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Sporadic photos and notes from a Psyche-midwife, cheerleader, anthropologist--aka clinical social worker in therapy practice. Photos are usually mine except for those of historical events/famous people. Music relevant to the daily topic is often included in a web video embedded below the blog. Click on highlighted links in the copy to get to source or supplemental material. For contact information, see my website @ janasvoboda.com or click on the button to the right below. Join in the conversation.

Monday, September 20, 2010

How to Do Therapy Part Two: Bang for Your Buck

Therapy is expensive.  Insurance helps, if you have it, but the copays and deductibles can be significant.  I grew up frugal and I haven't changed. I want to get, and give, best value.    Psychotherapy is usually much less expensive than medical therapy (I think I paid $350 for 12 minutes with one doctor this year), but it can quickly add up with multiple visits.  Here's ways to make the most of the investment.

First, a disclaimer.  This is how I do therapy, and how I like to get it.   I use a very interactive solution-focused style.   Lots of therapists have different models and these won't apply to all of them, for example, to the practice of long term psychoanalysis.  This isn't meant to suggest those aren't useful modes of treatment; it's just not what I do.

Know what you want.  It helps a lot if you have some global goals and specific objectives for what you want to gain from your therapy work.  Your therapist should be able to help you articulate these, so don't worry about being confused at first or having vague ideas of "being better". You can work on these together.   An example of a goal:  Be happier.  An example of an objective:  increase social support network by spending quality time with two or more people this month.  Goal:  Improve my marriage.  Objective: learn and use two positive communication skills with spouse.  Goal:  Improve health and lose weight.  Objective: reduce emotional eating and decrease daily calorie count.  Goals usually remain constant for the course of the therapy while objectives change as you meet them and move on to new challenges.

Share what you know of yourself as early as you can to help your therapist know how best to work with you.  Some questions to ask yourself:  what's not working for me now?  What's been a historical pattern for me that hasn't served me?  What strengths do I bring to this work?  What learning style works best for me?

Tell the therapist what you don't want.  If you have dyslexia, for example, lots of reading assignments might prove overwhelming.  Maybe you've had a previous therapist and things didn't feel right.  Tell your therapist what you can about what doesn't work for you and why you think that is true.  Your therapist may ask you to trust them to try new things.  If you have real doubts, tell them. 

Do your homework.  Not every therapist gives it.  I do, for several reasons.  First, we get maybe 50-55 minutes together a week (and often I see people much less than weekly).  The main work really needs to happen outside of the session for you to see much change.  Secondly, I have a reason for assigning the homework.  Usually I want you to practice a new skill or gain some new information.  Even if you practice skills in session, that doesn't mean they translate in the rest of your life.  I want to know what works, what doesn't and this is how I find out.  Finally, insight without change is really not that worthwhile.  It doesn't help to label yourself and excuse behaviors that have never worked.  The idea is to find new ways of being in the world that serve you.  By the way, I don't fire clients for not doing homework, or yell at them.  Sometimes I get that you just got busy or distracted.  But if you consistently aren't doing any work outside of session, it's time to look at what that means.   Am I moving too fast?  Have we failed to appreciate the function of the symptom and find a healthier alternative to meet it?  Do we need to include significant others in your life to support the changes?  If you aren't doing the work, explore that with your therapist. 

Similarly, Prepare for your sessions.  Keep a notebook and jot down things that come up during the week you want to address, reactions to homework assignments, questions about the therapy process. Have your copay ready at the beginning of the session so time can be used for therapy, not paperwork. It really helps me if you come in having thought about your session and with some idea of what you want to get out of it.  Don't worry if you feel confused at times about this-- we're used to that.  But when you don't think about your process and therapy except when you are in the office, and wait for the therapist to do all the leading of the session, you just aren't going to get nearly as much out of it.

Ask questions.  This is a partnership in which both of you are working toward your best health.  You are relying on and paying for specialized expertise.  But if you don't understand what your therapist means by a certain comment, why they are suggesting a particular course of treatment, or their motive in asking to see you more/less often, etc.-- just ask.  Similarly:  make comments.  If something feels uncomfortable, if you don't know WHAT you are thinking or feeling-- it's fine to say so.  It's our job to help you figure it out when possible.

If it's not working, talk about it.  It may be a poor fit-- I know, for example, that I am not everybody's cup of tea.  I move and talk fast and some people need a much gentler, more reflective and less active style.  That's not a slam on them or me-- no one can be everyone's everything.  You can always vote with your feet, as psychiatrist Jim Phelps says-- just go to someone else.  But I prefer it, and it's usually helpful to both of us, if we talk about what doesn't seem to be working and either adjust treatment or talk about who might be a better fit.  Also I have found that sometimes just the conversation is enough to clear up misunderstandings about expectations and barriers to change.  

It's pretty common for people to come to a stuck point.  Sometimes it's simply fear about change, or discomfort (believe it or not) with being comfortable.  If you've been in crisis mode for a long time, you may not trust peace.  Sometimes it's time for a break to practice skills.  Sometimes you are just done-- you've done what you came to do, and it's time to stop.  Again, if things seem to be standing still-- talk about it. 

The gist of this is to encourage you to take agency in your therapy work.  You aren't meant to be a passive recipient in this process.  What you bring to the session makes a huge difference and saves you money, and will help you make the changes you are here to make.

If you have additional thoughts, comments are always appreciated.


Drew Hutchinson, Psyshotherapist said...


What a great blog. You have inspired me again.


Jana Svoboda, LCSW said...

Thanks, Drew. You're a good therapist: what would you add to this?