I have been approached by people who are thinking about starting therapy, and say in a confessional or embarrassed way that they don’t know how to choose a therapist. They may have tried an online search, looked through directories and registries of the various regulating bodies, and even read about different approaches, but rather than feeling wiser as a result of obtaining the information, they feel more baffled by the vast array of therapists and therapies on offer in what is a busy marketplace.
I would like to make this process a little easier, firstly by saying that the business of therapy runs now like any other business in a competitive environment, and feeling confused by the information and options available is as understandable as feeling confused about any unfamiliar field we engage with for the first time.
Secondly, I thought it would be helpful to summarise a number of the approaches as succinctly as possible. The information provided is not exhaustive, and is based on my perspective and understanding, so if any therapists out there would like to amend or comment on my list, please contact me.
Before summarising some of the approaches available, it feels important to say that most, if not all, therapists espouse the notion that it is the relationship as opposed to the specific approach that heals. That said, therapists have to choose which approach(es) to train in, usually involving a significant investment of time and money, and the choice of approach is informed by the therapist’s own journey and what resonates with her or him personally, ideologically and professionally.
There are overlapping aspects of the approaches below, and many therapists will have trained in multiple approaches, though this is not essential.
Approaches in Psychological Therapies
The Arts Therapies: The Arts Therapies use various art forms (art, drama, dance/ movement, and music) to access and explore thoughts and feelings, bypassing the conscious, more controlling and limiting parts of the mind. These approaches are very helpful for people who are or want to become creatively open, and for whom the talking therapies feel less engaging. They are also helpful for moving through a block in other therapies.
Attachment-Based Therapies: Many therapists use an attachment model in their work, while some are trained specifically in attachment. Attachment is about our patterns of relating, established from infancy onwards in response to our primary caregivers’ behaviour towards us. In my opinion, a person’s attachment patterns and behaviours are at the root of a great deal of struggle and discontent, both within ourselves and caused by us to others, so becoming aware of and exploring how we relate to our inner selves and to the outer world is essential if we hope to develop our understanding of ourselves.
Cognitive Behavioural Therapy: CBT looks at how our thoughts and emotions interact to influence our behaviours. Therapists use mainly talking and may assign tasks to undertake outside the sessions. In my opinion, CBT is useful when there is an urgent need to manage symptoms, rather than to address the root cause of inner disturbance.
Dialectical Behavioural Therapy: Designed originally for the treatment of personality disorders, DBT combines aspects of CBT with distress-tolerance, acceptance and mindfulness. Because it targets triggers, it has proven to be effective for people with self-harming behaviours, suicidal thoughts, and drug and alcohol misuse.
Existential Psychotherapy: Therapists using this approach base their work on the “existential givens”, taking the perspective that psychological suffering comes from an inability to reconcile conflicting feelings around inescapable truths such as existential isolation and death. Whilst the client’s history is taken into account in the work, a key aim is to become more autonomous and free from the past.
Gestalt: Gestalt therapists use the “here and now” to develop the client’s non-judgemental self-awareness. A classic example of a Gestalt technique is chairwork, wherein a client uses chairs to represent other people or aspects of the self. Like the arts therapies, this can be an effective way to bypass the controlling mind, so as to address the less conscious thoughts and feelings that motivate behaviour.
Jungian Analysis: This is a niche field based on the work of Carl Jung which, unlike other equally rare fields, I have only included here because my own therapist of many years is a Jungian analyst. Broadly stated, this approach uses Jung’s theories of archetypes and personality types, as well as dream work, to explore the client’s unconscious and its interaction with behaviour.
Psychoanalytic Psychotherapy: This is seen as the classical approach to psychotherapy, created by Sigmund Freud, wherein clients are encouraged to explore unresolved issues through the relationship with the therapist. The approach is associated with the therapist as a blank canvas and although some clients can find this frustrating, and even persecutory, it can be an effective way to reveal defences and inner conflict.
Psychodynamic Psychotherapy: Many therapists use the psychodynamic approach in combination with other approaches, and as with Psychoanalytic Psychotherapy, it can involve limited or no self-disclosure by the therapist. It entails working with the present moment to explore how the client relates to the world via the therapeutic relationship. This process throws light on entrenched patterns of behaviour which have evolved since birth, so it can be a useful way of uncovering defences and releasing unhelpful ways of being.
Transpersonal and Spiritual Approaches: These approaches are based on the idea that we are spiritual beings having a human experience. Whilst there is often a crossover with other approaches, therapists offer a variety of talking and experiential techniques to explore the unconscious and to use spirituality and the notion of self-transcendence as a means of growth and healing.
Group therapy can be profoundly transformative, whatever the focus or approach, and can be used on its own as a form of personal therapy or to augment individual therapy. The reason groups are so useful is because clients have the opportunity to share their thoughts and feelings, whilst relating to other members of the group who are often in the same or similar situation. Engaging in group work is an effective way of seeking support whilst exploring our patterns in relationships. Many therapists offer groups as well as individual sessions.
Location: Harley Street or the therapist’s home?
Although there are plenty of excellent therapists on Harley Street or equivalent areas elsewhere, a therapist’s practice location is no indicator of their expertise, talent or fitness to practice. Provided that the space is appropriate for the work (quiet, accessible, and private), the main location considerations for a potential client are geographical proximity and, in the case of therapists who practice from home, whether the client feels comfortable with this. Larger practices have waiting rooms which may raise issues of privacy for some clients.
Most if not all therapists now work online, and there are numerous trainings that offer therapists an in-depth understanding of the legal, ethical and therapeutic differences from face to face work. It is not a requirement that therapists working online undertake this further training, but if you’re not sure or you have questions about a potential therapist’s ability to work ethically online, check that out with them during your initial call.
The Therapist’s Own Journey
In my opinion, it is vital for practicing therapists to engage thoroughly in their own personal therapy, preferably throughout their career. Though some therapists might disagree with me, I think that it is appropriate to ask a prospective therapist how long they have been in therapy and what the approach is of their own therapist.
The Therapist’s Supervision
It is a requirement of the registering bodies that therapists work safely and ethically, which includes having supervision. Hired by the therapist or by the employing organisation, the supervisor’s job is to take care of the therapist’s clients’ interests, supporting the therapist to explore what is going on for the client and the the therapist, and how best to offer treatment. Again, although some therapists might not be in accord here, I think clients would be well-advised to ask about prospective therapists’ supervisory arrangements.
The Therapist’s Approach
My tendency has been to shy away from therapists who espouse only one approach because I have encountered therapists who are so evangelical about their own method that they seem inflexible and less client-centred as a result. That said, I would refer to the statement above that it is the relationship that heals, and if we find a therapist with whom we have a positive working connection, their specific expertise in one area can be highly beneficial to the treatment process.
The Therapists’ Qualifications and Registrations
All practicing therapists should hold a recognised higher-level degree certification, and be registered with a professional body such as the BACP, the UKCP or the HCPC. Trainee therapists can be a good option for low-cost or free therapy, provided that they reveal they are in training and let you know how much supervision they engage in.