And really a large part of therapy seems to be diagnosis, with the added benefit that the clarity you get from working towards diagnosis (and the ability to confide in someone) already being helpful.

I would suggest just going to see someone and being as honest about why you are there, and what you hope to change as you can bear. The therapist will take the conversation from there. And if you ever feel resistance to being honest about something, just say that. You aren't required to be fully open about everything.

And no therapist is ever going to sit there thinking you are an idiot. They are there to help people, and they probably recognize that seeking help is hard. I think they will appreciate and respect the effort it takes for someone to seek help. They certainly won't ridicule someone for not knowing exactly what they want. Because they know how hard that stuff is when it comes to mental well-being.

I can imagine even starting by saying “I don’t really know what is wrong and what to say, so I’m afraid I’ll just be awkward and you’ll think I’m an idiot” and they’ll be like “Haha, that’s interesting, do you often feel like other people might think you’re an idiot?” and you’re up and running!

Sounds like something Dr. Sbaitso would say.. And he's a lot cheaper! :)

You can even truly leap the conversation forward with something as simple as what you wrote in your message:

"I have issues I'm struggle to fix myself"

That is as good a place to start as any, but there is no expectation for you to come to the meeting ready to say that. And you will lose nothing by not saying it.

My advice, after long experience, is simply to go in the moment and see what becomes of it. The prize of health is worth it.

Another way to start is checking if you match these (though you could be suffering from one and not even recognise it by reading the abstract description): https://en.wikipedia.org/wiki/List_of_maladaptive_schemas -- if you match any, this is a great place to start, regardless of the therapy affiliation.

I really like Schema Therapy, though I've only seen one therapist qualified in it, and while she started great -- gave me a long questionnaire that pointed out my maladaptive schemas I already knew were present(she made me feel "wow, finally, a great professional, just like I read in the manual they should be"), she just didn't stick at all to the Schema Therapy session protocol I read in the manual and the sessions just devolved into the usual "so how have you been since our last session .... bla bla bla ... you're making great progress" that I'm all too familiar with all the therapists that I know.

So whatever therapy you choose, try to find a therapist that's also sticking to the therapy method.

You could ask yourself witch bothers you the most.

Also if there are clusters of schemas, start with the ones in the same cluster, but your therapist should also be able help with what to start.

I do know of such a prioritization for BPD where you first have to learn to answer back to your internalized "punitive/critical parent" mode, and eventually eliminate it, because it will sabotage your progress, just like a real life punitive/critical parent would.

The idea is that when you (as a developer) run into a software bug you can't fix, you try to describe it out loud to a rubber duck. It turns out that the act of formulating these thoughts into speech is massively effective as a debugging method.

So my challenge to you is to revisit this statement:

>If they asked me what is wrong, I genuinely don't know.

Instead of shutting down because you don't know, just start speaking. Keep speaking. Deliberately turn off your filter. If that's hard, narrow the question. Instead answering "what's wrong?" answer "what's wrong today?" or "what's the strongest emotion you felt last week" or etc. And then expand around it. Describe the experience. Etc.

Journaling can also be useful in forcing you to produce words that describe what's going on, but it's also easier to slack off when there's nobody else in the room. If you worry about what you'll say in a therapy session, start writing and you'll likely come up with plenty to talk about.

I have the same thing. Every time I start thinking “big” I need to consciously stop myself and ask “what do you not know?”/“what needs to be measured?” Instead of continuing making assumptions.

You don’t need to speak to a duck to do that though. Speech has got nothing to do with your ego/laziness that makes you believe there’s nothing to be done and everything can be solved by thinking.

I've always had a good relationship with my mother but it was only though my therapist I even realized I did in fact have some attachment issues. Anecdotally when I mentioned that to my aunts they immediately starting sharing stories about mom. Family knew all along but they remained silent until I asked for detail. The point is for both the therapist and family just talking is enough to prime the process of discovery. You won't start with a giant epiphany.

It was immediately clear to me that she was warm and personable - for this reason, the article linked above resonated with me a lot.

I don't feel that I have any more ability to explain the state of my mental health than I did at the start of the sessions, but I'd definitely credit her with improving it.

To reflect on what you have said: If you ask me how my mental health has improved, I genuinely don't know. I just know that it has.

Never forget, the therapist probably had hundreds of patients like you with the same problem getting started which means he probably knows a thing or two to help you get started :)

First of all, don’t stress about explaining “what’s wrong” to a therapist before you meet them, or let this become a barrier to you getting started (I fell into this trap for years myself). A simple “Hi my name is X and I’ve been been thinking about finding a therapist to work on some issues with. When would you be available for an initial call?” is perfectly sufficient.

