A Person-in-Environment Perspective Informed by Ecological Systems Theory

“The central focus of social work traditionally seems to have been on people in their life situation complex—a simultaneous dual focus on individuals and environment” (Gordon, cited in Compton, Galaway, & Cournoyer, 2005, p. 6). A generalist approach embraces this traditional person-in-environment perspective of social work practice. This perspective emphasizes the need to view the interdependence and mutual influence of people and their social and physical environments. Also, it recognizes the link between private troubles (i.e., individual problems) and public issues (i.e., social problems; Mills, 1959). The person-in-environment perspective has been one of the primary factors that has distinguished direct social work practice from the practice of other helping/counseling professions (i.e., psychology, marriage and family therapy, psychiatry).

Ecological systems theory (see Chapter 4) is a conceptual framework for the person-in-environment perspective that “has been almost universally accepted in social work over the past three decades” (Mattaini & Lowery, 2007, p. 39). This theory “recognizes an interrelatedness of human problems, life situations, and social conditions” (Shatz et al., 1990, p. 223). As explained in Chapter 2, it is a high-level or meta-theory that is particularly useful for helping workers to see the big picture in terms of the reciprocal influence of people and the various systems (e.g., family, work, community) with which they interact. As such, it provides an “organizational tool for synthesizing the many perspectives that social workers apply in practice” (Miley et al., 2013, p. 27).

The Development of a Good Helping Relationship That Fosters Empowerment

Historically, social work has led the helping professions to advocate the importance of a collaborative, warm, empathic, supportive worker–client relationship. Social workers have described this type of relationship as the “soul” (Biestek, 1957), “heart” (Perlman, 1979), and “major determinant” (Hollis, 1970) of the helping endeavor. Although clinical social work has drifted away from such an emphasis over the last few decades in favor of attention to the theoretical/technical/scientific aspects of practice (Coady, 1993a; Perlman, 1979), the generalist perspective has reemphasized the importance of the helping relationship.

Along with a reaffirmation of the importance of a good helping relationship, the generalist perspective has promoted a focus on empowerment. A number of authors of generalist textbooks (e.g., Landon, 1999; Locke et al., 1998; Miley et al., 2013; Timberlake et al., 2008) have combined a consideration of empowerment and the strengths perspective (Saleebey, 2013). For example, Miley and colleagues (2013) argued that “an orientation toward strengths and empowerment compels social workers to redefine their relationships to embrace the notion of collaboration and partnership” (p. 85). Gutiérrez (cited in Miley et al., 2013) noted that this involves basing the helping relationship on “collaboration, trust, and shared power; accepting the client’s definition of the problem; identifying and building upon the client’s strengths; actively involving the client in the change process; [and] experiencing a sense of personal power within the helping relationship” (p. 133).

The Flexible Use of a Problem-Solving Model

Since Perlman’s (1957) formulation of the problem-solving model for social casework, problem solving has been an integral part of social work practice. Most generalist approaches to social work practice include some version of the problem-solving model, and although there are various conceptualizations of the stages or phases of problem solving, all versions include guidelines for the entire helping process, from initial engagement to termination.

Some generalist approaches, in an effort to emphasize a strengths focus versus a problem focus, have renamed the problem-solving model. For example, Locke and colleagues (1998) called their version of the problem-solving model a “phase model,” and Miley and colleagues (2013) called their version “phases and processes of empowering practice” (p. 103). We agree, however, with McMillen, Morris, and Sherraden (2004) who contended that the “grudge match” within social work that pits strengths-based against problem-focused approaches represents a false and destructive dichotomy. Thus, our use of the term problem-solving model does not denote a deficit or pathology orientation to practice. As is generally the case within social work, we construe problem solving as a collaborative process between workers and clients that has the ultimate goal of capacity building and empowering clients (see Chapter 3 for a more detailed discussion of problem solving).

A Holistic, Multilevel Assessment

The person-in-environment perspective and ecological systems theory suggest the necessity of a holistic, multilevel assessment. The term holistic refers to a “totality in perspective, with sensitivity to all the parts or levels that constitute the whole and to their interdependence and relatedness” (McMahon, 1996, p. 2). This represents a focus on the whole person (i.e., the physical, emotional, spiritual) in the context of his or her surroundings. Multi-level assessment goes hand-in-hand with a holistic focus because this means considering the entire range of factors, from micro to macro, that could be impacting a client. Thus, in conducting an assessment, the generalist-oriented direct practitioner should consider the potential influence of biophysical, intrapsychic, interpersonal/familial, environmental, and sociocultural factors. With regard to the latter class of factors, a generalist approach to direct practice assessment includes particular sensitivity to issues of diversity (e.g., gender, race, culture, class, sexual orientation, disability, age, religion) and oppression (Shatz et al., 1990). A generalist approach also demands that the assessment process includes a focus on clients’ strengths, resources, and competencies.

