I’d like some therapy but which one do I choose?
If you’ve decided you’d like to try some therapy, you may be feeling confused by the different options out there. It can seem like a minefield. The British Association for Counselling and Psychotherapy lists more than 30 different types of therapy – so where do you start?
Here, we focus on two of the most established therapeutic approaches: Cognitive Behavioural Therapy (CBT) and psychotherapy. These therapy types support people to develop the all-important skill of psychological flexibility and mindfulness which are proven skills in improving mental health and emotional well-being.
Cognitive Behavioural Therapy (CBT)
CBT is a widely used technique that focuses on identifying negative thought patterns and behaviours, then working to change them. It doesn’t necessarily involve exploring why these thought patterns exist; instead it offers practical tools and techniques to tackle them. There are often specific goals in mind and sessions may take place over 10-12 weeks, but can be longer. CBT has evolved since it first emerged in the mid 1900s and now includes new approaches which go beyond changing thought patterns and promote acceptance, psychological flexibility and emotional regulation.
What to expect in a CBT session
Clients may be encouraged to identify the specific thoughts that cause distress and explore how they affect behaviour. For example, the thought could be “people don’t like me” and this results in avoiding social situations. The therapist may help the client to challenge and re-frame this thought. This could be supported by practical techniques to help the client overcome their barriers. For example, therapists may suggest an anxiety ladder to help the person, in this example, work up to attending a social occasion in a way that feels achievable and manageable. There also might be ‘homework’ to track specific thoughts and feelings throughout the week. This may involve recording instances when they feel upset or anxious and practise replacing negative thoughts with more balanced ones.
Acceptance and Commitment Therapy (ACT)
ACT is a branch of CBT and encourages people to accept their thoughts rather than fighting them. There is a big focus on exploring personal values and helping clients to discover the behaviours that embody those values. With ACT, clients learn mindfulness practices that help them stay focused on the present moment and accept thoughts and feelings without judgment.
What to expect in an ACT session
A therapist might begin by helping the client identify their core values such as joy, compassion or creativity and then exploring what they could do more of to support those values. This process involves identifying patterns of trying to control or avoid thoughts and feelings, particularly those that disrupt living life by your values.
ACT uses metaphors and exercises that reveal thoughts to be less powerful than previously believed and this is achieved through acceptance. For example, the therapist may invite you to write a difficult thought down; the card is handed between you to represent the struggle to accept it before you finally receive the card into your lap where you can practise having contact with it.
As the sessions continue, clients are encouraged to set goals that are directed by their values and this may involve exercises where they imagine a future event or experience to be. As individuals pursue their goals, they are equipped to deal with the thoughts and emotions that arise as perceived barriers.
Dialectical Behaviour Therapy (DBT)
Dialectical describes a way of discovering the truth by considering opposing ideas. Its main goals are to help people live in the moment, develop healthy ways to cope with stress, regulate emotions and improve their relationships. It’s particularly effective for people who are struggling with intense emotions.
What to expect in a DBT session
Sessions will involve practising mindfulness techniques to help you pay attention to what is happening inside you as well as tuning into the world around you. These skills help you slow down and stay calm in difficult moments.
You will also work on building your distress tolerance skills so you are better equipped for handling intense emotions. These could include distraction, self-soothing and tools you can use to improve the moment.
DBT sessions may also involve interpersonal skills exercises to help you say what you need while maintaining healthy and positive relationships.
Emotional regulation is another key area of focus so that you learn to identify, name and cope with intense emotions. One exercise is called ‘opposite action’ where you could be invited to identify how you’re feeling and take action in the opposite way – for example socialise if you are feeling sad.
Psychotherapy
While CBT explores changing your relationship with your thought patterns, psychotherapy is all about examining the root of issues which involves delving into the unconscious mind and past experiences to understand how they influence behaviour and feelings. Some may feel that their experience isn’t serious enough to justify psychotherapy but anyone can benefit from understanding more about how they see the world and why. It takes a less structured approach than CBT techniques so that, over time, you can make sense of things that have happened in your life, not what is wrong with you.
The aim is to improve self-awareness and insight so that you can foster positive change in your life and improve the relationship you have with yourself.
What to expect in a psychotherapy session
Sessions involve talking about an emotional or behavioural difficulty. Therapists are trained to help you express your thoughts and feelings and explore what comes up when you do. The focus is on compassionate listening. Some therapists will help you to talk generally about what’s going on for you and others will have specific exercises to do together. They may ask questions to help you see things differently and there is often a focus on unresolved childhood experiences.
Your therapist might suggest activities alongside your sessions such as journaling or creating a plan together to manage a particular challenge. Therapists may use a variety of techniques during the sessions such as role-playing, visualising or bringing awareness to the breath and body.
To sum up
The simple act of talking can be transformative. When choosing what to go for, consider what you will respond best to. Are you someone who prefers a practical, goal-orientated approach? If so, CBT is a good option. If you feel there are unresolved feelings in your life that you want to explore in a safe environment, psychotherapy could help you do this. Whatever you choose, remember, change takes time. Personal growth doesn’t happen in a neat line, there will still be bad days when things feel messy but, with time, talking therapy can unlock our unhelpful thinking and behaviours so that we feel better.