“Spice Rack” of Treatment Modalities

Summary

Advancing Resiliency in Education with Jen & Jen
Episode: “Spice Rack” of Treatment Modalities
Date: November 13, 2020
Hosts: Jennifer Baker (A) & Jennifer Johnson (B)

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Episode Overview

In this episode, Jennifer Baker (LMFT) and Jennifer Johnson (LCSW) answer a school-based clinician’s question: “When should I switch treatment modalities?” Drawing on over 20 years of experience, the hosts explore how therapists can identify the right moment and reason to transition between approaches, and how to tailor their “spice rack” of modalities to best serve each client—especially in educational settings. Throughout the discussion, Jen & Jen break down complex therapeutic concepts into accessible real-world examples and offer practical, school-friendly strategies for clinicians.

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Key Discussion Points & Insights

Defining Treatment Modalities in Therapy (01:02–01:58)

• Modalities Explained:
  Jennifer Johnson describes modalities as various therapeutic approaches or frameworks:
  • Common examples: Cognitive Behavioral Therapy (CBT), Acceptance Commitment Therapy (ACT), Narrative Counseling, Dialectical Behavioral Therapy, Problem Solving Therapy (PST), and Interpersonal Therapy (IPT).
  • “Spice Rack” Metaphor: Johnson emphasizes the importance of having a diverse set of modalities rather than just relying on one.

    “You usually want to have a really nice spice rack of modalities...whatever the stew is calling for, whatever the situation is calling for, you can reach for that spice.” (B, 02:25)

Modality Choice: Personal Strengths & Context (02:58–03:42)

• Therapists naturally have preferences and proficiencies, but must adapt to client needs and the setting (e.g., school-based work differs from acute care or private practice).

Top Modalities in School Settings

Cognitive Behavioral Therapy (CBT) (03:42–05:31)

• CBT’s Strengths:
  Well-suited to school environments, particularly effective with thought-related challenges and “faulty thinking.”
• Theory:
  CBT’s model links thoughts, feelings, and behaviors—teaching students cognitive restructuring to develop healthier outlooks.

Narrative Therapy (05:31–08:57)

• Fit for Children:
  Children naturally tell stories. Narrative therapy dovetails with this, allowing kids to externalize problems.

• Key Quote:

  “The problem is the problem.” (B, 06:00)

• Notable Example:
  Johnson shares about “Jake” (a pseudonym) who suffered from bedwetting. Through narrative therapy, Jake separated his identity from the problem and even “talked” to his bedwetting, regaining self-esteem. (07:10–08:29)

• Reducing Stigma:
  Emphasizes “person first” language and working against labeling or pathologizing students. (A, 08:36)

Acceptance Commitment Therapy (ACT) (10:39–17:19)

• Transitioning Modalities:
  ACT is often appropriate when insight is present (students recognize their problematic thoughts are unfounded, but the thoughts persist).

• ACT Essentials:

  • Acceptance: Recognizing and not fighting against persistent symptoms/struggles.
  • Commitment: Acting in accordance with personal values, rather than being led by symptoms.

• Blending Approaches:
  Acceptance can be introduced when cognitive strategies hit a wall—e.g., “I know these are irrational worries, but I still have them.” (B, 14:52–15:43)

  “If you as a therapist hear anything like that at all from your client...that is almost a golden permission slip to move towards acceptance commitment therapy.” (B, 15:04)

• Metaphor:
  Worrisome thoughts are “backseat passengers” in life’s car; values should dictate the direction, not anxiety.

  “Let’s accept them, but let’s ask them to get in the backseat so you can keep driving the car...What do you value? What is your destination?” (B, 16:32)

• Clarifying Acceptance:
  Acceptance isn’t resignation:

  “People often question, is accepting like giving up? ...It’s not.” (B, 18:01)

  • Integration with narrative (“name it to tame it” – Daniel Siegel) helps further externalize and manage symptoms. (B, 18:42–19:42)
  • Pop culture reference: “Dexter and his dark passenger” – accepting anxieties as a passenger, but not letting them drive. (B, 19:42)

Practical Tips for School-Based Clinicians

• All Three Approaches Work Well in Schools:
  Each can be structured, goal-oriented, and time-limited—suiting the school context where students benefit from brief, effective interventions. (A & B, 21:18–21:32)
• Listening for Cues to Switch Modalities:
  Insightful students may directly or indirectly indicate readiness for a new approach (e.g., “I already know it’s not factual”—time to try ACT). (B, 21:32–22:41)
• Professional Growth:
  • Continuously replenish your “spice rack” of modalities through training, reading, and peer consultation.

