What was the objective of this post? If it was to diminish the value of psychotherapy, then I ask next what is the point of this blog? Some of the points above have merit, I will say that freely, but the tone is demeaning overall, and I am offended to read this at a site that is supposed to support mental health issues and interventions.

At least that was what I thought this blog was about. The take home message I would like to offer readers is this: being a mental health care professional is a life long committment if you are invested in the job description. And it is nothing less than perverse and disgusting how many non-mental health care professionals have stuck their intrusive noses into the profession and truly screwed it up, and us as the alleged gate keepers of the field have contributed to this sizeably! Too many whores and cowards, that is what I see in my travels.

Let me end with this little pearl: if drugs were such a simple intervention, why aren’t most people with mood and anxiety disorders so much better that they don’t seek out further treatment? I’ll give you my take: because it is not a simple “biochemical imbalance” problem, but a psychosocioeconomic problem that requires a multifaceted approach to treatment to see real improvement and return to function.

Dr Grohol is right about the sales pitch for meds though. Treatment is NOT cookie cutter, so if you go to a provider who uses one or a few meds alone, run, do not walk, to the nearest exit!

Skillsnotpills, board cert psychMD

Excellent post John. Number one is very important.
Skillsnotpills - Lighten up for goodness sake. Remove the chip off your shoulder, take off that hair shirt and stop whipping yourself. Having an irreverent sense of humour about life, especially something as heavy as psychotherapy is important. It’s not all bleak bad news. Even my mother laughs occasionally.

Excuse me, but I am entitled to an opinion that can be voiced here if it is not excessively rude or personal. If you are just looking for the choir to hoist you up, like having T Borchard who is another author at this site commenting above, then your select company will only insulate you from the reality of differing opinions. I did not expect you to appreciate my comment, but that is how I interpreted the post, and I hope other readers who are not simple choirboys or girls will chime in supporting or dissenting.

And, I did finish noting you were correct in commenting about how physicians can be narrow minded in offering psychotropics. Seems like a supportive comment to me. Hmmm?

And to Sonia, I’ll “lighten up” when insurance companies stop intruding into the psychotherapy process, like starting with allowing reimbursement for psychiatrists to provide such care. Maybe if such a disruption into your job description occurs, you might not be so jocular!

Some topics just don’t come across as funny or enlightening to those who are negatively impacted by the issue. Think about that a bit.

Constructive enough now?!

My therapist and I did in fact have a discussion once about how difficult dealing with insurance companies can be for therapists. He assured me that mine had been okay. I would want for him to be compensated for his services. I was also very aware that he would have to make a diagnosis in order to receive payment. It would be nice if it were possible to treat the person and not their label, but if that is how it works, then I would certainly understand. I always considered myself very fortunate to be able to see him for a $20 co-payment, but I would really want for him to get the money that was due to him.

I’ve been running right into every blog that triggers me this week. Wonder what that is all about? I get a little uncomfortable with the “not a friend” being brought up time and time again. I like to think of it as that we couldn’t ever act as friends do because of the nature of the relationship, but that knowing and respecting this (as I always did) would not lessen the relationship’s value. And it also doesn’t mean that I’m not friendship-worthy or that we couldn’t have been friends had we met under different circumstances. But just because I can’t ever socialize with him does not mean that I don’t care about him. This relationship is just different and unique. It’s still pretty special and always will be to me.

As far as #10 goes, well I certainly have a great deal of respect for anyone in this profession. I know it can’t be easy at times, but therapists really can and do make a difference. My therapist helped me tremendously and I have always appreciated that. I hope that my progress gave him some contentment in knowing that he’d done his job well. I still miss him a great deal.

Sonia you really made me laugh out loud! This is an excellent post and I do find that most of these points hit the nail right on the head especially with the insurance issues…I wish I would have known some of these things before I started therapy, not that it would have changed my choice to enter therapy but it would have been nice to have the heads up. I didn’t find the post demeaning or negative at all, I found it practical and informative.

I thought it was a very good, informative article. Kudos!

Just to throw this out there, for those who seem to think otherwise, therapy is not all rainbows and butterflies, nor will it ever be. I did not find this article demeaning in the least, rather, it revealed the truths that most people wish to ignore. As someone going into the mental health field within the next few years, I definitely appreciate the article for its accurate, raw, and truthful message.

Skillsnotpills, whatever your damage is, is it necessary to take it out on those simply providing you with the facts? And there is a solution to your issues with managed care intruding: pay out of pocket. That’s the only way that managed care will ever not be involved, so try that if you have such an issue with the people paying for your therapy.

Skillsnotpills…you seem to be the one that always has something negative to say and yes we get it you are always making references to being “anti” medication. Almost every comment you make has something to do with using medication as a last resort. Sometimes since our insurance gives us problems regarding psychotherapy and stated in the blog, medication is the only thing some of us can afford!

I’m not a big fan at all of people perscribing medication for mental illness all the time. I think it’s a preventative measure until the problem is solved.

What I do hated about this post is psychotherapy is only one type of therapy amongst many. One that is also not recommended.

I think this post really discourages people from seeking help which is dangerous. This most could be doing more damage than good, not what I would like to see froma site named psychcentral. It would be particularly off putting for theose already anxious about seeing someone or males who are often more reluctant. Many people need therapy. It is good for them to speak it out. You’re almost poo pooing on these people for doing so.

Therapists, councillors, psychologists etc at the end of the day are like all people. Some you will get along with, others you want, because hey they’re human too. The point is trying to find one that works for you.

I sometimes wonder if some of the commenters who comment regularly here are in the same reality I am in. You get what you pay for folks. I have part of my practice as out of pocket, and people are cheap, because they seem to think that insurance guarantees them care for little out of pocket expenses. And my rates are fair, as I get that reinforcement from those who also are in my reality. If your insurance only reinforces a meds only mentality, go back to my last comment: if meds are so effective, why aren’t most people with mood and anxiety disorders so much better?

