Congratulations! You’ve made one of the best decisions you can make: asking for help. Whether you’ve decided to get help to control or moderate your use of alcohol or substances, or whether you’ve decided you want to be entirely abstinent, or whether you just want to explore the role that addiction might play in connection to an underlying depression, anxiety, stress, or self-esteem issue, you are being proactive in trying to find someone who can help you. Acknowledging that you need help is never easy, but it’s one of the best things you can do for yourself. Finding the right addiction therapist is just as important as making the decision to get help.

Before determining whether the treatment provider is “expert” enough, you have to decide what type of practitioner you would like to consult. Addiction treatment often involves working with a combination of professionals. Probably the most comprehensive place to start would be to meet with an addiction psychologist for a complete evaluation. However, there are several other types of therapists with the necessary and sufficient experience to get you on your way. It is important to know the differences between these sorts of treatment providers.

People often will begin their search for addiction treatment by consulting an “addiction psychiatrist” or “addiction psychologist.” In actuality, these are two very different kinds of professionals. Knowing the difference is essential. Furthermore, the professions of psychotherapist, social worker, and counselor all have different specialties, and their focus and breadth of treatment can vary considerably. In most instances, their credentials are much less important compared to their experience and the connection you can establish with them. Most therapists would likely agree that the most curative factor in the psychotherapeutic relationship is the rapport that develops between therapist and person in therapy. So while you’re looking for someone you can afford, you are also looking for someone with whom you can connect.

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What Is an Addiction Psychiatrist?

An addiction psychiatrist is a medical doctor who specializes in treating people with addictive and mental health issues primarily with medicines such as antidepressants, antipsychotics, and medications that help to treat underlying mental health conditions and comorbid issues. While there are many psychiatrists who don’t prescribe medications much and focus primarily on therapy instead, most psychiatrists manage medications and work closely with psychologists and other therapists who will provide the talk therapy treatment. Subsequent psychiatric appointments following an evaluation tend to be short, about 20- to 25-minute med checks; they are mostly concerned with how a person is adjusting to a drug regimen, minimizing side effects, and gauging effectiveness.

Most importantly, an addiction psychiatrist has special training in prescribing medications to help individuals who are struggling with their substance use. It is important to work with an addiction psychiatrist and not just a general psychiatrist when you are trying to determine the nature of your relationship with drugs and alcohol and considering making behavioral changes. An addiction psychiatrist can prescribe medications to help you detox or withdraw from drug and alcohol use, and they can also prescribe medications to help you with cravings, which could avert relapse.

What Is an Addiction Psychologist?

An addiction psychologist, on the other hand, is a doctor but not a medical doctor. Addiction psychologists are trained mental health professionals who can help you explore the role that addiction plays in your life. An addiction psychologist can help you become more aware of your thoughts, feelings, and behaviors, and teach you different ways of dealing with problems through therapeutic approaches such as cognitive behavioral therapy, motivational interviewing, mindfulness-based relapse prevention, 12-step facilitation treatment, and community reinforcement and family training.

Additionally, addiction psychologists let you talk your way through a problem and help you get to the heart of the issue so you can make the necessary changes that will improve your life for the long haul, and not just put a bandage on a major wound. A typical appointment with a psychologist is 50 to 55 minutes.

Other Professionals Who Can Help

There are other types of addiction therapists in addition to psychologists who might be helpful, including social workers and licensed professional counselors. Social workers may have their master’s or doctorate, while licensed professional counselors may have only a master’s-level education, though both are trained in mental health issues to varying degrees. Social workers in particular are trained in obtaining the best social agency support services, and they tend to take a social and networking approach to the treatment of mental health issues.

Psychotherapists may have any of the above degrees or none at all. A psychotherapist is sometimes a catch-all for someone who practices talk therapy, but the therapist may or may not be adequately trained according to the standards of another professional degree or certificate. For example, a psychiatrist or psychologist may describe themselves as a psychotherapist, but so too can a recovery coach or Joe Shmoe because he’s been a “spiritual advisor” ever since he was electrocuted while trying to repair his garage door. That said, many psychotherapists do receive comprehensive training, but it is important that you vet their experience, training, and credentials, as you should with any other therapist. (GoodTherapy.org does this work on your behalf as it has strict educational and training requirements for membership.)

Certified addiction counselors and certified alcohol and drug counselors are just a few of the titles bestowed to professionals who are counselors but not at the educational or academic level of psychiatrists, psychologists, or social workers. Often, these titles vary slightly according to state board guidelines, which can be somewhat less standardized from state to state. They may be no less qualified to treat you, but it is important to see someone who is licensed in his or her professional field. Ideally, your clinician would be qualified as both an addiction counselor and as a licensed mental health professional.

Finding the Right Addiction Therapist

Now that you know the differences between professionals, let’s talk about how to find the right addiction therapist for you. There are two common ways to find a psychiatrist and/or psychologist: (1) research local addiction professionals online, or (2) identify an addiction therapist who is recommended to you by another professional, friend, or family member. Both are perfectly legitimate ways to begin your search for the best match.

Once you think you have found someone, follow these steps to determine if they are competent, credible, and a good match for you. First and foremost, check their credentials to see if they are who they say they are. Make sure they have the associated degree of the professional discipline you personally are looking for. The professional you go to should be licensed, and the license should be up to date and clearly indicated on his or her website or profile listing.

If you think you found someone but they end up not being the right match for you, do not give up hope. It may be important to explain very clearly to this person what it is that you feel you are not getting.

Secondly, whether you want to see an addiction psychologist, psychiatrist, counselor, or psychotherapist, you should determine what expertise the person has in the field of addiction. This can be daunting because, across disciplines, there is no standardized way of determining one’s expertise in addiction. For example, while psychiatrists can be board certified in addiction medicine, addiction psychologists might obtain their proficiency by having (1) additional certification as a certified alcohol and drug counselor, (2) by being a member of the American Psychological Association Division 50 Society of Addiction Psychology, or (3) by having conducted research and published articles on addiction. Moreover, addiction counselors may have a certification through a state board, yet they may lack the background and training that a psychologist receives in mental health issues. This is important because half of all individuals who are diagnosed with a lifetime prevalence of addiction will also be diagnosed with a lifetime prevalence of another comorbid mental health diagnosis. Furthermore, one might not want to see a psychiatrist who specializes in medication management and may not have as much training and experience in the various treatments involving the talk therapies.

Third, check reviews online. There are excellent therapists who don’t yet have reviews online, perhaps because they haven’t had an online presence or because it’s just not ethical to ask for reviews. Many psychotherapists will have colleagues write reviews for them, which is a helpful way of getting recommendations. One bad review can affect someone’s listing significantly, so look carefully at all the reviews to be fair.

Fourth, review the professional’s website and other sites where their practice might be listed to see that they offer “evidenced-based” or “best practices” treatment. While these buzzwords have quite frankly become passé and obsolete as they have been co-opted by marketers, you want to be sure that your therapist at least knows about the most up-to-date evidenced-based treatment approaches. Ask what treatment the professional uses that is evidenced-based, or ask for an opinion on something you’ve learned about, like harm reduction, 12-step facilitation, motivational interviewing, or mindfulness-based stress reduction or relapse prevention.

Fifth, have a phone conversation to see if you feel some sort of connection to your addiction therapist. This may be a feeling of confidence or an inexplicable bond of initial trust, but in either case, feeling secure with your addiction therapist is crucial. It is completely appropriate to say you are shopping for a therapist and that you’d like to speak on the phone to ask some questions or let the person know what is going on to see if it even makes sense to set up an appointment. This also allows the therapist to gauge whether you’re a good fit for him or her, and if not, to offer a referral.

Sixth, make a follow-up appointment where you can meet the person face-to-face and see if your initial instinct was correct. It is also reasonable to meet once or twice before you decide whether to commit to working with the person while you develop a treatment plan together. Remember, most importantly, you are looking for someone you connect with. You and the professional should both believe that the therapist can help. You are looking for someone you can afford, someone with whom you can feel comfortable, and someone you believe can help you.

If you’re lucky, you may get all these steps right on the first try, but many people do not. If you think you found someone, but they end up not being the right match for you, do not give up hope. It may be important to explain very clearly to this person what it is that you feel you are not getting. Often, the difficult experience you are having with the therapist is related to the reason you are in therapy to begin with. In other words, the conflict or problems you are having with your therapist may be the sorts of problems you have in other relationships and could be driving addictive or compulsive behaviors, and now you have an opportunity to work through those issues with a therapist who is trained to help you see your role in the relationship and in other, more important relationships. This is a wonderful opportunity to learn about yourself.

