MENTAL HEALTH MATTERS: Demystifying the world of mental health therapy

It was the fall of 1995. We lived on a gravel road in the Midwest. I can remember it like it was yesterday. As I was putting my 5-year-old daughter to bed — a process that consisted of me and my child talking about the day, her worries and her joys — I could see that she was not settling. She was restless. Her little arms and legs were thrashing around like she was full of electricity. “What is going on, honey?” I said. “You are not usually restless at this time of day.”

The following day was her first day of kindergarten. I was going to drive her to school each day, but just for the sake of having her know what to do and how to do it, I had arranged for her to be picked up by the school bus at the end of our driveway. After I asked my question, she sat up straight in bed and out tumbled her fear. “I am afraid I won’t know all the things I am supposed to know!” Just know that this was an early window into her personality.

Taking on new things and trying to figure something out for the first time can be frightening and mysterious. “Newness” can be overwhelming, whether you are 5 years old and about to go to kindergarten or whether you are in midlife trying to switch careers into something you are just not that familiar with. It can leave us bewildered and afraid.

I have owned my mental health practice for the last 13 years. I will frequently get a call from someone interested in starting therapy, and one of their first statements is “I’ve never done this before. I am not sure what to do.” In other cases, prospective patients may have had a rough experience with therapy and are very anxious about trying it again. I will say “It is OK! All of us have had our first session with a therapist and not known what to do.” I talk with them about us working together to figure out what to do and how they are going to do it.  They do not have to figure all of that out by themselves.

The reality of this situation is that many people put off or avoid therapy altogether because of stereotypes, or they have heard stories from others who’ve had negative experiences with therapy. I want to take this edition of Mental Health Matters to talk about what therapy is, how it works and how to find a therapist that you can work with.

What is therapy?

The thought of going behind the office door and being alone with a therapist can cause some people a great deal of anxiety and fear. So, let’s talk about what generally happens in that office!

Ideally, therapy at its best is a collaborative venture where you work with a licensed professional, and it usually focuses on several issues. You and your therapist become a team, and your mission is to solve something, fix something or adjust to something that you haven’t been able to do on your own. No one should be lecturing you like a student in a classroom as you passively receive some miracle cure. At the same time, is it typically a structured, science-backed collaboration that helps you to develop tools to handle whatever challenges life has thrown your way.

By life challenges, I am referring to a whole host of possibilities. It may involve relationships. Perhaps you have recently experienced a shocking and painful event that you just cannot stop thinking about. Some people decide to start therapy because they have lost their job, have had a divorce or lost a loved one, and they feel “stuck.” Perhaps they have recently received a very concerning medical diagnosis and they are fearful. The point here is that the client decides what they want to work on and with whom. It is possible that you do not even quite know what you need to work on, but you know something is just not right.

How do I pick a therapist to work with?

This can feel like a daunting task. You can look at a whole list of providers and not know who to start with.  Here are a couple of ideas to help whittle that list down to a more manageable number. Sometimes we have friends or loved ones who are already in therapy or have been in the past. These connections can give you a bit more information and perhaps provide a recommendation.

Many employers have employee assistance programs where they have lists of providers they can recommend based on the information you give them about your situation. EAPs often offer five or six free sessions, and if the first therapist you try turns out to be a poor fit, they are usually more than happy to help you find a better option.

You can also look on Psychology Today’s website. This is a site where practitioners list their areas of specialty, a bit of information about how they work, their prices and whether they take insurance or work only with self-pay. You are also usually able to see a photograph of each therapist. This can help ease some anxiety about meeting someone for the first time and not knowing what to expect.

Another strategy is to call your insurance carrier to inquire about which practitioners are providers for your insurance. This can eliminate having to call practices only to be told they do not accept your plan. Even if a practitioner does not take insurance, they can give you all the information you need to file your claims directly with your insurance carrier. Practitioners will also indicate if they are currently taking new clients or if there is a waiting list.

I encourage you to ask for an initial consultation. In many ways, you are interviewing the therapist(s) and deciding which one you want to hire. All therapists have different personalities, approaches and policies, and you want to know what that looks like before you commit to working together. Just like any other provider of care in your life, you do not have to keep seeing a particular practitioner if it feels off to you.

What it looks like — the practical reality of therapy

We have all seen the stereotype of the patient resting on a couch with the expressionless therapist quietly taking notes. At the end, the therapist calls time and client gets up and they walks out the door. Thank goodness, we have moved a good way beyond this as the only approach to therapy. While you may be able to still find a practitioner who works this way, there are many other styles and approaches to therapy that have no resemblance to this scene.

Therapists usually work in comfortable, welcoming office spaces. In today’s world, it might be a virtual appointment where you can participate from the comfort of your own home. Many people find this to be very helpful. They do not have to fight traffic to get to an office. Others feel more comfortable with in-person visits. During and after COVID, many practitioners found that virtual practice can be just as effective as working face-to-face, but some clients still prefer face-to-face visits.

Appointments typically last from 45 to 50 minutes and occur once every one to two weeks. In very intense situations, you and your therapist may determine that it is best to meet twice a week. (You and your therapist make that determination together!)

 One dynamic of good therapy involves having a focused and collaborative conversation. There are two experts in the room. You are the expert on your own lived experience, including your thoughts, ideas, feelings and reactions. The therapist is an expert on helping and the tools to help ease mental and emotional pressure and stress. As you work together, you will figure out what needs to change and how that might happen.

Like my daughter at age 5, you may be thinking, “How will I know what to talk about?” While your therapist can be helpful in getting the conversation started by asking some well-thought-out questions, this is where the client’s expertise on their own life becomes the center of the conversation. I have experienced this myself when I meet with my therapist — what am I going to talk about? And yet once I start talking, those appointments often turn out to be some of the most productive in my course of treatment.

You can start wherever you want. If you are not sure where that is, the therapist can ask questions that will help you gain some focus. That usually looks something like “Hi, John. I am so glad to meet you! Can we start with what prompted you to call my office when you reached out for help?” You can talk about past experiences, your current stressors, relationship patterns or where you feel stuck. None of us has 360-degree vision, and it is very easy to lose track of what we are feeling and experiencing.

Most therapists will help guide us with targeted questions to help you clarify your situation or circumstance. They also can help open our natural blind spots and teach us concrete skills to take home and practice.

This opens another common feature of therapy. You may be given “homework.” This usually consists of tasks that the therapist asks you to complete before you come back for your next session. The therapist may also commit to also doing something related to your case between sessions. Homework may involve working on your awareness of certain patterns or habits. It often involves working on increasing your acceptance rather than your habit of constantly judging yourself and the problem that has you stuck.

It’s in between sessions where clients often experience emotional and mental growth. If you are going to therapy but do not spend any time working on yourself in between, it will take a very long time to make progress. Homework may involve practicing breathing exercises, working on changing your bedtime so you can get adequate sleep or exercising two or three days a week. Whatever it is, you are likely to be involved in that decision as well. Sometimes I may suggest something that my clients determine is too difficult. Other times, I find that they are already practicing some of the skills they need to continue growing. You can be involved in the choosing of the homework alongside your therapist, depending on that therapist’s particular style.

Summing it up

I hope this helps break down some of the mystery and corrects misinformation about mental health care. Therapists are real people who put their clothes on the same way you do every day. Remember, you are hiring them. This needs to be a good fit for you!

That is probably a lot for you to digest and think about. Next time, I will pick up where this ends by talking about common therapeutic approaches and strategies. This will give you some initial knowledge of what to expect when you do decide you want to try therapy.

My best! Enjoy the seasonal transition from summer to fall!