Therapy that Works - Why a Unifying Framework?

Therapy is Probably why You are Visiting this Site

With one billion people diagnosed with a mental health disorder, the world faces an unprecedented crisis, and in part, the field of mental health has unintentionally contributed to this crisis through fragmentation of approaches and theories. Furthermore, the field's standard treatment guidelines and ability to address physiological correlates of mental health symptoms are decades behind the research. Therapy that Works offers a twofold solution: first -provide a unifying framework to synthesize theories, knowledge, and research to empower therapists, and second - empower individuals to improve their mental health by mastering the five pillars of wellness by harnessing the power or micro-habits to bypass the stress response and challenge our inner critic. 

"Instead of juggling 500 theories and thousands of research journals, I propose a unifying framework...Its guiding principle is simple:

DO WHAT WORKS."

Why a Unifying Framework? 

Few jobs demand greater wisdom and skill than being a family therapist, and thus it makes sense that one benefits from having as much knowledge and research as possible. This is the foundation of integrative and cross-theoretical frameworks. In fact, for decades, family therapists have been quietly moving away from relying on one theory in favor of using more than one in their daily practice (Lebow, 1997). In a recent Delphi study, 56 psychotherapy experts were asked which therapies were most likely to grow in popularity in the coming decade, and integrative therapies rose to the top while classic theory-specific theories filled the bottom rankings (Norcross et al., 2022). This does not mean that therapy theory has no value - but today’s practitioners need frameworks that distill and synthesize the incredible wealth of knowledge in the counseling field in an integrative, streamlined and user-friendly way (Gehart, 2021d). 

Therapy that Works does not seek an explanation for why people do what they do but rather provides client and therapist with a roadmap for what to do - both in session and beyond. It provides both client and therapist a clear picture of client concerns - one that encompasses a full spectrum of being human, not just the emotional parts, and provides a foundation of wellness so that when challenges arise, individuals can quiet the inner voice of self-criticism to empower resilience and creative solutions.

What is Therapy that Works?

It is a framework evolved from decades of writing textbooks in which I approached researching each theory from a stance of appreciative inquiry, a collaborative, postmodern approach to organizational consultation and change (Coopperrider & Whitney, 2005). The Therapy that Works Unifying Framework is a real-world system for doing therapy, based in the principles of second wave integration. While the first wave of integration tended toward creating new, coherent theory from 2 or more pure forms of theory, the second wave of integration - and the one which informs the Therapy that Works framework, is truly integrative in nature.

This framework is characterized by unification of concepts and is transdiagnostic and grounded in the principles of change (Anchin et al., 2024). The result is a scientifically anchored, meta-theoretical scaffold that is sufficiently broad enough to form a coherent framework focused on person viewing rather than on theory or modality viewing, providing a full spectrum understanding from micro- to macro-levels that include biological, psychological, sociocultural factors - with an understanding that intervention on one level affects other levels. The value is in personalized evidence-based treatment that is naturally responsive, adapts to client and their needs, works from within client worldview, and aligns intervention with client/problem (Anchin et al., 2024; Boswell et al., 2019; Castonguay & Beutler, 2006).

Importantly, the integrative approach is excellent with diverse clients because it naturally encourages more options for adapting to their unique worldview. it considers cultural development and identity, and responds to social structures, values, and current events as well as integrates spirituality and indigenous healing traditions (Anchin et al., 2024; Harris et al., 2019; Prochaska & Norcross, 2018).

Who Can Benefit from This Framework?

The answer is almost everyone. In this approach, the exact same assessment process can be used for:

• Intrapsychic Symptoms: Depression, anxiety, trauma symptoms, unwanted behaviors, craving substances, uncontrollable behaviors, and most other psychiatric symptoms
• Interpersonal Conflict and Tension: Conflict and distance within couples, families, coworkers, organization, and any group of people.
• Solutions and Desired New Behaviors and Identities: The same four levels are used to help reinforce positive changes made.

How is it Different from Other Types of Therapy? 

Therapy that Works Unifying Framework is a synthesis approach, distilling or boiling down the essence of the broad consensus in the research of “what works” across the 50 major psychotherapy and family therapy approaches. Grounded in postmodern epistemology, this approach works from within the client’s worldview to understand problems across a 4-level systemic framework that includes behavior, emotions, cognition/identity, and societal contexts and includes the 4-level conceptualization of the solution/wellness which works to strengthen gains at all these same levels. The framework draws from positive psychology and research, the result of which is an overarching wellness focus for both client and clinicians. 

What does this mean for therapists?

This framework relieves the therapist of the burden to “translate” theory during session by providing a framework and simple, stream-lined method that a therapist can use to structure their thinking during a session. As much as possible, the framework uses neutral or non-theory specific language so that no matter which theoretical orientation a therapist gravitates toward, this framework is not only applicable but also enables them to draw from multiple theories at once, filling in the “gaps” and “holes” that are inherent in any single theory using a positive spirit of curiosity about what is working and appreciating the strengths of a given system. 

What does this mean for clients?

Unlike most approaches, this framework uses an equally well-developed approach for solidifying gains made in therapy and focusing growth on areas of life that researchers have repeatedly identified as essential for long-term emotional-mental wellness - which I call the five pillars of wellness (Gehart, 2021d). Why? Relapse rates in mental health are notoriously high (Lebow & Jenkins, 2018). Using the 4-level conceptualization of the solution/wellness allows the therapist to help clients strengthen gains using micro-goals that are readily achieved with micro-steps that lead to small “wins”. This creates surprising momentum and positive inner dialogue. With changes requiring less than 5 minutes per day, those using this approach report having lost weight, reduced drinking, repaired relationships, established meditation practices, improve their sleep routine, balanced personal budgets, paid of debt, strengthened friendships, implemented marketing initiatives, and written books. 

The Framework

The six main components of the Therapy that Works Unifying Framework includes:

1.   Self-of-the-Clinician
2.   Collaborative Connecting
3.   4-Level Conceptualization of the Problem
4.   Evidence-informed Treatment Planning
5.   Evidence-informed Intervention
6.   4-Level Conceptualization of the Solution/Wellness

The first element, self-of-the-clinician refers to the therapist creating an ongoing, personal process that enables them to engage in clinical work effectively and also includes practices to help reduce personal bias. More intricate than traditional therapeutic alliance building, collaborative connecting refers to a process in which the therapist “enters” the client’s meaning-making system so that all change can be made within the client’s meaning-making system rather than that of the therapist. At the core of the framework is the 4-level conceptualization, which can also be called a 4-level “assessment,” which allows the therapist and client to develop a much more intimate and nuanced understanding of the problem so the client can understand their situation in new ways that make the next step or thing to try obvious, with the “intervention” seeming to effortlessly spill out of the conversation. Collaboratively, the therapist and client take what is learned and determine whether what approaches and interventions fit within the client’s system of making meaning, a form of personalizing therapy that is advocated for meeting the needs of our increasingly diverse societies (Norcross & Cooper, 2021).  

Want to Know More?

Want to know more about Therapy that Works? You can watch my TED talk here: Mental Health Unmasked: Unveiling the Secrets to Sustained Sanity | Diane Gehart | TEDxQueensU - YouTube

Looking to know more or to train in Therapy that Works? Visit the Therapy that Works Institute to find Online Continuing Education for Therapists. Join the course waiting list and save: Therapy that Works Unifying Framework

Looking for a therapist certified in Therapy that Works? Find a therapist here