 Hello everybody. Welcome to Recovery Monday, episode number 47. We're going to wait for the usual suspects to start to roll in. First guy's in. Let me know that you can hear me. Let me know you can see me. Let me know everything is working. I desperately need new headphones. These headphones are literally falling apart. New ones are on the way. They just didn't get here on time today. So yeah, we're doing this is episode 47 of this. Oh, look at that. I'm testing at a new thing. And sure enough, it actually works on my website. A new way to broadcast these. Anyway, today, we're going to do a little chat about choosing a therapist, what to look for, how somebody becomes a therapist, so you know where they're coming from, different theoretical orientations, making sure that somebody fits with you, the fact that you might have to switch therapists from time to time. That's pretty normal. That happens pretty often. So it's not failure for you that we're going to talk about all of those things today. So let's wait for everybody to start to show up. Let's put the chat up here so I can see what's going on. Hello, Sarah. Hey, Julie, what up? I'll put it up on the screen. While we're waiting for everybody to roll in just for posterity, a couple of things to remember is that if you're following along with this content, and you are digging it, I'm going to hide this and I put some stuff up on the screen. Remember that I have written three books about anxiety and anxiety recovery there here on the screen. And you can find them at this URL at the bottom of your screen, the anxious treat comm slash books. So that's kind of new. I'm playing with all the toys today. I will also remind you that on the 19th of this month, Lauren, not Lauren, Joanna Hardison, I'm going to do our distress tolerance webinar again. That seems to be going over pretty well. So if you pop on over to the URL below that bit.ly slash tolerating distress, you can check out that webinar. We do it once every month. It's limited to 20 people. So pop on in if you want to register for that. I will hide this now. We will put the regular stuff up on the screen so we can get rolling here. I'll put the chat overlay up like I usually do. Hello from Scotland. Debbie Ellis. Oh, licensed clinical social worker. Welcome, Debbie. Debbie's a therapist. We're going to talk about this today. So Debbie knows what we're talking about. Boston in the house. Hello, strong island neighbor. Long Islander. Decatur, Texas. Today I'm wearing my contacts, not my glasses. I'm playing with a new prescription. So hopefully that will work. Let's see. I might have to put the reading glasses on. No, these are working great. New contacts. Isn't it great when you get new glasses and new contacts and you can actually see. So I'm digging that. So we've got 25 people here. Fancy new background. Yes, I have a new fancy background. I decided to try something different today. All the new toys. We have a new intro and all that stuff today. So there you go. Who else is here? New Hampshire is here. Kathleen. Let me close this real quick. If you're coming from the Facebook group, I won't be able to see your name. I'll only see Facebook user. That's okay. That's just the way StreamYard works. That's okay. Hey, look, so we get another Twitch person as tech working. Welcome. Welcome from Twitch, Boston again, Penelope Cruzify, which that screen name just kills me every single time. I appreciate you for being witty and your screen name. That's really cool. Hey, Jim, what up? Good to see you, my friend. So let's get cooking here. We're a few minutes in and before people start to bail because they're getting bored of me here, hearing me just riff. Today we're going to talk a little bit about choosing a therapist, like tips on choosing a therapist. So first of all, you guys know that I'm a huge fan of professional help. I think if you can access professional mental health help, that's a huge win. It's a big bonus. It helps things along a lot. You don't have to. People do recover completely without a therapist. For the most part, I did all my work without a therapist. I did have a therapist for a little while, but she was not actually an anxiety specialist, believe it or not, but it still worked out for me pretty well. But I did most of my work without a therapist. You don't have to have one. But if you would like to work with a therapist, we'll talk a little bit today about things that you can look for. Remember that I am in the United States. So I am most familiar with the way it works in the United States. I'm currently a graduate student in clinical mental health counseling. I am in the thick of becoming a licensed therapist. So I'm familiar with how this all works. I cannot say how it works in your country. I'm somewhat familiar with the way it works in the UK, but beyond that, I'm not 100% sure. So most of what I'm talking about here in terms of legal stuff and licensing will be US focused, but so many other stuff will apply in just about any country. So hopefully it will be helpful to you guys. So let's see here. She is one of Joshua's Fletcher's colleagues and she's great. I'm super hopeful. Excellent. Love it. So it's always, it's great when you find a therapist that you click with. So let's talk about that. What people often ask, like, how do I find a therapist? I'm going to touch on a few things. People often ask, how do I find a therapist that follows like your method? First of all, I say a million times, it's not my method. I didn't invent this. I'm just seemingly good at explaining it, I guess. So that's my thing, but it's not my method. You're looking for somebody who, if you want somebody who sounds like me, you're going to look for somebody who specializes in treating anxiety disorders and who has a cognitive behavioral theoretical orientation, which is officially what a therapist or a counselor would say. So people ask all the time, like, how can I find somebody who follows your method? Well, it's not my method. It's not the clear weeks method. It's a theoretical orientation that's focused on cognition and behaviorism, right? So, and that's complicated, but that's kind of where you want to go. And you're looking for somebody who really specializes in treating anxiety disorders, if at all possible. A lot of therapists are going to include, like, if you look in the US at the psychology today, directory of therapists, and we're going to talk about therapist directories too, because there's some really shady stuff going on right now in the industry, which is not cool. But if you