Finding
a good therapist is like finding a good coach when you're learning to swim:
They will make sure you are comfortable, teach you different skills, and show
you how to analyze your strokes so you swim farther and more confidently. Just
like a coach, they will also push you to do better and pull you out of the
water if you are struggling.
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But
finding a good therapist can be challenging: From deciphering opaque insurance
policies to making dozens of calls only to be put on waitlists, the experience
is rarely smooth. Even after finding a therapist, many people wonder what the
process is like, how to gauge if it is working, and when to wrap up.
The
reality is therapy is challenging, internal and often intangible work. It looks
different for everybody. On one end of the spectrum it can help you deal with
the daily stressors of life no matter how small, or help you process past
traumas. On the other end, talk therapy can also be vital for some people with
severe mental illnesses.
Starting therapyStereotypes
abound when it comes to therapy, whether that's counselors guiding mafiosos
through their anxieties like Dr Melfi in "The Sopranos" or quippy
counselors on the British comedy-drama "Fleabag" giving clients ominous
feedback.
One
common misconception is that therapy is only necessary after tragic events: a
soldier returning from war or a person on the verge of suicide. Therapy does
not have to wait for a "big enough" crisis. Experts say it can help
almost anyone know themselves more deeply or simply be a place for venting
about the stressful things in life
Michael
Swann, a mental health counselor working through Talkspace, suggests that in
your first consult or session with your new therapist, you come with a list or
goals or problems, whether that is trouble sleeping due to racing thoughts or a
recent death in the family that you need help processing. Bringing goals can
make the process clearer.
"Those
are things that we can build off of," said Swann.
Also
communicate with your new therapist about what you do or do not like: Some
people prefer that their therapist mostly listen, while others seek out
therapists for specific advice or want homework assignments — journaling
prompts, for instance — to help them reflect.
Swann
also encourages new clients to keep an open mind, "understanding that
you're not going to solve everything in one take. It might take several
sessions to help find some sort of resolution or relief."
Schools of thoughtWhen
it comes to how to heal, there are dozens of styles of therapy out there. The
American Psychological Association characterizes them into five broad groups:
psychoanalysis and psychodynamic, behavioral, cognitive, humanistic and
integrative or holistic therapy.
"The
funny part about all the different types of therapy is that either one can kind
of work for anything," explains Tamera Gittens, a licensed mental health
counselor in Seattle.
Gittens,
like many therapists, uses a hybrid approach. It includes cognitive behavioral
therapy, which leans toward more practical, short-term sessions where a
therapist helps a client identify certain patterns in their thinking in order
to change their behavioral response.
For
example, if a client is anxious in social settings, a therapist may help them
identify their triggering event as well as the thoughts, emotions and behaviors
that follow. That may look like thoughts of negative self-worth ("Everyone
thinks I am weird and no one wants to be my friend"), the physical feeling
of breathlessness or sweaty palms during the experience, and how that affects
your behavior (avoiding large gatherings or meeting new people). The therapist
will then help you reconfigure your thoughts, feelings and behaviors so that
the trigger is more manageable.
Dialectical
behavioral therapy or DBT focuses more on emotional regulation and was created
at the University of Washington by psychologist Marsha Linehan in the late
1970s. Initially targeted for patients with borderline personality disorder who
were experiencing suicidality or self-harm, it is now used to treat people with
depression, addiction, and eating disorders among other illnesses.
An
oft-used DBT technique includes mindfulness-based emotional regulation using
the five senses. A person experiencing stress, for example, can employ the
technique of naming three colors they see, two things they hear, and one thing
they smell.
Psychodynamic
therapy (or what many know as Freudian talk therapy), on the other hand,
focuses on trying to dig deeper into the reasons behind a person's suffering or
stress over a longer term. The technique has since evolved and is linked to
many offshoots of modern therapy.
Finally,
if you are interested in going on medication, your primary care provider or a
licensed medical professional like a psychiatrist are the best choice. Most
social workers and counselors cannot prescribe though they can still give
insight into the effects and advantages and disadvantages of psychiatric drugs.
Getting deepRather
than focusing on which treatment style might work best for you, Dave Walker, a
psychologist in Kitsap County, suggests checking in on your response to the
therapist: "If you have an initial intuition that you feel a level of
comfort with a person and feel like you can trust them — that's a good kind of
litmus test for hanging in there and not worrying too much about
technique," he said.
If
you find that after a few sessions you're not getting the support you want, it
is also reasonable to look for a new therapist who better matches your needs.
It's also wise to decide if it's important for you to have counseling in person
or if you're comfortable with teletherapy, which can significantly change your
therapeutic relationship.
At
the end of the day, Walker said, it's really a gut feeling and asking yourself
"Do I feel like I could really confide in (this new therapist) and tell
them stuff, talk about deeper sides of myself?"
Depending
on your goals and how often you're going, therapy can last a couple of months
or several years. For people with more complex traumas or those who find
comfort in simply talking to someone, it can be a tool to manage symptoms or
serve as a mental health "tuneup" either weekly or biweekly.
Insurance requirements often force an eight- to 10-session maximum, but in
reality, there is no wrong or right amount of time.
Ultimately
Gittens' golden rule is: "Go as long as you are still reaping the benefits
of therapy."
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