What's your theoretical orientation?

[Ya Ya]

I've always wanted to ask...

What's your current theoretical orientation? Did it change? What are some of the limitations of this orientation (in your opinion)? Also, if you were experiencing psychological distress (but not necessarily a diagnosable disorder), what would you want the orientation of your therapist to be?

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[heshmonster]

Cool question, similar to something I've been thinking about/asking people lately.
I'm primarily psychodynamic/psychoanalytic, but it really depends on the patient, and their level of functioning. I've found that in actual patient interaction, I'm more open to things like CBT (which, on a purely theoretical/intellectual basis, I think is inadequate), depending on the needs and "modes" of the patient. One thing that is overriding any treatment modality, though, is a decidedly humanistic/existential approach to therapy, whereby the integrity of the relationship and the focus on the phenomenology of the patient, are primary. The goal of therapy being to restore some sense of meaning in the face of (death, illness, interpersonal strife, etc.), and to facilitate individuation. Here I'm very much like Yalom or May.

In my theoretical/academic work, I am very psychoanalytic, with a healthy mix Freud, Fromm, Becker, Jaspers, and Rank thrown in. My work is in culture and psychopathology, and so it makes sense to be psychoanalytically orientated (the "deep" origins of culture, the sense in which culture and mind "make each other up", etc.).

And, if was experiencing distress, I would most certainly seek out a psychoanalyst or existential therapist. I'm not interested in scratching the surface of my cognitions, attempting to "re-write" them, but rather in seeking the source of their fertility. Psychoanalysis, when adequately understood and modified (as in Rank or Fromm's analysis), is wonderful for high functioning clients in helping them to dissolve the boundaries between their neurosis and the potential for meaningful, creative output. If I was SERIOUSLY ill, and was having psychotic episodes, I might seek out a psychiatrist first to do away with the psychoses, and then some form of depth therapy to explore the psychoses and its potential meanings.

But, then again, I might just spend more time at the symphony...

 

[futureapppsy2]

In very broad terms, CBT, with more emphasis on "B." Also, I tend to be a big fan of motivational interviewing as a technique. I haven't had that much therapy experience, so I guess it could have changed (past-tense because I'm moving to a pure research program next year--I'll really miss therapy, though! ), although I would have been surprised,

I tend to be very research/EBT-focused, and I've noticed research-focused people tend to trend more to CBT/BT. I sometimes wonder if this has anything to do with the collecting "evidence"/testing hypotheses cognitive components and the data collection behavioral components of CBT in addition to the strong empirical support, tbh.

ETA: Didn't see the "who would you see?" part. Definitely someone who practiced EST--I would probably be an awful client because I might ask for citations.

 

[cara susanna]

Third wave behaviorist. Mine didn't change, although I've become more of a staunch behaviorist in grad school. If I were in distress, it depends on what I was seeking help for. For most things, I'd probably want someone with a CBT or behaviorist orientation.

 

[The Everglow]

I'm pretty much strictly Skinnerian. There is no mind, there are no thoughts or feelings, just stimulus and response.

 

[Ollie123]

I frame my orientation is EBP, in this case indicating I hold no allegiance to one method beyond what evidence suggests is optimal for a given situation. In clinical practice, I rely primarily on CBT with incorporation of some third wave techniques. I'm perhaps a bit heavier on the "C" than those above, but it depends heavily on the situation (i.e. with anxiety disorders I tend to be far more heavily behavioral). I teach behavior modification though, so obviously have a behavioral background. Research is another matter though. I've had very negative experiences with folks who identify as pure behaviorists and now do my best to avoid working with anyone identifying as such.

My approach has certainly become more refined since entering grad school, but hasn't changed dramatically. If I need therapy, I would insist on seeing someone with a background in ESTs - the details would depend on the presenting problem. I've worked in environments where they were not used and it has only reinforced my view that I would never, ever, ever want to be one of their clients/patients.

