Therapy isn’t one size fits all. Here’s how to find what works best for you.
It’s taken a while, but mental health is finally starting to be taken seriously. Celebrities talk openly about their struggles. Politicians specifically mention mental health in discussions on improving healthcare. And the idea of seeking therapy is no longer stigmatized the way it once was.
More and more — particularly in the United States — there’s been a push to define mental health concerns as medical concerns. While mental health is an essential part of overall health — and mental illness is illness — selecting a therapist or mental health provider is not the same as selecting a doctor.
Here are some key differences that might help you find the right therapist:
Diagnosis is subjective
Medicine looks for a symptom’s cause, attempts to address the cause, and moves on. Mental health diagnoses don’t exactly meet this formula. No matter how much the insurance industry and our Western culture demands correct identification of mental and emotional problems, mental health diagnoses are simply descriptions of how someone appears or experiences things.
There are no definitive tests for common mental health disorders and descriptions of disorders have changed over time. Some people find medicalized diagnoses such as depression or anxiety helpful. These people should seek a therapist who is oriented to pinning down and working within those diagnoses. Others want help with trouble getting out of bed or following through on things and will do better with a therapist who takes those self-diagnoses into account.
Treatment must be customized
While many people experience unusual or difficult-to-diagnose medical conditions, the majority of diagnoses and treatment paths are relatively clear. If you have a sore throat and go to the doctor, they’ll test to see if it’s bacterial or not. If it is, they’ll prescribe antibiotics. If not, you’ll get advice on how to endure the discomfort until it passes.
Mental health diagnoses can be tricky, with a host of possible causes but no blood test or scan to pin them down. Different practitioners will approach reducing those symptoms in very different ways. Medication, mindfulness, talk therapy, and exercise have all been shown to be helpful — usually in combination. But, what’s life-changing for one person may not help someone else.
And as with diagnosis, when it comes to talk therapy, there’s a lot of variation in terms of philosophies, approaches, and techniques. While we fortunately have some broad information about how certain approaches are effective, the most important thing is that your therapist’s approach works for you.
Back to the sore throat analogy: You feel awful, so you head to urgent care. While you’d like to see a doctor who’s warm and compassionate and totally gets that you have a full week of work ahead of you and your kid’s baseball team is in a tournament and you don’t have time to be sick… it ultimately doesn’t matter if the doctor has zero bedside manner. You just want to know: Will antibiotics help or do I need to cancel my life for a few days and go to bed?
Not so for mental healthcare. In addition to connecting to your therapist’s approach, the therapist must be someone you can, well, talk to.
As a therapist, I’ve met so many people who endured therapy that wasn’t helpful because they didn’t think they could actively choose someone who felt good to work with. Some people thrive with a therapist who confronts and challenges them. Others need warmth and acceptance to open up vulnerable areas and get to work. Some people need humor and others will feel like their concerns aren’t being taken seriously if the therapist cracks a joke.
Culture and context are key
Western psychology emerged in a cultural context that focuses on measurable causes and effects, and prioritizes individual agency and responsibility. This has led to assumptions about both the causes and options for addressing mental health. However, we don’t experience our lives outside of our contexts and mental health especially is influenced by social circumstances.
This is particularly true for people experiencing marginalizing or scary things — think systemic racism, LGBTQ discrimination, anti-Muslim rhetoric — in their everyday lives. It’s important that therapists look beyond what the individual is doing about their internal experience and see how their life context might be contributing to their mental health.
You decide when you’re done
Returning to the sore throat, the doctor decides to prescribe antibiotics. You must take them until they’re gone — then, you’re done. For more serious medical diagnoses, one test identifies the problem and then follow-up tests tell you how a disease is progressing, or how well treatment is working. There are usually some objective data points that the doctor uses to tell you when you’re better.
In therapy, the client sets the goals and ultimately decides when they’ve come to a place that’s workable for them. Even with very challenging mental health problems that have relatively clear diagnostic criteria and medication treatments — such as paranoid schizophrenia or bipolar disorder — psychotherapy is only useful if the client finds it helpful.