Toward Unification of Clinical Science: The Next

Wave in the Evolution of Psychotherapy?

Jeffrey J. Magnavita
Private Practice, Glastonbury, Connecticut

This article presents evidence from converging lines of evidence to support the
emergence of a new phase in the evolution of psychotherapy away from inte-
gration and toward unification. Clinical science has been rapidly advancing on
a number of important fronts allowing for new theoretical modeling on which
to base clinical science and the practice of psychotherapy. Although there is
controversy about the value of identifying the common principles and compo-
nent systems of human function and psychotherapy a growing number of
clinical theorists and researchers are beginning to explore the value of articulat-
ing these to guide clinical practice. The concept of holism and a foundation in
systems theory may be important keys to advancing our understanding of
psychopathology, personality theory, and psychotherapy. This article presents
an evolving unified component system model based on findings and develop-
ments in clinical science and psychotherapy.
Keywords: unified clinical science, unified psychotherapy, component system model

THE END OF THE PHASE OF PSYCHOTHERAPY

INTEGRATION?

We may be witnessing a paradigmatic shift in the clinical sciences

(Magnavita, 2006). Emerging from the critical phase of psychotherapy
integration, what seems evident is a new phase best characterized by
“unification” of clinical science. This paper will review some of the evi-

Jeffrey J. Magnavita, Private Practice, Glastonbury, Connecticut.

A brief version of the material in this article was originally offered as part of a
symposium entitled “The Evolution of Psychotherapy: Is Unification in Reach?” presented in
2003, at the annual meeting of the Society for the Exploration of Psychotherapy Integration
in New York.
Correspondence concerning this article should be addressed to Jeffrey J. Magnavita,
Glastonbury Medical Arts Center, 300 Hebron Avenue, Suite 215, Glastonbury, CT 06033.
E-mail: MagnaPsych@aol.com

264
Journal of Psychotherapy Integration Copyright 2008 by the American Psychological Association
2008, Vol. 18, No. 3, 264 –291 1053-0479/08/$12.00 DOI: 10.1037/a0013490
Symposium: Toward Unification of Clinical Science 265

dence to support this contention as well as identify some essential elements

and trends from which this unification movement has emerged. What I
propose is that there is compelling evidence for the next phase in the
evolution of the field of psychotherapy, toward a holistic or unified model,
which necessitates broadening the domain of psychotherapy to include the
domain of clinical science. To make this emergent development more
apparent, I examine some of the historical trends in the evolution of
psychotherapy and clinical science. As shown, the field of psychotherapy
appears to be at a point of convergence, after over a century of critical
developments.
Paralleling the sequence of development that has characterized our
field, my journey as a psychotherapist and clinical theorists has evolved
initially from an interest in single school models toward increasingly inte-
grative ones, and finally a unified model. Initially, I published an intrapsy-
chic-dyadic model termed short-term restructuring psychotherapy (STRP;
Magnavita, 1997) suitable for treating personality disorders, especially
those from Cluster C (avoidant, obsessive– compulsive, dependent; Diag-
nostic and Statistical Manual of Mental Disorders, 4th ed. [DSM–IV];
American Psychiatric Association, 1994). This model had its limitations,
primarily its limited scope using individual psychotherapy. Another limi-
tation was that working in the dyad was constrained to the patient–
therapist dyad and descriptions of interpersonal transactions with signifi-
cant others. I then expanded this clinical model, blending systems theory,
to encompass more a broader array of dyadic configurations, as well as
triadic configurations more suitable to couples and families, in a model
termed integrative relational therapy (IRP; Magnavita, 2000). In this model
an added advantage was that dyadic and triadic processes could be re-
ported or actually observed depending on the modality of treatment. More
recently, I moved in the direction of developing a unified model termed a
component system model (CSM; Magnavita, 2002b; 2004c; 2005a; 2005b).
This new unified component system model adds a vital sociocultural com-
ponent, which is based on the central role personality systems play in
human nature from the microsystem to the macrosystem (Millon & Davis,
1996; Millon, Grossman, Meagher, Millon, & Everly, 1999).
The topic of unification in psychology and psychotherapy as well as the
clinical sciences (i.e., clinical-applied psychology/psychiatry) has and con-
tinues to be a source of polemics (Fishman, 1988; Frank, 1988). Therefore,
to provide a firm foundation for the material that follows, establishing a
working definition and identifying the scope of unified clinical science is in
order:
Definition and Scope of Unified Clinical Science. Unified clinical
science is a theoretical, clinical, and research movement, which attempts
to identify the structures, processes and mechanisms that interconnect
266 Magnavita

the major domains of human functioning. Included within the domain of

unified clinical science are personality theory, developmental psycho-
pathology, and psychotherapy, which include the processes and mech-
anisms of change that are initiated in relationship with a professional
psychotherapist.
Next, some of the important developments of the past century related
to unification are summarized to underscore the multiple-converging do-
mains from which unification is emerging.

THE EVOLUTION OF MODERN PSYCHOTHERAPY AND THE

STUDY OF A COMPONENT SYSTEM MODEL
OF PERSONALITY

The modern psychotherapy movement has its roots in the mid- to the
late-19th century in the work of various pioneering figures, such as Ivan
Pavlov and Wilhelm Wundt who sought to develop a “scientific” psychol-
ogy, as well as the psychiatric nosologists and psychopathologists, Emil
Kraepelin and Eugene Bleuler. The modern psychotherapy movement has
many parallel, interrelated, and convergent domains, especially those from
personality and psychopathology.
According to Lombardo and Foschi (2003), although it is often ignored
by Western psychologists, the study of the componential model of person-
ality in the modern era began in France with the publication by Ribot
(1885) of Les Maladies de la Personnalite. Slightly over a century old, the
term psychotherapy was coined during the late 1880s by Hippolyte Bern-
heim, appearing in the publication Hypnotisme, suggestion, psychotherapie
(Jackson, 1999). We do know from the historical record that the art of
psychological healing dates back to just about the earliest example of
recorded history (Alexander & Selesnick, 1966; Jackson, 1999). These early
healers capitalized on what we now call “common factors,” such as rela-
tionship factors, placebo, expectancy, and instilling hope, which are still the
most robust ingredients of psychotherapy. The relational matrix is empir-
ically supported as the most robust aspect of psychotherapy effectiveness,
accounting for more of the variance than techniques and methods
(Norcross, 2002).
The most ambitious “unified” theory of personality development
emerged in the late 19th century in the form of psychopathology and
treatment. The first century of modern psychotherapy began with Freud’s
“discovery” of the unconscious and use of free association (Magnavita,
2002a). Most historians of science would probably agree that the most
significant development in the history of psychotherapy was the birth of
Symposium: Toward Unification of Clinical Science 267

psychoanalysis. Psychoanalysis presented the most comprehensive meta-

psychological model to date of psychic functioning, developmental psycho-
pathology, and offered a new approach to healing emotional disorders
(Magnavita, 2002a). Freud’s accomplishments are considered to be one of
the significant intellectual milestones of the 20th century. Freud (1966)
identified many essential components of the human matrix and his meta-
psychology was based on the importance of unifying personality, develop-
ment psychopathology, and psychotherapy in a comprehensive system.
Freud emphasized the necessity that metapsychology demonstrate and
employ the vital interrelationships among personality, psychopathology,
development, and psychotherapy.
In the next section of this article I will briefly highlight the major waves
of development in the evolution of modern psychotherapy and related
clinical sciences, most notably psychopathology and personology, which
are necessary elements of a unified clinical science.

MAJOR WAVES IN THE EVOLUTION OF

MODERN PSYCHOTHERAPY

We are fortunate to be the beneficiaries of a century of groundbreak-

ing advances; one can identify three dominant phases in the evolution of
psychotherapy. From our vantage point, at the start of the new millennium,
we have the opportunity to imagine the fourth phase, that of unification.

