CHOOSING THE RIGHT APPROACH
Therapy is not a one-size-fits-all process. People come to therapy with different life circumstances, different histories, different nervous systems, different strengths, different symptoms, different values, and different hopes for change. What helps one person may not be the best fit for another person. For this reason, part of my clinical responsibility is to work with clients to choose a therapeutic approach that makes sense for them, their needs, and their unique circumstances. Choosing the right approach does not mean choosing a single “brand” of therapy and forcing every part of their experience to fit into that model. It means thoughtfully and intentionally deciding which concepts, objectives, skills, interventions, and treatment strategies are most appropriate for the problems they may want to address.
My approach is integrative, which means I may draw from several evidence-informed and clinically established models of therapy when doing so is appropriate, ethical, and within my scope of practice. These may include compassion focused therapy, cognitive behavioral therapy, dialectical behavior therapy, mindfulness-based approaches, acceptance and commitment therapy, emotion focused therapy, internal family systems therapy, parts work, motivational interviewing, trauma-informed approaches, person-centered therapy, psychodynamic concepts, somatic awareness practices, emotional regulation skills, values-based work, and other clinically relevant methods. The purpose of this process is to create therapy that is clinically appropriate, personally meaningful, and realistically usable in life.
Why the Therapeutic Approach Matters
For my clients, the approach we use in therapy matters because it shapes what we focus on, how we understand your concerns, what skills we practice, what goals we set, and what changes we work toward. A client who is experiencing panic attacks may need a different treatment emphasis than a client who is grieving a major loss. A client who is struggling with trauma symptoms may need a different pace and structure than a client who is working on communication skills in a relationship. A client who is neurodivergent may need a more flexible, concrete, sensory-aware, and identity-affirming approach than a client whose primary concern is a temporary life transition.
The therapeutic approach should fit the person, not the other way around. For clients, this means I will consider your mental capacity, critical thinking abilities, symptoms, behaviors, and presenting concerns, but I will also consider your abilities, preferences, values, culture, identity, developmental history, nervous system patterns, learning style, emotional intelligence, relationship needs, and current life demands. Therapy should challenge you in healthy ways, but it should not overwhelm you, shame you, or require you to become someone you are not. A well-matched therapeutic approach helps make therapy more understandable, more collaborative, and more effective. It gives us a shared map for the work we are doing together. It also helps you understand why we are using certain exercises, skills, questions, assessments, reflections, or between-session practices.
What We Consider When Choosing an Approach
When choosing the right approach, we will look at several areas of your life and experience. This process begins during the consultation, intake, assessment, and treatment planning process, and it may continue throughout therapy as we learn more about what is helpful for you.
We may consider your current symptoms, such as anxiety, depression, panic, trauma responses, emotional overwhelm, obsessive thoughts, compulsive behaviors, substance use patterns, sleep problems, attention difficulties, anger, grief, shame, relationship distress, low self-esteem, or difficulty with motivation and follow-through. We may also consider your behaviors and patterns. This includes what you do when you are stressed, how you cope with uncomfortable emotions, how you respond to conflict, how you avoid pain, how you pursue relief, how you make decisions, how you protect yourself, and how your current patterns may be helping you survive while also creating problems in your life.
Your circumstances also matter. Therapy must take into account your actual life. This includes work, school, family responsibilities, finances, housing, physical health, social support, caregiving responsibilities, cultural context, legal stressors, discrimination, trauma exposure, disability, access to resources, and the level of safety or instability in your environment.
Your abilities and readiness are also important. Some approaches require a person to have enough stability, emotional tolerance, cognitive clarity, time, energy, and support to use them safely and effectively. For example, deeper trauma processing may not be appropriate if you are currently in crisis, actively unsafe, severely overwhelmed, or unable to remain grounded during and after sessions. In those situations, therapy may need to begin with stabilization, safety planning, coping skills, emotion regulation, sleep, routines, support systems, and practical problem-solving.
Your preferences matter as well. Some clients prefer structured therapy with worksheets, skills practice, goals, and homework. Some clients prefer reflective conversation, exploration of meaning, emotional processing, or insight-oriented work. Some clients want education and clear explanations. Some clients want mindfulness and body-based awareness. Some clients want practical strategies for changing behavior. Some clients need a slower pace and more time to build trust. Some clients benefit from direct feedback, while others need a more gentle and exploratory process.
Your values are central to the process. Therapy should help you move toward a life that is more aligned with what matters to you. This includes your beliefs, priorities, relationships, identity, ethics, spirituality, culture, community, creativity, health, work, and sense of purpose. A treatment plan is more useful when it is connected to the kind of person you want to become and the kind of life you want to build.
Matching the Approach to the Problem
Different therapeutic approaches are useful for different clinical purposes. Some approaches are designed to help you change thoughts and behaviors. Some are designed to help you regulate emotions. Some help you build mindfulness and acceptance. Some help you understand your inner life and relationship patterns. Some help you resolve ambivalence about change. Some help you reconnect with values, meaning, and self-compassion. Some help you build skills for distress tolerance, communication, boundaries, and daily functioning.
