The Third Wave: The Changing Face of Psychotherapy

psychologistLike most of the helping professions, psychotherapy has changed and evolved a lot since the early days of Sigmund Freud.  In the counseling profession, these changes have been referred to as “waves”.  The first wave includes Freudian Psychology or Psychoanalysis.  Although these are the oldest forms of counseling, they are still practiced by many therapists.  Criticisms of first wave psychotherapy are that sessions are unstructured, the therapist tends to take on a passive role, and progress tends to be very slow.  The second wave of psychotherapy includes more modern therapies, such as the cognitive and behavioral therapies.  These therapies are more short term and goal directed, which tends to appeal more to clients.  However, some clients don’t like having the therapist take the lead and would like to have more control over their therapy like they do in first wave therapies.  Clients may also miss the “insight” that is gained in psychoanalysis.

Since the introduction of the second wave, therapists and psychologists have argued regarding which one is more effective.  Interestingly, the research has shown time and time again that all the different psychotherapies are equally effective.  The general advice to therapists then is to just choose the style of therapy that works best for you. This was certainly the advice I received when I was doing my graduate training: “Just choose the one you like best because it doesn’t matter”.  What I found upon becoming a practicing therapist however was that although style doesn’t seem to matter to therapists, it definitely matters to clients.  Any therapist who’s been around for a while knows that every style doesn’t work with every client.  Clients know this too.  They feel disappointed with some therapists but then do great with others.  The question is “why?”

When therapy doesn’t work out, therapists blame it on a lack of “fit” between the therapist and client.  This may be true in some circumstances.  For instance, if a therapist specializes in anxiety but a client comes for help with his anger management and video game addiction, that’s probably going to be a poor fit.  But in theory, if a client goes to a therapist that specializes in what they are seeking help for, that client should have a good experience.  The problem is, many of these clients are not, making finding the right therapist a tedious and tiring process.  Despite what some therapists may say, the problem here isn’t with “fit”.  It’s something much more fundamental than that.

When the second wave of psychotherapies became main-stream, therapists were very excited.  Many therapists thought that we had solved the problem with “fit” and that these new therapies would work with anyone.  Now that these therapies have been around for a while, we know that that isn’t the case.  CBT has the same success rate as psychoanalysis.  The problem has not been solved.  This has caused many therapists and psychologists to call for a third wave.  There has been much anticipation and speculation regarding the third wave.  Some have questioned if Acceptance and Commitment Therapy (ACT) represents a third wave.  I’m going to argue that it doesn’t and I’ll explain why.

When cognitive behavioral therapy was invented, it was a true shift from psychoanalysis.  The two are distinctly different and give the client a very different experience as well.  I don’t feel that ACT is a true shift from either the first wave or the second wave.  ACT, along with DBT and other mindfulness based cognitive therapies, incorporate elements of both the first wave and second wave.  Although this is certainly an innovation, I do not feel that these therapies are different enough to constitute a third wave.  They also still suffer from this problem of “fit”.  Although these therapies are certainly effective, like all of the other therapies, they don’t work for every client.

We know that the problem of fit is a genuine problem.  Most people are surprised to find out that the majority of clients drop out of therapy after just the first session.  Clearly this is an indication that clients are not finding what they are looking for in therapy.  For most clients, something’s missing from the therapy experience and they can tell right away.  A system of psychotherapy that addresses this problem of “fit” will be the true start of the third wave.

In my opinion, the reason why therapists consistently fail is because they are still using the “one size fits all” model.  They find a style that they like and then use it with all of their clients.  This is true whether you use Psychoanalysis, Gestalt Therapy, CBT, REBT, DBT, ACT, or any of the other styles of psychotherapy.  You will have success with some clients, but not most of your clients.  I see the rise in therapists who consider themselves to be “eclectic” as evidence that therapists are naturally starting to moving away from “one size fits all”. The popularity of “life coaching” also shows that people are looking for something different.  Clients and therapists want something that truly represents a shift in the paradigm.  It is due to this, that in my opinion the third wave of psychotherapy will be personalized therapy: An eclectic blend of therapy tailor-made for each individual client.

I call this method of personalized therapy Results Directed Therapy, because the therapist crafts the therapy based on what is achieving results for the client.  This is a very different view of therapy from the current one, which tends to put the blame on the client if therapy doesn’t work out.  Instead, here we see the therapist responding the client in a very dynamic way.  By having the therapist grow alongside the client, the client accomplishes much more than they would have with a non-personalized therapist.  In addition to dynamic, the therapy is also integrative, incorporating elements from many other styles of therapy as needed for the client.  Here, there is no more “one size fits all”.  The therapy is tailored to the client, decreasing the number of dropouts and failures in therapy.

We see the shift towards personalization in other helping professions as well.  Education is the perfect example of this.  Teachers used to teach in just one style and if the student couldn’t learn, they blamed the student for being “stupid” or “lazy”.  Now teachers recognize that there are different types of learning styles and that they need to adjust their teaching styles to better help the individual student.  I believe that the same thing is true for therapy.  Individual clients have different needs and preferences regarding how therapy is delivered to them.  The therapist who is able to do that will find they have a marked increase in their retention rates and success rates.  Surely this is something that every therapist, and client, could benefit from.

The third wave is coming.  Therapists and clients alike know that therapy is in desperate need of change.  Clients are tired of having to go to multiple therapists just to find the right “fit”, and let’s face it; most people simply are not willing to go through with that.  Therapists are tired of their low retention rates and the negative image that therapy has as a whole.  Those willing to make the shift to personalized therapy will do well in their profession.  Those unwilling to change will find a continued dwindling of clients that has been the trend of recent years.

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My name is Marina Williams and I am a licensed mental health counselor with a private practice in Jamaica Plain, MA. This website is my professional website devoted to my activities as a therapist. If you are interested in finding out more about my private practice, please visit my other website


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