Frequently asked questions about mental health therapy.
Written by Dr. Komal Gupta
Photo by Aaron Burden
What are some of the reasons that people seek therapy?
You can attend therapy for a variety of reasons. You may be trying to figure out how to manage a mental health condition, such as depression, post-traumatic stress, and anxiety, that may be interfering with your daily life. You may want to address specific challenges that might be impacting your well-being (e.g., communication problems, relationship conflict, parenthood struggles, family stress, cultural/racial trauma, existential fears, religious/spiritual issues). Or, you might be navigating a significant change or adjustment in your life (e.g., acute/chronic physical/neurological conditions, grief/loss, marriage, divorce)
There is often this misconception that you should only attend therapy when something is “seriously wrong”. However, you can also seek therapy to enhance specific areas of your life, or for personal growth (e.g., strengthening your voice, to have a space for reflection for decision-making, to deepen meaningful connections, to prepare for major life transitions, to explore your identity, and to live your life with more intention).
Why would I share my problems with a stranger when I can talk to my friends or family?
Being able to confide in and be supported by your family and friends is important for your well-being. Therapy is a form of treatment provided by a mental health professional who has specialized training and expertise to help you address specific goals related to your well-being - whether that is to manage a mental health condition, to navigate experiences that are hard to talk about easily with loved ones, and/or to disclose and process a trauma that would benefit from a safe space that is confidential, and non-judgmental.
Is what I am feeling all in my head?
The short answer is no. There are numerous studies that have been conducted on the mind-body connection that dismantles this myth of mental health conditions, such as anxiety and depression, existing “all in your head”. Mental health symptoms can result from a complex interplay of factors such as genetics, brain chemistry, biological/hormonal conditions (e.g., thyroid disease), stressful life events (e.g., financial problems, marital distress), unresolved trauma, systemic oppression and/or a lack of perceived social support. If you had diabetes, you most likely would consider treatment to manage it. Mental health concerns should be treated with the same importance and validity.
What are the differences between a psychologist, psychiatrist, social worker, counselor and life coach in the United States?
There are a lot of individuals offering services in the mental health space and it can be overwhelming to navigate. It is important to ensure the mental health provider that you are working with is licensed and that they have the appropriate qualifications to address the mental health concerns or goals you want to address. While basic qualifications are important, it can also be misleading to assume one therapist is “better” or “worse” than another because of the graduate school they attended, and/or having more years of clinical experience. An important distinction is that life coaches are not mental health professionals and they are not regulated by a governing body (i.e., your privacy and confidentiality is not protected by federal law, and anyone can call themselves a life coach). Please refer to the chart below for more specific information:
How do you determine whether your mental health therapist is a “good fit”?
Therapists typically offer a free 15-minute phone consultation (prior to the initial session) as an opportunity for you to ask any questions you have and for them to be open and honest with you if they have the appropriate expertise to address your goals. It can be incredibly validating to connect with a therapist who has a similar identity to you (e.g., culture, race, gender, religion, sexual orientation etc.) but it does not mean that they will automatically “get you”. Similarly, just because a therapist might appear to have a different identity from you, it does not mean that they will not understand you. Rather than making assumptions about their experiences, it can be helpful to ask the following questions during the brief phone consultation:
How does your own identity inform the work that you do with clients?
What is your training and/or experience when it comes to working with ______________ (e.g., immigrants, South Asian culture, polyamory, Buddhist beliefs etc.)?
How do you incorporate the sociocultural context in your understanding of someone’s concerns?
What is your comfort level and experience with having conversations about discrimination, systemic oppression, white privilege, and similarities and/or differences between us?
After the brief phone consultation, you might know right away if a therapist will be a “good fit” or it might take a few sessions of getting to know each other to determine how you might want to proceed. Similarly for the therapist, they also try to determine over the next few sessions if they have the appropriate expertise to continue working with you. Research has consistently shown that the feeling of connection you develop with your therapist and the ability to work together on your concerns are the two most important predictors of positive change (e.g. Ardito & Rabellino, 2011). Providing regular feedback (even though it can be understandably difficult sometimes) and sharing how you are doing throughout the process is important.
Will the information I share in therapy be kept private?
In order for you to feel comfortable disclosing information about your life, it is helpful to know how your information is protected. There is a U.S. federal law (HIPAA) that protects and secures the information you share in therapy and also informs you of specific situations in which your privacy cannot be maintained. Aside from the specific situations mentioned below, your mental health therapist does not disclose any of the information you share in therapy, or any content that would reveal your identity. Maintaining your confidence is part of our code of ethics. Here are some of the special situations in which confidentiality can be broken without your consent:
If you are an immediate danger to yourself or others.
If there is a reasonable suspicion of child, elder, or dependent adult abuse.
If you are deemed “incapacitated.”
If your therapist receives a qualifying court order.
If you are using insurance, your insurance company will be provided with a mental health diagnosis, a service code, and any necessary information required to justify billing or payment of services.
Typically, either before or during the first session, your therapist will provide you with an informed consent that should clearly explain confidentiality and any limitations to confidentiality. If you have any questions about it, you should never hesitate to ask.
Will I be judged?
It is a common experience to fear being judged by your therapist especially when you are taking the risk to share private information that makes you feel vulnerable or exposed. While you might feel vulnerable sharing parts of your life, therapists are accustomed to hearing a range of thoughts, feelings, behaviors, experiences and fears that people have - including the feeling or fear of being judged. If you are feeling judged, it is important to bring it up with your therapist (refer to the next question for how to address this).
What if I get upset with my therapist?
It is natural to experience moments when you feel upset or judged by something your therapist might have said or done. These are the moments where it can be helpful and informative (and sometimes not an easy task) to provide your therapist with feedback about the upsetting situation or interaction. Evaluate how they manage that upsetting situation with you and observe the next few sessions to determine whether anything has changed (or not). You can then decide whether it is possible to work through your concerns moving forward or whether you would like to proceed in another direction.
In the rare situation that a therapist commits a serious boundary violation, you can file an ethical complaint to the appropriate state licensure board in order for them to investigate further.
References
Ardito, R.B. and Rabellino, D. (2011). Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements and prospects for research. Frontiers in Psychology, 2.
