Needs, modes, and stances: Three cardinal questions for psychotherapy practice and training

Background: Advances in motivational science (Dweck, 2017), personality dynamics (Lazarus & Rafaeli, 2023), and process-based psychotherapy (Hofmann & Hayes, 2019) converge into a pragmatic, integrative, and transtheoretical model of practice and training. Method: The model comprises three elements: a formulation centered on clients’ psychological needs which provides guidance regarding the goals and processes most profitable to pursue; a recognition that such pursuit frequently requires contending with a multiplicity of clients’ internal self-states (i.e., modes); and an enumeration of pragmatic therapeutic stances likely to help address clients’ need-related goals in light of their modes. Results: We distill these elements into three cardinal questions: What needs does this client have that are not currently met, and what are the most profitable ways of remedying that frustration? What mode or modes does this client manifest – both generally and at this very moment? and What stance should I adopt in response to the client’s current mode?. We suggest that clinicians should be trained to continually pose these questions and seek to answer them collaboratively with their clients. Conclusion: This model – illustrated here using schema therapy terms – offers a process-based approach which serves as a theoretically integrative starting point but is general enough to provide an assimilative integration roadmap for therapists anchored in most primary orientations. Integrative or assimilative therapists trained to attend to needs, modes, and stances are likely to be (and be perceived as) particularly responsive, and thus, to enact “common factor” practices known to be conducive to therapeutic alliance and gains.