Toward an Integral Treatment Methodology for Schizophrenia: Part Four

The Integral Model

The Integral approach organizes and resolves the competing truth claims declared by various therapeutic schools. “Integral theory distinguishes itself by its ability to successfully situate and systematize the full range of therapeutic approaches within a coherent and organized set of mapping principles.”25 The Integral framework offers more than a piecemeal approach of diverse therapeutic theories and techniques. It comprehensively arranges these schools in a manner that proves useful to practitioners who are seeking a more inclusive vision in terms of theory, assessment, and treatment.26 Integral proposes utilizing techniques and procedures from the full range of psychotherapeutic orientations, while at the same time including an informed theoretical sense of how, why, and when to apply them.27

Integral theory is comprised of many elements. The five main elements include: quadrants, levels, lines, states, and types. By considering these elements of each client’s experience, one is able to develop an Integral treatment approach that is balanced, comprehensive, inclusive, and as unique as the individual it is serving. The quadrants represent four of the most important dimensions of reality and experience. These dimensions of reality are the interior and exterior aspects of the individual and the collective. These quadrants, among other things, generate first-, second-, and third-person perspectives that one finds in all major human languages, across all cultures. These pronouns represent real dimensions of reality and experience.28

The Upper-Left quadrant is known as the Interior-Individual. The Upper-Left quadrant includes the interior self, self-identity, introspection, intentionality, and subjectivity. In this quadrant, the integrally informed therapist investigates the client’s interior phenomenology, including both conscious aspects (as captured by the pronoun “I”) and unconscious (shadow) aspects.

The Lower-Left quadrant is known as the Interior-Collective. This quadrant is called “cultural” and includes our intersubjective mutual understanding, culture, morality, communication, value systems, and justness.29 The Lower-Left quadrant also includes aspects captured by the pronoun “You/We”. Here the integrally informed therapist looks at the clients relationships, the most important being to family, significant other, and the client’s boss.

The Upper-Right quadrant, or the Exterior-Individual, consists of the objective dimensions of experience and reality. The Upper-Right quadrant focuses on the behavioral, observable, and exterior aspects of human experience. This quadrant looks at the exterior descriptions of how objects appear from the outside in an empirical fashion and includes the aspects captured by the pronoun “It”. In this quadrant, the integrally informed therapist investigates the clients behaviors and health.

The Lower-Right quadrant, or the Exterior-Collective, represents society and systems in which individuals are embedded. The Lower-Right quadrant (“Its”) is called “social” and refers to “any objective, concrete, material components, and especially the techno-economic base of that society.”30 Individuals are shaped by the communities, towns, and states that they live in, as well as the media, government, and educational institutions in which they are rooted. Here the integrally informed therapist looks at the systems that the client is involved in, from the family to education to judicial.

The quadrants (“I,” “We,” “It,” and “Its”) are a simple way to keep track of the four major dimensions of reality and experience. “These quadrants are not only embedded in all major languages—and are therefore already present and fully operating in both you and I—but dimensions of reality that have been intensely investigated by literally hundreds of major paradigms, practices, methodologies, and modes of inquiry.”31 These quadrants are most simply summarized as self (“I”), culture (“We”) and nature (“It,” “Its”). So an Integral approach looks at the client’s mind, body, and spirit embedded in self, culture, and nature.

The quadrants do not exist as isolated pieces of the individual. All four aspects arise simultaneously. The quadrants tetra-arise, creating a four-quadrant affair in every moment— an interconnected happening of biological, psychological, cultural, and social aspects.

The treatment of schizophrenia is often reduced to one or two quadrants, usually consisting of psychopharmacology, the Upper Right and cognitive therapy, the Upper Left. If treatment only consists of one or two dimensions of the client’s experience, then only part of the client is truly being treated. This may account for the difficulty in treating schizophrenia over the past centuries. Figure 2 represents the various psychological interventions and therapies available to the Integral therapist from the major schools of psychology.

An Integral treatment approach provides a framework that is inclusive enough to contain various therapeutic modalities from all major competing schools of psychology. The Integral approach appreciates the various perspectives that each school of psychology adds to the overall treatment plan in order to fully assist the client along his healing journey. An Integral approach acknowledges the strengths of the various types of therapeutic interventions. Integral Treatment can be seen as an inclusive, strengths based, deficit building, meta-theory. By applying Integral theory to the treatment of schizophrenia, the therapist is able to see and understand more of, and therefore treat more of, the client’s reality.

- Kelly Sosan Bearer