1. How can I have a successful therapy?

For people unfamiliar with therapy, you may find in your search that therapists practice many different therapy styles. You may find yourself getting confused or overwhelmed with many of these acronyms (CBT, DBT, ACT, etc) as well as their educational credentials.

Ultimately the best predictor of whether you will have a good therapy session is if you end up feeling like you can trust your therapist to work on whatever issues you want to discuss with them. This is commonly referred to as the working alliance or therapeutic alliance.

Some basic things to consider when you are looking for a therapist:

-You feel confident that your sessions with them can lead to positive change.

-You feel like they like and appreciate you.

-You feel like your therapist is collaborative.

Most therapists will allow a free 15-minute phone consultation where you can get a feel for how they would conduct a therapy session with you.

2. Can Therapy be More Effective than Medication?

Currently there are no FDA-approved medications for personality disorders and complex trauma. Medication management for these individuals often include treating co-morbid psychiatric conditions and understanding the limitations that medications can provide for these individuals.

Some therapists specialize with working with these individuals to create lasting positive change. Therapy modalities such as eye movement desensitization and reprocessing (EMDR) and internal family systems (IFS) for trauma and dialectical behavioral therapy (DBT) and mentalization-based treatment (MBT) for borderline personality disorder can be effective therapies for these individuals.

3. Can Therapy Be Used in Combination with Medications?

For most individuals, the benefits of therapy can be combined with the benefits of medication management for optimal psychiatric treatment.

Some individuals are able to make good progress with a separate therapist and a medication prescriber (so-called split treatment).

-One benefit of this treatment is that it is likely more cost-effective to see a therapist weekly and then see a psychiatrist less frequently for medication management.

-Other individuals may be seeking a therapist who may offer more specialized therapeutic treatment than their treating psychiatrist would be able to provide.

Others individuals prefer working with a therapist who can also prescribe medication (so-called integrated treatment). This style of psychiatric treatment was once more popular, but has been increasingly more difficult to find as many psychiatrists have shifted more towards more specialized medication management roles.

If this is what you are looking for, you may have better success looking for “integrated psychiatrists” or psychiatrists who provide “psychodynamic or psychoanalytic psychotherapy.”

-One benefit to this is the convenience of being able to work with just one person to manage your mental health.

-Another benefit is that medication management changes can be done on a more gradual level given the higher meeting frequencies.

-However, this can be cost-prohibitive for individuals looking for this form of treatment and relatively few psychiatrists are currently able to provide this service compared to medication management.

4. What Is The Difference With All These Therapies?

Cognitive behavioral therapy (CBT) is focused on modifying unhelpful behaviors or thought-patterns. It can be helpful when individuals have very specific goals that they would like to work on and enjoy a goal-based approach.

Dialectical behavioral therapy (DBT) is a type of CBT where the focus on treatment is emotion regulation, improving relationships with others, and developing healthy coping skills. This was traditionally developed to treat borderline personality disorder but can be helpful for other individuals.

Psychodynamic or Psychoanalytic Therapy is a more traditional form of therapy that is geared towards facilitating an individual’s self-exploration and self-awareness of their thoughts and beliefs. It can be a more free-flowing process where treatment goals may change with time without a direct emphasis on eliminating symptoms. Paradoxically, this indirect approach may actually lead to symptom improvement for some individuals.

5. Is one therapy (CBT) better than another therapy (DBT, ACT, psychodynamic therapy)?

You may come across some therapists who may pitch that one therapy is better than other therapies.

To date, there have been no research studies that have been able to definitively prove that one therapy is inherently better than the other!

Whether or not you get a benefit from a specific modality will depend on what you’re looking for in therapy and the level of trust you’re able to build with your therapist.

If you’re interested in finding out more about how I approach therapy in my practice, give me an email and I’ll be happy to discuss more with you!