Triggers During this Pandemic

Hello everyone,

I made this video around March of this year when the pandemic was starting to rear its ugly head in the U.S. It provides information about a few triggers that we may experience at this time as well as ideas on what to do when that happens. I hope you find this information useful.

The Point of the First Few Posts

You may be wondering why someone would bother breaking down each process of looking for a therapist; after all, isn’t it pretty straightforward?

PC: Marco CBosio

Before I entered the mental health field, I was unfamiliar with the logistics of finding a therapist. I didn’t even know where to start. The only piece of knowledge I had was that as long as I was a student at a university, a few sessions would be free.

My first experience in therapy wasn’t so great. First, I was assigned a therapist, then a few sessions in, I realized that my therapist didn’t see me as a whole person and would not recognize my cultural and familial context despite my bringing it up. I was further confounded by her lack of follow up about the tasks she assigned to me. I found myself to be generally frustrated and anxious about upcoming sessions. I eventually stopped going and didn’t again engage in therapy until approximately a decade later.

Since my first foray into the role of a therapy client, I have come to realize that many people of color, immigrants, refugees, and individuals who have been disenfranchised in their respective communities have had similar – and generally worse – experiences. Young folx, immigrants and refugees of color may not even know how to go about looking for a therapist if they so desire, and when they do show up, they may be gaslighted or their experiences diminished by the use of therapeutic theories and modalities inappropriate to their experiences.

To destigmatize therapy and to make it more accessible, we need to first shed light on exactly what it is and how it looks. We need to make client rights available so that people can make choices appropriate to themselves even before they enter a therapist’s office.

What are other ways we can make therapy accessible and destigmatize it?

What to Expect at Your First Session

PC: Tim Chow

We have established by now that all therapists are not the same, so it only makes sense that your first session (or your first couple of sessions) will differ based on who you end up working with.

Some therapists use the first few sessions to go over their policies and documents indicating agreement with their policies. These policies generally focus on confidentiality, limits to confidentiality, disclosure of the therapist’s background, agreement to payment, policies around scheduling and canceling appointments, and the process of ending therapeutic relationship. If you are doing tele-therapy, policies on online counseling will also be included.

Your therapist may choose to have a structured or a semi-structured interview with you in order to get a better idea of who you are, why you are seeking therapy, what goals for therapy you have, information on your psychical and mental health, etc. They may work on a treatment plan collaboratively with you that you sign as an agreement of the objectives and goals you have for your work together – this is especially true if your insurance will cover your therapy sessions.

Or, your therapist may ask you to sign all the policy-related documents beforehand and welcome questions about them during your first session. They may also provide an intake document – essentially a questionnaire about the topics listed on the third paragraph – that they ask you to send over as soon as you can so that they can review the information before your first meeting. This way, you are free to start the session with any subject, concern, issue, questions you have that day.

It is important for you to know and understand exactly what you are signing. If you are unclear on anything, ask for clarification. You have the right to have a signed copy of all the documents you sign (if you so choose). You have the right to documents pertaining to you as well as to know your diagnosis if there is one.

The Most Important Question

PC: Nikita Kachanovsky

The most important question to ask your therapist is, “what is your experience working with people of diverse backgrounds?” Sounds easy enough, but don’t let this question fool you.

So, why is this question so important?

This question is important because, first and foremost, our psychological, emotional, physical, financial, social well-being are directly tied to our community and our status in our society. Without safety and stability in our day-to-day life, we cannot achieve internal safety. Living in a community that disregards us, dehumanizes us, and strips us of our human dignity is traumatizing, and that trauma will most likely be passed down to our future generations (epigenetics). It is therefore imperative that all therapists understand this and hold themselves responsible for providing a healing space.

It is also important that therapists acknowledge that how anyone – including ourselves – engages with their community and are allowed to engage with their community are political statements and a political reality. Thus, our work is always political.

I will explore these topics in more detail in future posts, so hang on.

