Jan 3, 2022
Curt and Katie chat about how therapists typically select their clinical theoretical orientation for treatment. We look at the different elements of theoretical orientation (including case conceptualization, treatment interventions, and common factors), what impacts our choices, the importance of having a variety of clinical models to draw from, the types of practices that focus on only one clinical theory, and suggestions about how to approach choosing your theories for treatment, including some helpful assessments.
We received a couple of requests to talk about clinical theoretical orientation and how Curt and Katie chose their own. We tackle this question in depth:
“You need to know the theories well enough to know when not to use them”
– Curt Widhalm
“Theoretical orientation actually can be very fluid over time” – Katie Vernoy
Buying Time is a full team of Virtual Assistants, with a wide variety of skill sets to support your business. From basic admin support, customer service, and email management to marketing and bookkeeping. They’ve got you covered. Don’t know where to start? Check out the systems inventory checklist which helps business owners figure out what they don’t want to do anymore and get those delegated asap. You can find that checklist at http://buyingtimellc.com/systems-checklist/
Buying Time's VA's support businesses by managing email communications, CRM or automation systems, website admin and hosting, email marketing, social media, bookkeeping and much more. Their sole purpose is to create the opportunity for you to focus on supporting those you serve while ensuring that your back office runs smoothly. With a full team of VA's it gives the opportunity to hire for one role and get multiple areas of support. There's no reason to be overwhelmed with running your business with this solution available. Book a consultation to see where and how you can get started getting the support you need - https://buyingtimellc.com/book-consultation/
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Petko, Kendrick and Young (2016): Selecting a Theory of Counseling: What influences a counseling student to choose?
Poznanski and McClennan (2007): Measuring Counsellor Theoretical Orientation
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano http://www.crystalmangano.com/
Curt Widhalm 00:00
This episode of the modern therapist Survival Guide is sponsored by Buying Time.
Katie Vernoy 00:04
Buying Time is a full team of virtual assistants with a wide variety of skill sets to support your business. From basic admin support customer service and email management to marketing and bookkeeping, they've got you covered. Don't know where to start, check out the system's inventory checklist, which helps business owners figure out what they don't want to do anymore and get those delegated ASAP. You can find that checklist at buyingtimellc.com/systems-checklist.
Curt Widhalm 00:31
Listen at the end of the episode for more information.
You're listening to the modern therapist survival guide where therapists live, breed and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 00:51
Welcome back modern therapists. This is the modern therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about how we are as therapists. And we have received a couple of requests for in episodes about how people select their theoretical orientations. And I think that this is a great opportunity for us to maybe gear an episode a little bit more towards early career therapists, some of the students who listened to our show, but also for those of you who are maybe a little bit later in your practice to consider how you came up with your theoretical orientation or orientations. And we're gonna dive into a little bit of our stories about this, but also what some of the research ends up saying about how a lot of therapists end up practicing in the way that they do. So, Katie, from the top of the show, what are your orientations? And how did you get to where you are?
Katie Vernoy 01:54
I think the the word that probably best describes my orientation is one that I was told not to use because it was bad, which was eclectic,
Curt Widhalm 02:06
Katie Vernoy 02:07
Curt Widhalm 02:08
Katie Vernoy 02:11
And I think it's, it's not exactly true. But I really feel like I draw from a lot of orientations. A lot of models, maybe it's better than orientations, where there are a lot of really cool interventions that I like from CBT DBT narrative, even psychodynamic or Gestalt, or different things like that. There's a lot of really cool interventions that I've been able to kind of pick up in my my toolbox or tool tool belt over the years. And so to me, when we talk about orientation, and maybe this is a question to ask, I would say, I'm probably mostly existential, and certainly relational. And, and that's kind of where I sit. I think with orientation, though, there's how you conceptualize a case, how you treat a client's you know, so, orientation feels like a very broad thing, where case conceptualization seems more like okay, that's my that's how I'm orienting myself to a case specific interventions, I think tie to theoretical orientations. But I once had a supervisor say, pretty much all theories are the same. They just use different words, people want to make money. And orientations are different, but I feel like you can you can mix and match pretty well.
