Let’s think about how your symptoms or issues are affecting your daily life and your ability to function (or maybe you are thinking about preventing future symptoms). If you feel uncomfortable or concerned or are having difficulties AND you see the symptoms are not improving or going away enough, then yes, therapy is worth a try. Too often people hesitate to work on themselves and risk falling into greater troubles and suffering. My website has a lot of information about symptoms and solutions. This will give you an idea of what therapy is like and who would benefit. Some clients have mild or early onset type symptoms- certainly professional attention can help correct things and prevent complications. Therapy is a form of self-care, yet people seem to avoid it due to pride, embarrassment, unaware of emotional needs/therapy benefits, and passivity. Throughout therapy I ask about goals, needs, response, etc. such that you play an active role in the therapy and can use it as often as needed until you are satisfied with your response. With informed consent, you can tell me what you expect and I can provide a time estimate of how long it will take to reach your goal(s).
Isn't therapy for 'crazy people'? My family/friends don't understand why I am in therapy and it makes me feel embarrassed and weak. I want to get better, but I don't know if I can trust you and this counseling process.
Stigma: People who come to therapy come for all kinds of reasons. What they have in common is that they are all seeking professional help for issues they are unable to fix. I think this “crazy people” question is similar to the idea that students who ask questions risk “looking dumb.” In therapy, you will learn skills and new ways of thinking and doing things so that you can become a happier and better version of yourself. With therapy, some experience relief to no longer have to hide an unhealthy, broken, lonely, and shameful identity. With these improvements, there can be a restored sense of control, confidence, healing, and optimism. If someone, such as your doctor, refers you for talk therapy/counseling, ask them for the reason for their recommendation. Everyday challenges, such as handling stress, dealing with relationship difficulties, or having too much worry- are common topics that are addressed by otherwise “healthy and normal” people.
Privacy: You have complete control of your privacy with therapy participation. Share what you want, when you want, if you think it will be safe and beneficial. I understand the difficulties with talking about personal and uncomfortable matters with someone you do not know. At the same time, the professional setting is a safe one where you will receive therapy, help, support, and feedback from a trained psychologist. You can talk about these topics and ask questions- something you may not be able to do as freely with other people in your life.
Trust: Therapy can be uncomfortable as you will be developing new ways of responding to others and your symptoms. Sometimes people continue to do things that they know are not good or helpful just because it is more comfortable, convenient, or easier. If you are not a willing therapy participant seeking to improve, then this may not be the for help for you.
What is therapy about anyway? People tell me I should "talk to someone" about what I am going through, but I don't see how talking fixes things. How can a stranger's advice be useful when they don't even know me?
Therapy starts with a review of the reasons why you are seeking professional help. Therapy is a place to share thoughts and possibly “vent” with the intention of identifying what you want and need to be different. The first session, similar to a medical physical exam, is purely assessment based without focused treatment. Subsequent visits include education and teaching/practicing of new ways of thinking and responding/behaving. Homework assignments or personal goal setting are commonly used to practice the skills covered in session. Assessment is ongoing throughout therapy to observe how the techniques are working. Most therapy lasts for 8-10 weekly visits, with each session lasting 50-55 minutes. Therapy participants identify what they want to work on and what goals to set. In these processes, the participant receives healing, growth, or support in making healthy life changes. Patients can return for help at any time as significant challenges arise.
Can my partner/spouse attend therapy with me? or Can my partner/spouse attend therapy with you also? They need help too.
Your partner may attend the first couple of sessions if it is supportive and encouraging. Typically, clients prefer to participate alone as it allows them greater privacy and freedom when talking about personal topics. If you are interested in couples therapy, I can provide references for therapists who specialize in this work. Typically two spouses do not work with the same therapist simultaneously for individual therapy due to a conflict of interest. In all cases, a signed release of information or collateral services agreement form may be needed as a review of patient privacy rights.
What is the difference between psychologists, psychiatrists, and other types of therapists?
