Taking risks in therapy

   

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We all have something that we don’t like to talk about. While therapy is an appropriate setting to explore these issues, we sometimes hold back on certain things — even in that context — out of fear. “Will I sound crazy?” “Will I be believed?” “What will my therapist think of me?” “What are the consequences of saying this?” “Will my therapist think less of me?“ These questions and more prevent us from being completely open in our treatment. 

But if you never take risks, you won’t progress when it comes to those issues. In fact, they may become worse as feelings of shame, embarrassment, guilt, hostility and unworthiness fester inside of you. The fact that you won’t talk about the topic becomes an issue in and of itself. 

The first obstacle you need to pass is trusting your therapist. You can read more about that here. In short, developing a strong therapeutic alliance in a safe relationship allow you to be more open. Keep in mind the ways in which your therapist has been trustworthy in the past. If you remind yourself of these things, opening up might not seem quite as impossible.

Still, even with trust, it can be hard to explore certain topics. I spent a lot of time trying to figure out how to talk about a series of events that happened a few years ago. I had been seeing the same therapist I’m seeing now at the time these things happened and my irrational fear was that I’d remember things wrong and become discredited. But I have yet to find a way around those fears. So what could I do?

It got to a point where my only options seemed to be to keep quiet and never heal or to take a risk and see what happened. After years of deliberation, I decided to just go for it and see what would happen. For me, that meant telling the story regardless of my fears. So I did. 

I was not prepared for how well that went. At first, I addressed my concerns about how he might remember things differently than I did. I asked my therapist to not go back and read his notes from the time in question and he agreed to follow my request. This removed a lot of pressure. 

It’s going to take a while to get through everything. And that’s okay. Breaking the larger story into smaller segments allows me to do a little each week. This way I get insight into each part, which helps me understand the larger context at play. While the content is very difficult and, at times, triggering, I’m feeling better about myself and am more realistic about my role in those events.

Jumping in is not always the solution, but I’m pretty sure that at this point in the post, you have a specific issue or situation in mind. Test the waters. See what happens. Be honest about your concerns. You can discuss them before you get to the actual content. But when you’re ready, opening up despite fear can be extremely healing. I know it has been for me.

What risks have you taken in therapy? How did it work out? Tell us about it in the comments.

7 alternatives to harmful behavior

Mental illness does not just affect our minds and our thoughts. It affects our behavior. There are things that people struggling with mental health will do that helps them feel better, but are actually more damaging in the long run. These include self-injury, substance abuse, eating disordered behaviors, acting out obsessions, lashing out at others and more.

 

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It can be difficult to stay away from harmful behaviors, especially during times of great distress. This is why it is important to have alternate ways of coping. It can take a long time to change harmful behaviors, as they do serve a purpose. As a starting point, though, here are some ideas of what you could do instead of engaging in harmful behavior.

1. Replacement behaviors
If you don't want to engage in a destructive behavior, replace it with something else. People use this strategy all the time to quit smoking by sucking on hard candy, chewing gum or playing with putty to give their hands something to do. In other cases, this could mean drawing on yourself with a red marker instead of cutting or drinking tasty non-alcoholic beverages when you feel the urge to drink. The point is to put something less harmful in the place of the old behavior.

2. Creative expression
You can engage the emotions you are feeling without engaging in the behavior that usually
accompanies it. Try to take that energy that is pushing you towards self-destruction and let it live out another way through using it as fuel for creativity. What does your drug use look like when painted as an animal? What would your eating disorder say if it were a character in a novel about your life? Looking at your behavior from a creative perspective can also help you see things differently, which is a good start for more permanent change.

3. Talk to someone
You don't have to go through tough times alone. If you are worried that you'll engage in harmful behavior, see if you can spend time with someone else. You can talk about what is triggering your desire to engage in the behavior or you can just try to focus on something else now that you're not alone. If you don't have someone to spend time with, see if you can call someone. If there's no one to call, try writing an email to someone you trust. Involving another person can make it easier to resist.

4. Write it out
Written expression can help calm down feelings that surround destructive behaviors. There are many ways you can do this. You can try to process what you are feeling through journaling. You can vent out everything that's causing you distress and tear the paper into as many pieces as you'd like. You can write a letter to bring to your therapist the next session. The point is to communicate instead of act.

5. Distraction
Sometimes, it is better to get your mind on something else. My mother would say that if you're feeling miserable, you might as well clean. If you're able to, you can use the stress you are under to accomplish another task. Not all of us can do that, though, and self-care is an excellent way of distracting. You can use this activity in advance to come up with things to do.

6. Take out your frustration on something inanimate
At times, people feel so much tension, pain, anger and frustration that they can't slow down and do something else. In this case, let the damage be something inanimate, not your body or another person. Sit in your parked car with loud music on and yell at whoever or whatever is causing you problems. Punch a pillow or even your whole mattress. Destry things that won't harm you in a disassembled state (yes on tearing up a pillow; no on breaking glass). Redirecting your emotions allows you to feel catharsis without causing any actual harm.

7. Reward yourself
For some people, having a reward system helps keep dangerous behaviors in check. This can have as much or as little structure as you'd like. It might be a system set up in advance where you have a list of rewards for making it X amount of days without engaging in harmful behavior. It could also be having a secret snack stash or video game that you gain access to only when you are actively controlling your impulses. Some people like having a visual reminder of how long they've made it without those behaviors. You know yourself best, so find what motivates you and use it to stop yourself from doing further harm.


What do you find helps when you feel like engaging in harmful behaviors? Trade tips in the comments.

What to expect your first session

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The first session with a therapist is a unique experience. It is different from all future sessions, which will be dictated by what problems you are facing. But in that first hour, there is lots of important information you and your therapist will be going through. Every therapist is different, but here’s what you might expect in your first session.

First of all, arrive early. There is likely some paperwork for you to fill out. Some of this will be

financial. This would include insurance information, so make sure to bring that with you. If you don’t have insurance, you may have to sign a contract stating that you take financial responsibility for paying for the sessions. You might also be asked to fill out questionnaires about your symptoms and history.

You might also be given a paper stating the limits of confidentiality. Whether or not you get the paper, your therapist should talk to you about it and answer any questions you have. You can also read more about confidentiality in therapy here.

You may have filled out paperwork on it already, but your therapist will likely ask you about your background and what symptoms you are experiencing. Be completely honest. You’re not going to be rejected for telling the truth. Only if you are open can your therapist formulate the best possible treatment plan for you.

