Tips on finding the right therapist for you

A quick detour from the spiritual awakening posts is the subject of therapy. I’ve been thinking about this blog and where it is going. I thought what would be good, would be to intersperse my own experiences of awakening with my practice as a doctor and to offer some helpful advice to others who may or may not be on a similar path. So with that in mind, here’s something about choosing a therapist.

This is a huge topic and one that I have felt compelled to write about recently. I’ve had a number of patients come to see me over the last week complaining of various emotional issues / conflicts / life-upsets One of the ways forward that we have explored is the possibility of some form of talk-therapy / counselling / psychological help. This loosely falls under the umbrella of “therapy” although I am aware that this is an over-simplification.

One of the common responses that patients have is – Well how on earth do I choose someone? It’s a minefield. There are so many people offering so many different options. Which one is the right one for me? I have had a think about these questions and here are my thoughts. They are my opinions, so please don’t take them as some sort of “Therapy Bible”. I’ve based them on my own experiences of working with therapists, both bad and good and some of the experiences that my patients have had and been kind enough to tell me about. Like many things in life, please feel free to disregard any suggestions that do not work for you.

Firstly decide, if you can, what the problem is and what you would like as a solution. Sometimes this is fairly straightforward. You might be getting really angry with people and want to explore alternative behaviours or look at what lies beneath the anger. Sometimes people don’t feel “right” or they feel “bad” in some way and that is as far as they have got. This is not uncommon, as many, if not most of our driving behaviours and emotions are unconscious and our reasons for doing things may not be immediately accessible to us. This is fine. You may notice that in both cases, the person has a narrative about what is going on and some idea of what they would like instead (even if they don’t yet fully know what that is yet). A therapist can work with this. It can be helpful to put pen to paper and write down the problem and some potential solutions and areas that you would like to work with.

The next step is to research therapists. Most people do this via the internet now. I think it is good to get personal recommendations from friends and family. This is a way of filtering down through the huge numbers of people out there and gives you some sort personal testimonial for that individual’s work. I’d always suggest having a look at their website as to what methods they use to see if that resonates with you. You can Youtube the methods and find out more about them as well.

Next, I’d make contact and arrange an appointment to speak with the therapist personally. Most are happy to chat through options over the phone for free, others may offer a low cost intro face to face session. Remember this is your time to ask them questions about the issue. Personally I wouldn’t waste time asking them for information that is already available on their website. Give them a brief description of the problem and see if it is something that they feel they can work with you on. It’s okay to ask what their experience is with particular problems and if they have had success with this issue before.

Just as an aside, I will slip in here that I also work as a therapist alongside my main occupation as a family doctor. When a potential client rings me up, I am listening to the problem, but I’m also assessing as to whether I am the right person to help. It’s a two way process and this how many therapists work. Personally, I would not agree to see and charge someone for therapy if I didn’t feel there was a good fit between us. I don’t think it is ethical. If I don’t feel I am the best person for them, I’ll either refer them to a colleague or suggest other forms of help.

I think it’s helpful to chat to a few different therapists and see how you feel when talking to them. I know therapists who are excellent at what they do but they are not the right “fit” for certain clients. I had a patient who was having sessions with a guy who is extremely talented at what he does but for some reason the client felt he was criticising her whenever he worked with her. They discussed it and it wasn’t really resolved. Eventually she found another therapist who did very similar work with her, but had a slightly different manner and they were a better fit. The client was more relaxed and made excellent progress. It is different strokes for different folks.

I often get asked by clients how many sessions are needed to “sort” the particular problem. This is difficult to say. Some therapy methods appear to promise “one session cures” and in-fairness this can happen but it is less common in my experience. Change work can be tough with lots of stops and starts and you need a good ally in the therapist (and often friends and family) to get through. Personally I would be wary if a therapist, that didn’t really know me, told me it would take “10 sessions to sort the problem”. I’d be even more suspicious if I had to pay up front for all these meetings in advance. Sometimes coaching programs are more fixed in session number and this is fine. Again it depends. Go with your gut feeling on this and ask friends and family for advice. Perhaps try having a few sessions with the therapist and seeing how you feel and take it from there. It’s not uncommon for therapists to ask for payment up-front for a session. This reduces their no-shows and demonstrates some commitment on the part of the client. I wouldn’t part with large sums of money up-front though until you have some idea of whether you and the therapist are a good fit.

