There are dozens of different approaches to psychotherapy. My bookshelves overflow onto the floor with books about ACT, CBT, ecotherapy, Gestalt, psychoanalysis and more. But are all these approaches just the decoration on the cake?
Not long after completing my initial training in psychotherapy, I became aware that most other therapists had been taught specific approaches to many of the most common mental health challenges. They’d done modules on what we call ‘presenting issues’ like bereavement, anxiety, depression and whatever else. I felt somewhat confused, as my extensive training – a Masters degree and then Focusing-Oriented Therapy – hadn’t covered any of that. We’d considered some of the key approaches, but in each case highlighting their limitations and the danger of a theoretical ‘frame up’; fitting the client’s unique experience into the frame of a theory.
Keen to be a better therapist, I started to learn about all the things I thought I’d missed. I learnt about the techniques I might use to help with specific presenting issues. Then I ‘caught up’ on classic CBT and some of the newer approaches that have emerged from it. But the curious thing is I don’t use techniques very much and I’m beginning to suspect that my original training had it right all along: Psychotherapy isn’t about doing but simply being. What I remember most from my training are the hours we spent in group work and the years of personal therapy. We were being developed as people rather than taught techniques because theory, though fascinating, is just the icing on the cake.
To a large extent, the research backs this up. The Dodo bird hypothesis claims that all bona fide therapeutic approaches have much the same outcomes: “Everybody has won and all must have prizes,” just as the dodo insisted in Alice in Wonderland (Wampold et. al 1997). In fact, the therapeutic relationship is more important than the approach we use: It’s more about who you are than what you do.
Given all that, I’m wondering about the constant flow of new approaches. Almost every month I hear about some new technique which will transform my therapeutic work and will give my clients a unique healing experience. Do I need to sign up for the latest course or would I be better off spending more time just developing my capacity to be present?
Really needed to read this. Thank you for writing it.
I’m very pleased it was helpful.