Least popular counseling theories?

[foreverbull]

My theories textbook discusses several theories, some of which seem to have fallen off the map in actual practice.
I would love to hear from you all about which of the less-popular theories in my textbook you haven't heard of ANY colleague/grad school practicing/training in depth throughout your entire career. This will help inform me which information isn't quite as practically useful to teach students, although we are a small sample size. I already have a few theories in mind that I've never heard of anyone practicing in the field and would love to see if you all have the same feedback.

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[Ollie123]

Make sure you include the 1-2 obscure therapies originating in Japan that each only have a handful of articles published on them, but for some reason are part of the EPPP.

I've literally never-ever heard them mentioned in any context at all outside of the EPPP. Which is why I don't even remember their names now.

 

[DynamicDidactic]

Sometimes terms are used across theories. In this case, is Narrative the one where you write about yourself?

Also, for those that chose Gestalt, just look over some of the master's-level folks in your area and I am sure you will find someone endorsing this orientation.

Finally, there are two professional schools (3 campuses) that are named after Adler. Plenty of folks out there that concentrate on the inferiority complex.

 

[BuckeyeLove]

95% or more always say "technically eclectic." Which means.....i sit and talk with you and reflect with some ok interviewing skills, maybe some introspection, reflection, basic goals discussed, and out the door you go. Rinse, wash, repeat. all....day.

 

[psycho1391]

My question is how often is REBT discussed when talking about cognitive behavioral thories.

 

[cara susanna]

I had a supervisor in grad school who identified as an Alderian

 

[clausewitz2]

My neck of the woods has a cluster of card-carrying (doctoral-level!) Gestalt types, so I may have a skewed idea of its prevalence.

Make sure you include the 1-2 obscure therapies originating in Japan that each only have a handful of articles published on them, but for some reason are part of the EPPP.

I've literally never-ever heard them mentioned in any context at all outside of the EPPP. Which is why I don't even remember their names now.

Are you trying to tell me that you aren't using the Morita therapy on the regular? Shocking, just shocking.

EDIT: Okay having read up more on it I am kind of shocked the ACT people don't really acknowledge it as a precursor. Take away RFT and basically seems like "what Steve Hayes would have been doing if he lived in the 1910s and was Japanese".

EDIT EDIT: Also a version of it was translated into English and published in the mid-80s (Constructive Living). I wonder if it's not entirely a coincidence.

 

[iliketohelppeople]

In graduate school at a community-based externship site with folks from all sorts of programs (from FSPS PsyDs to R1 PhDs), I sat through a fellow student case study presentation that focused on Adlerian theory, in particular, birth order.

 

[foreverbull]

My question is how often is REBT discussed when talking about cognitive behavioral thories.

It’s in textbook CBT chapters as foundational to CBT, but in practice, doesn’t seem anywhere near as popular as Beck’s CT.

I’m curious about its use today. I don’t hear a lot of folks in my generation using it, although a former professor from NY saw Ellis deliver a lecture. That was decades ago, though.

 

[foreverbull]

Thank you all for the comments and votes!

I forgot about the Adler school in Chicago—but many of you picked that one as unheard of, interestingly.

Also, most of you concurred based on the results that Reality/Choice therapy is extremely rare to hear about. I have never met a practitioner of that theory and it never gets discussed when theories are mentioned in conversation. Anyone know any practitioners?

 

[MCParent]

My question is how often is REBT discussed when talking about cognitive behavioral thories.

Endlessly if you took my grad theories class.

Kidding aside, I’ve always found Ellis’ stuff to be some of the most easily graspable therapy approaches. I also found it valuable to have an example of a therapist who wasn’t a teddy bear.

Fun fact: Ellis made my undergrad research mentor cry at an apa at a therapy demo

 

[EnPsychlopedia]

My question is how often is REBT discussed when talking about cognitive behavioral thories.

Not often, but I got a lecture and live demonstration of REBT by Albert Ellis' late wife when I was in my M.A. program, and she made sure to stress how much her husband's work provided the necessary framework and inspiration for Beck.

 

[AbnormalPsych]

I love Ellis' work.

Also, most of you concurred based on the results that Reality/Choice therapy is extremely rare to hear about. I have never met a practitioner of that theory and it never gets discussed when theories are mentioned in conversation. Anyone know any practitioners?

I had a mid-level secondary supervisor in a community practicum in grad school who taught us some of this and used it on a few cases. Not particularly memorable to me all these years later, but I do remember it was fun trying out, and not entirely practical in day to day outpatient work.

 

[WisNeuro]

I love Ellis' work.



