Psychotherapy is currently burdened with fragmentation of models, theories, and interventions. Psychotherapy requires an integrative framework rooted in the expanding sciences of developmental psychology, neurobiology, medicine, and medical illness.

The future of our field rests largely on the integration of multiple disciplines into a poly-theoretical approach to human suffering. With the multitude of current brands of therapeutic approaches, I would like to see more melding of ideas and interventions, particularly those that prove to work. This would require thought leaders to work together more collaboratively. John Gottman once said, and I agree with him, that the field of psychology must now keep up with, and even collaborate with, the hard sciences. A single psychological theory alone, I’m paraphrasing him here, is no longer sufficient for understanding and treating human mental health problems.

Psychotherapists (and remember, I am one) have long been reputed to be slow to change, preferring instead to cling to tools and methodologies that may be as archaic as the buggywhip. For instance, not that long ago, many therapists would resist using an answering machine over a service, an electronic organizer over a paper one, a computer over a pad of paper, an online scheduler over a paper calendar. I struggle today to get even my advanced students to incorporate video recording and playback as part of their practice with couples. John Gottman was seminal in waking psychotherapists up to the fact that many of our precious techniques had little or no effect on therapeutic change. We didn’t want to know the truth or be critiqued by those outside of our clinical walls. That has all been changing as the last few decades have seen consideral shifts in psychoanalysis, behavioral medicine, and cognitive science as affective neuroscience, infant attachment, arousal regulation theory, and the science of somatics are showing their influences on these institutions. Several catalysts may be credited with such a shift, such as Antonio Demasio, Jack Panksepp, Robert Sapolsky, Allan Schore, and Stephen Porges, to name just a small few.

In my own experience as developer of a psychobiological approach to couple therapy (PACT), I have been able to speak to many professional organizations that, perhaps only a short time ago, would have taken no interest in my work. Doors are opening. Despite the new integration movement, there are many challenges. The field of psychotherapy is still not like the sciences. It remains stuck in the past, in a tribal-like, commercialized product-oriented marketeering of ideas that strive to survive the ever onslaught of newly minted psychotherapy approaches that largely re-invent the wheel, but just call it something else. I would like to see us become the scientists we already are by coming together a bit more; advance our field by learning from each other instead of remaining siloed in our own approaches. Perhaps think-tanks could emerge as a way to consolidate theories, methodologies, techniques, and interventions. So many of our theories and approaches could benefit from regular updates and revisions and even become more centralized so as to benefit the field as a whole and to turn out better trained clinicians. Of course, this is easy to say and extremely difficult to accomplish. Still, it starts with a wish, a dream, of making psychotherapy the science it can and will be.

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