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Beyond Four Forces: The Evolution of Psychotherapy

824492

SGOXXX10.1177/2158244018824492SAGE OpenFleuridas and Krafcik

research-article20192019

Literature Review - Original Research

Beyond Four Forces: The Evolution of

Psychotherapy

SAGE Open

January-March 2019: 1–21

hDttOpsI:://1d0o.i.1o1rg7/71/02.11157872/241450812484802148489242492

journals.sagepub.com/home/sgo

Colette Fleuridas1 and Drew Krafcik2

Abstract

One framework for studying the evolution or development of personality theory and psychotherapy is the concept of

forces—theoretical models, paradigms, dimensions, movements, or worldviews—that have made significant contributions

to and shaped the field. This article describes and documents the rise of this evolutionary construct, the identification of the

first three forces of psychotherapy (psychoanalytic, behavioral, and humanistic-existential), and the naming of the fourth force

given to several, significant theoretical paradigms (transpersonal psychology, family systems, feminist psychology, multicultural

psychology, ecopsychology, and social constructivism and postmodernism). In the past decade, a fifth force (social justice

and advocacy) has been widely acknowledged. An integrative, inclusive, and holistic conceptualization of psychotherapy is

presented as an emerging sixth force. These evolutionary milestones of the field demonstrate an expanding process that has

become increasingly more integrative; a more comprehensive, systemic, and holistic approach is needed to better address

diverse individual, community, and global needs.

Keywords

counseling psychology, educational psychology and counseling, diversity and multiculturalism, psychotherapy, humanistic

psychotherapy, systems/family therapy, feminist therapy, transpersonal therapy, ecopsychology, social justice, holistic

The lens through which one views the evolution of psycho-

therapy is shaped by historical, sociopolitical, philosophical,

and cultural worldviews and movements, as well as by rele-

vant scientific discoveries, global developments, and eco-

logical changes. One popular way to frame the evolution of

personality theory and psychotherapy is through the concept

of forces or paradigms that shape the field. The first three of

these forces are commonly presented as psychoanalytic,

behavioral, and humanistic-existential (e.g., Friedlander,

Pieterse, & Lambert, 2012; Maslow, 1962; Rogers, 1963). As

demonstrated in this article, several primary theoretical mod-

els or metatheories have been labeled as the fourth force in

the field: transpersonal psychology, family systems, feminist

psychology, multiculturalism, ecopsychology, and social

constructivism. In the last decade, social justice and client

advocacy have been identified as the fifth force (e.g., Ratts,

D’Andrea, & Arredondo, 2004; Ratts & Pedersen, 2014).

Finally, integrative approaches to psychotherapy and more

holistic metatheories, which include the above develop-

ments, are another significant paradigm or emerging sixth

force in the evolution of psychotherapy (e.g., Friedlaander

et al., 2012; Ivey, D’Andrea, & Ivey, 2012; Ivey & Rigazio-

DiGilio, 1992; Mahoney & Patterson, 1992; Norcross &

Newman, 2003). Knowledge of this evolutionary develop-

ment in the field may provide a better foundation for transi-

tioning to an evidence-based transcultural, integrative, and

more comprehensive approach to understanding human

nature and supporting mental health and wellness.

The purpose of this article is (a) to identify the move-

ments that have been recognized in the literature as signifi-

cant forces in counseling and psychotherapy, (b) to engender

an appreciation of the broad evolution of the field, and (c) to

confirm the importance of moving toward more comprehen-

sive and integrative approaches that address systemic and

individual well-being across the lifespan. Often, significant

psychological paradigms have been identified as a force in

the field when scholars contend that a given theoretical

approach has made a significant and necessary contribution,

given the earlier forces or prevalent paradigms. This brief

overview of the forces, past and present, is intended not only

to inform but also to support the evolution of the field as it

becomes increasingly comprehensive, as well as interna-

tional and global (e.g., Ægisdottir & Gerstein, 2010;

Arredondo & Tovar-Blank, 2014; Borgen, 2007; Casas, Park,

& Cho, 2010; Christopher, Wendt, Marecek, & Goodman,

1Saint Mary’s College of California, Moraga, USA

2Stanford University, Palo Alto, CA, USA

Corresponding Author:

Colette Fleuridas, Counseling Department, Saint Mary’s College of

California, Moraga, CA 94575, USA.

Email: cfleurid@stmarys-ca.edu

Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License

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the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages

(https://us.sagepub.com/en-us/nam/open-access-at-sage).

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2014; Chung & Bemak, 2012; Draguns, 2013; Glover &

Friedman, 2015; C. C. Lee, 2012; Ng & Noonan, 2012; van

de Vijver, 2013).

The First Three Forces Identified in the

1960s

In the preface of his book, Toward a Psychology of Being,

Maslow (1962) described an emerging psychological the-

ory as the third force, which he differentiated from the other

two dominant psychotherapy paradigms of the time, “the

Freudian and the experimental-positivistic-behavioristic”

(p. vi). Maslow postulated that the existential-humanistic

psychological understanding of human nature offers a more

complete understanding of those who are “relatively

healthy” (p. 158). Therefore, this may be “another branch

of psychology, the psychology of the fully evolved and

authentic Self and its ways of being” (pp. 15, 78). In the

second edition of this same text, Maslow (1968) wrote a

new preface wherein he asserted that “humanistic psychol-

ogy . . . is now quite solidly established as a viable third

alternative . . .” (p. iii). He emphasized that this humanistic

understanding of human nature is a new approach not only

to psychotherapy but also to many other fields, from busi-

ness to education (for an excellent history, see DeCarvalho,

1990; Moss, 1999). Other humanistic psychologists agreed

that this third force was distinct from the deterministic and

positivistic premises of psychoanalysis and behaviorism

(Bugental, 1964; Rogers, 1963; Welch, Tate, & Richards,

1978).

Finally, although the field of psychology has changed

significantly over the last several decades, the identifica-

tion of humanistic-existentialism as the third force of psy-

chology and psychotherapy has persisted and includes a

strong professional identity, national and international (and

other national) professional associations, and scholarly

journals. DeRobertis (2013) argued that, although not as

influential as it once had been, humanistic psychology is as

relevant as ever. Its values inform important developments

in the field, including the legitimization of qualitative

research and the emerging interest in positive psychology,

existential neuroscience, the phenomenology of conscious-

ness, and the creation of meaning through interpersonal

interaction. The effectiveness of humanistic-existential

therapies has been summarized in several extensive reviews

of the research (e.g., Cain, 2016; Cain, Keenan, & Rubin,

2016; Elliot, Greenberg, Watson, Timulak, & Friere, 2013;

Lambert, Fidalgo, & Greaves, 2016). Furthermore, the

validity of the central theoretical premises of these

approaches has been supported by the research on the

importance of common factors first emphasized by human-

istic approaches (therapeutic alliance, empathy, genuine-

ness) that contribute to positive outcomes (Lambert, 2013a;

Messer & Wampold, 2002; Norcross & Wampold, 2011;

Wampold, 2001; Watson, 2016).

A Variety of Fourth Forces

Within the same decade that a third force was popularized, a

fourth was identified: transpersonal psychology (Assagioli,

1969; Maslow, 1968, 1969a, 1969b, 1971; Sutich, 1968,

1969). This new force or psychological perspective of human

nature and psychotherapy gave rise to a new professional

identity and strengthened an area of psychological research,

including the study of consciousness and transcendence.

Over the years, psychoanalytic, behavioral, humanistic-exis-

tential, and transpersonal theories evolved, and hundreds of

other psychological ideologies and psychotherapies were

propagated. Occasionally, significant trends were identified

as a new force or paradigm shift in psychology; these include

family systems (Becvar & Becvar, 1998; L’Abate, 2013),

feminist psychology (J. Daniels, 2007; Ivey, 1993), multicul-

turalism (Comas-Díaz, 2000, 2014; Comas-Díaz & Greene,

1994; Essandoh, 1996; Ivey, 1993; Pedersen, 1990, 1999a),

ecopsychology (Buzzell & Chalquist, 2009; Clinebell, 1996;

Rosak, 1992, 1995; Rosak, Gomes, & Kanner, 1995), social

constructivism (Burr, 1995; D’Andrea, 2000; K. J. Gergen,

1985, 2009), social justice (Ratts, 2009; Ratts, Lewis, &

Toporek, 2010), and integrative, integral, or interdisciplinary

psychology (Goldfried & Newman, 2003; Melchert, 2015;

Norcross & Goldfried, 2003; Sarris, Glick, Hoenders, Duffy,

& Lake, 2014; Wilber, 1995). This article briefly considers

the contributions of each of these approaches to the evolution

of the field in an effort to enhance our understanding of how

the field is advancing toward greater inclusiveness.

Transpersonal Psychology

In 1968, Maslow (1968, pp. iii-iv; 1969a) proclaimed that

the third force in psychology was “transitional, a preparation

for a still ‘higher’ Fourth Psychology, transpersonal, transhu-

man, centered in the cosmos rather than in human needs and

interest, going beyond humanness, identity, self-actualiza-

tion, and the like.” In the same year, Sutich (1968), a found-

ing member of humanistic psychology, pioneered that

transpersonal psychology was the “emerging” fourth force in

psychology, a field interested in “ultimate human capaci-

ties,” unlike the other three forces (pp. 77-78).

Maslow (1969b) and Assagioli (1969) described and dif-

ferentiated the attributes of those who are considered to be

“normal” from those who develop beyond-normal ways of

being, people who are motivated by transpersonal values,

and people who have transpersonal traits. These traits include

the willingness to descend into the lower realms of human

nature to face their darker attributes or “shadow,” as they

also pursue development into the higher realms of the mind

and spirit through engaging in practices that expand con-

sciousness. This process often includes the experience of

rebirth or liberation (Assagioli, 1969), as well as a drive to be

immersed in humanity (Maslow, 1971), to take responsibility

for one’s behaviors and to engage selflessly in the world to

Fleuridas and Krafcik

serve others (Maslow, 1971; Vaughan, 1981). Although not

viewed as a primary force by many, transpersonal psychol-

ogy continues to make contributions to the field through

multinational and international associations in over 18 coun-

tries, national and international conferences, and profes-

sional journals and textbooks that continue to feature

transpersonal psychology as one of the foundational theoreti-

cal models in the field (e.g., Fadiman & Frager, 2013; for a

current description of transpersonal psychology and its his-

tory, see M. Daniels, 2013; Friedman & Hartelius, 2013).

Given the purpose of this article, it is important to note

that, unlike the first three forces, transpersonal psychology

was never identified as one theoretical model guiding one

psychotherapeutic approach. The other three forces were

remarkably distinct from each other, describing human nature,

health, pathology, and psychological treatment in ways that

were quite different from the other two forces. Transpersonal

psychology was offered as a more expansive way of working

with clients across other theoretical models. For example,

there are transpersonal-psychodynamic therapists, transper-

sonal-behavioral therapists, and transpersonal-humanistic

therapists (e.g., see Boorstein, 1980). This fourth force is also

unique in that it prioritizes the role of (a) consciousness (e.g.,

Rodrigues & Friedman, 2013), (b) spirituality (Hartelius,

Friedman, & Pappas, 2013), and (c) “extreme health and

well-being,” as well as other experiences mostly ignored by

the other three forces, including “altered states of conscious-

ness, peak experiences, self-realization, and meditation and

other consciousness-altering techniques” (Walsh & Vaughan,

1980, p. 13). In addition, a couple decades after the inception

and development of transpersonal psychology, the positive

integration of spirituality and religion into the general frame-

work of psychotherapy and personality theory was finally

encouraged (e.g., P. S. Richards & Bergin, 1997; Shafranske,

1996) and has continued to gain support (e.g., American

Counseling Association, 2009; Vieten et al., 2016).

Long before mindfulness became popular in the West, the

use of meditation in therapy was described by Goleman

(1971, p. 4) as “a main route for the newly emergent fourth

force.” Other mindfulness activities and spiritual practices

that aim to enhance awareness and expand consciousness

have been central to transpersonal therapies for decades

(e.g., Grof, 2012; Rodrigues & Friedman, 2013; Walsh,

2014). Hundreds of empirical studies have documented vari-

ous health and psychological benefits of engagement in the

regular practice of meditation; for a review of this research in

the context of transpersonal psychology, see MacDonald,

Walsh, and Shapiro (2013); for summaries and discussions

of research studies demonstrating the benefits of other inter-

ventions commonly used in transpersonal approaches, see

Friedman and Hartelius (2013). To their credit, from the

1970s onward, transpersonal psychologists have encouraged

a transcultural approach to therapy, one that respects cultural

differences and invites collaboration with psychological and

spiritual and religious traditions and practices from around

the world (Boorstein, 1980; Walsh, 2001; Walsh & Vaughan,

1993; also see Friedman, Krippner, Riebel, & Johnson,

2010). Thus, in essence, this perspective is a transcultural

and transtheoretical or metatheoretical ideology and approach

to therapy.

Family Systems Psychology

In the 1950s, general systems theory (von Bertalanffy, 1968),

viewed by many as a “revolution in scientific thought” (e.g.,

Steinglass, 1978, p. 301), was integrated into the newly

emerging practice of family therapy. This systemic theoreti-

cal approach became increasingly popular in the 1970s and

1980s, when it was pronounced the fourth force in the field

(Broderick & Schrader, 1981; L’Abate, 2013). L’Abate

(1985) explained that, in the middle of the 20th century, psy-

chotherapists were unprepared to work with families, even

though family life and relationships are critical to human

existence and well-being. He emphasized the significant

clinical difference between the linear focus on an individual

and a “circular, contextual, and dialectical” focus on families

(p. xi). In 1998, Becvar and Becvar proposed that second-

order cybernetic systems theory, particularly as applied to

family therapy, represented a paradigm shift in the field of

psychology and psychiatry. Unlike previous paradigms, this

approach provided a postmodern understanding of humans

who live in their own social and cultural constructions that

are co-created and shared with others, systemically through

mutual interaction. By the end of the century, systemic rela-

tionship therapy had become mainstream, with its own inter-

national professional identity, journals, societies, state

licensure, and university curricula (Becvar & Becvar, 1998,

2013; Goldenberg & Goldenberg, 2009; McGoldrick, Carter,

& Garcia-Preto, 2011). Although there are several classical

family therapy theoretical models (e.g., structural, strategic,

and experiential), systemic family therapy is similar to other

fourth force approaches in that it is also metatheoretical and

has been integrated with many single-school approaches

(e.g., Nichols, 2017).

Over the last few decades, empirical evidence has demon-

strated the validity of family and couples’ assessment tools,

as well as the effectiveness and efficacy of a systemic inter-

ventions, in general (e.g., for summaries of this research, see

Becvar & Becvar, 2013; Goldenberg & Goldenberg, 2009;

Nichols, 2017; Sprenkle, 2012; for a wide range of specific

child- and parent-related concerns, see Becvar & Becvar,

2013; Couturier, Kimber, & Szatmari, 2013; Tanner-Smith,

Jo Wilson, & Lipsey, 2013; Vermeulen-Smit, Verdurmen, &

Engels, 2015). L’Abate (2013) has continued to emphasize

the importance of this “paradigm as the fourth force in psy-

chological theories” (p. 5). Becvar and Becvar (2013) reaf-

firmed that second-order cybernetics is “a metaperspective”

that validates many perspectives and “embraces an ethical

imperative to act in a manner that participates in the creation

of a more humane reality” (p. xviii).

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Feminist Psychology

In the late 1960s and 1970s, an influential group of women

and feminist scholars issued scathing critiques of the field of

psychology as a whole and of the primary schools of psycho-

therapy: A radical transformation of psychology was needed

(e.g., Broverman, Broverman, Clarkson, Rosenkrantz, &

Vogel, 1970; Chesler, 1972; Hare-Mustin, 1980; Parlee,

1979; Weisstein, 1968). These feminists illustrated how the

traditional personality theories, diagnostic categories, and

even so-called objective research methods were grounded in

a limited worldview of a White, upper-middle-class, hetero-

sexist patriarchy that ignored the tremendous influence of

sexism, gender roles, social class, race, oppression, privi-

lege, and power on identity development and psychological

health. They pushed the field of psychology to look beyond

the intrapsychic, behavioral, and androcentric self-actualiz-

ing nature of the individual and beyond the dynamics of the

family system to the sociopolitical systems that legitimized

social contexts that are oppressive to those with less power.

In essence, they pressed therapists, theorists, and researchers

to realize that they had all been encased in the perspective of

a socially constructed dysfunctional mega-system (e.g., L. S.

