How do I get started in therapy?

Since opening my practice last year I have become more outspoken about mental health. In response I’ve had numerous people ask me about how to get started in therapy. I love helping people learn about how to find a good therapist and these experiences have opened my eyes to the stigma and uncertainty surrounding mental healthcare. I am going to share with you some of the important steps to take when looking for a therapist.

When should I go to counseling? Isn’t it only for certain people?

Whatever image you have of the “type” of person you envision going to therapy, erase it. Every therapist or approach to therapy might not be for everyone, but everyone is the kind of person who can gain something from therapy. That being said, ambivalence about therapy is normal. There are very loud parts of society that tell us that we need to figure our problems out on our own and this is part of the stigma and problem of seeking help. If you’ve ever felt emotional pain or been stuck in life then therapy can be helpful. Therapy is more about helping you live the life you want and deserve than it is about analyzing and fixing yourself. Also, every day doesn’t have to be bad for you to go to therapy. Counseling can help you identify patterns or problems that don’t cause problems every day but are still stuck points in your life. The only prerequisite for therapy is realizing that you want things to be different in your life. You don’t even necessarily have to know what isn’t working or what you’d want to be different - a good therapist will help you figure this out. After you schedule that first session, you and your therapist will collaborate on how often and for how long you will meet.

How do I choose a counselor? Where do I even start?

I’ve heard a lot of people say they chose their therapist because someone recommended them. If you know someone who is in therapy, ask them about their experience and for recommendations, but you should do your own research too. How many times have you had a bad hair cut or felt displeased by your experience with a mechanic because of a recommendation from someone else? You may need something different than your best friend or sister. By putting in a little bit of work you can make an informed decision about who you trust to be part of your healing journey. I recommend starting your search online. Helping professionals put a lot of work into their websites and online profiles to help people learn about them and their services. Most mental health professionals have profiles through sites like PsychologyToday, GoodTherapy, or TherapyDen. You can use the filters on these sites to help narrow your search.

Depending on where you live it may feel like there are too many providers available. This can be a little overwhelming, so I’m going to try to break things down as concisely as possible. Before even beginning your search, I’d encourage you to consider what it is that you’re wanting to work on in therapy. For instance, you may want help with anxiety, relationship problems, premarital counseling, addiction, or grief. Look for providers who work with the presenting problem that you have. Also look for providers who work with your age group. Read through their profiles and spend time on their websites; this will help you get a feel for the type of person they are. Finding a therapist that is a good fit for you is super important for therapy to be effective. You want to be able to connect to and feel empowered by your counselor. After you’ve narrowed your list of options down, give them a call or send them an email. Most mental health practitioners I know offer some kind of free consultation. This is an opportunity for you to ask questions you have or receive clarification from the therapist on their services.

Depending on your circumstance, there may be other options available to you as well. For instance, if you’re a college student you should have access to counseling through your school. Also, certain employers have Employee Assistance Programs (EAP) that provide therapy services to their employees. On a side note, EAPs are typically limited to a certain number of sessions so double check with your human resources department. There is less autonomy in these situations because individuals may be assigned a counselor or choose from a list of providers. The most important thing is that you feel comfortable with the person you are working with and that they have the skills to work with you on whatever it is that you’re bringing into the therapy room. My first experience with therapy was through an employer’s EAP program. It was a positive experience but I’m also happy that I can now freely choose who I want to work with.

Take a look at how you live your life. Your lifestyle and needs may also play a role in how you choose a therapist. Specifically, if you’re experiencing marital or familial problems I’d recommend seeking out someone who specializes in and offers couples or family therapy. If you’re seeking an evaluation for a specific concern such as ADHD, I’d recommend you look for someone who offers those specific evaluations. It is also not uncommon for someone to meet with both a therapist and psychiatrist if medication support is recommended. You may also be interested or need the convenience of online therapy; this can be helpful if you travel a lot, work non-traditional hours for work, live in a rural area with very few providers, or are simply drawn to the idea of healing from home. Think about what it is that you need from therapy and make a decision that is sustainable.

Lastly, I want you to know that it’s okay to discontinue therapy with someone if you feel that they are not a good fit for you. Before choosing to no longer see a counselor I would encourage you to bring up the concerns you have about fit. Sometimes all that is necessary is a little adjustment in the approach to therapy, but it’s okay to part ways if necessary.

What about paying for therapy? Why should I consider opting out of using my insurance?

