When to Call a Therapist

Copyright © 2019 by Robert C. Ciampi

All rights reserved, including the right to reproduce this book, or portions thereof, in any form. No part of this book may be used or reproduced in any manner whatsoever without written permission from the author, except in the case of brief quotations embodied in critical articles and reviews. The views expressed herein are the responsibility of the author and do not necessarily represent the position of the publisher. For information or permission, write counseling@rciampi.com.

This is a work of creative nonfiction. The events herein are portrayed to the best of the author’s memory. While all the stories in this book are true, some names and identifying details may have been changed to protect the privacy of the people involved.

The author of this book does not dispense medical advice or prescribe the use of any technique as a form of treatment for physical, emotional, or medical problems without the advice of a physician, either directly or indirectly. The intent of the author is only to offer information of a general nature to help you in your quest for emotional and mental well-being. In the event you use any of the information in this book for yourself, the author and the publisher assume no responsibility for your actions.

Cover design by Natasha Brown

Interior print design and layout by Marny K. Parkin

eBook design and layout by Marny K. Parkin

Published by Scrivener Books

ISBN 978-1-949165-31-9

First Edition: July 2019; Expanded Edition: September 2021

Contents

 Acknowledgments

 Introduction

Chapter 1 My Story

Why I Believe Therapy Will Help

Chapter 2 How to Get the Most Out of Therapy

Some Practical Tips

Chapter 3 Premarital and Marital Counseling

The Sooner, the Better

Chapter 4 Anxiety

Your Shrinking World

Chapter 5 Depression

Not What Everyone Thinks It Is

Chapter 6 Bipolar Disorder

The Challenges of Widely Fluctuating Moods

Chapter 7 Anger Management

Controlling a Difficult Emotion

Chapter 8 Substance Abuse

Destructive on Every Level

Chapter 9 Stress and Burnout

Know Your Limits

Chapter 10 Problematic Interactions in the Workplace

Where’s the Teamwork?

Chapter 11 Assertiveness Issues

You Can Say How You Feel

Chapter 12 The Complexity of Adolescence

The Toughest Time of Their Lives

Chapter 13 Abuse and Neglect

The Hidden Problem

Chapter 14 Existential Angst

Finding Your Way

 In Conclusion

 Additional Resources

 Notes

 My Vision for You

 Get Help Today

 About the Author

clock.jpg Acknowledgments

I would like to acknowledge to the people listed below, for their help and support in the writing of this book. To the many clients I have worked with over the years who entrusted and shared their life stories with me. Without you, this book could not have been written. My friend and colleague Margaret Debrot, LCSW, Psy A., with her experience as a writer, provided thoughtful insight and encouragement throughout the process of publishing my book. Giacomo Jim Giammatteo, author, who advised me telephonically, by email, and through his blogs on so many areas of the writing and publishing process. Thank you! To Kate Colbert, owner of Silver Tree Publishing, for editing my manuscript early on and for guiding me through the publishing process by email and videoconferencing. You pointed me in the right direction from the very beginning. To the many professional social workers at the National Association of Social Work New Jersey (NASWNJ), who guided me with answers to my questions regarding social-work policy and ethics. Your advice has always been appreciated! To Tammy Smith, LSW, psychiatric social worker, for reading sections of my nascent book and also providing feedback and support in the process. To Natasha Brown, author, for working closely with me in helping to develop my cover design. To the folks at Eschler Editing—Angela Eschler, Chris Bigelow, Michele Preisendorf, Shanda Cottam, and Melissa Dalton—for your expertise in helping me make this vision a reality.

Comfort is the enemy of change.

            —Robert C. Ciampi, LCSW

clock.jpg Introduction

For many, making the first appointment with a therapist is an anxiety-producing experience. Questions like the following come up quite frequently.

• Who do I call?

• Should I get a referral from someone I know?

• How do I know if therapy can help me?

• Should I tell my family and friends I am going to see a therapist or keep it private?

