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Pluralistic Practice

Celebrating diversity in therapy

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

July 15, 2019 Integrative and Eclectic Practices Philosophy 7 Comments
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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.

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7 thoughts on “What is the pluralistic approach, and how is it different from integrative and eclectic practices?”
  1. Aroha O'Brien
    April 28, 2020 at 12:16 am

    I still dont understand the difference between pluralism and intergrative\ecclectic. Is there any simple to understand bullet points to note about pluralistic approach?

    Reply
    • Nicole
      July 25, 2020 at 7:15 pm

      As I understand pluralism is about being open-minded to different approaches and modalities. So you could have trained in person centred therapy, but you may see that EMDR would work really well with your client who had experienced trauma and you would be open-minded enough to refer them for that. So whatever is best for the client is the way you would work with them.

      An integrative approach is more about combining specific therapies in a particular way, so you are more likely to work in a similar way with all your clients. So you might combine person centred and CBT or TA and psychodynamic and use both of those with all your clients.

      An eclectic approach just takes bits and pieces from different theories and styles of therapy and don’t combine them in any systematic way.

      So you can be pluralistic and integrative. But not really integrative and eclectic. You can obviously be pluralistic and eclectic. But also pluralistic and not eclectic (because you’re open-minded to different approaches but you only practise one approach yourself).

      Based on these definitions I think we should all be pluralistic. There is far too much closed thinking and siloed ways of thinking in psychiatry, psychology and psychotherapy.

      Reply
      • Marie eve Jette
        May 8, 2022 at 2:02 pm

        Thank you Nicole
        really helpful comment

        Reply
  2. kate
    July 6, 2020 at 4:48 pm

    Integration is therapist led, pluralism is collaboratively led. integration is an adaptation or a diversion from a therapist-held truth, pluralism is the development of a new, shared, truth

    Reply
    • sienna
      July 13, 2020 at 12:25 am

      Thanks for clarifying Kate 🙂

      Reply
  3. Denis Grace
    April 17, 2021 at 7:55 am

    Good replies that summarise the differences well there.

    Reply
  4. Mary
    June 21, 2022 at 7:21 am

    But EMDR therapy IS an integrative (mindfulness, CBT, psychodynamic integration)?

    Reply
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