I’ve talked to a fair share of people — those who have been to counseling before and those who have never set foot in a therapist’s office — who break into a cold sweat when thinking about talking with a therapist. I have been in the client’s chair myself, and my experiences in counseling deeply inspired me to want to help others by becoming a therapist. I believe in the power of therapeutic change and benefit and I’ve also “been there” and empathize with how daunting it might seem to enact change in one’s life.
Anxiety and nervousness can precede a therapy appointment. They can cause you to drive around the block a few times before finally parking and walking into the office. I know that sometimes it can feel worse after the appointment, instead of better. I know that discomfort might be part of the protocol. I understand that talking about personal matters can feel foreign, vulnerable, and risky.
So why do it?? Because change can happen. Steps can be taken, with the trust and security of a therapeutic relationship, to achieve personal goals that bring peace, happiness, and clarity to one’s life. This is absolutely possible. But, you may wonder, what do I have to risk in order to achieve that change? These common fears may keep some folks from calling a therapist and today I wanted to “normalize” those fears — and talk about what to do to overcome them. Because everyone deserves a fair shot at a balanced and healthy life.
In working with clients in recovery from eating disorders such as bulimia, anorexia, or binge eating disorder, I often encounter some anxiety around change. Through my own recovery from an eating disorder, I went through various stages of change and different levels of readiness for change. I discovered that I needed to follow my own path, and it may take me up hills and down valleys; most significantly I found out that therapy, while terrifying at times, helped me make the changes that got me to the place I am today — healthy and fully in recovery!
Here are three of the biggest fears that those with an eating disorder who are contemplating therapy may experience. These can also be widened to anyone who is approaching the decision to pursue therapy:
Three Big Fears About Going to Therapy – and how to conquer them:
1.) My therapist is going to force me to change. This is not only a fear about therapy, but also a misconception. A therapist will never (should never) force someone to change. We cannot. It is your life and you make your own choices. Sometimes when health issues are highly concerning, a client may enter a treatment center where he/she must follow certain rules. These rules are for the therapeutic benefit of the client, and while the rules may limit behaviors that are self-destructive, it is ultimately up to the client to open his/herself up to changing thoughts, behaviors, and ways of relating to self and others. If you enter therapy, you are in charge. This isn’t to say that your therapist is not going to challenge some things you do or say, but confrontation is a therapeutic tool that is also for the good of the client. Therapists point out what we sometimes cannot admit to ourselves.
2.) If I open up and am honest, my therapist is going to judge me. Honesty is one of the biggest risks in therapy — because being honest makes us vulnerable, possibly subject to judgment. Honesty is also a vehicle of change, as it allows us to connect with how we truly feel and explore those feelings. A trusting, solid, connected therapeutic relationship can foster a healing and safe space for honesty and this is one of the cornerstones of therapy. A therapist’s job is to be a non-judgemental and non-biased professional whom you can feel comfortable talking with about personal and sometimes painful subjects. If you have concerns about judgment in the therapy room, this is certainly a topic that should be discussed.
3.) If I go to therapy, I will have to keep going for the rest of my life. Sometimes people are afraid of “opening a can of worms”, and feel it’s safer to keep the genie in the bottle. I can relate to this. When I share some of my personal therapy experiences with clients, they sometimes ask me how long it took me in therapy to feel healthy and stable enough to go out on my own. As everyone’s path is different, the length of therapy might be conditional based on each person’s needs and goals. For some, a few sessions might alleviate some presenting symptoms. For others, a few weeks, or months. In the initial few sessions, I go over goals with my clients and we keep track of how progress is going as we move on. The goal of therapy is to help you find tools and strengths that you can utilize whenever you need them, and to empower you to know that you can walk on your own two feet. So, while I empathize with the fear of “being in therapy forever”, this is not ultimately healthy, and an experienced therapist should continue the conversation with you about how you are feeling as therapy moves forward.
