IN SEARCH OF THE UNIFYING PRINCIPLES OF PSYCHOTHERAPY

1. IN SEARCH OF THE UNIFYING PRINCIPLES OF PSYCHOTHERAPY Conceptual, Empirical, and Clinical Convergence Jeffrey J. Magnavita

2. Evolution of Psychotherapy • Single Domain Schools (psychoanalysis, behavior therapy, client-centered therapy etc. • Rapprochement (Personality & Psychotherapy-Dollard & Miller, 1950) • Integration (Handbook of Psych Integ-Stricker & Gold1980) (blending of approaches) • Unification (Psychology’s Crisis of Disunity- Arthur Staats, 1983)

3. The Fourth Wave a Paradigmatic Shift • “There are aspects of a paradigmatic shift, a new holistic perspective on psychology that is needed to address symptoms of mind, body and spirit”. Psychology has celebrated the ‘Decade of Behavior’ and the ‘Year of Cognition’: it is time for a psychology of the Whole Person” (Serlin, Psychotherapy Bulletin, 2005)

4. Millon Speaks of Holism “Integration does not inhere in treatment methods or their theories, be they eclectic or otherwise. Integration inheres in the person, not in our theories or the modalities we prefer” (Millon, 2000, p. 49)

5. Definition of Psychotherapy Unification A comprehensive theoretical framework which seeks to understand how the multiple interrelated domains of the human system function and dysfunction, and based on the best evidence from clinical science, how adaptation can be enhanced through the application of methods and processes of psychotherapy

6. Definition of Clinical Science A theoretical, clinical, and research movement which attempts to identify processes and mechanisms that interconnect the major domains of human functioning and dysfunction from the micro- to macro-system.

7. Sub-disciplines of Clinical Science which Inform Psychotherapy • Personality theory • Developmental psychopathology • Psychotherapy & Relational Science • Affective & Cognitive Neuroscience • Ecology • Primatology • Cultural Anthropology

8. “Jousting with Windmills or in Search of the Holy Grail” • The movement toward unification has been criticized for being an impossible mission • Various forms of psychotherapy are said to have differing philosophical assumptions so are therefore incompatible • There will be many systems which will compete and create confusion

9. Why Unify Now & Not Wait Until Later? • Many of the component domains of human functioning such as the attachment system, cognitive-affective-defensive system, dyadic processes, family processes and structures have been fairly well articulated. • We are also making strides in delineating the neurobiological substrate • The field of psychotherapy is overly fragmented and clinicians need ways of understanding complexity.

10. Requirements for Unified Psychotherapy • Clinical Utility.The system should be capable of organizing the vast array of data into pscyhodiagnostic and clinically meaningful intervention strategies. • Evidence-Base.There should be a solid evidence base to support the constructs which should be multi-perspective and inter-disciplinary.

11. Unification Principles Points of Convergence in Clinical Science

12. The Principle of Holism The human ecological system can be best characterized as part-whole relationships, which exist in networks of sub-domain and larger systems which can be viewed from the microscopic to the macroscopic level

13. The Relational Principle Relationships represent the essential crucible of human growth, adaptation, function and dysfunction, and is the main operating arena for all psychotherapy and change processes

14. The Component Domain Principle All domains of human functioning must be recognized and considered as the basis for conceptualization and treatment, which is best characterized with a biopsychosocial systems paradigm as originally articulated by Engel (American Journal of Psychiatry, 1980)

15. The Affective Convergence Principle Emotion is a uniquely adaptive mechanism which is implicated in almost all forms of psychopathology from the neurobiological system to the socio-familial system and represents a convergent force or central process

16. The Holonic Principle of Emergent Phenomena Personality, consciousness, and psychopathology are emergent phenomena of a complex system whose characteristics cannot be explained by the sum of its parts, which can be depicted as a holograph. Thus, each perspective taken is only partial.

17. The Principle of Self-Organization Complex systems organize themselves in order to adapt and survive. Complex systems are prone to be chaotic and nonlinear oscillating between states of order and disorder. One aspect of this phenomenon has been labeled the “Tipping Point” (Gladwell)

18. The Principle of Self-Organization (continued) Within all complex systems and expressed at various levels are points of convergence or attractor states which we depict as encoded patterns to be deciphered such as transference, maladaptive schema, reenactment, family and social dysfunction, etc.

19. A Unified Framework A Component System Perspective

20. An Initial Attempt to Formulate a Framework Useful for Clinical Work Clinical theorists have made major advances over the past century formulating and articulating various levels and domains of human functioning which have been used to guide treatment from multiple schools and orientations. These can be used to divide the human ecological system into four levels.

21. Four Interrelated Levels of Unified Model • Intrapsychic-Biological Matrix • Interpersonal-Dyadic Matrix • Relational-Triadic Matrix • Sociocultural-Familial Matrix

22. Sociocultural-FamilialTriangle Relational-Triadic Matrix Interpersonal-Dyadic Triangle Intrapsychic-Biological Triangle

23. Domains within Levels • Cognitive-Affective-Defensive Operations • Neurobiological Processes and Structures • Relational Processes & Schemata • Dyadic & Interpersonal Processes • Attachment System • Triadic-Family Operations • Sociocultural Structures and Processes

24. Assumptions • Holism • Multidirectionality • Relational Matrix is the Crucible for Human Adaptation and Maladaptation • Human functioning exists as “nested structures” which are interrelated

25. Parsimony, Chaos & Restructuring Complex Systems THE MAIN GOAL OF UNIFIED THERAPY IS INCREASED DIFFERENTIATION AND INTEGRATION OF VARIOUS COMPONENTS OF THE TOTAL SYSTEM TO ALLOW FOR THE HIGHEST LEVEL OF ADAPTATION AND ENHANCED FUNCTIONING

26. Dialectics of the Therapeutic Process • DISEQUILIBRIATION-EQUILIBRIATION • DISORDER-REORDER • STRUCTURING-RESTRUCTURING • REGULATE-DYSREGULATE • DISINTEGRATE-REINTEGRATE • ACCOMMODATE-ASSIMILATE

27. Methods of Unified Psychotherapy • INTRAPSYCHIC RESTRUCTURING • DYADIC RESTRUCTURING • TRIADIC RESTRUCTURING • MESOSYSTEM RESTRUCTURING

28. Formulating Treatment Packages • Interventions can be aimed at level and domains of system in greatest need of reorganization and restructuring • Therapist is not confined to perspective of mode of operation

29. Implications of a Unified Model for Differential Treatment Strategies • A cartography for mapping the terrain of complex patient systems • Deciding which level of the overall system to focus one’s intervention at any given moment • Flexibility to change from one level to another and one perspective to another

30. Implications for Unified Model (continued) • An understanding of how complex systems express themselves in convergent points often seen in high levels of affective resonance • A way to organize a complex sequence of proven treatment methods and techniques • Ability to see a holonic view—vertical and horizontal

31. Thank You! Jeffrey J. Magnavita Email: MagnaPsych@aol.com