Frequently Asked Questions about Psychotherapy
Melissa Miles Therapy FAQ
Melissa Miles — at the time, a psychology student and someone who had been in psychotherapy — wrote this frequently asked questions (FAQ) file about psychotherapy in 1995. Although it is somewhat outdated, it still has a lot of good information about psychotherapy and the therapy process.
So many people have asked me questions about therapy and there is so little information out there on the web that I decided to write this Psychotherapy FAQ (Frequently Asked Questions file). Its purpose is to help people who are not yet in therapy but would like to try it out.
Why go to a therapist?
Not all therapy experiences are alike, nor should they be. In this FAQ I explain in detail the various types of therapy and people who give therapy, but to simply answer this question, the question I would ask you is: What do you want out of therapy? This is important because a lot of the success between the therapist and client depends on your expectations. I had a psychology professor who cited a study which showed that success in therapy is correlated with wanting to succeed, and I would argue that success in therapy also depends on what you expect to happen, and whether those expectations are compatible with what a therapist can and will do.
Going to a therapist can be a worthwhile growing and stabilizing experience, good for times when you have specific problems, interpersonal problems, or generally feeling down. You can go to a therapist once, for a few months or embark on long-term therapy–each depends on different expectations and goals.
The time when most people tend to go to a therapist is during a crisis. A crisis is an immediate threat to your life, where you feel in danger, suicidal, or inability to live your life in a normal productive way. Examples of when a crisis can occur includes:after love ones have died, breaking up in relationships, times of depression or if you are in danger or have been harmed in some way. The reason for going to therapy at this point is so to be able to stabilize your life so that it is not in any immediate threat. Sometimes, this entails only having a short visit, in which the therapist uses crisis counseling. The point in this case is not to uncover any underlying motivations or access you for long-term treatment, but to provide "intervention". Sometimes, however, people go into a therapist's office with a crisis and find that there are things that underlie it that you want to uncover or work on. At this point it is no longer intervention, but on the path to psychotherapy.
Another time that is common for people to go a therapist is for specific non-crisis problems, such as insomnia, procrastination, low grades, or even feeling depressed. This is often called "counseling" rather than psychotherapy. The defining factors is that the person does not have an immediate threat to life but has a specific identified problem to be worked on. Many people tend to go to cognitive-behavioral therapists or rational emotive therapists. I had a psychology professor who argued that specific behavioral or emotional problems are best treated by the cognitive behavioral camp, so you might keep this in mind if you chose to go into see a therapist, however I am a little less adamant about this distinction. One thing to keep in mind though is that your problem might be like a symptom. An example of this is a person who comes into to a therapist's office because they are having trouble in school. This might be the result of many factors, such as interpersonal problems, an addiction or alcoholism, an eating disorder, etc. It might end up that the counselor or therapist might not be qualified to work with your problem or might have time constraints (school, employee or college counselors often will be limited by expertise and time). This might also lead you to psychotherapy.
Finally, what used to be the most common type of therapy, and now is a dying art, is personal psychotherapy. This usually takes place with a psychotherapist or clinical psychologist, although MFCC's and MSW's are doing it more and more lately. Sometimes people go into psychotherapy in order to work on problems which seem more nebulous. Often people go in for growing, rather than stabilizing. An example of this is a couple who has been together for 15 years who are dealing with an affair. A crisis intervention or dealing with the affair as a specific problem might be what brought the couple in but it might turn out that more is going on, such as years of resentment, an environmental pressure, a death in the family, etc. Another type of reason people go into psychotherapy is so to work on psychological problems. This can range from being abused and having intimacy problems to having a smothering family which has led you to overeat. As you can see that these are problems which need a more in depth analysis than intervention or counseling would provide. Despite this managed care does not usually believe that psychotherapy is worthwhile for the time it might take, and you should keep this in mind if you are depending on insurance to fund your therapy. Psychotherapy is often a long-term commitment, however short-term therapy has been "in" for awhile and there have been studies that show it can be effective under the right conditions. This is a discussion that is best had with a therapist you are considering going to–they would give you advice based on an assessment of your situation.