The Emergence of Single School Models of Psychotherapy

During this phase single paradigms were developed focusing on one or

more of the domains of human personality and functioning. Each school
tended to believe that they had arrived at the truth and the beginning of a
dialectic process ensued. During the early phase psychoanalytic and be-
havioral models whose assumptions and epistemologies were diametrically
opposed had little use for the other. This phase in the evolution of psy-
chotherapy was characterized by contentiousness among adherents of var-
ious orientations (Norcross & Newman, 1992). Only more recently have we
seen the two approaches showing signs of finding a middle ground with the
recognition of unconscious processing and affect by the cognitive behavior
camp and the use of behavioral methods by psychodynamic camp. During
the first half of the 20th century, a number of “schools” of psychotherapy
emerged, the most notable of these were behavioral, existential-
humanistic, family systems, and later, cognitive. These single schools were
268 Magnavita

like tribes, each with their own religion, which they adhered to often with
a supercilious stance toward their competitors.

The Phase of Rapprochement

The rapprochement phase of the evolution of psychotherapy was

characterized by the emergence of various braches within the dominant
models. The phase is marked by forays into the “camps” of the others
seeking understanding of differing approaches and interpreting the ap-
proaches in various therapeutic “languages.” This rapprochement occurred
during the period of proliferation of multiple theories of psychotherapy
and attempts at interpreting seemingly disparate models. Dollard and
Miller’s (1950) publication of Personality and Psychotherapy took a signif-
icant step toward understanding the commonalities between the dominant
psychoanalytic and radical behavioral models.

The Integration Movement

This current phase of development in the evolution of psychotherapy

has been a productive one, as various individuals attempt to find the
commonalities among differing approaches, and often merge them into a
stronger amalgam. The Journal of Psychotherapy Integration was one of
the outgrowths of this exciting movement and a leader in publishing the
latest developments. Noteworthy in this regard is the work of Wachtel’s
(1977; 1997), who developed a cyclical psychodynamic model merging
psychodynamics, behavioral, and systems theory. Goldfried and Newman
(1992) wrote,
The idea of being able to integrate the psychotherapies has intrigued mental health
professionals for over half century. Before this integration movement could emerge
there had to be enough diversity to integrate. The field needed a sufficient level of
differentiation among approaches before they could integrate. It is only since the
1980s, however, that the issue of psychotherapy integration has developed into a
clearly delineated area of interest. (p. 46)

There are a number of features identified by Norcross and Newman

(1992) that characterized the integration movement:
(1) proliferation of therapies, (2) inadequacy of single theories, (3) external socio-
economic contingencies, (4) ascendancy of short-term, problem focused treatments,
(5) opportunities to observe and experiment with various treatments, (6) paucity of
differential effectiveness among therapies, (7) recognition that therapeutic com-
monalities heavily contribute to outcome variance, and (8) development of a
professional network for integration. (p. 7)
Symposium: Toward Unification of Clinical Science 269

Overall, the psychotherapy integration movement has represented

various approaches to integration, which include four dominant ones: (a)
technical eclecticism, (b) theoretical integration, (c) assimilative integra-
tion, and (d) common factors (Norcross & Newman, 1992).
The integration movement has set in place many elements, which are
considered necessary for unification. In many ways assimilative integration
and common factors approaches provide more of a foundation to the
integrative movement than technical eclecticism and theoretical integra-
tion (blending of two or more theories). Eclecticism on the other hand is
not as far reaching in its attempt at theoretical convergence. Norcross and
Newman (1992) compared and contrasted eclecticism to integration iden-
tifying some key features that distinguish integration which are also aspects
of unification. These include “theoretical, convergent, combining many,
creating something new, blend, unifying the parts, more theoretical than
empirical, more than a sum of parts, idealistic” (p. 12). Greenberg and
Korman (1993) wrote “To be comprehensive, theories of human function-
ing must integrate cognition, behavior, interaction, motivation, and emo-
tion” (p. 249). Additional domains that are required for a comprehensive
theory include sociocultural structures and process.

The Quest for Unification: A “Paradigmatic” Shift?

The quest for unification is not new. As an undergraduate psychology

major in the early 1970s, I was influenced in my personal epistemology by
reading Rychlak (1968; 1973), one of the leaders in the field who reminded
us in his classic texts, not to artificially separate psychotherapy from its
sister disciplines personality and psychopathology. Unified science requires
that these be seamlessly connected, and Rychlak (1973) wrote that person-
ality theory requires a “theory of illness, theory of cure, and therapeutic
techniques” (p. 21). Rotgers (1988) explained that “Efforts to unify psy-
chology as a whole date back to the era of grand theories in the 1930s, 40’s
and 50’s. . . with the positivistic philosophies of such theorists as Tolman
and Hull” (p. 16). The move toward unification represents a paradigmatic
shift toward attempting to understand the total field of human functioning
and the processes that interconnect the various domains. This shift has
major implications for clinical practice, theory, and research. A number of
individuals have pondered the task and have even elaborated many if not
all of the componential aspects. In Principles of Psychology, William James
(1890) identified many of the known domains of the human personality
matrix. He wrote,
Psychology is the Science of Mental Life, both of the phenomena and their
conditions. The phenomena are such things as we call feelings, desires, cognitions,
270 Magnavita

reasonings, decisions, and the like; and superficially considered, their variety and
complexity is such as to leave a chaotic impression on the observer. (p. 1)

James (1890) used as his “unifying” entity the “personal Soul” (p. 1).
It is interesting to note that some recent theorists in search of unification
such as Wilber (2000) also incorporated the soul as a vital construct.
In the following section I will review some of the previous theorists
who have called for unification.

PREVIOUS THEORISTS WHO HAVE CALLED FOR OR

OFFERED UNIFIED OR HOLISTIC THEORY

There are a number of individuals who have been captivated by the

quest for unification of psychology and/or psychotherapy. Gordon Allport
(1968) made an urgent call for “systematic eclecticism” by which he meant
“a system that seeks the solution of fundamental problems by selecting and
uniting what it regards as true in the specialized psychological sciences”
(pp. 5– 6). He clearly was encouraging synthesis and unification, and dis-
cussed personality as an “open system” (p. 17). “Personality is the most
eclectic concept in psychology, and an open system view the most eclectic
interpretation of this concept” (p. 22). Nearly 40 years ago, in words still
relevant today, he described the field with the following:
The situation at present is that each theorist typically occupies himself with one
parameter of human nature, and builds himself a limited model to fit his special
data and personal style. Those who concern themselves with either the brain or
phenomenology may be said to focus on one important parameter (body-mind);
depth psychologists on the conscious-unconscious parameter; trait theorists on the
stability-variability parameter; and others on self and non-self. Trouble arises when
an investigator maintains that his preferred parameter, or his chosen model, over-
spreads the whole of human personality. (p. 10)

Another less well-known clinical theorist, Andras Anygal (1941,

1982) called for a holistic theory of human functioning and personality.
His theory, although grounded in psychoanalytic thought, emerged from
his clinical work and is surprisingly systemic in nature, giving a central
role to personality:
Personality may be viewed as a highly organized whole, a hierarchy of systems. The
significant positions in its overall organization are of systems. The significant
positions in its overall organization are occupied by parts which themselves are
systems; the constituents of these secondary systems may also be systems and so on.
Since in systems the dimensional domain in which the parts are distributed partic-
ipates in their patterning, the dimensions enumerated also provide the general
bases for the formation of these hierarchies of systems. (p. 50)

Although foreshadowing many contemporary trends, Angyal’s work

Symposium: Toward Unification of Clinical Science 271

never gained the prominence it deserved. Possibly he was just too far ahead
of his time in his notions about unification.
At about the same time, from the competing school of behaviorism
another highly influential ground swell toward unification was set in mo-
tion. In his volume, Psychology’s Crisis of Disunity: Philosophy and
Method for a Unified Science, Arthur Staats (1983) called for unification
and wrote, “We need integratory theorists, and works that pull together the
chaos of such materials that exist in psychology” (p. 266). He wrote further
There are also theories in psychology that claim a more unified characteristic, but
which are eclectic in the sense that they contain parts that have not been unified in
principles. Rather the parts are included in the same conceptual schema, but the
parts are unrelated and perhaps even inconsistent. (pp. 293–294)

Staats (1983; 1991) thought the disunity of the field of psychology

would prevent advancement to a more mature science.

