What is therapy (or psychotherapy)?
Why enter psychotherapy?
Why choose a psychologist?
Is medication a substitute for therapy?
Is therapy confidential?
Do you accept insurance?
What if my cultural background is different than yours?
Objections to using therapy
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What is therapy (or psychotherapy)?
Basically it's a system of respectful interventions which invite you to develop new and better ways to cope and grow in your life. It identifies and improves ineffective or uncomfortable old habits of thinking and acting, which may have made sense at one point in your life, but no longer serve you well. It encourages you to use your best skills and talents, not knee-jerk semi-automatic reactions that leave you wondering why you acted a particular way. It seeks to unblock your creativity, shine light into your dark areas, put more tools in your toolbox, and tackle all manner of problems and personal growth. Freud called it "the talking cure." Done well, it's educative, inspirational, and life-changing.
Psychotherapy generally happens in a face-to-face meeting in the therapist's office. After initial consultation, the therapist presents her impressions and treatment plan. This plan delineates which problems/pains and goals are to be addressed and provides an estimate of time required to complete work on them. The number of sessions needed depends both on the depth and breadth of the problem, and the rate at which the client is able to gain insight and make changes. Some clients find such great benefit from the process that they revisit the therapist for new work intermittently over many years. The "therapeutic relationship" formed between therapist and client is one of trust and great good will, and it is at the heart of the psychotherapeutic process.
A metaphor that I often use for therapy is one of "getting our troops back." The idea is that we all come into this world with legions of troops which are equipped to protect us, guide us, and fight our battles. Each time we have a conflict, or pain, or reach an impasse, or get stuck in procrastination, our troops are engaged. They are mighty and they work hard. Over time, however, they begin to wear down from all the combat. Each conflict which remains unresolved ties up some of our troops. Each goal unreached ties up an additional number. At some point our troops are scattered quite far and wide, still hammering away, fighting on our behalf. Ultimately, too many of them are stuck at these various emotional outposts. and we are left with too few marching along with us. Bottom line, we need all our troops with us at all times, and we need them to be strong, well-rested, and ever-ready. Therapy frees up our troops.
Why enter psychotherapy?
People come to therapy for many reasons. Some are in great psychological or existential pain and are feeling at the end of their rope. Some have been told by their spouse or partner that it's therapy or the relationship is over. Some are stuck at a particular point and can't get beyond it, e.g., they can't find a job or a mate, or can't stop an unhealthy habit, or can't control their anger or sadness, or can't get their creative juices flowing, or can't leave a destructive relationship. Some have been sent by their doctor, because their stress is too high and they are having physical symptoms and diseases. Some have long-standing psychological issues that they now feel ready to address, while others have unexpected life changes which have resulted in a new imbalance. Some simply want more expert input in their lives, because they feel they could be doing better. Finally, some have chosen a lifestyle of personal growth and want to keep exploring new frontiers and upping their game. Basically, people enter therapy because of an inner need to live life more comfortably, competently, and completely.
It was Socrates who said, "An unexamined life is not worth living." His point was that life is enriched by being mindful about one's path. Reflection leads to increased balance, depth, and happiness. It helps you decide what's most important in your life and provides a context for deriving meaning from your experiences. Therapy is a well-proven way of examining one's life.
The benefits of the "examined" life are many for those who choose and use the therapy path. Goals are reached, relationships are deepened, problem-solving skills are enhanced, daily life becomes more fruitful, and personal competence and contentment grow. Wisdom is accelerated as the balance of mind (thinking and emotions), body (health and fitness), and spirit (depth, gratitude, and joy) strengthens.
Why choose a psychologist, instead of a psychiatrist or counselor/social worker, or coach/mentor?
The various types of licensed psychotherapists have differing educational and clinical training backgrounds. Choosing the right one for you is more of an art than a science--great therapists can be found from each of the training models. A psychologist is the right choice if you want doctoral level training and experience in your therapist, and are not looking primarily for medication management. Clinical Psychologists with a PhD have done 5-7 years of focused graduate study and pre- and post-doctoral internships, as well as original research in clinical psychology. Psychologists are also trained in testing. A psychiatrist is a medical doctor (MD) who completes 3-4 years of residency training in mental health diagnosis and treatment after medical school, has the ability to prescribe medications, and may focus their practice on medication management. Both psychologists and psychiatrists are trained to treat complex, severe mental illness in both in- and out-patient settings, as well as provide short and long term therapy for more common psychological difficulties and/or for personal growth. Licensed counselors/therapists (LMFT) and social workers (LCSW) generally have a master's degree and requisite clinical internship hours for licensure. They often work in a variety of community-based settings, and may practice privately as well, often with a focus on marital and family issues. Consider shopping around before you make your decision about which type of therapist is the best fit for you.
