What Is a
If you're new to the counseling field, in your first practicum, or interviewing for a job fresh out of grad school, it's likely you will be asked, "What's your theoretical orientation?"
If you're like me, you will probably pause and wonder, "what the heck is a 'theoretical orientation', and how do I figure out mine?" In a nutshell, the "theory" part of theoretical orientation provides a framework for understanding how people develop and maintain problems, and how those problems are best treated. The "orientation" part refers to the alignment of your beliefs with a particular theory.
For visual learners, the video below provides a brief overview theoretical orientation that you may find helpful.
There are a number of psychology and counseling theories out there. Most often, you will find theories falling under the three umbrellas listed below: behavioral (which has been merged with cognitive), psychoanalytic, and humanistic. For a brief definition, hover over each theory. If you click on the box, you will be directed to more resources on each theory.
What's the Difference Between a Theory and a Therapy?
One thing that isn't always made clear is the difference between theories and therapeutic modalities (therapies). Above we explain that a theory is like a guide for conceptualizing a client's problem, the origin of their problem, and how to best treat said probelm. A therapy is the process you use to treat the actual problem. Your "theoretical orientation" will guide the type of therapy you will use with a client.
For example, if my theoretical orientation is cognitive behavioral, then I believe that a client's problems are caused by their thoughts and behaviors. Therefore, I may employ cognitive behavioral therapy or dialectical behavioral therapy which specifically targets problem thoughts and behaviors.
Check below for a brief overview and links to training, resources, and certifications for various therapeutic modalities.
Acceptance and Commitment Therapy (ACT)
Uses acceptance and mindfulness strategies combined with commitment and behavior change strategies to engage and overcome painful thoughts and feelings with the goal of growing in self-compassion.
Body-Centered (Somatic) Therapy
Works with how the body processes and stores physical experiences, such as trauma. Explores the linkage between physical experiences and processing of emotions and thoughts. Techniques include: Tai Chi, breath-work, mindfulness, Qi Gong, and more.
Emotionally Focused Therapy
Primarily used with couples, but also used with families and individuals. The goal of EMF is to alter the interactional patterns between partners (or families) and to create new patterns for interacting, while creating a secure bond between partners or family members.
Gestalt therapy focuses on experiences in the present, and seeks to connect clients with their inner resources. Stresses the importance of letting go of the past. Therapists and clients may use re-enactments and to better get in touch with emotions in the present moment.
Developed by Viktor Frankl following his experience in a Nazi concentration camp, logo therapy stresses that terrible circumstances do not take away a person's ability to choose their attitudes towards the experience or make meaning.
Attempts to change the negative and problem-filled stories clients have about their lives to discovering and re-telling the story to include the client's strengths, what the client hopes for, values, and desires.
Rational-Emotive Behavior Therapy
The predecessor to CBT, REBT focuses on identifying and challenging harmful and irrational thoughts and emotions.
Cognitive Behavioral Therapy
Examines the relationship between thoughts, feelings, and behaviors. Thoughts and behaviors influence emotions. Functioning can be improved by targeting & changing unhelpful thoughts and behaviors.
Eye Movement Desensitization and Reprocessing (EMDR)
During EMDR therapy the client sequentially confronts
emotionally difficult material while simultaneously focusing on an outside stimuli, typically lateral eye movements. Thought to result in new learning and elimination of emotional distress by re-processing the traumatic memory and re-pairing it with new and adaptive thoughts or memories. This process also desensitizes the client from the trauma.
Integrates the principles of CBT with mindfulness techniques such as breath-work, meditation, and yoga to help clients become more aware of their bodies and the present moment. Most often used for treating depression.
A technique that allows children to work through difficult emotions and issues through play, without having to put words to their difficulties. May include work with puppets, doll houses, stuffed animals, etc.
Reality focuses on the present and avoids discussion of the past. The goal is to improve present relationships and circumstances. Therapy is based on choice theory, or the idea that a person has the ability to choose their behavior.
Used for children diagnosed with Reactive Attachment Disorder. Focused on building trust and the bond between the child and caregivers.
For adult clients, therapist-client bond acts as a corrective experience for early attachment issues.
Dialectical Behavioral Therapy
DBT therapy focuses on increasing mindfulness, distress tolerance, emotial regulation, and interpersonal relationship skills. The goal of DBT is to improve a client's self-understanding and ability to self-regulate. Treatment typically includes indivudal therapy and group skills training.
Existential psychotherapy explores the anxiety and fear of death and loss, personal choice, finding meaning, and reconciling issues of mortality and morality.
Hypnotherapy is a form of guided concentration. Typically hypnotherapy is used to create a relaxed state in which a client may be better open to suggestions (such as smoking cessation) or memory recovery.
Mindfulness & Meditation
Emphasizes awareness of the present moment, acceptance, and non-judgement. A practice of mindfulness can be incorporated into daily activities and therapy.
Processes that build on strengths, the development of meaning, and promotion of factors that contribute to optimal functioning and mental health.
focuses on solutions, does not focus on the client's problem. Helps clients to become aware of alternative solutions and take action. Pays attention to client descriptions of how they are trying to solve their problems, the language they use, and core beliefs behing their descriptions.
Works to identify, analyze, and change problem behaviors through principles of operant conditioning, classical conditioning and modeling. Includes prolonged exposure therapy, and applied behavior analysis. Interventions include behavioral experiments, role-playing, homework, and self-management training.
Utilizes imagination and creativity to assist clients in confronting fears and experiencing their emotions through dramatic play.
Feminist therapy explores the impact of specific issues such as discrimination, gender bias, oppression, stereotyping, and other factors, on the mental health of women.
Focusses on an individual's characteristic patterns of interacting with others. The goal of therapy is to improve interpersonal patterns of relating to self and others. IPP relies heavily on the interactions between a therapist and client, utilizing the process dimension, transference, and countertransference reactions.
An approach that helps to move individuals from ambivalence or resistance towards motivation for healthy change. Empowers the client by focusing on their strengths and ability to make change and reach goals. Frequently used in working with substance use disorders.
Problem patterns are rooted in early childhood experiences and
unconscious forces. Healing occurs through the development of new insights and understandings through therapy.
Diagnosis is a controversial topic in the field of mental health. Mental health diagnosis is based on diagnostic criteria outlined in the Diagnostic Statistical Manual 5th Edition (DSM-5). The controversy of diagnosis lies in its inherently deficit-based nature, the assumption of one (Westernized) culture in which "normalcy" is based, the dismissal of psycho-social stressors and influences, ignoring client strengths, and the potential self-fulfilling prophecy that can accompany a diagnosis.
Criticism aside, diagnosis is an important aspect of clinical practice for a few reasons:
The DSM 5 organizes information and symptoms into categories that can be helpful in determining the best course for treatment.
Diagnosis can help a client better understand their experience by linking clients to resources and research that provide explanations on the possible course and causes of what they are experiencing.
On a practical level, diagnosis is often required for service reimbursement (aka getting paid).
Differential diagnosis essentially refers to "ruling out" other disorders or conditions that might cause a particular set of symptoms. When making a differential diagnosis, consider the following:
Are the symptoms real?
Could the symptoms be caused by a substance (medications, drugs / alcohol, toxins)?
Could a medical condition be causing symptoms (example- brain tumor)?
What chief psychiatric disorder(s) are involved?
Rule out adjustment disorders.
Do symptoms cause impaired functioning (social, occupational, educational) OR clinically significant distress?
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