61: [Interview] All About Therapy w/ Our Resident Psychiatrist

Join us in welcoming our friend Madeline to talk about all things therapy! Madeline is a physician (MD) and current psychiatry resident. In this episode, she covers several topics related to therapy, including:
-difference between psychologist vs. psychiatrist
-difference between therapists, counselors, coaches, spiritual guides, etc.
-when to see a therapist
-different kinds of therapy (CBT, EMDR, marriage, etc.)
-tips for finding a therapist
-what expectations to have for therapy
-tips for helping your therapist help you
-what therapy ISN'T

We hope you love this episode and find it helpful! A few resources Madeline shared include:
Psychology Today website (finding a therapist)
Alma (another therapist finder)
BetterHelp (online therapy)

CHEERS!

Transcript

0:02

okay? Ready? Okay, I'm ready. Welcome to the Fill Your Cubs podcast. We're your hosts, Morgan and Bailey. Hey everybody. We are really excited for today's episode. We have been trying to bring in guests once a month-ish. Yeah. And today we have our really good friend Madeline, with us. Woo. So yeah, if you're watching on YouTube, you already could see that. But otherwise you can hear here in a second. But Madeline is here. We're gonna talk all about therapy. Bailey and I have been wanting to have Madeline on as a guest, but we're like, she could literally talk about anything. Yeah. I feel like whenever we were brainstorming, like who could be guests, Madeline was like one of the first ones we were like, she could talk about so many different things. Yeah. What should we have her talk about? Yeah. I feel like you just make yourself like an expert in any topic that fascinates you. You just a lot about several different things. I don't know if I'm an expert about everything. I just hyper fixate on a lot of, I could talk to a brick wall about like rocks. Just, I like that. So before we get into the juice of the episode, what's filling our cups? Well, let's fill my cup. Today is of course my water. But then I also have a Dr. Zevia, which I feel like I haven't drank a zevia in actually a really long time. I'm excited for it today. I think it's good. I think it's very cherry and I think it's good. What's filling your cup, Morgan? I have literally the same thing actually. Yeah. I haven't popped open mine. So let's see if we get a asmr. That felt like a good one. It was a really good one. But yeah. So I've got a Dr. Z and I've got my water as well. And then Madeline, what's still in your cup? So Morgan provided me with a spin drift, I think it's the blood orange. Mm-hmm. And a wine glass.'cause I can't drink out of cans. Heck. But also I love the thinness of a wine glass when drinking the same way sparkling water. So, oh, I'm the exact same way. I'll drink everything outta a wine glass es it so much better. Tines outta of wine glass, sparkling water, actual wine hits different, Well, should we move on to our shout out? Yes. Normally we have our own shout out, but with Madeline being on today, we asked her, she had a shout out and she does. What's your shout out Madeline? Well, I just wanted to shout out Alex'cause he's with our 1-year-old son, Felix this evening. I can't believe he's one. Yeah, he's walking around everywhere. Um, yeah, we've just been like ships in the night. This weekend I was on call all day yesterday in the hospital. So he was with Felix and then. I was with Felix this afternoon while he was at Drumline practice and then now he's with Felix this evening. So gosh, you guys are like running around. Mm-hmm. I love it. Absolutely. Well shout out, Alex, thanks so much for taking care of Felix so that we can steal Madeline from you. We love a supportive partner. Yes, absolutely. So let's get into the episode. Yes. Like we said, when we started thinking of guests, you can to mind pretty quickly. But then also I feel like, so Madeline's in our book club and I feel like we get into topics regarding therapy or psychology or just, or just health and different kinds of Like mental, yeah, mental health and Yeah. Things like that. And so obviously we knew that you have. A background in that. But also Bailey and I have mentioned therapy several times on the podcast, but neither of us are in any way, shape or form, experts. Oh yeah. Or we just all only can speak from our experiences of going to therapy. Yeah. But we don't have any of the background knowledge of it and kind of Yeah. So I'm super excited. Yeah. So I feel like it'll be good to kind of hear from a little bit more of maybe like you have a little bit more clinical view or. Hyper fixated view of it, I guess. Yeah. And so you could share some of that with our listeners and we can just kind of talk about it. Yeah. My favorite thing with having Madeline on is that we texted you and we were like, Hey, like what are some topics that you think that you would be good at talking about? And then you were like, here's a couple. And I was reading through'em and I was like, I love all of these topics. It was like sleep, there's therapy, overall health in general, And I was like, I love all of these topics. Yeah. But I felt like therapy was super topical. Yeah. So I was like, we should do that one. And it was the one that I was like, I'd be the most interested in that one for sure. Yeah. And we're always talking about like bettering yourself Yeah. And choosing to get better and not choosing to stay the same. So therapy is a great first step and I'm excited to talk about it. Yeah. Before we, yeah, before we start asking you any questions, anything you wanna No, I preface with. Well, I guess I'll just preface, I mean maybe this leads into like what my actual title and like background is, is that I'm don't consider myself an expert in therapy. Mm-hmm. And I want that to be clear also, in the medical field, we always have to say like, I can't, anything that I say is not like personal medical advice. Oh, yes. Okay. Does it represent the views of my organization? Uhhuh. Oh, okay. Yeah. I need, I need a little bit of a disclosure there. I didn't, I didn't know that. Yeah. Yeah. Makes sense. Yeah. Cool. Well, let's start it off. Can you share a little bit of your background with us? So,, I am a physician. Um, I'm still in training, so that means that I've graduated medical school. Congratulations. Thanks. And I'm almost done with my residency training. So the specialty that I chose is psychiatry, which is mental health. Mm-hmm. And psychiatry is just like the physician form of being a mental health practitioner, and so that means that I can prescribe medications. Mm-hmm. And also we get trained in therapy, and learn about other modalities for treating health, but we, we are able, like I could treat like blood pressure issues and things if I wanted like Hmm. Nothing too outside my scope, but I have all of the general medical training, but I, my specialty is psychiatry. Mm-hmm. And yeah, I have one year left out of four of residency training. Oh, heck yeah. That's so exciting. That Okay. I did it again earlier where I said psychology for sure. So. Okay. Were you ever, just between you and me, were you ever studying psychology or No. No. Okay. I studied biology in college. Okay. That was my major. Yeah. But like psychology, a psychologist is actually, that title is reserved for someone who has a doctorate in psychology. Okay. So a PhD in psychology. Okay. And they do a lot of therapy too. But not all therapists are psychologists. Okay. I gotcha. And the di, like the main difference, like you were saying, is as a psychiatrist you can like prescribe medication? Yeah. So we actually have like the medical school training where psychologists don't have the medical school part