What You Should Know About Exposure and Response Prevention (ERP)

Did you know that there’s a treatment for Obsessive Compulsive Disorder (OCD) that’s been shown to be effective for up to 80% of people with OCD? It’s a type of Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP).

What is Exposure and Response Prevention (ERP)?

ERP was developed to treat OCD, and it can be an incredibly effective form of treatment for folks dealing with obsessive thoughts and compulsions. 

To understand ERP, it can help to understand more about how Obsessive Compulsive Disorder works. OCD involves intrusive thoughts that are disturbing and unwelcome. Often, these thoughts create a lot of distress for the person who is experiencing them. When these thoughts pop up and cause distress, people with OCD attempt to relieve the distress through compulsions, which may work briefly. 

After a while, though, the thoughts come back, and the cycle starts again. The compulsions that a person uses to relieve their discomfort eventually become part of their daily routine, which can get in the way of work, family, and other relationships. 

When we think of OCD, we often think of someone who is obsessed with cleaning, but that’s not actually how most people experience the disorder. People may have recurring, unwanted thoughts about harming people they care about, or that something bad will happen if they don’t follow through with their compulsions. Some people experience intrusive sexual thoughts, or thoughts of doing something violent or illegal. These thoughts are not in the control of the person experiencing them, and they can be extremely frightening. 

To try to lessen the fear they feel from these thoughts, people with OCD may develop compulsions or rituals like checking to make sure the smoke detectors work, making sure the baby is still breathing, making sure that the emergency brake is on, or checking that the security system is on. The overwhelming feeling is that if they don’t practice these compulsive rituals, something terrible will happen, and that can be an exhausting way to live. ERP was designed to interrupt this cycle and reduce the anxiety that feeds these intrusive thoughts. 

How does ERP work? 

There are two parts to ERP - the exposure and the response prevention. Within the safety of a therapist’s office, you’ll be exposed to the triggers and thoughts that cause you distress. Then, you’ll practice resisting the urge to perform the corresponding compulsions or rituals. 

First, you’ll work with your ERP therapist to determine what all of your triggers, intrusive thoughts, and compulsions are, so you can work through them in a safe place. This helps you and your therapist determine which triggers and obsessive thoughts cause you the most distress, so you can work your way up from lower levels of distress to higher levels over time. Exposure and Response Prevention works gradually. You aren’t going to be asked to confront your worst fears right away. As you move up the hierarchy of distress, you’ll gain confidence and experience, which help when it comes to the more distressing levels. 

As you’re exposed to your triggers or your intrusive thoughts in ERP therapy, you’ll learn skills from your therapist to help you learn how to sit with discomfort and resist your compulsions. Working with a therapist can help ensure you avoid replacing one compulsion with another, in addition to teaching you skills to help lower your distress level when the unwanted thoughts come up. 

Exposure and Response Prevention works for two reasons - habituation and inhibitory learning. Repeated exposure to your triggers will help you learn to tolerate your distress and discomfort more effectively, which reduces your overall distress level over time. This is known as habituation. Inhibitory learning happens when you learn that your intrusive thoughts don’t always come to pass when you’re exposed to your triggers. ERP helps to prove your obsessions wrong, which helps to lessen their impact. 

What are the benefits and drawbacks of ERP?

ERP is generally known as the gold-standard treatment for OCD, because research has shown that it can be extremely effective. However, it’s important to note that Exposure and Response Prevention takes work, and it’s not always easy. 

Confronting the things you’re afraid of can be terrifying. Effectively learning how to break the cycle of obsessions and compulsions requires work in between therapy sessions, which can be intimidating, especially at first. Folks with OCD are practiced at avoiding discomfort, so learning how to be okay with discomfort takes time and practice. 

Can ERP help with anything else?

Yes! ERP can help with disorders besides OCD, including: 

• Anxiety

• Eating disorders

• Phobias 

How to find an ERP therapist

If you or someone you know is struggling with intrusive thoughts, ERP might be a good fit. Our clinicians at Hope+Wellness have experience supporting clients who have Obsessive Compulsive Disorder. We serve the McLean, Great Falls, Falls Church, Arlington, Alexandria, and the greater Washington DC regions, as well as offering online services in DC, MD, VA, and all PSYPACT states. 

If you would like to talk to one of our therapists, please contact info@hope-wellness.com or get in touch with us here.

Cognitive Behavioral Therapy: 5 Things You Should Know About It

If you’re thinking of starting therapy, you’ve likely run into the term modality before. A modality is the approach a therapist takes when providing care for their patients. One of the modalities we utilize here is called Cognitive Behavioral Therapy (CBT). 

