Theoretical Orientation: How Mental Health Providers Approach Therapy
Research is constantly being done and built on in the field of psychology. Experts are continually discovering new things about the human mind and learning more about different approaches that may be effective in treating various mental health problems.
Today, there are different theories about how best to counsel people who are experiencing different types of mental health challenges. Each therapist or counselor tends to have a theoretical orientation or specific treatment approach that they believe in and primarily practice. When beginning your search for a counselor to speak with, it may be helpful to understand what their theoretical orientation is and if it might be compatible with your needs.
What is theoretical orientation in counseling?
It provides the clinician with a conceptual framework for identifying client needs and discerning which specific interventions might work best to treat them. It gives them a perspective and a toolbox of tactics to use to help each individual they work with. Note that two counselors who subscribe to the same theoretical orientation may still treat the same individual differently. A theoretical orientation is a broad framework, and a particular treatment provider will use their own experience and professional judgment to treat individuals within that.
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Common theoretical orientation examples
Each individual’s mind and situation is unique. That means the treatment a practitioner recommends may be different for two individuals presenting with the same symptoms. However, a theoretical orientation gives the mental health professional a starting point for deciding what to recommend for a given client. Some of the broad therapy types listed below are examples of such theoretical orientations that a counselor might work from.
Cognitive behavioral therapy (CBT)
CBT is an extremely common type of therapy, but the approach behind it represents one possible theoretical orientation. Cognitive behavioral therapy is based on the idea that thoughts influence feelings and behaviors. If an individual’s thought patterns are flawed or otherwise unhealthy, they may experience distressing emotional symptoms and behaviors as a result.
Such is often the case with a mental health condition like depression or antisocial personality disorder, for instance, as people with this disorder tend to be prone to cognitive distortions. CBT can be used to address several other conditions, including the following:
- Anxiety disorders
- Bipolar disorder
- Trauma-related disorders
- Substance use disorders
- Obsessive-compulsive disorder
- Eating disorders
That means a therapist who abides by this theoretical orientation is likely to focus on helping their client become aware of problematic patterns in their lives as a first step toward shifting them in a healthier direction.
Family therapy tends to view an individual and their challenges in the context of the family they come from. In some cases, this orientation means that the therapist may be interested in including other families in sessions. For instance, couples counseling involves both parties in a relationship attending therapy together to work through the challenges they may be facing. This orientation recognizes that an individual changing their own behaviors without the context or sometimes even cooperation of those in their immediate family can be difficult in some cases.
The concept behind the narrative therapy orientation is that an individual is an expert in their own life. It’s a non-blaming approach centered on curiosity, where the therapist will tend to rely on asking questions to help the client gain a better understanding of themselves. This orientation is typically very client-led, with the therapist being responsible for asking guiding questions to allow the person to delve more deeply into the way their own mind and emotions work.
A psychodynamic approach to therapy typically involves formulating a rationale prioritizing the impact the unconscious mind has on a client's feelings and behaviors. It stems from the idea that uncovering subconscious trauma can help a person heal and engage with themselves, others, and the world from a healthy place rather than one of pain. The object of psychodynamic therapy is usually to promote self-awareness.
As the name suggests, a counselor who has an integrative theoretical approach is likely to pull from two or more different orientations to inform their practice. It allows them to rely on a wider variety of approaches to treat a wider variety of clients and disorders. Integrative therapy by nature is individual to the practitioner—so if your provider uses this approach, it’s typically worth asking them which orientations they integrate into their work.
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How to choose a theoretical approach for mental health treatment as a counselor
If you are new or are about to become a licensed therapist, you may wonder how to choose the right theoretical approach for your future practice. There are a variety of factors to consider:
- Take stock of how your own mind works – There may be some orientations that simply don’t click with the way you think about things.
- Choose an orientation you know well – Experience with the principles and techniques of an approach can help you feel more confident while providing care.
- Remove biases – Think about how you might be influenced to use certain methods. For example, the main orientation your professors or mentors in graduate school subscribed to may not be the right one for you.
