Is all Talk Therapy the Same?

All psychology is dependent on talk.  Talk from the client and talk from the therapist.  But the meaning of talk and the amount of talk done by therapist and client vary by the psychological theory behind it.  Take for instance, narrative psychology.   It is a field in psychology that investigates the value of stories and storytelling by the client.   In such a therapeutic setting the therapist encourages the client to tell or narrate their own stories, especially about issues that cause them a great deal of emotional distress.  As with all stories there is a plot and a sequence of events.  How clients link certain events and in what sequence helps them, in collaboration with the therapist, to provide meaning to the narratives that emerge.  The repetition of certain themes over time helps uncover the ways in which their narratives influence their thinking, feelings, and behavior.  The therapist’s role is to help the client change problematic narratives into healthier ones, or, put another way, to teach clients how to create alternative stories by “re-telling” older ones in a more productive way.   The therapist does so by using the language and “talk” that the client presents when telling their stories.  Often the therapist will help the client to break down what appears to be an overwhelmingly problematic story, one which may have existed for a long time, into a smaller set of stories.  Perhaps what is most distinctive about narrative psychology is that the therapist and client “talk” of the problematic issues as if they exist outside of the storytellers not within them.  Therefore, unlike other therapeutic approaches, narrative therapy is not interested in diagnosing individuals (no use of the Diagnostic and Statistical Manual of Mental Disorders during any point of the therapy) since the client and the problem are seen as separate.  The goal of narrative psychology is to get the client to “re-author” or “re-story” their experiences by making a whole new productive one; to change unhelpful stories about themselves and others to better cope with distressing situations. 

In contrast, Psychoanalytic therapy, a form of in-depth talk therapy aims to bring unconscious or deeply buried internal thoughts and feelings to the conscious mind.  In this case interaction between therapist and client encourages the client to reveal repressed experiences and emotions, often from childhood, by “talking” those feelings to the surface and examining them together. In the main, the talk between client and the therapist rests on the client freely sharing any thoughts, words, or feelings that come to mind; the subject matter is the client’s choice and talking about dreams is encouraged.  In- depth talk therapy requires that the therapist pay attention not so much to the specific stories their clients tell, but to the patterns of presentation and the feelings and emotions the client reveals through such storied talk.  And while the subject matter is the choice of the client, the therapist, as the expert, uses diagnostic guidelines to engage in a rehabilitative therapy.    By encouraging what is called a process of transference (where the client transfers their feelings for a person to the therapist), in-depth talk therapy helps the client to reflect on the internally located sources of their distress.  The goal is to free clients’ psychic energy and thereby give them more control over how they respond to their emotions.  In so doing the hope is that clients are enabled to engage in a more mature and productive life.  Psychoanalytic therapy rests less on talk perse and more on the analysts’ deep empathy with their clients.

By comparing these two approaches (there are of course major variations and many more psychological approaches) we can see how talk in the therapeutic setting works in different ways.  Narrative therapy does not aim to change a person, rather it allows each client to become an expert in their own lives in learning how to “re-author or re-story” their problematic experiences in a positive way.   In contrast, psychoanalytic psychology raises the consciousness of the client through a very different experience (often using transference to the therapist).  As the diagnostic expert the psychoanalytic therapist focuses less on the stories clients tell about themselves and more on the way those stories are told and the feelings and emotions the stories evoke.  While the narrative therapist holds that clients “know” where their distress and discomfort rest and work as a collaborative partner with the client; the psychoanalytic therapist focuses on the very issues about which the client may be least cognizant.   Each therapist engages in “talk” in different ways: the psychoanalyst uses talk less as a substantive revelation and more about the ways in which it is rendered by the client; for the narrative psychologist stories by the client are therapeutically critical. 

Both kinds of therapists are sensitive to the idea that “talk” is always conditioned by larger societal and political issues which in turn are intertwined with gender, class, race, and sexual identities.   Which kind of talk is more effective?  This is a hard question to answer.  The data are limited.  Because narrative psychology is still rather new, especially in contrast to psychoanalytic therapy, there are few studies to evaluate its efficacy.  However, large scale studies have shown that psychoanalytic therapy is effective in leading to lasting improvements in depressive and anxiety symptoms.    Irrespective of the approach, talk is essential for any therapeutic setting.