Coaches and mentors are not licensed therapists and do not treat psychological difficulties--they generally focus on a particular set of skills in which they may be certified by a training institute. A mentor is generally a wise and trusted person who has successfully navigated the situations you are in, brings their resources to you and points out minefields. A coach guides from the sidelines, holds you accountable and inspires your inner resources. Many licensed therapists are trained and experienced in both mentoring and coaching, and employ both these forms of guidance in their work.
Is medication a substitute for therapy?
No medication can provide insight or problem-solving skills, or identify or treat the underlying causes of emotional distress. That said, people are physiological beings who rely on brain chemistry for much of their psychological and behavioral functioning. Many things impact brain chemistry, including diet, thoughts, drug/alcohol intake, exercise, use of targeted nutrients, and prescribed psychotropic medication. Psychologists regularly obtain excellent therapeutic results without the use of medication. At times, however, a combination of medication and therapy is the right course of action, and psychologists often collaborate with a prescribing physician. Also, there are some individuals or situations which are not amenable to psychotherapy, but may be stabilized with medication alone. The side effects of psychotropic medication are significant for many people, however, so the risk/benefit profile needs to be carefully considered for each individual. The decision to use medication should never be taken lightly nor seen as a substitute for the rich work of personal growth.
Is therapy confidential?
In general, the law protects the confidentiality of all communications between a client and psychotherapist. No information is disclosed without prior written permission from the client. You should be aware, however, that if you use insurance benefits to pay for all or part of your therapy, some information about your treatment will need to be reported to your insurer.
In addition, there are some special circumstances in which the law requires therapists to break confidentiality. These exceptions include:
- Suspected child abuse or dependant adult or elder abuse. The therapist is required to report this to the appropriate authorities immediately.
- If a client is threatening serious bodily harm to another person. The therapist is required to notify the police.
- If a client intends to harm himself or herself. The therapist will make every effort to work with the individual to ensure their safety. However, if an individual does not cooperate, additional measures may need to be taken.
Do you accept insurance? How does insurance work?
Yes, I accept insurance, as an "In-Network" provider for Blue Shield, and as an "Out-of-Network" provider for many other insurance companies. To determine the extent of your mental health coverage, I'll provide you with my "Insurance Worksheet" at the first visit. This will clarify your benefits and show you exactly what your net payment to me will be. Basically you'll need to find the answers to the following questions:
If you would like to use your insurance to cover your therapy with me, using your "Out-of-Network Provider" benefit, you will pay in full for therapy at the time of service, and then submit my statement with required documentation to your insurance company for reimbursement to you of the "covered" amount.
- What are my mental health benefits for for Blue Shield providers or for out-of-network providers?
- What is the "allowable" fee?
- What percent of the allowable is covered?
- What is my deductible? How much of it has already been met?
- How many therapy sessions does my plan cover?
- Is pre-authorization required before starting therapy?
- Are all mental health diagnoses covered at the same rate?
Using your insurance to cover your visits to a psychologist, or any therapist, can be a mixed blessing. While your out-of-pocket expense will be reduced, so will your privacy. At the least, I will be required to submit a diagnosis, dates of service and charges to your insurance company. Many insurers require much more information, including justification that the treatment is medically necessary, statements about your capacity to benefit, treatment plan, and progress notes including therapeutic methods used and your response to them. Since neither you nor I have control of such information once it leaves my hands, you might reasonably choose not to use insurance coverage.
What if my cultural background is different than yours?
I have worked with people of many diverse cultural backgrounds over the years. It's my responsibility to learn about your culture and understand you within that context. That said, I'm always amazed at how universal many of the issues and themes are which bring people into therapy. My in-patient work has provided me with the opportunity to work with natives of Viet Nam, Philippines, Korea, Taiwan, China, and India. I've also worked with many people from Mexico, Central and South America, Europe, Africa, and the Middle East. At times I've used a translator or family member to help with communication during sessions. Often, however, we are able to proceed just fine, maybe with the occasional use of a pocket dictionary.
In some cases it may make the most sense for you to work with a therapist who shares your cultural heritage. On the other hand, many people who are in the US from other countries prefer to participate in therapy within the Western/American culture, since they are living here. Solid English-speakers often fall into this category, as do people in bi-cultural marriages and families in which the children have learned more English than the parents. My first priority when working with people from other cultures is make sure you feel understood, whether by me, or via my referral to a therapist from your culture.
Common objections to therapy, and responses:
No time. It takes too long to drive there, sit for nearly an hour, and drive back.
Shorter sessions and possible teletherapy should help with that. On the other hand, maybe a nice break in your busy day is part of what you need.
Process is too slow and open ended. Therapist is not motivated to be quick.