Take your shots, live in your alternative reality, and when the reality I sense is the truth of this society bangs on your door, don’t open it. It might be knocking to save you, not harass you!

Man, you sure have a choir, Dr Grohol!

I’m having a hard time understanding skillsnotpills’ English (the syntax is very confusing).

I can understand, however, to a certain degree, why John’s post can be taken as slightly offensive. Personally, as a patient (and non-therapist), I really appreciate the tips and insights into your profession that you are giving us outsiders. And I know that much of the impetus to share this information comes from a very genuine attempt to educate and help. Yet, when I read these kinds of posts, I often also feel a slight hint of pent up resentment and frustration with your patients and profession looking for an outlet. Moreover, while your experience may speak for you and your colleagues, I imagine it doesn’t speak for all therapists (I know my therapist would agree with some points and disagree with others). I wonder, perhaps, if skillsnotpills would have bristled less had you not taken it upon yourself to speak for all therapists and instead, more bravely, titled the post “10 secrets I don’t tell my patients.”

That said, I still appreciate the post.

Geez…based on the posts here from skillsnotpills, he/she sounds bitter and angry and I can’t imagine ever opening up to and trusting this person with my life.

My therapist has been straightforward about how insurance works, from having to diagnose me with something on the preprinted form he must fill out to his dislike of insurance companies when it comes to mental health, but he deals with them because he doesn’t want to treat “just the rich people”.

I’ve been in therapy for over a year and still read posts/articles like this one because it helps keep me centered and focused on the facts of therapy. Every so often he reminds me that our relationship is contained to his office, not to diminish me or our work together but to continue to establish and protect the trust that I have with him by the boundaries he made clear on day one.

I’m of the belief that if I’m involved with something - especially my health/wellbeing - that I have the right to all the facts, whether positive or seemingly negative. Why would you want anything less from your therapist than complete honesty?

Elvira,

What works for you is great. However, it doesn’t always work for patients. I have excellent insurance but it has poor out of network mental health benefits. My therapist’s fee was 200/session; insurance wound up reimbursing $28 - after a $4000 deductible was met annually. Needless to say, it didn’t make a bit of difference. I saw her for two years, the second of which she saw me at a 50% discount, and simply could not afford to continue.

I’m looking for a new therapist now who will have to be covered under my insurance. Please don’t convince all other decent therapists to take your route! (Said with a smile, but a fair bit of seriousness!)

Skills not pills is entitled to his opinion. Stop bullying him everyone! (I’m surprised that therapists, etc. wouldn’t be more self-aware in this aspect).

In talking with (potential) clients, I’m upfront about each of these that applies to me.

I don’t file insurance so 8 & 9 don’t apply. And 7 & 10 are simply not true of me/my practice.

I do, however, put these points more respectfully than presented here; which seem to be phrased for maximum emotional impact (quite appropriate to the style and intent of the piece, IMO).

I do the first 6 because it’s The Right Thing, however, most of them are in fact required or at least suggested by some combination of professional ethics, state or federal regulation, and/or best practices.

I agree with skillsnotpills. This article seemed to discourage people from seeking help from a psychotherapist. I’m glad I didn’t read it when I had a deep depression. I probably wouldn’t have gone to see a therapist after my attempted suicide.

Jaye

Very interesting……… extremely

This was a great article. I have received therapy, and I can see why these are things to keep in mind, from the therapist’s perspective. I think this article brings to light some challenges the therapists encounter on a daily basis, such as getting you to open up but not be a friend, etc. I know for myself that my therapist always encouraged me to explore all avenues regarding my treatment, such as using medication, exercising more, interacting with others and the like. Most people unfairly assume therapy “doesn’t work”, but it is a component for you to heal yourself. Most of the heavy lifting falls on your shoulders, and it’s difficult. But, you have to work on it in order to get better.

Realistic and practical. Thank you.

I have been planning to go back to school to become a therapist. This article is making me rethink my decision.

I thought the article was well written and gives another perspective to clients. It certaintly has brought up some interesting issues related to reimbursement practices and other areas, based on the comments. Great job!

This will be my last comment for this post, and I hope it will be illuminating at the very least.

I am angry because I care about the work I do, and that is helping people help themselves, and do it in the least invasive and paternalistic manner as possible. The hassles and intrusions are beyond acceptable and tolerable, and I am sick of those who practice the adage “hear the lie enough and it becomes the truth”! Insurance has only deaded and demeaned this field of mental health, and I defy any active provider who engages in mental health care to say otherwise, meaning such provider is at peace with the state of affairs of their practice and collegiality with others. The people I have met in the past 5 or more years who have no issue with mental health care as is are usually clueless or in their own little niche practice that does not serve the general community.

I’ll end with this: Dr Grohol’s post has validity to issues, that is not the gripe. It just does not come across as a positive posting to me, and I read above today some others agree with my perspective. I do not want him to lie or be overly cynical, like me the latter, but also do not defend choices and disruptions that should be rejected as interfering with the skills and intentions we as providers should be able to offer and provide without interference, as long as it is in the realm of standards of care.

That is my position. And guess what, to those who take exception to what I have wrote: the patients in my private practice, by in large, appreciate my position and thank me for taking a stand. So, to those who do not know me outside this medium, infer what you want, ’cause in the end I know in my heart I am fighting for what is right. Deal with it!

Have a nice day.

I think all points in the article are valid - I can relate to them after working in a variety of settings.

I disagree that it doesn’t matter where your therapist went to school and got their training.

As a general rule, some training programs tend to be more selective about whom they accept than other schools. I want my therapist to have gone to the most selective training program possible, because the selectivity tends to reflect the degree of the therapist’s past commitment to their undergraduate studies and previous work history. It’s not a golden rule, but it helps.

