Blogshop Collaborations: Choosing a Therapist

Welcome to the Blogshop! Brain Health Workshops on the Blog.

Dr. Jennifer Akullian, written by Cassie Cohen with collaborations from Dr. Elizabeth George

Jennifer Akullian

There are countless reasons why you have made the decision to begin exploring or returning to therapy. There are a myriad of reasons why things in your life might be more challenging than they need to be. According to the National Institute of Mental Health, brain conditions like depression, anxiety, bipolar, etc. occur in 1 of every 4 in the U.S., and the net of individuals who feel overwhelmed and even debilitated by stress, traumatic events, loss, etc. is even wider.

So you’re looking for a therapist. Three things to remember.

1. You’re not alone.

2. You are your own best advocate. Ask questions. Be brave.

3. Therapy takes time, but can be extraordinarily effective.

Let’s Start with the BASICS: So what is psychotherapy, anyway?

• Psychotherapy is a collaborative treatment based on the relationship between an individual and a therapist. Grounded in dialogue, it provides a supportive environment that allows you to talk openly with someone who is objective, neutral and nonjudgmental.
• You and your therapist will work together to identify and change the thought and behavior patterns that are keeping you from feeling your best, or figure out why you’re having trouble changing these behaviors on your own.
• The goal is that by the time you’re done you have addressed the reasons that brought you to therapy as well as learned new skills so you can better cope with whatever challenges arise in the future.
• In psychotherapy, therapists apply scientifically-validated treatments and procedures to help people develop healthier, more effective habits. There are several approaches to psychotherapy — including cognitive-behavioral, interpersonal and other kinds of talk therapy, and somatic therapies (i.e. EMDR, brain spotting, somatic experiencing, etc.) — that help individuals work through their problems.
• Not all therapists provide scientifically-validated treatments, it’s important to ask what treatments a therapist will provide. Specifically for bipolar, the research has shown that validated treatments with specializations in the disorder are more effective than general ones.

On to the WHO: Why should I consider choosing a psychologist (vs. other designations) for psychotherapy?

• Psychologists who specialize in psychotherapy and other forms of psychological treatment are highly trained professionals with expertise in mental (brain) health assessment, diagnosis and treatment, and behavior change.
• After graduating from a four-year undergraduate college or university, psychologists spend an average of seven years in graduate education and training to earn a doctoral degree. That degree may be a PhD, PsyD or EdD.
• It is this combination of doctoral-level training and clinical internship that distinguishes psychologists from many other mental health care providers, who’s designations are listed below.

Different designations of therapists (i.e., mysterious acronyms explained):

• MSW (masters in social work)
• LCSW (licensed clinical social worker)
• MFT (marriage and family therapist)
• LMFT (licensed marriage and family therapist)
• MA (masters in art)
• MS (masters in science)

On to the WHAT: What is a theoretical orientation? And how does that change my experience in therapy?

-Each theoretical perspective acts as a roadmap to help the therapist understand their clients and their problems and develop solutions.

-The kind of treatment you receive will depend on a variety of factors: current psychological research, your therapist’s theoretical orientation of training and what works best for your situation (e.g. your diagnosis, why you are seeking therapy, and your past history).

-There are many different approaches to psychotherapy. Therapists generally draw on one or a combination of these.

• CBT: Your therapist’s theoretical perspective will affect what goes on in his or her office. Therapists who use cognitive-behavioral therapy, for example, have a practical approach to treatment. Your therapist might ask you to tackle certain tasks designed to help you develop more effective coping skills. This approach often involves homework assignments. Your therapist might ask you to gather more information, such as logging your reactions to a particular situation as they occur. You might be practicing new skills between sessions.
• Psychoanalytic/humanistic: In contrast, psychoanalytic and humanistic approaches typically focus more on talking than doing. You might spend your sessions discussing your early experiences to help you and your therapist better understand the root causes of your current problems. While the psychoanalytic/humanistic approach is effective with some, it is less scientifically-validated than other therapeutic practices.
• Interpersonal Psychotherapy: This therapy is focused on improved interpersonal functioning and increased social supports. For bipolar specifically, this therapy can be integrated with a social rhythm therapy (called interpersonal social rhythm therapy) to help build routines and social relationships that will best support symptom reduction.
• Mindfulness Based Psychotherapy: Mindfulness based psychotherapy includes therapies such as (MBCT) Mindfulness Based Cognitive Therapy, Acceptance & Commitment Therapy (ACT), etc. and employs techniques of mindfulness along with traditional therapy techniques.