 

[PsychBoxe]

At this point, the cognitive-interpersonal framework presented by Safran and Segal really connects with me both in theory and in application. Combining the realms of constructivist, cognitive psychology with the psychodynamic conceptualization of the therapeutic relationship creates a layered, integrated approach.

 

[Shatani]

my internal orientation tends to be object relations...that's just how i've come to think about things. mine changed in that, i didnt have one before grad school...hadnt really thought about it. so, i guess it evolved.

in my practice i'm all about schema focused therapy...

i think i'd like to be in schema therapy.

 

[ChildhoodAlumni]

"Someone's got to do some more research, but I would really like to know:
when a CBT therapist really gets distressed, who does he go see? I just
have a strong sense it's not another CBT therapist. I think he wants to
go out and search for somebody who's wise and can help him explore
deeper levels."

Irvin Yalom

 

[AcronymAllergy]

I stick with CBT-based interventions when it comes to the actual therapies I deliver, as those are the ones with which I feel the most competent. For conceptualizing cases, though, it's generally a mish-mash of a variety of orientations and theories.

Were I to ever seek out therapy, the orientation of my therapist would likely depend on the types of problems I was having. In general, though, I'd probably be most comfortable with a predominantly CBT-oriented individual.

 

[Doctor Eliza]

I am eclectic with psychodynamic leanings. I remember reading that most full-time therapists identify as eclectic.

It was interesting, during my time in my program the program shifted from having very dynamic and analytic faculty and students to having very CBT focused faculty and students. There was practically a war between the old guard and the new, which each being dismissive of the other approach. It seemed silly to me to be so closed-minded. Different things can be helpful To patients and (especially as a grad student) broad exposure can be useful.

CBT feels like a bad fit for my own personality. But I certainly have had patients where it seemed like it would be the right thing for them and so I wove some of it into treatment.

Sample size of 2, but FWIW my two friends who are CBT therapists sought out dynamic therapists for their own therapy.

Dr. E

 

[Pragma]

How's about "integrative" or "biopsychosocial" Can we think of more ways to say "I use whatever is needed by the client" ?

I'm a little biased towards CBT/behavioral approaches, but my favorite approach was always solution-focused. Miracle questions and short term stuff resonate well with me.

I also always wanted to try a paradoxial intentions, but never got a chance to.

If I were to seek treatment, it would depend a) what the problem was and b) how much I actually wanted to change. I'd probably branch out if I were trying to become a better therapist or self-actualize.

 

[erg923]

How's about "integrative" or "biopsychosocial" Can we think of more ways to say "I use whatever is needed by the client" ?

I'm a little biased towards CBT/behavioral approaches, but my favorite approach was always solution-focused. Miracle questions and short term stuff resonate well with me.

I also always wanted to try a paradoxial intentions, but never got a chance to.

If I were to seek treatment, it would depend a) what the problem was and b) how much I actually wanted to change. I'd probably branch out if I were trying to become a better therapist or self-actualize.

How can one "integrate" multiple approaches?

Many approaches conceptualize things very, very differently and will 1.) focus treatment on completely different things, 2.) view the etiology of the disturbance or meaning of behavior in very different ways. It seems much more honest to say "eclectic," cause I don't think you can really integrate 3 different approaches in any meaningful or sensible way.

Frankly, "integrative" sounds like it was made up by bunch of academic folks who think its really important that we hold on to all this theory and pretend we can always figure out what's going on with a patient so we can feel better about why we do the things we do in session...

 

[Pragma]

How can one "integrate" multiple approaches?

Many approaches conceptualize things very, very differently and will 1.) focus treatment on completely different things, 2.) view the etiology of the disturbance or meaning of behavior in very different ways. It seems much more honest to say "eclectic," cause I don't think you can really integrate 3 different approaches in any meaningful or sensible way.

Frankly, "integrative" sounds like it was made up by bunch of academic folks who think its really important that we hold on to all this theory and pretend we can always figure out what’s going on with a patient so we can feel better about why we do the things we do in session...