Brown, 1994; Comas-Díaz, 1991, 1994, 2000; Comas-Díaz

& Greene, 1994; Enns, 1993, 2004; Gilligan, 1982; Hare-

Mustin & Marecek, 1990; Inman & O’Shaughnessy, 2013;

Silverstein, 2006; Williams & Barber, 2004).

By the late 1970s, new and revised models of psycho-

therapy that integrated feminist principles and values were

developed, including nonsexist psychotherapy, assertiveness

training, and social action that prioritized systemic change

through consciousness raising and a redistribution of social

and political power (e.g., Rawlings & Carter, 1977; also see

J. Daniels, 2007; Enns, 1993, 2004; Enns, Williams, &

Fassinger, 2012; Greenspan, 1983; Miller, 1986). By the

1990s, feminist psychology was identified as one of the

fourth forces in psychology (Ivey, 1993; Ivey & Rigazio-

DiGilio, 1992). In fact, Ivey (1993), among others, described

the emerging fourth force as both feminist and multicultural

psychology (J. Daniels, 2007; Pedersen, 1990, 1991). He

urged all scholars and practitioners to become gender-fair

and to revise the patriarchal theories of the autonomous self

that lacked a consideration of the self in relation to others and

to community. Many others agreed, asserting that the

advances in social justice and advocacy for historically

oppressed groups should be attributed, at least in part, to the

persistent work and scholarship of feminist activists (e.g., L.

S. Brown, 1994, 2010; Comas-Díaz, 1991, 1994; Comas-

Díaz & Greene, 1994; Goodman et al., 2004; Inman &

O’Shaughnessy, 2013; Silverstein, 2006).

Thus, the field of psychology was forever transformed by

this feminist “revolution in psychology” (J. Daniels, 2007, p.

356; S. N. Davis & Gergen, 1997, p. 11; also see L. S. Brown,

1994; Comas-Díaz & Greene, 1994; Greenspan, 1983). In

addition to their insights and social critiques, feminist scholars

and practitioners developed innovative theories, gender-fair

interventions, and qualitative research methods; they pro-

moted nonsexist, multicultural clinical practice, education,

training, and sociopolitical action (American Psychological

Association, 2007; L. S. Brown, 1994, 2010; Comas-Díaz &

Greene, 1994; J. Daniels, 2007; S. N. Davis & Gergen, 1997;

Enns et al., 2012; M. M. Gergen, 1988; Greenspan, 1983). For

a history of the significant contributions made by feminist

multiculturalists to psychological and sociocultural theory,

research, and practice, including to the treatment of sexual

abuse and intimate violence, see L. S. Brown (2010), Enns

(1993, 2004), and Enns and colleagues (2010, 2012).

According to L. S. Brown (2010), it has been difficult to

assess the effects of the specific components of feminist psy-

chotherapy, given that feminist therapies and interventions

are integrated into a wide range of theoretical models and

modalities. Nonetheless, reviewers of research have criti-

cally examined the core components of feminist therapies

and have affirmed consistently positive outcomes, overall,

and specifically in the areas of (a) empowerment of the

oppressed, (b) critical consciousness development, (c) reap-

praisal of gender roles and social identity, (d) resocialization,

and (e) social activism (e.g., L. S. Brown, 2010; Enns, 1993,

2004; Enns & Byars-Winston, 2010). Feminist multicultural-

ists continue to make critical contributions to the evolution

of psychotherapy and psychology, especially as the field

acknowledges the importance of social justice as integral to

health and well-being (e.g., L. S. Brown, 2010; Comas-Díaz

& Greene, 1994; Enns et al., 2012; Inman & O’Shaughnessy,

2013).

Multicultural Counseling and Psychology

In the 1950s and 1960s, the civil rights movements in the

United States ignited social changes that strengthened aca-

demic interest in gender, racial, ethnic, and diversity psy-

chology and identity development, as well as in the negative

effects of prejudice, oppression, and victimization.

Psychotherapists and academics gradually began to confront

and address the lack of cultural awareness and expertise in

their clinical practice, theoretical models, and research strat-

egies. By the 1970s, many began to challenge the field to

examine how current personality theories and counseling

models were limited, inadequate, inaccurate, and often harm-

ful, especially given that Western values framed the defini-

tion of mental health and perpetuated the assumption that

internal factors accounted for personal deficiencies (e.g.,

Arredondo-Dowd & Gonsalves, 1980; Atkinson, Morten, &

Sue, 1979; Ivey, 1973; Pedersen, 1974, 1983; P. M. Smith,

1971; Sue, 1978). Gradually, a mandate was established that

all counselors and psychologists (a) become culturally self-

aware; (b) gain the values, knowledge, and skills that demon-

strate respect for human differences; (c) use culturally

relevant and adaptive interventions, when appropriate; (d)

and seek knowledge about the prevalence and impact of

oppression and privilege on the health and well-being of

diverse populations (e.g., Atkinson & Israel, 2003;

Fleuridas and Krafcik

Comas-Díaz, 1991, 1994, 2000, 2014; Arredondo & Perez,

2003; Arredondo & Tovar-Blank, 2014; Goodman et al.,

2004; Ivey, 1993; C. C. Lee, 1998; Pedersen, 1990, 1991,

1999a; Sue et al., 1982; Sue et al., 1998; Sue, Ivey, &

Pedersen, 1996; Sue & Sue, 1981/2013; Toporek, Gerstein,

Fouad, Roysircar, & Israel, 2006; Vera & Speight, 2003).

Through years of persistence and the advocacy of many,

the American Psychological Association (1981, 1990, 2000,

2003, 2007, 2018) acknowledged the ethical responsibility

of psychotherapists and researchers to gain awareness,

knowledge, and skills to work with diverse people; in this

context, diversity included culture, ethnicity, race, religion,

gender, sexual orientation and gender identity, age, ability,

and economic class (Arredondo & Perez, 2003; Ivey &

Collins, 2003; Sue, Arredondo, & McDavis, 1992; Sue et al.,

1982). The American Counseling Association followed suit

(Arredondo & Perez, 2003; Ivey & Collins, 2003; Ratts,

Singh, Nassar-McMillan, Butler, & McCullough, 2016; Sue

et al., 1992). An increasing emphasis was placed on educat-

ing and training graduate students to be “culturally effective”

and to engage in advocacy roles (Arredondo-Dowd &

Gonsalves, 1980; Pedersen, 1974, 1978; Ponterotto & Casas,

1987; Sue, 1978a; Sue et al., 1982). Multicultural and ethical

guidelines and competencies were developed, revised, and

codified, by both the American Psychological Association

(1990) and the American Counseling Association (Ratts

et al., 2016; Sue et al., 1992), throughout the end of the 20th

and into the 21st century, in an effort “to eliminate biases,

prejudices, and discriminatory practices” among psycholo-

gists and counselors (American Psychological Association,

1990, Guideline 8). These standards were designed to aid

counselors and those in training to address personal and

institutional racism, as well as to engage in more culturally

relevant and meaningful therapy with diverse clients

(Arredondo, 1999).

By the turn of the century, a paradigm shift in counseling

and psychology was in full force (Ivey, 1993; Pedersen,

1991, 1999a, 1999b). All theoretical approaches needed to be

revised to address a more complete, complex, and dynamic

understanding of human nature—to include social and envi-

ronmental contextualism and specifically the impact of cul-

ture and diversity broadly defined (Pedersen, 1990,

1991,1999a, 1999b). Multiculturalism must inform all psy-

chological theory development and refinement, research and

assessment tools, and application through psychotherapy,

community service, and education policies and licensure

standards (e.g., Quintana, Chew, & Schell, 2012; Sue et al.,

1996). This new paradigm included the critical importance

of culture, race, ethnicity, immigration, acculturation, encul-

turation, language, religion, sexual and gender identities, dif-

fering abilities, and so forth on core identity development; it

emphasized an examination of the sociopolitical factors that

perpetuate prejudice, discrimination, oppression, and privi-

lege and the psychological consequences of oppression, pov-

erty, and classism-based and race-based trauma (e.g., Carter,

2007; D. R. Fox & Prilleltensky, 2009; Goodman et al.,

2004; Liu, 2011, 2013; Mirowsky & Ross, 2003; Nurius,

Uehara, & Zatzick, 2013; Quintana et al., 2012; L. Smith &

Mao, 2012).

Pedersen (1990, 1991, 1999a) may have been the first to

articulate that the profession was “moving toward a generic

(and perhaps even grand) theory of multiculturalism as a

‘fourth force’ position” (Pedersen, 1991, p. 6). Others agreed

(e.g., Arredondo & Tovar-Blank, 2014; J. Daniels, 2007;

Essandoh, 1996; Ivey, 1993; Lewis & Arnold, 1998;

Ponterotto & Casas, 1991). Social scientists and counselors

can only begin to understand, assess, and assist others given

a culture-centered perspective (Pedersen, 1999a). This newly

recognized fourth force was not intended to displace the first

three, but “rather to complement them by framing them in

the cultural contexts” (Pedersen, 1999a, p. 4). This grand

conceptual framework was being shaped through much dia-

logue and debate in the field and beyond (Pedersen, 1983,

1991, 1999b; Sue et al., 1998). Sue and colleagues (1998;

Sue et al., 1982) emphasized a postmodern definition of mul-

ticulturalism that acknowledged the coexistence of multiple

socially constructed worldviews, cultural norms, and values.

Multicultural competence, according to these authors,

includes diversity broadly defined (i.e., socioeconomic sta-

tus, gender, sexual orientation and identity, abilities/disabili-

ties, and so forth), in addition to race, ethnicity, multiracial,

and multi-heritage identities. Therefore, multiculturalism as

a fourth force in psychology is described as a metatheory and

praxis with an organizing framework that is more integrative

and holistic; it must be applied at the individual, group, and

universal levels (Comas-Díaz, 1994, 2000, 2014; C. C. Lee,

2007, 2012; Pedersen, 1990, 1999a, 1999b; Ratts & Pedersen,

2014; Sue et al., 1996).

Empirical evidence has consistently demonstrated the

negative effects of oppression, prejudice, and racism (e.g.,

Carter, 2007; Constantine & Sue, 2006; Nurius et al., 2013;

Ratts et al., 2016) on identity development, mental and phys-

ical health, and academic and occupational success (Leong,

Comas-Díaz, Nagayama Hall, McLoyd, & Trimble, 2014).

Numerous studies have begun to examine the effectiveness

of multicultural counseling: (a) the effects of multiculturally

competent therapists versus the less multiculturally skilled

(e.g., Fuertes et al., 2006; Owen, Leach, Wampold, &

Rodolfa, 2011; T. B. Smith & Trimble, 2016; Tao, Owen,

Pace, & Imel, 2015); (b) the effects on therapy outcome of

ethnic matching of client with therapist (e.g., Maramba &

Nagayama Hall, 2002; Owen et al., 2011; T. B. Smith &

Trimble, 2016); and (c) the effects of therapist orientation,

cultural competence, and involvement in communities of

color (e.g., Berger, Zane, & Hwang, 2014). Overall, these

results demonstrate the importance of multicultural compe-

tence among therapists and the need for further investigation

to identify the therapeutic relationships and interventions

that contribute to positive outcomes among diverse popula-

tions with multiple identities (e.g., Berger et al., 2014; Enns

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& Byars-Winston, 2010; Enns et al., 2012; Lambert et al.,

2006; T. B. Smith & Trimble, 2016). The momentum of this

force has continued to push the entire field forward, urging

psychotherapists to engage in social justice and advocacy, as

well as to gain competence in international and global psy-

chology and in clinical work with the immigrants in one’s

own country (e.g., Ægisdottir & Gerstein, 2010; Arredondo

& Tovar-Blank, 2014; Borgen, 2007; Casas et al., 2010;

Christopher et al., 2014; Draguns, 2013; C. C. Lee, 2012;

Leong, 2014; Ng & Noonan, 2012; van de Vijver, 2013).

Ecopsychology

Numerous environmental movements arose in the mid-

1960s through the 1980s (e.g., deep ecology, ecofeminism,

bioregionalism, and environmental justice) to challenge

political, corporate, and government policies and practices

that mechanized, commercialized, and devalued nature

(e.g., Carlson, 1962; W. Fox, 1990; Merchant, 1980; Plant,

1989). The behavioral sciences were also subject to criti-

cism. L. R. Brown (1995) summoned psychologists to

acknowledge that human sanity requires an emotional rela-

tionship with and deep valuing of the natural environment.

Multidisciplinary theorists traced the changing interrela-

tionship that humans have had with nature over the millen-

nia and the negative impact that humanity’s increasing

separation from nature has had on the environment and on

the human psyche (e.g., Diamond & Orenstein, 1990; M.

Fox, 1988; Gomes & Kanner, 1995; Rosak, 1992; Shepard,

1982).

By the end of the 20th century, ecopsychologists self-

identified themselves and called for a revisioning of psychol-

ogy that included the essential nature of humans as

inextricably interconnected with the natural world (e.g.,

Clinebell, 1996; Conn, 1995, 1998; Gomes & Kanner, 1995;

Mack, 1992; Metzner, 1995, 1999; Rosak, 1992, 1995; Rosak

et al., 1995). They contended that the health of the ecosystem

and the well-being of the human species are synergistically

interrelated (e.g., Conn, 1995, 1998; Kahn & Hasbach,

2012). Most ecopsychologists have been as concerned about

human values and behaviors that have led to the deterioration

of the earth’s ecology as they have been about the physical

and mental health risks associated with people’s decreasing

respect for the natural world (e.g., Fisher, 2009; Macy, 2007;

Metzner, 1995, 1999; Rosak et al., 1995). Although ecopsy-

chology was not recognized as a fourth force, it was pre-

sented as an “enlarged paradigm” because it is an

“ecologically grounded theory of personality development”

paired with interventions that promote “ecobonding” and a

greater love and responsibility for nature (Clinebell, 1996,

pp. 25-26, 33-34).

Empirical evidence suggests that humans who lack a

conscious and fond relationship with nature suffer nega-

tive psychological consequences, including anxiety,

depression, and a greater sense of meaninglessness (e.g.,

Capaldi et al., 2017; Chalquist, 2009; Fisher, 2009; Louv,

2005, 2012; Metzner, 1995, 1999; Rosak, 1992). Studies

have found that human health may be enhanced through

contact with nature (plants, animals, natural landscapes,

and wilderness; e.g., Frumkin, 2012; Hasbach, 2012;

Ingulli & Lindbloom, 2013; Kahn & Hasbach, 2012).

Furthermore, the use of ecotherapy or nature-engaged ther-

apies may improve overall mental and physical health; the

benefits of spending time in nature include elevated mood,

reduced stress, improved immune system, enhanced self-

esteem, and increased vitality (e.g., Chalquist, 2009;

Frumkin, 2012; Greenway, 2009; Ingulli & Lindbloom,

2013; Trigwell, Francis, & Bagot, 2014; Wilson et al.,

2010). In his popular books, Louv (2005, 2012) summa-

rized the research to emphasize how healthy childhood

development requires direct involvement in nature.

Similar to several other proposed fourth forces, eco-

therapy was not developed to be a singular theoretical

approach to therapy; rather, it is readily integrated into a

wide range of therapeutic approaches (e.g., Tudor, 2013).

O’Conner (1995) encouraged psychotherapists to accept a

new professional ethic in their clinical work that includes

and addresses the reality of and responsibility for the

global environmental crisis. Manning and Amel (2014)

contended that environmental justice is inseparable from

social justice in that all people deserve to have access to

nature, in their day-to-day lives, as well as to clean air and

water. Psychology is inadequate unless it includes and

addresses the fundamental needs and rights of humans to

be in relationship with nature and the critical importance

of a healthy natural environment to support the overall

well-being of all living species (Conn, 1995; Rosak,

1995). Psychotherapists and behavioral scientists are

urged to recognize the importance of nature on mental and

physical health and to be advocates for earth justice; this

includes engaging in social action to reduce human behav-

iors that contribute to the multiple environmental crises

(e.g., Masuda, Poland, & Baxter, 2010), many of which

adversely affect human health. Comprehensive psycho-

logical, sociopolitical, and spiritual approaches are needed

to address this crisis (e.g., Buzzell & Chalquist, 2009;

Trigwell et al., 2014).

