INTEGRATIVE APPROACH TO MENTAL SUFFERING- ELENA MUSTAKOVA, Ed.D
Abstract: The search for integrative approaches to psychotherapy has emerged as a response to the dynamic needs of the global age, characterized by deep cultural, socio-political and geo-economic changes. The author describes the impetus that advances in neuro-psychology and in the understanding of mental health and well-being in the United States have provided for rethinking traditional approaches to psychotherapy. She discusses the contributions of logotherapy and social-cognitive developmental approaches to understanding mental suffering. The focus is on the author’s specific approach to the role of deep motivational dimensions of meaning and their evolutionary re-structuring in the direction of overcoming suffering, the developmental integration of consciousness, and mental well-being.
Key words: mindfulness, motivation, developmental integration, health
In 2014, the World Health Organization stated that the rapidly escalating burden of mental disorders in all parts of the world warrants a radical rethinking of both national and global responses to mental suffering in the intensely destabilizing conditions of globalization. WHO announced a plan of action in order to mobilize resources in the decade of 2013 – 2020, dedicated to mental health. In the United States, as well as in other countries, these developments have propelled forward the search for more flexible and dynamic integrative approaches to address psychological suffering – a search which began in the 1980s in the United States.
These efforts toward integration in the United States date back to the 1940ies, when Dollard and Miller (Dollard, J., Miller, N. E., 1950) first attempted to unify psychanalytic and behavioral approaches on the basis of their shared understanding of the formative influence of early shaping experiences and learned mental models on personality. In 1970, Richard Erskin, a professor at University of Illinois, began to formulate and develop his integrative approach, and in 1976 he created The Institute for Integrative Psychotherapy in New York. Separately, 1979 saw the establishment of the Society for the Exploration of Psychotherapy Integration – SEPI. Since 1991, SEPI has been publishing the Journal of Psychotherapy Integration, published by the American Psychological Association/ APA.
In the 1980s, the search for integrative approaches came increasingly into focus for many psychologists and psychotherapists in an effort to find a more holistic response to the psycho-social needs of people in an increasingly unstable age of globalization, in the context of profound and traumatic global changes toward the end of the 20th century.
At its foundation, integrative psychotherapy seeks to integrate the affective, cognitive, behavioral and physiological aspects of personality, and effect healing at the levels of body, mind, and spirit as it integrates the developmental, psycho-social and transpersonal dynamics of a fully functioning person.
In order to better understand the movement toward integrative psychotherapy, it may be useful to place it in its historical context. There have been four major orientations in the history of psychotherapy, each of which has generated dozens of different schools.
The first orientation is the psychoanalytic and psychodynamic approach to personality. The second orientation is behavioral and cognitive psychotherapy. The third is existential and humanistic psychotherapy, most commonly associated with Carl Rogers and Fritz Pearl. The fourth orientation is social constructivism and post-modernism in psychotherapy (e.g. cross-cultural and trans-cultural approaches, feminist, solution-oriented approaches, spiritually-based approaches, family systems, positive psychotherapy, neuropsychology, art therapy, etc.).
The last 100 years have seen rapid development in the fields of psychology in particular and social sciences in general, which has radically changed our conceptions of human personality. While Freud describes personality from the point of view of its biological and instinctual foundations – particularly helpful understanding when we work with patients with a minimally coherent ego structure, and a minimal orientation to reality – the development of the latter above-mentioned orientations presents an ever fuller and more complex picture of levels of personality structure and of the processes of psychotherapeutic strengthening of the ego. The analytic psychology of Jung, for example, enriches our understanding of the working of the psyche with the concepts, potential, and inclinations which the collective unconscious adds to the unconscious memories and experiences of personality. In psychotherapy, that points us toward getting to know the ethnic and psycho-social history of previous generations, on whose shoulders the individual stands; as well as toward understanding the compartmentalized aspects of the persona and its shadow side.
In contrast, Adler’s individual psychology emphasizes consciousness, cognition, meaning, and values, as well as the role of family constellations in negotiating the three main tasks of the adult life – love, occupation, and friendship. The object-relational psychotherapeutic theories of Melanie Klein, Harry Sullivan, Margaret Mahler, and Donald Winnicott emphasize the essential need of the subject to relate to an object.
With the development of psychology, it is becoming increasingly clear that the psyche is a dynamic structure, the product of a complex web of interacting processes – intrapsychic, as well as outward, psycho-social and socio-historical – which cannot be encompassed by any one particular orientation in psychology. That has propelled the intensified search for synthesis. The rapid advancements of neuroimmunology have revealed the unsuspected plasticity of the adult brain and have opened up a new wave of research on the most effective approaches to the treatment of various psychopathologies. The concept emerged of “best psychotherapeutic practices” for various conditions described in the Diagnostic Manual of the American Psychiatric Association (DSM 5, APA).
At the core of integrative psychotherapy is the recognition that human beings seek and create meaning, and their subjective experience of health is deeply related to the possibility of finding meaning in their relationships with the world. Depending on the problems that lead an individual to seek psychotherapeutic assistance, as well as depending on their specific developmental needs, the psychotherapist has to configure a carefully individualized approach, drawing on the strengths of different orientations and schools, as well as on the latest research.
