What therapy is like

Disclaimer

I am not a trained professional. I'm just a dork who's been in the system for a long ass time. Will your experience differ? Yes. Is this the end-all be all for all things counselor? No. Will this give you the general idea of how the process works with no promises? Hopefully!

Intro

Finding a counselor can seem like a daunting task when you've never done it. There's supposedly still "stigma" behind it (although, I personally have not seen it.) Finding a therapst who actually “gets it” can sometimes be stressful, especially when you’ve been through the system for every like I hae. After 25 years and dozens of different therapists, you learn that the process is often repetitive, occasionally triggering, and above all else, requires you to advocate for yourself, even if it's scary!

Some Terminology

Counselor? Therapist? Behavioral Specialist? Psychiatrist? Maybe even in some cases... Social Worker? Does it all mean the same thing? Yes and no. In casual conversation, these are often used interchangeably.

There IS technical definition behind these all, but outside of 1 exception, the process for them all has been mostly the same as below. For the sake of ease I will refer to them all as Counselors. The #1 thing you should check is, which ones your insurance covers.

The Exception: Psychiatrist

Counselors, Therapists, Behavioral Specialists, etc do not prescribe medicine. They use 'talk therapy' to help you understand and work through issues. Psychiatrists are the ones that prescribe the medicines. Honestly, it will differ depending upon what country you're in. I have experiences with 2 different countries, so I shall share them!

• USA: In the US, you can get a referral from a counselor or behavioral health facility to see a psychiatrist for 15 (maybe 30 in some cases) minutes, use them wisely. Briefly describe the feeling you get as quickly and efficiently as you can, as they will 'diagnose' you quickly. I think this is dumb, as they have 'diagnosed' me with all sorts of weird stuff that isn't relevant. You will go back to this psychiatrist once a month or so for another 15 minute to tell them how the med is working, and get a refill if needed.

• Canada: In Canada, you can ask your general doctor (or a walk in dr if you don't have one) for a referral to a psychiatrist for medicine. I get 1 hour with a psychiatrist, and I thought that perhaps you booked regularly with them, but NOPE. I see him once, and he sends off a couple prescriptions to try to your general doctor, then your general doctor will prescribe them to you. Do you ever go back to see them? I'm not sure, I haven't made it that far yet. Sorry!

What if the medicine doesn't work?

If it's doing NOTHING, don't feel shy to speak up and say you want to try something else! They put me on every fucking SSRI/SNRI in the galaxy and none of them worked for me. SSRIs work by "holding onto the happy chemicals" a bit longer, which wasn't my issue. My issue is that I am WIRED. My fight or flight is constantly on due to all the trauma I've had in my life. What worked for me was things that depressed my central nervous system and evened out my nerves misfiring. So... weed edibles! (and then later, the prescription, Lyrica)

Finding a Counselor

Before you panic about the costs of counselors and how to find one, the solution might be actually quite easy.

1.) Check your "in-network" providers through your health insurance. If you don't have health insurance, don't forget to check if your workplace has an Employee Assistance Program for free hotline sessions. When I worked at Walmart, they offered me many!

2.) Ask the receptionist at your school for either counselors hired directly by your school or they may have a referral to one partnered with your school. It may even be free or cheap!

3.) Search The Interwebz: You could just search "therapists near me" but using specific terms like "Adult Autism counseling near me" or "PMDD specialist" to find people who understand you as a unique person might be more tailored to your needs! :3 Many places "near you" will do phone appointments, and having the flexibility to move to in person is nice if you need it!

Speaking of, decide if you want in-person, video, or phone sessions. Phone is great for those days when you don't want to wear pants, but it might lead you to be slightly distracted if you get lost on your phone or computer during the session. Also, for some people body language is very important as well, and it something that is lost in phone appointments.

• Resource: Psychology Today! [[1]] (or depression, or anxiety, or stress or trauma, whatever you might think relates)

Make sure to read what other people say about the clinic's atmosphere and responsiveness on Google Reviews. Check their website and read the bios of each counselor to see if maybe you 'jive' with one of them more than the others!

The Waitlist

There may no openings for a particular counselor, but feel free to ask to be put on the waitlist! Sometimes they can be long, especially in Canada, but keep calling around, and keep putting yourself on waitlists, you may find someone that doesn't have a waitlist! Just because 4 counselors are completely booked doesnt mean they ALL are! NEVER GIVE UP!

