10 Tips to Help You Open Up With Your Psychotherapist

If you've never been in therapy before or if you haven't had a good experience with a prior therapist, you might find it difficult to open up with a new psychotherapist, so this article will provide you with some tips that can make it easier for you.

Opening Up With Your Therapist

10 Tips For Opening Up With Your Psychotherapist

• 1. Start By Choosing a Therapist Who is Right For You: The most important consideration when you're ready to go to therapy is whether you and any potential therapist you might choose are a good fit. Starting with a new therapist can be an adjustment--especially if you've never been in therapy before. It's a unique relationship where the focus is on you. Before committing to therapy with any particular therapist, you can attend a consultation with a therapist to see if you feel comfortable her. You might not be certain after one consultation, but you can usually tell after a few sessions. Even after you have chosen a therapist, it takes a while to build a rapport with a therapist because you're talking about the most emotionally vulnerable aspects of your life, so give it time. Also, make sure the therapist has the expertise you need for your problems (see my article: How to Choose a Psychotherapist).

• 2. Think About What You Want to Talk About Before Your Sessions: If you want to get the most out of your therapy sessions, take some time before the session to reflect on what you want to talk about.  Many clients find it helpful to make notes for themselves so they use their time well in session. There are also many other clients who prefer to be more spontaneous in session because that's what works best for them. But if you have problems opening up to talk about yourself, prior reflection can be helpful (see my article: Getting the Most Out of Your Therapy Sessions).

• 3. Talk About Your Fear or Anxiety About Opening Up to Your Therapist: Most therapists know that clients often have a hard time opening up, especially if they weren't encouraged to talk about their feelings when they were growing up. A skilled therapist can help you to get comfortable enough to explore your fear or anxiety about opening up so you can eventually open up.  If a therapist is a mind-body oriented therapist, she can help you to get more comfortable with breathing or grounding exercises.

• 4. Consider Your Therapy Sessions a Collaboration Between You and Your Therapist: Therapy is a team effort.  Gone are the days when therapists just listened to you talk and after a while made an interpretation that was supposed to unlock profound insights. These days therapy is much less hierarchical and there's a recognition that clients and therapists work together in therapy to make it a meaningful experience. Although your therapist can help you to speak about difficult topics, you have the responsibility for initiating what you want to talk about.  Therapists aren't advisors, so they won't provide you with answers to your problems, but they can help you through the process (see my article: Psychotherapy as a Collaborative Effort Between Client and Therapist).

Opening Up With Your Therapist

• 5. Take Some Time Before the Session to Relax, If Possible: It's understood that most people lead busy lives, but if it's possible for you to take even a few minutes before your session, do some breathing or stretching to help you relax before the session starts.

• 6. Keep Your Therapy Appointments on a Regular Basis and Come On Time: In order to keep the momentum going in your therapy, you need to come regularly. It's understood that you might have to cancel once in a while (make sure you know your therapist's cancellation policy), but weekly sessions are generally the expectation.  Coming on time allows you to have the full benefit of the therapy time because sessions start and end at the appointed time, so if you're late, you won't get a full session (see my article: How to Keep the Momentum Going in Your Therapy).

• 7, Keep the Focus on Your Sessions Without Distractions During Your Appointment: This means you don't have any other distractions (e.g., phones, pets, etc) so you can stay focused on your session. If you're having an online session, make sure you have absolute privacy. Therapy sessions where you don't have privacy are considered unethical and therapists won't conduct a session under those circumstances. 

Opening Up With Your Therapist

• 8. Recognize That Therapy is a Process: You might not feel comfortable divulging the most vulnerable parts of yourself during the initial stage of therapy and that's alright. Give it time.  If you have issues opening up about a particular topic that you would like to work on, tell your therapist about your difficulty so she can help you to get comfortable (see my article: Progress in Therapy Isn't Linear and Setbacks Are a Normal Part of Therapy on the Road to Healing).

• 9. Opening Up Usually Gets Easier Over Time: Assuming you and your therapist are a good match, opening up usually becomes easier over time as you build a rapport with your therapist and develop trust and confidence.  This is also part of the process.

• 10. Talk About the Therapy With Your Therapist: If you're not sure about the process, talk to your therapist about it. Whether you're in the initial stage of therapy or you have been attending for a while, you can talk to your therapist about how you think therapy is going.  Many therapists do a check-in with clients periodically to see how the clients are feeling about the therapy, but you can talk about the therapy at any time, especially if there's something you don't understand or an area where you and your therapist don't agree. It's also a good idea to talk about the therapeutic relationship and whether you think it's going well.  If there's anything you feel went wrong in a session, bring it up so it can be addressed as soon as possible (see my article: Ruptures and Repairs in Therapy).

