marlier.proMultimodal Therapy
October 26, 2003
Multimodal Therapy was invented by Arnold Lazarus. Clients' behavior is a result both of nature and nurture, of affective, cognitive and behavioral components. This is why these open systems require technical eclectism. Multimodal Therapy borrows from other approaches The techniques are borrowed from several systems (mainly behavior therapy, rebt and cognitive therapy) but has several distinctive features which set it apart. Let's take an example of a man, Marc, who suffers from a high level of stress and seeks help from a multimodal therapist
The multimodal approach rests on the BASIC ID system and the use of the Multimodal Life History Inventory. On the first session, the evaluation session, Marc receives a copy of Lazarus' Multimodal Life History Inventory, a 15 pages questionnaire which he will have to complete at home. Here is the contents of the questionnaire:
General Information
Personal and Social History
Description of Presenting Problems
Expectations Regarding Therapy
Modality Analysis of Current Problems
Behaviors
Feelings
Physical Sensations
Images
Thoughts
Interpersonal Relationships
Friendships
Marriage (or a committed relationship)
Sexual Relationships
Other Relationships
Biological Factors
The first letters of the BASIC ID acronym mean Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal, Drugs/Biology and correspond to the subtitles in bold of the table of contents above. These concepts, or modalities, exist in a state of reciprocal transaction and flux: They will allow the therapist to build a profile of therapeutic action which will be the starting point of a multimodal therapy. They are explained in the following table.
Table 1. The BASIC ID acronym
--------------- Table begin ----------------
Modality Questions which may be asked
Behavior What would you like to start or stop doing?
Affect What make you angry or sad?
Sensation What do you like/dislike to hear, taste, etc?
Imagery What do you imagine yourself doing in the near or far future?
Cognition What are your main musts, shoulds, beliefs?
Interpersonal How do you get on with others; do you act passively, etc?
Drugs/Biology Do you take medication? Do you smoke? How is your health?
=============== Table end ==================
Marc completes this task for the following session. The therapist and Marc review in detail the answers to the LHI questionnaire. They discuss which specific problems are most salient. The therapist also asks Marc what he would like to do first, what approach he would like the therapist to take. The therapist carefully assesses the ordering of the chain reaction of the various modalities (tracking). He adapts his approach to the needs of the client, starting first with what the client feels he needs then bridging with what the therapist thinks the client needs.
Here are the answer Marc gave to BASIC ID questions:
Table 2. Marc's BASIC ID Modalities
--------------- Table begin ----------------
Behavior Strict and rigid. He always wants to do what is correct or good. Never allows himself any unusual or pleasing activity.
Affect Feels guilty when he does not succeed in reaching his goals of perfection.
Sensation Physically tense with episodes of feeling exhausted
Imagery Images of failing
Cognition Beliefs of low self-esteem. He must not do anything wrong or bad. He must gain other people's respect.
Interpersonal He never allows himself any recreational pastimes. At the same time, refrains from asking anything from people, very limited relationships with people.
Drugs/Biology Headaches. High blood pressure. No alcohol, no smoking
=============== Table end ==================
Regarding Marc expectations from the therapy, he seeks to be relieved of the permanent stress he feels. In fact the goal of perfection he imposes on himself is due to his low self-esteem. At the end of the second session, the therapist points out that Marc is trying too hard to be perfect which puts a lot of stress on him. A modality profile is produced in which Marc's problems and the agreed interventions are recorded. The treatment will first begin with stress management techniques according to Marc's preference and then rather focus on enhancing Marc's self-esteem.
The range of treatment techniques is wide ; among those which the therapist may apply to Marc's case, he might chose the following to address the various modalities of Marc's BASIC ID.
Table 3. Marc's treatment
--------------- Table begin ----------------
Behavior Psychodrama (what would happen if Marc let it go for a while?)
Affect Anxiety management
Sensation Relaxation training, hypnosis, meditation, massage
Imagery Thought stopping imagery, positive imagery
Cognitive Bibliotherapy
, disputing irrational inferiority beliefs
Interpersonal Assertion training, friendship/intimacy training
Drugs/Biology Lifestyle changes, going out, going on vacation, exercise, meet people
=============== Table end ==================
In case of difficulties with one or several modalities, the therapist would perform a second-order BASIC ID assessment to focus on the area in which change is proving difficult.
The multimodal therapist's mottos are flexibility and eclectism. MMT goes in the same direction as the mainstream of current psychotherapy.
