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#25 Therapy Demystified Part 1: What Goes On Behind the “In Session” Sign · College Is Fine, Everything's Fine

In this week's episode, we were lucky to have, a college student agree to sit down in Sarah's office and do an analog or pretend therapy session so that our listeners could have an idea of what it would look like for the first time to have an intake session with a therapist. I know we had such a brave student and ambassador who agreed to do this for us today. She was so open and willing to share some of her thoughts. So she is, she's a rockstar. We couldn't have. This without her. And I always felt like it's so interesting and everyone I talk to, I don't know about you, Liz wants to be a fly on the wall of a therapy session.know? Do you ever get that?  Definitely. A friend stopped by to gimme coffee yesterday and she knew I was gonna have like a virtual appointment and she's like, can I just like sit in the corner? And I was like, absolutely not. So lucky. Like we said this student Anushka, who she's agreed to share her name, was willing to sit down with Sarah and have an initial C B T intake appointment.Right. So a couple of things to note. One is that the, well, I would say the reason I think people are really intrigued also is. Related to why we wanted to do this, which is that a lot of people feel intimidated to even make that call. They don't know where to start. And I think not knowing what it's like sometimes it's not just curiosity, it's anxiety and that what is, what keeps people from making that call So, The reason we felt like this could be very, I mean, hopefully cool and interesting to hear but also that it could give you a window into what it might be like so that you, if you hear it and it feels like, oh, that's not so bad, maybe you could make that call., I also wanna say that I actually have a lot of anxiety going into this. I'm just noticing my anxious thoughts because. People can listen to this and hear me as a therapist and wonder like, oh, what's she getting paid for? ? You know, like there's some, there's nervousness around kind of, you know, I feel vulnerable too, but that's why I'm so happy, Liz, that you got to listen to this and give your thoughts.And we wanna make sure we, the audience knows this this is, , a general idea of a session. At the same time sessions, they can vary widely, you know certainly therapists vary widely so we wanted you to get a general sense of this, but obviously, obviously there's a wide range and I might not be your style. Liz might not be your style, but there is a therapist out there for you. Sometimes it takes a little work to find the right fit and personality fit as some don't you think that's so important?Oh, I say to people all the time that I, even as a therapist probably know after the first session if a patient's a good fit for me or not, and I'm very transparent about that, not just the problems that they're struggling with in terms of me having expertise, which. You know, just a side tangent, usually you will have a screener call that you'll have with a clinician if they have availability to see you, where you kind of just talk for five or 10 minutes and you're just sharing some of brief details about what's going on in your reason for seeking help.And if a therapist decides, you know what, like you're facing some issues that I feel like I have expertise in, I have availability. And you come in. Really what you're trying to assess in that first meeting is fit. Particularly like if you compared Sarah and I, we have really similar backgrounds. We might have some strengths in certain areas but for certain problems we we're pretty similar in terms of our training and expertise, that really it comes down to do I like this person?What's their sense of humor, their style, how do I feel in the room? Kind of what we would call, again, like our wise mind or our gut afterwards, you know? Might indicate like, okay, I, I wanna move forward with this person, or sometimes not. And, and I think that's something that maybe to even highlight, some people feel compelled to stay with a therapist even if they feel like it's not a good fit. , I know it's hard to find therapists right now, but really shop around, you know, ask questions. Really think about is this the right person that I wanna work?Yeah, . It's totally okay to shop around. Make some calls, look at websites, do some due diligence to see is this the right person? Yes, in terms. Kind of therapy you want in their training, but also are they a right fit for me? You know, sometimes people want a little tough love, some people want something warm and fuzzy. Sometimes a mixture of both.So , again, as there's a therapist down there for you (above- is all making initial calls, deciding to find a therapist) So, alright, so you finally found your therapist, . Liz, what are you looking for? You already mentioned a little bit, so you said in that first call you're really looking for.You know, some basics. Does my schedule fit and do I have the skillset that you need? Am I the right person? Yeah, I, I'm essentially looking for if you have, if you know what your problem is, can you label it and is it something that I feel comfortable treating? So, for example, I'm not an eating disorders expert, so if you're really struggling with eating, I wanna refer you to somebody that's an expert in that area.If you call me and say that you're anxious and depressed, That's something that I. , you know, deal with daily. So