If your therapist shies away from this sort of dialogue, they will not be helpful to you. Sometimes, the match is just not right and you have to find another therapist. The right person is out there; you just might have to work a little harder to find that person.

Conclusion

In summary, because addiction treatment is a unique field, it is essential that your addiction therapist have a solid background in mental health and not just expertise in addiction. Since many of those with a substance use issue in their lifetime will also meet the criteria for another mental health condition, it is clear that these comorbid conditions are interrelated and may fuel each other. This is why it is so important that your therapist be an expert in both domains. When you seek help for addiction, you may experience issues such as depression, anxiety, trauma, attention-deficit hyperactivity, and relationship problems. Addiction therapists who are not licensed, such as recovery coaches and interventionists, can have an important role, but only when mental health professionals who are licensed are supervising and quarterbacking the treatment.

Once you’ve found an addiction therapist who is a good fit and you begin to understand your addiction issues—medical, psychological, and otherwise—you may feel as if a big weight has been lifted off of your shoulders. While most individuals considering stopping or reducing their drug or alcohol use are loath to imagine their lives without the use of alcohol or drugs, many recovering individuals report that their lives are vastly improved and that that their worst days in recovery are far better than their best days using.

One aspect of psychotherapy is that the person in therapy and the therapist participate in a process larger than what either or both can directly observe. Something can be happening in plain sight, but we might not see it because it doesn’t fit into our way of looking at things. But sometimes we fit into its.

Tom—not his real name—was in his early thirties. He was dealing with a number of opportunistic infections that had him confined to a hospital bed in a back bedroom of his family’s house and changed his once-handsome appearance. I saw him through an AIDS service organization that put services into people’s homes, and one of those services was therapy. Tom presented with symptoms supporting a major depression diagnosis, which he wore with a decidedly gloomy air—with anger beneath the gloom.

I’ve never felt as flattened as a therapist as when working with Tom. “What the eff good is this supposed to do me? Pardon my French,” he drawled halfway through our second session. He was always polite, and deeply weary.

He had a point. The infections which had affected his appearance and made movement out of bed virtually impossible had interrupted a life that had always been characterized by independence, a successful career, and enjoyment. I tried bereavement work and adjustment interventions, but Tom only withdrew from dialogue, observing me from across an ironic distance. He also made it clear that he didn’t want to address his health (“I live with this all day, every day. You think I want to spend another hour talking about it?”).

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What he was willing to talk about were his teenage years. He’d been born and raised in the Midwest, and his narrative, once he got going, was vibrant with details. Not just of what he’d done and the people he’d known, but about the landscape, the wildlife, and even the weather.

Tom had a highly developed extroverted sensation function. In depth psychology, this is a way of saying that a person is interested in the physical details of the world, and that these details are a source of deep pleasure. Issues of insight and meaning or even feelings weren’t high on Tom’s agenda. But he could describe the particular quality of the snow the night he and his cousin decided to walk to the corner store half a mile from the house for cigarettes (the flakes were slightly wet, so they tended to stick together, coming down in a spin because the wind kept changing direction, which was why he and his cousin lost their way on the street they’d both grown up on).

To me, this level of detail seemed like concrete thinking. I was someone driven by insight and deeply rewarded by it. It’s also how I gauged progress in the work. I couldn’t see anything happening in our sessions, which naturally made me think that nothing was. Early on, I asked him, tentatively, if he would prefer to work with someone else. To my surprise, he told me, “This is working OK. I don’t have any complaints.” I didn’t get it. Gradually, I learned to set aside my own expectations—one of which was that I was supposed to get it, was supposed to get something—and just be available to sit with him.

I was someone driven by insight and deeply rewarded by it. It’s also how I gauged progress in the work. I couldn’t see anything happening in our sessions, which naturally made me think that nothing was.

And so, without leaving the back bedroom of the little house in Los Angeles, I went on walks in the Midwest woods with Tom. I learned that the trees were mostly hickory, with a few spruces here and there. They never grew much over 12 feet and weren’t thick-growing, but they had plenty of walking space between them. It was a wet country, and you could usually hear at least one creek, often more, and the katydids. Birds sang around us, warblers and bluebirds, chickadees whistling like they wanted to get our attention. And of course the mosquitos were murder in spring and summer, and that’s one of the reasons he smoked Kools nonstop as we walked, because skeeters don’t like the smoke.

Sometimes we’d go down to his uncle’s for the Fourth of July barbecue. Everybody was there. His uncle used a cut-open water heater for a grill, and there was never any barbecue sauce, just salt and plenty of smoke. It was the best barbecue we ever tasted, and just one of the things lacking in L.A.

Other times, in the season, we’d go chasing storms up on the flatlands with his cousin—when she could be convinced, anyway, and by ourselves when she couldn’t. Yes, it was a pretty stupid thing to do, but when you saw those big, purple storm heads, bigger than anything you see here, and all that lightning, you forgot about everything else. And the tornadoes, when they came, were the best thing in the world. You never forgot those. And when you were stuck laying in a bed all the time, you dreamed about them and wished one would come out this way and take you back home.

Tom’s health went up and down—down most often. Eventually, he was hospitalized. Part of what I did was to follow people and keep meeting with them when they went into the hospital or nursing facility or hospice. The first week, Tom was in the ICU and not receiving visitors except family. When his mother told me it was OK, I went to sit with him.

“I haven’t slept in days,” he grated miserably. “I can’t sleep here. It’s too noisy, and they’re always coming into the room for something.”

I asked him to close his eyes. We went on a guided imagery walk out in the Midwest countryside. I knew the way. The hum of the air conditioner was the breeze through the tops of the hickory trees. That beep of the IV monitor—was that a grebe calling out on the pond or maybe a thrasher? The air circulating in the special mattress that reduced the chance of bedsores was the sound of the creek that ran along beside us. In this familiar landscape, we walked on and on, in no hurry, until the end of our visit. The last time I saw Tom, he was sleeping peacefully.

When Tom visits me in my thoughts, he reminds me not to judge the work because it’s not mine to judge. Its fruits might not show up anywhere that I ever see or know about. He reminds me to trust in a process that’s larger than I am, that I’m only part of.

At the beginning of therapy, many people are curious about what they need to do to make therapy work for them. They know that they will have to work in therapy to make it effective, but they often don’t know what that entails. Unfortunately, the unknowns of therapy cause some to feel that they’re just wandering and not making progress, or it causes them to leave therapy before they get to experience all the wonderful benefits. On a different end of the spectrum, these circumstances can also cause a person to stay in therapy too long and still not reap the rewards of good psychotherapy.

Getting the most out of therapy requires an alternation of spontaneity and focused reflection. It’s important to let your feelings and thoughts flow freely, but it’s also important to slow down, step back, and reflect on what those thoughts and feelings tell you. There are many ways and many areas of your own self-exploration in which you can practice this. While the content of your therapy sessions will be unique, I’d like to offer some additional guidance I’ve picked up from people who seem to get a great deal out of their therapy sessions:

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• Bring all of the different parts of your personality into your session. There may be a frightened and vulnerable child who needs to come in and cry, a micromanager who wants to tell the therapist what to do, a demon filled with hate, or an angel too sensitive for the real world. We all have many different parts to our personalities; some we’d like to hide, and some that are the only parts we’d like to show. Notice what you’d like to leave at the door and instead bring it in, either by showing it to your therapist or by telling him or her about it. Then, reflect on why you feel you’ve needed to deny this part, and what it may have to offer you if it could be included mindfully.
• Bring all of your emotions into your sessions. Your tears, your anger, your fear, your shame, and your delight—bring them all. Notice which ones you try to avoid, and welcome them all in as much as possible. Be willing to step back, contain them, and be curious about them without letting your emotions get out of control. In therapy, we exercise the capacity to have an emotion without it having us.
• Try to keep the focus on yourself. It certainly feels good to be able to blow off steam about what others have done wrong. A little venting can go a long way, and your therapist’s empathy, at this point, is indispensable. Eventually, though, you’ll need to step back and ask how you can think about the situation differently and how you can respond to it differently. When you focus within, you’ll find a lot of resources to make the changes you want and be much more empowered to make them.
• Forge an authentic connection with your therapist. Research tells us that the connection between a Please don’t feel you have use all of these suggestions, or that these are rigid rules that you must follow. It may take time to develop the ability to use these, and that’s OK.therapist and a person in therapy is profoundly important for change. But, as with all relationships, a good therapeutic relationship is made rather than simply found. To accomplish this, be direct with your therapist.No therapist is perfect. What is your therapist doing that works and doesn’t work? Is he or she leaving things out that you had hoped would be part of your work together? Do you find him or her cold? Intrusive? Not challenging enough? Too challenging? Do you worry that you like the therapist too much or that you depend on him or her too much? Say so.This sort of direct communication not only helps your therapist help you, it also helps you get comfortable with parts of yourself that you usually hide. A core principle of therapy is that it’s the relationship that heals. But you can’t just show up; you need to open up, too.

