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Have you been struggling with anxiety or depression but put off coming to see a professional? You are not alone. Feeling anxious or depressed is common, and affects tens of millions of people each year. Unfortunately, only half of all people who struggle with a mental health condition will pursue treatment. Some people struggle with stigma or judgments from others, and others do not have access to care. Some people have a poor understanding of mental health conditions and falsely believe they don't have a problem or believe the problem would get better on its own.
You are not "crazy" or "weak" for having a mental health condition. Thinking you are "crazy" or "weak" are often signs of anxiety or depression itself. You are suffering and coping the best you can. No one wants to suffer. Therapists are not here to judge you. Therapists are here to understand you and help you live your life to the fullest potential.
You are not "crazy" or "weak" for having a mental health condition. You are suffering and coping the best you can.
We all have rainy days
What to expect if you are new to psychotherapy
It takes courage and willingness to make the first call. Maybe you've decided that enough is enough, or witnessed the impact that your emotional health has had on your physical health or on your loved ones. Perhaps you haven't been participating in hobbies or withdrawn from social gatherings, or your mood has affected your ability to concentrate on work or school. Maybe you've spoken to a spouse or loved one and they encouraged you to seek help. Please know that it's okay to still feel uncertain. You get to think and feel however you think and feel.
The next step is the phone call. You might find therapists by asking a good friend or family member for recommendations. You might also search therapist directories such as www.psychologytoday.com. You might look on google for reviews of therapists, although be aware that many therapists don't have reviews on directory websites to be discrete and maintain their clients' confidentiality. Therapists are not allowed to solicit their clients for reviews.
You may also find listings of therapists in organizations dedicated to specific mental health conditions. For example, the Rape, Assault, Incest National Network (www.rainn.org/) has a listing of therapists with special training with treatment of interpersonal and sexual traumas. You can also look at national or local psychological organizations such as the American Psychological Association (www.apa.org) or the San Diego Psychological Association (www.sdpsych.org). Your city or county may also have resources on governmental websites. In San Diego, the resource is 211sandiego.org/. If you are using insurance, then you can contact your insurance and request a list of in-network providers. For an additional list of resources, click here.
The next step is the phone call. You might find therapists by asking a good friend or family member for recommendations. You might also search therapist directories such as www.psychologytoday.com. You might look on google for reviews of therapists, although be aware that many therapists don't have reviews on directory websites to be discrete and maintain their clients' confidentiality. Therapists are not allowed to solicit their clients for reviews.
You may also find listings of therapists in organizations dedicated to specific mental health conditions. For example, the Rape, Assault, Incest National Network (www.rainn.org/) has a listing of therapists with special training with treatment of interpersonal and sexual traumas. You can also look at national or local psychological organizations such as the American Psychological Association (www.apa.org) or the San Diego Psychological Association (www.sdpsych.org). Your city or county may also have resources on governmental websites. In San Diego, the resource is 211sandiego.org/. If you are using insurance, then you can contact your insurance and request a list of in-network providers. For an additional list of resources, click here.
If you are using insurance, you should call your insurance before you begin services to verify coverage and eligibility. You should ask about your deductible (i.e. the amount you need to pay out of pocket before you can receive benefits) and co-pay or cost-share (the amount you are expected to pay the provider for each session).
If you are using an HMO, then your options are more limited in terms of therapists and you will be required to use a provider in-network to utilize benefits. You should ask your insurance whether you need a referral from your primary care or pre-authorization for mental health services.
If you have a PPO plan, then you likely will be able to see a therapist outside of the network; however your share of cost may be higher than an in-network provider. If you are planning to utilize a PPO, then you will likely pay the provider directly for services and then submit a receipt for services called a superbill for reimbursement from your insurance. If your insurance doesn't cover services with specific provider, then you are always able to pay out of pocket for services. If you have an Health Savings Account (HSA), then you would also be able to use this account to pay for therapy sessions.
If you are using an HMO, then your options are more limited in terms of therapists and you will be required to use a provider in-network to utilize benefits. You should ask your insurance whether you need a referral from your primary care or pre-authorization for mental health services.
If you have a PPO plan, then you likely will be able to see a therapist outside of the network; however your share of cost may be higher than an in-network provider. If you are planning to utilize a PPO, then you will likely pay the provider directly for services and then submit a receipt for services called a superbill for reimbursement from your insurance. If your insurance doesn't cover services with specific provider, then you are always able to pay out of pocket for services. If you have an Health Savings Account (HSA), then you would also be able to use this account to pay for therapy sessions.
Everyone feels pain. But that doesn't mean you have to suffer.
