Q&A with a Therapist Part I: The Nitty Gritty

Starting therapy can be a leap into the unknown, and it makes sense to have questions. 

I’m an actual real life therapist, and today I’ll answer some of them for you. Here in part one I’ll focus on answering the more nitty gritty sorts of questions; questions about terms, definitions, and the process of starting therapy. 

1. What even is therapy?
Therapy is a broad term to describe mental health care from a trained mental health professional. Other terms, like counseling and psychotherapy, fall under the umbrella of therapy and are also types of mental health care and treatment.

Therapy can have different formats. I work with individuals one-on-one, but therapists also work with couples or entire families, or offer group therapy to a small group of unrelated individuals focused on a specific topic or skill.

When a mental health professional says “therapy,” they are talking about working with mental health issues specifically. As I’m sure you know, there are lots of other types of therapy like massage therapy, physical therapy, and occupational therapy. When people ask me what I do I usually say “I’m a mental health therapist” in order to distinguish myself from other therapeutic professionals. 

2. Why do people go to therapy?
People seek out therapy for a lot of different reasons. Therapy can help with specific issues like anxiety, depression, or relationship problems. Therapy can also be a form of general mental health care like going to the doctor for a regular checkup. Seeing a therapist is also a way to work through life direction questions about topics ranging from career path to where you want to live, who you want to date, and how to make friends as an adult. 

3. What is a therapist? 
The term “therapist,” like therapy, can be confusing because it covers a broad range of training and qualifications. Adding to the confusion, levels of training are given different names depending on the state agency overseeing the profession. For example, I am licensed by the state of Colorado as a Licensed Professional Counselor, although I more often call myself a therapist. A Licensed Clinical Social Worker (another Colorado-specific name) might also call him or herself a therapist. Social workers and licensed counselors both have master’s degrees in their field. 

There are also psychologists (a doctoral-level degree) and psychiatrists (people who went to medical school and now specialize in assessing and providing mental health medication), as well as psychiatric nurse practitioners (they do the same thing as psychiatrists, at least in Colorado). 

In categories like social work, counseling, and psychology, a person can be pre-licensed and still call themselves a therapist (which is totally fine, it just means the person has graduated from their advanced degree program and is now working on the hours required to be fully licensed.) 

So, it gets complicated! In Colorado, anyone who provides mental health care is required to give a description of the different training and qualifications for each type of mental health professional in their informed consent documents (which is all that paperwork you skim when you go to a medical professional.) 

You’re also free to ask anyone calling themselves a therapist about their training and qualifications, and follow up with clarifying questions if you don’t understand—sometimes we forget that not everyone lives in the mental health world all the time and therefore accidently explain things using a lot of trade-specific terms. 

4. How long will therapy take?
The length of therapy depends quite a bit on what you’re coming in for. I encourage people to attend at least 8-10 therapy sessions before deciding if therapy is helping and if the therapist you’re seeing is a good fit (more on “fit” later). A therapy “session” is usually an hour-long meeting between you and the person you’re working with. 

Because you see your therapist for an hour every week or two and live your life the remaining 168 hours/week, there is also a time commitment outside of session in order to put all the good stuff you’re learning in therapy into practice. 

People with more complex histories will likely feel supported spending a longer time in therapy (a year, or several years). If you grew up in trauma and neglect, it takes a significant amount of time and support to work through all the ways you protected yourself to survive your upbringing. Whatever you did to survive worked…and it’s likely hurting you in some way as an adult. It’s a complicated knot that takes more than a few months to untangle. 

5. How do I find a therapist?
Finding a therapist can be an overwhelming process. You can narrow the field quite a bit right off the bat by asking yourself these questions:

• Do I need a therapist who takes my insurance or am I open to paying cash?
  
  
• What is my budget for seeing a therapist weekly or every other week? 
  
  
• Do I have a gender or other identity preference for my therapist? 
  
  
• What do I need or want help with? 

The answers to those questions give you the basis for a google search like “female Indigenous self-pay therapist anxiety Durango Colorado.” You can also look at a therapist directory like Psychology Today, Therapy Tribe, or Mental Health Match. Therapists pay money to be listed in these directories, and you can search for a professional by geographic region, gender, identity, insurance, and specialty. 

(A note about google searches: Huge mental health conglomerate companies like BetterHelp, Sondermind, Alma, and Headway spend gazillions of marketing dollars each year to make sure they show up at the top of a search. If you want to find a local therapist and support local small businesses, scroll down a bit to the map-linked results.)

You can also ask friends, family, and trusted colleagues for recommendations. This is a great way to get some names on your list as the therapist has already been “vouched for” by someone you trust. If there’s too much overlap a therapist probably won’t see you for ethical reasons (for example, I wouldn’t see two siblings as separate clients). If there is too much overlap with someone I’m working with currently, I will try to make a recommendation for someone with a similar approach or style.  

After you narrow down your search, send a quick email or text to the therapists on your list. Ask if they are accepting new clients, and verify they take your insurance (if using insurance) and their session rates. Most therapists offer a complimentary consultation call, so it also helps to send your availability in order to get a call scheduled. 

6. How do I choose a therapist?
Now that you’ve (hopefully) narrowed down your search, there’s the whole idea of therapeutic “fit.” Research shows the therapeutic relationship to be the number one factor in client satisfaction, much more so than a therapist’s training or approach. This is why a phone call is helpful and important—you and the therapist can get a sense of each other and whether or not you’ll be a good “team” therapeutically. 

When you talk to a therapist on the phone before deciding whether or not to move ahead, ask yourself:

• Do I feel like this person “gets” me and understands what I’m going through?
  
  
• Do I feel heard and validated?
  
  
• What sorts of feelings do I get when talking to this person? Do I feel warm and fuzzy, or anxious and wary?
   
• Are any of these feelings the reason I'm seeking therapy to begin with? For example, if you’re seeking therapy because you often feel distrustful and wary, you may sort of automatically feel that way when talking to a new person. You might see if you’re able to share these feelings with the therapist and see what you think of their response. 

7. What comes next?
If you feel good about your conversation with a potential therapist, you’ll probably want to go ahead and schedule your first appointment. Each therapist has a different process around this; I ask people to complete their intake paperwork first, then get them scheduled. 

If you’re not sure and it’s within your financial means, it’s totally fine to do a first session with a couple of different therapists (at least it’s fine by me; other therapists might feel differently). 

Therapists all approach a first session differently. I tend to go a bit broader in a first session and try to get a big-picture sense of the person I’m working with. 

Based on information from the first session, I work together with the person I'm seeing to to identify how we’ll know if therapy is helping. Ongoing sessions are focused on working towards these collaboratively identified markers. 

Phew! What a process! It’s definitely a bit more complicated than finding a dentist or a doctor, but well worth it when you find a therapist who is a good fit. 

Still have questions? Schedule a complimentary 15 minute consultation call with me and ask away. And stay tuned for part two in a few weeks which will be more focused on the process of therapy and what's happening between the therapist and client in a session.