For example, if your primary concern involves anxiety, worry, avoidance, or fear-based thinking, we may use cognitive behavioral therapy, exposure-based principles, mindfulness, acceptance and commitment therapy, relaxation skills, nervous system regulation, and values-based action. The goal may be to help you understand your anxiety cycle, reduce avoidance, challenge unhelpful thinking patterns, increase tolerance for uncertainty, and take meaningful action even when anxiety is present.
If your primary concern involves emotional intensity, impulsive reactions, relationship conflict, or difficulty tolerating distress, we may use dialectical behavior therapy skills, emotion regulation tools, distress tolerance strategies, mindfulness, interpersonal effectiveness skills, and behavior chain analysis. The goal may be to help you pause, understand what is happening, regulate your nervous system, communicate more effectively, and respond instead of react.
If your primary concern involves trauma, chronic stress, shame, emotional numbing, hypervigilance, or nervous system dysregulation, we may use trauma-informed therapy, grounding skills, stabilization, psychoeducation, body awareness, parts-informed work, self-compassion, and careful pacing. The goal may be to help you feel safer in your body, understand trauma responses, reduce self-blame, increase emotional tolerance, and support healing without overwhelming your system.
If your primary concern involves substance use or another unwanted behavior pattern, we may use motivational interviewing, stages of change, relapse prevention, values clarification, coping skills, emotional regulation, mindfulness, and harm-reduction or abstinence-based planning depending on your needs and goals. The goal may be to understand the function of the behavior, strengthen motivation, reduce risk, build replacement behaviors, and support sustainable change.
If your primary concern involves identity, self-worth, meaning, grief, life direction, or major transitions, we may use person-centered therapy, existential therapy, narrative therapy, values work, mindfulness, self-compassion, and reflective exploration. The goal may be to help you understand yourself more clearly, make meaning from your experiences, and choose actions that align with your values.
If your primary concern involves neurodivergence, such as ADHD or Autistic traits, the approach may need to be more neurodivergent-affirming, concrete, flexible, sensory-aware, and shame-reducing. The goal may not be to make you appear more “normal.” The goal may be to help you understand your nervous system, reduce unnecessary masking, improve executive functioning supports, communicate your needs, manage overwhelm, and build a life that works better for you.
Choosing Objectives and Interventions
After we identify the general therapeutic approach or combination of approaches that fits your needs, we begin choosing specific objectives and interventions.
An objective is a specific area of change we are working toward. Objectives are usually smaller and more concrete than broad treatment goals. For example, a broad goal might be, “I want to reduce anxiety.” A more specific objective might be, “I will learn to identify the physical signs of anxiety before I become overwhelmed,” or “I will practice one grounding skill three times per week,” or “I will gradually reduce avoidance of one important activity.”
An intervention is what we do in therapy to support the objective. Interventions may include psychoeducation, skills practice, mindfulness exercises, journaling, cognitive restructuring, behavior tracking, exposure planning, values clarification, parts work, communication practice, emotional regulation skills, problem-solving, motivational interviewing, self-compassion exercises, relaxation training, assessment tools, safety planning, or between-session reflection.
The process generally works like this: first, we identify the concern or problem area. Then we clarify what you want to be different. Next, we choose an objective that is realistic and meaningful. Then we choose one or more interventions that are likely to help you move toward that objective. After that, we practice, review, adjust, and refine the plan based on what is actually helping you.
This process is collaborative. I may recommend certain objectives or interventions based on clinical knowledge, assessment information, ethical standards, evidence-informed practice, and my understanding of your situation. You also have an important role in telling me what feels useful, what does not fit, what feels overwhelming, what feels too vague, what feels too structured, and what matches or conflicts with your values. Therapy works best when clinical judgment and client self-knowledge are both respected.
How We Decide What Comes First
Not every concern can be addressed at the same time. Sometimes therapy needs to follow a sequence. If everything feels urgent, part of our work is deciding what needs attention first. Safety comes first. If there are concerns about suicidal thoughts, self-harm, violence, abuse, severe substance use risk, medical instability, psychosis, inability to care for basic needs, or another urgent concern, then therapy must first focus on safety, stabilization, crisis planning, appropriate referrals, and the correct level of care. Stabilization often comes before deeper exploration. If you are overwhelmed, emotionally flooded, dissociating, actively unsafe, or unable to function in daily life, we may need to begin with grounding, coping skills, routines, sleep, emotional regulation, support systems, and practical problem-solving before moving into deeper trauma work or emotionally intensive material.
Skill-building often comes before major behavior change. If you have been surviving with avoidance, shutdown, anger, numbing, people-pleasing, compulsions, substance use, or other protective patterns, we may need to build new skills before expecting those patterns to change. It is rarely helpful to remove a coping strategy without replacing it with something safer and more effective. Values and motivation also matter. When change feels difficult, we may need to clarify why the change matters to you. This may include exploring your values, your ambivalence, the costs of staying the same, the risks of changing, and the kind of life you want to move toward.
