Mick Cooper and John McLeod define pluralistic therapy as ‘the assumption that different clients are likely to benefit from different therapeutic methods at different points in time.’ Pluralism allows for a more responsive and fluid approach to a client’s needs. See the materials below to help you assess your own relationship with therapies.

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The ethics of adopting integrative and pluralistic practices

Taking the practice of pluralism and considering it in a context of ethics, interventions and interactions will be shaped by the client in a purposeful way, but these may (and almost certainly will) change on a session by session basis, for example.

Gabriel offers a checklist of decision-making prompts for ethical practice (Gabriel, 2016, pp. 307–11):

• Stop, think and identify the situation or problem: it is easy in therapy to become reactive to a given situation and problems. Here, the challenge is to allow time for informed and considered thinking, rooted in reflective practice (and, in turn, shaped by supervision). This best positions the therapist to meet more fully the needs of the client
• Construct a description of the situation: while a reflective position is incredibly useful – and arguably critical to good therapy – finding a space and time to externalise our internal discourse can be helpful in creating some space in our thinking. Writing down thoughts and responses, as well as detail about a situation, can help us to achieve that
• Consider ‘whose ethical issue or challenge it is’: in creating a clearer discourse – preferably externalised – about a situation, it will be more possible to be clear about who the key stakeholders are in any given situation, and the roles and responsibilities that might sit in that context. For example, beyond the client and therapist might also sit a position held by an employer, or organisation, or professional body, or family of the client
• Review the situation in terms of your ethical framework or code of ethics: as a member of a professional body you will almost certainly be required to work within the context of the ethical expectations of that body, as outlined in their framework or code of ethics. It is important you take the detail of your situation and apply it in the context of your ethical requirements to help determine the key factors or considerations
• Consider moral principles and values: We need, therefore, to be able to bring our decision-making process in response to ethical challenges alongside our own positions, and understand what aspects of our own world view are consistent with, or contradictory of, aspects of the situation we are considering
• Reflect upon the relational processes that have played out in the situation: consider the place of the therapeutic relationship in the situation and keep in mind that, from a pluralistic position, it is likely the relationship will be framed and informed by a range of different perspectives and theoretical concepts, drawn across a number of modalities
• Identify what support is available: you will have an opportunity to appropriately draw on different sources of support for your decision-making process, including your supervision, peer supervision, colleagues and your manager, for example. It is important to use these sources fully, keeping in mind the contract of confidentiality with your client and how that is shaped by organisational expectations. Likewise, there may be information and guidance available for your client; it is important to ensure they are made aware of such information if it is available
• Identify and critique potential courses of action: if we keep our position as pluralistic practitioners in focus, we will rightly be drawn to a variety of different perspectives and views. It is important to consider a range of actions in response to the situation, being clear for yourself about the advantages and challenges inherent in any particular action
• Choose a course of action: Gabriel (2016, p. 310) offers some specific guidance here:
  • Could your course of action be recommended to others in the same/similar situations?
  • Would you take the same course of action with another client in a similar context?
  • Would your decision be influenced by a client who was famous or influential?
• Evaluate the outcome: consider the outcome and how it mapped onto how you anticipated the outcome might be – was this better, or worse, and why? It is also important to reflect on whether, in hindsight, you had considered all the relevant factors and whether there was learning you might take forward to future situations
• Check for personal impact: re-visiting your reflexive position, as outlined in the first point above – how has this situation impacted on you personally, professionally and in your wider role as a therapist? What additional learning might you glean from this situation, and what ongoing support would be of value to you?

Extract taken from The Handbook of Pluralistic Counselling and Psychotherapy, edited by Mick Cooper and Windy Dryden