Every profession has its stereotypes and therapists are no exception to the rule. Yet understanding the huge variety of therapists and the kinds of therapy they practice can make all the difference when trying to select one that is right for you.
A Night at the Museum
Language fails when I try to express the enormous variation in attitudes, styles, techniques, and beliefs that separate one therapist from another, so let me propose an image instead. Imagine visiting some large and august museum of natural history (perhaps the Natural History Museum in London or the Smithsonian in Washington D.C.), walking past the public areas into dusty back rooms where they keep collections of insects neatly organized and stored away and pinned in display cases. One thing you might notice right away is the sheer bulk of the collection, going on and on through the building. As you wander from case to case, you can see the huge variety of different beings we lump under the word “insects.” Yet within a single display case, dozens of different species look nearly identical. Someone (many “someones” in fact) have gone to great lengths to divide this diversity into meaningful categories and subcategories.
For the remainder of this article, I propose a much less ambitious undertaking. I’d like to point out a few of the ways that therapists differ from one another. Although far from a complete or accurate description, I’ll propose three dimensions along which different therapists exist. I’m sure there are more relevant dimensions beyond the scope of this piece. While I have my own biases and preferences, I wish to emphasize from the start that I don’t wish to state that any one stance is inherently more valuable, productive, or “right” than any other.
‘Huggers’ Versus ‘Hitters’
The dichotomy between ‘huggers’ and ‘hitters’ is one that therapists have ascribed to themselves for many years. To be clear, both of these terms are figurative, not literal. Literally hitting a client would be beyond the pale for any therapist. Hugging clients, while it does happen, is considered ethically risky and to be avoided.
If you have a therapist and use words like “rigorous,” “challenging,” or “demanding” to describe them, then you may well have a ‘hitter’ on your hands. Most hitters come from the belief that clients need to be pushed out of their comfort zones to make progress, and it’s going to take an outside force to provide this push. “That which does not kill me makes me stronger” is a quote from Nietzsche that could also serve double-duty as the hitter’s credo.
On the other hand, if your therapist seems to be more motivated by helping you feel validated, safe, and in control, you are probably working with a ‘hugger.’ Huggers are more likely to believe that people stay stuck in their negative behaviors because of fear or lack of confidence. A popular hugger goal might be to build up the client’s self-image to the point where change looks possible.
To reiterate, these characterizations are two extreme ends of a continuum. Most competent therapists can both challenge and nurture their clients when the situation demands it. However I find that different therapists ‘lean’ one way or the other more from their basic temperament than any theoretical commitment.
True Believers Versus Eclectics
Just as there are all kinds of therapists, there are all kinds of theories about how to approach therapy. There are Psychodynamic therapists, and existential therapists. There are Cognitive-Behavioral (CBT) therapists and attachment therapists. The list goes on and on. Some therapists latch on to one of these methodologies and stick to it. They believe their chosen school of thought is The One Best Way to practice therapy, or at least the one best way for them to practice. These therapists I consider the ‘true believers.’
On the other hand, some therapists find something to like about several styles. Rather than committing to just one, they mix and match techniques and viewpoints from different theories to arrive at a style that is unique and fits them best. Therapists of this stripe will self-identify as ‘eclectic’ in their approach.
It is interesting to watch the tension ebb and flow between true believers and their eclectic counterparts. As I began my training as a therapist, most of the older professionals I met described themselves as some flavor of eclectic. Yet in school, the “eclectic” label was eschewed and we were strongly pushed to adopt, if not a single-theory viewpoint, at least a dominant theory. It seemed as if this guidance came from the idea that “eclectic” might mean “whatever the therapist decides to do at any given moment.” While eclecticism can degenerate into personal whim, most eclectics I know are more than capable of stating their strong beliefs and values when it comes to therapy.
Technicians Versus Qualitatives
People commonly confuse “therapists” with “psychologists.” While there are licensed Psychologists who also practice therapy, many therapists are not psychologists. To make things even more confusing, while Psychology is clearly a science, counselling and therapy are not. This may be surprising because many therapists pursue their practice in a scientific mindset. Every therapist owes much to the field of psychology for discovering basic facts about the mind and how it functions. Therapists who stick close to this empirical, evidence-based foundation tend to be structured and perhaps a bit formal. They’re more likely to give out written worksheets and specific homework assignments. For lack of a better word, I categorize this group of therapists as ‘technicians’ in that they orient to specific techniques validated by scientific research.
Yet as I said before, therapy is not a science and for a very specific reason. Many of the theories and techniques that are bread-and-butter in therapy are validated by anecdotal evidence rather than by formal experiment. Why haven’t these experiments been run? It turns out that measuring therapy is not that easy. Therapy takes weeks of time to produce change. Experiments demand holding all variables constant except the ones explained by the theory. How, given the huge individual differences between therapists, can such variables be controlled? Some would say these variables cannot be controlled well enough, however the best efforts to date involve scripting therapist interventions into large documents or manuals. Cognitive-Behavioral Therapy (CBT) was so successful not only because it worked, but because it worked fairly quickly and CBT techniques were easy to write down in manuals and therefore test at some level of control.
Other therapists were not entirely pleased with CBT’s popular success. Many felt CBT was easy to manualize because it avoided deeper, more subtle problems addressed in other approaches. These therapists were unable to constrain their therapy in ways that scientific rigor demanded. Irvin Yalom is often quoted as saying “It is the relationship that heals.” But “the relationship” is nearly impossible to quantify or manualize. Many therapists practice their craft not from a scientific understanding but from a qualitative, one might even say intuitive, understanding of what works in therapy. Perhaps, given additional time, money, and clever experiment design, some of these subtle elements of the therapeutic process may be tested scientifically, but the therapists who won’t wait for science to catch up to what their experience tells them, I classify under the term “qualitative” to differentiate from the quantitative requirements of hard sciences.
Fit is Everything
Clients often go to therapy, stay for a session or two, then give up in discouragement. I’d like to suggest that some failures in therapy result from mismatches between the client and the therapist’s individual style. Just as none of the differences I highlighted earlier are inherently better or worse across the board, I’d like to believe there is at least a good-enough therapist for every combination of client and problem, but a precondition to getting the right therapist for you is recognizing that ‘fit’ is necessary.
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