We all come into this world as individuals and leave the same way. Ultimately, any clinical approach that purports to deal with relational systems (couples, families, organizations) also must be able to illuminate a path that permits individuals to address problems, adapt to their circumstances, and to grow. Such an approach, therefore, must be able to account for the complexities and ambiguities associated with being an individual while at the same time living within a web of social relationships. Arthur Koestler, in his book The Ghost in the Machine (1967, p. 48) coined the word “holon” in an attempt to reflect the fact that while we are all always relating to others we still can and must act in a autonomous and self-determined manner as individuals. So, any clinical approach must be integrative in that it has to be able to permit a simultaneous appreciation of the individual’s relationship with and to himself/herself as well as offer a concurrent “view” of his/her relationships with others.
One of my past teachers at the Family Institute of Chicago was Bill Pinsof and he developed such a clinical approach which he called integrative Problem-Centered Therapy and is now referred to as Integrative Problem-Centered Metaframeworks Therapy. This approach allows the clinician to see the client from the many perspectives that impact his/her life; the individual in relation to himself as well as the individual in his relationship to the significant others in his/her life now and from his/her past. This multilayered lens provides a powerful vantage point for the helper in understanding the external presses and internal pressures that each of us have to contend with in navigating our life circumstances. Pinsof’s approach also provides the helper with a roadmap of sorts to assist in making judgments about how to choose the best interventions in helping the client, e.g., the present problem or past history (individual or relational or some mix of the two), present day individual concerns or relational- based issues, and cognitive or emotional (past or present or both) regulation. As can be seen from these decision points, the clinician must come to appreciate the specific problems of each client, why their problems developed when they did, and the specific ways in which these problems have been maintained over time. I have found that a problem-centered approach permits such an appreciation while a clinical approach based just on diagnosis, theoretical orientation, or a prescribed treatment philosophy is much more likely to produce a “one size fits all” understanding of each individual case.