What is therapy like?
August 19, 2008 4:22 PM   Subscribe

What is therapy like?

I'm a 30 year old woman, and I'm almost certain that I've been more than a little depressed for a pretty big part of my life. I just never noticed it until recently because I've kept myself insanely busy with work and school and other things. I've always been the sarcastic, "bitter" one of my group, but I always played it off as, "oh, I'm just funny in that sarcastic, cynical way." While there have been some moments in my life where things were good, overall, that's really how I see the world. I've come to believe that my life just blows and there really is no point, because everything sucks anyway, so why bother?

So yeah, I need/want therapy. Problem is that right now, I don't have health insurance. I'm looking for a new job, and assuming it provides benefits, I'd like to start seeing someone as soon as the insurance kicks in, because living like this sucks and I'm officially Over It. I understand that there are places (especially where I am, I live in NYC) that work on a sliding scale based on income, but really - I have NO money at this time to spare. I know it's easy to say "well, you can always find some money," but really - it's not an option right now, so please don't ask me to consider it. (I am borrowing money from family to make ends meet, which is just adding to my self-loathing.)

What I would like to ask is this: when I start therapy, what can I expect? How does one go about finding a therapist (other than looking on the health insurance website for a list of names)? And finally - how do I actually TALK to this person? I've never really been one to open up (this has been a pretty big problem in all areas of my life), and I'm worried that I'll pull the "oh yeah, everything's great!" BS that I've been doing with EVERYONE for as long as I can remember. How do I get over the fact that I never let them see me down, and now I'm supposed to open up to a complete stranger (and one that I'm paying to care, no less)? I'm sure the therapist will see right through it, but I'm also probably the most stubborn person you'll ever meet.

I guess all I want to know is basically - what is therapy like, and how can I get over my issues of opening up to people? I know I'll never make any real progress if I don't open up to whoever I end up working with. So if I'm gonna do this, I want to do it right. I've never done ANYTHING like this before (growing up, the attitude in my family was, "don't talk about it, just deal with it," and that's obviously carried over into adulthood) so any advice/insight you can offer would be helpful.
posted by anonymous to Health & Fitness (21 answers total) 23 users marked this as a favorite
Therapy is pretty simple. Just say what's on your mind. It's the therapist's job to guide the conversation.
posted by mpls2 at 4:33 PM on August 19, 2008

If you have trouble opening up, try not making eye contact, therapist's couch-style. Talk like you're talking to yourself, not an individual person. Try to forget that you have an audience.
posted by MadamM at 4:39 PM on August 19, 2008

There's this a-ha moment in that everybody who's been in therapy for some time finally gets struck with. It's that part when you realize that you've been spending an exorbitant amount of money to not talk about your problems. You figure going is enough. Or talking about these other things is enough. And that's partly true...it's your money, you get to decide how to make the most of it.

Also, there's a second moment when you realize that you have to do all the work. All the talking. It's so exhausting and boring that you'll figure its not worth it. That's part of the problem too.

Just go there, you'll figure out what to do.
posted by iamkimiam at 4:40 PM on August 19, 2008

I've never really been one to open up (this has been a pretty big problem in all areas of my life), and I'm worried that I'll pull the "oh yeah, everything's great!" BS that I've been doing with EVERYONE for as long as I can remember

growing up, the attitude in my family was, "don't talk about it, just deal with it," and that's obviously carried over into adulthood

This could be me writing these sections. I've always had problems talking about myself and my problems, and opening up in therapy has been hard for me at times. Over the years I've tried many different therapists - some are easy to talk to, some aren't. Some guide the conversation more and ask questions, others sit back and wait for me to talk which results in awkward silence.

I can tell you from experience that feeling pressure to talk (even if it's from yourself) will only hinder the therapeutic process. I think the thing for you to remember is that every therapist is different and if the first one you go to makes you feel uncomfortable, try another one! Find one that has the right balance of guiding and letting you lead. Find one that you feel comfortable opening up to.

And who knows, maybe the first "issue" that you tackle in therapy could be the way you keep your feelings closed in and don't talk about them.

But good for you for deciding on your own to seek therapy. In my own experience, I know that that can be the hardest part. Good luck!
posted by Nickel at 4:44 PM on August 19, 2008

My experience is largely with psychodynamic psychotherapy, which sounds like it's what you're thinking of. Individual psychotherapy has been like this for me:

At the first appointment, you tend to talk about what's going on in your life, and your goals. What do you want out of therapy? Do you want to feel better? What is the "living like this" that you're over? Your therapist might want you to elaborate on that, or to talk about your goals, or possibly even the cliche "So, tell me about your childhood." I would expect to pay for this first session, but don't feel like you have to commit to the therapist at this session. If she or he reminds you of someone you hate, or smells weird, or their rug just gives you the willies, it is OK to find someone else.

