A client mentions a video game you have never heard of.

Another describes a family expectation that does not fit neatly into the frameworks you learned in graduate school. Someone describes work, marriage, identity, religion, or responsibility in values different from your own.

What happens next?

For GoodTherapy member Hansel Wong, the answer begins with curiosity.

“Just be curious.”

It may sound like simple advice, but in Hansel’s work, curiosity is not merely a conversational skill. It is part of how therapists communicate respect, recognize cultural context, and build a relationship in which clients feel understood.

Hansel is a counselor and supervisor based in Adelaide, Australia. Originally from Kuala Lumpur, Malaysia, he began his practice in one multicultural city before continuing his work in another. Moving between the two required more than adjusting to a new location. It challenged him to reconsider what clients may want from counseling and what therapists may miss when they assume everyone is working toward the same version of healing.

His experience has led him to a central belief:

“Human connection can promote healing and co-regulation.”

For Hansel, techniques and modalities remain important. But therapy becomes meaningful when clinical knowledge is paired with genuine interest in the person sitting across from you.

PLAY

Video Interview: Watch the Conversation with Hansel Wong

Watch Hansel Wong’s Member Spotlight interview.

Watch on YouTube

In this interview:

  What moving across cultures taught you about counseling
  Why curiosity belongs in a therapist’s clinical toolkit
  What to know before your first therapy session
  What if nothing is wrong but something feels off
  How to find a therapist who truly gets you
  How to choose a therapist from an online profile
  How to reach someone who does not believe in therapy
  Men’s mental health and the myth that therapy is weakness
  Frequently asked questions

What Moving Across Cultures Teaches You About Counseling

Hansel began practicing in Kuala Lumpur, a fast-paced urban environment he describes as highly driven and achievement-oriented.

Many of the millennial clients he worked with were trying to reach a particular milestone. They wanted to progress in their careers, prepare for marriage, buy a home, improve their relationships, or move into the next stage of life.

After moving to Adelaide, Hansel encountered clients who were sometimes more interested in acceptance, balance, and understanding their present circumstances. Rather than immediately searching for the next milestone, they might be exploring how to feel more content with where they were.

While these observations were broad and should not be treated as fixed descriptions of either population, the important lesson was recognizing that he had been carrying assumptions about what clients wanted from therapy.

“Coming out of this glass bowl and seeing another side of the world expanded my understanding. Different cultures bring different values.”

A therapist may believe that a client needs to become more independent, set stronger boundaries, slow down, pursue a promotion, leave a relationship, or communicate more openly with family.

But before encouraging any of those outcomes, the therapist needs to understand what independence, family, success, responsibility, and healing mean to that client.

The clinical question is not only, “What would help this person change?”

It is also, “What would meaningful change look like in this person’s life?”

Why Curiosity Belongs in a Therapist’s Clinical Toolkit

A therapist’s professional development often focuses on treatment modalities, certifications, interventions, and clinical techniques.

Hansel encourages the counselors he supervises to think more broadly.

“Understanding the values, beliefs, and history of different cultures can be as valuable, important, and practical in counseling sessions as learning a different modality, tool, or technique.”

This does not mean therapists need to become experts in every cultural background their clients represent. It means they should be willing to learn about the histories, family systems, communities, interests, and everyday realities that shape a client’s life.

For Hansel, that includes learning beyond what is traditionally considered clinical material.

He recalls supervising a counselor whose client had begun talking about video games. The counselor was not a gamer and had limited knowledge on the topic. Hansel’s first response was not to redirect the conversation but to be curious about the game.

“What video game was it? Was it an open-world game? Was it a platform game? What was the name? Go search it up. If you can, play it. When a client starts talking about something niche, being able to pick it up and say, ‘I know what you’re talking about,’ immediately builds connection.”

Without curiosity, a therapist may hear only a hobby. With curiosity, they may recognize an important part of the client’s emotional and social world.

What to Know Before Your First Therapy Session

Curiosity is what a good therapist brings to the room. But what about the person on the other side of it, someone weighing up a first session? Here too, Hansel likes to lower the stakes. He compares starting therapy to seeing a physical therapist, a family doctor, or even going to the gym.

“No one is going to hand you a diagnosis or a label at the door. It is simply time with someone whose job is to hold a safe space for whatever you bring. And if it does not feel right, it was one hour of your life. Think of it like reaching a checkpoint in a game. You get to unload for a bit, pause from life, take a break, and then you click play and go through it again.”

For anyone who has been putting it off, that reframe can be the difference between booking and closing the tab. If you want a fuller picture, here is what to expect in a first therapy session.

What if Nothing Is Wrong, but Something Feels Off

Not everyone arrives with a clear problem. Sometimes nothing is obviously wrong, yet something feels off. Hansel hears this constantly, and his first suggestion may surprise you. He recommends a physical check first, because the body often registers strain before the mind does.

“Often the body can signal things faster than the mind can catch on. You feel the aches and pains before you realize you’re coming down with a fever. Mental health can work the same way.”

From there, he notices two common patterns.

Some people have carried stress for so long that it now feels normal, and they no longer register the weight of it. Others have finally built a stable, safe life, and it is that very safety that lets older, unprocessed experiences rise to the surface. Feeling off, in other words, is rarely random. It is often a signal that something is ready to be looked at.

Therapy is where you can put words to it and make sense of what is underneath.

How to Find a Therapist Who Truly Gets You

If connection is what makes therapy work, how do you find it? Hansel answers from both chairs. As a therapist, he wonders who will walk through his door. As a client, you are looking for someone you can genuinely open up to.

“What’s important at the end of the day is to feel like, hey, I can sit down with this person and have an honest chat about life. That’s really the crux of it.”

Shared background, gender, or faith can help you feel understood, but it is not the only path. Someone quite different from you can offer a fresh perspective. He notes a nuance familiar in smaller communities: sometimes people prefer a therapist from a different background, because a shared one raises the odds of being recognized through a friend or a relative. What matters most, he says, is whether you can imagine that honest conversation.

How to Choose a Therapist from an Online Profile

Choosing from a directory can feel like a lot, since you are often judging someone from a written profile alone. Hansel sees that as an advantage rather than a limitation, because a thorough profile tells you a great deal.

“Comb through the bio and find the therapist who specializes in what you’re looking for, whether that’s a specific approach, an age group, or a particular area they work in.”

Clients often know what they are after, whether that is a method like EMDR or acceptance and commitment therapy, a certain age range, or experience with a specific community. Read closely and match those specifics to your needs. A detailed profile is exactly what makes that possible, a useful reminder for any therapist writing their own. You can compare approaches and specialties across the GoodTherapy directory.

How to Reach Someone Who Does Not Believe in Therapy

Many people run into this wall, often with a parent, a partner, or an older relative who simply will not discuss mental health. Hansel notes that the cultures he has worked in are deeply multicultural, so there is no single attitude to push against. Rather than argue anyone into it, he starts where their interest already is.

“Lean into the things people like to talk about, work, relationships, and slowly weave in. Sounds like anxiety. Sounds like depression. Slowly but surely, people realize it’s not that big a taboo to talk about.”

Work stress, burnout, a breakup, a divorce. These are approachable, everyday topics people are often willing to discuss. The move is to follow that thread and gently name what you hear, rather than leading with a clinical label that closes the conversation down. It is a kind, practical approach for anyone with a loved one who treats therapy as off-limits.

Men’s Mental Health and the Myth That Therapy Is a Sign of Weakness

Ask Hansel which belief about therapy he would most like to correct, and he goes straight to the one that keeps so many people away, especially men: the idea that seeking help means you are weak. It is a stigma he cares about deeply, and one he has watched hold men back from support they need.

“The people I’ve sat across from and spoken with about their emotions, with such brutal honesty, are the strongest people that I know.”

Putting difficult emotions into words is not a failure of strength, Hansel argues. It is one of the hardest and bravest things a person can do. Men seek therapy at lower rates than women, a gap shaped more by cultural expectations around masculinity than by any lower need for support.

Hansel extends the same grace to therapists themselves.

“For therapists, we always feel like we need to be this perfect pillar of mental health. We are not. We are just two human beings sitting in front of each other, talking about life in a way that regulates each other’s emotions.”

The difference a therapist brings is training, ethics, the right questions, and a safe space. Beyond that, the work is human on both sides. That belief also shapes how Hansel guards against burnout, and his approach is refreshingly plain. A supervisor once showed him that decompressing after a hard session could be as simple as playing a game on his phone, no special technique required. For Hansel it is running along Adelaide’s beaches, tending his plants, and time with his wife and daughter.

GoodTherapy explores this in depth in the stigma around men’s mental health, and you can learn more about the challenges men face on our men’s mental health page.

Therapy Is Two People Talking

Across every question, whether about culture, curiosity, a first session, or the courage it takes to walk in, Hansel keeps returning to the same quiet truth. Strip away the fear and the jargon, and therapy is two people talking, one of them trained to make that conversation safe and useful. That is reassuring if you are nervous about starting, and grounding if you are the one holding the space.

“It doesn’t mean you’re weak to come in for therapy. It means you’ve taken a really tough step, and that requires strength.”

Hansel Wong is one of the counselors you will find on GoodTherapy. You can read more from the Member Spotlight series, including spotlights with Brooke Pomerantz and Annette Popernik.

Find a therapist who gets you Whether you are looking for support or building your own practice, GoodTherapy is where thoughtful therapists and the people who need them find each other.

→ Browse Goodtherapy.org

Frequently Asked Questions

Q: What is cross-cultural counseling? +

A: Cross-cultural counseling recognizes how culture, family, language, identity, religion, migration, community, and social context may shape a person’s experiences and expectations of therapy. It asks therapists to adapt their understanding to the individual rather than assuming one model of healing applies to everyone.

Q: How can therapists become more culturally responsive? +

A: Therapists can learn about different cultural histories and values, examine their assumptions, ask clients respectful questions, seek supervision or consultation, and remain open to correction. Cultural knowledge should guide curiosity rather than be used to make conclusions about an individual.

Q: Does a client need a therapist from the same cultural background? +

A: Not necessarily. Some clients feel more comfortable with a therapist who shares an identity or lived experience. Others value a different perspective or greater anonymity. Therapeutic fit depends on the individual and the quality of the connection, not similarity alone.

