4 Things To Look For In A Therapist

With conditions like depression and anxiety on the rise, more Americans are seeking out therapy for treatment, and with the price of medications and therapy’s recorded success (75-80% effectiveness), it is a very popular option. What makes a good therapist? This is a question each person must work through and it may take a few visits to different therapists before the answer is clear. Therapy is an extremely intimate experience and there are several guiding principles to keep in mind when selecting a counselor.

1). Is your therapist understanding and non-judgmental?

Everyone has a unique backstory and lifestyle, and it is crucial that your therapist does not judge you based on either of these factors. It is part of their job to help you work through unhealthy habits, but if you feel like they are disparaging you because of your choices, you should not continue with them. Therapists should be sensitive and understanding no matter where you are in your recovery.

2). Does your therapist provide you with a sense of hope and inspiration?

Motivation is quite possibly the one ingredient than you cannot do without when it comes to recovery. If you are not motivated, it doesn’t matter how great your therapist is in other ways; you will not make progress. Your therapist should be a source of encouragement and prompt you to keep working towards your goals even when you are discouraged.

3) Is your therapist able to track and communicate your progress?

A very common fear when it comes to therapy is that it will last forever. No one wants to keep spending time and money on something that seems to be going nowhere, so it is imperative that your therapist be able to tell you where you are succeeding and how to keep making improvements in your life. Some therapists do a regular check-in where you are asked a series of questions and scored on a 1-10 scale. The lower the number, the better your well-being. However they chose to monitor you, a good therapist will be able to tell you how effective their guidance has been.

4). Do you feel like the therapist is a partner in your recovery?

The last principle to keep in mind is perhaps the most important. There are many different kinds of therapists, including ones who serve more as listeners than coaches, but the key is if you feel like the therapist is on your side and invested in meeting your goals. It is irrelevant if a therapist is sensitive and inspiring if you feel like you’re doing this thing on your own. The whole point of therapy is that you have someone who is walking alongside you, and if your therapist seems detached or uninvolved, they are not the right therapist.

When searching for a therapist, it is perfectly acceptable to be selective. Don’t settle for a therapist you feel is only “ok,” but instead keep looking until you find someone you really click with and who can make a strong impact in your life. Utilize resources like client reviews to gather information about the kind of therapist you want to work with, and be patient. A therapist is a person who will be developing a very close, unique relationship with you, and you want to be confident in their ability to help you.

 

Sources:

Novotney, A. (2013, February 1). The therapist effect.. Retrieved May 3, 2014, from http://www.apa.org/monitor/2013/02/therapist.aspx

Whitbourne, S. (2011, August 8). 13 Qualities to Look for in an Effective Psychotherapist. Retrieved May 3, 2014, from http://m.psychologytoday.com/blog/fulfillment-any-age/201108/13-qualities-to-look-in-effective-psychotherapist

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Change of Plans

Instead of lowering my medication dose like I planned, my therapist has suggested I stop messing with it for now. She said there might be a “better” time, but pessimism tells me that no “good” time exists. It’s basically trying to anticipate the pitfalls of lowering medication (withdrawal, depression and anxiety coming back stronger) and plan life accordingly. If I’m in a job, that could be tricky.

My therapist is retiring, too. I had my last session with her. So now I have to find another therapist at a time when the depression and anxiety has actually been increasing again. Liz even said she feels that she isn’t finished working with me and that I should definitely keep seeing a counselor. Merg. I have a couple names, but starting over with a therapist is always kind of exhausting.

 

The Anticipation is Always Worse

 

My therapist is strongly considering retiring in a month.

When she told me, I was kind of in shock. I got that feeling in your sinuses like you’re going to cry, but I managed to just stare at her, unblinking, and triumphed over my emotions.

There’s always that initial feeling of selfishness. What? You’re leaving me? How dare you have a life outside of this office. One of the reasons she’s so good is probably because she’s been doing this for so long, so it makes sense that she’d be at the end of her career by the time I came along. 

