"Let's Talk Therapy" with Maggie

someday I hope I can call myself an earlybird, too🐦

Welcome to this tiny corner of the internet where an off-duty psychotherapist keeps the conversation going on how to make sense of this life thing we’re all doing.

This week’s newsletter is an interview series, “Let’s Talk Therapy.” Through these dozen or so questions, you will get a deeper sense of how therapy can look and feel within oneself. Like most things, transparency about an experience can do wonders in deepening our compassion. My sincerest wish is this series will help in normalizing the complex feelings that can arise through doing therapeutic work and empower us to utilize it more wholeheartedly. Also, if I’m honest, I hope to learn even more about the experience of being a client so that I can continue to be an increasingly attuned psychotherapist.

One thing before we jump in, I show up very much as myself here. Myself first, and all my other labels are secondary. If a therapist speaking candidly feels like too much to your system, that is absolutely is OK and this may not be the best particular newsletter for you.¹

This week Maggie of earlybird answers the Let’s Talk Therapy questionnaire.

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I suspect many of you already know Maggie and her best-selling newsletter, earlybird. If you’re not, in her words, it’s “the online equivalent of catching up with a friend over coffee - an invitation to pause, to reflect, to connect. Expect highly researched recommendations, essays, and ideas for a well-rounded life.”

I would say even “highly researched” is modest here. The amount of time, effort and love she puts into every single edition is evident from the first paragraph. All while also feeling palpably authentic and grounded in life and all it’s lifey-ness.

I recently had the pleasure of being featured on her coffee with… series and I cried reading my responses back. The power of a question that makes you feel interested and curious in yourself can be astounding—especially when you’re the one used to asking the questions.

Speaking of which, here we go with Maggie’s answers…

• First things first: How are you feeling–in this very moment–about volunteering to talk about therapy and mental health?

I feel good! It’s something I actually used to do a lot of (both personally and professionally) and have done less and less over the last few years, so it’s been an interesting opportunity for self reflection and reassessment of what has changed in that time!

• Tell us a bit about you.

Hi! My name is Maggie (she/her) – I’m a 34 year old living in Seattle with my husband, two kids (3Y and 6M) and our golden retriever. I’m currently on a pause from my corporate career, which focused on strategy and communications for social good organizations with a speciality in scientific and public health work (basically: helping scientists and researchers build and communicate more effectively and translating their work for normal people to drive adoption). In my time “off” from corporate work I’m exclusively doing relaxing things like renovating a 120 year old house, having a whole baby / parenting a toddler, writing my newsletter earlybird, and (attempting) to draft a novel. In my abundant spare time I love hiking, travel, photography and yapping with my friends over coffee.

KE: Kaitlyn jumping in here. You can learn even more about Maggie and earlybird in this piece here.

• What has your experience in therapy been like? Has it been what you expected?

Overall I would say my experience in therapy has been positive, and generally what I expected (I have my degree in psychology and spent my early career working in mental health, first in research on adolescent onset mood disorders and family focused therapeutic interventions, and then for a national mental health nonprofit).

I have been in therapy three times, all related to significantly challenging transitions and life events: once during college in the fallout of the end of a friendship, once in my late twenties to address what I would nonhyperbolically describe as the worst year of my life (got laid off, moved to a new city while unemployed and having a quarter life crisis, realized my new city brought on severe seasonal depression, and then lost all three of my living grandparents in the span of four months), and once in my thirties as a preventative measure during my transition into pregnancy and motherhood. All three experiences were pivotal in my ability to process, adapt and grow from the challenges of these specific phases.

KE: I really appreciate Maggie mentioning using therapy to address the impact of a friendship ending. I got a lot of questions in my AMA form about how to navigate friendships (like a lot). We are all wondering and trying to figure it out...²

I will say the most unexpected challenge for me personally was coming to understand that an intellectual understanding of therapeutic principles and processes and self-awareness of your challenging thoughts, feelings, and behaviors is not, in fact, the same as “doing the work”. ~rude~.

KE: Incredibly rude.

• Tell us about the types of therapists or modalities you’ve tried. Bonus vulnerability points for transparency on how much it cost.

The different types of therapy I’ve tried coincided fairly directly with the challenges I was facing during that time, and my own level of self-awareness and expertise at managing them.

