If you’re dealing with depression or low mood, then therapy can really help. But with so many approaches out there, how do you choose the right one for you? Here is a handy guide to different types of therapy…
Low mood can be a frightening, isolating and bewildering experience. It can also feel different to different people.
For some it can feel like a deep, unshakeable sadness, as if you have a heavy weight wedged in your chest. For others it can be a sense of numbness, where your emotions feel flat and your usual hobbies no longer interest you. And sometimes it might show up as suicidal thoughts or a desire to run away from everything.
Low mood can also manifest as physical symptoms, for instance, fatigue, insomnia or seemingly inexplicable aches and pains. And while you should always see your GP if you’re feeling physically unwell, these symptoms can also be linked to depression. Social withdrawal, addictive behaviours and lack of motivation are other signs, as are irritability and loss of appetite or libido.
However low mood or depression shows up for you, it can be hard to gain perspective when you’re feeling this way. You might even find that you have an inner voice telling you that you’re ‘worthless’, you’ll ‘never feel better’ or that reaching out for support is ‘pointless’. However, don’t believe it — that inner voice is actually just a part of feeling low.
And while talking to family and friends can make a difference, they might not be equipped with the skills and experience to fully help you. That is why reaching out to a therapist can help you to understand why you’re feeling this way, as well as develop tools to process, manage and heal it.
Yet if you do decide to try therapy, the range of choices can be bewildering. For instance, what’s the difference between approaches like CBT, CAT or CFT? And should you be seeing a psychotherapist, counsellor or psychologist?
As a starting point, our post on choosing the right kind of mental health professional for you might come in handy. But to summarise, it’s worth noting that psychotherapy is different from counselling. In general, counselling offers a supportive, non-judgmental listening space from an individual usually trained at diploma level and sometimes at degree. Typically, it is a low-cost or free service that takes place over a set time, often between six to 12 weeks. Counselling tends to deal with immediate issues in a talk therapy format, yet isn’t always ideal for more serious issues like depression linked to trauma or thoughts of hurting yourself.
In contrast, a psychotherapist or clinical psychologist can offer deeper, longer term and more specialised support, sometimes using methods that go beyond talk therapy. They will also tend to have more extensive training, in some cases at Masters, doctoral or postdoctoral level. Often they will specialise in particular issues like trauma and might also be trained in a variety of approaches.
That said, do check an individual’s qualifications before booking an appointment, as anyone can actually use the title of ‘counsellor’ or ‘therapist’ without any formal training.
In terms of their approach, different types of therapies tend to come under different categories. Many approaches have been proven to help with low mood, although they tend to use different methods to do so. For instance, some might focus on changing day-to-day behaviours while others might emphasise exploring your past. Still others will focus on understanding depression in the context of trauma, so will work on processing this to improve self-worth and mood. Research indicates that various different approaches can work, so there isn’t one single choice that’s best for everyone. It depends on what is right for you as an individual.
When considering the best approach for you, it can be helpful to consider what you want to get from therapy and how you want to engage with your therapist. Are you open to talking about past experiences so you can better understand how you're feeling — or do you want to focus on the here-and-now and learn practical ways of managing your mood, emotions and thoughts? Also, some people want to hear and explore the therapist's interpretations of what they're bringing to sessions. Yet others prefer to work with a therapist who is more active and directs sessions, perhaps by suggesting exercises or providing education and resources.
To give you a better picture, here are some key approaches to consider:
1. Structured and symptom-focused therapies — CBT, ACT, CFT and Mindfulness
These kinds of therapies can help you to develop skills for managing your thoughts and emotions in the present.
For instance, Cognitive Behavioural Therapy (CBT) can help you to challenge negative thoughts and beliefs that could be sending you into a low mood spiral, such as ‘I’m worthless’, ‘Everything is all my fault’ or ‘I don’t deserve to be happy’. It can also help you identify things you might be doing that inadvertently reinforce your low mood, such as cutting yourself off from people, not taking care of yourself and avoiding activities that bring you pleasure or a sense of accomplishment.
Acceptance & Commitment Therapy (ACT) and Mindfulness-Based Therapy aim to help you to accept the presence of negative thoughts when they show up, rather than pushing them away or going along with what they say, thereby responding to them in healthier ways that help your mood and self-worth. And with Compassion-Focused Therapy (CFT), you can learn to be kinder to yourself instead of being self-critical, for instance through imagery exercises and by developing self-soothing practices.
These approaches would suit you if you would like to focus on some practical methods of tackling low mood by developing healthier thoughts, behaviours, habits and coping strategies. The sessions are often structured in that the therapist will often share information and take you through techniques with a view to you practising them yourself in between sessions.
2. Exploratory therapies — Art Therapy and Psychodynamic Therapy
These types of therapy can help you to uncover unconscious or deeper processes that could be affecting your mood, without you even being aware. The therapist interprets information that is spoken, not spoken, enacted, expressed in dreams, expressed in symbols and even the therapeutic relationship. In this way, they can help you to understand yourself and make internal shifts.
