How do I chose a therapist/psychologist?
There are many ways to do this. One can look for a type of therapy, eg. CBT, ACT, psychodynamic psychotherapy etc. You can look these things up and find a person who specializes in the one which appeals.
Alternately one goes on the recommendation of a GP or a friend. Or you can ring and speak to a few different psychologists and see who appeals.
I think that sometimes the best thing to do with any of these methods is to trust your intuition and go with the intangible thing that feels right. Isn't psychological health about being able to trust your instincts and act upon them with confidence. Malcolm Gladwell has written a book called "Blink" where he talks about the significance of intuition - this book is a great read and highly recommended.
What is CBT and what is psychodynamic psychotherapy?
Cognitive Behaviour Therapy (CBT) is a model for working with psychological issues which focuses on the way we think eg. are we catastrophising, do we think people will not like us if we make a mistake etc., and how these habitual ways of thinking shape the way we process our emotions. Treatment focuses on reducing our symptoms by challenging our thought processes and giving exercises to practice in between sessions, as well as teaching techniques to reduce tension (eg, relaxation techniques) and clear the mind( eg, mindfullness practices). There are a number of newer techniques which have sprung from CBT in recent years such as Acceptance and Commitment Therapy (ACT), Schema Therapy, Dialectical Behaviour Therapy etc.
Psychodynamic psychotherapy on the other hand focuses more on emotion and affect and is interested in the impact our personal history has on our present behaviour and how this "plays out" in our relationships as adults. This type of therapy is often about what we do not know , what we hide from ourselves and is about the process of self discovery. The idea here is that when we really understand something about our behaviour the cognitive restructuring occurs organically.
I think that good therapy, whatever the style, comes out of being with a supportive counsellor/therapist who makes you feel safe and who you feel understood by and not judged. Counselling needs to be stimulating, enjoyable, comforting and challenging.
How long should therapy take?
Therapy takes as long as it takes- to give a Zenlike answer that is both true and tremendously frustrating. There is some evidence that the optimal time for therapy across all treatment styles is one year (Shedler, 2009).
Of course many issues can be resolved much quicker than this and some will take much longer.
It really depends what you want from the therapy and your therapist needs to help you clarify this. For example if you have a fear of spiders that you wish to conquer, as you are about to do a camping trip to the Amazon (personally I would not recommend this trip for you, I'd suggest New York or even Melbourne might be more enjoyable. Nonetheless) if you are determined to go, I'd recommend four or five sessions of CBT, which would encompass gradual exposure of increasing intensity and proximity to spiders (firstly in imagination) and pair this with a relaxation regime.
If this is what you are after then four or five sessions would do it. On the other hand, if your fear of spiders is more widespread, if your anxiety is not just restricted to spiders then you could look at the role anxiety plays in your life. For example, what is your motivation to go somewhere where your greatest fears exist. If you are going because someone you lust after is going, what would it mean if your fear prevents you from going? Does it mean he/she will reject you because of your vulnerability? If that's the case why would you want to be with someone who you fear rejection by? What kind of relationships do you want?
So there are many ways to go in therapy and sometimes a fear of spiders is just a fear of spiders!
What is Depression and Anxiety, and how are they treated?
Martin Seligman, who's other books are some of the best self help books around, wrote about this in his book "Learned Helplessness". He has an experiment where he puts a dog in an experimental chamber. The dog soon learns that when it presses a lever it gets food- so the dog is happy there (in their little Chamber!)- it's in control and is getting what it wants. After the dog has learned this, he changes it so that when the dog presses the lever it sometimes gets food and then randomly it will get an electric shock on pressing the lever (yes some psychologists really are cruel and manipulative).
What happens next is that after this has been tested out , most dogs will stop pressing the lever and will go without food. They will give up and just lay down even to the point of death.
What happens here is what Seligman terms "learned helplessness" and this is the core of anxiety and depression. That when one's actions do not result in the desired outcomes, then firstly, one becomes anxious as one tests out what's going on, and then when one realises that they have lost control in their environment, then one gets filled with a sense of helplessness that prevents further action- and this is DEPRESSION!
What about medication?
There are a number of medications for depression and anxiety.
Medications for anxiety are often not that effective and are generally addictive (eg. Valium, Zanax) and have the side effect of making you drowsy. On the other hand some antidepressants have an anxiolytic component that can be quite effective.
According to the Black Dog Institute at POW Hospital Depression can be divided into "Melancholic" and "Nonmelancholic". The former is marked by retardation of motor functioning- people have trouble getting moving. Black Dog suggests that people with this type of Depression have a biological depression, which requires medication and that therapy can only work once the medication takes effect.
It's generally thought that antidepressant medication takes about three weeks to take effect, however my experience is that people will often have an immediate impact and that often if one doesn't get this, patients often respond that they "think" it's working but they are not sure.
Private discussions with Black Dog staff indicate similar findings.
A number of studies (eg. Turner et al. 2008, Moncrieff, Wessely and Hardy, 2004) indicate quite limited improvements with medication only, but significantly improved results for medication and counselling in tandem.
When and why should I talk about my past?
One talks about ones past as is necessary. It's always important to get a good history of significant events and relationships, family dynamics etc. These things are the building blocks of all our future relationships and inform the choices we make and the way we interact with the world.
Many times I see people with, for example, a partner with a drinking problem, and in a significant number of these cases the client may have had an alcoholic parent. One would think they would have learned what to avoid, but the power of our history often works upon us in mysterious ways.