Online Therapy for Complex & Multiple Difficulties

When what you are experiencing doesn’t fit neatly into one box

Mental health difficulties do not always occur one at a time.

You may be experiencing anxiety alongside depression, trauma alongside relationship difficulties, intrusive thoughts alongside low self-esteem, or a combination of problems that seem to overlap and affect one another.

Perhaps you have had therapy before but found that focusing on just one diagnosis or problem did not fully capture what was happening for you.

You do not need to work out which difficulty is the “main” one before asking for help.

At My Therapist Online, we specialise in looking at the whole picture. Our clinical matching team reads what you tell us about the different problems you are experiencing and recommends a therapist whose training, clinical experience and therapeutic approach are suited to that particular combination of needs.

Personal clinical matching · Free 15-minute introductory call · Online sessions across the UK

What Do We Mean by Multiple or Complex Difficulties?

For some people, one problem clearly stands out.

For others, several areas of difficulty are happening together.

For example, you might experience:

• anxiety and depression

• trauma, low self-esteem and relationship difficulties

• panic attacks and agoraphobia

• OCD or intrusive thoughts alongside depression

• childhood trauma and relationship difficulties

• grief, anxiety or low mood

• anger, shame and low self-worth

• perfectionism, anxiety and burnout

• attachment difficulties and fear of abandonment

• trauma alongside dissociation

• ADHD or autism alongside anxiety or depression

• chronic health difficulties alongside anxiety or low mood

• sleep problems alongside several other psychological difficulties

• difficulties that have developed following several stressful or traumatic life experiences.

Sometimes these problems share common roots.

Sometimes one difficulty has developed in response to another.

And sometimes several different things have happened over time, leaving you unsure where therapy should even begin.

That is precisely where careful assessment and formulation can help.

You Do Not Need to Choose Just One Problem

Application forms, healthcare systems and even therapy websites can sometimes make it feel as though you need to select a single problem:

Anxiety. Depression. Trauma. OCD. Relationships.

Real life is rarely that simple.

You may recognise yourself in several different descriptions.

One of the strengths of the My Therapist Online matching model is that we do not simply match you according to the first box you tick.

Our clinical team reads the description you provide and considers the combination of difficulties, how they may interact, and the level of clinical experience your therapist may need.

For example, somebody experiencing anxiety, low self-esteem and relationship problems may need something quite different from somebody experiencing anxiety alongside significant trauma, dissociation and intrusive thoughts.

The words “anxiety” may appear on both applications.

The clinical picture is not the same.

Not sure which difficulty should come first? You don't need to decide before contacting us.

Making Sense of the Whole Picture: Psychological Formulation

When several difficulties overlap, therapy does not necessarily begin by choosing one diagnosis and treating it in isolation.

A skilled psychologist or CBT therapist may instead develop a psychological formulation with you.

A formulation is essentially a shared understanding of:

• what you are currently struggling with

• how different problems may connect

• experiences that may have contributed to these difficulties

• situations or triggers that bring problems up

• thoughts, emotions and behaviours that may keep difficulties going

• strengths and resources you already have

• what might help things begin to change.

The British Psychological Society describes formulation as an ongoing and collaborative process of making sense of a person's experiences, taking account of psychological, social, relational, biological and other relevant factors. Importantly, a formulation can change as you and your therapist understand more.

A formulation is therefore not about putting another label on you.

It is about creating a map, or a picture of the problem, that helps you and your therapist understand where you are, how you may have arrived there, and where therapy might most usefully begin.

Why Formulation Can Be Particularly Helpful When Problems Overlap

Imagine someone experiencing: trauma + low self-esteem + anxiety + relationship difficulties.

These could be treated as four completely separate problems.

But therapy might reveal connections between them.

For example, earlier experiences may have contributed to beliefs such as:

“I am not good enough.”

or

“People will eventually leave me.”

Those beliefs might then influence anxiety, relationships, reassurance seeking, avoidance and the way the person responds to themselves when something goes wrong.

Understanding those connections can make therapy feel far more coherent.

Rather than repeatedly treating individual symptoms as they appear, formulation can help identify some of the underlying patterns linking them together.

Where Do You Start? Setting Priorities and Goals

A common concern we hear is:

“There is so much going on. I don't know where to start.”

