10 Secrets Your Therapist Won't Tell YouPsychotherapists 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. …

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10 Secrets Your Therapist Won’t Tell You

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  1. 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.

  2. 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!

  3. Good comment, relaxin67!!!

  4. 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….

  5. 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

  6. The amount of comments here is epic.

    Best 2 all.

    daily.

  7. 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.

  8. 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.

  9. 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’?

  10. 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

  11. 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)

  12. 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.

  13. 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!

  14. 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

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

  16. 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.

  17. 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. ;)

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

  19. 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

  20. 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.

  21. 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.

  22. I’m not here to pass judgment about whether these practices are unethical (depends on one’s professional ethics) or even illegal. I am here to let people know what goes on in real-world therapy practices, whether right or wrong.

    I think you’d be hard pressed to find a therapist that’s gone into practice in the past 20 years and who worked for a practice that primarily took private insurance to not find an occurrence of this happening at least once, especially by moving something that is likely more of an “adjustment disorder” into “major depression” (since the former is not reimbursed while the latter is). Diagnosis, after all, is fairly subjective (despite appearances otherwise), unless done with standardized assessment measures.

    Since most clinicians do not use such measures, and most professionals don’t call one another out on their disagreements with a particular diagnosis, this is not a practice easily “caught,” even when done.

    Should it be done? Of course not. But it’s an unintended byproduct of the current mental health care system (and its reimbusement) we have here in the U.S.

  23. 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.

  24. 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.

  25. 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.

  26. 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!

  27. 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.

  28. 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.

  29. 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.

  30. 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.

  31. Does “time itself heal most wounds”?

  32. Time itself definitely doesn’t heal all wounds. I don’t know about “most” wounds.

  33. I guess I’m misunderstanding your point as a PsyD in writing this article in this particular tone. Are these really secrets? You make the profession sound like a joke or a crock when it is actually a very effective mental health tool and valuable resource for mental health patients and/or client! It is bad enough that the societal stigma deters people that really need help from seeking out assistance. An article with such tone is not needed and in my opinion not even warranted. Just to address some concerns I have with your SECRETS:

    I honestly don’t know whether I can help you or not.

    This is no secret but instead common sense. That’s just as if you were physically injured and went to the doctor, they don’t know until they assess the injury what they can or can’t do for you! And yes every single individual is unique hence the different theories, methods, strategies, and orientation of therapy. There is no one size fits all or no cookie cutter fix for peoples psychological state.

    I’m not your friend, but I want you to open up to me anyway.

    This too is no secret. They didn’t schedule an appointment with a friend. They scheduled an appointment with a therapist. Any initial consultation and/or consent form explains the “therapeutic relationship”, not friendship! If they are coming to a therapist for help how else will one be able to assist without them opening up?

    If you ask to see your chart, I’ll probably give you a hard time about it.

    Well if you are going to tell it, please tell it all. Although, it is the patients right to see their chart, it is also the therapist’s duty to protect their client. So if there is something in the chart that may not be understood by the client or be misinterpreted in a negative way this could be harmful to the client. Some of the things in the chart may not make clear sense to the average non-mental health professional. So rather than sending them off with a sheet of paper written in a foreign language, the therapist would be more helpful just to explain their diagnoses and chart info to the patient.

    I’m not supposed to give you advice, but I will anyway.

    Actually, it is not giving advice, but instead assisting the client to create an objective to meet their goal by making a mere suggestion this “may” be accomplished! The question/suggestion “Why don’t you try keeping a journal of your irrational thoughts?” would definitely be appropriate if the client has a goal of understanding and changing their thought process or distorted views, values, or beliefs; which majority of the time is one of the main objectives of therapy.

    My graduate degree probably doesn’t matter much; neither does where I graduated from.

    If this isn’t a very negative and derogatory statement to the degree holders and a misleading statement to the intended audience, I don’t know what it is! The graduate degree does matter! Without it you cannot get licensed!!! This statement comes across as to say any ole Joe Blow can be a therapist! WOW!!!

    If I’m pushing a particular brand of medication, you can likely thank a pharmaceutical company.

    Now are you really talking about psychotherapist or psychiatrist, because psychiatrist and some psychiatric nurses prescribe medication? Therapist may refer you to your medical doctor or to a psychiatrist for a medication evaluation but they have no interest or benefit in pushing any particular brand of medication.

    I work for you, but battle your insurance company to get paid.

