Ep. 173: Things to Know When Starting Therapy

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today I would like to discuss with you a question that comes up quite a lot when I am starting with a new client. So often my clients will say to me "What can I expect during my first session?" I want to share with you what I tell my clients about the things to know when starting therapy.

The first thing I say to my clients is that your brain can change. You may have a disorder that was inherited or triggered by a certain event, but the good news is that by changing your behavior, you can actually change your brain.

The second thing I say is that no matter your mental health struggle, there is a science proven way to treat that disorder. We have evidence based treatments and you can absolutely can get better.

Thirdly, I tell my clients that no matter what struggles they are going through, it is not their fault. This is not something they asked to have happen. We are going to move away from assigning blame and move towards self-compassion.

The fourth thing I would say is that you should not enjoy coming to see me. The work can be really hard and it will mean facing your fears, so if you are enjoying coming to see me then we may need to look at the reasons why. The goal is to actually give my clients the tools they need so that they do not need me anymore.

Finally I tell my clients that they need to be prepared to do the hard work. There will be lots of homework and a lot of facing your fears, but nothing changes if they are not willing to do the work. I always remind them that it is a beautiful day to do those hard things.

If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews!

ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information.

Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Ep. 173 Transcript:

Guys, I am so grateful to have you with me today. I know your time is incredibly precious and valuable, and so I'm so happy to just be with you.

How are you doing? Just checking in. How is everybody? It is well and truly 2021. Lots and lots of happening in the world. Lots and lots of changes. I'm just wrapping my head around them all.

In this new year, I made a deal with myself to spend a little bit more time on social media, which is so funny because I think most people were saying, "No, I think I'd like to spend less time." I'm actually saying, "No, I'd like to spend more time on social media." I hang out a lot on Instagram and on the Facebook group called CBT School Campus or on my Facebook page. I promised myself I'd spend more time there because I'm realizing after last year that I felt really disconnected to you guys and I really wanted to get back into feeling connected. I have loved it.

If you're on Instagram, go over and follow me @kimberleyquinlan, or you can go over to the Facebook group. It's CBT School Campus, or my Facebook is Kimberly Quinlan with CBT School after it.

That being said, I just wanted to let you know that today, I wanted to chat with you about something I have not talked about, but I thought it would be a really great topic. A lot of people in the new year have been reaching out, looking for clinical services – help for OCD, help for anxiety, help for an eating disorder, or help for a BFRB. We love helping people. I have a great staff of seven licensed therapists who all treat the same disorders that I do. It's just been so wonderful to see all the new clients and people coming in really ready to get help.

It really came across my mind in that one of the questions new patients and clients have is: What should I expect in the first session? What does the first session look like? What would you tell me in the first session? I thought this would be a great topic to talk to you guys about.

So I want to share with you the five things I tell every single client or patient in their first session. Are you ready? Let's do it.

Once I have introduced myself and they've introduced themselves and they tell me a little bit about their struggles and what they're wanting to work on, I, at some point in the session, are going to tell them I'll do a thorough assessment. But I will, at some point, either at the beginning or at the end or somewhere, wherever it's most appropriate, share with them one major piece of good news.

1. Your brain can change.

Even if you have a disorder that may be is hereditary, has been passed down from generation to generation, or you have a disorder that was triggered by a certain event, or you have a disorder or a problem that was triggered by societal expectations, such as eating disorders, I always share with my patients and clients the great news, which is you can change your brain. In some cases, for those of us who have anxiety, even though your brain might be firing away, setting off the alarm bells all day long, "Danger, danger, danger," you can change the way your brain reacts to these misfires.

Now, you can't do it by simply trying to change your thoughts. We know that. Changing thoughts sometimes can be very, very important. I'm not going to deny that. It's an important piece of depression work. It's an important piece of, like I said, eating disorder work and so forth for everybody.

But the cool thing here is more importantly, by changing your behaviors, you can change your brain. By changing the way you react to fear, you can change your brain. You can connect parts of your brains that weren't connecting. You can strengthen parts of your brain that is weak or they're not connecting and the connection isn't so strong. Your brain can change, and this is good news. This is great news.

