Note: For decreasing the amount of language confusion in this post, I’m using ‘therapist’ as a blanket term to mean ‘someone who practices therapy’. In fact, this is not precisely accurate, though it seems to be colloquial use. For sorting between psychiatrist, psychologist, and therapist, take a look at the Terms section in Part I.
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Part IV: In which forgotten things are unforgotten.
I am not a therapist! However, lots of people ask me a lot of the time about getting therapy, and are often willing to keep me updated on what worked and what didn’t. This four-part guide, which is essentially the sum total of every bit of advice I could think of, and a few I didn’t come up with (thank you, proofreaders and feedback-givers!) aims to make the therapist-getting part less mysterious and more accessible.
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If you have had previous experiences where you found it hard to tell someone in person what had been going on, you might consider bringing in writing or notes. I have done this! It was very helpful, and meant I didn’t accidentally get too tangled up in my emotions and forget something important. Write poetry or journal in the moment and feel okay sharing it? Also a thing. Even my clinical training scenarios have included stories of clients bringing in such things, and if it means giving your therapist a clear picture of the issue it seems worth it. With one therapist, I showed up to our first meeting with data: a calendar reflecting how often I’d had trouble with my ED and significant events around each episode.
I’ve found it very helpful to avoid scheduling therapy between daily tasks. Sometimes there are surprise!emotions and I’ve felt much better when I had an hour or so to process the experience before interacting with people.
Despite liking my therapist(s) and seeing improvements as a result of therapy, I’ve often been tempted to skip sessions when I was having especially bad brain days. (If this sounds like a terrible plan, you’re correct!) My solution to getting around this was twofold. First, I set up a reminder in my phone to go off an hour before I had therapy. It read something like “Past-Kate wants you to remember that therapy makes you feel better and is worth doing” Secondly, I asked my partner to, if he ever thought of it, remind me of times when I felt really great after therapy, or point out progress I’d made. So far: success!
Sometimes insurance only covers a certain number of sessions (or your budget will only get you X amount of meetings.) I strongly encourage telling a therapist about this up front or as soon as you know—it can give them important information about structure and prioritizing how you meet, as well as allowing them to prepare you for termination of treatment.
What else would you add?
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I am actively looking for things I’ve left out, so if upon reading any section, you have unanswered questions–even if you think they are trivial or might mean you’ve missed something, please let me know. I would much rather spend time responding with “no, that’s in paragraph two” than have a whole subset of people think they didn’t read properly and not tell me I was unclear. Further, many thanks to Rita Messer for checking over the advice within.
Kate,
Sprry if you covered this elsewhere and I just missed it, but I would have liked to read “Part 0: Should You Get Therapy?” It seems like we shouldn’t expect this to be an easy question for people to answer for themselves. Examples follow:
Zohan considers himself a hard-headed person. He has some personal problems that might respond well to therapy, but he thinks that most people with those kinds of problems are doing it for their own personal sense of well-being. Zohan doesn’t care much about his personal experience of happiness, and prefers to focus on concrete achievements and helping others, so he is not interested in therapy for himself, though he appreciates its value for others. He would change his mind if he were convinced that therapy would help him achieve his goals, but seeking out this information himself feels suspiciously like rationalizing a self-indulgent behavior.
Ygritte has a severe mental illness that affects her life adversely in many ways, and would respond well to therapy. One of the ways her mental illness affects her is that it causes her to believe that therapy is a bad idea, and would not work for her. She is self-aware enough that she would provisionally defer to an expert’s judgment that she would benefit from therapy, if it were specific enough to her case that it obviously applied to her.
Xamander has no major problems in his life of the sort where therapy is an efficient solution. One day he reads a magazine article on people who don’t seek therapy when they need it. This article quotes an expert saying, “if you don’t know whether you need therapy, go to therapy.” Because Xamander is overly literal, he reasons that since he has never considered going to therapy before, he does not know whether he needs therapy – and therefore he dutifully heeds the advice of the expert and dutifully finds a therapist and meets with her regularly. His therapist patiently helps Xamander work through the very minor issues in his life, expecting that his major problems will surface in therapy once he’s comfortable enough with the process to share them. Xamander wastes a lot of money and many hours of his and the therapist’s time to no effect.
