My Review: Mark Forman - A Guide to Integral Psychotherapy: Complexity, Integration, and Spirituality in Practice

I was very fortunate to get to read a copy of Mark Forman's A Guide to Integral Psychotherapy: Complexity, Integration, and Spirituality in Practice (Suny Series in Integral Theory - the series is edited by Sean Esbjorn-Hargens) in a review copy, well before its April 8, 2010 publication date.

Mark D. Forman, Ph.D., is a graduate of John F. Kennedy University in the Bay Area, one of the few places to offer an integrally informed program. He provides "therapy both for individual adults clients as well as boys (6-18) and their families." He also is an organizer of the biannual Integral Theory Conference hosted by JFKU and co-sponsored by Ken Wilber's Integral Institute.

A quick look at the cover blurbs will give you a sense of the significance of this book (the first psychology book, I believe, in the Integral Theory series from SUNY):

"Integral Theory offers a remarkably comprehensive conceptual framework, and this book offers a view of psychotherapy through its encompassing lens." ---- Roger Walsh, MD, author of Essential Spirituality: The Seven Central Practices to Awaken Heart and Mind

"Mark Forman has made an important contribution to the entire field of psychotherapy with this book, which is delicately balanced with theory and research, and always with direct clinical implications. Highly recommended for any mental health professional." ---- Andre Marquis, author of The Integral Intake: A Guide to Comprehensive Idiographic Assessment in Integral Psychotherapy

"The first full application of Integral Theory to psychotherapy by a practicing clinician, this is a pioneering and very good book on Integral Psychotherapy." ---- Michael Washburn, author of Embodied Spirituality in a Sacred World

That's some pretty high praise from some big names - all three authors are highly recognized and respected in the integral world.

Mark begins with the basic introduction to integral psychology that is required with a book of this nature. Although more and more people are getting exposed to the model (and a book such as this is crucial in bringing these ideas to a wider audience that might be turned off by or simply unaware of Ken Wilber and his work), there is still a need to introduce people to the basic ideas.

What sets this book apart from others I have seen (there are other books attempting to offer an integral model) is that Forman cites a wide range of sources whose work, while not necessarily part of the integral model, supports elements of the model that have not otherwise been included in other integral psychology books. This is crucial - if we want this model to be taken seriously, we need to provide empirical support for the central ideas that Mark offers in his book.

I'm going to do something here I don't normally do in reviews and that is to offer up the table of contents as a simple list.

Chapter 1 Integral Theory and the Principles of Integral Psychotherapy
Chapter 2 Psychotherapy as a Four-Quadrant Affair
Chapter 3 Drives and the Unconscious from an Integral Perspective
Chapter 4 Dynamic and Incorporative Development
Chapter 5 Lines of Development in Practice: Cognition, Self-System, and Maturity
Chapter 6 Prepersonal Identity Development
Chapter 7 Early and Mid-Personal Identity Development
Chapter 8 Late Personal and Transpersonal Identity Development
Chapter 9 Interventions for the Prepersonal and Early Personal Stages
Chapter 10 Interventions for the Mid-Personal, Late Personal, and Transpersonal Stages
Chapter 11 Spirituality in Integral Psychotherapy
Chapter 12 Gender and Typology in Integral Psychotherapy
Chapter 13 Diversity in Integral Psychotherapy
Chapter 14 The Development of the Integral Psychotherapist

Mark offers the reader the whole model, what is called AQAL in the Ken Wilber version of integral theory. AQAL stands for all quadrants, all levels, all lines, all states, and all
types. Here is an image from the text that simply explains the quadrants (p. 13):

Readers of this blog will be familiar with many of the other basic concepts, but for those who are not, a brief quote from the text might be useful:

To make this somewhat clearer, and without getting too far ahead of ourselves, the basic gist of Integral philosophy is as follows:

• What is real and important depends on one’s perspective.
• Everyone is at least partially right about what they argue is real and important.
• By bringing together these partial perspectives, we can construct a more complete and useful set of truths.
• A person’s perspective depends on five central things:

■ The way the person gains knowledge (the person’s primary perspective, tools, or discipline);
■ The person’s level of identity development;
■ The person’s level of development in other key domains or “lines”;
■ The person’s particular state at any given time; and,
■ The person’s personality style or “type” (including cultural and gender style). (p. 11)

This is the basic integral model, and to many working therapists this probably sounds like the biopsychosocial model that has been gaining traction in the psychotherapy and research worlds. This approach is also known by some as the eclectic model.

