I would like to focus this post on Randall's experience of therapy and the experience of beginning therapy. This is not the traditional review/recap of the show so I will not address everything that occurred in the episode.
We are back with a new episode of NBC's This Is Us. This week we have "Clouds" and if you have not read my review for last week's episode, stop what you are doing and click here. Randall has finally decided to enter therapy and this episode focuses on the experience of Randall in therapy which is different from Randall's experience of therapy. I will address both here.
The Experience of Randall in Therapy
One thing this episode does extremely well is keeping the focus on Randall. The episode focuses on power and control, which is Randall's self-diagnosed issue. Randall worked really hard to push the attention away from him. He pointed out the painting on the wall, he continued to get distracted by the coffee pot, he addressed the therapist's potential 'game' or 'agenda.' Each of these behaviors was Randall's tactics to steer the car away from talking about why he came into treatment. No matter how hard Randall tried to move the car, the focus (the camera) stayed on him. An excellent choice for the directors of this episode. I loved it.
Randall's power and control issues come up even when he does talk about his past. Randall is smart and wants to get things right. He wants to be the perfect client, so he tries to use humor, be charming, and be an "open book" as he says. However, this open book Randall says he has is on his terms, in a way that he can feel control over. So, he dives into the story about his fire station drop off, being adopted by white people, you know the story. This story is open enough that people feel like they know him, but it is only the story Randall feels he has mastery over and the therapist SHUT IT DOWN.
I LOVED THIS!
This therapist, I think, is going to be a perfect match/fit for Randall. He needs someone who can stop him from putting on his performance of Randall. I think it may have been a bit much for the first session and they definitely need to build more a relationship before she is this straight with him. I like her and it will work out great. I think it was important for her to say straight out the gate, I know who you are. He is a public figure so it should be expected. Now, any old everyday person should not expect their therapist to Google them, cause...that's a no-no, but it does provide context for this scenario. There's no point in this therapist pretending she does not know who he is and to hear this story that she is heard before.
Your therapist is not your friend. Friendship requires mutual sharing, trust, emotional vulnerability. Therapy requires this of the client, but your therapist will not be sharing their personal life with you (which can be very uncomfortable and jarring at first). Remember, you are paying for this service. You are paying for someone to help you work through whatever is going on in your life or to better understand who you are. Maybe a goal in therapy (Randall!) can be to examine your friendships and partnerships to make them more effective and make you a better giver and recipient of friendship and partnership.
*caveat that this can all look differently with adolescents and children*
In a way this episode the viewer is able to be the therapist providing their undivided attention to Randall and nothing else. WOW is that undivided attention uncomfortable for Randall. As previously stated, he continued to attempt to deflect attention. He could not stop moving, he continued to be distracted, he was just so uncomfortable which leads me to our next section.
Beginning Therapy
A first therapy session is make or break for a lot of people. Statistics show most therapy clients drop out after the first session. This statistic makes the first session especially difficult for us therapists because we, of course, want to make sure our clients come back. We see Randall already looking for reasons to discount/discredit/devalue his therapist and therapy in general. The magazines are from 2017, which Randall interprets as the therapist possibly being unaware or flippant. The water cooler is out of cups and Randall wonders if this person can not restock cups how can they help me? We, of course, see this in Randall's rant as he storms out of the room and complains about the coffee pot on his way out.
No. Therapists do not do this to "mess with their clients' minds." We are people too. People who may be forgetful, people who do not make a ton of money and maybe can not afford a fancy office. People who may be so busy that replacing magazines are probably the last thing on our minds. I think the lack of communication is highlighted in this episode as well. Instead of Randall saying, "Hey, I noticed you are out of cups" and allowing a response from the therapist, Randall jumps to conclusions about the ineptitude of others and their inability to be on his level. (Which is something Randall does to everyone, especially his family).
Now, even booking an appointment and showing up to the first session is a huge step. Sometimes, professionals can forget this and it is important to remember and acknowledge. Therapy requires a relationship for it to work. Therapy also is not a magic pill that can cure you in one session. Think about the important relationships you have in your life. They took time and investment to get to where they are today. All relationships require time, trust, and investment so expect the same from your therapy. If you walk into the room looking for faults, you will find them. This is why I believe the choice to focus on Randall while in the room was so important because it did not give the viewer a reason to discount the therapist as well. If the show allowed us to see the therapist before the end, we would not have focused on Randall and we would have done the same thing he did to try to find reasons he could not relate to or be helped by her. That said, having a good match is important as well. I would not recommend sticking with a therapist just to "push through it" if the relationship is not a good match. Every therapist's style, personality, approach the therapy is different so you may encounter someone who is not a good fit for you. The important piece to remember is just because that person may not be a good fit for you, does not mean therapy is not a good fit for you.
