What To Ask When You Call a Therapist

What To Ask When You Call a Therapist

Finding the right therapist is daunting. Even for me- when my friends and family ask for help finding the right person to work with, I struggle.

There’s no perfect way to be sure that a therapist is right for you. That might be frustrating to hear already- that you can’t just pull up a score, or fill out a survey, and be assured by numbers and hard science that you’ve made the right choice. There’s not even one particular therapeutic approach that stands out as the “best”- some are better than others, but there’s no guarantee. And when you’re making a commitment of time, money, and your own vulnerability, it’s totally understandable to want the best you can possibly get.

Fortunately, it’s not quite that dire. What matters for you in finding a therapist isn’t their modality, training, or impressive CV- it’s that you feel heard and understood when you talk to them. Research shows over and over again that the relationship between you and your therapist is one of the most important factors in determining whether therapy will be effective. To put it simply: you just need to feel like your therapist gets you.

To help with this, most therapists offer free consultations. From the therapist’s end, they want to sort out whether your concerns fit with their treatment approach, and give you a chance to find out what you need to know to make your decision. If for any reason they can’t work with you, they should let you know during this call as well. For you, this is a way of finding out whether this person is going to understand you.

There’s no required questions to ask, and there’s no need to prepare for the phone call (other than finding some privacy so you don’t share your concerns with your coworkers or spouse). But if you want to come prepared, here are some that might help you figure out if this is the right person for you.

Have you worked with _____ before? This one is probably self-explanatory. While fit is super important, some level of experience with the thing that’s bringing you into therapy is pretty crucial.

What do you do to maintain your clinical skills? Most good therapists will keep up with a mixture of consultation (speaking with other clinicians about cases, while maintaining confidentiality, to see if they’re missing anything important), their own psychotherapy, trainings, conferences, reading groups, and self-study. Your therapist doesn’t need to do all of this, but if they try to assure you that they don’t need to do any, I’d call that a red flag.

How do you feel about _____? Do you have personal experience with _____? Yes, it’s okay to ask your potential therapist questions about their personal life or personal feelings. Therapists vary pretty widely in how much they prefer to disclose, but any professional will be comfortable declining to answer anything they don’t want to. And there may be something important to you- if you’re LGBT, your therapist better damn well be LGBT-affirming and knowledgeable. If you’re a parent, you may prefer a therapist who is also a parent so they can really understand what’s going on for you. If you’re recovering from an abortion, you probably don’t want to work with someone who’s pro-life. And if spirituality is a big resource for you, you may want to work with someone who understands that feeling.

But really, how does it work? If you’re confused about any of the nuts-and-bolts type of stuff- frequency, scheduling, homework, or confidentiality- it may be really helpful to get clear about what you’ll need to do to be successful with your therapy.

These are just a few ideas- there really aren’t any wrong questions, and there isn’t a rule that you have to ask any. In writing this, I hope I helped you think through what you really need to feel supported in a therapy relationship (even if it’s not with me!) and gave you permission to communicate your needs. And communicating your needs is another key to successful therapy and successful relationships- so you’re hitting the ground running!

So now you know why I offer a free introductory phone call– because it’s really important to help you decide if this is the right therapy for you. If you’re in San Francisco or the East Bay and looking for therapy, get in touch- let’s find out if we’re a good fit!

How to Opt Out of Diet Culture

How to Opt Out of Diet Culture

First, let’s define “diet culture.” The internet has lots of varying definitions for this term, so I’ll focus on diet culture as it affects the people I care about both in and out of my office: a culture that conflates thinness and certain styles of eating with beauty, morality, and well-being, despite plenty of evidence to the contrary.

Is healthy living bad? Of course not! Eat foods that make you feel alive gorgeous inside and out, and move your body in ways that are affirming and fun. You can even work on changing your body if that’s your jam. But what I want to warn you about is making body size, eating, or exercise anything “more” than just that.

For most people, opting out of diet culture starts with three levels of awareness: advertising and media, interpersonal relationships, and finally their own thoughts and choices. In each category, we’re aiming for mindfulness- just become aware of what you’re hearing, seeing, and thinking and how that affects you.

