Social work theory · Volume H: Integrative & Practice-Oriented

Integrated and eclectic practice

Integrated and eclectic practice refers to the deliberate selection and combination of theories, models and techniques to fit the needs of a particular person, problem and setting.

1. What it is

Integrated and eclectic practice refers to the deliberate selection and combination of theories, models and techniques to fit the needs of a particular person, problem and setting. Most social workers and psychotherapists do not practise from a single model, and surveys have consistently found eclectic or integrative orientations to be among the most common (Norcross & Goldfried, 2019). Social work has an especially strong tradition of drawing on multiple theories because it works across individual, family, community and structural levels (Coady & Lehmann, 2016; Payne, 2021). The key questions are how theories can be combined coherently, and on what grounds choices should be made.

Technical eclecticism. Technical eclecticism uses techniques from different approaches without necessarily accepting the theories they came from. Arnold Lazarus (1967) argued that practitioners should use whatever techniques have been shown to work, selected according to the client’s needs. His multimodal therapy assessed seven modalities (behaviour, affect, sensation, imagery, cognition, interpersonal relationships and drugs or biology) and matched techniques to each. Technical eclecticism prioritises empirical evidence for techniques over theoretical consistency.

Theoretical integration (Norcross). Theoretical integration seeks to combine two or more theories into a new conceptual framework that is more than the sum of its parts (Norcross & Goldfried, 2019). Wachtel’s (1977) cyclical psychodynamics, which combined psychoanalytic and behavioural ideas, is a classic example. Prochaska and DiClemente’s (1982) transtheoretical model integrated processes of change from many therapies around stages of readiness. Norcross also described assimilative integration, in which practitioners work mainly from one approach and selectively incorporate methods from others. A fourth route, the common factors approach, looks for the elements shared by all effective therapies.

Common factors (Wampold; Lambert). The common factors view holds that therapies work mainly through elements they share. Rosenzweig (1936) first suggested this, borrowing the Dodo bird’s verdict from Alice in Wonderland that everybody has won and all must have prizes. Luborsky et al. (1975) later found few outcome differences between bona fide therapies. Lambert (1992) estimated that outcome variance could be attributed to extratherapeutic factors (about 40%), relationship factors (30%), expectancy and placebo (15%) and specific techniques (15%). These figures were clinical estimates drawn from a review of research, and they became widely influential (Duncan et al., 2010). Wampold’s contextual model proposes that therapy works through three pathways: the real relationship, the creation of expectations through a credible explanation and treatment, and the promotion of health-related actions (Wampold, 2015; Wampold & Imel, 2015).

Selecting approaches by context, evidence and client preference. Integrative practice requires principled choices. Evidence-based practice, as defined in medicine and adopted in social work, combines the best available research evidence with practitioner expertise and client values and preferences (Sackett et al., 1996; Gambrill, 1999). The American Psychological Association added client characteristics, culture and context to this model (APA Presidential Task Force on Evidence-Based Practice, 2006). Systematic treatment selection matches interventions to client features such as coping style and resistance (Beutler & Clarkin, 1990). Client preference matters in its own right. A meta-analysis found that accommodating client preferences reduces dropout and modestly improves outcomes (Swift et al., 2018).

Risks of eclecticism. Unsystematic eclecticism, sometimes called syncretism, occurs when practitioners combine methods based on habit or personal preference without a clear rationale (Norcross & Goldfried, 2019). This can produce incoherent work, contradictory messages to clients and practice that cannot be evaluated. Payne (2021) noted that some combinations involve conflicting assumptions, such as mixing a structural analysis of oppression with an individual deficit model. Practitioners may also drift away from evidence-based protocols without realising it.

2. Historical development

The integration movement grew out of dissatisfaction with competing “schools” of therapy in the mid-twentieth century. Comparative research showing similar outcomes across therapies undermined claims that any one school was superior (Luborsky et al., 1975). This prompted interest in what therapies share and how they might be combined. Integration became a field in its own right in the 1980s, with its own society, journal and handbook.

Social work has always been pluralist, partly because the profession’s breadth demands more than one theory. Generalist and eclectic models emerged in North American social work education in the 1970s and 1980s and remain common (Coady & Lehmann, 2016). Australian texts encourage students to build a reflective practice framework from multiple theories, linked to values, context and evidence (Connolly & Harms, 2015; Healy, 2014). The AASW Code of Ethics (2020) also requires practice to be informed by knowledge and evidence.

3. Practical guidance

The following principles support coherent integrative practice.

