Therapy and counseling

Psychotherapy, often referred to just as therapy, is a general term used to describe treatment that occurs through communicating (usually by talking) with a trained mental health professional. There are many different approaches to therapy, each with its own techniques and strategies. Generally, though, therapy tries to educate a person more about their condition, how to identify productive or negative thoughts or feelings, and how to cope with difficult circumstances. Many of the people we interviewed described experiences with receiving therapy.

Getting access to therapy

Getting access to a therapy was a barrier for several of the people we talked with. Many who were students first sought free therapy appointments offered on campus or at their school, but these appointments were limited in number. Natasha had seven free sessions, but needed to continue therapy and that ‘was a bit of an issue because at the time I couldn’t really afford to get an off campus psychiatrist.’ Others described issues with finding a therapist when they did not have insurance. In contrast, although Sam lost his student health insurance when he took a semester off, he was able to find a counseling center in the city where he lived who offered therapy at low rates for people without insurance. Julia found a similar service in her city.

Finding the right therapist

People we talked with who went to therapy talked about the importance of finding a therapist they felt was a good ‘fit’ – that is, someone they could easily talk to. This fit greatly impacted how effective people felt therapy was for them. Jacob emphasized the importance of the first encounter with a therapist, saying it can, ‘make or break not just that therapist but therapy in general.'

Shayne compares finding a therapist to a first date and emphasizes the importance of liking your therapist and wanting therapy.

Age at interview 27

Gender Female

Age at diagnosis 13

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It’s exactly like a first date. You want to have chemistry. You want to be able to laugh with them and you also want to be able to cry. It might not be on the first date or the first meeting with your mental health provider, but it’s important to feel comfortable. If you don’t feel comfortable, then you can’t share with them the problems that you’re having that are personal. So you’re surrounded by stigma. And it’s, you know, their job to approach you without that stigma. They understand, you know, they get it. They’re not going to judge you. Or they’re going to judge you but with, you know, a knowledge base of information surrounding your illness, you know, so they can best help you. You know, that’s their job. So I guess like comfortableness. Looking, you know, chemistry. If you would respect what they have to say to you. You have to be able to look up to them to a certain extent, where you’ll respect what they tell you. Because if you can’t respect what they have to say to you, then you’re not going to learn anything from them and their insights are useless. So yeah, comfortableness and being, yeah, being able to share. That’s the most important thing with a therapist.

Maybe, maybe you’ll be lucky. But therapy doesn’t work unless you like your therapist.

Yeah.

So, it, you have to want to look for one that’s worth it. And that takes a lot of effort that a lot of people who are depressed or have a mental illness don’t want to put in. Especially if it’s, you know, you’re admitting that there’s something wrong with your brain. That’s a really personal statement because of the stigma surrounding it. So, you know, it’s, I think everyone should have a therapist at some point in their life. Maybe not all the time, but at least some point in your life, everyone should have a therapist. Because to have someone whose job it is to take into account all possible explanations to your feelings given your environment, given your upbringing, given your medical history. Like, to have a professional that can take all of that into account and say, Hey, I know why you’re feeling like, sort of upset or angry. Or you know, it doesn’t just have to be depressed. It can be any number of emotions that need to be regulated that are affecting how you live, you know. I think therapy is amazing and I’m a big proponent of medication and therapy. Because, I mean, it helps. It really does. But the therapy only helps if you want the therapy and you like your therapist. That’s the only way therapy works.

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Many people tried multiple therapists before finding one they could relate to. Sally found it difficult to find someone who ‘fits with what you need and your wants.’ Mara needed to find someone she could ‘click’ with. Colin and Sophie said it was important to have the feeling that they weren’t being ‘judged’. One therapist Leanna saw ‘didn’t mesh very well with her personality,’ so she requested to be changed over to a different counselor. The new person she saw had a ‘softer approach’ and she felt like, ‘I was hanging out with a friend instead of being drilled with questions which was nice and that really helped.’ Julia described why the first therapist she saw was not a good fit, ‘And she was awful, we would end up talking about books and stuff. And I’m like, I’m not paying you to have a book club.'

Jackson discusses how finding a therapist that was flexible with his needs changed his life.

Age at interview 27

Gender Male

Age at diagnosis 14

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I, it completely change my life, yeah, she was an amazing counselor, she was able to– because I felt like I, like I’ve been through counselors just like on and off, like mostly because it is required or other desperation and this was the first I found a counselor that was like, you need to feel these things but also like, we need to get the context and look forward. And, and that medication is an option but depending on where you are maybe not the best or we could try it, you know, or not, it’s not required. So I just found someone who is really flexible with, with my needs and willing to be very organic about it, and that really help me move through a lot of emotions and I mean like, I still feel sad. I wouldn’t say I feel depressed now anymore though because of working with that person. I think mainly I just– I was able to learn how to let go of a lot of judgment and shame. And, and then like, and then I realized that I was trans, like I didn’t know that was a thing, yeah, that was random.

