Therapy is about helping you get clarity and insight around what you want for yourself and how your mental health provider can help you define and reach your goals within your value system and framework.
Each mental health provider has their own style, or approach to counseling, and it’s best to ask them about their approach to mental health therapy prior to booking an appointment here. You can read more about the different types here. Also, you can always request a free phone consultation to ask the provider any questions you may have and also to see if you feel you would click with them (see What to Look for in a Mental Health Provider.)
WHAT THERAPY IS NOT
Therapy is not about your mental health provider judging you, telling you what to do and giving you advice. Nor is therapy where you just come in and talk for 50 minutes (or for however long) and then leave. Therapy is also not a quick fix or a magic pill. It’s also not about therapists “fixing” people. As much as therapists would like to have a magic wand to help everyone struggling, therapy takes time. There is also no specific time frame a therapist can give regarding when a person will get better or when marital distress will decrease.
Some approaches, such as Cognitive Behavior Therapy, are described as short term therapy with the goal to address the concern within 12 sessions. However, it may take longer depending on the person, the problem and other factors. Also, during the therapy, a mental health provider does not give advice or tell a client (individual or couple) what to do.
Finally, ethically, therapists can not attempt “conversion therapy” which is therapy to “convert” someone who identifies as LGBTQ to being heterosexual. Some states in the US have legal mandates in place making conversion therapy illegal. This is important for Muslim parents to know as even though your child’s therapist may be Muslim, they cannot ethically, and may not legally, be allowed to perform conversion therapy on your child.
MODES OF THERAPY
There are different modes of therapy you can seek out. Knowing which type of therapy you are interested in will help you in your search for a provider.
- Individual Therapy
The mental health provider works with individuals one-on-one.
- Couples Therapy
The mental health provider works with the couple to address issues impacting the relationship and emotional connection. The two research-based approaches with high success rates are the Emotionally Focused Couples Therapy (EFT) and The Gottman Method.
- Premarital Counseling
The mental health practitioner works with the couple to discuss key issues to determine similarities and differences between the couple and how to approach difficult issues in a healthy manner of communication. There are multiple premarital counseling assessment tools including SYMBIS (Saving Your Marriage Before It Starts), PREP/ENRICH, and the Gottman Relationship Checkup. The mental health provider must be trained in administering that specific inventory. After the couple takes the assessment (separately), your mental health provider will review the results with both partners.
- Family Therapy
The mental health provider works with the entire family to address family dynamics to help with emotional connection and increase communication. While Licensed Marriage and Family Therapists are trained to work with families, other providers can also do family therapy as long they have received training for working with families.
- Group Counseling
Group counseling can be very effective. Therapy groups are usually small (six to eight individuals) and can be run by two therapists. Therapy groups can be educational (stress management), explorative (processing the grief over the loss of a child) or one where individuals with different issues meet to discuss their concerns and get support from each other. While group counseling can be challenging because of having to share with many strangers, group counseling can also be very rewarding.
- School-Based Counseling
Schools offer counseling at school for their students during the school day instead of the child or adolescent having to go to an office outside of school. Usually, the school contracts with other mental health providers who come in to provide those services. The school must obtain legal consent from the parents for children under 18 to provide those services in the school setting.
- Distance Therapy
Many therapists offer online therapy as more and more insurance companies are allowing it as an option. Therapists must use a HIPAA approved platform (Skype, Google Hangout and Facetime are not HIPAA approved). Often the provider will have the client sign an additional form to allow this type of therapy. It is important to note that mental health therapists, of most licenses, are not allowed to cross state lines to provide counseling unless they are licensed in the state where the client lives and if there are specific circumstances such as the client having moved from the state where the therapist currently is to a new one. In the second situation, your therapist needs to verify with the boards of both states to confirm it is allowed.
- Home-Based Therapy
In-Home Therapy (IHT)- In order to make mental health more accessible for everyone, many states are working towards offering IHT, especially for children, mothers with newborns, and other individuals based on certain factors. IHT times are set up by the therapist and client (or the client’s parent) for the therapist to meet with the client at their home.
- Residential Treatment
There are types of mental health treatment offered with the requirement or option for the individual in treatment to live at the program site. There is usually a full staff including a medical team, mental health treatment team, and in the case of children and adolescents, educators to help them with school. Treatment in this setting includes in the treatment plan individual client, family and group counseling.
