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Questions

1. Don’t only weak or really messed up people go to therapy?
2. How long does therapy take?
3. How do you know when to stop?
4. How is talking to a therapist different from talking to my friends?
5. How would I know what to talk about if I came to you?
6. Wouldn’t you just listen, then tell me what I’m doing wrong?
7. I saw a therapist before and he didn’t say much. Is that the way you do it?
8. Do you do the same thing with every client?
9. What about recovery and self-help groups? Since I go to one, why would I need a therapist?
10. Does life have to be a struggle?
11. I already understand what’s wrong, so how can talking to you help?
12. If it’s not really obvious what’s wrong, how do you know what it is?
13. What if I’m afraid I’ll find out something really bad?
14. Do you blame parents for every problem?
15. How do you work with couples?
16. Does it mean I’m sick if I see a therapist?
17. Why don’t you talk about things like depression, anxiety, addiction, manic-depression?
18. What is all this about different personality styles?
19. I’ve know some pretty weird therapists. How do you choose a therapist?
20. When is the time to consider therapy?
21. Don’t some people get too dependent on therapy?
22. Do you prescribe medications?
23. I hear a lot about anti-depressants and things. Aren’t they better than therapy?
24. Is it always bad to see a therapist who you know?
25. What are the different kinds of mental health people – psychotherapists, psychoanalysts, social workers, psychologists, Christian counselors, and psychiatrists?
26. Is it best to see a therapist whose sexual orientation, race, or gender is the same as mine?

1. Don’t only weak or really messed up people go to therapy?

Funny idea isn’t it? We think smart people use consultants all the time: personal trainers, financial advisors, nutritionists, tax consultants. We never think them weak, now do we? Generally, the people who I see in my office are people who are doing very well in most aspects of their lives. Some come for assistance with working through a particular crisis — death, divorce, ending relationships, etc.

The majority are business and professional people. If we want to be sure we’re getting the best advantage, or if we want to be sure of making good decisions we use business consultants, investment advisors, interior designers, and dietitians. Doesn’t it make sense to use a professional when you’re dealing with something as important as your very own life?

2. How long does therapy take?

Although psychotherapy almost always takes longer than anyone wants it to, progress and effectiveness are slowed dramatically or stopped completely when:

1. the therapy style is poorly matched to the personality and needs of the client, and when
2. the real issues are incorrectly identified during the therapy.

3. How do you know when to stop?

I believe clients get to decide to end therapy when they have gotten enough of what they want. It is helpful if the decision to end therapy is discussed with the therapist simply because there are times when it may seem the therapy has plateaued just before important issues arise.

4. How is talking to a therapist different from talking to my friends?

If you have friends to talk with, you are indeed fortunate. Therapy is a particular kind of talking that is really so different from what we do with our friends. I know how to listen at a really deep level, to help you make sense of whatever you are trying to sort through. Since our friends and family care deeply for us, they frequently find it difficult to be objective.

5. How would I know what to talk about if I came to you?

Lots of people have the experience early in therapy of just “stumbling around in the dark” to find something to talk about. Others are somewhat fixated on a particular theme. Neither is very helpful, so, through many years of experience, I’ve developed a better way. By drawing on your existing knowledge and experiences, I will help you with skills which get to the bottom of the problem. You even learn to tell when you’ve gotten “off track,” and will be able to get back on when you’re ready.

6. Wouldn’t you just listen, then tell me what I’m doing wrong?

Most of us get lots of advice, “constructive” criticism, or blind approval from our friends and family. If that were going to work, it probably would have by now and you wouldn’t be reading this. Often times people are hesitant to come for therapy because of these experiences with friends and family, and they can’t imagine any other way of talking about problems. I have other ways of helping.

7. I saw a therapist before and he didn’t say much. Is that the way you do it?

There are times for me to be quiet and listen, to think, to understand. There are other times when you may need and want more. I’ll try to be sensitive to that and to explore those needs with you. It’s amazing the things that come from this. Sometimes I learn that the client who wants more from me also wants more from his/her spouse.

People who feel neglected at home, may feel neglected by me. By being sensitive to those interactions between us, we get to look at some of the touchy things that come up with other people — these are some of the unique facets of your personality. Amazing changes and insights come from this very thing.

