Mental health counseling can be an important aspect of hidradenitis suppurativa (HS) care, as physical pain and social stigma put people with HS at risk for people with HS at risk for depression. If you’ve never tried counseling before, it’s normal to feel nervous and wonder what to expect.

In this article, we’ll cover what to expect when you start mental health therapy, touch on evidence that counseling helps with depression and chronic pain, and hear from myHSteam members on their experiences with therapy. Read on to help put your mind at ease so you can access the care you need.

What Happens During Therapy?

Mental health counseling techniques vary. Regardless of the type of therapy, the initial appointment usually involves you sharing your story. You may be asked to fill out a questionnaire before going to the office.

During your first session, be prepared to answer lots of questions about how HS affects your mental health and your daily life. This is a good time to ask the provider questions as well. You can ask what to expect from future sessions and talk about goals you’d like to set.

After the first appointment, the structure of the sessions will depend on the style of counseling. In general, sessions last about an hour. Most people think of psychotherapy or talk therapy when they picture mental health counseling. In psychotherapy, you’ll meet with a licensed therapist individually or with a group to become more aware of your emotions and learn mindfulness strategies. You’ll work on gaining control over how you feel, and you’ll also get support from the group or the therapist to improve your well-being.

Different Types of Therapy

Cognitive behavioral therapy (CBT) is one type of psychotherapy often recommended for people with HS. CBT helps you change your inner monologue — the conversation you have with yourself in your head. With the guidance of your mental health provider, you’ll work to reshape negative thoughts and identify false beliefs that may bring you down.

One myHSteam member described why they find therapy necessary with HS. “I think nearly everyone who has HS needs to have mental health counseling, as the stress of the disease is horrendous. While one can talk to intimate friends and family, a therapist can suggest approaches for dealing with ‘distress tolerance,’” they explained. “I also took a course on Coursera with regard to resilience training. Living with HS and other chronic problems is like training for a marathon. We must be working at advancing our craft, or we’ll slip backward into negativity, despair, and self-destruction.”

Learning about different types of therapy can help you make the right choice. In addition to CBT — which can be done in a one-on-one or group format — there’s also art therapy, hypnotherapy, mindfulness-based cognitive therapy, and many other types.

Before committing to one therapist, you can ask to set up an introductory meeting to learn more about the practice. You can also read reviews to see what others have said about the practice you’re considering.

Does Counseling Work?

Depression is a treatable condition, and mental health counseling can be life-changing. Psychotherapy has been shown to offer lasting benefits for depression. Meeting with a counselor for the first time is a definite step toward feeling better. If you’re not comfortable meeting with someone in person, consider using a mental health services over the phone call or online. Just making that first connection can help you move toward a healthier headspace.

One myHSteam member encouraged others to give therapy a chance. “Talking to a counselor or a psychologist helped me a lot with depression. With HS, I believe that stress and depression are triggers. … Depression is caused by HS; HS can also cause you to be depressed. It’s tricky. Talk to someone. Give it a try. I hope it will be helpful.”

Therapy May Also Improve Pain

There is little specific research on psychotherapy for HS pain, but some studies have shown the benefits of therapy for chronic pain in general. One study showed a combination of CBT with other therapies (such as self-hypnosis or therapeutic music) offered sustained benefits for people with chronic pain. Participants reported less pain intensity and better sleep. For many, the effect lasted at least one year.

Another study on veterans facing orthopedic surgery found that participating in a one-day workshop on acceptance and commitment therapy before their operation led to greater pain reduction at three months post-surgery. In addition, participants discontinued opioid pain relievers nine days sooner compared to those who didn’t take the workshop. Research into the effects of psychotherapy on physical pain is ongoing.

Setting Realistic Expectations

Therapy won’t cure your skin condition or eliminate your physical pain, but it can provide several benefits, including helping you reframe the way you think about HS.

It’s important to have realistic expectations about counseling. Mental health therapy can teach you self-care strategies to reduce stress, think positively, and find moments of happiness. It can be an outlet to express your frustrations and disappointments, give you tools to improve your relationships, and help you discover meaning in everyday life.

Give Therapy a Chance

You’ll need to give mental health counseling enough time before you start to see the results. If you’re unsure after the first session, don’t give up. Not every potential therapist is the right therapist for you. Mental health professionals have different specialties and strengths. Your first therapy session probably isn’t enough to pass judgment on whether therapy will work for you. After additional sessions, you may decide a different therapist or a different counseling approach is a better fit.

As members of myHSteam share their mental health challenges, other members offer hope. “I can remember having these feelings of depression and hopelessness, and it really sucks,” said one member. “I swear stressing about it only makes it worse and creates more flare-ups. I've been coping for over 12 years now and still going. A positive mindset is key! I hope you’re in a better place now. … Keep your head up; you are beautiful.”

Talk With Others Who Understand

On myHSteam, the social network for individuals living with hidradenitis suppurativa and their family members, more than 32,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.

Have you found a good therapist or type of therapy to support your mental health? If you recently tried therapy for the first time, how did it go? Share your experience in the comments below, or start a conversation by posting on your Activities page.