• Be very curious about why you are the way you are, and don’t judge yourself for what you find out. We’ve all adopted strategies for getting along in life; some help and some hinder. What are your strategies? Why have you developed them, and what do you get out of them? Some people, for instance, realize that they amplify their anxiety in order to get help from others because that’s the only way they were heard when they were young. Once you identify your strategy, don’t judge it. Have compassion for yourself. Self-acceptance is indispensable for therapeutic progress.
• Take responsibility for your behavior, but not for things that are out of your control. There is a huge price to pay for imagining that you can control things you can’t. Depression and anxiety are two mental health conditions that often arise from this dilemma. On the other hand, if you spend your therapy sessions blaming other people for how you live now, your progress will be slow to nonexistent.
• Use your sessions to identify themes and patterns in your life. Therapy is most effective when we connect the dots between events and understand how our personalities and our responses affect our well-being. Search for a deeper understanding of how you operate in different circumstances and it will serve you once you stop attending sessions and navigate the world on your own. Your therapist will help you recognize themes and patterns that underlie the events you discuss in session, but you don’t need to wait for your therapist to do this.
• Continue your work outside of session. Once you’ve made progress in some of these areas, it’s time to take the show on the road and apply what you’ve learned in therapy to your world. This can take the form of specific assignments you want to take on, such as going to the admissions counselor at a community college to find out what you need to do to start a degree. Or it can take the form of more general intentions about how you want to behave going forward, such as an intention to not avoid situations that make you anxious. Also, meditation, exercise, support groups, community, and creative work can all help you to actualize the change you’ve been discussing in your sessions.
• Use your challenges—even the small ones—as opportunities for growth. Once you know what your triggers are, welcome these situations as opportunities to respond differently. This is an attitude that often develops without conscious effort in therapy as we bring in the most challenging situations from our lives each week. But if you can begin to do this in a more conscious way, your difficulties will be less painful, and you are more likely to grow as a result of them.

Use of even a few of these points can help you not only overcome symptoms, but it can also help you develop a fuller, more satisfying life. Please don’t feel you have use all of these suggestions, or that these are rigid rules that you must follow. It may take time to develop the ability to use these, and that’s OK. It is the exercise of them that makes therapy so potentially powerful. Many people have entered therapy to fix a specific problem and leave treatment with a more balanced personality and more fulfilling approach to life. If you are using these suggestions, rest assured that your work in therapy will bear fruit.

I’m always curious as to what others have done to make their therapy effective. Please leave a comment and let me and other readers know how you get the most out of your therapy.

Choosing to see a therapist is a huge decision. It’s that moment when you decide:

• You need or want help (did you actually just admit that to yourself?).
• You can no longer manage this situation as effectively as you’d like to.
• You’ve been stuck for a while and want to move forward.

As a therapist, I can often perceive a shift in the person I’m speaking to on the other end of the line once that first appointment has been set. I can sense that person breathing just a little bit easier, and there’s often a subtle acknowledgment of hope and even accomplishment, as in, “I’ve just taken the first important step toward my future well-being.”

What leads up to that first step? How can you take that first step with more confidence so that you don’t feel like you’re grasping at straws? So that you feel empowered in the process?

I recommend doing five things before finding a therapist.

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1. Think About What You Want to Gain from the Counseling Process

It’s helpful to have a goal or two in mind as you begin. For example, are you focused on processing a particular incident in your past? Are you interested in developing better communication skills? Are you eager to challenge the way you customarily think about yourself or the world around you (your inner dialogue)? Do you want to create a toolbox for coping with anxiety? Are you looking for a “safe” place to express your feelings regarding a loss?

It can be helpful to have a place to begin and to be able to express that to the person you choose to work with. Of course, you can alter your goals or add to them once you begin counseling. Sometimes a deeper objective comes to the surface later on, once a therapeutic foundation and a sense of trust has been established.

Find out which therapists in your area are accustomed to helping people with the kinds of things you hope to explore. Most therapists have online profiles that outline the type of work they typically engage in.

2. Do a Little Research

Find out which therapists in your area are accustomed to helping people with the kinds of things you hope to explore. Most therapists have online profiles that outline the type of work they typically engage in.

If you’re comfortable asking, find out if people you trust have any recommendations. You will need to be sure that if you choose to work with someone who also counsels someone you know, you will not find yourself censoring what you have to say. (You can expect anything you say to remain confidential.) Otherwise, it’s probably best to find someone on your own.

Stack the odds for a successful and pleasant experience in your favor. This might mean finding someone you don’t need to travel too far to see, finding a therapist who has an ample parking lot (so that you don’t get stressed trying to find parking each time you go), making sure the office is handicap accessible, or ensuring the office has hours that will accommodate your schedule. You want to remove as many potential barriers as possible to getting there and obtaining the help you desire. You certainly don’t want therapy to add an additional layer of stress.

This leads us to the third thing to do before therapy.

3. Explore Your Behavioral Health Benefits

Be familiar with the insurance coverage you have, if any, and what it will cover in terms of behavioral health, both in-network and out-of-network. Find out if you have a deductible and how much you have satisfied so far, what the therapist’s fees are, what your copayment is, whether you need a referral or authorization, and whether you are allotted a limited number of sessions. Having this information will enable you to be an informed consumer.

It’s best to know what therapy will cost per session before you begin so there are no surprises once you start. Again, you want it to be as comfortable and smooth a process as possible.

4. Have Questions Ready When You Schedule Your First Appointment

Write down the name, number, and location of the therapist you are calling, as well as the questions you want to ask. This way, you can keep track of responses if you reached out to more than one counselor. Don’t be afraid to get the answers you need. You may want to ask the therapist directly about how they work, how long the sessions are, and how often you will typically meet. Feel free to ask about office procedures such as last-minute cancellations, what happens when there’s bad weather, etc.

This conversation gives you the opportunity to get a “vibe” or sense of whether you will be comfortable working with a particular therapist.

Finally …

5. Prepare to Do Some Work

You will get out of counseling what you are willing to put into it. It’s not always easy. It requires thought, introspection, reflection, and effort, a willingness to “try on” different perceptions or experiment with alternative behavioral approaches.

Know that there will be days you will feel resistant and won’t want to attend your session. I tell people I work with in therapy that THOSE sessions, when you DO show up, are often the most meaningful and powerful ones. Hesitation can serve as a signal that important work is about to be done. Showing up and telling your therapist that you contemplated canceling can open up a significant dialogue about where you are in your healing process, as well as where you’re going.

Don’t throw a dart at an online directory. Take responsibility for your healing as best you can. Don’t expect that every therapist will be the perfect match for you. Find the right fit. Feel the relief and self-assuredness that you are making an informed choice when you make that call and schedule your first therapy appointment.

Moving or relocating, be it near or far, is a great reason to plan ahead and seek help from a therapist. After all, there is substantial evidence showing relocation causes significant psychological stress and associated emotional challenges. Rarely, though, do I hear people cite a move as the reason for coming to therapy.

People typically pursue therapy when they are in emotional anguish or unhappy. In many cases, psychologists hear about emotional and physiological symptoms such as depression, anxiety, insomnia, worry, or stress that make coping with daily tasks challenging. Other times, the reasons for seeking therapy are relational, such as problems at work, bad behavior at school, relationship discord, or lack of friends.

Any or all of the above could result from relocating. Fortunately, the emotional, physiological, and relational difficulties associated with moving can be averted or ameliorated with early intervention.

The personal and social changes involved in a move vary widely with individual experiences and backgrounds, making such changes almost impossible to generalize. Nonetheless, commonly there are environmental/external or individual/internal factors at play. Environmental factors may include cultural or language differences, finances, and reasons for relocating. A family moving to London for a job promotion is very different than a family fleeing to Miami after a natural disaster, such as Haiti’s 2010 earthquake.

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The larger the cultural differences and the greater the geographical distance between the place of origin and the new home, the more complicated the adjustment to the new life is likely to be. A move to a country with an unfamiliar language may be more stressful than relocating within your home country. According to Kupka and Cathro (2007), who studied a sample of German expatriated families, expatriates rely more on social support from other expats in their adaptation to the new environment when there is a greater cultural distance. The existence of a social network in the new home may improve the well-being and adaptation of the moving family.

