5 Things to Know Before Your First Therapy Session

So you made your first therapy appointment. Maybe you struggled for months to get it (like me) or maybe you got in with the first person you called (lucky duck), but either way you’ve made that harrowing and important step on the recovery journey.

Congrats, fellow recovery warrior.

Here’s the bad news: First sessions suck. Big Time. It’s a nearly universal complaint, and one that’s back up by own three first sessions with a new treatment provider. It’s the same whether it’s a therapist or psychiatrist. That first session is necessary and oh-so-worth it bump in the road — and yes, it does get so much better with time — but there are a few things you should know to make it easier.

1. Come prepared.

This is about more than making sure you have the rights forms or ID for insurance purposes. You will need to tell this person your life story, or at least the portion of it that pertains to your mental health struggles. For some of you, like me, there will be a lot to tell. And even if your struggles are relatively new or not connected to a complicated history, you will still need to give as clear and complete a picture of your symptoms as you can. It may seem like that would be a no brainer — after all, you’re suffering from these things enough that you sought out treatment, they’re obviously on your mind. But it can be surprisingly difficult to remember all the important details when you’re sitting in front of this stranger who wants to know about your darkest moments.

So take some time before your session to organize your thoughts and think of everything you want to say. Include the symptoms that are bothering you, as well as what you’re feeling, your thoughts on therapy and any worries you have. Write it down if that will help. Seriously, I brought a notecard to my first session with bullet points about my childhood trauma, my screwed up sleep cycle and my inability to cry. Don’t worry if it seems like there’s not enough. Don’t worry if it seems like there’s too much. Just make sure you give the person helping you the best baseline you can, so they can create a treatment plan for you. You want them to know where to go after this first meeting.

2. Accept the awkward.

The first session is almost guaranteed to be a little awkward. Even the most welcoming, relaxed therapist or psychiatrist is still asking you deeply personal questions when they’ve only known you for a few minutes. When you’re having small talk, you’ll feel weird that you’re not talking about the reasons you sought them out. When you’re talking about your mental health struggles, you’ll feel weird that you’re talking about this stuff to this polite stranger. And, if you don’t have a lot of experience talking about your mental health, it will be awkward and difficult to talk about it at all.

Even after two years and a practically infinite number of discussions with my recovery buddy, I can still have problems putting my feelings or my suffering or my fears into words. It can be difficult to get started, scary to make it real by voicing it and strange to recognize the illogical in what you’re feeling. You will feel “crazy” sometimes. It’s okay. Just accept that it will feel strange and be difficult, know that it will get easier the more you do it, and don’t fear the awkward.

3. Remember: This is your choice.

You made the choice to seek treatment. You have the choice to continue or not, to stay with this provider or to find someone else. Don’t let yourself feel trapped or out of control. Don’t accept a treatment plan that makes you uncomfortable just because your therapist suggests it. Don’t continue going to the first person you see if you don’t think they’ll work for you. And if you really don’t think this kind of treatment, or any treatment, is what you need, then it’s your choice whether or not to continue.

However, and this is a big however, don’t judge therapy or your therapist on the first session. You won’t be able to really tell anything this soon. You might be able to tell if you just can’t stand a particular provider, but most of the time you need to give it a little time before you can tell how you’ll mesh. And you certainly can’t tell if therapy is going to be worth it for you based on the first session. Remember: First session suck. Second sessions, not as much. So just like you shouldn’t make the choice to give up on treatment based only on how you feel in a dark moment, don’t give up on a particular form of treatment because you have a bad first session and don’t want to go back. Which brings us to:

4. Prepare for the aftershock.

You may have a super awkward first session that feels pointless and excruciating. You may have a difficult first session that leaves you crying or anxious or generally feeling the weight of your mental illness. Or you may be one of the lucky ones who has an easy session or at least leaves feeling productive and proud that they made the choice to get help (this does happen). But no matter what happens or how you feel when you leave, you need to be ready for the aftershock.

It’s different for everyone, but the aftershock is what we call the rush of emotions that hits you anywhere from the second you step out of your treatment providers office to an hour or two later. You may suddenly feel incredibly sad, or frustrated with your condition, or angry with your therapist (and God), or just generally defeated. You will likely feel exhausted. And whatever the combination of emotions and fatigue you feel, you will be absolutely convinced for least a few minutes that you are NEVER DOING THAT AGAIN. It will pass, and you’ll likely have your self convinced to go again by the time your next appointment roles around. But it’s important to be ready and have a plan for self-care during this time. Invite a friend over after your appointment or plan to go home and do something comforting. Note that this is practically guaranteed with the first few appointments, but can flare up again at any time during treatment, so don’t be worried or discouraged if it happens after your 67th session.