- Applied Behavioral Analysis (ABA)
ABA is usually home-based, school-based or done in a therapeutic school for individuals with autism. The reason why it is usually offered at the child’s home or school is to allow the child’s parents flexibility when scheduling appointments and to give the individual treatment in a place they are familiar with.
UNDERSTANDING THE THERAPY PROCESS
- What happens in the first few sessions?
There is a general structure followed by practitioners which is listed below. (Please note, each provider will have their own structure, so please verify with them when you are scheduling an appointment).
- Prior to your first session
- At your first session
If you did not sign any documents prior to your first appointment, you will sign the necessary paperwork during your first session. If you did sign documents prior to your appointment, your therapist will review them with you, especially key issues such as confidentiality and its limits. The first session usually involves the therapist completing your intake: your current concerns and issues, past mental health history, family history, etc. The intake may proceed into the next session if needed.
- Subsequent sessions
Your mental health therapist will work with you to develop treatment goals to work on in your sessions together.
- As you continue therapy
You and your therapist will work together to achieve the goals you have set out for yourself in your treatment plan. With time, you may decide to add on other goals or remove some goals. Your therapist will check in with you periodically to help you explore how much progress you have made towards your goals.
- Are treatment plans and goals necessary?
Treatment goals are necessary to reach your goals and measure your progress. Figuring out your treatment goals is a collaborative process: you identify what you want to work on with your therapist. Treatment goals/plans are not final in that you can modify them with your provider as you see fit. The general consensus is that treatment plans are important as they help your therapist guide the session towards the goals.
- How do I know if therapy is working?
It’s important to remember that therapy takes time. Progress is not necessarily linear in that you might find yourself sometimes struggling with something you thought you had fully resolved. In those situations, it’s important to bring it up to your mental health provider. You can also tell if therapy is working if you feel you are learning new skills and techniques to help yourself, if your therapist is engaged and willing to challenge you gently to help you understand more of your struggles and how you view things. You can also tell if therapy is working if you find that you have more clarity about your struggles and notice some alleviation in your initial symptoms.
- What can I do to get the most out of therapy?
There are three key things you can do to make the most out of therapy: attending your sessions consistently, being engaged in session, and being open with your mental health provider. Mental health providers are aware that it takes time to build trust and it takes time for a person to open up and share deeper feelings and thoughts. They will do their best to help develop that relationship of trust with you. It’s also important to remember that change is determined by how much work you put in. While talk therapy once a week is great, it is really helpful to try some of the techniques your provider is suggesting or teaching you in between your sessions. Regarding consistent attendance, sometimes issues may arise that might make it difficult for you to attend consistently. It’s helpful to discuss these issues with your provider.
- Are medications mandatory?
Your mental health provider will discuss medications and whether medications will be helpful for you. For some mental health disorders, medications are necessary for stabilization. However, this is best discussed with your provider. If you are working with a therapist, your therapist may refer you to a psychiatrist or APN so you can discuss medication.
- Does my mental health provider diagnose me? Who knows about my diagnosis?
Your mental health provider does diagnose you, especially when insurance is being used for reimbursement. Unfortunately, insurance companies in the US do not reimburse unless there is a diagnosis. It is your right to ask about the diagnosis and have your questions about your diagnosis answered. If you are using your insurance benefits for therapy, your insurance company will know about your diagnosis. If you get your insurance through your employer, know that your employer will not know about your diagnosis. (Please also see the section “Understanding How Your Insurance Works” to see why some people decide not to use insurance and how some high clearance jobs may find out about your diagnosis).
- How long does therapy last?
The duration of therapy varies based on your work with your mental health provider, your goals, your progress and your mental health provider’s approach to therapy. Some therapists focus on providing short-term therapy (using, for example, CBT). Other therapists are willing to see the client as issues arise, new treatment goals are formed and met. Clients can discuss with their provider when they feel they might want to decrease how often they meet with their provider and then when to terminate therapy. With your psychiatrist, depending on your diagnosis and what your psychiatrist says, you may meet with them continuously for medication management.You might want to terminate therapy for other reasons besides feeling you have made progress and met your goals. You might be considering terminating because you feel you are no longer benefiting from working with this particular provider. You might also want to terminate if you feel that something is wrong and that your relationship with your therapist is causing you more harm than good. Ultimately, it is your right and decision to terminate when you want to.