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Sally describes how to her a sign that the therapist is a good fit is that she thinks about the points that were made in the session afterwards.

Age at interview 25

Gender Female

Age at diagnosis 19

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Yeah, I guess it’s hard to explain. It’s sort of like, it’s sort of like, with someone you meet and you want to be in a relationship with them. Like, there’s some sort of spark that like, you know, that happens with the first day you meet them even. Like, something about the way the session goes or something about the way that. Like when I leave a session, I want to know that I, I want to I want to still have the thoughts in my mind of the things that we talked about. The point that it had an impact on me even after one hour so if that’s like, you know, the case then, then I feel like, you know ,something, that, that might be the right one for you. If you have that like in the back of your mind, Oh that was a really good point she made or I never really thought about it from that perspective. You know, if you’re able to have that revelation or that thought that you never had before, you know, obviously something is coming of it. So I guess that’s kind of where it comes from.

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Age and gender of the therapist also mattered to a few people we interviewed. Jacob wanted ‘somebody older’ because he felt he has a hard time identifying with his peers and wanted someone ‘with way more experience who has seen way worse cases than me.’ He also wanted to see someone who was female, because he feels he has an easier time communicating with women than men.

Shayne talks about the ideal age for her therapist at different stages of her life.

Age at interview 27

Gender Female

Age at diagnosis 13

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I was in therapy when I was in high school and I hated it. I didn’t want to talk to somebody who looked like my mom about my problems [laughter]. I wish I had had a younger therapist at that point in time. When I was in college, I had a therapist who was almost my age. And at that point I was like, I don’t need to listen to you.

You’re not that much older than I am?

Yeah. They were, they were psychology resident in grad school and I was in undergrad. I was like, whatever. You know. And then, and then I met someone who was my mom’s age when I was in grad school. So I was like, young twenties, twenties. And she was perfect. She was the best therapist I’ve ever had.

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Types of therapy

People we talked with most commonly described their experience with behavioral therapies such as cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT). They received this therapy from a variety of health professionals including psychologists, psychiatrists, and social workers.

CBT works on identifying negative thoughts and behaviors and replacing these with more positive ones. Maya described ‘we dealt with these, very rationales, like how to deal with my negative thinking.’ Whitney says CBT helped her understand the connection between her thoughts and substance use, ’cause once you break down your thought process you really start to understand why you think the way you doand ways to effectively cope and stay away from drugs and alcohol.’ Julia said CBT has helped her learn to regulate her emotions as well as ‘just accepting something for what it is.’ For Sophie, CBT helped her ‘try to find… alternative solutions or something to make it better, to make it less stressful or less scary for whatever it was that was bothering me.'

Elizabeth talks about how behavioral therapy has taught her to think positively

Age at interview 28

Gender Female

Age at diagnosis 17

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A lot of the therapy that I have been through, the cognitive behavioral therapy that I have been to, really helps to change that thinking and the thing that’s incredible about it is that I’m to the point now in my life where the thinking is automatic. I don’t have to think the negative and remind myself to think the positive, it’s automatically positive. So the persistence is one thing, but that automatic positive thinking is another that, It’s going to be ok. I’m going to get through it. I have to work hard. I have to try and I’ll be ok. And there’s something chemically that works well with that too and they work together to help me get through what’s going on.

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DBT is a form of therapy that helps people identify and build upon their strengths, thoughts and assumptions that make life harder. Often it requires regular homework and practicing skills outside of the session. Sierra Rose described DBT as ‘rewiring the way you think.’ Shayne says, ‘It’s for people who’ve experienced severe trauma in their lives and it’s research based, which means it’s been shown to work and help rehabilitate and cure these people who have experienced severe trauma and have problems emotionally regulating.’

A few of the people we talked with sought therapy with a psychiatrist, who also managed their medication. Sally went to a psychiatrist after seeing a therapist whom she felt was a little too ‘fluffy’ and she preferred something more ‘concrete.’ Although she found her psychiatrist helpful for managing her medication and providing therapy, she also found him biased and ‘old fashioned.’

Social workers were also a source of therapy for some of the people we talked to. Shayne says he preferred this approach because ‘a social worker is trained to take your environment and the environmental factors into the way you act and react… as opposed to just putting you in a box based on this diagnosis and you acting in a certain way. It’s not about how you act, it’s about how you’re reacting to a certain environment that’s shaped how you function.’
Several people described how they used therapy on an ‘as needed’ basis.

