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I'm *eventually* getting therapy... What to know before?

Discussion in 'General Support and Advice' started by Lyman, Jun 3, 2021.

  1. Lyman

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    I'll be going to a psychologist for the first time in my life very very soon.

    I was very reluctant to it until quite recently, and what helped me the most was to think about it in the same terms as physical therapy — if was feeling the same amount of muscular discomfort that I'm feeling mentally, I would have gone to physical therapy a year ago, so why not go to (mental) therapy? It's basically about massaging the muscles in your brains, isn't it? :slight_smile:

    I collected a lot of information before choosing where to go, as apparently it's not unusual to find really bad "professionals." I found two places that looked okay online and had been recommended to me by several independent sources and phoned them. Both of them had a waiting list of two months... And I'll be living far away by then. So it was no-no. (I'm so f-ed up right now that I prefer having a couple of sessions and interrupting them than doing nothing. Does that make sense?)

    I received good references of another person, but she's really old (which might indicate that she doesn't have very progressive views on sexuality) and I didn't like her attitude towards time and money, when asking on the phone.

    So I've eventually chosen a guy who I've been told that is "okay" by a former patient of his. I like that he's the only therapist in my area to mention self-esteem on their website and that he's on my health insurance (which means a significant discount). I also like that one of his specialities is treating phobias, and I'm starting to think that I have something with sex going on (thanks to the trauma with Anthony and the insane, pseudoscientific attitude of my parents towards STIs, combined with my inexperience and ignorance).

    I'm a bit concerned because he's only 35 years old (he's been working for 7-8 years as a therapist) and he's too cheap (his usual prices are ~75 % of what would be "normal" for a therapist here) and too available (he basically has no waiting list, and I can talk directly to him when phoning). Are these big red flags?

    I guess that anyway I can try, as the alternative is waiting forever and I don't think I should, after the huge mental breakdown I had recently. So this brings me to my other question...

    What should I be paying attention to during my first session(s) with a therapist? How do I know if he's a good professional? Some essentials have already been mentioned at Tightrope's thread, but I want to hear what else is important. As I have a history of being manipulated, having a bad therapist is the last thing I want.

    Any other relevant advice will also be appreciated. After all, I don't know that much about therapy, so please feel free to share any DOs or DON'Ts. ^^
     
    #1 Lyman, Jun 3, 2021
    Last edited: Jun 3, 2021
  2. Ram90

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    I've been to therapy a few times. The therapist had really good reviews, but was a bit expensive when compared to other therapists. At least in the by-the-hour/by-the-session charges. That said, he was young too. Mid-to-late thirties. I felt that was a positive thing in my case, since he could relate to a lot of things I said. The biggest fear I always had about therapy was getting an older therapist who would dismiss my feelings, my opinions like my parents do. Having one closer to my age was a positive.

    That said, it took 3 sessions for me to open up completely, to cry out my anguish and fears. I was "ashamed" to have taken that long, especially when his sessions weren't cheap ha ha, but in hindsight that is completely ok. It is important to be comfortable with your therapist. So taking time to completely open yourself up is fine! Don't worry about it.

    I stopped therapy after a few sessions, since I couldn't keep up with it anymore, so I'm not an expert. I'll stop here and let others comment. :slight_smile:
     
  3. DecentOne

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    Maybe in your area male therapists are not as popular. So discounts and availability are side effects?

    Otherwise you have a recommendation he is OK, and you see him mentioning areas that you want to cover, so that’s positive.

    When you talked, did things seem ok? Go by your gut.
     
  4. Unsure77

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    As for his availability, I’d be curious to know how long he’s been in your area and how booked other therapists are. It’s possible he just moved to the area fairly recently and just doesn’t have a client base built up. Or it’s possible there’s just a glut of therapists in the area that do the same thing. It’s also possible he’s been a therapist awhile but just finished his degree level (maybe he’s a new PhD, but was treating people before with a Masters). Then, it’s also possible he either has a rate negotiated with your insurance company or that he believes (for some reason) that you need a needs based lower rate.

    or he could suck. But, there are lots of possible explanations. Maybe.
     
  5. Aspen

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    Like others have said, there could be some logical explanations for his low rates and availability, or it could be a red flag. Did his former patient have anything else to say or did he only say “he’s okay”? That isn’t exactly a ringing endorsement. I don’t think the fact that he’s 35 is at all a red flag. All therapists have to start somewhere and you can find therapists with decades of experience that aren’t good at their job or are actively harmful to work with.