Well, I was being a little lighthearted about it myself, because I am not a therapist anymore and don't want to be. When I was during training, "integrative" meant that I wasn't going to be tied to just one approach for every client in the broad sense. More specifically, it meant that perhaps you might be doing more than one thing within therapy with one client (e.g., motivational interviewing regarding some of their problems and more strict CBT for others).

It is quite possible to "integrate" more than one approach within therapy, but it really depends on the client. I agree with you that some approaches are probably mutually exclusive, but some of them may work well together.

 

[Pragma]

It seems much more honest to say "eclectic," cause I don't think you can really integrate 3 different approaches in any meaningful or sensible way.

To this point specifically, I think "eclectic" is too artsy for me. It seems to mean that you derive your awesome therapist knowledge from different sources, and use that knowledge however you see fit. It doesn't seem that the therapist's purpose has to have much evidence behind it, and lends itself more towards the "intuition" epistemology.

I could 'integrate" (or combine) methods if the goals of therapy warrant it. I might be using MI to work with a depressed client who wants to stop drinking, and CBT to augment these efforts with some strategies for relapse prevention and to reduce depression. It seems like each method could be "combined" in therapy to help the client's goals (sobriety and reduced depressive symptoms), and each tactic is evidence-based.

I don't know, I'll defer to the 'real" therapists for this issue.

 

[Doctor Eliza]

I was advised to use the term "integrative" as a substitute for "eclectic" on internship apps to emphasize that I had theoretical knowledge rather than just using whatever strategy I thought might work.

I do believe that there is a way that one can be thoughtfully eclectic (as well as a way to be haphazardly eclectic). Also, I would like to clarify that being an eclectic practitioner does not necessarily mean that you are applying a whole bunch of conceptualizations and strategies to any one client. It also can mean that you thoughtfully choose an appropriate conceptualization and intervention strategy on a case by case basis.

For example, this has come up for me with OCD treatment. My (more typical) exploration of relationship patterns would not be nearly as useful as symptom-relieving behavioral and cognitive strategies.

Dr. E

 

[erg923]

To this point specifically, I think "eclectic" is too artsy for me. It seems to mean that you derive your awesome therapist knowledge from different sources, and use that knowledge however you see fit.

And that's bad because....

 

[Pragma]

And that's bad because....

Because I think it is a bit arrogant to think that one is endowed with knowledge such that they know how to handle any issues a client faces, because they got *some* training. The part of my quote that you left out should answer your question - I think that those therapists that rely too much on their intuition, and not enough on the current evidence available in the extant literature regarding how to approach treatment, probably are less effective overall.

I am not saying that intuition is not an important part of one's repertoire. But, much like "clinical judgment" I think it is too vague for it to be your primary resource (if eclectic means what I think it means). We've all probably had supervisors whom we disagreed with at times, and at least in the case of my own therapy training, I occasionally encountered some folks who were more inclined to "go with their gut" than to try a new approach with evidence behind it.

This is actually part of what made me decide not to be a therapist. I think a lot of therapists out there practice with too much of an emphasis on their own intuition, probably don't terminate clients when they should (perhaps for economic reasons), and sometimes provide reasons for people to regard our profession as an art more than a science. I wasn't motivated to pursue a career in therapy for other reasons as well.

Disclaimer - yes some elements of psychology are more qualitative, some "art" is okay, and sometimes circumstances may require one to deviate from an evidence-based practice. But I am not about to go out and call myself 'eclectic" because I think that implies, IMHO, too much subjectivity.

 

[Shatani]

I am eclectic with psychodynamic leanings. I remember reading that most full-time therapists identify as eclectic.

It was interesting, during my time in my program the program shifted from having very dynamic and analytic faculty and students to having very CBT focused faculty and students. There was practically a war between the old guard and the new, which each being dismissive of the other approach. It seemed silly to me to be so closed-minded. Different things can be helpful To patients and (especially as a grad student) broad exposure can be useful.

