What is EMDR Therapy?

EMDR Therapy (Eye Movement Desensitization and Reprocessing)

TREATMENT for TRAUMA, ANXIETY, OCD, CHRONIC ILLNESS, and MORE

EMDR therapy is one of the best-known and most effective psychological treatments for trauma and post-traumatic stress disorder (PTSD). In addition to treating trauma, EMDR can also be used to treat a surprising variety of other issues such as anxiety, chronic pain and illness, phobias, OCD, performance anxiety (such as in sports or exam-taking), addiction, phantom limb pain, and even irritable bowel syndrome. It combines recalling old memories with targeted back-and-forth movements (such as tracking a moving object with your eyes, holding handheld buzzers that alternate gently between each hand, or crossing your arms in a “butterfly hug” and then tapping your hands across your shoulders), to help re-process distressing thoughts and memories, and reduce the degree of distress attached to them.

Why does EMDR work for so many different things?

Our minds and bodies are inextricably connected, and when we have gone through an extremely difficult experience, our bodies can sometimes have difficulty returning back to a relaxed baseline, and so we react as if we are constantly under threat, whether that means being emotionally on edge, or in chronic physical pain. EMDR can address both the mental and physical manifestions of chronic, toxic stress that underlie a wide variety of emotional, psychological, and physical problems.

Why Is Processing Trauma Important?

When people have experienced something traumatic, it’s natural for them to want to put it in the past and try to forget about it. But the problem is, sometimes the event is not easily forgettable, either because it was so upsetting or so ongoing. And because our brains are good at telling us when our bodies need to take action to resolve something (like sending us hunger pangs when our stomachs are empty), our brains might also keep sending danger signals long after a trauma has passed, reminding us that we’re still distressed about it. So instead of forgetting the trauma as we’d hoped to do, we end up being continually reminded of it through flashbacks, anxiety and nightmares; or we find it so intolerable to remember the trauma that we numb our emotions completely, float through life absently, or block out whole time periods from our memory. And while these are all admirable survival instincts that our brains use to try and protect us, they can make us miserable when unresolved, either by disrupting your sleep, leaving you emotionally numb or robotic when you wish you could feel more present, or leading to chronic physical health symptoms as a way of expressing the emotional pain that you haven’t been able to resolve.

What does processing trauma with EMDR look like?

The goal of EMDR is essentially to provide a safe and structured framework where disturbing thoughts and memories can be allowed to surface, but without having to linger on or talk much about them - instead, you’re imagining the details of the event passing by as if you’re a passenger on a train, while incorporating back-and-forth movements that mimic the kind of back-and-forth fluttering your eyes do during REM sleep. Ever noticed how when you “sleep on” an issue, you often wake up feeling more calm and clear-headed about it? While sleeping on day-to-day stressors is often sufficient for feeling better, traumatic memories require a bit more direct intervention. With EMDR, you’ll use back-and-forth, REM-like movements that assist with processing — but you’ll be awake and alert the whole time — and you’ll have the help of the therapist to guide you through the distressing content that your brain has had trouble “putting to rest” on its own.

Is EMDR Overwhelming?

Sometimes people worry that they’ll be so overwhelmed by revisiting painful memories that it will just make everything worse, or conversely that it will be hard for them to access their feelings at all when they’re so used to feeling nothing.

That’s why you and your therapist will do some really good, thorough preparation work before starting any reprocessing. Whether you’re the type of person who gets easily overwhelmed with emotion, or struggles to connect to any emotion at all, we can tailor the process to a pace and approach that works for your personality type.

Preparation is Key

Your therapist’s job is to help you feel prepared both with what to expect about the process of EMDR, as well as teach you calming strategies that the two of you will use to close each EMDR reprocessing session. You can also pause and use these strategies anytime during the session as needed if things get too overwhelming. And while it’s possible that you might feel momentarily overwhelmed during the process, you and the therapist will be working together to identify and operate within the “sweet spot” of what we call your zone of tolerance for distress. If things get too distressing, we will pause and use a variety of calming and grounding strategies to help you get back to a more comfortable emotional baseline.

We want to make enough space for emotion that your brain can do its job of reprocessing, but not throw you in the deep end of painful emotions with no ladder out — that would be counterproductive and re-traumatizing, and it’s exactly what an EMDR therapist is trained to prevent from happening.

Growing Your Ability to Tolerate Distress

That said, one of the goals of EMDR is to increase your zone of tolerance for handling difficult emotions, so that you don’t feel so triggered or overwhelmed by life. Part of how we achieve that is by practicing toggling back and forth between the difficult emotions and the calming strategies you will learn. Through the experience of increasing trust with your therapist, the relief you begin to feel from the reprocessing work itself, and the experience of being able to stretch briefly into negative emotions and then come back to center, your ability to handle distress will grow stronger. You’ll be able to trust more and more strongly that “I can feel sad / angry / scared, and still know that I am safe right here, today.” In other words, we’re re-training your nervous system to be able to re-establish a sense of safety instead of a constant experience of being triggered and under threat.

How Do People Feel During EMDR?

This varies quite a bit from person to person. Some people cry during EMDR reprocessing sessions. Some people feel angry, or numb, or empty. Sometimes people even laugh as they come to new insights. There is no “right way” to feel during EMDR - we are just following and noticing together where your mind takes you during the process, and your therapist is there to gently direct as needed.

How Quickly does EMDR Start to Work?

Some topics can be fully resolved in just a single session of EMDR, but it’s more common for the process to take multiple sessions per issue. For traumas that were recurring, and are therefore connected to many different memory networks in the brain (such as a history of childhood abuse), it will of course take a greater number of sessions to resolve the distress associated with those memories.

That said, many people begin to experience some degree of relief starting right from the first session of reprocessing, and your brain continues to process the material on its own for 2-4 days following your session, so by the time you come back in for your next session, you may have progressed even beyond where you left off with your therapist.

Compared with traditional talk therapy, the results people experience with EMDR often happen within a matter of weeks to months (rather than months to years).

How Do You Feel After an EMDR Session?

The most common thing people report feeling after an EMDR session is “tired but good.” Each session will end with some sort of calming practice or closure so that you feel composed and ready to go back out into your day.

It’s common to feel wiped out after an EMDR session, and many people prefer to schedule sessions for a time of day when they don’t have to rush off to another commitment and can spend some time reflecting and winding down afterwards.

Others might leave a session feeling invigorated or like they have a renewed sense of clarity and confidence. Much of it depends on what we are working on that day, and whether we’re in the middle of reprocessing difficult material, or we are “adding in” some confidence-building material.

It is certainly possible to feel “worse before you feel better” as you’re starting out with EMDR, and this is normal. After all, we’re reopening some topics or memories you’ve worked hard not to think about, which could leave you feeling more emotionally vulnerable or raw following an EMDR session. You’ll be encouraged to take note of anything unusual or concerning that you might experience between sessions and let your therapist know, which will help provide good information about the way your brain is processing and how the therapist can best structure your treatment.

What is the Goal of EMDR Therapy?

Simply put, the primary goal of EMDR is stop old wounds from running your life. Here are some of many things that can also result from EMDR:

• The elimination or partial reduction of physical or emotional symptoms related to trauma (e.g., nightmares, OCD compulsions, chronic pain)

• The ability to cope more effectively with future stresses and challenges

• Greater emotional maturity and flexibility

• The ability to be more emotionally present, available, and connected to others in satisfying relationships

• The ability to integrate and make meaning out of life experiences that were previously incomprehensible

• A greater ability to self-advocate

• A strengthened sense of one’s identity, agency, autonomy, safety, confidence, voice, and/or value as a person

• Strength and resilience in future decision-making

Why I Love Doing EMDR Work as a Therapist

EMDR has brought relief and deep healing to my clients more rapidly and effectively than anything else I have seen. The beautiful thing about EMDR is that it can be so tailored to each individual, and can be paired with regular talk therapy, or done all on its own for a more intensive approach. And as opposed to talk therapy (which is very left-brain heavy work), EMDR focuses on the right brain, which is the less verbal, more intuitive, creative side. There are moments in this work where people come up with profound and poetic insights that talking alone would never have brought them to, and it’s amazing to see the human brain doing what it does best — pursuing its own healing.

If you’ like to learn more about EMDR and whether it could be a good fit for you, visit my Contact page and send me a message. I’d be happy to connect!

-Rachel

How Can I Get Insurance to Help Pay for Therapy?

Will My Insurance Help Pay for Therapy?

Easy, affordable access to mental healthcare access should be a given, for anyone who needs it. And yet for many people, the cost of accessing therapy can feel out of reach.

If you’re starting the search for a therapist, you might be wondering:

• What are the options available to people to help make therapy more affordable?

• Will insurance help cover the cost of my therapy?

The short answer: It depends.

How much — and whether — your insurance will reimburse you for the cost of therapy depends on the type of insurance you have, the deductible associated with your plan, the type of diagnosis you will be receiving treatment for, and, honestly, the whims of the insurance company. I’ll explain.

What kind of insurance do you have?

If you have an HMO insurance plan, your insurance will only pay for you to see someone “in-network.” I, for instance, am not in-network with any insurance company, but if you want to use your HMO insurance for therapy, you can contact your insurance company (or check their website) for a list of the in-network providers they contract with directly.

If you have PPO insurance, you can select any provider you wish, but getting reimbursed for therapy usually means paying the fee for sessions out of pocket and then submitting a “superbill” (an official receipt for services which includes a mental health diagnosis) to your insurance afterward, and receiving a check in the mail after the fact.

What’s Your Deductible?

Whether you’re looking to see a therapist in-network or out of network, your particular insurance plan may have a set “deductible,” i.e., an out of pocket amount that you must pay for services in a given calendar year before insurance will chip in anything. This can be a huge variable in determining whether you’ll see any insurance reimbursement for the cost of therapy, and how much.

To find out what your deductible is, you can call the customer service number on the back of your insurance card, look at the plan details provided by your employer, or (my personal favorite method), use an outstanding new app called Reimbursify to check your benefits (and easily submit out-of-network claims, too). I love this service and I use it to help prospective clients check their coverage, as well.

Not all diagnoses are equal

To reimburse for mental health care, insurance companies require your therapist to specify a mental health diagnosis (or diagnoses) from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, also known as “the DSM” (currently in is 5th edition, DSM-5).

However, not every condition listed in the DSM may be considered “reimbursable” by insurance. For instance, there is a whole section in the DSM-5 manual which lists various problems of daily life or circumstance that are significant enough to require support but don’t quite fall under the umbrella of mental health disorders (these situational stressors are called “V-codes”). Some insurance companies may not reimburse for treatment if a V-code is the only diagnosis, so you should discuss this with your therapist before starting treatment if being able to get insurance reimbursement is a necessity for being able to work together. Your therapist cannot assign you a diagnosis that you do not actually have just to get insurance reimbursement for you, but they may be able to offer you a sliding scale fee, or refer you to another practitioner or clinic that can work within your budget.

Insurance Companies Make the Rules

When you’re using insurance to help pay for therapy, the amount of possible reimbursement you may receive depends on the rules set by each individual insurance company. Each insurance company sets a “usual, customary, and reasonable (UCR)” amount that they are willing to reimburse for various services. This amount is based on what is typically charged by similar providers who work within the same geographic area.

Depending on what the insurance company has decided they’re willing to pay for different types of diagnoses and service types, you might receive total or only partial reimbursement for the cost of a given session. Insurance companies really don’t like to disclose ahead of time what their established “customary" fee is for a particular service, so often you don’t find out how much reimbursement you’ll receive until you get the first check from them in the mail.

