Mapping existing therapy approaches into the process model

Mapping existing therapy approaches into the Process Model

By Dr Graham Little PhD AFNZIM January 2003

There is a profusion of approaches to psychological therapy, each with a theoretical view of human conduct and development. None of these existing theories adequately embraces the full range of complexity of a person, none is fully based on a complete and general theory of knowledge, and none deals comprehensively with the problems embedded in the idea of human causality. Existing therapies are not wrong, each is based on a valid insight into a person, and hence any theory claiming to integrate existing therapy approaches must map or otherwise order these existing approaches.

The process theory offers the exact manner of integration lacking in existing theoretical approaches, and as a result, it must then map or otherwise order existing approaches making sense of their insight and integrating the technology into the broader theory.

In this paper just such integration is discussed and I show how process theory fully replaces existing theoretical approaches, and integrates existing therapies into a single model providing understanding of the causal structure of human mood and conduct and guiding direction for further research into therapy practice and effectiveness.

Contents

Abstract *

On the failings of existing theoretical approaches *

Psychological dysfunction as arising in process model *

Categories of psychological dysfunction within process model *

Mapping of process model dysfunctions onto existing understanding and existing approaches to therapy *

Concluding comment *

On the failings of existing theoretical approaches

I have previously addressed this issue¹ and will not address them all here. The failings, if they can be put as such, for it is important to understand that each existing approach is based on a valid and often sharp insight into the human condition and so can hardly be a failing; the limitation of existing approaches can be summed via several observations that raise questions rather than give answers.

Any theory of psychology must be fully and tightly reflective. That is, a theory is knowledge; humans create knowledge, then unless there is a theory that coherently and accurately explains its own existence we need be very cautious.

Any theory of psychology must address underlying causality of human conduct and mood. But to do so the theorist must first convincingly deal with the very issues of cause. It is simply not good enough to make vague comments and claim the theory is being considered in some way with other factors held constant. I have already shown in earlier papers how the issues are irrevocably linked and to seek serious resolution of one necessarily means that psychology, cause and general theory of knowledge must all be resolved.

Each existing theory rests on a valid insight into human mood and conduct, but each struggles to stretch and account for its peers and only does so with obvious tensions and with the boundaries clear, and the pervading sense of arguments and thinking being overworked.
Empiricism and its place have been a difficult issues in social science, psychology no exception. Any well-founded general theory of psychology that has the necessary reflective qualities will make clear the role of empiricism in science and in the evaluation of the theory itself.
To a significant degree mathematics parallels the universe. Why? Does the universe embrace mathematics, or does our knowledge of the universe have a structure that is inherently mathematical? Again, it must be remembered that a valid theory of psychology must account for all that humans do and have done and are likely to do in the future. There can be nothing left unexplained; but again, the theory itself must offer clear guidance on what an explanation is and what it itself can and cannot tell us, these reflective questions must emerge as central and be accounted for.
Consciousness, freewill, and intent must have clear explanation, along with hope, and faith. Above all, the theory must account for the positive in humanity, not merely be a catalogue of the failings of human psychology; which means there must be a inherent defining of what it is to be mentally healthy, and not merely define this as the absence of mental illness.

Any careful, logical review of existing theoretical approaches which backs into sound judgment as opposed to pre-existing assumption must reasonably reach the conclusion that existing theoretical approaches, while based on valid and sharp insights, are incomplete, and as a consequence cannot be accepted as general theories of psychology.

Psychological dysfunction as arising in process model

In assessing the categories of psychological dysfunction I have only taken to account the Process Theory and sought the ways and manner in which the theory in principle can malfunction.

Diagram 6, above illustrates the process theory,² the diagram representing the structure of the psyche. There are three very important qualifications inherent in the diagram: first, the psyche of any actual person would be much more complex than this, having many, many more mental sets than the six shown above; second, the psyche of any actual person would need to be researched carefully before the structure could be written down, for the theory provides the tools but does not prescribe what the actual structure would necessarily be; third, once the actual psychic structure obtained, then for any actual situation the researcher would need secure the details of the values of variables, place them into the model and so assess the result. The process model inherently places significant restrictions both of practice and of principle on what we can and cannot know of any person in any practical situations.

We can now ask: in what way can this structure malfunction in such a way as to course psychological issues and disturbances for the person? Obviously, with such a questions, normative issues are immediately implicated, however if we step over those for the moment, we can deduce a number of ways in which there are potential dysfunctions of a solely psychological nature, unrelated to psychological disorder a consequence of neural failure. The following list summarizes the ways the system as in diagram 6 can malfunction. It is quite a limited list, and later I will show how this maps onto the typical issues of psychological dysfunction, and how these fundamental categories of malfunction do account for all psychological disorder encountered in practice.