• Am I ready to make this kind of commitment?

• How long will I need to be in therapy?

• Should I work with a male or female therapist?

• Can I trust spilling my feelings to a stranger?

And When should I start therapy? As we will see throughout this book, getting into therapy should start much sooner than later in order to make needed adjustments before relatively benign issues can turn into deep-seated problems.

Therapy can fall under a number of different names: psychotherapy, counseling, marriage-and-family therapy, social work, substance-abuse counseling, licensed professional counseling, coaching, psychoanalysis, and more. Therapists can work with many different populations, such as children and adolescents, adults, substance abusers, the developmentally disabled, the elderly, and forensic clients. And therapists can practice with numerous different modalities, including cognitive-behavioral therapy (CBT), dialectical-behavioral therapy (DBT), solution-focused therapy, eye-movement desensitization and reprocessing (EMDR), family-systems therapy, twelve-step programs, and many other types and subtypes of helping therapies.

A common question people ask is What is the difference between a therapist, analyst, counselor, social worker, psychologist, and psychiatrist? The short answer is that therapy is a category of psychology practiced by mental-health professionals who are trained differently and have specialties and degrees other professionals may not have. For example, substance-abuse counselors are trained in alcohol and drug abuse, social workers and clinical social workers can work in many different settings (i.e., schools, hospitals, mental-health-care facilities, government agencies, etc.), with many licensed clinical social workers also in private practice. Psychologists have a PhD in a defined area of focus and are trained to perform psychological testing in many different settings. Analysts are trained to look at clients’ characterological issues. And psychiatrists are medical doctors who primarily prescribe medication in various settings. With so many therapists and their different titles and roles, it’s no wonder why getting into therapy can be a daunting task.

Getting Started

Where can potential psychotherapy clients find a therapist? Some people start with a search engine like Google to research nearby therapists. Others search specific sites, such as Psychology Today, which list therapists along with a brief biography about their style of therapy and the populations they serve. Word of mouth, or a recommendation from a friend or family member, is another way people learn about a therapist. Another health-care professional, such as a physician, can refer a patient to a therapist if they feel their patient can benefit from the psychotherapy process. And a person can go online to their health-insurance-company site to find an in-network provider. These are the most common ways to connect with a therapist, but ultimately it will be the client-therapist relationship that proves most important. More on this later.

American society has come a long way in diminishing the stigma of having emotional, psychiatric, or substance-related problems and needing to seek help. However, the fear of others knowing that a person is in therapy or the thought that they must have a weak character and cannot handle their own problems is still a barrier for many. And, unfortunately, this barrier may preclude people from embracing the help they need in order to live a more contented and productive life. Fortunately, there are many stigma-free programs being initiated in municipalities, in counties, on college campuses, and elsewhere, with the hope that many more individuals will reach out for help without fear of being labeled for an illness they suffer with in silence.

This book should be read by anyone thinking about calling a professional therapist for help. With therapy, many become aware of how their skewed thinking patterns, poor communication styles, anger, sadness, anxiety, substance abuse, lack of decision-making abilities, and that feeling of being stuck can negatively affect their life. Some problems are multifactorial. For example, a married couple with poor communication skills who argues regularly about their chronic financial problems may find it affects their intimacy. Various issues need to be worked through by the client and therapist to enable the client to make a better decision about any conflicts weighing on their mind. Still other problems are more complex, like substance abuse and eating disorders, where not only would it be beneficial to be in individual therapy but also a higher level of care such as a program, meetings, and possibly medications or hospitalization.

