How to Get the Most from Your Therapy
Pick a good therapist.
Approximately one third of all therapists consistently harm and help
their clients get worse. Another third of the therapist do no harm, but
they also do not help. Only one third of the therapists consistently
help their clients get better!
The terms "Therapist" or "Psychotherapist" are
generic labels that are used by many different kinds of licensed
professionals and non-licensed paraprofessionals. Make sure the
therapist is licensed and is not vague about the type of license. A
license is a only minimum standard and does not guarantee high
Be as clear as you can about what you want help with - stress,
relationships, your spouse, children, elderly parents, divorce, child
custody, step-families alcohol or other substance abuse, eating
disorders, sexual issues, grief, depression, anxiety, anger, etc. Then
look for a therapist who has training and experience in that area.
If you are going to a low fee clinic, the therapist will
likely be a graduate student in training, or someone who has
graduated and is working toward licensing. Some of them are very good
therapists, just make sure they are being supervised by an experienced
licensed therapist, and that both the therapist and supervisor have training in the area you want
The therapist should always be relevant to you, your issues and the
purpose of your therapy. The therapist will need information about you
and your life in order to tailor the treatment to you, and may ask about
things that seem irrelevant to you. If you do not understand how
the question, material or topic the therapist has introduced is relevant
to you, ask. It might be very relevant, or it may not. The purpose or goals of your counseling or therapy should be clear,
and they should be established by a collaborative effort. Don't
accept or stay with a therapist who imposes his/her own interests and
issues into your therapy, or establishes goals for your therapy that you don't want.
The most critical factors for successful counseling and psychotherapy
are for the therapist to be able to accurately understand your feelings
and concerns, have an accepting nonjudgmental attitude, and to be
authentic and real (as opposed to pretending or just playing the role).
The development of a positive, trusting relationship with the therapist
is also critical. Either in a telephone conversation before making an
appointment, or in the first or first few sessions make sure you assess
the therapist. The best material on selecting a therapist that I have
seen was written Dr.Ofer Zur. You can find his "Psychotherapists: A
Buyer's Guide" on his website at www.drzur.com.
Don't let your insurance get in the
The better Managed Care Plans and HMOs will have a system for
rationing insurance benefits for therapy. The system will likely be a
data base of all the diagnostic categories that is covered by the
insurance contract, the specific and recommended treatment for each
diagnosis. Some systems specify the number of sessions needed to achieve
the specified treatment goals, others limit the number of sessions
allowed by the terms in the insurance contract. Participating therapists
have to follow the plan's system if they are to remain in the provider
pool and continue to receive referrals from the insurance company.
I found the managed care and HMO systems to be too rigid and too
limiting, unable to adequately consider the multitude of individual
differences, life style differences, differences in the types and
amounts of pressures and stress, and differences in support and
resources available to people. Too often the treatment that was
authorized was not based on the information that I submitted, was not
relevant to the needs of my client, but seemed to be based on saving the
insurance company money. I have seen too many people get frustrated,
discouraged, lose motivation or get distracted and waste time and
energy fighting with their insurance company.
It is your life, your benefit or your loss. Consider the opinions and
information given to you by others and then follow your best judgment in
improving and solving the problems in your life. If the problem or
issues is significant enough to have serious consequences for your life,
don't settle for the generic and limited services of your HMO or managed
health plan, go for the best treatment available and pay out-of- pocket
if necessary. If your insurance does
not assist you but wants to dictate to you, express your dissatisfaction
about it to your employer if it is a plan provided by your employer, and
get another policy if
possible. Sometimes there is too much at stake and
too much to lose to follow the limited treatment plan of the insurance
Make sure you do your work.
responsibility for your learning, don't loose sight of what you want to
learn, resolve or get out of therapy, and don't talk about material you
know is irrelevant. Use your therapist as a coach, guide, consultant,
but you have to do the work. Don't make yourself helpless and look to
your therapist to do the work for you. When you are trying something new, don't
blame it on the therapist, by saying something similar to "my
therapist told me to ....". Take responsibility for and own
what you do or want to do.
Be honest, reveal and disclose yourself, don't censure out
your irrational thoughts because you know they are irrational. Don't
withhold contradictory or confusing thoughts or
feelings. Don't avoid discussing or revealing
something to your therapist because it is uncomfortable, painful,
shameful, or illegal. Don't intentionally withhold or leave out information.
Face the difficult stuff.
Take what ever you discover or learn in the
therapy session and apply it or work with it in your life. Don't just
work with it in session.
Don't just accept what
your therapist says. Seriously consider what your therapist says, but
then if it does not seem right to you, tell the therapist and discuss it
with him/her, and follow your
best judgment. If you don't understand something your therapist
says, tell him/her you don't understand. If you don't agree, don't like
or are offended say so.
Sometimes it can be
very helpful to share with someone what you discuss and learn during
your therapy session, but sometimes it can be harmful. Generally, it is
probably better to keep
your therapy private, so talk with your therapist about it before you
discuss your therapy with others.
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