Beyond the Couch: What is Therapy Really Like?

Serena: Hey Everyone, I’m Serena.

Tina: And I’m Tina and we are the Mental Health Mamas.

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Serena: Welcome to No Need to Explain, we are so glad you’re here.

Tina: First, as always, a quick disclaimer.

Serena: We come to you NOT as mental health professionals or experts in the field, but rather as the parents of kids who struggle with their emotional health.

Tina: If you or someone you love is experiencing a mental health crisis, please seek professional support. You’ll find a variety of resources in our show notes and on our website, NoNeedToExplainPodcast.com.

Tina: So Serena, let’s talk therapy!

Serena: Let’s do it!

Tina: I have been very open about the fact that I sought therapy not only for my family but most recently for myself. I HIGHLY recommend it. As we have shared this quote, “no one should be on the streets of 2020 (and of course now 2021) without a therapist”, so let’s talk about how you might go about finding a therapist.

Serena: As we just mentioned, we always approach topics with our parent hats on and we will do the same with the topic of therapy. The information we share with you is from our perspectives as parents and reflects our own experiences and may not be everyone’s experience. That being said, I do think that therapy can feel like this mysterious, secret kind of thing. It’s a part of the stigma around mental health.

Tina: Absolutely. And therapy can certainly feel stigmatizing, especially in a small town like ours, right? And I always reminded my people that people seeing you in the therapist’s office, well, they’re also in therapy, right? And I’m not sure what notions at all I had about therapy growing up since it was not in my cultural radar and that said, I guess I was aware that some kids went places in school that wasn’t in a regular classroom.

Serena: Mmhm. Yeah, so I asked my kids if they could think back to what their ideas about therapy were before they started going and they actually shared with me the stereotype of the person laying on the couch with a therapist, you know, sitting behind taking notes. Like we see on TV shows like Mad Men. That kind of old-school psycho-analysis kind of stuff.

Tina: Yeah and like in New Yorker cartoons you always see that.

Serena: Right.

Tina: So again, accurate for the 50’s and 60’s, but the image seems to continue to persist.

Serena: It does. That and the Rorschach Test. You know, those are the inkblots that you’ve maybe seen, perhaps on screen on TV or in the movies. They’re supposed to provide a mental health diagnosis or a personality assessment based on what you see, what you interpret, in a random ink splat on a piece of paper. I do hope we’ve moved beyond this kind of thinking especially since the research tells us, we know that our views and our perceptions, they change all the time depending on how we’re feeling in a particular moment. Have you ever seen that in a therapist's office, Tina?

Tina: I have never seen nor heard of that! And I guess maybe that’s a good thing that we don’t use it anymore?

Serena: Yeah, it’s something that was developed in the 1920’s and I don’t think there’s much scientific validity to it. And what about the couch set-up with that judgmental psychologist sitting behind taking notes?

Tina: I have certainly seen that in kind of old-timey movies and shows and again, in a New Yorker cartoon.

Serena: Mmhm. Yeah. I’ve been inside many therapy spaces and I can assure you that I have never seen this. Often there IS a comfy couch although generally people sit on it. They don’t lie down on it. And there are chairs. I’ve spent a lot of time in the offices of therapists who see young children and their offices tend to have lots of toys and games, maybe bean bags to sit on and even things like small trampolines for kids to be able to move around. Media definitely has a strong influence on our perceptions of therapy and I have to say that, I’ve been noticing this more and more lately as I’ve been thinking about it, but therapists on screen, they’re often portrayed as irresponsible and lacking boundaries.

Tina: I can think of MANY examples. The one I’m thinking of right now is that I’m binge watching A Million LIttle Things and one of the characters, who is a black man, he is struggling with the cultural stigma of feeling depressed and so he asks a friend to be his therapist. And she does become his therapist for a little bit while she transitions him to someone else.

Serena: Yeah and I think that’s a good example, I think, of some appropriate boundaries and I think that responsible therapists wouldn’t make much of a story line, but it does affect how we view therapy.

Tina: Yeah, there are some things that have, you know, there are some shows that have gotten it right. For sure.

Serena: Yeah, that is true. One of my favorite shows, This is Us,

Tina: Oh, that’s mine too, yeah.

Serena: I know! So, I think that they have been doing a beautiful job of following Randall, one of the characters, through his journey. First he decides to seek therapy, he finds a therapist, then he fires that therapist and then we see him finding a new therapist.