The larger the cultural differences and the greater the geographical distance between the place of origin and the new home, the more complicated the adjustment to the new life is likely to be.

Personal or internal factors may increase or ameliorate the stress surrounding the move and transition. Working at a counseling center in Tokyo, I found that many of the people in therapy who struggled with adaptation to their new environment and to cultural norms had experienced similar emotional distress back home. When someone had difficulty making new friends or assimilating to a new social group in Tokyo, we often found a history of family disengagement or painful and traumatic interpersonal relationships at home. Moving rarely solves the problem by itself.

Church (1982) supported these anecdotal observations while surveying families that had relocated internationally. The researcher found that people with preexisting, untreated psychological conditions tend to develop more problems in the international assignment. On the other hand, those who had experienced previous successful moves or had a higher experience of self-efficacy tended to adapt more successfully and faster.

Personal factors such as previous losses, forced moves, and a history of complicated adjustments may complicate the adaptation and perhaps escalate to social and psychological issues that interfere with daily functioning. For example, a family forced to move because of war or a natural disaster may be ill-prepared to face the challenges of the new adjustment. Contrastingly, a family excited about their new life that has developed accurate expectations, a connection to their future community, and has educated family members about the transition is likely to experience less stress and fewer difficulties adjusting. Planning and preparation, education, and anticipation of challenges related to a move may function as buffers to the development of more severe social and psychological problems.

Early intervention can build protective factors and coping skills to face the stress of change and adjustment. Research on families relocated internationally by companies has found that the success of the international job is related, among other factors, to the adjustment of the employee’s partner to the new country. When partners did not adjust and families had to return to their country of origin before the completion of the contract, the result was major financial loss for the companies.

Thus, multinational companies were motivated to invest in research into factors that would make the adjustment to moving successful. Then companies invested in implementing those findings. For instance, companies hired consultants to educate about cultural differences, to develop realistic expectations for adjustment, and to create social networks to embrace and help acclimate families. In many international schools, there is a process of absorption that may include assigning buddies, as well as teachers, counselors, and volunteers monitoring daily progress and creating experiences of inclusion for new students. On the other hand, there are schools that lack experience absorbing new families, often throwing new students into large classes with only a brief introduction and an expectation to fend for themselves. Some students adjust and thrive in almost any environment, while others struggle and develop physical, social, or emotional problems. Because the failure of an international assignment may cost 2.5 times the salary of the employee—sometimes more than $1 million—multinational companies began investing in preparation and support for families relocating.

If faced with a move, consider seeking the help of a therapist or other expert guide. The cost of help will likely reduce the emotional cost and improve emotional gains associated with relocation.

References:

1. Church, A.T. (1982). Sojourner adjustment. Psychological Bulletin, 9, pp. 540-572.
2. Kupka, B., & Cathro, V. (2007). Desperate housewives – social and professional isolation of German expatriated spouses. International Journal of Human Resource Management, 18 (6), 951-968.

At its most basic definition, self-care is any intentional action taken to meet an individual’s physical, mental, spiritual, or emotional needs. In short, it’s all the little ways we take care of ourselves to avoid a breakdown in those respective areas of health.

You may find that, at certain points, the world and the people in it place greater demands on your time, energy, and emotions than you might feel able to handle. This is precisely why self-care is so important. It is the routine maintenance you need do to function your best not only for others, but also for yourself.

GoodTherapy’s own business and administrative, web development, outreach and advertising, editorial and education, and support teams have compiled a massive list of some of their own personal self-care activities to offer some help for those struggling to come up with their own maintenance plan. Next time you find yourself saying, “I really need to do something for myself,” browse our list and pick something that speaks to you. Be silly, be caring to others, and make your self-care a priority! In most cases, taking care of yourself doesn’t even have to cost anything. And because self-care is as unique as the individual performing it, we’d love to invite you to comment and add any of your own personal self-care activities in the comments section below. Give back to your fellow readers and share some of the little ways you take care of yourself.

Check out our therapists in Seattle, WA or find a city closer to you.

The Web Development Team

Our web development team made up of programmers, web developers, designers, and SEO professionals is all about optimizing the user experience. When they aren’t hard at work making our site function, these are some of the ways they keep themselves functioning:

1. Pick one thing that you need to do and get it done so it’s off your mental “to do” list.
2. Get a manicure or pedicure.
3. Get a massage.
4. Try acupuncture. Read up on it if you’ve never tried it.
5. Get a book from the library (free) or bookstore about some topic you’ve been interested in, but have never taken the time to learn. Afterward, spend a few minutes each day learning about it.
6. Use a planner or a calendar to intentionally schedule “me time.”
7. In the morning, listen to music that inspires and motivates you.
8. Write a list of things you’re grateful to have in your life and post it somewhere you can see it often. We have a tendency to focus on the negative, so remind yourself of the good stuff.
9. Go through your closet and purge the clothes you haven’t worn in years. Donate them to a charitable organization.
10. If you bring your lunch to work, pack a few extra items to share with someone less fortunate on your way or during your lunch break.
11. Share a kind smile with strangers on your way to and from work. Some people may go all day without anyone acknowledging their existence.
12. Start a cycle of encouragement. Tell someone near you what you appreciate about them. They may return the favor when you need it most.
13. If you buy your morning coffee, skip it today and donate the money to a charity of your choosing.
14. Call your mom, dad, or any other family member you care about just to say hi.
15. For fun, dress your pet in a silly costume and take them on tour to make others smile.
16. Learn how to sew. Self-sufficiency may have some other mental health benefits for you as well.
17. Send a completely random care package to someone you love. Who doesn’t love a surprise?
18. Intentionally reestablish contact with someone you’ve lost touch with or have unresolved conflict with. If there is conflict, resolve it and let go of the unnecessary baggage.
19. Try out a form of martial arts. A lot of schools offer a free lesson.
20. Learn how to make a budget and keep track of your money coming in, going out, and know how much money you have right now. If you live paycheck to paycheck, this can be incredibly empowering.
21. Take a moment at the end of each day and consciously list a few good things in your life. This can help refocus your emotions on all the positive things that happen each day, even when it doesn’t seem like it.
22. Turn off your phone and step away from the computer for a whole day.
23. Carry some extra change and feed someone’s meter if you see it running low. Random acts of kindness come back around!
24. Take a few minutes out of your day and a enjoy a funny animal video on YouTube

The Support Team

The support team at GoodTherapy is all about taking care of our members and connecting our visitors with the right therapist. Here, they offer an abundance of their own tips for building your self-care routine:

