A Bit of This, A Bit of That? The Truth About Integrative Therapy

Which therapy is the right therapy? Is that even the question we should be asking? Is there really a “one hat fits all” option? 

And what does it actually mean to be integrative? Is it just a way of saying “a bit of this and a bit of that” - something vague, unstructured, or even inconsistent? 

It’s understandable why people might think that. If you walk into a restaurant offering dishes from every continent, you might question whether they truly specialise in anything at all. Does variety mean flexibility. Or does it risk mediocrity? 

It feels important to bring some clarity to the word integrative when we’re talking about therapy. 

Because people, especially children, are not uniform. They are complex, individual, and shaped by unique experiences. While some more traditional, structured approaches can meet these needs, there are times when they don’t. So what then? 

Sticking rigidly to a single approach can limit our ability to truly attune to the child in front of us. 

Attunement is at the heart of the therapeutic process. It is how a child comes to feel heard, understood, and emotionally held. Without it, therapy can feel distant, confusing, or even unsafe. 

Attunement means adapting, moment by moment, to the child’s needs. It is not about giving in to every whim or removing boundaries. Boundaries remain essential. But within those boundaries, it means recognising, accepting, and empathising with the child’s emotional experience as it unfolds. 

And that often requires more than one way of working. 

The limitations of a single model can, at times, make it difficult to respond to what is happening in the room. An integrative approach allows the therapist to draw on a range of informed tools and perspectives, in order to meet the child where they are. 

For example, I was asked to undertake some therapeutic life story work with a child. Very early on, it became clear that a “traditional” approach was not going to be effective. This child became dysregulated quickly, was highly hypervigilant and needed constant movement, and avoided anything that felt demanding or emotionally exposing. 

Sitting together to complete structured activities – or working through a narrative in a linear way – was simply not accessible for them. 

However, over time, through sensory-based experiences, play, and consistent attunement grounded in acceptance and empathy, we were able to begin exploring aspects of their story. Questions about the past were approached gently, indirectly, and at a pace the child could tolerate. 

This was still life story work. But it did not look traditional. 

It required flexibility, responsiveness, and a blending of approaches in order to make the work safe and meaningful. 

Importantly, this did not mean there was no structure. Far from it. 

As Dr Bruce Perry describes, there is a fundamental sequence to therapeutic work: regulate, relate, reason. For this child, who had experienced developmental and relational trauma, this sequence was essential. Connection (relate) could not happen without first supporting regulation. And cognitive processing (reason) was not possible without both. 

An integrative approach, in this context, was not optional. It was necessary. 

But integration is not about doing “whatever feels right” in the moment. It requires a depth of knowledge, a clear understanding of different therapeutic models, and careful, intentional decision-making about when and how to draw on them. 

So perhaps the question is not “Which therapy is the right one?” but rather, “What does this child need – and how can I be equipped to meet them there?” 

And that brings us back to something important. 

This kind of work carries responsibility. 

It asks us to keep learning. To deepen our understanding. To stay curious about both theory and practice. To reflect on what we are doing and why. 

Because while our clients are often our greatest teachers, it is our role to ensure we have the knowledge and skill to respond to what they show us. 

Integration, at its best, is not a shortcut. It is a commitment – to thoughtful, informed, and responsive practice. 

And ultimately, to shaping the therapy around the child, rather than asking the child to fit the therapy. 

Which hat?

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