Psychological Health from a Neuropsychological Perspective on Integrative Psychotherapy
Every psychotherapeutic theory and practice begins with a particular understanding of psychological health. In the last decade of the 20th century and the first decade of the 21st century, the rapid development of neuro-science opened new horizons on the nature of psychological health. Daniel Siegel, psychiatrist and professor of medicine at the University of California in Los Angeles, as well as founder of the UCLA Mindful Awareness Research Center, poses the question: how can we encompass the full diversity of behavior, temperament, values and orientations, characteristic of the full spectrum of cultures worldwide, and yet develop a coherent understanding of psychological health (Siegel, D., 2010). As he points out, positive psychology introduces an important and necessary corrective in the medical model, which emphasizes psychopathology, by asking the question what common processes characterize people from different contexts who exhibit psychological health and equilibrium.
Siegel’s research reaches similar conclusions as those of a number of other psychologists and psychotherapist at the turn of the 20th century – namely, that at the core of mental health is not just the differentiation of personality but its ultimate integration. Neuropsychology studies highly integrated people and describes the paths of integration which awaken mindful awareness associated with the prefrontal cortex. The concept of mindfulness emerged. From a neurological perspective, it is characterized by an activated left pre-frontal lobe, which dials down the fear-based reactions of the amygdala in the limbic brain and stabilizes and integrates emotional processes. This pre-frontal lobe activation is characteristic of people with a regular spiritual practice such as meditation or some form of mind/body arts (e.g. tai chi, qui gong, martial arts). A well-developed personal spiritual practice appears to associates with better overall health and rarer addictions and emotional disturbances (Miller, W. R., 1999). The regular activation of this most advanced part of our brain creates pre-conditions for the development of what Siegel calls mindsight. Mindsight, or our ability to see and reflect on our own inner condition, is at the foundation of emotional and social intelligence and allows for attuned communication, equanimity, flexibility of response, modulation of fears, empathy, insight, moral consciousness and intuition.
Siegel’s interdisciplinary research offers a definition of consciousness as a “relational and embodied” (i.e. not just brain-based) “process of regulating the flow of energy and information” (Siegel, D., 2010, p. 52). In other words, when we work psychotherapeutically to unlock and integrate as much as possible all aspects of consciousness (including the unconscious) in the direction of activating mindsight, we have to consider the energetic and informational processes at every level of the body and the interpersonal space. Based on his clinical experience, Siegel describes eight processes of integration in the direction of personal transformation and mindfulness, the development of mindsight and mental health (Siegel, D., 2010, pp. 71-75):
- The Integration of Consciousness
That includes stabilizing attention through cultivating a diffuse inner center of self-awareness which allows us to identify troubling emotional states without becoming subsumed by them.
- Horizontal Integration
This refers to the right brain/left brain integration, as in ordinary functioning, one hemisphere tends to dominate over the other. The domination of the analytical left brain results in a tendency for excessive and constant analysis and regurgitation of past and future circumstances – so-called “thought storms” – and a resulting tendency for anxiety and depression. The domination of the left non-verbal brain is often expressed in difficulties with identifying and consistently pursuing life goals and aspirations, loss of direction and subsequent self-esteem issues.
- Vertical Integration
The integration of the nervous system, distributed vertically throughout the body, is often impaired with traumas or emotional deprivation. Such integration overcomes degrees of numbness expressed in flat affect or limited emotional sensations. This often requires including in the therapeutic process of breathing and other focusing exercises which encourage concentration on sensations in the body and on the intuitions of the heart.
- Memory Integration
This refers to layers of memory. Implicit memory begins with in-utero development and is dominant in early childhood. Emotions, perceptions, actions, and bodily sensations in this period create unconscious mental models that shape our expectations of how the world works. Later, explicit memory for factual and autobiographical information configures the pieces of implicit memory into concrete stories. The more mindsight develops, the more we are able to become aware of our implicit models and to integrate them into our present awareness.
- Narrative Integration
We make sense of our lives by creating stories that weave the narrative function of the left hemisphere into the direct non-verbal experiential memory of the right hemisphere. Research shows that the best predictor of the security of our children’s attachment to us is our ability to build a coherent story of our own childhood. Blockages in our own story signal unresolved cross-generational issues; our ability to overcome these issues frees our children from the potential burden of the unconscious mental models of previous generations.
- State Integration
Our distinct states express our fundamental needs: for closeness and solitude, autonomy and independence, connection, care, competency, etc. Cultivating mindsight permits us to encompass and modulate these often painfully contradictory states without assimilating or repressing them.
- Interpersonal Integration
This refers to the “we” of well-being, i.e. the deepening realization that emotional health is never just limited to the individual’s intrapsychic reality but requires also interpersonal integration. As Siegel points out, when we are not blocked by restricting past maladaptive interpersonal models, “our resonance circuits enable us to feel the internal world within others” (Siegel, D., 2010, p. 74), which brings the joy of connection with another and the experience of health. The development of mindsight assists us in recognizing old interpersonal models which often limit the flow of our present relationships.
- Temporal Integration
Characteristic human experiences of uncertainty, impermanence, and mortality in life require making sense of. Obsessive-compulsive fixations are examples of the inability to make sense of these human realities.
In summary, psychotherapeutic work in the direction of mindfulness and the cultivation of mindsight by addressing blockages in the eight types of integration constitutes an emergent neuro-psychological understanding of integrative psychotherapy.