On Twitter, Anonymous asked, “How did you find a good therapist?”
This was specifically in reference to the topics of autism and depression.
So. How did I find a good therapist?
I started by finding a bad one. That was step one, for me. I’m not recommending this, but that was how I began the process. Mostly the things I write in this blog are what-not-to-do sort of things.
The trajectory of beginning therapy went like this:
I was suicidally depressed. Not in a way where I was feeling big, dark emotions, but in the more scary way…the very calm and exceedingly organized kind of way.
I decided that before making any definitive moves, I would try therapy. It felt like a box that I needed to check off, as a result of the whole “exceedingly organized” mindset I was operating with. I was going around for a few years there with a lit-fuse mentality.
I didn’t know how to find a reasonable therapist, so I took out a phone book…I looked at the section for therapists…and I chose the biggest ad on the page. That was my sole criteria. I didn’t know how else to make a decision.
One ad was substantially larger than the others. It looked pricey and well-designed, so I thought, “Well…this one must be doing okay.”
I made an appointment.
Several sessions of just talking ensued. Therapist guy asked the sort of questions one would expect. Background info, family history, current emotional status and so on. I dutifully responded.
The few sessions after that, he did the bulk of the talking. He basically had an idea of what was “really” going on with me. He had theories. He had plans.
Every single thing he said indicated that he had not been listening. There was little doubt that he was a genuinely smart guy…he had a good memory. He absorbed my words, and retained everything I told him. But he wasn’t listening. He very quickly arrived at tidy solutions and tried to work me over to his way of thinking. He knew the direction my life should be taking and I just needed to set aside my ego and agree with him and follow his advice.
Once he arrived at this stage, where he was doing more talking than I was…it was pretty clear that my feedback was no longer relevant. He became increasingly irritated the more I questioned his conclusions. My input would be brushed aside. My irritation grew as well and I switched from sharing personal information to teasing him about his theories.
I would say that by about the fourth session it was pretty clear: we did not like one another. We were power struggling, not talking. The dynamic was poison. I went for a total of six sessions, the last two just to antagonize the guy.
Because his theories were odd- he was Jungian, which I’m sure can be helpful for some folks, but it was a terrible fit for the issues I was there for- I felt like I had not really made a genuine attempt at therapy. I really needed to definitively check that box, put it behind me. So, I tried again with another therapist.
At the time, I was seeing a psychiatrist for the depression. I worked through a variety of meds. I’m pro-meds, but none of them were helping.
When this psychiatrist heard I was without a therapist, she recommended one. I was told this person was new to the field and was a specialist in autism and that, to her colleagues, she had expressed an interest in working with adults on the spectrum.
Also, this was all in the Ozarks. It was made clear to me: I would not be finding a lot of autism specialists around. The psychiatrist was strongly encouraging me to try this person…and my genius pick-the-biggest-ad technique no longer felt super reliable. So, I called and made an appointment.
Once again, there were several sessions going over the sort of questions one would expect. Background info, family history, current emotional status and so on. I dutifully responded.
The therapist then made clear: she did not have a plan. She felt like most theories about autism and how to provide therapeutic support were woefully inadequate and under-studied. She said, “My professors kept talking about autistic kids. And I would ask, ‘What’s happening with adults? How do we best support adults?’ And the professors would shrug and go back to discussing children.”
Feeling like maybe this person was too new and couldn’t help me, I asked her what therapy would look like going forward. She replied, “I don’t know. Let’s figure that out together.”
So, a little frustrating. I wanted all of this to be over with as quickly as possible. But after the first therapist- who had no shortage of easy answers and tidy conclusions- it was a relief to find someone who was intellectually curious and who was willing to say, “I don’t know.”
That alone put some trust into place. I didn’t feel like my words would be ignored and that I would be pressured to accept ideas that did not feel relevant. And, over time, it was clear that she was listening. That put the rest of the necessary trust in place.
Her habit was that she would ask questions. After I responded, she would repeat back my answers and ask, “Am I getting that right?” She very methodically worked through topics, asked questions, and put together a picture of who I was, how my mind worked. As a result, most of her feedback felt relevant and to the point. I never felt like she had a pet theory in reserve that she was just waiting for a chance to crank out.
When therapy started, I did not have any real goals. I wanted to die. I wanted to check off a lot of nagging boxes that my mind had conjured up, things I felt obligated to try before giving up completely. Because this second therapist was a good listener, she eventually figured this out and made establishing goals- authentic, realistic, constructive goals- a goal in itself.
She used my words and thought-habits as tools to build a set of goals that actually made sense to me (since they were predicated on my own feedback), and this made it easier for me to feel like there was a concrete reality to work towards. The therapeutic style that she developed over the course of our discussion, and that was obviously informed by her training: it grounded me to some extent and diminished some of the gravitational pull of suicide.
I’m terrible at advice. Like, “How did I find a good therapist?” The above trajectory is how it played out. I don’t know how to summarize that as advice.
Having said that: I’m going to try an advice thing now. This will suck. This will be inadequate.
Before seeking out a therapist, I would recommend reading a lot of personal stories about autism, by autistics- stories that click with your experiences. Lots of reasons to do this. One reason is that there is a huge amount of racial and gender bias at play when it comes to autism diagnoses. It can be hard for anyone to find the right sort of help, but women and people of color in particular are at risk for under-diagnosis and misdiagnosis. Hopefully reading personal stories will help you have a stronger sense about your own autistic traits, so that you can stand firm about who you are and what sort of therapeutic approaches are right for you.
I mention this because therapists who do not have a very good understanding of autism can often coast on stereotypes. They can be dismissive of the nuanced, varied ways that autistics differ from one another. Reading personal stories can help you feel out a solid framework for these nuances, commonalities, as well as your own unique differences.
Do not hesitate to pre-screen therapists. I randomly chose my first one. Had I inquired, perhaps I would have learned that his background was Jungian. It would have been nice to avoid that situation.
Call ahead and ask about a therapist’s educational background. Ask if they have worked with autistics. Ask if they have worked with adult autistics. Ask if they have worked with depressed adult autistics. Inundate them with questions as a way of determining whether or not this person has any qualities that might make them a comfortable or uncomfortable fit for you.
And then, once you are there, make them earn your trust. Obviously this is easier said than done, but trust is necessary for these situations to work. If it doesn’t feel like that is happening, leave. Feel good about leaving. Don’t look back. There are crappy therapists out there who, intentionally or not, will do more harm than good. But there are also empathetic, talented therapists who can make a positive difference.
This is just me, but when a therapist expresses certainty and confidence and they have a lot of answers- that’s a big pile of red flags.
Humility, the absence of certainty and a willingness to say “I don’t know”: these are better traits. These are part of a more sensitive and humane approach that can ideally help you feel safe as you share your thoughts and personal information.
I know that this stuff is painfully difficult and that me saying supportive stuff doesn’t mean anything. But, I’m saying supportive stuff anyway. I hope you find the help you need. I hope you can find some peace and enjoyment in your life.
I never thought I would get there, but it happened. Probably not even because of me. I know it’s not. My entire existence can best be summarized as a long line of better, stronger people dragging me through an endless series of life experiences that I am unequipped to handle.
Good luck, Anonymous.
