WHAT IS THERAPY? 

Therapy is a process that helps you make changes in your life by helping you to pay careful attention to your thinking, feeling, daily habits, and ways of getting along with others. Most appointments are scheduled in advance, and a usual clinical appointment is 50 minutes in length. Some appointments can be pre-arranged for shorter or longer times.

WHAT IS THE PURPOSE OF THERAPY? 

In the long run, the goals of therapy are for you to develop more awareness of your feelings, make the most of your strengths and abilities, and to gain insight about yourself that can lead you to change behavior that is not working for you. At the same time, therapy may also be understood as ultimately striving to promote an immediate felt sense of radical self-acceptance.

WHAT IS YOUR ROLE IN THERAPY? 

Ultimately the responsibility for change rests with you. The therapist will not provide you with a psychological blueprint that will tell you who you are. The therapist’s role, rather, is to provide an environment and a relationship where such questions can be addressed. Similarly, therapists will not often give advice, but rather, help you to understand the conflicts within you that make it difficult for you to make your own decisions. In therapy try to be as honest as you can with yourself and your therapist, so that both of you can genuinely get to know you and your concerns. With your therapist’s help, you will work towards thinking differently about yourself and your relationship to the world, decide on a plan for growth and change, and then practice the new behaviors both in counseling and outside counseling. For those who find it difficult to decide what to talk about: as a rule of thumb, to the degree to which you find comfortable, you should strive to talk about whatever produces the most emotion.

WHAT CAN I EXPECT FROM THERAPY? 

On the one hand, therapy is an experience where you can expect to feel relieved that you are not alone with your problems. On the other hand, therapy does require work, so it does not always immediately provide a sense of relief. Sometimes you might even feel worse before you feel better. You may confront feelings, thoughts, memories or personal insights that are uncomfortable, sometimes even painful. And these experiences may result in you wanting to make changes in your beliefs, values, habits or behaviors that can be scary, and sometimes disruptive to the relationships you already have. 

The process is not always easy, and no one can guarantee a specific outcome. Many people who do take these risks, however, find that therapy results in their gaining a better understanding of themselves and are able to implement positive change in their lives. How things go in therapy depends on you, whether you and the therapist are a good match for working together, and whether psychotherapy is the best way to help with your concerns.

SHOULD I CONSIDER TAKING MEDICATION? 

As psychotherapists, we cannot prescribe medication. If at any point you or your therapist feel that medications might be helpful, we will recommend that you make an appointment for an evaluation with a psychiatrist (an M.D. who has completed a residency in psychiatry). On this website you can also access a list I've compiled of recommended psychiatrists. With your written permission, we can also discuss your case with the psychiatrist so that they may get a more complete picture of your concerns than might be possible for you to relay to the psychiatrist in the intake session. Your family physician can also prescribe medications, although this would not be their specialty.

We do want to explain that although medication in most cases does not eliminate the root causes of one’s distress, it can sometimes play a very critical role as an adjunct to psychotherapy. In some situations medication can make one’s day-to-day suffering more manageable on a short-term basis so that the difficult work in therapy of analyzing and making changes in one’s life becomes more feasible. In other cases, a combination of medication and psychotherapy is the research-determined best-practice treatment for a given problem over a longer period of time. 

We do want to reassure those people who are reluctant to take any kind of medication that we do not recommend medications to all of our clients, and that the final choice as to whether or not you will take medication is always yours.

HOW LONG WILL IT TAKE? 

Every client is different and comes to psychotherapy with a different set of goals and obstacles to those goals. The duration and frequency of therapy, therefore, varies from client to client. Deciding when therapy is complete is meant to be a mutual decision, and we will discuss how to know when therapy is nearing completion. Very broadly speaking, it can be helpful to consider psychotherapy as being either "short term" or “long term".

WHAT IS SHORT-TERM THERAPY? 

Short-term therapy is typically indicated for clients who desire support during a recent crisis or who are adjusting to a phase of life change (e.g., retiring, changing jobs, beginning a marriage or coping with a separation, etc). Clients with such time-bounded concerns may feel ready to discontinue therapy within six weeks to a few months. Short-term therapy may also be useful for clients who enter therapy with a specific goal in mind, such as addressing a specific phobia, controlling anxiety symptoms (e.g., panic attacks), or developing specific skills (e.g., parenting, social skills, etc). Again, such clients may find that they meet their goals relatively quickly and are ready to stop when they do. Others opt to continue therapy in pursuit of another goal. A good number of individuals remain in therapy as long as they are seeing ongoing progress as measured by feeling better, achieving goals, gaining insight into themselves, resolving issues, etc.

WHAT IS LONG-TERM THERAPY? 

Long-term therapy tends to be less structured in approach than short-term therapy. Specific goals and behaviors may be addressed along the way, but the focus is on working-through more complex concerns such as a pervasive sense of emptiness in one's life, an enduring discontent with oneself, or a persistent frustration with one’s relationships with others. In long-term therapy a client often discovers a few signature themes with which they have struggled repeatedly in various guises throughout their life. In therapy the therapist and client work together to develop a recognition of these patterns, and to come to understand what internal conflicts and fears have often got in the way of breaking these habits. Together we create a safe environment within which one may then carefully dismantle the defenses one has developed to protect oneself from the challenges of changing. Over time, talking about these patterns in therapy slowly replaces the unconscious need to repeatedly act them out outside of therapy.

WHY IS CHANGE SO HARD? 

Change makes people anxious, even if the change will lead to a better life. That’s part of being human. We tend to repeat familiar behaviors in general, and familiar behaviors that cause discomfort are no different. It is difficult to avoid gravitating towards habits once they are ingrained. The process of interrupting the repetition of an old, self-defeating script, therefore, tends to be incremental.

