Therapists Differ and so do Their Approaches

In the most basic sense, therapy is a form of treatment for disorders.  However, not every person that seeks therapy meets the full criteria for a clinical diagnosis, thus therapists are often engaging a client regarding presenting problems.  These issues may or may not lead to diagnosis, but more often than not, are affecting the individual’s overall functionality.  So, while you as a client may feel that you need therapy, understand that you may not be receiving treatment for a disorder. In many cases, at the request of the client, therapists seek to assist the client with restoring or increasing the client’s level of functionality (often recognized by the client as balance, happiness, meaning or fulfillment).  This process typically includes a clinical assessment of the client’s level of functionality, and a determination on whether or not the client’s thoughts or actions meet the criteria for diagnosis.

In order to provide therapeutic assistance, therapists use their experience and expertise, which may be derived from a variety of tools, techniques, theories and models.  Because of the vastness of the research, experiments and studies that have occurred over time, there are an abundance of valid (proven) approaches to therapy that may be chosen by a given practitioner.  While there is no identified “best” approach to therapy, the client’s situation and the therapist’s competence play a large role in determining which model the therapeutic engagement will follow.  If you are interested in seeking therapy, it may prove helpful to understand what specialties potential therapists claim, as well as what approach(es) to therapy they practice.  Below is a comparative look at a few popular therapeutic models.

Reality Group Therapy versus Structural Family Therapy

While applying the Reality Group Therapy method, the therapist focuses on the individual’s control of their behaviors.  The clinician aides the client in performing a self-evaluation in which they identify the quality of their behaviors, then determines what the contributors of their failures are.  The therapist’s role is to guide the client through the process of developing a plan of action to eliminate these behaviors, and then hold them accountable throughout the execution of the devised plan by confronting them and identifying any possible deterrents or reasons for any incapability of completing the plan.  The therapist and client work closely together to formulate the plan of action for the client to modify the behaviors causing their negative emotions in order to reach the desired outcome.  Whereas, in Structural Family Therapy, the therapist emphasizes the dysfunctions of the family as opposed to strictly the individual’s control of the issues.  Abiding by the Structural approach limits the therapist’s overall involvement as he is not used to establish intensive reparative for the family members, but to simply outline the framework, develop the foundation for reframing, and then encourage the family to continue a positive progression of growth.  The Structural therapist’s role is to be an active agent in the process of restructuring the family, emphasize clear boundaries, facilitate the unearthing of hidden family conflicts and then outline the manner in which the family can modify them.

Person-Centered Therapy versus Strategic Family Therapy

The Person-Centered therapist is one who is congruent, removing all sense of authority and de-masking of professionalism.  To be an effective Person-Centered therapist, it entails revealing personal information if it is an accelerant to the progression of therapy.  Typically therapists have the general understanding of the limitations when involving self-disclosure; however, in Person-Centered therapy the clinician is transparent.  Person-Centered therapy is client-guided as they explore their life experiences, and with the aid of the therapist, analyze their history and the result is the client resolving their own issues.  In this approach, it is vital for the therapist to exude unconditional positive regard, providing no criticism, guidance for behavior, or discouraging them from any behaviors.  In opposition, Strategic Family Theory requires the therapist to employ guidelines and directives, no matter how ambiguous.  The Strategic therapist pays extreme attention to detail and accepts only the positive, whereas the Person-Centered therapist must accept all aspects of the client—positive as well as negative.  Therapists abiding by the Strategic approach also develop a distinct outline for treatment involving defining the problem, investigating all solutions, defining clear change to achieve, and formulating strategy for change.

Rational Emotive Group Therapy versus Psychodynamic/Bowenian Family Therapy

Rational Emotive Behavior Therapy contends that individual’s belief systems are responsible for emotional consequences.  In theory, a client’s irrational beliefs could be effectively refuted by challenging them rationally and inevitably reducing the conflict.  In a group setting, the therapist takes a lead role in attempting to change the minds of the clients.  The therapist can accomplish this without fostering a “warm” relationship with the clients.  In a group setting, there is potential for judgments to be made of group members by other members of the group, which may prove of benefit or detriment to the therapeutic experience.  Rational Emotive Behavior Therapy holds that humans have the equal potential to be rational or irrational, and both preserving and destructive.  Therapists must promote clients to confront their behaviors as well as accept their faults.   Additionally, Rational Emotive Behavior therapists claim that it is possible to assist clients with changing their behaviors as a means to restructure their way of thinking.  In this light, the therapist must continue to encourage self-discipline as well as self-direction.  The primary similarity between Rational Emotive Behavior therapists and Psychodynamic therapists is that the principle focus of both is essentially for the client to reach full self-reliance, and operate at a high level of differentiation by exploring and developing their own autonomy.  The Psychodynamic therapist accomplishes this not through confrontation, but through examining the client’s family of origin, constructing and dissecting a multigenerational diagram, and guiding the client to remove emotionality from their family system and begin approaching it from an objective approach in order to identify its highest level of functionality.