• Cognitive Behavioral Therapy (CBT) for anxiety & panic attacks - college mental health center. $10/ session: My first experience in therapy was the most practical – following an extraordinarily stressful year and low-key traumatic friendship group breakup, I started having severe anxiety before social events. When this progressed to panic attacks, it was time to stop white knuckling and see the professionals. I got a short course of six CBT sessions (all the center had space for) and an rx for PRN Ativan. I made it through the semester and the combination of time, distance and some practice with CBT strategies helped keep the anxiety under control through the rest of college.

• CBT / Dialetical Behavioral Therapy (DBT) for a very jumbled adjustment disorder with mixed anxiety and depression/ seasonal affective disorder - University mental health clinic, sliding scale payment $50 per session. When the Worst Year Ever hit, I immediately reached out to the mental health clinic at University of Washington where I was assigned a therapist in training for CBT. During our time together it became very apparent that I didn’t really need more intellectualizing to identify my challenging thoughts and behaviors – I knew exactly what was causing my symptoms, and my reaction to them was honestly pretty reasonable (although still distressing). We switched to DBT practices and strategies to build radical acceptance, distress tolerance, and emotional regulation.

• Mindfulness-based (included Eye Movement Desensitization and Reprocessing Therapy, or EMDR, and some psychodynamic) independent therapist who took insurance. $125 per session. I sought out a therapist before embarking on a journey to having kids – I had been previously told I may struggle to have kids due to a PCOS/PMOS and endometriosis diagnosis, and didn’t want to get caught off guard by mental health challenges during the process. MBT was much less structured than my experiences in CBT and DBT, and I found I really struggled with it – partially due to therapist fit and partially because I eventually just felt like I was complaining a lot but not “doing” anything about it.

  KE: Such a moment of clarity and attunement here for Maggie to notice which modalities allowed her to click in and which ones did not. I’ll say it til I’m blue in the face: Therapy is not a one-size fits all situation.

• What do you notice you feel before sessions?

I won’t lie – I feel a not insignificant amount of dread before sessions. Something about the vulnerability of being seen in my worst moments combined with having to confront where my own thoughts and behaviors are exacerbating a problem is very hard for this recovering people-pleaser.

• What is the average session like?

My first two experiences in therapy (CBT & DBT) were at research based training institutions where I worked with therapists-in-training who were still under supervision and who had some element of research to their work (a process that I had worked on the other side of and thus was extremely comfortable with). For both experiences, I would fill out online questionnaires related to my ~official diagnosis~ prior to our sessions– (PHQ-9 and GAD7, if you’re curious) as well as questionnaires related to my therapists’ research interest. It was helpful self-reflection, although it did not entirely help me with my tendency to over-intellectualize. Sessions typically started with a review of the answers/scores and details around how the past week to two weeks had been, review of homework or other skills we had previously discussed, with the second half of the session focused on either learning and practicing new skills in relation to recent challenges.

KE: It’s so interesting to hear about this way of receiving therapy. I’ve only been on the research side of this equation. (I have a question about this below for you, dear reader.)

The mindfulness based therapy was my only proactive experience (e.g. working on preventing a potential challenge, rather than addressing an existing one.) It was also my only experience outside of research and online (shoutout zoom therapy during the pandemic). In the absence of a pressing mental health issue, and the structure provided by research elements and CBT and DBT frameworks, we spent a lot of time just… yapping. My therapist would occasionally recommend EMDR during certain conversations (I’ll be honest – it didn’t hit for me, especially in an online context), but we were primarily just talking. Having the space to talk about whatever during a time of transformation was definitely freeing, but I also could not shake the feeling that I was wasting my therapist’s time // just complaining a lot!

• How do you tend to feel after a session?

Absolutely wrung out – as a self-indentified “helper”, I struggle to accept help, and the emotional vulnerability hangover can be overwhelming. I started scheduling my sessions on Friday afternoons so I could just log off and not have to worry about rolling straight into a client meeting after crying my eyes out while feeling like a burden to everyone who has ever loved me.

KE: Oof yes. I can also imagine how the experience where she felt like she was just “yapping” (usually can be complimentary, in this case not) would exacerbate that feeling.

• How has therapy been different from other support you receive?

