For those suffering from anxiety, it can feel insufferable. People often reach the point where they would do anything not to feel a constant sense of fear, agitation and anticipation. The physical side effects are draining, and the intrusive thoughts and constant rumination exhausting.
Anxiety disorders are complex problems that cannot be solved simply and while many people seek a fast and easy cure through medication, sadly there is no “magic pill”. Medication works at a superficial level by dampening down the physiological (or in some cases, depending on the medication, cognitive) symptoms of anxiety, but doesn’t address the underlying psychological issues which need to be addressed through psychological approaches. That is where therapy comes in.
1. Ask for recommendations
Ask anyone you know if they know of a therapist they can recommend. You could also go on forums, websites or other social media and seek advice from peers who may have a recommendation.
2. Choose a therapist based on their mode of therapy
There are a range of psychological therapies in use for anxiety:
- Cognitive behavioral therapy is the most widely-used and accepted therapeutic approach for treating anxiety disorders. Considerable research has been carried out into CBT and it is effective as a treatment for many anxiety disorders. CBT sets out to change negative patterns of behavior and address cognitive distortions in the way we view ourselves and the world around us.
- Exposure therapy is a behavioral approach which involves repeated contact with the thing that feeds your anxiety. The rationale of treatment is that over time, repeated exposure to the situation reduces the associated anxiety. The idea is that the fear can be unlearned by effectively separating the associated stimulus and response.
- Acceptance and commitment therapy (ACT) posits that the meaning and significance we give to thoughts reinforces emotional distress. It draws heavily on the basis of CBT, but it is different in that it accepts and embraces thoughts that CBT would hold as dysfunctional and in need of repair. So rather than the focus being identifying, challenging and correcting thoughts that may be causing or reinforcing anxiety, ACT encourages people to view them without emotion and in a “matter of fact” way. Rather than fighting distress, people are encouraged to accept it and learn to follow a life based on values that are important to them instead of allowing their symptoms to dictate their life. Meditation and mindfulness are therefore a key part of this approach as the person moves towards acknowledging their thoughts without judgment or avoidance.
- Dialectical behavior therapy combines individual therapy with skills training group-work. The focus is on helping people manage intense emotions more effectively, better manage interpersonal relationships, and enhance their ability to cope with emotional crises. This therapy teaches patients to manage conflicts in life that are concerned with dialectics or polar opposites (usually to do with change and acceptance) and finding a balance in those situations, so avoiding the “all or nothing” script. The four components of therapy are mindfulness, tolerance of distress, emotional regulation, and interpersonal effectiveness.
- Interpersonal psychotherapy is a brief (attachment-focused) psychotherapy that draws both on psychodynamic and CBT traditions. It focuses on interpersonal relationships as a cause of mental distress – holding that our psychological difficulties are a response to difficulties we experience when interacting with others. The aim of IPT is to enable the person to develop better interpersonal and intrapersonal communication skills in their relationships through identification of emotions, healthier expression of those emotions and exploring how past relationships affect your current interactions.
- Solution focused brief therapy is different to many therapeutic approaches as it is solution rather than problem-focused and is goal-directed. The future is a key focus of the approach and it encourages people to consider preferred futures and aims to help them uncover the changes they need to make to achieve those goals. It is less about the therapist as expert but posits that the individual has the answers or solutions to their own problems and just needs the right questions asked to help uncover them. A person has no need, in a way, to talk about their problems.
- Mindfulness-based approaches include mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive behavioral therapy (MBCT). MBSR brings together various elements of Eastern meditation practices and merges them with western psychological theory; and MBCT combines mindfulness components such as breathing, meditation and yoga stretches with cognitive therapy elements.
- Psychodynamic psychotherapy is focused on learning to understand, acknowledge and express emotions and understanding how earlier emotions and experiences that have been repressed affect the present. The relationship between the therapist and client is used as part of therapy to help the person understand how they interact with others.
3. Biological sex of the therapist and other cultural issues
This may or may not be important to you, but it is worth thinking about in advance as you may reflect on difficult relationships you may have had and if sex or cultural background/ethnicity was a factor, choose to avoid that in case of conflict or damaging the therapeutic relationship in any way.
4. Call and speak to potential therapists
There are many questions you might ask which are worth thinking about. You might want to ask potential therapists if they have experience of working with your difficulties and what approach they use, alongside other practical considerations such as when they are available.
5. Notice how you feel when talking to a therapist
This is important, as while sometimes first impressions can be faulty, our instincts are often good indicators and worth listening to.
6. Meet your therapist in person
- Would I feel comfortable opening up to them and sharing private, uncomfortable feelings or experiences?
- Do I feel at ease and safe in their presence?
- Do I like the way they are towards me? Do they seem genuine and respectful?
The most effective tool in therapy is the "therapeutic alliance" and what has the greatest influence on outcome is the relationship the person has with the therapist.
7. The process of choosing a therapist may take some time
It may take you a few sessions to realize you are not comfortable or that you are not making the progress you would like. There are certain things that may serve as indicators of an unhelpful therapist:
- The therapist talks more than you do.
- They frequently interrupt you.
- They behave inappropriately or have unclear boundaries.
- They do not maintain confidentiality.
8. There may also be practical considerations
Depending on where you live, you would need to check if the therapist is licensed or accredited by a training body. You may be using insurance to pay them so would need to check if the therapist you are considering accepts that and if the insurance places any limitations on sessions. There are now websites designed to help with the process of finding a therapist, including ones affiliated with accredited bodies, that may also assist you in your search.