Case in point. If I had a choice between a therapist with a Ph.D. in clinical psych from the University of Southern California, one of the premier CBT training programs in the nation, and someone who attended a far-lesser school? I’ll go with the USC grad. The USC grad will study with far more qualified professors.

Maybe it doesn’t matter as much fifteen or twenty years after graduation, when a therapist could have made their reps on their own. But as another indicator of competence? I care.

By the way? In my totally anecdotal experience with various therapists, my theory seems to hold. No, they don’t all have to go to USC or NYU and then train at the Ackerman Institute or Tavistock. But it can’t hurt.

Just a note that this is very US-specific and it might be good to state that overtly or try to provide some information for other jurisdictions. For example, if you see a psychiatrist in Canada (at least in British Columbia) it is through the public system - so insurance companies don’t come into it (the doctor is paid by the government) and there aren’t covered and non-covered diagnoses that I’m aware of. And I’ve only ever been prescribed generics. You also don’t generally “choose” who you see - you might be given a selection but you’ll be referred by your GP.

It took me 12 different therapists (from 1971-1996) to get a diag. & treatment that worked. I was put on Haldol by the 1st (court-ordered) psychiatrist. Court ordered b/c I was arrested during a huge protest in Washington DC & fought the police. That psych’ took me off meds 3 mo. later & pronounced me “cured of schitzophrenia.” I tried: Primal Scream, cognitive, behavioral mod’, guided meditation, biofeedback. ETC working hard.
It wasn’t until my MD & I talked that I was diag. (after a week of tests & discussions, Q & A w/a psychiatrist) with seizures, OCD & bipolar dis. After 5 years of heavy therapy & trial & error, I got on the right medication. ONLY after taking seroquel for 6 weeks did my suicidal thoughts (previously 5-10 times/day) go away. I am rarely depressed now, my insomnia is gone–manias are only happy, not wild. OCD only comes out if I am super-stressed (like the day I was attacked by a dog.) So to put down meds as pushed by Pharm. companies is NOT OK. Many people (like me) tried very hard with just therapy & no meds, with bad results. Why denigrate a methodology that works great? I have been on meds w/out a therapist for over a year & am doing great. I’ve had poems published in recognized journals, am in 2 writing clubs. Involved in local theater. My marriage (23 years) is great. More friends now than ever. I am 57 & healthy physically & mentally. I credit my wonderful MD, therapist & great medications (Depakote, seroquel & folic acid with xanax just for the super stressful events.)

Dr. Grohol, you state: “There’s no evidence to support the idea that…. a Ph.D. is better than a Psy.D. for your feeling better, sooner.” But what about LICSW’s? I’m looking for a therapist, and the referrals I’ve gotten are for social workers. Is a psychologist a better?

It’s been my experience that it doesn’t matter what degree or degrees social workers, psychologists and psychiatrists have or where they got this knowedge from, it is the relationship between client and therapist and most importantly the level of empathy that is displayed.

Empathy is something that cannot be gained through education.

Hi. Thanks for the insight to a therapists mind. I doubt other therapists including my own would be this honest about the profession.

Just a few points. In my country it is illegal for the drug companies to push drugs onto the doctors however they can still do it and get away with it, in ways disguised as education for doctors. Also our government pays the balance after the patient pays the co payment. So our therapists wouldn’t have to chase insurance. They however get the secretary to ask for the cheque which gets posted to the patient. So could be chasing cheques!

I also think that if people make important decisions based on a blog on the internet, they are in serious need of psychotherapy. People can’t say “oh Johns post made me re think therapy” or “made me think suicide was an option.” That is ridiculous. Have responsibility for your own life and own choices.

Psych Central always encourages people to get professional support and I don’t think that this post goes against that value at all.

“I also think that if people make important decisions based on a blog on the internet, they are in serious need of psychotherapy.”

I could not have put that better myself.

half of these issues should be addressed in the therapists informed consent or they are doing their job. I do not work with insurance companies so I have no idea what it is like to work with them. But I found the article silly. Therapists don’t push medication, they don’t use medication. Did the author mean psychiatrists? Has the author ever met a therapist or is this from having watched a movie or TV show that had a scene about therapy in it? just plain uninformed.

Eliza says: ‘I think this post really discourages people from seeking help which is dangerous. This most could be doing more damage than good, not what I would like to see froma site named psychcentral. It would be particularly off putting for theose already anxious about….”

Eliza, psychotherapy can be very dangerous, indeed, and it’s really naive to believe that only medications cause damage. both therapy and medications have the potential to cause great damage, and great benefits, as well as both of the above.

And the more highly trained that therapist is, I believe, the more dangerous it potentially is.

The reason psychology and religion hate each other so much is because they have so awfully lot in common.

Sonia said : “It’s been my experience that it doesn’t matter what degree or degrees social workers, psychologists and psychiatrists have or where they got this knowedge from, it is the relationship between client and therapist and most importantly the level of empathy that is displayed.

Empathy is something that cannot be gained through education.”

I agree with this 100%. Book smarts offer knowledge, but it can’t teach you how to relate with another human being. It can’t teach a therapist how to care about and understand a client.

Most of what was written in this article were things that I already knew going into therapy. And my therapsit did in fact discuss a lot of these things with me. He may not have been as blunt as this article has been, but nothing in here really surprises me.

After writing a lengthy comment and having it disappear into nether-land, I’d like to add that I too am bothered by Dr. Grohol’s article. I am a therapist and feel that his article is way too slanted toward the negative about the work, and attitudes, of therapists. I also felt it was discouraging to potential clients who are probably already nervous about starting therapy. Not to mention people who are considering joining the profession.

In short, I think Dr. Grohol took tidbits of truth and oversimplified them to make them look agregious. Therapy is about so much more than diagnoses and reports and what label is put on the relationship.

