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Toward Unification of Clinical Science: The NextWave in the Evolution of Psychotherapy?

Jeffrey J. Magnavita

Private Practice, Glastonbury, Connecticut

This article presents evidence from converging lines of evidence to support theemergence of a new phase in the evolution of psychotherapy away from inte-

gration and toward unification. Clinical science has been rapidly advancing ona number of important fronts allowing for new theoretical modeling on which

to base clinical science and the practice of psychotherapy. Although there iscontroversy about the value of identifying the common principles and compo-nent systems of human function and psychotherapy a growing number ofclinical theorists and researchers are beginning to explore the value of articulat-ing these to guide clinical practice. The concept of holism and a foundation in

systems theory may be important keys to advancing our understanding ofpsychopathology, personality theory, and psychotherapy. This article presentsan evolving unified component system model based on findings and develop-ments in clinical science and psychotherapy.

Keywords: unified clinical science, unified psychotherapy, component system model

THE END OF THE PHASE OF PSYCHOTHERAPY

INTEGRATION?

We may be witnessing a paradigmatic shift in the clinical sciences(Magnavita, 2006). Emerging from the critical phase of psychotherapyintegration, what seems evident is a new phase best characterized by

unification of clinical science. This paper will review some of the evi-

Jeffrey J. Magnavita, Private Practice, Glastonbury, Connecticut.A brief version of the material in this article was originally offered as part of a

symposium entitled The Evolution of Psychotherapy: Is Unification in Reach? presented in2003, at the annual meeting of the Society for the Exploration of Psychotherapy Integrationin New York.

Correspondence concerning this article should be addressed to Jeffrey J. Magnavita,Glastonbury Medical Arts Center, 300 Hebron Avenue, Suite 215, Glastonbury, CT 06033.E-mail: [email protected]

Journal of Psychotherapy Integration Copyright 2008 by the American Psychological Association

2008, Vol. 18, No. 3, 264 291 1053-0479/08/$12.00 DOI: 10.1037/a0013490

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dence to support this contention as well as identify some essential elementsand trends from which this unification movement has emerged. What Ipropose is that there is compelling evidence for the next phase in the

evolution of the field of psychotherapy, toward a holistic or unified model,which necessitates broadening the domain of psychotherapy to include thedomain of clinical science. To make this emergent development moreapparent, I examine some of the historical trends in the evolution ofpsychotherapy and clinical science. As shown, the field of psychotherapyappears to be at a point of convergence, after over a century of criticaldevelopments.

Paralleling the sequence of development that has characterized ourfield, my journey as a psychotherapist and clinical theorists has evolved

initially from an interest in single school models toward increasingly inte-grative ones, and finally a unified model. Initially, I published an intrapsy-chic-dyadic model termed short-term restructuring psychotherapy (STRP;Magnavita, 1997) suitable for treating personality disorders, especiallythose from Cluster C (avoidant, obsessivecompulsive, dependent; Diag-nostic and Statistical Manual of Mental Disorders, 4th ed. [DSMIV];American Psychiatric Association, 1994). This model had its limitations,primarily its limited scope using individual psychotherapy. Another limi-tation was that working in the dyad was constrained to the patient

therapist dyad and descriptions of interpersonal transactions with signifi-cant others. I then expanded this clinical model, blending systems theory,to encompass more a broader array of dyadic configurations, as well astriadic configurations more suitable to couples and families, in a modeltermed integrative relational therapy (IRP; Magnavita, 2000). In this modelan added advantage was that dyadic and triadic processes could be re-ported or actually observed depending on the modality of treatment. Morerecently, I moved in the direction of developing a unified model termed acomponent system model (CSM; Magnavita, 2002b; 2004c; 2005a; 2005b).

This new unified component system model adds a vital sociocultural com-ponent, which is based on the central role personality systems play inhuman nature from the microsystem to the macrosystem (Millon & Davis,1996; Millon, Grossman, Meagher, Millon, & Everly, 1999).

The topic of unification in psychology and psychotherapy as well as theclinical sciences (i.e., clinical-applied psychology/psychiatry) has and con-tinues to be a source of polemics (Fishman, 1988; Frank, 1988). Therefore,to provide a firm foundation for the material that follows, establishing aworking definition and identifying the scope of unified clinical science is in

order:Definition and Scope of Unified Clinical Science. Unified clinical

science is a theoretical, clinical, and research movement, which attemptsto identify the structures, processes and mechanisms that interconnect

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the major domains of human functioning. Included within the domain ofunified clinical science are personality theory, developmental psycho-pathology, and psychotherapy, which include the processes and mech-

anisms of change that are initiated in relationship with a professionalpsychotherapist.Next, some of the important developments of the past century related

to unification are summarized to underscore the multiple-converging do-mains from which unification is emerging.

THE EVOLUTION OF MODERN PSYCHOTHERAPY AND THE

STUDY OF A COMPONENT SYSTEM MODELOF PERSONALITY

The modern psychotherapy movement has its roots in the mid- to thelate-19th century in the work of various pioneering figures, such as IvanPavlov and Wilhelm Wundt who sought to develop a scientific psychol-ogy, as well as the psychiatric nosologists and psychopathologists, EmilKraepelin and Eugene Bleuler. The modern psychotherapy movement hasmany parallel, interrelated, and convergent domains, especially those from

personality and psychopathology.According to Lombardo and Foschi (2003), although it is often ignoredby Western psychologists, the study of the componential model of person-ality in the modern era began in France with the publication by Ribot(1885) of Les Maladies de la Personnalite. Slightly over a century old, theterm psychotherapy was coined during the late 1880s by Hippolyte Bern-heim, appearing in the publication Hypnotisme, suggestion, psychotherapie(Jackson, 1999). We do know from the historical record that the art ofpsychological healing dates back to just about the earliest example of

recorded history (Alexander & Selesnick, 1966; Jackson, 1999). These earlyhealers capitalized on what we now call common factors, such as rela-tionship factors, placebo, expectancy, and instilling hope, which are still themost robust ingredients of psychotherapy. The relational matrix is empir-ically supported as the most robust aspect of psychotherapy effectiveness,accounting for more of the variance than techniques and methods(Norcross, 2002).

