Lets start by differentiating philosophy of practice from method of practice and manner of practice.  My chosen method of practice is cognitive behaviour therapy (CBT).  Given the growth within the field, nowadays it makes more sense to talk about CBT as an umbrella term that covers intervention models rooted in cognitive psychology, behaviourism and learning theory.  CBT has its unique toolset that among others includes thought records, behavioural experiments and exposure exercises.  Manner of practice refers to the way in which therapist and client interact.  Philosophy of practice is a set of principles that inform the therapist’s choice of method and manner of practice and generally will impact your experience of the therapeutic process.  As a social worker, I am bound by a professional code of ethics that you can find on the website maintained by the Ontario College of Social Workers and Social Service Workers.  However, field expertise notwithstanding, it might be very difficult to engage in successful therapy with a person whose life philosophy differs from yours.  

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I root my practice in: (1) pragmatism, (2) collaborative empiricism, (3) balancing comfort with challenge, (4) commitment to a simplified frame of reference to understand complex problems, and (5) a belief that living is learning.

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Simply put, pragmatism means doing what works and not wasting our time and effort on what does not work.  Pragmatism is the polar opposite of wishful thinking.  Pragmatism is closely related to a principle of radical acceptance that underlies dialectical behaviour therapy developed by Marsha Linehan.  Radical acceptance is not endorsement.  Radical acceptance is not defeatism.  It is a willingness to recognize facts of our circumstances and to take responsibility for actions that have a chance of improving our lot.  It allows us to live our lives with eyes open.  Pragmatism is not about positive thinking or blaming ourselves for everything that has happens.  To paraphrase Steven Hayes, the founder of Acceptance and Commitment Therapy, thinking is not doing.  Positive thoughts that do not translate into action steps, are just this, positive thoughts while self-blame eats immense amounts of mental energy and leaves no room for corrective action.  Sometimes the most effective thing to do is to learn to live despite loss or past hurts and train our mind to focus on what is still available.  In therapy, it means that we will spend a lot of time clarifying your values, short-term and long-term goals and challenging mental processes that interfere with these values and goals. 

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Collaborative empiricism is the application of scientific method to everyday life.  During our initial appointments we will develop a case conceptualization that is simply a working hypothesis about mechanisms that hinder your life.  Here “mechanisms” refers to thinking shortcuts, assumptions about how the world works or reactive behaviours that might feel justifiable and yet fail to give us what we want.  We then start gathering data to verify if these processes actually take place (e.g. activity logs, mood monitoring sheets, thoughts records) and construct experiments to introduce and evaluate the utility of a different approach (behavioural experiments).  The main premise of collaborative empiricism is that data speak better than a therapist’s assumptions and a client who learns this method well is capable of becoming their own therapist – a skillset that they can retain for life.

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Balancing comfort with challenge is tricky.  We need both.  A person who overfocusses on comfort might ultimately become highly distressed as they have lost the ability to tolerate even minor discomfort. An individual who constantly challenges themselves will ultimately experience burnout.  Whenever we get close to getting what we truly want, we become uncomfortable at a prospect of the price slipping through our fingers so being able to tolerate discomfort makes it easier for us to take advantage of opportunities that life throws our way.  Therapists walk a fine line between offering support and coping strategies and finding the right dose of challenge to enable our clients to take the necessary steps even when such necessary steps are panic inducing.  Do you prefer to panic and learn to drive or never to drive?  Panic, cry and implement that difficult decision that you have been analyzing for years or status quo?  Sadly, for many of us the choice of “no panic and drive” does not exist.

Since CBT’s goal is to give clients enough tools to become their own therapists and to learn to balance coping with challenging themselves, a unified frame of reference is a must.  Even a cursory look at the family of cognitive behavioural therapies reveals an alphabet soup of interventions: CBT (the umbrella term that subsumes classic approaches), ACT (acceptance commitment therapy), DBT (dialectical behaviour therapy), REBT (rational emotive behaviour therapy), MBCT (mindfulness based cognitive therapy), ERP (exposure-response prevention), MT (metacognitive therapy), PE (prolonged exposure)… Tired yet?  These approaches might differ in what they are targeting and what tool is being emphasized, but ultimately all are rooted in a cognitive behavioural model that blends cognitive psychology and applied behaviour analysis.  By remaining focused on case conceptualization (our working hypothesis about mechanisms that maintain your pain), we end up by adapting the available tools for your personal use.  By staying firmly rooted in cognitive behavioural tradition, we might have to introduce some new concepts when working on different problems but there is no need to introduce a whole new frame of reference.  That is why I chose to be a cognitive behaviour therapist instead of borrowing from a variety of schools. 

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Finally, we are left with a view of living as learning.  Imagine that you are attending a first lecture of a biochemistry course.  You can start feeling overwhelmed and if you were to write a final exam right now, you would fail.  And that is exactly how it should be as presently you are a novice at biochemistry and haven’t started studying.  It is tempting to blame ourselves for not being able to solve our problems in the past and to take such failures as evidence of our inherent lack of problem-solving ability.  Yet it is incredibly difficult to solve a problem that you have encountered for the first time, especially when such a problem does not come with a textbook and weekly tutorials.  Our beliefs about how mind works might appear to be common sense, but many are flawed.  A classic example of such a flawed belief about workings of our mind is a belief that understanding the root cause of emotional pain will eventually eliminate it.  A victim of an assault knows very well why they are suffering from flashbacks but the pain does not seem to be eliminated as a result of that knowledge. However, once such a person learns about the role that ruminative thinking, vigilance and avoidance of reminders play in maintaining their distress, a chance at a life worth living emerges.  Prior to the assault, there simply was no need to know these things.  Prior to experiencing your current difficulties, you did not need to know the evidence-based methodology for overcoming them.  If we accept life as a learning process, we can eliminate the “I should have knowns”.  If we accept life as a learning process, it becomes interesting.  You might develop curiosity about what might happen in a day or a year.  Curiosity is very different from that paralyzing sense of uncertainty that all of us have encountered at one point or another. Curiosity helps us grow.