8. Do you do the same thing with every client?

We are all so different. One person comes in and talks non-stop from the beginning of the first session; another comes in and says little more than “I don’t know what to talk about?” Clearly I have to have different ways of working with these two types of people. Think about the last time someone said to you, “I want to talk to you.” About half the people in the world feel as if someone has grabbed them by the throat; the others are thrilled to death that someone is interested. Very different therapy styles are necessary to work with differences in personality styles.

If I say “I think you know how to handle that” one client hears it as a vote of confidence; another hears it as being unresponsive; another hears it as scolding; another as sarcastic. I have to be aware of these subtleties, and then help you see them more clearly. Most always, these are some version of the issues that come up with business associates, friends, partners, and other loved ones. My experience says that once you really have a handle on what’s going on, it will change.

9. What about recovery and self-help groups? Since I go to one, why >would I need a therapist?

Certainly many people have and continue to find recovery and other self-help groups helpful. These groups frequently provide a great deal of support and comfort. People often have a sense of belonging there. Other aspects of them that are worth additional consideration. In these groups it is common to hear people talk about being “stuck.” That usually means “I’ve tried and tried, and things still aren’t working out.” It usually also means both the individual and the group have run out of ideas.

The temptation is to do more, harder, of what already hasn’t worked. I’m inclined to think that when the solution is appropriate, it works. A simple analogy: It’s a little like changing shoes to eliminate foot pain. The pain won’t go away if the cause is a broken bone. Incorrect analysis of the problem is the most usual reason for failure of improvement in both self-help and professional situations. Another way to think about it is this.

A group of computer-challenged people would certainly benefit from having a person who is at ease and skillful with computing; otherwise, the group will certainly agree that computers are frustrating; that computer are evil instruments which only make life harder; and they will make little advancement in running a computer more skillfully. It these self-help groups could benefit from professional leadership, why don’t they have it?

There are probably many reasons, some of which I’ll mention. One is purely a matter of economics. Second, some people believe (because of unpleasant experiences with judgmental people) “you can’t understand my problem unless you have had it.” It’s easier for them to go to a group where they believe they will be free of criticism. Third, Alcoholics Anonymous is the great grandmother of most of the groups, and when AA was first being developed many years ago there were few if any professionals who worked with alcoholism. A support group of people working to overcome their problems with alcohol was a huge advancement. It’s always tempting to stay true to our history.

Are you saying recovery and self-help groups are not good? Not at all! I’ve seen statistics that say these groups are effective for about twenty percent of the people who have attended them. If you go to one of these groups, see your life improving, see yourself moving close and closer to your goals of happiness, that’s super. If you go and feel as if you’re just getting by, then you might want to consider some other avenues.

10. Does life have to be a struggle?

What a hard question! It seems that life has ups and downs, but shouldn’t kick your butt at every turn. Probably the same problems don’t have to recur, year after year. I personally believe that very, very few, if any, people are so “wounded” or “damaged” that things can’t be worked through with some success. Just as a cut in my hand will heal if I look after it properly, so will a wound to my heart and soul. If the cut doesn’t heal, I have to find out what is keeping it from healing so it will get better. So it is with my feelings – except that they’re more complicated and harder to see. I think that’s just the way we’re made – with the ability to heal and get better and be happier.

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11. I already understand what’s wrong, so how can talking to you help?

My guess is that if you really knew what was wrong and what to do, you would have taken care of the problem before now, and you’d be out having a great time right now instead of reading this. If you’ve not taken care of it by now, you’ve probably miss analyzed the situation. After all, nobody wants to be unhappy or have a messed up life.

That’s were I come in.

12. If it’s not really obvious what’s wrong, how do you know what it is?

I’ve worked really hard for years to find ways to help people find out what is really the problem, and seem to have found a method that works well for lots of people. Amazingly, it’s not that hard to master the skills.

13. What if I’m afraid I’ll find out something really bad?

I’ve heard loads of people say they’re afraid of learning something awful about themselves. I can’t think of a single person to whom that has happened in our work together. Instead, as you start to really understand yourself, you’ll probably find that the things which have been most puzzling, shameful, or embarrassing, made sense at one time. Or they may have been the best of a lot of bad options. Understanding this usually helps you think much more kindly toward yourself. When you get that, you’ll probably find you have many more options in the future.

14. Do you blame parents for every problem?

That’s a strange misconception some people seem to have. While time is usually spent talking about our families in therapy, the purpose of this is not blame, but understanding.