Curt Widhalm 03:33
And on that point, you're talking about Bruce Wampold's common factors that soar looking at therapeutic treatment where theoretical orientation affects treatment about 1%. Maybe some of the emphasis of where some of these questions are coming from is our therapists, education, emphasis on every class being about orientation, really not looking at the other 99% of what actually makes therapy work? Yes. Now, like you, maybe Unlike you, I look at myself not as a dirty eclectic therapist, but as a very intentional, multimodal therapist.
Katie Vernoy 04:19
Oh, my goodness, words, words.
Curt Widhalm 04:24
So, like you, I also end up using a lot of CBT. In my practice, I'm also drawn to existentialism, and very much utilize a lot of EMDR work which, for the EMDR people that I trained with over at the Institute of creative mindfulness, we really look at EMDR as being the greatest hits of a lot of other therapeutic styles that got it just naturally pulls from a number of different areas. But when we first got these cases, My first reaction was kind of, I wonder how much of how we practice is based in who our supervisors were and how they practiced at, you know, kind of a developmental stage of where we were at in becoming therapists. And if that's just stuff that because we were forced to practice in a way for a while, if that's why we continue to practice that once we're out on our own, and I'm wondering how much of that rings true for your story here.
Katie Vernoy 05:34
It certainly rings true for me, I think about some of the newer clinicians and certainly talking to like Carrie Wiita and Ben Fineman over it. Very bad therapy, it seems like they're more thoughtful than we are, or than I was anyway, when I was coming up. But I found myself trying to soak everything in and I had a psychodynamic supervisor and a CBT supervisor when I first started, and then I went into community mental health, it's very behavioral and, and CBT oriented, with some, you know, trauma informed, you know, different things that kind of layered in there. But I did find that the supervisor made a big difference if they had a strong orientation, because I that's how they framed everything. And that's why I think I, when I say the case, conceptualizations are oftentimes more along the lines of like psychodynamic or CBT. I think it's because that was how I was trained. The other piece that I was really lucky is that I also had a group supervision with several folks who are narrative, and they would talk about their cases from a narrative perspective, and would provide feedback on some of the cases that I was working on from a narrative perspective. And so I feel like there's some narrative that came in early enough that that was something that also I added to the pool. But it wasn't something I learned in school, I think it was newer, you know, I was getting ready to get licensed at that time. So to me, I feel like the people around us, primarily the supervisor, but also potentially even, you know, our colleagues in our group supervision can really impact how we see cases how we've, you know, kind of the types of interventions we try, and therefore our orientation.
Curt Widhalm 07:22
I don't know that I can tell you my supervisors orientation from my trainee years, maybe that speaks to the quality of supervision that was being given at the time, potentially, but I, I largely agree with you in the what did end up shaping up out at the time was the other people who were part of my supervision groups and kind of being pushed into recognizing that we were naturally drawn to some techniques, whether we knew it or not. Looking at a 2016 article from the universal Journal of Psychology, this is by Pepco, Kendrick and Jung, and aptly titled selecting a theory of counseling, what influences it counseling students to choose?
Katie Vernoy 08:13
Very good, very appropriate, Good, find, Curt!
Curt Widhalm 08:16
Good find Curt. They came up with three categories that probably worth exploring here a little bit for ourselves, the first topic on here does not necessarily fall into that I practice this way because my supervisor practices this way. And in fact, none of these three do. The first one is the counseling theory is similar to my personal value system. And
Katie Vernoy 08:43
that's where I remember because we did that orientation game. What was that called? With Carrie and Ben and Ben?
Curt Widhalm 08:51
Oh, the elimination game?
