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Key points
- For therapy to be effective it needs to match your problem and your preferences.
- No single type of therapy has been proven to work for everyone or for every problem.
- Particular treatments do make a difference, especially in more complex cases, but we don't know by how much.
The best exercise is not running, swimming or Pilates; it’s the exercise you’ll do. Same with therapy: Choose something that makes sense for you and that you’ll stick with.
Clients matched to a therapy that suits them have a 58% chance of greater improvement and are about half as likely to drop out of therapy. And if you’re paying for therapy privately, there’s a lot of choice. So, consider four key questions below, drawn from a well-researched checklist (Cooper & Norcross, 2015), to help you decide what makes the most sense for you.
Remember, it’s not just your preference; it’s about getting the best outcome from a considerable investment of time and money and increasing the odds of being in the 75% of people who end up with better mental health after they’ve had therapy.
4 important questions
1. Do you have a strong preference for therapy to focus on goals, teach coping skills and to include tasks to complete outside the session? Or would you prefer your therapist to listen and follow your lead?
2. Do you want to focus mainly on thoughts or feelings? For some, putting strong feelings into words is the point of therapy. Others prefer to focus on thoughts and behaviour as the driver to change how they feel.
3. Would you find it helpful to reflect on your childhood or would you prefer to focus on problem-solving in the present? Some approaches center on how your first relationships continue to influence you today. Other approaches focus on changing current behaviour, irrespective of your past.
4. Would you want your therapist to challenge you if they think your behaviour is causing you problems? Similarly, would you want them to interrupt you if you’ve strayed from the point? For some, anything less would be a waste of time and money. Others prioritise support and want time and space to explore their feelings – and get to their own answers in a less direct way.
Answering these questions honestly will direct you towards short-term, solution-focused options or more open-ended “depth” approaches.
Short-term approaches
Broadly, short-term, problem-solving, or solution-focused therapies (such as CBT) will have a more present-day focus. These approaches can be highly effective in helping you with immediate, pressing problems. They are also most likely to challenge you to do things differently outside of sessions; for example, to speak up at work or ask someone out on a date.
Most people express a preference for this type of therapy, when asked. But this type of therapy can also feel challenging. It will ask you to recognise how you contribute to your problems and whether you’re willing to work hard to make changes. It will challenge any excuses you make and invite you to risk experimenting with new behaviours that have worked for others in similar circumstances.
Short-term, problem-solving therapy is helpful in providing focus and breaking problems down into manageable challenges, but it can feel stifling if you need space to work out exactly what’s wrong and what’s most important to you.
Long-term approaches
Longer-term, open-ended therapy (such as counselling and some forms of psychotherapy) assume that your past affects your present and therefore sheds light on your difficulties. Given the impact of your early years on brain development, those approaches also assume that you’ll need time to change the habits of a lifetime.
For some, this time and space is valuable. They want therapy to allow them to see for themselves the way they contribute to their problems. And they want to decide if and how to change that. They don't want cookie-cutter suggestions of what’s worked for others or advice on how they might behave differently.
Therapy isn’t just about fixing what isn’t working. It can also be a place to catch your breath; a moment in the week to drop the game face and reflect. Therapy that focuses on deep listening allows you space to get to know yourself and accept who you are.
For others, this approach can feel slow, too concerned with rehearsing disappointments, not practical enough, and lacking in accountability.
No right or wrong
Different therapies are good for different things and different people. In the end, it’s seldom a case of ‘right or wrong’ but where you want the balance to be. Of course, you’ll likely want a mix of support and challenge, but you will have a natural tendency to prefer one more than the other. That's the bit to take seriously and be honest with yourself about.
Therapy is hard. You won’t always want to show up for your sessions and you won’t always enjoy them. Given that no single treatment works for every issue or every person, make sure you choose one that matches your preferences.
Therapy works, when it’s tried and tested, matched to your problem, delivered by a qualified professional, and suited to you.
To find a therapist, visit the Psychology Today Therapy Directory.