of it. Okay. So they've done their like college and grad school and doctorate degrees, PhDs in psychology. Mm. And so they're kind of more experts in they can assess, they can diagnose, and then they do a lot of like therapy and research and stuff in like mental health and yeah, like mental health disorders. Mm-hmm. But they don't do the medic. The biggest difference, the easiest way to distinguish it is psychiatrists like medications. Yeah. Psychologists not medications. However, there are like two states. That you can prescribe medications as a psychologist really, but you have to have a like a year extra of training or something. Oh, that's funny. Okay. Yeah, so I've heard that the biggest difference is usually that psychiatrist can actually diagnose as well. Like I think I went to a therapist one time when I was talking about like, I think I have this, I think I have this. And she's like, well, I can't really tell you yes or no. Mm-hmm. Like, I'm not really, that's not my specialty kind of thing. Like, I can't diagnose you. Is that accurate? Yeah, it's semi accurate. So like someone psychologists actually can diagnose. Oh, okay. Um, sometimes it might be coming from a different perspective, like a clinical diagnosis versus they're both clinical diagnoses, but maybe a, the, a therapist that goes through, like you can become a therapist through like social work. You can become a therapist. There are like, like therapy grad schools. So a master's in like therapy and counseling, a master's in social work. There's a path through that to get to therapy. And, um, you know, they can like do screenings and like, give preliminary diagnoses, but I think like more official, like in your like health chart diagnosis would come from a physician. Mm-hmm. But also, again, that doctorate level degree I do believe can also diagnose as well. Okay. That makes sense. Yeah, that does make sense. I was gonna ask you before we move on into the bulk of, I guess like the, the, the part about therapy still on your background, and we can take this out if you don't wanna share it, but Jared and I were talking today because Jordan from book club that, you know, her brother-in-law, he is chief resident, which you are also mm-hmm. In your group or whatever. Mm-hmm. Just recently like you were awarded that or how does that work? So, yeah, so my residency program is four years and Every year in my, program, they choose one chief resident. And so that just kind of means that I am not necessarily like in charge of the residents. They don't like report to me or anything like that. Mm-hmm. But I have three roles I would say. One is like conflict resolution. So if someone is experiencing like an issue maybe with an attending physician or with another resident, or just like really struggling with someone, ideally they come to me first. I can help them triage the problem. Mm-hmm. See if I, they need me to escalate it to administration or I can give them advice on like how they can solve it themselves or maybe just be a listening ear. Mm-hmm. The other one is very like administrative, logistical. I'm kind of in charge of the call schedule and just sending out guidelines or sending out, expectations for different rotations, things like that. And then the third is I'll help with recruitment. So. I'll interview the candidates that will enter the class next year. So Cool. It's kind of like a mentor instead of like their boss, it sounds like. Yeah. Like I'm definitely not their boss, that's for sure. Yeah. But like I am in leader, I kind of think of myself as a bridge between administration and the resident. That makes sense. Because I am still a resident. Yeah, that makes sense. For sure. So, so this is the part that's rude and we might want to take out if you don't want to talk about it, but Jared and I were like, do they get paid for that or is it like, because I know emotional pay kind of thing? Yeah. Or is it like in title only because mostly we were just talking about, there's like an episode of Scrubs that JD and Elliot are like co-chief residents or whatever, and I think they get paid$10 a month or something. It's like really, really silly because residents, like it's residents are like slave labor in America it feels like. Yeah. So, I get like a little bit of an extra pay boost. It does not translate towards, It kind of depends on the program, but for me, like it wouldn't be worth it to apply for chief resident for the extra amount of money. It's more, I see it's more work than what I'm getting, but I'm okay with that because I'm actually really, really loving the role and um mm-hmm. It's just been so fulfilling to be that mentorship aspect that you're talking about. Yeah. So yeah, it is a little bit of an increase in pay, but it's like, it's like not why you do it. Yeah. Yeah. And, and um, like if you calculate the amount per hour, like it really, like if you were just in it for the money, it would not be worth it. Yeah. That makes sense. I wanna ask why you chose psychiatry out of all of the other kind of mm-hmm. Base options or broad options? I had a really hard time deciding,'cause I was the type of medical student that loved everything. Mm-hmm. And for that reason, I really thought I'd go into primary care because you kind of treat everything Yeah. In primary care. Um. But, and I still really love primary care. I'm actually gonna do a primary care rotation this year just to kind of brush up on some of those skills, uhhuh. But, um, I think what drew me to psychiatry is the, like diversity of presentation. So in primary care there's a lot of, like, when you're kind of treating blood pressure, you kind of do it the same every time, which is good. Like that's how you should practice. Yeah. Um, and every individual person is unique. But what I liked about psychiatry is you could have someone with like schizophrenia and like, everyone's gonna present like so radically different. Oh yeah. I could treat 20 people with schizophrenia and they would all be so different. And that was just really exciting to me. It's like very interesting. That seems stressful to me. It can. It can be at times. But I think what made me think like,'cause I was really just going back and forth was like the fact that like some of this very like severe mental illness, like doesn't scare me off like that. I find it like fascinating and really enjoyable I think is a sign that I need to go towards that. Yeah. I also really liked the idea of being there with people, at their most vulnerable. Mm-hmm. And obviously that can be like really mentally taxing, but it just seemed at the time, and I still believe this, like really important, I really liked the way society was moving towards, you know, I was in medical school during the pandemic and there was a really big like push for mental health treatment and awareness and destigmatization, ugh. Destigmatizing. Yeah. Mental health and. I really saw a bright future within the field and yeah, kind of felt like that's where you needed to be almost. Yeah, and from an evidence-based too, like we're constantly like really improving the field too, and there's a lot of really cool, like new modalities coming up. So it really felt, that's kind of a long way of saying that's how I chose it. Okay. Yeah, that makes a lot of sense. Yeah. Well, you kind of, in your background part kind of already broke down the difference between like psychologists and psychiatrists, but I feel like there are a lot of terms, and maybe there are even more than I'm saying, but like a lot of terms that people throw around and even just now, like therapists versus, well psychologists, psychiatrists we've covered, but like counselor or like life coach or mm-hmm. Spiritual counselors, I