Tina: Yes, and there’s a great scene where he’s interviewing therapists online, since we are, after all, in a pandemic. The first therapist is kind of new agey, the second one is a bit more formal and he doesn’t really click with that person and then he finally settles on the third therapist who he feels like is a good fit.

Serena: Hmm, yeah. I love that we get to see the process of him talking to different therapists and I also think it’s important to point out that there was nothing wrong with the first two therapists.

Tina: Exactly. It’s really about, you know, finding that right fit for you. The character Randall at first sees a white woman therapist and he is a black man. Then as, kind of, racial tensions are ramping up in our country, they bring this story line in, and he’s feeling some very strong feels about that. And he has grown up, he was adopted into a white family and does not feel like he has a whole lot of people to talk to about that. So he needs to find someone who understands him. He finds a therapist who is also a black man, a father and seems to be just the right fit. And just like a doctor or a dentist, different personalities and styles are fits for different people.

Serena: Right. And in therapy it can be even more important to find the right fit. Unlike a doctor who you might see a few times a year, you might be seeing that therapist every week. So you need to be comfortable with this person and feel that you can trust them. And if you don’t feel like that?

Tina: Find a different therapist! It is totally OK.

Serena: And this is really hard. Having that conversation with a therapist and telling them that you don’t think it’s working. This is hard for me. Is it hard for you Tina?

Tina: I would say, at first it was very hard. In an earlier episode I talked about having a not so great fit for our therapy needs when my kids were younger and I appreciated the clinician within the clinic who helped us transition. I am not sure with as little experience as we had had that I would have been able to do that with much grace. And you know me Serena. It would have happened, but probably not in the most pleasant way. So, I am grateful to that clinician for helping make that transition smooth. So again, find your champions.

Serena: For me, I have to remind myself that what it comes down to is that any good therapist would want you to be comfortable and to tell them if you’re not. They want this to work too.

Tina: Absolutely. And in some ways, now is a great time to do exactly what Randall was doing in that episode and use technology (if you have access to it) to explore the different providers. And when we go back to in-person, it’s OK to do that too.

Serena: Mmhm. And there are so many more options online than there were just a few years ago. Some of these resources are accepting insurance and they provide support in new and different ways. Not only on the computer or over the phone, but some are doing text messages as well.

Tina: Yes. And so I had talked about TalkSpace which is Michael Phelps, the Olympic swimmer, he started that company and it’s one that I’ve seen online a lot. And I think especially popular with younger people.

Serena: Mmhm. Yeah. Another example is BetterHelp.com. It’s also quite popular. And both of these sites connect you with licensed providers and we will provide you with links in the show notes.

Tina: Absolutely, but what if you need to find a therapist close to home or covered by your insurance? Where do you start?

Serena: That is such a great question and I would say it isn’t always obvious how to go about this. My suggestion is to look to your champions, we’ve talked about this before, the people you lean on in your community. If it’s for your kids, I always suggest going to the pediatrician first. There are even some practices that now have mental health professionals on staff. That’s true for where I take my kids for medical care and while the mental health provider does not offer long-term support, they do offer some short-term supports. They can, you know, give you suggestions and help you find another provider that’s a good fit for you. There are also often mental health providers connected to your child’s school who can either offer support during school hours if they’re available for that or again, help you find somebody outside of school. What else Tina?

Tina: So I’m not sure that people are aware and I want to make people aware if they’re not of EAP which is the Employee Assistance Program. It’s through your employer and it is a quick way to get into therapy. I used it myself and essentially you get in right away because, it’s not a crisis service, but it is a service where your employer really wants you to get well so that, of course, you can work well at work. So, instead of the six week wait I would have had had I just waited for a therapist, EAP got me in the next week so it’s a really good resource.

Serena: And it’s a benefit that is really underused, at least from what I’ve heard from employers. So, be sure to check with your employer to find out if you have this benefit.

Tina: So another good resource that we have personally used is Psychologytoday.com. You can get to it anywhere you use your internet and it is searchable by location. It’s also searchable by types of diagnoses. So, anxiety, OCD, that was certainly something that I included. So you can look at Psychology Today.

Serena: And I think people often look to friends for recommendations and this sometimes works out, but I guess I would be cautious about doing this. Someone who’s a good fit for me or my kids might be a terrible fit for you.

Tina: We might just have that experience among us.

Serena: Mmhm.

Tina: Ok, so we’ve found someone who we think will be a good fit and we’ve made an appointment. Let’s talk about what to expect with therapy. What is it really like?

Serena: So, the quick answer is that it depends. And by that I mean that there are many different styles of therapy and different types of providers.

