Monday, April 30, 2007

The Rule Book

As we work to empower clients to get the most out of their therapy, we start by taking a look at the framework of the relationship. Long-held myths and misconceptions often leave clients feeling unnecessarily confined in what they say, ask, or do in sessions. Let's straighten this out.

In the spirit of collaboration, I'll propose some ideas and if you have ideas for changes or additions, please let me know!

10 Rules for the empowered client in therapy:

1. Clients can ask any question they want.

Too many clients censor themselves because they believe it is impolite or against protocol to ask the therapist questions. This censorship restricts the authentic communication in the session. You might not always get the answer you were looking for, but you might learn something about therapy or about yourself in the process.

2. Clients can talk about anything they want.

It's your time, your session, your life. You're paying the bill, so you can talk about anything you want. To get the most out of your therapy, have a clear idea of what you'd like to cover before the session.

3. "Odd" thoughts are allowed & encouraged.

The apparently random thoughts or memories that we keep to ourselves in the rest of our life are absolutely fair game for therapy sessions. In fact, they can be among the most illuminating material you cover.

4. Clients can take their own notes.

Writing down your thoughts and feelings between sessions has proven invaluable for many people. It greatly improves the flow and continuity of sessions.

5. Clients get to take the whole hour.

Most therapy "hours" are 45 or 50 minutes, giving the therapist time to write notes, return phone calls and attend to personal business before the next session. Show up for your session 10 minutes early to collect your thoughts and plan what you'd like to talk about in the session.

6. Issues between client and therapist take top priority.

Problems within the relationship need to be addressed first because all other work will be impacted. Don't wait for the therapist to bring it up, he may not even be aware there is a problem.

7. Clients choose how they want to be helped.

Are you looking for feedback? Someone to sit with you as you think out loud? Wisdom, advice, professional opinion? A companion as you face some difficult emotions? Fine, all are welcome in therapy - just tell the therapist how you want to be helped with your issue of the day.

8. Clients and therapists team up against obstacles.

Problems arise all the time in therapy. That's the nature of the work. Try to remember it's you and your therapist teamed up against the problem, not you vs. the therapist. If it feels like the latter, be sure to talk about it (point 6).

9. Clients don't need to take care of the therapist.

The pleasantries of the outside world aren't necessary in therapy. Christmas cards, "how was your weekend?", sugar-coating difficult material, and avoiding conflict are not needed. Therapy is one place that is all about you. You pay plenty for this time - let the therapist meet her social needs on her own time.

10. Clients can ask for a status report at any time.

You're always entitled to know where you stand. Are you reaching your goals, engaging in the process sufficiently, or getting caught by an obstacle? Feel free to ask. Better yet, give your own opinion and collaborate on the status report with your therapist.

Your thoughts?

Thursday, April 26, 2007

Power to the People

Psychotherapy is supposed to be a collaboration - therapist and client working as equal partners to achieve the client's goals. This is the ideal. But all too often, it's not the reality.

Why? Consider this: therapists have from two to eight years of graduate training learning their role in the therapist chair. They have thousands of hours of experience honing their craft. There are roughly 500 recognized theoretical orientations (approaches to problems and their origins) for them to choose, practice, and perfect. The client entering therapy for the first time has none of this training and experience.

This imbalance results in countless hours of frustration for numerous clients - and therapists, too. It's like pairing Tiger Woods with someone who's never picked up a club and expecting them to win the tournament. The gap in skill, training, and experience is often too great. For many, the first few months of therapy is spent raising the client's therapeutic aptitude to a workable level. Even then, the client is adopting the orientation of the therapist - which may or may not be the best approach for the client's personality or issue.

It's time for a change. Clients need to be empowered to know what they want, ask for it, and participate in the process. We're stuck in a medical model mindset where the patient is passive recipient of the doctor's intervention. This doesn't work in therapy. In fact, there is a movement in medicine to make patients their own case managers - equipped with more information about themselves and their condition (thanks to the internet), patients want to take control of their treatment away from the MD's and insurance companies. Shouldn't this be even more the case in psychotherapy? Collaboration requires client empowerment, not passivity.

I'm hoping this idea of client empowerment shakes some people up. Especially therapists.

Check back as the plan for this revolution unfolds.

Thursday, April 19, 2007

Being In Therapy

"How does this work? What should I talk about?" Every therapist has heard these questions, and most clients have asked them. This blog will take a stab at giving some answers.

The simple answer is: talk about yourself. Therapy is a laboratory where you and your therapist meet regularly to explore this one topic. Why you think, feel and behave the way you do, how you came to be the person you are, and what can be changed if you so desire.

Anyone who has spent some time being in therapy knows how this simple task can become quite complicated. There are an endless number of approaches to exploring one's self. Should you rehash your week? Talk about your childhood? Your dreams? Do you mention the discomfort you feel when the therapist gives you a certain look? Your doubts about the effectiveness of therapy? Or should you wait for the therapist to ask you questions? Each are valid approaches, but it can be confusing to know which one most effectively helps you reach your goal: to understand yourself better, resolve your problems, and not waste your time and money.

As a psychologist with a decade or so of experience, I've dealt with this dilemma plenty. I often need to spend the first several sessions helping clients learn what to do and say to get the most out of their treatment - at a significant expense to the client. It occurred to me that there exists a huge rift between client and therapist where the process of therapy is concerned: therapists spend many years learning theories and techniques of psychotherapy, while the client may know nothing. No wonder many clients leave therapy frustrated, unable to reach their goals because the process remained a mystery to them.

My goal for this blog is to level the therapeutic playing field. I'd like to equip clients - beginning as well as current - with the tools necessary to get the most out of their time, money, and emotional expenditure. I plan to talk about:

1. How to find and begin therapy
2. The rules and roles within therapy
3. How the exploring/healing process works
4. How to relate to the therapist
5. Topics many choose to cover in therapy
6. How to overcome roadblocks in therapy
7. Knowing when and how to end therapy

Thanks for joining me, and I welcome your feedback.

*NOTE: While I am a psychologist who will be discussing the process of therapy, I will not be conducting any on-line therapy. I welcome your questions about how therapy works, but know that I won't be giving specific advice about your particular personal issues - hopefully, some of what I discuss will help you get that kind of assistance from your therapist!