Kate’s List of “The Top 10 Myths About Therapy”

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Psychotherapy, Therapy
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If you’re considering psychotherapy, for yourself or for someone you love, you’re far from alone. Over 12 million Americans enter therapy every year. Sadly, though, many more who could be helped by therapy never seek it out. Why? Because most therapists haven’t cracked the code on how to explain what we do in straight-forward, common-sense, plain English. I don’t know why, it’s not that complicated. Yet, crazily (that’s a term of art), we’ve mostly left our public relations messaging to radio and TV “therapists” (think: Dr. Phil and other entertainers masquerading as clinicians) and to portrayals of therapy on television and in movies. So it’s no wonder therapy is still widely stigmatized, skepticism-inducing, and (for some folks) terrifying. Therapy may or may not be right (or even necessary) for you. But the best way to find out is to become an educated consumer. Many moons ago I wrote a book about that, and in it I did a countdown of my “Top 10 Myths About Therapy.”  I’ll share it with you here (for free!). Maybe you’ll recognize one or two.

Therapy may or may not be right for you. But the best way to find out is to be an educated consumer.

Myth #10: Talking About My Problems Will Make Them Worse

This is a great one to start with because it’s really important and applies to so many areas of our lives, not just therapy.

Lots of people tell me they stay away from therapy because they’re afraid they’ll be asked to dredge up unpleasant memories and feelings they’d just as soon leave buried. Maybe you feel this way, too. Maybe you figure that whatever your day-to-day problems are, they can’t be as bad as the pain you’d feel if had to unearth ghosts from your past. In other words, what you don’t know can’t hurt you. Actually, the opposite is true. Here’s why:

Think of your emotional energy as money in your psychic bank. You have a finite amount on deposit. Choosing not to think about or remember something doesn’t come free—in fact, it’s costly. Once you force, say, a painful memory out of your awareness, it’s not really gone. It’s just exiled to your unconscious where it lurks and threatens to break back through. You will have to continue to spend emotional currency to keep it there. The process of banishing an unwanted feeling, memory, idea, or wish from your conscious mind and keeping it in exile is called “repression.” Repression is mentally expensive; doing it costs more emotional energy than facing your problems head-on.

Beyond draining us emotionally, past events, feelings, and relationships that we try not to think about have other influences on the ways we feel and behave now. As an example, let’s consider Larry, the divorced father of a ten year-old girl I saw in therapy.* I asked him to come see me because his daughter had been complaining that she was afraid of her weekends with him. She had tearfully told me that he had a volatile temper. He was extremely critical of her, often becoming explosively angry for small misbehaviors—yelling, pounding his fists, and sometimes shaking her. Eventually he would calm down and, feeling remorseful and ashamed, would ask for his daughters’ forgiveness. My patient loved her father and wanted to be close to him, but felt understandably unsafe and mistrustful. She also felt guilty about her mistrust, since he clearly felt so bad about his angry outbursts.

When I saw Larry, he acknowledged his problems managing anger and frustration, and admitted that he often lashed out at his daughter in ways he felt terrible about. In fact, it had been his temper that had driven his wife away. Larry said he had resolved many times to stop directing his temper at his loved ones, but had never succeeded for long. And it wasn’t just his family; whenever anyone argued with him, spoke rudely to him, or disappointed him, he felt instantly overwhelmed with rage.

Larry was reluctant to talk about himself. Eventually, he did tell me that his own parents had divorced when he was ten. His mother had abandoned the family, and he had been left in the care of his father, an alcoholic with a terrible, abusive temper who had beaten his children. As Larry spoke about his father, his eyes filled with tears. I pointed out that this was a painful topic for him. He said that it was, but that he tried not to think or talk about it. In fact, he had cut off all contact with his father, who lived only a few miles away.