The Flexible and Eclectic Use of a Wide Range of Theories and Techniques

The commitment to a holistic, multi-level assessment precludes a rigid adherence to narrow theories of human problems. A generalist approach should be “unencumbered by any particular practice approach into which the client(s) might be expected to fit” (Sheafor & Landon, 1987, p. 666). Theories can be useful in the assessment process if they are tentatively considered as potential explanations for clients’ problems; however, theories represent preconceived ideas about human problems and can blind one to alternative explanations.

Just as the assessment process must avoid rigid adherence to narrow theoretical perspectives, the same is true for the intervention process: “the generalist perspective requires that the social worker be eclectic (i.e., draw ideas and techniques from many sources)” (Sheafor & Horejsi, 2006, p. 87). Generalists are open to using theories and techniques that seem most relevant to the understanding of the unique client situation: “Single model practitioners do a disservice to themselves and their clients by attempting to fit all clients and problems into their chosen model” (Hepworth, Rooney, & Larsen, 2002, p. 17). Guidelines for selecting theories and techniques for particular types of clients and problems are reviewed later in this chapter in the discussion of approaches to eclecticism, as well as in Chapter 3.

A Differentiated Understanding and Demystification of Theory

One distinctive aspect to our approach of using theory in practice is differentiating between types and levels of theory, and classifying clinical theories in like groupings. Our approach to understanding theory differentiates between (a) high-level, metatheories (ecological systems and human development theories, the strengths perspective; see Part II, Chapters 4–6); (b) mid-level practice theories (see Part III, Chapters 7–20); and low-level models for specific populations and problems. Metatheories provide general guidance for holistic assessment and the generation of ideas for intervention, mid-level practice theories provide more specific ideas and directions for assessment and intervention for a range of presenting concerns, and low-level models provide more specific guidelines for work with specific populations and problems.

Furthermore, in an effort to demystify the vast array of practice theories that exist, we classify these theories in like groupings (psychodynamic [Chapters 7–9], cognitive behavioral [Chapters 10–12], humanistic [Chapters 13–15], critical [Chapters 16–17], and postmodern [Chapters 18–20]) and provide a brief overview of the distinguishing characteristics of each of these larger classifications of theory (see Chapter 2).

A Critical Perspective on the Use of Theory and Valuing the Artistic Elements in Practice

Perhaps the most distinctive feature of our generalist-eclectic approach is that it includes a critical perspective on the scientific view of practice, which contends that use of theory and technique reflects the essence and is the cornerstone of effective direct social work practice. We certainly do not deny the value of this scientific approach to practice (after all, this book focuses on the use of theory in practice), although we clearly favor an eclectic use of theory and technique over adherence to a single theory and its techniques. Still, a key element of our framework is the recognition and valuing of the artistic elements of practice (Coady, 1995; Goldstein, 1990; Kinsella, 2010; McCoyd & Kerson, 2013; Schön, 1983).

An artistic approach to practice, often referred to as reflective practice (Schön, 1983), includes the use of relationship-building skills, intuition, gut instincts, empathic listening, and inductive reasoning to collaboratively build with the client a theory that fits his or her unique situation and to problem solve creatively. We believe that practice is at least as much art as science, and is based at least as much on reflection-in-action (Schön, 1983), intuition, inductive reasoning, theory building, and general interpersonal/relationship skill as on the deductive application of theoretical knowledge and technical skill. Theory and research that pertain to this issue are reviewed both later in this chapter and in the second part of Chapter 2, where the artistic, reflective, intuitive-inductive approach to practice is discussed. Our stance is that the best social work practice integrates scientific (i.e., theoretical/technical) and artistic (i.e., reflective, intuitive-inductive) elements.

