The silent war: Which school of therapy should I choose?

Last Updated on December 29, 2023 by It’s Complicated

My trajectory to become a clinical psychologist was highly assorted. It was composed of an introduction to a wide variety of schools of therapy. That’s how it works at the University of Copenhagen. Going the clinical way means two years of exploring which ways of thinking and practicing therapy appeals to you the most as a psychology novice.

This is possible because the 3-year bachelor degree already is an entry into the building blocks of psychology as a scientific and humanistic field, with equal measures of neurobiology, sociology, anthropology and philosophy.

But despite this very broad focus and integrative way of training mental health practitioners where I’m from, the very human tendency to stereotype and judge couldn’t be prevented. Amongst my peers, the politically-minded Foucauldians who aspired to become systemic and narrative therapists would feistily call the cognitive therapists-in-spe for narrow-minded essentialists. “You are individualizing problems which are structural and interpersonal,” they would argue, and the CBT-warriors would shake their heads and lecture the poststructuralists on the significance of measurable, evidence-based therapeutic success-rate.

These two opponents – the relativists versus the essentialists – also had a common adversary. The psychoanalysts, they agreed, were so outdated in their theory and practice that they shouldn’t even be taken seriously as a valid approach.

When I moved to Berlin, the camps of the therapy scene appeared different. Everyone asked me: “Are you a depth therapist or a behavioral therapist?” So, I answered again and again that I was actually just a clinical psychologist who had a more integrative approach, combining both cognitive-behavioral methods with narrative therapeutic tools.

Now, six years into my working in Berlin, I know that the culture of therapy isn’t as black-and-white and divided as it initially seemed. I’ve found, rather, that the scene is actually quite diverse, and that the reason for people referring to mainly either depth or behavioral therapies is how the training in Germany is conducted.

To become the most “legitimate” type of mental health practitioner, you don’t just become a psychologist here. You first you get your master’s in psychology and then you do a 3-year training in either behavioral or depth therapy – and recently it became possible to also take the systemic route. After you’ve completed such a training you are hereby a licensed psychological psychotherapist – and then you’re as qualified as can be on German grounds.

But Berlin is also a mekka for different schools of thought and this is something that is highly infectious to the therapy scene as well. As soon as you look outside the official German psychotherapy schools, you see that foreigners aren’t just coming to the city to make art, produce music, work in start-ups and party.

There is also a big bunch of expats looking to practice the therapy that they educated and trained themselves to practice, back where they’re originally from. With this vibrant melting pot of therapeutic cultures, it’s hard not to be inspired – and equally hard not to pass some judgments along the way.

I’ve met and befriended way more psychoanalysts during my years in Berlin than I ever imagined possible (living in Copenhagen, I seriously thought they were an extinct species). And I’ve gotten acquainted with Solution-focused therapy and Gestalt therapy, which are both approaches I learned nothing about during my time at university.

Now, one of my favorite things about working in the field of mental health, is getting colleagues together to have symposium-like afternoon discussions around psychology. So, a couple of weeks ago, I invited fellow It’s Complicated counsellors from different schools of therapy to talk about their own prejudices against other types of therapists.

I wanted to explore what assumptions and stereotypes are the most prevalent, which led to a rich conversation about the basis on which we judge our peers. What are the judgments we pass in our field of work – and why?

Based on our conversation, psychoanalysis really is the approach that is most often stereotyped as esoteric and elitist. We reflected that this could be due in part to the reality that psychoanalytical training programs often are quite expensive and have a vast majority of white, male candidates, and also that our prejudices might often be based on our own uncomfortable experiences.

For instance, several therapists had tried having encounters with psychoanalytic colleagues who had seemed very sure of their ways, giving the sense that this approach holds an air of arrogance and superiority. We also discussed how CBT therapists can seem quite efficiency- and manual-fixated – this was a judgment that many passed, even those who used behavioral tools themselves. Other prejudices: Gestalt therapists are kooky, and always asking “what are you feeling right now?” Integrative therapists are too superficial in their insight into all the approaches they combine. ACT therapists are acceptance and mindfulness junkies. The list goes on.

As for why we judge, well… For one, because we’re human. And passing judgements is in many ways just an extension of categorizing and labeling the world around us – it’s how we’re wired. But we also ended up blaming the universities and training institutes for being too polarizing in their programs. Too much focus on teaching students about why this approach is the superior one and too little focus (if any at all) on how the different schools of therapy are alike and can be used to complement each other.

So, maybe multi-modal supervision groups are the way forward? Or new teaching programs with more emphasis on overlap and integration?

But then again, maybe a bit of tension between schools isn’t always harmful. Maybe it’s part of what keeps us learning, developing and doing our best as practitioners.

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