  • Advertising and media: Ask yourself a few questions. In the media you regularly look at, whether it’s TV or magazines or instagram or anything else, how are bodies portrayed? Is there a wide variety of shapes and sizes, or do you see only one “type” of person? (lookin’ at you, Yoga Journal and Psychology Today). What about eating- are there foods portrayed as “good” or “bad?”
  • Interpersonal relationships: How much of your day-to-day interactions center on discussions of food or dieting? When you’re out with friends and someone orders fries or desert, do they make comments about being “bad” or “deserving it” or what they’re doing to burn it off? Diet-culture-moderated talk is a pretty common bonding method. Important!: It’s really crucial to remember that we’re not trying to change anything or judge anyone here. And we’re definitely not going to change someone else’s way of thinking. I’m just asking you to notice diet culture in your relationships so you can make informed choices about how much to engage with it.
  • Your own thoughts:  Now’s where it gets tricky. I’m not gonna lie- for most people I work with, this aspect takes a while to master, but you’ll feel better with even a little bit of awareness. What thoughts run through your head as you make choices about eating or exercising? Can you feel sexy in your body as it is today- and do you think you could feel sexy at 50 pounds heavier or lighter? Again, we’re not looking to change anything directly, which is cool, because you’re not your thoughts despite having a lot of them.

 


OK, Abby- I did the awareness work and can see that my life is positively steeped in diet culture nonsense. What now? Good question! In session, we’d rely on your felt sense- an inner way of knowing- to determine which place to start “opting out.” Since you don’t have me to coach you through that right now, I’m going to ask you to pick a low-hanging fruit: something that feels easy.

The key is to add something in rather than change something. Here are a few examples from each category:

  • Advertising and media: When you see the thin ideal or “fat shaming” in mass media, silently affirm to yourself, “That may be their ideal, but it isn’t mine.” Follow body-positive artists and activists on social media to expose yourself to other ideas of beauty.
  • Relationships: Make a point of being relentlessly positive with people you care about. Tell them when you think they look great, or when you’re really impressed with something they’re doing. Make it super clear that you love them regardless of size- and that you hope they will treat you with the same kind of care.
  • Your own thoughts: When you catch yourself thinking shitty thoughts about yourself or your habits, ask yourself what you’d say if someone you loved- your best friend or partner or child- said those kind of things. Acknowledge the thoughts: “I hear that you don’t like your _______ right now, but I hope you know I’m so proud of you for _______.”

 

This is definitely a “yes, and…” approach to reclaiming your relationship with your body and food. If it were up to me, magazines would show gorgeous people of all shapes and sizes, friends would be positive and nurturing, and your own inner critic would be helpful rather than a jerk. But that’s not usually the case, and as we talked about last week, you can’t force something to change without accepting it.

I often remind my clients that ditching the diet mentality means being “sane in an insane world”- even when you’ve completely let go of it, you’d still probably be getting negative messages on a daily basis. So please treat yourself with kindness and approach this as an open-ended exploration- it can be so amazing to see what you can create when you let go of the diet culture focus.

I know this isn’t easy, and I want to support you on this empowering journey. Schedule a free phone consultation to discuss whether therapy can help.

 

Why is Acceptance the Key to Growth?

Why is Acceptance the Key to Growth?

I’ve been doing some self-reflection lately about what is important to me about this work, and I keep coming back to the idea of acceptance. This is so important to me that I have a mission statement with the sentence:  “Everyone deserves acceptance.”

One of the pioneers of this field, Carl Rogers, posited the idea of unconditional positive regard– that is, that the therapist responds to the client with complete, loving acceptance. And yet, most people come into therapy wanting to change something about the way they behave, feel, or think. In Rogers’ thinking (and mine!) change and full acceptance are not incompatible- in fact, acceptance is a necessary ingredient for change. It’s my hope that in experiencing positive regard from me, you’ll gradually be able to cultivate self-acceptance.

Many people believe they need to be harshly self-critical in order to change. My clinical experience leads me to disagree. Shame and self-criticism sometimes feel productive, but very little lasting change comes from shame. Most of us have had one or more habits in our lives that we try to self-berate ourselves out of doing and that white-knuckle, miserable approach may work temporarily but rarely lasts.

Self-acceptance does not mean you are okay with everything about yourself and have no desire to change. Not at all. In fact, accepting yourself means embracing all the things you don’t like about yourself and the reasons they exist.

