Unification in Psychotherapy & The Clinical Sciences
Jack Anchin & Jeffrey Magnavita
Published in The Neuropsychotherapist Issue #1
A major new phase of advancement in the evolution of psychotherapy and in the clinical sciences more broadly is emerging before our very eyes. As the field makes its way through the first quarter of the 21st century, it appears to be moving beyond the dominating role played by the traditional theoretical orientations (e.g., psychoanalytic/psychodynamic, behavioral, humanistic/existential, cognitive, systemic, biomedical, feminist, multicultural, and integrative approaches) that progressively emerged in the field of psychotherapy, as the 20th century unfolded (Lebow, 2008; Melchert, 2013) The field is now moving towards a unifying paradigm taking the form of biopsychosocial systems metatheory grounded in the relational matrix (Anchin, 2012; Magnavita, 2012). This unifying framework recognizes and seeks to describe and understand the multilevel, multiple domain complexities and intricacies of human development, mental health, psychopathology, relational disturbances, and change processes. And in its comprehensiveness, a unifying framework contains the potential to advance and accelerate integration and synthesis of multiple and diverse realms of knowledge and study, as well as the latest developments in psychotherapeutics. Unified clinical science must be fundamentally grounded in neuroscience, as well as other relevant disciplines, and in this respect encompasses neuropsychotherapy, which is primarily concerned with brain/mind and dyadic relationships. A unified framework encompasses the Total Ecological System (TES) and thus adds additional levels to account for human functioning and dysfunction.
The essence of a unified framework is the biopsychosocial model at its various levels from cells to society. Essential theoretical aspects include the centrality of the relational matrix, systems/chaos theory (order vs. disorder; oscillation between stability & change), and cybernetics (human organism as goal-oriented; nonlinear processes). Traditional theoretical orientations incorporated within this framework are essential to mapping, through concepts and empirical findings, different levels and components of the biopsychosocial system. A unified framework is trans-disciplinary in that relevant findings from converging lines of knowledge seek to substantiate and inform its’ continual evolution, as more knowledge is accumulated and converging evidence provides validation.
The Four Levels of the Total Ecological System
The totality of the human ecological system (TES), accounts for all aspects of human functioning from the micro- to the macro-system. We can conceptualize these levels as embedded, one in the other, with related domains that have been elucidated by clinical scientists primarily during the course of the 20th century. Human beings need to be understood with an appreciation for the contextual field. For heuristic and scientific purposes it is essential to divide the system at various levels of organization to enable us to study the structures and processes, as well as subdomain systems that are embedded in each level. The TES can be divided into four levels: (1) intrapsychic-biological (mind/brain), (2) interpersonal-dyadic (what occurs between two-people) (3) relational-triadic (what occurs in a threesome) and (4) sociocultural-familial (what occurs in larger social units). As we shift our view from level I to level IV, our perspective moves from the micro-system elements to the macro-system, which entail larger social and political structures (Magnavita & Anchin, in press). We can focus our attention at any level and examine the domain systems that have been elucidated by clinical science and theoretical advances. For example, at Level I: intrapsychic-biological, we seek to understand the relevant aspects of brain functions-structure, as they relate to attachment, emotional regulations, stress-response, and cognitive-relational schema.
Relevance to Clinical Practice
A unified clinical science and psychotherapy provides clinicians a map of the human ecological system, showing where there are possible points of intervention that will most efficiently shift the function of the patient system to a more adaptive level. In addition to a comprehensive framework, the full range of methods, techniques and strategies of change are possible. Various approaches to treatment, modalities of therapy, and formats of treatment can be arranged in individualized treatment packages, which optimize treatment by matching these components with patient characteristics.
Anchin, J. C. (2012). Prologue to unified psychotherapy and clinical science. Journal of Unified Psychotherapy and Clinical Science, 1, 1-20. Lebow, J. L. (Ed.). (2008). Twenty-first century psychotherapies: Contemporary approaches to theory and practice. Hoboken, NJ: John Wiley & Sons, Inc.
Magnavita, J. J., & Anchin, J. C. (in press). Unifying psychotherapy: Principles, methods, and evidence from clinical science. New York: Springer Publishing Company.
Magnavita, J. J. (2012). Mapping the clinical landscape with psychotherapedia ™: The unified psychotherapy project. Journal of Unified Psychotherapy and Clinical Science, 1, 21-36.
Melchert, T. P. (2013). Beyond theoretical orientations: The emergence of a unified scientific framework in professional psychology. Professional Psychology: Research and Practice, 44, 11-19.
Jeffrey J. Magnavita, Ph.D., ABPP, is Co-Founder & Co-Editor of the Journal of Unified Psychotherapy and Clinical Science. APA award winner for Distinguished Professional Contributions to Independent or Institutional Practice in the Private Sector for his Unification and Personality Systematics work.
Jack C. Anchin, Ph.D., is the Adjunct Professor of Psychology, University at Buffalo, New York. The 2011 recipient of the APA Division 29 (Psychotherapy) Distinguished Psychologist Award for contributions to psychology and psychotherapy. Co-Founder & Co-Editor of the Journal of Unified Psychotherapy and Clinical Science.