This article is the second in a series on how to find a good therapist. In the first installment, I addressed some of the stigmas that keep some people from getting into therapy and reaping its rewards. Hopefully it helped readers with apprehensions about therapy to consider giving it a try. Today I’m going to decode some lingo and demystify a few things, so that if or when you seek out a therapist, you’ll know what to look for.
Countless terms are used for the different kinds of therapy that exist, but for the most part, when it comes to individual therapy for adults, they fall into one of two broad categories: psychodynamic or cognitive behavioral.* These schools of thought refer to a therapist’s “theoretical orientation,” and they define how clinicians work, as well as how we think about what we do. While many therapists integrate approaches to a certain degree, most of us “pick a camp,” if you will, and the two styles are very different. Which kind of therapy you want has everything to do with who you are and why you’re seeking therapy in the first place.
Cognitive behavioral therapy (CBT) tends to work by isolating a problem, or “symptom,” and targeting it. So, if you have a fear of spiders, for example, a CBT-oriented therapist would work with you directly by challenging the “irrationality” of your fear. He or she might also expose you to a series of escalating challenges designed to make you confront your fear, such as showing you pictures of spiders, followed by making you touch stuffed-animal spiders, and then eventually bringing in real spiders. The upsides of this are that it’s effective in helping people to overcome very particular issues (which can sometimes be quite debilitating), and it can be done in a discrete amount of time.
Psychodynamic psychotherapy, on the other hand, is usually less time-restrictive and less intensely focused on “symptom reduction.” I say “usually” less time-restrictive because there are short-term dynamic therapies out there, but the classic version of psychodynamic therapy is more open-ended when it comes to how long it takes to get the job done. The idea behind this approach is that you talk to your therapist more generally about your life, and over time you should (1) develop insight about your past experiences and the effect they’ve had on how you think and feel, and/or (2) develop a relationship with your therapist that helps you to sort out how you interact with people and what kinds of expectations you have about relationships. The upside of psychodynamic therapy, by contrast to CBT, is that it better accounts for the totality of the individual. Rather than by breaking us down into symptoms that ought to be reduced or eradicated, it contextualizes our thoughts, feelings and behaviors, and understands them as part of a larger picture. It is through this process of understanding that change occurs.
To clarify the difference between these two approaches, try thinking about it this way: If you’re the kind of person who is looking to get into therapy because you either want to grow emotionally or spiritually, or if you feel like the issues you want to work on are slightly amorphous or ill-defined (if you’re not totally satisfied in life and you don’t know why, for example), my recommendation would be to look for a psychodynamically-oriented therapist. However, if you’re so afraid of getting into a car accident that you refuse to drive, or so afraid of plane crashes that you won’t fly, even when you really want to travel somewhere, you may want to look for a CBT therapist who will work with you directly on this particular issue. Perhaps once you’ve vanquished your fear, you can follow up with a psychodynamic therapist to take a deeper look at other issues that may be manifesting in your life, but that’s a decision you can make later. Capiche?
I hope I’ve shed a little light on this subject. If you have thoughts or questions, feel free to put them in the comments section below, and we’ll all continue the conversation together. In the next installment of the series, I’ll cover the differences among practitioners (psychologist, psychiatrist, social worker, etc.) so you’ll understand the cast of characters better. The kind of referral you’ll look for will depend, in part, on the kind of clinician you need to see. In the fourth and final post, I’ll address how to obtain a good referral, and how to handle that (often somewhat anxiety-inducing) first session.
* There are varieties of therapy for individual adults that exist that don’t fall into either of these two categories, but it’s fair to say that most major kinds of therapy do. It isn’t my goal here to be exhaustive as much to provide the best information in a concise, digestible way. For a little cheat sheet on which therapies are psychodynamic and which fall under the rubric of CBT, examples of psychodynamic therapies are things like existential psychotherapy, relational or interpersonal psychotherapy and anything using the term “psychoanalysis” (and this includes the Jungian variety). The CBT therapies are like an alphabet soup of letter combinations: CBT, DBT, ACT, etc.