Integrative Psychotherapy claims a flexible, holistic approach to psychotherapy, designed to meet the full range of client needs by drawing on a broad range of schools and approaches within a coherent framework. Currently, there are several approaches widely adopted by clinicians including Theoretical, Common Factors, Assimilative and Technical Eclecticism.
In the U.K Gilbert & Orlans (2011) offer a prominent, foundational approach to integration within a relationally orientated, humanistic framework. This attempts a meta-theoretical framework that centralises the therapeutic relationship as a key component for integration, foregrounds the importance of clinical research to inform practice, and considers the role of client idiosyncrasy. The framework explicitly attempts to understand several domains of relationship relevant to the therapeutic encounter including the self as a spiritual entity (the transpersonal domain). Gilbert & Orlans approach remains committed to a social constructivist, relational, phenomenological position, preserving post-modern assumptions regarding the co-creation of relationship. Their underpinning philosophy is established on the works of Kant, Hegel and writers within phenomenological and existentialist traditions.
Aims of this paper.
In this paper, I discuss the theoretical and philosophical tensions inherent in their model which I argue become prominent when attempting to use their framework to integrate transpersonal (psycho-spiritual) experiences. It’s possible such tensions influence the way integrative psychotherapists using this model conceptualise, think, view and act towards transpersonal encounters. It’s also possible that these tensions may be unhelpful and even harmful for clients when therapists attempt to operationalise their framework for transpersonal experiences. Integrative frameworks are designed to allow the practitioner to bring together several or more approaches, claiming this permits the therapist to meet the client where they are in the fullest sense. To do this coherently however becomes a more challenging task with the inclusion of the transpersonal. In part, this is because transpersonal experiences by their very nature challenge the theoretical and philosophical limits of what can be considered real and meaningful through the models dominant within mainstream western medicine.
Transpersonal psychology classifies such experiences as Exceptional Human Experiences (EHE) White (1993) that often occur spontaneously, and frequently during altered states of consciousness (ASC) Ludwig (1966). In such cases, the ASC may or may not have been induced deliberately. Here Parapsychology favours the term anomalous experiences (AE) to also describe the same phenomena although some within this field consider an AE a precursor to a full blown EHE, see White (1997, 1998a) and Brown (1998). Either way, both disciplines study these experiences:
particularly for their meanings and their transformational potentials in the lives of the experiencers. EHE typically consist of mystical experiences, psychic experiences, encounter experiences, unusual death-related experiences, exceptional human performances, healing experiences, desolation / nadir experiences, and dissociation experiences, Palmer & Hastings (2013).
Qualitatively, “transpersonal experiences may be defined as experiences in which the sense of identity or self extends beyond (trans) the individual or personal to encompass wider aspects of humankind, life, psyche or cosmos”, Walsh & Vaughan (1993).
Within integrative psychotherapy, how these types of experiences are understood and engaged with varies greatly amongst practitioners. This is influenced by the philosophical position adopted by the individual therapist and that which their chosen theoretical frame of reference infers and can facilitate. The aim of this paper is to help broaden the understanding of how integrative psychotherapeutic frameworks equip practitioners to work with experiences sitting towards the edges of what can be understood through current frameworks. This paper forms part of my developing research question and thinking towards a PhD proposal. Currently this is being explored around the following research question;
How do integrative psychotherapists engage with exceptional human experiences in clinical practice, and what theoretical and philosophical resources enable or constrain that engagement?
Why this research is important. A cultural and clinical contextualisation of EHE in Western society today.
We are arguably living through times where the culture has never been more complex and diverse. Carried by a global economy, the inevitable cross-pollination of knowledge and ideas shows no sign of slowing. The wide-spread adoption of digital technologies appearing to expedite this process may even increase the occurrence of EHE in today’s society. For e.g., over the past two decades there has been a significant resurgence of interest in contemplative practices and psychedelics across Western cultures. Both are increasingly recognised as methods for inducing altered states of consciousness (ASC) with potential therapeutic significance (Jiwani et al., 2025). Such practices as these are now widely adopted by many and have even become embedded within well-established subcultures as both emblem and method. A good example of this can be seen in the electronic music scene which in the U.K, arose circa 1989 / 1990 onwards. Drawing on my own long-standing interest in this movement, I have seen first-hand how people routinely engage life in ways which both encourage and enable ASC and EHE in a normalised, matter-of-fact way. Whatever view one might take on this from a legal, moral, ethical and regulatory perspective, whilst all important, what cannot be ignored is that this is happening. That these types of experiences occur, and that EHE are being brought into, and occur in psychotherapy, Blades (2023). This has consequences.