Psychologists spend four years in graduate school after completion of their Bachelor’s (undergraduate) Degree. They also complete 1 year of full-time supervised residency work prior to receiving their doctorate degree and 1 year of full-time supervised postdoctoral work prior to taking the state licensing exam for independent practice. Surprisingly, while physicians are often the “gatekeepers” for referrals of patient with mental health needs, most family medicine residency programs in California provide only 4-6 weeks of behavioral medicine/psychiatric training within the 3 year program. Physicians are able to prescribe; psychologists in most states, including California, do not have prescription privileges.
Psychiatrists graduate from medical school, complete residency, and receive specialty training for the diagnosis of psychiatric disorders and the ability to prescribe and manage medication treatments.
Marriage Family Therapists and Social Workers have Master’s level Degrees and complete training to provide therapy. The focus of their training is different from the psychologist’s training and less in depth. Pastoral Counselors and Coaches may have completed certificate programs and do not have the same role, approach to care, or level of training as the clinical psychologist. Oftentimes the term “therapist” or “counselor” is used interchangeably as a general term to describe the role (but not the education or specialization) of the Psychologist/Marriage Family Therapist/Social Worker.
When can I expect to see improvements? Would it be a good idea to have more than one therapist or counselor helping me at the same time?
Many patients have told me that they feel better after the first session, even though there was no focused treatment, because they were able to talk about their problems and receive validation. There is research that talks about the benefits of single session therapy, but these benefits may not apply for every individual and situation. Lastly, there is also a concern for addressing root causes of symptoms (usually long-term therapies) versus putting a temporary “Band-Aid” over it with short-term therapies. Chances are if you are hoping for a quick fix and going through a crisis, you will be disappointed. The actual duration of your therapy will depend upon you, the time/effort you put into your treatment and growth, and the seriousness of the emotional difficulties you are facing. Ethically, we are not allowed to have multiple therapists or psychologists working with the same patient at once on the same content. For one thing, the patient can feel like they are pulled in two different directions as each therapist has their own approach. Simultaneous participation in group therapy and individual therapy can also be tiresome (although allowed) as there is a lot of material or skills to learn and homework to be completed.
What style of therapy do you provide in your work with adults?
I primarily approach patient care using a Cognitive Behavioral Therapy (CBT) model. The CBT model supports a collaborative relationship in which the patient is the “expert” and therefore ‘49% responsible’ for treatment outcomes and the therapist is 51% responsible based on expertise. I also assess and address other aspects, such as relationship quality, work performance, and health concerns, as there is often an interaction that can affect treatment response. As a psychologist that is a practicing Christian, I do have patients who request these values are included as part of treatment. Let me know if this is something that you would like. I also use techniques from other approaches, such as mindfulness and motivational interviewing, to help treatment. Since I often work with patients who have health concerns, it is helpful to the patient and to the quality of treatment to consult with the patient’s health care provider regarding their health (only with the patient’s consent). Medical providers I have experience consulting with include: physical therapists, pharmacists, family practice physicians, internal medicine physicians, social workers, neurologists, speech and language therapists, oncologists, podiatrists, nutritionists, surgeons, and psychiatrists.
What if I am "beyond hope" or am unable to improve?
My gut reaction to this question is that the person asking may be pessimistic or fearful failure in different area(s) of life, including treatment. To be honest, it is hard to talk about painful or uncomfortable topics, especially if it seems unlikely to change. Personally, I have been doing this work for a long time, and few things surprise or overwhelm me. My balanced approach to life allows me to provide a safe environment for my patients. I’m honest; if I don’t know something, I will admit it, find an answer, or guide you to someone who does. I welcome honesty from my patients- this is your treatment, so tell me what you want and what you don’t want. I also expect my patients to put forth effort in therapy and try to get better. There is nothing “magical” about spending 60 minutes with me each week that will fix your problem unless you change. IF you are not responding to treatment, or maybe even seem to be getting worse, let’s talk about what is happening and how we can fix things. Psychiatric medication is often prescribed or changed by a prescriber when symptoms are not responding to therapeutic interventions.