Considering Psychotherapy
Why might I consider therapy?
Therapy is an opportunity to gain expert guidance on a life problem you’re having trouble navigating. Therapy promises neither a quick nor simple fix. With your thoughtful approach and active engagement, you might find yourself rewarded, as others have, with newfound abilities to:
Respond more flexibly and capably to the problems we naturally encounter across living.
Experience our own lives and close relationships more deeply.
Protect ourselves from becoming disabled by the range of emotional conditions that hamper our potential.
Therapy is not the only avenue of working on oneself. One might first try reading some self-help books or talking through an issue with a family member or a mentor. However, therapy is the enterprise that most directly leverages the science of personality, relationships and human flourishing. The therapist is professionally trained in these sciences – and the sophisticated art of personal relations – to guide you along your journey.
Do I need therapy?
I’m reluctant to say that anyone needs therapy. I’m more interested in supporting your exploration of whether therapy could be helpful. Some questions I would offer for your consideration:
How much distress am I able or willing to tolerate before seeking help?
Are my problems interfering with my family, partner or work roles and responsibilities?
Have I tried working on the problem in other ways and found my progress slowing or stalled?
Is there a critical event for which I would like to be in a better place? (e.g. an engagement or wedding, birth of a child, a job promotion or career transition)
If you’re feeling anxious about starting therapy, know that it is anxiety-inducing for almost all new patients. I think it can be helpful to regard therapy as a time-limited experiment. Give it four sessions (if you’re happy after the first one) and re-evaluate after that month.
How do I know whether I'd benefit from therapy?
Therapy isn’t necessarily a great fit for everyone. Those patients of mine who tend to benefit the most are:
Naturally curious and sensitive to problems or puzzles.
Capable of thinking abstractly about a puzzle.
Modestly aware of their emotional lives.
Available for forming an alliance with the therapist.
Relatively stable in work and relationships in their ordinary lives.
Motivated to improve their lives and courageous enough to introduce changes in their lives.
How can I recommend therapy to my husband or my daughter?
Suggesting therapy to others is a delicate matter. If you were the target of such an appeal, can you imagine how you might infer that someone thinks something’s wrong with you. No one likes that feeling.
A helpful approach is to inquire respectfully (“I’m aware that this has been a challenge. Have you ever considered talking with a therapist about this problem?”), offer some resources (e.g. See my Therapy Resources page or my FAQ) and then leave the decision to them. Decisions to enter therapy are more successful when we get to make them ourselves.
If you’re in a position of wanting to understand the other person’s perspective, you might benefit from having a consultation to talk over your concerns about your spouse or family member. You can schedule that type of consultation from the Schedule a Consultation page.
Understanding Therapy
What’s the difference between a psychologist and an LPC?
A psychologist and an LPC (Licensed Professional Counselor) both deliver therapy. The psychologist has a doctoral standard of training and is uniquely qualified to conduct psychological testing. A psychologist and an LPC can be equally capable in helping you. What we’ve learned about what matters most in therapy is the quality of your relationship with the helper. In an effective relationship, you like your therapist, trust their opinions, count them as an ally, and have confidence in their ability to guide you. If you’re with someone and don’t have this fundamental experience, you might try a brief separation for perspective or gain an outsider’s opinion on the matter.
What’s the difference between a psychiatrist and a psychologist?
A psychiatrist is a medical doctor (MD) who has undertaken additional training in brain science and often treats mental disorders with medications. A psychologist cannot prescribe medications and treats mental disorders through psychotherapy. The simple distinction is drug therapy versus talk therapy! (Incidentally, the gold standard of treatment of many conditions such as depression is a combination of drug therapy and talk therapy.)
How long does therapy take to work?
Many patients find some benefit merely after scheduling an intake and before their first session. Go figure! It turns out there’s something incredibly palliative about taking action on a problem.
How long it might take you to find sustained relief or adequate understanding depends, of course, on different factors of your presenting problem: the severity, duration, contextual factors, etc. It also depends on your expectations of what it would mean for therapy to ‘work.’ What your timeframe might look like is a wonderful subject to explore with your therapist.
