The Truth About (Psycho)therapy: 101
For those of you considering therapy after a long sabbatical from this form of self-work and for those of you embarking on a therapeutic journey for the first time, this post is for you! Even in 2018 I still hear a lot of people echoing some old ideas about what psychotherapy is, who it is for, and where you have to go to get it (No, you don't have to go to a sterile, elevator-music-playing office to get high quality therapy...unless that's what you're into). These archaic ideas about psychotherapy being for "the sick," "the crazy people," (oof!!!) or basically, anyone but me, are completely understandable given the way that we are socialized to think about self-examining in this way. Movies, television, and our opinionated (and usually under-informed) family members are some of the best sources for this misinformation.
Let's tackle the first, most common question out there: "Is psychotherapy for me?" In short, ABSOLUTELY, 100%, YES! "But Emily, you don't know me, my background, my strengths, and how I've never been depressed ever, or never used medication...etc!" To that I say, great, you are going to be starting your self-work in a strong position. Understanding our strengths, abilities, and social ecosystem is definitely part of the work in therapy, but there are a lot of life experiences and genetics that factor into those abilities. Unpacking our strengths and understanding where they come from is part of the key to understanding our growth areas, challenges, and full-on, life-altering sh** storms! Therapy is for everyone, period. I thought briefly about listing out all the variations of human beings, but since there are so many intersections of human identity, I won't waste good space here. Just know that therapy is for the high-functioning as much as it is for folks living with Chronic and Persistent Mental Illnesses (CPMI).
Often times, when I'm working with a new client who has never been to therapy, they will present with an almost predictable, albeit perfectly reasonable and valid, cautiousness. They will peer around my office to see if there are any tangible threads to who I am as a person and professional clinician. They will usually wait for me to give instructions about where to be seated and nervously clutch their belongings, in case they need to flee (just kidding, this only happens some of the time!). One of the most significant roles I have as a therapist is to be aware of this inherent power difference in our relationship, even seemingly before the relationship has begun. You see, when working with a trained, ethical clinician, everything about the process is designed with intention to keep your safety, confidentiality, and best interest at heart. The first rule for any therapist is "Do No Harm." With this in mind, everything from our websites, intake forms, practice policies, directions to our office, the layout of our space, down to the therapeutic interaction, itself, is designed to "Do know harm," and more aspirationally, to "do the most good."
The first session is about getting to know you, but it's also about you getting to know me. This can be really empowering to turn the tables and view those first couple of sessions as an opportunity for you to determine if a therapist is the right fit for you. Goodness of fit is extremely important and should not be over-looked (I know, I said "should"! More on how to stop "shoulding" yourself in a later post). Consider the fact that this is a person you will be opening up to about the most private details of your life and inner-most feelings. Feeling safe emotionally and physically in that space is extremely important for the therapeutic process to work effectively.
Does he talk too loud? Is her specialty area not aligned with your specific needs? Do you want more transparency from your therapist or do you feel more comfortable with not knowing anything about your therapist? Do you want someone who challenges and confronts you (strategically and gently, we hope) or do you prefer a therapist with a more reserved, passive approach who offers limited feedback? Goodness of fit also takes into account where you are in your self-work journey. For example, a person with a history of sexual assault who is beginning their work to process and repair those trauma wounds may need to consider the therapist's gender and specialization in sexual trauma work so that a feeling of safety in the room is optimized.
This is where I hear many of my first time clients reporting feeling exhausted and overwhelmed by the process of finding a therapist. In urban areas, the market for experienced and quality therapists is often saturated. While this gives clients the luxury of choosing from a dense pool of high quality clinicians, it can feel overwhelming to discern who is the best fit (I call it, the Netflix complex... Too many choices!!!). For those who live in rural areas where there are less providers available, consider telemental health options like phone or video sessions. Most telemental health providers, including yours truly, require at least one in-person session before beginning a telemental health therapy relationship. It's important for us to interact at least once face to face as body language and non-verbal communication is as important if not more significant than what is often being shared. Allowing that first visit, and perhaps a few subsequent in-person visits, gives both you and the clinician time to determine goodness of fit for this particular form of therapy. When looking for a telemental health provider, make sure they have the proper certification and training to provide this service. Distance Certified Counselor (DCC) will often be included with their name and credentials.
