Marcia Gralha


The Core of Therapeutic Healing in Brazil


WHAT LIES AT THE ESSENCE of therapeutic healing? What are the fundamental processes that can break vicious cycles of psychological struggles, such as anxiety, depression, loneliness, and existential dread? These are increasingly relevant questions against the backdrop of global mental health & meaning crises that are now well-known in liminal web spaces.

We can propose many potential psychological and sociocultural drivers of the mental health crisis, which can include the patterns of the meaning crisis itself, a cultural increase in youth’s emotional fragility, the rapid evolution of technology and social media, and a mismatch between the environment we evolved to live in and our current one (Henriques, 2014; Haidt, 2023). This brings us to face an associated surge in people seeking therapeutic services. These individuals show a prevalent set of symptoms termed "internalizing symptoms"—manifesting as anxiety, depression, low life satisfaction, low self-esteem, and problematic coping mechanisms, among others.

While Latin American countries have been shown to have, in general, higher levels of happiness when compared to other parts of the world, they paradoxically exhibit a substantial prevalence of mental illness, particularly anxiety and depression disorders (Guzman-Ruiz, 2023). In Brazil, mental disorders constitute one-third of all noncommunicable diseases, with anxiety and depression ranking as the most frequent issues and the country is grappling with an alarming increase in suicides compared to other Latin American countries (Guzman-Ruiz, 2023; Araujo & Torrente, 2023).

In this context, we have started an initiative in Belem, Brazil—near the heart of the Amazon—named the Nexus Project.

Nexus is being developed as an online platform that endeavors to spark discussions and share content exploring the core of therapeutic healing for people struggling with internalizing conditions. Specifically, Nexus will explore ways toward coherent integration in psychotherapy in Brazil, challenging the prevalent tradition of “school of thought" affiliation as well as transcending the language barriers inherent in individual therapeutic approaches and paradigms.

Nexus is inspired by the psychotherapy integration movement that gained momentum in the United States in the 1980s. The project’s ambition is to open a pathway in Brazil for educating on the key insights learned since then, and actively engage the movement’s mission of looking across the boundaries of single schools to see what can be learned from other approaches to conducting psychotherapy.

Historically, psychotherapy has been fragmented, with various schools of thought offering conflicting claims about the right way to understand (and thus, treat) human behavior and mental processes. The disparity of their isolated language systems contributed to conceptual confusion and fragmentation of approaches. What unfolded was a pre-paradigmatic psychological science and practice. In A New Synthesis for Solving the Problem of Psychology: Addressing the Enlightenment Gap (2022), Gregg elucidates how this problem in psychotherapy is tightly connected to the philosophical and scientific problem of psychology.

This fragmentation stands in stark contrast to the robust findings that culminated in the common factors approach to psychotherapy, which emphasizes shared general processes, especially the therapeutic relationship, as the principal drivers of therapeutic success across different approaches. In a paper under review, Gregg and I recently articulated how these common factors findings can gain metatheoretical depth, forming the common core of psychotherapy. The outline of the common core consists of three major domains of psychotherapeutic healing reliably associated with therapy success. Those are the quality of the therapeutic relationship, the cultivation of shared understanding, and practical tasks, strategies, and interventions toward reversing problematic cycles.

Using the UTOK system to add the metatheoretical content to those domains, we described how: 1) the Tree of Knowledge System can contextualize the endeavor of psychotherapy from a zoomed-out, Big History perspective that embraces a metamodern approach to the field; 2) UTOK’s JII dynamic framework, particularly with the Influence Matrix, can frame the therapeutic relationship, 3) the shared understanding between therapist and patient can be facilitated by UTOK’s formulations in its unified approach to psychotherapy (i.e., CAST, the Wheel of Development, the Nested Model of Wellbeing), including the system’s framework for neurotic loops, and 4) CALM MO serves as a central intervention tool that unites the key insights from the major approaches to reverse neurotic suffering.

Since the 1980s, professionals in the U.S. began to adopt a more eclectic approach to therapy (Norcross & Goldfried, 2005). In Brazil, the trend has not been carried through as reliably, and the field has largely maintained the tradition of “school of thought" affiliation. Another indicator of what seems to be a slower pace to adhere to developments in the field is illustrated by how, more recently, the Brazilian psychotherapy field has shown a growing concern with empirically supported treatments for specific psychiatric conditions. This same clinical concern emerged in the U.S. back in the 80s and, due to conclusions from research, shifted into inquiries about the general principles and processes that can be empirically validated.

The ideas in the common core approach serve as the foundation for the Nexus project, aiming to pave the way for a more unified and coherent approach to psychotherapy in Brazil. It strives to move beyond a sole reliance on empirical data to legitimate individual interventions and highly relativistic, postmodern attitudes that resist unifying metatheoretical truth claims. It envisions, instead, a more coherent integrated pluralism of approaches to psychotherapy in Brazil.


For more ideas on the common core of psychotherapy and how it can help foster increased mental health and well-being amid the global mental health crisis, join UTOK’s second edition of the Consilience Conference, where these ideas will be further explored. The conference is scheduled as a virtual event on April 12th and 13th. More information is upcoming, and will be announced in the UTOK community:


Araújo, T. M. D., & Torrenté, M. D. O. N. D. (2023). Mental Health in Brazil: challenges for building care policies and monitoring determinants. Epidemiologia e Serviços de Saúde, 32.

Guzman-Ruiz, Y. (2023, July 5). A Neglected Challenge of Mental Health. In

Haidt. J. (2023, February 22). Social Media is a Major Cause of the Mental Illness Epidemic in Teen Girls. Here’s the Evidence. In

Henriques, G. (2022). A new synthesis for solving the problem of psychology: Addressing the Enlightenment Gap. Palgrave MacMillan.

Henriques, G. (2014). What Is Causing the College Student Mental Health Crisis? [Psychology Today blog].

Norcross, J. C., & Goldfried, M. R. (2005). (Eds.). Handbook of psychotherapy integration. Oxford University Press.

Schmidt MI, Duncan BB, Silva GA, Menezes AM, Monteiro CA, Barreto SM. (2011) Chronic noncommunicable diseases in Brazil: burden and current challenges. Lancet.;377(9781):1949-61. doi:10.1016/S0140-6736(11)60135-9

Words by Marcia Gralha