feel like. Mm-hmm. Like what, I guess would you, when we're talking today, like kind of lay them out, define the terms that we know what we're talking about, I guess. I would say, for the most part, therapist and counselor can be relatively interchangeable. Mm-hmm. Except for like, you might have like a camp counselor, like obviously Yeah. They're not your therapist, but like, um, there, it's confusing because there's a lot of paths to becoming a therapist. Mm-hmm. Um, but the biggest thing between like getting into therapy is that they are licensed to treat like mental illness, like anxiety, depression. But if you go to someone who doesn't have like one of those degrees to get into therapy, then they aren't, they shouldn't be like treating like anxiety and depression and all that. They could still be some sort of like supportive role. Mm-hmm. Depending on the setting. So like a coach, can be really, really helpful in a lot of different situations. I actually have used a coach before, They're more like goal oriented. So like, I want to improve this part of my life. For me, I actually helped them make my rank list for residency. Oh. I was just having a really hard time, like figuring out like priorities and she really helped me like, figure out, sift through all the programs that I interviewed at and like what I liked about each one. It was, that was like my primary goal. It was very, very goal oriented. That's cool. That makes sense. And so was that just, it was a lot of like just external processing kind of with someone else? Yes. So, well, she would just, she asked me a lot of questions, and she asked me my priorities. And with me, what was really hard is we had, like, I interviewed all virtually because of the pandemic and all of that kind of stuff. And so it just was all muddled in my head. Mm-hmm. So she helped me sort through my thoughts. She wrote down like. Location, priority. What I like about this program versus this program and like long-term goals Yeah. And where it fits in your life now. Yeah. So it was, um, I was just having a hard time making a decision. Mm-hmm. And she helped me make that decision. It wasn't necessarily like I was struggling with, um, like a deeper like anxiety issue. Mm-hmm. I was having anxiety about the decision, but mm-hmm. The, um, I feel like the underlying problem was that I was being like really indecisive and I was overwhelmed. Mm-hmm. Um, with all of the information and less of like, there was something deeper going on, like that was causing me not to be able to make the decision. Yeah, that makes sense. That's cool that you have the experience with a coach. Mm-hmm. Yeah, because that neither of us do. No, that's not even, so I wouldn't even actually know how to like, start to look for something like that. So that's cool that you have firsthand experience with something like that. And so, yeah. And coaching is different'cause like kind of anyone can kind of call themselves a coach. Yeah. I coach. So I feel like the quality is probably, you know, variable depending on, um, who you go to. But, um, therapy is more like protected as far as like licensing, you know, all of that. Mm-hmm. So when would you direct someone to therapy versus something else? Like a coach or, or a psychologist or, yeah, or a psychiatrist. So I would say that if you want medications, then go the psychiatry route. Um, and probably most psychiatrists don't practice like therapy. At least definitely not full time. Mm-hmm. But there are like a lot of people who do kind of incorporate, they'll have like maybe a day a week where they have longer appointment times. Mm-hmm. That they'll have like therapy and medication management. That makes sense. So I would say medications go towards the psychiatry route or, you know. Diagnosis, I think is really helpful. And just making sure that there isn't, one thing that we do in psychiatry is we, we really like to rule out, like someone could have low thyroid and it looks like they're, they're not actually depressed. Mm-hmm. But their thyroid is low. Oh yeah. So, so we're really good about, like, thinking about the whole picture, like making sure there's not something like physical going on too. Yes. Mm-hmm. Yes. So that's where I think it's helpful to have a psychiatrist involved and then, a therapist. I really think that, if you are really struggling with, something in your life, therapy can still be goal oriented. Actually. I think it should be goal oriented. Mm-hmm. I know I painted coaching as that's more like specific or like improving yourself. Yeah. Whereas therapy could be like self exploration, trying to find maybe like. Patterns in your life. Mm-hmm. Whether things that have happened to you or things that you find yourself doing. Mm-hmm. If you feel like you're struggling more with like, anxiety, depression, PTSD, like those kind of things, there's a lot of evidence-based treatments for those things within therapy too. Mm-hmm. It doesn't just have to be like medications for those things. So that's when I go for therapy. The other thing that I would recommend is, asking the therapist too, like, do you like these are, this is what I'm looking for, is this, does this make sense? Like, is that something that you can help me provide or would you point me in a different direction? Mm-hmm. Mm-hmm. I like that. I have a question and we can take this out. And this is strictly like just your opinion. Mm-hmm. But do you think like if someone was going in for like anxiety for example, do you like lean towards medicated options or do you per personally lean towards like non-medicated options? I think therapy is one of the most evidence-based treatments for anxiety. Ah. So, I'm always happy to talk through medications. Mm-hmm. But, my personal practice currently and what I hope to continue to be in the future is to be conservative on medications. Not because I don't believe in them. Yeah. Because I do. But, I think that, well, the evidence shows, we'll talk about depression, is that a combination of, medications and therapy is the best evidence base. Mm-hmm. And if you think about it, there are things that medications can help you with, but there are a lot of things that medications can't. And I think that that should be worked out in therapy. Mm-hmm. So, yeah, that makes sense. Whenever I got diagnosed with a DH ADHD and I had a different psych like. My old psychiatrist had left, I think I got a new job. So then I got a new psychiatrist and I was telling him that the Adderall was giving me like the roids or rayons. It was just like really constricting all my blood flow. So I would get it really bad. And wait, I didn't know that was from the Adderall. I have always had it, but then with the adderal, just, it was triggering it more. It was like exacerbating. Wow. Like my toes never had feeling in them before I got in the shower. I knew it was gonna hurt every single time that like hot water. Interesting. I did not know that it was know that. Yeah. Oh. And then the winter was horrible. My hands and my feet could never get warm anyway, so it like really exacerbate the problem. And so he was like, okay, like let's try to put you on a different medication. And I was only on 20 milligrams a day for extended release for the Adderall, and I think he was gonna try to put me on Ritalin. And he was like, I'm gonna, he said that it was different than the way the Adderall was set up and that it was like in tears or something like that. Like instead of milligrams there was like. You're on level three? I don't, I don't really remember something like that. And I, he was like, I'm gonna put you at the highest one and if you feel like you're like tweaking, let me know. And I was like, uh. I was like, well