Choosing a therapist

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Each therapeutic method has pluses and minuses.  Photo by Javier Allegue Barros on Unsplash

Many people go for psychotherapeutic help.  Counselling, psychotherapy, cognitive behavioural therapy… it may have different names, but I guess we all share the intention of sorting something out that couldn’t be sorted out another way.  It could be a life change you want, or a mental health issue you have, or simply something you want to explore.  Self-development is another good reason to seek psychotherapeutic help.

It is worth spending a bit of time thinking about the mechanism by which such help works.  You might be willing to take yourself to a therapist much as someone takes their car to the garage – trusting in the repair person to know their job.  But the problem with this approach is that, unlike with your car, you are likely to be the best expert available in yourself and how you work.  So understanding how your therapy works might help you to help yourself.  Equally, leaving it a mystery might leave you overdependent on your therapist, and a bit lost without them.

HOW PSYCHOTHERAPY WORKS

No two therapists work the same way.  However, there are some common factors in psychotherapy as currently practiced.  The analogy I would use is that of an athlete wanting to improve their performance.  The therapist is a little bit like a coach.  There is usually an aspect of your life or behaviour that is not working for you.  Perhaps anxiety is getting in the way of your peace; or perhaps lack of self-care is getting in the way of your health.  Perhaps, again, the memory of a past experience is damaging your current life, and you want help negotiating through to a happier future.

The therapist’s aim is your happiness.  They have certain advantages over you – otherwise you could just help yourself and save yourself the trouble of visiting them.  Firstly, they have done some training, in which they became familiar with how the human mind works. Secondly, they have accumulated experience in assisting clients, and may know some shortcuts to better communication between you, and within yourself.  And thirdly, they have probably become a specialist in a particular style of therapy, with its own theory about how people can be helped.

THREE MAIN THEORIES OF PSYCHOTHERAPY

To keep it simple, divide your life into past, present and future.

THE PAST – PSYCHODYNAMIC THERAPY

If you want to look at your past, and to understand how you came to be the person you are, then perhaps look for a psychodynamic therapist.  These therapists tend to have a view of human beings grounded in history.  Before you were born, your ancestors evolved a certain way, and then you were born and you developed a certain way.  The story of how all that happened in the past, is the story of your development.  You won’t always be consciously aware of what you have become.  So you will act in certain ways, and maybe be profoundly confused as to why you react as you do.  A psychodyamic therapist is, in a way, a specialist in working to help you reconcile yourself to your past.

On the downside, they can be a bit fatalistic, labelling you as narcissistic, or avoidant… and they may not share those labels with you, so they can seem a little unsharing and hidden in their approach.  On the plus side, they are often good at a kind of roleplay in the therapy itself, whereby they play the part of the ‘other’ in the relationship, and by enacting the role wisely, they can help you come to greater knowledge or effectiveness in how you relate to others.  For instance, if you had a problem relating with your mother, they might, to you, become a kind of mother figure for a while, and help you negotiate a better mother relationship.  This is simplistic, but explains the point.

THE PRESENT – PERSON-CENTRED THERAPY

If you prefer to exist in the present, and to work with how you are in the moment, then perhaps look for a person-centred therapist.  These therapists tend to have a view of human beings grounded in moment-to-moment acceptance.  Whatever your history, they feel that it is always possible to free yourself, if only you are given a welcoming, understanding environment.  They don’t view you as confused, but as having an inherent wisdom inside you which only needs kindness to come out and shine.  A person-centred therapist is, in a way, a specialist in working to help you become free of past and future, and accepting of the present.

On the downside, they can be a bit optimistic at times, ignoring the fact that we all have histories that are sometimes quite hard to escape fully.  But on the plus side, they are usually good at giving you a kind, caring environment.  Also, they are specialists at working in an open and transparent way, so you should have less of the game-playing that can characterise psychodynamic work.  If you don’t like being told what to do, a person-centred therapist can be more pleasant to work with, as they are committed to trusting your own inner wisdom to flourish.

THE FUTURE – COGNITIVE BEHAVIOURAL THERAPY

If you prefer to exist in the future, and plan your improvement effectively, then a cognitive behavioural therapist may be for you.  These therapists tend to have a view of human beings based on our planning ability.  To them, life is a continuous experiment in which you make plans to improve, try an experiment, test the results, and then revise your plans.  They don’t usually have too much focus on the past, nor on the present, but are very forward-looking, often encouraging you to participate in homework between sessions to keep you working on your goals.

On the downside, it can feel a bit like school, agreeing tasks for each week, trying them out, and reporting on the results.  But on the plus side, they are good at supporting you with a positive approach, and helping you to test yourself to see if you can improve in managed stages.  You will often find you surprise yourself by overcoming a phobia, or doing things you previously didn’t believe you could do.

WHAT THESE SYSTEMS HAVE IN COMMON

Each method, as mentioned above, has pluses and minuses.  I have laid them out in simple terms to help you decide what suits you.  Some therapists are integrative – in other words, in one way or another they combine methods to provide a more rounded, flexible approach.

But what they all have in common, is the presence of a person who is there to help you, and who has developed some expertise in their system of improvement.  In all cases, there are two parts to the transaction: the therapist’s interaction with you; and your own interaction with yourself.  At the end of your sessions, the ultimate aim is for you to be able to independently manage your own improvement.  Psychodynamic therapy may make you wiser about your past; person-centred therapy may make you more accepting of the present; and cognitive behavioural therapy may make you better at planning your own goals.

As I mentioned above, your therapist is a bit like a sports coach of the mind, there to help you to work with the mind you have inherited, to accept the environment you find yourself in, and to develop the future behaviour that you want to develop.  Hopefully the above helps you to choose wisely, or at least to know what you are getting!

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SUMMARY

Psychotherapy is not quite like getting a car repaired – as you can’t leave your mind with the repair shop, your active participation is required.  Psychodynamic therapists often work with you to help you be wiser and more balanced about your past; person-centred therapists often work with you to bring out your inner wisdom in the present moment; and cognitive behavioural therapists often work systematically with you to organise and achieve future improvement goals.  The aim of all therapists, in the end, is that you can manage your own mental health and happiness more effectively.

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