CBT is an approach that focuses on how our thinking patterns influence our behavioral patterns. The main idea behind CBT is that thoughts influence how we feel and act. Basically: how we act can in turn also affect how we think and feel in a given situation, and our unhelpful thoughts can then lead to unhealthy behaviors and feelings. CBT helps you to understand and break this cycle.

Here are five things you should know about Cognitive Behavioral Therapy: 

1). CBT has been shown to be effective for a wide range of presenting concerns: 

CBT is an active, goal-oriented psychotherapy treatment. As a treatment, it’s been studied and shown to be highly effective in treating a wide range of people (children, adolescents, and adults) with a wide range of presenting emotional and behavioral concerns such as: 

• Depression

• Anxiety

• bipolar disorder

• Perinatal mood and anxiety disorders (e.g., postpartum depression)

• Sleep

• Relationship problems

CBT has also been found to contribute to significant improvements in functioning and quality of life.

2). CBT has been studied extensively in both research and clinical practice. 

CBT is an evidence based treatment. What that means is that its efficacy has been proven to be safe and effective through extensive scientific and clinical research. This research involves thousands of patients and meticulous comparison of effects to alternative treatments. Evidence based treatments help increase the effectiveness of the treatment and helps reduce the risk of recurrence of damaging behavioral patterns. There’s heaps of scientific evidence out there showing that CBT is effective in producing meaningful change and improvements for clients.

3). One of the core principles of CBT is that problems with mood are related to unhelpful behaviors and thought patterns. 

These negative thinking patterns can influence our mood and exacerbate feelings of anxiety, depression, or other feelings of insecurity and self doubt. This can then contribute to a pattern of unhealthy behaviors–which in turn starts the cycle all over again. With CBT, these thought and behavior patterns are explored and new, healthy ways of coping are explored to effectively relieve symptoms and improve quality of life. 

4). Psychologists and clients work together collaboratively to develop goals and to actively target symptoms. 

Time is spent examining present-day issues, thoughts, and behaviors. For example: 

A teen who is depressed might think, "Everything is hopeless," or "There's no point to anything I do." 

Emotionally, these thoughts may occur with feelings of sadness, depression, apathy, and lack of motivation. Behaviorally, the depression may appear as increased isolation, withdrawal from usual activities, refusal to attend school, etc. However, these behaviors only reinforce the negative thinking patterns, and exacerbates the cycle of withdrawing from life due to a feeling that there’s no point in participating.  

For this, treatment would involve teaching the teen to identify and challenge negative thoughts, skills to cope with depressed mood (e.g., activity scheduling), and working with parents to develop a reinforcement system to encourage positive behaviors and use of coping strategies. CBT is highly collaborative, practical, and goal oriented. 

5). Because CBT is very goal oriented, there are many skills clients develop as part of the process. 

They are learning how to face fears, problem solving difficult situations, recognizing patterns of unhelpful thoughts and behaviors, and ways to calm the mind and body. Other skills taught as part of CBT include:

• Problem solving

• Communication training

• Cognitive restructuring aka learning to identify and dispute cognitive distortions. You can read more about cognitive distortions from these posts on our blog: 

• 8 Common Cognitive Distortions to Watch Out For

• 10 More Cognitive Distortions to Be Aware Of

• Managing Cognitive Distortions

• What is All or Nothing Thinking?

• Why “Should” Statements Make You Feel Worse

• Social skills training

• Relaxation training

• Behavioral activation aka intentionally practicing specific behaviors that promote a positive mental state, or avoid negative thinking traps. 

Are you interested in CBT? Our clinicians at Hope+Wellness offer CBT therapy in our office and online. We serve the McLean, Great Falls, Falls Church, Arlington, Alexandria, and the greater Washington DC regions, as well as offering online services in DC, MD, VA, and all PSYPACT states. If you would like to talk to one of our therapists, please contact info@hope-wellness.com.

What You Should Know About EMDR

Have you ever heard of EMDR?

EMDR stands for Eye Movement Desensitization and Reprocessing. It’s a kind of psychotherapy that was developed in the 1980s by Francine Shapiro. Dr. Shapiro was walking outdoors in 1987

when she noticed that the distress she was feeling, related to upsetting memories, was lowered when she moved her eyes back and forth. She did further studies on this phenomenon, and eventually developed EMDR as the treatment it is today, as well as the Adaptive Information Processing model to explain how the treatment works. 

While EMDR is a newer treatment, it’s been shown to be incredibly effective in both research and in clinical settings. Many people experience a dramatic decrease in their distress level after EMDR therapy, and studies show it’s effective for many many mental health issues, including trauma, depression, anxiety, and OCD. 