Q: What should therapists do when clients mention unfamiliar interests? +

A: Therapists can ask thoughtful questions and learn enough to understand why the interest matters. They do not need to become experts or pretend to share it. The goal is to recognize the role it may play in the client’s identity, relationships, coping, or emotional life.

Q: What should therapists include in an online directory profile? +

A: A helpful profile should explain who the therapist supports, the concerns they commonly address, how they approach therapy, what sessions may feel like, and any relevant languages, identities, services, or areas of experience. It should help prospective clients assess fit, not simply display credentials.

Q: How can therapists decompress after difficult sessions? +

A: There is no single correct ritual. A helpful transition may involve movement, music, gaming, time outdoors, caring for plants, connecting with family, or another repeatable activity that signals the end of clinical work. Persistent burnout should also be explored through supervision, consultation, personal therapy, workload changes, or other professional support.

You may have thought about therapy more than once. Maybe you have even opened a directory, read a few profiles, and then quietly closed the tab. A familiar worry talks you out of it. Other people have it worse. You are not in crisis. And what would you even say once you got there?

Therapist Amy Hooper hears some version of that all the time, and her answer is steady and reassuring. You do not have to be in crisis, carry a diagnosis, or know exactly what is wrong. You can come to therapy simply to understand yourself.

Amy Hooper, LCSW-C, CEAP, is a psychotherapist in Gaithersburg, Maryland, and the founder of Gaithersburg Counseling Center, a private practice she has grown since 2009 into a thriving boutique group practice with highly experienced therapists with a range of specialties. Amy and her team work with teens, adults individually as well as couples, and families. The therapists drawing on a range of approaches to best fit for each client such as trauma informed care, attachment-based work, intimacy and infidelity counseling using CBT, somatic therapy, art therapy, acceptance and commitment therapy and EMDR. Her practice often supports people navigating anxiety, trauma, self-esteem, relationships, depression, life transitions, and the quiet difficulty of speaking up for what you need and feeling good about yourself.

What comes through in her interview is a gentle insistence that therapy is not a last resort. It is a place to understand yourself, and you are allowed to walk in long before anything falls apart.

READ MORE:
Not sure where to begin? Take our short quiz to start your healing journey and see what kind of support might fit.

In this interview

Do you have to be in crisis to start therapy?
How do you choose the right therapist?
How do you know if a therapist is right for you?
When can I know therapy is working for me?
How long do I need to be in therapy for it to work?
What should you do if therapy is not working?
Frequently asked questions

Do you have to be in crisis to start therapy?

This is the worry that stops so many people at the door. They are not falling apart, so surely therapy is for someone else. Amy meets that idea head on, and it is the heart of how she thinks about her work.

You don’t have to have a diagnosed mental illness. You don’t have to be sick. You don’t have to be at the bottom of the barrel. You don’t have to be at a point where everything’s falling apart to start therapy. People go to therapy just to understand what’s going on for them.
– Amy Hooper, LCSW-C, CEAP

That is the whole reframe. Maybe you are having trouble concentrating, or something does not feel quite right in your relationship, or you are not sure how to relate to your kids or your parents. None of it requires a label or a breaking point. Therapy can simply be a place to understand yourself more clearly and live a little more calmly, before the small things become big ones.

How do you choose the right therapist?

If the idea of picking one therapist from a long list feels overwhelming, Amy has a freeing piece of advice. You do not have to get it right on the first try, and you are not locked in. Meet a few.

I really encourage clients to shop around. As you’re looking on the directory and seeing different therapists pop up, if you read their profile and it speaks to you, I would encourage making appointments with one or two or even three different therapists, just to get a feel for what it’s like to have an initial session.
– Amy Hooper, LCSW-C, CEAP

It is a generous thing to hear from someone who runs a practice, because it puts your fit ahead of bookings. If her own team is not the right match, Amy says, they help people find who is a better fit. You are allowed to be selective and directories like GoodTherapy make it easier to compare approaches, and our step-by-step guide to finding the right therapist walks through how.

How do you know if a therapist is right for you?

Once you are in the room, how do you tell whether it is working? Not by their credentials alone, Amy says. Your own felt sense is the most reliable signal you have.

Trust your inner wisdom to know, wow, this person’s really easy to talk to, or after I talk to this person, I’m feeling a little bit lighter. Or maybe it was hard and I was crying during the session, but I trust them. Any of those feelings you have, I would listen to.
– Amy Hooper, LCSW-C, CEAP

SIGNS THE FIT MAY BE RIGHT

  • They are easier to talk to than you expected
  • You feel a little lighter, or clearer, afterward
  • Even after a hard session, you trust them
  • If it does not feel right, you feel free to keep looking

When can I know that Therapy is working for me?

If you walk in hoping to feel fixed by the end of the hour, the first session can surprise you. Often it feels like the therapist is mostly getting to know you. Amy wants you to know that is the point, not a delay.

The first session or two, the therapist is really starting to get to know you, to understand you. We do not want to be putting band-aids on bullet holes. We don’t want to be giving you these quick fixes before we even understand what’s happening.
– Amy Hooper, LCSW-C, CEAP

The deeper work tends to begin around the third or fourth session. That does not mean you are left struggling in the meantime. If anxiety is running high or your mood is very low, a good therapist helps with that right away. Here is what to expect in a first session.

How long do I need to be in therapy for it to work?

How long until I feel better is, in Amy’s words, one of the greatest questions therapists are asked. The honest answer is that it depends on your goals, how often you go, and what you are working through. But she describes a hopeful shape to it, one that circles right back to understanding yourself.

Maybe at first the symptoms that are bothering you decrease, and then you get to know yourself better. Maybe you have different boundaries with different people. Maybe you’re living more authentically and more calmly. All of those things can happen over time. Some people come to therapy for five or ten sessions, and some for five or ten years. It really depends on your goals.
– Amy Hooper, LCSW-C, CEAP

Relief from specific symptoms, like better sleep or a calmer mind, often arrives early. The deeper changes unfold in layers. The point is that the timeline is yours, and progress that feels slow is not the same as therapy failing.

What should you do if therapy is not working?

Maybe a therapist offers a few approaches, like talk therapy, art therapy, and somatic work, and one of them simply is not landing for you. Amy’s advice, fitting for someone who helps people learn to speak up for what they need, is to say so.

I would encourage clients to communicate that to the therapist they’re seeing, because so often we don’t say what’s wrong and don’t allow an opportunity to repair and course correct. But that can be the difference between sticking with your path of healing or pausing on it.
– Amy Hooper, LCSW-C, CEAP

Speaking up gives the relationship a chance to adjust. And if you raise it and the fit still is not right, that is okay too. Trusting that instinct and finding someone who suits you better is part of taking your care seriously.

If you are in crisis or need urgent support, please reach out to a local emergency line or visit GoodTherapy’s crisis resources. Therapy is one form of support, and it works best alongside the right help for where you are today.

You deserve support, even now

Amy Hooper’s reflections emphasize the importance of timing in therapy. You do not have to wait until you are falling apart, have the perfect words, or feel like a textbook case. You can come to therapy to understand yourself, choose someone you trust, go at your own pace, and say what you need along the way.

It might feel really hard to call and ask for help, because so many of us have learned not to ask for help. But that’s what we’re here to do. Everybody deserves to have support. You deserve to have support too.
– Amy Hooper, LCSW-C, CEAP

If Amy’s words resonate with you, explore her GoodTherapy profile to learn more about her approach. If you are still looking for the right person, browse the GoodTherapy directory to find a therapist whose style fits your needs. You might also enjoy our spotlights with Brooke Pomerantz and Annette Popernik.

Frequently asked questions

How much does therapy cost?

Costs vary with your location, the therapist’s experience, and whether you use insurance. Many therapists offer sliding-scale fees, and some accept insurance, so it is worth asking on a first call. See our guide to how much therapy costs, or filter the directory for therapists who take your insurance.

How often should you go to therapy?

It depends on your goals and what you are working through. As Amy notes, someone going weekly often sees change faster than someone going once a month. Many people begin weekly or every other week, then adjust the pace with their therapist as they make progress.

What if you do not know what to say in therapy?

That is completely normal, and you do not need the right words to begin. Part of a therapist’s job is to help you make sense of what you are feeling, even when it is vague or hard to name. You can simply start with what brought you in, or say that you are not sure where to start.

Is online therapy as effective as in-person therapy?

For many people and concerns, online therapy can be as effective as meeting in person, with the added benefit of flexibility. Some people feel more at ease at home, while others prefer being in the room. Many therapists, including Amy, offer both. You can explore telehealth options in the directory.

Is what you say in therapy confidential?

In general, yes. Therapists follow professional and legal standards to protect your privacy, with limited exceptions, such as when there is a risk of serious harm. If this matters to you, you can ask a therapist to explain how confidentiality works in their practice during a first call.

Starting therapy can come with a lot of pressure.

For some people, the pressure comes from not knowing what to expect in a first session. For others, it comes from the fear of being judged, misunderstood, or told how they should be able to handle things on their own. And for many, it comes from a quieter thought that can be even harder to shake: Shouldn’t I be able to do this by myself?

In her Member Spotlight interview, Annette Popernik offers a perspective that feels both grounding and deeply human. She introduces therapy as a conversation where safety is built, and where clients are both validated and challenged. It is a space designed not just to comfort, but to help people better understand themselves and move forward with greater clarity.

What makes Annette’s approach especially meaningful is the care she brings to helping people feel fully themselves in the room. Fluent in English, Spanish, and Italian, she places real importance on both cultural and linguistic awareness in her practice. She encourages clients to express themselves in the language that feels most natural to them, even if that means bringing in words she may need to learn along the way. For Annette, that is part of creating a space where people feel safe, understood, and true to who they are.

That philosophy carries through everything she shared in our conversation: therapy should not feel like a place where you have to perform, translate yourself, or arrive with everything figured out. It should feel like a place where you can begin honestly, be met with care, and explore what growth might look like from there.

PLAY

Video Interview: Watch the Conversation with Annette Popernik

Watch Annette Popernik’s Member Spotlight interview.

Table of Contents

. What should someone know before starting therapy?
. Why do so many people feel like they should handle everything alone?
. Can therapy help even if nothing feels wrong?
. Why does finding the right therapist matter?
. Why do language and cultural awareness matter in therapy?
. How can virtual therapy feel safer and more supportive?
. What does it mean to grow through therapy?
. You do not need to have everything figured out
. FAQs

What should someone know before starting therapy?

