Find me a therapist who specialise in anxiety
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 specific psychological problem or diagnosis. After all, a diagnosis is just a symptom of the many underlying things that can gnaw at our minds and make us suffer. Some counsellors specialise in anxiety, depression or as a made-up example of a niche, high-functioning women with burnout.
Psychological problems, however, do not come in neat categories, and any well-rounded therapist should be able to take into account other things about you that affect how we work together. Things that matter, such as family and early experiences in life, trauma, life stage and current transitions and challenges, 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 we start with a consultation, and I take time to speak to you so we can work out if we can work together and I assess if therapy with me can help you with the problem you want to work with.
What makes therapy effective and why does it matter in relation to the question of specialisation?
This is an important question to consider in the context of whether you should choose someone who specialise or not. Therapists are not all-knowing, but you should expect curiosity and aptitude for helping you find resilience and agency in whatever emotional or mental struggle you have - therein lies the expertise.
Regardless of whether you choose a specialist counsellor research consistently shows that the therapeutic relationship—feeling comfortable, safe, and understood by your therapist—is the biggest predictor of success, even more than their specific niche.
Specifically, research shows, that therapists who achieve better outcomes (Bargmann and Chow, 2014) are the ones who continue to adapt to what their clients need beyond the modality or technique.
Clients also have good outcomes when therapists focus on what meaningful therapy is, as explained by psychoanalyst and researcher Jonathan Schedler in this YouTube video and written about in his publication, The Efficacy of Psychodynamic Psychotherapy (Shedler, 2010). The therapeutic relationship also appears to be the most important ingredient in outcomes, which Shedler discusses in the podcast, Championing Relational Therapeutic Solutions in a Quick-Fix World.
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, or dominant cultural norms (which is something we often challenge in narrative therapy).
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 symptoms of underlying 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 or any other variable.
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 am a trauma 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, wittingly or unwittingly, it may affect your curiosity and the development of your own resilience and agency as an outcome of therapy.
On helping others and passing it forward
Regarding the disclosure of lived experience as a therapist (which goes with being human), I think there is a difference between using it as an open advert versus using it as background for the therapist’s 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.
References
Bargmann, S., & Chow, D. (2014). Feedback Informed Treatment (FIT): Achieving Clinical Excellence One Person at a Time. Independent Practitioner (APA).
Shedler, J. (2010). The Efficacy of Psychodynamic Psychotherapy. American Psychologist, 65(2), 98-109. https://doi.org/0.1037/a0018378
