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How Does Therapy Work?

What it's not: Mind Reading, Getting "Shrunk," and other myths

· psychology,Therapy,Treatment

You're a shrink, right?

Whenever I hear "shrink," I think of a client lying on a couch with a creepy guy lurking behind him with a clipboard. This is not therapy (not the modern kind anyway), and nobody gets "shrunk." Therapists don't read minds. We can't predict the future (we can just tell you how groups of people with similar concerns have fared, but everyone is an individual). And you know what else? We don't know it all. A good therapist will listen more than talk, and work together with you to help you meet your goals. (If lying on the couch helps you do this, then that's ok! But I promise not to lurk.)

So.... What happens in therapy?

We typically meet once a week or maybe once every other week. Sessions are 45-50 minutes long. Our first session is a little longer -- 75 minutes -- so we have time to set goals and talk about what works for you and doesn't. We could talk about many different things in therapy, but most clients want to focus in on key issues so they can get back to the business of living their life. It's ok to add to your goals, but we also want to make sure that therapy is working for you. In each session, we talk about how things have been since the last time we met, progress toward goals, and ideas to try. I will use different approaches, depending on your goals. For example, if your goal is to reduce anxiety, then you'll walk away knowing how your anxiety works, strategies to help, what not to do in a panic attack, and how your thoughts trigger stress. Your job is to tell me about your particular anxiety, so I can give you ideas that can work.

How long will I be in therapy?

It depends on what you want to work on. Therapy could be a few sessions to address a limited issue and learn some new skills. Several months might be helpful for a more complicated situation. Some clients prefer therapy over a longer period to address larger or longer-term issues, or for ongoing support in their lives. Clients may return to therapy if something new comes up, or if old issues resurface.

But what if therapy isn't working?

A good therapist will want to hear if therapy isn't working. That's the only way we get closer to effective strategies! Clients are scientists, gathering info that tells us what works and what doesn't. The client is the one that goes back to their life, relationships, school, or job and has to function, so getting specific about how a strategy worked in Situation A but not B, and with Friend C but not Coworker D is vital information. If therapy isn't working because the therapist's skills, expertise, or approach is not a good fit, that is also important to discuss. It might be something that can be changed, and leads you to push your boundaries and grow in a new direction. Or it might mean that it's the wrong therapy, wrong therapist, or wrong time. It doesn't necessarily mean that you and therapy don't mix.

Shop around for the right therapist

Research has found that it is the therapeutic relationship between you and the counselor that makes a big difference between staying stuck and getting better. This is a big deal! Shop around until you find the therapist that you feel comfortable and safe with, and who you feel "gets you." It might take more than one or two sessions with the therapist to get a good sense of how they work. Every therapist has their own training, experience, style, and preferred therapy approaches. You or your loved one might require a certain kind of therapy to address your concerns (if you really need Applied Behavioral Analysis, but your therapist is only trained in Cognitive-Behavioral Therapy, then this may not be the right therapist for you). Ask your therapist what kind of therapy they think would be most effective, and if there are other approaches that could work.

Be your own advocate

Do research online about appropriate therapies for the issue(s) you want to address from reputable sites like Psychology Today (see:, the American Psychological Association (see:, and for treatments in Autism Spectrum Disorders try Autism Speaks (see: and the Centers for Disease Control (see:, among others.

Consult your physician or your child's pediatrician. Ask current providers who they would recommend, as they know you/your loved one well. Ask friends with similar concerns what worked for them, but remember that every situation - and person - is different.

Your insurance company can give you a list of providers, but don't be afraid to ask about out-of-network benefits if the provider you want to see is not in-network (see the Insurance tab on my website for more info about out-of-network benefits: Some insurance companies will allow you to get a second opinion, as it potentially means saving the insurance company (and you) a lot of money to avoid inappropriate treatment.

If you fell down yesterday, stand up today.

- H.G. Wells, The Anatomy of Frustration, 1936

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