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How to Start Therapy

Written by Joshua F. Medeiros, MS

            As this year comes to a close, many minds turn to reflections of the past year. Fond memories, big changes, obstacles overcome, and victories won abound, yet all too often the focus turns to the negative. Regrets, things we wish we had accomplished, broken promises to others, but more subtle and possibly more painful are the promises we have not kept with ourselves. Invariably, the resolution to do better in the coming year wells from within and a sense of hope and determination takes hold as a list of new year’s resolutions begins to form. Perhaps the list includes working on yourself in some way, be it physically, emotionally, mentally, interpersonally, or spiritually. For this, might I humbly suggest beginning counseling. “WHAT!?!?! Counseling? I’m not depressed or anything! I mean, I do get stressed but that’s everybody! I just need to manage my time better so that I can do all the things I keep promising everyone and myself I am going to do. You know, I just need to BE better” you say. To which I respond, “that’s sounds like a lot… would you like to talk more about that?”

            In all seriousness, the reality is that beginning counseling can feel like a big undertaking, and without some guidance, almost impossible for someone who is already overwhelmed. First, there is the vulnerability and self-awareness necessary to acknowledge that “I need help.” That vulnerability needs to be accompanied by the simultaneous fortitude to seek help. As if that weren’t enough, complicating factors like availability and scheduling, insurance and finances, and therapist specialties or qualifications can seem impossible to navigate without having a degree in therapy yourself. In this post, I would like to discuss some steps that may help you begin the process of finding a therapist that is right for you and entering a therapeutic relationship that is meaningful and healing.

How to Start Therapy

Step One: Take a Deep Breath

            Let’s be clear, if this is an emergency, call 911. Otherwise, this is the perfect moment to take a step back and take a breath… Now take another breath… Aaaand one last deep breath… Good! Why was that important? The simple answer is that entering a counseling relationship is an important decision. Making decisions while actively stressed tends to result in poorer choices with less meaningful forethought. Now that we are in a clear(er) state of mind, we can begin the work in earnest.

Step Two: Ask Yourself A Few Questions

            In many cases, clients come for the intake session without knowing exactly what they want or need from their counselor. This is perfectly fine! Part of your counselor’s job is to help you identify your needs and wants, develop goals for therapy, and walk with you as you work toward them. Still, it can be helpful to think over some initial questions before therapist shopping to help guide your search and prepare you for the journey of personal growth ahead.

            Question #1 – Why am I seeking counseling? Asking yourself about the symptoms you are experiencing that let you know something is amiss can help to pinpoint the pain points. If you are seeking counseling because of problems in your marriage, individual counseling might not be as helpful as marriage therapy. Likewise, noting different symptoms (physical, emotional, cognitive, behavioral, and spiritual) can be beneficial when formulating goals for therapy down the road. This can also be helpful in picking your therapist. If it is helpful, you can make a list of the symptoms that are an issue for you now. Then, add to that list the things those around you have indicated (whether you think they are accurate or not).

            Question #2 – Why now? This question takes the previous one to a new level. Chances are that everything you are experiencing did not just happen overnight, though in some cases, like trauma, that might be exactly what happened. Identifying what it is about your current situation that triggered you to consider reaching out for help might indicate the values and motivations that will make reaching your future therapy goals possible. Maybe you noticed the anxiety you feel has been interfering with your relationship with your spouse or children. Perhaps a friend has commented on your absence from recent social gatherings. Maybe a boss has noted a decline in recent performance. Whatever the answer, reflecting on the ‘why now’ can help shed light on what is really important in the matter and provide the sustained motive for change.

            Question #3 – What do I want to get out of counseling? A great way to frame what the desired outcomes of counseling are for you would be to consider what would be different if the current problem were solved. In other words, how will you know when things are better? There is an exercise that does a good job of getting to that answer that is often referred to as “the miracle question.” Take a moment to try it out for yourself…

Imagine that while you are sleeping tonight, a miracle happens (thus the miracle question). While you are sleeping, [insert problem] is miraculously resolved but you are unaware because it miraculously resolved while you were sleeping. When you wake up the next day, what would you notice that would indicate to you that this problem is no longer a problem?