Patients often ask me as to how they will know that the therapy is working. Well, basically, their lives tend to change for the better. They start reaching their goals. They get less “stuck” in life and have more choices. They may laugh at themselves more and take life less seriously. Their relationships improve. Therapy is not about paying someone to make you feel better. A good therapist will challenge you and you may even dislike them for a bit. You have to do the work and you will reap the benefits. Revelations about yourself in the therapy room may well be painful. You are not paying someone to countersign your bullshit. However I do believe that therapy should be done with kindness and with the client’s best interests at heart. Most people find at the end of it all that they are nowhere near as bad or sometimes as good as they thought they were. We are all human with human traits.

Finally some therapy red-flags. Most therapists are very ethical, but there are some funny ones out there. Here are some no-no’s,

Excessive personal disclosure. I sometimes disclose aspects of personal stories to clients and patients when I feel it will help them. Too much of this, when it is unnecessary and not helpful to the clients recovery, smacks of “therapist ego”.
Inappropriate sexual behaviour. There is no place for this in the therapy room. Basically it’s anything that makes the client feel uncomfortable. I had a patient who received a text from a therapist late at night telling her that his mate had seen her picture on Facebook and thought that she was attractive. When she confronted him about this, the therapist told her that he was gay and she shouldn’t worry about it, (still not appropriate)!
Freebies. You are paying for a certain amount of time. Beware therapists who offer extra sessions without payment or schedule sessions at the end of the day so that they can spend more time with you. It implies poor boundaries on the part of the therapist or perhaps excessive “rescuing behaviour”.
It’s best to avoid therapy with people who are close to your social or work circle. For example I was due to have some sessions some time ago with a therapist who was also seeing one of my work colleagues. When we discussed this, it was agreed that I see one of her colleagues.

Trust your gut on your therapy relationship and if it is working, you will know. Don’t be afraid to pause therapy or take a break if you are not sure about where it is going. Also if you have any questions or concerns, try and discuss them directly with the therapist in the first instance. If they are the right one, they will want to help and resolve things.

Until next time,

Lily x

Twelve – Stepping into Narcotics Anonymous

So I joined Narcotics Anonymous. I was desperate and I knew that if I continued to use, I would lose my career and my relationship with my future husband. I had some knowledge of Alcoholics Anonymous. I remembered having to learn about the program for an exam I was sitting. I had envisaged crusty old men in a dusty church hall. NA was very different. For a start, most of the “members” were around the same age as me. Our backgrounds were very different though. They were mostly males and many had been addicted to heroin and been through the criminal justice system. A large proportion of them were smokers. I didn’t really know what to say to them.

When I get stressed and anxious, I tend to use long, intelligent sounding words to cover my insecurity. One guy, named Tony came to chat to me and told me all about his recent leg operation where he had ended up with septicaemia and post-thrombotic syndrome. Many years later, he told me he had seen straight through me and this was his way of breaking the ice and helping me to feel at home. I was very grateful to him.

I remember sitting down in the circle and trying to work out who the “leaders” of the group were. What were their credentials and qualifications? Perhaps I could be the leader? I probably had more letters after my name than most of them there. I was also very arrogant. Never mind. After my second meeting, I was given a job making tea for the meeting. This was in theory easy to do but there was one small problem. The amount of sugar used. This is not uncommon in twelve step groups where members will switch addictions from say, drugs to sugar and caffeine. I felt that from a health promotion point of view, I was not being true to my profession, if I didn’t ration the amount of sugar being consumed. I even bought sugar cubes and tongs to aid me in this quest. Needless to say, this was not well received by the group and I was forced to reign in my controlling tendencies. I was still very arrogant

Twelve step groups work on many levels and to be honest, when I first arrived I wasn’t expecting much. I went to meetings, I did what they told me to do, keeping it simple. I attended 90 meetings in 90 days and I found myself a sponsor. A sponsor is simply another member of the program who agrees to keep tabs on you and help you work through the steps. My sponsor was a pharmacist who had become addicted to dextroamphetamine. This suited me as I felt a greater connection to her because of my pharmaceutical addictions.

