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Sculpting Psychotherapy Integration in Argentina: The Aiglé Project 1977-2016.

Cite This Article

Game, B., & Esnal, J. (2015). Sculpting psychotherapy integration in Argentina: The Aiglé Project 1977-2016. Psychotherapy Bulletin, 50(4), 9-13.

An Introduction to Aiglé

Dr. Beatriz Gomez

Dr. Beatriz Gomez

Aiglé Foundation is a 38-year-old nongovernmental organization (NGO) that focuses on the professional development of mental health practitioners and the delivery of clinical and community services. Aiglé is a classical Greek word that means “shining,” “radiant,” or even “illumination.” Today, aiglé is the term used for the torch carried by Olympic athletes. The clearest definition is an everlasting flame.

Aiglé was founded by Héctor Fernández-Alvarez with a group of colleagues during harsh conditions in Argentina. In 1976 the country had been taken over by a military government at the height of military repression and became a hostile environment for dissent and for psychology. In this climate, the founders initiated Aiglé as a space of freedom to develop knowledge and clinical practice, and began a systematic, close contact and collaboration with psychologists overseas. As Consoli, Corbella, and Morgan Consoli (2013) point out, this international engagement became the “oxygen” that sustained the group at a moment when the circumstances were quite asphyxiating and dangerous.

Ms. Josefina Esnal

Ms. Josefina Esnal

The first decade of our development (1977-1987) was devoted to giving shape to the project. Perhaps the most novel feature was the organizational structure of the project itself. We became a cohesive group based on trust, mutual collaboration, efforts in conflict resolution and work, work, work. We tended to a broad spectrum of patients suffering from a wide range of clinical conditions and representing a broad cross-section of the Argentine society. These experiences provided the basis for much study and research.

In the 1990s Aiglé became a full-fledged institution. It joined the NGO sector as a self-managed and self-supported foundation and has remained so to this day. Our staff increased in number and we traveled throughout our country and abroad. Being exposed to other places and environments enabled us to incorporate new knowledge, better confront and deal with our proposals, and build an invaluable network of researchers and practitioners.

Over time, we reached a level of recognition that filled us with pride and satisfaction. At present, Aiglé focuses on the professional development of mental health practitioners and the delivery of clinical and community services—both informed by an active research program that evaluates the process and outcome of training and care. We developed a theoretical model tailored to our practice and as a common basis for our multifarious activities.

A graduate training program is conducted jointly with public and private universities and with an agreement with the Ackerman Institute for the Family, New York. Training is delivered in Buenos Aires and in eight cities in the country. Faculty members of Aiglé also travel regularly to teach in other countries in Latin America and Spain. Established exchange programs for graduate students also exist with institutions. Psychologists and psychiatrists from Chile, Colombia, Ecuador, Guatemala, Paraguay, Uruguay, and Venezuela, as well as Italy, Spain, and the United States of America, annually engage in professional practicum and internship programs at our institution.

Research work started early on. The institution conducts research in collaboration with other academic centers in the country and abroad and takes part in multi-site research programs. The activities in this area are characterized by strong communication between clinicians and researchers and efforts to translate knowledge into clinical applications and training aims across an extensive range of interests, including the study of clinical problems such as obsessive-compulsive disorders, single-case studies, and the integration of different theoretical approaches. Special efforts have been devoted to the development and study of personal style of the therapist as a construct; after 20 years, this development well illustrates our integrative perspective of psychotherapy and the productiveness of collaborations across national borders.

Since 1992, the institution has published the journal Revista Argentina de Clínica Psicólogica, indexed and/or abstracted in international databases, which includes papers from all over the world. From its beginning, the journal became an important media for the dissemination of cutting-edge psychological knowledge for Spanish-speaking readers. The journal has been particularly instrumental in facilitating a fruitful interchange of ideas in clinical psychology.

Last, but by no means least, the institution is committed to social outreach, providing professional help to food kitchen centers, teenage mothers’ shelters, hospitalized children, and elderly people, as well as psychological care to populations with limited economic resources.

Today, a large network of therapists in the country follows an integrative philosophy in practice, training, and research based on the values of openness and collaboration. Aiglé has centers throughout Argentina, as well as in Guatemala and Spain.

Our ongoing commitment to the discipline has been underscored most recently by Héctor Fernández-Alvarez being recognized as the recipient of the APA 2016 Award for Distinguished Contribution to the International Advancement of Psychology.