You don't have to know.

Part of your therapist’s role is to help you identify what is affecting you most, how different difficulties may connect, and which areas are most important to address first.

Together, you might consider:

• what is having the biggest impact on day-to-day life

• whether one difficulty is maintaining another

• what feels most important to change

• whether anything needs addressing before other work begins

• what feels realistic and manageable.

Goals can then give therapy direction without expecting you to “fix everything” at once.

For example, you might work towards:

• reducing reassurance seeking

• responding differently to intrusive thoughts

• feeling safer in relationships

• processing a traumatic experience

• becoming less self-critical

• rebuilding activities or relationships that matter to you.

These goals help you and your therapist decide where to begin and what to prioritise next.

They are not fixed. As therapy progresses and your understanding changes, you can review and adjust them together.

Do All My Difficulties Need Separate Therapies?

Not necessarily.

Sometimes several problems are connected by common psychological processes.

For example:

• avoidance may maintain anxiety, trauma symptoms and low mood

• harsh self-criticism may contribute to depression, perfectionism and low self-esteem

• intolerance of uncertainty may play a role in worry, health anxiety and OCD

• difficulties regulating emotions may affect relationships, impulsive behaviour and coping strategies

• beliefs developed through earlier experiences may influence how somebody sees themselves and other people across several areas of life.

A therapist with broad clinical training may therefore work across these overlapping processes rather than treating every difficulty as an entirely separate condition.

At other times, a more specific evidence-based treatment may be appropriate for one particular difficulty.

The important thing is that treatment is planned around how your difficulties fit together, rather than forcing you into a single standard protocol.

Which Type of Therapist Is Best for Multiple Difficulties?

There is no single answer.

It depends on the combination of difficulties you are experiencing, their severity, previous treatment and what you would like help with.

Where several difficulties overlap, or where broader assessment and formulation may be helpful, we may be more likely to recommend a Clinical or Counselling Psychologist.

Psychologists undertake broad clinical training in psychological assessment, formulation and different therapeutic approaches. This can be particularly helpful where there are several interacting difficulties and an initial assessment is needed to understand how they fit together.

An experienced CBT therapist may also be an excellent choice where the difficulties fall within their areas of specialist training and experience. Shared formulation is a core element of high-quality CBT practice.

Other approaches such as:

• Schema Therapy

• Acceptance and Commitment Therapy (ACT)

• Compassion-Focused Therapy (CFT)

• EMDR

• trauma-focused therapies

• integrative psychological therapy

may also form part of treatment, depending on your needs.

The important question is not simply “What type of therapist are they?”

It is:

“Does this particular therapist have the training and experience to understand and work with my particular combination of difficulties?”

That is the question our matching team considers.

Why Matching Matters More When There Are Multiple Difficulties

If somebody is looking for help with one clearly defined problem, finding an appropriately trained therapist may be relatively straightforward.

When several difficulties overlap, therapist selection can become much more important. A therapist may have excellent experience in anxiety but limited experience in trauma. Another may specialise in trauma but not OCD. Another may work extensively with depression and self-esteem but have less experience with dissociation.

At My Therapist Online, we do not simply search for a therapist who lists one of the problems you describe.

We look for someone whose experience fits the combination.

This is one of the reasons My Therapist Online was established.

What If One Therapist Is Not the Best Fit for Every Problem?

When several difficulties overlap, it is not always realistic — or clinically best — to expect one therapist to be a specialist in every area you may eventually want to work on.

Sometimes the most effective approach is to begin with the difficulties that are having the greatest impact on you now.

For example, you might initially work with a therapist who specialises in anxiety disorders, trauma, CBT and EMDR because panic, trauma symptoms and severe anxiety are your most pressing concerns.

As therapy progresses, those symptoms may improve significantly.

At that point, a different issue may become more important — perhaps longstanding relationship difficulties, attachment patterns or problems with intimacy and trust.

Your original therapist may have helped enormously with the first stage of therapy but may not be the person with the strongest specialist experience for that next area of work.

That does not mean the first therapy has failed.

It can mean that your treatment priorities have changed.

