International Journal of Integrative Psychotherapy
The International Journal of Integrative Psychotherapy (IJIP) is the official journal of the International Integrative Psychotherapy Association (IIPA). IJIP publishes original peer-reviewed papers concerning theory, practice, and research in integrative psychotherapy. IJIP accepts papers presenting new developments in theory and practice, case studies, research articles, and papers that review existing work in the area. IJIP is indexed in ERIH PLUS and DOAJ.
International Integrative Psychotherapy Association
Foreword to Volume 17, Number 1 of the International Journal of Integrative Psychotherapy
I am delighted to present Volume 17, No. 1 (2026) of the International Journal of Integrative Psychotherapy. This issue offers an eclectic array of articles: cutting edge research on trauma, two in-depth case studies, and a heartfelt description of how life experiences can impact one’s choice to become a psychotherapist. Each article demonstrates a unique sense of passion and professional commitment to the field of psychotherapy, with the ultimate goal of bringing best practices to our clients.
Copyright (c) 2026 International Journal of Integrative Psychotherapy
Untangling the Skein: From Substance Dependence to Trust in the Relationship
This clinical case study condenses knowledge from 30 years of working in the world of addictions as an integrative psychotherapist. The theory (the map) is not the territory. By using relational methods, we can transcend the label of "addict" and get to know the human being behind it; this facilitates bond development and internal contact. The client recognizes himself, and is re-integrated, in the mirror that the therapist offers. The relational failures, especially early ones, that have been experienced by the client shape internal processes and the client’s relationship with the outside world. The substance takes on a stabilizing and regulating function in the face of emotional pain. A secure psychotherapeutic relationship is required to achieve this same stability and regulation. A conscious and nonreactive countertransference is crucial, as is the managing of the shadows, prejudices, fantasies, and internalized models of help. This way the client can show his vulnerability, have a true and reparative encounter, and overcome his addiction—his life script.
Life Experiences That Have Shaped Me as an Integrative Psychotherapist
This is an expanded version of the keynote speech John Hallett gave at the International Integrative Psychotherapy Association’s 2025 conference in Ljubljana, Slovenia. In this keynote, Hallett shares the experiences and learnings that have shaped him as a psychotherapist. He starts with the influence of his parents and follows with significant occurrences in his life that were pivotal for his development as a person and an integrative psychotherapist.
Eye Movement Desensitization and Reprocessing
Grief, the Body, and Script: An Integrative Psychotherapy Case Study
This article presents a case study conducted in accordance with the principles of integrative psychotherapy. The study addresses the physical and psychological difficulties experienced by a 36-year-old female client who lost both her father and her older sister to cancer within the same year. Over the course of two years of therapy, full-contact, relationship-oriented, and developmentally based interventions were utilized. The case study focuses particularly on the concepts of grief, the body, and script. Throughout the process, inquiry, attunement, and involvement—methods that facilitate contact—were employed, resulting in a strong healing effect on the client’s script beliefs. The study also details the dynamics of transference and countertransference within the therapeutic process. This case study is written for the attention of professionals working in the field of integrative psychotherapy.
Increasing awareness of physiological symptoms of C-PTSD: A qualitative analysis
Complex trauma has unique impact on survivors, distinct from what is commonly seen in Post Traumatic Stress Disorder (PTSD). Complex Post Traumatic Stress Disorder (C-PTSD), has established diagnostic criteria in addition to what is seen in PTSD, as well as implications for impact to the physical self. This study uses secondary data analysis to further increase awareness of the physiological symptom presentation of C-PTSD. The data analysis shows physical symptoms as result of complex trauma are equally present as other diagnostic criteria in a sample of 187 individuals who completed a survey exploring symptoms. Qualitative analysis further examines the phenomenon of physiological symptoms from a sample of 12 survivors of complex trauma. Themes identified in qualitative analysis include: elevated stress response, pain, disconnection and disregard for the physical self. Results of this study highlight the importance of integrating presence of physiological symptoms into therapeutic approaches to ensure best clinical practice.
The Consumer Culture, the Client, and the Clinician
The purpose of this keynote presentation is to explore how consumer culture shapes our clients’ sense of self and their relationships with others, and how integrative psychotherapists can respond. I begin by explaining how humans evolved in villages that wired our minds for connection, and how, over the past 20,000 years, these villages have all but disappeared, leaving us to navigate life in a monolithic consumer culture. In this culture, we are set up to have our relational needs go unmet—as two parents alone can’t do what an entire village once did—leading to a fragmentation within ourselves. I then describe how the culture exploits our unmet relational needs, hooking us into cycles of purchasing and achieving, and turning us into its consumers and producers. I explore the healing that psychotherapists can facilitate in their clinical work today, drawing parallels to the kind of healing that once took place within our ancestral villages. Finally, I offer a vision for how therapists can support clients, not only in coming home to themselves and building more meaningful connections with others, but also in creating communities (villages) of care. I challenge the isolating patterns of consumer culture and deliver an important take-home message: therapists can, and must, play a vital role in helping clients build nourishing communities that support and sustain the growth cultivated in therapy.
