The Journal of Contemporary Psychotherapy recently published an article written by psychologists from several institutions where they clearly articulate how different orientations to psychotherapy are being unified in clinical theory and practice.
Unification is a recently emerging trend toward integrating theories and techniques from varying psychotherapeutic orientations to better attend to clients’ distress. According to the lead author, Andre Marquis from the University of Rochester:
“Unifying metatheories not only enable us to hold many perspectives, but they also organize the data that emerge from those different perspectives, setting the stage for an evidence-based, principled approach that takes seriously the individual, unique nature and setting of the problem and the complex work of psychotherapy. We advocate for a shift toward ‘integrated pluralism,’ in which there is a shared frame of understanding regarding the central features of the discipline, out of which many diverse, pluralistic views are adopted.”
There has been a push to integrate complementary aspects of different approaches to psychotherapy. For example, cognitive-behavioral therapists may integrate techniques from psychodynamic therapy to improve the effectiveness of treatment.
Traditionally, therapists were trained to practice a singular theoretical orientation – whether psychoanalytic, behavioral, or humanistic psychotherapy, for example. Over time, a proliferation of approaches and orientations were developed, and therapists began combining theories and practices through technical eclecticism, common factors, theoretical integration, and assimilative integration.
Unification is a fifth pathway integration and offers a meta-theoretical perspective of psychotherapy. Rather than understanding different orientations as providing a specific way of working and understanding the client’s lived experience and finding connections between distinct approaches to therapy, the lens of unification sees orientations as providing specialized information on a larger, more complex phenomenon.
The authors use a metaphor to explain these differences:
“A potentially useful analogy is that each of the paradigms can be considered as being akin to a ‘mountain,’ and the other four pathways towards psychotherapy integration are concerned with developing connections between the mountains. In contrast, a unification view steps back and offers frameworks to see the whole of the mountain range from a zoomed-out perspective.”
By having this larger picture, clinicians can understand the complexity of an individual’s presenting concerns and find a holistic and comprehensive set of tools that would be most beneficial for the client in this diversity of approaches. This integration is facilitated by the growing body of work aimed at connecting metatheoretical concepts to psychotherapeutic practice.
The authors identified three complementary approaches to unification: The Dynamical Biopsychosocial Systems View, Integral Psychotherapy, and the Unified Theory of Psychology.
The Dynamical Biopsychosocial Systems View is the most commonly used approach to unification. It accentuates the interrelationship between different levels of analysis, from the macro-level societal dynamics to the micro-neurobiological, from the intrapsychic to the interpersonal and familial. Most mental health professionals, and their theoretical orientations, often focus on one of these domains while failing to address others.
The Biopsychosocial Systems approach to unification allows the therapist to conceptualize each case by being mindful of each domain and how these domains dynamically affect each other (e.g., how social processes might influence the client’s negative self-concept). Having this conceptual and clinical flexibility that allows therapists to use practices and techniques from multiple theoretical orientations. They can then attend to the manifold needs of their clients identified from their comprehensive and exhaustive biopsychosocial analysis.
Integral Psychotherapy, like the Dynamical Biopsychosocial View, acknowledges the value and importance of many theoretical orientations and adapts clinical practice according to client’s needs and concerns. Instead of seeing the variety of approaches to therapy as contradictory, they highlight their unifying constructs.
Integral psychotherapists also developed their own form of analyzing clients’ experiences and distress in a thorough and complex fashion, considering what is occurring within and outside of the individual and occurring within and outside of the larger collective. Each of these points of analysis corresponds to different psychological schools of thought that, when used together, provide a complex and contextualized picture of people’s experiences and suffering that can enhance clinical practice.
Lastly, the Unified Theory of Psychology stresses that because there is no consensus about the concept of human psychology between schools of thought, it has become difficult to unify the field. However, proponents of the Unified Theory of Psychology argue that psychology can be unified by developing a clearer understanding of what the psychological profession is and does. Like the previously addressed approaches to unification, this approach uses a biopsychosocial, integrative model of understanding human wellbeing and mental illness.
Additionally, since most orientations to psychotherapy work to understand how people adapt to their environment and develop adaptive or maladaptive patterns, Henriques combined modern theories of personality into a Character Adaptations Systems Theory. This metatheory of personality, he believes, can help the therapist understand the different components of adaptation and then tailor treatment using the skills and techniques from varying theoretical orientations.
Although there are different frameworks to unification, the authors stress that they share many commonalities that will “advance a core consensus in the field” and professional practice.
They also identified two unified approaches to assessment, Integral Intake, and the Well-being Checkup, which “provide both the client and the therapist a rich shared narrative of the person in their biological, developmental and social contexts.” This shared narrative helps both parties focus on particular problems, strengths, and resources to guide the therapeutic process and case conceptualization.
Additionally, these unified approaches share core principles. First, and most important, is the belief that the therapeutic relationship is central to the process and healing. Psychotherapy and the relationship are understood to be a developmental process of awareness, understanding, acceptance, and change. Both the therapist and client need to have a mutual understanding of the nature of the work.
