The Process of Therapy
Knowing when and how to engage in professional help for concerns about your mood and how you are coping can be challenging. The following describes the steps involved in this process, including making the decision to seek treatment, how to find an appropriate mental health professional, and what is involved in the therapy process.
When to Seek Treatment:
- When your mood and/or behavioral problems/symptoms are interfering with activities, functions, relationships
- When you regularly experience “toxic” emotions such as guilt, shame, resentment
- When you keep doing the same things expecting or hoping for different results and feel unable to generate new options; leaving you feeling stuck
- When you find yourself dwelling on and/or replaying the same thoughts, conversations, future events— this is called rumination
- Rumination is nonproductive and wears you out!
- When people you trust and have your best interests in mind express concern to you about your mood and behavior
The bottom line is when you have concerns about your mood, your behavior, and your coping, tell someone!
Finding a psychologist, therapists, or counselor:
- Call the National MS Society (800-344-4867) to speak to an MS Navigator about therapists in your community.
- Most state and local psychological associations have online referral programs that list psychologists by zip codes, counties, insurance accepted, and areas of experience (e.g. chronic illnesses).
- Ask your current providers, including your MS care team, your primary care provider, and your OB-GYN (if applicable).
- Check with your insurance company about your mental health benefits and what services are covered. They should be able to provide names of therapists covered by your insurance and located in your area.
- You can ask potential providers what codes they use for billing such as individual, family, and group therapy. Some providers use Health & Behavior codes when medical issues are a primary focus of treatment.
- When at all possible, look for someone who has had experience working with people who have chronic health conditions, especially health psychologists or providers with behavioral health experience.
What does a therapist do?
- Provides support and validation; challenge client as appropriate
- Works with client to identify goals for treatment
- Assists with clarifying sources of stress and identifying symptoms in order to provide appropriate diagnosis and treatment recommendations
- Listens for themes/patterns and assists client in becoming more aware of them
- Teaches research-based strategies for dealing with symptoms (e.g. better sleep habits, anxiety, depression, stress-reduction)
- Focuses on client strengths and skill building as needed
- Encourages and assists with problem-solving as client develops possible solutions and options for their unique situations
- Helps client assess what is working and what isn’t working
- When appropriate, helps client determine how the past may be influencing the present and addresses this as needed
- When client is having difficult following through with recommendations, helps them identify obstacles and strategies for working through and overcoming obstacles
Preparing for your first appointment:
- Make notes about what is bringing you to treatment, including your current concerns, your symptoms, and any changes in your functioning
- Note any previous experience with therapy, including what was helpful and what was not
- Make a list of questions you have about office procedures, such as the best ways to communicate with your therapist, how long you will likely wait for a call to be returned, and how you can reach someone after normal office hours
- You might want to know if the therapist would agree to talking with other people in your life (if that feels like it could be helpful)
What usually happens during a first appointment?
- You will be asked about:
- Your concerns and what brought you to therapy at this time
- Your physical, mental health, work, relationship and substance use history - this will likely include information about any previous treatment, including psychological counseling and/or medication for depression, anxiety, and/or ADHD
- Family members’ mental health and behavioral difficulties
- Treatment goals - what you want to accomplish in therapy
- Frequency and scheduling of treatment sessions
- You may also be asked to complete paper-and-pencil questionnaires about your symptoms, including depression and anxiety to assess the severity of your distress and related symptoms. Be sure to ask the therapist to review the results with you.
- Bring a list of your medications as therapists often want to review them
What is the role of the client?
- Regularly attending and actively participating in sessions
- Completing homework whenever possible and identifying obstacles when completing homework is difficult or doesn’t happen
- Being as open and honest as possible
- Asking questions when you need clarification or experience confusion
- Communicating with your therapist about how treatment is going for you. Keep in mind, a good therapist responds appropriately to feedback
Common treatment goals:
- Reduction of symptoms, e.g., less depression, anxiety; better sleep
- Learning and using new skills, e.g., more effective ways of communicating, stress-management strategies
- Improvement in relationships, especially communication
- Greater self-confidence
- Ability to generate options and solutions
- More effective management of chronic illness symptoms such as fatigue, cognitive changes, pain
- More consistent adherence to disease-related treatments recommendation such as exercise, medications, health eating
What therapist and client characteristics and behaviors are associated with more effective therapy outcomes?
- When the client and therapist are engaged in a working partnership with mutual respect, trust, and effort
- Working on common goals in an atmosphere that encourages curiosity & questions
- Empathy & Honesty
- Regular feedback, including acknowledgement of effort, progress, and successes
- Sense of humor
Books and readings:
Women Who Think Too Much: How to Break Free of Over-thinking and Reclaim Your Life by Susan Nolen-Hoeksema
Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness by Joh Kabat-Zinn
The Wellness Book, The Comprehensive Guide to Maintaining Health and Treating Stress-Related Illness by Herbert Bensen, MD and Eileen M. Stuart, RN, C, MS
Mindfulness for Dummies by S. Alidina
CDs and Podcasts:
Naparstek, Belleruth. Guided imagery for multiple conditions and topics, including stress, sleep, pain, depression, and specifically MS, A Meditation to Help You with MS from Health Journeys
Kabat-Zinn, J. Three series of practice CDs, Guided Mindfulness Meditation available through
Relaxation Program: Find helpful podcasts from Cleveland Clinic doctors on proper behaviors and techniques for relaxation—Clevelandclinic.org/relax
Mind/Body Medical Institute at Massachusetts General Hospital,
Center for Mindfulness at University of Massachusetts Medical School,
Mental health information and help with finding a therapist:
National MS Society (800-344-4867) to reach an MS Navigator for screening of your symptoms and help finding mental health professionals in your area
Mental Health America
MS Connection.org for information on MS and depression, mood swings
Downloadable brochures from National MS Society:
“But You Look So Good”
Depression and MS
Sleep Disorders and MS: The Basic Facts
MS and Your Emotions