Therapy

Therapy: Is this how it should be?

Posted on by ALL ROUND WELLNESS

Stepping into the therapy room for the first time can be a daunting experience for some, and a complete relief for others.  There is no single way that therapy should be done, and no single way that it should feel.  There is no single approach to therapy that is the perfect solution to every problem and every client.  So how do you know if the therapy experience that you are having is working?

There are a few tell tale signs that all good therapy will have – and there are few tell tale signs that  let you know that you should probably find yourself a different therapist.  Regardless of which therapy professional you see (The Many Faces of Therapy), good therapy is certainly easy to tell apart from the not-so-good type of therapy.

So what should you be looking for, to know if your therapy experience is everything that it should be?

“How this therapist works fits for me”.

Different therapists will have different personal styles – we are all human after all.  You should feel like, even when you are feeling challenged by your therapist, that their personal style fits your needs and preferences well.  To understand more about the therapy relationship read What Makes Therapy Work.  You will know that your therapist is a good fit for you by how you feel during the vulnerable, difficult, challenging, and insightful moments of your therapy – you will feel supported (not forced), nurtured (not uncomfortably so), and respected as the driver of your own therapy experience while your therapist offers some navigation assistance.  Your red flags should be alerting if you feel that your therapist is forcing, controlling, directing, or harming you in any way. 

“When I don’t know the boundaries, my therapist does”.

You are not expected to automatically get how this therapy thing works – and that includes the boundaries involved in an good therapy relationship.  A good therapy experience will have occasions in which your therapists kindly and clearly alerts you to a boundary that is needed to keep your therapy relationship exactly that – a therapy relationship.  After all – this is not a new friendship in the making (although you will often feel that you and your therapist would make good friends!) – your therapist is a season in your lifetime, there for a special purpose. 

Your therapist will show you how to form, share, and farewell and healthy trusting healing relationship, and they will do this by keeping sound boundaries to protect that relationship. 

If your therapist is making a lot of contact with you between sessions, socialising with you outside of session, allowing you to call them whenever you please, or being overly affection or touchy – your red flags should be alerting.

“I don’t always come out of therapy feeling totally happy”.

If you are coming out of every session beaming with happiness and positives – you may find that your therapist isn’t doing so good for you.  This is why.  You likely came to therapy because you were struggling with something, right? Doesn’t it make sense that therapy is going to feel a little uncomfortable sometimes as you address this struggle?   During good therapy you should feel challenged, defensive, resistant, vulnerable, maybe even a little embarrassed to tell your story in its completeness.  Good therapy should include experiencing sadness, anger, confusion and all other emotions also.  People learn the most when they find their own discomfort.  But here is the thing – a good therapist will help you find these discomforts, while also supporting and nurturing your wellbeing.  Therapy should feel like the safest place to feel your discomforts – no judgement, no criticism, no punishment, and no disrespect.  So be ready for a journey through the whole spectrum of your emotions with the most trusted travel partner keeping you on track – sitting right beside you.

“Just for a change, it was all about me”.

Good therapy will be about you. Seems obvious right? This is your time, and while you are here, you are the most important topic of conversation!  Your therapist should be more interested in hearing your story, sharing your experiences, indulging in your insight building, than in themselves.   Don’t get me wrong, some therapists do have a very transparent and authentic personal style, and will share small insights into themselves or their own life experiences. This is usually done with a special focus on being relevant to your story – having a purpose to boost your understanding of your own experience, or to help you recognise that we are all humans having very human experiences.  This is totally acceptable in good therapy.  However, if you find that most of your session is not about you – or you feel that you are learning way too much about your therapists life – then your red flags should be alerting.

“ I don’t always understand what’s going on, but things are changing in my life for the better”.

