A Theory To Unify Behavioral, Cognitive, and Psycho-Dynamic Approaches

The orbits-gravity model provides a singular theory for conceptualizing and diagraming the central intent of all successful treatment modalities.  

The model is inclusive of unifying behavioral, cognitive, psychodynamic and paradoxical interventions under one single umbrella theory.

As discussed, the orbits-gravity model is able to define the underlying mechanism that drives paradoxical interventions. It turns out that this same model helps reconcile an area that has been problematic for psychology.

While practitioners have long been aware of the obvious interrelation between behavioral, cognitive, and psychodynamic approaches, the field has been unable to reconcile a common theory between them.

The orbits-gravity model formulates a concise theory regarding the overlap and unity between behavioral, cognitive, and psychodymamic orientations.   

Relevant research -                                                                                                                                         1. Reseach has concluded that the treatment success rate of these orientations has consistently been shown to be “statistically equal”. This has often lead to confusion. How is it possible that interventions that seem to be so diverse in their direction and focus can have statistically equal success rates?

Along with this finding, the research also concluded that a strong ‘therapeutic alliance’ was indicative of higher treatment success rate regardless of therapeutic orientation.

While these two pieces of research indicate important findings, there has been no concise theory that was able to bridge the gap  substanciate a link into the effectiveness of the various approaches has not provided any hints to clarify the dilemma. As it turns out, comparative research perpetuated confusion in the field. This is evidenced by the fact that even though behavioral, cognitive, and psychodynamic interventions  the research indicates that they all had a  The confusion here is how can such divergent approaches have ‘statistically equal’ success?! The answer is that there is a common factor between them that continues to be overlooked and not addressed.

 While many clinicians identify their approach as ‘eclectic’ as they attempt to use “the best” aspects of behavioral, cognitive, and psychodynamic methods, such treatment has represented addressing clients with splintered efforts and focus when addressing specific treatment issues.

While it has become commonplace for providers to combine these approaches in an ‘eclectic’ manner, the clinician’s ‘primary orientation’ often takes precidence when defining the direction and emphasis of treatment. 

While many attempts have been made to ‘integrate and combine’ these approaches, a centralized theory has remained elusive. From a ‘theoretical perspective’there has been no progress in reconciling the seemingly diverse emphases of these orientations within the context of a unified theory.  

 

 

While the research indicates that the ‘therapeutic alliance’ is the most correlated aspect of successful treatment, this piece of information is often considered an ‘obvious part of treatment’, that needs no further scrutiny. For the most part ‘conventional wisdom’ has not focused on the properties of the therapeutic alliance, but rather the actual techniques that seem most directly responsible for impacting targeted behavioral issues.

 

In general there is little understanding as to impact, consequence, and significance of the ‘therapeutic alliance’. entails. Most clinicians take the attitude that the ‘therapeutic alliance’ is likely similar to a ‘political alliance’. In a ‘political alliance’ the two or more parties must be ‘willing to enter into’ an agreement for the alliance to remain intact. In this type of alliance, if one party chooses to leave or not ‘take part’, the first party has little recourse to change their mind. Under this assumption, most clinicians believe that the client must ‘be willing to meet them half way’; and if the client is unwilling to do so, there is little that can be done.

 

From this perspective most clinicians favor working with clients’ who are motivated to address their problematic and often uncomfortable issues. In essence, these motivated clients are willing to reach out and form the necessary alliance, bond, or connection that is needed to process their underlying issues. However, the clients that clinicians have the most difficulty are the ‘treatment-resistant client’. Such clients often do not see the value or need for treatment, and therefore make no attempt or actively refuse to make the necessary alliance or bond that allows treatment to be successful. Similar to a ‘political alliance’ most clinicians assume that without the clients cooperation, they have no ability or recourse to change the client’s mind.

 

 

 

Orbits-Gravity Model

The advantage of the orbits-gravity model is that it offers a new clinical perspective by which clinicians can conceptualize the significance and process of the ‘therapeutic alliance’. The model indicates that the alliance is central to all areas of treatment; from the most to the least motivated. By understanding the orbits-gravity model we recognize that the ‘therapeutic alliance’ is parallel to the concept of ‘gravity’. Just as ‘gravity’ is the force that attaches, bonds, and connects a given system, so too does the ‘therapeutic alliance’ represent the force that attaches, bonds, and connects the client and clinician. Similarly, just as changes in ‘gravity’ within any given system will impact the system as a whole, so too, shifts in the therapeutic alliance will impact the client’s status-quo equilibrium. The bottom line is that the therapeutic alliance is the common factor and ‘active ingredient’ that will dictate whether or not change will occur within the ‘client system’.

