5. Sometimes a friend will work just as well.
One of psychotherapy’s little secrets is that up to 40% of new clients never return for a second session. Why is that? Researchers speculate that it could be for a variety of reasons, including feeling uncomfortable with the process (#2) or the therapist (#1). Or because one session is all the person needed — the ability to just talk to a stranger and let out everything one is feeling or experiencing can itself be cathartic.
At times like this, many people might gain similar results from talking to someone you trust — a close friend or family member, or even your favorite pet. While such people (or animals!) can’t replicate a therapist’s training or experience, for many people this may be sufficient enough. The challenge, though, is to find someone who won’t blab your feelings to others. With a therapist, you’ll never have to worry about that.
6. “Side effects” of psychotherapy are unpredictable.
At least with psychiatric medications, you have a laundry list going into your prescription knowing what to expect. In psychotherapy, you never know what to expect. You could go into a session feeling perfectly comfortable, end up discussing a traumatic childhood experience, and come out feeling completely exposed and re-traumatized.
Unfortunately, many therapists won’t discuss or acknowledge such “side effects,” but they occur all the time. And the worst part for an individual is that you never know what might be in store in any given week. Being aware that psychotherapy is often a very emotionally trying experience helps, but it can still catch you off guard.
7. Therapists can be just as crazy as any of their clients.
Just like the old joke about the general contractor’s house being the one that is most in need of repair, sometimes a therapist can be the person who is also need in some of emotional “repair.” People aren’t barred from becoming a therapist just because they have their own psychological demons they battle — although it may be discouraged unless the person is actively working on themselves in their own private therapy sessions.
You can try to find out if your therapist is seeking therapy themselves by asking, but not all therapists will tell you. That’s not an attempt to deceive you, but some therapists have the belief that the less you know about them, the better. This is to encourage the formation of transference, which some therapists believe is crucial to the psychotherapeutic process.
If you’re uncomfortable with this possibility, ask the therapist before you even begin therapy with them. If you’re not comfortable with their answer, it may be a sign that another therapist may be more compatible with your needs.
* * *
Therapy can be a powerful treatment modality, when wielded by experienced and well-trained professionals who understand these issues. Being aware of these challenges ahead of time can help you better a more informed and empowered consumer, and help make your psychotherapy experience a positive one.
23 comments
Wow! What a super article. I wish I had known years ago that #1 was okay, I’ve had too many #4s, #6 has kept me from going back at times (like now), and the heading of #7 made me laugh out loud. I truly think a therapist who walks a few steps away from the center line is a gift. Empathy comes more easily and thinking is understood.
Thanks.
Great article, but I think therapists often acknowledge that the relationship is very unusual. That comes up frequently.
This is one of the best articles regarding therapy / therapists that I have ever read. These are all things that come up in the relationship, yet some of them are never acknowledged.
Really good article. I wish everyone who goes into therapy with this information. It should be on the informed consent information. I dread the day when I leave my therapist (funny, after continuing to think that he is going to leave me).
I’ve known my therapist since 1987 and have been in treatment except for five of those years and generally saw him 2 -5 times per week. And, at one point 6-7 hours per week because an hour wasn’t enough. Now, I’m only 4 days/4 hours. We’ve watched and helped each other grow…the thought just terrifies me.
But, I did have to shop around a lot…for more than a year or so.
I’ve always said therapy should come with a warning label.
Most therapists neglect to explain the process from beginning to end. They want the therapy to be mysterious so they can build an attachment from patient to therapist. It isn’t meant to be devious but it should be explained.
Then, some will punish patients for thinking the relationship is more than it is.
my guess is many therapists can’t handle the attachment and make it the patients issue.
I believe that many therapists think that ending therapy can be handled in a few sessions and off you go. Perhaps for them it is easy, for the attachment is not there, but for the patient it has become so much more than that and a pat on the back combined with the words good luck is in no way closure.
I think you have to “click” with a therapist, in much the same way you “click” with someone on a date. Deep in your heart, you know right away if he/she is the right therapist for you because he/she “gets” you. Often, this comes down to whether you both have the same sense of humor. I’m not saying that this should be a substitute for finding out about a therapist’s credentials or treatment modality; it should come at the very end of your assessment. You’ll have a lot to cry about during therapy–with the right therapist you can also find moments to laugh.
Wendy Aron
author of Hide & Seek: How I Laughed at Depression, Conquered My Fears and Found Happiness
http://www.wendyaron.com
I wish that I had read this article when I started therapy, it would have saved me a tremendous amount of emotional pain. My first therapist bullied me, and when I finally terminated treatment, I found myself suicidally depressed with no back up. Fortunately, my new therapist has been a life saver.
My brother was voted “Therapist-of-the Year” in the hospital where he works. He and one other shrink were chosen by that hospital to come to NY and do grief counseling in the immediate aftermath of 9/11. (They came home a 5 AM, crashed on my living room floor, and looked devastated, night after night.)
He also has a successful private practice and I just know there are patients suffering the agonies of transference for him. And for what? He’s a walking fruitcake.
I’ve been a patient, have idolized my doctors (sometimes) but see the other side because of my brother. He called a while back to wish me a happy birthday and then said, “Gotta go. Got group therapy with a room full of nut jobs down the hall — ugh!”
How many of my therapists have said the same thing about me? I cringe to think.
Excellent article. Very good point about how many clients waste their time with therapists who they don’t click with, when they should be changing therapists.
I don’t know why so many clients are scared to change, even when it isn’t working.
