Psychotherapists are a unique profession in the world because they are paid to listen and help people improve aspects of their lives or combat a mental health issue that’s affecting them. But there’s some stuff that goes on in the therapy office that you should know about before you decide to take the plunge (or if you’ve already taken it, well, better late than never!). Here’s a few…
1. I honestly don’t know whether I can help you or not.
Most therapists honestly believe they can help most people with most problems. However, until you get in there and start working with a therapist, a therapist can’t really predict whether they’ll be able to help you or not. Most therapists believe they can help anyone who comes to them with a specific problem they’re trained or experienced to handle. However, every single individual is unique and there are few reliable predictors of any given therapist’s success with any given client.
2. I’m not your friend, but I want you to open up to me anyway.
As I’ve written about previously, the therapeutic relationship is not a natural one. Nowhere else in our lives do we have this kind of professional relationship that demands openness, honesty and intimacy (not of the sexual kind). Without those components, your therapy isn’t likely to be as beneficial. It feels like a close friendship sometimes, but it isn’t.
3. If you ask to see your chart, I’ll probably give you a hard time about it.
Despite the rights of patients to be able to view and have a copy of their own medical records and data, most mental health professionals still resist attempts for a patient to view their own mental health chart. They’ll ask you why you’d like to see it. They may hem and haw a bit, and ask that you pay for copies of it rather than just look at the chart itself while in the office. Your chart likely contains little eye-opening information, as it’s probably just full of short progress notes that describe very generally your progress in therapy from week to week.
4. I’m not supposed to give you advice, but I will anyway.
The first thing a young therapist in training learns is that psychotherapy is, Do not give advice to your clients. “If a person needs advice, they should talk to a friend,” one of my professors said in class. And yet, most therapists end up doling out advice as though their client’s lives depended upon it. Even cognitive-behavioral therapists will give advice, disguising it in the form of “homework” — “Why don’t you try keeping a journal of your irrational thoughts?” It’s a successful strategy for most to try, but it’s still advice.
5. This is probably going to hurt, but I may not tell you that up-front.
Most medical professionals rarely are up-front about the extent of how painful an operation or procedure is going to be. Why would they be? The more painful you hear it is, the more you tense up, become anxious, and the more it does end up hurting. (Ah, the joys of the mind-body connection!) The same is true of good therapy. Good psychotherapy requires you to make changes in your life — in your thinking, in your behavior, and how you interact with the world around you. This isn’t easy, and it usually takes most people a lot of hard work, effort and energy. And if you start digging around in your past (as some, but not all, therapies do), you may find it very painful indeed.
6. My graduate degree probably doesn’t matter much; neither does where I graduated from.
There’s little research to demonstrate that one degree will produce better patient outcomes than another. A “patient outcome” is you feeling better, faster. Because, after all, time itself does indeed heal most wounds. As long as the mental health professional has a Master’s or better in education, it’s likely they will all be equally just as helpful. There’s no evidence to support the idea that a graduate degree from one psychology program is better than another, or that a Ph.D. is better than a Psy.D. for your feeling better, sooner. Find a therapist that you feel comfortable in working with. As long as they are licensed (or registered) and paid for by your health insurance, you’re good to go.
7. If I’m pushing a particular brand of medication, you can likely thank a pharmaceutical company.
You can’t throw a Google keyword without hitting a blog that talks about how various pharmaceutical companies have influenced physicians’ prescribing practices (including psychiatrists’) over the past few decades. Pharmaceutical companies, for instance, love to give doctors free samples of their newest and most expensive medications. Doctors then prescribe these to their patients, who get the free samples as a starter. But the free samples aren’t forever, and then the patient (or their insurance company) winds up paying an arm and a leg for the medication when an older, less expensive medication will work usually just as well.
8. I work for you, but battle your insurance company to get paid.
Yes, you pay your $10 or $20 co-pay to see a therapist, but the majority of their fee will often come from your insurance company. And what your therapist will rarely tell you is how much work it can take to actually get themselves paid from your insurance company. There’s not a lot you can do to help this process along, but it can be a time-consuming and frustrating process — especially in the past when patients would bump up against their maximum-allowed sessions for the year. Or the insurance company denies payment for a certain diagnosis. It’s a mess, and many therapists end up spending more of their time on paperwork for reimbursement than they’d like. Although most therapists won’t admit it (or may not even be aware of it), if your insurance company is giving them a hard time, it may impact their relationship with you.
