Amid the height of the pandemic, while friends announced pregnancies and career changes, and others held postponed weddings in the brief window between the vaccine rollout and the variant surge despair, I quietly marked a milestone of my own: 52 therapy sessions in 52 weeks.
If you’ve never engaged in therapy, this might seem insignificant. But therapy is not just a casual chat on a comfy couch, as it is so often portrayed in television and movies. For me, committing to processing past trauma while simultaneously experiencing a year of upheaval was no small feat. Knowing what to expect from the process could have made some of it easier, so I’ve come up with some tips based on my experience and advice from mental health experts.
Determine your needs
As licensed therapist and trauma expert in Birmingham, Ala., Candyce “Ce” Anderson said, “you don’t have to have a crisis to see a therapist.” There are innumerable reasons people seek therapy, including personal growth, relationship issues, coping strategies and support to address a mental health condition.
If you’ve decided to take this step, “figure out what you want to get out of therapy,” said Aisha R. Shabazz, a therapist, licensed clinical social worker and anxiety specialist in Philadelphia. Make a list of goals, such as processing trauma or grief, or acquiring tools to cope with anxiety. If you aren’t sure yet what your goals are but just know you want someone to talk to, write down the issues that prompted you to consider therapy. You can bring that list to the therapist and identify some goals together.
Pick a therapist
When it comes to a therapist, consider identity-related preferences. “For instance, do you prefer someone of a certain gender, racial background or nationality? Is it important for you to see someone who is LGBTQ knowledgeable and affirming? Do you want someone who understands anti-racism? Your faith? These are all things that go into your personhood,” Anderson said.
If you plan to use insurance, ask your provider for a list of in-network mental health professionals. If you’re paying out of pocket, you may cast a wider net and consult directories such as Psychology Today, Therapy for Black Girls and Therapy Den.
“Look closely at the therapist’s profile,” said Brittany A. Johnson, a licensed mental health counselor in New Albany, Ind., specializing in anxiety, depression and trauma. “What credentials and experience do they have? Find someone that speaks directly to your pain points.”
Ask whether they offer a free consultation. “Before you open up to someone, you want to have a baseline level of confidence that they’ll be able to help you,” said holistic and culturally affirming licensed counselor Sana Powell, a licensed professional counselor in Austin, Texas, with expertise in holistic and trauma-informed care. “Go through your own screening process and feel empowered to ask questions.”
Take time to settle in
The first session often involves info-gathering, so you’ll likely touch on a number of topics rather than dive deep into one (before your appointment, you may be asked to submit an intake form). Shabazz said this session, combined with the consultation, if you’ve had one, serves as a jumping-off point. You can expect questions about your family, relationships, mental health conditions and goals.
“Your first session may be overwhelming emotionally, because this is probably the first time you’ve said things out loud that you’ve been holding in,” Anderson said. It’s normal to feel tired after being so open, but a well-trained therapist will do their best to “send you out zipped-up,” Powell said. They may, for example, offer grounding techniques.
Don’t make a snap judgment. “Give yourself three to four sessions to see if it’s a fit,” Johnson said. “Make sure when you’re talking to them you feel seen and heard.”
If it doesn’t feel like a fit, consider communicating concerns before terminating the relationship. “While therapists are helpers, we’re also human,” Anderson said. “There are moments we may not give you exactly what you need, but we’re open to making adjustments.” She recommended using direct language. You can say something like, “I’d like to share a concern. What you said made me uncomfortable.”
What if you offer feedback and your therapist reacts adversely? “Find a new therapist,” Anderson said.
If the first therapist doesn’t work out, don’t lose hope. The experts said it’s normal to try a few before finding a match.
Engage with your therapist
The provider is there to support you, but you’ll need to participate. Ask questions, request clarifications, and take notes, if you find that helpful. If you’re doing a form of therapy where note-taking isn’t feasible, such as somatic work — which focuses on the connection between physical sensations and the mind — enlist the help of your provider.
“Ask if they can help you summarize during the last few minutes of your session,” Shabazz said. “Or have a notebook on hand and write down your takeaways after you leave.”
If you’re attending teletherapy, eliminate distractions as much as possible. “Try to cultivate a similar space of confidentiality and sacredness as you would for in-person sessions,” Shabazz said.
Practice between sessions
Engaging during sessions is a solid start, but, as I discovered and the experts confirmed, much of the work happens outside of that time. “You have to do the work between sessions to really solidify and process everything,” said Powell. For example, if you’re working on changing a behavior such as fawning (appeasement that can be a result of trauma), you’ll need to learn to recognize what triggers that response in you and replace it with the new behavior (boundary setting, perhaps) that you’ve discussed with your therapist.
Your therapist may provide homework or resource recommendations to help you apply what you’re learning, but if they don’t and you work best with defined tasks, ask. You can also write down questions that surface throughout the week and bring those to your appointments.
Create a buffer
You may have residual feelings, emotions and thoughts after a session, Shabazz said. “Give yourself space, physically and also emotionally, before moving on to the next thing,” such as taking the long way to work or going for a walk. “You want to signal to your mind and body that something significant just happened. If you just go through the flow of the rest of your day, you’re not allowing yourself to differentiate it from another event.”
You may also need time to regulate your nervous system with strategies such as deep breathing and progressive muscle relaxation — to take you out of the hypervigilant mode. “Find healthy outlets that are grounding for you,” Powell said. “That might be things like gardening, exercise or crafting.”
Share on your own terms
The experts recommended finding a trusted friend or family member you can count on to help process your experiences. “Sometimes you need someone — who understands and affirms therapy as a part of self-care — to talk to or just sit with you,” Anderson said.
If you’re not sure how to initiate the conversation, Shabazz recommended role-playing with your therapist. Sharing something so personal can be scary but, she said, “the more you talk about your experience [with trustworthy people], the more you’re able to connect.” Having someone in your corner as you work through things is imperative.
Expect ups and down
There were weeks I made leaps forward and days when I felt I’d been yanked backward. But my therapist and the experts confirmed this is normal. “A lot of people think when you enter therapy, it’s going to be this gradual uptick. But it’s not,” Johnson said. “You will have ebbs and flows.”
The bad days don’t negate your progress; they’re part of it. “Sometimes you’ll leave the session feeling relieved. Other sessions dredge up things from your past. It’s not always going to feel good,” Powell said. “It might feel like you’re taking a couple of steps back sometimes, but that’s part of your growth process.”
The nonlinear nature of healing may make it difficult to know when you’re ready to reduce the number of sessions, pause or stop therapy completely. Shabazz said your original list of goals comes in handy here. “If you’ve been able to cross some off your list and decrease some symptoms, you may be ready to reduce the number of sessions.”
Celebrate
Your mental health achievements deserve to be celebrated like the other milestones in your life. Therapy requires time, effort and courage.
“Before you even started working with your therapist, you’ve already overcome so many barriers by prioritizing your mental health and making that appointment,” Powell said. “Commend yourself. It takes a lot of courage, and you can inspire others to prioritize their mental health, too.”
Fitzgerald is a freelance writer. This article appeared in The Washington Post.