*European Association for Integrative Psychotherapy. (2025). The professional competencies of an integrative psychotherapist. Retrieved 31.01.2025. [https://www.euroaip.eu/training-and-supervision/the-professional-competencies-of-an-integrative-psychotherapist][This document has been translated using OpenAI’s ChatGPT model (version GPT-4) to ensure an accurate and professional translation.]BHIDAPA Academy of Psychotherapy
Integrative psychotherapy is unique among psychotherapy modalities because it has two dimensions of identity, which correspond to two different aspects or conceptual levels of psychotherapy as a whole. In this way, it offers the field of psychotherapy insight into the challenge it faces—the task of creating a unified theory of psychotherapy. These two dimensions are as follows:
1. General and methodological form of identity: Assimilation of other approaches.
The creative dilemma of integrative psychotherapy
At the logical level of meta-analysis, integrative psychotherapy possesses a general and methodological identity thanks to its ability to assimilate elements from different psychotherapy modalities. Here, a conceptual distinction is made between constructing submodalities at the content level—which will be addressed in the second dimension—and the meta-conceptual logic of integration, insofar as it is defined as adopting elements from other modalities. This integration allows any meaningful combination or synthesis of different modalities to be considered integrative, thereby distinguishing it from certain (though not all) multimodal and eclectic approaches. The only necessary criterion for this is the existence of a sufficiently grounded basis for the synthesis to be meaningful, to constitute an authentic integration, and to have retrospective criteria that validate it.
At this meta-level, integrative psychotherapy operates as an experimental methodology for the process of integration and thus can serve as a mirror that illuminates not only the process of psychotherapy but also the formation of any psychotherapy modality. This raises the question of what actually constitutes the unity of a psychotherapy. It should be emphasized that elements of integration exist in all contemporary psychotherapy modalities.
At the level of content, integrative psychotherapy has the identity of a modality
At the level of content, integrative psychotherapy possesses the identity of a modality, regardless of the form of integration adopted. These content-based types of integration may include: the overlap of common factors; personality integration; unification through stances on the degree of client-centeredness or relational dialogue.
Many psychotherapy approaches began in this way and, over time, became independent modalities. This implies that, on the one hand, no content-based modality is completely closed and rigidly delimited, and that all approaches to some extent include elements of integration at the content level. On the other hand, at the meta-level, modalities—although crucial for the development of the field of psychotherapy—are not in themselves sufficient to resolve the question of what constitutes the identity and theoretical foundation of psychotherapy as a whole. This leaves one fundamental question unresolved.
However, our primary goal in developing these competencies is to provide a detailed overview of a specific type of approach to integration.
EAIP integrative approach
Our EAIP integrative approach belongs to the second dimension—the identity of a modality—and is grounded in the dialogical relationship, the process, and the related developmental and aspirational dynamics.
DOMAIN 1: PROFESSIONAL, AUTONOMOUS, AND RESPONSIBLE PRACTICE
For the European integrative psychotherapist (hereinafter: the Integrative Psychotherapist), professional practice implicitly entails an ethical and volitional dimension, situated within the framework of Kant’s practical rationality. In this context, the integrative psychotherapist should creatively engage with the tension between autonomy and professional responsibility.
Autonomy entails and requires personally responsible action, which is a mark of maturity, self-responsibility, and personal authority in an individual who has undergone life-span developmental processes as well as psychotherapy training and personal development.
Professional responsibility, which ethically exists within the social contract (Rousseau), represents a radical obligation, yet it is not reducible to mere obedience to legal, social, and political rules. The integrative psychotherapist inevitably works with conflicts, from which creative problem-solving may emerge—though not always. There are personal and existential limits regarding intervening or refraining from intervention, but abdicating responsibility is not an option.
At the level of knowledge, the integrative psychotherapist strives to:
- To be aware of and able to critically evaluate the available knowledge and wisdom within the written and oral traditions of the profession, drawing on different modalities and broader relevant sources of knowledge.
- To take into account the developmental–relational nature of psychotherapeutic work.
- To engage in the everyday process of self-discovery and understanding of others, which forms the basis for research, the evidence base, and the profession’s qualitative foundation.
At the level of practice and socialization, the integrative psychotherapist strives to:
- To cultivate a harmonious and as authentic a public presence as possible.
- To create an appropriate working environment.
- To obtain the necessary support from colleagues or relevant authorities when needed.
The integrative psychotherapist is competent to:
1.1. Establish a professional practice
This entails building a personal relationship and working alliance with clients, as well as respecting legal and professional aspects, including financial arrangements, appointments, and the duration of the therapeutic process.
1.1.1. Acts Professionally
Professionalism is based both on relationships and on establishing personal and professional boundaries, which have a contractual and legal dimension.
1.1.2. Builds an Independent Practice or Becomes a Member of a Professional Team
This is founded on the principles of good collaboration, such as Nolan’s Seven Principles of Public Life: selflessness, integrity, objectivity, accountability, openness, honesty, and leadership.
There is also a legal and contractual dimension to this aspect.
1.1.3. Approaches Work According to Professional Standards
Using an appropriate theoretical foundation, the psychotherapist integrates broader social dimensions, legal requirements, and ethical criteria. A qualified integrative psychotherapist uses their own judgement to balance the weight and importance of different factors.
1.1.4. Maintains Accurate Records
The integrative psychotherapist records necessary information, supplementing it according to professional judgement, while bearing in mind that all records may be subject to legal requests or court subpoenas.
1.1.5. Collaborates with Other Professionals
When necessary, the psychotherapist is competent to work with other experts, paying particular attention to: differences in professional language and approaches; power structures within relevant institutions; ethical and legal norms; and the principles of non-violent dialogue.
1.1.6. Recognises Difficulties Faced by Other Professionals in the Workplace
The integrative psychotherapist is aware of the challenges and limitations that other professionals encounter.
