Models informing Therapy

There are literally hundreds of approaches to therapy. This can be viewed critically as does Vybíral, Z. (2014) in:

Thomas’s Psychotherapy Encyclopaedia of Critical Psychology, Chapter 253.

….. where he identifies approximately 250 different therapies recognized by the scientific community; and that will be conservative estimate nearly ten years later. Vybíral concluded that therapy was especially effective for people who are ready to change; that is, for about 75 % of clients. 

He said that some 5-10% of clients showed a deterioration of their mental state during therapy. Vybíral, and several others, notice the implication of this:  there is little variation in outcomes between models of counselling. You can research into this area if it helps.

Look up ‘commonalities between therapeutic models‘ in a search engine!

New approaches are being developed every year.  The latest I came across (December 2021) is ‘Religiotherapy’, in a paper sub-titled “A Panacea for Incorporating Religion and Spirituality in Counselling Relationships“. ‘Panacea’, says it all, does it not?  Everyone keeps finding one! Yet therapists practising in different types of therapies appear to achieve approximately the same results.

In the business, this finding is called the paradox of “content non-equivalence and outcome equivalence“,  a fancy way to say: you get roughly the same results whatever approach you take to the therapeutic task! It was this finding that led Rosenzweig (1936) to formulate the motto based on the Dodo bird verdict: everybody has won, so all shall have prizes.

The main conclusion from all this is at that common factors appear to be responsible for the benefits coming out of therapy, rather than the ingredients specific to particular theories.  As a consequence, experienced therapists tend to do a mixture of things and, if you are lucky, they will negotiate that ‘mixture’ with you.

If you are even luckier, you will be helped to find a ‘scenic route’ that works for you – through your own effort.  Do keep in mind, if you would, that the best therapists do not always know what is included in the therapeutic mix you negotiate. In that respect, you may both be ignorant about what works,  and for whom. I am including myself in this!

DO NOT BE PERTURBED BY THIS CONCLUSION

It can be ‘evidence’, in my eyes, of success as long as everyone involved knows how to respond to any small defeats arising from not-knowing.

At a time when ‘evidence’ is touted as a key requirement for effective therapy. There is even an approach called Evidence Based Treatment (EBT). The evidence is that EBT does not necessarily improve treatment effectiveness or outcomes! Even more odd is the model called Perceptual Control Theory (PCT). I say ‘odd’ as Richard S. Marken and Timothy A. Carey (2014) published a Paper in Clinical Psychology and Psychotherapy called  Understanding the Change Process Involved in Solving Psychological Problems: A Model-based Approach to Understanding How Psychotherapy Works. 

In it they say their ‘new’ model divides problems into two categories: those that can be solved using existing skills and those that require the generation of new skills. In general, psychological problems belong in the second category.

I’ve little concern about this statement with its optimistic view that change can be learned through practice.

However, they continue by saying “therapy will be efficient when the reorganization process is focused at the right level of the client …. when the client’s reorganization system –
not the therapist – has managed to come up with a solution“. 

Note the similiarity here, with my observations on the levels of ‘discounting’.

They do not take that observation one further step and add that ‘solutions’ come out of a negotiation acknowledging the uniqueness of each therapeutic event. Instead, yet another name for another therapy finds its way into the world.

Sadly, the clue for this oddity is in the title: Perceptual Control Theory (PCT).  ‘Control’ issues appear to be at the primary motivator for the proliferation of labels. The names of therapies tell you a lot about the individual(s) seeking to be in charge – at the very time you are being told: ‘ gosh, no, I do not want to be in control of your life: how can you think that‘!

Throughout this website, you may be able to develop a new hobby: spot Robin being controlling! It’s difficult not to let my guard slip from time-to-time.

In short, what a client or therapist say about the nature of any ‘problem’ may be of less importance than we might think. So says Nathan Beel,  an Australian researcher. He invites us, along with many other writers, to learn what works across therapies. So how can you and I find out what works for us? It is a precarious business as you will need to find out what works for you!

Even well-respected researchers such as Norcross (1997) suggests that this challenging approach to the integration of available models invites confusion and irrelevancy. He required that the ‘‘me and not me’’ elements be established – note the ‘and’, rather than a ‘with’. He seems to exclude the ‘we’ or, at least, he is troubled by the even more complex boundary presented by ‘us’. You – working with me –  are just one ‘commonality’. I’d assert that it is a rather important ‘commonality’ too often missed. Dan Siegel seems more able to spot it with his new word: MWe.