Many problems and goals can be broken down into well-defined steps within a specific time frame, resulting in "brief" or "solutions-focused" therapy. Further, I offer a "2-Hour Solution" option that delivers an action plan for a specific issue, during one 2-hour session. During your initial contact or consultation with me, we will address the scope of the issues at hand along with treatment time frames. You should be clear at the outset what you are entering.
Speed of therapy will depend a lot on your own ability to focus on and implement new insights and actions. Major life changes take time to develop and become integrated. While the greater goal of therapy is overall wholeness and balance, it is possible to approach that in small bites. On the other hand, you may find that you want to continue your therapy momentum, reach additional goals, and extend the process longer than you originally thought. The important thing is that you are engaged and excited about your life improvements, and that the time frame is one that feels right to you.
Most therapists are no good. How do I know if I've found a good one? I don't know the person.
Be prepared to do some shopping for this important decision. Take the time you need to find a good-fit-for-you therapist. Check out their education, years of experience, licensing, and areas of specialization and interest. Think about what's most important to you. For example, you may want to know if they have "walked in your shoes" in some way, or successfully navigated impasses such as yours. You may prefer one gender over the other, or someone older than you (or not). You may want a specialist in "your" area rather than a generalist. Don't just choose a therapist because they are on your insurance provider's list, have an office nearby, or because your friend likes them--none of these insures quality.
Your first face-to-face meeting with a potential therapist should engage you and answer all your questions. You should feel understood, and hopeful about moving forward. If something doesn't seem right, say so. If, after the initial consultation, the fit isn't optimal, a good therapist should be able to refer you to someone else who would be a better fit. Remember, you are in charge of your therapy and can leave at any time.
It's not cool. There's a stigma. It says there's something wrong with me.
In many circles, therapy is very, very cool. It shows you are reflective and willing to learn how to work through problems and grow. In fact, the lack of personal therapy can be a red flag to some people who might want to befriend, date, marry, admit, or hire you.
Most successful people realize the importance of expert guidance and readily utilize such counsel in ensuring their continued development. Teachers, coaches, advisors, and mentors are common helpful experts, and are generally revered, not stigmatized. A seasoned therapist is all these and more. You are free to refer to your therapy or therapist in any way you wish, if the notion of "therapy" is off-putting to you. And don't forget, your therapy is entirely confidential, so the only people who will know about it are the people you choose to tell.
I'm not crazy. I'm not a nut case.
Of course you're not crazy, or a nut case. You are taking a reasonable approach to problem solving and personal development.
I don't see its value. It's not a credible answer.
See if you can find someone who has benefitted from therapy and explore with them how it helped. A literature search on the "efficacy of psychotherapy," will produce many supportive scientific studies. The American Psychological Association posts a Guide to Beneficial Psychotherapy which lists therapies which have met scientific standards for effectiveness: http://www.apa.org/divisions/div12/rev_est
Ultimately the issue will be whether a particular therapist can help you as a unique individual, and if so, whether that is of value to you. Therapy is not for everyone, even if they could benefit from it. Whether it has credibility for you is a highly personal matter. There are many paths up the mountain, and therapy is only one of them.
It costs too much.
Therapists are experts at what they do, and as such, are paid like other experts you might employ, such as physicians, attorneys, contractors, architects, consultants, dentists, real estate agents, etc. As with these other professions, therapists' fees comply with a community standard, based on education, experience, specialization, and performance/reputation.
Fear of the unknown.
It is normal to feel anxiety when beginning something entirely new. Once you take action by scheduling the initial consultation, meeting your therapist, and getting your questions answered, the anxiety will begin to lessen. You can also gain more knowledge and comfort by talking to friends about their therapy experience or by reading about therapy or viewing films which depict therapy--such as Good Will Hunting.
My problems aren't that bad.
You don't have to have a "problem" at all to enter and benefit from therapy. All you need is a desire to learn more about yourself and to improve your personal growth and life balance. And when you do have a problem, it's better to get a course correction early, when pressures are lower and options are greater. If the problem is causing you or the people around you discomfort, it's probably a good idea to get it checked out with a therapist--the same way you would schedule an exam with your physician for an uncomfortable physical ailment.
I can talk to my friends about things.
Yes, friends are great for that. If they are helpful, talk to them often. Most people find, though, that friends will either tire of hearing replays of the same old situations, or they will become worried if you are too upset for too long. Often friends are quite relieved when you finally consult a professional psychotherapist.
It will be uncomfortable.
In therapy, there will probably be times when you won't like what you're seeing in yourself or your relationships, and that may indeed feel uncomfortable. Yet at the same time, at another level, this new view will feel "deeply right," and lead to a sort of "aha" experience. Therapy is sometimes a bittersweet process of enjoying deeper self-appreciation while saying good-bye to comfortable old patterns which no longer serve you well. Good therapy is respectful of your comfort level.
Request a therapy appointment online now:
You may request a therapy appointment online here.