    Why would they need to inform the client of this? Isn’t it the client’s responsibility to understand their coverage and benefits, and the insurance company’s responsibility to explain it to them if questions should arise? As for impacting the relationship, that’s just the same as a medical doctor, if the insurance doesn’t pay you will be liable for the remainder or unpaid percentage. Are therapists really liable for this or can you let the client’s have some responsibility and accountability in their therapy coverage.

    I will give you a diagnosis whether you need one or not.

    It is no secret that the insurance industry has made plenty of red tape to pay out for any services. Again, this is such a derogatory statement. If you are to education your intended audience could you please be courteous enough to give them the complete facts without trying to scare the dickens out of them. Yes it is true a diagnosis will be given. However, a diagnosis is only a diagnostic “impression”. And major depression does NOT have to be your diagnosis. And honestly, if you are going to see a therapist then there is obviously a reason. That is what the diagnostic impression (Diagnosis) tells the insurance company (the reason why)!!!

    I love my job, but hate the long hours, client’s often-slow progress, and the difficulty in being understood as a profession.

    You actually wrote the rebuttal yourself “Like most people, a therapist isn’t always going to be in love with their jobs.”

    I must say this was not a very good read for me. I think it was negative, misleading, and incomplete.

    I would ask that in the future please write complete article that will completely inform your readers!

    Thank you in advance for your understanding in my position.

  34. Offended – Thanks for your feedback; I think it speaks for itself. If you think an article “with such tone is not needed and in my opinion not even warranted,” then perhaps you have come to the wrong place! :) Because that’s what I do — I write. With an opinion. If you disagree with it, that’s fantastic, because it means I struck a nerve and you felt impassioned enough to write a response.

    Most people aren’t as “therapy wise” as you may believe (especially when all you do is see patients every day). So indeed, many of these points are eye-opening “secrets” to them, things that most therapists won’t openly disclose or discuss up-front with their clients.

    Advice is advice (no matter how you rationalize it), and graduate degrees don’t matter in terms of client outcomes (happy to be shown the research that demonstrates otherwise). And just because an individual seeks out professional help does in no way suggest that everyone should be diagnosed just because they walked in the door. Ridiculous!

  35. Probably needs to be contrasted with the list of 10 things you will likely hear when you meet with a therapist.
    1) Here’s where I went to school, my degree, my license.
    Doc John and the comments say that for most people, this stuff won’t matter as much as the therapist’s empathy. BUT if you have a complex illness with many medical complications, then a specialist could be a good thing. (secret #6)
    2) This is your co-pay – $N.
    But my real charge is $NNN, and I’m going to spend an additional $N min trying to get paid by your insurance company (either in my personal time or by paying an assistant). (secret #9)
    3) We’ll just talk!
    You will talk, all about yourself and your fears, concerns, childhood misery, etc. I will not tell you anything. (secret #2)
    4) Most people feel better after 12-20 sessions, but it varies.
    They feel worse after 3-5 sessions. Like a herd of elephants trampled on their hearts. And then anything will feel better than where you were after that experience. (secret #5)
    5) [silence about a diagnosis]
    For secret #9, how will it help to know that maybe it’s dsythymia or generalized anxiety disorder or PMDD? The therapy is going to be about what you talk about. The label may be helpful to you if you haven’t been able to figure out what is going on. But, if you went thru a trauma then the PTSD label is not a big reveal. Insurance companies require a diagnosis in order for the therapist to get paid, that’s basically the secret. At my HMO, I got three different labels from three therapists and one from the psychiatrist. So, a diagnosis is not very helpful for me.

    The secret you left off the list?
    11. “I only care about you for the 45 min you are in my office”

  36. I am a Marriage and Family Therapist (not currently practicing), and I agree with your points on the whole. I would add two things, which are reasons that I am moving to another field.
    1) As to #10 – long hours, this seems to me the exception, more than the rule. I did okay, but in my experience, therapists continually struggle to find enough clients to pay the bills. This is particularly a factor when taken with #8-the tedium of insurance reimbursement. I was happiest when I worked as an intern for a non-profit, and I had little expectation of making a good salary. But you just can’t do that forever.
    2) I agree with you that it is an art, and that’s one of my beefs. I might go even further: it is very unscientific. I can’t count the number of therapists who “shoot from the hip,” evaluating problems after a session or two from some “gut feeling,” and then use whatever technique (or, worse yet, no technique at all) to treat a client. Many of my peers did things that had no research to support them whatsoever, and when I asked them about their treatment plans, very often I was given extremely vague answers that often amounted to “I don’t have one.”

