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.

Know Thyself

When I was in college, one of my classes offered extra credit for participating in the research projects for some of the graduate students in the psychology department. I decided to participate in a few.  From what I remember, most were simple questionnaires that I could do on my own time, asking about my attitudes about a variety of topics: religion, race, sexual orientation.  I do remember, however, one extra credit opportunity that invited me to participate at a specific, scheduled time and location.  The invitation asked for a written prompt about potential traumatic experiences I had, so I replied with a story about Hurricane Katrina and my mom's health.  When I arrived at the time and place, I was given instructions to enter a room, where a camera would be waiting, and simply talk about myself.  Immediately I felt on edge; what was I going to say? I got about two sentences out before I looked into the camera and said "I don't know what to say," and then left the room. 

When I reflect back on this event, I realize that I had so much trouble discussing myself because I had spent so much time trying to go unnoticed by others.  I was the person in a group of friends who nodded, laughed, and agreed, but never shared much about my thoughts and opinions simply because I didn't really know what they were. I later received similar feedback from my graduate school professors - they said I needed to speak up and participate more in class so they could get to know me and help me learn.  I fumbled through the process of trying to feel comfortable with other people and articulating what I wanted in relationships for a long time before I finally realized that I didn't really know who I was.  I could tell someone simple facts about my life, but not much more than that and really nothing to show people my true self.  

Numerous talented researches and authors have devoted their lives to exploring the concepts of true self and core identity in an effort to learn more about character, personalities, values, eclectic energies, auras, and so forth.  And if your interest lies in knowing your Myers-Briggs (INFJ here!) or what Hogwarts House you belong to (Slytherin here!), then I want you to take those quizzes and assessments and learn more about your traits and personality ticks.  I believe any time we spend trying to get to know ourselves a little more deeply is time well spent, even if we conclude that we don't agree with the results. Ultimately, understanding why we don't agree is knowledge gained! But for a lot of us, this isn't enough to help us feel connected with our identity.  

To begin gaining clarity on who you are, you'll need to spend some quality time exploring a few key ideas and for people who have experienced trauma and chaos, emotional healing is part of that journey as well.  For those of you who are interested in starting to understand who you are, I encourage you to make yourself comfortable and explore the following ideas and questions:

Values

Values are what make life worthwhile for us and they help give us meaning.  We receive values from society, our family and culture, and from within. Our values are also fluid, meaning they occasionally change.  Some of the values we hold feel monumental and some may be more frivolous but both are important! Sometimes our personal values don't align with the values that society or our culture has given us and that's okay too.  When this happens, it's important to acknowledge these differing value systems and decide if and how we want to make space for both in our own lives.  We have specific values related to our career, health, relationships, spirituality, etc. and it's important that we know and articulate each of these, and I encourage you to dig deeper than just identifying communication as a value in romantic relationships, specifically.  What about communication is important to you in relationships? What does good communication look like in a relationship and what will it mean for your relationships? 

Interests

What are the hobbies or activities that you have passion for and feel energized by?  If you're unsure then now is a great time to start trying out new things.  Surely there's something you've thought is interesting but haven't yet tried. Spend some time with new or old activities and see which ones you like best.  The neat thing about personal interests is that we don't necessarily have to be skilled to enjoy something! I have a couple of recommendations on interests: make sure you have solo interests that aren't something you do with or because of another person, and don't let the fact that you're not skilled at something interfere with it being an integral part of your interests.  For example, I enjoy creative activities but it's not something that comes naturally to me and I'll never be recognized as a leader in the art community, but it doesn't stop me from drawing, coloring, and practicing lettering. 

Skills

What are you good at?  What comes naturally to you and not everyone else?  Skills can include mental capabilities, use of our hands, and mastery with certain concepts, just to name a few.  Our skills and interests sometimes align and that's cool but sometimes they don't align and that can be confusing at first but also perfectly okay.  Similar to interests, understanding our own personal skills may require some trial and error and a bit of creativity if we haven't spent much time thinking about them.  If you're unsure of what skills you have, ask people who watched you grow up and some of your close family or friends.  What areas did you excel at in school, extracurricular activities, jobs, and relationships?  Get to know these areas and articulate why you were successful in them.  

Internal Clock

What do you know about how your body responds to different parts of the day? Are you a morning person or a night owl?  When are you most productive and have the most energy?  What about when you're least productive and have the least amount of energy?  Do you optimize your most productive times with top priority activities? Are you a morning person but find that you've been trying to have serious relationship talks with your partner late at night?  Each one of us have an internal clock that gives us important information on how to use our time and when to rest, and ignoring this rhythm will likely result in confusion and chaos.    

Personal strengths

Often times we're much better at identifying the things we lack or the things we need to improve, meaning that it can feel overwhelming to articulate our strengths.  Luckily, if you've taken some time to reflect upon some of the earlier topics, your brain may be more willing to metaphorically pat you on the back.  Of course, our strengths can include things we're good at, but more often than not there is a mountain of character strength that's hiding somewhere inside of us, such as creativity or honesty. In considering your own character strengths, I encourage you to ask yourself this question: What kind of person am I?  If you're still struggling to identify your personal strengths take a look at this link where some really smart researchers put a lot of energy into helping us find our strengths. 