Therapy Can Happen in Stages

Where appropriate, your therapist can discuss this with you and refer you back to the My Therapist Online matching team.

We can then help identify a therapist whose expertise is a better fit for the next stage of your work.

For example:

Stage 1: trauma, panic and anxiety are prioritised with a CBT and EMDR specialist.

Stage 2: once these symptoms are more stable, the focus moves towards longstanding relationship or attachment difficulties with a therapist who specialises in those areas.

This kind of staged approach can be particularly helpful where several difficulties require different types of specialist expertise.

We Match According to What Needs Attention First

If no single therapist has specialist expertise across every difficulty you describe, our aim is not to make a poor compromise.

Instead, we will usually look at:

• which difficulties are most urgent or impairing

• which problems may need addressing before others

• which therapist has the strongest expertise for those priority concerns

• what may reasonably be addressed later

• whether a planned transition between therapists might eventually be helpful.

Your therapist can review this with you as treatment progresses.

If the focus of therapy changes and another clinician would be a better fit, we can support a smooth transition to someone whose expertise matches your new priorities.

Where appropriate, this can include communication between therapists, with your consent, so that you do not feel as though you are starting again from the beginning.

The aim is always the same:

to make sure you are working with the therapist whose skills are the best match for the problems that matter most at that stage of your treatment.

A Matching Service Built From Specialist Clinical Experience

My Therapist Online was founded by Lisa Johnston, a BABCP Accredited CBT and EMDR Therapist with more than 20 years' experience in mental health, including work within specialist anxiety services at the Maudsley Hospital.

Working with people whose difficulties often overlapped or did not fit neatly into one diagnosis helped shape the way MTO works today.

Rather than matching someone simply because they select “anxiety” or “trauma”, our clinical team reads the full problem description and looks for therapists whose training and experience fit the combination of difficulties described.

That principle remains central to our service.

Assessment is Part of Therapy

When difficulties are multiple or longstanding, your first sessions may involve more assessment than you expected.

This does not mean your therapist is unsure how to help.

Good assessment helps make sure that therapy is:

• appropriate

• safe

• focused

• realistic

• tailored to you.

Your therapist may ask about:

• what is currently happening

• previous episodes of psychological difficulty

• previous therapy or treatment

• important life experiences

• relationships

• physical health

• medication

• coping strategies

• alcohol or substance use where relevant

• current support

• risk and safety

• what you would like to change.

Assessment is not something that necessarily happens once and is then forgotten.

For people with changing or overlapping needs, assessment and formulation may continue throughout therapy as new information emerges.

Making Sure Online Therapy Remains the Right Support

Is online therapy appropriate for me?

Online therapy can be highly effective and convenient for many people experiencing multiple psychological difficulties.

However, online therapy is not always the safest or most appropriate form of support for every person at every point in treatment.

Your therapist has a professional responsibility to consider this.

At assessment, they will consider whether online individual therapy is suitable for your current needs.

They will also continue to review this throughout treatment.

For example, circumstances may change in a way that means you would benefit from more intensive local support or input from several professionals working together.

If this happened, your therapist would discuss it openly with you.

They might recommend:

• involving your GP

• accessing local NHS mental health services

• seeking additional specialist assessment

• moving towards face-to-face treatment

• working with a local multidisciplinary team

• adding other appropriate support alongside therapy.

This would not mean that you had “failed” therapy or that your therapist was giving up on you.

It would mean that your needs had changed and that a different level or combination of support was considered safer or more appropriate.

Any recommendation like this should be discussed with you carefully and transparently.

When local or multidisciplinary support may be more appropriate

Individual online therapy offers one therapist working with you during scheduled appointments.

For many people, that is entirely appropriate.

At other times, somebody may need support that individual online therapy alone cannot provide.

A multidisciplinary service might include several professionals such as:

• psychologists

• psychiatrists

• mental health nurses

• occupational therapists

• social workers

• GPs or other medical professionals.

This kind of joined-up local support can sometimes be important where needs become significantly more intensive or where frequent risk monitoring and coordinated care are required.

Your MTO therapist's responsibility is not simply to continue online therapy regardless of changes.

It is to keep considering what form of care is most appropriate for you.

Suicidal thoughts or self-harm

Experiencing suicidal thoughts or thoughts of self-harm does not automatically mean that online therapy can never be appropriate.