How does it work?

The basic premise of EMDR is that our minds can heal wounds in the same way that our bodies can, but sometimes those wounds don’t heal correctly and cause pain long after the event in question. It’s almost like the painful memories and emotions get stuck. When this happens, we experience negative outcomes like trauma, anxiety, and other kinds of emotional and mental distress. Resolving these issues requires us to access and process these stuck memories and emotions, which happens through EMDR. 

EMDR offers a way to locate, access, and reprocess these stuck memories and emotions. The goal is to change the way the brain is storing these stuck memories so that they stop causing pain. EMDR treatment requires a clinician who is trained in EMDR, because the process of accessing and reprocessing traumatic memories is very sensitive. EMDR therapists have extensive training in the background of why EMDR works, and how to adapt it for different situations based on what the client needs.

What happens during an EMDR session? 

EMDR helps you to locate and reprocess traumatic memories, so it’s not something you can just jump into without preparation. EMDR has 8 phases, and each phase is essential, especially the phases where you work with your therapist to develop resources to help you during upsetting moments. 

• The 8 phases of EMDR are: 

• History & Treatment Planning

• Preparation

• Assessment

The first 3 phases are completed before reprocessing can begin. These phases are focused on understanding how EMDR can help the client based on their history, developing a treatment plan, building a rapport between the client and therapist, providing resources for the client to use in moments of distress, and deciding what event or memory to reprocess. 

• Desensitization

• Installation

• Body Scan

The next 3 phases are the reprocessing phases, where the client works with the therapist to access and reprocess the memory until they no longer feel distress around it. These phases include the bilateral stimulation that EMDR is famous for. Some clinicians will have you use eye movements, tapping, headphones, lights, buzzers, or tappers to direct the bilateral stimulation that allows you to access the memory networks that need reprocessing. 

• Closure

• Reevaluation

The final 2 phases help to build safety for the client as each session ends and begins. Each session will end with helping the client return to a calm state of mind, and each session will begin by checking back in to make sure that their distress level stays low around the reprocessed memory. 

Some of the phases go faster than others, and once you are ready to begin reprocessing, most of your EMDR sessions will be some combination of phases 3-8. 

What can EMDR help with?

EMDR was initially developed to help process trauma, and lessen the effects of PTSD, and it is an incredibly powerful way to treat trauma, including trauma from childhood or abuse. However, research has shown that EMDR can be helpful with a number of other mental health concerns, including: 

• Anxiety

• Depression

• Chronic Pain

• Dissociative Disorders

• Personality Disorders

• Addiction

• Eating Disorders

• Grief

• Self Esteem 

• OCD

EMDR is a treatment that can be used for children, teens, and adults. There are some situations where EMDR is not an appropriate treatment, so it’s important to check with an EMDR therapist to determine if it’s a good treatment choice for you. 

What are the benefits and drawbacks of EMDR?

One of the biggest benefits of EMDR is how effective it is as a treatment. Although it’s a newer treatment modality, there have been many studies conducted on EMDR that show it works. The data showed that EMDR was working for people before we even understood why it worked! Many organizations, including the World Health Organization, the American Psychological Association, and the US Department of Veterans Affairs recognize EMDR as an effective treatment for PTSD and other disorders.

Another major benefit of EMDR is that it doesn’t require a person to talk in detail about the distressing memories they have to reprocess them. EMDR does require you to focus on the memories, but you don’t have to put them into words. While focusing on the memories is definitely upsetting, it’s less intense than having to narrate or fully relive a traumatic memory. EMDR is also fully confined to the therapy session - you won’t have homework to do or be expected to process things on your own, everything will take place with your therapist, which can be appealing. 

Are you interested in EMDR? Our clinicians at Hope+Wellness offer EMDR therapy in our office and online. We serve the McLean, Great Falls, Falls Church, Arlington, Alexandria, and the greater Washington DC regions, as well as offering online services in DC, MD, VA, and all PSYPACT states. If you would like to talk to one of our therapists, please contact info@hope-wellness.com.

How Can My Therapist Help with My Chronic Pain?

How can my therapist help with my chronic pain?

Suffering from chronic pain, or having a chronic illness with severe physical symptoms might not seem like the kind of thing you can go to a therapist for, but a therapist can be a key element of your chronic pain management. 

While your illness or pain may be physically located in your body, that doesn’t mean it’s entirely separate from your mental health. In fact, mental and physical health are incredibly linked. So, when your mental health suffers, your physical health often suffers, and vice versa: 

You might have experienced swings in mood or energy when you’re not feeling well, and that can be exponentially more intense in the case of chronic illness. In fact, people with chronic illnesses are two times more likely to experience anxiety and depression than people who don’t have a chronic illness…In fact, it has even been suggested that depression is associated with inflammation in the brain, so increased inflammation in the body due to physical illness may directly play a role in depression. 