5. Know what you want  — and ask for it.

Like with any treatment, physical or otherwise, it takes two to tango. You need to take an active role in every aspect of your recovery, and this includes treatment like therapy or psychiatry. This can mean doing in depth research on your symptoms, likely diagnoses, possible kinds of treatment, etc. It’s okay to go into a session with an idea of what you might have and what treatment you think would be helpful, as long as you listen to the professionals when they have different ideas. (Though if someone tells you something that doesn’t sit right, you’re more than justified in seeking a second opinion.)

But it doesn’t have to be so in-depth. If you don’t know much about psychology and aren’t a big research nerd like I am, you still need to be sure you know what you’re seeking from therapy. Which symptoms do you want to treat? Which are the most important or first priority? What do you want to feel like/your life to be like after treatment? What do you want to talk about first? How might you envision your sessions unfolding? It’s okay not to know the answers to all these questions, as your treatment provider can help you figure them out in the first few sessions, but doing some thinking before you go helps you maintain an autonomous presence in a process that can easily start to feel out of your control.

So, no, a first session is not likely to be easy. But go anyway. And keep going. Because you have already done the hard part by making the choice to change your situation. It won’t get better immediately, and it won’t happen in a nice steady curve, but the only way it will get better is if you do something. So take that first step.

Caveat: Yesterday, I had a first session with my new psychiatrist, and it was lovely. We clicked immediately, I knew exactly what I wanted help with, and I didn’t have to tell my entire life story for the forth time. I did still have a bit of an aftershock, but it was a nice reminder that sometimes things can go right from the beginning.

We’re back

In honor of my psychiatrist appointment yesterday (finally) and today being the first day of my treatment with antidepressants, I’m restarting my recovery blog. Both in the hopes that I’ll be more able to update as the pills help out with my symptoms, and because I’ll likely have a lot to write about. So be prepared for my first new post in a few minutes about that all important first visit with a therapist.

On what trauma feels like

childhoodtraumaOn Thanksgiving, I had a major triggering event. You’ll have to forgive me for not going into details, but suffice it to say it was basically deja vu of my childhood trauma (funny how that can happen even when your family is thousands of miles away). So I thought I’d try to describe what the effects of trauma can feel like.

My initial reaction was crisis mode: Things needed to be done and said, so I went to that place where everything is calm and rational and devoid of feeling. I did what needed to be done. Before I started recovery, this state would be both my first and last reaction — until I went into a depressive episodes several days later, anyway.

Now, several steps down the road to recovery and with just enough progress that I recognize dissociation for what it is, I don’t have the luxury of not feeling. I know that’s a blessing, but that day it felt like a curse. I sat there, hugging my best friend/recovery buddy, shaking slightly, thinking Any minute now all of this will recede, I’ll straighten up and be ready to go to Thanksgiving dinner. It didn’t happen.

When the tears came, it was like each one had to force its way between my eyelids. Each breath tore out of my throat in a ragged gasp, stalling at the height of my exhale like my diaphragm had spasmed and caught. Like the force of denial and emotions, all mixed up and unidentifiable, was trying to punch its way out of my lungs. I was stuck there, noncommittally crying, dragging my lungs through each stuttering breath, thinking What happens now? and I think I’m supposed to let myself feel things, but I don’t know how, until my best friend took control and told me “We’re going to go in the other room, lie down and cry for as long as you need to.”

As soon as we curled up on the bed, the tears came in earnest, but my mind was still an obliterated blank. In the last few months, I’ve fought off my obsessive need for control so many times. I’ve climbed over mental walls and liberated emotions like stolen princesses. I have let myself cry. But this was the real deal. This was a tendril from my past. This was a real test.

I’m not sure I passed.

I tried to open up to what I was feeling, but damn those old habits are deeply ingrained when push comes to shove.  I felt the edges cracking, and I tried and tried to tell my recovery buddy what was going on in my head, but I could barely even begin to pull apart the threads.

The moment started to get fuzzy around the edges, distant, like I wasn’t in my body or in that moment in time. But for once, my emotions didn’t lift and separate. They become more real, and as they loomed bigger and bigger, everything else become less so. I looked around my home, and it was like looking at a backdrop. I stared down at my hands, wiggling my fingers, and they were completely alien.

And then the flashbacks came.

I told my best friend it was like I was experiencing every moment of my life at the same time. Old, traumatic memories slipped through my head and some stuck, as real to me as the present even though I wasn’t experiencing them with my senses. For a little while, I was a scared 14-year-old girl again.

End note: Eventually, things settled enough that I could go enjoy our Thanksgiving festivities. I still couldn’t tell you what emotions I was experiencing that day, and since then I’ve been fairly solidly dissociated. But I’m grateful for the coping mechanism. For now, I’m focusing on self-care, finals and doing whatever I can to ward off the uncomfortable feeling of unreality. 

The danger in “feeling better,” or The sneakiness of depression

If you’re interested in  a personal update first, check it out here. And don’t forget the Tumblr.

The past few weeks since my last update have been very productive — both a blessing and a curse. I’ve noticed more and more that my good days, my normal periods, come after periods of high productivity. When I’m coming back from my long class day feeling smart and capable or after a day at my internship accomplishing measurable things. So I know I’m doing the right thing by not completely stopping my life to make room for recovery.

