How to Get the Most Out of Ther­apy

Reader's Digest (Canada) - - Contents - LISAN JU­TRAS

IN 2013, SU­SAN* and her hus­band Scott were at a re­mote cot­tage near Vic­to­ria Beach, Man­i­toba, when the un­think­able hap­pened: Su­san’s daugh­ter en­tered the bed­room to find Scott ly­ing on the ground, un­con­scious after suf­fer­ing a mas­sive heart at­tack. While her daugh­ter called 911, Su­san leapt into ac­tion. “I tried to save him with CPR,” she says, but it was no use. By the time the first re­spon­ders ar­rived, he was al­ready dead.

The shock of sud­den wid­ow­hood at the age of 61 was hard enough, but Su­san’s grief was com­pli­cated by her feel­ing that if she had just done some­thing a lit­tle bit dif­fer­ent—per­formed CPR bet­ter, or not asked Scott to lift some heavy stones ear­lier that day—he might still be alive. “I couldn’t get out of the trauma,” she says. “I was stuck.”

Fi­nally, a year later, her fam­ily doc­tor re­ferred her to a ther­a­pist who spe­cial­ized in grief, a re­la­tion­ship that helped her be­gin heal­ing.

For many peo­ple—not just those suf­fer­ing a loss—psy­chother­apy can be a safe har­bour dur­ing a dif­fi­cult time, or an in­valu­able part of treat­ing an on­go­ing men­tal health prob­lem. And as the stigma once as­so­ci­ated with see­ing a “shrink” is fad­ing in this era of self-care and well­ness, peo­ple who never con­sid­ered ther­apy be­fore in or­der to ad­dress prob­lems old or new may be cu­ri­ous enough now to take the plunge. The ques­tion is: where do you be­gin?

Find­ing a Ther­a­pist

When seek­ing men­tal health sup­port, some peo­ple may get a re­fer­ral to a ther­a­pist from their physi­cian. The be­reaved may con­sult hos­pices and grief sup­port or­ga­ni­za­tions. And many peo­ple may sim­ply ask around and find a pro­fes­sional by word-of-mouth. If none of those op­tions are avail­able, Google will cer­tainly pro­vide names and directories in your area. But no mat­ter how you find a ther­a­pist, a lit­tle re­search be­fore com­mit­ting to a con­sul­ta­tion can save a lot of time.

The first thing po­ten­tial clients should do, says Pat Rayman, a Toron­to­based reg­is­tered psy­chother­a­pist, is check for cre­den­tials. In prov­inces where psy­chother­apy is reg­u­lated— On­tario, Que­bec, Nova Sco­tia and New Brunswick—the ther­a­pist should be reg­is­tered. For ther­a­pists in other prov­inces, Rayman sug­gests mak­ing sure they are at least part of an as­so­ci­a­tion, such as the Cana­dian As­so­ci­a­tion of Psy­cho­dy­namic Ther­apy.

After that, it’s use­ful to look into the ther­a­pist’s area of ex­per­tise, which many ad­ver­tise on their web­sites. Find­ing some­one who can help you with your par­tic­u­lar is­sue—whether it be re­lated to death and be­reave­ment, trauma and PTSD, ag­ing, fam­ily con­flicts, sex­ual iden­tity or ad­dic­tion—is also a good be­gin­ning.

Ther­a­pists use a va­ri­ety of tech­niques based on a num­ber of dif­fer­ent the­o­ries. Psy­cho­anal­y­sis, some­times called “the talk­ing cure,” was pi­o­neered by Sig­mund Freud in the 19th cen­tury, and even now most ther­a­pists still en­cour­age clients to speak ex­pan­sively about what’s on their mind. How­ever, some clients may pre­fer a more short-term treat­ment fo­cused less on ex­ca­vat­ing the past and more on chang­ing harm­ful thoughts and self-talk; cog­ni­tive be­havioural ther­apy (CBT) is a pop­u­lar op­tion along these lines.

Dr. Jo Hoff­man, clin­i­cal as­sis­tant pro­fes­sor of psy­chi­a­try at the Univer­sity of Bri­tish Columbia and a psy­cho­an­a­lyst, sug­gests keep­ing in mind the kinds of re­sources—fi­nan­cial, emo­tional and time—you have avail­able. “If you’re go­ing to do the deep-dive type of work, you need to have sta­bil­ity in your reg­u­lar, ev­ery­day life,” she says. Some­one in im­me­di­ate dan­ger—for in­stance, an abu­sive re­la­tion­ship—may in­stead re­quire tar­geted cri­sis sup­port in the short term. What­ever your sit­u­a­tion, try to be re­al­is­tic about how of­ten you can meet and what you can af­ford.

First Im­pres­sions

Dur­ing the ini­tial ap­point­ment, the ther­a­pist will be look­ing to get a sense of what brings you in, and you should learn how they work, ask­ing ques­tions about any as­pect of ther­apy you don’t un­der­stand. The two of you may have a con­ver­sa­tion about treat­ment goals, and also dis­cuss things such as fre­quency of ap­point­ments, fees and can­cel­la­tion poli­cies. But most im­por­tantly, this first con­sul­ta­tion—which is not a com­mit­ment—is a chance for both of you to gauge com­pat­i­bil­ity.