9. I will give you a diagnosis whether you need one or not.
Nobody likes to admit this, but without a diagnosis, the therapist won’t get paid by your insurance company. And it can’t just be any diagnosis (despite the mental health parity law passed last year). It has to be a “covered” disorder. Which means that if you come in with something that isn’t quite clinical depression, your therapist may diagnose you with it anyway, just so they can get reimbursed. (That’s one of the many reasons why you shouldn’t put too much faith into your diagnosis in the first place.)
10. I love my job, but hate the long hours, client’s often-slow progress, and the difficulty in being understood as a profession.
Like most people, a therapist isn’t always going to be in love with their jobs. There are a lot of daily frustrations a therapist faces, including those mentioned above. Unless the therapist is well-established and successful, many therapists work 10 hour days, or up to 6 days a week. Sometimes clients aren’t committed to the process of changing as much as they say they are, which can be frustrating. And many people still believe that therapists listen to you talk about your dreams as you lay on a couch. It’s hard to be respected as a profession (psychiatrists are often looked down upon by their physician peers), and everyone believes that it’s one of the easiest professions in the world that just about anyone could do (“You just sit there and listen to people’s problems all day?! Sign me up!”).
154 comments
i have feelt like my theripist dosnt care about me and i just read this artical saying that most of them dont but i have been suffering from depression and she said she has to care about me cuse she sighned a paper saying she would i was so upset and i still am what am i to do??
my therepist after treating me for several months for depression and a suicide attempt. As well as low self esteem.After making remarkable progress I asked her what her oppinion of my character was thus far.She replied”I think that you have a Good Heart ,Are Intellegent,You posses a marvelous sennce of humor,However you are mean and aggressive. Session over! I left her office stunned at her last remarks and bleeding emotionally. I don’t know if its even worth confronting her how awful I felt and confused as to how she came to that conclusion or just move on.
Like many people these days (I believe) I have found the mental healthcare system to be compromised by bureaucracy and ineptitude and also a kind of corporate attitude that makes trusting in treatment very difficult.
1. I suppose I am lucky to have MassHealth but it makes mental health providers run for the hills. Seems like anyone with quality references and adequate experience won’t deal with Mass Health, they obviously make it too difficult for them to get their $$$.
2. When I call mental health providers that do take my coverage they tell me they have a wait list that is solely base on a database of patients that already use their primary health services. Shortage of mental health professionals? Why is that?
3. Until last week I had a full time retail job (that means working over the normal business hours of health professionals and irregular days off). So who was out there who could see me after 7 pm? Nobody. Means working class people can’t get treatment.
4. Now that I do have time to see a therapist (took me 4 weeks to find a place taking patients) I’ll get to see a counselor but wait up to 4 weeks before getting an appointment with a Psychiatrist who can prescribe meds. If I hear one more time “I think we can’t really expect you to see progress till you get meds” I’m gonna scream at the top of my lungs. Which might get me hospitalized and thus immediately medicated (that’s your only choice folks).
5. Of course the quickest way of getting treatment would be to get hospitalized, which I’ve already experienced. In this case the treatment is highly impersonal, and I found the professional staff to be condescending. All the treatment is distress tolerance, no therapy, just the same endless series of handouts being read aloud in a circle.
I’m gonna give these mental health people another chance, since I’ve already spent close to a month trying to get services. But damn if this time I’m gonna make sure they know that I AM THE CLIENT, and hold them accountable for all their practices.
I went to a therapist one time in order to get into the Peace Corps. She gave me a diagnosis of Depression in order to get paid by my insurance company. The problem is that now I have a “history of depression” on my health insurance and it is affecting my ability to get new insurance. I also do not want a fake diagnosis, especially not one with such negative connotations associated with it, following me for the rest of my life. Is there anything I can do?