I, I, I really feel comfortable kind of treating those problem areas. And sometimes people don't really know, they might kind of say like, I'm having a hard transition, or I'm just struggling.And in those cases then I'm like, you know what we need, you need to maybe come in and I'll ask you some more questions in person to kinda. Bigger assessment of what's going on. And if I, if I determine that I'm not a good fit in that intake appointment, then I'm gonna help you hopefully find somebody that has expertise in the area that you're struggling with., we also wanna really make sure that you're aware we are two people in private practice who have our own style, and this is probably what we're discussing is people probably what the initial part of this feels very similar to other people in private practice, but. Let's be, let's be real. There's a lot of different ways to find a therapist.Sometimes it's through your pediatrician, a wider group practice, a medical practice through an academic center. And if we're talking to college students, a lot of times it's the college counseling center. So some of these initial pieces might not feel familiar. I do think that once we get into that first session , there's some generalities that you can assume are gonna take place.. Once you're in the session, we wanted to share with you guys, a little bit of what we might be thinking, what are we looking for in that first session. So I think in general, it's fair to say.that the person is gonna be taking sort of their background and their training. You know, am I a CBT therapist? Okay, I'm gonna be kind of paying attention to this from a CBT perspective. Am I a psychodynamic perspective? Am I doing this from a D B T perspective? There's all sorts of letters and so on and so forth, right?But in short, the therapist will be thinking about, okay, what is my general approach? And that's what you should know too as a student, that therapists. Sometimes a very specific approach. They only practice cognitive behavioral therapy or it's brothers and sisters. Sometimes therapists have what they call an eclectic approach.They have a wide range of various training, but they have a more. Sort of general or eclectic approach to things. So that's something for you to know ahead of time. Are you okay with their approach? But once you're in there, the therapist is going to be starting to ask questions to think about how, based on the way I see the issue, am I going to get to know this client enough so that I can figure out a treatment plan and help them feel better, help their symptoms become less intense or less frequent?Is that fair to.Yeah, definitely fair to say. I think, you know, people see therapists taking notes and they're like, what are they writing over there? Right? But essentially in that initial appointment, we're trying to take a athletic of your life essentially. And then a current. Assessment of what's going on.That's kind of getting the way of your functioning and then viewing it through these different filters or lenses based upon what type of therapy that you're seeking. But you're gonna hear a lot in this episode around cognitive behavioral therapy and C B T, cuz that is the therapeutic. Practice that Sarah and I both have adopted.You know, I was thinking Sarah, like where to start that. I think the initial question I often ask people can be really overwhelming now that I think about it and when I was listening to your episode with Anka is like, why are you seeking treatment? Right? , there could be a million reasons for that, but if you're going to see a C B T therapist, the things I'm looking for when I ask that question is, You know, are there behaviors or emotions that are a problem for you?Are they impacting the quality of your life? , are you feeling too little of certain emotions too? Me too much of others? Are there behaviors you're trying to do but can't? Are there too many behaviors that you're engaging in that you realize aren't really great for you? So we're looking for, what symptoms are you experiencing?And that usually is in the feeling or behavioral kind of area. And what, how, what kind of impact is that having on your light? And when I think about impact, I'm thinking about is it influencing your relationships? Is it influencing your activities of daily living? Like the ability to shower, go to bed, eat,, and then is it impacting your occupation, being a student, your academics, your job?Where do you see that it's, you know, having an negative impact on your life? I'm always writing things down too, and, and I, I try to show people, I'm like, I'm like, first of all, I'm making sure I'm getting the names right, you know, of like your sisters and your brothers and so on and so forth. And, and also, you know, sometimes people will say to me, oh my gosh, am I even making sense?And, I say, , your job is just to talk and I'm gonna be organizing it, you know, as I'm writing, I'm taking what you're saying and I'm just trying to put it into a place for later, and I'm gonna share all that with you. So they're not writing down deep, dark secrets, most likely.They're just trying to make what you're able to say. So you can just talk free flow style, fit into where they can help you the most. So they, they're kind of actively listening and writing for that reason. Alright, so we've talked about the call. You're going into session. Let's hear a little bit about what that first part of a session can sound. (MUSIC / TRANSITION Below = ANUSHKA intro questions through first statement about patterns/triggers)  So I know we talked a little bit on the phone about some of the things that have been on your mind, kind of enough to know that this felt like the right fit in terms of what you needed to get out of it and what I could offer you.  