How to therapy
This talk isn't cheap. Here's how to make the most of it.
Disclaimer, before I say anything else
I am not a therapist1. I’m also currently not consulting regularly with a psychotherapist2.
However, I am extremely pro-therapy, will be back in therapy as soon as I possibly can and have a variety of other therapeutic practices that I supplement with in the meantime.
I see a theta healer regularly, to spend some time with my subconscious. I also do ad hoc work with a range of energy workers3, all of whom invariably act as sounding boards and give me the benefit of their infinite wisdom.
Aaaand *deep breath*, in the last 5 years, in addition to the above, I have:4
Consulted with 3 psychiatrists5
Consulted with about 8 psychologists in addition to My Main Guy
Done daily group therapy for 6+ hours a day for 4 weeks6
Done the Hoffman Process
Done two iterations of ISTA7
Taken every plant/amphibian medicine you care to name8
Done - honestly - every type of energy work imaginable9
Read every self-help book in the known Universe10
[Basically, I had A Very Bad Lockdown, and let’s leave it at that for now 😊11]
Why therapy?
Therapy is an opportunity to unburden yourself of any unhelpful shit that’s taking up unnecessary space in your head. And that could be Major Trauma or it could be your inability to stop thinking about how amazing Bridget Fonda looked in Jackie Brown12 when you’re supposed to be focused on something else Terribly Important.
There can be significant benefits to emptying your head on a consistent basis to a neutral third party13. Therapists aren’t encouraged to make your decisions for you, but they should be able to help you figure out if and why you’re stuck on a particular thing. Once you’ve figured this out, changing your attitudes and reactions can become easier14.
At the risk of being one of ‘those’ people who tell lesbians that they just haven’t met the right chap yet; there is a therapist out there for every single one of us. It’s even possible that you’re currently using a trusted friend in this capacity, but you haven’t realised it yet15.
Try a professional on for size and see if it helps.
N.B. Psychotherapy is different to psychiatry. Psychiatrists don’t typically offer therapy; they diagnose mental health conditions and prescribe/monitor drugs to treat those conditions.
What therapist?
You might not know the answers to all of these upfront, but they’re worth bearing in mind when looking for a therapist and during your initial sessions with a new one:
Do you want a general sounding board with whom you work out your shit, or do you have a specific thing that you want to work through (addiction, trauma, neurodivergence, anxiety, compulsive behaviour, couples therapy, family therapy)?
Do you want someone of the same sex, or the opposite sex?
Do you want someone who reminds you of your mum/dad/ your primary school teacher? Or is the literal opposite of any of those people?
Do you want someone a bit sweary? Someone who scares you a bit? Is very casual? Someone you could be friends with? Someone who’s rigidly professional? A bit of a hippie? Someone who wears a tie? Someone who definitely doesn’t have a beard16? Will it bother you if your therapist is substantially more/less attractive than you?
Crucially - can you imagine yourself feeling comfortable telling this person all of your random shit?
Is it important to you to do in person or online?
No one else can answer this for you, but you may cycle through a few therapists before meeting The One. Generally, you will just realise that someone is really helping you, even if you’re not sure how.
I love my guy because he is so unfeasibly a) clever and b) wise that I trust absolutely in his ability to help me sift through the confusing maze of my brain. He’s infinitely kind but calls me out on my bullshit with unerring consistency. You may want something completely different, and that’s ok. But it’s pretty important that you do realise what you want and need from your therapeutic relationship17.
It’s also useful context to let your therapist know which of their qualities or characteristics you find beneficial.
Reminder: you can end a therapeutic relationship at any time, for any reason. Try not to end it because your therapist is getting too close to uncomfortable truths that you’re trying to pretend you’ve dealt with. But you’re human. It might happen.
What type(s) of therapy?
When people refer to therapy, they tend to mean talking therapy, but somatic therapy (i.e. body-centred therapy) is increasingly recognised as having equal standing/benefit18. Stay open-minded. You never know when a shaman beating you with twigs might provoke a profound breakthrough in your relationship with your siblings.