Adjusting the Approach Over Time
The first approach we choose may not be the final approach we use. Therapy is an ongoing process of assessment, practice, feedback, and adjustment. As we learn more about you, we may change the focus, modify the pace, add new interventions, remove interventions that are not helping, or shift to a different therapeutic framework. This does not mean therapy is failing. It means we are paying attention.
A treatment plan should be a living document. Your needs may change as your symptoms change, your life circumstances change, your insight increases, or your capacity grows. An approach that is helpful at the beginning of therapy may become less central later. For example, early therapy may focus on stabilization and coping skills. Later therapy may focus on deeper emotional processing, values-based action, relationship patterns, trauma recovery, identity development, or long-term wellness.
We will also monitor whether the approach is producing meaningful benefit. This may include your self-report, our clinical discussions, symptom measures, behavioral changes, improved functioning, increased emotional awareness, better relationships, reduced avoidance, improved coping, or progress toward treatment plan goals.
Your Role in Choosing the Approach
Your voice matters in this process. I want you to be an active participant in your therapy, not a passive recipient of treatment. You are encouraged to ask questions about why we are using a particular approach, what an intervention is intended to do, how it connects to your goals, and whether there are other options.
You are also encouraged to tell me when something does not feel like a good fit. Sometimes an intervention is clinically appropriate but needs to be modified. Sometimes the timing is wrong. Sometimes the language does not fit. Sometimes the approach needs to be adapted to your neurotype, culture, learning style, trauma history, spiritual beliefs, disability, or emotional capacity. You do not need to pretend something is helping if it is not helping. Honest feedback gives us better information. Therapy is not about performing compliance. It is about building insight, safety, capacity, responsibility, and meaningful change.
At the same time, some helpful interventions may feel uncomfortable at first. Growth often involves practicing new ways of thinking, feeling, communicating, and behaving. The goal is not to avoid all discomfort. The goal is to distinguish between productive discomfort and harmful overwhelm. Productive discomfort may feel challenging but manageable. Harmful overwhelm may leave you feeling flooded, unsafe, ashamed, shut down, or unable to function. We will work together to find the right level of challenge.
My Role in Choosing the Approach
My role is to bring clinical training, ethical judgment, professional experience, assessment information, and knowledge of therapeutic models into the process. I am responsible for recommending approaches that are appropriate to your needs, within my competence and scope of practice, and consistent with professional standards of care. This means I may recommend a particular treatment focus, explain why a certain intervention may be useful, suggest an alternative approach, or identify when a concern may require referral, consultation, additional assessment, medical evaluation, medication evaluation, psychological testing, substance use treatment, higher level of care, or another specialized service.
It also means I will not use approaches that are outside my level of competence, outside my scope of practice, or inappropriate for your clinical needs. Ethical therapy requires humility, honesty, and clear boundaries. If your needs fall outside what I can responsibly provide, I will discuss this with you and provide referral options when appropriate.
Informed Consent and Clinical Choice
Choosing a therapeutic approach is part of informed consent. You have the right to understand the general purpose of the therapy we are using, the possible benefits, the possible risks, the alternatives available, and the reasons I may recommend one approach over another. Some approaches may involve emotional discomfort, increased awareness of painful experiences, changes in relationships, difficult conversations, temporary increases in distress, or the challenge of practicing new behaviors. Some approaches may not be appropriate for certain symptoms, levels of risk, or life circumstances. These issues will be discussed as part of treatment planning and ongoing clinical care.
You also have the right to ask about alternatives. An alternative may include a different therapy approach, a different provider, group therapy, medication evaluation, psychological testing, medical evaluation, peer support, community support, coaching, higher level of care, or another resource. The goal is not to convince you that there is only one correct path. The goal is to help you make informed decisions about your care.
A Collaborative and Flexible Process
The process of choosing the right approach is collaborative, flexible, and ongoing. We begin with your presenting concerns, but we do not stop there. We also consider your history, strengths, values, culture, identity, preferences, abilities, resources, relationships, nervous system, and current circumstances. The approach we choose should help answer several practical questions: What are we working on? Why are we working on it? What model or method helps us understand it? What objectives are we trying to reach? What interventions will we use? How will we know whether therapy is helping? What needs to change if the current plan is not working?
Therapy is most effective when the approach is clinically sound and personally meaningful. My intention is to work with you in a way that is respectful, ethical, evidence-informed, individualized, and responsive to your lived experience. The goal is not simply to apply a technique. The goal is to help you understand yourself more clearly, reduce suffering, increase capacity, change patterns that no longer serve you, and move toward a life that is more aligned with your values.
Copyright Notice:
The content on this page was adapted from my client handbook. The client handbook contains all the documents, forms, assessments, and materials associated with their therapy. Every client is required to review and sign the necessary consultation, intake, and treatment plan documents and forms in their client account portal. The material you are currently reading may be part of, or may include, copyright-protected intellectual property, and you are expected to review and follow the Terms and Conditions for Use of Copyright Protected Materials. Copying, saving, sharing, distributing, modifying, uploading, publishing, selling, or otherwise using these materials outside your own personal educational use is prohibited.