We might seek a therapy for various reasons: depression, anxiety, feeling lost or overwhelmed. Each country possesses different mental health system - in some, therapy is available through a public medical care. In others, insurance is required. But in most places, we can undergo a therapy through a private practice.
Getting a good therapy is not a simple matter, as there are many things to consider before we decide to either go to a therapist privately or through the public mental health care. In this article, I will focus on the most important elements which we should consider before committing ourselves to a therapy.
1. Am I ready?
Therapy requires commitment, occasional leaps of trust, resilience and being open to all kinds of possibilities. When I started my first therapy years ago, which lasted only a few sessions, I was not ready to receive what has been given to me. Many people might have an impression that the therapist is there to provide us with a magic pill that will make all problems go away. It doesn’t work exactly like this.
I strongly believe that at each point in our lives we are receptive to certain lessons - whilst being blind to others. If we are forced or if we force ourselves to learn something by using a shortcut, chances are that we will not be receptive enough to receive the gift of someone’s teachings. Especially highly intuitive people will understand this idea - sometimes it's simply not the right time.
The best lessons are learnt through experience. Of course, being told by someone what to do and what to avoid doing can shield us from making many mistakes, but equally, receiving such advice might prevent us from learning things we wouldn’t have learnt if we didn’t make any mistakes.
The same rules apply to therapy - there are many lessons to be learnt in the process of the therapeutic change, but we must be ready to change in the first place.
“How many psychologists is needed to change the bulb? Depends if the bulb wants to be changed.”
2. What to look for in a therapist
We need to be willing to give up on the idea of a 'perfect therapist'. There is no perfect human being. In fact, interacting with a 'perfect therapist' could provide us with unrealistic expectations towards other people in our lives. Therefore, our ideal therapist should be simply 'good enough' - as natural as they can be; someone we can relate to and feel comfortable around.
The most important feature of the therapist is their ability to handle their own mind. In many schools of psychology such as in psychoanalysis, it is emphasised that the therapist should undergo their own therapy/analysis. The therapist could be compared to a doctor or a surgeon - they use their own mind to cure another mind, just like the surgeon uses their own hands to cure another body. If I remember right, it was Carl Jung who came up with this analogy, emphasising that the therapist’s mind should be sterile in order to avoid infecting the client/patient with their own diseases. First and foremost, a therapist should be able to take care of their own mind.
How to recognise if the therapist’s mind is ‘sterile’? Obviously, the quickest way would be to simply ask them whether they underwent their own therapy. However, it is not always the case, and some therapist never underwent a therapy and instead, handled their own problems by themselves. I would personally avoid such therapists, simply because the human mind is prone to bias, unconsciously ignoring things that could trigger shame and anxiety - which then could be unintentionally projected onto the client. But it all highly depends on every individual so it is not entirely a strict rule that each therapist must have had their own therapy.
Different forms of therapy will have different requirements. For instance, cognitive-behavioural therapy might have a brief practice training, whereas in order to become a psychoanalyst one needs to undergo own extensive psychoanalysis with a trained psychotherapist. Thus, it's not always required for the therapist to undergo a therapy themselves.
In such cases, we should be looking at actual human traits. Are they aloof, somehow distant? Is there a barrier you are not able to cross? If there is no immediate connection or rapport, that therapist is not for you. It is important not to confuse professional boundaries with a total emotional/mental distance - in the first case, the therapist simply protects their personal life, whereas in the second case, they shield their own mind and emotions. There won’t be any healing if you can't connect with your therapist because the quality of the relationship is one of the most significant influences on the therapeutic process. On a side note, that’s where the point about having a sterile mind comes in again.
If there is a good rapport and connection, there are other important things to look for next:
- Do they regularly forget important details about you? Occasional forgetting is acceptable - remember, therapists are just humans.
- Do they enforce onto you ideas or feelings that make you feel extremely uncomfortable or even anxious? It’s important to draw a distinction between moving outside of your comfort zone in order to embrace better change, and being somehow bullied or abused by your own therapist. Many therapists will want to change people, but it is not the job of a therapist to change anyone. Their job is to facilitate a potential change and provide support in that process, rather than forcing the client to change. It is very important to pay attention to your feelings inside and outside the therapy session: do you feel as if your self-esteem is lowering? Do you feel lesser of a person? Do you feel intimidated by your therapist? If you answer yes to any of these questions, you need to start questioning whether that therapist is right for you.