    “As clinicians, we start to learn different ways and having good consultation, having someone...that can be a mentor or even just a colleague that you can have conversations about, because it can get really easy to get stuck.” (A, 22:41)

  • Consultation with peers “nourishes the clinical soul.” (B, 23:29)

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Memorable Quotes & Moments

• On Modality Flexibility:

  “You never want to be that clinician that’s only got salt on their spice rack and you’re bringing out the salt all the time.” (B, 02:26)

• On Externalizing Problems:

  “The problem is the problem. And then when we make that bold statement... you get to take back your identity.” (B, 06:02) “Narrative therapy allows you to take your pen back...I want my pen back. I want to write my story.” (B, 08:57)

• On Acceptance ACT:

  “Acceptance commitment therapy is about accepting struggles that you might have...But not letting them dictate your every move, every step...the actions and the steps that you take in life are based on your values, not your symptoms, your challenges.” (B, 11:17)

• On Peer Support in the Field:

  “When people speak your language, it’s like speaking your native tongue. It feels nurturing and nourishing, and we all deserve that.” (B, 23:29)

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Important Timestamps

• 00:43: Introduction of the key listener question about when to switch modalities.
• 01:26: Explanation of treatment modalities with practical examples.
• 02:25: "Spice rack" metaphor introduced.
• 03:42: Discussion of CBT’s strengths in school settings.
• 05:31: Narrative therapy’s fit for natural child storytelling.
• 07:18: Jake’s narrative therapy example for bedwetting.
• 10:39: Introduction and strengths of Acceptance Commitment Therapy (ACT).
• 15:04: Key indicators for moving from CBT to ACT.
• 16:32: Car/values metaphor to explain ACT.
• 19:42: Pop culture “Dexter” reference for understanding acceptance and self-management.
• 21:32: Maximizing modality effectiveness in schools; monitoring for readiness to switch.
• 22:41: Importance of ongoing training and professional support.

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Tone & Language

The episode is conversational, warm, and accessible—demystifying therapy concepts with relatable metaphors and real-world stories. Both hosts use humor, encouragement, and professional candor, making the content relevant and uplifting for mental health practitioners in educational spaces.

Transcript

[A]

Hello and welcome to Advancing Resiliency in Education with Jen and Jen. My name is Jennifer Baker and I'm a licensed marriage and family therapist. And my co host is Jennifer Johnson, licensed clinical social worker. We invite you to listen in as we respond to real questions on current mental health topics from educators. Our hope is that the ideas, stories and experiences shared on this podcast will help you build resiliency and well being in your own lives. Hello. So we want to welcome you all back to Advancing Resiliency in Education with Jen and Jen. Hi, Jen. How are you doing today?

[B]

I'm good, thanks for having me.

[A]

So the question that has come in this week was actually from a school based clinician who works with fifth grade and up in the secondary schools and was asking if we had any suggestions or advice as to when to switch treatment modalities.

[B]

That's a good question. I think every therapist at one time or another in their career has had this question, you know, how do I know to jump from one modality to another?

[A]

So can we real quickly, just for maybe some people who don't understand what modality means in our line of work, could you explain that a little bit more? Sure.

[B]

So for therapists, we have several different treatment modalities that we might lean on. Right. Many people have heard about cognitive behavioral therapy, so that's one therapeutic modality. Cbt. You hear me mention a lot. Acceptance commitment therapy. That's a modality I lean on a lot. There's narrative counseling, there's dialectical behavioral therapy, there's pst, problem solving therapy, there's, there's ipt, Interpersonal therapy.

[A]

So there's a lot.

