Why Choosing a Theoretical Modality Feels So Ridiculously Hard for Therapists
It's not just you, but here are some solutions that can offer a roadmap
On paper, choosing a therapeutic modality is supposed to be a straightforward, professional decision. The gist is that you train in something, you commit to it, you build a practice around it. CBT, psychodynamic, ACT, EMDR, somatic- pick your lane and start driving. The rest will unfold accordingly.
In reality, the vast majority of therapists don’t choose a modality decisively or actively. More often, they are introduced to a smattering of frameworks in graduate school, like customers grazing on Costco samples. As they move through their fieldwork, they are possibly influenced by a supervisor who happens to favor one orientation over another. Then, they’re left to largely figure out the rest on their own.
I often hear new therapists, in slightly embarrassed tones, admit they have no idea what their modality is yet, or that they’re still piecing together how all the interventions or presence are supposed to fit together. Years pass, and they still don’t feel confident that they know “how to be” or “what to do.”
Why Choosing a Theory Is More Complicated Than It Seems
If you feel behind because you don’t have a clear theoretical orientation yet, you are not alone. Despite what many books and social media algorithms depict, many therapists feel confused and unsettled when it comes to this part of their work.
Developing a modality isn’t always as simple as just choosing a framework and practicing it. It involves integrating a way of thinking, being, and sitting, and it takes time and deliberate practice to build this competence.
That said, here are some of the barriers many therapists wrestle with:
You may only receive foundational classes in graduate school
Many graduate programs emphasize breadth over depth. What I mean is that they introduce you to various orientations, but they rarely offer enough sustained immersion in any single one to fully internalize its blueprint in practice.
This begins the gap that coincides with the many structural issues prevalent in our profession. You can understand a theory conceptually long before you can comfortably apply it in real time with real patients sitting across from you. Knowing what to do does not mean you actually do it.
So, by the time you graduate, you might be able to articulate the meat of the main modalities, but you have not developed a genuine felt sense of how they structure a session.
There’s pressure to collect credentials as a proxy for legitimacy.
After graduation, many therapists start accumulating training and certifications like children collecting items on a scavenger hunt. This is out of the sense that obtaining “more” expertise makes things “more solid.”
Therapists want more letters after their name. More completed trainings. More frameworks they can confidently say they use. More offerings to provide.
It’s a way to function like professional reassurance. If you learn just enough modalities, you’ll feel legitimate in one of them.
In actual practice, however, the opposite effects tend to occur. Therapists often find that more exposure without integration simply leads to having more tools without a coherent way of arranging them. Instead of feeling more coherent, these therapists feel scattered in their thoughts and inconsistent in their practice.
There’s pressure to follow whatever is trending.
Modality popularity is a real thing in this profession, and it seems to evolve every few years.
At different times, certain approaches gain popularity and momentum. If the seemingly cool therapists are doing therapy one way, everyone wants to do it that way. And clinicians then feel this pressure to “get trained” or risk falling behind.
Over the years, I have seen this cycle in waves around cognitive-behavioral therapy, dialectic behavior therapy, acceptance and commitment therapy, eye movement desensitization and reprocessing, internal family systems, brainspotting, ketamine-assisted therapy, the Gottman method, emotionally focused therapy, somatic experiencing, emotional freedom technique- to name a few!
Amid this ABC soup, when one sequence of letters “rises,” another tends to “fall.” Suddenly, for example, you’re ostracized if you still practice CBT after everyone has embraced somatic work. Or you begin wondering whether you’re inferior to other clinicians who are all praising the life-changing benefits of EMDR.