A month later, Larry was back in my office, upset about another incident with his daughter. At dinner the previous night, she had accidentally knocked over a glass of milk. Before he knew what he was doing, Larry had slapped her across the face. I said that he must be feeling ashamed to have abused his daughter in that way, as ashamed as he had felt when he had been abused by his own father. And the worst part was that he was behaving just like his father, in the way he wanted most not to. Even though Larry was frightened of the feelings he was going to have to face, he accepted a referral from me for a therapist of his own. Within a couple of months, my little patient reported improvements in her relationship with her father; the angry outbursts dwindled, then stopped. When I spoke to Larry a several months into his therapy, he reported that he still felt sad and angry about his father, but also tremendously relieved. He realized that what had been keeping him from talking about his past was mostly the shame he felt about it. “But after all,” he said, “I was only a little boy when my father did those things to me. Now I’m a man, and I can make my own decisions.” These days, Larry is more in control of his temper and feeling better about himself. He is considering initiating contact with his father, and his relationship with his daughter is better than ever.

Larry’s experience illustrates a critical point: therapists don’t put ideas in people’s heads, they just illuminate the ones that are already there. Think of your mind as a dark room, and your old worries and fears as the furniture you bump your shins on as you stumble around, unable to see. A therapist can turn on the light so you can navigate better.

Myth #9: A Stranger Can’t Help Me, That’s What My Friends and Family Are For

Friends and family, teachers, clergy, and professional mentors can and should be great sources of support in our lives. But there are a number of reasons they can’t help in the way a therapist can. Here are a few important ones:
  • Friends and family are not neutral. Even if they want what’s best for you, they have a personal investment. Whatever support or advice they offer will be biased according to their own agendas. And friends aren’t trained to factor these agendas out.
  • You won’t feel free to share everything with your friends or family. Friends and family are people you see socially and with whom you have complicated emotional relationships. When talking to people with whom you have close personal ties you are likely to hold some things back or carefully craft your message in particular ways—if even you’re not always aware you’re doing so.
  • Even a good friend with good intentions might not be able to follow through on a promise to keep something confidential!
  • Good friendship is a mutual give and take. In therapy, unlike in friendship, you won’t be expected to share the spotlight. This time will be only for you.
  • Friends don’t have the professional training and experience to bear in helping  you to develop insight about yourself.
  • Have you ever felt as though your friends and family listen but somehow make your problems their problems so that your unburdening suddenly feels like it’s about them? Therapists are trained to practice both empathy (the ability to “get you” on a gut level) and “sympathy” (the ability to offer comfort) without taking on your problem. It’s not that therapists don’t care, we do. Deeply. But we are skilled in being able to connect emotionally without becoming personally invested such that your problems become burdensome to us. That leaves you free to express yourself in any way you need to.

Myth #8: I Don’t Have Time

Maybe you’ve been thinking about therapy for a long time, but can’t imagine how you could shoehorn another appointment into your already crammed schedule. Before you send therapy to the bottom of your list of Things I’ll Do for Myself When Life Slows Down, let’s think about this a bit more.

You may have already calculated that if you go into therapy once per week for 50 minutes and you’re lucky enough to find a therapist within, say, twenty minutes of your office or home, you’ll have to budget for 90 minutes each week. But maybe you have a demanding job with an inflexible boss who wouldn’t look kindly on you slipping out for a long “lunch.”  Maybe your family is already lobbying for your non-existent spare time. Perhaps, on top of it all, you’re taking night classes or working a second part-time job to make ends meet. All of our lives are some version of this circus.

First, you should know that therapists are often quite sympathetic to the demands of a busy life. Many offer early morning or evening appointments for people with inflexible work schedules. Some offer weekend hours. Most therapists have chosen their office locations with public transportation and easy parking in mind—to save clients time on either end. Have to travel out of town unpredictably? These days, therapists are used to that, and many will schedule week-to-week (rather than holding you to a fixed day and time), offer forgiving cancellation policies, or will conduct sessions by telephone or Skype if necessary.

Second, time is like money in that, often, how much or little of it we have is a subjective experience rather than an objective amount. We all know someone who is impressively productive. Say it’s a friend who works full-time at a challenging career and makes it to every PTA meeting, yet doesn’t seem inordinately stressed. It’s true that people have varying amounts of energy and tolerance for being on-the-go. Some of us need a lot of downtime, others don’t. But it’s also true that busy people are often organized people, and organized people get more done. Most of my patients find that allocating time for therapy results in their having more disposable time then they used to. With time, as with money, not having enough is usually a matter of how we spend it. Therapy helps us spend our time more wisely.