I had a mid-level secondary supervisor in a community practicum in grad school who taught us some of this and used it on a few cases. Not particularly memorable to me all these years later, but I do remember it was fun trying out, and not entirely practical in day to day outpatient work.

It has its place, but in today's current MH zeitgeist of infantilizing the patient, it would not do well.

 

[psycho1391]

It has its place, but in today's current MH zeitgeist of infantilizing the patient, it would not do well.

I incorporate it into my pain groups with Vets. There is a video of Ellis that I show and they love it. Often I do use his ABCDE model when explaining unhelpful thoughts.

I got my primary certification in 2021 in REBT which is a rarity among practitioners around my same age.

 

[foreverbull]

I’m curious what you all think are the top 3 major counseling approaches used today in practice out of the following taught in textbooks:

-CBT (includes REBT, CT, ACT)
-Contemporary psychodynamic (IPT, Self-psychology, Object-relations, Attachment, etc.)
-Person-Centered
-Solution-Focused
-Existential
-Family Systems (Satir, Bowen, Minuchin, etc.)
-Narrative
-Feminist
-Behavioral
-Adlerian
-Gestalt
-Reality/Choice

CBT is certainly at the top, but I think the other two would be an interesting topic of debate in here.

 

[borne_before]

My neck of the woods has a cluster of card-carrying (doctoral-level!) Gestalt types, so I may have a skewed idea of its prevalence.



Are you trying to tell me that you aren't using the Morita therapy on the regular? Shocking, just shocking.

EDIT: Okay having read up more on it I am kind of shocked the ACT people don't really acknowledge it as a precursor. Take away RFT and basically seems like "what Steve Hayes would have been doing if he lived in the 1910s and was Japanese".

EDIT EDIT: Also a version of it was translated into English and published in the mid-80s (Constructive Living). I wonder if it's not entirely a coincidence.

I like, literally, have no idea what gestalt therapy is. I've done a deep dive, and for the life of me, just cant grasp it.

 

[borne_before]

I’m curious what you all think are the top 3 major counseling approaches used today in practice out of the following taught in textbooks:

-CBT (includes REBT, CT, ACT)
-Contemporary psychodynamic (IPT, Self-psychology, Object-relations, Attachment, etc.)
-Person-Centered
-Solution-Focused
-Existential
-Family Systems (Satir, Bowen, Minuchin, etc.)
-Narrative
-Feminist
-Behavioral
-Adlerian
-Gestalt
-Reality/Choice

CBT is certainly at the top, but I think the other two would be an interesting topic of debate in here.

I think the number one is not CBT - it's just active listening and LARPing as Rogers. No prep, patient gets a release, you can go into auto mode and collect a couple hundo. Just knowing someone is in your corner is probably an excellent treatment for 95% of the worried well.

 

[WisNeuro]

I’m curious what you all think are the top 3 major counseling approaches used today in practice out of the following taught in textbooks:

-CBT (includes REBT, CT, ACT)
-Contemporary psychodynamic (IPT, Self-psychology, Object-relations, Attachment, etc.)
-Person-Centered
-Solution-Focused
-Existential
-Family Systems (Satir, Bowen, Minuchin, etc.)
-Narrative
-Feminist
-Behavioral
-Adlerian
-Gestalt
-Reality/Choice

CBT is certainly at the top, but I think the other two would be an interesting topic of debate in here.

If we're talking about what most people are getting in therapy in a broader sense, I would agree that it's probably not CBT. From a lot of the masters level folks, it's some surface level mishmash of CBT/supportive listening/half-assed dynamic stuff. If we restricted it to psychologists, then I'd say CBT is probably number 1.

 

[PsyDr]

I think the most popular form of therapy is "Whatever absolves the person". How psychotherapist label that approach seems to vary.

Which is an easier sale?

a. "You are responsible for your actions. Your negative behaviors can be changed through effort."
b. "You are not responsible. Your brain made you do it. And trauma made you do it."

Selling absolution is easier than selling hard work. There's a reason for Ozempic being more popular than Calories In Calories Out. Therapists are not immune to those market forces.

 

[WisNeuro]

I think the most popular form of therapy is "Whatever absolves the person". How psychotherapist label that approach seems to vary.

Which is an easier sale?

a. "You are responsible for your actions. Your negative behaviors can be changed through effort."
b. "You are not responsible. Your brain made you do it. And trauma made you do it."

Selling absolution is easier than selling hard work. There's a reason for Ozempic being more popular than Calories In Calories Out. Therapists are not immune to those market forces.

b.) Late-stage capitalism and society made you do it

 

[foreverbull]

I like, literally, have no idea what gestalt therapy is. I've done a deep dive, and for the life of me, just cant grasp it.

