How To Go To Therapy

Why we need to break the stigma, and how to go to therapy for the first time if you’ve never been before.

How I started going to therapy

When I was in college, I had a great professor — who ended up teaching several of my psychology courses — talk to me more seriously about depression and realism. He and I were chatting in his office, and one day I mentioned to him that I wasn’t sure if I carried depression around with me, or just a slightly starker way of looking at the world. I didn’t know how to deal with my sadness, and I didn’t know if the amount I felt was normal. How do you know whether or not your mind is working? How does anyone know—can you ever really tell what your mind “should” be doing, when it’s impossible to compare it outside of your own experience?

I told him it felt like I had more access to the pain and sorrow of the world, and I wasn’t sure how to carry it. Also, that I cried a lot, and I never quite felt happy. Not that it was bad, per se. Just… flat. Sometimes it felt like something was off; I couldn’t tap into the ranges above zero, for some reason.

I struggled a lot with sadness and despair in my teenage and college years, for reasons I won’t go into today—being a teenager in today’s world is often hard, being a person is hard, becoming a woman can be a lot. I felt alone more than not. And, if you suffer any sort of trauma or bullying or ways you feel like you don’t fit in or identify, life can feel painful at best. It was one of the reasons I was drawn, at seventeen, to the study of the mind. As a result, I majored in Psychology because I wanted to learn more about how humans work. How I worked.

And, when I was in college, I started going to therapy.

I’ve now been in therapy on and off for over a decade, and I am so grateful I made it through some of the hardest times of my teenage years and my twenties. There have been too many times when life threw a wrench in my way and I felt like I couldn’t breathe, move, or carry on. Therapy has helped.

But more than during the times when things have been “wrong” in my life, I’ve learned how essential therapy has been for my stability and well-being in the long term.

In my partnership today, both my husband and I go to therapy every week, separately, as part of our long-term self maintenance and care. There wasn’t a trigger or a moment when we thought anything was broken or wrong; we went because we wanted to improve our baseline state of being, better understand ourselves, and—most importantly—set a stable foundation for the future.

Looking at all that we wanted to do together, which included being married and in a partnership together, creating and raising new human beings, and weathering life’s storms, we realized that having people to support us and help us through it all was going to be critical. Rather than wait until crisis mode five years into it (when many marriages fall apart under the stress of life and work and children), we wanted to see if we could sign up for some ongoing preventative care. Like… mental maintenance. Or at least a place to vent about each other if we needed it.

But even more importantly, therapy, like yoga-teacher training, or learning to navigate the open oceans, or starting my own company—these have been things that have changed my life. I’m a better person because of it. Because of therapy. In fact, I’m really happy. And for that, I’m beyond grateful, and I want to pay it forward however I can.

Why I’m writing this post

Today I want to write about how therapy has affected my life, but more importantly, I’d like to write about therapy in a way that potentially helps anyone reading this post figure out how to do it, what to know when you go, and if therapy (or one particular therapist) is something you think you might benefit from.

To be fair, I have a clear point of view on this: I think that every human being on the planet should go to therapy, because it can only help us. Learning more about how we work, why we do what we do, and how our brains operate is a gift we can give ourselves for the rest of our lives. I believe in it so strongly that it’s one of my life philosophies: Make yourself the best place you can to be.

In our lives, we carry ourselves, and I’d like to do everything I can to make this life as wonderful as possible. As such, I invest in my mind, my soul, and my body as much as I do in my work.

My goals with this post are to:

1. Continue to destigmatize the idea of going to therapy in any way I can, even if that’s just sharing my own experience.
2. Give people who have never thought about it reasons why it might help or how it could benefit them.
3. Share practical steps for how to get over the hurdle of starting if you have crossed into “okay this could help, now what do I do about finding a therapist?”

Additionally, with the recent high-profile suicides, and given my history in the startup world with founder suicides, and with the anger and desperation afflicting huge parts of our population, I wanted to write this all down in the off chance that one person would see it and use it and think, “Hmm, maybe I should try this.”

Who needs it?

Everyone. I say this without cheekiness or sarcasm. I truly believe every person can benefit from having a specialist look into their minds and help them unpack what’s there. The benefits of therapy help across multiple levels: first, in talking and learning how to express yourself, second, in having the therapist (or you) see patterns across time, and third, in creating longevity in the relationship with your therapist, which itself can provide value.