Keep Good Counselors

In NA, a big frustration is the "State Line" law with counseling. Most therapists cannot practice outside of the state/province where they are licensed. If you move frequently, you will likely need to find a new counselor every time. Keep your own notes so you can keep the next counselor up to speed if you need.

In conclusion, be picky and demand results (politely). This is YOUR mental health, and you deserve a counselor who pays attention and respects your boundaries.

You x Counselor: First Date (It's Clinical!)

The first session is rarely "juicy." Most therapists spend the first session on normie pleasantries and administrative intake.

These days most counselors will ask the PHQ-9 (Depression) and GAD-7 (Anxiety) questionnaires (pictured to the right!) Some counselors have a massive boner for these forms and may ask you to fill them out every single session. I have told them in the past, I do not like doing this, and they have respected it, and we might do it once every 6 months. The assessments may take the entire hour, depending if you autisitcally ask 9003 questions about each question.

After the assessments, the conversation might be pretty light, such as: "What brings you in today?" "What are your goals?" or "How have you been feeling?" It’s Okay Not to Know! If you feel sad or down but can’t pin it down on the "why", it's okay to answer with "I don't know" or "I'm just not sure". It's a 100% valid starting point. A good therapist will probe gently to help you find the words that apply to you!

Please note that these ARE trained professionals, and if you are having insecurities or even bad thoughts such as "It is hard to admit there is something fundamentally wrong with me", they will know how to despute these thoughts and help you see the forest through the trees. :3

You x Counselor: Social Boundaries

You are the boss of your own session. If certain topics trigger you, or if you know your limits, speak up! For me, "How are you?" feels like a loaded or annoying question when I am clearly struggling, so I would put it in my before session notes. "Please don't start with social norms of asking how I am. I want to dig in."

You x Counselor: The Tough Conversation on Triggering Subjects

It's okay to be triggered by things that aren't socially conventionally triggering. I literally am triggered when people ask "How are you" and that's something everyone says on a daily basis!

Regardless of WHAT triggers you, you deal with them all in a similar way.

Warning: Content regarding self-harm/etc - Click "Expand" at the right to show this content

Therapists are trained to assess for self-harm or suicidal ideation. They need to ensure you’re safe. They will often ask "Have you ever felt like hurting yourself or others?". If you do answer yes, they WILL dig in more. I have personally answered yes often, my PMDD Makes me, uh, mentally spicy for a couple weeks out of the month. They need to make sure that you arn't a current threat to yourself or others, so I will usually answer of "Because of my PMDD I often feel like yeeting myself off the balcony, but I know they are invasive thoughts and I have no intention on acting on it." Like, I have already explored that subject, and it is not for me, it just makes me upset. There's nothing to dig into there, it's just hormones get me invasive thinking 2 weeks out of the month. I know it will go away.'

At the end of the day, if a subject, ANY subject is invasive and unhelpful, you have the right to say: "I’ve explored this and I don’t want to discuss it further."

The Homework

Often times counselors will give you homework, worksheets, or something to do before the next session. It is IMPERITIVE that you do it. One of my exes refused to do any of our couples counseling homework, and she said "If you don't do the homework, I will not see you anymore." We... broke up not long after that, and I left. DO YOUR HOMEWORK! If you just need some place to vent instead of results, that might be okay too, but please remember, venting doesn't solve problems, it just releases steam. Sometimes that's enough for you to get back on track, but often times it needs more than that. <3

What Homework?

One of my best therapists used things like this: TherapistAid.com Worksheets

You x Counselor: Best Fit Forever <3

Not all counselors are equal. Some offer "toxic positivity" (think happy thoughts!) that doesn't fix real world trauma or abusive history. (I've had them, and I've "fired" my therapist for toxic positivity!) I need results, not bandaids. (Those aren't even bandaids for me, lol)

I've told therapists I need homework or actions to take inbetween sessions. I need some way to try new things and gauge if I am good at them or not. :3 "I’ve been in therapy for a long time and I’m looking for strategies, homework, and results, not just a place to vent. How do you measure progress with us?"

I've told a counselor you can only meet after Wednesday, and they suggest Monday or Tuesday, they aren't paying attention to my basic needs. If they don't respect my booking details, they likely won't respect my deeper emotional boundaries, and while IDK if this is the healthiest way to deal with it, I move on when I get counselors like this.

If you don't feel comfy with a counselor's style after a few sessions, there is no obligation to stay there. You don't owe a counselor your loyalty if they aren't providing you with help that... helps you. I have called and talked to the booking agent saying "Hey, I would like to try a different counselor until I find one that fits.