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6 Ways to Open Up and Talk in Therapy

by John M. Grohol, Psy.D. 8/9/2023

6 Ways to Open Up and Talk in Therapy “I’ve shared more in my blog than I could ever tell my therapist.”

“I wish my therapist could read this online support group. Then they might begin to understand what I’m really going through.”

You’ve gathered up the energy and resources to start psychotherapy. It’s a big step and you’re excited to begin. But you find yourself unable to talk in therapy. What’s the point of talk therapy without the talking? We find it so incredibly easy to open up online, but when we’re in the therapy office, we become suddenly mute.

There are many strategies to help “open up” and be able to talk more freely while in psychotherapy. Here are a few.

1. Write it down.

One of the easiest ways to help overcome your fear or inability to talk in therapy is to write down some things that are important to you to talk about before session. Jot it down on a piece of paper, or keep a “therapy journal” even of topics or areas of your life that you want to talk about, you just find it difficult. Bring it to session, open it up, and pick a topic for that session.

8/9/2023 28 comments

Group Therapy for Binge Eating

by John M. Grohol, Psy.D. 2/13/2023

By John M. Grohol, Psy.D.

Group Therapy for Binge Eating Binge eating disorder is characterized by a person having frequent episodes of eating what others would consider an abnormally large amount of food, while at the same time feeling out of control — the personal feels like they are unable to control what or how much is being eaten.

According to government statistics, people with binge eating disorder are considered clinically obese, but plenty of people can engage in binge eating while maintaining an average or less-than-obese weight. Binge eating disorder probably affects 2 to 3 percent of all adults.
People with a binge eating problem often experience:

Eating much more rapidly than usual.
Eating until uncomfortably full.
Eating large amounts of food, even when not physically hungry.
Eating alone out of embarrassment at the quantity of food being eaten.
Feelings of disgust, depression, or guilt after overeating.

Binge eating disorder is a serious mental health concern that, left unchecked, can ruin a person’s life with the feeling of being out of control. The resulting weight gain can also contribute to a person’s poor self-image and self-esteem.

Group therapy is one treatment method used to help people who have binge eating disorder. There are many different kinds of group therapy available, and recently researchers (Peterson et al., 2009) compared three different types of group therapy treatment to gauge their effectiveness in treating binge eating:

A traditional therapist-led psychotherapy group
A therapist-assisted group (where the therapist played a secondary role in the group)
A self-help group

Here’s how the researchers described these three groups: “In the therapist-led CBT groups, a doctoral-level psychotherapist provided psychoeducation during the first half of each session and homework review and discussion during the second half. In the therapist-assisted CBT groups, participants watched a psychoeducational videotape (a specific tape was designed for each session) during the first half of each session, and during the second half a doctoral-level psychotherapist joined the group to review homework and lead a discussion. In the self-help groups, participants watched a psychoeducational videotape during the first half of each session and conducted their own homework review and discussion during the second half. Participants rotated as facilitators for this group.”

The researchers assigned 259 adults to one of these three groups (plus a fourth — a waiting list for treatment, used as a control group). They tested for the severity of binge eating using abstinent rates from binge eating, as well as a measure called the Eating Disorder Examination at the start of treatment, at the end of treatment, and then two more times at followups at 6 and 12 months. Ideally, we’re looking for treatments that would reduce the person’s rate at engaging in binge eating behavior — the higher the abstinent rate, the more effective the treatment. The most effective treatment would have someone no longer engaging in binge eating altogether.

Their findings? “At end of treatment, the therapist-led (51.7%) and the therapist-assisted (33.3%) conditions had higher binge eating abstinence rates than the self-help (17.9%) and waiting list (10.1%) conditions.”

So let’s put these numbers into some context. Getting help from a professional therapist resulted in the most effective treatment at this point — 5 out of 10 people got significantly better, and in the group therapy where a therapist assisted, 3 out of 10 people were helped. But even in the self-help condition, nearly 2 out of 10 people were helped, nearly double that of the control group. In that context, getting some help is better than none at all. And time alone does help some people get better on their own. Patients in the therapist-led group had the highest rate of abstinence and the fewest dropouts at end of treatment.

But here’s where things get really interesting. What about those abstinent rates measured 6 and 12 months after treatment was completed? After all, effective treatment needs to stick in order to prove it’s better than nothing at all. The researchers found no differences between the groups’ abstinent rates at these two followups.

Abstinent rates for binge eating disorder

Leave it to the researchers to the best possible light onto their findings:

Therapist-led group cognitive-behavioral treatment for binge eating disorder led to higher binge eating abstinence rates, greater reductions in binge eating frequency, and lower attrition compared to group self-help treatment. Although these findings indicate that therapist delivery of group treatment is associated with better short-term outcome and less attrition than self-help treatment, the lack of group differences at follow-up suggests that self-help group treatment may be a viable alternative to therapist-led interventions.

Well, that’s the kicker then, isn’t it? What use is a professional intervention if you can’t tell it apart from the self-help group (or worse yet, the control group) after treatment is over?

What this research really demonstrates quite well is how any targeted intervention is better than none at all. And that watching a psychoeducational video and then having a discussion about it with a group of other people may be just as effective as a professionally-led psychotherapy group, in the long run.

Reference:

Peterson, C.B., Mitchell, J.E., Crow, S.J., Crosby, R.D. & Wonderlich, S.A. (2009). The Efficacy of Self-Help Group Treatment and Therapist-Led Group Treatment for Binge Eating Disorder. Am J Psychiatry. DOI: 10.1176/appi.ajp.2009.09030345

2/13/2023 1 comment

10 Secrets Your Therapist Won’t Tell You

by John M. Grohol, Psy.D. 1/21/2023

By John M. Grohol, Psy.D.

10 Secrets Your Therapist Won't Tell You 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!”).

1/21/2023 154 comments