This is the second half of my interview with Dr. Petra McGuire. If you missed Part 1, you can read that at this link. Here in Part 2, we’ll demystify the process of selecting and getting started with a therapist.
A: How do we find a good fit? What does that look like from the client side and what does that look like from your side?
P: It’s important for lots of professional services that you might enter into, but especially with a therapist you need to find some who you can trust and talk to openly. People say, I want to be comfortable with my therapist. But I would suggest to you that you want to be comfortable in your discomfort. Change is uncomfortable, so expect to be a little uncomfortable in therapy where you’ll be challenged to try things you’ve never tried before. That’s the essence of therapy. But you want to be working with someone who lets you feel safe, who helps you feel comfortable-ish in the discomfort. I also take some of the responsibility of fit on myself. I’ve done this work for a while so have a pretty good feel for what problems and people I work well with. There are client phone calls that I get, and I need to refer that person to another therapist who would be a better fit. And that is not anything personal. It’s really about, given what you have going on and what I have going on at this point in time, I think you will be best served by someone else.
A: So, it’s kind of like if I go to an ENT and he says, you really need to talk to a dermatologist instead and I know a great one I can connect you with. You would still be a great starting point. Because if you’re not the person to help me, you probably know who might be.
P: That’s part of my role. If you call me and I decide, for whatever reason, I’m not the best person to meet your needs, I owe it to you to help you get connected to the right person. Continuing to see the ENT, when this is really not an ENT issue, doesn’t make any sense. The way I’ve structured my practice, I really want to work with people who I feel like I can do great work with. I don’t want to just do good work, I want to do great work and that’s different.
A: What do those clients look like in your specific case?
P: It’s hard to describe. I feel like I kind of fell into a practice that works primarily with women, and if you would’ve asked me in grad school if that’s what I was going to seek out, I would’ve said no. Part of it is the nature of therapy clients in general. We know that women are more likely to seek therapy than men are by kind of a large margin, so that’s part of it. But it’s also just the experiences I’ve had in my career. I’ve had the fortune of working with a lot of women with gender-based experiences, so I’ve worked with a lot of things like the guilt that women experience as mothers for having jobs, or not having jobs, or spending time with their kids and feeling resentful while also feeling guilty the whole time they are not spending time with their kids. I’ve worked with moms who experience more anxiety, in general, about the nature of the world once they have children in it and they have this other being to take care of. I’ve worked with a lot of that, and it seems to be kind of a gendered experience. Similarly, the sexual assault experience is one that I work with a lot – dealing with the trauma response to sexual assault or sexual violence. It does happen with men, and you do see similar reactions in men. But women are much more like to show up for therapy and talk about it. And generally, they want to do that with a woman.
A: So, we’ve talked a lot about therapy from this ‘preventative maintenance’ perspective, but can you also help with some with a particular mental health diagnosis, such as clinical depression? You can help someone with that?
P: Absolutely yes. Some of the most common in my practice are depression and anxiety. I also work with a fair amount of eating issues, and often that is showing up as a symptom of this stress/coping imbalance.
A: We’ve talked about what finding a therapist who is the right “fit.” Would you walk me through what starting therapy looks like as a client?
P: Every practice is different, but what that looks like for me is if you call my office we will talk briefly by phone. I ask people to carve out 15 minutes and start by sharing some of the information about who I am, what I do, and what my practice does so that you know just what you’re getting yourself into. Then I ask for the client to briefly share about what they’ve got going on and what they’re hoping for out of the therapy process. That’s really my way of getting a feel for what it’s like to interact with this person – how it feels – and I’m also getting a sense of what kind of problems we’ll be working on in the therapy space.
That lets me be able to sort out if I feel like this is a person that I can mesh well with, that I can get some good work done with, and if they dealing with problems that I have good expertise in so that I can offer the kind of support and structure that they’ll need to develop some skills, make good sense of what they’ve got going on, and take those skills and apply them to their life. If I don’t get that sense, I’ll probably refer them to another therapist who may be a better fit for them.
