By: Dr. Anoosha Avni
The first time I went to see a therapist was pretty awful. The therapist began the session with a relaxation exercise (for her benefit, not mine. She didn’t even know why I was there to see her so she had no idea whether or not I needed to learn relaxation techniques). Her phone rang shortly afterwards…and she answered it. Then she took out an apple and started chomping away while I began telling her what prompted me to seek help.
I wasn’t impressed with her, so I didn’t go back after our first (and only) session. I’m grateful I had this experience because it showed me what bad therapy looks and feels like. Something didn’t feel right when she started the session with a relaxation exercise without knowing why I was there to see her. Answering the phone and eating that apple while I was talking just made things worse.
It’s really important to find the right therapist to work with. Research has shown that the most important ingredient for successful therapy is the relationship with your therapist. Techniques are secondary, contrary to what many believe. Since you’ll be sharing the intimate details of your life with a therapist, you want to make sure you choose one who is right for you.
Here are five tips to help you choose a therapist:
Asking family, friends, your family physician, dentist, etc., is a great place to start. If you know people in therapy, ask them if they like their therapist. If they do, find out what it is they like about their therapist and give them a call. Even if you don’t end up seeing that particular therapist, s/he can provide you with a list of referrals, if you ask.
You can call institutes (e.g., Dialectical Behaviour Therapy Centre of Vancouver) to find which therapists are in your area. You can also call professional associations, such as the British Columbia Psychological Association, and ask for a list of referrals.
With all of that being said, don’t choose a therapist who is convenient. You want someone who is good. Good and convenient often don’t go hand in hand. You could have a mediocre therapist who is five minutes from your home, but you could have an amazing therapist an hour away. Why would you settle for someone mediocre?
A lot of people begin their search for a therapist online. Some people use therapist locator services such as counsellingbc.com or psychologytoday.com while others type what they’re looking for in a search engine (e.g., anxiety counselling Kamloops). You’ll probably find at least a few therapists’ names this way. Read their bios and put together a list of the ones you think you might connect with.
People usually have an idea of the gender of the therapist they’d like to work with. Some people are adamant about their preferences for a certain gender while others don’t really care much, as long as the therapist is professional and competent. There’s no right or wrong when it comes to choosing a particular gender. However, I think it’s a good idea to pay attention to which gender you absolutely wouldn’t want to work with. Make a note of that and let your therapist know. It’s valuable clinical information.
4)Call potential therapists.
Once you’ve created your list, call each therapist before you meet with them in person. When you talk to a therapist, you should ask them the following questions. You don’t just want to hear their answers; you want to get a feel for how comfortable you are talking to them:
- Are they licensed? If they say yes, you should still contact their regulatory body just to make sure. Don’t be afraid to ask for their registration number. A therapist with something to hide would refuse to provide this information. It also doesn’t hurt to check with their regulatory body whether they have any infractions against their license.
- Where did they go to school? With this question, you want to make sure they graduated from an accredited program and not an online coaching certificate program.
- What is their specialty? Be wary of generalists. Don’t see someone who specializes in EVERYTHING. Would you go to your family physician if you needed knee surgery or would you go see an orthopedic surgeon?
- What is their training? If they say they’re trained in Cognitive-Behaviour Therapy, find out where (and for how long) they received their training. Was it a one day seminar, a two hour online course, or a six month practicum in graduate school? RUN if they claim they’re an expert in something after a one day seminar or two hour online course.
- Do they have experience working with people with your issues? This is not the same as asking how long they’ve worked in the field. You want someone who has experience working with the issues you’re dealing with.
- If you choose to set up an appointment with a therapist, ask about their fees and methods of payment. If their fee is too high, ask if they have a sliding scale and whether they can lower your fee. If they say no, ask them if they can refer you to someone who works like they do, but charges less. With that being said, cheaper is not always better.
- If you’ve called and left a message and the therapist doesn’t respond within two business days, it’s best to call the next person on your list.
Having said all that, don’t email potential therapists. You won’t get a sense of who they are over email. It’s always best to call them. If you find the therapist arrogant, impatient, or evasive, move on. Obviously, nobody will spend an hour talking to you on the phone, but if they won’t answer some of the above questions over the phone or they insist on a paid consultation, end the call.
Pay attention to how you feel during and after the phone conversation with the therapist. It’s normal to feel nervous during the first call to a therapist (it took me months to call that first therapist!). And it’s pretty normal not to have an immediate “Yes! That’s the one!” feeling, too (although this can certainly happen).
