NZ Herald Column Kyle MacDonald

Kyle MacDonald: What type of therapy is right for me?

This is my column this week in the New Zealand Herald.  Click here for the original article…

“It’s been recommended I have therapy, and CBT was suggested. But I’ve been told a few different things. Does it matter what type of therapy it is?” Confused.

Since the time of Freud the field of psychotherapy has been a series of conflicts and disagreements about what helps people in mental anguish. At times different disciplines have behaved more like warring tribes.

So if it can be difficult for professionals to agree about what course of treatment is best for people, how are clients supposed to know what the best approach is?

“CBT” or “Cognitive Behavioural Therapy” is a type of therapy that has a strong body of scientific studies behind it, and is often recommended for people struggling with depression, anxiety or both. There’s no doubt it can be helpful, but some research suggests its effectiveness has been overstated: and it isn’t for everyone.

When it comes to depression there’s also Interpersonal Psychotherapy, Mindfulness Based Therapy, Psychodynamic Psychotherapy and Rational Emotive Therapy just for starters.

People with anxiety can be helped by most of the above as well as exposure therapy. And then there are also different general approaches: Psychoanalysis, Narrative Therapy, Transactional Analysis, Gestalt Therapy, Existential Therapy, Jungian Analysis… the list goes on.

If you’re confused, you’re not alone. But more recent research into therapy effectiveness suggests these differences only matter to the therapists themselves.

This doesn’t make it a free for all and it doesn’t just mean anyone can do therapy. These studies assume you’re seeing someone trained in something reputable. But when these large reviews of therapy are done, it is possible to isolate what works, and what doesn’t.

So what really makes the difference?

Well the numbers fluctuate a bit, depending on the study, but by far the strongest predictor of therapy working is the quality of the therapeutic relationship and what they call “therapist factors” defined by very normal human things like warmth, empathy, collaboration and genuineness.

The type of therapy matters, but in most studies it is one of the weakest predictors of a good outcome. What does matter is that your therapist is trained in something, that the therapist believes their approach is effective and that they have a consistent and clear way of thinking about what they do and why they do it.

So at the risk of living up to the stereotype (he says thoughtfully stroking his beard) all of this is a rather long-winded and complicated way of saying something that is common sense.

When it comes to picking a therapist, first make sure the person is trained, experienced and qualified. And second, make sure you like them, feel listened to and they’re someone you can relate to. It is true that specific techniques like mindfulness can be very helpful, you can learn those from a book or an app.

But an app can’t give you a genuine experience of feeling understood and cared about.

That’s the human factor, and that’s what makes the difference.


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