There will also probably be questions about your current situation – occupation, relationship status, living situation, family and social relationships, and so on. This is done to get a better idea of the stressors you might face and the support you have. Again, be honest. You’re not trying to impress anyone.

The most important question, though, is what brings you to therapy. Think ahead of time about what you would like to accomplish with your time together. You don’t need to know exactly what the plan is – that’s something your therapist and you will come up with together. But a basic idea of what you want to change in your life is very helpful and an important starting point for treatment.

With all the questions you are being asked, you probably have some of your own. That’s perfectly appropriate. Now’s a great time to learn about your therapist and the process of therapy. Some ideas for questions you might want to ask are here. 

What you shouldn’t expect, however, is for problems to be solved. Some therapists might jump right into the issue and leave some of the questions discussed for later, but even then, remember that therapy is a long-term process. If you have an imminent emergency, make that clear to your therapist early on, but if not, let the first session be what it is. It’s a time for you and your therapist get to know each other and make goals for treatment.

What has your experience been with first sessions? Tell your story in the comments.

Why you should see a student therapist

Every therapist has to start somewhere, so there are plenty of student therapists who are practicing under supervision. They can often be found in university counseling centers and in community clinics. This means that college students and those utilizing community resources may well end up working with a student therapist.

   

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Not everyone is entirely comfortable with this. If you’re a senior citizen, how can you put your trust in someone in her twenties? Does a student feel like he is getting appropriate treatment when his therapist only a couple years ahead? It’s an issue that student therapists have to deal with sometimes. The thing is, they shouldn’t have to.

Research shows that student therapists perform just as well as licensed practitioners. Some even suggests that they might actually be better. The reason for this is unknown, but it could have to do with being regularly supervised, the fact that their education is still present or recent, and the initial zeal that old hands lose. No one knows for sure. What matters is that you shouldn’t be worried about having a student therapist – you might actually be better off that way.

Supervision allows students to have a second pair of eyes on their clients. Supervisors often watch tape of students performing therapy, meaning they can give very detailed and relevant feedback. Students also have someone who can help them conceptualize their clients and give suggestions. It’s kind of like having a second therapist behind the scenes.

By virtue of being in school, students are actively learning. They are dealing with the material both theoretically and practically. They spend a lot of time actually thinking about all the things that lie behind therapy, something a seasoned clinician might not do. Students also have multiple professors at their disposal, meaning that experts are on hand.

Students are also enthusiastic about their work. They are at the very beginning of their careers, following their dreams. You don’t commit to graduate school unless the subject has significant meaning to you. They haven’t been jaded by time and they are excited to learn and grow. It’s a unique period in their lives where there is lots of energy on hand. 

So if you are under the care of a student therapist, you shouldn’t worry about her being inexperienced. There are other factors at play that make up for that. Every therapist, no matter how long he has been practicing, has something unique to offer. If you find someone who’s a good fit, it doesn’t matter whether or not she has “Ph.D.” after her name.

Have you seen a student therapist? How did it go for you? Tell us in the comments.

Learning to trust your therapist

  

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It’s hard to make progress in therapy if you don’t trust your therapist. Trust is essential to the therapeutic relationship, which in turn is essential to recovery. But for many people, it’s by no means easy to open up to a complete stranger and talk about the most personal parts of their lives. This is where trust building comes in.

Your therapist has a responsibility to act in a way that makes you trust her. He has to do his part of the work to create a safe environment. But it’s not entirely up to her. There are things that you can do to build that trust, too. 

To start with, don’t be afraid to ask questions. Get to know your therapist. They have varying levels of comfort when it comes to discussing personal matters, but some questions are entirely appropriate. Asking him about his education, how he approaches treatment and what his experience has been in treating people with similar concerns. A more complete list of questions to ask your therapist can be found here. If your therapist is open to it, ask a little about her family or hobbies. This makes him more relatable, which can help build trust.

This goes the other way, too. Not everything you talk about should be symptoms and problems. Let her get to know you as a person. Tell him what you like to do and what brings you joy in your life. If something good happened to you since last time, talk about it. Therapy is not meant to be entirely depressing. You’ll feel better if you believe your therapist
                                                                                  understands you as a person, not just a problem.

Another important factor is giving feedback to your therapist. She is not a mind reader and won’t catch everything. You can let that fester into decreased trust, or you can address it as it happens. If you were upset by something he said or didn’t like how she responded to your concern, bring it up. If something was important and your therapist minimized or didn’t catch it, emphasize how much it matters to you. Talk about why you’re in treatment so it is clear that you are on the same page.

Sometimes, not trusting your therapist actually has very little to do with her. If you have other people in your life that haven’t been trustworthy, you can project your feelings about them onto him. Step back and remind yourself that they are not the same person. If this is the problem, acknowledge that the distrust comes from your end, not from something he did. Remind yourself of how your therapist has been trustworthy in the past. And by all means, talk about why you don’t trust people.

Trust is a difficult issue. Your therapist doesn’t expect it to be easy for you to establish it. Recognize your feelings about trust in your therapeutic relationship and accept that it’s normal for it to take time to build it. But believe it can change. You have to trust yourself as well. Go at your own pace and make note of when your therapist is being trustworthy. Remember those times when you find it difficult to trust her. You can even keep an ongoing list. 

Because trust is an essential part of therapy, developing it is crucial. But it’s okay if it’s something your therapist has to earn over time. Just make sure you are doing your part to move forward. Take small risks in telling him things you are concerned about his reaction to. Take bigger chances as time goes on. When you actively and openly work together on building a relationship based on trust, your progress will be worth it.

Have you found it difficult to trust your therapist? What has helped you work through that? Tell your story in the comments. 

7 signs you need a new therapist

Not every therapist is a good match for every client. This means that sometimes, finding someone else is the best thing to do to progress in your recovery. There are, of course, reasons to stay with the one you have. By working through your differences, you develop a stronger bond and learn how to manage relationships outside the therapy room. But if any of the following points are a problem, then it might be time to find someone new.

1. You are not being respected.

One of the great tasks in life is learning to get along and grow with those who are different than us. The variety of people in the world should be celebrated, as it allows humanity to reach its highest potential. But these differences can also be a source of prejudice and unkind behavior. If your therapist is devaluing your experiences, not honoring your belief system, asking you to change culturally appropriate behavior or making you feel inferior in any way, it’s time to switch therapists.

2. You can’t establish trust.

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Sometimes, we just don’t trust people. Maybe they remind us of someone that hurt us in the past or appear similar to a stereotype we have problems with. If this is the case, the first thing you should do is talk to your therapist about it. Working through that mistrust can be huge in terms of personal growth. But if you’ve tried your best and just can’t make yourself trust her, find someone that makes you feel more secure.

