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Writing Mental Health: Therapy



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Fri Apr 19, 2019 12:50 pm
Jaybird says...



Two of my novel's protagonists go to therapy for their respective mental health issues. (One of them has social anxiety, while the other has depression.) I've never been to therapy myself, save for physical therapy when I was a little kid, so I'm not exactly sure how to accurately portray the therapy experience. I want to make sure my portrayal is realistic and unoffensive, so any help you can give would be greatly appreciated!
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Fri Apr 19, 2019 3:59 pm
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ShadowVyper says...



Lol so I'm kind of thinking about that Sherlock scene where he's talking to Watson and he goes "You've got a psychosomatic limp, of course you've got a therapist."

But it's kind of true here haha. I've got anxiety and a bit of depression, so I also go to therapy sometimes. I've only been a handful of times because I'm still relatively new to therapy myself, but here's what I've got.

My first session my therapist introduced herself and went over the, for lack of a better description, terms and conditions? I suppose. Like, they have a strict nondisclosure policy -- however, if the records get subpoenaed by a court of law, they have to release them. If I report abuse or neglect and there's a child under the age of 18 in the household where that happened, they are required to report that to the authorities. If I am considered to be a threat to myself or others, that's going to get reported. And I've also got a master's student for my therapist, so she told me that she might share what I say with her direct supervisor for advice, but that the supervisor also has the strict non-disclosure policy so it wouldn't go beyond them. So, basically pretty standard, reasonable things -- but they explain it and ask if you have any questions.

My sessions are generally her asking how I am and me instantly going "Good! How are you?" Because that's just how I've programmed myself. And then her saying good and then calling me on the fact that I'm lying lol. I mean she never says that I'm lying, obviously, but she knows about my anxiety from our first session with her asking me what it was that I wanted to talk about and also the screening questions (which I'll mention in a second) so she'll be like so how's the anxiety been since we last talked? Have you had any panic attacks? Is there anything in your life you're currently anxious about? etc.

Okay, I forgot to mention before, but the screening questions. So before the first session I had to fill out a LOT of paperwork about mental illness/substance abuse in my immediate and extended family, and also answer questions like "I feel anxious -- this never describes me, this sometimes describes me, this frequently describes me, this always describes me" and there were a lot of other screening questions about anxiety and depression and self harm/harming others/suicide/eating disorders, just for them to kind of get an idea of what it is that's bothering me and I guess also to kind of get a feel for how stable I am? I mean I'm an anxious slightly-depressed mess, but I'm not a threat to myself or others, so I think that probably colors the way they approach my therapy vs. how they'd counsel someone who is less stable.

But anyway, yeah, the very first session I was an anxious mess about being in therapy and so my therapist stopped our session at one point to do a breathing/relaxation technique with me to help me relax so we could talk. But most weeks she'll ask me questions and I'll answer and then there is an awkwardly long pause before she answers me. I think it's an intentional strategy to be sure that people are saying everything they actually want to say without being cut off, but my social anxiety doesn't like it xD I feel like one of us should be talking at all times and after I've finished what I want to say I feel SUPER awkward waiting for her to answer me.

In general we focus on stuff immediately bothering me. Like, my oral exam, pretty sure all of YWS at this point knows how much I was angsting about that xD So we talked about that a lot. And she tries to uncover the roots of why I'm worrying about it so much and kind of deal with those directly. So I realized that the reason why I was so worried about my exam was because I was afraid the faculty doing the exam not liking me afterwards > because I was afraid of them thinking I was stupid > because I feel like I am stupid > because I was told as a child that I'm stupid and I've internalized that to a severely unhealthy degree.

I had no idea that my current academic anxiety is tied directly to childhood trauma, but it makes a lot of sense. So she's explained to me how the way we're treated as children affects the way we learn to view ourselves. And now that the exam is past we've been working on combating that destructive inner voice where I screw up and instantly go "I'm sooooooo DUMB!!!" and instead going "No, I'm not dumb. I am a student and I am learning and it's okay to make mistakes. No one is perfect, and I'll do better next time."

