therapy for complex issues
April 15, 2020 6:34 AM Subscribe
I have some questions about seeking online therapy for complex issues. What kind of therapy would be best suited for the issues I would like to address?
I've always thought it would be good to seek therapy and now seems like a good time to start. I feel 'stuck' in various aspects of my life.
What sort of therapy does one seek for really complex, life-long issues that don't fit neatly under a particular heading? The issues I want to talk about range from basic angst about what I want to do with my life, issues around body image and my longstanding kind-of-but-not-really-dormant eating disorder, sex and relationship stuff, to managing my OCD, and issues around boundaries with friends and family, etc. I am a POC and an immigrant, which colours many of my day to day experiences. I also had a complex and in places traumatic childhood. I realise that none of this makes me special or different, I'm just trying to enumerate the many facets of what I would like to be able to talk through with someone.
I don't have an actual issue that I can pinpoint, it's more that it would be good to have someone knowledgeable and understanding to help talk me through certain sticking points in my life that are stopping me from where I want to go.
What I really don't want is for a therapist to fixate on the issues in my life that fit in closely with their specialisms. The last therapist I spoke to was really fixated on the fact that I was being bullied at work, but while that was a thing I wanted to talk about, that was really only part of a range of issues I could have done with help processing. They also had absolutely no idea how Asian family values worked and were convinced that I came from a deeply dysfunctional and abusive family, which isn't quite accurate. And some years ago I spoke to a therapist who was only interested in those of my problems that were typical of someone of my race and ethnic origin.
What kind of therapy should I be looking for, if I'm seeking someone who deals with wide-ranging issues and doesn't focus on work with a particular issue or will only view your experience through one particular lens? Is there a name for therapy of this type?
I'm in the UK.
I've always thought it would be good to seek therapy and now seems like a good time to start. I feel 'stuck' in various aspects of my life.
What sort of therapy does one seek for really complex, life-long issues that don't fit neatly under a particular heading? The issues I want to talk about range from basic angst about what I want to do with my life, issues around body image and my longstanding kind-of-but-not-really-dormant eating disorder, sex and relationship stuff, to managing my OCD, and issues around boundaries with friends and family, etc. I am a POC and an immigrant, which colours many of my day to day experiences. I also had a complex and in places traumatic childhood. I realise that none of this makes me special or different, I'm just trying to enumerate the many facets of what I would like to be able to talk through with someone.
I don't have an actual issue that I can pinpoint, it's more that it would be good to have someone knowledgeable and understanding to help talk me through certain sticking points in my life that are stopping me from where I want to go.
What I really don't want is for a therapist to fixate on the issues in my life that fit in closely with their specialisms. The last therapist I spoke to was really fixated on the fact that I was being bullied at work, but while that was a thing I wanted to talk about, that was really only part of a range of issues I could have done with help processing. They also had absolutely no idea how Asian family values worked and were convinced that I came from a deeply dysfunctional and abusive family, which isn't quite accurate. And some years ago I spoke to a therapist who was only interested in those of my problems that were typical of someone of my race and ethnic origin.
What kind of therapy should I be looking for, if I'm seeking someone who deals with wide-ranging issues and doesn't focus on work with a particular issue or will only view your experience through one particular lens? Is there a name for therapy of this type?
I'm in the UK.
I agree with what MiraK wrote. I have been a therapist for not quite a year, and from what I have learned in school, the most important factor in therapeutic success is not modality but the "therapeutic alliance", which basically means the relationship between therapist in client. Therefore, it is super important that you are comfortable with and "click" with your therapist.
Most (good) therapists are eclectic in orientation; they work from various modalities depending on the needs/personalities etc of the clients. IMO, narrowly focusing on just one modality is way too limiting and doesn't make sense.
CBT is mentioned a lot because it has been studied a lot- its outcomes are easily measured. It can be good for certain situations and people, but it is rather narrow and focuses on changing behaviors.
