Ask A Therapist: On Finding a Therapist and Answering "How Are You?" When the Answer is "Not Good."

Counselors Roy Fisher and Liz Covey answer two questions each month for South Seattle Emerald's "Ask A Therapist." Have a question about a relationship? Wondering about the struggles of being a parent? Others likely have the same questions and Covey and Fisher bring years of professional experience to provide their insights.

This month, readers asked the Emerald how to find a good therapist, and what to do when people ask "How are you?" and you're not doing well and unsure how to answer.

If you have a question, please click here and let us know.* We will select two questions each month to answer. The form requires no email address or identification and is completely anonymous. If you are in crisis or in immediate need of care, please contact Crisis Connections at 1-866-427-4747.

Selecting a therapist can be overwhelming and there are so many. What are some things that need to be considered before finding a fit therapist, such as insurance limits or what to do if you don't drive? How do you set goals when going into work with therapist? People have so many years life experiences. It seems overwhelming to pick up one thing to work on. How do you really rule out what kind of issue people should work on with working with therapist? How do you know if a therapist is a good fit for you?

Dear Reader,

To say that we humans are complex is an understatement. Nonetheless, we go about our everyday lives, navigating roles and relationships and keeping things moving along pretty well most of the time. Until we don't. It's my personal and professional view that everyone will veer off course from time to time (with varying degrees of severity). It's the job of a therapist to be there for folks when that happens. But that seems to leave many, like this reader, wondering: When that happens to me, what can I do to have the best shot at getting the help I need?

First let's start with the bad news. Psychotherapy isn't the practice of medicine, with its decades of study, mentoring, peer-review, and oversight. The open secret is that, though the practice of therapy requires an advanced degree and state-monitored hoops to jump through, there isn't a thorough training to become formed in the profession. Further, there is little to no oversight once the license to practice is obtained. In other words, it's not that hard to become a therapist if you set your mind to it.

Psychologist Alice Miller warned that therapy can cause the patient to be "misled by pseudo-knowledge," and she is right. The nature of the work is delicate and personal. Therefore, finding someone who feels relatable, reliable and trustworthy to you is imperative. This person is charged with creating the conditions in which your private material can emerge and be worked through with compassion, so that past or current knots get a chance to be undone and rewoven into a pattern that better matches your truest nature to date. Since therapy is about getting real and being laid bare (and also because it's hella expensive!), to whom you entrust your deepest goods matters much.

So begin by looking within, and be honest: What has caused things to come up? And to come up now? Learn a bit about what you really need, lack or want. Then, ask around. Find someone you know (or a trusted person of your someone) who can help point you toward professionals who works with that kind of thing, and who is in your area. Then, have a phone or in-person meeting, and give it your all.

Brene Brown's principle that "the thing people most want to see is what we hide" should act in reverse in this meeting. Do not try to impress them. And do not assume this person will be the one. This first meeting is a date, not a wedding. Give it a gut check. If they feel real, and potentially trustworthy, meet another time or two. Then invite your brain and heart to weigh in on whether this person feels legitimately safe, understands how you tick, offers some insight, and is easy to talk to.

Remember above, when I said that we are complex? I'm talking about you, Reader. Your therapy work should reflect that. So find someone who gets you, but also has something to offer. Even if it takes a little work, they are out there. And you are worth the effort.

—Liz Covey

"How are you?" What's the best way to answer this question when life feels rough? When making small talk, I'm okay with answering "fine," but it feels dishonest and shallow to give the same answer to a friend. I know people usually mean well, and care and I'm okay with keeping it real. What I don't want are questions and/or solutions. How can I respond to acknowledge that I'm struggling without inviting more?

We go through so much of our day following a predictable script. "How are you?" "What's going on?" "What's new?" The social contract expects some version of the following responses "I'm fine," "Not too much," or maybe, "Same ole, same ole." But what about when we're not feeling our best, should we still follow the script?

When considering your question, I was left wondering, what is it that you want to get out of the interaction? I'm guessing you want to leave the conversation feeling better in some way. Saying what you don't want (questions and/or solutions) is different than asking for what you do want. For example, do you want support? Or are you looking for someone to vent to? Having an idea of what you're looking for creates a framework for how to speak to your friends. This strategy shifts from the predictable script to potentially a more meaningful dialogue.

When thinking about these conversations, in addition to knowing what we want to get out of them, it is important to reflect on the following: Is this the right place to have this conversation? Is this the right person to have this conversation with? And finally, is this the right time? Dr. Marshall Rosenberg developed a really good template to use when keeping it real:

1. Name the issue, i.e.," Thank you for asking, I've been going through it a little." (Feel free to be as descriptive here as the situation, person, time permit.)
2. Name your feelings, i.e., "I'm struggling," "I'm tired," "I'm sad," "I'm angry," etc. (Naming our feelings connects us to what we're going through and gives others the chance to fully understand.)
3. Name your need i.e., "I need someone to listen," "I need support." (This is the place where you identify what it you're looking for)
4. Make a specific request i.e., "I'm just looking for someone to hear me out without giving me advice, can you do that?" (Framing this as a question gives the other person the opportunity to agree or not.)

Following this template will create a new script and ultimately increase the chances that you'll leave the conversation feeling better. At minimum it will help you identify what it is you're looking for and be able to articulate that to your friends.

I hope this has been helpful.

—Roy Fisher

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Roy Fisher has a BA in psychology from the University of California, Berkeley, and a MA from Pacific Lutheran in Marriage and Family Therapy. With over 10 years of experience in various roles as a clinician, consultant, supervisor, and teacher, Roy has seen the positive impact of engaging others in thoughtful dialogue.

Liz Covey, LMHC, LMT, is a counselor and parent coach with a private practice in South Seattle working in the specialty area of attachment, adoption, and trauma, with children, families and individual adults. She is also a trainer, presenter, and writer on topics related to the changing face of mental healthcare, disseminating ideas and practices aimed at improving mainline therapeutics so that they are more inclusive, holistic, and effective. Liz is a Rainier Beach resident, and the extremely proud parent of two incredible school-aged kids.

*South Seattle Emerald's Ask A Therapist advice comes from professionals and are provided for informational purposes only and do not constitute medical advice and are not a substitute for professional mental health care. By submitting your question, you are agreeing to let South Seattle Emerald use it, in part or in full, and it may be edited for length and/or clarity.