It’s OK to be sad. Everyone feels “off” sometimes, whether that means angry, frustrated or just down in the dumps. Those are normal human emotions.
But to be depressed is something else: It’s a diagnosis.
“When someone has a prolonged period of time when they can’t get out of bed, they don’t enjoy their usual things, or their eating and sleeping (habits) are off, that’s different than being sad,” said Michelle Warren, a therapist in Metro Detroit. “If you had an issue with your cholesterol, we wouldn’t say, ‘Keep doing what you’re doing. You’ll be fine.’”
People who suspect they’re depressed should talk to a professional, but getting to that point isn’t always easy. If it’s you who’s struggling, you might ask yourself: “How do I find a therapist? What is that person going to ask me? How long will it take before I feel better?”
Or, “Can’t I just talk to my sister or a friend?”
You can, but it’s helpful to have an outside source, Warren said.
“If we go to our friends, they’re often going to take our side or give us the feedback that we want to hear,” she added. “A therapist can help you see blind spots, offer new perspective, and help you see your role in what’s going on. Friends can’t always do that.”
They can be supportive, but they’re only so much help in some circumstances, Warren said.
Some people have an idea in their head about what therapy is like, based on a TV show or movie.
“People will ask, ‘Does anyone lay on the couch?’” Warren said. “They do, but because they think it’s funny. Or they’ll want to fix everything in a first session. But that’s when we’re having an assessment and gathering information. It’s a match-making process in that way. Unless someone has (spent a lot of time in therapy), there can be some misconceptions and anxiety leading up to the first appointment.”
So, what exactly should someone know or do before session one? Here are some tips Warren provided.
No. 1: Do your research.
Don’t just pick a therapist’s name out of a hat. Try to make sure this person would be a good fit for you and your specific needs. Therapists do have specialties, and they go into part of the field that they’re personally and professionally interested in, Warren said.
For example, if you had a heart issue, you wouldn’t see a dermatologist. That would be out of scope.
You want to find someone who could be as helpful as possible for whatever you’re seeking help with.
Warren recommended using the website Psychology Today as one of the best platforms to look for a therapist in your area. You can search by insurance, as in, who takes what types; or training and location. Then you'll want to do some research ahead of time to ensure you’re making an informed decision.
No. 2: ‘Just know that we aren’t magicians.’
“I don’t have a magic wand or pixie dust to make things better,” Warren said. “(Therapy is) a process and it takes time in and out of the office to make changes, but the more authentic someone can be about what they’re wanting to work on -- that helps. After that first session, it’s not like now you’re enlightened and all better. Sure, that would be easy, but humans are much more complicated than that.”
No. 3: Be aware: Therapy can be hard work.
The sessions set the foundation, but many therapists give people “homework” to do outside the session.
There’s nothing magical that happens at the session itself.
“The real work is (what happens) in the real world, outside the office,” Warren said. “People come in and want (things) to be fixed, like, let's check this off the list. But it takes a while to unearth what’s going on that brought the person in in the first place. It’s not always a quick fix, like the Staples ‘easy’ button.”
And you have to be dedicated to making the change.
Warren said even if she sees a young adult, that still might mean a decade or more of background to sift through.
“It’s not going to be like, ‘I went three times and I felt amazing.’ But you shouldn’t aspire for perfection anyway," Warren said. “Sometimes, individuals or couples will say, ‘I want you to fix it this time.’ But that’s like going to a doctor and asking for a chronic issue to be fixed today. It takes time for that to work.”
No. 4: Therapists aren’t meant to be your friends.
Warren said it’s flattering when clients say they want to be friends outside sessions.
“But that shouldn’t be our goal or role,” she said. “People would likely say I’m friendly and compassionate and I hope therapists are that way, but we’d lose our objectivity (if we became friends with our clients).”
People pay therapists, and work with therapists, to get unbiased input, and so they can make changes in their lives.
“If we were friends outside, we’d lose our ability to do that,” Warren said. “We want to help you see blind spots and areas you might want to reconsider. It’s hard to do as friends.”
No. 5: Sometimes things get worse before they get better.
Humans are complicated.
Emotions can be difficult for us to navigate through.
If you’re in therapy, you need to be patient and trusting throughout the process.
If you have a good therapist, that person will be there for you in your journey, and present to support you through it.
But it helps if you’re realistic. These things take time.
“Not everyone in your life is going to love your decisions or what you’re doing,” Warren said. “Be comfortable with that discomfort. Your relationships will change and dynamics might change.”
This might prompt other people in your life to look at themselves and make changes, as well.
And then on the flip side, “We think everyone’s going to be supportive, but sometimes, there’s something they’re getting from our struggles,” Warren said. “(It can be) difficult as you navigate through that.”
No. 6: Your history or family of origin’s history is not your destiny.
“Everyone is capable of change. I just can’t predict who’s going to make those changes,” Warren said. “It comes down to, how much do you want to change?”
She continued by saying, if you want to reduce your anxiety, most therapists have tools to help, but clients still have to do the work.
“We can’t just make it better or make it go away,” Warren said. “How much do you want to work with what you have, to reduce or eliminate symptoms that you’re having?”
Good food for thought.
No. 7: Your therapist isn’t there to tell you what to do, or make decisions for you.
Warren said that many times, her clients will say, “Tell me what to do!”
But it doesn’t work that way.
“I can help you to look at your choices and paths, but clients have to make decisions for themselves,” she said. “I can help you walk through (something) objectively, but we're (here to) help you with tools for conscious decisions.”
Finally, don’t give up on the idea of therapy even if you haven’t found the right fit.
You have to trust your therapist, sometimes with some pretty heavy stuff. That trust is vital, or things won’t surface. Whether it comes down to personality or you just don’t like the office, keep looking for a therapist if you sense something is off, or if it’s not an effective relationship.
"If something I’m suggesting doesn’t resonate, I’m happy to give a referral and won’t take it personally,” Warren said.
Also worth a mention: Many therapists offer to work with people on a sliding scale -- and a lot of professionals take insurance.
Therapy can be cost-prohibitive for people, but that shouldn’t be the case, Warren said.
“And if someone doesn’t have insurance, sometimes another avenue is local universities; and their programs will offer low-rate or free therapy,” she said. “There’s always a way to be able to get it. (At one university in particular), graduate students are supervised by PhDs, so the students are the ones offering therapy, but they’re supported by licensed therapists. It should be available. It shouldn’t be something that’s stigmatized, because our seat of our emotions is part of our body.”
This story was first published in 2019. It has since been updated.