Current Article

Psychotherapy as a Process
Thomas Klee, Ph.D.

Over many years of teaching, training and supervising both novice and experienced clinicians, I find there are two general categories of clinicians: those who approach therapy as a process and those who approach it as a series of techniques. Certainly, in the current environment of managed health care, there is a greater emphasis on technique based therapy because it fits better into a short-term managed care model. In addition, much of the outcry against managed health care from the mental health community comes from process based therapists who feel constricted by the focus on time limits and superficial symptom relief. Because of the need to survive in the managed health care market, process oriented therapists have increasingly adapted short-term technique based strategies for working with patients.

However, even for the many therapists who blend process and techniques, a predominant philosophy or orientation that stresses either process or technique emerges. I believe this difference in basic orientation determines both the effectiveness of the therapy and the professional satisfaction of the therapist. Simply put, those who focus on process are more effective and those who focus on technique are less effective. That is not to say that those who focus on technique are not successful. We have plenty of efficacy studies to show the short-term success of technique based therapies on symptom relief. However, when you look at effectiveness as determined by the patient’s perception, technique oriented therapists do not fare as well, in part because they work in short-term models grounded in efficacy studies.

A striking difference between process oriented and technique oriented therapists can is evident if you account for the factor of experience when comparing the two groups. One way of doing this is to compare process oriented novices with experienced technique oriented clinicians. My experience as a teacher of novices in the classroom and a trainer of seasoned clinicians in workshops has shown me a clear difference between process and technique based therapists.

Beginning students who are quite good at doing therapy always impress me. When I meet them as graduate students, they have relatively little experience and exposure to therapeutic techniques. Yet, they seem to take to the therapeutic process naturally. I have even met non-degreed counselors in drug and alcohol treatment programs who show an intuitive understanding of the complex processes of psychotherapy. In contrast, I have met experienced clinicians who seem clueless about how to do therapy well. They went to good schools, learned a wide range of techniques and therapeutic interventions, but lacked something fundamental in their ability to do therapy. When they attend my workshops on various issues in psychotherapy, they seem limited and unable to deal with new ideas. This is in part because they see themselves as already having expertise, and in part because they are limited by the techniques that define therapy for them.

The difference between these two groups is the first group has at least a rudimentary sense of how to develop a therapeutic relationship successfully and the second group does not. The first group understands and works through process; the second group limited by the techniques that define their orientation to therapy. This is not to suggest that techniques are inherently wrong; they can be helpful. However, without understanding the process of human relationships the therapist is unable to truly understand or connect with the patient. It is this understanding and use of process that makes therapy meaningful and effective for the patient.