Copyright (c) 2025 International Journal of Integrative Psychotherapy
The terms empathy and compassion are often used interchangeably when, in fact, they represent and reflect different ways of expressing care for ourselves and others. Empathy calls us to actively engage in and be impacted by the emotional experience of another. Compassion prompts us to act on behalf of those who are in distress, in measurable and actionable ways. This article, based on a closing keynote speech delivered at the 12th Biennial Conference of the International Integrative Psychotherapy Association, explores the relationship between compassion, spirituality, and the practice of developmentally based, relationally focused integrative psychotherapy.
Carol Merle-Fishman, Editor-in-Chief, introduces Volume 16, Number 2 of the International Journal of Integrative Psychotherapy.
When and How I Became a Developmentally Based, Relationally Focused Integrative Psychotherapist
In this adaptation of my keynote address, I describe the client-centered therapy, Gestalt therapy, transactional analysis, psychoanalytic, and existential philosophy influences in my professional life that have led to the refinement and elaboration of various concepts of developmentally based, relationally focused integrative psychotherapy.
Laughter and Humor in the Therapy Room and the Impact on Security, Reliability, and Compassion
This keynote was chosen because there is a paucity of literature on the topic of humor use in therapy. The presentation identifies humor as a therapeutic skill and provides the reader with some ideas around competence and incompetent use in therapy. When humor is used purposefully, it enhances connection, but when used without thought, it can create distance and confusion.
This article is based on a keynote address delivered at the 12th International Integrative Psychotherapy Association Conference (Ljubljana, Slovenia, May 8, 2025). It explores the proposition that the therapist’s state of being, beyond technique or verbal intervention, plays a central role in the therapeutic process. Drawing on contemporary research in physiological synchrony, the author highlights the bodily and physiological dimensions of psychotherapy, with particular emphasis on physiological attunement and the therapist’s embodied presence. Physiological attunement is introduced as a newly defined sixth component of the Keyhole model of integrative psychotherapy (Erskine et al., 1999/2023; Žvelc & Žvelc, 2021). The article argues that mindful awareness and self-compassion support therapists in regulating their autonomic arousal and conveying cues of safety to clients, which are key factors in fostering effective therapeutic involvement. A transcript from a therapy session is included to illustrate psychotherapy beyond words. In the final section, the author reflects on broader relational fields that support healing beyond words, drawing inspiration from Māori perspectives on interconnectedness, nature, and ancestry. It concludes with a guided practice, inviting readers into embodied, compassionate presence.
psychotherapy beyond words, physiological attunement, mindful awareness, self-regulation, integrative psychotherapy, Māori wisdom, embodiment
This article provides an adapted transcript of the Presidential acceptance speech made in 2023 at the IIPA Conference. The speech considers the role of AI in therapy and references how IIPA is represented currently with ChatGPT. A request is made for all members of the audience to go onto this platform and re-educate the current material that is presented there, which is incorrect and is not representative of how we see ourselves.
Integrative psychotherapy, ChatGPT, artificial intelligence, philosophy, the keyhole, chatbots
Intersubjectivity and the Shared Third Perspective in the Therapeutic Relationship
The relationship between two people and their own individual subjectivity, each with their own mental processes, requires mutual recognition of the existence, needs, and perspective of the other. The recognition of subjectivity in the therapeutic relationship is a co-created process that leads to a shared third perspective from which to reflect about the relationship and regulate the conflicts of the dyad. In integrative psychotherapy, the recognition of the client and the therapist as two different subjectivities co-creating the therapeutic relationship is expressed through inquiry, attunement, and involvement with the relationship’s four components: acknowledgment, normalization, validation, and presence (Erskine, 1997, 2015; Erskine & Trautmann, 1996). The client may bring through transference with the therapist old relationships in which his or her subjective perspective was not sufficiently taken into account. The intersubjective therapeutic relationship is a co-created process in which the two participating subjectivities experience a “shared third perspective,” from which both can reflect on their own relationship and feel a sense of “we.” Recognizing that the client has a separate mind with their own needs and experiences is key to treating disorders of the self, fostering the evolution of the subject from his or her arrest at an experience of disconnected emerging self-states, such as psychosis, Autism spectrum disorder, Asperger’s syndrome, etc., acquiring a coherent a nuclear self and, beyond, experiencing an intersubjective and verbal self (Stern, 1985).
