Should a Therapist Have a Theoretical Orientation?

December 12th, 2012

     Is it good to have a working model from which one directly pulls during therapy or is it better to have none and work from scratch with each client?  As with most extremes, working in the middle seems more appropriate.  Both extremes have their distinct advantages and disadvantages.
     Working from a model provides the clinician with a sound foundation, off of which he can issue thoughts and attempt techniques.  These ideas have been milled down to their finer points and through practice, the practitioner makes them his own.  Strictly working from a certain viewpoint can be very inefficient, through.  If a client presents with depressive characteristics due to ideas an "inner language/dialogue" with himself, an analyst cannot move from home territory to talk about such communication.
     On the other extreme, one without orientation can be dynamic and compelling.  He can feel free to flit around the various models and use what seems appropriate at the time.  A problem may arise when he is asked why he is taking route A instead of route B.  Is he doing it because he thinks that B is grounded in better evidence-based research or that he feels more comfortable with it?  Maybe.  But it seems to me that such abstract knowledge disallows depth of insight into one (or more) particular categories of therapy.  If the therapist knows a little about a lot, will he ever know a great deal about something more specific?
     And so I think that a home base with much knowledge of other areas may be the best way to go.

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October 4th, 2014

     I find it unsettling when people ask me what my "theoretical orientation" is.  It's a dumb question.  Why does it matter?  What box does a such a term put me in?  Why can't I partake of many things?  I have this image in my head that ACA or APA conventions or conferences are a little like gang hangouts.  I picture a ballroom where analysts are in one corner with their cigars and conservative cravats; humanists are in another corner hugging each other and softly whispering, "I hear you."  CBTers  and true behaviorists in a third corner are re-programming passersby only to wash this behavior extinguish rapidly.  I know that such a thing doesn't really happen, but part of me would really like if it were the case.
     That all being said, if I had to pick a psychotherapeutic backer, it would be something very phenomenological and human potential-based.  Authors that come to mind are Husserl and Heidegger for phenomenology and Rogers and Perls for human potential.  I choose these not only because they closely follow my own thoughts and observations on human behavior, but also because they give me the freedom to supplement their incompleteness with other styles' techniques.  I think it is very OK to harness the power of REBT when speaking of a client's fear of public speaking.  I just don't think that REBT is a very good starting point in understanding the client.
     My opinion tends toward the view of decreasing the limits on self.  I find so many theories inherently limiting.  CBTers can only use CBT.  Behaviorists will only use behaviorism.  Analysts with their analysis.  Choosing a theory, while it seems to be almost compulsory anymore, is not a good idea.

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November 11th, 2014

     We must ask ourselves why we ask the question of someone's foundation theory.  Is it for our benefit or is it for the benefit of the client?  From a strictly professional point of view, the answer would most definitely involve the client more than the practitioner (perhaps substituting should for would would make that sentence a little more powerful).  But how does this benefit the client?  Yes, different techniques will be used and the therapist will approach the client from a specific standpoint, but if we look at each therapeutic theory, they are all interconnected, meaning that each is just another reframe of the former.  There is much in various theories that blurs the lines between different, if not opposing, theories.  For instance, irrational beliefs in REBT are so ingrained into the client's psyche that they most likely could be aggregated and be called the unconscious, a more Freudian term.
     If we assume this, then we all seem to be coming at theory from different points, yet all are hitting something that bears fruit.  So this can't be for the client, because no matter where we come from, we'll most likely be able to affect them positively.  It must be for us.  What use do we have for this designation?  It seems somewhat idiotic to eschew one way of thinking for another due only to a particular school of thought's doctrine.  Thinkers are supposed to take in voices from all sides of the equation, digest them, and allow some of the good ones to permeate their thought process.  This will give them new avenues of thought.  It seems that without new blood, some theories will stagnate and die out.
     So why do we do this odd exclusion and choice warfare?  Aren't we supposed to be empathetic and understanding professionals?  It could be, just like in any other business where multiple people are involved, that there must be an us-vs.-them designation.  While I think that this is natural (as it seems to be a human reaction to happiness or strife or lack thereof), to an extent I would think that clinicians would have the understanding nature that would allow them to not engage in such behavior.
     This point would be moot if it were not for the fact that there is much distress in the (at least beginner) clinical community as to which general psychological philosophy to choose.  This can stunt us or retrain us to think differently about other theories or practitioners.