Systemic Integrative Psychotherapy

This seven level therapeutic model of Systemic Integrative Psychotherapy was taught by Petruska Clarkson in Pretoria in 1975 before knowledge of similar models of Wilber (1980) and Lazarus (1981) (Clarkson, 1993, 146-7). Its seven levels offer a holistic (for the person) and integrative (for psychotherapy) approach. They are conceptual (like a map) so to understand the various aspects of the person striving for whole health. The levels are:


Seven Levels

Physiological (Body basics)
Emotional (Preverbal outbursts)
Nominative (First language)
Normative (Social)
Rational (Truth)
Theoretical (Pluralist truths)
Transpersonal (Spiritual handling of the all)



1 Physiological
Here the person is a Amoeba or Body (Clarkson, 1993, 150), with basic needs, sensations and predispositions. It is core biology and as going through life with minimum requirements. People realising past traumas may react bodily and need direct therapy (see 160-161). In terms of psychotherapy it means body orientated exercises like conditioning, desensitisation, breathing (especially used as a means to overcome anxiety) and relaxation (150). It can be combined with body based medical techniques (including alternative homeopathy). Body posture is important. Gestalt theory can be utilised to enhance sensory awareness.
2 Emotional
Here the person is Mammal (Clarkson, 1993, 150), that is centred on experience, activity, effect and emotion. The focus is bonding, attachment, nursing, and (at the negative) deprivation (150). People express their emotional range (and rages), and their reactions to life with its rough corners. Crying can be withdrawal not relief (161). Methods which allow emotions to come out (asking what might make one angry, for example, to lead on to more outward expression) are relevant here and can take place with one practioner or within the supportative group. It requires therapies of focussed expression, the gestalt (polarity), primal (preverbal experience), psychodrama, bioenergetics, rechilding, rebirthing, redecision work in transactional analysis and visualisation methods to release emotions (151). People can get back in touch with the "frozen child" and bring back these lost emotions (see 162) in a safe therapeutic environment.
3 Nominative
Here the person is Primate (Clarkson, 1993, 151). This is about awareness and application of basic language. Experiences are labelled and named in order to validate and gain some sense of ownership and control (151). This is a means to clarify and overcome the otherwise confusions of emotional states (see 162). Methods here include reframing, reflecting, empathetic attunement, making overt what was covert, neurolinguistic programming, phenomenology, resistance and paradoxical interventions (151). Gestalt theory offers top dog/ underdog polarities as well as awareness, and placator/ blamer/ computer/ destractor (151). Jungian archetypes name, as do levels of parent/ adult/ child in transactional analysis. Diagnosis means naming, as does borderline personality organisation (151-2). In cases of abuse, this naming may be of the relative who was responsible for the abuse (163) facilitating then an ongoing examination of contradictions therein between the person who loved and abused at the same time.
4 Normative
Here the person is Social Animal (Clarkson, 1993, 152). This level engages culture and looks at norms, values, beliefs and collective expectations in the tribe or community (152). In Freudian terms this stage means the superego (the social) (borrowed egos/ parent egos elsewhere). This is the culture of what people should do, and deviance from the norm. This creates a dilemma of observing such norms with a group's need for coherence and membership within (153) or developing individuality (autonomy through to self-actualisation) potentially against such norms (152). The dilemmas of self and society can be as simple yet as overbearing as views of body shape (163). Methods include reality therapy, the cathexis approach, and the values clarification movement (152). There is transactional self and spot reparenting. For women, and the issue of body shape, it can mean dressing to please oneself (as well as understanding social expectations via the media), becoming one's own photographic model to affirm the shape one is. It also means something as straightforward as giving eye contact with others in order to positively interact (163). Yet with deeper anxieties the child within may need reassurance regarding socialising (163) before adult confidence comes along.
5 Rational
Here the person is Homo Sapiens (Clarkson, 1993, 153). Thinking comes into play, with language used on a more complex level than stage 3 but still with a simple unified view of truth. This means looking at causality, frames of reference and skills of taking in information (153). Rationality needs experimentation and testing; rational-emotive therapy is used; cognitive therapy engages language; insight is developed; defining, distinguishing and debating irrational beliefs is a three stage process; and decontamination in transactional analysis is used where the reality testing is of the adult ego state distinguishing between parent prejudices and beliefs, child magical thinking and aimed for rational adult thought (153). So for the patient it means careful logical examination of what is the case and what is not and where the connections lie and where they do not by filtering out irrational beliefs and going forward with clearer thinking about the world and its people, especially those encountered (and their motives) now as well as in the past (see 164-5).
6 Theoretical
Here the person is a Storyteller. Thinking becomes human experience put into narrative, dealing with higher levels of meaning, and dealing with symbolism and metaphor (Clarkson, 1993, 153). Now at this abstract level a person can handle plurality and difference, where truth is in the story for its duration. Truth does not have to be fixed and for all time. No longer is there simple attachment to truth claims (as in stage 4) but a more enriched basis of using theories (154). Theories abound: it is even understood that psychological theories are themselves limited and within the plural map. Understanding the theories of psychology itself gives means for the patient to understand the present in terms of the past at a more theoretical level (165). Pyschotherapies offer methods - we know these are means - to personal advancement. Patients realise that they are becoming "psychologically minded" (165) themselves. Psychoanalysis, Jungian, behavioural therapy and humanistic psychotherapy offer their own narratives by which people can with theoretical awareness make sense of their experiences (154). Even theory can be added to by application of life stories (this way around). In a sense, patients at this stage become their own therapists and have greater ownership of seeing in perspective the process of change. The patient can even handle unconscious and subconscious ideas and experiences, with dreams incorporated into the self therapy (see 166).
7 Transpersonal
Here the person is a Spiritual Being among Spiritual Beings (see Clarkson, 1993, 154) with a high level of overview of the wealth of everything. Religion comes in with Eastern views and creation spirituality, and so does the whole nature of experience beyond facts and even theories (154). Here is the mystical, inexplicable, even dreamlike, world. There is art, including especially the surreal. There is spiritual healing and the New Age. The mind combines with the world. Clearly Jung's archetypes and notions of the collective unconscious have parts to play; and transpersonal therapies with their spiritual elements (psychosynthesis, gestalt, some transactional) are very relevant. Relationships are important too, with claims about unconscious and subconscious understandings between partners (155). Integrative psychology is important, and the body is not lost in this spiritual approach but is as much part of the holistic high level healing process towards integration (see 155). In fact all the stages seem to come together, as might be expected in the integrated final level.