25. Do something nice for someone and make sure no one can trace it back to you—an incognito act of kindness.
26. Go for a walk by yourself with headphones on, listening to music you love.
27. Prepare a meal, no matter how simple.
28. Create something for no practical purpose such as a song, a poem, an essay, a painting, a drawing, a comic strip, a collage, etc.
29. Start a genuine conversation with someone you care about that covers the following: things that are going well, things you’re having a hard time with, and things you are grateful for.
30. Lay on the floor on your back with your eyes closed for five minutes (or longer) and just breathe.
31. Shower with all the lights off. It forces you to move incredibly slow and it’s so relaxing. Make sure to have safety mats in place so you don’t slip on your way out.
32. Stare at your pet or another animal and seriously contemplate their existence. Do you think they believe they have a higher purpose?
33. Rearrange all of your furniture in a way that makes you more comfortable or just to try something fresh in your living space.
34. Check in with yourself a few times each day and take a moment to process your thoughts and emotions. Don’t let them build up.
35. Swing on a swing set. Too many adults forget how much fun this is.
36. Call your friend or sibling when you know they can’t answer and leave a ridiculously funny made up song as your voicemail. You’ll spread a little laughter while also laughing in the process.
37. Make up a brand new dance move and teach it to someone.
38. Do a five minute meditation on your feet.
39. Carve a couple hours out of your schedule this weekend to enjoy the classic film You Can’t Take it With You.
40. Go out to see a movie at your favorite theater all by yourself.
41. Make brownies and give them away to a neighbor, family member, friend, or someone you know that could use a pick-me-up. Enjoy any leftover batter.
42. Make a piece of artwork—draw, paint, cut and paste, whatever—that someone might interpret as ugly and tell it you love and accept it anyway.
43. Watch RuPaul’s Drag Race and bask in the charisma, uniqueness, nerve, and talent of the contestants. Try to channel some of that in your own life when you find yourself needing it.
44. Karaoke, but do it completely sober.
45. Worry less about your bathroom scale or any other appliance that makes you feel bad about yourself.
46. Go to a support group meeting and share.
47. Go to a support group meeting and listen.
48. Listen to a podcast about something that interests you that you haven’t yet explored.
49. Tell your cat all of your darkest, most shameful secrets. His or her nonchalance and snuggles will remind you that you’re okay.
50. Share dorky pictures of yourself from middle school and angsty teenage poetry and drawings with your friends. Ask for your friends to share theirs with you. This is a great way to let go of feelings of shame or any embarrassment you might be holding onto from those awkward years.
51. Roll out a blanket and eat your dinner on the grass at home or in the park. Invite someone else if you’d like company.
52. If you live near them, two words: hot springs. If you don’t live near hot springs, find the one nearest to you and start planning a vacation.
53. Make yourself a gourmet grilled cheese and some tomato soup. Comfort food at the right time or during the right type of weather can be great for boosting your mood.
54. Tell yourself something that resists self-criticism but feels encouraging like, “I’m doing the best that I can.”
55. Taking care of yourself can start with something small! Maybe today you just need to lie down on the couch instead of on your bed for a change of scenery.
56. Write a zine, or a mini-zine, about something you care about, or that you think is interesting. You can make a mini-zine with just one sheet of 8 1/2 x 11 paper!
57. Write something encouraging on a post-it and put it where you will see it every day! Or write directly on your mirror: “I am beautiful and brave.”
58. Say a magnificent affirmation out loud, like “I am a child of the universe, and I have been given endless talents and capabilities.”
59. Commit to posting mostly or only positive things on your favored social media site for a while. For every sad news item, there’s a related (or unrelated) story of resilience, bravery, and triumph.
60. Write a review of a business you like. Send that positive energy into the universe and share some love for your favorite local places!
61. Do something you used to like to do, whether or not you were or are “good at it.” Remind yourself that you can do something just because you enjoy it, and the only way most people get better at something is practice.
62. Read a book that’s easy and fun. You can give it away to a younger person in your life after if you feel like giving it up.
63. Listen to an album you loved when you were younger but haven’t heard in a long time.
64. Make a playlist or mixtape about your current mood. Give yourself permission to make one that expresses how you feel, or maybe even how you’d like to feel.
65. Congratulate yourself for doing difficult things, even if they might not seem difficult to others. Depending on the individual, plenty of everyday things can be difficult, like riding the bus, standing in line, filing paperwork, going to the doctor, making food, doing chores, etc.
66. Send a postcard to someone far away. Decorate it before sending it.
67. Paint your nails a fun color. Use jewels, glitter, nail stickers, or false nails. If you don’t want to spend money, try to use something you have around the house and see where your creativity leads.
68. Go to a store that sells crystals and buy one that speaks to you. Look up what it means or does. Sometimes they are $1 or less!
69. Reflect on the struggles your ancestors endured so you could exist and remember that you have inherited their strength and resilience.
70. Try to memorize one constellation you don’t already know and find it in the sky tonight.

The Editorial and Education Team

The editorial and education team at GoodTherapy is all about providing high-quality information, whether you’re a casual reader or a seasoned mental health professional. Between publishing articles on the blog, creating directories of information like PsychPedia, and hosting continuing education events for our therapist members, this is how they take care of themselves:

71. Set your camera to macro and take close-up pictures of bugs, flowers, and anything else that catches your eye outside your home or in a public space.
72. Select a lesser-known book by one of your favorite writers and dive into the pages.
73. Use a site like meetup.com, find something you’re interested in, and commit to attending at least one meeting.
74. Hand write a letter to a friend or relative and start a conversation the old-fashioned way.
75. Learn a new board game you’ve never played such as chess, backgammon, or othello.
76. If you play guitar, try learning a song from a genre you don’t typically listen to.
77. Find a spot in a busy place such as downtown, a bus station, or a mall and sit in silence with nowhere to be.
78. Read a religious text you aren’t familiar with.
79. Build something spectacular with Legos, either from a kit or from your imagination.
80. Dedicate a day to learning more about the local history where you live.
81. Take an Epsom salt bath in total darkness and silence, or perhaps with just a candle or two.
82. Bring a little cheer to your local animal shelter. Pet the kitties and walk a dog. You don’t necessarily have to take one home with you.
83. Go for a walk around the neighborhood, or hike a local trail you’ve never been on.
84. Cook a healthy and delicious meal using fresh ingredients you rarely splurge on.
85. Plant something—a tree, a small vegetable garden, a flower.
86. Sing! Turn up your favorite sing-along tunes and channel Etta James, Eminem, Eddie Vedder, or whoever moves you.
87. If you live near a body of water and have access, go kayaking or canoeing. Bring a buddy, and wear a life vest.
88. Go to a local gym or park and shoot some hoops, even if basketball isn’t really your thing; don’t worry about being “good” at it.
89. Get that trendy or fashionable haircut you’ve been thinking about but always talk yourself out of.
90. Finish this sentence: “I love myself because I ______________.” Do this once per day, with a new ending each time.
91. Watch a couple episodes of a feel-good sitcom for a few giggles. Have an exit strategy so you don’t get sucked into an all-day marathon and feel guilty for it.
92. When you wake up in the morning, get in the habit of making your first thought a positive one: “I am ready for today.” “Today is a new opportunity.” “I will do something I am proud of today.”
93. Touch nature every single day. Hug a tree, pick a flower, or run your fingers through some grass.

The Outreach and Advertising Team

Our outreach and advertising team fulfills the traditional role of marketing and then some. They help our company establish and foster relationships while leveraging technology to provide unique advertising opportunities online. They offered these activities for the next time you need some “you” time:

94. Pilates!
95. Cut some fresh flowers and display them prominently to lift your spirit.
96. Take a nap on the next Saturday you find yourself with an extra hour or two.
97. Treat yourself to a tasty meal at a fancy restaurant because you’ve earned it.
98. Learn the basics of a new language.
99. Attend a local high school sporting event and remember what sports are like when nobody is getting paid to play them.
100. Go to a comedy club. Laughter really is the best medicine.
101. On a clear night, find a safe and secluded spot away from the lights of the city, grab a blanket, stare up at the stars, and let your mind wander from big to small thoughts.
102. Go for a bike ride or a drive to nowhere in particular.
103. Attend a local music performance. Many small clubs, restaurants, and coffee shops have free admission for some shows.
104. Listen to a chapter or two from an audiobook.
105. Allow yourself to sleep in a couple of extra hours this weekend; errands and chores can wait!
106. Instead of always going to the tried-and-true, try a new restaurant this week. You might discover a new go-to.
107. Next time you’re getting lunch, buy lunch for the person behind you in line. Say you’re “paying it forward” and walk away with a smile on your face.
108. Book a night at a hotel outside of town, somewhere you’ve never spent much time. Explore the scene and enjoy the sights.
109. Go wine tasting. It’s an inexpensive way to sample a variety of local wines you might not be able to find in stores.
110. Learn Photoshop, Excel, or some other program you’ve been wanting to learn. There are many online tutorials.
111. Take your mom, dad, or another family member to lunch. You’ll be glad you did.
112. Write a limerick or a haiku!
113. Drink more water. The benefits are endless.
114. Write positive affirmations or inspirational quotes on small pieces of paper, then go to a bookstore and hide them in random books for strangers to find.
115. Try to find somewhere you can skip rocks on water.

The Business and Administrative Team

The business and administrative team ensures the wheels of GoodTherapy spin smoothly. They keep us growing, improving, and constantly reaching new therapists and readers that help make our mission and vision a reality. When they need to practice a little self-care, here’s what they do:

116. Make an inspiration collage and hang it where you can see it. Use it to help generate new ideas and thoughts when you need them.
117. Ask for help when you need it. It sounds simple, but trying to handle everything without help causes stress and anxiety for a lot people.
118. Take five to 10 minutes before bed to focus on what’s going on inside. Notice any parts of you that don’t feel relaxed. Invite them closer, listen to them, pay close attention and discover what their worries, fears, concerns, or other feelings are. Witness each part. Once all parts have relaxed, confirm with yourself that everything’s going to be all right and fall blissfully into sweet dreams.
119. If you want cuddles or a massage or quality time or whatever from your partner, ask for it! Sometimes the easiest way to get your needs met is to voice your needs in the first place.
120. Start a blog and write absolutely anything. You never know how your words might touch or hook people from all over the world!
121. Join a forum like Reddit or another place to talk about things you like.
122. Spend an hour this weekend at a soup kitchen or other volunteer opportunity.
123. Find a shop with tea, chocolate, or spices and enjoy the free smells for a while.
124. Go to an antique shop and marvel at all the history represented there. Make up stories about the objects’ pasts and the people they belonged to.
125. Go camping or backpacking and spend some time truly immersed in nature.
126. Go dancing and forget about any shame or regret. Even if you think you look like a fool, get out there and get moving.
127. We all get busy, but make it a point to make a date night with your significant other.
128. Stay in this weekend and host a family movie night.
129. Try something different with your coworkers and do standing meetings this week at work.
130. Try journaling if you’ve never tried it before. There are a lot of different ways to do it and lot of resources available to help you get started.
131. Learn how to tactfully say no to invitations or requests at times when you already feel overwhelmed.
132. Have a glass (or two) of red wine. Other than temporary stress relief, there are some great health benefits as long as you don’t overdo it.
133. Take a bubble bath with a good book.
134. Use the internet for its intended purpose and look up cat .gifs.