    It’s a great field, don’t get me wrong, and I really feel that I helped people. But I was bothered by the fact that for many reasons, it involves a crapshoot: how you mesh with your therapist, how hard they work, how willing they are to consult with their peers, how versed they are in what really works, as opposed to what seems like it should work on an intuitive level. My advice to anyone who needs a psythotherapist: look for well established practitioners, call for a short phone interview (say, 15 minutes), ask them what theory they use, and have them explain it to you in basic language. If they hem and haw and say, “I’m pretty eclectic,” or “I borrow from several theories,” or “I don’t use a theory, I just work with people,” or “I do what feels right to my client and myself,” or some other variation of “I don’t really know,” hang up and keep looking. Try out several. Once you find a potential, tell them that you are only committing to one session at a time, until you are sure that the fit is good. Evaluate with a critical eye how comfortable you feel talking with this person. If you feel like you do, you have what we call Goodness of Fit, and it is the single biggest predictor of success in psychotherapy; more than a therapist’s age, gender, years of training, school attended, theoretical orientation, or the like. After three or four sessions, if you like a practitioner, ask them if you could read a copy of your treatment plan, along with your diagnosis (be willing to wait a week if they need to get it on paper – yes, our paperwork gets stacked up pretty high). If they hem and haw, you should head for the door. If they show you your treatment plan, read it, ask questions about it, and be honest with yourself. Does it makes sense and sound reasonable? Does it gloss over things in a way that indicates he or she may not really know what the heck is going on? Trust your own instincts. If you smell fish, don’t discount that. Ask your therapist what he or she will see (specifically, and in terms of your behavior) when the work is nearing completion.
    Finally, work hard in your therapy, push yourself to be honest with your therapist, and give credit to he/she says something that is true, but you don’t want to hear.

    In short: be a discerning consumer and choose wisely. Once you’ve chosen, do your part. I also recommend clients read the book Love’s Executioner, by Irving Yalom, M.D., which beautifully describes the process of psychotherapy, including what it is like for the therapist. Not all therapists practice the same way Dr. Yalom does, but no one describes the process better.

  37. What Paul just wrote above should be required reading for anyone who is either starting therapy, in therapy, or has finished therapy. Particularly concerning the issue of treatment plans. You wouldn’t go to a doctor, dentist, or lawyer without them giving you a specific plan for what they’re going to do with you. Why would it or should it be any different for a psychotherapist? Maybe your therapist won’t get it down on paper, but he or she ought to be able to tell you in great detail what the plan is, and what you ought to be looking for as a measurement of success.

    Dr. Grohol, your thoughts on treatment plans?

  38. One more add to the list.

    11. Your therapist’s interpretations may be way off the mark (but that doesn’t mean they’re necessarily bad for you).

    Interpretation in the room is a strange/odd thing. Sometimes they are right on target, but they don’t make you think at all. Sometimes they are way off the mark, but they get you thinking in new, different, and important ways. The latter kind are often as valuable — maybe more valuable — than the former kind.

    However, a therapist whose interpretations prove over and over to be way off the mark? That therapist should become your-former-therapist sooner rather than latter. With Mr.-or-Ms. I’m-Almost-Always-Wrong? There are fifty ways to terminate therapy. Choose the one that says “It’s time for me to move on, this isn’t working for me the way I want it to, and I don’t really want to discuss it,” and move on.

  39. Skills needs to relax. All that stress and internal conflict is going to drive him (her?) to an early grave. Take a pill and chill!

  40. I am a paranoid mental patient who already has trust issues with everyone, and this information only makes it worse.

  41. A.T., you have no reason to be scared, because you are the one in control, as long as you go into it that way. Choose wisely. Most people choose a therapist like they’re buying a mattress–they look in the local stores to see what is available, lie down on it for 2 minutes, check the price, and then break out a credit card. Therapy is personal. It’s important, and potentially life-altering in a good way. Don’t just call your insurance, get a name that they’ll pay for, and assume you’ve done all you can. Just as any two random people on the street may or may not mesh, so it is with you and a particular therapist. You don’t consider everyone you meet to be a good friend, do you? No. You get to know people and decide over time who you trust and want to be around. If the first therapist doesn’t feel right, keep looking until another one does. When it does, your therapy will be more effective, satisfying, and a far better use of your time and money. Be a smart shopper, not an impulse buyer.

  42. My psyche-therapist had indeed told me all that ‘he woont be doing or prefers not to do’ etc… but one thing that he did do was to ask me
    as to ‘why arent you laughing’?? You have ‘forgotten to laugh’… You make an effort to laugh…. And that didi help me a lot…

    For … I used to tell myself… okay with these happenings affecting me . since I cant get out or change… I can either cry or laugh… I have moaned enough .. let me try to ‘laught at it’…
    I know that by that the folks around ‘more than ever confirmed that I was mentally not okay to be laughing as I was sufferring’… but it helped me
    and ….

