The Therapy that Works Unifying Framework for Psychotherapy

A Unifying Framework: Is Mental Health Practice Ready for an Extreme Makeover?

I have arrived at a place in my career that I never believed possible. After spending more than 30 years researching the 500 forms of psychotherapy, counseling, and family therapy theories—and loving every minute of it—I no longer believe our traditional approach to theories is practical or sustainable. The irony is that I arrived at this conclusion as an unexpected side effect of authoring numerous psychotherapy theory textbooks that were designed to teach these many approaches.

Numerous fields have created unifying frameworks in recent years, including physics, computer science, mathematics, engineering, education, and research psychology (Bargagliotti & Orrison, 2014; Ford, 2018; Hoemann et al., 2021; Huang, 2022; Willroth, 2022; Yang et al., 2019). A unifying framework organizes diverse perspectives into a single streamlined system by identifying overlapping concepts labeled differently in different theories. For example, in psychotherapy, the solution-focused concept of exceptions to problems is theoretically different than the narrative therapy concept of unique outcomes to problem narratives, but—practically—for the clinician in the room, they are the same thing: identify a time when the symptom or problem could have happened but didn’t.

I call this framework the Therapy that Works Unifying Framework for Psychotherapy because it is built on a simple principle: do what works. The framework is not a theory because it does not attempt to explain why problems develop or why people do what they do. Instead, it is a system for doing highly effective therapy that synthesizes the theoretical and research foundations of the field (Castonguay & Hill, 2017).

The Therapy that Works Unifying Framework involves six main elements:

• Self-of-the-Clinician: Consciously creating a personal development plan to enables clinicians to develop a lifestyle that enables them to do this work well. This personal development plan involves setting goals in six areas of life wellness, including emotional/spiritual, relational, physical health, finances, career, and fun/adventure and encourages using micro-habits to achieve these goals.
• Collaborative Connecting: Most of us learned that a good therapeutic relationship requires empathy and positive regard. I believe it requires more. Drawing upon interpersonal neurobiology and social constructionist approaches, collaborative connecting is an advanced approach to building therapeutic relationships that are truly transformative and work well with a diverse range of clients.
• 4-Level Conceptualization of the Problem: Synthesizing over 50 different theories, the 4-level assessment of the problem enables clinicians to quickly and thoroughly assess and develop a rich case conceptualization that precisely identifies where to intervene and how and enables one to effectively diagnosis. In most cases, this "assessment" also serves as a powerful intervention for change.
• Evidence-Informed Treatment Planning: After a comprehensive assessment of the problem, the client's situation is filtered through the field's evidence and research bases to identify what approaches are most likely to work for the client.  
• Evidence-Informed Intervention: The framework includes several specific interventions for problems that research has identified as needing specific forms of intervention, such as trauma (PTSD), couple and family conflict, obsessive-compulsive disorder (OCD), and depression/anxiety. 
• 4-Level Conceptualization of the Solution/Wellness: Finally, the 4-level assessment is used for instances when the solution occurred to reinforce positive gains, and, more importantly, help strengthen client's preferred identities in relation to the problem. This is especially important for clients who feel marginalized in their families and communities. Additionally, the 5 Pillars of Wellness are used to help clients maintain their gains long after treatment ends.