Let’s say you hate the way you snap at your partner after a long day. After you snap, you feel guilty and awful, because you want to be a better partner than that. Self-acceptance doesn’t mean you just drop the guilt and say shitty things left and right. It does mean that you acknowledge that you’re less loving when tired or cranky or dehydrated or off-center. It means you appreciate that you’d like to be better. It means you make a realistic plan for how to be better and what to do when it happens anyway.

So the next time you snap at your partner, you take a deep breath. You acknowledge that you had some feelings that were not well-cared-for. You sit with the disappointment. You may apologize to your partner, able to sit with their frustration or hurt as well.

In short- self-acceptance broadens your capacity. You can do so much more from a place of ease and self-love than from shame.

Doesn’t that sound amazing? Let’s work together to create a field of acceptance and growth- book a free intro call with me today.

Boundaries: Why They’re Awesome and How to Create Them

Boundaries: Why They’re Awesome and How to Create Them

Boundaries are love.

Bear with me here. I know we don’t always feel this way. After all, it doesn’t always feel great when people set boundaries with us.  You probably don’t consciously want your friends and loved ones to say “no, you can’t do that.” But if you’ve ever found yourself up late at night wondering if you offended someone or overstepped, you know what happens when boundaries aren’t communicated well.

I like to think of boundaries like the rules of a good board game: things are just more fun when the rules make sense. If everyone on board understands the rules, you can relax into the experience and get as silly or competitive as you like- but still be friends at the end of the evening. If the rules are fuzzy or unclear, though, or people “choose” to interpret them to their own benefit, you might have a really miserable time arguing about them. If you are super clear with the rules, you might mutually decide to flex them a little bit for some “house rules.” This, too, can be really fun.

That’s how relationships should be. If you know where the lines are and how not to cross them, you can relax. You can experiment with different behaviors, knowing they’re not against some secret rules. You can be messy- which in my book, is definitely a prerequisite to intimacy.

Of course, it isn’t always that simple. It’s hard to know what kinds of boundaries you really need, how to tell people that without being super awkward, and what to do when people trample over them anyway. You may have thrown up your hands and said “fuck it” in one or more boundary-necessary situations. Stick around- we’ll talk about how to ID them, how to set them, and how to maintain them so your relationships can get way more comfy.

 

Boundaries: What are they?

We all know the literal definition- a line that separates two things. We have ways we don’t want to be treated, and we can ask people to respect those boundaries. In interpersonal relationships, we can think about two kinds of boundaries: physical and non-physical.

 

Physical Boundaries

We all know the proverbial line in the sand- don’t move past this point! Physical boundaries can be about your body, like not wanting people to come within a few feet of you, or not wanting someone to touch you. We all have physical boundaries to maintain a sense of physical safety.

You also probably have physical boundaries with your home and belongings. For example, if a stranger came to the door and you answered it, it would be really uncool for them to barge right in. And you probably don’t want your partner to mess with your clothes or your journal.

 

Non-physical Boundaries

These boundaries delineate ways you’d like to be treated in relationships or socially. Many people aren’t OK with their partner raising their voice at them- that would be a boundary. You may not be comfortable with people asking about a medical condition or difficult relationship. You may not like a person you’re dating texting you about their feelings. Many people find relationship boundaries a lot harder to set, because they’re not as universal or easy to visualize.

You’ll also have to negotiate boundaries in your relationship to yourself- like not becoming agitated when others do, or not snapping into “caretaking mode” simply because a loved one is unhappy.

 

Determining Your Boundaries is an ongoing process

Good news! You don’t need to sit down today and know exactly what your boundaries are in all realms of life. For most people, figuring out their boundaries takes time. It often takes someone crossing a boundary to realize you had it in the first place.

I stress this because clients often put so much pressure on themselves to already have a perfect map of their boundaries- and many feel that such clarity is a prerequisite for conversations about them. While I do recommend being consistent about your boundaries and not changing them dramatically week-to-week, most worthwhile relationships should be able to withstand a request like this:
“I’m not sure if I am comfortable doing X with you. I’d like to experiment with not doing it for several weeks and we can check back in about it.”
Good boundaries are also flexible. On a crowded Muni/BART train, you might be somewhat OK with people brushing against you, but that is probably not going to be the case in a more spacious park.

