Applications now open
We are accepting applications for the new academic year, starting on the 9th-10th of November 2024. In order to apply, please send an e-mail to secretariat.accpi@gmail.com or call 0040744333362.
Course Philosophy
Integrative strategic psychotherapy is a research-informed approach to psychotherapy, organized around the centrality of the therapeutic relationship. It works with a model of the Self, which integrates several major theories in a coherent framework based on research in neurobiology and attachment. The ten basic principles of integrative strategic psychotherapy take into account the common elements of most psychotherapeutic approaches. In other words, the common therapeutic factors are considered the main forces behind therapeutic change, whilst the therapeutic relationship stands out among these factors. At the core of the therapeutic relationship are the client and therapist variables, and in this context the left-right brain hemisphere interplay is considered crucial for a positive therapeutic outcome.
Integrative strategic psychotherapy proposes that there are a series of central assumptions found in most theoretical approaches to psychotherapy and that the growing body of knowledge needs to constantly influence the way we conduct therapy. Whilst presenting a coherent model of the Self and a series of core principles, integrative strategic psychotherapy leaves room for integrating even more theories and models of intervention.
The training curricula in integrative psychotherapy
Basic training takes place in the first three years of training in integrative psychotherapy. It includes a theoretical and a practical component. The training modules have a duration of 20 hours, out of which about 4 hours of theory, 11-12 hours of practical applications and 5 hours of individual work. In basic training students acquire abilities and knowledge necessary for the application of various interventions and work techniques with the client / patient. The practical component of the training is especially important in this context – we cannot learn psychotherapy from books alone. The basic training in psychotherapy, taught in English, can take place online or live, depending on your option. Basic training includes 20 training modules, detailed here: basic training
The advanced training programme
The advanced training in integrative psychotherapy takes place in the 4th and 5th year of training and includes techniques, interventions and conceptual case models for the main diagnostic categories in the DSM 5. The training modules have a duration of 20 hours, out of which about 4 hours of theory, 11-12 hours of practical applications and 5 hours of individual work. Advanced training familiarizes the beginner psychotherapist with diagnostic and treatment plans, mainly the development of treatment plans and the choice of adequate interventions, depending on the client / patient individuality. The advanced training in psychotherapy, taught in English, can take place online or live, depending on your option. Advanced training includes 10 training modules, detailed here: advanced training
Group personal development
Personal development is one of the fundamental components of the training in integrative psychotherapy. Research shows that the level of the psychotherapist’s personal development is directly linked to psychotherapy efficiency. If we don’t know ourselves well enough, or the psychological problems we have are not sufficiently tackled, we will not be able to avoid projecting onto the client / patient our own emotions and personal way of thinking. Active and empathic listening and clarifying the patient’s problems without significant counter-transferential obstacles is the beginner psychotherapist’s greatest task.
To become an integrative psychotherapist, you need at least 25 hours of individual therapy, with a psychotherapist of your choice, and 12 modules of group personal development / therapy.
Supervision takes place in the 4th and 5th year of training and has the purpose of supporting the beginner psychotherapist in working with clients / patients. When we begin our career in psychotherapy, there are still many things unknown and many uncertainties. We need more experienced colleagues to guide us when we are stuck, and we need support with our anxieties when we are not sure we do well what we do.
Group supervision modules have a 15-hour duration and they are online. If you need additional individual supervision you can ask any of our supervisors.
During the supervision period, you will work with your clients / patients, in your private practice or in an institution. To graduate and finalize supervision you need to work with clients / patients for at least 300 hours, and have supervision protocols for at least 10 supervised cases, from various pathologies.
You can read more about supervision here: Supervision
Intervision / peer supervision
Intervision is organized monthly, online, an dis free of charge for ACCPI members. Intervision sessions are of 3-4 hours. Intervision helps in emergency situations or in situations in which you need some quick advice or a short answer. Intervision cannot replace supervision, but can be an additional resource for our students.
Intervision meetings are announced monthly on our Whatsapp group.
Exams
You will have both theoretical and practical examinations. Theoretical examinations are wither oral (online) or written (live). You will have examinations at the end of the 1st, 3rd and 5th year. You need to write at least 4 essays and book reviews, 10 case protocols and two dissertation papers: at the end of the 3rd and 5th year of training.