The authors also stress the importance of emotions in the process of change, as avoidance and defensiveness are driven by strong emotional influences that lead to the development of distress and maladaptive cycles. Much of the work of therapy is to identify and change these maladaptive cycles of thoughts, behaviors, emotions, relationships, and ways of understanding oneself. Changing these cycles can nurture psychological wellness.
Finally, there is a rejection of the tendency to identify with a particular approach to psychotherapy as practitioners must engage in a broader training where they can learn to apply different strategies, skills, techniques, and frameworks in treatment.
According to the authors:
“The treatment plan is developed from the spectrum of interventions that might be appropriate based on psychological theory and empirical research, and it is constructed in collaboration with clients, taking into consideration their values, culture, systems, stage of change, level of functioning, available resources, the treatment context, and the expertise of the clinician.”
While some praise these efforts to unify the field, others have concerns about this unification. The most common concern is the potential loss of diverse perspectives that keep a critical dialogue alive, questioning human nature and clinical practice. Others have been concerned that unifying theoretical orientation will threaten clinicians’ openness to listen to different experiences outside their developed metatheory. Finally, some have been concerned that unification might leave out some subgroups.
The authors respond to these concerns by clarifying that there seems to be no authoritarian dogmatism and that differences will continue to exist within unification. They also believe that openness is required for the expansion of the field and proper therapeutic practice. Because of the “zoomed out” lens of unification, the authors believe that less popular approaches to therapy can also be integrated.
The field of psychotherapy is often fraught with conflict due to differences between theoretical orientations and practices. The authors’ proposal for unification attempts to combine these different orientations to create stability within the field and improve clinical practice by acquiring a broader set of tools that can attend to the complex combination of factors that affect human suffering.
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Marquis, A., Henriques, G., Anchin, J., Critchfield, K., Harris, J., Ingram, B., Magnavita, J. & Osborn, K. (2021). Unification: The Fifth Pathway to Psychotherapy Integration. Journal of Contemporary Psychotherapy, https://doi.org/10.1007/s10879-021-09506-7 (Link)
How can you talk about unifying different approaches and theories within psychology if you don’t include the theory and model of the psyche that already does that. It’s called The Map of the Psyche: The Truth of Mental Illness. Psych-ology is a study of the psyche, the mind. By definition, all psyche-logical theories must examine or explain some aspect of the psyche. Which also means an accurate theory and model of the psyche must be able to incorporate, explain, and unify other psychological theories. Which the psyche model can do. The Map doesn’t replace other psychological theories, it unifies them. Use the Map.
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Conceptual depth and breadth as proposed by some pluralistic integrative approach will still only provide general and oversimplified answers to a specific and complex question: what will work/bring about change/relief for this particular person, in this co-constructed process with this psychologist, who both have particular histories, backgrounds, current circumstances and relationships, who both make sense of things in these ways and who both have these preferences and needs?
The closest (but still remote) answer to this is a real relationship and it astounds me how little (if any) time and effort are spent selecting people for psychologist’s training programs who 1) are naturally kind and generous, 2) have a bit of wisdom and humility about them, 3) are comfortable enough with themselves and thus other people and 4) display some basic interpersonal facilitation skills that can be harnessed. Instead it would seem universities prefer to select the “academic” ones, arm them with a bag of tricks aka CBT techniques, well equipped to “provide treatment” to their passive, unthinking, disordered patients.
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Very well said!
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Well said Gerard.
I must say that there would be a shortage of everything because in reality, a whole bunch of people just go out and try to make half assed decisions, or from proddings, get training and off they toddle to their “jobs”.
We also know that often we choose jobs because we can’t, not able to do what we really want to.
I mean this is fine if you box up goods on a conveyer belt. But the instructions and training for the mental health field resemble those instructions of a boxing on a conveyer.
The difference is the amount of info one can remember, but remembering words does not a mensch make.
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Dear José, you wrote, with finger tips touching keys, I presume:
“Unification is a fifth pathway integration and offers a meta-theoretical perspective of psychotherapy. Rather than understanding different orientations as providing a specific way of working and understanding the client’s lived experience and finding connections between distinct approaches to therapy, the lens of unification sees orientations as providing specialized information on a larger, more complex phenomenon.
The authors use a metaphor to explain these differences:
“A potentially useful analogy is that each of the paradigms can be considered as being akin to a ‘mountain,’ and the other four pathways towards psychotherapy integration are concerned with developing connections between the mountains. In contrast, a unification view steps back and offers frameworks to see the whole of the mountain range from a zoomed-out perspective.”
And as a survivior of the well intentioned mind’s that saw only words like schizophrenia & Bipolar Disorder Type 1 for 28 years, I respectfully ask you to consider the existential paradox of human minds that can be afflicted by analogies, in the same way human skin can be afflicted by allergies?
