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?

Thanks!
Thinkin' about Therapy

Dear Thinkin' about Therapy,

Addressing anxiety is no small feat, and it sounds like you’re headed in a great direction by considering therapy. As you’ve gleaned, a “therapist” can mean any number of specialists. With all the choices out there — Licensed Clinical Social Worker (LCSW), Marriage and Family Therapist (MFT), Doctor of Psychology (PsyD) Doctor of Philosophy (PhD), psychiatrist, psychologist, etc. — how do you narrow the options to find the right fit? As you’ve correctly described, psychologists and psychiatrists go through different educational paths. Psychologists receive graduate training in psychology, usually obtaining a PhD or PsyD in clinical or counseling psychology. Psychiatrists, on the other hand, first go through medical school and obtain an MD, then complete an additional four-year residency training in mental health. As medical doctors, they may prescribe medications to assist in treating patients. Beyond these two types, there are therapists who are licensed counselors, social workers, and specialists (such as drug and alcohol counselors), just to name a few. While a number of these professionals are equipped to help you with your anxiety, you may consider the types of therapies that fit your situation, instead of the types of therapists. Asking a few questions about a therapist's approach to treatment may help you find one that’s a fit for you and your needs.

Just as “therapist” can refer to different specialists, “anxiety” can mean several different anxiety disorders, which a mental health professional can help pinpoint. In terms of treatment, the National Institute for Mental Health recommends cognitive behavioral therapy (CBT), and if needed, in combination with medications (anti-anxiety, anti-depressants, or beta-blockers), support groups, or stress management strategies, for long-term progress in managing a person’s anxiety. While medications may not eliminate anxiety all together, they may help temporarily soothe some symptoms of more serious anxiety disorders for some people. However, CBT is just one of many types of therapy out there and may be accessed with most licensed mental health professionals. Some of the more common approaches to therapy include:

  • Psychotherapy (a.k.a., talk therapy, counseling, or just therapy) is a more general strategy that consists of talking with a mental health professional about any thoughts, feelings, past experiences, etc. as a way to help you deal with the situation.
  • Cognitive behavioral therapy (CBT) is a strategy that combines both changes in harmful thought and behavior to help the patient develop healthy attitudes and actions. This form of therapy helps train an individual to think and react in a more positive, constructive manner. CBT is often used for those with anxiety disorders, bipolar disorder, and depression, among other mental health conditions.
  • Dialectical behavior therapy (DBT) is a type of CBT that teaches the patient skills to help tolerate stress, regulate emotions, and improve relationships. DBT is often used to help those diagnosed with eating disorders, borderline personality disorders, or suicidal ideation.
  • Exposure therapy is a kind of behavior therapy where the patient is exposed to stimuli that they have identified as upsetting or disturbing. Exposure therapy may be used with disorders such as obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).
  • Interpersonal therapy is often used for treating depression. The goal of this therapy is to help the patient express their emotions in a healthier way while also improving relationships or helping to resolve conflicts with others.
  • 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 therapy is like traditional psychotherapy but with a focus on increasing awareness of unconscious emotions. This type of therapy might require that the patient delve into their past to identify potential influences on current thoughts and behaviors.

Another form of therapy, Mindfulness-based therapy (MBT), has been shown to significantly reduce anxiety. Mindfulness techniques train the patient to focus their attention on their immediate experience. This can include cultivating interest in what’s happening in the present, tolerating new ideas, and not resisting pain. Using MBT may help you to look at anxiety with less judgment and more acceptance, and it could also help you to be more aware of thoughts and feelings as they come and go.

As you can see, there are a lot of options out there, which may be stress-inducing for some. A first step you could take is to call potential therapists to ask about their therapy approach. Some questions to consider include:

  • What kind of training do they have in treating anxiety disorders (or whatever concern you have)?
  • What’s their approach to treatment?
  • Can they prescribe medication (if indicated) or refer to someone who can?
  • How long is the typical 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?

As you embark on your search, it’s good to note that not every therapist will be a good fit. Taking the effort to establish achievable goals and expectations with a trusted therapist can greatly improve your experience and outcomes. It may take multiple sessions to feel progress, so it’s crucial that you find someone with whom you feel comfortable talking openly. It's worth spending the extra time to find someone who’s a good fit, even if you need to try a few therapists before you find your match.

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

Alice!

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