Therapy is a bit of an art.  This is not a chat with a friend.  Your therapist probably spent many years (and yes you should ask about this as part of choosing your therapist) studying and learning the refined art of therapy.  So you may not always completely know why they took a particular tack in your session or why they have asked you to try a particular exercise.   Often, regardless of giving as much explanation as possible, clients will still explain that they have no idea how EMDR (Eye Movement Desensitisation Reprocessing) works. Yet their safe therapeutic relationship and trust in me allows them to ‘give it a go’ and as a result see subtle yet significant changes occur in their lives following this treatment.  So if you aren’t supposed to understand it all completely – how do you know when you have entered red flag territory?  When the effect of any therapy technique is ongoing distress, feeling more unstable, or making you feel unsafe in any way – you are in the red flag zone.

“I feel like I am the one making my own choices”.

This one is pretty straight forward.

You are the expert on your life. You are also the one who will carry the consequences of any decisions that you make about your life as a result of therapy.

A good therapist will know and respect this. They will make sure that you also know this, and as such will walk with you, but will not drag you along. A good therapist will see that although you are struggling, you are also capable and have the right to your own choices.  Classic red flag examples include being told to leave a partner, to cut yourself off from friends or family, or that you have to engage in a treatment that you are not comfortable with.

So despite there being a whole range of pathways of training to become a therapist, regardless of the pathway or the profession, the journey that you take with a good therapist will be a distinctly different experience from the one that you will find yourself in with a ‘not so good’ therapist.

Notice your red flags – find the face of therapy that fits best for you – remember these common qualities that can be your sign posts along your therapy journey.

THE MANY FACES OF THERAPY

Posted on by ALL ROUND WELLNESS

There is a tendency towards misconception when people start seeking out therapy. 

It seems everything that we see, read, and hear directs our understanding of what is actually available to us. As an individual person who is already struggling to make decisions and find solutions we actually become very easy to manipulate in this way. 

The familiar solution that springs to mind when seeking therapy is to see a Psychologist. Seeing a Psychologist gives you access to a range of therapeutic models and assessment tools that can help you understand your current psychological needs and experiences, and work through important issues to improve your condition. Further information about what Psychologists do can be found on the AAPi (Australian Association of Psychologists Inc) website.

Are you aware that there are also many other types of Therapists that can help you? Many people are completely unaware of the many therapy professions available to them when they are seeking therapy. A significant reason for this is that we are dictated to flow in the direction that funding is available for services in the form of rebates. 

As a Psychologist who has practiced for over 20 years, some people may question why I would choose to educate people about the broad range of therapy practitioners that are available to them, additional to Psychologists, in their community? It is really a matter of ethics. 

Currently in our communities, access to mental health services are stretched and often difficult for people to financially afford. It is only ethical to ensure that our public are aware of all options available when needed, rather than supporting a continued monopoly-of-sorts on mental health provision by only a few selected professions.  Afterall – it is not a profession or industry that determines whether you will get what you need from therapy – it is the Therapist that you choose based on best fit for you, and all people should have choice about who they access to work with.

Afterall – it is not a profession or industry that determines whether you will get what you need from therapy – it is the Therapist that you choose based on best fit for you, and all people should have choice about who they access to work with.

CHERIE DOROTICH

So who are these many faces of therapy that are available for you? 

One such profession that can support your mental health needs through therapy is Social Work. Many Social Workers are highly skilled, qualified, and trained in providing therapy for a broad range of mental health issues. You can find a Social Worker on the Australian Association of Social Workers website.

The AASW explains “Accredited Mental Health Social Workers (AMHSWs) are recognised providers with Medicare Australia and other programs, delivering clinical social work services in mental health settings and utilising a range of evidence-based strategies.”

You can also choose to work with a Counsellor. I have met many highly skilled and compassionate therapists who are Counselling trained, who pride themselves on providing professional therapy to clients that present to them. There is an assumption that Counsellors are not educated at a degree level – this is incorrect. In fact, Counsellors who are members of ACA (Australian Counselling Association) are required to have completed accredited courses of training, and maintain ongoing professional supervision and professional development – hallmarks of a professional and skilled Therapist.

Another rarely considered profession for therapy services are Occupational Therapists. Yes it is true that Occupational Therapists are more commonly known for working with mobility issues, however many are also mental health trained to work in therapy with clients. 