They suitably adapt their work with relevant skills, understanding, authority, and creativity.
1.1.7. Monitors, Critically Evaluates, and Revises Their Workload
Case load review is essential for professional development.
Each therapist uses their professional judgement to determine the most appropriate way to approach a client.
1.1.8. Maintains Fitness to Practise
Different therapists apply different methods to preserve their professional capability.
There is a minimum standard that everyone must meet in order to remain competent to practise.
1.2. Ensure an appropriate environment
This is a general requirement, further specified as follows:
1.2.1. Ensure a safe working environment
This pertains to both physical and psychological safety, including confidentiality, protection from accidents and potential violence, hygiene and care for the environment, an appropriate level of professional decorum without excess, a relaxed yet unobtrusive approach, and similar aspects.
1.2.2. Ensure a psychotherapeutic environment
This partially overlaps with the previous requirement, but the emphasis is adapted to the therapist’s individual approach. It may include elements of play, a focus on verbal communication, body-oriented work, and similar methods that suit a given therapist and their working modality.
1.2.3. Establish clear agreements
Similar criteria apply to agreements on session timing and the process of professional communication—it is necessary to strike a balance between the professional framework, the individual approach, and a certain degree of informality.
1.3. Ensure quality control
This concerns the entire spectrum of service provision in the manner already described. Quality control may include more or less formal elements, depending on the therapist and the context in which they operate.
1.3.1. Regularly evaluate practice
The means and methods of evaluation vary among therapists, but are necessary at all times, regardless of how they are carried out.
1.3.2. Review practice
This may lead to different types of audits and critical reflections on practice at various stages of the integrative psychotherapist’s development and career.
1.4. Maintain continuous professional development
Professional development encompasses a wide range of approaches, depending on the therapist, context, and national standards. The importance of continuous learning has already been noted, and it is crucial for all integrative psychotherapists to prevent stereotyping, rigidity, and non-individualized responses.
This development may include workshops, but is not limited to them—for experienced therapists, deep inquiry and creative work can be equally valuable forms of development.
1.4.1. Reflect on oneself and one’s professional work
Methods of self-reflection and processing experiences are at the core of the integrative psychotherapist’s work.
1.4.2. Incorporate research findings into practice
This may entail various research approaches, reading and reflecting on the latest studies and publications, as well as ongoing supervised practice.
1.5. Maintain personal development
This may include different forms of self-work, such as alternative supervision, personal therapy, and similar experiences.
DOMAIN 2. PSYCHOTHERAPEUTIC RELATIONSHIP
The working alliance represents a common therapeutic factor that consistently predicts psychotherapy outcomes across all major approaches. As such, it is recognized as a key integrative variable (Castonguay et al., 2006). A competent integrative psychotherapist understands that developing a positive working relationship is an important principle of change, because it not only facilitates the application of techniques but can, in itself, offer opportunities for transformative and corrective experiences.
Competence in this domain includes not only facilitative factors (see Ackerman & Hilsenroth, 2003), but also the continuous assessment of the alliance, recognition of alliance ruptures and interpersonal conflicts, and familiarity with various methods for repairing them, which requires the ability to view the alliance from multiple perspectives (e.g., facilitative conditions and/or collaborative empiricism).
2.1. Establish a psychotherapeutic relationship
In developing the therapeutic relationship and working on the client’s difficulties, a competent integrative psychotherapist is able to:
2.1.1. Continuously formulate the client’s difficulties through the lens of integrative psychotherapy.
2.1.2. Provide a receptive, sensitive, and appropriately bounded therapeutic relationship.
2.1.3. Carefully help the client gain awareness of their cognitive, emotional, behavioral, social, and spiritual functioning, validating their past and present experiences.
2.1.4. Accept and respect the client’s defense mechanisms and adaptations as ways they attempt to understand and cope with their world.
2.1.5. Help the client recognize the connection between early developmental deficits and current relational patterns.
2.1.6. Support the client in understanding their defenses and adaptations as creative adjustments or survival strategies that no longer serve them.
2.1.7. Tolerate, affirm, and normalize seemingly overwhelming emotions in the client and in themselves, regulating affect appropriately.
2.1.8. Work at a pace that suits the client and, over an extended period, enable an emotionally reparative relationship.
2.1.9. Anticipate the possible direction of therapy.
2.1.10. Recognize and work within the transference and unconscious processes that arise in therapy, using countertransference responses sensitively in the client’s best interest.
2.1.11. Recognize and repair ruptures in the therapeutic relationship.
2.1.12. Devote special attention to the therapeutic relationship.
2.2. When conducting the initial assessment, a competent integrative psychotherapist is able to:
2.2.1. Establish a professional relationship and communicate empathetically with the client.
2.2.2. Gather relevant information about the client’s past, including psychological, medical, and family history, as well as sociocultural/transcultural factors. Establish the client’s goals and assess their suitability for psychotherapy. Assess the nature and severity of the client’s difficulties, their connection to intrapsychic processes, and how they manifest in interpersonal relationships.
2.2.3. Assess the level of the client’s personal and social resources (e.g., resilience, coping abilities, family and social support).
2.2.4. Be aware of standard mental health classification systems where applicable and recognize one’s own professional boundaries. Assess the client’s capacity to form a therapeutic alliance—their motivation, commitment, capacity for insight, and psychological mindedness.
2.2.5. Provide information about the nature and process of integrative psychotherapy.
2.2.6. Enable a certain degree of hope while also ensuring a realistic outlook.
2.2.7. Recognize contraindications for therapy and/or one’s own professional limits and, if necessary, refer the client to another specialist.
2.2.8. Enable the client to develop a deeper level of self-compassion and a sense of meaning.
2.2.9. Regularly reflect on the appropriateness and effectiveness of intervention strategies and the therapeutic relationship, using supervision for support and challenge in the work.