There is no doubt to my mind that 12 Step programs such as NA work. They are not perfect and they certainly don’t fix everything. They operate on many levels. Firstly, they provide a solution to the isolation and dishonesty and characterises active substance addiction. Suddenly, you are part of a community of people who have all done what you did and so there is nowhere left to hide. Rigorous honesty is called for (especially with your sponsor) and members work together to help the newcomer – who is the most important person at any meeting.

The Steps themselves are spiritual in their outlook. The concept of God is a very loose concept. Basically God can be anything as long as it isn’t related to the addictive process. Albert Einstein said that “No problem can be solved from the same level of thinking that created it”. Once you step outside of the problem, you have a better chance of finding the solution.

The 12 Steps of Narcotics Anonymous

https://www.na.org/admin/include/spaw2/uploads/pdf/handbooks/IGG.pdf

Deep change can really only come from surrender and this is the basis of Step One. “We admitted that we were powerless over our addiction, that our lives had become unmanageable”. For me, this ties in with Leonard Cohen’s quote a blog or so back. When we finally STOP doing what we are doing, there is a metaphorical space for something new to come in. Then we have the concept of the “Higher Power/Higher Self” – whatever which can help and guide us into new choices. (Steps 2 and 3).

The motivational author Louise Hay once said that “In order to clean a house, you had to be able to see the dirt”. This is the basis of Step 4 and 5 where you identify your personal character defects and share them with your sponsor. I’m not a fan of the term “character defects”. In my experience, patterns of behaviour develop to help the person cope with the environment they are living in.

We are adaptive creatures and this serves as a helpful survival strategy. For me, my preferred character defects were perfectionism, people pleasing and self obsession. In many ways, I hadn’t matured or grown up and I was still trying to control and ensure care by controlling others. It was all about me. I was also frightened. Frightened about being alone, people leaving me and a horrendous feeling of being bad and defective. It kind of made sense but it was not helpful in 2019. Sharing this part of oneself with another is a very freeing act. One of the really healing aspects of 4 and 5 is the realisation that the sponsor has often struggled with the same issues and to a wider perspective, so do most of humanity. We are all in it together.

Steps 6 and 7 allow us to prepare and subsequently ask our higher power to remove these defects. Again for me, this allows one to step back and exercise new choices. To come out of that pattern of problem behaviour and allow new choices to come in. Depending on the belief system, some people have experienced miraculous healings which they have attributed to divine intervention . It doesn’t really matter why it happens, only that it does sometimes.

We then move onto Steps 8 and 9 which are the amends steps where we seek to make retribution for our wrongs. In my case, I had stolen drugs from various medical establishments when in active addiction and so it was not practical to to simply admit this as it would have set in chain a number of consequences. I decided that the way to rectify this was to donate the value of the drugs to charity and commit to mending my ways. I did this through extensive personal work and did what I could to become a more caring and effective health professional. Where possible I tried to show myself the compassion I would have shown to a patient who was unwell and this practice actually helped me to become more compassionate in general. I still have a long way to go.

The final three steps work in the present. They teach us to be awake and aware. Moment by moment . How do we conduct ourselves in the Now? Are there people that we may have offended and we need to apologise? This means, paying attention to one’s speech. Is what I am saying kind? I might think it is funny but does the other person see it that way? Free speech is all very well but are we mindful of others? Does this itch to share something have to do with my ego, my importance or is it helpful to the other person? Taking inventory at the end of the day is another part of the tail end of the steps. It’s like a reflection of what happened and what could change. Depending on the belief system, we can ask a higher power for help. Perhaps we tap into the sense of humanness, the Universe, the sense of “Us”

And finally Step 12, the giving back. The buzzword is “carrying the message”. We seek to connect with newcomers and help others to get clean. Working with others without strings attached is therapeutic. It integrates us back into society and the human race. We start to wake up and become useful to others and that builds our sense of esteem and helps to keep us clean.

