Therapy: The Beginning Steps
First, let's start off with a disclaimer: Not everyone can afford therapy. Not everyone can get to therapy. There are options for online or skype sessions- but those don’t work for everyone. A lot of people have had bad experiences with therapy. This post is by no means intended to try and shove anyone who isn’t ready to go to therapy, or who can’t/doesn’t want to for any reason.
So, I have some good news and some bad news.
We’ll start with the good.
Finding therapists in your area is pretty simple. You can google ‘therapists in -insert city- and you will most likely get a list of therapists in your area. Some of these lists you can even sort by types of therapy and whether or not they have experience with _________. You can usually filter them by whether or not they take your insurance too. If not? Their website should have that information. So no awkward phone calls or guessing.
A rising number of therapists are beginning to have reviews online. These can contain helpful information, like if they’re flexible about payment plans or really good at being on time. Someone might compliment a specific therapist on a trait that you think is necessary.
Most therapists are open about what kind of therapy they offer and what kind of clientele they have seen in the past.
Unless someone has really messed up, most reviews are going to be mostly positive. Unfortunately, the nature of therapy means that any complaints are going to feel extremely telling- and most people don’t want to risk the therapist knowing exactly who is complaining.
A therapist checking the box that they deal with LGBT clients does not mean that they are good with them. It does not mean they know how to deal with specific issues. Some of these therapists will be great at these things- they might even be on the spectrum themselves. They might be that person who checks it off just because theoretically they would be okay with it. Or they consider themselves okay with it- but will commit microaggressions. This goes for any sort of marginalization.
Most therapist bios sound the same. There is a Language to therapy and therapists with wildly different styles will have extremely similar bios. Still look over them, but understand that it might be frustrating.
A word of forewarning, a lot of therapists do a sort of ‘mixed bag’ approach to therapy- so they might not fit a singular category here. This list is by no means all-inclusive, and it definitely doesn’t go in depth. It’s just meant to be a jumping point for some of the acronyms you’re likely to see most.
CBT: Cognitive Behavioral Therapy is one method of ‘talk therapy.’ Completely by itself, it is intended to last for only a short period of time and is meant to walk through challenging thought processes and behaviors that are creating, or even just not helping our problem. It is also one of those therapies that is often wrapped into just general talk therapy- so if you see the acronym there, it isn’t necessarily saying that they only meet for a few sessions. ‘True’ CBT usually comes with homework and worksheets.
DBT: Dialectic Behavior Therapy often comes in two parts, Skills Training and Individual Therapy. Skills Training is kind of like a therapy workshop where they teach you different skills as a group. Individual Therapy is where you can work out how to apply these skills to your life and talk more in depth about the problems that are popping up. Some centers also have a sort of crisis line where someone can call in and get coaching for how to use skills in their current crisis. DBT focuses on four key components. Mindfulness, Distress Tolerance, Interpersonal Effectiveness, and Emotional Regulation.
EMDR: Eye Movement Desensitization and Reprocessing is sometimes referred to as exposure therapy in a hat. Unless you’re being charged more for it, don’t let these complaints bother you. In this therapy, a trained therapist asks you to think about different aspects of the painful memories while performing another task- such as following the movement of a therapist’s hand with your eyes. This is a processing trick that many people have found helpful for making new connections and being able to interact with the meat of the memory without falling into the emotional spiral of it.
There’s group therapy and art therapy and even therapists with animals to help with the process. It’s just a matter of finding something that seems at least partially appealing.
Reasonable Expectations For Therapy vs Not So Reasonable Ones:
It is reasonable to expect a therapist to work with you on language. If you don’t want to use x word to describe your experience? That is okay. But a lot of therapists, even if they respect that, are going to slip up. They see a lot of clients, they’ve had a lot of training that will basically make your experience and that word synonymous. They may slip up because of that. Many therapists will tell you that they think it would be better if you did use it- that in and of itself is not a warning sign. If you say “I respect that, but at this time it isn’t something I’m willing to budge on” and they argue with that? It is a warning flag.
Most therapists are not crisis centers. Just like most of you are not on 24/7 call, neither are they. It’s understandable to want to be able to call your therapist whenever you have a panic attack- but this is a service select few would even consider. It’s also okay to ask if they have an email address that you can reach them at when in a panic- but again, expecting a response quickly might not happen. Depending on where you are or their practice’s policy- they may not even be able to respond in depth. But sometimes it can help to at least have that ‘you know where I was in the middle of my panic, and I’m afraid I won’t be able to bring it up again later.’
It is reasonable to be involved in the goal setting process. If your therapist isn’t willing to listen when you say ‘I want to work on X before working on Y’ this is a warning sign.
That being said- you need to be involved in the therapeutic process. I know many people, myself included, who consider themselves therapy savvy- who think they can talk circles around therapists. And sometimes this is true. But just as often? The therapist not confronting the lie or the circular thinking is because the client is being resistant and they’ve decided pushing is detrimental. If you need a therapist to confront you on hard topics? You need to tell them that early on.
