Therapy Craft and Science
Much is said of models. There are value systems, philosophies, and arguments about models. IMCT affords the chance to eliminate the conceptual "baggage" and vagaries that can accompany modular thinking like, Gestalt, RET, CBT, NLP, Hakomi, hypnosis, Freud, Jung, TA, counselling, "therapy", psychotherapy, behaviour therapy and so on and so on.
Thus, one selects a skill from any model and employs this under certain conditions. Perhaps relaxation therapy is an example of a skill, which is used in many ways across many models and with many other skills e.g. hypnosis, regression work, behaviour therapy, and systematic desensitisation. Similarly counselling "skills" pervade our practice, as do "communication skills". Perhaps the client is the final judge for they, are never a model, they are, simply "themselves" and whatever works for them seems appropriate as distinct to whatever model or philosophy may suit. Hence, inevitably a model is put forth but a unifying one not a divisive, inaccessible, knockdown, "mine is better than yours" system. Clinical experience suggests that it is easier to master and integrate the different modular skills than is first thought. One can drive a car very competently without a knowledge of electronics, physics, plastics, mechanics, hydraulics, geological knowledge of oils and so on. One learns what is necessary and how to coordinate these diversities. In fact one can drive many models of car once the basics of one are mastered. IMCT is one such model.
Integrated not eclectic
Eclectic is a word that seems to reassure a lot of professionals that they are acceptable to many value systems that seem to conflict. Unfortunately, these models and their magical connotations still exist we just swap the baggage occasionally. It is difficult to drive many cars at once but one can build a great car and drive it using the best ingredients from many other vehicles!
Integrated skills is a freeing concept where one is client centred, determining which skill is working with whom and when. One is also free to blend skills without calls of "heresy"! One's mind is freer to create, on a momentary basis a tailoring of skill-blends that suit the dynamic nature of therapy.
Finally IMCT allows an open system where a training body, a skilled professional and the feedback from one to the other can continue evolving, a craft where skills are added, blended and tested in open dialogue rather than with competitive schools and models.
Random Controlled Trials (RCT) are vital but 'post'- Clinical Evidence is avant-garde
It is essential to have evidence-based procedures. A clinician always stays abreast of current valid research. More so, a good clinician is in addition aware that clinical evidence is vitally important as to what is working with each individual client. The clinician in IMCT format experiments with different approaches to further the cause of the client. Unfortunately, looking to only 'researched' therapy means that the focus becomes regressive, looking only at what has been previously established. This may even cause the clinician to doubt their own judgement or experimentation.
If we take the example of Beck (1979), he had validated a 'package' of skills after he had experimented with them in his clinic. How else did he know they were worth researching? The clinician must courageously accept the position of being a true leader in therapy research, whether that person conducts it for themself or leaves it for someone else to follow in their footsteps. Hence IMCT encourages the clinician to be up to date and avant-garde, searching always for what is genuinely working with the individual client. Further whilst not all skills in this IMCT package are on their own evidence-based, we trust that the use of them is and this is explained in the next segment. Suffice to say here that we wish students to be exposed to many varied skills so that they can experience them at this training stage and make up their own choices and decisions about the skills.
The Ghost in the machine?
The clinician becomes existentially aware that it is the individual that is responsible for the progress of therapy and not the model of therapy. Like the previous car analogy we can say that the model cannot drive itself, it must be driven. Your will is the driver and you are the guiding decision maker as to what competent skills you choose in order to "get the client to their destination".
Several super-ordinate skills permeate and insure IMCT success. These are vital, clinical skills.
The client is seen as co-author in the process of skill application. The therapist has the skills and to criterion expertise but the client is essential to success. This becomes clearer under the notion of "Inner Tracking".
2. Inner Tracking
Inner tracking is essentially the clinician's empiricism. (Empiricism to imply the observation and experimentation process pertinent to this clinical level of experience.)
3. Multi-level focusing
It is important that IMCT is seen as a multi-level process. If one incorporates so many skills then one must be respectful of the levels of the psyche that they were originally intended for. It is clear for example that relaxation therapy, (RT) affects many levels at once; somatic, physiological, emotional, and cognitive. This is why we use RT preliminary to imaginal or hypnotic procedures; it does not just quieten the body but also the mind and allows superior recall, attention and access to unconscious processes.
4. Closing skills
A 'mysterious process' that does not have a ready dialogue is the one surrounding the finalizing of effect. This may be stated as "what heals or works" in the final microscopic analysis.
The issue of closure highlights in a systematic way the need to focus as much as possible on this vital issue. The questions we ask as therapists are "what is this client seeking? What will cease this pain, end this anxiety, what will aid this person to truly face their phobic stimulus". Another important question is also here "and which level of healing is indicated?" With a process of inner tracking and clear clinical construction we have the concept of closing skills—"the methodical and conscious selection of skills and their construction to knowingly complete the healing effect".
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