Although exclusively addressing one dimension of the patient can help improve it, most psychologists maintain that it is difficult for aspects of people to remain isolated from each other.
Having family problems may affect both the physical health and the emotions of the individual, which means that, if the latter two are ignored, not much is really being achieved to increase their well-being.
The multimodal therapy of Arnold A. Lazarus It tries to address up to seven dimensions of the person, see how they interact with each other and initiate a treatment that tries to improve them all as a whole. Let’s take a closer look at what it consists of.
Multimodal therapy, developed by Arnold Lazarus, is a type of treatment that is part of the cognitive-behavioral approach although it also draws on other psychological approaches and opts for an eclectic intervention.
According to this model, the human being is a biological organism, that is, influenced by chemical processes, which at the same time has an entire cognitive and behavioral world, manifested in the form of thoughts, feelings, actions, imagination and interactions with other people. .
Given the complexity of each human being, Lazarus maintains that, in the context of therapy, The intervention should not focus on a single 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, given that 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 is logical to think that they will not only see the glass half empty. You will also imagine that bad things will happen, you will be living in constant stress and worry, which will show up in the form of physical pain and even the consumption of certain substances. Based on this, and according to multimodal therapy, most psychological problems occur as both a cause and a consequence of several negatively affected aspects.
Given the psychological problems are multifaceted and multicausal Lazarus proposes the following seven modalities, whose acronym in English make up the word BASIC ID, which allow us to understand the type of problem that affects the individual and their particular type of dysfunction.
Since most therapeutic intervention that addresses biological imbalances involves the use of drugs, the acronym of the BASIC ID model, D is taken as an acronym for Drugs.
Strengths and criticisms
The main point in favor of this model, and what makes it stand out above other multi-component but more limited models, is that It is not limited to addressing the three main classic variables, which are the patient’s emotions, behavior and thoughts associates. These three variables are the flagship of Ellis’s ABC model, the letters standing for affect/emotion (affect), behavior (behavior) and cognition (cognition).
Although Ellis’s model is interesting and has proven useful in therapy, it has the disadvantage that it leaves aside or addresses, but goes far beyond, aspects such as sensations, the patient’s imagination, their interpersonal relationships… In addition, it ignore the biological aspects of the individual which, although they do not explain all of their behavior, help to understand it better.
Theoretical fundament
Multimodal therapy draws on the principles and procedures of experimental psychology and also on Albert Bandura’s social learning theory. Within this theory, it is argued that behaviors, whether healthy or pathological, are created, maintained and modified through the action of environmental events. That is, stimuli external to the person and coming from the environment, especially the social environment, influence their behavior.
The first behavioral theories were based on animal models, the clearest case being behaviorist theories. This type of approach gave an explanation of animal behavior in a somewhat mechanical way, based above all on the principle of stimulus-response, but without going into details of how the animal felt when faced with a certain event. Since they could not enter the animal’s mind, they could hardly extrapolate its behavior to human behavior beyond what was directly observable.
From the most Skinnerian behaviorism, it has evolved to the theories of a 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 impact their social sphere and immediate environment. Multimodal therapy takes into account this constant reciprocity between personal actions and environmental consequences.
Application of multimodal therapy
As we have already seen, although most current therapies do not focus on a single aspect of the person, most of them are limited to addressing the person’s state 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 their problem and how it affects other dimensions of the person.
In multimodal therapy, we never forget the idea that human beings are biological organisms, that is, biochemical and neuropsychological entities that behave (act and react), feel emotions, sensations, imagine, think (have opinions, values, attitudes, etc.). beliefs) and interact with other people.
Although the model defends the idea that all aspects that make up the person are taken into account, it does highlight that There are two aspects that must have a certain priority: the most biological aspects and interpersonal relationships
The patient’s biological processes must be taken into account first of all because, in case their problem is due to some type of drug intoxication, brain injury or genetic problem, it will be necessary to direct the therapy in another way, and under the tutelage from a psychiatrist or a doctor. There are many cases of people who, after suffering a brain injury, have manifested an important behavioral and personality change, the best-known case being that of Phineas Gage.
Regarding interpersonal relationships, it is very important to know how the network of family and friends that surrounds the individual is functioning, since, if it is somewhat dysfunctional, it will hinder their recovery. Toxic family dynamics can be the source of the patient’s discomfort and if this is the case, therapy should focus on working on strategies to improve these same dynamics or find ways to cope with them.
Especially During the first session, the psychotherapist must ask himself several questions that touch on each of the seven modalities, to ensure which aspects are most affected in the patient’s life, and how these interact or are the cause or consequence of the main problem. Some questions that can be asked, organized in each of the modalities, are the following.
1. Conduct
What is the individual doing that contributes to his or her happiness? What causes it to end up harming you? Self-defensive actions, maladaptive behaviors? What should the patient stop doing?…
2. Affection
What emotions does the patient express? Are you anxious, depressed, angry… or a combination of different negative emotions? What is it that makes you feel this way? How do you respond when you feel this way?
Do you complain of any sensory deficit or discomfort (chronic pain, tremors, sensation of needles in your body…)? What positive sensations do you feel? What emotions are associated with these bodily sensations, both bad and good?
4. Imagination
What fantasies and images are predominantly displayed in your mind? Are they positive or are they negative? Do they represent the patient’s self-concept? Do you see flashbacks, have nightmares, catastrophic thinking…?
5. Cognition
What are your main attitudes, beliefs, values, opinions…? Are they 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 beneficial to you and which are detrimental to your mental health?
7. Biology and drug use
Is the patient physically healthy? Do you have medical complaints? Do you consume any substances? Do you do sports? What kind of diet does he have? Are you overweight or underweight?
Tools to use it
There are two main questionnaires used by multimodal therapists.
1. The Multimodal Life History Inventory
The Multimodal Life History Inventory (Lazarus and Lazarus, 1991, 1998) is a 15-page questionnaire that helps direct treatment, as long as the patient completes it It is usually administered during the first session.
It helps to obtain detailed information about the individual, which allows us to specify the typology of their main problem and what aspect has a negative impact on the other dimensions of the person.
2. The Structural Profile Inventory
Another useful tool in multimodal therapy is the Structural Profile Inventory (SPI), which consists of a 35-item questionnaire.
It asks questions that reflect essential components of the BASIC ID model, allowing us to know the degree of activity, emotionality, concern for sensory stimuli, imagination, cognitive ability, interpersonal relationships and concerns of biological origin.
The SPI is especially useful in couples therapy where differences in the perception of the problem between both spouses can generate friction.
Discussing them in consultation and recording them in a more or less objective way through the SPI makes it easier to develop a therapy that contributes to producing a constructive therapeutic context.
