Since beginning my study of psychology I have witnessed a plethora of approaches to the art of psychotherapy. My own studies have included the therapeutic systems of Freud, Jung, Adler, Perls, Rogers as well as behavioral therapy in it's many forms, Gestalt art therapy, EMDR, hypnotherapy, Emotion Focused Therapy, narrative therapy, family systems therapy from a number of perspectives, couple's therapy from as many perspectives, and even more approaches that I could probably recall if I were to make more effort. The most salient conclusion I can draw from investigating all of these approaches is that we are still pretty ignorant of how to create change, reliably, with the whole range of people who are hurting enough to seek help from us. Although the search for a biological basis for all mental health issues continues, there is little evidence that the biological interventions we have available--such as psychoactive medications, electroshock, dietary changes, exercise programs and such are providing any "magic bullet" solutions for the people seeking help with the issues that are causing them grief in their daily living. Trying to find the biological underpinnings of all mental health issues and creating biological interventions for dealing with them seems such a reductionist approach to dealing with people as to dehumanize them. It makes even more likely that medicine will treat the problem and not the person.
From my perspective, far too little attention is paid to the interaction between the patient/client and the person providing care. We know with some certainty that some therapists routinely get better results than others. There has been some very interesting research on so-called "super-shrinks," those who are substantially more successful with their clients than other therapists. Any technique can be useful if applied in the right way and the right time by the therapist. A therapist with a drive to be helpful and the flexibility to adjust to the condition of the client at any given moment is probably more successful overall than one who holds rigidly to a therapeutic dogma regardless of the client's response to the treatment. What we used to call "resistance" we now recognize as the natural response by the client to the therapeutic approach of the therapist and the failure of the therapist to establish a trusting relationship where the client feels the support necessary to allow his/her anxieties and fears to come to the fore where they can be fully experienced in a safe way, thus allowing for a more useful way of dealing with them.
Lately, I have become more intrigued with attachment theory. It fits my notion of how defense mechanisms develop at varying ages and how the lack of a safe emotional environment for a child can help "lock in" behaviors at the emotional level that continue long after they are useful for dealing with the situation where they were originally engaged. A person can get trapped in a loop of fear (anxiety) and automatic emotional response that is not mitigated by the left brain and is therefor constantly an anxiety-producing surprise when unconsciously activated by any current stimulus that resembles the original situation at the emotional level. The goal of therapy is to help the client re-experience the feelings, fully, while in a safe relationship with the therapist and find out that they no longer need to act automatically with the same defense mechanisms that they had used to keep themselves safe in the first place. They need to know that they do not need to be afraid of their own feelings. My bias is that therapies that focus primarily at the emotional level (and there are a number of such approaches) are the ones that can create the greatest and most lasting changes because they rely on the person's natural resilience and striving toward health to allow change to happen. When change happens in this way, clients know within themselves that they do not have to be held hostage by their feelings any more. An intriguing aspect of emotion-focused therapies is that they fit well with the trend toward "short term" therapy (therapy that can produce excellent results in from 6 to 24 sessions for most people). There is no reason that I can think of where therapy should not be pursued at the most rapid rate that is effective for the client rather than at the rate that is the most comfortable or lucrative for the therapist.
I still believe that there is a great deal of "art" to the practice of psychotherapy, but there is also a great deal of skill needed as well. Successful therapists need to be willing and able to deal with strong emotions--both in their clients and in themselves-- because that is where change takes place. Practicing psychotherapy is "not for sissies." Client's stories and feelings can make the hair stand up on the back of your head. You can become immersed in deep pain and distress. The hopelessness expressed by the client can test your own beliefs for the possibility for a good outcome for the person. You can doubt your own skills and abilities. There might even be a danger of becoming addicted to the adrenaline rush of vicariously living on the edge of so many people in such deep distress. It is important to know who you are and to have someone to talk with when you have doubts that get stuck in your own head. What keeps us going, however, is the positive changes we see in the people we come to know so intimately so quickly. To share in their joy when they see the curtains open to a new life free of old distress is immensely rewarding. I know that each successful outcome for a client is a reward in itself and that, only when we see that, do we recognize that part of our reward is taking on a challenge to our own abilities when we can't predict reliably that we will be successful and finding that we were able to help a distressed person in a meaningful way. Personally, this is the only kind of puzzle-solving I like to engage in.