Rabbi Azriel Hauptman
A theoretical orientation is the therapist’s understanding about how psychological problems develop and how these problems are treated or changed. There are countless theories out there, and as a therapist’s personal journey progresses, he or she will gravitate towards a handful of approaches and these become the bedrock of their entire method in treating clients. The purpose of this article is to highlight the roadblocks to effective treatment when the therapist does not embrace any specific theory or theories and therefore lacks a coherent approach to therapy.
To illustrate what we mean, let us pick two approaches that are on the polar ends of psychological theory, and they are psychoanalytic theory and cognitive-behavioral theory.
Sigmund Freud famously developed psychoanalytic theory that understands that unconscious urges and desires that have their underpinnings in early childhood experiences are the primary driver of human behaviors and emotions. According to this theory, if your subconscious thoughts can become conscious then you will no longer be bound by them and you will achieve relief from your mental health disorder. Therefore, gaining insight into the root of your thoughts and emotions is the foundation of this form of therapy.
Cognitive-behavioral theory takes a completely different approach. This theory understands that thought distortions and maladaptive behaviors are the cause of psychological disorders. Relief can be achieved through teaching the client new ways of thinking and reacting. Delving into the past is not necessary.
This extremely simplistic presentation of two theories of human behavior shows how two people can look at the same situation, and view it in two totally different frameworks. You might ask that if there are numerous ways of conceptualizing human behavior and there is arguably no specific right or wrong way, then why must a therapist have a specific orientation?
In order for a therapist to guide the treatment, the therapist must be able to think clearly about the situation that is presented by their client. If a therapist is aware of the hundreds of orientations and techniques that exist in the field of psychotherapy, and has no specific methodology, then their thinking process regarding any specific client will be confused and disoriented as they try to contain in their head all the different ways that this can be umderstood.
Every therapist needs to assess the nature of the mental health disorder of every individual client. If the therapist does have any specific approach, then there is no way to make an assessment. Psychoanalytic theory states that this client’s issue is that subconscious thoughts are driving the negative thoughts and emotions. Cognitive-behavioral theory believes that the client lacks the tools for engaging in rational thought patterns and avoiding maladaptive behaviors. Rogerian theory believes that the client lacks the empathetic and accepting environment that will free the client to self-actualize on their own, and the list goes on.
Setting Goals and Techniques
Most individuals entering therapy are not doing it for fun. They are in distress and are seeking help. In order to achieve their goal, the therapist and the client will work on determining goals of treatment in order to facilitate the therapeutic process. Here too, theory determines goals, which then determines the nature of the intervention.
As one’s therapy proceeds, the client has a right to know if he or she is making progress. When there is a specific theory or orientation that forms the basis of the therapy, then that theory forms the framework for defining the nature of progress. Although the theory of change differs from one modality to another, they all have some sort of way of defining the nature of change. Without a specific orientation, it can be very hard to determine if the therapy is meeting the needs of the client.
Many therapists will tell you that they have no specific orientation. Rather, they are eclectic or integrative. There is nothing wrong with being eclectic, but it depends if it is sloppy eclecticism or one with a structure and a purpose.
Ask your therapist what are his or her primary orientations and what they integrate. If the response that you receive comes across as a deer in headlights, then your therapist is probably suffering from sloppy eclecticism and the likelihood of successful therapy is greatly diminished. However, if your therapist can name you one or two theories that form the bedrock of their orientation and then name a bunch of other theories that they integrate, then you have an eclectic therapist that has coherent thought in their eclecticism.
Therapy is expensive and as the consumer you have the right to ask any potential therapist as to the nature of their practice. Doing some legwork prior to engaging the services of a specific therapist can have tremendous benefits in the long-term.