Then comes disappointment. You’re leaving? Oh. That means I have to try and find someone else. Again. Liz was my fourth therapist.

The weirdest feeling is feeling like I’m losing a friend. They always say, “Therapists aren’t your friends,” and they’re right. They feel closer than friends, a lot of the time. You tell them things you haven’t told anyone, or tell them things before you tell your friends. They help ease your fears and encourage your successes. Liz is the first therapist I’ve felt completely comfortable with. I don’t want to let that go.

Anticipating hard things is always worse than the actual experience, at least to me. It’s much longer, that’s for sure.

Seeing It Through

I’m at that point in therapy where you don’t think you need therapy.

I no longer have a long list of grievances to vent, or a terrifying event coming up that’s giving me nightmares. The hour sometimes seems like it’s going by really slow, and I find my mind wandering to other things I could be doing with this time.

Given my past with therapy, I know that I have to see this through.

Every time I’ve hit this point in therapy before, I’ve just stopped going.

I get a few good techniques, I’m no longer petrified by things I used to be petrified by, and the cost, even with insurance, seems like money that might be useful elsewhere. I get overly confident.

I’m not going to stop seeing my therapist. Why, you ask?

Because life can change in a second.

I could get into another car accident. Major family changes could happen. A pet could die. I could get into a big fight with someone.

Don’t misunderstand me, I’m not living in fear of these things, but I know that they can happen. I want to go through as many different experiences as possible with this therapist, so when they happen again in the future and I’m not seeing a therapist at that time, I’ll know what to do.

It might look like cutting back on therapy so it’s just once a month. It might look like going back to once weekly. I’m not making a clean break with this therapist. Not this time.

Their Eyes Are Watching Me

My therapist and I have been working on why I have anxiety about going to the grocery store alone. It isn’t a huge anxiety, I’ve been able to get there a lot these last few months, but I still have this weird tension when I go into a store, like I’m watching on eggshells. I want to make as little an impression as possible. It’s basically because I don’t like being looked at. I like to control my social interactions, and when you’re just wandering around a store, you can’t control who is going to look at you or not.

My therapist thinks it’s because I’m afraid people will judge me negatively, and that’s part of it, but it’s not completely accurate. She’ll say things like, “If people are looking at you, it’s probably because they’re either just spacing out, or because they think you’re pretty.” That’s not really a comfort to me. First of all, I don’t believe (like my therapist says) that people don’t think about other people at all. One of my fears is I won’t be able to find something and will wander the same aisle a couple times. I don’t want the same people to notice that, because I assume they’ll think, “Oh, she can’t find something. Har har,” or something to that degree. My therapist says that people don’t put that much effort into noticing things. That baffles me and I always stare at her with squinted eyes when she says that. How does that..that doesn’t take ANY effort. I notice stuff like that all the time, I don’t even control it, it just happens in my brain. And people are judgmental. They talk about strangers all the time. For me, the main way of getting over the anxiety is just to not care about what people think. I can’t believe that they just aren’t thinking at all.

The second thing is that I don’t really want or care if people think I’m pretty. I obviously do, but on my terms, y’know? I’m going grocery shopping, not looking for attention. When I was young, I was really awkward with clothes. I wanted to wear certain clothes, but I was afraid to. My mother was telling me frequently to pull my shirt up, such and such was too tight, I shouldn’t bend down, or that my jeans were riding too low, and I got really self-conscious. I just got my first two-piece swimsuit last year and did not tell her (guess she knows now), but I was too nervous to wear it, and now it doesn’t fit anymore. I have ordered another one, FYI. Whenever I decide what to wear, it’s hard for me to not be consumed by thoughts of what people will think, and Chris is no help. He likes everything. In my mind, I’m always agonizing over if something is too “sexy,” but I also don’t like to wear unflattering clothes. This level of self-consciousness is at its highest when I’m out in the world alone and all people will notice is my clothes and body. I can’t talk to them so they walk away thinking something else besides, “Oh, she’s cute. Nice scarf. Cleavage. Hideous face,” or whatever.

