Category Archives: About Psychotherapy

See You Next Week!

Why Therapy Needs to be Weekly (or more frequently)

Psychotherapy represents a significant investment of both time and money. It is because I respect the significance of this investment that I only see people who are willing and able to meet weekly or more frequently.

You are probably thinking that this is a contradiction: if I recognize that therapy is time-consuming and expensive, why would I not be willing to meet with people less frequently so that more people can afford it? I hope this blog post will help you understand why meeting with your therapist at least weekly is so important.

For most of us, when we spend money or give up our valuable time, we usually expect something in return. When it comes to spending time and money on therapy, we are naturally expecting something from the experience: maybe you want to feel better, find new ways to understand yourself, reduce your anxiety, have a safe place to talk about your life, or receive some other benefit. Therapy is costly and it can be uncomfortable. Looking at ourselves and our problems is not easy! You choose to do it because you want to see results for your time and effort. You want something to change, to improve, or find a way to better understand yourself and what you might be feeling .

But when people go to therapy less frequently than weekly, there are things that happen or, perhaps more importantly, don’t happen, that can get in the way of seeing results and from truly seeing a return for the time and money they are spending. Here are some of the things I have observed:

  • It is harder to build a solid therapeutic relationship when you see your therapist less frequently;
  • Your therapist never gets to know you well enough to offer the kind of insight that can only come from knowing a person deeply–or it takes so long to get to know you that valuable time is lost before the work can deepen. You might even become frustrated and decide it isn’t worth continuing with your therapist;
  • The continuity of the conversation that takes place in therapy gets lost, e.g., it is hard to hold onto the thread of what is being worked on or to keep track of important topics have come up but have not yet been discussed. Or something big came up since your last session and you never get back to what you last talked about because there isn’t enough time;
  • When people come to therapy less frequently, considerable time is spent updating your therapist on the events that have taken place since the last meeting. There is a lot less time available for the deeper work of therapy;
  • Some of what happens in therapy, while it can’t always be described, happens as a result of continuity–the knowledge that you have set this time aside. Knowing this, people can “hang on” when they are having a hard time because they know they will soon have a chance to talk about whatever is going on for them;
  • You may decide–consciously or unconsciously–to avoid difficult topics because there isn’t time to talk about them and work through them;
  • Or you may decide–consciously or unconsciously–to avoid difficult topics because once you open up a topic, you won’t see your therapist for two whole weeks and this is a long time to wait before you can talk about it again;
  • You might find yourself frustrated with therapy because you don’t feel a connection to your therapist or because nothing seems to be happening;
  • You may be thinking that every other week is just fine, but you may not be fully aware of your unconscious motivations. For example, you might be thinking that it is about finances, but maybe it is about something else. Some things to consider: are you comfortable with close relationships? What happens when someone tries to really get to know you? Does the thought of being close to someone or allowing someone to really know you feel energizing or like you want to run screaming from the room? If you see yourself in this paragraph, going to therapy less frequently will simply replicate issues in your life that do not serve you. Therapy is about looking at things in as safe a way as possible, even when they are scary;
  • You may have other reasons for not wanting to meet weekly such as discomfort with spending money on yourself, prioritizing the needs of others over your own needs when it isn’t necessary, not making time for yourself, or there may be fear about what you might find out if you saw a therapist weekly;
  • You might be worried that you won’t have enough to talk about every week. In fact, some of the most important therapy sessions will occur when you don’t know what to talk about. If you are working with a good therapist, these sessions are great opportunities to look “under the hood,” so to speak, to see what is happening for you when the problems and distractions of daily life are not the topic of conversation.

Many people feel that opting for every other week therapy is a way to spend less money but, in fact, it is likely that they will spend more money in the end and get less out of the experience.

Consider your own reasons for wanting to meet less frequently. Is something other than time and money standing in the way of getting the help and support you need? Are you afraid of what you might find out? Are you experiencing shame or other uncomfortable feelings when you think about the things you want to talk about in therapy? One thing worth mentioning is that enthusiastically embracing the idea of weekly therapy is not a requirement for going to therapy! When you contact a therapist to see about starting therapy, express your concerns about this and listen to the response.