Why is there a stigma associated with it?

I think going to therapy is such a gift and a privilege—and I’ve gone for so long—that I forget the stigma associated with it. The stigma usually comes around “having something wrong with you,” or the pride of not wanting to get help, or being seen as weak around your family or friends. Oftentimes this stigma is more pronounced for men, who have been harmed by the current cultural norms of what “masculinity” should look like.

There can also be big cultural stigmas associated with it. A friend of mine messaged me privately and shared, "For the most part Indian people are taught that therapy is for crazy people and I’m guessing I’m not alone. How would you address this?”

I’m at a loss for how to address these wide-spread cultural and social stigmas. In particular, the ones that shame men—people who more than ever need someone to talk to, close friends, and a way to navigate out of the deep binds that depression and isolation can put people into.This is not a small problem: we are seeing a rise in deaths by despair—suicide and overdose—across America, often in men. We also have huge levels of violence by men, and in my mind, epidemics of both loneliness and exhaustion. It will take incredible work to help unwind this. Therapy will not solve this, but it is something we can start with on an individual level.

Addressing the stigma—this is what therapy can do for you:

Being strong does not mean that you don’t get help. Being strong means that you are willing to face the fear and dig deep into your own soul.

• If your current life isn’t working, why not shrug and throw a whole bunch of new ideas at it? There’s no harm in trying therapy. You might as well give it a shot (but give it at least ten sessions minimum, because it doesn’t work in an instant—more on that, below).
• Look at who you admire. Look at who you don’t want to be like. Which ones are willing to take the risks and try something new? What are the patterns?
• It’s the best brain hack there is. For my super-smart productivity friends: we prioritize productivity hacks and efficiency tools and clap for those who are intelligent. What better “hack” to your own intelligence than taking a look at how your brain is wired, and how to upgrade it? (Seriously!)
• Therapy is not about fixing something that’s wrong. It’s about understanding what currently is. Having data around how we’re wired, what our behavior is, and how our default operating systems are set up makes us stronger, wiser, and more capable.
• The best consultant you can hire. I know so many people that hire consultants at huge prices and then scoff when a therapist is $150-$250 an hour. The only difference is the subject matter: your mind.
• Therapy is like building mental resilience. It’s one of many tools you use to take care of your life. As one of my friends shared, "I think of therapy like mental health insurance. I also have to explain the idea of investment to some of my loved ones who expect that it might create immediate results (for me, or for them). It’s self-knowledge work that compounds over time.”
• There are many ways to be intelligent, and many ways to grow. We have so many tools in this culture for success and growth, but we’re limited in our understanding of them as “book smart” or “financially wealthy.” Richness comes in many forms. More of them include your emotional wellbeing, your connectivity to others, your understanding of self.
• What better investment to make than in your own self? You have to walk around with yourself for the rest of your life.

Why not make yourself the best place you can to be?

When to start?

Oftentimes we wait for something to go wrong before we think to address it. A broken arm, an error message on a laptop screen. Most of our medical system is currently set up to mitigate against things that have already gone wrong, versus investing in preventative care for the long-term, although that is slowly (slowly!) starting to change with insurance covering preventative care costs and annual screenings. But this is mostly for the physical body, not the mental body.

You can start therapy in the middle of a crisis—I highly recommend going, especially if something is wrong. For many of my close friends, I’ve seen them finally go when shit hit the fan. That works.

You can also go before you feel ready. You don’t need to be 400 pounds overweight to start going to the gym. You can start going to the (mental) gym as soon as you’d like, to better understand yourself.

Life is hard in many ways. Big life transitions like moving across the country, getting married, having children, switching jobs, breakups are all reasons to go. Start before you feel ready. Life is hard enough in many ways — you don’t have to be completely underwater or feel broken to benefit from it.

My two cents: start before you feel ready.

How to find a therapist + what to look for

This is the tricky part. Finding a therapist can be a big research project, and quite a pain. This is another reason I’d say start before you feel ready—you want someone in your corner who knows you so that if big things end up happening, you already have someone in place to talk to. Having a therapist is important, but having ‘the right therapist’ is key.

Here’s what I do to search:

1 — The Research Project: Searching For Therapists.

