If you think your mental health might benefit from psychotherapy, booking an appointment with a professional—often an Herculean task—is only the beginning. Before you start, there might be some mental cobwebs you’ll need to clear out to make therapy work for you.
Maybe you feel like your problems are insurmountable, or even doubt a therapist’s ability to make a difference. Maybe you fear or distrust the medical system, and opening up seems terrifying.
Therapists often see these hesitations with their clients and assure that by addressing them, you can overcome them and fully benefit from your time, financial, and emotional investment in the process.
“Me and my therapist didn’t click”
So you went to a therapist and after talking to them for an hour you decided there was no connection. It happens—as much as they’re professionals, they’re also just people, and it’s impossible to connect with everybody. Maybe they were poorly trained, which is not only discouraging, but also downright harmful, says Josh Jonas, a psychotherapist at The Village Institute, a therapy practice in New York City.
This is why it’s so important to find a good fit. Meeting with multiple therapists in your quest to find a dynamic that works for you is normal. Whenever it doesn’t feel right, just try another one. But, as anyone who has looked for this unicorn knows, it’s easier said than done.
Mental healthcare needs have spiked in the US over the past four years, according to the Centers for Disease Control and Prevention, and a shortage of mental health professionals that predated the COVID-19 pandemic only worsened after the health crisis. This has made it hard to find a therapist that’s a good match. The reality is even grimmer for the 160 million Americans that live in states like California, Texas or Arkansas, where mental healthcare access is limited.
To increase the chances of finding a match, ask for a quick intro call with the therapist you’re planning to see. Even if you are using an online platform where you are matched with someone through a questionnaire, you can request to interview them ahead of your first session and change therapists at any time.
You can ask them anything you want that will make you feel more at ease about working with them. But if you don’t know what to ask, Jonas suggests some ideas to get you started:
- What is your typical process for getting to know your patients and their concerns?
- What type of therapy do you use and why?
- How quickly might I anticipate seeing some sort of progress?
- Do you anticipate me needing to set aside time outside of therapy for “homework” or other to-dos?
It will take time and some effort, but Jonas says finding a good therapist is a fight worth fighting.
“My therapist won’t ‘get’ me”
Your therapist might be a person with an entirely different background than you, which might result in them not understanding you at first. But even if that’s the case, they should really want to try.
“People can have the sense that because of disparities, you might not get the same treatment,” says Marlene Watson, a licensed therapist and director of training at the Ackerman Institute, a family therapy clinic in New York City,
People of color, for example, might feel an inherent mistrust in psychotherapy (a field where the grand majority of professionals are white) based on the known history of systemic racism in the medical community.
In addition, some women might be concerned that male providers will be more dismissive of their experiences based on a history of sexism in healthcare. A 2021 study published in the journal Psychological Services, shows that women with serious mental illness are often overlooked in mental health and rehabilitation settings, and have a higher risk of treatment bias, abuse, and violence compared to men.
But even if you and your therapist have physical, cultural, or communicational differences, Watson says a good professional will not only have training on cultural bias, but will actively and openly talk to you about not feeling understood.
“We talk about communication as our business […] a therapist engaging in that type of dialogue is a sign you are in the right place,” she says.
If, on the other hand, they don’t initiate a conversation about it, you can. And if they seem closed off to it, it might be time to look for another therapist.
“I’m going to get reported or committed to a hospital”
Jonas and Watson validate that the fear of real life repercussions from opening up to a therapist can cause clients to think twice about what they share. From patients sufferring from suicidal ideations or self-harm, to parents worrying Child Protective Services might get involved, some people wonder where the line is when it comes to sharing the hard stuff.
Watson and Jonas say that outcomes where authorities need to get involved are rare and only happen when there’s a serious and imminent risk to the safety of the patient or someone in their life. Both professionals encourage those with suicidal thoughts to seek help, and clarify that asking about these ideations is actually a normal part of their job. Watson says that bringing it up themselves helps patients relax and turns treatment into “just a conversation”.
“I’d say to people, we are here to help you. To make sure you are safe, and that those around you are safe,” Watson says.
“I’ll be seen as weak”
There’s long been a negative social stigma around mental illness, implying that seeking therapy is a sign of weakness. This, Jonas says, is especially true among men and particularly prevalent in certain cultural groups, where the notion is exacerbated by the fear that this prejudice might permeate other areas of the patient’s life.
But Jonas explains this belief is not based on reality, especially as pursuing therapy becomes more common. According to the Substance Abuse and Mental Health Services Administration, 42 million people in the US sought help with their mental health in 2021, a number that has been steadily increasing since 2019.
In fact, he explains physical and emotional strength are much more similar than people realize. The emotional equivalent of being able to lift and hold 50 pounds at the gym is handling and processing your own emotions in a healthy way without offloading the weight onto someone else. Because that’s what snapping and yelling at people at home or in line at the register is—dropping those heavy dumbbells on the people around you. So therapy is your workout, says Jonas: “It makes you stronger emotionally.”
“Therapy doesn’t work… nobody can really help me”
A lot of people want to work on dealing with the long lasting effects of neglect and emotional disconnection. Ironically, this experience can perpetuate the feeling of neglect, because if a patient was abandoned once, they might feel it’s likely they’ll be abandoned again—even by their therapist. This feeling is also prevalent in patients suffering from addiction, who generally can’t find solace in people but in whatever they’re addicted to.
Luckily, Jonas says a lot of the time you only need one good experience with psychotherapy to dispel that belief. A 2018 literature review published in the journal Psychotherapy showed that a positive relationship between a patient and their therapist is strongly related to a good outcome, so unpacking your own barriers and challenges in that relationship is a must.
“There are many people I’ve seen who don’t trust, but for some reason trust you. That’s reparative, and a huge win, and the beginning of them learning people can help,” he says.
This is yet another reason why finding the right therapist for you is so important—it can change your entire disposition to your mental health journey. Because trusting the process, Watson says, is essential: “It’s not all about what the therapist can do, but it’s also about what you do.”