Maya talks about finding a therapist and calling her when she needs help.

Age at interview 27

Gender Female

Age at diagnosis 15

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Therapy, and I know this isn’t a perfect analogy, but therapy is like dating. You really need to find someone you can develop a rapport with, who you like, who you feel like likes you. I mean I’ve had therapist who I feel like, just don’t like me and are judging me and I might see them for a little bit because they might be useful with one thing or another, but they may not be useful in general and you also need to take into account that, like, these people are human, so they have their limitations. And so I saw a gifted therapist and we mostly did phone stuff and I remember the first time I saw her, I saw her like, literally once and we like, and she was like, here’s some bibliotherapy read these books. I went home and read them and problem solved. I started a new career and I was like, well that was terrible for your business. I saw you once and now I’m not going to see you again. I called her 6 months like, actually no, it was like a couple of years later and then I talked to her once because I was getting so anxious. It had taken me two weeks to buy a bottle of shampoo just because I was like, being greedy and stuff and chemo phobia and I just, you know, I would have this incredible decision process like, Alright, I guess my anxiety is out of control again I should call a professional. So I called a professional and maybe talked to her like, maybe twice and for 6 months again I really didn’t need to see anyone, so I really use therapy on an as-needed basis. And I recognize what each individual therapy and what each individual therapist can offer.

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A few people experienced therapy in group settings. Sierra Rose initially thought this was unhelpful, but after being forced to go by her grandmother, ended up staying in the program.

A few people described group therapy as part of an intensive outpatient program. This is an important option. In the United States it is very expensive to be inpatient, and most insurers encourage or rapid discharge to outpatient treatment – so hospitalizations are short and often crisis management oriented rather than intensive treatment oriented. Out-patient programs include intensive therapy and intensive groups, usually for a number of hours per day a number of days per week often for a number of weeks.

Sam said his program was six to seven hours per day and included talking about ‘feelings’ and ‘art therapy in which we would try to express them through drawing.’ Sierra Rose agreed to continue with outpatient therapy after being hospitalized because of one special nurse, and described learning important skills once she attended.

Colin describes his outpatient program.

Age at interview 20

Gender Male

Age at diagnosis 18

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But this program, where I had to be there at 8:30 in the morning every day, which was not like too early or not too late. I had grown used to working at 6 a.m. over the summer. I had a car, so I wasn’t, my anxiety wasn’t pushed over the roof by like an unpredictable bus schedule, or I knew I would be able to get there at the same time every day. I didn’t know what the traffic would be like, I didn’t know if, I didn’t have like a cab on speed dial just in case the bus didn’t get there in time. So it was all very comfortable. And then the first week was pretty scary. It was, it was a lot. They keep you really busy during that program. And it was really a lot more intimate than I thought it would be because it was a group setting. And if I had not had so much previous therapy prior to that, I don’t think I could have been as open as I was. You had to be really open with pretty much what were near strangers to begin with. And, but then as I got to know these people and I started opening up to them, I just got, I looked forward to seeing them every day. I’d be like, wake up and I’d be like oh, I’m so glad I’ll go and get to see [name] or [name] or [name]. It was just like, and I especially look forward to seeing the therapist of that program. She was, she, I don’t know what she’s getting paid, but she should get a raise. She’s so good. Like she just made you want to be there. She’s so interactive, so understanding, but at the same time will push you beyond where you’re comfortable just enough. And yeah, by the time I left, I’d gone from like counting the days until I got to leave to like being reluctant to go. And just I felt like I kind of developed a family there.

Were you able to keep up with that family?

A few of them. One of them goes to [name] as well, somebody [inaudible]. I have her number and I talk to a number of people still through like social media and [inaudible]. It’s been nice.

And Yeah, I would do the same thing every day. It would vary a little bit because they made it, so it didn’t get stagnant, like you’d do different things every day. They had like a schedule, but it was pretty loose. It’s not, we had art therapy, but everyone did the same thing. Every day you’d have like different projects and different things, you know, keep it fresh and. When I first started going there, like I said, I was really scared. I think I was still kind of scarred from the inpatient. Like I went in there, and I was in another, you know, institution kind of, and just when they told us, I remember the first day when they told us that we got to leave for lunch, I was like oh, yeah, if you have lunch you can go out to your car and like grab it if you made one. I got really scared. Like I walked by this, I remember walking up to the exit doors and just waiting for somebody else to go out because I thought somebody was going to yell at me if I left, you know? Or like stop me or just call the police on me, or just, that was the existential thing I had on my mind was like that the door would be locked when I tried to leave. And it took a while to get over that, like, you know, oh, I can actually go out the area into the parking lot. Yeah, every morning I would get there, secretary, you know, the person at the front desk would greet me. She knew my name. Sign in. Go, sit down, chat with the people before, like the therapist would get there. Towards the end of the program I had made such good friends now that we would go out to lunch together. It was real nice by then.