look, almost every therapist will put anxiety in the things that they treat, almost every one of them. But that doesn't make them an anxiety specialist. So that's one of those things we're going to talk about today. So what is the difference between the different types of help that you can access? Excuse me. So you have a few choices, at least here in the US. And again, this may or may not drive in your country, but guidelines are probably roughly the same. People often don't know the difference between a psychiatrist and a psychologist. A psychiatrist is its own form of mental health profession or helper, if you will. A psychiatrist is a medical doctor. That is somebody who went to medical school. They generally follow a medical model. So when you find people who are involved in treating anxiety, depression and that sort of stuff, and they are a psychiatrist, you know that that person has been through medical school, and they specialized in med school in psychiatry, they have the ability in the United States to prescribe and manage medication use. So if you're working with a therapist and therapist and psychiatrist rarely go together anymore, at least here in the West, we don't usually use those terms interchangeably anymore. So if you're working with a psychiatrist, somebody who is giving you medications and managing that, you're working with somebody who has gone to medical school. Is that better or worse than somebody who has not gone to medical school? It's just different. So I'm sure I'm not taking away from anybody who has been through medical school and obtained a medical license. That's impressive as all get at my respect all of that. But in the case that we're talking about here, is it better if you have a psychiatrist who has a medical degree? It's not better or worse. It's just different. And you keep in mind that a psychiatrist will tend to have a more medical model that they follow in treating these sort of things, mental health issues. But that's okay. I'm not faulting them. That's their training. A psychologist or somebody who has the term, the title psychotherapist or counselor, mental health counselor, Debbie's here, she's a licensed clinical social worker. These are people who are not medically trained. Like I will not be a doctor, I'm not going to be a medical doctor, I will, I'm going to be a therapist. So psychotherapy is also the realm of people who do not go to medical school. So if you are working with a psychologist or a mental health counselor or a clinical social worker, somebody like that, then you're working with somebody who is not medically trained and cannot prescribe or manage your medication use, because it's just outside of our belly wick. Sometimes those people will work as part of a team. And if you have a psychiatrist or in some cases a general practitioner who is working with you with meds, then your therapist, your psychologist, your counselor, your LCSW may work with that doctor, psychiatrist or GP to work together and consult with each other to make sure that everybody's on the same page. But a psychologist or a counselor is not able to prescribe or manage medications with you. And we'll generally steer clear from offering advice about medication because you just can't, that's not what we're trained to do. So that's a big difference between psychiatrist and psychologist, counselor, social worker. And I think it's a good place to start, because for a long, long time people would go to a doctor and wind up getting referred to a psychiatrist and think that that is therapy. In some cases, is a psychiatrist practicing psychotherapy? Yeah, I'm not going to say they're not, but in most cases these days, and I'm going by my own experience dealing with thousands of thousands of people, it's kind of rare to find a psychiatrist that engages in practicing therapy or psychotherapy. And copper clearly has an opinion on that too. So just note the difference there. When you go to somebody who is non-medically trained in the U.S., you can go to somebody who can call themselves a psychologist. And a psychologist generally has a doctoral level degree. That is a PhD or in the U.S. a PSID, PSY.D. That means that that person has got an undergraduate degree and then a graduate degree beyond the master's level. They are a doctoral level. They've obtained a doctoral degree. So a PhD is a little bit more research oriented, where PSY.D. is somebody who's a little more clinically oriented. But in both cases, that person has earned the right to call themselves a clinical or a licensed psychologist. So I will not be a licensed psychologist because I am not getting a doctoral degree. I'm getting a master's degree. So other types of mental health helpers that you may run across. And this is probably the majority right now, I would think. Yes, you can, you could see if copper has openings, but he's not taking any new patients right now. But he, the vast majority I think these days, just because there's so much of a need for it, are people who are trained at the master's level. That will be me. So people who have a master's degree in not in psychology, usually it is a master's degree specifically in social work or in clinical, my master's degree, clinical mental health counseling, an MA in psychology, like a general psychology degree does not qualify you in most states to become a licensed psychotherapist. So at the master's level, you're getting somebody who is trained to be a therapist specifically. And we do not engage in the type of research activity that PSY.D. and PhD candidates do. So that is the difference educationally, right? You can have somebody, nobody that is at least in the United States, nobody who just has an undergraduate degree in psychology is qualified to be a therapist. So an undergraduate degree in psychology really kind of qualifies you to do nothing, which is true. That's, I don't mean to, I'm not, I'm not taking away from anybody who gets a degree in psychology. That's totally fine. I had a minor in behavioral psych is an undergrad. That's cool. But an undergraduate degree in psychology does not qualify you to be a psychologist, a therapist, or anything like that. So you have to be at least at the master's level, you can be a clinical mental health counselor, like in New York, my title will be LMHC, licensed mental health counselor. Sometimes you'd be LPC, licensed professional counselor. So you might have the title counselor, you may have the title psychotherapist, they're interchangeable, I would probably use the term psychotherapist, it doesn't matter in the end, but