Lazarus has Risen: Multimodality in the Modern Age

Despite the popularity of specialty trends in psychotherapy, it behooves us to remember Arnold Lazarus for introducing Multimodal Therapy (aka technical eclecticism). It was Lazarus, the South African psychologist, who coined the term behavior therapy in the late 1950s (under the guidance of Dr. Joseph Wolpe) and observed the effects of implementing interdisciplinary approaches in private practice.

Through his assessment technique known as BASIC I.D., Lazarus provided insight into the cognitive processing of interpersonal dynamics and subsequently reinforced the work of Aaron Beck and Albert Ellis to broaden the field of cognitive behavior psychology. Nonetheless, even though the behavioral movement revolutionized a shift away from strict Freudian orientation, one can’t help but notice the unintended “slip” or intentional homage to Freud via Lazarus’s play on words. The basic idea behind BASIC I.D. is to comprehensively assess the client’s behavior, affect, sensation, imagery, cognition, interpersonal interactions, and biology. An unfortunate tendency among many behavior therapists is to abandon the psychoanalytic model, including the methodology of free association, for fear of being seen as professionally antiquated. However, an acknowledgement of dynamic systems is exactly the reason why we must make psychoanalysis an unshakable bulwark while discovering creative ways of incorporating it with modern behavioral modalities. While recognizing the empirical efficacy and stealth of cognitive behavior therapy (not to mention popularity), it’s also helpful to see how the psyche and sexual identity create a baseline for understanding the biological self in relation to social behavior. For example, an effective combination of psychoanalysis and cognitive behavioral approaches can be witnessed during EMDR therapy.

As specialization becomes an increasingly lucrative phenomenon in health care, the therapist must remain somewhat defiant to this trend and open to experimenting with a variety of theoretical models. Technical eclecticism allows the therapist to creatively engage the client in ways particular to salient issues while considering the personality of the individual. Consequently, the therapeutic alliance is more easily consecrated when the therapist allows for adaptation to various treatment protocols based on the client’s needs. Furthermore, the therapist may alternate between several modalities during a given session—depending on the direction the client feels comfortable with and where progress is ascertained. Whether it’s Gestalt, cognitive behavior therapy, psychoanalysis, rational-emotive therapy, client-centered therapy or a combination of the aforementioned, the Lazarus legacy provides a conceptual framework for the therapist to act as a lucid and flexible surveyor when interpreting a multitude of perceptual and behavioral responses.

Reversing Rigidity

Neither separateness nor union is the goal of the therapeutic process, but rather the exhortation of the endless and often painful undulation between them. — Walter Kempler

Many philosophical, political, and ethical topics are conveniently bifurcated, buffered, or dismissed simply because of the psychological implications involved when addressing the fact that most situations in life require a willingness to challenge comforting intuitions, biased assumptions, and developmentally imbedded preconceptions.

Walter Kempler, the American psychiatrist who worked closely with Fritz Perls (founder of Gestalt therapy), noticed an indispensable continuity within experiential and existential modes of ontological awareness that was pivotal to the outcomes of long-term emotional equanimity. Kempler focused on the importance of accepting disappointment, challenging intuitions, confronting obscurity, and developing a capacity for compromise and resilience in the face of uncertainty. From an existentialist viewpoint, an inability to cope with impermanence predominates when a denial of change persists. Likewise, experience sculpts perception and the type of experience often measures an individual’s ability to emotionally process and reflect on life events in a healthy, congruous manner. Ideally, a regulatory flexibility should occur that enables one to adapt to change while realistically assessing and differentiating actual threats to survival from situational inconveniences. “Oriented to an exploration of the resistances to experience” was Kempler’s philosophical position, and realistic compromise is the necessary ingredient to facilitate life transitions.