The most ambitious unified theory of personality developmentemerged in the late 19th century in the form of psychopathology and

treatment. The first century of modern psychotherapy began with Freudsdiscovery of the unconscious and use of free association (Magnavita,2002a). Most historians of science would probably agree that the mostsignificant development in the history of psychotherapy was the birth of

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psychoanalysis. Psychoanalysis presented the most comprehensive meta-psychological model to date of psychic functioning, developmental psycho-pathology, and offered a new approach to healing emotional disorders

(Magnavita, 2002a). Freuds accomplishments are considered to be one ofthe significant intellectual milestones of the 20th century. Freud (1966)identified many essential components of the human matrix and his meta-psychology was based on the importance of unifying personality, develop-ment psychopathology, and psychotherapy in a comprehensive system.Freud emphasized the necessity that metapsychology demonstrate andemploy the vital interrelationships among personality, psychopathology,development, and psychotherapy.

In the next section of this article I will briefly highlight the major waves

of development in the evolution of modern psychotherapy and relatedclinical sciences, most notably psychopathology and personology, whichare necessary elements of a unified clinical science.

MAJOR WAVES IN THE EVOLUTION OF

MODERN PSYCHOTHERAPY

We are fortunate to be the beneficiaries of a century of groundbreak-

ing advances; one can identify three dominant phases in the evolution ofpsychotherapy. From our vantage point, at the start of the new millennium,we have the opportunity to imagine the fourth phase, that of unification.

The Emergence of Single School Models of Psychotherapy

During this phase single paradigms were developed focusing on one or

more of the domains of human personality and functioning. Each schooltended to believe that they had arrived at the truth and the beginning of adialectic process ensued. During the early phase psychoanalytic and be-havioral models whose assumptions and epistemologies were diametricallyopposed had little use for the other. This phase in the evolution of psy-chotherapy was characterized by contentiousness among adherents of var-ious orientations (Norcross & Newman, 1992). Only more recently have weseen the two approaches showing signs of finding a middle ground with therecognition of unconscious processing and affect by the cognitive behavior

camp and the use of behavioral methods by psychodynamic camp. Duringthe first half of the 20th century, a number of schools of psychotherapyemerged, the most notable of these were behavioral, existential-humanistic, family systems, and later, cognitive. These single schools were



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like tribes, each with their own religion, which they adhered to often witha supercilious stance toward their competitors.

The Phase of Rapprochement

The rapprochement phase of the evolution of psychotherapy wascharacterized by the emergence of various braches within the dominantmodels. The phase is marked by forays into the camps of the othersseeking understanding of differing approaches and interpreting the ap-proaches in various therapeutic languages. This rapprochement occurredduring the period of proliferation of multiple theories of psychotherapy

and attempts at interpreting seemingly disparate models. Dollard andMillers (1950) publication ofPersonality and Psychotherapy took a signif-icant step toward understanding the commonalities between the dominantpsychoanalytic and radical behavioral models.

The Integration Movement

This current phase of development in the evolution of psychotherapyhas been a productive one, as various individuals attempt to find thecommonalities among differing approaches, and often merge them into astronger amalgam. The Journal of Psychotherapy Integration was one ofthe outgrowths of this exciting movement and a leader in publishing thelatest developments. Noteworthy in this regard is the work of Wachtels(1977; 1997), who developed a cyclical psychodynamic model mergingpsychodynamics, behavioral, and systems theory. Goldfried and Newman(1992) wrote,

The idea of being able to integrate the psychotherapies has intrigued mental healthprofessionals for over half century. Before this integration movement could emergethere had to be enough diversity to integrate. The field needed a sufficient level ofdifferentiation among approaches before they could integrate. It is only since the1980s, however, that the issue of psychotherapy integration has developed into aclearly delineated area of interest. (p. 46)

There are a number of features identified by Norcross and Newman(1992) that characterized the integration movement:

(1) proliferation of therapies, (2) inadequacy of single theories, (3) external socio-

economic contingencies, (4) ascendancy of short-term, problem focused treatments,(5) opportunities to observe and experiment with various treatments, (6) paucity ofdifferential effectiveness among therapies, (7) recognition that therapeutic com-monalities heavily contribute to outcome variance, and (8) development of aprofessional network for integration. (p. 7)

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Overall, the psychotherapy integration movement has representedvarious approaches to integration, which include four dominant ones: (a)technical eclecticism, (b) theoretical integration, (c) assimilative integra-

tion, and (d) common factors (Norcross & Newman, 1992).The integration movement has set in place many elements, which areconsidered necessary for unification. In many ways assimilative integrationand common factors approaches provide more of a foundation to theintegrative movement than technical eclecticism and theoretical integra-tion (blending of two or more theories). Eclecticism on the other hand isnot as far reaching in its attempt at theoretical convergence. Norcross andNewman (1992) compared and contrasted eclecticism to integration iden-tifying some key features that distinguish integration which are also aspects

of unification. These include theoretical, convergent, combining many,creating something new, blend, unifying the parts, more theoretical thanempirical, more than a sum of parts, idealistic (p. 12). Greenberg andKorman (1993) wrote To be comprehensive, theories of human function-ing must integrate cognition, behavior, interaction, motivation, and emo-tion (p. 249). Additional domains that are required for a comprehensivetheory include sociocultural structures and process.

The Quest for Unification: A Paradigmatic Shift?

The quest for unification is not new. As an undergraduate psychologymajor in the early 1970s, I was influenced in my personal epistemology byreading Rychlak (1968; 1973), one of the leaders in the field who remindedus in his classic texts, not to artificially separate psychotherapy from itssister disciplines personality and psychopathology. Unified science requiresthat these be seamlessly connected, and Rychlak (1973) wrote that person-ality theory requires a theory of illness, theory of cure, and therapeutic

techniques (p. 21). Rotgers (1988) explained that Efforts to unify psy-chology as a whole date back to the era of grand theories in the 1930s, 40sand 50s. . . with the positivistic philosophies of such theorists as Tolmanand Hull (p. 16). The move toward unification represents a paradigmaticshift toward attempting to understand the total field of human functioningand the processes that interconnect the various domains. This shift hasmajor implications for clinical practice, theory, and research. A number ofindividuals have pondered the task and have even elaborated many if notall of the componential aspects. In Principles of Psychology, William James

(1890) identified many of the known domains of the human personalitymatrix. He wrote,

Psychology is the Science of Mental Life, both of the phenomena and theirconditions. The phenomena are such things as we call feelings, desires, cognitions,



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reasonings, decisions, and the like; and superficially considered, their variety andcomplexity is such as to leave a chaotic impression on the observer. (p. 1)

James (1890) used as his unifying entity the personal Soul (p. 1).

It is interesting to note that some recent theorists in search of unificationsuch as Wilber (2000) also incorporated the soul as a vital construct.