Temperament and personality

When I think about the ideas of temperament and personality, I think of all the fun quizzes on the internet designed to put us into boxes with colorful ideas, like discovering our spirit animal or our color of the universe. These can be entertaining but they don't necessarily give us huge insights into our own personalities.  Temperament is commonly recognized as a collection of inborn traits that remain fairly stable throughout life, and personality is built from that temperament and also other life experiences. For the sake of time, they're quite similar and intermingled.  Understanding your temperament means knowing where you feel most energized in life: is that surrounded by a group of people or going on a solo activity? What activities help you feel calm, relaxed, and in your element?  Knowing your personality means understanding your unique mannerisms in both how you experience the world, events, and other people.  Luckily some smart researchers have spent a lot of time trying to better understand personality and have developed a free assessment to help people get to know themselves.  This assessment focuses on five major areas of personality: Openness (to new experiences), Conscientiousness, Extraversion, Agreeableness, and Neuroticism.  Of course, you can think on your own about these areas or you can learn more by clicking here.  If you have concerns about what you'll discover, please take caution and meet with a professional counselor about this.   

Core beliefs

Our beliefs are the truths we hold about ourselves, others, and the world.  In return, these beliefs drive our thoughts and actions.  For instance, if I believe that the world is a good place and people are inherently good, then I'm likely to demonstrate my trust in others easily: by the way I treat them and in how I think about them.  Often times our core beliefs do not announce themselves proudly and so we have to do some digging to find them. Discovering them is empowering, though, and can help us understand ourselves more, regardless of whether or not we want to change these potentially hurtful core beliefs.  Another example: if I realize that deep down I don't believe I'm good enough to be loved, then this belief will tangle itself in my every thought and action, likely leaving me with relationship problems.  To better know your own core beliefs, and bring them to the surface, look for patterns in your thinking and behavior and ask yourself: what's that about?

Life goals

Is it just me or was it so much easier to talk about future plans as a kid in elementary school?  I think that's just because, as adults, we get consumed by the monotony of everyday life. At some point we have to stop and remember that this life is for living and building it how we want.  Ask yourself whether or not you're satisfied with the direction your life is headed.  What do you want to accomplish in the next few months? Within in the next year? Ten years? What legacy do you want to leave when you're no longer alive? How do you want people to remember you?  What fears are keeping you from doing that thing you've always wanted to do? 

Once you've spent some time answering and reflecting on these ideas, it's important to adjust your life to begin living with integrity and decrease the dissonance in your life.  Also, make room for some flexibility because a lot of these topics are fluid and represent who we are today, not necessarily who we'll be five years from now.  A value driven life is an intentionally lived life which usually makes for a happy life.  

 

Dear Client, Your Counselor Thanks You

Dear Clients,

I want each of you to know something: your counselor cares about you and thinks your story is important.  Our passion lies in seeing you succeed and planting seeds to help you along the way.  And you might not realize this, but you help your counselor too. We’re just humans helping humans.

When I think about the people I’ve counseled, a line from the Broadway musical Wicked comes to mind: Because I knew you, my life has been changed for good. That’s right, our conversations that help you explore and understand your world are good for me too.  I often hear remarks from people who say they could never do what I do for a living. They wonder how I hear all the stories I hear and not let it affect me.  The truth is I usually think the same thing about the work they do and, to be honest, it does affect me sometimes but not in the way people assume.  While I’ve imagined what I’d do if I wasn’t a counselor (write books, teach) I’m grateful for my job and for the people who let me walk with them on their journey to wholeness. 

So I’d like to share with you some of the influential moments, shared connections, and ah-ha moments that stick out to me.

1.     To my client who wasn’t afraid to tell me I’d gotten it wrong, by trying to fixing it when all you needed was me to be present and listen, I needed to learn that lesson more than you could know.

2.     To my client who trusted me to learn about your shame through shallow breathing, shaky hands, and a lowered head, you taught me that, above all, we’re all human. A textbook couldn’t teach me how to respond to these delicate moments.

3.     To my client who was much older than me but still trusted me right out of graduate school, you played a huge role in my confidence and helped me believe in myself.

4.     To my client who was much younger than me and was unsure if I could relate, you’ve taught me so much and have reminded me to love my inner child.  Thank you for reminding me to not take myself so seriously.

5.     To my clients with different racial and ethnic backgrounds, thank you for sharing your story with me and teaching me about white privilege.  Because of you, I feel empowered to be a part of the changes our society needs to work together, be stronger, and fight hate.

6.     To my client who taught me about your spiritual journey and the difference between spirituality and religion, you’ve opened my eyes and shown me how beautiful the universe and life are.  My other clients also thank you for helping me expand my understanding.

7.     To my client who disagreed with me, your honesty was refreshing and it pulled me out of a therapeutic slump. I can’t thank you enough.  I think back to this moment often in times needed growth.

8.     To my client who allowed me to be human and flawed, your compassion was exactly what I needed.  Thank you for being okay with a counselor who isn’t perfect.

9.     To my client who fired me as their counselor, your insight and honesty saved us both a lot of discomfort and pain and it’s helped me recognize that I’m not a good therapeutic fit for all clients.

10.  To my client who moved from suspicious and guarded to exclaiming gratitude for therapy and personal growth, you give me hope that the stigma against seeking support for mental health is shrinking.  Future people will need your support.

11.  To all of my clients, thank you for propelling me away from assumption and towards curiosity and acceptance.  Judgment doesn’t look good on anybody.

I’m reminded of yet another quote: 1 universe, 9 planets, 204 countries, 809 islands, and 7 seas and I had the privilege of meeting you. Dear client, your counselor thanks you.  

Best,

Your counselor

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.