If you're searching for therapists, I agree that psychodynamic is a good place to start- that's what we think of as "deep" thearpy focusing on childhood and family relationships. "multicultural" is also an orientation (taking cultural factors into account which should be done always but isn't always focused on; you can also look for people describing themselves as "eclectic".
It's fine to shop around, and also important to find someone who understands your cultural background and context.
posted by bearette at 4:15 PM on April 15, 2020 [3 favorites]
Most (good) therapists are eclectic in orientation; they work from various modalities depending on the needs/personalities etc of the clients. IMO, narrowly focusing on just one modality is way too limiting and doesn't make sense.
CBT is mentioned a lot because it has been studied a lot- its outcomes are easily measured. It can be good for certain situations and people, but it is rather narrow and focuses on changing behaviors.
If you're searching for therapists, I agree that psychodynamic is a good place to start- that's what we think of as "deep" thearpy focusing on childhood and family relationships. "multicultural" is also an orientation (taking cultural factors into account which should be done always but isn't always focused on; you can also look for people describing themselves as "eclectic".
It's fine to shop around, and also important to find someone who understands your cultural background and context.
posted by bearette at 4:15 PM on April 15, 2020 [3 favorites]
What is the issue that you struggle with the most? The one you find that most people in your life fail to understand? The one you'd consider to be the main driver of your unhappiness? I would try to choose a therapist who has the ability to deal with this specific issue.
In my experience, everything is interconnected, so if the therapist doesn't understand something fundamental about you, it can really lead to the relationship getting stuck at a certain point. Most therapists have a basic level of competence with, say, existential or relationship boundary issues, so you might prioritize choosing one who understands your culture or has a strong background in treating trauma.
And, as MiraK and bearette said, the feeling of just clicking with your therapist is really important. You should feel comfortable with them right off the bat (as comfortable as you ever feel with people, that is — if you're not a very open person it can be hard to feel totally comfortable with anyone at first!).
For a therapist who deals with wide-ranging issues and sees you as a whole person, I have had good luck with therapists who practice psychodynamic, humanistic, or existential therapy. I've also found that somatic therapy helped a lot with my anxiety, OCD, and body-based issues, much more so than the standard CBT-based stuff.
posted by fire, water, earth, air at 8:35 PM on April 17, 2020
In my experience, everything is interconnected, so if the therapist doesn't understand something fundamental about you, it can really lead to the relationship getting stuck at a certain point. Most therapists have a basic level of competence with, say, existential or relationship boundary issues, so you might prioritize choosing one who understands your culture or has a strong background in treating trauma.
And, as MiraK and bearette said, the feeling of just clicking with your therapist is really important. You should feel comfortable with them right off the bat (as comfortable as you ever feel with people, that is — if you're not a very open person it can be hard to feel totally comfortable with anyone at first!).
For a therapist who deals with wide-ranging issues and sees you as a whole person, I have had good luck with therapists who practice psychodynamic, humanistic, or existential therapy. I've also found that somatic therapy helped a lot with my anxiety, OCD, and body-based issues, much more so than the standard CBT-based stuff.
posted by fire, water, earth, air at 8:35 PM on April 17, 2020
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When I first looked for a therapist, it felt very important to me to find someone from my cultural background, and I did. It was the best thing for me at the time. I was very glad not to have to contextualize and explain my ethnic and cultural background/assumptions/etc. But I've subsequently worked with a white therapist who has a great deal of awareness as well as experience working with culturally diverse patients, and that's been fantastic as well. So there's hope even with white therapists, I'd say. Ask about their experience with Asian clients/patients.
I would advise against CBT and DBT. These modalities are great for people with more severe and/or narrow issues (e.g. CBT is great at helping people manage severe phobias and DBT is the gold standard for personality disordered people), but for what you describe, they will potentially be too superficial and possibly even invalidating. They are not well suited for deeper exploration and meaning-making. CBT might well be highly recommended to you by others because it's the flavor of the moment - and idk, you could try it! I just have a personal bias here.
posted by MiraK at 9:20 AM on April 15, 2020 [8 favorites]