If, like so many other people these days, you’re feeling overwhelmed by everything — stressed out, anxious, depressed or worse, please know you’re not alone. You’re in good company and help is available.
[ READ:What to Look for in a Therapist. ]
Different Types of Therapy
There is a wide range of types of therapy for mental health issues, and finding the right one for you may take a little research. “Every person is unique and there is no one or correct way to get help,” says Carmen Nicole Katsarov, executive director of behavioral health integration with CalOptima, a county-organized health system in Orange County, California.
The key is to ask for help when you need it. Some conditions lend themselves to a certain kind of treatment approach.
“Division 12 of the American Physiological Association maintains a list of evidence-based psychological treatments for specific conditions,” says Jay C. J. Fournier, director of the mood and anxiety program at the Ohio State University Wexner Medical Center in Columbus. There are nearly 90 treatments for specific conditions listed in this resource.
More generally speaking, there are several primary approaches to psychotherapy when treating common mental health issues such as depression, anxiety and behavioral- or trauma-related conditions. Among the more common types of therapy are:
— Psychoanalysis and psychodynamic therapies.
— Cognitive-behavioral therapy.
— Dialectical-behavior therapy.
— Family or group therapy.
— Eye movement desensitization and reprocessing.
Psychoanalysis and Psychodynamic Therapies
“Also known as psychoanalytic psychotherapy, this is the type of therapy you most likely saw on your favorite sitcom,” says Stephanie Kors, a postdoctoral fellow at Cambridge Health Alliance and a clinical fellow at Harvard Medical School in Cambridge, Massachusetts.
This is the type of analysis was pioneered by Sigmund Freud in the 1890s, and as such, it’s “one of the oldest modalities,” says Stephanie G. Thompson, director of clinical operation for Lightfully Behavioral Health, a Thousand Oaks, California-based mental health treatment provider.
“In this type of therapy, the patient talks freely about what’s on their mind and the therapist helps tie these feelings to ongoing patterns in the patient’s life stemming from childhood to better understand current struggles,” to address the root of the problem, Kors explains.
“The therapist does this in part by building a cohesive narrative of your life into a story that makes sense — how the patient got from here to there,” she says. The importance of relationships with others in both the past and present are key elements of this approach. “This therapy is often open-ended — the patient decides when they’re done with therapy.”
It also tends to be less structured than some other types of therapeutic approaches with patients taking the lead on choosing what to discuss in each session.
Psychodynamic therapy may be helpful for individuals who have:
— Panic disorders.
— Chronic pain, to help people with certain pain disorders such as fibromyalgia, better cope with the emotional aspects of the condition.
— Personality disorders.
— Psychopathologic conditions, such as schizophrenia, alongside medication.
Kors explains that cognitive-behavioral therapy, also known as CBT, “is based on the idea that psychological distress stems from unhelpful ways of thinking and behaving that people have learned over time.”
In this form of therapy, the provider focuses on the here and now to help you learn to manage a specific problem, rather than trying to uncover what past experiences may be contributing to the current situation.
In this type of therapy, “the therapist takes a more active stance, helping the patient learn new ways of responding to stress and teaching more effective coping skills,” Kors says.
Learning to challenge “automatic negative thought patterns and establishing new learning through exposures,” is a key element of how the CBT therapist works, and they will usually ask you to practice the skills you’re learning during sessions in between sessions — sort of like if you were taking music lessons.
CBT is typically a shorter-term approach, typically ranging from about five to 20 sessions, although there can be a lot of variation in that number. The goal is to graduate from treatment quickly, Kors says.
CBT is well suited to help people with certain conditions, Katsarov says. These include:
— Eating disorders.
— Anger management.
— Substance use disorders or addiction.
“The client actively works with the therapist to identify and implement new strategies including identification of new coping and stress management skills and effective self-monitoring and self-care skills,” she says.
Dialectical Behavioral Therapy
Also known as DBT, dialectal behavioral therapy is similar to CBT in that it’s also a “skill-based therapy focused on regulating emotions and building healthier relationships,” Kors says.