There are different ways to pay for therapy. Typically people either pay for therapy privately or use their insurance. Insurance can be a cost-conscience way to receive therapy. You can set your insurance provider as a filter on the sites listed above or contact your insurance company for a list of providers. Not all providers accept insurance, though, so choosing this route may limit who you can work with. It’s also worth noting that even private pay counselors can offer monthly statements that you submit to your insurance company for reimbursement (definitely check with your insurance provider’s out of network policy). Helping professionals have very valid reasons and arguments for the choice they make about billing insurance for psychotherapy services. For full transparency, I am a private pay counselor and not billing insurance allows me to focus all of my energy and resources into helping my clients. I don’t have to split my time between my client and their insurance company. For you, this will be a very personal decision that depends on a lot of factors. My goal here is to help you understand all of your options. If you’re interested in utilizing your insurance and need to meet online, I’d recommend that you contact your insurance provider and learn more about what options you have.

What if I don’t have insurance and am on a tight budget?

Therapy is still for you. Having low funds is not a good reason to avoid getting the support and help you need and deserve. I’d recommend taking a look back at the list of providers you found earlier and look for those who offer a sliding fee scale. A sliding fee typically means that the provider will offer a reduced rate if you qualify based on your finances. I also recommend looking for a provider through Open Path Collective. Open Path connects individuals with providers who agree to offer a reduced rate for services.

My hope is that this post is informative yet generalized enough to help you make the decision and move forward with therapy. By no means is this post exhaustive or meant to cover everything there is to know about therapy resources, but I hope it has you thinking. For your convenience, I’ve added links with all of the sites I mentioned above. And if you have any questions, please reach out and let me know: trisha.lpc.thespace@gmail.com

Good luck!

A concert inspired me to talk about mental health, suicide, and LGBTQ issues.

In July, my boyfriend surprised me with tickets to the Imagine Dragons concert in Orange Beach, Alabama. The show was spectacular, to say the least. It also felt like more than a concert - the band seems on a mission to lift people up and rise above hate and judgment. Before they performed the song “Believer,” singer Dan Reynolds said a few words about his experience with anxiety and depression. He encouraged the audience to consider the fact that denying and minimizing emotional and mental health problems is harming us and plays a factor in the rising rates of suicide attempts. There was a beautiful moment when somebody near the stage through a rainbow flag up on the stage. I noticed how the lead singer seemed to pause, appearing to consider his next move. Then he picked the flag up, draped it over his shoulders, and continued discussing the catastrophic rates of mental health problems, including suicide among our LGBTQ peers. He implored the audience to seek help from a counselor if they’ve struggled with depression, anxiety, or feelings of hopelessness. Listening and watching everything unfold, I felt a lot of emotions. Specifically, I felt proud and empowered to be a counselor and do the work I do. Dan later tweeted about the moment when the pride flag was thrown on stage:

we played in Alabama tonight & a fan threw a flag on stage & as I sang & looked at it on the ground I thought to myself, this is one of the most conservative places we will play in America - if I pick that flag up some fans will be upset - that’s why I knew I HAD to pick it up - @danreynolds

As a counselor in Alabama it feels good to say to potential clients, who call with uncertainty in their voices, that I’m an LGBTQ ally. Because of fear and limited resources, members of this community are dying and I refuse to be part of the silence. Suicide is the second leading cause of death in our youth and our LGBTQ youth are attempting suicide nearly three times that of our heterosexual youth. But death by suicide is preventable.

When I was in high school, a family member close to me survived a suicide attempt. At the time, this experience was confusing and heartbreaking. Listening to the lead singer take time out of their show to have an open and honest discussion about mental health and suicide, I found myself reflecting on that experience. Back then, I knew what depression and suicide were but nobody around me was talking about it. The day I returned to school, the counselor there asked if I wanted to talk. Of course I said no.

It wasn’t until I began studying psychology, mental health, and counseling in college and later in my graduate program that I took part in informative, honest discussions about suicide and efforts we can take to prevent it. I feel comfortable talking with my family, friends, and clients about suicide now, but we cannot solely rely on helping professionals to advocate for the people struggling with mental health problems. There are too many good resources available to us to not become informed and do what we can to decrease the number of people taking their lives because they feel alone and hopeless.

If you’d like to learn more about suicide awareness and prevention, please take a look at these links.

You And Your Cortisol

What's the purpose of stress?

