Okay, so you know what’s wrong – officially or not, for that matter – but now you have another problem: there are tons of different therapies out there and you don’t know which one to choose.
Beyond the therapeutic alliance and individual competence of each practitioner, certain conditions have well-established reference treatments, while others require a more personalized approach, since two people can have the same problem but for completely different reasons.
This article offers clear guidance to help you find the right professional for your situation.
Table of Contents
Work with a specialist whenever possible
Generally speaking, the best thing you can do – by far – is to find someone who has the specific skills to help you. First, for their experience, since this person will be used to working with your condition. But also for efficiency. Someone who is specialized in your particular issue should know it inside and out. They know which techniques work, and they probably stay up-to-date on new developments in the field.
Even for very common conditions like depression or anxiety, a specialist is still more effective than a generalist. The problem is that specialists are often hard to find because they have longer waiting lists, are potentially more expensive, and there might not be any in your area. But if you can find one and they’re accessible to you, I really recommend working with them.
For neurodivergence, you absolutely must choose someone trained in this area, because it’s not a pathology but a difference. Your brain works differently and you need someone who understands this and helps you navigate a world that wasn’t built for you. Most of the problems that neuroatypical people suffer from come from over-adapting to a neurotypical world. A specialist understands this distinction well and will help you develop strategies that are adapted to you and your brain.
The same goes for people who are part of the LGBTQ+ community: make sure your therapist is LGBTQ+ friendly and understands the specific difficulties of navigating a world that is often hostile towards you.
Certain conditions have established treatments
After all this time trying to find concrete and effective solutions to our psychological problems, we’ve actually been able to work out that certain conditions have treatments that are particularly well-suited to them.
Trauma
We started seriously studying trauma since World War I, faced with the terrible psychological damage it left on surviving soldiers. Today, thanks to advances in neuroscience, we know that trauma is a major nervous system dysregulation, and that’s why talk-based therapies are often ineffective in treating it.
The most “simple” version of a traumatic state is PTSD (the famous post-traumatic stress disorder). This occurs following a single traumatic event, unlike complex PTSD and dissociative disorders, which are due to repeated and/or prolonged trauma that damages or even completely fractures the self.
You absolutely must choose a “trauma-informed” therapist, meaning someone who knows the effect of trauma on the nervous system. To treat PTSD, we now know that certain approaches are much more effective than others, notably:
- Brainspotting
- EMDR
- Neurofeedback
Brainspotting is currently THE cutting-edge therapy for trauma-related problems. It’s more effective than EMDR and less protocol-based, however, it’s harder to find a therapist who practices Brainspotting because there are far fewer of us. EMDR remains the best known, and even though it’s less suited for people with dissociative disorders, it’s a very effective therapy, just like Neurofeedback. These approaches work directly with the nervous system. In cases of complex PTSD or dissociative disorders, you need a multidisciplinary approach or a specialist because the healing process is longer.
⚠️ Important: CBT and traditional psychoanalysis are not effective for treating PTSD.
Grief
There are many types of grief, but the ones we’re interested in here are so-called “normal” grief and those that are “complicated” or “traumatic.” Although these last two were long considered different, complicated grief is now considered similar to traumatic grief, and thus the best approach takes the nervous system dimension into account.
If you’ve experienced a loss and need support, a psychoanalyst will know how to create a space where you can simply express yourself and be heard in your suffering. If you realize you can’t move forward, and/or you have traumatic symptoms like flashbacks or nightmares, you need to treat the problem at the nervous system level, with EMDR, Brainspotting, or Neurofeedback. Nothing stops you from combining both approaches, by the way, to benefit from both.
Borderline personality disorder
Borderline personality disorder is a complex disorder that requires an approach tailored to it. Today, the most effective therapy that exists for this condition is dialectical behavior therapy (DBT), which was designed specifically for it.