3. Your therapist is crossing boundaries.

Your therapist should be your therapist and nothing else. He is not a potential business partner. She is not someone you’ll hang out with at social events. He is not the friend you call at 3:00 a.m. Most importantly, she is not a romantic or sexual partner. If your relationship with your therapist is expanding into these areas, that needs to stop immediately. It’s highly unethical and could even have legal implications for your therapist. If he can’t stick to his job, find someone who can. 

4. Your therapist doesn’t respect your time.

When you go into a session, that is your hour. Your therapist should not be focusing her attention on anything but you. He should not, for example, answer calls when with you. She should also be more or less on time and not frequently canceling sessions. Be understanding that occasionally, something major might be going on. But if you see a pattern of these behaviors, you might want to look into finding someone else.

5. Your therapist breaks confidentiality.

Your therapist has to keep all information about you private. He can’t give your information to anyone, even another therapist or healthcare provider, without your permission in written form. If someone asks, she can’t even acknowledge whether or not she’s seeing you for therapy. The only exceptions are related to major safety concerns and rare legal orders, which can be read about here. But if your therapist is, for instance, chatting with your significant other about your progress without your express permission, that’s an ethical violation and a legitimate reason to dump the therapist. 

6. Your personalities clash. 

We all have certain types of people we just don’t get along with. If your therapist has a personality that is particularly irritating or difficult for you, don’t give up right away. You can become a more open and accepting person by working through those issues with your therapist. If it doesn’t work, though, it doesn’t work. On the other hand, sometimes self-improvement is secondary to an immediate concern, in which case, find someone you get along with.

7. Nothing is happening.

Progress in therapy is not as simple as a line gradually moving upwards. You’ll be all over the place. Sometimes, you’ll have a huge change for the better, while other times you’ll take a few steps back. There is some truth to the “getting worse before it gets better” concept, so don’t jump ship just because you become a bit more symptomatic. It’s part of the healing process. But if everything just stays the same, then something’s wrong and you could be better off working with someone else. 

Have you ever switched therapists? Why did you do so and how did it go? Report your experiences in the comments.

Thoughts to make you feel better

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Mental illness can be very discouraging. Sometimes, you just need a little boost of positivity to help you get through a challenging time. So if you are having one of those days, here are some thoughts that might make things seem a little more okay.

You deserve help

A sense of worthlessness often accompanies mental illness. When your ability to function and be productive is compromised, you can feel like you aren’t earning your place in the world. If you can’t give, then why should you receive? Alternately, if your problems are minimal, what makes you deserve help when it seems like others need it more?

The truth is, everyone deserves help. Everyone. No matter what. Help is not a limited resource. It is not something that is carefully allocated to whoever has earned it or is the most needy. Getting help can take so many forms, from having a cup of coffee with a neighbor to spending time in in-patient treatment. And even when you are receiving help, you might be giving it, too. A friend who listed to you might feel wanted and like her life has some purpose because you chose to open up to her. Your therapist could become a better clinician because he is working with you, furthering his ability to help others. You can’t make yourself an exception to everyone. You are a human being. You deserve help, no matter what you are or aren’t giving back.

You are not your struggles

Mental illness is not your identity. The way you handle it says more about you than the fact that you have it in the first place. Mental illness can happen to anyone at any time. You are not a flawed person for struggling with it. That’s just your particular battle at this point in time. When we admire someone, we don’t look up to her because of the odds she faced. We admire her because of what she did despite them. 

There are so many things that are more important and interesting about you than what your diagnosis is. What matters the most to you? What makes you passionate? Who do you love? What makes you laugh? Why do you keep trying? These are who you are. Having a name for a disorder can help a clinician get a general sense of what he’s dealing with, but it doesn’t mean much beyond that. Who you are has a larger impact on your life that what you are up against.

Trying means you are strong

The work it takes to recover can be astounding. It’s flat-out overwhelming at times. You might not be able to fix everything, but the fact that you are trying – even if it’s just a little bit – is an incredible feat of courage. Mental illness will try to make you succumb to it. It will tell you whatever it needs to in order to gain control over your life. But if you are putting forth effort, you are saying that you’re not giving in. Even if you slip up, the strength it takes to say you’ll try again anyway outweighs that mistake. And that is amazing. 

The smallest bit of effort can be a large victory because you aren’t on neutral ground. You’re not getting out of bed when you have a wonderful day to look forward to. You’re getting out of bed when everything inside of you is screaming at you to stay. You are going outside when you are crippled by fear. You take a chance by saying, “I’ll get through another day,” even when as far back as you can recall, all the days were miserable. It doesn’t look like much from the outside, but your determination to keep trying is an incredible feat.

What do you tell yourself when you get discouraged? Share your motivators in the comments.

9 things you need to believe in order to heal

Healing from mental illness is one of the most difficult things you will ever do. It’s a scary process and you never know if you’re going to relapse. But a lot of it is about attitude and belief. Here are some of the things you need to believe if you want to recover from mental illness.

1. It is possible to heal.

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There is very little point in trying to recover if you do not believe it is possible. Not believing it sets up a major barrier that makes progress in treatment minimal at best. Belief in the method of healing is essential to recovery. Take the placebo effect. If a pill that does nothing can make some people better because they believe it is something else, then believing in your actual treatment is going to be fruitful.

2. It is okay for it to take time.

At the start of therapy, people usually want to know how long it is going to take. Some people even expect everything to be solved in a single session. The truth is, it’s going to take however long it’s going to take. The average is 8-12 sessions, but that number is, in a lot of ways, completely meaningless. Whatever you need is how long it’s going to take and that’s okay.

3. It is normal to take a step back.

Recovery isn’t a straightforward trajectory towards wellness. There are ups and downs. You will get worse before you get better. And even when you do get better, you’ll still have bad days/weeks/months. The thing with setbacks is that they actually make you stronger than you were before. You may feel like you overcome it to end up in the same place, but you’ll have grown even more.

4. You are worthy of love no matter where you’re at.

Measuring our self-worth is often done by looking at our output. How well do we do in school? How much money do we make? What kind of significant other have we won over? Mental illness can affect one’s ability to produce, but it doesn’t affect self-worth. You’re just dealing with a different set of characteristics. Now your courage in facing your disorder, determination to get better and willingness to comply with treatment set you apart.

