The Confusing World of Therapists’ Theoretical Orientations

The terms used in therapy can be confusing, especially if it’s your first time seeking help from a therapist. One of these potentially confusing terms is your therapist’s theoretical orientation. If you’ve been searching for a therapist, you may have noticed that they often list the theoretical orientations they practice from. As a first-time client—or even a seasoned one—you might feel like you’re supposed to know what it all means. Here’s why I believe it both does and doesn’t matter for clients to understand their therapist’s theoretical orientation.

So, here’s why I believe it does and doesn’t matter for clients to know their therapist’s theoretical orientation.

Why do therapists have theoretical orientations?

In simple terms, there are many ways to do therapy and many ways to conceptualize human behavior and the challenges people bring to therapy. Emotional, relational, and behavioral problems are usually abstract in nature, meaning they’re complex and don’t have clear-cut answers. Therapists need a way to make sense of these issues, and having a theoretical framework helps us organize and understand complex challenges like trauma, mood disorders, and interpersonal difficulties. 

This theoretical “language” also enables therapists to communicate with other professionals when seeking supervision or consultation. I like to think of theoretical orientations as the “behind the scenes” of what your therapist is considering as they listen to and track their clients. It helps them decide which interventions might be most effective and how to structure the therapeutic process.

While it might seem like your therapist is simply listening and reflecting your words, they are actually processing a large amount of seemingly unrelated information and translating it into a framework that helps them break down the problem into more concrete terms. Whether this matters to you as a client depends on your preferences.

Some clients appreciate transparency in how their therapist practices because they have experience with certain types of therapy and already know what works for them. For others, it feels less important, and they judge their therapy experience based on whether they feel it’s beneficial or on the quality of their relationship with their therapist.

How do therapists choose their theoretical orientations?

During graduate school, therapists are typically exposed to a range of theoretical orientations, including psychodynamic, cognitive-behavioral, existential, feminist, humanistic, narrative, family systems, gestalt, solution-focused, and strength-based approaches. From there, therapists gravitate toward orientations that align with their personal beliefs and values, often pursuing additional training after graduation.

Some graduate programs focus on specific orientations, like psychodynamic or cognitive-behavioral, which may influence the therapist’s practice. Additionally, therapists often choose orientations based on the clinical population they serve. For example, Dialectical Behavior Therapy (DBT) was developed for clients with Borderline Personality Disorder (BPD), while Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP) is the gold standard for Obsessive-Compulsive Disorder (OCD).

If clients have specific diagnoses, their therapist’s theoretical orientation may matter if they’re seeking a specific style of therapy to address their needs.

What Does "Integrative" Mean?

Many therapists describe themselves as “integrative,” meaning they draw from various theoretical orientations to address their clients’ needs. This approach allows therapists to treat a wider range of issues and expand their “toolbox” of strategies and interventions.

In my experience, therapists often have a dominant theoretical orientation, which gives therapy its overall “flavor.” For example, a therapist practicing mainly from cognitive or behavioral frameworks might offer structured, goal-oriented therapy focused on changing thought patterns, while incorporating humanistic principles to create a safe and empathetic environment.

Similarly, a therapist with a relational or attachment-focused orientation might take a deeper dive into uncovering the “roots” of emotional or relational challenges by exploring early childhood experiences and caregiver relationships, while still integrating skills-based techniques like those found in DBT.

How do I determine the best fit for me?

A therapist’s theoretical orientation might be important to consider if you’re seeking a specific style of therapy or have a particular diagnosis. Other times, it might matter because you prefer a certain “flavor” of therapy that aligns with your beliefs and values.

However, more often than not, the theoretical orientation is less important than the quality of the therapeutic relationship. If you feel comfortable and supported by your therapist, their theoretical orientation might become irrelevant. Therapists are human beings with unique personalities and quirks, and just as with anyone else, you’ll connect with some better than others.

That’s why I encourage people seeking therapy to take advantage of free consultation calls when offered. These calls give you an opportunity to ask about the therapist’s approach and get a sense of whether you’ll feel comfortable working with them.

Therapy is an investment, so don’t be afraid to “shop around” to find the right fit—it can make all the difference in your experience and outcomes.