Updated: May 13
When is therapy helpful?
I'm a huge fan of going to therapy, but it's good to know when it's going to be most helpful or when something else, like working with a life coach or support group, might be more helpful.
To help with the decision-making, here are some of the differences between coaching and therapy:
Working with a life coach, the coach delivers the content and facilitates an experience related to their specialty or expertise
In therapy, the work is client-guided. So if you were going to therapy, you would go in with what's called a "presenting problem"—a specific thing you want to work on or a specific experience you're having trouble with.
Coaching is often curriculum-driven, offering a specific curriculum for you to follow and work through.
Therapy is circumstance driven. The work you do in therapy will flex and flow with what's happening in your life. As new things come up that change or alter your circumstances, that impacts the therapy work.
Coaching often focuses on learning broad, foundational changes.
In therapy, the focus is on processing and working with a specific problem.
Coaching often incorporates immersive work you do on your own to help you experience, process, and integrate everything you're learning.
Therapy relies heavily on the format of talking during weekly or bi-weekly sessions. Some therapists assign homework, while others don't.
Coaching often follows a program for a set amount of time, with the option to discuss further support if needed after the initial program has been completed.
Therapy is open ended and can go on for months or years, depending on the goal and the focus.
Coaching is not regulated the same way therapy is, and this means a few things. You can work with anyone you find who is your jam. You'll need to do your own reading about their background to determine if you feel comfortable with their level of expertise and experience.
Therapy is regulated by state laws and licensing boards, which means that you can only work with people in your state. That licensure doesn't guarantee expertise or experience beyond what is required by the state.
Both therapy and coaching can be hugely beneficial, but it does involve choosing the right person.
Looking for a Therapist
The important thing to remember is therapy is simply one component of your healing. Depending on your presenting problem, some therapists may ask you to get a physical so you can both have a picture of how your physiology is being affected. Personally, I ask my clients to take up some kind of movement practice—yoga, walking, anything that gets them moving, simply because this is a vital way that our body heals and it makes it easier for you to deeply integrate therapy work.
Which brings me to another important point—the therapist cannot heal you. The therapist is the expert about the mind, behavior, relationships, attachment, emotional experience. You are the expert about you and your life. Therapy is the process of putting those two expertises together, and the work is done by you, the participant. No one else can do our inner work for us.
When you're thinking about going to therapy, I recommend writing down your problem in your own words. Write down the symptoms or effects that are most difficult for you, in your own words. I say to do this in your own words, because we're inundated with a lot of pop-psychology and pharmaceutical commercials, sometimes we get fed the words we're supposed to say. Like, "If I have A problem, then that means I have B symptoms." Define your experience in your own terms. Also know that the presenting problem is almost certainly not the whole of the problem. You will probably discover layers once you get into the work of therapy, and that's good, that's what it's there for.
Next you move on to finding a therapist. This can feel overwhelming if you've never done something like this before. You can ask around if anyone you know has a therapist they enjoyed working with, and then ask if they have a website or a business card so you can look them up on the Internet. It's great if someone else likes them, but that doesn't necessarily mean they'll be a good fit for you.
You can also find a therapist by looking online. I recommend TherapyDen.com. It's the most inclusive listing and search site I've found. When you go there, make sure to click "or, search by gender, ethnicity, cost and more."
When you click that, here's what the different category filters will help you find:
This is where you choose:
If you are on psychotropic/psychiatric medications, I do recommend finding someone who is able to help with medication management. You will probably be seeing your therapist more often than you see the prescribing doctor, and they will be able to help you monitor progress and side effects, as well as consult with your prescribing doctor under your consent.
This is where you select the specific issue(s) you are seeking help with.
If you live in the US and have mental health insurance coverage, congratulations! Even if you do, be aware that some insurance companies require a diagnosis from your therapist in order to cover your sessions. That information does not stay confidential, but gets shared with your insurance company. Some insurance companies also dictate the treatment techniques that can be used or the amount of sessions they will cover.
You can choose a price range you are comfortable with.
This is where you can choose to filter for therapists who have special experience for:
Body positive/Health at every size
Racial justice framework
Sex worker positive
Psychedelic Integration Therapy
Make sure to select whether you are looking for online or in-person visits. You can also select for free consultation, ADA and gender accessibility, LGBTQ affiliation, language, therapist gender and ethnicity, and faith.
A note about Treatment Techniques:
What this means is there are a lot of different theories or approaches to counseling. Cognitive Behavioral Therapy is a theory. Existential therapy is a theory. Adlerian therapy is a theory. Psychodynamic therapy is a theory. Typically, therapists work from one or a few theoretical approaches that inform how they work with participants. You do not need to learn all the theories. I'm going to tell you which theories I like and which ones are most common.
CBT is probably the most common theoretical approach right now. It's popular because insurance companies love it. It follows a manual and they can prescribe the number of sessions it should take you to get through the work. There is some research support for CBT and similar therapies that work from an outside-in perspective—these work on correcting your thoughts and behaviors with the goal of those changing your emotional experience. These tend to work best for more surface level problems, like I have a phobia of snakes and want to take my child to the zoo. Or, I'm feeling depressed about this specific change in my life.
However, if the reason you're afraid of snakes is because you were there the day Harry Potter let the snake out from behind the glass barrier, and it slithered right over you and you were afraid for your life, and that was a traumatic experience for you, then CBT probably won't help you. Or if you're feeling depressed about graduating college and that's weird! You should be happy! But it's actually related to your family's story around success and money and your experiences around that, CBT will only be able to help directly with the transition out of college, not all the underlying stuff.
