Just curious

[IrmaJean]

I don't know if it's okay to ask such a question, but I was wondering what types of therapists we have here on the boards? Orientation and such? If it isn't okay to ask or is an invasion of privacy or something please ignore this. I've noticed different approaches and I was just wondering if this was more of a personal thing or an orientation thing. I find it interesting either way.

[David O]

Good morning IrmaJean,

This is an excellent question and one every client should ask their therapist before they begin the process. The question I always ask is: What is best for this particular client, at this particular time, for this specific situation/condition--- and what is the client’s goal?

My approach is integrative (although I tend to lean towards the cognitive-behavioral, brief and family as a cultural system)--meaning it takes what may be most effective from various approaches/strategies (and there are >500 approaches now), but the issue is much more complex. For example, I also look at:

• Culture- in many Asian cultures, the family reflects a highly traditional role structure for each family member, so this must be taken into account. Some cultures have prohibitions against self-disclosure, or toward control. Some Arab cultures resist emotional exploration and view American needs for self disclosure, constant self analysis and emotionality as unhealthy, counterproductive and self absorbing. However, therapists must also see beyond the distinct margins of a specific culture and look at the individual as made up of a confluence of different influences.
  
• Women often respond differently to therapy, and to drug therapy- communication differences may also affect therapy.
  
• Men also tend to give reports while women try to establish rapport
  
• The client’s condition, someone with paranoid personality or Schizoid disorder will respond suspiciously to warmth, understanding and compassion whereas, someone with depression and feelings of worthlessness would respond openly to understanding and sensitivity.
  
• Poverty- what role does being poor play in the condition and client trust of an outsider looking in
  
• Gay men and lesbians bring still being another view to gender roles in the therapeutic situation
  

And we can’t forget the role of managed care, which now leads to brief therapy- six weeks is common, and 16 is considered lengthy. One objective of brief therapy is saving clients (but mostly the insurance company) money and time. So money can dictate what we do, even if it flies in the face of our better judgment. I personally don’t accept insurance, which allows me to do what is best w/o outsiders telling me what and how to do it.

I’m sure there are other views here, but this is mine. There is no right or wrong and no best therapy in general, most of it depends on the competence, warmth, compassion, sensitivity, and understanding of therapist, and the relationship between the therapist and client. Orientation or therapy model is secondary—the relationship is key!

Sorry about the very, very long winded answer. Tough question if you look closely.

David

Edited October 24, 2009 by David O

[IrmaJean]

Thanks, David O, for your informative response. I suppose it is a complex question, knowing all that is involved in choosing the best way to proceed with individual clients. There a lot of factors to take into account that I hadn't thought of, including different cultures. That must be very challenging.

I never thought to ask my therapist about all of this going into therapy, so I suppose I am just very lucky that he was such a good match for me. I really agree with your assessment that the relationship is the key. There seems much to discover about oneself in just looking at that.

I have found it rather fascinating on here seeing how all of you approach different situations in your own way and then try to adjust to the person you're trying to help. Each of you is recognizable in that way, I think. It's interesting.

Thanks.

[David O]

Thanks, David O, for your informative response. I suppose it is a complex question, knowing all that is involved in choosing the best way to proceed with individual clients. There a lot of factors to take into account that I hadn't thought of, including different cultures. That must be very challenging. At first it's a nightmare... all that training and training (13-14 years) and you're still at a loss once you start doing the real work. The interesting part is that you're always learning.

I never thought to ask my therapist about all of this going into therapy, so I suppose I am just very lucky that he was such a good match for me. I really agree with your assessment that the relationship is the key. There seems much to discover about oneself in just looking at that.

I have found it rather fascinating on here seeing how all of you approach different situations in your own way and then try to adjust to the person you're trying to help. Each of you is recognizable in that way, I think. It's interesting. I would have loved to hear how others approach this. I know, for example, that there are others here that no matter what and how far we go into talking with someone, still approach the client completely differently than I would. There's no right/wrong, just a difference.

Much of this is about where and how well you trained... even decades later!

Great question IrmaJean!

Thanks.