Do you relate to any of these common therapy worries? Entering into therapy is an investment in yourself — your mental, physical, emotional, and spiritual wellbeing. To find balance and health, this may involve talking about uncomfortable things and confronting destructive coping mechanisms. As someone who has gone through therapy and sometimes still checks in with my therapist, I can attest to the benefits of this process. You are worth the investment!
If you or anyone you know is thinking about “dipping your toe” into therapy, please contact me and I’d be happy to tell you more about the process and what to expect: 720-340-1443 or firstname.lastname@example.org.
An article in the April 22, 2012 New York Times entitled: “In Therapy Forever? Enough Already” did its job and caused me to reflect on my career, my personal journey, and the complexity of the therapeutic process. I ended up evoking an audible “hmmmmm.”
Some of my therapist colleagues and I meditated on the clinical and ethical reasons for working with clients and wondered how we know when our clients can ‘graduate’ from therapy. The article, written by New York psychotherapist Jonathan Alpert, is not anti-therapy. It’s mostly a conversation-starter about why clients seek therapy and the reasons that they stay in it. I strongly encourage you to read the article and come up with your own thoughts and opinions about it — as it is a very personal subject.
Therapy, in general, is very personal. This is why I don’t think there is a black-and-white answer to the question of “when is enough, enough?”. When are we ever finished evolving and changing as human beings?
I was motivated to reflect on my own personal philosophy about therapy as I read the article, both as a client of therapy myself and as a clinician. As I work often with eating disorders (bulimia nervosa, anorexia nervosa, binge eating), I contemplated an additional factor of readiness for change in the therapeutic process. I am blessed with encountering clients who are at every stage of the change process….for some, this means coming once or twice and then taking their own journey, perhaps, to decide how and when they are ready to commit to recovery.
Recovery in and of itself is fluid and ambiguous. Some clients come for a while, take some time off, and then return when they feel they need some accountability, some support, some insight. When I was struggling with my own eating disorder, I was in and out of therapy many times — “tasting” it a bit, smelling it, figuring out if it was what felt right at the time. I had to do a lot of soul searching before I committed to therapy, and I credit my experience in therapy as my saving grace and the avenue I chose to get to my own recovery. Since that time, I have gone back to therapy several times, as a way of checking in and tuning up any loose ends. I believe that therapy will be an essential tool for my mental health for decades to come. I also believe it helps me grow as a mental health professional, as I am able to know and understand the benefits of working with a therapist whom I wish to emulate myself.
What struck me about the article was the way the author looked at different therapeutic orientations and how (he felt) some are more effective than others. For example, Mr. Alpert states: “there’s a difference between feeling good and changing your life; feeling accepted and validated by your therapist doesn’t push you to reach your goals. It might even encourage you to stay mired in dysfunction.” Herein lies the debate between supporting and enabling a client: how do we know when to encourage a client to try to spread their wings and fly, and how do we know if it would be harmful (ethically, therapeutically) to do so? This caused me to consider three of the foundations of therapy: unconditional positive regard, empathy, and non-judgment.
Are these enough and sufficient to help clients create the change they wish to see in their lives? Or do clients need something more?
I believe that the answers depend on each unique client and the therapist with whom they commit to working with. Not every client and therapist are going to be a perfect fit at the perfect time. This is why it is important for clients to get to know a therapist, see if they connect, decide if the therapeutic relationship will be strong enough to create a framework for healing and change. I feel that when the relationship is based on trust, safety and honesty, change can happen. What is said or not said can be secondary.
I am still reflecting on the complexity of therapy and the players that it involves. Client needs and goals are the focus of the process, but these can be met in so many different ways. Just as every human is different, there is no one “perfect” or “right” way to engage in therapy…and that’s the beauty of it!
I have been on both sides of “the couch”. I have been a client for many years and currently also inhabit the role of therapist with my own clients. I know how it feels to sit and talk to someone who you do not know on a personal level but still feel this uncanny and close connection to. I also am familiar with the sensation of sitting down with a client, sensing that certain natural anxiety that accompanies every session (even if I’ve been meeting with that person for a long time). Both therapists and clients have feelings and reactions. That is in part why people become therapists: because they can empathize, feel, and connect so deeply with their clients. Clients come to therapy because they would like to sort through some of the feelings and reactions they have to life circumstances…or to try to understand why they DON’T have feelings or reactions to those circumstances.