Katie Vernoy 08:53
Yeah, yeah. And I just I hear Ben talking about how amazing narrative is. And it seemed like it was so aligned with his values and stuff like that. I was like, I don't know that I was that thoughtful when I was in that stage of my my development.
Curt Widhalm 09:09
It's something where I really expect our audience to resonate with this one, just because we do talk about value systems as such an important factor of the work that we do, and that obviously should be reflected in the work that you do with your clients and make sense as far as how that would carry over as, as an extension of yourself and your personality to make the therapeutic alliance work. I think it's better done when it's intentional, maybe not in the way that you're describing of like looking for justification five years after a journal article is published to be like, Yeah, that's what I did. But to really be able to clarify, it's like you're giving credit to Ben for doing it. As far as saying, These are my values, this is a theory that ends up reflecting what those are. And I think that there are going to be certain theories that end up lending themselves to that more easily than others. Things like narrative therapy, where it really does have more of a social justice aspects to it. Yeah, as compared to something like behaviorism, which is going to be very much about pushing people to certain measurable outcomes, unless that's who you are as a person and why you don't get invited to dinner parties?
Katie Vernoy 10:38
Well, I think that there are things that I was trained as a therapist 20 years ago. And I think that there are, there are limitations on some of the research that was available 20 years ago, and so even if I were to come up now, I don't know that I would spend a lot of time on CBT, just based on, you know, kind of the limited transfer across different cultures and that kind of stuff, I think that there are great interventions, and I've kind of learned over the years, especially in working in a lot of different multicultural and cross cultural environments, how to make those adjustments and kind of what to hold to and what not to, but I think that there are, are definitely different pieces of information around orientation and kind of our personal value systems that I think, is a constant or a continual assessment. I don't know that, you know, I don't know that there's, you know, it kind of goes to that, like, what's what's been indoctrinated and what needs to be unlearned, and kind of the whole decolonizing therapy, but I think that there's, there's definitely things that feel inherently true to me, because of when I learned about them and and how they were just kind of organically fold it in. And I would have liked to have that assessment that personal values assessment around which theory fits best for me early enough on so I'm glad we're talking about it, hopefully, the students are going to do those assessments for themselves. But, um, but I don't know that I even thought to do it, because it was, you know, everything was kind of a truism. Like, this is what psychology is, you know, back in the olden days, when I was trained.
Curt Widhalm 12:20
And you what you're leading into, is this second on this list, which is people to series, because it's what makes sense logically, yeah, it's, oh, I can see how a leads to B leads to C. And this might lead to some more of those directive type therapies and CBT being an example of this, where but I think in, it's not just let me get to CBT. It's also being able to look at anything from a comprehensive way. And as much as I know, students, and really anybody else hates doing case conceptualizations it's an important factor to be able to see this is how people fit logically into this set of patterns as described by this theory. Historically, I have seen some pushback from educators and supervisors as far as this approach when it comes to trying to make clients fit into a theory, rather than hearing the client stories. And this is where I think most educators, most researchers when it comes to this, and we'll put some citations in the show notes. But people like Lazarus, Norcross and golden freed, all talk about the importance of learning a variety of theories. So that way you can shift to when clients don't fit a particular one that you're still able to practice in a way that makes sense for them. So having some theories that do make sense to you make sense. But don't, don't fall just into the logic trap of everything needs to follow into this set of patterns.
Katie Vernoy 14:05
Completely agree. And I want to just acknowledge that what makes sense to you may be what you were trained, which I think ties back into, it makes sense to me because that's what my supervisor taught me. And that's how the, the practice of doing therapy, this is what it is, and this is what makes sense to me. The follow on to that is the importance of either having a supervisor that has this kind of palette of different orientations and teaches to all of them and and has that as part of your supervision or having a number of different supervisors across your internship or trainee years or your associate years so that you can get your own perspective on something versus this is how it logically fits into the model I was trained by my one supervisor.
