A lot of people stay in therapy because it keeps them unhappy

Just about everyone I’ve talked to who has been helped by therapy has experienced therapy as something with a beginning, middle, and end.  The people I have talked to who expressed the most dramatic change, I’d say, were in therapy for a period of six months to two years, and then stopped.

A lot of people have told me things like, “I can’t live without my therapist.”  Every single person whom I’ve heard say this has ended up in the hospital.

I’ve also heard things like, “My therapist keeps me out of the hospital.”  These people usually end up in the hospital as well.

What I am seeing is that “therapist” is defined differently for people who are labeled “mentally ill.”  The therapist is seen as someone who is life-sustaining.  Many people who do not have the label also see their therapists as life-sustaining.

Insurance will pay for a lot of therapy if the company can be convinced that therapy will be life-sustaining for the patient. So the label comes in handy here.

If the patient is self-pay, the cost of therapy is generally very high.  Very few places go on an affordable sliding scale nowadays.  I have asked therapists about their fees, which run from, say, $90 to $120 or higher per 50-minute session.  “Sliding scale” generally means half price.  We’re still talking one heck of a lot of money.  Still, folks shell out bucks for this if they can be convinced to keep coming back.  Tell them that they have a label and it will be a lot easier to convince them.

There are many possibilities from hereon in.  You can live the label.  Or you can live your life.  You can depend on your therapist to keep you alive.  Or you can choose to keep yourself alive.

If you are considering psychotherapy, here are my suggestions:

If you are in the process of starting up, have a goal in mind.  What do you want to change about yourself?  What other ways have you tried to change yourself?  Why are you seeking this sort of treatment?

Ask the therapist if therapy is the appropriate treatment, or if something else might be a better alternative.  Ask the therapist if he or she feels that his or her type of therapy will be helpful for you.  You don’t have to pay for a session to get these questions answered, and if necessary, get pointed in another direction.

Ask the therapist how he or she can help you meet your goals.  Seek out specifics and also seek out flexibility.

Be upfront and ask the therapist to be upfront with you about “prognosis.”  This is tricky because while no one can predict the future, you need to know what the therapist foresees and what the therapist expects from you.

Beware of therapists who  make promises that sound too good to be true, but at the same time, also beware of therapists who have expectations of you that are far below what you know you can achieve.

Seek out professionals who take you seriously.  Seek out professionals who take time to listen, and listen well.

Ask about Plan B, that is: What if something goes drastically wrong?  Better to ask now than later.

Share your goal very specifically with the therapist.  Ask the therapist what his or her goals are for you.  Is there a conflict?

As treatment proceeds, have points where therapy can be reassessed.  This can be once a month, or shorter, or longer.  Are you improving, staying the same, or getting worse?  Is therapy helping or making you worse?  What else is helping? What else is getting in the way?

If you are already in therapy, consider asking your therapist the questions I outlined above.   Consider redefining your relationship with him or her.

Warning signs:

If the following things happen, get out of therapy with this person as soon as you can:

The therapist abuses you mentally, physically, or psychologically.

The therapist has “boundary issues.”  Sometimes, this can be remedied with a reassessment, but my experience is that these fixes are rarely implemented, or the changes are very short-lived.

If there is a confidentiality problem or disagreement, it may be worth working it out or discussing it.  Often, a confidentiality issue is nothing but miswired communication.  If the consequences of this confidentiality disagreement are severe (if you lost your job, for instance) then you may be wise to stop seeing the therapist.

Same goes for breaking the law.  It depends on which law and what the intent was.  For instance, if the therapist parked illegally to get into the office in time for your appointment, well, think about it.

Feedback and comments welcome!