Here is a summary of the basic biopsychosocial concept (which is not really a new idea, but has been slow to be adopted):

The emergence of the bio-psychosocial model is described as a progressive reaction to the bio-reductionism of traditional psychiatry. Though formally announced by the physician and psycho-analyst George Engel in 1977, the roots of the model can be traced, via the inter-disciplinary project of social psychiatry, to a range of theoretical influences in psychiatry, biology and sociology. The advantages the model offers to practitioners and researchers are outlined but its limits are also explored by drawing upon some philosophical principles of critical realism. It is concluded that the biopsychosocial model has not fulfilled its potential because of its uncritical silence about professionally-codified knowledge and a range of professional, social and economic interests. (Pilgrim, Kinderman, & Tai, 2008)

This also is the central premise of integral psychology, except that Mark's explanation and conception of integral psychology is more comprehensive. Allow me to explain.

While the eclectic model is willing to use more than one therapeutic approach (to be fair, most therapists are eclectic, aside from maybe Psychoanalysts), and the biopsychosocial model looks at more than one form of manifestation and/or etiology, the integral model takes both of these approaches and adds much more.

For example:

When a client presents with generalized anxiety, an integral psychotherapist will consider the physical aspect (brain chemistry, physiology, nutrition, and so on), the psychological (emotional issues, stress, stage of life, and so on), the cultural (interpersonal issues, family dynamics, and other issues), and the social (economic crisis, job loss, housing crash, political turmoil, and so on) - as well as the developmental stage of the client, his or her ego integrity, the personal worldview, attachment style, gender issues, personality type, and so on.

In addition, the therapist will look at cognitive tools in the client, adaptive strategies, relationship status, interpersonal skills, and anything else that might offer insight or explanation, including religious and spiritual beliefs or practices.

The approach to treatment will be equally diverse, depending on the findings from the intake evaluation. Chapters 6-10 present the various developmental stages and their pathologies, which provide the therapist with a basic template to fit treatment with developmental dysfunctions. For example, psychoanalytic approaches work better for early stage dysfunctions, cognitive therapies work better for middle stage issues, and the transpersonal approaches are better suited to existential and spiritual issues in development.

To his credit, in my opinion, Mark relies less on Wilber's developmental stages and more on a combination/blending of Robert Kegan and Susan Cook-Greuter - and to be fair, Cook-Greuter is simply reworking the original and ground-breaking work of Jane Loevinger. While Jenny Wade is mentioned, I would have liked to also see her work and that of Michael Washburn (a Jungian) included, even though neither are as well regarded as the other three people.

One other note, and my only serious criticism, is that Wilber and the other integral psychologists have tended to leave out the whole field of cultural psychology as created by Lev Vygotsky, Jerome Bruner, and Ciaran Benson (his Cultural Psychology of the Self should be required reading for all psych students), among others. In these models, self is less of a structural property than it is a socially constructed object, and in some models we are not confined to a single "self" but, rather, experience multiple "I-positions," which are equivalent in some ways to subpersonalities (an issue Mark and Wilber do address in their models).

Essentially, however, the integral model is a structuralist model and the cultural psychology people offer a constructivist model - there has been very little cross-pollination between these two approaches, unfortunately.

If you are a therapist seeking the most comprehensive model of understanding and treating your patients, than Mark Forman's A Guide to Integral Psychotherapy: Complexity, Integration, and Spirituality in Practice is the book you need.


Reference:
Pilgrim, D., Kinderman, P., & Tai, S. (July 2008). Taking stock of the biopsychosocial model in the field of 'mental health care'. Journal of Social and Psychological Sciences, 1, 2. p.1 (38). Retrieved March 28, 2010, from Academic OneFile via Gale: http://find.galegroup.com/gtx/start.do?prodId=AONE&userGroupName=apollo

Tags: Psychology, books, Integral, therapy, Review, Mark Forman, A Guide to Integral Psychotherapy, Complexity, Integration, Spirituality, Practice, integral psychotherapy, biopsychosocial, eclectic model, cultural psychology, AQAL, stages, lines, types, quadrants, structuralism, constructivist