Thank you to everyone who responded to our July Clinician's Quandary. Here are some of the top responses! Submit to next month's Clinician's Quandary here.
July Quandary: I’m a graduate student in my first year in a clinical psychology program. My program requires me to pick an approach and focus on it as far as training goes. This feels restrictive to me and I’m not sure which path to go down. What was your experience with this and how did it affect your career?
1) Why Fit a Square Peg in a Round Hole?
I had a similar experience as you in my MFT master’s program. Our professors advised us to pick one approach and master it. This was an impossible choice for me, as all the theories seemed brilliant and resonated in some way. Desperate to find “the one” (approach), I test-ran different ones with clients on my internship. But each time I tried to limit myself to just one, it felt as though I had one hand tied behind my back and was doing a disservice to my clients. One of my classmates aptly described sticking to one approach as trying to push a square peg through a round hole.
In reality, most therapists don’t subscribe to a single approach when doing therapy---they adopt an integrative style. My view is that if this is where experienced therapists end up, new students such as yourself might benefit from adopting an integrative approach earlier in their careers. Integrative therapy was founded on the premise that it’s possible to combine the strengths of different theories into an even more effective approach, one that provides a wider choice of concepts and techniques and is also more effective at matching particular interventions to particular clients. Still, many grad schools aren’t teaching integrative therapy to new therapists since they perceive it as too complex. In the process, they create a gap between teachings and actual practice.
If your instinct says not to pick a pure-form theory yet (or ever), I’d listen to it. My advice is not to integrate theories haphazardly, but to hit the books and find an integrative approach you like. There’s a plethora of excellent integrative approaches out there that will provide you with a road map for shifting between different theories and their associated practices.
When you’ve found an approach that suits you, ask your program if they’ll allow you to use it. Hopefully they’ll say yes, and you’ll have paved the way for new therapists in a similar predicament. As you progress, you may find yourself drawn to a particular pure-form or integrative theory. But by this point, you’ll be making an informed, experience-based decision.
Fortunately, my program was supportive of me picking an integrative approach. In fact, I was their first ever student to write a thesis on an integrative approach to couples therapy. I still practice an integrative systemic therapy approach today, and I love it. If your program is not open to you adopting an integrative approach now, know that you have lots time ahead of you to try different approaches and figure out which one suits you best.
Talia Litman, MFT
New York, NY
2) Never Stop Learning
I’ve been teaching graduate students for almost 25 years, and I always encourage my therapy students to stay open minded and explore as much as they can during their journey toward licensure and becoming a professional. I tell them it’s important to never stop learning, to always keep stretching your mind and abilities.
Therapists in training need be open to any technique, theory, or approach. You want variety in your therapeutic toolbox, so you can reach for the approach that seems most appropriate and effective in a particular situation with a particular client. Therapy, theory, and techniques aren’t static or practiced in a sterile environment, and classes only provide a gateway. Life teaches you therapy. In sessions, you learn how to use what experience has taught you.
In my nearly 30 years as a counselor and marriage and family therapist, I’ve added several approaches to my toolbox. An important one is hypnosis, which helped me learn to use my voice, my eyes, and my ears. I’ve found it especially helpful when working with distressed clients, allowing me to read them and their issues and project a calm mood to help them relax and focus. By controlling the volume of my voice, they can focus on listening to my words and really hear me. I’ve even been told by several clients that outside of therapy, they’re able to think back to my voice when they become stressed to help them calm down.
This, of course, is just my experience. Now go discover your own! The world is your supply house. Never stop learning. Never stop improving. Keep an eye out for things that surprise you.
Richard McWhorter, PhD
Prairie View, TX
3) Take a Modern Approach
Rather than think of specializing as restrictive, I’d think of this as an opportunity to attain thorough training and a unique understanding of an approach of your choice before you begin practicing. What seems restrictive now may later lead to greater opportunity and serve as the foundational knowledge upon which you build a career.