Use of the Problem-Solving Model to Integrate the Art and Science of Practice

One of the main difficulties with both theoretically eclectic and artistic, reflective, intuitive-inductive approaches to practice is a lack of structure and guidelines for practice. For example, workers who are theoretically eclectic are sometimes overwhelmed by the sheer number of theories from which to choose. Also, practice can lack coherence and direction when one moves back and forth between theories, and sometimes workers can become preoccupied with or distracted by multiple theoretical considerations. When this happens, the worker’s understanding of and relationship with the client can suffer.

On the other hand, workers who prefer a more artistic, humanistic approach to practice that is based on reflection, intuition, and inductive reasoning sometimes feel as if they are “flying by the seat of their pants.” Their practice can similarly lack coherence and direction. This is a major reason why some practitioners prefer to adhere to a single theoretical orientation in their practice—a single theory approach provides clear structure and guidelines. The cost of adherence to a single theory is too large; however, there is no one theory that is comprehensive enough to fit for all clients, and clients should not be forced into theoretical boxes.

We believe that the problem-solving model offers a solution to the lack of structure and guidelines for practice that are commonly experienced by workers who prefer theoretically eclectic and/or reflective, intuitive-inductive approaches to practice. The general strategies for the various phases of helping (from engagement to termination) that constitute the problem-solving model provide useful and flexible structure and guidelines for both the scientific and artistic approaches to practice and enable workers to integrate these two approaches in their work. The generality and flexibility of the guidelines in each phase of the problem-solving process provide sufficient structure and direction for practice while also allowing workers to integrate theory and use reflection, intuition, and inductive reasoning. This issue is discussed briefly later in this chapter, and in more depth in Chapter 3.

Historical Resistance to Eclecticism

A historical perspective is necessary to understand the contentiousness of eclecticism. For most of this century, the helping professions have been marked by rigid adherence to narrow theories. Up until the 1960s, psychodynamic theory remained relatively unchallenged as the dominant theory in the helping professions (Lambert, Bergin, & Garfield, 2004). As humanistic and behavioral theories gained increasing prominence in the 1960s, they began to challenge the dominance of psychodynamic theory, and this initiated the era of the “competing schools of psychotherapy.” For the most part, the next 25 years were marked by rigid adherence to one or another of an increasing number of theoretical camps, rancorous debate about which theory was right, and extensive research focused on proving which therapeutic approach was the most effective. Although there were some efforts to bridge the differences among the numerous competing schools of therapy, eclecticism was clearly a dirty word. As Norcross (1997) has commented:

Unfortunately, such negative views of eclecticism are still prevalent within the field of counseling, particularly within clinical social work. Despite the endorsement of eclecticism by the generalist perspective, many social workers do not seem aware of or at least have not embraced the movement toward eclecticism that has been sweeping the larger field of psychotherapy. Also, despite the prevalence of eclecticism in practice, many social workers seem loath to admit this publicly because they know that eclecticism is still a dirty word in some circles. We have encountered many clinical social workers (academics and practitioners) who have disdain for eclecticism. One of the social work academics whom we approached to write a chapter for the first edition of this book, and who ascribed to a psychodynamic perspective, declined to contribute because of our endorsement of both a generalist perspective and eclecticism. Similarly, another academic who ascribed to a critical perspective declined to contribute a chapter to the current edition of this book for similar reasons. Unfortunately, such traditional negative views of eclecticism are difficult to change and they quickly filter down to students. We have had students tell us that their field instructors counsel them to never admit to an eclectic orientation in a job interview because it would count against them.

It is not surprising that adherence to one theoretical orientation is most prevalent for those who were trained in an older, more traditional theory. The Jensen et al. (1990) survey found that the most common exclusive theoretical orientation was psychodynamic. Furthermore, to bolster our contention about the traditional nature of clinical social work, this survey found that “of individuals endorsing an exclusively psychodynamic approach, 74% were either psychiatrists or social workers” (Jensen et al., 1990, p. 127; 25% of social workers and 36% of psychiatrists identified themselves as exclusively psychodynamic, whereas less than 10% of the other professional groups did so).

It should also be pointed out, however, that this phenomenon of adherence to one theoretical perspective also seems to be common for social workers who embrace more recent therapeutic approaches—for example, in the 1980s, family systems therapy (see Coady, 1993b); in the 1990s and forward, solution-focused therapy (see Stalker, Levene, & Coady, 1999); and from the late 1990s and forward, many critical approaches to social work practice. Thus, we felt that it was important to emphasize our endorsement of eclecticism in the title of the book and to review the fact of and rationale for the trend toward eclecticism.