The purpose of this book is to help individuals get a sense of when they should enter therapy. It has been my experience that many people, especially couples, start therapy way too late. Often, with marital counseling, couples decide to enter therapy as a last-ditch effort to save their marriage only to find that the process should have been started much sooner. Those suffering from anxiety wait until they have built compensatory coping strategies for their fear and panic that have stopped working for them. Substance abusers are often in denial and cannot admit they have a problem until they hit rock bottom, which can come in the form of legal problems, loss of employment, loss of relationships, or an overdose. And those suffering from prolonged depression may not have the energy to call a therapist, which can have deadly consequences. It’s bewildering to me that some clients say they will get into therapy or back to therapy when they are feeling better. I have heard clients say, I’m feeling too anxious to come to therapy right now or I’m too sad over my divorce to come in when, in fact, this is the exact time to schedule an appointment. This counterintuitive thinking can get in the way of feeling better. Getting into therapy sooner than later can give many individuals the time they need to work through their issues before those issues become serious problems.

Please note: This book is not meant to assess, diagnose, or treat anyone with medical, emotional, or psychiatric problems. If you are experiencing any serious physical or mental-health issues and believe you need help, either go to your nearest emergency room or call 911 immediately.

Chapter 1

clock.jpg My Story

Why I Believe Therapy Will Help

Years ago, when I was in my twenties, a friend suggested I reach out to a therapist to talk about what was going on in my life or, more aptly, what was not going on. I was stuck trying to figure out what to do and which direction I wanted to go in life. I was anxious, depressed, and confused as to whether I should settle for a secure regular job with good benefits, as my father wanted me to do, or dare to have higher aspirations and build a professional career. After graduating high school, I did not have plans for college, nor did two of my high school buddies. The thought of not having much to do that summer did not sit well with me. One of my friends came up with the idea of driving across the country to see his brother who was in the air force in California and had an off-base apartment, where my friend was planning to stay. Another friend had been invited and joined suit, and then I was invited. After some haranguing with my parents to let me go, the three of us hopped in a Chevy van and were off. For me, this was going to be the beginning of a journey, literally and figuratively, in finding my way in life. I was going to the West Coast to find myself, as did many other seekers in the 1960s and 1970s. The trip itself was wonderful. My friends and I discovered what a vast and beautiful country we have, with so many various points of interest. From the cornfields of Indiana, to the Rocky Mountains in Colorado, the Pacific Ocean and Mohave Desert in California, and the Grand Canyon in Arizona, I knew I would be a different person when I returned home. Several weeks later, back to New Jersey we went, filled with tales about our trip. But after the photographs were developed and the adventures discussed, there was reality staring me in the face again. What did I do now? And where were all those answers I was hoping to find on the trip?

I started working a succession of odd jobs, but nothing meaningful came of it. I did some house painting, helped my girlfriend’s parents set up antique shows in malls, dabbled in some retail work, and was given a job by a relative driving luxury cars off the New Jersey docks into New York City. It was fun for an eighteen-year-old, but it didn’t last long. It seemed like everyone around me was offering suggestions as to what I should be doing, but I had little interest in what they were saying. Eventually I found work as an ID checker in a bar, then graduated to bartender. That job was fun, fast-paced, loud, and high energy, everything a late teens–early twenties person would want. Making quick tips and getting paid under the table wasn’t a bad deal either. Eventually, after doing that for a couple years, I decided to look for work that would earn me a steady paycheck in a less chaotic environment. I found a job in a retail wine store and began to feel as though I had finally landed and had the structure I was looking for: eight-hour days, five days a week, regular paychecks, and an environment where I learned a considerable amount about wine. Here I had a following who would come in to see me for my wine selections, which did a lot for my ego. With friends, colleagues, and customers who became friends, I put together wine tastings, wine dinners, went to tastings with the owners and winemakers of established wineries, and did just about everything that could include wine. I even worked my way up to wine manager—a proud achievement. Life was good. However, I knew deep down that this was not my future. As much respect as I received from the customers and the satisfaction I derived from teaching new staff members about the wine business, there were still issues I wasn’t addressing—issues regarding my parents and family, relationships, self-esteem, anxiety and depression, not to mention the financial struggles that ate away at me incessantly. I developed ailments, such as stomach issues, IBS, what I thought was a brain tumor, anxiety attacks, fatigue, and other conditions that could not be diagnosed by the many doctors I visited. Spiritually, I was lost. I didn’t know who I was and felt I had no purpose. I felt directionless, confused, and was numb to life. This was particularly frightening because, at times, I was sure I didn’t exist at all.