I just don’t like to be looked at when I don’t want to be looked at.

Adrenaline Rush

In therapy, we’ve started to focus on anxiety. I’m much more concerned about that right now than I am about depression; depression is something I’ve learned to deal with and to a certain degree, can’t be “cured,” but anxiety is relatively new, and I believe that can be trained out of me.

I don’t remember my life without depression, but I remember it without anxiety, and I want that life back.

We talked about activities that I can practice, the ones that are on the lower end of my anxiety. Leaving the apartment to do laundry, going to the store alone, talking to clerks, and driving are all things I can practice pretty easily, and have made a lot of progress in. I went to my psychiatrist yesterday, and when I saw her last month, I wasn’t even able to go downstairs to the laundry room because of the anxiety. Since then, I’ve done laundry four times, gone to the store twice, and driven myself to every counseling appointment. The changes in medication has definitely played a part in that; when I sleep better and stay asleep for longer periods of time, the rest of the day automatically goes better and I’m able to concentrate my energy on achieving my goals.

There are certain activities that I can’t really “practice,” and those are on the highest end of my anxiety spectrum. Job interviews, saying something potentially embarrassing, and going back to school are all petrifying. When I think about school, it’s not school itself that I’m anxious about. I’m afraid of repeating what has happened before and what can only be described as a crash and burn. I’d start out the semester ok and then over time, get more and more anxious about things, miss more classes, and panic about everything. As I went through college, the periods of time where I could push past my fears got shorter and shorter until I collapsed on Chris’ floor just before midterms of my junior year and stopped going to school. I’m afraid that will happen again.

I’m afraid that when I walk through the school buildings, sit in class, and just navigate life as a Macalester student, the memory of my anxiety will be too vivid to ignore. Simply by being in a situation where in the past I’ve felt a lot of anxiety will be enough to send me spiraling. My brain will go into protection mode and a shot of adrenaline will disrupt the normality of finishing 20 credits.

What has basically happened to my brain is that my adrenaline is overly sensitive. While most people only experience that level of intensity when there’s an actual crisis (running from danger, gaining super strength when a car falls on a child, etc), I will begin feeling a sense of danger when I’m just doing everyday things, like asking for help in a store or meeting with an academic adviser. The physical symptoms of adrenaline kick in and I interpret that as meaning something is actually wrong, and my thinking follows. Why can’t I stop shaking? Why is my mouth so dry? If I talk, it sounds like I’m going to cry, and that will make me seem weak and weird. I can’t be around people right now, they’re making it worse. Now I can’t breathe. The fears going through my mind only make the adrenaline rush worse and that can cause anxiety attacks. The physical and mental panic build on each other until I can’t tell the difference between them.

Since my anxiety is so physically based (shaking, difficulty breathing, dizziness, feeling out of control of my body), the solution is also physical. What I basically have to do is calm my physical state before my mind can interpret the situation as one involving actual danger. In my head, I know that sitting in a class is not scary, but when my body is responding to the situation with shakiness and cold sweats, it’s hard to convince my mind that everything is peaches ‘n cream. When an adrenaline rush happens at an inappropriate time, I need to make some physical adjustments to ease the adrenaline back to a normal level. Deep breathing is key. When breathing gets out of control, everything just falls to pieces. Focusing on maintaining deep, even breaths calms down panicky feelings and concentrates the mind on something other than the non-existing peril. My therapist also suggested carrying water wherever I go, since getting a very dry mouth and not being able to swallow are very common symptoms for me. Drinking water helps so many things. The dizziness might even be caused by partial dehydration or low blood sugar, which I also tend to have, so having water and keeping a good blood sugar level are possible solutions. It certainly wouldn’t hurt.