Curt Widhalm 15:02
And this is getting a comprehensive understanding, not just not just like, oh, we covered this in class last week, and I should try this out on clients. And here's parts of it that work. And because it worked, it made sense to me. But it does take a ability to get in to the depths. And I've always kind of naturally described this as you need to know the theories well enough to know when not to use them. And knowing that you should be able to shift to something else is the level of depth that you need to know. And rather than just forcing clients to do something, because the theory says that it should work means that you're maybe not quite there yet. And that's where having a more comprehensive understanding of switching between theories, or utilizing aspects of different theories, together with intention definitely helps out.
Katie Vernoy 16:04
Oh, for sure, I think to me, I see folks that are very immersed in a single theory, or a single orientation. And I think there are reasons to do that. I don't want to say anything negative about folks who do that. But to me, that wouldn't fit for me, because I would have to refer clients out who I could serve with a different theory. But specifically, I'm talking, the most frequent one that I see are, are people who are like doing comprehensive DBT. And that's their whole practice. And then there's also folks that end up doing a lot of EMDR, I feel like that's become less because there's so many people that have been trained in EMDR at this point or anything. But the DBT thing, it requires a lot to set up, you have to have a consultation team. You know, if you're doing comprehensive stuff, you have to have a group with CO leaders, there's a specific way you run your individual session. And it works really well for the folks that works for. And I think that the comprehensive DBT therapists who only do DBT would argue they know who it's not for, and they refer them out. For me, I don't think I'd be comfortable with that. But I think the level of knowledge to determine that, I think is is higher than I think some folks who initially come into a single theory, and maybe this is where the question came from is I need to have my orientation. And it's like, should I become an EMDR? therapist, or a DBT? therapist, or a CBT? therapist or a blank right? kind of therapist? And I think very few people end up with just one orientation, I believe. I think when someone's learning an orientation, you know, and I've seen this with like EFT folks, they go really deep into it. It's like they have, you know, at least a portion of their practices only EFT. I think that there is there is a and I'm talking about Emotionally Focused Therapy, not Emotional Freedom Techniques. Right? I understand there's two FTEs. But But I think that there's a necessity when you're digging deep into a very specific theory maybe to focus in on it. But I really like this idea of having that palette of orientations and intervention so that you can shift when it makes it makes sense. But what would you say for folks who are single theory that there is a different developmental stage? Or do you feel like it's folks that have a different style? Like, where does that fit? Do you think?
Curt Widhalm 18:41
You know, it's interesting that you talk about the DBT therapists, and when I talk with other therapists and in the community, and some of you are listeners of the show it sometimes I get accused of being a DBT therapist, I know I heard that recently. And I liked DBT, I've done some workshops towards, you know, learning DBT a lot of it, a lot of it makes sense. I'm not trained in DBT. But just the way that I understand where these comments are coming from is for a lot of DBT therapists, it's also ways that you run your life, and it's ways that fall into that first category of almost being value based. And with the bonus of things making sense. And also with the the third category here that we'll be leading into in just a moment, but it's a very comprehensive structured package that also immerses the clinician in needing to be in that lifestyle, too. I don't see this with other theories quite to the same extent. You know, I think they you bring up EMDR I think that there's a very big mindfulness component of it that the good EMDR clinicians that I know tends to exhibit as far as their practice. I don't necessarily see it when it comes to some of the more directive therapies that I don't see solution oriented therapists being like, standing in front of the the milk cartons in the grocery store being like, this one is an eight out of 10 solution, but this one over here is a nine out of 10 solution. Maybe they do, maybe it's just internal, I don't know. And, but the people that I really do see, stuck very much into single theories really aren't practitioners, it's researchers. And it's people whose research is based on needing to stay within a particular theory. And, you know, while I do have respect for the CBT therapists out there, it's those people who are like, well, everything's CBT, you know, that's just, you know, CBT with this or equine therapy is just CBT with more horsepower, or, but our third category is that people choose theories because they like techniques, or they like interventions that come from that theory. And it may not be the most comprehensive way of choosing a theory, it might be something that you find that a particular set of interventions works for certain situations. It's from just that description of it go further than that, like yes, yes, you know, you can't be in the middle of psychodynamic and being like, you know, what, we need some intermittent reinforcement right here. But it can be a place that starts you into getting more of that comprehensive look at a theory if what you find is that a certain technique ends up working, learn more about the theory. So that way, you can understand how it fits comprehensively in the explanation for why a client's pattern of behaviors or outlook on the world may be influenced or susceptible to being changed by that kind of an intervention.