However, DBT “has a more specific focus on techniques to regulate emotions by teaching and incorporating skills such as mindfulness,” Katsarov says. Whereas CBT helps patients recognize problematic thoughts and how to adjust their responses to them, DBT focuses more on helping patients accept themselves and feel safe as a means of managing emotions and regulating harmful behaviors.
DBT has been shown to help treat:
— Eating disorders.
— Borderline personality disorder.
— Substance use disorders.
— Bipolar disorder.
With DBT, “the goal is to build a meaningful life through mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness,” Kors explains.
Another form of DBT is called acceptance and commitment therapy, or ACT. This approach “focuses on someone’s relationship to their experiences as opposed to the content of their experiences,” Kors explains. This means that “rather than expending energy trying to avoid painful experiences, this treatment approach encourages the patient to willingly accept those experiences and choose to move towards the things that are important to them.”
Family or Group Therapy
Katsarov notes that some issues lend themselves to being worked through in a group setting, rather than a one-on-one situation with just the patient and therapist. In these instances, group or family therapy might be a good option.
With family therapy, the therapist works with “the whole family or the individual to understand and work through patterns of behaviors that may be contributing to underlying problems.”
Common issues that can be dealt with effectively in a family therapy setting include:
— Substance use disorders.
— Eating disorders.
— Behavioral problems.
— Complex medical issues, such as a family member with a disability or terminal cancer.
In group therapy, people who are struggling with similar experiences meet and work with one or more therapists in a supportive environment. “Many people benefit from the support that this type of therapy offers,” Katsarov says, as they learn coping strategies from others who are having similar experiences. Situations where group therapy might be the most effective approach include:
— Aging issues.
— Grief and loss.
— Family issues.
— Substance use disorders or addiction.
Eye Movement Desensitization and Reprocessing
Also called EMDR, this approach can be very effective for individuals dealing with trauma or stressful life events that prevent them from functioning optimally in their daily lives, Thompson says. EMDR works to help these individuals “process traumatic memories and stressful moments by activating both hemispheres of the brain through rhythmic tones or taps. This provides an opportunity for individuals to work through often fragmented memories by tapping into the logic and emotion of the moment in a safe and supportive environment with a licensed professional.”
EMDR has been shown to be useful for individuals who are dealing with:
— Anxiety, including phobias.
— Substance use.
— Disordered eating patterns.
Where to Start in Finding the Right Therapist
With all these options, knowing which treatment will work best for you can be challenging. “A good approach is first to get evaluated by a mental health professional. Knowing what kind of condition you have will help determine which kinds of treatment are likely to work,” Fournier says.
It’s often best to start by contacting your insurance provider for information about which mental health professionals are in your plan. Word of mouth is also a good way to learn more about a potential therapist.
Katsarov notes that some therapists specialize in treating a specific age group, such as adolescents or older adults. This info is often easy to research on the therapist’s own website, and there are several other online resources that can help with this initial search including:
Kors recommends thinking about what type of therapy you might find more helpful. “Would you prefer putting pieces together with your therapist in an unstructured conversation, or would you prefer a therapist who has planned in advance what you will discuss or practice that session?”
She adds that “big picture questions like ‘Why do I always find myself in relationships with emotionally unavailable partners?’ are often better suited for a more insight-oriented therapy like psychodynamic therapy. More specific questions like ‘How can I overcome my fear of public speaking?’ might be better suited for a more symptom-focused, skill-building treatment like cognitive-behavioral therapy.”
If you can, try to meet with a few different people to see who you click with. “Ask a new therapist what their approach to treatment is and see if it aligns with what you’re looking for,” Kors says. “If it doesn’t seem to be working, request to see someone new instead. Therapists differ widely in their approach to treatment, and it can take some time to find the right provider for you.”
No matter which type of therapy you access, understand that your therapist will develop an individualized treatment plan designed specifically for you. Therefore, it’s really “important to have open conversations early in therapy about your goals for treatment and about the provider’s plan to help achieve those goals,” Fournier says.
