(an audio version of this blog for those who find reading less accessible)
It's Mental Health Awareness Week (10th - 16th May 2021). With the uncertainty of things opening up from lockdown, such as workplaces and social spaces, not to mention the inevitable slow-burn effect of Covid-19 on people's mental and physical health, here's a blog all about finding therapy.
Some of you may have been in therapy before and are seeking new ways to examine your emotions and experiences. For others, this could be your first time considering therapy. Either way, there’s a lot of choices out there. Each client has the right to shop around for the right therapist. Part of that might be understanding a bit about the different therapeutic modes.
This is not an exhaustive list of therapy styles, but it should give you a brief overview of some popular options available.
1. Person-Centred Therapy
This approach puts the client’s ability to grow within themselves at its heart. It facilitates the client’s personal growth by providing a space to explore their feelings and experiences with the therapist’s support. The therapist is non-directive and does not interpret or directly lead the client, but shows them empathy, unconditional positive regard (acceptance), and congruence (is genuine). Think of a person-centred therapist as your companion in discovering more insight into your emotions and thoughts. It sounds simple, yet it can be incredibly powerful.
“It is the client who knows what hurts, what directions to go, what problems are crucial, what experiences have been deeply buried” — Carl Rogers
2. Cognitive Behavioural Therapy (CBT)
CBT explores how we think about situations and how they affect the way we feel and behave. A CBT therapist will guide the client to break down their experiences into different parts, such as thoughts, emotions, behaviours or actions. From there, they help the client change unhelpful thoughts and behaviours. It is a form of therapy that primarily focuses on present issues, rather than historical experiences.
I believe CBT receives more criticism than other therapies. There is a misconception that it doesn’t ‘go deep emotionally’ or is not useful for serious mental health issues. A lot of this criticism, I believe, is unfair and based on research bias and misunderstanding. I don’t use CBT in my practice, but I’ve seen it work well for people living with; Personality Disorders, PTSD, Eating Disorders, Addiction, Depression and Anxiety.
3. Psychodynamic Therapy
This approach works with the unconscious and looks at how past experiences influence our current behaviour. A Psychodynamic therapist will work with everything from childhood to the relationship between the client and therapist. It examines issues like transference - how past feelings about previous relationships are projected onto the therapist in the therapy room.
Psychodynamic therapy originates from Psychoanalysis, based on the work of Sigmund Freud. Psychoanalysis also works with childhood experiences, as well as dream analysis, repressed feelings and the unconscious.
“One day, in retrospect, the years of struggle will strike you as the most beautiful.” —Sigmund Freud
4. Existential Therapy
Existential therapists fundamentally search for sense in the world. They do this from a general standpoint that life essentially has no given meaning. They examine the inner conflict and anxiety experienced when we’re confronted with the inevitability of death, meaninglessness and freedom.
This can all sound incredibly lofty, but I know Existential therapists who very effectively work in addiction or sexual abuse services. Ultimately, it boils down to deciding how you want to live your life based on what you believe in and meeting challenges in a way that is true to yourself.
Sidebar: one of my favourite therapists was an Existential Therapist called Viktor Frankl. During the Second World War, he helped mentally unwell patients avoid the Nazi euthanasia program before being deported to the concentration camps. He is the founder of Logotherapy, a form of Existential therapy.
“When we are no longer able to change a situation, we are challenged to change ourselves.” — Viktor Frankl
5. Eye Movement Desensitisation and Reprocessing (EMDR)
This therapy is very popular at the moment. EMDR imitates the psychological state we enter when asleep and undergoing Rapid Eye Movement (REM). This helps our brain understand and process painful memories and experiences. It is frequently used in the treatment of PTSD.
Some EMDR marketing claims to be the ‘super cure for trauma’. Personally, I like to think of it as an effective tool to reduce the volume of traumatic memories from a 10 to a 4. The memories are still there, but they are not as loud in our mind. Some report it can be followed by nasty flashbacks or dreams and doesn’t work for everyone.
