A Match Made In [Therapy] Heaven

Deciding to see a therapist, be they psychiatrist, psychologist, social worker, etc. is a railroad-tracksmajor step. Some see the writing on the wall and will get help quickly while for others it is the signal that things have gotten so bad that the standard tools for coping have broken down and life is going “off the tracks”.

Either way, the question is, “How do you find the right therapist?” You are about to engage on a journey of personal exploration… with a complete stranger… It’s the ultimate blind date! Therapists come with their own personalities, their own biases, thoughts, feelings, and behaviours. How do you maximize the potential for a good fit between you and your therapist so that you can have the best chance at success to achieve your goals?

interviewUnfortunately, you can’t really hold an interview with every therapist, so you have to rely on second hand information such as a conversation with a friend, a referral from your family doctor, or by reading the therapist’s website. More and more therapists are creating an online presence for themselves and I think that this is an extremely valuable resource for prospective clients/patients. You can see our own clinical preferences here.

Our view at Inspired Living Medical is that there is large overlap between therapies. All of them seek to help change  problem behaviours and internal states (thoughts and feelings). The differences between the therapies are often a matter of focus. So, when choosing a therapist it can be very important for you to select someone with whom you might share a common understanding of the problem. Perhaps more important still is to have agreement about the best way to tackle the problems you have come seeking help with? If you don’t believe your therapist’s way of thinking, or if it doesn’t make sense or resonate with you, you will not do the work necessary to create change in your own life, and the therapist certainly can’t do it for you!

So, what follows is a brief, but not exhaustive, description of some of the major therapies and their proposed mechanisms of change to help you find your Therapy Match Made In Heaven.

Remember that “There are many roads to Rome”, and just because one form of therapy “fit” for someone else, does not mean it will for you, or that just because therapy didn’t “fit” for you in the past, does not mean it won’t now, or that a different type of therapy won’t. They are all just ways of helping ourselves create a life we are excited to live!

As you read through keep two questions in mind: 

  • A. Does this approach make sense to me?
  • B. Do I feel ready to put in the work? (make sure you answer this question honestly)

Cognitive Behaviour Therapy (CBT): The theory behind CBT is that our thoughts cog-triangleinfluence our behaviours, our behaviours influence of feelings, and our feelings influence our thoughts – and so the cycle continues. CBT practitioners propose that changing your thoughts will change your feelings and change your behaviours.Therapy usually focuses on looking at how irrational thoughts or beliefs affect your behaviours and feelings. It also asks you to be willing to experiment with new behaviours or routines. This mode of therapy usually has homework associated with it (that you do on your own time) and often requires writing or keeping a journal. Many people find this form of therapy “easier” to approach than emotion focused, though don’t confuse “easier” with “easy”. No matter what approach speaks best to you, they require commitment and work.

Behavioural Activation (BA): This therapy came about because some therapists believe focus on thoughts is unnecessary to promote change. What we need for good mental health is to engage in reinforcing activities. If we take care of ourselves through choosing more and more rewarding activities, whether or not we feel like it, thoughts and feelings will change on their own. Patients will make a list of increasingly difficult goals (based on desirable activities) along with rewards for reaching new milestones. Other alternatives of Behaviour Therapy ask the patient to start tracking the problem behaviours (such as alcohol/drugs) and “analyze” the sequence of events that led to. This form of therapy, like CBT usually involves homework in between sessions.

Acceptance and Commitment Therapy (ACT): The theory behind ACT is that thoughts and feelings are NOT the problem, but it is our relationship to these thoughts and feelings that causes suffering and prevents us from living a value based life. The focus of therapy is to train individuals to keep contact with the present moment, through mindfulness meditative techniques, and become observers of the thoughts and feelings in us so that we can mindfully chose which thoughts and feelings we fuse with or invest in. It also teaches patients how to “defuse” from the unhelpful thoughts or feelings that are preventing value-based living. Finally, it also encourages reflection about what constitutes value-based living (how to make our lives meaningful for us). As with the above therapies, it does have homework, though choice about doing the homework is emphasized. homework

Emotion Focused Therapies: There are a number of emotion focused therapies. Our preference at Inspired Living Medical is Intensive Short Term Dynamic Psychotherapy (ISTDP), but broadly speaking emotion focused therapies believe that the root of the problems are a result of unexperienced / avoided feelings we have in the present, about the things that have happened to us throughout our lives. Instead of experiencing these uncomfortable emotions (often a mix of both powerful love AND powerful rage towards those that matter to us) we use different coping strategies to avoid the feelings (like drugs or alcohol, or becoming detached from our emotions). This form of therapy does not usually have homework or exercises to be completed outside of the therapy session. Our experience has been that these kinds of therapies are can be very difficult for patients, because it asks them to face often painful emotions. This can be very difficult to do, but can be transformative for people for whom it is a good fit and who are ready.

Psychodynamic Psychotherapy: The classic therapy developed by Sigmund Freud. This therapy model typically supposes that early life difficulties result in maladaptive coping. Much of this maladaptive coping is at an unconscious level (we don’t even notice it). So, the therapy uses a lot of interpretative methods, also focuses on the relationship between the therapist and the patient, and is often a long term commitment (years). As with emotion focused therapies there is no homework. FreudCartoon14web

There are other therapies such as Interpersonal Psychotherapy (IPT) and Dialectical Behaviour Therapy (DBT) which are described in the links. These can be harder to find in Halifax as far as we know.

Finding a good match with your therapist is critical if you hope to evoke positive change in your life. In fact the research about the different types of therapy shows that this (technically called the “Therapeutic Alliance”) is the single most important factor determining how helpful a particular therapy is, not the type of therapy itself.  If you don’t have a good relationship with your therapist, you won’t do the work, and your chances at making lasting change shrinks.

Sharing a similar view of the problem and how to tackle it does not guarantee you and your therapist will be a good fit, but it is an important starting point.

Don’t forget, you can find links to all our posts on twitter @DrAdrianaWilson. Let us know what you think!