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I’ve never been to therapy, what should I expect?

Anna W

Whenever someone who has never been to therapy walks through my door, I always congratulate them on taking the first hard step inside. Therapy can seem very intimidating when you’re not sure what to expect… what the therapist will say, how deep things will get, how it will feel talking about personal difficulties, etc.

  1. Expect your therapist to ask about both about difficulties and highlights of your life
    • A good therapist won’t just focus on the bad or hard stuff. Your therapist should also ask about your interests, your social life, goals you’ve already met, and the better parts of your personality.
  2. Expect some unexpected emotions
    • Sometimes, people will experience some sudden tearfulness when talking about their difficulties. Other times, they are surprisingly casual when sharing a traumatic experience. You don’t have to do anything with these reactions just yet, just simply notice what is happening emotionally for you in the moment.
  3. Expect your therapist to talk about the therapeutic relationship itself
    • A lot (and I mean a lot) of therapy is learning to recognize your patterns of behavior, stuff that has become so habitual that it just becomes a massive blind spot. One of the ways therapists get clients to recognize their behavior is reflecting on the therapeutic relationship. Think “I notice you use humor to deflect whenever I ask a challenging question” or “I notice you get irritated with me whenever I point out your tardiness to session” etc. Be ready to talk about whatever is happening in the moment
  4. Expect things to get a little bit worse before they get better
    • I always give the analogy of resetting a broken bone. The resetting causes temporary enormous pain that can be as bad or worse than the actual break, but it’s for a good cause. Therapy can be much the same… you might feel a little worse off when working through difficult topics or emotions. Don’t worry, this won’t last forever, and it’s for a good cause.

There are as many ways to practice therapy as their are clients, but these are some consistent traits you will find across therapy experiences. Therapy should always pull you towards growth and healing, and you should feel like you have a trusting relationship with your therapist. Take the plunge into therapy, even if you are scared. It’s for a good cause.

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Why would a therapist not accept insurance?

Anna W

I will be answering this to the best of my knowledge as a therapist that accepts all major insurances.

The short answer is that insurance companies can be very difficult to communicate and work with through all parts of the reimbursement process. Behavioral health is its own branch of healthcare service, and many insurance companies contract it out. So you need a contract with the original company, and then whoever they contract out to. It’s a convoluted process to get paneled and reimbursed.

Another factor is reimbursement rates. This work is the clinician’s first line of income (many of us have side hustles), and an insurance company’s reimbursement rates might not match the clinician’s rates for self-pay.

Lastly, being a self-pay therapist allows for the most freedom for practicing clinical judgment. When insurance companies provide reimbursement, they are allowed to do records requests and dictate if they feel a client should continue treatment, decrease treatment frequency, or in some other way altar the treatment plan. A therapist can, of course, appeal an insurance company’s decision, but this is unpaid time.

So like with most things in life, there are pros and there are cons. I decided to accept all major insurances (including Medicaid) as access to care is an important guiding principle for my practice. But if you’re having a hard time finding a therapist that accepts your insurance, you’re not alone. I would encourage you to keep reaching out.

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What is the most effective form of therapy?

Anna W

Excellent question! And one that is actually pretty easy to answer. Most people are familiar with the third wave of therapeutic modalities… cognitive behavioral, dialectical behavioral, and acceptance with commitment (CBT, DBT, and ACT, respectively). These three are evidence-based and can be very structured modalities. But there’s a whole plethora of modalities… psychodynamic, somatic, solution-focused, Gestalt, and Adlerian, to name a few.

Fun fact! Did you know that DBT was developed by Dr. Marsha Linehan, who herself had borderline personality disorder?

Dr. Marsha Linehan

So, which modality is best? Actually, the answer is none of them. It turns out, one modality is not better than the other. The number one predictive factor for therapeutic growth and change is this… it’s the relationship. If you feel like you get along well with your therapist, you trust them and you feel like you can share anything, then there’s a pretty good chance you will have a good outcome with therapy.

A relational therapist is not rigid. I don’t say “CBT for everyone”, because it’s not appropriate for every client’s treatment plan. A relational therapist notices both the client’s strengths and areas of growth, which helps inform the therapist on what will be most helpful for the client.

So don’t be fooled by “CBT is best” or “ACT is the most helpful” (even though I really do like ACT’s principles). If you build trust with your therapist, then you are well on your way to positive change.

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What’s a DSM?

Anna W

I think we’ve all heard of the DSM at some point in our mental health journeys. So… what is it, exactly?

The DSM, also known as the Diagnostic and Statistical Manual of Mental Disorders, is on it’s 5th variation. Each variation comes with an updated list of diagnoses and criteria for each diagnoses. Often, names of diagnoses are changed to address the colloquialism of mental health disorders (eg., Munchausen’s by Proxy was changed to Factitious Disorder Imposed on Another… doesn’t have quite the same flow, but Munchausen isn’t even a real person). Some disorders are disposed of alltogether (homosexuality was dropped as a disorder in the 3rd variation), and sometimes, the powers at be change minute language to better match the statistical outcomes of what’s been researched.

So what does the DSM do? It serves as a basis when understanding basic criteria for mental health diagnoses. The DSM does not carry the breadth of symptoms for diagnoses. For example, an inflated sense of responsibility is a significant and debilitating symptom of OCD, but you won’t find it in the DSM. It’s a nuance of the disorder that isn’t part of the minimum criteria for diagnosis of OCD.

The DSM also serves as a universal playbook for licensed clinicians to bill insurance. Chaos would ensue if we didn’t have a universal standard for diagnoses and subsequent treatment plans.

To summarize… the DSM is useful, but doesn’t cover all nuances of every disorder. It’s called a manual for a reason… an instruction manual for your favorite IKEA furniture isn’t going to tell you all the great ways you can use your new rocking chair, it’s simply going to give you the building blocks.

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Introduction to The Nest

Anna W

Welcome to my fresh new blog! I’m so excited you have found this space. I’m excited to start posting! As with many things new and novel, of course I want to publish 10 posts in a row, but that’s a good way to burn myself out on the process. So I will start slow, and I hope to build a steady pace with posts.

With this blog, I hope to publish about a variety of topics and issues that my clients face. I may take a question about a diagnosis and flesh it out, or I may review current events that could have an impact on mental health (holiday cheer, anyone?). I would also like to speak on the therapeutic process (what is going through my therapist’s head when I drop the trauma bomb?), and I even might get personal and share some of my own experiences and insights from my therapy. Yes, therapists have therapists. As they should. The professional culture is designed to lift each other up.

I love the title of The Finch Nest, as it next evokes a sense of home and belonging. I have always relished the idea of coziness. Our friends in Denmark have a word specifically to describe the sense of coziness; hygge (pronounced hoo-ga). Hygge isn’t just a fuzzy blanket… it’s a sense of all encompassing warmth and cheer. Hygge is warm lighting with your favorite meal in the crockpot, holding a cup of hot cocoa and admiring your Christmas tree. Hygge is also laying out on the warm sand at your favorite beach with a can of soda in hand.

You get the idea. My hope is that this blog brings a sense of hygge to my readers. You are welcome here.