Psychotherapy Orientation and Therapist Personality

Psychotherapy orientations are now commonly seen as distinct sets of skills and knowledge that can be chosen from a metaphorical toolbox and applied at will. Like the general surgeon, the eclectic psychotherapist is said to be able to select from a variety of techniques and deliver the most effective treatment for a given patient, independent of the personal characteristics of the therapist. I argue that this claim is false, namely because it fails to recognize that psychotherapy orientations flow from the personality of the therapist and cannot be considered distinct from it.

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Decades ago, in the mid-20th century, it was generally accepted that the psychotherapist (who was most likely a psychiatrist) had a set therapeutic style and more-or-less applied it to all of his patients. If he felt that he could not help a particular patient, he referred the patient to a specialist in a different therapeutic approach, who might be more likely to help the patient.

For instance, if the psychoanalyst found a depressed patient unlikely to benefit from psychodynamic treatment, he referred the patient to a psychopharmacologist, or to a supportive psychotherapist, or both. Psychotherapy orientation was seen as being specific to the individual therapist; it could not be chosen at will as if selected from a toolbox.

In the latter half of the 20th century and continuing into the 21st century, a different idea emerged. This idea holds that the therapist ought to try to adapt his style to each particular patient, select from a number of approaches in which he deems himself competent, and apply techniques from that approach to work with the patient. Thus, in the course of an 8-hour workday, the therapist may say that he practices cognitive therapy in the morning, interpersonal therapy after lunch, and psychoanalytic therapy in the late afternoon.

The emergence of this “eclectic” approach reflects the idea that psychotherapy orientation has nothing at all to do with the person practicing it; it is just a skill to be learned and applied, the way one learns algebra and uses it to solve polynomial equations. Attempts at “psychotherapy integration” view psychotherapy orientation similarly, though these attempts aim to create a single, unified psychotherapy approach that can be applied by any therapist independent of the therapist’s personal characteristics. I see these ideas as reflecting a misunderstanding of the relationship between psychotherapy orientation and therapist personality.

Why do I say that psychotherapy orientation cannot be separated from the personality of the therapist? It is because the various psychotherapeutic orientations are based on differing ethical systems and philosophies, and therapists who value particular ethical philosophies will find themselves naturally inclined to practice particular psychotherapies consistent with their own moral-ethical beliefs. To submit that psychotherapy orientation can be adopted at will—independent of the therapist’s own beliefs and personality—is to ignore this basic premise.

Directive and Non-Directive Therapies

While there is no shortage of specific psychotherapies—indeed, new ones seem to be developed every few months—it can be argued that there are two basic approaches to therapy: directive and non-directive. In directive therapies, such as cognitive-behavioral therapy, the therapist adopts an active role in teaching the patient new skills, techniques, or strategies. In some forms of directive therapy, the therapist may give advice.

In non-directive therapy, such as psychoanalytic therapy, the therapist seeks not to directly influence the behavior of the patient but rather to help him come to a better understanding of himself and what ails him. Szasz (1965) made a similar distinction between types of therapies, and Langs (1973) later described these differences as fundamental to understanding psychotherapy theory.

Psychotherapy Orientation Flows from Personality

I contend that the orientation of the psychotherapist flows directly from the personality of the therapist and cannot be considered distinct from it. In this respect, the psychotherapist differs significantly from the physicist, who may apply a vast array of theories, and from the general surgeon, who is skilled in a variety of techniques.

Indeed, the history of psychotherapy is replete with examples of therapists cultivating techniques best suited for their individual psychologies. Freud, for instance, abandoned hypnosis because he realized his personality was ill-suited for the authoritarian-intrusive role of the hypnotist. He went on to develop psychoanalysis and the method of free association not only because he felt it to be a more effective technique but also because it meshed more naturally with his personality.

When Sullivan introduced his own variety of psychoanalytic therapy, this was reflective of his need for closeness in the psychotherapy relationship; he was a lonelier man than Freud. And when Albert Ellis introduced rational emotive therapy, this, too, reflected his own personality, which was much more direct and confrontational than many of his psychoanalytic peers.

This is to say that the differences between the two types of therapies described above—directive and non-directive—are representations of differences between two types of individuals who practice these therapies, and not just differences between styles or techniques. While my aim here is not to describe in detail the personality differences between these two types of therapists (but merely to point out that such differences exist), it seems possible that the directive therapist is in greater need of structure and perhaps control, whereas the A non-directive therapist is driven more by his introspective qualities and need for understanding.

Ramifications for Education and Treatment

If it is true that a therapist’s theoretical orientation flows from his personality and cannot be considered separately from it, this would have significant ramifications for the training of psychotherapists and the treatment of patients. In terms of training and education, the young therapist ought to very carefully explore the various modalities of therapy to see which one feels most authentic.

Certainly, a personal analysis or psychotherapy is a good place to start, though the introspective work should not end there. The trainee should immerse himself in the literature, focusing particularly on the philosophical tenets underlying each theoretical orientation. He should look at his life and see how he lives it in relation to others and to himself. Only then will he be able to select an authentic therapeutic approach.

When it comes to treatment, the therapist would be wise to limit himself to working with patients with whom he feels he can be most authentic, since it is only when the therapist is authentic that he can be effective. Importantly, such decisions about who to treat and who to treat should not be made on the basis of diagnosis, since the personal characteristics of patients with a varied psychiatric disorder may be just as the personal characteristics of people in the general population . I argue that the therapist ought to wear only one hat in the consulting room, and if he feels that a different therapeutic approach is likely to be more beneficial for a particular patient, then he should not put on a different hat but refer the patient accordingly .

Conclusion

In this post, I have argued that psychotherapy orientation is a reflection of who the therapist is as a person, and that it should not be considered something that can simply be adopted or applied at will. Accordingly, I have also argued that the “eclectic” therapist is a myth. Since the eclectic therapist can have only one authentic theoretical orientation, in my view, he would be wise to refer poorly matched patients to other therapists rather than trying to apply a therapy that runs counter to his personality. Such ideas have significant ramifications both for the training of psychotherapists and for the treatment of patients.

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