Make sure to call a few different therapists. Find one who makes you feel comfortable. Ask lots of questions on the phone. Are they accepting new clients? How much are their fees? Do they accept insurance? Do they see adults, children/adolescents, or couples? How long have they been practicing? What type of therapy do they practice? Do they have any experience with your specific problems? What type of degree and/or credentialing do they have?
If your intuition feels off or they seem rushed to answer these questions, then listen to your gut. Politely let them know you don't feel like it's a good fit and end the phone call. If you don't find a therapist right away, keep trying. Eventually, you will click with someone.
- Psychologists have doctoral degrees (Ph.D. or Psy.D.) with 4 to 6 years of graduate level education.
- Masters-levels therapists, such as a Licensed Marriage and Family Therapist (LMFT) or Licensed Clinical Social Worker (LCSW) have 2 years of graduate level education.
- Psychiatrists (MD) have four years of medical school followed by four years of residency. Psychiatrists are also licensed to offer psychotherapy, although many focus exclusively on prescription of medications.
- Some therapists are pre-licensed or operate under a supervisor's license. Ask for the name of their supervisor and the type of training/supervision they receive.
- Unlicensed therapists, or "coaches" are not a regulated industry and are not legally or ethically allowed to provide psychotherapy for mental health conditions.
If your intuition feels off or they seem rushed to answer these questions, then listen to your gut. Politely let them know you don't feel like it's a good fit and end the phone call. If you don't find a therapist right away, keep trying. Eventually, you will click with someone.
The First Visit
Once you have found a therapist, you will schedule an appointment for the first visit. The therapist may send you informed consent forms or have you fill in the forms in the waiting room. Read the forms carefully and ask questions. These forms discuss things such as fees for services, cancellation policies, your rights as a client, and limits of confidentiality. Legally, therapists are mandated to maintain your confidentiality and only permitted to disclose any protected health information (PHI) in extreme exceptions (i.e. imminent danger to self or others, child or elder abuse).
Arrive early to the appointment to make sure to find parking and have enough time to settle in. It's okay to bring a spouse or family member to the initial appointment. Make sure you feel comfortable in the waiting room. Therapists may have water or tea in the waiting room. Therapist's waiting rooms and offices should be both warm and professional.
Arrive early to the appointment to make sure to find parking and have enough time to settle in. It's okay to bring a spouse or family member to the initial appointment. Make sure you feel comfortable in the waiting room. Therapists may have water or tea in the waiting room. Therapist's waiting rooms and offices should be both warm and professional.
Welcome! Dr. Sage will be with you shortly.
The therapist will greet you and bring you into the therapy room. Sit wherever you feel comfortable. The therapist should be friendly, engaged, relaxed. Typically, the therapist then reviews the forms and asks you if you have any questions. Then the therapist will ask you what brought you in, how long the problem has been occurring, and how it has affected various parts of your life. Feel free to ask questions during this process. Also, feel free to be specific about what you are looking for out of the treatment. Do you want to stop smoking? Do you want to learn more healthy ways of communicating to a spouse? Do you struggle with a specific phobia?
You should receive a diagnosis in the first session, although this may sometimes be extended after a few meetings if you have a complicated history. Some therapist say they 'don't diagnose' clients because they feel that it unfairly labels the person as unhealthy. I believe that a label can instead be empowering, especially after learning that other people have struggled in the same ways as you.
For example, combat veterans with PTSD often find solace after learning that the horrors of war have been affecting soldiers for centuries and that the first written record of PTSD symptoms date back to Homer's Odyssey in the 8th century BC. I believe that you are not your diagnosis, rather your diagnosis is a part of a bigger story of the challenges you've faced in your life and how you've learned to cope with these struggles.
You should receive a diagnosis in the first session, although this may sometimes be extended after a few meetings if you have a complicated history. Some therapist say they 'don't diagnose' clients because they feel that it unfairly labels the person as unhealthy. I believe that a label can instead be empowering, especially after learning that other people have struggled in the same ways as you.
For example, combat veterans with PTSD often find solace after learning that the horrors of war have been affecting soldiers for centuries and that the first written record of PTSD symptoms date back to Homer's Odyssey in the 8th century BC. I believe that you are not your diagnosis, rather your diagnosis is a part of a bigger story of the challenges you've faced in your life and how you've learned to cope with these struggles.