I wanna try to ask a few questions and then see if we can make sure that some of the things that you're talking to me about, we make a plan and I can give you some strategies or give you at least a roadmap for how I can work with you in those ways. Let's go into it in a little bit more detail. , do you just have like a quick spiel on what brought you in today?Yeah, of course. So I think this past semester a lot of what I've been struggling with, is this feeling of imposter syndrome. Mm-hmm. . And like, one of the classes that I was taking last semester was organic chemistry and like being, um, a pre-med student, like organic chemistry is kind of known as like one of the, the weed out classes.Mm-hmm. and like the most difficult classes.   And throughout like the semester, I just like felt more, um, I guess like, I don't like using this word, but I guess like dumber or like not as, not as smart.So you're suddenly in this room of people who typically you'd feel pretty comfortable.You're in a class, you've taken certain things before, you have a good reason for doing it, and suddenly out of nowhere, , you're struck with this idea that you sounds like you don't experience a lot, which is the dumb word, the D word. And so, and then when you feel that, even though you said no, I technically know that that's not a word that we're supposed to say to ourselves.And so even though logically, you know, oh, I know I'm not quote unquote dumb, I feel this in the moment. Yeah. What are some things that bring that up for you?  What are some of the triggers? Yeah, I mean, I guess like just low test grades. And that was like a big theme for me in this class. Um, we only had two exams and like one final. . Um, and like on both exams, like I scored pretty much like below average.Mm-hmm. , and that's not something that I was ever used to. I, in most classes I was like, I was the type of like overachiever to feel and like the high end mm-hmm. . So just like, kind of like having those roles reversed.  (BELOW = BACK TO L AND S, Orientation to CBT/ Does this need a transition or ok? I THINK THIS IS OK NOT SURE WHAT TRANSITION SENTENCE WOULD BE )  the other thing we should mention is that Liz and I are cognitive behavioral therapists. So you hear us say C B T a lot, it's short for cognitive behavioral therapy. That can actually mean a. Range of therapies, but the main thing that they have in common is they're looking at the interaction between how you think, where that helps you, where that hurts you, where that gets in the way, what actions you're engaging in that are making your symptoms flare up or keeping them around longer than they need to.And also paying attention to your body. Like what are some of the, red flags that your body is sending to you to say you're stressed, you're anxious, and then sometimes are those body signals accurate or are they false alarms? So that's the very general thing that we're trying to look at.Various thought patterns, self-talk certain avoidance behaviors or withdrawal behaviors are oftentimes something we see in anxiety and depression where we're just trying to kind of pay attention to those things. So in C B T. , Liz and I are probably commonly trying to look for certain words that come up.We're gonna be starting to look at ways that people are thinking that fall into some pretty understandable or common categories for anxiety or depression. And your, your, our ears are sort of perk for that.  just like taking a small thing and making it kind of like this volcano in my mind.It was like kind of like the angel in the devil  You know, certain phrases like, imposter syndrome comes up today. I hear that all the time. Or certain words like always or never or must my ear starts to pay attention. Okay? What comes after those words? Right? So you're just trying to kind of pay attention. You're hearing the story, but you're paying attention to certain themes or words that, you know, might indicate a thing to.? () (MUSIC + TRANSITION: NEED TO ADD SOMETHING HERE LIKE "LET'S HEAR A LITTLE MORE") Let's hear a little bit more from their session.  I think I've taken a lot of time in like, trying to understand myself and develop that like level of self-awareness where like I know I'm the type of person to not care what my friends think or what like other people think, but I care a lot about what my parents think.Mm-hmm. , um, more of like people who are older than me and people I look up to. I really like, kind of crave that like, acceptanceum, so I think like other people's in my head, like my perception of of other people's expectations of me kind of prevents me sometimes from. doing what I want or feeling the way that I want. Um, I have like an older sister. Who's also pre-med, and she's one year older.  