Finding Your Best Therapeutic Modality
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There are many different modalities in psychology, providing counselors with an array of therapeutic approaches to work with everyone under the sun. Yet, with over 50 modalities to choose from, psychology and counseling majors don’t always know where to begin—and clients seeking therapy can feel just as lost.
Finding a therapeutic approach that aligns with who you are can help to examine the main schools of thought from which these modalities branch.
Psychoanalytic theory navigates the conscious and unconscious mind. This school of thought includes psychoanalysis, psychodynamic therapy, and Jungian therapy. These modalities tend to dive deep into a person’s inner world.
Humanistic theory concerns itself with human potential. This school of thought includes person-centered, gestalt, and existential therapy. These modalities tend to be open-ended and exploratory, relying on the client’s intrinsic wisdom.
Behaviorism seeks to adjust or adapt cognitions, behavior, and the relationship between the two. This has generated a lot of modalities, including cognitive behavior therapy, dialectical behavior therapy, and acceptance and commitment therapy. These modalities tend to focus on things you can actively do to promote personal growth.
Constructivism focuses on social constructs and how people create meaning. This school of thought includes narrative therapy, feminist therapy, and affirmative therapy. In order to help each unique client, these modalities explore how identity is impacted by culture and social roles.
Systems theory focuses on the power of connection within our social networks. This school of thought includes many family therapy methods, like structural family therapy, systemic family therapy, and couples counseling, like the Gottman method. Such approaches go beyond individual counseling to improve relationship dynamics.
Integrative Therapy takes a holistic stance, observing that different aspects of a client may need more than one therapeutic approach. Some rely on technical eclecticism, implementing exercises from different modalities as needed, whereas others favor theoretical integration, hybridizing frameworks into something new (like combining acceptance and commitment therapy with affirmative therapy to create affirmative acceptance and commitment therapy).
As one might imagine, there are a lot of nuanced differences between each school of thought and some clear overlap. Yet even with these overarching categories, it can still be difficult to ascertain which is right for you. There can be a lot of broad concepts and jargon to sift through since each modality has its way of talking about things.
Often, our receptiveness to a therapeutic approach stems from a feeling, and that feeling stems from how we engage in the therapeutic relationship. While each modality includes unique tools and techniques, they also conceptualize the role of the counselor and the client in different ways.
Modalities that spotlight the counselor’s expertise are called directive counseling, since the counselor maps out a treatment plan with detailed specifics. Modalities that center the client’s intrinsic wisdom are called nondirective counseling. This language is somewhat dated, showing up in the 1940s to distinguish the prevailing psychoanalytic literature from the up-and-coming humanistic literature. Of course, things aren’t so binary, revealing a third category we’ll call adaptive counseling, where the role of the counselor and client may change over the course of therapy.
Directive Counseling
Psychoanalysis, rational emotive behavior therapy, and gestalt therapy exemplify directive counseling in different ways, yet they all focus on the counselor’s ability to interpret the issue at hand, analyze the client, and provide therapeutic options. In simple terms, the counselor steers the course of therapy to address a particular problem or diagnosis. This is easy to envision with psychoanalysis, as the image of Sigmund Freud scrutinizing his clients is very salient. Yet notice how even a humanistic modality like gestalt therapy can be direct, expanding perspective with the two-chair technique or facilitating closure with the empty chair technique.
While considering the client’s insight, directive counseling relies on the counselor’s insight and deduction. The concept was presented in 1947 by E.G. Williamson in what is largely considered to be one of the first comprehensive counseling theories: The Minnesota Point of View. To paraphrase Williamson, Directive Counseling assumes:
- The counselor is competent at giving advice
- That counseling is an intellectual process, more so than an emotional process
- The objective of counseling is problem-solving
- The counselor cannot solve every problem
This direct, advice-giving, intellectual approach can be quite helpful in remedial counseling when a client is trying to change a particular thought process or behavior. In-patient mental health facilities also use directive counseling, especially when a client struggles with faulty or cyclical reasoning. This approach can be quite expedient, as a counselor can express their evaluations and get to the root of the issue quickly.
That said, critics of directive counseling say that it can be too direct, and even confrontational, especially when the counselor draws attention to a suppressed or repressed issue the client is not yet willing or able to address.
Cultural bias can also impede the counselor’s insight, and those who try to compensate for this by overly relying on their textbook may overlook the Western bias baked into contemporary psychology. Transference, power dynamics, and co-dependency are also issues to address when a counselor is elevated to the pedestal of “expert.” When counselors struggle with competency or burnout, directive modalities can become formulaic and cookie-cutter, pigeonholing a client and their issues to fit a particular theory or manualized treatment plan.