Although I have given many reasons why you should consider weekly therapy, finances are real and important and can’t be ignored. Therapy is expensive. What do you do if you want to see a  therapist but money is an obstacle? Rather than settle for every other week, consider the following:

  • If you have insurance, find a therapist who accepts your insurance. Be cautious and make sure you understand what your plan covers so that you don’t end up with unpleasant surprises. Some of the risks of going this route are:
    • Your plan may only cover a certain number of sessions, which may be less than what you need or want. This could get in the way of digging deeply into the issues you are bringing to therapy;
    • Your therapist may decide to stop taking your insurance (insurance typically involves considerable paperwork for the therapist, along with significantly reduced payment from insurance companies, which is why many therapists choose not to accept insurance) or you may change jobs and end up with a different insurance plan that your therapist doesn’t accept;
    • When you use insurance, your therapist has to give you a diagnosis. This may or may not cause problems down the line if an insurance company decides to call your diagnosis a “preexisting condition;”
    • While therapists are legally and ethically obligated to maintain your confidentiality (with certain very specific exception such as if you are danger to yourself or someone else), insurance companies are under no such obligation;
    • Because accepting insurance requires considerable additional paperwork and pays therapists a very low rate, many experienced therapists do not accept insurance. This may mean that it will be difficult for you to find someone with openings, the therapists who accept your insurance may be less experienced, or the therapists who have openings may not feel like the best fit for you. Unfortunately, when you use your insurance, you may have fewer choices.
  • Find a therapist who will issue a “superbill.” A superbill is a type of receipt for services. In most cases, you would pay your therapist directly and then receive the superbill and submit it to your insurance company for reimbursement. Most therapists are willing to provide a superbill upon request. Or use the money in your flexible spending account, if your company offers this. Some downsides to these options include:
    • You will have to pay your therapist directly and then submit the superbill to your insurance company and wait for payment;
    • You will likely be reimbursed for a percentage of the actual cost of your sessions, which means that you will have to pay for more of the actual cost of the therapy;
    • Your plan may have a high deductible that needs to be met before you will see any money from your insurance company;
    • Your therapist will have to give you a diagnosis which could be seen as a preexisting condition;
    • Your insurance company may not reimburse for out of network providers;
    • If you use your flexible spending account, this will help offset some of the cost of your therapy, but the rules will not allow you to set aside enough money to cover everything.
  • Look for a training center. There are many training centers in the Bay Area that provide excellent services. Some of the places I routinely suggest include Access Institute and the Marina Counseling Center, both in SF; and The Psychotherapy Institute in Berkeley. Your therapist will likely be someone who is gaining experience towards licensure and is working under an experienced, licensed therapist. Some downsides to this approach are:
    • Your therapist will eventually leave the training center when they have completed the program and you will be assigned to someone new;
    • The fees vary and are based on your income. The fee can often be surprisingly similar to seeing a therapist in private practice;
    • You will likely be assigned to a therapist, although most places will ask if you have any preferences, e.g., a male or female therapist, a therapist of color, etc., and try to match you IF there is someone on staff who meets your requirements AND has openings. Again, you will have less choice.
    • Be sure that the training center you choose offers individual supervision for each of their therapists in training. This way, you can be sure that your therapist is getting appropriate guidance so that he or she can be helpful to you. There are a surprising number of training centers that do not offer this.

Ultimately, only you can decide what you can afford to pay for therapy and what will work for your budget. Before you decide to meet with a therapist who is willing to work with you every other week, please consider whether this is really what you want and whether it will help you get to wherever you might want to go. For most people, a much better option is to try to find a therapist with fees you can afford so that you can attend weekly.

Questions about psychotherapy or about my approach to psychotherapy? Please see my website at www.marlacass.com and contact me at my San Francisco psychotherapy office: 415-218-2442 (phone link works from smartphones only) or at info@marlacass.com.