Categories of psychological dysfunction within process model

Category of dysfunction	Mechanism of dysfunction in process model
Unconscious psychic structures	Structures 4, 5 and 6 in diagram 6 represent unconsciousness psychic structures. Structure 6 gives rise to the psychodynamic issues of emotional forces that can be very powerful, and for which there seems to be no clear reason. These can be and will be often developed during early life, and often only by reviewing what is known and understood can such structures be clearly identified and dealt with. Structures 4 and 5 are solely behavioral, are essentially habituated reaction. For example, one such would be jingling keys in ones pocket while delivering an address.
Nature of cognitions.	Structures 1, 2 and 3 have embedded, fully developed cognitive systems. Collectively, this cognitive system I call the person’s worldview. Several types of malfunction could arise resulting from the nature of the cognitions themselves. Cognitions within a mental set could be dysfunctional – for example, believing everyone to be a threat. The nature of the thinking could be too extreme, or too limiting. For example, I always have that or this happen, when a more limiting statement is more accurate and more useful.
Nature of emotions.	Structures 1, 2, and 4 contain emotions. These can be maladaptive within certain situations. For example, anxiety, or phobias.
Incomplete mental sets.	Structures 3, 4, 5 and 6 are all incomplete, 4, 5 and 6 are discussed above. Structure 3 represents a situation where there could be cognitions and a lack of emotion that could be dysfunctional, particularly if emotion was or should be expected. For example, having no grief at loss of child.
Overall tone of the cognitive and emotional structure.	This does not result from the actual cognitions as from the tone of the cognitions. So the person is hopeful, or pessimistic, or reliable or unreliable. The tone is a sense of the quality of the psychic structure, which can be sensed by others and may be felt by the person.
The nature and structure of mental sets.	There may be large extremes in the mental sets, so the person exhibits and experiences large swings in mood and behavior. There may be a large degree of variability in mental sets in relation to similar situations. So the person may feel and act differently in quite similar situations. There may be linked cognitions between mental sets, such that if a person enters one of these linked sets, the psychic flow is directed to a mental set the focus of the linked system. For example, a person may recall some past failure, and then many linked mental sets become linked so that the person ends up constantly thinking of this failure; or the person may be grieving, and is ‘hanging on to’ the memories such that everything trends back to the source of the grief and in time, this becomes habituated.
Ineffective transitions and processes.	The movement between roles (mental set structures) may be dysfunctional, resulting in the exhibition and experience of discontinuities, and variable mood and conduct, and the general processing skills and abilities, including interactive skills.
Maladaptive ‘self’ (the emergent core psychic structure).	In the process model there is only one psychic structure common to everyone that is the ‘self’. It is emergent, because while it is in everyone, it is different in everyone, it is explicable using the variables of process model, but as emergent, it can develop a supporting structure associated with it that can profoundly influence the experience and exhibited mood and conduct of the person. Here the term ‘self’ includes the entire psychic structure surrounding and in fact constituting ‘self’ in the person. This structure is, itself, likely to be a structure much larger than that demonstrated in diagram 6, with likely the range of and variation of mental sets, and subject to all the potential dysfunctions outlined above. Hence this imagery is of a psychic structure of considerable variation and subtlety as a structure within the overall psychic structure of the person, and this inner structure being a pervasive influence throughout the overall structure. So not only can we have a ‘self’, we can and do have cognitions about our ‘self’, and this may be unrelated to our ‘self’ and our experience of it.

A number of points need noted.

There are quite a limited number of ways that the system that is the process theory can in fact malfunction. Each of these can and will result in a range of actual dysfunctions, depending on the person and the exact nature of the dysfunction.
Each of the categories of dysfunction stems from a different fundamental cause. It then follows that any number of these dysfunctions can be present in any actual person, each interacting through the system and producing a complex array of symptoms.
Several aspects of these dysfunctions bear directly to mental health. Mental health within the process model is defined as the presence of a balanced worldview and associated emotional states, supported by generally smooth and ready transitions between roles and mental sets.

These factors form part of several defined dysfunctions, but the chief point is that as far as promoting mental health, these factors of balance and ease of transitions and neural processes are as value free as is possible. Selection of any set of values for any core variables within the process model is selection of one set of human values and morals at the expense of others. For any Government or group to so select for others, is then to impose upon them values and morals to which they may or may not subscribe.
All psychological dysfunction undermines mental health, but the particular parameters defined as mental health have been selected as those suitable of being promoted to a society without imposing upon those people the values and morals of the power group. The parameters defined as ‘mental health’ are as close to value free parameters as able to be selected that will and do increase the spiritual fulfillment of a society, and hence are worthy of being promoted within that society.

