How To Start Therapy: Life Kit If the mere thought of going to therapy seems overwhelming, you're not alone. Plenty of people put off seeking therapy because of the stigma, cost and inconvenience. We've got four tips to help you make your first appointment.
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How To Start Therapy

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How To Start Therapy

How To Start Therapy

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LAUREN HODGES, HOST:

Hi. I am Lauren Hodges, and this is NPR's LIFE KIT. So we need to talk. Actually, you need to talk. That's why you clicked on this episode. Something is getting to you or confusing you or even hurting you. Your check engine light's on, and it might be time to see a therapist about it. Of course, it's not as simple as flopping down on the nearest couch and spouting out some feelings. It requires a bit of homework. I know - gross. You're already overwhelmed, and you're about to turn this off. But I already did a bunch of it for you. Of course, I can't do the actual work of therapy for you. I'm just going to get you through the part that seems to be really hard for a lot of people - scheduling that first appointment. Why is it so hard exactly? Well...

LORI GOTTLIEB: I think that a lot of people feel like if they start therapy, that means something's wrong with them and other people might look at them differently.

HODGES: Lori Gottlieb is a psychotherapist and author of the book "Maybe You Should Talk To Someone." She says we tend to treat physical and emotional health very differently. We wouldn't hesitate to go to the doctor if we needed stitches or pain medication. But our thoughts and feelings...

GOTTLIEB: We feel like there's a hierarchy of pain. And if our problem doesn't feel big enough, we wait until we're basically having the equivalent of an emotional heart attack before somebody will make that call.

HODGES: And those 2 a.m. calls to our best friends don't count. They love you, but they need sleep. Also, there's a big difference between venting to our people and talking to a professional. Yes, I know. It's more familiar and comfortable to talk to loved ones. They already know the backstory, and they're on your side. But that's kind of the problem.

GOTTLIEB: I think that there's something about going to a therapist that keeps people from doing it, which is they kind of know in the back of their head that the therapist is going to kind of call them on the truth.

HODGES: I'm completely guilty of this, by the way. I've used my friends and red wine and bad TV as a replacement for real therapy several times. It feels really good in the moment, but it's a short-term fix. And when I wake up the next morning, my problems were still there, along with a small hangover. Starting therapy became that perpetual item on my to-do list - when I had more time, when I had more energy, more money. But here's the problem with that strategy.

GOTTLIEB: If you had just come when you were first experiencing something, it probably would've been a lot easier on you. If you wait until things have gotten really, really bad, it's harder to treat.

HODGES: In this episode of LIFE KIT, we're going to confront some obstacles that are standing between you and peace of mind. We're going to figure out how to find the right person or form of therapy for you to take that step toward relief, insight and getting some stuff off your chest. But it's not your turn to talk just yet. It's mine, along with a few other people, like Lori, who have some great advice for you. But for now, you can just relax and listen.

Lori knows how hard it can be to start therapy not just because she's an accomplished therapist, but because a few years ago, she was you. She had reached a point in her life where she needed to talk to someone.

GOTTLIEB: The boyfriend that I was supposed to marry told me one night that he had decided that he didn't want to live with a kid under his roof for the next 10 years.

HODGES: But Lori had an 8-year-old old boy. They'd already been living together as a family.

GOTTLIEB: This was shocking. I had no idea. It was completely out of the blue, and I was blindsided.

HODGES: But instead of getting help to process the breakup right away, she pushed herself into a numb daily routine, driving her son to school, bawling over the bathroom sink between client meetings, wiping the mascara off her cheeks and just going back to work.

GOTTLIEB: When we're in the middle of a crisis, we're very disoriented and we're just trying to plow through. And I think sometimes we feel like, I'm doing really well. I went to work today. I took care of my child, even though at night I'm crying in the bathroom.

HODGES: At the time, Lori felt that if people found out she was struggling, her career would suffer.

GOTTLIEB: Because I felt that people might not refer clients to me, they might think that I'm more sort of unstable than I really was. And I was really worried what people would think.