I may not be able to go practice going to school by actually going to school, but thinking about it is all it takes for a lot of my anxiety to kick in. I can use that to practice breathing and other techniques to calm myself down. Simulating anxiety-causing situations and then learning to control the feelings that arise is definitely a new goal on my list.

Sleep Paralysis

“The Nightmare” // John Henry Fuseli

Definition: A phenomenon in which people, either when falling asleep or waking up, temporarily experience an inability to move. It is often associated with terrifying visions to which one is unable to react.

Sleep and I have a terrible relationship. It’s pretty common for people with depression to either sleep too much or too little. I don’t sleep well at night, sometimes not at all, and then have trouble staying awake during the day because of exhaustion. In high school, I would always fall asleep during math and history class, and people stopped trying to wake me. The last time I was at college, I would fall asleep sitting up. Lately, the trend is to not fall asleep until between 3-5 am. I either lie in bed listening to Chris sleep (he’s pretty chatty), play Angry Birds on my phone, or sit in the living room and watch Baxter play by himself with his paper tubes.

Another trend has been to experience sleep paralysis. I remember having it first at church in the prayer room. I was supposed to be praying (this being the room’s purpose), but I slipped between a wakeful/sleep state and became convinced that I couldn’t breathe or move. I could hear voices around me; voices of people I knew were not in the room with me. I tried flailing my arms, signaling for help, but it was impossible. When I did wake up, I was completely in a daze.

I probably had minor episodes of paralysis during the time I had trouble going to an 830am class. I would hear my alarm and it would take all the strength I had to turn it off. I imagined heaving my body from the bed and crashing unto the floor, but no amount of imagining was enough to actually inspire the reality.

The worst has happened this year. I woke up already terrified, convinced that someone was in the apartment. I could hear their voices, as clear as day. They were even calling each other by name: Katie and Marty. They had come in from the balcony and were rustling around, eating our food and watching “The Twilight Zone” on the TV. In my paralyzed state, I imagined falling out of bed and seeing Marty standing in the doorway. He was more surprised than murderous, but I was completely vulnerable. Sleep paralysis is supposed to be temporary, but this episode seemed to last forever.

The latest was just this past week. I was supposed to meet one of my best friends for brunch, but when I woke, I saw that I had not heard my alarm. My plan was to leave immediately but to my horror and extreme frustration, I was once again immobile. I texted him, frazzled. I ended up not explaining what had actually happened, but in my imagination, I did. I also imagined a bunch of other texts that I later saw never happened. When I fell deeper into sleep/wakefulness, I was attacked by bees. This spell lasted the longest ever – about four hours.

Sleep paralysis is common for people who have anxiety disorders or even separate sleep disorders like narcolepsy. My therapist has recommended I see a sleep specialist. No one has ever suggested that and it seems kind of basic, now that it’s been brought up. A person’s whole health is determined more or less by how much sleep they get and what the quality is. Not getting enough sleep can lead to an increased risk of heart disease, diabetes, and a variety of cancers. Without any sleep, a person can literally die. Literally. Die. It’s as essential as water and food. I’ve always known how important sleep is, and I try to keep a schedule, but maybe there’s something medical about why I can’t seem to get into the REM cycle that determines actual restfulness.

Most people don’t think about sleep as being just as much of a medical issue as stomach pain or migraines. Maybe there’s something medical that explains why YOU can’t sleep.

The New Therapist Update

I’ve only been to “Liz” twice now, but I’m very optimistic about working with her. She seems more qualified than the other therapists, maybe it’s just her method, but she just seems to know what she’s talking about, and most importantly, what I’m talking about.

Her office is small. It’s a suite in an office building, with a little waiting room with warm, slightly dim light. Her office itself is brightly lit with natural light. She has a fountain she plugs in that fills the room with the sound of water. The environment is calm, but not sleepy. The couch is insanely comfortable. It’s also significant to me that she sits at a very balanced distance from me; she’s not too close or too far away. Most therapists I’ve been to seemed very far away. There was this empty space between us. I felt a little like I was being observed in a zoo. With Liz, we’re in this together.

