It’s a question that’s asked in many grad school classrooms. It’s the same question that therapists love to explore and debate: Is therapy really an art or a science? We posed this pivotal question to five therapists. The consensus? All of them agreed that therapy is a bit of both — though their responses revealed different reasons and insights. Some may or may not surprise you. But one thing is for sure. They will give you a deeper understanding of something that still remains shrouded in mystery: therapy. Which is really the goal of our Therapists Spill series.
“I believe therapy is an art that is based on a science,” said Rebecca Wolf, LCSW, a Chicago therapist who specializes in working with adults and couples with addiction, relationship, workplace and communication issues. She noted that there are plenty of evidence-based, scientifically-proven practices for treating different symptoms. But the strongest indicator of success, she believes, derives from an art form: the relationship between clinician and client.
“It is an art to get to know someone, to get them to trust you, to allow them to feel safe in your presence. It is certainly an art to craft your words as a therapist so that they are spoken at the right time, in the right tone, when a client is ripe and ready.”
Psychotherapist and relationship expert Lena Aburdene Derhally, MS, LPC, agreed. “As a therapist there is a real art in knowing when to support, empathize and reflect with a client or when to possibly challenge them (in a caring way, of course) or push them a little outside their comfort zone.”
Derhally believes therapy is more of an art because each person is so diverse and complex. How one person responds to a treatment may be entirely different from how another person responds, she said.
In addition, she believes that it’s critical for the field to keep prioritizing evidence-based studies. They help “us gauge whether or not something is effective as opposed to harmful.” She also stressed the importance of specialized training. “While the ‘art’ of the therapy is important, studying and advanced trainings in evidence-based practices allow the therapist to help their clients in an effective way.”
Psychologist and anxiety specialist L. Kevin Chapman, Ph.D, believes that good therapy is an interplay between art and science — but mostly science. “A ‘crafty’ clinician who lacks an empirical understanding of the ‘craft’ will likely make many mistakes and/or keep clients in therapy for longer than necessary.”
For instance, cognitive-behavioral therapy (CBT) is the gold standard for treating anxiety and related disorders, Chapman said. Once a clinician has a solid understanding of CBT, they can get creative. A therapist might leave the office to try an exposure exercise with a client. According to Chapman, she might ask the client to run around a parking lot on a hot day (“symptom exposure”) and take him to a crowded mall (if he’s “anxious about panic attacks in an agoraphobia situation”).
Psychologist, author and depression expert Deborah Serani, PsyD, defined science in psychotherapy as “the training, theories and practice skills a clinician learns while in graduate school. The science of neurobiology, psychology, behavior and treatment applications all meld together in years of coursework and field training.” The art of psychotherapy is the clinician applying those tools in a way that benefits the client, she said.
Serani has known clinicians who have a deep understanding of therapy and practice but “don’t have the finesse or sensitivity that expresses treatment in meaningful ways.” She’s also known compassionate therapists who are creative with their services but are missing the scientific building blocks to bolster their work. She called these good clinicians.
“However great therapists have the art and science of psychotherapy in their bones. It’s part of who they are and it resonates when you meet, talk or work with them.”
Board certified psychologist Ryan Howes, Ph.D, views therapy as “co-created art built on a sturdy foundation of scientific research and theory.” Art without science and vice versa only leads to an “empty, short-lived profession.” He likened therapy to other fields that need both. For instance, without art in architecture, you get hideous structures. Without science, you get structures that collapse. In education the tenets are science and the application is art. Even in science, art is a must for finding creative solutions.
Howes also likened psychotherapy to fractal art:
[Fractal art is] the digital, artistic representation of mathematical calculations. It’s another example of science as the foundation for an amazing art form. Without the artistic rendering, the math isn’t art, it’s just equations. Such it is with psychotherapy — it’s the unique, creative, and often beautiful rendering of complex theories and rigorous research within the medium of a relationship.
Like Serani, Howes believes that therapists must be well-informed about different psychological theories — both their philosophy and efficacy. He gave the example of modern psychodynamic psychotherapy. It has “philosophical roots in Freud’s psychoanalytic theory, but has since evolved and transformed into an empirically-validated, evidence-based practice.”
How a therapist applies the theory and technique in session with a unique client — who has a different history, symptoms and style of relating — is an art, he said.
If you’re currently working with a therapist, and your sessions feel stale or cold or clinically scientific or too free-flowing and aimless, talk about it, Howes said. Letting your therapist know that you’re uncertain about where treatment is headed or you don’t feel much compassion from them may invite more balance, he said. And if it doesn’t, consider finding another therapist “who can hold the balance of [science and art] a little better.” Because that’s what effective therapy is all about. And that’s a great thing for both clients and clinicians.
Art or science image available from Shutterstock