Conclusion

You can usually get a sense of whether you and your therapist are a good match.  If it's not a good match, you can tell your therapist rather than ghosting her. Experienced therapist are aware that every therapist isn't for every client, so this shouldn't be a problem.

Most clients get comfortable opening up over time, but if you have a particularly difficult time and you're aware that you and your therapist are a good match, bring up your difficulty in your therapy session.

Your therapist can help you to identify and work on overcoming whatever emotional obstacles might be getting in your way.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT therapist (for couples), Somatic Experiencing and sex therapist.

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Tips on How to Check If a Therapist is Licensed

More and more people are seeking help in therapy.  Unfortunately, it can be a confusing process to try to determine if someone claiming to be a therapist is actually a qualified mental health professional (see my article: How to Choose a Psychotherapist).

How to Check if a Therapist is Licensed

Tips on How to Check if a Therapist is Licensed:

It's important to check if a prospective therapist you're considering working with has a state license because working with someone who doesn't have a license means that you're working with someone who is unqualified.  

Not only is this a waste of your time and money, it can also be harmful to you. 

Just like you would want to make sure that a medical doctor is licensed, you also want to make sure that anyone who calls him or herself a therapist has a state license.

Here are some tips to check on state licensure:

• Real Psychotherapists Have a State License
• There are many people who claim they're therapists when they're really not, including life coaches, personal coaches and other people who work outside the scope of their expertise.  
• Anyone can call themselves a therapist, but real psychotherapists have a state license.  

• Why State Licensing Matters For Real Psychotherapists
• Licensing is important because you want to make sure that the person you have chosen to help you with your problems is qualified.  
• A licensed therapist has a verified skillset to help people with various mental health issues.  
• A therapist obtains a license by satisfying various state and clinical requirements and have the necessary qualifications to treat you.
• A licensed therapist have fulfilled the necessary supervised clinical hours and have demonstrated that they have the necessary skills to obtain a license.  
• A licensed therapist has the proper training and experience to be a mental health professional.

• In New York State: Check with the Office of Professions - NYSED Website
• It's important to check that anyone who calls themselves a therapist is licensed.
• When you put yourself in someone's hands to help you with your problems, you want to know that they have the minimum requirements to work with you and that minimum requirement is state licensure.
• When you take it upon yourself to check a therapist's license, you're being a smart consumer of psychotherapy services.
• You can look up if a particular therapist you're considering by name by visiting the website of the licensing organization in the state where the therapist works.  In New York State, you can click on this link, NYSED - Office of Professions, and look up the therapist you're considering by name. 
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• Why is it Harm to Work With Someone Who Doesn't Have a License?
• Anyone who claims to be a therapist who doesn't have a license isn't a psychotherapist.
• If someone says s/he is a therapist and isn't licensed, they don't have the necessary skills, training and experience to help you.
• From a legal perspective, an unlicensed individual who attempts to practice therapy is committing fraud.
• More importantly, from a clinical perspective, anyone who isn't licensed will be harmful to your mental health and overall well-being.
• An unlicensed person who calls himself as therapist can leave you in a worse state than when you first started because s/he doesn't know what he's doing.
• An unlicensed person who fraudulently says he is a therapist is someone who hasn't demonstrated the basic skills required to be a psychotherapist.
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• Is a State License Enough to Qualify a Therapist to Treat You?
• Licensure is the minimum requirement for being a psychotherapist.  
• After a psychotherapist obtains a license, s/he must go on to do continuing education to stay current with regard to best practices in the psychotherapy field.
• For instance, if a therapist claims to have a particular expertise, like trauma therapy, s/he must have the necessary education and training beyond graduate school to develop the expertise to do trauma therapy.

Getting Help in Therapy
Beyond making sure that a therapist is licensed, finding a psychotherapist who is right for you is usually a process that begins with a consultation to see if the two of you are a good therapeutic match.

You might meet with a particular therapist a few times before you know if you're comfortable with him or her.  Ask questions about how the therapist works with the particular issue you want to work on.

There are many qualified psychotherapists in New York, but you're not going to feel comfortable with all of them, so trust your gut feeling.

During the COVID-19 pandemic, many therapist are providing online therapy, which is also called teletherapy, telemental health or telehealth (see my article: The Advantages of Online Therapy When You Can't Meet With Your Therapist in Person).