Social Constructivism and Postmodernism

Social constructivism, a popular postmodern worldview,

has been identified as a fourth force in psychology and

one that has had a significant impact on the field (Jones-

Smith, 2012). The theory is grounded in the assumption

that, although reality exists, truth, or anyone’s percep-

tion of the truth about reality, is relative and rooted in the

multilayered context of an individual. This context

includes history, culture and religion, relationships, lan-

guage, and the natural world. Personality is not deter-

mined by biomechanisms or internal intrapsychic drives,

Fleuridas and Krafcik

as much as it is constructed by individuals, collectively

with others, through their relational processes and given

their shared context. Social constructivists have chal-

lenged the psychological and ontological understandings

of the idealized, autonomous self and have proposed

revised constructs of individual freedom and responsi-

bility through the contextual lens of this historical and

relational co-construction process (Burr, 1995;

D’Andrea, 2000; K. J. Gergen, 1985, 2009) Many per-

sonality traits and emotions believed to be inherent or

essential to human nature are also reframed as social

constructions. From this perspective, gender is socially

constructed, as are race, power, and privilege (e.g., S. N.

Davis & Gergen, 1997; Hare-Mustin & Marecek, 1990;

Weisstein, 1968).

In the mid-20th century, Kelly (1955) introduced personal

constructivism to the field of personality theory, postulating

that people construe their own sense of themselves and of

their world. Self-constructions, informed by socially and cul-

turally constructed systems, are formulated at a very young

age and help people to make sense of their lives and to pre-

dict outcomes of behaviors. Informed by personal construct

theory, therapists attempt to understand their clients’ unique

personal worldviews and to assess what may and may not be

helpful, psychologically sound, or socially moral. Using

eclectic techniques, these therapists aim to assist clients to

engage in a reconstruction of their own personality and/or of

their worldviews such that they can be more productive or

content in their day-to-day lives.

In her counseling and psychotherapy theories textbook,

Jones-Smith (2012) identified both social constructivism and

postmodernism as the fourth force in psychology. She stated

that multiculturalism, while tremendously important and

something that she has integrated into every chapter of her

text, is subsumed under this larger rubric (pp. 3, 8). A few of

the primary principles of postmodern therapy are as follows:

(a) clients are the experts; (b) therapists are to work collab-

oratively with clients to empower them to accept responsibil-

ity for their actions; and (c) the focus of therapy is on clients’

strengths, not on their problems or on what they lack

(p. 290). In his textbook on theories of counseling and psy-

chotherapy, Corey (2017) described the postmodern move-

ment as an important “paradigm shift most likely to affect the

field” (p. 369); under this domain, he included solution-

focused and narrative therapies.

The evidence for the effectiveness of postmodern

approaches is building. Meta-analyses and systematic

reviews of the results of numerous studies examining the

efficacy of solution-focused brief therapy have shown small

but positive results, and other reviews of research are opti-

mistic (Franklin, Trepper, Gingerich, & McCollum, 2012;

Kim, 2008). Similarly, although empirical investigations of

narrative therapy are less common, they tend to demonstrate

its effectiveness (Combs & Freedman, 2012; Etchison &

Kleist, 2000; Lopes et al., 2014).

Common Themes of These Six Identified Fourth

Forces

Pedersen (1999a), who had proposed that multicultural coun-

seling was the fourth force in 1990, mentioned that others

had also proposed a fourth force in the field, such as transper-

sonal psychology, feminism, and social constructivism.

Themes that he had identified in these postmodern fourth

forces include (a) a greater tolerance of ambiguity, (b) more

emphasis on subjectivity, (c) an appreciation of nonlinear

dynamics, (d) the recognition of multidimensional truths,

and (e) the value of qualitative research methods. This col-

lective “new paradigm,” according to Pedersen, offered to

transform the field, from a monocultural perspective, repre-

senting the views of the dominant culture, to a multicultural

perspective, broadly defined, including all elements of dif-

ference that shape human experience and identity (also see

Ratts & Pedersen, 2014, Chapter 2). The field of psychology

appears to be evolving from one that prioritized objectivity

and reductionism and defined human behavior, health, and

pathology with primarily intrapersonal descriptors to one

that has become increasingly systemic, subjective, contex-

tual, holistic, and nuanced (with a greater focus on diversity,

culture, language, symbols, and discourse, as well as more

emphasis on each client’s needs and preferences). These

developments have led to the identification of two additional

forces as significant paradigm shifts in psychotherapy: social

justice and an integrative, inclusive, and holistic approach to

psychology and mental health care.

Social Justice: The Fifth Force

When a psychotherapy paradigm is identified in a public

forum as new force, it is not unusual for the proposal to be

debated as to whether or not the trend, model, or worldview

merits this stature. In some cases, detractors argue that the

newly proposed force is not significantly distinct from a pre-

viously identified force. For example, this was the case with

transpersonal psychology. Some psychologists contended

that transpersonal, religious, and spiritual values, needs, and

peak experiences were already included under the rubric of

humanistic psychology, the third force (e.g., May, 1986;

Swartz, 1969). A similar debate ensued when social justice

and advocacy were first identified as a fifth force. Some

scholars claimed that multicultural counseling (a fourth

force) already emphasized justice, equity, and advocacy

(e.g., Arredondo & Perez, 2003). Nonetheless, sufficient dis-

tinctions were made, and the field of counseling and psycho-

therapy rather quickly supported the movement to identify

social justice as the new prevailing paradigm or fifth force in

the field (Ratts, 2009; Ratts et al., 2010; Ratts et al., 2016;

Ratts & Pedersen, 2014).

The field of counseling psychology is rooted in sociopo-

litical reform movements. Its mission has been to enhance

the well-being and human dignity of many as well as to

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increase human rights, justice, and equal access to quality

education, vocations, and health care (e.g., Aldarondo, 2007;

Goodman et al., 2004; Ivey & Collins, 2003; Kiselica &

Robinson, 2001; C. C. Lee, 1998; Prilleltensky, 1994, 1999,

2001; Prilleltensky & Nelson, 1997, 2002, 2013).

Nonetheless, traditional Western counseling theories and

practices viewed individuals primarily through an intrapsy-

chic and apolitical lens; client problems and challenges were

assumed to be a function of biological, psychodynamic,

emotional, cognitive, and/or behavioral deficits.

Psychotherapists of various theoretical orientations focused

on assisting clients to create meaningful lives for themselves

as they often remained in an unjust social environment that

limited their opportunities for optimal mental health and

wellness. For the most part, until the rise of feminism and

multiculturalism, psychology and counseling had been silent

about the deleterious effects of sociopolitical and economic

inequity and cultural oppression on the mental and interper-

sonal health of millions (e.g., L. S. Brown, 1994; Enns, 1993;

Ivey, 1993; Prilleltensky, 1994; Sue et al., 1992).

By the end of the 20th century, psychotherapists were

warned that they may be inadvertently perpetuating systemic

oppression of their clients by providing one-on-one remedia-

tion therapy; they were challenged to revise their theoretical

models and to engage in prevention, client empowerment,

advocacy, and social action (e.g., Martin-Baró, 1994;

Prilleltensky, 1999, 2001; Prilleltensky & Nelson, 1997).

Counseling professionals began to realize that their clinical

work may do more harm than good unless they better under-

stood the systemic causes of many psychological problems

and challenged the injustice inherent in social systems that

perpetuated the oppression and marginalization of most peo-

ple (e.g., Collison et al., 1998; C. C. Lee, 1998; McWhirter,

1997). Psychologists and psychotherapists needed to under-

stand the effects of sociopolitical oppression on human

development and to actively work to eradicate societal injus-

tices that limited opportunities to live well. Thus, the con-

structs of social justice, oppression, unearned privilege,

power, and equity began to be centralized in psychological

curricula, theories, research studies, and practice models

(e.g., Arredondo et al., 1996; Goodman et al., 2004; Helms,

2003; Ivey & Collins, 2003; Kiselica, 2004; C. C. Lee, 1998,

2007; Lewis & Arnold, 1998; Prilleltensky & Nelson, 2002,

2013; Sue et al., 1998; Vera & Speight, 2003, 2007).

Furthermore, a growing body of empirical evidence made

it increasingly apparent that human development, health, and

pathology can only be understood given individuals’ political,

social, and economic as well as cultural contexts. Research

substantiated that, for most people, healthy intrapsychic

development requires a perceptively equitable, fair, and safe

sociopolitical environment (e.g., Bryant-Davis & Ocampo,

2005; Carter, 2007; Draine, 2013; Hudson, 2005; Inman &

O’Shaughnessy, 2013; Liu, 2011, 2013; Liu & Estrada-

Hernández, 2010; Mani, Mullainathan, Shafir, & Zhao, 2013;

Mirowsky & Ross, 2003; Nurius et al., 2013; L. Smith &

Mao, 2012; Toporek, 2013). Consequently, by the 21st cen-

tury, an ethical and moral imperative was issued for all mental

health counselors and psychologists to work proactively to

enhance the well-being of everyone. Psychotherapists were

called upon to work for justice and to help end racism, sex-

ism, classism, heterosexism, and other forms of oppression.

Integrating social justice into the core of psychotherapy

gained increasing support from many (e.g., Arfken & Yen,

2014; Chang, Crethar, & Ratts, 2010; Chung & Bemak, 2012;

D’Andrea & Daniels, 2010; Fouad & Prince, 2012; Lewis,

Lewis, Daniels, & D’Andrea, 2011; Lewis, Toporek, & Ratts,

2010; Ratts, 2009; Ratts et al., 2010; Toporek et al., 2006).

A major shift in the field occurred. Counseling profes-

sionals responded by redefining their moral and ethical

responsibilities to be more politically and socially engaged

in institutional, community, societal, and global prevention

and intervention (e.g., American Counseling Association,

2005a, 2005b; American Psychological Association, 2000,

2003, 2014; Herlily & Watson, 2007; C. C. Lee, 2007, 2012;

Vera & Speight, 2007). Furthermore, they began to centralize

the sociopolitical implications of oppression and of social

justice into clinical theory, practice, ethics, and research

methods (e.g., Arfken & Yen, 2014; D. R. Fox & Prilleltensky,

2009; Goodman et al., 2004; Liu, 2011, 2013; Lyons et al.,

2013; Prilleltensky, Dokecki, Frieden, & Ota Wang, 2007).

Numerous intervention models of integrative social justice

counseling, empowerment, and advocacy have been pro-

posed, and many have been implemented in diverse settings

(e.g., Chung & Bemak, 2012; D’Andrea & Daniels, 2010;

Liu, 2013; Ratts et al., 2010; Ratts & Pedersen, 2014;

Toporek et al., 2006).

Ratts and colleagues (2004, p. 28; Ratts, 2009) are cred-

ited with being the first to announce that social justice coun-

seling is the “fifth force” and “a new paradigm. . . emerging

in the counseling profession.” Others agreed (e.g., Chung &

Bemak, 2012; Goodman et al., 2004; C. C. Lee & Hipolito-

Delgado, 2007; M. A. Lee, Smith, & Henry, 2013), and the

revised Multicultural and Social Justice Competencies were

endorsed by American Counseling Association Governing

Counseling in 2015 (Ratts et al., 2016). Now that counselors

better understand how social oppression and the misuse of

privilege diminish mental health, they realize that they may

be more effective by engaging in social action and advocacy

to help ensure human rights and a more fair distribution of

power, resources, and opportunities. Rather than replacing

the other forces, the fifth force complements them (e.g.,

Goodman et al., 2004; Lewis & Arnold, 1998). Ratts et al.

(2004) concluded that counselors “must develop more proac-

tive, value-laden, politically conscious, and advocacy-based

counseling interventions” (p. 30).

This recently strengthened paradigm represents a primary

shift in several areas. It affects counseling professionals’

knowledge, identity, roles, ethics, and skills (e.g., Chung &

Bemak, 2012; Goodman et al., 2004; Herlily & Watson,

2007; Kiselica, 2004; C. C. Lee & Hipolito-Delgado, 2007;

Fleuridas and Krafcik

Ratts, 2009; S. D. Smith, Reynolds, & Rovnak, 2009). It is

distinct from traditional models of psychotherapy in that the

etiology of mental illness is viewed as rooted in social dys-

function rather than as primarily due to internal personal

deficits or narratives. This assumption requires knowledge

and understanding of the politics of power, including the

oppressive power of injustice and the liberating power of

social justice (Albee & Joffe, 2004; M. A. Lee et al., 2013;

McWhirter, 1997; Prilleltensky, 2008, 2012b, 2013; Williams

& Barber, 2004). Furthermore, these changes have required

revisions to counseling psychology and counselor education

curricula and training opportunities (e.g., Chang et al., 2010;

Goodman et al., 2004; Ivey & Collins, 2003; Kiselica, 2004;

Ratts et al., 2010; Vera & Speight, 2007). Consequently, in

2009, the Council for Accreditation of Counseling and

Related Educational Programs released its revised standards

for the accreditation of master’s and doctoral degree pro-

grams in counselor education to put more emphasis on social

justice.

As stated earlier, the deleterious effects of discrimina-

tion, oppression, and racism on mental health have been

well documented (e.g., Bryant-Davis & Ocampo, 2005;

Carter, 2007; Inman & O’Shaughnessy, 2013; Liu, 2011,

2013; Liu & Estrada-Hernández, 2010; Liu & Pope-Davis,

2003; Mani et al., 2013; Mirowsky & Ross, 2003; Nurius

et al., 2013). Poverty and classism also negatively affect

mental health, in general, and significantly impair early

childhood development (e.g., Draine, 2013; Hudson, 2005;

Lawson, Duda, Avants, Wu, & Farah, 2015; Luby et al.,

2013; Mani et al., 2013; Noble & Farah, 2013; L. Smith &

Mao, 2012; Toporek, 2013). There is also a growing body of

evidence that supports the benefits of proactive multicul-

tural, feminist interventions that aim to empower clients (L.

S. Brown, 2010; Enns, 1993, 2004; Enns & Byars-Winston,

2010; Enns et al., 2012). More recently, studies have begun

to examine the impact of a social justice emphasis in coun-

selor training (e.g., Collins, Arthur, Brown, & Kennedy,

2015; Cook, Krell, Hayden, Gracia, & Denitzio, 2016).

Research studies that examine the immediate and long-term

benefits of counseling interventions and effective social

action strategies, shaped by this fifth force, are needed.

Finally, when social justice scholars contemplate the

future, they encourage counseling professionals to become

globally literate (e.g., Borgen, 2007; Glover & Friedman,

2015; C. C. Lee, 1998, 2007, 2012; Ng & Noonan, 2012;

Prilleltensky, 2012a; van de Vijver, 2013). Global trends

affect local communities, and events in local communities

(schools, colleges, villages, and cities) affect nations. Critical

events that may impede the well-being of many include cli-

mate change; the lack of precious resources like water; epi-

demics spread easily through modern transportation and

commerce; financial, international, and political instability;

and harmful technologies, to mention a few. C. C. Lee (2012)

emphasized the importance of framing human development

and mental health from an international perspective.

Transculturally competent counselors and researchers must

be guided by social justice values, be informed by global

diversity, and work collaboratively across nations (Glover &

Friedman, 2015).

Integrative, Integral, and

Comprehensive Holistic Approaches: A

Sixth Force?

The last force to be addressed in this article is a integrative,

holistic, inclusive approach, one that includes the best aspects

of the other forces and of other significant developments in

the field not commonly identified as a “force” (e.g.,

evidence-based practice, community psychology, psycho-

neuroimmunology, positive psychology and psychiatry,

emotion-focused or emotionally focused therapy, attach-

ment-based therapies, mindfulness, expressive arts, and neu-

ropsychotherapies). We affirm that a more comprehensive

and holistic integrative approach is a sixth or significant

force that warrants more emphasis and appreciation as an

important paradigm shift in the field (e.g., Friedlander et al.,

2012; Ivey & Rigazio-DiGilio, 1992; Norcross & Beutler,

2014; Norcross & Newman, 2003; Sarris et al., 2014).

Although mental health professionals have been intrigued

by the idea of integrating single-school psychotherapies

since the 1930s, integrative approaches began gaining favor

as legitimate models of therapy in the 1970s (Goldfried &

Newman, 2003; Norcross & Beutler, 2014; Norcross,

Hedges, & Prochaska, 2002; Patterson, 1985). In 1980,

Jordaan and Jordaan proposed an integrative metatheory that

they claimed to be the sixth force in psychology. Mahoney

and Patterson (1992) assessed the development of the four

theoretical forces and described the international “conver-

gence movement” as the most recent force; they emphasized

the growing attention to the importance of meaning-making,

diversity, complexity, social systems, holistic considerations,

and quality human relationships to support change. Norcross

and Beutler (2014) have been leading advocates of the flex-

ible use of integrative psychotherapies for many years; they

contend that outcome research (focused on mechanisms of

change) and clients’ specific needs and characteristics should

guide clinical practice, rather than single-school theoretical

approaches. Recently, Friedlander and colleagues (2012)

described integrative psychotherapy as the fifth of the five

major trends in the field of psychotherapy: (a) psychoana-

lytic and psychodynamic theories; (b) humanistic and exis-

tential therapies, including existentialism, motivational

interviewing, and emotion-focused therapy; (c) cognitive-

behavioral therapies (from behavioral modification to ratio-

nal-emotive behavior therapy, cognitive therapy, and

multimodal therapy, to personal construct therapy and post-

modern constructivism, to dialectical and behavioral therapy

and acceptance and commitment therapy); (d) family sys-

tems therapy; and (e) psychotherapy integration. These

authors supported modern applications of integrative

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psychotherapies, given the “contextual factors” of the client,

which they described as the “problems in living” (e.g.,

trauma to race-related stress), client characteristics (gender

and minority group status), development and resilience

(attachment style and spirituality), and the therapeutic rela-

tionship (pp. 43-50).