Questions to Ask Your Insurance Company When Checking Your Mental Health Benefit Coverage

If you are going to be checking on your own benefits coverage (rather than having a prospective provider doing it for you), here are some important questions to ask your insurance:

1) Do they reimburse for out-of-network mental health services, or do you need to see a provider within their specific network for services to be covered?

2) Is there a maximum benefit amount you can receive per year? (ex. do they cap you at a certain number of sessions per year?)

3) Do they reimburse for telehealth? Certain states, such as California, have telehealth parity laws that require insurance companies to reimburse for telehealth sessions at the same amount as they would for in-person sessions. Unfortunately, while insurance companies have been covering telehealth services more broadly since the onset of the pandemic, not every state has the these same parity laws which require insurance companies to do so.

4) Does your plan have a deductible you need to meet, and if so, what is that amount? The deductible is a set amount decided by your insurance company that you'd need to pay out of pocket during a particular calendar year for mental health services, before they'd begin to reimburse you a portion of the cost. There may be a separate deductible amount for in-network services versus out-of-network services, so be sure to ask what the amount is for both.

How to Submit Out-of-Network Claims For Therapy to Your Insurance

The process for submitting out-of-network claims varies by insurance company:

• Sometimes, your provider can submit the claim directly to insurance on your behalf (this is somewhat uncommon, though, because it usually requires hiring a designated insurance billing person to handle this task).

• Some insurance companies make it easy for you to submit out-of-network claims with a few clicks on their website.

• Others require that you mail or fax them a paper copy of your superbill for sessions in order to process your claim.

• You can get the free Reimbursify app, and sign up for an individual account. If your provider is already set up with Reimbursify, you’ll be able to submit a certain number of claims per year for free (if not, it’ll cost you about $2 per claim to submit your own).

How To Pay for Therapy Without Insurance

If you don’t have insurance coverage, the provider you want is out of network, or you don’t feel comfortable with a mental health diagnosis going onto your medical record*, here are some additional options you can pursue to pay for therapy out of pocket:

• Explore paying with funds from an employer-provided health savings account (HSA), medical savings account (MSA), or flexible spending account (FSA). Your employer may also be able to provide a limited number of counseling sessions through a therapist contracted with their Employee Assistance Program (EAP). Ask your employer about whether any of these types of benefits are available to you as part of your benefits package.

• Ask your prospective therapist if they have any discounted “sliding scale” spots available, and if so, for what duration of time.

• Search online directories that list therapists who accept sliding scale rates or who work within the specific price range that fits your budget (for two great options check out Mental Health Match and Open Path Collective)

• For more help in finding a great therapist you click with (in your area, price range, and preferred demographic), check out my resource-packed blog post on How To Find a Good Therapist.

*Note: Your medical record is private information is covered by HIPAA law in the U.S. Your private health information cannot be shared without your consent, with a few legal exceptions. Ordinarily, your mental health diagnosis remains private information unless you choose to disclose it, but to my knowledge, there are a few areas in which life could possibly be impacted by having certain types of mental health diagnoses on your record. These most notably include applying for life insurance or long-term disability insurance, and historically, people have been concerned about the possible impact to their job prospects in fields such as law enforcement, public safety, ministry, aviation, the military, or other types of jobs that could require a psychological evaluation. If you are concerned about the possible impact of a diagnosis, please discuss this with your therapist at the outset of treatment or consider paying out of pocket for your therapy without seeking insurance reimbursement. If you have received a past diagnosis that you feel is incorrect, or your condition has noticeably changed, you should mention this to your new therapist, as well. Your therapist can perform their own assessment and add any new information to your record to reflect why they believe an updated diagnosis is appropriate; however, an old diagnosis cannot legally be deleted from your record.

Therapy Should Be For Everyone

There are so many options that exist today for seeking mental healthcare, as stigma surrounding mental health decreases, and access to mental healthcare improves. Now more than ever, in a world that will be grappling for a long time with the mental health effects of the pandemic, everyone who needs support should have the opportunity to find it. Don’t let fear of the cost stop you from reaching out for the help you need.

For further reading, check out Why People Go To Therapy.

Important disclaimer: Although I am a licensed marriage and family therapist by profession, I am not YOUR therapist. The content on this site is for informational or educational purposes only. Although I strive to provide accurate general information, the information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Your use of this website does not establish any kind of patient-client relationship with me, and you should consult a healthcare provider in your area if you are seeking medical advice, diagnosis, or treatment. Reliance on any information provided herein is solely at your own risk.

Why Does Therapy Cost So Much?

There are so many obstacles that stop people from seeking therapy, and cost is a major one. Many people who are curious about therapy are unsure how to find a good therapist, or might think their concerns aren’t “serious” enough for therapy. There can be cultural factors and social stigma that discourage people from looking for emotional support beyond what’s available within their family, or perhaps their church. But for many people, the number one obstacle to accessing mental healthcare is the cost.

Why is Therapy So Expensive?

Therapy is a Form of Healthcare

The cost of therapy can range anywhere from under $50 to $200 or more per session. Costs vary widely depending on the license type and experience level of your therapist, whether they have advanced specializations, and the going rates for therapy where you live. Although people might think nothing of spending $100+ on an occasional self-care expense (a woman’s haircut can easily run that much), when it comes to therapy people often have a hard time justifying the ongoing expense, unless there’s an acute crisis.

But in reality, therapy for mental health belongs in the same category as any other kind of healthcare, both in the complexity and variety of conditions it addresses, and in the degree of positive (and preventative) impact it can have on a person’s functioning. Just as getting treatment for a broken femur allows you to perform some pretty critical daily functions, getting treatment for anxiety, anger, trauma, or a troubled relationship can help give you the emotional skills, mental flexibility, and coping abilities needed to function better in some of the most pivotal areas of your life. Not to mention the fact that unresolved emotional difficulties can often begin to manifest as physical symptoms if left untreated — e.g., digestive issues, chronic pain, fatigue, immune disorders, headaches, and more. Your mental well-being is an irreplaceable resource for you to be able to go to work, be a functional parent, maintain the relationships on which your quality of life depends, and better cultivate the awareness of what your physical body needs to stay healthy. Our emotions and our physical health are inextricably linked, and as a society we are finally beginning to acknowledge that.

You’re Paying for Your Therapist’s Expertise

As with the medical profession, much of the fee you pay has to do with what your provider knows, not just what they do. If you’re working with a licensed mental healthcare provider (whether they’re a therapist, psychologist, or psychiatrist), that person has spent YEARS obtaining a Masters degree (if not a doctorate as well), and completing thousands of hours of closely supervised additional training. They need to know enough to be able to independently diagnose and treat an extensive variety of mental, relational, and emotional concerns. A single therapist needs to have a broad working knowledge of just about every topic related to human behavior and functioning (neuroscience, cognition, sleep, motivation, relationships, communication, and sexuality, just to name a few), as well as a specialized knowledge of an array of specific disorders and their treatment protocols. To top it off, they need the interpersonal skill and technique to communicate and implement all that head knowledge in a way that’s actually useful to people.

You’re Paying for all the Time Your Therapist Puts in Outside of Session

In addition to what happens in session, there is also a lot that happens off the clock to bring you the best possible care. In many ways, a therapist cannot take you further in your personal growth than they have gone themselves, so their continued growth, both in clinical skill and in personal maturity and wisdom, are actually quite vital to what you can hope to gain from therapy.

The cost for therapy actually covers:

• time for your therapist to read and keep up on current psychological literature,

• time to attend ongoing trainings and professional conferences,

• time to maintain good clinical records, write treatment plans, and keep up with legal compliance requirements for their practice,

• time to complete the recurring continuing education courses required by their licensing body in order to maintain their professional competence and a license in good standing,

• time for to regularly engage in professional consultation with other mental health clinicians,

• time to respond to client emails and provide you with referrals to additional resources as needed (e.g., nutritional consultants, psychiatrists, and other specialists — and perhaps even books and resources relevant to your ongoing treatment),

• time to run the nuts and bolts of their business so that clients can interface with a well-organized system for scheduling, attending sessions, and evaluating progress on their goals,

• time to do marketing so they can stay in business, and ensure that the people who need their help can find it,

• time to participate in their own ongoing therapy so that they are always growing, too (and can remain sensitive and present to the experience of what it’s like to be a client).

All of what happens outside of session allows your therapist to show up as the person that they do in your work together, and to constantly be learning and growing alongside of you.

All of it is important to the quality of care you experience as a client.

Why Don’t More Therapists Discount Their Rates?

In my experience, most therapists wish they could offer more of a discount. We go into this profession to help people, above all else. And while the hourly rate can seem expensive, the vast majority of therapists are not providing 40 paid hours of counseling per week (and the ones who do burn out very quickly). If you’re curious, a “full caseload” is roughly 20 clients per week, give or take — but this varies widely depending on the clinician, whether they have a child with special needs at home, or any number of other personal factors that are largely invisible to the client. For therapists, “full time” work is essentially defined as the number of clients that your life can realistically sustain while still allowing you to provide a high-quality standard of care.

The vast majority of the therapists I know are incredibly gracious with regard to fees, and in fact have spent years undercharging what their services are worth. Many therapists offer pro bono sessions to certain vulnerable populations, or discount their fees to assist clients during periods of crisis. But if your therapist is not able to offer those accommodations, remember that their choice to charge a higher fee may be a big part of what enables them to limit their client load in order to bring you the best, most attentive care.

Why Don’t More Therapists Take Insurance?

There are a lot of answers to this question, and for a detailed look into this issue see Dr. K. Dixon’s article on the 10 reasons why more therapists don’t take insurance. But to put it simply, here are two of the biggest reasons:

• Insurance companies grossly underpay therapists for their services. Each insurance company essentially decides whatever amount they are willing to pay a therapist for services rendered to treat a specific diagnosis. It can vary from one insurance company to another, and by geographic area — meaning that compensation is not based on the therapist’s own rate, or level of experience. As a result, solely insurance-based therapists often have to add many more clients to their caseloads just to survive in business, leading to professional burnout and poorer client outcomes.

• Insurance companies benefit by finding ways not to pay for the services people need and deserve. They can make demands of providers that are enormously time intensive, forcing them to justify their services, or even “clawback” thousands of dollars they’ve paid to therapists in the past, sometimes for administrative mistakes that they themselves have made. The likelihood of being underpaid, and the time required away from seeing clients to deal with administrative headaches, discourages many therapists from accepting insurance, even though it kills us to see so many people not getting the treatment they need. Removing the societal obstacles to affordable mental healthcare access is something we all need to work together to change.

That said, even if a therapist does not contract directly with your insurance company, there’s a good chance you might be able to get some of your therapy reimbursed through “out of network” coverage. For more on the ins and outs of using insurance, check out How Can I Get Insurance to Help Pay for Therapy?

Where To Find Affordable Therapy

The good news is, even without insurance, there are still options for people who need more affordable therapy, and of course there are ways to find a therapist who works with your insurance. Many therapists will reserve a couple of spots in their caseload specifically for sliding scale or insurance clients, so they can run a financially sustainable business but still help more people who otherwise might not be able to access mental healthcare.

Here are some great places to start your search:

• Alma - You can search Alma’s directory for providers in your insurance network with some great customizable search filters. I love how easy this site is to use, and if you’re going to deal with insurance, they make it as painless as possible for both the client and the therapist. Alma is available in a growing list of states and compatible with a variety of insurance plans (and they also let you search for out-of-network therapists who could be a good fit, too).