A Review of Therapy

A Review of TherapyRelational Psychotherapy for Therapists

One of the values of the internet is that it not only provides opportunities to easily find the services we are looking for, it also gives us a chance to see what others are thinking about those services. While we probably don’t know the people who have written these reviews, we trust that they are mostly honest and fair and, at a minimum, are offering some useful information on which to base our decision as to whether or not to use a given service.

To the extent this might work for some services, many services do not fit this model at all or, at least, only fit with some major caveats. Psychotherapy is an example of a service that fits awkwardly, at best.

For example, something most people do not know, including many therapists, is that a therapist is ethically prohibited from asking someone they have worked with to write a review for them. Some therapists who are aware of this ethical requirement try to get around it by having signatures on their email that include language such as “Like me on Yelp,” which delivers a strong hint that the therapist would appreciate an online review. Arguably, this is not keeping with the spirit of the ethics of the profession.

If you think about this, it is easy to see how being asked to write a review for your therapist can be a conflict. If my therapist asks me to write a review, I might do it to please her or because I want her to like me (or not dislike me!). It might cause me stress when I start to worry about whether I wrote the “right” thing. If I refuse, will my therapist be angry? What if I say something negative? Will it get in the way of the work we are doing? You can see how this can quickly turn into a conflict and potentially take the therapy off course. This is a big reason why our code of ethics prohibits the solicitation of reviews.

In addition, therapy is supposed to be about you, not about your therapist. When a therapist asks (or even hints) that you should write a review, the needs of your therapist are getting in the way of your needs. This is not what therapy is supposed to be about and, in fact, is a violation of ethical standards.

Despite this, some therapists have dozens and dozens of reviews on sites such as Yelp. How does this happen? In some cases, the therapist may not be aware that asking clients to post to social media on their behalf is ethically prohibited and s/he may be unwittingly asking clients to do this. Or the therapist may know that what they are asking is inappropriate but might be assuming that the client doesn’t know the ethical standards of the psychotherapy world so it isn’t a problem. Many businesses routinely ask their customers to review them, so they assume clients will not think anything of the request. In other cases, the therapist may offer classes and workshops and groups and the reviews may be a result of many enthusiastic attendees who have not actually been in therapy with the therapist.

The theoretical orientation of the therapist may play a role, as well. A therapist who primarily works with people for short periods of time on specific issues will have many more people passing through his or her door than someone who primarily works with people who are looking for a longer and more depth-oriented experience in therapy.

Often, the population with which the therapist works may be a factor. For example, a therapist who works with young children may have few reviews because young children are (usually!) not writing reviews and busy parents (usually!) don’t have the time. A therapist who works with older adults may not have any reviews because the people he or she works with are not active on social media.

On the opposite end of the spectrum, a therapist who focuses on services for people in the tech industry may have many reviews because tech people are usually more comfortable with social media. But for most people, psychotherapy is a uniquely private matter, which means that they are not likely to be writing online reviews about their therapist.

In the end, however, the number of social media reviews for a given psychotherapist is dependent on many factors and may or may not be a reliable source of information.

If you can’t rely solely on reviews, what should you do? Read the online profile(s) for therapists and see who resonates with you. Try to be specific when you search on google or look at sites that have profiles set up by therapists in your area, such as Psychology Today or Good Therapy. Consider whether you are you looking for help with a specific issue or whether you want to focus on looking at yourself at a deeper level. Is there a particular approach to therapy that interests you? Has a trusted friend worked with someone who might be a good fit for you? (This can present additional complications, so make sure to check with your friend and with the therapist to make sure everyone is ok with this.) Gather information, contact the therapists who sound like they are interesting and could be helpful, and then talk with them and meet with them in person.

Online reviews can be helpful, but they are just one data point to consider. Don’t let a lack of social media visibility deter you from contacting a therapist who might be just the person you are looking for.

Questions about psychotherapy or about my approach to psychotherapy? Please see my website at www.marlacass.com and contact me at my San Francisco psychotherapy office: 415-218-2442 (phone link works from smartphones only) or at info@marlacass.com.