Intersubjectivity, integrative psychotherapy, autism spectrum disorder, Asperger’s syndrome, mirroring, mirroring relating
I am delighted to bring you Volume 16, No.1 (2025) of the International Journal of Integrative Psychotherapy. This issue brings an array of riches, perspectives, and opportunities to explore integrative psychotherapy “in action” through six distinct yet interrelated articles.
Finding Home: My Journey as an Integrative Psychotherapist
Our early experiences have a strong influence on who we become as therapists and how we develop a personal philosophy about the meaning of our work. In this keynote, the author discusses how a history of “lost” childhood homes, and the absence of a secure base, impacted her personal and professional growth and the creation of a world view about the necessity of a sense of “home” in order for deep healing and integration to occur. The importance of helping clients find “home” within themselves, and in their world, is also explored. This article is an adaptation of a keynote originally written and delivered in 2019.
Psychotherapy of Relational Withdrawal: Perspectives from a Client and Therapist
This article presents a unique form of psychotherapy research. Rather than using a parametric research design involving several participants, the single-person research format presented here makes use of three significant components: a verbatim transcript of a recorded psychotherapy session; a detailed description of the client’s internal experience during and after the psychotherapy session; and the psychotherapist’s reflections on what he was feeling and thinking. Additionally, this article describes how to engage in an in-depth psychotherapy for the client who is emotionally sequestered and relationally withdrawn. It emphasizes how relationally withdrawn clients have a particular need for a sensitive psychotherapist who is responsive to their fear laden and non-verbal affect states—a state of being that may be present but often overlooked in a verbal psychotherapy.
Wayne: The Emptiness of the Unloved Child
This article describes the in-depth psychotherapy of a client who was an unloved child. His presenting problems were alcoholism and a nagging sense of emptiness. Through a developmentally based, relationally focused integrative psychotherapy, and with the assistance of AA, the client was able to stop using alcohol, remember his experiences of neglect and abuse, express his internalized anger, and establish a sense of contentment with himself.
Stimulus, Structure, and Relationship: An Integrative Psychotherapy Theory of Motivation
The integrative psychotherapy theory of motivation is composed of three parts: stimulus, structure, and relationship. This theory of motivation determines which theories of personality can be integrated and which are conceptually inconsistent and do not integrate into a unified, comprehensive theory of human functioning. When theories of motivation and personality have an internal validity and consistency, they work together as a conceptual organization for a unified theory of therapeutic method.
Gender, Sexual, Erotic, and Relationship Diversity (GSERD)
This paper was presented at a psychotherapy conference. The purpose was to look at gender, sexual, erotic, and relationship diversity. Sally presents her own personal and professional history, as a psychosexual therapist, of meeting diversity in the therapy room. She provides definitions of current terms and ways to consider opening up the topic with clients. She challenges the heteronormative positions and delivers an important take home message around keeping curious, open and not making assumptions. Please be advised that this Keynote contains sexually explicit language and descriptions of a variety of sexual behaviors and lifestyles. This content is meant for educational and supervisory purposes for trained psychotherapists and counselors and those in training. If you believe that this content would be inappropriate for you in any way, please refrain from reading beyond this point.
Copyright (c) 2024 International Journal of Integrative Psychotherapy
Empathy, Empowerment, and Self-Agency in Psychotherapy
Empathy is the ability to emotionally connect with another’s internal sensations and experience. Attunement goes beyond empathy by providing a reciprocal response to the other’s rhythm, affect, and relational needs. We provide empowerment when we validate the function of the other person’s style of thinking, fantasies, and stories. Self-agency is the result of having all of our relational needs acknowledged and validated.
This keynote speech describes the significance of a relationally focused and developmentally based psychotherapy in the treatment of shame, using the author as a clinical example. Richard Erskine (1994) defines shame as a complex process involving five emotional dynamics: 1) sadness at not being accepted as I am, 2) fear of rejection for who I am, 3) compliance with how I am being defined, 4) disavowal and retroflection of anger, and 5) a core belief that something is wrong with me. Each of these components of shame are discussed and exemplified in this speech.
Introduction to “The Manchester Trilogy: Keynotes of Note”
We are pleased to offer three Keynotes delivered in November 2024 at the Manchester Institute for Psychotherapy’s conference on “Empowerment – Empathy – Self-Agency Within the Therapeutic Relationship” (https://mcpt.co.uk). Each Keynote, delivered by a leading expert in Developmentally- focused, Relationally-based Integrative Psychotherapy, offers a unique perspective on the theme of the conference and the importance of creating an empowering environment for relational healing in Integrative Psychotherapy, the role of empathy within that relationship, and the therapeutic necessity to support self-agency as a positive therapeutic outcome.
