We could all use someone to talk to right now. But sifting through different types of therapy to figure out which is right for you is a tall order in the midst of, well, everything.
In the past year and a half, many of us have become family caregivers or parents with less support than ever before. Or we’ve had to move back home just when we feel like we should be setting off on our own. Or any other number of huge life changes. Add this to fears of getting sick or recovering from getting sick, isolation, job losses, financial strain, housing insecurity, massive social and racial injustices, and the trauma of more than 700,000 lives lost in the U.S. to COVID-19, and it’s a lot to carry.
If you feel like you need help now, you’re not alone. “Studies show that the COVID-19 pandemic has contributed to an increase in depression and anxiety in many young adults,” Lauren Kerwin, Ph.D., an L.A.-based licensed psychologist who provides DBT (dialectical behavioral therapy) and CBT (cognitive behavioral therapy), tells SELF. “Those who have a history of preexisting mental health issues are especially struggling right now.”
But being in need of support often makes it even more difficult to figure out exactly what you need. “It can be really tough to go online and start googling mental health treatment and support because you’ll get a whole slew of responses,” Christine M. Crawford, M.D., MPH, a psychiatrist and associate medical director of the National Alliance on Mental Illness, tells SELF. “And if you’re already feeling overwhelmed with anxiety and depression or experiencing trauma, it’s going to be incredibly difficult to process all of the information to know where to start.”
A potentially more approachable first step: Schedule an appointment with a primary care provider, Dr. Crawford suggests. They can quickly assess your symptoms and guide you in a direction that’s tailored to your unique mental health needs. But that won’t work for everyone; many people don’t have ongoing relationships with primary care providers or feel comfortable enough with theirs to broach this kind of vulnerable topic.
So, below, get to know six of the most common types of therapy, including what to expect from each, what kinds of issues they may help with, and how to get started finding providers who practice these modalities. Keep in mind, also, that different providers will practice these therapies in different ways (within reason). Many providers practice multiple types of therapy too, or regularly do a mix. And even if you’ve found the right type of therapy, landing on the right person to take you on that journey is key. In addition to the therapist-finder starting points we’ve outlined below, here are more tips for finding a great therapist, locating an excellent culturally competent therapist specifically, and making sure they’re a fit for you. And for more information on getting started with therapy, check out SELF’s Guide to Caring for Your Mental Health.
1. Psychodynamic therapy
Like the idea of self-analysis for big-picture insights about your life? Psychodynamic therapy (P.T.) aims to offer a safe space to dig deep. The idea is to use free-flowing conversations with a therapist to become aware of previously unconscious thoughts, blindspots, and relationship patterns.
Developing a deeper awareness of how your past affects your present can help you see some of the habits you fall into and why they exist, says Dr. Crawford. When unhelpful defense mechanisms or beliefs rise to the surface, tools like reality checks and goal setting can help you steer yourself in a more positive direction.
For example, if you’re struggling with a lack of purpose or satisfaction in your life, you could eventually trace this back to a deep-rooted desire to please an unpleasable parent or guardian. The inability to feel satisfaction from within could be something you discover you’re still carrying with you. But when you see it, you can begin to work on making changes so you can find inner peace and in turn improve your mood.
Multiple studies show psychodynamic therapy can effectively relieve symptoms of multiple mental health conditions. And research suggests the process can jump-start psychological shifts that continue to serve you long after you finish therapy, per the American Psychological Association.
Among other issues, P.T. can help with: depressive disorders, anxiety disorders, complicated or prolonged grief, eating disorders, borderline personality disorder, somatic symptom disorders like irritable bowel syndrome, and substance use problems.
What to expect: Weekly sessions lasting around an hour for a (potentially) long-term therapeutic relationship. Since it can take a long time to unearth and process parts of yourself and your life story, it’s not uncommon to meet with a therapist for years, says Dr. Crawford.
One way to get started: Use Psychology Today’s search tool to find a psychodynamic therapy provider in your area.
2. Cognitive behavioral therapy
If you feel like you’re stuck or often get trapped in the same old mood spirals, cognitive behavior therapy (CBT) could help you finally step out of your own personal whirlwind.
“The theory behind CBT is really the interplay between thinking patterns, emotions, and behavior or habits,” Martin Hsia, Psy.D., a licensed psychologist and clinical director of the Cognitive Behavior Therapy Center of Southern California, tells SELF. With CBT, you learn how to identify unhelpful thoughts and rewrite them to be more realistic and constructive. In turn, you can set new goals and change your behavior.