what do you mean? Like if I feel like I'm tweaking. And he's like, like if you feel like you're kind of like on drugs, I was like, well then maybe we should start a little lower. Instead. I was like, I dunno if I wanna feel like that. Especially if like the 20 works and that's like pretty low for an all day thing. And he was like, oh, you're right, you're right. Let's put you a little bit lower. And I was like, that was crazy what you'd put me at the highest dose or something when I'm telling you like, the 20 works great. I just have blood flow problems. I don't know. That just reminded me of like, like you said, you're gonna be pretty conservative. And he was like, lemme know if you're tweaking. I was like, okay. Oh my gosh. I just love, that was funny. Yeah. Yeah. That's interesting. I mean, I definitely like, I would never characterize medications as bad or harmful. Um-huh. But I like to just look at the whole picture, look at all options. And to me. All treatment options include like diet, exercise, therapy, medications. Mm-hmm. Increasing your social support and, you know, helping people find like a lot of people like don't have like a community or Yeah. Things like, obviously I can't solve all their problems for them, but helping them brainstorm on, you know, what is missing in my life. So that's kind of what I hope my future practice to be. Yeah. And medications are like one piece of the puzzle. Mm-hmm. That makes sense. I was just curious on how you thought about it. Yeah. Mm-hmm. I like that a lot. So if, if someone was looking for a therapist, if someone's listening to this episode and they're like, okay, well maybe I should start therapy. Mm-hmm. But they don't know where to start, where would you suggest they start? So some very practical suggestions. First is if you have like a primary care doctor, not every practice has this, but I think it's really helpful when they do just say like, Hey, like do you have someone that you refer to? Mm-hmm. Like either someone that works at the practice or like, do you have a list of people in the area? I also really like, psychology today.com. So Psychology Today, you can, if you just go to the website, you can filter by location. You can filter a male or female. The most helpful thing is you can filter by insurance. Ah, that's the one. Okay. The, and a lot of them will be, say they take a lot of insurances and maybe they don't, or it's still really expensive with your insurance. So the other thing you can do, which no one likes doing, is calling your insurance. Mm-hmm. And saying, Hey, do you have a list of people mm-hmm. That you're gonna cover? And then another avenue is sometimes people have like benefits through their job too. Oh yeah. I feel like almost every major company these days will give you like six free sessions of online. Mm-hmm. Which, I think that if that is the only way that you can do therapy, it's a really good foot in the door sometimes. I don't think online therapy is the highest quality, but I have heard some people really benefit for it and sometimes they're just really going through something like grief or, you know, they're just really stressed out about something. Mm-hmm. And like all they need is just those six sessions. Mm-hmm. Then that helps them like move forward, but mm-hmm. Makes sense. So those are practical suggestions., It's hard friend referrals is great. Sometimes you don't always like want to go to the same therapist as your friend. Yeah. I think word of mouth is a really good Yeah. Like comforting way to like find a recommendation. Mm-hmm. When I was going to therapy regularly, which I just haven't since getting pregnant, which seems like a weird time to stop, but I was just like, I've got other priorities right now. But when I was regularly going to therapy, I found my therapist through insurance. Mm-hmm. And I didn't have to call them, but my insurance just had like on their website. Oh, nice. It was like therapists offered within your coverage, within your area. Cool. And I was like, oh yes. And so that's how I found my therapist. And then there's a couple people, I know some of you guys are listeners who see that same therapist's office because of word of mouth net. Yeah. Yeah. Yeah. I feel like even if, even if you. Don't go to the same therapists word of mouth. The office at least might have Yeah. Other therapists or whatever. Mm-hmm. Mm-hmm. But yeah, I have struggled to find a thera. I actually, my most recent therapist that I went and saw, I really liked, but her hours just were really hard for me. Oh, I hate that. Yeah.'cause it wasn't her full-time job. It was her part-time job. Oh, okay. And so they would either be like really late on the week weekdays or on the weekends and just in all honesty, which some people like would want that like Yes. Yeah. Because they wouldn't have the flexibility of like taking an hour off work or something. But for me, I'm like, on Saturday I just don't wanna go through all my problems, you know? Yeah. Like that late night is not your, it's not comfort zone. No, it's really not. Yeah. So it's just, yeah. So it, I jived well with her, but didn't love the hours. And honestly it was expensive. Like I didn't realize,'cause I did the thing where I looked at my. Provider, it was UnitedHealthcare and I, I it found in, what's that called? Network in-network providers. But even with them being in network, it was still like your copay was really big. Co was, yeah. High. So I di which I, I like, didn't really realize. Mm-hmm. But you don't really know what your copay is gonna be going in, I feel like. Yeah. Sometimes they'll, the benefits package will say like, specifically for therapy, like, this is what it is. Oh yeah. There's also some therapy practices that have sliding scale, which is really nice. Oh, that's true. Um, for like, and it's like based on your income. Mm-hmm. Yes. Um, if you ever see like students or trainees, it's always gonna be cheaper. Obviously the quality is gonna be, you know, little, little bit less. Mm-hmm. But, but um, that's like a good, you know, foot in the door, but also like they're getting like direct supervision from someone who's like experienced too. So that could be a pro. Yeah. There's lots of different ways to find a therapist, but from like a practical, like, how do I find a therapist? Those are what I normally tell people's. Two step three. Yeah, I like that. Have you ever heard of Alma? I just heard of that recently. Is it kind of like a better help? It's, no, it's like a finder. It's, it sounds like kind of like psychology today. So Alma, Alma isn't the, isn't the therapy source. It's just, it's like a database source. Yeah, yeah, yeah. And so you just put in your preferences or whatever, like female, male, like the, that's cool. Christian or not, you know? Mm-hmm. And then it pulls people for you. Mm-hmm. And I think you can also put in your insurance. But I, but yeah, it A-L-M-A-I think. Oh yeah. I haven't heard of it. Oh, either. Sounds good. Yeah. I will say, whenever I look at, like when you look at your insurance website or OMA or Psychology say, or whatever, I feel like I always see a lot of different types of therapy. Like I see ccb, like do you, or whenever you're doing the little survey of like, what do you want? It's like cognitive behavioral, behavioral therapy. Oh, yeah. Or like marriage or, yes. Mm-hmm. Yeah. But some of them I'm like, it's jargon that like doesn't make sense to me. So I'm, so I'm like, how do I know if I want CBT? I don't know. You know? Like what, what would you say, like with all the different kinds, what would you. So that's a hard question to answer. Mm-hmm. And I honestly, even like, as someone who knows the definitions of all the