2.3. In working with the process of therapy termination, a competent integrative psychotherapist is able to:
2.3.1. Manage premature discontinuations of therapy.
2.3.2. Allow sufficient time for planned endings, recognizing and challenging avoidance or denial of therapy termination.
2.3.3. Recognize, accept, and work with feelings of loss and/or separation anxiety.
2.3.4. Review the work to date, including the effectiveness of therapy relative to the initial goals, and consider the client’s future expectations and hopes. Enable reflection, reminiscence, grieving, and celebration of what has been achieved.
2.3.5. Model the capacity to let go and move forward.
2.3.6. Recognize and acknowledge the impact of previous endings/losses on the client’s experience and, where possible, offer an opportunity for a different experience of ending.
2.3.7. Recognize and accept situations in which the therapist proposes or imposes termination when this is not appropriate for the client, consider the possibility of renegotiation or, if continuation is not possible, recommend an appropriate referral.
2.3.8. Seek supervision when facing challenges in maintaining boundaries related to termination.
DOMAIN 3. RESEARCH (ASSESSMENT, DIAGNOSIS, AND CONCEPTUALISATION)
A competent integrative psychotherapist is able to:
3.1. Conducting assessment
3.1.1. Use of assessment tools: This may include developing a clear policy and/or implementing institutional procedures for assessment, ensuring they align with the organization’s aims, ethos, and objectives and the therapist’s theoretical perspective. It also includes developing and/or applying pre-assessment tools, providing clear and transparent information to the prospective patient/client about psychotherapy and forms of assessment, and, where applicable, using pre-assessment information in the initial assessment interview to shape the subsequent process and the outcome of the interview. Assessment tools can be used flexibly, in an integrative manner consistent with different theories and modalities. Therapists from different approaches within integrative psychotherapy may employ different working methods, depending on the degree of open relationality or a systematic approach.
3.1.2. Conducting the assessment interview: This may include ensuring transparency of the assessment process and the client’s clear understanding of it; conducting the interview in a manner consistent with the aims, ethos, and objectives of the organization and of integrative psychotherapy; and eliciting—to the extent possible—the client’s problems, insights, and difficulties. It also includes recording significant past events, previous psychological problems or periods of stress, inquiring about prior psychotherapy experience, and keeping detailed assessment records. The assessment encompasses cognitive, emotional, psychodynamic, humanistic, and systemic aspects. Where appropriate, the therapist will use their own countertransference as part of the assessment process.
3.1.3. Conducting risk assessment: This may include knowledge of the service’s risk-assessment procedures and their critical application in line with ethical guidelines; recognising language used by the patient/client that may indicate self-harm or violence toward others; asking direct questions about intent to harm self or others; facilitating the client’s ability to speak openly about suicidal thoughts and quantifying the likelihood of acting on them; assessing the client’s overall support system; and involving the client in the assessment process through a clear, empowering, and sensitive approach.
3.2. Diagnostic formulation* (Note: The term “diagnosis” is used here in a broader sense, not solely in a medical or psychiatric context.)
3.2.1. Recognizing and critically evaluating possible mental health problems: This may include vigilance for possible indications of mental health needs, mental disorders, or mental illness; assessing or diagnosing any social, relational, somatic, and/or emotional difficulties associated with mental health; using prior knowledge, training, and experience in psychopathology; involving the client in the mental health assessment process; ensuring that any assessment or diagnosis is in line with organizational policies, the aims and ethos of the integrative/multimethodological perspective, and national medical/psychiatric guidelines; recognizing personal limits of competence.
3.2.2. Recognizing and evaluating possible psychological difficulties not classified as mental disorders: This includes assessing the nature and intensity of the difficulties, their connection to the client’s intrapsychic processes, and how they manifest in interpersonal relationships; assessing the client’s level of personal and social resources (e.g., ego strength, coping strategies, social support); assessing the client’s potential to establish a therapeutic alliance—their motivation, commitment, capacity for insight, and psychological mindedness; gathering relevant data on psychological, medical, family, and sociocultural/transcultural history.
3.2.3. Recognizing and evaluating the impact of various factors on the emergence and maintenance of the client’s difficulties, which includes an integrative conceptualization of the problem: This encompasses a cognitive conceptualization of the difficulties; recognizing the impact of emotions; understanding the connection between attachment systems and the client’s problems; understanding systemic diagnostic factors; knowledge of and work with stages of change; a psychodynamic conceptualization; and an appreciation of spiritual factors.
3.2.4. Responding to the client’s needs: This includes establishing a professional relationship and communicating empathetically with the client; discussing possible outcomes or strategies, as far as possible; recognizing the need for advice, support, or another professional assessment by a supervisor, manager, or mental health consultant; responding promptly to indications of mental difficulties to ensure appropriate intervention; critically assessing and evaluating any immediate risk to the client, the therapist, or others in cases of deteriorating mental health or the emergence of psychiatric disorders, and taking appropriate measures if needed; recognizing signs of substance misuse (including prescription and over-the-counter medications) and taking appropriate action if necessary; working in collaboration with other mental health professionals in line with the aims, ethos, and objectives of the integrative perspective and in accordance with national medical/psychiatric guidelines.
Regulatory and self-regulatory aspects of the client’s experience should always be part of the assessment process. Where appropriate, the integrative psychotherapist should use their own (embodied and relational) countertransference throughout the entire assessment process.