You don't need to have a "major" problem to go to a therapist. Just feeling unable to deal with your problem or feeling unhappy makes you a good therapy candidate. As I have shown, therapy can have many different levels, all which might be more appropriate at certain times than others. I once had a psychology professor who said that at times, going to the gym will help more than going to a therapist. I know from experience that sometimes art, or writing will do the trick. But therapy should be viewed as a *tool* which can be used to work on even problems you consider "minor." So, Why go to a therapist? Now that you have read some reasons people go to one, remember that therapy is the commitment to improving your mental health, and sometimes this can be done with out a therapist, and sometimes a therapist is a god-send. And anyway, it doesn't hurt to try one out.
What kind of therapist do I choose?
Sometimes this depends on the reason you want to go to a therapist, while other times this only amounts to a personal preference. More important though than the type of therapist is the amount of training and experience with patients, (but one psych prof cited a study that showed that the "best" therapists are the ones who are just beginning, and older therapists–middle ones were "worse") who is compatible with your problems and personality and who you don't feel uncomfortable with. Basically you need to feel as if you trust the therapist, and knowing that he or she knows their stuff or is compatible with you will help this trust. Unfortunately, degrees aren't the best indicator of this trust factor. Sometimes certain MFCC's are better than Psy.D's, etc. Here is the run-down of the degrees in case it matters to you:
- MFCC–Master's in Family and Child Counseling. Takes 2 years, with usually one year of supervised counseling experience in school. Less academic or virtually no research experience. Heavy emphasis on counseling, but are qualified to do personal psychotherapy. The majority of what is out there.
- MSW–Master's in Social Work. Takes 2 years, with usually a year of supervised counseling experience while in school. Also less academic or virtually no research, however they are different because they are taught to view the individual in the context of their environment. Thus they like to visit your home (e.g. The Social Worker), and often emphasize family or community dynamics in treatment.
- Psy.D.-Psychology Professional Degree. Takes 4-6 years and usually entails 2000 hours of supervised therapy experience. Also, they are usually required to undergo personal psychology. Less academic/research oriented and are usually solely trained in practicing therapy.
- Ph.D.–Psychology Ph.D. Takes 4-6 years and usually entails 2000 hours, etc like the Psy.D. but it is heavily emphasizing research and academics. There are less and less Ph.D.s who do therapy now days, but they are the group who have been doing therapy the longest.
Also, psychologists can be broken down by their emphasis, such as cognitive-behavioral, psycho-analytic, Rogerian, etc. However, often most therapist are eclectic, meaning they use the techniques that work best/are most appropriate for different disorders or with different types of people. This is not really of much concern to the prospective therapist client, but if you are _really_ interested you can check out some books on types of therapies. However, I think the trust issue is much more important and can be more readily accessed than their type of therapy.
How do I pay for this therapist?
A therapist can cost up to $150 dollars an hour so this is a big factor for most people. If you have insurance you should check and see if it covers therapy at all and what the limitations are. Limits sometimes include amount of times you can go to the therapist, the reasons you can go, co-payments, or what therapist they will pay for. Sometimes it is better to forget insurance and pay it alone. In that case you have more choice, and it doesn't have to be expensive–go to a "sliding-scale" therapist or clinic, who will determine how much you can afford. They are very reasonable, and depending on your financial situation can discount it to as low as 35 dollars a session. I suggest people do this anyway because studies have shown that people do better in therapy when they view it as an investment; you will be a lot less likely to skip a session or not do something a therapist asks you if you have to pay even a little bit. And you will be more active in getting your therapist to do what you need, so that you get your "money's worth."
Where do I find a psychologist or therapist?
Psych Central has its very own therapist directory you can use to quickly find a qualified therapist in your local community.
They are listed in the yellow pages like other businesses (I found one of my therapists that way) but my first suggestions are:
- Go by references!!!! Talk to your friends who have been in therapy and ask them for a reference. They know you and your personality and could possibly suggest or ask their therapist who could suggest a good match.
- Psychology professors are usually friends with or actually are clinical psychologists…they can be good references in finding a psychologist also.
- Read psychology self-help books and when you find a therapist you think is interesting, write to them or call them and ask if they could suggest someone in the area.
- Sometimes your insurance company, even if you decide not to go with them for paying the therapist, can give you lists of therapists in the area.
- Colleges or even your workplace may have "in-house" psychologists–even if you choose not to go with them they can be good references.
What do I ask to determine if the therapist is a good match?
