Therapy 101: The 5 Stages of Help

Therapy 101: The 5 Stages of Help

I’m a huge proponent of therapy. It’s helped me get my life on track in ways I never would have expected. I’m always eager to advocate for it whenever someone I know is struggling with their feelings, thoughts, or relationships.

That said, I remember how much I resisted getting therapy at first. Some people tried to sell it to me as a cure-all, an easy way to get my emotions under control. A lot of media representation paints it as an invasive process where a therapist picks apart your brain and tells you what your thoughts and feelings actually mean. My own repression told me that talking about my problems wouldn’t help me deal with them. Maybe it would even make them worse.

I pushed back and put off therapy for a long, long time. Three things changed my mind: first, a mental health episode that proved to me that my brain was NOT alright and that I needed help. Second, the efforts of Paul Gilmartin, host of the Mental Illness Happy Hour podcast. Paul’s dedication to demystifying therapy by sharing his experiences convinced me to accept it as an option. Third, a promise from my parents to pay for therapy if I decided I wanted it. That’s by far the best thing they ever did for me, although I doubt they anticipated the consequences.

I want to start paying my recovery forward by opening up about the therapy experience—the emotional struggle, the huge payoff, and all the mundane obstacles that make getting mental health care such a pain in the ass.

So without any further ado, I present Therapy 101: The 5 Stages of Help

1. A VERY Annoying Search Process.

The worst part about starting therapy is finding a therapist. The effort required to search for good mental health help is probably the second-most prohibitive barrier to entry (behind pure financial cost). It’s absolutely unfair that mental health care isn’t free and easily accessible for everyone.

If money or insurance is an issue for you, there are likely many options for sliding-scale counseling in your area. Community organizations (like LGBT centers) often retain a group of therapists and students for this exact purpose, and some individuals—especially younger therapists—might even be willing to cut you a special rate.

If you feel like the effort barrier is too high to surmount, I strongly recommend you head to an online service like BetterHelp or Talkspace with a dedicated onboarding system. I haven’t used these sites myself, but many people I trust vouch for the way they take pressure off the user and make mental health care more accessible.

If you do decide to seek in-person therapy, the first question you need to ask is: what kind of therapy do I want? There’s talk therapy, of course, but there’s also hypnotherapy, massage therapy, group therapy, EMDR, CBT, and plenty of other specialized acronyms and titles that can feel beyond overwhelming to someone seeking help.

For simplicity’s sake, let’s stick to talk therapy/individual counseling here. I think it’s a good first stop on your mental health journey. Almost everyone can benefit from individual counseling no matter their mental state, and a good talk therapist can help you triage your various problems and refer you to the specialized therapy that’s right for you.

Once you settle on your therapy type, there are still a ton of practical questions to ask. Where is this therapist located? What are their specialties? Do they take your insurance? Is their approach a match for your needs? I recommend heading over to Psychology Today and use their advanced search tool to help narrow down your options. Make sure to read the profiles and trust your gut while assembling your shortlist.

Now it’s time to make some calls. I suffer from phone anxiety myself, I know how hard this part of the process can be. If it helps, you’ll almost always get sent to voicemail, and, if calling isn’t an option, most therapists have e-mails you can use instead. The important thing is to just to start reaching out.

I’ve gone through two therapist searches. The first was atypically easy, because I was able to set aside financial concerns (thanks to my parents’ promise) and just look for a good fit. I also had a good grasp of the issues I needed help with, so I was able to narrow down my options to therapists who specialized in trauma recovery right away. I got lucky—the second therapist I contacted had an opening and a warm energy I liked. When she relocated six months later, she referred me to another therapist in her office who was also a good fit.

Six months after that, cutting my parents out of my life forced me to leave that office and find a new one. This time it was much harder. Many therapists simply didn’t have openings, and several more refused to take me on because of they’d been stiffed by my insurance in the past. Eventually I connected with the LA Gender Center and started sliding-scale counseling.

