Choosing a Therapist

Dear Tony,

As you know, I am a mental health researcher. One of the issues I sometimes research is what factors produce a good therapeutic relationship. Those factors are complicated and difficult to determine. But based on some of what I have observed and personally experienced, I wanted to give some advice about choosing a therapist.

I realize you might not always have a choice of therapist. Geographic and insurance (among other) factors may limit who you are able to see. But you might have a choice between a few people or be able to request a transfer. Everyone's situation is different, which means I cannot give general advice. You need to figure out yourself what your options are.

With that caveat, here are some suggestions about choosing a therapist:

The absolute primary factor is: You must be comfortable with that person. If you are not comfortable, you are not going to be open and honest, which means you are not going to be able to address the complexities of your own situation. You might be more comfortable with a certain gender or a certain age group. If so, try to request it or look for it. Do not try to be fair to the therapist. Health does not play fair. Your needs have to come first.

This ideally works both ways. The therapist might say s/he is not comfortable treating you. This is very painful to hear (I have had that happen). In the long run it is most likely for the best. But you can be left feeling like a mutant. There is not much advice I can give about that situation, except to be aware that it might happen.

I have a few warning signs that you need to find a new therapist:

1. If you cannot discuss something which you feel you need to discuss. Therapists do make mistakes, and they may cut off an important point during a session. But if you bring up this point several times over different sessions and are never able to talk about it, then you are not receiving the help you need.
2. If you disagree with your therapist and are not comfortable saying so. Or if you do tell the therapist you disagree and are repeatedly ignored.
2.a. On a similar note - if the therapist tells you things about yourself that appear wildly speculative or just wrong, and you are not able to disagree (or it is too much effort to do so).
3. Very important - if your therapist becomes enraged if you do something without his/her approval. Therapists are not supposed to become angry in session, but it does happen. But if they grow enraged if you do something without his/her permission, they are insisting on having control over your life. That is wrong - the goal of therapy should be to help you lead the life you want, not to be dependent on the therapist. The therapist should be a guide, not a caretaker.

That is all for now. I will add more suggestions as I think of them later.

Outside Resources

Dear Tony,

You probably have some clear, tangible needs which my blog cannot help with. Maybe you would like to connect with other people who are living with mental illness. There are clubhouses designed for people with mental illness to socialize and support each other. Maybe you would benefit from face-to-face support.

That support can be difficult to find. I would like to give some suggestions. Every region is different, and what works in one area might not work in another. This is especially true for readers outside the United States. But I hope some suggestions will help.

Often these centers are familiar with each other: If you can find one, you can find help from others. The difficulty is finding that first one.

Large mental health organizations such as the United States Psychiatric Rehabilitation Association (www.uspra.org), the Depression and Bipolar Support Alliance (www.dbsalliance.org) and the National Alliance on Mental Illness (www.nami.org) have chapters in each of the fifty U.S. states (and some locations outside the United States). If you check their websites you might find a branch near you. If not, I would suggest you e-mail a contact person from the nearest geographical area in your state for suggestions.

Many states have 2-1-1 organizations which try to connect people with resources they need. These sites vary widely by state - some states don't have them and others have extensive lifts of resources. I suggest you check your state government website to see if they have lists of resources. You might need to spend some time looking at different links, but I would strongly suggest it. If that does not work, try typing "211 + the name of your state" into a search engine.

That tactic can work for a lot of needs. If you are having difficulty, you might want to try simply typing  "clubhouses + your city" or "mental health resources + your city" into a search engine. Make sure what you find is really geared towards your needs. But that can work.

Also, you might want to try looking on www.meetup.com. Meetup is a place where many different groups search for new members and advertise events. A lot of groups promote themselves there. Depending on your region, you might find groups dedicated to supporting people with mental illness.

Finally, you might want to searching www.craigslist.org. Craigslist is an all-purpose site. Make sure your search is on "Community" and then try typing in "mental health" "mental illness" "depression" "schizophrenia" etc.

Be aware it might take a while to locate these resources. Nothing works for everyone and every region. But hopefully it will be enough for you to start finding what you need. If you can, check out the site's individual pages and try to determine what you need. You often cannot tell in advance, but it is still a good idea to look first.

Good luck!

Questions

Dear Readers,

Thank you very much for joining me here. I hope you have found the blog helpful and informative.
I would appreciate hearing your thoughts about the blog. Please e-mail me at arioseo@gmail.com and answer the following questions:

1. What is your favorite post thus far? What is your least favorite post? (This can apply to both Tony and Kayla's letters.)