Annette describes therapy as a conversation where a safe space is built and where the client is both validated and challenged. That balance is central to her approach. Therapy is not about giving people all the answers. It is about supporting them in a way that helps them reflect more honestly, understand themselves more clearly, and move forward with intention.

For someone starting therapy for the first time, that can be reassuring. You do not need the perfect explanation for why you are there. You do not need to arrive certain about what you feel or what you need. Sometimes, the first step is simply entering a space where the conversation can begin.

Why do people feel like they should handle everything alone?

One of the most relatable parts of Annette’s interview is what she says about the pressure people place on themselves before they ever seek support. She points to the “should” statements many clients carry: I should be able to do this on my own. This should not be a problem. I should have figured this out already.

These thoughts may sound small, but they carry real weight. They can make ordinary struggles feel shameful and turn the need for support into something that feels like failure.

Annette offers a gentler alternative. Therapy can be a place where internal pressures are examined instead of being obeyed. It can help people stop measuring themselves against what they think they should be able to handle and start paying attention to what they need.

Can therapy help even if nothing feels wrong?

Absolutely.

Annette speaks openly about the value of therapy for self-improvement and personal growth, even when life seems fine on the surface. She also makes a simple but powerful point: “…there is something meaningful about having a space where someone is focused entirely on you, what you need, and what is going on in your life.”

That expands the role of therapy in an important way. It does not have to be reserved for crisis, conflict, or burnout. It can also be a place for insight, reflection, and self-care. A place to understand your patterns more clearly. A place to check in with yourself more honestly. A place to build awareness before things become overwhelming.

That perspective is valuable for therapy seekers who may wonder whether their concerns are serious enough, and just as meaningful for therapists who want to show that their work supports not only pain, but also growth.

Why does finding the right therapist matter?

Annette highlights the importance of establishing a connection between the therapist and the client. She sees the relationship between therapist and client as one of the strongest predictors of positive outcomes. That is why finding the right therapist is more than expertise alone. It is also about whether they understand the different layers that shape your life.

She encourages people to look for a therapist who can make space for:

What stands out in Annette’s approach is that she values human connection without making assumptions. Shared identity can help, but real support comes from taking the time to understand each person’s individually lived experiences.

Why do language and cultural awareness matter in therapy?

One of the most distinctive parts of Annette’s practice is the importance she gives to cultural and linguistic awareness. Fluent in English, Spanish, and Italian, she is intentional about creating room for people to express themselves in the language that feels most natural to them.

That matters more than it may seem at first.

People do not always think, feel, or process in perfectly translated language. Sometimes the right word only exists in the language spoken at home. Sometimes a phrase carries emotional meaning that does not fully come through in English. Annette makes space for that. Even when a client uses a word she does not know yet, she is willing to learn it so that the person in front of her does not have to filter themselves to be understood.

This part of her approach offers an important reminder for both therapy seekers and therapists. Feeling safe in therapy is not only about emotional warmth. It is also about being able to show up in ways that feel culturally real and personally natural. The more room there is for that authenticity, the more possible trust becomes.

How can virtual therapy feel safer and more supportive?

Annette also offers a thoughtful perspective on virtual therapy. Instead of seeing it as a lesser version of in-person care, she encourages people to think about how to make it work for them. Her advice is simple: create a space that feels safe.

That could mean settling in with a cup of tea or coffee, a pillow, fuzzy socks, a candle, or anything else that helps your body and mind feel more at ease. In Annette’s view, the physical environment around you matters. When you create a space that feels calm and comforting, that sense of safety can carry into the session itself.

She also points out that virtual therapy offers something unique. In an office or any physical setting, the space is already defined. The room looks the way it is. Nothing much can be done about the walls, the furniture, the setting in which the session takes place. But in virtual therapy, there is more room to shape the environment around your own needs and preferences. That can make the experience feel more inviting, more personal, and more supportive.

What does it mean to grow through therapy?

What stands out most in Annette’s interview is how she does not describe therapy as only soothing or only solution focused. Instead, she sees it as a place where people can be validated while also being challenged.

That distinction matters.

Being validated means your experience is taken seriously. Being challenged means you are not left exactly where you are. Together, those two things create conditions for growth. They allow therapy to feel supportive without becoming passive, and honest without becoming harsh.

For therapy seekers, this offers a helpful way to think about what good therapy can feel like. For therapists, it is a strong reminder that care and accountability can work together in the room.

You do not need to have everything figured out

At the heart of Annette’s interview is a simple but lasting idea: you do not need to have everything figured out before you begin. Therapy can be a place where you let go of some of the pressure to manage everything alone, speak in the words that feel true to you, and explore what support, insight, and growth might look like on your own terms.

Her perspective reminds us that the right therapeutic space is not one where you have to shrink yourself to fit in. It is one where you can feel safe enough to be honest and supported enough to keep evolving.

If Annette’s words resonated with you, explore her GoodTherapy profile to learn more about her approach. If you are still looking for the right fit, browse GoodTherapy’s therapist directory to find a provider whose style, perspective, and approach align with your needs.

FAQs

Frequently Asked Questions

Common questions about therapy that feels safe, inclusive, and supportive.

Q: What makes therapy feel safe? +

A: Therapy often feels safe when there is trust, validation, and space to be honest without fear of judgment. Annette also emphasizes the importance of cultural and linguistic awareness, which can help clients feel more fully understood.

Q: Can therapy help even if I am not in crisis? +

A: Yes. Therapy can support self-improvement, reflection, and personal growth even when nothing feels obviously wrong. It can also help you better understand patterns, emotions, and needs before things become overwhelming.

Q: Does language matter in therapy? +

A: Yes. Language shapes how people express emotions, identity, and lived experience. Annette emphasizes the importance of allowing people to speak in the language and words that feel most true to them.

Q: How can I make virtual therapy feel more comfortable? +

A: Creating a calm, private, and comforting environment can help. Annette suggests using small comforts such as tea, a pillow, fuzzy socks, or anything else that helps you feel more at ease in your space.

Q: How can I find a therapist who feels right for me? +

A: Look for a therapist whose approach, values, and communication style feel aligned with what you need. Reading therapist profiles can help you understand not just their expertise, but also the kind of space they aim to create.

Back to top.

Starting therapy can feel hard to explain.

Sometimes there is a clear reason. A loss. A breakup. Burnout. A period of anxiety that has become impossible to ignore.

Other times, the feeling is more subtle. Life may look fine from the outside, but something internally feels off. You may feel stuck, disconnected, overwhelmed, or simply no longer at ease in your own life.

For therapist Brooke Pomerantz, that in between space matters. It is often where the most meaningful work begins.

A licensed clinical social worker who has been in private practice since 2007, Brooke works with adults and young adults in Oakland and via telehealth. Many of the people she supports are highly capable, thoughtful, and outwardly successful, yet privately struggling with anxiety, perfectionism, burnout, or a deeper sense of dissatisfaction they cannot quite name.

What stands out most in Brooke’s approach is not just what she helps clients work through, but how she meets them there. Her philosophy is grounded in curiosity, patience, and the belief that every person deserves to be understood as an individual, not reduced to a category or rushed into change before they are ready.

Read More

Take Our Quiz to Start Your Healing Journey

PLAY

Video Interview: Watch the Conversation with Brooke Pomerantz

Hear Brooke discuss starting therapy, feeling safe with a therapist, and finding the right fit.

In this interview

. Why starting therapy can feel so hard
. What to do if you feel anxious about therapy
. Can therapy help even if nothing feels wrong?
. What makes your practice unique?
. How to find the right therapist for your needs
. FAQs

Why starting therapy can feel so hard

For people starting therapy for the first time, I acknowledge that the experience can feel vulnerable and anxiety-inducing. That anxiety, she says, is not a sign that something is going wrong. It is often part of the process. A competent therapist can recognize this vulnerability and adjust the pace of treatment at a pace that works best for their client. This is why the initial sessions are a huge opportunity for both the individual and the therapist to assess if they are a good match and whether the individual has an agency in the process.

What to do if you feel anxious about therapy

It’s simple. Name the feeling. Saying “I feel anxious being here” can lead to a much deeper and sincere conversation. It gives both therapist and client somewhere real to begin. Instead of trying to arrive with everything figured out, a person can start from what is true in the moment. It also gives them a chance to notice if they feel safe, understood, and ready to share their experiences in a particular setup with the therapist in question.

A gentle first sentence

If starting feels awkward, a simple sentence like “I feel anxious being here” can be enough to open the door.

Can therapy help even if nothing feels wrong?

Yes. Therapy does not only belong to moments of crisis or chaos. It can also be a place to think more deeply about your life, understand your patterns, strengthen your relationships, and develop a more connected relationship with yourself. Even when someone says they are “fine,” there is often something underneath that is asking to be explored.

That idea makes therapy feel less like an emergency response and more like a meaningful form of self-reflection. It becomes a space to pause, take stock, and ask harder questions about how you are living and what you may need next.

What makes your practice unique, and how do you know if you’re a good fit for a client?

It is about being intentional about not getting ahead of the person in front of you. As therapists, we need to understand each person in the context of their own life, strengths, challenges, and readiness for change. That means honoring where someone is, instead of pushing them toward where they “should” be.

This way of working can be especially supportive for people who are used to pressuring themselves. Like many of my clients who are high functioning and driven. They may look successful on the outside while internally feeling exhausted, unhappy, perfectionistic, or chronically disconnected from their own needs. I also work with young adults who are having trouble launching into adulthood, perhaps having had setbacks like a mental health crisis, and need support navigating the transition.

How to cope when life feels emotionally overwhelming

When life feels overwhelming, it can help to slow everything down and focus on getting through one moment or one hour at a time. Reducing the size of the problem can make it feel more survivable. And when depression or hopelessness makes action feel nearly impossible, even a very small step can matter. A walk. A phone call. Any small movement or action can combat the tendency to retreat and feel paralyzed.

There is something deeply humane about that advice. It does not romanticize healing or pretends that change is easy. It simply offers a gentler entry point.

How to find the right therapist for your needs

Finding a therapist is rarely a one size fits all process. It is highly individual. People may begin by exploring therapist directories, asking for referrals from their community, or looking for someone with a shared background or area of expertise. What matters most is finding someone with whom you feel safe and someone you believe can understand you and help with the areas where you feel stuck.