[B]

Yes. Yes, there is a lot. And so many of us have been trained in different modalities. Some of us prefer some modalities over others, but as therapists, we usually recognize it's not so much just about what we like. It's based on the client and what's going on with the client, what the situation calls for. You know, you usually want to have a really nice spice rack of modalities.

[A]

Right.

[B]

You never want to be that clinician that's only got salt on their spice rack and you're bringing out the salt all the time. You want a nice robust spice rack so that whatever the stew is calling for, whatever the situation is calling for, you can reach for that spice. Right.

[A]

And it's part of growth in our business too, as well. As we grow, we learn more modalities and we learn when and where to use them and with who.

[B]

Definitely. And as we Learn. I like the growth mindset. As we learn, some of us might realize, oh, we're not so good at certain modalities. And so maybe we shouldn't always grab for the cumin, leave it on the shelf. If someone else comes into the kitchen, they might want to pull that off the spice rack and use that, they might have a better go. Apparently it. And so, yeah, in our, in our scope of practice, it's about recognizing our strengths and weaknesses. And some of the spices we don't necessarily handle so well.

[A]

So a little bit personal, you know, as well as preference as far as what works for you and also where you're doing it at. So in this case, we have a school based clinician, so their work may look different than someone that was working in an acute in care facility or in a private practice.

[B]

So true. So true. And if we do some reading, you know, the literature lets us know that there are certain modalities that work like gangbusters at school settings. You know, you have your typical treatment modality, cbt, which works really well in any type of setting and with most problems, especially if the problems are really thought related. Right. So if we have some faulty thinking going on, CPT is just beautiful about going in and kind of questioning that thinking and hopefully correcting that faulty thinking. Right. In our scope of practice, we call it cognitive restructuring and just learning how to adapt our thinking, modify our thinking and have healthier thinking. And the belief is that, that that thought process will affect how we feel and behave. CBT is actually built on a model thinking, feeling, behaving model, as are many of the other modalities. So CBT is great in school settings, especially if you're working with someone that has some faulty thinking going on. And as you know, some of our kids have some faulty thinking going on. Right. Another modality that works really well is in a school setting is narrative counseling. Because narrative counseling is actually built on the premise that individuals need to tell their own story. Right. Well, what do kids do naturally? They talk in story format. Right. Like, have you ever asked a kid a question and then, you know, 20 minutes later you finally got the answer, but they had to tell you this really long story? That's because kids naturally talk in story format, narrative style. So narrative counseling actually works really well because it builds into their natural style of speak. Anyway.

[A]

Yeah. When I first learned about narrative pretty early on in my career and Michael White's work around narrative therapy, we used it a lot with little kids at the time to make it not about them being the problem. But more that it was this outside, you know, it wasn't so ingrained that it's, you are the problem. There are problems outside of you in how to look at making your story.

[B]

I love it. Yes. And in narrative therapy, we often teach the problem is the problem. Right. The problem is the problem. And then when we make that bold statement, when it becomes conceptualized, then you get to take back your identity. Right. So I may be Jen, and here's all of my identity, all the things about me. And I might be challenged with a particular problem, I might be challenged with a particular struggle, but the problem is the problem. Right. I still get to keep my identity. And so it's beautiful. Narrative therapy naturally unfolds that. Yeah.

[A]

And for those on the outside, too, because instead of making it that that child's the problem child or the bad child, we really make it about what's going on for that child that we can actually be helpful and influence to help them do better and be more healthy within the school environment.

[B]

Absolutely, absolutely. You know, it's amazing that even kids will start to adopt themselves as the problem. They'll start to adopt it. I can remember working with a young fellow one time and, you know, fake name. I'm just going to make up a name. Let's call him Jake. And Jake had some bedwetting issues that were coming back and they were reemerging in his life. And there wasn't any trauma or anything like that going on. There was just some stressors. You know, I had some school stressors and some difficulties with academics and whatnot. So anyway, bedwetting started to occur. But how everyone was talking about really started to be that Jake was losing his identity. He was no longer Jake. He was a bedwetter. And so narrative therapy actually allowed us to, you know, get his identity back and also start to have conversations with the bedwetting. And that sounds really strange, but in reality, Jake was able to say to bedwetting, hey, I see that you're back again. I don't really appreciate your presence. You're actually keeping me from having sleepovers. You're actually, I think, creating a lot of conflict with me and my parents. I'm actually embarrassed. So I don't know why you're here, but I am ready for you to leave. So narrative therapy allows you to put language so you can actually externalize the problem and actually start talking to the problem. And again, the purpose for that is so that Jake can have his identity back. You know, Jake is a, you know, a great Kid, he loves Legos and he likes to walk his dog, and he loves to ride BMX bikes, you know, whatever, whatever it may be for that particular child, but he gets to take back his identity.