Psychometric Properties of a Brief Spanish Version of the Experiences in Close Relationships (ECR) Instrument Applied to Significant Others
Measuring attachment in adulthood is still a challenge. Despite progress in developing brief instruments, there are currently no instruments that assess attachment to significant persons without being limited to a specific type of relationship. The present study aims to develop a brief scale to assess attachment to significant persons (SP), as well as to provide evidence of validity and reliability. For this purpose, the brief Spanish version of the Experiences in Close Relationships instrument was used. 385 emerging adults, divided into two groups, Spanish psychology students and psychotherapists, completed the study online. A two-factor structure (Anxiety and Avoidance) was supported through confirmatory factor analysis. Likewise, evidence of convergent and concurrent validity, respectively, was provided through correlations with the Inventory of Parent and Peer Attachment and the Relational Needs Satisfaction Scale. The scale also demonstrated gender (men vs. women) and age (18-25 years vs. 26-30 years) invariance and adequate internal consistency. The study has allowed us to obtain a brief 11-item psychometrically robust scale—the ECR-SP11—which helps to understand attachment styles in clinical practice and psychotherapeutic research. The instrument’s applicability through more heterogeneous samples should be explored.
Development and Preliminary Evidences of the Validity of Erskine's Relational Needs Scale
Erskine’s Integrative Relational Psychotherapy is founded in a theoretical model that proposes eight relational needs, but there is a lack of an assessment instrument to facilitate research and therapeutic exploration. The development of a new scale to assess the eight needs is described including expert analysis, comprehensibility testing, and a preliminary study of its factorial structure and validity. Results show an optimal apparent and content validity (concordance kappa coefficients between .62 and .96), a high reliability (Cronbach alpha .96 for total scale and above .76 in the eight dimensions), and promising psychometric data. Future research work is discussed, especially the possibility to refine the scale, reducing the number of items in studies with more heterogeneous and ample clinical and normative samples.
Dear Readers, I am delighted to present Volume 15 (2024) of the International Journal of Integrative Psychotherapy. This volume brings an array of riches. You will have an opportunity to explore cutting-edge research from our Spanish colleagues and immerse yourself in some deeply personal statements from a few of our most wise and esteemed leaders in IP.
A time in the ashes: How grief can liberate us from our life script and our culture of separation
This article sheds light on how humanity fell into today’s collective sorrows, falling from a time of great hospitality into a culture of great separation. It explains how this cultural fall plays an integral role in the inner fragmentation we each experience early in life, when each of us break apart into adult, child, and parent ego states; and it explains how this takes each of us far away from our natural relational self and into an individual and collective life script. Most importantly, it explores how embracing the grief of where we are, within ourselves and within our culture, comes with the remarkable power of liberating us from these scripts and bringing us home to each other. But, to arrive here, we must each endure a time in the ashes.
Nature in integrative psychotherapy and supervision
In the article the author describes how we can integrate nature into relational integrative psychotherapy and supervision. A proposal for an expanded model Self-in-relationship is given. The integration of nature into different relational methods is presented. The author explores different ways of working outdoors like using mindfulness, metaphors and equine assisted supervision. Possible consideration and difficulties when working therapeutically outdoors are discussed. At the end ecological and spiritual topics in outdoor therapy are considered.
Review of Mindfulness and Compassion in Integrative Supervision by Maša Žvelc and Gregor Žvelc, Routledge, 2024
Mindfulness and Compassion in Integrative Supervision is a highly accessible and comprehensive guide that will be a valuable resource for both experienced clinicians with years of providing supervision as well as those who are beginning to expand their scope of practice into this area. This model provides a structure that can be applied to the supervisory relationship within most theoretical paradigms, particularly those that are relationally focused and value working with the intersubjective through incorporating many universal themes related to change and growth in human relationships.
Presence and Involvement: Personal Perspectives on Countertransference
Reactive countertransference is nontherapeutic, whereas responsive countertransference is an integral aspect of psychotherapy when the psychotherapist is attuned to the client’s affect and needs. Personal examples are used to illustrate the concepts of responsive and reactive countertransference. Awareness and use of each form of countertransference is essential. The psychotherapist’s stance of presence and involvement delineates the necessary elements of an effective relationally focused psychotherapy.
Copyright (c) 2023 International Journal of Integrative Psychotherapy
Memory Reconsolidation Through EMDR in an Integrative Psychotherapy: A Case Example
This article describes memory reconsolidation and how the author uses the concept to explain the success of a psychotherapy session using eye movement desensitization and reprocessing (EMDR). A transcript of the session is provided to demonstrate how the author works in a relational way and to give a personal example of how memory reconsolidation occurs in everyday life.