On that note- No therapist is required to put up with verbal abuse. If you need to be confronted- you have to be able to handle that in a respectful way. Therapists are professionals, but they’re still people. In the case of needing to be confronted- it might help to have a sort of therapy safe word. Something to signal ‘no, really, drop it or I walk out.’
It is understandable to want a quick fix- but therapy isn’t it. Sometimes you’re going to be asked to try something that didn’t work before again. You’re allowed to talk to your therapist about concerns, especially safety concerns, or ask for new strategies for approaching it. Sometimes the issue is just that we expected it to be a +20 in mental health and unfortunately, those rarely happen. So learning to approach things from the new light of +1s and +5s while not as immediate, do help- can also involve revisiting old strategies. Another common issue is people not practicing a new skill, and only trying it in the middle of a panic. Much like a ‘handy trick’ for math requires you to practice it before you attempt it on the test- so do things like breathing exercises.
It is reasonable to ask your therapist to explain why they think something will be helpful or if there are smaller steps you can take before reaching that point. One of the biggest problem with unsolicited advice is that it gets thrown around without context. ‘Just breathe’ and ‘exercise will fix it’ are useless without context and restrictions. Breathing exercises are not the same as ‘just breathe’ and they usually involve breathing in a specific way to stimulate the vagus nerve. Exercise can help a lot of people for a lot of different ways. It can help create mind-body connections, boost confidence, stimulate certain effects in the brain. But when it is being sold as a generic health cure? There’s a problem.
It is reasonable to ask your therapist to let you know before they contact outside sources. Unfortunately, they are usually bound to report under circumstances. If they feel you are in immediate danger of killing yourself, if they think you’re going to kill someone, and cases of child abuse.
One disclaimer, because I know it’s a common worry: If you are an adult, they are not required to report drug use or self-harm. They shouldn’t call over suicidal ideation. And most don’t stretch ‘cases of child abuse’ to include past child abuse. Meaning that if you were abused as a child, you should be able to talk about that without worries of them reporting it.
If you are a minor worried about them reporting it to your parent- talk to them in hypotheticals first. “My friend is in therapy and is worried that if she tells her T that she cuts, he’ll tell her mom. But she really wants to get help- what should she do?”
Teenagers talking about cases of child abuse is another grey area where it’s a good idea to figure out what your individual practitioner’s stance is. Some will report no matter how long ago it was. Some will only report it if they have reason to believe that another child is at risk. Some are willing to not report if you keep the details vague enough that they believe reporting would be pointless. But if you’re not out to your family about your history, or if you were abused by someone in the family- it can be extremely important to clarify these things before opening up.
Make a list. Try to have three to four names on there at least of therapists who you’re willing to give a shot. Keep in mind how far away they are from you or where you work/go to school- whichever place that you’re likely to be traveling from and to. Add this in to your ‘how long will this take out of my week.’
Be willing to use the list. One of the biggest mistakes I see repeated over and over again is people who feel trapped with the first person they meet. One meeting? Isn’t enough to know whether or not it will work. Two? Well, maybe they can make things work. Three? They’ve already put in so much work, it feels terrible to start the process over again. Give yourself a leeway period. If things don’t feel right by session three or five? Let yourself try another therapist. It does take effort to go through the beginning stages again, but what’s worse than that? Is wasting two years with the same one.
Walk into your first meeting prepared to leave. Have a list of questions and boundaries. If you need them to be able to discuss the ins and outs of your sexuality or race? Bring it up before you ever go over your history. If you need them to understand that you can only come in once every other week and for them to not push it more than that? Let them know. If you want to go over coping skills before ever touching your trauma history? Tell them. If they won’t commit to that? Leave. Don’t get trapped with a therapist that is going to push your boundaries immediately.
Walk into your first meeting prepared to share some of your personal details. If you’re reading this, chances are you’re a trauma survivor or mentally ill. If possible, have a list ready of the ‘tl;dr’ of your history. You don’t have to write out every trauma- but they’re going to want the ‘sexual trauma ages ___-____’ details. Go ahead and list out the symptoms you know you have. If possible- even write out your main wants from therapy.
You’re allowed to reference this while there, or even just hand it to them and tell them that they can ask follow-up questions if need be. Maybe even call ahead and ask if it would be okay to email it to them ahead of time.
Have a plan of action for after therapy. Chances are? You’re going to feel a bit amped up. This isn’t a bad thing even though it isn’t an enjoyable feeling. First meetings don’t give enough time for both going over history and for soothing agitated nerves. So make a plan for how you’re going to deal with them. You might be the take a warm shower type, the make lunch plans with a friend type, or the go to the gym type. Whatever you find best to do when you feel nervous and over-stimulated.
