The following material is to help you understand a little better how I practice therapy. If you have any questions about what you are reading, please ask me and I will do my best to clarify.
- What is Psychotherapy?
- What sorts of things should I tell my therapist?
- What if I don’t want to tell my therapist something?
- How often should I come in for therapy?
- What do I do if I am dissatisfied with how things are going in therapy or am confused why my therapist said or did something or I want to stop coming to therapy but am uncomfortable to say so?
- How will I know that I am ready to stop therapy?
- Is there a right way to stop therapy?
- Is there a wrong way to stop therapy?
What is Psychotherapy?
The ‘psycho’ part of psychotherapy involves a more or less structured exploration of your psyche—that is, your experience of your emotions, behaviors, memories, thoughts, and relationships with the intent of better understanding how any of these areas may be leading to problems or imbalance in your life. The ‘therapy’ part of psychotherapy involves developing and practicing new behaviors, perspectives, and strategies that result in you feeling more balanced, safe, comfortable, and satisfied in and with your life.
The ‘therapy’ part also involves acceptance of who you are and where you are right now, with an eye towards the future changes in behavior and perspective that you might want to establish. When we find self-acceptance, we simultaneously find that the path on which to move forward has become much clearer.
What sorts of things should I tell my therapist?
The simple answer is that you are free and encouraged to tell me anything you like and that I am interested in whatever you tell me. Nothing is too big or too small or too random for you to bring up.
What if I don’t want to tell my therapist something?
If the material you are not wanting to disclose involves safety concerns (for you or others or both) you need to move past any reluctance and disclose this material at once. The stressors that lead to thoughts about, and plans regarding, suicide or homicide are stressors that virtually always can be addressed and improved, whether in therapy or elsewhere. Also, sharing these thoughts with your therapist very often make any urges to act on those thoughts or plans seem less intense and more manageable.
Also, if you are the victim of abuse or know a victim but are afraid to disclose because of my mandated reporting requirements, you need to move past this reluctance and disclose as soon as possible. Reporting this type of material, though hard, is essential to maintaining the safety and welfare of yourself and those around you.
Otherwise, it is completely your call to tell me about something or not. Though full disclosure often can feel helpful to clients, psychotherapy research suggests that sometimes it does not. In my experience, whether full disclosure feels helpful or not depends on the therapist’s response to the disclosure, as well as the length of time the therapist and client can process the disclosure.
Psychotherapy research suggests that clients choose to withhold information or make untruthful statements to their therapist pretty often. One survey found that 93% of therapy clients reported either not disclosing or not telling the truth to their therapist on at least one occasion.
The most frequent topics that clients withhold information about (or make untruthful statements about) are current suicidal thoughts and plans, acts of self-harm like cutting or burning, how bad they are feeling inside, memories of childhood abuse, substance misuse, sex, reactions to their therapist or their therapist’s interventions, and feelings about their progress in therapy.
The research suggests that sometimes clients feel that not disclosing/making untrue statements had no impact on their therapy. Sometimes clients feel that not disclosing/making untrue statements had a negative impact on their therapy, especially if it pertained to symptom severity, suicidal thoughts or acts of self-harm, current substance use problems, and childhood trauma. In rarer cases, clients report that not disclosing/making untrue statements had a positive impact on their therapy, usually because they felt they had maintained control of their information and that this was empowering.
The research suggests that therapists quite often are not aware when they are not getting the whole story or are being told untruths.
To make untrue statements to, or to withhold information from, your therapist is a personal (sometimes spontaneous) decision that is influenced by many factors. The material can feel embarrassing or sensitive. The material may not seem relevant to why you are in therapy. You might not believe that the therapist will be helpful regarding the matter. You might anticipate that the therapist might get alarmed and send you to the hospital or call the police or have someone else arrested. You might perceive your therapist as distant and uninvolved and therefore not worthy of your trust. You might anticipate a negative therapist reaction by reason of your therapist’s age, gender, religious belief, or sexual orientation.
My suggestion to you about disclosure is do your best to provide as complete information as you can at the time. You can add more information later as you feel more comfortable with therapy. Alternatively, you can let me know that there are some things that you might want to talk about but are not sure about doing so. We can work on the reasons why you might not want to disclose as a first step, if you like. In general, the anticipation about talking about hard things causes a lot of anxiety that tends to reduce after you talk about them. That anxiety might return as you start to talk about the topic again, but again it generally tends to reduce. Eventually, the anxiety may not return at all or may be much reduced.
