How do I know if I need therapy?
There is no one right answer to this question. Going to therapy or feeling the need to go to therapy often comes from a subjective feeling of distress and unease about yourself, your life or your circumstances. Perhaps it’s an internal sense of unease about who you are and what you want for yourself or how you relate to other people. Sometimes people feel confused about whether their perceptions are reasonable in the face of what they’re experiencing. Typically, people are seeking help to resolve issues in their relationships with others and/or they feel confused about themselves.
In 25 years of practice, I've noticed that people come in for a variety of reasons – from an acute, intense crisis to a long-term, chronic problem. People typically enter therapy when they are in great distress. First, they want to feel relief. Some people stay longer to make changes that will help them prevent the crisis from happening the next time. I notice that the people who just want to have their immediate distress relieved sometimes end up coming back again for the same problem, often because they don't understand the underlying issues that are causing these problems to reoccur. Those who stay to understand what's causing the problems learn to shift the way they respond to stress and triggers and make significant, long-term change.
Having said this, there are people who benefit from targeting one problem, are in therapy for a brief period, and report feeling better upon termination. Both ways of participating in therapy are reasonable and an individual's choice.
What actually happens during therapy?
When I work with people in therapy, initially I have a brief telephone conversation in which I gather information to make sure that my skill set lines up with their treatment needs. Then I have them fill out paperwork at home before coming so we can make efficient use of our in-person, intake process. The first few sessions are spent gathering information about the history of the problem and the individuals' lives in order to develop a treatment plan. Also, during this time, one of our first goals is to develop the beginning of a working relationship. After we have a treatment plan, we begin the first phase of therapy to work on the goals of treatment. I call this the "working phase." As an eclectic therapist, I utilize tools from many different schools of thought and tailor the treatment to the patient’s needs. Throughout the process, we are checking in to see whether they feel they are accomplishing their goals. I give feedback as well about how I think the process is going.
Periodically we review our goals, recognizing when goals have been achieved and sometimes adding new ones. At some point along the way, we collectively realize that we have achieved our goals and it is time to terminate. There are times, however, when the patient decides to leave therapy when there still may be further goals to address. Whether it’s mutually agreed upon to terminate therapy or whether the individual decides to stop, it is beneficial for the patient to come in and reflect on the treatment progression. At this point, it’s strongly recommended that we go through a termination process, in which we review their progress and the skills that they’ve developed.
What are the methods/modalities used during therapy?
Basically, I believe that people’s early relationships inform the relationships they seek later in life. In essence, the past informs the present. Our early childhood experiences form an emotional roadmap and influence who we pick as friends and partners, how we respond to our children and even how we feel about ourselves. Through therapy, learning about how these experiences and feelings affect you helps you respond differently in your current life.
I vary how I work with people depending on the needs of the individual and their treatment goals. Specifically, I work with them on changing misconceptions they have about themselves or others, changing their behavior, and on strengthening coping skills and interpersonal skills, and developing insight into their behavior. All of these approaches serve to help them develop more control over their choices and, most importantly, how they feel about themselves as a result of those choices.
How long does it take?
The length of treatment varies depending on many factors, including level of distress, difficulty of the problem, and how quickly we can get to the heart of the issue. This makes the assessment process a critically important part of treatment. The more we understand initially about what challenge is, the more quickly we can treat it. A typical treatment length could range from a few months to a few years, depending on the degree of difficulty and number of problems people face.
When is psychotherapy enough, and when is medication a necessary component of the treatment plan?
Instead of just treating the symptoms, therapy addresses the cause of our distress and the behavior patterns that curb our progress. In many cases, talk therapy is sufficient to treat the problem. In some cases, the symptoms are causing enough distress and impairing functioning to the point that taking medication can help people function better and make better use of therapy to reach their goals. In these cases, an integrative approach can be quite useful. When people need medication, the medication serves as a foundation and allows for more productive psychotherapy. Extensive research shows that the long-term solution to mental and emotional problems, and the pain they cause, cannot be solved solely by medication.
Do you take insurance, and how does that work?
To determine if you have mental health coverage through your health insurance carrier, the first thing you should do is call them. Check your coverage carefully and make sure you understand their answers. Some helpful questions you can ask them:
- What are my mental health benefits?
- What type of plan do I have?
- Do I have a PPO? (This is the plan that allows people to receive reimbursement for out-of-network providers. If you do not have a PPO or POS, which may offer some options for reimbursement, you will not be able to get reimbursement for my services. When insurance reimbursement isn’t an option, we can discuss the possibility of a fee reduction.)
- How much does my insurance pay for an out-of-network provider?
- What is the coverage amount per therapy session?
- How many therapy sessions does my plan cover? Is there a yearly limit?
- Is a referral required from my primary care physician, or can I call the psychotherapist directly without a referral?
- Do I have a deductible to meet before I can seek reimbursement? If I have a deductible, how much is it?
- Do I have a co-pay? How much is it?
- Where do I send claims?
How confidential is the therapy process?
Confidentiality is one of the most important components between a patient and psychotherapist. Successful therapy requires a high degree of trust with highly sensitive subject matter that is usually not discussed anywhere but the therapist's office. Every therapist should provide a written copy of their confidential disclosure agreement, and you can expect that what you discuss in session will not be shared with anyone. This is called "Informed Consent." Sometimes, however, you may want your therapist to share information or give an update to someone on your healthcare team (your physician, for example), but, by law, your therapist cannot release this information without obtaining your written permission.
State law and professional ethics require therapists to maintain confidentiality except for the following situations:
- Suspected past or present abuse or neglect of children, adults, and elders; therapists are required by law to report this to the authorities, including Child Protection Services and law enforcement, based on information provided by the patient or collateral sources.
- If the therapist has reason to suspect the patient is seriously in danger of harming themselves or has threatened to harm another person.
- If a patient intends to harm themselves, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures provided to me by law to ensure their safety, even without their permission.