What to Expect in Therapy, Part 1: How to Choose a Therapist

Written by Aleks Stepanenko (they/them)

There is a certain unjust irony in the fact that once a person realizes things have gotten to be too much to manage on their own, they must first manage even more things before they get to talk to someone about it. The steps between, "I should really find a therapist," (or, perhaps, "I should really find a new therapist,") and actually having your first session can be cruelly mysterious. I'd like to offer a rough guide to help demystify the process.

Logistics

You know that therapists theoretically exist out there somewhere, frolicking in the wild listings of Psychology Today -- but how do you even start narrowing down your options? (There are many other sites that provide therapist listings, but Psychology Today is the most widely used so I'll be focusing on it for the sake of simplicity.) First, let's address some constraints of our current reality:

Location

In the United States, therapists are professionals licensed by each state. This means that if you are here in Ohio, you would be looking for therapists licensed to practice in the state of Ohio. If you prefer to see someone in person, you can search for the city or zip codes you would be willing to travel to for your sessions. If you prefer to have online sessions, you can search for "Ohio" in general, which would give you the most options to choose from.

Cost

If you don't have insurance:

Without insurance, you are going to be doing what's called self pay or private pay -- just good ol' exchanging money for services. Consider what you can afford to pay, and how often you would be able to afford sessions. (It's most common to see your therapist weekly or every two weeks, but the frequency can be adjusted depending on financial constraints.)

You can set the price search filter for whatever is within your budget.

If you're not able to afford the standard rates, you can search for therapists that offer a sliding scale. This means that the therapist is willing to offer a discounted rate for those who need it. Exactly how much and for how long depends on each therapist, so it's something you will need to ask them directly. You can also search on Open Path, which is a listing of therapists and therapists-in-training that all offer sliding scale fees.

If you have insurance:

Here, some mystery re-engulfs the process. The quickest way to dispel the mists is, unfortunately, to call the number on your insurance card and ask a person, "What is my co-pay for mental health care?" That is the amount you can expect to pay for each session yourself, as long as your sessions are with a therapist who accepts your insurance. Your therapist will charge your insurance for the rest of their fee.

To find a therapist in-network with your insurance, you can see if your insurance's website has a listing of providers that you can look through, or you can set your Psychology Today search filter to only show providers that take your insurance. Frustratingly and yet somehow unsurprisingly, it's common for both of these to be out of date, so it's a good idea to confirm with the therapist that they do take your insurance.

If you have a type of insurance coverage that doesn't do you much good -- for example, if your co-pay is too expensive or there are too few in-network providers to choose from -- you're considered under-insured and can follow the advice for folks without insurance, above.

Availability

The last step of the logistics trifecta is to find out which therapists are taking new clients, and if the times they have available match the times you're available (particularly if your schedule isn't very flexible). The best way to do that is to ask! Here is a form email you can use to reach out to therapists to get the ball rolling:

Hi [Therapist Name],

I’m looking for an [in-person/online] therapist who is currently accepting new [Insurance Provider Name/sliding scale rate] clients, with availability on [weekday mornings/Thursday evenings/etc.]. Please let me know if you’re available.

Thank you,

[Your Name]

If you want, you can also add a sentence about yourself to help the therapist have an idea of what you're looking for and what inspired you to reach out to them in specific.

Vibes

"But Aleks," I hear you cry, "Why did I reach out to them in specific? There are a billion therapists in my area who take my insurance -- how do I actually know which ones are any good? Is it the ones trained in the most correct treatment approaches? The ones with the most letters after their name? The ones with the cheekiest smile?"

The Research

The answer, which may be in equal parts both soothing and alarming, is that there is no right answer. While the field of psychotherapy research has continued to eke out evidence for the effectiveness of various therapeutic approaches with one promising but inconclusive study after another, there remains a lot of art to the science. Ultimately, as long as a therapist has some qualifications and is using an approach generally supported by the field, studies have repeatedly found that the most important factor in a client's improvement is the strength of the relationship they have with their therapist. This holds true regardless of if the therapy is in-person or remote and regardless of the therapist's years of experience. (Unfortunately, there have been no studies on cheekiness of smile as of yet.)

Essentially, therapy will probably go well if you like your therapist, if you feel that they like you, and if it seems like you're on the same team and have the same plan. It's easier to have a strong relationship with a therapist that you feel is trustworthy, confident, open, and respectful -- if you feel that the vibes are good. This is something that you get to decide.

The Deciding

You can get a pretty good sense of the vibes by looking at the therapist's photo, reading their little blurbs, taking a look at their website, and then checking in with yourself. Even through the porridge-like sameness of most therapist bios (I know, I know! I apologize on our behalf), you may still feel particular ones resonate more clearly. Are they speaking your language? Does something about them give you an extra spark of hope? Send them that email!