Third, if you don’t have 90 minutes per week to spare, even on something as important as your own happiness, then something is wrong. If you’re genuinely overbooked, it could be you’re taking on tasks that should be delegated to others. Perhaps the issue is one of time management, of ordering your priorities, or of difficulty saying “no” when people ask you to do things. Maybe you feel harried and stressed to the point where you’re not taking pleasure in tasks you’d otherwise enjoy. All of these issues could be explored in therapy.

Fourth, therapy is a good time investment because it makes everything else you do easier. If you’ve been unhappy for even a few months, you may have lost your perspective on how mentally and physically draining it can be to feel that way. Our emotional conflicts, whether they’re small (like pebbles in our shoes) or big (like anvils around our necks), distract, preoccupy, and exhaust us. It requires effort, sometimes tremendous effort, to battle on in the face of them. And that leaves less emotional energy left over to use in productive ways, such as paying attention to the people we love or advancing our careers. In fact, it takes a lot more energy to function in spite of our problems than it does to talk about them in therapy.

Rather than finding therapy to be another onerous task that saps your energy, like picking up the dry cleaning or going to the dentist, you’re likely to find that it mentally organizes and energizes you. Even if –especially if–the topics you discuss are painful, good therapy will leave you with more emotional zest for the other parts of your life.

Myth #7: Most People in Therapy are Whiny, Self-Indulgent and Entitled

Nobody likes a complainer. We all know people who wallow in their past misfortunes and blame their problems on others. People who come from the “pull yourself up by your bootstraps” school of life often have disdain for therapy because they think it encourages people to sit around feeling sorry for themselves.

Actually, the reverse is true. The point of therapy is to help you take responsibility for your life by dealing with the ideas, feelings, or conflicts that hold you back. If you get stuck in therapy ruminating endlessly over the same emotional territory, your therapist should help you get unstuck.

Consider Lisa, who came to me for therapy because she was unhappy in her marriage. For several months, in weekly sessions, she complained that her husband was lazy, self-involved, and unreliable. She didn’t think it was entirely his fault; she was able to talk about her own contribution to their difficulties. But in the end every conversation circled back to the ways her husband had let her down, so the overall effect was to confirm that the problem was, after all, mostly him.

Initially, Lisa enjoyed therapy because she liked having a place to air her frustrations and feel supported. But after a few sessions she realized that using my office as a place to vent wasn’t helping her improve things. If anything, it was contributing to her staying stuck, since “getting the anger out” in session left her more able to tolerate the stifling sameness of her marriage.

One day, Lisa admitted to me that she worried about boring me with her constant railings against her husband. I acknowledged it was difficult to hear the same complaints week after week and to see her feeling hopeless. After all, we didn’t have the power to change her husband. We explored the “stuckness” she felt: she was married to a man who disappointed her, but she loved him and wanted to stay. She couldn’t fix him, yet she couldn’t accept him the way he was.

Lisa had needed to complain in therapy for a while in order for me to understand, and for her to really experience, how helpless she felt. But after that, our work changed direction. The box she felt trapped in was in many ways her own construction. After all, she had chosen her husband, and she was choosing to stay with him now. In the safe setting of therapy, as she examined (and explored the roots of) her self-perception as a martyr in her marriage and other areas of her life, Lisa began to remember the good qualities in her husband that had drawn her to him in the first place. Over time, she became less critical and, to her surprise and delight, her spouse responded by being more attentive. Things between them, while not perfect, began to improve.

Myth #6: There’s No Evidence That Therapy Works

Because the practice of psychotherapy is a “soft” rather than a “hard” science, it often comes under attack as quackery. Some critics have argued that the success rate of therapy is no greater than that of spontaneous remission—in other words patients would have gotten better on their own anyway. Others have argued that the benefits of therapy are due to the placebo effect. They claim it’s the client’s expectations that produce change, not the therapeutic process itself.

