Toward the Theoretical Unification of Clinical Psychology

1. Toward the Theoretical Unification of Clinical Psychology Gregg Henriques, Ph.D. Department of Psychiatry University of Pennsylvania

2. Preface • Goal is to provide an introduction to a new way of thinking about the field of psychology in general and clinical psychology in particular. • Only key points, highlights, and major components will be addressed • Diagrammatic Representations • Full Circle

3. Outline of Presentation • Psychology is a fragmented discipline • Three New Sets of Ideas • The Tree of Knowledge System • Behavioral Investment Theory • The Justification Hypothesis • Unifying Clinical Psychology • Connecting previously disparate domains

4. A Unified Psychology is a Powerful Concept The difference between fragmentation and unification is the difference between noise and music.

5. Applied (Effect Change) Individual Human Level Focus on fixing psychopathology Applications based on unified pure science of psychology Pure Science (Describe Change) Defined as Science of Animal Behavior, Mental Behavior, Behavior of Nervous System as a Singularity A precisely defined set of ideas that exists between Skinner and Freud and Biology and Sociology Defining the Elements of a Unified Clinical Psychology

6. Psychology is a Fragmented Discipline • No agreed upon definition of the field • No agreed upon subject matter • Proliferation of overlapping, yet contradictory concepts • Fundamentally different epistemological assumptions

7. Schisms Abound • Nature v. Nurture • Mental v. Behavioral • Constructivist v. Empiricist • Scientist v. Practitioner • Free Will v. Deterministic • Natural v. Social Science • Bio-psychiatric v. psychosocial

8. Fragmentation Hurts • Empirical findings are of limited value if there is no shared agreement about relevant questions. This seriously impedes accumulation of knowledge. • Loss of respect from those outside field and often seen as a “would be” science • Paradigms are defined against one another and huge resources are spent on infighting.

9. The Fragmentation of the Field can be characterized as “The Skinner-Freud Problem” “Skinner and Freud occupy opposite ends of the full spectrum of positions that psychologists take regarding the nature of their inquiry...” (Stanovich, 1992, p. 3) Science of SKINNER FREUD PSYCHOLOGY “Skinner and Freud remain pillars of the field, but there is currently no way to blend the insights of the two together in a coherent fashion.” (Henriques, in press)

10. The Current State of the Field Psychology is currently a poorly organized set of ideas that exists between Skinner and Freud on the one hand and Biology and Sociology on the other.

11. Lack of an Overarching Framework “We have a surfeit of facts. What we do not have, and most of us in the quiet of our nights know it, is an overarching conception of context in which we can put these facts and, having done so, the truth then stands a chance of emerging.” Seymour B. Sarason (1989, p. 279)

12. The Tree of Knowledge System The Needed Overarching Framework

13. What is the ToK System? • A proposal for a universally agreed upon representation of scientific knowledge. • A diagram that depicts a consilient scientific philosophy on the dimensions of time and complexity. • A new form of knowledge technology that functions to merge theories together into one integrated framework.

15. Four Fundamental Levels of Complexity

16. Four Fundamental Classes of Science

17. Four Fundamental Classes of Objects

18. Four Fundamental Levels of Existence

19. Key Points About the ToK System • Provides a new way of defining extremely broad concepts (e.g., Life, Mind) and defines how they exist in relationship to one another. • Demonstrates a strong correspondence between levels of complexity and fundamental divisions in science. • Suggests the presence of two key theories or “joint-points” that provide the framework for unifying psychology and the social sciences.

20. The Structure of the ToK Suggests the Existence of Four Fundamental Theories

21. Solving the Skinner-Freud Problem JUSTIFICATION HYPOTHESIS BEHAVIORAL INVESTMENT THEORY

22. A Remarkable Unacknowledged Correspondence “The three personae of psychoanalytic theory are in many respects close to our three levels of selection; but…” (Skinner, 1981) “[T]he assumption of a distinction between ego and id [in higher animals] cannot be avoided.” (Freud, 1940)

23. Behavioral Investment Theory A Formal Proposal for the Life-to-Mind Joint Point

24. What is BIT? “Behavioral Investment Theory is a theory of the conceptual nervous system… BIT posits that the nervous system evolved as an increasingly flexible computational control system that computes and coordinates the behavioral expenditure of energy of the animal-as-a-whole. Expenditure of behavioral energy is computed on an investment value system built phylogenetically through natural selection operating on genetic combinations and ontogenetically through behavioral selection operating on neural combinations. As such, the current behavioral investments of the animal are conceptualized as the joint product of the two vectors of phylogeny and ontogeny.” (Henriques, in press)

25. What Does BIT Do? • BIT provides the theoretical framework for understanding how the psychological dimension of complexity emerges out of the biological dimension by suggesting the following “parallel” synthesis: Darwin + Genetics = Modern Synthesis (Biology) Skinner + CNP = BIT (Psychology) • BIT links distal causation with proximal causation with the same general concept of behavioral investment. These two vectors can be used to identify the focus of various disciplines.

26. The Two Vectors of Phylogeny and Ontogeny

27. Integrating Skinner with Mainstream Psychology BEHAVIORAL INVESTMENT THEORY LINKS SKINNER WITH COGNITIVE SCIENCE AND BIOLOGY

28. BIT Ultimately Combines Five Prominent Brain-Behavior Paradigms into One Unified Framework

29. BIT can be thought of as a Cognitive1-Behavioral2, Bio3-Physical4 Systems5 Theoretic6 Approach to the Science of Psychology 5 1 2 4 6 3

30. The Justification Hypothesis A Formal Proposal for the Mind-to-Culture Joint-Point

31. What is the Justification Hypothesis? • The JH is the notion that humans have an elaborate self-awareness system because the evolution of language created the problem of justification. Humans became the only animal that had to explain why it did what it did.

