Help! How Do I Know Which Therapy I Need?

Dear GoodTherapy.org,

I am just starting to look into therapy for some stuff I am dealing with (depression, anxiety, phobias, maybe an addiction or compulsion), but I don’t know where to even start. I am overwhelmed by all of the information and choices there are. I’m so intimidated. I wonder if I should even bother.

I don’t know how to figure out the best type of therapy for me. If I have a cavity, I go to the dentist and get a filling. If I’m sick, I go to the doctor and get medicine. But with therapy, I have no idea what I need, so how do I know who to call? How do I know whether I should seek cognitive behavioral therapy, exposure therapy, narrative therapy, this therapy, or that therapy? Are they just different ways of achieving the same results? Do they all cost the same? What if I need one therapy for one issue and another type to fix the rest of what’s wrong with me? And what if one kind doesn’t work?

It’s exhausting to think about. I feel like I’m supposed to know all this stuff up front, but I don’t. Help! —Overwhelmed

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Dear Overwhelmed,

Thank you for your question, an excellent one at that.

Before becoming a therapist, I, too, was in therapy, and I recall the same confusion. Since then, options for therapy have perhaps gotten even more overwhelming.

In addition to the ones you listed, there are dozens of types of therapy to choose from out there: psychodynamic, EMDR, psychoanalytic, somatic experiencing, hypnotherapy, sensorimotor work, acceptance and commitment therapy, solution-focused therapy, group therapy, gestalt therapy … the list goes on and on. There will probably be a few new ones by the time you finish reading this. What is a person to do?

One thing that can help is asking those you trust if they have or know of a good therapist, or if they or someone they know has found a therapist who helped with the kind of problem you are facing. Even if you’re just asking for, um, “a friend.”

Most of the answers you seek can only be found by reaching out to potential therapists. I suggest you contact a few therapists who seem, based on their online profiles, like they might be a good fit; they can clarify over the phone, by email, or in person whether they offer what you need or seek, any costs involved, and what insurance (if any) they accept. If they don’t think they can help you, they should be able to refer you to someone who can or at least point you in the right direction. That’s what I’ll attempt to do here.

Of all the research studies I have seen, there remains one consistent factor in successful therapy: the therapeutic relationship. If the relationship between a person in therapy and their therapist is marked by trust, warmth, understanding, and mutual honesty, then therapy has a better chance of succeeding.

Generally speaking, cognitive behavioral therapy (CBT) focuses on “tools and techniques” such as workbooks, exercises, reading, and so forth for managing anxiety, depression, or other challenges. CBT does not typically focus on unconscious thoughts, wishes, or feelings, as psychodynamic therapy might. As you note, there are many different types of approaches, and by visiting this website, you landed on a great resource for finding answers. Often you will find that therapists overlap to some degree.

Here are a few other things I have found to be helpful from my time as both a therapist and a person in therapy:

• A good therapist, first and foremost, acts in the best interests of the person in therapy in order to “do no harm.” The emotional safety of the person in therapy remains primary. This would mean, as one example, that therapists do not prolong therapy for their own financial gain. If a person feels the initial treatment goal has been met, and would like to stop or take a break, a caring therapist discusses but does not force the issue, providing there is no crisis at hand (suicidal ideation, for instance). This might also mean that if a person finds a certain type of feedback unhelpful—provocative or blunt statements, for instance—and asks the therapist to stop, the therapist listens rather than remaining inflexible “for your own good” or saying, “Sorry, that’s just my style.”
• A good therapist cherishes honest feedback. Therapists need honest feedback as to what is helpful and what is not. Everyone is different and has different needs at different times. I want someone to tell me if something I said or did bothered them. Not that I want to upset anyone, of course, but supporting a person’s expression of their emotional truth is essential. A therapist who is consistently defensive or closed off to feedback, even if it’s “unflattering” to the therapist, or a therapist who is always quick to say “you misunderstood me,” foreclosing the exploration of a person’s experience, is blocking something essential to the process.
• A good therapist admits mistakes. Every once in a long while, I mess up my scheduling—double-book, write down the wrong date for a reschedule, etc. I may misunderstand or misremember something I’ve been told. I cannot claim to be perfect, but I can do my best to “own” errors and, most of all, explore their impact on the people they affect. I recall a person new to therapy who showed up in the waiting room at the same time as another person due to a snafu on my end; the new person was understandably upset; in childhood, his parents were disorganized and neglected dates and events that were important to him. He later said the fact I both (1) apologized and did not charge for that session and (2) listened openly to his feelings about the matter, including his irritation with me, allowed him to begin to trust me. I tell newer therapists that mistakes are inevitable, but they can be treatment gold.
• A good therapist doesn’t pretend to know what they don’t know. We live in an era of hyper-specialization—think those who treat addiction among females who were born in the 1970s as only children. (I’m being hyperbolic, but you get the idea.) Some therapists practice only eye movement desensitization and reprocessing (EMDR) or hypnotherapy. In such cases, the therapist should be up front about what their practice does and does not cover, and to what extent. At the other end of the spectrum is a therapist who claims to do “a bit of everything,” from grief work to trauma to adoption to addiction treatment. Such a kitchen sink approach does, I have to admit, make me a little skeptical; often someone practicing a handful of specialties, rather than the whole encyclopedia, has focused on specific training with specific challenges, and may be better positioned to help with those issues than someone who professes to do it all.
• A good therapist collaborates with the person in therapy. This includes creating a treatment plan—what “successful therapy” might look like—and establishing the goals of the therapy. A therapist who remains vague about what course the treatment is taking, who says, “Well, let’s see how it plays out,” or, “Why do we need goals?” or, “Don’t ask me, you’re the customer” is evading responsibility. A goal can be specific (getting sober, finding a partner, deciding whether to leave a relationship or job) or more general (reduction of anxiety or depression, higher self-esteem, less conflict at work or home). Goals can change, but I think it’s important to discuss them from time to time for the sake of clarity and focus.
• A good therapist says what needs to be said, but does so with empathy, respect, and care. There are therapists who like to think of themselves as teddy bears, always warm and fuzzy … as well as those who fancy themselves as tough, disciplined, and “free of B.S.” Most of us probably need a happy medium. Empathy and compassion are indispensable, but there are times we have to tell people things that are hard to hear—especially with one of my specialties, addiction. I might notice a behavior or habit that is harmful or self-sabotaging; such behaviors or beliefs (self-loathing, for instance) ought to be challenged, in as empathic a way as possible. Of course, being unusually pointed about a self-defeating pattern can itself be empathic. Statements such as, “Things probably won’t change until you stop drinking,” or, “I’m concerned the way you’re saying this is angering or pushing away your partner/boss/child, so you’re not being heard,” or, “Let’s have an honest discussion about why you keep canceling appointments” can be in a person’s best interests. The art of saying such things lies in doing so while conveying support and care rather than judgment. A good therapist can, for example, outline the conflicting ways both they and the person in therapy seem to be viewing or feeling about a situation, without making one of them “wrong.” Collaborative problem solving is a key part of the therapeutic journey.

I’m sure this is a lot to digest. Ultimately, you want to feel you can bring all of you to therapy, be safely candid and seen, and that even the darker or scary parts are welcome—not just the brighter and happier sides.

I hope this helps, and wish you the best of luck with your search!

Kind regards,

Darren Haber

Darren Haber

Darren Haber, PsyD, MFT is a psychotherapist specializing in treating alcoholism and drug addiction as well as co-occurring issues such as anxiety, depression, relationship concerns, secondary addictions (especially sex addiction), and trauma (both single-incident and repetitive). He works in a variety of modalities, primarily cognitive behavioral, spiritual/recovery-based, and psychodynamic. He is certified in eye movement desensitization and reprocessing (EMDR) therapy, and continues to receive psychodynamic training in treating relational trauma, including emotional abuse/neglect and physical and sexual abuse.