5. Others will support you if you let them.

There are others who will want to help you. And if they’re not already in your life, you will be able to find them. I spent so many years trying to recover without letting others really be there for me. I thought I had to do it myself. You don’t. Once I started letting other people in, I’ve made tremendous progress. I don’t have a big social network, but even one person supporting you makes a difference.

6. Your treatment team can help you.

Research has shown that believing in the ability of your therapist to help you improves therapy outcomes. That’s why sending someone to therapy who doesn’t believe in it or who isn’t ready is pretty useless. If you don’t entirely trust your specific therapist, look for someone else. It is critical that you have faith in those who are helping you. (Here’s a list of questions to ask potential therapists.)

7. Things are always changing.

Don’t give up on yourself because you believe you’ve exhausted every option. The world is in constant flux and your circumstances are changing all the time. There are always new treatments, new research, new therapists, new medications, new friendships, new hobbies, new everything. The belief in change is also helpful when you’re having a setback because you know it won’t last forever.

8. You are not an exception.

I spent a lot of years thinking that there was something so terribly wrong with me that I wasn’t going to get better. I put forth all my best effort with minimal results. I just thought that I was someone who couldn’t get better and that the most we could do is not make things worse. It took six and a half years of therapy to find a crucial component that turned things around. But we found it. You will find it, too, eventually.

9. It will be worth it.

Mental illness changes the way you view the future. It can be very hard to see yourself living the life you want. The truth is, things might not work out the way you’d like. I’ve worked on my undergraduate degree for eight years and still don’t know if or when I’ll get it. But I’m learning to appreciate any progress. I don’t have a lot of relationships in my life, but the ones I do have really matter. There are a few things I enjoy doing that I didn’t know about before. You have to believe that you’ll find something worthwhile, even if it isn’t exactly what you planned.

What beliefs have helped you in your recovery? Add your thoughts in the comments.

5 tips for discussing trauma

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Trauma is one of the hardest things to talk about, yet doing so is essential to healing. If you continue to repress the bad experiences of your past, they will continue to interfere with your life in ways you may not even realize. So it’s something that’s both incredibly important and incredibly difficult. Here are some strategies on how to make it more manageable.

1. Get stabilized first.

When doing trauma work, you need to be in a reasonably stable place. The week after a breakup or before a stressful holiday event are not ideal times. Work on getting yourself in the best situation you can. Make sure you have strong relationships you can rely on, as it is difficult to go it on your own. You also need to have a firm grasp on which coping tools work best for you. Your therapist should be able to help you identify if you are in a good place to start working on
the trauma.

2. Go in intervals.

You’re not always going to feel better after blurting out a narrative of everything all at once. It can even be retraumatizing. Trauma is very complex and all the different aspects need to have their own time to be addressed. That’s why going in intervals is important. You can set aside sessions to discuss specific components – the narrative of what happened, how it impacted your relationships, what fears it left you with, etc. You might also want to set time limits. Start with a low time, maybe even as low as 10 seconds. Then increase it each week until you feel you have reached a productive time.

3. Stop when you need to.

You have no obligation whatsoever to keep talking when you get uncomfortable or triggered. You can stop discussing your trauma at any time and for any reason. It takes time to learn to talk about such a difficult subject and even when you are able to, you’ll need breaks. No matter where you’re at in your story or thoughts – even if you are seconds away from a critical point – you can stop. That’s your prerogative and it’s not good to push yourself too far. Discuss in advance with your therapist how far you think you are able to go in each session.

4. Reestablish a sense of safety.

Always leave time to get yourself feeling somewhat normal again. It’s not ideal to leave the session a complete wreck. When you are done with talking about the trauma, take time to ground yourself firmly in the present. Remind yourself of where you are, when it is and who is with you. Your therapist can help you with that. Remind yourself that you are safe, that your circumstances have changed and that you have what it takes to ensure your own wellbeing. Trauma work has a way of sending us back to a different time, so make sure you have a return ticket. (In addition, here are some grounding techniques).

5. Prepare self-soothing activities.

Have planned activities for after session. Do things that help you feel better. These might include taking a bath, reading a book, going to lunch with a friend, meditating or going for a walk. Whatever works for you is what you should do. By knowing in advance what you are doing after session, it’s easier to navigate the difficult post-trauma talk space. Have backup options ready in case the coping strategy you selected is not proving effective. It’s okay if it takes you a while to recover from talking about the trauma. It is a very difficult thing to do and you should always be proud of yourself for doing it – even if it’s only a few seconds.

What have you found helpful when discussing trauma? Share tips in the comments. 

13 theoretical orientations (and what that means)

This post is part of an organized reader request series. Stop by at the beginning of each month to make your requests on the designated post. This topic was suggested by reader Julie.

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There are as many different types of therapies as there are therapists. Maybe even more. Everyone has their own style and finds particular techniques or ideas to be helpful. Even so, there are general categories of therapy. These are called theoretical orientations.

A theoretical orientation is a theory about what causes mental illness and what can be done to heal it. In graduate school, future therapists are exposed to a variety of these and find what works best for them. There isn’t one that’s inherently better than another; research has shown that theoretical orientation doesn’t significantly affect therapy outcomes. 

But some therapies will work better for some people. When looking for a therapist, you can ask about his theoretical orientation in order to assess whether he might be helpful to you. You can also ask your current therapist about hers, as it might help you understand your treatment better. Here are 13 of the more common ones.

Cognitive-behavioral therapy (CBT)

This type of therapy focuses on beliefs and behaviors. With your therapist, you look at your thoughts, feelings and actions and look for maladaptive patterns. You might receive homework to track these things. They can then be worked on using specific techniques. CBT is commonly used to treat anxiety and depression.

Humanistic therapy

This orientation posits that people naturally strive for self-actualization. It encourages self-exploration and creativity. It emphasizes that everyone can be the center of their own healing. You will look at your values and help you find your inner wisdom. The focus is on positive adaptive traits rather than pathology.

Existential therapy

In this type of therapy, pathology is seen as stemming from internal conflicts with the givens of existence. These include death, freedom and its accompanying responsibility, isolation and meaningless. The present and future is focused on more than the past. The goal is to find out how to fully live.

Psychoanalysis

This therapy was developed by Sigmund Freud, but has been built on ever since. It believes that early childhood significantly impacts ones development and that we are driven by unconscious, irrational drives. Unconscious material causes us distress, which can be handled by bringing the material to consciousness. Sessions occur multiple times a week.

Psychodynamic therapy

Psychodynamic therapy is closely related to psychoanalysis, but is less intensive and focuses more on the therapeutic relationship. Psychodynamic therapy still addresses unconscious material and internal conflicts. It acknowledges maladaptive behavior and seeks to find its root. By bringing it to light, resolution can be achieved. 