    Now I can tell you all that ‘sense of humour’ is indeed the best cure for depressing of any sort…
    and humour is nothing but ‘a recounting of the chaos in tranquility’… Humour calms the mind as well…

  43. I have a question. If a psychologist is trained not to give advice, then what does a psychologist really do then? Sometimes friends are not always the best people to turn to for certain types of problems. Is there a reason advice can’t be given especially if it is a problem a person really has difficulty resolving him/herself?

    • What you want is a person that is born with the gift to understand and not judge problems and be able to give clear solutions to those problems. You can’t go to school to learn wisdom, psychology classes teach people mass problem solving skills. No one is in the exact same situation so there for can not be giving the same advice as anyone elts, so to cover there butts they do not allow therepist to give advice cause you can’t teach wisdom. And not everyboby care’s like they should!

  44. I have a simple observation to inform you so called psycho therapists. Why is it that when people go to therapists they end up getting a feeling that they already know this stuff?

    In a nut shell, and this is no secret, that psychotherapy and counselling both are fields in which:
    1) you are paid to listen
    2) you are paid to tell the patient what he already knows

    That is a fact you cannot deny that. Basically what therapists do is pep-talk. Any one who does not agree with this is delusional. A patient that feels good after a session of therapy is only because the therapist was understanding and a good listener. And probably told the patient what he already knows (subconsciously).

    Any thoughts and reflections on this, fellow therapists?

    • My therapist rarely gave me advice as that would have inhibited my personal growth and made me feel less inclined to think for myself and own my decisions. I often felt an inclination to want advice though as somehow i felt my therapist had all the right answers. That’s not always true. My understanding of my therapist’s role was to listen to me get my feelings out, help me to dissect the issue and understand it, and ultimately question any negative cognitions that came from it. I would finish up feeling better from addressing the negative thoughts and feelings, with a greater awareness and ability to see things objectively. It has been very effective for me and after 3.5 years I have been able to process my traumatic childhood, break the cycle of sibling emotional abuse, process my mother’s rape, cut ties with my father, and address a load of PTSD. I think it takes persistence to realize the full benefits therapy has to offer. It has been a life saver for me.

    • My therapist rarely gave me advice as that would have inhibited my personal growth and made me feel less inclined to think for myself and own my decisions. I often felt an inclination to want advice though as somehow i felt my therapist had all the right answers. That’s not always true. My understanding of my therapist’s role was to listen to me get my feelings out, help me to dissect the issue and understand it, and ultimately question any negative cognitions that came from it. I would finish up feeling better from addressing the negative thoughts and feelings, with a greater awareness and ability to see things objectively. It has been very effective for me and after 3.5 years I have been able to process my traumatic childhood, break the cycle of sibling emotional abuse, process my mother’s rape, cut ties with my father, and address a load of PTSD. I think it takes persistence to realize the full benefits therapy has to offer. Therapists are highly skilled professionals that are trained to help you help yourself.

  45. I applaud articles like this that might serve to put clients on a little more equal basis with their therapists. Thank you Dr.Grohol.

    I’m not surprised this post brought out the angry respondents like Skillsnotpills. His indignation reminds me of so many clinicians who like their clients docile and idealizing and will use every harmful strategy to keep them that way.

  46. Psych Central always encourages people to get professional support and I don’t think that this post goes against that value at all.
    Sonia at 9:17 pm on September 30th, 2009“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. -Sonia

    I don’t know Sonia. I thought 3 prior psychiatrist were eduated and experienced with treatment of mental disorders, so I trusted their recommendations. Finally, after years, when that did not work out so well, through my own research, I discovered psychotherapy. I am an intelligent, educated patient who once knew little about psychology. Though now I am not influenced by such blogs, prior to my own research, it may have steered me another way. People have distored thinking-and can’t always determine what’s legit and what’s not. And despite expectations, the reality is-people are influenced by these sorts of materials on the internet. If no one was influenced, there would be no motivation to write them, would there?

    Despite existing research, psychoanalystic therapy-in just 3 sessions-helped me more than any recommendation by prior psychiatrists. How would the lay person know? Especially since more articles here recommend CBT as the ultimate treatment for mental heatlh problems. Should everyone become their own expert before getting mental health treatment? I thought that was why practitioners go through many years of school and training….so that I do not have to figure out how to best treat myself.