• Mental Health Match - I recently discovered this directory and. love it, too. You can filter your search by price range, the kinds of elements you’d like to have included in treatment (equine-assisted therapy, anyone?), and even some personal characteristics/affiliations of the therapist, so it only shows you people who fit your price range match your most important criteria. It’s a great way to cut down on the overwhelm of scrolling through PsychologyToday or similarly endless listings!

• Open Path Psychotherapy Collective - Therapists who list their services on Open Path agree to provide sessions within the $30-60 price range ($30-80 for couple or family sessions). This is one of the best prices for therapy you’d probably find anywhere, short of a local clinic in your area that offers an assistance program for clients in need. For a nominal membership fee, you get access to therapy at these rates for as long as you have financial need. You can filter your search results for in-person or online therapy, therapist specialities, treatment approach, and more.

For a detailed list of tips and resources on how to find affordable therapy in your area, check out my blog post on How to Find a Good Therapist.

Is The Cost of Therapy Worth It?

There is some interesting research that shows a correlation between the amount of money that people pay for therapy and the amount of benefit they report getting from it. Is this because only high-priced therapists are good at their job? Is it the placebo effect? Could it be that people who pay more for therapy are more invested in using it to its fullest potential, e.g., by coming prepared with topics to discuss, and working hard to self-reflect and implement changes between sessions? Or — because they’re paying enough to want to get the most of this experience — are they more willing to push back and ask questions of the therapist when things aren’t clicking, so that adjustments can be made to improve the experience? When things involve some financial sacrifice, we tend to value them more.

some things are better at full price

In my years as a therapist, I’ve found that charging too little for therapy actually becomes problematic for many clients. It creates feelings of guilt for them, or concern for the therapist’s well-being, in a way that distracts from the work they came to do. In a society that discourages us from burdening other people with our problems, paying for therapy is actually a relief to most people, because it gives them a feeling of permission to take up space. It allows people to not feel guilty about “burdening” the therapist with their problems, particularly when it comes to the heavier emotions, traumatic stories, or harder-to-kick habits that keep cropping up again and again. 

You don’t have to worry about wearing out the therapist’s patience, or sounding selfish because you’re talking too much about your life.  You paid for that time.  You’re allowed to use it however you need to.  And you can trust that your therapist doing what they need to do in charging more than the bare minimum for services, so they have the emotional reserves to be fully present with you in whatever you’re going through.

permission to be a mess

For a long season in my own life, I was half an hour late to every session with my own therapist, but she never criticized me for it, even though I felt terrible about it every single time.  Before long, we both came to understand that having the freedom to be late was exactly what I needed during a season of intense overwhelm, and it comforted me to know that she happily got paid just the same, whether I was there for the whole session or only half of it.

My therapist’s gracious understanding of what I needed at that time was so life-giving for me, and helped me learn to structure my life more compassionately, in a way that matched my actual needs and capacity in any given season, rather than trying to force life to work in a way that didn’t make sense for where I was. Without having to worry that I was being a burden to my therapist, I was able to explore and find resolution to this tension over time, and benefit from therapy in the ways I needed most.

The Value of Health Can’t Be Measured

We live in a world full of critical voices saying that we don’t really matter that much. We are measured according to our instrumental value to the world — our productivity, our output, our visible success — rather than our inherent worth as people. We are conditioned to be focused on the needs of others (or at least to politely pretend that we don’t have any needs). We’re not supposed to take up too much space. We tell ourselves we don’t have the time or the money to work on those things simmering in the background of our lives — the ones ready to boil over if the temperature gets turned up just one more degree.

And yet. Imagine how life would be different if each of us were operating as the most fully functioning version of ourselves — the most alive, vibrant, generous version, with energy left to give for others. The most emotionally attuned parent. The most thriving, supportive spouse. The person able to be brave and vulnerable enough to reap the irreplaceable benefits of real relationship. Imagine how the world could be different.

Don’t Wait

If you’re ready to stop putting your needs on the back burner and learn how therapy can help you grow into a healthier version of yourself, click here to schedule your free 15-minute phone consultation, or give me a call at 626-598-6234. I’d be happy to answer any questions you have about therapy, and if I’m not a good fit for you, I’d be glad to recommend someone else!

Don’t wait to start the process of reaching out. There are some endeavors that are too costly not to begin.

Important disclaimer: Although I am a licensed marriage and family therapist by profession, I am not YOUR therapist. The content on this site is for informational or educational purposes only. Although I strive to provide accurate general information, the information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Your use of this website does not establish any kind of patient-client relationship with me, and you should consult a healthcare provider in your area if you are seeking medical advice, diagnosis, or treatment. Reliance on any information provided herein is solely at your own risk.

Faith and Mental Health: A Conversation with Revival LA

How are mental health and faith related?

Depending on who you talk to, psychological science and Christian faith can either be seen as competing value systems with opposing end goals, or complementary avenues for understanding and pursuing human flourishing. And while there are certainly psychological theories that align more or less closely with a Christian view of life, there does not need to be an inherent opposition between pursuing a life of deep faith and a life of vibrant emotional and psychological health.

All Aspects of Human Flourishing Matter To God

Faith and spirituality can be a profound resource that supports our mental health, offering (among so many other things) a meaning-making system and a source of hope. And psychological health and awareness can make us more effective in our faith, and emotionally mature enough to minister to others from a place of health. When we can draw on the best of psychological resources and faith resources at the same time, we can grow more fully into the thriving, multidimensional human beings God made us to be.

Psychology and Christian Faith Can Be Friends

Back in May 2020, when all of us were still deep in the early stages of pandemic anxiety, trying to keep our kids creatively entertained during lockdown and gradually restocking our toilet paper, Revival LA hosted an awesome virtual talk and Q&A called “A Conversation About Mental Health and Faith” that I was privileged to be part of. There is so much packed into this talk that is clear, hopeful, and articulates the profound relationship and connection between mental health and faith. You’ll hear both from Christian professionals in the mental health field and ordinary Christians who have wrestled with mental illness. I hope you’ll settle in with some tea and a pair of headphones and give this a good listen, whether you’re dealing with mental health challenges, supporting someone who is, or just curious about how mental health and Christian faith go together.

The panel of presenters also includes Dr. Deb Gorton (Gary Chapman Chair of Marriage and Family Ministry and Therapy at Moody Theological Seminary), John and Marina Stratton (recording artists and worship leaders), and Iza De Leon (Director of Operations for Revival LA). I hope you’ll check it out and be encouraged by what you hear!

A Conversation About Mental Health and Faith with Revival LA (May 9th, 2020)

“From the Perspective of a Counselor”

Here’s the transcript of what I shared (for you visual processors out there), beginning around minute 13:21:

Dustin Lang, moderator ("DL”): What kinds of trends have you noticed amongst those who seek mental health services these days?”

Rachel Engels, LMFT (“RE”): “What I see come through the door fits the medical criteria for all these different diagnoses – anxiety, depression, etc., etc. – but when it comes down to it, a lot of what people are dealing with is no different from anyone else in the general population…it has just reached a level where it’s interfering with their functioning. 

“What’s really interesting to me is that even though I work a lot with anxiety, trauma – some of these specific diagnosable issues — a theme that keeps recurring, at least with a lot of my clients, is that it’s women with complicated relationships with their fathers.  So when you start to peel back the biological piece, the medical piece, the diagnostic piece, there’s so much influence in critical relationships in our lives that drive a lot of mental health and mental illness – so I’m definitely seeing that theme play out.”

DL: “Would you elaborate on that a bit?  How do relationships influence our mental health?”

RE: “There’s so much overlap there.  And part of the reason relationships have such a strong impact on our mental health is, I believe, that we were designed for relationship originally. That’s part of what it means to be in God’s image — that God is in constant relationship with himself as the three Persons of the Trinity. He desires relationship with us. And that was part of the point of the Garden of Eden – we were meant to dwell with God, and with each other – to enjoy that, to enjoy taking care of his creation. And then the Fall tainted every aspect of that.  So we were kicked out of the garden and out of God’s presence, there was enmity between the man and the woman, thorns and thistles came up and made the work with the earth much more difficult.  And so when we’re in a world that’s broken by sin like that — whether it’s our individual sin, collective, generational, institutional – we so often find, in relationship to the other people and systems around us, that we don’t get what we need to thrive.  And that’s where the dysfunction starts to take root.   

“Other people routinely disappoint, and even harm us (and we may do the same). We start to feel unsafe in the world, or suspicious of others, or hesitant to be in relationship. And then, because we’re so interconnected – love for God, love for others – we start to get suspicious of God, too.  Can he really take care of me?  Does he really care about me?  Because the people that reflect him are not doing that.  So that’s when we see some of the mental health symptomatology increase – depression increases, anxiety increases, insomnia, all of those things.   And so in that way, I think, relationships have a really critical part to play, where sin has this cyclical and generational effect in propagating symptoms of mental illness, because it routinely, repeatedly breaks down the life-sustaining relationships that we’re meant to have with each other and with God.  So that’s what broken relationships do to our mental health.

 “But on the other hand, relationships can also  be a doorway into our healing, and help us to experience greater well-being, and experience God’s love again.  When we encounter somebody who’s filled with the love of God, they demonstrate, just like Jesus did, that we can be loved even in spite of our imperfection.  And that was one of the coolest moments recently with a client – we weren’t even talking about faith, but it was her experience of being accepted when she was sharing a very shameful thing.  She told me afterwards, “That was a spiritual experience for me; that’s the first time I’ve ever said that out loud, and I felt so loved.”  So when we experience that reality from other people — that we can be loved and we can be safe — it makes us more able to trust that God is good.  It becomes easier for us to endure hardship, because we have a community to lean on, and we have a faith narrative that says there can still be meaning in the midst of suffering.

 “So relationships can either reflect God’s love and goodness to us, and draw us into greater congruence with who he made us to be, or they can be a painful barrier that keeps us from experiencing his love, and fullness of life.   And so for some people, a relationship with a therapist might be the first safe place they ever had to access that.  For some people, it’s the church community – that’s where they find safety after a family of origin experience that was really wounding.   So, as followers of Christ, when we can mirror Christ in our lives – in our words and our actions – we either make the love of God more believable, or we make others question how God could possibly be good.  And so I think in that way, we can either speak truth into others’ lives in a way that fosters their freedom and growth -- and what I would call mental health: the ability to rest securely in the love of God – or, we can repeat the painful wounds that foster mental illness.”

DL: “I appreciate the fact you commented on the way relationships can hurt us, but they can also heal us – that just gives so much hope, that as members of the body of Christ, we can go out and we can show people that we’re safe people, they can come as they are, be accepted, experience grace, and ultimately the gospel.

“What would you say to someone – maybe even someone on this call who has gone through pain in their past relationships and is struggling with their mental health.  What are some words you would share with them?”

RE: “The first thing that comes to mind is a passage from 1 Peter 4 (verses 12-13), which says, “Beloved, do not be surprised at the fiery trial that has come upon you as though something strange were happening to you.  But rejoice that you share in the sufferings of Christ, so that you may be overjoyed when his glory is revealed.”  And when I read that, it just comes home to me that our suffering is not a surprise to God.  It’s not unknown to God.  And we have a God who cares so deeply about our suffering that he willingly entered into it: took on a human form, was born into an oppressed people group, was a refugee with his family, endured utter rejection from the people who were closest to him, was wrongfully accused, died the most painful and humiliating death possible – so that we could be free from the effects of sin and suffering in the world and in relationship.  And so, to remember that your suffering is something that Jesus died to heal – that he cares that deeply about your wholeness, and our collective wholeness.

