Choosing a therapy

There are dozens of different therapeutic modalities. I provide my opinion on a small subset of modalities, informed by two years of (nonprofessional) exploration. This may be helpful for people trying to navigate therapy or ‘self-healing’ more generally.

Context

Two years ago, in the midst of a personal crisis, I started taking ‘self-healing’ as a goal very seriously. I spent hundreds of hours reading about different approaches to therapy, trying techniques and taking notes on my experience. When I later consulted a therapist, I was introduced to techniques that required a trained practitioner, and also received some tacit confirmation of the hypotheses that I’d formed.

Months after I became obsessed, the crisis was dissolved. More than that, I began to unravel a tangled mass of suffering linked to my childhood. My sense of wellbeing significantly changed; my body and mind felt lighter, and my relationships, particularly with my family, began to improve.

Friends, after learning from my experience, have suggested I write down and share my thoughts more broadly. This document is in response to their prompt.

I’m not an expert, and this isn’t expert medical advice. Treat this as the opinionated account of some person on the internet who says he healed himself after hundreds of hours of various self-therapies. I’ve written it as ‘advice to my former self’, but I strongly encourage adopting a way of judging for yourself when interventions do/don’t work for you.

My hunch is that this post is most helpful not for my particular thoughts on therapy but rather the collection of therapies and resources I’ve put together.

Thank you to J, NS, QF for early feedback on this document.

A big therapy comparison table

How I group these different therapies in my head

Caveat: each therapy is highly nuanced and is exceedingly difficult to capture in a sentence or two. I suggest reading different descriptions of each therapy (or listening to an interview with a practitioner or reading a book on it) to get a better sense of what I’m pointing at.

Therapy	Principle	Function	Most useful for¹
Focusing	Attuning to your internal, subconscious ‘felt senses’ helps you understand and process your issues	Settling down and turning inwards, ask yourself an open ended question and pay close attention to body texture	Building up internal awareness; learning to dialogue with your intuition.
Internal Family Systems	Your mind is a family of many ‘parts’. They all want the best for you, even in a way that seems different. Listening and literally talking to them is key to understanding and resolving emotional issues.	Turn inwards, identify your parts and see if you can establish a visual. Try to understand their beliefs and wants, and how you can help each other. Express gratitude when appropriate.	Broad spectrum emotional and mental difficulties. Also helpful for interpersonal communication.
Core Transformation	Your ‘parts’ all want some core set of feelings. You can just give them direct access to these core feelings	Understand what a part needs, and keep investigating this need until you get to a ‘core feeling’. Allow yourself to step into the core feeling and then from that feeling examine the part’s needs.	Broad spectrum emotional and mental difficulties. Helpful for fostering broad flourishing and wellbeing. Can be incorporated into meditative practice.
Coherence Therapy	Many symptoms come from implicit emotional learnings. By using techniques of memory reconsolidation, you can eliminate symptoms at their roots	Bring awareness to core areas of emotional learning that are problematic. Revisit a difficult instance, noticing the associated beliefs. See if there are disconfirming situations and hold the feelings of the conflicting situations together.	Broad spectrum emotional and mental difficulties. Can encompass other therapies. Good if you want neuroscience / heavily evidence based therapy.
Ideal Parenthood Figure Protocol	Many emotional problems have roots in your relationship with early caregivers. By re-visiting difficult moments with safe imaginary nurturers, you can fully heal attachment traumas.	Evoke memories of safety and love, conjure up an ideal nurturing figure and feel their presence in the face of difficult past experiences.	Attachment / relational difficulties (which are often upstream of many different things).
Cognitive Behavioral Therapy	By finding and thinking about contrary evidence in the face of troubling thoughts, you can repair your beliefs and eliminate bad feelings.	Rationally question and tease apart the assumptions of thoughts labeled as negative or inaccurate.	Rationally challenging beliefs without touching the painful emotions (at the expense of potentially not healing symptoms ‘at the root’)
Accelerated Experiential Dynamic Psychotherapy (AEDP)	The therapist can serve as a healthy attachment figure, and allow treatment “to lead with a corrective emotional experience”²	Allow the therapist to create an environment of connection with you as you allow the therapist to witness you amid difficult past experiences	Attachment / relational difficulties.
Eye Movement Desensitization and Reprocessing (EMDR)	Under ‘dual stimulation’ (where you focus on two experiences at once, typically eye movements, at the same time as internal elements), you can desensitize and reprocess past traumas.	Therapist identifies themes and specific memories before providing dual stimulation during traumatic recall. They then also help you ‘install’ a positive belief.	Generally processing traumatic experiences
Psychoanalysis	Most of our psychological problems are rooted in unconscious early childhood experiences and can be resolved by making the unconscious conscious.	Rationally analyze your past with the psychoanalyst to diagnose how they have caused your current mental problems	Getting a theoretical (often rooted in Freudian philosophy) understanding of your problems. Progress typically requires several years of treatment.
Psychedelic assisted therapy[^3]	Hallucinogenic substances can provide a safe container to revisit traumatic experiences and to deeply change our patterns associated with these experiences.	For a couple of sessions, in a safe setting, and with a trained practitioner, ingest psychedelics and ‘allow the effects of the medicine to move through you’.	Depression, severe anxiety, addiction, PTSD, dealing with a fatal illness.
Intentional Peer support	Having conversations with peers with deep listening can develop ‘trauma-informed, mutually responsible relationships’ where you and your peer can emotionally support each other in a sustainable way.	1 Establish connection 2 Help each other understand your respective worldviews 3 Redefine help as co-learning and growing process 4 You and your peer help each other towards what you want	Deepening connections within a community, establishing higher level of general emotional stability.
Bio-emotive framework	To move beyond emotional distortions, we need to experience, differentiate, and express feelings and emotions. This involves explicitly naming feelings and noticing felt shifts inside.	Turn inwards, and alternate naming each of the nine core feelings. Notice if any of the phrases make an emotional resonance. Repeat if they do.	Addressing feelings of emotional blockage. Good as self-practice and complementary to other practices.
Mindbody practices (Feldenkrais, Alexander Technique, Qigong, …)	Differ according to practice. ”Rediscovery innate capacity for graceful, efficient movement”. Unify mind, body, and spirit (Alexander Technique according to Nobes), work with energy in the body to encourage flow, reduce blockages (Qigong).	Depends on practice	For general mind-body integration. Often indirectly significantly helps emotional difficulties.

