Preamble
In a popular text on psychotherapy, a very wide range of psychotherapeutic modalities is described (Corsini & Wedding, 1995). It is interesting to speculate on why there are so many modalities. In so speculating, a variety of questions come to mind. Are these therapies all equally efficacious, or is it that some are more effective than others? Is it that we need all of these widely varying modalities in order to deal with different aspects of what it is to be human? Are there really different aspects of what it is to be human, or is there one single aspect of human nature that is the source of all the varying problems that bring clients to psychotherapists?
The final question above is a key question because it implies the other questions. If there were this one aspect, then the modality that could treat it would alone facilitate wholeness. Janov, 1970, claimed such for the basis of his primal scream therapy. As appealing as the idea is that there is one such aspect it seems unlikely that this is the case. In fact, the writer subscribes to a model of human nature that is multi-faceted, and in which dysfunction can occur in any one or all of the component parts. Such subscription appears to preclude the possibility of one single universal psychotherapeutic modality. But, more than this, such subscription implies that we do in fact need a variety of modalities in order to treat the whole person. It is suggested that this is why we have so many differing modalities. That is, the developers of modalities have been aware, to varying degrees, of a multi-faceted model of what it is to be human. Further, they have speculated on why the component parts become fragmented and dysfunctional, and have speculated on the manner in which these could come together to produce wholeness.
These speculations also raise questions about the purpose of the psychotherapeutic process. It is suggested that there is a generally accepted assumption that, at least ideally, the psychotherapeutic process is one that leads toward wholeness. That is, in working with the client, the therapist is aiding in the process that brings together, in an optimally functioning manner, the constituent parts of the client. Also, in doing this, the client is brought into an optimal relationship with reality.
Of major interest is the nature of this multi-faceted model that is differentially treated by theorists, and over which adherents of modalities might argue. In order to explore this notion, a comprehensive but tentative model of human nature is offered here. This is followed by an attempt to show how the variety of current psychotherapies might match the component parts of this model. Also, it is argued that no single modality can facilitate wholeness, and an appeal is made for an eclectic approach, where the term eclectic is used in much the way Arnold Lazarus (Lazarus, 1976) uses it in his multi-modal therapy.
A tentative model of human nature
How then should we characterise a comprehensive model of human nature? The traditional approach within psychology is that we have a biological, emotional and cognitive nature. While this is comprehensive enough, it fails to deal with some aspects of what it is to be human. For example, it fails to deal with those aspects that the humanistic strand of psychology came into being to address (eg, love, self-actualisation and the mystical response). Beyond this, it fails to deal with those aspects that the transpersonal strand of psychology attempts to address (eg, the transcendent aspect of our nature).
A model of human nature that has antecedents in a variety of religious and mystical traditions is based on a tripartite nature. Without getting caught up in labelling difficulties, we can describe these three components as follows:
A physiological component: This covers all those aspects of human nature that modern medical science deals with, and includes the central nervous system and the physiological aspects of what we call emotion.
A psychological component: This covers all of those aspects that modern psychology claims to deal with. There is clearly some overlap here with the physiological component, as in the central nervous system.
A transcendent component: This covers those aspects that the mystico-religious traditions deal with and, more recently, the transpersonal paradigm within psychology.
In describing these thus, it is not being argued that they are watertight compartments that operate in total independence of each other. While they appear to be qualitatively different, they do interact with each other and, together, constitute what it is to be fully human.
Of the physiological component, there is an immense literature that has been informed down the centuries by disciplines as disparate as physics, chemistry, biology, medicine and neuroscience. It is the component of our nature that has been most studied, and about which we have a great deal of information and even understanding. This very fact has acted as a barrier within the sciences to the wider recognition and acceptance of the existence and function of the other two components. More than this, our knowledge and competency in this domain has led to biological determinism becoming a powerful and seductive paradigm.
Psychology is a very recent science, even though its antecedents go back to at least the ancient Greeks. Yet in its short life there has come into being a very large literature base on this aspect of human nature within the many branches of psychology. However, knowledge and understanding in this domain is not as clear-cut as is the case in the domain of physiology. In the domain of psychology, we are dealing with a subjective aspect that cannot be pinned down in the same way as the physical structures and functions of the body. An added complication is the range of paradigms that have arisen within psychology (from the behaviourist paradigm, through those giving credence to psychic structures and states of consciousness, to the transpersonal paradigm) where these have arisen out the various philosophical stances taken on the mind-body problem.
