{image via pinterest; originally found at The Quilted Castle}

Despite having been one half of hundreds of therapeutic relationships over the years, I work hard to remember that for many individuals who sit down in my office, this could be the first time that they’ve entered into this experience.

I recognize that making the decision to go to therapy isn’t an easy one. It usually comes on the heels of deciding that something significant in one’s life isn’t working as she thought it should. Sometimes what isn’t working is incredibly profound, and touches nearly all aspects of her life. Or it may seem on the surface to be minor, trivial even – but hits on such valued parts of an individual’s life so as to push them into my office. Whatever the reason that someone decides to enter treatment, it’s a big decision and one that is never taken lightly.

So if you’re that person – you’ve decided to allow a trusted professional to help you make important changes in your life – you might want to know what to expect. While sitting down in a stranger’s chair is never easy, per se, being armed with an understanding of the process is key to developing the trust that is vital to the process.

Here’s what you can – and should – expect when starting therapy:

1. You’ll be asked why you’re there. It may sound obvious, but the therapist will want to get a thorough understanding of what brings you to treatment. Even if you’ve alluded to “relationship issues” on the phone, he will want to hear in your own words (and in more detail) how you think about the problem, and why you’ve chosen to get help now. Even if you think that certain parts are irrelevant, share them. It helps the therapist to help you if he has a richer context in which to understand the issue that concerns you.

2. You’ll be told about your rights as a patient. The therapist will spend some time letting you know about what you can expect from her and the process of therapy. She’ll likely explain that you can expect your information to remain confidential and secure, unless you are at risk of seriously hurting yourself or someone else. She should generally also let you know things like her fees, cancellation policy, how you can access your records, and more. The specifics will be based on the laws of your area and the specifics of her profession.

3. You’ll learn about the nature of the therapy relationship. The therapeutic relationship is quite different than other relationships that we are used to. When you think about it, it can actually seem a little strange. You’re pouring your heart out to a person who just met you recently and you know nothing about. But certain therapeutic boundaries are in place for a reason. You should be able to trust that you will not have to take care of your therapist’s needs and feelings. You’ll learn, likely quickly, what your therapist’s style is when it comes to this. Some may disclose some personal information about themselves, and you’ll need to decide what you feel comfortable with.

4. You’ll learn about the therapist’s approach. There are more styles and approaches of therapy than we could possibly discuss here, but they often fall along a continuum of directiveness. Some therapists will take a more active approach, asking you to do things like monitor and challenge thoughts and feelings and experiment with changing your behavior. Others will spend time helping you to develop insight into your patterns of functioning and work to provide a new relationship experience via the therapy itself. Others will do a bit of both. While it’s not always important to know precisely how things are working (in fact, it can sometimes steer you off course to get caught up in the details), you should check in with yourself to determine how comfortable you are with the therapist’s style.

5. You’ll be invited to ask your own questions. I encourage you to use this space to really be a savvy consumer. Questions that can be helpful to ask include: What kind of license do you have to practice? Do you have a supervisor or will you be consulting about my case? Have you worked with others who have my issue? What can I expect from therapy? Can I call you between sessions if I need to? How will I know if things are improving? If the therapist avoids these questions or doesn’t give you the answers you are looking for, I suggest proceeding cautiously.

It’s important to remember that the effectiveness of therapy is based heavily (very heavily, in fact) on the therapeutic relationship, so it’s vital to feel a good fit is in place. If you don’t initially, however, that might not mean the therapist isn’t for you; it could mean that you need to give the process time. Unless there is a significant issue, I always encourage patients to give a therapy relationship at least a few weeks for trust and rapport to develop. If these things don’t happen, I urge you to seek a therapist who will meet your needs. Remember, this is your treatment and your mental health.

If you’ve been to therapy, what has your experience been like? What would you ask a new therapist?

I’m lying on a softly padded table in a small, dimly lit room full of fresh flowers and the scent of jasmine. Vivaldi is swirling around me. The esthetician is gentle, speaking in a low voice as not to disturb the carefully constructed ambiance. And then, just as my heartbeat has slowed, RIPPPPPPP!!!!! She pulls the wax strip off of my eyebrow and with it comes hundreds of tiny hairs that were simply minding their own business, not really hurting anyone. “How does that look?” she asks me with mechanically whitened smile. “Perfect!” I tell her, hoping the bright red around my eyes fades before meeting up with friends.

Eyebrow waxing, facials, eyelash implantation, corsets, tanning beds, liposuction, breast augmentation…. just a few of the literally thousands of ways that humans have found to change their appearances. We pluck and we pull and we tuck and we stretch and we apply and we hide. We change our bodies, and in the process we change ourselves. And so certain questions emerge, like my tiny eyebrow hairs popping up to my chagrin:

Can we change our bodies while also accepting them? Are change and acceptance mutually exclusive?

Fortunately for cosmetic companies and laser hair removal facilities, I believe that change does not have to occur to the exclusion of acceptance. However this simple answer comes with some major caveats, so read on…

When most of us think about the notions of Acceptance and Change, we think of a dichotomy, which is defined as the splitting of a whole into two, non-overlapping parts. We grow or we stagnate. We publish or perish. We like our bodies or we hate them. The problem with this dichotomization is that it leaves no room for other possibilities – like the possibility that two truths can exist at the exact same time. This is where dialectics come in, so hang on to your hats!