October 26, 2003
Multimodal Therapy was invented by Arnold Lazarus. Clients' behavior is a result both of nature and nurture, of affective, cognitive and behavioral components. This is why these open systems require technical eclectism. Multimodal Therapy borrows from other approaches The techniques are borrowed from several systems (mainly behavior therapy, rebt and cognitive therapy) but has several distinctive features which set it apart. Let's take an example of a man, Marc, who suffers from a high level of stress and seeks help from a multimodal therapist
The multimodal approach rests on the BASIC ID system and the use of the Multimodal Life History Inventory. On the first session, the evaluation session, Marc receives a copy of Lazarus' Multimodal Life History Inventory, a 15 pages questionnaire which he will have to complete at home. Here is the contents of the questionnaire:
General Information
Personal and Social History
Description of Presenting Problems
Expectations Regarding Therapy
Modality Analysis of Current Problems
Behaviors
Feelings
Physical Sensations
Images
Thoughts
Interpersonal Relationships
Friendships
Marriage (or a committed relationship)
Sexual Relationships
Other Relationships
Biological Factors
The first letters of the BASIC ID acronym mean Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal, Drugs/Biology and correspond to the subtitles in bold of the table of contents above. These concepts, or modalities, exist in a state of reciprocal transaction and flux: They will allow the therapist to build a profile of therapeutic action which will be the starting point of a multimodal therapy. They are explained in the following table.
Table 1. The BASIC ID acronym
--------------- Table begin ----------------
Modality Questions which may be asked
Behavior What would you like to start or stop doing?
Affect What make you angry or sad?
Sensation What do you like/dislike to hear, taste, etc?
Imagery What do you imagine yourself doing in the near or far future?
Cognition What are your main musts, shoulds, beliefs?
Interpersonal How do you get on with others; do you act passively, etc?
Drugs/Biology Do you take medication? Do you smoke? How is your health?
=============== Table end ==================
Marc completes this task for the following session. The therapist and Marc review in detail the answers to the LHI questionnaire. They discuss which specific problems are most salient. The therapist also asks Marc what he would like to do first, what approach he would like the therapist to take. The therapist carefully assesses the ordering of the chain reaction of the various modalities (tracking). He adapts his approach to the needs of the client, starting first with what the client feels he needs then bridging with what the therapist thinks the client needs.
Here are the answer Marc gave to BASIC ID questions:
Table 2. Marc's BASIC ID Modalities
--------------- Table begin ----------------
Behavior Strict and rigid. He always wants to do what is correct or good. Never allows himself any unusual or pleasing activity.
Affect Feels guilty when he does not succeed in reaching his goals of perfection.
Sensation Physically tense with episodes of feeling exhausted
Imagery Images of failing
Cognition Beliefs of low self-esteem. He must not do anything wrong or bad. He must gain other people's respect.
Interpersonal He never allows himself any recreational pastimes. At the same time, refrains from asking anything from people, very limited relationships with people.
Drugs/Biology Headaches. High blood pressure. No alcohol, no smoking
=============== Table end ==================
Regarding Marc expectations from the therapy, he seeks to be relieved of the permanent stress he feels. In fact the goal of perfection he imposes on himself is due to his low self-esteem. At the end of the second session, the therapist points out that Marc is trying too hard to be perfect which puts a lot of stress on him. A modality profile is produced in which Marc's problems and the agreed interventions are recorded. The treatment will first begin with stress management techniques according to Marc's preference and then rather focus on enhancing Marc's self-esteem.
The range of treatment techniques is wide ; among those which the therapist may apply to Marc's case, he might chose the following to address the various modalities of Marc's BASIC ID.
Table 3. Marc's treatment
--------------- Table begin ----------------
Behavior Psychodrama (what would happen if Marc let it go for a while?)
Affect Anxiety management
Sensation Relaxation training, hypnosis, meditation, massage
Imagery Thought stopping imagery, positive imagery
Cognitive Bibliotherapy
, disputing irrational inferiority beliefs
Interpersonal Assertion training, friendship/intimacy training
Drugs/Biology Lifestyle changes, going out, going on vacation, exercise, meet people
=============== Table end ==================
In case of difficulties with one or several modalities, the therapist would perform a second-order BASIC ID assessment to focus on the area in which change is proving difficult.
The multimodal therapist's mottos are flexibility and eclectism. MMT goes in the same direction as the mainstream of current psychotherapy.
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