FAQ’s About Therapy

In my last article, “To Be, Or Not To Be… (in therapy),” I talked about how to recognize signs and symptoms of stress, depression, and anxiety.  I also discussed the questions “should I be in therapy” and “how do I know when it’s time to seek help.” Because of the positive response to the article and the questions I was asked by people who read it, I decided it was time to write next about the frequently asked questions that people have about therapy.

Q: How do I know who will be the right therapist for me?

A: Not every therapist is right for every client.  The therapist/client relationship is very important, and it’s important that it be a good fit.  The first and foremost rule is to “shop around”. After all, think about buying a new car. Would you buy one without looking at many options and testing them out? Since many therapists offer a free initial consultation, I suggest that you interview two to three therapists before you make your decision. Remember, it is a very significant investment in yourself that you are about to make!

Q: What should I ask the therapist before starting therapy?

A: First, rely on your first impressions of the therapist. Are they friendly, warm, inviting? Do they express a genuine interest in what you have to say? Does it seem like they are understanding you as you talk together? Second, inquire about the therapist’s credentials: How long have they been working as a therapist? What are their specialties? Are they licensed in your state? Third, depending on you thoughts about a treatment plan (such as medication, proper diagnosis, reimbursement), it may be important to know if they are a psychiatrist, psychologist, social worker, or a marriage and family counselor. You ask these questions because you want to know that the therapist is well-educated, highly experienced, and officially recognized by the state in their profession.

Q: Can I get references from former or current clients?

A: Unfortunately, this is not usually possible. Most everything you say to your therapist, and especially your identity is completely confidential. Therapists are not allowed to give out any information about their clients.

Q: What if I’m traveling or located too far from the therapist?

A: If meeting in the office isn’t possible, a good alternative is “telecommunicative therapy.” This is where the client and therapist use a computer or smartphone for video-conferencing instead of meeting at the therapist’s office. I use several different platforms with these clients such as Skype, FaceTime, and Zoom. This is a growing trend in therapy, since people seem to be busier than ever or are traveling frequently for work. It allows the therapist and client to hear and see each other, even though they are not in the same place.

Q: Should I ask them about their fee? Will they adjust the fee if I can’t afford to pay it? Do they accept insurance? What is their cancellation policy?

A: It’s often a bit awkward to talk initially about money with a therapist. Either they should offer this information without your having to ask, or be willing to discuss these questions in the first session. Some therapists accept insurance; others do no. Remember that even if a therapist does not “accept” insurance, you may be able to submit a claim to your insurance company for reimbursement. Finally, most therapists have a cancellation policy, which is typically that a client is charged for a missed session without at least 24 hours’ notice. This is not only a common practice for therapists, but it’s also an incentive to be consistent with your therapy.

Q: Is what I tell you confidential?

A: Your identity and almost everything you discuss with a therapist is completely confidential.  However, a therapist is required by law to report to authorities when (1) there is an imminent danger of harm to the client or to someone else, and/or (2) there is a situation of child or elder abuse that is occurring or about to occur in their immediate surroundings. You can be sure that the laws governing the practice of therapy require that the therapist keep confidential any information that a client shares about a past event. It’s called the “therapist-client” privilege, which means they don’t have to testify about the what the client has said or done in the past. Finally, if the client is a minor or is mentally disabled, the therapist and the guardian will design a way of communicating information that is in the best interest of the client.

Q: If I am depressed or have anxiety, why can’t I just take medication? Why do I have to be in therapy too?

A: A great deal of research has been done on this question. The research strongly indicates that for clients who have depression or anxiety and need medication, the combination of therapy along with medication produces better results than either therapy or medication by themselves.

Q: What will happen in the therapy session?

A: All forms of therapy involve talking to a therapist. The topics may differ depending on the situation, and the therapist listens and provides insight to the client. The therapist may also make specific recommendations about how to change behaviors, manage feelings, or improve relationships. Therapists vary in how the interact with the client during therapy sessions. Some are very active and directive. Others listen more and talk less. Therapists typically comment when there is an important connection or insight that the client can use to change old patterns of behavior. Few therapists these days sit silently and simply nod or say “un-huh,” which can be very off-putting for clients. Therapist vary in their interactions during a therapy session. You will get an initial sense of this during the introductory interview.

Q: Will I have to do anything after a therapy session?

A: It may be that the therapist will recommend doing “homework,” which could be reading an article or book, practicing new forms of behavior, or setting new goals and keeping records of progress. Many therapists recommend that a client keeps a journal, where they write down their responses to situations or write about important thoughts that occur to them.

Q: How will I know if I’m making progress? How will I know when it’s time to stop therapy?

