The decision to enter therapy is often difficult. You may find that you need to put much thought into it. Before entering therapy, it is important that you understand why you are considering going into therapy. Most people who enter therapy do so because they are trying to get help for a particular problem. For example, a couple may enter therapy because they are having trouble in their marriage. A few enter therapy out of curiosity or a want for self-growth. And even fewer enter therapy against their will, such as is court-order cases. The more motivated you are to be in therapy, the better the results will likely be.
If your are considering therapy for help in dealing with issues related to your self-injury, there are some questions that would be helpful for you to ask yourself before taking the plunge. First of all, what particular problems or issues do you want to address in therapy? Are you trying to control your self-injurious behaviors? Are you seeking therapy for issues related to SI, such as past abuse? Are you considering therapy to learn how to deal with stress or to better manage your environment? Being clear about what you want to address in therapy is an important part of your decision to enter it.
The second important question to ask yourself is what you hope to achieve through therapy that you can't achieve on your own. Your answers to this question may be numerous and varied. Maybe you want to get an objective opinion on your problems. Maybe you just want someone to talk to who will give you support during difficult times. You may want to learn about self-injury and gain insight into it or perhaps you want some suggestions on how to control your self-injury. Through this question you may find out that you are able to achieve your goals with the help of a therapist.
The third question to ask yourself is: why now? It will help determine if you wish to enter therapy at this time. What is going on in your life that makes you want to consider therapy? How have things changed in the past week, month, or year that make you feel that you might benefit from seeing a therapist? Maybe you are feeling more out of control than usual, or you may be hurting yourself more than you want to. Or maybe now you have time and money for therapy that you didn't have before. Or have you used all your coping skills and support systems and need outside help. Perhaps other people are urging you to seek help or maybe they are even threatening that if you don't go into therapy they will sever all ties with you.
Whatever your answers are to these questions, they should help you determine whether you want to enter therapy at this particular point in time. And if you do decide to enter therapy, be aware that this is not a magical solution to your problems. You will not go into therapy and instantly be "cured." Therapy often requires much time, effort, and expense. You most likely will feel worse before you feel better, and at times you may feel that therapy isn't helping you at all. On the other hand, at times therapy can be fun, wonderful, and motivating. You may gain much insight into your behavior and into yourself, you may learn healthier ways of coping. However, it does have its ups and downs, its good and bad qualities, and a lot in between. Therapy requires motivation and commitment to be helpful. You must be determined to stick with it even through the bad times. Therefore, your decision to enter therapy should be given a lot of thought.
Finding a Good Therapist
Once you have decided to enter therapy, you will need to find a therapist. It is generally easy to find a therapist, but it is more difficult to find a therapist who is well qualified and with whom you feel comfortable talking about your problems. You may be able to locate a therapist through a referral from a friend, family member, religious leader, school counselor, physician, or someone else who knows you well. You will generally have better luck finding a good therapist through a referral than you would through an advertisement or the yellow pages. But regardless of how you find the therapist's name and number, you should ask some questions before entering therapy with that individual. By asking questions you will be able to determine if you feel comfortable talking with that individual, if they are experienced in treating individuals with self-injury.
Because therapy involves such an intense and personal relationship between you and the therapist, it is very important that you find a therapist you are comfortable with. Different factors may increase or decrease how comfortable you feel with a therapist, including the therapist's academic degree, knowledge, therapeutic approach, age, sex, experience and/or personality. It is often helpful to schedule a first appointment in which you will "interview" the therapist. You may ask them questions and voice your concerns. Most therapists will be willing to answer your questions. During the first appointment therapists usually refrain from asking highly personal questions. For example, they will probably not ask, "Why do you self-injure?" because this is a personal question which would take many therapy sessions to cover. Through this "interview" you should be able to determine if you wish to enter therapy with this person. If not, you maybe will want to schedule another session.
You are not likely to find a therapist that meets all your criteria but it is crucial that you feel comfortable talking with your therapist and that you form some level of trust with them, once you have gotten over your fear and doubts about therapy. The following questions are some you may want to ask during your "interview:"
- What type of degree and/or license do you have?
The majority of therapist have some graduate training in psychology, human behavior, social work, counseling, or medicine. The therapist's title will depend on the degree or license that they have obtained-- PhD, PsyD, MFCC, LCSW, MD, etc. The only type of therapist allowed to prescribe medication are psychiatrists, because they are actually medical doctors. Psychiatrists, psychologists, counselors, social workers, etc. all have different therapeutic approaches, depending on how they were taught and depending on what psychological perspective they agree with. You may want to ask about the particular approaches or the specific types of training required for their degree. This may also give you insight on how they may go about treating you.
It is important that the therapist be licensed through a state accrediting agency. "Licenses to practice therapy are generally designed to protect you, the clients, and to ensure some type of quality control. The therapist's possession of a valid license ensures that you as a client have some recourse if you are dissatisfied with the nature of the therapy." There may be some great therapists out there that practice without a license (some states or countries do not require a license to practice), but it is generally recommended to seek treatment with a licensed therapist. This is to protect you from possibly being treated by an un-trained "therapist."
