The decision to start therapy can be a courageous and empowering step towards improving your mental health and overall wellness. However, how to find a good therapist for you can be a daunting task. With so many choices available, it’s important to consider several factors to ensure that you find a therapist who meets your unique needs and preferences. Here are some key points to think about when wondering how to find the right therapist for you.
by Counseling and Wellness Center of PittsburghApril 26, 2023 best counselor for me, how to find a good therapist, how to get the most out of therapy, searching for a therapist pittsburgh, what is an lpc vs lmhc vs lcsw, what is lcsw, what is lpc0 comments
How to Find the Right Therapist for You
Determine what type of therapist you need. There are different types of therapists with varying specialties, backgrounds, trainings, and approaches. Some common types are psychologists, psychiatric practitioners, licensed clinical social workers, licensed professional counselors, and marriage and family therapists. It can be helpful to understand all those abbreviations (what’s an LPC vs LCSW vs MSW?) and determine which one aligns with your specific needs. Do you prefer alternative therapies like EFT Tapping or even Reiki? Think about the kind of therapy you are looking for, such as child therapy, teen counseling, couples therapy, or family therapy, and choose a therapist who has experience in that particular area.
Consider your preferences. Consider what qualities are important to you in a therapist. Do you prefer an LGBTQ+ or LGBTQ-Friendly Therapist, a Black Therapist or a therapist of a certain gender, age group, or cultural background? Do you prefer someone who takes a direct or more empathetic approach? Do you prefer someone who specializes in a certain therapeutic modality, such as Cognitive Behavioral Therapy, Mindfulness or Somatic Therapy? It’s important to be clear about your preferences and values to find a therapist who aligns with them.
Think about your therapy goals. Before starting therapy, it’s important to have a clear understanding of what you hope to achieve. Are you looking to manage depression, improve self-esteem, work through trauma, develop coping skills or begin medication? Having a clear idea of your therapy goals can help you find a therapist who has experience in addressing those specific issues and can tailor their approach to help you achieve those goals. For example, if you are struggling with PTSD, finding a therapist who has experience working with PTSD can be beneficial to reaching your goals.
Figure out your budget. Therapy can vary in cost, so it’s important to determine your budget before starting your search. Some therapists offer sliding scale fees based on income, while others may accept insurance. Make sure to clarify the costs and payment options with potential therapists to ensure that it fits within your budget.
Trust your instincts and comfortability. Establishing a trusting and comfortable relationship with your therapist is crucial for successful therapy. Pay attention to how you feel during the initial intake or in session with your therapist. Do you feel heard, understood, and respected? Do you feel comfortable discussing your concerns and emotions with them? Trusting your instincts and feeling safe with your therapist is essential for building a strong therapeutic relationship that fosters growth and healing. Therapy is a collaborative process, and it’s essential to have a good rapport with your therapist to have the best outcomes.
In conclusion, finding the right therapist for you requires consideration of various factors. Finding a therapist who understands and supports your needs is incredibly important for your mental health and well-being. Here at the Counseling and Wellness Center of Pittsburgh, we have a variety of therapists with different specialties and experience. If you need help in finding the right therapist for you, you can contact us for more information and learn how to get connected to a therapist who meets your needs and goals. Don’t be afraid to ask questions, do your research, and take your time in finding the right therapist who will guide you on your journey towards wellness.
Written by Téa Del Rio, Counseling Intern.
by Counseling and Wellness Center of PittsburghApril 24, 2023 fight flight freeze, fight response, flight or fight, freeze response, nervous system, nervous system regulation, road rage, stress responses, sympathetic nervous system0 comments
Welcome back to our stress responses series; what they are and how they manifest in different contexts. So far, we’ve explored the different stages of the freeze response: Freeze in a survival scenario and Freeze during social threats, and in our last blog, you survived the ultimate cage fight with Michael Myers (you’ll have to go back and read that one if you are wondering how you survived). As you are starting to see, stress responses have a lot of overlap and often manifest as a cascade of physiological manifestations with the sole purpose of survival. In this blog post we will look at some relational aspects of the fight response in our daily lives.
