I’m back! A perfect storm of personal events and
graduate school has kept me away from you. However, my life has calmed down
significantly and I will try to update this blog much more often.
This is part one of a two-part series regarding how
to find the right therapist for you. A number of people have been requesting
these posts for months and I am finally able to put this up. In this post, I
will give very brief and basic descriptions of some of the more prevalent
theoretical approaches that therapists work from. Knowing a therapist’s
theoretical orientation/approach is incredibly important. All therapists are
not the same. I have heard the following statements countless times from people: “My
therapist is so awful! This proves therapy just doesn’t work for me!” Then I
usually say, “Damn, I’m really sorry your therapist didn’t work out for you. What
theoretical approach was your therapist working from?” And then I usually get a
blank stare. Theoretical approaches determine how a therapist views you as a
client, their role as a therapist, their relationship with you and what
techniques they will and will not use. Think of theoretical approaches like a
pair of glasses with which your therapist views the world. As a client, I think
it is very important for you to know the theoretical orientation of a potential
therapist. It is something that you really should consider when you are trying
to figure out if a specific therapist is right for you. Do you want to simply
focus on your anxiety symptoms? Do you want to talk extensively about your
childhood? Do you want to figure out your place in the world? Different
approaches focus on different aspects of life and different aspects of human
psychology. Finding a therapist whose theoretical approach fits with what you are
looking for can help avoid being with a therapist who simply is not compatible with you.
In this post, I will describe each approach by
asking the following questions: “How Does This Approach View Clients and/or
Humanity?,” “How Does This Approach View the Role of the Therapist?,” “How Does
This Approach View the Therapeutic Relationship?,” and “What Are the Overall
Goals of This Approach?”. I am only describing some of the many approaches and,
as stated earlier, these descriptions are basic. This post is meant to serve as
a diving-board for your own research.
Classical Freudian Psychoanalytic Therapy and Modern
Psychodynamic Therapy
Psychoanalytic therapy
is basically what first pops into everyone’s head when they think about
therapy. Sigmund Freud is the founder of psychoanalytic therapy and his work
influenced all of modern psychotherapy. Every theory that came after Freud’s
was either inspired by or in retaliation of psychoanalytic theory.
Psychodynamic therapy is the more modern version of Freud’s classical
psychoanalysis.
How Does This Approach
View Clients and Humanity?
- In Freudian
psychoanalytic therapy, human behavior is motivated by unconscious and irrational
urges. Freud believed that humans are inherently savages that were reined in by
society.
- Human psychology can be
split between things we are aware of about ourselves (the conscious) and things
we are unaware of (the unconscious). Becoming aware of the unconscious parts of
ourselves is the main goal of psychoanalytic therapy because with this
awareness comes choice and change.
- The experiences people
have early on in their childhood have a huge impact on who they are as adults.
How Does This Approach
View the Role of the Therapist?
- The therapist is the
expert and is the one who will provide the insight. The therapist makes
insightful interpretations based on what the client has told them so the client
can grow and change. Interpretations include calling attention to and
explaining the meaning behind a client’s behavior.
- In classical Freudian
psychoanalysis, the therapist tries to remain anonymous and emotionally
detached from clients to encourage transference (a client’s unconscious
rehashing of old feelings and reactions from past significant others onto the
therapist). The therapist explores these feelings and reactions as a window
into the client’s unconscious thoughts and feelings. This approach assumes that
the client acts in similar dysfunctional ways with the therapist as they do
with other people in their lives.
How Does This Approach
View the Therapeutic Relationship?
- Classical
psychoanalytic therapists want to remain emotionally detached from clients in
order to provide insights and interpretations. In contrast, modern
psychodynamic therapists see a solid and healthy therapeutic relationship as an
important part of creating change.
- The psychodynamic
approach views emotional communication with clients as another way to learn
more about the client and to build a connection with the client.
- Sessions are fewer and
shorter than traditional Freudian psychoanalysis (nearly every day of the week
for many years).
- In the current
psychodynamic approach, clients and therapists sit face-to-face, instead of
lying on the couch.
What Are the Overall
Goals of This Approach?
- Making the unconscious conscious (classical Freudian
psychoanalysis).
- Increasing
the client’s ability to function in society.
- Reducing symptoms and resolving internal conflicts.
Adlerian Therapy
How
Does This Approach View Clients and Humanity?
- Human are motivated by their desire to relate to others
in society.
- Humans have agency in their own lives, but their ability
to make choices is limited by biological and environmental factors.
- It is our feelings of inferiority and insecurity that
motivate us to become better.
- Clients are not sick.
They are discouraged by life and this discouragement results in dysfunctional
behavior.
How Does This Approach
View the Role of the Therapist?
- It is important for a
therapist to be able to see the world from the client’s point of view. It is
essential that an individual be understood in the full context of their life.
- The therapist takes on the role of teacher and encourages the client by making them aware of their strengths.
- The therapist helps the
client create goals for therapy.
How Does This Approach
View the Therapeutic Relationship?