The fact is that many successful therapists who’ve specialized early in their career discover and incorporate new approaches later on. And of course, a part of your ongoing work should always be learning about new approaches and methods that will help the clients you serve. It’s likely that as you progress in your career, you’ll become passionate about many different approaches.
Personally, I’d recommend adopting a modern approach that resonates with you and the clients you’ll see. Internal Family Systems, Acceptance and Commitment Therapy, and Dialectical Behavior Therapy are some examples of more modern approaches relevant to today’s problems, and there’s plenty of literature, online courses, and other guides available to facilitate your learning in these areas. You’ll also likely find an active community of therapists who practice these approaches daily and are more than willing to provide assistance if you have questions. Of course, there are other approaches out there, and finding ones that are helpful to the type of client you intend to serve would be wise.
Being a student or new practitioner is all about discovering what works for you, and while you can be partly guided by a specific approach, you’ll always put your unique personal spin on it. It’s what gives therapists a sense of authenticity. Just remember: ultimately, you’re not bound to the confines of any approach, and most modern approaches are very conducive to integrating other approaches as well as your own unique style of delivering therapy. In the end, no matter what approach you’ve studied, your thumbprint will be upon it.
Jamie Suarez, LPC-MHSP
4) Build a Foundation
Your concern is a valid one. It’s hard to argue against the value of eclecticism in practice. While there are some clinicians who do practice according to one specific approach or theoretical model, most these days are eclectic, and there are good reasons for this. Each approach has its own strong points, and when you look at them closely, they’re more likely to complement than contradict each other.
However, I do think there’s also some value in starting your graduate education with a focus on one model, and here’s why: it’s kind of like playing scales on the piano; it can serve as a foundation. A student might say, “Can’t we skip the scales and go straight into playing actual music? Isn’t that the whole point?” But music teachers value the deep level of learning that repetition provides.
It’s helpful to think of this in terms of the Feynman Learning Technique, devised by Nobel Prize-winning physicist Richard Feynman. It posits that to truly know a subject, you should be able to explain it to a sixth grader. That means not relying on jargon, but understanding the deeper meaning behind each and every thing you say. You start the process by summarizing what you know about a topic. Then, you imagine how you would explain it to someone with no preconceived knowledge about it. You review this explanation and identify gaps where you have failed to simplify it adequately. Then, you fill in the gaps.
If you focus these graduate years on learning one modality inside and out, that gives you a foundation. Think of it as the “bones” of your knowledge, the core. Once you’re out of school, it’s time to take that foundation and add to it.
I’ve observed that most of what I’ve learned has been in the years since graduate school (and my guess is that most clinicians would say the same). Continuing education, whether books read or courses taken, tends to be specific, and it’s been more useful in developing my overall knowledge than the never-ending cascade of information I was presented with in graduate school. But first, build a foundation.
Julie Borden, LCSW
Los Angeles, CA
5) Nothing’s Set in Stone
This is a common task in grad programs. Choose something that appeals to you now. You can change your chosen framework at any time. You will evolve and grow, and as you gravitate toward an area in counseling, the type of approach that feels right to you will reveal itself. Grad school is for getting a solid foundation, not etching your future practice in stone. You can earn certifications for all kinds of frameworks after you become a licensed professional. Your framework is mainly the lens you use to contextualize your cases. It’s okay to be eclectic! I’m existentially oriented, yet I use solution-focused brief therapy and motivational interviewing.
This is a stepping stone in a long and adventurous journey. What do you want to know more about? What kind of counselor do you see yourself being? What feels right to you now?
Sarah Tammen-Gruber, MA, LPC
Next Month’s Quandary: I often take notes during therapy. It helps me better digest what my clients are saying and helps me recall detailed information. However, I sense that some clients are bothered by it. Sometimes they get distracted when I start writing. Recently, in the middle of a note, one client asked whether I’d just heard what he said. Another asked what I was writing and was bold enough to ask if he could see my notes! I’d hate to give up this valuable tool, but worry that it sometimes impedes therapy. What should I do?
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