The Experience of Therapy

The Experience of Therapy

It can be helpful to keep in mind that, regardless of how stuck you may feel, there are many opportunities to view the world through a different lens. Many years ago, I read a poem about washing dishes.[1] The poet, Al Zolynas, made this ordinary task sound like a fascinating exploration. His poem offered an opportunity to look at something we have seen and done countless times, yet experience it in an entirely new way.

Thoughts and Feelings

I think that psychotherapy is a lot like this poem. In therapy, we take the events of our lives and their accompanying feelings and embark on an exploration in the hope that we will find a new way to see. We consider the content—the moments that have caused us grief or sadness or disappointment—and allow these buried thoughts and feelings to come to the surface. Some of what might emerge may be painful feelings that seem almost unbearable, but in the safety of working with a trusted person, we can stop keeping them in the darkness and allow them to be seen.

Like vampires who can’t bear the light of day, many of these old feelings will dissolve under our gaze while other feelings will find a way to tell us that they are reluctant to emerge. Even if it is not yet possible to look directly at some of our buried feelings, we might be surprised to find that they can often lose some of their energy and power in the course of our exploration. Just like light illuminates our path even though we don’t look straight into the sun, we can often change how we think and feel about things without looking directly at the source of the pain.

“Therapy is what happens when you are doing something else”

How does this happen? I like to say that “therapy is what happens while you are doing something else.” The conversation between you and your therapist looks like, well, like a conversation. I am often asked “what should I talk about in therapy” and I always respond that the answer is to talk about whatever you want, whatever matters to you. While you are talking with your therapist, the quiet and often mysterious work of therapy is happening in the background.

Helping you understand your partner

Some of this is simple and straightforward: for example, if you are having a problem with your partner or with your relationship and you talk about it with your therapist, you are thinking it through, formulating the words you would want to use, and practicing how you will say them. You might not be consciously thinking that this is what you are doing, but it is happening in the background. When you and your partner are together, you are likely to find that the words come more easily and you are able to talk rather than retreat or become angry.

…and your worklife

Some of it is more subtle: your boss keeps making you mad and when you talk about him with your therapist, you are not in the heat of the emotions and you can suddenly see how he reminds you of your alcoholic father. With this insight, you can be more compassionate with yourself when you are triggered, get grounded more quickly, and move on with your day. Underneath all of this is a sense of being deeply understood that helps you build more confidence to handle whatever life throws at you.

Seeing things in a different way

Psychotherapy is often called “the talking cure,” but, as you can see, talking is just what we are doing while something else is taking place behind the scenes. Our ever-increasing knowledge about how the brain works shows that our brains can actually “rewire” themselves: the neural pathways actually change when we start to see things in a different way. This can potentially lead to feeling less triggered and to a quicker resolution when things get bumpy. So even though it seems like you are just having a conversation, what is actually happening is far deeper and more beneficial!

[1] Addonizio, K. & Laux, D. (1997). The Poet’s Companion: A Guide to the Pleasures of Writing Poetry. New York, NY: W.W. Norton and Company, Inc.

Also available online by searching “The Zen of Housework.”

Questions about psychotherapy or about my approach to psychotherapy? Please see my website at www.marlacass.com and contact me at my San Francisco psychotherapy office: 415-218-2442 (phone link works from smartphones only) or at info@marlacass.com.

Supervision of Mid-Life Supervisees

Supervision of Mid-Life Supervisees

This article first appeared on May 1, 2018 in the newsletter for the San Francisco Chapter of the California Association of Marriage and Family Therapists. Click here to read the original article on the SF CAMFT website.

Feature Article:
Supervision of Midlife Supervisees

By: Marla Cass, LMFT

One of the many interesting things about the practice of psychotherapy is that it is a profession that attracts people from a wide range of backgrounds. Unlike many career paths, becoming a psychotherapist does not require any particular background prior to graduate school, aside from a college degree and a few psychology courses. As a result, becoming a licensed psychotherapist is a career people can pursue later in life, often after being in other professions and after considerable life experience. To add to the appeal for older career changers, it is also one of the few careers in which being older is actually valued.

The transition from being in other professions to becoming a psychotherapist, however, is not an easy one. Many older Interns/Trainees/Associates are moving from careers in which they felt competent and were recognized in the form of praise and compensation. While they may have anticipated the challenges of returning to school as older students, they are often ill-prepared for the experience of working under a clinical supervisor.