- The therapeutic relationship is collaborative, as the
client and the therapist work together
to create change.
What Are the Overall
Goals of This Approach?
- Encourage discouraged clients.
- Help clients better understand how they see themselves
and the world, which should avoid the repetition of symptoms.
Existential Therapy
How Does This Approach
View Clients and Humanity?
- This approach asks the question: “What does it mean to be
human?”
- Humans
are constantly changing in response to the conflicts of life.
- This approach focuses on how humans deal with being alone
in the world and how they handle the anxiety that comes with it.
- Humans are free to make
decisions within the environmental and social limitations of life. Humans may
not be able to control exactly what happens to them, but they can control how
they deal with it.
- This freedom comes with
responsibility and the choices people make comes with consequences. Trying to
avoid one’s responsibilities or trying to avoid making choices results in
existential guilt and anxiety.
How Does This Approach
View the Role of the Therapist?
- The therapist helps clients explore their current values to see if these
values are benefiting them.
- The therapist confronts clients with the fact that they must become
their own person and not allow others to define who they are. Clients are encouraged to accept responsibility for their actions.
How Does This Approach
View the Therapeutic Relationship?
- The therapeutic
relationship is seen as a sample of other relationships in a client’s life.
- A caring, respectful
therapeutic relationship is more important than being an objective, detached
professional.
What Are the Overall
Goals of This Approach?
- To help clients see the
ways they are not living fully authentic lives full of freedom and
responsibility.
- To help clients face their
anxiety and create meaning lives.
Person/Client-Centered Therapy
How Does This Approach
View Clients and Humanity?
- People are trustworthy and are capable of creating
constructive change.
- Clients already have the strengths and assets within them
to overcome their problems.
How Does This Approach
View the Role of the Therapist?
- The expertise, clinical
knowledge and techniques of the therapist are not as important as the quality
of the therapeutic relationship. It is the therapist’s ability to connect with
the client as a person and their ability to be present for the client that
truly matters.
How Does This Approach
View the Therapeutic Relationship?
- The therapeutic
relationship is incredibly essential. A good, solid relationship allows the
client to feel safe enough to explore thoughts, feelings and behaviors that
they have not been able to express otherwise. This leads to clients being able
to become their own healers and create their own positive change.
What Are the Overall
Goals of This Approach?
- Help clients recognize
their strengths and become independent so they can handle problems on their
own.
- Create a safe space
that will give clients the freedom to explore parts of themselves they may have
been too afraid to explore previously so they can live whole and authentic
lives.
Gestalt Therapy
How Does This Approach
View Clients and Humanity?
- Clients have the
ability to make positive change when they are fully aware of themselves and
their environment.
- Clients have an active
role in therapy as they find their own insight.
How Does This Approach
View the Role of the Therapist?
- The therapist is a
guide who encourages the client to change by discovering and accepting
themselves and their environment.
How Does This Approach
View the Therapeutic Relationship?
- It is a collaborative
relationship in which the therapist and client share their experiences in
therapy together in the here and now.
What Are the Overall
Goals of This Approach?
- To expand the client’s
awareness of themselves and the environment in the current moment because
change comes through awareness.
- To help the client
accept themselves.
Cognitive-Behavioral Therapies
Cognitive-Behavioral Therapy is an umbrella term for many
different theoretical approaches. All CBTs use techniques/interventions that
focus on the cognition (thoughts) and behavior of clients as a way to create
positive change. CBTs also tend to be short-term therapies that focus primarily
on reducing psychological symptoms. I chose Albert Ellis’s Rational Emotive
Behavior Therapy (REBT) and Aaron Beck’s Cognitive Therapy (CT) because they
are the most well-known of the CBTs.
How Does This Approach
View Clients and Humanity?
- REBT
- People are born with the potential for both
rational and irrational thinking.
- They learn irrational beliefs from childhood
and actively reinforce these beliefs throughout their lifetime.
- Blaming the self or the world is the root of
emotional problems.
- Life experiences and events do not cause
psychological issues (i.e. anxiety or depression). It is our beliefs about the
event that impact our emotions and behaviors. For example, according to REBT,
you are not depressed because your father died. You are depressed because
of how you perceive your father’s death. Your perception therefore influences
how you behave and the emotions you feel. If your perception was changed, you
would feel better.
- CT
- Humans have core beliefs about themselves and
the world that they maintain all throughout their lives. When these beliefs are
not accurate, psychological problems occur.
How Does This Approach
View the Role of the Therapist?
- REBT
- The therapist is the expert and teacher, who models
rational behavior for the client.
- The therapist disputes the client’s
irrational thinking and teaches them techniques to independently dispute and
replace irrational beliefs with rational ones.
- CT
- Therapists encourage clients to turn their
core beliefs into hypotheses to be examined. Clients conduct experiments to
test the validity of their beliefs.
- The therapist asks open-ended questions to
encourage clients to find their own answers to their problems.
How Does This Approach
View the Therapeutic Relationship?