There’s a pretty exhaustive list of talking therapies here. Your therapist will likely have a few specialisations/preferences.
Just to recap a handful of them:
CBT19 - this is usually for short-term management anxiety-based issues and focuses on immediate things you can do to distract or reassure yourself when panic looms. I was referred to a CBT therapist whilst having a full-on existential crisis. I can’t say that that helped enormously20.
EMDR - this is for deep-rooted trauma release. Awareness of it is increasing and it can be absolutely transformational.
Gestalt - holistic approach to therapy that encourages examination of mind and body and the emotions stored in both.
Schema - Increasing in popularity. Typically used to unpick how your childhood relationship with your parents might explain adult behaviours and reactions. Can be overwhelming if your therapist isn’t an expert in this.
Psychodrama - this shit is bananas21.
How to find your therapist
Either someone makes a recommendation, or you go looking.
A friend of mine recommended my guy. I would never have found him in a million years (we live on separate continents), but he is perfect for me.
It might feel odd to share a therapist with someone you know, but part of the therapist’s job is to compartmentalise this shit.
In the UK, your GP or insurance can make a referral, but it’s increasingly normal to find someone you like and then ask to be referred, if necessary.
Your other big resource is Psychology Today (they have coverage for about 25 countries). You can filter on all kinds of factors - it gets weirdly like online dating if you’re not careful. I am yet to turn up a good ‘un here from search results, but my guy is on here - albeit on a different country’s site - so there is gold in these hills.
So now, we’ve covered the ‘why’, the ‘what’ and the ‘who’. If you’re keen that therapy isn’t a waste of your time and money, please consider my unsolicited life advice on the ‘how’.
Don’t fucking lie to your therapist
I have known a handful of people down the years who are ostensibly22 in therapy, who either have The World’s Worst Therapist, or they’re outright lying to their therapist, based on the actions and insights they’re taking from therapy.
It’s highly unlikely that they all had The World’s Worst Therapist.
Don’t lie to your therapist. What’s the point? If you need someone to tell you that you’re flawless and an impeccable, irreproachable being, just ask Chat GPT nicely23.
Tell the truth, see where the chips fall.
Be ready to do the work
That’s it, really. Show up, engage and be brave. If you feel like you’re not getting anywhere, talk to your therapist about your expectations. If you’re still ending your sessions feeling they were pointless, ask your therapist’s advice and/or consider changing therapists.
Don’t weaponise therapeutic language
We all know someone24 who says stuff like “No one can make you feel anything. Only you are responsible for your feelings.”25.
Top tip: if you ever find yourself saying “My therapist says I have to be more selfish right now,” you might be an asshole and you’ve almost certainly misunderstood your therapist’s intention.
And, actually, using “my therapist says…” in most contexts is a copout. Be a grown-up. “My therapist encouraged me to think about why [whatever] bothers me so much and what it made me realise was…'‘.
Own your shit.
Record your sessions
A friend of mine encouraged me to write down after my sessions the things that I’d found most helpful.
My handwriting is terrible and I also didn’t need the pressure of remembering the nuggets of wisdom as they landed, so I started recording the sessions on the voicenote app on my phone. This proved unbelievably helpful.
I find it interesting to listen back to them during the week of the session - to see where I’ve been resistant or where an idea has percolated since, but I also dip into the back catalogue every once in a while.
Try it, you might like it. Also, therapy is expensive; might as well bank some of it 😂.
The piece of advice that may change your life
My unbreakable rule: the thing that I categorically never, ever want anyone to know is the thing that I need to tell my therapist the next time I see them. No matter what it is.
There are really only two outcomes here:
It’s not as big a deal as I think it is and they’ll help me work through it to see that and to understand why I thought it was so unimaginably terrible. (The latter is actually the important part.)
It IS a big deal, in which case things won’t start to improve/change/stop until I’ve told someone. As Liz Gilbert says: “The truth has legs. Things move quickly when you tell the truth”.
