Theoretical Orientation


Counseling and Social Work academic programs both contain theory classes.  Generally at the Master’s level, students are exposed to a variety of theories.  Student’s are expected to select one or two that they resonate with and further develop their understanding of that particular body of work.  Most historical theorists since Sigmund Freud are generally lumped together under a few categories of theory and I will outline the three main ones below in a grossly oversimplified manor. 

Disclaimer:    This oversimplification is for illustration and brevity  and should not be interpreted as  minimizing  either the integrity of the therapeutic strategies, or  the more serious issues treated in psychotherapy.

While students tend to establish a practice based around an established theoretical base, the therapist also brings their own unique understanding of the theory into the process, as well.  Theories are a way of conceptualizing and categorizing the patient’s self report, but they remain flat unless the therapist is skilled in applying the framework as a base, upon which, positive change can grow. One might think of theory as a road map.  But the road map has to be utilized by something moving, in order to be useful

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Behavioral therapy:  The primary emphasis to elicit change in an individual is to focus on problematic behaviors and set up systems to modify those behaviors.  Little emphasis is placed on the individual’s feeling states  at least initially.  The  behaviorist’s approach is that modifying maladaptive behavior, will produce better feelings for the  patient, because there will be an improvement in a situation.

An example:  Mary is anxious because she  is drinking too much caffeine.   A behaviorist would look at Mary’s routine,  and discover that she has Starbucks every morning on her way to work.  They might suggest she alter her routine by having her kids ride the bus rather than, her taking them to school.  This way, she is no longer,  out and about in the car, with easy access to Starbucks.  She might also begin the day with a morning walk and change her breakfast routine, so that she doesn’t miss the Starbucks.  The therapist might ask Mary to keep a log of how many times she skips Starbucks and Mary might decide to reward herself with a new piece of jewelry, after she saves a certain amount of money from not going to Starbucks each day.

Cognitive therapy:  The primary strategy in cognitive therapy is to look at cognition or thoughts of the individual.  According to cognitive therapists, understanding the thought patterns  (chains of thoughts), by both therapist and patient, can lead to interruption and  modification of those thoughts.  Once there is a modification of the thought, the resulting behavior will be modified as well.

Example:

The cognitive therapist would interview Mary and gather a collection of thoughts that have established the pattern of going to Starbucks each day.  The therapist might learn things such as:
-Mary likes the jumpstart of the caffeine
-Mary uses a prepaid card and doesn’t really think about the cost when she just has each cup deducted from the card
-Mary feels like its a treat every day, that, provides her with private time
-Mary sees it as compensation for driving her kids to school

Therapy would first involve taking these thoughts apart to better understand them.
-Why does Mary need a jumpstart? Is she getting enough sleep? Does the jumpstart work initially, but then drag her down after a crash later in the day? Does the caffeine affect her sleep?
-Are there other ways that Mary could get a jumpstart?
-Is there anything that Mary is depriving herself of by getting this expensive treat?
-How much time does Mary lose for herself, by being in the car, driving too and from?

By examining each of these chains more thoroughly, Mary can make decisions based on her revised understanding of these patterns and determine whether or not these cognitions still feel accurate to her.  She can then decide to leave behind those that do not, and replace them with modified cognitions such as:
-A walk in the morning gives me more time to myself and gets my day going.

Psychodynamic therapy:  The emphasis in psychodynamic therapy is to help the patient understand the origins/motivations that propel the patient’s unwanted behavior.  A psychodynamic therapist would ask Mary questions about how she determines what is a reward, what are the benefits of time alone etc.  The therapist might learn that Mary grew up watching her parents drink coffee together every morning and that it was one of the happiest parts of her day.  Or the therapist might learn that Mary didn’t feel she was entitled to special treats or time to focus on her own needs as a child, and she was trying to over compensate for that now.  The psychodynamic therapist assumes that Mary developed behaviors within a  historical context and that context must be understood in order understand the message of the current symptom.

Psychodynamic therapy does not rely on picking apart every memory of the individual.  In fact, very often, people cannot remember details, positive or negative about their childhood.   The therapist also assumes that today’s patterns are reenactments of historical data and that these reenactments, may well be played out in the relationship between the patient and the therapist (transference*).  This is where the psychodynamic therapist must be especially adept in their knowledge of human behavior patterns, and especially human development processes.  They must also be skilled in managing the transference.  This allows the therapist to look at behaviors today, and with a little bit of information from the patient, to make inferences or interpretations.

Once adequately identified, the patient can see how automatic their behaviors have become because, they are deeply rooted in past experiences that are no longer present or active, except to the extent that the patient is recreating them.  This allows the patient to then decide if they would like to implement new strategies based on the here and now.  The patient might also use therapy to develop new methods for helping them in maintaining awareness of when unconscious motivations. This assumes that learning to identify one’s own emotional states more clearly, provides data for consciously choosing behavior.

Although I was a practicing therapist with a master’s degree, I opted to pursue a doctorate because I felt master’s level training provided only an overview of theory.  I selected a specific doctoral program that was immersed in psychodynamic theory.  Thus, in my doctoral program, I spent four additional years learning about the development of the human being, what is necessary in the nurturing milieu and how pathology develops when such a milieu does not optimally occur.   Moreover, I learned how life events and impingements are likely to activate the onset of symptoms, at various life stages throughout the life span.  I found this training gave me enormous confidence that I did not possess early in my career with only my masters degree.

I should add however, that while I think predominantly in psychodynamic terms, I will at times intervene with cognitive suggestions and insights.  Insight without action is not productive. This is necessary in situations where there isn’t time to wait for insight to occur (such as with dangerous or risky behaviors).

*Transference simply stated is when a patient projects certain attributes from their own past on to the therapist, in an unconscious manner.  I.e. the patient sees the therapist as a maternal figure and falls into automatic childhood responses in response.