Feelings and emotions are natural and normal, and everyone has them. In therapy, where the room is safe and secure and there is a degree of comfort between client and therapist, emotions can play and explore the open air between the participants. A psychotherapy blog that I read talks about reactions that clients might have towards their therapists or towards a situation that are really not about that certain thing at all. Psychodynamic therapists call this projection. In this blog, the writer talks about feeling angry at her therapist and feeling that “the connection was lost” between them. As she works through this with her therapist, she realizes that she was upset with him because he was going on vacation for three weeks and she feared being lonely and losing her identity without him. Through this confrontation, she was able to work with her therapist towards developing more autonomy and she explored defense mechanisms that, according to psychodynamic theory, have been in place since the age of three.
In the above example, we can see how a reaction to a situation brought out some deep-seated feelings that the client was unaware of herself, and processing these with her therapist allowed her more freedom and release. This is an instance where the timing was right (the client was able and ready to go to the level of processing she needed to) and the relationship was built from enough trust that the two could sort through some uncomfortable feelings. But those circumstances are not always in place. Sometimes, the client is not able to yet make the steps towards understanding the deeper levels of his/her reactions and feelings, or the therapist is not prepared to hold the anxiety of such a situation and may allow her own feelings to enter the picture.
I have had clients expose a wide variety of emotions in session, and I am grateful that those clients felt safe enough with me to allow me to see them. There have been clients who have let me into their deepest thoughts, thoughts that they sometimes do not feel are “okay” to have. When working through challenging situations, such as when clients are trying to recover from an eating disorder, thoughts and feelings that have not been allowed to come out for fear of rejection can enter the therapy room. This is a healthy dynamic of the therapeutic process, as clients feel accepted despite their struggles. It is crucial that both therapist and client are prepared to work with these sensitive emotions when they are expressed, as they could be stuffed back down at any sign of judgment.
Fear of judgment or being unaccepted can be presented in forms of anxiety, withdrawal, dismissal, and aggression. I had a client that I had been working with for a long time whose eating disorder was spinning out of control. I could tell that she was terrified of this disorder because she felt torn between two very powerful forces: the temptation and addiction of the eating disordered behaviors, and the desire to be healthy and free. We worked for months exploring this tug of war and attempting to empower the voice of recovery that was buried inside of her. When we finally got to the point of challenging the eating disorder, she responded with anger and retreated back inside. The anger was a natural reaction that, if given the chance to work through it, could have been a tool for her to turn against the disorder. However, we did not get to explore that possibility and she never returned.
Timing and readiness for change are essential components to progress in therapy. The therapist must have the tools and experience needed to help support clients as they take steps towards expressing themselves freely and finding those answers that they came into treatment to uncover. One of the most difficult things for therapists to accept is if their clients are not yet ready for change. This is something only the client can decide, as it is ultimately their work. Through my learnings and wanderings as a therapist, I have come to accept that clients will make that commitment when they are ready and that is it my role to support them (and not push them) as they grow.
Taking that step and beginning the process of selecting a therapist that is a good fit can be a daunting challenge. When considering the decision to open up to someone about the inner-most feelings, emotions, thoughts, and secrets that you might not even know are there, you want to be talking with someone you trust. It can seem unnatural to open up and process feelings with someone you don’t know – someone whose inner secrets you will never know yourself. But, in a way, that is the point of therapy – talking to someone about those things that you may not want to or cannot unravel with your best friends and family members. So how do you decide which therapist is going to be the truest fit for your needs, offering you trust, empathy, and safely?
We all are different and have different qualities that we look for in friends, mates, and even therapists. There cannot be a “top ten list” that fits everyone, based on these unique characteristics and backgrounds. But perhaps you can consider these items and fit them to your specific situation, and perhaps they can help you in some way to narrow down the necessities you desire in that confidential communicator you meet with every week.
