No One Size Fits All in Healing: the wisdom of Bessel van der Kolk

Published on 27 September 2024 at 11:51

I stumbled upon an enlightening passage in Bessel van der Kolk's landmark book 'The Body Keeps the Score' that resonated deeply with me. On page 212, van der Kolk powerfully states, "There is no one 'treatment of choice' for trauma, and any therapist who believes that his or her particular method is the only answer to your problems is suspect of being ideologue rather than somebody who is interested in making sure that you get well." This passage struck a chord because it captures the essence of what effective psychological treatment should be: tailored to the individual needs of the client, compassionate, personalised, collaborative, and open-minded.

The Myth of the "One-Size-Fits-All" Approach

Many people, in the search for healing, encounter practitioners or services who advocate for a singular methodology as the ultimate solution. Services will often steer towards CBT therapy as this is more widely available and where the most research has been conducted. It is however important to recognise that the research base is developed where the funding has been provided - research studies may not have been funded in other area or for other approaches which creates the perception of 'gold standards' of treatment. In reality we would need to research and treat all approaches equally in order to truly, scientifically state that any one is the 'gold standard'.

Van der Kolk's statement argues against this narrow-minded approach of suggesting one size fits all. Distress is a highly individual experience, and so the path to recovery should also be an individual one. Rigid adherence to a single treatment modality can limit the efficacy of therapy and potentially hinder recovery. Instead, it's crucial for psychological therapists to recognise the diverse needs of those who are in need of support.

The Importance of Therapeutic Flexibility

A therapeutic journey often involves exploring multiple avenues. Whether it's somatic experiencing, Poly-vagal exercises, cognitive behavioural therapy, EMDR, or mindfulness-based interventions, the potential pathways to healing are abundant. As van der Kolk points out, no therapist can be an expert in all methods. Therefore, the best therapists are those who are willing to collaborate, refer out to other specialists, and stay continually educated about new developments in the field. Personally I love learning and believe therapists need to invest heavily in their continued professional development to learn as much as possible about the different treatment options.

Client Autonomy and Collaboration

Another critical takeaway from van der Kolk's insight is the emphasis on client autonomy and collaborative treatment planning. Effective therapy is not just about the therapist's knowledge and skills; it's also about a good relationship and empowering clients to be active participants in their healing journey. This involves clients understanding their options, feeling comfortable to voice their preferences, and having a therapist who actively listens and respects their individual needs.

Moving Forward

Reading van der Kolk reinforces the necessity of adopting a holistic, client-centered approach to psychological therapy. We must prioritise the wellness of the individual over the popularity of any given method. By staying flexible and open, both therapists and clients embark on a journey that truly honours the complexity of human experiences and what it means to heal. 

The beauty of EMDR therapy is that it's creator Francine Shapiro brought together her vast knowledge of many different therapy modalities - mindfulness, memory processing theory, recognising cognition, body sensations and emotional experiences - EMDR is also structured in a way that allows for flexibility in integration of other types of therapy at different phases such as IFS / Ego State / parts work, CBT and third wave variations such as ACT and CFT, somatic, and poly-vagal theory, can all be introduced at phase 2 preparation and integrated throughout all phases. 

For anyone deeply invested in providing support to recovery, van der Kolk’s advice is invaluable: eschew rigid ideologies, embrace therapeutic diversity, and most importantly, remain steadfastly committed to the ultimate goal—your client's well-being!

So let’s champion flexibility and openness in our healing journeys, just as van der Kolk so wisely advises.

Linda Sunderland 

MA (Hons) psych., MSc psych, PGDip CBT, GMBPSs

Accredited EMDR Europe, Accredited BABCP

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