CALLS FOR AND EVIDENCE OF A NASCENT

CONTEMPORARY MOVEMENT TOWARD UNIFICATION

An informal Google search I conducted, using the keywords unified

psychotherapy, produced about 999 entries. A cursory review of these,
eliminating those not directly related, left approximately 30 entries
related to my topic. There were only a handful of individuals who
proposed their own unified models, some with specific application such
as borderline personality (Allen, 1993; 2003). Orsucci (2003) offered a
workshop on “The Unified Approach to Psychotherapy” “for those
willing to apply Chaos & Complexity Theory in clinical situations” (p.
1). This seems to be at least nascent evidence of an initial movement.
The move to unify the field of psychology creates a greater but similar
challenge that unifying psychotherapy and the clinical sciences presents. In
1986, at the 94th annual convention of the American Psychological Asso-
ciation, the Society for Studying Unity Issues in Psychology (SUNI) was
founded, and the first president was Arthur Staats, as noted above, a vocal
proponent of the unification of psychology. SUNI was described as “a
scholarly society devoted to the study of theoretical, conceptual, method-
ological and technical unity in psychology in all aspects” (Staats & Burns,
1988, p. 30).
There is another, disparate group of contemporaneous workers from a
variety of disciplines that have made a call, or attempted to develop,
models for unification. The diversity of their disciplinary identification
seems to suggest that a broad nascent movement is gestating. I will identify
but a few of these individuals. Among the most noteworthy are Sternberg
272 Magnavita

and Grigorenko (2001) who, in the American Psychologist, made a re-

newed plea for unification in the field of psychology. One of the most
compelling calls for unification is by the renowned biologist, E. O. Wilson
(1998) whose book Consilience encouraged unification of the sciences and
made a special plea to psychologists. Ken Wilber (2000) also offered a
unified framework he termed Integral Psychology, which represented his
attempt to bring together all that is known of human consciousness.
Although he is not a psychologist, psychiatrist, nor academic, his work is
compelling in its inclusiveness. Michael Mahoney (1991) offered many
elements of a unification paradigm, depicted in his comprehensive volume,
Human Change Processes and more recently Constructive Psychotherapy
(2003). Mahoney does not formally use the construct “unification” but at-
tempts to identify the domains of the human personality system and identify
the necessary processes and mechanisms that facilitate change in various
subsystems. In this sense it does appear to represent a unified model.
Millon (1990) has been a major force in attempting to synthesize the
fields of psychopathology, personality theory, and psychotherapy, and has
also developed empirically based objective measurements for personality
and clinical syndromes. His work influenced a number of contemporary
thinkers (Strack, 2005). Millon (Millon et al., 1999) emphasized the cen-
trality of personality in his theorizing and his approach to therapy, which he
aptly termed personality-guided therapy. Millon conceptualized his model
using a systemic framework. He wrote: “Comprehensive theories are in-
viting because they seek to encompass the full multidimensionality of
human behavior; personality-guided therapy grows out of such a theory”
(Millon et al., 1999, p. xi). His personality-guided model was an important
step that fell only slightly short of unification, but he was clearly advocating
this unity when he wrote: “we join with thinkers of the past and argue that
no part of human nature should lie outside the scope of a clinician’s regards
(e.g., the family and culture, neurobiological processes, unconscious mem-
ories, and so on)” (Millon et al., 1999, p. ix).

UNIFICATION OF CLINICAL “PSYCHOLOGICAL” SCIENCE

VERSUS UNIFIED PSYCHOLOGY

Unification within our field must also consider the differential challenge of
developing a unified clinical-psychological science and a unified psychology, an
issue explored in a symposium sponsored by SUNI at the aforementioned 94th
annual convention of the American Psychological Association. Addressing
this issue, Sechrest and Smith (1994) contended that psychotherapy was the
practice of psychology and would benefit from the “integration of psychother-
Symposium: Toward Unification of Clinical Science 273

apeutic theory and practice into the science of psychology” (p. 2). They used
the term integration to mean “making whole,” which referred to the unifica-
tion of clinical psychology within the broader human system. Further, they
believed that “Truly useful theoretical integration would occur . . . only if one
or both of the theories involved were somehow cast into an entirely new light
and made distinctly more effective” (p. 3).
Millon et al., 1999 were also proponents of understanding how domains
were embedded in the larger systemic processes and structures and wrote:
Whether we work with “part functions” that focus on behavior, cognitions, uncon-
scious processes, biological defects, and the like, or whether we address contextual
systems that focus on the larger environment, the family, the group, or the socio-
economic and political conditions of life, the crossover point, the unit that links
parts to contexts, is the person. (p. xi)

Of course, not everyone believes that the search for a metatheoretical

model is a fruitful endeavor (Safran & Messer, 1997). Safran and Messer
believed that there were inherent difficulties when the field moved away
from pluralism to a single unified theory, derived from what might be a
misunderstanding of the philosophy of science, and how basic assumptions
signify the model. In a later chapter, Fishman and Messer (2004) cautiously
considered unification but believed that it should not be in the form of a
grand unifying theory, which they believed to be inherently problematic.

IMPLICATIONS FOR THE FIELD OF PSYCHOTHERAPY

Abandoning the Tribal Mentality and Seeking Common Goals for the
Advancement of the Science of Psychotherapy

Separate tribes with esoteric language systems dominate the field of

psychotherapy. Many have likened this trend to the “tower of Babel”; al-
though diversity in the field is welcome, there is a tendency to fractionalize and
this limits more rapid advances. There are many competing approaches to
psychotherapy, all claiming dominance, which must be very confusing to
scientists and practitioners from other disciplines. Although competition in
science is inevitable and probably necessary, it must appear to outsiders that
psychotherapists behave like members of competing tribes, with different
esoteric languages and rituals. Unification assumes that we all work in the
same realm with the same processes regardless of the subsystem or specific
domain we emphasize and specialize in. A unified model encourages us all to
be aware of the larger picture and even if domain-specific treatment is under-
taken, an understanding of the system and interconnections of domains and
processes keep us alert to other possibilities for further developments.
274 Magnavita

The Necessity of Establishing Clinical Utility and Evidence-Base

For theories of psychotherapy and models of human functioning (person-

ality theory & developmental psychology) and dysfunctioning (psychopathol-
ogy) to be of use to the clinician, they must have clinical utility and emerge
from scientific evidence, or they will not survive (Magnavita, 2004a). A com-
prehensive meta-theory must have an array of techniques, methods, and
processes applicable to diverse clinical populations, and these must be
grounded in scientific evidence. Clinical practice must be based on the “best
available research, clinical expertise, along with patient characteristics, culture
and preferences” (Norcross, Hogan, & Koocher, 2008, pp. 5– 6). Theory guides
the clinical process by narrowing the range of choice among the plethora of
techniques and methods. Theoretical systems offer maps of the domain and
ways of conceptualizing and navigating complex systems (Magnavita, 2004b).
“Clinical realities have come to demand a more flexible, if not integrative,
perspective” (Norcross & Newman, 1992, p. 7). Clinical utility is demonstrated
in clinical settings, informed by empirical evidence, and guided by assessment
and theory. Clinicians often have an uncanny ability to discern what works and
what does not through trial and error: The patient system can shape the
clinician as much as the clinician’s system shapes the patient. Researchers
should then offer empirical findings that either support or disprove the effec-
tiveness of these clinically derived techniques and methods and the theories
that support them.
Because it is fairly well established that integration is the predominant
force in the field, I next turn attention to the key differences and similar-
ities between integration and unification.

What Are the Similarities and Differences Between Integration

and Unification?