Gestalt therapy

In Gestalt therapy, the focus is on being able to fully experience each moment. It also acknowledges the interconnectedness of everyone and everything. Relationships, including that with the therapist, therefore become important. It emphasizes personal responsibility and teaches one to have a higher level of awareness.

Feminist therapy

This therapy acknowledges the difficulties one might face due to sex, gender, race, ethnicity, religion, sexuality, level of ability, age and other traits that influence one’s position in society. By recognizing these forces, one can find ways to become more empowered. A lot of emphasis is placed on the therapist and client working together as equals.

Relational therapy

Relational therapy stipulates that reality is found in relationships. A relational therapist believes that a client’s problems stem from his relationships. Psychopathology comes from disconnection or dysfunction in one’s relationships. There is, naturally, a lot of focus on the therapeutic relationship, which can serve as a corrective experience.

Family systems therapy

This type of therapy will look at families and relationships as a unit and aims to treat it. The goal is to improve relationships and the family as a whole. It takes note of different patterns in the family and offers new alternatives. It is usually practiced by bringing in the entire family, but might also be used in individual therapy. 

Solution focused brief therapy (SFBT)

SFBT is a very structured and goal-oriented approach to treatment. It doesn’t delve into what the problem is and try to analyze it, but rather focuses on what the solutions are. By looking at times when the problem isn’t present or is less severe, successful practices can be identified and utilized in the future. 

Dialectical behavioral therapy (DBT)

DBT isn’t exactly a theoretical orientation, but it is a specific type of therapy. It is usually done as a group, but therapists will pull from it in individual work, too. The focuses of DBT are mindfulness, interpersonal effectiveness, emotional regulation and distress tolerance. It was created to treat borderline personality disorder, but has proven useful for other conditions, too.

Expressive therapies

Expressive therapies are a group of therapies that use creative expression to promote healing. This might include using art making, music, dance, drama, writing and recreational activities. The focus is on the process on creation. It is often used in conjunction with psychotherapy, but can also be used as the primary treatment when appropriate.

Eclectic therapy

Eclectic therapists take elements of different theoretical orientations and put them together in an individualized way. This could, for instance, mean combining the structured techniques of CBT with a good look at existential concerns in order to address feminist issues. A large number of therapists identify themselves as eclectic, so feel free to ask which modalities are an influence.

What types of therapy have you tried? What did or didn’t you find helpful? Share your experience in the comments.

7 rights you have in therapy

  

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Because therapy can become so intimate, you might occasionally lose sight of the fact that it is also a business transaction. As the client, you have a set of rights. These also apply with psychiatrists and other doctors.

1. Right to know your therapist’s qualifications

You have the right to know that your therapist has been properly trained and is professionally competent. You can ask about his education, membership in professional organizations and standing with regards to his license. Any therapist who is hesitant to give you this information is worth investigating or dropping altogether. 

2. Right to know the limits of confidentiality

For the most part, you can tell your therapist anything. But by law and ethics, there are a few things she might have to disclose. At the beginning of therapy, you should be informed of these. It might be in your initial paperwork. If you are unsure about something, ask. You can also read the post about the limits of confidentiality.

3. Right to know diagnostic information

If you want to know any diagnostic impressions your therapist has, you can ask for that information. You are also entitled to an explanation of what your condition is and how it is treated. Don’t expect him to have this information at the end of the first session. An accurate diagnosis takes time. But as you move forward, you can check in on it.

4. Right to know your treatment plan

When treating a client, a therapist should think ahead and see where treatment is going. This is information you can ask for as well. There won’t always be a written plan, but your therapist should be able to tell you where she is going and what strategies she will be using to get there. Don’t expect a play-by-play, but you have a right to know the basics.

5. Right to have questions answered

While your therapist will probably be the one asking the most questions, you can ask for information, too. This can range from explanations of terms used to his reaction to something you said or did. When it comes to personal information, therapists have varying levels of comfort in disclosing. Respect that. But if your question is relevant to your treatment, ask away.

6. Right to be treated with respect

As intimate as therapy can get, you are also in a professional situation. You are paying for a service and that entitles you to a certain level of respect. Your therapist should not be rude, mock you, blow you off, be offensive or otherwise make you have an uncomfortable experience. While minor offenses should be worked out in sessions (read how here), a pattern of disrespect is grounds for termination. 

7. Right to have boundaries observed

Another part of therapy being a professional situation is that there are certain boundaries. Your therapist is not your friend. She should not be a business partner. And he should certainly never, ever be your lover. Your relationship should be confined to the therapy room and never be physical. Your therapist might be okay with occasional contact between sessions (email or phone calls), but that should only be about treatment.

What has been your experience in regards to client rights? Tell us your stories in the comments.

When you're upset with your therapist

When it comes down to it, the process of therapy is a relationship. It is being able to open up to someone and finding acceptance, care, empathy, hope and help. But like any other relationship, there can be times when things aren’t going so well. No relationship is perfect.

 

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That doesn’t mean that when you get upset, you should go and replace your therapist. You don’t just switch out family members or close friends. There are certainly circumstances in which changing practitioners is warranted, but you should always try to work things out with your current mental health provider. 

Part of why it’s important to work on repairing ruptures in your therapeutic relationship is because therapy is not entirely unique. You have probably had someone else similarly hurt you. You might have had someone react negatively to you in that particular way. But the great thing about therapy is that you have a chance to work through those problems. You have a captive audience, so to speak, where you can play out the difficulty to its full extent. This can give you incredible
                                                                                                                 insight into your other relationships.

But that doesn’t mean it isn’t hard when something upsetting happens with your therapist. Try hard to see what is actually going on. Was something she said offensive to you? Are you maybe working towards separate goals? Do you disagree with your current treatment plan? Was there a misunderstanding? You need to know what has gone wrong in order to fix it.

And if you want to know what it is, the only way you can find out for sure is through talking about it. Don’t be afraid to say something to your therapist. Some phrases you might try using include:

• “I feel like there is something off in our relationship and I want to work through it. What do you think about that?”
• “I’m not sure we’re heading in the same direction. Could you explain to me why you are choosing the interventions you are using?”
• “I’ve noticed that whenever I ______, you ______. Can you tell me why that is?”
• “It offended me when you said ______, which made me feel ______.”
• “I’m not sure if I/you understood what you/I meant when you/I said ______. How did you interpret that?”

