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Talking Things Out
How therapy can help
Danielle Chambers

Whether you’ve been diagnosed with a mental illness or not, therapy can help you make sense of your problems and find ways to cope. We spoke with therapist Toni Heineman in San Francisco to find out how talk therapy works. Dr. Heineman is the director of A Home Within, a network of therapists who provide free therapy to people who have been in foster care.

Q: Why is therapy important?

A: Therapy helps people understand themselves and the reasons they do things, why they react a certain way to a person or a situation, and why some things are hard for them. Therapists can be incredibly helpful for understanding relationships. A difficult breakup, the loss of a friendship, or the death of a family member are all things that can be talked about in therapy.

For kids in foster care, there have been so many changes and they often have an overwhelming feeling of loss. So anxiety and depression are often talked about in therapy. Many kids in care have also experienced trauma, and one long-term effect of trauma is difficulty handling your feelings and behavior. Therapy can help with that.

Q: How does talk therapy work?

A: Talk therapy traditionally is directed by you, not by the therapist. The therapist should ask what you think is important. The therapist might point out important things not being talked about, but in general, you set the topic.

Talk therapy is a kind of storytelling. You talk about an event and that reminds you of another event, and you begin to connect them together to make sense of things.

Q: So why not just talk to a friend or family member? Why trust a complete stranger?

A: A therapist can help you set goals. Also, you see the therapist in a specific time and place, and that sets boundaries for the relationship and creates an area of safety. And unlike family and friends, you don’t have to worry about hurting the therapist’s feelings the way you might be concerned about hurting mom, a friend, etc.

As for trust, that gets built over time. You have to get to know a therapist and they have to get to know you.

image by Edwin Yang

Q: What if you get a therapist who you don’t feel is helpful?

A: Say to the therapist, “I don’t think this is helpful. I don’t think this is doing what I want it to do.” The two of you can sometimes try a different way. If it’s still not working, try someone else. Often the therapist can help you find someone who’s a better match.

Q: What if you’re forced to go to therapy?

A: If you’re seeking therapy, it should be because you and the therapist agreed to work together, not because someone forced you. A sensitive therapist will say, “I understand you’re coming here because you’ve been told you have to. Let’s talk about that rather than telling me about other things.” That’s where you and the therapist have to start.

Things are very different once someone feels like they’re in charge of the decision to attend therapy. We hear from kids who age out of the foster care system who felt forced into therapy when they were younger. Now that they’re making the choice to go, it’s a young adult saying, “I’m here because I understand that the events of my life impact how I feel now. I want to deal with that so I can have more control over my life.”

Q: What about confidentiality?

A: In general, your confidentiality should be respected unless the therapist feels you are a danger to yourself or someone else. If you feel that your confidentiality is being violated, ask the therapist about it.

Q: Is it better to get therapy when you’re younger?

A: We certainly think early is best. Life builds up layers of experiences, so if a child is traumatized it’s good if you can get to that right away before other things get added on top of it. It’s like if you cut yourself and you get antiseptic and a bandage right away, as opposed to if you don’t and the cut gets infected and builds up scar tissue. You have to unlearn the old way before you can learn it a new way, and that can be hard. But people use therapy in different ways at different times in their lives. It’s not an exact formula.

Q: How do you know when you don’t need therapy anymore?

A: Together, you and the therapist decide when you’ve accomplished what you set out to do. You can always keep working on a problem on your own, and you can always return to therapy later.

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