In recent years, especially as insurance companies have cracked down on longer-term therapy in favor of short-term treatment and medication, the mental health field has had to substantiate the efficacy of therapy. It turns out that the research shows that most people who work with a well-trained and skilled therapist experience significant benefits, regardless of the nature of their problems. In fact, therapy has been shown in many cases to reduce other health costs.

The data further suggests that the benefits of therapy will last longer if the goal is long-term change rather than short-term symptom relief. In other words, you’re more likely to keep the gains you make if you’ve developed strategies for dealing with crises and stresses in the future.

Still have disturbing or puzzling questions about therapy? Quite likely, you do. Making the decision to try therapy with a stranger, whether you’ve done it before or not, is a leap of faith that takes courage. If you’re skeptical, discuss your doubts with the prospective therapist from the beginning.

Remember: you’re in the driver’s seat, and you can always decide to drive away.

Myth #5: A Therapist Will Try To Convince Me To Stay Forever

Lots of people worry that going into therapy is like entering a vortex; they’ll never escape! Some worry their therapist will try to turn them into a “lifer”– holding them in treatment much longer than they need it simply for the money. Other folks are anxious about become emotionally dependent on their therapist.

If it goes well, your relationship with your therapist will be important. Especially in the beginning, you may find yourself waiting eagerly for your next session, so you can discuss something that’s happened in your life. Hopefully, you’ll feel comforted and supported.

But a good therapist doesn’t strive to make himself indispensable or encourage you to hang on his every word. He’ll help you understand yourself better and develop tools you can use in your own life to feel more fulfilled, get along better with people, and live and work more effectively.

A good therapist is working toward being out of a job.

PS: Also, most therapy is brief. While some people can and do benefit from a longer stint, lots of folks get the help they need from just a few sessions.

Myth #4: I Want to Work on a Specific Problem– A Therapist Will Want to Dredge up My Whole Life!

In therapy, you’re the boss. If you want to work on a specific problem, a good therapist will respect that.

Say, for example, you’re in a committed relationship with someone who wants to get married, but you’re ambivalent. It would be reasonable for you to seek couple therapy with the express goal of deciding whether or not to tie the knot. You might choose to contract with a therapist for a limited time, say six sessions, or you might feel comfortable with a more open-ended arrangement. But either way, you’d be doing it with the explicit understanding that dealing with the question of your potential marriage would be front and center.

What you can’t know, though, is what issues might come up after you start. Perhaps as you explore the reasons of your reluctance to marry, you’ll discover fundamental doubts about your partner’s character. Or maybe you’ll uncover some lingering feelings about your own parents’ divorce that need working through. Because the path of your therapy is not predetermined, neither is its course.

Quite often, people decide to change the goals or focus of their therapy as it unfolds and new ideas and feelings come to the surface. Other times, they choose to end treatment when they’ve completed a piece of work or come to a better understanding of the issues that brought them to treatment.

It will be the job of your therapist to help you assess, in an ongoing way, the progress you’ve made with respect to your goals and to offer you possibilities for future work. But it’s up to you whether to go on.

Myth #3: Therapy Will Come Back to Haunt Me in the Future

Your therapy is nobody’s business but your own, and therapists are bound to keep your work strictly confidential.

However, it’s true that health insurance companies can request reports from your therapist when considering payment, and health and life insurance companies can request reports when considering whether to underwrite new policies. Those records will then be stored in a database somewhere outside of your control. For some people that breach of confidentiality is a reason to consider bypassing insurance and paying for therapy themselves, entirely out of their own pockets.

You can and should discuss with your therapist the proposed content of any communication she has with insurance companies or any other third party. Therapists have some leeway in what they write, and most can word their reports in a way that will be honest and ethical, but not damaging to you. You should ask for a copy of any letter or report written about you before it’s sent.

Myth #2: All Therapy is Confidential

Ok, I sort of tricked you with this one. I’m not trying to simply reassure here—just tell you the honest and balanced truth.