However, we never stop being aware of the challenges that the future may hold for us. We know we have to continue innovating in order to prove ourselves and keep growing. The need to continue to develop is one of the growing pains in any organizational project. Being aware of the difficulties and prepared to overcome the inevitable crises has always been part of our strength—just as the human component remains our substance. 

Why Integration?

Aiglé was founded at a time when psychoanalysis was, in our country, dominant in the field. This resulted in rich intellectual production and the sparking of the collective imagination of Argentines to the point that they became some of the largest consumers of psychotherapy. Psychotherapy was expanding in the world and the different approaches were contributing to the growing and diverse demand. Practice-related, theoretical, and training needs called for greater openness and clinical flexibility. It was in this cultural and scientific environment, and looking to both preserve traditional methods while simultaneously moving toward new ways to channel our work in the field, that Fernández-Alvarez (1992, 2008a) developed the Aiglé Model of Integrated Psychotherapy. Proposing a model based on integration meant, at first, being pushed to the margin in our field. Fortunately, a few years later the landscape of mental health began to transform. The renovation of models and therapeutic approaches created another environment, and the word “integration” came of age (Fernández-Alvarez, 2008a). This process was facilitated by the regular visit of well-known North American and European professionals who conducted seminars and workshops. Argentine therapists, on the other hand, fed on developments abroad, developing new and unique versions of these practices in their own work (Fernández-Alvarez, 2008b).

In the first issue of the Revista Argentina de Clínica Psicólogica, Safran (1992) described the barriers to psychotherapy integration and viewed different therapeutic orientations as cultures. The author stated that the process of integration can proceed through engaging in a dialectical process in which adherents to different worldviews discuss their relative positions in an open-minded way. The development and maintenance of a truly integrative spirit should be the goal of the integrative movement (Wachtel, 2010). As Gelso (2011) pointed out almost twenty years after: “It would seem that the days when it was seen as nearly sinful to draw from different theories…are thankfully gone” (p. 184). Although, some caution needs to be taken since there is no solid empirical evidence indicating integrative treatments are superior to single-theory treatments.

By integration, we mean not just a method, but an attitude and philosophy: an ongoing dialectical process between “the one and the many,” between the similar and different, between me and us. Integration is at the heart of our modus operandi, in all the dimensions influencing psychotherapy practice.

How Do We Integrate in Psychotherapy?

Psychotherapy practice is a combination of clinical experience and evidence based knowledge, an application of clinical methods, and interpersonal relationship.

The Aiglé Integrated Psychotherapy Model was developed to provide a common basis for all treatments and, at the same time, a tailored plan for each clinical condition. The model allows treatment planning with different goal levels, ranging from addressing symptoms to personality patterns and communication problems with diverse therapy formats: individual, family, couples and/or group therapy, and/or with other treatments (e.g., pharmacotherapy, nutrition therapy, social assistance).

The model examines clinical problems in the light of two main axes: 1) a vertical (or synchronic) one related to the type of process, to explain the genesis and maintenance of the pathological processes, involving development and personal history; and 2) a horizontal (or diachronic) one, involving the individual-context interaction (Fernández-Alvarez, 2008a; Fernández-Alvarez, Gómez, & García, 2015).

The overall objective is to expand awareness and to increase functional processing. The four traditional modalities provide different perspectives for a constructive psychological transformation. Psychodynamic approaches focus on the dynamic reactions; cognitive-behavioral approaches focus on behaviors and dysfunctional cognitions; humanistic approaches focus on the person as a whole, emphasizing self-consistency and personal decision making; and systemic theories focus on interactive systems’ influence (Längle & Kriz, 2012). Cognitive psychology is the basis for the integration of these perspectives into our model, and diverse procedures were selected to accomplish goals agreed upon by patients and therapists as part of the construction of a strong therapeutic alliance.

The optimal match between therapist(s) and patient(s) is central to our work model. In referring to specialized therapists, we take into account the presenting problem, patients’ characteristics, and the professional and personal characteristics of potential therapists.

Aiglé and the World of Integration

From its beginnings, psychotherapy integration stemmed from the desire to look beyond school boundaries to see what could be learned and how patients could benefit from a broader approach. It eventually developed into a consolidated movement in the 1980s (Norcross & Goldfried, 2005). Psychotherapy Integration was substantially strengthened by an international association, the Society for the Exploration of Psychotherapy Integration (SEPI), which was founded in 1983.