What are a few problematic responses and perspectives?

  • That they will rely solely on their clients to teach them about their background, culture, identities, etc.
  • That they can only provide full acceptance of who their clients are.
  • That their mere function is to listen or be a listening ear without judgement.
  • That the modality they use works for everyone.
  • That they are not political or that they choose not to be political – this is impossible!.
  • That they have had diversity and/or inclusivity trainings – this is not sufficient.
  • That they practice cultural competency – another impossible thing to achieve. We are never culturally competent; it is actually about our life-long process of learning and unlearning.

While these responses/work are somewhat helpful, they are not close to being sufficient in reducing harm to individuals who have been exploited and marginalized by their society.

So then, what should you be looking for from a therapist?

  • That we understand our privileges as well as our identities that have been marginalized.
  • How we leverage and use our privilege(s).
  • How we engage with anti-oppression in our professional and personal lives.
  • That we have experience working with a diverse population and engaging in social justice work.

It is about our internal work and external actions, not merely our intentions. It is about the impact we have on our clients and our community. It is about being able to center Black, Indigenous, and other people of color. It is about centering LGBTQIA+ folx. It is about de-centering bodies, race, religions, orientation, identities that have benefitted from and practice colonization.

If your therapist is a social worker, remember that social justice is a part of their professional code of ethics. Without social justice, we will end up harming even those individuals who have privileged identities and bodies.

PC: Clay Banks

How to Search for a Therapist

So, you are ready to pursue therapy, but where do you start? Well…let me tell you all about it.

PC: Thomas Kinto

First and foremost, you can search for therapists through websites like Psychology Today or Good Therapy. Depending on where you live, there may also be a local directory of psychotherapists available. You can also obtain a list of therapists through your insurance.

I would highly recommend also looking at the therapist’s personal website if one is available. This will help you find the most updated information, such as a change in hourly rate, modalities offered, a change in office hours, etc.

Most therapists offer a brief consultation over the phone (and sometimes in-person). This is your opportunity to ask questions about the therapist before making a decision and the therapist’s opportunity to do the same. During this conversation, you may jointly come to a conclusion about whether you might be a good fit, or you may even decide to speak to a few other individuals before making a decision.

Here are a few questions to ask to get to you know your therapist –

  1. What is your niche/area of focus?
  2. What is your counseling style?
  3. What modalities do you use? If you are unfamiliar with a modality, ask the therapist to briefly describe it and how it would be implemented for what you are seeking.
  4. What is your hourly rate?
  5. Do you accept insurance? If not, do you offer help with seeking reimbursement?
  6. Do you offer sliding scale?
  7. What are your office hours? When are you available? You may negotiate a weekly schedule at this point or wait to do so until you have had a couple of sessions.

As the first few sessions may focus on gathering information, getting to know each other, discussing policies, and completing paperwork, it may take about 4-6 sessions to get used to and learn about a therapist’s style, and to decide whether they are a good fit for you. Some of you may realize much sooner than the 4-6 weeks whether you want to continue to work together with your therapist. Either way, if you find that a therapist is not a good fit for you, you have the right to end your sessions and look for another individual. I always recommend being clear about wanting to end your work together – you will not hurt your therapist’s feelings. We already know that we aren’t a good fit for everyone!

To learn about the most important question to ask during your therapist search, stay tuned.

Common Misconceptions About Therapy

PC: Hello I’m Nik @ Unsplash

I recently asked my friends and family about questions or concerns they or people they know have about therapy. I compiled the responses into a list (below) along with accurate information to clear up misinformation. Although not comprehensive, here are a few points of clarification about therapy and therapists –

