Is therapy right for me?
Do I really need therapy? I can usually handle my problems.
How can therapy help me?
What is therapy like?
How do I choose a therapist?
How do I tell if therapy is working?
How do I know when to end therapy?
Is medication a substitute for therapy?
Do you accept insurance? How does insurance work?
Is therapy confidential?
Is therapy right for me?
Have you ever wondered why we spend 12 years in school to learn reading, writing, and arithmetic, yet there is no time set aside to prepare us for equally necessary and far more complex tasks of living?
How do you learn to be comfortable and effective in creating and maintaining relationships? How do you learn to make major life choices with confidence? How do you gracefully handle transitions? How do you survive and recover from traumatic experiences? How do you go about feeling comfortable with who you are?
For some people these answers may come naturally, but for most, they are a struggle! Therapy is right for you if you are not satisfied with your current situation and you believe that more is possible.
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Do I really need therapy? I can usually handle my problems.
Choosing therapy means choosing to hire a trained professional to help you sort things out in your life. It does not mean that you could not handle things alone if you had to. You may just think that having help is a better option.
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How can therapy help me?
The benefits of therapy depend on what you choose to work on. Possibilities include:
- Understanding yourself, your goals and values
- Developing skills for improving your relationships
- Addressing the issues that led you to seek therapy
- Learning new ways to cope with stress and anxiety
- Managing anger, grief, depression, and other emotional pressures
- Improving communications and listening skills
- Changing old behavior patterns and developing new ones
- Discovering new ways to solve problems in your family or marriage
- Improving your self-esteem and boosting self-confidence
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What is therapy like?
At a very basic level, therapy consists of you and your therapist talking about your life and your concerns. Sessions last about 45 minutes. What sessions are like depends on the therapist and the style of therapy.
In my practice, I first spend 2-4 sessions on assessment - that is, to get background and to decide with you on a plan for our work together. I spend this time because thanks to my extensive training, I can offer a variety of different therapy approaches. That way you can be sure the therapy is tailored to suit your needs.
Here are the major therapy approaches that I offer:
Psychodynamic
therapy
: Sessions are "free-form" and there is a focus on how past relationships provide the "blueprint" for relationships now. One focus is exploring the relationship between you and your therapist, since it may be similar to your other relationships in many ways. There is growing evidence that psychodynamic therapy is effective in treating depression, anxiety, relationship problems, panic, eating disorders, and more. You can read all about it
here
. If you would like to read more about psychodynamic therapy, I recommend "The Gift of Therapy" by Irvin Yalom.
Cognitive Behavioral Therapy (CBT):
This is a type of therapy with a huge amount of evidence that it is effective. Sessions are usually structured. There is often homework given and the focus is usually on the present moment. The therapist is usually more talkative and more directive than in psychodynamic therapy. "Feeling Good" by David Burns is a classic CBT book addressing depression.
Mindfulness:
Mindfulness is paying attention to the present moment on purpose and without judgment. Many different forms of therapy incorporate mindfulness. For more on mindfulness, check out anything written by Thich Nhat Han.
Dialectical Behavioral Therapy (DBT):
DBT can be thought of as CBT + mindfulness. It has been shown to be remarkably effective in helping people who do not do well in other forms of psychotherapy. It can be applied to a range of different problems. DBT sessions are structured and they often incorporate mindfulness practices. I do DBT-inspired psychotherapy since "full" DBT is extremely intensive. You can read more about DBT
here
.
Cognitive Processing Therapy (CPT):
This is a brief therapy for trauma. It has a strong base of evidence that it works. It is time-limited, usually to 12 sessions, although if more than one trauma is involved the treatment may be extended.
Too often, people end up simply working with the first therapy style that they encounter. Then if that form of therapy does not help their problem, they may believe that therapy itself does not work. An advantage of working with me is having the chance to find an approach that works best for you.
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How do I choose a therapist?