OTA (Occupational Therapy Australia) explains  “Occupational therapists in mental health use individual and group programs/activities to enhance independence in everyday activities. An occupational therapist may help to develop coping strategies for people overcoming their mental health issues or improving confidence and self esteem in social situations.”

Also often overlooked are our highly skilled Mental Health Nurses Practitioners who have been nursing trained and done further additional training in the mental health industry to provide therapy. You can find some additional information about Nurse Practitioners here .

Let’s not fail to highlight the profession of Psychotherapy. Often people assume that this is the same as seeing a Psychologist or a Counsellor, however this is not entirely true.  While there are similarities, there are also vast differences in terms of the therapies experience that you will engage in.   Psychotherapy is a diversely skilled profession in its own right. 

PACFA (Psychotherapy and Counselling Federation of Australia) explain “Although counselling and psychotherapy overlap considerably, there are also recognised differences. While the work of both Counsellors and Psychotherapists with clients may be of considerable depth and length, the focus of Counselling is more likely to be on specific problems, changes in life adjustments and fostering the client’s wellbeing. Psychotherapy is more concerned with the restructuring of the personality or self and the development of insight.”

Every profession brings with them a cast of quality skilled professionals who can guide you through therapy to achieve the outcomes that you are seeking. Every profession brings with them different tool kits which have emerged from different models and theories, to help you do this. The key value in acknowledging all therapy professions exists in precisely this diversity. After all – I am sure that you are not a one- size-fits-all person right? 

Possibly the key factor that gave Psychology it’s stand out profile as the one-stop-shop for mental health treatment, is the feature that Psychologists use psychometric testing for assessment and diagnosis as congruent with the medical system. It can label you to determine which treatment protocol or medication applies. 

Think about it – while such assessment and diagnosis has its place in the therapeutic realm, is this all that YOU are looking for? Is this EVEN what you require?  Is this the therapy ingredient that will get you living life well again? Do you even WANT this as a part of your therapy experience? Because therapy IS an experience! It is an important and transformational experience when provided by a Therapist who knows how to bring the essence of humanity to their therapy.  

Therapy IS an experience!

I may cop some flack for that previous comment, however it is important that the everyday person can easily understand what is offered so that they are also able to make informed choice about who they wish to see. 

So how do you choose a Therapist to work with you through your difficult times? There is much credible research that demonstrates that the key to client outcomes in therapy is the ability of the Therapist to create a sound and safe working relationship with their client (1) 

This is barely something that can be taught while achieving our degrees at university. This is a quality that is specific to the Therapist’s nature and intention in choosing their profession. It is a skill that Therapists develop through experience with other humans (clients). This is determined by the Therapist that you choose simply because they are a good fit for you and what you need. 

The results of the meta-analysis indicate that the overall relation of therapeutic alliance with outcome is moderate, but consistent, regardless of many of the variables that have been posited to influence this relationship.

Martin, D. J., Garske, J. P., & Davis, M. K. (2000)

So next time you are seeking therapy during a difficult time, make sure that you choose a Therapist that you feel comfortable with and that you feel is a good fit for you in the way that they work. Also, if you choose wrong the first time – shop around until you find the right person. 

Psychologists, Social Workers, Occupational Therapists, Counsellors, Psychotherapists and Mental Health Nurse Practitioners are ALL potential therapy professionals that you can access – each with varying provision of medicare or private health rebates available. 

Don’t allow yourself to be limited by the restricted information and direction that you are sold. If you are going to invest in your own wellbeing by attending, then also invest by looking around for the best person for the job – not the closest, not the cheapest, not the one you were told to go to – invest in yourself more than that. 

To share space and vulnerability with another human being, with the aim of improving your own mental health, is daunting at least and terrifying for most. So allow yourself the time to find the Therapist, regardless of degree or profession, that is going to work the best for you and your therapy goals. 

Therapy is a human art. 

Humans are individuals. 

The Art for Individuals. 

As such it can not be ‘owned’ or delivered effectively by any single professional pathway. 

References:

(1) Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68(3), 438–450. https://doi.org/10.1037/0022-006X.68.3.438