Katie Vernoy 22:13
As you were talking, the thing that came to mind, for me, was the validity of this kind of construct. So I'm getting really far afield. So we'll see if this bears fruit. But there are some theoretical orientations that feel very rich, they feel like they have a lot to them, that you can really dig your teeth into them. They're a way of conceptualizing a case with potential suggested interventions or ways of being with the client in the room. And there are others that feel a little bit more stilted or really based on someone trying to put stuff together. So they can prove a point with their research or a slight change to something that's already present and all of that. So I guess I'm kind of pushing back on, needing to have a really in depth understanding of all of the orientations. And I know, you didn't say that, but like, there's some of this where I think about how I actually work. And I, it's almost kind of a post hoc description, saying that I'm existential, or I use narrative, or I've got psychodynamic or or CBT, or DBT, or whatever. Like, to me, it's something where and this is potentially more of a later career situation. And I'm sure you experienced this too. I have absorbed so much knowledge from so many different continuing education, things, different clinical consoles, and conversations. That to me, and this kind of talks about, I think what Diane was putting forward is that there's so many orientations at this point that it's gotten ridiculous. And so she's simplifying it doing something and we'll, we'll put Dr. Gehart's episode in our show notes, the link to it, but, but to me, I feel like there's so much I've absorbed so much that is similar. It's so much that goes together. And maybe this is about making sense and having techniques. And so it's not the strongest way to do it. But I don't know that I'm ever consciously thinking, Well, I'm going to approach this client with CBT to start and then we'll see if it goes into something else. Like I feel like I'm meeting the client. I'm hearing what they have to say I'm conceptualizing it probably from two or three or four different theories because they kind of all melded into one. And then I'm doing interventions based on my conceptualization, but it doesn't necessarily tie and maybe this just is lazy. eclectics eclecticism but it doesn't necessarily apply. Like I'm going to start with this orientation and move to this one then move to this one and that feels to in a box for me and how I actually practice.
Curt Widhalm 24:52
I think that with practice, it ends up becoming where, when you're versed in a couple of different theories, you see that certain things are going to be better approached in certain ways. If a client's coming to me, the intake phone call is to deal with trauma, I'm immediately going to go to my trauma modalities. First, as far as how I'm listening for the story developing, somebody is coming to me for something like obsessive compulsive disorder, I'm pretty much going to be going to what's an exposure and Response Prevention Plan. Part of these are where research shows some of the effectiveness part of this is really being able to look at how things make sense. And honestly, for me, part of it is how am I going to be most effective at utilizing something that I can be decently good at some theories that research shows, you know, 95% of people who get CBT by this are fixed by this. But if it doesn't fit with how and how I think about the approach, it's something where I may only be 75%, effective using CBT, with something where I might be 93% effective with something else. Yeah. And so part of that also does look at the influence of who I am. And one of the people that really led the way, as far as this kind of thing is one of those people who had a theory, and that was Milton Erickson, who was largely just kind of seen as it was his relationship with his clients. And yeah, he did a lot of strategic therapy work, but it ended up being him pulling from stuff that worked in the moment because that's what worked for him and the relationship that he had with his clients. So I
Katie Vernoy 26:49
guess the point that I wanted to make with that a new just kind of set it in a different way. But I want to make sure we're on the same page is it can be very fluid, it doesn't need to be I start with a conceptualization that is tied to one theory. And I make a treatment plan that's tied to that theory. And then if it needs to shift, I shift to a different theory. It's really to me it feels way more fluid than that. And like I said, I'm existentialist I'm, I'm a Yalom existentialist where it's really just about the relationship and being a real person in the room. So it gives me a lot of freedom to conceptualize things differently. But I think it's hard to describe it to someone that's just starting out when they're like, Okay, what do I do in therapy, and it's like, we'll be in the room, see what's happening with the client, and provide them what they need. I mean, like, that's kind of how I that's, that's my orientation.