CBT feels like a bad fit for my own personality. But I certainly have had patients where it seemed like it would be the right thing for them and so I wove some of it into treatment.

Sample size of 2, but FWIW my two friends who are CBT therapists sought out dynamic therapists for their own therapy.

Dr. E

i know that these days eclectic is a dirty word! our professors told us not to say that on job interviews!

i suppose i think of myself as client-centered....the way that i conceptualize things in my head tends towards object relations as i mentioned earlier, but what i DO depends on what my clients NEED. i think that's how most clinicians operate....willing to be wrong on that, but hope i'm not!

 

[Ollie123]

Agree regarding eclectic...to me it just conjures up images of folks flying by the seat of their pants with little rhyme or reason for what they do. This is almost certainly biased by the folks I've interacted with who identify as eclectic, many of whom simply used it as an excuse for not actually knowing anything or having proper training in any modalities. That's not directed at the folks here...just what I've encountered.

As I see it, the ease/possibility of integrating varies substantially by client. As an obvious example, the "C" and the B" certainly have different origins, but have obviously been effectively integrated. One could certainly incorporate MI components as a lead-in or sporadically throughout treatment for ambivalent clients, etc..

To me, its just a question of when and how these things are done. To me, integration (or "eclectic" if preferred) is something that needs to be done with an appropriate degree of caution and full understanding of what one is doing. Unfortunately, that seems to rarely be the case in many settings.

 

[Neuropsych2be]

I am psychodynamic with an emphasis on object relations. But I am very respectful of the other orientations. I frankly started out as CBT but moved into psychodynamic work when the limitations of CBT became real apparent to me during a year long practicum. But I could also say I am integrative on both a theoretical and practical level because I use what works for the client. I really regard myself as a person who derives a model from general systems theory and I view the different orientations as representing different aspects of a very complex system. Change can occur in a complex system through any number of interventions. The brain is the single most complex object known to science and *all* of our theoretical orientations are an insult to that fact. All of our theoretical formulations are inaccurate, flawed, and incomplete because none of them can encompass the complexities of what it means to be human. I enjoy object relations because in many ways I see it as comparable with many aspects of CBT while it also encompasses a rich developmental understanding of clients rooted in attachment theory and the development of internal working models etc ....

 

[AcronymAllergy]

I am psychodynamic with an emphasis on object relations. But I am very respectful of the other orientations. I frankly started out as CBT but moved into psychodynamic work when the limitations of CBT became real apparent to me during a year long practicum. But I could also say I am integrative on both a theoretical and practical level because I use what works for the client. I really regard myself as a person who derives a model from general systems theory and I view the different orientations as representing different aspects of a very complex system. Change can occur in a complex system through any number of interventions. The brain is the single most complex object known to science and *all* of our theoretical orientations are an insult to that fact. All of our theoretical formulations are inaccurate, flawed, and incomplete because none of them can encompass the complexities of what it means to be human. I enjoy object relations because in many ways I see it as comparable with many aspects of CBT while it also encompasses a rich developmental understanding of clients rooted in attachment theory and the development of internal working models etc ....

+1. As my advisor likes to say: in 20 years, most of what we think we know about the brain is going to be wrong, but it's all we've got to go on right now.

 

[JeyRo]

I frequently call myself "eclectic-integrationist," although because of my training as geropsychologist and the dominance of CBT in my specialty area, my case formulations tends to be primarily CBT in orientation (with a dash of dynamic theory), and most of the interventions I use are CBT in nature (when you have a hammer, everything looks like a nail). Essentially, by default my orientation is CBT.

I should say eclecticism when run by "intuition" is just laziness, poor training, or both.

Technical electicism, when it's dictated by selection of empirically supported interventions (across orientations) that are best suited for relevant client characteristics discovered through careful assessment - that's entirely a different thing.

http://en.wikipedia.org/wiki/Integrative_psychotherapy#Technical_eclecticism

also:

Beutler, L. E., Consoli, A. J. & Lane, G. (2005). Systematic treatment selection and prescriptive psychotherapy: An integrative eclectic approach. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 121–143). New York: Oxford.