A thing people say about therapy is that it’s like a bit like dating. Don’t be discouraged if it takes a few tries to find someone who is accepting new patients and feels like a good fit (most will offer a free consultation as well to help you evaluate this). Give them a fair shot, a few sessions at least (I was skeptical of a therapist I was randomly assigned ~10yrs ago, but he swiftly cured a very acute case of hypochondria that had bubbled up out of nowhere. However, you should move on to the next one if it really isn’t working—unlike dating, your therapist won’t be hurt (or if they are, then they have the tools to deal with it right?). This is probably the best directory for finding local therapists: https://www.psychologytoday.com/us/therapists

Most will give you a set of questionnaires to complete before or during your first appointment (e.g.: https://www.uwgb.edu/UWGBCMS/media/Continueing-Professional-...). This gives them a coarse baseline of what’s going on.

The conversation simply evolves from there. Over time, you will occasionally pull out surprising memories and insights from the depths of your mind like the proverbial Mary Poppins bag. There’s a lot in all of us to unpack, and they are there to facilitate that process.

A common attitude (again, one I’ve suffered myself) toward therapy is: “What will a therapist tell me that I don’t already know? I can solve these problems on my own if I actually tried.” Maybe, but the operative word phrase here is “actually tried”. Actively reflecting on your thoughts/emotions/actions and vocalizing them to another person for an hour is challenging, but it is therapeutic in and of itself. It’s very hard to do on your own, and sometimes take a probing question or two to dislodge a blind spot.

Also, if you want to listen to some real therapy sessions (intermixed with lecture content on the theory and research behind a common type of therapy), these lectures on Cognitive Behavioral Therapy are excellent. It follows a few different people from the very beginning (skeptical of or unsure about therapy or what their deeper issues are) through their process of improvement via weekly sessions/assignments. It can really help demystify therapy for the unfamiliar: (https://www.audible.com/pd/Cognitive-Behavioral-Therapy-Audi...)

PS—Keep asking good questions.

I don't like listing complaints, instead of a productive comment like yours. Obviously, some people make it work, but maybe you need to know people with similar personalities and similar issues, to get recommendations?

Not long after that I (spoiler alert) needed a psychiatrist. It took me 30 calls to find someone with availability. I punched a hole in my wall around call #20.

As recently as last Fall, I was still spinning my wheels, delaying the unpleasant search process for a therapist. I was so frustrated with “the system” that it short-circuited any desire to make the effort. There were at least four major barriers:

1) communication anxiety — worried about explaining myself and my problems to a prospective therapist. [addressed in my previous comment—keep any introduction email/call extremely simple.]

2) financial anxiety — as with all healthcare in the US, the amount you pay is a random variable. Maybe it will be a waste? Maybe I will go bankrupt? [if you have insurance, find someone on your plan using the Psychology Today search filters—they also often list the cost. if not, there are other free or low-cost resources available, but it’s context/location dependent. some potential options include the VA, school/college therapy, counseling programs @ your employer, therapists in-training, various community/nonprofit organizations. ask a trusted friend to help you search, it can alleviate some of the frustration. you can ask me.]

3) avoidance anxiety — embarrassment around explaining my life story. Why and how should I explain the fact that I smoke weed 10x a day (a true 10x developer over here) to cope with my issues, when I could simply roll another joint? [one role of the therapist is to be a non-judgmental sounding board and co-strategizer—they aren’t your coworker, parent, partner, etc. this is a hard mindset to learn, even for me to this day. I find myself saying things I think my therapist wants to hear. as a corollary: ER docs have seen the full Cartesian product of injuries from {objects} x {orifices}. whatever you come in with is not as unique or embarrassing as you think. they do this all day long.]

4) perfectionism — “Yeah I’m sure this therapist can help someone get over a breakup or their dead cat, but I’m a special brand of fucked up and they won’t get it. I need to find a someone that is perfectly specialized in my personality/problems, or it will be a waste. Also they need to have a PhD from a good school, female, not too young or too old, not ...”. [just a reminder that this is not a search for your soulmate. a student therapist or MSW may be more effective for you than a famous professor with books and accolades (see above). anecdata: the two therapists that I hand-selected didn’t pan out for me at all. the two that were chosen for me at random were a wonderful fit.]

Finally, I would push back on the idea that remote therapy is ineffective. Telehealth in general is proving to be pretty effective, and with therapy they don’t need to interact with any physical structures. The only thing that is slightly diminished is nonverbal cues, but that’s not insurmountable. There are a lot of advantages: significantly more options (no location constraints), easy to schedule and keep appointments, can be more comfortable to not be physically present, and no stressful driving. I recently did a therapy appointment call from the Appalachian Trail!

    I'll need some information first
    Just the basic facts
    Can you show me where it hurts?
    …
    When I was a child I had a fever
    My hands felt just like two balloons
    Now I've got that feeling once again
    I can't explain you would not understand
    This is not how I am