• Build an explicit practice framework. Identify the theories and models you draw on, how they relate, and the values that connect them (Healy, 2014).
• Start from assessment and formulation. Choose methods based on a shared understanding of the person’s situation, strengths and goals.
• Invest in the relationship. The working alliance, empathy and collaboration predict outcome across approaches and deserve deliberate attention (Norcross & Lambert, 2018).
• Use evidence without being bound by it. Consider what research supports for this problem and population, then weigh it against context and the client’s circumstances (Gambrill, 1999).
• Ask about preferences. Explain options and invite clients to choose approaches that fit their values, culture and experience (Swift et al., 2018).
• Check coherence. Before combining methods, consider whether their assumptions about people, problems and change are compatible.
• Monitor outcomes. Routine feedback from clients helps identify when an approach is not working and needs to change (Duncan et al., 2010).

4. Critical evaluation

Strengths. Integrative practice allows workers to respond flexibly to diverse clients and complex problems. It reflects research showing that common factors, especially the therapeutic relationship, contribute substantially to outcomes (Wampold, 2015). It also fits social work’s multilevel perspective and its commitment to client self-determination. A well-articulated framework makes the worker’s reasoning transparent to clients, supervisors and colleagues.

Limitations. Eclecticism can become a cover for unreflective practice in which techniques are chosen without rationale (Norcross & Goldfried, 2019). Integration of theories with conflicting assumptions can produce confusion. The common factors argument is contested: critics argue that specific techniques matter more for some conditions, such as exposure for anxiety disorders (Budd & Hughes, 2009). Integrative practice is also harder to teach, standardise and evaluate than single-model approaches.

Overall importance. Most social work practice is integrative in some form, so the important issue is how well it is done. Systematic integration, guided by formulation, evidence, client preference and reflective supervision, offers a sound basis for practice. It links the theories in families A to G with the practice models in family H.

5. References

• American Psychological Association Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271–285. https://doi.org/10.1037/0003-066X.61.4.271
• Australian Association of Social Workers. (2020). Code of ethics.
• Beutler, L. E., & Clarkin, J. F. (1990). Systematic treatment selection: Toward targeted therapeutic interventions. Brunner/Mazel.
• Budd, R., & Hughes, I. (2009). The Dodo bird verdict: Controversial, inevitable and important: A commentary on 30 years of meta-analyses. Clinical Psychology & Psychotherapy, 16(6), 510–522. https://doi.org/10.1002/cpp.648
• Coady, N., & Lehmann, P. (Eds.). (2016). Theoretical perspectives for direct social work practice: A generalist-eclectic approach (3rd ed.). Springer.
• Connolly, M., & Harms, L. (2015). Social work: From theory to practice (2nd ed.). Cambridge University Press.
• Duncan, B. L., Miller, S. D., Wampold, B. E., & Hubble, M. A. (Eds.). (2010). The heart and soul of change: Delivering what works in therapy (2nd ed.). American Psychological Association.
• Frank, J. D. (1961). Persuasion and healing: A comparative study of psychotherapy. Johns Hopkins University Press.
• Gambrill, E. (1999). Evidence-based practice: An alternative to authority-based practice. Families in Society, 80(4), 341–350. https://doi.org/10.1606/1044-3894.1214
• Healy, K. (2014). Social work theories in context: Creating frameworks for practice (2nd ed.). Palgrave Macmillan.
• Lambert, M. J. (1992). Psychotherapy outcome research: Implications for integrative and eclectic therapists. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94–129). Basic Books.
• Lazarus, A. A. (1967). In support of technical eclecticism. Psychological Reports, 21(2), 415–416. https://doi.org/10.2466/pr0.1967.21.2.415
• Luborsky, L., Singer, B., & Luborsky, L. (1975). Comparative studies of psychotherapies: Is it true that “everyone has won and all must have prizes”? Archives of General Psychiatry, 32(8), 995–1008. https://doi.org/10.1001/archpsyc.1975.01760260059004
• Norcross, J. C., & Goldfried, M. R. (Eds.). (2019). Handbook of psychotherapy integration (3rd ed.). Oxford University Press.
• Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy relationships that work III. Psychotherapy, 55(4), 303–315. https://doi.org/10.1037/pst0000193
• Payne, M. (2021). Modern social work theory (5th ed.). Red Globe Press.
• Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice, 19(3), 276–288. https://doi.org/10.1037/h0088437
• Rosenzweig, S. (1936). Some implicit common factors in diverse methods of psychotherapy. American Journal of Orthopsychiatry, 6(3), 412–415. https://doi.org/10.1111/j.1939-0025.1936.tb05248.x
• Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. BMJ, 312(7023), 71–72. https://doi.org/10.1136/bmj.312.7023.71
• Swift, J. K., Callahan, J. L., Cooper, M., & Parkin, S. R. (2018). The impact of accommodating client preference in psychotherapy: A meta-analysis. Journal of Clinical Psychology, 74(11), 1924–1937. https://doi.org/10.1002/jclp.22680
• Wachtel, P. L. (1977). Psychoanalysis and behavior therapy: Toward an integration. Basic Books.
• Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–277. https://doi.org/10.1002/wps.20238
• Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). Routledge.