Q&A: Therapy For Chronic Illness

As you probably know, one of the things I’m trying to do this year is create resources and guides for people living with chronic illness. From how to pace to understanding subluxations and dislocations, I want to provide information that will help educate in an accessible way.

Last year, I reviewed my experience of online therapy with BetterHelp [sp], and for most weeks since then, I have continued to see my therapist via video chat, and work on my mental health. This has the first time therapy has ever really been ‘work’ for me – in the past it was very much just venting, and was never really about learning skills. I feel extremely lucky to have finally found the right person for me, and I have absolutely noticed a significant improvement over the time that we’ve been working together.

For a while, I’ve wanted to write a post that’s an introduction to therapy for chronic illness, and offers basic support and advice on issues like finding the right therapist for you, what to expect when you first have a session, boundaries with your therapist, and things that both you and your practitioner should keep in mind when it comes to looking for support with a long-term condition.

Of course, I’m not really qualified to speak about this, so I turned to my amazing therapist Karlee Carter and posed her some of the biggest questions that I had (and were shared with me by my Instagram audience) about therapy for chronic illness.

I hope you find this helpful – I certainly learned a lot!

This blog post is kindly sponsored by BetterHelp, but they had absolutely zero input on the content. All questions, thoughts, and resources are mine and Karlee’s.

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Hi Karlee! Can you tell us a little bit about your background and why you decided to start offering therapy online?

I have worked in the behavioral health field for about 10 years now! I studied psychology in undergraduate and then obtained a Master’s Degree in Counseling. I am a Licensed Independent Mental Health Practitioner, which means that I am qualified to diagnose and treat people with major mental disorders. I am also able to assess, treat and provide therapy. I also am a Provisional Licensed Drug and Alcohol Counselor, which means that I can evaluate individuals for substance use disorders and recommend treatment options.

Through these past 10 years I have worked in various settings that have provided me with great experience and knowledge. I have worked with children and adolescents in a residential psychiatric facility, adults with severe and persistent mental illness in a Day Treatment program, as well as provided outpatient therapy.

I decided to start offering therapy online when a few colleagues referred me to BetterHelp who had been providing therapy for several months. I am very passionate about telehealth because it increases access to healthcare for clients who live in rural areas, have limited financial resources, do not have means for transportation, or struggle with symptoms that make it difficult to see a provider in person. I knew that I could contribute my time, energy, and skills to that need. My experience with BetterHelp has been wonderful. I get to help people across the globe and learn new things about all different types of people. I really enjoy it!

What are some of the ways therapy can help someone living with a disability?

Therapy is beneficial for someone living with a disability for several reasons. A person living with a disability faces many stressors and emotions that increase their likelihood of suffering from anxiety and depression, or a more severe mental illness.

From the shock of the initial diagnosis to adjusting to changes in lifestyle, ongoing medical treatment, to feeling anger towards those who do not have the same limitations, living with a disability can be incredibly isolating.

Therapy is an important resource that enables that person to have a safe place to share their feelings and receive support. Therapy can also be helpful to improve the client’s feelings of self-esteem, self-worth, and discuss ways to navigate through the stigma and stereotypes they may face in daily life.

How do you view your role as a therapist with this?

My goal is to help my client accomplish their goals, and to create a safe place for them each week. It is very important to meet the client where they are and provide empathy, but also not be afraid to encourage and motivate them.

I think that some mental health providers are be afraid to do this when working with people living with disabilities. For example, they may make the mistake of thinking that a person with a disability is emotionally weak because of their physical limitation. However, if you stop at empathy as a therapist, you are doing the client a disservice. As a therapist, you need to challenge, assign homework, and hold the client accountable.

How can people go about finding a therapist that is understanding of things like their disability/sexuality/gender/race/religion etc? 

Be very specific with what you want and be prepared to do some research. There are some logistical questions to ask yourself before narrowing down your search to the specialization.

• Do I want to meet with a female or male therapist?
• Do I care how old my therapist is?
• How far am I willing to travel to see this therapist regularly?
• What is my budget for weekly therapy and what does my insurance cover?
• Do I want a specific type of therapist, such as a psychologist?

You also want to make sure that they have the credentials and training to help you. You can look to places like the American Psychological Association (APA) or the British Psychological Society (BPS) to ensure that they are licensed and do not have any disciplinary action taken against their license.

Reach out to a family practitioner, local university with counseling or psychiatry departments to see if there are any recommended therapists. Use word of mouth! If your friends, loved ones, or co-workers have had positive experiences with therapy, don’t hesitate to ask more questions about that therapist to see if it might be a good fit for you.