Although there are strong similarities between integration and

unification, there are also important points of divergence (see Table 1).
Unification is not merely another version of integration: it is fundamen-
tally different in some critical aspects. Theoretical integration in its various
concatenations is a blending or joining of models that become theoretically
and clinically more versatile when achieved in a consistent way. Integrative
models inevitably fall short of unification because they necessarily blend
two or more separate models in a new amalgam, often a better one but not
necessarily, and inevitably leave some component subsystem out. This
blending becomes a problem in that with the number of extant models to
be blended the new integrative modeling takes on an exponential function
Symposium: Toward Unification of Clinical Science 275

Table 1. A Comparison of the Differences Between Integrative and Unified Theory

Psychotherapy integration
Integrative theory melds “pure form” therapies
to form a stronger amalgam
Integrative theory generally covers a limited
number of domains of the human system
Integrative theory evolves piecemeal,
assimilating, and accommodating elements
Integrative theory primarily offers models of
psychotherapy and is less concerned with its
relationship to psychopathology and
personality theory
Integrative theory generally emphasizes
particular domain systems as central to a
particular model of integrative therapy
Integrative theory may only loosely be
connected to personality theory
Integrative theory uses a limited number of
paradigms for knowing (i.e., observation and
empirical research)
Unified psychotherapy
Unified theory emphasizes the essential
function, structure, and processes
common to all human systems
Unified theory attempts to establish the
interconnectedness of all the
domains of human functioning
Unified theory attempts to shift to a
metatheoretical model or total
paradigmatic matrix
Unified theory attempts to offer a
theory of the functioning of the
entire ecological system of human
functioning, including all pertinent
areas of psychology, especially
psychopathology/maladaptation,
personality theory, developmental
processes as well as
psychotherapeutic processes
Unified theory attempts to recognize
all the major domain systems of the
human biosphere
The personality system is seen as the
central organizing system of human
adaptation, function, and dysfunction
Unified theory relies on multiple
paradigms for knowing believing that
each one offers some aspect that
deepens understanding

that becomes a morass of models often with subtle or semantic differences.

For example, within one domain of psychotherapy, in a the very narrow
domain of short-term therapy, within the smaller realm of psychodynamic
therapy, there exists a plethora of competing approaches, emphasizing one
or another aspect of the intrapsychic-dyadic domain. Others have often
said and we have observed that seasoned clinicians when you watch them
work are more similar than dissimilar in what they actually do.

Criticisms and Potential Hazards of the Trend Toward Unification

There are valid criticisms of unification as it pertains both to psychol-

ogy as a whole and to clinical psychology. Green (1992), in an article in the
American Psychologist, opined that a premature attempt at unification may
unnecessarily cause damage to the field. However, he also suggested “We
must, in a sense, let unification come to us via good theory-construction
practices rather than explicitly pursuing it” (p. 1058). Messer (1988) noted
276 Magnavita

“The goal of unifying clinical psychology is a noble and compelling one,

albeit exceedingly difficult if not impossible to attain” (p. 22). He believed
that one of the greatest obstacles to unification was the need “to have an
agreed-upon language” (p. 22), although he viewed the issue of empirical
versus interpretive methodology in clinical psychology to be less of an
obstacle. Less of an obstacle is the issue of empirical versus interpretive
methodology in clinical psychology. In a more recent writing, Fishman and
Messer (2004) stated,
On the other hand, we welcome the development of new psychotherapy theories
that integrate elements from present theories. The ultimate practical value of such
integrative theories can then be contextually tested in the crucible of numbers of
detailed, systematic case studies. (p. 56)

Bearing in mind concerns voiced in criticisms of unification, several

questions must be addressed, which are discussed briefly in the following
section.
• Isn’t unification just another form of integration?

Many in the field have and will continue to question whether the
difference between integration and unification is only a semantic one and
possibly a waste of effort. This is certainly a question that requires some
attention and at first blush may appear to be an exercise in hair-splitting.
The move toward unification can be challenged with these often-heard
questions: “Isn’t unification just another brand or school of integration?”
and “Won’t this lead to a new phase where there are different types of
unification?” These are questions worth considering. However, I will try to
illustrate why moving toward a unified model is indeed a worthy endeavor
for the field of psychotherapy. A unified model to be useful must be an
emergent phenomenon of human nature and functioning. Each of the
established domains of human functioning must have a place as they do in
the biopsychosocial model and the processes must be articulated. This is
not a blending of theories such as cognitive and behavioral or psychody-
namic and systemic.
• Will we merely promote development of a plethora of different flavors
of unified theory?
Through unification might we encourage the placement of the descrip-
tor “unified” before each school of therapy such as we witnessed during the
ascendancy of managed care, when every school inserted the descriptor
“brief” or “short-term” in front of their model? To some degree this may
already be occurring as various unified models are developed and pre-
sented to the theoretical-scientific community. Gold (2005) believed that
we may run the risk of establishing different schools of unified therapy and
Symposium: Toward Unification of Clinical Science 277

will continue to have separate methodologies. Even if this is the case, I do

not believe this is reason not to proceed. As unified models are developed,
as there have been in the past, there will be an inevitable convergence of
approaches. It seems hard to imagine the field unfolding in any other way.
Human nature after all is unified, even though complex and chaotic.

• Are we engaging in a new wave of tautological discourse that results

in too many trees being used to print these efforts?

Unification does indeed run the risk of being so grand that one can
never prove or disprove the overall integrity of any unified system. To
avoid some of the difficulties encountered by psychoanalysis, it is important
that the various domains of the unified system be supported by research.
Unification attempts to characterize the total domain of human functioning
by looking at the common structures, processes, and mechanisms that
represent the entire ecological system. Thus, in the attempts at unified
modeling, all domains that have been empirically and clinically docu-
mented must have a place in the model. The basic assumption is of holism
as opposed to reductionism. This is not to say that reductionistic forms of
knowing are irrelevant, they certainly add to knowledge and understanding
and are necessary but not sufficient.

• Have we really reached a level of sophistication in our clinical science

where this effort toward unification enhances the effectiveness or
outcome of psychotherapy?

This is another valid question, which deserves our attention. Norcross

and Newman (1992) wrote over a decade ago “In view of the early stage of
the integration movement and in view of the fundamental philosophical
differences separating therapists, it is unrealistic to advance exclusively any
one metatheoretical monolith” (p. 5). Nevertheless, there is evidence in a
number of areas of convergence that we are on the right course. Neuro-
scientific data is beginning to explain why traumatic experience is so
pervasive and resistant to alteration—the impact on neural circuitry seems
to be permanent.

• “Finally, can momentum toward a unified theory ever be consistent

with the notion of humans as beings who are in flux, who evolve in
history, and whose future psychological makeup is necessary
unpredictable?”

(Fisch, 2001, p. 121 [italics added]). Fisch believed “that a unified grand
theory would be undesirable even if we could find some way to neutralize
the human biases or overcome the human limitation on the acquisition of
perfect knowledge” (p. 120). It is a misunderstanding to think that espous-
278 Magnavita

ing a unified system means we are at the endpoint of knowledge. Because

human systems are influenced by evolutionary principles they will continue
to adapt and change in relation to environmental demands. Any system to
be vital must not be stagnant but evolving, dynamic and flexible enough to
transform itself.

• “If we are ever able to develop such a [unified] theory of psychother-

apy, do I believe it will stand the test of time and become and ossified
relic of a system-building age?” (Wolfe, 2001, p. 131 [italics added).

He replied “No, I do not. The appearance of a unifying theory will

set the stage for the next period of differentiation” (p. 131). This
does not necessarily invalidate the task being proposed; building
unified theory. In a similar fashion to the human genome project, we
have discovered most of the important aspects of the human system,
and the critical task that now lies ahead is to fill in the blanks—that
is, the intricate details of these different aspects of the human
system—which will take future generations devoted to this task.

The evolution of clinical science and psychotherapy has been relatively

brief in the history of humankind and science. The quantum advances that
science has made in the 20th century have been so monumental as to make
it difficult to predict where we will be at the end of this century. Scientists
from many disciplines are attempting to find the unity in the universe and
in the smallest microcosms. The personality system is truly a unified one
and while we learn much when we break it down into it components, we
must keep sight of the fact that the interrelationships of the domains are
the central feature.