In the following section I will review some of the previous theoristswho have called for unification.

PREVIOUS THEORISTS WHO HAVE CALLED FOR OR

OFFERED UNIFIED OR HOLISTIC THEORY

There are a number of individuals who have been captivated by thequest for unification of psychology and/or psychotherapy. Gordon Allport(1968) made an urgent call for systematic eclecticism by which he meanta system that seeks the solution of fundamental problems by selecting anduniting what it regards as true in the specialized psychological sciences(pp. 56). He clearly was encouraging synthesis and unification, and dis-cussed personality as an open system (p. 17). Personality is the mosteclectic concept in psychology, and an open system view the most eclectic

interpretation of this concept (p. 22). Nearly 40 years ago, in words stillrelevant today, he described the field with the following:

The situation at present is that each theorist typically occupies himself with oneparameter of human nature, and builds himself a limited model to fit his specialdata and personal style. Those who concern themselves with either the brain orphenomenology may be said to focus on one important parameter (body-mind);depth psychologists on the conscious-unconscious parameter; trait theorists on thestability-variability parameter; and others on self and non-self. Trouble arises whenan investigator maintains that his preferred parameter, or his chosen model, over-spreads the whole of human personality. (p. 10)

Another less well-known clinical theorist, Andras Anygal (1941,1982) called for a holistic theory of human functioning and personality.His theory, although grounded in psychoanalytic thought, emerged fromhis clinical work and is surprisingly systemic in nature, giving a centralrole to personality:

Personality may be viewed as a highly organized whole, a hierarchy of systems. Thesignificant positions in its overall organization are of systems. The significantpositions in its overall organization are occupied by parts which themselves aresystems; the constituents of these secondary systems may also be systems and so on.

Since in systems the dimensional domain in which the parts are distributed partic-ipates in their patterning, the dimensions enumerated also provide the generalbases for the formation of these hierarchies of systems. (p. 50)

Although foreshadowing many contemporary trends, Angyals work

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never gained the prominence it deserved. Possibly he was just too far aheadof his time in his notions about unification.

At about the same time, from the competing school of behaviorism

another highly influential ground swell toward unification was set in mo-tion. In his volume, Psychologys Crisis of Disunity: Philosophy andMethod for a Unified Science, Arthur Staats (1983) called for unificationand wrote, We need integratory theorists, and works that pull together thechaos of such materials that exist in psychology (p. 266). He wrote further

There are also theories in psychology that claim a more unified characteristic, butwhich are eclectic in the sense that they contain parts that have not been unified inprinciples. Rather the parts are included in the same conceptual schema, but theparts are unrelated and perhaps even inconsistent. (pp. 293294)

Staats (1983; 1991) thought the disunity of the field of psychologywould prevent advancement to a more mature science.

CALLS FOR AND EVIDENCE OF A NASCENT

CONTEMPORARY MOVEMENT TOWARD UNIFICATION

An informal Google search I conducted, using the keywords unified

psychotherapy, produced about 999 entries. A cursory review of these,eliminating those not directly related, left approximately 30 entriesrelated to my topic. There were only a handful of individuals whoproposed their own unified models, some with specific application suchas borderline personality (Allen, 1993; 2003). Orsucci (2003) offered aworkshop on The Unified Approach to Psychotherapy for thosewilling to apply Chaos & Complexity Theory in clinical situations (p.1). This seems to be at least nascent evidence of an initial movement.

The move to unify the field of psychology creates a greater but similar

challenge that unifying psychotherapy and the clinical sciences presents. In1986, at the 94th annual convention of the American Psychological Asso-ciation, the Society for Studying Unity Issues in Psychology (SUNI) wasfounded, and the first president was Arthur Staats, as noted above, a vocalproponent of the unification of psychology. SUNI was described as ascholarly society devoted to the study of theoretical, conceptual, method-ological and technical unity in psychology in all aspects (Staats & Burns,1988, p. 30).

There is another, disparate group of contemporaneous workers from a

variety of disciplines that have made a call, or attempted to develop,models for unification. The diversity of their disciplinary identificationseems to suggest that a broad nascent movement is gestating. I will identifybut a few of these individuals. Among the most noteworthy are Sternberg



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and Grigorenko (2001) who, in the American Psychologist, made a re-newed plea for unification in the field of psychology. One of the mostcompelling calls for unification is by the renowned biologist, E. O. Wilson

(1998) whose book Consilience encouraged unification of the sciences andmade a special plea to psychologists. Ken Wilber (2000) also offered aunified framework he termed Integral Psychology, which represented hisattempt to bring together all that is known of human consciousness.Although he is not a psychologist, psychiatrist, nor academic, his work iscompelling in its inclusiveness. Michael Mahoney (1991) offered manyelements of a unification paradigm, depicted in his comprehensive volume,Human Change Processes and more recently Constructive Psychotherapy(2003). Mahoney does not formally use the construct unification but at-

tempts to identify the domains of the human personality system and identifythe necessary processes and mechanisms that facilitate change in varioussubsystems. In this sense it does appear to represent a unified model.

Millon (1990) has been a major force in attempting to synthesize thefields of psychopathology, personality theory, and psychotherapy, and hasalso developed empirically based objective measurements for personalityand clinical syndromes. His work influenced a number of contemporarythinkers (Strack, 2005). Millon (Millon et al., 1999) emphasized the cen-trality of personality in his theorizing and his approach to therapy, which he

aptly termed personality-guided therapy. Millon conceptualized his modelusing a systemic framework. He wrote: Comprehensive theories are in-viting because they seek to encompass the full multidimensionality ofhuman behavior; personality-guided therapy grows out of such a theory(Millon et al., 1999, p. xi). His personality-guided model was an importantstep that fell only slightly short of unification, but he was clearly advocatingthis unity when he wrote: we join with thinkers of the past and argue thatno part of human nature should lie outside the scope of a clinicians regards(e.g., the family and culture, neurobiological processes, unconscious mem-

ories, and so on) (Millon et al., 1999, p. ix).

UNIFICATION OF CLINICAL PSYCHOLOGICAL SCIENCE

VERSUS UNIFIED PSYCHOLOGY

Unification within our field must also consider the differential challenge ofdeveloping a unified clinical-psychological science and a unified psychology, an

issue explored in a symposium sponsored by SUNI at the aforementioned 94thannual convention of the American Psychological Association. Addressingthis issue, Sechrest and Smith (1994) contended that psychotherapy was thepractice of psychology and would benefit from the integration of psychother-

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apeutic theory and practice into the science of psychology (p. 2). They usedthe term integration to mean making whole, which referred to the unifica-tion of clinical psychology within the broader human system. Further, they

believed that Truly useful theoretical integration would occur . . . only if oneor both of the theories involved were somehow cast into an entirely new lightand made distinctly more effective (p. 3).