Top ten things to consider when selecting a therapist:
1.) Specializations. Do you have a specific issue that you need/want to work on more than others? Is there a need to focus on one or two things so that you can lessen your anxiety or depression? Do you want to see a therapist with your partner? If this is the case, search for a therapist based in his or her specialization. Some examples might be: substance abuse, trauma, grief and loss, eating disorders, couples therapy, bipolar disorder, divorce issues.
2.) How is the therapist spoken of by others? If you know someone who sees this therapist, or if you were referred to him/her by a colleague or friend, or if you found him or her on the internet, what reputation does the therapist have? Are they known to be comfortable to talk to, have they given speeches or seminars in the area and had feedback given, do they try innovative practices or are they comfortable with traditional techniques (also may be a quality that you are looking for in a good fit), what sort of credentials do they have? Their impression on others can tell you a lot about how they do their work and impact those they interact with.
3.) Location. Is the therapist close by? It can seem inconvenient to drive an hour every week to meet with a therapist, and you could arrive worn out and stressed. Or, you may prefer the traveling and you may seek out therapists in another area.
4.) What is their office like? This is something that you can only truly know once you have met with the therapist. Is the office warm, accepting, inviting? Or is it stark, dark, and drab? You might consider what type of environment you would feel most comfortable in as you process your thoughts with your therapist. Location can also factor into this.
5.) Is she or he professional? Meaning, do they approach you with professionalism and do you feel respected? Another reason we go to therapy is so that we can have a nonjudging third party to bounce our thoughts off of. We don’t want our therapist to act like our friend — we have friends for that, who don’t charge so much! We want a friendly, organized therapist who will be honest and direct with us when we are working on our goals. A recent blog talks about 21 tips for clients in psychotherapy…and it mentions the same thing in reverse: clients should also be professional and responsible. It reduces awkwardness and increases trust.
6.) Is your therapist listening to you? Again, this is something you will know after the first session, but it’s important. As you are searching for a therapist, take note of the therapists that truly listen to your story in a non-judgmental, open, curious way. You are going to therapy to work through things that you are having difficulty with, and the last thing you want to do is have to repeat yourself or for your therapist to get a blank glaze over their eyes as they stare off into space. You are the client: you are in charge, this is your therapy, and your therapist is there to listen to, support, challenge, understand, empathize with, and encourage you.
7.) Do your needs fit? Some therapists do not see certain types of clients, like children, or men, or couples, or those who are perpetrators in abusive or violent situations. Some therapists offer 24 hour care; some have strict limits on the amounts and types of services they offer. Be sure to check with the therapist to see if he or she is qualified to work with you, if he or she meets your needs, and if you are a client that fits with his or her treatment approach.
8.) Does your therapist accept insurance, or does he or she have a sliding scale that fits your ability to pay? Some of us are able to pay the full amount that a therapist might ask for, and some of us are unable. This is an important thing to talk to your therapist about, so that you can develop a strong relationship with him or her by being able to attend weekly sessions. Financial restrictions are very real, but it is unfortunate if these are the reasons that you cannot find the treatment you need and want.
9.) Does your therapist make you do the work? Yes, that is what therapy is about: you processing your struggles with the help of a trained professional. Therapists do not give you advice, do not tell you what to do, do not tell you what not to do. They are a reflecting board, a mirror, a discussion. They will help you answer your questions and work on your goals, but they will not do it for you. If you have a therapist that does the work for you, he or she is not listening to you and is instead doing you a disservice. Make sure your therapist is supportive, sometimes directive, but not directing you in what you “should” think, feel, or do. The “shoulds” are never healthy.
10.) Do you LIKE your therapist? Is he or she someone you can laugh with, cry with, be honest with, be upset with, be trusting of? The therapeutic relationship is the most important part of the healing process in therapy, and work cannot be achieved without the basis of a solid and human therapeutic relationship. This may take a few sessions, so don’t rush it, but if after several weeks you do not feel connected in the way you want to be, bring it up with your therapist.