A “NATURAL” COURSE TOWARD

UNIFICATION—OBSERVATIONS OF A PERSONAL JOURNEY

The way we conceive of the world is certainly determined by our

perceptual field, experience and personal epistemologies. As a proponent
of unification, I offer my observations of my own journey as a psychother-
apist, theorist, and clinical scientist, as well as that of others I have
encountered in my various roles as teacher, trainer, and clinical supervisor.
There seems to be a tendency early in our careers as psychotherapists to
seek models that offer dogma, clearly articulated techniques and methods
that are often found in single school orientations, such as psychodynamic,
cognitive, and experiential. We embrace this model, devoting ourselves to
learning and practicing a particular form of psychotherapy. Over time we
Symposium: Toward Unification of Clinical Science 279

discover its limitations and become disillusioned, and then begin a search
for some other version of the “truth.” This leads to a search for yet another
model, usually representing another domain of the component system.
With each addition, previous knowledge and experience are assimilated
and form a new synthesis by blending aspects of previous models. Messer
(1992) commented on the natural tendency toward convergence, as ther-
apists practicing competing theories seemed to use increasingly similar
techniques as they gained experience. Over the course of time, many on
this road develop their own “unified” model of the mind and human
functioning. In this sense, I believe we all move toward a unified model; a
more formal effort in this regard, I believe, will only strengthen these
idiosyncratic learning trajectories. There are fairly robust findings that all
of the major schools of psychotherapy are about as equally effective. In
reviewing the findings from accumulated studies, the researchers Bergin
and Garfield (1994) often stated “all won and all shall have prizes.”
Greenberg (2002) believed the reason for this was,
Each therapeutic approach probably affects the system at a chosen level—
cognitive, emotional, behavioral, or interactional—and any specific effect at one
level of the system probably reverberates through the highly interconnected levels
of the system and produces comparable change in the whole person. (p. 154)

Unification must enable the disciplines of clinical science to unite in a

meaningful way.

IN SEARCH OF THE “HOLY GRAIL” OF

UNIFICATION—REDISCOVERING AND EXPANDING WHAT
ALREADY HAS BEEN ESTABLISHED

The Elements Necessary for Unification

Arthur Staats (1983) wrote about the nature of this task of unification
in psychology:
There are some general characteristics of the task of constructing multilevel, unified
theory that may be mentioned. Each field can be expected to be composed of a
mixture of “junk” along with the valuable. The theorist must separate the junk from
that which can be used productively in the theory construction task. In addition, the
theorists must abstract from the hodgepodge of detailed information in a field that
which has significance for a general, unified theory. (p. 327)

For unification to be considered an attainable goal of the clinical

sciences, substantial work on the major domains of the human personality
system needed to be accomplished. William James (1890) in his Principles
of Psychology was aware that this noteworthy goal would need to be
280 Magnavita

postponed until sufficient aspects of the domains of the human system had
been articulated and empirically established. Although James was aware of
many of the relevant domains and explored the known terrain at the time
of the publication of Principles, a key element of what was missing would
not emerge until the mid-20th century. This necessary element represented
a paradigmatic shift embraced by many disciplines and was termed the
Systems Theory (von Bertalanffy, 1968) and also cybernetics and more
recently Chaos and Complexity Theory, which are all elaborations of
nonlinear dynamical systems.

The Relevance of Systems Theory as the Grand Unification Paradigm

Systems theory represented a paradigmatic shift in the natural and

social sciences during the mid-20th century (von Bertalanffy, 1968). Un-
fortunately, much of mainstream psychology did not adapt this nonlinear
dynamical model. There were exceptions and these are evident in the work
of developmental psychopathologists who have embraced this model, and
in the clinical sciences in the field of family therapy that used systemic
modeling as the basis for family/systemic therapy. This model failed to
influence many personality theorists or psychopathologists. However, sys-
tems theory is a necessary element for grand unification. As stated one of
the major proponents of unification, Staats (1983) did not mention the
potential that systems theory held for linking the movement, when he
described the challenge of those in search of unification:
It has been said that we need conceptual works that strip away obfuscatory
distinctions to reveal simplifying commonality. It is the central weakness of the
preparadigmatic science that it cannot recognize commonality. For to recognize the
forest of commonality in the complexity of all of the trees takes skill. The integra-
tory theorist must be able to go into different areas of the science and cut across the
fact that the relevant similarities may be embedded in theories that have differences
in addition to the similarities. The scientist must be able to cut across differences in
methods, apparatus, terminology, and subjects. (pp. 267–268)

Millon et al. (1999) wrote of the components of the personality system:

“They flow through a tangle of dynamic and changing configurations. Each
component of these configurations has its role and significance altered by
virtue of its place in these continually evolving constellations” (p. 93).
Systemic modeling allows us to follow the flow of interconnectedness
among the domains systems of psychopathology, personality, and psychother-
apy. Greenberg (2002) wrote “With a complex system view, such as this, it is
clear that intervention can and should occur at different levels at different
times or with different components of the system” (p. 155). Systems theory
and an evolving branch called complexity or chaos theory offers promise for a
Symposium: Toward Unification of Clinical Science 281

unified model (Abraham, 1996; Abraham & Gilgen, 1995). Chaos theory (Gleick,
1997) has particular application to nonlinear systems such as human personality
systems. Abraham (1996) wrote of complexity or chaos theory: “Dynamics takes
a complex set of interrelated phenomena, observes the pattern of their behavior
over time, and attempts to model them” (p. 85). Complex systems can be
understood by viewing the process by which they configure and recon-
figure themselves from chaotic states to states of self-organization based
on attractors. These attractors represent a convergence of vectors,
which may result in a bifurcation, or reorganization of a system. For
example, one might conceptualize adolescence as a chaotic state in
which attractors converge and may eventually reorganize the personal-
ity to a more stable structure. It is well-known to many clinicians that a
state of confusion is often a precursor to change (Paar, 1992). The chaos
of confusion can result in letting go of something negative and reorga-
nizing the personality system in a more adaptive way.

A Flexible Scope for Moving From the Microscopic to the Macroscopic

Level of Conceptualization

Some theoretical systems such as psychoanalysis, particularly the struc-

tural-drive variant, with its focus on defense-affect-action patterns, offer a
microscopic lens with which to view the phenomenology of the patient’s
system. Cognitive approaches also focus microscopically on the internal
schemata. Interpersonal approaches view the action through a wider lens of
dyadic process. Family approaches are mostly concerned with triadic pro-
cesses, and ecological ones with sociocultural and environmental elements.
There exists much overlap but generally the breadth of field increases as
one moves from the internal to the external processes. Only a shifting
perspective can attempt to derive a holonic or three-dimensional view of
the human personality system.

META-THEORETICAL MODELING

An Example of a Unified Component System Approach

It seems important as the authors of this paper and proponents of

unification to take the leap of briefly presenting our conceptualization of
how a unified model might be organized and how it might inform the
clinical process. This presentation is necessarily very compacted but will
attempt to cover the main elements. Readers who are interested can refer
282 Magnavita

to other works, which more fully articulate the model (Magnavita, 2004c,
2005a, 2005b, 2006). We begin by organizing the component domains of
human personality functioning into four subsystems that have been iden-
tified during the past century by various clinical theorists and supported by
various converging lines of research and that encompass the relevant
domains of human personality functions. An essential aspect of this model
is its emphasis on the centrality of the relational field in understanding
human development and adaptation. In a major collaborative effort by the
National Research Council (Shonkoff & Phillips, 2000), summarizing con-
vergent lines of research and integrating findings from the neurobiological
domain to the community and culture, the committee underscored the
importance of a relational framework. This volume was aptly entitled From
Neurons to Neighborhoods: The Science of Early Childhood Development
reflecting the committee’s consideration of components from the micro-
system to the macrosystem in shaping human development. The model that
they used has many commonalities to the model that will be presented
especially in its emphasis on systemic processes, relational factors, and
nested structures of human functioning. We underscore five of Shonkoff
and Phillip’s 10 “core concepts” whose knowledge is “generated by inter-
disciplinary developmental science” (p. 3). These core concepts are directly
related to central elements of their model and support essential compo-
nents, processes, and structures, such as nonlinearity, significance of cul-
ture, multigenerational transmission, relational processes, and importance
of anxiety-affect regulation.

• Human development is shaped by a dynamic and continuous inter-

action between biology and experience.

• Culture influences every aspect of human development and is re-

flected in child rearing beliefs and practices designed to promote
healthy adaptation.

• The growth of self-regulation is a cornerstone of early childhood

development that cuts across all domains of behavior.

• Human relationships, and the effects of relationships on relation-

ships, are the building blocks of healthy development.

• The development of children unfolds along individual pathways

whose trajectories are characterized by continuities and discontinui-
ties as well as by a series of significant transitions (Shonkoff &
Phillips, 2000, pp. 3– 4).

