What is the pluralistic approach, and how is it different from integrative and eclectic practices?

Mick Cooper, Professor of Counselling Psychology, University of Roehampton

The pluralistic approach to therapy is something that John McLeod and I first started to articulate back in 2007, with our first book in 2011, and a handbook with Windy Dryden in 2017. John and I both came from person-centred backgrounds, but had also been informed by postmodern thinking (which holds that there are no fixed ‘truths’), psychotherapy research, and a commitment to socio-political change. So although we loved the person-centred approach, we also felt that it could get a bit fixed and rigid at times, and not see that there were other effective ways of working with clients. Linked to that, we also felt that there was something of a paradox when clients came in wanting more direction, guidance, and techniques. How was it ‘person-centred’ if, at times, you were actually going against what the person wanted by only engaging in non-directive ways?

So our pluralistic approach to therapy was, in many ways, trying to develop a person-centred approach to the counselling and psychotherapy field as a whole. To try and hold ‘unconditional positive regard’ to the many different ways in which you could help clients. And then, also, to try and really value the client by listening to what it was that they wanted, and to try and respect their preferences and choices—even if it went again what you, as a therapist, thought was ‘best’ for them.

Of course, we also knew that counsellors and psychotherapists couldn’t offer everything. So we distinguished between a pluralistic perspective on therapy and a pluralistic practice. Subsequent research has shown that, indeed, these are separate dimensions. A pluralistic perspective is about a general attitude of acceptance and valuing to the whole array of therapeutic approaches, but it doesn’t mean you have to practice them all, or even more than one. For instance, you could hold a pluralistic perspective while, at the same time, choosing to just practice psychodynamic therapy yourself, or to offer only EMDR. But the difference between a pluralistic psychodynamic therapist and a non-pluralistic one, is that the former can see the value of other therapeutic approaches and is prepared to refer on, whereas the latter is more stuck in the rhetoric of ‘psychodynamic therapy is best for everyone.’ Then you have a pluralistic practice, which is about actually combining methods from different approaches into a coherent whole, based around what clients and therapists think is best for that particular client. So here you have more extensive use of metatherapeutic communication: talking to clients about their particular preferences, wants, and goals. 

So how does this all differ from integrative and eclectic therapies? Well, first of all, it’s probably worth noting that John and I came from person-centred, rather than integrative, backgrounds. And that means the relationship between integration and pluralism is rather complex, because we didn’t specifically set out to develop and advance integrative therapies—rather, we developed something in parallel that both crosses over and doesn’t. A first difference, though, is that, as we’ve seen, pluralism can be a general attitude towards the therapeutic field as a whole, whereas integration or eclecticism refer to a specific practice. So, for instance, while you could say that you practice solely EMDR within a pluralistic framework, it wouldn’t make sense to say that you practice solely EMDR as an integrative therapist. Second, as Linda Harris explains in her excellent blog, some forms of integrative therapy, ‘theoretical integration’, consist of particular integrations of particular therapies (e.g., cognitive analytic therapy, CAT), whereas pluralism is about valuing the full diversity of therapeutic approaches. Of course, you could be a CAT practitioner and still hold a pluralistic outlook, but it’s possible that you could advocate and practice a form of theoretical integration that was as ‘schoolist’ and dogmatic as advocates of a pure form therapy. Finally, in pluralistic therapy, there’s a particular emphasis on metatherapeutic communication between clients and therapists and a tailoring of the practice to the individual client. That is there also in a lot of integrative and eclectic approaches, but it isn’t intrinsic to what it means to be integrative. For instance, it could be possible to combine different theories and methods but in a very therapist-directed way, without ever really consulting the client on what they want or varying it for different clients.

Pluralism isn’t trying to promote itself as another brand of therapy or take over from integrative or eclectic approaches. The whole point of pluralism is about maintaining a critical, reflective edge about our work; so of course we need to be vigilante about getting stuck in a pluralism-ism: when we start saying that pluralism is best and everyone else should be one. So, from a pluralistic standpoint, if counsellors or psychotherapists see themselves as ‘integrative’ or ‘eclectic’ that’s great, and there’s no (or, at least, not much) desire to proselytise. But integrative and eclectic therapists can also think about whether they might be ‘pluralistic’ too: which would be about really wanting to work closely with clients to find out which methods and theories are best for them, and tailoring the therapy as much as possible to each individual client. For some therapists, that’s exactly what ‘integration’ is about, and if that word works best then there’s no need to refer to ‘pluralism’ at all (for instance, a colleague of ours, Biljana van Rijn, refers to pluralism as ‘collaborative integration’). But, for some of us, ‘pluralism’ does represent something a bit broader than ‘integration’ and perhaps more philosophical and political: which is about an ethical and pragmatic commitment to valuing diversity, and seeing the good in difference and dialogue. That’s what I love about the term ‘pluralism’: that it links in to a much wider set of values and practices, linked to democracy, social justice, and progressive change. You find it, for instance, in the work of Isaiah Berlin, who developed the concept of ‘value pluralism’; or in religious or cultural practices that strive to prize multiple perspectives.

I’m going a bit off point so I’ll stop here, but finally just to say that, of course, John and I didn’t create a pluralistic approach to therapy. Rather, we just articulated something that a lot of therapists already think and do—particularly, no doubt, in the integrative field. But ‘pluralism’ describes a particular way of being and doing integration that is, I think, a bit distinctive from other integrative and eclectic perspectives. It’s that commitment, first and foremost, to really valuing and prizing difference; to keeping an ‘open mind’; and to always trying to make sure that the things we say and do are for our clients, and not for our own self-promotion.