- What if I don’t like my mental health provider and would like to switch?
Sometimes, clients realize after the either the first meeting or some time after that they are not completely happy or comfortable with their mental health provider. It is your right as a client to switch providers if you want to. It’s always recommended that you share your concerns with your provider first to see if it’s something that can be resolved. It’s also understandable when someone feels uncomfortable sharing their feelings with their provider. Either way, it is your right to find a new therapist. In community outpatient offices, it might be harder to get someone different but it is still your right to ask.
- What if my therapist says something hurtful or does something I don’t find helpful?
Sometimes we mental health providers make mistakes. We might say something you find hurtful, or misunderstand, or suggest techniques you don’t find helpful. While a good mental health provider does check in with the client when they notice a shift in the relationship, sometimes they may not realize it. It is your right to bring up your concerns and a good therapist must acknowledge your feelings and process the experience with you.
But if your provider does something unethical which is harmful to you (trying to initiate sex, friendship outside the office and insurance fraud are a few examples), it is your right to file a complaint with their state licensing board so they will be reprimanded as needed and not cause further damage to others.
DIFFERENT APPROACHES TO COUNSELING
- Acceptance and Commitment Therapy (ACT)
ACT focuses on acceptance and mindfulness, along with behavior changes, to help one become more psychologically resilient and flexible. ACT is an empirically based treatment approach found to be effective with multiple disorders.
- Adlerian Therapy
Adlerian Therapy is an approach that is brief, goal-oriented and centered on the idea that every person is innately good. Adlerian therapy emphasizes every individuals’ struggles and desires for success, connectedness with others, and contributions to society and how all three are indicative of mental wellness. Adlerian therapists’ help clients come up with strategies to overcome obstacles in their path to their goals. Adlerian therapists’ believe that when a person gains more insight into their struggles and challenges, their feelings of inferiority decrease.
- Applied Behavioral Analysis (ABA)
Applied Behavior Analysis (ABA) is a type of treatment that focuses on using learning behavior and applying it to help individuals with psychological disorders, specifically across the autism spectrum, learn specific skills. Specific skills of focus range from social skills, reading, academic, hygiene and job competence, among others. ABA can be provided by practitioners at schools, homes, office settings and residential treatment centers. Research shows the effectiveness of ABA for individuals with special needs.
- Art Therapy
Art Therapy combines art and psychology by using creative art making in therapy as a means to help individuals develop insight, self-awareness, raise their sense of self worth, address unresolved emotions and explore emotions. The goal of art therapy is to help clients experiencing emotional and psychological struggles achieve overall wellness.
- Attachment-Based Family Therapy (ABFT)
ABFT is a type of family therapy, grounded in attachment theory, in which a mental health professional aims to help a parent and a child repair and build an emotionally secure relationship. Attachment theory is based on the idea that humans need to form secure attachment figures throughout their life.
- Cognitive Behavioral Therapy (CBT)
CBT is a brief therapy approach that focuses on the relationship between beliefs, thoughts, and feelings, and the behaviors that follow. In CBT, the therapist teaches new techniques and strategies to help the client identify their negative thoughts, learn new healthy behaviors and healthier ways to address difficult feelings.
- Compassion-Focused Therapy (CFT)
CFT focuses on developing compassion towards oneself and others. Compassion-focused therapy is usually integrated with other therapy approaches. Self-compassion has been found to help.
- Dialectical Behavior Therapy (DBT)
DBT focuses on providing clients with skills in four main areas: mindfulness, distress tolerance, emotion regulation, and finally, interpersonal effectiveness. The goal of DBT is to help the client learn these new skills to manage painful emotions and decrease conflict in relationships by learning to regulate emotions in a healthier manner, increase their ability to accept distressing situations, be more mindful, and learn new, healthy communication patterns.
Ecotherapy is based on the idea that humans have a strong connection to using nature in therapy to help individuals move towards healing. Ecotherapy interventions can range from taking walks in the park to listening to ocean waves. Ecotherapists propose that being connected with nature is essential to people’s well-being.