Psychotherapy supervision is a hierarchical model that requires that the supervisee take direction from the supervisor. This may be an efficient and arguably necessary structure (not to mention a legal requirement), given that the supervisor has more experience in the field and the supervisee is working under the license of the supervisor. However, it often fails to recognize the unique perspective that an older supervisee brings to his or her work, as well as the psychological difficulties involved in transitioning from a person who felt competent in his or her job to being a person who now needs to take direction.

Coming to this work with considerable work and life experience is certainly an asset with respect to understanding clients, but it can also be a liability when it comes to learning to become a psychotherapist. For example, it can be difficult to grasp the many ways in which the role of a psychotherapist is different from whatever role they may have had in their previous profession. And even where similarities may exist, therapists may approach seemingly similar situations very differently from people in other professions.

In addition, supervisees are expected to talk about their feelings and personal reactions to their work with clients, and to be vulnerable with their supervisors. In most professions, however, talking about feelings and being vulnerable with peers and superiors is inconceivable. It may take a supervisee time to adjust to this cultural shift and the process may be slow and difficult. This can be puzzling to supervisors, especially to supervisors who have primarily worked in the field of mental health where such openness is expected and normal.

As an older supervisee, it can help to slow down and try to understand the perspective of the supervisor. What is the underlying reason for the supervisor’s position? Ask questions about the concepts you are being taught and listen to the answers with an open mind. Recognize that learning to be a clinician is also an entry to a language and professional culture that may be very different from that of your previous profession.

For supervisors of older supervisees, it is helpful to recognize the experience the supervisee brings to his or her work and to consider how you can make use of this in supervision. Keep in mind that older supervisees may be used to dealing with their superiors in a very different way, as compared to younger supervisees. Older supervisees are more likely to challenge their supervisors when there is a difference of opinion, and it can be harder for them to take direction when there is disagreement. The emotional upheaval of being the learner rather than the teacher can be disconcerting and lead to frustration and impatience. Older supervisees may also feel the need to display a level of confidence that may not match the uncertainty they feel inside.

While supervision is not therapy, many of the same principles apply: listen closely, ask clarifying questions, try to understand the underlying feelings, and consider how the past experiences of the person in front of you may have impacted him or her and be showing up in your work together. Think about the transference and countertransference that may be occurring in the supervisory relationship.

Don’t forget about the cultural issues and recognize that psychotherapists have their own culture, too, which can present a steep learning curve for supervisees, especially those new to the field. Keeping these tools in mind will not only help clinicians get the most out of supervision and supervising, but they will also help to make them the best therapists and supervisors they can be.

Marla Cass (MFC 45402) is in private practice in downtown San Francisco. Her focus is on working with women who are successful in their careers but not in their relationships. She has been a group supervisor at The Boulder Institute for Psychotherapy and Research, Pacific Center, and The Women’s Therapy Center; and is currently an individual supervisor for Queer Life Space and Community Institute for Psychotherapy. For more information, please see her website at www.marlacass.com.

Questions about psychotherapy or about my approach to psychotherapy? Please see my website at www.marlacass.com and contact me at my San Francisco psychotherapy office: 415-218-2442 (phone link works from smartphones only) or at info@marlacass.com.

Therapy is About Mental Health

Therapy is for Problems…And a Whole Lot More

One of the concerns often faced by people thinking about psychotherapy is that psychotherapy is commonly associated with mental illness, rather than with mental health. This has created a stigma that, sadly, keeps many people from seeking the help that they deserve.

Daniel J. Siegel, a psychiatrist and author of numerous books about the brain and neuropsychology (the understanding of how the brain works and how to make use of that understanding to help people) poignantly begins his presentations to therapists by asking: “who here has had a class on mental health?” In a room with one hundred or more therapists, perhaps five or so hands will go up. This is a problem for psychotherapists and for the people we serve.

