A New Big Five for Psychotherapists (Part I)

Character Adaptation Systems Theory (CAST) was just published in the March 2017 issue of Review of General Psychology. CAST is a proposal for linking integrative psychotherapy to the science of human psychology via the delineation of five systems of character adaptation: (1) the habit system; (2) the experiential system; (3) the relationship system; (4) the defensive system; and (5) the justification system. The theory represents a significant advance in psychotherapy integration because it allows practitioners to combine the key insights from the major paradigms into a single, unified whole.

Before proceeding further, let me offer a quick note of clarification regarding the term “New Big Five” in the title of this blog. As those familiar with personality trait theory will be aware, the term “Big Five” is a common term in that literature that refers to thinking about traits in terms of five broad domains of Openness, Conscientiousness, Extraversion, Agreeableness, and Neuroticism (sometimes referred to as OCEAN). My hope is that CAST’s five systems of character adaptation (Habit, Experience-Emotion, Relation-Attachment, Defense, and Justification) will enter the consciousness of integrative psychotherapists the same way (perhaps it can be HER DJ?)].

Source: Gregg Henriques

I have divided my review of CAST into two blogs. Part I provides the background, explaining why the field of psychotherapy is fragmented and why we can look to the relationship between medicine and biology for a good model for how the field of psychotherapy should relate to the science of human psychology going forward. Part II is about the five systems of character adaptation and why they can assimilate and integrate the key insights from the major traditions in psychotherapy. Taken together, this means that CAST opens the door for a fundamental realignment of the relationship between psychotherapy and the science of human psychology. Namely, we can now move toward developing a unified approach (UA) to psychotherapy that is grounded in a unified theory (UT) of psychology.

Psychotherapy and Psychology are both seriously fragmented

The field of psychotherapy is, currently, a jungle of different approaches. Click on Wiki’s list of psychotherapies and one finds over 150 different approaches. Some professional estimates have catalogued over a 1,000 different approaches in the published literature. It is important to be clear that we are not talking here about approaches to treating specific problems or unique populations. We are talking about approaches to doing psychotherapy in general.

Source: Gregg Henriques

As noted on the APA website, we can bring some order to this chaos by pointing out that there are four major separate traditions (or paradigms) in (individual) psychotherapy. They are the 1) psychodynamic; 2) behavioral; 3) humanistic; and 4) cognitive traditions. As I learned early in my training, each of these perspectives has valuable insights to offer. But it is also the case that they exist as separate traditions because they each have fundamentally different starting points regarding their views on mind and behavior, the nature of human nature, human change processes, and the nature of psychopathology. They also have different philosophies of science and different moral visions for the good of humanity. This is true even for cognitive and behavioral approaches, despite the fact that practitioners routinely blend these traditions in practice (see here). In graduate school, I found this fragmentation deeply troubling, and I became obsessed with the question: “Could a comprehensive approach to psychotherapy be developed that was grounded in a coherent science of human psychology?”

The field of medicine offers a clear analogy for how I was thinking about the problem. Modern medicine is reasonably well unified, at least compared to the field of psychotherapy. There is, of course, much debate in medicine. But the ideas of mainstream medicine are not fundamentally fragmented in the way ideas and paradigms are in psychotherapy. Modern medicine rests on the science of biology, especially the branches of physiology, anatomy, and pathophysiology. Physiology is the science of cells, organs and organ systems, and anatomy is the science of the structure of organisms, and pathophysiology is how organic systems breakdown and cause dysfunction.

We can see a basic harmony between these sciences and the various medical specialties. Consider, for example, that several years ago my son Jon had an unusual dysfunction in his hip. He played soccer all the time, and one day he kicked the ball awkwardly and felt an unusual pull and snap in his hip. He rested for a week or so and then was back playing again. But the event happened again a couple of months later. And then it happened again. We took him to see his regular doctor, who conducted an examination, did an X-ray and determined that he had fractured a bone in his hip. Upon that diagnosis, we were referred to a pediatric orthopedic specialist. An orthopedist is an individual who specializes in disorders of the muscular-skeletal structure. She diagnosed it as an avulsion fracture and recommended a path of rest and physical therapy for rehabilitation. Unfortunately, this did not fix his problem and every time he went out and played hard, he would snap off the piece of bone again. Finally, we had to go to yet another specialist, this time an orthopedic surgeon, who developed a plan for operating on his hip and placing a screw into the bone to reinforce the weak area. Thankfully, this turned about to be a strategy that was very successful. (Indeed, it was such an unusual phenomena and the surgery worked so well that the surgeon, Dr. Winston Gwathmey, wrote it up for a medical journal).