For practitioners, I argue this requires awareness of one’s own beliefs and philosophical commitments in regards to EHE phenomena including how one reconciles this clinically / theoretically. Research shows clients who engage therapy having had an EHE are often reluctant to disclose their experiences in therapy for fear of being pathologized or seen as “mad” by the therapist, Roxburgh, E. C. and Evenden, R. (2016). Furthermore, research conducted on the prevalence and phenomenology of EHE, found that “44% of a sample of 226 therapists had experienced EHE in the therapeutic setting, but that these experiences came as a shock to therapists and challenged their concept of reality”, Roxburgh, E. C. and Evenden, R. (2016). Dein (2012) also highlighted that according to Targ, Schlitz, and Irwin (2000): in most countries where surveys have been conducted, psi (paranormal) related experiences have been reported by over half the population. A prevalence of over 50% has been found in surveys undertaken in North America, Great Britain, and other countries in Europe, especially Iceland, the Middle East, Brazil, South Africa, Asia, and Australasia, Cardeña, Lynn, & Krippner, (2000).
This is perhaps no surprise when we consider that some people routinely alter their states of consciousness via a variety of means, leading to experiences that are exceptional, unusual, and anomalous. The data shows, while these experiences may be considered 'non-ordinary’, they are by no means rare, and inevitably find their way into the therapy room. Consider this, a ‘normal’ Saturday night might, for some people, include a face-to-face encounter with an entity resulting from a DMT (dimethyltryptamine) experience, or shamanic journey. Another could experience an unusual dissociative or unitive state as a result of a meditation retreat. Further still, another could die on a hospital bed during routine surgery, only to watch themselves being resuscitated from an unusual vantage point within the same room.
In any case, these experiences all have an impact on the psyche. Where required, they need processing and integrating in a way that feels safe and meaningful to the experiencer, like all good therapy. When this does not happen, and depending on the psychological structure of the experiencer, the EHE may become a source of overwhelm leading to what is sometimes termed a spiritual crisis or spiritual emergency, Grof & Grof (1992). This term broadly describes a form of disruption in the psyche which may become mistaken for something unhealthy if not handled in a careful and informed manner. This is directly relevant for psychotherapy as:
pathological and spiritual experiences cannot be always distinguished from each other in form or content. Similarities exist between transpersonal and pathological experiences, but there are diagnostic features that necessitate different case conceptualisations and clinical interventions, Kaminker & Lukoff (2013).
Gilbert and Orlans as a suitable framework for working with EHE.
Gilbert & Orlans (2011) position their framework as a specialist training pathway for therapists built on the humanistic challenge to positivistic psychology, established on the phenomenology of the likes of Kant, Hegel et al. Their inclusion of the transpersonal however may be more aspirational than operational when considering these philosophical commitments. In particular, attention is explicitly given to the foundations of their epistemology as being rooted in Kant’s phenomenon / noumenon distinction. That the object-in-itself can’t be directly known, and only known as it appears to the observer. While this holds weight from a localised ego bound perspective, they draw a remarkable conclusion from this that, "any one theoretical perspective as a potential 'truth' within the psychological therapies becomes impossible." This is a sizable philosophical leap to make such a claim. This removes epistemic potentiality dissolving it into an unnecessary globalised relativism. Kant’s transcendental idealism is a specific, technical claim about the limits of knowledge, it doesn't simply warrant "therefore no therapeutic model can claim truth." This is a decisional limitation imposed upon the framework by their philosophical commitments creating a boundary for what the framework can subsequently hold. From this perspective they make a further opaque claim that functionally resolves their position into a typically constructivist ontology. As, at the heart of their framework, lays the claim all relationships are co-created. To extrapolate Kant’s epistemic claim about the limits of knowledge i.e. we can't know the noumenon, only the phenomenon is simply that, a claim regarding the limits of knowledge, not a claim that reality is relationally co-constructed. This is not a neutral ontological statement and, is presented in an unexamined and unnamed manner. This appears to move quickly from a type of epistemic humility about ultimate truth to a relational co-creative ontology as operative stance. While Gilbert & Orlans openly advocate for practitioners to continually develop their own meta-perspective, if one takes their framework as the starting point, it is not possible to do this coherently when it comes to the transpersonal domain. This is because the framework is fundamentally predicated on an ego-based psychology, relational, social constructivist phenomenology, presented as a methodology that is also workable for the transpersonal. How can this be? Not only do they derive a constructivist practice methodology from a Kantian epistemic premise that doesn't entail it, they also claim a transpersonal domain through an ego-based psychology that doesn’t entail it, but forecloses it. While therapists need frameworks that are flexible and free of the burden to conclusively resolve ontology, this cannot be at the expense of foreclosing ontological possibility or the epistemological means of engaging it. Particularly if part of the requirement is to provide an operative methodology inclusive of phenomena and experiences that lay beyond the skin incapsulated ego. It is reasonable to assume therefore that therapists at the very least need ways to conceptualise ontological possibility when faced with phenomena that can rock the very foundations of a person’s sense of reality. Surely, this cannot be at the expense of a client’s, or for that matter a therapist’s, sense of what is real and meaningful in the world.
