Shaded Bough Counseling

Tag: therapy

  • What to Expect From Your First Therapy Session

    What to Expect From Your First Therapy Session

    Have you been considering therapy, but aren’t sure about taking the plunge? Are you worried about what to do, or whether you’d screw it up? Here’s a play-by-play of what a first therapy session looks like, so you can decide what you’re ready for, and what kind of therapist is right for you.

    Getting Comfortable

    Therapy starts with finding a comfortable place to prepare for your session. If you’re seeing a therapist in-person, their office will usually have a waiting area with chairs, a couch, maybe magazines or a water cooler. You might talk to a receptionist if it’s a larger agency, and they’ll hand you paperwork at the first therapy session. You might pay before or after session.

    Therapists don’t really ask for the “lie down and stare at the ceiling while monologuing” anymore. You totally can if you want to, though. There may even be blankets or stuffed animals you can borrow for extra comfyness!

    If you’re seeing an online therapist (like me!) then you have options. Most of my clients do therapy at home, often with a cup of coffee, or a dog in their lap. Some clients will have sessions from their car (while parked) or workplace. This is okay as long as it’s a completely private space that you’ll have for the full 50 minutes. You’ll also need to be in the same state your therapist is licensed in, since our licenses usually don’t cross state lines. Most of us use Zoom or other HIPAA-compliant video platforms, and I find that progress usually comes faster with video. But, phone calls and text-based therapy are also available.

    Many therapists are switching to digital paperwork and billing. For instance, my clients get a secure link where they can do the paperwork, put a credit/debit card on file, and download any receipts or other documents they need. I love this because you can just set and forget it.

    The First Therapy Session Special…Paperwork!

    Your first session will involve reviewing the paperwork, as well as talking about what brings you to therapy. The papers are pretty dry stuff, mostly about scheduling, payment, digital security and privacy policies. But on the bright side, you’ll know exactly what charges to expect, how to handle the internet going out mid-session, accessing your records, and things like that. This also lets you decide if you’re comfortable with your therapist’s style before sharing really personal, heavy stuff with them.

    I tend to meander a bit while talking about the paperwork. Because it’s more fun to hear your thoughts instead of just monologuing. But that’s alright; anything we don’t get to, we’ll have time for in the next session.

    Identifying Your Problems

    You probably had a chance to chat with your therapist over the phone about your concerns. And the paperwork will usually have a space for that, too. But this is where you get to elaborate more and start working together!

    It’s normal to feel some anxiety or awkwardness in the first therapy session. It’s okay if you’re not sure where to start or how to put things into words. We’re trained to help you find the words. If you’ve found the right therapist for you, it’ll feel like they’re listening to you, that they want to get to know you as a person, and that they know what they’re talking about.

    Safety Check-Ins

    At some point your therapist will gauge whether any issues could affect your immediate health or well-being. These issues might involve domestic violence, suicidal thoughts, substance use, eating disorders, or financial hardship. Some therapists will ask you outright, some will have you fill out the answers in the paperwork, and others will play it by ear.

    I like to poke a little fun at myself and flat-out call these the Awkward Questions. Because that’s what they are! Very personal things to tell someone you’ve just met! But you can say “pass,” or tell me as much or as little as you like. Besides safety, I’ll also check with people about whether they have concerns about their physical health, or intersectional issues like race, gender, and orientation. Maybe you do, maybe not, but the topic’s open in case it’s on your mind later.

    Wrapping up the First Therapy Session

    Between the paperwork, the Awkward Questions and identifying the issues, that usually leaves a few minutes to explore your options moving forward. I like to list ideas I have for coping skills, habits, and other techniques that I think could be useful for you. If there are specific diagnoses you’re interested in, we’ll assess for that in the next session to make sure there’s enough time. You’re also welcome to add things you want to get to later, too.

    There’s a lot of ground to cover in the first few sessions. It can be nerve-wracking to reach out, and heavy subjects to talk about. But my clients have told me that they ended the first session feeling relieved and hopeful. Like there was a path open for getting better. If that’s the feeling you get from your therapist, you’ve probably found a good one.

    Did this article help you feel more confident about whether to try therapy or not? Are there questions I didn’t answer? Let me know! I’m always happy to help people find the right healthcare for them.

  • How Long Does Therapy Take To Work?

    How Long Does Therapy Take To Work?

    If you’re thinking of starting psychotherapy, it can be an intimidating commitment. How do you know whether you’ll get results? How do you know if you’ve found the right therapist? And how much time should you give it before trying something else? There’s no one-size-fits-all answer, but here are a few pointers to help you figure out how long therapy may take to work for you.

