397: What Kind of Therapy Is Right for Me?

Hello, friends!

In today’s episode, we dive deep into a listener’s question about finding the right therapy for a variety of complex mental health issues. This 29-year-old woman is struggling with childhood trauma, mental health challenges such as anxiety and depression, and relationship issues. She is also seeking guidance on possible autism/ADHD symptoms and needs help navigating the overwhelming array of therapy options available.

We explore the IPA framework (Immediacy, Problem, Approach) to help her and others identify the most suitable types of therapy. Additionally, we discuss the different types of therapists and their qualifications, the importance of cultural competency, and practical tips for finding a good therapist using various resources. This episode is a comprehensive guide for anyone looking to start their therapy journey.

As always, you can send me questions to duffthepsych@gmail.com and find the full show notes for this episode at http://duffthepsych.com/episode397

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What Kind of Therapy Do I Need?

Hello, friends!

In today’s episode, we tackle a profound and multifaceted listener question that may resonate with many of you. A 29-year-old woman is seeking guidance on where to start with therapy. She has a long history of childhood trauma, mental health struggles, and relationship challenges. Overwhelmed by the various types of therapy, she needs help navigating this landscape and finding the right path for her needs.

This episode aims to provide a comprehensive guide to finding the right therapy. We’ll explore the different types of therapy, qualifications of providers, and offer a framework to help you think about the searching process.

The Listener’s Story

A 29-year-old woman wrote in, sharing her struggles with:

  • Childhood trauma (dysfunctional family, abuse, neglect)
  • Mental health issues (suicidal thoughts, anxiety, depression)
  • Relationship problems (difficulty with emotional regulation, communication)


She is looking for guidance on:

  • What type of therapy to start with
  • How to address childhood trauma and relationship patterns
  • Possible autism/ADHD symptoms
  • Finding a good specialist
  • This dense and significant question will serve as our jumping-off point.

Understanding the Types of Therapy

There are many types of therapy out there, and it can definitely be confusing to know what sort of therapist you should see, what sort of work you should do together, which approaches are right for which issues, etc. I won’t cover every single type of therapy, but I will give you information about the most common types you will encounter as you search for a therapist.

The IPA Framework

From my perspective, there are three main dimensions to consider when it comes to therapy: Immediacy, Problem, and Approach (IPA).

Immediacy: What timeframe will the work primarily focus on? The immediate moment, the near future, or the distant past?
Problem: What issue are you seeking help for? Bipolar disorder, grief, ADHD, etc.
Approach: What does the actual process of therapy look like? The nuts and bolts of how therapy is conducted.
Provider Qualifications

Before diving into the IPA, let’s briefly talk about the qualifications of providers.

Common Terms

Psychotherapy: An umbrella term for all the approaches we will discuss.
Therapy: Often used interchangeably with psychotherapy, though it can also refer to other types of treatments like physical therapy.
Counseling: Sometimes used more loosely; not all counselors are licensed therapists.
Provider Types in the US
Psychiatrists (MD or DO): Medical doctors who can prescribe medication. Some provide therapy, but this is less common nowadays.
Psychiatric Nurse Practitioners: Similar to psychiatrists in terms of medication management; some provide therapy.
Psychologists (PhD, PsyD): Non-medical doctoral level professionals. They must pass a law and ethics exam and the Examination for Professional Practice in Psychology (EPPP) to conduct therapy.
Master’s Level Therapists (MFT, MA, MS, MSW, LCSW, LPCC): They need to pass licensure and law and ethics exams.
Licensed Drug and Alcohol Counselors: Can provide therapy focused on substance use, requiring specific coursework and exams.
Coaches and Pastoral Counselors: These are less regulated. Coaching can be helpful for life organization, but it lacks the protections of licensed therapy.

Immediacy: Types of Therapy Based on Urgency

Immediate help:

Crisis Counseling and Rehabilitation Therapy: Focused on immediate stabilization and coping tools.
Typically encountered in hospitals or detox facilities.
Solution-Focused Brief Therapy (SFBT): Short-term and goal-oriented. Useful for depression, anxiety, stress, relationship problems, life transitions, or trouble at work or school. Techniques include the miracle question, scaling questions, exception seeking, and coping questions.