Because these comparisons are very general it may prove helpful to conduct further research regarding any approaches that are of interest.  Additionally, understand that there are a multitude of other approaches to therapy as well and the best interpretation for you to have regarding any approach is the interpretation used by your therapist.  Understand that even though some therapist’s practices are based on the same principals, each therapist will inevitably approach therapy in their own manner.  This is to say that just because a certain therapy model was unsuccessful in the past with a specific therapist, you should not necessarily avoid seeking help from others utilizing a similar approach.

Atlas Concepts, LLC_Jordache WilliamsJordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.

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Finding a Good Therapist

Fields of Knowledge_Choose a Therapist

Though they have dissipated in the last decade to a degree, there are still stigmas regarding the world of mental health. Of those exists the thoughts that therapy is for “crazy people”, “individuals who need medication” or “those who have way too much to say and no one else to talk to”. The reality is that therapy may or may not be for any of those individuals and likewise may be effective for those who are often considered normally (mentally) healthy. Growing up in South Carolina I am very familiar with the phrase, “if it ain’t broke, don’t fix it”. While this maxim has proven very true in many instances, there are times when it doesn’t necessarily apply. I believe therapy to be included in this list.

Let’s switch gears for a moment and think about a scenario involving an automobile mechanic (pardon the pun). You speak to a mechanic over the phone and discuss with him the fact that your headlights do not work. The mechanic schedules you an appointment. When your car is returned to you, you are told that the issue with the lights has been repaired, so you render thanks (i.e. $). Before you leave you ask the mechanic what the issue was and he tells you that the problem was corrosion in your car’s fuse box.

Hold on a minute…you came for your headlights and he spent the last hour working on your fuse box? The point here is that while there are common issues that arise with individuals and families, those “in the mix” may not clearly understand the root of those problems. The mechanic could have changed the light bulbs, installed new wires and even changed your tires, but until he fixed the actual problem with the fuse box, the headlights would have never operated properly.

Yes, as a client, therapy at times may seem like a process that involves “going around your hip to get to your elbow.” So how do you find a therapist? In all actuality, many people go about it very similarly to how they arrive at finding “their” mechanic. People often consider items like location, reputation and cost(s). And while this process is understandable, it may not be inclusive. All therapists are not created equal.

The mechanic analogy is a great one, because it applies in so many ways. Another example is that many auto mechanics have specialties, whether it’s a specific make of vehicle, a specific component, etc. This holds true for therapy as well, though there are some “jack of all trades” out there, therapists may be better suited to work with clients with certain concerns or issues. When seeking a therapist, I encourage you to conduct some amount of research pertaining to the specialties of the practitioner. This may include contacting them directly.

Some therapists have the ability to utilize objectivity and empathy with a nearly artful balance, allowing “hard truths” to descend at the rate of the feather on Forest Gump (1994). Therapists can be practical, eccentric, rigid, playful, exotic…you name it. A therapist’s “style” is typically a mixture of their personality and the model(s) of therapy they practice. As a client, it is critical that you are comfortable with your therapist but you must understand that while personable may be comfortable, it does not necessarily mean therapeutic.

Let’s face it, a person seeking therapy is looking for something which they perceive they cannot offer themselves. The client’s goal going into therapy is, to at the end of the session or through the course of therapy, feel better…BE better. Unfortunately, the best understanding a client will get of what a particular therapist can offer is to participate in the process. This means paying for something that may or may not work. Here are a few tips for narrowing your options through conducting research, telephonic inquiries or attending a consultation.

  1. Trained – Often you can learn a great deal about a therapist’s level of training from the internet. Company websites, business review pages, LinkedIn and other social media sites may offer insight into the level and type of training a therapist has attended. Consider the scholastic reputation of institutions of which the therapist is affiliated. Programs which are evaluated and accredited by notable organizations and entities may elude to the quality of the educational and training experiences thereof. In general, therapists are required to participate in continued education annually in order to maintain licensure. Because these educational experiences are chosen by the therapist, such experiences can reveal some of the therapist’s recent interests and/or concerns.

 

  1. Experienced – Not to be confused with how long a therapist has been in the profession. Time and experience can often be uncorrelated concepts. To determine the type of experience a therapist has consider what they claim as “specialties”. Experience in itself does not make a therapist suited for all clients; however, it may allude to a level of comfort and proficiency with their work, an ability to adapt and generally represent their “brand”. Therapists are as diverse as their experiences, a key to aligning yourself with an appropriate therapist is to discover their success with issues similar to your own. Experience is a progressive step from the training environment which leads to the next topic…

 

  1. Competent – Very easy to agree with but possibly not as easy to identify as one would imagine. Competence can initially be masked by accolades, fast talk and promises of success. While a clean and inviting office environment, polite administrative staff, short wait times and a nice business suit may allude to a professional environment, these may not necessarily be clues of therapeutic competence. Competence speaks directly to the therapist ability to use therapeutic intervention to assist a client with attaining goals. Testimonials and reputation are great gauges of competence.