The fight or fight responses ebb and flow throughout our daily interactions with others and are dependent on a host of different experiences that prime our brains to react in one way or another. Remember we learned what neurological priming is in the freeze response article. These are natural human reactions to our environments and who we surround ourselves with. Knowing how to recognize them and then developing the skills to re-regulate your body will help you interact with your others in more effective and healthy ways.
For today’s adventure, let’s put ourselves through a common situation that will help you recognize that your fight response has been triggered. It’s a beautiful morning. You have the car windows down, music turned up, and the sun is shining down. There’s not a cloud in sight—you might even have your hair combed back and your sunglasses on. On the road today you see a deadhead sticker on that Cadillac (If you caught it, go ahead and finish out the lyrics, I know it’s tempting), as you take it all in with a smile in your heart.
As you cruise along the highway suddenly you are cut off by a big black pick-up truck with some unsavory bumper stickers. I am sure that in this situation none of my readers would ever start cussing the driver out, calling them every name in the book, waving their fists, nor would you produce one very specific bird; but we all know that person who would (wink, wink).
The reaction just described is caused by a cascade of physiological responses starting with messages from the hypothalamus which sends signals down the spinal cord and out into your body. These messages tell the adrenal glands to release large quantities of norepinephrine which results in increased alertness, arousal, and attention. It constricts blood vessels which prepares your body to respond by fighting or fleeing. During this acute stress response adrenaline and cortisol are also released into the blood stream, and this all happens about 100 times faster than it took you to read this sentence. The combination of these three powerful chemicals coursing through your veins creates a strong physical response that prepares your body for survival. Your nervous system is simply responding to a perceived threat. At the same time this is taking place, you are simultaneously losing meaningful connection to the rational part of the brain that controls impulse, ahhh, so maybe some of you do respond in this way. Pro tip: Now that you know the signs of this fight response you can take active steps to work through it!
Step 1: Recognize the changes occurring in your body.
Step 2: Breathe into it. Deep long breaths, in through your nose and out through your mouth.
Step 3: Notice the shift that takes place in your body and then breathe into that.
Step 4: Ask yourself, “What might be some reasons that this person just cut me off, other than them just being a jerk?” “Maybe they just received a phone call that their child is being rushed to the hospital.” “Maybe they are having a medical emergency.” “Maybe they just lost a loved one.” And yes, maybe they are just terrible drivers and jerks, but WE DO NOT AND CANNOT ACTUALLY KNOW THEIR SITUATION IF WE HAVENT TALKED WITH THEM. So, let’s try to avoid that fundamental attribution error.
If any of this sounds familiar it’s because it is a natural human reaction. It happens when driving and in other social situations like relationships, and you can learn healthy ways to recognize and cope with it. It takes practice and you often start by recognizing what happened after all is said and done. That’s okay. It takes time to learn how to respond to your body and no one will ever do it perfectly all of the time!
If you’re interested to learn more about why humans are more likely to go into fight mode while behind the wheel of a car check out “What Causes Road Rage,” by Wendy L. Patrick, J.D., Ph.D.
by Counseling and Wellness Center of PittsburghApril 19, 2023 fight flight freeze, flight or fight, freeze response, nervous system, nervous system regulation, stress responses, sympathetic nervous system0 comments
Welcome back to this series on the stress responses. Our hope is to untangle the web of confusion that has been spun surrounding these responses, and to demystify this innate human ability that we all possess and experience regularly. Our last two articles explored the freeze response—you learned how to recognize the differing stages of the freeze response in both Big T (catastrophic events), and Little T/social (equally important series of events, that happen over a period of time) experiences, and how to move through it. In this article we are going to explore the fight or flight responses, and what better way to explore this than by examining the classic slasher film, Halloween.
TRIGGER WARNING: This blog may be triggering for some to read. While the situations discussed are hypothetical, and taken from a classic horror film, it may be dysregulating for some readers.