A simple way to begin is:

1. Read a few therapist profiles carefully

Notice how therapists describe their approach, specialties, and the kinds of clients they work with.

2. Look for what feels aligned

Shared identity, expertise, communication style, or lived experience may all play a role in helping you feel understood.

3. Take the next step to assess fit

A consultation or follow up call can help you decide whether the connection feels right.

This is one reason directories like GoodTherapy can be a helpful place to start. They make it easier to explore therapist profiles, understand different approaches, and find a therapist whose style feels aligned with what you need.

For therapists, it is also a reminder that a thoughtful profile matters. The clearer you are about your approach and who you help, the easier it is for the right clients to find and connect with you.

The right support can change everything

Brooke Pomerantz’s approach reminds us that therapy is not about having everything figured out before you begin. It is about making sense of your feelings and things that are weighing you down and channeling it into an effort to find a space where you can be honest and feel safe. Her reflections offer something deeply reassuring that growth can happen at your own pace, that support can be valuable even before a crisis, and that the right therapeutic relationship can help you move through life with greater clarity and self-awareness.

If Brooke’s words resonated with you, take a moment to explore her GoodTherapy profile and learn more about her approach. If you are still looking for the right fit, browse GoodTherapy’s therapist directory to find a provider whose style, perspective, and approach align with your needs.

FAQs

Frequently Asked Questions

Common questions about starting therapy and finding the right therapist.

Q: How do I find the right therapist? +

A: Start by reading therapist profiles, looking for someone, whose approach and expertise feel relevant to your needs, and then taking a consultation call if possible. The right therapist is often someone with whom you feel safe and understood.

Q: What if I feel anxious about starting therapy? +

A: Feeling anxious about therapy is normal. Brooke suggests naming that anxiety directly, since it can become a helpful starting point for the conversation.

Q: Do I need to be in crisis to go to therapy? +

A: No. Therapy can help with self-awareness, life transitions, relationships, anxiety, and personal growth, even when nothing is obviously wrong.

Q: How do I know if a therapist is a good fit? +

A: A good fit often means you feel safe, understood, and supported. The first few sessions can help both you and the therapist decide whether the relationship feels right.

Ready to find the right therapist?

Explore GoodTherapy’s directory of vetted professionals and find someone whose approach aligns with your needs.

Browse Now

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What makes therapy work isn’t always what people expect. It’s not the credentials on the wall or even the specific modality a therapist uses. Linda Baker, PsyD, MA is a Denver-based licensed clinical psychologist and GoodTherapy member, has spent her career helping people find what they need: a therapeutic space where they feel genuinely safe, seen, and understood.

With a background that spans men’s correctional facilities, international disaster psychology, and trauma-informed care, Dr. Baker brings a rich and unexpected depth to her practice. Today, she works primarily with men using a hybrid of Internal Family Systems (IFS) and Cognitive Behavioral Therapy (CBT), a combination she developed over years.

We sat down with Dr. Baker to talk about what first-timers should know before walking into therapy, how she creates emotional safety for her clients, and the one mindset shift she shares with almost everyone she works with.

Read More: Take Our Quiz to Start Your Healing Journey

 LIVE INTERVIEW: Watch the Conversation with LINDA BAKER

 

Table of Contents

Click a question to jump to it.

  1. What should someone know before their very first therapy session?
  2. What if you know something feels off, but you can’t explain what it is?
  3. Why does it matter to find a therapist who truly gets you?
  4. How do you create emotional safety for your clients?
  5. How would you describe your approach to therapy?
  6. What’s one mindset shift that helps people start feeling better?
  7. Is there any other advice or thoughts you want to share for clients or clinicians?
  8. The First Step Means Taking a Leap of Faith

Q&A with Linda Baker

Q: What should someone know before their very first therapy session?

Linda:

If you look statistically and you look at the research around positive therapy outcomes, the number one indicator of positive therapy outcomes is about goodness of fit. It doesn’t matter if somebody’s CBT trained, it doesn’t matter if they’re ACT trained, it doesn’t matter their modality. What really matters is how comfortable you feel with that person, if you feel like you could feel safe, if you feel heard…The more honest and authentic you can be, obviously, the better the therapy process is going to go.

If you meet with somebody and it doesn’t feel like a good fit, it’s totally okay to move on. There are so many different kinds of clinicians out there and there’s absolutely an opportunity to find somebody that you just feel safe and seen and heard with…

It’s sort of like dating. You’re allowed to go and meet and see how it feels and maybe give somebody a second shot if you’re sort of curious. And if it’s just not right, it’s not right.

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Q: What if you know something feels off, but you can’t explain what it is?

Linda:

I think that’s sort of the whole purpose of therapy, actually. People [often]…notice a behavior…a feeling,…a mood shift,…[or] something sort of internally. And it’s actually really common for people to not know exactly what’s going on for them, especially when so many of our root issues come from historical experiences. It’s really hard to name that when we grow up and become adults.

[Therapy] gently brings that internal struggle to the surface and gives a voice to it. So then people can really understand what’s happening for them, and then they know what to do about it. That’s the good news about therapy, right? We can see what the issue is, we can name it, and then there’s a plan. There’s hope that can come from it.

It could be something really mild — I just feel really off and I don’t know why, or my energy or my motivation has really shifted, or my sleep is off, or I’ve been really moody with my partner….And that’s kind of the whole point of therapy: we sort of translate that for folks.

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Q: Why does it matter to find a therapist who truly gets you?

Linda:

You have to feel really safe. I don’t mean just physically safe, but you have to feel emotionally safe with the provider you’re working with because this experience is so intrinsically vulnerable and it’s so intimate.

I have sort of a recipe for safety. For me, safety is consistency, predictability, and reliability. If a clinician shows up in those ways, then oftentimes what that does to the client’s nervous system is it helps them take a nice deep breath. So for me, whoever the client is, hopefully that therapist has expertise in working with all sorts of people. And regardless of their demographic or their background, what’s important for a clinician is to make sure that you’re providing that super safe, consistent, reliable, predictable space so the client can explore whatever those deep vulnerabilities are for them.

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Q: How do you create emotional safety for your clients?

Linda:

I think a big one for me is showing up authentically…It’s so important to be really mindful and attuned to yourself coming into sessions. So if that means meditating, if that means going outside, if that means a hot bath, tea — whatever the thing is to ground you. To me, that’s so important. So you can show up and really be present and have an internal openness with clients…even clients virtually can sense when you’ve got space and room for them.

It’s hard because there’s so many things going on in the world and life is hard. But to me, it’s crucial for therapists to make sure that they’ve got internal room so they can provide it for the client. So then we’ve got this space we’ve co-created where we both can explore and make sense of things.

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Q: How would you describe your approach to therapy?

Linda:

I’m classically CBT trained. That was kind of the approach when I was in school. I’ve since shifted into Internal Family Systems. [For] Internal Family Systems…I conceptualize all of us like we’re a bus and we’ve got all these different parts of us riding on the bus. Depending on the environment, a part of us will hop up and grab the wheel. Sometimes that’s really beautiful because it’ll drive us into prosperity [and] we make good choices. Sometimes the part is pretty problematic and drives us into a ditch…

We’re not…making people feel more ashamed around whatever the issue is that they’re having. It’s about approaching a part with genuine curiosity, understanding, compassion, and acceptance. That feels really important to me.

In terms of what makes me different as a clinician… I went through school wanting to work with women…[But] I kept getting shuffled into working with men, [including] men’s prisons, men’s jail, halfway houses, those sorts of things. And now…over half my practice is working with men. I get to use my deeply feminist intentions and background to help men behave differently in their relationships. It’s sort of an inadvertent way of helping the population I was really focused on originally, by helping the demographic that has a lot of interaction and impact on them.

I was also the second ever graduating class from the University of Denver’s International Disaster Psychology program, so I’m very deeply trained in trauma [and] working with refugees, asylum seekers, high-intensity circumstances. I would strongly recommend people to have a really good foundation around trauma because it’s so pervasive and it really shows up with whoever you’re working with.

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Q: What’s one mindset shift that helps people start feeling better?

Linda:

One thing I say to clients constantly is: it’s not a problem unless it’s a problem. Clients will come to me and [their beliefs are] based off of our culture, based off of these pressures, or based off of what they grew up believing.

And it’s so interesting when you really get into clinical work with most clients: a lot of times things are not what they seem. Sometimes the concept or the value that they’re bouncing off of isn’t actually their own. It was something that was ingrained in them via culture, via family of origin, or their own history…I say to folks all the time: maybe this isn’t as bad as you think it is, and maybe it’s not actually a problem in terms of aligning with your own values and what matters for you.

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Q: Is there any other advice or thoughts you want to share for clients or clinicians?

Linda:

Something I would recommend to therapists…is finding your own voice around what makes the most sense to you because then it’ll make the most sense to clients.

[Also,] check in with your clients. There’s this idea of trying to get it right all the time, and I think in this field there’s a good amount of perfectionism. It’s so important to ask clients Is this going well for you? Is it not going well for you? What feels good? What doesn’t feel good?

I’d strongly encourage clients: all you have to do when you come to therapy is show up and be yourself. That sounds really simple, but in a lot of circumstances, it’s so hard because it does feel so exposing and vulnerable. So I just really encourage people to take the leap and just see how it goes…Trust your gut, trust your insights, and then go from there.

You don’t have to wait until it gets so bad that you don’t know what to do next or you feel incapacitated. Therapy is a luxury…we get to have this experience, we get to have these opportunities…If you have access, take advantage of it. There are people out there that are good at helping, that are interested in helping. And you don’t have to suffer alone.

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The First Step Means Taking a Leap of Faith

Linda Baker’s journey — from disaster psychology and correctional facilities to a thriving private practice — proves that the most meaningful work often finds us in unexpected ways. Whether you’re a first-time therapy-seeker trying to quiet that sense that something is off, or a clinician looking to refine your own approach, Dr. Baker’s insights offer something rare: clinical wisdom delivered without pretense, and a genuine belief that the right support can change everything.

If her words resonated with you, we encourage you to take that next step. Browse GoodTherapy’s therapist directory to find a provider who feels like the right fit that creates a consistent, safe space for you to grow.

Read More: Ready to Find Your Therapist?

