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During Christmas, three professions will have rubbed their hands in anticipation of what the New Year always brings. Real estate agents. Divorce lawyers. And therapists.
I’m not an expert on matters of the heart or mortgages, but I can tell you how to find the right therapist. And that means finding the right therapy for you. People don’t always realize that the term “therapy” is incredibly broad, encompassing many types of treatment with a variety of approaches.
Every once in a while I see a new patient who tells me it’s a lost cause. When I ask them why they feel that way, they say it’s because they’ve already had therapy and it hasn’t worked; However, closer questioning reveals that it is because they have not received proper therapy. It is estimated that there are at least 500 types, but not all of them work on all problems.
It is worth noting that the word can mean different things. The therapy is often used interchangeably with “psychotherapy,” a type of talk therapy that uses key psychological principles to help the patient. But it is also sometimes used to mean “counseling,” which is a little different and is not typically considered a treatment for mental illness. Counseling is a space for an individual to explore their thoughts and feelings with a compassionate listener.
The problem is, when a patient with depression Googles “therapy” and unknowingly ends up receiving counseling, they won’t be receiving real treatment for their condition, like CBT (I’ll explain what that is later). Many doctors don’t really understand this either; I have heard doctors say that a patient needs “counseling” when they really mean CBT.
Psychotherapy, meanwhile, is broadly divided into two areas, defined as cognitive and psychodynamic (sometimes called “analytical”). The cognitive approach specifically analyzes a person’s thoughts and behaviors and helps them make personalized changes. It is very problem-focused and good for someone with a mental illness with specific symptoms.
The psychodynamic approach is broader and explores deep-seated, often unconscious issues. It closely examines interpersonal relationships and often focuses on childhood. There are different ‘schools’ of psychodynamic therapy: Freudian (following the ideas of Sigmund Freud), Jungian (following Carl Jung) or Kleinian (following Melanie Klein), for example. In reality, most use a combination of different schools.
Sigmund Freud, the founder of psychoanalysis. His ideas form the basis of the Freudian schools of psychodynamic therapy.
In the NHS, psychodynamic psychotherapy has been largely superseded by the cognitive version, although courses for personality disorders are still sometimes offered. What the NHS almost never offers is psychoanalysis (sometimes called ‘analysis’): this is the same approach as psychodynamic psychotherapy but with sessions three or four times a week for many years.
If you’re not sure which type of therapy is best, don’t guess. If you are seeing someone through the NHS, this is usually less of an issue because you should be directed to a service that offers evidence-based therapies. But waiting lists are long and the threshold for treatment is often high, so many opt for private therapy. I think this is where the problems lie because most people don’t know what type they need.
Some people have private health insurance through their employer. If so, don’t assume that they will necessarily direct you to the right type of therapist. A psychiatrist will be able to guide you toward the best therapy for your specific problem.
Some charities offer subsidized therapy, but again, make sure it is the appropriate, evidence-based therapy for the problem you have.
You can always arrange a one-off private appointment with a psychiatrist for advice and guidance. Starting therapy is a big task: you are putting your mind in the hands of another person and it is important that you do it well.
One problem is that the term “therapist” is not protected, meaning anyone can claim to be one regardless of their qualifications or training. For that reason, I tend to recommend that people see a psychologist rather than just someone who calls themselves a “therapist.”
Patients sometimes ask if they should try online therapy, which can certainly be more convenient and easier to fit into their daily lives. The other benefit is that if you want to see someone with specialized training or experience, you can easily access them anywhere in the country.
My list below is not exhaustive, but it gives you an idea of the type of therapies you can explore…
feel depressed
The gold standard treatment is CBT (cognitive behavioral therapy), which focuses on people’s thoughts and behaviors. It aims to address symptoms of depression and “retrain” people’s brains into a more positive mindset. It typically lasts ten to 16 sessions and requires a certain degree of effort and motivation – there is homework!
feel anxious
Anxiety can be really crippling but, again, CBT has the best evidence base for treating it. People often find that combining CBT with mindfulness (focusing on the here and now and clearing the mind of noise and clutter) can help combat symptoms. Anxiety is actually more common than depression, although the two are often seen together.
OCD
Obsessive compulsive disorder is also very susceptible to CBT. Depending on the severity of symptoms, people will typically need between six and 16 sessions.
panic attacks
Again, CBT is best for this type of problem. People often need fewer sessions compared to, for example, OCD.
post-traumatic stress disorder
The most popular treatment for PTSD is EMDR (eye movement desensitization and reprogramming). During EMDR, in addition to some of the same techniques used in CBT, the therapist asks the patient to think about the trauma while moving their eyes rapidly back and forth.
Eating disorders
A specially adapted version of CBT called CBT-ED is the gold standard. CBT-ED does not address why you have problems with food, but it does address the specific behavior and helps stop it. People then typically receive more exploratory therapy, such as psychodynamic psychotherapy or compassion-based therapy, see below.
self-harm
DBT (dialectical behavioral therapy) is the most common treatment. This is specifically aimed at people who experience emotions very intensely and struggle to cope with them. It is also useful for people who have suicidal thoughts. Once self-harm has been addressed, people often pursue more exploratory work, such as psychodynamic or “schema” therapy, which aims to address embodied patterns of thinking and behavior.
A difficult childhood
Psychodynamic psychotherapy is incredibly useful in allowing someone to explore and understand the difficulties they had in childhood and the impact this has had on their lives. Schema therapy is also often used, as is CFT (compassion-focused therapy) and MBT (mentalization-based therapy), where the therapist helps you think about problems on your own.
personality disorder
People with a diagnosis of personality disorder will often be able to receive psychodynamic psychotherapy on the NHS. CAT (cognitive analytic therapy) is also sometimes offered; It is a cross between cognitive and psychodynamic approaches and will typically last 16 weeks.
People don’t always realize that the term “therapy” is incredibly broad, encompassing many types of treatment with a variety of approaches, says Dr. Max Pemberton (image taken by models)
Duel
Accepting a death can be difficult. Grief counseling has good evidence to help people understand the grieving process and work through it with someone.
Abusive or difficult relationships
CFT (compassion focused therapy) aims to promote emotional and psychological healing through compassion. It is very useful for people who struggle with feelings of shame, inferiority and self-criticism.
Drug/alcohol problems
Addressing addiction is a long process so several types of therapy are often needed. In the early stages, a modified version of CBT is often used, specifically aimed at addressing unhelpful thoughts related to a substance. Once they have successfully maintained a period of abstinence, people often consider psychodynamic psychotherapy to explore the underlying reason for their addiction. Supportive counseling or group therapy (including support groups like AA) can also help someone maintain sobriety.