Therapy is for: relationships, confidence, personal growth, and more

With members of the public associating therapy with mental illness and therapists themselves primarily receiving training in how to work with mental illness and not in how to foster and support mental health, it is no wonder that therapy is most often seen primarily as a treatment for severe mental and emotional problems–and often dismissed by people who could benefit from it. Many people who find their way to therapy often experience intense shame because of this association and we have no way of knowing how many people never see a therapist at all because of this shame.

Of course, psychotherapy can be very helpful to people who suffer from specific problems such as depression, anxiety, PTSD, etc., but the benefit of therapy are not limited to just people with particular problems. Many people turn to therapy as a way to understand themselves better—why they do what they do, what events happened in their past that have shaped them, and how they might reassemble these pieces to create a more satisfying life.

You Can’t Always Do It Alone

While it may seem like it would be easy enough to do this work on your own, and, to some degree, that is certainly one way to approach this, there is no substitute for what happens when two (or more) people meet in a room with the sole purpose being the understanding and personal growth of one of them. Many psychotherapists have a word for this: the “third,” meaning that something new and unique is created that is the result of the combining of the conscious and unconscious minds of two people. The “third” can only be created by the two specific people interacting. A metaphor from chemistry class might help: oxygen and hydrogen atoms combine to create water, which is greater than the sum of its parts.

Therapy as a Place to Talk and to Listen

Another purpose of therapy is simply to have someone to talk to who will listen, offer ideas for thinking in a different way, and, most importantly, does not ask anything from you in return, other than for you to be there at the agreed upon time and to pay a fee for that time.

The content of what is talked about may vary greatly from week to week, from dealing with pressing problems to understanding yourself and your relationships in a deeper way. Regardless of what is talked about, being able to share your inner thoughts and feelings with a trusted therapist can help you to let go of some of the things that weigh you down and hold you back without the added burden of having to take care of the other person.

Surprising Voices for Mental Health

Although I am admittedly not much of a podcast person, I was recently moved by a podcast that was featured in the Daily Telegraph by Bryony Gordon, a columnist for the newspaper. In her series, Gordon speaks with different guests about their own mental health and how they have dealt with problems. As she introduces us to the podcast, she reminds us that “the point is, mental health issues affect everyone; one in four of us…it is really, really, really normal to feel weird. In fact, it is weirder if you feel normal the whole time.”

In the first podcast of the series, Gordon interviews Prince Harry, who speaks quite candidly about his own experiences with therapy and how talking with a therapist has helped him. (If you are interested in listening to it, here is the link:  https://bryonysmadworld.telegraph.co.uk/e/mad-world-prince-harry/.)

And in another great article, basketball star Kevin Love talks about how therapy helped him deal with depression and anxiety attacks: https://www.theplayerstribune.com/kevin-love-everyone-is-going-through-something/. As more and more public figures talk about how therapy has helped them, hopefully, more and more people will feel comfortable seeking the help they deserve.

Questions about psychotherapy or about my approach to psychotherapy? Please see my website at www.marlacass.com and contact me at my San Francisco psychotherapy office: 415-218-2442 (phone link works from smartphones only) or at info@marlacass.com.

Therapy: Not Just For Problems

Therapy: Not Just For Problems

Why do people come to therapy? Therapy, on the surface, can seem like a very strange thing to do (What! Tell my problems to a therapist??) and it is surrounded with misconceptions. It involves a commitment to show up at a certain time at a certain place and pay money to talk to someone you don’t know about things you may have spent years of your life avoiding. It can feel uncomfortable and can stir up things you have tried very hard to ignore. To make matters worse, having made that commitment to spend all that money to talk about things you don’t want to talk about, you will probably put pressure on yourself to change something in your life. After all, if we are taking up time and spending money, we expect something to happen, right? This doesn’t exactly sound like something most of us would sign up for. So why do it?

Ok, Sometimes, Therapy IS For Problems…

Many people see therapy as a necessary evil; as a place to go to talk about a problem that needs solving. Usually, the person coming to therapy has tried a lot of things before picking up the phone or getting on the internet. For example, she or he has likely talked with friends, thought about the problem, tried some possible solutions or distractions, and maybe read some books that might be relevant to their situation. After exhausting everything they can think of to do and discovering that the problem is not resolved, therapy might start to sound like a good idea.