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Starting therapy can feel overwhelming, especially when you’re not quite sure what to expect or where to begin. For Anna Aslanian, a licensed therapist at GoodTherapy, helping clients navigate that uncertainty is at the heart of her practice. With extensive training in evidence-based modalities including Gottman Method couples therapy, Emotionally Focused Therapy (EFT), and attachment-focused EMDR, Anna brings both expertise and compassion to her work with adults seeking support for anxiety, depression, relationship challenges, and trauma.

In this Member Spotlight, Anna shares valuable insights on what makes therapy successful, from finding the right therapeutic fit to understanding that you don’t need to have all the answers before you start. Whether you’re considering therapy for the first time or looking to deepen your understanding of the process, her perspective offers reassurance that healing is possible when you find a therapist who truly gets you.

Read More:
Take Our Quiz to Start Your Healing Journey

LIVE INTERVIEW: Watch the Conversation with Anna Aslanian

 

Table of Contents

Click a question to jump to it.

  1. For those who have never been to therapy, what should they know about starting their first session?
  2. How can therapy help someone gain clarity if they feel like something is off with themself?
  3. Why is it so important for people to find therapists who truly understand them, their background, or their identity?
  4. What makes your practice unique, and how do you know if you’re a good fit for a client?
  5. Why is it important for therapists to have varied certifications, experiences, and educational backgrounds?
  6. What’s one tip or mindset shift that you can share that helps people start feeling better?
  7. Finding Your Path Forward

Q&A with Anna Aslanian

Q: For those who have never been to therapy, what should they know about starting their first session?

Anna:

I think it can be nerve-wracking to start therapy, and a lot of people have different ideas of what therapy is… It’s very different. If you’re looking for a therapist and it’s your first time, I have two tips that I think would make this successful.

Number one, look for someone who is specializing in what you’re looking for. So if you’re looking for therapy for, let’s say, depression, or you’re looking for couples therapy, or for your anxiety, or you’re trying to heal from childhood trauma, then look for that specific therapist who…mentions that they work with that specialty.

Don’t shy away from asking questions in terms of their experience, [including] what trainings they have.

Number two is your comfort level. I think therapy is different in that it’s very relational. So if you’re not clicking or connecting, or this person is not really making you feel safe to really be yourself and share, you might need a different fit. It doesn’t mean that a therapist is bad or you’re not doing a good job. It’s just really about connecting with one human being.

Just be as open as you can. Most of us therapists have heard all sorts of things. So there is nothing you can tell me that I will be shocked [to hear]. The more open you are and more you share, the better I can help you.

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Q: How can therapy help someone gain clarity if they feel like something is off with themself?

Anna:

It’s not your job to do detective work to figure out what’s happening…The best thing to do is just be honest with the therapist, and you can just share what you know…I have these thoughts, I have these feelings, I have these body sensations. Based on that, your therapist should be trained enough to ask follow-up questions to narrow down what is happening and give you insight and psychoeducation so you can connect the dots.

So don’t feel like it’s your job to know the whole thing…Your therapist is there to really guide you and figure out why you’re feeling, what you’re feeling, what it ties to, and what tools you need to move past that.

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Q: Why is it so important for people to find therapists who truly understand them, their background, or their identity?

Anna:

If you don’t feel safe with another person in the room, emotionally safe, it’s hard to open up and to share your deepest wounds and your thoughts. [Maybe] we’ve never shared that with somebody else before, or there is shame associated with what we’re going to share.

It’s really about the connection with the therapist and [if] you feel comfortable. You can also [tell] the therapist, “Hey, this is what would make me feel more comfortable,” just so that they can help you the best they can. But even then, sometimes you may feel like we’re not clicking, and that’s okay. There are so many therapists out there.

This is why so many therapists, including myself, provide free phone consultations before meeting. So that way you can have that 15-20 minute conversation on the phone…[and discuss] what you want to work on and see what they say. And if that really feels like, I’m excited to start this journey with this therapist and I feel comfortable, or it just feels like, I’m uneasy about this, then just follow your intuition on that.

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Q: What makes your practice unique, and how do you know if you’re a good fit for a client?

Anna:

So with adults, it’s kind of two branches: couples and individual therapy. For couples, I have done many additional trainings on top of just getting your degree. For example, I’m certified in Gottman Method couples therapy, and that’s all research-based…So I’m not just listening to their problems and being a witness to it. I’m giving them research-based tools.

But I’m also trained in Emotionally Focused Couples Therapy, which is all about the attachment styles and how you relate to another human being. And that really stems from childhood stuff. So I can really bring that into my work when people feel stuck and know how to get them out of that.

Within these years that I’ve been practicing, I’ve had a lot of both work experience as well as additional trainings to work with subcategories of couples therapy. So it’s not just a general approach. You have couples who come in when there is infidelity…or couples who are new parents…or premarital counseling, [or] addiction and couples therapy. All of those factors really change the dynamic and what interventions will be helpful.

For individual therapy,…I’ve worked in different populations, in different clinics, in different settings, …as well as had many certifications that really continue this growth as a therapist. I think that’s very important. We don’t just get our degrees and say that’s it or do an online course and that’s it. It’s…the schooling, the additional trainings, the practice in different settings to know how to actually utilize that in real-life situations.

I am certified in attachment-focused EMDR, as well as the traditional protocol of EMDR. I’m trained in polyvagal theory, which is all about nervous system regulating, in ACT, which is acceptance commitment therapy that’s super helpful for anxiety or just life transitions…Because I’m trained in all these different modalities, but also have the work experience and years of doing the actual work with clients, I can tailor that to what the client needs.

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Q: Why is it important for therapists to have varied certifications, experiences, and educational backgrounds?

Anna:

If you’re only trained in one modality or you’re just generally trained, there are only a handful of techniques you might know how to do. That’s why it’s important to go to a specialist, or as a therapist, it’s important to continue your growth, because not every person heals and learns or unlearns the same way. There are different methods that work for different people, and one isn’t better than the other.

You need to have a really rich toolkit as a therapist to know, Okay, this client is processing things like this, so this approach is going to be better for them, instead of trying to fit them into the way you think.

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Q: What’s one tip or mindset shift that you can share that helps people start feeling better?

Anna:

Get curious and compassionate about what’s happening instead of judgmental or solution-focused. Sometimes we can be very solution-focused, which isn’t a bad thing in itself. We have a problem, we want to fix it…But there may be a lot of judgment with that too, and pressure to change…

We [should be] compassionate with ourselves…[and] kind to ourselves the way we would be kind towards someone we love that’s going through a hard time. That’s number one. That would help you have less of that judgment and negativity around what you’re experiencing…

Whether you’re experiencing anxiety, depression, you’re stressed, or you’re feeling feelings that you think are shameful, the first thing that you can do is just allow all of that to be present in a room with you and know that it’s human and it’s normal. So you can be kind towards that aspect of yourself struggling, and then get curious: Where can I get my answers? Who can help me here? What do I need right now to take care of myself? I think those are the two fundamentals that will help you in this process of healing.

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Finding Your Path Forward

Anna’s approach to therapy reminds us that seeking help doesn’t mean you need to have everything figured out. In fact, uncertainty is often what brings us to therapy in the first place. Whether you’re navigating relationship challenges, processing past trauma, or simply feeling like something is off, the right therapeutic relationship can provide the safety and tools you need to move forward.

If you’re ready to take that first step, look for a therapist with expertise in your specific concerns, trust your gut about whether you feel comfortable, and remember that it’s okay to ask questions during a consultation. Therapy is a collaborative process, and finding a therapist who understands your unique needs can make all the difference.

To learn more about Anna Aslanian’s approach and see if she might be the right fit for you, visit her profile on GoodTherapy. If you’re interested in exploring more about the therapy process, check out GoodTherapy’s resources on how to find a therapist, what to expect in your first therapy session, and tips for getting the most out of therapy.

Read More:
Ready to Find Your Therapist?

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As part of our new GoodTherapy Member Spotlight series, we’re excited to introduce Samantha Mirarchi, director and founder of Wild Sage Therapy. This series highlights therapists who are eager to offer insight into the therapy experience and share valuable perspectives on how to make mental health care more approachable and authentic.

 

In this interview, Samantha offers practical advice and essential tips on starting therapy for the first time, choosing the right mental health professional, and why authenticity and trust are at the heart of effective therapeutic relationships.

Live Interview

Watch the conversation with Samantha

 

Q&A with Samantha Mirarchi

Q: What would you want someone who’s never been to therapy before to know about starting therapy or attending the first session?

Samantha:

It doesn’t have to be as scary as it sounds. In terms of choosing a therapist, the vibe has to be right. That’s the best indication of therapy success. Take advantage of phone consultations or video consultations, just to feel out the connection that you have with that person.

It doesn’t have to be super scary or overwhelming. The first session is usually just the therapist getting to know you, gathering information so that they can best support you. There’s no pressure to share everything all at once.

Q: If someone feels like something’s off but they can’t quite put their finger on it, how can therapy help them find clarity and direction?

Samantha:

That’s such a big deterrent for starting therapy for a lot of people, because it’s like “maybe my problem’s not big enough,” or “because I can’t articulate exactly what’s wrong, how is somebody going to help me?”

Having the space to just talk through and explore what that looks like for you can help bring clarity into what’s off, and so that you can actually create some goals and work towards that in therapy. But that is, honestly, a normal starting point for a lot of people: just that feeling of something’s not right. Therapy can really help: the beginning phases of [therapy] can really help open that up more to get you back to feeling like yourself.

Q: Why is it important for people to find therapists who truly “get” them, whether that’s about background, identity, or something else?

Samantha:

You need to be picky with choosing your therapist. [This means] reflecting on what is important to you, whether that be a therapist’s lived experience or, again, their specialty, and their ability to help you.

Therapists tailor their education and experience to certain areas, and it’s important to find a really good fit that way. The foundation of that is essentially based on trust. That’s going to impact your therapeutic result over time. Trust in the relationship is the number one indicator for success in therapy. It’s important to just find a therapist who has the education and experience to support you with the challenge that you’re facing.

Q: If you had to explain your therapy approach in one sentence, what would you say makes your work with clients unique?

Samantha:

I really value authenticity in my approach. Going back to the therapeutic relationship, I think that authenticity helps me really connect with clients, and it should make the therapy experience feel a lot more comfortable. That’s really important when it comes to therapeutic work and therapeutic growth.