Cultural and gender issues need not be added to the process model, these issues are merely one set of values of the variables, and so all gender and cultural differentiation can be accounted for within the model through the range and variation of the variables relating to the specific circumstances.

Mapping of process model dysfunctions onto existing understanding and existing approaches to therapy

Process category of dysfunction	Match to common psychological dysfunction	Application of existing approach to therapy³
Unconscious psychic structures	Inappropriate emotional responses. Dysfunctional life structures.	The general thrust of identifying historical precedents for deep structures in the psyche. Typically, Freudian/Jungian style analysis.
Nature of cognitions.	Generally, maladaptive cognitions and related emotions.	Cognitive therapy of Aaron Beck also related rational-emotive therapy of Albert Ellis.
Nature of emotions.	Managing the emotional responses and states in relation to life, self and situations. Anxieties, phobias.	Rational-emotive therapy; person-centered therapy of Carl Rogers.
Incomplete mental sets.	Behavioral structures. For example, maladaptive habits. Buried emotional structures. Missing emotional structures.	Behavioral therapy, Skinner and others. Psychodynamic type analysis. Person centered therapy, or Logotherpay of Victor Frnakl where people seek greater meaning and greater sense of ‘being involved’.
Overall tone of the cognitive and emotional structure.	This is very much existential in several ways; questioning life and purpose; or maladaptive tone such as despair or fear or rejection.	Reality or choice therapy of William Glasser; Gestalt therapy of Fritz Perls; and existential therapy of Irvin Yalom and Rollo May.
The nature and structure of mental sets.	Large mood swings for no apparent reason, large swings in cognitions, and variable response to similar situations, consistently thinking about some object of thought such that this comes to dominate all else. Likely involve several different approaches depending on the precise symptoms presented. Research and review main issues and adopt pragmatic approach to therapy judged best to deal with it.	Multi-modal therapy.
Ineffective transitions and processes.	Inability to manage emotions; poor processing skills; and inadequate interactive skill, and role structures.	Building nouskills (from process). Transactional analysis, Eric Berne. Role analysis and redevelopment (process).
Maladaptive ‘self’ (the emergent core psychic structure).	Inadequate self esteem, assertiveness, lack of self-belief realized through relationships and life choices, etc.	Rogers, person centered; reality therapy, particularly building better life/success images; rational emotive.

Commentary and discussion points as follows.

There is no therapy that applies across the range of dysfunctions. There is an important consequence.

There is no ‘one therapy fits all circumstances’, this position is rejected. The therapy adopted is done so in relation to the judged nature of the dysfunction and the presenting details of that dysfunction.

The process model replaces all existing theoretical positions, but all existing therapies are accepted and understood as technologies of behavior and mood change and development.
Within some categories of dysfunction there is variation depending on the precise detail of the presented symptoms and the psychological and social context within which they present. This paper does not go into that level of detail.
The existing therapies are matched according to the thrust and focus of the therapy. However, under the process model often the aim of the therapy emerges as more precise. These refinements of application represent important refinements to development of the technology for the intervention into the life and psyche of a person.
Also, no therapy quite has the focus on nouskills and their development; hence these are seen as arising from within the process model.
Given the breadth and subtlety of dysfunction in actual circumstances, it would appear that while clinicians could be trained in all therapies, that would as normal in professional development, develop more detailed and precise skills in practice. This could result in no one clinician being seen as ‘expert’ across all therapies, leading to groups of clinicians who between them offer the full range of therapies with the practiced sharpness and acute judgment that only arises from professional experience.
All comments on psychological dysfunction do not include neural disorder. The dysfunctions noted are the ways in which the process model could psychologically dysfunction. Neural disorder will obviously have psychological symptoms, many will have the same presenting symptoms as psychologically dysfunction, and in the assessment of any case, and this will often make diagnosis and judgment of therapy most difficult.
Neural disorder can affect psychological functioning in two ways:

The malfunctions of the neural system will allow/inhibit some neural functioning and thus any psychology dependent on that neural functioning will exhibit symptoms of the disorder.
The person can be affected by knowing they are ill. This is precisely analogous to, say, a tetraplegic and the resulting impact on attitudes and spirit