The primary catalysts of the integrative psychotherapy

movement include (a) a general decline in polarized debates

across theoretical systems, (b) an intensive reappraisal of

existing theoretical approaches, (c) an emerging recognition

of the value of other schools of thought, (d) a transtheoretical

conception of the process of behavioral change (Prochaska,

DiClemente, & Norcross, 1992; Prochaska, Johnson, & Lee,

2009), (e) empirical evidence documenting the critical

importance of common factors such as empathy and thera-

peutic alliance (Norcross & Wampold, 2011; Wampold,

2001), and (f) an increasing trend to tailor clinical interven-

tions to include clients’ needs, preferences, and cultural

worldviews (American Psychological Association, 2006;

Comas-Díaz, 1994; Duncan, Miller, Wampold, & Hubble,

2010; Norcross & Beutler, 2014; Norcross & Newman,

2003). Furthermore, hundreds of empirical outcome studies,

including extensive meta-analyses, have failed to demon-

strate the consistent superiority of one theoretical approach

over the others (Duncan et al., 2010; Lambert, 2013a;

Norcross & Wampold, 2011; Wampold, 2001).

Particularly significant to formalizing the integrative psy-

chotherapy movement was the creation of the Society for the

Exploration of Psychotherapy Integration (SEPI; n.d.),

founded in 1983, and its Journal of Psychotherapy

Integration (Goldfried & Newman, 2003). The inception of

SEPI fostered enhanced dialogue among a growing number

of therapists and researchers of disparate theoretical orienta-

tions (Norcross & Goldfried, 2003). In sum, the first decade

of intensive investigation into integrative approaches yielded

several journals, professional conferences, 200+ peer-

reviewed publications, and two comprehensive handbooks

(Norcross & Goldfried, 2003; Stricker & Gold, 1993).

Ultimately, the goal of the movement—its great ambition

and creativity notwithstanding—was to “promote the explo-

ration and development of approaches to psychotherapy that

integrate across theoretical orientations, clinical practices,

and diverse methods of inquiry” (SEPI, n.d., p. 3) to increase

the overall effectiveness of clinical interventions (Norcross

& Beutler, 2014).

By the 21st century, more than half of clinicians in the

United States identified their practice as integrative or eclec-

tic, rather than as solely affiliated with a particular school of

therapy (Lambert, 2013b; Norcross & Newman, 2003).

Today, few therapists use only one theoretical model to guide

their work, and most are integrative or pluralistic (Lambert,

2013b; Norcross & Beutler, 2014; Norcross et al., 2002). The

commonly identified pathways toward psychotherapy inte-

gration are (a) technical eclecticism, (b) common factors, (c)

theoretical integration, and/or (d) transtheoretical approaches

(Norcross & Beutler, 2014; Norcross & Newman, 2003). A

few popular integrative approaches include (a) a transtheo-

retical approach to behavioral change (Prochaska et al.,

1992; Prochaska et al., 2009); (b) community, multicultural,

and social justice counseling (e.g., Chung & Bemak, 2012;

Comas-Díaz, 2014; Lewis et al., 2011); and (c) a develop-

mental–wellness model (e.g., Ivey, Ivey, Myers, & Sweeney,

2005).

In addition to the integration across clinical approaches

to enhance treatment, another equally important change is

emerging. There is a growing trend to conceptualize clients

and their care from a more holistic and systemically com-

prehensive perspective, with a greater focus on prevention,

overall health, and wellness (e.g., American Psychological

Association, 2014; Ivey et al., 2012; Lake, 2009; Lewis

et al., 2011; Melchert, 2015; Sarris et al., 2014; Walsh,

2011). Promotion of a clinical approach that includes an

emphasis on physical health, spiritual-existential develop-

ment, and interpersonal-sociocultural well-being has been

promoted for two or three decades (e.g., Lazarus, 1973;

Myers & Sweeney, 2005; Sweeney & Witmer, 1991;

Vaughan, 1986; Walsh, 2011; Wilber, 1995, 2000, 2006).

However, holistic wellness has not been central to most inte-

grative theoretical models (e.g., Corey, 2011).

Since the end of the 20th century, there has been an

increasing emphasis on an integrative approach to medicine

that is more holistic; it includes psychological and behav-

ioral lifestyle interventions and other evidence-supported

complementary or alternative approaches (e.g., Micozzi,

2015; Monti & Beitman, 2010; Nawaz, Via, Ali, &

Rosenberger, 2015). A more comprehensive, inclusive, and

holistic psychotherapy considers numerous factors that pre-

dict mental health and wellness, as well as the ever-increas-

ing body of research regarding evidence-based practices

(Lambert, 2013a, 2013b). For example, a more comprehen-

sive approach includes valuing community access to healthy

natural environments (e.g., J. V. Davis & Canty, 2013; Rosak

et al., 1995), as well as to fair and just social, cultural, eco-

nomic, and political environments, where all people have

relatively equal opportunities to succeed (e.g., Carter, 2007;

Draine, 2013; Enns et al., 2012; D. R. Fox & Prilleltensky,

2009; Liu, 2013; Mirowsky & Ross, 2003; Prilleltensky,

2012b, 2013; Toporek, 2013; Toporek et al., 2006). An inclu-

sive approach supports the integration of spirituality and/or

existential well-being into therapy, given the increasing

empirical evidence that has demonstrated short- and long-

term benefits of engagement in spirituality to mental and

physical health (e.g., Bonelli & Koenig, 2013; Hodge, 2006;

Hook et al., 2010; Hook, Worthington, & Davis, 2012;

Koenig et al., 2016; Koenig, King, & Carson, 2012;

Pargament, 2007; Vieten et al., 2016).

Recently, integrative, complementary, and alternative

medicine has had a greater influence on the field of mental

health; this may be due, in part, to the increasing popularity

of these approaches among the general public in the United

Fleuridas and Krafcik

States to treat anxiety or depression (e.g., Barnett, Shale,

Elkins, & Fisher, 2014; Kessler et al., 2001; Monti &

Beitman, 2010; Sarris et al., 2014). In the last decade, psy-

chotherapists have been encouraged to use a more compre-

hensive assessment and treatment plan that addresses

biological/physical, social/interpersonal, and spiritual/exis-

tential needs of their clients (e.g., Barnett et al., 2014; Lake,

2009; Meyers, Clarke, Brown, & Champion, 2012; Micozzi,

2015; Monti & Beitman, 2010; Walsh, 2011; Weil, 2011).

The contributions of neuropsychology influence this trend

(e.g., Erickson, Creswell, Verstynen, & Gianaros, 2014;

Hansen, 2013; Ivey et al., 2012; Littrell, 2015), as does the

increasing evidence that lifestyle habits that strengthen phys-

ical health, such as through reduced stress, daily exercise,

good nutrition, and regular and adequate sleep, are critical to

psycho-emotional well-being (e.g., Dale, Brassington, &

King, 2014; Lake, 2009; Monti & Beitman, 2010; Myers &

Sweeney, 2005; O’Neil et al., 2014; A. Richard, Rohrmann,

Vandeleur, Mohler-Kuo, & Eichholzer, 2015; Sarris et al.,

2014; Walsh, 2011; Weil, 2011).

Ivey and colleagues (Ivey et al., 2012; Ivey & Rigazio-

DiGilio, 1992) proposed that a metatheoretical, multiper-

spective approach to counseling, one that integrates moral

and spiritual growth as well as cognitive, behavioral, and

emotional development across the lifespan, is “a growing

paradigm shift in the field” (Ivey & Rigazio-DiGilio, 1992,

p. 39). They argued,

This paradigm shift will extend well beyond traditional

psychodynamic, cognitive-behavioral, and existential-humanistic

views of counseling and therapy, but in this extension, these

traditional theories will retain their vitality and importance. What

will be different in the future is that when the old question “What

is your theoretical orientation?” is asked, the new answers are

going to be developmental, constructivist, multicultural, and

systemic-contextual . . . . a more holistic and complete model of

therapy and counseling that will be congruent with fourth force

orientations. (pp. 39-40)

A metatheoretical framework that is more holistic would

include an ecosystemic, biopsychosocial, and spiritual, reli-

gious, and existential view of the individual, as well as a

social justice understanding of mental health.

One of the most comprehensive, holistic, and visionary

examples of theoretical integration is integral metatheory,

developed by Ken Wilber (e.g., 1995, 2000, 2006). The inte-

gral framework provides therapists with a more comprehen-

sive way to enable a greater understanding of human

existence and development and of the psychotherapeutic

process, including social justice practices. It provides a con-

ceptual map that supports the functionality of a complex,

ecosystemic, multidimensional, and multilevel approach that

is, by nature, more inclusive than other integrative and holis-

tic models that have been proposed thus far. Ivey and col-

leagues (2012) promoted the use of integral theory as a

“comprehensive framework that represents a pioneering

effort to synthesize the tremendous amount of information

that currently exists in counseling and psychology” (p. xxiii),

as well as in many other important disciplines relevant to the

field.

Primarily, the integral metatheory includes five basic fea-

tures—quadrants, stages (levels), lines, states, and types—

and these five facets inform the core principles of integral

psychotherapy (Forman, 2010; Marquis & Wilber, 2008;

Wilber, 1995, 2006). The quadrants are foundational among

the five features and represent four basic perspectives that

humans take on reality: subjective-individual, subjective-

collective, objective-individual, and objective-collective.

Mapped together, these four perspectives provide a more

complete and complementary view of any given phenomena.

The four quadrants relate to the four other basic features of

the integral approach—levels, lines, states, and types—each

of which can be seen from the perspective of each quadrant

(Forman, 2010; Marquis, 2007, 2008; Wilber, 1995, 2006). It

is beyond the scope of this article to describe each of these

constructs other than to emphasize that an integral consider-

ation fosters a more comprehensive assessment and under-

standing of clients (not only in terms of mental and physical

health and well-being but also ecosystemically in terms of

family, culture, community, social connections, resources,

sociopolitical oppression, access to nature, and so forth).

Fundamentally, the integral framework provides a concep-

tual means for therapists to work integratively and systemi-

cally across theoretical models and modalities, given their

understanding of the evidence and of client needs and

resources. It supports therapists and clients to think in terms

of healing, growth, and development in prioritized areas and

also assists therapists to consider the need for and to engage

in client advocacy and in social and ecological justice.

Although much of the psychotherapeutic community

remains unaware of this integrative, systemic, and holistic

approach to working with clients and communities, integral

metatheory is growing in influence (Baker, 2011; Combs,

2002; Esbjörn-Hargens, Reams, & Gunnlauson, 2010;

Esbjörn-Hargens & Zimmerman, 2011; Forman, 2010;

Ingersoll, 2010; Ingersoll & Zeitler, 2010; Schlitz, Amorok,

& Micozzi, 2004). The benefits of using a metatheoretical

approach to counseling have been identified and promoted

by Ivey and colleagues (Ivey & Goncalves, 1988; Ivey &

Rigazio-DiGilio, 1992). The current edition of Ivey and

coauthors’ (2012) theories of psychotherapy textbook offers

Wilber’s (e.g., 1995, 2000, 2006) integral metatheory as the

lens through which to see each theory in an attempt to

encourage students to consider a more comprehensive,

developmental, and holistic approach.

How widespread this integral, transtheoretical metatheory

will become as a force in the wider psychotherapeutic com-

munity remains to be seen. This will depend, in part, on the

ability of scholars and practitioners to foster its dynamic

development in the face of sound criticism and to verify its

relevance and utility to address the needs of individuals and

SAGE Open

groups in the complex global community. Nonetheless, the

field has evolved toward inclusion and integration (of theo-

ries, praxis, and research), and there appears to be an increas-

ing interest in holistic, ecosystemic approaches that aim to

better meet the immediate and long-term needs of diverse

individuals, families, and local to global communities.

Finally, Walsh (2016) provided an extensive rationale for

integrative, inclusive metatheories, emphasizing that they

may better provide the tools needed “to address the great

social, global, and ecological crises of our time” (p. xvii).

Conclusion

Ecological, multicultural, and systemic understandings of

human nature, interrelationships, health, and pathology have

changed dramatically over time, as have theories of person-

ality and psychotherapy. This article offered a brief overview

of the development of an evolutionary framework used to

identify major movements in the field of psychotherapy for

the last several decades. Reviewing the history of these

forces provides information about how psychotherapy has

been conceptualized from within, by a few, over time. It also

sheds light on what theorists and mental health professionals

may miss as they attempt to be comprehensive in their under-

standing of human nature and of what may be effective strat-

egies to support individual and systemic change. This is

especially true as psychology and psychotherapy become

increasingly shaped by international voices, needs, and

trends, as well as by advances in knowledge and technology.

Attempting to be inclusive, holistic, and integrative, while

knowing how to prioritize what may be most helpful for

those in need, given the knowledge and resources available,

seems to be essential keys as the field continues to evolve.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect

to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, author-

ship, and/or publication of this article.

References

Adler, A. (1927). Understanding human nature: The psychology

of personality (B. Wolfe, Trans.). New York, NY: Greenberg.

Ægisdottir, S., & Gerstein, L. H. (2010). International counseling

competencies. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, &

C. M. Alexander (Eds.), Handbook of multicultural counseling

(3rd ed., pp. 175-188). Thousand Oaks, CA: SAGE.

Albee, G. W., & Joffe, J. M. (2004). Mental illness is NOT “an ill-

ness like any other.” The Journal of Primary Prevention, 24,

419-436. doi:10.1023/B:JOPP.0000024799.04666.8b

Aldarondo, E. (Ed.). (2007). Advancing social justice through clini-

cal practice. Mahwah, NJ: Lawrence Erlbaum.

American Counseling Association. (2005a). American Counseling

Association code of ethics. Retrieved from http://www.counsel-

ing.org/knowledge-center/ethics

American Counseling Association. (2005b). American Counseling

Association resolutions passed: Resolutions from Counselors

for Social Justice. Retrieved from https://www.counseling.org/

news/updates/2006/01/16/resolutions-adopted-by-governing-

council

American Counseling Association. (2009). Competencies for

addressing spiritual and religious issues in counseling.

Retrieved from https://www.counseling.org/docs/default-

source/competencies/competencies-for-addressing-spiritual-

and-religious-issues-in-counseling.pdf?sfvrsn=8

American Psychological Association. (1981). Ethical principles of

psychologists. American Psychologist, 36, 633-638.

American Psychological Association. (1990). Guidelines for pro-

viders of psychological services to ethnic, linguistic, and cul-

turally diverse populations. Retrieved from http://www.apa.

org/pi/oema/resources/policy/provider-guidelines.aspx

American Psychological Association. (2000). Guidelines for

psychotherapy with lesbian, gay, and bisexual clients.

American Psychologist, 55, 1440-1451. doi:10.1037/0003-

066X.55.12.1440

American Psychological Association. (2003). Guidelines on mul-

ticultural education, training, research, practice, and organiza-

tional change for psychologists. American Psychologist, 58,

377-402. doi:10.1037/0003-066X.58.5.377

American Psychological Association. (2006). Evidence-based

practice in psychology. American Psychologist, 61, 271-285.

doi:10.1037/0003-066X.61.4.271

American Psychological Association. (2007). Guidelines for

psychological practice with girls and women. American

Psychologist, 62, 949-979. doi:10.1037/0003-066X.62.9.949

American Psychological Association. (2014). Guidelines for pre-

vention in psychology. American Psychologist, 69, 285-296.

doi:10.1037/a0034569

American Psychological Association. (2018). Guidelines for the

psychological practice with boys and men. Retrieved from

https://www.apa.org.about/policy/boys-men-practice-guide-

lines.pdf

Arfken, M., & Yen, J. (2014). Psychology and social jus-

tice: Theoretical and philosophical engagements. Journal

of Theoretical and Philosophical Psychology, 14, 1-13.

doi:10.1037/a0033578

Arredondo, P. (1999). Multicultural counseling competencies as

tools to address oppression and racism. Journal of Counseling

& Development, 77, 102-108. doi:10.1002/j.1556-6676.1999.

tb02427.x

Arredondo, P., & Perez, P. (2003). Expanding multicultural com-

petence through social justice leadership. The Counseling

Psychologist, 31, 282-289. doi:10.1177/0011000003031003003

Arredondo, P., Toporek, R., Brown, S. P., Jones, J., Locke, D. C.,

Sanchez, J., & Stadler, H. (1996). Operationalization of mul-

ticultural competencies. Journal of Multicultural Counseling

and Development, 24, 42-78. doi:10.1002/j.2161-1912.1996.

tb00288.x

Arredondo, P., & Tovar-Blank, Z. G. (2014). Multicultural compe-

tencies: A dynamic paradigm for the 21st century. In F. T. L.