 

[ClinPsychEnthus]

I am integrative, and think I can discuss how so in a manner that addresses erg's points, which are excellent... but be forewarned, this is a rather lengthy post.

A therapist CANNOT be "integrative" if they do not have a strong (very strong) grasp on the theoretical orientations that they draw from, including how to accurately conceptualize cases and implement interventions or techniques, or everyone's concerns about them B.S.'ing and flying by the seat of their pants is completely warranted.

My initial training was in family systems and client-centered therapeutic styles. During my Masters I interned at a college counseling center and a co-occuring substance dependence/mental health treatment facility. Family systems wasn't a helpful conceptualization or skill set for most of the presenting problems I worked with, and client-centered therapy techniques weren't tangibly helpful enough when it came to working with many of the disorders people were presenting with, including anxiety disorders such as panic d/o. Some of my supervisors clearly gave me training and supervision in using CBT for panic etc. after some failures with using the approaches I knew.

This is when I became a therapist who utilizes empirically-supported treatments. I was infuriated that any supervisor would allow me or have me use anything as a first approach that had no research backing as effective for treating a set of symptoms. I started attending trainings and getting CEUs in ESTs, reading more journal articles, psychologicaltreatments.org, psychotherapy brown bag... any and every resource I could on IDing and learning ESTs. Then I decided to continue on with school (rather than sticking with a terminal Masters) and chose a strictly CBT school, where I have intensively studied Cognitive therapy, Behavioral therapy, CBT, and some second and third-wave (but heavily CBT) approaches such as MI and Problem-Solving Therapy.

However, since my passion is working with complex co-morbidity between mental health, physical health, substance abuse and anything else under the sun, I have experienced the shortcomings of CBT. It can be rigid and inflexible (which at times is absolutely necessary/critical to the proper implementation of an intervention, like Prolonged Exposure and other exposure protocols such as EXRP... but at times is off putting to the clients), cold and/or impersonal (I've heard from clients, mostly related to its standardized format), and protocols technically HAVE to be integrated with a clinical rationale and strong enough research backing for any true co-morbidity, as so many studies on interventions isolate 1 disorder (this is easier for certain co-morbidities and more challenging for others). Then there's always the tricky part of the people who don't respond well to CBT or other ESTs, or who could be considered "treatment resistant," etc... or who have very chronic cases...

This realization is when I started receiving training and supervision in Acceptance and Commitment Therapy. I was an extern in a behavioral medicine placement working with persons with chronic and severe medical conditions, some of whom also experienced chronic serious mental health conditions as well as substance use disorders. Several of the supervising psychologists implemented ACT, so over the course of this last year I received training and supervision in it and Relational Frame theory, the empirical support for it thus far, etc... and it has completely revolutionized my practice. I've seen it be effective with several clients who were hitting walls in CBT, and have seen it tie together the overall treatment of co-morbid cases where one disorder was receiving primary intervention while others took a back seat for various reasons.

In order to do this well (back to erg's point and concern), I have to clearly conceptualize this person's presenting issues through the lens of the research, meaning what treatments are supported, which EST case conceptualizations appear to fit the client, and what conceptualization do THEY SAY fits them? Then ongoing review continues to dictate if the approach is being effective, as well as whether any alternative conceptualizations (that have empirical support) add to or potentially explain barriers. Again, this is discussed with the client, and at times additional theories are introduced (whether that is MI regarding a certain problem, developing communication skills or assertiveness, or incorporating ACT and ACT consistent approaches).

IF the treatment interventions are not consistently anchored in the research and a strong case conceptualization that is confirmed by the client, then the therapist is either flying by the seat of their pants, guessing, sticking with what they feel comfortable with, or making some type of assumptions. I also emphasize that however progress is measured, it must be measured on an ongoing basis to help both the client and the therapist know if they need to switch gears (which a therapist can do if they are well trained in multiple approaches, know their stuff, and have supervision and/or consultation) or refer.

