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#414: What are the green flags for a good therapist?

Do not go to anyone who works from a booth. (Photo by Kevin Dooley; click for Flickr original.)

Do not go to anyone who works from a booth. (Photo by Kevin Dooley; click for Flickr original.)

Hello Captain Awkward and Awkward Army,

I have been in and out of therapy off and on for the last decade or so. I don’t want to give my entire life history, but I will summarize by saying that I have clinical depression, and have anxiety that hasn’t been formally diagnosed yet but which has been plaguing me for years now, and my siblings and I were raised in a one mostly normal parent and one parent with unacknowledged Borderline Personality Disorder household.

In the past, I’ve had some relatively good-for-me therapists, and some less-good-for-me therapists. I am trying to figure out what makes a good therapist overall, and how to tell sooner than several sessions in whether or not they will work well with me. My mostly normal parent has agreed to help me pay for said therapy for the foreseeable future, so I don’t necessarily have to stick with whoever my (crappy) insurance will allow. I’m VERY good at subconsciously and consciously steering away from uncomfortable topics, so a big important thing for me in therapy is a therapist who will help me not get off track, and who will ask me questions.

I do want to get to a better set of coping and living skills, though, and I’m at the point where I am pretty sure that therapy is the way to go. The last therapist I was with had just started scratching the surface of reevaluating my current official diagnosis (major clinical depression) and medication when I had to stop seeing her because her job changed and she could no longer see outside clients. She did observe, however, that I have some BPD-like symptoms, and the stigma attached to BPD is such that a potential diagnosis of that terrifies me. 

My questions are these: what are the hallmarks of a good therapist? What kinds of questions do good therapists ask? What kinds of questions can I ask *them* in order to determine whether we’re a good fit? How can I tell a prospective therapist about these fears? How do I begin to deal with the shame and stigma a BPD diagnosis carries amongst the people I know, if I get diagnosed as such?

Hoping some of you have some insights on this,
Determined and Terrified

Dear DAT,

Sweet Machine here. First, let me applaud you for continuing to pursue therapy and recognizing that a bad fit with a therapist is just that, rather than swearing off the whole enterprise. Therapy is a process in which you’re consciously making yourself vulnerable, and when it doesn’t go well, it’s easy to mistrust it. But as you know, when it does go well, it can really help you make sense of your life — and you clearly want to do that. Jedi hugs!

Here is where I need to put a huge disclaimer: I am not a therapist. I have been in therapy for 4+ years with the same person, but I totally totally lucked out and hit it off with the first person I was referred to. Just about all of my friends have been in therapy at one point or another, because we’re mostly in our 30s and that is apparently when you decide to Straighten That Shit Out. At my 10-year college reunion, we wanted to yell at the graduating seniors “Get therapy now, save time!” as a joke (not a joke). So my advice here is coming mostly from a general place of being in a good therapeutic relationship and seeing friends go through their own process. PROTIP: NOT HOW THERAPY SHOULD WORK

You probably know that there are different schools of therapy, which sometimes overlap. Asking a potential therapist what her theoretical framework is and how she puts it into practice would be a good place to start. Some people swear by different approaches for different issues, and I don’t know what you’ve tried in the past, which is why I think the part about the practical effects is important. A therapist should be able to explain clearly, in a non-condescending manner, how she will approach your sessions, and what her goals are as a practitioner of [whatever] type of therapy.

Because you mention your tendency to steer away from the uncomfortable stuff and change the conversation rather than address what scares you, I think you probably need to pay attention to your first emotional impressions of a potential therapist. Here’s what I mean: you need someone who is not going to let you get away with that, right? But also someone you can trust with your vulnerability when you open up. What kind of person, in your normal life, makes you feel like that? A friend? A teacher? A relative? You probably want a therapist who kinda reminds you of that person. I know this is wildly unscientific and idiosyncratic advice, but since you are looking for early green flags, I think that could be one of them. For example: when I was looking for a therapist, I had to start by doing an interview at my campus counseling center (I was a grad student). The doctor who did the intake interview recommended a long-term arrangement and offered referrals, and she asked me if I had any preferences about my therapist. At the time, blogging at Shapely Prose was a major part of my life (even though it was only a minor part of my stress), and I knew I didn’t want to have to waste time explaining or defending my feminism to a therapist — so I said that all I cared about was that my therapist be a feminist, and I’d go from there. When I got to my first appointment with the referred therapist, she opened the door and I saw a friendly, butch, fat lady who reminded me strongly of my friend C. from college. I literally thought “My people!” when I saw her. That immediate, shallow, but real emotional ripple allowed me to talk pretty openly in the first session and get a sense of how she’d respond — and here we are, years later, and I still go every couple weeks. I offer this as an example because it is a contrast to some experiences I’ve seen friends have, where they were put off by the therapist’s persona but felt they had to stick it out to be “fair.” Fuck fair. You need someone to help you; you don’t need to “help” a therapist with your business just because you tried them out. If you start going to a therapist and you feel “this is not going to work for me,” you get to go to someone else.

It sounds like you maybe liked your last therapist — if you did, can you ask her for recommendations? When you do that, you might also her what you asked us — how would she advise you to figure out early on whether this is a good match?

Your fear of the stigma of a BPD diagnosis is understandable, both in terms of the pop culture understanding of that condition and from your own experience with your parent. Please remember, though, that whether you get this diagnosis or not, it doesn’t mean that it has to play out the way it has in your parent’s life — especially if your parent never got a diagnosis or therapy! Your desire to face your fear, even as it terrifies you, is actually a sign of mental health. That doesn’t mean you are wrong to be scared; it just means you are already a strong person and that you want to do right for yourself. A good therapist will acknowledge the “determined” part as well as the “terrified” part.

I hope that any of this is helpful. You are not the only person out there with this question — we recommend therapy all the time here at Awkward HQ, because it can be the greatest thing ever. (A friend of mine describes it as having a personal trainer for your psyche.) But, as you’ve experienced, “what makes good therapy” is harder to pin down. I’ve given you a glimpse of my opinions and experiences, but now I turn it over to the Awkward Army: What makes a good therapist? How do you know early on if it’s going to work out? What questions should DAT ask at the outset? What questions should she get asked? Is this the greatest image of all time y/n?

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241 comments
  1. This is likely to seem less-than-helpful at first, but it’s the best advice I’ve got.

    Think back over your previous therapists, good and bad. Are there common threads within each group? What ratio of talking/listening felt most helpful? Do you mind if your therapist gives you homework?

    Then there’s the stuff that feels superficial but still matters: are you more comfortable with a particular gender? Does someone who’s your parents’ age make you feel subordinate? Do you need your therapist to be feminist, queer-friendly, fat-friendly? Do you want religion to come into things, or to stay far away?

    If you’ve got any friends or family in your area who have a good therapist, you can ask them if they can get some recommendations for you. My therapist has done this for friends of mine a couple of times — I give her the general parameters, and a couple weeks later she gives me some names. You can also ask if their therapist is accepting new clients, with the caveat that a lot of good therapists won’t take a new client who is too closely linked to an existing client.

    • MC_Flea said:

      Seconding the asking the therapist if they are feminist, fat-friendly, etc. I saw a therapist who was not a feminist, and any time I brought up feminist issues (sexism, misogyny), she would address it in a not-feminist way, which just ended up annoying me and was not very helpful. If you have very different world views, then it makes it difficult to connect with them and take their advice.

      Also, you may consider the different types of therapists with their different training/background, depending on what you need (this is my Canada-specific advice based on personal experience and what I have heard from other people, not sure how it correlates with the professionals where you live). There are counsellors with university degrees and a college diploma, psychologists, psychotherapists, psychiatrists (and maybe more?). I do not have experience with all of these, but as far as I know, they generally have different ways of treating you (counsellors only do talk therapy, psychiatrists prescribe medication, etc).

      You can also look for self-help groups in your area through your therapist or a mental health resource centre, it can be helpful to listen to other people who are going through the same stuff as you.

      • Asking the therapist if they are feminist, fat-friendly, etc… I had not thought of that, thank you for that advice.

  2. I don’t have any suggestions about finding a good therapist, as I’ve tried a handful over the years and have always left with the impression that I get more out of talking deep things over with my friends, and they’re nice and don’t charge me for the privilege! So, beats me. But I DID want to say that even if you do get a diagnosis of BPD, it’s up to you how and when and to whom you disclose that diagnosis. You do not have to go shouting it from the rooftops. You can quietly and privately address your BPD through your therapy and any other recommended means, but you don’t have to tell anyone unless and until you choose to trust someone with that information. You do not have to expose yourself to that social stigma if you don’t want to; that’s not your responsibility. Your responsibility is just to yourself – to take good care of your own mental health.

    • Redgirl said:

      This is a great point. Getting an official diagnosis doesn’t change you into someone you weren’t before. It simply offers new insights for solving your problems. And you don’t have to share the diagnosis with ANYONE if you choose not to (if in fact there is one). Whatever you tell your therapist is confidential.

      • Mostly Lurking said:

        Getting an official diagnosis doesn’t change you into someone you weren’t before.

        That.

        Like myself, every single one of my friends who has gotten a diagnosis for a mental or physical health issue has felt happier about it – being able to place their individual problem in a wider framework, being better able to talk about it or read up on it, or seek out people/blogs/resources talking about their individual challenges beats knowing that you have a problem but not what it is and what you might do about it (or how badly it might come to bite you if you don’t do anything about it.)

      • I think that I am so used to being out about most things in my life that this did not occur to me.

        I am now finding, also, that I feel very uncomfortable when people bring up “BPD people” and “how terrible they are”. I sometimes bite my tongue, but other times, I say, “It sounds like the person you are speaking of is treatingly you badly. I’m sorry to hear that; that’s never easy. I hope they’re able to get help.” to remind the person I’m speaking with that people are PEOPLE, not walking disorders. :/

        • I hear you on not being super-comfortable concealing your diagnosis. It’s hard, and weird, because it sometimes feels dishonest. Or you feel as if you ought to be changing people’s conceptions about BPD or whatever. But that really isn’t an obligation – you don’t HAVE to do it just because you could.

  3. PBnoJ said:

    Watching with interest! I’ve been working on a Caprain Awkward question that boils down to “how do I do therapy” and “how do I do therapy well”?

    To the LW: cheers to you for being so good at recognizing your avoiding tendancies and wanting someone to call you them!

    • Bee said:

      YES! I’ve been thinking about a similar question too. LW, thanks for asking it, and Sweet Machine, thanks for answering it.

      The last two therapists I’ve seen, I’ve gone in telling them that I want to work on my PTSD/panic attacks from rape, and both times it’s amounted to not much in the way of working through PTSD/panic attacks and a lot of talking about things I’ve been doing, how I’m doing in my classes, etc. It’s painful, because I know the PTSD is going to affect me again in about 9 months if I don’t get this worked out, but I’m scared to push the issue, especially after starting out making it clear that this is the issue I want to talk about.

      I told them what I wanted. I “interviewed” them. My current therapist uses a method that is supposed to benefit PTSD. I asked her if she could help me, and asked her how she approaches her clients. I’m not really sure what else to do to get the results I want.

      • C.H. said:

        If you and your therapist are still pretty new, she may feel that she still needs to establish a relationship with you before she moves forward. Or maybe she’s waiting for you to bring up related issues on your own. I’d strongly encourage you to express your concerns and ask about her process and how she feels about your theraputic relationship thus far. Even in therapist/client relationships, no one can read minds.

        • This, absolutely. Communication is essential in any sort of relationship, counselor and patient included. The sooner your therapist knows you are concerned about how things are or are not progressing, the sooner the concern can be addressed consciously and with focused intent.

      • staranise said:

        A lot of therapists, absent anything else, will let the client lead the session. It’s good to build a mutual understanding before digging into the hard stuff, after all. I agree with C.H. above: bring it up with her. Do you feel ready to talk about the rape? Or about your PTSD? But because reaching in and going “LET’S DIG OUT THIS TRAUMA NOW” is a bad thing for therapists to do, it’s mostly your initiative to bring it up.

      • I’ve had panic attacks for totally different reasons, but I found that CBT was the first step for me to get it under control. Different methods work for different people, but you should feel free to ask what their approach is.

        • Seconding CBT if you’re looking at working on preventing panic attacks or symptoms of your illness rather than digging into all the background. I don’t want to make it sound like that’s a bad thing: for a long time my main priority was the symptoms not the cause because they were unbearable. I then graduated from CBT to pschodynamic therapy to deal with the background stuff, but I could only do that once I wasn’t having panic attacks and severe anxiety symptoms.

    • I’m glad it helps more than just me, fellow reader.

  4. I would add someone who respects your boundaries as well as her/his own. I.e. I’ve been in therapy for problems with my parents (abuse). I state at the first session that I don’t want to bring them in. Nevertheless, several therapisths have tried to make me invite them. Like, I told you not to do it, what are you doing?

    As for the their boundaries I’ve got a part of me that keeps on digging to find out how much I can get away with. I have a need to know how much I can push a therapist before I trust them. Again, out of several ones, all but one broke down and gave me their home phone, adress, told me to call in the middle of the night if need be… The same ones gave me way to much detail about their personal life.

    I’m sure for some that’s a great things. Me, I need to be able to project things safely onto my therapist. Almost believe that she lives at the office. (I know she doesn’t, I saw her in my neighbourhood and freaked out a bit.) I really don’t need to know things about her personal life that allow me to push and pull and focus on something other than my issues.

    • just_like_the_blues said:

      I hear you about not wanting the details of a therapist’s personal life, but I’ve also had a problem with the opposite — therapists who are dedicated to being perfect mirrors, perfect walls, which feels very uncomfortable to me. I want to converse with another real person, not feel like THE METHOD OF THERAPY is staring me in the face at all times.

      One thing I know I need from a therapist is imperturbability. I don’t want them to show surprise about x or y terrible thing, because when I’m not in control of my feelings about something, I want to feel like they’ve heard it before, they’ve dealt with it before, it’s not earth-shattering to them the way it is to me.

      • Yeah, it’s a fine line. ‘I want to feel like they’ve heard it before, they’ve dealt with it before, it’s not earth-shattering to them the way it is to me.’

        This was interesting reading. My first impulse was to agree with you, then I thought some more. I suppose I can see it in different ways. (a) Yes, you want someone who’s been around the block so to speak (b) But also, I like someone who shows surprise when something is extra bad.

        What constitutes as extra bad is tricky to say for me since I’ve gotten that beaten out of me, literally. That’s why I need someone I can trust to tell me when something is bad all-around and when something is super awful, time to call the cops/move out of state-bad. I’ve come across both approaches in therapy (I’ve seen quite a few in my quest for the One true great therapist) and generally speaking I like someone who reacts a bit more than someone who is super cool.

        YMMV, of course I respect your way.

        • Esis said:

          I think you two might be talking about two very different types of situations. If you’re describing abuse to a therapist, it does sound good and important if they react. But if you’re anxious for no reason (like me) it’s probably better if they don’t freak out at your behavior.

          For example, my anxiety is rooted in social issues so having someone react badly when I’m already in an anxious spiral would only make it worse. But when I was explaining how some of my “friends” treated (*cough* MIStreated *cough*) me in the past, it was nice to have her react and assure me that those were NOT good friends nor were they responding particularly normally. Basically, I’d stumbled onto several bad bunches of people.

          Does that make sense?

          • Yes, absolutely. Well put.

          • This sounds so familiar. Having a therapist back me up when I correctly identify people treating me badly is so incredibly helpful.

        • FlyBy said:

          Yup, part of therapy is putting things in perspective. Ideally a therapist won’t be personally upset by anything you say, but can also convey ‘hey, that is not good and I’m really worried about it’ as appropriate. It’s an interesting balance, I’m not sure how it’s taught.

        • staranise said:

          Yeah, there’s a difference between “earth-shattering” and “generally bad”. I like a therapist who isn’t disbelieving–who can readily accept that my experience happened to me, happen to other people, and will happen to people to come (alas) and yet at the same time gets grossed-out face if I’m describing something deeply gross. One friend called her shrink “someone who stays green, but keeps listening.” My own therapist, listening to part of my story where someone was being awful to me, instinctively cried out, “That’s so mean!” and I just felt so normal, you know?

          • AG said:

            So much this! *TW*
            I was telling a previous therapist about the time I tried to commit suicide at 14 and my parents’ response (there were ultimately many but the money shot that still blows me away was “What if your sister had found you? She would have been traumatized for life.”)

            After I got done telling her about the money shot, she *snickered*, then looked at my not-so-amused face and said “You’re joking.” I assured her I was not.

            While I want and need people to react to the things I’ve been through in a way that lets me know that it was shitty, *that* particular reaction was a bit much.

      • goldenpeanut said:

        “I don’t want them to show surprise about x or y terrible thing, ”

        Yes. The dealbreaker for a therapist who I was unsure of was when she had a visible reaction to something I said. I’m not a mind reader, so I have to admit that I don’t know what her reaction meant – and that was part of the problem. I don’t know what it meant, and I don’t want to be wondering what the therapist is thinking of me.

    • Kellis-Amberlee! I love the NEWSFLESH universe. :D

      For me, I need a therapist who can spot my avoidance tactics and point them out. I don’t necessarily need them to force me back to a topic, but rather to point it out and ask what I am avoiding and why. I need a therapist who is not easily manipulated; a strong personality who is capable of friendly neutrality and critical-thinking-oriented questioning.

  5. Sarah said:

    This talk of therapy raises another question for me, that I’ve been pondering for a while. That being, *cue stream of consciousness because I can’t think of a better way to say it*… “I love captainawkward, but it frustrates me how the answer to so many things is “are you getting therapy for that?” For me, and everyone I know, therapy would be the last ever port of call, and reserved for severe emotional trauma, like… soldiers, rape victims, those with PTSD… Not… “I have issues with relationships (or whatever). I dunno, perhaps it’s a US vs UK divide… But for me, and all the people I know IRL, therapy just isn’t something to even be considered, much less done… For me, I’m perfectly capable of having a therapeutic chat with myself about any issues. I honestly wouldn’t know how, where, or why to get a therapist. Is it more a US than UK thing?”

    Not casting any judgment, just curious.

    • No idea whether it’s a US/UK thing, but “emotional trauma” can result from a lot of issues that don’t sound as dramatic as “soldiers, rape victims, those with PTSD.” But actually, I’d really prefer that we not follow this line of commenting, because I fear it could very quickly turn into a derail about who is Really Worthy to receive therapy. I know it’s not your intent to cast judgment, but I really can’t see how anyone could try to engage with your question without doing so.