Considering that we are born with no beliefs and virtually no knowledge, we have to learn pretty much everything. Since we all learn different versions of life’s lessons, it is helpful to discover the source of our beliefs and assumptions. After all, these are the guideposts by which we make every decision, have most every feeling, and take action.

Most parents do the very best they can, but children understand things in very different ways from which adults. For example, when an adult is bitten by a dog s/he will probably know that only some dogs are dangerous. On the other hand, a child has limited experience, and is likely to become afraid of all dogs. This fear very well may carry right into adulthood.

Now think about what could happen if your caretakers were unavailable, or mean, or irritable, or neglectful, or critical, or too demanding, or too busy, or …

15. How do you work with couples?

Couples are extremely complex, and must be treated as such. First of all, every couple is made of two people who come from vastly different beliefs and experiences. This very fact is hard for a partner/spouse to understand. It even can be used as a small to medium sized weapon; "Well, I certainly wasn’t raised that way."

The reality of two persons making a couple, means the issues with couples are at least twice as complicated as an individual. You have two persons and their complexity plus the complexity of the interaction between the two. Therefore, it is even more important for me to be sensitive to the personality styles of both persons. If my understanding is inaccurate or adequately, one person will feel misunderstood by me and the other will feel vindicated by whatever I say or do.

This carries lots of implications, especially right now, when there’s been a move afoot amongst couples’ therapists to find one particular method they like, and then try to use it with each couple. Most of the research I’ve seen indicates that there is no single method which is more effective than any other, but that the relationship (read understanding) between therapist and clients is the real issue.

With this in mind, it seems to me that I have to have several different styles from which to draw, the sensitivity to know what is working and what is not, and the ability to create something new when that advantageous. I’m constantly tailoring therapy to the needs of the clients and the situation at hand..

16. Does it mean I’m sick if I see a therapist?

Absolutely not! It probably means you have a great desire to live and love to the fullest, and have the courage to look for more.

17. Why don’t you talk about things like depression, anxiety, addiction, manic-depression?

Such words as depression, anxiety, co-dependence, addiction, obsessive-compulsive behavior, attention deficit disorder, and so forth are words used by some mental health professionals and lots of lay-people to describe groups of symptoms and associated behaviors – syndromes.

To over simplify with an analogy:

Syndrome: Walking funny

Diagnosis: Aching feet

Problem: Poorly fitted shoes? Fallen arches? Broken toe? Bunions?

Solution: New shoes? Arch supports? Cast? Wheelchair? Bunion pad?

In a nutshell, you can’t solve the problem without understanding the cause.

A major problem with diagnostic labels is that the implications of cause and solution are weak. Also consider the complexity of making these diagnosis, and the casualness with which we pepper our conversations: "Oh, you’re just co-dependent" or "She’s got to be manic depressive!" or "I’m just too much a perfectionist." Funny how hopeless and critical these start to sound. In a nutshell, no matter what you call it, you can’t start to fix it until you know what’s really wrong!

18. What is all this about different personality styles?

I believe that our personalities are largely shaped by our experiences, our beliefs, and how we’ve come to make sense of what we’ve seen and felt. From here we develop reactions, interpretations, and emotional responses to certain things. They are so much a part of us we don’t even notice them; we even assume everyone is like us – or should be!

Suggestions are helpful to one, but feel like criticism to another, or may even imply incompetence.

Each individual is amazingly consistent throughout his/her lifetime unless serious efforts are made to change. (Consistent inconsistency is consistency) The person who is jolly, is jolly in most circumstances; the person who is honest at one time is honest at most times; the person who is reliable is most always reliable; the person who gets hurt, gets hurt in a lot of situations.

This is the very fiber of our lives. You may want to look at it if you want to be happier.

19. I’ve know some pretty weird therapists. How do you choose a therapist?

Guess you’re right about that, but since we have different definitions of weird, you may want to choose someone who doesn’t seem so weird to you.

Look carefully at background, education, and experience. I personally believe the extensive and in depth personal experience I’ve had being in therapy are immeasurably helpful to myself and my clients. Being "comfortable" is important, but it may also mean "I believe this person won’t disagree with me." This is particularly likely when the client is really frightened there’s something seriously wrong. Try to distinguish between having confidence in someone and feeling comfortable with them.