To me, that is a responsible way to do therapy on multiple levels, and the best way that I can define my "integrative" approach to therapy. Admittedly, I my theoretical orientation is CBT first or as the core/basis, branching out from there. I honestly don't care what other therapists' core orientations are as long as they are ESTs.

Did that help anybody? I feel like I just wrote my theoretical orientation essay for the APPI.

Oh and lastly, if I were to see a personal therapist, I would absolutely see someone who practices from an ACT perspective. I'm applying a lot of the interventions to my personal life and am seeing personal growth and changes from it. However, the ADHD/grad coach type psychologist I see is very CBT. I definitely need the skills development emphasis there... but I wouldn't for personal therapy.

 

[ClinPsychEnthus]

I am psychodynamic with an emphasis on object relations. But I am very respectful of the other orientations. I frankly started out as CBT but moved into psychodynamic work when the limitations of CBT became real apparent to me during a year long practicum. But I could also say I am integrative on both a theoretical and practical level because I use what works for the client. I really regard myself as a person who derives a model from general systems theory and I view the different orientations as representing different aspects of a very complex system. Change can occur in a complex system through any number of interventions. The brain is the single most complex object known to science and *all* of our theoretical orientations are an insult to that fact. All of our theoretical formulations are inaccurate, flawed, and incomplete because none of them can encompass the complexities of what it means to be human. I enjoy object relations because in many ways I see it as comparable with many aspects of CBT while it also encompasses a rich developmental understanding of clients rooted in attachment theory and the development of internal working models etc ....

+1

...excellent and humbling points made here.

 

[ClinPsychEnthus]

I should say eclecticism when run by "intuition" is just laziness, poor training, or both.

Great way to word this, JeyRo, particularly with the research we have on the accuracies of "expert" intuition.

 

[paramour]

I thought this article re: how some folks might choose their orientation interesting: How do therapists decide which therapeutic orientation they prefer?

 

[roubs]

I also see myself as going in the direction of mindfulness enhanced CBT. And I wanted to add that "A CBT Practitioner's Guide to ACT" is a useful introduction to integrating these two approaches.

 

[ClinPsychEnthus]

I also see myself as going in the direction of mindfulness enhanced CBT. And I wanted to add that "A CBT Practitioner's Guide to ACT" is a useful introduction to integrating these two approaches.

I also liked that book, as RFT was quite the intellectual exercise for me... though, I think attending ACBS trainings and intensive bootcamps made the difference for me in feeling as though I was accurately integrating ACT with other approaches.

 

[cara susanna]

I like some components of ACT, but I have trouble understanding RFT.

 

[Iwillheal]

I feel like we're comparing cooking recipes. Doesn't feel very...scientific, lol. Reminds me of the Dodo bird verdict and that whole headache-inducing debate. So it's okay that I make my lasagna with eggplant, extra cheese, and tomatoes, and you make yours with asparagus, spinach, and chicken. It's all subjective, right? Okay, I know, not a good analogy. Personally I'm just exploring my own orientation. I do sense that certain approaches are somehow better or more useful (but can't defend it "empirically") like with CBT and phobias, or Bowlby's attachment theory and also the object relations theory when dealing with certain relationship dynamics.

The idea is not that unscientific at all, to be honest. Physics has its own problems too, in trying to find one grand theory and theoretical approach for understanding every phenomenon. So at high speeds, relativity may better explain some things and when working in very small dimensions, it's quantum physics, etc. Of course, our field is many times more fragmented than physics and with less clearly defined objectives, but the idea that certain theoretical approaches or frameworks or conceptualizations work better for certain types of problems is not necessarily indication of weakness of the scientific approach but may simply reflect the nature of the kinds of things studied...if that makes any sense. Where's my coffee!?