Tina: Right. There are social workers, there are psychologists, there are clinical therapists, psychiatrists. And that’s just to name a few.

Serena: And in terms of the people who see kids, we have to also include guidance counselors, school social workers and school psychologists. In my experience, the therapeutic approaches between these roles, in other words, how they sort of approach mental health, they’re not all that different with the exception of the psychiatrists.

Tina: Right. While psychiatrists may offer counseling, there are only a few of those in our community. We, like many, have a shortage of psychiatrists (specifically child psychiatrists) and I think the main purpose of psychiatry is to manage medications for those who need that.

Serena: Right. And because of this shortage sometimes there are only certain ways to access a psychiatrist. For example, one of my kids was seeing a therapist who we really liked, but when we came to the decision that it was time to think about medication, we had to switch to a new therapist in order to access that psychiatric care. So, she currently receives weekly counseling which then allows us, at a particular agency, which then allows us to access that psychiatrist every few months for medication management. Just another thing to know for parents in the US is that sometimes pediatricians will offer psychiatric medication management depending on their comfort level with that.

Tina: Right. So, not to complicate this any more, but in addition to the types of providers, there are many different types of therapy.

Serena: Yes, so many different types...art therapy, play therapy, cognitive behavioral therapy, dialectical behavioral therapy, family therapy, group therapy. It’s a really long list. There are even therapists who use animals or nature or movement to help people. I’m actually remembering a story about a child who’s therapist would go for a run with her because she didn’t like being in an office setting and that was what worked for her.

Tina: That’s awesome. Which brings us to the message we really want you to hear. While you could do endless research into types of providers and types of therapies so that you know all the acronyms and can find the perfect combination for you and your child...we don’t really think that’s necessary. The important part is to find a good fit.

Serena: Exactly. So, for an example, perhaps you’ve decided that Equine therapy is the right thing for you, but when you go to your first appointment you discover you don’t feel so good with this therapist or maybe you discover that you’re terrified of horses. So, not a good fit after all. So, instead of the specifics, I’m going to suggest focusing on the idea of a partnership instead. Is this therapist someone you can partner with to support the mental health of you or your child?

Tina: I love that. Partnership is so important! As a parent taking my child to therapy, I wanted to know how I was going to be included in the treatment plan, because that person does not exist in a bubble, right? We are all a part of a unit. And how and when do we communicate with this therapist and how can we monitor the progress that’s being made.

Serena: Yes, communication is huge! We say it all the time, but we’re going to say it again...YOU are the expert on your child and you can provide valuable information to your child’s therapist. In a best-case scenario, that therapist sees your child for an hour a week. That’s such a teeny tiny window into your child’s world, that you as the caregiver, see and experience all the time.

Tina: Yes. Which brings us to a question we hear a lot. How do you know when to seek therapy for your child?

Serena: Yeah, we definitely hear that question a lot and I think it’s on the minds of a lot of parents, especially right now. So, I’m gonna start with something else we’ve talked about before and that is that we ALL have mental health, just like physical health. And mental health exists along a spectrum, just like physical health. If you’re not feeling well, you go see a doctor. So, let’s normalize the idea that if you or your child are not doing well emotionally, then you should seek mental health support.

Tina: Absolutely. 100%. Yes, yes, yes. There are certainly things to look out for...changes in behavior, loss of interest in normal activities, constant conflict, harming oneself or others.

Serena: Right. Any signs of helplessness or hopelessness should never be ignored. Those are a definite seek support. And, I would say, trust your gut. You know your child.

Tina: AND therapy can be about so much more than managing crisis. Therapists help people with relationships, work issues, life transitions, school challenges, life skills and building your “toolbox” to manage whatever situation that you might be in right now!

Serena: Clearly we are big believers in the benefits of therapy and we do know how hard it can be to take that first step. I do hope that someday getting a check-up from the neck up will be as accepted and normal as an annual physical.

Tina: Check up from the neck up. That would be amazing! I love it! So just do it! If you are thinking that therapy might benefit you or your child, just make that call.

Serena: And with that we’re going to wrap up. So podcast friends, we are, as always very grateful to all of you for listening and supporting us. You can help us out by visiting Apple podcasts where you can leave us a review, subscribe and please share our podcast with others.

Tina: And visit our website for additional content. You will find us at noneedtoexplainpodcast.com.

Serena: And this is your gentle reminder to take good care of yourself while you are also taking care of your people.

Tina: Thanks for listening!

Serena: Bye!

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