A: Do you charge for that 15-minute appointment, that 15-minute phone call?
P: I do not. I’ll do that phone consultation with anyone. I have regular conversations where that person becomes a client and I have conversations where we talk about why at this point in time I feel that you’d be better served by someone else.
A: After the 15-minute phone call, assuming that it goes well and that’s a good fit, what does step two look like?
P: At the end of that phone call we either talk about referral options or we schedule an appointment and try to find a time that works well for both of us. I really try to schedule that within the next 7 days. Because when people call for a therapy session typically there is a problem. ‘I’m calling today, because I want to be seen yesterday.’ And I get that. Even if it’s not a crisis, it feels big and you need some support with it. So, I really work hard to prioritize and save space for those initial appointments to get them started. It doesn’t always work, but we at least try to make space for that. Then we’ll have some paperwork to fill out. With me they can do that either electronically or come a little early to that first appointment, we get that out of the way, and then sit down together and kind of think through what’s going on.
A: And then is it at that initial session that you talk about a plan, or is that premature?
P: Generally, this is the structure of that first appointment: I like to leave it open at first, so you get to tell me what you feel like I most need to know in this first meeting to have a good sense of what’s going on for you. Then I round that out with a bunch of nosy questions, they are not intended to be invasive or icky and it’s always okay to say I’d rather not talk about that right now. We’ll move on, no questions asked. That’s fine. Usually, that’s not a thing that clients do, but occasionally there’s a sensitive area where we’re not ready to go and that’s okay. It takes some time to build trust for some things, and I get that and am respectful of that.
But I will ask the nosy questions, some of which get at history and some current things like how’s your sleep, what’s your eating look like right now. These things can feel a little peripheral to people but really help in getting a sense of how their life looks. By the end we talk about your goals for this process and what I think some good goals for us would be. We try to develop some mutually agreed upon goals and think together about what kinds of skills or other work would be the most helpful to get you from where you are today to where you want to be. And we can think together about what that timeline might look like. By the end of that initial meeting we hope to have at least a general overview of what we want the process to look like.
A: Nice… hmm
P: Does that feel surprising to do that at the end of the first session?
A: No. It makes sense, I just wasn’t sure. I think most people, myself included, don’t have a good picture of what going to a therapist looks like. I sort of have this idea of that maybe it’s interminable, like every Thursday you come in and it is sort of forever. It’s one of the things that I like in talking with you that it feels much more accountable.
P: You used the word accountable and I really like that because it holds the therapist accountable to provide a good service, which is so important, because I do think for a long time that people would do therapy for years and years and years.
That is not at all what my therapy looks like. I tend to be pretty active in therapy, we’re very skills-based and strengths oriented, so we’re looking a lot at what is already going well and we try to apply that to the places you’re struggling. It’s very different than that kind of classic model that some people hold.
And it also holds the client accountable because there is homework. I think there’s this illusion that this work is going to happen in one hour in the week, but there are a whole bunch more hours in the week where things could go back to how they were before. So you will leave the session with things to think about, to write about, or to evaluate. And if you’re not willing to do that work, it’s really hard for that hour of therapy to make that much of a difference.
A: But it’s not unreasonable to potentially see strides in a few sessions if you’re doing your homework.
P: Yeah, I talk with clients about how we maybe cannot go from A to Z, but we can go from A to B. And if we string enough of those together, we can get there. When people come in with the sense that it cannot get better from here, I tell them it may not get to best, but it can get better.
A: You’re talking about hope – restoring hope to people at some level. Cause that is the most depressing thing if you feel like it’s never going to get better.
P: Yeah, that idea of hopelessness is debilitating. So, it may take a long time to get to best, but better is already happening because you’re here. You’re already taking a step, you’re already invested, because you picked up the phone and showed up to the first appointment. That’s already better and you’re already doing something different.