HODGES: There is something that needs to be addressed before we continue. Lori and I are both white. We're both financially stable and have health insurance. As women, it's more socially acceptable for us to talk about our feelings. Traditional therapy was basically designed for us. So if we have a hard time starting out, clearly there's a massive emotional barrier. Deep down, you probably know exactly what I'm talking about. Because if it were as simple as just making a phone call, you'd have done it already.

We're going to make a to-do list in a few minutes and get you in for that first appointment. But first, we're going to spend a little time discussing those stigmas that stop people from getting help. That's actually our first takeaway, and it's a big one. It's really hard to admit you need therapy, but you're not alone.

PAHOUA YANG: You know, a lot of folks may not even know where to start. And I would say that that's probably true for the general population. And then you layer on top of that, you know, language and culture.

HODGES: Pahoua Yang is vice president of Community Mental Health and Wellness at the Amherst Wilder Foundation. She works with immigrant families, and she meets a lot of resistance when it comes to convincing people to try therapy for their trauma, anxiety or depression.

YANG: You know, I'll never forget a refugee client said to me, in my country, if you start talking about being mentally ill, you get taken away by soldiers and you never get seen again. And so sometimes it's that serious backdrop of people learning that it's OK, it's helpful to find mental health services.

HODGES: How do you help them start to break down that wall of trust and fear about what they need to talk about?

YANG: You know, I think of seeing a therapist as really just - you're just getting a second opinion about what you're doing. And then you can decide from there.

HODGES: OK. We all do that, right? We read movie reviews online before hitting play. We present scalding hot spoons to our loved ones' faces, saying, try this, before adding more salt. We send screenshots of our dating conversations to friends before deciding how to reply. So why is therapy different?

YANG: What I hear a lot is what if something's so broken about me that I can't be fixed?

HODGES: That right there is a huge and very common obstacle - shame. The stakes are different for everyone, but the concerns are pretty universal. How will this affect my family, my reputation?

YANG: You know, it very much is that strong sense of, you know, keep things in our family. We'll fix it. We'll figure it out. You don't need to talk to some stranger who's not going to know anything about you.

HODGES: But the thing to stress there is therapy's completely confidential. Licensed mental health professionals are bound by the law to protect your privacy. Unless someone's a threat to themselves or others, what goes on in therapy stays in therapy. But that can be a hard thing to understand emotionally if you're worried about what your small or tightknit community might think. So Yang spent years educating clients about privacy laws and therapists, and it's paying off.

YANG: More and more now, when clients come in, confidentiality is an expectation, so they're not as worried about it as they were 20 years ago.

HODGES: But it's still pretty common to have a relative, a partner, a friend who isn't supportive. And that can make people shrink away from the idea of therapy. It's a great excuse, to be honest, but you're not off the hook yet. Dr. Joy Harden Bradford, a clinical psychologist based in Atlanta, Ga., says there are ways to address this with skeptical people in your life.

JOY HARDEN BRADFORD: I think it's always best to talk about the symptoms that you're experiencing. So to talk about maybe the fact that you've been missing classes or it's been difficult for you to get to work or you're noticing that you have a lot of anxiety when you're driving or whatever the specific case is, I think leading with symptoms can be really helpful.

HODGES: So to recap on this really quick, if somebody close to you doesn't feel comfortable with therapy or that you're attending therapy, there are ways to talk about it with them. Focus on the symptoms in the conversation, as Dr. Joy just told us - abnormal sleep, poor diet, short temper. Making an appointment for those issues frames it as a medical issue. It is, by the way.

And stress the confidentiality, like Pahoua Yang does with her clients. No one else will know what's discussed in the session. It's the law, and therapists are required to follow it.

But it's not always a skeptical family member holding us back from mental health assistance. Sometimes it's just us. Dr. Joy hosts the podcast "Therapy For Black Girls," where she talks about a lot of powerful stereotypes around black women that influence their attitudes about therapy. And there's a pretty deep history there, too.