It’s an approach that combines:
- cognitive-behavioral techniques
- acceptance and mindfulness approaches
- interpersonal effectiveness strategies
- emotional regulation strategies for dealing with distress
It is currently the only empirically validated treatment for borderline disorder, and unlike other approaches, it integrates both a non-stigmatizing approach where the intense emotions of borderline individuals are recognized as adaptive responses (no “manipulation” or “attention-seeking”), but also teaches positive behavioral changes to manage intense emotions and build healthy relationships.
You should also know that comorbidity between ADHD and borderline disorder is common (up to 34% of adults with ADHD have both diagnoses), which complicates diagnosis and treatment. Given that 70% of borderline people have experienced childhood trauma, it’s crucial that your treatment takes this into account and that your therapist is trauma-informed, and if possible, trained in EMDR, brainspotting, or neurofeedback.
The problem with “symptom-conditions”
Depression, anxiety disorders, and eating disorders are “symptom-conditions,” meaning they are very often symptomatic of something else, and to be able to treat them effectively, you need to know what that something else is.
Let’s examine the following cases:
Severine: She consults because she’s felt very anxious since her car accident and has panic attacks whenever she gets behind the wheel. She jumps at the slightest noise and sleeps poorly. She was diagnosed with an anxiety disorder, but in reality it’s trauma manifesting this way because her nervous system has been hyperactivated since that event. So she needs trauma-informed therapy, not CBT.
Marc: He’s always been a boy who “worried about everything,” but it got worse when he started believing he had to be perfect or he couldn’t be loved. He can no longer undertake the slightest project because the possibility of failure is too risky. Here, he needs to change his beliefs and thoughts, and structural therapy like NLP would be the ideal approach. CBT could also help him.
Elise: After having a very difficult childhood where she suffered significant emotional violence, she’s hypervigilant in her relationships and constantly watches for the moment when she’ll be rejected. She can’t trust her own perceptions of reality and feels anxious all the time. Here, she needs therapy that takes attachment bonds into account, like psychoanalysis. She could also benefit from NLP to change her limiting beliefs, or brainspotting or EMDR to potentially treat difficult emotions or trauma.
So these are three anxious people, but who are anxious for completely different reasons, and who therefore need approaches that differ as well. Treating Severine’s anxiety with CBT would be as ineffective as treating Marc’s with EMDR. And the same goes for depression and eating disorders, although the latter requires a specialized and probably multidisciplinary approach because they often involve additional medical and nutritional aspects.
When you need a multidisciplinary approach
Certain conditions require combining the expertise of several professionals, like psychosis, for example, or bipolar disorder. For example, working with a psychiatrist to have appropriate pharmaceutical treatments, but also with other therapists for support and listening, or to resolve trauma-related or relational problems.
Burnout and eating disorders also need this multidisciplinary approach, although consulting a specialist in the matter remains ideal. And the same goes if you’re unlucky enough to have several problems to treat, like PTSD coupled with depression, or ADHD accompanied by an anxiety disorder.
Finally, in cases of severe trauma, complex PTSD, significant dissociative disorders, and failing to find a specialist to work with, combining a trauma-informed approach (EMDR, Brainspotting, etc.) and supportive therapy (psychoanalysis or other) is ideal for regaining a regulated nervous system and quality of life.
Conclusion
Choosing a therapist is complicated, but I hope that with this article you’ll have an easier time making a decision and getting the help or support you need.
Remember, finding the therapist who’s right for you can take time, and that’s normal. A specialist remains your best option when possible, but someone competent and attentive can also work wonders if they know what they’re doing. The important thing is that this person understands what you’re going through and knows how to accompany you with kindness and humility.
Finally, keep in mind that your needs can evolve over time. It’s perfectly normal to need to change approaches along the way, test other therapies, or even completely change therapists depending on your evolution. Healing is not a linear thing – sometimes we think we’ve resolved something, but it comes back because we need to work on it more deeply. At other times, treating one problem brings others to the surface. This can be terribly frustrating, and we can feel like we’re not moving forward (or even going backward), but it’s normal, and it means quite the opposite!
Mental health is more of a journey than a destination, and you deserve to find the right support. So take charge of it: don’t be afraid to do your research and trust yourself, because even if you make a mistake, at worst it’ll just be a detour.