Mental Health

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Evaluate Your Therapist

Are you dissatisfied with your therapy? Is it you or is it your therapist? Let’s evaluate and find out.

First I will tell you what is reasonable to expect from a competent, experienced therapist. In the next post I will explain the notion of transference, positive and negative, and then how to work with your current therapist to see if negative transference is the problem.

Here are some fair expectations you should have of your therapy process and your therapist:

  1. You should make progress. If you don’t think you are, ask your therapist why they think you are or aren’t making progress. Don’t automatically discount your your own instincts. Listen but don’t assume the therapist knows more than you do just because they are “the professional” if what they say doesn’t make sense to you.
  2. You should get something new out of every session. If you are not, ask yourself if your therapist is:
    • not really working when you are in session – they should be.
    • just being “someone to talk to”: therapists should have a lot more than this to offer.
    • not clearly showing you how to get engaged in your sessions: You have to if you want to grow.
    • just giving advice: you should be learning how to answer your own questions and make your own decision.
  3. You should be learning from your therapist. Your therapist should know more than you do about the general kinds of issues you are dealing with. They should be able to clearly relate this understanding to your specific situation.
  4. You shouldn’t feel worried about your therapist’s feelings – it’s the therapist’s job to take care of themselves. The therapist should call you on doing this and reassure you they don’t need or want this from you.
  5. You should feel your therapist likes and cares about you. If your therapist doesn’t accept who you are and like things about you, you deserve more.
  6. Your therapist should have several ways to approach you and your problem. You should never feel like you are supposed to fit into their way of doing therapy.

If these expectations are not being met, talk to your therapist about them. It is also reasonable to look for another therapist. Remember, just because this therapist is set up in an office or clinic doesn’t mean they are good at their trade.

On the other hand, if you find yourself repeatedly switching therapists I would recommend you stick with your current therapist and make a sincere effort to work out your dissatisfaction.

If you fire a therapist, it may rid you of the problem at hand, but another version of that same problem will likely show up with your next therapist. You need to give your current therapist 3 to 5 more sessions while you focus on working out your relationship. This may well be about transference which is the unconscious phenomena of transferring feelings from one person to another; in this case unconsciously transferring your feelings for some one else in your life to your therapist.

Transference is one of the reasons therapy can work so well and it is also a reason why it can fail. More about that next in “Transference in Therapy“.

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Reluctant to take Medication for Depression, Anxiety or Bi Polar Disorder?

You are justified in your concerns about “putting strong drugs in my body,”  as many of my  clients put it.  How do you decide if it is the right thing to do?

It depends on how severe the depression, anxiety or bi polar symptoms are; how much it is effecting your life.  Some people with mild to moderate symptoms are sure they are not being effected enough to warrant the use of psychotropic drugs. Other people can get a clearer perspective by talking  with the people they are close to and spend a lot of time with.  The people who live around you can often see changes in you that, subjectively, you can’t see but can recognize  when they are pointed out.

Let’s say that your mood problem is effecting your life enough that you want to do something for relief. You can try the medication, see  how helps, and then decide whether or not to stay on it.  You can also try holistic methods, like daily aerobic exercise (for depression), acupuncture or homeopathy. I’ve had clients stop therapy because one of these methods improved their life so much they didn’t need it any more.

Of course there are people  who stay on a maintenance dose of medication to keep their lives worth living. Many have told me they are  glad the medicine exists, knowing that generations back people just suffered.

I strongly recommend seeing a professional if you think you have one of these mood problems.  Good therapists can often determine if the kind of problem you are struggling with will respond to medication or holistic help. You don’t need to suffer, or function at a lower level than you can.  Take hold of your life, it belongs to you. Make it good.

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Everybody Needs Their Version of A Horse (Tongue in Cheek Serious Advise)

Despite the wisdom of Freud,  (who said adult’s lives are about love and work)  I propose  that life for adults is really about Joy and Passion, or ought to be.*

That’s why I say everyone needs their version of a horse.

I have had horses, one or two,  in my life ever since I was in fourth grade.  They have brought me reliable joy, if there is such a thing.  This is not to  diminish the importance of my  partner, my family and good friends.  My partner and I  joke that,  as regards each other,  we are ” necessary but not sufficient.”  To have a full  life  don’t forget to include passion.  ( I don’t mean sexual passion here.)

I am passionate about my horse and riding dressage.  I get high nearly every ride, and get terribly excited about learning something new with him.  I miss him when I don’t see him,  and I love him dearly.

You need to be doing something you are passionate about. Don’t wait for your kids to grow up, or for there to be more money, or hold back because you will look like a beginner and your 45 already.  Go find a way and get into your passion now.    Live your life with joy and passion in it. Your own, very personal, way .

If you don’t know what it is you are passionate about, or believe you can’t do it, therapy could very likely help.  Therapy is about preparing for good living, after all.

*OK, you do need satisfying love and work .

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Are You Getting What You Need From Your HMO?

Every so often someone comes to me for therapy who has already been through counseling at their HMO. Often they blame themselves for not feeling resolved  about what it was that they went to a therapist for in the first place. Blaming your self is reinforced because you’ve been   discharged from their HMO as no longer needing therapy. “So what is the matter with me, I’m still feeling lousy?”

It is not uncommon that the person has been put on a psychotropic medication which they may indeed profit from. The problem is medications work better in combination with talk therapy. The therapy actually helps the medication  to be more effective,  and the medication definitely helps the person get the most out of therapy. In my opinion the person has been short changed. She, or he , could have gotten more help. Often, unfortunately, what they did get was a band aid to “stop the bleeding” but not induce a cure.

Why is this ? HMOs, due to their cost containment strategies, are set up to do short term therapy, which is fine if that is what you need. It can be all you need if you have a present situation which can be cleared up quickly with some help, and has no roots in your past. On the other hand if you are struggling with problems that exist in your life  because of your beliefs about yourself and your world,  it can be a relief to see how you learned these negative beliefs in your childhood.  Making the connection between the present situations and the past  is a doorway to changing in a real way. You deserve to have longer therapy.

I offer in-depth therapy that can get to the bottom of what troubles you. I’m not comfortable with skimming the surface, because most human problems  do have roots in our childhood. When that is obvious to me as a therapist, I can offer you the option of dealing with these underpinnings of the present problem. My commitment to you holds until you decide you are ready to leave therapy, and my investment in you is still there  if or when you want to return.

Going to your HMO therapist is often free or nearly so. I am aware of the expense of paying for insurance and then paying again for therapy out-of-pocket. I have devised a sliding scale that roughly correlates to the income into your household and the number of people that income supports. Almost always,  a fee that works for you will work for me.