Documenting the Trend Toward Eclecticism in Counseling/Psychotherapy

Three decades ago, with regard to the broad field of counseling/psychotherapy, Garfield and Bergin (1986) concluded that the era of the competing schools of psychotherapy was over:

The trend toward eclecticism is evidenced in a number of ways. First, the precedence of eclecticism has been demonstrated by surveys. The Jensen et al. (1990) survey found that the majority of practitioners in each of the four groups of helping professionals were eclectic (68% overall). Furthermore, similar surveys have repeatedly indicated that one half to two thirds of practitioners in North America prefer some type of eclecticism (Lambert, 2013a).

Second, an international professional organization, the Society for the Exploration of Psychotherapy Integration (SEPI), which has been in existence for over 30 years, has been influential in furthering the study of eclecticism in psychotherapy. SEPI has published the Journal of Psychotherapy Integration since 1991, holds annual conferences, and has a website (www.sepiweb.org). We should clarify that the term integration is often used together with or instead of the term eclecticism in the literature. In brief, the difference between these approaches is that integration focuses on joining two or more theoretical approaches to arrive at a new, more comprehensive theory, while eclecticism simply draws on different theories and their techniques (Lambert, 2013a). The difference between eclectic and integrative models is revisited in our discussion of approaches to eclecticism; however, for the most part, we use the term eclecticism to encompass both approaches.

Third, there has been a proliferation of literature on eclecticism. The number of journal articles focused on eclecticism continues to increase annually. This is also true for books on this topic. Psychoanalysis and Behavior Therapy (Wachtel, 1977), Systems of Psychotherapy: A Transtheoretical Analysis (Prochaska, 1979), and Psychotherapy: An Eclectic Approach (Garfield, 1980) were three of the first books that presented arguments for eclecticism and/or integration. Some of the more recent editions of such books include Dryden (1992), Stricker and Gold (1993), Garfield (1995), Gold (1996), Beutler and Harwood (2000), Lebow (2002), Norcross and Goldfried (2005), Stricker and Gold (2006), and Prochaska & Norcross (2014).

Reasons for the Trend Toward Eclecticism: Key Conclusions From Cumulative Research

Although various writers have argued for eclecticism (e.g., Thorne, 1950), or have promoted the integration of various theories (e.g., Dollard & Miller, 1950), in the more distant past, it is only in the last 35 years that a definite trend toward eclecticism has emerged in the broad field of counseling/psychotherapy. The trend toward eclecticism has been fueled primarily by two interrelated sets of research findings, which are discussed here.

Pockets of Resistance to Eclecticism

Acceptance of the research findings that have fuelled the trend toward eclecticism has not been easy for many mental health practitioners. Four decades ago, Frank (as cited in Lambert & Ogles, 2004) anticipated resistance to his hypotheses about equal outcomes across therapies and the importance of common factors when he noted that “little glory derives from showing that the particular method one has mastered with so much effort may be indistinguishable from other models in its effects” (p. 175). Similarly, as Glass suggested in the foreword to Wampold’s (2001) book, giving up the idea that one’s cherished theory and associated techniques are no more effective than another approach to therapy and that effectiveness is due largely to factors that are common across therapies “carries a threat of narcissistic injury” (p. x).

Even more dramatically, Parloff (cited in Wampold, 2001) contended that, in some practitioners’ minds, if the conclusion about the primary importance of common factors is accepted, “then the credibility of psychotherapy as a profession is automatically impugned” (p. 29). With regard to this last point, we would argue that acceptance of these research findings does not impugn the credibility of psychotherapy, but it does change the general conceptualization of psychotherapy from a primarily scientific, theoretical/technique-oriented enterprise to one that is more humanistic, artistic, and reflective. Wampold and Imel (2015) have called for such a shift toward what they call a “contextual model” of therapy, in which common factors are emphasized, to replace the current “medical model.” Still, there is “tremendous resistance” (Lambert, Garfield, & Bergin, 2004, p. 809) to accepting these research findings and this reconceptualization of psychotherapy/clinical practice.

