Sunday, May 6, 2012

Treatment Modality - Playing Favorites

While some disciplines focus narrowly on one modality (e.g., Marriage and Family Therapists, or Art Therapists, etc.), social work is almost by definition incredibly broad. Even narrowing it to clinical social workers in the field of mental health, most of us have experience with several treatment modalities. We may be practicing multiple modalities currently, and have probably used others in previous experience and training.

One of my students is researching clinicians' perspectives on their own and other treatment modalities. It's interesting: in spite of (or perhaps because of?) our breadth of experience, many of us are pretty biased in favor of our "favorite" approach to treatment. Whether that's individual, family, or group therapy, psychodynamic, CBT or another theoretical approach, we develop an allegiance to our modality that affects how we think about each other's work, as well as new ideas and innovations in the field.

For example, a supervisor of mine has decided to only take interns who express interest in learning psychodynamic psychotherapy. He explains that he has spent years honing his understanding of the therapeutic process, and he does not feel comfortable working with students who are trying to learn approaches he sees as inferior.

This idea of alternatives to our preferred approach being inferior actually seems to be pretty common. Through training, experience, and trial and error, we have come to an understanding of how best to help people, and begin to see all of the myriad alternatives as inadequate substitutes for "real" therapy. Individual therapists see family or group work as a band-aid approach that is faster but doesn't accomplish core psychological change that may be necessary for lasting stability. Family therapists disagree, and think that individual therapy can't accomplish lasting change because it neglects the influence of the system in which the individual operates. While individual therapists may see group work as a diluted form of individual therapy, group therapists argue that the group process becomes a change agent more powerful than the therapist and client dyad.

Who is right? I would say everyone and no one: each group has a valid argument for why their favorite modality is effective; however, the validity of one does not negate the validity of the others, as we too often assume. None of them represent the be-all-end-all of therapy, nor a weak option for the less skilled. Instead, we each have a unique set of traits, tendencies, and skills that make a particular modality and/or theoretical approach more effective for us - because it fit us, rather than something inherently better about it in and of itself.

That's what makes therapy an art rather than a science. Even if we manualize our favorite treatment, bottle it so that others can use it too, it may not work as well out of context with other clinicians and clients. I think it's largely about "goodness of fit." Similarly, we're likely to find that we have to tailor our approach for each client, because each is different and has different needs. We and our clients are enriched if we can consider alternatives, and complement rather than compete with each other.

Do you or other clinicians you know have a favorite modality? How do you think about other approaches? What do you make of the potential bias clinicians develop against "competing" approaches?

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