Levels of Meaning and the Need for Psychotherapy Integration

We argue for the importance of multitheoretical integrative clinical intervention and training. Mental health professionals, including clinical social workers, are frequently primarily committed to a single dominant therapeutic theory, perhaps one that was favored by a school, fieldwork agency, inspiring teacher, or influential supervisor. However, each such theory tends to target just one aspect of the extraordinarily complex human meaning system that scientific research has shown to operate at biological, neuroscientific, behavioral, cognitive, unconscious, family-systems, and cultural levels in complexly interacting ways. We know that any monotheoretic intervention approach likely fails to help a substantial number of clients, implying an ethical imperative not to equate failure to respond to monotheoretical treatment with clinical failure. Thus, there are persuasive scientific and ethical arguments supporting the move toward psychotherapy integration in which multiple theories and their associated techniques are seen as part of a larger theoretical and interventive metasystem. Such integration is especially urgent in clinical social work with its diverse and often multi-problem clients. In this article, we consider the reasons for integration, review the levels of the human meaning system that interact in normal and abnormal functioning and thus justify a multitheoretical approach, examine recent research in support of integrationist practices, and offer the example of the natural conceptual convergence occurring between cognitive and psychodynamic approaches to illustrate how, as theories mature, they tend to converge and recognize the same reality of the human meaning system.