Curt Widhalm 27:45
So I do want to point out that there are a handful of different instruments that are out there that you can look at, take it with a grain of salt. You might talk about the ways that you might view the importance of aspects that might steer you in the direction of looking at theories that might more naturally come to you. A couple that we've come across in preparation for this episode. One is the theoretical orientation scale, developed by Smith in 2010. It's 76 questions that you fill out Likert scale types, you score it, it points you to sub scales that might fall across a couple of different theories that you might want to look at. Another one is a 40 item scale called the counselor theoretical position scale. This was developed by Posnanski. And McClellan, either of these might be things where if you're looking for a questionnaire that is based on where you're kind of already existing, as a person might steer you into some directions to more easily find, I might want to research this more, you get into practicing that way, you might find that it continues to gel with you, you might find that parts of it gel with you. But if you're looking for a little bit more of a direction, if you're not quite familiar with a number of different theories, yet, these might be some starting places for you to look at as well.
Katie Vernoy 29:15
And I think the takeaway that I want folks to have or a takeaway that I want them to have is that theoretical orientation actually can be very fluid over over time, you can start with, I really want to dig into narrative and you do narrative therapy with a lot of your clients. you conceptualize it that way. Maybe you have a few other things that you're doing in the background and not just adhering to one theory. But over time, there may be something else that comes down the pike. You do a training on Emotionally Focused Therapy EFT I have a lot of people that they later in their career, start sending EFT and they're like I'm completely changing how I'm working. This is an awesome way to work with couples or even individually EFT or you Find DVT later and you start digging into that, and you really understand the conceptualization, those things. I think people get really freaked out. And part of it is, I think, the interview questions. I've even designed them, like, what is your theoretical orientation? Like, I think people get freaked out that they have to choose an orientation, and that sets them up for the rest of their career. And I don't think that's true. I think that they there there is certainly foundational work that may stick with you forever. And so you don't want to be mindless about what you choose to focus your attention on at the beginning of your career. But I think it is something where it does shift, you're going to be impacted by research that hasn't even been done or theories that haven't even been concocted yet. And so I think find things that gel with you I'll use your word there and and dig into them, but but don't fear that you're going to be locked into a particular orientation for the rest of your career you You most likely won't be,
Curt Widhalm 30:54
we'd love to hear how you came up with your theories or further questions that you might have the best place that you can do that is over in our Facebook group, the modern therapist group. You can follow us on our social media and we'll include links to those as well as the articles and measurements and citations in our show notes. You can find those at MTS g podcast.com. And until next time, I'm Curt Widhalm with Katie Vernoy
Katie Vernoy 31:22
Thanks again to our sponsor Buying Time
Curt Widhalm 31:25
Buying Time's VAs support businesses by managing email communications, CRM or automation systems, website admin and hosting email marketing, social media, bookkeeping and much more. Their sole purpose is to create the opportunity for you to focus on supporting those you serve while ensuring that your back office runs smoothly. The full team of VAs gives the opportunity to hire for one role and get multiple areas of support. There's no reason to be overwhelmed with running your business with this solution available.
Katie Vernoy 31:54
book a consultation to see where and how you can get started getting the support you need. That's buyingtimellc.com/book-consultation once again, buyingtimellc.com /book-consultation.
Thank you for listening to the modern therapist Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.