2. Which topics would you like to see addressed?

Thank you again,

Ariose

Building

Dear Tony,

I want to remind you that you need to go one step at a time.

I have come a long way since I was hospitalized. But I needed to do it piece by piece. If I tried to go too far, I would crumble. Recovering from mental illness is about a million small steps. In my expeience, there are very few big steps.

I think of it as building a foundation. When you are building anything, literally or figuratively, you build one brick, one nail, one small piece bit by bit.

You can do impressive things, but you need to do them a little at a time.

Starting

Dear Tony,

Starting anything is generally the most difficult part.

Once you have figured out what to do, start as soon as you feasibly can. If you are having nagging feelings that something is off than you need to pay attention to that. That is a legitimate reason to postpone starting. On the other hand, if you honestly believe this step is the next step, and you are just nervous, then you should start as soon as you can work yourself up to it. Postponing things usually does not help and can make the anxiety worse. Many times I have needed to start things just because the difficulty of taking that step was still better than continuing to live with my anxiety about it. I have learned to start things as soon as I can. Hopefully you can learn from my mistakes.

You need to decide what you need in place before you can start something. It might be a certain time or access to specific books or other materials of an infinite variety of other factors. No one else can tell you what you need - it is specific to you. It is not reasonable.

Even today, when I start a new skill - even reading a new book - I burn out very quickly the first time I try. I often can only do the exercise for about 10-15 minutes, and then I can't focus. My brain needs to rest and adapt to this new skill on its own. Once I grow used to it I can do it for longer periods of time.

Steps Towards Healing from Trauma

Dear Tony,

Major interventions such as healing from past trauma come in parts. You need to work on it for a while, make some improvements, then leave it and go work on something else. Think of a medical condition which requires multiple surgeries to fix. You prepare yourself and go to one surgery, heal and recover from that, then try to live your life to the fullest capacity until you are ready for the next surgery. Each surgery is legitimate, and you grow better after each one. But you can't do it all at once.

I needed to be out of the hospital for a while before I started to work on my trauma. When you decide to try to heal from trauma, that is what you are working on. That is the one skill you are working to build at the time. That is the primary reason why I waited: I felt I was better off improving my immediate life for a while. But that is just me.

Start with what is bothering you now. There may indeed be root causes or traumas which caused other traumas, but you still need to start with the most obvious and pressing issues. (One of the reasons why you will probably need to revisit trauma multiple times - you will develop a better understanding of the root causes are you are trying to heal. This cannot happen quickly.) The memories you work on should be based on how much it bothers you now - not how much it bothered you at the time or how much it does or does not bother other people.

Do what you can do, not what you need. Work on the feelings you can handle, deal with them, and let them go. Often, if I start to work on it, I can cut part of the troublesome feelings out pretty quickly. I generally felt like I could take off about 20% of my negative feelings by focusing on them this way.

Then I had to put it aside and go back to more immediate interventions. While I was doing that I gained more understanding of the causes of these traumas and what the next steps were. But I still needed to revisit it multiple times after that.

Sleep

Dear Tony,

As you have probably guessed, sleep is extremely important. Psychiatric problems can be intensified by sleeping difficulties; I think sleeping troubles might actually cause some mental health problems. All of my most serious mental crises either were preceded by or included substantial insomnia.

In order to stay healthy, I have learned to pay close attention to my sleeping and figure out when things are going badly astray. Everyone has nights when they do not sleep well, but trouble arises when you cannot sleep night after night.

If you are having trouble sleeping, try to relax. Being anxious about your sleeping can feed on itself and make the problem worse. You become worried about going through the next day without sleep and that worry keeps you awake. Tell yourself that you can do it, that you can make it through the next day even if you don't sleep well. You have functioned fine without enough sleep several times in the past. You can do it again if you need to.

For me, the main reason I cannot sleep is anxiety. Often it is a sign that there is a problem I am ignoring and need to address. Once I identify the problem I start to figure out precisely what I can do immediatley to address it and promise myself I will take those steps the next day. I tell myself that over and over again. Sometimes I need to address the problem immediately in the middle of the night. But most of the time it is enough to make a concrete plan about what you will do. For longer-term problems, try to think of something small you can do to address the situation. If you have honestly done everything you can that is helpful, tell yourself that over and over again. Other times I can't sleep because I am hungry and not aware of it. If so, just eat something. Try not to go overboard, but your need to sleep is more important than your diet.

Finally, if you start to have major problems sleeping, put these techniques into practice as much as you can and try to sleep as much as you can. As much as possible don't worry about when you sleep. Chances are you are run down or stressed and need the extra sleep. Just sleep whenever you can.