Dr. Grohol asks for constructive feedback. I would ask that next time he offers a more nuanced and textured picture of the “inside story” of therapy, and to remember that sometimes, every now and then, a life does hang in the balance of whether they seek out therapy or not. People do put stake in what they read and are influenced by a professional’s point of view. It’s not just about making an article “sell.” Even the title sounds like he’s ratting out a car salesman - oops - I mean, “therapist.”

The article seems like one among many resources for what information to cover during the “informed consent” process when engaging a client in therapy. Describing what the client is getting into (unnatural relationship, types of approaches, what goes into a treatment plan, etc.), challenges to the therapy process (pharmaceutical ads, discomfort, confusion about therapists’ qualifications/competence), benefits (learning how to fish - how to help oneself and cope with biopsychosocial stressors), costs (insurance companies, fees, being labeled with a diagnosis), etc. Also needing to be covered are alternatives to treatment and the costs and benefits of these as well (doing nothing, diet, exercise, support groups, meds only, sun lamp, etc.). I agree that the message should be encouraging and hope engendering, but also objective and thorough. The standards of informed consent mandate that the client know what they are getting into. Thank you for the post.

Dr Grohol:

Since you addressed me in your last comment, I will run the risk of being hypocritical and comment once more.

“I’d love it if people would do psychotherapy only first, but that is simply not realistic thinking” only reinforces my comment about ‘hear the lie enough and it becomes the truth’ as insurers have drummed into the heads of too many providers that therapy is not an easy option.

Truly disappointing to read that from you. And, I think Katrin’s comment of “the more highly trained the therapist is, the more dangerous [the therapy] potentially is” is so over the top; good luck to you ma’am if you seek mental health services in future times. That is exactly the problem: too many people without the training hang a shingle as a ‘therapist’ and demean the field with substandard care, and then someone attempts to validate it. Well, I go on record as saying your perspective is unfortunate to believe, but do as you will.

Hey, as I said earlier, why aren’t we seeing people improve as a majority with these wonderful interventions of this millenium? Maybe the quick fixes aren’t so lasting, eh?

“If you want to get better, take a pill, but if you want to get it right, face the truth.” Won’t be accomplished in 6 visits or less, oh ye insurance worshippers!

Dr. Grohol — Being an empirical kind of person, I’m always willing to have my mind changed by facts. Might you post the Google search terms that would lead me to the research about level of degree/institutional training/patient outcomes to which you allude? Or post a couple of links so I can read the actual study or studies? I’m really interested. Thanks so much.

Skills, my words are not written in stone..never!

What I mean is not that higher up the ladder therapists are worse than lower down the ladder therapists. It did sound that way so let me just explain what I meant.

I meant that the higher up the ladder a therapist is, such as a psychiatrist and/or PhD psychologist, the more sure he/she is about her ‘knowing best’, and also the more sure the patient believes him/her to be ‘GOD’.

And the more protected this professional is by her/his license.

But of course, when transference and dependency hits, I guess most patients are so vulnerable to being hurt.

I think this article is very good. Why? Dr. Grohol, as we may have noticed, writes an awful lot of articles, and all the time.

It is completely unrealistic to expect him to cover every single point of view, and ever ‘but’ and ‘also’ and ‘different’ in each and every one of his articles.

Of course he knows that therapy also has all those other great and good points and he has covered those points in many other articles.

I think it would be more productive to look at what he did discuss rather than pointing out every single point he did not discuss.

Katrin

I myself was in long term, intensive, psychodynamic therapy with a psychiatrist for years. The only one he was guilty off was NR. 5 and even then when I think about it, he really was not.

He was extremely conservative with medications. I mean he gave them as little as possible.

The worst thing he did was that he didn’t make me sign the same kind of form that patients have to sign before surgery, and that this may kill them or damage them.

On top of that, every patient should be aware off, and sign a form, that the moment he/she steps into this shrink’s office, her ‘rights’ are forever gone. (legal rights, human rights, etc) GONE!

And so lets just hope it never comes to that, and I don’t mean with the therapist per se, but in general…ever.

Oh, and just before we terminated, I was allowed to, even offered, to read all my charts from the beginning.

There were stacks of them and each session had at least a one page typewritten page or more with incredibly organized observations, questions the therapist asked himself, and about what took place. it was amazing, and he did say that most other therapists do not take nearly as much care.

My former therapist is a clinical psychologist and most definitely does NOT think he is “all-knowing” because of his education. In fact he was always very real and human with me, which I appreciated tremendously. That being said, I don’t feel that it’s his degree that makes him effective…I think it’s his person. He is very empathetic and very ungod-like.

I think you are right, Beth. I’ll take what I said back and limit what I said to Psychiatrists, and well…Social Workers.

I appreciate the clarification from Katrin. That said, degrees don’t infer expertise, it is experience and reliability, and a sizeable dash of humility and realism what you can do as a doctor, not as a director or tyrant or god.

I am about to put up in my office my “ten commandments of psychiatry”, and the last reads as this:
You can only help patients as much, NEVER MORE, than patients can help themselves.

Have a nice evening.

Addendum: I hope Dr Grohol sent a notice of warning to a prior posting by another writer he removed that was completely inappropriate. I for one will never dialogue with said individual again.

I think I knew all those points, but liked reading them. Not one comment affects my opinion.
I look forward to another ‘ten something.’

I am on the same page as Beth. My therapist is a clinical psychologist and does not throw that in my face at all. He doesn’t even address himself as “Doctor” he does by his first name, that action alone in my opinion makes him down to earth. He is also very human and actually one of the most unpretentious and humble people I have ever met. He definitely does not posess the “god complex” cliche.