DOMAIN 4. ‘CONTRACTING’ (DEVELOPING GOALS, PLANS, AND STRATEGY)
A competent integrative psychotherapist is able to:
4.1. Contracting with the patient/client
4.1.1. Formulation of the main issues: This usually includes the following criteria, but it can also be much more open depending on the relationship and experience between the therapist and the client. It entails critical reflection on the assessment (and sometimes the contradictory information within it) and on information from other sources; the ability to integrate all these perspectives; articulating the patient’s/client’s key problems and possible causes; presenting (or reflecting) these perspectives to the patient/client in a sufficiently appropriate and sensitive manner so that they can understand and accept them; verifying the accuracy of these formulations and discussing the parameters that shape them; ensuring that this formulation is reasonably consistent with the basic ethos and theoretical understanding of integrative psychotherapy.
4.1.2. Identification of appropriate and attainable goals, plans, and strategies: This includes consideration of the patient’s/client’s prior history and economic, social, emotional, intellectual, and psychological capacities; recognizing potential contraindications or conducting a risk assessment; discussing the duration, frequency, costs, setting, and external parameters (including the patient’s/client’s relationships) of the planned treatment; considering issues of confidentiality; distinguishing what is realistically achievable from what may be beyond the client’s capacities.
4.1.3. Discussion of the patient’s/client’s motivation: This includes understanding their wish and motivation for change and the factors that brought them to this point; recognizing and assessing the level of the patient’s/client’s self- and other-awareness; appreciating possible factors that might hinder their ability to fully engage in the psychotherapeutic process; recognizing their capacity to understand their own psychological functioning and to take responsibility for their own process.
4.1.4. Making a decision on the duration of psychotherapy: This includes a critical assessment of the nature of the patient’s/client’s key problems; a clear explanation of any limits on the number of available sessions (e.g., due to institutional policy or insurance, where applicable); an explanation of the process of regular reviews at different stages, especially if the contract is open-ended; making an informed and mutually agreed decision on the suitability of integrative psychotherapy and the expected number of sessions.
4.1.5. Establishing a ‘contract’: This includes taking into account the patient’s/client’s circumstances; negotiating mutually acceptable terms and conditions; defining rules on cancellations or missed appointments, policies related to holidays and illness, fees and costs of psychotherapy, and possible strategies or alternatives in the event of a ‘contract’ breakdown.
4.1.6. Moderating the ‘contract’: This includes critical evaluation and revision of the contract and re-assessment of goals at regular intervals; listening to the patient’s/client’s feelings and experiences; consulting with a supervisor (where applicable); taking into account changes in the patient’s/client’s circumstances and in psychotherapeutic practice.
4.1.7. Enabling the option of referral to another professional: This includes checking whether the patient/client is satisfied with the therapist; being clear about the likelihood of meeting the patient’s/client’s needs; being open to offering and explaining other options; facilitating a potential referral to another psychotherapist or mental health professional; discussing alternatives.
4.2. Planning psychotherapy
4.2.1. Utilizing evidence of psychotherapeutic practice effectiveness: Within integrative psychotherapy there is a wide range of working methods—from those that rely on quantitative data to those that draw on experience, intuition, countertransference, and other criteria. Therefore, the therapist should, as far as possible, use evidence of practice effectiveness, including a critical appraisal of appropriate and effective treatments for the patient’s/client’s specific problems; providing information on recommended strategies; and ensuring that the methodology they use has sufficient evidence supporting its effect on the patient’s/client’s specific problems.
4.2.2. Relying on psychotherapeutic theory: This includes critical reflection and evaluation of theoretical perspectives of integrative psychotherapy that may be useful in the patient’s/client’s context, with awareness of other theoretical orientations; using theoretical perspectives relevant to the patient’s/client’s specific difficulties; explaining these approaches to the patient/client in an understandable way; defining their implications in developing the psychotherapy strategy; having knowledge of theory from at least two major psychotherapeutic schools; and the ability to adopt a meta-perspective on theory.
4.2.3. Deciding on a psychotherapy approach or strategy in accordance with the client’s readiness: This includes discussing different options with the patient/client; explaining the advantages and disadvantages of various strategies; using clinical experience and research to propose strategies with reasonable prospects of success; making a joint decision on the most appropriate approach for the patient/client and their specific problems; and building or fostering an ongoing self-reflective component on both sides that monitors and develops the strategy.
4.2.4. Moderating the plan or strategy in line with the implicit criteria of integrative psychotherapy: In integrative psychotherapy, the approach can be intuitive, spontaneous, and not fully defined, so it is important for the therapist to be flexible in shaping the therapeutic process. This includes critical reflection and evaluation of one’s own experience as a key element in the psychotherapy process, and adjusting aspects of theory and practice that become relevant at a given moment; using the self-reflective aspects of clinical experience, professional practice, one’s own therapy, and supervision to modulate affect and the choice of interventions; ongoing self-reflective practice; and sensitivity and flexibility regarding the current situation and the patient’s/client’s emotional state, allowing this to influence the choice of interventions in the moment, without necessarily deviating from the overall plan.
DOMAIN 5. DIFFERENT TECHNIQUES AND INTERVENTIONS
A competent integrative psychotherapist is able to:
5.1. Using different techniques and interventions
5.1.1. Identification of appropriate techniques and interventions: This includes using the previously conducted assessment of the patient’s/client’s problems and difficulties to decide which techniques or interventions are suitable at that moment; being aware of possible contraindications for certain techniques or interventions.
5.1.2. Identification of appropriate modalities of interaction: This entails flexibility in approach; the ability to modify or adapt the approach; at times offering support and encouragement, at times taking a more directive or educational stance, and at times confronting the patient/client with certain aspects of their process—all in line with the situation and the client’s needs. It also involves finding a healthy balance between professional intervention and empowering the patient/client, with that balance shifting over time and circumstances; awareness of the differences between the traditional “medical model,” where the patient requires treatment, and the “humanistic model,” where the client chooses to use the therapist’s services.
5.1.3. Monitoring and managing the process of change: This includes awareness of the patient’s/client’s development and process, as well as their varying needs at different stages of therapy; recognizing changes that have already occurred and anticipating possible future changes; flexibility in strategies and interventions in line with changes in the process and context; consistency in working according to ethical guidelines, standards, and professional responsibility.