At the same time, all it takes is a few decent days an unfinished to-do list to set off some subconscious subroutine that decides I’m fine. Totally normal now. Depression over. No need to think about that anymore. Let’s work on all of your ambitions at once. It’s like I only have two settings: slow, easy, remember-you’re-in-recovery or fast-forward.

And when I’m in that state, I become completely disconnected from my own mental state, completely in denial about the fact that I don’t have the mental resources to do all the things I want to. This gap between my thoughts and reality begins to generate massive amounts of anxiety, which (at first) I have no idea the source of. And when I can’t get things done, can’t find my focus, etc. I start to panic even more. After all, I’m only even trying to do a fourth of what i was doing last year. I’ve never been so overwhelmed by a little to-do list before.

As this escalates, the depression symptoms start to break through, but I instinctively, ruthlessly push them down. Subconsciously, I’m terrified of giving up “normal” and admitting I’m still depressed. Who wouldn’t be? And, after all, I’m very good at pushing through. At putting my head down and just working,

All this tension and cognitive dissonance eventually lulls me back into old thought patterns, the old coping mechanisms. (In a way, this whole cycle is itself a coping mechanism.) These quickly devolve into the fear, frustration and pain that characterized my pre-recovery life. I end up lashing out a myself and those closest to me with negative thoughts and emotions. Nothing I do is good enough. My best friend doesn’t really love me or want to be around me. I’m not worth the air I breath, You get the idea.

Until I realize what’s going on (which thankfully happens after only a little while of this now that I recognize the pattern), these thoughts don’t seem like symptoms of my mental state. They just seem like reality. Even though I logically recognize the conclusions as false, the premises that lead me to them seem valid and entirely based in empirical evidence. Right now, coming out of one of these cycles, I’m struck by easy it is for my brain to lie to me about reality. And how completely I believe those lies.

This cycle isn’t particularly surprising, given that my primary way of coping with my childhood trauma was to center my entire identity and self worth on my achievements/ambitions. But it does have an interesting side effect: It’s actually better for me to stay depressed right now.

I need a real recovery, one that’s founded on new ways of thinking and processing the world, and these false starts are just making that goal harder to reach. So I have to work to avoid the relapses into the worst of my depression, but i also have to work to avoid relapses into “everything is fine.”

Quick update

Before I put up my real post for today, I thought I’d throw out a quick personal update.

Mood-wise, I’m coming off a week or so of pretty high spirits and productivity. Yesterday, my mood started to dip, and I’ve been feeling quite low today. But I also feel fairly capable of handling this mood. Self-care and all that. And later today I’ll be skyping with the family back home, and then the roommate/recovery buddy extraordinaire will be home to commiserate with me. So things aren’t looking too grim.

The internship is going very well. I’m learning a lot, I love the people I work with, and I really love the feeling of accomplishing practical things every time I’m there. School is still a bit of an adjustment, but I’m keeping up with and enjoying the material, so I can’t ask for more.

I still haven’t gained back any of the weight I lost at the beginning of this depression thing, so I’ve started keeping closer track of what I’m eating so I can be sure I’m not forgetting meals or something like that.

This week marks about a month and half since I’ve had a really decent night’s sleep, thanks to this bout of insomnia. That’s making everything more difficult, but I’m sure I’ll figure out the trick to sleeping again any time now.

Should be getting my first therapy appointment set up any day now, so my treatment regimen can begin again in earnest. It’ definitely about time.

On the name …

So what does “Everything is Tigers” mean? It comes from  the amazing webcomic on depression from Hyperbole and a Half (part one, and part two). In it, she includes this panel:

It’s a great illustration of the emotionless grey that comes with depression.  And, of course, it’s hilarious.

Everything is spiders quickly became a common phrase in our household. At the same time, as my roommate and I tried to come up with easy ways to express the depression and anxiety we were facing, we hit upon the idea of the tigers. See, early humans developed fight or flight responses to dangers and predators in their environments. They needed certain biological and psychological things to happen to enable them to be aware of and escape these dangers.

As my oh-so-smart roommate pointed out, anxiety and the emotional angst that can accompany depression are like twisted versions of this response. Except instead of responding to actual dangers, your brain sees dangers everywhere. Everyday things look like tigers. Sometimes the tigers just appear out of nothing.

So having anxiety: Everything is tigers. Having depression: Everything is tigers, but you don’t care.

Sometimes, when it’s really bad, you might even take a bath in soy sauce.

I did it!

Interviewed for my internship today and, though it wasn’t my most impressive interview, it was a success. I’m hired and already scheduled. And though I had a spike of anxiety afterward that was seriously unpleasant, the fact remains that I didn’t let my depression convince me not to bother and I didn’t let my anxiety convince me I made a terrible mistake.

To be honest, both are going to be ongoing battles. But this is proof that recovery can happen.