Homework

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!”).