The integrative strategic model of psychotherapy
The Four-Self Model
Integrative case formulation models take into account a multitude of variables, from biological to transpersonal, generally including biology and medical influences, behavioural and learning models, cognitive models, psychodynamic models, existential and spiritual models, and social, cultural and environmental factors, including crises, stressful situations and life transitions (Brooks-Harris, 2011, Eels, 2011, Lichner-Ingram, 2006).
In 1999 Damasio formulated a theory of the self which postulates the existence of a proto-self and a core self. In our view, integrative case formulation needs to take into account four large domains: the proto-self, the ‘core set’ contained in the core-self, internal causality/maintenance mechanisms or the ‘plastic self’ and the ‘external or outer self’:
These domains are more prominent in one of the brain’s hemispheres, either the right, or the left, depending on the impaired neural circuits. In addition, depending on the ‘highest impact area’ of an external or internal stimulus (meaning the right or left hemisphere), clients bring forth one or more of the faulty mechanisms, creating manifestations designated by the general term ‘external self’. Therefore, the first observable manifestation in certain clients may be the faulty cognitions or maladaptive behaviours, while in others it may bring forth enactments or inappropriate emotional responses.
The behavioural domain was not considered separately, taking into account that each of the above-mentioned domains results in a behavioural impact.
The therapeutic relationship contributes to the way the observable manifestations of the external self are worked through, due to the interplay between the therapist’s own internal organization and the client’s internal organization. This may also account both for the fact that for certain therapists and/or clients a certain type of psychotherapy may be more suitable than another, and for the therapeutic relationship in itself. The therapeutic relationship therefore becomes the central ingredient of the therapeutic process and the main factor influencing the therapeutic outcome.
Neurobiological aspects of the Four-Self model
As Siegel (2001, p. 69) says, “The key issues are these: each neuron connects to an average of 10,000 other neurons. There are about 100 billion neurons, with over 2 million miles in their collective length. In addition, there is an incredible range of possible “on-off” firing patterns within this complex, spider-web like set of neuronal connections – estimated to be about ten times ten one million times. The fact that our brains can be organized in their functioning is quite an accomplishment!”
A child always connects to his/her caregivers in infancy, and the infant’s experiences will directly shape the organization of his/her internal world. These experiences involve the activation of neurons in the brain that respond to the stimuli from the external world. During the child’s development, these neurons begin more and more to respond both to external stimuli and to the internally generated images created by the brain itself. Action potentials pass down the axon to the synapse, causing the release of neurotransmitters, which flow across the synapse space to activate or inhibit the receiving neuron. The receiving neuron sends an electrical signal and releases neurotransmitters in turn, activating or inhibiting other neurons. The processes of the mind emanate from the activity of the brain (Mesulam, 1998, Siegel, 2001). Various mental processes are created due to the activation of certain neuron clusters or brain circuits. A neural map is created and this map creates a mental representation: sensations, images, linguistic representations, etc. The pattern of neuron firing within a certain circuit creates a certain type of experience. According to Siegel (1999), the mind can be understood in terms of patterns in the flow of energy and information.
The brain is part of the central nervous system, which is interwoven within the whole body, and therefore the flow of energy and information within the brain is part of the functioning of the body as a whole (Siegel, 2001), explaining why biological and medical factors need to be taken into account when formulating a case in psychotherapy. Although therapy focuses on certain aspects of the mind (or in other words, on certain aspects of brain activity), the brain is a complex of integrated systems which function together.
Emotional communication is both at the heart of the client’s presenting problem, and the therapeutic interventions. Emotion is both an intraindividual mental process and an interpersonal communication. From a neurobiological point of view, emotion is not limited to certain circuits of the brain (for many decades it was thought that emotions are the produce of the limbic system). Emotions are both regulated and perform a regulatory function, involving neurobiological, experiential and expressive components (Izard & Kobak, 1991).
