You've been seeing your therapist for a few sessions and the relationship is building. You're able to afford it, but it's not cheap. So how can you maximize its effectiveness so that you get every penny's worth on the path to transforming yourself and your life?
Every therapeutic relationship is different, and there are many forms of therapy out there. My recommendations here are broad and aimed towards those in typical talk-therapy work. Therapeutic work requires enormous bravery, but if you practice these tips and tricks below, the work will become deeper and more effective
You've been struggling with a particular problem or feeling for a while. You've sought advice from friends, done some reading, experimented with changes in your life, but things haven't shifted enough to satisfy you. You know in your heart of hearts that change is possible, and you determine that psychotherapy would probably be helpful. Someone you trust gives you the name of a therapist or you otherwise find a therapist that you're interested in checking out. What comes next?
I typically am able to return phone calls or emails within a day. I know that it is a huge step to reach out.
When a potential client contacts me, I assume that they will probably be nervous: how much should a therapist be told right away? will a potential therapist judge you? what should you say on the phone? will the therapist like you and will you like them? will they understand you?
It might ease your fears a little bit to know that the vast majority of therapists have been clients in their own therapy for extended periods of time. Many psychoanalysts are in ongoing analysis as clients for most of their careers. We've all felt nervous with a new therapist.
Every private practice therapist has a different intake process. In terms of initial phone calls, some therapists simply want to hear your voice and set up a time to meet face to face. Others have many concrete questions prior to meeting up in order not to waste your time or theirs. I fall somewhere in between. I generally want to know a little bit about what's going on that makes you want to enter therapy at this time and a little bit about what you're looking for in a therapist or in treatment generally.
Most therapists consider the initial phone call part of an intake process rather than just information gathering, so it's wise to make that first call once you're pretty sure that you're ready to start therapy. That doesn't mean you have to stick with the first person you talk to, but it does mean that if you think you won't be ready to start therapy until June, don't make the first contact in March. Likewise, many therapists in private practice only see clients on certain days of the week. If you only have Tuesday evenings free, you're going to have to find someone whose schedule matches. It's good to know your scheduling availability before reaching out to a potential therapist.
If I'm very clear that we're not a match or the nature of your problem would better be served by someone specializing in it (assuming that I don't), I'll make that clear and provide contact info for other therapists. Assuming things look promising, I'll suggest meeting face to face.
In a first face to face session, I will again assume that the client is nervous about being there. I'm a stranger, and one to whom you might end up disclosing some of your most vulnerable thoughts and memories. In my role, the first session is similar to the initial phone screening in that I want to hear more about what's bringing you to therapy and what you're looking for. And I want to start to get a sense of who you are. I will ask more concrete questions during the first session than the phone screening, and I will ask yet more questions in the second session as I start to fill in gaps in my understanding of you and what brought you in. I really want to stress that I'm not making moral judgments during this process because that would get in the way of my professional consideration of what it is you're talking about. Most therapists I know *love* that we live in a big, wide world full of very unique people, and we also enjoy helping people with unique challenges. People don't become therapists to judge.
At the end of the first session, I'll ask how the session felt and if you'd like to schedule another appointment. At that point we'll also discuss the fee. One thing you can do to prepare for that conversation is to know what you can afford and whether you'd like to get reimbursed by your insurance company. You probably will want to call your insurance to ask questions that I describe in the "details" section of this website. In my experience, an average HMO plan will reimburse you about $65/session, but there are several factors in play, and it's wise to call them and get all the information if you do intend to seek reimbursement. If you aren't sure whether or not you want to seek reimbursement or you need to review your personal finances after the first session, that is of course fine. It's probably worth it to know that most therapists will negotiate their fee at least a little bit, and it can be hard to predict who will negotiate and within what range. Sometimes therapists who charge $350/session don't negotiate, but sometimes they're more willing to treat extremely low fee clients because they're very financially secure. Another thing to consider is that many therapists will accept a reduced rate if the sessions are held during business hours.
Most therapists refer clients to other therapists that they trust or institutions that they trust. If you need an extremely low fee (in NYC that's something under $50/session), it's probably worth it to contact one of the psychoanalytic training institutes or other training institutions. They tend to be located either near Union Square or the Upper West Side. You'd be seeing a trainee, but trainees are very devoted and get tons of supervision. It's a good option if your finances are very limited, but you're sure it's the right time to start therapy.
If all systems are go for the next session, I'll ask you to spend some time after the first session in the waiting room filling out a few forms. Some therapists prefer you to fill out those forms beforehand. We'll probably review those forms together in the next session.
For most people, that's it. You're on your way! If you get a clear gut sense that this isn't someone you want to talk to week after week, don't continue. Or maybe do one more session together. It isn't worth it to have 8 sessions with someone knowing that the vibe is off. Similarly, if you cannot come to an agreement about a rate that is sustainable (at least for the next few months), be up front about that. It's disappointing to therapists and even more disappointing to clients to get knee-deep in the work and not be able to continue. In long-term therapy, I recommend checking in about the fee every six months, and I recommend checking in every six weeks to three months with new clients.