Don't worry too much about "doing it right", but you might want to give your therapist the heads up that you are concerned about doing it right. Like Mpls2 said, the therapist is there to guide you. At risk of sounding kind of dippy, the hard work of feeling your feelings is yours.

(Nota bene: the phrase "feeling your feelings" kind of makes me puke but I don't know how else to say it.)
posted by chesty_a_arthur at 4:46 PM on August 19, 2008 [1 favorite]

Since other people have covered the "problems with opening up" question pretty well, I'll address your other ones.

When you start therapy, you can expect to tell your life story. Usually that's what they like to start with. Then it can be either self-directed or therapist-directed.

There are a number of ways to find a therapist but usually most people end up going through the phone book. Make a single getting to know you appointment with a few different therapists and then wait until you've seen them all to make your decision about who to call back. Don't worry about offending the ones you didn't choose; therapy is a lot about the bond between you and your therapist and first impressions can be a strong indication of how things will go.

Don't worry so much about doing it "right". There really isn't right and wrong in therapy.
posted by saveyoursanity at 4:54 PM on August 19, 2008

When I started therapy, I didn't tell my life story. I had a therapist recommended to me, I called her and asked for an appointment, and she said "how can I help you" and I said "I have no idea" and she said "that's okay, we'll work through it."

On the first appointment, I told her that I was sad for a particular reason, and we went from there. Each session she learns a little more, but we always focus on something I can actually DO to address what we've talked about (she's also a life coach, so advice tends to be practical -- this may be because I'm not, apparently, clinically depressed, more situationally).

I find it extremely empowering. First of all, it feels like I'm actually DOING SOMETHING to help, which is great. And it's like a challenge, figuring myself out. And, it's been working.

Don't fear it, the therapist, if she's a good one, will help you through it!
posted by dpx.mfx at 5:31 PM on August 19, 2008

I've been in therapy for the last six months or so. (CAT which is essentially cognitive behavioural therapy with some psychodynamic stuff thrown in). It's been interesting and helpful. I don't have any difficulty talking about problems that I've had, so long as I can distance myself from them in some way. But I found it very hard to talk about problems that were ongoing (partly because of the just deal with it thing). Dealt with things I could manage, but there wasn't much point focusing on them.

So the therapy kind of hit a brick wall after six or seven sessions. My therapist and I talked about being stuck. It was clear that I had to take the risk of talking about things that made me uncomfortable for the therapy to move on and be of any help to me. And so I did. It was difficult and felt incredibly unsafe, but my therapist was very supportive and we talked a lot about how it felt and what I could do to cope with the feelings that talking about these things would stir up.

Therapy isn't easy. If it is, then your therapist is doing it wrong. But part of their job is to help you through thinking about things that make you feel like shit. A therapist isn't there to care about your problems, and that's not what you're paying them for. It's like how a good mechanic will probably care about your car, which helps, but you're paying them to fix it. (Of course the metaphor isn't ideal - a therapist can't solve your problems, but they can help you to fix them.)

Anyway, good luck with everything.
posted by xchmp at 5:31 PM on August 19, 2008 [1 favorite]

I also grew up in a "don't talk about it, just deal with it" kind of family. Therapy was really refreshing, because I could babble about whatever was bugging me - whether it was recent events in my life or old stuff from my childhood that I'd half-forgotten. It's amazing to realize how events in your life connect. Try to mentally relax as much as possible; if your brain jumps from an annoying co-worker to a moment from when you were 6, don't just swallow that moment and try to stay on topic, but mention the incident that came to mind, because they might illuminate a connection. Therapy can feel a little artificial, because you're paying someone to listen to you. But it can also feel very natural, since you don't have to mediate your thoughts and emotions the way you do in social conversation.

Still, you will self-censor at times. Work towards not doing that. For example, it took me a while before I could admit to having any negative thoughts about my relationship. I mean, I'm human, my SO is human, obviously we have frustrations; but I had to keep up a "we're perfect" illusion for a while before I felt comfortable talking about us as a fallible entity. You'll probably have your moments like that as well; first, acknowledge that you're doing it, and then you can work on saying the stuff that's really hard to say to another person.