    As for your other question, here’s a few thoughts:
    • The conversation should focus on you. Your therapist should keep any personal anecdotes to a bare minimum and shouldn’t spend much time talking about themselves
    • Your therapist should never tell you what to do or how to feel. Leading questions and giving suggestions are all fine, but it’s important for you to be the one in control of your own life.
    • A good professional is professional. Occasional distractions are one thing but your therapist should be actively listening and focused on you.
    • If at any point you feel uncomfortable, speak up. Therapist-client relationships can be highly personal for obvious reasons but they are also a business relationship. You are paying your therapist to help you. If your therapist is leading you to talk about a certain area of your life and you’d rather talk about a different area, it’s okay to say so. This is especially important when you’re only talking to a therapist for the short-term, as you are.
     
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  6. Chip

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    One of the absolute best therapists I know... clinically the sharpest and most knowledgeable I've run into... is 35 and has been in practice for about 10 years. I do think finding a therapist with a certain amount of experience (probably several years) is probably wise.

    That said, a therapist I went to for a number of years was still in her supervised hours (meaning, she was not fully licensed) when I started seeing her. She, too, was brilliant.

    And I regularly run into therapists with 15 or 20 or 40 years of experience that I swear could not talk themselves out of a paper bag. Literally so utterly incompetent that I cannot imagine they are ever of any meaningful use to anyone. On the other hand, I know therapists in their 70s who have been practicing for 40+ years that are absolutely brilliant and more capable than 90% of the therapists with 10 or 15 years experience.

    So in my experience, years of experience, by itself, has almost -zero- correlation with skill or effectiveness. Similarly, cost has very little correlation either. I've seen absolutely terrible therapists that charge $275 an hour, and wonderful ones that charge $50.

    Some point before long I want to write an article on how to find a good therapist. Somewhere in our archives, I've made some posts on this before, so you might try searching and see if you can find them.

    Aspen has offered some awesome suggestions. Here are some (incomplete) cliff's notes to add:

    -- Connection and attunement with the therapist is the absolute single most important thing. If you don't have that, you don't have complete trust. If you don't have complete trust, you'll hold stuff back. If you hold stuff back, you aren't going to get much work done.

    -- Someone who is flexible and uses a combination of theories and practices is a necessity. Someone who, for example, almost exclusively uses DBT, CBT, EMDR, Brainspotting or the like is probably not going to be helpful other than perhaps for very specific things.

    -- If the therapist is not getting supervision or getting their own therapy (or, perhaps, has been in therapy for many years but isn't currently doing so), RUN! Any competent therapist MUST do their own work, or else they will have blindspots. It is beyond shocking to me how many therapists have never been to therapy themselves. I would never go to one of these. (And yes, it's OK to ask that. If the therapist is offended by that question, they aren't the therapist you want.)

    -- I am a very strong believer that virtually everything in mental health resolves back to childhood bonding/attunement/trauma issues. If the therapist is not skilled at helping the client work on that, or does not commonly do psychodynamic work, if they are uncomfortable with a client expressing strong emotions, or unwilling to "go there" with the client, they aren't going to be of much help.

    -- Surprisingly, level of training has almost zero correlation with therapist skill and ability. Most (but not all) of the best therapists I know are masters-level clinicians (LCSWs or LMFTs) rather than doctoral-level psychologists. If you are restricting yourself to doctoral-level professionals, you may end up with someone who is highly intellectual... and that is generally not going to be terribly effective in actually doing the deep work. Ph.D psychologists do a lot of training on research methodology and how to conduct research and less on actual therapy, while PsyD psychologists and clinical social workers and marriage-family therapists, almost *all* of their training is focused on therapy.

    -- Some people think you need a therapist that's lesbian or gay. I vehemently disagree. In fact, in many cases, I've found that LGBT therapists have often not done enough of their work and have more wounds that get in the way of their being really effective. (This is often, but not always, less true of older LGBT therapists, and is a very broad generalization that has an awful lot of exceptions.)

    --
     
    #6 Chip, Jun 4, 2021
    Last edited: Jun 4, 2021
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  7. SteveBi45

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    I’ve been to therapy a number of times, the first when I was 20, and the last just 2 years ago.

    The most important thing is that you feel comfortable with your therapist, regardless of their experience or pricing, if there’s no connection to be relaxed and open in your conversations you won’t get the full benefit from it.

    normally the first session is for both of you to meet and see if that will work. The therapist will want to know why you’re there and then they will see if they’re the right person to help you.

    with one therapist I went to, we agreed after that first meeting that she wasn’t the right person for me, but she was able to give me details of someone who could.