With that said, this page exists to address some of the better-known therapies although I mention, elsewhere, a therapy more suitable for a specific culture (Morita therapy). I run the risk of over-simplifying things here as there is now research available to demonstrate some of the complexities.

Consider, for example, this summary of the most of the models available to us:

The Medical Model: characterised by

1. Diagnostic categories, syndromes, diseases
2. Focus on Individual, rather than systems perspective
3. A narrow view of physical causation: external substances or forces, or genes
4. Use of physical modalities of treatment: pharmacology, surgery
5. A separation of mind from body

The Biopsychosocial Model: characterised by

1. Seeing disease as the endpoint of a process and accepting that disease and illness are not seen the same way by doctor and patient.
2. Seeing the individual as part of a system, and illness in the individual as the expression of a systemic problem
3. Mind/body are not separated, but seen as interactive.
4. Sees illness as having meaning beyond its direct effects on the person: Why this person, why this illness and why now?

Gabor Mate goes on to summarise what he terms:

A Super-system

  • that is: psychoneuroimmunoendocrinology! This comprises:

1, The psyche: the brain centres that perceive, interpret emotional stimuli and process emotional responses.

2, The nervous system that is:
–“electrically” wired together, with its two branches: voluntary and autonomic
–the autonomic system helps modulate blood flow, muscle tension
–the hypothalamus as the apex of the autonomic system (and also of the hormonal apparatus)

— I’d would add that Stephen Porges’ material on the working of the Vagus system can be incorporated in here.

3, The endocrine glands
–endocrine: an organ that secrets a substance into circulation to affect
another organ: e.g., thyroid, adrenal, pituitary
— the hypothalamus as the master gland

4, The immune system
–“the floating brain”: functions of learning, memory, response
–bone marrow, thymus gland, lymph glands, white blood cells, spleen

5, Neurotransmitters/chemical messengers in the nervous system: such as GABA (do you want to know this?  GABA is a non-protein amino acid that functions as an inhibitory neurotransmitter throughout the central nervous system) and glutamate (a principal excitatory neurotransmitter in brain).

Doesn’t stop there, I fear, as what is now needed on top of all this is Dan Siegel’s notion of Mind that considers what happens when a group of people mix their ‘super-systems’ (do not even try to do the Maths!).

Super systems are not so new as some think

Work on ‘super-systems’ goes back further than some of us think, a couple of centuries one could suggest. Ken Wilber, an American philosopher, described a philosophical map bringing together more than 100 ancient and contemporary theories in philosophy, psychology, contemplative traditions, and sociology. He worked to avoid seeing his perspective as “the one correct view”. but still ended up with the Integral Theory! This material described a framework for understanding and valuing the different philosophical traditions, their relationship one with the other.

What I like about Wilbur’s worldview is the recognition of an ‘evolution’ of ideas and impulses that respect previous perspectives and those who have contributed to each one. Although his Integral theory is most closely-linked with the ​humanistic and transpersonal forces​, Wilber himself (1983) described his work as integrative as he believed conventional psychology was ‘at home’ in is approach.

Therefore, he saw Integral psychology as including – possibly transcending –  the four forces in psychology of psychoanalytic, behaviouristic, humanistic and transpersonal (K. Wilber, 2005). Now, of course, we have an ability to link all this to the growing convergences of psychology with the neuro-sciences.

It takes a lot of skill to just notice all these world views, but it enables me to accept that the human mind is not making 100 percent errors, as James Duffy put it in his Primer on Integral Theory and Its Application to Mental Health Care (2020).

I can avoid judgments of ‘right and wrong’  and, instead, approach each perspective as a partial truth. With that, maybe I can figure out how these partial truths fit together to better understand my world.  If I can integrate them and, if I can make good relationships, might I help others to do the same. This is my own understanding. It is an element too often overlooked or simply taken for granted.

This latter point is important;  when Steve de Shazer and others researched Milton Erikson’s pragmatic (or atheoretical) approach to therapy, they found a number of visible patterns in his approach to ‘clients’;  five, patterns,  I understand.

Unfortunately, the sixth pile of recorded cases that were studied remained the largest and they were ​unclassifiable​. Erikson’s approach refused to be fitted into a theory. He would have been pleased by that – if not the modern catch-all name – Eriksonian Therapy!

As I see it, that sixth pile did not offer Erikson-patterns, but a rather more complex pattern emerging from client/Erikson. Without material from those client, that sixth pile must remain ‘unclassified’. Interestingly, figures around the 80% mark keep recurring when research assesses what is ‘successful’ therapy! I wonder why that is??

