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  • Fonda Tokushige, LCSW

Updated: Aug 5, 2019

When I started my private practice, I was surprised by the sheer density of licensed therapists in the 90277 zip code where I practice. In fact, if you used a site like Psychology Today to guide your search for a therapist, you would find 20 licensed mental health professionals per page across umpteenth pages (including my business card). By the time you got to page 5, you would have superficially perused the pictures of nearly a hundred potential providers and clicked into - at least - 20 profiles, probably based on those pictures. The process of finding a therapist alone can be a deterrent to getting into therapy, let alone effective therapy. Here are ten helpful tips to help you find a therapist in what can turn out to be a costly trial-and-error process and make your time and financial investment worthwhile.



What is Effective Therapy?


Simply, effective therapy facilitates positive progress in your life and is contingent on your level of motivation and engagement with the therapeutic process and the skillfulness of your provider. Keep in mind three basic principles. First, you are doing the best you can even if you feel like a royal disaster and your willingness to engage in therapy speaks volumes to your desire and motivation to make positive changes in your life. Second, progress is far from being a linear process and will translate to forward movement in the long run. Third, making progress requires implementing positive changes outside of the sessions, which means you will need to make a concerted and genuine effort to take what you’re learning in your sessions outside of your therapist’s office.


On a more expository level, I want you to think about parity, specifically related to the expectations you have from your primary health care providers. For example, if you had persistent flu symptoms that weren’t resolving with getting more rest and taking some over-the-counter medications, you would schedule a next day appointment with your primary care doctor or walk into a local urgent care. Most likely, you would be prescribed stronger medications that would more effectively suppress the flu symptoms and let your body get the rest it needed in order to recuperate and recover.


What would you do if you completed the prescribed medication regimen and felt even worse? Hopefully, you would either go back to your primary care for another evaluation or walk into your local emergency department for further evaluation, assessment and treatment. Either route would likely lead to more testing, a more accurate diagnosis (perhaps your flu was really bronchitis), and more targeted treatment to resolve the symptoms you’re presenting with. This decision-making process is more straight-forward because we tend to be much better versed at navigating primary health problems.


When it comes to our mental health, we tend to avoid seeking professional mental health care or wait until the symptoms have reached moderate to severe levels at which point our personal and professional lives feel like a complete mess. It is all too common, unfortunately, to hear people share that they have been muscling their way through weighty emotions and life problems for DECADES, which is a recipe for chronic, severe and debilitating clinical depression and other mental illnesses. In fact, the prevalence of untreated depression and anxiety has led to increased work loss and decreased productivity, resulting in an economic burden of $210.5 billion (1 , 2). Essentially, we’ve been muscling through the mental health equivalent to severe pneumonia oftentimes because conversations around emotional hygiene just don’t happen. The path to health and wellness is more readily achieved early on in the illness course.


This is absolutely true for our mental health. It is time to aggressively chip away at the stigma that keeps us from increasing our understanding of and ability to navigate mental health care and the systems that revolve around it, especially in light of the increasing rates of depression (3, 4), anxiety (5) and suicide (6). Regardless of where you are starting in your recovery journey to health and wellness or how severe your symptoms are, effective therapy will guide you to experience progress and improvements in your life even though it doesn’t always time well with your schedule and timetable. If after a fair trial you determine that you are not making progress in your treatment and/or your treatment becomes stagnant, it may be an indicator that it’s time to find a new provider.



Parity Applied to Licensed Mental Health Providers


Let’s go back to this idea of parity between primary and mental health. In primary care settings, medical providers - doctors and nurses - generally specialize in a specific area. If you had concerns about your heart health, you wouldn’t go see a podiatrist. Vice versa, if you were experiencing foot and ankle problems, you wouldn’t go see a cardiologist. While each of these providers started off with the same foundational courses and training, they eventually chose a path to receive specialized training to become experts in their respective fields.


The same concept of specialization applies to mental health practitioners. Generally, licensed therapists start their training as generalists and eventually pursue specialized training in an evidence-based practice (7) based on their inherent interests and the opportunities presented to them along their career path. What this means is that licensed therapists have specialties too. So, if you were experiencing on-going anxiety related to a traumatic experience, you would want to connect with a licensed therapist trained in a mode of trauma therapy, such as Prolonged Exposure or Eye Movement Desensitization and Reprocessing (EMDR). If you or a family member were experiencing symptoms related to a psychotic disorder, you would want to get connected to a psychiatrist to be evaluated for medications immediately and complement the medication trial with psychosocial and cognitive behavioral therapeutic approaches (8).


As a professional mental health provider, I fully acknowledge that finding an effective therapist who will be a good fit for you can be a frustrating process, especially with the current insurance climate. Taking the time and pushing through the frustrations to find an effective therapist who is a good fit can have worthwhile payoffs.


Tips for Effective Therapy


Now that you have a better understanding of what effective therapy is and that mental health providers have specialties too, here are tips to keep in mind to ensure that your time and financial investment into therapy is worthwhile and facilitating forward moving progress.