Finally, there is the transcendent aspect. What can be usefully said about this? By definition, it is dealing with that which is beyond ordinary personal experience, and so is ineffable. However, there is a very large literature on this domain, some of which is very ancient (eg, the Hindu Upanishads, Buddhist texts and early Christian mystical writings). There is also a large body of more modern literature within the genre of spiritual paths and mystical experience. Science is uncomfortable with this domain. It does not lend itself readily to the scientific method. None the less, simply because science has difficulties with it does not rule it out of consideration. While science may raise issues of empirical validity and testability, the amount of self-report evidence in support of a transcendent aspect of human nature cannot be brushed aside.
If we map these three aspects or components of human nature such that there is an overlap between each aspect, we end up with seven distinct regions. This is because there are the three major aspects, plus the overlaps between any two adjacent aspects yielding a distinct region, and there are three such overlaps. In addition there is the central overlap of all three aspects. We can characterise these regions as:
Autonomous physiological: this region deals solely with the bodily functions and structures
Autonomous psychological: this region deals solely with our psychological nature
Autonomous transpersonal: this region deals solely with our transcendent nature.
Physiological- psychological: this region deals with the interaction between the body and psychological states. It covers such aspects as emotion and perception that are a mix of body and conscious awareness.
Physiological- transpersonal: this region deals with the interaction between the body and transcendent states. For example, the physiological states reported by those in a mystical trance.
Psychological- transpersonal: this region deals with the interaction between psychological states and our transcendent nature. For example, as in rapture or altered states of consciousness.
The interaction of all three aspects: this interaction deals with what can best be described as ordinary waking consciousness in which all three aspects come together. It is this overlap that we can most relate to, and is the common experience of being human.
Assuming this model has some validity, then an examination of these seven distinct regions, in relation to psychotherapy, indicates that some regions are not dealt with adequately if at all. For example, most of the talking therapies deal mainly with the purely psychological region. Even the physiological-psychological region is not dealt with adequately. There is, of course, a degree of variation within this class of therapies. For example, our emotional nature is catered for to some extent within the psychoanalytic tradition. Conversely, the so-called psycho-pharmacological therapies deal only with the physiological region. The psychological dimension is not existent there, despite the psycho component in the label. The drugs used are directly treating the central nervous system. There is no truly psychological interaction. There are a few therapies that work directly with the body in a different way other than by the administration of drugs. For example, there is that class of therapies that entail physical manipulation of the body. Also, some therapies use biofeedback. However, this latter therapy might be more correctly regarded as dealing with the physiological-psychological region, because mind is a factor. There are very few therapies that deal directly with the psychological-transpersonal dimension or the physiological-transpersonal dimension. There are no therapies, to this writer's knowledge, that deal with the purely transpersonal dimension.
Therapeutic modalities
Having considered a model of human nature, we are now in a position to consider the relationship between the aspects identified in the model and the existing major modalities. The first step in this direction is to consider the key psychotherapeutic modalities in terms of their category, key theorists and their dominant ideas.
Psycho dynamical category: The key theorist are: Breuer, Freud, Jung, Adler, Mahler, and Kohut. The dominant ideas of this category are: posits a basic psychic structure, psychic structures are in a dynamic relationship, unconscious mechanisms which influence behaviours, talk modalities, the past as the focus.
Phenomenological category: The key theorists are: Rank, Reich, Perls, and Lowen. The dominant ideas are: Posits a mind-body interaction, Seeks a correct relationship between mind-body, Psycho-sexual energy systems are dealt with, A here-and-now focus.
Cognitive-behavioural category: The key theorists are: Skinner, Wolpe, Beck, Ellis, and Moreno. The dominant ideas are: Uses operant and classical conditioning principles, recognises cognitive processes, Seeks realism in thought processes.
Humanistic-existential category: The key theorists are: Maslow, May, and Rogers. The dominant ideas are: Celebrates being human, Recognises higher values, Deals with existential crises, Recognises a developmental potential, and Is client centred.
