Overarching Principles of Therapy

Effective therapists have a solid grounding in the basics of psychotherapy, a stylistic “disciplined flexibility”. This means that the therapist structures ways to adjust theories to his/her personality, as well as to the individualized needs of the client (Bankoff and Howard, Journal of Psychotherapy Integration ((4) 1992:273-294). The key is for the therapist to move about seamlessly and easily, while prudently strategizing for maximum, efficient change.

This change is effected by using the following overarching principles:

• Disciplined flexibility, as defined above
• Theory and technique are authentic to the individual personality of each therapist. No matter how leaders of schools try to churn out followers in their own image, practitioners seem to adjust their chosen theoretical orientation to their own interpersonal style. This is a good thing because the last thing you, as the client, would want is your therapist “play-acting” and behaving in a way that’s incongruent or uncomfortable (and hence ineffective) for him/her.
• Therapists adjust to qualities clients bring to the psychotherapy relationship, and strive to match client characteristics with the most potentially aligned interventions. Rather than forcing clients into therapist-imposed restrictive formats, therapists need to respond empathically to the individuality of each client.
• Experienced therapists learn to move readily between commonly accepted change paradigms. The three meta-strategies that guide how therapist apply techniques are:
  • Key Change Strategy – Sometimes the available evidence suggests that one intervention offers the quickest, most efficient avenue to change. For example, a woman comes in with a phobia of spiders. The techniques of exposure, systematic desensitization, progressive relaxation methods, and cognitive rebuttals are used.
  • Shifting Change Strategy – Therapy begins with the most indicated and easily used technique. If not effective, switch to another strategy. For example, a couple comes in because they’ve been arguing about commitment issues. Techniques begin with exploration of interpersonal dynamics, communications training, empathic alliance and meta-level observational homework exercises – all in a couples format. This is simultaneously later supplemented with anger management and emotional expressivity work with the man, while the woman focuses on psychodynamic family of origin issues – both in individual formats.
  • Maximum Impact Strategy – With complex or multi-dimensional cases therapists work simultaneously on several patterns: parallel processing. Instead of hoping for a sequential effect, therapists work for a synergistic effect, as multiple changes mass together to bring about the desired change. This relies on the principle of using the least amount of energy to produce greatest output.
  • For example, a man comes into therapy in the early stages of recovery from alcohol addiction with a recent concomitant diagnosis of multiple sclerosis, and symptoms of chronic anxiety, depression, and insomnia. He has frequent outbursts with his live-in girlfriend and conflicts with co-workers. His boss has also placed him on a six month probation for “unreliability and low productivity”. He is overwhelmed and stressed to the point of near non-functionality. Interventions used in this case might include: erecting necessary psychosocial supports, i.e. 12 step groups and/or group treatment, anti-alcoholic medications, identifying internal/external triggers in order to maintain abstinence and to prevent relapse. This is in addition to possible referrals to a primary care physician (to rule out organic causes of depression, e.g. hypothyroidism) and to a psychiatrist for medication evaluation/management of mood disorder.
  • The therapy sessions provide guided structuring of the preceding, plus supportive therapy with a chronic illness management focus: assertiveness training about work issues, communications work regarding his girlfriend, and meditation skills for his insomnia may also be implemented.
  • Cognitive work – identifying and rebutting maladaptive automatic thoughts – may also be used; awareness based homework assignments within a larger framework of relational developmental, familial history, suing psychodynamic templates – all this would be standard for such a complex case (Prochaska, DiClemente, Norcross; American Psychologist (9), 1102-1114:1992).
• Seasoned therapists reflect on and analyze their own thinking/emotional responses, looking to their internal experiences with the client in order to differentiate their own subjective reality from client-induced ones. These insights and observations help clients in their therapy goals and also help therapists grow as human beings and as professionals.
• Theory and technique are influenced by the cultural context in which they are practiced. In turn, the practice of psychotherapy also dialectically informs the culture in which it grows.
• Overall, the common denominator of these six overarching principles is an ethical one; everything a therapist says and does is intended to help the client.