If you're struggling with problems and feel overwhelmed, get help from a licensed psychotherapist who is right for you.  Getting the right help from a licensed mental health professional can help you to overcome your problems so you can lead a more fulfilling life.

About Me
I am a licensed NYS psychotherapist, hypnotherapist, EMDR, AEDP, EFT and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

I am currently providing online therapy while I'm out of my office due to the COVID-19 pandemic.  

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

How to Choose a Psychotherapist

At various times in our lives, we all need help. Trusted friends and family members can be a source of strength and support to help us cope with difficult times. But sometimes friends and family are not qualified to help us work out our problems. At those times, you might decide to see a psychotherapist.

How to Choose a Therapist?
Choosing a therapist can be a daunting task, especially if you've never been in therapy before. How do you know what to look for? How do you know if a particular therapist is right for you? There are many different types of psychotherapy. How you do know which one would be best for you?

How to Choose a Therapist

Feeling Comfortable with the Therapist
I believe that the most important factor in selecting a therapist is whether you feel a connection to the therapist, regardless of who recommended the therapist or what type of therapy they practice.

So, how do you know if you feel a rapport with a particular therapist? I recommend going for a consultation and trusting your gut instinct.

Now, it's true that you might not feel comfortable the first time that you go. After all, it's not easy talking about personal things to a stranger. So, you might need to go a couple of times before you can distinguish your initial discomfort, which is normal, from what might not be a good match between you and the prospective therapist.

Make Sure the Therapist is Licensed
Make sure that whoever you see is licensed. I cannot stress this enough. Unfortunately, there are many people who call themselves therapists or counselors, but they're not licensed and they have no professional training.

Unlicensed, untrained wanna-be "therapists" usually do more harm than good and it's best to steer clear of them. If you're not sure if they're licensed, you can contact the State Professional Licensing board or go online. If they're licensed, their names will appear with their license number and the date of their license. Of course, having a license is no guarantee that they're a good therapist, but at least it's an indication that they meet the State's profesional requirements.

Ask for a Consultation
During the consultation, feel free to ask the prospective therapist questions about training, skills and experience. If a therapist is unable or unwilling to answer these questions or s/he becomes defensive or turns the questions back on you, move on.

How to Choose a Therapist:  Ask For a Consultation

You also want to know if the therapist has experience working on the particular problem that you are experiencing. You can also ask about their particular theoretical orientation. A therapist should be able to explain this to you in a way that you can understand without using jargon. Many therapists are eclectic, which means that they work in many different ways, depending upon the needs of the client.

During the consultation, ask yourself:

• Do I feel heard by this therapist? 
• Does the therapist seem interested in what I'm saying? 
• Other than normal anxiety that most people feel during an initial consultation, do I feel comfortable? 

You might need to interview a few therapists before you find the right one for you. And don't feel badly or that you'll be hurting the therapist's feelings if you decide to choose someone else. Any professional therapist understands that not all therapists are good for all clients.

If fee is a consideration, talk about the fee. Do you have out of network benefits that will provide you with a partial reimbursement?  

A Meaningful Experience in Therapy
When you find the right therapist for you, you are likely to have a meaningful experience. You'll have a chance to free yourself from old negative patterns that are keeping you from thriving in your life. Psychotherapy can be a rewarding, life changing experience. Good luck in your journey.

About Me

I am a licensed NYC Psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a psychotherapy consultation, call me at (917) 742-2624 during regular business hours or email me.

Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent in Therapy

Even the most motivated people who start psychotherapy often feel anxious and ambivalent about beginning to see a psychotherapist. As a psychotherapist, I understand that this is often a common reaction to beginning the psychotherapeutic process.

Why Do People Feel Often Anxious and Ambivalent About Starting Psychotherapy?
In general, making changes can be challenging for many people, even when they know they need to make these changes and they feel the time is right.

Starting Therapy:  It's Not Unusual to Feel Anxious or Ambivalent

Most people decide to begin psychotherapy because they want to make certain changes in their lives. But even when we know that we can benefit from making changes or that the people around us might also benefit, change can be scary.

We're familiar with our old habits and ways of being. Even when we've become uncomfortable with those ways or they're not working for us any more, often, when we think about what it might be like to be different, we're faced with the unknown:

"How can I make these changes?"
"Will I be able to do it?"
"I've tried before to change, and it didn't work. Will this be just another unsuccessful attempt?"
"What if I change and my family and friends don't like these changes in me?"

It's not unusual for doubts to start to creep in our minds when we begin thinking about making changes.

If you've never been in psychotherapy before, the psychotherapy process is very different from anything that you've done before.