Leong (Ed.-in-Chief), L. Comas-Díaz, G. C. Nagayama Hall,

Fleuridas and Krafcik

V. C. McLoyd, & J. E. Trimble (Assoc. Eds.), APA handbook of

multicultural psychology: Vol. 2 Applications and training (pp.

19-34). Washington, DC: American Psychological Association.

Arredondo-Dowd, P. M., & Gonsalves, J. (1980). Preparing cultur-

ally effective counselors. The Personnel and Guidance Journal,

58, 657-661. doi:10.1002/j.2164-4918.1980.tb00351.x

Assagioli, R. (1969). Symbols of transpersonal experience. Journal

of Transpersonal Psychology, 1, 1-9.

Atkinson, D. R., & Israel, T. (2003). The future of multicultural

counseling competence. In D. B. Pope-Davis, H. L. K. Coleman,

W. M. Liu, & R. L. Toporek (Eds.), Handbook of multicultural

competencies in counseling and psychology (pp. 591-606).

Thousand Oaks, CA: Sage.

Atkinson, D. R., Morten, G., & Sue, D. W. (1979). A cross-cultural

perspective. Dubuque, IA: William C. Brown.

Baker, M. (2011). An integral approach to counselling refugees.

Asia Pacific Journal of Counselling and Psychotherapy, 2,

117-125. doi:10.1080/21507686.2011.565932

Barnett, J. E., Shale, A. J., Elkins, G., & Fisher, W. (2014).

Complementary and alternative medicine for psychologists: An

essential resource. Washington, DC: American Psychological

Association.

Becvar, D. S., & Becvar, R. J. (1998). Systems theory and family

therapy: A primer (2nd ed.). Lanham, MD: University Press

of America.

Becvar, D. S., & Becvar, R. J. (2013). Family therapy: A systemic

integration (8th ed.). Upper Saddle River, NJ: Pearson.

Berger, L. K., Zane, N., & Hwang, W.-C. (2014). Therapist ethnic-

ity and treatment orientation differences in multicultural coun-

seling competencies. Asian American Journal of Psychology,

5, 53-65. doi:10.1037/a0036178

Bonelli, R. M., & Koenig, H. G. (2013). Mental disorders, reli-

gion and spirituality 1990 to 2010: A systematic evidence-

based review. Journal of Religion & Health, 52, 657-673.

doi:10.1007/s10943-013-9691-4

Boorstein, S. (Ed.). (1980). Transpersonal psychotherapy. New

York: State University of New York Press.

Borgen, W. A. (2007). Counseling and social justice: An interna-

tional perspective. In C. C. Lee (Ed.), Counseling for social

justice (2nd ed., pp. 161-179). Alexandria, VA: American

Counseling Association.

Broderick, C. B., & Schrader, S. S. (1981). The history of profes-

sional marriage and family therapy. In A. S. Gurman & D. P.

Kniskern (Eds.), Handbook of family therapy (pp. 5-31). New

York, NY: Brunner/Mazel Publishers.

Broverman, I. K., Broverman, D. M., Clarkson, F. E., Rosenkrantz,

P. S., & Vogel, S. R. (1970). Sex-role stereotypes and clinical

judgments of mental health. Journal of Consulting and Clinical

Psychology, 34, 1-7. doi:10.1037/h0028797

Brown, L. R. (1995). Ecopsychology and the environmental rev-

olution. In T. Rosak, M. E. Gomes, & A. D. Kanner (Eds.),

Ecopsychology: Restoring the earth, healing the mind (pp. xiii-

xvi). San Francisco, CA: Sierra Club Books.

Brown, L. S. (1994). Subversive dialogues: Theory in feminist ther-

apy. New York, NY: Basic Books.

Brown, L. S. (2010). Feminist therapy. In J. Carlson & M. Englar-

Carlson (Eds.), Theories of psychotherapy series. Washington,

DC: American Psychological Association.

Bryant-Davis, T., & Ocampo, C. (2005). The trauma of rac-

ism: Implications for counseling, research, and education.

The Counseling Psychologist, 33, 574-578. doi:10.1177/

0011000005276581

Bugental, J. F. T. (1964). The third force in psychology.

Journal of Humanistic Psychology, 4, 19-25. doi:10.1177/

002216786400400102

Burr, V. (1995). An introduction to social construction. London,

England: Routledge.

Buzzell, L., & Chalquist, C. (Eds.). (2009). Ecotherapy: Healing

with Nature in Mind (Forward by D. W. Orr). San Francisco,

CA: Sierra Club Books.

Cain, D. J. (2016). Toward a research-based integration of opti-

mal practices of humanistic psychotherapies. In D. J. Cain,

K. Keenan, & S. Rubin (Eds.), Humanistic psychotherapies:

Handbook of research and practice (2nd ed., pp. 485-535).

Washington, DC: American Psychological Association.

Cain, D. J., Keenan, K., & Rubin, S. (Eds.). (2016). Humanistic

psychotherapies: Handbook of research and practice (2nd

ed.). Washington, DC: American Psychological Association.

Capaldi, C. A., Passmore, H., Ishii, R., Chistopolskaya, K. A.,

Vowinckel, J., Nikolaev, E. L., & Semikin, G. I. (2017).

Engaging with natural beauty may be related to well-being

because it connects people to nature: Evidence from three cul-

tures. Ecopsychology, 9, 199-211. doi:10.1089/eco.2017.0008

Carlson, R. (1962). Silent spring. Boston, MA: Houghton Mifflin.

Carter, R. T. (2007). Racism and psychological and emo-

tional injury: Recognizing and assessing race-based trau-

matic stress. The Counseling Psychologist, 35, 13-105.

doi:10.1177/0011000006292033

Casas, J. M., Park, Y. S., & Cho, B. (2010). The multicultural

and internationalization counseling psychology movements:

When all is said and done, it’s all multicultural, isn’t it? In

J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander

(Eds.), Handbook of multicultural counseling (3rd ed., pp. 189-

200). Thousand Oaks, CA: Sage.

Chalquist, C. (2009). A look at the ecotherapy research evidence.

Ecopsychology, 1, 64-74. doi:10.1089/eco.2009.0003

Chang, C. Y., Crethar, H. C., & Ratts, M. J. (2010). Social jus-

tice: A national imperative for counselor education and super-

vision. Counselor Education and Supervision, 50, 82-87.

doi:10.1002/j.1556-6978.2010.tb00110.x

Chesler, P. (1972). Women and madness. Garden City, NY:

Doubleday.

Christopher, J. C., Wendt, D. C., Marecek, J., & Goodman, D. M.

(2014). Critical cultural awareness: Contributions to a glo-

balizing psychology. American Psychologist, 69, 645-655.

doi:10.1037/a0036851

Chung, R. C. Y., & Bemak, F. P. (2012). Social justice counseling:

The next steps beyond multiculturalism. Thousand Oaks, CA:

Sage.

Clinebell, H. (1996). Ecotherapy: Healing ourselves, healing the

earth. New York, NY: Haworth Press.

Collins, S., Arthur, N., Brown, C., & Kennedy, B. (2015). Student

perspectives: Graduate education facilitation of multicul-

tural counseling and social justice competency. Training

and Education in Professional Psychology, 9, 153-160.

doi:10.1037/tep0000070

SAGE Open

Collison, B. B., Osborne, J. L., Gray, L. A., House, R. M., Firth, J.,

& Lou, M. (1998). Preparing counselors for social action. In C.

C. Lee & G. R. Walz (Eds.), Social action: A mandate for coun-

selors (pp. 263-292). Alexandria, VA: American Counseling

Association.

Comas-Díaz, L. (1991). Feminism and diversity in psychology: The

case of women of color. Psychology of Women Quarterly, 15,

597-609. doi:10.1111/j.1471-6402.1991.tb00433.x

Comas-Díaz, L. (1994). An integrative approach. In L. Comas-Díaz

& B. Greene (Eds.), Women of color: Integrating ethnic and

gender identities in psychotherapy (pp. 287-318). New York,

NY: Guilford Press.

Comas-Díaz, L. (2000). An ethnopolitical approach to working

with people of color. American Psychologist, 55, 1319-1325.

doi:10.1037/0003-066X.55.11.1319

Comas-Díaz, L. (2014). Multicultural psychotherapy. In F. T. L.

Leong (Ed.-in-Chief), L. Comas-Díaz, G. C. Nagayama Hall, V.

C. McLoyd, & J. E. Trimble (Assoc. Eds.), APA handbook of mul-

ticultural psychology: Vol. 2 Applications and training (pp. 419-

441). Washington, DC: American Psychological Association.

Comas-Díaz, L., & Greene, B. (Eds.). (1994). Women of color:

Integrating ethnic and gender identities in psychotherapy. New

York, NY: Guilford Press.

Combs, A. (2002). The radiance of being: Understanding the grand

integral vision: Living the integral life (2nd ed.). St. Paul, MN:

Paragon House.

Combs, G., & Freedman, J. (2012). Narrative, poststructur-

alism, and social justice: Current practices in narrative

therapy. The Counseling Psychologist, 40, 1033-1060.

doi:10.1177/0011000012460662

Conn, S. A. (1995). When the earth hurts, who responds? In T.

Rosak, M. E. Gomes, & A. D. Kanner (Eds.), Ecopsychology:

Restoring the earth, healing the mind (pp. 156-171). San

Francisco, CA: Sierra Club Books.

Conn, S. A. (1998). Living in the earth: Ecopsychology, health and

psychotherapy. The Humanistic Psychologist, 26, 179-198. doi

:10.1080/08873267.1998.9976972

Constantine, M. G., & Sue, D. W. (2006). Factors contribut-

ing to optimal human functioning in people of color in the

United States. The Counseling Psychologist, 34, 228-244.

doi:10.1177/0011000005281318

Cook, A. L., Krell, M. M., Hayden, L. A., Gracia, R., & Denitzio, K.

(2016). Fieldwork using the professional development schools

model: Developing a social justice orientation and multicul-

tural competency. Journal of Multicultural Counseling and

Development, 44, 176-188. doi:10.1002/jmcd.12045

Corey, G. (2011). The art of integrative counseling (2nd ed.).

Belmont, CA: Brooks/Cole.

Corey, G. (2017). Theory and practice of counseling and psycho-

therapy (10th ed.). Boston, MA: Cengage Learning.

Council for Accreditation of Counseling and Related Educational

Programs. (2009). 2009 Standards for Accreditation. Alexandria,

VA: Author.

Couturier, J., Kimber, M., & Szatmari, P. (2013). Efficacy of fam-

ily-based treatment for adolescents with eating disorders: A

systematic review and meta-analysis. International Journal of

Eating Disorders, 46(1), 3-11. doi:10.1002/eat.22042

Dale, H., Brassington, L., & King, K. (2014). The impact of healthy

lifestyle interventions on mental health and wellbeing: A sys-

tematic review. Mental Health Review Journal, 19(1), 1-26.

doi:10.1108/MHRJ-05-2013-0016

D’Andrea, M. (2000). Postmodernism, constructivism, and multi-

culturalism: Three forces reshaping and expanding our thoughts

about counseling. Journal of Mental Health Counseling, 22(1),

1-16.

D’Andrea, M., & Daniels, D. (2010). Promoting multiculturalism,

democracy, and social justice in organizational settings: A case

study. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M.

Alexander (Eds.), Handbook of multicultural counseling (3rd

ed., pp. 591-602). Thousand Oaks, CA: Sage.

Daniels, J. (2007). The fourth force in counseling and therapy:

Multicultural and feminist perspectives. In A. E. Ivey, M. J.

D’Andrea, & M. Bradford (Eds.), Theories of counseling and

psychotherapy: A multicultural perspective (pp. 319-358). Los

Angeles, CA: Sage.

Daniels, M. (2013). Traditional roots, history, and evolution of

transpersonal perspective. In H. L. Friedman & G. Hartelius

(Eds.), The Wiley Blackwell handbook of transpersonal psy-

chology (pp. 23-43). Malden, MA: Wiley-Blackwell.

Davis, J. V., & Canty, J. M. (2013). Ecopsychology and transper-

sonal psychology. In H. L. Friedman & G. Hartelius (Eds.),

The Wiley Blackwell handbook of transpersonal psychology

(pp. 597-611). Malden, MA: Wiley-Blackwell.

Davis, S. N., & Gergen, M. M. (1997). Toward a new psychology

of gender. In M. M. Gergen & S. N. Davis (Eds.), Toward a

new psychology of gender: A reader (pp. 1-27). New York,

NY: Routledge.

DeCarvalho, R. J. (1990). A history of the “third force” in psy-

chology. Journal of Humanistic Psychology, 30(4), 22-44.

doi:10.1177/002216789003000403

DeRobertis, E. M. (2013). Humanistic psychology: Alive in the

21st century. Journal of Humanistic Psychology, 53, 419-437.

doi:10.1177/0022167812473369

Diamond, I., & Orenstein, G. F. (Eds.). (1990). Reweaving the

world: The emergence of ecofeminism. San Francisco, CA:

Sierra Club Books.

Draguns, J. G. (2013). Counseling and psychotherapy around the

world: Current status and future prospects. In R. Moodley,

U. P. Gielen, & R. Wu (Eds.), Handbook of counseling and

psychotherapy in an international context (pp. 417-427). New

York, NY: Routledge.

Draine, J. (2013). Mental health, mental illnesses, poverty,

justice, and social justice. American Journal of Psychiatric

Rehabilitation, 16, 87-90. doi:10.1080/15487768.2013

.789684

Duncan, B. L., Miller, S. D., Wampold, B. E., & Hubble, M. A.

(Eds.). (2010). The heart and soul of change: Delivering

what works in therapy (2nd ed.). Washington, DC: American

Psychological Association.

Elliot, R., Greenberg, L. S., Watson, J., Timulak, L., & Friere, E.

(2013). Research on humanistic-experiential psychotherapies.

In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of

psychotherapy and behavior change (6th ed., pp. 495-538).

Hoboken, NJ: John Wiley.

Enns, C. Z. (1993). Twenty years of feminist counseling and

therapy: From naming biases to implementing multifac-

eted practice. The Counseling Psychologist, 21, 3-87.

doi:10.1177/0011000093211001

Fleuridas and Krafcik

Enns, C. Z. (2004). Feminist theories and feminist psychothera-

pies: Origins, themes, and diversity (2nd ed.). New York, NY:

Haworth Press.

Enns, C. Z., & Byars-Winston, A. M. (2010). Multicultural feminist

therapy. In H. Landrine & N. F. Russo (Eds.), Handbook of

diversity in feminist psychology (pp. 367-388). New York, NY:

Springer.

Enns, C. Z., Williams, E. N., & Fassinger, R. E. (2012). Feminist

multicultural psychology: Evolution, change, and challenge.

In C. Z. Enns & E. N. Williams (Eds.), The Oxford handbook

of feminist multicultural counseling psychology (pp. 1-26).

New York, NY: Oxford University Press. doi:10.1093/oxfor

dhb/9780199744220.001.0001

Erickson, K. I., Creswell, J. D., Verstynen, T. D., & Gianaros,

P. J. (2014). Health neuroscience: Defining a new field.

Current Directions in Psychological Science, 23, 446-453.

doi:10.1177/0963721414549350

Esbjörn-Hargens, S., Reams, J., & Gunnlauson, O. (Eds.). (2010).

Integral education: Exploring multiple perspectives in the

classroom. Albany: State University of New York Press.

Esbjörn-Hargens, S., & Zimmerman, M. E. (2011). Integral ecol-

ogy: Uniting multiple perspectives on the natural world.

Boston, MA: Integral Books.

