Choosing a therapy approach can feel more complicated than it needs to
If you have ever searched for a therapist online, you have probably come across a long list of approaches: CBT, EMDR, somatic therapy, parts work, mindfulness, art therapy, attachment-based therapy, trauma-informed therapy, and many more.
It can quickly start to feel like you are supposed to know exactly what kind of therapy you need before you even begin.
I do not think that is realistic.
Most people do not come to therapy already knowing what modality is going to work best for them. They usually know what they are struggling with. They know that they feel anxious, stuck, disconnected, overwhelmed, burnt out, triggered in relationships, or like the same patterns keep repeating. That is often enough to begin.
The rest can be figured out together.
One thing I think people sometimes put too much pressure on is finding the “right” therapist based only on training and certifications. Those things matter, of course, but they are not the whole picture.
A therapist can have excellent training in a particular approach and still not feel like the right person for you.
For me, one of the first questions is much simpler: How do you feel when you are sitting with this person?
Do you feel heard? Do you feel rushed? Do you feel like you can be honest? Does your body feel relatively safe in the room? Do you feel like there is space for you to not know what you need yet?
Those things matter just as much as the modality listed on someone’s website.
The most popular therapy is not always the right therapy for you
Certain therapy approaches become very popular at different times.
CBT is one example. EMDR is another. Someone may hear that a friend had an amazing experience with EMDR, or see people talking online about how much CBT helped them, and assume that must be the approach they need too.
But therapy is not one-size-fits-all.
What worked incredibly well for someone you know may not be what you need right now. It may not fit the way you process emotions. It may not fit the stage of therapy you are in. Sometimes an approach may eventually be useful, but there is other work that needs to happen first.
For example, someone may be interested in trauma processing, but if they are currently overwhelmed, highly dysregulated, or do not feel safe enough in the therapeutic relationship yet, jumping straight into deeper trauma work may not be helpful.
Sometimes we need to build more stability first. Sometimes we need to work on awareness. Sometimes we need to understand what is happening in the present before going deeper into where it started.
The right therapy can also change over time.
Safety comes before the modality
In my own work, safety is the first thing I am paying attention to.
Before I am thinking about which intervention or modality might be useful, I am thinking about how safe the client feels in the room and how safe it feels for them to talk about different parts of their life.
That safety does not mean every conversation needs to feel comfortable. Therapy can be uncomfortable. We may be talking about things that have been avoided for years. But there needs to be enough safety that the person feels they can stay connected to themselves while doing that work.
Once that foundation is there, then we can begin thinking more clearly about goals.
What is most important to the client right now?
What do they want to be different?
Is there something we need to work on first before getting to that goal?
Then I start thinking about what tools may actually help us get there.
Do we need to identify and challenge certain thought patterns? Do we need to work on coming back into the present and noticing sensations in the body? Do we need to build awareness cognitively, or would it make more sense to build awareness somatically? Are there different parts of the person showing up in conflict with each other? Do we need something other than words to access what is happening?
Those answers help guide the work.
Therapy does not always need to be one approach
My own style of therapy is very eclectic.
I do not generally think, “This client is doing CBT,” and then only use CBT with them.
We may borrow something from one approach and then use something completely different later in the same course of therapy.
Maybe a client benefits from understanding a thought pattern through CBT. Later, we may need to slow down and notice what is happening in the body. At another point, it may be helpful to work with different internal parts. Sometimes words are not enough, and expressive approaches are more useful.
The approach should serve the client, not the other way around.
I think therapy can become limiting when we become too attached to one modality and try to make every client fit inside it.
There are times when a structured approach is very helpful. There are also times when flexibility matters more.
My own experience with different types of therapy
I have experienced this personally in my own therapy.
I started by working with a therapist who used CBT. At that point in my life, CBT was very helpful. It helped me create awareness around my behaviour, my thought processes, and some of the patterns I was repeating.
I needed that awareness.
But after a while, I stopped making the same kind of progress.
The therapy had not failed. CBT had not stopped being valuable. I had simply reached a point where understanding things cognitively was no longer enough.
The next part of the work required me to come back into my body more.
That was when I started working with an art therapist.
That experience gave me access to things that talking and thinking alone had not. It allowed me to relate to my emotions and experiences in a different way.
Eventually, that work also reached a natural end.
I needed something deeper. I wanted to work more directly with trauma, and that is when I moved into EMDR therapy. (Read more about EMDR here)
Looking back, none of those approaches was “the right one” and the others “wrong.”
Each one was right for a different stage of the work.
That is something I think is important to understand when choosing therapy. You are allowed to need something different later. You are allowed to outgrow an approach. You are allowed to have a conversation with your therapist about whether the work has hit a dead end.