Wendigo feels stressed out and tired and resentful of their family and employer and friends and doesn’t understand why. They go to therapy to try to figure this out. Since the actual problem is that they have a big extended family with lots of people to take care of and they don’t have enough time to get everything done in a day and take care of theirself, spending money and time on therapy makes things worse and tips Wendigo into a downward spiral.
Victoria has lots of things she could make better in her life, some of which might be responsive to therapy, some of which might be responsive to other life improvement strategies. She is not sure how much benefit to expect from each approach, and since her time is finite, the time investment in therapy – not just the sessions, but applying what she learns in them to everyday life – uses time and attention that could be applied to other strategies, she can’t just “do both”.
Ulysses suffers from depressive episodes. He had a therapist respond poorly to a worsening episode, which precipitated a bout of hopelessness and suicidality of unprecedented severity, culminating in an inpatient stay that was itself a strongly negative experience with haphazard, ineffective, and expensive treatment. It’s possible that he would benefit from therapy, but he feels that he cannot handle another such catastrophic failure and has no idea how to protect himself except to avoid therapy altogether.
Is it a good idea or an ethical no-no to go to the same therapist as your partner? My past experiences make me really want a personal recommendation from someone who has a lot in common with me, and there’s certainly nobody else I can ask about this sort of thing, but I’m not sure it’s a good idea.
Also can you suggest ways to actually get yourself to spill out your problems at all? The last time I tried therapy (largely for anxiety) I was so anxious I just froze every time and couldn’t manage to explain my problem, so after a month she told me to just stop coming. I imagine showing up drunk wouldn’t be very acceptable.
Sadly, I am not Kate, but I do know how to think of five things. Not all of these will be good ideas – but maybe one of these will help. If not, try coming up with 10 terrible ideas of your own.
1) Mention to your new therapist that in the past you had problems saying anything, and you want to see whether showing up drunk will at least get you talking enough to break the ice. The right therapist might be okay with this, even though it’s not optimal.
2) Write down in advance what you want to say. Then just hand it to your therapist.
3) If you can’t get therapy for your problem, get therapy for your inability to explain your problem – you might be more able to talk about that.
4) Show up to therapy drunk without your therapist’s permission. You’re the one paying them, it’s not like you operate heavy machinery during therapy, just make sure you have a ride home afterwards.
5) Try explaining what your problem isn’t, rather than what your problem is. “I don’t have persistent hallucinations. I don’t have foot pain. I’m not afraid of spiders.”
6) Talk about something. Doesn’t have to be your problem at all. Doesn’t even have to be true – just keep words coming, and talk about your problem when you have enough momentum.
7) If you can’t even do 6, make sounds, If you can’t even do that, move your mouth, or make gestures.
8) Find a therapist who is willing to help soothe you. Figure out what makes you feel safe and comfortable, and make sure it’s available during your session. A blanket? Candy? Hugs? Death metal? A cuddle pillow? Total darkness?
9) Ask your therapist to play “20 questions” with you to figure out what your problems are.
10) Wear a mask.
I partly agree. Writing things down can be helpful. But what therapy is really about is when you “accidentally get too tangled up” in your emotions and your therapist is there with you. That something you forgot isn’t really important. Sharing how it feels to be you in the moment is important, even if it feels bad…especially if it feels bad.
Setting aside extra time after each session to process things is a good idea, and I also like “Past-Kate wants you to remember…”
Insurance or budget limitations should perhaps be in the first post in this series, as something you establish before therapy starts. Therapists can often work within a limited number of sessions, or space sessions further apart to spread the cost, but it’s helpful to know this in advance.
I disagree, or perhaps we misunderstand each other. I’m not advocating that therapy take place only in the context of reviewing journal articles, but that if discussing your issues is seeming not-possible, or you’re not sharing stuff because you can’t bear to bring it up, this is a solution. I think we generally agree that therapy is for handling emotional discussions, but sometimes this isn’t feasible.