What to expect from therapy

Most people come to therapists or counselors looking for relief. These individuals have identified areas of concern that get in the way of their happiness, freedom from worry, and overall state of mind. Often, but not always, the prospective client has a pretty clear idea about what it is, specifically or in more general terms, that’s causing the psychological or situational discomfort.what to expect from a therapist

At times, though, people present with a constellation of symptoms that simply translate to “unhappiness“ with no clear understanding of what’s causing this downturn in their state of being. In any case, an accurate and detailed understanding of the presenting problem(s) is an absolute prerequisite of successful, purposeful therapy.  One way or another, it’s the job of the therapist to shape and guide the initial therapeutic dialogue in such a way that both therapist and client understand what the focus and objectives of the therapy are, and what possible outcomes might result. It is here that therapist and client must agree as they embark upon their journey.

Therapy is serious business. When it’s done well it’s all orchestrated. If the therapist is on his game, every word, every silence, every shift in body position, change of tone, use of language etc. should be calculated and geared to facilitating the dialogue. The dialogue, while at times feeling “lighthearted“ or “social,“ is never empty and always purposeful. The light banter serves the purpose of opening the door to discussion of the serious matters at hand.

At times I’ve heard clients complain that they sometimes feel worse walking out of my office than they felt walking in. That’s OK by me… usually. The work of therapy often involves exposing painful, uncomfortable memories, feelings and realities that have escaped the awareness and attention of the client but which are, nonetheless, getting in the client’s way. This material needs to be uncovered and discussed. Hopefully, with improvement in the client’s insight and understanding, more successful and adaptive strategies can be adopted and the old ways of doing things… or NOT doing things… can be discarded. Getting to the material and arriving at solutions often takes the client into unfamiliar, uncomfortable territory; thus, the sense of unease which translates to sometimes feeling worse than when they walked in. It’s all part of the work of therapy, and if this occasional discomfort is never present, then I seriously question whether any real work is being done. Remember, therapy is always about change, and change often creates discomfort.  If the work of therapy is done well, whatever happens along the way will be well worth it.

At the end of the day, therapy should be a positive and worthwhile experience that, at least, meets the client’s stated need(s). When it’s really good, it should exceed expectations.

Whatever the case, the client should expect greater insight and understanding of himself, his life-situation, his relationships and relationship style. He should understand how he operates and how he participates in the creation of his problems. Moreover, he should learn to avoid creating new problems, develop new patterns of behavior, and master strategies for problem resolution.

The client should, ultimately, come out of the therapeutic encounter wiser, happier and better off.

- Mark B. Dunay, LICSW, LADC 1

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OnOctober 1, 2012, posted in: counseling, psychotherapy by

How to find a therapist

Finding a therapist — someone who is skilled, well-trained, experienced, and someone with whom you can connect and develop trust — can be a daunting, even intimidating experience.  For many, simply knowing the right questions to ask and qualities to look for is puzzling.  Nevertheless, there are some central and essential elements to the process and you should know what they are.

First, start with the assumption that you are a consumer.  Mental health providers provide and clients purchase their services with a significant investment of time, energy and money.  Give yourself permission to access services with the same sense of entitlement to quality as you’d apply to the search for a surgeon, electrician or financial advisor.  Take yourself seriously.  Do not minimize the importance of your problem or concern. Remember, you wouldn’t be seeking professional help if you didn’t need it, or if you’d been able to find solutions and answers on your own.

Try to have a clear definition of what you need help with.  Give it a name:  “I’m not getting along with my husband and he doesn’t want to talk.”  “ I find myself crying at times when it doesn’t seem to call for tears and I can’t sleep.”  “ I’m drinking more than I want to and more frequently than normal.  I’m worried about this.”  These self-defined problem statements will help you determine why you’re seeking help and what specific help you need to find.

Start the search for skilled, qualified help.

Here’s where things can get tricky.

Believe it or not, in Massachusetts and many other states, ANYBODY can call themselves a therapist and counselor.  Sad but true!

So how should you shape your search ?

First, find an individual who is educated, on an advanced level, from legitimate mental health programs offered by bona fide, accredited educational institutions.  If you find someone with MD (Psychiatry ), Ph.D. (Psychology), MSW (Social Work) after their name you are probably on the right track.

Next, any of the state licensing authorities, i.e. Board of Registration of Medicine, Psychologists, Social Workers, will have reliable information about levels of licensure and also, any disciplinary history associated with a specific license and name.

NEVER get involved with non-credentialled, unlicensed individuals.  The person you do engage may not be a perfect fit for you but with a reasonable degree of up-front research you can establish a baseline level of quality control.  Whatever energy you put into this is well worth it.

Another reliable and very time-efficient way of securing good quality help is to call the Member Services Department of your insurance carrier and tell them, in as precise a manner as possible, what you’re looking for.  They pre-qualify all providers in their network and maintain an accurate profile on each of them which outlines the particular skills and training of therapists affiliated with the company.  If you tell them that you think you may have an eating disorder and you live on the South Shore, they’ll  generate a list of appropriate resources for you to contact.

Now what?

Remembering that you’ve defined yourself as a consumer, you get on the phone.

Feel free to interview the prospective therapist and ask whatever you want to ask.  Within broad limits, the therapist should be open to your questions and forthcoming and clear in answering them.

Ask about training.  Ask about experience.  Ask about philosophical and theoretical orientation and if you need clarification ask for it and expect that you’ll get it.

Find out about scheduling and availability.  Determine how accessible the therapist will be if you have questions between sessions.

In short, get a feel for the person you’re talking to, and if your questions have been answered to your satisfaction, if you’ve been spoken to in a patient and respectful manner, and if you think that you like the person on the other end of the line, make an appointment.

You’ve, most likely, just found yourself a therapist.

- Mark B. Dunay, LICSW, LADC 1

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OnJune 1, 2012, posted in: counseling, psychotherapy by