Although dealing exclusively with one dimension of the patient can help to improve him/her, most psychologists argue that people’s aspects are hardly kept isolated from each other.

Having family problems may affect both the physical health and the emotions of the individual, which means that if the latter two are ignored, not much is actually being achieved to increase their well-being.

Arnold A. Lazarus’ multimodal therapy tries to address up to seven dimensions of the person, see how they interact with each other and initiate a treatment that tries to improve them all as a whole. Let’s take a closer look at what this is all about.

What is multimodal therapy?

Multimodal therapy, developed by Arnold Lazarus, is a type of treatment that forms part of the cognitive-behavioral approach , although it also draws on other psychological approaches and opts for an eclectic type of intervention.

According to this model, the human being is a biological organism, that is, influenced by chemical processes, which at the same time has a whole cognitive and behavioral world, manifested in the form of thoughts, feelings, actions, imagination and interactions with other people.

Given the complexity of each human being, Lazarus maintains that, in the context of therapy, the intervention should not be focused on only one aspect of the person . It is necessary to ensure that all the components of the person, understood in the form of modalities, work together effectively, given that if one of them is altered, it can have a negative impact on the others.

For example, if the person has a pessimistic thinking style, it is logical to think that he will not only see the glass as half empty. He will also imagine that bad things will happen, he will be living in constant stress and worry, which will show up in the form of physical pains and even the consumption of certain substances. Based on this, and according to multimodal therapy, most psychological problems present themselves as both a cause and a consequence of various aspects being negatively affected.

Given that psychological problems are multifaceted and multicausal , Lazarus proposes the following seven modalities, whose acronyms make up the word BASIC I.D., which allow us to understand the type of problem affecting the individual and his particular type of dysfunction.

  • Behavior.
  • Affect.
  • Sensation.
  • Imagination.
  • Cognition.
  • Interpersonal Relationships
  • Biological processes/Drugs

Since most therapeutic intervention that addresses biological imbalances involves the use of drugs, the acronym for the BASIC I.D. model, D is taken to stand for Drugs.

Strengths and Criticisms

The main point in favour of this model, and which highlights it above other models that are also multicomponent but more limited, is that does not limit itself to addressing the three main classical variables, which are the patient’s emotions, behaviour and associated thoughts . These three variables are the flagship of Ellis’ ABC model, the letters being the initials of affect, behavior and cognition.

Although Ellis’s model is interesting and has been shown to be useful in therapy, it has the disadvantage of leaving out or addressing, but far beyond, aspects such as sensations, the patient’s imagination, his interpersonal relationships… In addition, ignores the biological aspects of the individual , which, although they do not explain all his behaviour, help to understand it better.

Theoretical Foundations

Multimodal therapy draws on the principles and procedures of experimental psychology and also Albert Bandura’s theory of social learning. Within this theory it is held that behaviors, whether healthy or pathological, are created, maintained and modified through the action of environmental events. That is to say, the stimuli external to the person and coming from the environment, especially the social environment, influence his behavior.

The first behavioural theories were based on animal models , the clearest case being behavioural theories. This type of approach gave an explanation of animal behaviour in a somewhat mechanical way, based mainly on the principle of stimulus-response, but without going into detail about how the animal felt when faced with a certain event. Since they could not be introduced into the animal’s mind, it would be difficult to extrapolate its behaviour to human behaviour beyond that which was directly observable.

From the most skinnerian behaviourism we have evolved to the theories of cognitive-behavioural approach , in which the cognitive aspects of the person are taken into account, which can be determined by external events. This cognition may manifest itself in the form of behaviours that have an impact on the person’s social sphere and closest environment. Multimodal therapy takes into account this constant reciprocity between personal actions and environmental consequences.

Application of multimodal therapy

As we have seen, while most current therapies do not focus on a single aspect of the person, most of them are limited to addressing the person’s state in a tri-modal way: cognition, emotion and behavior. In the multimodal model, seven modalities are analyzed, which allow a deeper approach to the reality of the individual, the characteristics of his problem and how it affects other dimensions of the person.