- How much experience do you have in treating self-injury?
If you are entering therapy to work on issues relating to self-injury, it is important to ask about the therapist's experience in this area. Many therapist will have little, if any, formal training on how to deal with a client who self-injures. Yet there are some therapists that have more practical experience than others in this area. Before entering treatment with any therapist you should feel comfortable about the therapists experience and/or knowledge where it concerns self-injury. Or at the very least feel comfortable with how willing they are to learn about self-injury to help treat you.
- What is the normal course of treatment for self-injury?
This question asks the therapist about how they generally treat self-injury. Is this therapist likely to suggest hopitalization? Or medication? Will he or she be able to discuss issues of self-injury in a way that you are comfortable with? This way you will find out what will most likely happen if you enter into therapy with this particular therapist. And by asking this question during the "interview" during your first visit, you are less likely to be surprised by the way your therapist will go about treating your self-injury. In my experience I find that it is not helpful to enter into therapy with someone who threatens to send you to a psychiatric hospital every time you self-injure unless they have a good cause (e.g. you are suicidal, are out of control, are refusing to try to stop self-injuring, etc.)
- How much do you know about the issues related to self-injury (such as abuse, eating disorders, dissociation, or dissociative disorders)?
It is recommended to assess the therapist's knowledge and experience in issues related to SI. You may want to be specify the issues that are relevant to you in particular.
- How long do you expect I'll be in therapy?
Most therapists will not be able to give you the exact length of time that you will be in therapy. Usually, the length of therapy will be easier for your therapist to estimate after you have spent some time in treatment. They then will be able to make an educated guess rather than just pick a number out of thin air, because during a first appointment, or even a second or third appointment, they cannot tell how long you'll have to be in therapy. But even after you have been in therapy for a while and they give you an estimate it may often be wrong. The length of therapeutic treatment often depends on your willingness to work through your issues, your therapist, and what is currently happening in your life. For example, it would be difficult to get better if you are currently being abused.
- What is your general availability?
It is important that you assess the therapists availability- not only for scheduled sessions, but for emergencies, extra sessions, and after-hour calls. Does the therapist carry a pager? Is he or she available for emergency sessions? How often does he or she go out of town or take vacations? How long does it normally take them to return phone calls? In dealing with SI you will probably need a therapist who is generally available for you and for emergencies that may occur. This does not mean that your therapist is expected to instantly return your late at night phone calls, but that they respond to you and your needs in a way that is both fair to you and to your therapist.
- How much do you charge?
The fees for your therapy should be within an affordable range. While therapy is rarely expensive, you will need to find a therapist that fits within your budget. Some therapists offer fees base upon your income level or financial situation (sliding scale). Some agencies provides therapy at considerably lower rates than that of a therapist in a private practice.
Keep in mind that the amount of money you pay a therapist does not necessarily correspond directly to their skills or their competence as a therapist. Basically, just because a therapist charges an extravagant amount of money does not mean that he or she is a great therapist, and vice versa. But, be sure to discuss the cost of therapy before setting up your first appointment.
- Is there anything else that you think I should know about you or the way you do therapy?
This question gives the therapist the opportunity to provide any relevant factors that may influence your decision to enter therapy with them. The therapist may tell you of a particular psychological perspective that they follow. The therapist may reveal information about cultural factors, sexual orientation, age, office location, or accessibility for the disabled. With this question you may learn something about the therapist that may either increase or decrease your desire to enter into therapy with them.
These are just a few of the questions you may wish to ask a potential therapist. When you enter therapy, you are entering a relationship. It is important that before entering this new relationship you be as informed as possible. You may wish to ask additional questions as well as the ones discussed above. "Don't be afraid to address all these issues before or during the first session."
What happens in therapy?
The experiences of each person in therapy will be different, because what happens in therapy depends on you. How you choose to use each session, your particular therapist's approach and experience, and your own knowledge, experience, and motivation will help determine your therapy.
In the majority of cases, the first few therapeutic sessions will be spent relating historical or factual information and developing or defining therapeutic goals. During these first sessions your are getting to know your therapist, and vice versa, and determining whether this therapeutic relationship will suit your particular needs.
After these first few sessions is when the real work begins. "You are likely to experience times when you feel overwhelmed, anxious, sad, angry, or dissatisfied." You may think that therapy is not helping you at all. Or you might think that therapy is helping you too much- "that all your success and positive feelings are due to therapy or your therapist." Your perceptions of therapy and your therapist will most likely fluctuate, as well as your commitment to therapy. All of these experiences are normal and to be expected.
The nature of therapy itself and the therapeutic relationship is not possible to describe because it is different for every individual and because it is so personal. Everyone perceives therapy in a different way and will benefit from therapy differently. It is not possible for me to tell you what will occur once and if you enter therapy. "However, if at any time you are dissatisfied or confused with the way in which therapy is progressing, it is recommended that you discuss this with your therapist."
Information from 'Scarred Souls' by Tracy Alderman.