Multimodal therapy: what it is and how it works

While treating only one dimension of the patient can help improve it, most psychologists say that it is difficult for some aspects of people to remain isolated from each other.

Family issues can affect both an individual’s physical health and emotions, which means that if you ignore the latter two, there isn’t much you can do to improve your well-being.

Arnold A. Lazarus Multimodal Therapy he tries to approach up to seven dimensions of the person, to see how they interact with each other and to initiate a treatment that seeks to improve all of them as a whole. Let’s take a closer look at what it consists of.

    What is multimodal therapy?

    Multimodal therapy, developed by Arnold Lazarus, is a type of treatment that is part of the cognitive-behavioral approach, Although he also feeds on other psychological approaches and opts for an eclectic type intervention.

    According to this model, the human being is a biological organism, that is, influenced by chemical processes, which at the same time has a whole cognitive and behavioral world, manifesting itself in the form of thoughts, feelings, d ‘actions, imagination and interactions with others. people.

    Considering the complexity of every human being, Lazarus argues that, in the context of therapy, the intervention should not focus on just one aspect of the person. It is necessary to ensure that all the components of the person, understood in the form of modalities, work together and effectively, because if one of them is altered, it can have a negative impact on the others.

    For example, if the person has a pessimistic thinking style, it makes sense to think that they won’t just see the glass half empty. You will also imagine that bad things are going to happen, you will live in constant stress and worry, which manifests itself in the form of physical pain and even the use of certain substances. On this basis, and according to multimodal therapy, most psychological problems have both a cause and a consequence of various negatively affected aspects.

    since psychological problems are multifaceted and multicausal, Lazarus offers the following seven modalities, the acronyms in English make up the word BASIC ID, which help to understand the type of problem that affects the individual and his particular type of dysfunction.

    • Behaviour.
    • Assign (Assign).
    • Sensations.
    • Imagery.
    • Cognition.
    • Interpersonal relationships.
    • Biological processes (biological processes / drugs).

    Since most therapeutic interventions targeting biological disorders involve the use of drugs, acronym of the BASIC ID model, the D is considered to be the acronym for Drugs.

    Strengths and criticisms

    The main point in favor of this model, and which highlights it above other models which are also multicomponent but more limited, is that it is not limited to approaching the three main classical variables which are the patient’s emotions, his behavior and his thoughts. associated. These three variables are the hallmark of Ellis’ ABC model, the letters being the acronyms for affect / emotion (affect), conduct (behavior) and cognition (cognition).

    If the Ellis model is interesting and has proved useful in therapy, it has the disadvantage of leaving aside or addressing, but well above, aspects such as sensations, the patient’s imagination, their interpersonal relationships … avoid biological aspects of the individual, Which, without explaining all their behavior, helps to better understand it.

    Theoretical foundations

    Multimodal therapy draws on the principles and procedures of experimental psychology as well as Albert Bandura’s social learning theory. In this theory, it is argued that behaviors, whether healthy or pathological, are created, maintained and modified by the action of environmental events. That is to say that stimuli external to the person and coming from the environment, in particular from the social environment, influence his behavior.

    The first behavioral theories were based on animal modelsBehaviorist theories being the clearest case. This type of approach gives an explanation of animal behavior in a somewhat mechanical way, based primarily on the stimulus-response principle, but without going into the details of how the animal feels during a given event. Since they couldn’t get into the animal’s mind, they could hardly extrapolate their behavior to humans beyond the direct observable.

    From the most Skinnerian behaviorism it evolved to the theories of the cognitive-behavioral approach, In which the cognitive aspects of the person are taken into account, which can be determined by external events. This cognition can manifest itself in the form of behaviors that affect their social sphere and their immediate environment. Multimodal therapy takes into account this constant reciprocity between personal actions and environmental consequences.

    Application of multimodal therapy

    As we have seen, while most current therapies do not focus on a single aspect of the person, most are limited to approaching the state of the person in a trimodal way: cognition, emotion and behavior. In the multimodal model, seven modalities are analyzed, which allow a deeper approach to the reality of the individual, the characteristics of his problem and how it affects other dimensions of the person.

