As a therapist, it’s common to encounter clients who come in with specific requests for certain types of therapy, often based on recommendations from previous therapists. One frequent scenario I experience is receiving emails from Psychology Today from prospective clients who explicitly ask for Dialectical Behavior Therapy (DBT) or other specific therapies instead of Cognitive Behavioral Therapy (CBT). These requests are usually rooted in a recommendation from a former therapist, suggesting that another form of therapy might be more suitable for them.
Picture this: it’s a Tuesday afternoon, and my inbox pings with yet another email from Psychology Today. The subject line reads, “Seeking DBT Therapist” As I open the email, I can almost hear the desperation in the client’s words. They explain how their last therapist insisted that DBT is the only thing that will work for them. I glance at their history, noting a pattern of similar emails, each one demanding a different therapeutic approach. It’s like they’re collecting therapy modalities like Pokémon cards, hoping that the next one will be the magical fix.
On the surface, it seems reasonable for a client to seek out the therapy they believe will best address their needs. But here’s the kicker: many of these clients have no idea what DBT or CBT really entail. They’ve simply been told, “You need DBT,” and they cling to it like it’s a lifeline. It’s almost like they’re shopping for therapy on Amazon, looking for the best-reviewed product without really understanding what it does.
This brings us to a bigger issue. I often find that these clients are fickle and challenging to work with. They jump from one therapy to another, convinced that the next one will be their saving grace. In reality, they could likely benefit from a range of therapeutic approaches. The underlying issue often isn’t the type of therapy itself but the way these clients are passed along in the system. It’s a bit like musical chairs, except the music never stops, and they never find a seat that feels right.
The Problem with Therapy Hopping
When clients bounce from therapist to therapist, citing a need for a different therapeutic approach each time, it often signals deeper issues. The recommendation for a specific therapy can sometimes be used as a way for therapists to justify dropping a client. They may claim that the client isn’t a good fit for their expertise, thus pushing the client to seek another therapist who practices the recommended therapy. This cycle can create a sense of instability and frustration for clients, leading them to feel unheard and misunderstood.
Therapy as a Universal Tool
In my experience, most clients can benefit from various forms of therapy. The principles of CBT, DBT, or other modalities often overlap, and the effectiveness of therapy largely depends on the therapeutic relationship and the client’s commitment to the process. The fixation on one type of therapy over another can detract from the broader goal of therapeutic work: fostering growth, understanding, and change.
Building a Strong Therapeutic Alliance
To break this cycle, it’s crucial for therapists to focus on building a strong therapeutic alliance with their clients. Here are some practical strategies for doing so:
Educating Clients
Helping clients understand that while different therapies have unique elements, many share common goals and techniques. It’s the therapeutic process and relationship that often matter most. Practical steps include:
- Informative Sessions: Dedicate initial sessions to explaining the similarities and differences between various therapies, emphasizing how each can be beneficial.
- Resources: Provide clients with articles, videos, and books that explain different therapeutic approaches and their effectiveness.
- Personalized Plans: Create a tailored therapy plan that integrates elements from different modalities based on the client’s needs, helping them see the value in a comprehensive approach.
Setting Realistic Expectations
Clients should know that therapy is a journey and that progress can be made with various approaches. Emphasizing the importance of commitment and consistency can help manage their expectations. Strategies include:
- Goal Setting: Work with clients to set realistic, achievable goals and milestones.
- Progress Reviews: Regularly review progress with clients, highlighting improvements and areas for further work.
- Honest Conversations: Have open discussions about the potential challenges and timeframes involved in therapy, ensuring clients have a clear understanding of the process.
Addressing Underlying Issues
Sometimes, the request for a specific type of therapy is a way for clients to avoid confronting deeper issues. Exploring these underlying concerns can provide more significant insights and progress. Approaches include:
- Thorough Assessments: Conduct comprehensive assessments to identify underlying issues and inform the therapeutic approach.
- Integrated Therapies: Use a combination of therapeutic techniques to address both surface-level symptoms and deeper-rooted issues.
- Referrals: If necessary, refer clients to specialists or additional services that can address specific needs beyond the scope of your practice.
Collaboration with Previous Therapists
When possible, collaborating with a client’s previous therapist can provide valuable context and continuity in care, helping to create a more cohesive therapeutic experience. Steps to take include:
- Obtaining Consent: Ensure you have the client’s consent to communicate with their previous therapist.
- Sharing Information: Exchange relevant information and insights with the previous therapist to build on their work.
- Continuity Plans: Develop a continuity plan that incorporates previous therapeutic progress and builds towards future goals.
Conclusion
While the request for specific types of therapy like DBT or CBT is understandable, it’s essential to recognize that the effectiveness of therapy is often less about the specific modality and more about the relationship and commitment to the process. By focusing on these elements, therapists can help clients move past the cycle of therapy hopping and towards meaningful, lasting change. It’s about finding the right fit, not just in therapy type, but in the therapeutic journey as a whole.
Author Info:
Max E. Guttman
Max E. Guttman is the owner of Mindful Living LCSW, PLLC, a private mental health practice in Yonkers, New York.
