Going into therapy can be anxiety-provoking, overwhelming, and scary, so having an idea of what you want to work on, where to go, and who to see can be really helpful to get going as quickly and comfortably as possible.
Before you go on, read this quick post with definitions.
To start with, in this post we’re going to learn about the following:
What types of therapy fit different needs (and what the names and letters are). Broken roughly into three categories:
Client-directed therapies
Cognitive therapies
Specific treatment
Figuring out what you need and want from therapy.
Before going to a GP or starting to look for a therapist, having an idea of what you want to get out of therapy can be really helpful. This can be as simple as thinking about your goals so you can tell the therapist when you get there, or as in-depth as writing down what you want out of therapy and taking this to your first session. However you decide to do it, I’ll go through some of the things I think are helpful and to at least consider before seeing a therapist. (I know, the homework starts before you are even here! ARGH!)
Outcome Expectations
Ask yourself, if therapy were to be successful in improving my life, what would be objectively different for me? Write down what behaviours you would be doing differently, how your way of thinking might change (what from and to), or any other change that you would see from successful therapy.
Knowing what you want from therapy is so important because you and your therapist can know where you want to go from the start. To use a metaphor, you wouldn’t get into a taxi and say, “I want to go somewhere; please drive me there”. The taxi driver needs to know where you want to go.
What’s also helpful is that if you got into a taxi and said, “I would like to drive from Australia to Japan”, the taxi driver would be able to tell you that’s something he can’t do, and you’d need to get a ship or plane. Knowing where you want to go can, therefore, also help your therapist ensure you have realistic expectations. Research has shown that outcome expectations can predict how much of the change you create in therapy will last after treatment ends. This is because if clients expect too much, they will feel defeated trying to reach unrealistic goals and tend to drop out of therapy earlier, whilst the other side of the coin is that if clients don't expect enough, they may get to the "end of treatment" and not get as much positive change as they could out of it and feel let down.
Therapy Expectations
Clients come to me with a huge range of differing views on what therapy is about, what it looks like, and what it includes. Having an idea of what you're expecting to happen in therapy can be really helpful for the therapist. Are you prepared to talk about your emotions? Is your goal to get tools and techniques to manage emotions? Do you just want to understand yourself better in therapy and figure out how to do it differently outside of therapy? When the therapist knows what you think therapy is about. they can then do two things 1) ensure you are at least in the right ballpark with what we can provide and 2) begin providing it as early as possible.
Therapist Expectations
Therapists are human. This means we will naturally exist and work in all different ways. When clients ask me what type of therapist I need, my most succinct answer is usually, whatever works for you is what you need!
I’ll discuss this more in the section about specific types of treatment, but for now, it’s important to know that research has shown that the relationship between the client and therapist contributes to 30% of change, while treatment type contributes only 15%. This means finding a therapist you can work with is one of the most important parts of therapy (hence this post).
If you want the therapist to just reflect on what you’re experiencing and discuss our reflections so that you can begin to find your own path, or if you need them to give you tools to help cope with a certain situation, or if you want them to ask questions to deepen your understanding of yourself, let us know. We may feel something else might be helpful as well or instead, but we can then talk to you about that and figure out a way forward together.
What therapy is not.
Now that you’ve considered and know more about what you want out of therapy, what it looks like, and what the therapist can help you with, I think it would be helpful for me to explain what therapy is not. It’s important that you have an idea of what your therapist may not be able to help with because you may be better suited to a different type of support. If you are in doubt after reading this, I would strongly recommend seeing a therapist and asking them outright, “Is this something you can help with?” Often, a therapist can help you with some parts of your struggle, just not all of it.
Number one! Advice on what to do. Whilst many think that a good therapist gives good advice, that’s not at all what we do. Opinions about therapists giving advice, but the way I was trained and the way I work, is to see that our role is to take in what you are experiencing and reflect that back in a way that is helpful for you in moving closer to your goals. How you do this can look different from one therapist to another, but essentially, the therapist's job is to help you feel you’ve created change, not that they have created change for you, and giving advice outright often doesn’t achieve this and leads to you relying on the therapist to make big decisions in the future.
While opinions on advice-giving can vary among clinicians, one thing that is very true for all therapists (and is a part of the Australian Psychological Society’s Ethical Guidelines) is that therapists must only work in their area of competence. Similar to making promises about therapy that you cannot keep (like being a taxi driver and saying you can drive across the ocean), therapists must be very careful not to put themselves in a position where they have advised a client on something they don't have knowledge of, as this can ruin the trust you have with the therapist. So, if you want to know how to run your business better, we might consider with you what options you have available for seeing someone who can advise you on finances for example, or if you want to know what diet you need to train for a marathon, we might discuss the cost and benefit of you seeing a dietitian, which is different to advising you to see a dietitian.
Types of therapy and how they fit different needs
Now that you know more specifically what you want and can get out of therapy, we can finally start to look at what therapeutic interventions are out there and what might work for you. There are SO many ways you can categorise or organise therapy, and I'm going to talk about one way of categorising them to try and help you understand what you might need. I’m going to do this by categorising therapy as client-centred, cognitive therapies, or specified therapeutic interventions.
