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Are We There, Yet? Theoretical
Convergence, Part I
Jeffery Smith
Introduction
In the last issue of The Integrative Therapist, we published responses by leaders
in the field to a structured interview focused on key issues related to a unified
theory of psychotherapy, taking into account recent discoveries about biological
mechanisms of change such as reconsolidation, and their relationship to different
theories of psychotherapy. Based on those responses, The Integrative Therapist
developed a set of principles forming the outline of a proposed theoretical
framework. Following the publication of that issue, the principles were published
on the web as an online survey, asking readers to rate each principle and offer
comments and discussion. Today, we publish a revised version of the principles,
based on comments and reservations expressed in the 22 responses received.
In many cases, objections were the result of assuming that terms like “information” and
“avoidance” were being used in a narrow sense. In this version we have tried to improve
clarity and respond to objections while remaining faithful to the goals of the exercise. The
goals remain:
1. Build a theoretical framework within which the wisdom of all schools and
orientations can be valued and accommodated.
2. Find the simplest set of constructs compatible with all schools and having
the power to explain etiology, maintenance and cure of those
psychological pathologies that are amenable to psychotherapy.
3. Make the science of psychotherapy upwardly compatible with the
theoretical umbrella of biological science and evolution.
4. Incorporate more recent findings about the neurobiology of memory and
change processes.
5. Use plain language and avoid terminology specific to any one school.
I am pleased to report some early positive responses from individuals particularly well
qualified in the area of unifying theory:
Jack Anchin: “I think that collectively the 10 principles do succeed in meeting the
challenge of achieving the five goals identified at the outset of the document.”
Gregg Henriques: “Psychotherapy is at a crossroads and the time for a more
systematic, integrated approach is here. These 10 principles are an excellent start in
building consensus toward a shared understanding of psychological problems and the
enterprise of psychotherapy.”
Richard Lane: “One thing that I got out of the SEPI symposium that we did together
was to come away with a clearer sense of what might be achieved here. I used the
analogy of an automobile -- it has a function and works a certain way. But there are a
potentially infinite number of makes and models. I don't think we want to have everyone
drive the same car.…I think what you are trying to do is define the basics, but not
everyone will say that the description captures exactly what they do or think, which I
think is OK.”
Ten Theoretical Principles:
P1: The human central nervous system evolved under the influence of natural
selection. This history, favoring survival and procreation in a social context, is
reflected in its organization and functioning as an organ of appraisal of
opportunities and dangers and generation of adaptive responses. (See also,
Henriques’ Behavioral Investment Theory, 2011) The majority of
information processing takes place outside of consciousness.
Discussion:
In this principle, we lay the groundwork for placing a theory of psychotherapy
within the overall scientific framework of biological science, built on the
foundation of evolution. In addition, we acknowledge the importance of
information processing taking place outside of consciousness, which is central in
psychodynamic theory, but is also increasingly recognized in other theoretical
orientations.
P2: Inputs to the human brain (from without and from within) are
enormously varied and complex. Processing of information is nonlinear and is
influenced by the history of the species, the individual, and, indirectly, the
community. Outputs include thoughts, feelings, behaviors, and impulses to
act, as well as physiological adjustments. (See also, Anchin, J.C., 2008)
Discussion:
We continue to build a basis for joining a biological, information processing
perspective with the richness of content familiar to every therapist. In doing so, we
introduce the idea that the mind/brain produces outputs, which will include those
that turn out to be maladaptive.
P3: While the human mind can be described as processing and storing
information in its broadest sense, the subtlety and individual uniqueness of
human experience shared between humans defies reduction and makes
psychotherapy an art as well as a science. Processing of information can be
schematized as appraisal emotion motivation response, however, in reality,
this complex processing is simultaneous and nonlinear.
Discussion:
A number of respondents to the survey found the principles “reductionistic.” In no
way was this intended. This revision reinforces that, even if we recognize
biological principles incorporated into the organization and functioning of the
mind, its contents have an inescapable uniqueness and complexity that make
psychotherapy the exciting and challenging endeavor it is. We use this principle as
a place to emphasize the nonlinear nature of the mind’s information processing.
P4: Currently, understanding of the emotional and motivational links
mediating appraisal and the production of conscious and/or observable
responses is in an early stage. A consensus exists that emotion and motivation
are closely linked and can be seen schematically as standing between
appraisal and response. Furthermore, emotion and motivation, tend to be
organized around positive and negative valences associated with approach
and avoidance behaviors. (for further discussion, see LeDoux, 2012,
Panksepp, et al., 2016)
Discussion:
The importance of this item is that both healthy and maladaptive responses are
motivated and that motivation is closely related to emotion. Responses are shaped
in complex and important ways by many factors, but motivation is a common
denominator that potentially offers a unifying central theme to our understanding
and approach to pathologies ranging from the early, nonverbal schemas of
personality disorders all the way to intrapsychic conflict and addictions.
P5: For now, a useful model is to consider the valence and intensity of
emotions as the mind’s proxy for adaptive advantage. In this way, what the
mind appraises as opportunity or danger (both in their broadest senses) is
“tagged” or associated with positive or negative emotion, which promotes
adaptive reaction and setting of goals. Success or failure in pursuing goals, in
turn, generates additional positive or negative emotions.
Discussion:
This item attempts to schematize how evolution has programmed the mind/brain
to generate reactions, both adaptive and maladaptive, using emotion as a common
currency that drives motivation and determines which goals take precedence.