I used to ask clients this question while giving a lecture on stress and relaxation.  I was met with a variety of responses: to drive me crazy, to help me learn, I don't know - you tell me, etc. Sometimes people would tell anecdotal stories about how they worked well under pressure so maybe stress had something to do with motivation.  ...Now we're onto something. 

The real purpose of stress is to keep us alive.  

You've probably heard of the term "fight or flight," right? The body's experience of stress is chemical. Imagine that you're reading this blog from the comfort of your home then, all of a sudden, there's some kind of comotion - maybe a loud noise.  What happens inside of you in that moment?  It's likely that your heart starts racing, you stop focusing on reading, you start focusing on escape, you look for something to use as a weapon, and you start sweating.  During times of duress, your body releases hormones that prepare you to run away or take action and this is a fantastic innate gift... if survival is the goal.  

By now you may have already thought, That's cool, but I feel stress even when I'm not being chased by lions, tigers, and bears.  You're absolutely right.  You see, we all have a built-in mechanism called the HPA axis which is made up of the hypothalamus, pituitary gland, and adrenal gland.  A simple way to think of the HPA axis is this: feeling stressed = activated HPA axis, not feeling stressed = non-activated HPA axis. The most important thing to understand about the HPA axis is that when it is turned "on" it releases the hormone cortisol, which is commonly known as the stress hormone.  This HPA axis that we all have prepares our bodies to respond to any perceived stress.  Chemically, there is no difference between how the body responds to an actual threat or a perceived threat.  As a result, the body responds the same way to a car nearly hitting you and a to-do list that is a million miles long, even though only one could actually kill you. 

While there are a lot of factors that determine how each individual experiences and expresses stress, one thing we all have in common is the release of some amount of cortisol into the body.  How much and how long this stress hormone gets released determines how much damage you do to your body.  You see, this stress mechanism was developed to aid in our survival during moments of acute stress - those moments when we experience a true threat to our life.  But most of the stress you and I experience today is not life threatening.  We worry about job deadlines, our relationships, paying bills, and what others think of us, just to name a few.  Because these types of stressors result in chronic stress we end up with a steady and small amount of cortisol that is released into the body.  Instead of an intense flood of cortisol followed by a period of restoration, we allow a small, constant flow that is undetectable moment to moment, which is ultimately more insidious.  

For those of us who experience chronic stress for any extended period of time, there can be a litany of negative effects:

  • Muscle tension

  • Poor immune system

  • Difficulty concentrating on important tasks

  • Problems with memory

  • Loss of energy

  • Headaches

  • Acne

  • High blood pressure

  • Gastrointestinal problems

  • Weight fluctuation

The good news is that there are things we can do to repair and prevent the damage done to our bodies due to stress.  I want you to think of the first couple of things that come to mind when I ask "What do you do to relax?"  It's likely that you said watch TV, read a book, listen to music, exercise, yoga, take a nap, pray, or maybe talk to a friend, and all of these are fine ways to calm the mind and body and stop the flow of cortisol.  It is also important to know the difference between passive and proactive relaxation, especially if you experience chronic stress.  When we choose to take a nap or zone out in front of the television we're engaging in passive relaxation, meaning we're avoiding or tuning out the thing that was causing us stress.  While this isn't necessarily a bad decision, it likely won't prevent you from experiencing the stress again once you wake up from that nap or finish watching that movie, so it's important to begin integrating proactive measures to respond to stress.

I mentioned earlier that we feel stress as cortisol is released into the body, so in order to avoid feeling excessive stress, we need to find ways to get rid of the cortisol that has built up inside our body.  We do this through breathing.  By learning and practicing true belly breathing we can decrease the levels of cortisol and thus feel less stress.  This means that we will look and feel healthier, have more energy, experience fewer bodily pains, feel peace and relaxation, and improve memory and concentration.  Some of you may be thinking that you've tried deep breathing before and it didn't work.  If you didn't feel some sort of relief from belly breathing then it's likely you need better instructions and guidance on how to properly belly breathe.

There are so many resources available to help us understand our emotional health and promote wellbeing and wholeness.  As a naturally anxious person by nature, I feel passionate about helping people learn about stress and relaxation.  Click here to watch one of my favorite videos to learn the basics of belly breathing.  If you have any questions, feel free to email me at trisha.lpc.thespace@gmail.com. 

