Personal Values
We all experience changes in our lives, many good, some not so good.
My approach is based on the idea that over time we develop ways of seeing the world, schema, that may not fit with the place we find ourselves in at any given time. This can be especially true after experiencing a major life event.
Often when we experience a life-changing event in our lives our understanding of the world around us and our place in it changes. It is perfectly normal to experience frustration, anger, sadness, and happiness as we learn to integrate recent changes into our worldview.
Sometimes we may find ourselves unable to integrate the changes into our lives and move on without a bit help. That’s where a therapist can help.
Underlying Assumptions
My assumptive world-view is shaped largely by three domains: constructivist, cognitivist, and person-centered. I’ve selected therapeutic models from the cognitivist and from the person-centered domains with the understanding that they include sufficient elements of constructivist relational ideas.
The cognitivist therapeutic models are Cognitive Therapy (CT) and Emotional Schema Therapy (EST). The two models share a common theoretical framework with ‘schema’ at their center. Schema are mental structures that we develop over time in response to our environment. Cognitive and emotional schema are how we understand the world and respond to it.
Person-centered therapy (PCT) is based on the premise that we are motivated to be our best selves, that we are driven to actualize our true potential. When that drive is blocked or diverted depression and anxiety can result.
Human Pathology
When things are going fine, no worries. However, when things are not going fine we need to find out why and remedy the situation. Cognitivist models tell us to look in one place and person-centered models in another. The two share common ground and so its likely that one would impact the other.
The cognitivist models, CT and EST, posit that at times and in response to our environment including major life events we develop maladaptive schema that result in maladaptive responses to the world. Through mechanisms such as automatic thoughts we may perpetuate the maladaptive responses. This is what Beck called a cognitive triad of negative views: about the world, about oneself, and about the future.
PCT is based on the idea of continued movement towards self-actualization. When that movement is blocked or derailed somehow we may become depressed and/or anxious. This in turn has an impact on our motivation. Until we are able to continue moving forward the problem will likely persist.
How change occurs
Each of the therapies motivate change in different ways. CT and EST work to change maladaptive schema, to make it more adaptive and in cases where schema-change is difficult, create new schema. This is accomplished by various techniques including establishing change towards goals using a continuum or keeping positive data logs, as well as several others. The goal is to change the schema to a more positive interpretation of experience.
PCT acts to uncover your true self, identify barriers to reaching your true self, and strategies to move forward. It is posited that in an environment of unconditional positive regard a climate of trust and safety can emerge and the client can explore more freely what it is that they want and what directions they need to go.
Evidence for diversity
The challenge here is to ensure that the therapeutic models used are sensitive to diverse client populations and cultures. As is often the case, a new model or theory begins with a small population and, if effective, continues to grow in terms of populations and cultures so the gauge of inclusion for diverse populations should be commensurate with the amount of research conducted thus far.
CT was initially developed with western homogenous populations but has now been in use for over 40 years and across populations and cultures effectively.
EST does not have the research experience that CT but it does include the premise that cultures can shape how we respond to emotions and so recognizes the need for openness when working with diverse populations.
Originally PCT was developed from a small relatively homogenous population and had to be slightly re-interpreted to accommodate different cultures. For example, the principle of self-actualization was originally interpreted to be met when one could individualize. However, in collective cultures just the opposite was the case. Thus PCT now has an awareness and integration of diverse populations.
Evidence of effectiveness
CT has been the topic of considerable research for over 40 years. It has been particularly effective in the areas of depression, anxiety, and panic disorders consistently showing large effect sizes. CT has been combined successfully with many other therapies including pharmaco-therapy demonstrating its effectiveness alone and in combination with other therapies.
EST as a therapy is fairly new so there has not been much research conducted with EST. However, it has been shown to be successful in reducing anxiety and depression and in changing negative emotional schema. Given the common theoretical constructs, I would expect EST to be as successful as CT given time and appropriate research.
PCT has its roots in empirical observation of therapists conducting sessions with clients. The common characteristics that emerged were those of the therapist and how they interacted with clients. PCT is based on those common characteristics and has demonstrated effectiveness in building a therapeutic alliance and therapist-client relationships. It is particularly effective in creating safe and trusting environments, all of which have been shown effective in facilitating change.
My take on psychotherapy integration
It is unlikely that any single therapy or psychotherapeutic model can treat or explain the range of mental health challenges that will come our way. That means we do need to think in terms of psychotherapy integration in order to provide a more robust psychotherapeutic service to our clients. It does make sense to use and integrate the best therapies based on evidence of their success. However, it also makes sense to select therapies that align with your beliefs and share some level of internal consistency (the therapies work well together).
There are a number of different psychotherapy integration models: (1) technical eclecticism (empirical), (2) theory-based, (3) assimilation, and (4) common factors. The first, technical eclecticism, ignores theoretical differences and integrates purely on empirical evidence of success. The second, theory-based, simply means that integration needs to happen at the theoretical level. The third, assimilation, begins with a primary therapy and assimilates strategies, etc. from other therapies. Finally common-factors assumes integration should occur where therapies share something in common, typically the need for a strong therapeutic alliance, client-therapist relationship, and hope and expectancy.
In my own practice I have tried to bring together theory and common-factors in my selection of CT and EST as a theory-based integration of two ways of looking at schema and PCT as the shared common factor focusing on therapeutic alliance and therapist-client relationship.