Therapy

Multimodal Therapy: A Unifying Approach to Psychotherapy

A system of therapy that is at once elegant, comprehensive, and effective.

Posted Nov 30, 2019

antoniodiaz/Shutterstock
Source: antoniodiaz/Shutterstock

Most people are aware that there are a variety of psychotherapy approaches, such as cognitive-behavioral therapy, person-centered or humanistic psychotherapy, hypnotherapy, and psychoanalysis. But few people know that there are currently several hundred distinct psychological therapies (Pearsall, 2011). And even fewer know, including most therapists, ironically, that since the 1980s, there has been a unified and unifying system of psychological therapy that is arguably the most elegant, comprehensive, and effective therapeutic approach yet devised. It is called Multimodal Therapy (MMT) and was originated by Professor Arnold A. Lazarus (1932-2013). 

A. Lazarus hypothesized that most psychological problems are multifaceted, multi-determined, and multilayered and that comprehensive therapy calls for a careful assessment of seven reciprocally transactional dimensions or “modalities” in which individuals operate: Behavior, Affect (emotion), Sensation, Imagery, Cognition, Interpersonal relationships, and Biological processes.

The origin of MMT has its roots in the 1950s, when, as a graduate student at the University of Witwatersrand in Johannesburg, South Africa, Arnold A. Lazarus contributed to the genesis of Behavior Therapy (BT). A term he was the first to use in the professional literature in 1958. In the 1960s and 1970s, he innovated CBT, which he introduced with his 1971 book, Behavior Therapy and Beyond. During the 1980s, A. Lazarus ultimately created Multimodal Therapy: a comprehensive, biopsychosocial approach to psychological assessment and theoretically consistent, technically eclectic psychotherapy (A. Lazarus, 1989).

MMT arose out of A. Lazarus’s realization that there were significant treatment omissions in BT and in CBT, which he found too limited and narrow. Hence, in addition to focusing on behavior, cognition, and affect, MMT also thoroughly assesses imagery, sensations, interpersonal relationships, and biological factors, resulting in a seven-point assessment framework termed the BASIC I.D.

Given that the most common biological intervention is the use of psychotropic drugs, the first letters from the seven modalities can be combined to produce the convenient acronym “BASIC I.D.” although the “D” modality actually represents the complete range of physiological and biological factors beyond the use of substances, prescribed or otherwise. Hence, as noted above, the BASIC I.D. refers to:

  • Behavior (our actions)
  • Affect (our emotions)
  • Sensation (our senses)
  • Imagery (our ability to visualize, imagine, and think in pictures)
  • Cognition (our language-based thinking)
  • Interpersonal relationships (our intimate connections and other social involvements)
  • Drugs (our physical bodies, health behaviors, and medical matters)

Therapeutically, MMT addresses response deficits and excesses within and across the BASIC I.D. and rests on a social and cognitive learning theory foundation. While rejecting theoretical integration (i.e., trying to blend together often incompatible theories of psychology), multimodal therapists use effective strategies from diverse approaches without subscribing to the theories that spawned them—technical eclecticism—and preferentially rely on empirically supported and evidence-based methods.

In addition to its use as a template for conducting therapy, the BASIC I.D. concept stands alone as a model of human personality and phenomenology. As importantly, the BASIC I.D. reflects the uniqueness of individuals; it can represent a person's "basic identity." 

And while all people have a BASIC I.D., no two people will have identical psychological experiences and, therefore, will require individually tailored psychological therapy. Also, because of its breadth and emphasis on technical eclecticism, MMT can subsume most other therapeutic approaches (e.g., traditional CBT, DBT, ACT, EMDR, mindfulness, etc.) while the converse is not possible.

One of MMT's most powerful features, however, is that it transcends simple diagnostic labels and facilitates highly individualized therapy (C. Lazarus, 1991). This is because many people with the same diagnosis can experience very different symptoms, and thus require very different treatment plans. For example, one person with a diagnosis of major depression might report insomnia, anger, agitation, loss of appetite, anxiety, lack of motivation, rumination, pessimism, and social withdrawal. Yet another person with the same "depression" diagnosis might describe experiencing hypersomnia (i.e., sleeping too much), fatigue, trouble concentrating, guilt, worthlessness, crying, loss of pleasure, and thoughts of suicide.

Obviously, despite having the same formal diagnosis, these two people will require very different and individualistically tailored therapy programs. And because MMT's aim is to identify specific problems within and across a person’s BASIC I.D. and provide the best interventions for them, it is uniquely suited to customize therapy regardless of diagnostic labels. What's more, no matter what a therapist's theoretical orientation is, since all people have a BASIC I.D., the MMT approach can be utilized by almost any health care professional.    

Simply put, MMT is probably the single most elegant and comprehensive, evidence-based form of psychological therapy yet devised. Moreover, it is also a model of personality and a paradigm for understanding the universal yet unique aspects of human psychology. Among his numerous awards and honors, in 1996, Professor Arnold A. Lazarus received the very first PSYCHE award for his seismic impact on the field of contemporary clinical psychology.   

To see how you can personally apply the power of MMT, check out this post.

Remember: Think well, act well, feel well, be well!

Copyright 2019 Clifford N. Lazarus, Ph.D. This post is for informational purposes only. It is not intended to be a substitute for help from a qualified health professional. The advertisements in this post do not necessarily reflect my opinions, nor are they endorsed by me.

References

Lazarus, A. A. (1958). New methods in psychotherapy: A case study. South African Medical Journal, 32, 660–664.

Lazarus, A.A. (1989). The Practice of Multimodal Therapy. Baltimore: Johns Hopkins University Press.

Lazarus, C.N. (1991). Conventional diagnostic nomenclature versus multimodal assessment. Psychological Reports, Vol. 68: 1363-1367.

Pearsall, P. (2011). 500 Therapies. New York: WW Norton & Co.

Lazarus, A. A. (1971). Behavior therapy and beyond. New York: McGraw-Hill