As others have said, there's no absolute right or wrong, and you can ask your therapist if you're on the right track to making progress. It feels a little strange to ask, "Am I doing this right?", but it's part of the process.

For recommendations, I asked a friend (that I knew was in therapy) to ask her shrink for a recommendation based on what I was hoping to do. I called, made an appointment, and showed up. Voila: I had a therapist. It took a few appointments before I really felt that it could be helpful and decided that it was worth the investment of time and money.

You already seem very aware of your potential roadblocks heading in, so maintain your awareness of those (tendency to gloss over problems, stubbornness, etc.) and work, bit by bit, at eroding them.
posted by bassjump at 5:38 PM on August 19, 2008 [1 favorite]

One way is to walk into the first session and tell them that you have trouble opening up to people.

Therapy is what you make of it. If you want to have a life coach and talk about how things are fine and you just have trouble doing your vacuuming every week, that's one thing. If you want to start with "I'm sick of being cynical," you can do that. If you want to root out your "Touched By An Uncle" memories, that's also fine. The therapist will be able to handle that, too. It's your money, you can figure out how fast you want to progress based on that.
posted by rhizome at 5:44 PM on August 19, 2008

If you freak yourself out about how to conduct your therapy, you may overlook one of the most important foundational parts of therapy: finding a therapist who's a good fit for you.

I recommend baby steps:

1) If you feel comfortable, ask people you know for recommendations for therapists. This doesn't have to be limited to people who you know to be in therapy; if there's a person you admire or who you think is the kind of happy you admire, try to ask that person if they know of a good therapist.

2) I understand Angie's List is now rating doctors, which should include psychiatrists (MD). Check if that refers also to psychologists (PhD or the less common PsyD) and social workers (LCSW and other forms of "SW").

3) The eenie-meenie-minie-moe method: choose a name from your insurance coverage list. I recommend you do not go for a psychiatrist because insurance rules these days are such that psychiatrists often don't do talk therapy anymore and sometimes see patients only to prescribe in conjunction with a non-prescribing talk therapist. So you might choose a psychologist or clinical social worker. Maybe someone who lives close to where you live or work. Maybe someone of your own sex, or maybe not. When you call the office, you'll need to say up front if you need evening or weekend appointments, because many don't keep those hours.

4) Just choosing is task enough. Just getting to the first appointment is an accomplishment when you're depressed. This may not technically qualify as answering your question, but I believe if you've found the right therapist, he/she will know what to do to get you to open up. It won't be magic, but it will be easier with the right person.

Good luck!
posted by ImproviseOrDie at 5:53 PM on August 19, 2008

Lots of good stuff here already, so I'll just add this angle:

It's like talking to a friend who will patiently and actively listen to your boring stories, but you don't have to reciprocate by listening to theirs.
posted by Fuzzy Skinner at 6:11 PM on August 19, 2008 [4 favorites]

Ms. Vegetable is 24 years old and has had depression on/off for quite a while -

1. My current therapist rocks and was a recommendation from my primary care doc. My primary care doc I picked randomly from the list of which doctors in my HMO were close, and who had privileges at hospitals I was comfortable going to if need be.

2. I needed the referral from the primary care doc to get my insurance to cover it - which they do, except for the copay.

3. I really like going to see my therapist. Sometimes I don't look forward to the appointment itself because I know it won't be a ton of fun, but I also know it's better for me.

4. You don't have to have a goal in therapy - sometimes I go just to talk without having to censor myself. Sometimes I go with a goal in mind of "I have to get this off my chest and explain how crazy this is making me!" Sometimes I'm in maintenance mode and go once a month. Sometimes I'm in more of a needy mode and go once a week.

And yes, it really does help. Getting up the courage to go is one of the hardest parts. Good luck!
posted by a robot made out of meat at 6:12 PM on August 19, 2008

I kept a journal of my psychotherapy experiences. Hopefully this will be helpful to you. My psychoanalyst was a very charming lady, about my age, perhaps a couple years older. I spent 90 minutes with her in the introductory meeting. She asked most of the questions, I answered the best I could, convincing myself to be open-minded. It mostly worked.

She was a Gestalt therapist, a discipline that helps people stand aside from their usual way of thinking so they can tell the difference between what is actually being perceived and felt in the current situation and what is residue from the past. The goal of Gestalt phenomenological exploration is awareness, or insight. Awareness without systematic exploration is not ordinarily sufficient to develop insight. Therefore, Gestalt therapy uses focused awareness and experimentation to achieve insight. How the therapist and the patient experience their relationship is of special concern for this manner of treatment. I would say our relationship started out on the right footing.