    It depends on the challenges you’re facing.

    In general, the more “problems” you need to work on, the more time you will need. The more intense those problems feel, the longer they will probably take. Some of these problems might be mental health related, but they can also come from your relationships, work or school, or other circumstances that give you stress.

    Some diagnoses need a longer treatment than others. A person with complex PTSD and depression will probably need more sessions than someone whose only issue is overcoming a phobia of dogs. A person who starts therapy to figure out how to be happier at work might no longer need therapy once they have a new job they love. It’s hard to give a definite timeline, since so many things can make recovery easier or harder. The shortest I’ve seen a person meet their goals is two months, and the longest is several years.

    It depends on your goals.

    If you want to only see a therapist for two months, that’s probably long enough to improve your coping skills, or learn to handle job interviews. It may be enough for some kinds of phobias or grief. But it will probably take longer to work through complex feelings about your parents, or overcome a major depressive episode, or handle guilt about a childhood trauma. Deeper work, or changes that affect big parts of your life or relationships, tend to take longer.

    You can decide how deep you want to go, and what you want to work on. Perhaps you only want to focus on quitting smoking, and not on family issues or anxiety right now. That’s okay. If you wish, you can change your goals later, too.

    Your therapist may give you “homework” to try between sessions. This could mean filling out a worksheet, practicing conversation skills, journaling, or many other things. You don’t have to do the homework, but it usually helps your brain learn new skills or insights faster.

    It depends on how well you and your therapist connect.

    There have been a lot of studies done on which therapy techniques work best. But the most important factor isn’t actually the specific technique: it’s how supported you feel in therapy. The process of working with someone who listens, takes you seriously, accepts you as you are, and who believes you can recover is healing in itself.

    On the other hand, if you don’t feel comfortable with your therapist, or don’t feel like therapy is working for you, bring that up with the therapist! We make mistakes sometimes, and it’s helpful for us to hear if we did something wrong, so we can fix it. Or, if you’re not comfortable discussing it, you can contact their supervisor (if they have one) or switch to a new therapist.

    It’s also okay to ask for a therapist who shares your background or culture. For instance, if you would feel most comfortable with a Black therapist, the Black Therapy Network is a great place to start. Psychology Today’s directory lets you filter therapists by gender, race, and other demographics. Another great option is to find a therapist who is an ally, even if they aren’t in your community. You can ask therapists in the first email, phone call or session about their experience with your issue or community, and that will help you gauge whether they’re a good fit for you.

    How to make therapy work faster for you

    1. Get help early. It’s easier to address the molehill before it becomes a mountain.
    2. Find a therapist you feel comfortable with. Don’t be afraid to shop around or do a “trial run” of 1-3 sessions first.
    3. Identify your goals. This will help you know when you’re moving in the right direction.
    4. Do the homework. More practice between sessions usually means faster results.
    5. If something isn’t working, let the therapist know. We don’t want to waste your time going down the wrong path!

    Okay, but how long does therapy take to work on average?

    For my own clients, it takes anywhere from four months to a couple years. For most people. It might be shorter if you have a lot of support, a relatively straightforward concern, or your external situation improves. It might be longer if your situation is complex or you change your goals midway through therapy. I wish I could be more precise, but it wouldn’t be truthful.

    I have found that most people who aren’t sure if their problems are “serious enough” for therapy do benefit from it. Even if the problem really is small, it means therapy goes faster and prevents worse problems later. I’m a big fan of preventative care, both for doctor’s visits and for mental health. So if you’re on the fence, know that you can reach out to me or another therapist, give it a go for a few sessions, and quit or see someone else if it isn’t working for you.

  • Do I Need a Therapist or Psychiatrist: How to Decide

    Do I Need a Therapist or Psychiatrist: How to Decide

    Mental health services are more widely available than ever, but with that comes the question of figuring out what service is right for you. Who prescribes medication? Who can teach you coping skills? So here’s a simple explanation to help you find the right therapist or psychiatrist for you.

    What’s the difference between seeing a therapist or psychiatrist?

    Psychotherapy or counseling usually means “talk therapy.” You sit in a room with the therapist, talk about your problems, and come up with solutions together. There are variations like art therapy, play therapy, group therapy and even adventure therapy. Therapists help you build a stronger relationship with yourself and other people in your life.