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Pros and cons of therapy

Many people we talked with said therapy gave them useful suggestions or allowed them to see a situation from a different perspective than they might otherwise have had. Therapy also allowed them to better identify their thought processes and depression or anxiety triggers. Jason described the benefits of therapy as, ‘just being able to be completely honest with someone, talk about things. I think that helped me reflect back on what are the trigger points.'

Crystal talks about her therapist’s advice to listen and observe her depression

Age at interview 20

Gender Female

Age at diagnosis 15

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Advice that my therapist gave to me which is really listen to your depression which is hard to do because you think, Oh my gosh its so, it’s so negative, it’s so painful to do, But often times just observing it can help. I know that you know I, I started to do this, this past semester, I definitely think it helped when I’d feel like I would start to have a panic attack or go through a really rough crash, I was actually able to elongate it and mitigate the intensity of it by just saying, Ok I know I’m about to have one, I feel the rush of emotions coming forward. Let me try to just like accept the fact that they are coming forward and write about it in my journal or like just think about it. And you know work is always going to be there unfortunately I can’t get it done right now but what I can do it just like, just talk to myself and just sort out what’s going on and look at the issues. And sometimes just talking about it or looking at it just its face like right in front of you is helpful because then you’re just like, Oh this is a thought, not oh my gosh this is happening to me and having all these implications, You can just kind of look at things as, if, as if, as if they are written on a page right in front of you and so it’ll take you, it gives you a chance to process them instead of live them, if you know what I mean.

Yeah it sounds like maybe getting a little but more of a dispassionate distance like, Oh this is happening to me, I observe that this is happening to me and I’m going to not judge that it’s happening, I’m just going to be in it and write about it and.

Exactly. Yeah. Yeah it kind of takes the anxiety off of it so instead of thinking, Oh my gosh this is happening to me, I have to deal with it someway I’m not really sure what to do, oh my gosh I’m so worried. Now you can say, Ok this is happening to me period.

Yes.

What am I going to do next; I don’t have to anything next. That’s a perfectly logical answer. And you could sit there and you could just let the thoughts happen and you could just keep reminding yourself every couple seconds, this is happening to me, And just, just put a period at the end of your thoughts that way they’re not rushing on.

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Many people also liked having someone they could ‘check in with,’ especially about topics they might not be comfortable talking about with family or friends. Sometimes these visits were to deal with short term solutions. In therapy, Crystal works on short term solutions for ‘some of the daily struggles.’ Sally discussed issues relating to transitional periods in her life, such as moving in with her boyfriend. For some, these ‘check in’s’ evolved from talking about daily struggles to discussing issues like ‘self-perception’.

Colin talks about being able to discuss his suicidal thoughts without feeling judged.

Age at interview 20

Gender Male

Age at diagnosis 18

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I’m still seeing him, if not every week, biweekly and.

And how does that help you?

At first when I was still very suicidal and very depressed, I was just going for like mood remediation like just to take care of my immediate needs. And I just needed somebody to talk to and anybody close to in my life, I was so afraid to talk to about this. I have never been really open about it, I didn’t feel comfortable talking about with anybody besides a professional. And so after that after I, the medicine started helping and after we started dealing with just techniques to kind of calm me down and deal with suicidal thoughts and just, and just somebody to talk to was great, to be honest. It was, I looked forward to it every week, I went every Thursday and I was looking forward to it. Just so I could have some time, somewhere to vent all of these terrible things where I wouldn’t feel judged or isolated. And after I started getting more control on that and like I said, the medicine started helping along with that therapy and I started actually feeling better, I started actually focusing more on just like, how to make myself want to get out of bed in the morning, how to find purpose in my day, and how to just get through the day with, not with being happy, but just with hope and that was, I’m still working on that [laughter].

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Mara talks about how therapy helped her not feel isolated or feel like she was burdening other people.

