Sunday, March 30, 2008

Thoughts on Therapy Trends

Every few years a new fad blows across the therapy landscape like a fresh breeze. Now that I've been in practice long enough to see some of these trends come (and sometimes go) I am able to appreciate the many valuable approaches to the promotion of personal growth and development that so many of them have brought to the profession.

In the 1970's Transactional Analysis was the "in" thing. People learned how to determine whether they were acting from their "adult", "child" or "parent" center, and dynamics between couples could be understood through the various combinations of the above three patterns as expressed between two people.

The 1980's brought some exciting trends into psychotherapy, including strategic and structural family therapies, approaches which emphasized altering behavioral patterns and interjecting paradoxical or directive interventions to alter or disrupt these patterns to promote healthier adaptation. (I realize that tried to say a lot with a little, but since I'm just breezing over these topics that's OK for now.) The 80's was an exciting phase of development in the family therapy field. Other approaches, such as Neuro-Linguistic Programming, began exploring the intersection of language, hypnotic suggestion and behavioral change.

The advent of Prozac and other "newer-class" antidepressants in the late 1980's ushered in a new era of "better living through chemistry" approaches to symptom relief. I remember when the majority of my clients were taking some sort of anti-depressant, often with my blessing. Now the proportion of my clients on medications is much less.

The advent of the 90's was the heyday of the "Men Mars/Women Venus" approach to couples communication. It was also the age when "solution-focused therapy" swept across the profession, partly in response to the increased managed-care limitations on the length of reimbursable therapy.

Toward the start of the new century narrative approaches to therapy, which had been around for a decade or more, really took root in the general therapeutic consciousness. The idea that stories frame life experience has been very valuable in "contextualizing" how people view their lives. Similarly, social constructionist theory began to be expounded with greater frequency: the idea that reality is greatly influenced or "constructed" in a social contract became very influential.

The trend this decade seems to be "mindfulness". This is the ability to remain self-aware through the ebb and flow of emotions and events. A person who is mindful of his or her own reactions is less likely to act in ways that will alter be regretted. All sorts of therapeutic approaches have a mindfulness basis. Dialectical Behavioral Therapy (DBT) is a psycho-educational technique to increase self-awareness during times of emotional stress. EMDR and brainspotting, which I've previously written about, both help to create a richer depth of self-awareness. Other techniques similarly advocate the benefits of increased self-observation as a way to manage life's ups and downs. It's a strategy that has essentially been around for thousands of years in meditation, and now seems to be entering the mainstream of public awareness.

What will be the next "wave" of therapeutic interest? I think the mind-body connection will be one major focus. I'd love to think a more altruistic, less ego-centered focus will bring people together around a greater sense of community rather than techniques which upgrade clients to a better room on the Titanic, so to speak.

This has been a very brief sketch of therapeutic trends across recent decades. I think all these approaches have a useful place in the toolkit of a well-trained therapist, and each requires the focused, empathic "self" of the therapist to facilitate the power of human change. I consider this profession to be deeply rewarding of the effort I bring to it and this very moment is an extremely exciting time to practice. I hope to be able to say the same sentiment for as long as I am in this business, as I plan to continue learning to perfect my craft for the remainder of my days.

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