Multimodal Therapy

Arnold A. Lazarus
 e-Book 2015 International Psychotherapy Institute

From The Psychotherapy Guidebook edited by Richie Herink and Paul R. Herink

All Rights Reserved

Created in the United States of America

Copyright © 2012 by Richie Herink and Paul Richard Herink

 Table of Contents

DEFINITION

HISTORY

TECHNIQUE

APPLICATIONS

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 Multimodal Therapy

Arnold A. Lazarus

DEFINITION

Multimodal Therapy is a technically eclectic approach to psychotherapy.

While drawing heavily on communications theory, cognitive theory, and

social learning theory, multimodal therapists are willing to apply effective

methods and techniques from any discipline. In Multimodal Therapy, the

most significant process is a careful and systematic inquiry into seven

dimensions or modalities of “personality.” Every case is thoroughly assessed

for problem areas in behavior, affect (moods and emotions), sensation,

imagery, cognition, interpersonal relationships, and also in the

biochemical/neurophysiological realm. If the medical or physical modality is

subsumed under the term “drugs,” a very convenient acronym can be

constructed. Taking the first letters from behavior, affect, sensation, imagery

and cognition, we have BASIC. The interpersonal and drug modalities give us

ID. Thus, Multimodal Therapy is the assessment and treatment of the BASIC
ID. (It needs to be stressed that the D modality encompasses much more than

“drugs” and also includes diet, exercise, nutrition, and many other

medical/physical considerations.)

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 A basic premise is that the seven modalities are interactive (a change in

one modality will affect all the others to a greater or lesser extent) and yet

each modality is also sufficiently discrete to require specific assessment and

therapy. In essence, thorough therapy needs to cover the entire BASIC ID. To

ignore, bypass, or overlook one or more of these modalities is to practice

incomplete therapy. This leaves patients prone to relapses and/or the

development of new problems.

HISTORY

My initial training in psychotherapy was along traditional lines. I was

exposed to psychodynamic thinking and most of my clinical supervisors

adhered to the principles of Freud, Harry Stack Sullivan, or Carl Rogers. I

received some training from Adlerians during my internship and found this

orientation, with its emphasis on human dignity and didactic interventions,

more appealing and more helpful than the others. But behavior therapy
(Wolpe and Lazarus, 1966) offered the widest repertoire of systematic

techniques. I found methods like assertiveness training and desensitization

far more effective in facilitating observable change than the interpretive

methods I was first taught to employ. In retrospect, it is now obvious to me

that I made the error of needlessly subscribing to the idea that human

neuroses are a result of conditioning, instead of realizing that behavior

therapy transcends the constraints of “behaviorism” and is effective for

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reasons that animal analogues cannot begin to explain (Lazarus, 1977).

While conducting follow-up studies of clients who had received

behavior therapy, I found that about 36 percent had relapsed anywhere from

one week to six years after therapy (Lazarus, 1971). Subsequent follow-ups

were conducted more thoroughly and revealed an even higher relapse rate,
especially in cases who were disturbed and maladjusted rather than merely

suffering from minor adjustment problems and situational difficulties.

When looking into the reasons behind the disappointingly high number
of relapses, it became evident that people were not falling victim to

unconscious forces welling up from unresolved complexes. Most of the people

who relapsed had simply not acquired sufficiently effective coping responses
to deal with inimical life situations. The usual behavior therapy approach

does not deal in sufficient detail with many aspects of affect, sensation,

imagery, cognition, and interpersonal factors (Lazarus, 1976). Most

practitioners of behavior therapy do not devote sufficient time to “existential

problems,” or to issues of self-esteem. They gloss over various values,

attitudes, beliefs, and neglect several significant nuances of interpersonal

functioning. The conventional behavior therapist is also inclined to disregard

important areas of defective learning, despite his avowed allegiance to

principles of learning. For example, behavioral approaches do not pay

attention to the fact that many clients suffer from a lack of information about

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their own emotions and motivations. Furthermore, many people are inclined
to block thoughts and feelings from their own awareness — another fact that

most behavior therapists seem to disavow.

The first series of Multimodal Therapy follow-ups comprised twenty

clients after a two-year post-treatment period. Stability and durability of

outcomes were clearly established. Only two cases required booster

treatments before this period. Their relapses were due to the fact that they

had been inadequately prepared to deal with “future shock” (i.e., various

inevitable changes in life’s circumstances). This problem is probably best

handled through imagery (Lazarus, 1978). A second series of follow-ups is

presently under way. Initial impressions of the data seem to confirm the fact

that Multimodal Therapy produces enduring, positive results.

TECHNIQUE

After establishing rapport, conducting a thorough assessment (which, at

the very least, includes a Life-History Questionnaire and a functional analysis

of all presenting complaints), and administering any tests deemed necessary,

a Modality Profile is constructed. Here is the Modality Profile of a forty-year-

old woman whose presenting complaints were: “I drink too much and I worry

too much.”

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 Comprehensive therapy at the very least calls for the correction of

deviant behaviors, unpleasant feelings, negative sensations, intrusive images,

irrational beliefs, stressful relationships, and physiological difficulties.

Durable results appear to be in direct proportion to the number of specific

modalities invoked by any therapeutic system. Lasting change is a function of

systematic techniques and specific strategies applied to each modality.

Patients are usually troubled by a multitude of specific problems that tend to

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require a similar multitude of specific treatments. Multimodal Therapy

encompasses:

1) specification of goals and problems,

2) specification of treatment techniques to achieve these goals and

remedy these problems, and

3) systematic measurement of the relative success of these

techniques.

APPLICATIONS

Multimodal Therapy has been applied to individuals, couples, families,

and groups. Target problems include depression, anxiety, psychosomatic

difficulties, obesity, sexual inadequacy, and mental retardation (Lazarus,

1976). Other practitioners who use the multimodal approach are encouraged

by the results. For instance, I launched a Multimodal Therapy Institute where

four of my associates have treated a variety of people with different problems

in several settings. Furthermore, in collaboration with Dr. J.J. Shannon of

Seton Hall University, a controlled research project is being planned. And

finally, Dr. Lillian Brunell has been using Multimodal Therapy on hospitalized

patients at Essex County Hospital Center with most promising results.

In essence, Multimodal Therapy provides a useful framework for

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detailed assessment, one that is open to validation, and one that permits a
problem-centered treatment plan to emerge within the context of patients’
needs rather than within the constraints of therapists’ theoretical

predilections.

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