In multimodal therapy, the idea that human beings are biological organisms is never forgotten, that is, biochemical and neuropsychological entities that behave (act and react), feel emotions, sensations, imagine, think (have opinions, values, attitudes, beliefs) and interact with other people.

Although the model defends the idea that all the aspects that make up a person should be taken into account, it does highlight that two aspects should have a certain priority: the more biological aspects and the interpersonal relations .

The biological processes of the patient must be taken into account first of all because, in case his problem is due to some kind of drug intoxication, brain injury or genetic problem, it will be necessary to direct the therapy in another way, and under the tutelage of a psychiatrist or a doctor. There are many cases of people who, after suffering a brain injury, have shown a significant change in their behaviour and personality, the best known case being that of Phineas Gage.

As far as interpersonal relationships are concerned, it is very important to know how the network of family and friends involving the individual is working, since, if it is somewhat dysfunctional, it will hinder recovery. Toxic family dynamics may be the origin of the patient’s discomfort , and if this is the case, the therapy should focus on working on strategies to improve these same dynamics or finding ways to deal with them.

Especially during the first session, the psychotherapist should ask several questions touching on each of the seven modalities , to make sure which are the most damaged aspects in the patient’s life, and how these interact with or are a cause or consequence of the main problem. Some questions that can be asked, ordered by each of the modalities, are as follows.

1. Conduct

What is the individual doing that contributes to his happiness? What causes him to end up hurting himself? Self-defensive actions, maladaptive behaviors? What should the patient stop doing?…

2. Affection

What emotions does the patient express? Is he anxious, depressed, angry… or a combination of different negative emotions? What makes him feel this way? How does he respond when he feels this way?

3. Sensations

Do you complain of any sensory deficit or discomfort (chronic pain, trembling, sensation of needles in the body…)? What positive sensations do you feel? What emotions are associated with these body sensations, both bad and good?

4. Imagination

What fantasies and images are predominantly shown in your mind? Are they positive or negative? Do they represent the patient’s self-concept? Do you visualize flashbacks, have nightmares, catastrophic thinking…?

5. Cognition

What are their main attitudes, beliefs, values, opinions… Are they dysfunctional ideas?

6. Interpersonal relationships

Who are the most important people in the patient’s life? What do you expect from others? Which relationships are beneficial and which are detrimental to your mental health?

7. Biology and drug use

Is the patient physically healthy? does he or she have medical complaints? does he or she consume any substances? does he or she play sports? what kind of diet does he or she have? is he or she over or underweight?

Tools to use it

There are two main questionnaires used by multimodal therapists.

1. The Multimodal Life History Inventory

The Multimodal Life History Inventory (Lazarus and Lazarus, 1991, 1998) is a 15-page questionnaire that helps to guide treatment, provided the patient completes it . It is usually administered during the first session.

It helps to obtain detailed information about the individual, which makes it possible to specify the typology of his or her main problem and what aspect of it has a negative impact on the other dimensions of the person.

2. The Structural Profile Inventory

Another useful tool in multimodal therapy is the Structural Profile Inventory (SPI), which consists of a 35-item questionnaire.

It asks questions that reflect essential components of the BASIC I.D. model, allowing us to know the degree of activity, emotionality, concern for sensory stimuli, imagination, cognitive capacity, interpersonal relationships and concerns of biological origin.

RLS is especially useful in couples therapy , where differences in the perception of the problem between the two spouses can generate friction.

Discussing them in consultation and recording them in a more or less objective manner through CPS makes it easier to develop a therapy that contributes to producing a constructive therapeutic context.

Bibliographic references:

  • Lazarus, A.A. (2008). Multimodal Therapy. In R.J. Corsini & D. Wedding (Eds.) Current Psychotherapies (8th ed.) (pp. 368-401). Belmont, CA: Thompson.

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  • Lazarus, A.A. & Lazarus, C.N. (1991). Multimodal Life History Inventory. Champaign, IL: Research Press.
  • Lazarus, A.A. (2008). Technical eclecticism and multimodal therapy. In J.L. Lebow (Ed.) Twenty-First Century Psychotherapies. (pp. 424-452). Hoboken, NJ: Wiley.