When you go for your first session, pay attention to everything. Is the waiting room neat and tidy? Is the therapist professional? Notice how you feel while you’re talking to the therapist. Do you feel heard when you speak? Does the therapist look bored or irritated when you talk? The relationship with your therapist is essential to the process, so you want to find someone with whom you feel comfortable and safe. Remember that in therapy, you intentionally make yourself vulnerable to another human being, which can be pretty scary.
You may not decide at the first session if the therapist is right for you; sometimes, it can take a few sessions. If you decide the therapist isn’t right for you, let them know what you’re looking for. The therapist may have some referrals that would work better for you. Don’t be afraid of telling the therapist that you don’t want to continue with the sessions. A secure therapist would not take this personally. If they do, you know you’ve made the right choice to stop seeing them.
Of course, the desire not to go back may stem from anxiety about being in therapy. Talk to your therapist about this, too.
If your therapist is behaving unethically or unprofessionally (eating and answering the phone during a session come to mind for me), don’t go back. The search for the right therapist may take some time, but it’s well worth the effort when you find the right one.
By: Dr. Anoosha Avni
Have you noticed that when you’re anxious or worried, you’re more prone to making bad decisions? There’s a biological reason why this happens. The amygdala, which is the part of your brain responsible for emotional regulation, becomes flooded when you’re anxious or worried. This makes it hard for the prefrontal cortex to engage in planning, reasoning, and problem-solving. When you’re anxious, you literally can’t think clearly!
The next time you find yourself feeling anxious and worried and you have the urge to make a decision right away because you think it’ll lower your anxiety, HALT!
What does HALT even mean?
HALT is an acronym that’s often used in addictions counselling, but it can also be used by people who struggle with anxiety or worry. When you’re anxious or worried, you can’t reason, plan, or problem-solve. What you need to do is HALT; that is, immediately stop what you’re doing and pay attention to your basic needs. Are you:
H – Hungry
A – Angry, Anxious
L – Lonely
T – Tired, Thirsty
When you HALT, you become aware of which of your basic needs are not being met in the moment. Sometimes, the onset of anxiety or a sudden decrease in mood can be traced back to having forgotten to eat so your blood sugar levels are off course. Other times, you may be feeling lonely or angry towards someone who has hurt you. And, of course, there are days or weeks when you’re really busy and you don’t get enough sleep.
Being too hungry, angry, anxious, lonely, tired or thirst can make you vulnerable to even more anxiety and worry. When this happens, you’re more likely to make bad choices to get rid of the uncomfortable feelings that result when your basic needs aren’t being met.
Learn to pay attention to your signs of hunger, anger, anxiety, loneliness, tiredness, and thirst. Practice ways to get your basic needs met and resolve any personal issues you have with the people in your life in ways that will enhance your life, not take away from it.
By: Dr. Anoosha Avni
Do you believe that you were born a worrier, panicker, or phobic? Have you been told that worry and panic “run in the family?” The medical establishment and the popular media would like you to think so. You might even think so yourself. For years, researchers studying anxiety disorders thought so, too. The idea that people are born worriers, panickers, or phobics stems from the belief that biology and heredity are at the core of anxiety disorders. Now, the research is showing us that genes and biology are only a small part of the equation.
So what does this mean?
It means that people aren’t born with anxiety disorders. Researchers (e.g., Leonardo & Hen, 2006) have found that the genetic contribution to anxiety disorders is about 30-40%. While your genes may make you more vulnerable to an anxiety problem, it’s not the same as inheriting an anxiety disorder.
So what makes an anxiety problem cross the line to an anxiety disorder? A lot of it has to do with how you relate to anxiety and fear – what you do about anxious feelings and thoughts. How you relate to anxiety is important because it’s something you can control and change.
You can’t change your genes, but you can change what you do when anxious thoughts and feelings come up. And that makes a world of difference when you’re feeling anxious or worried.
Leonardo, E. D., & Hen, R. (2006). Genetics of affective and anxiety disorders. Annual Review of Psychology, 57, 117-137.
By: Dr. Anoosha Avni
“Am I going crazy?”
This is a question I’m asked every week by some of my patients. When people come to see me, they’re experiencing symptoms that are out of the ordinary for them: rapid heartbeat, shortness of breath, stomach upset (peeing a lot or diarrhea), muscle tension, dizziness, headaches, irritability, insomnia, or lack of concentration. Some of my clients have experienced these symptoms for a few months while others have experienced them for many years. My answer is always the same:
No, you’re not going crazy.
The symptoms I’ve just described are typical of anxiety. Anxiety is the body’s natural response to danger. Think of anxiety as an automatic alarm that goes off when you feel threatened. For example, it’s normal to feel anxious or scared when you’re facing a challenging or stressful situation like an exam, a job interview, a presentation, a first date, or a confrontation with a friend, romantic partner, or co-worker.