20. When is the time to consider therapy?

Simply put, the time to consider therapy is when you’re not feeling good about the way things are, or when the same unwanted things keep happening, or when you feel like it’s just too hard, or when life seems empty or meaningless. If you’re wondering about it, you may want to pay attention to that. People come into therapy at different times and for different reasons, but generally those can be broken down into three times:

1. When a specific difficult or devastating event has happened, such as failing relationship, death, loss of job, illness, etc – both individuals and couples come at these times
2. When an individual or couple decides they want things to be better than they’ve been in the past or when one particular facet of life keeps being troublesome
3. Rarely an individual simple has to have support from a therapist just to keep things from getting unbearable

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21. Don’t some people get too dependent on therapy?

I’m sure there may be some who do, but I’ve probably not seen one. In some instances, a period of dependency is a necessary stage before the next one. In reality, if people keep going to the gym, they’re probably getting something from it. Same is true of therapy. Therapy is time consuming and expensive, so people don’t usually go unless they are getting something they value.

22. Do you prescribe medications?

No. In Texas only physicians prescribe medication, so I make referrals for that. Besides, I don’t know how to prescribe.)

23. I hear a lot about anti-depressants and things. Aren’t they better than therapy?

There are lots of wonderful medications these days and they help some people. In certain instances they get to the root of the problem if there’s something wrong with the way the body is working. For others, they only reduce the symptoms. For some they do nothing. For example: John has trouble sleeping. Is it because he feels agitated and can’t stop his mind from racing when he goes to bed? Is he worrying about his failing relationship? Does he have nightmares and dread going to sleep? In the first case there may be things going on in his life which make him feel afraid and need to be resolved. Obviously, medications won’t solve the problem of a troubled relationship.

Depression and anxiety are common complaints. Sometimes they may be organically based. It is advantageous to explore the underlying causes. Frequently, they are indications of things in our lives that need to be taken care of. When that’s the case, the outcomes are often really excellent.

24. Is it always bad to see a therapist who you know?

Not necessarily. Consider the extreme case of a small town with only one psychiatrist. Are you better off seeing that person, or no one at all? If it can work there, it can probably work in other circumstances.

It is considered unethical to see a person professionally if there is a sexual or romantic relationship between therapist and client. If there are business relationships which would in any way influence the therapy it is unadvisable.

On the other hand, there are people who have confidence in a particular therapist and want to work with that person even though they may see each other at social events. I’ve seen this work extraordinarily well if the therapist has a clear understanding of the intricacies of these kinds of working situations and is able to be clear in helping the client understand the issues unique to this situation. However, it is usually advisable for only highly skilled therapists to do this. Therapist with unresolved "boundary" issues should never work in this situation.

If you are considering this arrangement, you may want to bring up your concerns on the telephone before formalizing any agreement.

25. What are the different kinds of mental health people – psychotherapists, psychoanalysts, social workers, psychologists, Christian counselors, and psychiatrists?

The professional field of mental health is really a little confusing in that there are a number of overlapping areas. Generally there are four or five disciplines where mental health is a focus; however, in each of these disciplines, there are people who are trained specifically in treatment or clinical skills. Others are trained for research, evaluation, teaching, medication, advising, spiritual guidance, advocacy, and so on.

At the risk of generalizing, we can say that psychiatrists are physicians and tend to focus on medications, psychologists are generally trained in testing and evaluation, clinical social workers are generally trained for psychotherapy, counselors are more inclined to work in an advisory or teaching style, and pastoral or Christian counselors work primarily from a religious perspective. Psychoanalysts may come from any of these disciplines and are schooled in a particular style of psychotherapy. Certainly, within each of these areas are people who represent a wide variety of skill levels and professional competence.

( Interestingly, the majority of talking therapy in this country is done by clinical social workers like myself.)

26. Is it best to see a therapist whose sexual orientation, race, or gender is the same as mine?

Not necessarily, since people are people and we all deal with similar issues throughout our lives. Being unhappy feels the same to all of us; we all live in the same world and confront many of the same issues, just in slightly different forms. We also know that romantic relationships are pretty much the same regardless of the gender of the persons involved, and the issues are about the same.

On the other hand, members of minority groups sometimes experience situations unique to their life circumstances, and may feel more comfortable with a therapist who they believe has had experiences similar to their own. It probably would not be productive for a person who is homophobic to work with a gay therapist, nor for a heterophobic gay or lesbian therapist to work with heterosexual clients.

That being said, there are areas in which I don’t work because I have little knowledge or experience with them. Generally, I don’t work with parenting problems, mental retardation, childhood disorders, and chronic drug abuse, but would be happy to try to help you find someone who is knowledgeable in those fields.

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