    Taking the decision to go is great! You are so right that your mental health is just as important as your physical well-being. This is something that thankfully is becoming more known and acknowledged than before.
     
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  8. Lyman

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    When I said “very very soon” and that the therapist was really available, I meant it. I’ve already had my appointment and it was bad. Remarkably bad. This is not one of those instances in which I need to write a super long and overthought post asking for advice. He's appalling, and he's done me much more harm than good. I'm not going back to him. Period.

    Despite the final outcome, thanks to all for your input! It was useful for realising how bad this experience was, and it'll be useful for the next time I attend a therapist. Much appreciated :slight_smile:

    The former patient meant that he's not a bad therapist (upon which I disagree), but that he isn't the best (I do second that). I only went for this therapist because my anxiety is starting to cause me sleep problems and I didn't want to wait two months for the therapists that had been ringingly endorsed. Anyway, I guess that the best I can do now is manage the horrible recent problems with anxiety the best I can on my own, while I wait.

    This worries me... Virtually every therapist in my area either says that they do only CBT, or don't describe their therapeutic approach in any meaningful way. For what kind of "very specific things" would someone that only does CBT be useful for? Would such a therapist be better than no therapy for someone like me?
     
    #8 Lyman, Jun 5, 2021
    Last edited: Jun 5, 2021
  9. Mihael

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    Pure CBT is very much like those CBT self-help books, but in person. Not my piece of cake at all. It's for people who have problems with self-management.
     
  10. Chip

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    If you are comfortable doing so, it might be worthwhile to describe what was problematic. Some folks who have only been to one or two therapists (or have had remarkably bad luck and had 4 or 5 that sucked... sadly, not that unlikely) may not realize what godawful therapy looks like. Additionally, if it is so egregiously bad that it's risky to the clients, it may be worth considering making a formal report to the licensing board.

    CBT was, for a while, the magic "go-to" and insurance companies aggressively pushed therapists to do it. Why? It's evidence-proven to reduce or eliminate symptoms. Sounds good, right? Here's the catch: The effect is temporary, because CBT makes zero effort to address the underlying problem. It assumes that a given symptom (anxiety, depression, low self esteem) is based on thought distortions, and CBT seeks to basically change the thought distortions.

    That would be great if it were true. And to some extent it is, in that pretty much all mental health issues, at least, according to the most recent and widely growing perspective, are rooted in trauma. So the things like anxiety, for example, are rooted in the traumas in our past. So in this example, maybe we worried because at one point we needed to worry, because we understood that our environment wasn't safe. So the worry kept us vigilant... which helped to keep us safe. It was an adaptive strategy. But now that's no longer true, and we've used the adaptive strategy for so long, it's all but hard wired, because we believe, at a deep unconscious level, that we still have to protect ourselves.

    CBT serves to change the conscious thought. But it does nothing for the unconscious thought, because it does not seek any form of insight and reprocessing and understanding of how what happened affected us, so that our unconscious can genuinely learn that the threat is no longer there.

    So CBT will help in the short term in managing the symptoms if the therapist is competent and genuinely knows how to use and adapt it to the client's needs. Many simply go through a mechanical process of doing CBT that isn't very helpful.

    I wouldn't rule out someone because their primary modality is CBT, but it would be pretty low on my priority list. Virtually any therapist, regardless of training (with a few exceptions) knows CBT and how to use it, it's just that the best folks have realized what I just explained above and use the CBT only as a tiny part of the overall strategy.

    What country are you in? If in the US, what general part of the country? (if you don't mind sharing). Therapy is practiced a little differently in different places, and so what's available, and what you have to ask for, can vary somewhat.
     
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  11. QuietPeace

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    This makes me sad. I have had one preliminary meeting with the only therapist available to me and she said that all she does is CBT. When it was described to me I felt that what it sounded like was repressing on purpose and I worried that it would only last until my next crisis. (she mentioned that my diagnosis of PTSD was likely actually C-PTSD, I do not know what effect this has on anything)
     
  12. Chip

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    For what it's worth C-PTSD is sort of a diagnosis du jour right now, in that everyone in the field is talking about it. I do think that many/most people who have PTSD probably do actually have C-PTSD, but it also a bit of a buzzword. The main difference between the two is that PTSD is typically caused by major traumas or events (auto accident, rape, battle trauma) where complex PTSD is the "death by a thousand paper cuts" (a whole bunch of traumas that, by themselves, are typically not traumatizing, but taken together, add up to having a severe impact on the individual.) If an individual has both major and "paper cut" trauma, then it would probably be diagnosed as complex.

