Getting Started in Therapy

Intro and Author’s Statement 🌱

I, Eyram Bossiade, interviewed six clinicians at Neurodiversity Empowerment Services (NDES) and asked their thoughts for helpful advice and experiences with getting started in therapy. As an intern who has gotten to know the practice over the past nine months, I felt clinician and NDES founder Sherry Mergner summed up its getting started experience well with the phrase, “All are welcome here.” I hope this post provides a brief snapshot of the getting started process at NDES and showcases its clinicians’ genuine care, acceptance, and thoughtfulness. Thank you, and enjoy!

Step One: Building Trust 🌱

You may have heard that trust and a strong relationship with your clinician are the keys to success in therapy. A critical first step in the getting started process at NDES is naming and normalizing that it can feel like there is a lot of pressure to meet this goal of building trust. Therapy intern Amelia Currie shared that especially when you’re just discovering your neurodivergence or recently out of a crisis, the process of starting therapy can feel “stressful” and “disorienting.” It can be “hard to know what’s up and down,” and you may start questioning yourself, your diagnosis, or feeling that you have to hide parts of yourself to navigate inaccessible or disabling systems to survive. Discovering neurodivergence can feel “freeing” but also “frustrating,” Amelia continued. This is why it is so helpful to find a “neurodivergence-affirming therapist” whom you can trust to validate complex types of struggles and share, as well as model, essential therapy skills. Build trust with your clinician by asking questions. When asked what was helpful for clients to know for building bonds of trust with their therapist, clinician Bailey Woodruff replied being aware that, “Therapists and providers are people with huge life experiences.” “Ask your therapist at least two questions.” Your therapist is someone you are going to be “building community with,” and to do that, you are going to need a connection firmly rooted in “authenticity.” To brainstorm questions, you may ask yourself, “What do I need to know about this person,” or, “What experiences could I ask about or think about with this provider that would help me see how they show up for me?” Your therapist is also going to need to be a “strong container,” Bailey emphasized. “What matters is that you trust this person and feel like you can talk to them about things that really matter.” So that you feel there is “so much space in the therapeutic container” and you “also don’t feel alone.”
Additionally, “Trust your own first impressions.” So often, when we come into therapy and aren’t feeling safe due to our circumstances, it can feel like we need to please people or change ourselves, but doing that can lead to our challenges getting harder as we mask our discomfort and struggles. Asking trust-building questions during an initial consult call or meeting with a therapist is a “huge opportunity to deflate the pressure” in the getting started process, and through practice, it will become easier to use your values and intuition to identify how a clinician can show up for you.

Step Two: Self-Care and Compassion 🌱

As NDES clinicians guide you through the intake paperwork and trust-building steps in starting therapy, focusing on self-care and compassion is the next essential part of beginning the hard and rewarding work of checking in with yourself and navigating your challenges. During our interview, Sherry explained, "Therapy is just as important as self-care.” Both therapists and clients must pay attention to their “mental, emotional, and physical health” during and after therapy sessions. Sherry shared that after years of engaging in therapy and self-care, she continues to find that "I have to keep working on compassion to myself” in order to be a compassionate human being and provider. We receive many messages from society that can cause us to feel resistance towards self-care and compassion. It is really common for our culture to tell people that “taking care of themselves is selfish,” going to therapy is “shameful,” and if they “can’t pull ourselves up by our bootstraps,” then they are worth less. Both clinicians and clients may bring effects of these messages to therapy. Similar to the process of finding a clinician you feel you can build trust with, it is important to work with clinicians who help you heal from the harmful effects of shaming messages. Clinicians who engage in regular self-reflection can use their experiences to display “a deep presence,” Sherry continued. They can role model what it looks like to “affirm vulnerability” and use their “authentic selves” to benefit their clients and promote safety. We all carry different experiences and have different relationships with healing. Amelia shared that it can be helpful to "see clinicians modeling the tools that they are suggesting for clients.” She emphasized that through engaging in intentional self-disclosure (therapists sharing their own relevant experiences), skills modeling, and validation they can help therapy feel more “collaborative.” While promoting and modeling effective self-care in therapy, NDES clinicians share "unconditional acceptance” and "positive regard” through their therapeutic relationship with clients. Amelia and I discussed how, for clients, this deliberate sharing by clinicians can spark “genuine” and “authentic” communication and connection that promotes self-care and community-based healing vital to releasing trauma, internalized ableism (disabling beliefs), and legacies of invalidation.

Step Three: Embracing Difference and Curiosity 🌱

The final part of getting started in therapy at NDES is embracing difference and curiosity. Clinician Lydia Stellwag shared that differences in “labeling and naming conventions” and treatment “frameworks and modalities” can be a lot for clinicians to decide how to navigate with clients. Clinician Yaa Yamoah shared that because providers differ in so many ways, finding a provider “who is the right fit,” “has experience with people with your diagnosis and identity,” and has “warmth and compassion” can at times feel like “dating different therapists.” and take a great deal of “patience.” Clinicians may also differ in their willingness to discuss fit or their openness to sharing that they “may not feel confident with your diagnosis or identity.” Yaa has found it helpful to know that you may tell if you will have a healthy relationship with your provider during your initial intake conversation—or it may take as many as “five sessions” before you know for sure. Clinician Molly Marus-Quinley shared that explaining her specialties and capabilities “in really practical terms with simple language and providing more information to make it [her role] seem less abstract” helps her clients feel less hesitant to share what they want to pursue in therapy. From “verbal processing,” “guidance,” “role-play,” “skills practice,” and “homework” to “a mix of asking questions and practicing skills,” the clinicians at NDES extend curiosity toward their clients’ needs and embrace the inherent value and potential in each difference present in the getting started process. For example, to acknowledge differences in language and disparities in relationships to the DSM-V, Lydia often helps her clients identify and use vocabulary and modalities that feel “most helpful” to them. Through centering and highlighting her clients’ unique experiences, she has found that “Cognitive Behavioral Therapy can feel very dis-affirming” to her clientele. Instead, conversational and check-in-based “relational therapy” and body-based “somatic therapy” with a neurodivergence-affirming clinician helps her clients “shift their perspectives,” reconnect with themselves and their “resilience,” and have the space, flexibility, and time to work on liberation from feelings, thoughts, and memories tied to complicated cycles of shame or other emotions. To acknowledge influences such as race and sexuality, Yaa regularly checks in with her clients to help them explore if looking for clinicians who have experience with their identity and how their “diagnosis fits within their identity” is important to the work they are looking to do in therapy. Illustratively, she shared that when she was upfront about lacking experience with a client’s diagnosis of dissociative identity disorder (DID) during their getting started process, they decided to work on other skills for “one and a half years, and the client asked for a referral to a provider with DID experience when they were ready.”

In short… 🌱

When starting therapy, NDES clinicians shared that it is beneficial to focus on building trust with your provider, normalizing real conversations about self-care and compassion, embracing differences, and being curious about our different needs, identities, and experiences. Again, as Sherry beautifully stated, “All are welcome here.”