We ought to have some sympathy for ourselves, though, because these repeated behaviors, more than likely, were not always just "symptoms." When we were children, they probably worked--however imperfectly--to protect us against some real or perceived fears or threats. After all, if these behaviors had never worked at all, if there had never been any "pay-off" to them, then we would not have learned that it was helpful to keep returning to them. It would have been easy to cast them aside. We repeat them because we learned at an early age that they were helpful in some way. As adults, however, our challenges become more complicated, and we find that the "solutions" we found as children are no longer adequate. There is a saying in psychoanalytic circles that captures this thought: "What saves you as a child, kills you as an adult."

Also, there is a wonderfully simple poem by Portia Nelson that illustrates some of the incremental stages one may go through in therapy as you work towards making positive changes in your life. It is called “Autobiography in Five Short Chapters."

WHAT IF I START TO HAVE NEGATIVE FEELINGS TOWARDS MY THERAPIST? 

Having negative feelings towards your therapist is actually expected to occur at some point during long-term therapy. If you do begin to feel this way toward your therapist, it is important that you openly discuss these feelings with the therapist so that they become “grist for the mill” as opposed to becoming a destructive force that you feel as though you need to grapple with on your own. It is part of the “job description” of being a therapist to help you to experience and to examine your feelings. As such, please understand that it is neither rude nor unfair for you to express these feelings in therapy.  

There are, in fact, at least two reasons that clients should expect to have negative feelings towards their therapist at some point:

( 1 ) First, as was discussed above in "Why is change so hard?" all of us on some level desire the security of what we already know. In therapy, as clients get closer to implementing the changes they are seeking to make, this security is threatened. As a result, it is not uncommon for a dedicated client to go through a period when they find themselves feeling more confused or anxious than when they began. This sometimes comes in the form of feeling angry with, resentful toward, or distrustful of the therapist for being the catalyst for these threatening changes. 

These moments can be challenging, but ironically, this period is oftentimes an encouraging sign. It often marks the point in therapy where a client has developed the courage to confront and grapple with the issues they have been systematically avoiding in their life up until that point.

( 2 ) Second, as children we internalize early, formative relationships and experiences such that they often profoundly affect the nature and expectations of future relationships. These old scripts can play out repeatedly in a client’s life without their understanding why—and they do so in therapy as well. Clients will sometimes experience the therapist as a “stand-in” for a critical relationship in a drama that needs to be worked through. 

For example, an individual with a stern and disapproving father might interpret a therapist’s interest in hearing more about a story as evidence that they had failed to say enough, and was therefore a “bad client.” Similarly, a client with a mother who had shown little interest in them as a child, might interpret a therapist scheduling a week’s vacation as evidence that they were being dismissed as unimportant to the therapist. 

In therapy—unlike in the repetitions in everyday life—clients have the opportunity to replay a manageable portion of these old scripts in a secure environment where they can be controlled and understood. In reconstructing these old narratives, the therapist can help the client to become more aware of the distortions in their thinking that allow a contemporary experience to look like an old one. And once the contemporary experience is no longer seen as something from their past, the client becomes free to respond to it in a new, less rigid way. 

In other words, psychotherapy can help one to see the ways in which one may be confusing the present for the past. Through practice one may then learn to identify these mis-recognitions in the moment they are happening. Only then is it possible to react to the present with more freedom and flexibility than one has been able to in the past — when a long-established, predetermined script was the only available response.

DOES THERAPY REALLY WORK? 

In 1994 Consumer Reports surveyed nearly 3,000 individuals who had been in therapy during the previous 3 years. Over 90% reported significant long-term improvement. Moreover, those individuals who reported the most discomfort and upset at the beginning of treatment reported the most improvement from psychotherapy. This study found that therapy that lasted more than six months was significantly more effective than shorter-term therapies. Some have argued that this is the best meta-study ever conducted to answer the question of whether psychotherapy is efficacious. It should be highlighted that a 90% improvement rate across many different diagnoses is a better statistical outcome than most medical treatments, and no one asks, “do doctors cure illnesses?” 

Statistics aside, well over one hundred years of experiential evidence has been gathered regarding the efficacy of psychotherapy. After all, deductive experimentation where variables are systematically controlled is not the only way to do science. Induction from observation of patterns in case studies is another. Countless therapists have documented case after case in which mental and emotional distresses were successfully overcome, stubborn clinical issues resolved and the general quality of life vastly improved. 

That said, although the majority of therapy clients report significant benefits from treatment, therapy is not for everyone. In the spirit of scientific investigation, the only way to genuinely evaluate the effectiveness of therapy may simply be to keep an open mind, try a few sessions and see for yourself.

WHAT POSITIVE EFFECTS CAN RESULT FROM THERAPY?

Clients who dedicate themselves to therapy oftentimes find that their old, destructive patterns of thinking, feeling and behaving will gradually have less power over their lives. This is not to say that one should expect to “rid oneself” of a grief, “recover” a loss, or totally eliminate any trace of the wounds from one's previous experience. Rather, one should expect that, just as when recovering from surgery, scars remain where the wounds had been, but the pain is diminished, and the scars do become less noticeable over time.

Ultimately, therapy is successful to the extent that you experience these effects:

Your responses to what is familiar become less rigid,
Your vulnerabilities less threatening,
Your struggles less isolating,
Your challenges more tolerable,
Your sense of belonging, of home, more secure,
Your resiliency strengthened,
Your insight more keen,
Your sphere of influence expanded,
Your imagination enlivened,
Your options more varied,
And your life more vital.