Essandoh, P. K. (1996). Multicultural counseling as the “fourth

force”: A call to arms. The Counseling Psychologist, 24, 126-

137. doi:10.1177/0011000096241008

Etchison, M., & Kleist, D. M. (2000). Review of narrative ther-

apy: Research and utility. The Family Journal, 8, 61-66.

doi:10.1177/1066480700081009

Fadiman, J., & Frager, R. (2013). Personality and personal growth

(7th ed.). Upper Saddle River, NJ: Pearson.

Fisher, A. (2009). Ecopsychology as radical praxis. In L. Buzzell &

C. Chalquist (Eds.), Ecotherapy: Healing with nature in mind

(pp. 60-68). San Francisco, CA: Sierra Club Books.

Forman, M. D. (2010). A guide to integral psychotherapy:

Complexity, integration, and spirituality in practice. Albany:

State University of NY Press.

Fouad, N. A., & Prince, J. P. (2012). Social justice in counseling

psychology. In E. M. Altmaier & J. C. Hansen (Eds.), The

Oxford handbook of counseling psychology (pp. 856-872).

New York, NY: Oxford University Press.

Fox, D. R., & Prilleltensky, I. (2009). Critical psychology for social

justice: Concerns and dilemmas. In D. Fox, I. Prilleltensky, &

S. Austin (Eds.), Critical psychology: An introduction (2nd ed.,

pp. 1-19). Thousand Oaks, CA: Sage.

Fox, M. (1988). The coming of the cosmic Christ: The healing of

Mother Earth. San Francisco, CA: Harper & Row.

Fox, W. (1990). Toward a transpersonal ecology: The context,

influence, meanings, and distinctiveness of the deep ecol-

ogy approach to ecophilosophy. Boston, MA: Shambhala

Publications.

Franklin, C., Trepper, T. S., Gingerich, W. J., & McCollum, E. E.

(Eds.). (2012). Solution-focused brief therapy: A handbook of

evidence-based practice. New York, NY: Oxford University

Press.

Friedlander, M. L., Pieterse, A., & Lambert, J. E. (2012). The evo-

lution of theory in counseling psychology. In N. A. Fouad

(Ed.-in-Chief), J. A. Carter, & L. M. Subich (Assoc. Eds.),

APA handbook of counseling psychology: Vol. 2. Practice,

interventions, and applications (pp. 31-58). Washington, DC:

American Psychological Association.

Friedman, H. L., & Hartelius, G. (Eds.). (2013). The Wiley Blackwell

handbook of transpersonal psychology. Malden, MA: Wiley-

Blackwell.

Friedman, H. L., Krippner, S., Riebel, L., & Johnson, C. (2010).

Transpersonal and other models of spiritual development.

International Journal of Transpersonal Studies, 29, 279-294.

Retrieved from http://digitalcommons.ciis.edu/ijts-transperson

alstudies/

Frumkin, H. (2012). Building the science base: Ecopsychology

meets clinical epidemiology. In P. H. Kahn & P. H. Hasbach

(Eds.), Ecopsychology: Science, totems, and the technological

species (pp. 141-172). Cambridge: Massachusetts Institute of

Technology Press.

Fuertes, J. N., Stracuzzi, T. I., Bennett, J., Scheinholtz, J., Mislowack,

A., Hersh, M., & Cheng, D. (2006). Therapist multicultural

competency: A study of therapy dyads. Psychotherapy, 43,

480-490. doi:10.1037/0033-3204.43.4.480

Gergen, K. J. (1985). The social constructivist movement in

modern psychology. American Psychologist, 40, 266-275.

doi:10.1037/0003-066X.40.3.266

Gergen, K. J. (2009). Relational being: Beyond self and community.

New York, NY: Oxford University Press.

Gergen, M. M. (1988). Toward a feminist metatheory and method-

ology in the social sciences. In M. M. Gergen (Ed.), Feminist

thought and the structure of knowledge. New York: New York

University Press.

Gilligan, C. (1982). In a different voice: Psychological theory and

women’s development. Cambridge, MA: Harvard University

Press.

Glover, J., & Friedman, H. L. (2015). Transcultural competence:

Navigating cultural differences in the global community.

Washington, DC: American Psychological Association.

Goldenberg, H., & Goldenberg, I. (2009). The revolution and

evolution of family therapy and family psychology. In J. H.

Bray & M. Stanton (Eds.), The Wiley-Blackwell handbook

of family psychology (pp. 21-36). Malden, MA: Wiley-

Blackwell.

Goldfried, M. R., & Newman, C. F. (2003). A history of psycho-

therapy integration. In J. C. Norcross & M. R. Goldfried (Eds.),

Handbook of psychotherapy integration (2nd ed., pp. 46-93).

New York, NY: Oxford University Press.

Goleman, D. (1971). Meditation as meta-therapy: Hypothesis

toward a proposed fifth state of consciousness. Journal of

Transpersonal Psychology, 3(1), 1-25. Retrieved from http://

www.atpweb.org/journal.aspx

Gomes, M. E., & Kanner, A. D. (1995). The rape of the well-maid-

ens: Feminist psychology and the environmental crisis. In T.

Rosak, M. E. Gomes, & A. D. Kanner (Eds.), Ecopsychology:

Restoring the earth, healing the mind (pp. 111-121). San

Francisco, CA: Sierra Club Books.

Goodman, L. A., Liang, B., Helms, J. E., Latta, R. E., Sparks, E.,

& Weintraub, S. R. (2004). Training counseling psycholo-

gists as social justice agents: Feminist and multicultural prin-

ciples in action. The Counseling Psychologist, 32, 793-837.

doi:10.1177/0011000004268802

Greenspan, M. (1983). A new approach to women and therapy.

New York, NY: McGraw Hill.

SAGE Open

Greenway, R. (2009). The wilderness experience as therapy:

We’ve been here before. In L. Buzzell & C. Chalquist (Eds.),

Ecotherapy: Healing with nature in mind (pp. 132-139). San

Francisco, CA: Sierra Club Books.

Grof, S. (2012). Revision and re-enchantment of psychology:

Legacy of half a century of consciousness research. The

Journal of Transpersonal Psychology, 44, 137-163. Retrieved

from http://www.atpweb.org/journal.aspx

Hansen, R. (2013). Hardwiring happiness: The new brain sci-

ence of contentment, calm, and confidence. New York, NY:

Harmony Books.

Hare-Mustin, R. T. (1980). Family therapy may be danger-

ous for your health. Professional Psychology, 11, 935-938.

doi:10.1037/0735-7028.11.6.935

Hare-Mustin, R. T., & Marecek, J. (1990). Making a difference:

Psychology and the construction of gender. New Haven, CT:

Yale University Press.

Hartelius, G., Friedman, H. L., & Pappas, J. D. (2013). The call-

ing to a spiritual psychology. H. L. Friedman & G. Hartelius

(Eds.), The Wiley Blackwell handbook of transpersonal psy-

chology (pp. 44-61). Malden, MA: Wiley-Blackwell.

Hasbach, P. H. (2012). Ecotherapy. In P. H. Kahn & P. H. Hasbach

(Eds.), Ecopsychology: Science, totems, and the technological

species (pp. 115-140). Cambridge: Massachusetts Institute of

Technology Press.

Helms, J. E. (2003). A pragmatic view of social jus-

tice. The Counseling Psychologist, 30, 305-313.

doi:10.1177/0011000003031003006

Herlily, B. R., & Watson, Z. E. P. (2007). Social justice and coun-

seling ethics. In C. C. Lee (Ed.), Counseling for social justice

(2nd ed., pp. 181-199). Alexandria, VA: American Counseling

Association.

Hodge, D. R. (2006). Spiritually modified cognitive therapy: A

review of the literature. Social Work, 51, 157-166. doi:10.1093/

sw/51.2.157

Hook, J. N., Worthington, E. L., Jr., & Davis, D. E. (2012).

Religion and spirituality in counseling. In N. A. Fouad (Ed.-in-

Chief), J. A. Carter, & L. M. Subich (Assoc. Eds.), APA hand-

book of counseling psychology: Vol. 2. Practice, interventions,

and applications (pp. 417-432). Washington, DC: American

Psychological Association.

Hook, J. N., Worthington, E. L., Davis, D. E., Jennings, D. J.,

II., Gartner, A. L., & Hook, J. P. (2010). Empirically sup-

ported religious and spiritual therapies. Journal of Clinical

Psychology, 66, 46-72. doi:10.1002/jclp.20626

Hudson, C. G. (2005). Socioeconomic status and mental illness:

Tests of the social causation and selection hypotheses. American

Journal of Orthopsychiatry, 75(1), 3-18. doi:10.1037/0002-

9432.75.1.3

Ingersoll, R. E. (2010). Prologue. In R. E. Ingersoll & D. M. Zeitler

(Eds.), Integral psychotherapy: Inside out/outside in. Albany:

State University of NY Press.

Ingersoll, R. E., & Zeitler, D. M. (2010). Integral psychotherapy:

Inside out/outside in. Albany: State University of NY Press.

Ingulli, K., & Lindbloom, G. (2013). Connection to nature and psy-

chological resilience. Ecopsychology, 5, 52-55. doi:10.1089/

eco.2012.0042

Inman, A. G., & O’Shaughnessy, T. (2013). Women’s issues, femi-

nism, social class, and counseling. In W. M. Liu (Ed.), The

Oxford handbook of social class in counseling (pp. 498-514).

New York, NY: Oxford University Press.

Ivey, A. E. (1973). Counseling: The innocent profession or fiddling

while Rome burns. The Counseling Psychologist, 4, 111-115.

doi:10.1177/001100007300400115

Ivey, A. E. (1993). On the need for reconstruction of our present

practice of counseling and psychotherapy. The Counseling

Psychologist, 21, 225-228. doi:10.1177/0011000093212004

Ivey, A. E., & Collins, N. H. (2003). Social justice: A long-term chal-

lenge for counseling psychology. The Counseling Psychologist,

31, 290-298. doi:10.1177/0011000003031003004

Ivey, A. E., D’Andrea, M. J., & Ivey, M. B. (2012). Theories of

counseling and psychotherapy: A multicultural perspective

(7th ed.). Los Angeles, CA: Sage.

Ivey, A. E., & Goncalves, O. F. (1988). Developmental therapy:

Integrating developmental processes into the clinical prac-

tice. Journal of Counseling & Development, 66, 406-413.

doi:10.1002/j.1556-6676.1988.tb00900.x

Ivey, A. E., Ivey, M., Myers, J., & Sweeney, T. (2005).

Developmental counseling and therapy: Promoting wellness

over the lifespan. Boston, MA: Lahaska Press.

Ivey, A. E., & Rigazio-DiGilio, S. A. (1992). Counseling and psy-

chotherapy as moral and spiritual practice: Facing a major

paradigm shift. Counseling and Values, 37, 39-46. doi:10.1002/

j.2161-007X.1992.tb00379.x

Jones-Smith, E. (2012). Theories of counseling and psychotherapy:

An integrative approach. Thousand Oaks, CA: Sage.

Jordaan, W., & Jordaan, J. (1980). Metatheory: A sixth “force” in

psychology. South African Journal of Psychology, 10(1-2), 28-

41. doi:10.1177/008124638001000104

Kahn, P. H., & Hasbach, P. H. (2012). Introduction. In P. H. Kahn &

P. H. Hasbach (Eds.), Ecopsychology: Science, totems, and the

technological species (pp. 1-21). Cambridge: Massachusetts

Institute of Technology Press.

Kelly, G. A. (1955). A theory of personality: The psychology of

personal constructs. New York, NY: The Norton Library.

Kessler, R. C., Soukup, J., Davis, R. B., Foster, D. F., Wilkey, S.

A., Van Rompay, M. I., & Eisenberg, D. M. (2001). The use

of complementary and alternative therapies to treat anxiety

and depression in the United States. The American Journal of

Psychiatry, 158, 289-294. doi:10.1176/appi.ajp.158.2.289

Kim, J. S. (2008). Examining the effectiveness of solution-focused

brief therapy: A meta-analysis. Research on Social Work

Practice, 18, 107-116. doi:10.1177/1049731507307807

Kiselica, M. S. (2004). When duty calls: The implications of

social justice for policy, education, and practice in the mental

health professions. The Counseling Psychologist, 32, 838-854.

doi:10.1177/0011000004269272

Kiselica, M. S., & Robinson, M. (2001). Bringing advocacy

counseling to life: The history, issues and human dramas of

social justice work in counseling. Journal of Counseling &

Development, 79, 387-397. doi:10.1002/j.1556-6676.2001.

tb01985.x

Koenig, H. G., King, D. E., & Carson, V. B. (2012). Handbook

of religion and health (2nd ed.). New York, NY: Oxford

University Press.

Koenig, H. G., Pearce, M., Nelson, B., Shaw, S., Robins, C., Daher, N.,

. . .King, M. B. (2016). Effects of religious vs. standard cognitive

behavioral therapy on therapeutic alliance: A randomized clinical

Fleuridas and Krafcik

trial. Psychotherapy Research, 26, 365-376. doi:10.1080/105033

07.2015.1006156

L’Abate, L. (Ed.). (1985). Preface. In The handbook of family psy-

chology and therapy (pp. ix-xii). Homewood, IL: The Dorsey

Press.

L’Abate, L. (2013). Beyond the systems paradigm: Emerging con-

structs in family and personality psychology. New York, NY:

Springer.

Lake, J. (2009). Integrative mental health care: A therapist’s hand-

book. New York, NY: W.W. Norton.

Lambert, M. J. (2013a). The efficacy and effectiveness of psy-

chotherapy. In M. J. Lambert (Ed.), Bergin and Garfield’s

handbook of psychotherapy and behavior change (6th ed., pp.

169-218). Hoboken, NJ: John Wiley.

Lambert, M. J. (2013b). Introduction and historical overview. In

M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psy-

chotherapy and behavior change (6th ed., pp. 3-20). Hoboken,

NJ: John Wiley.

Lambert, M. J., Fidalgo, L. G., & Greaves, M. R. (2016). Effective

humanistic psychotherapy processes and their outcomes. In

D. J. Cain, K. Keenan, & S. Rubin (Eds.), Humanistic psycho-

therapies: Handbook of research and practice (2nd ed., pp. 49-

79). Washington, DC: American Psychological Association.

Lambert, M. J., Smart, D. W., Campbell, M. P., Hawkins, E. J.,

Harmon, C., & Slade, K. L. (2006). Psychotherapy outcome,

as measured by the OQ-45, in African American, Asian/Pacific

Islander, Latino/a, and Native American clients compared

with matched Caucasian clients. Journal of College Student

Psychotherapy, 20(4), 17-29. doi:10.1300/J035v20n04_03

Lawson, G. M., Duda, J. T., Avants, B. B., Wu, J., & Farah, M. J.

(2015). Associations between children’s socioeconomic status

and prefrontal cortical thickness. Developmental Science, 16,

641-652. doi:10.1111/desc.12096

Lazarus, A. A. (1973). Multimodal behavior therapy: Treating the

“BASIC ID..” The Journal of Nervous and Mental Disease,

156, 404-411. doi:10.1097/00005053-197306000-00005

Lee, C. C. (1998). Counselors as agents for social change. In C.

C. Lee & G. R. Walz (Eds.), Social action: A mandate for

counselors (pp. 3-16). Alexandria, VA: American Counseling

Association.

Lee, C. C. (2007). Conclusion: A counselor’s call to action. In C. C.

Lee (Ed.), Counseling for social justice (2nd ed., pp. 259-271).

Alexandria, VA: American Counseling Association.

Lee, C. C. (2012). Social justice as the fifth force in counseling. In C.

Y. Chang, C. A. Barrio Minton, A. L. Dixon, J. E. Myers, & T. J.

Sweeney (Eds.), Professional counseling excellence through lead-

ership and advocacy (pp. 109-120). New York, NY: Routledge.

Lee, C. C., & Hipolito-Delgado, C. P. (2007). Introduction:

Counselors as agents of social justice. In C. C. Lee (Ed.),

Counseling for social justice (2nd ed., pp. xiii-xxviii).

Alexandria, VA: American Counseling Association.

Lee, M. A., Smith, T. J., & Henry, R. G. (2013). Power politics:

Advocacy to activism in social justice counseling. The Journal

for Social Action in Counseling and Psychology, 5, 70-94.

Available from http://jsacp.tumblr.com/

Leong, F. T. L. (2014). Introduction. In F. T. L. Leong (Ed.-in-Chief),

L. Comas-Díaz, G. C. Nagayama Hall, V. C. McLoyd, & J. E.

Trimble (Assoc. Eds.), APA handbook of multicultural psychol-

ogy: Vol. 1 Theory and research (pp. xxi-xxvii). Washington,

DC: American Psychological Association.