it is difficult being the younger sister and just like, she's very like able to like, multitask a lot of different things and do well and I felt like she had taken the course that I had, that I was taking and she ended up doing really well.And at that point where I was withdrawing, I kept comparing myself to her and being like, she was able to do this and she did it. Well, why am I not able to do that as well? Mm-hmm. . Mm-hmm. . And then like, it was kind of like this battle in my mind where like, , yes. But you are not her. You're your own person, so you cannot have that expectation of yourself.So it was like kind of like the angel in the devil on like both sides, like talking to me. so you mentioned imposter syndrome. Okay. And then you mentioned comparisons to an older sister, right. To just have that nice easy comparison there. And you mentioned the need to seek approval or gain the approval in general, right? Imposter syndrome might encompass some of the comparisons and so on and so forth.But there's a little bit of addition to that term, ? It means I shouldn't be here, that somehow I got here and I'm a fake and I'm gonna be discovered as a fake. Mm-hmm. , is that what you mean when you say imposter syndrome?, whenever I'm in a room with like other pre-med students, I'm always like, they're smarter than me.so can I ask a little bit about when you're with your sister, you're with your sister and you're saying, I, my sister could take this class and my sister can do X, Y, and Z and she can do this. And when I'm in class with medical students, they're able to do X, Y, and Z. They can multitask and then you share, you know, I have anxiety and I have a d. . Those things both take a lot of energy. Mm-hmm. and can be at the end of the day draining. Mm-hmm. . Right? Because your mind is having to work to battle some of the anxiety and your mind is having to work to, you know, chug and get the engine revving a bit more in terms of organizing your mind and adhd, et cetera. What kind of emotions and thoughts come up when you see people who in your eyes have it more easily than you? Yeah, I will answer that. I just wanna go back just a little bit. Please do. And always correct me if I've said something that's off.Yeah. No, no, no. Not even, not correct. You just like kind of like. explaining something a little bit more. Cuz I feel like at least like my relationship with my sister, I think I like, it's, it's honestly like really good. Well, let me, let me start by saying I'm really glad you clarified. And this is something that happens a lot when people come in, they describe something that's difficult for them, for whatever reason, there's a person in their life who might be a cure or a trigger for some of those things. And then they feel, I dunno, maybe a little guilt, they really wanna clarify to me.Yeah. By the way, I love my mom, dad, sister, brother. Yeah. It's just that insert, you know? I just wanna be really straightforward and clear. Whenever someone comes in and they start to describe some of these things, I'm also in my head holding a dialectic that I know might be coming, which is to say, and you said it yourself, two things are true at the exact same time.Yeah. I love my sister. I'm proud of her, she's proud of me. We support each other and I have no. , I, I'm only have excitement for her that she's doing well. I can hold all of that inside me. And at the same time, some of the ways in which she does well just so happen to be rural areas of sensitivity for me.Right. And that's hard. And when I see it along with proudness for her a plus 98, whatever comes sadness for me. And that those two things can be hard to hold at the same time and they can be true at the same time. So for you to know, and also to just give you some comfort when you're describing anything with me, whether it's about your parents friend, I'm never going to assume that that's the only part of the story is the hard part.Yeah. Unless you tell me and we talk about it a bit more and we realize, no, maybe this is a bit more of a difficult friendship, but I'm always gonna guess and assume first that there is that what we think of as a dialectic. Yeah. That, that you love your sister, you support her. She loves you. and some of the ways that she thrives happen to be some of the ways that you're struggling.Yeah. Who wouldn't have a hard time? Yeah. And so the reason I say that is because we don't wanna throw away and just kind of push to the side your version of what you go through so quickly. Right. Because if you're saying, like, I looked at that 98 and it made me feel like I got punched in the stomach. If we go too quickly, but I love my sister and she's okay, it's then I'm worried that we're not gonna take enough care of the part of you that got punched in the stomach  (MUSIC / TRANSITION BELOW = OUR DISCUSSION OF RELATIONSHIPS/THE PAST)  You just heard Sarah talk with the student about their relationship athletic, who are some of the key players in their life, and the rationale for doing that is to understand , are the dynamics in these relationships helping the student, or is there something that maybe they need to work on?Are they getting their needs met? Are they able. Say no. And this could be with family, friends, , professors. So a really important part in the first assessment is to understand what does the social support system look like? And because we're human beings, what's going on in our relationships really impacts our psychological functioning.So that's why Sarah really took her time to really understand the landscape of anusha's socialright. I think a big myth about CBT is that we don't care about the pastOh yeah.I'm like, no, of course. That's where so many of these patterns begin, and it's such an easy way to validate the story of how someone got to where they are. I, I talk a lot about the past. I just don't wanna stay there too long. We can't recreate the past.We can't relive. But it's important to know that it's there is is sort of something to say, oh yeah, of course that