- Emotionally Focused Therapy (EFT)
EFT is a research-based approach designed to address emotional distress in intimate adult relationships. EFT is based on the theory of attachment and the bonding process in couples. EFT can also be applied in work with families and individuals. The ultimate goal of EFT is to help couples and families develop secure and lasting bonds between each other. The EFT therapist works with the couple to help them develop a safe environment where they can be more secure and vulnerable with each other.
- Existential Psychotherapy
Existential Psychotherapy focuses on the entire human condition from a holistic perspective and the capacity for each person to develop their own maximum potential. A person’s limitations are acknowledged and recognized, while a person’s capacities are celebrated. Existential Psychotherapy takes into account existential questions, including the meaning of one’s life and one’s purpose.
- Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is a research-supported therapy approach designed to treat trauma and post-traumatic stress. In order for a mental health provider to use EMDR with a client, they must have had training. EMDR is used by mental health providers to help the client process unresolved memories from traumatic experiences. EMDR can be integrated with other types of therapy.
- Family Attachment Narrative Therapy
This approach is based on the principle that trauma, abuse, and neglect early in life can significantly negatively impact a person’s attachment, development, and relationships in life. Family attachment narrative therapy aims to address and heal the long-term effects of childhood trauma. This approach is used with individuals between the ages of 3 to 21 who are struggling with adoption, display disrupted attachment, or have a history of childhood trauma. Therapists who use this model incorporate the child’s caregivers to help address the needs of the child or adolescent.
- Gestalt Therapy
Gestalt Therapy is a person-centered approach of therapy to help clients understand how their own negative thought patterns and behaviors are making them unhappy. Gestalt Therapy focuses on what is happening in a person’s life in the present instead of talking about past situations. Therapists who follow this theory help clients re-enact past experiences to help them experience them and process them.
- The Gottman Method
The Gottman Method was developed by Dr. John Gottman and Dr. Julie Schwartz Gottman after decades of researching couples. It is an evidence-based form of couples therapy that aims to help couples become closer by strengthening their friendship, conflict management, and creating shared rituals/meanings.
- Humanistic Psychology (humanism)
Humanism is based on the idea that people are innately good. This branch of psychology proposes that the driving forces of behavior are morality, ethical values, and good intentions. On the other hand, negative social or psychological experiences can be attributed to deviations from the natural disposition and tendencies. This approach also emphasizes the goal of self-actualization–each individual reaching their full potential.
- Integrated Approach
The integrated Approach is when therapists draw from multiple theories to form their own cohesive approach to working with clients. Some counselors use the phrase “eclectic approach” instead.
- Internal Family Systems (IFS)
IFS is an evidence-based approach that is based on the Family Systems theory: the idea that individuals cannot be completely understood without understanding the family unit. IFS focuses on developing strategies and techniques to address an individual’s internal community or family. IFS proposes that each individual is composed of multiple parts and in order to heal, each part must be understood. IFS certified therapists attend rigorous training to become certified as an IFS therapist.
- Jungian Therapy
Jungian Therapy is based on the founder Carl Jung’s belief that each person strives to achieve wholeness by attaining harmony within their consciousness and unconsciousness. Jung proposed that dream study would be the way to accomplish this harmony.
Logotherapy is based on the idea that human nature is driven and motivated by the search for a life purpose. Logotherapy helps individuals find meaning for their life. Victor Frankl, a survivor of the Holocaust, is the founder of this type of therapy
- Mindfulness-Based Cognitive Therapy (MBCT)
MBCT combines CBT techniques with mindfulness techniques to help individuals better understand and manage their thoughts and emotions while cultivating mindfulness.
- Narrative Therapy
Narrative Therapy focuses on helping individuals explore the meaning the individual has assigned to their personal life stories to help them discover their life purpose. Narrative Therapy has been especially helpful for older adults.
- Parent-Child Interaction Therapy (PCIT)
PCIT is a behavior-based, family-oriented therapy with the goal to improve parent-child interactions. The focus is on helping parents develop effective parenting techniques. The ultimate goal is to lead to a reduction in behavior issues and may also lead to stronger familial relationships. This therapy is often effective with children who have behavioral issues or are at risk.