Client Centred Therapy
Client-centred therapy sees the client as the one in the room who knows the most about how to help you. This doesn’t mean the therapist knows nothing, but instead, they are a tool that the client can use to understand themselves better and find ways to engage in life in a more meaningful and positive way.
In reality, client-centred therapy styles can be found throughout nearly all therapy types. However, it was originally developed by Carl Rogers following many decades of psychoanalysis being the cornerstone therapy style. I won’t give details about psychoanalysis vs client-centred, as that could be an entire series in itself, but in a very concise and somewhat insufficient but necessary summary, client-centred therapy was developed because Carl Rogers felt that everyone wants to be the best version of themselves and this will naturally occur if given the right situation. This meant that the therapist's job isn’t about noticing the person’s flaws; it’s about learning what they need, and their inherent drive toward being the best version of themselves means they know best what can work for them.
What people often like about client-centred therapy:
You often come away feeling you have been the one who’s achieved your goals and you feel empowered to do this again in the future.
The therapist actively asks for and wants your feedback, so if the therapeutic relationship is not working for some reason, you will be able to change it.
If you are anxious or worried about talking about too much, too soon, you can drive the therapy somewhat and tell the therapist if you feel they are asking you questions that are too intense.
Struggles that the client can sometimes have with client-centred therapies.
Sometimes you might feel a bit lost, or feel as though there is the possibility that you aren’t moving in the correct direction.
Some clients want “tools” and ways to manage thoughts, feelings, and behaviours, but a lot of client-centred therapy is about learning to become more comfortable with your emotions rather than erasing them. This can lead clients to feel like they aren’t getting the tools they need out of therapy.
Cognitive Therapy
Something to know! Cognitive Therapies can still be client-centred.
To make things clear, though, I’ll be talking about how, in isolation, cognitive therapies are about clinicians providing tools and knowledge to the client for them to understand their problematic patterns of behaviour or unhelpful thinking styles, which can, in turn, begin to create change. Both the clinician and the client work on changing behaviours and thoughts with the aim of altering emotions to make them less intense.
What people often like about cognitive therapies:
There is more structure than client centred therapies.
Provides tools on how you might be able to manage big feelings, difficult thoughts, or maladaptive behaviours.
Struggles that the client can sometimes experience with client-centred therapies.
Can sometimes be done in a way that can lead the client to feeling like they aren't "doing well".
Often need to do set tasks outside of therapy that some clients can struggle to remember to do or find time or motivation to do.
Sometimes, the tools don’t seem to work, or it feels like putting a band aid on a cut that needs stitches.
Specific Treatment
There are some therapeutic interventions that are worth mentioning for specific diagnoses. In general, the research shows that any treatment is better than no treatment. However, research has also found that for the majority of mental health issues, there is no one treatment that is more effective on the whole than any other treatment. Research has found that only 15% of change that occurs for clients who are attending therapy can be attributed to the model that is used. Interestingly, this is equal to the amount of change that occurs due to the placebo effect, and the last 70% is left to the client to engage in creating change outside of therapy and the therapeutic relationship. One exception to this rule, however, is PTSD. Separate research has found that eye movement desensitization reprocessing (EMDR) and trauma-focused cognitive behaviour therapy (CBT-TF) are significantly more effective in treating trauma symptoms than other therapies.
I want to make a comment here about CBT and DBT especially. The general understanding is that CBT is the “gold standard”, or the most effective therapy model. This statement is somewhat true but very misleading. In reality, CBT is only the gold standard because we have researched it the most and can, therefore, say with the most certainty that it will create a significant amount of change as opposed to not engaging in any therapy at all. What the research cannot provide us, though, is evidence that CBT is more effective than any other type of therapy. The same can be applied to DBT and borderline personality disorder. Now, this doesn’t mean that you shouldn’t engage in CBT or DBT, it means that you should focus less on the therapy type and more on finding a therapist that you can create a good relationship with, and once you have that sorted, then discuss with your therapist what therapy you think would be helpful.
Associations that expect high standards of the clinicians they endorse:
EMDR International Association
EMDR Association of Australia
EMDR Institute
What this all means
Before you start looking for a therapist, it can be really helpful to consider what you want from therapy, how it might look, and what you think the therapist can do to support you. Once you've considered this, you can start to look at what types of therapies might work for you, so you know what to look for when searching.
If you want to learn tools and techniques and prefer the therapist to take the lead, you might want to look into therapists who are trained in cognitive therapies such as CBT or DBT. Alternatively, client-centred therapy styles may be a better fit if you aren't completely sure what you need but would like to learn more about yourself and have a psychologist help you understand yourself better. Alternatively, if you are struggling with symptoms of PTSD, finding a therapist who can do EMDR would be helpful.
I've included in tables throughout what you might be looking for in therapist's about me or bio sections when looking for certain therapy types.