Therefore, I argue this is not enough. This is again particularly pertinent to psychotherapy when one considers the range and nature of EHE. Consider such examples as near-death experiences and evidence from veridical psi (scientific parapsychology) research. In these cases awareness, or the consciousness of the experiencer, are not bound by locality (time and space) in the same way a socially constructed, co-created ontology would require. Therefore, conceptual possibility of such phenomena becomes automatically foreclosed as being epistemologically plausible. Is it not reasonable therefore to consider how this influences the therapists beliefs about what is real and meaningful, and in turn, how they then respond when faced with phenomena that may not only oppose their own worldview, but also their clinical frame of reference? We might also consider here for a moment the ethical dilemma this creates for therapists. Even with the best intentions to, amongst many others matters, do no harm, they now become faced with doing the very thing they wish not do by virtue of their training and the framework used. This does of course assume some degree of awareness of such matter on behalf of the therapist. We therefore may also reasonably ask, how much more important this then becomes where the therapist has not arrived at an operative position regarding the transpersonal.
Most significantly, where Gilbert & Orlans, (2011) directly engage the transpersonal domain and relationship from an operative perspective, they determine in both cases that these fundamentally represent a form of disconnection in the client. I argue this illustrates the limits of their conceptualisation and underpinning philosophy. Clients are described as generally coming with some form of fragmentation between body, mind, and spirit which means that they “should rightfully include some concern for the spiritual domain of experience”. Here the transpersonal arrives from a pathologizing position. Hycner (1993) is used to substantiate this position and their stance towards both the transpersonal domain and relationship starts from a position of lack, and as they state, separation, void, anxiety and emptiness. Viewed as driven by a spiritually repressed anxious society with anxious individuals, the disconnection they warrant is said to be restored most often by pseudo substitutes. Coming from, and as referenced by them, the likes of “money, drugs, sex, and television”.
Particularly revealing here is the case referenced by Gilbert & Orlans (2011) from Maguire (2001) to illustrate the transpersonal “most directly and poignantly”. This comes from work with torture victims and survivors of extreme situations. Maguire (2001) is directly quoted describing how trauma of such inhumane proportion can take its victims to “another realm of existence”. I do not disagree that this can be the case. However, their reliance on this single case example is illustrative of a deeper limitation I believe. This example falls within the dissociative category of EHE. The reliance here on a singular EHE category leaves the fuller range of transpersonal phenomena conspicuously unaddressed. I suggest that in the case of Gilbert and Orlans this indicates the limits of what a socially constructivist ontology can accommodate when meeting phenomena pushing against its boundaries. The transpersonal is being essentially conceptualised through the lens of deficit and reparation rather than treated as phenomenon with independent epistemic value.
Conclusion.
Gilbert & Orlans framework is to be commended in its aspiration to integrate the transpersonal into the therapeutic relationship. They make interesting and valid points around the contribution this brings to those clients for whom the search for meaning may be considered transpersonal. And this may well be the limitation of their framework. The transpersonal here as limited and constrained by existentialism, and relational phenomenology. EHE require a broader, more inclusive epistemology that leaves the door open on ontological certainty. This permits not only the scope of transpersonal phenomena but also the range of the philosophical commitments of practitioners. Where frameworks foreclose possibilities for experiences that are happening, yet remain outside the scope of what a framework can contain, leads to conceptual confusion. This tracks my own experience of interviewing practitioners regarding EHE which indicated a need for practitioners to smuggle in unexamined philosophical commitments and theories to help conceptualise their clients experience. If this is more widely found to be the case, it may be in-part responsible for producing a type of inconsistent, belief-dependent quality of care that Roxburgh’s data also points to. To qualify the potential of this gap further, a wider literature review is required across other key models of integration to identify repeating patterns. If this is demonstrated it would warrant the need for further study. The major deliverable of such a project would be to create a report derived from a broader sample of the actual experiences of integrative psychotherapists in regards to this matter. This would evidence how they engage with exceptional human experiences in clinical practice, and what theoretical and philosophical resources enable or constrain that engagement. This could generate the required data to support further downstream projects to help design integrative frameworks in a way that coherently includes the scope of transpersonal experiences.
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