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There are many reasons why people enlist the help of a therapist. Sometimes we simply want a little extra support and it can be great to have a weekly check-in with a caring therapist. There are other circumstances, however, when supportive counseling is unlikely to cut it. If you are experiencing symptoms of anxiety and/or depression that are interfering with your daily life, recounting the events your week may feel validating in the moment, but is unlikely to lead to lasting relief. The good news is that very effective treatments for anxiety and depression have been developed; research strongly supports the use of cognitive behavioral therapy (CBT) for these common mental health difficulties. Many therapists list CBT on their websites as a service they provide, but actually fall back on more supportive (How was your week?) techniques in practice. As a result, people seeking a therapist need to be savvy consumers who ask the right questions to make sure they’re getting their money’s worth. In same way we might interview a new mechanic or contractor about their expertise, we should question potential therapists to ensure they are actually providing evidence-based strategies that will address anxiety and depression. Here are four tips for interviewing a potential new therapist:
1. What were you thinking? The way we think about events or situations in our lives can really color how we feel about them. Individuals with anxiety and depression tend to see the world through tinted glasses that paint things in a negative light. The “cognitive” part of CBT refers to questioning initial thoughts in order to land on a more balanced or realistic interpretation of a situation. For example, after a friend doesn’t text you back, your first thought might be that he/she is angry with you. A CBT therapist will encourage you to consider how likely that interpretation actually is (what has happened in the past in this situation? What is the evidence to support this interpretation?). Challenging negative thoughts is a hallmark of CBT! Ask a potential new therapist if he/she teaches cognitive restructuring, which is CBT-lingo for challenging our negative first impressions. Also ask if he/she uses a thought record, a standard practice form that facilitates learning how to challenge thoughts.
2. Act the way you want to feel! People with anxiety and depression often attempt to cope by trying to avoid situations or activities that bring up negative emotions. This avoidant approach works in the short-term but backfires in the long-term. The more you struggle against negative emotions, the more limited your life becomes (e.g., avoiding going to a party means you won’t feel anxious but it also means you won’t expand your social circle). The “behavioral” part of CBT refers to encouraging individuals to approach situations that are consistent with their goals (like talking to new people or engaging in pleasant activities), even if they bring up strong emotions. Over time, we learn that negative emotions are temporary and necessary for moving forward in our lives. Ask a potential new therapist if he/she encourages clients to face situations and activities that bring up strong emotions – in CBT, these practices are called exposures.
3. Let it be. More recently, CBT has begun to include meditation-based strategies called mindfulness. The goal of mindfulness is to focus on the present-moment in a nonjudgmental way. Often people with anxiety and depression are hard on themselves for the thoughts and feelings they experience (“I shouldn’t be feeling this way,” “this is so stupid”). They mistakenly believe that beating themselves up for feeling anxious or down will make them less likely to feel that way in the future. Research shows that the opposite is true - judging ourselves for having feelings actually makes us feel worse. Being nonjudgmental refers to giving yourself a break and acknowledging that your emotional reactions make sense given your circumstances. Mindfulness is taught by participating in meditation exercises that encourage observation of thoughts, physical sensations, and urges to act without judgement. Ask a potential new therapist if they will guide you in mindfulness meditation during sessions and if they’ll provide you with an audio recording so you can practice at home.
4. Practice, Practice, Practice! Generally, people meet with their therapist for 45 - 50 minutes per week. Even if your therapist is teaching you new coping skills, you are unlikely to see lasting benefits without practicing them in your life outside of session. Changing the way you think or act in difficult situations is hard work, so your therapist should be encouraging you to try out your new skills. Bonus points if he/she gives you worksheets to fill out that provide structure for your practice.
* Edited in response to comments: Of course, it is important to note that no type of therapy is one-size fits all - there are other research-supported treatments available. That said, CBT is often short term (12-16 sessions) with an 80% success rate (Barlow & Craske, 2007). For that reason, it is generally recommended as the first line treatment, with the knowledge that a small percentage of people will need to turn elsewhere.
