When it comes to therapy experiences over the last four decades, I’ve had the good, the bad, the ugly, the surreal, the pointless, the helpful, and the enlightening.
I’m not going to give you a laundry list of all of the therapists I‘ve had, partly because I literally don’t even remember some (most) of their names. I’ve moved so many times in my adult life that the number is well over 20 at this point, in multiple locations across two countries.
The main thing to know about therapy is that it can be really helpful. It can also be a hot mess.
First, the bad news:
1) Most therapists don’t take insurance.
2) Those who do are usually booked up for months.
3) Therapy is often prohibitively expensive with OR without insurance.
And here is the good news:
- Telehealth has revolutionized therapy for many people. Once you no longer have to actually be in person to meet with a therapist, a huge obstacle (travel) is overcome in terms of access and availability.
2) Furthermore, it appears that mental health community professionals are embracing this as much as the patients they serve.
3) I thus both hope and predict that this will lead to cheaper and more easily available therapy for all of us.
Most Important Advice
So this first piece of advice is critical. As I wrote about in the P is for Psych section, there are many different kinds of therapists, and you should find one with verifiable credentials. ALWAYS.
I got in way over my head in my early 20s with an unverified woman who was a con artist disguised as a therapist, and I had PTSD for over 20 years as a result of leaving her “fold”. I don’t have enough time to tell you that story. The takeaway is simple: check credentials, and if it’s too weird to be true, get the hell out of there.
Types of Therapy
There are many kinds of therapy from which to choose:
1. Psychotherapy, or “talk therapy,” is one of the most common. This is usually a pretty unstructured give-and-take between client and therapist. It might focus on the client’s past, present, or even future. One might delve into childhood issues or trauma, relationships with family, romantic difficulties, negative thinking, low self-esteem, social anxiety, coping skills, and making positive plans for the future.
2. DBT is Dialectical Behavioral Therapy. Originally designed for folks with Borderline Personality Disorder, this is often used in group settings in mental health hospitals for many mood disorders, or individually with a therapist. There are some good strategies to remind you to regulate yourself, and it employs loads and loads of acronyms. I found learning them exhausting, and not as useful as CBT, which I’ll get to soon.
DBT is based on four strands of skills:
-Distress Tolerance (handling yourself better when you’re upset)
-Emotion Regulation (keeping calm in the face of obstacles)
-Interpersonal Effectiveness (communicating clearly and effectively with others)
-Core Mindfulness Skills (having self-awareness about how you are behaving and how to solve problems)
A DBT strategy, known as DEAR MAN, is used when trying to achieve clear communication and positive social interactions:
DEAR MAN
Describe
Express
Assert
Reinforce
In the DEAR MAN methodology, you’re given a plan, and you’re meant to go through each step, with or without the help of a mental health practitioner, to get your coping and communication skills stronger.
3. Cognitive Behavioral Therapy, or CBT, is a really effective and versatile form of therapy that addresses a wide range of challenges. It is based on reframing and retraining your mind to healthier adaptive behaviors. It can be used to help challenge distorted thoughts and beliefs, and activate more engagement in healthier behaviors. It’s about using your brain to train yourself to make positive choices and pay attention to the thoughts that work for, and not against, you.
CBT is often used in the treatment of OCD. One of its components, Exposure Response Prevention, helps a person gradually and safely face their anxieties. It really works. And it can be used for other mood disorders, too, such as depression. It’s all about thinking about your thinking, and challenging your thoughts. It’s very meta. (But not The -website-formerly-known-as-Facebook Meta. No. Check, please.)
4. There’s also ACT, aka Acceptance Commitment Therapy, about which I know very little. Yet another acronym, it pretty much explains itself: Deal with reality, work with it, not against it. I can’t tell you any more than that, as I’ve never done it, but some people really love it. You can find out more online. Just remember to get your information from a credible research institution, or a book or article written by a credentialed mental health professional.
Selecting a Therapist
In my experience, having a bad therapy situation is worse than nothing in most cases, in my humble opinion. For example, consider someone who might be at risk of doing self-harm. In that situation, you must just tell your therapist you’re in danger of hurting yourself or others, and get to the closest emergency room. Then, forget about your therapist for the time being. Never pass off emergency care if you need it. Good or bad therapist, just GET SAFE FIRST. Then, use the resources at the hospital for your next move regarding therapy going forward. Some therapists may help you save your life. YOU also have to save it. You can.
