What kind of therapy is right for you?

Your experience in therapy is going to vary greatly depending on the theoretical orientation and underlying ideas that your psychotherapist holds. Different psychotherapists and different theories of psychological healing can vary vastly, and therapy is not a one size fits all solution. Many times I’ve heard people say that past treatments did not work for them because their expectations and what the therapist offered did not match up. I believe it's important to understand some of the basic underlying assumptions that different approaches to psychotherapy hold, and how they might change your experience in therapy.

One way to think of these differences is to think of an axis with “behavioral therapies” on one end, and “insight oriented” or “depth” therapies on the other. Most therapists can be situated somewhere between these zones, and understanding the difference can help you figure out what you are actually looking for. As a depth oriented therapist, I’ll admit some bias from the start in how I’ve framed this, but I do intend to offer an honest way to think about the differences between certain kinds of therapies.

Behavioral psychotherapy

Behavioral therapies include CBT (cognitive behavioral therapy), DBT (dialectical behavioral therapy), ACT (acceptance and commitment therapy), and others. These therapies are first and foremost focused on changing the presenting problem or behavior of a patient. If you come into therapy struggling with depression, a behavioral therapist will typically apply a structured set of tools and strategies aimed at reducing your symptoms. Sometimes you will get a workbook or set of written exercises, or homework to do between sessions. The goal is measurable change on a defined problem.

Behavioral treatments have their place, particularly when someone is suffering acutely and needs direct, structured support.  People suffering from acute issues like eating disorders, addictions, obsessive compulsive disorders, and panic disorders, may initially appreciate the structured and direct approach of behavioral treatments. But some people can complete a course of behavioral treatment and feel that something has been missed. People who are looking to not just change their behavior but also understand themselves on a deeper level might end up seeking out a different kind of experience.

Depth-oriented psychotherapy

On the other end of the spectrum from behavioral therapies lie what I will call “insight oriented” treatments. These include psychoanalysis, psychoanalytic psychotherapy, psychodynamic therapy, as well as any range of relational, humanistic, Jungian, and depth therapies. Unlike behavioral treatment, insight oriented treatment is fundamentally interested in understanding the symptom before jumping to trying to change it with a tool or strategy. Depth therapies begin from a different premise: that your symptoms are trying to tell you something about your inner life. The goal of a depth oriented therapy then becomes to try to understand what might be outside of your awareness in your unconscious mind that is resulting in the apparent symptom you are suffering.

Using the same example of the depressed patient who comes to see a therapist, this time with a psychodynamic orientation, the therapist won’t give you an exercise, suggestion, or workbook, instead they will take their time to deeply consider and try to understand the depression and what it might symbolize in your life. The depth oriented therapist will assume that the depression is not an isolated problem, but will view the depression as an expression of a deeper dynamic at play. The psychodynamically oriented therapist will work together with you to understand and map the territory of your inner world, and critically, what childhood experiences might have led you to organize yourself in this way, in order to gain more insight into the psyche.

When we take the time to try to understand before jumping to change something, we can accomplish more lasting and fundamental changes to who we are at our core. Most people already know how to do a breathing exercise when they are anxious, or they know they should get sunlight, exercise, and eat healthy to tip the scales of their depression. Most people seeking therapy aren’t just looking for someone with more ideas and better tools for you to apply in your life. What many people are looking for is a different kind of experience. They are looking for a space in therapy to speak to and from new parts of themselves that they might have never explored before. They are looking for a therapist who is flexible and patient enough to go into deep parts of their psyche and help them gain insight, and over time reorient the fundamental structure of who they are.

Finding the right fit

Whether you seek understanding, or immediate change through tools and strategies, there are a wide variety of psychological approaches available to you when you seek out psychotherapy. Some therapists will be able to help you with what you are needing, and others may offer something of value that is not quite what you are looking for at the moment. Don’t just assume that because someone is a highly credentialed therapist they will be able to help, take the time to consider for yourself what you are really looking for in therapy and ask prospective therapists how they approach their work.

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Connor Moss, LMFT is a psychodynamic psychotherapist practicing in Santa Cruz, CA. He offers couples therapy and individual therapy for trauma and PTSD, depression, addiction, anxiety, and more. He welcomes inquiries from new clients and can be reached at (831) 204-0131 or online.