I do a few different types of searches; local based on reviews, through friend networks I trust (aka referrals), and then through whatever my insurance provider has, if they'll offer it. Psychology.com has some OK places to start, and ZocDoc.com can be okay if you think of them as "casting the net" and doing the first round of searching.

2 — What To Look For.

Every therapist has a different area of expertise and specialty. You’ll often see them listed (like Addiction, Teenagers, End of Life, Substance Abuse, Sexuality, Identity, Anxiety, Depression). Each therapist will have a different set of skills. Pick ones that match you.

I like to find someone that’s my gender, typically, and has experience dealing with the type of issues I’m bringing to the table.

Don’t know what issues you have? Start with what’s stressing you in your life plus how you identify (aka, “I’m a male founder with a lot of business pressure, and I’d like someone to help ease my anxiety and stress”). You can always meet for a consultation with a therapist and then ask them for their recommendations for someone that would be a good match for you. You don’t have to go with the first therapist you find.

3 — Call Around (And Around)

Plan to make at least a dozen calls to different offices. Then, yes, more calling: and asking the therapists for referrals, too.

I try to approach it like a research project. Set aside time to matter-of-factly make a lot of calls. About 25% of your calls will go through, and a lot of therapists are so over-booked that they won’t be able to respond quickly. Is this great? No. Does it frustrate me? Of course. I want people to get help right when they need it. But I find knowing this in advance helps—so plan to make a ton of calls and don’t get hung up on the first one you find.

Now it’s really hard on the individual who might need help to have to do this in a moment of crisis, so I've personally done this research phase for a number of family members and friends. If you have it and it’s available to you, ask for help from a friend. (Or volunteer to help a friend.)

4—What to Say When You Call

When you call, tell them who you are, even if you don’t know exactly what’s wrong.

"I'm looking for a therapist that works with {AGE} + {SUBJECTS} that has availability. I'm based in {LOCATION}, and I have {INSURANCE}." (The caps are for you to add in your own stuff, like "I'm 35 and a working mom who has had several miscarriages and I'm looking for someone that works with females with anxiety/depression and going through major life transitions."

Or other topics: Sexuality, Grief, Identity, — include a broad-spectrum of what you *think* might be the issue. Each therapists should have a list of what they specialize in (addiction, teenagers, etc, etc) and what their credentials are.

If you don’t know ‘what’s wrong’ or where to begin, begin with telling them who you are and a little bit about your life.

5—Next Steps

When you get someone on the phone, they’ll do business first, like insurance + pricing + availability, and then they’ll ask you to make an intake appointment. Often the intake appointment is a phone call, but some therapists will be in-person. (They’ll screen via phone first to make sure you’re matched well.) Ask their rates.

In the first appointment, bring a list of all the things you want to talk about. Give them an overview of who you are and what you think you might need help with. (It’s okay not to know, too.) Ask them questions: how long they’ve done this, what you can expect, how they like to work together, what their training is. Tell them if you’ve never done therapy before, and ask them to explain how it works and what they’d like you to do.

6—Insurance and Payment

This is a dicey one, because the people who need therapy the most are often those who are under- or uninsured. Check your insurance plan to see what they cover. Often some plans have a co-pay for mental health services now, because of the Affordable Care Act, and others will cover a certain number of sessions (like 5, 10 to 20 per year).

Sometimes folks don’t go because insurance doesn’t cover it. Do the math to figure out what the true cost is. If you don’t have coverage for mental health services, check what your deductible is. If your deductible is $5,000 for the year and you go 52 times (so, weekly) to therapy, your cost will be approximately $100/session, less if you have other medical expenses. (Check your insurance provider and give them a call to confirm costs, of course.) The point of this paragraph is to say that you might still be able to go when you think you can’t. $5,000 is a lot of money, of course, and more than many people can afford. I like to think of it like a gym membership for the mind. Over time, it’s become a non-negotiable item in our budget, and we go more frugal in other areas of our lives to make this a priority.

Another option is to ask if the therapist has cash rates or a sliding scale. Cash rates can be lower because the therapist is not negotiating or submitting insurance paperwork. There are therapists that take patients at a reduced fee if they are under income hardship. Often these spots are harder to find, but it’s worth asking for one or the other.