Often, these people come to therapy with a very specific issue and a very specific goal. Coupled with this might also be a very specific time frame in which they would like to accomplish the work and arrive at a solution. This approach can work very well in cases where the problem is well defined and the person has already made some progress with respect to resolving the problem.

Unfortunately, our minds and our problems don’t always work in a linear fashion and, much like a home remodel, it is a good idea to have some room for unexpected things that may surface. At first glance, a problem may look like a problem, but looking under the hood, so to speak, may reveal underlying causes that require deeper investigation. In such cases, the problem may actual be a symptom of another problem.

For example, a couple may come to therapy to look at the way they argue. Helping them find ways to argue less will be helpful to a point, but understanding that they each come from families where every conversation turned into an argument will create a level of understanding that can lead to lasting change that feels more authentic than memorizing a script on how to argue less.

But Sometimes, It is for Personal Growth…

For another group of people, however, therapy is not specifically about solving a particular problem, but about looking at the problem of being human in a complex world. There are very few places where our inner life can receive such careful and gentle attention.

For these people, therapy is a place where the noise of their day to day life is quieted, at least for a short time, and they and their therapist become absorbed in the intricacies of observing something that is not always visible. Like a scientist observing the world through a microscope, looking at your life through the lens of psychotherapy can open up worlds that are fascinating and enlivening and can lead to a richer and fuller human experience.

Have you thought about what it might be like to take an hour out of your week to look at yourself? What might get opened up for you? What thoughts and dreams do you

And, Often, Therapy is About Not Having to Do It Alone.

For a third group of people, therapy may not be as much about problem solving as about problem management. Sometimes, things just are what they are and the solution is not necessarily about trying to find a fix to an unfixable problem, but in learning to accept the problem as it is, or having a safe and confidential place to talk so that it doesn’t feel like you are holding onto the problem alone.

People who fall into this category are often similar to people who come to therapy to look at their inner life, but, for people in this third category, there is a specific topic or issue that remains at the center of the therapy work. Talking about it with another person can create the space to manage the problem and let go of some of the overwhelm that may accompany it.

While most people come to therapy with the goal of fixing something or feeling better about their lives, therapy is not always something that needs a goal. Like Zen, the process of being in therapy can, in and of itself, create rewards that we could not have anticipated.

Questions about psychotherapy or about my approach to psychotherapy? Please contact me at 415-218-2442 (phone link works from smartphones only) or at info@marlacass.com.

Deciding to Go to Therapy

Deciding to Go To Therapy

This article appeared in the Fall 2012 issue of Bridge Newsletter. 

Why Therapy?

In most cases, the decision to talk with a therapist is the result of a painful problem that has not gone away. You may have tried many things to fix the problem. You may have even taken steps to try to do some things differently, but the problem persists. The problem can range from a crisis that keeps you awake at night to a nagging feeling that something is wrong that just won’t go away. You may be at the point where you are wondering whether anything can help.

Perhaps you are thinking about therapy as a way to help you with problems in your relationships. You may be looking for ways to repair a troubled relationship, for guidance on how to be successful in your current or future relationships, or for support in ending a relationship that is no longer viable. You might be considering getting help for yourself alone or together with your partner.

You might also be wondering about  therapy as a path for exploration and personal development. You may have a strong desire to understand yourself at a deeper level. Perhaps you are curious about what motivates you,  how you relate to others, or how your past history impacts your current life. Therapy can help people look at places where they may feel blocked or stuck, and to open up to new possibilities.

The word “therapy” is often interpreted to mean that something is broken and needs to be repaired: for example, someone needs to go to physical therapy to help them walk after knee surgery. But therapy is not necessarily about fixing something that is broken. When we feel better about ourselves and have a greater understanding of who we are, we tend to be able to ride out the bumps and have increased energy to engage more fully in our own lives and in our relationships.