The vitriolic combativeness from some professionals on this thread only supports the argument that just because a therapist has credentials, doesn’t mean he has act together. No one can be more psychologically nasty than a threatened therapist, and consumers are wise to approach them discernment and skepticism. Scare the public from putting themselves in some of these children’s hands? Absolutely! Therapy would be much healthier if clients and professionals approached it with fewer delusions.
Regarding “advice” or lack therof in the profession….
In all of my years in and out of therapy (actually, more out lately) the greatest lesson that I have learned is that the best of the lot don’t actually give advice but rather, push the problem right back into your lap while gently prodding/teaching you to hear your own inner voice so that you can solve the problem yourself.
This is great. It’s so true. Number one really hit me because I’ve been in this profession as a social worker for about 2 years and I still doubt myself which is hard for me to deal with. Any advice? I want to help clients badly but at the same time I wonder sometimes if there is anything I can do.
my friends always come from advise from me but hoe can i reject them.i can sometime read their mind and know their suffering nervours breakdown such as sexual feeling, emotional and pysical
If you have bpd and were unilaterally terminated by your therapist, can they still be of help to you if you were to re-enter therapy with them at a later time?
Excellent post – well done.
My children have been in therapy for years, and all the things that have been listed are right on.
What I would add is something that I learned from my husband, who used to be a psychotherapist and got out of the field because he wasn’t able to help enough people.
“There are therapists and there are ‘healers’ Most of us are therapists, in the business for the money more than anything else. We don’t really have the experience nor interpersonal skills to really be of help to all that many people. As to diagnosis, we are ‘guessing’ most of the time.
I don’t get the hemming and hawing about the release of record. I don’t know any other professional field where this would be problematic. There shouldn’t be things in records that therapists have not told clients. Therapists are allowed to keep separate psychotherapy notes that clients cannot access if they want to, but the record is what is passed between clinicians and can have legal/economic implications. How about send a client your notes after each session so that there are no surprises, or just write it together if it is just a very short summary.
If you are nervous about the “why” someone is asking for their record, then they may rightly sense that you are keeping something important from them and that your relationship together does not allow for more open communication.
Exactly! And really it should be included in the process normally, because I can’t even begin to express the number of times incorrect, unrepresentative, or sometimes completely fictional nonsense information can be found in charts that needs to be gone over again with the therapist. It’s proven an absolutely essential diagnostic tool for the therapist and patient relationship and for maintaining a sense of trust.
“Despite the rights of patients to be able to view and have a copy of their own medical records and data, most mental health professionals still resist attempts for a patient to view their own mental health chart.”
Calling BS on this. HIPPA rights to see your records do NOT extent to psychotherapy notes. It is a psychiatrist/therapists JOB to try to manipulate your mind in the right direction, and this can be compromised if you’re aware of what he’s doing.
Thought provoking article. I practice in the UK and it was interesting to reflect on the differences in routine practice. In my experience, in the UK points 1 to 6 are openly communicated to clients within the first few sessions. I find that it helps to form realistic expectations of therapy, to be informed of what it involves and to form a collaborative relationship. Points 7-10 are not relevant within a national health system, where health care (including mental health) is provided free for all.
Psychologists, Psychiatrists, MFC’s, LSW,well, they’ll all human. I have had violent crime victim therapy, rape victim therapy, been unlawfully committed so someone could take my extra role-in LA, CA my doctor told me “believing” I had an extra gig was Delusional, my actress land lord and co worker raided my apartment during my confinement. I was told to break up with a wealthy guy because it appeared, ” I was too destructive and read too much, and he was “rushing things” and she said I was a gold digger and needed to stick to my class. I was guided by a MFC to place my child for adoption because, as he said, the fact that I was raped would absolutely possibly contribute to creating a child who was a psychopathic killer and trying to be a mom was a fatal risk. I was consulted to drop out of college even though I was doing well at school. I was concerned about my weight as it increased when I got my medication and was screamed at and sent home by my psychologist, he Screamed, ” I don’t care about your weight”. As my son, far away in his adopted home approached college, I was worried and concerned he get the bet opportunity. When I told my Psychiatrist I worried about my son, who was adopted, he said, “forget it, it was a long time ago” I worked ata psych out patient clinic. I saw a homophobic nurse elbow a gay client in the face and later tried to get said patient to take a large handful of Depakote.
