How to have a successful therapy experience
March 6, 2015 6:41 AM   Subscribe

I'm seeing a therapist for the first time in my life next week following chronic illness. How do I get the best out of it?

I'd describe it best as almost health PTSD. I was really sick for a very long time and only a matter of 8ish weeks ago got treatment. I was also severely depressed and anxious because of how sick I was and how much pain I had before treatment.

I'm still recovering and have some symptoms that I will investigate if they don't go away (dizzy and headaches, weakness). But when I start to feel off I freak out that I'll be sick again like before and that makes me feel worse and the anxiety gets worse... and it spirals. The depression is pretty much gone and has been replaced with anxiety.

I have at minimum, mini panic attacks every day and it's holding me back at my job and from finding a new job and having a fulfilling life.

So what should I do before, during, and after my appointments?

I was planning on making notes for goals and specific issues I'm looking to solve so I don't get side tracked onto other topics. Should I take notes during the appointment?

I'm a pretty open person and not really shy when it comes to talking about feelings in these types of settings.

I also would love some ideas on how to track what I should see my gp about versus trying to tackle in therapy. (For example daily headaches are probably a medical issue, but maybe the fatigue is both?)

In general, I don't want to be on daily meds. I have a super low dose of Xanax. (.25 mg that I am to take only half of). Meds make me feel weird and I kind of hate it. I've only taken it once and haven't taken it at work. I also plan to have more quiet time at home and hope to be healthy enough to do light exercise. I want to get the most out of this and get my life back.
posted by anonymous to Health & Fitness (7 answers total) 6 users marked this as a favorite
I'm sorry about what you're going through. It sounds like you're doing a great job handling it responsibly.

You won't know how well you "click" with this particular therapist until meeting, but if it goes well, I'd recommend scheduling more visits so you don't feel a need to address everything in one session.

If notes help you, then absolutely feel free to use them. I'd tell the therapist everything you said here. There's nothing wrong with being goal oriented, but try to allow room for the therapist to ask questions.

I also would love some ideas on how to track what I should see my gp about versus trying to tackle in therapy.

Please mention your physical symptoms (headaches included!) to the therapist and your gp. Let each know that you're working with the other, and let them both do their jobs of working to find the causes and best solutions.

Taking notes during therapy is perfectly fine. I personally have trouble taking notes in that setting, as I feel it breaks the flow of conversation, but YMMV, and I would encourage you to have something to jot down words or short phrases that you'll want to look into more (and/or ask your gp about).

Above all, I'd say that even as frustrated as you must be, try to limit your expectations of what can be accomplished in one session, and plan to go back. That takes patience, I know, but again it sounds like you're doing a great job already.
posted by whoiam at 7:09 AM on March 6, 2015

My favorite metaphor lately is that a therapist is like a personal trainer you'd hire at the gym -- they're there to help guide you through exercises and experiences that can help you reach your goals, but you have to do the work.

I find that a lot of new therapy clients come into my office expecting me to fix them, or give them a list of things they can do that will solve all their issues unrealistically quickly, and those clients tend to end up disappointed (which can actually be a useful part of the therapy process, but it's not a necessary one). The clients who seem to progress and make the most profound changes are those who trust that it's often a slow process, especially for longstanding issues.

Especially at the beginning, the therapist may ask you about all sorts of issues that you may not identify as the "real" issues, but she or he will probably be able to help you more by learning about lots of different areas of your life and how you tend to respond in different situations. That doesn't necessarily mean you're getting sidetracked. A lot of the work that happens in therapy is possible due to a strong relationship between the client and therapist, and that relationship (like all relationships) takes a bit of time to develop.

If you are seeking short-term therapy (less than six months) and your therapist is not working in an agency where that's an explicit parameter (i.e., there's a limited number of sessions for any client), then it would likely help tremendously to let your therapist know that at the beginning. Any problem has different "levels," so to speak, and knowing any time parameters like that will help the therapist assess how deep to be working. (That's not the only parameter for making that decision, but it's the one you have the most say in!)