[A]

And it's that person first language. Right? So that's what we're really trying to do, is make it so that we less labeling of individuals as a diagnosis or a problem, to get rid of the stigma so that really we can all get help and get better.

[B]

Yes. Yes. You know, narrative therapy, it actually allows you to take your pen back. And so narrative therapy often acknowledges that there may have been forces in your life that started to author your story for you, but that some of those forces might not have had your best interest at heart, might not have your best interest in mind. And so as they were authoring your story, it wasn't authored with care or love, acceptance or understanding. And so your story was authored in a harmful way. Narrative therapy is about, I want my pen back. I want my pen back. I want to write my story, I want to write my chapter. Where we're at, it's not about ignoring that we had some chapters in our life that were harsh or harmful. It's not about ignoring that or negating that. It's about recognizing that there are sometimes forces in our life. The forces could be a parent that was abusive. The forces could be a community that was not accepting and understanding. The forces could be a peer group or a family unit that wasn't kind and gentle. And so it could be outside forces. But narrative therapy is about acknowledging, I don't want you writing my story anymore. It's mine. I. I'd like my pen back. And I want to start to author my story, and I have the right to do so.

[A]

Yeah, perfect. All right, so we have cognitive behavioral therapy. We have narrative therapy. What else? For school based clinicians.

[B]

You know, I really like acceptance commitment therapy. I've mentioned it, so surprise, surprise, I've mentioned it so many times, but I think it will play into the original question. So the original question is about when do I move from one modality to another? So let's roll it out. Let's roll out. Moving from CBT to act. So acceptance commitment therapy, which is referred to as act. I still get stuck and say act. But for everyone out there, apparently you're supposed to call it act acceptance commitment therapy. So excuse me if I slip and say act. So let's move from CBT to act. Acceptance commitment therapy is about accepting struggles that you might have accepting, maybe even symptoms that you experience. But not letting them dictate your every move, every step that you take. You're not going to let your symptoms and your struggles dictate your movement in life, your direction in life. And the C is for commitment, where you identify your values and you make a commitment to live your life through your values. And so the actions and the steps that you take in life are based on your values, not your symptoms, your challenges, your struggles and your failures. So it's not. It's about accepting you have those failures, accepting you have those struggles. Because we all have had a failure at one time or another. We all have had a struggle or a challenge. And many of us have had symptoms of whatever kind of clustering there is, but we've had symptoms. And so it's about maybe accepting those and committing to living our life by our values versus letting our symptoms dictate where we go from there.

[A]

Okay, so I'm already starting to hear how it blends from cbt, which is very action oriented, cognitive, behavioral can be. It's really changing your thoughts and actions, you know, which is what the commitment part I'm almost hearing in the. In the act piece and the acceptance part is not owning that as being you, but really looking at the story, right? I see you smiling at me, right?

[B]

So that would be the narrative component. Okay, so here's how we might jump, right? We might jump from one modality to the other. So if we've done this action oriented approach, cbt, right? Let's say we have. Let's bring in a mythical client. So we bring in a client and they have some anxious thoughts, right? And so they struggle with anxiety. They have some anxiety symptoms. And so they struggle with lots of worries and lots of doubt, a lot of fear thoughts. And so we are CBT ing the heck out of it, right? We're meeting together, we explain what CBT is, and we look at some of their thoughts and we pull them apart. And we do your typical CBT practices and activities, which are about, you know, checking for facts, checking for proof, then exploring to see if it is even a real thought, a factual thought. It might be really a faulty thought. So we do all of that, right? All of your CBD practices and your action oriented approach. And at the end of a couple months, that client looks at you and says, listen, Jen, I understand that the thoughts that I'm having are worrisome. I understand that the thoughts I'm having are really fearful and they're anxious. And I'm using all the skills we've done cognitive Restructuring. And I'm understanding they are not factual on understanding that I've done all the CBT skills, they still are coming. The thoughts still happen. If you as a therapist hear anything like that at all from your client, anything that even sounds remotely like what

[A]

I just shared, I was going to say that would be a really. Maybe an atypical client that would be that insightful, especially a kid. So we'd be probably hearing this isn't

[B]

working, know that it's not factual. That's what a kid might say.