- REBT
- According to Albert Ellis, a warm therapeutic
relationship is not necessary for success and can actually be harmful to the
client. He believed that it could cause clients to become dependent on the
therapist.
- CT
- A collaborative, empathic relationship is
incredibly important, but it is not the only thing needed to create change.
Techniques are needed too.
What Are the Overall
Goals of This Approach?
- REBT
- Teaching clients to accept themselves, flaws
and all.
- Teaching clients how to change dysfunctional
thoughts, emotions and behaviors into functional ones.
- CT
- Helping clients analyze their core beliefs
and change them if necessary.
Postmodern Therapeutic Approaches
Postmodern theory is a
reaction to modernism, which believes that there is one true, objective reality
that can be studied and known through the scientific method. Theoretical
approaches based on modernist thinking are founded in the idea that people who
seek therapy have deviated from some objective norm and need to be put back on
the right path. Postmodern theory disagrees, believing that there are multiple valid
and subjective realities. Each person lives in their own reality that is
influenced by the time, place and society in which they live. There is no
single objective truth and, following that, there is no single right way to
live.
I will describe two
postmodern therapeutic approaches: Steve de Shazer and Insoo Kim Berg’s Solution-Focused
Brief Therapy (SFBT) and Michael White and David Epston’s Narrative Therapy.
How Does This Approach
View Clients and Humanity?
- Both postmodern approaches agree that clients are the
experts of their own lives.
- SFBT
- SFBT believes that
clients already have the strengths within them to resolve their problems, but
sometimes people lose their way.
- Clients are not reduced
to a diagnostic label.
- Narrative
Therapy
- An individual’s life is
made of up stories, regarding how they perceive themselves and the world. These
narratives dictate how clients live their lives and shape their realities. Psychological
problems can come from the internalization of the narratives from the dominant
culture, which takes away the personal agency of the individual. Modernist
theoretical approaches would encourage clients to conform to the dominant narrative or simply
help them to cope with the socially constructed “truth” imposed upon them by
society.
- Clients are not reduced
to a diagnostic label.
How Does This Approach
View the Role of the Therapist?
- SFBT
- The therapist helps the
client become aware of their strengths so they can use these strengths to
create their own solutions.
- The therapist guides
and encourages the client towards change, but does not tell the client what to
change.
- Narrative
Therapy
- The
therapist has an active role, guiding the client toward change.
- The therapist helps the
client detach themselves from the dominant narratives they have internalized so
they can create their own stories.
- The therapist asks
questions to assist clients in coming up with their own answers.
- The therapist helps the
client work through their problems and helps them take steps to solve them.
How Does This Approach
View the Therapeutic Relationship?
- SFBT
- The relationship is
very collaborative. Therapists are not the sole experts in the therapeutic
relationship. Clients are the experts in their own lives and therapists are
experts in the therapeutic process. Together, they both bring their sources of
expertise to the table.
- The therapist strives
to create a relationship based on mutual respect and open communication.
- The client sets the
tone of therapy and of the relationship.
- Narrative
Therapy
- The client and the
therapist work together as experts to solve the client’s problems.
What Are the Overall
Goals of This Approach?
- SFBT
- Goals are specific to
each client and are created collaboratively by the client and therapist.
- Goals are small and well-defined
so clients will not become discouraged.
- Narrative
Therapy
- To make clients aware of
how the dominant culture’s narratives impact their lives.
- To invite clients to
create their own stories and take back their agency.
Integrating Approaches
Some therapists (myself included) prefer an eclectic
approach to therapy. Meaning they combine aspects of theoretical approaches and
techniques in order to fit who they are as therapists and to do what is best
for their clients. Self-disclosure time: I personally work from a postmodern
person-centered theoretical approach with some cognitive therapy interventions.
Meaning, the way I see the world, my clients and my role as a therapist is
influenced by post-modern and person-centered approaches. That said, I also see
the value of some of the techniques from cognitive therapy in cases of anxiety,
depression and phobias, for example. My specific theoretical orientation gives
me a firm foundation to work from while also providing me with enough
flexibility to work with clients as complex individuals and not as diagnoses.
Integrating theoretical approaches can go wrong if not done properly. A
therapist cannot just combine any theoretical approach and technique at random.
The approaches and techniques must complement each other. If they conflict at
their roots, the therapist does not have a proper clinical compass and is
basically a ship lost at sea. No one would want that person to be their
therapist.
The point of this post is to show you that all
therapists are not alike. Each therapist works from a theoretical framework
that seriously determines how they view you as the client, how they view
themselves as the therapist and the techniques/interventions they will use. Do
they see you, the client, as an equal partner-in-crime, as a student or as a
patient who needs their insight? Do not hesitate to ask a potential therapist
what their theoretical framework/orientation is. And then do a little research
to figure out how this framework dictates the way they do therapy. This may be
my personal approach showing, but do not think of therapy as something being
done to you. Think of therapy as something you do with your therapist. You have
power. You have agency. And I like to think that therapy works the best when
both the client and the therapist work towards a common goal. Part two of this
series will discuss your rights as a client.