I find that clients who have to go back to work immediately after a session progress a bit more slowly, because it can be hard to open up about difficult things if you know you have to show your tear-stained face to your colleagues afterward. If possible, have at lease some downtime scheduled for after the session. If it's not possible, you may want to let your therapist know you'd like some "pulling it back together" time at the end of a difficult session, so that she or he eases up a bit in the least 5-10 minutes. Many therapists will do this with everyone anyway, which is fine, too (and which is often why your therapist may be glancing at the clock a bit more near the end of a session).

Most importantly: Try to use what you're learning in the sessions outside the sessions. It is useless to develop a bunch of skills that only work in a therapist's office, because you don't live in a therapist's office. Some weeks may be more active in this regard than others, but it's helpful to at least think over what you talked about with your therapist between sessions. That's the "personal trainer" bit -- you need to make sure you're doing the work, not just showing up to sit on a couch for an hour a week and expect your therapist to do the work for you. (I'm not saying you have this expectation, just that it's a very common one in new clients.)

This series on Therapy Myths and Facts might be helpful for you.

Congratulations! It's sometimes a hard step just to seek out help, and I wish you the best with it!
posted by jaguar at 7:25 AM on March 6, 2015 [6 favorites]

A rule of thumb that's served me pretty well in therapy is, if I notice I'm scared of talking about something, that's an extra reason to bring that something up.

Like, sometimes to the point where I'll just pipe up out of the blue and say "Huh. I just realized I was trying to avoid mentioning XYZ because it's kind of scary and I don't want to talk about it."

It's not like I've got a 100% success rate at opening my mouth about the scary stuff. Honestly I'm probably closer to 1%. But whenever I do manage to do it, it turns out to be so worth it in the long run.

(Also, it's okay if it takes you a while to build up enough trust in your therapist that you can bring up really scary things. You can't just decide out of the blue to trust a total stranger immediately.)
posted by nebulawindphone at 8:26 AM on March 6, 2015 [2 favorites]

A lot of time, meds take a while to smooth out the initial side effects, and sometimes they have severe, strange side effects. Their positive effects can also be harder to notice, after all, when things are working better/smoothly, we tend to not notice as much as the serious issues.

Generally, therapy + meds seems to be the best combo. Therapy by itself is of course far better than nothing. But you really might want to coordinate with your doctors to get on a good med regiment that works for you. I fully understand the desire to not be on pills 24/7.... but it might be worth it, for your general health and happiness. And you can get off them in the future if need be.
posted by Jacen at 9:11 AM on March 6, 2015

Honestly it sounds like you're pretty prepared already.

One thing to keep in mind is that if after a few sessions you don't feel like you "click" with this therapist, it's totally okay to stop working with them and find another. You won't hurt their feelings, it won't be weird, it happens all the time.
posted by radioamy at 10:15 AM on March 6, 2015

A rule of thumb that's served me pretty well in therapy is, if I notice I'm scared of talking about something, that's an extra reason to bring that something up.

So much this. At a session a few weeks ago, my therapist mentioned something. I sort of hemmed and hawed, and then started actually squirming in my seat, then said "Huh, that's making me uncomfortable, isn't it?" Then we had one of the most intensely productive conversations we've had.

One of the real keys to effective therapy, for me, is to be as absolutely honest as you can. Which includes stuff like "I don't know" when you don't, and then exploring that. Taking notes may or may not work for you; personally it doesn't work for me as it takes me out of the moment. Writing down your impressions after may be more useful; YMMV.
posted by feckless fecal fear mongering at 10:27 AM on March 6, 2015 [2 favorites]

Coming late as usual, but (if you haven't already seen it) you might take a look at OmieWise's classic comment from 2006. It's the best advice I've seen for people who are considering or about to begin therapy.
posted by tangerine at 10:42 PM on March 9, 2015 [1 favorite]

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