Psychodynamic Therapy is a way of bringing the unconscious into the light by exploring how repressed emotions and experiences from earlier in life might still be affecting you today. This way, you can become more aware of underlying reasons why you might be feeling low, for instance, inner conflicts, relationships in which needs were not met and/or inexpressible anger turned inwards.
Art Therapy is a way to process your inner world and feelings through practices like drawing, pottery and collage. By using art materials, it can be possible to find ways to express emotions that were otherwise suppressed, often affecting your mood. It is also a way to bring your unconscious into your consciousness through creativity, all while being supported by a therapist.
These approaches would suit you if you would like to go on a deeper journey of self-exploration to uncover hidden parts of yourself. They can be useful for people who tend to intellectualise the experience of being with a therapist. In essence, the process of exploring unconscious processes can lead to a deep-level change that can be hard to put into words.
3. Structured exploratory therapies — CAT Therapy and Schema Therapy
Both Cognitive Analytic Therapy (CAT) and Schema Therapy combine structured and exploratory approaches to make links between early experiences, unmet needs and how you feel about yourself in the present. They are about exploring the deeper causes of unhelpful patterns in your life and healing their origins, as well as trying to address those patterns in the day-to-day.
CAT examines unhelpful thoughts, feelings, behaviours and actions by exploring events earlier in life and the core pain associated with them, for instance, abandonment by a parent. The therapist then helps you draw out the vicious cycles, barriers to change and dilemmas that have developed as solutions to this but maintain current issues such as low mood. You can then develop ways of breaking free of the patterns that could be causing depression or other issues.
Schema Therapy explores how unmet needs in childhood can cause you to have negative beliefs about yourself. This can include beliefs like ‘I am not worthy of love’ or ‘People always leave me’. Once these beliefs have been brought to the surface, you can start to break free of any unhelpful patterns of behaviour or ways of being that they are causing. This could include people-pleasing, disconnecting emotionally or distracting from feelings by keeping busy all the time. With Schema Therapy, old wounds can be healed using experiential exercises, resulting in more accurate ways of viewing yourself and your self-worth. Added to this, you can also learn more effective ways of getting your needs met in the present.
These approaches would be useful if you would like to combine practical change with a deeper dive into why you might be stuck in certain behaviours, beliefs and coping strategies. This is helpful if you notice the same patterns repeating, particularly when it comes to areas of your life that impact your mood, such as relationships.
4. Trauma-based therapies — EMDR
Trauma is a response to a disturbing or shocking event or experience that overwhelms our capacity to cope. This could be an experience of being attacked, humiliated or even ignored (when you really needed support). It could also include a threat to your health or safety, or witnessing this happening to someone else when you were powerless to stop it.
Complex trauma responses can also be caused by living through a longer-term period of distress, particularly in childhood, such as growing up in an unhappy or stressful home. This experience can have a lasting impact on our nervous systems. Signs can include low mood, unstable emotions and challenging relationships. EMDR and Body-Focused Psychotherapies can help you to work through unprocessed traumatic events and the impact that they’re continuing to have — for example, being emotionally disconnected and shut down (which can look a lot like depression).
EMDR is a combination of both talk and body-based therapies that encourages your mind to heal itself. It does this by taking you back to a distressing event then using a range of techniques to help you to process it. It can help you understand the experiences that are driving your low mood, identify the negative messages you’re still telling yourself about these experiences and update these messages so that they more accurately reflect you and your life in the present.
EMDR and other trauma-focused therapies might be a good option if your mood has dipped after an upsetting event or loss, or just after a life change such as becoming a parent, moving to a new area (or country) or taking on a new challenge in your work life. Or perhaps you’ve always felt a level of sadness or melancholia that is holding you back from living the life that you want? Even if you don’t know what triggered your depression, EMDR might help you to make links you weren’t previously aware of, as it goes to places that talk therapy alone doesn’t.
Remember that when it comes to choosing a type of therapy, there isn’t necessarily a ‘right’ or ‘wrong’ choice, so don’t put pressure on yourself to make the perfect decision. It’s more about how you respond to therapy and what you need. But if one approach in particular feels appealing, then that could be a good starting point. Also, bear in mind that clinical and counselling psychologists tend to use combined and integrated approaches, so will draw upon whichever tools seem best suited to you and your goals as they get to know you.
Before finding a therapist, it’s also worth asking yourself whether you would prefer in-person, video or live text chat appointments. Each option has its benefits and if you feel daunted about the idea of travelling to an appointment, then hopping onto a videocall from home or sending texts could remove a lot of pressure.
If you feel uneasy around the idea of seeking support, then it can be useful to explore why that might be. Maybe you feel that your problems somehow aren’t ‘important’ enough or you are worried that the therapist will judge you? Or maybe you grew up with the message that there was a stigma around getting help? It’s actually very normal to feel this way and you might find some reassurance from our post on common barriers to starting therapy as well as 4 things to expect from your first therapy appointment.
Beginning therapy is a big step, especially when you are feeling depressed, but caring, non-judgemental help is out there. With time and patience you can heal low mood, understand it better and develop strategies to help you maintain your wellbeing in the long term.
Dealing with depression, low mood or suicidal thoughts? We’re here for you. Book an in-person, video or live text chat appointment with an MTA therapist today.
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