- Be open to evolving your approach – As you learn what works for you and your clients, tweaking your strategies and overall orientation can help you optimize sessions.
How to choose a theoretical approach to manage feelings and behaviors as a client
If you’re planning to seek therapy, you may be wondering what theoretical orientation you should look for in a counselor. First, you might start by thinking about the main reason you’re interested in pursuing therapy. If you suspect you may have a mental health condition like depression or anxiety, for instance, studies show that cognitive behavioral therapy can be an effective treatment—so finding a provider who practices CBT may be a good first step. If you’re facing challenges in your romantic relationship or with a parent, family therapy could be the right orientation to pursue.
If you’re unsure, meeting with a general therapist for a consultation is one way to get advice on what type of mental health professional to seek out next. You might also try a session or two with a few different therapists with different orientations so you can see which one seems to click best with you. In the end, there’s typically no right or wrong answer; it’s simply about finding the provider you feel comfortable with and who believes they can offer the most effective treatment and support for you. Remember also that it’s not uncommon to try out a few different therapists before finding the one that feels like the right fit for you.
How online therapy can make the choice easier
There are a few unique advantages to pursuing therapy online instead of in person, though keep in mind that it typically just comes down to your own preference and comfort level. Some people simply feel more comfortable speaking with a therapist virtually from the comfort of their own home, while others have trouble finding providers in their area or aren’t able to leave the house and commute to regular appointments. Either way, studies suggest that the two formats can provide similar benefits in most cases.
What’s included
with BetterHelp
Another unique advantage to online therapy is that with a platform like BetterHelp, you’ll be asked to fill out a brief questionnaire about your needs and preferences when you sign up. If you’re looking for couples counseling rather than individual sessions, for instance, you can indicate it on the questionnaire—and the same goes for requesting a therapist who is experienced in LGBTQIA+ issues, trauma healing, or challenges related to grief, intimacy, anxiety, or others. You’ll then be automatically matched with a licensed therapist who is likely to have experience in these areas, which means there’s a good chance that the theoretical framework they use will be compatible with your needs. You can then address the challenges you’ve been facing by speaking with them via:
- voice call,
- video call, or
- in-app messaging.
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Takeaway
What is an example of theoretical orientation in counseling?
Cognitive behavioral therapy (CBT) is a common example of a theoretical orientation in counseling. CBT is a counseling approach based on the theory of a multidirectional relationship between thoughts, feelings, and behaviors. Mental health professionals often treat individuals with disorders like anxiety and depression using cognitive behavioral therapy. This counseling approach works by addressing cognitive distortions that may cause psychological distress, highlighting their inaccuracies and helping the client reframe those thought patterns. CBT often involves techniques such as cognitive restructuring, relaxation training, and behavioral activation.
What are the four theoretical orientations in mental health counseling?
In their education and training, psychotherapists typically learn four theoretical orientations from which they build a psychotherapeutic framework. Understanding these theoretical orientations can help you find the right therapist for your particular mental health concerns. These theoretical orientations include the following.
Cognitive-behavioral
Cognitive-behavioral theoretical orientation blends cognitive and behavioral approaches, emphasizing the interaction between thoughts, emotions, and behaviors. It hinges on the belief that dysfunctional thinking patterns can lead to negative feelings, which can influence maladaptive behaviors. By changing such thoughts, the individual can improve their emotional well-being and behaviors.
Cognitive behavioral therapy (CBT) is a focused therapy integrating the principles of cognitive theory (which focuses on identifying and restructuring thought distortions) and behavioral theory (which emphasizes learning through conditioning and the modification of behavior).
Humanistic-existential
The humanistic-existential theory emphasizes personal growth and self-awareness. It is rooted in the belief that humans are inherently good and are primarily driven by a desire to reach their full potential. Humanistic therapeutic methods stress the importance of unconditional positive regard, acceptance, empathy, and authentic therapeutic relationships. Instead of offering solutions, humanistic therapists help clients develop their own problem-solving abilities.