5.1.4. Managing difficulties: This includes working within the framework of the therapeutic alliance; identifying and analyzing difficulties as they arise; managing interventions that might provoke confusion, discomfort, anxiety, or feelings of offense in the patient/client; addressing situations in which the patient/client experiences discomfort regarding the values, beliefs, or behaviors of others (including the therapist); flexibility in the choice of interventions, mode of expression, and time frame (short-, medium-, or long-term psychotherapy, varying session frequency when needed); awareness of possible alternative techniques and interventions and exploring the feasibility of their application.
5.1.5. Using research-based techniques and interventions: This entails keeping up with the latest findings in psychotherapy, new methodologies and approaches, and research on their efficacy and effectiveness; applying only those techniques and interventions that are appropriate for the patient/client and their situation; ensuring that these techniques are used in a professional and correct manner, based on appropriate training, supervision, and experience.
5.1.6. Ensuring adequate training and supervision: Where needed, this includes additional training through appropriate programs and supervision by qualified supervisors for new and/or different techniques and interventions, so that they are applied professionally and safely.
5.2. Managing the emotional content of sessions
5.2.1. Facilitation of emotional processing: This includes recognizing the patient’s/client’s emotions at different levels; helping to overcome inhibitions and resistance to expressing feelings; enabling the patient/client to experience and explore emotions in a way that facilitates their process.
5.2.2. Maintaining psychotherapeutic ‘intimacy’: This entails being present for the patient/client, regardless of their emotional state at the given moment; developing the capacity for sensory and bodily receptivity as part of psychotherapeutic work.
5.2.3. Managing extreme emotions: This includes the ability to conduct risk assessment; awareness of how to respond if the patient/client becomes hypermanic, panicked, aggressive, or at risk of suicide; undertaking additional education and training if the therapist works with patients/clients who frequently experience extreme emotional states.
DOMAIN 6. PROCESS OF CHANGE; CRISIS INTERVENTIONS AND TRAUMA WORK
Integrative psychotherapy competencies for managing change, crisis, and trauma:
6.1. Working with people in crisis within integrative psychotherapy
Developing awareness of crisis intervention: As an integrative psychotherapist, it is essential to have a comprehensive understanding of the principles and the role of short-term psychotherapy, crisis intervention, and prevention within the context of integrative psychotherapy.
6.2. Working with people affected by trauma
6.2.1. Developing awareness of working with trauma: This includes knowledge of the possible causes and consequences of trauma, symptoms associated with traumatic experiences—including post-traumatic stress disorder (PTSD)—and intergenerational and transgenerational trauma. Understanding the key parameters required for working with individuals experiencing traumatic states, as well as awareness of available options for referring patients/clients to specialized services, constitutes a fundamental aspect of this competence.
6.2.2. Working with people affected by trauma: This entails the therapist’s awareness of their own competencies and limitations when working with individuals who have survived trauma. If necessary, the therapist should refer patients/clients with traumatic experiences to additional specialized trauma treatment services. Additional professional training in trauma work is recommended to enhance competencies.
6.2.3. Developing awareness of challenging moments: This entails recognizing difficult moments during the patient’s/client’s integrative psychotherapy, such as anniversaries of traumatic events or specific triggers of emotional distress, as well as unexpected factors that may activate traumatic reactions.
6.3. Trauma-informed approach and self-care
6.3.1. Application of trauma-informed practices: Integrative psychotherapists have a deep understanding of trauma and its impact on individuals. They apply trauma-informed approaches in their therapeutic interventions, creating a safe and supportive environment that fosters healing and resilience. They also recognize the importance of using sensitive language, adjusting the pace of therapy, and strengthening the sense of empowerment and choice in clients affected by trauma. Where possible and appropriate, additional training in trauma-informed practices and methodologies is recommended. In this process, integrative psychotherapists also take care not to interpret all presentations solely through the lens of trauma and to remain aware of the different ways trauma may manifest.
6.3.2. Prioritizing self-care: Integrative psychotherapists understand the importance of maintaining their own well-being in order to provide effective trauma-focused therapy. They regularly practice self-care, seek supervision and support, and set clear boundaries to prevent compassion fatigue and burnout.
DOMAIN 7. TERMINATION AND EVALUATION
A competent integrative psychotherapist is able to:
7.1.1. Preparing for the termination of psychotherapy: This includes discussing the possibility and inevitability of ending therapy at appropriate moments during the psychotherapeutic process; regularly reviewing progress against the client’s initial goals and any changes to those goals; and attending to the development and significance of the therapeutic relationship, helping the client recognize and acknowledge their achievements and/or disappointments. It also involves helping the patient/client recognize when they feel ready to end therapy and assessing their readiness for that step. The integrative psychotherapist does this within their integrative model, paying attention to the level of integration the client has achieved—intrapsychic, interpersonal, emotional, physical, and, where appropriate, spiritual.
7.1.2. Exploring Feelings Related to Endings:
This includes exploring feelings, anxiety, and unconscious fantasies about “endings”, “loss”, “separation”, or “abandonment”; considering these feelings in the context of the client’s history and experiences, and how they may affect them in the current therapeutic relationship. The integrative psychotherapist supports the client in avoiding unconscious or unwanted repetitions or premature endings. The therapist also explores processes of “integration”, including “individualisation”, “independence”, “autonomy”, and “self-regulation capacity”. The therapist is also aware of their own feelings regarding endings, including bodily reactions to the ending of this specific therapeutic relationship, in order to best support the client’s interests and needs.
