The Common Core of Psychotherapy
This blog was co-authored by Marcia Gralha, MA.
Since the birth of modern psychotherapy, therapists have developed various approaches to healing psychological ailments, each with its own language, techniques, and theoretical claims. From Freud’s psychoanalysis to Roger’s person-centered approach to Beck’s cognitive therapy, these paths have emphasized distinct perspectives on how to conceive of and alleviate psychological suffering.
Yet, as the field evolved, a surprising realization emerged: despite their differences, bona fide psychotherapies tend to produce similar outcomes for most problems.
This raises an intriguing question: If these methods are generally equivalent in effectiveness, what is the common thread that ties them together? That is, what are the core processes that make these very different therapies work in a similar way? The evidence suggests that the key to successful therapy lies in shared, fundamental processes rather than in selecting any single “right” approach. Understanding these core processes can help clarify what truly drives positive outcomes across different modalities.
In our recently published article in the Journal of Psychotherapy Integration, The Common Core of Psychotherapy: Bridging Common Factors with Unification to Frame the Center of the Field, we propose a framework that clarifies what lies at the heart of the psychotherapeutic process. Specifically, we outline a metatheory to ground the common factors of psychotherapy.
Our article was part of a special issue dedicated to charting a new vision for unifying the field of psychotherapy — an opportunity for practitioners, theorists, and researchers to address long-standing gaps in the field and clarify common principles that guide effective therapeutic practices. Here is a description of the whole special issue, which is titled Toward a Unified Psychotherapy:
Psychotherapy has never been paradigmatic; that is, it has never had a shared framework that defines its core identity in theory, research, or practice. This special issue of the Journal of Psychotherapy Integration offers a new vision for unifying the field. It includes a series of articles that enable practitioners, theorists, and researchers to (a) specify the “common core” of psychotherapy and ground it in a clear, coherent metatheory; (b) clarify the difference between mechanisms of change and principles of change; © identify the key process elements associated with positive outcomes in psychotherapy; (d) educational systems that effectively map the various techniques in a way that is both integrated and differentiated; (e) home in on the central role that memory reconsolidation plays in transformational outcomes; and (f) provides an example for applying a unified model for working with neurologically diverse individuals. The emerging, unified approach to psychotherapy includes and transcends key insights from the traditional schools of thought, coherently bridges the practice of psychotherapy to the science of human psychology, and shows how we can specify the center of the field and generate cumulative knowledge going forward. As such, it is an exciting hopeful issue emerging at an exciting time for our field.
In this essay, we summarize the key points from the article, showing how UTOK, the Unified Theory of Knowledge, provides a metapsychology that can bridge the gaps between different schools of thought, offering a clearer, more cohesive framework for understanding the core principles and processes of psychotherapy.
The common core is forged by: 1) identifying the key common factors elements, as organized into the Contextual Model by Wampold and colleagues; 2) drawing on key insights from UTOK’s metapsychology for science and practice that can frame the essential elements of the contextual model; and 3) consolidating this bridge to form a clear metatheory of common factors that we call the common core.
Understanding Common Factors
The dodo bird verdict (Luborsky et al., 2002), one of the most relevant findings in psychotherapy research, suggests that no single therapeutic modality consistently outperforms the others in achieving general therapeutic outcomes such as reducing anxiety, depression, or overall distress. Meta-analyses of clinical trials show that, despite differences in technique, most bona fide therapies have similar levels of effectiveness (Wampold & Imel, 2015). This highlights the importance of shared, general factors over specific techniques or theoretical orientations in determining psychotherapy outcomes.
These shared elements, known as common factors, have been described by many in the literature. Early work by Rosenzweig (1936), who first proposed the common factors, and Jerome Frank’s Persuasion and Healing (1961) laid the foundation for understanding psychotherapy as a relational healing process. These include factors like the quality of the therapeutic relationship, the development of a shared understanding of the client’s problems, and the implementation of interventions that promote adaptive living.