Wow. This seems a bit like “rant and rave” on craigslist. Always bickering–not everyone; the funny thing is I usually see both sides of the “argument,” which I do in this case also. I realize it is healthy for both camps to be able to express their views, but maybe it would be a good idea to tone down the sting of antagonism, especially on a website specifically set up for mental health issues and the healing involved. Quickly, to comment on the original post: In my twenty years of therapy, I had two therapists that I went to for a total of about sixteen years (they effected the most positive change in me and my perception of the world), it was most helpful for me to “pretend” or act as if they were a friend (and that’s how they treated me), even though logically I knew in the back of my mind that they were my therapist. Well, enjoy the spirited forum, just realize that some readers of these posts may be precariously reaching for any reason to live, and EVERYONE deserves a chance at healing.

How many therapists does it take to change a light bulb? Okay…only one, but the light bulb has to WANT to change. Hey, enjoy the day!

Good comment, relaxin67!!!

Aloha!

I’ll first agree with the first poster (Skillsnotpills) on his/her amazement at the “take-home feeling” of this ‘blog’. It does condescend more than uplifts. Just like the point in #10 says, that could have done without the “Sign me up!!” comment at the end.

Granted, as with most everything in the medical profession (mental AND physical) there’s still a LOT of stigmatisms floating around from the early to mid 1900’s today that are solely based on ignorance more than anything else.

I’ve been on both sides of the fence in my 54 years of life. I’ve seen a therapist for 8 of the last 12+ years of my life due to a chronic illness that literally left me in an unbelievable state of mental health. Honestly, I still can’t believe what has physically happened to me and thus the mental anguish that came with it with not forewarning at all! I firmly believe that one thing a physical physician SHOULD DO is after all has been said and done and the patient is left in worse condition due to the failures of surgeons and various other specialists, etc.. is refer them to a highly qualified therapist (either a Psychiatrist or if none is available, a Psychologist).

It ISN’T an easy “job” and shouldn’t be considered as such. Any profession that works with human beings shouldn’t be classified as a “JOB”! Those all should be classed as CAREERS!

Comprehend? Good….

What about personal coaching which could be an alternative to therapy in some cases?

Therapy isnt always the best option

Anyway I would like to hear\read your personal proffesional opinion on personalk coaching

Thanx
Taggi

The amount of comments here is epic.

Best 2 all.

daily.

I am a therapist (though currently using my skills in an avenue other than insurance) and I have seen a therapist (as all therapists should).

The problem with Social Workers? None — some are natural counselors, but their training can be seriously devoid of therapeutic skills (bending much more towards the administrative side of helping people). That said, I would be cautious when choosing a counselor, regardless of degree. I may be a great therapist, but I may not be the RIGHT one for YOU. Kind of like shoes…lol.

I don’t think the degree matters — in fact, I have often thought that the education required to be a counselor would be much more beneficial to have AFTER one has been practicing for a few years. Before that, you just don’t have much of a clue! Ultimately, from Ph.D to M.S. — it’s all about the person. No amount of education can make a person empathetic or effective as a counselor. That is not to say that natural born counselor-types don’t need education!

If I ever go back to private practice, I will most likely do so without billing insurance. I figure if I charge someone 30-40 dollars a session (not much more than a co-pay) that the time and aggravation I save by avoiding insurance companies will make up the difference.

Counseling, in the end, is a calling. It is not a profession anyone can expect to get rich from, much like teaching. I am a counselor because that is what I am — money be damned. If a person is not called, they can be of help but will most likely burn out and leave the field (or cause a lot of damage while they stay).

In my program, I am one of only 2 students (from a class of 30) who is actually practicing as a counselor. The others are certainly using their education, but not specifically in the counseling field.

Wasn’t clear from point #6 if you feel there is a difference between master’s level therapy training and PhD psychology training. My post-graduate experience as a clinical supervisor (14 years) suggests that PhDs often have more and wider variety of types of clincial training experiences and diversity of supervisors. I think a particular strength of psychology training is a process aspect, meaning the oral tradition of clinical supervision and the growth that the relationships over time in multiple supervisory relationships can promote. In my view, probably as important as the content of training.

to therapistIam, I liked your comment a lot.

I always thought it’s the best of the therapists that have the greatest tendency to ‘burn out’?

Thanks, Katrin.

Hopefully the best therapists have a great support system and are able to compartmentalize their work (not take it home, separate themselves from it). Counseling can be a grueling field — you always have to be aware of transference issues, rarely do you get to see the growth/healing and end results, and rarely do you get to ‘finish’ or get closure. A counselor does their best work behind closed doors — no opportunity for kudos or the respect of friends/peers for a technique that worked or a great session. It is not a career for those who need a constant pat on the back or reassurance that they did the right thing (although, ironically, many who are drawn to become counselors crave those very things). You have to keep a healthy honesty and insight about your own weaknesses and frailties. All of these components are stressful — but if you know you are doing what you are meant to do, I think it moderates the stress. If it’s just a job? Not so much. There are some career fields that you can do whether you love it or not (though perhaps not happily), but this one is not it.

I personally was very closely involved with someone with the training to be a counselor, but not the personality or calling. Very little willingness to confront their past or to be honest about their weaknesses. I question how effective they were to their clients — they are no longer in the field, btw.

I know that my strongest skills are in communication/listening/intuition/empathy and that I am really good at finding the ‘thread’ that underlies behaviors (and can reveal underlying dysfunction). I enjoy hearing people’s stories and find people in general fascinating. I am painfully aware that I do not have all the answers, but believe that sometimes we need the unconditional acceptance and objectivity of a counselor to help us heal.

Research has shown that eventually people recover from life traumas, with or without counseling. Research also indicates that the type of counseling matters not a whit — from Gestalt to Cognitive Behavioral to Pastoral — none made more improvements than any other, over time. But, I do have to believe that those who seek therapy may heal more quickly, with less scarring and more coping skills to use when the next difficult time comes around.

Well…obviously being verbal is not a problem. LOL

Another great comment from you. I have been seeing a counselor a while now. it started with dad and son going and then I got involved and then they finished and I stayed.

The reason your response is great and relevant is becuause this counselor is great, and she does great work behind closed doors, and she regularily attends continuing education workshorps and has done tone of work on her own stuff.

