How can a person know what kind of therapy they need?

For an already overwhelmed mind, the many kinds of therapy available can make trying to understand what is needed to support recovery a confusing and potentially restricting experience. From art therapies and talking therapies, such as cognitive behavioural therapy, to EMDR (eye movement desensitisation and reprocessing), psychodynamic therapy, emotion-focused therapy and so many others, how can a person know, not only when they should seek therapy, but what kind of therapy they need?

“People seek therapy for a whole host of reasons, but usually they are prompted to do so because they have noticed an unhelpful pattern in their lives or in their relationships that keeps repeating,” says Dr Roísín Joyce, director and chartered clinical psychologist at the Evidence-Based Therapy Centre in Galway. “While the person may have insight into the pattern, they may not have the resources to prevent it from happening again or to maintain any changes they have made in the past.

“Some people attend because they have become aware of a symptom that is distressing them, such as anxiety, low mood or binge-eating, and others come with insight into a symptom they are experiencing, such as explaining that they are getting angry a lot due to a recent stressor they have experienced. The other group is people who have been asked to come by members of their family or a loved one.

“It is really important to ensure that you are attending therapy because you want to make changes, because someone else wanting you to change rarely results in a positive outcome. For this reason, at EBTC we do not allow third parties to make appointments for another person and the person attending has to make their own appointments.”

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Making the conscious decision to begin and attend therapy takes courage and strength. Taking this step with as much understanding and information as possible is beneficial, which is why discussing the various options available with a GP or therapist is necessary so that a person can work with a therapy and therapist that will benefit them and the issue they are struggling with.

“At EBTC, we always start with an assessment session where we ask about the presenting problem, the history of the problem, the impact of the problem and what the goals for therapy are,” says Dr Joyce. “It is also important to consider previous input the person may have had and whether it was helpful or not, as there is no point in offering the same approach if the person did not find that approach helpful last time.”

Therapy is not a straightforward process and recovery can’t be marked in a linear fashion as some sessions are harder than others. It can at times be complicated to navigate the issues within the therapy room and can take longer to see the benefits and successes arise from sessions. The signs can be subtle, making it harder to know if a specific therapy is working, however, as Dr Joyce says, “the type of therapy offered will depend on what the person is bringing, how long they are willing or able to stay in therapy and what they want to get from the process.”

Assessments consider what the problem is and what caused it. What is maintaining the problem and keeping it going. What the client wants and what their specific goals are with therapy. What they want to explore and if they are in the right place to begin therapy. What is their personality and if they are willing to do homework with therapy or if they like science and want to understand the technicalities behind what is happening for them.

“Often there are a number of therapeutic approaches that could be helpful and the pros and cons of each can be discussed with the therapist,” says Dr Joyce. “For example, a person who is experiencing symptoms of PTSD (post-traumatic stress disorder) such as flashbacks, nightmares and behavioural avoidance could be offered EMDR therapy or trauma-focused cognitive-behavioural therapy, whereas a person coming with anxiety linked to high self-criticism could be offered compassion-focused therapy/cognitive behaviour therapy or parts work.

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“As well as different psychological approaches to therapy, different modalities can also be considered. For example, a person who is struggling with unmet needs due to ongoing people-pleasing may attend for individual therapy to focus on their relationship with themselves and work on learning to express their needs more effectively. Alternatively, they could attend couples therapy where the therapist would work on the couple dynamic as patterns emerge in the room. Both approaches are valid and could be helpful, so it is about making sense of what seems the best fit for the person.”

Dr Joyce emphasises that it is not only the therapeutic approach that needs to be considered but also the relationship a person maintains with the therapist. “The literature is very clear that the most important predictor of a positive outcome in therapy is a strong therapeutic relationship,” she says.

Signs that a therapist is a good fit include feeling as though they are listening and understanding you and your experience; you don’t feel judged, shamed, or misunderstood; you feel empowered and challenged in a positive way with session progression; you are able to put into practice supporting techniques to help cope within your daily life.

“It is essential that you have a good alliance, rapport and trust with your therapist and that you agree regarding the best treatment plan,” says Dr Joyce. “This is why the assessment session is so important, not only to have a better understanding of your presenting problem and the treatment plan, but also to assess the quality of your relationship with the therapist.”

Not only are the varying kinds of therapies often confusing but understanding the difference between a psychotherapy and counselling is also another factor to consider. With such a huge variation in the training and experience of counsellors, psychotherapists and psychologists, Dr Joyce explains that is important to vet potential therapists to ensure they have the adequate education, training and experience required to deal with the presenting problem, and that they are registered with a professional body such as the Psychological Society of Ireland or IAHIP.

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“Clinical psychologists are all trained to doctorate level and psychotherapists are all trained to master’s level, though some have gone on to do ‘top-up’ doctoral training,” says Dr Joyce. “It is important to be aware that these titles are not yet protected in Ireland, meaning anyone can set themselves up as a therapist. You can assess a therapist’s level of professionalism by paying attention to how promptly they respond to enquiries and questions you may have and their openness to discussing their credentials. If a therapist is defensive about their training or experience, I would take that as a red flag and move on to another therapist.”

Therapy can be a tiring experience at the beginning, and it can take time to see if the current approach is helping. There are many reasons why therapy may not be working with varying factors playing a role in how effective treatment is including personality type, therapist-client relationship, the kind of therapy and the potential necessity for a dual approach.

Discussing your needs with your therapist may mean adjusting your current therapy to ensure therapy sessions are working for you.