      • If this is inappropriate or seems likely to derail, I’m really sorry, and you can delete away, but I actually did want to engage with this, because: it kind of frustrates me, too, that “are you getting therapy” is so frequently a key part of the answer, because. I would like to believe that there are things I can do on my own, that have a much lower activation energy than therapy, to at least ameliorate non-diagnosis-involving situations, because I’m fairly sure that to actually find a therapist and go regularly I would have to either be very lucky in finding a good one right away, or hit rock bottom and feel I had no other choice. So I kind of understand this question! I am actually pretty impressed with people who can manage to get themselves to therapy, you know? And I understand that professionals are better at it, but does that mean that there’s nothing I can do for myself?

        • I would like to believe that there are things I can do on my own, that have a much lower activation energy than therapy

          I feel this way too. I’m sure therapy can be really helpful but…it takes a shit-ton of time, energy, and money to find a good therapist. Especially when your work situation, and therefore the hours that you’re available, keeps changing…and your health insurance situation too (major ARGH to both of those).

          My past experiences with therapy have been pretty meh–it felt like a lot of energy wasted on something that wasn’t particularly useful. Going through all that again just doesn’t appeal to me, even if maybe it would pay off eventually. So even though I understand why “go to therapy” is regularly given as advice here, I find it a bit frustrating too.

        • I’ve heard really good things about Mood Gym, which is an online thing that teaches some of the stuff you’d learn in cognitive-behavioral therapy. I haven’t tried it myself, so I can’t confirm that, but a lot of the tools I gained from doing that kind of therapy IRL have been really useful in all kinds of situations.

        • estelendur, I get what you’re saying, but again, this question is specifically *about* therapy. That’s why I see the “why do people go to therapy” and “what should I do that’s not therapy” as not being relevant. LW wrote in to ask about therapy, which is what we’re discussing.

        • staranise said:

          I’m not really replying to your point, estelendur, as much as kind of using this as an excuse to voice a thought I’ve had lately.

          And I understand that professionals are better at it, but does that mean that there’s nothing I can do for myself?

          I think a lot of people think of psychotherapy as… kind of like massage therapy? You go in and lie there, the therapist does their thing, you walk out again feeling better. When it’s really, really not. A good psychotherapist is like a consultant or a coach. They’re someone you bring in to take a look at things to give you perspective; they provide a space for you to examine your own issues; they know exercises that can help you function better. But if you don’t do the work yourself, they are a really expensive useless post.

          The things a therapist contributes that it’s hard to provide on your own are: 1) dedicated time and space to examine your stuff. 2) An empathetic listener to help you feel less helpless and alone. 3) A repository of knowledge and experience about these issues and whether ways of dealing with them are generally helpful or not-so-helpful.

          The actual ability to heal and create change is something you bring in yourself.

          • Yes! It’s not like massage therapy (lie on this couch and let me fix you); it’s like physical therapy (your ankle is messed up and you need to do 100 of these squats to make your legs stronger). It is kinda the opposite of having a conversation with a friend, in my opinion.

        • Pterinochilus murinus said:

          Well, if you don’t need help from anyone, why are you writing in to an advice columnist? /flippant

          More seriously: no one has eyes in the back of their head. You can’t see how you’re coming across to other people, you can’t see your own blind spots, and you aren’t always a perfect judge of your own actions or thoughts. No one is. That’s why a trained observer can help – as a mirror.

          Also, re the thing about whether things are serious enough to see a therapist: how serious do things have to be for you to see a doctor, assuming you can afford one? We don’t think someone’s insufficiently self-reliant for getting an x-ray on that maybe-sprained, maybe-fractured ankle just because it’s not cancer. Some forms of therapy are like setting a bone, short-term and limited in scope. Others are like treating metastatic cancer, long-term and very invasive.

    • Anna said:

      I am from the U.S. but live in the U.K. and in my experience, YES this is definitely a cultural difference.

      • elodierose said:

        Yeah I’m Australian, and the culture is different here too. From what I’ve seen, short term kinds of counseling (especially run by your school/uni/college) for the purpose of maintaining stress during those turbulent growing up/working/studying times is pretty normal. As is any treatment specifically related to overcoming addictions or substance abuse, and youth support type services. Beyond that, psychiatry or therapy of the more ‘official’ ‘full on’ kind are still fairly unmentionable. Thats not to say nobody does it…I think people just don’t mention it for fear of that “but why do *you* need therapy?” question that can arise if you don’t have an overt and obvious reason for it (ie major trauma).
        It’s really sucky, but theres is sort of this “Aussie battler” culture here that advocates stoically enduring hardship and not showing weakness by seeking help. There is definitely a stronger stigma here than I experienced when I lived in the States (in New Orleans and San Francisco) where I found many more people openly referred to therapy in a more casual way. If not necessarily their own current one, then often a friends, or one they saw in the past.
        There is still stigma that needs to be removed, but the US really should take some credit for how far they’ve come already. Whatever your personal view is on therapy, it’s hard to argue that lots of lives aren’t richer and more functional, and better off for having access to therapy and counseling even in the short term.

        • Ali said:

          I think part of it here in Australia is also about how therapy gets paid for. In the US, while my insurance did have a limit on the number of sessions I could have with my therapist, that limit was endlessly renewable as long as she spoke to the insurance company and basically said, “Look, Ali needs more help, we’re not even close to done.” Here, you have to go through an uncomfortable GP visit to get an official referral once a year that is only good for ten sessions, and then hope it’s covered by private health (if you have it) if you need more. Ten isn’t even once a month if you need long-term help! I put off going for a long time because I didn’t want to deal with that process.

          Add it in with the obnoxious battler culture and I’m not surprised at all it’s very quiet and private here. The boy I’m seeing actually mentioned that my openness about having had therapy and intense anxiety and depression when he was having a panic attack was one of the reasons he knew he could like and trust me right away, and that kind of breaks my heart, you know?

          • That is heartbreaking. :( No one should have to worry about being stigmatized for getting the health care they need and bettering themselves.

    • JenniferP said:

      I can’t speak to the cultural difference, but I am definitely interested in de-stigmatizing therapy. It doesn’t have to be a life-threatening event for someone to want to learn, say, better communication skills. Or to chew on a past trauma or pattern of behavior and figure out a different way of working on it. Or to get mental health problems diagnosed. More expansive post here.

      • sp4rema said:

        Yeah, I think the fact that people DO often have that reaction of “but it’s not REAL emotional trauma” and treat therapy as a last resort is why it’s great that this site does suggest therapy for other things.

      • Destigmatization is a big fracking deal. I call people on stuff about this often, and I call *myself* on it often, because I’m tired of people being shutdown when they are trying to get better.

    • Manatee said:

      Hi Sarah, to address the ‘I don’t know how or where’ aspect of your question in a non-definitive, non-specialist, experience based way…

      In the UK your GP is a good first port of call. They will either be able to refer you to a suitable therapist or to a specialist who will have a more in depth discussion/assessment session with you to help work out what sort of therapy would suit your needs. Either the GP or specialist should be able to recommend and advise on private options as well if your issues are not the sort usually treated by the NHS (nb whether or not you can get help on the NHS is no indication of how ‘valid’ your problems are it is literally just about what your local area can afford to fund).

      You could also dive straight in and book some sessions with a private therapist, although if you are uncertain about the types of therapy available or would feel more comfortable with a recommendation then ask your GP for that information.

      For relationship issues (including if you are working these out alone rather than seeking couples therapy) then Relate is the main UK hub for accessing services. They have a good website which should give you more of an idea of what you can expect, and also publish some good self help books if you are looking for alternatives to therapy. For therapy about other specific issues, then the various national helplines and charities would be a good source of information.

      If you are a student it is worth knowing that most universities in the country have in-house counselling services. At the very least they will have information on accessing local services in the Student Support Office or via the Student Union Welfare Officer.

      If you are on a low income but are considering private options, some practitioners offer rates on a means tested sliding scale.

      We might not talk about therapy so much in the UK, but it is available and a lot of us do use it! Good luck.

    • Speaking as someone n the UK who does use therapy, I second the GP thing, although I will warn you the NHS waiting lists can be *long* and you might only get a set number of sessions depending on area/issue so if you go down that route make sure you ask

      If you check out the MIND website, they offer interim counselling sessions while your on waiting lists in some areas

      @Manatee- Do you know where I can get information on sliding scales etc? I’m thinking about going private but can’t afford £70 an hour which s the going rate around here

      • Manatee said:

        Serious sympathy on the NHS waiting lists. I remember those feelings and it was not a good time.

        I’m sorry, I don’t have specific info on sliding scales as that’s only something I’ve read about in the abstract as something that exists rather than actively pursued myself. I believe from a friend’s experience that Relate mention it, but I’m not sure where you would look for non-relationship/sexual specific therapy on a sliding scale if that’s not relevant to your situation. My only suggestion would be asking google, GP, and MIND (good catch – I’d forgotten about them!). Anyone else know?

      • marykmac said:

        The British Association of Counselling and Psychotherapy has a website about finding a therapist – http://www.itsgoodtotalk.org.uk/. I think that has stuff on finding someone with sliding scales. Good luck!

      • Shiny said:

        Hi bewhatyoudream! Without knowing what you want counselling for or what area you live in it’s hard to give good resources, as unfortunately I’m not aware of any good comprehensive national lists. However there are definitely some excellent local or focused ones which you can use, for example the Mind Guide in my area: http://www.omhi.org.uk/ . And when it comes to individual counsellors (rather than organisations) there are lists held by accrediting bodies and things like the BACP. They’re generally not too sophisticated in terms of functionality but they are thorough. So if you search for key words like ‘cost’, ‘income’, ‘scale’, you catch the places that describe themselves as ‘low cost’, ‘low-cost’, ‘for low incomes’, ‘sliding scale’, etc.

        Note though that some places may have that option but not put it in their description (which generally has to be brief) in which case they won’t come up from that kind of search. So I’d suggest also searching for the specific things you’re interested in and contacting the people/places that look really good to you and asking. Even if they can’t accommodate you themselves they may be able to point you in the right direction.

        Sorry there isn’t a super easy solution I can point to, but I hope that was at least a bit helpful!

    • Sarah said:

      Thank you to everyone who replied with thoughtful, reasoned comments. One of the best things about Captain Awkward is how someone can post something that goes in a different direction, but receives intelligent “non-shut-downy” responses, even if they don’t agree with the original statement.
      My comments were geniunely a thought process I was having, and I’m not actually in need/want of therapy myself. But thank you to Manatee for the “how to” guide to therapy in the UK. Hopefully it will be useful for someone else here.
      Sweet Machine – My intent was never to de-rail, but thank you for allowing the thread to continue, despite your obvious reticence to do so. My comment actually led to more specific support/help for a large proportion of your international readership, so… thanks.

      • Hey Sarah, thanks for the followup comment. As the Cap’n said, there is often a stigma against seeking mental health care, and we are very invested in defanging that stigma. Even when people have “normal” levels of stress and anxiety in their lives, there are things a professional can help with! As Pterinochilus murinus says above, you still get an x-ray of your sprained ankle even if you know it’s not cancer — I just wanted to make sure we didn’t get into “If it’s not rape/war/ptsd, therapy is a luxury” territory. Thanks for understanding.

    • But for me, and all the people I know IRL, therapy just isn’t something to even be considered, much less done

      Coupla things: 1) all the people you know well enough to know if they are in therapy (and you might not know) are going to be generally similar to you. You don’t have any kind of broad cross-section of population going on there, and it can lead to what’s called “confirmation bias”.

      2) This space is an outlier in terms of how it approaches therapy. Many many people in the US still feel the way you describe about it (last-resort thing, stigmatized, only for really bad problems, whatever that means). I live in the San Francisco area, and even around here there are people who are very resistant to the idea that therapy can be useful. So don’t assume that everyone in the US is just like the Awkward Army, ‘coz they aren’t. We’re a special & wonderful sub-set of humanity.

  6. Keely said:

    I want to leave a big comment here regarding BPD, but I’ve been trying and I can’t seem to get my thoughts untangled. Suffice it to say that I have some experience myself with the diagnosis, as in it sort of fits and some mental health pros have applied it to me at various times in my life.

    I wrestled with the diagnosis for awhile. What helped me was reading some first-person accounts of living with the disorder. It’s a little depressing looking for them, as most of what you’ll find is guides for people who have to live with those horrible borderline people, but there are a few good borderline memoirs out there. (I liked this one a lot.

    This may just be my own quirk–I’m a nerd and I deal with issues by diving into studying them. That said, I think there is a lot of value in seeing how other people have wrestled with similar situations to ones own. When you read memoir you take what is helpful/applicable and you leave the rest–you see that everyone has their own story, sometimes with similar themes to be learned from, but with different details.

    Diagnosis is the same way. BPD is, in a sense, a story we tell about a certain kind of person with a certain kind of history and a certain set of problems. From that story, you may learn ways to heal that are helpful. Take those. You will also learn lots of unhelpful and flat out harmful ideas about what BPD says about you as a person. You don’t have to take those. I know making that distinction is difficult, but it can be done.

    Also, to echo what was said above–you don’t have to tell anyone you don’t want to about your diagnosis. Tell people if and only if you think it would be helpful to your own recovery. Otherwise it is none of their damn business.

    • I also dive into problems by studying them (sometimes resulting in me scaring myself more *sigh*). You are not alone in that trait. :D

      Thank you for the memoir recommendation. I have added it to my private wishlist and will likely check it out.

  7. TheJackdaw said:

    Ahhh – spam filter, why must you test me so?? I c+p’d, hope that’s okay!

    The only green flag I can think of (and I think it ties in Sweet Machine’s idea of finding someone who is One Of Your People), is finding someone who you feel is talking to you as a whole person, not a set of symptoms or practice for their particular brand of therapy.

    I was diagnosed with BPD in 2004 and went through a couple of therapists, one of whom asked me to talk about my dreams and the other who wanted me to take out my anger issues on clay. These can be great techniques for some issues, but with BPD, you need someone who will call you out on your hypersensitive bullshit at the same time as providing a space of no judgement – a place where you can feel for once that you will not be abandoned. The therapist who I clicked with did that. She asked me what I wanted from the sessions, listened and then provided that for me.

    I was started on a Cognitive Behavioural Therapy course but as my needs became more apparent, she shaped and moulded the course to me, rather than forcing me to work to a particular timetable. I think that kind of adaptability is also really useful.

    What you want is important – it’s difficult to remember that in the sort of crisis that brings you to therapy in the first place – but do remember it! Therapy is purely selfish – the good kind of selfish – where you can talk about your problems and get help finding answers but you don’t have to think about making small talk or asking after the kids.

    On the BPD front, I want you to know that it is not the life sentence it can be made out to be. A Little Coffee is right – you don’t have to shout it from the rooftops and no one ever has to know. When I was diagnosed, I was in a cycle of loneliness, intense relationship, break up, meltdown and hospitalisation and it fucking sucked. But I knew there was a better life for me on the other side and I just needed help getting there.

    With that help, I finished my degree, removed myself from an abusive situation, moved to the Big City, got a cool job, met an awesome fella and I’m now married. I had my last crisis 3 years ago (and that was entirely due to working night shifts) and I’m not on meds or in therapy.

    It’s a beast but it’s mostly tamed and I have no shame about it – I know my limits, I know how to push myself and when to take care of myself and the tools I learnt in therapy have helped me build this life.

    I wish you all the best LW, whatever the diagnosis, you’re doing all the right things!

    • Thank you for your whole comment, TheJackdaw. Seriously, all of it, and especially the reassurance that I’m doing something right. One of my incessant Inner Gollum chants is “you can’t do anything right/nothing you do is right ever/you are horrible because you never do anything right”, so being reminded that IG is patently wrong about that is so damn helpful.

      Thank you.

      • TheJackdaw said:

        You are super welcome, righthandstar!

        Good luck with everything and Jedi hugs if you need/want them :)

  8. staranise said:

    I’m in therapist school, so I get a lot of these questions. So hm. I will see what I can boil down.

    LW, you are right that it’s important that you and the therapist get along. On a practical level, what predicts success in therapy is hugely “whether you and your therapist feel like you’re in it together” + “whether you’re willing to work”. That matters MORE than how smart or educated your therapist is, for real. Generally speaking, most people know whether a therapist is for them within three sessions. (No, for real, this are research.)

    A lot of this is your observation, LW. Of course everyone who’s done therapist training will be like, “I try to be empathetic to my clients!”. Instead, watch for things like: when your therapist listens to you, does it seem like they are really hearing you? Do their verbal and nonverbal responses seem to imply that they understand what’s going on with you? If you disagree with them about something they say about you, are they willing to take your feedback into account instead of telling you that you’re wrong? (“You sound sad.” “No, actually, I’m angry.” “Ah, okay. Anger.”)

    If you fear a diagnosis, and your therapy is being paid for privately, you can up-front tell your therapist that diagnoses freak you out and you’re not asking for an assessment. Also, consider seeking a therapist who can’t diagnose. For example, I’m a Masters-level counsellor; in my region I couldn’t diagnose if I wanted to, no matter what. I can just say, “I think this person’s problem is like this, but lol, what do I know”, but no one else even reads what I’ve written unless specific circumstances means I release my files, or my client asks me to write something for them. This makes me and a Masters-level social worker different from a Ph.D-level psychologist, or a psychiatrist with an MD. Keeping that stuff separate is why I see a Masters-level therapist for actual therapy, and a GP or psychiatrist, separately, for medication. I can do my therapy without actually needing to slot myself into little boxes. On the other hand, I can take insights from there to my doctor and say, “My therapist and I discovered that I actually am anxious all the time. Can we deal with that?”

    This is me not giving colleagues the benefit of the doubt: Broach these concerns in the context of, “I know I take a long time to get to what’s bugging me, and I have serious issues with diagnosis, so I don’t want any kind of diagnosis at all until you’ve known me for six months/a year, and only then if we need one.”

    I am kind of ambivalent about therapists calling people on their shit. It’s absolutely useful! But it’s most useful, I think, after you’ve built up a relationship of trust and understanding. Even consensually leaping right into Big Important Shit from the get-go isn’t always great because I don’t know the person, and I don’t know the signs for, “This person is self-inducing a flashback to their trauma in my office and will spend the rest of the week highly upset and volatile because of this, I should stop and make sure they’re stable.” So sometimes it takes twenty minutes from first meeting someone for me to go, “This isn’t about Problem A, is it? It’s really Problem Y.” But sometimes if I do that, they’ll just blow up and I’ll never see them again, so what use is that?