The Contextual-Process Model
More recently, Wampold and Imel’s The Great Psychotherapy Debate further advanced the common factors perspective by developing what they termed the Contextual Model. We prefer the label Contextual-Process Model, as it better captures their proposal of both the general social context of psychotherapy and key aspects of therapeutic process that foster healing.
Below is a schematic representation of the Contextual-Process Model, with our labels for the components in black boxes. As outlined, the model includes: 1) a cultural context that legitimizes the healer and the process; 2) three core therapeutic processes that are central to effective change; and 3) an analysis of outcomes that reduce symptoms and improve well-being.
The Need for a Meta-Theory of Common Factors
Although Wampold and Imel (2015) use the term “metatheory” to describe their formulation, we think this is a bit of a misnomer. It is a model not a metatheory. It definitely does not provide a genuine explanatory account of the science of human psychology that can thoroughly ground the practice of psychotherapy. Their framework, while valuable, largely focuses on broad generalizations, such as characterizing humans as a highly social species, and contrasting these with the premises of the medical model in psychotherapy research and practice. However, it does not explain why the common factors are so central to effective therapy, nor does it connect them to the broader principles of psychological science.
This gap exists because both psychology and psychotherapy remain “pre-paradigmatic,” which means they lack a shared big picture conceptual and metatheoretical framework that assimilates and integrates key insights into a coherent whole. In UTOK, this is explicitly labeled the problem of psychotherapy.
This is “the problem of how we bridge research and theory in a way that assimilates and integrates the key insights from the major perspectives to develop the most comprehensive and effective systems of understanding that are up to the task of grounding the work of licensed health service psychologists in a scientifically justifiable frame” (Henriques, 2022, p. 76).
Over the past four decades, the psychotherapy integration movement has sought to bridge gaps between different schools of thought by exploring how key concepts, techniques, and theories from various approaches can complement one another to improve understanding and outcomes in psychotherapy. More recently, UTOK has contributed to this shift, emphasizing unification over integration (Marquis et al., 2021). Unification shifts the focus from connecting different schools of thought to “zooming out” and viewing the paradigms as a whole, identifying their relations and allowing their core meanings to be extracted in a complementary way.
When viewed through a unification perspective, we get to see the entire landscape of psychotherapy as a mountain range. From this vantage point, the mountains are not isolated peaks, but part of a larger, unified, and coherent terrain. This broader view reveals how the different therapeutic approaches form a unified terrain, connected through deep, common processes that drive healing across therapies, and not just through shared techniques or ideas.
This brings us to a crucial point: the common factors approach has been missing a robust explanatory framework grounded in the science of human psychology. Specifically, it lacks a metatheory that can provide an account of the human condition and explain why these factors are essential for successful therapy. Such a frame can be considered by asking the following questions: What crucial elements of the psychotherapeutic process are the different approaches tapping into? Can we identify and explain them with metatheoretical robustness to advance the field? Moreover, can we distinguish these shared core elements from the specific factors that are unique to individual therapies, so we can better understand why certain treatments work better for particular problems?
UTOK as Metatheory for the Contextual-Process Model
Our proposal is to bridge this gap by defining a common core of psychotherapy, grounded in a unified theory of psychology. To make this bridge, we summarize four key points from UTOK that allow us to place the Contextual-Process Model within a larger theoretical system.
UTOK Bridging Point #1: The ToK System provides a Large-Scale Conception of Cultural Context
Regular readers of this blog will know that UTOK’s Tree of Knowledge System traces the evolution of human beings from the simplest forms of matter to our complex cultural institutions. More specifically, it organizes the universe into five ontological layers: 1) Energy-Information; 2) Matter-Object; 3) Life-Organism; 4) Mind-Animal; and 5) Culture-Person. This “new map of Big History” is central for several reasons. First, it carves nature in a way that clearly delineates the Mind-Animal plane of existence. This is crucial for solving the problem of psychology, which in turn is central for framing and resolving the problem of psychotherapy.
