Stephen Simmer, LICSW, PhD


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What happens in therapy?  

That’s a little difficult to answer, because there’s always some mystery in the process. Over 100 years ago, one of the founders of psychotherapy called it the “talking cure,” and that’s basically what it still is—talk. There’s something important that happens when we step back from our lives and look at things from the outside. This outside position gives perspective and understanding, but is also the place where we can start making decisions about how to approach things differently. A therapy session is a little like a time-out in a football or basketball game. It allows us to reflect on what’s been happening and make changes in strategy. 

Sometimes, a therapy session is the place where we begin to really feel what’s been happening in our lives. Many of us are pretty busy—with work, school, family, relationships—and rarely stop the engine to check what’s going on under the hood. This allows us to make the outward events of our lives into inner experiences. 

At the beginning, like most therapists, I will do an initial evaluation. The first session is very different from all the rest, because it is a fairly directed interview, with lots of questions about your reasons for coming, your family, your job, your moods. This is my attempt to get up to speed as quickly as possible with what’s happening, to scan quickly the terrain we will be working on together.  

After the first time, the sessions will be determined largely by what issues you bring in. It is generally helpful if you do some thinking in advance about how you want to use your time, what issue you would like to work on. 

If I go to a therapist, does this mean I’m crazy? 

 First, very few people who go to a therapist these days are “crazy” in the sense of hallucinating, hearing voices and so on. Therapy by itself is not very effective with people who are having hallucinations and delusions. Usually, it’s important for them to also take the very effective medications which have been developed in the past thirty or forty years.  

The vast majority of people who go to therapy are not crazy, they’re stuck. It’s common for a person to report that things have gone ok in many areas, but he or she is having trouble with one area—some mood that he or she can’t shake, an addiction to alcohol or sex, a problem relationship, or some memory that won’t let go. It’s not uncommon for a person to report that he/she has been thinking about going to talk to someone for years before finally doing it. It’s actually a triumph to have made the call and to come to a first session. It represents a commitment to begin to work, to make life better. 

Will a therapist give me advice about how to handle things in my life? 

After listening to Joy Brown, Dr. Phil, or Dr. Laura, it’s easy to get the impression that a therapist is going to lean over your shoulder and tell you how you should be running things by the next commercial break. Some therapists actually do this. Speaking for myself, I try not to. My goal as a therapist is to help create a space where you can see your life with clarity, have a stronger sense of your mission, and have a deeper understanding of the decisions which are right for you.  This doesn't mean that we can't discuss your decisions.  We can, in great detail.  But I assume you're the expert at what's right for you—whether to get a divorce, how to parent your kids, whether to change jobs, what to say to your boss. 

My adolescent child is getting into trouble, and I think he/she needs therapy, but he/she doesn’t want to go. What do I do?  

To be honest, I’d be a little suspicious of an adolescent who wanted to go to therapy. They often see therapy as an attempt by parents to run their lives by enlisting yet another adult to try to talk sense into them. The suggestions I’d make are these, to be tried in order: 

  1. Say to them, “I don’t think we’ve been getting along as well as we might, and I’ve decided it would be a good idea for us to talk to someone so we can maybe get along better.” In other words, frame this as an us-thing. 

  2. Give choices: “Would you like to see a man or woman? Would you prefer to go to a group or see someone individually? Would you like us to see someone as a family, or would you rather see someone by yourself?” 

  3. Make a deal: “You need to come. Go four times. If you choose to quit after four times and you haven’t gotten into any trouble, we’ll stop. But if you get into trouble again, we’ll go back.” 

  4. Load up: “We’d like you to come. That way you’ll have a chance to explain how you see things, and you’ll have a say in how things are decided. If you won’t come, we’ll have no choice. We’ll go anyway, and get some advice from a therapist about how to get you under control.  And you may not like the result.”

Why does this cost so much? 

Let’s talk about cost a bit. Therapy takes time—more than a 10-minute doctor’s appointment once every three months. Sessions last for the better part of an hour. Insurance can help with the cost, but there are generally limitations to how much insurance will pay per year.

But we must also talk about the cost of not doing therapy. There is a difference between spending and investing. We can spend money on toys or clothes, or we can invest it in the future. Investing saves us money in the long run—we get it back several-fold. I think we should see the money we put into therapy as an investment. Divorce, for instance, is one of the greatest financial catastrophes a family can face. A teenager getting into trouble and dropping out of school has just put himself or herself into a significantly lower income bracket. Effective and timely therapy might make a difference in these cases, so the money spent will come back several-fold.

How about medication?

You may know from television commercials or magazine articles about the many psychiatric medications that can help with emotional and psychiatric problems.  I cannot prescribe medicationsthat must be done by a medical doctor or psychiatric nurse practitioner.  I have worked with many clients who have taken medication.  Many have benefitted.  Some have not.  If I sense that medication might be helpful to you, I will suggest it.  Feel free to ask my opinion about it, too. 

I have worked for many years in a medical setting, and am very used to collaborating with psychiatrists and doctors around medical issues.  Medication is not a substitute for psychotherapy, and psychotherapy is not a substitute for medication.  According to brain studies, they work on entirely different parts of the brain, and are about equally effective in helping people change and feel better.  Medication and therapy often work well together.  One difference, according to research, is that the gains from psychotherapy continue long after you stop therapy, but the gains from medication only last as long as you keep taking it.