Implied is a theory of knowledge: of different stages or levels of organisation about how we understand what is around us. The psychotherapist can collect aspects of diagnosis and treatment into these categories. It might be immediately seen that each stage onwards involves growing in ever more complex and rounded ways. However, Clarkson is at pains to state that these are not developmental (in the sense that one level is higher than another) (Clarkson, 1993, 148) because all levels should function well together. They are, for her, only epistemological levels, all of which go into the variables through time between the psychotherapist and the client (the diagram at 157 puts the levels together and not spaced out through time).
This really is inconsistent with similar models in education approaches (e.g. QCA levels for teaching RE), hierarchy of needs theories (like Maslow), some business organisation theories (such as Mary Parker Follett) and religious development views (such as Fowler's Stages of Faith).
Nevertheless these models in psychology, religion and education are often taken as stages of development from basic requirements to stages of higher achievement. Such is the presentation of "Susan" (Clarkson, 1993, 156-157): from her introversion through her realisation of abuse to understanding it and connecting that to a liberating present self using the various psychotherapy theories.
The idea is that these stages or levels are co-existing so that the healthy person develops all levels at once, and the claim is that one can never be developed at the expense of another so that focussing on one develops the others. Whilst this may (or may not) be so, this is still presents itself as a theory of development, from the most basic and bodily to the most mind-integrative. It might be claimed, after Maslow in his field, for example, that without the earlier bodily and expressive difficulties (needs) sorted out, patients cannot progress to higher levels.
Assuming then that these levels do offer a model of development, are the stages in the right order? The Physiological might be considered the very basics of existence: body and dependence. The Emotional stage categorises the first attempts at communication at a preverbal stage. Both these two are prelinguistic and child centred. The next stage is Nominative, which is like the child beginning to speak and understand words, connecting in a more discriminating way with the universe around. Next level, the Normative, is like the child playing with others. The Rational stage is rather like the concrete thinking teenager who is yet to achieve a more abstract view. This comes in the Theoretical stage, where truth gives way to truths. This is the stage many adults fail to achieve: they cannot understand that narratives offer other justifications of existence. Nevertheless it is an adult stage of juggling different philosophies and running within one, realising the relativity of its narrative power. The final stage is the Transpersonal, where the various philosophies, despite their contradictions, are somehow handled and integrated at a far higher level, with the implication that with this kind of thinking the mind is integrated. So we might expect the sages and prophets to handle the depth of thought with confidence. This is perhaps the wisdom of old age: the one who has seen it all and is able to smile back at everything.
However the final two types are quite close. If the final stage is handling differences (postmodern) whereas the penultimate stage is recognising difference alone (postliberal) then the order seems right; but if the final stage is substituting the handling of relativity and philosophies with a grand philosophy (universal doctrine) then this a retrograde development as it reasserts a single truth, a pure meta story to beat the plethora of stories. Confidence with plurality must be higher than overcoming it with universality. Clarkson seems to promote a confidence with various sources for psychotherapy after relativity has been achieved. The patient can see a whole range of resources available, knowing they are all pathways to improving the mind and body as one. This is recognition of the usefulness and depth in everything. There are two approaches here: one is the relativism and non-objectivity of each story, or the Isaiah Berlin approach of clashing objective truths all of which have resource and depth. On this basis it need not be (but can be) a conclusion that all psychotherapy views are made up language games (147) with perhaps nothing but self-connectivity. We can certainly see parallels here between theories of the mind, philosophy, biology, culture, religion and the richness of all, such as in parallel narratives of development themselves (as presented here) but also recognised (and not overturned) is the continued plurality of everything including the integrity of these theories, such as those of development (presented here). The question then is to what extent confidence in the self then means a preferred pathway, whilst aware of and undergoing an encounter with the rich validity of everything else, and the meaningful examination in depth of the stories that constitute "narrative reality".



Clarkson, P. (1993), On Psychotherapy, Psychotherapy series, ed. Dryden, W., London: Whurr Publishers, 146-167.

Refers to (here mentioned):

Lazarus, A. A. (1981), The Practice of Multimodal Therapy, New York: McGraw-Hill.

Wilber, K. (1980), The Atman Project: A Transpersonal View of Human Development, Wheaton: Theosophical Publishing House.