we are all trained at the master's level also. In many states in the United States, somebody who studies social work, it gets a master's degree in social work can be a licensed clinical social worker. And those people are also qualified to practice psychotherapy. And there are LCSWs, clinical social workers who do specialize in treating anxiety disorders. In every one of these cases, you're still looking for somebody who is specializing in treating anxiety disorders. So even if that's a psychiatrist, you might have to dig a little bit, but you'd want somebody again who is focused on anxiety disorders. So this is sort of the educational differences, at least here in the U.S. Again, it's really important to remember, nobody can get a certificate that says that they are a therapist in the U.S. You can't just have no college degree and decide you're a therapist. You can have an undergraduate degree, get a certificate and call yourself a therapist. You can't get a certificate for coaching and call yourself a therapist. In every state in the U.S., this is a licensed and regulated profession and I think probably rightly so. Now we can argue about the shortage of help and we need to be better at providing more helpers because we are literally in a mental health crisis, at least here in the States and I think pretty much everywhere, but there's not enough therapy to go around. That's true. So that's sort of the educational differences that you can find and the differences between a medical doctor, somebody who's not medically trained, somebody at the doctoral level and the titles they can have, somebody at the master's level and the titles they can have and the education below that does not get a title at all, nor would they be legally able to practice psychotherapy anywhere in the United States. Now in the U.K., I understand it's a little bit different and I could be wrong here, but with all the work that I've done with my friends in the U.K., Josh and that crowd, it would appear that anybody with no education and no qualification can call themselves a therapist and there is no law against that. Here in the States, at least in New York and in most States, somebody with an undergrad degree or no qualifications who's not passed the licensing exam could not legally say they are a therapist, but it seems to be that in the U.K. that is possible. I don't know about other countries, I can't really tell you. So what does it mean when you go and reach out to a therapist? Like what are you going to get from them? What do you have to look for? Really the probably the most important part of choosing a therapist is finding a therapist that you click with, that you connect with, that you can trust, that you can form a relationship with, that you feel is there to help you, that you see as an ally and a resource. Like the personal relationship between the client and the therapist is probably the most important part of the therapeutic endeavor to be honest with you. So there's a lot of evidence that says in therapy almost everything works if you have a good relationship with your therapist and that's true, but what you're looking for is somebody that not only in the U.S. this would be you are qualified to be a therapist, that's your qualification or your credential. So I will be licensed LMHC in New York or somebody might be LPC or licensed marriage and family therapist, LMFT is another one, LCSW, that is your qualification or your credential, but on top of that you might want to look for somebody who has a certification in certain modalities and treatment types that focus on anxiety disorders. That might be people who have certifications in cognitive behavioral therapy and dialectical behavior therapy and metacognitive therapy and acceptance of commitment therapy. There's a bunch of different CBT and CBT variants and subtypes that you would then after I finish my master's degree, I will get certifications in one or more of those. That is additional on top of your education. So some people think that you just finished your degree and as part of my master's degree I learned all about anxiety disorders, but the reality is that's not true. The reality is that after the master's level with a master's level therapist, that's when the certifications and specializations begin to kick in and we are taught at the master's level to pick a specialization if possible and investigate what it takes to be additionally trained and certified in those areas. So even though every therapist in the online directories will tell you that they do treat anxiety and that's true because anxiety is the single most common presenting mental health problem in any therapist's office, if somebody has some form of anxiety, it doesn't necessarily mean that that therapist is certified or specialized in treating anxiety disorders the way you hear me and people who sound like me talk about them. So if you're asking about that with a therapist you would want to specifically ask do you specialize in treating anxiety disorders? Not do you treat anxiety because almost all of them will say oh I do anxiety, yes I do that, I have patience with anxiety. You really want somebody who says this is my specialty, this is what I do. Like I have a professor this this term in my master's program that is what he does. He is a specialist treating anxiety disorders. When you hear me collaborate with people like Lauren Rosen or Joanna Hardis or Josh or Kim they specialize. These are specialists that's what I will be. So it's kind of important to do that because treating anxiety disorders it's almost its own thing. If you're not familiar with the mechanics, if you're not aware of how these things really work the people who specialize in treating anxiety disorders are like odd ducks in therapy circles. So even in my master's program when I talk about anxiety disorders people tilt their head and look at me funny because it's not intuitive. So much of what we talk about and you guys know this are not intuitive. These things go counter to common sense. They feel like this is not what I should be doing, I should be trying to feel safe, I should be grounding, I should be doing all the things to calm down. And me while you got guys like me out there saying no no no that's the bad lesson you shouldn't do that so we're often a little bit weird in therapy circles. We're the engineers, we're the mechanics, we're the odd ducks out in a way. And it's been fascinating as part of the educational process to have people say this to me and have professors say oh no no no he's one of them in the