“And what also really just blows me away, that I find so encouraging, is that Jesus didn’t only spend his time on earth preaching salvation for souls, but healing people’s physical diseases, and casting out the demons that caused them mental suffering, and feeding food to the hungry.  So Jesus cares about your soul, but he also cares deeply about your body, and your mind, and your relationships.  And he lived and died and overcame death the demonstrate that.  So you can trust him to guide you and provide for you in the process of working toward that wholeness.  And ask him for wisdom, because he gives that gladly – in terms of where to look for healing: where to find the right therapist, the right friend, the right medication, mentor, spiritual director.  Because God’s in the business of restoring things, and he never wastes a difficult experience that he can use to shape us and equip us for the life he has in store.“

DL: “Amen, amen. So good. ‘He never wastes a difficult experience.’ I appreciate that you shared that; it reminds me of C.S. Lewis’ quote in the book, The Problem of Pain, where he says, ‘God whispers to us in our pleasures, speaks in our conscience, but shouts in our pain: it is His megaphone to rouse a deaf world.’ “

—-

From the Q&A time (minute 1:15:13):

DL: “One of the questions directed towards you is, ‘What’s so unique about the father relationship to both sons and daughters that affects their mental health, and how does that affect those who deal with mental health issues with their relationship to God the Father?’

RE: “I will say it’s not just unique to fathers – it’s definitely mothers, as well, and it’s a lot of pressure on parents, because we are the first formative influences in our children’s lives.  But when we study the area of faith development, a lot of the expectations we have toward God and what he’s like and what his role is – are shaped vaguely around the images we have of our parents, in their behavior and their treatment toward us.  So ‘what about fathers and mothers affects children’s mental health’ is a whole lot.  Obviously, none of us will ever be perfect parents, and I joke sometimes that there are endless ways to screw up your children -- and thankfully the grace of God covers many of them, and “Love covers over a multitude of sins” – but we as parents convey to our children their basic lovability; their basic sense of safety in the world, how much do they have to perform to please us.  You know, all these little implicit messages that get sent in every interaction become part of the makeup that helps them adjust easily to life, or burdens them with a lot of extra anxiety and difficulty. 

 “And so, the way that that affects our relationship to God, with regard to mental health issues, is that the lessons and the messages we’ve learned from our parents – if we don’t check them — we easily apply them to God.  And we can see God as a critical, or controlling, or withholding-of-affection kind of God, when that’s not who he shows himself to be in Scripture and in history.  So it’s something to actively be aware of when it comes to, “What are those mental messages I’ve learned or taken in about the way that God views me?  What’s the look on his face when he sees me?”  And if it’s anything that’s not 100% love, then we have some work to do to correct those ideas.”

Ways to Delve Deeper

• If you’d like to read more on re-framing your view of God as a good and loving father, check out the fantastic book by James Bryan Smith called The Good and Beautiful God: Falling in Love with the God Jesus Knows.

• If you want to learn more about how to find a good therapist in your area — someone who fits your price range, preferred approach, and even your value system — check out my detailed and informative blog post on How to Find a Good Therapist.

• If you’d like to chat with me about beginning therapy together, feel free to reach out to me at 626-598-6234 or use the Contact form to schedule your free 15-minute consultation.

I’m eager for you to experience the fullness of flourishing that God designed you for — mentally, spiritually, relationally, psychologically, and all the rest. May you keep seeking to grow and heal, knowing that you were made for fullness of life.

Why Do People Go To Therapy?

Thoughts on When (and Why) You Should Pay Someone for Help Rather Than Going to a Friend

Why Do People Go to Therapy? 

People have all kinds of assumptions about what being in therapy is like, and who it is for. Is it for people in crisis, or is it a weekly self-care exercise? Is it a luxury, or a necessity? How do you know whether the things you want help with “count” enough to talk to a therapist?

My First Experience With Therapy

I remember when it first dawned on me that I could go to therapy for myself.   I was a young college student at the time, just beginning to study psychology. To me, going to therapy seemed almost like a sacred privilege reserved for people who had something truly life-altering happening to them, and that you couldn’t go without a very compelling reason—perhaps a death in the family, or an existential crisis of some kind.  I was toying with the idea of becoming a therapist someday, but figured I would need to try out this mysterious experience for myself at some point before I knew if it was worth doing.  The only problem was, I was pretty convinced I didn’t have a good enough reason to go.

And so, like a true psychology nerd, I was genuinely thrilled the day I learned in class that my inconvenient, hereditary (and very socially alarming) tendency to faint at the sight or suggestion of blood was actually a specific type of phobia that is very treatable with therapy.  Right after class, I called my school’s counseling center and set up an appointment with someone ready to help.  After just a few sessions, I not only had control over my overwhelming impulse to faint at the sight of a needle, I was actually able to give blood for the first time ever, without passing out. What do you know - this stuff really works! I thought.

And I’m happy to say that I have never fainted since.  I can make it through medical TV shows without getting queasy, and be there for my kids when they have to get a shot at the doctor’s office…without worrying that someone will have to pick me up off of the floor in the process.  What I gained in that first experience of therapy was a small victory that has had major, life-changing ramifications.  It replaced what used to be a huge source of anxiety about an unavoidable part of life with a new level of freedom and confidence enabling me to do things I couldn’t do before (like, well, get medical care).

That early experience also got me oriented to the experience of therapy, so that it was less daunting to go back to therapy in the future when bigger things did come up in my life. And it taught me that even a seemingly small issue can be reason enough to reach out for help.

Therapy is for Everyone

You do NOT need to be in crisis to go to therapy. Therapy is not an experience reserved for the few and the desperate.  Mental health diagnosis or not, ALL of us need support at times, and therapy can be a fantastic way to get it—before getting to the place where we’re a mess and things are falling apart. In fact, starting “too soon” is far better than starting too late.

Whether it’s coping with stress, dealing with the ongoing collective trauma of the pandemic or political events, getting help for a relationship issue, or trying to overcome generational patterns of dysfunction, I can’t think of a single person who doesn’t have something to gain from being in regular therapy.  But I suspect many people don’t believe they have a good enough reason to pursue it.  They think their pain certainly isn’t as bad as someone else’s, or they’ve been taught to focus on the positive and not dwell on the painful. But deep down, they long for an experience of feeling truly seen and heard, of being able to talk about the hard stuff in a place where they can be understood and find some relief.

Don’t Wait for a Crisis

Keeping yourself functional is not selfish.

You do not need to be in crisis to reach out for support. It’s enough just to want to be healthy and whole.

When is Therapy Helpful?

While I truly believe that almost anyone would benefit from therapy at some point, people typically start therapy for one (or more) of the following reasons:

1. Distressing Symptoms

2. Impairment in Daily Functioning

3. Crisis

4. Prevention and Personal Growth

Although therapy can look a little different depending on what your needs and goals are, ALL of these reasons for seeking therapy are valid.

Distressing Symptoms

All of us will deal with stress, sadness, and anxiety in our day-to-day lives.  But when the distress is persistent enough that irritating or worrisome symptoms begin to develop or worsen,  people often begin to seek help.  These symptoms might be physical problems like trouble sleeping, stress headaches, or muscle tension; relational problems like communication difficulties, emotional disconnection, or sexual dissatisfaction; or emotional problems like increased depression or anxiety.

Impairment in Daily Functioning

A second common time for people to seek therapy is when a problem begins to disrupt the rhythms of their daily life. For example, a person’s anxiety might be making it difficult for them to get to work on time, or the stress of a strained marriage is leading to physical health problems that can no longer be ignored.  For some, the impairment in functioning could be related to emotions that are too intense (e.g., depression so bad that you can’t get out of bed some days); for others, it’s that emotions are conspicuously absent (e.g., the absence of feeling after a trauma that makes it difficult to feel like yourself, connect with your own needs, or connect genuinely with others).

Crisis

Some people wait until things have reached a crisis level to reach out for therapy – perhaps they’re on the brink of a breakup or a divorce, they’re at risk of losing their job, or they’ve begun having crippling panic attacks.  Waiting till a crisis strikes can make the problem more difficult to solve, and by then the issue may require a higher level of care (e.g., inpatient therapy for substance abuse recovery; a referral to a divorce mediator instead of a marriage counselor, etc.).  On the other hand, sometimes a good crisis is what people need to finally come to terms with the fact that something needs to change, and to give themselves permission to get help. 

Prevention and Personal Growth

There are plenty of good reasons to pre-emptively seek therapy for personal growth, such as learning to deal with emotions in a healthy way, learning why you operate and react to things the way you do, preparing for or adjusting to a major life transition, working to undo generational patterns of family dysfunction when you’re entering a long-term relationship or become a parent, learning to set better boundaries to prevent job burnout, avoiding the repeat of a toxic relationship pattern, or gaining greater self-insight in order to be a more effective leader.  For those who have a direct influence on the shaping of others’ lives, including (but certainly not limited to) bosses, parents, pastors, and therapists, engaging in one’s own ongoing therapy can be a critical part of caring well for the people you serve, without wounding them in the ignorance of your own personal blind spots.

How Does a Friend Differ From a Therapist?

Friends, family, significant others, and those in our social circle can do a great job of supporting us through immediate and short-term problems.  But, the reality is we often need more focused and consistent support than they can provide amidst their own struggles and busy lives.  I’ve heard many clients say things like, “My friends are sick of hearing about this, and this is the only place where I can talk through it with someone,” or “People were supportive early in my grieving process, but it seems like they’ve all moved on now.  I need a place to process my ongoing grief without someone getting uncomfortable and changing the subject.”  

Friends may also offer unhelpful remedies like unwanted advice-giving, talking about their own worst experiences instead of making space for yours, or projecting their own values and opinions onto you instead of considering what is truly best for your situation.  All of those responses are very natural human impulses, but when you’re in deep pain, careless words or advice can really sting, and leave you feeling like you can’t safely share your real self with others.  So you stuff it back inside and keep marching.

In friendship, there is also the unspoken (and necessary) social expectation that both parties should be allowed to share more-or-less equally about their lives.  If your friend asks you about your day, generally you’re expected to return the favor by asking about theirs.  While this reciprocity is important, there are situations in which we genuinely need to take up more space and time than we are able to give back, or are struggling with something that requires a more in-depth focus in conversation.  There is certainly allowance for this in a healthy friendship, but if our friends or family are routinely tasked with the job of helping us process a particularly heavy and distressing situation, over time it can burden and exhaust the relationship by altering those important dynamics of mutuality and reciprocity. This leaves our loved ones feeling like they don’t receive enough of the support they need from us, and can create distance in the relationship. 

Why Friends sometimes aren’t enough

“If our friends or family are routinely tasked with the job of helping us process a particularly heavy and distressing situation, over time it can burden and exhaust the relationship by altering those important dynamics of mutuality and reciprocity.”

Therapy is a dedicated space where you can struggle for as long as you need to, and get to the root of why you experience things the way you do, rather than just being told to stop feeling or acting that way.  You don’t have to politely share airtime with anybody else.  You can be a mess and not put a happy face on it for someone else’s benefit.  The time exists for you. 