Dialectics (à la Plato, Hegel, and even Marx) broadly refers to a manner of communication in which two individuals with opposing ideas are trying to persuade each other (“You’re fine just the way you are!” vs. “You could really stand to lose ten pounds!”). At its core, dialectical thinking involves holding two “opposing” ideas and understanding that more than one truth can exist. To take this further (and this is my favorite part), truth is always evolving. Too philosophical for you? Okay, let’s take it back to eyebrows…

The idea is that both acceptance and change can coexist. In fact, we need both of these stances present to live a more balanced life. It might go something like this: I accept that I have allowed my eyebrows to take over my face and now am starting to resemble a man. I accept that I have been busy with other things that are important to me and have not made it to get this issue resolved. I accept that I was born with thick, dark hair, which I love and am grateful for. I recognize in myself the desire to make a change by making an appointment with the nearest salon.

This is obviously a somewhat light-hearted example, and I do not want to minimize the challenge that lies within balancing acceptance and change. In fact, I would argue that that we cannot move toward real and sustainable change until we have come to acceptance. And acceptance is often the more challenging piece of the puzzle.

Take for example the woman who overeats and has become overweight, or is even suffering from obesity. It may seem ridiculous to think that this woman should work to find acceptance. She has high blood pressure! Diabetes! Cannot keep up with her children!  How can she possibly sit back and accept what has happened?

It is important to remember that acceptance does not equal approval. The woman does not have to enjoy the fact that she feels unhealthy. She does not have to believe that hers is the best way to live. She simply has to accept where she is in this present moment. Because, in fact, not accepting where she is in this moment is likely to be precisely what got her to where she is now. Emotional eating, the usual cause of overeating, is all about non-acceptance. It’s a rejection of what I feel in favor of something else. It is the polar opposite of living in this moment. Now, there are hundreds of options for her to change. She could eat cabbage soup. She could elect bariatric surgery. She could get a personal trainer. But until she accepts herself in this very moment in which she is living and breathing, these “changes” are not likely to be sustainable.

The problem with focusing only on change and not on acceptance is that it gives us the illusion that we are in control. We feel powerful and capable because we are taking charge of our lives. But the reality is that we are not always in control. We have past traumas, broken relationships, environmental constraints, and that pesty little thing called genetics. And when the person who gets on the change train without taking the morning dose of acceptance bumps up against one of these issues, (s)he often wants to jump right off because the illusion of control is suddenly shattered. The accepter can work toward growth and development while being at peace with what is. And that is what leads to a little thing we call “happiness.”

So, will I stop tweezing and manicuring because I am supposed to love my body completely and totally as it is? In a word – no. And I feel okay about that because I accept that I was born with certain… traits… that I don’t have to adore. I accept that I will not love every aspect of myself as much as others (and don’t get me wrong, there are many I do think are pretty great), and I also accept that each aspect in some way adds to the mosaic that is me. And I also accept that my eyebrow waxer is pretty much my best friend and should be on speed dial.

So, I will leave you with a brief but powerful prayer (or affirmation, mediation, or however you would like to think of it) that speaks to the peace that can be found in striking this balance:

Grant me the Serenity to accept the things I cannot change,
Courage to change the things I can, and
Wisdom to know the difference.

Capitulate. Capitulation, Capitulating. Any way you dice it, it’s pretty much my favorite word as of late. It has this sound to it, this harshness. This sense of roughness. But this isn’t a vocabulary blog (Does one of those exist? If not, I have my next idea!), and thus I’ll move on to explain just why I love this word. And no, it’s not just the way it feels on my tongue to say it.

First, I must give credit. The idea behind capitulation comes to us, or at least to me, by way of Debra Safer, PhD, one of the developers and researchers of Dialectical Behavior Therapy for the treatment of eating disorders. Safer describes capitulating as giving up on your goals or acting as if there is no other option other than to do what you usually do (e.g. binge and purge).

We might think of capitulating as surrendering, as that is the word’s usual definition. To capitulate is to surrender to your habits or to your disorder or to your history. It is to cut off all option of making a different choice in this moment than you did yesterday. It is to give up on reinventing yourself and do more of the same (And we all know the definition of insanity, correct?).

Unfortunately, capitulation is a stubborn, sneaky little bugger. It shows up in the most imperceptible ways, wiggling in when we least expect it. For example, capitulation is what’s happening when we decide that, “I’m this far into the binge, I’m going to have to throw up anyway. I’ll just keep going.” Or, “I haven’t worked out in five days. Really, what’s one more?” Or, “This yoga teacher is nuts. It’s too hard to try to keep my mind focused on my breath… I wonder what I should do about Rachel being such a jerk.” Or, “I’m never going to get that job. Why bother wasting my time on the cover letter?”

The problem with capitulating is that it not only giving up on abstinence or health or employment opportunity, it’s giving up on yourself. And to give up on yourself is quite a dangerous endeavor. Capitulating leaves us feeling we are subject to the whims of others and our circumstances and thus robs us of our sense of agency. And that, my friend, leads to more… capitulating.

Change is no walk in the park. I particularly like the phrase…

“I never said it would be easy. I just said it would be worth it,”

…often cited by religious denominations (but even the non-religious can appreciate this message). And capitulating is a part of change. The first step is simply to recognize the ways in which you are surrendering, giving up on an idea of who you might or could be. Then you sigh, cognizant of your desire to let go, and you resume the reigns. Unless you’re my husband, in which case you should capitulate to my every desire… <insert evil laugh>

Your homework, dear readers, is to consider just how you capitulate, and (if you’re brave or maybe bored) why. And, even if it’s just once over the course of the week, choose to take the road less traveled.