However, these experiences need careful assessment.

Your therapist will want to understand things such as:

• the nature and frequency of the thoughts

• whether you feel able to keep yourself safe

• what support you have around you

• whether risk is changing

• whether additional local support is needed.

Your therapist will continue to review whether online therapy remains safe and appropriate throughout treatment, rather than making that decision only once at the beginning.

If your needs change, they will discuss this with you and may recommend involving your GP, local services, or a different level of support. This does not mean therapy has failed — it means your care is being reviewed responsibly and adapted to what you need at that point.

My Therapist Online is not an emergency or crisis service. If you are in immediate danger or feel unable to keep yourself safe, please seek urgent local support rather than waiting for an online therapy appointment.

Therapy Does Not Have to Address Everything at Once

When you arrive with several problems, there can be pressure to explain everything immediately or begin working on every issue.

You do not have to.

Good therapy should provide structure.

You and your therapist might decide to:

1. Understand the whole picture

Spend time assessing what is happening and developing an initial formulation.

2. Agree priorities

Identify which problems are causing the most difficulty or need addressing first.

3. Stabilise where necessary

Develop skills or support that will make other therapeutic work safer or more manageable.

4. Begin focused therapeutic work

Work on agreed priority areas using an evidence-based approach.

5. Review

Regularly consider what has changed, what remains difficult and whether the original formulation still makes sense.

6. Adjust the plan

Move onto other priorities when appropriate rather than rigidly following a predetermined programme.

This provides a treatment direction without removing flexibility.

What Types of Therapy Can Help With Multiple Difficulties?

Treatment should be based on your individual formulation rather than simply the number of diagnoses or problem areas you have.

Depending on your needs, your therapist may draw upon one or several approaches.

Cognitive Behavioural Therapy – CBT

CBT helps identify connections between thoughts, feelings, behaviour and physical responses.

It can be particularly useful when several difficulties are maintained by overlapping patterns such as avoidance, reassurance seeking, rumination or self-criticism.

CBT is collaborative and usually involves developing a shared understanding of difficulties and agreeing goals for treatment.

Schema Therapy

Schema Therapy can be particularly useful where difficulties appear longstanding or linked to deeply established patterns in the way you understand yourself, relationships and other people.

It integrates elements of CBT with attachment, developmental and experiential approaches.

Compassion-Focused Therapy – CFT

CFT can be useful where shame, self-criticism or feelings of inadequacy cut across several different difficulties.

Acceptance and Commitment Therapy – ACT

ACT can help people change how they respond to difficult internal experiences while moving towards activities and relationships that reflect what matters to them.

EMDR and Trauma-Focused Therapy

Where trauma is an important part of the formulation, trauma-focused approaches may be considered.

Your therapist will first assess whether trauma processing is appropriate and how it fits alongside the other difficulties you are experiencing.

Integrative Therapy

Some psychologists draw upon several evidence-based approaches rather than working exclusively within one model.

This can be particularly helpful where a person's needs do not fit neatly into a single treatment protocol.

Frequently Asked Questions

How My Therapist Online Can Help

Finding a therapist when you have several overlapping difficulties can feel daunting.

You may open therapist profiles and find:

“They treat my anxiety…but what about the trauma?”

or:

“They specialise in trauma…but do they understand OCD?”

You do not have to make that judgement alone.

1. Tell us what you are experiencing

Complete our confidential matching form and describe the problems you would like help with in your own words.

You can include as much relevant information as you feel comfortable sharing.

2. Our clinical team reads your application

We consider all of the difficulties you have described rather than simply matching you according to one category.

3. We identify therapists with the right combination of experience

We look at clinical background, specialist training, therapy approaches, experience and your personal preferences.

4. Meet your recommended therapist

You can have a free 15-minute introductory call to get a sense of whether you feel comfortable with the match.

5. Your therapist carries out their own assessment

Matching is the first step.

Your therapist will complete their own clinical assessment and agree with you whether they are the right person to help and how therapy should proceed.

Recommended Reading

When several problems overlap, books that focus on understanding broader psychological patterns can sometimes be more helpful than books aimed at a single diagnosis.