Usually, most therapists will then offer a short, free call during which you can ask each other questions to figure out if this therapist is the right person for the job. Think about what questions would help you feel like you could build that strong relationship together. What is important for you to know about them? You may be looking for someone with lived experience in the same communities as you, or someone who has really seen it all so that you don't have to worry about shocking them, or someone with similar spiritual or political perspectives. You may also not have any questions at all, and simply see how you feel while they're talking. Having no objectively right answer about how to decide means that there is no wrong answer, either.

If you choose to work together, remember that you get to keep deciding how you feel. It's okay to decide that you want something different after a few sessions, or even after a few years of sessions. Considering that it is the relationship itself which so often does the healing, it is well worth it to find a good fit.

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What is EMDR?

Written by Laura Valentino, MSW, LISW-S (she/her)

If you’ve spent any time looking into trauma therapy, you’ve likely heard of EMDR. I want to talk about what EMDR is in the same way I usually explain it to my clients... straightforward, relatable, and grounded in how the brain actually works.

What does EMDR stand for?

EMDR stands for Eye Movement Desensitization and Reprocessing. It’s an evidence-based therapy most commonly known for treating trauma, but it’s also used for anxiety, panic, depression, grief, phobias, and other experiences that feel emotionally “stuck.”

At its core, EMDR helps the brain do something it already knows how to do: heal.

How the brain normally heals (and when it doesn’t)

I often explain EMDR by comparing emotional healing to physical healing.

Think about getting a paper cut. It hurts, maybe bleeds a little, and it’s annoying, but you don’t have to try to heal it. You might clean it, put on some ointment, throw on a bandaid, and then… your body takes over. It knows exactly what to do. The cut heals on its own because your body is wired for healing.

Now think about breaking your arm.

Technically, you could choose to do nothing. Over time, the bone would likely heal. But without proper treatment, without a doctor setting the bone first, it may heal incorrectly. You could be left with pain, limited movement, or long-term problems.

Trauma works much more like that broken bone.

After experiencing something traumatic or adverse, we can choose not to seek support or therapy. And yes, we may still heal, but often in ways that leave an impact, such as nightmares, heightened startle responses, hypervigilance, emotional reactivity, or a persistent sense of being on edge. You can continue living with these symptoms. (Although, it won't be pleasant.) 

When we process trauma with EMDR, much like a doctor setting a broken bone so it can heal properly, we give the brain what it needs to truly heal.

Our brains are designed to process and adapt to information, including difficult experiences. But when something is overwhelming, frightening, or happens when we don’t have enough support, the brain may not fully process it. The memories, emotions, body sensations, and beliefs associated with that experience can become “stuck.” Over time, this can show up as anxiety, emotional reactivity, negative beliefs about yourself, or feeling triggered by things that don’t seem to make sense logically.

This is where EMDR comes in.

How EMDR helps trauma heal properly

EMDR doesn’t force healing any more than a doctor forces a bone to heal. Instead, it helps set the bone, so your brain can do what it’s already capable of doing.

During EMDR, a therapist guides you through a structured process while using bilateral stimulation (often eye movements, but sometimes tapping or sounds). This bilateral stimulation helps the brain reprocess traumatic or distressing memories so they can move from being “stuck” to being fully integrated.

When that happens, memories usually become less emotionally intense. The beliefs connected to them often shift (for example, from “I’m not safe” to “I survived", and the body (aka the nervous system) begins to settle.

You’re not erasing memories. You’re helping your brain store them in a way that no longer disrupts your present-day life.

What EMDR is actually like

A few things people are often relieved to hear:

• You don’t have to share every detail of what happened

• You stay present and in control during sessions

• The process is paced carefully and intentionally

  
  

Some people notice changes quickly; others notice shifts more gradually. A very common experience is being able to think about something that once felt overwhelming and realizing it just… doesn’t hit the same way anymore.

Who can benefit from EMDR?

EMDR can be helpful for:

• Trauma or PTSD

• Childhood emotional wounds or attachment injuries

• Anxiety and panic

• Grief and loss

• Medical or birth trauma

• Distressing memories that still feel “raw”

• Negative beliefs about yourself that don’t shift with talk therapy alone

  
  

You don’t need to have one specific traumatic event to benefit. Many people seek EMDR because they feel stuck in patterns they understand logically but can’t change emotionally.

Is EMDR evidence-based?

Yes. EMDR is supported by decades (EMDR is as old as I am!) of research and is recognized by:

• The American Psychological Association (APA)

• The World Health Organization (WHO)

• The U.S. Department of Veterans Affairs (VA)

  
  

Final thoughts

EMDR isn’t about pushing through pain or “fixing” you. It’s about giving your brain the right conditions to heal, just like setting a broken bone so it can heal the way it was meant to.

If you’re curious whether EMDR might be a good fit for you, talking with a trained EMDR therapist is a great next step.