The second time I met with her, she had typed up all the problems I talked about, and had a section for goals and methods. Here’s a sampling:

Panic Disorder/Mild Agoraphobia – move to reduction of social anxiety, agoraphobia resolved, no panic attacks – learn and practice coping skills, desensitization, identify factors that cause anxiety

No other therapist ever handed me a piece of paper with something concrete on it. I want to attack this illness from a rational viewpoint; it’s the emotions that are the problem. I’m used to studying. This is familiar ground, this is my court. CBT seems to have the tools I’m looking for.

The biggest thing I’ve noticed with Liz is that unlike with other therapists and even with my current psychiatrist, I don’t feel like I’m performing. I usually feel the need to have the “right” answer, to always be articulate, even funny, but with this therapist, I don’t always know the answer. That’s why I’m seeing her. Why do I often feel crippling physical and emotional anxiety when I’m in a group of friends? Liz is able to help me break down the question into smaller questions that I can better answer. Am I afraid of rejection, even from friends? Am I afraid that when I get quieter, withdrawn, that people won’t like me? Is that why I feel like I’m always performing, pretending to be an extrovert when I’m around people, and then the consequence of that is exhaustion and anxiety?

These are the important questions. I don’t have all the answers, but maybe simply asking the question is where the real change begins.

My Grown-Up Wish List

I’m looking at my intake sheet for my new counselor and it is eleven pages long. I guess I shouldn’t be surprised. This should be thorough. I’m asking this person to help me learn how to live. They should know just about everything about what’s up with me. I’m looking at the section where it asks, “What do you hope to get out of counseling?” Hmm. I’ve only recently developed a more concrete idea of what I want my life to look like. I’m starting simple.

• Keep the apartment clean
• Go to the grocery store alone
• Cook more
• Read more
• Socialize more
• Go outside and exercise

These things may seem basic, and that’s because they are. It’s been pretty difficult to admit to myself that I can’t do the basic stuff. I tried to jump right into school, work, etc and I couldn’t even vacuum a room. Ya gotta start from the bottom rung of the ladder and climb up. Jumping around on a ladder usually results in falling right off. Some people can do it (like those insanely smart 13-year old kids who go to college and they can’t even start driver’s ed), but those people are the minority, and there’s probably a lot they missed out on, too. The world looks a little different from each rung, and I want to take my time enjoying the view. Or at least learning from it. Some rungs are harder than others, especially since I’m afraid of heights. It’ll be ok though. I’ve got a safety harness – people who support and love me. They’re helping me climb and they’ll be there if I fall.

 

Therapists

(Therapists’ names have been changed)

I saw my first therapist at about sixteen. Candice was nice, but as I continued to see her, I figured out she was a passive therapist. They are just there to listen to you sort things out; you simply talking leads the patient to have personal revelations. Or something. The problem with that for me was that I wasn’t coming to anything new in talking to her. I was telling her everything so she could help me. That wasn’t her style. Eventually, I just stopped seeing her. Rehashing everything in my brain was exhausting.

The next therapist I saw was at college. She offered more insight and tips on how to manage my night panic attacks. I really liked Donna. That year was especially lonely for me, and I felt depressed that my closest friend was my therapist. And therapists aren’t supposed to be your friends. They care about you, but there’s a delicate balance. The therapist-patient relationship is not like any other relationship you have. When I left the school, I had to leave my therapist. The thought of finding another one was too difficult.

It took a while for me to see another. Sandy had more active techniques and used some CBT and anxiety-coping skills. It was promising. Then something came up that I hadn’t discussed with other therapists and I felt that Sandy was arguing with me. I felt, for the first time with a therapist, that she wasn’t listening. That was the last time I met with her.

On Tuesday, I go see yet another new therapist. I feel more prepared. She specializes in CBT. I have a concrete idea of what my goals are. I’m hoping this therapist will stick.