Psychotherapy Integration: Bump Theory Explains How to Do It
If you aim to draw on diverse techniques as a therapist, take this map with you.
Posted Apr 13, 2018
There are hundreds of techniques for doing psychotherapy. Which is best? In my clinical practice, in accord with a currently popular movement among many therapists, I answer that question with the response "All of the above." Research corroborates that in general, integrative therapy, weaving multiple therapeutic strategies into a comprehensive treatment, gets the best results. But how, as a therapist or as a self-helper, do you connect all the pieces into a cohesive and effective whole treatment? In my book Prescriptions Without Pills I offer the map shown here, in the picture above, as a guide for integrative therapists.
What are the challenges of working as an integrative therapist?
Integrative therapists aim to be broadly skilled, That way they can pick from among many intervention options, utilizing the most effective technique for whatever their client needs to accomplish at that time. That's the good news.
At the same time, integrative therapists face a dilemma. With so many techniques in their treatment repertoire, therapists need a way to stay organized in treatment. Therapists need a single simple comprehensive map that can clarify the causes of all the forms of emotional distress. They need that same conceptual map also to help them to decide which treatment to use when.
What is Bump Theory?
Bumps are upsetting situations—a tough personal decision, a conflict between you and others, or difficult circumstance such as illness or financial set-backs. That is, bumps generally occur in three realms: within a person, between people, or between a person and a negative circumstance.
On the Heitler Hand Map of bump theory, a bump is represented by the red exclamation point: ! . Notice on the map above that as we walk along the road of life (represented by an arm), from time to time we hit a bump (the bump at your wrist).
When you hit a life bump, there are five potential pathways you can take from there. Only one of these pathways, Find Solutions, returns you to the land of well-being. That's the thumb route. Thumbs up!
The four fingers by contrast represent pathways that perpetuate distress. Each of these pathways leads to a specific type of emotional challenge:
- Fold on what you want and you'll feel depressed.
- Fight to get you what you want. Fighting invites anger, potentially both within you and within others you are dealing with.
- Freeze your capacity for problem-solving thought and you will perpetuate anxiety.
- Flee from the problem, such as by stopping at the local bar, and you risk getting stuck in addictive or other obsessive-compulsive habits like workaholic, sportsaholic, etc.
Last time you felt distressed (which may be now), what was the problem or problems—the bump— that triggered your negative feelings? Which pathway did you take in response?
So how does a therapist who is integrative use the bump theory hand map?
Integrative therapists have skills for intervening in a problem in four areas.
1. Utilize fingertip interventions.
Meeting you at your fingertips and beyond, where you have entered the realm of negative emotional and habit states, integrative therapists may help you to reduce the intensity of your negative emotional state or addictive habit. A cognitive reframe, mindfulness, acupoint tapping (Emotional Freedom Technique), deep breathing, temporal tapping or a Do or Become visualization can bring calmness in the moment. These techniques all can be performed either by a therapist or as self-soothing techniques.
2. Return to the bump and turn onto the Thumb Route.
A therapist can guide you back to re-clarify the bump, and then guide you along the Thumb Route of Finding Solutions. Or, you yourself can face the bump problem squarely, and use the win-win waltz to gather information and create an effective new plan of action. For a win-win problem-solving worksheet, click here.
As you create more effective solutions for dealing with your bump, you will feel a return of well-being.
3. Find the origins of your bump response
On your own or with the help of a therapist, identify where you learned the reaction pattern that you had to this particular bump. The technique That Was Then, This Is Now, for example, is a visualization method for identifying that earlier moment. Other psychodynamic techniques can get you there as well.
For instance, close your eyes and ask yourself "Allow an image to come up of a time earlier in my life when I had a similar feeling. Alternatively, you might ask, "How old do I feel when I have that reaction?" This psychodynamic therapy technique utilizes understandings from Internal Family Systems and also from Emotion Code to help you to gain insight into the source of what might otherwise seem like a purely ineffectual response pattern.
Chloe Madanes, a family systems theorist, explained the importance of pulling up "bad habits" by the roots, as it were, when she said, "A symptom is a solution." "Symptoms" such as depression, anger, anxiety and addictive behaviors often were learned earlier in life, including from modeling by parents, dealing with difficult siblings, or struggling to cope with damaging teacher or peer relationships at school.
Often a specific bump reaction template worked, more or less, in that earlier life situation even though now it is causing you emotional distress. As you understand what made sense about your choice of bump response routes back then, it becomes easier to realize that now you are older, the situation is different, and you consequently, fortunately, have additional options.
4. Expand your repertoire of effective bump reaction techniques.
Develop skills such as:
- a) effective problem-solving cognitive patterns to replace a tendency to take depressive, angry, anxious or addictive routes,
- b) cooperative interpersonal problem-solving skills to replace arguing or going silent, and
- c) visualization techniques for reducing depression, anxiety and anger
In sum, how does Bump Theory, illustrated by the Heitler Hand Map, help a therapist?
Bump theory clarifies the routes that lead to the four main types of distressing emotional states. If you know how you got somewhere, instead of feeling lost you can retrace your steps, return to your starting place, and then take a new route, enabling positive feelings to re-emerge.
Bump theory helps therapists to visualize where in the healing process they are choosing to intervene.
The bump theory Hand Map can guide individual treatment—and also therapy with a couple and/or a family.
Likewise, the Hand Map can guide the work of professional therapists, and also of self-helpers.
Best of all, if you'll pardon a pun, the Hand Map is especially handy. Everyone, client and therapist alike, carries their hand with them all the time.
Would you like to become, or are you already, an integrative therapist? For yourself? For others?
If so, and you would like to learn more about this integrative treatment model, and also about new visualization treatment techniques derived from it? If so please see:
- a) videos and handouts on bump theory interventions on prescriptionswithoutpills
- b) my books From Conflict to Resolution and Prescriptions Without Pills
- c) my short article on Bump Theory on the website of the Society for Advancement of Psychotherapy
- d) the communication and conflict resolution skills set forth in The Power of Two and The Power of Two Workbook
Try using the Heitler Hand Map of bump theory for understanding the causes of negative emotional responses and guiding the way back to well-being. Hopefully, you will like it.