Anxiety isn’t a bad thing in moderation. In fact, anxiety can help you stay alert and focused, get you going, and motivate you to solve problems. However, if your worries and fears are starting to feel overwhelming and are interfering with your daily life, you may have a problem with anxiety.
If you’re one of millions of Canadians who is experiencing the debilitating effects of anxiety, you’re not alone (though you may feel alone some days). You may think that nobody understands what you’re going through. You may have hidden the anxiety for so long that your family, friends, and co-workers would be shocked to learn that you’ve been struggling emotionally.
It’s important to remember that anxiety problems respond very well to treatment – and often in shorter amounts of time than you may think. While you may feel like you’re going crazy, it’s important to remember that you’re not. Help is out there if you’re ready.
By: Dr. Anoosha Avni
In my private practice, I focus primarily on teens and adults struggling with anxiety. Over the years, I’ve noticed that the majority of my clients who struggle with anxiety all have one thing in common: They’re all nice. Too nice, actually. Their kindness and generosity was making them sick. Literally. They suffered from excessive worry, headaches, shakiness, muscle tension, irritability, sleep difficulties, nausea, and gastro-intestinal problems. Some even developed ulcers.
It was hard for many of my clients to accept that the very qualities they were taught were desirable were the very qualities that were making them sick. They were people-pleasers. They sought approval from everybody. They were afraid of saying “no.” They avoided conflict at all costs, even at the cost of their own health.
Out of the many theories of anxiety, the Hidden Emotion Model is one that a lot of people who struggle with anxiety can relate to. This model is based on the idea that niceness is the cause of all anxiety. People who are prone to anxiety are almost always people-pleasers who fear conflict and distressing emotions such as guilt and anger. They ignore the guilt and anger they’re afraid to express. They do this so well that they’re usually not aware they’re doing it. These distressing emotions resurface in disguised forms as anxiety, panic, worry, and fear.
When you expose the hidden, distressing feelings and solve the problem that’s bothering you, your anxiety will often decrease. Your health will improve and you’ll begin to see the world through a different lens. You’ll find the courage to set and maintain boundaries with others.
Remember: Being nice shouldn’t cost you your health.
By: Dr. Anoosha Avni
Did you grow up hearing that if you do things slowly and carefully enough, you won’t make any mistakes? Or that if you take the time to learn from other people’s mistakes, you can avoid making your own?
As well-meaning as this advice probably was, it likely did you more harm than good. How? By teaching you that it’s unacceptable to make mistakes and not to try anything new because of fear of failure. Research shows that perfectionists fear challenging tasks, take fewer risks, and are less creative than non-perfectionists
No wonder so many people struggle with perfectionism and the feelings of anxiety and fear that can come with it.
So how do you break free from perfectionism and allow yourself to make mistakes? Read on to find out:
1)Determine where your perfectionism comes from.
Many people are afraid to make mistakes because they’re afraid of being criticized or seen as incompetent by parents, teachers, friends, co-workers, or people in general. Were you judged harshly or criticized for making mistakes growing up? Were you singled out in class for making a mistake and ridiculed by your teacher or peers? Think about where your perfectionism comes from. These early childhood experiences can have a lasting effect on you.
2)Examine your beliefs about failure.
‘Failure’ is the other f-word that people don’t like to hear. Examine your thoughts about what would happen if you failed at something. For many people, if they fail at something, they automatically think that their mistake will lead to a catastrophe.
For example, I failed my very first midterm in university. When I received my mark, I automatically thought that I would fail out of university and end up poor and homeless. Obviously, these thoughts were illogical, but that’s the nature of perfectionism – perfectionism is illogical because nobody can be perfect. What are your beliefs about failure? Chances are, they’re probably illogical. Think of an instance when you were scared to fail or make a mistake. What’s the worst thing that could happen if you failed or messed up? What would happen after that? How do you think you’d handle it?
3)Find examples that prove your beliefs about failure are wrong.
I’ve failed more than one test since my first midterm in university and forgotten what to say during more than one presentation. Guess what? I didn’t get kicked out of school and become homeless. More importantly, the world didn’t come to an end. Can you think of any facts that challenge your beliefs about making mistakes?
4)Develop new and healthy beliefs.
One reason why we fear making mistakes is because of the negative or critical reactions of others to our screw-ups. When we see others respond negatively to our mistakes, we learn to think that making mistakes is bad. Yet making mistakes is actually a good thing! How else would you learn? Think about when you were learning how to ride a bike. If you hadn’t fallen off your bike a few dozen times, you wouldn’t be able to ride a bike today.
5)Allow yourself to make a mistake.
