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!

Where “I” statements fail, demon dialogues prevail.

My eyes roll when I think about how matter-of-factly I used to tell couples about the importance of using “I” statements when talking to each other. For those who don’t know, an “I” statement is a communication skill that challenges people to deliver feedback to others by taking responsibility for their personal thoughts and feelings. So instead of Bill saying to Torrie, “You don’t give a damn about how hard I work every day to make sure we have a comfortable living,” an “I” statement would allow him to express himself this way: “It’s really hard for me to hear that you don’t think I care about spending time with you and the kids. Work has been really demanding lately, and I’ve felt like I’m being pulled in every direction. I need you to understand that until I can find a new job I’ll probably be more tired in the evenings, but I promise I still love you.” Can you see the difference? Can you feel the difference?

Don’t get me wrong, I think using “I” statements is great for healthy communication - I just don’t think they’re singularly powerful enough to change the course of a crumbling relationship. Even from the example I shared above it’s obvious that there’s more context to that story, whether Bill and Torrie got off track with one another or they picked up defensive and critical communication long before they met. Only using “I” statements to rebuild a relationship isn’t realistic because they require a great deal more personal insight, understanding, and humility than many people can muster once things feel too disconnected.

If “I” statements are a new, revolutionary concept to you, then I definitely encourage you to try using them yourself; it’s a great way to connect with your thoughts and emotions. So, what can you do when your relationship feels like a tense ice bath? Due to the complexity of relationships, it’s important to learn more about how both you and your partner respond to feeling disconnected. All relationships have periods of insecurity, and learning to move through difficult situations together helps partners stay on the same page and strengthen their connection and security. Based on your attachment style, or how you seek connection in relationships, you might find that you respond to disarray in your relationship differently than your partner. Some people become clingy and demanding when they feel an emotional wedge in their relationship, and some people disconnect and pretend they’re not bothered by it. With more secure relationships, there is less of the pursue-withdrawal dance.

Even without considering the things we bring into the relationship from our past, there are so many other opportunities for our emotional connections to be tested. Learning more about your attachment style and how you and your partner navigate through those tough times may help break the cycle of what Dr. Sue Johnson calls the “demon dialogues.” There are three demon dialogues:

  • Find the bad guy: As a way to protect ourselves during sensitive moments we attack our partner by blaming them. Discussions become more about building our case and proving our point to one another. It may feel like you and your partner are battling for empathy. Using our example above, Bill shares that he feels hurt by Torrie and she reminds him that he didn’t seem to care how she felt last week when he did some other thing. Most couples lose sight of when they first started blaming the other one or what it was even about, but because vulnerability doesn’t feel safe they maintain this back-and-forth dance until things escalate and explode or freeze with bitterness and shame. The only way to stop this accuse-accuse cycle in the relationship is for both partners to agree that is actually this find-the-bad-guy dance that is the enemy and not each other. When partners can agree that it’s more important to call out the pattern of blame-to-protect behavior than it is to “win” the argument, then interactions can begin to soften. Then safety can make its way back into the relationship. This can be a great opportunity for partners to learn more about their emotional needs and how to be there for one another.

  • Protest Polka: This type of dialogue involves not just romantic partners, but is often seen in parent-child and sibling relationships. The Protest Polka is a pattern where one person is seeking emotional reassurance and the other person is not providing the reassurance in a way that creates safety, leading to escalating demands of protest. You may have heard some of these yourself: It’s like we’re more like roommates. I can’t get him to open up about anything. Anytime I try to get close, she pushes me away. I can’t do anything right. It feels like I’m walking on eggshells so I just keep my mouth shut. Anytime I try to give her advice she seems to get angrier and I don’t know what to do anymore, maybe we’re not meant to be together. The Protest Polka reminds me of something I heard many years ago: Negative attention is better than no attention at all. When emotional connection is missing from a relationship, one partner will poke and pressure the other to reassure them that they are important and their feelings are valid. When partners are unsure of how to provide this emotional support (maybe they’re more logically minded or have limited insight into emotional needs) they may withdrawal, provide advice, or criticize their partner, inviting the Protest Polka to continue. Because of societal norms, we typically see women as the one demanding reassurance and men as protesting these demands. This isn’t a hard and fast rule, just generally what we see most often. Like before, only when both partners can see and identify that the pattern of demand-retreat-DEMAND-RETREAT-DEMAND!!-RETREAT!! is the enemy, not their partner, can they begin to make room for the role of the attachment needs of one another. When we make room for emotional expression and needs, we see a shift where demands become gentle requests from our partners.

  • Freeze and Flee: Often a result of the protesting partner giving up, this dialogue can more accurately be described as a non-dialogue. Partners remain in the pursue-withdrawal dance of the Protest Polka until the the pursuing partner stops trying to seek validation and connection. This partner discovers a set of skills that allows them to shut down, rationalize, or refocus their emotional needs. In short, they give up hope for emotional connection with their partner and begin to detach. It is here that we usually see the other partner, the more withdrawn one in the Protest Polka, notice and begin to feel the emotional iciness. And while this person may now begin trying to “fix” the relationship, there is so much emotional distance between partners that efforts to reconnect result in frustration and shame. Because both partners have likely created a mental narrative about their internal flaws ruining the relationship, this is when we see people leave emotionally void relationships or seek comfort outside the relationship. While Freeze and Flee is the last and most vicious of the demon dialogues, it does not necessarily mean that partners cannot kindle emotional connection. Partners that desire reconnection, are motivated to work through their disconnect, and also recognize how they ended up at Freeze and Flee can begin the process of healing their relationship.

Even though there are more people on this planet than ever before, opportunities for emotional connection seem to have shrunk. We now rely on very few people to meet our emotional needs and, regardless of which way you look at this, it makes emotional connections even more fragile. If you’ve read this post today and see you and your partnership among these passages, I’d encourage you to consider taking some steps to better understand yourself and your emotional needs. For more information on demon dialogues and creating love in relationships, check out Dr. Sue Johnson’s Hold Me Tight: Seven Conversations for a Lifetime of Love. If you have questions about getting started in couple therapy, please don’t hesitate to contact me for more information.

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.