 

The Story About A Family

I've been thinking about the idea of what it means to be a family lately.  You see, the narrative of of my family always felt different than the other kids when I was growing up.  I remember sitting in Spanish class in sixth or seventh grade and we had to introduce our family members by name to the person behind us. Out loud. For everyone to hear.  El apellido de mi madres es Leblanc.  El apellido de mi padres es Haydel. El apellido de mi hermana es Emile.  Mi apellido es McMillon.  I already had a hunch that my classmates probably knew that I came from a poor background and here I was ousting myself that my family relationships were messy, all because we had different last names.  

Like all children I thought people were paying far more attention to me than they really were - thank you undergrad developmental psychology for teaching me this was incorrect!  It wasn't until I went to therapy in my early 20s that I really began to do some healing and started rewriting my family narrative.  Prior to that, I had been operating under a few general beliefs all surrounded by the fact that we were poor, nobody in my extended family talked, my parents were never married, and I saw a lot of death at a young age.  These were the beliefs I developed and brought into every new encounter I had with others:

1. Love is conditional. 

2. All relationships end poorly, no matter how hard you try.

3. Being a chameleon is the only way to make friends, so I better get good at it.

4. My family secrets make me unrelatable and I'll never find a partner who will accept me.

5. My friends offer more support than my family.

Because I didn't want my past to limit my dreams and future relationships, I sought healing.  Luckily, I had put a lot of effort into building solid friendships, so I leaned on them for support as a teenager.  Going to college offered me endless resources to help in my personal development and knowledge.  And when I was ready, I went to therapy and allowed my counselor to challenge my beliefs and offer me the opportunity to replace them with better ones.  She told me I deserved the whole buffet, not just the leftovers and that resonated within me, not just then but now.  She also had me read, Healing the Child Within: Discovery and Recovery of Adult Children with Dysfunctional Families by Charles Whitfield, which I recommend for anybody who can relate to the title.  

I don't believe or live my life by any of the statements above because I chose to change the narrative of my family story.  Healing doesn't mean that these old beliefs don't affect me from time to time, but I'm much more prepared today and allow myself grace, to be flawed without becoming consumed by these thoughts.  For instance, my mom has struggled with illness most of my life, and she had an episode a few weeks ago that has reminded me of my old family narrative, but I'd like to share with you my current beliefs based on my new narrative:

1. While some people put conditions on love, this is not the love I value, so I will not put energy into relationships with conditional love.  Conditional love says a lot more about the other person than it does myself.

2. Some relationships do have a final chapter and that's okay, but most are fluid, allowing for moments of separation and closeness.  Authentic friendships require a joint effort and a relationship  that feels forced, unbalanced, or rigid is probably not healthy.

3. Relationships require compromise, but not at the expense of my values.  When I put energy into knowing who I am and what my values are, I'll build relationships that are authentic.  I'm allowed to say no and state my beliefs and opinions without losing people I care about. 

4. My family has secrets, but so does every other family.  I choose to not give my family secrets any power over me and I'll do my best to not allow toxic relationship patterns to be passed down through future generations. My boyfriend accepts every piece of me, even the pieces that are tough to share. He also shares his family with me and for that I am grateful. 

5. My friends are my family and often times they do provide the most support, but that doesn't mean anything other than I've done a good job at cultivating a great support system.  I have members of my family who love and support me unconditionally and I can never allow my old beliefs to ruin these relationships.

My hope is that readers of this blog, especially those who can relate to the pain in some of these sentences, recognize that the narrative you've lived by your whole life isn't the only story you have to tell.  Family secrets and trauma do not have to define the path your life takes or the relationships you build.  You're deserving and capable of genuine connection, unlimited support, and freedom of personal expression in your life's narrative.   

 

Stop Believing You're Insignificant

I’ve been wanting to write a new blog post for the past few weeks, but I just felt… stuck.  I don’t feel right crediting writers block for my lack of blogging, not necessarily because I’m not a writer, but because I know deep down that this explanation isn’t honest.  Since my last post, I’ve had thoughts and ideas on what topics I could write about.  I’ve had “ah ha” moments where I’d think of a clever statement I could make while writing.  But I didn’t follow through and write about social anxiety or abusive relationships or any of the other ideas that I had.  I didn’t write because my thoughts were getting the best of me. 

What does she mean that her thoughts were getting the best of her? Isn’t she a counselor? Isn’t being ahead of and on top of her problems supposed to be, like, her thing? Didn’t she go to school for all those years to learn about being the type of person who could put life’s stress aside and help other people?  While parts of these statements may have reflections of truth in them, I am not a robot. 