Age at interview 18

Gender Female

Age at diagnosis 14

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So I think it was just really effective having somebody who could listen to you. Which sounds kind of obvious, but I think sort of the problem with being that age and having this, like a mental condition that promotes feelings of isolation and desperation is that you really feel like you have nobody to go to so that’s including parents, including a lot of friends, just that overwhelming feeling of being totally isolated. So having a professional that who is for the most part a stranger, who can’t really enter other parts of your life, I think is really nice. Just somebody who can sort of walk with you parallel, somebody who you can check in with weekly or like twice a week or once a month, pretty much just to give them like a blow by blow of the things you are concerned about and to get some perspective on things that you can’t normally with just talking with a friend who may or may not have similar problems with anxiety or depression or what have you, so [coughing]. Furthermore, in talking to a professional, you don’t really have to feel like you are burdening anyone, so there’s no, there’s no fear, or at least there wasn’t for me, of like bothering somebody with my problems who isn’t going to want to care or doesn’t have to care.

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Some people we talked with had specific issues their therapists helped them address such as a death in a family of prior failed relationships. Teddy had issues at work, and his therapist told him, ‘the best way is to not give them a second chance, if they really hurt you badly’. He described that this advice ‘just stuck with me and it still is to this day.'

Teri talks about how getting counseling helped her prepare for her father’s impending death.

Age at interview 24

Gender Female

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So after I met my wife, this would have been two years into that, my father was diagnosed with cancer, and my-my friend at work, my very good friend who I owe a lot to, he could kind of see, I think, what was, what was going on, he understood like well, this is going to be really hard for Teri and so he really encouraged me to go get counseling and this was the first time I had ever thought of going to get counseling, and he was like, you know, this was the place that I go and you should go here and this is how you can get it through work, for free, so he said what do you have to lose?’ and I thought that sounded like a great idea. So I went and I know now that it could be really hard for people to find a good fit with their, with their counselor, but I was so lucky to get someone who was such a good fit for me. We talked a lot about, because this was a couple of years after I met my wife, I was starting to feel better about myself, but a big theme for us was preparing for the loss of my father so it was, it was very helpful to just be able to talk to someone who —she was unbiased and extremely helpful without being judgmental or giving advice. So, I look back now and I’m like man if I had had that help back then, what could that have done for me? yeah just to think about how I may not have recognized how serious things could have gotten.

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For some people we talked with, therapy was not effective. Some preferred medication, while others, like Sierra Rose described therapy as not helpful if they were not in the right mindset. Jackson ‘felt dead inside’ and as a result, thought he wasn’t ‘receptive’ to what a therapist had to say. Ben described therapy as ‘ok, but it wasn’t that beneficial but it, it was decent.’ Frankie found the number and length of sessions to be unhelpful and felt like ‘it’s just not worth the time.’

A few people described not liking how therapy approached dealing with their problems. Shayne didn’t realize the work she would have to put into therapy to feel better. At first, Shayne found therapy to be unhelpful because she thought ‘all I needed was a therapist once a week and [to] take all my medication.'

Meghan discusses her preference of medication over therapy.

Age at interview 18

Gender Female

Age at diagnosis 18

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And I didn’t want to have counseling; I didn’t want to be in a support group. I didn’t really want to talk about what was going on because nothing even triggered what was going one with me. Like it not like I had a traumatic thing that initially started it and then built up and I just couldn’t even put my finger on what was going on, so. I, immediately when I was in my counseling sessions I made it very clear that I just wanted to get help with medication. And, [clears throat] excuse me, it was kind of an odd thing to like, really make clear because that can seem kind of like with the wrong thing in mind or at least that’s what I think. But it’s just because that I knew that talking about it wasn’t going to help and that’s not what I wanted to do. I just wanted to, I just wanted to have my potential with my semester and get on track. So I made it very clear I wanted medication and it, through the university health services it was very hard to go about getting medication and that’s kind of unfortunate in my opinion, because not always is it that counseling is going to help people. And I did end up trying out counseling because that’s just the process that they take, but I just think that individual circumstances that I just don’t really think that counseling helped me at all. And I think that they should evaluate. I don’t know. I don’t even know.

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Kate discusses how therapy wasn’t helpful because they approached her problems as something to be solved.

Age at interview 21

Gender Female

Age at diagnosis 12

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I tried to do therapy in high school for the college part of my high school. And I was in a college, they gave free therapy for students. So I tried that but the therapist that I had was still learning and they approached it as a problem to be solved. And I always felt bad coming back to them and saying well I’m still having this problem even though you told me how to solve it, it’s still there. It’s part of me. So I stopped going to that therapist and simply tried to study the techniques that she’d been using that were getting some progress but I didn’t feel the need to try and to achieve something or solve a problem. I could simply reflect upon myself.

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See also ‚Äö√Ñ√≤Depression, medication, and treatment choices‘, ‚Äö√Ñ√≤Getting professional help for depression‘, and ‚Äö√Ñ√≤Holistic and integrative approaches to depression‘.
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