An Interview with :: Tony Meiners, PsyD – Clinical Director

Evidence-Based Practices and Neurotypes

I have been talking a lot lately about the idea of model mismatch in therapy, and what it really pertains to is this idea that like not, not all therapy is accessible. I think as clinicians were trained in evidence based practices and gold standards and certain modalities and then we bring a client into that treatment assuming that it’s meant for all neurotypes and all individuals. And that’s just not the case, not all therapies are universally accessible. So model mismatch is really this idea that you know we can have a therapy and we can have a client and if the the therapy does not match with the client’s neurotype the actual therapy is not gonna be accessible.

The Challenge of Model Mismatch

Why this is important is I think as clinicians or or treatment centers, sometimes there’s this push to to force a client to adapt to the therapy, but we don’t often get trained in how to adapt a therapy to a client. I think there’s a lot of ramifications if we don’t do that.

Structure, Containment, and Processing Styles

An example of being, you know, someone may not be comfortable with you know an open ended free flowing kind of ambiguous structured therapy, so if you were to ask them an open ended curiosity question they may respond with “I don’t know”, and it looks like avoidance, shut down, not engaged not motivated, but maybe the reality is that their brain needs more structure, more containment in order to have safety to kind of process and move through things.

Same thing with emotional recall. A lot of therapists will be like, what what are you feeling now? You know, what do you notice now? and kind of expect immediate access to to verbal and emotional recall of of their experience of a memory. Some brains you know maybe there’s a delayed emotional response. Maybe the the memory recall is not linear, and if you’re not taking that into account when you’re conceptualizing and working with an individual you’re going to run into barriers, and a clinician who’s not on on the lookout for these things is going to make a lot of assumptions about a client’s engagement and treatment.

Shifting Responsibility to the Clinician

I like the idea of model mismatch in therapy because I think it takes the onus off of the client um in this assumption that it’s all the client’s problem or the client’s issue if they’re not engaging in therapy it really makes us take a step back and think hey is this therapy accessible for for their neurotype for the person in the room? How can I pivot and change this therapy so that it’s more easily accessed by the client.

Unlearning Rigid Fidelity

That’s really what the idea of model mismatch in therapy teaches us. It’s uh a bit of unlearning as a clinician. I think as clinicians we are again trained in very manualized evidence based practices fidelity to the treatment. Which is you know, all important of course, but sometimes if that’s not lined up with the narrative, or a processing style, or a way of seeing and experiencing the world, um of the clients, that the therapy is not going to work.