Often, people are reluctant to seek psychotherapy because they feel shame or embarrassment about talking to someone about their problems. Perhaps they come from a family or cultural background that frowns on sharing “things that belong in the family.” This can make it feel awkward or even impossible to consider psychotherapy. While it may feel like a contradiction to go to therapy to talk about this, looking at your hesitations with a competent therapist can be the best way to move forward. Taking some time to explore the negative messages you may have heard about therapy can  give you the tools to decide your next step.

For many people, talking about themselves can feel awkward. They may fear that they will be rejected or judged in some of the same ways they have been rejected or judged in the past. A trained therapist is interested in providing help, not in judging you. She or he will work with you to find ways to help you to feel safe when uncomfortable topics or feelings come up. It can help to keep in mind that it is often the wish to avoid discomfort that keeps us stuck. Your therapist should be with you every step of the way to make sure that therapy unfolds at a pace that works for you.

Often, people are reluctant to consider therapy because of a previous experience that did not go well. Maybe you once saw someone for help, but you didn’t feel any better. Or perhaps you were sent to see a therapist against your will because of a family situation such as a divorce, and you thought it was a waste of time or you were left feeling that there was something wrong with you. Whatever the reason, giving therapy another try may lead to getting the help that you deserve.

Finding a Therapist

Even people who are ready to begin therapy can find the process of locating a therapist to be daunting. How do you even start? Some ideas may include asking a healthcare provider, such as your doctor, OB/GYN, or chiropractor. You might ask trusted friends and family members, although it may not be a good idea to see the same therapist as the people closest to you.

The Internet has opened up new possibilities for finding a therapist. Many therapists have websites that offer very useful information about their practices. In the past, getting a referral to a therapist usually meant receiving just a name, address, and phone number. Today, therapists are writing about topics such as their theoretical interests and their approach to therapy. Some therapists’ websites include blogs and lists of suggested books. All of this information can help you to begin to get a sense of the person and how he or she may be able to help.

Once you have decided on a potential therapist, the initial phone call will give you further information about her or him. Most therapists are willing to spend a few minutes on the phone in advance of the first meeting. This is a great time to ask questions regarding the therapist’s experience with the issues you want to talk about, and to find out the fee. It is also an opportunity to listen to the therapist and to start to get a sense of whether this person is someone you will feel comfortable talking to.

The First Appointment

Your first appointment is another opportunity to make your decision about therapy and the therapist. In most cases, you will quickly have a sense as to whether the person you are meeting with is a good fit. Does the therapist seem to understand you? Does he or she respond in ways that make you want to share more of your story? A therapist who makes you feel like you want to stop talking or makes you feel like you are being judged is probably not a good fit and you may want to explore other possibilities. Before deciding that a therapist is not a good fit, you may want to think about why you feel that way. As we discussed earlier, talking about ourselves with someone we have just met can feel awkward and uncomfortable. Try to be sure that the issue is genuine lack of connection with the therapist and not discomfort with the idea of therapy. You may even want to talk about your hesitations with the therapist to help you get some insight about how you are feeling about starting therapy. Sometimes, it may also help to have several sessions with a therapist before deciding whether she or he is a good fit for you. Often, the first session can go by quickly as you begin to talk to your therapist. If you are undecided about a therapist after the first meeting, you may want to take an extra session or two to make your decision.

A Good Fit

Just like with people we meet in other parts of our lives, there are therapists with whom we will resonate and therapists with whom we will not resonate. The best therapist in the world, or even the person who was the best therapist for your friend or for your boss, may not be the best therapist for you. Unfortunately, the nature of therapy is such that people are often trying to find help during a time when they are in pain and feeling overwhelmed. Finding a therapist with whom you feel comfortable and who you feel can be helpful to you is worth the effort. Give yourself permission to meet with several therapists, if necessary, to be sure you will be working with someone you trust. Often, people either stay with the first person they meet with, despite misgivings, or they decide that therapy is not for them after a session or two with someone who makes them feel uncomfortable. There are many excellent therapists who can offer you the help and support you are seeking. Please take the time to make the best decision you can.

Questions about psychotherapy or about my approach to psychotherapy? Please contact me at 415-218-2442 (phone link works from smartphones only) or at info@marlacass.com.