Tip 1: Time and circumstances permitting, take a step back and write down your reasons for seeking therapy. Cite examples of specific emotional and behavioral problems you are aware of and want to address. Write down what your treatment goals and expectations are and what you want to see change in your life. Keep in mind, this document is a dynamic document that will provide you and your therapist a starting point. An effective therapist will help you to increase your insight, teach you skills to make progressive changes and re-evaluate this document periodically to ensure you are moving forward in life.



Tip 2: Mentally prepare yourself for the trial-and-error process of finding an effective and skilled therapist to guide you through your journey to recovery, health and wellness. Keep in mind that you are interviewing prospective therapists during this trial-and-error process as well, and the goal is to find the best fit provider to help you achieve your therapeutic goals. This can become costly if: (a) you are paying out-of-pocket for services and (b) the provider charges a session fee for the initial intake/consultation session. If conditions (a) and (b) apply, take time to do recon work via a telephone consultation before scheduling an appointment.


Tip 3: Come as are you are, make the time and show up even if it’s in your pajamas. Effective therapy requires you to make the time investment and to be present.


Tip 4: Fight the toxic shame, break the stigma and ask around for a good referral. Given the prevalence of depression and anxiety, it is important that we start having conversations about mental health. Understandably, this is an intimate conversation, so I'm NOT suggesting you put an advertisement out on your social media feeds. I'm suggesting you talk to people in your family and friends network who you trust and respect. This also does not mean you have to share the intimate details of why you’re seeking therapy. You have complete control over how little or how much you share. Chances are that a good referral is just a good conversation away.


Tip 5: Find a balance between showing yourself some grace through the process and pushing yourself to do the hard work involved in therapy. Ultimately, your consistency - between showing up and being prepared for each session - is a major ingredient to successful outcomes.


Tip 6: Be receptive to feedback and being challenged to live life more skillfully. An effective therapist will not allow you to complain or “ventilate” session after session after session because complaining generally does not lead to the effective problem-solving that might lead to a different outcome. Instead, an effective therapist will challenge you as and when needed to get you outside of your comfort zone and will give you real and honest feedback (versus sugar coating life).


Tip 7: Give your therapist feedback and be your own advocate. When given respectfully and in your best interest, an effective therapist welcomes feedback to improve the quality of the sessions in efforts to help you reach your personal best.


Tip 8: Assess your progress on a quarterly or semi-annual progress, especially if your therapist does not incorporate the use of measurements/inventories or assessment updates. It is a pre-condition for therapists to be welcoming and good listeners. An effective therapist will meet those pre-conditions and guide you to progressively reach your therapeutic goals or, at least, set you on the path to reaching those goals. Periodically, reviewing your progress will help you to gauge the effectiveness of your treatment.


Tip 9: If it's not the right fit, don't force it. You may know after the first session or you may know after a few months worth of sessions. This realization may even occur months to years into working with a therapist who was effective for a period. It is possible to get too comfortable or grow out of your therapist. At that point, it may be time to talk to your therapist about your needs and discuss transferring your care to a new provider.


Tip 10: Be patient through the process. Unfortunately for us, progress has its own timing. There’s no rushing through the parts of life that just are emotionally miserable or even intolerable. Oftentimes, we can’t even go around it. If you’re reading this article, you most likely need to work through it with patience. Making a commitment to the therapeutic process may prove to be a life changing and maybe even a life saving experience and can help you to create a life worth living.


On The TBH Therapist


Having worked in community mental health programs and for a large HMO, I genuinely understand the complex challenges that can serve as a barrier to getting connected to an effective therapist. For these reasons, I offer brief telephone consultations to provide assistance and guidance to navigating the healthcare system at no cost to new and prospective clients. To learn more about my practice, click here.


Additional Readings


1 Beck, PhD, A., Crain, PhD, A. L., Solberg, MD, L. I., Unützer, MD, MPH, J., Glasgow, PhD, R. E., Maciosek, PhD, M. V., & Whitebird, PhD, MSW, R. (n.d.). Severity of Depression and Magnitude of Productivity Loss. Retrieved July 30, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3133577/


2 Kuhl, PhD, E. A. (n.d.). Quantifying the Cost of Depression. Retrieved August 1, 2019, from http://workplacementalhealth.org/Mental-Health-Topics/Depression/Quantifying-the-Cost-of-Depression


3 Major Depression. (n.d.). Retrieved August 1, 2019, from https://www.nimh.nih.gov/health/statistics/major-depression.shtml National Institue of Mental Health (NIMH)


4 Morin, LCSW, A. (2019, July 26). Depression Statistics Everyone Should Know. Retrieved August 1, 2019, from https://www.verywellmind.com/depression-statistics-everyone-should-know-4159056


5 Anxiety Disorders. (2018, July). Retrieved August 1, 2019, from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

National Institute of Mental Health


6 Weir, K. (2019, March). Worrying trends in U.S. suicide rates. Retrieved August 1, 2019, from https://www.apa.org/monitor/2019/03/trends-suicide


7 McKibbon, B.Sc., M.L.S., K. A. (1998, July). Evidence-based practice*. Retrieved August 1, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC226388/pdf/mlab00092-0108.pdf


8 Chien, W. T., Leung, S. F., Yeung, F. K., & Wong, W. K. (2013, September 25). Current approaches to treatments for schizophrenia spectrum disorders, part II: Psychosocial interventions and patient-focused perspectives in psychiatric care. Retrieved August 1, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3792827/

  • Fonda Tokushige, LCSW

Updated: Aug 3, 2019

TeugByeolHan (특별한) is a Korean word that translates to special, exceptional or extraordinary. Generally, we tend to reserve the spirit of this word for stars, musicians, artists, billionaires and the outliers. So, what about the rest of us?