As renowned ther­a­pist Irvin Yalom once said, “It’s the re­la­tion­ship that heals.” In­deed, stud­ies have shown that across all types of ther­apy a good rap­port be­tween client and ther­a­pist is es­sen­tial for ef­fec­tive treat­ment.

To suss out whether it’s a good match, Hoff­man sug­gests be­ing as forth­com­ing as you can be about your life and prob­lems. “But also, be open and hon­est with your­self about how you feel about the ther­a­pist,” she says.

Dr. In­grid Söcht­ing, clin­i­cal as­so­ciate pro­fes­sor in the depart­ment of psy­chi­a­try at the Univer­sity of Bri­tish Columbia and a CBT ther­a­pist, says she en­cour­ages peo­ple to shop around. “Some clients find it off-putting if a ther­a­pist is too ‘touchy feely’ and overly ex­pres­sive, so they may pre­fer—at least ini­tially— more dis­tance and per­sonal space,”

It’s im­por­tant to pay at­ten­tion to, and share, feel­ings you have dur­ing ses­sions—in­clud­ing those about the ther­a­pist.

she says. “On the other hand, some ther­a­pists dis­play a sur­pris­ing lack of warmth and em­pa­thy.”

Söcht­ing sug­gests giv­ing it two to three ses­sions, and if you have a lot of neg­a­tive feel­ings, then just say “thank you” and move on.

Use­ful Home­work and Build­ing Rap­port

After sev­eral ses­sions with your new ther­a­pist, you’ll find your­self ob­serv­ing your feel­ings and be­hav­iour in a new light. For some clients, sim­ply show­ing up week after week will be enough to spark a heal­ing process, but there are ways to deepen the work.

Rayman sug­gests it can be use­ful to keep a jour­nal. Mostly, she says, “you’re train­ing your­self to be aware of what you’re feel­ing and what’s hap­pen­ing for you by writ­ing it down.” The jour­nal can also be good for de­scrib­ing dreams, since anx­i­eties blocked from our con­scious minds dur­ing the day can bub­ble up at night—and are good dis­cus­sion starters in ther­apy.

Be­havioural ther­a­pists may give clients work­sheets to fill out, which help re­frame ob­ses­sive, de­pres­sive or anx­ious thoughts. They might be asked to record out­comes of ex­er­cises meant to chal­lenge fears, or to keep track of how their be­hav­iours are linked to their moods. A binge eater, for in­stance, may record what they eat, and note their feel­ings and thoughts be­fore and after.

But no mat­ter what type of ther­apy you’re do­ing, you can aid the process by pay­ing at­ten­tion to, and shar­ing, feel­ings that you’re hav­ing dur­ing the ses­sions them­selves—in­clud­ing those about the ther­a­pist.

“The more the client can be open— if they are both­ered by some­thing the ther­a­pist does and can tell them—it will work to their ben­e­fit,” says Rayman. A quiet ther­a­pist may have no idea that their client wants more ver­bal in­put, or a client may need to make it known they’re be­ing pushed too hard to re­veal vul­ner­a­ble feel­ings.

For some­one who isn’t used to be­ing as­sertive, chal­leng­ing a ther­a­pist may feel out of their com­fort zone—which is ex­actly the point. The ther­apy of­fice is a use­ful place to test out new ways of be­ing in a re­la­tion­ship, which can carry over into the world out­side.

Red Flags

Even if a psy­chother­a­pist does not prac­tice in a prov­ince where the pro­fes­sion is reg­u­lated, they should be a mem­ber of an as­so­ci­a­tion with a clear code of ethics. These groups’ rules typ­i­cally pro­hibit bla­tant bound­ary vi­o­la­tions such as sex­ual re­la­tion­ships or un­re­lated busi­ness deal­ings be­tween ther­a­pists and their clients.

Some bad prac­tices, how­ever, are sub­tler. For ex­am­ple, since a ther­a­pist can be a strong, in­flu­en­tial pres­ence in a client’s life, it’s im­por­tant that the

client’s well-be­ing and agency are pri­or­i­tized. Rayman sug­gests be­ing aware of that power dy­namic: “Whose agenda is be­ing fol­lowed—the client’s or the ther­a­pist’s?” For in­stance, she says the ther­a­pist should not be de­cid­ing the top­ics of con­ver­sa­tion for the ses­sion or pres­sur­ing the client to have par­tic­u­lar emo­tional re­ac­tions.

Where the treat­ment pe­riod is ope­nended, Söcht­ing sug­gests ther­a­pist and client should eval­u­ate to­gether how things are go­ing at the three-month mark. If no progress has oc­curred, the ef­fec­tive­ness of the re­la­tion­ship should be re­con­sid­ered.

At any point, switch­ing ther­a­pists is an op­tion. A suc­cess­ful ther­apy re­la­tion­ship can con­tinue as long as the client wishes—some peo­ple may de­cide to see the same ther­a­pist for many years, while oth­ers may de­cide after a while to try some­one with dif­fer­ent strengths.

IN THER­APY, Su­san found her­self able to talk about things she had never told a soul be­fore—not just about the trauma of her hus­band’s death, but events from her more dis­tant past. Hav­ing suf­fered from de­pres­sion on and off her whole adult life, she cred­its her new-found emo­tional re­silience to the ther­a­peu­tic work she did. “When you get the strength to talk about deep-seated is­sues, that’s a huge thing,” she says. “Ther­apy was re­ally very heal­ing for me.”

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