The Four-Self model and its connection to various therapeutic approaches
Although there is very little consensus when it comes to the nature and status of the self, most psychotherapists agree that the sense of Self is a fundamental feature of human experience (Praetorius, 2009). Zahavi (2005) discussed the self as an experiential dimension: a first-person givenness of experiential phenomena. This is a concept borrowed from phenomenology (the ipseity or selfhood as a basic characteristic of consciousness). Experiential properties of experiences are not real objects, but properties of the various types of access or modes of givenness of experiences (Praetorius, 2009). In other words, present experiencing of the world depends on prior experiencing of the world, tracing back to the proto-self and the core self.
Each major psychotherapeutic orientation describes the self as a part of a global hologram: accurately but incompletely (Fall, Holden & Marquis, 2010). The integrative strategic model does not mean to pretend it manages to capture ‘the entire hologram’, but takes a step forward toward the understanding of the complex system, which is the human mind.
The basic principles of the integrative strategic model
Common therapeutic factors are the main factors responsible for therapeutic change.The therapeutic relationship stands out among common therapeutic factors, being co-created by the therapist and the client (Gilbert & Evans, 2003). At the core of the therapeutic relationship are the client variables and the therapist variables.
The therapeutic myth or rationale of integrative psychotherapy presented to the client needs to be flexible and adapted to the client’s needs.
The stages of the psychotherapeutic treatment and the therapeutic strategy focus on: (1) developing the therapeutic alliance; (2) developing and maintaining the therapeutic relationship; (3) categorical and dimensional diagnosis, (especially psychotherapeutic diagnosis and relational diagnosis); (4) case formulation; (5) presentation of a therapeutic myth; (6) developing a treatment plan; (7) selecting interventions; (8) mastering the verbal and non-verbal structure of psychotherapy; (9) re-learning; and (10) transferring acquired skills from the therapeutic context to the client’s environment.
The level of the psychotherapist’s self-development correlates with the therapeutic outcome (Gilbert & Orlans, 2011, Connor, 1994).
Integrative psychotherapists must use suitable interventions for different clients, matching interventions to clients’ needs.
The integrative theoretical framework must take into account: (1) cognitive aspects; (2) behaviours; (3) psychodynamics; (4) systems; (5) personality; (6) motivation; (7) developmental aspects, including sexual development; and (8) multiculturality.
It is important for the integrative therapist to be flexible and choose an approach that is geared to the problem presentation and the relational needs of the particular client (e.g. integrative psychotherapy for depression, anxiety disorders, personality disorders, etc), adapting the therapeutic strategy to the client’s needs.
Therapeutic change includes: (1) emotional experiencing; (2) cognitive abilities; (3) behavioural regulation; (4) biopsychosocial factors; (5) psychodynamic aspects; (6) systemic change; (7) multicultural awareness; (8) self-examination and self-observation; (9) testing various approaches and solutions.
Integrative psychotherapy as a treatment modality must be based on research.
Psychotherapeutic diagnosis
As psychotherapists, we are presented with a dilemma: what kind of clinical interview is best, considering the above-mentioned issues regarding flexibility, reliability and validity? Even more, do we need a highly structured categorical diagnosis? Some years ago, in a discussion among psychotherapists about psychotherapeutic diagnosis, one of them took the DSM from the table and threw it in the dust-bin, to point out what he believed about it. Many psychotherapists don’t use the DSM for diagnostic purposes, at least in private offices, probably because many of the patients in therapy cannot be fitted in any of the diagnostic categories of the DSM-IV-TR. On the other hand, how do we communicate with other professionals, in terms of understanding each other regarding the patient’s difficulties? Case formulation doesn’t help much, considering psychotherapists belong to different orientations and they don’t usually have a common language. In addition, psychotherapeutic diagnosis is an ongoing process, unfolding during the therapeutic sessions.
The integrative perspective on psychotherapy holds that truth and reality are not merely discovered, but co-created by the therapist and the patient (Evans & Gilbert, 2005). As a consequence, diagnosis becomes “an ongoing reference to truth in the service of the client’s healing and/or better coping” (Wehowsky, 2000, p. 247).
In any case, the initial evaluation of a client needs to be conducted in such a manner as to provide him/her with a potentially secure auxiliary attachment figure: emotional attunement, collaborative communication and repair of disruptions (Finn, 2012). Much of this interaction occurs at a non-verbal level. A non-judgemental, open and curious attitude on the part of the therapist facilitates assessment.