When we found this out in science, we all had a big party because it was really reinforcing that if you do a scan of someone pretreatment of their brain, and then you did a scan of their brain post-treatment, we would be able to see the changes in their brain, and this is really cool.

2. If you have OCD or a phobia, generalized anxiety, panic disorder, social anxiety, health, anxiety, hair pulling, skin picking, and eating disorder, any of these, any of the mental health issues, that there is a science proven way to treat your disorder.

This is good news. I fill you with hope by saying, I understand that what you're going through is really painful, but the good news is, we have scientific evidence to prove that we're on the right track and we're going to be administering the correct treatment.

If you have OCD, the science proven treatment is exposure and response prevention. If you have hair pulling, skin picking or nail biting, the science proven treatment is habit reversal training. If you have depression or an eating disorder, the science proven treatment is cognitive behavioral therapy. If you have health anxiety, you're again going to have a combination of cognitive behavioral therapy with the focus being exposure and response prevention, same goes for phobias, same goes for social anxiety.

All of these, we're going to, let's say the frosting on top is that we're also going to apply science proven techniques, such as mindfulness and self-compassion. This is not woo-woo stuff here. This is science. We have tons of evidence to show that you can get better, that your disorder isn't a mystery. Thank goodness.

Imagine back in the sixties if you had OCD, at that point, or even the seventies, there was no treatment for OCD that was proven. If you had OCD, you were told "Good luck." A lot of disorders had this. If you had hypochondria, if you had agoraphobia, a lot of times back in those years, people said, "I'm really sorry. You have to just accept that your child is going to be this way." But no longer.

2.a We have tons of evidence to show that we're on the right track.

We're using the right treatment and you can be hopeful. Really cool.

3. The struggles you're having were not your fault, you didn't ask for this. You didn't want this. This is not your fault.

The high levels of anxiety that you experienced, that's not your fault. The depression that you're experiencing is not your fault. The fact that you get stuck doing behaviors that you don't want to be doing, but you feel like you have to do, that's not your fault either. This was not your fault.

We're going to work on this treatment journey. We're going to work at not assigning blame to anybody. Mostly you were going to work at being compassionate instead of self-critical. This was not your fault. You didn't ask for this.

Most of the time, people with OCD or anxiety, panic disorder, health anxiety, eating disorders, they say, "I would never wish this on my worst enemy." Again, if you wouldn't wish it on your worst enemy, you wouldn't wish it upon yourself. It was not your fault.

4. If you're starting a journey of recovery, you're in treatment, you're ready to get the work done, here is one thing you should remember: You should not enjoy coming to see me. You should not want to see my face.

I should make you happy. I should make you feel comfortable. I want you to trust me. I want you to enjoy my company. I want you to respect me, but you should not enjoy our sessions together. I know you are probably thinking, "What is she saying here?" But hear me out. The work that I do, and the fact that you're listening to me and hopefully you've listened to me for a while, shows me that you have had struggles with anxiety. This is Your Anxiety Toolkit, so we're talking about anxiety. And the natural response to fear is to run away, is to fight it, is to freeze. Naturally, you are biologically set up to go into fight, flight, or freeze when you have fear.

The treatment that I use, the gold standard science proven treatment is the opposite of that. Treatment with me and with anyone who's trained in these disorders is going to mean that you are going to have to stare your fear in the face. You're going to have to in-session, be doing scary, hard things.

Therefore, you shouldn't want to see me. If you want to see me and the sessions are only enjoyable, I'm missing the point and I'm not being the best therapist I could be to you. I really gauge myself. I tell them not to hold me accountable. I don't want to be giving treatment to people where they're not being forced to grow. Not forced, I shouldn't say forced, because I never make my clients do anything. But what I'm saying is, the session should be focused on this major concept, which is the more you lean into fear, the less power fear has.

And so therefore, I say to my clients, "Please, if at any point in treatment you are looking forward to sessions, let me know, because it means I need to up the ante." I don't want to be diddle-daddling. I want to be effective. I want to be immediate. I want you to get results. I want you to not need me. That's another thing.