I'm not a huge fan of CBT and similar therapies. For one, I think it's really boring, both as a therapist and as a participant; and two, It doesn't address underlying trauma. You can actually go and buy a CBT manual for yourself and work through it on your own. If you've been to therapy before and felt frustrated because it seemed to stay on the surface but you couldn't really put your finger on why, this is probably why.
Here are some therapy approaches, or treatment techniques, I do recommend:
Attachment Based Therapies - there are models of this therapy for individuals, couples, and families. This model works from a perspective of healing our attachment wounds and working with our unhealthy attachment patterns that underly the way we interact with ourselves and with the world.
Emotion Focused Therapies - this is very similar to attachment based therapies, but the perspective focuses on our emotional experience of those attachment wounds and experiencing new kinds of attachment within the therapy work so we can take those new experiences into our life.
Accelerated Experiential Dynamic Psychotherapy (AEDP) - This is an attachment based approach that incorporates Emotion Focused techniques, and tends to work on a shorter timeline than more long-term therapy
There are a lot of other really cool therapies out there that I could nerd out about all day, but I know that's not super helpful to you. I want to give you this information because when you go to search for a therapist, it can feel a bit overwhelming, and these therapies here are the ones that I think offer the most bang for your buck.
Choosing a Therapist
As you're looking through the listings, here are things to consider:
What do they look like? Yes, this is actually okay to pay attention to. It's not the ONLY thing to pay attention to, but be aware if there are any gender or age or race issues for you. For example, as a participant, I am much more comfortable working with women than cis-het men. As a therapist, I have also had participants address age disparity or cultural background with me directly. And that's good! Do that! There are generational differences in experience as well as gender differences and racial or ethnic differences.
I would recommend picking 1-3 therapists who resonate with you. Read their bios, look at their website, Internet stalk them (just a little, don't actually stalk them). But really look into how they speak, what they have to say, the kind of clients they help, the kind of problems they work with, how much it costs to work with them.
Then you're going to set up an interview with them. See if they offer an initial consultation or ask the scheduling person if you can talk to them for 15 minutes to see if they would be a good fit. I know this can feel super intimidating, but you are interviewing them. You are going to pay them for their services and it is okay to make sure you actually want to spend your money and time working with this person. I also recommend picking more than one incase there's just a schedule incompatibility with one or some other logistical issue that would prevent you from working together.
When you talk to them, here's what you can say:
Tell them a little bit about your problem and what you want to work on. This is where you can use your written version of your problem and experience. This will give them a clear idea of what you want to work on and whether or not they can help you.
If they say they're not sure they can work with you and may need to refer you out, don't take it personally. There are 1,000 reasons a therapist might refer a participant out. For instance, for myself after my dad passed away, I screened out people who were dealing with a recent loss. I knew it was something I wasn't prepared to hold space for yet, and that person would benefit from working through their grief with another therapist. Also, as therapists, we have an ethical responsibility to refer people to another professional if we believe a certain issue is outside of our competency. Again to use myself as an example, I have no training or experience helping people with substance abuse and addiction. It would be a waste of that person's time and money and may even put them at risk if they worked with me.
You can ask them a little bit about themselves and their professional experience—how long have they been working, why did they choose mental health therapy as a career, what types of clients and problems to they typically work with.
You can ask them if they've ever done their own therapy work. They don't need to tell you when or what for, but it's important that they've been on the experiencing side of therapy. If the answer to that question is no, I would be highly skeptical. It's important to work with someone who practices what they preach, and also to work with someone who is aware of their own working models and biases that will affect therapy.
You can ask them how they might help with your problem in particular or what the process of therapy will be like—this will be just a quick overview, but it gives you an initial gauge of their comfort and familiarity with your problem as well as their style of working.
You can ask how often you'll meet and whether they have any vacation or extended leave coming up.
After this, you'll usually have a pretty good feel for whether or not you want to work with them. If it's a clear no (remember your felt sense of 'no'), you can simply say, "Okay thank you so much! I'm not sure this will be the best fit, but I really appreciate your time." I know that might feel weird, but remember you are the one hiring them, so you don't have to say yes just because you looked them up and talked to them on the phone. If it's a yes, then you can move on to scheduling and payment.
What to Expect
When you first go to therapy, the first session or few will probably focus on your personal history and a brief overview of the problem. They absolutely should go over informed consent with you to make sure you both understand the terms of the therapy relationship.
After that, the two of you will collaborate to construct your work together. Remember that at any time in the therapy process it is welcome for you to give your feedback to your therapist. Let them know if something feels stuck or the last session just totally pissed you off or you left feeling invalidated. Sometimes when we're the participant we feel like we have to "perform well" in therapy or say that everything is working so well. Pay attention to the dissonance between what you report and what you feel, because this is likely your attachment strategies coming up. You can even say to them, "I keep telling you how much I'm loving therapy, but actually I noticed that I'm not. I mean, I like parts of it and it's helpful in some ways, but there's this other stuff, too." Whoa! That's all such great insight, awareness of parts of self, and it gives you and the therapist grist for the mill—it's the real stuff of your experience to work on.
Another note: It is okay to fire your therapist. Not everyone who has a degree and a license is the right fit for you. Not everyone who has a degree and a license is trained in trauma healing. Unfortunately, not everyone who has a degree and a license is good at what they're doing. I've heard a lot of stories of therapists saying terrible things to clients that are completely invalidating and perpetuate a trauma response. If your therapist blames you for your trauma, or tells you you're overreacting, or demeans or belittles your struggles, that's not acceptable, ethical, or helpful. If this happens, you can choose to discuss it with them with the intent of continuing therapy, discuss to terminate, or terminate on your own and find someone new.