Transpersonal category: The key theorists are Assagioli, Grof, Maslow and Wilber. The dominant ideas are: Deals with ego-transcendence, Recognises spiritual crises and Is holistic and eclectic in approach.
Having provided an initial categorisation of modalities, we can now consider what relationship there might be between them and the aspects of the model given above.
Autonomous physiological: The related modalities are phenomenological and cognitive-behavioural. Only those modalities that are able to work directly with the body can deal with this aspect. Both the phenomenological and cognitive-behavioural modalities recognise bodily states as being relevant to therapy, the former modality more so than the latter. No other modalities work in this way. Autonomous psychological: The related modalities are psycho dynamical, cognitive-behavioural humanistic-existential. The so-called talking therapies deal directly with this aspect. The listed modalities deal differentially with it, where the physiological element in cognitive-behavioural therapy makes it less applicable than the other two.
Autonomous transpersonal: There is no modality that deals directly with this aspect. All that comes to mind are practices such as meditation. However, these are not recognised as therapies in the ordinary sense of that term.
Physiological- psychological: The related modalities are phenomenological and cognitive-behavioural. Both modalities deal with the physiological and psychological dimension. No other modality deals with the physiological dimension.
Physiological- transpersonal: The related modality is transpersonal. Certain of the transpersonal modalities (eg, Grof's) deals with the physiological dimension.
Psychological- transpersonal: The related modality is transpersonal. All of the transpersonal modalities deal with the Psychological component.
Interaction of all three: The related modality is transpersonal. Only the transpersonal therapies can deal with all three aspects in interaction.
We can see that no single modality can deal with every one of the seven dimensions identified with the model of human nature presented earlier, and that no modality deals within the purely transpersonal dimension. We can also see that some modalities cover several dimensions whereas other modalities are more restricted in their coverage. In terms of coverage, it is the transpersonal therapies that provide the widest coverage.
This attempt to map modalities onto the dimensions of human nature raises interesting questions about the key modalities and their efficacy. If the aim of therapy is a movement toward wholeness in which the component parts of our nature are integrated into effective function, then clearly some therapies fail. While they may be dealing with their narrow aspect of human nature adequately, they are not dealing with all that it is to be human. This approach of mapping modalities is tentative and fraught with problems. However, as difficult as this process of mapping is, I believe that it has wide utility. It helps to clarify the complexity of the huge range of psychotherapies enabling one to see where they fit. It also shows that this range has validity, and that no one single modality can suffice. Further, it lends support to an eclectic approach, such as that offered by Lazarus. Finally, it gives an indication of the wonderful complexity of human nature, the ways in which it can malfunction, and the ways that are available to lead from fragmentation to wholeness.
On the aims of psychotherapy
In relation to the aims and nature of psychotherapy, we need to take account of the analysis of John Heron (Heron, 1990), who has considered the characteristics and dynamics of both the client and the therapist. In particular, his concept of the emotional competence of the therapist is a clarifying one. Here he argues that this competence must be at a certain level if what he terms either degenerate or perverted interventions are to be avoided. He talks of three levels of such competence. In the first, the help and intervention is contaminated by hidden and distorted emotion, and is of an oppressive, interfering and inappropriate quality. At the second level, much of the time, the help and interventions are emotionally clear and free of contaminations, but there are slips at other times into compulsive, intrusive helping without the realisation that this is occurring. At the highest level of emotional competence, such slips can still occur, but are infrequent and within the full waking consciousness of the therapist. This stage is achieved only as a result of considerable self-work by the therapist.
Related to Heron's notion of emotional competence is the therapist's aim or point of wanting to help in the first place. Not only do we have degrees of emotional competence within the therapist, we also have the therapist's worldview and value system. According to Heron there are two major categories of intervention, each of which is clearly value-laden.
One category he terms authoritative which has prescriptive, informational and confrontational components. This approach comes from a set of values that places the therapist hierarchically above the client, and has very clear ideas about how we should be in the world. This is epitomised in the more traditional therapies regardless of their specific modality, where they are informed by the medical model and in which we refer to patients and not to clients. It is suggested that this approach is easier and more attractive to those who are operating at levels one and two on Heron's emotional competency scale.