Leong, F. T. L (Ed.-in-Chief)., Comas-Díaz, L. Nagayama

(Ed.-in-Chief), Hall, G. C., McLoyd, V. C., & Trimble,

J. E. (Assoc. Eds.). (2014). APA handbook of multicultural

psychology: Vol. 1 Theory and research. Washington, DC:

American Psychological Association.

Lewis, J. A., & Arnold, M. S. (1998). From multiculturalism to

social action. In C. C. Lee & G. R. Walz (Eds.), Social action:

A mandate for counselors (pp. 51-65). Alexandria, VA:

American Counseling Association.

Lewis, J. A., Lewis, M., Daniels, J. A., & D’Andrea, M. J. (2011).

Community counseling: A multicultural-social justice perspec-

tive (4th ed.). Belmont, CA: Brooks/Cole.

Lewis, J. A., Toporek, R. A., & Ratts, M. J. (2010). Advocacy

and social justice: Entering the mainstream of the counsel-

ing profession. In M. J. Ratts, R. A. Toporek, & J. A. Lewis

(Eds.), ACA advocacy competencies: A social justice frame-

work for counselors (pp. 239-244). Alexandria, VA: American

Counseling Association.

Littrell, J. (2015). Neuroscience for psychologists and other mental

health professionals: Promoting well-being and treating men-

tal illness. New York, NY: Springer.

Liu, W. M. (2011). Social class and classism in the helping pro-

fessions: Research, theory, and practice. Thousand Oaks, CA:

Sage.

Liu, W. M. (2013). Introduction to social class and classism in

counseling psychology. In W. M. Liu (Ed.), The Oxford hand-

book of social class in counseling (pp. 3-20). New York, NY:

Oxford University Press.

Liu, W. M., & Estrada-Hernández, N. (2010). Counseling and

advocacy for individuals living in poverty. In M. J. Ratts, R.

A. Toporek, & J. A. Lewis (Eds.), ACA advocacy competen-

cies: A social justice framework for counselors (pp. 43-53).

Alexandria, VA: American Counseling Association.

Liu, W. M., & Pope-Davis, D. B. (2003). Moving from diversity

to multiculturalism: Exploring power and its implications

for multicultural competence. In D. P. Pope-Davis, H. L. K.

Coleman, W. M. Liu, & R. A. Toporek (Eds.), Handbook of

multicultural competencies: In counseling and psychology (pp.

90-102). Thousand Oaks, CA: Sage.

Lopes, R. T., Gonçalves, M. M., Machado, P. P. P., Sinai, D., Bento,

T., & Salgado, J. (2014). Narrative therapy vs. cognitive-

behavioral therapy for moderate depression: Empirical evi-

dence from a controlled clinical trial. Psychotherapy Research,

24, 662-674. doi:10.1080/10503307.2013.874052

Louv, R. (2005). Last child in the woods: Saving our children from

nature deficit disorder. Chapel Hill, NC: Algonquin Books.

Louv, R. (2012). The nature principle: Reconnecting with life in a

virtual world. Chapel Hill, NC: Algonquin Books.

Luby, J., Belden, A., Botteron, K., Marrus, N., Harms, M. P.,

Babb, C., . . .Barch, D. (2013). The effects of poverty on

childhood brain development: The mediating effect of care-

giving and stressful life events. Journal of American Medical

Association Pediatrics, 167, 1135-1142. doi:10.1001/jamape-

diatrics.2013.3139

Lyons, H. Z., Bike, D. H., Ojeda, L., Johnson, A., Rosales, R., &

Flores, L. Y. (2013). Qualitative research as social justice prac-

tice with culturally diverse populations. The Journal for Social

SAGE Open

Action in Counseling and Psychology, 5, 10-25. Available

from http://jsacp.tumblr.com/

MacDonald, D. A., Walsh, R., & Shapiro, S. L. (2013). Meditation:

Empirical research and future directions. In H. L. Friedman

& G. Hartelius (Eds.), The Wiley Blackwell handbook of

transpersonal psychology (pp. 433-458). Malden, MA: Wiley-

Blackwell.

Mack, J. E. (1992). Inventing a psychology of our relationship to

the earth. In S. Staub & P. Green (Eds.), Psychology and social

responsibility: Facing global challenges (pp. 237-247). New

York: NYU Press.

Macy, J. (2007). World as lover, world as self: Courage for global

justice and ecological renewal (Rev. ed.). Berkeley, CA:

Parallax Press.

Mahoney, M. J., & Patterson, K. M. (1992). Changing theories of

changes: Recent developments in counseling. In S. D. Brown

& R. W. Lent (Eds.), Handbook of counseling and psychology

(2nd ed., pp. 665-689). New York, NY: John Wiley.

Mani, A., Mullainathan, S., Shafir, E., & Zhao, J. (2013). Poverty

impedes cognitive function. Science, 30, 976-980. doi:10.1126/

science.1238041

Manning, C. M., & Amel, E. L. (2014). No human left behind:

Making a place for social and environmental justice within the

field of ecopsychology. Ecopsychology, 6, 14-15. doi:10.1089/

eco.2013.0084

Maramba, G. G., & Nagayama Hall, G. C. (2002). Meta-analyses

of ethnic match as a predictor of dropout, utilization, and

level of functioning. Cultural Diversity and Ethnic Minority

Psychology, 8, 290-297. doi:10.1037/1099-9809.8.3.290

Marquis, A. (2007). What is integral theory? Counseling and

Values, 51, 164-179. doi:10.1002/j.2161-007X.2007.tb00076.x

Marquis, A. (2008). The integral intake: A guide to comprehensive

idiographic assessment in integral psychotherapy. New York,

NY: Routledge.

Marquis, A., & Wilber, K. (2008). Unification beyond eclec-

ticism and integration: Integral psychotherapy. Journal

of Psychotherapy Integration, 18, 350-358. doi:10.1037/

a0013560

Martin-Baró, I. (1994). Writings for a liberation psychology.

Cambridge, MA: Harvard University Press.

Maslow, A. H. (1962). Toward a psychology of being. New York,

NY: D. Van Nostrand Company.

Maslow, A. H. (1968). Preface to the second edition. In Toward a

psychology of being (2nd ed., pp. iii-v). New York, NY: D. Van

Nostrand Company.

Maslow, A. H. (1969a). The farther reaches of human nature.

Journal of Transpersonal Psychology, 1(1), 1-9. Retrieved

from http://www.atpweb.org/journal.aspx

Maslow, A. H. (1969b). Various meanings of transcendence.

Journal of Transpersonal Psychology, 1, 56-66. Retrieved

from http://www.atpweb.org/journal.aspx

Maslow, A. H. (1971). The farther reaches of human nature. New

York, NY: Penguin Books.

Masuda, J. R., Poland, B., & Baxter, J. (2010). Reaching for envi-

ronmental health justice: Canadian experiences for a com-

prehensive research, policy and advocacy agenda in health

promotion. Promotion International, 25, 453-463. doi:10.1093/

heapro/daq041

May, R. (1986). Transpersonal or transcendental? The Humanistic

Psychologist, 14, 87-90. doi:10.1080/08873267.1986.9976758

McGoldrick, M., Carter, B., & Garcia-Preto, N. (2011). The

expanded family life cycle: Individual, family, and social per-

spectives (4th ed.). Boston, MA: Allyn & Bacon.

McWhirter, E. H. (1997). Empowerment, social activism, and

counseling. Counseling and Human Development, 29, 1-14.

Retrieved from http://www.lovepublishing.com/catalog/coun-

seling_and_human_development_10.html

Melchert, T. P. (2015). Biopsychosocial practice: A science-based

framework for behavioral health care. Washington, DC:

American Psychological Association.

Merchant, C. (1980). The death of nature: Women, ecology, and the

scientific revolution. San Francisco, CA: Harper & Row.

Messer, S. B., & Wampold, B. E. (2002). Let’s face facts:

Common factors are more potent than specific therapy ingre-

dients. Clinical Psychology: Science and Practice, 9(1), 21-25.

doi:10.1093/clipsy/9.1.21

Metzner, R. (1995). The psychopathology of the human-nature

relationship. In T. Rosak, M. E. Gomes, & A. D. Kanner (Eds.),

Ecopsychology: Restoring the earth, healing the mind (pp. 55-

67). San Francisco, CA: Sierra Club Books.

Metzner, R. (1999). Green psychology: Transforming our relation-

ship to the earth. Rochester, VT: Park Street Press.

Meyers, J. E., Clarke, P., Brown, J. B., & Champion, D. A. (2012).

Wellness: Theory, research, and applications for counsel-

ors. In M. B. Scholl, A. S. McGowan, & J. T. Hansen (Eds.),

Humanistic perspectives on contemporary counseling issues

(pp. 17-44). New York, NY: Routledge.

Micozzi, M. S. (Ed.). (2015). Fundamentals of complementary

and alternative medicine (5th ed.). St. Louis, MO: Elsevier

Saunders.

Miller, J. B. (1986). Toward a new psychology of women (2nd ed.).

Boston, MA: Beacon Press.

Mirowsky, J., & Ross, C. E. (2003). Social causes of psychological

distress (2nd ed.). Edison, NJ: Aldine Transaction.

Monti, D. A., & Beitman, B. D. (Eds.). (2010). Integrative psychia-

try. New York, NY: Oxford University Press.

Moss, D. (Ed.). (1999). Humanistic and transpersonal psychol-

ogy: A historical and biographical sourcebook. Westport, CT:

Greenwood Press.

Myers, J. E., & Sweeney, T. J. (Eds.). (2005). Counseling for

wellness: Theory, research, and practice. Alexandria, VA:

American Counseling Association.

Nawaz, H., Via, C. M., Ali, A., & Rosenberger, L. D. (2015).

Project ASPIRE: Incorporating integrative medicine

into residency training. American Journal of Preventive

Medicine, 49(5, Suppl. 3), S296-S301. doi:10.1016/j.

amepre.2015.07.010

Ng, K.-M., & Noonan, B. M. (2012). Internationalization of

the counseling profession: Meaning, scope and concerns.

International Journal for the Advancement of Counselling, 34,

5-18. doi:10.1007/s10447-011-9144-2

Nichols, M. P. (with Davis, S. E.). (2017). Family therapy: Concepts

and methods (11th ed.). Hoboken, NJ: Pearson Education.

Noble, K. G., & Farah, M. J. (2013). Neurocognitive consequences

of socioeconomic disparities: The intersection of cognitive

neuroscience and public health. Developmental Science, 16,

639-640. doi:10.1111/desc.12076

Norcross, J. C., & Beutler, L. E. (2014). Integrative psychothera-

pies. In D. Wedding & R. J. Corsini (Eds.), Current psycho-

therapies (10th ed., pp. 499-532). Belmont, CA: Brooks/Cole.

Fleuridas and Krafcik

Norcross, J. C., & Goldfried, M. R. (Eds.). (2003). Handbook of

psychotherapy integration (2nd ed.). New York, NY: Oxford

University Press.

Norcross, J. C., Hedges, M., & Prochaska, J. (2002). The face

of 2010: A Delphi poll on the future of psychotherapy.

Professional Psychology, 33, 316-322. doi:10.1037/0735-

7028.33.3.316

Norcross, J. C., & Newman, C. E. (2003). Psychotherapy integra-

tion: Setting the context. In J. C. Norcross & M. R. Goldfried

(Eds.), Handbook of psychotherapy integration (pp. 3-46).

New York, NY: Oxford University Press.

Norcross, J. C., & Wampold, B. (2011). Evidence-based therapy

relationships: Research conclusions and clinical practices. In

J. C. Norcross (Ed.), Psychotherapy relationships that work:

Evidence-based responsiveness (2nd ed., pp. 423-430). New

York, NY: Oxford University Press.

Nurius, P. S., Uehara, E., & Zatzick, D. F. (2013). Intersection

of stress, social disadvantage, and life course processes:

Reframing trauma and mental health. American Journal of

Psychiatric Rehabilitation, 16, 91-114. doi:10.1080/1548776

8.2013.789688

O’Conner, T. (1995). Therapy for a dying planet. In T. Rosak, M.

E. Gomes, & A. D. Kanner (Eds.), Ecopsychology: Restoring

the earth, healing the mind (pp. 149-155). San Francisco, CA:

Sierra Club Books.

O’Neil, A., Quirk, S. E., Housden, S., Brennan, S. L., Williams, L.

J., Pasco, J. A., . . .Jacka, F. N. (2014). Relationship between

diet and mental health in children and adolescents: A system-

atic review. American Journal of Public Health, 104(10), e31-

e42. doi:10.2105/AJPH.2014.302110

Owen, J., Leach, M. M., Wampold, B., & Rodolfa, E. (2011).

Client and therapist variability in clients’ perceptions of their

therapists’ multicultural competencies. Journal of Counseling

Psychology, 58(1), 1-9. doi:10.1037/a0021496

Pargament, K. I. (2007). Spiritually integrated psychotherapy:

Understanding and addressing the sacred. New York, NY:

Guilford Press.

Parlee, M. B. (1979). Psychology and women. Signs, 5, 121-133.

Available from http://signsjournal.org/

Patterson, C. H. with Holden, C.). (1985). The therapeutic rela-

tionship: Foundations for an eclectic psychotherapy. Belmont,

CA: Brooks/Cole.

Pedersen, P. B. (1974). Cross cultural training of mental health

professionals. In P. B. Pedersen (Ed.), Readings in intercul-

tural communication: Vol. IV. Cross-cultural counseling:

Intercultural helping relationships (pp. 116-124). Pittsburgh,

PA: Intercultural Communications Network.

Pedersen, P. B. (1978). Four dimensions of cross-cultural skill in

counselor training. Journal of Counseling & Development, 56,

480-484. doi:10.1002/j.2164-4918.1978.tb05292.x

Pedersen, P. B. (1983). The cultural complexity of counseling.

International Journal for the Advancement of Counselling, 6,

117-192. Retrieved from http://link.springer.com/journal/10447

Pedersen, P. B. (1990). The multicultural perspective as a fourth force

in counseling. Journal of Mental Health Counseling, 12, 93-95.

Pedersen, P. B. (1991). Multiculturalism as a generic approach to

counseling. Journal of Counseling & Development, 70, 6-12.

doi:10.1002/j.1556-6676.1991.tb01555.x

Pedersen, P. B. (1999a). Culture-centered interventions as a

fourth dimension of psychology. In P. B. Pedersen (Ed.),

Multiculturalism as a fourth force (pp. 3-18). Philadelphia, PA:

Brunner/Mazel Publishers.

Pedersen, P. B. (1999b). The positive consequences of a culture-

centered perspective. In P. B. Pedersen (Ed.), Multiculturalism

as a fourth force (pp. 191-211). Philadelphia, PA: Brunner/

Mazel Publishers.

Plant, J. (Ed.). (1989). Healing the wounds: The promise of eco-

feminism. Santa Cruz, CA: New Society Publishers.

Ponterotto, J. G., & Casas, J. M. (1987). In search of multicul-

tural competence within counselor education programs.

Journal of Counseling & Development, 65, 430-434.

doi:10.1002/j.1556-6676.1987.tb00749.x

Ponterotto, J. G., & Casas, J. M. (1991). Handbook of racial/

ethnic minority counseling research. Springfield, IL: Charles

C. Thomas.

Prilleltensky, I. (1994). The morals and politics of psychology. New

York: State University of New York Press.

Prilleltensky, I. (1999). Critical psychology foundations for the pro-

motion of mental health. Annual Review of Critical Psychology,

1, 100-118.

Prilleltensky, I. (2001). Value-based praxis in community psy-

chology: Moving toward social justice and social action.

American Journal of Community Psychology, 29, 747-778.

doi:10.1023/A:1010417201918

Prilleltensky, I. (2008). The role of power in wellness, oppression,

and liberation: The promise of psychopolitical validity. Journal

of Community Psychology, 36, 116-136. doi:10.1002/jcop.20225

Prilleltensky, I. (2012a). The what, why, who, and how of global-

ization: What is psychology to do? Journal of Social Issues, 68,

612-629. doi:10.1111/j.1540-4560.2012.01766.x

Prilleltensky, I. (2012b). Wellness as fairness. American Journal

of Community Psychology, 49, 1-21. doi:10.1007/s10464-011-

9448-8

Prilleltensky, I. (2013). Wellness without fairness: The missing link

in psychology. South African Journal of Psychology, 43, 147-

155. doi:10.1177/0081246313484238

Prilleltensky, I., Dokecki, P., Frieden, G., & Ota Wang, V. (2007).