 

A  Few Simple Rules for Communicating Your Boundaries

Many of us don’t communicate our boundaries- and often hope that nobody goes near them. Many of us have been socialized to be accommodating, or are afraid of being rejected or hurt when we draw a line. Even worse, we might have early memories of our stated boundaries being ignored or laughed at. Communicating them can be a leap of faith.

To start, the saying “‘No.’ is a complete sentence” is spot-on here. Boundaries don’t require explanation. If I don’t want to be talked to on public transit, I don’t want to be talked to. If you’re not comfortable doing something with your partner, you are not required to provide an explanation.

If you do decide to explain, be respectful but firm. Your preferences and rules are just that- yours. You do not need permission to set them and they don’t need to make sense to the other person. These choices do impact others, so it is a good idea to acknowledge that impact and consider how to minimize it. And of course, be respectful of other’s communicated needs whenever possible.

 

Some people will always push your boundaries

Clear communication isn’t exactly a foolproof plan for physical and emotional safety. Almost everyone knows someone who repeatedly “pushes” boundaries- not outright crossing them, but making you nervous that they might. And lots of people know someone who loves to trample right over them.

I view boundary-setting as an internal process that we practice in external relationships. That means that, no matter the reaction the other person has, setting a boundary is always a win. Yes, really. If I say “please don’t cross this line” and you go ahead and cross that line, I’ve still done something healthy. I’ve affirmed for myself that my needs are important to me, even if they aren’t important to you. I have a better context for understanding my feelings. And I’ve practiced good communication and relationship building, which will over time improve the quality of my relationships.

 

Want to go deeper?

Boundary-setting is a concept I talk about all the time in therapy- and of course more complex than a single article can address. Make an appointment with me and we’ll figure out how to create more clarity and ease in your relationships.

 

How to Know if You’re Centered

How to Know if You’re Centered

“Centering” isn’t a major concept in any therapeutic modality that I practice, yet it is so integral to how I conceive mental health and thriving. In my practice, “centered” means you are aware of your body and able to work with it as a partner and an ally. You take good care of your physical self and are rewarded with mental clarity and intuition. In short- good stuff!

 

We all know what it’s like to be “off center”- we make choices we later regret, say things we don’t mean, and generally don’t feel like ourselves. If we’re lucky, or we’ve done a lot of personal work- we can sometimes know that we’re off center. But knowing doesn’t always mean we can “snap back” to a clear, calm sense of self.

Here are some ways that I, and my clients, know that we are centered

  • We can feel our feet on the ground
  • We can breathe easily
  • Our heads feel pretty clear
  • We are aware of what emotions we’re feeling
  • We are aware of where we are in space
  • We can engage with others with clear boundaries and genuine curiosity
  • We feel connected to our values

 

Getting “off center” is a natural part of day-to-day life and usually nothing to worry about- unless you spend the majority of your time there. You can maintain center by attending to your physical and emotional needs:

  • Making sure you are well hydrated
  • Making sure you are well fed
  • Making sure your body is comfortable
  • Taking a mental inventory of your stressors and fears

 

If you think about centering as a bullseye, this basic self-care will at least get you near the outer circle! Once you can actually see your target, you can refine a little more by engaging mindfulness:

  • What sounds can you hear? Notice sounds both close to you, inside the room or building you’re in, then sounds further away, perhaps a few blocks.
  • Feel the weight of your body on whatever is supporting it right now (chair, bed, floor)
  • How deeply can you breathe without pushing or forcing anything? If it’s shallow or fast, that’s totally fine. Focus on releasing tension with your exhales, and inviting the inhales deeper into your belly.
  • What is the quality of your thoughts right now? Are they fast or slow, agitated or curious?
  • Do you know how you’re feeling right now? If it’s “okay,” probe a little deeper to see if it’s something like “numb” or “content” or “distracted.”

 

I hope you can generally get yourself back to somewhere-near-center on your own, but if you’re having a hard time getting there frequently, it might be time to get some help. Schedule an intro call with me here to see if counseling is what you need to get back to your center.

 

Catch my interview on BFF.fm radio!

Catch my interview on BFF.fm radio!

Last week I had so much fun as a guest on Radical Advice on BFF.fm, a community radio station in San Francisco.

Host Lily Sloane and I talked about therapy, family boundaries, Weight Watchers and anti-dieting, and trauma. There were lots of giggles and a few tears.

You can hear the broadcast here.

Radical Advice airs Tuesdays from 10-12 PST and you can catch the playback.