BRADFORD: Going back as far to slavery, when families have been divided and, you know, you don't have maybe a partner in the home, or for whatever reason, there has been a history of black women having to kind of take on lots and kind of bear the brunt of a lot of pressure in the community.

HODGES: So reaching out for help becomes that much harder when you feel like so much of your identity is built on being strong, resilient, independent.

BRADFORD: Am I still seen as valuable or needed if I admit that I'm struggling?

HODGES: And you don't need to be an immigrant or a black woman to find all of this relatable.

JOHN KIM: I think culturally, when it comes to gender, men don't get help and men don't express themselves. That's just a blanket statement.

HODGES: John Kim is known online as The Angry Therapist. After his divorce, he started a blog to express his feelings and tell his story, which is not a typical move for someone in his profession. Therapists aren't supposed to talk about themselves. They're supposed to be neutral. But actually, his challenging that whole idea of what we are and aren't supposed to be is what got him such a big following.

KIM: Followers turned into emails, and emails turned into sessions.

HODGES: And when it comes to his male clients, and even with himself, John noticed that there was one emotion that felt acceptable to express - anger.

(SOUNDBITE OF MUSIC)

KIM: It's almost not only OK, but promoted. In media, you know, when the protagonist gets angry, then it gets exciting and, you know, he saves the day or whatever. And I think that boys see that, and they think it's OK. And so they tie anger to being a man.

HODGES: And how does that affect their relationships? Again, John can speak from experience here.

KIM: I used to be a very angry person, not aware of how my anger affected other people. And then you start taking hostages, especially in relationships. If you are not able to process your own anger, then you're steamrolling your partner and you're changing the dynamic of the relationship.

HODGES: So since that whole keep it to ourselves thing isn't working out, let's get to the actual process of finding a therapist, which is our next takeaway. It's time to start our research and make that appointment. First, if you do have insurance, your insurance company is there to help you. If you're uninsured, I'll get to you in a second. You can still talk to someone, I promise. Hang tight.

BRADFORD: So a lot of people, I think, feel incredibly frustrated with the insurance process and, like, trying to find a therapist maybe who accepts their insurance.

HODGES: That's Dr. Joy Harden Bradford again.

BRADFORD: I typically will tell people to first start with a list from their insurance company so that they don't find a therapist that they think they will love and then come to find out they're not actually in their insurance plan.

HODGES: But if you find someone great who doesn't take your insurance, they might work with you.

BRADFORD: Do they have the capability to file out of network for you, or can they give you what's called a super bill that would allow you to file it with your insurance and perhaps get a bit of a reimbursement?

HODGES: And don't forget about sliding scale therapy. That's really at each therapist's discretion. Basically, you let them know if you can't afford their regular fee, and they might adjust it for you. That'll depend on a lot of things. Sometimes they just can't afford to do that either. But it never hurts to ask.

OK, let's pause here and make a to-do list. Get some names from your insurance company or a website like Psychology Today, which lists therapists in your area with reviews and information. Figure out what you want in a therapist and what kinds of questions to ask them in that first conversation. Here are a few options.

YANG: What do you do?

BRADFORD: Do you have specific expertise in working with my particular concern?

YANG: How can you help me?

BRADFORD: What kind of scheduling, flexibility they have.

YANG: Are you going to understand what I'm going through?

BRADFORD: What are your hours?

YANG: How long they've been practicing. How does just talking to you, how will that help me with what I need?

HODGES: And if you're looking them up online, you might get a little confused by some of the letters after their names, like LSW, LMFT. That's another great thing to ask them. They can translate all of that for you. But one isn't necessarily better than the other. And the most important thing, says Lori Gottlieb, is the relationship you ultimately have with your therapist in person. So her advice is just go. Make the appointment.

GOTTLIEB: The reality is that you're not going to know if it's the right fit until you're sitting in a room with that person.

HODGES: And she says there's an added benefit to just getting that date on the calendar. For her, having the appointment locked in was the first step to recovery.

GOTTLIEB: Just knowing that I was going to have a place to fall apart, to be myself, because I was holding it together everywhere else, it felt like a huge relief.