    You can think of “therapist” as an umbrella term with several types:

    • Professional counselors are pretty much what most people think of as “talk therapy.” This is what I am, hello!
    • Marriage and family therapists specialize in working with couples and families.
    • Clinical psychologists have doctoral-level knowledge and sometimes work as therapists, sometimes work in institutions or community agencies.
    • Social workers may also do counseling work, may be case managers or involved in other social services.
    • Depending on where you live, there may be a lot of overlap in what these professions do. In Texas, where I work, all of these professions can diagnose and treat mental illnesses. It’s also common for one person to hold multiple licenses.

    Psychiatry is a special case! Psychiatrists are physicians (MD) who can prescribe medication for mental health. Most professionals in the previous group are not trained to prescribe medication. Appointments with psychiatrists are often shorter, more focused on symptoms and medication management, and may feel more like doctor appointments. Because, well, they are doctors. Psychiatrists can also prescribe behavioral treatments like exercise, journaling and coping skills if they choose.

    These are generalizations. Some psychiatrists are also psychologists or therapists. Psychologists with PsyD degrees can prescribe medication in certain states. When in doubt, ask the provider what working with them would look like.

    Many people get best results from working with a therapist and psychiatrist, to ensure all sides of their recovery are addressed.

    Try reaching out to a therapist if:

    • You want to get support weekly or biweekly.
    • You want plenty of time per session to explore your problems.
    • You are more interested in talk therapy, changing your behaviors, or developing coping skills than in medication.
    • You want to try couples therapy, group therapy, or another treatment psychiatrists usually don’t cover.

    Key words to look for: clinical psychologist (PhD, PsyD), LPC, LCSW, LMFT, LMHC, LCDC.

    Try a psychiatrist if:

    • You want to try psychiatric medication.
    • You want to better understand what’s going on with your brain chemistry.
    • You’re already on medication, and want an expert to help you manage it.
    • Your symptoms don’t get better from talk therapy or behavioral treatments alone.
    • You have an illness that usually needs medication for best results.
    • The therapist you want to see also happens to be a psychiatrist. They are out there!

    Key words to look for: Psychiatrist.

    If you can’t decide between a therapist or psychiatrist, try interviewing them.

    When in doubt, ask. I love it when my clients ask me what kind of work I do. It helps make sure that we’re a good fit before we start working together! And if we aren’t, I’m happy to refer them to a psychiatrist, or marriage and family therapist, or whoever is best qualified to treat them.

    Some useful questions to ask a therapist or psychiatrist are:

    • What license do you hold?
    • What do you specialize in?
    • How long are your sessions and how often would we meet?
    • Do you do talk therapy, medication, or other treatments?
    • If there’s a particular treatment I want (CBT, EMDR, art therapy…) can you provide it?
    • If not, can you refer me to someone who does?
    • How would we know if I’m getting better?

    I hope this helped you get a better idea of what to look for when seeking help. Don’t hesitate to contact me if you have questions, or if you’re interested in starting therapy for yourself.

  • Happiness is a skill

    Happiness is a skill

    Hi everyone! I’m Kara, a therapist working in Texas, and I believe happiness isn’t just an emotion. Happiness is a skill – a set of skills – that you can put into practice to create a fulfilling life.

    In this blog I’ll share with you the tools and strategies that my clients and I have discovered help them achieve happier lives. Some of these tips will be tangible, like improving your sleep cycle. Others will help you explore your deeper needs so that you can shape your life into the right path for you. A “good life” means something different for everyone, and you’re the best judge of which tools work for you.

    It may be a skill, but it’s not easy.

    Your potential happiness is affected by the world you live in. You may face obstacles in the form of prejudice, discrimination, financial constraints, disability, or harmful people. So I will also explore ways you can get support from other people, advocate for yourself, and handle the challenges of living in an unequal society.

    Happiness is not a gift some of us receive and some of us don’t. It is not obliviousness to the harshness of the world. It isn’t an “ever after” you reach once and then you’ll never worry about again.

    Happy people choose to practice doing more of what makes them happier. And since happiness is a skill, like other skills it takes time, work, and active maintenance. But it is something you can practice. I see people from all walks of life get better at it, and you can do it, too.

    Where to start?

    I’ll be posting articles to help you develop your own happiness at least once a week. I’ll also talk about your options for therapy, which is great if you want more in-depth support for solving problems, getting to know yourself or developing a happier life.

    Are there topics related to therapy, mental health or happiness you want to see me cover? Or do you want more personal support for your journey? Drop me a line!