However, more specifically relevant for bridging to the Context-Process Model is how UTOK’s ToK frames the Culture-Person plane as being structurally and functionally organized by large scale systems of justification. This insight is part of UTOK’s Justification Systems Theory (JUST). This means that we can readily frame the cultural context of therapy. To do so, we can directly apply the lens of justification systems to the first (blue) box highlighted by the Contextual-Process Model. It enables us to see that human culture is set up to legitimize healing, healers, and patients via a particular logic and understanding.
Consider, for example, there are many cultures that exist today and historically where “psychotherapy” or “psychotherapists” would make no sense at all. This is because the culture’s conception of human nature, suffering, and change processes are completely different than is the case for modern, Westernized folks.
JUST helps us see how a society will contextual the psychotherapist’s role as a legitimate healer, both in the client’s eyes and within the broader culture, is critical to legitimizing the relationship and building trust. This legitimacy, which reflects a shared system of justification, reinforces the therapeutic bond, which is necessary for therapeutic change.
In our article, we make an additional point that UTOK’s metamodern sensibility allows us to frame the evolution of Culture via four basic phases (in the history of the West): 1) oral-indigenous; 2) traditional; 3) modern; and 4) postmodern. This is another helpful angle, in that it enables us to situation the tensions that psychotherapy has as a discipline in the current context between the modernist, empirical assumptions about truth, and postmodern critiques about power, language, and the social construction of reality. With the societal context of trust and expertise framed by UTOK’s ToK and JUST, we can now shift into the three core process elements of the therapeutic relationship identified by the Contextual-Process Model.
UTOK Bridging Point #2: Relational Value in the Context of JII Dynamics
UTOK’s Unified Theory of Psychology gives is a metatheoretical framework that integrates three core aspects of human psychology: i) behavioral investments (how we allocate resources and work effort); ii)social influence patterns (how we navigate relationships and social emotions); and iii) dynamics of justification (how we legitimize our beliefs and values). This is summarized as the “JII dynamic” framework, which classifies human persons as: (a) goal-driven animals engaged in behavioral investments to achieve desired outcomes via Behavioral Investment Theory, (b) social primates navigating influence and value dynamics in relationships via the Influence Matrix, and (c) socialized persons using justifications to legitimize beliefs and coordinate actions within cultural systems via JUST.
These metatheoretical structures allow us to integrate key insights from psychological science into a unified understanding of human functioning. By using the JII dynamic framework, therapists can better understand how individuals navigate the dynamics of justification, investment, and influence, deepening their grasp of both client behavior and broader human psychology. This creates a theoretically sophisticated folk psychology grounded in scientific principles.
While JII Dynamics provide us a general frame for understand the relational dynamics, we can get a richer understanding of why exactly the therapeutic relationship is so important by focusing on the central line highlighted by UTOK’s Influence Matrix. The “RV-SI Line” on the Influence Matrix posits that humans are motivated toward achieving social influence (the ability to move others toward one’s interests) and relational value (the degree to which one is seen, known, and valued by others).
The summary point is that we can apply the JII Dynamic lens to generate a metatheoretical perspective for understanding the role of the quality of the therapeutic relationship in treatment outcomes. The most general observation is that human beings have a need for relational value and social influence, and a therapeutic context will require a certain amount of liking and respect, such that some intimacy is achieved, and sensitive emotional issues can be expressed with a feeling of safety. This provides us a strong metatheoretical framework for the first domain of the Contextual-Process Model, the quality of the therapeutic relationship.
In addition, the JII Dynamic frame allows us to explore the development of the therapeutic relationship over time and zoom in on the specifics of how patients and therapists are determining what is relevant and how they are or are not able to co-construct a healthy, healing relationship grounded in trust and respect. The JII Dynamic framework also points to the extent to which both patient and client develop a shared justification for the work of psychotherapy. This fact enables us to shift to Bridging Point #3 and show how UTOK provides a way to frame how shared conceptualizations are developed.
