Getting the Most Bang for Your Buck with a Shrink

You knew it was coming (thanks, Ashley, Laura).  Now I’m gonna give you my take, today’s version (I’m sure I’m leaving something important out).  How to get the most out of your therapy experience.   Not the definitive guide, just a few tips learned in 30 years as a therapist.

Pick your therapist wisely.  You’re going to share your innermost everything with this person, so you want someone you feel comfortable enough to really talk to.  You want someone who seems to ‘get’ you – and it, whatever it is you’re coming in for.  It shouldn’t be as easy as talking to your favorite aunt or your best friend;  you need someone who will push you to explore, and that’s apt to make you uncomfortable at times.  It shouldn’t be like talking to your high school principal;  you need someone you can feel safe with, who’s working with you on your mission.  Goldilocks:  you’ll know it’s just right when you see it, especially if you interview a couple before you decide. 

Research shows that the therapist’s orientation, and whether you see a social worker, psychologist or psychiatrist, man or woman, doesn’t affect outcome nearly as much as one crucial thing: your working relationship.  The therapeutic alliance, building a strong trusting relationship with your shrink as you work together, is the most important determinant of a successful experience.  It takes time, testing, exposing.  It’s the bullwark of therapy, so make sure you’re just the right kind of comfortable with the therapist you pick. 

Therapy takes courage.  No, really.  Real courage.  To go spelunking inside your mind, your emotions, your motivation, your relationships, your fears and wishes…It’s hard work, often scary, and sometimes surprising.  And you do it in front of – no, with – another person.  So there’s no hiding from your therapist or yourself.  No, actually, you can hide; you’d be amazed how many patients do.  And it’s understandable:  it’s tough to face up to yourself, out loud with another person.  But therapy works best when you are scrupulously honest with your therapist and yourself.  So make a pact with yourself to be honest.  And, when you find yourself painting a picture to please or impress or make your therapist like you, ‘fess up.  Talking about when and why you do that is an important part of the process, and of learning about yourself.

So let’s assume you’re going to be honest and open (within limits: there are all those unconscious things you don’t yet know about yourself).  What else?

Have a goal.  Oh, it may well change during the course of your therapy, but have some idea of what success will look like.  What do you want to accomplish in therapy?  What are the issues you need to address and make headway on?  Clarify with your therapist what you’re going for, and check in periodically to see how you’re doing.  Most people don’t want Woody Allen-style it-goes-on-forever therapy.  And just going through the motions… well you read the first post on therapy.  Keeping focused on your issues and how you’re doing is a way to ensure you’re doing the work you need to do, not just getting “um hm, um hm” therapy.  Support’s important, just not enough.

Show up on time, ready to work.  No, show up a few minutes early.  You don’t have to go into the waiting room.  Go for a walk, get a coffee.  But take a few minutes to switch gears, turn off your cell (you’d be amazed at how many people bring a blackberry into session) and, as we said in the ’60’s, “be here now.”  Your therapy time is a gift, a refuge from the world, a time for you to do one thing only:  focus on you.  And if you can, take a moment after your session to solidify what happened, what you learned, before you re-enter the rest of your life.

Take some time between sessions to really think about your session: what happened, how you felt, what you learned.  If you’re doing behavioral or couples work, do your homework, practice what you’ve learned.  Therapy doesn’t just happen during the session.  If it did, it would be one very expensive hour.  Therapy happens as you incorporate what you learn in that hour into your life.  Questioning, trying new behaviors, listening to yourself (and the voice of your therapist in your head).  You want to start thinking, experiencing life from a different perspective, and that takes practice.

