Which therapy is for me? A therapist's view

You have decided to see a counsellor or psychotherapist and find that there are lots of us, and therapies and qualifications sound so different. In this article, I set out to simplify what can sometimes seem like a big step. Firstly, the choice to have therapy is probably because you have some concerns or problems – this is what I term ‘Stuff’. Secondly, and more important, is to know that counsellors and psychotherapist are professionals, whose training and practices are regulated which means you can be assured they are able to provide the support and help you are looking for. So really, the type of qualification they have is less important at this stage than them being part of a regulated body such as UKCP, BACP, etc.

Other considerations of a therapist such as gender and distance from home, is a personal choice; along with considerations such as face-to-face, online, etc.

There is a range of therapies, which is why there are so many qualifications, but they are all regulated. Broadly speaking there are four domains of the mode of action (how it works) and are identified below:

• Cognitive – the focus is on thinking and supports exploring how you think about yourself, others and the world around you. Promoting change by supporting you to think about these.
• Behavioural – simply, this is about what you do, how you behave when it comes to yourself, others and the world around you. Promoting change by supporting you to stop harmful and/or adopt helpful behaviours.
• Affective – the focus is on your emotions/feelings and exploring them about yourself, others and the world around you. Promoting change by supporting you to control the emotions rather than them control you.
• Relational – simply, this is about how you connect and interact with yourself, others and the world around you. Promoting change by supporting you to manage these interactions.

In the main, the therapist will work with you in at least two of these domains:

• cognitive behavioural therapy (CBT) – works with cognitive and behavioural.
• Psychodynamic works with affective-relational.
• Transactional analysis (TA) works across all domains.

All the therapies are effective and are evidenced-based (this means they have been tested for effectiveness). The type of therapy you choose will depend a little on your values and beliefs. If you believe that your ‘Stuff’ is because the brain is not functioning well then you might choose cognitive-behavioural. If you believe that your ‘Stuff’ is because of thoughts, emotions taking over, you might choose affective-relational.
‘Stuff’ varies from person to person; however, most therapists can support you in the areas of depression, anxiety disorders (anxiety, post-traumatic stress disorder, fears, etc), trauma and relationships. Some ‘Stuff’ requires specialist support e.g. eating disorders, ADHD, sex-related, etc. Best to check this out when you are looking for a therapist.

The important point here is that you have chosen a domain, a type of therapy and a therapist. Most sessions will last 50 minutes, the frequency of contact, duration of the therapy, fees etc. can be discussed. All of this forms an agreement. It is the relationship between the two of you that is key to meeting your needs. You do not have to like your therapist as soon as you meet them but you need to feel safe and comfortable with them. The relationship will grow.

Some key points

On your first contact with the therapist it is worth asking the following questions:

• What approach do you use? To get an understanding of which domains they work with.
• Which regulatory body are you a member of? You know they follow a code of practice and ethics.
• Have you any experience of working with my type of ‘Stuff’?

You do not need to learn or understand the ‘language of the therapy’. It is my opinion that models, language, terminology, etc of the therapy is for the therapist to understand and know how best to support. Your therapist will be able to explain in simpler, less technical jargon and language.

Sometimes it feels like what is happening for you is uncomfortable, the relationship is not good, or something is not quite right; maybe in or between sessions. This may be part of the therapy process so raise it with your therapist. There is the possibility that the therapeutic approach is not best for you.
There are times when personal or financial circumstances can get in the way of therapy; discuss them with your therapist to agree ways of coping. If face-to-face is becoming difficult, switching to online might be useful, most therapists have this option; and it is still able to meet your needs.

The duration and frequency of sessions will be something to negotiate between you and the therapist, and this will be impacted by the type of therapy and any between-session work that is required. You will know when it is time to end therapy - it is best to discuss, and plan rather than suddenly stop. The option to take a break, or to reconnect with the therapist should be borne in mind.

Summary

• There are four key ways in which therapy works and therapists tend to use a combination of two of the domains.
• All therapies are effective and have evidence, the relationship between you and the therapist is of fundamental importance.
• The safe, confidential and non-judgmental space is for you to discuss your ‘Stuff’ and things that come up in therapy.