We learned in the first article that yelling obscenities at the TV screen during slasher films is to no avail. The victim’s nervous system has completely taken over and thrown them into the freeze/collapse/flop response. They physically cannot make the conscious decision that we all swear up and down that we would make if we were thrown into that same situation. I hate to be the bearer of bad news, but you likely would not grab any of the number of objects laying within arms reach to protect yourself with. Your body will probably release any functions it’s holding onto to reserve energy for survival. You can use your imagination as to what these functions might be….I see your wheels turning…..what might it be….ahhhh, yes those are the ones. There’s a reason for the saying “You scared the _______ or ______ out of me!” Oh yes, and this can happen during several of the stress responses.
So, while you are screaming and yelling at poor Laurie Strode when she first spots her adversary it is actually YOUR body that has gone into fight mode. Wait a minute Autumn, I am sitting at home on my couch watching a movie, why would I go into fight mode? Great question! It is because the nervous system cannot tell the difference between a real and a perceived threat. As you’re watching Michael stalk after his victims, your body is releasing stress hormones like cortisol, epinephrine, and norepinephrine, which are making changes in your body on a physiological level.
Pay attention next time, how did your posture change? I bet you are sitting more upright and leaning towards the TV. What do your muscles feel like? I’d be willing to guess they are tense. What are your arms doing? Hmmm….they aren’t flailing towards the TV are they? How about your mouth, do you find you need a drink soon after calling poor innocent Laurie every name in the book, and boasting about how you definitely would not run up the stairs, because obviously there’s no way out, or how you would pick up that fireplace poker just there to her right.
Okay, okay, wait a second. So, Laurie is running, and I am sitting on my couch in fight mode? It sounds like she is in flight, while I am in fight, but she is the one in danger, what is going on here? I understand, there are a lot of complicated nuances that go into all of this. So, let’s go to Haddonfield and take on the master of horror for ourselves.
It’s October 31st and naturally you’re asked to babysit your neighbor’s kid Tommy, because you have nothing better to do on Halloween night. You make popcorn, and reluctantly (NOT!) watch a horror flick with little Tommy (Hello foreshadowing), and now it’s bedtime (finally peace at last!). You sent Tommy up to his room to get ready for bed, you’ll be up in a minute to tuck him in.
It is likely that at this point the phone rings taking your attention away from the unlocked back door or open dining room window. You hang up the phone and notice a sudden cold breeze coming in through the dining room window. As you approach the dining room, you see the white curtain blowing in the breeze (Interesting, you could have sworn this window was just closed 30 seconds ago, but instead of listening to your gut and getting out of there, because society teaches us not to trust those gut instincts) you walk over with that confused look on your face, close and lock the window, (ummm too late BTW), and rub your arms in an attempt to warm up. Something feels “off” but you can’t put your finger on it (Ahhh, now look who is making all of those same choices we judged Laurie for), so you proceed to load the dishes into the sink before heading upstairs to tuck Tommy in for the night.
Standing at the sink you hear movement coming from the next room. Your body immediately tenses up, your head turns towards the noise, and you’re holding your breath (you might recognize this as the startle response)—your nervous system is doing its job by scanning the environment for cues of safety or threat. Of course, we are going to talk ourselves out of whatever silly fear we have because for now you can still access the prefrontal cortex (the part of the brain responsible for impulse control, rational thought, decision making, and other higher order thinking functions), but that will not be the case for long.
As we continue to make those Laurie Strode decisions and approach the noise slowly (pay attention here, your body is approaching slowly but your brain is trying to rationalize, they are in conflict, and in about 20 seconds we are REALLY going to wish we listened to our body), your heartbeat is increasing and you can hear it pounding in your ears. This is a natural fear response, one of the very first changes the body makes in a threatening situation is in the inner ear. The muscles in your inner ear shift and blood flow to the ear begins to slow so that it can pick up on low frequency noises that in Paleolithic times meant danger.
As you walk through the dining room entryway you sigh in relief and smile at yourself when the room is empty. Dropping your hands to your side, and shaking your head at your dramatic over reaction, you turn back towards the kitchen to finish the dishes. As you turn, the dining room door slowly swings closed, and Mr. Myers himself is quietly standing in the corner, the knife from the sink in his hand, cocking his head slowly to the side, as he sizes you up.