A poster above says “I don’t know why so many clients are scared to change, even when it isn’t working.”
Psychotherapists can function similarly to a cult leader–accentuating the target’s irrationality and defects, then posing as the wise parent figure to “cure” them. Therapy can exploit our reflexive compliance to authority and our hopes that someone actually can deliver us from the inevitability of life’s difficulty and pain.
So we invest in the person who makes these promises. When the therapist fails to deliver, they tell us we didn’t want to change, didn’t believe, didn’t do the work.
Are the therapists complicit? Absolutely! Just on this website, we’re told that if therapy fails, we just didn’t WANT it to: “Everyone who wants to engage in therapy can benefit. Not surprisingly, people who don’t have a modicum of motivation to change probably won’t.”
http://psychcentral.com/lib/therapists-spill-11-myths-about-therapy/00012005
Thank you for this excellent article, John. It’s very insightful and well-written.
I once read that 40% of clients do not attend their second session.This could mean that they recieved some insight from the first session or they decided not to continue for whatever reason. Some may want collusion and we all know that this is not very helpful. They may be frightened of challenge,so tend to stay safe. Better the devil you know than the devil you don’t.
Regards
Dawn pugh
http://www.dawnpugh.com
I love that last point: “Therapists can be just as crazy as any of their clients”
I totally agree. I’ve had many patients tell me about nightmarish relationships with their therapists in terms of how they were disrespectfully treated, how their therapists projected on the patient their own issues, etc.
I’m not saying that I’m beyond my own dysfunctions but I do agree that every clinician has “crap” of their own. Sometimes it seeps through in a therapy session. That’s unfortunate.
Samuel Lopez De Victoria, Ph.D.
http://www.DrSam.tv
It’s far more than “unfortunate”.
It can be damaging and even traumatic, and I wish more therapists were called to account for perpetrating it.
someone who does that needs to be barred from practice, period.
the entitlement we extend to rich highly educated whites is the most irrational thing about this country and it needs to stop.
I agree with the idea that 1 session might be all a person needs… Sometimes clients just need one session to vent, and that’s it. Thanks for a great article!
great article overall. I am a therapist. I do both individual and groups, and also run groups on choosing a therapist…ask questions! Including if you are struggling with something specific like eating disorders or chronic illness…what is their experience?
Just a side note though. There have now been studies though… And for individual therapy studied show 50 to 60 min sessions accomplish the same amount as you would in longer seasons..
Of course these are subjective, and I an sure if you found someone who really wanted to price the opposite, you might be able tho find that person. Often family, couples, group, and arty therapies are a bit longer….
You run groups on choosing a therapist?
On the one hand, it’s nice to have a therapist appreciate & acknowledge that it is that complicated a process and that support is so important it’s near-required.
OTOH, it would be nice if more therapists acknowledged that, instead of practically looking down their noses at prospective clients who were having difficulty with the process.
I think this is a great article. Still even years later very relevant, especially as growth in the industry continues. It provides a very human side to both the therapist and client. I wish that many others adopted / acknowledged these same considerations.
I really like your thoughts around side affects because you’re right maybe like medication, not everyone will experience the same affects, there are many things impacts of engaging in psychotherapy. It would be great if this was seen as equal in importance to confidentiality and other such contract agreements that are acknowledged and signed at the commencement of therapy.
That’s for promoting such a good message.
Michele
I have to disagree with a statement made in #1 on this list. I “stopped at the first therapist” and chose not to look any further. She has tremendously changed my life and our bond is still very strong after a year. We constantly face new obstacles, but it has nothing to do with a lack of connection.
The most ironic part is I did not even look for this therapist. I was referred to her by a Psychiatrist. I went with it and have zero regrets.
thank you, very helpful article. i do wish i didn’t feel like therapy sounds like a dysfunctional relationship however! there should be respect for the patient even if it is one-sided.
Great article, I have been with my therapist for 12 years & have done the medication shuffle many times. It took approx 3 years to find a combo that worked. After Chemo & radiation treatments over the past year, I was thrown into medically induced menopause, that brought on a whole new load of emotional issues & the medication shuffle started again, it has not been an easy journey for anyone in my circle of trust.
I am thankful my therapist is a laid back & easy going most days, he has been a blessing & a curse (I say this with respec). I didn’t have insurance when I first started seeing him, I had plenty of “diagnostic codes” in my file, but I didn’t have to worry about having a “fabricated” diagnostic code for insurance purpose & I always requested & received (with no issues) a copy of my medical records from his office after the last appointment of the year so I could stay on top of “diagnostic codes” & my challenges/changes/progress or lack of progress in therapy. Sometimes, he is hesitant to challenge me, but I can read his facial expressions & body language & know when I am pushing. A few times I have gone off topic because it to difficult, raw & painful to continue. When I do this, I usually look him in the eye & say that I want the name of the therapist he sees & the drugs he takes, so I can be as laid back as he is, he usually chuckles or grins, but let’s it go & allows the topic to he changed for the time being. The first time I did this caught him off guard, his face turned red & he couldn’t look me in the eye. Basically, his body language & facial expressions confirmed that he was seeing a therapist & taking meds. At the end of the session I asked him about it. He simply stated that with some of the things he sees & hears, its safer to see a professional than to internalize or transfer his feelings to someone who doesn’t deserve it.
Basically, IMO I have a great psychiatrist, finally! It actually took me 12 years, a lot of anger & frustration ending in a long list of therapists that I didn’t click with, to find him.
I use the term “diagnostic codes” so that I don’t disclose my actual diagnoses.