- Personal traits of a therapist: are they regularly defensive, uncomfortable about themselves or their own life (it’s ok to ask a therapist about their personal life, they are human), seem anxious or unsure about what they’re doing? If yes, this therapist is not for you.
- Lower your expectations. Therapists are human - they might get anxious during therapy or unsure or insecure. The whole point is in how they're handling their own discomfort. Are they overwhelmed by their own feelings? Are they allowing their personal feelings or prejudices to affect the therapeutic process? Do you feel more worried about your therapist's feelings than your own? If you answer yes to any of these questions, you need to question whether that therapist is right for you.
3. Which therapy is best for me?
There are so many forms of therapy that I would probably need to write a book in order to explain them all. I will focus on the ones which I consider the most popular.
CBT is rooted in the belief that your thoughts affect your emotions, your emotions affect your thoughts, and both influence your behaviour. It focuses mostly on modifying your thoughts and behaviour in order to change your feelings.
This form of therapy is rooted in a combination of cognitive psychology and behaviourist approach. In other words, it’s rooted in beliefs that cognitions can be modified and this, in turn, affects the behaviour. The behaviour is learned and therefore can be unlearned and changed.
It’s very cost-effective and usually much quicker than other forms of therapy. By many, it is considered as a quick fix producing fast changes. Whether these changes are long-lasting is another story.
There are many forms of CBT and many forms of therapies strongly related to CBT: Logic based therapy, mindfulness-based therapy, schema therapy.
Generally, CBT is useful in dealing with specific problems, such as anxiety, depression or low self-esteem.
Psychoanalysis is based upon psychodynamic perspective which focuses on unconscious forces, inner dynamics of the mind and childhood influences which might dominate our behaviour.
It often lasts much much longer than CBT - usually to make long lasting changes, one needs to remain in psychoanalysis for at least 1-2 years. Some people take much longer, others become dependent on it. Woody Allen spent over 30 years getting psychoanalysed!
Psychoanalysis focuses on the discourse and experience. In contrast to CBT, it doesn’t necessarily focus on making behavioural changes, but rather, discharging stored emotions, dissolving mental blockages and often, increasing the potential of one’s personality due to discovering things about ourselves that we were not aware of before.
The key difference could be illustrated by this example: CBT therapist will approach a person with depression by isolating specific causes, then derive a plan to combat these forces and then work with a patient on modifying their thoughts and behaviour which seem to be causing the depressive symptoms. The depression here is often viewed as an outcome of one’s thoughts and behaviour. In contrast, a psychoanalyst will go much deeper than the surface behaviour - what are the internal dynamics of a person? What lies behind a depression? Is is their self-esteem? Did something happen in the past that planted the seed of depression? What do they repress about themselves? And so on and on, to a point where the whole ‘complex’ called ‘depression’ becomes dissolved.
Two major schools of psychoanalysis include the classical one based on Freudian theories, and Jungian school of depth & analytical psychology. Psychoanalytical methods and theories are also used in other forms of therapy, such as schema therapy and Gestalt therapy.
Associated with existential philosophy, this form of therapy is based on a belief that the encounter with the existence and its unavoidable limitations leads to conflict and anxiety. The way we handle life determines our mental health. For instance, confrontation with freedom and responsibility produces existential anxiety. Confrontation with death might also lead to anxiety or sadness.
From this perspective, people are seen as strongly capable beings who are competent enough to face life and resolve their problems. Therapy is focused on allowing the client to discover their own set of skills and help them realise their own limitations and potential.
This form of therapy is especially useful during transitional periods in our life as it helps us to make sense of our experience.
The key element of this therapy is a relationship between the client and the therapist which enables the client to discover themselves within a safety net of that relationship. It is entirely client-centered, meaning that the therapist does not position themselves as an expert, but rather, it is the client who is the most competent is resolving their problems. By providing unconditional regard and empathy, the therapist provides the client with an opportunity to experience nearly perfect conditions for growth and becoming who they truly are.