most respectful way that's not an insult. Like no no no if you run across this problem you listen to somebody like Drew he's not wrong about this. But a lot of therapists aren't interested in treating anxiety disorders and that's okay they don't have to in a way. So you want somebody who really is focused on treating anxiety disorders like panic disorder, agoraphobia, health anxiety, OCD really helpful if you can find somebody like that. Now I do understand it's hard to find a therapist as it is. Finding somebody who specializes in that who doesn't have right now like a two-year waiting list is really hard. Like let me I don't have an answer to that I wish I did. I mean I guess in about two years I'll be one answer to that if you live in New York. But I do understand that this is true. It is not easy to find a therapist so you really have three things that you're trying to accomplish. If you're listening to me because you're dealing with OCD or panic disorder or agoraphobia and you want to find professional help you want somebody who is qualified and credentialed which means they are a psychiatrist they're a doctoral level psychologist they're a master's level psychotherapist that's the first thing. So you got to find that you got to find somebody who has availability who can take new patients you have to find somebody who is well versed and potential and really preferably specializes in treating anxiety disorders and then most important you have to find that person and be able to build a relationship with them that's really important. Like even though anxiety specialists tend to be mechanical more so than other types of therapists that therapeutic relationship is very very important to us too like or to me too to those clinicians as well. Building a therapeutic relationship where there's a click you trust me you can get behind what I'm saying you know that I have your best interest in mind we just have a connection you know how that is the relationship with the therapist is like any other relationship some you click well with some you don't that's okay we all have different personalities right so I can tell you for sure that there are some very big names in this field some of which has been on my podcast and I know people that have had them those people who have very big names in the field sometimes are also practicing clinicians who get rave reviews from some of their past clients and terrible reviews from other others even though nobody would doubt their knowledge they're tremendous contributors to the field but they have personalities like everybody else so they don't click with everybody I wouldn't click with everybody right so those are the things you're looking for now let's talk for a quick second where are we here 20 minutes I have a lot to say today clearly let's talk for a second about online directories of therapists because this is this is becoming a thing now in the era of the internet you would think well this is great because now we have directories where I can go and find a therapist here in the states you can say what state you live in you could stay with zip code you are and I'm sure there are in other countries as well and find therapists of various types they might be doctor or level or they might be master's level whatever social workers that can treat because of the legal structure like yes you live in this zip code I can treat you no problem and they will tell you this is here's my bio here's my education here's my my view of therapy give me call maybe we could work it out okay what's happening is the good part of the internet is now being really cloudied by some really shady stuff so there are companies that do online therapy and you you know some of the names right so you've seen if you watch any youtube videos if you've watched any of my youtube videos and I bet you are seeing ads in your youtube stream from some of these companies that are providing online therapy services especially in the last three years that has exploded so some of those companies now are beginning to co-opt the other directories even the neutral directories so if you go to a therapy directory one there's one company I'm not going to name the name this is not okay but you have to be careful about that because if you go to find a therapist online and you find a therapist that you think you want to contact and that listing says oh yeah cool but this therapist is really super busy and might not be able to take you so click over here and you wind up in another directory that's proprietary to a particular company that particular online therapy company and that's what they are their companies red flag so now you're starting to see that those companies are beginning to game that's you got it that's exactly right those companies are beginning to game the system so I might not be in their directory because I don't practice with that particular company but they'll put me in there anyway make it look like it's not them and then when you click on my name they'll tell you he's really busy he can't take you but here's some people who can so they're beginning to actually leverage the internet and the SEO game to try to get business yeah in a kind of a shady way so just be aware of that too finding a therapist is not an easy thing and the other thing I'll say before I take some questions and comments here is in the end I think it's about finding the person you click with that's really important and that might mean that you change therapists you may interview a therapist have a session or two and decide this is not working out you may immediately on the phone before you ever have a session say this isn't working out you may get down the road six months and it was working great and now it's not anymore that's okay that sometimes we have to change that's normal it's really important to understand that if you feel like you need to change therapists or you go and talk to the therapist and you don't want to hire them that has nothing to do with them at all like it's just like a plumber in a way I'm being trained to know that that has nothing to do with me I mean we might not click I can't make you hire me I can't make you like me I can't make you do any of those things I could be as authentic as I could be I could be as congruent as I could be I could be transparent I could be knowledgeable I could be evidence-based and ethical but if you don't connect with me that's okay it's not your responsibility to manage your therapist's feelings ever so especially if you deal with a little bit of social anxiety or attachment based