- Person-Centered Therapy
Person-Centered Therapy was a huge shift from the traditional psychoanalytical model of therapy where the therapist was perceived as the expert. The founder of Person-Centered Therapy emphasized the need for mental health therapists to empower individuals by being empathetic, authentic, and genuine. The founder of person-centered therapy promoted the idea that therapists must hold their clients in unconditional positive regard –the idea that the client has innate self-worth and value. Many theoretical approaches developed later were influenced by Person-Centered Therapy and the idea that every human being has the capacity to fulfill their own potential.
- Play Therapy
Play Therapy is a form of therapy that uses play, considered as children’s primary “language,” to help them better express themselves and address and resolve their issues, including unresolved trauma. Play Therapy is used with children, primarily ages three to twelve. Play Therapy helps children communicate, explore thoughts and emotions, and experience personal growth. Play Therapy is considered an effective treatment approach for children.
- Psychoanalytical Therapy
Psychoanalytical Therapy was founded by Sigmund Freud. Psychoanalytical Therapy is usually a lengthier type of therapy. The main goal of this therapy is to bring unconscious material into consciousness and enhance one’s functioning of the ego so that the individual becomes less controlled by biological drives.
- Psychodynamic Therapy
Psychodynamic Therapy is also known as insight-oriented therapy. This approach focuses on helping the person get more insight and awareness of their unconscious processes manifesting in their present behavior. The goal of Psychodynamic Therapy is to help increase awareness of how the person’s past is affecting and influencing their current behavior.
- Object Relations Therapy
Object Relations Therapy is considered an offshoot of psychoanalytical theory with the premise that humans are driven primarily by their need to form relationships. The goal of therapists who follow this approach is to help the client uncover early mental images or experiences that are contributing to present challenges in their relationships with others. The ultimate goal is to help the individual improve their interpersonal functioning.
- Rational Emotive Behavioral Therapy (REBT)
REBT focuses on the development of rational thinking and learning to new healthy behaviors in order to develop healthy emotional expression. REBT laid the foundation for the development of CBT.
- Reality Therapy
Reality Therapy is founded on the principles of choice theory. The premise of reality therapy is helping the person realize that it is only through choosing to change one’s own behavior rather than trying to change someone else’s, that one can make more strides and be more successful in attaining their goals.
- Sand Tray Therapy
Sand Tray Therapy is a form of expressive therapy that is often used with children, although it can be used with adults, teens, couples, families, and groups. Sand therapy helps the person to address and resolve conflicts and gain self-acceptance via the construction of their life with sand and miniature toys.
- Sensorimotor Psychotherapy
Sensorimotor Psychotherapy is an approach that aims to address the somatic symptoms of unresolved trauma. The trained therapist who uses this approach focuses on the bodily experience of the individual to help improve mental health by healing the unresolved trauma. Therapists trained in the techniques of this approach help the individual begin to heal by helping that person re-experience, in a safe environment, the physical sensations associated with a traumatic event. The basis of using bodily experiences is the argument from proponents of this approach that traditional talk therapy may not be helpful in uncovering the underlying, deeply seated issues around unresolved trauma.
- Solution-Focused Brief Therapy (SFBT)
SFBT is a goal-oriented approach where the focus is on the client’s present and future circumstances instead of past experiences. Also, SFBT focuses on helping the person identify and determine the skills and abilities to achieve their goals and aspirations.
- Somatic Experiencing® (SE™)
SE was developed to address the impact and effects of trauma. When stressed, individuals often override natural ways of regulating the nervous system with feelings of shame and pervasive thoughts, judgments, and fears. Somatic Experiencing works to help individuals move past the place where they might be “stuck” in processing a traumatic event.
- Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
TF-CBT is an evidence-based therapy model developed to help children, adolescents, and their families overcome and address the negative effects of a traumatic experience. Research shows that TF-CBT is effective in resolving a broad range of emotional and behavioral issues associated with trauma experiences.
- Transactional Analysis
Transactional Analysis is a form of modern psychology that combines some ideas from Freud’s theories of personality and the founder of transaction analysis’ observations about human interaction. This theory examines a person’s relationships and interactions to help establish and reinforce the idea that each person is valuable and has the potential to change and grow.