    So I’ve had clients go one session, three sessions, six sessions, however long, talking about something totally unimportant or lying about an important part of things, and I can *tell* they’re doing it, but the time isn’t right to challenge them. (And honestly, sometimes it’s really illuminating to see what they lie about when they do lie; I’m not mad at being misled, because it’s all data. And they see me for free, which eases my conscience since I’m still not comfortable with the whole “paying” part of it.) So we spend months talking about coping skills and dealing with your emotions and having a social life, and then they’re ready to talk about the big traumatic past.

    I get a lot of guidance on that combination of patience and deep empathy from supervisors who work with complex trauma, which is why for me, a google search for a new therapist is “Complex PTSD Counsellor Location”–even though I don’t have PTSD, I know that a complex trauma therapist will know it’s all more complex, it isn’t going to be solved in six sessions, and even at my best, I’ll never look “normal”. I just want to be the best abnormal I can be.

    • ‘I am kind of ambivalent about therapists calling people on their shit. It’s absolutely useful! But it’s most useful, I think, after you’ve built up a relationship of trust and understanding. ‘

      Totally agree. I can still hear the lambs, I mean, feel the anger from when one bad-for-me therapist called me out on something on our fourth session. I’d not at all begun to trust him enough and got upset och really didn’t want to talk about it with him, who kept trying to call me out on it… Oy.

      Also, if you do call someone out on their shit, do it while there is still plenty of time left. Otherwise it’s likely to be a conflict, not enough time to resolve it and a whole week to be upset and anxious about until the next session. And by then, maybe you’ve become anxious enough to cancel the whole thing and it all snowballs from there.

    • Kaz said:

      Instead, watch for things like: when your therapist listens to you, does it seem like they are really hearing you? Do their verbal and nonverbal responses seem to imply that they understand what’s going on with you? If you disagree with them about something they say about you, are they willing to take your feedback into account instead of telling you that you’re wrong? (“You sound sad.” “No, actually, I’m angry.” “Ah, okay. Anger.”)

      Oh my GOD I just had a horrific therapist experience that was pretty much exactly this in all the worst ways. We managed to talk past each other in ways where I still don’t understand how it was even possible. I spent two sessions explaining how I am disabled and have various issues as a result and how they affect my life and that I have some good workarounds for dealing but not really enough and would like help with more. She spent two sessions telling me how I just need more willpower, zeroing in on my coping strategies and then telling me that she can’t help me if I don’t *want* to change when I say that I don’t think tearing down my coping strategies while ignoring the actual problems will lead anywhere good, encouraging me to stop using the workarounds I have come up with in favour of self-discipline!!! and willpower!! oh god the memories. At the end of those two sessions, I discovered that she somehow managed to miss the fact that I was disabled. Quite a feat, considering I talked about pretty much nothing else! I still have no idea what the hell she was hearing the entire time.

      I really could have used this advice before I met her, ‘s all I’m saying!

      Re: calling out shit: I have to say from that experience that therapy is something during which you can be very vulnerable, and that it’s probably not a bad idea to guard your soft spots until you know the therapist can be trusted near them. Like, the therapist I mentioned up there actually did some real and serious damage, set me back quite a ways and reinforced thought patterns I’d been trying to break because they were bad for me; I seriously considered the things she was saying and the advice she was giving when I usually would’ve usually dismissed it out of hand because I figured she was a therapist and knew what she was talking about. In retrospect, I’d have done better to be less open and more critical until I worked out whether or not we were actually in the same library, let alone the same page.

      • MamaCheshire said:

        Yikes! I am really, really sorry you had to deal with something like that.

        Disability: It’s a Thing In The World.

      • staranise said:

        MY FACE when classmates or colleagues discuss disability-related cases: so epic that occasionally I see people in group supervision swiveling their heads my way as soon as someone makes an obnoxious comment. Whoops. >.< Disability rights is not a perspective many of them even know exists, let alone use.

        I am the person in the back going, “WHAT IF THE CLIENT’S PROBLEM IS THAT THERE’S NOTHING WRONG WITH THEM? AND THEY’RE JUST SURROUNDED BY ASSHOLES? AND WESTERN SOCIETY?”

        • Bad Caregiver said:

          StarAnise, can you please train ALL THE THERAPISTS?

          I’ve run into therapists (not necessarily mine) who tell me that my boyfriend is being “controlling” by expressing a need for me to change my behavior. Or that maybe he’d learn to do more for himself if I didn’t do so much for him. How do they leap to this conclusion? Have they worked with so many addicts/codependents that they apply that model to everybody?

          To steal a line from one of the best _Party of Five_ moments ever: Addicts can stop using. My boyfriend can’t STOP BEING SICK.

          The irony is that I am such a very bad caregiver. I snap at him all the time for interrupting me in the middle of anything, even though I know he genuinely needs whatever he’s asking for. I have no desire to change my behavior when he requests it, because I don’t want to be controlled, even though I know he’s asking so his stress will be reduced and not specifically to control me. If an asshole like me can realize he’s not looking for an enabler, why can’t trained therapists? Or, at the very least, why can’t the trained therapists at least reserve judgment when they’ve never met him?

          Sorry for the derail. I just wanted to praise one of the only people who seems to get it. And vent.

    • MK said:

      I wish you were in my therapy school! We needed that person in the back of the room saying “Maybe society’s the problem in this case!”

      I did the doctorate level of therapy school for a year before I had to leave because of ill-timed trauma and some faculty members making it worse (There are some awful therapists out there, just to say.) I’ve also been on the other side as the patient for a good part of my life. I found one excellent therapist and a not-so-good one during school. Plus one awful, ethics-violating psychiatrist. There are definitely both good and bad doctors out there and everything in between.

      From all that I learned, the most important thing in a therapist/client relationship is connection and trust. And as has been said here, that can be for any reason such as gender, age, religion, preferred type of therapy, because that mole is ill-placed, because they dislike “fill in the blank” type of people, etc. It never has to be a “good” or “fair” reason, just that you are not as comfortable as can be. And as starnise has said, this can often be felt in the first few sessions (research!). So if anything feels off, just find someone else. It’s about a stylistic match.

      When searching while in school, I zeroed in on a guy who said he was experienced in my diagnosis, comfortable talking about sex (had to process a rape, therefore very important. Not everyone can talk about sexual things), and I chose a younger guy so I could practice saying no/feeling comfortable. I purposefully avoided an older woman, who had a non-traditional style, and liked to talk about religion. Most therapists (minus the awful ones) will work great for someone, but not everyone. LW, you can always use my narrowing down trick and seek out someone specialized in what you’re dealing with (e.g. childhood trauma, BPD, anxiety, depression, etc.) After that, look for a connection.

      Some general good things as starnise mentioned, too: Do they listen to you? Respect you? Not criticize you? (unless very gently when needed after trust is built and you said you want that) Do you feel safe and comfortable? Do you feel like you could say anything or almost anything to this person? Treat it as a relationship, you should feel good with this person. You should feel safe to be vulnerable. And a good therapist, ethically (as I was taught in the big old ethics manual) should notice if the fit isn’t optimal (or if they are not equipped to help you) and gently refer you to someone they think would be better. Without you having to ask first. Obviously, this is not an ideal world, but a therapist who does that is a big, waving green flag.

      • staranise said:

        Other possible reasons for a mismatch: They use eye contact much more often/less often than you do. They sit too close/too far. Their body language is alarmingly expressive or bafflingly taciturn. They are more fidgety/less fidgety than you. They have the wrong pheremones. Who knows! If your options are limited you may have to put up with a less-than-ideal therapist, but if you have a choice and the luxury of time, there’s nothing wrong with finding someone new. It’s not about finding someone who instantly gets you as much as someone you feel has a real willingness and ability to try.

        (Now, if you’ve seen and broken up with six therapists in a month, it might be worth asking yourself some hard questions about whether your criteria will yield a fruitful search, but that’s also a personal decision.)

        • “It’s not about finding someone who instantly gets you as much as someone you feel has a real willingness and ability to try.”

          Looking at previous experiences, I find this statement to be particularly true.

      • “It never has to be a “good” or “fair” reason, just that you are not as comfortable as can be.”

        I needed to hear this (so I read it outloud to myself). In all seriousness, thank you. Being female sometimes means having to figure out that “no” without giving reasons is okay to say.

    • Now that I realize that I don’t have to tell people my diagnosis (if I get one), it isn’t as scary, and I can see it as more of a tool than a label. That being said, I really just want to be able to unfuck my mental habitat, y’know? If that does or does not involve a diagnosis, it doesn’t matter nearly as much as the process itself. If having a diagnosis helps me, I’m okay with getting a diagnosis. If not, I can come to peace with not having one.

      One of the things I am having hard time with right now is my dad (who had to leave my BPD mom when I was 14 because she falsely called the cops on him), when I express my fear of this possible diagnosis, says “There’s no way you could have that because you are self-aware.” Dear Dad, I love you, and that is NOT. HELPING. AT. ALL. :(

      • TheJackdaw said:

        Sometimes, parents not accepting you have mental health problems (particularly BPD and particularly if one parent already has it), has a lot to do with them feeling like they have failed in bringing you up ‘normal’.

        My relationship with my mother is probably irrevocably broken but I do recognise that a lot of her minimising and dismissing my problems was down to her to feeling like a bad mother and not being able to accept that sometimes, even with the best of intentions, you can’t protect your child from the effects of living with damaged parents.

        This is in no way meant to excuse your dad; he is being mega unhelpful!

        The other prong to this (and I don’t know if it’s primarily a BPD trait or not), is I was caught up for a long time in the fear that no one would believe me that I was as ill as I was. The ‘you’re too self-aware’ talk rings a lot of bells for me! This fear could lead to me acting up or spiralling into shame, depending on the day.

        What helped was having someone believe me (a therapist!) and then coming to terms with the idea that other people’s opinions of your diagnosis and mental health are not as important as your actual lived experience. Your dad may choose to never come to terms with any diagnosis you’re given. And it will hurt and be so frustrating and it will make you question your own view of reality but hopefully you will find eventually that it Does Not Matter.

        You are the One True Arbiter of your life. And by that, I mean you, righthandstar NOT your Inner Gollum!

        • This comment means a lot to me. Thank you.

          I am so grateful for all the insights I’ve received on this post. Among other things, it is immensely comforting to know that I’m not alone in this, and that bring it to a degree that is a little easier to bear when things get sketchy.

  9. roramich said:

    I have had good success with doing some phone interviews with prospective therapists before actually making an appointment. That way I have been able to ask some of awkward-feeling questions (will you tell me to lose weight? what is your feeling about excessive porn use were two of them) that would have been harder for me to choke out face to face I found easier on the phone (email would have been even better in that sense! But harder to get a read on the prospective therapist.) without investing in the full 50 minutes and payment deal. When I did that, I paid careful attention to how my breathing was while I talked and while I listened to their answers… did I feel more tense? Or did I feel relief to get it out in the open? And how did their response make me feel? It’s really hard to have “rules” for what to look for with therapists because the connection is so individual. But I have found that if I can literally breathe more easily, it’s probably worth trying it out with that person; if I feel more tense, probably not.
    Also, YES, that is the greatest image OF.ALL.TIME.

    • It’s really hard to have “rules” for what to look for with therapists because the connection is so individual. But I have found that if I can literally breathe more easily, it’s probably worth trying it out with that person; if I feel more tense, probably not.

      Yes! That’s what I was trying to say with the “My people” thing, too.

    • FreyaKitten said:

      For finding my therapist, being able to ask those questions in an email (actually, a series of emails, by the time I asked all of my questions) was gold. In answering my questions the way my therapist did, said therapist proved themselves to be my kind of people, and a probably-good fit for me.

      I also looked said therapist up on Facebook, and throughout the rest of the internet, just to be certain that they weren’t posting anything about work publicly. Not that I’m paranoid or anything, but…

    • Good idea… I may very well try that. I do not know why it didn’t occur to me to try it before.

    • hummingbear said:

      That’s a great suggestion! I would be paying for therapy entirely out of my (very shallow) pockets so I truly cannot afford 2-3 sessions just to interview someone and see if they are the right fit. It’s encouraging to hear some therapists at least are willing to do this initial interview for free.

  10. Denzi said:

    I have no answers, just a similar question from the opposite end. If you have had an effective therapy relationship, how do you know when to end it?

    For me, this is complicated by a combination of real and imagined perfectionism. The last time I felt like therapy was not at all effective any more and I had stopped wanting to tell my therapist things, we eventually decided that increasing my sessions so that I could actually dig into things rather than just catch her up on the past month would help. In that conversation, she made the point that I tend to be perfectionistic and so may have unrealistic expectations of any therapist, particularly since the first several therapy sessions tend to be very paradigm-shifting and then you settle down a bit, so she wasn’t sure changing therapists would fix the “need better therapy” feeling, because a good chunk of it was probably coming from the “NEED PERFECT SELF NOW” perfectionism.

    I think this was true and valid, but unhelpful in the long-run, because now the perfectionism is turning itself at THE PERFECT AMOUNT OF HAPPINESS TO BE ACCEPTABLE. I need a better heuristic for when my FEEEEEEELINGS (not generally in a romantic sense) signal important things to act on and when they are just feelings.

    • staranise said:

      Answering questions with questions! The first time, did stepping up the frequency of sessions actually help? This time, how’s the therapy going? Normally, therapy is considered “done” when you’ve made as much progress together as you can reasonably expect to make right now, so you toddle off to live your life for a bit, and come back to therapy when you think it’s time for something new. So is this “am I done with therapy” or “am I done with this therapist”?

      • cadenzamuse said:

        Lessee. Stepping up frequency of sessions definitely helped for several months, but now the ”helpful” feeling has tapered off. I do feel like I’m in a “need a break from therapy for a few months” place (and thankfully am about to leave the country for a few months in four days, so that is an easy break), so perhaps I know it’s time to be done with therapy for now. But I wish I had a better sense of both “am I done with therapy for now?” and “am I done with this therapist?”

        Partner is very counseling-phobic–AAAAAAAGH RAAAAAAAGE (mine towards this aspect of him). This makes figuring things out more difficult, as while he is usually supportive, sometimes his instinctive “Aren’t you just doing therapy for it’s own sake? Aren’t they just trying to scam you out of money?” feelings come out in a way that tends to read to me as pressure to “be less needy.” We have been doing some very good work in marriage counseling (he is cooperative and open and demonstrably growing, even though he steadily maintains that he is getting nothing out of it), and if we were going to be in country I would like to continue that for another, say, three months. Work on his tendency to vastly undervalue my opinions and experiences when it comes to our relationship issues and both of our trust issues some (me: “This is making me upset and is a problem” him: “You’re an anxious perfectionist and nothing is ever good enough for you; I don’t feel like it’s a problem so it isn’t”); work on how to make the DOOM!spiral of when we’re both mental illness-symptomatic less DOOM-y; work on our relationship with money; go home and be spouses and reassess in a year. Anyway. Sorry, that was a lot, and as caveat for THE WHOLE INTERNET that is reading, I really am not intending to open up commentary on my spouse-person, because even though we have some problems (and I would call the first issue a HUGE MAJOR RED FLAG PROBLEM even), he is my favorite person in the world.

        Anyway, I am leaving this in because I think the spouse pressure and the previous therp pressure to feel content in situations where I am not content is sometimes useful (change the situation slightly, get a more objective view, reassess after a couple of days and a little extra alprazolam) and sometimes STATUS: BEARS! in terms of hobbling me from working out that I actually need to get out of a situation.

        • staranise said:

          Agh, it really sucks to feel invalidated. :( It especially sucks, for me, when I am totally out of whack and have lost perspective and it really isn’t very bad after all. Sounds like you had it right on the nose with, “I need a better heuristic for when my FEEEEEEELINGS (not generally in a romantic sense) signal important things to act on and when they are just feelings.”

          Which, yeah, sounds like something to work out, preferably with some form of looking at things objectively: friends you trust (who don’t invalidate you, so your husband probably isn’t your preferred barometer here) who you can use for reality testing, maybe. For myself, I’ve journalled on a daily basis for over a decade, so I’m able to read back on old entries and compare how I thought I felt, what I was saying about how I felt, and how I remember feeling, so I can get a more finely-tuned sense of when I’m picking up something real, and when my brain is full of Ridiculous.

        • You can rachet appointments way back and keep the connection alive, and then increase them when things are going more poorly.

          You have identified several very specific areas that you are concerned about for the long-term. You can schedule appointments to check in on how that is going, and catch problems early. Maybe once a quarter or once every six months. You do that with other specialists, no reason not to do that with therapists! (although I know that many people say “okay yay I’m good!” and stop going to therapy altogether and I think that is awesome for them! It kind of depends on what you’re there to work on and what you’re getting out of it.)

          I suggest it mostly because for me it is terrible to have to Go Find Another Doctor or Go Find That Doctor Again (and therapist counts) so Keeping The Connection Alive is important.

        • If I were you, I would maybe take your break and not schedule a session definitively for when you get back. If at the end of that time you’re thinking ‘man, I really need to see my therapist to talk about x, y, and z!’ then go ahead and make an appointment! But you may well find that you get back and realise you’re done with therapy for now.

          Do let your therapist know that you’re doing this, though, because one thing that would be helpful would be for them to be aware you might pop up again when you’re back in the country. Or they might tell you they’re planning on retiring in six months or something!

    • JenniferP said:

      I saw my therapist pretty intensively for a couple of years, but then I take long breaks to go work on stuff – like, I don’t need to talk about it, I don’t need to identify the problems, I just need to go and solve the problems. Then I circle back in when something feels too big to handle on my own or I want a knowledgeable, trusted, kind-neutral perspective.

    • Kacienna said:

      My experience both times I finished therapy with a good therapist was that I went in one day for my regular session and found that I didn’t really have anything to say. I could talk about my week, but there wasn’t anything I needed to unpack – the sense of need for the therapist was gone. And in both those cases, we talked about how I felt and mutually came to the decision that it was time to end. I did see my more recent therapist again for another issue – for a much briefer time – and if I do need therapy again at some point, she’ll be the first one I call.

  11. One thing my counseling professors taught and that I’ve always remembered is that a good therapist (even one that’s not good for you personally) should have a network of people that they can pull recommendations from, and will be willing to recommend you to another counselor. If you talk to them and realize that you don’t mesh or you don’t like their approach, tell them (they deal with it all the time) and ask if they could recommend a different approach or a different therapist.
    Therapists, as a rule, generally aren’t offended if you want to try someone else. A good therapist knows that therapy is about helping the client however possible.
    I hope this helped.

    • staranise said:

      Yes, this! Therapy is so much about the relationship. There is no “perfect therapist”–just the right therapist for that person. I’ve had first sessions as a client with more than a few competent professionals who were just somebody else’s right therapist.

      Most people don’t say to their therapist, “I don’t feel this is working out–who else would you recommend?” and it’s a pity, because in a way that would be getting the best referral–from someone who knows you, your personality, and issues, and who knows what the local resources are.

