SEATTLE — Finding a good therapist is like finding a good coach when you're learning to swim: They'll make sure you're comfortable, teach you different skills and show you how to analyze your strokes so you swim farther and more confidently. Just like a coach, they will also push you to do better and pull you out of the water if you're struggling.
But finding a good therapist can be challenging: From deciphering opaque insurance policies to making dozens of calls only to be put on waitlists, the experience is rarely smooth. Even after finding a therapist, many people wonder what the process is like, how to gauge if it's working, and when to wrap up.
The reality is therapy is challenging, internal and often intangible work. It looks different for everybody. On one end of the spectrum it can help you deal with the daily stressors of life no matter how small, or help you process past traumas. On the other end, talk therapy can also be vital for some people with severe mental illnesses.
Starting therapy
Stereotypes abound when it comes to therapy, whether that's counselors guiding mafiosos through their anxieties like Dr. Melfi in "The Sopranos" or quippy counselors on the British comedy-drama "Fleabag" giving clients ominous feedback.
One common misconception is that therapy is only necessary after tragic events: a soldier returning from war or a person on the verge of suicide. Therapy doesn't have to wait for a "big enough" crisis. Experts say it can help almost anyone know themselves more deeply or simply be a place for venting about the stressful things in life
Michael Swann, a mental health counselor working through Talkspace, suggests that in your first consult or session with your new therapist, you come with a list or goals or problems, whether that's trouble sleeping due to racing thoughts or a recent death in the family that you need help processing. Bringing goals can make the process clearer.
"Those are things that we can build off of," said Swann.
Also communicate with your new therapist about what you do or don't like: Some people prefer that their therapist mostly listen, while others seek out therapists for specific advice or want homework assignments — journaling prompts, for instance — to help them reflect.
Swann also encourages new clients to keep an open mind, "understanding that you're not going to solve everything in one take. It might take several sessions to help find some sort of resolution or relief."
Schools of thought
When it comes to how to heal, there are dozens of styles of therapy out there. The American Psychological Association characterizes them into five broad groups: psychoanalysis and psychodynamic, behavioral, cognitive, humanistic and integrative or holistic therapy.
"The funny part about all the different types of therapy is that either one can kind of work for anything," explains Tamera Gittens, a licensed mental health counselor in Seattle.
Gittens, like many therapists, uses a hybrid approach. It includes cognitive behavioral therapy, which leans toward more practical, short-term sessions where a therapist helps a client identify certain patterns in their thinking in order to change their behavioral response.
For example, if a client is anxious in social settings, a therapist may help them identify their triggering event as well as the thoughts, emotions and behaviors that follow. That may look like thoughts of negative self-worth ("Everyone thinks I'm weird and no one wants to be my friend"), the physical feeling of breathlessness or sweaty palms during the experience, and how that affects your behavior (avoiding large gatherings or meeting new people). The therapist will then help you reconfigure your thoughts, feelings and behaviors so that the trigger is more manageable.
Dialectical behavioral therapy or DBT focuses more on emotional regulation and was created at the University of Washington by psychologist Marsha Linehan in the late 1970s. Initially targeted for patients with borderline personality disorder who were experiencing suicidality or self-harm, it's now used to treat people with depression, addiction and eating disorders among other illnesses.
An oft-used DBT technique includes mindfulness-based emotional regulation using the five senses. A person experiencing stress, for example, can employ the technique of naming three colors they see, two things they hear, and one thing they smell.
Psychodynamic therapy (or what many know as Freudian talk therapy), on the other hand, focuses on trying to dig deeper into the reasons behind a person's suffering or stress over a longer term. The technique has since evolved and is linked to many offshoots of modern therapy.
Finally, if you're interested in going on medication, your primary care provider or a licensed medical professional like a psychiatrist are the best choice. Most social workers and counselors cannot prescribe though they can still give insight into the effects and advantages and disadvantages of psychiatric drugs.
Getting deep
Rather than focusing on which treatment style might work best for you, Dave Walker, a psychologist in Kitsap County, suggests checking in on your response to the therapist: "If you have an initial intuition that you feel a level of comfort with a person and feel like you can trust them — that's a good kind of litmus test for hanging in there and not worrying too much about technique," he said.
If you find that after a few sessions you're not getting the support you want, it's also reasonable to look for a new therapist who better matches your needs. It's also wise to decide if it's important for you to have counseling in person or if you're comfortable with teletherapy, which can significantly change your therapeutic relationship.
At the end of the day, Walker said, it's really a gut feeling and asking yourself "Do I feel like I could really confide in [this new therapist] and tell them stuff, talk about deeper sides of myself?"
Depending on your goals and how often you're going, therapy can last a couple of months or several years. For people with more complex traumas or those who find comfort in simply talking to someone, it can be a tool to manage symptoms or serve as a mental health "tuneup" either weekly or biweekly. Insurance requirements often force an eight- to 10-session maximum, but in reality, there's no wrong or right amount of time.
Ultimately Gittens' golden rule is: "Go as long as you are still reaping the benefits of therapy."
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If you're just starting the process of looking for a therapist, The Seattle Times has a guide. A few tips include:
* Start by checking your insurance to see which therapists are in-network. Most companies have a search option on their website or you can also try calling them to get a list. The APA Psychologist locator is also useful.
* Youth can also typically receive services through their school district or university, and some employers offer free, limited sessions to employees.
* Some mental health counselors will also offer sliding scale options if you're out-of-network, and there are also free community options like the services offered through the South King County Emotional Wellness League.
You can also look for therapists in 33 other states, thanks to the passage of House Bill 1286 in 2022. The legislation allowed Washington to join the Psychology Interjurisdictional Compact, meaning therapists can now offer telehealth services to patients in partner states.