The first visit is where you get to assess the therapist and they get to give you an "in-take" interview. They will differ in what information they need to know from you, but it is important that you have in mind what you want them to tell you. Here are my suggestions of things to say or ask:
- Tell them why you are here…inform them that you are shopping around. This will help them know what they can tell you.
- Tell them why you want to be in therapy, and then ask them if this fits their training or interests.
- Ask them what kind of therapy they suggest, how long they would want to do therapy, how much it costs, up front. Compare this with your preferences and needs.
- If it doesn't fit, tell them what you want and ask them if they would be willing to accommodate. Either way, be prepared to shop around more.
- Pay close attention to how you feel–it is normal for you to feel a little uncomfortable or nervous. Sharing personal information can be nerve-racking. However, do you feel like you would be unable to trust them? Tell them your feelings and ask them how they would deal with it if they were your therapist.
Should I choose a male or female therapist?
Many people have asked me this question, and I have always been wary of answering this with a either/or answer. I try to emphasize the trust factor, so I am more likely to suggest the gender in which you would feel most comfortable and trusting with. However, I think that even if you are uncomfortable with one gender it could turn out that it could be a worthwhile experience. One reason for this is the fact that not all people's personalities are typically male or female, e.g. a women therapist could have pronounced male qualities, making it hard to determine just by gender whether they would be a good fit. Yet, I have known certain people who are argued vehemently that they would only go to a female therapist, since they feel that their experience as a women would be best understood by the female therapist. But, you could say the same for race or class, and some people do use these as factors in choosing therapists, just as we use gender, class and race in choosing friends, employees and lovers. So, I would suggest to people who have stringent preferences, that there is no reason to go to someone you can not trust. For example, if you are a woman who has been abused by a man, it might be really hard for you to trust the male therapist.
Yet, there aren't hard and fast rules for this. I have had both male and female therapists, and I think the differences between them occurred more from their techniques, or simply because they had different personalities. It is hard for me to point out gender as the factor in what made them more compatible. Now I have a therapist who is female and has a very similar background–yet, I am aware of the fact that she emphasizes our similarities as a way to both form trust between us and for me to work out problems using her own experiences as a reference. But having a male therapist before helped me when I was having problems with a boyfriend–it gave me evidence that men could be trust-worthy, good listeners, and especially made me feel validated when he supported "my side" when my boyfriend and I had a disagreement. So if you are up for a challenge, or even just for an experience that could be worthwhile, I would say there is no reason not to try a therapist of a different gender, or race or class. No matter what therapist you get you need to pay close attention to your progress and your comfort level–and don't forget that it helps if you discuss these kind of issues with a prospective or current therapist.
What makes therapy successful?
In short, you make therapy successful. I said before that not all therapy experiences are the same and the biggest cause of this is that each person is different and brings in different expectations, talents and experiences into the therapy relationship. However, despite the fact that you are the determining factor in whether therapy is successful, many people think of therapy as if it is a doctor/patient relationship. I read a post on alt.psychology.help which said, "I have been going to various therapists for 15 years, and nothing has helped." Or there is the great part in Woody Allen's Annie Hall where Allen's character complains that Annie Hall has been in therapy for a few weeks and making more progress than he has made in 15 years. The problem with these people is the fact that they see success in therapy to be something outside of their control. Other people can't even define what success in therapy means. If you don't take responsibility for your own mental health, there isn't much a therapist can do. Practically, this means:
- Taking therapy seriously, as if it is a class you want to get an "A" in by doing the assignments the therapist assigns you.
- Think about the session and what you and your therapist have talked about outside of the session.
- Get family members or friends involved in your therapy experience, by talking about your sessions and assignments and tell them what they can do to help you.
- Keep a journal, writing down times when you feel like you have "slipped up" or when you feel like you are making progress, and keep it in mind to talk about with your therapist.
- Be patient–sometimes the most "productive" therapy session or time while your are in therapy is when you feel frustrated or even depressed.
- Do one nice thing for yourself a day, and take one day a month to do something totally nice and fun _just_ for you–therapy will be helped by your appreciating yourself, making mental health more valuable.
- Remember, therapy is hard work, an investment in your mental health, but just in exercise, the rewards can be invaluable.
Miles, M. (2013). Frequently Asked Questions about Psychotherapy. Psych Central. Retrieved on May 29, 2015, from http://psychcentral.com/lib/frequently-asked-questions-about-psychotherapy/