One of my clients described it like this:
“It was cool. EMDR helped solve one piece of my puzzle, but sadly trauma affected more than one of my pieces, which is why I’m still talking to you.” — Client
6. Arts Therapy (or Creative Therapies)
Creative therapies employ a wide range of different creative skills to help a client express themselves beyond words. They can include; sand play, art, drama, writing and dance.
Scientific evidence on the effectiveness of art therapy is limited. Anecdotally, however, I have seen it have a significant effect in group therapy as well as seen it used effectively as a form of emotional expression for people going through cancer treatment. (I run a group for survivors of sexual abuse and always have paints and modelling clay close by for topics that clients might need extra support in expressing themselves about.)
7. Integrated Therapies
An integrated therapist has trained in and uses different modalities, models and perspectives and applies them to each individual client with their own unique set of circumstances.
For example, I am an integrated therapist. My practice has a person-centred approach, but I might offer psychodynamic interpretations that the client can unpick and agree or disagree with. I also specialise in a few areas, like psychological trauma, and use psycho-education to give clients more practical tools for dealing with specific issues, like complex PTSD.
8. Group Therapies
Groups can be incredibly powerful if you have a lived experience of trauma, a chronic or severe illness, or struggle with drugs or alcohol.
Some groups exist to support specific people when society is not accepting of them due to prejudice and institutional/structural racism. Groups that understand a lived experience of specific identities are necessary. An example of this might be a QTIPOC* harm reduction group.
Other groups may be for specific people because their experience is specific to their identity, like a group for male survivors of sexual abuse.
“I was in group therapy for years, but that wasn’t the same thing. That was about growing” — Sally Kellerman
9. Antidepressant medication
Okay, this isn’t a type of therapy. However, it can be helpful to learn a little about medication. They are often vilified as unnecessary quick fixes or exalted as the savours of mental health. As with most things, the truth probably sits somewhere in the middle.
The most common antidepressant on prescription is what’s called an SSRI. Popular SSRIs are Sertraline or Fluoxetine (also known as Prozac in the US).
The science of antidepressants is surprisingly vague. We don’t know precisely how they work, but if you’ve read my blog before, you’ll know I love a bit of neurobiology, so here’s the theory.
Serotonin is a hormone responsible for a lot of different functions in the body. It helps the vascular system by clotting blood cells when we cut ourselves, the digestive system in regulating bowel movements helps the brain control sleep and helps us regulate our mood. Once the body is done with serotonin it absorbs it, unless that body is taking an SSRI! SSRIs block the absorption of serotonin into the body, meaning it stays in our system for longer, therefore stabilising our mood for longer.
SSRIs are popular because they have fewer and more tolerable side effects than other antidepressants. A list of side effects can be found HERE.
Medication for depression and anxiety can be a divisive topic, even among mental health professionals. Some are critical of antidepressants saying they cause emotional numbness, inhibit creativity, or are prescribed too easily, forming long-term dependencies (there is no evidence proving SSRIs create dependencies). There is also a stigma concerning them that claims a person should manage mental health issues without drugs.
I’ve always thought if we’re in physical pain, most of us would seek as many medical interventions as it takes until the physical pain goes away; doctors, painkillers, chiropractors, pharmacists etc. Mental pain should be no different. If your mental health is in a bad state for a sustained period, speak to your GP to discuss whether antidepressants might be right for you, as well as other interventions they may have available.
Summary
Whatever mode of therapy you choose, I believe the most critical element is the relationship you build with your therapist. Finding someone who feels empathetic, non-judgemental and genuine is incredibly important. After all, therapy is a journey you invest time and money into, so ensure you have the right therapist on that journey with you.
Signposting
Find your local GP by doing a postcode search: https://www.nhs.uk/service-search/find-a-GP
A lot of private therapists will offer reduced rates for low-income clients. Find a private therapist:
I have compiled a list of services, charities and helplines on my website that provide different counselling and mental health support. Some you can contact 24/7 if you need support now, most have free resources, links to low-cost counselling and support groups: Mental Health Helplines & Links
Here is a huge list of different types of therapy compiled by the British Association of Counsellors and Psychotherapists HERE
*Queer, Trans and Intersex, People of Colour