Therapy Craft and Science

Demystifying modular-magical thinking

Much is said of models. There are value systems, philosophies, and arguments about models. IMCT affords the chance to eliminate the conceptual "baggage" and vagaries that can accompany modular thinking like, Gestalt, RET, CBT, NLP, Hakomi, hypnosis, Freud, Jung, TA, counselling, "therapy", psychotherapy, behaviour therapy and so on and so on.
However, when we come to training especially of a new psychologist, this modular field presents an overwhelming plethora of books, concepts, workshops and years of training and therapy much of which may need to be done overseas and at great cost.
One has found the lolly shop but can only ever look through the window! Even behavioural techniques are difficult enough to master let alone therapies that are far harder to comprehend and hence master. With IMCT, one can competently use some of the skills such models offer without taking on the entire training values, philosophies and costs of time and money. Later with this greater exposure to more sophisticated skills a novice might explore more confidently, expansions of these previous 'models' if they wish.

Thus, one selects a skill from any model and employs this under certain conditions. Perhaps relaxation therapy is an example of a skill, which is used in many ways across many models and with many other skills e.g. hypnosis, regression work, behaviour therapy, and systematic desensitisation. Similarly counselling "skills" pervade our practice, as do "communication skills". Perhaps the client is the final judge for they, are never a model, they are, simply "themselves" and whatever works for them seems appropriate as distinct to whatever model or philosophy may suit. Hence, inevitably a model is put forth but a unifying one not a divisive, inaccessible, knockdown, "mine is better than yours" system. Clinical experience suggests that it is easier to master and integrate the different modular skills than is first thought. One can drive a car very competently without a knowledge of electronics, physics, plastics, mechanics, hydraulics, geological knowledge of oils and so on. One learns what is necessary and how to coordinate these diversities. In fact one can drive many models of car once the basics of one are mastered. IMCT is one such model.

Integrated not eclectic

Eclectic is a word that seems to reassure a lot of professionals that they are acceptable to many value systems that seem to conflict. Unfortunately, these models and their magical connotations still exist we just swap the baggage occasionally. It is difficult to drive many cars at once but one can build a great car and drive it using the best ingredients from many other vehicles!

Integrated skills is a freeing concept where one is client centred, determining which skill is working with whom and when. One is also free to blend skills without calls of "heresy"! One's mind is freer to create, on a momentary basis a tailoring of skill-blends that suit the dynamic nature of therapy.

Finally IMCT allows an open system where a training body, a skilled professional and the feedback from one to the other can continue evolving, a craft where skills are added, blended and tested in open dialogue rather than with competitive schools and models.

IMCT Position on Evidence-Based Procedures

Random Controlled Trials (RCT) are vital but 'post'- Clinical Evidence is avant-garde

It is essential to have evidence-based procedures. A clinician always stays abreast of current valid research. More so, a good clinician is in addition aware that clinical evidence is vitally important as to what is working with each individual client. The clinician in IMCT format experiments with different approaches to further the cause of the client. Unfortunately, looking to only 'researched' therapy means that the focus becomes regressive, looking only at what has been previously established. This may even cause the clinician to doubt their own judgement or experimentation.

If we take the example of Beck (1979), he had validated a 'package' of skills after he had experimented with them in his clinic. How else did he know they were worth researching? The clinician must courageously accept the position of being a true leader in therapy research, whether that person conducts it for themself or leaves it for someone else to follow in their footsteps. Hence IMCT encourages the clinician to be up to date and avant-garde, searching always for what is genuinely working with the individual client. Further whilst not all skills in this IMCT package are on their own evidence-based, we trust that the use of them is and this is explained in the next segment. Suffice to say here that we wish students to be exposed to many varied skills so that they can experience them at this training stage and make up their own choices and decisions about the skills.

The Ghost in the machine?