I typically propose an initial trial of 4 sessions of therapy to help you gauge how therapy works and what you can expect to gain over different time periods.
Are some people really in therapy their whole life?
Woody Allen popularized the idea that someone might be in therapy (or psychoanalysis) their whole life. And indeed, some people with developed mental health conditions would benefit from regular support on an ongoing basis. The worry that you could never leave therapy, or never get to ‘the bottom’ of your problems, could be a very natural fear.
I can’t say how long I’d recommend you stay in therapy. Most of my patients are engaged with me for between 6 months to 2 years. I want to encourage you by pointing to the fact that: 1) all problems are treatable (in some way), and 2) that it is the responsibility of the therapist to ensure you understand your treatment, including how long you might stay engaged. Ultimately, I want you to feel free and empowered to decide whether the investment you’re making (in time, energy and money) is worth what you’re receiving.
I’m a frugal DIY-er. Why might I pay someone to help me?
I sympathize completely with you as therapy is no light investment. The simple case for recruiting help is that you’re having trouble finding meaningful progress on your own. To help you put the cost in context, I might offer the below comments about the value of therapy:
One way to think about the value of therapy is to consider the potential costs of avoiding your problem. Could it lead to a medical problem, being passed over for a promotion, strained relationships with your children, a divorce, etc. How much would you pay to avoid those problems (or to have prevented the problems you might be suffering now)?
Therapy may be regarded as a legitimate financial investment when it can help develop your earning potential (e.g. by becoming more productive, developing your ability to assume more responsibilities, inspiring you to new positions where you’re more properly valued or better matched with your interests).
Applying your hard-earned resources toward therapy is a powerful way of affirming your belief in improving yourself – and making a stand against a powerful cultural or family standard against personal growth.
The benefits of therapy (highlighted above) compound over time so that the gains you make will multiply, over and again. It’s what leads many to conclude that therapy is the best investment they made in their own life.
The final thing I’ll say is that if you’ve been wondering about therapy for a while, a single session to explore therapy would almost certainly be a worthwhile experiment.
Beginning Therapy
What can I expect from the first session?
There’s anxiety about the first session, and so I think it wise to keep modest expectations. A good first session, in my opinion, does two things:
1. It lets you share about your main concerns toward building a shared understanding with your therapist.
2. It lets you feel out whether the therapist is someone you would want to continue with.
You can prepare for our initial meeting just by thinking through the circumstances that have led you to want to seek some help. I’ll prepare for it by reviewing the intake form I ask new patients to complete and showing up open and interested in learning how best to offer support to you.
How can I usefully present my concerns?
Excellent question. Your concerns may seem hard to get a handle on, and that fact is what leads many to seek therapy out in the first place! We therapists are usually interested in understanding some of the following:
When did your problem begin?
How has it progressed?
What has brought you some relief?
What has made the problem harder?
Finally, how do you make sense of the problem?
Many of my patients feel a pressure to get out as much of your story as possible. I would encourage you to relieve yourself of that pressure. If we don’t get to something in the first session – which is always the case – we can return to it in a future one.
What can I hope to gain from therapy?
At the risk of being that therapist, what do you hope to gain from therapy? It may sound evasive but I think it important for you to be able to define success for yourself. It would be my job to help you clarify your goals and to assess your progress. I’d encourage you to be flexible enough to allow your measures of progress to evolve over time as your understanding of yourself changes.
Advancing in Therapy
OK, how does therapy work?
This is a tricky question. The aspects of therapy that make it work for you depend on multiple factors, including the person of the therapist, their theoretical approach, personal characteristics you bring, and the nature of your problem, among others.
Some common avenues for different forms of therapy include:
A basic experience of validation and normalization (“You mean I’m not crazy!?!”)
An ongoing sense of unconditional positive regard (“I do deserve more credit than I’ve been getting!”)
Education about problems in thinking and behaving (“That’s helpful to know.”)
Support exploring your thoughts and feelings about a personal puzzle (“I’d never thought about it that way.”)
Help developing strategies to solve your problems (“I didn’t know I could do it that way.”)
