What Is the Right Type of Therapist?

One of the first blogs I wrote for Psychology Today back in 2011 was in response to the question of what type of therapy facilitates post-traumatic growth. At the time, post-traumatic growth was still a relatively new idea for most practitioners, and many, in my experience, struggled to understand it, so immersed had they been in the ideas of post-traumatic stress disorder. I wanted to share what I thought was a helpful metaphor for understanding this exciting new idea.

I wrote about how it was useful to think of the metaphor of therapists as either car mechanics or gardeners. I chose these two professions deliberately because they represent two very different mindsets of the therapy world. A car breaks down. You look under the hood but you have no idea yourself what the problem is. You need to take it to the appropriate expert mechanic who will then diagnose the problem. The mechanic knows about cars. He knows how they work. He knows what sounds to listen for that mean something is wrong. He knows what the right levels of fluids should be. After a time, the mechanic looks up. He tells you what is wrong and what needs to be done to get the car back into working order. A lot of therapists are like car mechanics in the sense that they offer themselves as experts in identifying what the patient is suffering from and administering the prescribed treatment to cure or fix the problem.

But you can’t fix someone for post-traumatic growth. The meaning of the term growth, familiar to humanistic psychologists, is a biological process in which living creatures are born and strive to develop to their best potential. The growth model implies that the organism has the resources within it to flourish if the nutrient conditions are right. Gardeners do not grow the plants; the plants grow themselves, even when there are no gardeners. What gardeners do is cultivate and nurture.

The growth model is a way of understanding human experience in terms of development, maturity, increasing complexity, and the idea that human beings have a natural and normal propensity towards the development of their potential. In humanistic psychology, the idea of growth as a biological process is a familiar idea with a long and distinguished heritage going back to the writings of Kurt Goldstein, who saw self-actualization as a fundamental process in every organism; Karen Horney, who described the process of self-realization; Abraham Maslow, who built on these earlier ideas to a further understanding of self-actualization; Erik Erikson, who took an epigenetic approach to how personal growth unfolds over the life cycle; and, perhaps most famously, Carl Rogers, who developed the person-centered approach.

Carl Rogers proposed that relationships that are false, lack empathy, and are judgmental thwart a person’s natural tendency toward growth. To facilitate growth in a person, what was required was a social environment characterized by genuineness, empathic understanding, and unconditional positive regard. The therapist doesn’t do anything to the client; they focus on being a genuine, empathic, and accepting person. That’s what being a gardener is about.

The gardener naturally adopts the growth ideology. She turns the soil around the new plant, making sure that it gets the right nutrients, is not too cold in winter and not too warm in summer, and is getting the right balance of light and shade. With trees whose growth has been stunted by a lack of nutrients, or whose branches have twisted at an angle by straining to get at the sunlight, the gardener sets out to feed the tree, remove the barriers to sunlight, or provide support to grow anew. The gardener trusts the plant to grow as healthily as it can if all these barriers to growth are removed.

I went on to write that sometimes we need therapists to be like car mechanics and sometimes we need them to be like gardeners, and that good therapy ultimately rests on what the therapist thinks they are doing — their fundamental assumptions. Both sets of assumptions have their roles to play in helping people. But we need to know when to be like car mechanics and when to be like gardeners.

To help people suffering from post-traumatic stress disorder, it may be that therapists need to be like car mechanics, but to facilitate post-traumatic growth, my argument was that they need to be more like gardeners.

Since I wrote my blog, the idea of post-traumatic growth has become more popular and widely known among therapists. But, in my experience, it continues to be an idea that attracts confusion such that many researchers and practitioners still approach it with the car mechanic mindset, although often unaware that this is what they are doing.

It requires a radical shift in one’s mindset as a therapist to understand that therapy can be about being rather than doing. What I have come to realize is that although many practitioners and researchers now use the term post-traumatic growth, they do not approach it from a growth model mindset. For that reason, the concept can seem strange and confusing to them. I have realized that for many of them, the idea of growth refers not to a biological process but to the use of the word growth purely in an economic sense of something getting larger. In the same way that economists talk about the economy growing, these therapists talk about post-traumatic growth to refer to scores increasing on various states, as measured by a questionnaire, for example. Or, they may see post-traumatic growth as a process in which scores on post-traumatic stress are decreasing. It is not surprising, perhaps, that such misunderstanding exists, because the topic of post-traumatic growth initially arose out of trauma psychology, which is largely embedded within an illness ideology, and, as such, these car mechanic ideas still shape the field.

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But it is my hope that as we move forward, more therapists will reflect on their practice. The topic of growth following adversity challenges the assumptive world of mainstream psychology. For me, the idea of growth implies a humanistic psychology, one in which nurturing growth in others requires skillful gardening. This is not only an academic debate between different ways of doing psychology. It matters in the real world, where clients will truly benefit from being in nurturing therapeutic relationships.