Also, if you did not provide the whole story about something and you find that you want to make a more truthful disclosure later, I urge you to do so. To do so is truly brave; you have my deepest support and respect in doing so. The therapeutic relationship is a unique one and accommodates these developments.
How often should I come in for therapy?
How often you attend depends on several factors, including how much time you want to invest in therapy and how much you want to pay in fees or copays/deductibles. It also depends on what your goals are and where you are along in the process of therapy.
I generally recommend to most clients who are beginning therapy that they attend once per week for at least eight-twelve weeks. This allows me to get to know you and your situation better and allows us to clarify and focus on your goals. There are some instances in which I recommend that a client come in twice per week for a period of time. This usually occurs when there is something particularly stressful occurring in the client’s life or if there are significant current safety concerns. Some clients prefer twice per week, and this frequency can lead to a richer therapy.
Many clients choose to continue attending weekly as they move through their work. In my experience, weekly attendance is associated with better outcomes. This is probably because attending weekly helps you keep your goals clearly in mind and helps you remain connected with the process. Additionally, a lot can happen in a short period of time. Having a weekly opportunity to review what has been happening can help identify behavior or relationship patterns that could benefit from some therapeutic work.
As a client begins the termination process, I typically suggest that they start to taper down the frequency of their attendance in a manner that makes sense to them. I typically suggest that a person who completes therapy come in a for a follow up one month after their last session to see how things are going and to see if anything might benefit from a change that can be discussed in that follow up appointment.
What do I do if I am dissatisfied with how things are going in therapy or am confused why my therapist said or did something or I want to stop coming to therapy but am uncomfortable to say so?
The best thing to do is try to talk to your therapist about your experience. Bringing up these topics can be understandably highly challenging for clients to do. However, in my experience, these are very helpful discussions to have. They are a part of the therapist’s job to have because these types of client experience happen. It is the therapist’s job to listen to and respond to your concerns empathically, and with your best interests in mind, so that a solution that is comfortable to you can be established.
How will I know that I am ready to stop therapy?
Clients usually know when they are ready to stop therapy. Common reasons for stopping include when clients have completed most of their goals, when they notice that they are not moving forward any longer in therapy, when they notice that therapy does not meet their needs, when they would rather spend their money/time on other things, or when they can’t form a connection with their therapist. Sometimes other aspects of life intervene, and therapy no longer fits with a client’s schedule.
Is there a right way to stop therapy?
If you find yourself thinking about stopping therapy, that is a good time for us to talk about you stopping. Sometimes clients feel uncomfortable about raising this topic because they worry that the therapist will tell them that they are not ready to stop, or that stopping is a bad idea, or otherwise put up barriers to their exiting. In general, therapists should help you explore your reasons for stopping, provide their clinical opinion on the matter, and support you in what you feel is best for you.
I generally recommend that a client reduce their session attendance to every other week for about a month or two prior to stopping completely. If you want to end sooner than that (and you can stop at any time), I have found that a good way is for the client and therapist to hold one or two sessions prior to the last session, especially if the client has been attending for some time. A single session is usually not enough time to fully understand the reasons why a client wants to stop. One session also usually does not allow sufficient time for closure and to review what you have worked on and learned and what you might think about as you move forward.
As mentioned above, I find a one month follow up after the last session can be very helpful.
Is there a wrong way to stop therapy?
Possibly. Simply stopping attendance or canceling an appointment without coming in for a follow-up is generally seen by therapists as not being helpful for the client. I am not sure whether or not this is actually true, because I only know this situation from the therapist’s perspective, and not the client’s. Maybe stopping right then is something the client feels strongly that they need to do. It is hard to argue with that and unhelpful to say that the client is in error.
However, sometimes a client decides to leave therapy because they are getting to some difficult material and the anxiety or other difficult emotions that this stirs up causes them to want to bolt. Maybe leaving is really the best thing for them. On the other hand, maybe if they were to have a more extended conversation about the matter, they could make some progress on the matter and experience benefits in their life. My suggestion to you is to be as open as you can about stopping therapy. My role is to provide an as non-judgmental and safe space as possible so you can feel relatively comfortable that fits best for you.