      • Yan said:

        The first therapist I tried out said she would do this, and when I e-mailed to say “thanks for the first session, but not a match, can you recommend anyone?” I got radio silence. So that was a bummer.

        But then, my problem with her is that she spend more than half the session listening to half of my sentence and then telling me how I felt and how people she’d never met in my life probably felt. Which was utter B.S.

    • MamaCheshire said:

      Oh, that bit about therapists not being offended if you want to work with someone else. SO MUCH that. One of the problems I had with Dr. Unethical was his saying, “Go ahead and try someone else – if you want – but you’ll be back because I’M the real deal!” and similar stuff.

      One problem I’ve noticed, though, is that therapists who are hardcore into a theoretical orientation won’t recommend outside it. DBT is the fancy new hammer that makes everyone look like nails to certain therapists – and it’s still a bad fit for a lot of people, but the therapists who are particularly all about it will often insist that the client is the problem and start breaking out whatever diagnoses they use to indicate “difficult patient”.

      • staranise said:

        Maybe that’s another question to explore–“What is your opinion on other theoretical orientations?” Some people are just eclectic, some are One True Wayists, and some are like, “Well, I’m Jungian, but when that doesn’t work out for people I know some very good CBT therapists in the same area.”

        • Pterinochilus murinus said:

          Yes, this! My therapist sometimes suggests that I have a few sessions with someone else to work on problems that would respond better to a different modality. And while that has its own problems (new people to trust! argh!) it is good to not feel like he’s forcing a square block into a triangular hole.

    • Pterinochilus murinus said:

      Ooh, ooh, one for the LW to remember: the converse is true too. If the therapist you are interviewing tells you that they are The Only One Who Can Help You, that is an epic red flag. Actually, that applies more broadly than to therapists. Run away, run away. Do not stop for a debriefing or an exit interview or because they want right of reply. Just run.

  12. GaG said:

    I think Sweet Machine’s following sentence is very useful: “A therapist should be able to explain clearly, in a non-condescending manner, how she will approach your sessions, and what her goals are as a practitioner of [whatever] type of therapy.”

    In my own experience, a client-therapist relationship only works if both are participating and want to make it work together. The best therapist I ever had, I emailed ahead of time to ask about the information I found on her on a website for finding therapists. She said she had experience in some types of therapy I’d found useful in the past, but also listed types of therapy that were a huge turn-off to her. I told her about this and she said that in our work together, we would not use those methods, then. And she was honest! And we didn’t! She was always very frank with me, and yes, non-condescending. She didn’t view herself as some magical superior being with magical knowledge only she could bestow in order to fix me. Working with her in a very frank manner was really great for me.

    In contrast, once I saw a therapist who advertised himself as doing [a type of therapy that works for me], but when I saw him, he jumped right into [a type of therapy that really ticks me off] and pushed that the whole time. I felt like he’d lied or at least presented himself falsely to me, and then he showed himself uninterested in working together with me. (He just wanted to do what he thought would work instead.) I did not go back to see him as that would not have been a useful patient-therapist relationship.

    There are some websites that do list various therapists, like the one I used to find my best one. I think some of them are for certain geographical areas? Anyway, I find these useful because they often list details like what schools of therapy that person is into, what types of diagnoses/issues they have experience with, etc. Makes it a lot easier to narrow down choices, and then you can often email or something to get a feel for someone before even going to that first appointment.

    • Yan said:

      I think I ended up finding my current and very helpful therapist on a website like that — it was something national, but you could search by your city. In my case, I was looking for someone with experience in the particular dynamic and issue I needed to discuss, and it took a while to find someone. I wasn’t up for being someone’s first case or guinea pig. The website helped me narrow down my options to 3 in my immediate area, which I figured I’d try. I got lucky and found someone.

    • Knowing my counselor is a person, and knowing that they KNOW that they are a person, like me, helps immensely.

  13. Calypte said:

    I’ve had various therapists over the last few years. I have also had a BPD diagnosis. Unfortunately, my experience has been that there are still many mental health ‘professionals’ who strongly dislike people with BPD and who will ascribe negative motivations to you. For instance, under my BPD diagnosis, I was considered ‘manipulative’, ‘unwilling’, ‘passive-aggressive’, ‘excessively angry’, etc., by some psychologists and psych nurses, when in truth I was just severely depressed, too terrified to speak (selective mutism) and having autistic meltdowns when they continued to push me. Some people will interpret your behaviour in the worst possible light when they know you have a BPD diagnosis.

    I don’t want to scare you, because happily, I’ve also had awesome therapists who saved my life, but it’s worthwhile to know that mental health professionals are not free of prejudices (even some otherwise good therapists) and please, please, RUN DO NOT WALK if you encounter such a person. Do not believe that you are being manipulative, passive-aggressive, etc., if you know that you are not. If you do meet criteria for BPD, you need a therapist who WANTS to work with people with BPD, who can set strong boundaries if necessary and yet keep believing that you are a good, decent person who is simply struggling and needs help to do better.

    • TheJackdaw said:

      THIS ^^^ About 80 times more eloquently than I put it.

    • staranise said:

      If you do meet criteria for BPD, you need a therapist who WANTS to work with people with BPD

      YES YES YES. Some therapists look at BPD and go, “Aww, crap, can’t I get someone who just needs help goal-setting?” and some look at BPD and go “Yesss, I can work with this!” Thankfully, the former do not usually spend their lives working with PTSD, BPD, and related issues.

    • Oh, good point. I hadn’t thought about that. I will tread carefully if that should come to pass.

  14. ona555 said:

    Fuck fair, indeed.

    It occured to me as I read that, I have seen several friends who were going to therapy for relationship issues end up sticking with an incompatible therapist– being in yet another non-working, energy sucking relationship that they stay with because they’ve “invested so much already” and “don’t want to start over.” From that observation I take away this: comfort with ones therapist is everything if therapy is going to be helpful rather than another burden to carry.

    When I made my first foray into therapy, I ended up in session with someone who seemed almost overwhelmed (or bored, I couldn’t tell) by my problems and assigned me books upon books to read rather than mirroring or giving practical advice. I was a single mom who worked full time. The only time I had to allow myself to let my guard down or think about where I was at was in 30 minutes increments once a week, during therapy. I certainly did not have the luxury of reading lengthy self-help texts on my parenting time nor did I posses the emotional resources for dealing with the issues that the reading would bring out all on my own, that was why I was in therapy to begin with! I quit going. Looking back I can see that she was in over her head and not skilled enough to manage what I brought to her office with me, and I should have trusted my first impressions to look elsewhere for help.

    • piny1 said:

      Yes, exactly–it’s not entirely the same, but a lot of therapy is chemistry. It’s like friendship, or even dating: you need to find someone you click with. I’ve had problems with therapists who didn’t share my sense of humor.

      More specifically…My therapist sucked so hard I had to call my MOM after talking to my THERAPIST. She referred me to another crap therapist. I think that my advice would be to trust your gut. If your therapist starts to make you feel uncomfortable or less happy after sessions, even–nay, especially–if you can’t really figure out why, then it might be time to move on. Therapy should be like yoga: you might be sore after a lot of emotional stretching, but you shouldn’t ever feel bad.

      Also…one problem that I’ve heard from a lot of other queer people, and which I definitely had myself? Make sure your therapist has some knowledge of your specific demographic. “Queer” is a big umbrella.

      I think I’d say the same thing about eating disorders. I ended up with a therapist who didn’t know that comments like, “You looked amazing before [when you were thirty pounds lighter],” are not cool. (She said stuff like that a lot! A LOT! Like, more than most people I know, and she was supposedly trained to ameliorate emotional distress, not cause it? And she seemed to say them a bunch when I was talking about how I felt stressed and anxious about my body and life in general? Maybe she was stuck in reverse or something.)

      • Yes, exactly–it’s not entirely the same, but a lot of therapy is chemistry. It’s like friendship, or even dating: you need to find someone you click with. I’ve had problems with therapists who didn’t share my sense of humor.

        SO true. That’s bloody frightening, what you’ve had to deal with with your so-called therapists, piny1. I’ve been lucky with both mine, and reading the comments here makes me appreciate them all the more. I’ve only had two sessions with the second (it’s years since I saw the first) but the green flags are there – he’s got a warmth about him while respecting boundaries, like asking if I mind talking about an important-to-me but not-directly-relevant-to-the-problem subject – my answer was that he’d have trouble shutting me up about it.

        He also cut my fees when he realised I work part time. And it doesn’t hurt, on a purely trivial level, that he has a cat. :)

      • Pterinochilus murinus said:

        Therapy should be like yoga: you might be sore after a lot of emotional stretching, but you shouldn’t ever feel bad.

        …Oh. Well, this is embarrassing. I guess now I know why yoga has never worked for me. And that possibly I should actually talk to a physiotherapist about my joint and muscle pain, instead of just telling myself repeatedly that I can’t have another thing wrong with me.

        I actually kind of disagree about therapy, though: sometimes it will feel really bad, but your therapist should be able to warn you and give you the choice of whether and when to proceed with the bad pain, and provide proper aftercare, and it should heal up better than it was before. Sometimes therapy is like surgery. And like surgery, if it’s done wrongly or nonconsensually it’s just someone sticking a knife in you.

      • straycat said:

        Re therapy as friendship and the need for chemistry, this terrifies me.

        It so happens that I’m tentatively starting to think that possibly therapy might be a good idea. But one of the reasons that very seldom form friendships or experiencing that chemistry with people, and if I need therapy before I can successfully connect with a therapist then I’m probably kind of screwed.

        Which is like, where do I go from here?

        • I think it’s a different level of chemistry. I went with my daughter to her first visits with two therapists. The first woman was nice enough, but I knew immediately she was too reserved for my happily introverted teenager. She kind of passively offered my daughter a “safe place to talk about whatever was on her mind,” when my daughter was like “I have safe places to talk, out the wazoo! What I need is someone with expertise to help me tease out why I sometimes act in ways that are counter to my own interests, and help me develop tools/strategies to cut that out.” The other therapist was much warmer and more engaging and in-your-face and we knew just as immediately “yup, going to get a lot more out of this one!” Which has proven true.

        • Elsajeni said:

          The type of chemistry people are talking about in this thread, where you just “click” with the therapist, can be fantastic and is definitely useful as a green flag, but I really don’t think it’s a necessity. When I did find a therapist I felt that way about, I felt really lucky and delighted, and I got a lot out of my time with her — but I also got a lot out of my time with the lady I saw before her, who I didn’t get along with on a personal level at all.

        • rinna2412 said:

          Yeah, as someone who’s slow to open up and trust people, I embarked on therapy without really “clicking” immediately with my therapists. After about six months, I’m finally feeling comfortable with my current therapist.

          Because my therapy needs are less intense, I was perfectly happy to find someone who practiced the kind of therapy I felt comfortable with and with whom I felt cautious, but not…hostile or repulsed, and then just forced myself to open my yap. Three of four times, this has worked out relatively well and the counseling relationship solidified into one that worked for me.

          I have no idea if this would work for you, or what level of trust you need with someone before you can tell them what’s going on. Just that the lack of an immediate “click” with someone isn’t the death knell for a therapist. An immediate “ick” reaction, though, is!

          • straycat said:

            Thanks (all of you) for your thoughts–you’ve reassured me a lot. Though it sounds like I need to give it a lot more thought as to what I might need from a therapist before I make that initial call.

            Thank you!

      • nonnikins said:

        Ack, the calling the mom thing! OMG. I am really loving this thread because SO much good information, especially as I’ve been knowing I need help, but god just so scared. Specifically, that I’m Too Broken For Therapy, due to having had 2 terrible attempts in a row? And that was couples therapy, my personal needs are… so much more complicated and dire.
        So this helps! Having starting places, rather than just going to a person and feeling horrible and alienated and judged and under a thousand tons of pressure because potential conflict if it doesn’t work out.

        So, um, thanks everyone. This community is really open, and it feels safe here, so I hope it’s ok to share my own Horrible Therapy Story, because holy shit.
        I’m going anon for this though.

        TW: suicide/suicidal ideation, domestic abuse, general horrible psychological fuckery? Erm. Warning, generally, and I’m sorry if I missed something.

        I had one (a couples therapist – we’d been to one dual session, he’d done a solo session, and this happened during mine) that… ok, spouse has some abuse issues. He’s working on them. The two times we tried counselling, we’ve had Very Bad Experiences. It might just be my location.

        Background: I’m bad with new people. I have intense trust issues, and I’m rubbish at social interaction with people I don’t know well. Even /with/ people I know well, sometimes. So the New Therapist thing (as well as first therapist ever, barring a counsellor I had as a kid) was already making me all nervous.

        So the evening I go in to my solo session. Spouse and I’d just fought awfully, for hours, and all week he’d been dropping remarks about what Therapist said about us/him, and how ~interested~ he was to know what she’d say about me (and ok, just awful horrible shitty abusive fuckheadedness, generally, in the spirit of using Therapy /against/ me.) so, um, that helped my nervousness a lot! I was already sobbing uncontrollably, and had wanted to cancel the appointment, but felt horrible at home so went anyway, and I almost wrecked the car on the way there, *possibly* because I’d wanted to. I know I kept thinking about it. I’d been hyperventilating and just, where normally I’d have been MUCH more cautious about trusting her, I was just in an absolute state of crisis and so I exploded in a mess of trauma (the kind where you shake back and forth, literally choking on your sobs) for an hour, trying to just communicate how NOT OK things were, asking for help. I didn’t know what kind of help even, I just remember being so desperate. It culminated in us going overtime and my sort of shuffling around the lobby, making small talk, and sort of just… I spent a lot of time shaking and nervously avoiding the door. Finally I up and reveal I’m super fucking scared to go home.

        Ok, therapists-in-training! Just so you know this is not at all a good time to make a joke about “making dinner, slipping on a nightie, and things will blow over.”
        After I was just sort of standing there utterly shocked and sick inside for a minute, she went “oh, just a joke”, laughed, and then continued to shoo me out the door.
        Not any info about a helpline, or a shelter, or anything. It turned out to be safe at home, obviously, but she couldn’t possibly have known that. She didn’t take me seriously about any of it.
        About the abuse, about the fear, about feeling suicidal. None of it. None.
        And y’know, his post strikes hard because what she DID do? Minutes within that? Was dismiss my fears /literally/ by suggesting I might have BPD.
        Which, fuck, I guess means you can’t be abused or afraid or in genuine crisis or some fuck, Idek.

        I am not being melodramatic when I confess I very nearly did not make it out of that night intact. This woman knew I had been suicidal. Recently! Chronically! She knew I was shitting-myself-terrified to go home! The only place I had to go! To the only person I was close to in the surrounding 1500 miles! I didn’t trust her, didn’t like her, but I wanted to be fair so I went and tried anyway, and forcing myself to do that almost fucking killed me.

        When I brought all of it up in the next session (I went again because again I was, ugh, ~being fair!~) she scoffed it off as my not being able to take a joke.
        yeah.
        I wish I knew how to report her.

        This got really long and I’m sorry! I didn’t realize I was still so sick/hurt/angry. If it’s not ok to post, I won’t be offended if you delete it.

        tl;dr
        The point is FUCK BEING FAIR.
        Forcing yourself to be fair is unfair to you, and possibly really fucking dangerous.
        And! This lady IDed as sort-of-a-feminist, too, so even that isn’t necessarily a green flag. If you feel you’re not being listened to, or you just don’t trust this person, even if you feel a little silly because of it, GET OUT. You deserve peace of mind, and to feel safe, and if someone feels unsafe, trust that. You know what you need, and to hell with politeness.
        (Erm. I really hope next time I seek out therapy I can take my own advice.)

        • Wow. I don’t even. I am so fucking sorry you encountered that kind of treatment, especially from someone who was supposed to helping you.

          I will definitely pay attention, and if things genuinely feel wrong, I will gtfo.

        • Oh, nonnikins. I’m so sorry for what you went through. I volunteered for a crisis help line years ago, and one of the things that always stuck with me way past the training was that couples counseling for abusive relationships often doesn’t work, because if the counselor doesn’t have a very good grounding in the dynamics of domestic violence/abusive relationships they keep trying to do that compromise and listening to each other crap that normal, healthy relationships benefit from. Abusers often use therapy to manipulate the people who have to deal with them still further, and the person who really needs the help winds up getting their concerns minimized. I could have understood if she was just being manipulated/deceived, and to some extent it seems like he managed to convince her that you were the problem, but it actually sounds like you had a genuinely crummy therapist, because when you tried to address your concerns and feelings with her she was all “Whatever. I’m smarter than you and your feelings don’t matter.” Minimize, degrade, ignore, kind of crap, which as others have pointed out is a big red flag.

          Also, side note (but maybe, sort of on topic, heh) but when I worked at that crisis line they had an entire database of almost every mental health professional in town and some of the surrounding areas, and we could look up recommendations for people based on health insurance/sliding fee scales, the types of therapy they did, and the sorts of disorders they dealt with. If I were going to look for someone who did couples therapy and I had any suspicion or was flat out told that there was abuse involved, I could find someone who was more likely to be aware of abuse dynamics in relationships and strongly recommend that they also see a separate therapist on their own who could help with any other issues (and couldn’t be stained by abuser logic). I do not know if other cities have anything similar, but it might be worth looking into if anyone is looking for a therapist. After giving a caller the top three possibilities, I’d always tell them that there were lots more where that came from, that choosing a therapist is personal, and no matter how good they are it just might not feel right, and if for any reason they wanted to see someone else, a good therapist should gracefully understand their reasoning. Then they could call back, and I’d happily give them some new names.

        • Brian said:

          First, that is ABSOLUTELY WRONG. On so many levels. You were treated badly by a professional who should have known better.

          If you want to file an ethics complaint – and I’m not saying you should or shouldn’t, but it sounds like you have a valid complaint if you *do* want to file – the first step is to look up the professional association for whatever profession this therapist is in. If she’s a psychologist, for example, you’d look up the APA and hopefully find this page (http://www.apa.org/about/contact/contact.aspx) which, if you scroll down a bit, has the address to which to send an ethics complaint. If she was a social worker, or marriage and family therapist, or some other specialty, you should be able to google that specialty and find similar information. (Some therapists include this information in the information they give you at the first session; if you still have it you might check there first.) I would suggest starting with a phone call to the organization to ask how to proceed. They might suggest involving a lawyer. They certainly should be able to tell you what information you will need to provide as part of the complaint, and might be able to give you a more informed opinion than I can as to whether the therapist’s behavior as you report it actually violated the ethics code of her profession.

