What therapeutic approach is right for me?
October 6, 2015 5:05 AM   Subscribe

I need some help in seeking a therapist. Not a recommendation to a specific therapist, but some insight into various approaches.

I'm feeling very very down due to (what I am pretty sure is) the dissolution of my relationship with my partner of 3ish years (past year LDR). I am still very much in love with her, but her own personal issues have her wanting time apart, and I have a feeling that it's permanent (we are not talking, per her request, so I don't know for sure, but this is a necessary step for me either way).

I would like to put some resources (time and money) into seeing a professional of some sort, both to help me make sense of my grief and sadness right now, but also to help me more fully understand myself and my own issues. I want to learn to be a better partner, and a better person.

What sort of therapeutic approach might work well for me?

I'm a mid-30s man, in academia. I live across the world from 'home', and because I don't really have close friends here, and my (ex?)partner lives in another country, I feel very isolated and lonely (if that makes any difference?).

I've been to therapists before. As a kid, I had some serious anger and depression issues (mostly, as it turned out, stemming from my parent's hard divorce and my unhappiness with being uprooted, etc.). That approach, from what I recall, was a lot of quiet time involving art and whatnot in a dimly lit room. I don't recall much talking in those sessions. That is not what I need here.

In my early 20s, I saw a psychiatrist for about 18 months (weekly), and found it therapeutic in the sense that it felt good to talk, but I can't say I got any real actionable knowledge from it.

About 18 months ago, my partner and I saw a couple's counselor about half a dozen times. I found that very useful, and it really helped me see where I was failing to be a good partner while also helping me articulate my own needs. In those sessions, the counselor acted as what I would call a moderator, helping my partner and I engage in productive and meaningful conversations about our life together.

I've had issues of depression and self esteem in the past, although nothing really devastating on the depression end in at least 15 years. I don't really want to jump into medication, but am not categorically opposed to it. Really, I just want to understand myself better, and work on being the best I can be for myself and in other relationships. I want to learn how to communicate more openly, and how to love myself with the same dedication I love others.

So, what approach should I look for? In my area, there are a handful of centers offering therapists working with a wide range of approaches--psychoanalytic, psychodynamic, CBT, Rogerian, humanist, etc. Can you help me understand the differences in these styles, and what to expect from them, while also making any suggestions based on my background and current issues?

I feel like I've been hit by a truck here, but I also feel hopeful that I can use my current pain and grief as an opportunity to make myself stronger and more loving. Any ideas?
posted by anonymous to Human Relations (10 answers total) 1 user marked this as a favorite
From experience, CBT is very goal-oriented, to change behavior or patterns of thinking. For me, it worked very well for anxiety issues and OCD, because I would use the exercises given by my therapist to get past the anxiety that causes me to get into patterns of thinking that are unhealthily distracting. For a more generalized depression, I don't know if that would work as well, but that's what I know about that.
posted by xingcat at 5:20 AM on October 6, 2015 [1 favorite]

I would also recommend that you find a therapist that is proficient in CBT, research shows that it is effective, and, as xingcat mentioned, it is goal oriented. there tends to be much less mucking around in the past (although, there may come a time for that to determine some root causes) and more time in the here and now making some concrete changes in the way you respond to the world around you.. Best of luck....
posted by HuronBob at 5:26 AM on October 6, 2015

The single most important factor across all of those modalities is what's referred to as the strength of the therapeutic alliance—your working relationship with the therapist in which you're committed to working toward an agreed-upon set of goals. That's a better predictor of the therapy's success. So whether or not you pursue CBT (or whatever style), spend some time finding someone you feel comfortable working with.
posted by listen, lady at 5:44 AM on October 6, 2015 [7 favorites]

As a therapeutic model, Health Realization is less well known than CBT but has also shown positive benefits. It may be a little harder finding a practitioner, though.

Also, the next part of my response is a little off-axis from your original question but I hope it will help: I strongly recommend self-care as an adjuvant to seeking help from a professional. Exercise has been shown to help in healing depressive symptoms, and meditation has likewise shown some positive benefits.
posted by theorique at 6:32 AM on October 6, 2015

The Good Therapy website has links to descriptions of many different types of therapy.