anxiety where you feel like you need the approval of your therapist or you can't stand the thought your therapist might not like you you don't have to worry about that your therapist is being trained to understand that if if you leave me I'm actually going to help you find somebody to replace me it's part of my job and it is not on you to make sure you don't hurt my feelings I'm not saying to be nasty or violent or disrespectful but changing therapists is very very common it happens all the time and we're actually trained to recognize when well maybe that is sure this is a good fit it doesn't this might not be a good fit is it okay like we're always trained to circle back and make sure is this okay to give you every opportunity to say I'm not really feeling it with you anymore and we talk about a change absolutely you can talk about a change so you don't have to worry about that if you're going to change therapist totally acceptable happens all the time it's really normal it sucks in this environment where it's hard to find a therapist to begin with much less a second or third but it doesn't mean you're failing if you connect with a therapist who may be this happens like yes I treat anxiety and it seems right but you know three months into it all you're doing is talking and there's no exposures and there's none of what you hear here okay well this isn't really working for me I think I'm going to switch no harm well I'm saying no harm no factor you spend some money that's true but that doesn't mean that you failed so you might change therapists for a variety of reasons therapeutic orientation of the therapist doesn't match your problem that happens all the time right and that's okay that's not that's not a failure by you in any way shape or form for whatever reason the personality of a therapist you're just not clicking maybe you started off great and that's sort of cooled off and it's not working anymore all of those things all of them are really common so if you have to switch it's okay to switch it doesn't mean you failed and you are not responsible for for the feelings of your therapist you're not going to hurt their feelings if you say that you want to you want to leave them and go somewhere else right it's really important so hopefully I've covered most of I think what this works out let's talk about insurance for a little bit I guess this is a hot topic I understand that insurance is different in the United States than it is in almost every other developed country I get that this is not a political debate I don't even want to go that way we have what we have right now who knows if it's going to change or what it's going to change too but right now this is what we have not every therapist will take insurance some do some don't unfortunately in the UK some therapists work with the NHS in Canada therapists are working with the National Health Service there I'm not sure what Canada's NHS is called so in some countries you can access mental health care as part of standard health care that everybody gets but there are also private therapists that do not participate in that public system that you have to pay and here in the US some may participate in the insurance that you have some might not and you would have to pay them out of pocket and that cost can vary most therapists will do at least some of their practice because it's sort of an ethical requirement and a professional requirement on a sliding scale or pro bono we all want to do that so we'll try to do the best we can with that but you'll see that depending on where you live the cost of an hour might be a little less if you're in a rural area where the cost of living is a little lower if you're in New York City or San Francisco your therapist is going to charge more that's just the way it is unfortunately but that you know that's going to work that way and then in other countries as well like you're going to find private pay therapists that charge in a very scale it's a red flag when any other therapist charges you know 90 to 175 dollars an hour in the US depending on where you are and then you find somebody who wants to charge you 450 dollars an hour that's a bit of a red flag they can charge that if you want if they want they they are welcome to charge that there's no law against it but keep in mind that why why would you be three times more than anybody else so just be careful about that too I wish I had better answers about paying and insurance I don't but unfortunately I don't is what it is okay so let's go through some questions and comments 28 minutes of rambling at you that was a lot to say hopefully it's been useful information I hope so let's see what we have here oh yeah okay bye so let's go up to the top here let's look at some comments the psychiatrist prescribed medicine but uh scroll up scroll okay here we go I've been recovering the podcast for the past two plus years thank you very much are you very welcome as tech working from twitch uh from not leaving kind of a lot more than before I got just got a new therapist one of John helped throw this I'll throw up some uh comments on the thing here one of Joshua Fletcher's colleagues she's great and I'm super helpful one thing that's kind of cool is if you find an anxiety specialist like Josh for instance or Kim or Joanna or any of the people that I that I you know that I work with all the time a lot of times people like them will be able to refer you to somebody like them it's a bit of a close-knit community so in any given area most anxiety specialists will know other anxiety specialists too so that might be a helpful thing um let's see here yeah this is true panel let me put this on the screen I wish this wasn't true but this is true it's extremely hard to find an ERP or CBT specialized anxiety and panic trained therapist that accepts insurance it is hard it is very hard I'm going to be totally transparent with you so as a therapist in training and in an unusual circumstance where I mean I it's I am in an unusual circumstance there's no doubt about that because I have an audience already so I face some of I face less challenges in building a private practice than say that my my classmates do which puts me in a weird place I don't have to take insurance and taking insurance in the US is a pain in the butt I think it isn't just about every place so I know in the UK a therapist that works with the NHS is buried in paperwork so many therapists choose I'm not going to do it though I'm just going to be private pay because there's a market for that so keep in mind also that therapists do