The point here is that orthopedics is a subspecialty of medicine that is organized and focused on a particular organ system (i.e., the muscular-skeletal system), which is a clear domain within human physiology and anatomy. If Jon had a problem with his heart, we would have seen a cardiologist; if it had been with his bladder, we would have seen a urologist; if had been with his eyes, we would have seen an ophthalmologist and so on. All of these are different specialties that connect to a larger (and largely unified) picture of human physiology and anatomy.

Imagine if, instead of being connected to that larger picture, each subspecialty in medicine claimed that they had the key insights for bio-medical health in general. Imagine also that they had different training systems, different languages, different visions and values, and the leading experts were proponents of one system and were politically and culturally defined against experts of the other systems. Consider an exchange between a cardiologist, an orthopedist, and an endocrinologist such as the following:

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“The key to health is a well-functioning heart and circulatory system,” proclaims the cardiologist.

“You are wrong,” the orthopedist says. “The key to health is a strong body, with strong muscles and good bone density.”

“You are both way off base,” says the exasperated endocrinologist. “Hormones are where we need to be focusing and the root of pathophysiology is in hormonal dysregulation.”

This conversation sounds silly because we live in an era in which modern medicine is anchored to a relatively clear and unified understanding of biology, physiology, anatomy, and pathophysiology. We recognize that the specialists are focused on organ systems that are part of a larger whole. With that recognition, we can see easily why the idea that all of our biological health could be reduced to just one organ system is laughable. No one would suggest that there should be a “horse race” between cardiologists and endocrinologists in terms of who offers the better pathway to bio-medical health in general. Instead, the map of the physiology and anatomy of the whole organism makes very clear the subsystems that go into it. And, thus, it makes very good sense that we would have generalist physicians who can diagnose and treat common ailments, and more advanced specialists who are there for treating more complicated, specific disorders of particular systems, such as the pediatric orthopedists that treated my son’s hip.

The analogy with medicine points to a potential solution for the problem of psychotherapy’s fragmentation and competition between the paradigms: the field of psychotherapy should be clearly anchored to the science of human psychology. This fact dawned on me in the late 1990s, and I spent many years on this problem. Psychotherapy was fragmented because the science of psychology was fragmented, thus if psychotherapy was going to become more integrated/unified, a more unified science of psychology was required. If we could develop a UT, then we could go from racing horses to seeing the elephant in psychotherapy.

Of course, the deep problem with this analysis is that the science of psychology is hopelessly fragmented. And it was this problem that drew my most concentrated attention in the 1990s and 2000s. In a series of publications, I answered why psychology was never unified and what was needed to solve the problem. For clarity, when I use the term “unified”, I mean it in the same way we can say that the field of biology is “unified”. Biology is unified in the sense that it has a clear subject matter (the science of Life) and there are some foundational, consensually agreed upon ideas that ground the discipline (e.g., natural selection, genetics, and cell theory). Applying this standard to psychology, we see a complete absence of unification. The field has no consensually agreed upon subject matter nor is there consensus on the key insights or foundational ideas that guide the work of psychologists.

A Unified Approach to Psychotherapy Grounded in a Unified Theory of Psychology

The unified theory (UT) of psychology I developed addresses these issues. As delineated in my book, the UT consists of four new ideas that solve the problem of psychology, which are: 1) The Tree of Knowledge System (which provides a new map of the universe as an unfolding wave of Energy Information); 2) The Justification Hypothesis (which provides a new understanding of language, human self-consciousness and the evolution of human culture); 3) Behavioral Investment Theory (which consolidates our knowledge of mind, brain, experiential consciousness, and behavior at the animal level of analysis); and 4) the Influence Matrix (which provides a map of the human relationship system). The UT offers up a way to define the field and address foundational questions, such as the relationship between mind, brain, and behavior and the relation and difference between animal and human minds.

A major limitation of the UT is that it is complicated, multifaceted, and nuanced. That means it takes a lot to learn and most individuals are not terribly inclined to devote huge amounts of time to studying a new and complex set of ideas. Practitioners are busy trying to treat patients. Researchers are busy conducting empirical studies on phenomena of interest. Even theoretical and philosophical psychologists have generally not been focused building broad, integrative systems; instead, they have been more concerned with critical theory and critiquing mainstream empirical approaches.

A positive of CAST is that it offers an extension of the UT that most folks find to be very straightforward. Indeed, you just have to remember the five systems and how they line up with the four major approaches to psychotherapy and the map begins to make sense. This sets the stage to transcend the different paradigms and integrate them into a truly unified approach to psychotherapy. Part II of this blog series (which will be published by the end of the week) offers a review of how thinking in terms of the five systems of character adaptation delineated by CAST sets the stage for assimilating and integrated the key insights of the four major paradigms.