The humanistic-existential orientation also utilizes the philosophical exploration of meaning and existential questions, such as the search for purpose, freedom, and responsibility, as well as dealing with existential anxieties like death and isolation. Both humanistic and existential orientations encourage clients to take ownership of their choices and live authentically, even in the face of uncertainty. Narrative and Gestalt therapy are two examples of humanistic-existential therapy.
Psychodynamic
Psychodynamic theory explores unconscious drives, conflicts, and unprocessed emotions as they manifest in current thoughts, feelings, and behaviors. It posits that early childhood experiences shape personality and emotional functioning. Key concepts include how we develop defense mechanisms and the idea that much of human behavior is motivated by unconscious desires.
Psychodynamic therapy focuses on bringing unconscious factors into conscious awareness, helping individuals gain insight into their internal conflicts through exploring relationship patterns, dreams, and free association. The goal is to cultivate emotional understanding and healing by resolving deep-seated issues.
Systemic
Systemic orientation highlights how individuals are influenced by their relationships and larger social systems like families, communities, and cultures. Instead of viewing psychological issues as stemming solely from the individual, this theory highlights the interactions and patterns within these systems that contribute to emotional and behavioral problems. In therapy, systemic approaches address these relationship patterns, improve communication and conflict-management, and restructure dysfunctional interactions to cultivate healthier relationships. Counseling approaches that draw from aspects of systemic theory include structural family therapy, strategic family therapy, and other forms of family therapy.
What are the major theoretical orientations in personality theory?
The most common theoretical orientations associated with personality theory include psychoanalytic, humanistic, trait, social-cognitive, biological, and behavioral perspectives. Here are they are in greater detail:
Psychoanalytic
Emotional disturbances emerge from unconscious psychological processes such as unresolved childhood conflicts and experiences. These processes shape our personalities and influence how we behave and cope with challenges in everyday life. A popular example of psychoanalytic practice is dream analysis.
Humanistic
This perspective uses a therapeutic framework based on unconditional positive regard. Rather than approaching the individual as someone who has a disorder, this therapy teaches them how to fulfill each stage in the hierarchy of needs to develop more self-awareness and self-esteem.
Trait
Trait theory posits that humans are often genetically predisposed to certain personality traits. It utilizes measurement methods such as the Big Five to identify, describe, and examine individuals' personality characteristics.
Social-cognitive
This personality framework operates with the assumption that external factors, such as our social conditioning and observational learning, interact with our cognitive functioning to shape our personalities and behavior patterns.
Biological
The biological perspective emphasizes personality as a product of biochemical, genetic, and physiological functioning. These factors influence personality and behavior and are viewed as the underlying cause of mental health conditions.
Behavioral
Behavioral theory argues that personality is formed throughout an individual's life based on their experiences and interactions with others. Rather than unconscious processes like those posited in the psychoanalytic approach, behaviorism focuses on stimuli and responses (i.e., positive reinforcement, punishment/reward, etc.).
What is the theoretical orientation of the psychodynamic perspective?
Psychodynamic theory highlights the role of unconscious psychological processes as primary drivers of thoughts, motivations, and behaviors. Such unconscious motivators might include unresolved or forgotten childhood experiences.
What is theoretical orientation in psychological assessment?
Theoretical orientation in psychological assessment refers to the framework or perspective a therapist or counselor uses to understand and treat psychological issues. Orientation typically informs how a therapist views human behavior, personality development, and emotional challenges—influencing their strategies to help clients during therapy. Different theoretical orientations and counseling theories provide varying insights into why individuals may experience distress and how to resolve these issues. Some common theoretical orientations include:
- Cognitive-behavioral: Focuses on the connection between thoughts, feelings, and behaviors, helping clients change negative thought patterns and behaviors. Examples include cognitive-behavioral therapy, acceptance and commitment therapy, and dialectical behavioral therapy.