P6: A major source of clinical pathology consists of reactions that can be
viewed as originating from the mind’s natural avoidance of painful,
uncomfortable, or overwhelming emotions, more than from pursuit of the
positive. Maladaptive reactions in adulthood can be due to some combination
of change in conditions since the time of their origin, immature development
at the time of original stress, and exposure to unhealthy modeling. A second
major source of problems and potential therapeutic gain is the absence of
opportunities to learn from positive interaction during development.
Discussion:
Building on the previous two principles, this item brings into focus the problems
that psychotherapy aims to resolve and looks at their causation. It identifies a
common denominator as the mind’s attempts to adapt, driven by emotion. In
particular, it identifies the most entrenched maladaptive responses as motivated
primarily to minimize negative emotions. The item also recognizes that not having
learned more adaptive responses is another important source of trouble and gives
the therapist opportunities to foster new learning and positive experiences.
P7: Those maladaptive patterns of appraisal and reaction that are resolvable
in psychotherapy are held in memory structures known as neural networks.
These include procedural, episodic and semantic memory. While
Psychotherapy can and does affect biological parameters such as hormone
production and gene expression, it is primarily directed at adding to or
modifying information (in its broadest sense) stored in neural networks.
Discussion:
Here we lay the groundwork to join the latest science about memory and its modification
together with what we already know about therapeutic action. Change in synapses is the
final common pathway for psychotherapeutic action as described below:
P8: Studies of therapeutic change in those forms of stored information
representing maladaptive responses have so far shown that two conditions
must be met for change. First, the relevant memory structure must be in a
state of activation, and second, corrective information (in its broadest sense)
must simultaneously be presented. This finding applies, so far, to the known
change mechanisms of reconsolidation and extinction. (See Lane, et al, 2015)
Many examples of therapeutic change are too subtle and gradual for the
mechanism to be identified, but may represent a quieter, more incremental
version of the same processes. In humans, activation of emotion, allowing
change to take place, is usually identified with the conscious, visceral
experience of affect.
Discussion:
We have tried to bring to bear what is known, while acknowledging what is not
known at present. The importance of conscious experience related to activation of
neural networks is an important observation yet to be fully explored. It is,
however, consistent with much of clinical wisdom about the importance of
conscious awareness.
P9: Active maintenance of maladaptive patterns is often observed in
psychotherapy. A frequent contributor to this tendency is the natural reaction
of avoiding anticipated negative emotional experience in some way associated
(consciously or unconsciously) with positive change. An additional source of
maintenance of maladaptive patterns is the inertia of habit.
Discussion:
Here we address the persistence of maladaptive behaviors, sometimes referred to
as “resistance,” meaning a non-conscious, non-willful reluctance to accept change.
Habit is a term commonly recognized, and clinically distinct from active
resistance, but not yet well understood or scientifically defined.
P10: Among primary objectives of Psychotherapy are: 1) The activation of
memory structures associated with maladaptive emotion, thought, and
behavior, 2) The simultaneous provision of corrective information, and 3) The
assimilation of new and healthier approaches to life. In practice, these
objectives can range from explicit change to subtle, slow growth resulting
from positive human interaction. Additional therapeutic objectives, which
may derive from the primary ones listed above, include development of a new
life narrative, encouragement of conscious awareness of emotions and other
aspects of mental life, the use of the therapeutic relationship to create a
corrective context, and the practicing of novel behaviors in a manner that
simultaneously activates memory structures and provides new information.
Discussion:
Most respondents were comfortable with this broad formulation, based on a
neurophysiological interpretation of the corrective emotional experience. We have
attempted to leave room for modification of maladaptive patterns and new learning, as
well as “detoxification” of negative affects. The additional objectives can be interpreted
within the framework outlined in earlier principles, but room is left for them to turn out to
have unique mechanisms or aspects.
Where to go from here?
Even without the modifications and clarifications of this third iteration, the overall score
for the original survey was 68% positive, 14% neutral, and 18% negative. The changes in
this third iteration are intended to address most of the negative responses, hopefully
satisfactorily.
The question of where to go from here highlights an important unmet need within SEPI.
Nuno and many others have expressed how important it would be for SEPI to develop a
discussion forum for member comment. The Editor would like to invite readers to share
their comments as well as suggestions about where to where to go from here in the form
of “letters to the editor” via email at: jsmd@howtherapyworks.com. As much as
possible, they will be included in the next issue of The Integrative Therapist.
References:
Anchin, J.C. (2008). Pursuing a unifying paradigm for psychotherapy: Tasks, dialectical
considerations, and biopsychosocial
systems metatheory. Journal of Psychotherapy Integration, 18, 310-349.
Henriques, G. (2011) A New Unified Theory of Psychology, Springer Science.
Richard D. Lane, Lee Ryan, Lynn Nadel & Leslie Greenberg (2015) Memory
reconsolidation, emotional arousal, and the process of change in psychotherapy: New
insights from brain science. Behavioral and Brain Sciences 38:1-80
Joseph LeDoux, Rethinking The Emotional Brain, Neuron. 2012 Feb 23; 73(4): 653–676.
Panksepp, J, Solms, M, Lane, R, Smith, R. Reconciling cognitive and affective
neuroscience perspectives on the brain basis of emotional experience. Neuroscience &
Biobehavioral Reviews, September 2016. Full Text on Researchgate.net.