Processes of change

One way of trying to explore this minefield is to side-step the physics and chemistry and to explore the processes of change. In 1977, James Prochaska embarked on a journey through the various systems of therapy. He concluded that theories of psychotherapy can be summarized by ten processes of change and I am reducing this to seven. Apologies to any-one offended by my summary!

It’s a lot to cram in and some folk may well not wish to be associated with some of the labels I am using!! Remember, I am not writing an accurate research review; only creating a device to help you find ways to devise your safe experiments. When you sense I am misdirecting your thoughts, be alert as the very day when your ‘scenic route’ becoming clearer may be close by!

The seven categories I offer are:

Consciousness raising

That is, when you bring the unconscious, in to the conscious.

This is found in the ‘traditional’ approaches of psycho-analysis, Freud and Jung and many others. Also, the psycho-social model of Erik Erikson and Jean Piaget, and others, once dominated therapy by covering a range of ideas about how humans grown and develop. It is difficult to offer an helpful link into this vast area of research and study. However, you may find the page on ‘history’ of some help.

Also, the Discount Matrix and the Johari Window both assume there are things that are not known – yet worth knowing!

Self-liberation

…. breaking out of your prison created by your past. This can be seen in the radical therapies from the Lesbian, Gay and Bi-sexual and Transgender movement (LGBT), or in the material of Dorothy Rowe, and many others. I believe the Person-Centred School, emerging from the work of Carl Rogers, would want to see itself operating in this area even if the day-to-day therapeutic experience may not meet the expectations! Here, in the UK, there was a whole movement, seemingly short-lived,  started by a Scottish psychiatrist,  R.D Laing. Thomas Szasz did a similar job in the US.

Social liberation

…. working with others to change the existing social order. Rather a favourite of radical and revolutionary thinking, this approach is well represented by Extinction Rebellion and the older tradition of the radical South American RC priest, Paulo Friere.

More can be found on:  https://justliving808.files.wordpress.com/2017/08/freire-ch-1-and-2.pdf

Counter-conditioning

….. involves ‘inoculating’ yourself against past habits by the deliberate alteration of behaviour, attitudes and beliefs. Cognitive models such as Eye Movement De-sensitisation and Reprocessing (EMDR) are helpful here. Transactional Analysis is a particularly good example here as it helps us to identify our life Script and amend it. It has informed my old personal development and , consequently, a lot of what I have included in this website.

Stimulus control

Some models use affect regulation to help you to discriminate what you can control, from experiences and events beyond your own control.  One example, and there are many, include; https://www.emotionregulationtherapy.com/.

Contingency management

…. summarised as changing behaviour to hope for the best, and prepare for the worst, an approach well represented by Albert Ellis’s Rational Emotive Therapy (RET), and its cousins . See https://www.verywellmind.com/rational-emotive-behavior-therapy-2796000

Dramatic relief

that can be represented by Psychodrama and the work of Jacob Moreno and his followers. I wouls include more modern form of dramatic relief such as body psychotherapies and Walking Therapies. All may include talk, but place value on movement as well. I suspect that the late Archbishop Tutu was an exponent of this approach!

For further information on a traditional school, see: https://www.crchealth.com/types-of-therapy/what-is-psychodrama/. Also the work of  recently-deceased Arthur Janov and his ‘Primal Scream’ fits in here. Internal Family Systems will have a place here.  For more information, see: www.primaltherapy.com/what-is-primal-therapy.php.

The term ‘trans-theoretical’ is often used to cover a number of models that want to integrate different approaches – seeking to be above any one theory.

Get above the individual claims

In some ways, this has been my intention writing up this website. I share the approach that recommends that ‘good’ therapy involves us in acting differently, as well as thinking differently.

Too often, however, you may find the action is prescribed by the model, not by your own decisions.

I am asking you to move from the recommendations of others, toward confident design of your own safe experiments.  In case I over-state my case, I should say that action might not be everything. 

This tendency to proscribe, or instruct others is often overlooked, or carefully concealed; the ACT Approach does explicitly ask you to find your own direction, but too often, in other models,  the prescriptions are concealed. Why? Seemingly, to enhance the reputation of the ‘founders’.

If you are intrigued by this idea, research any model of therapy you can find and seek out the implicit instructions. Often, they are to be found in the ‘values’ that researchers identify.

