Find me a therapist who specialise in anxiety
Anxious and in hiding, what type of therapist may be best to turn to?
Should I choose a therapist who specialises in a specific mental health problem or diagnosis, such as anxiety or depression?
It depends.
I don’t specialise in one psychological diagnosis or label myself as a “trauma counsellor”. Although I see people who have experienced trauma and I am trained in working with people who have experienced trauma, I work with a variety of people and problems and at depth, as this does not come from specialisation alone when we are talking about humans.
After all, a diagnosis is just a symptom of the many underlying things that can gnaw at our minds and make us suffer. A trauma counsellor should also be a well-rounded therapist anyway, with the ability to take into account other things about you that affect how we work, such as family and early experiences, life stage, culture, personality style and how you connect with others (attachment).
There are areas of practice, of course, where I haven’t typically seen many people with a particular diagnosis or problem, and not every person can be helped in a private practice setting. This is why I take time to speak to you so we can work out if we can work together and what we both agree is the problem to work on.
What makes therapy effective?
This is an important question to consider. Therapists are not all-knowing, but we have or should have a curiosity and aptitude for helping you find resilience and agency in whatever emotional or mental struggle you have - therein lies the expertise. The therapists who research (Bargmann and Chow, 2014) says get good outcomes is the ones who continue to adapt to what their clients need beyond the modality or technique they use and focus on what meaningful therapy is, as stated by psychoanalyst and researcher Jonathan Schedler.
What might the problem then be, if you choose a mental health professional, whether they are a counsellor, psychotherapist or psychologist who focuses on one diagnosis and characteristic?
It could be fine, as many mental health professionals, regardless of what they market themselves on, see you as a whole person and understand that symptoms and diagnoses are just that, and that to address mental suffering, we need to get to the web of roots, not just one root of the problem.
It may not be fine if you find yourself in cookie-cutter therapy where the therapist has a set of exercises and psycho education based on their own lived experience and of that group of women that they exclusively treat for high-functioning anxiety.
The ladder approach can be problematic. Mental health struggles are woven into the fabric of our lives. Diagnoses such as anxiety, depression, Complex PTSD or prolonged grief often cover over deeper struggles, and they can be intertwined. If someone comes with anxiety, they might also feel depressed and vice versa. Depression or anxiety may also be the surface and underlying is traumatic experiences and ACE scores representing stories of abuse and neglect in a childhood deprived of warmth and responsible adults.
My main gripe with too much specialisation is that it narrows curiosity if we think we know how someone’s story will unfold when they first present in therapy with a symptom or specific characteristics, such as being a high achiever with anxiety.
Mental struggles are just not that simple, and there could be a thousand stories and paths to why someone ended up both high-achieving and anxious. We may miss something important if we focus solely on anxiety.
Additionally, enabling mere cognitive insight in therapy is only a part of what constitutes better outcomes in therapy, and the quality of the working relationship is the main factor.
The work in therapy is thus much more than the “treatment” of the presenting symptoms people come to see a therapist for. The work often deepens over time and deals with the underlying issues of the symptoms of depression, anxiety or repeated hardship in interpersonal relationship such as violence or abuse. This healing happens in a relationship, not due to the knowledge of a specific demographic group or the lived experience of the therapist per se, but mostly due to what happens in the relationship.
My other gripe with specialisation is that we as therapists may unwittingly set the scene for how you approach the problems in your life if the overarching narrative from therapists is that “I can heal your trauma as I only deal with this type of trauma so I am a specialist”, or “this is the trauma I, as a therapist, have overcome myself, so I know how to deal with it”. If I presented these narratives to you as a client and also stuck to them myself, I would not encourage your curiosity or foster your learning in figuring things out for yourself.
On helping others and passing it forward
Regarding the disclosure of lived experience as a therapist, I think there is a difference between using it as an open advert versus using it as fuel for your own hope and courage in working with someone who is really stuck. It is legitimate enough to want to help others, as we ourselves have been helped and pass it forward.
Many therapists have more or less lived experience of psychological wounding; this goes with being human, but I have never seen research show that this is necessarily a positive factor in itself in outcomes for our clients. And I would claim that if a therapist promotes their own lived experience as a reason to see them, you should also expect them to have been in therapy themselves and experienced working through really sticky problems and also have humility and knowledge about how your path is unique.
References
Bargmann, S., & Chow, D. (2014). Feedback Informed Treatment (FIT): Achieving Clinical Excellence One Person at a Time (APA Independent Practitioner, Miller,Hubble, Seidel, Chow, & Bargmann,2014). Independent Practitioner (APA).