What do you do? I bet that you are not approaching him in any shape or form, I bet you start to back away, even if that means the only place you can go is up those stairs! Your nervous system takes in this 6’8” man who is holding a knife and staring at you (clearly Mikey is not here to help you finish up the chores before Tommy’s mom gets home), and it goes into the “alarm stage.”
This is when the central nervous system is awakened and causes the body’s defenses to all come online at once. Your adrenal glands release a blast of cortisol, norepinephrine, and epinephrine, which trigger a cascade of responses such as increased heart rate, increased temperature, increased respiration, and increased energy to GET YOU OUT OF DODGE!
At this same time, the prefrontal cortex, that we talked about earlier, peace’s out and goes offline, leaving you very little to NO access to rational thought and decision making—you are in survival mode and your brain stem, limbic system, and central nervous system are in charge. Anything you do next you do not have much control over, no matter how much you thought you would when you were just watching on TV.
So, you turn and run (flight mode), because the first option for survival is to get far away from the threat. You can feel your heart pounding against your rib cage, your breathing is shallow and fast, and you may notice the warm wet stream of urine run down your leg (yea, they often leave this glamorous part out of the movie, but it’s a very real and natural reaction). Directly in front of you is that God-forsaken staircase and diagonally a bit off to your right is the front door (which we both know is locked now anyway.)
Unless you have trained for this, and laid the appropriate neuropathways in your brain, you just might find yourself running up those steps (yep, imagine that, even you are now running upstairs and leading danger directly towards poor little Tommy), but for the sake of argument, let’s give you the benefit of the doubt and say you run to the door (congratulations, the viewers watching you in this scene are cheering you on and not berating you….yet). You reach the door, stretch out your hand, turn the handle, and…. click, nothing happens. It’s locked, and you’re stuck because the 6’8” monster is within arm’s reach.
Pause the movie. Okay, right here the nervous system is going to make a choice and it very well may choose to freeze and flop, so just keep that in mind. In this exploration, your nervous system decides to….FIGHT! As Michael reaches you and grabs your hair to pull you into his massive body, you start to fight. But this is not going to look like how you would imagine it, because remember, you have no access to the thinking part of the brain. As a matter of fact, you have probably “blacked out” or dissociated from your own heroic fight scene. Your memory becomes fragmented, and you only see flashes of images before your eyes. You might only remember random flashes of memory (all of which will likely become future trauma triggers for you).
Your fight scene will likely feel like someone just hit the slow-motion button on you (if you’ve seen Rob Zombie’s Halloween 2, he exquisitely portrays this peritraumatic dissociation during the bathroom scene with Annie), and your pain tolerance has drastically increased, in fact, you probably feel very little as you fight off the Boogeyman. Your brain is releasing excessive amounts of endorphins (the brain’s natural pain reliever) to keep you from being distracted by the pain so that you can continue to fight.
Let’s say that someone came in and saved the day and you are transported to the hospital where you can receive treatment for your wounds. Your nervous system will eventually reach homeostasis allowing your body to calm down. This could take several hours because you have to metabolize all of those hormones and neurotransmitters that were released during your fight.
While this blog post places you smack in the middle of a horror film for the sake of education, the fight response can play out like this in any catastrophic event with some nuanced differences here and there, given the context. For the next blog, we will look at how the fight response shows up in a social context and what you can do to move out of this sympathetic nervous system response and back into the safety of the ventral vagal system.
by Counseling and Wellness Center of PittsburghApril 12, 2023 fight flight freeze, flight or fight, freeze response, nervous system, nervous system regulation, Parasympathetic nervous system, stress, stress responses, sympathetic nervous system0 comments
In our last blog, Stress Responses: What Are They, How Do They Work, and Why I am so Confused!?, you survived a vicious bear attack and learned how the parasympathetic nervous system kicks in when other responses fail. We explored different stages of the freeze response, and how to recognize them. You also learned some pretty cool new words, like neuroception and ventral vagal, that can help you better identify your experience; or just impress your friends with it—it’s really up to you what you do with your new knowledge. This blog post will explore the freeze response in the everyday social-emotional situations that you are more likely to experience.