5 Ways Chronic Illness Can Affect Your Mental Health

So how can your therapist aid in your chronic illness management? Your therapist can help you… 

…unpack and unlearn feelings of guilt and shame: 

We live in a culture that prioritizes hustling, being self made, and never resting. Those goals are often impossible to achieve for folks with chronic illness. There is much more rest, many more limitations, and many more instances of needing help from others when you’re chronically ill rather than able bodied. 

But, because of imposed cultural values like self sufficiency and productivity, taking the rest you need, caring for your body in the way it requires, and asking for help when you need it can all bring feelings of guilt and shame with them. That will be complicated even more by your family history, your history within relationships, and your history of getting your needs met. Your therapist can help you find your way through all of this and help you reduce those feelings of guilt and shame so you can take care of yourself the way you deserve. 

…develop self compassion and strengthen your self worth: 

It’s difficult to learn to rest. It’s even harder to learn to be nice to yourself about resting or respecting your limitations. And it’s an additional challenge to unlink your self worth from your productivity. In therapy you can explore what you feel the root of your self worth is, get comfortable with the idea of your inherent worth as a person, and develop habits rooted in self compassion rather than shame. 

…manage increased stress:

Managing an illness or constant pain is stressful. Adding in the logistics of likely needing medication, various doctors appointments, the work it takes to plan outings ahead of time to ensure accommodations, etc. Learning to manage stress to prevent burnout is a key skill practiced in therapy that can benefit anyone, but especially those managing chronic illness. 

…practice communication skills for difficult situations:

With chronic pain, comes limitations. You might not be able to do everything your friends want you to do. You may feel left out when friends or loved ones don’t make accommodations for you. These types of situations necessitate uncomfortable conversations, which depend on strong communication skills. Learning how to let someone know your needs, and finding ways to express your feelings clearly can help to strengthen your relationships as you navigate chronic illness. 

…work through the grief & trauma of chronic illness: 

Life after a chronic illness is very different to life before a chronic illness. And, with any major change or loss, that can bring grief or feel traumatic to us. Instead of trying to ignore that grief, you can take time to honor it in therapy. Your therapist can help you identify what it is you’re grieving, and help you hold that grief and move forward without it controlling you.  

…navigate relationship changes and loss: 

Sometimes the relationships we’re in aren’t able to withstand the challenges that come with managing a chronic illness. Or, if they do, they look distinctly different than the relationship did before there was a chronic illness to manage. That can be a lot to take on between two people, and it’s common to need outside support. Whether as a couple, or as an individual, it can be great to work with a therapist to navigate the changes and losses in your relationships that come along with chronic illness. 

The majority of people in the United States will experience chronic illness at some point in their lives. Treating the whole person is an important way to improve a person’s quality of life overall. It’s critical to take into account mental health when discussing physical health and vice versa. If you are living with a chronic illness and you’re looking for support, we can help. 

How Can Therapy Help Me Navigate Big Life Changes?

Why are life transitions so stressful?

It’s a cliche but it’s true: change is the only constant. So why does it always feel like such an insurmountable task? Change can be exciting, but more often than not, we find ourselves fixated on everything stressful about change: how we’ll soon be navigating something unknown, how we’ll be saying goodbye to things that are not only familiar to us, but comforting. 

Sometimes it’s not until our routine is disrupted that we realize having a routine isn’t the same as being in a rut; our routines can give us structure, provide us with resourceful ways to meet our needs, and give us the comfort of knowing how to take care of ourselves. So it’s natural that when our routines are disrupted with some big life change, we feel apprehensive in the face of losing that comfort and stability. This is just one of the reasons big life changes–even ones we want–are so stressful to us. 

Transitions require a lot more from us than our regular day to day lives. 

The stress of building new routines, the grief of saying goodbye to familiar parts of our lives, the fear of the unknown we have to trust ourselves to make peace with when starting something new–emotionally, life transitions require a lot of us. 

Preparing for specific life transitions isn’t always possible–some changes in life are sudden and unexpected and we have to find ways to navigate them quickly and without hesitation. But preparing for life transitions in a general sense is a key component of the therapeutic process. 

In therapy, along with navigating crises as they come up and exploring your internal experience, you get the chance to practice skills that make it easier to navigate life transitions when they come up. These skills can include: 

• Learning how to stay present when stress comes up 

• Remaining centered and grounded when problem solving and exploring feelings

• Effective and productive stress management 

• Prioritizing self compassion as you navigate stressors and learning to manage them productively

• Examining stress as a means of moving toward the life you want, rather than avoiding it whenever it comes up

• Learning to look critically but compassionately at your own behaviors: which maintain the stress you experience, and which help you break free of them?

