Wednesday, April 25, 2012

Eclectic Therapists

It sounds good on paper.

Commenter NYNM wrote this in response to my post about getting over therapy:

Not only are there different kinds of therapy, there are different goals, and different preferences from the client.

It is a cliche to say that therapy is "rehasing the past" or to retreat to Freudian charactures that died with him in 1939. Well trained therapists know many techniques and use them appropriately. I find it is the non-therapist who continue to discuss "therapy" as a foil to promote why "their" approach is better. We don't need a "mine is better than yours", we need a realistic sense of which approach (coaching, CBT, eclectic, psychodyanamic) would be best for a particular client at a particular time. 

I have copied it as is. Obviously, NYNM was writing in haste.

I assume that when he aims at non-therapists he is talking about your humble blogger, who is, truth be told, a recovering therapist and recovering psychoanalyst.

One point of information: Freudian treatment most certainly did not die with Freud in 1939. It is currently moribund, but it had an impressive run for decades after the war.

Be that as it may, NYNM brings out an important point. Many therapists today declare themselves to be “eclectic.” They provide insight-oriented therapy for those who want or need it, cognitive behavioral therapy, or CBT when useful, coaching when necessary… the list can easily be extended.

Those who call themselves eclectic have a simple rationale: one size does not fit all, so therapists offer different services to different patients.

We all know that there are dozens of different kinds of psychotherapy.

This, in itself, is relevant. When a field is mired in that level of diversity one suspects that therapists have not found a technique that is so effective that it has driven the others out of the market.

One exception is psychoanalysis, which no one really considers to be an effective therapy any more.

Another exception is phobias, which specifically require behavioral treatments.

In most cases, research suggests that the most important part of therapy is the ability of patient and therapist to make a human connection. This would suggest that, with the exception of psychoanalysis, which forbids such a connection, the therapist’s approach is not as important as his interpersonal skills.

If we want to call things by their names we can say that therapists who say that they are eclectic, who they promise to offer different therapies for different problems, or who even promote their offices as places where you can go for one-stop-shopping are employing a marketing strategy. 

On their websites or web pages more and more therapists will offer a laundry list of the kinds of treatment they declare themselves qualified to offer.

In fairness we need to voice some objections to the eclectic approach to therapy.

What if an eclectic therapist is really "a jack of all trades, master of none."

In other words, a therapist who can offer a multitude of different therapies might be a professional dilettante.

Which would you prefer, a specialist or a dilettante?

If you needed medication you naturally prefer to be treated by someone who specialized in the field, instead of someone who wrote an occasional prescription and who had not taken the time to inform himself fully about the latest scientific information about medication.

But, NYNM might be suggesting that therapists are mostly specialists who evaluate the best treatment option for each patient and then refer their patients out for different forms of therapy.

In truth, it does happen some of the time, but more often, I fear, therapists call themselves eclectic and offer treatment in which they have very limited experience.

For example, many therapists want to lead their patients on an exploration of their minds and hearts. They have very little experience giving advice.

So, when they do give it, they tend to be very bad at it. Not because they are bad people but because they have no experience with it.

I would also add that psychodynamic approaches are so radically different from cognitive-behavioral approaches that one can legitimately ask how a single individual can switch mindsets so completely.

You cannot induce a person to explore his past while at the same time you are helping him to plan for the future.

Even when patients want to talk about the past, the purpose of therapy is to allow them to put the past behind them and to look toward the future.

Alpert and I are really addressing a slightly different issue. What happens when a patient comes to your office expecting to explore his past and you know that he would do better to learn how to manage his current crisis and make an action plan for the future?

If you like, let’s stipulate that many therapists, regardless of what they call themselves, and regardless of the kind of training they have done, really prefer to do what Alpert and I suggest.

In most cases, patients come to therapy because they are having problems dealing with complex moral dilemmas. Effective therapists treat them by doing something akin to coaching. 

Clearly, they have very little interest in saying so. Their professional training and their referral networks involve adherence to one or another form of therapy, so they continue to say that that is what they are offering.


vanderleun said...

In a very real sense isn't most therapy a way of "rehasing the past" -- after all if we could only "rehave" the past then, we believe, we could fix it.

Or is it just pretty to think so.

JP said...

"In a very real sense isn't most therapy a way of "rehasing the past" -- after all if we could only "rehave" the past then, we believe, we could fix it."

The problem with life is that you don't have any idea how to make choices, but you have to make choices, so you make random choices (because you have to choose *something*) and then spend the rest of your life regretting your life.

But I think that's a feature of life.

"Life can only be understood backwards; but it must be lived forwards."

Søren Kierkegaard

Dennis said...

Maybe I am missing something here, but I learn from the past. I don't try to dwell on it. I make mistakes, I learn from them. This seems to me more like trying to treat symptoms instead of trying to cure someone.
One cannot change what one did in the past. The past is the past. One has to live in the present to create a future. The "What If" game is a waste of time that could better be used living and succeeding in the present.
Mistakes are a feature of being human.r

nynm said...

The past serves to illuminate the present. It's like history in general. Unfortuantely, to dismiss history (of any sort) trivializes the present. So should we forget the Civil Rights movement and just focus on the present? The Holocaust?

I have found that, in therapy, it can be respectful for clients to "understand" the past (to some extent). I did not say dwell in the past, I said understand it, as a way to change the present. It's like saying "How did that happen?" to help with changing it. It is my experience clients often know how they think and act is irrational, and then just criticize themselves for being "irrational". When they see the beginnings of their reactions, and then the development of it, they accept it more easily as a beginning to change. Understanding the past is the beginning to change, but it is not the goal in itself.
"Those who cannot remember the past are condemned to repeat it." (Santayana)