          You could also file a lawsuit, but that’s probably more difficult and I have no idea how that works. You’d probably also have to prove you were actually harmed by her behavior, which might be more difficult. An ethics complaint with the professional association is probably easier.

  15. What a great question! I know you will have a huge variety of responses to it, and the dialogue that opens up from it will be invaluable to therapy-seekers.

    It will also be valuable to therapists. A couple of months ago, I graduated as a Marriage and Family Therapist in California. In this state, and probably others, not giving recommendations when you have to stop seeing a patient is illegal and is called “abandoning the client.” So if your therapist has given you recommendations, check them out first. If not, ask her for some. It’s a good starting place.

    However, this is not an answer to your question. Therapists, and therapist interns, are constantly asked, by instructors, supervisors, colleagues, and all sorts of other people, including clients, what makes a therapist a good one, and what makes therapy effective?

    It’s different for different people, but Sweet Machine’s excellent suggestions are right on the money. I want to add that sometimes you have to take a few sessions before you and your therapist know if it’s going to be helpful to you or not. I’ve had about 15 years of therapy, on and off, and pretty much all ethical therapists seek therapy themselves at one time or another. We even get credit for internship hours for pursuing our own therapy! So yeah, we really care about good therapy versus the other kind as much as you do.

    I want to add to Sweet Machine’s ideas that you should not go to a therapist who offers advice or who has an agenda. The only agenda should be YOUR agenda. I had a therapist once–worst therapist I ever had!–who only wanted to talk about metaphysics during our sessions and when I started to tell him about childhood abuse flashbacks and nightmares I had been experiencing, told me to “forget about that, don’t think about it and it will go away.” Even as a grad student, I knew better than that. Needless to say, I left therapy with him and got somebody else.

    If you walk into the office and talk about exactly what you said in the letter above, your therapist, if s/he’s a good one, will be delighted to find such a knowledgeable, open, honest client. A good therapist, hearing that you need to have your feet held to the fire, then be comforted when you feel the burn, will know how to go about it.

    Asking about what approach or modality the therapist uses is a good idea, and you don’t really need to know much about the subject for the therapist to show you that he or she knows about it. Most really excellent therapists will have a favorite approach, but will be willing to be flexible and use whatever works for your particular problems. In my practicum, I discovered that working with clients, different approaches suggest themselves by the way the client is as a person. I would go in on a first session, make a tentative diagnosis, and make plans to discuss a certain kind of treatment plan with the client, then add or subtract or completely change things, depending on how the client saw it. My favorite approaches really, really work well in some situations, and don’t work at all in others. Flexibility is key in giving the client the most bang for his/her buck, but it’s hard to tell if your therapist is flexible without testing the limits in a few sessions.

    From the tone of your letter, I wouldn’t diagnose you with BPD. I don’t know you, so I could be wrong, but I really don’t get that kind of vibe from you at all. In any case, don’t let your diagnosis worry you too much, as even people with personality disorders can learn different ways to cope that make their lives more pleasant and effective.

    I hope something I’ve said helps. I think it’s absolutely stellar that you are continuing with therapy, despite losing the therapist you really liked and having to move on and find somebody just as good or better. I think your attitude guarantees that eventually you will find the right one.

    • The only agenda should be YOUR agenda. I had a therapist once–worst therapist I ever had!–who only wanted to talk about metaphysics during our sessions and when I started to tell him about childhood abuse flashbacks and nightmares I had been experiencing, told me to “forget about that, don’t think about it and it will go away.”

      Wha …

      Words. Just. Fail.

      WHY was this person a therapist? Why, why, why?

      • staranise said:

        What happens when therapists believe in The Secret. :(

    • “If you walk into the office and talk about exactly what you said in the letter above, your therapist, if s/he’s a good one, will be delighted to find such a knowledgeable, open, honest client. A good therapist, hearing that you need to have your feet held to the fire, then be comforted when you feel the burn, will know how to go about it.”

      This is an awesome way to put this; I may well use this.

      That being said, comments like “I wouldn’t diagnose you with BPD”, while I am sure are intended to comfort, actually don’t help me because as you said, you don’t know me. I’d very much rather hold off the diagnosis (or elimination of a diagnosis) until I can get it from a therapist who has worked with me and knows me.

      I appreciate the comfort, and the other things you had to say, but “I wouldn’t diagnose you with BPD” from a stranger on the internet feels empty and a little icky to me.

  16. goldenpeanut said:

    Even if you don’t have BPD, you might want to look into dialectical behavioral therapy if you have similar traits. It’s actually quite helpful stuff about emotional regulation. DBT therapists are hard to find, though.

    • I have been working through a DBT workbook, and it’s been helping some, especially with overwhelming emotion.

  17. MamaCheshire said:

    So glad to see this post!

    I’m therapist-hunting, myself, and part of the reason is that I had a therapist who was so horrible that I had to file an ethics complaint (it never went anywhere, that I know of, but hopefully it starts a paper trail in case someone else files a complaint, because I doubt Dr. Unethical has mended his ways). It’s been two and a half years, and I’m still really scared about trying again, but I know that I really do need to get myself to a therapist both to heal the damage left by Dr. Unethical and to deal with the stuff that had me in therapy in the first place.

    • m. said:

      I’d recommend being very upfront about the damage done by Former Therapist when you’re interviewing Potential New Therapist. If PNT says “Well, I’m sure that FT meant well,” you know you can pass. If PNT says “Wow, in my practice I address Issue X by Modality Y,” you might have a keeper.

      • MamaCheshire said:

        That makes sense. But some of it is “which part?”

        I mean, there’s the handful of stories that are the reason the ethics complaint was filed, that pretty much anyone in the field would hairy-eyeball. Like the part about how he doesn’t think I actually have the diagnosis for which I am prescribed medication, but it’s totally fine to take meds if I find them useful because he used to use illegal drugs in his younger days. The stuff that is just so cartoonishly over-the-top that I’m all, “LOL, did you get your license off of a cereal box or what?”

        But that’s separate and distinct from the actual damage that was done. The short version: Basically, he tried really hard to a) break up my marriage by b) painting me as an immature, lazy malingerer and my spouse as a frustrated creative genius who was constantly being held back by my unreasonable demands. (Spouse IS brilliant and creative; however, both of us have mental health stuff we’re dealing with, at the time I was having serious chronic pain issues as well, and my “unreasonable demands” tended to center around stuff that I physically could do with great difficulty if at all or around money. The “unreasonable demand” in question at about the point we realized what was going on with Dr. Unethical was that we take our seriously ill cat to the vet instead of buying spouse a new camera RIGHT NOW.) And my own personal Jerkbrain is always asking if Dr. Unethical was right about me, which is all kinds of uncool. :P

        • Holy hell, MamaCheshire. That cracking noise you just heard was my jaw hitting the keyboard. Internet hugs if you want them! And kudos for filing that complaint, even if it is gathering dust somewhere.

        • J. Preposterice said:

          …wow. Just wow. Dr Unethical sounds like a real charmer. Good on you for filing the complaint.

          Fwiw, I think a good therapist would be able to figure out from just that example, really, where to look for damage. “I had a really bad therapist who I think did some damage, to me personally and to my relationship, by saying some very strange things — like that taking our sick cat to the vet instead of buying my spouse a new camera was an ‘unreasonable demand’ I was making.” Something succinct like that, and see where they go with it, without getting into more details.

          Just from that story, I am feeling like — was Dr Unethical *gaslighting* you? ZOMG. Terrible person!

          • MamaCheshire said:

            Yes. Yes, he absolutely was gaslighting us both.

            I sought out therapy in the first place in large part because, as a newbie social work student, I wanted to basically give myself a good going-over before working with clients of my own. And my spouse was starting to muse about a similar career path, as well as his artistic pursuits.

            And I wound up in a situation uncannily similar to this one because, as it turned out, my Dr. Unethical was a protege of the “gentlemen” discussed in this article. I’m always scared/hesitant to post about this aspect of it but, well, I suppose readers can consider this my anti-recommendation? *small smile*

    • zixi said:

      Your Dr. Unethical sounds awful, and I’m so sorry you’ve had to deal with that.

      I found myself in a similar situation – very much needing help to deal with both issues I had, and how a terrible counselor had completely messed with my head in relation to those issues. It took me a long time (read: several years) to work up the courage to seek help and I don’t have any solid advice on how to find a good one, beyond a degree of trusting your gut, and that it helped me to know and remind myself that I could choose to stop at any time – I had that power and control.

      But at my first appointment I was very careful to very clearly explain that part of my issues were because a counselor had severely betrayed my trust (to be fair, that was partly because I had to explain why I was shaking in terror at being in the office). I think by laying that out there right away, my current therapist and I knew that we had to put extra work into building that foundational trust, and he’s been very careful, patient and understanding with letting me set and move boundaries as I need to feel safe.

      So I guess the point I’m getting around to is that I highly highly recommend being as honest as you can as early as you can about what happened with Dr. Unethical. You don’t have to tell all the details – but just the statement of “I’m partly here because I had another mental health “professional” mess me up” goes far and if you’ve found a good one, they’ll accept that and believe you about it and adjust interactions accordingly.

      [and, god, yes on the jerkbrain. I've made amazing progress and I still have days where I wonder if my version of Dr. Unethical was right. Stupid jerkbrain]

      • MamaCheshire said:

        Jedi Hugs!

        The jerkbrain sucks SO MUCH. I mean, 80% of the time, I am fully cognizant of just how, well, unethical Dr. Unethical and those he is affiliated with are. And having spoken with someone who went through a similar experience with another Newman protege in another location, (serious ANTI-recommend for these folks!) I even have knowledge of why and how they were doing what they were doing (undermining my confidence to look for more approval from “the group” and so forth). And I am even very pleased with myself that I recognized this for what it was and managed to GTFO before further damage occurred than did (like, say, my marriage actually getting broken up because of this, or my career suffering meaningful damage).

        The other 20% of the time, I’m still remembering how once i really looked up to this person, and well, maybe he was really right to point out my faults? It’s not like he didn’t LIKE me, he just wanted me to be AWARE of my weaknesses. And so forth and so on, and yeah this is a bunch of crap, but knowing it and believing it aren’t the same thing.

  18. The Other Side said:

    One of the things that has helped me in the past when choosing a therapist is having some sort of clarity with regard to what I am willing to address and what I am willing to do to address it. Is this something where I just sit and talk for awhile? Do I want to learn some new techniques with regard to managing my symptoms? Do I want some coaching in some aspect in my life? Do I want some help with some additional life skills? etc.

    Knowing a little bit or a general direction can help with choosing the best approach for what you are willing to address, as well as being able to ask targeted questions when screening for a new therapist.

    Also, I cannot stress enough how important it is to coordinate care between your regular physician, your psychiatrist (if applicable), and any other health providers you see regularly. Having a treatment team who is fully informed of what is happening and what is being addressed is a good thing; having compassionate health care professionals on your Team Me is awesome!

    In terms of green flags, trust your gut: Does this person make you feel at ease? Does this person feel safe? Does this person acknowledge your concerns and listen openly? Does this person stick to what you want to talk about and stay focused? Does this person seem attentive and compassionate? Does this person have healthy boundaries?

    Good luck to you, LW, and I hope this helps. :)

    • Having thought about what I am willing to do, yes, that is sound advice. Thank you for reminding me of that.

      Self-knowledge is an extremely useful tool.

    • Oh, spam filter. Why do you hate me?

      If this is a duplicate, please feel free to delete.

      The questions you ask at the end of your comment are succinct and helpful. Thank you.

  19. Laura said:

    Other people have addressed your question about how to choose a therapist, so I’d like to say a few things about living with a diagnosis.

    Diagnoses can be really useful, especially for physical conditions, and it can be very reasonable to want one, because it helps you get a sense of meaning. If you’re feeling unwell, your list of symptoms can be scary until a doctor makes a pronouncement about their meaning. Then it means you have some specific disease, for which there are a range of treatment options, and now you’re better informed and you can make choices. But a medical diagnosis does not define who you _are_. It doesn’t become your identity (unless you choose to make it your identity). If your sister is diagnosed with strep throat, you see it as something she _has_, not as who she now _is_.

    When it comes to mental health, though, it’s important to keep in mind that all diagnoses are things that people have made up, invented. They don’t correspond to something in the real world the way that bacteria do. Even imbalances in brain chemistry can manifest in a wide variety of ways, with various different associated thought patterns, and various different diagnoses.

    Sure, there may be a lot of people out there who have the same general pattern of thoughts and behaviors as you do, so it’s useful to learn what has helped them feel like their life is better on track, what general principles or therapeutic techniques or medications generally meet what they see as their needs, and it’s a lot easier to talk about these things when we put names on them, hence diagnoses. But again, if you’re diagnosed with BPD or any other mental health condition, it doesn’t mean that you are now defined by that diagnosis. It simply means that now you have a tool that ideally could help you, or people trying to help you, or people who want to understand you, because it now gives everybody access to insights into people with similar issues. (And also, for people involved with the insurance system, putting a label on a pattern makes it easier for them to get reimbursed, etc.)

    Where do shame and stigma come in? It’s a two-part process. First comes categorizing: “I am an X, being X defines me.” Then comes pathologizing: “X’es are bad.” Categorizing can be a handy shortcut in thinking, for when we’re tired or stressed or need to act very quickly on minimal information, but it cuts out all of the complexity, and complexity is what makes us interesting and gives us options and creative possibilities. And then pathologizing is another shortcut, but it’s not so great, because it’s the root of stereotyping, prejudice, etc. It means not accepting or even seeing differences between people in a category and commonalities between others and ourselves, and it means not extending compassion towards others and ourselves.

    Because this is a two-part process, you can fight it on two levels. First, because mental health diagnoses are not “real,” you only have to accept the label if you want to, and you can remind yourself repeatedly that this diagnosis is only one of the many, many facets that make up who you are. You can be BPD-diagnosed and an amazing knitter and kind to lost puppies and an excellent baker of vegan cupcakes. And then, second, you can resist the pathologizing. Think of all of the many, many people out there who have been teaching the world that being queer is normal, being 100 lbs heavier than your neighbor is normal, being autistic or deaf or Muslim or pagan is normal. Whatever your diagnosis, you probably still essentially fit within the vast, vast rainbow range of normal.

    That doesn’t mean that you have to embrace everything about a diagnosis, or about yourself. It’s just that it’s not a definition and a judgment. It’s a tool. It’s not who you are, it’s a description of a pattern, and you can change the pattern. You’re not out there to get transformed out of one category (BPD or depressed or anxious or whatever) into another (normal). You’re out there to learn new patterns that will serve you better, possibly augmented by medications, or exercises, or other healing experiences that will help you on this path. You can learn the functions that these patterns have served for you in the past, and you can find new, healthier ways to meet these needs.

    Good luck – I hope you learn interesting things!

    • keelyellenmarie said:

      This, times a million. This is what I was trying to get across earlier actually– take what is useful from the diagnosis, and leave the rest.

      For me personally, the biggest benefit of being diagnosed with BPD was that it got me looking into DBT techniques. I’ve never actually been in a STRICTLY DBT program–as has been noted, DBT therapists can be hard to find. That said, the ideas in DBT–which is basically CBT + dialectics + mindfulness–have been helpful for me.

      • Beth said:

        I’m glad to hear from someone else who has used and liked DBT. I just use a workbook, because I love my non-DBT therapist and am a bit uncomfortable with the idea of group therapy, but it’s been so helpful to me. Nice to hear I’m not alone :)

    • Wow, thank you so much for this. As someone who is still in the “I suspect I may have Problem X but am too terrified to get a diagnosis or even help for it” stages, this was a really really reassuring message.

      I’m also super-grateful for the post in general – I’d written to the Captain with exactly the same question! So thanks, Sweet Machine – and you guys can delete that letter I wrote. :D

      • I’d written to the Captain with exactly the same question!

        The wisdom of the Captain’s new letter-submission method shines! :-)

        As someone who is still in the “I suspect I may have Problem X but am too terrified to get a diagnosis or even help for it” stages, this was a really really reassuring message.

        I really sympathize with this, and I am so glad this discussion is helping you feel your way through. I just want to emphasize that, for mental and physical health, getting a diagnosis doesn’t have to be a Statement of Doom, but can be a Hey, Here’s What Will Help scenario. You might even be relieved once you’re out of the “maybe I have X” mode, because you won’t have to be in that limbo state anymore.

        Jedi hugs and best of luck to you!

        • That’s a really good point about the limbo state. (Great, now my brain can’t stop imagining The Limbo State, governed by calypso enthusiasts, where everyone’s always bending over backwards to scooch under precariously balanced bamboo poles…)

          I’m making my peace with the fact that Diagnosis =/= Doom, and I’ve mentioned to Mr. (Incredibly Supportive) Posh that I need to look into finding a counselor… It’s just so hard not to procrastinate on this sort of thing. It’s like homework: every time I go to do it, I suddenly remember a dish that urgently needs to be washed, or a Facebook status that cannot go another second without being checked. :p

          That said, it is definitely a great gift to have the support of the Awkwardeers.

          And yay for the new submission system! Yay for not burning the Captain out! :)

    • For me, the particular “mental diagnoses aren’t real” thing doesn’t work, because I am so VERY good at pretending that things are different than they are, it falls too close to that for me.

      That being said, though, the “take the useful parts, reject the rest” was very important for me to read. Having been raised by a woman who taught us that everything in the world is either good or bad (I have since learned better but sometimes still instinctively fall into this), reminding me that there are many, many parts and some will help me while others are not useful helps so much. Thank you.

      (dang it, Spam filter.)

  20. LW here.

    This isn’t the account I usually use to comment on this blog, but since my BPD parent often Googles me and knows that blog name for Reasons, I made a secondary account to deal with this question.

    I just want to say thank you for answering my question. I’m following the replies and will probably reply to several. For now, though, I just want to say thank you. Also, I wanted to say that many of these things ring smart and true for me, and I really appreciate it, because I’ve been going in circles about this for literally months on end. My Inner Gollum (aka Jerkbrain) is a horrid creature, and figuring out logical and conscious ways to work around/past IG so I can find a good therapist for me is more valuable than I know how to say.

    Thank you again. I’ll keep an eye on the comments, and Jedi Hugs to all who want them.

    • And yes, that is, in fact, the best graphic ever.

    • OT-sounding question that actually is relevant: are you into contra dance? Based on your user name, I’m guessing either contra or square. (Or I could be totally wrong.)

      Reason it’s relevant: where I live, contra dancers are very much crunchy-granola-hippy-leftist types, and I actually know several therapists who are regular participants in our local dance scene. I wouldn’t want to see one of them, because that would be really weird, but they’d probably be able to make some recommendations that would be useful.

      • Ha, I didn’t even know that “righthandstar” was a thing in contra dance.

