December 19, 2012 6:19 AM   Subscribe

It is quite clear I need therapy promptly, but I do not know how to start having it.

It is possible that I have been depressed or anxious or both for the bulk of my 50+ years, but current issues have brought the matter forward in importance. I must have some kind of help and have it soon, but I don't know how to start or what questions to ask. My choices boil down to: 1) (specific question) or 2) WAAH. 1) means I have to select what's highest in priority and I do not know how to answer that for myself. 2) feels like a throw of the dice. I need a human guide or meta-therapist one way or another, because everything seems like priority one. What do you do when you know something ails you and you have the clues but no way of knowing how to begin? NB. This isn't a question about finding a therapist; it's a question about knowing what questions to ask of one to begin with.
Well... that one. It sounds glib, but take this to a therapist and make him or her read it. They're not genies -- you don't get three questions and then you're done and they go back in the bottle forever. Tell a therapist that you don't even know where to start, because X. Then let the trained professional do his or her job.
posted by Etrigan at 6:23 AM on December 19, 2012 [4 favorites]

This is the job of the therapist. There's no magic question that they start with to begin unraveling the mysteries of your brain. Try not to stress too much over doing therapy perfectly. Such a thing doesn't exist. You'll begin somewhere and you'll get to the other things you need to get to, too.

I suspect this anxiety is a symptom of your general anxiety. Tell your therapist about it.
posted by inturnaround at 6:32 AM on December 19, 2012 [6 favorites]

You have "suicidal" as one of your tags. If you mean any more than suicidal thoughts, like you have a plan or something then please go to an emergency mental health service right now.

Otherwise, to the therapist you say you are depressed and you have some suicidal thoughts. They will take it from there.
posted by gaspode at 6:43 AM on December 19, 2012 [2 favorites]

When I started, it went kind of like this.

Therapist: "Hi, I'm JoeBob Q. Therapist, Ph.D"
Patient: "Hi, I'm Johnson H. McShittyfeeling."
T: "Pleased to meet you. I'm going to take a moment, before we get started, to talk a little about what therapy can and can't do for you. [discussion of his therapeutic style, some logistics, some expectations for how this relationship is supposed to work, &c.] Now, what is going on? What do you want or need for yourself today?"
P: "I don't know what I need. That's a hard question. I feel like I need a kick in the head."
T: "Why do you feel like you need a kick in the head?"
P: "Because I'm stuck. I don't know how to move forward."
T: "Let's talk about being stuck. What does it feel like to be stuck, for you?"
[&c. &c.]

The point is, your therapist will help you and prompt you to start talking about why you're there. It's their job to do that. This isn't like your boss, who doesn't want you to bring them a problem unless you can suggest two solutions for them to pick from. It's your therapist, and if you could break down your problems in a way that was productive for you, you wouldn't need a therapist.
posted by gauche at 6:43 AM on December 19, 2012 [12 favorites]

I am a huge believer in "get three estimates." This advice was initially given to me about roof repairs for our first house, but it applies to everything. Set up appointments with a couple different therapists and talk to them in person. You will be amazed at how different they are. Also, just the process of doing this will begin to clarify the issues in your mind.

If you're suicidal then call the suicide hotline (1-800-273-8255 in the US). "Suicidal" could mean simply feeling like there's no point in bothering with anything. If you feel that, then seriously call the 800 number. People there are trained to help you with that exact issue. The whole reason that number exists is for you to have easy access to a human meta-therapist, because you are not the first person to feel like that.
posted by selfmedicating at 6:51 AM on December 19, 2012 [1 favorite]

You don't have to arrive at your first appointment with an agenda; part of the therapeutic process is developing that agenda together. It is enough to describe your current situation, the one you say has made this a more urgent situation. They will help you take it from there. That's what they went to school for.

And yes, like inturnaround says, you are anxious and spiraling about doing this because you have anxiety. You can't wait until the anxiety goes away to get help, you'll have to power through it, but you can gain some control by calling it what it is. So when you find yourself looking for these reasons you can't go - because you don't have enough specifics, because you haven't had time to write a ten-page outline, because you don't have warm enough socks - just take a breath and say "woo, I am super-anxious about this, huh?" and dig your heels in a little harder to keep your momentum going.

One of your tags is "suicidal" - you can make a phone call right now to a resource relevant to your location and talk to them about your concerns too.

It's just about impossible to predict exactly how an individual therapist will structure their sessions, which I know would probably make you feel better, but in all likelihood there will be a place for you to sit, and a place for them to sit, and then they will ask you some questions and tell you about themselves. These questions aren't a quiz, they are conversational and informational. Eventually he or she will ask you why you are there, and nobody's going to expect you to tell them exactly what your diagnosis will be, or that the first thing you say is automatically the most important. It's just that you have to start somewhere, otherwise you'll both just sit there picking at lint on your pants.
posted by Lyn Never at 7:05 AM on December 19, 2012

By all means, bring all the process you can to starting therapy, but on the other hand... desperate times call for desperate measures. I have picked a shrink out of the phone book before, arrived, and been no more articulate than sobbing "help me, help me, help me" for the first 10 minutes. Having someone say "I can do that" goes a long, long way when you're that far in the hole.

So if you're not asking how to pick a therapist but rather how to begin with the therapist you've picked, it's OK to say "my life is falling apart and I'm beyond miserable and I don't know how to start fixing all the things I need to change." If your therapist doesn't suck out loud, he or she can work from there.
posted by DarlingBri at 7:14 AM on December 19, 2012 [2 favorites]

Oh, and mefi's own OmieWise had a great comment a while back addressing how to get the most out of therapy.
posted by selfmedicating at 7:18 AM on December 19, 2012

You can take a list of the issues that concern you most and give it to your therapist and tell them you don't know where to start.
posted by bunderful at 7:37 AM on December 19, 2012

The first appointment is called an intake. They'll go over some pretty standard questions of their own, in addition to any specific questions or thoughts you might want to bring up.