Technical Eclecticism

Technical eclecticism, which is sometimes referred to as systematic eclecticism or prescriptive matching, “refers to the relatively atheoretical selection of clinical treatments on the basis of predicted efficacy rather than theoretical considerations” (Alford, 1995, p. 147). Thus, those who ascribe to technical eclecticism use clinical knowledge and research findings about what has worked best with clients with similar characteristics or problems to draw techniques from different therapy models, without necessarily subscribing to any of the theories (Norcross, 2005; Wampold & Imel, 2015). Lazarus (1996) differentiated this type of eclecticism from “the ragtag importation of techniques from anywhere or everywhere without a sound rationale” (p. 61). Technical eclecticism attempts to address the specificity question posed by Paul (cited in Lampropoulos, 2001): “What treatment, by whom, is most effective for this individual with that specific problem, and under which set of circumstances” (p. 7). Of the four types of eclecticism, this type pays the least attention to the integration of theories (Gold & Stricker, 2006).

Theoretical Integration

In this second category of approaches, “there is an emphasis on integrating the underlying theories of psychotherapy along with therapy techniques from each” (Prochaska & Norcross, 2014, p. 431). The goal is to produce a more comprehensive, overarching theoretical framework that synthesizes the strengths of individual theories. Norcross (2005) has referred to theoretical integration as “theory smushing” (p. 8). The ultimate form of theoretical integration would incorporate all of the various theories of therapy (i.e., those subsumed under psychodynamic, cognitive behavioral, humanistic/feminist, and postmodern classifications, as well as biological and family systems approaches) into a synthesized/unified whole. Leaving aside the question of whether such a lofty goal is viable or not, Stricker’s (1994) conclusion that “psychotherapy integration has not succeeded in that grand attempt, … the leading current approaches usually incorporate two, or at most three, of these perspectives” (p. 6) still holds today. As Lampropoulos (2001) noted, theoretical integration is “the ideal, optimistic, but utopian view” (p. 6).

Assimilative Integration

This approach to eclectic/integrative practice was the last of the four categories of eclecticism to be developed (Stricker, 2010), and was proposed initially by Messer (1992). This approach maintains that it is important to keep a firm grounding in one theory of therapy while incorporating ideas and techniques from other theories. Lampropoulos (2001) explained how assimilative integration can be seen as a bridge between technical eclecticism and theoretical integration:

Common Factors

In this last category of approaches to eclecticism, there is an attempt to identify and utilize the “effective aspects of treatment shared by the diverse forms of psychotherapy” (Weinberger, 1993, p. 43). This approach has been influenced largely by the extensive work of Jerome Frank, particularly his classic book entitled Persuasion and Healing (Frank, 1961, 1973, and co-authored with his daughter, J. D. Frank & J. B. Frank, 1991). Frank’s writing on common factors amounted to a meta-model of psychotherapy, rather than a specific approach to therapy. Wampold (2001; Wampold & Imel, 2015) has adopted Frank’s broad common factors conceptualization of psychotherapy, calling it a contextual model of psychotherapy, and contrasting it to the medical model, which purports that theory and technique (i.e., specific factors) are the keys to therapeutic effectiveness.

As we have noted earlier, Wampold’s (2001) and Wampold and Imel’s (2015) thorough analysis of psychotherapy research provides compelling empirical support for the common factors/contextual model of psychotherapy. Although Wampold (2001) clearly attributed the meta-model discussed in his book to Frank, because of Wampold and Imel’s (2015) further conceptual development and empirical validation of the model, we see this model as a joint product of these authors’ work. We will review the common factors/contextual model of Frank and Wampold and Imel in some depth before considering more specific common factors therapy models.

Summary

It needs to be emphasized that these four broad approaches to eclecticism are not mutually exclusive and “the distinctions may be largely semantic and conceptual, not particularly functional, in practice” (Norcross, 2005, p. 10). For example, it is unlikely that models within technical eclecticism and common factors approaches totally ignore theory, and it is quite likely that all of the approaches to eclecticism incorporate an emphasis on common factors.

We should note that there is another trend within the overall trend toward eclecticism, which is the development of eclectic/integrative therapies for specific populations and problems. Prominent examples of these include Linehan’s (1993; Heard & Linehan, 2005) dialectical behavior therapy (DBT) for borderline personality disorder, McCullough’s (2000, 2006) cognitive behavioral analysis system of psychotherapy (CBASP) for chronic depression, and Wolfe’s (2005) integrative psychotherapy for anxiety disorders.