HODGES: But don't worry. One date isn't a commitment. You're just getting to know each other, which brings us to our third takeaway - it's OK to try out different therapists or even different kinds of therapy.

GOTTLIEB: Just because you go in for a first session with someone, that doesn't mean you're in therapy with that person. You can go in and treat it like a consultation.

HODGES: Dr. Joy agrees with that.

BRADFORD: You want to make sure that you find somebody who you actually feels like they get you. And it's OK to say, hey, I think I may need something else and to try to find another therapist who's going to be a better fit for you.

HODGES: That could be really nerve-wrecking, though. You know, if you've opened up to this person and they have all this knowledge about you, you feel very vulnerable in front of them, it might be really hard to sort of, like, break up with them.

BRADFORD: Yeah, and I think a lot of people feel anxiety about that because they're like, oh, am I going to hurt my therapist's feelings or...

HODGES: Right.

BRADFORD: ...You know, will this be awkward? And I would say to them, you know, it is a part of our training that we know that that kind of thing happens.

HODGES: She says while this might be a tough conversation, therapists ultimately just want you to get better. It's not helping anyone to stay in a relationship where your needs aren't being met. And, she says, by being honest, you might tap into a wealth of resources from your current therapist, even if you're ending things with them.

BRADFORD: I may be able to refer you to a colleague based on what you're saying who would be a better fit for you. So I think it can be a win-win situation.

HODGES: And let's say you've been to therapy before. Maybe it didn't go so great, and you're afraid to get stuck in that situation again. Pahoua Yang from the Wilder Foundation likens it to dating.

YANG: If you have one bad date, for most of us, that doesn't stop us from going on additional dates. Not every person's personality or even their philosophy is going to be a good match for you. Don't give up. That means it wasn't the right person. Find someone else, and have a different experience.

HODGES: I actually love the dating metaphor. It works. You're looking for a good match, someone who gets you and hears you and sees you, a great listener who asks about your day while you silently judge their wall art and furniture. Anyway, about those alternative options I promised, let's say you're uninsured, or you live in the middle of nowhere, or you don't have transportation, or you just don't have the energy to get off your couch.

Let's turn to technology for a minute. There are apps for you, like, Talkspace, BetterHelp, Breakthrough - ReGain is helpful for couples, and Teen Counseling is a good one for adolescents. Some therapists will also do Skype sessions. But one caveat there - if you and your therapist are in different states, you need to make sure they're licensed in your state. And if money is an issue, Lori Gottlieb has an idea for you, too. In fact, this is how she got started as a therapist.

GOTTLIEB: I trained at a clinic where people came in for no fee or a very low fee, and I was supervised by licensed clinicians. And that's also a great way to get help.

HODGES: Clinics like this are most commonly found at universities and hospitals, so reach out to your nearest college or medical center and ask to get in touch with their therapists in training. Ask about fees and financial options, and don't feel ashamed or shorted by the idea of low-cost therapy. Lori says a clinic session actually has an advantage over pricier options.

GOTTLIEB: In fact, you probably have more supervision than a private practice clinician does because when you're training, you have several sessions a week of supervision. So your case gets a lot of attention when you're in a clinic.

HODGES: Another option is group therapy. There are groups to help with grief and loss, divorce, anxiety, parenting, food and diet, anger management. And it's pretty easy to find these online, too. I'm going to go on Psychology Today, type in my zip code. And then here's one. It's free, and it's about three miles away.

So we've got some different paths to take, but you're probably wondering what can I expect once I'm in there - fast results, magic fixes? No, not exactly.

GOTTLIEB: You're not going to have some big revelation usually in that first session.

HODGES: But most importantly...

GOTTLIEB: Therapy will require you to go outside of your comfort zone if it's going to help you at all.

HODGES: I know that's a little daunting, but I'd be doing you a disservice if I made this sound like it was going to be a trip to the spa. It's going to be awkward, frustrating and weird at times. That's why so many people avoid it and go back to that power-through mentality. But strong emotions are a little bit like storm water. It all has to go somewhere. Letting it build up can be dangerous.