First, you may want to ask some trusted friends or your medical doctor if they can recommend anyone. If you have insurance, you can get the list of providers from your insurance company and see if any of them look promising. Once you have a list of potential candidates, here are some things you may want to consider:
Training:
You can tell the level of training of a therapist by his or her degree. Here are some common ones:
MD (Psychiatrist):
4 years of medical school + 4 years of specialty training in psychiatry. Psychiatrists are medical doctors. They can prescribe medications and are trained in psychotherapy as well. I am a psychiatrist.
Ph.D. or Psy.D (Psychologist):
About 5 years of graduate training plus 1 or 2 years of post-graduate supervised experience. Usually (but not always) Psy.D. training has more emphasis on clinical work and less on research. Psychologists are called "doctor" because of their high level of academic scholarship. However, they are not medical doctors and cannot prescribe medications.
LCSW (Licensed Clinical Social Worker):
Usually 2 years of post-graduate training with an emphasis on psychotherapy, an internship, and 1-2 years of supervised clinical work.
APRN/NP (Advanced Practice Registered Nurse/Nurse Practitioner):
2 years of master's-level training in nursing, and usually also have bachelor's-level nursing training. APRN's who graduate with a psychiatric specialty have a focus on mental health in their coursework. In Connecticut, APRN's are able to prescribe medications if they work in a collaborative relationship with a physician.
Therapists can also pursue advanced training in psychotherapy after they have achieved their degree. Most will be willing to share the specifics of this with you if asked.
Style:
I described psychotherapy styles in the section "What is therapy like?". However, you may also want to consider the personal style of the therapist. Some therapists are more gentle, others more direct. Some are quiet and others more talkative. Some are humorous and irreverent. Others are more conservative in their approach. Some are reluctant to reveal any personal information about themselves because they feel it interferes with the therapy process. Others put less emphasis on this and may even bring things up from their own life if they think it is relevant.
Ideally you want a therapist that you "click" with, although you may want to give yourself a few sessions to decide this. If something is not working for you in the treatment, say so. Your therapist may be able to adjust to your needs.
As far as my personal style goes, I tend to be interactive and friendly. I don't worry too much about being a "blank slate" so questions about me are fair game, generally - though I will try to keep the focus on you!
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Is medication a substitute for therapy?
Not at all. Medication and psychotherapy work in completely different ways. Think of your brain as a computer. Psychotherapy affects the software. Medications affect the hardware.
Psychotherapy is proven to be as effective as medication in addressing most common issues that bring people to treatment, such as mild to moderate depression and anxiety. It also has no potential side effects. It has been shown to be helpful even long after the treatment is over. This is why I consider psychotherapy an essential element of treatment. Often, psychotherapy alone is more than enough to do the job.
That being said, sometimes psychiatric medications can be extremely helpful. Sometimes they are even life-saving. If we agree that it would make sense, then we can incorporate them into our work together.
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How do I tell if therapy is working?
This is a great question to ask your therapist, since it is hard to answer in a general way. However, here are some things to consider:
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What does progress in therapy look like?
- Insight: You may start to get curious about things you took for granted before. You may notice that certain experiences in your life and your reactions to them are linked in ways you had not considered. You may discover painful truths or distressing emotions that you did not realize you had -- this part of the process is not usually pleasant, but it pays off. It results in a different perspective - feeling wiser, stronger, and more able to see yourself and the world clearly and act effectively. You will likely feel more at peace since you are no longer expending energy fighting off parts of your experience without even knowing you are doing it.
- Session "feel": There should be a balance of challenge and comfort in sessions - that is, you should feel respected and understood, but also pushed to look at things differently and/or try new things. Good sessions are not necessarily enjoyable at the time, because part of therapy involves facing internal distress and coming to terms with it. Good sessions, though, tend to have moments that are intriguing and interesting. After a good session, you should feel you have learned something, or that there has been some emotional movement, or that you have made a commitment to approach your life a little differently, perhaps all of the above.