    In multimodal therapy, the idea that human beings are biological organisms is never forgotten, that is, biochemical and neuropsychological entities that behave (act and react), feel emotions, sensations, imagine, think, have opinions, values, attitudes, beliefs) and interact with other people.

    If the model defends the idea that all the aspects that make up the person are taken into account, it emphasizes that there are two aspects which should be given some priority: the more biological aspects and the interpersonal relationships.

    The patient’s biological processes should be taken into account first of all, because in the event that his problem is due to some type of drug poisoning, head trauma or genetic problem, it will be necessary to orient therapy in another way, and under the supervision of a psychiatrist or a doctor. There are many cases of people who after suffering a brain injury have shown a significant change in behavior and personality, the most famous being that of Phineas Gage.

    When it comes to interpersonal relationships, it is very important to know how the network of family and friends around the individual works, as if it was something dysfunctional, it would hamper their recovery. Toxic family dynamics can be the source of patient discomfortAnd if so, therapy should focus on strategizing to improve these same dynamics or finding ways to manage them.

    mostly during the first session, the psychotherapist will have to ask several questions relating to each of the seven modalities., To check which aspects are most affected in the patient’s life and how these interact or are the cause or consequence of the main problem. Here are some questions that can be asked, classified according to each of the modalities.

    1. Driving

    What does the individual do that contributes to their happiness? What makes you end up hurting her? Self-defensive actions, inappropriate behaviors? What should the patient stop doing? …

    2. Affects

    What emotions does the patient express? Are you anxious, depressed, angry … or a combination of different negative emotions? What makes you feel that way? How do you react when you feel like this?

    3. Sensations

    You Do you complain of a sensory deficit or discomfort (chronic pain, tremors, feeling of needles in the body …)? What positive feelings do you have? What emotions are associated with these bodily sensations, both good and bad?

    4. Imagination

    What fantasies and images mainly appear in your mind? Are they positive or negative? Do they represent the patient’s self-concept? Do you watch flashbacks, do you have nightmares, do you think catastrophic …?

    5. Cognition

    What are your main attitudes, beliefs, values, opinions …? Are these dysfunctional ideas?

    6. Interpersonal relationships

    Who are the most important people in the patient’s life? What do you expect from others? Which relationships are good for you and which are bad for your mental health?

    7. Biology and drug use

    Is the patient in good physical health? Do you have any medical problems? Do you use substances? Do you play sports? What type of diet do you have? Are you overweight or underweight?

    Tools to use it

    There are two main questionnaires used by multimodal therapists.

    1. Inventory of the history of multimodal life

    The multimodal life cycle inventory (Lazarus and Lazarus, 1991, 1998) is a 15-page questionnaire that helps guide treatment as long as the patient completes it. It is usually given during the first session.

    It allows to obtain detailed information on the individual, which makes it possible to specify the typology of his main problem and which aspect has a negative impact on the other dimensions of the person.

    2. Inventory of structural profiles

    Another useful tool in multimodal therapy is the Structural Profile Inventory (SCI), which consists of a 35-item questionnaire.

    Questions are asked that reflect the essential components of the BASIC ID model, allowing us to know the level of activity, emotionality, concern for sensory stimuli, imagination, cognitive ability, interpersonal relationships and concerns of biological origin.

    SCI is particularly useful in couples therapy, Where the differences in perception of the problem between the two spouses can lead to friction.

    Discussing them in concert and recording them more or less objectively through the IBS facilitates the development of a therapy which contributes to producing a constructive therapeutic context.

    Bibliographical references:

    • Lazarus, AA (2008). Multimodal therapy. In RJ Corsini and D. Wedding (Eds.) Current Psychotherapies (8th ed.) (Pp. 368-401). Belmont, Calif .: Thompson.
    • Lazarus, AA and Lazarus, CN (1991). Multimodal life cycle inventory. Champaign, IL: Research Press.
    • Lazarus, AA (2008). Technical eclecticism and multimodal therapy. In JL Lebow (Ed.) 21st Century Psychotherapies. (pages 424 to 452). Hoboken, NJ: Wiley.

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