A therapist is trained to sit with heavy things and let you take your time, unlike a family member who gives quick advice to soothe their own discomfort.  A therapist is distant enough from your situation to be more objective, without making assumptions based on any prior knowledge of your circumstances. This allows you to explain your story from the beginning, and is  a great way to get more clarity on the situation for yourself, and verbally process parts of your experience you may not otherwise get to with people who already know part of the story.  A therapist’s job is to be attentively connected to what you’re going through, keep the conversation centered around your needs rather than theirs, help you understand the patterns that gave rise to your current situation, identify the obstacles getting in your way, and help you find healthier ways of coping –and even thriving—in the future.   And good therapy will also help keep you more richly connected to the other people in your life, strengthening your most worthwhile relationships by fostering a healthier version of you – one who can show up fully, willingly, and genuinely with the people in your day-to-day life.

How Do I Find a Therapist? 

The process of finding a therapist can feel a bit daunting, but it doesn’t have to be.  I’ve put together a list of super helpful tips and resources for finding a therapist anywhere in the U.S. who fits your budget range, location, and other must-have search criteria.  Click here to check out my recent blog post on “How To Find a Good Therapist” to get started.

If you’ve been wondering whether therapy is right for you, I encourage you to start your search today, with the confidence that you matter enough - and so do the people in your life - for you to be the healthiest, most flourishing version of yourself possible.

Important disclaimer: Although I am a licensed marriage and family therapist by profession, I am not YOUR therapist. The content on this site is for informational or educational purposes only. Although I strive to provide accurate general information, the information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Your use of this website does not establish any kind of patient-client relationship with me, and you should consult a healthcare provider in your area if you are seeking medical advice, diagnosis, or treatment. Reliance on any information provided herein is solely at your own risk.

How to Find a Good Therapist

A common question people ask me is, “How do I find a good therapist?”  And it’s such an important question.  When it comes to getting good mental health care, you need someone who connects with both your personality and your price range, who possesses the necessary expertise and approach to address the particular issues that concern you, and who demonstrates the sensitivity and tact to enter compassionately into some of the most important issues of your life with you.  It’s hard to overstate how important it is to find a good fit, when it’s about your well-being and your life’s story.

How TO fIND a GOOD THERAPIST

Where to search, what to look for, and what questions to ask

How To Find a Good Therapist 

There are many different factors to consider when choosing a therapist, some of which boil down to personal preference.  You probably want someone who feels easy to connect with.  Maybe you specifically want a female therapist, an older therapist, a Christian therapist, an ADHD-friendly therapist, someone with a soothing voice or a down-to-earth personality, a therapist with purple hair, or a therapist experienced in working with first responders.  The options and counseling specialties out there are almost endless, with therapists as unique as the people searching for help.  How do you filter through what’s really important and find the right person?

Today I’d love to share some thoughts to help you narrow down your search.  I’ll describe some different types of therapists and what distinguishes them.  I’ll share what I believe to be some of the most important things to look for in a therapist, what are red flags in a therapist, what to ask a therapist during the first phone call, and offer you some resources and directories you can use to help you find your best match. 

Which Type of Therapist Should I Choose? 

 First, let’s get our terminology straight.  What are some of the different types of therapists out there, and how are they different?

• A licensed clinical psychologist is a doctorate-level clinician with a PhD or PsyD degree.  They may focus exclusively on providing counseling and therapy, or depending on their training, they may also be able provide psychological testing and assessment services, to help identify or rule out various disorders.  Psychologists do not prescribe medication.

• A psychiatrist is a medical doctor, trained in mental health who can prescribe psychiatric medication as well as provide psychotherapy.  You might choose to see a psychiatrist only, a therapist only, or a therapist regularly with occasional check-in appointments with a psychiatrist to monitor and adjust medications.

• A licensed professional counselor (LPC), sometimes referred to as a “mental health counselor,” and also called an LPCC in certain states (i.e., “licensed professional clinical counselor”) has a Master’s degree in counseling and can diagnose and treat clients with a wide variety of mental health concerns.  LPCs/LPCCs have undergone thousands of hours of supervised training and passed a comprehensive licensing exam within the state where they practice, and are one of the most common types of counselors in the United States.

• A licensed marriage and family therapist (LMFT) has at least a Master’s degree in counseling or marriage and family therapy, and is trained in diagnosing and treating a wide variety of mental health concerns, with special training in the ways mental health intersects with relationships and family influences.  LMFTs have also undergone thousands of hours of supervised training and passed a comprehensive licensing exam within the state where they practice.  Interestingly, the vast majority of the country’s LMFTs are licensed in California, where the LPCC designation is much less common, even though much of their work can look very similar.

• A licensed clinical social worker (LCSW) has a Master’s degree in social work, and has completed thousands of hours of supervised experience and passed their state’s comprehensive licensing exam.  LCSWs, like the other types of clinicians above, are qualified to diagnose mental health concerns and to provide therapy.  Social workers’ training usually also prepares them to advocate for and connect clients with tangible community resources, and to view people’s concerns through a holistic lens that considers the impact of social and societal forces on clients’ lives.
  

What’s The Difference Between a Counselor and a Therapist?

If you are looking to begin therapy, whether you search for a “counselor” or a “therapist” may depend on your region of the country, and the titles that are predominantly used by helping professionals in your area .  

• The term “counselor” may be used more often in regions with a higher number of LPCs or LPCCs, or refer to job titles like “Mental Health Counselor,” “Addictions Counselor,” or perhaps a Christian lay counselor working at a church counseling center.   A counselor may or may not be licensed as a mental health professional, but might be someone trained to provide a specific type of counseling, such as crisis counseling, divorce mediation, or adoption counseling for families. The word “counseling” can sometimes imply the use of a more directive, advice-giving kind of approach, but not always. It never hurts to ask what kind of training and approach a counselor has if you have questions. 

•  The term “therapist” may be more commonly used in areas of the country with a higher percentage of marriage and family therapists. When differentiated from “counseling,” the word “therapy” can sometimes imply a more in-depth type of approach to mental health, involving working through the person’s past as a way of addressing present concerns.  In my experience, it is common for people to use the word “therapist” to refer to anyone who provides therapy, whether that is an LMFT, an LPCC, or a psychologist.  Although clinicians are required to use their appropriate legal titles when advertising their services, they might refer to providing “therapy” or “counseling” somewhat interchangeably depending on the context.

• Pre-licensed therapists, such as those with the word “associate,” “assistant,” or “trainee” in their title (e.g., associate marriage and family therapists, psychological assistants, marriage and family therapist trainees), are people who are in the process of earning their professional license, which means they are either currently enrolled in a counseling or psychology graduate program, or they have already received their graduate degree and are completing the required thousands of hours of supervised clinical experience necessary to sit for their licensing exam before becoming independently licensed. 

The most important ingredient to successful therapy is a good relationship between you and the therapist, so it’s important to find someone you click with, who makes you feel understood.

What Type of Therapy Should I Get?

There are SO many counseling approaches and theories out there, and the good news is, with the right therapist, you can benefit to some degree from many styles of therapy. 

It’s important to be clear that some diagnoses and issues are particularly well-suited to specific therapy approaches, such as cognitive behavioral therapy (CBT) for anxiety and obsessive-compulsive disorder, EMDR for post-traumatic stress disorder, and dialectical behavior therapy (DBT) for borderline personality disorder (although these approaches can be used to effectively treat other symptoms and conditions, as well). For couples issues, Restoration Therapy (RT), emotionally-focused therapy (EFT), and Gottman method therapy are all really helpful and well-tested therapy approaches.  Here are some other common types of therapy and what they’re often used for:

• If you’re looking to reflect on and make meaning of certain experiences, narrative therapy can help you make sense of the story of your life and how different elements of your journey fit together.

• If you want to focus on a particular, specific issue, solution-focused brief therapy could help you reach concrete goals quickly.

• If you need help with decision-making and are finding it hard to commit to the changes you need in your life, a counselor or coach trained in motivational interviewing could help you overcome your ambivalence.

• If you want to understand and change longstanding patterns in your life and grow in self-insight, psychoanalysis or psychodynamic therapy could help you get to the root of some of the underlying “organizing principles” or operating rules that you’ve learned to live by without realizing it.   

At the same time, research has shown time and again that the most significant predictor of successful therapy is the rapport between client and therapist, so don’t feel like you need to “nail it” on the first try in identifying the perfect-fit approach.  My best advice is to identify a person you are drawn to working with, and then ask them to describe their approach and how it can help with your concerns.  If it doesn’t seem like a good fit for your personality, comfort level, budget, or schedule, ask them for referrals to other counselors or therapists they know whose approach might be more conducive to your situation.

What QUALITIES Should I Look for in a Therapist?

No matter what type of help you’re looking for, there are some qualities in a therapist that I would consider non-negotiable:

• Warmth.  A therapist should convey a sense of empathy, caring, and approachability right from the very first phone call or email communication.  Again, the quality of the relationship between a therapist and client is THE number one indicator of how successful therapy will be, so it is pivotal that you actually like the person and sense that they exude genuine warmth toward you.

• Responsiveness.  A therapist who wants to work with you is a good therapist to have.   One indicator of their ability and desire to be present to you is the quality of their communication.  You need someone who is professional and prompt in their communication, otherwise it could be that they are overloaded or burned out and can’t provide you with the best quality of care right now. Generally, they should be able to reply reasonably promptly to your inquiry (within 24-48 hours), offer a clear path to scheduling, and make it easy for you to understand the process. 

• Competence.  Prior to the start of therapy and continuing throughout the process, your therapist should be able to exude a sense of competence, and articulate how their training and experience enables them to help you with your particular concerns.  If you don’t feel confident and inspired about their ability to help, you will not be as invested in the process, and it may be that the therapist is not as well versed as they need to be in treating your particular area of concern.  Therapists have a broad knowledge of an incredibly diverse range of topics, and yet none of us can be experts at everything.   Look for someone whose specialities and expertise seem to align with the issues that concern you most, and ask them questions about their experience if you need to.
  

• Relatability.  You don’t need a therapist who has experienced all the same things in life as you, but it can help sometimes to know that a person has some level of shared life experience that provides insight into your world.  For instance, depending on what you want to talk about in therapy, it might be really important to find someone who knows a lot about life in the military, or who is conversant in talking about faith issues, or who acknowledges the impacts of systemic racism, or who knows from experience what it’s like to be married, or divorced, or in recovery from addiction, or a parent.  Different therapists will vary in how much they’ll disclose to you upfront about their own experience, but even asking them about what types of clients they work with most frequently (or if they’ve ever worked with a client like you before) can give you a window into their level of fluency with a particular topic.  In any case, you should feel confident in their ability to have a good ongoing dialogue with you that is sensitive to your context and background, and be able to trust them to maintain a curious, nonjudgmental stance about your experience.

What makes a good therapist?

Warmth,

responsiveness,

competence,

relatability,

humility,

and affordability.

• Humility. While therapists should be able to convey their competence and skill in being able to provide effective treatment, good therapists also acknowledge that they don’t know it all.  They allow clients to be the experts on their own lives and don’t presume to know what is best for the client in every situation.  They take seriously their need for ongoing learning and growth, and participate in their own continuing education, training, professional consultation with other clinicians, and especially their own regular, personal therapy.

• Affordability.  Regular therapy can be a big investment, let’s be honest.  Some therapists have much higher fees than others, and I will say from personal experience that it is worth every penny to pay for someone who you trust has the necessary expertise to help you move forward.  But at the same time, it shouldn’t break you financially.  Trying to stretch outside of your own budget to make therapy work is going to put a strain on your experience, and make you inclined to end prematurely.   In order to get the best results from therapy, generally you need to be able to attend sessions weekly, especially in the beginning (although it’s possible to find therapists who operate with a different frequency, or can flex to fit unusual schedules).  Thankfully, there are tons of resources out there for accessing good therapy at all different price points, and I’ll share some of those below.