So, when I say my thoughts were getting the best of me, what I mean is that my insecurities were taking center stage.  You see, I took a leap of faith to pursue my dreams of opening a private practice and I haven’t regretted this one bit.  But with this I’ve invited a few more stressors into my life, at least temporarily.  Also, my life is just like everyone else’s, meaning I experience my own personal life stressors.  And get this, because things felt a little more stressful, my insecurities started gaining power and, before I knew it, my thinking shifted from “oh, that’d be a neat thing to blog about” to “you have too much going on and are too stressed to write anything worth sharing with others.” My thinking betrayed me.

I have a few activities and educational material that I use with clients who have similar issues with their thinking.  My favorite worksheet has 10 types of unhelpful thinking styles with simple illustrations to help describe each style of thinking.  You might be asking yourself, there are that many ways that my thinking can mess with me?! Yes, and I routinely share with my clients that I experience the majority of each of these on any given day.  I pulled out this worksheet because I wanted to identify exactly which of the types of thinking I’d been doing myself.  Here’s what I came up with:

·      Mental filter – I was only giving credit to feeling stressed, not putting any mental energy into            expanding on my ideas or writing anything.

·      Emotional reasoning – Believing that because I was having trouble focusing my ideas that I             was a bad writer with nothing to offer.

·      Fortune telling – Thinking that no one would enjoy or learn from what I had to write.

These beliefs are not true, and it took me a while to realize that my thinking was up to some trickery.  During the weeks that I was slowly convincing myself that I was not in the right frame of mind to write, I was aware I felt more stressed and had been doing relaxation training and mindfulness exercises.  But it wasn’t until I was confronted with the realization that I didn’t think I was good enough to write something worth reading that I felt better and more at peace.  My mind shifted to thoughts that were more realistic, supportive, and empowering. 

Our thoughts become our beliefs, and if we allow ourselves to think fear-based, limiting thoughts then we risk believing that we are limited, insignificant people.  No one wants this and we should keep a close eye on our patterns of thinking, especially when life gets a little tough and scary.  If your insecurities are running the show in your life it’s time to get to know them and give them a smaller role.     

The Crepe Myrtles are Blooming.

I sometimes feel overwhelmed by life's burdens.  Just the other day I was driving alone in my car and I realized, in that moment, how small I had made my world.  I had spent 20 minutes driving yet all I could think about were the things causing me stress.  I hadn't thought about the other people on the road with me, considered whether I was driving carefully, or even troubled myself to consider solutions to my worries.  The reality is, I was worrying about the same things that eat up most of our worried minds: the future, plans, finances, saying the wrong thing, so on and so forth.  I was allowing my past and my future to consume my present and could feel the discomfort spread: first my chest, then my stomach, and then my head. Then something special happened - I glanced to the left and saw a blooming crepe myrtle.  

I don't have a green thumb or know much about trees, but I remember living in an apartment complex about a decade ago that had sidewalks lined with crepe myrtle trees and they were beautiful, though not year round. From then on, I looked forward to seeing the first blooms because it happened so quickly and they filled the world with color - white, magenta, red.  I also associate it with the beginning of Spring, which for me is an easier season to love than Winter.  

But this isn't really about the beauty and wonder of crepe myrtle trees or Spring, but rather, having something to look forward to, especially during tough times.  Luckily, the things that you and I worry about most of the time are not things that are life threatening.  They bring us fear due to uncertainty and lack of control, and we can feel this fear in every ounce of our body, mind, and relationships.  The stress can't kill us, but it can feel paralyzing.   

I'm a bit anxious by nature, so I've collected a number of different coping mechanisms to help when I'm feeling overwhelmed or panicky.  But there are circumstances where I know my mind might be a bit more worried until the passing of an event, such as waiting on the results of something.  And in these conditions, I rely on another set of skills to keep me grounded and at peace.  I ensure that there are things in my day and life that I enjoy, such as taking five minutes to meditate with the crepe myrtle trees.  When I have a busy day scheduled, I treat myself to a breakfast and fancy coffee or plan a dinner I can look forward to throughout the day.  When I know a couple of weeks will be more stressful for me, I carve out extra time for my friends and plan ways to pamper myself during the week (hello epsom salt bath on a Wednesday).  I've learned to be gentle with myself.  

We need not feel all the worry all the time.  So find (or rediscover!) the things you enjoy and make time for them, especially when life asks a lot of you. Your body will thank you, your mind will thank you, and your people will thank you.