The most important part is getting the conversation going. Therapists know to expect these ruptures. They are trained in how to deal with them. It happens all the time. You are just two people talking and that won’t always work out ideally. It can be a great learning experience. If handled properly, it can help both you and your therapist make progress.

It’s not easy, though, to negotiate when there’s been a breech. At one point my therapist used an intervention that ended up causing me some distress. This caused me to become hesitant to talk about the topic that lead to the intervention. We talked about why he did what he did and why it upset me. We then discussed how that situation could be handled should it arise again. It took me some time to be comfortable discussing that particular topic. I am still very careful about what I say when I talk about it. But we both have a better understanding of how to work with that issue now. I learned to trust him in a new way. He now knows more about what that topic means to me and can act accordingly. 

All in all, you can either look at ruptures in the therapeutic alliance as personal insults that causes resentment and mistrust or you can look at them as a genuine aspect of relationships being played out in the therapy room. I don’t think I have to tell you which is the most helpful when it comes to progressing in your healing. The skill of repairing ruptures is important to all relationships and therapy is an excellent venue to practice doing so.

Have you and your therapist ever not seen eye to eye? Tell us what you learned from it in the comments.

20 questions to ask a potential therapist

First sessions with therapists can be kind of like first dates or job interviews. You want to find someone who is a good fit for you, so you ask a lot of questions. Figuring out what to ask, however, might not be the easiest thing to do while you’re in the moment. Pick whichever of the following questions are the most important to you and bring a list to your fist session. It’s better to know sooner rather than later if your therapist is the right person for you to be working with.

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1. Are you currently licensed? (In the U.S., this can be verified by searching “license lookup [state]”.)

2. How long have you been practicing? 

3, What is your educational background? 

4. Are you affiliated with any professional organizations? 

5. How do you believe people change? 

6. Have you ever treated anyone with my symptoms? 

7. What did you do? 

8. Did it work? 

9. What did you learn from it?

10. Why are you working in this field? 

11. What do you consider your strengths as a therapist? 

12. What are some areas in which you would like to improve in your practice? 

13. What do you consider the most important factor for healing and improvement? 

14. What are your expectations of a client? 

15. If something comes up between sessions, what would the best thing for me to do? 

16. Have you ever had any disciplinary procedures? (In the U.S., this can be verified by searching “license lookup [state].”)

17. If yes, do you believe you were in the wrong? 

18. What have you done to rehabilitate from disciplinary procedures?

19. Would you be able to recommend additional resources (books, support groups, physicians, complimentary treatments, etc.)?

20. Do you believe you can help me?

Don’t be afraid to ask for any information relevant to your treatment. You have a right to ask questions. Any therapist unwilling to answer such questions should probably not be in practice.

What questions have you had about starting therapy? Let us know in the comments.

Concerns entering therapy, part 2 of 2

Part 1

As promised, here's the continuation of Thursday's post covering concerns you might have entering therapy.

Will you tell anyone what I tell you?

The short answer is no, not unless absolutely necessary. If you are a danger to yourself or other or disclose child or elder abuse, the therapist might have to step in. Additionally, he can disclose some information if given a court order, but he will only give the least amount of information necessary. The only other time is as a part of medical records, but those are confidential anyway. For a more thorough look at this subject, read this.

Will you understand me?

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We all long to be understood, but ultimately, we're the only ones who will understand ourselves. That doesn't mean that it's not worth trying to know someone. More or less by definition, a therapist is trying to understand you. She won't get everything, but she'll know what questions to ask to help get a better idea of what you're going through.

It can also be a good thing that your therapist doesn't understand you completely. If you were going off of your own insights and it worked, you wouldn't be seeking therapy in the first place. We go to get a different perspective. Your therapist will notice things about you that you never saw. Through a shared process, the two of you can work together to form a more complete picture of who you are.

Will you respect my values and worldview?

What you believe is a huge part of who you are. This means that it's going to come up as part of your therapy. But this is where it is especially important to find a therapist who is a good fit. When assessing a potential therapist, let him know what's important to you in life. Ask about any specific concerns you might have regarding your therapist's openness to your particular beliefs. Therapists are trained to work with clients of varying backgrounds without letting their own values interfere. Of course, everyone is human, but it's something therapists stay aware of and check in with themselves on.

If you don't feel comfortable with someone, it's going to impair your work together. But remember to be open. If you feel like your therapist is disrespecting your values and beliefs, say something. Having a therapist is a relationship. Relationships have ruptures sometimes. It is good to learn how to work through those in a healthy way and therapy is an excellent opportunity to do so. Research has consistently shown that therapeutic alliance is one of the biggest factors in accounting for change in therapy.


It can be overwhelming to start telling a stranger about the most intimate parts of your life. Remember that you don't have to dump everything out in the first session. Find someone you can trust and learn how to work with that person. If you are worried about something, it's always okay (and maybe even helpful) to ask.

What have been your concerns regarding going into therapy? How did you resolve them? Please share your story.

Concerns entering therapy, part 1 of 2

It’s normal to feel some anxiety about starting therapy. Whether you starting the process for the first time or switching clinicians, a lot of concerns can come up. You should not let this get in the way of seeking treatment, but you should not ignore it, either. It’s perfectly okay and valid to be apprehensive. Let’s take a look at some of the questions that might come up.

Will you believe me?

The people in our lives, as well-intentioned as they may be, don’t always respond positively and supportively to everything we tell them. That’s where therapy comes in. We go to talk about things we might not otherwise discuss. It’s a safe environment where you should not be afraid to bring up anything.

But doing your homework is certainly warranted. Look for someone who has experience with your particular concerns. If the therapist specializes in your area, you’re probably not going to tell him something he hasn’t already heard. Even if you do, he will have the background to understand what you are communicating. For instance, if you are having hallucinations, you might want to see someone who works with schizophrenia and psychosis.

This question is of particular concern to trauma survivors. Trauma touches on some of the most horrific and extreme aspects of human existence. Sadly, there are no limits to what is possible and, by extension, to what you might ask your therapist to believe. Know that sometimes, the trauma was planned out to deliberately be “unbelievable.” Some abusers set up situations that seem impossible in order to discredit victims should they say something in the future. So don’t be afraid to talk to someone just because your story is “out there.”

For more information about choosing the right therapist, visit here and here.

Will I be diagnosed as "crazy"?

"Crazy" is a societal concept, not a diagnosis. Everyone has a slightly different definition and there is no standard for craziness. Your therapist will not, however, call you crazy. Yes, you might be diagnosed with something. That's okay. With about one in four American adults struggling with a mental illness in any given year, you're not alone.

