What Is Your Therapist Working On?

I asked a longtime patient what her therapist was working on.

“Working on? Well, she listens to me every week and I feel better afterward. I can tell her anything, and I really have nobody else to talk to …”

Another therapist who gets by with an easy hour. That is, of course, not therapy.

Therapy is actually fairly difficult intellectual work. The patient’s mood and attitude and safety and dangers and numerous symptoms need to be monitored constantly.

But wait — there is much more to this lecture that I need to give all too frequently.

Therapy needs a direction, from illness to wellness. No insurance company known to me will pay for psychotherapy, without a “treatment plan.” How many sessions are needed to see what symptoms go away?

If patients don’t yet react, we have to get down to the basics.

Money.

A patient is a boss. They pay for services with their cash money, the sweat of their brow or insurance for which they pay a premium. Even if they pay with “benefits” or tax or some other mechanism, they can and should ask a patient what they want and need.

There is certainly a lot of choice. I tell patients should shop around before committing to a therapist. Or change therapists in midstream, if they feel betrayed.

It is interesting to note what seems to make therapy work.

Early in my own training I read some classical research done in the 1950’s and published in a journal called “The American Psychologist.”

The credentials and the diplomas of the therapist did not seem to matter very much.

The belief that the therapist was somebody who could make the patient well, did make a difference.

The desire of the patient to get well did make a difference.

Go, psychiatric patients, and get well.