have to eat therapists are running a business I'm not saying that it's it's a tough call because I know a lot of people feel like therapy should be free I don't disagree with that it would be great if it was or a therapist that has a lot of clients that charges a lot of money and makes a lot of money sometimes is vilified but unfortunately it is free market just like anything else so the the impetus for a good therapist this is reality market forces here in the US is that not taking insurance is certainly easier than taking insurance and if you practice in a large area where there's a lot of people you can do that and so unfortunately it sort of incentivize the best therapist to not participate in health plans that's true I wish it wasn't I'm just trying to be honest with you and let you know how it's sort of working it's thanks but that's the way it is okay oh let's put this up on the screen here this is good so those of you who have you don't know Kathleen yeah let's see Kathleen was on my podcast a couple weeks ago she checked that out so she has come so far in her recovery to the point where her therapist is asking do you even need me anymore that's a big deal like a therapist is also trained to understand when it's sort of time to begin we would call that separation right or termination if you will sounds really cold but it's there's a thing and that's really a happy day for a therapist like even though they are rooting for you and cheering for you and a part of your support system the happiest day is the day that you're done that you don't need us anymore right so this is normal an ethically trained therapist who practices ethically will circle back and say and why am I taking your money like what am I still doing for you especially when you have gone so far down the road like Kathleen has and she's so much better than she used to be that I would expect her therapist to say what am I tell me again what I'm doing for you now because you can't be in a situation where you're just taking somebody's money because they want to give it to you that's not ethical so I would expect your therapist to do that Kathleen totally and it's okay like your therapist is never going to should not abandon you but sometimes it's important that you be able to say no no you're serving this particular purpose but sometimes especially in this thing that we all deal with these anxiety disorders that thing where well I want to hang on to you just in case at some point your therapist is going to challenge that like what what am I going to do so if you have two panic attacks in a row tell me what I'm going to do to fix that right so you have to be careful about that just keep taking my money I get it I get it okay um let's see a psychiatrist prescribed medicine for me that was totally wrong that's a whole I mean I understand Carol that's a shitty experience I'm sorry that that happened to you I know that in many instances I have not been kind to the psychiatrist I can own that I have not been kind to psychiatry at all some of that is my own personal experience being colored to a certain extent and I'm very upfront and honest about that this is why I don't talk about meds very often at all because it's not a good topic to talk about but yeah when you have somebody who is more medication based like a psychiatrist often would be stuff like that can happen but in the same vein even when there's no meds involved put Penelope's comments up here I feel like I'm teaching them how to help me unfortunately is also pretty common too because when a therapist is not trained on the mechanics of anxiety disorders but thinks they should treat it anyway and I'll explain this for a second here I did a podcast episode called why hasn't my therapist ever explained it like this which was about a year and a half or two years ago remember but um that sort of explains different theoretical orientations every therapist is allowed to pick the theoretical orientation that they think is right that we're supposed to practice in an evidence-based kind of way that's an ethical consideration in practice like we should be practicing in an evidence-based way yet it's also perfectly okay for a therapist to decide well I think that you know whatever pick any old theory that you want I think that being completely purely rogerian is the way to treat everything so I do it that way and a rogerian therapist will sit and say almost nothing just nod at you and provide you nothing but a positive mirror of everything you say and you work it through yourself that's okay like that might work in certain cases but a therapist can decide I think that's what works for anxiety disorders the therapist is free to decide that and try that really and truly they should be if they're ethically practicing should really be able to look and say this isn't really working so well for my clients doing it that way so maybe I should either change that or start referring those cases out but it is acceptable and legal although not necessarily ethical and that's a gray area for a therapist to decide that they can use whatever theoretical orientation they want to treat your anxiety disorder and they do I'll give you a very interesting statistic and that would be that every therapist has some contact with the stuff that we talk about in their training somewhere they are taught about cognitive behavioral therapy right somewhere along the line they're at least made aware of the way this stuff sort of works but they may decide well that doesn't fit with me I don't like that and they want to use another orientation that fits with them a little bit more personally intellectually emotionally spiritually whatever it is they want to use that in their practice and that is the way they view the world so that can happen but then there are therapists who understand well this crazy guy with the beard in New York is is right like we know that that's a way to do this and it's really the most effective way to do this but even though I know that I'm not going to practice this way because it makes me feel bad to do it that's a real concern so especially when you see here some of the discussion in my Facebook group when you hear a therapist that's really upfront and a little bit aggressive with a client and says no no no you've been doing this exposure now for six months this way you need to to step it up now or you need to drop the safety behavior and they get really directive that way that's actually a good therapist but not every therapist is going to have it in them to do that and be that confrontative and