Choosing the right therapy and therapist: Where to begin

One of the challenges of starting therapy (if the anxieties about beginning weren’t already enough), is choosing the right therapy and a therapist.

In this post, I’ll outline some of the main therapy types available and key things to consider when choosing a therapist.

Choosing a therapy

Broadly-speaking, there are three dominant types of therapy to choose from: Cognitive-Behavioural Therapy (CBT), psychodynamic/psychoanalytic therapy, and trauma-focused therapy (e.g. EMDR). These all vary in their style and aims, so having an understanding of what you need is a good starting point.

Cognitive-Behavioural Therapy (CBT) tends to be indicated for those who have a preference for short-term work (usually between 6–30 sessions), those who want to work on one specific issues (e.g. worry, self-esteem, depression...etc.) and want to learn strategies and tools to manage. It is a model which makes use of regular ‘homework’, helping people put different skills into practice each week. CBT tends to follow fairly strict rules about how the sessions should unfold, and so is less suitable for those who want space to explore their situation in a freer kind of way. If you’re someone who likes order and structure, CBT may well be a good fit (assuming your goals and mental health needs are also in line with what CBT can offer).

Trauma-focused therapy includes approaches such as Eye Movement Desensitisation and Reprocessing (EMDR), Trauma-Focused CBT, and Somatic Experiencing. Sessions are usually short-term (usually up to 30 sessions) and structured. They focus on processing traumatic experiences.

It is important to note that having experienced trauma does not necessarily mean that a trauma-focused therapy is indicated. These therapies tend to be indicated for people with active symptoms of Post-Traumatic Stress Disorder or Complex Post-Traumatic Stress Disorder, particularly re-experiencing symptoms like flashbacks and nightmares, or ongoing physical symptoms.

In cases of trauma without active PTSD, another therapy could be helpful.

Psychodynamic/psychoanalytic psychotherapy is the oldest and most traditional therapy available. It is exploratory in nature and tends to be long-term (except for Dynamic Interpersonal Therapy, which takes place over 16 sessions and is indicated for mild to moderate depression and anxiety).

Psychodynamic work takes the view that many of the difficulties people face have to do with unconscious factors operating beneath conscious awareness. Psychodynamic therapy aims to shine a light on the parts of ourselves getting in the way of satisfying relationships or living a meaningful life. It is particularly suited to those who notice repeated relationship dynamics, elements of self-sabotage, or who have tried other therapies but have not managed to make much change. By taking you deeper into your mind, it aims to create and encourage change on a more profound level.

Importantly, research suggest thats there are no differences in outcome between the therapies. So it really comes down to what you want out of therapy. Structure? Tools? Insight?

Choosing your therapist

Research suggests that the quality of the therapeutic relationship accounts for a significant amount of the change that happens in therapy. Safety and trust are key.

That being said, if you find yourself paralysed by choice (there are many therapists out there, so it is common to feel overwhelmed by all the options), then it may be worth considering whether the search for the ‘right’ one has become a way of avoiding engaging with anyone at all. Sometimes, the difficulty of choosing is part of the problem, and therapy can help you explore this.

Some people also wonder about the difference between psychologists, psychotherapists, therapists, and counsellors. In practice, the distinction usually lies in the focus of their training and approach, rather than in how effective they are. There are excellent practitioners in every field, and less effective ones too. Titles such as “psychologist” or “psychotherapist” don’t reveal much about how someone actually works and whether they are any good. When deciding who to see, it’s best to focus on whether their way of thinking and working resonates with you.

In Australia, Medicare does not provide rebates for psychotherapy or couples therapy. If cost is an important factor, seeing a psychologist may be more affordable, as Medicare rebates apply to a limited number of sessions before the full fee becomes payable.