I’m still in the process of getting to know my therapist. We had our first consultation last week and her relatively neutral affect gave my anxiety room to run rampant. But she has experience in my issue areas, comes vetted by an organization that has helped me before, and meets the practical requirements of my schedule and bank account.

Finding a therapist, especially if you have sub-par or out-of-state insurance, is often a case of looking for great and settling for good enough. But when it comes to mental health care, good enough is better than nothing. Good enough can save your life.

2. The Awkward Ice-Breaking Period

First consultations with a new therapist are never fun.

The therapist will start by asking you about yourself and what brings you to therapy. My anxiety often interprets this part as a pseudo-job interview and starts worrying my answers aren’t good enough. In reality, consultations ARE job interviews—for the therapist. They need to convince YOU that they’re worthy of your time, money, and trust. Take advantage of this and bombard them with questions about their methodology, their experience, and their opinions.

No matter how you approach them, consultations are a chore. In fact, your first handful of sessions with any new therapist are often a slog, no matter how quickly you dive into your traumas or issues. Therapy is valuable not just because it provides you a professional listener but also because the professional dynamic between you and your therapist allows you to learn skills that you can then apply to your real-life relationships. This therapeutic dynamic takes time and trust to establish, and patience is crucial.

It’s like going to the gym for the first time after a life of inactivity. You spend your initial visit learning how to use the machines and convincing yourself that everyone isn’t staring at you. You don’t get good exercise on the second visit either—your form is terrible, you’re aching from the last workout, and you still don’t want to be there. Each visit after, it gets a little bit easier to keep coming back. Finally, after a week or two, you’re actually getting the full workout from each exercise, and maybe even enjoying it. And then the hard part really starts.

Because this is where you learn what talk therapy really is—hour-long conversations about your thoughts, feelings, and behavior with a professional trained to listen and ask the right questions to keep you honest. It sounds like nothing, but it’s not until you start that you realize how rarely this world asks you to do that.

Maybe that sounds boring and unnecessary. I know that before I started therapy, I thought: I talk to myself about my thoughts and feelings all the time! What good would it be to have those same conversations out loud?

It’s different with a conversation partner. To explain why requires a deeper understanding of the human limbic system than I actually have (right now). I’ll probably get into that on a later date. But I hope you can trust me on this one.

Over time, you’ll relax around your therapist and start to let your guard down. And then, all of a sudden, your therapist will touch something raw inside of you.

3. Sudden Resistance

Maybe they shine a light on some feeling you’ve been trying to repress. Maybe they stumbled into a trigger they weren’t aware of. It might be ill-advised phrasing on their part or a fluke of misinterpretation on yours. It doesn’t matter. All the resistance that kept you from seeking therapy for so long rushes back in. You probably want to leave and never come back. Some of you may have been in therapy before, hit these moments, and terminated the process.

These moments are normal. They’re often necessary. Let me tell you about mine.

When I started therapy, I understood why I needed it. I had been triggered so badly days earlier that I blacked out and smashed my nose into the bathroom floor. I knew about the adult abuse that had caused the blackout my struggle to accept my abusive childhood was ongoing.

One day, my therapist asked me to close my eyes and tell me what I felt in my body. I told her that I’ve always only felt pain there—a painful tightness in my gut, like a corkscrew twisted tight underneath my ribcage. She asked me again to try and feel it, so I closed my eyes and did it. Yup, still there. She asked me if the pain had moved or changed thanks to the attention I was giving it. That’s when I got really angry.

My reaction came from multiple places. First, my assumption that she was trying to teach me how to get rid of or “handle” my feelings. Growing up, my pain was not allowed. My pain was fixable and my suffering melodramatic, or my pain would pass with and thus was unimportant, or my pain was caused by my parents and therefore a delusional or malicious lie. When they offered me financial support, my parents presented therapy as a way of learning to “handle” my feelings, which temporarily discouraged me from seeking it. All of this came roaring up when my therapist turned their attention to that pain and asked me to experience it.

