How do you know if you should see a therapist?
It is different for everyone. I think, honestly, everyone should go to therapy at some point in their lives. It's a way to have someone who can support you and validate you and provide help – even if you just have a small thing going on. Normally, people will seek therapy if they're struggling with a mental health diagnosis, but you don't need a mental health diagnosis to go to therapy.
You can go to therapy if you're feeling stressed, if you're having trouble navigating the ongoing uncertainty of the pandemic, or even if you're having relationship issues. So there's not one specific thing, but I think a lot of people think you have to be really, really struggling to go. And, honestly, you should go. The time is now, right?
What are the first steps that you should take when searching for a therapist? What questions should you make sure to ask?
Start by asking yourself:
What are my goals for therapy?
What do I want to focus on in therapy?
What modality of therapy am I interested in?
Do I want to do talk therapy and just go to therapy to have someone listen to me and validate?
Do I want someone who's going to be more directive?
Do I want to go to therapy to learn coping skills?
Do I want to address trauma?
Do I want someone who does in-person sessions, or telehealth or a mix?
Does this therapist specialize in what I'm looking for help with?
Do I want them to respond and provide solutions or skills?
What are things that might come up that I might be willing to talk about and some things that I might not be willing to talk about? Do I feel comfortable setting a boundary?
How available do I want my therapist to be while also respecting that they have a life? Do I want a coach who I can regularly contact and have coach me through difficult emotions? Or do I want a therapist who may respond to an email I send within a day or two?
What are the different types of therapy and what do they mean?
I'll start with the ones that are my favorites and that I specialize in. My two favorites are ACT and ERP.
Acceptance and commitment therapy (ACT) comes out of cognitive behavioral therapy (CBT), except instead of trying to reframe or label your thoughts as irrational, like in CBT, ACT is about accepting your thoughts as just that – they're just thoughts – and taking action toward our values, the things that we find are important in our lives. So, instead of trying to push distress and discomfort away, ACT works on acknowledging it and choosing to live your life in spite of the distress and discomfort, using your values.
Exposure response prevention (ERP) is used with anxiety and obsessive-compulsive disorder, amongst other things, and it's about increasing your distress tolerance and increasing your tolerance to sit with uncertainty and work through some of the things you might be avoiding.
Dialectal behavior therapy (DBT) is a therapy that everyone should have some sort of introduction to at some point, because it teaches very basic life skills in more of a structured way. It has four different modules: mindfulness, emotional regulation, distress tolerance and interpersonal effectiveness. It focuses on having you learn how to sit with discomfort, regulate your emotions and work on your personal relationships.
Eye movement desensitization and reprocessing (EMDR) and internal family systems (IFS) are both therapies that focus more on trauma work. Internal family systems can be really interesting and really powerful. It works off the basis of we're made up of different parts and working with those parts that make up our internal system.
How do you know if a therapist is a good fit? Is it appropriate to find a new therapist if they aren’t a good fit?
I think knowing, of course, that therapy can be a really uncomfortable thing, especially if you grew up in a family or a culture where there's a lot of stigma around mental health and seeking help. I typically recommend that people give their therapist three to six sessions.
And if, after those sessions, you just are not feeling like you're clicking, you're feeling uncomfortable, you're feeling judged, or you feel like they don't have the specialty that you're looking for, then you can look for another therapist. But typically, I like to tell people to give it a little wiggle room, because therapy's uncomfortable in general for a lot of people, and you want to kind of move through those growing pains.
Other things to see if it's a good fit is if this person wants what's best for you. And they also meet you where you're at. So they're not trying to impose their goals and what they want onto you. They hold you accountable. They’re not going to actively let you harm yourself. Other things to look for: You feel validated; they actively listen to you; they're a good communicator; they challenge you respectfully.
One really important thing is the therapist provides support and empathy and validation and problem solving while also not curing you or fixing you – because that's on you as a client. So they give you the tools to do the work yourself.
So therapy won’t automatically “fix” you?
It won’t. And that's a hard thing in therapy, thinking ‘This isn't working; I'm not cured.’ It has to be within the person to help themselves. Other things to look for in a good fit are: the therapist isn't trying to rush your treatment or you don't feel like they're just trying to get you out the door; they set realistic expectations; they're respectful of your identity; you're comfortable, while knowing that there's general anxiety and fear going into such a vulnerable thing, but over time, you're starting to feel comfortable and trust is being built.
You also want a therapist who has appropriate boundaries that are flexible. They're not rigid where the person is completely closed off, but there are actually boundaries. Another thing is you want someone who treats you like an equal, like a human being. So therapists might have the knowledge, but they don't act as though they're above you.
I think looking for a therapist is sort of like dating, right? First impressions aren't always spot on. It's always going to be awkward meeting someone. But, again, make sure to respect if your gut is telling you to run away.