If at first, you don't succeed...
Stepping outside of This Is Us a bit, let us focus on beginning therapy just a while longer.
Where to start?
If you are thinking about beginning therapy for the first time you may be wondering where you can even find a therapist?
My recommendations for places to start are looking at the provider list that is listed your insurance's online directory. At times, these lists may be out of date, but it is a place to start and can save you some money IF you have insurance that covers mental health services.
Well, what if I don't have insurance or no therapists in my area take insurance?
There are two major routes I will discuss here and it is by no means a comprehensive list of all of the ways you can access services. The first I will discuss is Community Mental Health, next I will discuss Private Practice.
Community Mental Health Centers (CMHC) are typically nonprofit organizations who aim to serve their regions' mental health needs. These are not hospitals but are small or large organizations that employ many providers including, but not limited to, master level practitioners, social workers, case managers, psychologists, and psychiatrists. CMHC's often take many forms of insurance, including Medicaid and Medicare. There are typically waitlists for these services because they serve a large number of people. CMHC's are often more accessible and provide many services so that a person can receive most of what they need in one location or by one organization. The drawbacks (outside of the waitlist) are there tends to be more turnover in these organizations (for many reasons that I do not have time to get into today), the hours of operation may be limited, and sometimes services may be limited due to funding of the organization since they often funded by grants and other government contributions.
Unfortunately, our government does not value mental health at the level we would like it to be. This results in ridiculously low reimbursement rates for the organization and since money does need to be made this can affect the availability of services at that organization.
To find a CMHC in your area serve for mental health centers on google in your area and they should all pop up.
So, maybe you decide to go the Private Practice route. If you choose to do this, I would highly recommend starting your search on sites such as Psychology Today. If you are interested in finding a Black/African-American therapist you can also search The Association of Black Psychologists directory or the Therapy for Black Girls directory. You can also search by race or religion or LGBTQIA affiliation on Psychology Today. You can also find different affinity groups by religion, race, etc of therapists and psychologists if you so choose so options are out there. I will give a caveat though, that not all people have an automatic bond or trust in their provider simply because they share an identity. I will write another post later about choosing therapists for marginalized identities.
Due to the insurance reimbursement issue, I mentioned earlier there are very few Private Practice Psychologists who take insurance. Providers in Private Practice are running their own business, business costs money, filing insurance forms, scheduling patients, completing billing, etc. all take time and money. Please remember this when you look at the rates/costs for therapy. When you call a doctor's office, there is a billing department, insurance department, scheduling department, etc. When you can call a Private Practice provider they are often doing all of that themselves or paying someone else to do that work and that is all factored into the cost of the session (not including renting space, utilities, paying back loans, buying therapy materials, etc). Finding providers who have a sliding scale for their fees can be beneficial as well.
Providers in Private Practice can offer more flexible hours as it is their office, so you may be able to see a provider at 7:00 am before work or at 6:00 pm after work. Some providers even offer weekend hours, this is not guaranteed by all practitioners, of course. With that flexibility, it does come with more of a cost. Some insurances will reimburse you if you submit invoices, just ask your provider. Private practice practitioners also tend to stick around longer which can provide the opportunity to meet with someone long term. Randall's therapist was in private practice.
I could go on forever about this but just wanted to provide some information about where to begin. Once you have found a person, my biggest piece of advice is to just be open and honest about what you are experiencing and what you hope to gain from therapy. If that provider is not equipped or trained to provide those services, then they should say that.
My final piece of advice in all of this is to be sure you seek a LICENSED provider. A Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), Licensed Psychologist, Licensed therapist, etc. Their credentials should be listed and if not, you are well within your right to ask for them and to double-check their status in the online registry for your state.
Interested to read your thoughts, other pieces of advice, or questions. How do you all expect Randall's therapy to affect his relationships with his family and himself? Did you like this therapist or not? Excited to hear all opinions.
Take Care.