MetaFilter tends to have a bias toward CBT because it does well in studies and, I think, because it treats emotions as less important than other therapies. CBT can certainly be effective, but keep in mind that it tends to do well in studies partly because it's more easily study-able than many other types of therapy (it relies on more standardized interventions) and that while many people who are upset want to avoid delving into feelings, sometimes (in my opinion, almost always) delving into feelings is the best way to understand and change feelings. I think CBT can actually be a disservice to overly analytical people, because it keeps those clients up in their heads rather than opening up their hearts.

"Actionable knowledge" is important, but if I were you, I'd make sure I wasn't thinking of "behavioral change" as the only form of worthwhile "actionable knowledge." Being able to identify one's emotions, allowing oneself to feel them, and learning how to communicate them can create enormous positive shifts in one's life, even if we as a society don't tend to value emotional intelligence (especially in men) enough to always recognize such work as "knowledge."

As other posters have said, it's generally more important to find a therapist you click with rather than necessarily the type of therapy you click with (though the one's going to influence the other, of course). If I were you, I'd be looking for a therapist who works with grief, stage-of-life issues, and relationship issues and not worry to much about the type of therapy they're providing. (Also, what you describe as a teenager sounds like "play therapy," which is mostly just done with children, so I wouldn't worry too much about wandering into that again.) If you click with the therapist on the phone or within the first couple sessions, great! If you don't, find someone else.

Good for you for seeking help, and I hope you find someone you do click with.
posted by jaguar at 7:23 AM on October 6, 2015 [14 favorites]

Also, if your couple's therapist was local, you could contact them and ask if they have any recommendations for therapists.
posted by jaguar at 7:28 AM on October 6, 2015

All bona fide psychotherapies (i.e., therapies with some sort of real, studied approach backed by theory; CBTs, psychodynamic, etc) have essentially equivalent outcomes in the short-run of treatment of depression.

What we know much less about, empirically, is the question of "what works for whom," and that's where I 100% endorse the excellent advice from jaguar and listen, lady.

In my own therapy, I found jaguar's statement to be astute that: "I think CBT can actually be a disservice to overly analytical people, because it keeps those clients up in their heads rather than opening up their hearts." -- If you're anything like me (also an academic, at least), this is superbly true. For me, CBT might be great if I had a particular goal in mind and needed the structure and tools to solve that goal. But part of the hard work in therapy can be (and was for me) figuring out what on Earth your universe of emotions and values and attachments are (and experiencing them), and the obscure patterns that you find myself falling into in part because you can't map out that universe. For me, these patterns have never felt particularly cognitive and were more deep grooves of behavior and experiencing, and both identifying them and sitting with the sometimes painful affects associated with them has helped me come out on the other side with a richer sense of life. I found psychodynamic therapy to be really useful to this end, personally.
posted by Keter at 8:33 AM on October 6, 2015 [4 favorites]

Seconding jaguar here too: as someone who was compulsively analytical and stuck-in-my-head, I found that CBT tended to keep me stuck there, which also undermined a lot of the other stuff CBT tries to do (e.g. if I were instructed to find counter-arguments to undermine "irrational anxieties," I'd also compulsively find counter-counter-arguments, to which I could find counter-counter...you get the idea).

Keeping in mind listen, lady's point about therapeutic relationship trumping the approach, I would recommend that you check out Acceptance and Commitment Therapy, which goes in a radically different direction from CBT (though it is sometimes considered a form of CBT). Rather than fighting to control your verbal/cognitive evaluations, ACT is very much about undermining such analysis, and then bringing yourself into contact with the feelings and experiences to which such private analyses are a response. Also, looking at your goals:

I just want to understand myself better, and work on being the best I can be for myself and in other relationships. I want to learn how to communicate more openly, and how to love myself with the same dedication I love others.

ACT could be a very good fit, as it also places a lot of emphasis on values-work (i.e., figuring out what matters for your life, and then moving your life in that direction), which I think separates it from more recent mindfulness-infused incarnations of CBT. The overall approach does not attempt to reduce the presence of "negative things" as much as it teaches you to move towards "positive things" in spite of all the negative. This website has a database of ACT therapists you can look through, though you may have to sign up (free) before you can access the search engine. I'm more than happy to answer more questions over PM if you've got them.
posted by obliterati at 8:46 AM on October 6, 2015 [4 favorites]

Just seconding obliterati - I also had limited success with CBT but have found ACT (and mindfulness practice in general) really helpful.
posted by amerrydance at 9:15 AM on October 6, 2015

(Also, feel free to MeMail me if you happen to live in NYC or Philadelphia, and would like a referral).
posted by Keter at 12:06 PM on October 6, 2015

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