If you have any questions about the process of starting therapy or how to find an appropriate therapist, please feel free to comment or contact me directly at the link up above.
In the next post, I'll cover some tips and tricks for how to get the most out of your work in therapy.
I'm generally not an anxious person, but in 2010 I was moving to NYC, and I had always had an intense fear of cockroaches! Thankfully, a course of EMDR treatment changed all of that for me.
EMDR is a structured, 8-phase reprocessing therapy that uses cognitive and brain-and-body-based interventions. It was initially developed to work with trauma, and while its applications have grown much more diverse with new protocols, it remains a common and effective approach to working with trauma.
In 2010 so many clinicians that I trusted were using it effectively that I decided to get trained in it even though highly structured treatments aren't my favorite way of working. As a participant in the training, I needed to receive my own EMDR therapy both as a way of learning more about the therapy and to have the experience I was asking others to have.
That same year was the year I was making a move to NYC to take a job as a therapist in a program for adolescents living with HIV at Mt. Sinai Hospital. I knew what I needed to do: I asked for and was granted permission not to process a trauma but instead to process a phobia of the freakishly fast, germ-ridden insects that live on every block here.
I went through the standard EMDR protocol. It was difficult and sometimes scary, but my therapist always helped me feel safe and supported. I had to describe the scenarios or memories that affected me the most; quantify my level of distress; figure out what kinds of limiting, negative beliefs occurred alongside my fears such as "I'm not safe" or "I can't handle this". Amazingly, in only a few sessions, my levels of distress went down to almost nothing, and those limiting beliefs felt increasingly untrue. Work was done on discharging the feeling of panic and anxiety from my body until it was non-existent. Then it was time to prepare to respond differently to those creepy critters and build confidence in the new ways of responding.
I completed the course of treatment in 2010, and the results have stuck. Trust me, I've had plenty of opportunities to test it out around the city. I don't have any pet cockroaches, but when I encounter them I experience a simple curiosity and a vague sense of yuck. I don't feel panic at all. While EMDR is not the right approach for all problems, the results I have seen with my own clients in combination with my own success story has given me a lot of confidence in this method.
"The New Yoga? Sadomasochism Leads to Altered States, Study Finds"
Do you find meditation frustrating and difficult? You might find
similar benefits without the hours of boredom by trying BDSM instead!
I’m partially joking in that I wouldn’t discourage anyone from
meditation. Boredom can actually be useful, and there’s a meditation
style out there for everyone. That being said, and while I confess that it's not my area of expertise, I’m encouraged by meaningful research into consensual sadomasochism.
For a long time, the mental health community disparaged all
non-normative sexual behaviors and took them as signs of pathology.
Currently the DSM V classifies Sexual Sadism Disorder and Sexual
Masochism Disorder as being disorders when they cause significant harm and/or dysfunction in the life of the participant. The studies cited
above seem to indicate that, when performed consensually in controlled
settings, sadomasochistic activities lower stress and increase a sense
of emotional connection to others.
A clinical psychologist friend of mine recently disclosed to me that
within the past year she became active as a submissive in NYC’s kink scene.She isn’t ready to be out about it to many colleagues. She also said, “I’m learning so many things about myself and my limits, that I’m not ready to see clients from this scene because I still want to
I suspect that when people mindfully try out practices from/within the BDSM community, the practices serve as ways of investigating one's relationship to desire, aggression, power, and intimacy.
I’m wary of pathologizing sexual practices, but I do think that sexual
practices are worthy of attention. While it’s not a topic that comes
up with all of my clients, discussing preferred sexual practices does
open a window into a person's hopes, needs, values and yearnings.
NY Mag’s recent article describes some of the recent history of the battle between free will and biological determinism. The most current data supports that there is free will, but it is enmeshed in a poetic relationship with our biology: ‘”…neuroscientists say the new picture [of biology vs. free will] is much more in keeping with our intuitive sense of our free will. When we form a vague intention to move [our bodies], they explain, this mind-set feeds into the background ebb and flow of neural activity, but the specific decision to act only occurs when the neural activity passes a key threshold — and our all-important subjective feeling of deciding happens at this point or a brief instant afterward....All this leaves our common sense picture [of free will] largely intact…’”
When I was studying in a psychoanalytic institute, we used to describe the habits and expectations we form in our early relationships as paths paved through the jungle of experience. These paths help make a map of the world that some neuroscientists and therapists call "procedural memory", "procedural process", or "implicit memory". As these habits and expectations become well-worn in our neurology, they become like paved roads and, in some cases, superhighways. This is part of the explanation of why some people end up in multiple relationships marked by domestic violence while other people consistently choose partners who are emotionally unavailable, etc. Those roads may not take us where we want to go, but the path is well-worn and hard to break out of.
We also know from studies that through neuroplasticity, our biology itself can change, which in turn can change our whole metaphoric map of the world. The jungle is always available to us to forge new paths. But how to make a new path? Where will it take me? How do I know if I’m heading in the right direction? This is where a skilled therapist can make a huge difference. In therapy the client has the benefit of going down the old roads in the controlled environment of a therapy session, having the therapist notice the details of that process, and then finding new ways to head off-road together into the wilds of greater freedom and sanity.