No matter my actual mental health status, I have always been able to present myself as very composed and self-contained. Therapy was the first place that I allowed myself to acknowledge where I was struggling, to be seen struggling, and to (try to) accept help and support without minimizing my emotions for someone else’s comfort. Having the space to process and learn new skills separate from my primary relationships was an enormous gift to those relationships – I was able to be more open and honest about my experiences while also operating with more interpersonal effectiveness in those relationships.

• Any specific meaningful tidbit you’ve gleaned through therapy you’d be open to sharing (e.g., a saying or way of thinking)?

During my first pregnancy I was struggling a lot with my own physical limitations and my feelings around worthiness and productivity. It was a constant topic of discussion, until finally my therapist Susan stopped me and just said, “I wonder what it would be like if you allowed yourself to operate at the level of a normal person”.

KE: Damn, Susan. 👏👏👏👏👏 (I feel like this hits even harder cuz her name is Susan, right?)

While I’m of the opinion “normal” is mostly a myth we’ve been sold by fogies who want a mono-culture and uniformity at any cost, in our brains the recognition that we have our settings stuck on over-functioning can be a big light bulb moment. 💡

As a high achieving perfectionist, this was not the first time I struggled with productivity and achievement and worthiness, but it was the first thing someone had said that didn’t just feel like an underhanded compliment and challenge to continue (like “wow you’re always doing so much…”). I was honestly floored. I genuinely don’t think I had ever considered what it would be like to take a step back, or to do less, because my default had always been hard mode. It was pretty silly, but became a helpful mantra during pregnancy and early motherhood.

• From your experience, what do you think is something the media and/or the general public get wrong about therapy?

I think people of a certain age (and to some extent the media) highlight the “unpacking your childhood” elements of therapy and the groundbreaking revelation parts of therapy and don’t always touch on the hard, kind of boring work of examining your own thoughts and behaviors and working diligently to be honest with yourself about your own patterns and working to change them. Like sometimes therapy is just doing a lot of worksheets and realizing you might actually be the problem.

KE: The IFS therapist in me is twitching at the “you might actually be the problem” wording, buttttt I think I know what Maggie means here. Sometimes we are slowly learning where we are hurting ourselves and others and we are the ONLY ONES who can do anything about that—I’m sorry, I hate it, too. It’s not fair, but it is where we have agency. And, sometimes learning about strategies that actually help us feel comforted can be boring.

⚾ inside baseball moment— I sent Maggie a draft of this piece and she was in alignment with my interpretation, adding, “sometimes you are the only one who can do the work to change the patterns that are no longer serving you. Diligently completing DEAR MAN // GIVE FAST skills for the 87th time can be an eye opening mirror about how far you've come (or how far you still have to go ;)).”

🤓 quick skill sidebar— DEAR MAN & GIVE FAST are acronyms for DBT skills specifically aimed at working on interpersonal effectiveness during difficult moments:

• DEAR MAN stands for:

  • Describe the situation

  • Express your feelings and opinions about the situation

  • Assert yourself by asking for what you want or saying no clearly

  • Reinforce (or reward) the person by explaining the positive effects of the requested change and/or the consequence of it not changing. (This may sound more manipulative than it is. An example of this would be, “I would be much less disappointed if you under-promised over-delivered about how much work you will be doing on vacation.”)

  • (Stay) Mindful

  • Appear Confident

  • Negotiate

• GIVE FAST stands for:

  • (Be) Gentle

  • (Act) Interested

  • Validate

  • (Use an) Easy Manner

  • (Be) Fair

  • (No) Apologies (e.g., no over-apologizing for making an ask, having an opinion, setting a boundary)

  • Stick to Values

  • (Be) Truthful

Here is a digital worksheet with both of these skills. I also have the DBT Skills Training: Handouts and Worksheets by Marsha M. Linehan. It’s a behemoth binder full of very practical (and often empowering) skills.

• How did you find your therapist? What are you considering when you search for a therapist?

The first two were just assigned to me – I picked the third! At the time, I was primarily focused on finding someone without a months-long waiting list and expertise in a given modality that I could afford – today I would give a lot more time and effort to “fit.”

• How did you know they were the right fit for you?