Millon et al., 1999 were also proponents of understanding how domainswere embedded in the larger systemic processes and structures and wrote:

Whether we work with part functions that focus on behavior, cognitions, uncon-scious processes, biological defects, and the like, or whether we address contextualsystems that focus on the larger environment, the family, the group, or the socio-economic and political conditions of life, the crossover point, the unit that linksparts to contexts, is the person. (p. xi)

Of course, not everyone believes that the search for a metatheoreticalmodel is a fruitful endeavor (Safran & Messer, 1997). Safran and Messerbelieved that there were inherent difficulties when the field moved awayfrom pluralism to a single unified theory, derived from what might be amisunderstanding of the philosophy of science, and how basic assumptionssignify the model. In a later chapter, Fishman and Messer (2004) cautiouslyconsidered unification but believed that it should not be in the form of agrand unifying theory, which they believed to be inherently problematic.

IMPLICATIONS FOR THE FIELD OF PSYCHOTHERAPY

Abandoning the Tribal Mentality and Seeking Common Goals for the

Advancement of the Science of Psychotherapy

Separate tribes with esoteric language systems dominate the field of

psychotherapy. Many have likened this trend to the tower of Babel; al-though diversity in the field is welcome, there is a tendency to fractionalize andthis limits more rapid advances. There are many competing approaches topsychotherapy, all claiming dominance, which must be very confusing toscientists and practitioners from other disciplines. Although competition inscience is inevitable and probably necessary, it must appear to outsiders thatpsychotherapists behave like members of competing tribes, with differentesoteric languages and rituals. Unification assumes that we all work in thesame realm with the same processes regardless of the subsystem or specific

domain we emphasize and specialize in. A unified model encourages us all tobe aware of the larger picture and even if domain-specific treatment is under-taken, an understanding of the system and interconnections of domains andprocesses keep us alert to other possibilities for further developments.



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The Necessity of Establishing Clinical Utility and Evidence-Base

For theories of psychotherapy and models of human functioning (person-

ality theory & developmental psychology) and dysfunctioning (psychopathol-ogy) to be of use to the clinician, they must have clinical utility and emergefrom scientific evidence, or they will not survive (Magnavita, 2004a). A com-prehensive meta-theory must have an array of techniques, methods, andprocesses applicable to diverse clinical populations, and these must begrounded in scientific evidence. Clinical practice must be based on the bestavailable research, clinical expertise, along with patient characteristics, cultureand preferences (Norcross, Hogan, & Koocher, 2008, pp. 56). Theory guidesthe clinical process by narrowing the range of choice among the plethora of

techniques and methods. Theoretical systems offer maps of the domain andways of conceptualizing and navigating complex systems (Magnavita, 2004b).Clinical realities have come to demand a more flexible, if not integrative,perspective (Norcross & Newman, 1992, p. 7). Clinical utility is demonstratedin clinical settings, informed by empirical evidence, and guided by assessmentand theory. Clinicians often have an uncanny ability to discern what works andwhat does not through trial and error: The patient system can shape theclinician as much as the clinicians system shapes the patient. Researchersshould then offer empirical findings that either support or disprove the effec-

tiveness of these clinically derived techniques and methods and the theoriesthat support them.

Because it is fairly well established that integration is the predominantforce in the field, I next turn attention to the key differences and similar-ities between integration and unification.

What Are the Similarities and Differences Between Integration

and Unification?

Although there are strong similarities between integration andunification, there are also important points of divergence (see Table 1).Unification is not merely another version of integration: it is fundamen-tally different in some critical aspects. Theoretical integration in its variousconcatenations is a blending or joining of models that become theoreticallyand clinically more versatile when achieved in a consistent way. Integrativemodels inevitably fall short of unification because they necessarily blend

two or more separate models in a new amalgam, often a better one but notnecessarily, and inevitably leave some component subsystem out. Thisblending becomes a problem in that with the number of extant models tobe blended the new integrative modeling takes on an exponential function

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that becomes a morass of models often with subtle or semantic differences.For example, within one domain of psychotherapy, in a the very narrowdomain of short-term therapy, within the smaller realm of psychodynamictherapy, there exists a plethora of competing approaches, emphasizing one

or another aspect of the intrapsychic-dyadic domain. Others have oftensaid and we have observed that seasoned clinicians when you watch themwork are more similar than dissimilar in what they actually do.

Criticisms and Potential Hazards of the Trend Toward Unification

There are valid criticisms of unification as it pertains both to psychol-ogy as a whole and to clinical psychology. Green (1992), in an article in the

American Psychologist, opined that a premature attempt at unification mayunnecessarily cause damage to the field. However, he also suggested Wemust, in a sense, let unification come to us via good theory-constructionpractices rather than explicitly pursuing it (p. 1058). Messer (1988) noted

Table 1. A Comparison of the Differences Between Integrative and Unified Theory

Psychotherapy integration Unified psychotherapy

Integrative theory melds pure form therapies

to form a stronger amalgam

Unified theory emphasizes the essential

function, structure, and processescommon to all human systemsIntegrative theory generally covers a limited

number of domains of the human systemUnified theory attempts to establish the

interconnectedness of all thedomains of human functioning

Integrative theory evolves piecemeal,assimilating, and accommodating elements

Unified theory attempts to shift to ametatheoretical model or totalparadigmatic matrix

Integrative theory primarily offers models ofpsychotherapy and is less concerned with itsrelationship to psychopathology andpersonality theory

Unified theory attempts to offer atheory of the functioning of theentire ecological system of humanfunctioning, including all pertinent

areas of psychology, especiallypsychopathology/maladaptation,personality theory, developmentalprocesses as well aspsychotherapeutic processes

Integrative theory generally emphasizesparticular domain systems as central to aparticular model of integrative therapy

Unified theory attempts to recognizeall the major domain systems of thehuman biosphere

Integrative theory may only loosely beconnected to personality theory

The personality system is seen as thecentral organizing system of humanadaptation, function, and dysfunction

Integrative theory uses a limited number of

paradigms for knowing (i.e., observation andempirical research)

Unified theory relies on multiple

paradigms for knowing believing thateach one offers some aspect thatdeepens understanding



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The goal of unifying clinical psychology is a noble and compelling one,albeit exceedingly difficult if not impossible to attain (p. 22). He believedthat one of the greatest obstacles to unification was the need to have an

agreed-upon language (p. 22), although he viewed the issue of empiricalversus interpretive methodology in clinical psychology to be less of anobstacle. Less of an obstacle is the issue of empirical versus interpretivemethodology in clinical psychology. In a more recent writing, Fishman andMesser (2004) stated,

On the other hand, we welcome the development of new psychotherapy theoriesthat integrate elements from present theories. The ultimate practical value of suchintegrative theories can then be contextually tested in the crucible of numbers ofdetailed, systematic case studies. (p. 56)

Bearing in mind concerns voiced in criticisms of unification, severalquestions must be addressed, which are discussed briefly in the followingsection.