memory comes up for you all the time and that's why you do X, y, and Z thing. You know? So, so I think that that's another piece of it too. It is important to understand not only relationships in that landscape, but your middle school and high school experience in general.Some, some, you know, some of us, we all have those sort of stories that make us. You know, either smile or feel down or feel shame. And those are sort of stories that pop up all the time for us. And they're almost like habit. And it's important to get to know those because they're probably impacting your current day-to-day functioning.And that's again, where we're gonna try to maybe be a little bit. different in focus is to say, wow, when you have that memory, you really stay home all day or you, you sort of withdraw and so let's take a look at how we can have a different relationship with that memory. Right? So we're just trying to sort of pull it into the present and get to be able to manage it in the present.So, . I was really happy when Anishka started to talk about some relationships she had with her family early on. Some difficult medical athletic she had. We didn't share all of this in there, but that was really important for me to hear kind of why she was at this particular place right now, feeling the way she was feeling.Yeah, I'm glad you mentioned that. I think the assessment is really that first appointment. You're gonna talk a lot, probably about your past and sometimes that could be confusing for people, particularly if they don't want to talk about their past. But I think, Sarah, you're right. You know, sometimes I'm working with someone and knowing that they had like severe separation anxiety when they started kindergarten, or they were an extremely picky eater.does kind of help understand why they might be struggling with something now. Like what has the trajectory kind of looked like in terms of your temperament, your personality and then of course, were there any stressful life events as you've aged into young adulthood that might have been some points of in time where your mood has shifted or changed, or you started to develop some of the difficulties that you're currently facing.and I also get really curious when they've had really wonderful easygoing times in their life, I'll say, let's pay attention to that. What was going on? You obviously can't have control over everything, but let's sort of see what was happening and what were you doing then. that we can try to recreate or get you back to.So you clearly had some strengths going on for you. Those are still there. What are we, what are we able to use? That's good information. So again, I always just love to debunk the C B T therapist, don't care about the past myth. Sarah, you know, we were just talking about assessing relationships and how that might impact why somebody's coming to treatment. And I noticed with Anushka, she was, talking about her family and you kind of caught her, I think, in some overexplaining or kind of justifying,, how wonderful like her family iswonderful. My sister's wonderfulknow which they are. They sound wonderful. They sound wonderful. I know. And is that something that you tend to see, that people kind of are afraid to present people maybe in a way, or they wanna make sure that we get the exact impression of, of who their loved onesYeah. I mean, not always. I think it's fine to come in and just like lay it out and, and have faith that the person isn't gonna. judge them or judge you and to be able to kind of hold that objectively. But I do have people who come in a fair bit. Do you? I mean, I think it's definitely something I see enough to be like, oh, I know what's happening here.You're, you don't want me to think badly of your sister. And so that's when I always try to point out that dialectic, like, and then I hold that too. I, I'm, I'm not going to suddenly have a black and white response and decide that you know your sister's no good for you,Right. Yeah. And I think people also think like parent. Parents get blamed for everything. So if they have a really good relationship with their family, they're like, okay, they're not responsible for what's going on with me. Right. I'm not here to point fingers, and if I could point to the exact reason why anyone develops any problem, then I probably wouldn't.Maybe I, maybe I wouldlike he'd be a psych, a psychic or something.I know. Yeah. So it's really more about just understanding. what influence does this person have in your life? What role did they have in this experience? And that it's unjustified to feel any guilt if you're sharing the good, the bad, the inRight? And if you're feeling guilty about talking about someone in a therapy session with me, the chances are you feel guilty sometimes about being mad at them when, when it's. You know, when we all would understand that. So, so it's something you wanna tackle pretty early, I think. So Liz, you're done with your first session or two. What do you wanna know by the end? What are, what are the things that you've pulled together in your mind and are ready to share?So by the end of the first session, I want the client to leave with some kind of treatment plan that I'm proposing. You know, I've kind of gone over the C B T model of emotions. I've outlined some treatment goals. What are some behaviors you wanna increase or decrease? What are some symptoms that you want reduced?And that I want some commitment. Does this sound like something that you're interested in?  (MUSIC/TRANSITION - Below is wrap up and discussion of CBTmodel + hw/practice buy in)  (NOTE: Needs a transition sentence..."Let's see how Sarah wraps up this first session with Anushka) Let's see how Sarah wraps up this first session with the Nebraska. what I hear overall and one of the ways I wanna think through how, how can I. Help, right. Is to say, okay, one is noticing some of these patterns of thinking, catastrophizing, some mind reading that's going on. Um, this, this sort of imposter syndrome. You shouldn't be, you know, in pre-med I'll, you know, and then also a lot of future predictions. I'm never gonna get into medical school and so on and so forth.all of those things are, are thoughts, right? But then those thoughts influence how you act. So if you're sad, you're more likely to stay in bed. Mm-hmm. , I've definitely had people with imposter syndrome, you know, rethink whether they should even be at the school and and transfer, which is a big version of that.Or even say, okay, I'm gonna minimize or sort of reduce the amount of things live sort of a smaller life on campus because I wanna only do things that make me feel safe. That that fear of being outed, , you know, keeps me from not engaging in things unless they're really in my comfort zone. So they live sort of a smaller life.What we wanna look at is, As how your thoughts are working, how much you're buying into them when you have them. Right. And then are you, are your actions based in those things keeping those thoughts and kind of having them chug along or are they aligned with your overall, to your point, kind of zooming out your bigger goals.So if you're somebody who says, I eventually wanna be, you said a psychiatrist, well what is going to help? Is it gonna help if you start to really hook into thoughts like, I'll never make it? Is this is too hard? Or is it something where you can say, okay, well I'm having a lot of these thoughts and my bigger long-term goal is to become a psychiatrist or whatever type of doctor.And this is part of the process, is to sort of manage the hard times. Yeah. Because I have a big goal in mind. So we will be looking at some of the ways that your mind has certain thought patterns. We'll be getting to know what kind of actions are you doing that really help you for your goals versus, or they're really more helpful for your anxiety and depression than they are for your goals.You know, we'll be paying a lot of attention to what feelings do you have, what emotions do you have that you try to avoid too. Some people just, they can't, they, they'll do whatever it takes to avoid anxiety or to avoid sadness, but again, that kinda leads to a smaller life. So we'll be talking with you a lot about the bigger goals you have, both for school as well as in, you know, life with friendships and so on and so forth.What are the values you want driving you? Where do you see yourself wanting to go? What are the sort of bigger words in terms that are important to you? You know, the reasons you might wanna be a psychiatrist, helping others, being an advocate. The reasons that I wanna see friends, even when I'm sad, having that connection with other people.Are those the things driving your behaviors or is it sadness, anxiety, some of those emotions? And once we get to know this, then we can start to engage in some experiments a bit. Yeah. You know, when I'm feeling sad, what happens if while I'm feeling sad, I act as if I'm not right. I act on the value of community with my friends and that connection I have that leave my action.Mm-hmm. , what happens to the sadness if you get out of bed, even if you're feeling sad and you sort of trudge over and you text a friend, Hey, let's meet up for coffee. Right? What could you imagine what happened to sadness if you acted on a value of friendship instead of the sadness if you go to coffee and what?Um, well, I think that like, obviously like it would, I would be, I don't know if it would, it wouldn't go away, but. be redirected towards like something else, like the positive emotions of like friendship and like seeing someone I care about, um, and spending time with them. And I guess like it's kind of like a distraction.Mm-hmm. , which can be good because when you go back to your room or whatever it is, you come back with like the knowledge that like this feeling isn't, it's like temporary, right? Yeah. It's, it's not permanent because look, you just went for an hour and you had a good conversation, a good time. So like, it makes it more manageable I guess, like, um, when you realize that like sadness is, is just temporary Exactly.So that's what our work will be like. Right? We're gonna be thinking about how you think I'm gonna paying attention to that, having you track some of that between session two, because let me tell you, um, you know, this is a 45 minute session and I'm gonna guess you have a big life outside of these four walls.And what we wanna try to do is to say, what are you learning about here that we can take and implement and get to know outside of this room? So talking a bit about tracking some of those thoughts, paying attention to which type of patterns pop up. Mm-hmm. . We'll also be talking about how those thoughts lead to actions that keep you stuck.We'll start to get to know those outside of just the ones we talked about today and think through what are some actions that you can actually do instead to reverse this cycle. And we'll be getting to know too, which are the emotions that are the hardest for you to tolerate, and when do you need to tolerate them to reach