How Long Will I Be in Therapy?
Kors says that it’s difficult to say exactly how long you’ll be in therapy, and getting an idea for the length of treatment depends on several factors.
“It depends on how long you’ve been dealing with the symptoms, what’s underlying those symptoms and what kind of treatment you choose. It also matters how severe your symptoms are and what your goals are. Some patients want to manage moderate symptoms, while others want to work through trauma; the former generally takes less time than the latter.”
Constraints on access to therapy can also contribute to a longer treatment period. For example, if you can only see your therapist once a month instead of weekly, or if there is a cap on the number of times you can see a therapist, that can affect how treatment will progress.
Paying for Therapy
These days, most health insurance plans cover some form of therapy for members, but you’ll have to check the fine print in your plan to find out which providers and services are included. Some insurance plans limit patients to a certain number of therapy sessions while others only permit visits with in-network therapists.
Both Medicare and Medicaid offer mental health benefits — again, check your plan details. Annual depression screenings are covered as part of your annual wellness visit with Medicare and Medicaid.
If you don’t have insurance, contact your county mental health agency or public health agency to see what therapy or other community resources may be available locally.
Will I Need Medication?
In short, maybe, but maybe not. “Most forms of therapy do not require medication to be used with them, though patients may opt to combine therapy and medication to bring about change faster,” Kors says.
If your symptoms are severe or “causing such distress that you’re not functioning optimally in the activities of daily living, making participating in therapy very difficult if not impossible,” then you may benefit from taking medication, Thompson says.
The decision about whether medication is a good idea in your situation depends less on which type of therapy you’re accessing and more on the specifics of the condition. With some conditions, medication alone might work, while with others, a combination of therapy and medication may be the most effective approach. For example, “some conditions require ongoing medication to assist the brain with chemical deficiencies,” Thompson says.
Katsarov recommends speaking with your primary care provider about your mental health concerns so you “can be properly assessed by a doctor or a psychiatrist that specializes in the treatment of mental health conditions for any medication that might benefit you.” She adds that it’s really important that all members of your care team — therapist, doctor and any other mental health providers you may be working with — to coordinate and communicate.
If you don’t have a primary care provider, Katsarov recommends contacting your health insurer for assistance in finding a doctor. You can also ask for a referral to a psychiatrist who can conduct a complete evaluation and assess whether medications may be warranted.
Lately, telehealth options for mental health services have expanded significantly, which can be a good thing, Katsarov notes. “Telehealth can help increase access for many people to try and benefit from therapy,” she says.
Keep an Open Dialogue
When you do find a therapist, it’s critical to be as open and honest with your provider as possible all throughout treatment. “If you notice that your symptoms are getting worse or not getting better, be sure to address this with your provider,” Fournier says. “Like treatments for other medical conditions, not every treatment works for every person.”
There are lots of options out there, so if one approach isn’t working, your provider may be able to offer you a different tack or refer you to another provider who specializes in a different kind of therapy. “Providers have a legal and ethical responsibility to provide you with modalities they are trained in and to refer you to other providers if the treatment you would most benefit from is outside their competency or scope of practice,” Thompson explains.
But it may take a little time to determine what the right path forward is. Katsarov recommends “attending at least three to four therapy sessions with a new therapist before making any decisions to change.” This gives you and the therapist some time to build a rapport and “decrease any feelings of hesitancy or fear related to the unknown.”
But if it still doesn’t feel right, speak up. “Most therapists will welcome open discussion about any feelings related to the therapy possibly not being the right fit,” Katsarov says.
Kors agrees that “it’s OK to shop around. Research has consistently found that the most significant predictor of whether psychotherapy works or not is the strength of the therapeutic relationship.” In other words, if you feel genuinely connected with your therapist and you feel safe enough in that space to be vulnerable, you’ll get more out of each session.
“The goal of therapy is to help you feel and function more optimally in life, not to concern yourself with the provider’s ego,” Thompson says.
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