Starting Psychotherapy:  It's Not Unusual to Feel Anxious or Ambivalent

To begin with, you need to find someone to see and that's not always easy. Many people like to try to see someone on their insurance plan, but many psychotherapists have dropped off managed care insurance panels because many managed care companies have been cutting their fees to therapists to the point where therapists can no longer sustain their private practices and meet overhead expenses.

Even if they don't cut fees, most managed care companies have not raised their fees in over 20 years, so the fees are not keeping pace with therapists' overhead expenses, like rents in Manhattan offices. So, there is that challenge, which can be frustrating.

I usually recommend going with recommendations from people that you trust, like friends or doctors. If you find a therapist that you like who is not on your managed care panel, you might have mixed feelings about paying for your therapy out of pocket.

But when you stop to think about how you spend money in other areas of your life (maybe you pay $10 a day for cigarettes or you think nothing of spending $100 for dinner and drinks with friends), ask yourself if it's worth it to spend the money to make the necessary changes that you want to make.

After you find a psychotherapist that is either recommended to you or you find on the Internet, you might feel awkward about making that first call: What will you say? How can you explain what you want in a way that is concise but still gets across what you're looking for? Often, you'll get the therapist's voicemail when the therapist is in session: What do you say? Where do you want to be contacted?

People often find that after they've managed to find a therapist, call and set up an appointment, they feel good about making a commitment to change. They feel that they've set an intention to make changes in their lives--they've started the process with that phone call.

 But it's not unusual to have mixed feelings about it at the same time. Some people worry prior to the appointment, anticipating what the therapist might be like: "Will the therapist be judgmental?" "Will the therapist think I'm crazy?" and so on.

For many people, coming to the first appointment can be anxiety provoking. Usually, even the most anxious people settle down after a while. They might find starting difficult, but a skilled therapist can help them to feel comfortable so they can use their session in a productive and satisfying way.

I usually like to provide a vignette that illustrates the points that I'm making in my blog posts because I think that it helps to clarify these points.

 My vignettes are always composites of actual cases, which means that they are made up of several different cases, with all identifying information changed to protect confidentiality.

The following vignette is an example of the affects of anxiety and ambivalence when a new client is starting psychotherapy:

Daniel:

Before Daniel called me to set up a psychotherapy consultation, he had been thinking about starting psychotherapy for several years. In the past, he had gone through the process of getting recommendations for psychotherapists from friends and his doctor, but he was too anxious to follow through with making the phone call to set an appointment.

When he called me the first time, he was so anxious about leaving a message that he forgot to leave his telephone number, so I couldn't call him back. Fortunately, he realized that he forgot to leave his number, so he called back, got my voicemail again and left a call back number so I was able to call him.

When I called Daniel back, I sensed that he was very anxious about making the appointment, so we spent a few minutes talking about what he was looking for in therapy.

As we continued to talk, I could hear that Daniel's anxiety was starting to decrease. He was able to say that he felt his low self esteem was getting in the way of his personal and work-related relationships and he wanted to overcome his poor sense of self. We set up an appointment and, as I usually do, I gave directions to Daniel about how to get to my office, explained the intercom system, and that when I buzz him in, he would wait for me in my reception area.

On the day of the appointment, I received a call from Daniel that he had misplaced my office address. I sensed that this was due, in part, to Daniel's anxiety about coming to our appointment, so I gave him the address again and tried to allay his anxiety. On his way to the appointment, Daniel got stuck on the subway, which increased his anxiety but, fortunately, he had left himself a lot of extra time, so he arrived early for his appointment.

When he arrived in my reception area, due to his anxiety, Daniel forgot that I told him that I would be with another client before him and that he could wait in the reception area for me to to get him after the prior client's session. So, he got to the reception area and he wasn't sure what to do. My office is set up so that the door between the reception area and my office is locked, for safety as well as confidentiality purposes (so clients don't accidentally walk in on another client's session).

 Soon after he arrived, which was about 20 minutes early, I began to hear him calling out in the reception area, "Hello? Is anyone here?" So, I came out of my session with the client who was in my office, introduced myself and told Daniel that I would be with him in 20 minutes. I pointed to the magazines in the reception area and told him that he could choose one of them to read while he was waiting, which he agreed to do.

When I came back out to meet Daniel again in 20 minutes, I noticed that he looked very anxious and he was sweating profusely. I invited him to sit wherever he was comfortable in my office, and we were about to begin the session when Daniel told me that he just remembered that he needed to make an important phone call, and he would be right back. I waited a few minutes, but Daniel never came back that day. He left in a state of panic. After I called him later that evening, he told me that he bolted out of the office because he panicked.