Essentially the component system model presented in this article is a

biopsychosocial one emphasizing the centrality of the relational matrix in
Symposium: Toward Unification of Clinical Science 283

the development of human personality and responsible for function and

dysfunctioning in these systems (Magnavita, 2000).

The Component Domains of the Human Personality System

Part-Whole Relationships and the Nested Structures of Human

Domain Systems

There is little doubt that at the turn of the 21st century we have
established, although we are far from fully articulating them, the compo-
nent domains of human functioning and adaptation, and development. In
previous similar theoretical models the total ecology of the human systems
is divided into major nested domains, similar to that of a Russian doll
(Bronfenbrenner, 1979), moving from the microscopic (smallest doll) the
macroscopic (largest doll). Laveman (1997) also influenced by many of
those discussed in this article, most notably Wilber, also advocated a
similar “nested, part-whole” approach, which he described,
Since the premise that parts are embedded within wholes producing part/wholes is
true for every level of existence, there is no limit to how far up or down the
hierarchy we can go. Structural consistencies can be found in the hard sciences of
biology, physics, and neurosciences where the part to whole analogy exists as atoms
are within molecules, within cells, within organelles, within organs, all within the
human system. Each level of part/whole existence becomes more complex as the
smaller unit becomes embedded within the larger structure. The smaller unit
therefore becomes the building blocks for everything that comes after it because it
is in everything of a higher level. (p. 61)

These nested structures can be divided into four subsystems, derived

from the clinical and empirical literature as convergence points, each of
which contains many interrelated domains. Each of these subsystems chan-
nels and regulates anxiety thus attempting to provide homeostasis but also
being prone to chaotic states of disorder and reorganization. As we
progress, each matrix offers a wider angle perspective of process.
1. Intrapsychic-biological subsystem: This subsystem includes the af-
fective-cognitive-defensive matrix, the substrate of which is the
neurobiological or nanosystem of an individual. Perturbations of
any components of the subsystem will alter the organization of the
matrix and the way in which it functions. The domains of this system
include hereditary predispositions, temperament, and integrity of
neurobiological system, and internalized relational and cognitive
schematic representations. In this matrix we are concerned with the
integrity of the system to adapt to environmental challenge without
becoming symptomatic. Thus, we are concerned with the capacity of
284 Magnavita

the defensive structure to regulate affect, to be guided by suitable

cognitive and relational schema, and to maintain self-cohesion.
2. Interpersonal-dyadic subsystem: This subsystem includes the pro-
cesses that occur in interpersonal or dyadic configurations created
when two individuals are in a relationship. The domains include the
nonverbal and verbal aspects of communication processes; attach-
ment system shaped by early experience, and in the case of dys-
function or “psychopathology” termed bionegativity by Angyal
(1982), caused by traumata. Thus, in this subsystem we are con-
cerned with interpersonal processes primarily as they are enacted in
current relationships and treatment processes with the therapist.
These patterns are guided by interpersonal expectancies, inter-
nalized schema, and attachment experience. The capacity for
attachment and intimacy/closeness are hallmarks of differentia-
tion and integration of this subsystem. In other words, self-other
functioning that appropriately regulates intimacy-closeness, de-
pendency-autonomy polarities, enabling the individual to have
secure attachments.
3. Relational-triadic subsystem: This subsystem includes relational
configurations of two or more (2 ⫹ n) and is particularly concerned
with structure, function, and process that occur in unstable dyadic
configurations where anxiety is transmitted to a third person in an
effort to stabilize the dyad. The lower the level of intrapsychic
differentiation— emotional capacity (i.e., the capacity to experi-
ence, to identify with appropriate label, and express feeling), the
more one is prone toward triangulation (Bowen, 1976). Triadic
processes are ubiquitous in human relationships. Relational trian-
gles express themselves in various configurations often evident in
conflicted triads over multiple generations (Geurin, Fogarty, Fay, &
Kautto, 1996).
4. Sociocultural-familial subsystem: This subsystem, also termed the
mesosystem, includes the sociopolitical, family system, and individ-
ual personality system and their interrelationship. The domains
entailed in this matrix include the mutual influence of structure and
organization among the social and cultural system, the family, and
the individual. The perspective of evolutionary psychology is one,
which is helpful in understanding how mind shapes culture and
culture mind. Culture carries codes that Dawkins (1982) called
memes, which are similar to the genetic code carried biological, but
which in this case are carried socioculturally. The family transmits
the culture codes through child rearing practices, which are heavily
endowed by the attachment experiences of the caregivers and mul-
tigenerational transmission processes.
Symposium: Toward Unification of Clinical Science 285

An Emphasis on Holism

No domain or subsystem can be discarded and none is dominant. Each

domain and the subsystems all exist in holonic form—part/whole relation-
ships, which cannot be separated without a loss of understanding process
and function (Wilber, 2000). These subsystems and subsystems that they
include interact holistically. An example of the interrelatedness of these
subsystems can be seen in the work of the cultural anthropologist Naomi
Quinn (2003). She identified “cultural schema” (p. 146) “transmitted from
person to person and from generation to generation” (p. 147). What she
emphasized is how affective activation is a common cross cultural aspect of
child rearing. The cultural schema is transmitted by emotional arousal
demonstrating how the intrapsychic-biological domain interacts directly
with the sociocultural-familial one. By virtue of this interconnectedness, in
therapeutic work it is relatively impossible to focus exclusively on one or
another domain system.

Categories and Methods of Restructuring and Foci

of Therapeutic Action

In a unified model all proven techniques and methods should have a

position. A unified model allows us to organize the clinically and empiri-
cally proven methods to be delivered based on their domain and mode of
action (e.g., cognitive restructuring on the intrapsychic-biological domain).
We can theoretically divide our therapeutic methods into four categories
based on the four subsystems in which their primary action occurs. Within
each of the four categories, each group of methods has various foci and
modes of action and mechanisms of change. All methods in some way
address anxiety, affect regulation, defensive structures, interpersonal
processes, and relational patterns in varying degrees. Methods are aimed at
enhancing integration within a particular subsystem and increasing differ-
entiation of the components. Briefly, these include the following.
1. Intrapsychic restructuring (IR): The foci of intrapsychic restructur-
ing is the intrapsychic-biological matrix and uses the following
methods (a) defensive restructuring (Davanloo, 1980; Reich, 1933),
(b) cognitive restructuring (Beck, Rush, Shaw, & Emery, 1979), (c)
affective restructuring (Greenberg & Paivio, 1997; McCullough Vail-
lant, 1997), (d) cognitive– behavioral restructuring (Barlow, 1988;
Linehan, 1993; Shapiro, 1995), and (e) neurobiological restructuring
(Kramer, 1993; Magnavita, 2005a).
2. Dyadic restructuring (DR): The focus of dyadic restructuring is the
286 Magnavita

interpersonal-dyadic subsystem occurring between two individuals.

The following methods are included under this rubric (a) expected-
transactive restructuring (Magnavita, 2005a), (b) self-other restruc-
turing (McCullough Vaillant, 1997), and (c) relational-dyadic re-
structuring (Magnavita, 2005a).
3. Triadic restructuring (TR): The focus of triadic restructuring is the
relational-triadic subsystems that are three-person relational con-
figurations (Bowen, 1976; Minuchin, 1974). The following meth-
ods are included in this category (a) relational-triadic restructur-
ing (Magnavita, 2005a) and (b) symbolic-relational restructuring
(Magnavita, 2005a).
4. Mesosystem restructuring (MR): The focus of mesosystem restruc-
turing is the sociocultural-familial subsystem. The restructuring of
the mesosystem includes (a) familial restructuring (Magnavita, 2000,
2005a) and (b) social system restructuring (Magnavita, 2005a, 2006).
Within each of the four categories of restructuring there are numerous
techniques that have been developed and that are consistent with this
model (Magnavita, 2005a, 2006).

