What is Psychotherapy, Anyway?

One of the most pervasive publicly-held ideas about psychotherapy is that it consists of the therapist simply listening to her client complain.  Everyone has seen the image of psychotherapy like this one:

toon283“All I want to do is lie around all day. This isn’t helping.”

In reality, none of the therapists I know work in this manner.  Instead, this modality is more consistent with a therapeutic style known as psychoanalysis, which is typically focuses on a client’s past, involves more frequent visits, and is commonly associated with Sigmund Freud.  This is what was developed at the psychotherapy’s beginnings; since then, a lot of research has been conducted, and many other styles of therapy have been created and tested.

Each therapist chooses his or her own style of treatment, including what is called their “theoretical orientation,” which basically means the way in which the therapist views her clients her beliefs about why people develop certain symptoms, and the best way to treat them.  Some that may seem familiar: psychodynamic, cognitive-behavioral, family systems, dialectical behavioral, and humanistic therapies.  Each has their own explanation of clinical psychological disorders, and each has their advantages and disadvantages.

There is also an entire body of research supporting the idea that a therapists’ theoretical orientation does not matter per se, as long as they provide their client with certain basic things – called “common factors theory” – their client will improve.  These common factors include things like warmth, empathy, and trust.

Most therapists I know do not ascribe to or use only a single theory.  Most, myself included, would describe themselves as using more than one, depending on the client. On the other hand, I also have very distinct leanings towards cognitive-behavioral therapy (or, CBT).

Part of the reason for this is my own personality; I am a person who likes structure and who enjoys color-coding, making spreadsheets, creating schedules, and following a specific plan.  Another reason why I like CBT is because, among many of the most popular orientations, CBT has a remarkably strong body of research supporting its results.

A part of this is assuredly because, by it’s nature, it is structured and therefore more easily lends itself to scientific inquiry (as compared to psychoanalysis, where there is no step-by-step procedure).  And, to be sure, many factors affect what gets studied and what does not.

All the same, to me, the science speaks loudly and I consider that part of my job is maintaining an awareness of the most current research in my field.  I believe that doing the best by my clients means using the information available paired with my own judgment and instincts.  For me, CBT is comfortable and effective.  And when I am most comfortable, I am most effective in helping my clients achieve their best results.

Still, it’s not right for everyone, and that’s why I don’t use it with rigidity; I use interventions from other theories and I listen to what my clients are telling me they need – even if they never use those words.

Ultimately, my job is to do the best for every client and that means tailoring treatment to the unique needs and preferences of each person, couple, group, or family with whom I work.  So I use the science available as much as possible, all the while knowing that said research is imperfect and that the human mind and relationships remain more complex than modern science can address.