[A]

Or we're still seeing.

[B]

Yes, the behaviors. Right.

[A]

Or we're still hearing from the teachers or the administrators that, you know, this kiddos right. Back in the same spots always in my office is always getting sent up to me.

[B]

So we could be seeing something, observing it, or hearing it in a different way. So if there's been any indication that they are understanding that these are not factual thoughts, they get that, right. This is not faulty thinking or that it is faulty thinking, but yet it's still occurring. It's still happening. That is almost a golden permission slip to move towards acceptance commitment therapy. And so with a savvy client, with a cognitively savvy client, you're going to say, well, listen, I'd like to introduce acceptance commitment therapy. We've been CBT ing for a while.

[A]

We've been using that spice.

[B]

Yeah, we've been using that spice.

[A]

We need to switch to paprika now.

[B]

Yes. So let's pull out. Yes, another spice from the spice rack. And so we would talk with the client and say, you may be genetically manufactured, biologically engineered to have these anxious thoughts that visit quite often. That is how you are manufactured. Because it can be definitely organic. Right. These symptoms can come from an organicity place. And so we have to accept that these are your thoughts. We don't necessarily want them to keep you from maneuvering and navigating through the world in a healthy way. So I'm wondering if we can start practicing accepting that you do have some of these worrisome thoughts. You know, they're already not fault. You know, they're faulty, they're not factual. And so let's accept them, but let's ask them to get in the backseat so you can keep driving the car to the destination that you want. So what are your values? What is your destination? Where are we going in life? What do you value? Because right now, as it's happening, you're not living your life based on your values. You're over on the mat wrestling with the worrisome thought. So before you know it, you're on the mat wrestling, and 20 minutes have passed up. You've lost 20 minutes of your life wrestling with another worrisome thought. And so instead, acceptance commitment therapy, sprinkled with a little narrative gives the client permission to say, oh, I see you're back. You're my worrisome thoughts. I have you a couple times a day. I see you're coming down the hallway again.

[A]

I really love your clarification of acceptance because many times working with individuals around acceptance, they hear that word and they see it as, oh, I'm accepting this. Like, this is okay. Like it was, you know, an acceptance of what that person did to me or an acceptance of the situation. But you're really saying it's different. It's about accepting who you are and these parts of you in the sense of, oh, you're back. But it's not, not in a negative or a way that it's like, oh, okay, well, we need to move through this versus stay stuck with it.

[B]

Yeah, that's. You know, Jen, when you say that, I have heard people often question, is accepting like giving up and. No, I would definitely say it's not. Just the same way as resolving and having resolution isn't giving up. When I resolve myself to the facts, and the facts are I am biologically engineered and genetically manufactured to have anxious thoughts. Me, personally, me, Jen Johnson. That's me. And I realize that some of the worrisome thoughts that I have are not fact based. CBT has run its course with me. For me, it is about accepting and resolving myself, that is me. But that I don't have to give up all the other identity factors about who I am. I don't have to lose my identity. I don't have to get on the mat and wrestle with these worrisome thoughts all the time. You know, just to sprinkle in a little bit of Daniel Siegel, name it to tame it. Right. And so narrative therapy and acceptance, commitment therapy have room for that neuroscience concept, which is name it to tame it. So for me, I'm gonna name it when I see my worrisome thought coming down the hallway. I'm even gonna joke a little bit. Oh, you're back. You're the unwanted visitor. I didn't invite you, but you sure do live here. As if you pay rent. Right. And so I'm gonna call it what it is, but I'm not going to let it drive the car. Yeah, right. Instead, if you can kind of picture it, I'm in The driver's seat. I got my hand on the wheel. And just to reference a very old show, Dexter. Do you remember Dexter and his dark passenger?

