Book Review: Integration in Counselling and Psychotherapy by Lapworth and Sills

I teach on a counselling course that requires students to make sense of a number of different approaches to therapy; so I've been giving a lot of thought to integration and how it can be successfully achieved. After reviewing Cooper and McLeod on my blog here I have turned my attention to Lapworth and Sills and the second edition of their Integration in Counselling and Psychotherapy. The two books are similar because both are concerned with giving the reader an over-arching framework to help make integration possible; but whilst Cooper and McLeod provide one approach to integration - pluralistic counselling and psychotherapy - Lapworth and Sills provide an overview of what is needed if integration is to be achieved, their own model of integration - the Multi-dimensional Integrative Framework - and brief chapters on four other approaches, including a chapter on the therapeutic relationship and an outline of Multi-modal Therapy.

I am trying to work out why I disliked the first part of Lapworth and Sills. I found it too theoretical. I was left wondering how I had managed the task myself of integrating different counselling approaches. I was reminded of the cartoon strip in which Garfield the cat is stuck on the stairs after wondering how on earth he was able to co-ordinate the movement of his four legs. I could be at fault because I'm more of an activist when it comes to learning, which may also explain why my favourite chapter in the book is a case study of the Multi-dimensional Integrative Framework in action. But I don't think it's the theoretical nature of the material in these early chapters that's the problem, rather it's the lack of time taken to explain and illustrate what is being said. I was left with the sense of skating across the subject because of the authors' preference for summaries, outlines and bullet points. This tendency can also be seen at the end of the book when the authors give a brief outline of four competing theories of integration. It can also be seen in the first chapter where the authors give a potted history of integration in counselling whilst apologising because they don't have room to explore the topic further.

So for me the life saver, the thing that enabled me to go on reading, is the diagram on p89 and the case history that forms chapter six. Here the authors apply their Multi-dimensional Integrative Framework and the reader gets to see how useful it is as a model for explaining the problems experienced by the client, how these might be addressed (a formulation) and how therapy is progressing over time.

The authors argue in this book that in order for integration to happen successfully the therapist must have an over-arching framework that gives the therapist an understanding of human beings and of therapy and informs the choices the therapist makes about the strategies and techniques to borrow from different schools of therapy. It is the over-arching framework that gives those choices coherence and therapeutic power. I am reminded yet again of Yalom's point about creating a therapy for each client and I'm happy that ultimately Lapworth and Sills provide a way of doing that - and summaries of alternative frameworks that the reader can investigate further.

Lapworth, P. and Sills, C. (2010) Integration in Counselling and Psychotherapy, 2nd Edition, London, Sage.