“So, what’s your orientation?” someone asked me. A bit thrown by the random and blunt nature of the question, I reluctantly replied, “Um, I’m queer?” It was my first day of training at The Wright Institute, and I was suddenly starting to wonder what I had gotten myself into. “No, no. I mean what is your theoretical orientation?” the person countered. “Oh, well, how would I know that yet?” I answered quizzically. And with that, the conversation ended.
I remember at that moment being filled with an odd combination of curiosity, confusion, and shame. I had not come to The Wright Institute with a background in psychology. My undergraduate degree was in Peace and Conflict Studies at UC Berkeley. The majority of my time, prior to entering graduate school, was spent immersed in multicultural conflict resolution trainings and colloquiums about the unintended consequences of modernity and globalization. However, I did enter with several years of clinical experience in working with substance abuse and dual-diagnosis populations. My decision to pursue my doctorate in clinical psychology was shaped by my affinity for clinical work, as well as by the way in which psychology offers a nonviolent vehicle for change at both the micro and macro levels.
Well, here I was, my first day of graduate school and I already felt like a fraud. It was as though I was being asked to write the discussion section of an article, without having first conducted any research. As time went on, I began to feel like a pacifist, sitting on the sidelines of what felt like a civil war, it was “The Battle over Theoretical Orientations.” The CBT-identified proponents spoke ill and dismissively in regards to their Psychodynamic colleagues, and those on the Psychodynamic side spoke of their CBT oriented colleagues in much the same manner.
After hearing both sides I found myself thinking, “Why do I have to choose? They both sound useful, and they both sound limiting.” I could not imagine assigning activity logs or thought records all day with my clients any more than I could imagine breaking down the primitive defenses of a person, who is trying to function without the use of substances for the first time in their life. And despite presentations on the utility of taking an integrative approach, it still seemed as though I was being asked to choose.
Now I will be the first to admit that some theoretical orientations speak to me, while others turn me off. Falling prey to what feels like a true divide and conquer phenomenon, I found myself using the same dismissive tone about object relations theory that I had deplored in others. I found myself in CBT uniform, ready for battle against the whole of psychodynamic theory. Yet I also found that I still appreciated much of what object relations theory has to offer. The pressure to conform as a student and as a professional is very powerful, and I have often found myself disappointed by the ways in which I feel pulled to play the game.
For each person the theoretical orientation that they will most identify with, and that will help inform what they view as being useful, will stem from a myriad of factors: our own therapy, personal demographics and history, spiritual or religious beliefs, philosophy about the nature of change, etc. Early on in my education, I realized that I have a tendency to embrace a more supportive approach to psychotherapy. Simply put, I tend to believe that if a house is on fire then we should grab some water and put the fire out, and then, afterwards, we can figure out the cause.
It is only now, at this point in my training, that I feel compelled to answer the question that was posed to me on my first day of graduate school, “What is my orientation?” Well, when I reflect on my sessions with my clients, I find that I end up pulling from countless theoretical frameworks, including: DBT, multicultural, narrative, CBT, attachment-based, emotionally-focused, psychodynamic, mindfulness-based, feminist, social justice, positive/humanistic, and the list goes on. In other words, I find that I identify as integrative. Does the fact that I find value and borrow from each of these approaches somehow mean that my case conceptualization or clinical work is unsophisticated? Some would argue yes. Perhaps some would say that I am casting my net too wide. However, I feel that there is strength in taking an integrative approach. Being able to pull from different theories provides me with a toolkit that is diverse enough to help a wide range of clients in a variety of settings.
However, with that being said, of all the aforementioned theoretical orientations that inform my case conceptualization and work with clients, I do find that I have a favorite, narrative therapy. I was introduced to narrative therapy in my Family Systems class, and I took an instant liking to it. Marrying social justice theory and psychology, narrative therapy offers a collaborative approach to working with clients, and it views society (not the client) as the primary source of pathology. Last year, I was fortunate enough to do my second year externship at Alameda Family Services in the San Francisco Bay Area. It provided me with the opportunity to work from a narrative model, to receive training that involved weekly reflecting teams, and to provide collaborative treatment planning. And there was a true commitment to working from a multicultural framework. It felt like I had finally found a way to work with clients and be able to incorporate my Peace and Conflict Studies background. It spoke to my whole reason for entering the field of psychology in the first place.
I share all of this with the hope that as graduate students we can help each other find an alternative story to the dominant discourse that would have us believe that there is one, and only one, true theoretical approach. My hope is that together we can help remove the shame that at times can accompany outside-of-the-box thinking, as well as support one another in remaining open-minded and flexible in how we view our clients and our work at large.