But I can also see how all you mention is stressing her out, especially e-mails and phone calls between sessions, not to mention that she has other problems, like a sick father.

She is very honest and really puts out in a way that is very therapeutic but I must think not always easy and rewarding.

I also know she knows when she feels burn-out and tries to practice self care to the best of her ability.

To my own horror, I have not exactly been very helpful in NOT contributing to her stress.

It makes me feel horrible and I am reminded now that we need to really talk about this, and last time this happened, I ‘REALLY GOT IT’, and no longer felt the need to go against my own values afterwards. (before, it was just like I had no control, and after we talked about it, it was no longer a matter of control; just went away.)

Thanks again,

KAT (not edited)

Katrin –

Thanks again — but please PLEASE remember that in the therapeutic relationship, it is not YOUR job to take care of the therapist. Hopefully, she will catch this and you can talk about it.

When I was in therapy, I remember worrying about my therapist (for various reasons), and I think (in retrospect) that it is a sign of healing and maturing that I wanted to help him. However, it can also be a very effective and destructive coping mechanism to avoid some of the work that needs to be done! So often we spend all of our energy caring for everyone else (because don’t they deserve it?) and forget that WE deserve to take care of just ourselves. That is one of the things that makes therapy so great, in my opinion. It is the one relationship where it is not only acceptable but necessary to be selfish. There were times when I struggled with the relationship inequity (especially because I was infatuated with him — also very natural, albeit slightly embarrassing!) and wished that we could be equals. Ultimately, though, I was so grateful that he did not let me take care of him, that he kept those boundaries (and respected mine) because I did not need for him to be a friend - I needed him to be a therapist.

I remember once that he spent part of a session talking to me about being a single parent — turns out he was thinking of dating a single parent and was looking for advice. At first, I was flattered that he revealed this to me and that I could help him. After the session, though, as I journaled, I began to realize that I felt angry at him for using my session to talk about his stuff. After much soul searching, and lots of writing, I decided to confront him about how I was feeling. This was such a huge step for me, because I hated confrontation, feared abandonment, and was not used to speaking up for myself when it was really important. Being able to talk to him about it was an amazing, empowering experience and ultimately happened because we had a great therapeutic relationship. The bonds that we form in therapy allow us to work out issues we have in ‘real world’ relationships. I needed to be able to confront someone in a ’safe’ environment, where I could be heard and respected (which is what he did — he acknowledged his mistake, apologized, and praised me for expressing my need to be the focus of our sessions). Powerful.

Katrin –

Thanks again — but please PLEASE remember that in the therapeutic relationship, it is not YOUR job to take care of the therapist. Hopefully, she will catch this and you can talk about it.

When I was in therapy, I remember worrying about my therapist (for various reasons), and I think (in retrospect) that it is a sign of healing and maturing that I wanted to help him. However, it can also be a very effective and destructive coping mechanism to avoid some of the work that needs to be done! So often we spend all of our energy caring for everyone else (because don’t they deserve it?) and forget that WE deserve to take care of just ourselves. That is one of the things that makes therapy so great, in my opinion. It is the one relationship where it is not only acceptable but necessary to be selfish. There were times when I struggled with the relationship inequity (especially because I was infatuated with him — also very natural, albeit slightly embarrassing!) and wished that we could be equals. Ultimately, though, I was so grateful that he did not let me take care of him, that he kept those boundaries (and respected mine) because I did not need for him to be a friend - I needed him to be a therapist.

I remember once that he spent part of a session talking to me about being a single parent — turns out he was thinking of dating a single parent and was looking for advice. At first, I was flattered that he revealed this to me and that I could help him. After the session, though, as I journaled, I began to realize that I felt angry at him for using my session to talk about his stuff. After much soul searching, and lots of writing, I decided to confront him about how I was feeling. This was such a huge step for me, because I hated confrontation, feared abandonment, and was not used to speaking up for myself when it was really important. Being able to talk to him about it was an amazing, empowering experience and ultimately happened because we had a great therapeutic relationship.

The bonds that we form in therapy allow us to work out issues we have in ‘real world’ relationships. I needed to be able to confront someone in a ’safe’ environment, where I could be heard and respected (which is what he did — he acknowledged his mistake, apologized, and praised me for expressing my need to be the focus of our sessions). Powerful, and exactly what I needed to work on in therapy!

The above is part of why I agree with other posters who have said that what is important is the relationship between therapist and client. Where the therapist went to school, the level of degree they possess, how high their IQ — none of those make as much difference as the person they are and the relationship they can build with you.

It is important (to me) to point out that my therapist could easily have taken advantage of me (at least for a while). I was totally vulnerable and at times wished he would cross the therapeutic boundaries and be my ‘friend’. As a therapist, I see how easy it would be for a therapist to cross those boundaries (after all, they are human and need companionship and acceptance just like everyone else). Education can and should help prepare therapist to deal with these issues, as does supervision and strong peer relationships.

Anyway… Have a great day!

WOW, another such great comment from you, not just in general but really what I needed to hear, or really helped me to hear so much. I think my therapist would agree with you 100% and it’s those risks we take that usually accomplish the highest level of ???that are the most special and rewarding.

it’s like: “Taking no risks is risking everything’

You have really helped me with your words, therapistIam, and I feel really understood by you.

xxxKatrin

This is excellent! Funny in some ways, but yeah, true.

Oh, yikes! I posted an exceptionally insightful post (I’m sure) & hit some key & erased it!!

Anyway, my psychiatric nurse practitioner (meds provider) has been a wonderful supporter & I consider her a friend after 12 yrs. & I think she would agree. The meds helped me to be able to participate fully in therapy. She works in a collaborative effort w/me & I feel EQUAL to her. She has certain educational info. I don’t have, but I have the insight on myself so we are a good team!