I think a useful aspect to attend to is your relationship with the therapist. This is a powerful factor across different therapies. Basically, you want to like your therapist, feel understood by them, trust their judgment, and believe they are completely on your side of getting well. It’s hard for therapy to work at all without this foundation in place.
How do I tell if I’m making progress?
If I’ve done my job well, we’re starting out with some basic goals about what it might mean for therapy to succeed for you. Along the way I’ll hope to help you identify behavioral markers that you are making progress. These will of course depend on your specific life experience, but some common gains my patients might report:
Less reactivity to interactions that would have triggered them in the past
A sense of peace derived from understanding the underlying dynamics of certain events
Recovery of a capacity for joy, awe, curiosity, sadness, sympathy and compassion
A final comment about progress: lasting change can take time. We humans like to see change fast but our personalities are closer to ocean-liners than jet-skis; it takes time to set a new course. Setting realistic goals together is key to sustaining your engagement and avoiding disappointment that leads you away from therapy prematurely.
What should I do if I feel I’m not making progress?
Progress may occur gradually. But progress can also stall. Your experience of feeling stalled would make for an excellent subject to explore in therapy, which could invite questions about your observations, your measurement of progress, your personality as relates to achievement, etc. Simply say to me, “I’m feeling stalled” and we’ll go from there.
When I’m feeling stuck in my own life, I find encouragement in that idea that my next area of learning is right under my nose.
What can I do in between sessions?
When therapy works well, you carry the questions, exploration and musings from a therapy session with you across your life, inside session and out. You could be wise to imagine your whole life as therapy.
Some ways to consider sustaining your attention on important questions:
Take some time to actively process your learning from each session. Some questions you might try to answer: What was the key takeaway for me? How might I apply that in my life? What questions would I have wanted to ask? Am I avoiding discussing some specific issue? Journal about major insights, observations or reflections.
Talk with your family, friends or partner about the things that have you curious.
Write down questions that you would want to bring to therapy. Seek to draw connections between the broad themes discussed in therapy and the goings-on of your ordinary life.
Read further on a subject of personal interest. Feel free to ask me for a recommendation or explore for yourself the resource here: http://booksastherapy.com/
Ending Therapy
How do I know when to stop therapy?
The simple answer is that you stop when you’ve gotten what you started out to get. The reality, of course, is more complicated. Sometimes you aren’t clear exactly what you set out for, aren’t sure how to measure what you’ve gained, have discovered new needs in the course of our engagement, etc. And then there’s the nagging question: is my impulse to stop a sign that I’m avoiding something?
From my perspective, I want you to feel the freedom to stop at any point you wish. I want both to underline your own agency and to respect the fact that for some of you, asserting yourself is difficult enough as it is.
At the same time, I would want to invite you to reflect on your motivation. Some questions I’d offer to you for your consideration:
Of the multitude of reasons for stopping (e.g. financial, satisfactory progress, logistical challenges), what feels like the real reason for stopping?
If I’m feeling frustrated with my progress, have I discussed this with my therapist, and if not, might this juncture be an opportunity to express myself?
What is my history of trying to work through disappointments? How about ending meaningful relationships? Could this be an opportunity to practice a different approach?
Two final comments I’ll make on this matter. First, I’d invite you to frame our ending not as a termination but as a consolidation of the learning you’ve earned. And second, ending needn’t be the absolute end to our relationship. You can regard me as you might your primary care physician: someone you can consult as needed when other (mental) health concerns arise.
I’ve heard about a therapy vacation. What’s that about?
A therapy vacation is simply a break in therapy with an intention of returning (rather than stopping altogether). One might have multiple reasons to take a vacation, and I’d invite you to raise the notion for us to explore together. Some reasons a vacation could be wise:
I’d like to ‘take off the training wheels,’ so to speak, and practice the things we’ve been discussing with a longer period for my own trial and error learning.
I’m feeling stuck about therapy, not sure I’m ready to open myself up to exploring why and would prefer to be able to reflect independently.
I’m benefitting from meeting but my energy is increasingly drawn to this other project of self-exploration.