A clinical psychologist is a person trained in, or at least, familiar with all major approaches to therapy. Additionally, they are also trained within systems/family therapy which deals with family and group dynamics.
What distinguishes a psychologist from other therapists is that they usually hold a doctorate. It is not a requirement for the therapist to have PhD.
Psychologist is trained within the clinical setting, such as hospitals. They can diagnose people with mental illness, whereas a therapist cannot.
Although many psychologists might possess their own private practice and engage in psychotherapy, many psychologists work within clinical settings whilst dealing with most severe cases of mental health illnesses.
4. Therapy vs Coaching
Whereas therapy focuses on modifying thoughts, behaviour, feelings and sense of identity - coaching focuses on growth and development. Coaching usually doesn’t deal with emotions/feelings or past issues and it is not focused on fixing or healing anything (although healing might arise as an unintentional byproduct of coaching. Some coaches (me included) engage in a more experimental approach which embraces the area of feelings, emotions and past experiences to some extent, but to a lesser extent than therapy.
There are various forms of coaching, just like there are many different types of therapy: there is executive coaching dealing with learning leadership and executive skills, career coaching which teaches skills necessary in finding one’s self in a new career, change of career or advancing in one’s current position; there is also life coaching which deals with more general/personal issues such as relationships, sense of self, goals or dreams, or finding one’s self in the world.
Each form of coaching focuses on the development of the specific set of skills necessary for achieving previously established goals. For example, someone might demonstrate all signs of lack of assertiveness which cause problems in many areas in their life, and so, the goal of the coaching program will be to build the client's ability to be assertive. Someone else might struggle with feeling stuck - the goal would be to get this person out of the rut.
Coaching usually isn’t really suitable for people with mental health problems, simply because we cannot teach a person to stop having a mental illness. There are, however, cases where breaking down mental health problems into manageable steps can be translated into goals. It can prove to be an effective way to cope with a mental health issue. However, in contrast to therapy, the goal will not be to cure or heal a client, but simply to support them in discovering their own skills, goals and abilities.
Just like there are many different approaches to therapy, so there are different approaches to coaching. Some coaches use just one specific approach within their practice (for instance, person-centred or psychodynamic approach), others aim to become proficient in using different theories and methods in their practice in order to be more responsive and adaptable to their client's needs. In order words, they might use different theories and methods at different times - whatever is appropriate at that moment.
Choosing the right approach will depend on many factors, such as personality style, budget, type of a problem and what we try to achieve. For example, someone very introverted and introspective might strongly benefit from psychoanalysis, whereas such approach could seem like a waste of time for someone proactive, extraverted and prioritising the environment over introspection. The second person could most likely benefit from CBT, whereas CBT might seem too shallow or too intensive for someone who is introverted. It’s not a rule, however, and each person can benefit from all approaches, as long as they are committed and prepared to make long lasting changes.
Money is an important aspect to consider as well. The prices vary across countries, so it’s difficult for me to estimate the actual cost of a session in different countries. In the UK, regardless of the form of therapy costs range between £40 and £100 per session. It is important to consider the length of the therapy. CBT usually doesn’t last longer than one year, whereas psychoanalysis might last 1 - 6 years, depends on the severity of a problem. Therefore, CBT has been widely accepted as a cost effect form of therapy due to its short duration. Many people might need only 3-6 months to get better. However, the very same people might often relapse into old behaviours after some time.
Psychoanalysis might also require bigger commitment - most therapy sessions is conducted once per week, whereas psychoanalysis might require 2-3 sessions per week. So it is something to think about before committing to psychoanalysis.
Regardless of the approach, each form of therapy provides us with an opportunity for self-discovery. It opens the door into forgotten parts of our mind and deepest emotions. Some people consider the therapy being only for those who are weak or possess some mental illness - but a desire to change is universal and there is nothing shameful in wanting heal ourselves. Some people choose to change on their own, other prefer to get help - since when reaching out for help is shameful or demonstrates a weakness?