    As for CBT... if it's all she does, it's still worth doing, as it's helpful for symptoms, but the data is pretty clear that it isn't effective in the long term because of what I said above. In some cases, Brianspotting or EMDR can also be helpful for C-PTSD and PTSD.
     
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  13. QuietPeace

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    Then mine is complex. I have multiple major traumas as well as a multitude of minor. I thought that PTSD was for any major trauma while C-PTSD was for long ongoing repeated traumas. I will go ahead and pursue it since it is better than nothing. Maybe if I eventually I learn the local language I can pursue other methods with a different therapist, as the current one is the only one locally who is comfortable in the only language which I speak.
     
    #13 QuietPeace, Jun 6, 2021
    Last edited: Jun 6, 2021
  14. SteveBi45

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    I did CBT a few years ago and it helped a lot, but I had already been to therapy to deal with the underlying reasons behind my behaviors. In this way, the CBT helped me to break some bad habits.
     
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  15. Unsure77

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    It's kind of ironic. I suspect I have CPTSD (because I kind of think I may have religious trauma syndrome which I think is supposed to be a form of CPTSD), but my therapist talks much more about me having a high level of anxiety. But I don't outright have an anxiety diagnosis (which she said is because I'm high functioning. I have a lot of anxiety, but it doesn't interfere with my ability to work and things). So, my official diagnosis for insurance and stuff is just adjustment disorder (from the coming out process).
     
    #15 Unsure77, Jun 6, 2021
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  16. Chip

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    Your therapist is not connecting the trauma that's manifesting as the PTSD as the root cause of the anxiety. Unfortunately, that's really, really common, as the findings about trauma as the root of almost all mental illness is just beginning to find its way into the mainstream.

    Anxiety is, at its root, a coping strategy. At one time, it served a necessary purpose, which was to keep you on high alert in a situation that did not appear (or objectively was not) safe. Remember that, to a child, especially an infant, safety isn't "absence of threat" but "presence of connection." So anything that interferes with deep, attuned connection with the caregiving parent is going to induce anxiety. But again... many therapists have not made that connection, because it isn't yet being widely taught in masters programs. And I think you can see why religious trauma is very likely to cause or contribute to PTSD and, thus, anxiety.

    You might consider exploring this with your therapist.

    There's also a wonderful video by Gabor Maté, a free 70 minute talk called "The Power of Connection", which is the first episode of a series called "Healing Trauma and Addiction." Here's a short preview.
     
  17. Peterpangirl

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    I had an excellent, older, LGBT therapist. She was very good at helping me let go of many of my fears about being gay.
     
  18. Peterpangirl

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    For me a good therapist is one you feel safe to say whatever you want to. S/he is congruent. S/he models good boundaries. S/he listens empathically and does not judge you. S/he does not advise you which path to take but instead validates you as an autonomous individual. S/he provides you with a variety of tools to help you understand your thoughts and feelings and to help you grow and move in the direction of becoming your authentic, true self. S/he will also challenge you in order to promote self-exploration.
     
    #18 Peterpangirl, Jun 6, 2021
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  19. Unsure77

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    Yeah, she's tied my anxiety to my childhood church experiences. (just the years of fear of having anyone realize my sexuality and the fact that I literally couldn't trust anyone with that secret because it felt unsafe...I was a southern baptist in Arkansas in the 90's. pre-"Boy Erased". I wasn't wrong to be afraid of those people.). I literally hit the SBC trifecta. I was gay. I was there for the purity culture era (there are at least 2 other people I was in youth group with from that era who had broken marriages and are now in therapy because our church made them so afraid and ashamed of sex in program). And then I was touched inappropriately (as a 15 or 16 year old) by my 30-something year old, married youth director. So she's like "of course you have anxiety" and outlines all the ways she thinks my church screwed me up. She just has been hesitant to label it as trauma or ptsd. To use that word for it.

    I dunno. I like her a lot as a therapist. I think she's been good for me. She just seems to be guarded with what words she uses to label some things. But, I'm also about to come out next week, so it's also possible she's been trying to throttle how many ideas she's introducing to me at a time. All of which may be a moot point because she's about to move and I'm about to get assigned to a new therapist in a few months, which I'm kinda sad about.

    At any rate, I'll check out the resource you posted. It sounds interesting.