Framing thoughts

Pay attention to three basic pillars of sleep, exercise, and regular eating (SEE)

Sleep regularly
Start regularly exercising if you aren’t already
- Seriously, exercise is absurdly important for general health. Starting a regular exercise routine should be the first intervention.
- For exercise advice, I like this post and also Jerzy Gregorek’s Happy Body (which lacks scientific rigor but feels great)
Eat regularly
- I’m not talking about going on a diet, but just removing the stress from being hungry. Fasting can be great, but in my experience irregular eating does not help when your mind is under tension
Self-healing will be much easier when you aren’t neglecting any of these three factors. However, it is important to acknowledge that the (in)ability to consistently have healthy habits is closely entangled with the thing you are trying to heal.
If you are currently regularly neglecting one of these three, it can be helpful to gently incline towards doing by listening to yourself: is there a reason you/part of you is resisting?

If you have ongoing emotional difficulties, it could be very helpful if you make large consistent space and effort towards addressing psychological health

I have found it very helpful to explicitly put mental health in a category of ‘important task’ that is on par with ‘PhD thesis’ or ‘job’ or ‘romantic relationship’.
Note though that if this framing feels daunting, it can be great to ‘put it aside’ and revisit it later.
That is not to say that it will take the same amount of ‘work’ or effort as these tasks, but rather that it can require the same amount of space.

This will often mean adopting daily habits for self healing

What this looked like for me was over an hour each day dedicated to trying a technique, taking notes about my experience, on top of doing background research on types of therapies.

Treat yourself with great kindness

If you don’t have the space today to even begin processing emotions, that’s fine.
Know that you can witness significant changes with just a small amount of effort.
With the right approach, you can start to notice drastic differences in the course of a few sessions of practice. However, since progress is very hard to predict beforehand, it is quite helpful to ‘try not to expect any major change’

If going with a therapist, you should talk to multiple to find a good fit

I found that, at a minimum, talking to three different therapists was necessary to get a taste of the range of different competencies, attitudes, and personalities and how they affected treatment.
There is significant range in the competency of therapists. I have heard many anecdotes of unprofessional treatment among friends and family — I can say this most confidently of North America and New Zealand, but imagine that it broadly applies around the world.
Unfortunately most therapists are not very good (an opinion I’ve directly heard from psychotherapists)

On paying for therapy

You might feel nervous about spending money on therapy for a number of reasons:
- It’s too expensive
- It might take ‘too long’ to figure out whether it’s working
It’s too expensive: Money is not worth worshiping on its own terms. A healthy attitude towards money is using it to make your life better. If you are in a state where therapy could significantly improve your life, sessions of effective therapy is one of the most powerful interventions you could take.
- At the same time, it can be prohibitively expensive for a lot of people
- There are many ways you can make big steps towards self healing — for instance, there are individuals (e.g. Coherence Therapy ‘coaches’) who are not trained therapists but who do have some training in certain modalities.
- You can (and should) go very far with self-healing. Then approach therapists once you are ‘blocked’ and want to consult them on a particular issue.
It might take ‘too long’
- Good therapies should reveal changes within a couple of sessions. Once you ‘feel the therapy’, you can be in a much better position to evaluate it.