Isnt unification just another form of integration?

Many in the field have and will continue to question whether thedifference between integration and unification is only a semantic one andpossibly a waste of effort. This is certainly a question that requires someattention and at first blush may appear to be an exercise in hair-splitting.The move toward unification can be challenged with these often-heardquestions: Isnt unification just another brand or school of integration?and Wont this lead to a new phase where there are different types ofunification? These are questions worth considering. However, I will try toillustrate why moving toward a unified model is indeed a worthy endeavorfor the field of psychotherapy. A unified model to be useful must be anemergent phenomenon of human nature and functioning. Each of theestablished domains of human functioning must have a place as they do inthe biopsychosocial model and the processes must be articulated. This isnot a blending of theories such as cognitive and behavioral or psychody-namic and systemic.

Will we merely promote development of a plethora of different flavors

of unified theory?

Through unification might we encourage the placement of the descrip-tor unified before each school of therapy such as we witnessed during theascendancy of managed care, when every school inserted the descriptor

brief or short-term in front of their model? To some degree this mayalready be occurring as various unified models are developed and pre-sented to the theoretical-scientific community. Gold (2005) believed thatwe may run the risk of establishing different schools of unified therapy and

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will continue to have separate methodologies. Even if this is the case, I donot believe this is reason not to proceed. As unified models are developed,as there have been in the past, there will be an inevitable convergence of

approaches. It seems hard to imagine the field unfolding in any other way.Human nature after all is unified, even though complex and chaotic.

Are we engaging in a new wave of tautological discourse that results

in too many trees being used to print these efforts?

Unification does indeed run the risk of being so grand that one cannever prove or disprove the overall integrity of any unified system. Toavoid some of the difficulties encountered by psychoanalysis, it is importantthat the various domains of the unified system be supported by research.

Unification attempts to characterize the total domain of human functioningby looking at the common structures, processes, and mechanisms thatrepresent the entire ecological system. Thus, in the attempts at unifiedmodeling, all domains that have been empirically and clinically docu-mented must have a place in the model. The basic assumption is of holismas opposed to reductionism. This is not to say that reductionistic forms ofknowing are irrelevant, they certainly add to knowledge and understandingand are necessary but not sufficient.

Have we really reached a level of sophistication in our clinical sciencewhere this effort toward unification enhances the effectiveness or

outcome of psychotherapy?

This is another valid question, which deserves our attention. Norcrossand Newman (1992) wrote over a decade ago In view of the early stage ofthe integration movement and in view of the fundamental philosophicaldifferences separating therapists, it is unrealistic to advance exclusively anyone metatheoretical monolith (p. 5). Nevertheless, there is evidence in anumber of areas of convergence that we are on the right course. Neuro-scientific data is beginning to explain why traumatic experience is sopervasive and resistant to alterationthe impact on neural circuitry seemsto be permanent.

Finally, can momentum toward a unified theory ever be consistentwith the notion of humans as beings who are in flux, who evolve in

history, and whose future psychological makeup is necessary

unpredictable?

(Fisch, 2001, p. 121 [italics added]). Fisch believed that a unified grandtheory would be undesirable even if we could find some way to neutralizethe human biases or overcome the human limitation on the acquisition ofperfect knowledge (p. 120). It is a misunderstanding to think that espous-



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ing a unified system means we are at the endpoint of knowledge. Becausehuman systems are influenced by evolutionary principles they will continueto adapt and change in relation to environmental demands. Any system to

be vital must not be stagnant but evolving, dynamic and flexible enough totransform itself.

If we are ever able to develop such a [unified] theory of psychother-apy, do I believe it will stand the test of time and become and ossified

relic of a system-building age? (Wolfe, 2001, p. 131 [italics added).

He replied No, I do not. The appearance of a unifying theory willset the stage for the next period of differentiation (p. 131). Thisdoes not necessarily invalidate the task being proposed; building

unified theory. In a similar fashion to the human genome project, wehave discovered most of the important aspects of the human system,and the critical task that now lies ahead is to fill in the blanksthatis, the intricate details of these different aspects of the humansystemwhich will take future generations devoted to this task.

The evolution of clinical science and psychotherapy has been relativelybrief in the history of humankind and science. The quantum advances thatscience has made in the 20th century have been so monumental as to make

it difficult to predict where we will be at the end of this century. Scientistsfrom many disciplines are attempting to find the unity in the universe andin the smallest microcosms. The personality system is truly a unified oneand while we learn much when we break it down into it components, wemust keep sight of the fact that the interrelationships of the domains arethe central feature.

A NATURAL COURSE TOWARDUNIFICATIONOBSERVATIONS OF A PERSONAL JOURNEY

The way we conceive of the world is certainly determined by ourperceptual field, experience and personal epistemologies. As a proponentof unification, I offer my observations of my own journey as a psychother-apist, theorist, and clinical scientist, as well as that of others I haveencountered in my various roles as teacher, trainer, and clinical supervisor.There seems to be a tendency early in our careers as psychotherapists to

seek models that offer dogma, clearly articulated techniques and methodsthat are often found in single school orientations, such as psychodynamic,cognitive, and experiential. We embrace this model, devoting ourselves tolearning and practicing a particular form of psychotherapy. Over time we

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discover its limitations and become disillusioned, and then begin a searchfor some other version of the truth. This leads to a search for yet anothermodel, usually representing another domain of the component system.