I’ve had six different therapists since I moved to the area six years ago, and not one has clicked with me. There was one who was good, but she left the practice. She didn’t address my bipolar or OCD that much, but she did point out to me areas where I could challenge my distorted thoughts and beliefs, and that was helpful. I suppose you could say that the number of therapists I’ve had in a relatively short time is also a reflection on me. But two more out of the six quit working with my insurance. So that’s half of them right there.
I had one therapist who seemed pissed off at me all the time because I was coming once every two weeks and she wanted me to come every week. I distinctly got the vibe that she was irritated that she had to catch up with me and that I wasn’t devoted to her. Mmm bye.
Another was a young and well-intentioned person, who was not ready for my flavorS of mental illness. She didn’t know much about either of my disorders. She made me sit in the room with her and stare at a candle. I got out of there pretty quick. I could do that at home. No co-pay.
Another stared at me and would not reach out across the gaping maw of silence between us. She literally wouldn’t speak. Again, I could do that at home in my bathroom mirror.
Another pushed me into an uncomfortable situation I wasn’t ready for, and made things worse for me on all levels. She mainly talked about her pets, and how I was exhibiting bipolar symptoms (duh). She was the most unhelpful and the most arrogant.
The last therapist I had was basically a friendly young woman who only asked me, “Why do you think that is?” about five million times. Then she had a baby, went into private practice, and dropped my insurance.
The good news is I think I may have found a good fit for me. It’s within a psychologist’s practice, and he supervises new therapists, who run support groups online in various categories: anxiety, body image issues, depression, OCD. And, naturally, it is out of network, which means it’s expensive. But it’s worth a try, and I’m lucky I have the resources to use it.
And I think it’s going to be worth it, because after I did my intake (assessment) with the therapist two weeks ago, I felt a huge weight fall off my shoulders. The kind therapist asked relevant questions, paid very close attention to what I said, answered questions, and LISTENED. Sweet Georgia Brown, I don’t remember the last time a therapist really and truly listened to me.
What a relief.
So here are your criteria for a good therapist. An effective and good therapist will:
- Be trained by a reputable educational institution
- Listen to AND hear you
- Ask you helpful questions
- Answer your questions
- Have knowledge about your mental health situation
- Share appropriate resources for your continued mental health
A good and effective therapist should NEVER:
- Yell at you
- Touch you
- Be defensive (that’s a red flag — netrality is KEY for therapists to maintain)
- Ask you to share something you’re not ready to share
- Form a friendship with you
- Do “experimental treatment” or anything you’ve never heard of before unless you check it out or ask for the rationale behind it
And if your therapist asks you to talk to an empty chair as if it is you as a child, your parent, or someone who has wronged you, you have my full permission to walk out of the room then and there. I’m sorry, but I had to do that once and it was, in a word, dumb. I’m not a fan of the whole talk-to-the-chair shtick. If it works for you, have at it. Everyone has different needs in therapy. And everyone needs different strategies to support their mental health.
Finding the right fit with a therapist can be arduous and challenging and exhausting. Just keep trying different options, whatever you can, that is, until you find the optimal one. It may take awhile. It’s also great to buy some workbooks if you’re interested in specific types of therapy but you’re on a long waiting list to see a practitioner. There are tons of workbooks and informational books about ACT, CBT, DBT, and more. You can at least get an idea of what you think might benefit you in the course of therapy, and what kind you might like to pursue.
Well. I hope I haven’t discouraged you too much. Good therapy is hard to find, but it does exist.
And in the meantime, as you search, do the following to take care of yourself, because these things ARE therapeutic (and free)
- Eat well
- Sleep well
- Socialize
- Exercise
- Take your meds
- Watch something funny on a streaming service
- Hug your friends and family
- Get a pet if you don’t have one already
- Write in a journal that nobody ever, ever has to read
- Difficult but important: Be kind and compassionate to yourself. It is not your fault that you have a mental illness, and, of course, remember: You are NOT your illness.
And to the therapist who made me talk to my younger self in my chair? I did learn something from him, just not related to the chair gig. He said to always do something productive and something for pleasure every day. And that has served me well.
But you don’t have to talk to your furniture.
