conceptualise and how they intersect with each other and with the therapist’s views, each from their own ontological perspective. With this set of theoretical knowledge, but always from their own static location, the therapist relates to each client’s experience (in blue) as best they can. The more these experiences fall into a set of circles, the more the therapist is equipped to understand, empathise and help the client. The more the experience falls outside of the circles, the less the therapist is equipped to understand, and there is more risk of trying to make this experience fit the therapist’s world view. Thus, more risk of harm.

As I said before, I believe it to be basically the same mode of functioning, based on a Western Colonial way of being, where the chosen perspective is at the centre of “reality”, a location of power from which to observe every phenomenon.

While reflecting on what this means for the theory and practice of psychotherapy, I am deciding once and for all that this is not how I wish to position myself. Looking for alternative ways of being within these practices, I’ve come to see integration as changing perspectives instead of keeping a static perspective and trying to make different models fit into it. Otherwise, I fear the rich nuance and depth of each theory or model is lost or denatured. Not only this, but adapting to the client’s own world view will not be possible beyond a superficial level.

I’m still reflecting on how that fluidity of perspectives can look like in counselling and psychotherapy. Applying a decolonial framework seems to me the way to liberate our perspectives, but I need to explore some ethical considerations first.

Relativism and ethics

Theoretical relativism is sometimes seen as theoretically unsound. This is understandable as the problem may lie in a mixing or confusion of the basic ontology and life assumptions we are building our theoretical understandings on. If we then incorporate theories that carry different ontologies onto our thinking without reflecting on this and without explicitly mentioning this, the logic of our theoretical edifice is compromised. From this point of view, I can understand why relativism is sometimes deemed theoretically unsound.

However, it does not have to be this way. If we understand the fundamental worldviews underlying each and every one of the theories we are incorporating in our thinking, and if we name them and their possible contradictions explicitly when teaching or sharing them, we are building a framework that incorporates more than one perspective in a fair and ethical way. We are expanding the limits of our understanding instead of limiting them. In the case of psychotherapeutic practice, we are welcoming ontologies and epistemologies that will respect and fit our client’s experiences more effectively.

Another point I’d like to make about this is that I believe that people seeing relativism as a problem are conflating theoretical relativism with ethical relativism, which could, of course, be the basis for unsafe and harmful practice.

If I chose a certain relativism in my theoretical approach, it does mean that it is especially important to keep the ethical framework stable and present at all times. Ethics cannot be relative, especially in such a delicate endeavour as is therapy work, where clients entrust me with their vulnerability.

What this way of thinking brings, is the necessity of reflecting on the origin and the social function of the ethical frameworks we use. It begs the questions: where does the ethical framework I have chosen to follow come from? What is the context of its creation and who does it serve? And more importantly, how do I make sure I hold myself accountable for being an ethical practitioner, even when considering different fundamental perspectives in my practice?

It is important that I keep the process of reflecting on these questions throughout my career, and the answers will undoubtedly evolve with time. But what I can say right now is that my principles and values do not change depending on the theoretical perspective adopted, or the life assumptions I may be considering. What’s more, these reflections following the essay I had to write stem from a very specific ethical stance: every perspective has value, and we need to centre paradigms and perspectives that have been historically invisibilised by the Eurocentric colonial world view.

This is not about relativism; this is rooted in a basic sense of respect for life, epistemic and ontological justice. I believe thinkers that dismiss relativism like so should perhaps be equally concerned by issues of epistemic respect and justice as they are by theoretical rigour.

What can integration look like?

So, coming back to the topic of this article. I have no readily made answer to this question, and to be honest, I would personally be wary of any answer to this that comes quickly and that sounds definitive. What I am critiquing here is a vision of integration that feels comes from a static perspective and set of fundamental assumptions to which other sometimes contradictory perspectives have to adapt. I will not do the same by coming up with yet another integration model.

I do, however, have an embodied vision of what it would feel like. Much like the decolonial focus on adopting epistemological perspectives away from the cultural centre, I see a need to adopt different perspectives in psychotherapy theory as well. This, not only from a theoretical level, but also at the philosophical and ontological level.

This way of negotiating integration is, for me, a way to be flexible with our thinking and adapt to the real needs of our clients who may not come from a white middle class western culture and set of experiences, and may thus, hold very different fundamental ontological assumptions.

As illustrated on the diagrams above, if we’re pinned to one perspective, we’ll inevitable try to adapt our client’s experiences and world view to our only possible world view. If we have practice in changing perspectives, or at least, in constantly holding more than one perspective as true even in their contradictions, we may meet our client in a way that does not expect them to adapt. This is possible but it does not happen often.

Sometimes as clients, we may not even be aware of this deep ontological and epistemological push and pull unless we are very attuned to these movements. From my own experience I would describe this as an unacknowledged, unfelt, and unsaid discomfort that was more or less constantly present but never totally in awareness. Like a distant humming sound, that we don’t always hear, but it’s there. It becomes figural in certain moments of disconnection or of being missed by the therapist, much like the experiences of the divide I described previously. It is only now that I can put words on what I believe goes on in therapy. I focused on the emotional, relational experience last time, today, I speak of it from at the theoretical level.

Again, I do not know how this non-integration could look like. If it’s a fluidity in perspectives or a dwelling at the limit between different perspectives. One thing does seem important to me in every case, and that is developing the capacity to hold opposing views without seeking any kind of consensus.

I believe that for those raised in a Western mindset (this includes me) this stance is especially difficult to hold. To hold contradictions constantly, even between mutually exclusive truths, requires not an openness of mind, but a vastness of consciousness, the expansion of our spirit. Note the different quality of those two expressions. Feeling grounded and a certain robustness to face the inevitable vulnerability that comes with expanding consciousness like so is also needed, as this movement is deeply unsettling.

In truth, who am I to know if I believe humans to be fundamentally good or bad, if they’re driven by healing forces or destructive forces? Or to know if humans are directional or not, if time moves in lines or circles, if we are purely physical or also spiritual beings? I don’t have to decide what my life assumptions are and I don’t feel the need to. The more I learn the more I tend to believe that all of these things are completely true, all of the time, at the same time. If holding these permanent contradictions is what allows me to feel grounded in life, why do I have to decide on what ontology, what modality, or what model of integration fit my life and work?

I no longer need the illusion of certainty the answer to these questions would afford me.

This way of experiencing reality might be the reason I am usually unbothered by the concept of integration. In a way, I am glad I had to write that essay because from it stemmed my reflections, even though I felt such discomfort in having to answer some very reductionist questions. This way of seeing psychotherapeutic theory and practice is not mine, I do not feel part of it. Personally, this series of reflections on models of integration and their perspectives is leaving me with more questions than answers. Questions I am happy to keep reflecting on in the future.

References:

Kuhn T. (1970) The structure of scientific revolutions. 2^nd Ed. Chicago, London: University of Chicago Press Ltd.

Safran J.D & Messer S.B. (2006) Psychotherapy Integration: A Postmodern Critique. Clinical Psychology: Science and Practice. Vol 4(2) pp. 140-152