The quality of your therapist is very important, but so is the modality of therapy

See common factors hypothesis
See anecdotes of people who moved between different therapeutic modalities and experienced significant improvement

‘Sensing therapies’¹ are much more effective than other therapies

This is mostly informed by my own experiments and my mental model of how therapy works².
By ‘sensing therapy’, I mean therapies that involve turning inwards in an attempt to directly be in and access emotional states. IFS, IPF, Coherence Therapy, Core Transformation, Focusing, are all examples of techniques or modalities that I would call ‘sensing’.
This is as opposed to rational detached analysis of the sort you find in psychoanalysis, and, to a lesser extent, in Cognitive Behavioral Therapy

Beware of choosing a therapy that reinforces your coping strategy

While you want a therapy that conforms to what you believe about the world, you want to make sure this therapy doesn’t simply serve as a tool to entrench you further into your existing beliefs.
It’s hard to say exactly when you are doing this, but one antidote is paying attention to the feeling of ‘mental stretching’
Good self-healing should ‘stretch’ understanding of the past and present emotional terrain. This necessarily means challenging the way you currently perceive, think, and act. Be highly suspicious if you feel the therapy confirming everything you already know.

So what exactly might I do?

Take different paths depending on your resources and the severity of your mental health

If you have time and mental energy, and your daily wellbeing is tolerable, it may make sense to spend a couple of months doing self-therapy and/or working with a peer.

Begin with Gendlin’s Focusing by listening to the audiobook and doing guided sessions for at least two weeks or until it clicks.

Focusing is the technique with the least scaffolding. I have found it to be the most broadly applicable skill in any form of introspection. After two weeks, you may begin to already feel a difference in your daily experience, even if not, you will at the least be much better equipped for the next methods.

Turn to another experiential framework that allows self-therapy.

Depending on your issue and what resonates, you can choose from Coherence Therapy, Internal Family Systems, Ideal Parenthood Figure protocol, Core Transformation.

I found early success with IFS. With each technique, I would estimate ~5-10 hours before you get the basics, then 50 hours before a lasting shift happens. If you’re spending an hour a day on this, that’s only ~7 weeks for a change that could carry through the rest of your life!

Stick with the same framework until it feels stale, and then a little more.
If you are suffering a lot and you have the financial resources, it probably makes sense to immediately find a therapist.

I’m not equipped to give good advice about severe cases, but suggest the reader just choose a modality that fits with their worldview and start talking to someone (I’ve compiled a list of directories below). My favorite modalities have been Internal Family Systems and Coherence Therapy.

Don’t focus on ‘getting healed’, but instead make space for some form of healing or check-in as part of your daily life.

After doing the practice for a few months, you can try decreasing the frequency of the practice, and notice how that feels.

Resources

General

Articles

Audio

Attachment Repair Guided Meditation Library (note this is apparently not endorsed by the creator of Attachment Therapy. I and many others however have gotten some mileage out of it).
Esther Perel’s Where Should We Begin?

Therapy-specific

Therapy	Resources
Focusing	The Focusing audiobook by Gendlin is quite good. This guided guided Focusing video on Youtube I found very helpful
Internal Family Systems	*You Are the One You’ve Been Waiting For (my favorite book on understanding relationship dynamics. Many helpful exercises.)

*Self Therapy: A Step-by-Step Guide to Creating Wholeness Using IFS (book)

IFS Talks (podcast). Episode on welcoming protectors. Good for context / understanding emotions better | | Core Transformation | Core Transformation: Reaching the Wellspring Within, Andreas (book)

Core Transformation Video Example | | Coherence Therapy | Unlocking the Emotional Brain, Ecker. Best ‘neuroscience of therapy’.

Interview with Bruce Ecker, Coherence Therapy inventor. | | Ideal Parenthood Figure Protocol | Cedric Reeves Attachment Repair course (very helpful to start with course and continue self healing with the guided library)

Attachment Repair Guided Meditation Library

Attachment Disturbances in Adults: Treatment for Comprehensive Repair, Brown (textbook). Recommended in conjunction with the course. | | Cognitive Behavioral Therapy | Feeling Good, Burns.

