How to Know What Kind of Therapy You Need
Depending on what you're going through.
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This article originally appeared on VICE US.
So you’re ready to start therapy. Congrats—a huge part of feeling better is simply making the decision to sort through your emotional baggage with a professional. While you might now be focusing on logistics like insurance and office locations, it might also be worth thinking about which type of therapy you want to try.
Talk therapy comes in various forms and flavors—Behavioral, Existential, and Psychoanalytic, to name just a few, and there’s no “one size fits all” treatment for mental health concerns. But knowing learning how certain types of treatment work (and whether they tend to work well for various mental health challenges) can be helpful when you’re shopping for a therapist.
If you’re dealing with: Anxiety
You might consider: Cognitive Behavioral Therapy (CBT) or Psychoanalysis
Cognitive Behavioral Therapy (CBT)
Anxiety disorders are among the most common mental health concerns—they affect 40 million Americans each year. This type of mood disorder can cause a bunch of uncomfortable symptoms, such as worrisome thoughts, loss of appetite, insomnia, and grueling stomachaches.
When it comes to treating anxiety, studies show that Cognitive Behavioral therapy (CBT) works really well, and many mental health professionals view it as a go-to treatment for helping people tackle their worries, fears, and phobias.
Here’s how it works: A Cognitive Behavioral therapist helps people identify and acknowledge their irrational and self-limiting beliefs, like “If I go to the party, no one will talk to me,” and “Everyone thinks I’m too sensitive." The simple act of being able to identify a negative thought can help dismantle self-judgment and anxious feelings. With CBT, clients are also taught to become psychological detectives, looking for evidence that their worst fears are facts, which they’re unlikely to find. Using this cognitive tool can help them question irrational thoughts that arise by asking, “What proof do I have that my worry is accurate?"
When people hear "psychoanalysis," they picture someone lying on a couch while their Freud-looking therapist nods, mutters, “uh huh,” and jots down notes. But it's not like that. The basis of psychoanalysis is revisiting and examining the past, especially hard-wired family dynamics. This can often shed light on what’s hurting you in the present. Studies show that psychoanalysis can be just as effective as its behavioral counterparts.
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Intended to help people get at the root of what’s causing them too much anxiety, psychoanalytic therapists view symptoms as clues that can uncover insight and invoke healing. From this perspective, anxiety is a symptom to be understood, not something to be pushed away.
“Psychoanalysis helps one understand their relationship to all of their feelings,” says Molly Merson, a psychoanalytically oriented psychotherapist in Berkeley, California. For instance, anxiety may arise because it’s keeping uncomfortable emotions like aggression and sadness at bay. Understanding these connections, Merson says, can help lessen one’s worries, enabling people to let go of maladaptive coping mechanisms so that they can make new choices.
If you’re struggling with: Break-up Grief
You might consider: Meaning-Centered Therapy
Break-ups can stir up an intense type of grief. In fact, they’re a common reason why young adults seek psychotherapy. When coping with relationship loss, people often experience anger, shock, denial, and lingering sadness, which can cause them to feel stuck in their grief. Break-up grief can also cause feelings of helplessness, and Meaning-Centered Therapy (MCT) can help people make sense of the loss.
While MCT is often used for patients with cancer, it can be beneficial for anyone hoping to find the silver lining of grief. “MCT helps people see life through a paradoxical lens—life is full of suffering and also filled with blessings,” says psychologist and MCT researcher, Paul Wong.
Wong explains that love and pain coexist, and every relationship ending brings an opportunity for a new beginning. Similar to Existential Psychotherapy, MCT helps people find purpose by cultivating awareness and appreciation for the present moment, and one’s ability to connect and engage with the world around them. “Healing of grief is complete when we develop a new normal and integrate the loss into the larger narrative for the present and the future,” Wong says.
If you’re struggling with: Childhood Trauma
You might consider: Expressive Arts Therapy or EMDR
Expressive Arts Therapy
Childhood trauma like physical, sexual, and emotional abuse can leave lasting scars. As a result, adult survivors of trauma may struggle with trusting others, regulating upsetting emotions, and forming close bonds. While most types of therapy rely on talking to bring about healing, in some instances, discussing traumatic memories can activate one’s nervous system, pushing the body into fight-or-flight mode, which can heighten the intensity of one’s distress.