With each addition, previous knowledge and experience are assimilatedand form a new synthesis by blending aspects of previous models. Messer(1992) commented on the natural tendency toward convergence, as ther-apists practicing competing theories seemed to use increasingly similartechniques as they gained experience. Over the course of time, many onthis road develop their own unified model of the mind and humanfunctioning. In this sense, I believe we all move toward a unified model; amore formal effort in this regard, I believe, will only strengthen theseidiosyncratic learning trajectories. There are fairly robust findings that all

of the major schools of psychotherapy are about as equally effective. Inreviewing the findings from accumulated studies, the researchers Berginand Garfield (1994) often stated all won and all shall have prizes.Greenberg (2002) believed the reason for this was,

Each therapeutic approach probably affects the system at a chosen levelcognitive, emotional, behavioral, or interactionaland any specific effect at onelevel of the system probably reverberates through the highly interconnected levelsof the system and produces comparable change in the whole person. (p. 154)

Unification must enable the disciplines of clinical science to unite in a

meaningful way.

IN SEARCH OF THE HOLY GRAIL OF

UNIFICATIONREDISCOVERING AND EXPANDING WHAT

ALREADY HAS BEEN ESTABLISHED

The Elements Necessary for Unification

Arthur Staats (1983) wrote about the nature of this task of unificationin psychology:

There are some general characteristics of the task of constructing multilevel, unifiedtheory that may be mentioned. Each field can be expected to be composed of amixture of junk along with the valuable. The theorist must separate the junk fromthat which can be used productively in the theory construction task. In addition, thetheorists must abstract from the hodgepodge of detailed information in a field thatwhich has significance for a general, unified theory. (p. 327)

For unification to be considered an attainable goal of the clinicalsciences, substantial work on the major domains of the human personalitysystem needed to be accomplished. William James (1890) in his Principlesof Psychology was aware that this noteworthy goal would need to be



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postponed until sufficient aspects of the domains of the human system hadbeen articulated and empirically established. Although James was aware ofmany of the relevant domains and explored the known terrain at the time

of the publication of Principles, a key element of what was missing wouldnot emerge until the mid-20th century. This necessary element representeda paradigmatic shift embraced by many disciplines and was termed theSystems Theory (von Bertalanffy, 1968) and also cybernetics and morerecently Chaos and Complexity Theory, which are all elaborations ofnonlinear dynamical systems.

The Relevance of Systems Theory as the Grand Unification Paradigm

Systems theory represented a paradigmatic shift in the natural andsocial sciences during the mid-20th century (von Bertalanffy, 1968). Un-fortunately, much of mainstream psychology did not adapt this nonlineardynamical model. There were exceptions and these are evident in the workof developmental psychopathologists who have embraced this model, andin the clinical sciences in the field of family therapy that used systemicmodeling as the basis for family/systemic therapy. This model failed toinfluence many personality theorists or psychopathologists. However, sys-

tems theory is a necessary element for grand unification. As stated one ofthe major proponents of unification, Staats (1983) did not mention thepotential that systems theory held for linking the movement, when hedescribed the challenge of those in search of unification:

It has been said that we need conceptual works that strip away obfuscatorydistinctions to reveal simplifying commonality. It is the central weakness of thepreparadigmatic science that it cannot recognize commonality. For to recognize theforest of commonality in the complexity of all of the trees takes skill. The integra-tory theorist must be able to go into different areas of the science and cut across the

fact that the relevant similarities may be embedded in theories that have differencesin addition to the similarities. The scientist must be able to cut across differences inmethods, apparatus, terminology, and subjects. (pp. 267268)

Millon et al. (1999) wrote of the components of the personality system:They flow through a tangle of dynamic and changing configurations. Eachcomponent of these configurations has its role and significance altered byvirtue of its place in these continually evolving constellations (p. 93).

Systemic modeling allows us to follow the flow of interconnectednessamong the domains systems of psychopathology, personality, and psychother-

apy. Greenberg (2002) wrote With a complex system view, such as this, it isclear that intervention can and should occur at different levels at differenttimes or with different components of the system (p. 155). Systems theoryand an evolving branch called complexity or chaos theory offers promise for a

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unified model (Abraham, 1996; Abraham & Gilgen, 1995). Chaos theory (Gleick,1997) has particular application to nonlinear systems such as human personalitysystems. Abraham (1996) wrote of complexity or chaos theory: Dynamics takes

a complex set of interrelated phenomena, observes the pattern of their behaviorover time, and attempts to model them (p. 85). Complex systems can beunderstood by viewing the process by which they configure and recon-figure themselves from chaotic states to states of self-organization basedon attractors. These attractors represent a convergence of vectors,which may result in a bifurcation, or reorganization of a system. Forexample, one might conceptualize adolescence as a chaotic state inwhich attractors converge and may eventually reorganize the personal-ity to a more stable structure. It is well-known to many clinicians that a

state of confusion is often a precursor to change (Paar, 1992). The chaosof confusion can result in letting go of something negative and reorga-nizing the personality system in a more adaptive way.

A Flexible Scope for Moving From the Microscopic to the Macroscopic

Level of Conceptualization

Some theoretical systems such as psychoanalysis, particularly the struc-

tural-drive variant, with its focus on defense-affect-action patterns, offer amicroscopic lens with which to view the phenomenology of the patientssystem. Cognitive approaches also focus microscopically on the internalschemata. Interpersonal approaches view the action through a wider lens ofdyadic process. Family approaches are mostly concerned with triadic pro-cesses, and ecological ones with sociocultural and environmental elements.There exists much overlap but generally the breadth of field increases asone moves from the internal to the external processes. Only a shiftingperspective can attempt to derive a holonic or three-dimensional view of

the human personality system.

META-THEORETICAL MODELING

An Example of a Unified Component System Approach

It seems important as the authors of this paper and proponents of

unification to take the leap of briefly presenting our conceptualization ofhow a unified model might be organized and how it might inform theclinical process. This presentation is necessarily very compacted but willattempt to cover the main elements. Readers who are interested can refer



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to other works, which more fully articulate the model (Magnavita, 2004c,2005a, 2005b, 2006). We begin by organizing the component domains ofhuman personality functioning into four subsystems that have been iden-

tified during the past century by various clinical theorists and supported byvarious converging lines of research and that encompass the relevantdomains of human personality functions. An essential aspect of this modelis its emphasis on the centrality of the relational field in understandinghuman development and adaptation. In a major collaborative effort by theNational Research Council (Shonkoff & Phillips, 2000), summarizing con-vergent lines of research and integrating findings from the neurobiologicaldomain to the community and culture, the committee underscored theimportance of a relational framework. This volume was aptly entitled From

Neurons to Neighborhoods: The Science of Early Childhood Developmentreflecting the committees consideration of components from the micro-system to the macrosystem in shaping human development. The model thatthey used has many commonalities to the model that will be presentedespecially in its emphasis on systemic processes, relational factors, andnested structures of human functioning. We underscore five of Shonkoffand Phillips 10 core concepts whose knowledge is generated by inter-disciplinary developmental science (p. 3). These core concepts are directlyrelated to central elements of their model and support essential compo-

nents, processes, and structures, such as nonlinearity, significance of cul-ture, multigenerational transmission, relational processes, and importanceof anxiety-affect regulation.