4.a I want to treat you.

I want to give you treatment. I want to give you tools so that you don't need me anymore. I want to put myself out of business. I want to train you so well to do this, that you know what I would say and how I would say it and what you need to do.

For those of you who have OCD or a BFRB, you can go and download the courses, ERP School and BFRB school, which is me training you on what I would teach you. The cool thing about the courses is I'm teaching you what I would teach you in session. My goal is to teach you how to do it so that you can do it for the rest of your life, not just for a little while.

I'm beginning to feel like I'm giving you guys a big fat lecture, and I hope that's not the case. I'm getting all empowered here. You can tell I'm super passionate about the first session, and I am. These are key points to treatment. These are key points to providing good care. These are key points to your recovery. So they're really important to me. If you feel like you're getting a lecture, I'm very sorry about that. It's not a lecture. Pulling all the punches here. Sorry, you guys.

So that was a bonus point there for you.

5. Be ready to do hard work.

The patients and clients I have hear me say something often, which is nothing changes if nothing changes. Be prepared to do a ton of homework. The cool thing about cognitive behavioral therapy is there is usually a heavy component of homework. I give homework to all my patients and clients every session. I'll say at the end, "What's your homework? I'll put it in your notes. I'll hold you accountable. We'll check in next week."

Be ready to have an assignment. And then be ready to execute that assignment every single day.

I recently just finished the book on self-compassion for OCD. Yay! I know I'm really excited. The thing that was right at the very front of the book, and I'm giving you a spoiler alert here, which is, be prepared to do this work for around 45 to 90 minutes a day. That is important. Be prepared to do the work. Be prepared to practice because nothing changes if nothing changes.

I know it sucks. I know that's hard truths, but I'm only telling you because I really want you to get your life back. I know a lot of you don't have a therapist. I'm telling you this because I want that to propel you into a journey where you feel really empowered and you understand what is needed so that you can get it done. Knowledge is power here. But then once you have the knowledge, you got to put it into play.

Now you guys know what I'm going to conclude here on, and this is something I should say. There are six points here really. So there's actually two extra bonuses.

6. It is a beautiful day to do hard things.

I say it every day. I say it at every podcast, I say it in every Instagram post. I'm going to leave this podcast episode with that. Be ready to do hard work, but it is a beautiful day to do the hard things every day. I love you all.

I'm going to ask you one big favor. I am early to announce this, but I'm actually just going to announce it now because I want to get the ball rolling.

In 2021, I made a deal with myself because I love doing these podcasts and I love doing all these things. But one thing I noticed last year is, in order for these to really pack a punch, my hope and my goal is to get it to more people. The podcast is free. I don't make any money off the podcast. I don't do promotions or anything like that. The best payout here for me is that I get to help more people.

After research, I'm learning the best way to do that is to get more reviews. The more reviews I have, the more likely someone is to click on the podcast. Once they click on the podcast, then I get to help them. But if they see the podcast and they move past it, then I don't get to help them.

So would you do me a favor? If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. I encourage the feedback. I'd love an honest review so that other people can see that we're doing a good job and that you're getting help so that they can too. If you would be willing to do that, I would be so grateful.

I am actually following what another influencer did, that I love her podcast. She made a deal with her listeners that once she got a thousand reviews, she would give away a free pair of Beats headphones. I was like, "That is a banging idea. Let's do it." I haven't formally announced it, but I am now.

We are going to give away a pair of Beats headphones of your choice of color. Once we hit a thousand reviews, we will randomly take a review and we will put you into the competition, the box. I don't know what you'd say. But even if you've already left a review, you will still go in. So for those of you who've already left a review, thank you, and you'll get put into the drawer.

There we go. You have a chance to actually win something amazing, so we can go from there. Go leave a review.

Have a wonderful day. I love you guys. I appreciate you guys. Again, really, really from the bottom of my heart, thank you for spending your time with me. I know your time is valuable. I just feel super special that I get to spend some time with you.

Have a wonderful day.