Vol.:(0123456789) 1 3 Clinical Social Work Journal https://doi.org/10.1007/s10615-020-00769-6 ORIGINAL PAPER Levels of Meaning and the Need for Psychotherapy Integration Jerome C. Wakefeld 1,4  · Judith C. Baer 2  · Jordan A. Conrad 1,3 © Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract We argue for the importance of multitheoretical integrative clinical intervention and training. Mental health professionals, including clinical social workers, are frequently primarily committed to a single dominant therapeutic theory, perhaps one that was favored by a school, feldwork agency, inspiring teacher, or infuential supervisor. However, each such theory tends to target just one aspect of the extraordinarily complex human meaning system that scientifc research has shown to operate at biological, neuroscientifc, behavioral, cognitive, unconscious, family-systems, and cultural levels in complexly interacting ways. We know that any monotheoretic intervention approach likely fails to help a substantial number of clients, implying an ethical imperative not to equate failure to respond to monotheoretical treatment with clinical failure. Thus, there are persua- sive scientifc and ethical arguments supporting the move toward psychotherapy integration in which multiple theories and their associated techniques are seen as part of a larger theoretical and interventive metasystem. Such integration is especially urgent in clinical social work with its diverse and often multi-problem clients. In this article, we consider the reasons for integration, review the levels of the human meaning system that interact in normal and abnormal functioning and thus jus- tify a multitheoretical approach, examine recent research in support of integrationist practices, and ofer the example of the natural conceptual convergence occurring between cognitive and psychodynamic approaches to illustrate how, as theories mature, they tend to converge and recognize the same reality of the human meaning system. Keywords Psychotherapy integration · Cognitive theory · Psychodynamic theory · Stepped care · Technical eclecticism · Assimilative integration · Common factors · Theoretical integration Introduction In this paper, we explore the rationale for psychotherapy integration, a movement that aims to integrate diverse models and techniques in order to better understand psy- chological problems and improve treatment processes and therapeutic outcomes. The goal of psychotherapy integration is to move the therapist’s work with clients from depend- ence on one particular theoretical orientation that provides a single lens for understanding clinical work to an open- ness to and capability of using multiple empirically validated theories and ways of working. The primary orientation of the integrative approach is to use what works and what yields understanding, with an acknowledgment that the truth about psychological problems and their treatment transcends any one theory and involves many strands from among the rich set of available models. Integration thus ofers relief from the unjustifably bellicose traditional divisions of the feld. As Castonguay and Goldfried (1994) note, “Eforts at rap- prochement and integration sharply contrast with the acri- monious debates that prevailed in the feld a few decades ago” (p. 159). As reasons for the attractiveness of inte- gration, they mention the goal of greater efectiveness of treatment as well as greater societal pressures for therapist accountability. Based on arguments we present below, we believe that an integrative approach should be the standard approach in clinical social work education and that this view should be seen by students as one criterion for the adequacy of their clinical education. It should be emphasized that integration as we propose it does not require indiscriminate acceptance of every * Jerome C. Wakefeld jw111@nyu.edu 1 New York University, New York, NY, USA 2 Rutgers, The State University of New Jersey, New Brunswick, NJ, USA 3 Katholieke Universiteit Leuven, Leuven, Belgium 4 Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003, USA