What Are Red Flags in a Therapist?

Now that we’ve discussed what to look for in a therapist, let’s talk about the things you should avoid.  Here are some red flags to watch out for in a therapist:

• Their license is not in good standing.  Before reaching out to a therapist, Google “therapist license lookup” for your state and you should be able to verify the license status of that person, searching by name, profession, and/or license number.  If a person’s license is not in good standing, whether it’s because they didn’t pay their renewal fees, complete their required continuing education courses, or they have an ethics complaint filed against them, steer clear.  Working someone who takes seriously their legal and ethical obligations as a therapist is of utmost importance, for the quality of your care as well as your own protection.
  

•  They list too many specialties.  No one can be good at everything.  And while therapists are trained to help with a broad array of issues, claiming equal expertise about 30 different topic areas is unrealistic.  Good therapists should be able to articulate the handful of issues they are most passionate about working with and the most knowledgeable about, as well as acknowledge the issues and clients they aren’t best equipped to serve.  Knowing their limits and being confident in their skills is one of the marks of a good therapist –someone who is realistic about what they can help others with – and committed to doing a few things really well, instead of many things poorly.
  

• They talk too much about themselves. Whether during the initial phone consult or during sessions, if you find that a therapist repeatedly brings up their own experiences in a way that is distracting, jarring, or irrelevant, it could be time to switch therapists.  While even the best therapy has a few relational “misses” now and then, if a therapist continues to center their own experience without regard to what is actually helpful to the client, they are not paying adequate attention to their own unprocessed baggage, and are not in a place to be able to facilitate optimal growth for the client.  A therapist should be trustworthy and disciplined enough to keep things focused on the needs of the client, not perpetually caught up in their own story, and re-living or projecting their own experiences onto you.
  

•  They don’t provide adequate emotional containment or structure.  While some forms of therapy are a bit more open-ended and do provide less direct guidance from the therapist, I don’t think you should ever be left to feel like you are floating without any direction, or that you’re being ushered into big feelings only for the session to end abruptly, leaving you completely unraveled and exposed. For therapy to be its most effective, your therapist needs to help provide some basic structure around roles and expectations in session, so you feel comfortable about what to do, rather than having to wonder or guess.  This is particularly true when dealing with traumatic things in therapy.  If you get into difficult emotional material during a session, the therapist doesn’t need to magically make all the pain go away in that moment, but they should be able to provide the necessary warmth and responsiveness to create a safe holding space where you know it’s OK to be a mess, and where you can rest securely, knowing the therapist is on your team and you will find a way through the mess together.
  

•  They are defensive, or averse to hearing feedback.  The best therapy happens when clients and therapists can collaborate and speak openly about what’s going well and what’s not.  Well-trained therapists know not to take it personally when someone is upset about how therapy is going, or is offended by something the therapist said – and they don’t waste the opportunity inherent in a good misunderstanding.  By remaining non-defensive and welcoming of feedback, the therapist creates a space where important issues can be talked about and addressed honestly.  Inviting meta-conversations about therapy provides a way to re-adjust whenever things feel off, and helps safeguard the trust and rapport so essential for therapy to succeed.  Not only that, but being able to have meaningful dialogue about therapy itself can provide the client with indispensable insight into the way they show up in the world.  A person’s reactions to their therapist often mirror the way they feel with others in their life, so talking about the therapy relationship can actually provide a helpful microcosm for people to identify and make needed changes in their other relationships, as well.
  

Questions to Ask a Therapist in an Initial Consultation

What Should You Ask a therapist?

The initial phone call is a chance for both you and the therapist to discuss details and decide if it’s good fit.

Many therapists provide an initial consultation phone call or session before you mutually decide whether to work together.   In the initial consult, the therapist will probably ask to hear a bit about why you’re currently seeking therapy, answer any questions you may have, and describe a bit of their approach, so you can both determine whether it’s a good fit.

Here are some questions you can ask during the initial consultation to get a feel for a therapist’s approach, qualifications, and personality.  It doesn’t do you or the therapist any favors if you agree to work with somebody you have major doubts about, so ask your questions freely!

Questions about the therapist’s approach and expertise:

1. I wonder if you could tell me a little bit about your treatment approach. What are some of the guiding principles of your approach, and how can that help people like me?

2. What do you hope that therapy accomplishes for your clients? How do you hope or expect to see peoples’ lives change because of therapy?

3. How will we know when treatment is finished?
   

Questions about the logistics of therapy:

1. Do you offer in-person or virtual sessions, or both?

2. What is your fee and recommended frequency for sessions?

3. Do you take insurance? If not, do you provide a superbill I could submit to my insurance for possible reimbursement?

Questions to Ask Yourself Following the Initial Consultation

Here are some questions to help you reflect on your own gut feelings after the initial conversation with a particular therapist, and decide if they might be a good fit for you:  

• Did I feel heard, understood, and respected in our conversation?

• Does this person seem likable?

• Do I feel a sense of hopefulness that this person can help me?

• Is this someone who seems to enjoy and believe in what they do? 

• Does the way they speak resonate with and make sense to me?  Will it be easy to have good conversations with this person?

• Am I able to commit to the fee and the schedule required to work consistently with this therapist? 
  

Where to look for a therapist

Check out some of the awesome online directories and community resources that are available in your area.

Where to Look for a Therapist

Now that you know what’s important to look for in a therapist, the question is where to look.  Here are some great resources for finding a therapist that fits your budget and your needs:

• Mental Health Match  This is the perfect directory to use if you’re feeling overwhelmed and not sure where to start.  Mental Health Match will let you browse therapists in your area, or walk you through a series of multiple choice questions that show you matches for nearby therapists in your price range who meet your specific search criteria.  You can filter by desired mode of therapy (couples, individual, or family), your specific goals for therapy and presenting concerns, as well as specific activities you’d like included in therapy (e.g., art therapy, movement/yoga, biofeedback, equine assisted therapy, support groups, and more!).  If you prefer a therapist of a particular gender, age, race, religion, or sexual orientation, or someone who takes a particular type of insurance, your matches will be ranked in order of closest fit.
  

• TherapyDen is known for being an inclusive, socially conscious therapist directory for clients of every race, gender, and sexual orientation.  The search results and therapist profiles are concise, easy to navigate, and you can filter your search with many criteria related to the therapist’s background, expertise, and values that you might not find on other directory sites. 
  

• Open Path Psychotherapy Collective is a great site for finding affordable therapy.  Therapists who list their services on Open Path agree to provide sessions within the $30-60 price range ($30-80 for couple or family sessions).  You can filter your search results for in-person or online therapy, therapist specialities, treatment approach, and more. 
  

• There are so many other directories you can search, as well. Some are focused on serving specific populations:

  • Theravive

  • GoodTherapy

  • Online Counselling Directory

  • Multicultural Therapist Directory

  • Therapy For Black Girls Directory

  • Therapy for Black Men

  • Asian Mental Health Collective

  • Asians for Mental Health

  • Christian Counselor Directory

• A graduate school of counseling or psychology near you.  If you’re looking for even more affordable therapy options, look into “graduate counseling program” or “clinical psychology program near me,” and see if it brings up any graduate schools in your state who operate a community counseling center staffed by their own Master’s and doctoral-level therapists-in-training.  For clients in California, Fuller Psychological and Family Services is just one of many community mental health clinics providing affordable therapy for the general public, and staffed by MFT and PsyD/PhD students-in-training.  The benefit of a having pre-licensed therapist, in addition to lower cost, is that they are required to participate in an extensive amount of ongoing supervision and training.  So although less experienced, these individuals often bring a unique level of focus and dedication to your case, as they are eager to grow and learn, and have the benefit of frequent consultation with a seasoned supervisor who can guide and collaborate with them to bring you the best care possible.
  

• A church counseling center or community counseling agency.  Many churches provide their own counseling services, whether with a pastor or with trained counseling staff.  These individuals may or may not be licensed mental health practitioners, but can often help with a variety of concerns or serve as a starting point to refer you to additional resources if needed.  Alternatively, community agencies like Catholic Charities may provide counseling services in your area, with sliding scale fees based on income.   
  

• Your HMO insurance panel.  If you have HMO insurance that covers mental healthcare, consult your plan’s website for a list of in-network providers, and then do your online research on the clinicians listed using some of the tips above.  If you have PPO insurance, you can search for any therapist, who might bill insurance directly for you as an out-of-network provider, or provide you with a “superbill” (official receipt of services) to pursue insurance reimbursement on your own.
  

Tips for Searching for a Therapist

• Leave a voicemail when you call.  I can’t stress this one enough.  Don’t give up if you don’t get an answer on the first ring!  Although some larger therapy offices have a receptionist or professional answering service, the majority of independent therapists manage their own phone lines.  And we often don’t pick up the first time, for a variety of reasons: we might be in another session, our business numbers are publicly available and we get a lot of spam calls, and many of us actually prefer getting a voicemail message as a valuable first step in determining the right fit for you.  For me, when a person leaves a message it shows that they are serious about therapy, and have already done some research to identify me as a possible good fit for them.  And by briefly describing in their message why they’re seeking therapy, by the time we connect, I can be prepared to better answer their questions on the phone, or to have the names of other good referrals ready to go in case we find that we’re not a good fit.
  
  

• Take negative online reviews with a grain of salt.  If you find a therapist you like, who looks fantastic except for one or two negative online reviews, remember that people often leave reviews only if they’ve had a stellar experience or a perceived terrible one, with very little in between.  In the world of mental health, I’ve seen reviews written about colleagues where the content of the negative review reflected far more about the maturity or expectations of the person seeking treatment than the true and demonstrated quality of the therapist they reached out to.  Until recently, therapists were generally not allowed to solicit testimonials or reviews from past clients (and even now there are careful rules that must be followed), so it may be that a particular therapist who has no reviews is incredible — it’s just that no one has chosen to publicly say so yet.  Remember that online reviews are just one small part of the picture.

• Don’t let geography limit you.  Virtual therapy appointments were already popular before the COVID-19 pandemic, but have exploded in popularity since then.  They are convenient to fit into your day, require no commute, and bring the safety and privacy of being in your own space.  As long as you have a good internet connection, you can work with a mental health provider located anywhere in your state of residence.  So if you can’t find any good therapists in your immediate geographic area, search using the name of any big city in your state, and you’ll likely find a large number of options of qualified therapists would who be happy to work with you virtually.

Therapy should be accessible to anyone who wants it.  And there are so many skilled and qualified therapists out there who are ready and eager to help.  I hope this article gives you the tools you need to search with confidence and find someone who can help you thrive!

Important disclaimer: Although I am a licensed marriage and family therapist by profession, I am not YOUR therapist.  The content on this site is for informational or educational purposes only.  Although I strive to provide accurate general information, the information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Your use of this website does not establish any kind of patient-client relationship with me, and you should consult a healthcare provider in your area if you are seeking medical advice, diagnosis, or treatment.  Reliance on any information provided herein is solely at your own risk. 

Calling 911 for a Mental Health Emergency Could Be Dangerous - Especially if You're Black. Resources for Getting Help and Staying Alive in a Crisis

If you or someone you love deals with severe mental illness, it can feel daunting to know how to get help, especially in a crisis situation.  It's common for therapists or other professionals to advise their clients to call 911 for assistance in case of emergency.  But the response from 911 can be very different depending on the type of emergency - and, too often - the skin color of the person in distress.