The Freeze Response in Everyday Social Situations
As we move through our day, we encounter situations that either knock us above or below our window of tolerance. That is just another way to say that we can only cope with so much stress before we “snap,” which kicks us above the window of tolerance, into the sympathetic branch of the nervous system, or we “shut down,” which is the parasympathetic branch of the nervous system.
These are regular occurrences that we often recover from quickly and we can easily slip back into our comfortable little windows. This might look like the copying machine being out of paper, the driver in front of you being too slow, missing an important call, being so busy at work that you missed lunch, your boss getting smart with you and you don’t deserve it because they don’t pay you enough to do all that extra work, you didn’t drink enough water, you stubbed your toe first thing in the morning and that set up your mood for the rest of the day; you all know exactly what I mean, and I am sure that you are thinking of your own experiences as you’re reading this!
But what if you don’t cope with these instances and instead just allow them to continue building up in your nervous system? Hint: Just moving on and trying to forget about it has a paradoxical effect that can make those emotions stronger and more dysregulated. That is why we need to constantly check in with our bodies, listen to what it needs, and honor those needs by healthily discharging that energy.
How long does it take before you tap out, hit the couch, veg out, or lock yourself away in your room? How long before you can no longer deal with people, so you stop answering your phone, and isolate yourself away from the world? This is an example of the freeze response in action. Your nervous system is sending you a message. It is saying “Hey, I am worn out and you haven’t taken care of me all day, so I am shutting us down!”
What if as a child you experienced adverse situations (bullying, invalidation, lack of attunement from caregivers, feeling unseen, feeling unheard, being put down, being yelled at, being spanked, being told “I’ll give you something to cry about,” or left to your own devices during highly emotional times, etc.) that conditioned your nervous system to always be on high alert (there’s that neuroception again, see I told you it would come in handy).
What if as an infant your caregivers were unresponsive or inconsistent when you cried? What if you weren’t comforted and held regularly? Disclaimer: This is a very real phenomenon for children born in 1980s. We grew up in the “let them cry it out” generation. Adults truly believed that responding to crying babies would “spoil” them. Science now knows that our infant brains registered this as a threat to our survival, and that our nervous systems encoded these pre-verbal memories on a subconscious level. So when there is an event in your adult life that the nervous system remembers, it does not come back as an autobiographical memory, it comes back as a reaction.
Okay, so back to adulthood. Let’s say that you and your partner get into an argument over where to eat for dinner. During the conflict, something in your partner’s tone “feels” triggering for you so freeze up. You might not know how to respond, you might not be able to get the words floating in your head to come out of your mouth, you may dissociate, you may feel sad, you might feel a sense of guilt or shame, and you may walk away from your partner and lock yourself in your bedroom. This is the freeze response in action.
But why would my body go into this response if my life isn’t actually being threatened? Well, there are several systems at play here. Remember in the last blog post we said that the nervous system cannot tell the difference between an argument and a bear in the bush. If your system is “primed” (this is a neurological phenomenon in which our brain learns to expect a certain response after a stimulus, or any stimuli associated with it) or if you have experienced any of the situations listed above, your brain is primed to detect this as a threat and shut down. The icing on the cake is that because we are evolutionarily relational beings, meaning that we rely on social connection to survive, our brains register this as social rejection and social rejection was a threat to survival during the paleolithic era and that got handed down to us because it did save lives! Social rejection is registered in the same region of the brain as physical pain (the dorsal anterior cingulate, and the anterior insula). You know exactly what I am talking about if you have ever been chosen last for a team. Yea, that hurts. It hurt as a child and it hurts as an adult, and it’s okay to admit it.
Alright, alright. We get the freeze stuff, and why it’s important. But what about the other responses? Why do I sometimes want to yell and throw things or run away? Great question! Stay tuned for future blog posts that are part of the Stress Responses series. We will explore them all.