If you are a college or a graduate student, there are a number of schools that offer therapy for a wildly reduced rate. When I went to school, it was subsidized to $25/session, which seemed outrageously expensive to me at the time, and yet I still went. Looking back, I’m so thankful I did.

Another option for lower fee services: check out post-grad training institutions such as Psychoanalytic Institutes. Each therapist you see will already have an MA or PhD level training, but they are going for more training and they have to see a certain number of patients to fulfill their curriculum’s hours. In Manhattan, there are some institutes that charge $30-$60 for these sessions. (Keep in mind that these rates will only be for the duration of the time the therapist is in the program.)

7—It’s okay to quit and try a new therapist. It’s like dating.

In the beginning, you want to have a good feeling about the person. A sense of trust is very important. Yes, it will feel uncomfortable to talk about yourself, and it might feel weird, but you want to generally trust the person you’re talking to. If you find yourself annoyed, disagreeing with them, or like they aren’t “getting you” in the first few sessions, it is perfectly fine to switch to a new therapist. (If you find yourself getting annoyed later on, however, mention it to your therapist because it’s likely something is triggering you and it’s a great place to start when you dive in.)

What to say? What to talk about? What to expect when you go into therapy.

This will sound a bit counter-intuitive, but at first, don’t expect much.

Part of the process of therapy is going for long enough to build a relationship with someone you trust, someone that can see you and listen to you for long enough to see who you are and how you show up over time.

Showing up and talking to someone regularly can be extremely helpful.

I find the benefits of therapy can be multi-layered. For example, just having someone to talk through a problem with, or even show up on a consistent basis and hear about how your life is going can be such a relief.

When you go, talk about what your life is like. Talk about what your thought patterns are. Share what your worries and feelings are, and let yourself wander. When things come up randomly, mention them. Do your best to tell everything you can to your therapist, and share what questions you have.

Know that it takes repeated meetings for your therapist to start to see patterns.

Your therapist will be watching and learning a tremendous amount about you. How you hold yourself, what you say, what words you use, when you arrive, your mood, and more. They notice everything. Over time, they start to see patterns. My therapist has really challenged me at times because after, say, twenty sessions, she’ll mention, “For 12 of these sessions, you’ve expressed being really tired as the first statement when I ask how you are. Why do you think that is?”

When they have enough time working with you, they’ll pull together insights and patterns for how you work and reflect them back to you.

It is so cool—and yes, it can be scary—but so cool to have someone so invested in you that they can start to see how you work and what’s going on, not just in the day-to-day, but across time.

You’ll get out what you put in.

If you don’t tell your therapist everything that’s going on, it won’t work.

Being witnessed is huge.

I often forget the sheer amount of what I’m taking on and having someone to talk through it with can reflect back to me things I’ve missed or ignored about my own experience. She reminds me that being a new mother, a business owner, and pregnant in itself is a lot, and that it is okay to feel stressed about it.

A friend of mine shared her experience:

"One of the most powerful things therapy gave me was actual validation of my lived experience, and it's not something I see a lot of people give weight to. It is so easy to brush off any lived experience as "not that bad" or as over-dramatized in your own head. Having someone with no stake (not a loved one) validate that, "Yes, this thing you're dealing with is awful," is more powerful than most people realize. For me, it was the first step towards healing.” (@B)

It might be less about “Aha!” Moments and more about long-term stability.

In my work now, I keep trying to quit therapy. I keep thinking, “Well, everything’s fine! We should be done, right?” The thing I don’t see is that therapy is one of the reasons that I stay regulated and stable. Being in a weekly recurring pattern helps me fend off darker clouds and bigger crises because I’m always there, showing up, to talk about them.

What else do you want to know?

Thanks for reading through this post, and for being open. If you have any questions or ideas, please leave a comment or a response with what else we can add to this discussion. If you found this post useful, give it a few claps or share it. I write a weekly newsletter over on my site www.sarahkpeck.com. Thanks for being here.

Also, I’ve had several conversations both online and off with friends and acquaintances about the benefits of therapy. I’ve included anonymized quotes from them throughout this piece, so as to stay mindful of their own privacy, but a huge thank you to everyone that’s texted, emailed, and shared with me about their experiences with therapy and drawn into this conversation. Every person talking about therapy, mental health, and inquiry is helping to break the stigma and slowly change the culture.