            As discussed before, the process of finding the right professional to walk with you on your journey to wholeness can be daunting. However, armed with the answers to the above questions, you are better equipped to reach out with confidence in the asking.

Step Three: Locating the Right Therapist

            The process of finding a counselor can feel like a ready, fire, aim scenario. However, analysis paralysis is real. There are likely dozens of potential counselors in your area, each with their own well-crafted bio and laundry list of credential abbreviations after their name. Some may even have a beautifully retouched profile picture. If you are seeking services via telehealth, then the possibilities increase exponentially as you could feasibly work with any provider in the state! So how do you choose? Here are some suggestions for making the hardest step easier.

            Identifying how you will pay for therapy can focus your search. Not all therapists or counselors accept insurance nor work with all employee assistance programs. Beginning with the approved provider list from your employer or insurance company can help to simplify the choices. If paying out of pocket, deciding what you are willing to financially commit can help to provide winnowing questions to ask when you speak with a provider or agency. If finances are a limiting factor in your ability to seek therapy services, look for agencies that work with graduate students or pre-licensed professionals and offer an income-based fee scale. These are well educated therapists that receive regular direct supervision from more experienced licensed professionals, which is like having 2-3 therapists at a fraction of the cost! Depending on your needs, you may also explore group therapy options in your area which are generally cheaper than individual counseling.

            Not all therapists are created equal. If you have read this far, you have a list of symptoms that can double as a useful search tool to find someone who is best equipped to address your specific concerns. When speaking with a potential counselor, use the symptom list you came up with in a consultation to learn more about how that therapist might work with you. This can help you learn more about the counselor’s style and judge if they would be a good fit for you.

            Did you know that once you pick a therapist, you do not have to stick with them forever? This means that if you get it wrong, you can always move on! “WHAT,” you say, incredulously. “I am not going to throw away all that money on someone just to start all over again!” This is an understandable concern, yet it is important to understand that the time you spend with a counselor (yes, even the wrong one) can be extraordinarily fruitful. By spending time detailing your concerns and putting into words what the problems you face really are (which is what the first few sessions generally focus on), you are learning to define the problem in a more manageable way. This means when you begin with the right counselor, you can abbreviate the part where you identify and define the issue and get straight to the good stuff! Additionally, working with a therapist you may move on from also teaches you more about what is important for you to look for the next go round.

            On the flip side, it is not a good strategic plan to enter the therapy relationship not expecting to stick around for the long haul. This will inevitably lead to remaining guarded in the therapy session and you leaving not feeling heard or understood. Instead, I recommend committing to several sessions with a therapist (as if they are the one) before deciding to reconsider. If you do not feel more comfortable or that things are moving along as you hoped they would after a few sessions, tell your counselor and spend some time exploring that before deciding to move on or quit.

            Finally, ask for referrals. While you might not want to see the same therapist as your mom or bestie, you can still get some ideas about where to begin. Additionally, ask the counselors you speak to in your search for referrals if you choose not to work with them. Chances are that therapists know more about the professionals in your area than anyone else and would be a terrific resource in your search.

The Takeaway

            The ultimate goal of counseling is to help you experience healing and wholeness. While I hope these suggestions are helpful to you in beginning this phase of your journey, if you are considering working with a professional counselor, the most important takeaway should be to take the next step, wherever you are in the process. I have met many people who have reservations about beginning therapy, but I have yet to encounter someone who regretted their decision once they had begun. As a therapist (and I speak for many others), I consider it a privilege to do this work. I am perpetually humbled and honored by the openness and honesty of my clients, and I do not take for granted the challenge each one has faced in summoning the courage to ask for help. My hope and prayer is that you are able to do the same and that the reward is liberation from what is holding you back and freedom to flourish.

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