- Intrasession mood improvement: This means that after sessions, you find yourself feeling clearer, more decisive, more hopeful, and just generally healthier inside. Even if this better mood is only temporary at first, it is a positive sign and is likely to last longer and longer after therapy sessions are over as you continue to work with your therapist.
- Movement toward your goals: You may have come into therapy with certain goals for yourself. In some forms of therapy, part of the therapy involves measuring your progress toward goals, so this can be another way to notice if the therapy is helpful.
- Follow your gut: If you find yourself put off by your therapist's style from the very first visit, you may want to find someone else.
- Talk with your therapist about progress: In studies, psychotherapy tends to show positive results less quickly but more robustly than medications. This means that people not only tend to hold on to gains in therapy, but with some forms of therapy they will actually continue improving for quite a while after sessions are over (unlike medications). It often takes time for progress to begin, however. Don't fall into the trap of spending so much time evaluating therapy during your first few visits that you forget to be "in" therapy! You will need to give the process some time to unfold. Of course, you can't keep going forever without knowing for sure if it is helping either. You may want to talk with your therapist about when would be a reasonable time to check in about how therapy is going.
How do I know when to end therapy?
Good question! Sometimes the answer is obvious: you got resolution on the issue you came into therapy to work on, or you are moving away, or you and your therapist had an agreement that the therapy will last a certain number of sessions. Sometimes the answer is less obvious. For instance, you may begin to feel that you are no longer making the same kind of progress or you may begin to want to prioritize other things. I encourage you to talk with your therapist if you are starting to wonder about whether to continue the treatment or not. This is for two reasons:
- Pacing of therapy: All forms of therapy tend to have a beginning, a middle, and an end. Your therapist will not be able to help you finish the therapy process in an optimal way without some discussion of whether to end treatment and, if so, a time frame that the two of you can agree on.
- Making a mindful choice: Therapy tends to push you to work on the very hardest problems in your life. What makes these problems so hard to work on in the first place? Emotional barriers, knowledge barriers, judgment barriers (not being able to judge objectively whether you are making progress), and/or external barriers (your life may be set up in a way that hinders progress). When you start to really grapple with these major life issues, there is a good possibility that these barriers to positive change will start to act against the therapy process also. You may actually start feeling pulled to leave therapy right when it is beginning to be most relevant and important. I encourage you to share it with your therapist if or when you are starting to feel "anti-therapy". Your therapist and you can put your heads together and figure out whether there are anti-change forces at work, giving you a golden opportunity to become more effective at vanquishing these forces by finding a way to continue with treatment. Alternately, you may decide that you are satisfied with your current progress and ready to move on to other things, or that continuing would simply be too difficult, so it makes sense for treatment to end. All this being said, it will be up to you to decide whether the benefits of continuing therapy outweigh the costs. Your therapist can be helpful in clarifying the decision-making process about leaving, but in the end the decision will be yours.
Do you accept insurance? How does insurance work?
You may be reimbursed in full or in part by your insurance plan for your visits. Like many psychiatrists, I am "out of network" but can prepare a bill for you to submit to your insurer.
1) Do I have "out of network" mental health insurance benefits?
2) What is my mental health deductible and has it been met?
3) How many sessions per year does insurance cover?
4) What month does the coverage end or begin?
5) What is the coverage amount per therapy session? They may ask for a code – if so, tell them 99213 and 90836. 99213 is the code for assessment by a psychiatrist and 90836 is the code for 45 minutes of psychotherapy. Both apply at each visit.
6) Is approval required from my primary care physician?
Please be aware that while seeking psychotherapy does not require a "medical necessity", seeking reimbursement from an insurance company does. This means that you must qualify for (and receive) a mental health diagnosis if you would like insurance to cover psychotherapy visits. Your insurance company also may ask for significant personal information about you and your symptoms in order to decide how much treatment it will authorize.
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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.
However, there are some exceptions required by law to this rule. Exceptions include:
- Suspected child abuse or dependent 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 therapist and client cannot both feel assured of the client's continued safety, additional measures may need to be taken.