A Fourth Wave of Psychotherapies: Moving from Recovery Toward Well Being
John Peteet, M.D., Associate Professor of Psychiatry, Harvard Medical School
As psychotherapies have proliferated, a number of authors have recently distinguished three waves of approaches, based on historical, theoretical and practical considerations. These three waves, while at times enhancing resilience through learning social and emotional skills, are primarily directed at correcting deficits responsible for dysfunction. Here I suggest that many of the newest and most novel mental health interventions can productively be characterized as a fourth wave. This tradition of approaches, built on the legacy of existential psychotherapy and related humanistic approaches, aims beyond insight, mastery and problem solving toward the achievement of positive well being. These value and virtue oriented approaches include positive psychology interventions (PPI), dignity and gratitude promoting, meaning centered, forgiveness oriented, loving kindness and compassion meditation, and spiritually informed therapies. They overlap with traditional religious/spiritual (R/S) practices which utilize prayer, scripture study, sacraments, and supportive communities to help individuals achieve valued ideals, and to flourish. Although the diverse group of approaches categorized as fourth wave here raise challenging practical and ethical questions for clinicians about how and when to implement them, their proposed addition to the already defined three wave model could help clarify the continually expanding and often fragmenting field of mental health interventions. Implementation of fourth wave psychotherapies is uniquely challenging, both because there is conceptual ambiguity about their goals (and hence about their research base), and because they embody differing values about what constitutes human flourishing held by patients, clinicians and the treatment culture. Fourth wave therapies, which ask therapists to reflect on what constitutes human flourishing, call upon them to draw upon their world views – the universal, if often unacknowledged ways that people orient themselves within a larger frame of reference – for answers. Four widely shared world views - radical materialism, secular humanism, pantheism and monotheism – differ in their core assumptions, and clinical implications. The potential implications of each can be seen in the treatment of Ms. J, a hypothetical patient with depression. In summary, a fourth wave of therapeutic approaches, now supported by an increasingly robust evidence base, promises to help clinicians aim beyond symptom relief and cure to well being. The values inherent in these approaches challenge practitioners to remain alert to how they relate to both their patients’ values, and to their own understandings of what it means for humans to flourish.
As psychotherapies have proliferated, a number of authors have recently distinguished three waves of approaches, based on historical, theoretical and practical considerations. These three waves, while at times enhancing resilience through learning social and emotional skills, are primarily directed at correcting deficits responsible for dysfunction. Here I suggest that many of the newest and most novel mental health interventions can productively be characterized as a fourth wave. This tradition of approaches, built on the legacy of existential psychotherapy and related humanistic approaches, aims beyond insight, mastery and problem solving toward the achievement of positive well being. These value and virtue oriented approaches include positive psychology interventions (PPI), dignity and gratitude promoting, meaning centered, forgiveness oriented, loving kindness and compassion meditation, and spiritually informed therapies. They overlap with traditional religious/spiritual (R/S) practices which utilize prayer, scripture study, sacraments, and supportive communities to help individuals achieve valued ideals, and to flourish. Although the diverse group of approaches categorized as fourth wave here raise challenging practical and ethical questions for clinicians about how and when to implement them, their proposed addition to the already defined three wave model could help clarify the continually expanding and often fragmenting field of mental health interventions. Implementation of fourth wave psychotherapies is uniquely challenging, both because there is conceptual ambiguity about their goals (and hence about their research base), and because they embody differing values about what constitutes human flourishing held by patients, clinicians and the treatment culture. Fourth wave therapies, which ask therapists to reflect on what constitutes human flourishing, call upon them to draw upon their world views – the universal, if often unacknowledged ways that people orient themselves within a larger frame of reference – for answers. Four widely shared world views - radical materialism, secular humanism, pantheism and monotheism – differ in their core assumptions, and clinical implications. The potential implications of each can be seen in the treatment of Ms. J, a hypothetical patient with depression. In summary, a fourth wave of therapeutic approaches, now supported by an increasingly robust evidence base, promises to help clinicians aim beyond symptom relief and cure to well being. The values inherent in these approaches challenge practitioners to remain alert to how they relate to both their patients’ values, and to their own understandings of what it means for humans to flourish.