Similarly, a parallel analogy of this conceptual framework can be demonstrated in modern theoretical physics. For centuries cosmologists adhered to an Aristotelian model in which distinct realms of existence were defined by the idea that the earth was the orbital center for all celestial bodies. In the seventeenth century, this antiquated model of astronomy (otherwise known as the geocentric model) was replaced by a less rigid cosmological system known as the Newtonian model. Eventually, as the scientific community learned about general relativity, the expansion of the universe, and the counterintuitiveness of quantum mechanics, a very open-structured system known as the relational model acquired preeminence. The relational model, simply put, describes how the principle of perpetual fluctuation in the cosmos dictates that no point is any more significant than any other point in a spectrum of physical “relationships.” No longer are we saddled with a static hierarchy of definitive boundaries. The universe is unconstrained by stationary layers and the random particle relationships result in an infinite recombination during the interchangeable dance of mass and energy.

So what does this have to do with psychotherapy? An acknowledgment of the human need for safety, comfort, and security cannot be dismissed; however, in a world where change is inevitable, the ability to acquiesce to shifting parameters in the social landscape becomes a vital coping skill. Life is ephemeral and relationships between family members, friends, lovers, co-workers, and strangers involve complicated forms of exchange that require malleability, openness, and the willingness to reduce unrealistic expectations while relinquishing the desire for control. Humans encounter a plethora of goals, drives, beliefs, and ideas on the platform of daily interaction; more importantly, navigating this myriad of experiential diversity requires a mindset capable of eschewing simplistic black and white thinking. However, this does not mean that all positions or beliefs are relative. Clearly, many inquiries do have right and wrong answers based on objective methodologies that produce reliable and verifiable results, but our approach should include the realization that relationships and communication are based on process rather than destination (for example, field theory strategy in Gestalt therapy recognizes structures and relationships as dynamic rather than fixed).

Being “okay with the gray” is another way to think about reducing the black and white hues of cognition to enhance emotional and behavioral regulation, improve interpersonal effectiveness, and increase our level of distress tolerance when dealing with life’s acute or chronic adjustments. No matter how much impassioned momentum or emotional dividends we have acquired from certainty, reversing rigidity is a developmental process worth experiencing.

Denying Cognition

There appears to be a colloquial trend in modern therapeutic language that creates a false dichotomy between the intellectual and emotional components involved in psychotherapy. For the sake of poetic and metaphorical imagery, it is often emphasized that a client must “feel with the heart” rather than “staying in the head” as a means of eliciting cathartic breakthroughs and achieving insights into behavioral patterns. Certainly one cannot dispute the way the body responds to anxiety, fear, and the multifarious symptoms of internalized trauma. The core of experiential therapy relies heavily on re-experiencing emotionally provocative stimuli and assimilating it as a means of adaptive processing. This is not to be discounted. However, it is my contention that critical thinking should be valued as much as critical feeling (making your feelings count) during therapeutic encounters. After all, without sufficient contemplation and conceptual visualization, Cognitive Behavior Therapy or Rational Emotive Behavior Therapy would simply become Behavior Therapy. Processing emotional content necessarily involves discursive reasoning skills, or at least the capacity to be guided towards congruent and auspicious modes of perception.

I want to be clear about the difference between the words rational and rationalization. The former, for purposes of client-centered interactions, embodies a process or method of gathering, considering, and analyzing contextual information, while the latter refers to a conscious manipulation of information in an attempt to justify maladaptive behavior. Furthermore, I am not writing to argue that thinking should necessarily precede emotion. What I am proposing is that critical thinking should not be dismissed or pathologized as a form of resistance when it is properly applied to fostering or eliciting emotional release. Catharsis depends on a synergistic cooperation involving the brain’s pre-frontal cortex and limbic system. Likewise, when one hears such phrases as “language of the heart,” it is important to remember that the heuristics of emotional dilemmas are not actually being worked out in a metabolic muscle the size of a fist. Nonetheless, the symbolic heart can be a useful metaphor to signify honesty when communicating visceral experiences. In the final analysis, don’t let your feelings do all of your thinking and don’t let your thinking inhibit all of your feelings.