Depression, for instance, often lies with thoughts like, “Nothing will help me feel better.” Absorb these false beliefs, and you could begin to avoid the people and hobbies you love. But with CBT, you can rewrite a better script: “I feel crappy right now and that makes it hard to text friends. But seeing them could help—even if it’s only a little.”
“Sometimes there’s a little fake it till you make it,” says Dr. Hsia. “But you start to have some pleasure and gratification and that’s good, and the more you do that proactively—even with some resistance within yourself—you start to enjoy those things again.”
Compared with traditional talk therapy, CBT is generally more collaborative, structured, and focused on problem solving in the here and now rather than revisiting your past. If you’re feeling stuck, CBT can provide the guide and game plan you need to move forward.
Among other issues, CBT can help with: depressive disorders, anxiety disorders, obsessive-compulsive disorders, insomnia, loneliness, substance use problems, seasonal affective disorder, post-traumatic stress disorder (PTSD), bipolar disorder, schizophrenia, and easing mood-related symptoms in caregivers and people living with a variety of health conditions such as chronic pain and COVID-19.
What to expect: Weekly sessions for around an hour for about 10 to 25 weeks. Generally, CBT is time-limited, but the length of treatment can vary. At the first session, your therapist may ask questions like where you want to see yourself at the end of this process and what you hope to learn or accomplish. Often they’ll help you set concrete goals and provide “homework” assignments to help you work toward them (such as journaling out thoughts or exposing yourself to what you’re afraid of, like entering a second-floor balcony to address a fear of heights).
One way to get started: Find a certified CBT therapist in your area through the Association for Behavioral and Cognitive Therapies directory.
3. Dialectical behavior therapy
Dialectical behavior therapy (DBT) is a treatment program designed to help people with complex mental health issues like borderline personality disorder who struggle with out-of-control feelings or self-harm. “DBT offers practical, actionable tips and strategies to calm yourself when you have very intense emotions,” says Dr. Kerwin.
The key difference between DBT and CBT is that instead of diving right into analyzing difficult thoughts and feelings to change them, with DBT, you start by accepting them and then applying coping skills to take a different route. “In DBT, we talk a lot about dialectics—holding two opposites in hand at the same time,” says Dr. Kerwin. “So we encourage clients to make statements like, ‘I accept the way that I am, and I know I need to improve.’” In the moment, this small mindset shift can make a big difference.
With daily or weekly “behavior chain” exercises, you learn to trace unhealthy behaviors back until you reach the cause at the root of them, says Dr. Kerwin. Then you can strategize on how to prevent yourself from ending up in that situation again.
DBT uses a three-pronged approach to help you build mental strength and gain better control over your behavior. It involves one-on-one therapy, group skills training sessions, and phone coaching (via calls and/or texts, depending on what you and your therapist agree to). Since the COVID-19 pandemic began, many DBT groups have continued to meet with virtual arrangements.
Among other issues, DBT can help with: borderline personality disorder and related issues like depression, suicidal ideation, or substance use disorders as well as binge-eating disorder.
What to expect: Individual therapy sessions (at least once a week for around an hour), group classes (typically once a week for about one and a half to two and a half hours), and phone coaching (as needed or scheduled with your therapist) for at least a year. One-on-one, you’ll build a relationship with your therapist to practice social skills and deal with behaviors you’d like to curb or stop. In group sessions, you’ll join a class of about eight to 12 people to learn how to cope with distressing situations and emotions with mindfulness, communication skills, and more. Between sessions, phone coaching will help you apply lessons you’ve learned in the moment to manage personal conflicts and mental health crises.
One way to get started: Find a licensed therapist in your area who’s been intensively trained in DBT through the Behavioral Tech directory.
4. Interpersonal therapy
When you’re saddled with difficult emotions, there’s your pain, and then there’s the pain of how your mood and mindset can impact the people around you. Interpersonal therapy (I.T.) can help you dissect the relationship between how you feel and your social interactions.
I.T. zooms in on recent conflicts, role transitions, or points of sensitivity (think challenges of new motherhood, issues setting boundaries with your roommate, or expectations you can’t possibly live up to). For example, let’s say you’ve been on a lot of crappy dates recently and just can’t seem to connect with someone. Break down one conversation with a would-be suitor, and you might realize you were talking so much yet struggling to connect because anxiety from isolation has knocked your communication skills (extremely fair!). After you ID negative patterns or defense mechanisms, you can develop a better strategy for the next time you’re in a similar situation.
“The reason why this is helpful is that it gives you actual tools you can use and practice when you’re talking to people and can then improve your confidence level and make you more likely to go out and be more social,” explains Dr. Crawford. Learning how your symptoms affect your social life can help you reconnect and feel better.
