TIFT #14 Breaching the Silos of Psychotherapy

The pathway starts by narrowing our view to precisely what psychotherapy aims to treat. As discussed in TIFT #11, this leads to identifying Entrenched Maladaptive Patterns (EMPs), as the basic units of pathology treatable in psychotherapy. From there,we bring in evolutionary biology, suggesting that EMPs have in common that they generally representprotective responses to circumstances appraised as threats. Next, reaching out to neuroscience, we adopt a working hypothesis that neurophysiological mechanisms of change applicable to the learned fear paradigm can be generalized to EMPs. The well researched known mechanisms responsible for attenuation of learned fear responses are Extinction and Memory Reconsolidation.

Next, we examine the conditions required for Extinction and for Memory Reconsolidation and make the remarkable discovery that the three necessary and sufficient elements required for modification of existing patternscorrespond quite closelyto what each school of therapy already knows. With this joining of psychology and outside science, we bringtogether the branches and foliage of currentschools of therapy with the trunk and roots of a common infrastructure that belongs to all therapies. I’ll repeat the fundamental requirements for changefrom TIFT #11:

Clinical Requirements for Change:

1. Activation of old maladaptive response patterns with affect, required for both Extinction and Memory Reconsolidation, the two known mechanisms for change in established patterns (for example through exploration and empathy).
2. Exposure (in temporal juxtaposition) to new information that contradicts the old pattern and generates prediction error as required for both Extinction and Memory Reconsolidation. (accomplished, for example, through interpretation, cognitive and experiential exercises, and within relationship).
3. New learning, cognitive or experiential, offering healthier response patterns and narratives, where not previously acquired (multiple sources).

Goldfried’s List:

Once again, I am grateful for Dr. Goldfried (personal communication) for the following list of terms taken from diverse therapies tocapture the clinical juxtaposition of old (maladaptive) patterns with new information:

“reflective functioning,” “cognitive restructuring,” “observing ego,” “wise mind,” “self-observation,” “metacognition,” “decentering,” “witnessing,” “mindfulness,” “insightful”

Conclusion

I hope you appreciatehow strongly these words suggestthat every therapy includes the samethree elements leading to change. The differences between “incompatible” theories are mostly due to the language and constructs invented by some very wise people to describe the same phenomena, but in the absence of an agreed upon core of knowledge. Sometimes they are talking about different parts of the elephant and sometimes they have different names for the same parts. But as you observe what’s happening in your sessions, you will see yourself working to support the three conditions above (plus the Four Facilitative Factors listed towards the end of TIFT #11).

That’s how understanding the common infrastructure is, in my view, not so controversial and gives us a simpleand relatively accessiblecore of knowledge with which me might finally breach the silos that dividethe schools and orientations of psychotherapy.

Jeffery Smith MD

Further Reading:

Goldfried, M. R. (2019). Obtaining consensus in psychotherapy: What holds us back? American Psychologist, 74(4), 484–496. https://doi.org/10.1037/amp0000365

Jeffery Steven Smith & Benjamin Johnson. The Affect Avoidance Model: An Integrative Paradigm for Psychotherapy (Major Revision, Final). ResearchGate.org, June 2018

Jeffery Smith MD

Photo by Jim Witkowski-unsplash