You can also search on online databases like Psychology Today. Don’t be afraid to call the therapist and have a conversation! Ask about the therapist’s specialization and if they think they can meet your needs in therapy. You are seeking out a person who you plan to share your deepest thoughts and emotions; you deserve to know what you are getting into. I guarantee they will appreciate it too!

Online therapy is a great alternative to in-person therapy because it addresses a number of these issues. Although I am based in the US, I know that wait times for mental health services in the UK can be very long. If you are struggling with a mental health issue, it is important to get help in a timely manner.

Using an online platform connects the client with a therapist within days. If you are not comfortable going to a clinic each week, you can meet with a therapist over the phone or over chat. Online therapy is generally much cheaper than a private practice as well.

What are some signs that a therapist is right for you? Are there any good questions to ask to help get an idea of whether it’ll be a good match?

Ask the therapist to describe what therapy is like with them. For example, “What can I expect from the first session?”

Setting expectations can help to ease some of the anxiety of starting therapy and building that new relationship.

Ask about the therapist’s availability, office hours, and forms of communication. What kind of therapy model do they utilize most often? For example, Cognitive Behavioral Therapy (CBT) or Solution Focused Therapy (SFT) are types of therapy models. Ask them to explain what that is, that will be a good indicator if they know what they are doing.

Ask the therapist if they have experience working with the types of issues you are dealing with. What approach did they take when working with clients in the past with similar issues?

Most importantly, do you have a good feeling when you talk to the therapist? Can you feel empathy from them? Not every therapist will be a good fit for you, even if they have the right specialization and experience.

And are there any red flags people should be aware of to tell if a therapist isn’t right for them? What can someone do if they don’t connect with their therapist or they’re treated badly because their therapist isn’t understanding of their disability?

A key indicator is how you feel leaving your therapy appointment. Do you feel worse after leaving than when you started? Therapy appointments can be emotionally tough, but they should be opportunities for growth. If you feel bored or unchallenged, it is time to confront your therapist and tell them you need more out of your therapy sessions. Be direct and honest about your goals and see how your therapist responds to your request.

There are obvious red flags, such as your therapist being late, taking phone calls or texts during your session, eating during your session, cancelling often…that are all signs that they are not respectful and a not good fit for you (or just a bad therapist!).

Less obvious signs may take you longer to identify. Do they actively listen to you? Do they respond to what you are saying in a way that makes you feel heard? Do you feel judged or ashamed after you share your thoughts and emotions?

As a therapist, is not my job to give advice and tell the client what to do. You are not being set up for success if your therapist does not provide you with the skills to make decisions for yourself.  Do they focus on themselves often? It is common for a therapist to share parts of their life and experiences in order to build rapport, but if they consistently take the focus away from you, you are not getting what you are paying for.

A therapist should never initiate a duel relationship with a client. This means that multiple roles exist between the therapist and client, such as a sexual relationship. A therapist should never initiate any form of physical contact with a client outside of a handshake or hug. If you do not feel safe with your therapist, it is time to move on. In serious cases such as sexual assault, report the therapist to their credentialing body and call the police. If you are unsure about an offense, call and ask.

If you feel like it is time to choose another therapist, trust your gut and start the process. Talk to your current therapist, even if you are unhappy with them. Try not to just stop going to sessions or make up a story to end therapy. This won’t help you end the relationship in healthy way nor will it give the therapist a chance to accept your feedback and grow.

Let them know that you have been dissatisfied with your treatment and/or how they have treated you. Ask them for any referrals they may have for a new therapist. There may be a chance for you to have a “warm-handoff” to another therapist. This is a transfer of care between two healthcare members, which enables them to share your information so you are not starting over completely from the beginning.

How can people figure out which kind of therapy is right for them?

You may not fully know what kind of therapy is right for you until you try it out with a therapist and practice the strategies and techniques. While doing your therapist search, you can also learn about the models of therapy online or by asking a professional in the area.

What should people expect from their first session with a therapist?

Therapy sessions are typically 45 minutes-1 hour in length. If you are going to see a therapist in an office, you will likely be completing some paperwork! Usually the secretary will let you know if you need to arrive early for this. Online therapy with BetterHelp is typically different, as you complete all of your “paperwork” prior to being assigned to a therapist.

The first session is for you and your therapist to get to know each other! Your therapist wants to know how they can help you and what your goals are. You will likely be asked why you have sought therapy, your personal history and what is presently happening in your life. Your therapist will ask you about your symptoms and how they are impacting your daily life.

As a client, be open and honest with your thoughts and feelings, and ask questions. Therapy is a team effort, so don’t expect the therapist to do the heavy lifting for you.