We do not count these eclectic/integrative therapies for specific populations and problems as a fifth classification of approaches to eclecticism because each of these more specific therapies can be subsumed under one of the four broader approaches to eclecticism. For example, DBT and CBASP can be classified as assimilative integration models because, although they integrate a number of different theories, their primary theoretical base is cognitive behavioral. Wolfe’s therapy for anxiety, however, can be classified as a theoretical integration model because it blends psychodynamic and cognitive behavioral views of and treatment strategies for anxiety.

Finally, we would like to note that research on eclectic/integrative models has increased substantially over the years, although it still lags behind research on single theory approaches. In a review of research on eclectic/integrative therapies, Schottenbauer et al. (2005) concluded that there is substantial empirical support (i.e., 4 or more randomized controlled studies) for 7 such therapies, some empirical support (i.e., 1–4 randomized controlled studies) for another 13, and preliminary empirical support (i.e., studies with nonrandomized control group or no control group) for another 7. In 1992, Lambert predicted:

It would seem that Lambert was right. Still, we agree with those researchers who contend that it would be more productive to focus research on exploring common factors and therapist factors that impact on outcome than continuing to focus on validating individual models of therapy, whether these are single theory or eclectic models.

Comparison of Relationship-Based Theoretical Eclecticism to the Four Major Approaches to Eclecticism

Our approach to eclecticism is different from technical eclecticism in that it emphasizes the use of multiple theoretical perspectives, rather than focusing primarily on the techniques that are derived from theories and matching these to client characteristics or problems. It is different from theoretical integration because it does not attempt to synthesize or “smush” theories. Relationship-based theoretical eclecticism is different from assimilative integration in that it does not promote primary reliance on one theory of practice. Similar to these three approaches to eclecticism, however, our approach supports the idea of drawing techniques from a wide variety of theories, depending on their fit for particular clients. In contrast to some models in these approaches, however, our approach to matching techniques to client variables (e.g., coping style, level of resistance, stage of change) relies at least as much on worker judgment as empirical evidence.

There are two reasons why we do not favor an exclusive reliance on empirical evidence for choosing techniques. First, we agree with Stiles, Shapiro, and Barkham (1995) and Wampold and Imel (2015) who contended that there is not enough empirical evidence to warrant firm decisions about such matching of techniques to client variables. Second, we do not like the mechanistic flavor of some prescriptive matching models because individual clients are too unique to rely on formulaic decisions about a certain type of intervention for a certain type of client or problem.

For these reasons, we favor what has been called responsive matching (Stiles et al., 1995). “Responsive matching is often done intuitively, we suspect, as practitioners draw techniques from their repertoire to fit their momentary understanding of a client’s needs” (Stiles et al., 1995, p. 265). This type of matching should draw on theory and empirical findings but is more tentative and open to modification based on sensitivity to the client’s response: “it is grounded in both theory and observation of the individual case” (Stiles et al., 1995, p. 265). In the same vein, Garfield (1995) has argued that:

Such an approach fits well with our valuing of the artistic, reflective, intuitive-inductive aspects of practice.

As mentioned, our approach to eclecticism has the most similarities with common factors approaches, particularly with regard to the emphasis placed on the worker–client relationship. Similar to all common factors approaches, and supported by a vast body of research, we emphasize the importance of a trusting, collaborative, supportive, warm, empathic helping relationship that is focused on instilling hope, boosting morale, and empowering the client. Other common factors that have received strong empirical support, and that we endorse, include addressing and resolving problems in the worker–client relationship (Norcross & Wampold, 2011), achieving consensus on problem formulation and goals (Ackerman et al., 2001; Norcross & Wampold, 2011), soliciting and responding supportively to client feedback (Miller et al., 2005; Norcross & Wampold, 2011), supporting emotional expression/catharsis, providing the client with mastery experiences (Lambert, 2013b), and helping clients attribute change to their own efforts (Weinberger, 1993). Also, we agree with Wampold’s (2001) recommendation that, at least in parity with the emphasis placed on learning theory and technique, clinical practitioners should be trained to “appreciate and be skilled in the common … core therapeutic skills, including empathic listening and responding, developing a working alliance, working through one’s own issues, … and learning to be self-reflective about one’s work” (pp. 229–230).

Relationship-based theoretical eclecticism differs, however, from most common factors approaches in how theory is used in practice. Although Garfield’s (1995) model does support the eclectic use of theory, this is largely with regard to choosing techniques and procedures for intervention. Curiously, in Garfield’s (1995) book, there is virtually no discussion of using various theoretical perspectives in the assessment process to develop understanding of the client’s situation, which is a central feature of our approach.