• Building a stronger sense of self empowerment

These skills are taught and practiced over and over again in therapy. 

While you may start therapy for support in one area of your life, you’re also building the foundation you need to go back and practice those skills. And every time a new life stress or transition comes up, you get the chance to practice and strengthen those skills once again. These practices help us not just in single instances, but with lots of obstacles we face, like: 

• academic stress (starting a new school, applying for programs, keeping up with requirements, etc.)

• workplace stress (balancing responsibilities, navigating difficult professional relationships, feeling pressure to perform, burnout, etc.) 

• housing stress (finding housing, affording housing, keeping up with housing responsibilities like bills and chores, etc.)

• relationship stress (ending a relationship, starting a new relationship, navigating relationship milestones, managing relationship conflict, etc.)l

• chronic health concerns

We work with kids, teens, young adults, and adults going through various types and times of stress and life adjustment concerns, including academic stress, work stress, divorce, the end of significant relationships, moving, job changes, and chronic health stressors.

If you would like more support in coping with life transitions, our therapists at Hope+Wellness can help.

9 Commonly Asked Questions About The Therapeutic Process

Deciding to start therapy is an amazing and brave step. 

But it’s also one that comes with a lot of questions–mental health is only beginning to be openly talked about, but even though we seem to be willing to talk about seeking care a little more openly, the process and everything that goes into it is still a mystery for a lot of people. And that uncertainty can make an already vulnerable experience feel even more frightening. 

Since therapy is already a vulnerable experience, we want to help make it as easy and supportive to begin the process as we can, so we’ve put together this list of common questions and further resources for each to help you get started. 

How do I find a therapist that’s right for me?

This is often the biggest hurdle in the process. Even without accounting for things like location,  hourly cost or accepted insurance, it can be daunting to find someone to sit with you while you’re at your most vulnerable, to listen to your areas of insecurity or where you need support or thoughts you wouldn’t share with anyone else. First: remind yourself that it’s okay to feel nervous about this possibility. Don’t try to shove that feeling away out of shame. In fact–when you’re starting the process of therapy, that can be a helpful place to begin. Let your therapist know what apprehension you’re feeling and why–the two of you can explore the fears that come up and ease you into the therapeutic process as you do so. 

There’s a lot that goes into selecting a therapist that is right for you. You need to consider:

1. Your priorities; what are the areas you’re looking for the most support in?

2. Your preferences; do age or gender matter to you? Is it important to have a therapist who shares a marginalized identity that you hope to discuss?

3. What is your location? Are you open to telehealth?

4. Do you know anyone who has gone through the process of finding a therapist before? Can they recommend anywhere to start?

Follow our step by step guide on finding a therapist that’s right for you here. 

What’s the commitment involved in the therapeutic process?

Therapy is a financial and time commitment. It is an investment in yourself and in your ability to examine long-standing patterns in your life with the goal of practicing new, more effective thoughts and behaviors. Such change isn’t easy and it doesn’t happen overnight, but it can profoundly impact your quality of life, including your sense of self, relationships, work, and health. We believe that therapy is one of the most important investments of them all — in yourself and overall well being. When you feel centered, grounded, and comfortable in yourself and in who you are, the rest of your life can fall into place.

What do I need to know before my first therapy session?

When you’re going somewhere new, is it helpful for someone who has been there before to walk you through what to expect? That’s what we did in this blog–click through to read it if you’re coming up on your first therapy session. The basics are: 

1. Check if you need to do paperwork ahead of time

2. Review any contact from your therapist; if there’s anything specific you need to bring with you, they’ll have indicated so in any emails or texts, etc. 

3. Prepare to start with housekeeping; there are administrative logistics to figure out before diving into the work

4. Prepare for your own emotional experience; ask yourself what you need to feel safe being vulnerable in a new situation, and how to ease yourself back into your day after the session is complete.

What should I do with mental health content I see online?

You might be starting your therapy journey because of how social media has helped to normalize discussing mental health issues. And while there are a lot of useful tools and resources online, it’s also important to use your own therapist as a reference. Remember, you’re the expert on your emotional experience and they’re the expert on mental health in general–if you see something online that resonates, bring it up in session and discuss it with your therapist! With the expertise you’re both bringing to the table, you can figure out if there’s something more you need to explore based on the resource you found, or if there’s some context and information you’re missing. 

You can find our best practices on fact checking mental health information on social media here.

