Tag Archives: psychotherapist

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.

Psychotherapy for Successful Women

A Note to Successful Women

Therapy for Professional Women in San Francisco…You’re great at your job

Does this describe you? You are an intelligent woman, and you are fortunate to be in a career that you love–or, at least, like well enough. You are successful in your work, which, if you are living in the Bay Area, might be in one of the STEM fields: science, technology, engineering, mathematics, or business. You enjoy status and respect and you are well rewarded financially. At work, you feel comfortable and confident. People seek you out for your knowledge and experience, and you are often called upon to share your wisdom and to mentor colleagues. From the outside, it all looks great. When you are at work, it looks great to you, too. Work is a rewarding and comfortable place. When it comes to work, you are feeling pretty lucky.

…But maybe not so great at your relationships

But when you leave work, something else happens. You might be in a relationship, but it isn’t working very well. You are often in conflict with your spouse or partner, but you aren’t always sure why. You just don’t seem to understand each other. Maybe you are dating and finding it hard to connect with others. Or maybe you have given up on the whole relationship thing because it never seems to work out for you and it feels a lot easier to be single. You are frequently accused of being emotionally distant and, not so deep down, you wonder if this might be true.

You’re a problem solver

One of the ways you have been successful in your work has been to be a great problem solver. So when your partner is having a problem, you naturally want to help by brainstorming and finding a way to fix the problem. After all, people are always interested in solving problems, right?

…But you haven’t been able to figure out this one

The trouble is that we are all wired differently. For you, the path from problem to solution is a straight line. No point in wasting time going in circles. But for your partner, the path from problem to solution may not be so obvious. It is even possible that finding a solution is not the goal for your partner. To you, that may seem like a waste of time, but to your partner, it feels as organic as breathing. Just as solving problems feels natural and intuitive to you, feeling heard and processing feelings feels natural and intuitive to your partner.

Tips for dealing with your relationships

Relationships are complicated things that can have lives of their own. One of the keys to making your relationship successful is to spend some time learning to understand your partner, even if it might sometimes seem like he or she is speaking a foreign language. If you decided to live in France, you are definitely the kind of person who would not only learn French, but seek to be fluent. You would reason that you might be able to get by speaking English if you were a tourist, but you would never be comfortable with the limitations that would place on you. You would want to learn as much as you could about the language, even if it felt awkward to you and even if you sometimes failed at it. You would take pride in your successes and resolve to do better when you were unsuccessful. Even when things were frustrating, you would stick with it. That is just who you are. This is what you do at work and why you are so successful. Why would dealing with your relationship be any different?

In my work as a psychotherapist, I have found that what makes women successful in their careers can often lead to frustration and feeling unsuccessful in their personal relationships.

When we seek a mate, we are often driven by unconscious motivations, as unromantic as this may sound. One of those unconscious motivations can be qualities in the other person that you wish you had more of yourself. This is the well-known maxim “opposites attract.” So if you are an introvert, you will likely end up with an extrovert. If you are driven by your intellect, your partner is probably driven by her emotions. In some secret way, usually unknown even to ourselves, we do this because we think we will land somewhere in the middle—she will be influenced by our introversion and you will be influenced by her extroversion and the two of you will live happily ever after somewhere in the middle—but the more likely outcome is that what drew you to this person to begin with, often becomes what repels you and leads to difficulties when the honeymoon stage is over.

Learn to listen

This often results in frustration, anger, and disappointment, but it doesn’t have to. Couples can learn to listen to each other, to understand each other, and to find that elusive middle ground. One place to start is to listen—really listen—to what your partner is telling you both in her words and in her actions. Try to stay as present as you can, make eye contact, and imagine what she might be experiencing. What may feel like an attempt to push you away may actually be a bid for more connection. If you listen hard enough, you might be able to hear something you have never heard before.

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