At this point, a friend of mine started to push me toward calling a therapist, but my anxiety increased with the pressure to do so. My friend had already been in therapy and found much of it to be a good experience at a time when he was having increased anxiety after he’d left a position at an Ivy League university and started a family of his own. Therapy, for him, was a way to work through his anxiety and helped him change his angst into more positive thinking patterns. If it had helped him, he believed, it would help me too.

I began searching for a therapist close to home and was amazed at how many therapists there were in my hometown. I jotted down several of the names I found through various resources (there was no Google at the time) and began to call them. With most, I did not make contact directly but was given the option to leave a message. Since my anxiety was so high, I do not remember leaving a message for anyone. I just hung up the phone. But one day I called a therapist on the list and was surprised when someone actually answered the phone. It was one of the therapists at a counseling center who identified the center he was calling from and then asked in a calm and steady voice, How can I help you? Since my anxiety was so high, I was barely able to get the words out. I remember saying something like, Hi . . . I’d like to get some information on the counseling center. I waited for a response. The person at the other end of the phone politely asked me what kind of information I was looking for, which put additional pressure on me to come up with another response. I told the person I was thinking about making an appointment to see a therapist but was not sure how the process worked. The voice told me about the center and said there were several therapists who worked there. He indicated that he was one of the therapists and asked me what had prompted me to pick up the phone and call. Again, I wasn’t sure how much to divulge, and so I just explained how I wanted to find direction in life and was unsure where I wanted to go and how to get there. The therapist felt he could help me and asked if I would like to set up a time to meet. I froze and felt put on the spot, and I remember saying something like, Thanks for the information. I’d like to think about it, and I will call back. In a soothing voice, the therapist said he understood that I may not be ready and that I could call whenever I would like. I ended the call and for a while sat introspectively, wondering if therapy was something I really wanted to pursue. The idea of entering therapy increased my anxiety, but the thought of not trying to work through my issues also fueled that anxiety. I seemed caught in the middle. I let my friend know that I had called but did not feel ready to make a commitment yet. He seemed to understand and congratulated me for at least making the call. I felt like something in me was changing.

Several weeks passed, and I called the counseling center again. This time I did leave a message with my home phone number. Surprisingly, a short time later, the phone rang, and the same therapist I’d spoken to weeks prior was on the line again. After a brief conversation, I was again invited to set up an appointment, and again I indicated I was not ready for that. We ended the call with the therapist reassuring me I could call back anytime. I felt bad I had called the counseling center a second time and still not made an appointment. I was worried the therapist would think I was playing a game and really wasn’t interested in therapy. Now, in addition to my general anxiety, I was beginning to have self-doubts about my sincerity to begin the process. This weighed on me for about another week, when I called a third time and made an appointment for the following week. I felt relieved in the moment, but I obsessed about the appointment and worried about the upcoming session.

I had my first appointment the following week. I felt plenty of uneasiness and trepidation about what therapy was all about, and I was skeptical of what I could gain by going, but the therapist was a kind and gentle person who saw how anxious and depressed I was. He guided me expertly through the process each week, and I always left the sessions feeling relieved and empowered. After some time, I sensed I was becoming a new person. As the sessions continued, I was starting to feel less anxious and depressed. I seemed to have more confidence, was worried less about what others thought, and was starting to make requests of others, something I had never done before. Also, I remember being validated for the progress I had made, which made me feel like a worthy and good person, and in my dull, black-and-white view of the world, I started to see some color.

I liked my therapist because he was real. He was nonjudgmental in his guidance and would tell me when I was going down the wrong path, but he would also reward me for the progress I made. I began to feel that this was the right decision at the right time for me, and those closest to me noticed my growth. As I became stronger, a few people wondered what was different about