 

[roubs]

I feel like we're comparing cooking recipes. Doesn't feel very...scientific, lol. Reminds me of the Dodo bird verdict and that whole headache-inducing debate. So it's okay that I make my lasagna with eggplant, extra cheese, and tomatoes, and you make yours with asparagus, spinach, and chicken. It's all subjective, right? Okay, I know, not a good analogy. Personally I'm just exploring my own orientation. I do sense that certain approaches are somehow better or more useful (but can't defend it "empirically") like with CBT and phobias, or Bowlby's attachment theory and also the object relations theory when dealing with certain relationship dynamics.

They should all be subject to scientific scrutiny. I don't see how the existence of multiple methods/approaches drains psychotherapy of its rigor unless standards are lowered/bent in the service of having a larger menu of options. A discussion like this should lead to jumping into the lit.

 

[Iwillheal]

I agree Roubs. Though it is unfortunate that not every therapeutic approach receives as much scrutiny, as if some people have already made up their mind. Also I agree with your recommendation of "A CBT Practitioner's Guide to ACT."

 

[futureapppsy2]

They should all be subject to scientific scrutiny. I don't see how the existence of multiple methods/approaches drains psychotherapy of its rigor unless standards are lowered/bent in the service of having a larger menu of options. A discussion like this should lead to jumping into the lit.

I agree. As long as there's solid empirical evidence for a particular orientation with a particular issue, I see no issue.

 

[Iwillheal]

Oops, forgot to reply. I don't think it's as easy as you guys make it sound. What counts as "solid empirical evidence" is different for different orientations. For instance I have a lot of respect for Carl Rogers and for Maslow and the whole humanistic orientation but plenty of humanistic principles do not have the kind of empirical support that behavioral theories do. There is the issue of how easy it is to operationally define a certain concept. Again, behaviorism comes on top. There is the matter of bias in what kind of research gets funded. What kind of research gets published in prestigious journals.

I personally know a clinician who essentially don't consider the empirical evidence for the kind of therapy offer.ed I think s/he is cynical but claims it's about trusting one's intuition. S/he spoke to me about the Dodo bird verdict and many other controversies, telling me that at the end of the day it's about what works with a particular client, and the only people best judge of that are s/he and the client. I don't share that very subjective view and consider it dangerous but I also do think that it's difficult comparing evidence for different forms of therapy when people don't seem to be able to fully agree on what constitutes "solid evidence."

 

[Psychadelic2012]

I personally know a clinician who essentially don't consider the empirical evidence for the kind of therapy offer.ed I think s/he is cynical but claims it's about trusting one's intuition. S/he spoke to me about the Dodo bird verdict and many other controversies, telling me that at the end of the day it's about what works with a particular client, and the only people best judge of that are s/he and the client.

I'm surprised you only mention one clinician who fits that description! I can't tell you how many times, and I was just present for another group discussion like this, where therapists or therapists-in-training get all ramped up over certain therapies because "it just seems really cool!". I also know therapists who seem to like certain therapies because they enjoy doing them as a therapist, or they do it because the client requests the therapy specifically. Do they know anything about whether they work in that population or for that presentation? No. Frustrating.

 

[erg923]

I personally know a clinician who essentially don't consider the empirical evidence for the kind of therapy offer.ed I think s/he is cynical but claims it's about trusting one's intuition. S/he spoke to me about the Dodo bird verdict and many other controversies, telling me that at the end of the day it's about what works with a particular client, and the only people best judge of that are s/he and the client.

So..basically the kind of psychologist Paul Meehl refers to as Muddleheads?

 

[roubs]

Oops, forgot to reply. I don't think it's as easy as you guys make it sound. What counts as "solid empirical evidence" is different for different orientations. For instance I have a lot of respect for Carl Rogers and for Maslow and the whole humanistic orientation but plenty of humanistic principles do not have the kind of empirical support that behavioral theories do. There is the issue of how easy it is to operationally define a certain concept. Again, behaviorism comes on top. There is the matter of bias in what kind of research gets funded. What kind of research gets published in prestigious journals.

