Psychotherapy for the 21st century: An integrative, evolutionary, contextual, biopsychosocial approach

Fragmentation of processes and interventions plague the psychotherapies (Gilbert & Kirby, 2019). Part of the problem is that we have not agreed on a framework that could be the basis for integrating knowledge and the scientific enquiry of processes and interventions. This paper outlines an approach that brings together a variety of different disciplines in the service of consilience (Wilson, 1998, Consilience: The unity of knowledge, Vintage, New York, NY; Siegel, 2019). It presents the importance of an evolutionary framework for understanding the proclivities and dispositions for mental suffering and antisocial behaviour, and how they are choreographed in different sociodevelopmental contexts. Building on earlier models (Gilbert, 1989, Human nature and suffering, Routledge, London, UK; Gilbert, 1995, Clin. Psychol. Psychother., 2, 135; Gilbert, 1998, Br. J. Med. Psychol., 71, 353; Gilbert, 2016, Case formulation in cognitive behaviour therapy: The treatment of challenging cases, Wiley, Chichester, UK, pp. 50–89) the call is for an integrative, evolutionary, contextual, biopsychosocial approach to psychology and psychotherapy. PRACTITIONER POINTS: Evolutionary functional analysis is part of an evolutionary, contextual, biopsychosocial approach to mental health that can serve as a scientific platform for the future developments of psychotherapy. Therapist skills and training will increasing need to focus on the multidimensional textures of mental states especially the context‐social‐body linkages. Therapies of the future will also focus more on the moral aspects of therapy and address the need to promote prosocial and ethical behaviour to self and others.