Essential Lessons from Years of Therapy: Making Mental Health Support Work for You

By Asma

Read Part 1 of this series here

I have been to a few mental health professionals over the past couple of years and with each experience, I have learnt new ways to make therapy feel more comfortable and less daunting. I have also supported members of my family in seeking mental health support and that has helped me realise a number of ways in which therapy can be made easier. 

I give these tips to friends who are beginning their therapeutic journeys; tips that took me years to work out, because of which I find therapy much easier now. These have helped me seek out a therapist’s support, and I hope you may find some of them helpful too. (Note: I use the term therapist throughout this piece, but it includes other mental health professionals too, such as counselling psychologists and psychiatrists, unless clearly specified.)

1. Use Proxies when Talking about Money

Talking about money can often be an uncomfortable experience, especially with a therapist. I use proxies for income while speaking to a therapist because I don’t want to divulge details of my income. 

An example is saying, “I have enough money to survive without employment for x number of months.” 

Yet another way is to say, “I can afford x product/service comfortably.” 

While this may seem like a trivial concern at first glance, conversations around money can become awkward fairly quickly if you don’t have a plan in mind. 

A therapist once asked me, “How much did you earn at your previous job?” I thought I had misheard his question so I asked him to repeat it, and he did. I was so taken aback and flustered that I told him details of my salary, something I regretted later. I know how to address this sort of situation better now, and wish someone had given me the idea of using proxies for financial information before. In fact, I list out proxies for income/finances for family members who are seeking therapy for the first time to simplify things for them. 

2. Be Clear about Topics You Don’t Want to Delve Into

If you are uncomfortable talking about something to your therapist, you can and should let them know. A mental health professional I went to would often engage in guesswork around my finances and that made me incredibly angry, but I never addressed or acknowledged my anger and discomfort clearly. 

Instead, I tried side-stepping the topic because I was worried about offending him and him being defensive in response, based on similar experiences with him in the past.

All the effort I had to put in to avoid the topic eventually became exhausting and I realised I was censoring myself too much. As I write this, I’m aware I will never know how he would have reacted if I had been forthright about my discomfort. 

I will say this much – if a therapist is unwilling or unable to give you space and avoid talking about issues you are uncomfortable addressing (unless it is absolutely necessary or until you feel comfortable discussing them), it is probably time to find a therapist who will. Life is hard enough; you shouldn’t have to censor yourself around your therapist too.

3. Don’t Let Fear of Medication Deter you from Getting Help

Often, people are so terrified of the prospect of being prescribed and “forced” to take psychiatric medication that they avoid seeking mental health support entirely. You should know that psychologists and therapists cannot prescribe medication for psychiatric illnesses, only a psychiatrist can do so. (To be fair, the only reason that I am aware of this distinction – that psychiatrists can prescribe medication while psychologists can’t – is because I have family members who have sought psychiatric help and have used medication prescribed by a psychiatrist.)

Seeking support for your mental health is stigmatised enough in India, with people asking if you’re “okay” (implying that mental health issues are uncommon and something is “wrong” with you). Add to that the prospect of medication for your *gasp!* brain… clearly, you’re unlike everyone else and you’re dangerous! This isn’t true at all.

(Editor’s note: Hopefully if you’re on The Health Collective, you know that’s not true, and you know that you’re #NotAlone.)

Mental health issues are far more common than we realise. 1 in every 8 people live with a mental disorder, according to the World Health Organisation.  (In 2017, an estimated 197.3 million people had mental disorders in India, according to an article in The Lancet Psychiatry. That number has drastically increased as a result of the pandemic.)

Having said that, there is still a lot of fear surrounding psychiatric medication. I have heard phrases like “addictive”, “dangerous”, “too many side effects”, “weight gain”, and “mind-altering” being bandied about by relatives in response to a family member’s decision to start taking psychiatric medication, as prescribed. 

I’m guessing the relatives warning my family about the dangers of psychiatric medication probably don’t even know the mechanism of action of a simple analgesic like paracetamol, yet my aunts and uncles pop Dolo-650 like candy when they are unwell. And yet, when it comes to anti-anxiety medication or antidepressants, they are suddenly experts. Paracetamol is also medication, it is also a drug, I want to tell them (*cue gasps of shock and horror!*) but somehow, we don’t go around scaring people about it and waxing poetic about its dangers. How does everyone suddenly become an expert when it comes to psychiatric medication?

Unfortunately, several psychiatric practices in India also mention “minimal medication” as part of their features (on their websites). I believe this only serves to further the idea that medication for psychiatric issues is “bad” or “dangerous”. The reason these practices mention “minimal medication” makes sense – they want to assuage prospective patients’ fears. Only time will tell about whether this helps decrease or increase the current fear around psychiatrists and medication.

Anyway, here’s what I’ve learned: Psychiatric medication can be life-changing.

While a fair amount of due diligence and wariness makes sense, we also need to think about how we don’t usually question our other doctors about the medication we are prescribed. All drugs have side-effects, some of which are common and some, rare. 

Which is not to say, don’t ask about side-effects. You should! And it’s well within your rights. The best person to answer your questions about medication you might need to take is a psychiatrist. 

Also know that Psychiatrists don’t always force you to take medication, even if they feel you might need it. And you should feel free to bring up your concerns to them, about possible side-effects, about things like associated weight gain… and anything else. If you feel like your concerns are being dismissed or aren’t being taken seriously, consider getting a second or even a third opinion. Find a psychiatrist you are comfortable with before you start medication because the rapport you share with your psychiatrist will play a big role in shaping your ability to approach them to make changes in dosage/ medication.