So many people beat themselves up for making a mistake that they lose sight of the fact that they’ve just been given a great learning opportunity. You may feel ashamed or embarrassed and tell yourself you’re a loser, an idiot, you’ve let down your family and friends, and think about your screw up over and over again. When you notice yourself doing this, stop and notice the emotions you’re experiencing and where you’re experiencing them in your body. Observe the thoughts going through your mind and label them as just that – thoughts. Thoughts are not facts. Ask yourself what you’ve learned from your mistake and how you might use what you’ve learned in the future.
It’s easy to feel the pressure to excel in a society where our worth is largely dependent on how others evaluate us. Yet if you wish to learn and grow, you need to allow yourself to not only make mistakes, but to also learn how to handle the inevitable disappointment that comes with making them.
By: Dr. Anoosha Avni
In my previous post, I talked about why your anxiety isn’t getting better, no matter how much you exercise, sleep, eat better, or take vitamins or anti-anxiety medication. The reason is because these strategies teach you that anxiety is abnormal and should be avoided or managed in order to live a rich and fulfilling life.
So what are you supposed to do when anxiety starts to creep up on you?
The most important step you can take is to stop struggling against anxiety. Stop trying to control unwanted thoughts, feelings, images, fears, and worries. Stop the relentless tug-of-war. Allow yourself to feel the anxiety just as it is, in its entirety, without judgment, and without beating yourself up. One way of doing this is by practicing mindfulness.
Mindfulness involves paying attention to your present experience on a moment-to-moment basis in a curious, open, and nonjudgmental way. It involves being aware of what’s going on in your mind, body, and heart. Mindfulness is about connecting with yourself and appreciating the richness and fullness of each moment of life (yes, even those anxiety-filled moments!).
Mindfulness can help you learn to experience unwanted thoughts and feelings AND learn how to distance yourself from them so you can keep doing what you want to do, like go to the movies, ride on an airplane, take an elevator, meet new people, etc. Mindfulness can help you live a rich and full life, in spite of anxiety and fear.
When you’re no longer struggling against anxiety, you’re doing three things:
1) You’re acknowledging the struggle itself
2) You’re allowing yourself to experience just how exhausting and pointless that struggle is (and has been and will continue to be)
3) You’re facing how the struggle has kept you stuck in the same place for months, or even years. This can be an incredibly liberating experience
No longer fighting or running away from your anxiety is probably one of the hardest things you’ll ever do. Yet trying to control your anxiety will make your life worse, not better. Practicing mindfulness can help you become aware of what you’re avoiding while allowing you to experience unpleasant thoughts and feelings safely while developing self-acceptance and compassion for yourself.
By: Dr. Anoosha Avni
If you’re struggling with anxiety or worry, you’ve probably been told by well meaning friends, and even some health care professionals, to exercise more frequently, eat better, sleep more, make time each day for relaxation exercises, sign up for yoga, or take vitamin supplements or anti-anxiety medication.
None of these strategies will work in the long run. In fact, they can make the anxiety you’re experiencing worse.
How is this possible? What these strategies teach us is that intense anxiety is abnormal and must be avoided or managed to live a worthwhile life. This is not true. Intense anxiety is not abnormal; it’s not a sign of weakness; and it’s not a sign of ‘bad genes.’
Many people often confuse fear with anxiety. Fear is an intense, present-oriented emotion needed for survival when your health or safety is threatened. When you’re afraid, your body will do many things to make sure you get moving to take care of yourself, like increase your heartbeat and blood pressure, or stop digestion (who has the energy to digest a pie when you’re faced with a black bear?). Sometimes, your body will ‘freeze’ to prevent you from being harmed even further in the face of danger. These are all adaptive responses to fear that will help you take fast action to protect yourself.
Anxiety, by contrast, is a future-oriented emotion. People who are anxious feel a sense of doom, worry, or apprehension about the future. Their muscles become tenser. The bodily changes that accompany anxiety are much less intense than those associated with fear. Yet anxiety can last a lot longer than fear, sometimes for weeks, months, or even years. How is this possible? It’s because anxiety tends to be fed more by what your mind says than by real sources of threat or danger.
Anxiety is not the enemy; it’s the rigid avoidance of anxiety that’s preventing you from living a calmer and healthier life. Research has shown that avoidance is the most important factor responsible for turning anxieties, fears, and worries into serious physical and mental health problems. Avoidance means you’re running away from the people, places, or situations that bring about unpleasant feelings. No amount of exercise, sleep, or anti-anxiety medication will help with avoidance behaviours.
So if the well-meaning advice of your friends, family, and health care professionals isn’t helpful, then what can you do? Stay tuned for my next article on the most important step you need to take to stop struggling with anxiety and start living your best life.