Why does the therapeutic relationship matter?

Speaking of therapy content on social media…if you can learn about mental health online, is it necessary to have a therapist of your own? Short answer: yes! Longer answer: information you find online can be a great jumping off point for learning about mental health, but therapy is more than just gaining information. The process doesn’t start and stop with diagnosis! A key part of the healing that happens in therapy? The relationship building between you and your therapist. With a relationship where you’re safe to fully express yourself you can start to learn new relational patterns and heal old wounds. 

Learn more about that here. 

How can you make the most between sessions?

Engaging in therapy is a bigger commitment than 50 minutes once a week. While that will be where you do a lot of hard and vulnerable work, if you’re only showing up in that way for yourself while you’re in session, you’re not getting the most out of the experience. In order to fully engage in the process you have to do things like take time to reflect on what was brought up in session, practice new skills learned, take small risks, etc. This is also something you can discuss with your therapist–how would they recommend you practice what you’re learning in session when you’re on your own? Or to start, check out our guide on how to make the most of your time between sessions.  

What happens when your therapist upsets you? 

Therapy is supposed to be an emotionally safe place for you–but being safe doesn’t mean you’ll never be hurt. It does, however, mean that you can be sure to address that feeling of hurt without worrying about facing repercussions. This is part of how therapy works to write new relationship scripts–it gives you the chance to learn what it feels like to have your hurt heard and honored. 

However, it can be jarring to have your feelings hurt in a place that is supposed to be emotionally supportive. It’s not an insurmountable obstacle, but it can take some patience and practice to learn how to address it when your therapist hurts your feelings. But, when you do take the risk to practice bringing it up, it gets easier to do in your other relationships. 

What to do when you’re dreading your next appointment?

Therapy isn’t always fun. But it’s important to figure out if you’re feeling anxious because the space isn’t emotionally safe for you, or because there’s something else you don’t want to face. Follow this guide to figure out what to do instead of canceling when you’re dreading your next appointment. 

How involved is therapy?

At Hope+Wellness, we believe in tailoring therapy for each individual. Some clients find it therapeutic to talk about their feelings and to explore patterns. Others seek a more active approach, involving interventions, exercises and thoughtful actions to implement outside of therapy. We try to meet each client where they are at and are able to incorporate different approaches if this is what you are looking for as part of therapy. Overall, it is important to consider that you will get out as much as you put in to your work together with your therapist.

If you’re looking for support in the process of finding a therapist, contact us and we can help personally match you to a therapist based on your needs.

I'm Dreading My Next Therapy Session, What Now

Therapy is a wonderful, vulnerable and sometimes difficult process. 

It can be incredibly rewarding to go through when you commit to the process, but that doesn’t make it an easy thing to do. There is a lot of vulnerability involved in learning to trust your therapist, and building a relationship where you can spend intentional time talking about your fears, things you feel ashamed about, skills you want to work on to improve the relationships most important to you, conflicts you wish you showed up better in, etc. 

It takes a lot of bravery and a lot of patience with yourself. You might say something you’ve never shared with anyone, or bring up something you’re particularly sensitive about, and your therapist might respond in a way that hurts your feelings. 

Sometimes, even if you’re doing great work and you typically leave therapy with a new understanding of yourself (no matter how small), you might start to feel a little dread come up at the thought of going to your next session. 

If that feeling comes up, it’s important to take a step back and get curious about it. Your initial reaction might be to cancel it, but before sending your therapist a text or an email letting them know you “can’t make it” ask yourself a few questions to make sure that’s really what is best for you. 

When did this feeling start?

Was there something that came up between your last appointment and now? Was there something you didn’t handle well and don’t want to talk about? Or, was there something said in your last appointment that made you feel unseen, unheard, or abandoned in some way? While obviously never the intention, therapists are just human and might respond incorrectly once in a while. It can be extremely beneficial for the relationship to address and explore it–and doing so in therapy can give you practice in a safe space for when similar conversations need to take place in your day to day life.  

Where in your body are you feeling this the most?

When your feelings are so strong, it can be hard to figure out exactly what it is you are feeling. But our emotions don’t show up just in our minds, and learning how to connect the body sensations you’re experiencing to your feelings can help you decipher what is happening for you and what you need. For example, maybe you get nauseated when you’re anxious, or feel a certain type of headache when you’re frustrated. If you can identify what it is you’re feeling, you can use your next appointment to explore it–where it’s coming from, how it’s showing up, what you and your therapist can do to prevent or address it in the future, etc. 

 How often does this feeling come up?