The dysfunctions arising from the process model are independent of culture. All of the dysfunctions can or could occur in any culture or social subset of any broader culture. Whether or not any particular culture or social group exhibits this or that dysfunction will depend the exact range of values exhibited by the variables, that range of values then describing and circumscribing that culture or group; and from within the range of variables, so some types of dysfunction may be more prevalent than others. The range of dysfunctions typical of some culture or group can only be ascertained by research of that culture, that is because the range of values describes a particular instance and any averages or statistical data only ever averages and statistics of particular instances valid at that time and in that place and not able to be generalized or only done so with great care.
Similar comments to those made about culture, apply to gender issues, again gender is described by a range of values within the theory and requires no additional elements. Hence within any cultural context, there may well arise some types of psychological dysfunction, and due to the range of values exhibited by male and females, there may well be a difference in the exhibition of that dysfunction between genders.
A consequence of the arguments on gender and culture is that a clinician practiced in one culture or with one gender in one culture may or may not find their professional experience able to be translated to other cultures or to the other gender group, or to the other gender group if from certain types or styles of culture to social grouping. The level of specificity in relation to the identification and management of types of psychological dysfunction should not be underestimated, and is currently not well understood nor well documented.
A number of clinical issues emerge as follows.

There is a strong need for effective non-invasive systems enabling clear distinction between neural disorder and psychological disorder.
Once, even psychological dysfunction identified, then further assessment tools needed to identify the type and nature of the dysfunction and selection of the therapeutic technique best matched to the condition.
Longitudinal studies are needed that track the effectiveness of different therapies and to refine and consolidate therapeutic technique. Note here: that therapies less effective in one culture may be effective in another, and while some general principles may emerge, at this stage, given the low level of knowledge and understanding of therapy application, information on therapy effectiveness will need researched in a empirical and practical manner, both as regards particularly types of persons and different cultural and social groups.

The process model places emphasis on self-management and the extent the person can and does or does not effectively manage their own human spiritual fulfillment, with management of any and all psychological dysfunction merely an aspect of this general issue. For these reasons, the nature of the general social platform relating to these questions becomes a crucial element with any particular circumstance (say youth suicide) being at least in part merely a symptom of the general social platform, so efforts to particularize and manage the problem (such as youth suicide) is only dealing with the symptom and not the cause of the issue.
The goal of the therapist is to enable the person to effectively manage and gain enjoyment from their life. All therapy has as prime objective the alternation of neural sequences, the variable brain structures in the first instance so that psychological functioning is changed in a manner desired and deemed ‘helpful’ by the person.

Subsidiary therapy goals would include: build and consolidate more effective nouskills; guide cognitive change and choices enabling more effective satisfaction with life; provide better understanding of one’s own psychological and how it can be managed to one’s benefit.
The position of the therapist is as ‘facilitator’, meaning they should establish a position in the client’s life described more by ‘useful’, ‘helpful’ than by ‘important’. The therapist aims to have the person freestanding in their life as rapidly as possible, able to cope and manage their own affairs.
The therapist is also the person who best understands the psychic processes and how to penetrate behind any veils it may offer and how best to alter it. The therapist may be directive, but does so with care, for it is not the role to tell others how they should or should not live. Directive therapy is most likely to be on processes and nouskills, these while carrying some values are the most value free issues that can best assist the person.

Therapy always has a very specific focus within the process model for example, any psychodynamic exploration of the history of the person is done with the clear and stated intent of building better understanding and map a person’s psychic structures, particularly those overlain and hidden from direct view and contact by the person.

Within the process, dreams, for example may aid the mapping, but then given that the system is in an uninhibited state, dreams may just as well be meaningless.

Should there exist any aspect of the psyche related to or comparable to Jungian archetypes, then they will be present in the genetic heritage or the species, for the model proposes that all significant psychological issues are emergent, based on and bounded by the platform of neural sequences provided by the genetic history of the person.

Concluding comment

The process model offers a full and quite complete integration of existing therapy approaches, with largely all the existing therapies having a legitimate place derived from and within the model. More detailed work will follow and much detailed research needs done, but there is now a clear direction for the development of a recognized technology for intervening in the psyche of a person such that the person realizes for himself or herself, and as a result of the intervention, much greater life satisfaction.

Notes

1. Little, Graham R. Creativity and Conflict in Psychological Science, UNESCO: impact of science on society 134/135, pp203-210 circa 1984: and Little, Graham R. Paper 4: The drive to explain; and Paper 5: Why we do what we do, the outline of a general theory of psychology both at www.grlphilosophy.co.nz circa 2000.

2. See Little, Graham R. Paper 5: why we do what we do; the outline of a general theory of psychology. At www.grlphilosophy.co.nz.

3. The discussion of therapies is well presented in the textbook of Richard Nelson-Jones, Theory and Practice of Counseling and Therapy, Continuum, London and New York, Third Edition, 2001.