different types of therapy, when I was looking for a therapist, I was like, I don't know what kind of therapist I want uhhuh. Um, I kind of had some ideas, but, um, to, I, I can give like a brief background of some of the most common types of therapy. Yeah, that'd great. So CBT is cognitive behavioral therapy. It's more of a structured therapy. If, if they're truly going by like the pure CBT, like manual and model. Um, a lot of people will like incorporate CBT into an eclectic mix of lots of different types of therapies. But, um, I really love that. I love CBT. I learned how to do CBT this past year, not no, no means an expert. Mm-hmm. It was like mm-hmm. Two hours a week for the past year. Yeah. Um, but I really like it. I think the structured approach is good. It has some of the best evidence for treating anxiety and depression. Um, there's a little bit of a bias there because it is very structured. It is easier to study than other types of therapy Oh, that are less structured. So that may, that may be why there is the best evidence is because it's a little bit easier to study. But, um, I think it's great for anxiety, depression. I like that it's very goal based. So at the beginning of therapy, you're like, what is my goal? And then as you're kind of going through, you always bring it back down to the goal and you measure progress. And I think it's a really good type of therapy. Then there's, um, EMDR. Oh yeah. Uh, yes. Eye movement desensitization and reprocessing. Okay. Wow. So eye movement is, it was initially started as like you look at this light bar and you look at the lights. There's actually kind of a branch of EMDR where you hold like little buzzy sticks. Yes. So whether it's the lights or it's the buzzy sticks, um, that's kind of supposed to like distract you or, kind of keep you in a rhythm so that when you talk about these traumatic things of your past, it kind of keeps you focused on that and it helps. Regulate, I think your autonomic nervous system a little bit. Oh. And then the reprocessing is, you're reprocessing it. So you're going through things in a very, it's in a safe environment, in a supportive environment. And so you're supposed to talk through it so that, that like fight or flight, especially within something like if you have the full diagnosis of PTSD, it kind of like helps tamp that down. Interesting. So that you're maybe less triggered, like when things come up. So that's, that's the thought behind EMDR and it is a trauma based therapy. I was gonna say, I think it's, I feel like it's, when I've heard about it that it's used in very specific cases and not so much just someone that's coming in like, oh, I'm dealing with some anxious thoughts. Mm-hmm. Yeah. Unless they're directly tied to some kind of PTSD or something like that. Yeah. Okay. Interesting. So, there's a lot of. Branches of CBT that you might run into. I don't think it's necessarily worth it to go through all of them. Like acceptance and commitment therapy is like the third way of CBT. Then you have your, like psychodynamic or psychoanalytic., Those therapies are less structured, more maybe less action based, or less, goal oriented, more about like processing or trying to dive into your past and identify patterns. Mm-hmm. And so, yeah, if, if that's kind of more what you're looking for, that can be helpful. Mm-hmm. And then, there's a lot of therapists that use, so there, yeah, there's like marriage and family therapy. So that's gonna be more like couples counseling or even like family therapy where you bring like children and their parents or siblings Yeah. Or different things like that. DBT Dialectical Behavioral therapy is very closely related to CBT, but it was developed by someone who wanted a specific type of therapy to help with like emotional regulation and interpersonal, and like interpersonal conflict and yeah, identifying your emotions. There's also a couple specific diagnoses that it has been proven to help with as well. One of them being like borderline personality disorder. Mm-hmm. Which, people with that typically struggle a lot with like emotional regulation Yeah. And dealing with like conflict interpersonally. Yeah. And it's a really, really great therapy for that. That's really cool. But it doesn't have to be just for that specific sive. Mm-hmm. But just, yeah, I get what you mean. Mm-hmm. So it sounds like CBT is kind of the most, or what. Someone might run into if they're just like generally like wanting to start a therapy practice when you were talking about, it's like goal structured and stuff. This is something that I've had a hard time with in the past when I've sought out therapy and so well, and maybe I just shouldn't be going to therapy. Maybe I should be going to a coach or something. I don't know. But I've run into where we'll start and they're like, what are your goals for therapy? Mm-hmm. Like, well, I kind of just wanna be like a more normal human, I guess. I don't know, like I, I, it's hard for me to think of mm-hmm. Really specific goals sometimes I can think of. Okay. I just wanna feel less on edge in general or less prone to overwhelm. Mm-hmm. Or less obligated to meet people's needs or mm-hmm. You know, people please that sort of thing. But it's really, really hard for me to like nail down a goal, I guess. So the therapist should help you with that. Yeah. Okay. At least in my opinion. So like, I, I, I could totally see how someone going to therapy is just like, I kind of know, like I wanna feel better. Mm-hmm. Yeah. But I don't know how, and I'm just like, okay, well, like, well, what are things that you typically struggle with? Mm-hmm. And I think identifying a goal is really important, but at the same time, I recognize for the patient or the person seeking therapy, um, might not really know how to put that into words right away. Yeah. So I really think that the first few sessions, should, if they don't have a clear goal, it should be narrowing it down and something that's measurable. Or, and it doesn't even have to be like super, like data oriented, measurable, but I would like to, feel less anxious every time I drive, you know? Mm-hmm. Yeah. Something that's, You can actually think of like a very specific, yeah. Mm-hmm. And it doesn't have, like, that's super, super specific. Yeah. But that would be an example mm-hmm. Of a goal. So, or like, I notice that often when, you know, interacting with my siblings, kind of the same problems come up over and over again. And so you can like, dive into the roots behind that. And then practice like. I wanna learn how to assertively communicate in a kind way. Like that's something that I've worked on with, some of my patients before too. Now what if you go in and you just have so many things that you wanna talk about and so many things that you wanna work on? Because I went to a therapist one time and she asked me my goals and I listen to like six. I was like, I wanna do this, I wanna do this, I wanna be better at this. I'd like to be able to do this. And she was like, okay, well let's start with this. And I was like, okay. But I was like, I don't really know. I dunno, this felt funny, but I was like, everything. So in my opinion, and at least what I've learned is I think it's great if you have a lot of things that you want to work on, because that probably shows a lot of like awareness and like good insight into your own self. Mm-hmm. But it's probably more effective if you pick like one or two things at a time. Mm-hmm. So what I would do in that situation, I would say, okay, like you listed A, B, C, D, and E. Mm-hmm. What would be your top priority and what do you think could maybe we could get to later? Mm. Okay. And so that would be something where I