Things My Therapist Told Me:
1. I am a really nice guy, but I have to talk about myself a lot.
2. I am a super guy, but I have to throw in sexual content from time to time.
3. I have to talk poorly about my wife.
4. I am a warm & fuzzy person.
5. I really like money. Even more than talking
about sex.
6. “I used to like pretty girls.”
7. “My wife might not think I’m a good provider.”
8. “My friend has a $1000 a month car payment.”
I will stop now. I can tell you that all of this happened. The best part is the dummy who is writing this paid to here this $%@& !!!!!
Maybe therapy is not what you need. I empathize with your wasted experience at the hands of your therapist. I suffered one who wasted my time & decided I did not need to pay good money for someone to feign interest in my problems.
I spent 7 years and tens of thousands of dollars on 5 different therapists of varying types to try and fix some sexual dysfunction (psychological not physical)problems I was having in my marriage. The sex Therapists were the worst and the one psychiatrist I went to was better than the others in his approach but none were able to help me. And it’s absolutely true, only one of the therapists actually threw in the towel after 14 months and said he wasn’t sure what the problem was caused by and suggested I try someone else. All the rest kept leading me on for months or years. It was nothing but a big money grab. That was 12 years ago and my marriage is still sexless after all these years.
Interesting. I concede that not all problems can be solved by psychotherapy. The patient has also to be willing to experiment and attempt some changes in their personal life. I would have questioned the therapists concerned and asked for both strategy recommendations and regular progress reports. Therapy did not help? I would have expected certain tangible results in shorter time-scales or stopped the therapy much earlier than stated.
Nice and honest.
Congratulations.
The profound uselessness of the entire profession, is summed up by the secret “we are not giving advice ask your friends, if you want advice”. I am in engineering we give advice.
I liked the way you worded the title to grab attention of your readers. While I agreed with most of what you said, I’m not sure I would go so far as to say any licensed and paneled therapist is a good fit. There are bad therapists out there who don’t get good sell-care, don’t seek supervision when they should, and take on more than they can handle at times. In any profession you have people who are more effective than others. Sometimes a therapist has more experience in one niche than another therapist so it is important to consider all of these things when selecting a therapist.
I have gone to a few therapists and I feel that they were counterproductive. I was a teenager and my mom was making me go. The reasons that she wanted me to go were social conflicts. There were a couple of peer groups that I used to go to and there were some irreconcilable differences, and a lot of bullying. In other words, the groups did not work out for me. My mom felt that this was a legit reason to go to counseling. Anytime I would say that I did not want to go to said event or group they would always “demand” that I give a reason, then they would justify whether it was reasonable. In my eyes, they did not give a damn about how I felt. Plus, I felt that it was counterproductive and pointless to talk to strangers who in a reality setting would never be able to back me up or side with me. That is why the first point is true-therapists are not your friend. So how can they really understand my situation when they have never witnessed what I was going through?
Therapists need to be careful about how they try to diagnose a patient, especially if the client is there because of social conflicts or stress management. To me, those matters do not call for a diagnosis or to get drugged up. One therapist did try that. He had me talk to there staff nurse and she gave a me a sample of I think it was Paxil. All it did was make me have insomnia and irritability. I have to wonder if that is what they were going for. I stopped taking it and told them that it is not worth jeopardizing my daily functions, and that it won’t make me tolerable about a social conflict. That I am sure was unethical and maybe even illegal to just give me a sample of a medication.
I am sure that there are some legitimate therapists out there, but I have been to some bad ones, and for that reason, I do not take a lot of stock in therepists, period.
i need an answer.my therapist gives me positive stroke,but i can not believe on her,its my problem,i want to believe but i can not.She told me that in psychotherapy there is no false stroke.is it true?