Sometimes the answer is to adjust the approach within the same therapeutic relationship. Sometimes the answer is to work with someone who offers something different.
Both can be valid.
How do I know if therapy is challenging me or just not working?
Therapy is not always supposed to feel easy.
Some sessions are going to feel heavy.
You may be opening boxes that you packed away a long time ago. You may be looking at beliefs or experiences that you have avoided because they are painful. That can be uncomfortable.
But I do not think you should be consistently leaving therapy feeling heavy without anything changing.
If that keeps happening, it is worth talking about.
Maybe you need more time at the end of sessions to close the work properly. Maybe the therapist needs to slow down. Maybe you need more grounding. Maybe the approach being used is not helping you process what is coming up.
There is a difference between:
“This is hard because we are doing meaningful work.”
and:
“I keep feeling awful after therapy, nothing seems to be changing, and I do not understand what we are doing.”
The second one deserves a conversation.
Another sign that something may not be the right fit is when therapy feels like it is going nowhere for a prolonged period of time.
You may still be talking every week, but it feels like you are having the same conversation over and over without any movement, insight, or change.
That does not automatically mean you need a new therapist, but it does mean something needs to be discussed.
You should be able to talk to your therapist about what is not working
This can be surprisingly hard for people.
If you have spent a lot of your life believing that your needs do not matter, or that you should not inconvenience people, telling your therapist that something is not working can feel uncomfortable.
You may worry about hurting their feelings or seeming difficult.
But these conversations are part of therapy.
You should be able to say:
“I feel like we are stuck.”
“I do not think this approach is helping anymore.”
“I keep leaving sessions feeling overwhelmed.”
“I do not understand what we are working toward.”
“I think I need something different.”
“Can you explain why we are using this approach?”
A therapist should be able to have that conversation with you.
They may agree that the approach needs to change. They may explain something about the process that helps you understand where the work is going. They may recommend a different type of therapy or even another therapist if that would serve you better.
The goal should not be to keep you in one therapy approach simply because that is the therapist’s preferred modality.
What if I am completely new to therapy and have no idea where to begin?
You do not need to figure this out before contacting someone.
I sometimes compare it to going to a physiotherapist.
If my back hurts, I know my back hurts. I do not necessarily know which physiotherapy technique should be used, what exercises I need, or what treatment plan is best.
I go in and explain what I am experiencing.
Then I ask questions.
Therapy can work the same way.
You can simply say, “I know I am struggling with this, but I do not know what kind of therapy I need.”
That is a completely reasonable thing to tell a therapist.
Some useful questions to ask are:
What approach would you use for what I am experiencing?
Why do you think that approach may be helpful?
What would therapy with you actually look like?
How will we know if the work is helping?
What happens if this approach is not working for me?
Do you use more than one modality?
How do you decide when someone is ready for trauma work?
You are not interviewing them to prove their expertise. You are trying to understand how they think and whether their approach makes sense to you.
If you are still unsure whether therapy is something you need right now, you may also find How Do I Know If It’s Time to Start Therapy? helpful.
Pay attention to how you feel in the conversation
This is one of the things I would pay the most attention to.
How does your body feel when you are talking to this therapist?
Do you feel like you can breathe?
Do you feel like they are actually listening?
Are they interrupting or rushing you?
Do you feel pressured to share more than you want to?
Do they seem curious about your experience, or does it feel like they have already decided what is wrong with you?
Do you feel like there is space to ask questions?
You may not feel completely safe immediately. You are still talking to a stranger, and trust takes time.
But there should be something in the interaction that makes you feel like safety could grow there.
For me, that matters more than whether someone has every certification you were originally searching for.
There is something deeply important about feeling witnessed, held, and seen by another person. Therapy is not only about technique. It is also about the relationship in which that technique is being used.
So, which therapy is right for me?
The answer may not be one therapy.
It may be one approach for now and another later.
It may be an eclectic therapist who draws from several modalities depending on what you need.
It may be a therapy you had never considered before.
And it may take some trial and error.
Rather than trying to choose the perfect modality before you begin, I would start with a few questions:
What am I struggling with right now?
What would I like to be different?
Do I feel safe enough with this therapist to be honest?
Does their explanation of the work make sense to me?
Do I feel like they are willing to adapt if something is not working?
Does the therapy feel challenging in a productive way, or simply stuck?
You do not need to know exactly what you need before therapy starts.
A good therapist should be able to help you figure that out with you.
At Soul Prism Therapy, our therapists draw from different approaches depending on the person, their goals, and where they are in the process. Therapy is available in person in Vaughan and virtually across Ontario. If you are unsure where to begin, a consultation can be a useful first step to talk about what you are looking for and what kind of support may make sense for you.
