What Kind of Therapist Are You?
One of the most significant and revealing aspects of your graduate education will be discerning your theoretical orientation. As you progress through your graduate training, you will take a course – or many courses – that will explain various theories, or schools of thought, in psychology. These schools of thought outline how different psychologists over the years have viewed the development of mental illnesses and how these illnesses should be treated. Your theoretical orientation is almost like your unique sense of style as a clinician. It influences the way you assess, diagnose, and treat clients. It also helps a therapist connect with like-minded clients who view the world and, therefore, change from the same perspective.
The Importance of Finding Your Theoretical Orientation
Why is your theoretical orientation so important? Carrying on with the sense of style reference, you wouldn’t want to leave home without expressing to the outside world who you are and what they can expect from you. Sure, style is a blanket statement and various individuals can be completely different, but still share the same style. Therapists are similar. With more than 400 theoretical orientations out there, you are bound to have some overlap.
Nonetheless, your theoretical orientation guides virtually all of your clinical decisions. The techniques you use, your treatment plans, and the way you measure change may be closely linked to the theories you work from. If you are not channeling your theoretical orientation in your therapy, then your treatments may be all over the place and you may have a limited ability to measure client progress. Doing so will undoubtedly cause you to appear incompetent to your clients. Theoretical orientations are a way to ground therapists and give them a foundation to work from.
Furthermore, knowing your theoretical orientation helps you connect with clients that will be good matches for your style. Many clients may find you through referrals and use your services without any regard to your therapeutic style. On the other hand, some clients will fit best with a therapist who can work well with their personality, culture, educational level, and religious affiliation. While it’s certainly not necessary to have the exact same views or background as your clients to help them, when a client and therapist interact well, treatment outcomes are considerably better.
What Are the Theoretical Orientations?
As mentioned previously, there are hundreds of possible theoretical orientations to choose from. Below is a description of the four common orientations you can expect to encounter in your graduate training in psychology.
Psychoanalytic (or Psychodynamic) Theories
Popularized by the Austrian neurologist Sigmund Freud, who is considered to be the Father of Psychoanalysis, psychoanalytic theory emerged as a dominant force in the field of psychology in the late 1800’s. Since that time, it has expanded to include psychodynamic theory and various other approaches that stem from advancing research into the human mind.
Regardless of the specific direction of followers of psychoanalytic theory, most approaches share the same basic fundamentals. That is, they all believe that human behavior is motivated by both conscious and unconscious forces, which take root in early childhood and progress throughout human development. When a person suffers from a psychological or emotional issue, it is the result of conflicts occurring between the conscious and unconscious. Defense mechanisms keep these unconscious forces in motion through resistance. Additionally, psychoanalysts advocate the significance of transference in client reactions, meaning present situations are affected by those that precede them. Therefore, how a client reacts to his therapist is guided by how he once reacted to his parents, siblings, friends, and lovers. As a consequence, the relationship between the therapist and the client is central to the healing process in this approach.
How Therapy Works
Modern psychoanalytic treatment approaches focus on helping clients bring the unconscious forces that are driving their behaviors into awareness. These forces are seen as the root cause of problems ranging from anxiety and depression to marriage and work problems. Psychoanalysis is an intensive form of treatment in which the analyst and the client meet up to 5 times weekly for several years. This orientation also offers other forms of psychotherapy which may be less intensive in structure.
Cognitive Behavioral (or Behavioral) Theories
Behaviorism describes a psychological movement that shifted from internal forces to external forces of behavior. The movement was founded by John B. Watson, and one of his chief arguments was that thoughts were unobservable and, therefore, should not be studied. Actions, or behaviors, on the contrary, were the only objective aspects worthy of scientific inquiry. Such proponents of this theory include classic experimental psychologists such as Ivan Pavlov and B.F. Skinner. The major tenets of behaviorism are targeted at a stimulus and a response. For example, an individual was placed in this situation which caused them to behave this way.
Noteworthy due mostly to the work of Albert Bandura, social learning theory attempts to explain behavior through the interaction of three variables: the environment, the behavior, and psychological processes. With his model, Bandura stepped away from strict behaviorism and opened the doors for the cognitivist movement. His premise is that human behavior and learning is influenced by a complex network of observations made about the behaviors, beliefs, and emotional responses of those in our environment.
Built on a cognitive model, cognitive-behavioral theory directs its focus on the thought aspects that behaviorists find unworthy of study. This more recent movement emerged from behaviorism and social learning theory. Cognitive behavioral theorists view behavior as a consequence of learning history and a person’s internal thoughts, beliefs and expectations. For instance, you are placed in a situation and you behave a certain way. However, it is your previous understanding of the situation, coupled with your thoughts and attitudes that drove your behavior, not the situation itself.
How Therapy Works
Cognitive-behavioral therapy is not a distinctive form of therapy on its own. Rather, it can be conducted under the guise of various approaches, such as Rational Behavior Therapy, Rational Emotive Behavior Therapy, Cognitive Therapy, and Dialectical Behavior Therapy among others. In general, the therapy is based on the idea that individuals in distress will often form irrational beliefs about themselves or the situation. The goal of therapy is the help clients identify the erroneous thought patterns and assess their accuracy. Once, irrational thoughts are examined, clients can learn skills to alter these thought patterns for more adaptive thoughts. According to the Beck Institute, “when [people] think more realistically, they feel better.”
