"I Take an Eclectic Approach..."

Getting psychotherapy today, and looking back to how we got here.

Posted Jun 28, 2020

Today when the average person goes to the average psychotherapist, he or she likely will receive a mushy eclectic supportive psychotherapy that lasts 6-12 months, followed by an ending, usually followed a few years later by another mushy eclectic supportive psychotherapy. Sometimes the 6-12 month psychotherapy may be helpful, but not as much as the person might have hoped.

When you look at the typical Find a Therapist link on this website, you’ll find dozens or even hundreds of psychotherapists who share this same profile: They’re “eclectic," supportive, open-minded, nonjudgmental. This is all great, but not completely. I’ll focus on the eclecticism idea.

What does it mean to be eclectic? Does it mean that all approaches are used? Some? If only some, why these and not others? What’s the criterion to use some versus others? Is the therapist equally well trained in all the different methods he/she uses? How well are they trained in each approach?

Asking these questions raises the overall question of the legitimacy of eclecticism. I’ve written about this matter elsewhere in more detail, but I only want to raise the question here.

I raise these as questions that often don’t tend to be asked. They are relevant in particular when we see that most of these therapists have full practices, and many aren't taking new patients/clients. When demand is so high, what motivation exists for anything other than eclectic psychotherapy?

This brings us back to the 1980s. 

It is a pleasure to find this 2017 article which reminds the mental health professions where we came from. It also reminds us of a promising type of psychoanalytically-oriented “brief” psychotherapy that has receded from the clinical world: Habib Davanloo’s Intensive Short-term Brief Psychodynamic Psychotherapy.

To pick out a few points: At that time, psychotherapy was psychoanalytic and it was way too long and expensive, lasting years. Davanloo found a way that suggested many benefits could be achieved more quickly, meaning in a year, with a focused psychoanalytic therapy that was videotaped and analyzed by doctor and patient. At the same time, cognitive behavioral therapy was being developed as another short-term treatment. CBT became a major success while the brief psychoanalytic approach of Davanloo had less success. One reason might be that CBT could be learned quickly, while Davanloo’s therapy required extensive psychoanalytic training, just as in traditional psychoanalysis.

Back to the year 2020:

Can we get beyond the same mish-mash of eclectic supportive psychotherapy that almost anyone can provide with a few years of training? That’s not to say that supportive psychotherapy isn’t helpful. It is.

But it is limited. Many people can get much more benefit not only from CBT but from a more serious investigation of their psychic life. I don't mean one lasting years and decades as with traditional “psychodynamic” psychotherapy, which is the second most common type of practice seen after the 6-12 month eclectic approach. That long-term therapy is good for keeping one's practice full and stable, but it's less clear how good it is for the subjects of therapy. 

I'm not proposing answers here, for reasons of space, though I have some ideas, and the above article makes some good suggestions. Answers follow questions. And first, it's important to ask some questions that aren’t being asked.

To find a therapist, please visit the Psychology Today Therapy Directory