Modalities

The most important factor regarding positive therapeutic outcomes, regardless of the modality, is the quality of your relationship with the therapist. A solid therapeutic rapport is such that, not only do you like and enjoy your therapist, but you trust them implicitly. You feel safe to speak and emote freely without judgment. While you feel close to your therapist, they do not feel like a friend. You know your therapist will push you and hold you accountable.
A strong therapeutic relationship is like any other relationship in that it takes time to build a strong foundation. The following are some questions to consider when building a foundation with a therapist- Does your therapist have the ability to take a modality and tailor it specifically to your needs? Are they willing to think outside the box and do what works? Do they engage you in decision making regarding your treatment and empower your autonomy? Are they personable and genuine, or does their voice and demeanor put you off? Are they able to take direct feedback in a constructive manner and then shift in regards to the feedback? Does your therapist over disclose personal information, or none at all?

Next to the therapeutic relationship, the largest determining factor regarding therapeutic outcomes is YOU. Are you willing? Not “are you ready”, but are you willing? Willing to put in the hard work, to feel really uncomfortable and make changes in the way you think and behave. Oftentimes, I find that people are never quite “ready” or “want” to; but they are willing. And in order to be willing to do some really scary, vulnerable work when you don’t want to? See point above on relationship and how that will anchor you to your willingness. At the end of the day, a therapist cannot work harder than their client. Even a truly great therapist can only take you so far if the willingness isn’t there.

That brings us to the title of this section- Modalities. A modality is a specific type of therapy model, framework or intervention. While most modalities have similar threads, they are also quite different. The type of modality you receive from a therapist will have a significant impact on your treatment outcome. If you google search, “best therapy treatment for (insert almost any psychological issue)”, 99% of those google articles will reference Cognitive Behavior Therapy (CBT). While CBT most certainly has it’s place and is the foundation of most other modalities, the assertion that it is the “best” is a bit misleading. In reality, CBT is simply the most researched modality and thus gets purported as the strongest evidence based intervention. Now, do I use CBT in its pure form at times? Yes. But not often. I typically find that a person’s history, diagnosis (if they have one), social supports, culture and stage of life will require more than a chug-and-plug, cookie cutter therapy. People are complex, unique and nuanced. It is essential for the treatment modality (or modalities) to be in line with the reason treatment is being sought and the diagnosis.