Toward an Integral Treatment Methodology for Schizophrenia: Part Six

Lines of Development

People have different lines of development: cognitive, emotional, moral, artistic, etc. Individuals tend to do really well in some areas of their life, such as musical and cognitive abilities, but perform poorly in other areas, like morality or interpersonal relationships. This is due to their varying lines of development. These lines “unfold in progressive ways.”38 All these lines have the capacity to grow through stages of development. The therapist is able to discern where the client excels and what aspects of the individual need more growth and development. As part of the assessment process, the therapist is able to tailor a treatment plan that uses both the client’s strengths (strengths based) and weaknesses (deficits based) to better serve the client. Most treatment plans tend to focus on either the clients strengths (biopsychosocial model) or the clients deficits (medical model). The Integral approach allows for the therapist to use both the client’s strengths and weaknesses, while developing the treatment plan.

Many clients with schizophrenia have difficulty with treatment compliance. By including both strengths and deficits in treatment, the client may have a greater chance of actually complying with the treatment plan. Clients are not compliant out of a deviant stance. Clients tend not to comply when they don’t possess the necessary skills to carry it out. The Integral model offers the therapist a tool to actually assess the clients various lines of development. Figure 3, Appendix C, represents the Integral “psychograph”.

The client’s level of development and the therapeutic relationship are also important for treatment compliance. The therapeutic alliance, or the “we” space between the client and the therapist can be a large factor in determining treatment compliance. The therapist needs to be able to resonate at the same developmental level as the client. The integrally informed therapist words language to meet the client where he is at, so as not to talk above or below the client’s level of understanding. Different levels of development provide different skills and abilities. A lot of treatment compliance is determined by the meaning and value the client sees in treatment. The integrally informed therapist discusses this with the client in value language that the individual will relate to and be motivated by.

The psychograph is an easy way to visually represent these multiple lines of development. Through the stages of development (prepersonal, personal, transpersonal) the lines of development unfold. In figure 3, we see someone who excels in artistic and cognitive intelligences, but who is less developed morally, kinesthetically and emotionally. Each client will invariably have a very different psychograph.

The psychograph helps to locate where the client’s deepest gifts are and where they need help in their overall development. It helps to spot ways in which the client is unevenly developed. For the client, this will mean that the treatment plan not only focuses on the client’s strengths and gifts, but also those specific lines that are weak and causing issues in their everyday life.

Types

The fifth element of Integral Theory is types. This paper focuses on types in the Upper-Left quadrant. Everyone has a personality style. Some of these different styles or types can be seen along a continuum of polarities. For instance, masculine/feminine, thinking/feeling, active/passive, judging/perceiving, sensing/intuiting, extrovert/introvert, etc. Types are most often assessed using a personality inventory such as the Myers-Briggs or the Enneagram.

For example, a person with schizophrenia who is also an introvert may not be able to discuss his internal phenomena as easily as one who is an extrovert. The client who is more masculine in type, may have a more difficult time seeking help, versus the more feminine client who may present as overly dependent. The feminine type client may have difficulty with a treatment plan that emphasizes autonomy as the feminine type is known to thrive in communion with others. This client will fare better in group therapy, whereas the client with a masculine type may be overwhelmed participating in a large group.

An integrally informed therapist might choose to include a types assessment in treatment. The therapist takes everything into account, but may not treat all of the elements in the AQAL matrix. The therapist may choose to treat only one or two quadrants, but taking all elements into account when deciding that.

- Kelly Sosan Bearer