What’s the Best Form of Therapy?

workshop_6933-1_edited-1

The easiest method of doing something is not always the most effective; but it is the easiest, so that’s saying something for it. Easy is more effective than the most effective if the most effective is impossible for you to do.

When it comes to treatment for mental illness, if I were to rank the forms of therapy in order of effectiveness, meaning how thoroughly and reliably they can solve your problems, I would put it like this:

  1. Group psychotherapy
  2. Individual psychotherapy
  3. Medication
  4. Reading self-help books

But, if I were to rank them the easiest to hardest, it would go like this:

  1. Reading self-help books
  2. Medication
  3. Individual psychotherapy
  4. Group psychotherapy

Group Psychotherapy
When you join a good therapy group, you’re among people with some similar experiences, maybe for the first time ever. It’s easier to talk about what you would never talk about elsewhere. You have a chance to play different roles; you can be a teacher, counselor, exhorter, listener, friend, as well as a sufferer. You can observe your own madness played out before you by other group members; but you learn to be accepting of them as they learn to be accepting of you. Most of all, a good therapy group provides positive peer pressure. Encouragement seems more sincere when coming from others who share the same struggles; you are more willing to be held accountable.

On the other hand, group is hard. You’ve got to find one, show up regularly, and learn to talk to strangers about the most private things. There’s the risk of confidentiality violations. You can find some difficult personalities. You have to share.

Group is hard for the therapist, too. The more people in the room, the less control the therapist has over what happens there.

When I worked for a clinic that served hundreds of clients, I led many groups. I loved it. They were effective. The only group I have now is a group for therapists. I don’t do many groups now because it’s so hard to get people to attend and I have relatively few clients from which to recruit.

Group therapy can be found in different settings. If you don’t need a therapist to lead it, you can find a self-help group in AA or any of the other twelve-step programs. Almost every religious organization has at least one fellowship group. Then there are the weekly therapist-led groups that generally focus on a topic like DBT, grieving, or recovery from addictions. Not only do retreats, inpatient units, and residential programs have groups within them, you can think of them as groups themselves in which you live; a kind of total immersion in group. Then there are partial hospitalization programs which are almost as intense, but you don’t live there.

I would categorize family therapy or couple’s counseling, as special forms of group therapy. When family therapy succeeds, it succeeds for the same reasons group does; and when it’s hard, it’s just as hard. You can think of family therapy as a group that already has established norms before the therapist comes in as a newcomer to change them. That’s hard for a therapist to do, but when he can, it’s spectacular.

Individual Psychotherapy
Individual Psychotherapy gives you some of the same benefits of group and can be hard in the same ways, but less so. You have to learn to talk about your feelings, but it’s the easiest place to learn to do so. You can be encouraged and held accountable, but the encouragement and accountability are not as powerful as in group. You also have to show up, but you can do more to pick your time. Your therapist probably hasn’t had the same experiences as you, but she’s seen others who have, so she’s not a stranger to it. You can’t observe your own madness played out before you like you can in group; but if you hear yourself speak, you can. You can play different roles in individual therapy, but you’re just pretending. There’s some positive social pressure, but it’s the pressure of just one. You get the entire fifty minutes of a session, just for you; but sometimes that’s not a good thing; sometimes the best thing you can do for yourself is to shut up and listen.

Medication
It is far easier to swallow a pill regularly than to go to therapy. You don’t have to talk to strangers except for your doctor and he won’t want you to talk for long. Taking pills is unlikely to disrupt your day. You do have to deal with side effects and the whole seeing the doctor, getting refills, and going to the pharmacy rigamarole. Also, we often don’t know what the long-term effects of many of these chemicals might be. Then you often have to come off the medication someday or deal with withdrawal if you can’t get it.

If you have a severe condition, medication can relieve symptoms quite well; but if your ailment is mild, it might not do much good. Also, medication rarely, if ever, solves the underlying problem. Often the best that medication can do is help you reduce your anxiety, depression, psychosis, or anger just enough so that you can tolerate individual or group therapy, where the real change happens.

Reading Self-Help Books
This is the easiest method of them all. You don’t have to make an appointment, put pants on, and show up on time. There are no side effects other than paper cuts. No one has to know except for your librarian, bookseller, or the anonymous people at the Amazon warehouse. If you read online, you can clear your history or go to private mode.

Depending on your reading level, if you read enough books, you could end up knowing as much or more about your condition as the best educated therapist you can find; but if you have no opportunity to talk about what you’re reading, you might be getting it all wrong. If there is no person involved, sitting across from you, there is no encouragement or accountability. Also, most self-help books only espouse a single point of view. If your case is complicated or if you simply picked the wrong book, it might take you off track.

Nothing is easier than reading a self-help book. People sometimes say reading one changed their life; but they say that more often about therapy.

Other Options
I excluded many other options from my list that might help you. Things like meditation, yoga, weight lifting, getting a good night’s sleep, petting a dog, Reiki, acupuncture, and many others, too many to mention. Some might put smoking pot in the medication category or reading the Bible as a self-help book. For people with respectful, nurturing families, Thanksgiving dinner might be the best group therapy they can get. Talking with a good friend could be better than any therapist.

Good mental health is correlated with a willingness to entertain a multitude of options. If you want to find something that helps you, do this: try lots of things and carefully notice whether they help you feel and do better in the long run, or if they make it worse.

Which is best for you?
The question of which is best for you often comes down to how much therapy you can tolerate and how badly you need to get better. If your condition is relatively mild, then do what most people do: start with reading self-help books and work your way up the list if things don’t get better. The first thing you try may very well make subsequent methods easier. But, if you’re in a crisis, about to lose your job, a marriage, or take your life, then now’s not the time to fool around with lesser measures when you need strong medicine. Then it’s best to grit your teeth and start at the top with the things that are the hardest but most effective.