Hickey: Getting Help Part 2 — Therapy

It’s common knowledge that psychotherapy has come a long way since the heyday of Mr. Freud. It’s common knowledge that psychotherapy has come a long way since the heyday of Mr. Freud. And although most folks who seek treatment today know that they shouldn’t expect to lay on a couch and recount their dreams, a lot of people don’t know what they should expect. Having a solid understanding of how counseling works — and a plan of action for your own course of therapy — will maximize your chances of having a good experience with a counselor.

Although one of your goals should be to develop a trusting relationship with your therapist, it’s important to remember that you are still basically purchasing a service. The Counseling Center, like Pitt’s Student Health Service, is “free” in the sense that you’ve already paid for it. So like anyone who is in the market for something — in your case, a therapist who is competent, compassionate and well-suited to you and your needs — you should try to go in with a sense of what you want.

What do you picture when you picture yourself in therapy? Do you want someone who will listen quietly, or be forthcoming with lots of insights? Do you want to plop down and talk about whatever comes to mind, or be guided with lots of questions? Do you want to feel unconditional support and positive regard, or would you like someone to challenge you openly when you’re being self-defeating?

Do you care whether your therapist is a man or a woman? If you do, it’s OK. As a devoted feminist, I beat myself up for wanting my therapist to be a woman. Have I somehow internalized the idea that a man couldn’t excel in such a touchy-feely profession? But for me, therapy required that I open up about very personal sexual anxieties and body image issues — issues I wouldn’t have felt comfortable discussing with a grown man, no matter how sensitive. Political correctness, in this regard, would have gotten me nowhere.

What are your goals for therapy? Do you want to improve your self-esteem, cope better with stressful situations, recover from a past abusive relationship or fix your relationship with your mother? Do you need help managing your eating disorder or building the confidence to make friends?

Answer as many of these questions as you can before your first appointment. I would even recommend compiling a written list of the concerns that brought you to therapy and your hopes, fears and expectations about counseling. Bring the list with you to your first appointment. Having a list of talking points can ensure that you don’t freeze up, panic or answer the question “What brought you here?” with “I don’t know…”

Check in with yourself continually about what you want from therapy, what your therapist can do to aid you most effectively and whether he or she is doing that. Don’t be afraid to give constructive feedback along the lines of “Our discussion about X was very helpful in that…” or “When you said Y, it made me feel worse because…” A good therapist will appreciate these insights and take them into consideration.

Unfortunately, it is possible that you will do everything right and still have a terrible experience. My first psychologist — not at Pitt — told me during our third session that the reason I felt lonely was because my friends didn’t want to spend time with such a miserable person. A transgendered friend of mine was told by a school counselor — also not at Pitt — that he didn’t really identify as a man, he just wanted to dress that way because he was a sexual assault survivor and didn’t want men to look at him.

Friends, if your therapist does not respect your gender identity, GTFO. Do not pass Go, do not collect $200 — say goodbye, write a scathing review in the office suggestions box, and move on.

More broadly, although TV shows like “Dr. Phil” have popularized the idea of a “tough love” approach to counseling, something is probably wrong if your therapist makes you feel like sh*t. Unless you’re seriously harming or abusing someone in your life, there is very little reason therapy should make you feel guilty, belittled or judged. Your therapist shouldn’t make you feel like you’re being melodramatic and don’t really need help — or as though you’re stark, raving bonkers.

If your counselor makes you feel crappy — or if the two of you just aren’t compatible — you have the right to terminate the relationship. If you tell your therapist respectfully that you don’t want to be his or her patient anymore, you should not encounter resistance, drama or sass. If your counselor wants to ensure that you continue to see somebody, that’s one thing, but they shouldn’t try to insist that you continue to see them.

My aforementioned first therapist, when I told her I didn’t want to see her anymore, took it personally, tried to change my mind and generally behaved like a jilted ex-girlfriend. I’m glad I got out when I did.

Please don’t give up on therapy if you’ve had a bad or mediocre experience with your first (few) counselor(s). You wouldn’t quit school because of one bad teacher, and you wouldn’t stop getting your teeth checked because your first dentist was a jerk. Finding a counselor who’s right for you through trial and error can be devastatingly frustrating when you’re dealing with mental health problems, but it’s an ordeal that’s well worth sticking out.

Email Tracey at tbh15@pitt.edu.