You’re not alone in that. I’ve read multiple books by Perls and others and some parts of the theory are just so unnecessarily abstract and also jargon-laced (contact, continuum of experience, figure/ground and organismic self-regulation) while others are easy to grasp and far more intuitive, like integrating and accepting all parts of ourselves, experiential techniques, I-and-thou/here and now, etc. My main takeaway from Gestalt is that we need to allow emotional experiences in the present and become more aware and accepting of the parts of ourselves that we deny to be healthy. But the latter piece is a legacy from psychodynamic theory, so not original, anyway. Everyone takes pieces from other theories!

It seems like with some of the theorists, the idea is that the more confusing the jargon, the more impressed we’re supposed to be.

 

[smalltownpsych]

My question is how often is REBT discussed when talking about cognitive behavioral thories.

Rare as a therapy in and of itself, but as others stated, very important as a foundation for CBT. I also find Ellis himself helpful in training clinicians because of his personality and style. Exposing trainees to a lot of different styles is helpful for them to find their own. I am way more like Ellis than I am like Beck or Rogers. We even watched some fictional tv therapists during our training. Dr. Melfi from sopranos being one that I recalled.

 

[ClinicalABA]

Fun fact: Ellis made my undergrad research mentor cry at an apa at a therapy demo

One of my favorite conference experiences was AABT (now ABCT) in New York in 1996. Moderated discussion with Joe Wolpe and Albert Ellis. Wolpe talks about imaginal systematic desensitization, while Ellis sits there looking agitated (which may have just been his baseline affect). Wolpe finishes and Ellis says "I don't get it- if you're afraid of god damn snakes go the f**king zoo and look the mother f**king snake in the eyes!"

 

[Ollie123]

If we are going to discuss the most popular, I think it is important to distinguish therapeutic identity from what people actually perform.

I agree "supportive therapy" is certainly the most commonly performed, but I'm not sure anyone would identify it as their modality. In part it occurs from lack of training, but also oftentimes it can be an uphill battle to do anything else, particularly in settings where you don't have much direct control over your caseload or the powers-that-be dictate "You must keep seeing this person" regardless of their genuine interest in engaging. I don't mind admitting that while I almost invariably started out with some form of CBT when practicing, for a decent chunk of my cases (predominantly of the mild-moderate depression/GAD/life stress variety) it would morph into vague supportive therapy at some point along the way if they weren't really engaging and there was some pressure to keep them engaged.

As identities, I'd vote CBT & dynamic as overwhelmingly the most common identities. The number of people who claim to be dynamic but appear to know less about psychodynamic theory than my hardcore-CBT-self is astounding though. I doubt anything else even comes within a mile of those two.

Most commonly practiced?
Supportive therapy, CBT-lite, and a vague solution-focused/problem-solving approach. Assuming we're talking general population across all therapists for all populations and all things.

 

[foreverbull]

You all might find this interesting:

Barth & Moody (2018) - Discussing current trends:

"In 2010 Cook et al. conducted a study of psychotherapists from the United States and
Canada. Participants included social workers (36%), professional counselors (23%), psychologists
(17%), and marriage and family therapists (17%) (p. 261). The results indicated that
CBT (79%) was the most popular approach followed by family systems (49%), then mindfulness
(41%), psychodynamic/analytic (36%), with Rogerian/client-centered/humanistic
(31%) rounding out the top five (p. 262). In addition, only 2% of participants reported using
a single-theory approach.
Orlinsky et al. (2011) surveyed psychotherapists from the United States, Canada, United
Kingdom, Ireland, Australia, and New Zealand. Thirty-eight percent of participants identified
as counselors, 32% as psychologists, and 9% as social workers (p. 832). Participants reported a
strong preference for a broadly humanistic approach (48%), followed by analytic/dynamic
(38%), cognitive-behavioral (29%), plus another 9% for cognitive (other than
cognitive-behavioral), and systemic (25%) (p. 832).
Schofield and Roedel (2012) conducted a study in Australia in which 70% of the participants
identified as counselors. Similar to the results of Orlinsky et al.’s (2011) study participants in
this study also demonstrated a preference for a humanistic approach (39%). Other saliently
preferred theories included interpersonal 38%, family/systems theory 33%, experiential 32%,
analytic/psychodynamic 32%, and cognitive 25%. Five percent of participants reported no
salient orientation, whereas, 36% reported 3 or more salient orientations (p. 16)."

It doesn't seem like anyone has conducted any studies in this decade yet, but I could be wrong.