posted 25th June 2025
When beginning to search for private support for BDD it can seem very daunting. You’re likely to look online for a therapist and find yourself on one of the directories. Immediately you will realise that many therapists seem to tick all of the boxes, saying that they are competent to work with people suffering with multiple different symptoms.
Trainings are often nonspecific, teaching therapists a therapeutic technique and giving limited depth of understanding on any specific area, which may give the impression that the techniques and approach they have learned make them qualified across many issues. There is some limited validity to this non-specific approach, in many cases their work will have inherent value.
As a young man seeking therapy, many years ago I was unable to find anyone who really understood BDD. The experts I visited came from an academic background and although kind and attentive, they apparently didn't really understand the inner struggle of my condition. This was evidenced by interventions which provoked my distress, without adequate supportive care: a myopic approach to exposure techniques, which didn't recognise the necessity of a stepped approach, guided by personal hope and by instructions to break co-dependency with my mother, this didn't adequately support the either of us person and left her caught between professional advice and fears of the consequences of following this advice.
BDD is hard for the average therapist to relate to and so I found myself having to educate my therapists along the way. This process of helping them to understand the unique challenges of the disorder was costly in terms of time and therefore money.
A good therapist will listen attentively and non-judgmentally and fortunately I eventually found a supportive therapist who did offer this. Before this however, I visited many people who were impatient, the ebb and flow of my symptoms didn’t fit into their expectation that if I stuck with their treatment and did the homework, I would get better. Mostly BDD isn’t like that and as a result they couldn't support me. I also had one therapist who promised me outright that he could fix me, which was an irresponsible and egotistical over-evaluation of his capability, that resulted in him becoming frustrated and giving up on me in a very hurtful way, after a few years of investment into working with him.
I would like to offer you some advice on how to screen potential therapists, to get the best chance of finding solid and reliable professional support on your journey of recovery:
1. Choose a therapist who is qualified. Psychotherapy, counselling, coaching and hypnotherapy are currently an unregulated titles, so, even people who profess to be a psychotherapist or coach and who only advertise outside of the main professional bodies and directories may not be up to the job.
2. Interview a number of therapists until you find someone who you feel understands your concerns and with whom you feel you can form a good trusting relationship.
3. Try to find someone with lived experience, who has recovered. This will mean that you are far more likely to be immediately understood and to have the kind of relationship with supports your recovery.
4. Don't be seduced by overly confident claims about how you can be cured, sadly this hubris can be unethical.
5. Remember that therapists can’t cure you. Therapy is a relationship and a conversation which can guide and support you, but this can be a long road and insights gained may take time to realise in your life. The solution comes from within.
6. When looking at costs, remember that therapists can only see a few clients daily. They have many expenses and invest more than the allotted hour with you in preparation, processing, note keeping, supervision and continuing professional development. Hourly rates may seem high at times, but therapy is unlikely to make a practitioner wealthy for these reasons. Most therapists are in this line of work because they want to help people.
7. It may be preferable to find a therapist who understands over a therapist who is local.
8. Look for a therapist who offers open ended sessions. Ten sessions likely won’t help much.
9. Look for someone who is willing to be flexible, for example when you are too unwell to attend sessions might they be willing to reschedule rather than charge you for the missed session. Bare in mind that for many therapists missed sessions can’t be filled and if your BDD prevents you attending sessions, it may be part of the agreement that you do have to pay for missing them. A flexible therapist may be willing to offer you a bit more support when things are difficult for you. A flexible therapist will not charge you when they take a holiday!
10. Ask what model the therapist uses and why. It helps to be know what to expect.
And some further points:
If you experience challenges with your therapist, attempt to address these in sessions. You will get insight into their professionalism and integrity by doing so. Often difficulties can represent a gateway into a deeper therapeutic alliance when handled sensitively and appropriately.
If you still feel that this therapist can’t support you, then consider making an ending session. The therapist is in your employment and although it may be rather uncomfortable, it is valuable for you to debrief with them. It is also respectful to the therapist. As therapists, we are all constantly learning and we make minor mistakes along the way. Unless some boundary has been transgressed that is abusive, harmful or neglectful, then it is ideal to close sessions in a relational way.
Remember that therapy is not one hour a week, but a moment by moment challenge, even outside of your sessions. Choose how to invest your time and attention in wise ways between sessions. A good therapist will help you to figure out how to do this.
Don't invest all of your hope in therapy. Use life as stepping stones toward recovery.
If you feel failed by therapy in the past, remember that not all therapy is the same. Your relationship with your therapist is unique.