Q: From your experience, what’s a sign that a client and therapist are a good fit?

Samantha:

You want to check in with yourself and ask: how comfortable do I feel talking to this person? I’d say that’s the number one assessor for fit.

Obviously, this is a new person you’re not going to feel 100% comfortable right off the bat, but there should be a little bit of ease there when it comes to starting a new therapeutic relationship. And then in terms of fit, again, look at their specialties, their background, their experience supporting other people who’ve struggled with the same challenges that you’ve faced.

Driving Growth With Authenticity

Starting therapy can feel overwhelming, but it can help you work through challenges, create a safe space for real connection, and set goals for growth with a professional. Finding the right therapist might require some work and evaluation, but the benefits of working with someone who truly gets you are worth the effort.

“

We’re so grateful to Samantha for joining us as one of the first featured therapists in the GoodTherapy Member Spotlight series. Her perspective on authenticity, trust, and connection underscores what makes therapy such a powerful space for growth and self-understanding.

“

To find an experienced, licensed therapist through GoodTherapy, explore our catalog of therapists by location, specialty, and more.

Ready to take the next step?

Connect with a licensed, experienced therapist near you.

Find a Therapist
➜

If you’re a GoodTherapy member and are interested in participating in our Member Spotlight series, please reach out to editor@goodtherapy.org

Handwritten text “AI?” on a whiteboard, symbolizing questions about artificial intelligence in therapy.

 AI therapy apps pose serious risks to users, which is why the American Psychological Association recently called for a federal investigation. Recent cases include teen suicides linked to chatbot guidance. With 987 million chatbot users worldwide, understanding these dangers is critical before trusting AI with your mental health.

Why AI Therapy Is Dangerous:

Artificial intelligence has crept into nearly every corner of our lives, from the algorithm that curates your morning playlist to the chatbot that handles your customer service complaints. Now, it’s knocking on the door of one of our most intimate spaces: the therapist’s office. And the conversation around AI therapy has gotten complicated quickly.

While tech companies promise revolutionary mental health solutions at your fingertips, mental health professionals and advocates are raising red flags that are impossible to ignore. The question isn’t whether AI can mimic therapeutic conversation: it’s whether it should, and what happens when it inevitably gets things wrong.

 

The Rise of AI Therapy and Why It’s Under Scrutiny

Let’s be real: AI’s takeover of healthcare was probably inevitable. The technology has proven useful for everything from diagnosing medical images to streamlining administrative tasks. But can AI be your therapist? That’s where things get complicated.

The Numbers Don’t Lie:
987 million people have used chatbots, with 88% having interacted with one in the past year alone. These aren’t just casual users, many are turning to AI for mental health support.

The explosion of AI chatbots and therapy apps between 2023 and 2025 has been nothing short of dramatic. We’re talking about 987 million people who have used chatbots, with 88% having interacted with one in the past year alone. These aren’t just casual users: many are turning to AI for mental health support, often without fully understanding what they’re getting into.

Did You Know? The state of Illinois made headlines when it passed legislation on August 1, 2025, requiring clear disclosure when AI is being used in mental health applications.

The regulatory landscape is scrambling to catch up. It’s a small step, but it signals that lawmakers are finally paying attention to what’s happening in this largely unregulated space.

Meanwhile, GoodTherapy professionals remain committed to what AI simply cannot replicate: accredited, expert care that’s genuinely personalized and grounded in ethical practice. Therapy isn’t just about having someone (or something) to talk to: It’s about the nuanced, deeply human work of healing.

Read More: Why AI Can’t Be Your Therapist

 

The Human Cost: When AI Gets Mental Health Wrong

The consequences of AI therapy-gone-wrong can be devastating, which is why the conversation about AI’s ethics is so meaningful. When we’re talking about mental health, the stakes aren’t abstract: they’re life and death.

There have been alarming reports of kids using AI chatbots to plan self-harm or suicide. Even more devastating was the recent case of a teen suicide that was reportedly linked to AI guidance. These aren’t isolated incidents or statistical outliers: they’re real people whose lives were affected by technology that simply wasn’t equipped to handle the complexity of human crisis.

Recent Study Reveals Critical AI Therapy Risks:

But perhaps most troubling is how AI therapy might actually reinforce the very isolation that drives people to seek help in the first place. When someone is struggling with feelings of disconnection and loneliness, does it really make sense to offer them a relationship with a machine? AI therapy can feel like a polite mirror that reflects back what you say without the genuine human connection that makes therapy transformative.

AI therapy’s fundamental limitations are glaring: no crisis intervention capabilities when someone is in immediate danger, no ability to pick up on emotional nuance that might signal deeper issues, and zero accountability when things go wrong. These aren’t bugs that better programming can fix. They’re features of what it means to be human that simply can’t be replicated.

 

Watchdogs Step In: APA and Advocates Push for Oversight

Federal Action: The American Psychological Association (APA) recently made an unprecedented move, requesting a federal investigation into AI therapy platforms.

The concerns have reached such a fever pitch that federal officials are finally taking notice. The American Psychological Association (APA) recently made an unprecedented move, requesting a federal investigation into AI therapy platforms. This move puts AI therapy’s risks of misrepresentation, failure to protect minors, and the absence of ethical guardrails on full display.

Misleading Users
About the nature of service received

Inadequate Protection
For vulnerable populations

No Oversight
Professional standards missing

The APA’s concerns center on platforms that may be misleading users about the nature of the service they’re receiving, inadequate protections for vulnerable populations (especially children and teenagers), and the lack of professional oversight that would exist in traditional therapeutic relationships.

This regulatory push represents something crucial: recognition that the mental health space requires different standards than other AI applications. When a restaurant recommendation algorithm gets it wrong, you might have a mediocre meal. When a mental health AI gets it wrong, the consequences can be irreversible.

This is exactly why GoodTherapy remains committed to connecting people with real, qualified professionals who can provide the quality care and ethical oversight that human mental health requires. The role of ethics in therapy isn’t just about following rules: it’s about protecting people when they’re at their most vulnerable.

Read More: Explore the Importance of Ethical Therapy

 

What Stories Like This Reveal About Human Connection

Real Story, Real Connection

“Recently, a young woman, Savannah Dutton, got engaged and reported being so excited to quickly tell her longtime therapist. As one of the first people she told, her therapist of almost four years was crucial to helping Dutton feel safe, not judged, supported, and confident in her future.”

When done right, your therapist should be a healing, safe, and encouraging part of your life that helps you navigate how to be human, which is something AI platforms can’t offer. Recently, a young woman, Savannah Dutton, got engaged and reported being so excited to quickly tell her longtime therapist. As one of the first people she told, her therapist of almost four years was crucial to helping Dutton feel safe, not judged, supported, and confident in her future.

Therapy works because it’s human. It’s about the subtle dance of empathy, the ability to sit with someone in their pain, the intuitive responses that come from years of training and human experience. When we replace that with algorithmic responses, we lose something essential: not just the warmth of human connection but also the clinical expertise that comes from understanding how complex trauma, relationships, and healing actually work.

GoodTherapy knows that the therapeutic relationship is the foundation of effective treatment. Our network includes professionals who do what AI can’t:

Whether you’re looking for culturally responsive care or simply want to find a therapist you can trust, the human element isn’t optional: it’s everything.

Abstract glowing brain with circuit patterns and split design, representing AI in therapy and mental health.

The Future of Ethical AI Therapy: What Needs to Change

AI isn’t going anywhere. The technology will continue to evolve, and mental health professionals need to figure out how to work with it rather than against it. But the key to a future of AI and effective therapy is clear guardrails and safety measures that keep patients safe. 

The future of ethical AI in mental health will likely involve hybrid models with robust human oversight, transparent regulation that protects consumers, and clear boundaries about what AI can and cannot do. Maybe AI can help with scheduling, treatment tracking, or providing psychoeducational resources between sessions. But replacing the human relationship entirely is not innovation: it’s a fundamental misunderstanding of how care works.

For consumers, the message is clear: research your providers, look for licensed oversight, and use major caution when considering AI-only mental health services. There are eight key ways that AI is not therapy, and understanding these differences could prevent serious harm.

If you are thinking about or actively looking for a mental health therapist, start by seeking safe, evidence-based care from qualified professionals. Real therapy, with real humans, is still the gold standard for mental health treatment. At GoodTherapy, that’s exactly what we’re here to help you find: genuine care, clinical expertise, and the irreplaceable power of human connection with no algorithm required.

Read More: Ready to Find a Therapist? 

Resources:

American Psychological Association: APA Calls for Guardrails, Education, to Protect Adolescent AI Users

Futurism: American Psychological Association Urges FTC to Investigate AI Chatbots Claiming to Offer Therapy

National Library of Medicine: AI as the Therapist: Student Insights on the Challenges of Using Generative AI for School Mental Health Frameworks

The New York Times: A Teen Was Suicidal. ChatGPT Was the First Friend He Confided In

Exploding Topics: 40+ Chatbot Statistics (2025)

CNN: Your AI Therapist Might Be Illegal Soon. Here’s Why

People: Woman Shocks Therapist When She Calls to Tell Her Big News (Exclusive)

Nurse preparing with gloves and mask, symbolizing preventive trauma treatment for first responders in medicine.First responders and physicians run toward danger when most of us run away. Yet at the end of the shift, many carry invisible wounds, intrusive memories, disturbing images, flashbacks, weights too heavy to carry alone. Preventive trauma treatment for first responders has become more critical than ever as research reveals alarming rates of PTSD among healthcare heroes.

The Culture of Silence and Why It’s Harmful

In high-stakes professions, showing vulnerability has long been seen as a liability. For physicians, there’s a persistent myth that trauma somehow “doesn’t happen” to them. This couldn’t be further from the truth. The fear of professional repercussions, perfectionism, and cultural stigma often pushes doctors and first responders to keep their struggles hidden.

But research paints a different picture. A recent systematic review found that nearly 15% of physicians experience PTSD symptoms, compared to only about 3–4% in the general population. Other studies have found ranges from 4% up to 28%, depending on specialty and trauma exposure. Emergency physicians, in particular, show high rates, about one in six meet criteria for PTSD.

These numbers make one thing clear: trauma doesn’t skip over people with medical degrees or uniforms. It just hides more easily under the weight of stigma.