Having the occasional feeling of not wanting to go in and do some hard emotional work is not a red flag in itself. Modern life is very busy, and it does take a significant amount of energy to show up in therapy, not to mention the logistical time it eats up. If you’re having a super busy week where it feels like there’s not enough time to get everything done, of course you’re going to wish there was one less thing on your plate. Or maybe you’ve had a couple unexpected expenses, and you’d rather save a little bit of money this week. 

But, if you’re constantly feeling dread before going to your appointment, there could be a deeper issue. You might not feel the safety you need with your therapist to get into the work that would help you the most. Depending on why there’s a lack of safety for you, it’s up to you to decide if it’s best to address the issues with your therapist, or let them know it’s time for you to move on and find a better fit for your care needs. 

If you’re looking for support in the process of finding a therapist, contact us and we can help personally match you to a therapist based on your needs. 

4 Best Practices for Fact Checking #InstaTherapy Content

Mental health is a popular topic on social media. 

And because mental health care can often be inaccessible for a number of reasons (finances, insurance barriers, location, family/community culture, etc.) that can be a great thing–talking about mental health openly can help to destigmatize the need for care, and to normalize the idea that we all have things to work on. 

But there are a few dangers to relying on social media exclusively for mental health care:

1. You don’t get the full therapy experience, which needs a relationship in which to provide space for healing

2. There’s no factual requirement for posting on social media–meaning the mental health information you’re getting, might not be accurate. 

That doesn’t mean there’s no good information out there on social media–Hope+Wellness is on Instagram where we share bite sized posts from topics we’ve covered on the blog, and we follow plenty of other mental health professionals on that platform who are doing great work! It just means you need to have a bit of care when taking in content related to mental health. 

So what can you do to vet how reliable a mental health resource is on social media?

First ask: Who is the source of this information? 

What are their qualifications? Are they a licensed provider? Are they actively practicing? Is their license bound to any sort of ethics board?

Qualified resources will have their credentials listed publicly. Their qualifications/license type should be either: 

1. Listed in their account bio 

2. Stated clearly on the website linked in their account bio

If you can’t find credentials listed in their account bio, click over to their website to check the home and about pages. Credentials should be easy to find and where you expect them to be–if they are hidden away somewhere that you have to dig for, that’s a warning sign. 

Next: Is what they’re sharing within their scope of practice?

What sort of mental health professional are they? What is their area of expertise and scope of practice? Is the information they are sharing within that scope–or is it unrelated to what they are professionally qualified for? 

For example, mental health professionals shouldn’t be giving the advice of a primary care doctor and vice versa. 

Qualified mental health care professionals should also be making it clear on their profiles that their online presence is intended as therapeutic education, not a replacement for the treatment they offer or a method of seeking diagnosis.  

Check the comments:

While this isn’t always helpful, it’s good to do a quick glance through comments of popular mental health content on social media. If others in the industry are disputing the information in the comments, that’s a good sign to proceed with caution; look up what’s being shared and read more information on it from reputable sources. 

Check in: do they get specific about clients?

Talking about common concerns from the general clients or population they see is one thing–that can be helpful in destigmatizing care or addressing misconceptions, etc. But no mental health professional should be describing their client cases or bragging about their client successes as a way to prove their legitimacy. 

If you’re questioning how specific they are, consider if the person they were talking about found the content; would they be able to identify themselves as the subject of the content? If so–it’s too specific, and actually a HIPAA violation. That’s a big red warning sign that they aren’t considering how their ethical practices need to be translated to social media! 

Keep these best practices in mind when engaging with mental health content on social media: 

• Be selective with who you follow: take your time to check their credentials and make sure they’re creating content within the scope of their practice

• Consider each post on it’s own–don’t just assume something is factual because it’s from a source you followed 

• Use information shared as a jumping off point; go further with resources they provide or begin to look into the topic from other reputable and reliable sources 

• Bring up anything you’re unsure about with your therapist! 

If you’re looking for support in the process of finding a therapist, contact us and we can help personally match you to a therapist based on your needs. 

What Do I Need to Know Before my First Therapy Session?

First: take a second to feel proud of yourself.

Starting therapy is a big step. While therapy has been more normalized and less taboo to talk about socially in recent years, it’s still a difficult step to take for yourself. It requires a lot of vulnerability and self compassion–and hope! Taking the step is incredibly brave, and if you haven’t heard it somewhere else, let us be the first to say, we’re proud of you. 

Starting something new–especially something like therapy, which asks us to be present and raw and honest–often brings up some anxiety. If you’re feeling nervous or apprehensive before your first session, know that that’s completely common and nothing to be ashamed of. And if you’re willing to bring it up, it’s something you can tell your therapist in your first session so they can more specifically address what you’re concerned about! 