I don’t agree education doesn’t have an impact on the quality of therapy. I attend a Dialectical Behavioral Therapy group/class weekly & the therapist is specifically trained in this method. I also do indiv. therapy w/her & have had EMDR treatment from her, as well, which has been very successful in treating my chronic insomnia to such a point that I have been able to get off sedating meds at night.

She is highly trained & so effective that I’ve been able to get off many psych meds due to learning new skills of coping. My np works w/me on decreasing dosages & getting off meds. I agree if my symptoms reappear (as they have a couple times) I will go back up to a higher dosage or take a medication I have discarded (like Klonopin) for a month or so to get me over the hump & then try again.

My DBT & indiv. therapist is a Ph.D. & I call her Dr. So & So. Everyone else in the DBT group calls her by her first name, but I prefer to call her Dr. So & So as I think it is a sign of respect. I don’t think she is my “friend”, but I definitely have some laughs w/her, gave her some info. about her first time hiking the Grand Canyon as I’ve done it many times & gave her the “gift” of new pens to use on the white board during our DBT classes as it drove me crazy when she had to seek for a pen that still had ink in it. I told her to keep those pens just for herself & packed them in a zip loc bag for her!

I’m very comfortable w/both providers. I have been w/np for 12 yrs. (female) & we hug when saying “Goodbye.” My DBT therapist is also female as I have been unable to trust males due to some past experiences.

My ins. (through my husband’s work) doesn’t even pay a pittance as they are both out-of-network providers (np does not involve herself in any ins. co., but will file for you).

DBT & indiv. therapist WAS in my network, but the mental health facility where she works pulled out as the ins. co. was so pathetic on paying claims. I had to spend many hours on the phone w/the ins. co.

I called the supposedly “in network” psychiatrists & no one was accepting new patients & one had his phone # disconnected. I didn’t expect much as my ins. co. also has listed DEAD doctors as being in network. I tried several of the “in network” therapists & they seemed to just want to say, “Poor you, growing up w/such a chaotic, troubled family. No wonder you are having such difficulties.” BUT no practical help in getting on w/my life which DBT has done.

Dx of bipolar 1 as my mother had. She did commit suicide when I was 15 & I’ve had many attempts myself so I definitely benefited from the meds & therapy.

I don’t discount the helpfulness of either meds or therapy. BOTH have been so beneficial for me, but it is my desire (& common sense) for me to attempt to decrease dosages & getting off meds when I can as I have improved w/therapy–yet I couldn’t benefit from the therapy without the meds helping me to think rationally! I was paranoid & severely depressed.

So I am grateful for both therapy & meds, but ins. coverage sucks.

CBT homework is now the same as advice? When I think of advice I think of “You should leave your spouse” or something along those lines. The CBT hw might be a roundabout way of saying “You should work on your awareness of your thoughts, behaviors, and feelings” but I think there are big differences between the two. Advice is making a decision, not encouraging someone to better evaluate the situation, though evaluating the situation to make a better decision is always good advice.

Out of curiosity, why do therapists not want patients to view their charts?

Joy, the best way to go about answering this question is for you to try and put yourself in their shoes, or position. Imagine the notes you would take, and then think for what reasons you may or may not want for your client to see the charts. There is no universally true answer, here.

Like for myself, when I do this I can up with some examples that pertain to me and the notes I may take.

1) that I cannot communicate the nonverbal relationship I have with my client, and that by putting down ‘the usual requirements’ that my notes require, the outcome of my notes may sound dry and not in the least capturing the true relationship that I have with my client, and that we both are aware off. In that sense, my notes may give a different picture just because it is lacking.

2) I am sometimes sloppy.

Katrin

Joy, not all therapists mind if patients view their records. I wouldn’t want to see a therapist who didn’t have the guts to address what they had written in my medical record.

I had a shrink try to keep my records from me, and trust me there was very good reason he was trying to prevent me from viewing them. He had written some snotty comments (which I suspected)that he never would have said to my face. The good thing is I got my records, terminated my relationship with him, and found a therapist who treats patients more respectfully. If they try to prevent you from viewing your records, there’s a reason. What’s the saying? Those who have nothing to hide, hide nothing.

Dr. Grohol, I am concerned about secret #9 in which you state that you give clients a diagnosis whether they need one or not. Misdiagnosis and over-diagnosis in order to get reimbursement is not only unethical, it is illegal. No matter how many therapists and other health care professionals commit fraud, it is still wrong and should not be considered justifiable. Psychologists who commit such fraud should be arrested and lose their license. If you think these penalties are too severe, write your congresspeople and your state board. Just because you do not like certain ethical standards and certain laws does not mean you can ignore them. I think it is very dangerous to tell clients that they should expect unethical and illegal behavior by their psychologists. Recommended reading: APA Ethical Principles; “Managed Mental Health Care: Intentional Misdiagnosis of Mental Disorders” (Journal of Counseling & Development, 83, Fall 2005, p. 425); “Is It Ethical to Deceive Managed Care Companies?” (Journal of Contemporary Psychotherapy, 30, #3, 2000, p. 217). Thank you for the opportunity to comment.

Paying out of pocket dissolves the need for most of these secrets. Having a major medical crisis went a long way to getting me to understand the need to pay attention to all my health situations and to take an active part. Therapists aren’t going to/can’t do the work/cure one, time does indeed help but so does personal responsibility for one’s own health and health care.