Need Help Now? If you’re experiencing trauma symptoms, don’t wait. Find specialized trauma therapists in your area who understand the unique challenges facing first responders and healthcare workers.

Why Trauma Symptoms Don’t Just “Go Away”

Flashbacks, nightmares, and intrusive thoughts aren’t signs of weakness. They’re the brain’s way of saying: something needs attention. Left alone, these symptoms rarely fade. In fact, they often intensify, interfering with work performance, relationships, and physical health.

Too often, the advice in medical and first responder circles is to “tough it out” or to “just talk about it.” While talking can help reduce isolation, untreated trauma symptoms don’t fully resolve without an evidence-based approach. This is where preventive trauma treatment for first responders becomes essential.

Prevention Is Not Optional; It’s Professional

Just as helmets and protective gear are standard in high-risk work environments, preventive trauma treatment for first responders should be treated as preventive maintenance. Early treatment prevents small cracks from developing into fractures.

EMDR (Eye Movement Desensitization and Reprocessing) therapy is one such approach. Unlike general talk therapy, EMDR specifically targets and reprocesses disturbing memory networks. This helps symptoms like flashbacks and intrusive images quiet down.

But treatment isn’t just about methods, it’s about people. A trusting relationship with a therapist is the foundation of healing. Without rapport and safety, no evidence-based model will work. With it, even the most painful experiences can begin to shift.

Learn More: Discover how EMDR therapy creates a safe space for trauma recovery and why the therapeutic relationship is crucial for healing.

Physicians: A Group at Special Risk

Physicians often hold themselves to impossible standards. Add to that the fear of losing licensure or professional standing, and many suffer in silence. Yet studies show the cost of ignoring mental health is high.

For example, nearly one in three medical residents experience depressive symptoms, and suicide rates among physicians are significantly higher than in the general population. The data on PTSD only adds to this urgent picture. Trauma symptoms are present, measurable, and real.

During the COVID-19 pandemic, research found that 18.3% of physicians reported symptoms consistent with PTSD, with higher risks among female physicians and trainees. This underscores the critical need for preventive trauma treatment for first responders and healthcare workers.

Related Reading: Understanding the connection between trauma and workplace burnout can help identify when professional stress crosses into trauma territory.

Changing the Culture: From Stigma to Support

Healing begins when stigma loses its power. Hospitals, fire halls, EMS bases, and clinics can create cultures of prevention by:

These changes send a powerful message: seeking help isn’t just tolerated, it’s expected.

Understanding compassion fatigue and burnout in healthcare professionals is also crucial for developing comprehensive support systems.

For Organizations: Learn practical strategies for supporting first responder relationships and creating healthier work environments for your team.

Firefighter surrounded by smoke and flames, symbolizing preventive trauma treatment for first responders.

A Call to Action

Caring for trauma symptoms is not a sign of weakness, it’s a mark of professional integrity. It shows that first responders and physicians value themselves as much as they value the lives they protect.

Preventive trauma treatment for first responders isn’t a luxury. It’s a necessity. And when professionals heal, the benefits ripple outward, to their patients, their colleagues, and their families.

It’s time to normalize trauma care in medicine and emergency services. No one should have to choose between their badge, their license, or their life.

Frequently Asked Questions

Q: What makes preventive trauma treatment different from regular therapy? A: Preventive trauma treatment focuses on addressing trauma symptoms before they develop into full PTSD. It uses evidence-based approaches like EMDR therapy to reprocess traumatic memories and prevent long-term psychological damage.

Q: How common is PTSD among first responders and physicians? A: Research shows that physicians experience PTSD at rates of 15-28%, significantly higher than the 3-4% rate in the general population. Emergency department personnel show particularly high rates, with about 18.6% meeting PTSD criteria.

Q: What are the signs that a first responder needs trauma treatment? A: Warning signs include flashbacks, nightmares, intrusive thoughts, avoidance behaviors, hypervigilance, sleep problems, and difficulty concentrating. Physical symptoms like headaches and muscle tension may also indicate trauma-related stress.

Q: Is EMDR therapy effective for first responder trauma? A: Yes, EMDR has shown significant effectiveness in treating trauma symptoms. Studies show that 77.7% of veterans experienced elimination of PTSD symptoms after 12 sessions of EMDR.

Q: How can organizations support preventive trauma treatment for their first responders? A: Organizations can create supportive cultures by protecting confidentiality, normalizing mental health treatment, providing access to specialized trauma therapists, and implementing routine mental health screenings.

Take Action: Find Support Today

If you’re a first responder or physician experiencing trauma symptoms, don’t wait for them to worsen. Preventive trauma treatment for first responders is most effective when implemented early.

Ready to find specialized trauma therapy? Search our therapist directory to connect with qualified professionals who understand the unique challenges facing first responders and healthcare workers. Many therapists specialize in PTSD treatment and can provide the evidence-based care you need.

Remember: seeking help is a sign of strength, not weakness. Your well-being matters, not just to you, but to everyone you serve.


References

Person sitting alone at night in front of a glowing computer screen showing an abstract AI figure, symbolizing emotional reliance on artificial intelligence over real human connection.We’re living in a time when you can ask an algorithm for advice about anything, your marriage, your trauma, your loneliness at 2 a.m., and get an instant response. AI/ChatGPT therapy has become increasingly popular as people seek immediate mental health support. In some ways, that’s extraordinary. It can also be profoundly misleading.

While ChatGPT offer 24/7 accessibility as a therapy tool, they lack the nuanced understanding and therapeutic relationship that licensed therapists provide. More and more people are using large language models like ChatGPT as a stand-in for real therapy or meaningful connection. And while AI can offer information, or even momentary comfort, it also has a shadow side: reinforcing your biases, confirming distorted thinking with too much positive reflection, and leaving you lonelier than before.

It’s not that AI is inherently bad. It’s that it was never designed to replace the irreplaceable: human relationship, accountability, and the deep attunement that comes from being witnessed by someone who can see what you can’t. Understanding these AI therapy limitations is crucial for anyone considering ChatGPT therapy as a mental health solution.

The False Sense of Connection in AI Therapy

One of the most seductive qualities of AI is that it “feels” like you’re having a conversation with something that knows you. It’s programmed to mirror your tone and offer validation.

But unlike a therapist, a trusted friend, or a community, AI can’t perceive your nonverbal cues, notice your subtle contradictions, or check in about whether its reflection resonates. It can’t ask, “Are you sure?” or gently challenge you when you’re about to repeat the same patterns that keep you stuck.

Validation without reality-testing isn’t therapy, it’s an echo chamber. Research from Stanford University demonstrates that AI chatbots often provide generic responses to complex emotional situations, missing critical nuances that human therapists would catch.

Over time, the experience of being “heard” without being known can deepen the ache of loneliness rather than soothe it. This is particularly concerning given the rise in mental health stigma that already prevents people from seeking professional help.

Loneliness and Emotional Avoidance

For many people, turning to ChatGPT or other AI tools feels safer than the vulnerability of human connection. If you grew up believing your feelings were too much, or not enough, you might prefer something that always responds predictably and never has needs of its own.

AI can ease discomfort in the moment, but it doesn’t meet deeper longings for belonging and real connection. Using it repeatedly can become a way to avoid the risk, and reward, of genuine relationships.

A comprehensive study in Nature reported that people who relied heavily on AI for emotional support showed less motivation to seek human connection. Over time, their social anxiety increased. Easy access to AI interactions can unintentionally reinforce isolation.

Why ChatGPT Therapy Lacks Challenge and Reinforces Bias

AI is built to be agreeable. Its primary goal is to be helpful and inoffensive. This means that it often repeats back what you want to hear or what aligns with dominant cultural narratives, rather than offering nuance or challenge.

If you’re stuck in black-and-white thinking, shame spirals, or grandiose beliefs, AI is unlikely to question your assumptions. It doesn’t have a felt sense of you, so it can’t say, “I’m noticing this comes up a lot. What do you think it means?”

And that’s where therapy shines, someone who cares enough to help you see the patterns you can’t see alone. Licensed therapists are trained to recognize cognitive distortions, challenge unhelpful thought patterns, and provide evidence-based interventions that AI simply cannot replicate.

How ChatGPT Therapy Impairs Ownership and Creativity

The concern goes beyond mental health. Even in creative work, over-reliance on AI can reduce your sense of ownership and engagement.

A recent study exploring how people use large language models found something striking: “Participants who first worked without AI and then used AI tools to revise (‘Brain-to-LLM’) showed higher neural connectivity across multiple brain networks, alpha, beta, theta, and delta bands. They were more engaged, more integrated. In contrast, participants who relied on AI from the start (‘LLM-to-Brain’) demonstrated reduced neural effort and impaired perceived ownership of their ideas.”

Put more simply: when you let AI do the heavy lifting, your brain does less of the meaningful work. This shows up in therapy, too. If you outsource your reflection to a machine, the insights don’t feel like they belong to you. And when something doesn’t feel like it’s yours, you’re less likely to trust it, and less likely to change.

The Future of AI and ChatGPT Therapy

AI isn’t going away. It can be a helpful companion when used with intention, a spark to get unstuck or a tool to organize your thoughts. The key is understanding how technology in therapy can support, rather than replace, human connection.

But if you find yourself using AI as a stand-in for real connection or the brave work of therapy, it’s worth asking: “What am I protecting myself from (or avoiding)? And what might be possible if I reached for a living, breathing human being instead?”

We heal in relationship. No algorithm can replicate the magic of being known by someone who is committed to your growth and well-being. Human vs AI therapy isn’t even a fair comparison, they serve fundamentally different purposes.

Frequently Asked Questions

Q: Can ChatGPT diagnose mental health conditions?

A: No, ChatGPT cannot diagnose mental health conditions. Only licensed mental health professionals can provide accurate diagnoses based on clinical training and assessment tools.

Q: Is it safe to share personal information with AI?

A: While AI tools like ChatGPT don’t retain personal information between sessions, they lack the confidentiality protections and ethical guidelines that govern licensed therapy relationships.

Q: When might AI be helpful for mental health?

AI can help with journaling prompts, basic coping strategies, psychoeducation, and supplementing professional therapy. However, it shouldn’t replace real therapeutic support. The best way to use AI is as a tool within a broader mental health care plan.

Q: What are the biggest limitations of AI/ChatGPT therapy?