Nondirective Counseling
Nondirective counseling is best exemplified by person-centered therapy, the humanistic modality developed by Carl Rogers. Transpersonal psychology and more creative modalities like art therapy and sandplay therapy are also prime examples.
Collaborating with Carl Rogers, W.U. Snyder published the Casebook of nondirective counseling in 1947. To paraphrase Snyder, Nondirective Counseling assumes:
- The client has the right to select their own life goals
- Given the opportunity, a client will select goals that may possibly provide them great happiness
- Emotional disturbance may initially inhibit a person’s proper adjustment
- A client should quickly be able to function independently in the therapeutic process
Highlighting human potential, nondirective counseling focuses on the client’s natural inclination to self-actualize. The counselor takes a far more passive role, providing exploratory questions or reflecting on the client’s thoughts and responses to help them come to their own realizations at their own pace. Because of this, many person-centered counselors argue that “nondirective” is actually a misnomer since the client is charting their own direction. As such, many favor the term “client-directed” or “client-centered.” Because this approach helps clients develop their personal insight, it can fortify self-affirmation and self-actualization.
Critics note how nondirective counseling can be time-consuming, especially if the client is avoidant, has low self-awareness, or demonstrates elements of manipulation or narcissism. Some argue that nondirective counseling lacks structure, which may be needed to measure behavioral change.
Furthermore, a wholly nondirective approach may prevent the counselor from contributing beneficial insight. When counselors struggle with competency or burnout, nondirective counseling can fall out of congruence with the client, resulting in repetitive paraphrasing or vague, inattentive questions.
Adaptive Counseling
Some counselors adjust their approach to meet the contextual needs of each client. As such, adaptive counseling may progress from directive to nondirective, or vice versa, over time. A highly anxious client may need the counselor to take the lead until they affirm their voice and agency. A pent-up client may spend session after session sharing their story, only to reach a stuck point, requiring the counselor to jump in.
Striking a balance between counselor insight and client insight allows for both external education and internal awareness. Some modalities are already designed for this, especially when it’s the counselor’s task to guide the client toward self-expression. Narrative therapy and cognitive processing therapy demonstrate this, as a counselor will help a client write their life story while holding space for them to share said story. A similar balance can also be found in affirmative therapy, which provides psychoeducation on LGBTQ+ mental health, while simultaneously centering the client’s lived experience.
Critics may argue that this adaptive approach has less to do with the modality in question, and more to do with the practitioner applying it. Acceptance and commitment therapy, with all its mindfulness exercises, can be directive or adaptive, depending on the counselor.
Critics may also argue that technical eclecticism undermines treatment. Though it may seem beneficial to switch from person-centered therapy (nondirective) to cognitive behavioral therapy (directive) to address a specific issue, doing so deviates from the fundamental core of person-centered therapy. While some clients may be able to switch gears easily, others may have benefitted more from a referral.
Concluding Thoughts
Finding a modality that’s right for your practice as a counselor or your process as a client can take a bit of trial and error. Some mental health practitioners focus on a specific modality and spend their careers fine-tuning their skills. Others become certified in multiple modalities to have different tools prepared for different clients.
In turn, clients seeking therapy are encouraged to interview multiple counselors and try different modalities throughout their lives. Instead of giving up when therapy “doesn’t work” or “feels weird,” it can help to gauge what was beneficial and what wasn’t. Sometimes, it may be the personality, relatability, and level of experience of the counselor, but sometimes it may be their counselor’s very approach to therapy that you do or do not vibe with.
We all have certain hopes, concerns, and expectations for therapy, even if we’re unaware of them. If we feel lost, we may want a sequential treatment plan reassurance. We may flourish with unconditional positive regard if we value warmth and compassion. If we value engagement, we may find an adaptable tête-à-tête more beneficial.
It’s because of this diversity that directive, nondirective, and adaptive approaches may draw different counselors to them, and in turn, different clients as well.
Alex Stitt, LMHC
Writer & Contributing ExpertAlex Stitt is a nonbinary author, queer theorist, and licensed mental health counselor living in Hawaii. As a proud Queer Counselor, they work to educate professionals in the mental health field interested in working with LGBTQ+ populations. Their textbook, ACT for Gender Identity: The Comprehensive Guide, demonstrates how to apply Acceptance and Commitment Therapy to gender self-actualization.