The therapy room should be both warm and professional
The therapist should begin offering treatment options after a few sessions based on your diagnosis. There are many different types of psychotherapies. Psychodynamic Therapy focuses on fostering awareness of internal conflict and understanding the impact of early experiences on relationships. Humanistic Therapy focuses on the therapeutic relationship, and providing a safe, non-judgmental space to be understood as an essential component of getting better. Cognitive-Behavioral Therapy or CBT focuses on understanding how our thoughts and behaviors affect our emotions and gaining new insights and coping skills for addressing problems in our life. Mindfulness and Acceptance-Based Therapies focus on staying in the moment and being curious and non-judgmental to our experiences. The therapies differ in many ways, but all share very similar fundamental components (i.e. fostering a safe, collaborative atmosphere to explore thoughts and feelings with the intent of finding relief from painful emotions and enhancing one's engagement with meaningful and purposeful activities).
Some therapies are considered Empirically-Supported or Evidence-Based Treatments. These therapies have been scientifically studied to be safe and effective for treating a specific condition. They are considered to be the "gold standard" of care and are preferred for a first-line approach. For example, the three evidence-based treatments for Post-traumatic Stress Disorder are: Prolonged Exposure Therapy, Cognitive Processing Therapy, and Eye Movement Desensitization Reprocessing. These therapies have all been shown to be safe and effective when compared to one another, and the studies have been replicated enough times to be confident about the results.
If the therapist's explanation of the diagnosis and treatment feels accurate and fits with your observations/expectations, and the relationship seems like a good fit, then schedule a follow-up meeting. Sessions are usually held once a week for 50 - 55 minutes, although the frequency and duration of the sessions may vary. Some intensive therapies such as exposure therapy for PTSD can be scheduled for 90 minutes.
The duration of the treatment can vary depending on a number of factors, including the severity and chronicity of the problem, the client's insight into the problem and willingness to work in the therapy, complications related to concurrent problems (e.g. substance abuse, certain personality traits, stability with social support or employment). Some therapies such as Cognitive-Behavioral Therapy for Insomnia (or CBT-i) have been shown to work in as little as 6 weeks. Others, such as psychodynamic therapies can last for years.
You are not your diagnosis, rather your diagnosis is a part of a bigger story of the challenges you've faced in your life and how you've learned to cope with these struggles.
What you should expect over time
Over time your therapist will work with you to accomplish a few things. The therapist should help you feel safe to express your thoughts and emotions without fear of judgment. They should provide education about the mental health condition and offer resources as appropriate. They should work with you to develop goals. You may want to include a spouse or family member in with your treatment, so they too can learn how to support you with your treatment goals. The therapist should teach you some therapeutic techniques to achieve these goals so you walk away with insight or new coping skills for your condition.
As the weeks progress you should notice benefit in terms of feeling better, being able to recognize triggers earlier, and feeling more empowered in your life. If the treatment does not seem to be helping, then feel free to have an open dialogue with them about any obstacles which are hindering your progress.
Therapists should never take offense if a client feels that the therapy is not benefiting them, but instead should be grateful for the feedback and willing to talk openly about your work together. Giving your therapist feedback might be uncomfortable for some people, but is so important for the therapy to be effective. For some, it may actually benefit therapeutic goals if it mimics other patterns in his or her life (e.g. the client has difficulty setting boundaries in relationships or feels unable to communicate their needs to others).
In my experience, some of the most effective results in therapy only happened because the client was courageous enough to let me know when they weren't benefiting so we could identify barriers and brainstorm solutions. Being honest with ourselves and to others may be one of the best gifts of therapy.
As the weeks progress you should notice benefit in terms of feeling better, being able to recognize triggers earlier, and feeling more empowered in your life. If the treatment does not seem to be helping, then feel free to have an open dialogue with them about any obstacles which are hindering your progress.
Therapists should never take offense if a client feels that the therapy is not benefiting them, but instead should be grateful for the feedback and willing to talk openly about your work together. Giving your therapist feedback might be uncomfortable for some people, but is so important for the therapy to be effective. For some, it may actually benefit therapeutic goals if it mimics other patterns in his or her life (e.g. the client has difficulty setting boundaries in relationships or feels unable to communicate their needs to others).
In my experience, some of the most effective results in therapy only happened because the client was courageous enough to let me know when they weren't benefiting so we could identify barriers and brainstorm solutions. Being honest with ourselves and to others may be one of the best gifts of therapy.
Over time, you and your therapist may decide to lessen the frequency of sessions to once every other week or once a month until you both decide to no longer schedule appointments. You and your therapist may review all the insights and new coping skills you learned in the therapy and discuss ways how to maintain these gains through all the ups and downs of life. The final meeting is so rewarding for both the client and the therapist! A 'good goodbye' can feel both sad and joyous, and is an important recognition of your growth as a person.
If you have any questions about therapy, feel free to ask! Call (858) 228-7701 or click Contact Dr. Sage.