IMPLICATIONS FOR PSYCHOTHERAPY RESEARCH

A unified theory of psychotherapy, psychopathology and personality

theory has major implications for research.
Specifically, investigators will have to stop relying on a single methodology and
employ instead multiple, converging methodologies; loosen identification with
subdisciplines such as clinical and experimental psychology rather than the psycho-
logical phenomena under study; and stop adhering as closely as many do to
underlying paradigms, such as behaviorism or psychoanalysis. (Peterson, 2004,
p. 202)

Advancing unified clinical science, LeDoux, Debiec and Moss (2003)

published the results of a conference entitled The Self: From Soul To Brain
in the Annals of the New York Academy of Sciences.
The theme of the symposium was thus established by LeDoux: How can an
understanding of neural aspects of our implicit or unconscious selves contribute to
a better understanding of ourselves, one consistent with our explicit, psychological,
social, and spiritual selves? (p. 2).

Unified psychotherapy must be grounded in neuroscience that offers

an increasingly new way of understanding the brain-behavior relationships
we encounter in clinical practice. A common criticism of unified theory is
that it tends to be vague and our ability to verify such a theory is a
challenge (Gobert & Ritter, 2000). However, there is major dissatisfaction
Symposium: Toward Unification of Clinical Science 287

with the current paradigm for psychotherapy research, which tends to

emphasis single school models of treatment applied to discrete clinical
syndromes. Therapists in clinical practice are traditionally faced with more
complex clinical syndromes and are unlikely to adapt single school ap-
proaches (Norcross & Newman, 1992). Therapists in clinical practice are
traditionally faced with more complex clinical syndromes and are unlikely
to adapt single school approaches (Norcross & Newman, 1992), and there-
fore psychotherapy research needs to reflect this more synthetic approach
to treatment.

IMPLICATIONS FOR CLINICAL PRACTICE AND TRAINING

The implications of a unified clinical science approach for practice and

training are substantial. Peterson (2004) wrote “Unified multifield theory,
unified multiparadigmatic methodology—who but an obscurantist could
wish these efforts anything but well?” (p. 202).
An integrated psychological psychotherapy will not be able to characterized ac-
cording to school. There will not be any cognitive-behavior therapy, any psychody-
namic therapy, any supportive therapy. But there will be cognitive– behavioral
interventions for those aspects of problem complexes that seem amenable to those
approaches, and there will be psychodynamic interventions for other aspects of
problems. (Sechrest & Smith, 1994, p. 27)

Sechrest and Smith (1994) aptly summarized the challenge of unifica-

tion in the following:
In our view, though, psychology is making great strides in knowledge about many
aspects of behavior, for example, in the workings of the brain, in the genetic bases
for behavior, in cognitive functions, in the course of human development over the
life span, and so on. These gains in knowledge provide a large, sound database rich
with implications for psychotherapy. It will be a shame if psychotherapy continues
as a fragmented enterprise on the borders of psychology, limited both conceptually
and scientifically by self-imposed insulation from what by its origins is its birthright.
(p. 27)

The challenge of a unified model of clinical science and psychotherapy

puts a great deal of pressure on clinicians and clinical researchers to be
conversant with the domains of systems from neurons to neighborhoods.
These requirements then will demand continual engagement in learning
about new developments and expanding our arena of knowledge to many
related disciplines, especially neuroscience, developmental psychopathol-
ogy, personology, cultural anthropology, evolutionary psychology, cross-
cultural psychology, and many others. Training programs must continue to
provide models to psychotherapy trainees that are well explicated and can
288 Magnavita

be effectively taught but underscore their place in the unified system of

clinical science.

SUMMARY AND CONCLUSIONS

The challenge to theorists, clinicians, and researchers in psychotherapy

is to articulate a unified theory of psychotherapy that considers the estab-
lished domains of human functioning that have been identified over the
past century of modern clinical science. In addition it is vital to discover the
processes and regulatory principles that interconnect these domains as well
as the principles common among all forms of evidence-based psychother-
apy. We are poised at an exciting time in the evolution of the field as a
convergence of new technologies of neurosciences are enabling us to
investigate and verify many of the fundamental assumptions related to
human functioning and dysfunction and how human behavior is regulated
by the total ecological system of an individual from the microscopic to the
macroscopic levels of interrelated domain systems. This type of paradig-
matic shift will require increased multidisciplinary collaboration and joint
effort between theorists, clinicians and researchers.

REFERENCES

Abraham, F. D. (1996). Chaos, bifurcations, & self-organization: Dynamical extensions of

neurological positivism & ecological psychology. Blueberry Brain Institute & Chaos
Cooperative. Available at http://www.pacweb.com/blueberry/ (Reprinted from Psycho-
science, 1, 85–118.
Abraham, F. D., & Gilgen, A. R. (Eds.). (1995). Chaos theory in psychology. Westport, CT:
Greenwood.
Alexander, F. G., & Selesnick, S. T. (1966). The history of psychiatry: An evaluation of
psychiatric thought from prehistoric times to the present. New York: Harper Row.
Allen, D. M. (1993). Unified psychotherapy. In G. Striker & J. Gold (Eds.), Comprehensive
handbook of psychotherapy integration (pp. 125–137). New York: Plenum.
Allen, D. M. (2003). Psychotherapy with borderline patients. Washington, DC: American
Psychological Association.
Allport, G. W. (1968). The person in psychology: Selected essays. Boston: Beacon.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disor-
ders (4th ed.). Washington, DC: Author.
Angyal, A. (1941). Foundations for a science of personality. New York: Oxford University
Press.
Anygal, A. (1982). Neurosis and treatment: A holistic theory. New York: Da Capo.
Barlow, D. (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic.
New York: Guilford.
Beck, A. T., Rush, A. J., Shaw, B., & Emery, G. (1979). Cognitive therapy of depression. New
York: Guilford.
Bergin, A. E., & Garfield, S. L. (Eds.). (1994). Handbook of psychotherapy and behavior
change (4th Ed.). Hoboken, NJ: John Wiley & Sons.
Symposium: Toward Unification of Clinical Science 289

Bowen, M. (1976). Theory in the practice of psychotherapy. In P. J. Guerin (Ed.), Family

therapy: Theory and practice (pp. 42–90). New York: Gardner.
Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and
design. Cambridge, MA: Harvard University Press.
Davanloo, H. (Ed.). (1980). Short-term dynamic psychotherapy. New York: Aronson.
Dawkins, R. (1982). The extended phenotype. Oxford, England: Oxford University Press.
Dollard, J., & Miller, N. E. (1950). Personality and psychotherapy. New York: McGraw-Hill.
Fisch, E. S. (2001). What is the end point of psychotherapy integration? A commentary.
Journal of Psychotherapy Integration, 11, 117–122.
Fishman, D. (1988). A unified psychology? The International Newsletter of Uninomic Psy-
chology, 5, 28 –29.
Fishman, D. B., & Messer, S. B. (2004). Case-based studies as a source of unity in applied
psychology. In R. J. Sternberg (Ed.), The unification of psychology: Possibility or
pipedream? Washington, DC: American Psychological Association.
Frank, C. M. (1988). Unifying psychology: With special reference to clinical psychology. The
International Newsletter of Uninomic Psychology, 5, 25–27.
Freud, S. (1966). The standard edition of the complete works of Sigmund Freud (J. Strachey,
Ed. & Trans., Vols. 1–24). London: Hogarth Press.
Gleick, J. (1987). Chaos: Making a new science. New York: Viking/Penguin Books.
Gobert, F., & Ritter, F. E. (2000). Individual data analysis and unified theories of cognition:
A methodological proposal. Proceedings of the 3rd International Conference on Cogni-
tive Modeling. Veenedaal, The Netherlands: Universal.
Goldfried, M. R., & Newman, C. F. (1992). A history of psychotherapy integration. In J. C.
Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 46 –93).
New York: Basic Books.
Green, C. D. (1992). Is unified positivism the answer to psychology’s disunity? American
Psychologist, 47, 1057–1058.
Greenberg, L. S. (2002). Integrating an emotion-focused approach to treatment into psycho-
therapy integration. Journal of Psychotherapy Integration, 12, 154 –189.
Greenberg, L. S., & Korman, L. (1993). Assimilating emotion into psychotherapy integration.
Journal of Psychotherapy Integration, 3, 249 –265.
Greenberg, L. S., & Paivio, S. C. (1997). Working with emotions in psychotherapy. New York:
Guilford.
Guerin, P. J., Fogarty, T. F., Fay, L. F., & Kautto, J. G. (1996). Working with relational
triangles: The one-two-three of psychotherapy. New York: Guilford.
Jackson, S. W. (1999). Care of the psyche: A history of psychological healing. New Haven, CT:
Yale University Press.
James, W. (1890). The principles of psychology (Vols. 1–2). New York: Henry Holt.
Kramer, P. (1993). Listening to prozac: A psychiatrist explores antidepressant drugs and the
remaking of the self. New York: Viking/Penguin Books.
Laveman, L. (1997). The macrosystemic model of psychotherapy: Autonomy and attachment
in family systems. Journal of Psychotherapy Integration, 7, 55–74.
LeDoux, J., Debiec, J., & Moss, H. (Eds.). (2003). The self: From soul to brain. Annals of the
New York Academy of Sciences, 1001. New York: New York Academy of Sciences.
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New
York: Guilford.
Lombardo, G. P., & Foschi, R. (2003). The concept of personality in19th-century French and
20th-century American psychology. History of Psychology, 6, 123–142.
Magnavita, J. J. (1997). Restructuring personality disorders: A short-term dynamic approach.
New York: Guilford Press.
Magnavita, J. J. (2000). Relational therapy for personality disorders. Hoboken, NJ: Wiley.
Magnavita, J. J. (Ed.). (2002a). Psychodynamic approaches to psychotherapy: A century of
innovations. In F. W. Kaslow (Series Ed.) & (J. J. Magnavita, Vol. Ed.), Comprehensive
handbook of psychotherapy: Psychodynamic/object relations (Vol. 1., pp. 1–12). Hobo-
ken, NJ: Wiley.
Magnavita, J. J. (2002b). Theories of personality: Contemporary approaches to the science of
personality. Hoboken, NJ: Wiley.
290 Magnavita