Some people are actually relieved that there is a name for what they are going through. It gives them something they can look to in order to better understand themselves and what they are going through. If you don't want to know what your diagnosis is, though, just say so to your therapist. Explain that you'd rather not be told what you have and that wish should be respected. As long as the therapist knows what is going on, she should be able to treat you just as effectively whether or not you know your diagnosis.

Will I be hospitalized?

There are very few circumstances in which you would be hospitalized. The standard is that you must be a danger to yourself or others. Examples include being suicidal, psychotic or delirious. But don't think that the thought of killing yourself or the presence of some hallucinations automatically get you committed. Hospitalization is taken very seriously and is a last resort. Other options, like staying with a family member or friend, are usually considered first.


I will post again on Sunday going over a few more concerns you might have. If there is anything you would like me to cover, please leave a comment.

Part 2

Can you keep a secret?

One of the reasons that people seek out professional counseling instead of just talking to people already in their lives is that the conversations are confidential. While some people find talking to strangers uncomfortable, others find it liberating to be able to disclose details of their lives without the knowledge and involvement of other parties.

While an ethical mental health professional can be trusted with sensitive information, it's important to know the limits. The nature of their work means that they will encounter sensitive information that occasionally must be acted upon. Each therapist should provide information on when confidentiality must be broken before treatment begins. If this is not done (or if it's been a while and you've forgotten), ask your therapist to give you a copy of her policies. 

In general, the exceptions apply in these four situations:

1. Danger to self or others

If you threaten to hurt yourself or another person, your therapist will have to evaluate what actions are appropriate to keep all parties safe. Factors such as the the presence of an exact plan, directness of the threat, severity and the ability to follow through with it are all taken into consideration.

Don't hold me to these, as this is not an exact science, but here are some examples:

Should not report: 

"I'm so mad at my husband that I wish he'd get hit by a bus." 

"I wish I had a gun so I could shoot myself."

"If I catch my wife cheating again, I'll kill them both." (Contingent on followup questions suggesting it's a sentiment, not a plan.)

Should report:

"I bought a bunch of pills and alcohol so that when I go to bed tonight, I'll never wake up."

"I carry a knife so that when I see him, I can stab him repeatedly."

"After this, I'm gonna head over to my uncle's house and take care of him for good."

A threat of harm to self can be responded to as needed in the situation, ranging from calling a friend to come over for the night to forced hospitalization. As far as threats to others, law enforcement will usually be contacted, although the potential victim(s) may as well. Past crimes aren't held to the same standard as imminent threats, with a couple of exceptions.

2. Child or elder abuse

Because children and elders are considered vulnerable populations, reporting abuse and neglect of these groups is an obligation by law. Some states require everyone to be mandated reporters while others limit the duty to both therapists and some other groups, which may include teachers, health care professionals and law enforcement. 

The appropriate course of action is that when there is a reasonable suspicion of abuse, a report is made. The reporter gives relevant information to another agency, which then decides what the appropriate course of action is. Information leading to a report does not necessarily have to come from the victim or even be a verbal confession. A child with cuts and bruises of different ages with no compelling explanation, a mother who mentions her boyfriend's mistreatment of her son and a teenager mentioning that her underaged friend is a victim of incest are all cases that will most likely be reported. An adult discussing abuse from his childhood, however, will probably not require further action unless, for instance, he has a younger brother who is in the same environment and is likely to be abused as well. A therapist is also not forced to report situations between adults, such as domestic violence in the home of a childless couple. 

The same standards will often transfer to elders and possibly disabled individuals. 

If you have questions about reporting abuse, receiving support or available services, call 1-800-4-A-CHILD (1-800-422-4453). This will not create an official report, but the people on the line can help you find out the next steps. If you are unsure about a situation, please call. It's not a commitment and it's okay to just ask a question.

3. Court order

Occasionally, mental health professionals are asked by the courts to provide information about their clients. This does not mean that any time someone is arrested, the therapist is called to confirm the offense. The principle of confidentiality is so important to therapy that mental health professionals will only reveal the least amount of information required of them and only when presented with official orders. There are also limitations on what can be asked of them, as it has to be relevant. In a murder trial, your therapist can be asked to confirm that you confessed to being at the crime scene, but probably won't answer about whether or not you're having an affair (unless it's directly related to the case). 

This exception rarely comes into play, but it has to be mentioned. The point of therapy is to help you get better, so that should take precedence over the possibility that some day five years from now your therapist will be called upon to answer if you smoked some weed. (She won't.)

4. Medical records

A limited amount of information is given to your insurance company in order to qualify you for treatment. This usually is a diagnostic code showing what you are receiving treatment for. It's not comprehensive and it doesn't involve details; it's just a way of indicating what you are receiving treatment for so that they can cover you. This is a current issue, though, and if this is a concern, learn more about what is required in your area and by your insurance company.

Outside of this, your information may be disclosed to other health care providers with your permission. This will require you signing forms and you get to specify what, exactly can and can't be released and for how long. This applies to the medical field in general, so if you want your wife to be able to get your test results for you when you aren't at home next week, ask for the paperwork!

The topic of mandatory reporting is not without controversy, but these are general descriptions of the current standards. Please don't be afraid of opening up because the information may get out. Breaking confidentiality unless it's absolutely necessary would ruin the whole point of the entire field, so it's an ethical (and legal) obligation that is taken very seriously. 

If confidentiality is a concern, talk to your mental health professional. He'll be able to give you more information on local laws and his own stance on these issues. 

Finding "the one," part 2 of 2

First of all, I feel the need to apologize for this post coming a lot later than it should have. I became seriously ill last week and that inhibited me from getting it done. I'm working to build up a backlog for future incidents of that sort, but haven't gotten there yet. Thanks for your patience. :)

When the practical issues of finding a therapist have been resolved, it's time to narrow your options down based on who you want to work with. Remember that whoever you choose will be an important figure in your life, even if only for a while, so don't close your eyes and point at a random name on a list. Following are some areas to pay attention to.

The first thing you'll probably notice is personality. Now, everyone deserves a fair chance, but not everyone is going to be your confidant. If there is a trait or quality that truly interferes with your ability to fully engage in the sessions, it's worth some consideration. On the other hand, for a while I saw a therapist that seemed – no, was – excessively eccentric. It turns out that he was also extremely empathetic (and entertaining). A complaint about personality should not always be an automatic elimination, but if it keeps being an issue and it's not
                                                                                                                   something that can be addressed and solved, it                                                                                                                            might be worth looking elsewhere.