Give it time.  It’s difficult to be patient, particularly since you don’t start therapy because it’s Wednesday and they’re feeling fine and why not?  You’ve got a problem you want to solve, a relationship that doesn’t work, you feel horrible.  Whatever it is, it feels pressing.  Particularly since you’ve tried everything you know to do before you even got into the therapist’s office.  So you want some results, fast.  No, actually, if you’re going to be honest, you want the answer.  You want the pain gone.  Now.  Your therapist should know what to say and do, should say and do it, and you should leave transformed.  Nice wish.  Ain’t gonna happen.  And if it does, run for the hills.  Because if your therapist solves your problems for you it’s not going to hold.  But you know that.  So be patient, note the small changes, give yourself credit for hard-won insights.  You should see progress (and talk about it – or lack of it – with your therapist).

to be continued…Would love to hear what you have found helpful – and not – in your therapy experience.

And then we’ll talk about when, why, how to end therapy.

Copyright © 2009 Marlin S. Potash. All rights reserved.


5 responses to “Getting the Most Bang for Your Buck with a Shrink

  1. How long should you give it to see if you do have a good “working relationship?” I can’t tell if it is just that we are getting to know each other or if we are not working well together…

  2. Great question. So great, I think you should ask it at three points in time. Bottom line: trust yourself! If you get past session one thinking, “I could work with this person,” take it up with your therapist again, directly, somewhere around your third session. Something like, “what do you think about how this is going?” Say you’d like to discuss if s/he “gets you” enough, if you each think you can work effectively together. Then ask again around three months. At this point, your issues should be clear to both of you, you should be able to articulate some progress made (and what remains to be done), and you should be able to talk candidly about how you’re doing with one another. Bring up any concerns, and see how you do together addressing them. If you still don’t feel a connection, and you can’t talk about your concerns and figure them out together, it’s probably not apt to improve. Move on. And if you’re in long term therapy, you should periodically check out how the therapy is going, what you’re learning, how you’re changing, what you need now. If you’re stalled, if you feel you’ve gotten as much as you can from this particular therapy, it might help to get a consultation, take a break, end therapy, or see someone else.

  3. Jus wanted to know..
    I have a huge mess for a past – many broken relations, couple that traumatized me and almost changed my personality, issues like child abuse….many things nobody knows except me….sometimes..I feel miserable..thinking about what all I went through…..I feel I need to see a shrink to discuss my mess of a life…and understand …why andwhat….wht kinda shrink/therapist do I see?

  4. Hi. I think this is a really stupid question, but I’m going to ask it anyway… I don’t know how to tell if I’m being honest with my therapist. I think it’s because I really don’t know what I think or feel – it seems sometimes that my head is full of hundreds of pieces of thoughts, and I just can’t pull one out to work on. Even if I do, I don’t feel that I truly know what I think about it. It’s not ALL issues – some of them are clear-cut but others – well, I say things to my therapist, then after I think about them for a little, after leaving therapy, I change my thoughts and feel something very different. I’ve been with my therapist for more than a year now, and I have to say he is absolutely wonderful. He has helped me more in one year than I’ve been helped in my 47 years. Should I talk to him about this? I’m afraid he will ask me what issues, questions, etc., I think I haven’t been honest with him about, and I don’t even know how to answer THAT…. Do you have any suggestions for me? Thank you for your time!

  5. Your therapist is wonderful? He has helped you more in one year than you’ve been helped in forty-seven? Talk to him! Therapy is not a quiz show, not a math test, not a day in court; there are no “right” answers, and there’s no penalty for getting it “wrong”. And tackling these important questions not only isn’t stupid, it’s one of the most useful things about psychotherapy.

    Sometimes, we don’t really know what we think until we say it, talk about it, try it on for size. And that is made so much easier in the company of someone who “gets it”. You’re on an exploratory journey into yourself and how you think, feel, connect with others. Sometimes what you think is at odds with what you feel. Sometimes how you feel doesn’t correspond to your code of ethics, how you think you should feel. And sometimes you hold multiple thoughts in your head at the same time, some of them contradictory, some more or less developed. That’s all part of being a grown up; life’s complex and nuanced as well as simple. It’s just not always so easy.

    Take a leap. Give it a try. And remember: telling the truth and being honest aren’t always the same thing. Welcome to the human struggle. Glad to meet a fellow traveller. Let us know how it goes for you. All best.

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