I was buying it until nearly the end when my logical left brain impulses imposed a skepticism upon the first therapeutic experiment. She asked me to sit with an upright posture, close my eyes, and imagine holes in the bottoms of my feet. I was to feel energy arising from the Earth, through my feet, up my legs and into my torso. Whatever. Any ole way, she said that's OK — she wanted to focus future sessions on getting more of my thought process into right brain activities. My homework assignment after the first meeting was to be conscious of my breathing and concentrate on making it deeper.

At the second appointment the therapist told me to begin using a "grow light." It seems the pineal gland originally had a role as a light-sensitive organ. This smallish gland receives signals from regions of the brain directly affected by the signals traveling down the optic nerves, which control the night/day cycle of hormonal activity and the sleep/wake cycle, the body's so-called circadian rhythms.

The gland is known to secrete a hormone called melatonin. The amount of melatonin released by the pineal gland can be measured in the blood. Under normal conditions, melatonin levels are low in the daytime, and rise gradually at night, peaking at two or three in the morning, and gradually decrease until it is time to wake up. Through our daily cycle of alertness and tiredness, the biological clock affects our moods and our performance. Superimposed on the daily cycle, there are other biological cycles of various periods, in humans and animals, such as oestrus and winter hibernation.

Some people, perhaps as many as one in ten of the population suffer from Seasonal Affective Disorder or SAD, a form of depression characterized chiefly by its seasonality, by depressed moods, decreased energy, a tendency to sleep too much and to feel excessively tired. My therapist thought that might be going on with me. What is remarkable about this form of depression is that exposure to bright lights alleviates the symptoms. Depending on the light intensity, as little as half an hour each day causes the worst of the symptoms to pass. The mood lifts, and energy returns. Again, it is light through the eyes which matters.

For some, bright lights mainly work by strengthening the setting of the circadian cycle. For others, the lights affect a mechanism in the brain known as the serotonin pathway, because drugs which are known to increase the amount of the hormone serotonin in the brain appear also to alleviate SAD symptoms. So I tried a grow light instead of more serotonin.

At the next two appointments we talked a lot about anger. My psychologist kept insisting that anger was holding me back. She thought I had reached a plateau and wouldn't continue to get better until I released pent up emotion. When I was a drunk there was enough anger for two lifetimes. As a recovering alcoholic, I had reached the other end of the mad spectrum. I had become a doormat, carrying acceptance to an unhealthy extreme.

Over the next few weeks I learned to release much anger, but in constructive ways. As a result, the weekly therapy got more intense from then on. Basically, I was just sick and tired of being sick, and tired. The psychologist struck a nerve with the obvious follow-up: "What are you tired of?" After considerable gnarling of synapses, my answer was I'm tired of the sameness. Her response, and our subsequent discussion, revolved around change. Whatever physical problems I may have had that the medical doctors were searching for, it wasn't likely my mental health would improve until this ennui plague was dashed. The level of life change needed to be as dramatic as when I quit drinking eight years previous. It was a scary thought, one I'm sure my inner circle wasn't prepared for, but I found myself in complete agreement. Things got rough in my life after that. Spontaneity became the word.

The rest of the story I've already detailed on AskMe. It took major change in my life for me to get well. Hopefully it won't be as dramatic for you. I just wanted to share a little bit of what the early therapy sessions were like to give you an idea. Best of luck to you.
posted by netbros at 6:23 PM on August 19, 2008 [1 favorite]

And finally - how do I actually TALK to this person? I've never really been one to open up (this has been a pretty big problem in all areas of my life), and I'm worried that I'll pull the "oh yeah, everything's great!" BS that I've been doing with EVERYONE for as long as I can remember. How do I get over the fact that I never let them see me down, and now I'm supposed to open up to a complete stranger (and one that I'm paying to care, no less)? I'm sure the therapist will see right through it, but I'm also probably the most stubborn person you'll ever meet.

Print out the above lines and hand them to the therapist, first thing, right after you shake hands and sit down in the chair. It'll show them (and you) that you've got guts, that you're not wanting to come in and play silly games, that you want to get down to brass tacks, etc and etc. It'll also give them a sense of who they are dealing with, and who you are dealing with.