Calling 911 is such an engrained response for many of us. And it’s appropriate and necessary in many situations. After all, calling 911 for a heart attack can result in a life-saving response from medical personnel and an ambulance ride to the hospital. Calling 911 when your house is burning down brings the fire department to the rescue. But in the case of a mental health crisis, calling 911 can have disastrous results. Too often, the police sent to the scene are untrained in responding to mental health concerns,  and can unnecessarily escalate the situation, leading to traumatic and at times even fatal outcomes for the person who they were sent to help. While many mental health professionals and advocacy organizations realize that calling the police can be traumatic or pose additional risks for people in emotional distress, the outcomes are often worst for those who are Black. 

The Risks of Police Responding to Mental Health Calls, Especially for People of Color

As communities of color are painfully aware, calling the police in any circumstance can be a high-risk proposition.  With distressing regularity, encounters with the police have been injurious or fatal for people of color, even if they or their family members are the ones asking for help, and no matter how compliant, calm, deferential, innocent, or unarmed they may be.  The list of unarmed Black Americans killed by police continues to grow longer and longer, which should make us wary of assuming that 911 is the appropriate blanket approach for every person and situation -- especially when mental health is involved.

When people of color are experiencing a mental health crisis (e.g., suicidality, symptoms of psychosis or mania, paranoid delusions, or other erratic or aggressive behaviors that are likely to trigger alarm in responding officers) they are in much greater danger of being harmed or killed by police than White people experiencing similar crises.  Even without an untreated mental illness, Black people are already 3 to 6 times more likely to be killed by police than White people, depending on the region where they live - and adding a mental health crisis into the mix can make for an even more deadly combination.

According to one study, people with untreated mental illnesses are 16 times more likely to be killed in encounters with police. So we can see that for Black individuals suffering from a mental health emergency, the odds of a fatal encounter increase exponentially. One does not need to look far to find stories of Black people from all across the United States who were killed by police sent to respond to a mental health situation, as demonstrated by the deaths of Charleena Lyles, Reginald Thomas Jr., Deborah Danner, Miles Hall, Daniel Prude, Walter Wallace, and many others.  

And even when no one has been killed, there are all-too-real horror stories of mental health crises that almost ended fatally,  such as the story of Randy Evans, a 28 year-old Black Arizona man whose mother called 911 on his behalf during a manic episode.  Although she had called 911 for him previously, she was alarmed to see that this time, police arrived in riot gear, after dispatch apparently confused her son's name with that of a wanted felon.  Even as she attempted repeatedly to clarify his identity and mental health history with dispatch and the responding officers, she was threatened with arrest by an officer who said her attempts to help were "obstructing" their efforts, and the officers pointed assault rifles and tazers at her and her son in the midst of an already traumatic situation.  

For the Black community, it has been said that calling 911 can be the equivalent of a death sentence.  One woman describes her hesitations about calling 911 on behalf of her sister Erica who was experiencing a psychotic episode, aware of the potentially deadly ramifications. She instead convinced her sister to go with her to the ER to be evaluated for inpatient psychiatric treatment, and reportedly remains glad that she did. With the scarcity of adequate community mental health options in recent decades, police have increasingly borne the brunt of responding to mental health emergencies, too often with lethal results.

Treating Mental Health Concerns with Mental Health Solutions

There is a growing and overdue outcry for mental health crises across the country to be handled not by law enforcement but by trained mental health personnel.  Unfortunately we are still far from a reality where viable alternatives exist for all communities and are readily accessible nation-wide, but with the close of the year 2020, rapid changes have been developing.

In New York City, a pilot program was announced in November that would send mental health responders instead of police to respond to 911 calls that could be mental health emergencies, modeled after the innovative CAHOOTS program being used in Eugene, Oregon.  Other cities across the U.S. are beginning to adopt similar models.

Across California, efforts to shift mental health response away from police continue to gain traction, with the creation of new pilot programs to send trained counselors, medical technicians, and other non-law-enforcement personnel to respond to mental health crises.  In October, LA's City Council voted unanimously to begin developing an unarmed crisis response team that will be equipped to respond to some non-violent 911 calls.

Some police departments have already developed unique programs that offer a more mental health-aware approach. For example, the H.O.P.E. program in Pasadena, CA, which has been praised by local mental health practitioners, offers a cooperative law enforcement and mental health response for those affected by homelessness and addiction, connecting people in distress with resources to help them out of crisis.

But we still have a long way to go in providing adequate mental health resources for those in crisis.

Alternatives to 911

What can you do for someone experiencing a genuine mental health crisis? Instead of calling 911 as a first step, here are the top three resources you may want to consider, recommended by Mental Health America:

1. Mobile Crisis Response Teams:  According to Mental Health America, "Mobile Crisis Response Teams should be the first point of contact in calls regarding mental health crises. Made up of mental health professionals, community health workers, and/or peers, these teams have the knowledge and skills to respond and refer individuals in crisis to the appropriate resources. They work closely with police, crisis services, and communities to support individuals and their families in navigating systems and supports. With specialized knowledge and the ability to engage people who may be at risk for “wellness checks,” access to Mobile Crisis Response Teams can help prevent crises and avoid unnecessary hospitalization, police interactions, and arrests. The best of these models contain peers who can most effectively empathize with and engage the individual in crisis."

In Los Angeles County:

• Psychiatric Mobile Response Teams (PMRT) are run by the LA County Department of Mental Health. These consist of "LACDMH clinicians designated to perform evaluations for involuntary detention of individuals determined to be at risk of harming themselves or others, or who are unable to provide food, clothing or shelter for themselves. PMRT enables successful triage of each situation involving mentally ill, violent or high-risk individuals. PMRTs also receive community calls that do not rise to the level of direct services; in these situations staff provide information, referrals and other kinds of alternative support." (source: LACDMH).

• Psychiatric Emergency Teams (PET) are "mobile response teams based in and operated by psychiatric hospitals approved by the Department of Mental Health to initiate applications for 5150 and 5585 evaluations. Team members are licensed mental health clinicians. PET operates similar to PMRT and provides additional resources in specific geographical regions." (source: LACDMH)

  A caveat, however, must be included with regard to these specialized teams. Due to high demand and limited availability, wait times for these teams can be long - up to several hours or more. Depending on the severity and urgency of the crisis, PMRT, PET or other specialized teams may not be able to respond in time to help. In these cases, calling 911 may be your only option.

If you have time to wait, call the LA County Department of Mental Health Help Line at (800) 854-7771 to get connected to specialized 24/7 help in Los Angeles county.

2. Peer-Run Crisis Respite:  "In contrast to the unnecessary hospitalization and missed opportunities for connecting to services that occur in emergency rooms, crisis respite services are tailored specifically to the need of consumers experiencing crises. Peer-run crisis programs are places where people can to connect with peers with lived experience of mental health conditions, in an environment that promotes autonomy and empathy and provides people with the hope and resources to move in their recovery. This includes linking people in recovery to ongoing community-based services." (source: Mental Health America Position Statement 59)

3. Psychiatric Urgent Care Clinics: "Psychiatric urgent care clinics are the same as other urgent care clinics, but are specially trained to attend to mental health and substance use needs. [They offer] a place for individuals to go and receive immediate attention, avoiding a potential crisis. By making pre-crisis services available like any other health care services it makes mental health crisis avoidance accessible and normative." (source: Mental Health America Position Statement 59)

For a list of psychiatric urgent care clinics in LA County, click here, or this list of psychiatric crisis services from the LA County Department of Mental Health.

Hotline Resources

Besides calling the LA County DMH 24-Hour Help Line (800) 854-7771), you may find some of the following national hotlines helpful as well.  Each may be able to help you locate emergency services and resources in your area:

National Alliance on Mental Illness (NAMI) HelpLine: 1-800-950-NAMI (6264) (note their operating hours are Mon- Fri, 10am–6 pm Eastern time):

National Suicide Prevention Lifeline (24 hrs): 1-800-273-8255 

National Domestic Violence Hotline (24 hrs): 1-800-799-SAFE (7233)

Going to the ER

If it is safe to do so and the above options are unavailable to you, you can bring your loved one to a nearby Emergency Room for a psychiatric evaluation. Here is one psychiatric social worker's helpful account of what happens when you go to the ER for a psychological emergency. While not a perfect solution (ERs can be noisy, chaotic, prone to treating all psychiatric complaints in a similar way, and subject to long waits, among other limitations), it may be far less traumatic for someone to willingly go with you to the ER than to be responded to by police, whose response to a mental health emergency (at least in Los Angeles) will likely include handcuffing of the person in distress, which can be disorienting and alarming for someone already in distress, and has the potential to escalate into a violent encounter.

If you decide to go the route of the ER, this article has some helpful pointers about what to expect and offers practical ways to prepare yourself or your loved one for the visit. If your loved one is admitted for treatment at the ER or another psychiatric facility, it may be a good idea to also contact the person's mental health care provider (e.g., psychiatrist, therapist) for emergency assistance with crisis intervention.

If You Have to Call 911

With all of the risks involved, there may still be situations where calling 911 during a mental health crisis is unavoidable, necessary, or the best available option under the constraints you face.   If so, consider the following steps to help mitigate potential harm to the person in distress.

First, see these helpful Guidelines for Effective Communication with 911 Dispatch from the National Alliance on Mental Illness (NAMI). They recommend staying calm, calling 911 out of earshot of the person in distress if possible, and requesting a CIT Officer to be dispatched (CIT means "crisis intervention team," and refers to an officer trained in responding to mental health emergencies and other crises). While on the phone with dispatch, you can also request an evaluation for a 5150 (that is, involuntary confinement/hospitalization for someone who is a danger to self or others or who is "gravely disabled"). Use a landline if you can, or if calling from a cell phone, use your local emergency police number (look it up now and save it in your contact list for future reference). Explain your relationship to the person and why they are in danger, being as specific as you can.

Although still not a guarantee of safety, it is important to explain the nature of the mental health situation both to dispatch and to any officers who arrive at the scene, since dispatch may only communicate an abbreviated version of the facts to first responders.

NAMI suggests using these situation-specific scripts for what to say to 911 dispatch depending on the type of emergency you're calling about, whether it's:

- Suicide/overdose attempt

- Threat to self (with weapon)

- Threat to others (with weapon)

- Threat of violence (but NO weapon)

- Gravely disabled (with NO weapon), i.e., the mental health condition is severe enough that the person is refusing basic necessities such as food, essential hygiene, or cannot stay safely in the home until they get back on their medication.

Additional Resource Guides

You can also research whether additional, alternative resources exist in your local community. Below you'll find some of the most-referenced resource guides from NAMI that you can use now to begin identifying affordable mental health services and crisis resources in your area:

NAMI National Resource Directory

NAMI Resource Library

Top NAMI Helpline Resources

Ways to Prepare Now 

Think about what you can do now to prepare for an emergency. Put a list of emergency numbers and contacts in your phone, including the hotlines listed above, as well as your loved one's physician and mental health care provider.  Have plans in place for who will watch the kids or the dog if you have to transport your loved one to psychiatric urgent care or the ER, and have their insurance information handy. Check out this guide from HuffPost which offers some additional guidance and resources to consider as alternatives to calling 911, and know what the options in your area are ahead of time.  Practice what you would say on the phone with police dispatch if you ever needed to call 911, using the suggested NAMI scripts.

It's also never too early to prevent a mental health emergency by speaking with a psychiatrist or your primary care doctor for help with medication, or by reaching out to a therapist to begin counseling/therapy to begin treating the underlying causes of distress. There are plenty of online directories you can use to search for a therapist, filtered by criteria of your choosing, including Therapy Den, PsychologyToday, Open Path Collective (for low-fee therapy), Therapy for Black Girls (women, too), and Therapy for Black Men.  