        No, I’m not. My screenname is a reference to “second star to the right, and straight on ’til morning” from Peter Pan. :D

    • Jedi hugs to you, righthandstar – and I love “my Inner Gollum”! :)

      • Thanks. It was weird watching THE HOBBIT: AN UNEXPECTED JOURNEY because the Gollum parts really did sound a bit too much like some of my own inner dialogue.

      • Thank you, Sweet Machine. Your reply, and those of the others around me, have helped a lot, and I’ll be referring my future therapists to parts of this post and replies, for sure.

  21. Daywalker said:

    I think most therapists will let you do a brief phone interview before you actually see them in person and have to pay them for anything, so this is a good time to ask questions and find out if they understand you, or if you have to explain the same thing several different ways for them to get it.

    You definitely want someone who has experience working with people who have similar issues to yours. If a certain type of therapy (eg Cognitive Behavioral) had helped you in the past, that would be something else to look for. If you’re a member of a minority group which has had a significant impact on your life, it’s important to find a therapist who has the right cultural competence. Essentially, a very talented therapist who you get along with will not be as helpful to you if they don’t have experience and training that matches your unique situation

    When you’re on the phone with a potential therapist, it’s also okay to mention potential red flags and see how they respond. I’ve seen therapists yell at clients and verbally abuse them, for example. I once had a daycare provider tell me to stop holding my infant son because I was “spoiling” him, so now I tell any prospective person who might be watching my kids about this and I only hire the ones who seem horrified. Do you have any personal dealbreakers? When my husband and I were looking for a relationship counselor, it was important to find someone who didn’t expect us to fit into a rigid gender binary just because we’re a het couple. It’s definitely a good idea to bring up your tendency to avoid uncomfortable subjects and pay close attention to their response.

    Watch out for therapists who tell you what you should be working on instead of helping you with what you want to work on. For example, if you’re using street drugs and you don’t think it’s a problem (or you do, but you aren’t ready to quit), you don’t want a therapist who is going to focus on the drug use instead of what you want to focus on. (On the other hand, if a therapist gets to know you and then says something like “I really think the drugs are making your depression and anxiety worse and it might be helpful to cut back” then that’s a different situation.)

    Do you tend to get along better with men or women or people of a certain age group? It’s okay to be picky if it helps you find a therapist who you can feel comfortable with. Some people like therapists who talk about themselves a lot and other people hate it. I’m not a therapist but I am a behavioral health clinician. I tend to be quiet and reserved. Some clients really like this about me, because I’m a good listener or because I apparently have a calming influence on people with high anxiety. Other people hate it because they are more comfortable around high-energy, talkative people.

    I’m very aware of the BPD stigma and I’m possibly part of the problem (I’m working on it, I swear). I admit to getting nervous and groaning a little when I get the file on a new client and they have a BPD diagnosis because these clients tend to be the most frustrating ones. However, I’ve also seen some very inspiring success stories. It seems like self-awareness and motivation (which it sounds like you have) can make a big difference. [I don't read the comments on this site much but I've seen people get in trouble for talking about DBT so please delete this if I'm breaking any rules.] If you aren’t very familiar with Dialectical Behavior Therapy, it was developed by someone who has Borderline Personality Disorder and it can be very helpful. It includes individual and group therapy. It might help you to meet people with BPD who are working on improving themselves and their lives. You may or may not have to have a Borderline diagnosis in order to do DBT but the skills and techniques can be useful for almost anybody.

    • MamaCheshire said:

      Very much agree about the therapists that tell you what to focus on.

      The angriest I’ve ever been with a classmate in my social work program was one who came into an advanced clinical class venting about a client by saying, “He thinks he’s the expert on his life or something!” Fortunately, our instructor informed her that of course he is, who else could possibly be?

      And YES on the cultural competence thing, which can be very subtle. My spouse had a bad mismatch when he went looking for a therapist in the local gay yellow pages (spouse and I both consider ourselves “queer-identified bisexual”) and this therapist was so used to working with closeted, opposite-sex-married gay men that were looking to leave their wives that he didn’t have the foggiest notion of what to do with a bisexual man who very much wanted to stay with his wife and was there for entirely other reasons.

      • Cultural competence in several areas are important to being able to work with me, including consensual nonmonogamy, queerness, kink, paganism, and skepticism/critical thinking. Those last two often conflict with each other, and I need a therapist who is willing to let me be okay with having incompatible ideas about my world that don’t hurt or bother me to have.

        • Kacienna said:

          If it helps at all, I don’t think paganism and skepticism/critical thinking have to be incompatible. Faith and science are different things and have different ways of knowing. I think the problem comes when one tries to use faith to answer a science question or use science to answer a faith question (or an art question, or a subjective experience question). I’m a Christian and a scientist – both apply for different kinds of material.

    • All useful things, especially making sure I know my own dealbreakers and must-haves.

      I’m glad you are working on lessening your own contribution to the BPD stigma. I admit, it was upsetting to read that from a behavioral health professional. I appreciate that you are aware of it, though, and want to work on it.

  22. m. said:

    Quick background to my answer: I work in the mental health field and am living with PTSD (well-controlled at this point) and anxiety (less so). I also grew up in a home where one parent had BPD and have had some fears about my own ability to emotionally regulate. I’ve had awesome therapists who have drastically improved my quality of life and a terrible therapist who told me that based on my trauma experience I could never be happy, so I know the stakes in finding somebody to trust are very high!

    I have a few suggestions:

    1.) Not every good therapist is going to be a good therapist for YOU. Therapists nowadays tend to specialize in both topic & modality (fancy word for technique). Study up a little bit at home: read through some common modalities and see if you can identify ones that have worked for you or ones that you’d be interested in exploring. Conversely, find ones that you don’t think would be a good fit. The link Sweet Machine provided was a good one: here is a PDF that nicely summarizes more specific ones: http://www.svfreenyc.org/media/research/bc_4_models.pdf . A very common modality for BPD is called Dialectical Behavioral Therapy, or DBT. Even though you’re not sure of your diagnosis, read through some basic info on DBT & see if it sounds helpful. If a therapist uses a modality you don’t care for or isn’t applicable to your concerns, it won’t be a good fit.

    2.) Similarly, there is no set of “questions that good therapists ask.” It really depends on what you’re looking for. A good therapist for another person might be extremely gentle & affirming, for another very aggressive in their challenges of the client’s perceptions.

    3.) Interview first, and ask lots of questions! It’s totally okay to say in your initial phone call “Hey, I’ve been told I have some traits of BPD, and that’s terrifying me. What approach would you take to explore that?” You don’t need to give your life story during the first session (I’ve had clients literally ask if we could just talk about the weather), but if you have one major concern, it’s best to ask about it early to find those red flags. If you’re feeling shy, remember: we’re professionals & we’re used to tough questions! If the therapist is awkward with your personal information now, they’ll probably be awkward later.

    4.) Ask for recommendations. In most locations, the mental health field is very close-knit. If you can’t ask a former therapist, trusted friend, or church/school counselor, try calling a local referral line.

    5.) If you’re concerned about BPD traits (you didn’t mention which ones you noticed in yourself), therapy addressing those traits can sometimes involve even the best therapist saying things you don’t want to hear. Actually, pretty much every therapist, regardless of your diagnosis or their awesomeness, is going to eventually say something you don’t want to hear. Point it out, note their response, & take some time to think about it instead of immediately saying “JERK.” The eventual answer might be “JERK,” but that isn’t always the case.

    6.) Almost exactly what Sweet Machine said, but it bears repeating: you can fire your therapist. Finding the right fit is SO IMPORTANT. After my most recent move, I went through four therapists before finding one I felt was helpful. Some I saw for one session, one I saw for 8 sessions: there is no time limit.

    7.) If you are diagnosed with BPD: beyond you & your therapist, nobody else in your life is going to automatically know. You DO need to find a BPD-aware primary physician: stigma of personality disorders is alive & well everywhere, and your doctor really has to know to provide you with the best medical treatment. Among friends & family, that’s something a therapist can help you decide how & when to disclose. Again, it depends on your situation. Remember: your friends are already friends with you. If some leave because the “you” they know and love suddenly has a diagnosis they don’t like, that’s on them, not on you. BPD, like any mental or physical illness, comes in a spectrum, and you might need to do some education. It can be very overwhelming to reveal any diagnosis, let alone a stigmatizing one, so take it slow, establish supports, & seek advice from that wonderful therapist you’re sure to find!

    • Daywalker said:

      THIS to #7

    • J. Preposterice said:

      “Actually, pretty much every therapist, regardless of your diagnosis or their awesomeness, is going to eventually say something you don’t want to hear. Point it out, note their response, & take some time to think about it instead of immediately saying “JERK.” The eventual answer might be “JERK,” but that isn’t always the case.”

      True fact.

      I have a therapist who I think is very good, and who has been enormously helpful to me. Every now and then she says something that makes me FURIOUS and makes my brain start screaming at me that she is WRONG AND DOES NOT UNDERSTAND.

      I have learned that those are the times when she is really, really right.

      It is not the case that all therapists are going to be right at those times! Sometimes they are being a jerk and are wrong! But in *my* therapeutic relationship, when I start thinking she is a jerky jerky mcwrongo jerkerson la la la HATE, every single time so far, it’s because she’s been right about something *my* jerkbrain did not want to be told about.

      So that’s a thing that can happen, and it is worth being aware of.

      • MamaCheshire said:

        A contrary point to that, though?

        One of the reasons I had such a hard time breaking free of Dr. Unethical was exactly this dynamic. He would leave me all RAGESMASHANGRY with him…but in the process of that, somehow mysteriously certain things in my life would improve. It was like the rage provided the motivation I needed to change certain things, even if they weren’t the things he thought I should be changing in the way he thought I should be changing them. And I was convinced that he was doing his job well because he was leaving me upset but then I was making the changes that I felt I needed anyway. In fact, one of the things he told me one day was that he loved being a therapist because it meant he got to piss people off for a living and make them like it. (Yeah, I know. Ew.)

        There’s a line here, and I wish I knew better where it was.

    • To m., Daywalker, J. Preposterice, and MamaCheshire, thank you. These are all things I need to think about.

  23. I think it might be a good idea to list what you did & didn’t like about your last therapist, in terms of her approach, her attitude, even who she reminded you of. If you found your sessions with her useful, find out (through the web or from her) what type of therapuetic techniques she used so you can search for therapists who practice similar types of therapy (ditto to this research if you want to avoid her type of therapy, too).

    I don’t think it can be emphasised enough that your own instincts in this are key, whether or not there is ‘evidence’ for them or they are ‘irrational’. As with any sort of relationship, it’s important you feel at ease with the therapist – if you don’t feel comfortable or safe or just plain take against the person for no ‘good’ reason, they are not the therapist for you. It’s okay to feel that way, and it’s okay to then look for another. After any amount of sessions.

    • I wish I knew what kinds of therapy my old ones practiced, but because I can’t remember their names, I can’t even look them up to find out. *sigh* I’ll read the “types of therapy” links and see if things sound familiar, but I’m close to square 1 in that aspect.

  24. FlyBy said:

    Congrats on going out there and getting the help you need. Working on my own issues has been by far the most frightening thing I’ve ever done, I know how much courage it takes. It’s worth it.

    I’ve had a variety of therapists, some great, some good-but-not-the-best-for-me. If you’re worried about getting a diagnosis of BPD, it might be useful to ask how potential therapists handle diagnoses when you’re interviewing them. In my case at least, none of my therapists have even brought up the question of my diagnosis unless I asked. They may have had a label or three in mind for what I was dealing with, but it wasn’t relevant except possibly as a resource for them to consider which techniques to use with me. Your situation and the people you work with may be different, or may not – it’s worth asking for their opinion on the role of diagnoses in therapy.

    If you’ve got a parent who has BPD, it’s likely that you’ve inherited or learned some tendencies in that direction. Every member of my family leans towards the depression and addiction ends of the spectrum to some degree. It ranges from full-blown mental disorders to some harmful traits to a very normal personality type. (For example, we’re all conflict-averse. Some family members have turned to substance abuse rather than using their words to fix the situations they’re in, some are just gracious and unlikely to pick arguments. I try to be the second type, though I’ve had my forays into the first.) You may find that some tools that are useful for people with BPD are also useful for you, or you may not. Your next psychologist may think that your situation meets the DSM definition of BPD, they may not. It doesn’t actually change what’s going on in your head at all. And as others have pointed out here, you don’t have to tell other people, and you don’t even have to agree with it yourself. It’s useful to explore the family illness to understand the situation you grew up in and to understand what’s going on in your own head, but it’s not destiny and you’re not doomed to repeat it. You’re already very well on your way to a healthier life. Good luck!

    • Realizing that being raised by her means that I may have learned some of her behaviors without actually acquiring the disorder is helpful.

  25. Katie said:

    For me, a huge green flag is that a therapist will accept challenges or criticism without resentment. My current therapist and I have a really good relationship. I’ve occasionally asked him to be more responsive and to challenge me more, and he’s been completely comfortable hearing that. Another green flag for me is that I liked him immediately. He was someone I just felt good around. For me, it really helps to be working with someone who actually likes me, and who I like back.

    • I absolutely need to like my therapist. This is important.

  26. Datdamwuf said:

    Jedi hugs LW.
    I can’t add anything really other than how difficult it was for me to find someone who practiced CBT, every therapist *says* yes when you ask – but don’t actually do it. The few I found in my area that were certified did not take insurance so I never saw them. When asking what they use, it’s a good idea to ask them to give you some concrete ways they practice the therapy type you think would help you. I am recovering from PTSD and it was my talk therapist who pointed me to someone who does EMDR, so yes a good therapist isn’t invested in keeping you coming in forever.

    On sidelining your sessions because you don’t want to go to the topics you need to go to, I’m a champion at that and you have to straight out tell the therapist about it and decide between you how hir should handle it when you start talking about the cute puppy. My therapist runs domestic abuse group therapy sessions, she is hardcore and calls me on my circles.

    • Therapists who will work with a person the way they need to be worked with are awesome.

  27. Naamah said:

    Not just for the OP, but for anyone looking for a therapist:

    1) You should try your very best to be honest and up-front with these people when trying them on for size. The first time I was therapist-shopping, I got real brief phone calls with them, to see what they were like. Here is what I asked the woman I eventually chose:

    “Do you have a problem treating a bisexual, very kinky, atheist, feminist, sex-positive, pro-choice person who is strongly opinionated as though none of those things are a problem worthy of treatment, regardless of your own religious opinions?” Because around here, you DO need to ask. It’s Oklahoma.

    She answered that promptly with a gravelly laugh and “Sounds awesome!” She was great. A complete (self-described) bitch in the very best way. We were an excellent match in that regard.

    Not everyone will be able to be as in-your-face about it as I was right then. (TBH, I was very, very tired that day, in the middle of a long, long walk, very hungry, and plumb wrung out from having similar conversations with other people over the course of a week or so. I literally did not have the wherewithal to filter anything I said.) But it’s good if you can hack it.

    2) Do not be ashamed to say “This is not working, I need to see someone else.” Do not worry about hurt feelings. This is their job, they are professional, and they will be able to find other clients. They will almost certainly not go hungry or suffer sleepless nights from it. If they get snide or passive-aggressive about it or whatever, umm, that’s a key signal that you made the right choice.

    That’s what I’ve got. Maybe more later.

    I will end with this: I am in no way trying to make anyone feel guilty, but a lot of folks have NO choice in who they see. For instance, for my current therapist, I could choose anyone I wanted, as long as it was him. There was only one person who could take me, and I could not wait, since I was basically bleeding out psychically.

    So I know what it’s like both ways, and how important it is to get a good match. So IF you have the ability to do so, DO NOT be afraid to exercise it, shop around, or jump ship. Take advantage of it if you need to, because it is stacking the odds in your favor more than a little!

  28. Naamah said:

    Oh, Jiminy Criminy. I almost forgot. For anyone dealing with a scary diagnosis/potential diagnosis matching a difficult family member’s, and the angst stemming therefrom:

    My mom was seriously mentally ill. Most likely bipolar, but she never was diagnosed. But she was very ill. Her behavior was pretty awful as a result of never being accurately diagnosed or adequately treated, and as a result of being raised in a time/place where mental illness was just not A Thing That Good People Have, by people who didn’t really believe in it at all. She was a deeply injured woman, and like any animal caged too long and tormented too much, it made her very, very mean.

    My mom died just before I was diagnosed as bipolar, and I was horrified, because everything suddenly sprang into focus. This was most likely, in retrospect, what was wrong with her. And I became terrified: what if . . . what if I became like her? This person who broke and poisoned and ruined and hurt everything around her, even when she did not mean to. I could already see threads of behavior beginning to coalesce, patterns beginning to harden into stone. I could see the bad parts of her in myself. And that was *terrifying*, because I never, ever, ever, ever wanted to hurt anyone the way she had hurt us. I didn’t care if she mean to do it or not, whether it was her fault or not, I didn’t care WHY, I just knew I didn’t want to be like that. I desperately wanted the opposite of that.

    So I understand this creeping, nebulous fear of being tarred with the same brush, of feeling that your destiny is written before you in letters of fire, and you can’t escape it because it’s tied to you by the tail, by the shadow. Many, many just-diagnosed people I have spoken to have talked about this fear. This very real, totally understandable fear.

    And you know what? None of those people are their parent. Or their brother or sister or whoever it was who was difficult or hurtful and so on. None are even remotely like them. I mean . . . it is kind of amazing how not like other people these people are.

    There are as many ways to be mentally ill as there are people. You are one person, and regardless of the label put on them, the host of symptoms you experience belong to you and to no-one else. You are not anyone else. These symptoms will not affect you the way they affect others.

    And getting therapy really helps with that. With identifying negative behavior patterns and ending them, or circumventing them, or redirecting them, and so on. It really, really does.

    What was scary about my mom was not that she was bipolar. It was that she had never learned coping techniques for all the unique tortures of bipolar disorder. It was that she went without help and support for so long, it broke her and made her into the worst possible version of herself. And we all had to live with the side effects of that. Of her presence in our lives as a frightening and painful force, no matter how we loved her. And we did, I did.

    But I have learned so much, and the diagnosis was the first step to that. Good therapy was many steps after that. Having her as an example of harmful behavior patterns helped, too, once I was able to put those behaviors into context: the context of her as a mentally ill woman who needed help she never fucking got. (And it breaks my heart, it breaks my heart EVERY DAY that she never knew, and blamed herself her whole life long for being a fuckup, when she was only, as they say, just a little crazy.)

