Dear Alice,

I'm thinking about seeking therapy for my anxiety and I was wondering if you could talk about the different types of therapists out there. I know the difference between psychologists and psychiatrists is a psychologist didn't go through med-school and so can't prescribe drugs, but what about cognitive-behavior therapists verses... well, whatever else is out there?

Thinkin' about Therapy

Dear Thinkin' about Therapy,

You’re taking a brave step by considering therapy as a way to help address your anxiety. And choosing a therapist can certainly be a daunting task. With all the choices out there — LCSW, MFT, Psy.D., Ph.D., psychiatrist, psychologist, etc. — how do you narrow the options to find the right fit? And it sounds like you’ve already done some homework on this. Psychologists have received graduate training in psychology, usually obtaining a Ph.D or Psy.D in clinical or counseling psychology. Psychiatrists first go through medical school and obtain an M.D., then complete an additional four year residency training in mental health. As medical doctors, they may prescribe medications to assist in treating patients.

For the treatment of anxiety, the National Institute for Mental Health recommends cognitive-behavioral therapy (CBT) as one very effective method for improving symptoms of anxiety. CBT is also often paired with medications (anti-anxiety, anti-depressants, or beta-blockers) to treat specific types of anxiety. While medications may not eliminate anxiety all together, they may help temporarily soothe some symptoms of more serious anxiety disorders. This gives you time to work with a therapist on more long-term solutions.

Mental health professionals of all varieties may practice a number of different kinds of therapy. Some of the more common types of therapy include:

  • Psychotherapy (a.k.a., talk therapy, counseling, or just therapy) is a general term referring to treating mental and emotional disorders by talking with a mental health professional.
  • Behavior therapy focuses on modifying and gaining control over unwanted behavior. A focus of behavior therapy is giving the individual control over things in their life.
  • Cognitive therapy focuses on changing unproductive or upsetting thoughts and feelings. The therapist helps the patient examine thoughts and feelings in order to identify unrealistic and intrusive thoughts.
  • Cognitive-Behavioral therapy (CBT) is a combination of cognitive and behavior therapies.
  • Dialectical behavior therapy (DBT) is a type of CBT that teaches the patient skills to help tolerate stress, regulate emotions, and improve relationships.
  • Exposure therapy is a kind of behavior therapy where the patient is exposed to stimuli that s/he has identified as upsetting or disturbing. Exposure therapy may be used with mental health disorders such as obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).
  • Interpersonal therapy focuses on the patient's relationships with others with the goal of improving interpersonal skills.
  • Psychoanalysis, made famous by Sigmund Freud, is a type of therapy where the patient examines past events, feelings and memories to understand how they shape their life today. Psychoanalysis is a long-term approach to therapy, usually lasting a few years.
  • Psychodynamic psychotherapy is like traditional psychotherapy, but focuses on becoming aware of unconscious thoughts and behaviors to help the patient understand her/his own motivation.

In addition to this list, you may have heard of Mindfulness-Based Therapy (MBT) for reducing anxiety. Mindfulness techniques train the patient to focus their attention on their immediate experience. This can include cultivating interest in what is happening in the present, tolerance for new ideas, and not resisting pain. Using MBT can help you to look at anxiety with less judgment and more acceptance. It also helps you to be more aware of thoughts and feelings as they come and go. MBT includes Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy, and Zen Meditation.

As you can see, there are a lot of options out there. Before you choose a type of therapist you may want to ask trusted friends and family for recommendations.

As you search, you may want to call potential therapists to ask about their techniques. Some questions to consider include:

  • What kind of training do they have in treating anxiety disorders (or whatever concern you have)?
  • What is their approach to treatment?
  • Can they prescribe medication or refer to someone who can?
  • How long is the course of treatment? How long is each individual session?
  • Are family members asked to participate in therapy sessions?
  • What kind of insurance do they accept?

Not every therapist will be a good fit; taking time to find someone you feel comfortable talking openly with can greatly improve your experience and outcomes. Try to be patient as you interview potential therapists. It's definitely worth spending the extra time to find someone who is a good fit (and has a comfortable couch — just kidding!).

Good luck with your search, and in moving from "thinking about therapy" to finding a therapist and approach that works for you.


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