I’m going to be so honest and tell you that I don’t think any of them were quite the right fit for me. I know my second therapist struggled with me a lot as a patient – some combination of overly self-aware, psych background and the specific issues that brought me in and we had some real tough spots (think: me interrupting her line of questioning because I knew what disorder she was probing for and while well-intentioned it wasn’t at all aligned with my experience, or her crying in session in response to something personal I shared).

KE: Love the honesty here. The U2 song, “I Still Haven’t Found What I’m Looking For” is playing in my head right now.

🌸

• Tell us about a time(s) you’ve decided to stop working with a therapist or take a break. How did you know it was time? How did that feel to do?

My first two therapists had pretty structured sessions and were never intended to be long term– with my second, after I demonstrated ~total remission~ from the majority of symptoms that had brought me in we came up with a ramp down plan and an “if___, then____” for how to know if it was time to come back in. It felt great to graduate.

KE: This is a type of question I like to ask when a client is taking a break, “How will you know when it’s time to come back?”

With my last therapist, I knew it was time to terminate when I not only dreaded sessions but I found that sessions were stirring up unhelpful and unnecessary emotions by making mountains out of relative molehills. I let my therapist know I was feeling ready to terminate and her reaction (so nonplussed as to almost be offensive?) 100% validated that decision.

KE: This can’t be our girl, Susan, right?!

And all jokes aside, I can appreciate the near-apathy about the relationship coming to a close feeling like an ouch moment, to say the least—even if validating in the end.

• Outside of therapy, what do you consider part of supporting your mental health and well being?

SLEEP is a huge one. I really have no idea how I was operating on 4-5 hours of sleep for so many years, and I’m positive it contributed to me being an emotional wreck in college. I also rely heavily on time outside, reading, exercising and a small but incredibly supportive community in Seattle.

• How has therapy, if at all, impacted your relationship with creativity?

This is funny because I honestly think about some of my creative endeavors almost like mini-exposure therapy. Especially as a writer and creator on the internet, hitting “send” on some of my more personal posts or newsletter is something that genuinely is only possible because of therapy, and is also a regular opportunity to practice some of my therapy skills and techniques around perfectionism and fear of judgement. Otherwise, therapy has given me the freedom to feel seen, and to take more risks creatively.

KE: Exposure therapy is exactly the right way of describing writing on the internet.

• To you, what is a standout depiction of therapy or a therapist (e.g.,. TV, movies, books, podcasts, or reality)?

I really love Harrison Ford’s Paul on Shrinking (although ethical / boundary issues pop up left and right on that one). I love love LOVE the therapist from Crazy Ex-Girlfriend, and can’t not mention Robin Williams in Good Will Hunting.

KE: We, too, love “Shrinking” around here. If you wanna see my full season three download and debrief, start here.

• What would you say to your younger self about mental health and/or therapy?

I would say that you really would have benefited learning mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness skills way earlier – and it’s not your fault that you didn’t, or that you might have confused being academically good at psychology and research with integrating all of these concepts into your own behavior. We have to learn everything – from how to walk to how to read… Why would it be any different to learn how to think and feel and be a person in the world?

KE: Yes. Yes. Yes. 100 times Yes.

I would also emphasize that for those of us for whom being a helper is central to our identity (teachers, therapists, eldest daughters, people in the non-profit and social impact sectors,etc.) there can be a lot of unstated pressure to always be fine and never need anything. And this is, quite frankly, silly.

KE: and life sucking and dangerous at times…not to get too dark, but seriously.

• OK. We’re at the end. How was it to reflect on these questions?

This was lovely. I’ve been considering going back to therapy (once again as I process a Major Life Change) and it’s interesting to think about what I would want and the type of therapist that would be a good “fit” at this stage of my life!

☕

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Not to give too much credence to a parasocial impression, but I get the sense Maggie and I could hang for a coffee date that lasts for three, maybe four hours while our kiddos play and cause mayhem (or at least mine would) in the background. The type of honesty and heart she brings to her writing makes me feel less alone.

For more, check out early bird:

• a personal favorite of mine, followed by some classic columns from Maggie:

no. 31: up north at the cabin

extremely specific book recommendations, vol. 3

coffee with... minna lee jamison

no. 30: extremely specific summer reading recommendations

Questions & Considerations for you:

• Maggie talks about working with therapists in training. Has anyone else had experience with therapy in that setting? What did you like and dislike about this?