Mental Health directories like Psychology Today are a great place to begin your search and allow clients to filter their search by zipcode, insurance carrier, specialty area, and many more specifications to help you hone in on therapists who may be the best fit for your specific needs. Keep in mind that not all clinicians use this platform-- this is just the one I am most familiar with. I also recommend starting here because often times insurance panels do not accurately reflect an updated list of in-network providers. Since providers control and manage their own Psychology Today profiles and websites, you should get a much more accurate list of in-network providers when searching with that filter.
While viewing a clinician's profile is a helpful start, it may not give you a full picture of their therapeutic style. Be sure to check out their website if there is a link provided, group offerings, blog posts, practice Instagram or other social media profiles, pictures of the clinician and/or their space, and of course, their licenses, credentials, and educational background.
Next, look for their "theoretical orientation", which will tell you a lot about how they conduct the therapy session as informed by an evidenced-based psychological theory (For example, Feminist Perspective, Cognitive Behavioral Therapy (CBT), Existentialist, etc). Hint: if they list a theoretical orientation or "perspective" without defining what it means or how they apply it in therapy, either keep moving on in your search or be sure to ask the clinician about their theoretical perspective when you make that first phone call so that you can understand why that approach is used and how it will be applied in your work together (ahem... and maybe gently mention that it would be helpful for them to explain this more clearly on their profile or website).
Now for the grand-mommy of them all, "Why are so many therapists not accepting insurance? I pay for my insurance so that I can use it to get help and I can't afford therapy out of pocket!" My response to this question involves quite a bit of nuance and I will save most of it for another post where I will go into these details. Suffice it to say, for most clinicians, it's a matter of keeping a roof over their heads and their practice doors open. Many insurance carriers reimburse highly trained and qualified clinicians who have invested a lot into their education, on-going training, and specialized credentials at unsustainably low reimbursement rates. Check out this story at wuga.org for news on how Georgia is performing on Mental Health Parity. Often times, a clinician who is in-network with one or more insurance carriers has to take on 30+ clients a week in order to pay for their overhead costs and take a small paycheck home. This may not seem like a lot, but the mental, emotional, and spiritual stamina it takes to be fully present and alert for 30+ clients takes a substantial amount of focus, mental fortitude, and intentional self-care on the part of the clinician. These clients may be individually bringing in a variety of concerns which may include but are certainly not limited to childhood trauma, domestic violence, suicidal thinking, drug or alcohol abuse, grief and loss, etc. For every client there is also paperwork to insure ethical, compliant documentation and insurance claim filing. This can result in a private practitioner working 40+ hours a week, just to keep up with the in-person client hours, documentation and insurance claim filing. Most clinicians spend time outside of their direct contact with clients working on treatment planning, reading articles and consulting with clinicians (with client's express, written consent) for additional information and support on a given topic, and reviewing notes in preparation for the next session.
As entrepreneurs and small business owners, many clinicians must also do their own promotional work, marketing, and networking to keep a steady flow of clients on their calendars. Remember, for many of us in private practice if we don't work, we don't get paid. In addition, we have classes, workshops, and trainings we are required to take to keep our licenses and credentials active. These often come with a substantial price tag and also require us to take time out of the office, limiting or prohibiting our ability to see clients on those days.
A lot goes into the specific business model that each clinician chooses for their practice. These are some of the reasons you may find clinicians opting out of insurance panels and choosing the path of private pay options. Many clinicians do, however, offer "sliding scale" options for clients who have financial barriers that would otherwise limit their ability to receive quality mental health treatment (Hint: It never hurts to ask about this option... ethical clinicians will not be offended!). Some clinicians will ask for documentation from you to demonstrate your financial need and others will simply go by a "trust contract", giving the client the benefit of the doubt that they will notify the clinician if and when their financial circumstances change. Most clinicians I know would love to offer their services at low or no-cost rates because we love what we do and we believe in the power of therapy for everyone. But alas, we are working hard and have invested a great deal in developing our craft and their is a monetary value associated with it. Hopefully, as you take this step in cultivating and nurturing your mental wellness, you will see the value in this work much the way you do in other investments you make to ensure your sense of stability and overall wellness.
Feel free to comment below or write/call me directly with any questions, concerns, or feedback. I want this to be a resource for you and the people you care about so share with anyone you think may find this information helpful. You can follow me on Instagram @restorecounseling for information about upcoming workshops, links to my blog, and inspirational messages.
As always, be well.