CBT, DBT, SFBT—the world of psychotherapy is filled with many models and approaches. Making it even more bewildering is the use of acronyms and special vocabulary each model seems to have. For someone new to therapy, or trying to make sense of the different resources, it can be tricky, if not overwhelming.
There are over 125 models or approaches to psychotherapy listed on Wikipedia alone, from Adlerian to Wilderness Therapy. Many therapists are trained in a number of models. Some use a blend of approaches that they feel work, while others have one favourite model that they always use.
Certain models have developed a high profile and have been the focus of lots of research that verifies their effectiveness. Cognitive Behavioural Therapy (CBT), which focuses on helping people change their thinking (cognitions) and reactions (behaviours), is one of those, and as a result is often recommended by doctors and others making referrals to counselling. Other models such as Narrative Therapy appear to be similarly effective, but are harder to use in larger settings such as hospitals and instead tend to be used in agency settings, resulting in less research about them.
At times, people will go to counselling because their doctor referred them for CBT only to find that their therapist prefers to use Solution-Focused Brief Therapy (SFBT) or another model. Should they continue with that therapist or find a different one who does CBT?
Sometimes people try counselling but don’t find it helpful and give up, not realizing that it might be the model that isn’t a good fit rather than therapy itself. For example, some people who don’t respond well to CBT might find Narrative Therapy or Mindfulness-based approaches more effective for them.
Some people might have been in counselling for a while and have no idea what model or approach their therapist is using with them.
Some are less concerned about the model being used, but have other criteria for their choices. For example, for some, finding a therapist who shares their faith perspective is very important.
For others, their choice of therapist is directed by what coverage their work benefits give them—some benefits packages will cover the services of a Social Worker, but not a Registered Psychotherapist, or vice versa, even though both are able to provide psychotherapy.
So, what does someone do if they are considering counselling? How does one make sense of the many models out there? How does one choose the right therapist?
The good news is that overall, regardless of what model or approach is used, therapy has largely found to be helpful and effective most of the time. According to Scott Miller, who studied what works in psychotherapy, research shows that “the average treated client is better off than 80% of the untreated sample.”
Miller reports that the primary factor that contributes most to success in therapy is the connection between the therapist and the client (in clinical language, the “therapeutic alliance”). It fact, some research suggests that a client’s relationship with the therapist contributes about 60% of the outcome of treatment.
Another important factor, contributing about 30% to the outcome of treatment, is whether the therapist is using a model that they believe in and are comfortable using. In fact, only about 8% percent of the outcome of therapy can be attributed to the particular model or technique being used. As a result, it is generally more important that you feel you have a good fit with your therapist than that you pick a specific counselling model.
That is also why clients should feel free to shop around for the right therapist, and ask to switch to a new one if they don’t feel that a good rapport is developing with the first one they try. In some settings, however, asking for a different therapist might not be possible. In that case, it can still be helpful to give feedback to your therapist about what you find helpful and what is not working.
Does this mean that people shouldn’t care about the model of therapy they get? Not at all. Therapy is a very personal experience, and other research suggests that clients do best in therapy if the approach used closely matches their own “theory” of change. In other words, certain models will more naturally fit how you already process things and grow personally.
If you don’t feel you are making progress in therapy, it is important to raise this with the therapist to see what can be done differently. Perhaps a new model, or a referral to a different therapist might make a difference. Sometimes, when there are biological factors at play such as with significant depression or anxiety, a combination of therapy and medication can be most effective and so it might be helpful to add a doctor to the treatment team.
Ideally, when you first meet a therapist, he or she will listen to your hopes and goals for counselling and explain what approaches might be most helpful to address them, so that together you can develop a plan for your therapy, which model(s) to try, and what to adjust if you don’t seem to be making progress. Look for a therapist who seeks your input and consent about the counselling process, including the models of therapy being used. And don’t hesitate to ask your therapist about what they are doing and why.
After all, it’s your therapy.
Susan Winter Fledderus is a Clinical Therapist with Shalem Mental Health Network