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
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?