SEPI is an international, interdisciplinary organization. The aim of the organization is to promote the development of psychotherapies that integrate theoretical orientations, clinical practices, and diverse methods of inquiry. The organization encourages the participation of members from diverse cultures, regions, countries, racial/ethnic backgrounds, and religions. In 1990 we began to spread the word in Argentina and the region. In 1994 SEPI held its annual Conference in Buenos Aires, the first time ever in a Latin American country. Héctor Fernandez-Alvarez, who was Coordinator of the Regional Latin-American Network, became the Chairperson of the Program Committee and Beatriz Gómez, the Organizing Committee Chair.

A fruitful relationship between SEPI and Aiglé continued up to the present day. Fernández-Alvarez serves as chair of the Education and Training Committee and in 2016 Beatriz Gómez will be the first non-North American President of SEPI. This means a meeting point between Aigle´s continuous interest in building integration and SEPI´s continuous interest in expanding its outreach. The next SEPI Conference will be held in Dublin, Ireland, in June, 2016. Beatriz Gómez, together with an enthusiastic group forming the Program Committee and an active Executive Committee integrated by SEPI´s founders and by international members, foresees an exciting meeting at Trinity College. The aim is sharing clinical work, research findings, and educational practices. The organizing committee welcomes participants with a quotation attributed to W. B. Yeats: “There are no strangers here, only friends you haven’t yet met.” This is precisely how integration is meant.

In Latin America, Fernández-Alvarez together with colleagues from Chile, Ecuador, and Uruguay founded the Latin-American Association of Integrative Psychotherapy (ALAPSI) in 2006, aimed at promoting clinical interchange and communication between therapists and training institutes in the region. It is noteworthy to point out that psychotherapy in Latin America faces difficult community conditions. In many situations, it is necessary to use a broad array of resources to meet the needs of populations with scarce resources. This goal is the driving force for the development and interchange of a variety of approaches and procedures among therapists of the region. The Association will be holding its next conference in 2016 in Argentina.

Towards More/New Integration

As Gelso (2011) stated, “the term, integration, may be defined as the combining or putting together of different elements into some broader element or whole. Such integration may be seen as a sign of the maturation of a field or body of knowledge” (p. 182). It involves sculpting integration in a variety of ways: Establishing connection between different domains of knowledge and practice, fostering the joint work of mental health practitioners, and facilitating collaboration of practitioners and researchers. As Goldfried (2010) stated, this “collaboration [may] serve as the organizing force for integration [in this] century” (p. 395).

In the near future, professionals will be entrusted to increase health promotion, primary care, community programs, and efficient treatments to reach all populations, especially the ones who do not currently have access to psychological services. Continuing to build integration is a promising avenue in this direction.

We continue working in Aiglé, and though we certainly face difficulties, it is consistently rewarding. Sculpting integration is an open-ended endeavor; while we do so, we keep passing on the torch.

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References

Consoli, A., Corbella, S., & Morgan Consoli, M. (2013). International engagement as oxygen: Héctor Fernández-Alvarez- Argentina. International Psychology Bulletin, 17, 39-42.

Fernández-Alvarez, H. (1992). Fundamentos de un modelo integrativo en psicoterapia. Buenos Aires, Argentina: Paidós. [English edition (2001). Fundamentals of an integrated model of psychotherapy. Northvale, NJ: Jason Aronson].

Fernández-Alvarez, H. (2008a). Integración y salud mental. [Ìntegration and Mental Health]. Bilbao, Spain: Desclée de Brouwer.

Fernández-Alvarez, H. (2008b). Integration in Argentina: An approach from Argentina. Journal of Psychotherapy Integration, 18, 79-86.

Fernández-Alvarez, H., Gómez, B., & García, F. (2015). Bridging the gap between research and practice in a clinical and training network: Aigle´s program. Psychotherapy Research, 25, 84-94.

Gelso, C. J. (2011). Emerging and continuing trends in psychotherapy: Views from an editor's eye. Psychotherapy, 48, 182-187.

Goldfried, M. (2010). The future of psychotherapy integration: Closing the gap between research and practice. Journal of Psychotherapy Integration, 20, 386-396.

Längle, A., & Kriz, J. (2012). Humanistic psychology and contextual behavioral perspectives. Psychotherapy, 49, 455-460.

Norcross, J. C., & Goldfried, M. R. (2005). Handbook of psychotherapy integration (2nd ed). New York, NY: Oxford University Press.

Safran, J. (1992). Barreras para la integración en psicoterapia.[Barriers to Psychotherapy Integration]. Revista Argentina de Clínica Psicológica, 1, 7-15.

Wachtel, P. L. (2010). Psychotherapy integration and integrative psychotherapy: Process or product. Journal of Psychotherapy Integration, 20, 406-416.

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