During our next session, Daniel was still anxious, but he was able to talk about his fears about beginning therapy. I encouraged him to ask questions and to express his concerns. Gradually, over time, Daniel began to settle into the therapeutic process. His doubts didn't disappear over night, but he was able to express them, look at them more objectively, and feel safer and more comfortable coming to his sessions.

Starting Therapy: Daniel Was Anxious During the First Session

Like most clients who begin attending psychotherapy, Daniel began to learn how to use therapy by actively participating in treatment and with my assistance. Most skilled therapists know that new clients need psychoeducation about psychotherapy to help them begin the process.

As Daniel became accustomed to the process, his comfort level increased and his anxiety level decreased. He still often had mixed feelings about "what it meant" that he was in therapy, but those feelings also decreased over time.

Starting Therapy: As Daniel Became Accustomed to the Process, He Became More Comfortable

Helpful Tips About Starting Psychotherapy:

• Realize that most people are anxious and ambivalent about starting psychotherapy and, if you're feeling this way, you're having the same experience that most people have.
• Recognize that it might be hard these days to find a psychotherapist on your managed care panel.
• Ask people that you trust, including friends and your doctor, for recommendations
• Before you make that first call, recognize that it's normal to feel anxious, so think about what you want to say before you call.
• Recognize that procrastination won't make you feel any less anxious. If anything, delaying making the call might make you feel more anxious as doubts and fears creep into your thoughts and might cause you to lose your resolve about starting psychotherapy.
• Think about your financial priorities if you choose to call a therapist who is not on your managed care panel. While it's true that many people really can't afford to pay for therapy out of pocket, especially during these difficult financial times, often people can afford it, if they're willing to make some changes in how they spend their money and if they can find a therapist who works on a sliding scale.
• Give yourself plenty of time to get to your appointment.
• Recognize that most psychotherapists see clients back to back, so there is often a client in the therapist's office ahead of you.
• Take a few deep breaths, read a magazine, do a crossword puzzle, or listen to music quietly on your Ipod while you're waiting for the therapist to come out to greet you.
• Recognize that the initial consultation session is a time to talk about what brings you to therapy at this point in time. Many people have only a vague sense that their lives are not working for them or that they're not happy. But they might not know what the problem is or why they're not happy. This is completely fine and it's all part of the process. If you're not sure what's wrong, finding out will be part of your process in therapy. You don't have to come in with the answers. A skilled therapist can help you through this process.
• Try to get a sense of whether you feel comfortable with the therapist. People often don't know this from one or two sessions because of their own anxiety. It's often hard to distinguish your own anxiety about being in therapy from a discomfort that you might feel with a particular psychotherapist. So, it might take you a few sessions to sense if you have a rapport with the therapist.
• Assuming that you're able to separate out your own anxiety about the psychotherapeutic process from a lack of rapport with a particular therapist, don't hesitate to tell the therapist that you're feeling uncomfortable or that he/she might not be a good fit. Most therapists know that a good rapport is necessary for treatment to go well, and will not be offended by this.
• Recognize that there are different types of psychotherapy (psychodynamic psychotherapy, cognitive behavioral therapy, EMDR, clinical hypnosis, and so on). Most therapists will explain during the consultation session the different types of therapy that they do and might refer you to websites or give you written information. If you're unclear, ask questions. You're not expected to be knowledgeable about this.
• Know that, with few exceptions (smoking cessation being the most common example), most forms of psychotherapy, even EMDR and clinical hypnosis, which are often recognized to be faster and more effective, are not "quick fix" solutions. The therapy process is often an investment in time and money for you and you need to weigh this against where you are now in your life and where you want to be.
• Ask questions. It's appropriate and often helpful to know about a therapist's professional background, education, and expertise. Make sure you see a therapist who is licensed in your state. Most therapists will not answer personal questions about themselves because you are the focus of the therapy and not them. But if you have a need to be with a particular kind of therapist (e.g., you're gay and you want to be with an "out" gay therapist), you can explore this with the therapist. Some therapists will divulge this information, if they think it's important to your therapeutic process, most will explore the meaning of your questions first and then divulge the information, and others will not. It's often a matter of style and professional training.

I hope this post was helpful to people who are thinking about beginning psychotherapy. I've confined my remarks to the beginning of the process because people often have difficulty starting.

About Me
I am a licensed psychotherapist, hypnotherapist and EMDR therapist in NYC. I work with both individuals and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during business hours or email me.