Feeling stuck or strung out and don’t know why? Overwhelmed by life? Deeply unhappy?
You don’t have to have a serious mental illness to seek therapy. Talking to someone who doesn’t know you and has no preconceptions, judgments or invested interest can be really helpful – especially if you are struggling to make sense of what’s going on and feel bad bending the ears of your friends and loved ones.
However, as you scrawl through your therapy directories looking for the perfect match (it can feel a little like online dating) you may feel overwhelmed and confused by the enormous variety of therapies out there.
Should you go for CBT or counselling? Is hypnotherapy just for smoking – or will it brainwash you into eating an onion every time you hear Lady Gaga’s Stupid Love? Is a life coach a qualified therapist? (No). What the hell is EMDR?
Hopefully, our rough guide will help you navigate from your couch to a decent therapy couch – and, of course, there’s always the spa...
Types of talking therapy
Most talking therapies look and feel the same: two people - one empathic and compassionate, with a qualification and a few ideas that may help shine a light on your internal chaos. And you.
Two chairs and a box of tissues – or these days, two people on a Zoom call trying to fight off their demanding pets and children. However, there are some key differences in each approach:
Psychotherapists are similar to counsellors in the way they work – clients won’t be able to tell the difference – but have often had extra training on hospital wards and may have a more structured way of working. The focus is on developmental issues (family and childhood stuff) but also context (culture, environment). Try eco-psychotherapy if you want to work through your climate crisis anxiety. Good for those with serious mental health issues.
Considered the bog-standard talking therapy, good for anxiety, depression, life crises, relationship or work issues and personal growth. Counselling uses empathic and compassionate listening skills, lets the client lead the session and discover their own resources, although most can ‘offer’ useful tools and models to do this. Counselling covers a range of approaches including:
person-centered: a seemingly gentle but very powerful and ultimately empowering approach. Less talk from the counsellor than most therapies, so ideal if you are rarely given the space to be yourself.
Integrative: a holistic approach that uses a range of psychotherapeutic and counselling skills adapted to each client’s needs. Great if you have a lot of stuff to untangle and like to understand things.
Couples counselling: the counsellor acts as mediator and helps couples take responsibility for what’s driving their unhealthy patterns
3. Cognitive Behavioural Therapy or CBT
Called a ‘behavioural therapy’, CBT helps us get out of unhelpful thinking patterns (4am mind-whirlies, irrational fears, etc) which can have a huge impact on our relationships, moods and behaviours. Terms like 'critical voice' or 'automatic negative thoughts' come from CBT. Good if you like goals, diagrams, and believe the problem is all in your head.
This is not stage-hypnosis: you will not be brainwashed or mind-controlled. Your hypnotherapist simply guides you into a pleasantly relaxed, hypnogogic state which enables you to work on a deep level, without interruptions from critical thoughts. Good for addictions, phobias and changing limiting beliefs.
If your issue is work-related, or you want to get healthy and develop a new lifestyle goal, it can be useful to get a fresh pair of eyes. Life coaches can help you look at everything through a new prism (usually their ‘amazing 3-step programme’). They are not qualified to help with deeper issues and will be far more directive than counsellors.
There’s a lot of interesting work in the field of trauma therapy – new and creative ways of helping clients deal with triggers, flashbacks or looking after their inner child. Here are some of the big players, but there are many more to explore – creative and drama therapies, somatic therapy, polyvagal therapy… the list goes on.
IFS – Internal Family Systems therapy, based on the idea that we are not one person but a collection of personalities. You’ve seen the movie Inside Out? Like that, but more complicated.
EMDR – Eye Movement Desensitization and Reprocessing uses light rods and audible equipment to help you process trauma, so that you don’t keep being triggered. It’s difficult to explain but apparently effective with PTSD, and was the fashionable therapy du jour until…
Psychedelic therapy – therapy while under the influence of mind-altering party drugs. This is huge right now, especially in the US, but obviously has its detractors.
So… which therapy is best for you?
Most therapies can deal with most issues; it’s entirely dependent on the therapist themselves, their qualifications, experience and capability.
Think about whether you want to focus on one main symptom (ie anxiety, overeating, addiction) or whether you feel your problems are harder to pin down. Do you want short term therapy – usually six weeks – or do you feel you need longer support until you are through the woods? Some people stay with their therapist for years if they have a lot of issues to untangle, or simply need that space for a weekly mind-dump.
CBT or hypnotherapy are good for changing negative thought patterns and limiting beliefs that can perpetuate low moods and anxiety. You won’t totally escape the deeper issues, but it will be more of a whistlestop tour. However, with CBT you need to do a lot of the change work yourself outside and beyond the sessions, and you may be given homework.
Long term support?
Counselling and psychotherapy can be six to 12 sessions or more, depending on what you need. Most counsellors and psychotherapists will check in every six weeks to see where you are at, and work towards an ending that seems right you, so that you don’t become dependent.
If your problem is your marriage, you might want to seek couple’s counselling. If you notice you have problems with more than one relationship – parents, friends, bosses – then counselling and psychotherapy can help you work through your attachment issues. CBT can also help with anger, low self-esteem and other issues that may impact your relationships.
So, you finally find your perfect therapist – you think. Call or email first to discuss whether they are suitable to work with you. If not, they can signpost you to more specialised help.
It’s important that you like and trust your therapist, and that you feel you can tell him or her anything. If you can’t, it won’t work. If you have any doubts about your new therapist, quit and find another one, even if it means starting from scratch.