A psychologist's general theoretical background may not predict the approach used in specific therapy cases, according to a recent PracticeNet online survey of more than 200 practitioners. The data show that psychologists appear to modify their approach to treatment based on the interaction with their clients rather than relying on their general theoretical orientation.

PracticeNet--the APA Practice Directorate's online survey system--uses real-time behavior sampling methodology to gather "in the moment" information about the practice of psychology from volunteer PracticeNet participants. The PracticeNet methodology randomly selects a time from each psychologist's normal practice hours and asks about their practice activities at that specific time. In effect, the surveys provide practice snapshots by looking only at practitioners' most recent episodes of care (within a 72-hour window).

"While this is not a random sample of all APA practitioners, PracticeNet volunteers are a reasonable representation of practitioners," says Lynn Bufka, PhD, director of professional development demonstration projects for APA's Practice Directorate. "They are primarily or entirely service providers, most often in private practice settings."

General versus specific treatment approaches

This particular survey took place in July. PracticeNet psychologists indicated both their general theoretical approach to treatment and the specific approach guiding the provision of care they reported in the survey.

Similar proportions of those surveyed endorsed the same theoretical orientations for both their general and specific approaches--for example, 28 to 35 percent said they used cognitive behavioral approaches, 42 to 45 percent reported using a combination of many orientations, such as psychodynamic or systemic approaches, and approximately 15 percent said they adhered to a psychodynamic approach.

However, 35 percent of the respondents didn't report the same orientation in general and in the specific episodes of care they reported in the survey. And a third of that 35 percent actually reported quite different orientations.

One psychologist, for example, reported using a cognitive-behavioral approach for the specific case surveyed, but claimed to generally use a psychodynamic orientation. Indeed, Bufka notes that the correlation between the psychologists' general orientation and the orientation guiding care in the particular treatment session reported on in the survey wasn't very high.

Common treatment strategies

Regardless of their theoretical backgrounds or clients' diagnoses, the psychologists in the survey said that, during the therapy session reported, they discussed current stressors relevant to the client's problem, as well as relationship patterns or themes. Other interventions the survey respondents reported using most frequently include:

  • Identifying or challenging clients' thoughts, negative predictions or misinterpretations.

  • Encouraging clients to link their thoughts and feelings.

  • Validating emotional responses to situations or experiences.

  • Gathering information.

  • Guiding, directing or refocusing the client.

However, some of the interventions psychologists used did differ according to their theoretical orientations. Practitioners who reported using a psychodynamic approach in their session were more likely to explore repetitive dysfunctional patterns of behavior or expectations in relationships in order to aid their clients in forming healthier relationships. Meanwhile, those practitioners who employed a cognitive-behavioral approach in the session were more likely to educate clients about the nature of their problems, encourage them to set weekly goals and train them in skills relevant to their problems.

"These results are interesting because they suggest that psychologists demonstrate some flexibility in their treatment approaches and are not solely relying on one main theoretical orientation," says Bufka.

Among the benefits of PracticeNet, she adds, is that technology facilitates accessing information that is harder to gather by traditional survey methods: "Over 70 percent of PracticeNet respondents reported on a case seen in private practice, which gives us unique information."

To review complete results of this and other PracticeNet surveys, or to enroll, go to PracticeNet.