would, again, put it on you, what is most important to you, because it's gonna be more effective if we can stay, like, focused. Not that like, sometimes things come up and you like shift the focus. Like, yeah, we're working on this thing, but,, I actually just, you know, am having a really, really hard time in my job lately. Can we like divert to talking about my job for a little bit here? Mm-hmm. Like, that's fine, but yeah. Mm-hmm. That makes sense. It's funny'cause I feel like I was saying when I've gone to therapy, I'm aimless and you're like, when I go to therapy I have six aims. And like, dude, we're just so different. But I, I've gone to therapists before and they've opened the session and then like. So how are things? And it always feels, that's my least favorite question. Yeah. It like, makes me feel, I don't, I don't know how to respond to that, I guess. Mm-hmm. So I guess what tips would you give someone whenever they are either still kind of shopping therapists or they're trying to like, figure out their flow with a certain therapist? Like what kind of tips would you give them about, I don't know, I guess setting expectations or, or how, how to find the right fit. Is that what you're asking? So I think, I think that what I would want, like any person to know is that it is really hard to offend a therapist. So just keep that in mind. Like, it should be hard to offend a therapist. Yeah. Especially like in that first session, it can, especially if you're going for the first time, you can probably feel like really vulnerable and you don't know like what the right things to say or the right questions are to ask, but. I would do my, do your best to say like, this is what I'm looking for. I may not know exactly what I'm looking for. And then if you've had experiences with other therapists, like, this is what has not worked in the past, or I didn't like this in the past, that's a good idea. Do you think that you could help me in this other way? Mm. Because, it's not gonna be helpful for you if you're like, I really don't like a therapist that, so for me, I really didn't want a therapist that was gonna be like super, super gentle with me. Mm-hmm. And like, oh, you're doing great. Like, yeah, I wanted someone who would just kind of call out, like, not like obviously offend me or like berate me or whatever, but more just like. I don't respond well to people being like, no, no, no, you're totally fine. Mm-hmm. And it's just like, no, I'm, I'm here to be better. So like, um, mm-hmm. Like, be real with me, compliment the things I'm doing well, but also like, help me recognize the patterns of things that I'm struggling with, too. So I need more of a back and forth because, I could talk for six hours about anything as we, as we reference. So I need someone to like, keep me on track and like keep me focused and really like, challenge me. And so that's, what I would say in like my first meeting with a therapist is, is that something that is your style? Mm-hmm. And if not, then we can move on. Yeah. And so if you get like five or six sessions in, it's really not working. Really just be honest, because if you're not on the same page, it's not gonna be effective and you're probably wasting your time and your money. Mm-hmm. Yeah. I definitely like that. I know that every time I go to therapy I have such a problem with. Like politeness in manners. Mm-hmm. And I also have this thing with authority that like I respect all authority all the time, and I'm like, whatever you say is gospel. Mm-hmm. And I know that for me when they're like, so how's your week been? I'm like, good. How about you? I'm like, and I blink on everything, like mm-hmm. Or like sometimes I'm like, I feel like for me, a lot of times when I have looked out for therapy, it's less for immediate things that are happening in my life and more like feelings kind of thing of like, I would like to get better at this. You know, like all my little goals kind of thing. Mm-hmm. Mm-hmm. And so I do feel like it can be hard for me sometimes when I go in, they're like, yeah, so how'd you feel this week? Like, or How's your day going? Because I'm like, it's good. I don't know how to say, it's been a good day. How's your day? Mm-hmm. And then I just feel like sometimes it can be so short. Like one time I had a therapy session that was supposed to be an hour, and after like 20 minutes she was like, well. Sounds like you don't really have anything to talk about today. And I was like, I was like, well, if you would ask me a question, I'd love to, but, but instead, I was just like, okay, yeah, that sounds great. Thank you so much. I'll see you in two weeks. Mm-hmm. And then afterwards I was like, that was pointless. I don't know. Yeah. So I, I think what, I would say that the therapist's weakness in that situation was not just digging deeper. Yeah. And I think just being, and sometimes people, clients, patients can be like, really, really guarded and it's difficult. But, what I wish again, more people knew is that you can just be so honest with your therapist. Mm-hmm. And just be like, you know, like sometimes when you phrase questions like this, I just have a hard time figuring out like what to say. Yeah. What the best thing I learned about therapy this past year when I was being trained in therapy. Is, how valuable it is to work on conflict with the patient and the therapist. Mm. Oh, interesting. And it sounds like so crazy, I think from like a person going to therapist that like, especially people pleasers or people who just like want to like appear like they're doing, they're doing okay all the time. But it actually is the best way to work on conflict, is to doing it with someone who's like a trusted safe source. Well, and you're doing it in real time, right? Yeah. So like if, if uh, patient feels vulnerable enough to say like, Hey, I actually like didn't like the way you asked me that last week, and I just didn't really feel like it was helpful to me. Mm-hmm. I would be like, this is great stuff. Like, let's dig deeper into that. Like what were, because there are two witnesses here. Mm-hmm. We both saw it. Mm-hmm. But when you're talking about like, if you had like an argument with your husband or whatever, it's like the therapist. Doesn't know the husband's perspective. Yeah. They only know your perspective, so That's true. That's interesting. So working on like skills like that, um, like how are you feeling like in this moment? Mm-hmm. Was like one of like, it was just a revelation. I was like, that's really cool, but I could see how, people could just like hide all these things from their therapist because they like want to please them and I want Yeah. They want them to think that they're doing okay. Yeah. So I don't really know how the applicable that is to like someone listening, but like I it's super applicable. Yeah. Yeah. And it's good. I don't know, it's good knowledge or, or background to have from someone who, and I guess if a therapist doesn't respond well mm-hmm. I mean, if you're like, obviously be kind and like don't be break them. Yeah. But if you're being honest and vulnerable and they don't respond well to that, then they're probably not the right therapist for you. Yeah, that makes sense. I like that a lot of being like, just being honest. I think is huge in the beginning. Mm-hmm. Yeah. Mm-hmm. Yeah. Then figuring out how to go from there. Mm-hmm. Yeah. And I guess that's all about finding what fits best. Yeah. I also feel like some of it can be like tailoring your expectations or knowing what to expect, I guess. Oh, yeah. And I know that was one of our like last things that we definitely wanted to talk about or wanted to talk about was like, what expectations make sense to have