The Steps work – If you are struggling with an addiction, perhaps there is something in a group for you?

Where I came from – background

I feel it is only right to provide some information about my background. I hinted at this at this in the previous post. My journey had started many years before – perhaps as a child. I was brought up in quite a privileged family. Both my parents were physicians and I was the eldest of three children. I don’t remember my childhood being particularly happy and it was very difficult to put a finger on exactly why this was. I was anxious as a young child and my parents took me to see a psychiatrist at around the age of 3. I had a real problem with going into shops or any enclosed spaces and would freak out and “do a runner”. On one occasion, my mum took me to the circus and I was so alarmed when they closed the doors that I managed to crawl out under the edge of the tent to escape. That was even before the clowns came out!

I worried constantly that my family didn’t love me. I used to spend a lot of time alone, in my head, making up stories about imaginary parents that would come and rescue me. It was sad looking back on it. I had friends at school but they were not felt to be as functional as my sister’s friends and I used to compare myself to her and usually come off worse. Teenage years were probably the worst. I developed quite extensive cystic acne and was bullied at school for it. I covered my face with make-up but I was so distressed by the acne, I used to put the foundation on without looking in the mirror. Cue the nickname “cake face”. I think that bullying can be really damaging to a child’s self esteem and now, as a practitioner working with college students, this is a story I hear repeatedly. Name calling and singling out can stick with people for a long time. We have a duty to call this sort of behaviour out in schools. It’s not acceptable.

In my early teens, my father died suddenly after a short illness. He had worked as surgeon and I was incredibly proud of him as he fixed people. He’d operated on the mother of a friend of ours with breast cancer and she’d outlived him. He wasn’t around very much when we were growing up as he was often called away to various emergencies up at the hospital. I found myself in a real conflict with this because I knew the patients needed him but so did we – his family. I found myself being angry with him for not being around, then feeling bad about being angry because of the importance of his job. My mother, very much had the attitude that that was the way it was and so we needed to accept it, but I found this hard. It wasn’t until I became a doctor myself that I understood what an effect the “pull of human need” can have on you. It can be really detrimental to family life and such was my dedication to my job, I made the decision not to have children because I didn’t think I’d be able to balance my life effectively.

After Dad died, I was very proud of myself for the degree of emotion I managed to suppress. I don’t remember feeling anything for many years. I suspect the lack of emotions and grief might have had something to do with the eating disorder (bulimia) that I developed a couple of years afterwards and also an episode of ulcerative colitis. It’s funny I do feel slightly angry writing this – perhaps that was the emotion I didn’t feel? Who knows?

I realised fairly early on that I was reasonably proficient academically and this was my saving grace. This kind of helped me buffer a very precarious sense of self esteem. I’d also been told that I had a good sense of humour. I channeled most of my efforts into these two factors. I got into medical school, qualified and started working. Then came the problem that would bring me to my knees – addiction .

I don’t believe anyone sets out to become addicted to substances. I initially started using prescription opiates to help me sleep when I was resident in the hospital. I found it took the edge off the anxiety I felt. The problem was that it wore off and I had to take more and more to have the same effect. After a while, I had to use just to feel normal. This went on for 8 years. By this time I was a qualified family physician and realised pretty quickly I couldn’t go on like this. I was in a horrible limbo of not wanting to live but also not having the guts to end my life. I was really stuck. I have counselled many patients who have said the same thing to me almost word for word so perhaps it is a very common human predicament. It’s not at all nice. The drugs are a false friend, on one level they provide a sense of relief but on the other they are what they are – an addiction. Finally in 2010, I surrendered, entered treatment and gave up. As Leonard Cohen says in Anthem – “There is a crack in everything (there is a crack in everything)
That’s how the light gets in” https://www.youtube.com/watch?v=BCS_MwkWzes

This was the beginning of the next stage.

Photo credit

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