Psychotherapeutic Change Mechanisms and Causal Psychotherapy: Applications to Child Abuse and Trauma

Abstract

The study of change mechanisms in psychotherapy needs to be integrated with the causality of behavior, which leads to the concept of causal psychotherapy. Causal psychotherapy is posited as a useful adjunct to standard, evidence based psychotherapies for child and youth victims of abuse and trauma. The article illustrates six processes that could be involved in causal psychotherapy in this context, from the distal to the proximal. They include the distal mechanism of activation-inhibition coordination. The most proximal one relates to executive function. The intermediate levels include ones related to co-regulation (e.g., self control), analysis-synthesis, objectivity-subjectivity, and psychological reserve, which is a new concept in the domain of psychological change mechanisms. Each of the variables can vary from high to low, with the low end being more problematic. Psychotherapy can aim to bring the patient toward adaptive levels. The literature review focuses on psychotherapeutic change mechanisms, and standard psychotherapies for child/youth abuse/trauma, especially trauma-focused cognitive behavior therapy (TF-CBT). Then, it considers causal aspects of child/youth abuse and trauma, including PTSD. The discussion relates causal therapy to the question of unifying psychology and psychotherapy under the rubric of causality as a core integrative mechanism.

Keywords: Causal psychotherapy; Change mechanisms; Child psychotherapy; Pediatric PTSD; Psychological causality.

Fig. 1

The figure presents causal mechanisms in behavior, which refer to etiological ones in psychopathology. The left side gives major causality/etiology models. The middle portion gives six more specific causal/etiological factors, from more distal/top-down ones to more proximal/bottom up ones. The factors vary dimensionally, with the middle zone often being optimal for adaptation. In disturbances in behavior and psychopathology, behavior gravitates toward the less adaptive poles. Therapy can work toward righting imbalances in the factors beyond the more specific approaches used