On to the HOW: What should I be sure to consider?

1. Will you be using insurance or paying out of pocket? Some mental health providers accept insurance, some do not.
2. How far are you willing to drive?
3. Are you looking for online therapy? Engaging in online therapy, typically referred to as telehealth, teletherapy or telepsychology, can be an inexpensive and convenient tool. It’s important to remember, however, that the research in this field is far less robust than that for in person therapy. Learn more here: http://www.apa.org/helpcenter/online-therapy.aspx

Tools:

This Online Resource may be a useful shortcut: https://therapists.psychologytoday.com/rms

1. Enter zip code
2. Choose insurance provider
3. Choose theoretical orientation
4. Choose male/female
5. Choose any other domains (e.g., online)

Running into waitlists, providers not accepting new patients, or geographical barriers? These resources can provide help in the meantime, most of them for free.

https://greatist.com/grow/resources-when-you-can-not-afford-therapy

This is my first time in therapy: What should I expect during the first few sessions?

To make the most of your time, make a list of the points you want to cover in your first session and what you want to work on in psychotherapy. Be prepared to share information about what’s bringing you to therapy. Even a vague idea of what you want to accomplish can help you and your therapist proceed efficiently and effectively. This will help you know if this person can be helpful with the issues you want to work on.

What to expect:

Paperwork & Logistics

• Your therapist may ask you to come in a little early to fill out paperwork if you haven’t already done so. This should include a mandatory disclosure about your rights as a client — if this form isn’t part of the paperwork that might be a red flag.
• He or she may also go over logistical matters, such as fees, how to make or cancel an appointment, and confidentiality, if he or she hasn’t already done so by phone.

Taking time to build a rapport

• Don’t worry that you won’t know what to do once the session actually begins. It’s normal to feel a little anxious and uncomfortable in the first few sessions. Therapists have experience setting the tone and getting things started. They are trained to guide each session in effective ways to help you get closer to your goals. In fact, the first session might seem like a game of 20 questions.
• It’s important not to rush this process, which may take more than one session. While guiding you through the process, your therapist will let you set the pace when it comes to telling your story. As you gain trust in your therapist and the process, you may be willing to share things you didn’t feel comfortable answering at first.

Easy and not-so-easy questions

• Then the therapist may ask a question like, “What brought you here today?” or “What made you decide to come in now rather than a month or a year ago?” It helps to identify your problem, even if you’re not sure why you have it or how to handle it. For example, you might feel angry or sad without knowing what’s causing your feelings or how to stop feeling that way. If the problem is too painful to talk about, the therapist shouldn’t push you to say more than you’re comfortable sharing until you get to know each other better. It’s OK for you to say that you are not ready to talk about something just yet.
• Your therapist will also want to know about your own and your family’s history of psychological problems such as depression, anxiety or similar issues. You’ll also explore how your problem is affecting your everyday life. Your therapist will ask questions like whether you’ve noticed any changes in your sleeping habits, appetite or other behaviors. A therapist will also want to know what kind of social support you have, so he or she will also ask about your family, friends and coworkers.

A plan for moving forward

• Once your therapist has a full history, the two of you will work together to create a treatment plan. This collaborative goal-setting is important, because both of you need to be invested in achieving your goals. Your therapist may write down the goals and read them back to you, so you’re both clear about what you’ll be working on. Some therapists even create a treatment contract that lays out the purpose of treatment, its expected duration and goals, with both the individual’s and therapist’s responsibilities outlined.
• It is ok to ask your therapist about your treatment plan. And we encourage you to do so.

How do I know it’s the right fit?

1. You feel accepted and understood, not judged or criticized.
2. You feel comfortable in sessions (sharing personal thoughts might feel super uncomfortable for the first 3–4 sessions, but this should get more natural overtime).
3. You “click.” Liking your therapist does matter, and while developing this trust and mutual respect takes some time, if your gut reaction is negative that’s an important red flag.
4. You’ll begin to see progress!

To conclude, it’s most important to remember that efforts to support your brain health are often an ongoing process. Try not to feel frustrated if you feel like you move backwards every now and again; be kind to yourself and respect the greater process. Go forth and be well!

Cassie Cohen writes for Open Labs — changing the future of neurodiversity. Reach out to her at cassie@sigmend.com

Citations

American Psychological Association. (2017). Understanding psychotherapy and how it works. Retrieved from http://www.apa.org/helpcenter/understanding-psychotherapy.aspx