when surveyed there was an interesting data that came out a couple years ago where in a survey and a study of a bunch of therapists I believe this was in the U.S. only the percentage of therapists who understand that exposure based therapy is the best treatment for anxiety disorders is huge but the percentage of them that are willing to do it is low right therapists are people too and they are fearful that they will traumatize you if they see everything in a trauma lens which is not necessarily a bad thing they worry about hurting you about putting you in a state of distress about traumatizing or retraumatizing so they will not use those modalities even though they'll tell you yeah I know that's really the best way I just can't do it I'm having a hard time with it so that's pretty common also that's why it takes almost a special kind of therapist to be able to do that and it I'll just say is my own from my own experience somebody who's been through it who's lived it understands like I know you don't want to do this I didn't want to either but it really is the best way so keep that in mind too some therapists know that people like me are telling you the right thing they can't bring themselves to tell you to go do scary things because they think that's counter to what I'm supposed to make you feel better but in the end like it's feel better comes later so it's this is a crazy topic it really is um so let's see here it's really common for people to say I feel like I know more than my therapist unfortunately or what I just said like what Penelope's just agreed with the therapist knows that what you're asking for is kind of what you really need especially if you go in and aggressively say no no no I need you to help me do exposures I need you to do ERP this is what I want to do I want to do this and I need your help sometimes it's really hard for them to reconcile that like I know you're asking me to do that but I don't want to make you do scary things so that's a tough one really tough okay let's see here well this is good let me throw this out here one of the best things is if I can joke with my therapist too that's totally okay now your therapist is also trained not to become your friend you have to be super careful about that we'll do a whole another topic on that one day the difference between a therapist and a friend because it's an important difference it really matters but it is good when you have that kind of relationship but you can joke with your therapist that's a connection and that helps in a big way so let's scroll down here I think we're going to get near the end very shortly yeah I get this Carol this is true is a problem the trouble of spending so much money to find the right one yeah I get that that is a problem for sure let's see um I'm just going to scroll scroll scroll so you're saying Josh Fletcher could actually just be a florist this I almost need to I'm going to screenshot this and because I can't not that is the funniest comment that I've heard in a long time and yeah I guess it's possible he could literally be a florist then we wouldn't know it just in the UK anybody can call themselves a therapist evident I found a good therapist excellent Ellen and when you do find a good therapist a great thing it really is therapy can be a wonderful thing tremendously beneficial I'm a big fan of it if you can access it if you can afford it if you can find somebody that helps it is a big deal it's really really helpful so it can be a wonderful thing if you find the right person 100 so let's see click pretty well my therapist I know that if I get along well okay let's put this up here I can maybe address this I click pretty well my therapist that's good my deal is that I know I'll get along well with them if they put their spin on how maybe they did this and they I'm not sure that I understand the comment to be honest with Julie if they put their spin on how maybe they did this and that I can tell you that as a therapist in training the word spin is a red flag for me like recognize what you're bringing into the relationship also now the therapist brings their own things into the relationship we try to take it out if possible we do our best and that's why a therapist has a clinical supervisor even in a private practice working for myself I will have a clinical supervisor I have to somebody that's looking over my shoulder that I can bring things to hey am I being impartial here am I looking after the best interests of the client am I doing anything wrong we need that so just be careful because a therapist is not there generally to put a spin on anything so if you're seeing your therapist as somebody who is going to try to spin things to make you look one way or the other or to try to frame a narrative in some way that's something you might want to consider because a good therapist should not be doing that that's not a thing that we would want to do with you so let's scroll down to the bottom here I call over 50 therapists yeah that's a real thing that's a problem you're a veteran here they really therapists I'm sorry I'm just going to scroll down to the bottom here let me put this up this is a very nice comment first of all thank you so much these are very very kind words and I appreciate them it's really important though for me to say that my podcasts are not therapy like they're not they're not therapy that's really important there's a difference there's such a difference between just creating psychoeducational content and actually providing therapy now I appreciate that there's a very kind words I do appreciate I'm glad I'm able to help but sometimes we do the best we can if you can't find help you try to substitute in use maybe people like me or Kim or Josh or whoever to try and fill the blanks which is great but I always remember that we don't actually know you I don't I don't really know any of you guys so it's I cannot I can't give you like personalized advice it's really important to remember there is a line for sure well let's see here private pay horrible advice sorry Kathleen it was a learning experience you should start a recommendation list I would love to that's just another thing it's a good question for sure I started recommendation lift I would love to do that at some point that might be a thing people have asked me to do like help me find a therapist you know it's it's not a bad thing maybe one day I'll do that I don't know I just don't have a I don't have enough time to do that sort of stuff so I'm going to scroll to the end here what if you need okay it's a good question