    Fortunately, I now have enough sense of self to know I am not being out of bounds here. The layperson just does not know and can be influenced by blogs-some of it can be considered pop psychology. Think about what pop culture is all about and you might have a different opinion?

  47. WHEW! I realize that the responses to the original posting date back to last year but there were a few newer comments and with the subject I just felt compelled to put my two cents in.

    I am not taking exception with the article as a whole but my concerns are from a patients standpoint on these issues globally speaking.

    These are things that many patients like me know/believe:

    1. Treatment is costly! Nine times out of ten we HAVE to select a clinician in-network (most of which will not be accepting new patients) if we want to afford being treated for whatever issue is at hand. I have a clinician that I have worked with for a long time and she does not accept insurance. There have been many times I’ve had to cancel appointments because I could not afford the 190/session fee (even if I can submit it to insurance and wait months for reimbursement). That said, I too have worked in medicine and realize that the converse is not pleasant for the clinician. Insurance companies make things definitely difficult and diagnostic codes have to be ‘x’ or ‘y’ to be considered ‘covered’…then there is the re-filing etc. I’m sure I’m preaching to the choir.

    2. We come to YOU. You who have been called to this profession. Trusting that you’re there because you want to be. Hoping that we’ll find a good fit to help us with is usually a huge issue by the time we actually seek care. Not because we don’t want to go but nine times out of ten can’t due to financial reasons. We know in the backs of our wee brains that you’re not there to be our friend, we just expect you to be the ally we need to find our way out of the weeds.

    3. On the subject of pharmaceuticals. I have actually worked for a very large pharma company. I KNOW how they push medications to the offices of clinicians. I think there CAN BE an allure to go to them first because of the data and the expected outcomes. I just think that caution should be the order of the day.

    Therapy alone has it’s place and can work for many (thankfully), however, medications do serve a large population well – we just have to come to a balance between the two. If given the chance I’d much rather try therapy without medication first and then if needed, introduce pharmaceuticals in conjunction with medication secondly. Not bashing the product, just the ease of which it CAN be pushed.

    Lastly, I’m not a therapist and I haven’t walked a mile in your shoes. I know a bit, but not everything.

    My hope is that for the thousands of folks who never seek care due to cost, that a solution is found. I’ve fallen into this group many times in my life. I was a full time employee who could not afford psychological care.

    We want you to be paid. You worked for your credentials and this isn’t a free clinic. We know that…but just blanket telling your fellow clinicians to skip on working with insurance companies on the one hand and on the other complaining you have no clients…well, it doesn’t take a rocket scientist to figure out why. We have to come to some kind of middle ground.

    THANK YOU all for the services you provide us. Many of us have no one else that can listen and help. It’s hard to ask for help for many of us and knowing you care means the world to us.

    You don’t have to be my best buddy, just be my therapist with my best interests at heart, and mean it, don’t fake it.

    Thanks for letting a non-clinician share her thoughts.

    4.

    Yes, as a patient I should understand my policy and coverage – I agree with that. Yes, clinicians are providing a service and DESERVE to be compensated for their services/skills/etc. However, a solution needs to be identified for payment.

  48. As a patient I value the hour I get from my therapist – I look forward to having that “me” time, however, would I want to be sitting in the opposite chair? Not really. I think I can imagine how difficult it would be, one person after the other, pouring out their story as if it’s the first time the therapist has heard it. Walk a mile? No thanks. Are there professional secrets? I suppose – but after a while in therapy you get to know the rules fairly well. In Canada I think the insurance is a little easier to deal with – I know in the past when I submitted an expense I was reimbursed within a couple of weeks without trouble – doctor referred was the only clearance required. I don’t think you’ve really let any cat’s out of the preverbial bag here – don’t really understand why people are so upset – I guess that’s just me.

  49. Thanks for this post. I was going back into therapy thinking that it would help. But from reading this, I don’t think therapy is not a good choice. That hour can be used in reading a book or brushing up on memory techniques.

  50. I’m unsure why you consider these “secrets”. No therapist worth his salt will lie about his confidence in treating a problem or about the nature of the therapeutic relationship, nor will he disguise the potential distress built into the change process. Most people already know how insurance companies are a pain in the ass and tons of work, and who isn’t aware of the drug reps’ role in what drugs are dispensed?Some of what you say is factual, but you’re creating drama and secrets where they don’t exist. I’ve used creative titles to catch readers’ interest, but unless you are running your practice with these illusions you describe, you’re just making legitimate professionals look bad to entertain your readers under the guise of drama.

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