Need More than Self-Care to Get Back on Track?

Self-care, in many ways, is about prevention. It’s a way to make sure you stay strong and resilient when a crisis or other major life event occurs. However, sometimes you need more than a few self-care activities to feel centered again. If you find yourself experiencing emotions or a bad mood that seem to persist and negatively affect your life, consider finding a therapist or other qualified mental health professional. Sometimes examining these conditions in a safe, non-judgmental environment can help you understand what you’re experiencing better, help you build healthy strategies to cope with them, and help you build a self-care plan that works best for you.

From all of us at GoodTherapy, we’re wishing you the best!

In some a cases, a person might only be able to afford or only have access to an intern for mental health treatment, but that should not discourage him or her from treatment altogether. While there are very clear differences between a fully-licensed therapist and an intern in terms of what they have completed for licensing requirements, the capabilities of interns may surprise you, especially when coupled with the type of qualities that make a great therapist. Here, several therapists discuss the difference between therapy with an intern and a fully-licensed therapist:

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It should go without saying: conversion therapy is an outdated mode of treatment for an issue that is not, and has not been, a mental health diagnosis for quite some time. GoodTherapy.org does not endorse conversion therapy —also known as reparative therapy or sexual orientation change efforts (SOCE)—for homosexuality, nor does it permit mental health professionals to advertise those services to website visitors.

On March 3, 2015, The Huffington Post published an article in which Human Rights Campaign, a leading LGBT rights group, condemned Psychology Today, an online therapist directory, for allowing its therapist members to advertise conversion therapy on its profile pages. A representative of Psychology Today told The Huffington Post that the company did not intend to begin removing or refusing membership to therapists who offer conversion therapy. The backlash and criticism from health professionals, human rights advocates, and others was immediate.

Within 24 hours, Psychology Today had changed its position. In a statement issued March 4, the company asserted that it does not condone conversion therapy, and has notified therapist members that they would be de-listed if their profiles advertised this practice. Their updated stance is in line with what the majority of the mental health community has come to believe: conversion therapy has no place in mainstream mental health care.

Flaws in the Conversion Concept

Conversion therapy, also known as reparative therapy, is a controversial type of treatment aimed at changing a homosexual person’s sexual orientation on the assumption that homosexuality is an inherent flaw or disorder that must be altered. While homosexuality was once listed in the Diagnostic and Statistical Manual (DSM) as a mental health diagnosis, it was removed from the DSM by the time the third edition was published in 1980 with support from the professional mental health community.

In addition to rejecting conversion therapy as a useful treatment, GoodTherapy.org does not acknowledge homosexuality as a mental health disorder. The American Psychiatric Association (APA) agrees; a statement issued by the board of the APA in 1998 states: “The American Psychiatric Association opposes any psychiatric treatment, such as ‘reparative’ or ‘conversion’ therapy, which is based upon the assumption that homosexuality per se is a mental disorder, or based upon a prior assumption that the patient should change his/ her homosexual orientation.”

The APA isn’t the only organization to reject conversion therapy, as research over the course of years has affirmed concerns over conversion therapy as a treatment modality. The American Association for Marriage and Family Therapy, the National Association of Social Workers, the American Psychological Association, and the American Medical Association, among others, have issued statements against reparative therapy. Many cite research that suggests conversion therapy is likely to lead to harmful outcomes, such as contributing to anxiety, depression, relationship problems, self-loathing, and other issues. According to the Pan-American Health Organization (PAHO), “Services that purport to ‘cure’ people with non-heterosexual sexual orientation lack medical justification and represent a serious threat to the health and well-being of affected people.”

Several states consider conversion therapy detrimental enough that they have enforced or are considering bans on it. California, New Jersey, and Washington, D.C. have banned the use of conversion therapy on minors. Other states that have pending legislation to ban reparative therapy include New York, Massachusetts, Illinois, Iowa, Minnesota, Michigan, Ohio, Vermont, Pennsylvania, Colorado, and Hawaii.

Given a lack of research that supports the effectiveness or safety of conversion therapy, the American Psychiatric Association “recommends that ethical practitioners refrain from attempts to change individuals’ sexual orientation, keeping in mind the medical dictum to ‘First, do no harm.’ ”

GoodTherapy.org Philosophy of Membership

GoodTherapy.org is founded on a mission and vision to reduce harm in therapy by educating consumers so they can be equipped with resources and services that will help them achieve their mental and emotional health goals.

When mental health professionals sign up to be listed in the GoodTherapy.org therapist directory, applicants are required to certify that the services they provide accord in orientation and attitude to its Elements of Healthy Therapy Statement. A peer-review team verifies each clinician’s credentials and screens his or her profile content to ensure the person’s practice is in line with elements of good therapy. Profiles are reviewed for questionable content, such as homophobic, sexist, racist, or other discriminatory or harmful practices or beliefs. GoodTherapy.org does not list conversion therapy or reparative therapy as a type of therapy that members can select.

[fat_widget_left]Because the review process for inclusion in GoodTherapy.org’s therapist directory is done on a case-by-case basis by human beings, and because members are able to update their listings at any time, it is possible that an inappropriate listing could appear for a period of time in its directory. However, GoodTherapy.org addresses any such listing as soon as it becomes aware of it and takes action to remove the individual from its directory. Since GoodTherapy.org was founded in 2007, situations like this have been extremely rare.

It is important to note that there are people who seek therapy as part of an effort to change their sexual orientation. GoodTherapy.org’s position is in no way an invalidation of these individuals’ desires to work toward their chosen goals in therapy. GoodTherapy.org respects individuals’ rights to identify their treatment goals and choose treatment modalities that appeal to them for any reason.

It is perfectly acceptable for individuals to discuss, explore, and evaluate their sexual orientation in the context of a therapeutic relationship. Trained therapists should be equipped to support people in these efforts without prejudice or discrimination. GoodTherapy.org works to ensure that it offers people seeking treatment quality choices so they can find a therapist who meets their unique needs.

GoodTherapy.org was founded in 2007 with the mission of:

• Reducing harm in therapy
• Advocating healthy and ethical psychotherapy practices
• Encouraging therapists to work collaboratively and nonpathologically
• Depathologizing diagnostic-based language and therapy practices
• Educating consumers about the differences between healthy and unhealthy therapy practices

Toward this end, GoodTherapy.org makes every effort to avoid and remove from its site any content—including blog material and therapist listings—that contains a homophobic, sexist, racist, ableist, or otherwise discriminatory message. Dan Fajans, director of member services at GoodTherapy.org, explains, “Everything we do, from our therapist directory, to our Continuing Education Program, to The Good Therapy Blog, to our GoodCause program and beyond, is first and foremost an effort to put this mission into action. Providing an advertising platform for conversion therapy would be directly at odds with our mission.” GoodTherapy.org takes this stand based on mounting evidence that conversion therapy causes harm; leading mental health organizations do not view it as ethical; and it requires the therapist to operate from a fundamentally pathology-based understanding of the person who is seeking therapy.

Noah Rubinstein, GoodTherapy.org’s founder and CEO, stands behind GoodTherapy.org’s position on conversion therapy both professionally and personally. As a licensed marriage and family therapist who has worked in the mental health field for over 25 years, Rubinstein elaborates:

“In general, any psychotherapy that focuses on trying to depreciate, banish, or exile a psychological aspect of a person at the expense of curiosity, appreciation, and compassion is not in the best interest of the individual. Even with issues such as depression, anxiety, addiction, anger, self-criticism, and nearly every other symptom which motivates a person to seek help, the only agenda ever set by the therapist, in my opinion, should be to help the individual understand the purpose, function, and existence of such an aspect. The decision to help a person change some aspect of themselves should be made by the person in therapy only when he or she is in a psychological state of calm and self-compassion.