[A]

Yeah. I couldn't watch that show, Jen. It was a little too dark for me. But I'm sure many of our listeners are familiar.

[B]

Let's hope so. So picture me in the car and I have my hands on the wheel and I do in fact have my anxious thoughts sitting there right next to me. That's my dark passenger. They often show up. I never know where they come from, but here they are. But there's now someone else in the car with this acceptance, commitment, therapy. I've got my value tree in the car. There's another passenger in the car. And so now I'm going to turn to my values passenger on occasion and I'm going to check in. What do I value? Where am I going? Right? What's this journey going to look like versus me having my anxious thoughts telling me to turn left, don't go do anything because you're too anxious anyway, or don't believe that person really loves you because you're too anxious to accept that anyway. And so I'm now gonna look at my dark passenger and say, those are the things you quite. You tell me quite often. But I'm not having you tell me to turn left or right. You know, why don't you take a back seat? You know, hey, values tree, come on up here in the front, right? And then so now my values get to dictate what direction I'm driving in and where I'm going. So I just, I just love that.

[A]

Nice.

[B]

And with narrative counseling sprinkled in there, it gives me clearance and permission to talk to it. Right. Versus again, either fighting with it and wrestling with it or ignoring it and trying to pretend it doesn't exist. If anybody out there has anxious thoughts, let me know how pretending that it doesn't exist goes for you. Call in right away and let us know. Because research would say it doesn't work.

[A]

So as a school based clinician, then what's nice about all three of them is that they can be structured and more time focused. Correct?

[B]

Definitely. You know, your students do not want to remain in therapy forever. You know, typically we're interrupting their schedule and their wants and their focus areas, so we don't want to keep them. So you do want to be structured. You definitely want to be structured. It's easier to be time sensitive when you know when to move from one modality to the next. And so you just have to listen for the cues. I can remember a 10th grader coming into therapy was first assigned to me and came into therapy and let me know from the very beginning. He sat down and he said, all right, so listen, what I'm about to tell you, I already know it's not factual. Immediately I knew he had already been in therapy with the CBT approach already because he was taught that. So whoever his CBT therapist was, well done. You did a great job. Because now he was ready for something new. And so he started it off with I already know it's not factual. That gave me permission to move forward with acceptance, commitment, therapy, because he already knew. So again, it's about listening to those telltale signs about when we're going to leave here, we're going to go to

[A]

this modality instead, and then just starting to replenish your spice rack. Right. So we want to start looking and going into different modalities, start doing some more research, go to trainings. Jen does awesome trainings, by the way, as many of you probably, at least around here know, have seen Jen do the trainings. But that's. That's a way, as clinicians that we start to learn different ways and having good consultation, having someone that you can go to, that's also in the field, that can be a mentor or even just a colleague that you can have conversations about, because it can get really easy to get stuck, especially when you feel like you're out there on your own. Own.

[B]

Oh, yeah. Well said. Yeah, you have to have another colleague or group to banter and toss us around, because sometimes we're entirely too close, but other times, you know, we're so busy that we forget to explore a different treatment modality. Right. Most of us, by the way, do PST all the time. Problem solving therapy, but we don't call it that. But if we were able to sit around in supervision, if we were able to sit around in a group with other colleagues, and it would usually be a colleague that would remind us, oh, you're doing PST all the time. Why does that even matter? Because it's not like you put it in your notes or anything. But here's why it matters. It nourishes the clinical soul because you went into this work to do good treatment, to do effective treatment. And so when people speak your language, it's like speaking your native tongue. It feels nurturing and nourishing, and we all deserve that.

[A]

We sure do. Thanks for speaking my native tongue, Jen. I appreciate you being here. And we look forward to talking with you all again next time.

[B]

Thanks.

[A]

Thank you so much for listening. Support shared during today's episode is for informational purposes and does not substitute for mental health care from a licensed professional. Jen and I wish you well and look forward to you joining us on the next episode of Advancing Resiliency in Education.