While therapists purport to be specialists in certain issues or conditions, experience can be worth much more than certification. If you are an adult male with an eating disorder, you might be better off with a clinician who has dealt with a handful of clients in the same situation than with a specialist that has only worked with teen girls. During an initial consultation, ask what the concerns and conditions the therapist typically sees in her practice. Find out if she has experience with similar issues or populations. A child therapist might not be so great with end-of-life issues. Everything's case-by-case, but use good judgment.

Similarly, talk about what techniques are used. While hypnotherapy, thought modification and biofeedback can all successfully treat anxiety, you might have a preference for one. "Theoretical orientation," or the specific theory of personality and behavior a clinician subscribes to, might come up during this discussion. This deserves (and will get) its own post, but in short, be comfortable with how the therapist conceptualizes his field. A behaviorist believes that we become the way we are through our environment, punishment and reward, etc. while an existential therapist focuses more on the larger questions in human existence and how they impact the individual.

When it comes to choosing a therapist, however, the quality that trumps all others is trust. Treatment is more or less useless – maybe even harmful – if you don't trust your therapist. You might think you're coming in for something small and relatively unimportant ("I'm having a hard time sleeping"), but keep in mind that other unexpected issues might come up ("My spouse was killed in a car accident this weekend"). Would you feel comfortable with your therapist in more extreme circumstances? Alternately, are you confident that your therapist will take you seriously when you bring up something that might seem insignificant?

You are choosing someone that you can share every single aspect of your life with, as needed. Yes, trust does need to be earned, but if you just know it's not going to happen, trust that feeling. If not, you will be more likely to withhold important information or be less willing to follow any guidance you may receive.

Closely related to trust is rapport. You are entering a relationship of sorts and if you have a hard time communicating, it's the therapeutic equivalent of a highly inquisitive person dating someone that gives one-word answers. It's just not going to work. This doesn't mean that there has to be a constant conversation. Silence definitely has its place. I was told by one psychologist that he once had a client come in, cry on his couch for an hour without saying anything, then leave. He found out the next week that it actually helped. Find someone you feel comfortable around whether you're at your best or your worst. Trying to tailor yourself to your therapist (or trying to get him to be something he's not) defeats the whole purpose of why you are there.

It is essential that you feel comfortable with whatever practitioner you choose to work with. If you aren't, find someone else. You aren't getting married! It's okay to try someone else after one session or even ten years. If a therapeutic relationship fails and you still need help, don't be afraid to move on. If you are switching therapists on a monthly basis, however, the problem might be you. Be reasonable, but also go for what you need. You deserve respect as well as treatment that works for you, specifically.


Have you ever worked with a therapist where any of these issues were relevant? Share your story – good, bad or hilarious.

Finding "the one," part 1 of 2

One of the most intimidating aspects of mental health care can be actually finding a professional to work with. If there's insurance, then only certain practitioners will be accepted. If there's no insurance, there is the added task of finding someone within one's budget or who works on a sliding scale.

Following are two effective approaches to finding a mental health professional, although a combination of both is most likely to yield the best results. There are directories and there are recommendations.

DIRECTORIES

Short and simple: There's a list of people. Search for the ones nearby. Check specializations. Choose a few to look into further.

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Outside of phone book-like listings, there appear to be two major types of websites that have names and contact information for mental health professionals, maybe even with a profile that lists personal statements and/or specifics at what each practitioner is good at. There are ones affiliated with specific associations and there are others that exist as a catalog that one usually pays to be on.

In terms of professional organizations, these will not include every single counselor or social worker or anything else in an area. But it will list its members and being a part of a respected organization is a good sign, seeing as there are criteria that must be met and maintained, usually including continuing education. Because each specific sub-field has its own groups, it can be useful to look at several different sites to get a broader range of options.

An example would be the American Psychological Association (APA). This group might be the most respected professional organization in the field. (Well, there's also the American Psychiatric Association, who are also APA. For a reminder of how psychiatrists and psychologists are different, click here.) APA's psychologist locator allows the user to search by location, gender, specializations, cultural sensitivities and so on. This locator can be found here.

When it comes to non-professional listings, there is usually money involved. This limits the amount of results. I went to one of the larger sites and my only result when including every possible type of mental health professional or clinic in a 20 mile area gave me one option – and it only dealt with a very specific population. I don't live in an unpopulated area at all.

The best comprehensive search engine of this sort might actually be the one that Psychology Today runs, which can be found here. It has very specific search options and gives more results than anywhere else I have found. In addition to standard information like that APA have options for, they can also filter for specifications such as the type of treatment, which insurance companies are accepted and religious orientation. While originally a directory of therapists, it has now expanded to include psychiatrists, group therapy and treatment centers. The profiles are also very thorough, including personal statements, cost of treatment, education, years in practice, etc.

If an insurance company will be paying for at least part of the treatment, it is a wise idea to actually call them up and insist on a complete list of professionals they are willing to work with. Usually the information packets and such only list some of the options. Cross-reference this with other directories with more information in order to get a better feel for the person.

RECOMMENDATIONS

The other route to finding a mental health professional is through asking for recommendations. While, for instance, a therapist cannot see a husband and wife separately due to conflict of interest, there are many other ways to find suggestions. Ask family and friends and have them check with theirs. Someone always knows someone. If a certain type of treatment is necessary, such as substance abuse or eating disorders, it might be worth mentioning in order to weed out the ones who mostly see clients with mild to moderate depression or anxiety.

It can be hard to admit that one needs help, though. Community organizations, religious groups, schools and the like will often have specific people they tend to work with and refer to. This is a more anonymous way of finding a practitioner. There will, however, likely be a bias based on what group is giving the suggestion.


After getting a list of names, there are still a few more things to check. It is worth seeing if each practitioner or clinic has their own website, as this can give a better feel for the options. Online reviews and ratings, if available, can be very valuable, too. I have found the best way to get these is to enter the name (in quotation marks) and state into the search engine, then adding the word "reviews" or "ratings." This should bring up any available results and saves the time of sifting through each site individually.

Another important thing to verify is licensure. This information will be available through the state itself. Searching the phrase license verification and the name of the state should bring up an option with ending in .gov. Check that the individual is actually licensed to practice. There might also be other useful information, like whether or not disciplinary action has been taken against the practitioner and when licenses expire. If working with someone who is not licensed, you have no guarantees of anything. This is how "life coaching" came about, but that is a different story.

At this point, the list should probably be fairly short. Choosing who to work with from the finalists has its own process, which will be posted on Thursday.


How did you find your therapist or one for someone else? Please share any tips on how to locate mental health professionals.