here throw it up here what if you need a therapist for gore phobia but other things like childhood trauma do anxiety specialists also cover that too some are look we should all be making an effort to understand that not and how often do you hear me say this not everything is a clear weeks problem not every single thing is a floating accepting and surrender problem not everything is an exposure problem that's 100 true so the thing that I always find amazing in the therapy world is that anxiety specialists will be the first ones to tell you when we don't apply like this is not my thing I cannot tell you to float and accept through an abusive relationship that's not right yet other therapists will tend to take their theories and try to shoehorn them into anxiety I don't know why that happens this is one way thing but an anxiety specialist should understand and be able to identify when there's trauma there can they work with it sure in certain instances they will in other instances they may want to refer out and therefore you work as a team either one after the other or at the same time if that's at all possible but every anxiety specialist should understand be able to recognize when that is there and take steps appropriately to make sure you get the best treatment either directly from them from somebody else or somebody else with them hopefully that answers the question no no no every therapist yeah yeah this is a this is a problem for sure can I get this every therapist thinks they're an anxiety specialist an expert I get it because there are people right now I'm there are people in my class right now my classmates my peers my colleagues that are convinced 100 that every panic attack has some sort of deep rooted emotional meaning and if you don't find that you're never going to get better I have been in that discussion already and I'm not even done with my school so yes that's possible it can happen let's see I was going to hospital follow-up office person with direction to go in okay it's good I wasn't real okay this is good too I was in a I wasn't real interested in the soft treatment like I said before sometimes that's a little tricky because a therapist when you come in and say no no let me have it like I want you to make me do hard things some of us will like light up and like your that's it we're good match we're going to get along really well together others will be like well you know I don't I can't I don't want to be responsible for you being afraid is I think that we're a lot of therapists are and I understand that I really do I'm not picking on that I understand okay Julie thank you for clarifying that I understand I like it when they put how they got their personal situation yes and sometimes that's called self-disclosure sometimes a therapist will share some of their own experiences to help you understand how they did it or for some perspective that's a case by case basis sometimes a therapist will tell you those things other times we're we're not going to tell you stuff right so people who treat anxiety disorders like people like me when I wind up in practice we often share that because we've been through it before so we can understand what you're saying or that it helps to be able to say well when I felt this I did this doesn't mean she's your therapist is telling you how you're supposed to do it but a therapist who has lived the same experience as you that is willing to self disclose in an ethical way with good supervision can help you give a little perspective like hey I did it this way this might help you to think about it that way that's good Julie I like it very good uh let's see here do you feel like virtual therapy is effective as in person to be honest with you I think it can be I think I totally think it can be it's important to me I think it's super important to see the person now we we can see the person now like I can see you on a zoom call so that does work fairly well in that situation because I can see you is it always a hundred percent as effective as being in a room with somebody not so much but I think it's it's quite effective I don't think it's I don't think it's not I'm trying to be noncommittal here I don't it can't be I'm never who am I since why am I noncommittal yeah it's really it's quite effective I would always prefer in person if possible but tele therapy is a really good thing especially dealing with these type of problems but you got to be able to see the person that's so important just being on the phone in a pinch sure texting I cannot imagine that there are virtual therapy companies that will allow you to text with your therapist now one of the things we learn is you got to meet the client where they are so it's not a bad way to start but text based therapy ouch that seems difficult on the long run and I think we're open at the end here that is it another issue is having a high standard after hearing your thoughts and anxiety okay well um you know I'll throw that out there again it's a very nice words thank you Martin I appreciate you saying nice things about me but keep in mind that I'm not setting a high standard I'm just giving specific information about a specific theoretical orientation so in a way it's not like well you know I have such I'm the gold standard here the theoretical orientation that I'm bringing to this is the gold standard so that I get that I get but it doesn't mean that a therapist that doesn't sound like me is worse it's just not applicable right so it's like a tradesman like if you need a carpenter you get a carpenter if you need a plumber you get a plumber doesn't make one is better than the other so in a way that's kind of how that works all right well we did pretty well you guys listened to me ramble a lot I gave you a lot of words today thank you so much for hanging in still 43 people here I am amazed at that um this will stay on my youtube channel in the facebook group even though it's super hard to find in the facebook group because you got a search around it'll stay in my facebook page but subscribe to the youtube channel if you're not because it's the easiest way all these go into playlists call recovery monday go back and watch them again we'll come back and do it again next week well maybe next week we'll maybe do q and a I was talking about that last week but then this topic came up so maybe I'll throw like a q and a post up on instagram and I'll gather questions and we'll answer them and talk about talk about them in the comments or whatever it is so guys thanks for hanging out today appreciate it I will see you again