A: AI cannot provide genuine empathy, recognize non-verbal cues, adapt interventions to individual needs, or form therapeutic relationships. It also lacks the ability to handle crisis situations or provide specialized treatment for complex mental health conditions.

Ready to Experience Real Connection?

If you’re ready to move beyond AI assistance and explore authentic therapeutic relationship, finding the right therapist is your next step. Real therapy offers what AI cannot: genuine human connection, professional expertise, and personalized care tailored to your unique needs.

Understanding what to expect in therapy can help reduce anxiety about taking this important step. Many people find that the vulnerability required for therapy, the very thing that makes AI feel “safer”, is actually where the deepest healing happens.

Take Action Today:

If you’re feeling lonely, disconnected, or unsure where to start, working with a therapist can be a powerful first step. You deserve support that honors your complexity, challenges your assumptions, and helps you build a life that feels more alive. Find a qualified therapist near you!

Reference

Kosmyna, N., Hauptmann, E., Yuan, Y. T., Situ, J., Liao, X.-H., Beresnitzky, A. V., Braunstein, I., & Maes, P. (2025). Your Brain on ChatGPT: Accumulation of Cognitive Debt when Using an AI Assistant for Essay Writing Task [Preprint]. arXiv. https://doi.org/10.48550/arXiv.2506.08872

Dear GoodTherapy,

I had been seeing my therapist for 28 years. Around March, she was unwell. This was a rare occurrence in our time together. But her viral infection persisted until about six weeks ago, when she texted me to say she would not be returning to her practice. I was and am devastated.

I asked if it would it be okay to email her. She said yes, but when I did, she said she was still ill. Initially, I drew on our relationship, which I had come to internalize. However, as the weeks have passed, I have felt angry at the way it ended. And as a recovering alcoholic (dry for 10 years), I am fearful of the future. I would value your views. —Hung Out to Dry

Dear Hung Out to Dry,

Thank you for asking this question, and I imagine other readers thank you as well. Few things can be more painful than the sudden end of a relationship, particularly one in which we felt a strong connection and entrusted with our vulnerabilities. I can hear the loss and confusion you feel and what I presume is a sense of abandonment. These are huge, potentially overwhelming emotions. Congratulations for reaching out for help.

When therapy ends prematurely, especially when it is characterized by a deeply established relationship, it can feel like your world is being turned upside down. It is not uncommon to feel the way you feel. I imagine it is hard to understand what led your therapist to terminate her practice so abruptly and taper off communication. It is understandable to take this as a personal loss. In an ideal scenario, when a therapist plans to retire or end their practice, they communicate this plan with clients well in advance and they discuss and process the transition in session, perhaps even over time.

No doubt you have drawn many associations between the role of your therapist in your recovery and progress. It is clear from what you wrote that your therapist has been instrumental in your healing process. I would like to point out something else: YOU have made it through the challenges you have encountered during the time you worked with your therapist.

Unfortunately, sometimes illness and/or other circumstances beyond a therapist’s control may necessitate a less-than-ideal end to the therapeutic relationship. In this case, it is up to clients to pick up the pieces and move forward, perhaps with the help of another therapist. (It is worth noting, though clearly not what is happening in your case, that when a client leaves therapy prematurely or without closure, this presents another challenge for recovery.)

You mentioned that you recognize how you have internalized this relationship. No doubt you have drawn many associations between the role of your therapist in your recovery and progress. It is clear from what you wrote that your therapist has been instrumental in your healing process. I would like to point out something else: YOU have made it through the challenges you have encountered during the time you worked with your therapist. YOU have maintained your sobriety for the past decade. Your therapist was likely not with you during every one of your darkest moments, but YOU were. While you may have internalized the voice of your therapist when experiencing these dark moments, ultimately YOU have managed these circumstances. You made the decisions yourself.

It is understandable to fear what lies ahead for you. Hopefully, you are able to consider your future from a place of empowerment based on your past successes. Another important step is rebuilding your support network. This has been instrumental to you in the past and will likely continue to be instrumental in the future.

If you haven’t done so, you will want to explore options for therapy for yourself going forward. I see it as a positive indicator of success for your future that you formed such a strong alliance with your former therapist. You can do it again. The new relationship will not be the same because the therapist will not be the same. The new therapist will not always respond in the same ways, nor offer the same insights. This is okay, and arguably a real positive.

Change, though scary, can sometimes push us further into growth. You can explore options and consult with more than one therapist before starting anew. As you know, finding the right fit can make a world of difference.

I hope this feedback was useful, and I wish you luck as you move forward.

Marni Amsellem, PhD

Eating disorders, the most lethal of all the mental health disorders, kill and maim 6 to 13% of their victims, 87% of whom are children under the age of 20. “Best practice” treatment strategies for patients with anorexia nervosa, bulimia nervosa, and binge eating disorder all too frequently fall short of achieving timely and sustainable recovery outcomes. Beyond eating lifestyle dysfunction, eating disorders represent impairment of the patient’s Self, as seen in the loss of self-trust, self-control, self-regulation, self-care, and emotional resiliency, so necessary in coping with adversity and engaging in confidence-building life opportunities.

The development and recovery of the re-integrated Self in eating disorder treatment is best facilitated through the mindful and versatile use of the therapist’s self within a quality therapeutic relationship, the inclusion of parents and families in the treatment process where appropriate, and an appreciation of the fact that within the context of clinical treatment, healing changes in the patient’s behaviors and attitudes represent healing changes in the patient’s brain.

Eating Disorders and the Loss of Self

From infancy to adulthood, self-development occurs primarily within the context of human relationships, be they personal, familial, or professional. The loss of the connection with the eating disordered individual’s authentic Self becomes apparent cognitively, emotionally, physiologically, neurologically, and socially, typically rendering victims resistant to accepting diagnosis and engaging in treatment. Losses of connection can be seen in:

Self re-integration, a pivotal predictor in the achievement of positive mental health (Siegel, 2006) and a benchmark of full eating disorder recovery, becomes enhanced by treatment modalities that facilitate connections between people, mind-brain-and-body systems, and brain domains.

Because eating disorders are principally disorders of connection, the healing energy within the success of any treatment methodology occurs within the context of the therapeutic relationship.

Parents and Families As Recovery Advocates

Eating disorders insinuate themselves into relationships between family members. As family system disorders, eating disorders show up everywhere within the context of daily living, side by side with significant others, at kitchen tables, in restaurants, in family bathrooms, at school, and in places of employment. Though generally not responsible for causing eating disorders, which originate in genetic and temperament susceptibilities, parents who participate in their child’s treatment and engage in psychoeducation enjoy the potential to promote disease prevention and/or recovery. Becoming knowledgeable about eating disorders, the complex nature of their treatment and recovery, and their own role in their child’s recovery (particularly when the child remains in outpatient care while residing at home), parents can become ‘most valuable players’ in their child’s treatment team.

Recovering patients, faced with the demands and challenges of eating healthfully throughout each day, average no more than 50 minutes per week in face-to-face contact with helping professionals. Educated parents can become helpful in filling this void. With the understanding that the nature of parental support offered will need to change to align with their child’s changing needs as they progress, family participation in therapy gives both patient and family a voice, and an ear, in expressing and listening to feelings and in resolving conflicts and problems. By reconnecting with their child and learning how to understand, coach, and support their loved one, parents enhance their child’s emotional development and self-care.

The bonding and trust that develops in family treatment greases the path for the patient’s eventual separation and individuation, increasing the child’s capacity for autonomy and healthy self-regulation. Family sessions also diminish the potential for manipulative “splitting” and/or confidentiality breaches that could otherwise jeopardize a multi-disciplinary team treatment process. If not part of the solution, family members risk becoming part of the problem.

The Patient/Therapist Relationship in Research

Because eating disorders are principally disorders of connection, the healing energy within the success of any treatment methodology occurs within the context of the therapeutic relationship. The trust that develops between therapist and patient within the treatment process ultimately re-ignites the patient’s trusting reconnection within their own exiled Self. The mindful therapeutic relationship ideally becomes the prototype for other healthful, quality relationships elsewhere in the patient’s life outside of the treatment system. Dr. Christopher Germer, in Mindfulness and Psychotherapy (Germer, 2005), considers mindfulness in therapeutic practice to be the pathway to establishing a healthy, healing treatment relationship. He speaks of the therapeutic relationship as “an intervention in itself” with empathy accounting for “as much, and probably more outcome variance than does the specific intervention.” He describes good therapeutic relationships as “the most potent of all the treatment interventions for healing within a mental health venue,” (Germer) providing the pathway out of an eating disorder.

According to Dr. Allan Schore, it is through the quality of the human relationship that “deficits in internal working models of the self and the world are gradually repaired” (Schore, 1996). Schore describes a phenomenon that exists between therapist and patient called “empathic resonance” (Schore & Schore, 2008), “which results in the patient’s right brain hemisphere becoming neurophysiologically altered in form and function in response to a mindful, quality connection to the functioning of the therapist’s right brain hemisphere. Right-brain to right-brain human attachments through mindful psychotherapeutic connectedness often result in the patient feeling ‘felt,’ creating a state of neural activation with coherence in the moment that has been shown to improve the patient’s capacity for self regulation” (Siegel, 2006).

A quality patient-therapist connection lays the foundation for the patient’s development of the Self, in addition to the foundation of a complete and lasting eating disorder recovery.

References:

  1. Germer, C. K., Siegel, R .D., & Fulton, P. R. (2005). Mindfulness and psychotherapy. New York, NY: Guilford Press.
  2. National Eating Disorder Association. (n.d.). Retrieved from https://www.nationaleatingdisorders.org
  3. Schore, J. R. & Schore, A. N. (2008). Modern attachment theory: The central role of affect regulation in development and treatment. Clinical Social Work Journal, 36(1), 9-20. doi: http://dx.doi.org/10.1007/s10615-007-0111-7
  4. Siegel, D. J. (2006). An interpersonal neurobiology approach to psychotherapy; Awareness, mirror neurons, and neural plasticity in the development of well-being. Psychiatric Annals, 36(4), 248-256. Retrieved from https://www.researchgate.net/publication/241200655_An_Interpersonal_Neurobiology_Approach_to_Psychotherapy_Awareness_Mirror_Neurons_and_Neural_Plasticity_in_the_Development_of_Well-Being
Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.

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