Mind Over Mood — Dennis Greenberger & Christine Padesky

A practical introduction to CBT

Mind Over Mood helps readers identify connections between situations, thoughts, emotions and behaviour.

The structured worksheets can be particularly useful for understanding patterns that appear across several different difficulties.

Reinventing Your Life — Jeffrey Young & Janet Klosko

Understanding longstanding patterns

This accessible introduction to ideas from Schema Therapy explores longstanding patterns in how people think about themselves and relationships.

It may be particularly relevant where similar emotional or relationship difficulties seem to repeat across different areas of life.

The Compassionate Mind Workbook — Chris Irons & Elaine Beaumont

For self-criticism and shame

Where harsh self-criticism, shame or feelings of inadequacy contribute to several difficulties, Compassion-Focused Therapy can provide a different way of understanding and responding to yourself.

Get Out of Your Mind and Into Your Life — Steven C. Hayes

An introduction to Acceptance and Commitment Therapy

This practical ACT-based book explores ways of responding differently to difficult thoughts and feelings while building life around personal values.

Using Self-Help Alongside Therapy

If you are experiencing several difficulties, you do not need to read several different self-help books or try to treat each problem yourself.

In fact, too much information can sometimes make things feel more confusing.

Your therapist can help you decide whether a particular resource fits your formulation and treatment goals.

Therapists for Complex & Multiple Difficulties

MTO has psychologists and therapists whose broad clinical training makes them particularly well suited to working with overlapping and longstanding difficulties.

Our matching team may recommend therapists who are not displayed here if their particular experience is a better fit for the combination of difficulties you describe.

Not Sure What Kind of Therapy You Need?

You don't have to know.

You don't need to choose between anxiety therapy, trauma therapy, CBT, EMDR, Schema Therapy or a psychologist before contacting us.

• Tell us what is happening in your own words.

• We will look at the whole picture and help you find the therapist whose experience best matches it.

Personally matched · Free 15-minute introduction · No obligation

What If One Therapist Is Not the Best Fit for Every Problem?

When several difficulties overlap, it is not always realistic — or clinically best — to expect one therapist to be a specialist in every area you may eventually want to work on.

Sometimes the most effective approach is to begin with the difficulties that are having the greatest impact on you now.

For example, you might initially work with a therapist who specialises in anxiety disorders, trauma, CBT and EMDR because panic, trauma symptoms and severe anxiety are your most pressing concerns.

As therapy progresses, those symptoms may improve significantly.

At that point, a different issue may become more important — perhaps longstanding relationship difficulties, attachment patterns or problems with intimacy and trust.

Your original therapist may have helped enormously with the first stage of therapy but may not be the person with the strongest specialist experience for that next area of work.

That does not mean the first therapy has failed.

It can mean that your treatment priorities have changed.

Therapy Can Happen in Stages

Where appropriate, your therapist can discuss this with you and refer you back to the My Therapist Online matching team.

We can then help identify a therapist whose expertise is a better fit for the next stage of your work.

For example:

Stage 1: trauma, panic and anxiety are prioritised with a CBT and EMDR specialist.

Stage 2: once these symptoms are more stable, the focus moves towards longstanding relationship or attachment difficulties with a therapist who specialises in those areas.

This kind of staged approach can be particularly helpful where several difficulties require different types of specialist expertise.

We Match According to What Needs Attention First

If no single therapist has specialist expertise across every difficulty you describe, our aim is not to make a poor compromise.

Instead, we will usually look at:

• which difficulties are most urgent or impairing

• which problems may need addressing before others

• which therapist has the strongest expertise for those priority concerns

• what may reasonably be addressed later

• whether a planned transition between therapists might eventually be helpful.

Your therapist can review this with you as treatment progresses.

If the focus of therapy changes and another clinician would be a better fit, we can support a smooth transition to someone whose expertise matches your new priorities.

Where appropriate, this can include communication between therapists, with your consent, so that you do not feel as though you are starting again from the beginning.

The aim is always the same:

to make sure you are working with the therapist whose skills are the best match for the problems that matter most at that stage of your treatment.

Clinically reviewed by Lisa Johnston, BABCP Accredited CBT Therapist, Anxiety Disorders Specialist.