By Alison Lynn, PMC associate director of social work
There was a time when it felt shameful to tell someone you go to therapy. Luckily, over the past few decades, it’s become increasingly normal to be open about ones need for professional support. Particularly post-pandemic, it is impossible to scroll through Instagram without seeing some kind of infographic or inspirational story related to mental health. But, despite this wealth of new information, many still don’t know what actually happens at therapy in enough detail to decide whether it might be helpful for them. What happens in the treatment room (or, on Zoom) can feel mysterious and intimidating.
In this two-part series, I’ll explain how to get started and what to expect from a first session, as well as how therapy can specifically help individuals with Alzheimer’s disease and their family caregivers.
First thing’s first: who should I see?
Many types of professionals can provide therapy – PhD psychologists, licensed clinical social workers (LCSW), marriage and family therapists (LMFT), licensed professional counselors (LPC), and more. What degree someone holds is less important than their overall philosophy and approach, and how well you mesh with their personality.
Finding a therapist is a little bit like dating in that you often have to meet with a few less-than-perfect matches to find someone you truly feel comfortable with. Try to make a list of three potential therapists who seem like a good fit, request a brief phone consultation with all of them, and schedule a first session with the one you like best. Don’t over-think these interactions. Rather, trust your gut — you know when you get along with someone.
Where do I find a therapist?
If you can’t find someone through a word-of-mouth referral, you can call your primary care doctor’s office to ask for a list of providers, or go on an online database like Psychology Today’s therapist finder tool. If you have a specific type of therapy in mind (more on that in a second), you can also find an affinity group with a member search tool, such as the Psychoanalytic Center of Philadelphia. Keep in mind that many clinicians are still only seeing clients via teleheath, so geography may not matter as much as it once did.
It’s no secret that therapy can be expensive, and not all therapists accept insurance. To see what mental health services your policy covers, give your insurance company a call, and while you’re at it, ask them for a list of covered providers.
Depending on your plan, you may have no co-pay at all, or you might have a per-session co-pay of $10-$50. If your desired therapist does not accept insurance, the average private pay fee in Philadelphia is $150 per session (but you might see rates up to $250). If you’re having trouble finding someone in-network and can’t afford a standard private pay rate, consider asking your desired therapist if they have any flexibility to offer you a sliding-scale fee.
What are the different types of therapy?
There are dozens upon dozens of therapeutic modalities, so I’ve listed some of the more common ones here:
- Psychodynamic: This type of therapy assumes that we are shaped by our past. It focuses on trying to gain insight into our current behavior by evaluating past behaviors, beliefs, and relationships, and the unconscious forces that shaped them.
- Behavioral (ie: CBT, ACT and DBT): This type of therapy focuses on understanding the relationship between your automatic thoughts and feelings, and how these impact your behaviors. It is often more structured and could involve a manual or worksheets.
- Somatic: This type of therapy focuses on the connection between mind and body, and usually involves movement as well as a heightened focus on the physical sensations of different feelings.
- Creative: Creative therapies might include art therapy, music therapy – even equine therapy. This is anything that takes the traditional model of sitting in a room talking and flips it on its head.
What should I expect at a first visit?
Your therapist will set the tone for this visit, but it’s safe to expect two things – a discussion about why you’ve come to therapy, and a discussion about structure. A therapist may ask you an open-ended question to begin, such as “why therapy now?” or “tell me about who you live with.” Or, they might have a more structured intake process that includes a set group of questions or questionnaires.
Structure includes things like how often and how long your sessions will be held, payment, confidentiality, how your therapist prefers to communicate between sessions, and more.
Usually, the first few weeks of a therapeutic relationship are about assessing for fit, and focusing on getting to know one another since much of the healing of therapy comes from the relationship between therapist and client. Be prepared to be unprepared about how you may feel as you begin this process. Especially if you are talking about trauma or other difficult subjects you haven’t had a chance to unpack, you may feel worse after a session than you did going in. Not only is this normal, but it also means you’re “doing the work,” as we say in the field. It’s also normal to feel relief or satisfaction, especially if you’re able to get something off of your chest that’s been there for a while.
This is part 1 of a 2-part series. Hit here to read part 2 “Demystifying psychotherapy: How therapy can help you.”