FAQs

Many people have a hunch that psychotherapy could help them, but they spend much time and energy delaying the start of the process. This is often due to questions and uncertainties such of those below.

On the most concrete level, psychotherapy can relieve presenting symptoms. Even problems that may feel intractable, such as anxiety attacks, can often be addressed with surprising speed. Some people choose to end therapy as soon as they experience improvement of their symptoms. Others find that their symptoms have actually become doorways, opening their awareness to parts of themselves they wish to explore more deeply. This is a very exciting aspect of therapy, when goals change as vistas shift and expand.

Since the course of therapy is so unique to each individual, its benefits are as varied as the people who undertake it. For instance, one person might be striving to come out of her shell and forge more connections with other people. But for someone else, the challenge may be to step back from constant sociability in order to build more tolerance for being alone and independent. The benefits of the one person’s therapy will therefore appear to be the opposite of the other’s. To speak generally enough to encompass such differences, we could say that psychotherapy aims overall to increase a person’s experience of aliveness and fulfillment. But the contents of this goal take shape in wholly individual ways.

Some people think that only wealthy people can afford psychotherapy. Fortunately, this isn’t true. For those with insurance, some or even much of the cost might be covered. For those without insurance coverage, many therapists are committed to working with clients from a wide range of financial circumstances. I work on a sliding scale , and there are many wonderful therapists who will strive to work out a fee that will enable a client to be in therapy.

Psychotherapy can certainly be a financial commitment, like other valuable things, but with care and planning it can be feasible. And countless people find that psychotherapy is money very well spent.

This is an important process that should be carried out with care. My main suggestion is that once you have made sure a therapist is a well- trained professional, listen to your gut feeling of comfort. Ask yourself, ‘Is this someone I can imagine opening up with? Can I be at ease in this space? How do I feel in this space, in this person’s presence?’

It is widely recognized that what supports successful psychotherapy of any sort is therelationship between therapist and client. It must be a relationship of trust and comfort for therapy to be effective. The practice of psychotherapy is far more art than science. The fit between client and clinician is of primary importance. Therefore, if you find a therapist with an impressive new technique but whose personal style feels fake or removed or unnatural to you, that is probably not the right therapist.

As part of the choosing process, it may be helpful to ask about a therapist’s approach to psychotherapy. The point is not to get involved in an academic, theoretical discussion, but to ask a bit about the modes in which a therapist works and how he or she sees them helping you. Many therapists draw on a variety of approaches, but some are more narrowly focused. If you want a very short-term, concrete cognitive behavioral approach, and a particular therapist’s style is exclusively psychodynamic, that is important to discover right away. (If these terms are meaningless to you but you’re curious about them, then ask.)

Finally, practical considerations such as commuting distance are important because therapy is a regular commitment. Make sure you are planning realistically.

It varies a great deal. Every therapist has had clients who say they were helped significantly by just a few sessions or even by a single session. At the other end of the spectrum are people who continue to derive great benefit from therapy over many years. It depends on a person’s goals. Sometimes a person comes with a very particular issue to work through (‘Is my current partner the person I want to marry?’), and once it is solved, therapy ends. Others are struggling with difficulties and patterns that may have built up over decades. Sometimes people take a break from therapy and then return; sometimes they come less frequently or just for check-ins. As with other aspects of therapy, its duration is shaped around the individual’s needs and goals.

I am often struck by an assumption many clients hold: that their own psyches are far too messy to fit into a therapist’s vision of sanity, so if they let the truth out, surely they will be pronounced crazy after a few sessions!

One of the great contributors to psychodynamic theory and practice, Donald Winnicott, said he was pleased because he thought he had achieved a measure of insanity in his life. He meant that much suffering results from being too sane in the sense of trying to fit too neatly into the prevailing (or assumed) standards of normality. Social conventions powerfully condition us all, and while that is in many ways necessary and useful, it can also squelch our individuality.

Freeing ourselves from certain cultural or family expectations and norms can be a bit unsettling and extremely exhilarating. Bringing one’s unique self into being can feel at times like going a little crazy. To expand the boundaries of the self is to occupy a different and wider consciousness.

Some people who come for psychotherapy are already taking medication for depression, anxiety, or for another reason. Many have questions about the role of medications in addressing their difficulties. Some are strongly opposed to them; some come with a desire “for a pill that will just help me with everything”; and some are understandably confused by the whole issue. They may know some people who say they have been helped a great deal by their medication, and others who have experienced miserable side effects from them and no help at all. Some are also aware through periodic news reports of the risks involved with taking some medications.

This topic is extremely important and multi-faceted.

It should be noted, first, that psychotherapists do not themselves prescribe medications unless they are also medical doctors (M.D.) However, therapists often work in close conjunction with psychiatrists, who do prescribe them. There is often confusion about these roles. A psychiatrist is a medical doctor (M.D.), and only medical doctors prescribe medications. Medical doctors who are not psychiatrists (e.g., an internist) also often prescribe psychotropic drugs such as antidepressants, but psychotherapists usually prefer to work in conjunction with psychiatrists, who are specially trained in this field.

It is often assumed that psychiatrists are trained in psychotherapy. It would make sense if this were so, but most psychiatrists are not trained as psychotherapists. A few psychiatrists do choose to pursue separate and additional training in psychotherapy. If you are wondering about the background of a doctor you are seeing, you should ask. This distinction between the two roles, psychotherapist and psychiatrist, is important to understand.

But here is the main point. Psychoactive drugs are a terrific help in the lives of some people. They can be true life savers and life changers, especially those with conditions that can be deeply incapacitating for years and even for a lifetime. Medication can also greatly facilitate psychotherapy. But psychoactive drugs are currently vastly over-prescribed. This is a result of many factors. One is the aggressive, greed-driven tactics of the pharmaceutical companies to expand their sales.Another is the desire many people have for a quick fix for genuinely difficult parts of life.

My approach, in a nutshell, is that psychiatric and other medical consultations are often helpful and sometimes essential. I frequently direct clients to psychiatrists and other medical specialists to rule out various conditions and to get a medical perspective. However, I do not see medications as a first resort in most cases of psychological distress, and I prefer psychiatrists who share this conservative approach to medicating patients. Far fewer people need drugs than are prescribed drugs. Many of them involve risks, and when they are taken, it should most often be in conjunction with psychotherapy. Psychotherapy’s efficacy is abundantly demonstrated, and it opens the door to one of life’s greatest adventures and discoveries, that of knowing one’s self.

Unfortunately, this happens, as with medical doctors or anything else. If you are going to try again, a most important step is of course the choosing of a therapist. Try to get recommendations from people you know. Do not rush into a choice if you do not need to. Try to think carefully about what went wrong in the past, and make this difficult past experience a first priority with a new therapist. Your past experience will influence your present experience, for instance in feeling some distrust toward any therapist. It is best to bring this out in the open to the extent you can. The therapist’s ways of handling the situation should tell you a lot about whether you want to continue working with him or her. Does this therapist help you to evaluate your own present experience of working with him or her? Remember your freedom to continue or to end the relationship.

If you have other questions about psychotherapy or about some of the related topics discussed on this website, please feel free to contact me..