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Hotline Roundup: Alyssa Petersel (LMSW) Edition    

Hotline Roundup: Alyssa Petersel (LMSW) Edition

On April 14, The Local Optimist Hotline welcomed its second guest host, Alyssa Petersel, the founder and CEO of the therapy matching service, MyWellbeing. It was wonderful chatting all things therapy with her, and a big thank you to everyone who submitted questions.

For those of you who weren’t able to participate, we put together this special edition of the Hotline Roundup to share some of Petersel’s most helpful responses.

If you have any other questions for the Hotline, you can always text them to us at 310.299.9414.

How does one even start searching for a therapist? I don’t even know how to start! Even when it comes to credentials, I'm not sure what is best for me. 

When thinking about what you might want to look for in a provider, do some brain dumping around the people you turn to when you have a problem or are hurting. Why do you turn to them? Are you seeking input on action to take? Do you want something that’s going to “solve” the problem? Or do you want a safe space for someone to hear you and affirm what you are going through? 

It’s okay if you don’t know! But the first step is to think about when you've had a positive experience processing something talking to someone... how do you think they reacted, and how did that make you feel? That helps inform what type of care you may want to look for. 

For example, CBT is a lot more concrete. You’re more likely to have exercises or to identify a goal with a provider and work through it in an interactive, goal-oriented way. 

Psychodynamic therapy is more a warm, affirming relationship with a therapist that hears you and will reflect patterns back to you, but the outcome isn’t that you leave with a list of things to do. Instead, you have insights, light bulb moments, and realizations about your behaviors. 

Suppose you feel like you're having physical manifestations of stress and anxiety. In that case, you may want to try working with a mind-body practitioner to help relieve physical symptoms—things like: hypnotherapy, EMDR, or anyone who practices mindfulness. You might know this is right for you if you have tremors, digestive issues, headaches, difficulty focusing, quickening heart rate, etc. Or suppose you're feeling physically uncomfortable but can't point to a triggering event that might have happened to make you feel that way. In that case, you might not have the vocabulary to articulate that, so starting therapy with your body to have catharsis or stress release may work for you. 

When I try to search therapists, some are in-network, out of network, take reimbursements, sliding scale, there are so many options and I’m not sure what’s best for me. Where do I start? 

Regarding who to find and where to start, you need to know your options and what you can afford. Try to see if your insurance will cover therapy. If you have work-provided insurance, it may be worth calling the insurance to ask for behavioral health therapists that you can work with. 

It’s worth expecting that you may need to call a few times - usually, they give you five names at a time. Set the expectation for yourself that there may be a few rounds of that. If money is the main factor, take advantage of the resources you have.

If you don't have insurance or you want a smoother experience, MyWellbeing will be helpful. You have more options outside of insurance, but you are paying more per session. If you have the budget to spend $100-300 per session, you can get a lot more specific in terms of different combos of specialty areas. 

For example, if it's important, your provider is BIPOC, utilizes CBT strategies, and specializes in sexual trauma. The more layers you layer on, the more helpful it is to search outside of insurance, but there are also options to look within tighter parameters. 

With regard to out-of-network benefits, it can be very intimidating to learn what they are and use them. You'll want to learn from insurance what your deductible is (how much you need to spend for benefits to kick in); it can make a big difference. It's something to explore while keeping your options open. Tech platforms and services can help you with reimbursement (apps like Reimbursify chargers $2 per reimbursement for them to do all the paperwork for you). 

Also, when thinking about a provider, sometimes we're tempted to choose someone who is like us or makes us comfortable. Something to keep in mind is that you’re very likely to benefit from working with all sorts of people throughout different stages of life. 

If you identify as a woman and you have a difficult relationship with men, one possibility is that it may be worthwhile to start with a woman with who you feel safe. It may be cool in the future to think about what it would look like to work with someone in that identity group (in this case: men) and know that by license and training, they won't hurt you.

How do I know my therapist is the right fit for me? 

This is a hard one because sometimes therapy particularly takes a little bit of a leap of faith. You may not come out of every session like, “oh my god, I’m a new person!” Commit to 3-6 months of therapy before deciding whether therapy is working for you. 

I would look out for scenarios like: do you find yourself in situations that would have usually caused you to react in a certain way, and are you reacting that way now? Do you have more space between trigger and reaction? Do you have tools in your back pocket for that triggering moment? Be it: breathing exercises or remembering something your therapist might have said. Eventually, those situations might trigger you less, but that can be a long process. 

At an absolute baseline, you want to feel like they are remembering what you are saying in sessions and that you have the space you need to unpack and process. Some self-reflection questions worth thinking about are: Are you in it for the long haul? Are you interested in a safe space to grow over time? Is there something very specific you're hoping to get out of the sessions? 

If you're comfortable, it's powerful to have these conversations with your therapist. If you are having doubts, that is super normal. I’ve had so many doubts - Is it me? Them? Am I making progress? Am I talking about the right things? - If you can talk to them about it, it might help you decide! Did their response resonate? Afterward, did you feel: dismissive, isolated, exclusive, shamed? Or do you feel glad you talked about it? 

You may not have an immediate, actionable outcome. But even if the conversation itself felt aligned and now you feel like you can have more uncomfortable conversations in your life, that’s a good sign. The outcome is to brainstorm together what that means. 

When is DBT or CBT more appropriate than just traditional "talk" therapy?

Certain therapy techniques and methodologies are studied to be especially helpful for particular things. That said, there are exceptions to every rule. So always consult with a professional about your specific circumstances. A combination of things may be a good fit. 

All of that said, CBT is helpful towards something specific. Like sleeplessness or anxiety.  With CBT, you are generally learning tools and perspectives to apply, in an action-oriented way, to reduce symptomatology (like reducing effects from your thinking or feeling for anxiety). So if you’re having ruminating thoughts, CBT helps reframe those thoughts of “I’m not enough.”

More traditional talk therapy may help you understand where those thoughts come from and help you to build awareness about them. Then, over time it may reduce the frequency of those thoughts by giving you space to breathe and space to be understood. 

DBT is helpful for things that are behaviorally rooted, like personality disorders, substance use, EDs, OCD, etc. Not to say the other techniques are helpful for those things, but DBT is helpful as a combo of action-oriented modalities with mind-body awareness or learning to slow down any impulsive reactions. This can bring more awareness into the life cycle of triggering events or thoughts all the way through to the behavior. 

As always, if you're not sure, talk to a professional with that question in mind! A great place to do that is during consultation calls. Think about what things are most top of mind for you and talk to someone who practices all three of those modalities and ask them why they think that particular technique would be helpful for you and see what they say. Whoever’s response resonates with you as something you're seeking, or craving is who you can start with. 

Keep the conversation going by commenting on this story below. You can also connect with us about whatever’s on your mind by texting The Local Optimist Hotline at 310.299.9414.