Hey guys, i really hope this is something like a very sarcastic joke. if therapists in america are like this, i think they are a product of your hypercapitalism…we in germany learn to be transparent, direct and honest to our patients…most of these “secrets” a therapist would definitely tell his or her patients…
Im beginning to not trust therapist. I decided about two months ago that i needed to go on a short term disability from work about two months ago because i was going through some serious anxieties. My original plan was to be on leave for about a month and a half. Well toward my desired end of my leave, i went on to tell my therapist that i was ready to go back to work and her response was nothing but apprehension and recommend that i take an additional week, attend group therapies through out the week at the hospital and come back by the end of the week to discuss it further. Well, the end of the week comes, she decides she needs to postpone the appointment for the following tuesday because she has a dental emergency. The next week comes, she postpones the appointment for the next monday because shes going into dental surgery to have her teeth fixed. I am so pissed off. There is alot of things i am missing at my job and if i dont get back yo worl by early next week, i am going to miss some important deadlines which will impact my work schedule for the next 6 months. I will be really pissed if this bird therapist of mine decides to not release me back to work next week because i feel that this bitch is abusing her fucking authority. I had an idea she was a controlling bitch a couple of years ago when i went on leave and told her i was ready to go back after a year and a half because how she tried to orchestrate everything.Its pathetic when you decide to see a therapist for help and they decide to get crafty and controlling over your life just because you have a mental diagnoses. I feel totally fucking powerless right now, meanwhile Im broke as fucking hell struggling to pay my bills on my work disabilty money. I am totally not in the same place mentally as i was at the beginning of this leave. Who does the bitch think she is trying to tell me otherwise. Mental health professionals are scum. They make you think you can trust them, meanwhile your just a fucking puppet and they are the puppetmaster. If this creep therapist does not release me to my job next week, my contract with this woman is over and i am taking my business somewhere else. Its sad, this is about the only amount of power i do have. I wish i could sue this bitch. I certainly will be reporting her ass if she fucks my shit up.
Well this was fckn h̶e̶l̶p̶f̶u̶l̶ depressing 😒
I don’t know whether or not I can help you is very important. Many factors play into therapy/help. Some therapist are fine but that does not mean they can help you and your specifics needs/issues/diagnoses.
Some therapists like their job but are burnt out. Some therapists are OK with their job but would rather do something else. Some therapists don’t like people anymore but really wan to make $150-$250 hr and will gladly see you — they don’t think they cannot help you. They think they are worth it and enjoy their big house and elegant lifestyle.
11. As therapists we hear it al. Some of us are a little weird cause we hear the strangeness of humanity.
12. Some days I might want you to help me. Some of us therapists need to talk about ourselves.
13. You may think my compliments are sincere, once in a while they are.
14. It looks like I’m interested and here for you. In therapy as in life, looks are often deceptive.
15. You need to hear what I have to tell you. You’ll pay the same price even when I’m completely full of crap.
16. “I don’t know how long therapy will take.” My daughter no longer wants to attend an state college so you will need to come back for therapy for many more months.
17. You look pretty today. Screw therapy, better yet lets just chat.
As a student in the field of psychology, i found most of this article to be inaccurate as well as insulting to the profession. Although you even say in one part of the article that each individual is different and unique, this applies to those in the profession as well and you are just generalizing behaviors and context of therapists across the entire population which really is not fair and a contradiction even to your statements about how clients should be considered.
I’m sure a lot of therapists aren’t that good at there jobs, but in my experience I’d be much worse off without one, possibly dead. I’m afraid that if I’d read this article beforehand I may not have sought treatment, or I would have been paranoia they didn’t like me making progress impossible ( I have avpd). This is a potentially dangerous article and i hope no one has given up on help because of it thinking there was no help for them.
This article has many responses bc therapy is so unregulated. Many other reasons why, too many for a short reply. A good therapist who has structure and a plan can often help a client who wants help. Both client and therapist will need to work hard, or why go to therapy. Advise should be given by a professional after they know you and if you ask for it. I oould have avoided a huge setback had I known ahead that therapy can make you worse. I also could have left therapy sooner. Six months is a long time waste time and money. Honesty is when we say a person can practice for 20 or 30 years and not be great. A person can be a therapist for 5 years and be awesome and the best. I met four therapists who practice more than twenty years and were not great. If you have been doing it wrong for 23 years you don’t get better for doing it wrong another two years. They have to leave their egos and home. They have to sincerely want you to get better. Those I met didn’t want to help as much listen , talk and not hear what was said.