KIM: If you don't allow yourself to feel things like sadness, hurt, pain, frustration, whatever, they become stones in your shoe. And you kind of become a pressure cooker. And then eventually, you break, you know? Or you cope by using your vices, you know, our addictions - food, sex, drugs, whatever - that lead you down, obviously, an unhealthy path as well.

HODGES: So by ignoring our mental health, we're actually putting physical health at stake, too. And not just ours. When we're stressed out or struggling, we tend to take things out on those closest to us. So you're doing this for them, too.

Oh, while we're on the subject of doing things for others, if you're already in therapy and you feel comfortable, talk about it. This is going to be our fourth and final takeaway. One of the most powerful ways to break down the stigma against therapy is just being open about our struggles or at least being open about making mental health a priority. Dr. Joy will get us started there.

Are you in therapy yourself?

BRADFORD: Absolutely.

HODGES: And what about Lori? Does she still go?

GOTTLIEB: Yes, I do.

HODGES: And, John, what about you?

KIM: Yeah, lots of therapy. I've done everything from couples therapy to individual therapy. Therapy is something that I think will be in my back pocket for the rest of my life.

HODGES: And yep, me, too. I've actually been in and out of therapy my whole life. My parents sent me for various reasons as a kid - dealing with their divorce, an eating disorder. But, of course, I didn't talk about it openly back then. Middle schoolers are not exactly the nicest people, and I thought for sure I would end up eating alone in a broom closet if I admitted I had a therapist.

But as an adult, I started being more open about it, mentioning it casually around close friends and working it into conversation. And guess what? They didn't start inching away from me - quite the opposite, actually. They moved in closer. Some shared stories about their own mental health and therapy. But more often, they asked really interested questions about how they could get started.

John Kim says being an advocate for therapy normalizes it for others. But he says if you suspect someone might need to talk to a professional, it's always best to show, not tell.

KIM: I would share to my friends all the revelations I'm having about myself from who I used to be to who I am now and how much that's helping my relationships at work, at home, with friends. And all of that happened because of me starting therapy.

(SOUNDBITE OF MUSIC)

HODGES: OK, so you've got your to-do list. Let's recap our takeaways. First, we need to acknowledge and deal with those stigmas around therapy, whether that doubt is coming from your family, your friends, society at large or just from inside yourself. Remember; therapy is completely confidential. No one has to know. Second, there are resources to help find the right therapy for you. Use them. Enlist your insurance company to make a list for you, start making some calls, check out their websites, or just get yourself into the office. If you don't have insurance, or even energy, there are alternatives out there for you. Download an app, find a group, look up a local clinic where you can get low and no-cost therapy.

Our third takeaway is, it's OK to move on to a different therapist or kind of therapy altogether if you're not feeling good with the current one. In fact, your therapist is a great resource for other names and ideas if you can bring herself to tell them it's not working. Fourth takeaway - if you're already in therapy and you feel comfortable, try to work it into everyday conversation. Breaking down that stigma is something we all need to do together. And by talking about it openly, you're probably inspiring someone else to try it out. Share this episode. I'm here to help them, too.

For more NPR LIFE KIT, check out our other episodes. There is one about how to have a good weekend and how to start a creative habit. You can find those at npr.org/lifekit. And while you're there, subscribe to our newsletter so you don't miss an episode. And here, as always, is a completely random tip, this time from listener Crystal Berwick.

CRYSTAL BERWICK: To revive stale corn tortilla chips, microwave them for 15 to 30 seconds. Not only will they be crunchy again, but they'll be nice and warm. Not into microwaves? That's OK. Throw them in the oven. That'll work just as well.

HODGES: We want to hear from you, too. If you've ever used a LIFE KIT tip, tell us how it went. Email us at lifekit@npr.org

This episode was produced by Audrey Nguyen. Meghan Keane is the managing producer. I'm Lauren Hodges. Thanks for listening.

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