Is therapy an art, a science, a combo, or something else?

[woodsgnome]

I've experienced a wide variety of therapists--one (my first) quite good, some at the opposite spectrum, others of a middling sort, and an outstanding one (my current T). Kind of representative of people in general, I suspect.

There is no one-size fits all, IMO, but several promising options are now on the horizon. Still it seems to work best with compassion, trust, and creativity as the building-blocks; not a mere formula that suits everyone. In my jaded opinion, it takes a savvy therapist to set that sort of tone, and it truly is an art.

So my own view tilts towards therapy as being a science-informed art form/combo. I've never found or heard of a purely scientific approach with a 100% success rate for such a highly-charged emotional condition as cptsd; although I suppose it's entirely possible. But the difference seems to lie in those therapists who can first, take you as you are, and work with you in devising ways to get to the plus side of the therapy ledger, whatever the means used to extract a forward pattern.

My bias is obvious--I think of therapy as an art form, but fused with scientific observations too; people skills matter when dealing with fragile emotions. But without using a modicum of science, therapy can also deteriorate into opinionated mush mostly geared to the therapist, not the client. Going too far to the scientific side risks hitting the trap of one size fits all thinking, though; finding the balance seems as important, if not more so, than any particular set of data or techniques.

There's one more danger becoming more prevalent these days, however, and it often seems almost invisible; but left to run its course it could ruin therapy for lots of people. I'm speaking of the growing evidence that the insurance industry and its governmental partners are becoming the main drivers behind available treatment options. Just like in the medical field, they can influence and/or steer an individual therapist's options. Something to be wary of.

So that's one viewpoint, favouring the artistry of blending what's known with a creative edge based on what best serves people as if they matter, and not as specks on a chart. When and if the latter ever became the norm, we might as well trade in the notion of client for that of robots in a system said to serve people but with one glaring flaw--they forgot the people part.

Okay. Any thoughts?

[radical]

I completely agree with everything you've said.

DBT (or similar) can be an okay, general framework for therapy with a genuine, self-aware, and empathetic person, who is able to care, and has the artistry to initiate and then co-create a healing relationship with us. In and of itself it is nowhere near enough and and the details can be learned on the internet or at the local library anyway. 

There also needs to be a deep understanding of long-term trauma, otherwise we are in the position of needing to educate the therapist via our life experience, and we have to do enough of that anyway, in any therapy relationship.  Finding the words to express ourselves is more than enough of a challenge, and having a therapist piece together understandings from scratch would be ridiculously time-consuming.

A framework is just a starting point.  I think there does need to be one, and that the framework itself does need to be reasonably free of the bigotries and biases that can hurt us so badly.  There is no way any framework can ever be entirely culturally-neutral and therefore always and universally safe though, imo.  Also, that framework does need to reflect an understanding of the "science" behind how people are wounded and the ways those wounds affect us, and lead us into vicious circles that we can't see outside of.  I think we do need some practical strategies for taking the painful steps we need to take, that have been proven effective, and preferably a broad range to try and to choose from.  But the main reason for having a framework is so that there is a degree of focus and a shared understanding, so that therapy doesn't devolve into a long rambling conversation about nothing in particular.

The most healing part of cPTSD therapy is the part that is art; a relationship in which we can learn to trust and start to show ourselves, take those difficult steps and find genuine acceptance and support from another, and through that, ourselves, imo.  It's got to be about learning to trust ourselves, and to do that the therapist needs to have sorted enough of their own problems that they can trust and hear us, and focus on our feelings and needs. An inflexible focus or reliance on any method or theory, whatever it is, creates a straitjacket, and inevitably ends up invalidating us in order to validate the method or belief system behind it.  Even worse, is therapy with a dangerous pracitioner, but that's another story.

I agree that the direction of what is coming to be accepted as "best practice" in therapy is being set by financial interests, not the best interests of clients, and that it is one of the biggest dangers facing the art.

[sanmagic7]

i'd like to add skill to the factors of art and science.  (i do agree with what has already been said.  the combination of creativity and knowledge in extremely important).  i think it takes a skill set as well for a therapist to be more than just competent.  effective communication on all levels with each client as an individual is a skill.  there are words, intonations, body language, inflections, and eye contact along with appropriate emotional responses, among others,  that must be decided on in every interaction with a client. 

a therapist must also be flexible, ready to make changes in approaches with a client at a moment's notice, able to register when something isn't working and alter something in the approach quickly and efficiently.  at the same time, the therapist must have their ego in check and be ready to take a 'one down' position, back up, apologize for possibly moving too quickly or before the client is ready.   these types of skills are learned in classes, seminars, workshops, and through exploration.  a good therapist is always ready to learn new ways to serve the client best, and takes a proactive stance to their work.

the health care system, including the ins. companies, have been in disarray for a long time.  they come at clients from an illness approach, and dictate length of care allowed for each 'illness'.  for example, back in my day, depression was deemed treatable in 12 sessions throughout the course of a year.  therapists often had to get creative in order to get enough sessions paid for by the ins. company so that they could get the best care possible for the client, and for as long as it would take to do so.  it was and is a terrible crunch for therapists to find themselves in.  from what i know, this is because the people who decide how much and what is payable are not therapists but business people, for the most part.

i believe the best therapists utilize a 'wellness' approach.  they don't want to simply treat symptoms of an illness, but want to build on what the client does 'right' in life, building up the strengths they already have so that the clients can rely on and utilize those strengths when they encounter problems.  they help clients recognize their inner and outer resources, boost their belief in themselves, and serve as guides to help the client get to where they want to go.  the goal of these therapists is healing, to the point where the client doesn't need them anymore.  their aim is to put themselves out of business.

those are my thoughts coming from a therapist perspective. 

by the by, woodsgnome, i didn't think your opinion was jaded as much as realistic.  i'm just glad you've found yourself a therapist who is helping you and is a good fit for you.  that's the best.