Underneath was an ocean of fear. I started therapy, in part, to reconnect with my feelings. I’d been intellectualizing them away, putting them under a microscope until they no longer felt like anything—the way you can stare at a word for so long that it no longer seems like anything but a collection of letters and sounds. When that failed, I drank and drugged myself numb to survive traumas that could have killed me that way. My therapist was asking me to leave behind those defense mechanisms. I felt unsafe but plowed ahead and tried anyway. When the pain didn’t move or change, it scared the hell out of me. What if therapy wouldn’t work? What If I was just leaving behind my numbness and getting nothing in return except suffering?

I tightened up, got angry and numb, scolded my therapist for making me undergo such pain. She apologized for pushing me into a place of discomfort and thanked me for expressing my needs. My guard relaxed. I had never experienced this response to conflict before. I apologized to her for snapping. She explained that feeling and processing pain is a necessary step in working through trauma. That made sense. Over the next few weeks, I took dives back into the pain, digesting it in tiny chunks. I started to be able to differentiate between when others were hurting me and when they were just triggering old pain I’d rather ignore. I learned that I can say things like “I hurt and the pain isn’t going anywhere” without getting pushback. And I realized that navigating my own resistance to change would have been near-impossible without a helping hand.

This story might not apply to you, but I guarantee there’s something in your head and heart you’ve avoided dealing with in order to function under late capitalism. The therapeutic process will eventually lead you to it. When it does, everything in you will rebel against the prospect of dealing with it, against your therapist, against therapy itself. Stick with it. Work through the resistance. Because when you get to the other side, you’ll find—

4. LOTS of FEELINGS

I spent a few months crying. Sometimes from happiness. Mostly from sadness. The crying was absolutely a release, but the constant BIGNESS of my feelings exhausted me.

This is the part people don’t tell you about. They frame the breakthrough moment as an end in and of itself when the real work starts afterward. Everything feels like SO MUCH, and you have to stop yourself from sticking your head back in the sand where you used to be so comfortable.

It can be frustrating. I have 24 years of repressed emotions to sort through and I keep inviting more in. Cutting out my parents, coming out as trans—these things come with feelings and hurts and challenges of their own. Sometimes I feel like I’m trying to skate uphill.

Therapy isn’t easy. Even when it works. Especially when it works. Your feelings will chew up your energy. Old coping mechanisms might stop working. This phase is taxing. It doesn’t really end, although it does get easier. But it’s worth every moment, because of what you get in return.

5. Genuine Relief

Before therapy, I couldn’t cry at sad movies. I couldn’t relax, even among friends. I couldn’t tolerate silence or tension. I couldn’t get angry without feeling like a monster. I couldn’t apologize and mean it. I couldn’t ask for help without feeling guilty. I couldn’t write an essay like this one without gutting through pure terror.

Without therapy, I wouldn’t have realized I was trans.

Without therapy, I wouldn’t have connected with my kink community.

Without therapy, I wouldn’t have started this website.

Without therapy, I could never have found some small compassion for my parents.

Without therapy, I would never have learned how it feels to want to live.

I was emotionally disabled before I started therapy. I still am in some ways. But I look back at my life so far and I’m genuinely unsure how I survived without it. One of my friends died because he kept his suicidal ideation so under wraps that no one knew he needed help. I don’t want anyone else I care about to go that way, including myself. And I worry that I’ve gotten a little overzealous at times about pushing therapy because of that fear.

I worry about this piece, too. That maybe I was too honest about the difficulties you can face in therapy. That maybe I’ve overgeneralized and projected my own circumstances on the reader, that I haven’t been explicit enough about my own subjectivity. That I might make it harder for someone to seek therapy instead of easier.

If I did, I hope you’ll tell me. Comments, questions, and your own therapy stories are all greatly appreciated.

For a long time, worries like these kept me from publishing anything at all. I still struggle with them. But therapy taught me that the only way past those worries is through. That fear is a part of life, just like pain and joy and sadness and anger and love. That all I can do is my best. That help is waiting for me, if I can just reach out and take it.

I’ve said it before and I’ll say it again:

Everybody deserves to be helped.

Everybody deserves to be heard.

Nobody is beyond repair.

Triggered

Triggered

Transition 1

Transition 1