Life gives us enough challenges to shoulder.  Worrying about how to navigate a mental health crisis on your own - and stay alive through it - should not have to be one of them.

This blog post is for informational purposes only and cannot be used to give medical advice or guidance tailored to your exact situation. The author is not responsible for the content of linked articles or any changes made to them in the future. Please use your best judgment as to what fits your own circumstances.

Giving Depression Permission to Exist: How the Pursuit of Constant Happiness is Selling Us All Short

Recently I had the privilege of speaking on the intersection of depression and hope to a group of about 250 people gathered at LUMINATE,  a unique artistic event hosted by Creativity Catalyst meant to reveal the experience of depression, and to demonstrate the tangibility of hope through the arts, dramatic performance, and the spoken word.

Listen in and discover the ways in which depression can often be a necessary and appropriate response to circumstances that are not as they should be, and gain a fresh perspective on our culture's need to let go of the drive for constant happiness and uncover the unexpected gift hidden within the painful experience of depression.

TRANSCRIPT: 

"There's no way to capture, in a few minutes, the fullness of the experience of depression, but I want to talk about ways that we as a culture have not done very well with it.  And maybe we can give depression a little more permission to exist.

"As a culture, we don't do very well with depression.  We don’t like sad things.  We don’t do terribly well with grief, as compared to ways other parts of the world deal with it.   It’s written into the fabric of our society that we’re after the pursuit of happiness.  And we’ve decided, in fact, that depression is a mental illness - that it's a not-normal part of existence, something to be feared and avoided.  And whether we say it outright or not, we - or the culture around us - can often treat it like it’s the depressed person’s fault.  

"So I want to start by saying: we need to give depression permission to exist.

"You may often hear people say things like, 'We shouldn’t let our emotions get the better of us.'  That the rational part of our mind is what should be calling the shots, and that our emotions are just distractions that are not based in reality.  But the truth is, emotions are generated in our brain – from biological, generational influences, and in response to the real-world stimuli around us.  Emotions cue us to the real dangers in the world that we have to be on the lookout for.  They enable us to develop an affinity with other people, people we need for our survival and our well-being.  Emotions are critical sources of information about our environment, and how we can try and stay alive – and thrive - in it.

"So if we’re talking about depression, one of the first places we need to look is not just at the individual experiencing depression, but at the environment surrounding the individual that gave rise to the depression. 

"The truth is that often, depression is the most reasonable and appropriate response to a difficult environment. As human beings, two of the things that we need most at our core is the reassurance that we are loved, and the assurance that we are safe.  When either of those things are threatened or denied, we understandably react.  We get angry, or sad, or afraid.  But often our environments – whether our families, our workplaces, the way life was when we were growing up, the experiences of injustice we’ve endured – those environments don’t always respond well to anger or sadness or fear.  

Sometimes the response we get is that we just need to deal with it, that the pain we feel doesn’t belong, and that nobody’s going to accommodate us.  We can begin to experience lasting injury to our confidence that can be loved or safe.  And when the things around us don’t change, we can even start to believe that we are fundamentally to blame – that we are unloveable, or incapable, or flawed in some other way that means we’ll never be able to find love or safety. 

"When you’re chronically struggling - with the generational effects of depression, in relationships, at work, with your family,  with racism, with economic stress, with loss, with the overwhelming wrongness of what’s wrong in the world sometimes – your brain responds accordingly.  When you’re in emotional pain, the same neurons are firing as when you’re in physical pain.  It's no different.  It is no less real.   Depression is not irrationality, or weakness – it’s not a character flaw, or a lack of faith.  Sometimes it is an honest and healthy admission that things are not how they’re supposed to be right now, or maybe they never were how they were supposed to be for you. 

"Let’s give permission for depression to exist.

"When I was in school studying counseling, we learned about the fascinating role of  the so-called 'identified patient' in a family.  Often when families come in for therapy, it’s because they think there's something wrong with one of the children.  'Johnny is depressed.  He’s not doing well in school; his behavior is falling apart - we really need something to fix him.' But as it sometimes turns out, Johnny, the identified patient, is the healthiest one in the family.  He's giving emotional expression to problems in the family or in the environment that have not been successfully or honestly addressed by others.  Johnny, in fact, deserves a little credit for being the emotionally honest one, responding to the dynamics or events in his life that others may have chosen to ignore, or never been aware of. 

"American culture tells us we should be happy at all times and at all costs.  That our worth is based on our productivity and our success.  But we ignore a whole swath of the human existence – and of our deepest selves - when we falsely pretend that life is only good. 

"And so what I want to offer you is this: hidden somewhere within the pain of depression, there is a gift.  The gift of honest lament.  Our in-tune-ness with the fact that things are not as they should be can actually be a  freeing gift to others, because instead of forcing us all to play along with the sugarcoated lie that says, "Everything's great!", it actually points to the hope that it's not always -  but we were made for more than this; that this world was set up for flourishing, and that withering and decay and despair should not get to have the final word.

"We offer a great gift when we are willing to not be OK, when we are willing to say, 'This is not how things should be' - because if we can hold onto the pain of that, it means we are also holding onto the hope that something better is coming, and that we can use our pain to join with the pain of others, to advocate for others, and to work side-by-side for the flourishing of the good world that we were all meant to experience."

© Rachel Engels 2019

What Should I Talk About in Therapy?

Coming to therapy can be a daunting experience at times, especially if you're not always sure what to talk about.  Some weeks you might have very specific issues you want to address, and other times you might be questioning whether you have anything worth bringing up, or second-guessing what the purpose of therapy is when you don't feel like you're solving a new problem every week.  

Here are some thoughts I've put together over at the Sync Counseling Center blog, describing:

- What kinds of topics to bring up in therapy

- How to know whether something is important enough to address in therapy

- Ideas for jumpstarting the conversation if you're at a loss for what to talk about

Click here to read my thoughts on What to Talk About in Therapy: A Guide to Getting the Most out of Your Sessions, and you'll have some ideas in your pocket to give you greater confidence in how to use your sessions to their fullest potential.

What to Expect from Couples Therapy

Every relationship has its struggles. But for many people, couples therapy is not usually at the top of the list of solutions to try. They might think their issues aren’t big enough to bring to therapy, or that they should be able to handle things themselves. Shouldn’t you really be struggling, or have exhausted all other options before calling in professional help? I know that for me, the very term “professional help” itself raises some hackles - implying that some area of life is too much for me to do on my own and I need a pro to come in and function for me. Sometimes the feeling that we should be able to handle it can stop us from reaching out until the point that we’re exhausted, worn out, and feeling out of options. But it doesn’t have to be that way.

For many, the search for a therapist doesn't begin until you've hit a wall in your relationship and aren't sure how to move forward.  Maybe you're at a point where things have started to feel like they will never change, and you’re starting to lose hope. Maybe you’re embarrassed to bring someone else in on the struggle, or you’re worried you won’t feel understood. Or maybe you’re afraid that couples therapy is only for people on the brink of divorce, and that bringing in a therapist will push your relationship toward the point of no return.

Couples therapy is for couples at all stages of a relationship, from dating to engaged to newly married to couples who’ve been together longer than they were single. Each stage has its own unique challenges to be navigated, and whether it’s a high-conflict relationship, an emotionally detached relationship, or a mostly well-oiled relationship that just gets stuck at some familiar impasses from time to time, there is something to be gained by coming together in a space dedicated to fine-tuning your relationship into the best it can be, whether that’s doing major repair work or making some minor adjustments that will keep you going strong together for decades.

It can daunting trying to find someone that you think both you and your partner can relate to, who won't take sides and won't impose their own values.  You might be hoping to find a therapist who is kind and understanding, but who will do more than just listen - someone who will give you some tools that you can actually use to improve your relationship.

It’s good to know what you’re getting into with therapy, since different therapists and methods can be so different, and what’s a good fit for one client or couple may not be a good fit for another. I’m a big advocate for booking a consultation call (usually free) with any prospective therapist you may wish to hire, so you can hear more about their approach and voice your own goals and questions about therapy. For therapy to go well, you really want to be able to trust the expertise of the person you’re working with, and have some context for understanding what type of work you’ll do together and how you’ll know whether it’s helping.

Here are some basics you can expect from me in couples therapy:

1. I will work to understand where BOTH of you are coming from.

The unique story and history that each of you have play an important role in our work together.  I want to learn about where each of you is coming from in life, and am dedicated to giving fair and considered attention to the experiences that both of you have.  I am here to help create and protect a therapeutic environment where each of you can be heard, and your voice will be valued. It doesn’t do you any good as a couple if I take sides with one of you at the expense of the other person, and my goal is to help the two of you become the best team that you can be.

2. I'll help you make sense of the bigger picture. 

A lot of times we find ourselves arguing with our partner about the same things over and over, or getting stuck at the same impasse.  As we talk through the details of your situation together,  I'll be listening for the bigger patterns going on in the relationship that are making it hard to find resolution.  Once we can figure out your pattern as a couple, it frees us to work together on changing it, as a team.

Part of my job is to help us sort through the content versus the process of the challenges you face as a couple. Content is the stuff itself - the kindling, if you will - that fuels the arguments and disconnects between you. It’s the daily stresses, the personal triggers, the things we say to each other that drive us deeper into distress. Content is important, but if that’s all we talk about in therapy, it can become a “he did this” and “she did that” discussion that goes around in circles, as each person airs their pain and frustration with the other. In order for us to move the relationship forward together, we need to move beyond content and into the process of how you speak to each other, how you can work to emotionally regulate yourselves, how to come to places of understanding and goodwill and emotional connectedness so that no matter what the “stuff of life” you’re dealing with is, you will be equipped to face it as teammates and not as adversaries.

3. I'll give you tools for better understanding yourself, managing your own emotions, and improving your connection and communication as a couple, no matter where you are in your relationship.

When each of you can recognize and own your own emotion and experience,  it frees you to respond differently to your partner and to start building a different pattern together - a pattern based on connection, trust, and respect.  Whether you've just started dating or have been together for years, we can make positive changes to the way you interact with each other and bring new understanding and hope to your circumstances. It’s no secret that relationships are hard. Even the best possible partner is going to be fundamentally different from you in ways that are maddening at times. Even in the best relationship, you may find yourself questioning how you ever ended up together and whether you made the right choice. But it doesn’t have to stay that way. The thing I love about working with couples is that it’s a process where we can help you build the best thing possible with the partner you have chosen for yourself, not wasting time resenting each other or fantasizing about a different reality, but actively making the real relationship you do have into one that sustains, supports, and energizes both of you. Humans are messy. But love is still worth it.

Stronger relationships = better quality of life.  Think about what matters most to you. What do you spend the majority of your time, energy, money, and focus on? Is it on the key relationships in your life, or is it on recovery and escapism strategies that are necessary because your relationships aren’t functioning as they should? Often, we can direct so much of our focus to secondary things - expensive dates, getaways, self-care activities, the latest technology or convenience - hoping it will improve our quality of life, and we can neglect investing more of what is needed to get our primary relationships to a place that is healthy, stable, and truly rewarding. Whether you’re in active crisis or you’re in prevention and maintenance mode, couples therapy can be a place for you to really invest in the kind of quality of life that begins with your relationship and has the power to emanate outward to all areas of your life.

The average couple waits 6 years to seek help from the time they realize that they need it.   If you're wondering whether therapy would be helpful for you at the stage your relationship is in, shoot me a message and we can set up a time to chat, and talk about what it could look like to get you on the road to a better future.