From a Therapist’s Perspective: Blazing the Therapeutic Trail, Part One

By: Jessica Nappi, MS, LPCA

The stigma around mental health has changed drastically over the last century. Truthfully, a lot of this change has occurred in the last few decades. As a kid growing up in the early Ought’s, I could honestly tell you I had never heard of the terms “anxiety” and “depression”. My only run-ins with a counselor were school counselors I had only seen monitoring the bus loop outside of school and facilitating state testing at the end of the year. I didn’t know what therapy was all about until I was in college. Even then, my schema about therapy was primarily formed from Freudian stereotypes and Jamie Lee Curtis’ role in Freaky Friday. As a therapist now, my view on mental health and counseling as a profession has been altered quite radically.

This blog series is an attempt to bring an end to the mental health and therapy stigmas one question at a time. I’ve gathered sincere questions from friends, family, and curious acquaintances about things they wish they could ask their therapist. The goal being to answer them honestly, from a therapist’s perspective, and continue advocating for honesty, authenticity, and transparency within the mental health profession. 

When should I go to therapy?

This is a difficult question to answer, but only because the truth differs on a case-by-case basis. I would say that, in general, there is a stereotype that only people with certain mental diagnoses have a therapist. This assessment cannot be further from the truth. Personally, I specialize in life transitions and adjustment to change. That means I see clients that are experiencing birth or loss of a loved one. I see clients who are starting college, changing careers, or retiring. I see clients starting new relationships and some who are going through divorce. I see clients with chronic illness. Point being, you don’t need a diagnosis to see a therapist. 

There are several possible indicators that can help you assess your level of need for mental health help: 

• If thinking about a stressor or coping with that event/trigger is taking up a lot of mental bandwidth, it’s probably time to seek help from a professional. 
• If talking with your support system (friends, family, partner) isn’t enough. 
• If the issue causes you shame, embarrassment or makes you want to avoid others. 
• If this issue has caused the overall quality of your life to decrease, especially in multiple areas of your life (occupationally, academically, socially, romantically).
• If you have adopted noticeably negative changes to help cope with this stressor (binge drinking, drug use, stress eating, isolation).
• If you have a general prolonged sensation of being overwhelmed.
• If you’re feeling fatigued without an obvious cause.
• If you’re experiencing emotional dysregulation (inappropriate anger, excessive crying, lashing out at others, apathy). 
• If you’re experiencing anxious or intrusive thoughts that seem uncontrollable. 
• If you’ve had a recent decline in doing activities that you once found enjoyable.
• If you have an ongoing sense of hopelessness or dread. 
• If you’re looking for general self-improvement, but don’t know where to start. 

How do I find a therapist and how do I know they’ll be a good fit?

To answer the first question, you can find a therapist a few ways, such as by searching public online therapist directories for your region. You can also ask your insurance provider for a list of clinicians who may be in your network or see if your medical doctor has suggestions for someone they think would match well with your needs.  Additionally, you can look around town for bulletin boards promoting individual and group counseling or ask a friend for a referral or the name of the practice where they may see their own therapist. Community mental health care is an option in many regions across the United States and you may even find that your job offers an Employee Assistance Program where they have a network of therapists who will provide a limited number of sessions at the expense of the business.

The second question is one that requires internal investigation to find the right answer. Truth be told, therapists are not the aloof, mysterious, omniscient creatures the media has portrayed us to be. We have our own personalities. We are funny. We are thoughtful. We are genuine. We are just like you. It’s important to explore your own expectations of therapy and what it is you want in a therapist. Are you looking for someone who understands your experience because they’ve lived a similar life? Maybe search for a counselor who shares a similar spiritual ideology, sexual orientation, or race. These characteristics may not even be important to you. 

Maybe you’re looking for a therapist who has lots of experience with the area in which you most need help. Most therapists have a niche and you can refine your search by narrowing down what specific issues you wish to address. Is it sex, grief, relationships, chronic illness? There is a therapist in just about every niche you can think of. If it truly comes down to personality, review some profiles on therapist directories to get a feel for if the clinician has the traits you desire. Some profiles even offer a welcome video as a means of giving prospective clients a better idea of how the therapist presents themselves. 

Many clinicians offer free consultations where you can ask questions like “What can I expect the therapeutic process to look like with you as my therapist?”, “What is your role in this process?” or “How do you facilitate therapeutic rapport?”. It’s also important to check their availability. If you are looking for weekly sessions, make sure you don’t settle for monthly meetings. I would also check to make sure you are a financial match. Meaning, make sure the therapist is in network with your insurance and if not, consider whether you’re willing to pay their out-of-pocket rate.

Listen to your gut. If it feels like a good fit, it probably is. And if there is still doubt, just know that you have the right and autonomy to end services and pursue therapy with someone else. 

Be on the lookout for Part Two where Jessica answers the questions, “Trust is hard for me. Can I trust you?”, “Why do you want to help me?”, and “What are your first impressions of me as a client?”