Although the common factors/contextual model of Frank and Frank (1991) and Wampold and Imel (2015) espouses the value of multiple theoretical perspectives, there are important differences between their use of theory and ours. Wampold and Imel (2015) and Frank and Frank (1991) argued that practitioners should learn as many therapy models as possible so that they can better match or modify a model to fit clients’ worldview or understanding of their problems. This follows from Frank’s (1961; Frank & Frank, 1991) use of the word myth to underscore his contention that the accuracy of a theoretical rationale for the client’s problem is less important than its plausibility in the eyes of the client. He argued that any explanation of their difficulties that clients can accept alleviates distress and engenders hope. Thus, Frank allowed for the therapist to “persuade” the client that his or her theoretical rationale makes sense or to modify his or her preferred theoretical understanding to fit better with the client’s understanding.

What is missing from the common factors/contextual model is the emphasis our relationship-based theoretical eclecticism places on an open, holistic assessment that is conducted collaboratively with the client. In this process, the views of both worker and client are considered together with multiple theoretical perspectives in an effort to build a comprehensive and shared understanding of the client’s situation. This process allows for the development of understanding by both worker and client that may be different from and/or more comprehensive than either of their initial understandings of the problem. A more comprehensive understanding of the problem situation can lead to formulation of strategies for intervention that have a higher likelihood for success. We agree that it is necessary to eventually arrive at an understanding of the problem that fits for the client, but we think that an open, collaborative exploration/assessment can not only expand awareness of the problem and potential solutions, but can also foster the development of a strong therapeutic alliance and a sense of empowerment for the client, all of which help to overcome demoralization and instill hope.

One of the most important distinguishing features of our approach to eclecticism, which stems from its grounding in social work’s generalist perspective, is that it is broader in focus and scope of intervention than most of the approaches to eclecticism that are in the clinical psychology literature. The generalist perspective of social work demands a holistic, person-in-environment focus that is sensitive to issues of diversity, oppression, and empowerment. It necessitates that direct practice be viewed broadly. Thus, as mentioned earlier, we think that the mandate and role of clinical social work includes helping clients to meet basic needs by providing them with or linking them to resources and services, engaging in social advocacy, and supporting clients to engage in broader social change efforts.

It is heartening and worth noting that some of the leaders of the movement toward eclecticism in clinical psychology are also beginning to attend to a traditional social work holistic focus. In a consideration of the future of psychotherapy integration in the concluding chapter of Norcross and Goldfried’s (2005) Handbook of Psychotherapy Integration, it is suggested that “in order to understand and effectively meet clients’ needs, therapists should attend more to the broader social context of clients’ lives, including social values …, economic realities …, and cultural differences” (Eubanks-Carter, Burckell, & Goldfried, 2005, pp. 506–507). Also, in the introductory chapter to this same volume, Norcross (2005) noted that recent thrusts in psychotherapy integration include focus on multicultural theory, spirituality, and social advocacy. Furthermore, in elaborating upon the necessity for therapists to align their theoretical views with the client’s worldview, Wampold (2001) noted:

Although some might view these recent trends in eclecticism as an incursion by psychologists into the domain of social work, we welcome this broadened understanding of eclecticism in direct practice by an allied helping profession with the hope that all helping professionals can move together in such a direction.

One potential drawback to relationship-based theoretical eclecticism, which is also shared by the common factors and technical eclecticism approaches, is that without a primary theoretical base (as in assimilative integration), or a synthesis of two or three theoretical bases (as in theoretical integration), there can be a lack of structure and guidelines for practice. In our approach, however, this is remedied by the use of social work’s general problem-solving model. As explained earlier, the problem-solving model provides structure and guidelines for practice across all the phases of helping (from engagement to termination), but these are general and flexible enough to allow for an eclectic use of theory and techniques. We think that the use of the problem-solving model to guide practice in our relationship-based theoretically eclectic approach is better than using a primary theoretical base, as in assimilative integration, or using a synthesis of theories, as in theoretical integration. The latter approaches are less theoretically open and have more theoretical biases than a theoretically eclectic approach that uses a problem-solving model. Our use of the problem-solving model has parallels to Garfield’s (1995) common factors approach, which provides general guidelines for what he calls “the stages of the therapeutic process” (beginning, middle, later, and termination stages).