Human development is shaped by a dynamic and continuous inter-action between biology and experience.

Culture influences every aspect of human development and is re-flected in child rearing beliefs and practices designed to promotehealthy adaptation.

The growth of self-regulation is a cornerstone of early childhooddevelopment that cuts across all domains of behavior.

Human relationships, and the effects of relationships on relation-ships, are the building blocks of healthy development.

The development of children unfolds along individual pathwayswhose trajectories are characterized by continuities and discontinui-ties as well as by a series of significant transitions (Shonkoff &

Phillips, 2000, pp. 34).

Essentially the component system model presented in this article is abiopsychosocial one emphasizing the centrality of the relational matrix in

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the development of human personality and responsible for function anddysfunctioning in these systems (Magnavita, 2000).

The Component Domains of the Human Personality System

Part-Whole Relationships and the Nested Structures of Human

Domain Systems

There is little doubt that at the turn of the 21st century we haveestablished, although we are far from fully articulating them, the compo-nent domains of human functioning and adaptation, and development. In

previous similar theoretical models the total ecology of the human systemsis divided into major nested domains, similar to that of a Russian doll(Bronfenbrenner, 1979), moving from the microscopic (smallest doll) themacroscopic (largest doll). Laveman (1997) also influenced by many ofthose discussed in this article, most notably Wilber, also advocated asimilar nested, part-whole approach, which he described,

Since the premise that parts are embedded within wholes producing part/wholes istrue for every level of existence, there is no limit to how far up or down thehierarchy we can go. Structural consistencies can be found in the hard sciences of

biology, physics, and neurosciences where the part to whole analogy exists as atomsare within molecules, within cells, within organelles, within organs, all within thehuman system. Each level of part/whole existence becomes more complex as thesmaller unit becomes embedded within the larger structure. The smaller unittherefore becomes the building blocks for everything that comes after it because itis in everything of a higher level. (p. 61)

These nested structures can be divided into four subsystems, derivedfrom the clinical and empirical literature as convergence points, each ofwhich contains many interrelated domains. Each of these subsystems chan-nels and regulates anxiety thus attempting to provide homeostasis but also

being prone to chaotic states of disorder and reorganization. As weprogress, each matrix offers a wider angle perspective of process.

1. Intrapsychic-biological subsystem: This subsystem includes the af-fective-cognitive-defensive matrix, the substrate of which is theneurobiological or nanosystem of an individual. Perturbations ofany components of the subsystem will alter the organization of thematrix and the way in which it functions. The domains of this systeminclude hereditary predispositions, temperament, and integrity of

neurobiological system, and internalized relational and cognitiveschematic representations. In this matrix we are concerned with theintegrity of the system to adapt to environmental challenge withoutbecoming symptomatic. Thus, we are concerned with the capacity of



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the defensive structure to regulate affect, to be guided by suitablecognitive and relational schema, and to maintain self-cohesion.

2. Interpersonal-dyadic subsystem: This subsystem includes the pro-

cesses that occur in interpersonal or dyadic configurations createdwhen two individuals are in a relationship. The domains include thenonverbal and verbal aspects of communication processes; attach-ment system shaped by early experience, and in the case of dys-function or psychopathology termed bionegativity by Angyal(1982), caused by traumata. Thus, in this subsystem we are con-cerned with interpersonal processes primarily as they are enacted incurrent relationships and treatment processes with the therapist.These patterns are guided by interpersonal expectancies, inter-

nalized schema, and attachment experience. The capacity forattachment and intimacy/closeness are hallmarks of differentia-tion and integration of this subsystem. In other words, self-otherfunctioning that appropriately regulates intimacy-closeness, de-pendency-autonomy polarities, enabling the individual to havesecure attachments.

3. Relational-triadic subsystem: This subsystem includes relationalconfigurations of two or more (2 n) and is particularly concernedwith structure, function, and process that occur in unstable dyadic

configurations where anxiety is transmitted to a third person in aneffort to stabilize the dyad. The lower the level of intrapsychicdifferentiation emotional capacity (i.e., the capacity to experi-ence, to identify with appropriate label, and express feeling), themore one is prone toward triangulation (Bowen, 1976). Triadicprocesses are ubiquitous in human relationships. Relational trian-gles express themselves in various configurations often evident inconflicted triads over multiple generations (Geurin, Fogarty, Fay, &Kautto, 1996).

4. Sociocultural-familial subsystem: This subsystem, also termed themesosystem, includes the sociopolitical, family system, and individ-ual personality system and their interrelationship. The domainsentailed in this matrix include the mutual influence of structure andorganization among the social and cultural system, the family, andthe individual. The perspective of evolutionary psychology is one,which is helpful in understanding how mind shapes culture andculture mind. Culture carries codes that Dawkins (1982) calledmemes, which are similar to the genetic code carried biological, but

which in this case are carried socioculturally. The family transmitsthe culture codes through child rearing practices, which are heavilyendowed by the attachment experiences of the caregivers and mul-tigenerational transmission processes.

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An Emphasis on Holism

No domain or subsystem can be discarded and none is dominant. Each

domain and the subsystems all exist in holonic formpart/whole relation-ships, which cannot be separated without a loss of understanding processand function (Wilber, 2000). These subsystems and subsystems that theyinclude interact holistically. An example of the interrelatedness of thesesubsystems can be seen in the work of the cultural anthropologist NaomiQuinn (2003). She identified cultural schema (p. 146) transmitted fromperson to person and from generation to generation (p. 147). What sheemphasized is how affective activation is a common cross cultural aspect ofchild rearing. The cultural schema is transmitted by emotional arousal

demonstrating how the intrapsychic-biological domain interacts directlywith the sociocultural-familial one. By virtue of this interconnectedness, intherapeutic work it is relatively impossible to focus exclusively on one oranother domain system.

