Multimodal therapy: what it is and how it works

Although addressing a patient dimension exclusively can help with its improvement, most psychologists argue that it is hard for people to remain isolated from each other.

It may be that having family problems affects both the physical health and the emotions of the individual, which means that if you ignore these last two, you are not really getting much to increase your well-being.

The multimodal therapy of Arnold A. Lazarus tries to address up to seven dimensions of the person, see how they interact with each other and start a treatment that tries to improve them all as a whole. Let’s take a closer look at what it consists of.

  • Related article: ” The 8 benefits of going to psychological therapy

What is multimodal therapy?

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 type of intervention.

According to this model, the human being is a biological organism, that is, influenced by chemical processes, which at the same time has a whole 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 argues 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, since 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 he 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 be shown in the form of physical pain and even the consumption of certain substances. Based on this, and according to multimodal therapy, most psychological problems arise as both cause and consequence of several negatively affected aspects.

Since psychological problems are multifaceted and multi-causal , Lazarus proposes the following seven modalities, whose acronym in English makes up the word BASIC ID, which allows us to understand the type of problem that affects the individual and their particular type of dysfunction.

  • Behavior
  • Affect
  • Imagination (Imagery).
  • Interpersonal Relationships.
  • Biological processes (Drugs).

Since most of the therapeutic intervention that addresses the 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 that stands out above other models also multicomponent but more limited, is that it is not limited to addressing the three main classic variables, which are the patient’s emotions, behavior and associated thoughts . These three variables are the badge of the Ellis ABC model, the letters being the acronym for affect / emotion (affect), behavior (behavior) and cognition (cognition).

Although Ellis’s model is interesting and has been useful in therapy, it has the disadvantage that it neglects or addresses, but above all, aspects such as sensations, the patient’s imagination, interpersonal relationships … Besides obviate the biological aspects of the individual , which, while not explaining all their behavior, help to understand it better.

Theoretical fundament

Multimodal therapy draws on the principles and procedures of experimental psychology and also the social learning theory of Albert Bandura. 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, external stimuli 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 behavioral theories being the clearest case . This type of approach gave an explanation of the animal behavior in a somewhat mechanical way, based mainly on the principle of the stimulus-response, but without going into details of how the animal felt before a certain event. Since they could not enter the animal’s mind, they could hardly extrapolate their behavior to the human beyond the directly observable.

From the most skinnerian behaviorism it has evolved until reaching the theories of 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 affect its social sphere and its closest 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 of the current therapies do not focus on a single aspect of the person, most of them are limited to addressing the state of the person in a trimodal way: cognition, emotion and behavior. In the multimodal model, seven modalities are analyzed, which allow us to have a deeper approach to the reality of the individual, the characteristics of his problem and how it affects other dimensions of the person.

In multimodal therapy, 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, never forget) 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 point out 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 his problem is due to some type of drug poisoning, brain injury or genetic problem, it will be necessary to route the therapy in another way, and under the tutelage from a psychiatrist or a doctor. There are few cases of people who, after suffering a brain injury, have manifested a significant behavioral and personality change, the best known case being Phineas Gage.

As for interpersonal relationships, it is very important to know how the network of family and friends that surround the individual is working, given that, if it is something dysfunctional, it will hinder their recovery. Toxic family dynamics can be the origin of the patient’s discomfort , and if so, the therapy should focus on working strategies to improve these same dynamics or find ways to deal with them.

Especially during the first session, the psychotherapist should ask himself several questions that touch each of the seven modalities , to make sure which are the most damaged aspects in the patient’s life, and how they interact or are the cause or consequence of the main problem. Some questions that can be asked, ordered in each of the modalities, are the following.

1. Conduct

What is the individual doing that contributes to his happiness? What makes me end up hurting you? Self-defense actions, maladaptive behaviors? What should the patient stop doing? …

2. Affection

What emotions does the patient manifest? Are you anxious, depressed, angry … or a combination of different negative emotions? What makes you feel this way? How do you respond when you feel this way?

3. Sensations

Do you complain of any deficit or sensory discomfort (chronic pain, tremor, feeling of needles in the body …)? What positive feelings 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 negative? Do they represent the patient’s self-concept? Do you visualize 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? What relationships are beneficial to you and which are harmful to your mental health?

7. Biology and drug use

Is the patient physically healthy? Do you have medical complaints? Do you consume any substance? Do you do sports? What kind of diet do you have? Do you have 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 the 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 makes it possible to specify the typology of their main problem and what aspect negatively affects 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 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.


by Abdullah Sam
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