To help cover some more general concerns, here are our tips on how to prepare for your first therapy session:

Check your therapists website:

It’s common for therapists to have a page on their website that covers what goes into getting started with them. It’s possible any questions you have about the process have already been answered there! Ours includes a frequently asked questions section, but some practices have this as a separate page. While it’s not necessarily required, you could also review the modality your therapist will be utilizing so you can familiarize yourself with what it means and what that looks like in practice. 

Review contact from your therapist: 

How did you make your appointment? Did you get a confirmation email or a message from your therapist with any info on what to bring to the first session? For example, at our practice, once patients are scheduled they get an email with our welcome packet to complete in our online patient portal–this includes any paperwork we need from patients we need to get started with care. Be sure to check if you need to have paperwork completed before your first appointment! 

Prepare for some housekeeping: 

Starting therapy isn’t jumping into the treatment right away. First, you need to meet with your new therapist and go over what brings you in, what could impact your care, what steps your therapist thinks are right for you, etc. In these consultation sessions, your therapist will get some background information on you as a client and go over potential goals for your therapeutic treatment. This time is important for both you and your therapist to assess your fit together!

Ask yourself what you need to feel safe being vulnerable: 

Just as your therapist will be assessing the fit of their practice for your needs, as you begin your work together it’s up to you to decide how you’re feeling about the fit as well. Do you feel comfortable being honest with this person? How does your body react to being with them? If you’re tense or anxious or nervous in your body, is it a discomfort that you can sit with and overcome, or is it more severe, trying to tell you something doesn’t feel safe for you? If it’s discomfort you can sit with, take some time to think about what it is that is causing the discomfort. Are these things you can address with your new therapist? They may be able to help you overcome what might block you from being honest in that space. 

While you can always bring things up throughout your relationship, making intentional space with your therapist to go over what you need to feel safe trusting them with your vulnerability can help lay a strong foundation for the therapeutic relationship right from the beginning. 

If you’re looking for support in the process of finding a therapist, contact us and we can help personally match you to a therapist based on your needs. 

Healing through Relationships: Why the Therapeutic Relationship Matters

There’s a lot of mental health advice on the internet right now. 

Take this blog for example! Our blog is full of resources, thought exercises and tips meant to help support you in your journey to better mental health. But are the blogs themselves therapy? Are the social media posts describing different mindfulness exercises to try for your anxiety the same thing as therapy?

Short answer: nope!

Long answer: therapy is so much more than the tools you learn. Therapy is comprehensive mental health care, where the relationship between therapist and client is a crucial component to the treatment and healing process.

While there are lots of differences between the tools a therapist or therapy practice may provide online and the actual mental health services they offer, the part we’re going to focus on today is a part that is often overlooked: how the therapeutic relationship itself is crucial to healing. 

That’s part of why you can’t get the same experience reading a therapists blog as you would seeing that therapist in person–while they can provide you helpful tools to practice on your own, you’re missing the practice of showing up in relation to someone and writing new social scripts based on how they’re able to hold space for you. 

Okay….what does that all mean?

Let’s go back to our example from a few weeks ago about talking to your therapist about when they’ve hurt your feelings. 

The social script you’re working from might make telling someone they’ve hurt your feelings a scary, anxiety provoking conversation. Maybe you were yelled at as a child when you got upset or expressed your feelings. Maybe you’ve never been in a relationship where someone apologized after hurting your feelings. Or maybe you’ve never been in a relationship where you were safe to express that your feelings were hurt at all. 

In therapy, you get to practice showing up and telling someone they hurt your feelings.

While it’s not quite practice practice–you’re still communicating your real feelings and it was based out of a real situation, not just a theoretical scenario–you’re still given the assurance that you’re in a safe space where you won’t be punished for expressing how you’re feeling. That makes it an easier stepping stone to use to practice expressing those feelings because you have that safety net of knowing therapy is the space where you’re supposed to come in and discuss your feelings. 

This sort of relational healing is a crucial component to good therapy–and it doesn’t just come up in the moments where you need to manage conflict with your therapist!

You’re also engaging in relational healing in therapy when: 

• You express something you feel shame about and instead of responding with anger, repulsion, or what you fear they will respond with, your therapist responds with curiosity and compassion

• You come to therapy frustrated with how something is going, and you find support in collaborating with your therapist to figure out what to do next, rather than managing it all on your own 

These are two other simple and common examples of how the relationship between therapist and client is an essential part of the therapeutic process! That’s also why it’s so important to be sure you have a safe and trustworthy relationship with your therapist.

If you’re looking for support in the process of finding a therapist, contact us and we can help personally match you to a therapist based on your needs.