There are a number of reasons why someone might seek therapy. Some see it as an opportunity for personal growth and development, while others regard a therapist’s office as a mecca for discussing deep-rooted issues and unresolved trauma. Whatever the case may be, finding the right therapist is the first hurdle someone seeking therapy must cross.
But what are the most important factors to consider when trying to navigate a healthcare system that doesn’t always streamline the process of finding a suitable mental health professional?
“The first thing I would always say to somebody is to make sure that who you see is accredited because we don’t have statutory regulation in this country”, says Dr Marie Walshe of Leeson Analytic Centre. “So, if you have a problem with somebody who is a member of a professional body, you can make a professional ethics complaint. Because of the law, you can’t stop them practising, but you can make an ethics complaint and that’s what stops somebody getting referrals.”
The Dublin-based psychoanalytic psychotherapist recommends visiting the websites of professional bodies, such as the Irish Association for Counselling and Psychotherapy (IACP). She says the “various different denominations” of therapy sometimes leave people at a loss to know what type would be best suited for them.
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“There are a growing number of psychotherapeutic modalities,” says Dr Damien Lowry, chartered member of the Psychological Society of Ireland.
“Some resemble each other, and some are quite different and distinct from each other. I think most people will probably have heard of cognitive behavioural therapy (CBT). It’s certainly one of the more widely used forms of therapy and widely researched modality of therapy and quite practical in its approach. So that’s sometimes what’s appealing to people. It can also be quite structured too.”
Emotion-focused therapy, compassion-focused therapy and schema therapy are also among the different therapies. Due to the advantages that come from using certain therapeutic models, it would be inaccurate to say that one type of therapy is much more effective than another one, says Dr Lowry.
“What you’ll actually find in the real world is there are some people [experts] who are quite pure to the therapy models and they will identify themselves as a CBT therapist or a CBT practitioner or a schema therapist and that’s quite common,” he explains. “But what’s also quite common is for someone to describe themselves as an integrative therapist. So they pluck what’s quite effective and appropriate and practical from the different therapeutic models, and they succeed in piecing it together quite effectively.”
Integrative psychotherapist Cady Walker – founder of mental health and wellbeing centre Mynd – says there are some issues that come up in generic therapy that might require a patient to seek a therapist with specialised training.
“I think the main thing to consider is that most therapists have a core training, which means they are able to support a client with the majority of problems,” she says. “But therapists tend to specialise after their initial core training, from topics such as eating disorders to sex therapy, which might be more beneficial for certain clients to seek these specialised therapists.”
The Wicklow-based professional, whose centre has seven psychotherapists, says having a therapist with niche industry knowledge can be more beneficial when it comes to getting adequate support and developing a strong therapeutic connection. “For example, if a client is in active substance addiction, they would really need to go to an addiction therapist or even look to enter rehabilitation.
“Within rehabilitation centres, the client would work with a multidisciplinary team, which would include an addiction therapist, giving the client the best support.
“That [specialised] therapist is probably going to be able to hold you a little bit more in that space. And, when I say hold, I mean support, bring that kind of knowledge, really take you on that journey to healing. That’s one of the things I really think whatever you’re wanting to work on, it’s about seeing if that therapist has trained a little bit in that because it just gives you that additional connection.”
Relationship
A strong relationship between a therapist and their client is key in determining the effectiveness of therapy, says chartered member of the Psychological Society of Ireland Dr Damien Lowry.
“The largest slice of the therapeutic pie when it comes to determining positive, beneficial outcomes, is actually the therapeutic relationship,” he says, “so I kind of tend to think of it as the relationship being the cornerstone of the therapeutic process. Then there’s the model and its suitability for the person and their willingness to work with us. Then there’s the therapist’s skill and knowledge of the model and how to apply it to the individual’s circumstances. But without that relationship serving almost as the rudder for that, it’s just unlikely to be optimum.
“If the model itself was the be-all and end-all, I think we’d all be very, very threatened by AI and these AI platforms that could just walk you through a manualised version of CBT or schema or whatever it might be.”
According to Dr Lowry, some of the factors that play into developing a strong therapeutic relationship include deep empathy in a therapist, a positive mindset and the ability to show acceptance that is not misconstrued as approval. “The capacity for empathy on the part of the therapist is crucial”, he explains, “and also their ability and skill in being able to demonstrate unconditional positive regard in kind of a form of acceptance.
“So I’ll accept you as you are, whatever has gone on, whatever has happened, whatever you’ve done, whatever you might feel uncomfortable sharing, it’s all good here, and we’ll talk openly and honestly about it. But, at the same time, that’s not to be conflated with approval of it or anything as such. It’s about providing an environment that is accommodating and accepting.”
Gender
When it comes to the therapist’s gender, the Dublin-based therapist says it is a fair criterion on a person’s part if they have a preference for one gender over another – especially if it might be impacted by the issues brought up in therapy. “If there’s a gender dimension to whatever it is they’re coming to therapy to work on or to discuss, it might be heightened.
“I know it’s come up occasionally over the years for me when someone’s been in an abusive relationship with a female attending me and their partner is male, there can be a heightened sense of vulnerability or fight or flight in discussing it with someone like myself because of that gender aspect. But that’s not always the case either, and actually, it can work to an individual’s advantage sometimes as it did particularly for one female [client] because it was almost a corrective experience. It was demonstrative of or proof in a way of men not necessarily all being bad.”
Timing
Walker says knowing when the right time to seek therapy is contingent on whether a person is seeking maintenance therapy or crisis intervention. “I have two ways of looking at this,” she says. “One of them you call mental health maintenance. So if you can afford it and if you can go to it, therapy is a great thing because you always want to be able to have the tools in your toolbox that if something happens, that you actually have the resilience to be able to get through it. Whereas most people come in crisis.
“Obviously, there are things that happen in life that would need that crisis intervention. But, generally, people haven’t done the work before to be able to have the resilience to get through it. So I see that as twofold. There’s the one part of going when you’re actually not in crisis to be able to get that resilience and work through the kinds of things that maybe aren’t as crisis motivating, but then on the other hand, I think anyone that goes through anything in the present, going to therapy straight away will support you through the process.”
Dr Walshe says the best time to seek therapy is when something becomes a problem for an individual. “The time to come is when it’s a problem. For instance, let’s take a very common thing today like eating disorders. A lot of people with eating disorders don’t have a problem. Maybe their parents do, maybe their friends do, but it’s not necessarily a problem for the person themselves.”
Leaving
“So, usually, there’s some evidence for a person doing well,” says Dr Lowry, “I’m speaking for myself, I know I’ll be speaking for some others – not all – but that [ending therapy] is part of the therapeutic course, and it’s not like we do 10 weekly sessions and then abruptly finish.
“It’s more a case of there’s six, 10, 20, 30 sessions, but there’s a tapering to that so the better a person is doing, then there’s a discussion around lengthening the interval between sessions, and seeing how that goes for them in a way enabling them to trust in their own capacity to handle their situation or their life routine, or the issue that they’re attending for specifically.
“I think it’s important not to run the risk of having therapy be something that an individual uses like a crutch or becomes almost inadvertently dependent upon. We’re trying to help individuals become autonomous, capable in their own right, buoyant, resilient insofar as that’s possible so that they don’t need us.
“My objective when I start working with someone is always to make myself redundant, that is the best outcome that I can achieve. Sometimes, it’s unexpected, but usually there’s kind of a lead into it, and it’s almost like an occasion for some level of celebration, like I hope I never see you again is my parting joke because that’s the outcome we both ultimately wanted at the outset.”
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