‘The D Word’ by Shubrata Prakash was a revelation to me because I wasn’t aware of the dangers of tapering or altering the dosage of psychiatric medication without psychiatric supervision. (For years, I had watched a family member alter the dosage of their psychiatric medication on their own, with unpleasant results.)

4. Prepare Talking Points Before Sessions

I always recommend that people note down talking points before a session with a mental health professional to make sessions easier, especially in the beginning. Talking points that I note down include details like important events that have happened since my last appointment, emotions and behaviour associated with these events, fears I may have, any upcoming events before my next appointment, any revelations I have had or patterns of behaviour I have noticed etc.

(I find it easiest to note down talking points on the notes app of my phone as each day progresses, but you can decide to make your notes anywhere; just remember to take them with you.)

5. It's Normal to Feel Afraid or Worried about Being Judged

Often, talking about certain issues is difficult because of the fear of the other person’s judgement. Unfortunately, this fear doesn’t just disappear because the person you are speaking to is a therapist. I have found it easiest to talk about these issues by addressing my fear of judgement upfront. I let my therapist know that I feel like they will judge me for what I have said and more often than not, their response helps reduce the discomfort and fear I feel.

6. Shortlist your Therapy Essentials!

Before my appointments, I make sure to pack a notebook (to write important points during my session and questions I might have), a packet of tissues, a snack, a water bottle, and a book to read while waiting for my appointment. 

7. Plan a Post-Therapy Ritual for Yourself

Therapy appointments can be exhausting and it helps to plan around them so that you don’t have another meeting right after your appointment. I try decompressing at a café near my therapist’s clinic whenever possible. It gives me the time to write down anything that struck me as important during the appointment, any questions I have, and any topics I’d like to re-visit.

8. It’s completely okay to disagree with your Therapist 

You don’t have to agree with everything your therapist says.

It is completely acceptable to disagree with your therapist and to let them know that you don’t agree with what they are saying. In fact, in my opinion, an important indicator of the quality of a therapist is their ability to listen to opposing opinions without becoming defensive. Having a therapist who is defensive and unwilling to listen to differing opinions or becomes combative, hinders the therapeutic process and is counterproductive. I say this after having had a similar experience myself. Your therapist should listen to you even when you disagree with them. 

If your therapist reacts defensively or combatively when you disagree with them, try bringing it up with them in another session and if they don’t seem to understand or acknowledge their behaviour, it might be time to find a new therapist.

9. You Might Need to Move to a New Therapist

Sometimes, a therapist only serves you for a specific period of time beyond which sessions with them aren’t as beneficial as before. It is okay to move on to a new therapist. However, the prospect of searching for a new therapist can feel daunting. You’ll have to find a suitable therapist, explain your circumstances all over again, and establish rapport with them. The decision to move to a new therapist can be a difficult one to make and staying with your current therapist might seem easier; after all, you have put in so many hours to develop a therapeutic relationship with your current therapist.

Moving to a new therapist might make you feel like all the effort with your current therapist is gone to waste. The effort and time you have put in with your therapist might make you want to continue sessions with them, despite your growing discontentment with them. This reminds me of the sunk cost fallacy. (A sunk cost is an expense that has already been incurred and cannot be recovered. “The sunk cost fallacy is a psychological barrier that ties people to unsuccessful endeavours simply because they have committed resources to it,” according to Investopedia.)

In such circumstances, I find it useful to think of it this way – the effort and time I spent on my sessions with my previous therapist aren’t a waste; they were meant to help with certain issues and for a limited time period. That doesn’t undo all the progress I made then. I needed their support then but it is time to move on now.

10. Out of Office Referral: What to do When your Therapist is on Leave

In case your therapist is going on leave, ask them who you can contact in case of an emergency, as well as what they define as an emergency. 

Ask for referrals to another therapist in case you feel you need support while your therapist is away. A referral letter or email from your therapist to the therapist you plan to go to during the period of their leave can be incredibly helpful as well.

During the last few appointments before your therapist goes on leave, ask your therapist any questions you have about how you might manage in their absence. Think of any upcoming events that might be challenging and talk about them before your therapist leaves. 

11. Talking about Family to a Therapist Doesn’t Make you Ungrateful

While you might not intend to talk about your parents or family to your therapist, family inevitably comes up as a topic in therapy since our families often form a big part of our lives. Talking about your parents or your family to your therapist does not mean you are complaining about them or that you are ungrateful for all that they have done for you. Talking about your family isn’t betrayal either. You need support and in order to get that support, you need to be able to talk about all aspects of your life. 

You do not need to feel guilt or shame about mentioning your discontentment or unhappiness with how family members may have behaved. You can love your family and acknowledge that their actions have hurt you. 

We often imagine these two aspects to be mutually exclusive – you can either love your family (and never criticise them) or you can talk about how they have hurt you (and thus prove your disloyalty for them). We don’t realise that they are in fact not mutually exclusive; both can be true at the same time. 

Also, loving your family ≠ ignoring their faults.

12. Going to a Therapist isn’t a Sign that you Lack Faith in God

Unfortunately, the solution people are sometimes given for mental health concerns (even illnesses) is to pray more. In case you are told something similar, ask yourself these simple questions: What would the person giving you this advice do if they found out they had cancer? Would they sit at home and try praying it away? Or would they get medical treatment in addition to their prayers? The answer to that question is quite telling, isn’t it. 

The brain is an organ, just like any other. It requires just as much medical care and intervention as any other organ in the body. And faith can co-exist with a belief in evidence-based systems of support.

Views expressed are personal. Do share your comments or feedback with us right here or on social.

Do consider supporting The Health Collective via our buy me a coffee (grab some extras!) or Razorpay. (Any amount helps us to commission content, subsidise the #Grief listening circles we've kicked off, and more in the offing)