If this is what therapy is like in America, I’m glad I don’t live there.
I live in Australia and the psychologists/therapists here are open and honest about what they can and can’t do to help you with your problems. They also don’t keep any records secret and never withhold any information about your progress, or lack there of, from you.
Our healthcare system is in a much better condition than America’s too, as we wouldn’t misdiagnose somebody just for the sake of money. In some circumstances in Australia you’re even entitled to free therapy sessions.
If you’re suffering from a mental illness, and if this article is anything to go by, I’d suggest seeking help in a place that actually cares for your wellbeing and cares less about coercing and luring patients into more sessions so that they can make more money, leaving you to feel worse and like you weren’t helped at all.
It’s incredibly annoying how underdeveloped “modern” understanding of psychology is. We are forced to believe that the progress must be slow, that there might be no progress at all. It was like that with every single field. Understanding of human psychology is just not good yet, it’s not that it cannot change quick. I worked with many therapists over many years and they always fail to connect dots together. They just ignore inconvenient topics (for them), focusing on easy ones. They are forgetful (too many patients?) and most of time, rather telling you cants rather than fresh thoughts. No wonder most of us are crazy these days, our current world is totally against human nature with too much stimulus, too much information, too much rush, too much “I can’t have it”, too much “I could have done that” etc. Psychologists are just wrong.
Question : what is the point of therapy if the therapist can’t give advice???? That’s the whole point, to talk to someone who is qualified to give advice because people like your family members and friends aren’t qualified, isn’t it??? I don’t want to talk to a wall, I want to have a conversation with someone who can tell me how to fix the problem. I’m just confused!!
I’m 0/3 with my attempts to find a compassionate, observant, and motivated therapist, but I’m 3/3 with finding indifferent time-wasters!
Here’s some advice from the patient to the doctor: don’t get into this field if you don’t care about people and have no sense of personal integrity driving your decisions. Don’t muck about in the delicate lives of others if all you care about is money or prestige. You don’t have to love your job, but you still have to do it, and there’s no way you can do it well without believing in the merit of your work and people’s ability to change for the better.
I was seeing a phs ologist for 5 years on and off. Got sicker and was covered by ins to see him 2x a week. To.doffice my ins was changing ang and gave new cards and info. 3 months later office manager said I owed $1000.00 and if I don’t pay I can’t see the therapist that I depended on during a traumatic time. Is this legal. The therapist never called me
Don’t therapists have any guilt or qualms about updiagnosing to get paid and its effect on the person, such as rejection by an insurance company for disability insurance, or rejection of a job opportunity where a clearance is needed, as two examples? When I got my therapists’ notes, I saw he put down two symptoms – inability to concentrate and fatigue – with the explanation that I was now exhibiting these and so MDD would be given. Absolute lies and it was obvious that this was to cover himself should there be an audit. The questionnaire given to me would not have been sufficient for this “diagnosis”. I put “diagnosis” in quotes because these are made-up constructs, created by psychiatrists (with much evidence that this medical model of human distress would make prescribing drugs much easier). I’m rather disgusted with this industry.
oh my god. lol. people…
“And social workers?¨ I am a social worker. I highly disagree. I don’t know any one specific type of therapist group (LCSW LC LMFT PHD PSYD) that can be generalized as having one way of thought. Someone’s (or some part of a group’s) superior ideology about themselves or their degree comes from within themselves and can never speak for all.
I don’t know about other areas, but my board requires that we tell clients most of the 10 during the first session. I like to inform my clients about these things up front.
I forget where and how it was written, but I disagree with the part about not always enjoying my job as a therapist. I LOVE what I do and have never disliked my career.
I think the post is informative for clients, especially people who have never been to therapy before.
This was very helpful as someone who just made a therapy appointment for the first time and found that doctor does not accept insurance. She came highly recommended, but I almost cancelled because I would have to pay out of pocket. Good to know the trials that psychiatrists
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