Among other issues, I.T. can help with: depression, interpersonal crises or transitions like divorce, the death of a loved one, or a job loss, and as an add-on to treatment for bipolar disorder, eating disorders, PTSD, and anxiety disorders.
What to expect: Sessions lasting around an hour, once a week for about 12 to 16 weeks. With your therapist, you’ll create an inventory of your relationships then examine recent interactions and develop a game plan for improving your connections and mood.
One way to get started: Use Psychology Today’s search tool to find an interpersonal therapy provider in your area.
5. Family and couples therapy
With so many “new normals” to navigate, there are a gazillion reasons your household could feel like it’s in a pressure cooker—and sometimes individual therapy isn’t enough. Maybe you and your partner just can’t get over the same old argument, your child’s struggling in school, or money worries have everyone stressed out. Bullying and tech overuse are common reasons for families to reach out for help, while love, sex, and money tend to be top issues for couples, says Gilza Fort Martínez, LMFT, a Miami-based therapist who specializes in conflict resolution and life transitions.
If you feel like you just don’t have time to sit down with a therapist and the person or people you’re struggling with, hear this: Meeting with your loved ones in a neutral space under the guidance of a therapist can help you better understand your roles and relationships. It can allow you to build effective communication skills like how to give feedback, fight fair, and reach resolutions. At the end of the process, you can regain confidence in your ability to recover from crises together.
Even better? “[Family and marriage therapy] is also used as a preventative measure to address conflict before it explodes,” says Fort Martínez. In this sense, if you think it might be time to go in (or you just don’t want to repeat your parents’ marital or parenting problems), it’s totally okay to look into finding help before you’ve reached a crisis point.
Family and couples therapy could help with: interpersonal conflicts, grief, children’s behavioral problems, partnership challenges like recovering from a betrayal or sexual dysfunction, caregiving difficulties, substance use issues, and managing diagnoses such as autism, depression, anxiety, mood disorders, schizophrenia, and chronic physical health conditions.
What to expect: Fifty-minute to one-hour sessions once a week for at least 12 weeks. Typically, your first session will be with everyone involved to gather general information, explore each person’s definition of the situation, and go over the rules of engagement for respectful conversations, says Fort Martínez. Throughout the process, you may also meet with your therapist one-on-one instead of as a group, or do a combination of both.
One way to get started: Ask your primary care provider, school counselor or administration, or a trusted friend or family member for a referral to a licensed family and marriage therapist. You can also search for one in your area using the American Association for Marriage and Family Therapy therapist locator. (Here are more tips for accessing a great therapist, finding a culturally competent therapist specifically, and making sure they’re a fit for you.)
6. Group therapy
Finding your people can be transformative, and that’s why group therapy with a handful of others and a therapist can help with so many different situations.
“In group therapy, I think you really do get the sense that you’re not alone,” Cheri Marmaroush, Ph.D., a leading expert in group therapy and associate professor of professional psychology at George Washington University in D.C., tells SELF. Hearing someone else talk about their struggles can help combat shame and stigma and lead to your own revelations. Sharing your own hard-earned insights with others can also give your challenges new meaning.
Groups can range from short-term setups wherein you tackle a specific problem like coping with COVID-19 or relationship issues to longer-term communities where you support each other through ongoing challenges like complicated interpersonal struggles or recovery from trauma.
Unlike a support group on Facebook or even a virtual one led by a peer, group therapy is always facilitated by a certified group therapist. They should, ideally, know how to manage group dynamics, deal with conflicts and microaggressions, and ensure the space you share is secure, safe, and confidential. Group work can be challenging when you’re given honest (but painful) feedback or clash with other members. But difficult times can lead to growth, and you might also find yourself exchanging numbers after sessions or building years-long friendships.
Among other issues, group therapy can help with: substance abuse treatment, depression, low self-esteem, anxiety disorders, obsessive-compulsive disorder, personality disorders, eating disorders, trauma, PTSD, gender identity, and insomnia, as well as managing some symptoms of schizophrenia, a cancer diagnosis and survivorship, grief, and life with chronic physical health conditions such as diabetes or HIV/AIDS
What to expect: Once or twice weekly one- to two-hour meetings with one to two group leaders and about 5 to 15 group members. This can last anywhere from a single session to years of gatherings. Before you join a group, you’ll typically have a group screening session with a group leader to learn about the group, its structure, culture, and members, and ask any questions you may have. (A good one: How large is the group and is it still growing? At least five members is a good sweet spot for a lively conversation, notes Dr. Marmaroush.)
One way to get started: Use the American Group Psychotherapy Association directory search tool to find a group that suits your needs in your area.
See more from our Guide to Caring for Your Mental Health here.
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