What happens in
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
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
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
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
Will a therapist give me advice about how to handle things in my
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
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?
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:
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
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?”
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
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.
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
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
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
medications—that 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