A psychiatric nurse practitioner shares tips for therapy, part 1

First in a series.

Talking about mental health was taboo when I was younger. Thankfully, that has changed for me — especially at home. My wife, Jill, who is gene-positive for Huntington’s disease, knows that two of its symptoms, anxiety and depression, may require medication and talking to a therapist.

She found a wonderful one in Alexis Ryan, a psychiatric nurse practitioner whom we recently interviewed via email. Jill and I believe the topic is important enough to share more from Alexis in a two-part series. Excerpts of our conversation follow, with light editing for style and clarity.

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CB: What are some pro tips for anyone considering therapy?

AR: Take some time to research different kinds of therapies and make a list of your own personal therapeutic goals before reaching out to specific therapists. It’s more common for therapists to provide psychotherapy, or “talk therapy,” than some of the more action-oriented kinds of therapy. And talk therapy can be wonderfully helpful. This is the kind of therapy where you have your session every week or two and sort of wander through whatever current stressors come to mind during each session. The vast majority of therapists are capable of providing adequate talk therapy, so if that’s what you’re looking for, you can cast a wide net.

If you are more interested in action-oriented therapies, like cognitive behavioral therapy, dialectical behavioral therapy, or acceptance and commitment therapy, you’ll want to look for a therapist who specializes in these. An action-oriented approach is where you have structured sessions that work toward building various therapeutic skills by practically applying each newly learned technique to your life between sessions.

During your first few sessions with a new therapist, be as direct and thorough as you can be about your mental health goals. Ask questions. Get clarifications on the things that confuse you. Try not to be intimidated by the (totally overblown) authority of a healthcare provider and remember that nobody knows you better than you.

What should patients expect at the beginning of therapy?

Anxiety, vulnerability, uncertainty, discomfort, and definitely a unique kind of fatigue that comes from relaying your whole life story to someone you’ve just met over the course of a few sporadic hours. It’s entirely possible to develop solid rapport with your therapist quickly, sometimes even within the very first session, and that rapport can enable you to transition away from those heavier experiences and into much more enjoyable and exciting ones, like validation, support, levity, nurturing, insight, and growth.

It really helps in approaching therapy for the first time to not only be prepared to feel some initial aches and pains, but to also have the reassurance that it’ll get easier. Therapy itself is a practice, and the more you do it, the better you get at it. 

What advice would you give to people thinking about working in mental health counseling?

One of the most important and impactful skills to bring to this job is an ability to boundary-set. I get asked by people all the time how I’m able to do what I do without getting burnt out; how I’m able to empathize with pain day after day without getting depressed by it. The answer is boundary-setting.

I think sometimes we misunderstand empathy as not just an experience of feeling what other people feel, but also our own inability to set boundaries with those feelings. If I start to feel burnt out, I know to look to my boundaries for a solution, not the empathy itself. Empathy with adequate and healthy boundaries is infinitely sustainable. It’s like caring that someone else is hurting while simultaneously knowing you’re not responsible for their hurt.

I’ve learned to set all kinds of boundaries in my work. I stick to my office hours and am very intentional with my time off. I set aside structured time for the administrative aspects of my job, like paperwork and emails. I set reasonable expectations with my clients for treatment outcomes. I know how hard it is for all of us to change ingrained behaviors and patterns of thought and make sure to constantly remind my clients of this as well to help mitigate their own burnout. Most importantly, I am engaged at all times with the belief that I, as an outpatient psychiatric nurse practitioner in a society circling the drain of late-stage capitalism, can only do so much.

What’s your definition of an excellent therapist?

Jill. [Alexis laughs.] No, I honestly do think she’d make an excellent therapist, and I tell her that often. My ideal therapist is unafraid to make light of some really dark pain, looks first and foremost to their clients for expertise, truly disengages from judgment, and maybe most of all … really, really, really cares!

Come back next week to read part two of the interview.

Note: Huntington’s Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Huntington’s Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to Huntington’s disease.