- Psychodynamic: Associated with Freudian theory, this type of therapy emphasizes unconscious motivations, life experiences, and unresolved past conflicts.
- Humanistic: This perspective centers on personal growth and self-actualization. It uses an integrative approach, emphasizing an individual's capacity for self-awareness and self-direction. Examples of humanistic therapy include person-centered therapy and Gestalt therapy.
- Existential: Explores concepts of self-determination, free will, and life's meaning to treat psychological distress and help clients navigate personal challenges.
- Family systems: A relationship-focused theory, family systems posit that family dynamics and interpersonal relationships significantly affect personality and behavior.
What are the theoretical orientations of clinical psychologists?
Clinical psychologists might use psychoanalytic theory, behavior theory, cognitive theory, humanistic theory, and integrative theoretical models to fulfill their responsibility to provide effective treatment strategies to their clients. Their theoretical orientation can be influenced by many factors, including, but not limited to, academic training and experience.
What are the most common theoretical orientations for managing feelings and behaviors?
The most common theoretical orientations include cognitive-behavioral, humanistic, psychodynamic, and systemic.
What factors are important in choosing a theoretical orientation?
Many factors shape theoretical orientation preferences throughout a therapist's career. Some factors that may contribute to a clinician preferring a particular orientation include:
- Academic training.
- Clinical supervision.
- Personal alignment and values.
- Personal experiences.
- Common sense.
Therapists typically have a comprehensive understanding of the different theoretical orientations. They use this knowledge to determine when and what theories are the most appropriate to apply in various cases. Instead of conforming to just one, therapists often draw from several theories when assessing, diagnosing, and treating clients—using a holistic approach tailored to their needs. A therapist’s preferred orientation may also evolve through continued education, training, practice, and research.
What purpose does a theoretical orientation serve for counselors?
Orientation of counseling theories provides a guiding framework in several key areas of a counselor's role—including shaping how they understand their clients, assessing their issues, and picking the most effective interventions. Here are a few critical purposes that theoretical orientation can serve for counselors:
It guides the understanding of a client's issues
Theoretical orientation provides a structured framework for counselors to understand a client's psychological, emotional, and behavioral distress. It shapes how counselors perceive the origins of issues, whether they posit that they come from unconscious conflict (psychodynamic), faulty thought patterns (cognitive-behavioral), or interpersonal dynamics (family systems).
It influences assessment and diagnosis
Theoretical orientation informs how counselors assess and diagnose clients. For example, a counselor with a cognitive-behavioral orientation might focus on assessing distorted thought patterns, while a psychodynamic counselor might explore a client's unconscious conflicts and early life experiences.
It determines therapeutic goals and measures progress
Counselors might use their theoretical orientation to set goals for therapy. For example, a humanistic therapist might focus on helping the client achieve personal growth, while a behavioral therapist might set specific, measurable goals to change problematic behaviors.
It shapes intervention strategies
Theoretical orientation helps determine the therapeutic interventions and techniques a counselor will use. For example, a cognitive-behavioral counselor might use cognitive restructuring and behavioral activation, while a psychodynamic therapist may use techniques like free association or exploring defense mechanisms.
It provides treatment consistency
A theoretical orientation can provide a coherent structure to help guide the therapist through sessions. It ensures consistency in the treatment approach to aid counselors in maintaining a steady focus and direction as they work with clients.
It shapes the therapeutic relationship
In some cases, theoretical orientation can shape the nature of the therapeutic relationship between the therapist and a particular client. For example, a humanistic counselor might emphasize empathy, authenticity, and unconditional positive regard. A psychodynamic therapist might explore transference and countertransference within the therapeutic relationship.
Why is a theoretical orientation important in the assessment process?
Each theoretical orientation has a unique perspective on what causes an issue and its associated behaviors. For example, a psychodynamic therapist might view dysfunctional behaviors as an outcome of unprocessed internal conflicts from past relationships and experiences. A behavioral therapist might focus more on the present issues instead of looking to the client's past to form an assessment.
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