Caveat Emptor: How to Know if You're Trusting Your Mental Health Care to a Dangerous Therapist

The three main types of therapies and therapists.

Posted Apr 27, 2012

Does your therapist practice “psychoarcheology” by wanting to excavate into your unconscious mind and unearth insights?  Or, does he or she merely offer you a safe, nonjudgmental relationship and simply reflect back your thoughts and feelings?  Or, does your therapist help you learn useful skills for solving present-day problems, give you specific advice, and actively work with you to achieve your goals?

Well, here is a helpful keyhole to peek through onto the landscape of the major types of psychological therapy and the three basic kinds of therapists.

Someone (who evidently didn’t have enough to do) has determined that there are as many as 500 distinct therapeutic approaches in the current mental health marketplace. Fortunately, this bewildering array is easier to understand by grouping the 500 into three basic categories: psychoanalysis, person-centered therapies, and behavioral therapies. (Then, of course, there are a variety of fringe approaches such as “energy” therapies, regression hypnosis, and rebirthing, to name only a few, but these are so far afield that they do not deserve any serious discussion here.)

Psychoanalysis stems from the century-old work of Austrian physician Sigmund Freud. Emotional problems are treated through free association, nonjudgmental listening and dream interpretation. The patient’s resistance to change and the projection of thoughts and feelings onto the analyst (“transference”) also come into play.

• The aim is to produce insights that are believed to produce corrective emotional experiences and lead to personal and emotional growth.

Similar to, and derived from, psychoanalysis are a variety of therapy approaches termed “psychodynamic,” which also emphasize early life experiences, the unconscious mind, and see insight as the mechanism of change in therapy.

Person-centered or humanistic therapy was developed in the mid 20th century by American psychologist Carl Rogers, who believed that people naturally move toward self-actualization, or realization of their potentials. This approach is based on the notion that a person can grow and develop in a relationship with a genuinely caring, empathic therapist who neither applauds nor censures, but merely acts as a sounding board for the client.

• The person-centered therapist-client relationship encourages self-actualization and working out of emotional difficulties through the therapist’s unconditional acceptance and nonjudgmental reflection of what the client says.

Behavior therapy, and its more recent derivative cognitive-behavior therapy (CBT), teaches people specific procedures, emphasizing what to do about current problems, rather than dwelling on past experiences.

• The emphasis in behavioral therapies is on unlearning old habits and learning or relearning more adaptive responses.

CBT tends to be short-term, solution-focused and goal-oriented. Like humanistic therapy, CBT also has a deep appreciation for the client-therapist relationship, and sees it as the soil in which the specific techniques take root.  (By the way, when you look at them closely, some newer approaches like EMDR, DBT, ACT, and mindfulness, all appear to fit into the rubric of CBT.)

Today, many therapists draw on methods from several schools of thought. Such a flexible approach to client needs is sometimes called “eclectic” or “integrative” or “multimodal.”  Nevertheless, even eclectic therapists will usually have a preferred theoretical orientation (i.e., analytic, person-centered, or CBT) that guides their therapeutic decision making.

Just like there are these three major theoretical orientations that most therapies fit into, most therapists will also fall into one of three categories with respect to clinical effectiveness:  dangerous, benign, or truly effective.  Indeed, it is stating the obvious to say that not all counselors and therapists are equal. Many are truly effective clinicians, others are essentially benign providers, and some are downright dangerous practitioners who actually do more harm than good.

In general, dangerous therapists are ones who steer only by the rudder of intuition instead of considering the available scientific evidence. They tend to rigidly embrace a specific pet theory of human psychology and favor one or two methods of treatment. Instead of modifying their methods and theories to fit the facts, these “one size fits all” clinicians will try to squeeze the client into their unyielding and inflexible molds. And if clients dare to say something that a toxic therapist disagrees with, they are told that, “I know what’s best for you.” As if the therapist knows them better than they know themselves!

These practitioners are best described by the old saw “If all you have is a hammer, you’ll treat everything like a nail.”

Benign therapists are basically neutral, accepting or supportive clinicians who provide empathy, or a nonjudgmental relationship in which the client can explore thoughts and feelings. While better than the dangerous types outlined above, these therapists usually do little more than reflect back what the client tells them; they don’t offer any concrete advice, direction, correct misconceptions, teach coping skills, or actively help the client solve real life problems.

Truly effective therapists usually approach therapy as an active educational process.  In addition to providing an emotionally safe place to explore thoughts and feelings, these clinicians try to help their clients identify and correct misinformation that may be undermining their emotional or relationship success, and provide important missing information that was never learned.  What’s more, truly effective therapists often encourage specific behavioral change in their clients since corrective action steps are usually essential for lasting progress.  Hence:

Truly effective practitioners go far beyond conversational therapy and actively guide, coach, model and teach their clients to solve problems, think more constructively, regulate emotions better, relate better, and achieve their therapeutic goals.

Thus, in addition to being good listeners, effective therapists must also be good teachers.

In essence,

• The best therapists base their methods on careful assessment of client needs, treatments that are proven to work, and a flexible and accepting working relationship that is tailored to each unique client.

• The worst therapists adhere rigidly to a narrow or backwards looking viewpoint, and do not adapt their methods to the needs of different individuals.

• If you are in therapy, ask yourself: Does your therapist fit you to the therapy, or customize the therapy to suit your particular needs?

Remember:  Think well, act well feel well, be well!

Copyright by Clifford N. Lazarus, Ph.D.