FAQ

Therapy is an endeavor of growth. Anytime we try something new, it is natural to feel nervousness or trepidation. That’s one way our hearts and minds inform us that we are genuinely turning towards change. It’s also natural to feel nervous to let a stranger so close to our fears, insecurities, fantasies, and emotions. The therapy relationship is unlike any other relationship in modern society. We sometimes let therapists closer to our inner emotions than we let our partners, spouses, parents and our friends! Once we decide to begin this endeavor it is imperative that we find a therapist who genuinely can meet us where we are. Someone that can actually hear us, can give us reflections, and can engage with us honestly - while also having our best interests in mind.

If you want a deep dive on how I think about therapy, check out this video… otherwise keep scrolling!

How do I choose a therapist?

Everyone is different. Many folks who have the similar ‘symptoms’ have different personalities. Clients mostly want a therapist that they feel confident can help them feel better. Clinically speaking, the ground of progress in any therapy is the strength of the relationship. If a client isn’t open to what their therapist has to say, the therapist could have the most skillful and insightful ‘interventions’ and they wouldn’t matter. If a tree falls in the middle of the woods and no one is there, does it make a sound?

So first and foremost:

  • Do you feel a sense of ease when you speak with the therapist?

  • Do they feel present with you?

  • Do you feel subtly more in contact with yourself during or after the conversation?

  • Do you experience ‘warmth’ from the therapist?

Different approaches and techniques can be useful. But if your patterns formed in relationship, then the relationship itself becomes part of the work, not just what’s being talked about or the tools being used. This is why if it were me, I would focus on trusting how I feel inside when I talk to a potential therapist. If the above questions aren’t met with a “yes” I would feel less confident to make this person my therapist.

Is therapy modality important?

Therapists love to talk about the theory and 'modalities' that inform their work. However, research suggests that despite the increase in available number of modalities, the effectiveness of psychotherapy has been consistent over the last 40 years (Miller et. al, 2020). In other words, just because there are more modalities does not mean therapy has become more effective. Research consistently shows that a strong therapeutic alliance is associated with better treatment outcomes, regardless of the specific therapeutic approach used (Prusinski, 2022).

What does this mean for a prospective client? Don’t get caught in the marketing or social media fervor. Yes, certain modalities may work better for certain people. I for one am not a big proponent of CBT. However, there are people who CBT may work wonders for. I would not personally seek out therapy from a predominately CBT-oriented therapist…

I am fatigued by constant questing for the perfect ‘tool.’ That’s not how I learned to practice therapy; and that’s not what I learned therapy is really about. Exercises can be helpful, no doubt. But therapy is a exercise - a relational one.

And that’s why I would want to know that a therapist has committed to their own development, even if it looks different than mine. I want to know that they are not going to pathologize me. I want to know most importantly that they have the capacity to work relationally, which means being able to also work with their own reactions … In other words that the don’t think they know it all, they’ve been in therapy, they’ve looked at their junk, and they can sit with their reactions. I chose my current therapist precisely because he didn’t try to market himself based on fancy letters or therapy fads. He was clear in what he offered, and there were no frills, catchy marketing phrases… anything like that.

What do you mean by overthinking?


For many people, overthinking isn’t just a habit, it’s something that developed for a reason. It can be a way of staying safe, anticipating what others need, or trying to avoid conflict or disconnection. Often, it has roots in earlier relational environments where being attuned, careful, or self-monitoring was important. In the present, over-thinking is often a result of constricted affect that gets expressed through a cognitive stream of consciousness. Meaning, I over-think because I am trying to problem solve what I experience as threatening. The experience of ‘threatened’ is already happening inside of me, and so I try to find a way out. Understandable, but this is where we do want to develop the capacity to focus on other streams of consciousness, that

How does this connect to attachment or early experiences?

The ways we learned to relate to ourselves and to others don’t just disappear. They tend to show up in adulthood as patterns in relationships, decision-making, and how we handle stress or uncertainty.

Overthinking, anxiety, or self-doubt can be part of those patterns. In our work, we look at how these developed, not to analyze the past endlessly, but to understand what your system learned and how it’s still operating now.

Do I need to have experienced major trauma for this to be relevant?

No. Many people wouldn’t describe their background as “traumatic,” but still grew up in environments where emotions weren’t fully supported, where there was unpredictability, or where they had to adapt in subtle ways.

Those adaptations can show up later as chronic tension, over-responsibility, difficulty trusting yourself, or feeling stuck in certain relational dynamics.

What kinds of patterns do you help with?

This work often resonates if you notice things like:

  • Getting stuck in your head, second-guessing yourself

  • Feeling responsible for others’ emotions

  • Repeating relationship dynamics that don’t fully work

  • Difficulty slowing down or feeling at ease

  • Excessive self-criticism

  • A persistent sense of “something’s off,” even if things look fine on the outside

How is this different from just talking things through?


Understanding something intellectually doesn’t always shift the pattern. These responses are often held at the level of the nervous system and the body. In addition to talking, we pay attention to what’s happening in real time, sensations, reactions, impulses, so change can happen at the level where the pattern actually lives.

Is this focused on the past?

The past is absolutely relevant, especially in understanding how patterns formed. What is happening in the present moment is often a mixture of past, present, and future. It’s good to sort out these threads when we can.

I relate to recovery frameworks or adult children dynamics—does that fit here?

Yes. Many of the patterns explored in recovery spaces, like people-pleasing, hyper-vigilance, or difficulty trusting yourself, overlap with what we work with here.

This approach can complement that kind of work by helping those patterns shift not just conceptually, but experientially.

What does a session feel like?

Sessions are conversational, but often slower-paced than typical talk therapy. We might pause to notice what’s happening internally, track a reaction, or stay with a moment a bit longer than usual.

There’s no pressure to perform or “do it right.” The focus is on building awareness and allowing patterns to become clearer over time. We can’t force an insight. However, we can till the soil and plant seeds.

How do I get started?

You can reach out here to schedule a consultation. It’s a chance to see if this way of working feels like a good fit for you.

I'm here to talk during a free phone consultation where you can share what’s going on for you and I can share my ideas around how I can help you.

Email me today to get your free phone consultation at scott@scottmenasco.com.

or sign up through the calendar below!

Citations

Miller, S. et al. (2020).Better results: Using deliberate practice to improve therapeutic effectiveness. Washington, DC: American Psychological Association.
— Used to support the point that despite more therapy modalities existing, overall psychotherapy effectiveness hasn't meaningfully increased in ~40 years.

Prusiński, T. (2022). The Strength of Alliance in Individual Psychotherapy and Patient's Wellbeing: The Relationships of the Therapeutic Alliance to Psychological Wellbeing, Satisfaction With Life, and Flourishing in Adult Patients Attending Individual Psychotherapy. Frontiers in Psychiatry, 13:827321. doi: 10.3389/fpsyt.2022.827321. PMID: 35173642; PMCID: PMC8842997.