Approaches to therapy
Summary:
In this article I try to outline explicitly my own therapeutic orientation, to be open about how I work. I describe how I value the therapeutic relationship, the importance of direct experience and experience-oriented therapy approaches. I also refer to research from Professor Sabine Koch that explains why creative arts therapies support positive change as well as the importance of self-care for therapists and the need to address systemic and political issues that impact client well-being.
There are as many different ways to approach therapy as there are therapeutic orientations. As a therapist, I feel it is important to be open about the way that we work, and the way we see the work that we call therapy. Here are a few elements that I consider important.
1. Relationship
Therapy is primarily about relationship. Study after study has shown that the quality of the therapeutic relationship is a key element in any therapy across all therapeutic orientations.
… a crucial predictor of therapy outcome is the ability of the client to pause and listen to what is going on inside of (their)self, in order to reflect the next step in a meaningful therapeutic process/communication.
- Koch, 2021.
2. Science? Art? Both? The ‘science-practitioner’ model of therapy values both insight and intuition and research. It understands that humans are not robots but rather complex beings who live in, impact and are impacted by, complex systems and that therapy is not something to do with a manual. It also understands that there is value to reviewing and understanding research on “active factors” and “effect factors” in therapy; even while acknowledging the very many limitations of traditional research methods, as adapted from predominantly pharmacological research including risks of epistemic injustice from ignoring important voices of those with lived experience.
I held a research post at the Research Institute for Creative Arts Therapies - a centre for creative arts therapies research in Germany set up by Professor Sabine Koch, a trailblazing dance movement therapist and clinical psychologist who I was fortunate to train and work with.
Koch’s research has been instrumental in articulating the importance of phenomenological (experience-oriented) approaches across all therapies (including talk therapy) and in articulating elements in creative arts therapies that support positive change such as:
having a safe/structured space for creative experimentation
promoting relaxation and flow
being able to concretize/symbolise conflicts
artistic activity
releasing tension
expressivity in movement
connecting movement and language
group process, and
pleasure (Koch et al., 2021)*.
3. Integrative approach When we talk about approaches to therapy we are talking about all the different ways in which we understand therapy and how we understand humans. In common with many therapists, I draw from eclectic perspectives and theories under the umbrella of a resource-oriented relational lens. Some of these are:
theories of interpersonal neurobiology and developmental psychology including attachment theory. These understand early relationships to be important crucibles impacting how we experience and relate to ourselves (our identity, our inner voices including our inner critic) and others. Dance movement therapists apply an embodied perspective to attachment theory.
‘polyvagal’ theory and applied neuroscience that influences our understanding of the nervous system and physiology. These theories suggest that traumatic events impact implicit memory and deeply affect how we perceive and respond to ‘safety’ and ‘threat’. This is understood to impact upon our relationships with ourselves and others, our well-being, our experience of mental distress (including depression) and our access to life and to opportunity.
dance, culture and art. As a dancer, I value non-verbal language as an equally valid form of language to words that gives access to forms of expression and connections that may not be accessible with words alone. Dance also values important elements for life, such as joy, ongoing daily practice, action, celebration, symbolism and the communal. I understand dance in a performance context to have largely become divorced from earlier use as a primary healing modality.
experiencing and phenomenology. Arts-based therapies and somatic therapies place emphasis on body movement and attentional practices (Caldwell, 2021). These phenomenological approaches to therapy understand body movements and attention are important not just for meditation or other ways of studying subjective experience but also for the formation of identity or ‘self’, the experience of therapy and the languaging of therapy/psychotherapy. The body has a role in generating experience and this role can guide clinical work and provide a framework for therapists to understand experience. This leads to an approach to therapy that centralizes sensorimotor experiences of the body as critical to the ‘deep work’ of therapy. (For more on this see for example, Caldwell, C. (2021). Body, language and identity: biology and phenomenology’s role in experiential therapies in the Journal of Arts Therapies). https://www.egms.de/static/de/journals/jat/2021-3/jat000010.shtml
compassion-focused therapy theories such as those that apply Buddhist philosophy understand compassion as important in therapy (and life) especially for work with shame and complex post-traumatic stress disorder.
other influences such as psychodynamic psychotherapy, CBT, human rights and healing justice paradigms, 12-step recovery approaches and approaches to intergenerational and historical trauma.
4. Therapy as political I have an explicit political lens. My experiences in the criminal justice system and in immigration and refugee rights influenced my thinking on the impact of systemic and structural harm and so did my own experiences in childhood and adulthood. I believe that poverty is trauma and that we need to urgently widen access to all therapies as well as addressing the wider structural issues that impact upon safety and well-being including access to safe housing, food and water, equality of opportunity, effective and fair legal rights and remedies in line with international human rights standards. This also means that I understand that everything that occurs outside of therapy impacts the therapist, the client, the therapeutic relationship and the way in which therapy is offered. Understanding therapy as political means taking care in how certain diagnoses (such as BPD) are understood and used in ways that can harm not help. It means being committed to continuous learning and reflection and intersectional, trauma-informed, anti-racist, anti-capitalist and anti-oppressive practice. As far as one-to-one therapy is concerned, I believe it is important to support and amplify agency while taking account of different environments (social, economic, cultural, legal, physical, historical and so on) that impact you (client), me (therapist), and the therapeutic relationship. In this way, ‘trauma’ is understood as something that colonizes body and psyche and the work of therapy is understood in part as teasing out such external/introjected issues causing pain, oppression, shame or loss.
5. Self-care Finally, I agree with the words of Dr Amber Gray, a phenomenal dance therapist who speaks of self-care as
an ethical and moral obligation for all those in a healing capacity
Dr Amber Gray, R-DMT
Supervision and ongoing therapy are critical aspects of this. I also recognise that therapists live in the same environments as our clients and that self-care is not a substitute for systemic issues.