7.1.3. Identifying potential risks or difficulties: This includes examining possible premature endings and any (unconscious or transference) issues that may underlie them; considering the patient’s/client’s needs after therapy, including the need for additional sessions or maintaining some form of non-therapeutic contact; and discussing the implications of planned (or unplanned) endings with a supervisor or line manager, where appropriate.
7.2. Managing the conclusion of psychotherapy
7.2.1. Managing the Conclusion:
This involves enabling the patient/client to experience the ending of psychotherapy that is (a) agreed upon, (b) at a time when therapy is reasonably sufficient for them, (c) in a way that reasonably protects them (and others) from risk or harm, (d) as far as possible, relatively free from ‘countertransference’ influences related to ‘loss’ or ‘ending’, (e) allows unspoken material to surface, and (f) enables ‘closure’ to take place naturally. This also includes working with the patient/client to identify a reasonably clear end to psychotherapy.
7.2.2. Review of the process: This may include enabling the patient/client to review their psychotherapeutic process during therapy and any hopes and plans for the future; discussing changes in their perception of self and others, family, cultural and social structures, issues of power and self-esteem in relationships, and questions of attachment and independence; and addressing any potentially irresolvable issues that are unlikely to be concluded within this course of therapy. The therapist enables the client to explore the level of integration across their intrapsychic, interpersonal, emotional, physical, spiritual, and relational aspects of self.
7.2.3. Identification of Issues, Thoughts, and Feelings:
This includes discussing issues, thoughts, feelings, and implications of other ‘endings’, ‘conclusions’, ‘separations’, or ‘breaks’ the client has experienced, and how they affect the current ending. It involves developing thoughts, plans, and strategies for change with the patient/client, taking into account their current situation and relationships; exploring options for continuing their process, possible referrals, ongoing support and information, and future therapeutic alternatives, should the need arise.
7.3. Documentation and evaluation of the course of psychotherapy
7.3.1. Keeping records of the psychotherapy process: This includes concluding (summarizing), maintaining, and storing clinical records in accordance with clinical, local, national, and/or professional criteria; appropriately noting and recording any symptom reduction, other indicators of change (cessation of smoking, alcohol or drug use, return to work, etc.), any changes in circumstances, or satisfactory (or unsatisfactory) outcomes as a result of psychotherapy. It may also be important to record the client’s perception of changes, satisfactions and regrets, and their sense of how they were affected by the therapy and the therapeutic relationship from an integrative perspective.
7.3.2. Evaluation of psychotherapy: This may include using relevant outcome measures, client satisfaction questionnaires, follow-up studies, etc., to assess the efficacy (or effectiveness) of psychotherapy; writing a summary or case history, where appropriate; reflecting on the psychotherapy process and evaluating one’s own performance, issues, and practice; discussing with a supervisor, line manager, or peer supervision group any mistakes that may have been made, how they could have been avoided, learning processes, and/or how something could have been done differently. (see also 2.4.4.)
DOMAIN 8. COLLABORATION WITH OTHER PROFESSIONALS
The integrative psychotherapist is skilled at collaborating with other professionals to ensure a holistic approach to working with clients. This competence includes the following aspects:
Establishing effective communication: In accordance with professional standards—particularly confidentiality—the therapist may communicate with other professionals involved in the client’s care. This includes sharing relevant information, actively listening to others’ perspectives, and creating a collaborative and mutually respectful environment.
Recognizing and respecting professional boundaries: The therapist understands the roles, responsibilities, and expertise of other professionals involved in the client’s treatment. They respect professional boundaries, ensuring the optimal outcome for the client.
Participation in an interdisciplinary team (where relevant): The therapist can actively participate in team meetings and discussions, drawing on their professional competencies and collaborating with professionals from different disciplines. The integrative psychotherapist values diverse perspectives and can contribute to the creation of comprehensive treatment plans.
Sharing relevant information: As a rule, in collaboration with the client, the therapist may share key information about the client’s progress, treatment goals, and interventions with other professionals involved in the client’s care. This ensures continuity of care and enables informed decision-making.
Seeking and providing consultations: The therapist is open to seeking advice and consultation from other professionals when necessary, with the aim of enhancing understanding and effectiveness. They also contribute by sharing their own expertise to support collaborative decision-making.
Respecting confidentiality and privacy: The therapist adheres to ethical guidelines and legal regulations to protect sensitive client information when collaborating with other professionals.
Advocating for the client’s interests: Where relevant, the therapist advocates for the client’s best interests within the interdisciplinary team, ensuring their voice is heard and their unique needs are taken into account. They actively participate in discussions and decision-making processes to promote the client’s well-being.
8.1.1. Becoming familiar with the work of other professionals
The integrative psychotherapist is encouraged to develop an understanding of the work of other professionals involved in the client’s care. This includes:
Researching and understanding the roles and responsibilities of various professionals who may be part of the client’s treatment team, including psychiatrists, social workers, counselors, and other mental health specialists.
Acquiring knowledge of the theoretical approaches, techniques, and interventions used by other professionals. This enables the therapist to gain a broader understanding of different treatment modalities and how they can complement their own approach.
Attending interdisciplinary workshops, seminars, and conferences to expand knowledge about the work of other professionals. This provides opportunities for knowledge exchange, networking, and building collaborative relationships.
Establishing open and mutually respectful dialogue with other professionals to exchange ideas, insights, and best practices. This fosters a spirit of collaboration and enhances the therapist’s ability to work effectively within a multidisciplinary team.
Seeking opportunities to observe or shadow the work of other professionals whenever possible. This provides direct insight into their methods and enables the therapist to gain a practical understanding of different approaches and techniques.
8.2. Functioning as a team member
The integrative psychotherapist is able to function effectively as a team member in collaborative settings. Where appropriate, the therapist may act as an advocate for individuals subjected to oppressive behavior within institutions and systems of care. The therapist contributes to team dynamics by adhering to ethical principles and professional standards, and helps create a supportive and harmonious working environment.