I have been to over 15 therapists in the last 10 years. I can tell you based on my experience that degree/institution doesn’t matter. I’ve gone to Ivy league trained and plain old lcisw. In the end what matters is that the therapist has a strong, honest and introspective character. I have experienced everything from down right unethical behavior to temper tantrums from therapists. They have buttons like everyone and they can be set off just like the crazy bum around the corner. I have experienced a lot of complex trauma in my childhood and frankly therapists didn’t believe me. They couldn’t get their tiny provincial brains around the simple truth that bad things can happen to children. Therapy with these therapists amounted to re-traumatization. No accountability though. Completely unregulated profession.
I do believe there are excellent therapists like there are excellent teachers and doctors. But there is absolutely no accountability. It’s true that even when they believe that they are not able to help you, they will continue to pretend that they know what’s going on. Eventually I became an expert at figuring out the therapist’s skill level.
I have finally found a therapist who is trained to work with clients with childhood trauma. It’s like a miracle. So I do respect her but I don’t respect the profession.
And to the therapist who used the words “whores and cowards” - seriously - that’s how you speak in a public forum?
I wish everyone the best in their journey and thank you dr.grohol for being brave enough to point out areas for improvement with the system. In order to be good at our professions we need to aslo be brave enough to point out the flaws.

Dr. Grohol, thanks for your thoughtful reply to my comment. I am glad that you agree that making up a diagnosis, or exaggerating a diagnosis, should not be done. At the same time, you seem reluctant to say clearly that doing so is unethical and illegal. There is no gray area here. Deliberately making up a diagnosis or over-diagnosing simply to get money from insurance companies is both unethical and illegal. Such cheating is one reason we have a health-care crisis. Newsweek reported research that shows that $100,000 billion per year is lost to fraud. Psychologists who scam insurance companies contribute to this problem. When you say that everyone does it and that those who do it are not easily caught, you seem to be encouraging the practice. Regardless of how many psychologists cheat, it is still wrong, and psychologists are often convicted of such fraud. Just look at the lists of psychologists who have been sanctioned for being convicted of fraud on the web sites of the state psychology boards. I’m glad for you that you were not caught. You seem to think that because insurance companies do not reimburse for the treatment of some minor conditions, it is understandable that psychologists fudge the diagnosis so they can get paid. I suppose it is understandable that some people are willing to lie and cheat for money, but let’s not pretend that it is OK. By making one of your secrets “I will give you a diagnosis whether you need one or not” you are telling readers, including prospective therapy clients, that psychologists routinely lie and cheat. Yes, that happens, but there are ethical psychologists who do not. Why not make one of the secrets “your therapist will try to sleep with you” or “your therapist will bill you for services not performed”? Some do that too, but not many, and it is wrong and unhelpful to tell the public that psychologists routinely cheat on diagnosis just to make more money. I know you disagree, but I appreciate the opportunity to provide an opposing opinion.

I have only been out of grad school for a few months now, and I have started my private practice. I only have about 16 clients, and none of them pay my “full fee”.

I have decided the only way I can make a living is to take insurance, but then I see experienced clinicans like some of those above say it is not the way to go.

So, I’m left confused! I don’t know how exactly I am going to make a living if I don’t take insurance. I am tired of being an educated professional with a Master’s Degree that has to eat mac and cheese for dinner every night because I’m too poor to have anything else!

oh, and those reading this blog that might have any feedback for a new clinican are welcome to reach me at mbakerreach@gmail.com

Cheers.

I finally came to the conclusion that psychiatry and psychology are pretty much a waste of time in terms of being therapeutic tools for people with problems. Both disciplines make for good intellectual discussion. But I do not know one person who has ever benefited from paying a stranger to talk to. People I know who have been through therapy are worse. Particularly those who got on the Prozac Track. Besides, most therapists are total neurotics trying to work out their own crap. That’s why they got in the field to begin with.
You are your own therapist.

Tim, the clinician’s decision to choose a diagnosis seems similar to a tax loophole. Similar to the loopholes of income tax guidelines, where those who are wealthiest can hire an army of accountants and financial advisors to rearrange and categorize their finances in such a way that will enable them to avoid paying taxes.

I’m not sure if the selection of diagnoses, which are dynamic to begin with, grey areas in which many individuals can ‘fit’ into several categories for a doctor to interpret, cause harm as opposed to good. While the insurance industry may pay more (passing along the costs to those who have insurance), patients are healthier and can thereby save money for employers and other costs to society. People can be more productive and more effectively raise their children. I think allowing those who need mental health treatment access benefits society.

On the other hand, I’m not so sure that tax avoidance using loopholes helps society. I understand if you disagree, but if we are concerned about costs here-I’d welcome increased efforts to eliminate tax loopholes over the ‘cracking down” of diagnoses loopholes that help people. Loopholes are legal.

2 cents for the blog

Tim, Oct. 20: I am glad that you agree that making up a diagnosis, or exaggerating a diagnosis, should not be done. At the same time, you seem reluctant to say clearly that doing so is unethical and illegal. There is no gray area here. Deliberately making up a diagnosis or over-diagnosing simply to get money from insurance companies is both unethical and illegal. Such cheating is one reason we have a health-care crisis. Newsweek reported research that shows that $100,000 billion per year is lost to fraud. Psychologists who scam insurance companies contribute to this problem. When you say that everyone does it and that those who do it are not easily caught, you seem to be encouraging the practice. Regardless of how many psychologists cheat, it is still wrong, and psychologists are often convicted of such fraud. Just look at the lists of psychologists who have been sanctioned for being convicted of fraud on the web sites of the state psychology boards. I’m glad for you that you were not caught. You seem to think that because insurance companies do not reimburse for the treatment of some minor conditions, it is understandable that psychologists fudge the diagnosis so they can get paid. I suppose it is understandable that some people are willing to lie and cheat for money, but let’s not pretend that it is OK.

It is always refreshing to see facts such as these put out with transparency.

Having said that, I would like to add that after reading some ‘feedback’ I noted that a false dilemma had been created — if I voiced my own opinion, and this was a shared or popular one, or one which was positive to, or supported in any way, the original post then I am effectively a ‘member of a choir’. I found it quite odd to have this ‘us vs them’ mentality created by a so-called passionate member of the profession; I would think (hope?) that the true professionals in this field are less judgmental and more reasoned in their thinking.

Does “time itself heal most wounds”?