32. The Three Postulates of the JH • Freud’s fundamental observation was that the human consciousness system functions as a justification filter for behavioral investments. • This justification filter evolved because language creates the “problem of justification.” • The Justification Hypothesis provides the psychological foundation for a unified theory of culture and links the natural to the social sciences.

33. What Does the JH Do? • Provides the framework for understanding evolutionary changes in mind that led to the emergence of human culture • Links self-awareness at the individual level to cultural belief systems at the group level • Defines what makes humans unique • Provides functional conception of self-awareness • Links the natural and social sciences

34. Edward O. Wilson’s Description of the Fundamental Problem in Explaining Human Behavior We know that virtually all of human behavior is transmitted by culture. We also know that biology has an important effect on the origin of culture and its transmission. The question remaining is how biology and culture interact, and in particular how they interact across all societies to create the commonalities of human nature. What, in the final analysis, joins the deep, mostly genetic history of the species as a whole to the more recent cultural histories of far-flung societies? That, in my opinion, is the nub of the relationship between the two cultures. It can be stated as a problem to be solved, the central problem of the social sciences and the humanities, and simultaneously one of the great remaining problems of the natural sciences. At present time no one has a solution. But in the sense that no one in 1842 knew the true cause of evolution and in 1952 no one knew the nature of the genetic code, the way to solve the problem may lie within our grasp. (p. 126) From Consilience

35. Integrating Freud with Mainstream Psychology The JH links psychodynamic theory with social, cognitive, and personality psychology and sociological levels of analysis

38. General Summary of Unified Theory • ToK is a new form of knowledge technology which allows theories to be merged. Suggests presence of two “joint-points” that box in psychology • BIT is the Life-to-Mind Joint Point • JH is the Mind-to-Culture Joint Point

39. Unified Clinical Psychology Using the unified theory in the application of ameliorating human psychopathology

40. A unified clinical psychology integrates the best from the best within the SAME framework COGNITIVE THERAPY BEHAVIOR THERAPY PERSON- ALITY SOCIAL DEVELOP- MENTAL HUMAN- ISTIC PSYCHO-DYNAMIC FAMILY SYSTEMS BIO- PSYCH-IATRIC EXISTEN- TIAL INTER- PERSONAL FEMINIST

41. Some Current Directions • The Behavioral Shutdown Model of Depression • Definition of Mental Disorder and the differentiation of clinical psychology and psychiatry • Pervasive Adult Developmental Disorder • Connecting Cognitive Theory, Interpersonal Theory and the Personality Disorders

42. Connecting Sociotropy-Autonomy, the Interpersonal Circumplex, and the Personality Disorders As an example of how a unified movement can lead to empirical investigations, the following offers an integration between three traditionally separate domains of thought: • Beck’s concepts of Sociotropy-Autonomy • Leary’s Interpersonal Circumplex • The Personality Disorders

43. Self-Centered Orientation Invested in preserving independence, or dominance over situation Hyper-reactive to situations that impeded their goal directed behavior Other-Centered Orientation Invested in positive interchange with others Hyper-reactive to situations that might reflect loss of love or affection from others Beck’s Concepts of Sociotropy and Autonomy Autonomous Mode Sociotropic Mode

44. Independent Goal Attainment Sensitivity to Others’ Control Preference for Affiliation Fear of Criticism/Rejection Factor Structure and Sample Items of Sociotropy and Autonomy Autonomy Sociotropy “If a goal is important to me I will pursue it even if it may make other people uncomfortable.” “Having close bonds with other people makes me feel secure.” “I don't like people to invade my privacy.” “I censor what I say because I am concerned that the other person may disapprove or disagree.”

45. Leary’s Interpersonal Circumplex • Based on psychoanalytic tradition from Freud to Harry Stack-Sullivan to Henry A. Murray • The Circumplex consists of two underlying dimensions which range from hate to love on the horizontal axis (affiliation) and from submissive to dominance on the vertical axis (competition-control) Responsible- Hypernormal Competitive- Narcissistic C o n t Affiliation r o l Docile- Dependent Rebellious- Distrustful

46. Connecting the Sociotropy-Autonomy Factors with the Interpersonal Circumplex

47. Method • Participants were 1610 adult outpatients who were evaluated at the Center for Cognitive Therapy at the University of Pennsylvania. • All patients were diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised • Each participant also completed the Sociotropy-Autonomy Scale • Participants were included only if they either were not diagnosed with a personality disorder or were diagnosed with only one personality disorder.

48. Procedure • Individuals’ scores on each of the four subfactors of the SAS scale were computed. • To generate the scores for the dominance-submission dimension, scores on the FCR subfactor were subtracted from the scores on the IGA subfactor. Likewise, to create the hostility-affiliation dimension, SOC scores were subtracted from the PFA scores. This then created a two dimensional grid. • Scores from individuals with no personality disorder were then set as the center point (0,0). The means of each of the groups of personality disorders were then used to plot where the particular personality disorder fell on the grid.

49. A Priori Predicted Distribution of the Personality Disorders on the SAS-Circumplex Grid

50. Actual Distribution of the Personality Disorders on the SAS-Circumplex Grid