The therapist ensures interdisciplinary collaboration, integrating diverse professional perspectives to enhance the quality of treatment and support for clients.
DOMAIN 9. REGULAR EVALUATION OF PRACTICE
9.1.1. Organizing appropriate supervision: This includes finding a suitably qualified and experienced supervisor (or a peer supervision/intervision group); establishing an explicit agreement on the parameters of supervision/intervision (including frequency, roles, goals, confidentiality, costs, accountability); being honest about one’s own competencies and needs for supervision; ensuring that supervision/intervision complies with all national, professional, and institutional guidelines.
The aim of supervision is to: Improve the quality of psychotherapy that patients/clients receive and the therapist’s professional development and well-being; Ensure that the psychotherapist works within their own competencies and with client groups for whom they are appropriately qualified; Provide support to the psychotherapist in maintaining authenticity in the therapeutic relationship.
9.1.2. Active participation in supervision:
The supervisee can expect supervision to provide support, insight, safety, openness to creativity, careful monitoring and boundary management, engaged dialogue, and a joint exploration of values. The ideal supervisee commits to psychological availability, curiosity, openness to new learning, willingness for dialogue and creative disagreement, commitment to ethics and professional boundaries, and deep respect for the person of the client.
9.1.3. Creative response to challenges in supervision:
This may include: Increasing (or decreasing) the frequency of supervision depending on workload. Reflecting on the quality of supervision and whether it meets personal and professional needs. Seeking additional specialized supervision when working with particularly complex or unfamiliar clinical cases, or in situations of increased risk (for clients or the therapist). Securing additional supervision in cases of personal difficulties, conflicts with clients, dual relationships, complaints, etc. Changing the supervisor or the supervision arrangement, if necessary, after appropriate reflection and discussion. Taking responsibility to ensure that professional supervision/peer supervision is at the highest available standard.
9.1.4. Reflection on practice in accordance with the requirements of professional and accrediting bodies:
This includes: identifying appropriate evaluation criteria and tools (where applicable). Routine (at least annual) systematic evaluation of practice through monitoring client outcomes, annual reviews of the number of sessions per client, client satisfaction questionnaires, and follow-up studies. In doing so, the integrative psychotherapist ensures the continuous improvement of the quality of their practice, in line with professional standards and ethical guidelines.
DOMAIN 10. ETHICS AND CULTURAL SENSITIVITY
A competent integrative psychotherapist is able to:
10.1. Working within an ethical framework
10.1.1. Knowledge of relevant professional and ethical guidelines and codes of conduct: This includes awareness of national legislation related to professional practice in the field of mental health; familiarity with national and European codes of practice and ethical principles applicable to professional psychotherapy and good practices in mental health; and knowledge and understanding of ethical standards relevant to integrative psychotherapy.
10.1.2. Application of professional and ethical guidelines: This entails the ability to use relevant professional and ethical guidelines, codes of conduct, and practice; adhering to appropriate ethical, professional, and contractual boundaries in relationships with patients/clients; obtaining informed consent for interventions; safeguarding the interests of patients/clients, especially when working with other professionals, team members, and the client’s family; recognizing one’s own limitations in competence and the need for additional training; ensuring client/patient confidentiality and knowing when it may be breached; ensuring that one’s practice meets the highest professional standards; and maintaining appropriate standards of personal conduct.
10.1.3. Working with ethical dilemmas: This includes recognizing potential problems, ethical dilemmas, or contradictions between different codes of conduct and practice, or between ethical requirements and job demands; identifying issues such as dual relationships with patients/clients, colleagues, supervisees, students, or subordinates; using supervision or appropriate consultations to clarify ethical questions; analyzing and discussing complex ethical dilemmas with supervisors, colleagues, or the ethics committees of professional associations; identifying and taking appropriate steps (including consultation) in cases of improper practice by other therapists and colleagues; withdrawing from professional activities when personal or professional limits, personal challenges, or situations that may compromise ethical practice are recognized; and implementing necessary changes to ensure the practice remains ethical.
10.2. Working with social and cultural differences
10.2.1. Awareness of cultural and social differences: This includes identifying one’s own cultural and social position and the accompanying assumptions, beliefs, and values; awareness of possible cultural and social differences in relationships with clients, especially if they come from a different social or cultural context; recognizing differences related to class, gender, sexuality (including transgender issues), ethnicity, age, religion, political beliefs, individualism and collectivism; understanding how different social and cultural systems can sometimes be misinterpreted as mental disorders; recognizing how social and cultural factors can affect psychological well-being; understanding how traumatic and/or historical events (e.g., war, migration, climate change, natural disasters, persecution, discrimination) may have different impacts on individuals.
10.2.2. Application of knowledge about cultural and social differences: This includes respecting the personal goals, identities, and value systems of patients/clients and understanding how the integrative therapeutic framework may affect them; exploring how patients/clients see and understand their relationship to their own and other social and cultural issues; understanding the perspectives and value systems of patients/clients, even if they differ from or conflict with the therapist’s beliefs; recognizing the client’s family, social, and historical context and being aware of one’s own possible limitations when working with social and cultural differences.
10.2.3. Working with social and cultural difficulties: This entails gaining additional awareness, information, and consultation and, where appropriate, supervision when working with people from significantly different cultural and social contexts; recognizing that certain populations of patients/clients have experienced significant trauma due to discrimination and oppression; recognizing one’s own social and cultural position and its impact on the therapeutic relationship; facilitating referrals to therapists from the client’s own cultural or social background, where possible and appropriate; recognizing social, cultural, and political barriers to accessing psychotherapy services and working to reduce them; collaborating with social and cultural support groups, specialized professionals, interpreters, and other resources to reduce social and cultural barriers in therapy.
