Thinking of seeing a psychologist? Here's how to choose the therapy best for you

In any year, one in five Australians will experience symptoms of a mental illness.

While drug treatments are widely used and can be effective, they sometimes come with troubling side-effects such as weight gain, headaches, and fatigue.

Talking therapies can be just as effective for a number of mental health conditions including anxiety and depression, or can be a good add-on therapy for those who are finding success with medications.

And they have the added benefit of tackling any underlying reasons why the problem arose in the first place.

So, what are the options for treatment and how do they work?

Read more: More Australians are diagnosed with depression and anxiety but it doesn't mean mental illness is rising

First, find a psychologist you click with

One of the most important aspects of psychological treatment is having an engaging relationship with your psychologist.

If you don’t “click” within the first few sessions, treatment is unlikely to be effective.

This doesn’t mean there’s anything wrong with you or your psychologist. It’s just that this particular relationship isn’t going to be useful – and you should seek out someone you can connect with.

It’s also important to find the method of therapy that suits you best.

Some people, for example, like to get clear instructions and advice, while others prefer to take time to discover their own solutions. Each of these people will connect with different types of therapy and different psychologists.

So what are the key types of therapy psychologists offer and who are they best suited to?

Cognitive behaviour therapy

Cognitive behaviour therapy (CBT) is one of the most widely used and well-known talking therapies.

CBT refers to a range of different structured approaches that are based on the assumption that the way a person feels is closely related to the way a person thinks and the way they behave.

The treatment then uses activities to target both the things people think (their cognitions) and the things they do (their behaviours).

To change a person’s feelings, a psychologist providing CBT will help that person engage in different activities that can help to change thinking and behaviour patterns.

A CBT psychologist might encourage a person to keep a diary, for example, of the kinds of things they think through the day. Thought diaries often follow an ABC format:

• A, the activating event – the thing that made the thought happen
• B, the belief – the actual thought itself
• C, the consequence – how thinking that thought made the person feel.

Sometimes D and E are added:

• D, some disputing the person could do – what could they think instead
• E, the end result – reflecting on how this alternative way of thinking makes the person feel.

Read more: Explainer: what is cognitive behaviour therapy?

Acceptance and commitment therapy

Acceptance and commitment therapy (ACT) is another popular treatment that can be effective across a wide range of situations and problems.

ACT specifically targets the person’s tendency to avoid things and helps them develop greater psychological flexibility so they can pursue areas of value and live meaningful lives.

While CBT tries to change thinking and behaviour, ACT introduces the intriguing idea of people not changing their thoughts and behaviours but, rather, achieving a state of mind where they’re able to notice the problematic thoughts, images, feelings, or behaviours but not be overwhelmed or consumed by them. That’s the “acceptance” part.

Read more: Everything dies and it's best we learn to live with that

ACT also encourages people to identify values that are important to them and figure out ways their day-to-day life can reflect these values. That’s the commitment part.

ACT psychologists have a range of novel and engaging activities at their disposal. An ACT psychologist might help a person visualise placing their thoughts on leaves floating down a stream. They can then watch their thoughts float by and disappear down the stream.

Behavioural activation

Behavioural activation was initially developed for the treatment of depression but has since been used more widely. It involves identifying and scheduling activities that promote enjoyment or reduce stress.

Behavioural activation helps people identify things in their environment that are contributing to the problem, and the things that could really help, along with the behaviours that are associated with each of those things.

Read more: 'What is wrong with me? I'm never happy and I hate school'

The focus of behavioural activation is on helping people develop specific goals and achievable plans that activate rewarding behaviours.

Behavioural activation can involve similar activities to CBT, with more of an emphasis on the behaviours than the thoughts. Someone engaging with a behavioural activation psychologist, for example, might spend time monitoring the activities they do throughout the day and rating each in terms of the impact it has on their mood.

Method of levels

Method of levels is a newer and less well-known treatment but is gaining increasing interest. It focuses on the control that a person has in their life, how it was interrupted, and how it can be restored.

Method of levels has similarities with each of the other therapies but uses the conversation that develops in therapy, based on the indivdual’s perspective of their problems, as the main “technique”.

This type of therapy responds to how a person is functioning “right now” in the session as they’re talking to the psychologist.

The topic of any session is determined by the person with the problem. The psychologist focuses on the distress associated with any particular pattern of symptoms rather than the symptoms themselves.

If a person reported, for example, being highly anxious in social situations and constantly worrying about what other people were thinking of them, the psychologist would be interested in exploring what bothered the person about feeling that way, what it was interfering with, and what it was stopping them from doing.

Through these conversations, the psychologist helps people generate their own solutions to their problems rather than providing advice and guidance from their perspective.

Method of levels recognises the variability in how long it takes for people to resolve psychological and social problems and that psychological change often follows a nonlinear, unpredictable course, so it uses a patient-led approach to appointment scheduling rather than neat schedules.

What if it’s not working?

There are many more treatments available than those listed above, and many psychologists will be skilled in more than one treatment or may even combine different treatment types.

If you can find someone you relate to, who is interested in monitoring your progress on a regular basis, and who can work flexibly and responsively with you about the things you’re troubled by, it’s likely you’ll find the relief you are looking for.

But there are no guarantees. A treatment is simply a resource which people can use to help make sense of things that previously seemed senseless and to restore contentment, satisfaction, and feeling that you’re living a valued life. It’s the people who make treatments work.

If you don’t seem to be getting the results you want, it could be time to consider seeing someone else or trying a different type of therapy.

Read more: Talking therapies can harm too – here's what to look out for

Tim Carey has received research funding from the Australian Research Council, the Northern Territory Government, and the Central Australia Academic Health Science Network. He is currently Vice-President of the Australian Psychological Society and he developed and is the leading evaluator of the Method of Levels.