CBT tends to use evidence-based techniques, be briefer, more action-oriented, and time-limited, with clients averaging about 16 sessions. The therapeutic relationship, while important, is not the focus of the therapy. Instead, problem-solving and change is brought about through the collaborative effort of both the therapist and the client.
The humanistic approach was developed in response to psychodynamic theories failing to acknowledge certain principles like an individual’s subjective understanding and positive growth as opposed to pathology. Forerunners were therapists Carl Rogers and Abraham Maslow. These theorists propose that it is not necessary for behavior to be objective in order for it to have meaning. Human beings are capable of assigning their own meaning to behaviors through their subjective experience of the world.
To humanists, people are, at their core, good and healthy. Distortions of these natural tendencies – described by Maslow as self-actualization – toward goodness and health manifest in the form of mental illness, criminality and other issues. In humanism, the human appetite towards positive regard and positive self-regard is highlighted. All humans long for the love and attention of others. In fact, we assign our views of ourselves and thus our self-esteem and self-worth through the positive regard we receive from others. Yet, the world applies conditions of worth in order for us to receive positive regard. Parents, teachers, and the media only show positive regard for us when we have proven ourselves worthy.
When humans do not live up to their expectations of themselves, incongruity occurs. This is suffering. The humanist approach strives to find congruity between a person’s real self and their ideal self for optimal functioning and self-actualization.
Closely related to humanistic psychology is existentialism. Rooted in existential philosophy, this theory utilizes phenomenology to explain human experience. The events, relationships, memories, fantasies, thoughts, acts, and feelings we experiences directly influence how we view the world and our own existence. Where humanism emphasizes acceptance and growth, existentialism uplifts the concepts of responsibility and freedom. Nonetheless, the two schools of thought are united in their focus on understanding the human experience and directing energy towards the individual rather than symptoms displayed by the individual.
How Therapy Works
Humanistic psychotherapy, sometimes referred to as person-centered therapy, involves a therapeutic relationship that is accepting, collaborative, authentic, and that gives consideration to where an individual is in their life. It elevates all aspects of an individual: biologically, psychologically, socially, and spiritually. Therapy takes into account the client’s goals and expectations while clarifying the therapist’s role as the helper. The client’s strengths and weaknesses are regularly assessed as they apply to the presenting concern.
Some may argue that the integrative, or eclectic, approach is not a theoretical orientation at all. Nonetheless, when asked most therapists, will endorse having an integrative approach to treating their clients. What is an integrative theory?
Integrative theory was founded in an attempt to unite various aspects of many orientations with the assumption that the resulting theory would highlight the most effective approaches of its parts. This movement occurred for several reasons: due to the steady rise of new theories in psychotherapy that created an atmosphere of competition among clinicians; due to the ineffectiveness of any single theory to treat clients from different walks of life and with different problems; due to the ineffectiveness of any single theory of fully explaining or predicting human pathology; due to the growth of briefer, concentrated therapies; due to the increasing collaboration among clinicians; due to changes in the structure of the mental health care system with greater regard for short-term, prescriptive, problem-focused therapists; the recognition of commonalities among all orientations; and due to the development of professional organizations that advocated for integration.
Integrative therapies are not a one-size-fits-all grouping of precise theories. Instead, these therapies emphasize the importance of developing a framework that allows the clinician to use approaches that are most effective for their clients.
How Therapy Works
Integrative psychotherapy incorporates convenient and evidence-based treatments from a range of approaches with respect to which approaches are effective for specific disorders. A therapist may work from three or four orientations, but selectively use two that have a strong research-basis for treating a particular client. The goal is to holistically enhance an individual’s functioning while underlining a client’s inherent value in all areas of life.
How to Determine Your Theoretical Orientation
Now you understand that fully understanding and developing your theoretical orientation is essential for professional development within the field of psychology. The next step is figuring out how to get there. How do you determine your theoretical orientation?
The first step in figuring out which theoretical orientation aligns with your views is to receive a thorough understanding of the principles and techniques that characterize each one. Gaining exposure to different orientations, either through your faculty or internship experiences, is also vital. Keep in mind that your faculty members as well as professionals at your internship sites may teach their own orientations. Therefore, you must be proactive in gaining insight into orientations that are not commonly taught or used in your graduate training.
A paper prepared by Micere Oden for graduate students and early career psychologists instructs students to engage in meaningful self-reflection as another vital step towards developing their orientations. Your theoretical orientation should align with your goals and vision as a therapist. How do you see yourself engaging with your clients? Do you want to focus on the past, present or future? Do you want to be direct in motivating change or let the client move at his own pace? Answering questions such as these can provide you with useful information. Plus, you should consider personal experiences, beliefs, values, and your perspective on how humans grow and change. All of these variables will be important in developing your own theoretical orientation.
In addition, you should conduct research on the client populations or presenting problems that you are primarily interested in. Some populations are more receptive to and more effectively treated by particular orientations more than others, requiring that you adopt an integrative approach to best help them.
For help finding your theoretical orientation, consider taking this insightful quiz presented by The Society for the Advancement of Psychotherapy.