What are some ways for people to know they’re mentioning ‘enough’ of their history to a new therapist for them to get a good impression of your needs? And what kind of things can people expect therapists to say or do to help with this?

If you have a competent therapist, they should be asking you many questions to understand your needs. It might feel like a game of 21-questions!

A therapist also might have you complete an informational questionnaire to help gather information quickly. If you find that during sessions you are not discussing what you want to, it might be time to speak up and clarify your needs. The therapist might need some feedback to get your treatment back on track. 

How do you set healthy boundaries and realistic expectations when working with a therapist?

Remember that this is your therapy and you are in control of what you discuss. Your therapist is likely to ask you about difficult and sensitive topics, but you have the right to let them know that you are or are not willing to discuss a certain topic. It is also your decision to tell your therapy why you do or do not want to talk about it. It is okay if it takes you time to open up, or if you want to keep certain doors closed.

If it is hard to have a conversation in person with your therapist, try writing it down on paper as a letter or e-mail to your therapist. It is important that you feel comfortable!

You don’t specialise specifically in chronic illness or disability, but you’ve definitely been more effective than specialist therapists that I’ve seen – what skills do you think specifically have helped you when treating me?

I don’t think you can emphasize active listening and asking questions enough as it applies to being an effective therapist. Don’t be afraid to tell your client that you don’t know something. If you are able to hear the client and ask questions to show genuine interest, clarify your own questions, you will be able to connect with the person no matter what.

Make sure you do your research if you don’t know what is a specific disability or illness is. I have learned that you need to adapt to each individual in order to be an effective therapist.

One thing I definitely found quite novel about working with you is that this was the first time I had therapy that wasn’t just…venting…! We worked on tangible strategies and skills to help me cope. What are some of the major takeaways would you say from working with patients like me? 

Good question ☺ My major takeaway from our work together is that is has helped me realize that applying therapy for a person like yourself with a disability will not be the same as someone who does not have a disability.

A big reason for that is factors like fatigue and medical symptoms that you deal with every day. While I will still hold you accountable and push you in therapy to work on your goals and use strategies, I have to keep an open mind.

So if you miss an appointment, struggle to practice a technique, it is important for me to understand all of the other things you are trying to cope with behind the scenes.

Social media can play a hugely important role in helping people get support from others who are in the same boat as them, but there can also be negatives to some of these relationships – with well-meaning people offering advice based on limited knowledge or their own experiences. Are there situations when it’s important to seek help from trained professionals?

In my everyday life I often refer clients to support groups that are online or in-person. There is a huge benefit that can come from receiving support from someone who has experienced similar things to you.

Taking advice from others is very tempting, and often people online are looking for comfort and solutions. However, taking advice from someone who is not trained in the mental health field can lead to disappointment or more severe consequences. If you are experiencing significant mental health symptoms or going through a crisis, such as feeling suicidal, it is best to seek a professional who is a trained professional so that you get through that situation safely.

And I suppose an important follow-up to that is how can people go about getting access to help when they may not be able to easily access it – be that for financial, physical, or any other reason?

If you do not have private insurance, or can’t wait for public healthcare, some private therapists will offer a sliding scale for a fee that matches your financial resources.

Some universities and university hospitals have students working on their training and may offer a low fee or free sessions.

Try to seek out a state or local health department in your area, they may provide low-cost treatment options.

For those with physical disabilities or lack of transportation, in-home therapy may be an option if it is provided in your area. Alternatively, online therapy is another great choice!

Resources such as the National Suicide Prevention Lifeline (1-800-273-TALK) are available 24/7. This is a free and confidential service, and they may be able to refer you to other resources at the same time. 

Are there effective alternatives to talk therapy that people don’t need to travel to?

If talk therapy isn’t for you or isn’t any option for you, there are alternative therapies such as art therapy. Art therapy has been shown in studies to reduce mental health symptoms, as well as anxiety and depression related to chronic physical illness.

There are also various mobile apps that cater to depression and anxiety and help you track your mental health symptoms. Some examples are Headspace, What’s Up, and Mind Shift. Many of these apps are free! The internet is a great resource to find free materials like worksheets and exercises to try in your own home.

How, as a therapist, are you sensitive to the situations of people who come from a different background to yours – who and may have experienced prejudice because of their race, gender, disability etc?

In my career, I have worked with people of all different ages and background. I currently work with clients all across the globe.

My experiences have helped me understand that my culture, beliefs, and goals may be different from the client I am helping. I firmly believe that talking about differences between my client and myself is helpful to the therapeutic relationship, not harmful.

Again, asking questions and doing your research is important as a therapist! I try to show respect for the client by learning about their background and experiences in order to provide more effective treatment.

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