A Glimpse Into My Journey to Becoming TeugByeolHan

Moreoften than not, we don't have control over the cards we're dealt in life. This includes what families we're born into, what genes we're born with, and what problems we're going to face on the daily. Sometimes we're dealt with a series of bad hands and left wounded or broken and wondering how we're supposed to recover and move forward. In these moments that can sometimes turn into seasons and even years, it's critical to recognize that we do have control over how we deal with those bad hands and we have to take ownership over our lives.


My early formative years - from my earliest memory in preschool to my young adult years - were, for the most part, intolerable. I took a reductionistic perspective of my life and blamed my parents for the emotional pain that I was in and for the degree that I had been parentified. I had convinced myself that I was wise beyond my years. This wisdom mislead me and fast-tracked me (and my unsuspecting husband) into the depths of adulthood.


Essentially, I escaped my family-of-origin to start my own family at the ripe age of 19. Only I didn't escape anything. All of those dynamics that contributed to an intolerable family environment reappeared with a vengeance in my new family where I wore two new ill-fitting hats as a wife and mother. It didn't take long for that deceitful wisdom to dissipate.


At a time when I was, perhaps, at the most vulnerable point in my life, I arrived at a clear impasse with the dysfunctional beliefs and dynamics I was operating under. In a rock bottom moment, I decided I needed to accept reality for what it was and opt to fight for a life worth living, and since I didn't know how to fight this good fight, I actively sought out help in many forms - self-help books, higher education, making lifestyle changes, mentoring and life coaching, therapy and counseling - all of which offered me the support and tools I needed to take progressive steps forward. It was this multi-pronged investment that I made into myself and the willingness to approach life differently that's empowered me to gain insight and perspective into living my best life, at least, on most days. More specifically, increased insight and a broadened perspective opened me up to genuinely being grateful, even for the bad hands I'd been dealt.


For years I regarded my parents as the worst hand life had dealt me. They were incompatible for each other and incompatible with me. I had reduced them to horrible people and, consequently, parents. As a second generation Korean-American born and raised in Southern California, I knew very little about my Korean heritage. I assumed my Korean parents were backwards because they seemed so out-of-touch with the families I grew up with, like the Tanners from Full House and the Lawsons from Small Wonder. I never considered the alternate reality that I could ever appreciate and even admire my parents for their life journeys, exemplary resilience and courage, and terrible imperfections. It wasn't until I started researching the impact of enculturation (not to be confused with acculturation) and intergenerational trauma that I started to question my reductionistic analysis of my parents. I am grateful for my mentors who encouraged me to add contextualization to my analysis.

My father was born a few years before and my mother was born 3-days after the outbreak of the Korean War. They grew up in extreme poverty and, in my mother's case, she was separated from her own family-of-origin until she turned 18 to survive these difficult times. I came to learn that both of my parents danced intimately with hunger, instability and fear, all of which they couldn't shake off and carried with them throughout their lives. For my father, this translated to a brutal harshness and sternness that drove away those he loved the most. For my mother, this translated to a life of workaholism and unstable relationships with those she loved the most.


I recently lost my mother to liver cancer. While sitting and sleeping by her deathbed, I clumbsily danced with the sadness that came with watching my mother die, and during some of those missteps, I had transformative revelations settle on my somber thoughts. What I came to fully accept was that my parents lived the best lives they knew how for themselves, each other and their children. I came to appreciate and even admire their incredible resilience and grit to live everyday and to build a life they could only dream about in their youths in spite of the disadvantages from the hardships and struggles they faced. My parents weren't able to give me harmonious family relationships, but they gave me the greatest gift they could - a life where I never had to dance so intimately with the real hardships and struggles they faced. It is because of their sacrifices that I have the emotional footing to live a life motivated not by fear but by my genuine drives and passions.


TeugByeolHal Redefined

TeugByeolHan therapy and life coaching services is rooted in the resilient life journeys of these two terribly imperfect people. Drawing from the lives that they lived and from my personal journey, I've come to the conclusion that the TeugByeolHan person is one who takes responsibility and ownership for his/her life's journey and dedicates himself/herself to living his/her best life despite the hands that are dealt.


I founded TeugByeolHan based on the recognition of and an appreciation for every person's unique life journey, and for some that journey is complicated by dynamics that stem beyond one's control. This practice is dedicated to supporting and guiding each person to building insight and awareness and developing the necessary life skills to empower you to be resilient, skillfully deal with those bad hands, and live your best life.

Contact

(424) 247-6599

fonda@tbhtherapylcs.com

1611 S. Pacific Coast Hwy., Office 205A

Redondo Beach, CA 90277

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