Advocating for yourself in any situation with a helping professional can be really difficult. After all, they're the experts, right? Well, yes and no. They have been professionally trained to do this work, and often have thousands of hours and years of experience under their belts. But that doesn't necessarily mean they're an instant expert on you.
Advocating for yourself and your needs is part of the dance of therapy, and it can be intimidating. Here are a few tips to help you get started.
- Don’t expect your therapist to be a mind reader, speak your needs
Therapists are trained to help you identify what’s holding you back and help you move forward with your life. But they’re not psychic, and they can’t look at you and immediately know what’s really going on. Answer their questions, try to be open-minded, but if it’s going in a direction that isn’t important, tell them.
It’s really helpful to let a therapist know early on what you’re struggling with, if you know. Even if it’s the symptoms you’re experiencing or negative symptoms- what is not happening anymore.
- If the interventions the therapist is using are not helpful at all, say something. But also be willing to hear why the therapist went in that direction, and have a conversation about it.
When a client doesn’t speak their needs in the first few sessions, the therapist typically starts to sift through a wide variety of potential directions to go in, and asks a lot of questions. They’re trying to figure out why you’re in therapy and what you need to have a more full life. Eventually, they’ll go in whatever direction seems to make the most sense. But if it’s not helping you at all, say something. Therapists never become mind readers, even after getting to know you well.
The caveat to this is thinking that something isn’t helpful because it hurts or it feels uncomfortable. If it causes you pain, it’s probably because the therapist is touching on a wound. And wounds are generally why you’re there in the first place, right? But if it’s too much, tell the therapist and keep this dialogue going. They want to go at your pace.
- Take the time to see a psychologist or psychiatrist for a formal diagnosis if you are interested in medications.
Psychotherapists can often make excellent diagnoses, but they can’t prescribe medications. If you think that medications might be helpful, a full psychiatric evaluation through a psychiatrist will probably result in the most accurate diagnosis AND getting medications that match that diagnosis.
Another option is to see a licensed psychologist for an evaluation, and then take the results to your general practitioner. Many GPs will prescribe psychiatric medications for a much cheaper copay than psychiatrists, but they don’t specialize in mental health. Because of this, they may be reluctant to prescribe medications between the few most common ones out there. Having the documentation of a specialist may help the process go more smoothly.
- If you can only see a medication provider every few months, see a supplementary provider as well (PCP + therapy)
Most medical providers and psychiatrists can only see you every few months, and after the initial evaluation, this is generally a short appointment for refills. I would caution against thinking getting meds every few months is adequate to truly pursue mental health. I would recommend seeing a therapist in conjunction with getting medications. Most therapists see clients once a week or once every other week, so they can notice side effects or significant changes due to your medications much more frequently than a psychiatrist.
- If questions of suicidal thoughts come up, be honest, but advocate for yourself regarding supportive relationships and coping skills if you can believe you’ll be safe.
The regulations are different in every state, but generally speaking, if the therapist believes you are imminently in danger due to your own suicidal thoughts, they have to break confidentiality and take action. That being said, it should start with a conversation.
Some people have suicidal thoughts pretty chronically, and they’ve learned how to handle them and keep going. If that’s true of you, say that to your therapist. If you have people you can count on, or if you’re willing to check in with your therapist more often for safety, tell the therapist. Going to the hospital can be a traumatic experience, not to mention expensive, and it shouldn’t be used for treatment until it’s the last resort to keep you safe.
- If a provider restates what you said and gets it totally wrong, correct them
Therapists often summarize what you have been talking about and say it back to you, to help everyone stay on the same page. If a therapist does this and it’s not at all what you mean, correct them. Most therapists are happy to be corrected so that you are being understood. Don’t be afraid to make sure your true intent is known.
Overall, the vast majority of therapists do want to help, and want your goals to be the primary focus, not any agenda of theirs. But they are human. They misunderstand, they make mistakes, and they can get sidetracked. You deserve to be heard and understood, and the therapist wants that too. If you are willing to collaborate with them, the therapeutic process can be truly life-changing.