Multimodal Therapy

You may think that a whiteboard would be out of place in a psychotherapist’s consulting room but Stephen Palmer, Director of the Centre for Multimodal Therapy and editor of a new book on therapy* disagrees. He has several whiteboards which he uses to guide his clients through the systematic, organised approach that allows multimodal therapy to draw on a wide range of other therapies and disciplines to resolve the diverse problems that can drive people to seek the help of a therapist.

At the heart of multimodal therapy is a framework of seven different areas of human activity, known as modalities. The framework is used to categorise the client’s problems, plan the therapist’s interventions, and chart the client’s progress.

The first six modalities refer to the fact that all humans behave, experience emotional responses, have sensory experiences related to things that we see, hear, smell, touch or taste, conjure up images, think and interact with other people. The seventh modality refers to the fact that we are biological organisms subject to biochemical influences from food and drugs. The framework of modalities is known by the acronym BASIC I.D. which stands for behaviour, affect (the psychologists’ term for emotional reaction), sensations, images, cognition, interpersonal and drugs/biology.

The BASIC I.D. framework is usually introduced to the client in the first therapy session. It allows therapist and client to draw up an organised list of the client’s problems and to plan appropriate treatments for each problem. Using a set framework has the extra benefit that it helps the therapist to check that every potential problem area has been covered in their assessment of the client.

During the course of treatment more detailed assessments may be carried out using questionnaires. The client’s strengths in the different BASIC I.D. modalities can be represented pictorially as a bar chart, known as the structural profile. The actual profile can be compared with the clients desired profile, which represents the way they would like to be, in order to plan and monitor treatment.

In designing the treatment plan, a multimodal therapist will draw freely on other schools of therapy. They may even advise the client to use techniques that they themselves do not practise and to do homework exercises or reading between sessions. For example, they may use commercially produced relaxation tapes to teach the client to relax. They might even, in consultation with the client, choose treatments from outside what we normally think of as psychotherapy, such as diet and exercise regimes in cases where an unhealthy lifestyle may be part of the overall pattern of problems experienced by a client suffering from stress at work.

Multimodal therapists take great pains to tailor their approach to the needs and expectations of each client. Palmer describes the therapist as an “authentic chameleon”. They adapt their manner, their dress and even their style of interaction to the needs of the client. A grieving widow may need little more than a sympathetic ear, but an anorexic teenager or a middle-manager with a drink problem may need much more specific and directive intervention.

Unless there is a possibility of legal complications, a multimodal therapist will usually tape the therapy sessions and give a copy of the tape to the client. “It’s useful for the therapist to be able to check they haven’t missed anything, and to be able to listen to the tapes with their supervisor” says Palmer.

“The clients find the tapes useful too” Palmer says. “You teach somebody how to deal with panic attacks and they take the tapes away with them. If they have another attack two years later they can listen to the tape and remind themselves how to solve the problem.”

Multimodal therapy is intended to be quick and flexible. Individual sessions can be as short as 20 minutes or can last for several hours. It all depends on the client’s needs and how much help they need. Progress is reviewed frequently and a typical course of treatment would take six sessions with the gaps between sessions increasing as the client improves. It can be much quicker “For something straightforward like a simple phobia we can deal with it in a single session” Palmer says.

Contacts & further information

Most multimodal therapists in the UK are also cognitive and/or behavioural therapists accredited through the British Association of Behavioural and Cognitive Psychotherapies which is affiliated to the UK Council for Psychotherapy. For a copy of the BABCP register send pounds 2 and a 39p stamped 16cmx23cm SAE to BABCP, P.O. Box 9, Accrington, BB5 2GD. In the US the APA is probably the most useful accreditation service.



*Introduction to Counselling and Psychotherapy, The Essential Guide, edited by Stephen Palmer, Sage Publications, London, November 1999.

For general information on multimodal therapy try