Deciding on Therapy: A Leap of Faith?
The decision of whether to start therapy can be wrestled with; then there's the choice of therapy and the actual therapist
Dr Tom Bichard explores different therapy styles and suggests therapy always involves a leap of faith
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Do I need therapy?
If thinking about therapy has prompted you to see this article or browse the Welldoing website, then the answer is: probably. Another way to think of therapy is in its usefulness. Which may or may not go hand-in-hand with whether it is ‘needed’. Challenges in life are normal and everyone requires some degree of support or collaboration from other people at every stage of their life.
If repeated doubts about therapy raise a lot of anxiety, despite there being some reasons to attend and the practical side is covered (e.g. available time for sessions, funds if private), this might suggest that you are more concerned about what it means to take the position of being a therapy client.
Some believe being in this position makes their issues more ‘real’, or that a therapist could label them as inferior in some way. Here, I think it is largely a case of finding a therapist who you feel will be respectful. If you disclose of such prior doubts, a good therapist may have a genuine, simple curiosity about what you felt you have to lose.
Directive, exploratory, or both?
You may not know what you want (or need) without first trying therapy. But, aside from instinctive feeling on seeing a therapist’s profile or on hearing about a therapy service, there are some principles to consider and ways to gain more information.
Therapists’ profiles and the type of therapy offered may give some indication as to what can be expected. Speaking very broadly, two camps exist: directive therapies and non-directive/explorative therapies. However there is a vast spectrum in‑between and no position on this spectrum is inherently correct. It more depends on what you are looking for, what you need, and what the therapist is able to offer.
Therapists describing their work as integrative or eclectic may be more likely to sit in the middle of the directive/exploratory spectrum.
Some therapists may be single modal – normally the result of them receiving training in a single approach or endorsing it above others.
‘Traditional’ person-centred therapy sits at the far exploratory end and traditional CBT at the directive end. I would argue that psychodynamic and psychoanalytical therapies are both in the centre of the spectrum and outside of it, as they will gently encourage thinking about the context of your life and where you find yourself in relation to where you have come from, but shouldn’t explicitly tell you what to think or do.
What is useful for you?
To encourage long-term, meaningful shifts in your thoughts, feelings or habits, there is a balance to be had between supportive understanding of yourself and being gently challenged via a different, outsider perspective that a therapist can offer. This outside perspective should be based on a combination of what you have told them and their own relevant world views (e.g. psychodynamic theories), or through suggestions around actions or things to try outside of the therapy room (e.g. ‘homework’ in CBT).
Some people may come to therapy seeking specific advice and consider no benefit or relevance of discussing their personal histories. For others, any notion of being told what to do is unwanted. Instead there is a wish for a meaningful, supportive space through building a professional, trusting relationship with their therapist. Some may be seeking to explore what is known and felt in their history which a therapist may be capable of gently encouraging, jointly interpreting its relevance to the present in full collaboration with you and at your own pace.
Or, where the ability to listen well is most wanted from a therapist – and hence for you to have the experience of being properly heard – person-centred approaches may suit best. Here, a therapist can mainly provide the function of a ‘sane ear’ in a world felt to be insane. For some, this can be immensely useful on its own.
The above said, an experienced therapist will not necessarily be using any techniques obviously or imposingly. Instead their method or approach to therapy is well-developed and has its own naturalness, making therapy somewhat resemble a reasonable, understandable and calm conversation between two people. However, there are markers which distinguish therapy from everyday conversation and give it its effectiveness.
Mainly, a consistent space is provided which should focus primarily on you, rather than on the therapist or on textbook understandings around people’s wellbeing. Therapists generally don’t speak about themselves. Confidentiality and its limits should be clarified. Good therapists are not mind‑readers, but will take seriously their duty to consider if sessions are remaining useful, hence any decisions to end therapy – if the therapy is not time-limited by nature or circumstances – can be collaborative. In these ways, therapy has the chance to be empowering rather than involving any loss of autonomy.
Diversity of approach aside, there is much crossover in what therapists do and what a client’s experience of therapy is generally like. Following considering practicalities around location, time and fees, therapists’ qualifications and experience are important, but a therapist is often chosen on what feels like it could be a good fit. But you cannot know for certain. And given that the perfect therapist doesn’t exist, there always remains some leap of faith when arranging an initial session.
Again categorising here whilst acknowledging the spectrum in-between (as well as the natural malleability of a personality), clients may bring a personality of a carer or of somebody expecting to be cared for. The latter may well be quite healthy rather than narcissistic.
A carer may be someone largely expected by others to be measured, balanced and well behaved. They are perhaps more likely to lack spaces – in relationships or in work, historically or in the present – which focus mainly on themselves and on their own frustrations and challenges. A more exploratory therapy space may be most useful, where there is little to no hint of them being told what is best to do. They already know.
On another part of the spectrum, someone who brings a single, consistent barrier to their day-to-day functioning – such as a specific phobia – may better suit a more directive therapy. Some exposure to the fear (in thinking or in action) may be needed, but a good directive therapist will seek to be supportive, understanding and well paced rather than demanding.
The above is oversimplifying and only reflects my opinion. A good therapist does not set out to fundamentally change your personality in some way, but aims to draw in and gather your experiences together to enable deeper understandings of who you are, what you want and where your confidence can come from.
This article has touched on the themes around decisions of what therapy to attend and why. I suggest some anxieties around attending may be matched by a sense of being overwhelmed with choice. As mentioned, I think it is worth being curious as to whether this is a defence from having a space which could be important for you, but which does involve reaching out to a person.
Types of therapy, therapists’ qualifications and level of experience are essential things to consider. But my concern would be that if you have agonised over the decision and done too much research you risk being disappointed.
Here, I strongly encourage you to do what it takes to simply get through the door. Therapy horror stories exist and media portrayals aren’t always helpful, but therapy has been consistently shown to be useful and effective and may be a key, background contributor to your success.
Dr Tom Bichard is a verified Welldoing psychologist in London and Harrow