a bigger goal or to act on the value of something like friendship or.Achievement as opposed to just in the moment not wanting to feel this feeling. Mm-hmm. . So that is what we'll do. And we'll sometimes even say, Hey, let's try an experiment today. What happens if you go and apply for another class that feels like a stretch, right? Because the last thing I'd want you to do is to say, oh, I took a risk in this class and it didn't work out.So that means I should never try and stretch my academic potential again. Mm-hmm. , that that decision shouldn't be based on fear. Mm-hmm. , that should be based on your overall bigger goals. Right? So that's the kind of thing we'll pay attention to. How can we notice and have some experiments around what actions you do that make you feel better?And also what thoughts that you can challenge a bit and not have them lead your actions. Yeah. Some of the things we're gonna be talking about in here, we're gonna want to have implemented and sprinkled into your real life.How does that sound to you? Does it feel okay for us to talk about ways to track your thoughts or look at some of your actions and practice some of these things outside of session? Yeah, that sounds good. You know, you heard Sarah. In this episode, talk a little bit about giving homework or practice, but you know, I'm a pretty good therapist, but 45 minutes once a week is such a small percentage of your time.So that you really, for things to kind of move along in treatment, you gotta be able to and willing to work on things outside of my office. So those are the things I wanna be clear that although this is an ongoing process at this point, we've identified these problem areas. These are my suggestions in terms of some skills that, or directions of skills that I think we should go into.Are you on board and, are you willing to put in the work?a little bit of buy-in cuz I, I agree. I'm also not so great that I can take 45 minutes and expand it out. So I'm just kind of like, how are we gonna sprinkle this into your life every day, you know, in some way, shape, or form. So, yeah. And if it is collaborative, you wanna be able to just. Share. You know, by the end of the session we have something called a case conceptualization.So there's a lot, lot, lot of words for saying, you know, what are the thoughts or the actions or the feelings, the relationships, what's sort of the roadmap that has created the anxiety or the depression or what have you? The stressor the. and what are the ways in which I plan to help you navigate through that and out of that.And so that is what we're essentially sharing is to say, okay, here's how I think about it. Here's how I wanna help you navigate through it and out of it. Or at the very least, sometimes you can't solve every problem. How to sort of stay calm in the storm of life when you need to.And does that sound right to you? So yeah, so buy in some commitment and yeah, to say like if the more you work outside of session, the more quickly these ideas are gonna be able to really take hold. So that is such an important part of C B T and something. Might feel different than maybe more supportive therapy.We're gonna be saying, we're gonna be checking in. I usually wanna hear from someone the next session. Okay. What do you remember from last week and what did, what kind of hit home? Where are you still confused about? Where did you practice some of this? Where was it hard? That's gonna be sort of through the, you know, the beginning of the following session is some, you know, to pull a thread in between session 1, 2, 3, 4, et cetera.All right. We've talked a little bit about the, how you kind of start that call, what it might feel like in the room. What your therapist might be thinking, , and I'm curious from our audience, is that what you thought we would be thinking? You know, it would love to hear you guys share. Does this feel okay?Does this still feel scary? We, you know, we're hoping that this can help anyone who's feeling that sort of hesitancy to make that call or send that email. In terms of our next session, Liz, do you wanna share the big, fun, juicy details, what they'll get to hear next?So next week's session, we're gonna really show you what C b T is. You'll hear Sarah identify, , thinking mistakes, patterns that people can get into in terms of their thoughts that might lead to some unwanted emotions. Sarah, Flesh out a little bit more. Sh I know we talked about it today, what the thought behavior, emotional model looks like in C B T.And again, identify some behavioral patterns and emotional patterns that exist for this student. And then she'll do what we just talked about. You'll hear her kind of establish a treatment plan, orient to practice,, and check in with the student to see like, okay, are you on board for what, what I'm.Yep. All right. We'll have to hear what she says. All right. We wanna thank Anishka so much for taking the time. Anishka, you're the best. Thank you, (NOTE: have below play with music in background) We are not gonna expect to see any change overnight., you to build the base before you can see the results. But I'm very aligned with you getting to that goal so that you don't have to be in therapy anymore, and you can go and study or spend time with your sister.Go to coffee with that friend. And that's my goal too, to have you learn these things yourself and then be able to be your own therapist and internalize some of this for yourself. Make it unique to you. Sound good? Yep. Can't wait to start therapy. Yay,