Categories and Methods of Restructuring and Foci

of Therapeutic Action

In a unified model all proven techniques and methods should have aposition. A unified model allows us to organize the clinically and empiri-cally proven methods to be delivered based on their domain and mode ofaction (e.g., cognitive restructuring on the intrapsychic-biological domain).We can theoretically divide our therapeutic methods into four categoriesbased on the four subsystems in which their primary action occurs. Withineach of the four categories, each group of methods has various foci andmodes of action and mechanisms of change. All methods in some wayaddress anxiety, affect regulation, defensive structures, interpersonal

processes, and relational patterns in varying degrees. Methods are aimed atenhancing integration within a particular subsystem and increasing differ-entiation of the components. Briefly, these include the following.

1. Intrapsychic restructuring (IR): The foci of intrapsychic restructur-ing is the intrapsychic-biological matrix and uses the followingmethods (a) defensive restructuring (Davanloo, 1980; Reich, 1933),(b) cognitive restructuring (Beck, Rush, Shaw, & Emery, 1979), (c)affective restructuring (Greenberg & Paivio, 1997; McCullough Vail-

lant, 1997), (d) cognitivebehavioral restructuring (Barlow, 1988;Linehan, 1993; Shapiro, 1995), and (e) neurobiological restructuring(Kramer, 1993; Magnavita, 2005a).

2. Dyadic restructuring (DR): The focus of dyadic restructuring is the



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interpersonal-dyadic subsystem occurring between two individuals.The following methods are included under this rubric (a) expected-transactive restructuring (Magnavita, 2005a), (b) self-other restruc-

turing (McCullough Vaillant, 1997), and (c) relational-dyadic re-structuring (Magnavita, 2005a).3. Triadic restructuring (TR): The focus of triadic restructuring is the

relational-triadic subsystems that are three-person relational con-figurations (Bowen, 1976; Minuchin, 1974). The following meth-ods are included in this category (a) relational-triadic restructur-ing (Magnavita, 2005a) and (b) symbolic-relational restructuring(Magnavita, 2005a).

4. Mesosystem restructuring (MR): The focus of mesosystem restruc-

turing is the sociocultural-familial subsystem. The restructuring ofthe mesosystem includes (a) familial restructuring (Magnavita, 2000,2005a) and (b) social system restructuring (Magnavita, 2005a, 2006).

Within each of the four categories of restructuring there are numeroustechniques that have been developed and that are consistent with thismodel (Magnavita, 2005a, 2006).

IMPLICATIONS FOR PSYCHOTHERAPY RESEARCH

A unified theory of psychotherapy, psychopathology and personalitytheory has major implications for research.

Specifically, investigators will have to stop relying on a single methodology andemploy instead multiple, converging methodologies; loosen identification withsubdisciplines such as clinical and experimental psychology rather than the psycho-logical phenomena under study; and stop adhering as closely as many do tounderlying paradigms, such as behaviorism or psychoanalysis. (Peterson, 2004,p. 202)

Advancing unified clinical science, LeDoux, Debiec and Moss (2003)published the results of a conference entitled The Self: From Soul To Brainin the Annals of the New York Academy of Sciences.

The theme of the symposium was thus established by LeDoux: How can anunderstanding of neural aspects of our implicit or unconscious selves contribute toa better understanding of ourselves, one consistent with our explicit, psychological,social, and spiritual selves? (p. 2).

Unified psychotherapy must be grounded in neuroscience that offers

an increasingly new way of understanding the brain-behavior relationshipswe encounter in clinical practice. A common criticism of unified theory isthat it tends to be vague and our ability to verify such a theory is achallenge (Gobert & Ritter, 2000). However, there is major dissatisfaction

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with the current paradigm for psychotherapy research, which tends toemphasis single school models of treatment applied to discrete clinicalsyndromes. Therapists in clinical practice are traditionally faced with more

complex clinical syndromes and are unlikely to adapt single school ap-proaches (Norcross & Newman, 1992). Therapists in clinical practice aretraditionally faced with more complex clinical syndromes and are unlikelyto adapt single school approaches (Norcross & Newman, 1992), and there-fore psychotherapy research needs to reflect this more synthetic approachto treatment.

IMPLICATIONS FOR CLINICAL PRACTICE AND TRAINING

The implications of a unified clinical science approach for practice andtraining are substantial. Peterson (2004) wrote Unified multifield theory,unified multiparadigmatic methodologywho but an obscurantist couldwish these efforts anything but well? (p. 202).

An integrated psychological psychotherapy will not be able to characterized ac-cording to school. There will not be any cognitive-behavior therapy, any psychody-namic therapy, any supportive therapy. But there will be cognitivebehavioral

interventions for those aspects of problem complexes that seem amenable to thoseapproaches, and there will be psychodynamic interventions for other aspects ofproblems. (Sechrest & Smith, 1994, p. 27)

Sechrest and Smith (1994) aptly summarized the challenge of unifica-tion in the following:

In our view, though, psychology is making great strides in knowledge about manyaspects of behavior, for example, in the workings of the brain, in the genetic basesfor behavior, in cognitive functions, in the course of human development over thelife span, and so on. These gains in knowledge provide a large, sound database rich

with implications for psychotherapy. It will be a shame if psychotherapy continuesas a fragmented enterprise on the borders of psychology, limited both conceptuallyand scientifically by self-imposed insulation from what by its origins is its birthright.(p. 27)

The challenge of a unified model of clinical science and psychotherapyputs a great deal of pressure on clinicians and clinical researchers to beconversant with the domains of systems from neurons to neighborhoods.These requirements then will demand continual engagement in learningabout new developments and expanding our arena of knowledge to many

related disciplines, especially neuroscience, developmental psychopathol-ogy, personology, cultural anthropology, evolutionary psychology, cross-cultural psychology, and many others. Training programs must continue toprovide models to psychotherapy trainees that are well explicated and can



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be effectively taught but underscore their place in the unified system ofclinical science.

SUMMARY AND CONCLUSIONS

The challenge to theorists, clinicians, and researchers in psychotherapyis to articulate a unified theory of psychotherapy that considers the estab-lished domains of human functioning that have been identified over thepast century of modern clinical science. In addition it is vital to discover theprocesses and regulatory principles that interconnect these domains as wellas the principles common among all forms of evidence-based psychother-

apy. We are poised at an exciting time in the evolution of the field as aconvergence of new technologies of neurosciences are enabling us toinvestigate and verify many of the fundamental assumptions related tohuman functioning and dysfunction and how human behavior is regulatedby the total ecological system of an individual from the microscopic to themacroscopic levels of interrelated domain systems. This type of paradig-matic shift will require increased multidisciplinary collaboration and jointeffort between theorists, clinicians and researchers.

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