You absolutely don't have to do this, but one thing that might help is writing down something and bringing it in to share with the therapist at that first appointment. Just answer something like, "Why do I feel like therapy would be helpful right now?" And even if you think it's rambly or you find that it's hard to put your feelings into words, that's the kind of thing that a therapist can see as an indicator of how things are going for you.

But don't let "oh geez, I don't know where to start" stop you from making an appointment and going to it. This is your depression talking. It clouds your ability to make decisions for yourself or focus on specific things that are troubling you. A therapist knows this. A therapist knows that your guard is up and you're probably in self-protection mode. That's okay. Just do whatever you need to do to get in an office and see someone.

And yes, if you're feeling suicidal, please contact a helpline. They're trained to help. It's right in the name :)
posted by Madamina at 7:55 AM on December 19, 2012

If you are feeling like any of the things listed here, please call a crisis hotline in your area right now.

Assuming that you're basically stable and can wait a week or two:

The worst thing to do is to wait because you're not sure how to get started.

Luckily, therapists are basically experts in helping you sort through priorities and develop action plans. And they all know each other, and usually know who in the area can help you best.

Call a therapist from the list provided by your insurance company and ask for an intake/consultation appointment. Make sure that you can get in to see them within the next two or three weeks (there is almost for sure an appointment available with someone in the next two or three weeks; don't take an appointment for March till you're sure that's the earliest in your whole area.) I'm only giving you the "three" weeks because of the holidays. In my area, the waiting list to see any counselor (as opposed to a specific one) is generally 24-48 hours, because of the frequency of cancellations.

When you get there, tell them what you said in this post. Tell them you have no idea if they're the right therapist for you, and that you need help figuring out where to start and EVERYTHING.

This is pretty much exactly how I started therapy when I finally started doing it seriously, BTW. I walked into my EAP counselor's office and wept and gave a generally random rambling statement about all the things that were WRONG in my life, and she figured out the next steps and talked me through the process of actually getting into formal therapy. I had my first appointment with my current therapist (who was a good fit for my particular issues) three days later.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 7:59 AM on December 19, 2012 [2 favorites]

In the USA, calling 211 should link you with local support services. Simply tell them you need a therapist, and ask for three names. They may or may not be able to give you a therapist within a given insurance company, I'm not sure. I've mostly used them in relation to clients with medicare. I'm not sure how it works in other countries, but the internet might know if you do a search for your country and therapist.

I'm 100% behind multiple therapist "try outs". The first meeting should be free (unless it is through insurance, they're always weird), as that's when you discuss payment and whether you will suit each other.

I don't know if you've seen a therapist before, but I'll give you a breakdown of my first meeting with mine and what I was taught about what a first appointment should look like in school (I have a Masters in Marriage and Family Therapy).

First of all you will be asked what the problem is. This may be phrased in a lot of different ways - "What brought you here," or "What do you need help on," or "How would you describe what's bothering you." The jist is the same. Your answer is sufficient from the info you gave at the top - "I'm anxious and depressed and it's getting worse. I don't know what to do."

At some point, she will give you a short blurb on her approach and training. This may vary a lot; most therapists are trained in Rogerian techniques (essentially to be loving, honest, and have integrity) but the rest can be rather grab-bag. Some are very focused on the family and family of origin. Some are very focused on cognitive behavioral therapy. Some are focused on very challenging and aggressive techniques, others on much gentler, leading ones. Some do physical interventions, like combining movement or massage. Some will do more depth psychology, which would mean art, metaphors, and dreams. There is no one "right" psychological discipline; studies have shown roughly the same "cure" rate regardless of style. The focus you have is not on finding the right discipline, but rather on finding a person and her approach which feels comforting to you and lowers your anxiety.

At some point she will go over the rules, confidentiality, and disclosure. If you do have suicidal thoughts, than you might want to ask her about how she handles suicidal thoughts with her clients. You will most likely hear that things may get worse before they get better (often addressing psychological problems directly through therapy can trigger more of them in the short term, though you recieve relief in the long term). You will most likely be given the numbers of suicide hotlines for emergencies. You will be told to call for emergency help if you believe you might act on your thoughts. Suicidal thoughts without a plan or the ability to carry through with a plan is pretty common.

At some point you will go over fees and payment together, and see if fiscally it works. I always paid with check and paid in full. If you have financhial difficulties, looking for a group therapy situation might make some sense. Usually the fees are much lower, and depression is a very common experience which can respond well to shared experience and support. Many therapists are associated with scaling payment organizations as well; you can try several therapists at a single sliding scale place if you want as well, if money is an issue.

The rest of the session will be spent talking about your problem and where to start. The first few sessions are always about information gathering, so there is no need to worry about putting things into order or making sense of them - that's for later. You may or may not feel relief simply from talking about things. You may not trust your therapist at first, and that's all right. When I went to therapy as a child (which was much closer to "real" therapy than my adult sessions that were required for my degree) we spent the first few sessions on my not trusting her before we started actually working on my problems. I want to reassure you, though, that your therapist went to school for this; you don't have to know what to do, you just have to know there's a problem and ask for help.

Good luck; I hope you find the help you need and deserve.
posted by Deoridhe at 7:38 PM on December 20, 2012

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