Helpful resources:

• EMDR International Association (EMDRIA): https://www.emdria.org

• APA Overview of EMDR: https://www.apa.org/ptsd-guideline/treatments/emdr

• EMDR Made Simple by Dr. Jamie Marich

What Is Dissociation? A Gentle Guide to Understanding and Coping

Written by Dylan Crum, MSW, LSW (he/him)

What is Dissociation?

Dissociation is a common symptom of post-traumatic stress that results in a feeling of

detachment between our thoughts, feelings, memories, surroundings, behavior, and identity.

While some level of detachment can be healthy, dissociation typically impacts our quality of life and ability to function. Dissociation can range from a temporary lapse in awareness (think of “zoning out”) to a full break in identity or ability to access memories. One thing that I would really like to stress is that dissociation is not a “bad” thing, rather it is a survival mechanism that our brain has learned to use in order to protect us.

Learning skills to cope with dissociation is not learning the “right” way to cope with intense feelings, it’s learning ways that we can more effectively engage in our lives and feel safe and empowered.

What are Grounding Skills?

Fortunately, there are many techniques to cope with dissociation that require only the use of our bodies, minds, and some simple supplies. Regardless of the specific technique, any successful attempt at grounding from dissociation will involve reorienting your awareness to what is happening to you in the present moment. Through this reorienting, you are bridging the gap between where your mind has taken you and what is happening right now. This will allow you to cope with your emotions more effectively and work towards solutions to your problems. This post will detail three simple techniques that are highly effective in coping with dissociation.

3 Core Grounding Skills

1. 5-4-3-2-1 Technique

This first technique can be done in virtually any setting with a little bit of practice. The basic gist is that we are trying to identify things that we detect with our five senses. This is started by pairing different numbers with senses, typically according to how difficult it would be to detect different things.

My recommended pairing is as follows:

5 things that I can see

4 things that I can touch/feel

3 things that I can hear

2 things that I can smell

1 thing that I can taste.

Once you have paired the numbers and senses, you will start to observe your immediate

surroundings. As you observe and identify different things in your surroundings, label them. Try not to make judgments about your surroundings, rather continue to make observations. To strengthen your awareness, try to notice different qualities about what you’re observing. Examples of this might include: textures that you’re seeing, the play of light on an object, how sounds are impacted by the objects around you, whether a smell or taste is pleasant or

unpleasant, etc. This process is repeated until you’ve identified things in your surroundings with each sense.

If your mind starts to wander throughout this exercise, this is completely normal. When it

happens, just bring your attention back to your senses. This process can be repeated as many times as necessary. You’ll know that it has been successful if you feel more present and aware of your surroundings. Try to use this energy to engage in self-care activities or fulfilling hobbies.

A video guide to this technique can be found here:

2. Use Temperature to Regulate Your Nervous System

Extreme temperatures have the ability to regulate our nervous system, which is something you might have noticed purely by accident. Ever noticed how much you wake up when faced with a cold breeze? Or how drowsy you might get on a hot summer afternoon? We will be taking advantage of this fact with this next skill. More specifically, the use of cold water can trigger the activation of our sympathetic nervous system (our stress response), which is immediately followed by a relaxation response from our parasympathetic nervous system. This phenomenon is also known as the diving reflex.

In order to apply this skill, you only need a source of cold water. This can be a shower, a bowl of ice water, a cold body of water, etc. When you are feeling the effects of dissociation, either dunk your head in a bowl of cold water, take a cold shower, or splash cold water on your face a few times. It is important to apply cold water to your face, as this will most reliably activate the diving reflex mentioned above. If direct contact with cold water is not accessible to you, try placing ice cubes under your eyes or on the back of your neck.

Fortunately, with this skill we are taking advantage of our body’s natural responses, so not much practice is typically needed to find success.

3. Belly/Diaphragmatic Breathing

Finally, the use of our breath can be very helpful in grounding from dissociation. My personal

favorite breathing technique is belly breathing, which can be used in almost any setting with

enough practice. The use of full, deep breaths that utilize our lung capacity activates the vagus nerve, which plays a big role in regulating our nervous system (and is a core component of the diving reflex mentioned above).

To start, find a comfortable position, either seated or laying down. Place one hand on your chest and one on your stomach. Take a few normal breaths, trying to find your natural breathing rhythm. Once you find this rhythm, notice the rise and fall of both hands as you breath. As you notice this, try to direct all the air during your breaths to your stomach. You will know you’re doing this correctly if the hand on your stomach starts to rise and fall more dramatically, while the hand on your chest stays still. It can be helpful to imagine that there is a balloon in your stomach that you are trying to fill up with each inhale. Breathing in this way will force your lungs to stretch to their capacity and more effectively engage your vagus nerve. As you continue breathing, also notice if your mind starts to wander. As this occurs, use the sensation of your breath to bring you back to the present moment. With practice, this technique will become easier

and bring a stronger calming effect.

A video guide for this technique can be found here:

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