“I can only imagine how difficult it is in this culture for some individuals to recognize, accept, and explore their sexuality when it differs from the majority. I assume that those who want to change their sexual orientation are under enormous pressure internally and/or externally to assimilate and that any desire to alter their sexuality does not originate from self-compassion, unless their sexual practices are harmful to self and others—which homosexuality in and of itself is not. The only way to tell, I imagine, would be to first work with an individual to access the internal resources to transcend any internal or external pressures. At that point, one could reach a place of understanding, acceptance, and self-compassion for his or her own sexuality.”

As an organization, GoodTherapy.org reiterates its support for individuals experiencing any type of mental health challenge, in any stage of their mental health journeys. No person should be made to feel inadequate or broken because of a psychological concern, and all people are worthy of healing and love—especially self-love. If you feel discouraged or troubled, or if you feel you have been treated unfairly in therapy, there is hope and help available.

We invite you to share your thoughts or comments in the “Leave a Reply” section below.

References:

1. APA Board of Trustees. Position Statement on Issues Related to Homosexuality. March 2000. Retrieved from http://www.aglp.org/pages/LGBTPositionStatements.php#Anchor-55000
2. Herek, Gregory M. Facts about Homosexuality and Mental Health. Retrieved from http://psychology.ucdavis.edu/faculty_sites/rainbow/html/facts_mental_health.html
3. Millar, Katharine S. The Myth Buster. February 2011. Retrieved from http://www.apa.org/monitor/2011/02/myth-buster.aspx

Bipolar as a mental health issue is not well understood, but it is apparently caused by a neurological chemical imbalance which can often be managed by treatment with lithium or other medication. In a workshop on bipolar or manic depression, as it is sometimes called, a psychiatrist reported that one question often asked by people who experience it is, “Why me?” He proceeded to give what he thought was the correct answer, which involved a scientific explanation regarding the nervous system, genetic predisposition, and the chemical deficiency which may trigger the symptoms of bipolar.

The psychiatrist, however, had not understood the question. “Why me?” does not look for scientific explanations. Rather, it is a search for some meaning and purpose to any hardship or suffering that people with bipolar may experience. Furthermore, it assumes that there is something unfair about having to suffer, especially when so many others escape suffering. These are philosophical or perhaps even religious questions, not scientific questions. And they are not nearly so easy to answer. Indeed, they have no answer if the only source of knowledge is science.

People ask, “Is my marriage hopeless?” “Why did my child get killed?” “Will my life ever get better?” “Should I get a divorce? Have a child? Take another job? Go back to school?” In spite of the respect, even near-reverence, which many people have for their therapists, none of us can answer such questions. Our answers are no better than their own, and in most cases are worse. We cannot know a person better than he or she knows himself/herself.

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Psychotherapy may help a person achieve a sense of autonomy and control over his or her life. It does not, however, provide easy answers for the most difficult questions of human existence. The person who comes to therapy hoping that the therapist will take over his or her life and provide neat solutions to all problems needs to understand that life is difficult, that there are many unanswered questions, and that ultimately one must take responsibility for himself/herself. Learning these lessons while drawing on self-compassion should always be an important goal of therapy.

We do not learn and grow from quick fixes or easy answers, no matter how much we think we want them. And the therapist who offers such solutions is not doing the person in therapy any favor. People instinctively know that another person cannot run their lives. They resist in very creative ways the imposition of such solutions by overly helpful, not-so-helpful professionals.

There are a lot of questions I can’t answer—not for the people I work with in therapy and, in some cases, not even for myself. Life and death are great mysteries. And the best scientific research has not given, and cannot give, answers to these most important questions of human life.

On the other hand, the inability to answer such questions for the person in therapy is not the same as failure to grapple with them. And it does not mean that human wisdom is exhausted by the scientific enterprise. This leads to one final point about the nature of psychotherapy. Therapy of the psyche, the “healing of the soul,” is ultimately a spiritual or even a religious process. At some point, a competent therapist must feel comfortable dealing with these kinds of questions, questions about good and evil, what is the good life, and the meaning of life and death.

I remember when I first started out as a therapist. I loved offering advice. I had such important, good advice to share.

Actually, I was full of advice long before I became a therapist. I had good ideas for just about everyone in every situation starting from a fairly young age.

At one point in college, I decided to try an experiment. Instead of being so free and honest with my advice, I’d wait until people asked me for it. Why should I make it easy for everyone?

Strangely enough, no one asked.

Perhaps that’s part of what initially led me to this profession. Imagine my surprise when, three weeks into my first internship, my boss very directly told me and the other two interns, “Your job this year is to learn to listen and to not help anyone.”

What?

I found that to be glib and annoying. I figured he just wanted to say something bold, shocking, something to make us think twice. I mean, my earliest exposure to therapy was Lucy in the comic strip Peanuts. There was an advice giver if ever there was one.

Well, my boss was right.

Advice giving as a therapist should be a rare thing. Here’s why.

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• The person in therapy is the expert. It’s not just a business strategy, as in “the customer is always right.” Part of going to therapy is learning to trust yourself again. Sure, there’s an outside person who can help you see “the forest for the trees,” but good therapy means guiding without dictating. Ultimately—and maybe this is scary to hear—you know yourself better than anyone else, and perhaps a major reason you’re in therapy is to discover more.
• Empowerment. My wanting to give advice as a young therapist was more about me than the person in therapy. I feel like I need to be strongly on guard with respect to any kind of paternalism in my role. If I give you advice—even great, smart advice—I need to make sure I’m not taking away your growth in your own decision making. Sure, I can let you know if I think something is a really bad idea, but unless there’s a major safety issue, my main job is to guide your thinking (and feeling) through the situation. Someday, you’re probably going to not be in therapy. Am I preparing you for that?
• You’re rarely satisfied with advice. I can’t really remember a time when I gave direct advice that was really all that helpful in the long run. It was either not taken—which is fine; that’s at the other person’s discretion—or it was given because we were both avoiding something else that was going on. Meaning: maybe I gave advice to alleviate the person’s anxiety about a decision. You get advice from family and friends. You get advice from blog posts, attorneys, and trusted advisers. You don’t come to therapy to get advice. In my early days of therapy it’s been interpreted as an intrusion, an “I know you better than you know you.”
• It’s the relationship that heals. Ultimately, it’s your interaction with your therapist that provides the most healing and growth. While I might make some useful interpretations about a topic or uncover a long-hidden pattern, when asked what has been most helpful in my sessions (I think it’s important to regularly check in with a person about how we’re doing), most, children especially, say it’s that I listen and there is a space to just have feelings heard. People with anger management issues often get more out of working through their anger with me than they do from any step-by-step plans we formulate for time outside the office. It may seem counterintuitive at first, but we are relational people. It’s how we learn best.
• The last thing you need is another person telling you what to do. Let’s be honest. Before you got to therapy, you probably had a slew of wonderful advice givers: your parents, your in-laws, your partner, your friends—heck, the guy at the table next to yours. If you want advice, there are cheaper ways of getting it than going to therapy.

None of this is to say I’m never concrete with people in the therapy room or that I never offer suggestions. I don’t think it’s all that helpful to hold back or to be deliberately vague. But in my years of doing this work, I’ve given advice less and less and people seem more satisfied.

Sometimes my lack of advice giving brings up some strong feelings. I think back to when I wanted someone to make a decision for me. When someone did, I missed an opportunity to be better prepared for next time.

It’s like your mother telling you to look up a word in the dictionary instead of simply telling you its meaning. I was always angry when she did that. I considered her to be manipulative, withholding, and smarmy.

But I know what “pompous” means.

First, let me applaud your courage in seeking out therapy and for reaching out to GoodTherapy.org with your question. It is no small thing to acknowledge that one needs help, so bravo to you for taking those steps.

Your question of how to open up to a therapist is quite common. Many people feel overwhelmed at the possibility of sharing their deepest, darkest secrets and pain with a virtual stranger. It seems especially frustrating when you are paying for the services but still can’t seem to open up. However, this is perfectly normal, and many people find themselves in that position. There are a few things that might contribute to this: you may not have developed the level of trust you need to feel safe with the therapist you are working with, you may be fearful of being judged by the therapist, or maybe you are afraid that opening the pain of the past might be too much to handle. There are many reasons for people not opening up in therapy, so I will give you some ideas on how to get things going.

