about How to Choose the Therapist & Therapy Type that’s Right for You
Let’s play a thought game:
You’ve decided that this year, you’re investing in yourself, your emotional well-being, and your joy – and that means starting therapy.
You do a Google search, get on Psychology Today and Inclusive Therapist and you look for therapists who look relatively interesting and trustworthy, who fit your budget, and who specialize in what you want to work on.
Then, as you’re reading through profiles, you notice the acronyms. Tons and tons of acronyms.
LCSW. LPC. LMFT.
CBT. DBT. ACT. EMDR. MBCT. REBT.
Your eyes start to cross and you flip to social media because your brain can’t compute that many letters smashed together without making an actual word. So let’s break all this business down:
Types of Degrees:
In order to become a therapist, you have to have a master’s or doctorate-level degree, and there are three primary types of master’s-level therapists: LCSW, LPC, and LMFT. While, with enough practice and training, we all sort of end up in a similar practice space, the difference in these degrees is their academic focus and the lens through which therapists are taught to observe and consider clients. Basically, our priorities and foci are different.
Licensed Clinical Social Workers (LCSWs) take a broad view, focusing on how folks are impacted by social and environmental conditions; this is called person-in-the-environment. We might consider attachment and interpersonal relationships while also taking into account how someone might be impacted by their community or the sociopolitical happenings at the time.
Where LCSWs have a broad view, Licensed Professional Counselors (LPCs) look at mental health more from a brain science and neurobiology perspective. LPCs also tend to have a more individualized scope of practice.
Different from LCSWs and LPCs – whose services can run the gamut from individual work to families, groups, and even communities – Licensed Marriage and Family Therapists (LMFTs) specialize in addressing relationship and family dynamics. They might also consider systemic factors that could impact relationships, but their primary focus is always the relationship dynamic. LMFTs most frequently are couples and family therapists.
In addition to LCSWs, LPCs, and LMFTs, doctorate level psychologists, Mental Health Nurse Practitioners, and psychiatrists are also qualified to provide mental health therapy. However these folks are harder to find simply because you either have to earn a PhD if you’re a psychologist or because you’re a medical doctor or nurse – and psychiatrists and MHNPs tend to stay on the diagnostic and medication management side of things.
Types of Therapy:
Okay, so you’ve narrowed down the type of degree your therapist needs to have. Now it’s time to figure out whether their skills and specialties match your needs. If they list themself as a Generalist Practitioner, the answer to this question usually is “yes,” however the means of arriving at your desired outcome can vary wildly from therapist to therapist.
Generalist Practitioner is a succinct way of saying that we’ve been trained on at least the basics of several different therapeutic modalities, and we pick and choose from those methods to create treatment that works best for you. We consider what methods are evidence-based for your specific issue as well as your temperament and the strength of the therapeutic alliance.
When we’re in graduate school, therapists are taught that there are two overarching schools of therapy: Cognitive Therapies and Behavioral Therapies.
Cognitive therapies focus on changing negative thoughts patterns and beliefs by identifying distorted and irrational thoughts, interrupting them, and inserting more accurate or positive thoughts. This repetitive process is called cognitive restructuring, which I love, because you’re literally rebuilding your thoughts through practice.The most common types of cognitive therapies include Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), and Acceptance and Commitment Therapy (ACT). Cognitive therapies are effective for anxiety, depression, PTSD, OCD, eating disorders, and insomnia.
Behavioral Therapies focus on observing behavioral patterns and the environmental factors that influence them. Often, behavioral therapies incorporate modeling desired behavior, practicing the change behavior, and reinforcing change behavior through positive reinforcement and conditioning. Behavioral therapies are most effective for phobias, anxiety-related disorders, and OCD. Common types of behavioral therapy include exposure therapy, behavioral activation, and social skills training; CBT and DBT also are categorized as behavioral therapies as they have behavioral components within their methodologies.
While cognitive and behavioral therapies tend to be most common – especially when we try to envision an actual therapeutic intervention – there are several other methodologies that impact how or why we might choose a specific intervention; I tend to think of these more as therapeutic philosophies and frameworks rather than specific interventions. The most common outliers to cognitive and behavioral therapies include psychodynamic therapy, humanistic therapy, existential therapy, Gestalt therapy, and narrative therapy.
- Psychodynamic therapy looks at early life experiences and how they might influence present behavior and patterns. So if you are looking to work on childhood trauma or do attachment work, you’ll want a therapist with a psychodynamic bend.
- Humanistic Therapy takes a whole-person approach to therapy, looking at your cognitive, emotional, social, and spiritual needs with the intent of empowering you to achieve your highest potential (or self-actualization).
- Existential therapy focuses on the fundamental aspects of human existence – considering challenging concepts such as freedom, choice, responsibility, meaning, the experience of living, and mortality. Basically, you’re questioning the meaning of life, your role in your own life and the world at large. You are developing your values and how to be your most authentic self.
- Gestalt Therapy is similar to humanistic therapy in that it takes a whole-person approach, however, it differs in that it encourages you to be fully present in the current moment and engaged with your experience. It also focuses on taking responsibility for your thoughts, feelings, and actions, and significantly prioritizes the strength of the therapeutic relationship.
- Narrative Therapy relies on language and storytelling in the therapeutic process; the idea is that you are the author of your own story and that you have the power to revise or edit your story in a way that is empowering or promotes positive change. This is done by separating you from the problem, understanding that you are not defined by the problem at hand, allowing you to problem-solve creative solutions rather than attaching your self worth to your situation.
Other Types of Therapy – EMDR & Somatic Experiencing
In addition to traditional methods of talk therapy, some therapists practice additional models of therapy that are more body-based rather than emotion or cognition-based.
Eye Movement Rapid Desensitization is a highly popular intervention that is especially helpful for clients dealing with Post Traumatic Stress Disorder. The EMDR process is highly structured and also focuses on helping clients reprocess highly traumatic experiences while creating distance from the experience by splitting their focus on something visual, auditory, or by creating bilateral stimulation. Basically, you narrate an experience or answer questions on a script while following something with your eyes or by listening to tones that alternate from ear to each; theoretically, the bilateral stimulation keeps the hemispheres of the brain connected, allowing you to process an experience more completely while keeping your prefrontal cortex, limbic system, and brain stem all connected and online rather than flooded with stress hormones that would prevent the reprocessing as am unconscious protective action.
Somatic Experiencing is a body-oriented therapeutic approach that focuses on resolving the physiological and emotional effects of trauma. The idea is that by paying attention to bodily sensations, tracking physiological responses, and gradually processing traumatic memories, you can better regulate your nervous systems, move through reptilian fear responses faster, and have methods for literally moving stress and dysregulation through your body. Somatic Experiencing has proven helpful for trauma recovery, including PTSD, anxiety and stress related disorders, and chronic pain.
There are an overwhelming number of factors to consider when trying to choose a therapist. Hopefully this synopsis helps clarify some of the more tedious considerations.
But also remember: therapeutic modality doesn’t mean anything if you don’t vibe with your therapist. So in your search, give them a call and talk to them. See if they’re someone you feel like you can trust and who will help you grow. Because even if they’re an expert in their field, they might not be the best fit for you.