from therapy. Like what it is versus what it's not, what it can do versus what it doesn't do. Mm-hmm. And I know you have some thoughts on that. Yeah. And so I guess, I just wanna keep reiterating like I'm not the end all be all expert in therapy Right. By any means, but like, just my personal opinions. But that, you know, I have learned from my training and I've seen, you know, from some of my research is that maybe a misconception of therapy is that, it should. Be, like event session. And I, and I have experienced that a lot. A lot of people like go to therapy because they want someone just to vent to. Mm-hmm. Um, and I think it's fine to have like venting moments or maybe the first couple of minutes of a session or if like, you really just need to get out a whole story, but that's actually not what therapy is for. Mm-hmm. Um, I mean that would be just like a really expensive like vent session, right? Yeah. Like when hopefully, you might have like a friend or a sister or whatever that you could vent to, and some people don't have that. But I think therapy is most effective is when you take the information or the problem or the conflict that you're going through and then you try to like learn the skills in how to, move forward, how to better yourself or address like. Some unhealthy patterns or things like that. I'm glad you said that because I feel like a lot of the time in media, popular media, it is definitely portrayed a lot as event session. I don't know, like in the more cheesy ones, I would say there are, there are pieces of media that do a good job with it, but I feel like in some of the like silly movies or TV shows or whatever, when you, you see like the really rich housewife, for example. Yeah. Like there and like, and Jessica said like, you know, stuff like that and it's, I don't know, like some of, some of those blips that come to mind when you see therapy in like a movie or TV show or something mm-hmm. Is a little bit of just like event session or just saying what you want without really any sort of goal. Yeah. And, and maybe that's why so many of us when we go we're, we're not prepared to Yeah. To like target one or two goals or something like that. Mm-hmm. So that's. That's good to know. And it, it's good to know, like, no, you're not the end all be all when it comes to therapy, but you have been submerged in the world for much, far longer than most of us. And you have a lot more, you have a lot more education on it than us, or probably the people listening to it. So it is good to have that insight from someone who is in the world more. Yeah. Absolutely. Is Is there anything else besides like just one giant venting session that people should not expect when they're going to therapy? Yeah, so I have like three or four things that I came up with, like on my drive here. So one of them is that therapy is not always comfortable. Mm. Okay. And it shouldn't, like, you could have if everyone goes through ups and downs, so maybe we're gonna have a session with your therapist. I was like, wow. Like it was cozy. That was great. We talked about so much good stuff that pair. But I, I guess it's kind of a caution, That sometimes you get worse before you get better, especially when it comes to like trauma based or just like reopening old wounds. Yeah. That is like going to be potentially painful at first. A good therapist, will help you open those wounds and then kind of like close them again. Like, ideally like I would try to spend the last like five to 10 minutes of a session just kind of like bringing the topics lighter mm-hmm. So that someone didn't like leave feeling just super open and vulnerable and like bleeding or whatever. Yeah. But like bringing up those kind of things, like you may be like exhausted the first several weeks, but like discomfort is a sign of growth too. When. There can be times where that can go too far. Like you're just always feeling like shit after therapy for like once and months, then like, it's probably not working. But Uhhuh, I think that some people quit therapy when they're like, wow, I did not expect this to be so hard. And, and that's fine. Like if you're not ready for it, you're not ready for it. But yeah, that is something that, I would want people to know. Another, oh, what was my other one? So therapy, isn't like just advice. Mm. So ideally, the therapist is helping you come up. Like, I could, it would be easy for me to be like, you should sleep more, you should exercise more. You should. Not get upset when, things go wrong at your job or whatever, and like, yeah, you should wake up at this exact time, but if it doesn't come from the person themselves mm-hmm. Like I can make so many snap judgements and give someone advice based on like my general experience or my own experiences, but ideally the solutions come from the person themselves. Mm-hmm. Mm-hmm. And that's really hard work'cause you really have to think about like, realistically, if I want more time in my day, I should just wake up at 6:00 AM But if that's not gonna work for you, then that's not gonna work for you. Yeah. Did I explain that right? Like Yeah. Yeah. I think so. And I think that, I think that is one that in some of the popular media sources that do a good job of therapy mm-hmm. They do kind of show. And I do think that's why sometimes it can be frustrating when. You feel like the, the, like when we were saying the therapist's, like not asking questions or whatever. Mm-hmm. Like sometimes I think that their goal is to get you to figure out, you know? Yeah. Like, you ask a question, they're like, well, what do you think the answer, you know, you're right. Like, if it's like constantly that the whole time, that can be annoying, but like there is a reason. It's because like, we don't live inside your brain, you know? Yes. Only you live inside your brain. And so really just trying to like get to the root of issues, um mm-hmm. Yeah. But pointing out like patterns or, you know, some people giving people two different options. Like, some people when they experience, this, they feel like they need to just, I'm just gonna completely make this up. Like, you know, they like retreat into themselves and they hide or whatever. And then some people like, do this. Like, how do you feel like you've been dealing with this? Mm-hmm. And. Because some people don't have the words. So giving them examples but still kind of making the person really think about like, reflect how do I handle these situations? Yeah. Yeah. That makes sense. So if you're going into therapy, expecting them to just like tell you what to do in all the situations in life, like that might be a little surprising that it's often like flipped on you. Mm-hmm. Mm-hmm. Maybe that's why I go wrong with therapy because I feel like a lot of times I go in already, like I have like a know it all complex I think where I'm like, I already know this. Mm-hmm. I already know what my problems are. I already know how to fix them, it's not working, or something like that. Mm-hmm. And I remember one time I went in and I was talking about, we were going on a trip with our family to LA and I was like irrationally terrified of dying on this trip because of the plane. I was really scared about that.'cause planes were going down left and right. Yeah. It was like, yeah, it was during that time, months ago. And there was all the wildfires in California at the time. Oh yeah. And I was like, I'm gonna die on this trip and I dunno how to go on this trip. And like it was all of that. And she was like, well it sounds like you know that it's kind, kind of irrational and like it's all outta your control. So how are like, do you know some coping mechanisms? And I like Liz, it all five or six. She was