Counseling for wellness and justice: Foundations and ethical

dilemmas. In E. Aldarondo (Ed.), Advancing social justice

through clinical practice (pp. 19-42). Mahwah, NJ: Lawrence

Erlbaum.

Prilleltensky, I., & Nelson, G. (1997). Community psychology:

Reclaiming social justice. In D. Fox & I. Prilleltensky (Eds.),

Critical psychology: An introduction (pp. 166-184). Thousand

Oaks, CA: Sage.

Prilleltensky, I., & Nelson, G. (2002). Doing psychology criti-

cally: Making a difference in diverse settings. New York, NY:

Palgrave Macmillan.

Prilleltensky, I., & Nelson, G. (2013). Critical psychology, preven-

tion, and social justice. In E. M. Vera (Ed.), Oxford Library of

Psychology. The Oxford handbook of prevention in counseling psy-

chology. (pp. 141-159). New York, NY: Oxford University Press.

Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In

search of how people change: Applications to addictive behav-

iors. American Psychologist, 47, 1102-1114. doi:10.1037/0003-

066X.47.9.1102

Prochaska, J. O., Johnson, S., & Lee, P. (2009). The transtheoretical

model of behavioral change. In S. A. Shumaker, J. K. Ockene,

& K. A. Riekert (Eds.), The handbook of behavior change (3rd

ed., pp. 59-83). New York, NY: Springer.

SAGE Open

Quintana, S. M., Chew, A., & Schell, G. (2012). Counseling psychol-

ogy theory and research on race and ethnicity: Implications for a

psychological science of diversity. In N. A. Fouad (Ed.-in-Chief),

J. A. Carter, & L. M. Subich (Assoc. Eds.), APA handbook of

counseling psychology: Vol. 1. Theories, research, and meth-

ods (pp. 453-489). Washington, DC: American Psychological

Association.

Ratts, M. J. (2009). Social justice counseling: Toward the develop-

ment of a fifth force among counseling paradigms. The Journal of

Humanistic Counseling Education and Development, 48, 160-172.

Ratts, M. J., D’Andrea, M., & Arredondo, P. (2004). Social justice

counseling: “Fifth force” in field. Counseling Today, 47, 28-

30. Available from http://ct.counseling.org/

Ratts, M. J., Lewis, J. A., & Toporek, R. L. (2010). Advocacy and

social justice: A helping paradigm for the 21st century. In M. J.

Ratts, R. A. Toporek, & J. A. Lewis (Eds.), ACA advocacy com-

petencies: A social justice framework for counselors (pp. 3-10).

Alexandria, VA: American Counseling Association.

Ratts, M. J., & Pedersen, P. B. (2014). Counseling for multicultur-

alism and social justice: Integration, theory, and application

(4th ed.). Alexandria, VA: American Counseling Association.

Ratts, M. J., Singh, A. A., Nassar-McMillan, S., Butler, S. K., &

McCullough, J. R. (2016). Multicultural and social justice

counseling competencies: Guidelines for the counseling pro-

fession. Journal of Multicultural Counseling and Development,

44(1), 28-48. doi:10.1002/jmcd.12035

Rawlings, E. I., & Carter, D. K. (Eds.). (1977). Psychotherapy for women:

Treatment toward equality. Springfield, IL: Charles C. Thomas.

Richard, A., Rohrmann, S., Vandeleur, C. L., Mohler-Kuo, M., &

Eichholzer, M. (2015). Associations between fruit and veg-

etable consumption and psychological distress: Results from

a population-based study. BMC Psychiatry, 15, Article 213.

doi:10.1186/s12888-015-0597-4

Richards, P. S., & Bergin, A. E. (1997). A spiritual strategy for

counseling and psychotherapy. Washington, DC: American

Psychological Association.

Rodrigues, V., & Friedman, H. L. (2013). Transpersonal psycho-

therapies. In H. L. Friedman & G. Hartelius (Eds.), The Wiley

Blackwell handbook of transpersonal psychology (pp. 580-

594). Malden, MA: Wiley-Blackwell.

Rogers, C. R. (1963). Toward a science of the person. Journal of Humanistic

Psychology, 3, 72-92. doi:10.1177/002216786300300208

Rosak, T. (1992). The voice of the earth. New York, NY: Simon

& Schuster.

Rosak, T. (1995). Where Psyche meets Gaia. In T. Rosak, M. E. Gomes,

& A. D. Kanner (Eds.), Ecopsychology: Restoring the earth, heal-

ing the mind (pp. 1-20). San Francisco, CA: Sierra Club Books.

Rosak, T., Gomes, M. E., & Kanner, A. D. (Eds.). (1995).

Ecopsychology: Restoring the earth, healing the mind. San

Francisco, CA: Sierra Club Books.

Sarris, J., Glick, R., Hoenders, R., Duffy, J., & Lake, J. (2014).

Integrative mental healthcare White Paper: Establishing a new

paradigm through research, education, and clinical guidelines.

Advances in Integrative Medicine, 1, 9-14. Retrieved from http://

www.sciencedirect.com/science/article/pii/S2212962613000035

Schlitz, M., Amorok, T., & Micozzi, M. (Eds.). (2004).

Consciousness and healing: Integral approaches to mind-body

medicine. St. Louis, MO: C. V. Mosby.

Shafranske, E. P. (Ed.). (1996). Religion and the clinical practice

of psychology. Washington, DC: American Psychological

Association.

Shepard, P. (1982). Nature and madness. Athens: University of

Georgia Press.

Silverstein, L. B. (2006). Integrating feminism and multicultural-

ism: Scientific fact or science fiction? Professional Psychology,

37, 21-28. doi:10.1037/0735-7028.37.1.21

Smith, L., & Mao, S. (2012). Social class and psychology. In

N. A. Fouad (Editor-in-Chief), J. A. Carter, & L. M. Subich

(Assoc. Eds.), APA handbook of counseling psychology: Vol.

2. Practice, interventions, and applications (pp. 523-540).

Washington, DC: American Psychological Association.

Smith, P. M. (1971). Black activists for liberation, not guid-

ance. The Personnel and Guidance Journal, 49, 721-726.

doi:10.1002/j.2164-4918.1971.tb04841.x

Smith, S. D., Reynolds, C. A., & Rovnak, A. (2009). A criti-

cal analysis of the social advocacy movement in counsel-

ing. Journal of Counseling & Development, 87, 483-491.

doi:10.1002/j.1556-6678.2009.tb00133.x

Smith, T. B., & Trimble, J. E. (2016). Foundations of multicultural

psychology: Research to inform effective practice. Washington,

DC: American Psychological Association.

Society for the Exploration of Psychotherapy Integration. (n.d.).

Mission statement. Retrieved from http://www.sepiweb.

org/?page=3

Sprenkle, D. H. (2012). Intervention research in couple and fam-

ily therapy: A methodological and substantive review and an

introduction to the special issue. Journal of Marital and Family

Therapy, 38(1), 3-29. doi:10.1111/j.1752-0606.2011.00271.x

Steinglass, P. (1978). The conceptualization of marriage from a

systems theory perspective. In T. J. Paolino & B. S. McCrady

(Eds.), Marriage and marital therapy: Psychoanalytic, behav-

ioral, and systems theory perspectives (pp. 298-306). New

York, NY: Brunner/Mazel Publishers.

Stricker, G., & Gold, J. R. (Eds.). (1993). Comprehensive handbook

of psychotherapy integration. New York, NY: Plenum Press.

Sue, D. W. (1978). Eliminating cultural oppression in counseling:

Toward a general theory. Journal of Counseling Psychology, 5,

419-428. doi:10.1037/0022-0167.25.5.419

Sue, D. W., Arredondo, P., & McDavis, R. (1992). Multicultural

counseling competencies and standards: A call to the profes-

sion. Journal of Counseling & Development, 70, 477-484.

doi:10.1002/j.1556-6676.1992.tb01642.x

Sue, D. W., Bernier, J., Feinberg, L., Pedersen, P., Smith, E., &

Vazquez-Nutall, E. (1982). Position paper: Cross-cultural

counseling competencies. The Counseling Psychologist, 10,

45-52. doi:10.1177/0011000082102008

Sue, D. W., Carter, R., Casas, J., Fouad, N., Ivey, A., Jensen, M., .

. .Vazquez-Nutall, E. (1998). Multicultural counseling compe-

tencies: Individual and organizational development. Thousand

Oaks, CA: Sage.

Sue, D. W., Ivey, A. E., & Pedersen, P. B. (1996). A theory of mul-

ticultural counseling and therapy. Pacific Grove, CA: Brooks/

Cole.

Sue, D. W., & Sue, D. (2013). Counseling the culturally diverse:

Theory and practice (6th ed.). Hoboken, NJ: John Wiley.

(Original work published in 1981).

Sutich, A. J. (1968). Transpersonal psychology: An emerg-

ing force. Journal of Humanistic Psychology, 8, 77-78.

doi:10.1177/002216786800800108

Sutich, A. J. (1969). Some considerations regarding transpersonal

psychology. Journal of Transpersonal Psychology, 1(1), 11-20.

Retrieved from http://www.atpweb.org/journal.aspx

Fleuridas and Krafcik

Swartz, P. (1969). Fourth force psychology: A humanistic dis-

claimer. The Psychological Record, 19, 557-559. Retrieved

from http://opensiuc.lib.siu.edu/tpr/

Sweeney, T. J., & Witmer, J. M. (1991). Beyond social interest:

Striving toward optimal health and wellness. The Journal of

Individual Psychology, 47, 527-540. Retrieved from http://utpress.

utexas.edu/index.php/journals/journal-of-individual-psychology

Tanner-Smith, E. E., Jo Wilson, S., & Lipsey, M. W. (2013). The

comparative effectiveness of outpatient treatment for adoles-

cent substance abuse: A meta-analysis. Journal of Substance

Abuse Treatment, 44, 145-158. doi:10.1016/j.jsat.2012.05.006

Tao, K. W., Owen, J., Pace, B. T., & Imel, Z. E. (2015). A meta-

analysis of multicultural competencies and psychotherapy

process and outcome. Journal of Counseling Psychology, 62,

337-350. doi:10.1037/cou0000086

Toporek, R. L. (2013). Social class, classism, and social justice. In

W. M. Liu (Ed.), The Oxford handbook of social class in coun-

seling (pp. 21-34). New York, NY: Oxford University Press.

Toporek, R. L., Gerstein, L. H., Fouad, N. A., Roysircar, G., &

Israel, T. (Eds.). (2006). Handbook for social justice in coun-

seling psychology: Leadership, vision, and action. Thousand

Oaks, CA: Sage.

Trigwell, J. L., Francis, A. J. P., & Bagot, K. L. (2014). Nature con-

nectedness and eudaimonic well-being: Spirituality as a potential

mediator. Ecopsychology, 6, 241-251. doi:10.1089/eco.2014.0025

Tudor, K. (2013). Person-centered psychology and therapy, eco-

psychology, and ecotherapy. Person-Centered & Experiential

Psychotherapies, 12, 315-329. doi:10.1080/14779757.2013.855

137

van de Vijver, F. J. R. (2013). Contributions of internationaliza-

tion to psychology: Toward a global and inclusive discipline.

American Psychologist, 68, 761-770. doi:10.1037/a0033762

Vaughan, F. (1981). Transpersonal psychotherapy: Context, con-

tent, and process. In R. Walsh & F. Vaughan (Eds.), Beyond

ego: The transpersonal dimensions in psychology. Los

Angeles, CA: Jeremy P. Tarcher.

Vaughan, F. (1986). The inward arc: Healing and wholeness in

psychotherapy and spirituality. Boston, MA: Shambhala

Publications.

Vera, E. M., & Speight, S. L. (2003). Multicultural competence, social jus-

tice, and counseling psychology: Expanding our roles. The Counseling

Psychologist, 31, 253-272. doi:10.1177/0011000003031003001

Vera, E. M., & Speight, S. L. (2007). Advocacy, outreach, and

prevention: Integrating social action roles in professional

training. In E. Aldarondo (Ed.), Advancing social jus-

tice through clinical practice (pp. 373-416). Mahwah, NJ:

Lawrence Erlbaum.

Vermeulen-Smit, E., Verdurmen, E. E., & Engles, R. C. M. E. (2015).

The effectiveness of family interventions in preventing adoles-

cent illicit drug use: A systemic review and meta-analysis of

random controlled trials. Clinical Child and Family Psychology

Review, 18, 218-239. doi:10.1007/s10567-015-0185-7

Vieten, C., Scammell, S., Pierce, A., Pilato, R., Ammondson, I.,

Pargament, K. I., & Lukoff, D. (2016). Competencies for psy-

chologists in the domains of religion and spirituality. Spirituality

in Clinical Practice, 3, 92-114. doi:10.1037/scp0000078

von Bertalanffy, L. (1968). General systems theory: Foundations,

development, applications. New York, NY: George Braziller.

Walsh, R. (2001). Shamanic experiences: A developmental

analysis. Journal of Humanistic Psychology, 41, 31-52.

doi:10.1177/0022167801413004

Walsh, R. (2011). Lifestyle and mental health. American

Psychologist, 66, 579-592. doi:10.1037/a0021769

Walsh, R. (2014). Contemplative psychotherapies. In D. Wedding

& R. J. Corsini (Eds.), Current psychotherapies (10th ed., pp.

411-460). Belmont, CA: Brooks/Cole.

Walsh, R. (2016). Forward: The potentials of metatheory. In

R. Bhaskar, S. Esbjörn-Hargens, N. Hedlund, & M. Hartwig

(Eds.), Metatheory for the 21st century: Critical realism and inte-

gral theory in dialogue (pp. xiv-xix). New York, NY: Routledge.

Walsh, R., & Vaughan, F. (1980). Comparative models of the per-

son and psychotherapy. In S. Boorstein (Ed.), Transpersonal

psychotherapy (pp. 12-27). New York: State University of

New York Press.

Walsh, R., & Vaughan, F. (Eds.). (1993). Paths beyond ego: The

transpersonal vision. Los Angeles, CA: Jeremy P. Tarcher.

Wampold, B. E. (2001). The great psychotherapy debate: Models,

methods, and findings. Mahwah, NJ: Lawrence Erlbaum.

Watson, J. C. (2016). The role of empathy in psychotherapy:

Theory, research, and practice. In D. J. Cain, K. Keenan, &

S. Rubin (Eds.), Humanistic psychotherapies: Handbook of

research and practice (2nd ed., pp. 115-145). Washington,

DC: American Psychological Association.

Weil, A. (2011). Spontaneous happiness. New York, NY: Little,

Brown, and Co.

Weisstein, N. (1968). Kinder, kirche, kuche as scientific law:

Psychology constructs the female. Boston, MA: New England

Free Press.

Welch, I. D., Tate, G. A., & Richards, F. (Eds.). (1978). Humanistic

psychology: A source book. Oxford, UK: Prometheus.

Wilber, K. (1995). Sex, ecology, spirituality: The spirit of evolution.

Boston, MA: Shambhala Publications.

Wilber, K. (2000). Integral psychology: Consciousness, spirit, psy-

chology, therapy. Boston, MA: Shambhala Publications.

Wilber, K. (2006). Integral spirituality: A startling new role for

religion in the modern and postmodern world. Boston, MA:

Shambhala Publications.

Williams, E. N., & Barber, J. S. (2004). Power and responsibility

in therapy: Integrating feminism and multiculturalism. Journal

of Multicultural Counseling and Development, 32, 390-401.

Retrieved from http://onlinelibrary.wiley.com/journal/10.1002

/%28ISSN%292161-1912

Wilson, N. W., Fleming, S., Jones, R., Lafferty, K., Cathrine, K.,

Seaman, P., & Knifton, L. (2010). Green shoots of recov-

ery: The impact of a mental health ecotherapy programme.

Mental Health Review Journal, 15(2), 4-14. doi:10.5042/

mhrj.2010.0366

Author Biographies

Colette Fleuridas, PhD, is a professor at Saint Mary’s College of

California. She has been in clinical practice and teaching in the

fields of counseling and psychology for over 30 years, emphasizing

a holistic approach while following the evolution of the field through

various theoretical and ideological trends, foci, and paradigms.

Drew Krafcik, PhD, is a teacher, resident fellow, and educational

consultant at Stanford University. He is the co-founder and execu-

tive director of gradiant, an integrative college prep program that

helps high school seniors create a healthy and meaningful transition

to college. Drew has spent the last 20 years in the fields of counsel-

ing, psychology, and higher education.