Magnavita, J. J. (2004a). Classification, prevalence, and etiology of personality disorders:

Related issues and controversy. In Handbook of personality disorders: Theory and
practice (pp. 3–23). Hoboken, NJ: Wiley.
Magnavita, J. J. (2004b). The relevance of theory in treating personality dysfunction. In J. J.
Magnavita (Ed.) Handbook of personality disorders: Theory and practice (pp. 56 –77).
Hoboken NJ: Wiley.
Magnavita, J. J. (2004c). Toward a unified model of treatment for personality dysfunction. In
J. J. Magnavita (Ed.) Handbook of personality disorders: Theory and practice (pp.
528 –553). Hoboken, NJ: Wiley.
Magnavita, J. J. (2005a). Personality-guided relational psychotherapy: A unified approach.
Washington, DC: American Psychological Association.
Magnavita, J. J. (2005b). Systems theory foundations of personality, psychopathology, and
psychotherapy. In S. Strack (Ed.), Handbook of personology and psychopathology: A
freschrift in honor of Theodore Millon (pp. 140 –163). Hoboken, NJ: Wiley.
Magnavita, J. J. (2006). In search of the unifying principles of psychotherapy: Conceptual,
empirical, and clinical convergence. American Psychologist, 61, 882– 892.
Mahoney, M. J. (1991). Human change processes: The scientific foundations of psychotherapy.
New York: Basic Books.
Mahoney, M. J. (2003). Constructive psychotherapy: A practical guide. New York: Guilford.
McCullough Vaillant, L. (1997). Changing character: Short-term anxiety regulating psycho-
therapy for restructuring defenses, affects, and attachments. New York: Basic Books.
Messer, S. B. (1988). Philosophical obstacles to the unification of psychology. The Interna-
tional Newsletter of Uninomic Psychology, 5, 22–24.
Messer, S. B. (1992). A critical examination of belief structures in integrative and eclectic
psychotherapy. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy
integration (pp. 37–59). New York: Basic Books.
Millon, T. (1990). Toward a new personology: An evolutionary model. New York: Wiley.
Millon, T., & Davis, R. (1996). Disorders of personality: DSM–IV and beyond. (2nd ed.).
Hoboken, NJ: Wiley.
Millon, T., Grossman, S., Meagher, S., Millon, C., & Everly, G. (1999). Personality- guided
therapy. Hoboken, NJ: Wiley.
Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Cambridge University
Press.
Norcross, J. C. (Ed.). (2002). Psychotherapy relationships that work: Therapist contributions
and responsiveness to patients. Oxford, England: Oxford University Press.
Norcross, J. C., Hogan, T. P., Koocher, G. P. (2008). Clinician’s guide to evidence-based
practices: Mental health and the addictions. New York: Oxford University Press.
Norcross, J. C., & Newman, C. F. (1992). Psychotherapy integration: Setting the context. In
J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration. (pp.
3– 45). New York: Basic Books.
Orsucci, F. (2003). Clinical dynamics workshop: The unified approach to psychotherapy.
Available at http://users.libero.it/of/berk.htm
Paar, D. W. (1992). Introducing confusion to create change. The Psychotherapy Patient, 8,
93–102.
Peterson, D. R. (2004). Science, scientism, and professional responsibility. Clinical Psychol-
ogy: Science and Practice, 11, 196 –209.
Quinn, N. (2003). Cultural selves. In J. LeDoux, J. Debiec, & H. Moss, (Eds.), The self: From
soul to brain. Annals of the New York Academy of Science, Vol. 1001 (pp. 145–176). New
York: New York Academy of Sciences.
Reich, W. (1933). Character analysis. Leipzig, Germany: Verlag.
Ribot, T. (1885). Les maladies de la personnalite [Diseases of personality]. Paris: Alcan.
Rotgers, F. (1988). Introduction to a unified clinical psychology: Possibility or pipedream?
International Letter of Uninomic Psychology, 5, 16.
Rychlak, J. F. (1968). A philosophy of science for personality theory. Boston: Houghton
Mifflin.
Rychlak, J. F. (1973). Introduction to personality and psychotherapy: A theory-construction
approach. Boston: Houghton Mifflin.
Symposium: Toward Unification of Clinical Science 291

Safran, J. D., & Messer, S. B. (1997). Psychotherapy integration: A postmodern critique.

Journal of Psychotherapy Exploration and Integration, 4, 140 –152.
Sechrest, L., & Smith, B. (1994). Psychotherapy is the practice of psychology. Journal of
Psychotherapy Integration, 4, 1–27.
Shapiro, F. (1995). Eye movement desensitization and reprocessing (EMDR): Basic principles,
protocols, and procedures: New York: Guilford Press.
Skonkoff, J. P., & Phillips, D. A. (Ed.). (2000). From neurons to neighborhoods: The science
of early childhood development. National Research Council and Institute of Medicine.
Washington, DC: National Academy Press.
Staats, A. W. (1983). Psychology’s crisis of disunity: Philosophy and method for a unified
science. New York: Praeger.
Staats, A. W. (1991). Unified positivism and unification psychology. American Psychologist,
46, 899 –912.
Staats, A. W., & Burns, G. L. (Eds.). (1988). International Newsletter of Uninomic Psychology,
5, 15–31.
Sternberg, R. J. (Ed.). (2004). The unification of psychology: Prospect or pipedream? Wash-
ington, DC: American Psychological Association.
Sternberg, R. J., & Grigorenko, E. L. (2001). Unified psychology. American Psychologist, 56,
1069 –1079.
Strack, S. (2005). Handbook of personology and psychopathology: Essays in honor of Theo-
dore Millon. Hoboken, NJ: Wiley.
von Bertalanffy, L. (1969). General system theory: Foundations, development, applications.
New York: Braziller.
Wachtel, P. L. (1977). Psychoanalysis and behavior therapy: Toward an integration. New York:
Basic Books.
Wachtel, P. L. (1997).Psychoanalysis, behavior therapy, and the relational world. Washington,
DC: American Psychological Association.
Wilber, K. (2000). Integral psychology: Consciousness, spirit, psychology, therapy. Boston:
Shambhala.
Wilson, E. O. (1998). Consilience: The unity of knowledge. New York: Knopf.
Wolfe, B. E. (2001). A message to assimilative integrationists: It’s time to become accommo-
dative integrationists: A commentary. Journal of Psychotherapy Integration, 11, 123–131.