The clinician becomes existentially aware that it is the individual that is responsible for the progress of therapy and not the model of therapy. Like the previous car analogy we can say that the model cannot drive itself, it must be driven. Your will is the driver and you are the guiding decision maker as to what competent skills you choose in order to "get the client to their destination".
Two principles are important here, in IMCT, the notion of the therapist as the guiding force and the notion of the package of skills as the vehicle. Most recently, our own graduate Alison Bruer (2003) researched the use of IMCT at Highbury over several randomly selected clients. She tracked the different modalities that I used as I switched from skill to skill sometimes using as many as 3 different models in the one session. She found that not only was the overall therapy (IMCT) effective in significantly lowering BDI/BAI and Millon Scores but that the modalities within the session were all useful at the time they were used. Hence the skill package was useful and also the therapists judgement in timing when to use component skills.

IMCT Super-Ordinate Skill Emphases

Several super-ordinate skills permeate and insure IMCT success. These are vital, clinical skills.

1. Collaboration

The client is seen as co-author in the process of skill application. The therapist has the skills and to criterion expertise but the client is essential to success. This becomes clearer under the notion of "Inner Tracking".

2. Inner Tracking

Inner tracking is essentially the clinician's empiricism. (Empiricism to imply the observation and experimentation process pertinent to this clinical level of experience.)
It is a skill-unit in itself. In short, one enquires from the client how the skill is working for them. This is done unobtrusively and yields vital information. The two parties work collaboratively to utilize the skill, modify it or replace it with another. The client is educated to realize that the truthfulness of their feedback is vital and any appeasing of therapist ego is counter to the whole spirit of inner tracking. Instead client and clinician work side by side to observe micro-interventions and their immediate effect in the manner of being joint independent witnesses.
Inner tracking may also be assessed after completion of a skill but never when the consciousness of the client has moved too far from essential immediacy and freshness of observation.

3. Multi-level focusing

  1. Cognitive (CBT, Language skills, Imagery, symbol and metaphor, mind mapping, goal setting, history taking, pertinent diagnostics, assessing: client suitability; progress in therapy, inner tracking, closing skills)
  2. Emotional (counselling, language/feeling/body links, emotional 'states', moods)
  3. Somatic Unconscious (body language, body/emotional links, breathing regression, gestalt, defense mechanisms, 'LOCT skills', body focussed skills, child trauma work, pain management,)

It is important that IMCT is seen as a multi-level process. If one incorporates so many skills then one must be respectful of the levels of the psyche that they were originally intended for. It is clear for example that relaxation therapy, (RT) affects many levels at once; somatic, physiological, emotional, and cognitive. This is why we use RT preliminary to imaginal or hypnotic procedures; it does not just quieten the body but also the mind and allows superior recall, attention and access to unconscious processes.
Some skills like those of Gestalt, which are highly suitable to skill-unit notions, focus only on the body/unconscious. Many other so-called "body therapies" do so similarly. Why? People are never just one or the other. We have excellent minds, which can integrate valuable information appropriately and can also use defense mechanisms like rationalization at inappropriate times. It is a matter of timing.
So, having a multi-dimensional focus allows us to be more aware of the right level of attending at the right time, both for our clients and ourselves.
This allows for the correct and respectful foundation for criterion skill integration.

4. Closing skills

A 'mysterious process' that does not have a ready dialogue is the one surrounding the finalizing of effect. This may be stated as "what heals or works" in the final microscopic analysis.
For example we use counselling, the client cries, we presume this is good. Instinct or normal caring suggests it does help and for most grief work it is vital. However when we visit a complex area like horrific child sexual and physical abuse when do we stop the person from suffering in some agonizing pain because it's 'probably' cathartic. Apart from the unethical potential of adding to unnecessary pain, what are the guidelines here? Is this a hydraulic process where one simple has to empty out all the tears? I think not. Beck used to ask his patients respectfully (if tears where a significant issue), "does it help to cry", one replied: "no, I just don't know how to stop, I feel worse after, like I'm stuck some how?" A good question and perhaps just a tinge of Inner Tracking here.

The issue of closure highlights in a systematic way the need to focus as much as possible on this vital issue. The questions we ask as therapists are "what is this client seeking? What will cease this pain, end this anxiety, what will aid this person to truly face their phobic stimulus". Another important question is also here "and which level of healing is indicated?" With a process of inner tracking and clear clinical construction we have the concept of closing skills—"the methodical and conscious selection of skills and their construction to knowingly complete the healing effect".