This 22-minute episode of Life Kit titled "How to Start Therapy" tackles some initial questions you might have about therapy including how to find a therapist, fee, and how to talk to others about therapy.
Hey friend, it’s been awhile!
It was good to see you again although I wish it had been under different circumstances. I’m so sorry about your dad. You and your family have had a rough year. I wish we could have talked a bit more. You mentioned (it might have been said jokingly?) that you might start therapy.
Thought I’d write you and let you in on a secret: I’m in therapy. Promise you won’t tell my parents if you run into them? Thanks.
I wanted to tell you that therapy wasn’t what I thought it would be. I thought it would be totally focused on ways to cope with my unhappiness, my boredom, my anger…and we do talk about that sometimes.
What I didn’t expect was to focus so much on…well, me. That might sound silly because obviously in therapy, I’d talk about myself. But seriously, I’ve never really focused on myself.
I know we’ve lost touch over the years, so I don’t know what your family is like now. In high school though, I do remember our parents being similar in that they expected us to study hard, be at the top of our class, go to an elite university so that we could get into a prestigious graduate program, so that we could get a high-paying job and buy a nice house and car. I think we both worked really hard to meet all of those expectations.
In therapy I’m learning about what my parents didn’t focus on: me. Who I am, what I want, how I feel. My dreams, my worries, my fears. My feelings, my hurts, and my insecurities. It’s weird to talk about this stuff in therapy because it’s not something that comes natural to me. And at first, it was really, really hard. I’m still getting used to it. But I’m finding that there’s more to me than my degrees, my title, my car, my house. A lot more, actually. It’s been hard, and healing, and eye-opening.
Ah, but you notice that I asked you to not mention to my parents that I’m in therapy? Yeah, they don’t know and I don’t want them to know. They think that seeing a therapist means that something is REALLY wrong with you. Like you’re crazy. You know, I’m doing pretty okay. On the outside, it looks like I’m alright, doesn’t it? Yeah, it was on the inside that I was suffering, hurt, limping along, and sad. I was never really taught what to do with all of those feelings except pretend that everything was okay. I’m learning now that feelings aren't scary. They don’t last forever. And that it actually feels better if someone (or a handful of select someones) knows what I’m going through. I don’t have to be alone.
Anyway, that’s all for now. I’m thinking about you, your mom, and your family. Text me next time you're in town. We'll catch up over some coffee. Or ramen.
Sometimes it’s a joke thrown around at a party – someone will talk about a bad habit, hurtful situation, or a dysfunctional family member, and then add, “…so maybe I’ll need therapy!” and everyone will chuckle.
But, seriously, what are some of the reasons that prompt people to actually start therapy? Here’s a list to give you a general idea:
-A troubling relational pattern: You realize that all of your dating relationships tend to end the same way. Or you seem to be attracted to the same type of person that is no good for you.
-A big decision: You’ve come to a crossroads and don’t know what to do. You want to talk with someone outside of the situation to figure out what to do.
-Communication problem: You find that it’s difficult to express what you want in a way that others can hear and respond to. Or you are overwhelmed with everything you’ve agreed to do.
-Feeling sad and depressed: You’ve lost motivation and have difficulty concentrating. It’s starting to affect your daily life and work.
-A crisis situation: You experience the sudden (or not-so-sudden) end of a relationship
(i.e. break-up, divorce, death.)
-Self-awareness: You’re interested in personal growth and would like to do more in-depth processing of your past and present.
-Feeling anxious: You’re tired of being in a constant state of worry about one particular thing, or about everything.
-Grief: You’re grieving the loss of a loved one and tired of the clichés of well-intended friends and family members. You want someone to sit with you and listen and talk with you through the pain you’re carrying.
Maybe something on this list resonated with you, or maybe not. There are many other reasons why people start therapy. This is just a starter list to give you an idea of what your work in therapy could focus on. What could you use help with?
