A Thousand Ways to Therapy:
The importance of choice 

THE EXPERTS

DANIEL MILLS DA'BELL

XenZone’s Clinical Lead, Dan Mills-Da’Bell is an experienced counsellor, working mainly with young boys. Having trained in a wide variety of therapeutic approaches, he champions choice and flexibility in therapy. Working with young clients, sometimes with a limited emotional vocabulary, he also advocates creative therapeutic approaches, such as music, drama or art, as a way of exploring and unpicking issues without putting pressure on clients to sit and talk through their problems.

“I think it’s essential to have a number of different approaches and tools to be able to pull out. And this can change over the course of a session or multiple sessions with a client. A person-centred approach may be working, but then a client might come in with a problem more suited to solution-focused work. For me, this is very much led by the client and what they’re bringing.”
Dan also talks about evidence-based therapy and his concerns that if quantitative, evidence-based therapy is recommended and available, then clients will miss out on new approaches and therapies based on sound practice, qualitative data and good clinical thinking.

TIM TOD

Tim Tod is founder of Red 22, an organisation working with schools and organisations to support children and young people.
He talks about the significance of a young person feeling able to have a ‘first conversation’ about their mental health without judgement and without being immediately offered the choice of a referral or antidepressants as the only way to recovery.

“Whether we like it or not, young people, particularly teenagers, will often view adults and people in authority as likely to take control. This can make an initial conversation a big deal, to the extent that it might not happen at all…Just to create a space with trusted adults – perhaps anonymously – is important for disclosure, giving the young person the chance to ask questions and explore issues.”

AARON SEFI

Aaron Sefi, Research and Evaluation Director at XenZone, talks about the risks involved with offering a single ‘purist’ version of therapy: clients won’t engage and may give up on the idea of therapy altogether. He talks about the need for counsellors to build a wide framework of understanding so that they are able to apply the ‘right’ approach. He also discusses standards of evidence. His view is that we need to challenge our current notion of evidence to bring other therapeutic approaches in, which may appeal to large cohorts of people who may otherwise opt out.

“Within the system we have at the moment, I hear it time and again ‘oh I didn’t get along with my counsellor so I didn’t bother trying again’. That’s a sad thing to hear…what they didn’t get along with was that particular approach and if you can offer a range of different approaches then you can actually get the people who need it, in the way they need it. All our brains work differently, we think differently, we act differently, we respond to different types of attachment and different ways of being with people. So it goes…that different therapeutic approaches [are needed] to suit that.”

PROFESSOR MICK COOPER

Mick Cooper is a Professor of Counselling Psychology at the University of Roehampton and is a Chartered Counselling Psychologist. Professor Cooper co-developed the pluralist approach to therapy, which values all the different therapeutic approaches. In this video interview, Professor Cooper discusses choice and pluralism (register for Pluralistic 2019 if you're interested in learning more).

“It starts from the assumption that there are lots of different ways that people can be helped, whether through a CBT, person-centred, or psychodynamic approach. Lots of different approaches can be helpful. People are likely to need different things at different points in time.”

DR TERRY HANLEY

Dr Terry Hanley is the Programme Director of the Doctorate in Counselling Psychology within the Manchester Institute of Education. Dr Hanley discusses his belief that people need a therapeutic approach to suit them and that one size does not fit all. He maintains that this should be at the heart of any therapeutic work. He also talks about being creative in therapy, citing the Manchester branch of 'Freedom from Torture' as an example, where he provides psychological support to a football project.

Dr Hanley also discusses evidence in therapy.
“[evidence for CBT] complies with a lot of the norms within the more medicalised perspective of evidence-based practice…More humanistic or psychodynamic models have, however, prized different forms of evidence…So there is more qualitative research being conducted on those types of approaches which complies to a different frame of science, which we shouldn’t ignore or undermine.”

PROFESSOR MIRANDA WOLPERT MBE

Miranda Wolpert, MBE, is a Professor in Evidence Based Practice and Research at UCL and Founder and Co-Director of the Evidence Based Practice Unit. She is also Co-Founder and Director of the Child Outcomes Research Consortium. In this video interview, Professor Wolpert discusses the distinction between need and demand for mental health support, choice in therapeutic approaches, valuing individual therapeutic activity and the importance of evidence.

“I think this [choice] is one of the big challenges for the mental health community currently. I think we need to question and think about the choices that are available and to think much wider than we have to date. Not just choices within therapy but choices beyond therapy and for people’s lives more generally.”

A thousand ways to therapy: 
The importance of choice

In ‘A Thousand Ways to Therapy: The Importance of Choice”, we are gathering expert views on the importance of therapeutic choice. We’re also asking if we are eroding this choice and risking the recovery process as only those therapies with the requisite quantitative evidence-base become ‘NHS-recommended’.

XenZone Clinical Director Dr Lynne Green is a consultant clinical psychologist with 20 years’ NHS experience. In her foreword, Dr Green states that to secure best outcomes, different interventions may be required and that sometimes, the most appropriate treatment for a particular individual may not be the one that has the greatest evidence base. At the same time, offering treatments shown to result in positive outcomes for many is good practice and should remain central to the provision of health care, Dr Green believes that reliance on such evidence-based approaches should not stifle innovation: 

“It is crucial that we find new ways of working and demonstrating impact. This means we need to do different things, ask different questions and use different methodologies than we are used to. We need to be creative in working out what will work and for whom, and do this collaboratively with those – and for those - who use our services.”

Aaron Sefi, Research and Evaluation Director at XenZone, has summarised his concerns about the future of therapeutic choice in an article, drawing on the views of our panel of experts. He maintains that because we prize a specific brand of quantitative evidence, we are encouraging a prescriptive and singular approach to mental health support. This, he points out, directly contravenes the principle of choice we know is so important. 

Additionally, Aaron states that the field of therapy is moving quickly, with innovative approaches and modalities developing apace. To wait years building a top down evidence base risks blocking the availability of such treatments to those who could benefit today. Arguing against a therapeutic monoculture, Aaron says: “We should be open to finding new ways to demonstrate impact, deploying different methodologies which practice-based evidence shows us will benefit a client.”

Dr Lynne Green, Clinical Director, XenZone

Aaron Sefi, Research & Evaluation Director, XenZone