And having spent three years in Thailand resolving the madness of my normal consciousness, which reflexively confuses and conflates the word consciousness with the experience of consciousness (just as psychiatrists do with schizophrenia) I suggest that the ‘mountain’ of which you ‘type’ can be discovered within your breath.
With all due respect to the well educated ‘treatment’ perspective to ‘other’ people’s ‘madness’ experience, healing is not rocket science and a simple self-healing process is discovered in the steady release of trauma through breathing. The principle experience being how oxygenated blood optimizes brain function through cerebral blood flow.
Yet the fly in this self-ointment healing approach is the powerful and overwhelming sensations of ‘natural’ trauma release within the human body. Sensations, that for the ‘unaware’ are absolutely terrifying, while paradoxically only those of us who have endured our own painstaking process of recovery can make sense of the Buddhist caveat for education: words are not reality and only experience reveals the ‘nature’ of being.
While in the broader context of crazy normality it has become popular to speak of self-deception and a sense of drowning in ‘bullshit’ as humanity finds itself sleep walking towards an apocalypse of its own making. And I wonder if you endorse popular analogies about human behaviour like “this is where the rubber meets the road?” As Jordan Peterson did in his recent chat with Iain McGilchrist. See conversation here: https://www.youtube.com/watch?v=0Zld-MX11lA
Speaking about writing with two fingertips and almost going into the interior terrain of ‘introception’ and discovering his own ground of being, yet reflexively and rhetorically doing an about face with words: this is where the rubber meets the road? A Sophist mentality in full ‘flight’ we might say, from the inner perspective of our ‘unseen’ flight/fight/freeze and entirely subconscious motivation?
Incidentally, what set me on the path to self-liberation and my last self-treatment sense of needing medications was a chance encounter with book titled: Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development. Within which, Alan N Schore states: The attempt to regulate affect – to minimize unpleasant feelings and to maximize pleasant ones – is the driving force in human motivation. (Schore, 1995)
And with bipolar disorder also being ‘clinically’ described as a disorder of ‘affect’ in psychiatric and psychologist literature, I wonder if you care to examine your own affect-regulation when experiencing the presence of so-called madness? Or perhaps you would prefer to experience ‘the fall’ and reclaim the inner experience of reality that resides within your Infants Sixth Sense, as the Polyvagal Theory explains of our innate Neuroception: https://static1.squarespace.com/static/5c1d025fb27e390a78569537/t/5ccdff181905f41dbcb689e3/1557004058168/Neuroception.pdf
Could you ‘surrender’ to reality within and fall deeply, madly & seriously in love with the nature of creation? Please consider a famous lecture on the art of surrender and falling in love with reality, as it is:
“Falling in love. And say, it’s crazy. Falling. You see? We don’t say “rising into love.” There is in it the idea of the fall. And it is goes back, as a matter of the fact, to extremely fundamental things. That there is always a curious tie at some point between the fall and the creation. Taking this ghastly risk is the condition of there being life. You see, for all the life is an act of faith and an act of gamble.
The moment you take a step, you do so on an act of faith because you don’t really know that the floor’s not going to give under your feet. The moment you take a journey, what an act of faith. The moment that you enter into any kind of human undertaking in relationship, what an act of faith. See, you’ve given yourself up. But this is the most powerful thing that can be done. Surrender. See. And love is an act of surrender to another person. Total abandonment. I give myself to you. Take me. Do what…anything you like with me.
See. So, that’s quite mad because you see, it’s letting things get out of control. All sensible people keep things in control. Watch it, watch it, watch it. Security? Vigilance? Watch it. Police? Watch it. Gods? Watch it. Who’s gonna watch the gods? So, actually, therefore, the course of wisdom, what is really sensible, is to let go, is to commit oneself, to give oneself up and that’s quite mad. So we come to the strange conclusion that in madness lies sanity.” – Alan Watts
Can you step into your breath young man & experience the philosopher’s mountain, within?
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I confess: I tried to read the whole article and could not. All I need to get to was this phrase: “evidence-based principled approach.” I stopped dead on with this particular, useless, meaningless, over-worked, and over-used phrase. I knew from that point on; anything said or written is purely humbug words, words of wizards in sheep’s clothing destined to lead the sheep to “nowhere land.” You can not have “evidence-based” and “principled” in the same sentence. It is what you call an “oxymoron.” If you make your decisions “evidence-based” then all your principles disappear. If you want to make so-called “principled decisions” you can not make them with “evidence.” Thus, your goal of unification must be summed up as “you can not unify what cannot be unified.” So, I say “quit!.” People do not false goals of “unification” or “evidence-based principled decisions.” All people need is the permission to be who they are meant to be; created to be. But, the question is since this comes from our Creator, why do they need permission. Well, because, it goes back to these “evidence-based principled decisions.” and, Yes, I know this is “circular reasoning” and, that’s the point. Psychotherapy. no matter, how hard you try to reform it still remains nothing but running around in circles until the client/patient submits and is no longer nothing but the shell of his or her former self and then in eternal evil, psychiatry, etc. triumphs in devilish glees. Thank you.
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