Bridging Point #3: UTOK Provides a General Model of Character Adaptation and Neurotic Suffering that Can Help Explain Why People Seek Therapy
The second key therapeutic element in the Contextual-Process Model is that the therapist helps the client develop a good understanding of who they are and the problems they have in a way that instills hope that change might be helpful. UTOK’s CAST and Neurotic Loop formulation provide a clear structure to see how this is done.
UTOK’s Character Adaptation Systems Theory provides a robust, generalizable model for understanding adaptive and maladaptive human behavior. CAST first contextualizes character adaptation across biological, psychological, and sociocultural vectors of development, which are the left side vectors. Then, it identifies the character adaptation systems.
The first system of character adaptation, the habit system, encompasses sensorimotor patterns, reflexes, and procedural memories that generally operate unconsciously. It aligns with behavioral therapies, which focus on modifying ingrained habits and behavior patterns. The experiential system involves subjective conscious experience, including perceptions, emotions, and drives, and aligns with humanistic approaches, like emotion-focused therapy, which emphasize the importance of felt, emotional experience.
The relationship system is mapped by the Influence Matrix. The defensive system is tasked with maintaining psychological equilibrium by managing impulses, thoughts, or emotions seen as unacceptable by the individual and are defended against. These two systems align with psychodynamic approaches that address defense mechanisms such as repression, denial, or projection in the context of relationships and consideration of things like attachment. Finally, the justification system is focused on language-based beliefs and values, aligning with cognitive and existential therapies, which focus on reshaping maladaptive thought patterns and helping individuals find meaning and purpose in their lives.
These five systems form the basis for understanding how individuals develop adaptive or maladaptive coping mechanisms to deal with stressors. Indeed, UTOK has developed a framework that complements CAST for understanding entrenched maladaptive patterns, which represent the primary kind of problem that drives people into psychotherapy. UTOK calls such processes Triple Negative Neurotic Loops.
Triple negative neurotic loops start with psychological bumps and bruises. A bump is a negative life event that triggers a negative feeling. A bruise is a past psychological injury that makes someone vulnerable to being reactive. A neurotic loop emerges when a negative event or stimulus triggers a negative emotional response (i.e., bump), which is then followed by a maladaptive negative secondary reaction (usually because of a bruise became coupled with a maladaptive coping strategy).
Such reactions often involve avoidance, blame, or misguided control, which are UTOK’s “ABCs” of neurotic loops. These strategies can seem helpful, but often end up exacerbating distress. We liken them to trying to put out a grease fire with water: they seem intuitive but only worsen the problem. Individuals caught in these loops often lack the necessary resources, such as emotion regulation or impulse control, to break free. As a result, their responses become rigid, resistant, and self-defeating, perpetuating the cycle of suffering.
CAST orients toward the person’s habits and lifestyles, emotional functioning, relationships, coping and defenses, and justifications for who they are and why they do what they do. The Neurotic Loop formulation helps clients shift their perspective to see how they are reacting in a counter productive way and thus enables them to shift their perspective on how they might be more adaptive going forward.
Bridging Point 4: UTOK’s CALM-MO Identifies the Core Principles and Processes Associated with Reversing Neurotic Loops
The final element in the Contextual-Process model is providing actions, interventions, and tools that foster adaptive change. UTOK’s CALM-MO is an integrative approach to psychological mindfulness that consolidates knowledge we have that is designed to foster adaptive responses to stressors and negative emotional experiences. CALM-MO integrates the core principles from various therapeutic modalities, especially from Steven Hayes’ Acceptance and Commitment Therapy and Dan Seigel’s Interpersonal Neurobiology, and offers a cohesive approach to reversing the maladaptive patterns found in neurotic loops.
CALM-MO begins by helping clients and therapists shift from negative reactivity to reflective responsivity. This involves creating a relational container of respect and mutual understanding that holds the client’s distress.
The MO in CALM-MO stands for both Metacognitive Observer and Modus Operandi. The Metacognitive Observer refers to a reflective stance where clients become more aware of their thoughts, emotions, and actions. By adopting this observer perspective, clients distance themselves from their egoic justifications, allowing for nonjudgmental reflection. This perspective is akin to cognitive defusion in Acceptance and Commitment Therapy (ACT) or cognitive reframing in traditional Cognitive Behavioral Therapy (CBT).