As I said in #3, your therapy is nobody’s business but your own.

When you go to a therapist they are bound—legally and ethically—to keep everything about your work with them strictly confidential. That means that without a signed release a clinician can’t even tell anyone (including an insurance company representative) that you are in treatment.

There are limits to confidentiality, however.

  • It’s (very) rare, but a therapist can be subpoenaed to testify in court. Almost all therapists will fight it on the basis that therapy is legally protected, and they’ll probably prevail. But there are no guarantees. 
  • A therapist’s records can be subpoenaed, and the above concepts apply. Here’s some comforting news: what a therapist is required to keep in an official record is limited (time/date of session, person/s attending, diagnosis if there is one (not required), treatment plan (e.g., “ongoing individual therapy,” goals of treatment (e.g., “lessen symptoms of anxiety”), and progress to date (e.g., ”patient reports lessening of symptoms of anxiety”). It’s pretty vanilla stuff. Most therapists keep any personal notes (more nuanced issues they’re thinking about with regard to their work with you) out of the official record, and that’s perfectly legal.
  • If your therapist has any reason to believe that you are a potential danger to yourself or others, he/she/they is legally bound to report their concern to the legal authorities.
  • Health insurance companies can request reports from your therapist when considering payment, and health and life insurance companies can request reports when considering whether to underwrite new policies. If you release these records, they will then be stored in a database somewhere outside of your control. For some people, that breach of confidentiality is a reason to consider bypassing insurance and paying for therapy themselves, entirely out of their own pockets.

You can and should discuss with your therapist the proposed content of any communication she has with insurance companies or any other third party. Therapists have some leeway in what they write, and most can word their reports in a way that will be honest, ethical, and to the point, but not damaging to you.
You should ask to see a copy of any letter or report written about you before it’s sent.

And finally….

Myth #1: I Can’t Afford It

Of all the reasons people stay away from therapy, this is by far the most prevalent.

I know that many people consider therapy a luxury, but I find this puzzling. With the exception of the basics—food, shelter, and physical health—there’s nothing more important than the quality of your emotional life. What could be more valuable than your happiness?

Luckily, you don’t have to choose between your other financial responsibilities and therapy, because there are some great bargains to be had. A surprising number of experienced therapists offer a sliding scale.  Also, there are training institutes in every town. These are schools where already-degreed and licensed therapists work in a clinic as part of their post-graduate professional advancement—again, on a sliding scale.

Here’s something else to consider: Studies show that an individual’s income is likely to increase as a result of psychotherapy. In fact, many people find they actually have more disposable income after they enter therapy than they did before.

I can attest to this from personal experience. When I was a graduate student in my early twenties, I could barely make ends meet. I badly needed therapy, but couldn’t imagine how I would pay for it. Finally, I bit the bullet. Even though my therapist worked in the clinic of a training institute (and thus I was given a significantly reduced rate), the fees amounted to nearly one third of meager income. I was panicked.

What I discovered was that even though I had to do without some extras to afford my therapy, I was able to do so without a lot of difficulty. As I was forced to become more thoughtful about my expenditures, I also came to grips with the fact that I had a lifelong problem of over-spending and, as a result, depriving myself of things I really needed.

My situation was extreme; I’m definitely not suggesting you a third of your income on therapy. After all, at the time I was in therapy I was training to be a therapist myself, so it made extra sense to make my therapy a priority. But my experience illustrates the four reasons you might find therapy less of a financial strain than you fear:

  • People in therapy feel supported emotionally and therefore less deprived than they did before. If you’re someone who tends to overspend in an attempt to comfort yourself, you’re less likely to do once you start.
  • Therapy is not only a place to discuss purely emotional issues; it’s also a place to discuss practical issues, such as budgeting.
  • Therapy is a good place to explore obstacles to maximizing your own earning potential.
  • The responsibility for the therapy fee, if it’s not too burdensome, can encourage you to become more financially organized.

And remember: therapy is not forever, but its benefits to your money management and earning skulls are yours to keep.