Differences in Schools of Psychotherapy, and Why We Need Them.

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Note: We take a breather from the topic of first sessions in today’s blog. A handful more chapters from the newly released book, The First Kiss, will be shared here in the coming weeks (and the launch of the paperback version; kindle and epub versions is now available. Bulk discounts is also available for organisations), so make sure you are already subscribed to the Frontiers update. Please leave a review on Amazon to help get the word out on this book. Thanks so much.

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I hear some leading figures in our field say we should end different schools of therapy, suggesting that we pontificate schools of therapy like cult or religion.

I disagree. While we shouldn’t support fanaticism, we should allow our differences to co-exist.

Here’s why: We need to embrace differences in schools of psychotherapy the way we embrace different cultures in our societies.

Integration

Even when we push for an “integrative” or pluralistic perspective, we must remember that integration is not homogenisation. We must integrate the best knowledge existing in our times—even beyond the borders of our field—while not accidentally homogenising our attempts to serve a wide range of people in need.

Like Religion?

Different schools of therapy need not compete like cults.
Often, we say schools of therapy are pushing themselves to the public like a religion. In this statement, we infer that there’s something wrong with religion. Far from that, though much wrong and damage were cloaked in religion, a wealth of wisdom literature as we know it stems from such ancient traditions.

Still, the comparison between schools of therapy and religion is a fair one to make. This is because when a practitioner adopts a new model, they evangelise as if that’s the model i.e., superior to other approaches.

Writer Parker Palmer once said, “Fundamentalistic Muslims and fundamentalistic Christians have a lot in common.”[1] We need not be dogmatic, even though we hold our models dear. Instead, we should be dogged in our pursuits for better outcomes.

More of the Same in Different Cities

I’m not the most well-traveled Asian dude, but after seeing a few big cities, you know what’s annoying? You go to a new city, and it’s more of the same as the last one. When compared to architecture of old, architect Vishann Charabarti calls this physical homogeneity in urban landscapes as “a creeping sameness.”

Charabarti points out three primary reasons the same bland cities are being built in our modern culture:

1. Mass production
2. Regulation
3. Fear of difference

Maybe you can begin to see some parallels between cities and the landscape mode for psychotherapy. Let go into abit of details.

1. Mass production
Given the social demand, we want more counsellors, psychologists and therapists trained en masse.

In a previous blog, I wrote, “I suspect the push for adherence, competency, and treatment fidelity to specific treatment approaches were predicated from our obsession with standardisation of education – the way Edward Thorndike took Frederick Taylor’s idea of standardisation to improve productivity in manufacturing industries, which permeated into our factories and education system.”

Maybe we fail to appreciate the developmental arc of a psychotherapeutic approach: A master therapist experiments, ponders and articulates his ideas, thus developing his brand of therapy; his theories are developed after the fact (not before, as we imagined it to be).

2. Regulation
We want not only more mental health professionals trained, we also want them to abide by professional and ethical standards. By that we mean we want therapists to only deliver so-called evidence-based practice. We inadvertently conflate standardisation for homogenisation. 

We forget that evidence-based practice is not just whether an approach has been empirically tested, but  EPB at its best is “…the integration of the best available research…and monitoring of patient progress (and of changes in the patient’s circumstances – e.g., job loss, major illness) that may suggest the need to adjust the treatment…(e.g., problems in the therapeutic relationship or in the implementation of the goals of the treatment)” (APA Task Force on Evidence-Based Practice, 2006, pp. 273, 276-277).

3. Fear of difference
Finally, we want therapists to do more of the same type of “quality assured” psychotherapy. And our answer to that has been, “Do CBT, since it is EBP.”

Deeply embedded in us is a fear of difference. We not only fear to get it wrong, but even when we say we are non-conformist, we are afraid of being different. I first started to notice this when I moved to Australia. For the first time in my life, I am now the minority. Living in Australia, I’m acutely aware that when I open my mouth, try as I may, my accent is different from the locals. My skin colour is also different from the rest. I’m aware that “I’m different.” (Thankfully, I don’t feel outcast. Instead, I often operate like an alien, learning like a perpetual tourist.)

What About Teaching People the Common Factors?

I don’t believe we can teach practitioners how to do more “common factors” without getting them to embrace what Robert Fancher calls “A Culture of Healing.”[2] A therapist needs to find theoretical homes to deliver their own principles of practice.

We can be loyal to our approach without being theoretically facist. We can transform a health care system to be a learning health care system, by encouraging therapists to develop their own way, monitor their outcomes, one client at a time, and one therapist at a time.

The best form of standardisation is to allow customisation.

Closing

The moment we think we have exclusivity in the superiority of our methods, it’s time to rethink. Hold what you believe in lightly, because it’s going to work most of the time, and some of the time, it falls apart. Instead of trying to adhere to a treatment modality, we need to focus on our client’s needs.

We need less homogeneity and more heterogeneity. We need differences in schools of therapy.

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Notes:
[1] Parker Palmer in the Undivided Life (audiobook, but actually more of an interview with Tammie from SoundTrue production)

[2] I don’t know why Robert Fancher’s book, Cultures of Healing didn’t get much coverage as it deserves. What a well written piece of writing. I highly recommend practitioners who are serious about understanding our field to read this one. To understand someone, understand the culture that shapes the stories that they tell themselves.