After I’ve been working successfully with someone for awhile, we sometimes decide it would be helpful to ask a family member to join us, either briefly or regularly. If said family member comes reluctantly, he might say, “I don’t believe in psychotherapy”.  Luckily, I can honestly respond, “I don’t either”.  Psychotherapy is not something to believe in.

 To believe in something generally involves some sort of faith, faith that something which can’t be seen or proven is true.  I’d no longer see a psychotherapist based on faith than I would drive over a rickety bridge based on faith.  Psychotherapy is a tool for personal and relational growth, but it’s not the only tool.  Reading, 12 Step groups, supportive friends & family, meditation, yoga, exercise:  they are also tools for growth. 

 Successful psychotherapy is always collaborative.  The person seeking it should not feel in a one-down position to the therapist, be subjected to arcane language or process, or wonder if there is some sort of hocus pocus involved. 

 Psychotherapy involves a relationship, albeit a professional one.  This sort of relationship should be non-hierarchical, but is also non-reciprocal.  While I make a commitment of time, and all the skill and effort I can bring to the work, the client makes no such commitment to me.  And while therapist self-disclosure is an important part of ethical practice, it is the therapist’s job to make sure that the relationship is about the client at all times.  Therapy is confidential – no competent therapist ever shares information about the client without a signed release.  The client, however, can discuss the therapy and the therapist at will, if they so choose.

 A note about proof:  While insurance companies would like us to believe there is such a thing as “evidence-based practice”, and only reimburse same, it’s rather difficult to quantify much about a relationship.  While now somewhat in decline, Cognitive Behavioral Therapy (CBT), with its highly structured and limited number of sessions, has been the darling of insurers for a number of years.  It focuses on changing one’s thoughts, and for certain things, like phobias, it can be exceedingly useful.  However, you can’t fit relationship issues, trauma, or grief into a CBT formulary. 

 On the other hand, good psychotherapy generally has goals in mind, goals chosen by the client.  Therapy sessions should not be amorphous or meandering; unless the client feels that the absence of stated goals may enable the process in more significant ways. 

 I have a double-sided “therapy evaluation questionnaire” that I have culled from a number of other evaluative tools and my own experience.  It’s a way for me to let a client know what to expect from me, and to make sure we are both holding me to high standards.  It’s critical that at all times a client feels that he or she is free to question the therapist about anything going on.

 Finally, a client should feel that they can reach out to their therapist between sessions, if need be.  With very few exceptions, I do not think therapists should charge for between-session support.  It definitely empowers the process.  While therapists need to make a living like everyone else, you can’t engage in psychotherapy with your eye always on the clock or the bottom line.  We’re the only Western country that has not figured out that you can’t mix health care and the profit motive.

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