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If you’ve ever heard the saying, “If something scares you, you must do it immediately,” this will sound familiar. You have to build trust with your therapist AND with yourself—with your therapist, you need to know that he or she has the capacity to hold whatever pain you might share, and you need to know that you can handle sharing your past without falling apart, losing control, or being overtaken. The best way to do this is by taking small steps. First, I suggest talking with your therapist specifically about your inability to open up. This type of honest conversation can be a bridge to building trust in other areas. Second, after having that conversation, intentionally decide to take risks and share honestly in your therapy sessions. Even if you don’t want to share the trauma of the past, you can say, “I’m really anxious because I want to share, but I’m afraid of …” Simply naming the anxiety when it appears can help clear the way through it.

Finally, many people are concerned that the therapist will judge them when they share openly. While I can’t say that there aren’t therapists who judge, they are firmly in the minority. Therapists generally hold a genuine space of empathy and high regard for the people they work with, knowing that each individual has had a unique “pain journey” and that seeking help is not a sign of weakness, but rather of deep strength. Your therapist is a stranger only as long as you keep him or her that way. By taking small risks and building trust, you will deepen your relationship with your therapist, which will help your therapy progress.

You can make this therapeutic experience what you want it to be by taking ownership for how it has gone and making active choices in how to handle it going forward. I believe that you want this to work, and I believe that it will because you are willing to work. Best wishes in your journey!

Sincerely,
Lisa

Cognitive behavioral therapy (CBT) seeks to help people identify negative or unhealthy thoughts, replace those thoughts with healthier thoughts, and in so doing, change their behavior and feelings. People don’t have to spend endless sessions discussing painful childhood memories, and the formulaic nature of CBT offers some people reassurance.

Preliminary studies of CBT showed impressive improvements in symptoms of conditions ranging from depression to personality disorders, leading to a surge in therapists who offered CBT. This type of therapy continues to be one of the most widely used evidence-based treatments available.

According to famed British psychologist Oliver James, though, CBT is a “scam” that does little to address underlying psychological issues. James, a psychodynamic therapist, argues that until people understand what led to their psychological troubles, those troubles are likely to reoccur.

GoodTherapy.org CEO and founder Noah Rubinstein, LMFT, LMHC, takes a similar stance with regards to addressing underlying issues in therapy.

“I am certainly not an expert on what research has shown about the efficacy of CBT, and I certainly don’t want to throw the baby out with the bathwater. CBT is an evidence-based, short-term therapy that has helped many people. However, on a theoretical level, I’ve always considered CBT to be a surface-level treatment rather than a method for lasting changes,” Rubinstein said. “In my experience, the only way to make lasting change is to help people tend compassionately to the more vulnerable feelings that protective functions, or defense mechanisms—such as depression, anxiety, self-criticism, anger, or addiction—are shielding us from.”

CBT’s Short-Term Effectiveness

There’s no question about CBT’s short-term effectiveness; even James admits that people receiving CBT can see remarkable improvements in a short period of time. So effective is CBT in the short term, in fact, that CBT self-help manuals such as David Burns’s The Feeling Good Handbook have become bestsellers. Because CBT teaches people how to detect and stop automatic negative thoughts, it’s especially popular for treating depression and anxiety. Some therapists, regardless of therapeutic modality, even insist that their clients use CBT principles to treat these conditions. 

Can Short-Term Behavioral Interventions Provide Lasting Results?

When researchers evaluate the long-term effects of CBT, the treatment looks less promising. James points out that psychodynamic psychotherapy yields better results in the long term because it helps people address the root causes of their distress. Several studies support this claim. For example, a 2003 meta-analysis that compared CBT and psychodynamic therapy for depression across several studies found that people who used psychodynamic therapy had larger improvements. Another study of marriage therapy evaluated the effects of behavioral versus insight-oriented marital interventions. CBT relies on behavioral interventions, while psychodynamic therapy is built on insight. Thirty-eight percent of couples who used the behavioral strategies were divorced four years later, compared to just 3% of couples who relied on insight-based approaches.

Rubinstein takes the view that conditions such as depression and anxiety protect us from the vulnerable feelings associated with the true source of our distress.

“For example,” Rubinstein said, “the man with depression who’s shut down, can’t get out of the bed in the morning, and has given up might be protecting himself from trying, failing, and once again feeling that terrible worthlessness he’s felt in the past.” Like James, Rubinstein sees CBT as a short-term fix that “helps to eliminate the problematic, surface-level protective behavior.”

Indeed, one of the selling points of CBT is that it doesn’t require a long-term commitment to therapy. Many CBT programs take only a few months, and some promise near-immediate results. A study published in Psychological Medicine in 2008, though, found that long-term approaches may be preferable. That study compared long-term psychodynamic therapy to two short-term therapies: short-term psychodynamic therapy and solution-focused therapy. While the short-term approaches produced more immediate results, those results faded over time. At the three-year mark, people who had undergone long-term therapy saw more improvements. Although this study didn’t evaluate CBT, it does suggest that dedicating more time to gaining insight can be valuable. [fat_widget_left]

Laura Reagan, LCSW-C, a GoodTherapy.org Topic Expert on trauma and posttraumatic stress, blends CBT with a variety of other techniques. She sees CBT techniques as effective and essential, though she acknowledges that CBT may not be best for addressing long-term issues.

“In my practice with trauma survivors, focusing only on changing thoughts and behaviors through CBT without using a more depth-oriented approach will result in only temporary improvement of symptoms which are likely to return, as the underlying problem has not been addressed. I use CBT skills as part of my work with clients to challenge negative cognitions about the traumatic events experienced.”

Rubinstein agrees that underlying problems need to be addressed for lasting change, “I don’t agree with everything Freud postulated, but he did believe that if you eliminate a defense mechanism, another will take its place, and I think that is the problem with CBT in terms of its long-term effectiveness. Therapies that help people to resolve the deeper and more vulnerable feelings that fuel defense mechanisms offer potential for long-lasting change.”

Is It a Scam?

While CBT doesn’t work for everyone, it’s far from a scam. James is a well-respected therapist, but he’s also a practitioner of psychodynamic therapy, so his opinion is by no means free of bias. While some studies have shown that psychodynamic therapy is more effective in the long term, others show that the two approaches are equally effective. Few studies show that CBT doesn’t work at all, and several studies suggest that CBT can work in the long term. A study that evaluated people who had been treated with CBT for social anxiety found that, even three years later, they were able to use what they had learned in CBT to more effectively cope with anxiety. A 2006 review of recent studies found that CBT may help reduce depression relapse rates, particularly when researchers compare the effects of CBT to the effects of medication alone.

Carey Heller, PsyD, a GoodTherapy.org ADHD Topic Expert who uses CBT as well as other forms of therapy in his practice, highlights the importance of a strong therapeutic alliance. He explains, “Many studies have shown that the quality of the relationship between the therapist and the patient/client is one of the best predictors of treatment outcome. Thus, the specific type of treatment, whether it is CBT, psychodynamic, or an integrative approach, is not the only determining factor in whether treatment will be successful for a specific individual. I feel it is more important to find a clinician who you feel comfortable with and can look at your unique needs in determining the best treatment approach to help you rather than just seeking out a specific type of treatment on your own.”

References:

1. Hope, Jenny. (2014, November 10). ‘CBT is a scam and a waste of money’: Popular talking therapy is not a long-term solution, says leading psychologist. Retrieved from http://www.dailymail.co.uk/health/article-2828509/CBT-scam-waste-money-Popular-talking-therapy-not-long-term-solution-says-leading-psychologist.html
2. Kendall, P. C., & Southam-Gerow, M. A. (1996). Long-term follow-up of a cognitive–behavioral therapy for anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 64. Retrieved from http://dx.doi.org/10.1037/0022-006X.64.4.724
3. Knekt, P., Lindfors, O., Härkänen, T., Välikoski, M., Virtala, E., Laaksonen, M., . . . Renlund, C. (2008). Randomized trial on the effectiveness of long-and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up. Psychological Medicine, 38(05). doi: 10.1017/S003329170700164X
4. Leichsenring, F. (2003). The Effectiveness of Psychodynamic Therapy and Cognitive Behavior Therapy in the Treatment of Personality Disorders: A Meta-Analysis. American Journal of Psychiatry, 160(7), 1223-1232. doi: 10.1176/appi.ajp.160.7.1223
5. Snyder, D. K., Wills, R. M., & Grady-Fletcher, A. (1991). Long-term effectiveness of behavioral versus insight-oriented marital therapy: A 4-year follow-up study. Journal of Consulting and Clinical Psychology,59(1), 138-141. doi: 10.1037//0022-006X.59.1.138