Critique of CBT | | Accelerated Experiential Dynamic Psychotherapy (AEDP) | The best introduction I know of is in Chapter 6 (p. 140) of Attachment Disturbances in Adults: Treatment for Comprehensive Repair. Also, you can see an introduction through inventor Diana Fosha’s The Transforming Power of Affect. But really, if you are intrigued by AEDP, you should just find a therapist that does AEDP-informed treatment. |
| EMDR | EMDR International Association. | | Psychoanalysis | | | Psychedelic assisted therapy | Mostly out of my wheelhouse, but MAPS I hear is pretty good. Qwerky science (blog with relevant content). | | Intentional Peer support | Intentional Peer Support website. | | Bio-emotive framework | Main website. Tataryn’s handbooks are great.

*interview on Deconstructing Yourself. | | Mindbody practices (Feldenkrais, Alexander Technique, Qigong, …) | Awareness Through Movement (Feldenkrais book)

*Feldenkrais Project (excellent Feldenkrais guided audio free online)

Alexander Technique International (AT best

The Way of Energy (Self-guided Qigong) |

Directories

(generally, the official websites will have directories of their teachers)

More speculative

Mindease is supposed to be a self-guided tool that moves between therapy modalities. I haven’t tried it, but one person I know has recommended it.

Misc addenda

I use the term “Attachment” in the diagram and in the table. This is emphatically not what is referred to by Wikipedia as “Attachment Therapy”:

Attachment therapy (also called “the Evergreen model”, “holding time”, “rage-reduction”, “compression therapy”, “rebirthing”, “corrective attachment therapy”, and “coercive restraint therapy”) is a pseudoscientific child mental health intervention intended to treat attachment disorders.

This sounds horrible and antithetical to the methodologies I mean when I refer to “attachment-related therapy” such as IPF, AEDP.

Research comparing therapies is abysmal, and most therapists don’t know how to compare or move between therapeutic modalities

One of the top cited papers I could find comparing therapies is from 1977 and uses 8(!) college students as the entire sample
My therapist told me firsthand how sad and disheartening it is that there is no good research on moving between therapeutic modalities
In an interview, Bruce Ecker (inventor of Coherence Therapy) gives an anecdote about how at a therapy conference he estimated that nearly half of the therapists present were in active distress about the broad range of different treatments

“However, what I learned through a few weeks of CBT, deconstructing every bad thought and bad emotion, is that the frequency and intensity of bad emotions is not affected at all by reasoning. If anything, the thoughts that co-occurred with bad emotions got even more ridiculous. Without CBT, it might not have been clear that I had no control over the occurrence of bad emotions.” Critique of CBT

Other therapy comparisons

Attachment Disturbances in Adults has a chapter assessing AEDP, EMDR, and other related modalities.

There is a textbook that compares therapies, Theories of Psychotherapy and Counseling. Unfortunately, it does not mention the majority of therapies that I find promising. It is a good detailed examination of pre-2000s therapies though.

“John Weisz, an eminent psychologist at Harvard, concluded that there were only five principles of treatment, irrespective of diagnosis. Using what he calls a “transdiagnostic approach,” Weisz’s principles for therapy are (a) feeling calm, such as through mindfulness, (b) increasing motivation, such as through incentives for good behavior, (c) repairing thoughts, such as with reframing bias in cognitive behavioral therapy, (d) solving problems through goal setting, and (e) trying the opposite, via exposure to overcome avoidance or behavioral activation for depression. The application of these principles does not depend on a DSM label or diagnostic code.” from Thomas Insel’s (former head of National Institute for Mental Health) Healing: Our Path from Mental Illness to Mental Health.

Guilford has a chapter on his meta-protocol for treating patients here. I will note that from personal experience I would say that Weisz’s protocol is missing “allowing the feeling to be there” as a step, and that “reframing bias” in the way that CBT does it is too head-y and not enough experienced in the body

A theory for why therapeutic modalities stop working over time. As some psychiatrists on the internet have observed, there seems to be a trend

Errors or improvements? Email me at maxslangenkamp[at symbol]gmail[dot]com

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Notes

If you know of a better label for this, please tell me. ↩︎ ↩︎
This is too big to articulate in this post, but I would point the reader towards Unlocking the Emotional Brain which pretty much captures what I’m getting at. ↩︎ ↩︎