Day-to-Day Issues with Future Focus:

Cognitive Behavioral Therapy (CBT): Focuses on identifying and changing negative thought patterns and behaviors.
Structured approach with skills training, homework assignments, and in-session exercises.
Dialectical Behavior Therapy (DBT): Combines cognitive-behavioral techniques with mindfulness practices. Effective for emotional regulation, distress tolerance, and developing healthy relationships. Typically includes group and individual treatment.
Humanistic and Person-Centered Therapy: Focuses on creating a non-judgmental, accepting, and empathetic environment.
Aims to help clients achieve greater self-understanding and self-acceptance.
Acceptance and Commitment Therapy (ACT): Emphasizes psychological flexibility and acceptance of difficult emotions.
Uses mindfulness and values clarification to guide behavior.

Insight-Oriented and Depth-Based Approaches:

Psychoanalysis: Developed by Sigmund Freud; focuses on exploring early childhood experiences and repressed emotions.
Lengthy and intensive, often multiple sessions per week for years.
Psychodynamic Therapy: Modernized version of psychoanalysis. Focuses on deep, reflective work, early experiences, and interpersonal relationships.
Internal Family Systems (IFS): Based on the concept of different sub-personalities within the mind.
Aims to bring these parts into harmony and develop a strong core self.
Jungian Therapy: Developed by Carl Jung; emphasizes the role of the unconscious mind. Explores deeper levels of the unconscious, including archetypes and personal myths.

Problem: Types of Therapy Based on Issues

Trauma:

EMDR (Eye Movement Desensitization and Reprocessing): Effective for PTSD. Involves recalling traumatic events with bilateral stimulation (eye movements, tapping, etc.).
Brainspotting: Similar to EMDR, focusing on where someone looks with their eyes. Early research is promising but more studies are needed.
Trauma-Focused CBT (TF-CBT): Integrates CBT principles with trauma-sensitive interventions. Often includes family and support network.

ADHD:

CBT and Behavioral Therapy: Helps with emotional impact, organization, and time management.
Educational Therapy: Focuses on study habits and self-advocacy.
Executive Functioning Coaching: Practical skills-building.

Approach: Therapy Formats

In-Person vs Online: Both are effective; personal preference matters. Online therapy has grown in prevalence post-COVID.
Family and Relationship Therapy: Therapists can provide family or relationship therapy alongside individual sessions.
Group Therapy: Different from support groups; led by licensed therapists. Available for anxiety, OCD, addiction, emotional awareness, grief, etc.
Expressive Therapies: Art Therapy and Somatic Therapy – Involves creating art or moving your body to process emotions and traumas.
Substance-Assisted Therapy: Ketamine-Assisted Therapy – Integrates ketamine into psychotherapy. MDMA and Psilocybin Therapy – Gaining acceptance in clinical trials and specific regions.
Creative Durations: Retreats, longer single sessions, half-day intensives. These are valid but less likely to be covered by insurance.

Finding a Therapist

Psychology Today: Use their “Find a Therapist” tool with advanced filtering options.
Local Psychological Associations: Useful for finding therapists in your area.
Google Searches: Use specific queries like “OCD group therapy near Houston, TX.”
Insurance Portals: Online tools to search for behavioral health providers, though they can be clunky.
Community-Specific Resources: Effective altruism community, kink community, and other subgroups often have therapist directories.
Training Programs and Community Mental Health: Psychology training programs offer free or low-cost treatment.
Community-based mental health services for low-income or severe mental illness cases.

Conclusion

Navigating the world of therapy can be overwhelming, but by understanding the types of therapy, qualifications of providers, and applying the IPA framework, you can find the right path for your mental health needs. Remember, the therapeutic alliance is crucial, so take advantage of initial consultations to find a therapist who feels like the right fit for you.

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