If a particular orientation wants to throw away or minimize the principles of science (as we can best apply them to the study of human behavior) that is a choice, not a requirement, not something they should get a free pass on.

Sure, a CBT therapist who neglects humanistic principles can undercut their efforts, but that doesn't mean they form a a complete therapy. Rather, they inform the process and are employed within a variety of orientations. They are a foundation. A clinician who decides it's sufficient to sit in a room and follow humanistic principles is basically practicing friend therapy. And I get that existential therapy is the apex of intervention based on these theories but the vast majority of the clinicians who espouse stuff like "at the end of the day it's about what works with a particular client, and the only people best judge of that are s/he and the client" aren't doing deep existential work; they are being lazy.

 

[Ollie123]

Likely as no surprise to anyone, I agree with the above posters. It seems foolish to dismiss science...particularly as a psychologist. It always comes up on this board, but I still have no idea how one can argue that certain types of therapy "cannot" be studied scientifically. I have yet to see a solid rationale for why that might be. What can't be operationalized there? I've heard it before, but never gotten a good answer.

Personally - my biggest concern is with the training of those who don't seem to believe in EBP. It doesn't seem to be about learning and rejecting...it seems to be more like "I don't get this science stuff and don't want to learn it....so I need to justify it". It actually comes up frequently on this board whenever we get a major proponent of the Dodo Bird verdict on here. As soon as I push even slightly on discussion of the methodology and the relative merits of the various literatures, the tower of cards has typically come toppling down and its become clear they had no idea what they were talking about. I'd wager many of them cite it because someone once told them "All treatments are just as good, and here is why" and they never looked any further than that. As roubs said, it generally seems to be a matter of sloth more than anything else.

I'd actually love to meet someone who didn't believe in EBP but could actually hang with me on discussions of it. It would make for some very interesting conversations.

 

[LivingOffLoans]

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[Qwerk]

Likely as no surprise to anyone, I agree with the above posters. It seems foolish to dismiss science...particularly as a psychologist. It always comes up on this board, but I still have no idea how one can argue that certain types of therapy "cannot" be studied scientifically. I have yet to see a solid rationale for why that might be. What can't be operationalized there? I've heard it before, but never gotten a good answer.

Personally - my biggest concern is with the training of those who don't seem to believe in EBP. It doesn't seem to be about learning and rejecting...it seems to be more like "I don't get this science stuff and don't want to learn it....so I need to justify it". It actually comes up frequently on this board whenever we get a major proponent of the Dodo Bird verdict on here. As soon as I push even slightly on discussion of the methodology and the relative merits of the various literatures, the tower of cards has typically come toppling down and its become clear they had no idea what they were talking about. I'd wager many of them cite it because someone once told them "All treatments are just as good, and here is why" and they never looked any further than that. As roubs said, it generally seems to be a matter of sloth more than anything else.

I'd actually love to meet someone who didn't believe in EBP but could actually hang with me on discussions of it. It would make for some very interesting conversations.

+3 Sword of Rightness.

Well, just be glad you're not in social work. The anti-scientific position is strong in certain areas of the field. (Macro practice springs to mind.) I have solid reasons for choosing social work over psychology, and I love my profession to death, but the unscientific mindset that some of my classmates and co-workers share really grates on me. I think social workers in general have a wider range of orientations toward science. On one end of the spectrum, you've got social workers performing empirical research and using evidence-based practices. On the other end...sigh...you have the healing crystal crowd. I don't know if psychology has that particular crowd -- at least, I imagine it's a bit smaller.

 

[fullmetal1381]

I like some components of ACT, but I have trouble understanding RFT.

Cara,

I don't know if you have read it, but I would recommend the book "Learning RFT" by Niklas Torneke, M.D. Both Hayes and Barnes-Holmes recommend it for grasping RFT without going through the (somewhat-cyclopean) purple RFT book.