 

  1. Culturally appropriate – While it is incumbent for therapists to be attentive to ethnic and multicultural diversity, the truth is that some therapists are more suited for a specific gender, race or ethnic group. This is not to say that you should strive to find a therapist who is similar to you because that is not necessarily the best fit based simply on racial identity. There are indeed individuals who are not “of” the group of which they work with best. Go beyond the surface when looking for a therapist, the best therapist for you may not look like you and may not be located on a side of town you frequent.

 

  1. Ethical – There is no greater must in therapy. The ethical considerations of the therapist should be outlined and discussed as a part of an informed consent process which precedes therapy. Though your personal ideals may not be directly aligned with those of the therapist, it is the therapist’s responsibility to conduct therapy in a manner that is not offensive or harmful to you (the client). The counseling professional you choose will likely be affiliated with a licensing body based on the credentials they hold. These licensing and professional organizations set the minimal standards for ethical conduct. Find more on ethics from the American Psychological Association, the American Counseling Association and the American Association of Marriage and Family Therapy.

 

  1. Credentialed – Often mistakenly equated with competence, in actuality, credentials more closely relate to training. I am adding a note regarding credentials because the list of acronyms associated with many of these professionals can be confusing. The truth is that the credentials of a therapist are more relevant to other counseling professionals than they should be to clients. These credentials essentially align counselors with specific governing agencies and/or organizations. As a client, you are protected by the organizations with which licensed and credentialed therapists are affiliated. Don’t be confused by credentials, or get bogged down trying to sort them all out. For clients, the most relevancy of a therapist’s credentials may be the limitations regarding insurance coverage or reimbursement. Additionally, clients should understand that they may contact relevant credentialing bodies to report unethical conduct of a therapist.

Atlas Concepts, LLC_Jordache Williams

 

Jordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC.  He is a Certified Life Coach and holds a Master’s Degree in Human Services.

Therapist Self-disclosure

The matter of self-disclosure in the professional therapeutic setting is one that can be daunting to understand.  Foremost, disclosure in therapy is most identified as originating from the client.  Many of us picture a somewhat small, dimly lit office where the client is lying down with their eyes closed telling their personal secrets.  In many instances, however, this is not so.

Therapy has become so diverse that a generalization such as this can be very far from the reality a client faces when they enter the therapeutic setting.  So aside from not really knowing what to expect regarding the physical environment, clients are also leery about the process of therapy.

It is helpful for clients to understand that therapists have also undergone similar thought processes, such as the internal debate regarding how much of themselves they are to share.

Therapists teeter between disclosing too much and not enough about themselves to clients.  As a therapist, where do you draw the line? As a client, what are your expectations?

In general, self-disclosure should be used at the discretion of therapists with the intention of promoting wellness while avoiding harm at all costs (i.e. primum non nocere).  Self-disclosure is a natural (or promoted…or even integral) part of several models of individual and group therapy, thus for therapists practicing such models it is necessary in many cases.

Other models of therapy do not require therapist’s self-disclosure, and may even work more effectively if such disclosure is avoided.  So for therapists, the answer is to understand your model, and work within that frame…be comfortable and be authentic.

Hint: As a client, if you have the opportunity to research and select a therapist, you should consider what you perceive to be your presenting problem and evaluate the approaches of the potential therapists.

Not all therapists are created equally and some therapeutic models have been evidenced to work well with specific issues.  You also want to consider qualifications, credentials and reputation, but this will be covered more extensively in another blog.

As a client, you should expect therapists to be forthcoming with their particular intentions regarding the progression of the therapeutic experience, which may or may not include their intentions regarding self-disclosure.  At any case, therapists’ disclosure should be in keeping with the intent of the therapeutic experience as outlined during the process of informed consent.

The process of therapist self-disclosure is unique to each therapist, and clients who may have had previous experiences must understand that their own expectations can make their experience more or less productive.  If, as a client, you were forced to change therapists (e.g. because you relocated), you may be jaded.  If you discontinued seeing a therapist in search of a better experience, you may be disheartened by having to start over again (i.e. the administrative processes and the initial “introduction” sessions).

If you are completely new to therapy then your understanding of the uniqueness of therapists will prove helpful.  You are making an important decision in your life, and, in that regard, being informed is a process which you can directly influence…being informed is also something you should expect during the course of therapy.

In other words, be informed going in and be even more informed coming out.

Atlas Concepts, LLC_Jordache Williams

 

Jordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC.  He is a Certified Life Coach, holds a Master’s Degree in Human Services, and is an aspiring therapist.