A: It’s very important to talk with a therapist about what realistic expectations are for the length of treatment and the measurement of progress. While a therapist may not be able to give an exact answer as to the length of treatment, they should be able to give some guidance on this question based upon their work with other clients. Keep in mind that every client is unique and responds to therapy in their own way. Also, it’s important to remember that most of the problems that brought you to therapy have been problems for a long time. Usually they can’t be resolved or eliminated in a matter of days or weeks.

Q: How will I know that the therapy was successful? Can the success of therapy be guaranteed?

A: If you entered therapy with specific goals, you may be able to determine yourself if the therapy was successful. But usually the therapist shares what they are discovering about a client as the therapy progresses, and will be able to give an educated prediction of how well a client is going to do after therapy is completed. Determining whether or not therapy has been successful is a cooperative effort between therapist and client. A hard and fast guarantee is really not possible.

Q: Is personal insight enough? How will I be able to retain the insights in the future?

A: Identification of patterns of behavior, understanding how we developed them, and how this is affecting our lives is very important. But these are not enough. Clients need to make connections between what they are learning about themselves and how these things can be changed. Therapists can offer things like, “Now that we know you tend to become involved with unavailable people, let’s talk about how you can avoid this.” Discussion about patterns and how to change them is key to behavioral change; identifying “red flags” or warnings about repetitive and harmful behavior is particularly helpful. Remember that “An ounce of prevention is worth a pound of cure.”

Q: What if I think my partner and I need to be in couples’ therapy, buy they refuse?

A: It’s not uncommon for only one person to believe that couples’ therapy would be beneficial to the relationship. When one party refuses, it is often a good idea to start the couples’ therapy anyway with just one of the partners, where initial issues can be discussed, interactions can be described, and long term goals can be shared by the partner who does want to be in couples’ therapy. As a result, the other partner may observe these new insights and/or behaviors, and that will encourage him/her to “join in” on the discovery process and the improving/rebuilding of the relationship. Even if the partner that does not want to be in couples’ therapy, the person in therapy may gain insights about what they may be doing that is causing problems in the relationship. Even if only one partner is changing, this may well change and improve the relationship as a whole.

Q: Is it OK for the client to ask personal questions of the therapist, such as marital status, where they live, what they do socially, etc.?

A: It is perfectly acceptable to ask a therapist anything that you are curious about. For that matter, it is perfectly acceptable to say anything to a therapist that might be on your mind. The therapist, however, may not always answer these questions. Some therapists feel it is important to protect their own privacy. Others are less concerned about this. At times, a therapist may believe it will be more helpful to you that they not answer the question right away – that it may be more important to understand what motivates the question than to answer it right away. Sometimes, these questions are a request for reassurance: the client is asking these things to try to reassure themselves that their therapist can understand their predicament or have been in similar circumstances. At these times, it may be more useful for the therapist to offer their reassurance than to answer the question immediately and directly. The thing to remember is that it’s ok to ask, even if you don’t get the exact answer you are looking for.

Q: What if I get angry or frustrated with my therapist?

A: Sometimes you might feel angry or frustrated with your therapist. Talking about this anger or frustration can be very beneficial to the therapy. People need to know how to express anger and frustration in constructive ways, and this is a safe way to practice doing that. Stopping the therapy abruptly out of anger or frustration may decrease these feelings, but it doesn’t help you use these feelings constructively, or to learn about how to problem-solve.

Q: How do I know that it’s time to stop therapy? How should this be done?

A: There are many answers to this question. One possibility is that a client and therapist may agree that they are no longer a good fit with one another. Another is that the therapist and client may agree that they have reached an impasse in the work that cannot be resolved. Yet another is that the initial goals of therapy have been achieved, and there are no other issues that are getting in the way of the client’s well-being. It’s important that the client and the therapist together understand the reason(s) for ending therapy, and arrive at an agreement as to when and how therapy should end. Usually, there is a relatively short period of time devoted to discussing the therapy, treatment goals, and results before it actually ends. Some people choose to end gradually, such as having a session every other week or once a month for a while, to see how well they can put to use the things they have learned during the therapy.

Q: Is it OK to return to therapy with the same therapist?

Yes. Often, after some period of time, the client runs into a difficult patch or they discover that there may still be some issues that need to be discussed. They can choose to have a single “booster” session, or as many as they need to address these issues.

While I have addressed many of the questions related to therapy, I’m sure that there are many other questions that could have been addressed in this article. I have chosen the ones that are the most commonly asked, or that seem to have the most relevance to the greatest number of people. Remember that beginning therapy is a big decision, and not one to be taken lightly. Do your research about the potential therapists. Trust your own impressions on first meeting them. Ask questions. Listen carefully to the answers. The better informed a client is about therapy, the more successful therapy is likely to be.