10.2.4. Adapting Practice When Working with ‘Special’ Client Groups:
This involves working with clients who require additional specialist competences and/or whose capacity to give valid consent is in some way limited (e.g., children, individuals with developmental and neurological differences, individuals with communication difficulties, individuals with mental and physical disabilities, individuals experiencing extreme emotional states). Therapeutic work may require additional training, information, and supervision, particularly if the supervisor is not experienced in the specific area.
It also includes ensuring valid consent, agreeing on responsibilities, understanding the needs of the patient/client, and maintaining appropriate communication with parents, guardians, or other relevant persons, where appropriate. Where language or communication barriers are present, interpreters, specialists in alternative communication methods, or patient advocates should be provided. The therapeutic environment should be adapted to the age, developmental stage, and specific needs of the patients/clients, recognising that conditions may be challenging or less than ideal.
10.3. Working in the social, cultural, and political context of psychotherapy
10.3.1. Awareness of the social, cultural, and political context of psychotherapy:
This includes understanding how the field of mental health fits within social, political, and cultural contexts and how this has changed across different historical periods and cultures; awareness of contemporary debates about the organization of social welfare and mental health care systems.
10.3.2. Understanding different political and professional priorities: This includes recognizing professional and political agendas that may shape the provision of mental health services; awareness of differing priorities in the field of mental health and the ways they can affect the therapist’s work.
DOMAIN 11. MANAGEMENT AND ADMINISTRATION
11.1.1. Managing a full workload: This includes awareness of one’s own capacities; ensuring that the therapist is fresh, engaged, focused, and present at the start of each session; starting and ending sessions on time; keeping appropriate notes and client records; planning intervals between sessions to ensure optimal quality of work; avoiding too many sessions in a short period; ensuring sufficient time and space for other professional and personal activities so that professional practice remains clear and effective.
11.1.2. Maintaining appropriate support systems: This entails engaging in regular supervision, participating in case conferences, and evaluating professional work with clients (see also Domain 8); maintaining regular contact with colleagues and taking part in professional discussions; keeping abreast of new developments and trends in the profession, especially in integrative psychotherapy; attending professional seminars, symposia, and conferences; subscribing to relevant scholarly journals; engaging in continuing professional development (CPD); and maintaining status and membership in professional associations.
11.1.3. Regularly managing one’s own professional and personal capacities: This includes actively practicing self-care and managing one’s own resources; ensuring regular breaks, rest, and time for activities not directly related to professional work; in times of personal or professional difficulty, seeking additional supervision, consultation with colleagues, or guidance from a mentor.
11.2. Managing a private practice or small business
11.2.1. Maintaining good business practices, administrative and accounting systems: This includes awareness of good business practices, administrative and accounting systems, and regularly updating and monitoring these areas; aligning operations with local and national legal, accounting, tax, and administrative regulations and requirements; timely filing of tax forms and payment of VAT (where applicable); orderly management of financial obligations, including invoice payments and employee salaries.
11.2.2. Application of relevant regulations: This includes awareness and application of regulations related to health and safety, environmental and economic aspects of business—especially regarding office location and equipment procurement; ensuring adequate insurance for clients, employees (where applicable), and third parties; regularly monitoring the requirements of professional associations and aligning operations with their standards.
DOMAIN 12. RESEARCH
A competent integrative psychotherapist is able to:
12.1. Awareness of research in psychotherapy
12.1.1. Awareness of research in psychotherapy: This includes recognizing the value of research in the systematic evaluation of psychotherapeutic practice; understanding existing psychotherapy research and its impact on current practice; knowledge of different research parameters and methodologies; familiarity with appropriate research methods, especially those related to integrative psychotherapy.
12.1.2. Understanding research models relevant to integrative psychotherapy: This includes understanding research models that align with the philosophy and values of integrative psychotherapy. Given the significant variation within integrative psychotherapy models, there is also a wide range of research methodologies (Finlay and Evans, 2009). However, there are useful starting points, such as the European Journal for Qualitative Research in Psychotherapy, which offers articles on research methodology relevant to psychotherapy. In addition, current work on developing a metamodel of understanding for integrative psychotherapy provides another important point of reference.
12.1.3. Application of research in psychotherapeutic practice: This includes the ability to access a wide range of information sources (books, journals, the internet, databases) that can enhance practice; critically evaluate research and other evidence to act in an informed manner in one’s own practice; use and adapt relevant findings to improve therapeutic work; and remain open to adjusting practice in line with new knowledge and evidence.
The application of research in integrative psychotherapy entails an approach aligned with its fundamental concepts, including: attention to the meaning and subjectivity of the client’s experience; a focus on the phenomenological approach and the exploration of lived experience; mutual reciprocity and a co-created therapeutic relationship; and recognition of the meta-modal aspect of psychotherapy.
12.1.4. Contribution to research in the field of psychotherapy (where possible): This may include conducting, participating in, or disseminating research relevant to integrative psychotherapy. Integrative psychotherapists possess a range of skills useful to the research process, such as:
Phenomenological analysis and research attunement.
Engagement in embodied dialogical encounters with clients.
Capacity for reflexive reflection on one’s own and the client’s emotional responses.
These skills enable the therapist to function not only as a researcher but also as a co-researcher in the joint exploration of clients’ experiences. However, it is crucial that therapists also remain open to learning from the academic research community so that their contribution is validated and supports the development of integrative psychotherapy as a profession.
Integrative psychotherapy has a particularly important role in the field of psychotherapy, as it sits at the intersection of different modalities, enabling innovative approaches and research methods that enrich the profession as a whole.
DOMAIN 13. PREVENTION AND EDUCATION
A competent integrative psychotherapist is able to:
Integrative psychotherapists have the capacity to develop a deep understanding of prevention theories and their application not only within the psychotherapeutic process but also beyond it. They develop specific competencies in prevention and education that are holistic and socially responsible.