Anthony Rella, MA, LMHC

Tag: starting therapy

  • Where to Start?

    We are a world in need of healing, living lives in need of healing. Our communities and families need healing. I need healing.

    Sometimes when clients come in for therapy, they feel overwhelmed when laying out all their problems. There seem to be so many, so varied, so extensive that it is unclear where to start, what to do. They have psychological houses in need of new plumbing, a new roof, extermination of the bedbugs, a fire extinguisher for the stove that keeps igniting, and they have to live in these houses while doing this work.

    A small dog wrapped in a blanket.
    This guy wants to hide out a while. Photo by Matthew Wiebe

    Perhaps you are in good health, but you are looking out to your communities in need and finding a similar dilemma. The temptation is simply to abandon the house. The temptation is to run around screaming making inept efforts at all the problems. It is horrible to think about living in this place; we sense it could be so much more but the work of repair seems so big and so costly.

    Where to start? If you were sitting with me, I’d ask you to take a deep breath, filling your belly, and then let it out. Breathing doesn’t solve anything. Breathing helps us to slow down to figure out what needs doing. We must live in our houses to work on them. Many of us wish that we could simply avoid our houses and then come back to find them all better.

    The good news is; in some ways you can start anywhere. All of these things are problems, but working on any of them will immeasurably improve your house and make the other projects easier. What feels most pressing when you slow down? What problem is most urgent? What can we do to slow down the damage? If the stove is spontaneously igniting, then disconnecting the gas or electricity seems like a good first step. Things aren’t better, but they’re not getting worse.

    Now you’re thinking about all the other things to do, but remember to breathe again. What is your body telling you? What do your feelings tell you? What does your mind tell you? What’s the next step? If you become paralyzed trying to figure it out with your mind, acknowledge those thoughts and drop deeper.

    The challenge of deep, long-term healing is balancing the urgent and the important. What helps is diving inside and reconnecting to what I want to manifest. What kind of house do I want to create? What is the next step that will make my house more like my vision? Emergencies arise and want our attention. Sometimes it is necessary to address the emergency–the curtains are on fire. Other times the emergency is a distraction–the neighbor doesn’t like the color paint we’re using on the walls. No one can tell you which is which, they can only offer feedback and help you figure it out.

    Holding the big picture, the vision, helps but focusing on all the ways our house is not that vision paralyzes. It is a difficult skill, holding the vision while keeping our focus small and practical. We take the steps in front of us. We make the phone call to the exterminator. We wash all the bedding with hot water. We do a bit each day and the house improves. Emergencies arise, we deal with them, we get back to work.

    Where to start? If you can’t decide, just pick something and spend some time with it.

  • Advice on Finding a Therapist

    In the past few years I’ve supported several people who are looking for psychotherapy but are unable to work with me for a variety of reasons. Finding a therapist who is a good fit is a daunting task even for the most mainstream person, but those who are in oppressed groups, non-majority ethnic groups, sexual minorities, and religious minorities, it becomes even more complicated.

    Most clients naturally want to work with someone who shares significant pieces of their experience and culture so that the client doesn’t have to worry about educating their clinician or having their clinician impose values or inappropriate cultural expectations upon the client. Unfortunately, it may be difficult to find someone who fits into all of your communities due to region and economic factors, and even when you do, the smaller your community is the more likely it will be that you experience social overlap: your clinician may go to the same rituals as you, the same parties as you. They could be dating one of your exes. None of this needs to be a deal-breaker, except maybe the ex situation, but it’s certainly something you and your clinician will discuss how to navigate.

    This lady might want to talk to somebody.

    This concern about finding a good fit does matter. Establishing a strong, supportive, warm relationship with your clinician is necessary for having good results from your treatment. If you’ve met with a person for two or three times and you find yourself unable to trust them even a little, or feel judged by them, or otherwise uncomfortable, then that is important for you to discuss with the clinician up front to either discuss ways to improve the working relationship or find someone who is a better fit for you. However! I have had some wonderful working relationships with people who come from completely different cultural backgrounds as I do, and I have had some non-working relationships with people within my cultures.

    My primary piece of advice for those in this situation is: don’t hunt for a unicorn. You might find a trained therapist who is a queer, polyamorous person of color who practices Santeria just like you, but then it turns out they live in a different state or they don’t take your insurance. My recommendation is that you start by making a list of the qualities of a therapist that are important to you, then rank the top three in order of importance. The therapist’s theoretical approach might be one of those (cognitive-behavioral, Jungian), but again you might be surprised to find you have great results with someone who does a therapy you thought you would have hated. I think one of the tasks of therapy is to confront the patterns of thinking that are keeping you stuck in a situation, and sometimes being exposed to an approach that feels very unlike your normal way of thinking creates great opportunities for change.

    Once you’ve gotten your top three, start looking at local agencies, search engines, or other resources that connect you to an array of therapists that you can sort through. If you are in a small community, you might look for therapists who advertise at events, on websites, or in publications targeted to your community. If those therapists are full, ask for a referral. Try to find one or two that meet your top three criteria, or at least two of the three.

    The next piece of advice I have is to call the therapist and, before even scheduling the intake, acknowledging any questions or concerns that you have. “I am a member of a minority religious community and I want to be sure that my beliefs will be treated with respect.” “I am involved in the kink community and am wondering if you have any familiarity with it, or if you have reservations about working with someone in that scene.” “I live outside the mainstream and I don’t want you to try to fix what I don’t think is broken.” Something like that. The importance of this question, in my opinion, is for you to get a sense of how the therapist receives and responds to your question. Maybe they have the “right” answer. Maybe they acknowledge having limited understanding of your community, yet their response communicates humility and nonjudgmental curiosity. That is gold. That is a person who will let you explore your experience, even if they personally don’t share your values, and who could challenge you in ways that help you grow.

    I might reframe my first piece of advice. Go ahead and hunt for a unicorn, but know that you might just find a good, workable horse who’s willing to wear a horn.