The second category Heron terms facilitative, and has cathartic, catalytic and supportive components. It comes from a value system in which the therapist assumes a co-worker stance with the client and which sees empowerment as vital, and does not have rigid ideas about the end state for the client. This approach seems to be epitomised in the humanistic-existential and transpersonal modalities. It is argued that only those who have attained to Heron's level three of emotional competence would be drawn to and be able to successfully operate in the facilitative category.
Connected with the above notions of Heron are Grof's (Grof, 1988) concepts of higher and lower sanity, in relation to the societal goals of psychotherapy. In the case of lower sanity, the client achieving this state has little autonomy or even an awareness of what it is like to be truly authentic and autonomous. The behaviour is outer directed by societal norms, with no reflection upon those norms. In reaching this state, the insights provided by therapy were to do with being a good client, the need to conform, and becoming a good citizen. It goes without saying that the therapist would have subscribed to such a value system, and one has to wonder about the therapist's own degree of autonomy and authenticity. Lower sanity has been the goal of most of the traditional therapies. In the inherent pessimism of Freud's original approach, the best that could be hoped for was the resetting of the psycho-cybernetic set point such that the patient could function as a useful member of society.
In the case of higher sanity, the goal for the client is to become as authentic and autonomous as possible. This entails insights that enable the client to stand outside the game of life, to understand its rules, and to see how constraining these are. It demands a creative approach to self and relationships. Behaviour becomes internally driven from a basis of well thought out values. The goal for this client is individuation or actualisation. The achievement of higher sanity entails operating at Heron's highest level of emotional competence, and makes possible a process of self-transfiguration in which autonomy confers freedom of choice, and the self-determination to unfold the mind's powers, thus releasing their transmuting and transforming energies. It seems trite to say that therapists who can facilitate higher sanity must themselves be operating at this level of being, and must be using a modality or eclectic mix of modalities that treat the whole person.
It may be that higher sanity is an unrealisable goal for many (clients and therapists alike). This writer argues against this. In fact, unless this level of being is realised far more widely that at present among the Earth's population, the human race will not progress en masse beyond its rather disordered societal state. It might well be that operation at the level of lower sanity by most on the planet would bring about better conditions than pertain at present. However, it is argued that without operation at the level of higher sanity, human kind will not attain to wholeness as a species.
It is clear that, among the other forms of interventions in society (eg, care giving, compulsory education and penal institutions) psychotherapeutic interventions have the potential for enormous good and enormous harm. To facilitate a movement to the level of functioning described as higher sanity, an appeal is made for a broader and more holistic view of human nature such as in the model presented here. Further, an appeal is made for a breaking down of the artificial boundaries between the major psychotherapeutic modalities and for an integrative and eclectic approach in their application.
Concluding remarks
In this paper, a tri-partite model of human nature has been presented, along with a discussion on the ways in which the wide range of existing psychotherapeutic modalities might deal with the aspects of the model. It has been argued here that, on the basis of the presented model, there is no one single modality that will suffice. The model requires a range of modalities. However, even with the wide range of existing modalities, it is argued that there is a differential treatment across the aspects of human nature modeled here. In fact, some aspects of human nature are not served at all well. An eclectic approach such as used by Lazarus was argued for.
Beyond the model and modalities, the issue was raised of the competency of psychotherapists. Heron’s notions were used as a basis for this discussion, which included Grof’s notion of lower and higher sanity. It was suggested that only those therapists who are at Heron’s highest level of competency, and are themselves operating in Grof’s higher sanity mode, are in a position to facilitate a movement toward wholeness.
References
Corsini, R.J. & Wedding, D. (1995) (5th. ed.) Current Psychotherapies; Itasca, ILL, F.E. Peacock Publishers Inc
Grof, S. (1988) The Adventure of Self-Discovery; N.Y., State University of New York
Heron, J. (1990) Helping the Client: A Creative and Practical Guide; London, Sage Publications
Janov, A. (1970) The Primal Scream; N.Y., Vintage Books
Lazarus, A.A. (1976) Multimodal Behavior Therapy; N.Y., Springer
