You’ve learned about different theoretical orientations and the accompanying interventions in your graduate program. You may have even figured out which theory, or theories, best fit you as a counselor. But what about the client? How do you know what is a best fit for them?
The short answer is: whatever works. But how do we know what works? There is a dearth of outcome studies due to the sheer volume of theories, possible diagnoses, and other complicating factors such as client personality traits. Instead, we need to rely on our own observations about the client, and our clinical experience. This requires some flexibility. For example, although we may have chosen CBT as our theoretical orientation, if we have a client who is not cognitively oriented (i.e. aware of their own thoughts) CBT won’t work. If we persist in using CBT, we risk alienating the client and frustrating ourselves in the process.
Let’s start with you. Although you may have chosen a particular theory, or even a category of theories, it is important that you know other theories as well. With over 400 to choose from, obviously you won’t know them all. But you should know three or four that cover a wide variety of modalities. For example, if you are well-versed in a cognitive theory such as CBT, then you should focus on learning an experiential theory such as Gestalt, and a more feelings-based theory such as Rogerian.
But remember that you must feel comfortable using these theories in order for them to be effective. For example, if you are so cognitive that you cannot focus on empathy, then you should refer feelings oriented clients out. (More on this in a future post.)
Next, as the client is describing their issue, figure out how the client experiences their world. If they talk a lot about what they are thinking, use a cognitive theory. If they talk a lot about their feelings, use Rogerian, or another feelings based intervention. If they are visual, use imagery. If the client responds by going deeper, talking more, appearing more animated, or starts smiling, then you know it’s the right intervention. If the client shuts down, turns away from you, acts irritated or annoyed, then it’s the wrong intervention.
This is the “art” part of our work. You must think creatively in order to design an intervention that is evidence-based, fits the client, and fits yourself. Not an easy task! But one of the many reasons why our field is so much fun.
Yours in the Joy of Knowledge,
Dr. Barbara LoFrisco