The Modus Operandi element refers to the ultimate goal of CALM-MO, which is to transform the client’s habitual way of responding to stressors. Over time, and with practice, CALM-MO fosters a shift from maladaptive critic responses to a more adaptive, reflective attitude. This becomes the client’s new operating mode — what we like to refer to as “sage mode.”
The CALM acronym stands for Curiosity, Acceptance, Loving Compassion, and Motivation toward valued states. These four elements represent core attitudes and orientations that guide clients toward healthier patterns of thinking and behavior. Curiosity refers to an open, exploratory stance toward one’s inner experience and the situation. It involves cultivating an attitude of wonder and openness to multiple interpretations of events. In therapy, curiosity helps clients clarify their experiences by recognizing themselves as investing animals, social primates navigating influence and relational value, and justifying persons embedded in cultural systems.
Acceptance is the capacity to embrace oneself, others, and the world without attempting to react, resist, or control the situation. It encourages a therapeutic attitude of being present with one’s thoughts and feelings without judgment or avoidance, which is crucial in breaking maladaptive patterns of denial or rejection. Loving Compassion encourages clients to treat themselves and others with kindness, based on the humanistic value of conferring dignity to all human persons. This element helps transform self-criticism and judgment into understanding and empathy. Finally, Motivation toward valued states represents an orientation toward one’s values and goals, guiding clients to focus on what matters most to them in both the short and long term. This principle encourages clients to reflect on their core values and to actively pursue desired outcomes in alignment with their value system.
A Comment about Outcome Informed Treatment
The last element of the Contextual-Process Model refers to the fact that treatment should be “outcome informed.” This means that the treatment should have regular processes for monitoring its effectiveness. Usually, this involves feedback regarding both the quality of the therapeutic relationship and the effectiveness of the therapy in reaching expected goals regarding symptom reduction or improvements in quality of life. We applaud the work of leaders like Duncan and Miller who have developed the rationale, methods, and empirical support for this aspect of the Contextual-Process model.
Summary and Conclusion: A Vision for the Future of Psychotherapy
Wampold’s Contextual-Process Model provides us a description of the generalizable aspects that go into the psychotherapeutic healing process. We argue that it sits at the center of psychotherapy, and that the field should have it as its “common core.” The lack of a broad, deep, rich explanatory framework has resulted in common factors being separated from the specific schools of thought and specific interventions for specific problems. We have outlined a better way to go. A unified view of psychotherapy affords a zoomed-out metatheoretical perspective. UTOK enables such a view, one that can both define the science of human psychology, and assimilate and integrate the key insights from the major schools of thought.
Our article demonstrates how UTOK can assimilate and integrate the Contextual-Process Model and provide a clear explanatory network that accounts for why it is structured the way it is. With the common core in place, the field of psychotherapy can then be situated to “move” in a much more cumulative fashion.
For his keynote address to the 2024 Society for the Exploration of Psychotherapy Integration, Gregg gave a talk on the future of theory. That talk summarized the common core, and emphasized that the future would involve consolidating the common core as the standardized “control condition” for psychotherapy. That is, what is being described here is the effective generalizable treatment patterns for the internalizing, neurotic conditions.
With this common core in place, then we can move to explore the specific interventions for specific problems that might result in outcomes that are better than then common core. This means that with the common core, we have the “gold standard” for the control condition in psychotherapy. Good therapy involves a legitimate healer who fosters a high quality relationship, helps the client understand adaptive and maladaptive patterns, and skillfully encourages mindful responsivity toward valued states of being, along with active ways for learning new ways of being and reacting.
From this basic grounding, we can then move to enhance specific mechanisms to foster change in specific problems. This means we can move from what Wampold framed as the Great Psychotherapy Debate, to the synthesis of general psychosocial healing processes that then create an effective holding environment for specific treatments for specific problems. If we head in this direction, the field will be able to generate cumulative insights that foster psychological well-being.
