How to Find the Right Therapist: Considering their theory of change.
“The therapist must strive to create a new therapy for each patient”
When we say that our approach to therapy is personalized, we mean it. We’re all trained in a number of different approaches to therapy because we believe that counselling isn’t one size fits all. The approach that is right for you is going to depend on your unique context, your personal goals, and your past experiences with psychotherapy. During your first few sessions we’ll take the time to get to know you so that we can create a therapeutic process that will suit you best.
Common Factors of Effective Psychotherapy
This personalized approach to counselling is supported by research into what makes psychotherapy effective. Research consistently indicates that the specific therapeutic approach chosen by a counsellor is responsible for little variance in terms of treatment outcomes. This means what methods and models a counsellor uses isn’t all that important. Rather the success of therapy seems to depend on the quality of the relationship, the counsellor’s ability to collaborate with you on defining the goals of therapy, the counsellor’s ability to convey empathy for your struggle, the counsellor’s ability to adapt their approach to your culture, and the counsellor’s ability to instill a sense of hope and the expectation of positive change. These contextual factors require the counsellor to treat each client as the unique individual they are, honour them as the expert of their own experience, and adapt their therapuetic approach accordingly. A therapist who is skilled at this will continually seek out and be responsive to your feedback on how things are going.
Counselling Paradigms: Theories of Change
It is, however, important to note that not every therapist will be the right fit for you. This may be because you are looking for a counsellor with a specific type of lived or professional experience. It may also be due to fundamental differences in how you see the world and how the counsellor’s worldview informs their counselling paradigm or theory of change.
Many therapists consider themselves eclectic, meaning they draw from a variety of counselling methods and models in their work with clients rather than firmly adhering to one particular methodology. Eclectic therapists may have more flexibility in adapting to contextual considerations, however it’s important that even eclectic therapists approach their work from a coherent theory of change. Such a theory of change is often referred to as a counselling paradigm. This consistency is important because without it sessions may begin to feel disjointed, confusing, and lacking in focus. This can threaten to compromise your confidence in the relationship and the counselling process overall. Some methods blend more coherently than others, requiring a counsellor who is trained in multiple methods and models to thoughtfully consider their application. Such consideration leads to an eclectic approach that is integrative.
One way to think about this is to consider therapy as a journey. You’re bringing your therapist information about where you are, where you want to go, and the resources you have to get you there. Your therapist’s job is to help you select, out of many possible ways of getting there, which route you’re going to take together. They can then offer a map to follow to make sure you’re consistently moving in the right direction. The method of travel isn’t all that important, but some routes are inaccessible by certain modes of transport. If the map isn’t consistent, however, or the therapist starts focusing on alternate routes after the journey has already started, you might both get lost along the way.
While there are multiple ways that a therapist might describe their personal theory of change, and some may blend similar paradigms together, here are some simplified descriptions of the common underlying theories of change in counselling that you might find a particular counsellor holds. My hope in offering these overly simplified explanations is to help you understand some of the common jargon used by counsellors to help you discern what your counsellor means when they describe their approach and what that might say about their underylying theory of change.
Insight oriented psychotherapy
Insight oriented therapists believe that the goal of therapy is to increase your awareness of underlying patterns and unconscious beliefs you carry as the result of your past experiences. Therapists who approach their work from this stance believe that increased awareness leads to greater clarity about current struggles, offers new opportunities for choice, and facilitates personal growth and increased self-awareness. This was the broad stance adopted by historical figures like Freud and Jung who first promoted the notion that counselling, which they referred to as the talking cure, could help individuals suffering with mental health concerns. This stance is often associated with terms like “depth oriented,” “object relations,” “psychodynamic,” and “psychoanalysis”. Insight oriented therapists will draw from methods in many therapeutic models, but they will remain focused on increasing your insight and self-awareness.
Cognitive and behavioural therapy
Therapists who adopt this stance believe it’s important to focus on how you’re thinking and behaving in the present. They will have you track your thoughts and behaviours to help you identify patterns that are contributing to your concerns. Once you’ve recognized these patterns, they’ll work with you to adopt new ways of thinking and behaving that will help you achieve your goals. Cognitive and Behavioural therapists are commonly associated with Cognitive-Behavioural Therapy, Dialectical Behaviour Therapy, Acceptance and Commitment Therapy, Solution Focused Therapy and Schema Therapy but may draw upon methods from other approaches as long as the focus remains on modifying your thoughts and behaviours in the present to achieve your goals and improve how you feel.
Humanistic and existential psychotherapy
Therapists who adopt this stance are most interested in helping you live authentically in accordance with your most deeply held values. They believe suffering is caused by a lack of meaning and purpose and work to support their clients in identifying their own path to meaning according to their values about what matters most. Humanistic and Existential therapists tend to approach sessions from a reflective and contemplative stance, encouraging their clients to guide the conversation into the experiences, patterns, choices, and challenges they wish to explore. Specific interventions and approaches are never imposed, but may be drawn upon in response to your request. Therapists who hold to this theory of change may also describe themselves as person-centered, narrative or meaning oriented.
Experiential and relational psychotherapy
Experiential and Relational therapists tend to be focused on using the therapeutic relationship and context to facilitate new experiences and ways of being that can then be drawn upon in your personal life. They are primarily interested in your emotional experience, both past and present, and are focused on creating the conditions necessary for you to safely explore and express those emotions. They see therapy as helping you feel an increased sense of safety within yourself and within your relationships with others that will improve your capacity to feel what you feel and develop lasting and meaningful connections. Experiential and relational therapists draw from several methods and models, but the emphasis is always on experiencing and feeling in the “here and now” rather than thinking, analyzing, and planning. Therapists who adopt this stance may also refer to themselves as attachment focused, emotion focused, expressive, somatic or process oriented.
Finding the right therapist
As each of these theories of change can effectively create the conditions for healing and personal growth, consider which perspectives align most with your sense of what you need and might find helpful in achieving your goals. Misalignment on this fundamental basis of the counselling process is often what leads to individuals having negative experiences in therapy. While a therapist may desire and be willing to adapt their approach, attempts at adapting one’s counselling paradigm may render a counsellor ineffective and insincere given the ways in which their theory of change relates to deeply held core beliefs and values. If you notice such a mismatch with your counsellor, you may wish to consider asking them to refer you to someone whose worldview is more aligned with your own.
Challenge: Essential ingredient in counselling.
Regardless of their specific theory of change, however, an effective therapist will at some point challenge you. This is because a counselling relationship, unlike a personal relationship, is ultimately oriented towards helping you achieve a desired change in your life. That change may be internal, in terms of how you relate to yourself, or it may be external, in terms of relational or behavioural patterns. Regardless of your desired change, you can expect your therapist to push you outside of your comfort zone and current understanding to get you there. Your therapist should attempt to be thoughtful, intentional, and compassionate in how and when they challenge you, but they will challenge you. If you feel hurt, overwhelmed, or invalidated by your therapist’s attempts at challenging you, let them know. A quality psychotherapist will use this as an opportunity to strengthen your counselling relationship and improve the way they approach your sessions in the future.
If you’ve had bad experiences in therapy, and unfortunately many people have, don’t give up! I’m confident there is a therapist out there that is a fit for you. We want to help you find your fit. Contact our intake team for more information. If we don’t have the right fit for you on our team – we’ll help you find your match elsewhere. Let’s get started.