Being in therapy is an investment of time, energy, money, and emotional work. As a result of this investment, people can experience many benefits in terms of how they feel, act, and relate to others.
However, in order set yourself up for a productive therapy experience, there are a number of things to consider before you actually start. Below I’ve listed some questions to ask yourself as you think about starting therapy.
1. Do I have the time to be in therapy?
Therapy works best if you have regularly scheduled sessions. You will mostly likely have a standing appointment with your therapist which means that you will meet every week on the same day and time. Can you commit to carving out this time in your schedule every week?
Furthermore, therapy requires you to take a good look at your life, thoughts, hurts, and behavior patterns. Examining all of this stuff is hard work. A therapy session may only last 50 minutes, but there may be residual thoughts that will stay with you throughout the week. Will you have the emotional energy to pay attention to these thoughts?
2. Can I afford it?
Therapy sessions, depending on where you live and which therapist you work with, can cost anywhere between $100-$150/session.
If you’d like to work with a therapist who has completed the licensing process and has more experience, take a look at your budget and see how you can make room for therapy and/or start saving so that you can afford your sessions.
It’s possible to find lower cost therapy if you go to a counseling clinic. However, at most clinics, you will most likely work with a trainee or intern with less experience as they are still undergoing training and schooling.
You can also look into what kind of mental health services your health insurance covers. However, there may be a cap on how many sessions are covered and a limited number of providers you can choose from. Sometimes health insurance plans require that your therapist give you a formal mental health diagnosis (e.g. Major Depressive Disorder), and some clients feel uncomfortable with this being documented.
Another option is to look into being reimbursed by your Health Spending Account.
3. What do I want to work on?
Being able to clearly communicate what you’d like to work on is a helpful place to begin. It will give your work focus and direction. Maybe you’ve noticed that all of your dating relationships have ended the same way. Or perhaps your anger flares up more often than you’d like. Perhaps you’re just tired of feeling lonely and discouraged. Maybe you want to feel good about yourself.
If you could describe what you’d like to work on in two sentences, what would you say?
4. Am I willing to do this work?
People usually think about getting into therapy because they are in some kind of pain. Taking a good look at this pain and where it’s coming from can be challenging. It requires honesty about your experiences, feelings, and struggles. At times, it might feel pretty icky and uncomfortable. What comes from all of this work is more self-awareness so that you can identify ways to grow. But getting there will not necessarily be easy or feel good. Ask yourself: Am I willing to do this? Am I up for doing this right now?
5. Have I had a recent physical?
When I first start working with clients struggling with anxiety or depression, I ask when they last saw their primary care physician for a physical. Sometimes an underlying medical condition can cause symptoms that look and feel like anxiety and/or depression. Therefore, it’s important to rule-out or treat any medical conditions that might be contributing to how you’re feeling.
6. Am I open to changing?
Once you and your therapist have more awareness about what you’re struggling with, you may talk about ways to change your thinking and behaviors. This can be uncomfortable and scary because it’s new and unknown. Are you willing to experiment with a new way of communicating/thinking/responding? Are you open to taking a risk and trying something new?
If you’ve answered “Yes” to these questions, then there’s a good chance that you’re ready to start your work in therapy. If there are a few questions that you’re not so sure about, take some time to think about what needs to happen so that once you do start therapy, it’s a productive experience and a good use of your energy, money, and time.
Just one last note: I hope that the questions I’ve posed don’t discourage you from seeking out therapy! Rather, I hope that these questions will help set you up for a successful and positive therapy experience. Most people can usually benefit from being in therapy. If you desire more wholeness and contentment in your life and your relationships, I encourage you to consider therapy and do what you need to do in order to make it happen.
I’m Elaine Gee-Wong and I'm a therapist with a private practice in Santa Clara, CA.
Any information or advice on this website is for informational purposes only, and should not take the place of information or care provided to you by your physicians, medical, or mental health care professionals.