  1. Therapists give advice, or they will provide answers.
    • Therapists help facilitate change through questions, reflections, recommendations and suggestions, exploration of options, support, compassion, and by challenging you when needed. We don’t really do advice.
  2. Talk therapy doesn’t work. Therapy is useless.
    • No, talk therapy certainly doesn’t work for everyone. Luckily, there are several therapy modalities. There are also various types of talk therapy. Many therapists are trained in different modalities and they can adjust their work according to someone’s need. For more information on why therapy is helpful, check out my previous post.
  3. All therapists have the same treatment style or they are all the same.
    • Just as we encourage you to bring in your genuine self to our sessions, most of us come in with our authentic self. How we work with you is affected by who we are, our training, the treatment modality (modalities) we practice, and how we conceptualize mental health and emotional well-being. We also differ based on our niche, area(s) of expertise, and how we engage with anti-oppression work. One size never actually fits all.
  4. Part 1: Only those who are severely ill need therapists. If you see a therapist, that means there is something wrong with you/your family and/or you are weak.
    • It is true that appropriate therapy and therapeutic relationship will support the well-being of individuals who are experiencing mental illnesses. But, you do not need to have a mental health or substance use disorder diagnosis to see a therapist. As a matter of fact, not all therapists diagnose! Therapy is simply a tool like any other to achieve or maintain well-being. Refer to my previous post for more info.
    • Side Note: “Something wrong with you” is a code for “crazy,” which is a stigmatizing, harmful, and ableist label.
  5. Part 2: There is something wrong with you if you see a therapist.
    • For many groups of people or cultures, going to therapy can be controversial and difficult not only due to stigma or misunderstanding surrounding mental illness, but also because of having to preserve family honor. I am simplifying this topic, but is this familiar to you:
      • Nepali – Aru ley keh bhanchan?
      • Hindi – Log kya kahenge?
      • English – What will others say?
    • For those who have experienced any form of abuse in the family, it might be phrased, again, as honor. Or, it may become about keeping secrets to uphold family unity or to avoid shame.
    • Well, the shame is not yours to keep and to hold. The only thing you are responsible to hold space for is healing yourself and your community. Airing out secrets in the safety of a therapeutic relationship will lighten your load and your pain. Honor does not necessarily come from life-long suffering or hidden pain; it comes from the courage to change what’s not working, to find a different path. It’s brave to seek support and your well-being. Additionally, therapists are bound by HIPAA (in the U.S.) and other laws pertaining to privacy and confidentiality. We are legally bound to keep your information confidential and cannot reveal your identifying information without your written consent and knowledge, except for a few instances which I will clarify in another post.
  6. Therapy is too expensive, or it isn’t covered by traditional HMO plans.
    • Many therapists, mental health providers, group therapy practices, and mental health/therapeutic agencies accept insurance. Often, you will only be responsible for a small co-pay (you may not even have a co-pay depending on your insurance). Many therapists and practices offer income-based sliding scale, and will work with you on something that is cost-effective for you. Many therapists who do not accept insurance or offer sliding scale do so to support their work providing free therapeutic services in communities where it is generally unavailable. Contact your insurance for a list of providers.
  7. The waitlists for therapists are too long.
    • This is certainly true for some therapists, but there are literally hundreds of therapists or several agencies/practices to choose from if you live in a city. If you live in a rural area and can connect to wifi, look into tele-therapy.
  8. Therapists don’t have any problems. A therapist won’t understand my issues unless they have the same issues.
    • Therapists are human beings, and as humans, we also struggle, may have a mental illness, may be in recovery from a substance use disorder, experience internal and external conflicts, have fears and traumas, go through grief and mourning…you get the idea. I am sure you can think of an instance when you could feel or empathize with someone else’s pain – it’s the same for us. Also, we don’t have to have gone through the same things to actually provide the support you need. You may even come away with a different perspective because we aren’t in it with you.
  9. If a therapist has any personal problem, they aren’t a good therapist.
    • Pain is unavoidable at times for all human beings, and as such, when we heal from it, we gain new insights. This is actually helpful in supporting others. Many therapists have been in therapy or are actively in therapy, which only helps with maintaining appropriate professional boundaries and our ability to be present with you. And we come with a personal understating of what it’s like to be in therapy! Many of us also have supervisors and/or consultants, who support our growth as a therapist.
  10. They won’t believe me, or my therapist will judge me.
    • A therapist’s job is to support you and to remain non-judgmental. Most of us truly and deeply care about our clients; we believe our clients and want the best for you. At the same time, we will also explore behaviors that are harmful to you and/or others WITH YOU not without you. If you sense judgement from a therapist, you are allowed to bring it up. If a therapist does judge you, they are not a good fit for you, full-stop. You are allowed to end a therapeutic relationship at anytime for any reason, with or without notice.
  11. I can handle my own problems.
    • There is no doubt about it, and that’s why you are resilient! Therapy is merely a self-care tool, a tool for support. Your therapist will encourage and assist you in solving your problems using various methods, e.g. their knowledge of neurobiology, systemic factors, and who you are, by shedding light on parts that are unclear or hidden, by illuminating your areas of strengths and helping you develop skills where needed, etc.
  12. Therapists will make me think of my traumatizing experiences before I am ready. If I think of my trauma, I will get worse.
    • The beauty of having so many therapeutic modalities is that with some of them, you don’t even have to talk about your trauma to heal from it! I say this while also acknowledging that having an idea of your experiences will help us tailor our work to what would be the most beneficial. Regardless, we will go at your pace and not delve any deeper than you are ready to do, and at the same time, we might also ask you to consider things that may be helpful. If talking about your trauma is important, then we will get there when you are ready, or we will help you prepare for it so that you have all the support and skills needed before we get into the scary/tough stuff.
  13. I have to be in recovery to see a therapist.
    • You just have to look for a therapist who has experience treating substance use disorders. We may ask you to come in while sober, abstain from certain substances before and during a session, or recommend other forms of treatment that may be more beneficial depending on where you are, but you most definitely can receive therapeutic support when you are struggling with substance misuse.
  14. All therapists have a box of tissue in their office (inspired by a friend’s story).
    • Gotcha! We actually do have at least 1 box of tissue in our office so that either/both of us can use it…unless of course, we run out of it like several of us did at the start of this pandemic.