like, yeah, those are great coping mechanisms. And I was like, yeah, I know, but I'm not doing them. Yeah. Or like I'm doing, like I can tell myself these things. Mm-hmm. But it's not, it's not sticking. So then I would ask like, so what do you think gets in the way, like, you know, the coping mechanisms, what do you think gets in the way of you utilizing these coping coping mechanisms? So that would've been a great question. Instead she was like, well, do you wanna focus on some breathing techniques? And I was like, okay. Sure. And it actually did help a little bit, like in the moment of. Distracting my brain, kind of. So I did enjoy what we got from it, but I think that that's where I always go wrong, is that I want them to be able to tell me, like, how to fix it. Because I'm like, my fixes aren't working. Or like, I don't know. You know what I mean? Yeah. A little bit. I don't know. Yeah. And I think everything is like, nothing is black and white. Yeah. So like, and I want it to be so bad, the things that we've mentioned so far, like you're gonna have a little bit of venting in your therapy. Like Yeah. You're gonna have like, maybe a little bit of advice giving mm-hmm. Or just common practices. You're gonna have sessions where you, they do feel cozy and comfortable and that's great, you know? Mm-hmm. But, if they're like 100% venting, 100%, like they're just telling you what to do without much insight. 100%. Like, never getting below the surface level, or if it's just always uncomfortable all the time, like, that's like maybe a little concerning too. So. That makes sense. Yeah, I like that. Yeah. I feel like saying like, it's not event session, it's not always easy and it's not just advice is Yeah. Like those are good reminders for, and that it's not black and white. Yeah. Yeah. I wish it was. Mm-hmm. Yeah. That part can be frustrating. Yeah. And yeah, if something's not a good fit, like it is okay to bring that up with a therapist. Like you don't just need to ghost them. And I just, I wish more people would feel comfortable, because a, there might be something that's a really easy fix too, that's like, like, oh, like if I just didn't ask in the very beginning, so how are you doing? You know, like, then, then like this person would actually just, if we started it in a different way, this person would actually feel so much more comfortable. Yeah. That would be just like a really easy, like problem solving. Mm-hmm. And then you can continue with that therapist maybe. But also I think it's helpful, to give, feedback, but obviously it's so scary, like, especially for someone who doesn't have a lot of experience being Yeah. A patient. Like it's their first experience. So definitely. So we get it, but I just wish more people would know, like it's totally okay to say like, Hey, this isn't working. Because also if you do go to a group practice, they give, well, like what do you think could be better? Like maybe my colleague over here, I can refer you to her. Mm. And then you could still continue in therapy and maybe you'd have a better experience. Mm. Yeah. I could see that. I think my last question, which was not on our interview page, but I'm just thinking is I know that there people stop pursuing therapy a lot of times because of the wait times. Hmm. Of just like, like if you had a therapist and maybe you weren't clicking with them, they're like, yeah, I wanna refer you to my colleague, but they've got like a three month waiting list. Mm-hmm. Like, I feel like that's kind of a hard thing to be able to navigate and like, it kind of feels like a dead end sometimes and feels like, well, and I'm just not gonna try anymore. I don't know there like any advice on that, yeah. Well, subject, I don't know. I think it, yeah, it can be just really discouraging in healthcare in general. Trying to get appointment. Yeah. Even with like, yeah. Preferred care doctors and stuff. Yeah. So as far as advice, like maybe referring back to the, all the different avenues that we talked about and you might find someone, or I feel like if, you know, the gold standard for yourself is like, I do want in-person therapy, like eventually, but if you do feel like you're struggling mm-hmm. Trying one of the online resources mm-hmm. Better help. Could, I feel like they can typically get you in like pretty quick. Yeah, that's true. They do appointments like as a bridge appointments. Yeah, I don't know like long term how effect, like if you do that and then you switch, but like if you are struggling in the moment, that could be like an easier access point. Mm-hmm. But yeah. Sorry. I, I didn't No, no. It makes sense. I keep, keep just recognizing the flaws in the system. Yeah. They really suck. And I will say, one of the things is that I think ideally therapy, you're not in it for forever. Mm-hmm. Because, and this is a huge part of CBT, that I've learned is that actually they're hoping to teach you skills that are sustainable and applicable to things in the future. Mm-hmm. Not that it's necessarily like a failure or a re relapse if you go back to therapy in the future. Mm-hmm. But, there will be probably some therapists who would disagree with that though. Like some or some patients that think like. I need to be like, I will die, like if I don't go to therapy like every week for the rest of my life. But, that might be a misconception some people have is that you have to be like either super, super broken to go to therapy. Yeah. You have to have a diagnosis of something to go to therapy. That's not true. You don't have to have a diagnosis of anxiety or depression or PTSD, to go to therapy. If something that you're thinking about is less like, of a like distressing or conflict, I would maybe look into the coaching. Just know that the quality like is highly variable. So try to vet that person. Mm-hmm. But yeah, you don't have to be in therapy for forever. And I think ideally I encourage my patients when they're looking for therapists is like, I think you should also. Go like every week or every other week so that, everything's super fresh in your mind. Mm-hmm. And you're not having these like long periods and then maybe you take a break from therapy or you graduate from therapy. Mm-hmm. Yeah. And that's not to say that you can't go back later. Mm-hmm. But it doesn't have to be a forever thing. You don't have to be at your lowest of low to enter therapy. Mm-hmm. You can just want to like work on some things or discover something about yourself. Mm-hmm. Yeah. I like that. Me too. Well, before we close up here, do you have any like last final thoughts you'd like to share or anything that we didn't really cover that you wanted to talk about? No, I think that was actually just it, like my final thoughts, but yay. Yeah. Thanks for having me. It was fun chatting. Thanks for coming on. I like wanna get started into a therapy again? I know. Same. I feel like this always happens whenever we have a mental health episode, I'm like, Ugh, it sounds so nice. I need to get, I wanna get back. Yeah. So hopefully this inspires someone who. Has been thinking about therapy or has tried it before and just felt like you can never find the right fit kind of thing. And that like it is possible and here's some good tips and tools that you can use for yourself. And yeah, hopefully it's inspire someone to try again or start looking at least, or at the very least, feel comfortable offending their therapist.'cause you yeah, you, you won't or you shouldn't at least. Yeah. So yeah. So well thanks everybody for listening. Thanks Madeline for being here. I appreciate it. Thanks for being a guest. Yes. And otherwise we will catch you next week. Mm-hmm. And cheers. Cheers. Cheers. Kind of a clink. Kind of