• Do you prefer more structured therapy (e.g., tracking symptoms, working on specific skills) or unstructured (e.g., we talk and see where it takes us)? Somewhere in the middle?

• Anyone else relate to Maggie’s admission that maybe she hasn’t found the right “fit” yet in her therapeutic relationships?

• Wild Card: I mentioned U2 in this interview and I’m thinking “I Still Haven’t Found What I’m Looking For” may be my favorite of theirs—or the Friends obsessive in me says I have to put down “With or Without You.” What is yours?

Before you comment: As these interviews include vulnerable information, this is a disclaimer that will be at the end of every one of these interviews. A reminder to be thoughtful in any comment you choose to leave. Any abusive comments will be reported and deleted swiftly. This has been quite a friendly and loving space, however I don’t think it hurts to be specific about the rules of engagement. Basically, take a breath before commenting and pressing enter, please.

• Book Club + Workshop Series: The Summer I Learned How to Let Myself Be Bad 😈 is underway. We are going deep on Elise Loehnen’s On Our Best Behavior: The Seven Deadly Sins and the Price Women Pay to Be Good.

  • Next up is Gluttony & Greed on August 9th at 10a (MST).³ The meetings allow for equal parts quiet time (e.g., visualization and journaling) and group reflection. Replays will be available if you can’t attend live.⁴

• Disclaiming: Therapy can be great. This ain’t therapy. You can find more info and my full disclaimer on my about page here. Abridged version: I’m a therapist, but not your therapist—even if you are a client of mine ~hi, dear one!~ this isn’t a session. I don’t think you could possibly confuse this newsletter with mental health treatment. Alas if that were to happen, let me say definitively, dialoguing is an entertainment and informational newsletter only, not a substitute for mental health treatment.⁵ || There are affiliate links on this page! That just means if you click on a link, find something you like and buy it, I’ll make some cash. Don’t worry, you won’t pay any extra. You can check out my Bookshop.com storefront here and ShopMy here.

• Come say hi! Any comments, questions, suggestions, please feel free to email me at dialoguingsubstack@gmail.com—or if you’re reading this via email you can hit reply and send me a message. Love hearing from you for any and all reasons!

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• [Workshop Replay] what would happen if I let myself want?—Getting into Envy & Pride for our summer book club + workshop series

• AMA #4—various questions about therapy and being a therapist including, “What do you think about talking to AI about topics one might discuss with a therapist?”

• say more #28: notes from another week in *living*—convincing my shame rollercoaster to drop me off somewhere I wanna be🎢, the best movie I’ve seen in awhile and decoupling pain from identity. boop boop.

• 🪄 here is to every space that had some magic to it 🪄—saying goodbye to my office

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If this spoke to you and you’d like to support my work, there are lots of ways to show that love:

1. ❤️ || restack || come hang in the comments

2. Share with a friend!

3. Check out my ShopMy page

4. Upgrade to a paid subscription (grants access to the entire archive, monthly round-ups, free workshops—like the one mentioned above or this one on connecting time and values, exclusive In Session with Pop Culture editions about current TV shows—next up is Ted Lasso)

Whether it’s your hype, eyeballs or dollars, I’m so grateful for your support of any kind <3

1. This newsletter gets into several different areas of exploration.

• With the Let’s Talk Therapy questionnaire I get to ask my favorite Substackers about their relationship to therapy.

• In Session with Pop Culture is a series where I watch TV shows and movies or listen to a new album with my therapist hat on.

• The monthly round-ups, say more, covers the previous month of what I’m watching, reading, listening to, eating, moving to and learning—and what it made me feel.

If you’d like to receive some of these sections but not others, you can go to your account settings to opt in and out. Personal essays come through the main dialouging page.

2. Here are a few pieces I’ve written on the matter: One on long distance friendships and another on “lopsided” ones.

3. Remaining Schedule:

• Sunday August 9th from 10-11:30 am MST || Gluttony & Greed

• Sunday September 13th from 10-11:30 am MST || Lust & Anger

• Sunday October 4th from 10-11:30 am MST || Bonus Sin: Sadness + Closing

4. These workshops are free to paid subscribers. If you were to upgrade, you’d be sent a promo code which can be applied to each meeting.

5. To find a mental health provider, Psychology Today or Zencare can be a place to start.