Why Therapy?

As I get older, I have come to realize that more and more people from my generation are either considering therapy or are already in therapy. Curiosity and interest in therapy continues to increase. As a result, I often find myself providing information and education to my friends, relatives, acquaintances, and even coworkers about what therapy is, how to look for therapists, the various modalities that may be used, etc.

PC: Danielle MacInnes

Based on this experience, I want to share a series of posts that explore these topics. Today, I will begin with why you might consider therapy.

  • Therapy is a supportive and confidential space where you can show up as you.
  • Your authentic self will be supported, cared about, and even loved.
  • You have a listening ear and a human who will always cheer for you.
  • You will be able to explore all the shame, pain, fear you hold in your mind and body without retaliation or judgement.
  • When you have blindspots, or behaviors or beliefs that aren’t working out – or sometimes harmful – you will be gently challenged so that you can continue on your path to healing.
  • The work you do in therapy will show up as real changes in other parts of your life.
  • You may come to see yourself in a different and often a very powerful light.
  • You may break the line of intergeneration trauma in your family or community. You will be the change.
  • You may feel more integrated, solid, and whole.
  • You may feel a new passion(s) arise in life, and feel confident to pursue it.
  • You may learn new skills that will support and even improve your relationships.
  • Your relationship with yourself will improve and become healthier. You will be more in touch with yourself and as a result, you will experience a different form (sense) of internal freedom.
  • You will be able to challenge your own harmful beliefs and practices that do not serve you and/or others well.
  • You will learn healthy boundaries and relationship skills.
  • If you are simply seeking to resolve a problem or a conflict, you can do that too!

There are many other reasons to start therapy and there are many other benefits. It depends on what you are looking for. You may also find that as you work with a therapist, you have new goals you want to pursue. So, try it out when you are ready!

Psssst, you don’t have to feel ready to try it.