However, Expressive Arts Therapy, a form of therapy that integrates art, music, drama, writing, and storytelling uses creative outlets to help heal the mind, body, and spirit. “Expressive Arts Therapy can provide a platform for individuals to process difficult personal experiences in a creative format,” says Marissa Robinson, a San Francisco-based psychologist specializing in this form of therapy.
Robinson explains that using one’s imagination and creative problem-solving can foster resilience and self-connection, which can help shift you away from the fight-or-flight response in response to triggers.
EMDR (Eye-Movement Desensitization and Reprocessing).
EMDR can also treat trauma. Developed by Francine Shapiro in 1987, EMDR helps clients process traumatic memories in small increments while focusing on external stimuli (such as hand-tapping), soothing sounds, or by directing eye movement in a bilateral way. Shapiro found that these techniques can invoke trauma recovery. While EMDR isn't as common as Cognitive-Behavioral Therapy, it's growing in popularity. In fact, new research found that it may be an effective way to treat other mental health disorders, like depression. One thing to keep in mind if you're interested in EMDR: Facilitating it requires post-graduate training, so anyone looking for an EMDR therapist should make sure the therapist has completed advanced levels or EMDR training.
Clients typically receive 6-to-12 sessions of EMDR (EMDR therapists follow a specific format for each therapy session, which aims to address the trauma in a time-limited way). By processing emotions and memories of the trauma while also paying attention to external stimuli, distressing memories and emotions become desensitized, which can lessen the symptoms of Post-Traumatic Stress Disorder (PTSD).
If you’re struggling with: Depression
You might consider: Accelerated Experiential Dynamic Psychotherapy (AEDP)
or Mindfulness-Based Cognitive Therapy
Accelerated Experiential Dynamic Psychotherapy (AEDP)
Clinical depression is often referred to as the "common cold" of mental health concerns, even though it can feel way more hellish, both physically and emotionally. While depression is prevalent, affecting 16.1 million Americans each year, treatment isn’t always straightforward.
In many cases, depression can be caused by low levels of "feel good" neurotransmitters like serotonin or dopamine, which are responsible for sparking feelings of happiness and joy. In these instances, antidepressant medication, behavioral therapy, and exercise can help.
For others, however, depression may be a reflection of deep sadness, anger, or fear caused by painful life experiences (including non-break-up-related loss and grief), in which case, Accelerated Experiential Dynamic Psychotherapy (AEDP) could help. “Depression is often a reaction to buried emotions that have not had a safe place for expression,” says Hilary Jacobs Hendel, an AEDP psychotherapist and author of the book, It’s Not Always Depression.
According to Hendel, inhibitory emotions like shame, anxiety, and guilt block core emotions, such as sadness, fear, and anger. Using the body to heal the mind, AEDP therapists help people tune into their bodily sensations as a way to process their emotions in a safe environment. By helping their clients notice how they physically experience their emotions, AEDP therapists help connect them to their thoughts, which allow clients to process them to completion. Once this happens, depressive symptoms often begin to dissipate.
Mindfulness-Based Cognitive Therapy
These days, it seems like mindfulness is the panacea for many of life’s problems. Research suggests that meditating—in whichever form you consider meditation—can increase happiness, decrease anxiety, and cultivate self-compassion. Psychologists have also found that combining mindfulness with cognitive therapy can help treat depression, especially for those at risk of a relapse. It should be noted, though, that for a small percentage of people, meditation can cause greater distress.
The therapy known as Mindfulness-Based Cognitive Therapy (MBCT) encourages the use of mindfulness meditation to bring greater awareness to one’s thoughts, feelings, and bodily sensations. Instead of viewing negative thoughts as a forecast of doom and gloom, MBCT therapists remind clients that these distressing states are temporary. Studies show that freeing people from this negative spiral can help prevent the next depressive phase.
Various types of therapy can help relieve psychological pain. Whatever you choose, make sure you feel comfortable with your therapist. Talking about your innermost secrets with a stranger can be awkward at first, but feeling understood, being able to give feedback, and build trust are essential components for any successful client/therapist relationship.
Juli Fraga is a San Francisco-based psychologist.