Tag Archives: personal growth

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.

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.