    You don’t have to be that person. You won’t be that person. You will go about it your own way, and no matter who you are, I don’t care if I don’t know you, I think you WILL do better. Because in so many ways, an example like that, awful as it is, is the best damn incentive you will ever have to learn to be GOOD at who you are. And it is a tremendous learning opportunity, as much as I hate it when people go around putting silver linings on things like horrible relationships and old pain.

    We are not doomed to repeat other people’s pasts. Not even our own. We can change, or at least try to wait out the storm until it is safe to come out and change in a safer place.

    I was taught how to be human by a very human but very broken woman. I learned very, very broken and unhelpful and hurtful strategies, ways of communication, ways of seeing things. But I have managed to change, even though to begin with I was working with tools just as crappy and busted as hers. I clawed my way up. I did it. And I was pretty screwed-up in terms of healthy communication and the ability to take care of myself emotionally.

    And I think you can do it, too, whoever you are. Because you can find a lot of people, right here, even, who are willing to stick a hand down and help pull you up when life is the pits. To mark the way so you don’t get lost, or just to keep you company so you don’t get lonely or scared of what’s out there, or worse, scared of what might be inside you. And therapy is a useful tool for that, too. It’s learning survival skills for the long, dark walks we have to take through that awful forest.

    • ona555 said:

      The way you wrote about your mom, and the way her illness affected not just her but you as well, it is so compassionate and raw, I cried.

    • unagi said:

      Thank you Naanah. Beautifully said. The feeling of doom that can engulf you in terror when you realize that you can be diagnosed just as your over-the-edge family member(s) is overwhelming. Remembering all you said so well is really important.

      I’d like to add for LW that it seems to me that you can very well have therapists diagnose you on the basis of learned behavior alone. If you act like a duck you must be one absolutely? But maybe it’s just a reflex, not absolutely your true nature, and you’re really a swan raised by ducks. Yes, many mental illnesses are just as genetic as physical ones – you can be bipolar and cancer-prone like Mom for instance. But also you can be those things in part because of learned behaviors. If you learn to exercise more than Dad did, your potential tendencies toward both heart disease and depression can be minimized. So knowing you could fall into a direction can keep you working on prevention, and help a lot if it doesn’t paralyze you.

      It is tragic when lack of diagnosis and treatment allows someone’s life to get so derailed. But particularly for older generations it’s important to remember that not getting those could be helpful too, in context. And cultural context is also very important here, as in the different US/UK perceptions. I was recently horrified to realize how utterly backward a couple countries still are about autism for instance (France, Argentina..), and how right my mother was at the time to keep my sister out of that whole trap. Even though now diagnosis and treatment could be a huge improvement, in her childhood it’d have been soul-destroying without the least benefit. We can only take the best decisions we can at the time, and those are not necessarily the ideal best..

    • For this and your previous comment, thank you. I don’t have the words, but thank you. I have read your blogs elsewhere on the ‘net for several years, and your forthrightness and willingness to talk about things people won’t talk about has helped me many times.

      Thank you.

  29. I’ve tried….I dunno, around 11 therapists? Mostly because almost all of them were of the “you can only see me temporarily” variety offered through school and work and my insurance. My #1 thing for picking out a therapist is this: Do you hit it off with them? Can you talk to them like you would a friend? Do you relate to them and they to you?

    Seriously, I’ve had the best results with people that I can have a conversation with like that. I’ve seen a few people that came off as totally neutral/bland and I’m glad I didn’t see them for long. My mom saw a guy through our insurance and she absolutely did NOT hit it off with him. He didn’t understand a lick of her problems, it was like talking to an alien for the both of them. If there’s no rapport, it doesn’t work.

    Now, my winning shrink and I have, coincidentally, a lot in common. Her father died a few months before I started seeing her–mine was dying at the time. We have fairly similar personalities. She didn’t get married until her fifties and had a lot of nagging going on in her life due to that, I’m permanently single. So she literally does relate to my issues because she’s been there and done that. It works brilliantly for us. Now, I got lucky (after uh….many years) there. You may not get quite that lucky

    I definitely recommend the phone call screening before coming in. I did that with my winning shrink and the other lady whose phone number I’d been given–and the temp shrink I’d been seeing before that was friends with both of them, so she figured I’d hit it off with them both. I weeded the first lady out because I couldn’t get to her office, but she probably would have been fine too. We just really hit it off over the phone and I knew it would work. And it has.

  30. unlurking said:

    To shortcut to some green lights, instead of flipping through a phonebook, daunting!, you might ask a few people you trust (a friend, or if your doctor or nurse seems cool, or, well, really anyone you have a good rapport & trust with) if they know of any good counselors/therapists. The trick here is to ask people who you like & trust & who won’t judge the question — and /not/ to let yourself get derailed from asking them because ‘they’re so together and so awesome that surely they have never ever seen the inside of a therapist’s office.’ Because, yeah. : )

  31. Red light: telling you what you should think or do.

    Green light: seeking to empathetically understand how you perceive reality.

    • THIS. I have beliefs about the soul and afterlife that some (non-professionals, or rather, professional douchebags) have called delusional. My psychologist takes what I would call a utilitarian view of people’s inner lives: if something makes someone happier, stronger, and isn’t harming anyone, then he’s all for it. “This is not a medical condition, it’s a very rich life,” was what he said.

      • “This is not a medical condition, it’s a very rich life”

        Thank you. Thank you, thank you, thank you. I needed to hear this.

  32. Amy Pond said:

    Huh, this is all really helpful – I’ve been thinking about maybe seeing a therapist myself. I have a psychiatrist who I’ve been seeing for a long time, but their job is mostly to check that I’m not spiralling into depression, etc, and also they tend to go for drugs as a solution to problems, and I would prefer to remain drug-free at this point. But yeah, I’ve reached a point where I feel that talking to someone about my tangled ball of issues, having them acknowledged, and actually working out strategies to get around them would be really helpful. So thanks for all this,

    • I wish you the very best in your process, fellow reader. That’s never easy; good on you for figuring out for yourself what you need.

  33. Red light: Minimizing or explaining away your experiences, pain, fear, anger, or basically any other emotion.

    Quote from a previous psychologist – “I’d like you to consider that your husband is not abusive, but when pushed to his limits by YOU, he may choose some abusive behaviors.”

    • JenniferP said:

      That quote = RED LIGHT.

    • Amy Pond said:

      WTF – that is so bad I do not even

    • staranise said:

      *EXPLODES*

    • Copcher said:

      GUGH! THE WORST!

    • WHOAA THAT IS SO FUCKED UP JUST WHOAAA. That therapist is just…full of evil bees.

    • WTF????????????

      headdesk

      headdesk

      headdesk

      All I can think of is … is that therapist ‘only’ an abuse-apologist, or an actual abuser themselves?

    • HOLY VICTIM-BLAMING, BATMAN! (With a side of WTF?!)

      Plus, isn’t “choosing abusive behaviors” sort of the definition of being abusive? Or is it only abusive if it’s involuntary? That’s really fucked up.

    • MamaCheshire said:

      I’m wondering if your therapist and my Dr. Unethical were buddies, because that sounds totally like the kind of thing he’d say. In fact, I think he said something almost like that in one of the “group therapy” sessions I went to that he led. RED FLAG DO NOT WANT.

    • I just…I don’t even…what.

      Wow. Just…cheezits, wow.

  34. JenniferP said:

    I’ve had very good luck with therapists, though the first person I ever saw was a very neutral/bland person who gave me no feedback or reactions in our sessions and it didn’t last. I’ve found the good ones the following ways:

    School counseling center – they tend to be advanced graduate students looking to pick up clinical hours, so they tend to be younger, more liberal, and they REALLY get the whole grad school thing.

    Community Counseling center – they treat low-income patients, and see everyone and everything. Again, I had a social worker who was very near the end of her training and doing her clinical hours under supervision of a pro. She was great.

    Recommendation from a friend: I asked a friend for a recommendation for someone cool, and he sent me to his person, who is a kind, funny, fabulous gay man I(I had that same reaction that Sweet Machine describes – “My people!” I have recommended in turn to many, many friends – he’s either seen them himself or recommended someone they might like. So don’t be afraid to ask your friends. It doesn’t mean you’ll end up with the same person, necessarily.

    • That “my people!” reaction is something I will be looking for, for sure.

  35. Ms. Pris said:

    Disclaimer: I don’t know the LW and I am definitely not trying to diagnose them over the internet. I just want to put this info out there: Complex Post Traumatic Stress Disorder is a condition that can in many ways be similar to BPD, but it is NOT BPD. It is a result of long-term abuse or neglect. Anxiety and depression are also symptoms of C-PTSD.

    Just saying, this is something you might want to consider. I have C-PTSD, and there were years when my anxiety and depression were really crippling.

    • staranise said:

      Yeah, I decided not to be flippant earlier and say it, but: no doy, the LW has BPD traits. I have a few BPD traits, and I’m so un-Borderline I come out the other side into a different cluster (at my worst). BPD is one way of dealing with childhood abuse and neglect, and it’s not actually “worse” than some other ways, but it’s not the only way. “People with emotionally wonky childhoods” may share a cluster of a few common traits; of course people might be afraid of abandonment, or react quickly and irrationally when a small thing makes their brain go WARNING WARNING TRAUMA AHEAD. But the central mechanism of the self can vary a lot, which affects whether something’s BPD or anything else.

      • Eeyowch. The “no doy” part, while I get what you were saying, felt really gross to me. Yes, lots of people with emotionally wonky childhoods may have some similar traits. The reason that this diagnosis scares me so much is that I am VERY familiar with the symptoms and manifestations, and a decent chunk of what the inner world looks like for someone with the symptoms my mother has. I am not just frightened for something nebulous; I have specific reason to be frightened of this one.

        I’m trying to help myself as best I can, here. If you pick that up, please handle it carefully. :/

    • Siobhan Clarke said:

      Thank you for this! I know I’m late to the thread (just catching up on CA posts after holiday crazyness at work + travel) but reading Judith Herman’s work in Trauma and Recovery has helped me to understand complex PTSD–it’s made me question whether “personality disorder” even applies when the BPD cluster of behaviors appears with a history of childhood trauma: it looks so much like a broken leg that was set wrong, rather than an inborn set of traits. And like a bone that’s healed wrong, maybe you can’t go back and re-set it, but there is a lot you can do in physical therapy to regain something more like normal mobility, and that does line up with my experience of living very close to the triggers of someone with a cluster of behaviors that would merit a BPD diagnosis (but no diagnosis), but who is highly motivated not to pass on the trauma.

      OTOH, I have another relative who has no significant history of childhood trauma who DOES have a BPD diagnosis and found it very helpful because it gave her a way to understand her emotional structure and also gave her access to DBT. Just throwing more anecdata into the mix.

      • “Anecdata”: I like this word. :D

    • I didn’t know that existed; I will research it. Thank you.

  36. myshittyusername said:

    I don’t know if this will apply to the LW’s situation, but the way I found my current (wonderful, amazing) therapist was from an online database for kinky people. I needed someone who wouldn’t judge my kinky, non-monogamous relationship, so I included that in my email asking her if she was seeing new clients. It sort of screened out a lot of people who would not be helpful to me and I ended up with someone who really gets me and understands how to help me. Perhaps if there is a group the LW belongs to that is relevant to their therapy, there is a similar database online somewhere. Or maybe there is one for people with BPD if the LW thinks that would be useful.

    • Badsack said:

      I strongly agree that if you are from a marginalized group, subculture, etc. that it is wise to start looking for a therapist through local community channels. On one hand there is no guarantee that the local GBLTQ therapist (for example) is going to be a good fit, but the concepts of healthy behavior, community standards within a group, etc. may differ strongly from the dominant culture, especially if you are in a smaller or more conservative location.

      I have several friends who are sex workers, and their issues are just normal human issues – their JOB is irrelevant to why they are seeking therapy. A patronizing, judgmental therapist can be horribly damaging. Ditto for some specific social issues. Many therapists are not well educated about the many facets/dynamics of domestic violence (see sarahcircusnachos quote above), even though I think that many of us assume that a therapist will somehow know how to deal with any and all problems that may confront a human (not true).

      • myshittyusername said:

        Oh, for sure. If it’s relevant to the therapy I think it can be helpful, so I wanted to throw that out there. But it’s really just one more thing to consider. And if, for instance, my non-monogamy hadn’t been something I knew I would want to talk about in therapy, I wouldn’t have used that route to look for my therapist.

    • Thank you; I do have some subcultures that the therapist will need to be able to deal with smartly, so that advice is spot-on for me.

  37. Xeb said:

    I found my therapist via a therapist friend who asked what I’d liked/not liked about previous therapists and their approaches (the guy who just sat and waited for me to start talking? Kind of make me bonkers. I did get some good out of that, but really, part of me wanted to see if we could just sit and stare in silence for the whole 50 minutes). Then asked if I wanted someone same gender? Did they need to be queer? Don’t care about gender or queer, but they have to NOT make all my shit about gender/queerness. Got a fantastic recommendation. I feel like my therapist actually hears what I am saying. They also call me on my shit (they would call it pointing out trends and patterns, I’m sure!). Been with this person over a year, just *finally* opened up to them about All My Secrets.

    Things that were surprising perks:

    – they did not study it in school, but knew enough about my field to “get” my job.
    – they do not contra dance, but know what it is, so get it.
    (both of these things in my life are kind of odd; it was surprisingly refreshing to not have to explain my weird job/hobby. I have to explain what my job is and contra dancing to people all the time; it gets tiring, and I really don’t want to do it for $130/hr, even with insurance picking up most of it)

    – The kink/poly stuff is new for them. When I told them (cf All My Secrets), their response was “thank you for telling me.” Later conversation was “They’re not anything I usually deal with, but I like new things.” Not a peep of OMG YOU ARE BROKENS (my biggest fear, y’all). Also, no expectation that I Learn Them All The Things plus evidence of doing work on their own about this stuff.

    TL; DR: Find someone who is Of Your Peeps. Maybe not in all categories, but in the ones that count.

  38. AlmondBitters said:

    I can’t say what will 100% work for you, but I can say what my therapist does right. I’m seeing him for my depression and anxiety.
    My therapist comments on what he observes rather than what he assumes is in my head. He asks questions when he needs clarification. He points out ways that the anxiety and depression distort my thinking without minimizing or belittling me, and he gives me the tools to deal with those thought processes as they come up. If I get into an anxiety spiral in a session, he’s very good at defusing it with a well-placed joke or comment. My family went to him for family therapy for a few sessions, but he held back commenting on my mother’s toxic behavior in individual sessions with me until I was ready to talk about it and recognize it for what it was. I’ve been able to be open with him about my sexuality, and he never talks about my weight unless I bring it up first.
    And not once has he ever told me that I cause my problems by not trying hard enough.

    • Your therapist wins.

    • tinytop said:

      You could be describing my therapist! I don’t have much to contribute to the thread overall- I lucked out and clicked with my first therapist straight away- but felt moved to comment here all the same. The value of a great therapy relationship like that, where he or she just gets how to handle sessions and best help you (however that may look for a given person) seriously cannot be overstated. It’s made so much difference for me.

  39. Hi LW! I have a feminist therapist and it is wonderful. If you are interested in learning more about it, read on! If not, best of luck. Definitely find someone who respects you and your thoughts, and who invites you to reflect upon yourself in a way that doesn’t feel like they’re attacking you.

    This will vary depending on the specific therapist, but one thing I really love about Feminist Therapy (which is a specific school of psychotherapy that folks can be trained in) is that diagnoses are collaborative! The therapist generally does not put a label on you unless it furthers your mental health, and usually it is done to 1. obtain treatment/accomodations (medication, extra test time, etc.) and 2. with the patient reading the possible diagnoses and having a conversation about which one fits best. This means if you WANT a diagnosis, then you can get one, but if you don’t, you can just work on the things that you find problematic in your life, without having to put a label on it if that isn’t helpful for you. If you’re interested in Feminist Therapy, there’s a really good summary book by Dr. Laura Brown (http://www.amazon.com/Feminist-Therapy-Theories-Psychotherapy-Laura/dp/1433804611).

    • staranise said:

      I’m Narrative, not Feminist, but oh boy I love Feminist Therapy a whole lot. Especially since it’s actually very rarely about gender–it’s just therapy that really heavily foregrounds the effect oppressive structures have on people.

      • Fascinating. I shall read more.

  40. currently mulling over changing username said:

    Thirding being upfront about yourself right at the beginning, if that is a thing you are capable of doing right now.

    On my first day with the therapist I loved, she started having me do things that reminded me of the mindfulness practices I used to have to do when I was a kid. I panicked and blurted out, “Look, I grew up around a bunch of people who were super into mindfulness and used it to be terrible self-absorbed people.* I don’t want you to make me feel better by ignoring the world in exchange for inner peace. I don’t want to stop being angry. I hate the way this world works and I’m trying to get sane so that I have the energy to destroy it.”

    Then I practically clapped my hands over my mouth because I couldn’t believe I had just said that. She paused a beat and then said, “I can work with that. If you’re ever planning to kill people, we’ll need to talk about that, but for now that’s fine.” When I checked her website later I found out that she was actually the head of the mindfulness therapy group in our region, but she didn’t get defensive and we did other things. She believed me and she never pushed me and since I had already blurted all that out I felt like I could open up to her more without fear of judgement.

    * [This is much more of an emotional reaction, I have no logic around it and I don't mean to denigrate something that may work for others.]

    • Twitchy said:

      That sounds really awesome. I have some pretty harsh associations with mindfulness, meditation exercises, and all that jazz too. I can’t really get the benefits of it, because as soon as it starts I’m expecting to be attacked. My last therapist really wasn’t listening to that. She kept encouraging me to try it, and when I had tried it, to try it more because I hadn’t been doing it long enough to see how well it really worked. This comment is kind of encouraging. At least I know there are therapists out there who are respectful of boundaries like that.

  41. LW, I was very interested to read your letter and Sweet Machine’s reply, because I wouldn’t have the slightest idea what to look for either! I’m in therapy at present, only the second time I have been. I simply got very lucky with randomly picking a name from the phone book the first time, and seeing the psychologist who works from my general clinic this time. So all I have to say is kudos to you for all you’re doing, and my very best wishes for your future.

  42. Dear LW,

    I believe Captain Awkward and fellow commenters have covered most of the important stuff already as they usually do, but I’m finally going to stop lurking and add something.

    BPD seems like a terrifying diagnosis, or label, or what have you. Most of us don’t like being labeled, especially, heck, not for life, and if you’re looking at your mom and thinking that is the root of her problems, the idea is probably even more disturbing for you. But, oh but. It’s not as if someone has drawn your blood and definitively said, “You have this, no question.” In general, labels in the psych world still boil down to the idea that a patient exhibits certain behaviors/thinking patterns that resemble the behaviors/thinking patterns of other groups and might be helped by certain therapies that helped people with similar problems. As far as I’m concerned, that’s the sole utility of the label, to match a patient’s experience to something other people have experienced so maybe the proper help can be found for them faster.