As far as I am concerned, if it helps to state it explicitly, my education, training and experience has drawn me toward:

Transactional Analysis (TA): based on the mid-20th Century work of Eric Berne.

Cognitive Behavioural Therapy (CBT): based on the work of so many people, although the names of Beck and Albert Ellis come immediately to mind.

Eriksonian Therapy: based on the work of Milton Erikson (not Erik Erikson, a Scandinavian Development psychologist – still a very interesting guy!).

Systems thinking: of Virginia Satir and Paul Watzlawick.

Each influence the work I do but I am aware there are other approaches that have helped me to understand how therapy can work for different people. For instance:

Clinical Hypnosis:

Emotional Freedom Therapy (EFT):

Eye movement Desensitisation and Reprocessing (EMDR):

Mindfulness:

For those interested in trauma therapies, it is increasingly impossible to overlook:

Parts Therapy: such as Transactional Analysis (TA) and John Omaha’s perspective.

Internal Family Systems:

Psychodrama (see item 7, above):

Body Psychotherapy

Neural Feedback

….. as well as Action programmes such as Yoga, Pilates and Eastern Meditations such as Qigong and Tai Chi.

Many therapists embrace an integrative perspective in their practice – taking perspectives from a number of schools and putting it together in their own practice. There are a number of arguments about the nature of ‘integrative’ practice, but the primary focus, as I understand it, is  to embrace an attitude that affirms the inherent value of each individual.

Put it all together, and what do you get?

The integrative approach absorbs an affective, behavioural, cognitive, and physiological level of functioning, as well the spiritual dimension of life.  It is not always obvious where the boundary is between the practitioner doing this alongside a client

BUT who is doing the integration? 

Can the ‘relationship’ do it, as well as the individuals engaged in therapy?

When we look closely, the focus is often, in practice, on the practitioner’s perspectives and actions. ‘Noises’ are made about the unique relationship of ‘therapist-and-client’ — most obviously by the Person-Centred movement where there is less clarity offered about how this joint enterprise works day-by-day.

With the stated aim “to facilitate wholeness“, I would suggest that the older Gestalt perspective has much the same to say.  Indeed, would not most models of change value a process that enhances the “quality of the person’s being and functioning in the intrapsychic, interpersonal and socio-political space“.  Quotes taken from: https://www.integrativetherapy.com/en/integrative-psychotherapy.php.

Researchers called Norcross and Goldfried (2005) wrote up an inaugural edition of The Handbook of Psychotherapy Integration;  an early compilation of the early integrative approaches to therapy. It appears that six motivational categories can be discerned in an integrative therapist’s practice.

  • Empiricism: what you see is what you get?
  • Scientific Attitude: a willingness to make an ordered study of the work they do.   The modern world, here, has to struggle with the method of scientific enquiry, as well as the nature of relevant evidence.
  • Therapeutic Humility: here the client gets a look-in as it assumes a therapist has enough humility to include a ‘client’ perspective. Shame the ‘client’ is still a ‘client’ and humility is too often confined to the provisional language most often used by practitioners!
  • Perceived Inefficacy:  Social Cognitive Theory (Bandura) described the construct of perceived self-efficacy as the belief that one can perform novel or difficult tasks and still attain desired outcomes. ‘Inefficacy’ suggest that it is difficult to match tasks and outcomes.  I take a different view and believe that you can work with your therapist, or on your own, to make sense and to live with contradictions. Complexities do arise from the absence of order, predictability and a lack of meaning in my life. I suggest that seeking a pattern in my life is a ‘draw’ that I can understand, but is less necessary than one might think!
  • Need to Comprehend: there is a ‘nod’ her to both client and practitioner needing to comprehend and experience therapy as helpful.
  • Striving for Congruence. That is, a match between the way in which therapy is delivered, and the plans of action negotiated during therapy.

A useful list,  in some ways, as a demonstrates both the knowledge base absorbed by therapists, as the develop their own personal therapeutic approaches, together with an acknowledgement of their own personal needs and desires. All that may be needed, now, is to integrate the client contribution to the therapeutic situation.

What might you discern in any clinical relationship you are developing at this time, with a practitioner?

As and when I am able to offer some connection to these very different approaches, you will see hyperlinks appear in the above list.

Further links to consider

Welcome to Find Your Nudge

How to give yourself a nudge

Designing a  safe experiment

A first nudge?

Finding your scenic route

Selecting a therapist (is not about the ‘model’ they follow)

When ‘doing’ isn’t enough.

An ‘history’ of therapy

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