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Schouborg, Gary (in press).

"Review: Unifying Psychotherapy—Principles, Methods, and Evidence

from Clinical Science, by Jeffrey J. Magnavita & Jack C. Anchin”.

Journal of Unified Psychotherapy and Clinical Science.

 

Book review

 

Unifying Psychotherapy—Principles, Methods, and Evidence from Clinical Science

Jeffrey J. Magnavita & Jack C. Anchin

New York: Springer, 2014

xlix + 278 pages, ISBN: 978-0-8261-9982-9 (pbk); $49.90

 

Magnavita and Anchin (MA) are psychotherapists in full-time practice who offer a unifying framework to guide clinical decision-making. The unification is pragmatic rather than conceptual. Their goal is not the impossible conceptual task of tying all psychotherapeutic approaches together under a single over-arching theory. Instead, it is the practical goal of providing a pragmatic perspective—one that promotes wise decision-making in moment-to-moment particulars, whose complexity can be only partly illuminated by scientific research, seldom leaving certain the therapeutic path forward.

 

With over 1,000 different names for approaches to psychotherapy (p. xi) expressing over 400 different approaches (p. 5), MA provide a unifying framework to reduce stultifying bewilderment and to promote efficiency. Their aim is to provide “a beginning” (p. xi) toward unifying clinical science through “a multiperspective approach that provides the clinician with a framework to select from an array of technical interventions based on an understanding of relational principles” (p. xiii).

 

The approach is multiperspective, not eclectic. Based on Lazarus’ cognitive-motivational-relational theory (CMRT), it is a systematic framework grounded in the individual (or “patient system”) whose life develops through a dialectic of differentiation and integration in a “total ecological system” (TES) of four levels of relationship: intrapsychic-biological (mind-body), interpersonal-dyadic (two individuals), relational-triadic (three individuals), and sociocultural-familial (from more than three to a whole culture) (Fig. 3.3, p. 71).

 

MA’s framework aims to be an antidote to partisanship, which feeds off dichotomies. To that end, MA repeatedly appeal to dialectic. Time and again, they refuse to become mired in a static dichotomy by showing that both its terms are complementary or valid under different conditions. For example, to those who insist on family rather than individual therapy or psychodynamic rather than cognitive-behavioral therapy, MA’s framework helps decide what therapeutic approach is optimal under what conditions.

 

By its explicitness, the framework also offers an alternative to an eclecticism guided only by an inarticulate intuition that may be no more than a roll of the dice. It is a heuristic tool—PsychotherapediaTM (p. 199)—that helps the therapist pragmatically unify her practice through the moment-to-moment evolution of the therapist and her practice. The evolution occurs through a dialectic of empirical evidence, which reduces uncertainty where possible, and self-critical intuition.

 

The writing is clear and readable. The book’s organization is straightforward. The Preface identifies the problems—the bewildering complexity of the field of psychotherapy, the partisanship, and insufficient credibility. The Introduction by Allan N. Schore indicates how neuroscience can illuminate psychotherapy. Part I lays out the proposed framework and supporting evidence. Part II explains the four levels of relationship: intrapsychic-biological (mind-body), interpersonal-dyadic (two individuals), relational-triadic (three individuals), and sociocultural-familial (from more than three to a whole culture). Part III then lays out general principles for applying the framework.

 

Consistent with their pragmatic rather than conceptual aims, MA do not try to “prove” the value of their framework by extended argument and empirical evidence. Instead, they flesh it out, cite what empirical evidence supports aspects of it, and depict how it might apply to several cases. After all, this is just “a beginning,” an effort that they expect to evolve as research findings grow and individual therapists develop their personal skills and wisdom. Notably and admirably, MA expect therapists to question and test their work continually. To that end, MA identify common sources of biases in therapeutic decision-making and what can be done to counter them (pp. 248-256).

 

As “a beginning,” Unifying Psychotherapy does an admirable job of pointing readers in an illuminating direction. This by itself is a worthy accomplishment. The following quibble is therefore not intended as a criticism but as a helpful suggestion for a possible second edition. MA could have usefully reminded the reader at the end that their book is indeed just a start. They might have sketched out: 1) the limitations of research that currently supports the proposed framework; 2) future research that critically assesses it pro and con; 3) the factors that disincline therapists from actually questioning and testing the effectiveness of their work; 4) the factors that disincline them from actually reflecting on their biases; and 5) personal and systemic incentives that might be created to counter 3 and 4. Such a cautionary ending would help to stimulate the habitual open inquiry into practice that MA admirably promote, countering the natural tendency to latch onto the proposed framework in a way that turns it into yet one more partisan dogma.

 

Gary Schouborg

GaryNini.com

Walnut Creek, CA 94597

gary@garynini.com