So, in general, my therapist asks me a lot of questions and makes me work through them myself. And a lot of her questions are freaking impossible. "What does confidence feel like?", "what would it be like for you if you don't meet your expectations for yourself in your oral exam?", "what are you going to do if that actually happens?" -- those are the ones that come to mind that stumped me. You can't very well answer your therapist that you're probably going to go get drunk if you fail to live up to your own standards. :P So I have to do a lot of that work, but she will also give some suggestions and feedback on healthier ways to handle things, and also offer perspective.

The environment is intentionally relaxing. Generally they've got a little loveseat/mini couch thing and an overstuffed chair sitting opposite from each other, and she lets me choose which one I want to sit on and then she takes the other. The lighting tends to be from lamps instead of a harsh overhead light so it's kind of ambient. Most of the rooms have some sort of wall hanging with an inspirational quote.


And... I think that's all I've got for you. Same as before, if you have specific questions or situations you'd like my feedback on I'd be happy to help, but for now I'm going to stop rambling.
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Sat Apr 20, 2019 1:19 pm
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Jaybird says...



Thanks for the help, @ShadowVyper! I think your response answered a lot of the questions I had, but I'll let you know if I think of anymore. <3
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Mon Apr 22, 2019 7:24 pm
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StellaThomas says...



I've never been to therapy or to a psychologist, but I did work as a doctor in psychiatry/mental health services for 13 months, if that's of any use to you. It isn't therapy, we would tend to refer onto psychology and CBT for therapy, but if it's something that you're thinking about the person beginning on medications etc it would be a psychiatrist that starts those rather than a psychologist, and I'm happy to answer any questions from that side of the table ^^ I see you have multiple threads so won't reply to all three but happy to help however I can <3
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Mon Apr 22, 2019 7:53 pm
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Tenyo says...



I watched a documentary series some time ago which showed therapy sessions, but also had a commentary to go with them. It was more aimed at explaining the way some people respond in therapy sessions more than how the sessions itself works, but it was still fascinating to watch.

I'll see if I can find the link, it will be in one of my citation folders. If I don't get back to you by the weekend then give me a nudge.
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Wed May 01, 2019 11:58 pm
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Carlito says...



I'm actually a therapist as my day job :)

There are tons of different treatment modalities and approaches to therapy. I tend to use CBT (cognitive behavioral therapy).

I'll PM you! (And any future people who are doing research on this topic, feel free to PM me as well!)
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I want to read your work!

Ask me anything. Talk to me about anything. Seriously. My PM box is always open <3
  





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Thu May 02, 2019 3:59 am
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Lauren2010 says...



I've been in weekly therapy for 6 months? now for generalized anxiety disorder with a nice dollop of social anxiety on the side. My therapist practices cognitive behavioral therapy which primarily focused on changing your behavior to improve your mental health (might have been obvious by the name!). Shadow did an awesome job of talking through what a session feels like, I just wanted to add that you'll want to know what kind of therapy is practiced by the therapist your characters see!

For example, my therapist has never asked me "how does that make you feel?" Which I think is the stereotype xD instead, now that we've established my main issues (work stress, social anxiety) we talk through how my week went and any issues that have come up since we last talked. She usually touches base on the things she knows are pain points (she asks me how work is going, and how my social life is going, if I'm exercising, how I'm sleeping). We don't do a lot of digging into my past to explain things (though sometimes we do!) but mostly putting things in better perspective and tweaking my self care to manage my symptoms.

Examples of "tools" she's given me: exercise, meditate, eat healthy, do yoga, cut out caffeine, practice deep breathing, take my full break at work, positive self talk, reframing, good sleep hygiene, etc. A lot of it is straight forward or seemingly common sense, but honestly having her as a sounding board and accountability partner have been huge assets to me in managing my mental health.

Hope that helps!
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