 

Conventional Wisdom vs. the Orbits-Gravity Model

As it turns out, the conventional wisdom (CW) regarding the traditional therapies does not address the true underlying factor of what makes those approaches successful.

1. Behavioral– Conventional wisdom for behavioral treatment assumes that the process of ‘rewards or punishment’ works in shifting specific behaviors. From this view, it is the reward or punishment that influenced behavior change.

Orbits-gravity theory - However, through the orbits-gravity model, we recognize that in truth the ‘reward and punishment’ is impacting the therapeutic alliance / gravity between client and clinician. So for example, if the therapist offers an adolescent (client) front row tickets to the World Series, if he keeps his room clean for a month straight, then given the fact that the teen is a big baseball fan, he is likely to make sure his room remains clean. In this case the reward of the World Series creates a bond between the client and clinician that motivates the teen to keep his room clean. On the other hand, if the clinician offered the adolescent front row seats to the World Soccer Championship, but this reward has little meaning to client, then there would likely be no change in their ‘alliance’ and as a result the teen would make no effort to keep his room clean. In a similar way, the threat of ‘punishment’ can also have an impact as long as the adolescent experiences the punishment as having meaning to his focus and desires. In this way ‘punishment’ affects the alliance in a manner that brings the client and clinician closer since the adolescent recognizes that the punishment addresses him personally.

 

2. Cognitive– Conventional wisdom for cognitive treatment assumes that it has changed the ‘thought process’ or corrected the ‘thinking errors’ of the client. From this view, the clinician may conclude that his ability to convince or use logic were responsible for the client’s change in attitude. 

Orbits-gravity theory - However, through the Orbits-Gravity model, we ecognize that in truth the client felt a sense of connection with the clinician through their ability to share thoughts and ideas. In this manner the client feels himself accepted and seen in a way that there is strengthening of a mutual alliance (gravity) between them. So while the clinician may have thought that his logic was enough to change the client’s ‘thinking error’ to quit High School, in truth the teen felt a connection through their words that the clinician cared enough about him and his future that he was now willing to ‘report back’ the clinician to advise him of his progress in school. Had the teen not felt that alliance and connection, all the convincing and logic in the world would not have influenced him to change his mind.

 

3. Psychodynamic– Conventional wisdom for psychodynamic treatment assumes that by reviewing the client’s history and addressing unresolved emotions from the past, this will give the client the opportunity to express his feelings. From this view, the clinician may conclude that his ability to encourage the expression of ‘bottled up’ emotions is what allowed the client to move forward.

Orbits-gravity theory - However, through the orbits-gravity model, we recognize that in truth, it is the clinician’s ability to empathize and connect that allows the client to experience that his burden of pain and trauma has been shared and witnessed by the clinician. Rather than the cathartic expression of feelings that is of most significance, it is the bond and connection that the client experiences that trauma(s) he felt in isolation, are now ‘witnessed’ in the context of the therapeutic relationship.  Had the clinician been unable to convey that he understood to client’s pain on some level, there would have been no change in the therapeutic alliance / gravity and therefore no change in his status-quo personality system.

 

Paradoxical Interventions – For the most part clinicians have hesitated to usethese interventions as CW was unable to clearly identify and convey how and why they were successful. While some clinicians have used paradoxical methods as a ‘last resort’ when working with the treatment-resistant client, there was usually a discomfort in advancing a counter-intuitive approach that did not seem to progress logically. However, it is through the Orbits-Gravity Model that paradoxical interventions can be seen to have the exact same mechanism leading to the enhancement of the therapeutic alliance. The difference between the previous mentioned traditional approaches and the paradoxical method is that traditional approaches rely on the client’s ability to be motivated for change and thereby reach out to the clinician in a way that strengthens the alliance.

Contrary to those methods, the paradoxical approach does not hope or wait for the client’s active cooperation or participation in enhancing the alliance. It is the intent of a paradoxical intervention to ‘impose’ the therapeutic alliance upon the client in a way that he is unable to avoid or escape. As such the paradoxical approach does not focus on the ‘secondary aspects’ regarding specific behaviors, thoughts or emotions, but rather the overall frequency, rate, and range of a given pattern. By letting the clients know that (even without their participation) his frequency, rate, and range for a given activity or energy pattern is known and predictable, the clinician is able establish a ‘therapeutic alliance’. The client is put in the position where he must reflect on himself and his actions, as he suddenly realizes that his activities are being scrutinized. As the orbits-gravity model indicates, it is simply by changing the client’s experience of ‘gravity’ that in-and-of-itself promotes a degree of awareness in the client that (even though treatment-resistant) will result in a shift within the personality system.

 

 

www.ParadoxPsychology.com     Revised EPK: 12-24-10