How to Get the Most from Your Therapy

Pick a good therapist.  

Approximately one third of all therapists consistently harm and help their clients get worse. Another third of the therapist do no harm, but they also do not help. Only one third of the therapists consistently help their clients get better!

The terms "Therapist" or "Psychotherapist" are generic labels that are used by many different kinds of  licensed professionals and non-licensed paraprofessionals. Make sure the therapist is licensed and is not vague about the type of license. A license is a only minimum standard and does not guarantee high quality.   

Be as clear as you can about what you want help with - stress, relationships, your spouse, children, elderly parents, divorce, child custody, step-families alcohol or other substance abuse, eating disorders, sexual issues, grief, depression, anxiety, anger, etc. Then look for a therapist who has training and experience in that area.  

If you are going to a low fee clinic, the therapist will likely be a graduate student in training, or  someone who has graduated and is working toward licensing. Some of them are very good therapists, just make sure they are being supervised by an experienced licensed therapist, and that both the therapist and supervisor have training in the area you want help with. 

The therapist should always be relevant to you, your issues and the purpose of your therapy. The therapist will need information about you and your life in order to tailor the treatment to you, and may ask about things that seem irrelevant to you.  If you do not understand how the question, material or topic the therapist has introduced is relevant to you, ask. It might be very relevant, or it may not. The purpose or goals of your counseling or therapy should be clear, and they should be established by a collaborative effort. Don't accept or stay with a therapist who imposes his/her own interests and issues into your therapy, or establishes goals for your therapy that you don't want.

The most critical factors for successful counseling and psychotherapy are for the therapist to be able to accurately understand your feelings and concerns, have an accepting nonjudgmental attitude, and to be authentic and real (as opposed to pretending or just playing the role). The development of a positive, trusting relationship with the therapist is also critical. Either in a telephone conversation before making an appointment, or in the first or first few sessions make sure you assess the therapist. The best material on selecting a therapist that I have seen was written Dr.Ofer Zur. You can find his "Psychotherapists: A Buyer's Guide" on his website at www.drzur.com.

Don't let your insurance get in the way.

The better Managed Care Plans and HMOs will have a system for rationing insurance benefits for therapy. The system will likely be a data base of all the diagnostic categories that is covered by the insurance contract, the specific and recommended treatment for each diagnosis. Some systems specify the number of sessions needed to achieve the specified treatment goals, others limit the number of sessions allowed by the terms in the insurance contract. Participating therapists have to follow the plan's system if they are to remain in the provider pool and continue to receive referrals from the insurance company. 

I found the managed care and HMO systems to be too rigid and too limiting, unable to adequately consider the multitude of individual differences, life style differences, differences in the types and amounts of pressures and stress, and differences in support and resources available to people. Too often the treatment that was authorized was not based on the information that I submitted, was not relevant to the needs of my client, but seemed to be based on saving the insurance company money. I have seen too many people get frustrated, discouraged, lose motivation or get distracted and waste time and energy fighting with their insurance company.

It is your life, your benefit or your loss. Consider the opinions and information given to you by others and then follow your best judgment in improving and solving the problems in your life. If the problem or issues is significant enough to have serious consequences for your life, don't settle for the generic and limited services of your HMO or managed health plan, go for the best treatment available and pay out-of- pocket if necessary. If your insurance does not assist you but wants to dictate to you, express your dissatisfaction about it to your employer if it is a plan provided by your employer, and get another policy if possible. Sometimes there is too much at stake and too much to lose to follow the limited treatment plan of the insurance company.

Make sure you do your work.

Take responsibility for your learning, don't loose sight of what you want to learn, resolve or get out of therapy, and don't talk about material you know is irrelevant. Use your therapist as a coach, guide, consultant, but you have to do the work. Don't make yourself helpless and look to your therapist to do the work for you.  When you are trying something new, don't blame it on the therapist, by saying something similar to "my therapist told me to ....". Take responsibility for and own what you do or want to do.

Be honest, reveal and disclose yourself, don't censure out your irrational thoughts because you know they are irrational. Don't withhold contradictory or confusing thoughts or feelings. Don't avoid discussing or revealing something to your therapist because it is uncomfortable, painful, shameful, or illegal. Don't intentionally withhold or leave out information. Face the difficult stuff. 

Take what ever you discover or learn in the therapy session and apply it or work with it in your life. Don't just work with it in session.

Don't just accept what your therapist says. Seriously consider what your therapist says, but then if it does not seem right to you, tell the therapist and discuss it with him/her, and follow your best judgment. If you don't understand something your therapist says, tell him/her you don't understand. If you don't agree, don't like or are offended say so.

Sometimes it can be very helpful to share with someone what you discuss and learn during your therapy session, but sometimes it can be harmful. Generally, it is probably better to keep your therapy private, so talk with your therapist about it before you discuss your therapy with others. 

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