If it is the first time you've ever really talked with someone about yourself, about your situation, just the fact that you've spoken about it can be a huge relief, it's almost physical, palpable, it's entirely possible that you'll walk out of there just lots lighter, before you've even hit on anything of any depth. It's a great thing, to talk and to be heard, to be actively listened to, to be cared for, cared about, a sympathetic and empathic soul right there with you. It's sweet.

You needn't wait until you get that new gig. There are sliding scale therapists out there and many of them are quite good -- I've gone that route twice and both times had excellent experiences. (Ken Durham, are you out there? Thank you so much.) You can get therapy for ... Well, I don't know, exactly, today. Twenty bucks a pop though, I'd bet, maybe a bit more, or less, depending.

It's a crap shoot, especially the first time you seek help, because you don't know what a good therapist looks like, or feels like, and just like with transmission repair people, some are great, some not so great. But if it's your first time out, almost any direction you walk in will hit pay dirt, even an inexperienced and/or incompetent therapist can help you a lot, you can at least get a lay of the land, a sense of what psychotherapy is.

It can be the very best thing you've ever done for yourself. You're worth the time and effort. Good luck.
posted by dancestoblue at 6:59 PM on August 19, 2008

A therapist is like a friend who never needs to talk about herself and really wants to hear what's going on with you. The opening up process is gradual and seems to get easier over time. It's the therapist's job to ask the questions that make you dig for the answer, so don't worry about making it happen all by yourself.

It's takes a while to understand and really believe that the therapist isn't going to judge you, no matter how lame or selfish or scared you sound. And then eventually you realize how important it is to talk about stuff which you would never admit to anyone else. You do that for a while (could be years) and little by little you realize you can admit some of that stuff to those closest to you. Therapy is practice and rehearsal for intimacy in your relationships.

By the way, google "finding therapist" and you will see lots of help. I suggest you make an informal study of the therapist landscape to learn the various approaches available to you. They can be very different and you want to choose an approach that suits you. If I may, I suggest you look for approaches that are about emotions and relationships; avoid new-agey things like dream interpretation, or the Jungian, Freudian or Reichian schools. Be sure you consider Cognitive Behavioral Therapy, it's very effective and straight-forward.
posted by conrad53 at 7:04 PM on August 19, 2008 [2 favorites]

I have been the same person and still am in many regards. A few years ago I was unemployed and broke(the same as you describe,,aka, the real broke). I got super fast state funded free care. the they set you up with a shrink that takes free care. You go and see if it is a *match*. this is the hardest part b/c it is draining. The right person you will be able to talk to,will ask the right questions to steer you to your issues. It might not be that you talk it out and it gets better. I find alot of it they just plant seeds of thought and I become aware and then the changes come slowly through the thought.
But, it is hard to foind someone you click with. If you have any good MD relationships, or ever have, see if they can refer. thy might know someone that does the sliding scale even. I find that tough. With huge effort you might find someone for broke ppl but, most likely, youll have to get your tush on free care:)
posted by femmme at 7:44 PM on August 19, 2008

Anon, the White Institute has a seriously sliding scale.
posted by minervous at 8:56 PM on August 19, 2008

Take the time to find the right therapist and the rest of it will take care of itself. If you find someone that at some gut level you just click with and trust and just generally dig, then it's a little easier to open up to them, and that gets the ball rolling quicker.

(As for how to find someone -- I'm in the NYC area as well, and utterly LOVE the person I've seen off and on when I've found myself in rough patches -- I've recommended her to a couple other people and they love her too. We just have a fantastic rapport, she remembers just about everything I've ever said and points out connections I wouldn't have noticed otherwise, and is just downright cool and funky. Email me if you want the name.)
posted by EmpressCallipygos at 8:58 PM on August 19, 2008

The Theodor Reik Institute provided me with a referral to a wonderful therapist, very reasonably priced, who did me an awful lot of good.

Hope this helps.
posted by jason's_planet at 10:00 AM on August 20, 2008

Therapy varies depending on the kind of therapy you seek. Cognitive therapists try to make you aware of your own thought patterns and your reactions to those thoughts, among other things. Gestalt therapists have their own techniques, etc. etc.

If you are a university student you may be able to get therapy for free as part of your health services, as many universities are smart enough to include this benefit.

By the way, if you do not have money you may be shunted to a student or a social worker for therapy. The person may be fine for you - I don't want to denigrate interns or social workers across the board- but make sure you are getting the type of help you need from qualified people. Poverty-stricken or not, you have the right to adequate treatment.
posted by Piscean at 1:07 PM on February 27, 2009

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