Obviously, sometimes I hate this (entirely self-imposed) rule and I get a clawing feeling of dread in my stomach. But I only ever hate it beforehand, it always feels better afterwards.
Scheduling
Be thoughtful about scheduling. Decide whether having a set time weekly works for you or whether you want some flexibility. Some therapists have a hard preference for consistency.
Also, think about what time of day you do your best thinking/talking/listening.
Consider how much time you need to re-enter polite society post-therapy.
It’s okay to stop working with your therapist if you find your time together has reached a natural conclusion. Either find a new one or take a break. They’ll still be around if you decide you want to resume. I voicenote mine periodically and his replies invariably make me bawl my eyes out.
If, actually, you can’t be arsed
This approach is also entirely valid. You are the boss of you.
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One last thing
My therapist told me this story once. I think it’s beautiful.
When he and his therapist first started working together, around 20 years ago, his therapist said: “Therapy is two people embarking on a journey together, leaning on each other as they travel down the road. Every step, each trusts that the other knows the way. One of them will always be leading, but the responsibility will switch between them many times during the journey. In fact, neither of them ever knows the destination. But they trust.”
Until the next time x
Fun fact: every therapist I’ve ever worked with has told me I should be a therapist. I have no plans. For now.
This is because my therapist is $400 for 45 mins and I took the life decision to be unemployed for about 2.5 years. I love him and - annoyingly - so far all other therapists pale in comparison. Believe me, I’ve tried.
Currently: breathwork, acupuncture and shamanic singing
Therapy is not a competition, this is just some context as to why I think I am remotely qualified to have opinions on this topic
Two of whom were legitimately moronic. One of them wrote me a prescription for a fatal dose of sleeping pills (no, really). And that was AXA, not NHS.
Via Zoom. It was the fucking worst.
Spiritual sex camp
Except kambo. I am not made for suffering.
Including consulting with a woman in Bali who touched my feet and saw into my soul
Yes, including that one
I’m good now. Great, even. Thanks for caring
I mean…
I genuinely think this was the original intention behind Confession for the Catholics, but they got morbidly fixated on sexual revelations. Which is probably the inevitable outcome of giving the job to a bunch of men on whom celibacy had been enforced.
Although The Work Never Stops. Annoyingly.
With apologies to the (many) friends to whom I send 25 minute voicenotes as a substitute for therapy
One of the things that I should probably be in therapy for: I prefer a male therapist who I feel like is slightly in love with me, but not so much that it’s problematic.
Spoiler: they’re not going to ‘fix’ you. They can guide you to seek change within yourself, but people can’t fix people. And people don’t need fixing.
The Body Keeps The Score is the current Text Du Jour for this, but it’s an incredibly dry read. Feel To Heal is more accessible, IMO.
The therapy version, not the BDSM version
I was also once privy to the most amazing conversation during a group CBT session.
The group member was describing a debilitating fear of checking her bank account, as she was terrified that she would see that it had been emptied. She relied completely on her husband to deal with the bills etc as a result and would shake if she saw any bank details on screen at any time.
Therapist: OK, great, thanks for sharing. So, obviously, what you can do to help with this is to remind yourself that it’s very unlikely that your bank account will be empty and that this isn’t based on any rational or realistic outcome.
Group member: No, this is exactly what happened to me. My government [of a famously corrupt nation] emptied my account, leaving me with nothing.
And she started sobbing uncontrollably whilst the therapist looked like they wanted to sink into the bowels of the earth and the rest of us shifted uncomfortably in our seats.
B-A-N-A-N-A-S
And, usually, loudly
Seriously. This query took me 20 seconds to type and Chat GPT under a minute to respond to. And I AM “at once, a masterpiece and an enigma” 😂. Getting Chat GPT to make me feel better about things is in my top 3 digital pastimes. DM me for the revenge stories I get it to write for me to wreak havoc on my foes.
It’s always a man.
You can, if you’re so inclined, immediately disprove this by punching them in the nuts and asking if you made them feel that. (I mean, probably don’t do this. But you could, is my point.)