    If you’ve done any research on BPD besides the basic diagnostic criteria, you’ll have discovered that it has a complicated history. Some people think it’s a catch all label, or that it’s over diagnosed. Some people want to throw it out of the DSM entirely. I personally believe it exists but that some psych professionals don’t really understand all of the nuances that define the disorder from another disorder, or are too quick to classify a patient, or are working off of outdated information.

    Speaking of outdated information, IF you have BPD, then you might have heard that it’s not treatable, that you’ll be like this for life, and the great news is that new research indicates that you’d actually have substantial reason to believe that you can change and have a better life. The other great news is that a lot of other disorders can be confused with BPD, including, as Ms. Pris said, Post Traumatic disorders. There are mimicry disorders where a person can learn certain behaviors from being affected by a person with a disorder, too, and that’s not including all of the other well known disorders that can be confused with it. I guess what I’m saying is, there is hope for your situation no matter what angle you’re coming from.

    It’s been at least five or six years since I read the book, but you might consider giving “Sometimes I Act Crazy: Living with Borderline Personality Disorder” by Jerold J. Kreisman and Hal Straus a try. I remember it being enlightening and my preferred BPD book on a number of points, and even if the information doesn’t apply to you, it might help you manage life and self-care if you truly believe you have a BPD relative or friend.

    I wish you the best of luck finding a therapist who suits you (it’s so personal!), and finding a healthier, happier you, no matter what your label. Just remember that you’re still you, and that your diagnosis is supposed to help you reach that goal, not define you or lock you in.

    • Thank you for the book recommendation; I’ll add it to my list. And thank you for the information.

  43. duaecat said:

    A sort of awkward question. I know someone who has discussed the idea of therapy before. The biggest hurdle for them is that they had/have* a parent in the psych field who – A. Would come home every night and gossip about their clients to their family. And B. Insisted over and over to them that they were Perfectly Normal with No Problems and they should never ever seek help/treatment for their issues.

    So they are understandably very wary of seeking any sort of therapy, since they neither want to be laughed at around someone’s dinner table, nor have their concerns dismissed.

    Is there anywhere I can point them that will help reassure them that not all therapists are like this?

    *The parent cut off all contact until my friend apologizes for ‘pretending’ to have an issue.

    • Myrin said:

      My goodness! I can’t believe that parent, how absolutely horrible! So they cut off contact with your friend because they thought their child only pretended to have an issue? Or because they didn’t want to have a child who has an issue? Either way, it’s absolutely awful and I dare assume that that person isn’t a very trustworthy therapist if they gossip about their patients at the dinner table. What is that even?

      I’m sorry I don’t have any advice for you/your friend’s (very understandable!) problem, but I wanted to stress that this is NOT COOL!

    • staranise said:

      Insisted over and over to them that they were Perfectly Normal with No Problems and they should never ever seek help/treatment for their issues.

      This is my “oh shit, it goes up to ELEVEN” horrorface. Because in my experience, lots of parents to “You’re wonderful! Stop being so down on themselves!” but the ones who go “SO YOU SHOULD NEVER TELL ANYBODY ABOUT WHAT GOES ON HERE” do so because they’re actually afraid of what the child might say. So they deliberately sabotage any way that child might signal “something is wrong here” to other adults.

      While most therapists I know actually think everybody could stand to use a little psychotherapy, even if only as the equivalent to an annual physical exam. Sooo.

      I don’t think this is even a “what to look for in a therapist” question, it’s a “how to find out more about therapists” question. Which, therapists spend a LOT of time talking between ourselves and our feelings about/responses to our clients. It’s really important to handle, and it’s something clients almost shouldn’t see. Um. There’s a recent issue of a popular magazine in the field that focuses largely on the therapist’s inner experience during psychotherapy–maybe any of that might show a different perspective?

      • duaecat said:

        I think it was along the lines of “Don’t talk to anyone else. Because if you talk to someone else and say you’re depressed* then it means I’m a terrible parent and bad therapist” probably with a chaser of “40 years ago, when I was in school, depression* was treated with fresh air and sucking it up. That still seems like the best method to me!”

        *not necessarily real issue

        • staranise said:

          So wow, even better, they DELIBERATELY SAID they didn’t want the child to tattle and make them look bad!

          *contemplative* Less effective in screwing your child up for life than “Don’t tell anyone or they’ll think YOU’RE a terrible child and bad person”, but more honest, and easier to move past.

          Fortunately, the world abounds with evidence that most therapists are not like this. With bells on.

    • J. Preposterice said:

      Well, here is a story you can tell your friend, re: gossip.

      My spouse & I are very good friends with a couple, one of whom is a therapist, and loud, and talkative, and a horrible gossip, and likes to throw huge loud parties at which he drinks a lot and gossips.

      Never, not once, in all the years I have know Drunk Loud Gossip Therapist, has he said ANYTHING about a client. Not once. Ever. If I didn’t know the name of the place where he worked, I wouldn’t even know the sort of clients he sees (it’s a practice with a particular specialty, so if you know someone works there you know the basic demographics of their clients).

      If Drunk Loud Gossip Therapist is capable of keeping a lid on it while drunk off his ass and among very good friends, any therapist ought to be able to do the same, or else they are a TOTAL JERK.

      • unagi said:

        Well, on the other hand, I know a therapist in training who’s the opposite. A very nice woman, really, very kind and helpful and all you’d want in a friend. But a dreadful gossip. In a good way, in a “look at this poor person who was so mistreated by hir family, doing so well considering how fucked up zie is” empathetic kind of way. Still, identifying people, in public, as patients, hers or someone else’s, and discussing their problems at length. I’ve had not only to tell her very directly that this isn’t appropriate information to share, even with a relative stranger (obviously the victims and I do go to some of the same events..), but to repeat it forcefully on several occasions. I finally buttonholed some common therapists acquaintances and accused them of both putting patients at risk and of being a bad friend to her, allowing her to display her lack of concern for basic confidentiality like that. I think someone finally got through to her, at least she hasn’t done anything like that in front of me in several years.

        But I’d had an incident along those line myself previously. Someone who showed up to help my new roomate and I paint the kitchen (very nice of her I’m sure) asked me during the afternoon some very direct questions about the limping relationship with a girlfriend. I didn’t think anything of answering, as I was trying to figure out what to do myself. It’s only when the girlfriend called to scream at me that I realized Helpful Painter was girlfriend’s therapist. And had not only overheard conversation but grilled me deliberately, and then REPEATED what I’d said to her, or enough to be really upsetting. Needless to say, we broke up promptly. If I had been better informed at the time, I’d have turned her in to the state board..

        Anyway, all this to say that while it’s very good to have someone who understands where you’re coming from, I’d have deep hesitations about going to a friend of a friend, or even someone I may reasonably be expected to run into on social occasions.

  44. Jellyfish said:

    Regarding the possible BPD diagnosis–since you grew up with a parent who has it, you could be showing symptoms that you learned, without having it yourself. (Like the mimicry disorders twistingthreads mentions above.) My mom is on the Aspergers spectrum, and she was my main caregiver growing up; consequently I display some surface Aspergers behaviors even though I don’t have Aspergers neurology.

    • Came here to post this. It’s pretty common for people who have lived with a BPD parent/significant other to emerge with what look like symptoms of BPD themselves. Simplifying radically, this is because when you’re stuck dealing with someone like that (especially who refuses to acknowledge they’re acting like that in the first place), it’s almost literally the only way to interact with them in any meaningful manner AND keep yourself relatively safe at the same time. You pick up that mindset out of necessity, because the constant insecurity and hypersensitivity helps you predict what they’ll do next so you can work out how best to keep yourself out of trouble, if you even can.

      I know from personal experience that when you first realize that thinking like that is summat nuts, it’ll feel like you’ve just wasted X million years of your life learning how to deal with people completely fucking wrong. It is possible to unlearn the bits that are maladaptive when you’re working in the Magical Kingdom of Reasonable People, however, without completely trashing everything you know. A lot of it is useful as a lesson-by-ridiculous-counterexample. I managed to beat on it until the (destructive, emotionally draining) hypervigilance converted itself into (useful, remarkably fun) hyperobservantness instead, which has enabled me to basically become Sherlock Fucking Holmes, only (ideally, I hope) less dysfunctional.

      • FlyBy said:

        ” I managed to beat on it until the (destructive, emotionally draining) hypervigilance converted itself into (useful, remarkably fun) hyperobservantness instead, which has enabled me to basically become Sherlock Fucking Holmes, only (ideally, I hope) less dysfunctional.”

        Any tips on doing that? I have some originally protective mechanisms that are now getting in my way – turning them into something more useful sounds great. Trying to just turn them off has been more frustrating than successful.

        • Oh, I hear you on this. I’m interested in possible tips as well.

        • Sadly, not really. In my case, the role I was assigned in the family was ‘socially retarded smart kid’, and I had it beaten into my head repeatedly that I was doing badly in a social sense because I was just a poor little clueless thing who always thought wrong when she thought about people. I hit a point in college where I had lost pretty much every friend (and “friend”) I ever had, and concluded I couldn’t possibly do any worse if I just ran with what I thought was going on in the first place.

          I turned out to actually be very good at reading people, and what was fucking me up repeatedly was assuming that the relatives were right and whatever I thought first couldn’t POSSIBLY be accurate. The thing that fixed the situation was realizing that crazy people are crazy, and I should quit listening to them. I’ve always had the Sherlock Holmes-ness; I just didn’t apply it to people instead of academics for the longest time.

  45. clodia said:

    Oh bad therapists. I had an awful one earlier this year, but now I have a terrific one! My bad one gave me factually incorrect information and wouldn’t be corrected (on important things like how grad school works). She drew judgement conclusions conclusions from my statements about feelings for an ex. She told me that I probably wasn’t clinically bisexual because I’d never had relations with a female, but then asked me when I decided I was a lesbian after I described my feelings for a female crush of mine, even though I’d already established that I was in a long-term het relationship. She was far more interested in her opinions about me than about my opinions about me.

    My current therapist is lovely! Like the others above, I find him very easy to relate to. He’s close to my age, and at a LGBT and poly friendly practice, so even though I’m in a het monogamous relationship, I know I’m not going to be judged for having leanings outside “the norm”. I was not particularly trusting of him at first, due to my previous experience, but he remained professional, thought-provoking, and neutral, and I found myself relaxing the very first session. I wasn’t certain until about three later, but we’re got a great relationship.

    For me, therapy is about having a safe space to let my brain run amuck, and having a knowledgeable person there to help me get through the sticky bits. He provides that for me. He’ll let me ramble when I need to, and cut to the chase when I need it.

    If I can trust my therapist enough to be honest, and leave without having to go over what he or she said to make sure there was no BS; if I can feel like I’m taken seriously and my experiences not dismissed; if I feel like we’re going to talk about the things that I find important, not what he or she finds important; if I feel like the other person isn’t bringing his or her own prejudices and feelings into the experience – then I probably have a good therapist.

  46. Cthulhu Hungers said:

    I have very little experience with therapy (a few sessions with two therapists through school, one of which I only saw once because she tried to put me on both anti-anxiety medications and anti-depressants after only one session) but the one thing I liked about my other therapist was that he worked towards giving me the mental tools to manage my issues outside of therapy. Specifically, he taught me to meditate, which has been hugely useful in managing a lot of my free-floating anxiety. He was also able to sus out deeper issues I had than what I had originally came to him about and was the first person to tell me that I had been abused my parents.

    • Cthulhu Hungers said:

      Whoops, forgot the rest of the comment. Speaking of which, does the awkward army think that people who have been abused as children should always get therapy? I have been thinking about it, however I don’t have any real reason to get therapy- no glaring issues, unmanageable stress, ect, nor is it really affecting my life now. I could use some advice on how to manage my relationship with my family, and how much of my abusive past I should share with the people in my life (which this website has been very helpful with) but I’m not sure that’s something a therapist is really trained to offer.

      • M. said:

        I think everybody benefits from a good understanding of their histories & themselves. If clinical therapy doesn’t sound like a good way to achieve that goal, or you feel pretty awesome about your life now, go for it!

        That said, 90% of what I talk to my own therapist about is dealing with my abusive family now, even though the trauma there is long past. Depends on the therapist, of course, but I do think mental health professionals should be equipped to not rush in with a firetruck to help you with some ash stains.

        • I was leaving my own reply to Cthulhu Hungers, and realized that I was saying pretty much the same as you already had, but with slightly different phrasing. So instead I’ll just say I agree wholeheartedly.

        • Cthulhu Hungers said:

          Thanks for the advice, M & Other Becky. I’m still thinking about having a few sessions in a ‘checking to see that everything is in good working order, psychologically speaking’ way. Maybe I just need to talk about it with someone else.

      • I think mostly yes, because I think that the effects of abuse can be subtle and surprising, and I think people should understand them sooner and with help, in order to reduce their suffering. But there’s big caveats in that “always”, because therapy is only useful for people who are in a place to make it useful.

        I think therapists who have dealt with abuse survivors before will be familiar with your current questions, so yeah, they may be applicable. But you might have to filter out therapists who expect you to have stronger reactions than you have to your history.

        Still, since you’re thinking about it, if you have the time, energy, and money (or insurance, if insurance would cover it) it’s worth a try. While it might sound strange, you could try calling a local abuse hotline for local recommendations, in addition to the other sources of recommendations people have mentioned here.

        Then, when you see them, just lay it out and see how they react.

        Also… I guess, don’t be surprised if unexpected feelings and insights turn up on the way. My personal history includes something that is abuse adjacent, but minor enough that it’s hardly a thing. I have been surprised several times over by how that and one or two other really minor boundary violations have interacted with other experiences in my life to have surprisingly large effects. My empathy kind of breaks when I try to extend that to people who have had more significant violations. Turn that little thing up a hundred- or a thousand-fold?

        I believe you that you’re all good now, and I’m super-glad for it. I’m just saying that sometimes the insights can be surprising and upsetting.

  47. I kind of already said this in a comment above, but in case folks are (understandably) skipping to the end of the comments:

    Thank you, everyone, so much for this thread. I’d written in to the Captain with pretty much exactly the same question, so the advice and comments here have been extremely timely, helpful, and encouraging.

    My resolutions for this year?
    1) Get therapy.
    2) Have a better year than effing 2012 (seriously, 2012, WTF was that?).
    3) Learn cross-stitch.
    4) Make pillows.

    • currently mulling over changing username said:

      Go to therapy – also my new year’s resolution. Also Use Your Words (thanks Captain).

      • Amen to that.

        Also, I love your current username :)

  48. Rae said:

    As an almost licensed psychologist and long-term therapy client, I have a few thoughts. I have had 5 therapists. 2 were ok, 1 was pretty good, and 1 was aweSOME. 1 was so harmful to me that I spent a good bit of therapy getting over the havoc she wreaked on my life. (She also saw my mother as a client at the time (bad!), and was giving me advice that matched my mother’s advice to me, and I was too young and dumb to understand that she was comprimised. She also played mommy with me using my mother’s same tactic of differing degrees of negative reinforcement with no positive. Also, surprisingly she hated (just like who else??), my then boyfriend now saint of a husband and actually told me not to marry him. Totally f’ed up my sh**.) Who helped me get over the bad one? Awesome therapist.

    So with that preface, what would I look for?

    – Unconditional acceptance of and positive regard for as a person (not your behavior, but you as a person who is struggling in this thing called life)

    – The therapist’s willingness to be vulnerable and pull down his/her defenses (you should be able to give feedback and he/she welcomes it. you should also see emotion here and there – my awesome therapist has this skill or trait that she just has this faint watering around the eyes and it starts whenever i try to avoid emotion. it gets me every time) No therapy voice!!!!

    – i agree with an earlier poster, you want someone to call you on your sh**, but it must be in a loving and caring way and she/he should not give you answers – you should experience this phenomenon of he/she “coming alongside” you and facing the problem with you not as some all-knowing sage who imparts their wisdom.

    – If you believe that BPD tendencies are there, it would be good for your therapist to be familiar with DBT and the work of Marsha Linehan (My preferred orientation is an interpersonal and/or emotion focused style using DBT or ACT. If relevant, some psychodynamic therapy can also work wonders for the right client).

    • Wow. Your Dr. Unethical sounds like she should go hang with the Evil League Of Evil Therapists we seem to be aggregating in this thread. That is unbelievably Not OK.

      Makes the passive-aggressive email I got from my last therapist – asserting that I was stealing from him and that I was a low-life degenerate would would never pay my debts (that he said not to worry about) – seem like a cakewalk. Lordy.

  49. Kacienna said:

    In my particular case, what I needed from my therapist was extreme gentleness. It turned out that most of my issues at that time were from an unhealthy relationship, and it had me in such a state of self-condemnation and fear of criticism that the slightest harshness would have destroyed my fragile trust. Calling me out wouldn’t have worked in those circumstances – what did work was being asked to, very gently and with great patience and kindness to myself, look more deeply into a given issue.

    I also had a therapist that I stopped seeing because he annoyed me. He always referred to people in my life as Husband or Mother (yes, you could hear the capital letters), instead of by their name or as “your husband’ or “your mother.” I told him I didn’t like it and that I preferred to think of them as people rather than as archetypes, but he kept it up and didn’t even really respond to my complaint. He also seemed more interested in trying to psychoanalyze my husband by proxy than in the issues I was concerned with.

    • How disturbing!

  50. I read a thing once (that I found through here, actually) that said that in terms of a relationship, wanting to leave is enough.

    Does that apply to therapists, too?

    Because I don’t dislike my therapist, but I don’t feel like I’ve bonded with her in the slightest. And I don’t feel like I’m coming up with very much that I wouldn’t have thought of on my own. There are the occasional insights, but usually not big ones, and I have to wonder if that’s just the bare minimum you’re guaranteed to have if you let someone else in on your inner thought processes.

    I kind of don’t want to go through the whole process of bringing a new therapist up to speed again — I’ve done it a few times and it’s getting tedious — but I just don’t know if I should stay. There’s nothing *wrong* with my current therapist, per se, I just… feel like there’s something missing.

    This whole issue of therapy is so often presented in terms of “good” and “bad” and demonstrated with extremes, but sometimes it’s just not that clear-cut. Sometimes there’s just… non-optimal therapy. Therapy that isn’t hurting you, but you’re not altogether sure it’s helping. Are you supposed to be sure? Or is it just one of those things where you have to trust the process and stick it out?

    Help, I’m confused.

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