Thoughts on the progression of therapy

Feb 06, 2022
Psychology over the decades

Therapy style, or rather, what is offered to the public, has changed over the decades since I first began seeing clients at 22.  At that time,  psychoanalytic and humanistic models were practiced, although there was also deference to the medical model, and some approaches lingering from the zeitgeist, such as existential therapy and gestalt therapy. Behavioral therapy methods have become more prominent over time, and nowadays,  even more, cognitive behavioral therapy is usually cited as the most effective therapy. I don't think it really is, particularly the more formulaic styles of therapy involving progressing homework assignments,  filling out little questionnaires, and that sort of Mickey Mouse stuff.  Psychologists have arguments amongst themselves about this, the nay sayers regarding cbt as a McDonald's type approach. Probably at a certain point in a therapist's career, one hopes to make some sort of more significant intervention than one based on any single therapy style.  The actual theoretical formula becomes less relevant because, for the more complex or sophisticated clients who seek a seasoned therapist, the symptoms generally are very subtle, complicated, and in the context of social and biological events that themselves need understanding. Without an understanding, sometimes gained academically, sometimes by experience, of how marriage, divorce, probate, or grief affect a person one is working without a full arsenal. Too, without an understanding of how organizations tend to work, or how finances intrude on day-to-day life, how even a myriad of diseases effect behavior and psychological functioning,  or even how the mental health system can misfunction, it is difficult to do any sort of reasonable work worth the price.  Therapy mode of one type or another will not make much difference in outcome if conveyed without a substantial grounding in general knowledge and experience and probably some talent for the field.

This is not to say that more basic therapy approaches are not going to be helpful. They do help.  Likely, though, clients with more complex issues are likely to be undertreated.  Even paraprofessionals, the archetypal friendly bartender or hairdresser, can sometimes lend a helpful, supportive ear. But like everything else, there are different levels of skill and sophistication in any provider.