A:Psychotherapy (also known as just plain "therapy" or "counseling") is what was once known as the "talking cure." It is characterized by a series of private and confidential meetings with a psychotherapist. The course of these meetings can range from a few weekly sessions to a several years of multiple sessions per week, depending more on your goals and expectations than on the severity of your symptoms. Psychotherapy has scientific and intuitive components and to be useful demands a creative balance between the two. There are dozens of types of therapy. Research has shown that no one orientation is superior to all others although some therapists are consistently more useful to their patients than others. Accordingly, an important factor in successful therapy is that you feel good about your therapist and view him or her as a trustworthy, kind, open, healthy, competent and moral person who understands your problems and relates well with you. Even more important is that you sense movement in yourself because of your therapy.

Q: How do I know if I need to see a psychotherapist?

A:One of my colleagues has the most conservative answer to this question, "Just because you've got a difficult problem doesn't mean you need to get in psychotherapy. Life is, after all, one damn thing after another. When it's the same damn thing time after time, that's when you need a therapist." Other colleagues are more philosophical in their approach: "Whose life can't be improved by self examination?" They suggest that everyone with an above average I.Q. can benefit from therapy and that people get the most out of psychotherapy when they are not in a crisis. As a practical matter, the conservative answer to this question seems to be the primary motivation for most people beginning therapy. It is likely that the philosophical answer explains why many people elect to remain in therapy after their lives begin to settle down and improve.

Q: Can’t you be more specific about when I should consider psychotherapy?

A:Sure. You should consider it if you have any of the experiences below regularly enough to seriously influence the quality of your life:

Feel stressed, depressed, or hopeless.

Are unhappy with your marriage.

Need help for your child who is in trouble with the law or at school.

Have eating, sleeping, or sexual problems.

Are involved in an abusive relationship.

Are struggling with your own impending death or the death of someone you love.

Are concerned about alcohol or drug use.

Experience profound mood swings.

Think about suicide.

Are overwhelmed by fear or worry.

Feel like you are wasting your life away.

Behave in self-destructive ways.

Feel deep dissatisfaction with your job.

Wonder about the meaning and direction of your life.

Are often sick or have chronic health problems (headaches, digestive problems, back pain)

Are undergoing divorce or separation.

Have survived an unusually terrible trauma or accident.

Have unexplained fatigue or lack of motivation.

Q. What's the difference between a psychologist, psychiatrist, social worker, and counselor?

A.At the conclusion of their training, there are considerable differences, at least in California:

Psychologist: 4 years undergraduate psychology major (B.A. degree) + 4-6 years graduate school in psychology (M.A. & Ph.D.) +2 years supervised experience in the field leading to licensure as a "Psychologist"

Psychiatrist: 4 years undergraduate science major (B.S. degree) + 4 years of medical school (M.D. degree)+ 1 year internship leading to licensure as a "Physician and Surgeon" + 2 years psychiatric residency (mostly hospital-based supervised experience with some classes) leading to designation "Board Eligible" in psychiatry

Social Worker: 4 year undergraduate social work major (B.A. degree) + 2 years graduate school (M.S.W.) + 2 years supervised experience in the field leading to licensure as "Licensed Clinical Social Worker (L.C.S.W.)"

Counselor: 4 year undergraduate unspecified major (B.A. degree) + 2 years graduate school (M.A.)+ 2 years supervised field experience leading to licensure as "Marriage, Family and Child Counselor (M.F.C.C.)"

After 10 years of full time practice, the differences are not nearly as great. Even then, there is no question that the psychologists will the most knowledgeable about the science of human behavior and the psychiatrists will be the most knowledgeable about medicines. All other things being equal, if you don't believe you will need to be hospitalized, I recommend starting with a psychologist; if you do think you will require hospitalization, start with a psychiatrist.

Q: Why are some people so opposed to therapy?

A:Since I believe in psychotherapy, I am probably not the best person to answer this question but I will try it anyway. In the main, people opposed to psychotherapy believe that people who seek therapy are, or will at least be labeled as, "crazy" or "sick." They think it is shameful or "weak" to go to therapy because they do not believe an adequate adult should need anyone’s help in dealing with life. Many people have had bad experiences with incompetent, even damaging therapists or they have been told about such experiences from family or friends. None of these concerns is totally without justification and all may be accurate as far as a given individual’s personal experience dictates. My experience dictates much differently or I would not be a therapist. I can tell you first hand from being a patient, psychotherapy works!  It has been my experience that even when you are the epitome of mental health (whatever that is), if you leave yourself unattended for too long a period of time, you are likely to experience your most important relationships in serious disrepair and that you have lost touch with the essence, dignity and meaning of your life. None of us can do life by ourselves: If you do not believe me, look for a well adjusted, clear thinking hermit.

Q: How will I know a good therapist if I find one?

A:It depends on the therapist you ask.   Since you ask me, I think hiring a psychotherapist isn't that much different from hiring a wilderness guide for an extended trip through uncharted and unknown country.   It could be it won't much matter or it could be no less than a matter of life and death whom you pick.   You should be able to answer "yes" to 95% (a high "A") of the questions on the following quiz.  Why settle for less?

Is warm, accepting and has a sense of humor? Rigid, cold, or rejecting therapists are more likely to injure than heal their clients. Do not mistake rejecting or indifferent silence for "appropriate professional distance." Remember that the most critical factor in your successful therapy is the development of a positive, trusting, warm, and understanding relationship between you and your therapist. You cannot draw any more comfort from a therapeutic relationship than you can invest trust.

Is emotionally healthy? Make sure your therapist feels at ease with himself or herself. If you detect an affectation in voice or mannerisms, find someone who is real. If you see signs of debilitating depression, nervousness, or insecurity; look around some more. You want to work with someone whose own life is evidence that therapy can be useful.

Is aware that psychotherapy is a process done with the client, not to the client or on the client? To restate: therapy is done with you, not on you or to you. The therapist is not the "well one" and you the "sick one." The fact is that all participants in therapy sessions, clients and therapists alike, are all in life together and none of us was born with an instruction book delineating objective reality or subjective propriety. Nobody knows for sure how we are supposed to be.

Is willing to tell you the truth when you ask, even if the answer is not positive? Useful therapists do not lie to their clients or "tell them what they want to hear." False reassurances, even when well intended, are dirty tricks because they set clients up for future disappointments. Besides, how can you trust good news from your therapist if you believe he or she lied to you about bad news? On the other hand, if your therapist seems to enjoy breaking bad news in response to your questions, or worse, volunteers bad news with an obvious pleasure, Uh Oh!

Is similar in fundamental values with you? Fundamental social, moral and spiritual values shared with your therapist will generally be an advantage in therapy. It is okay to ask a prospective therapist about his/her views on issues that are important to you. A therapist's views do not have to be identical to your own but it will not be productive to work with a therapist you know you cannot respect from the outset.

Is open and knowledgeable about the benefits and limitations of both "talk therapy" and "drug therapy?" Be wary of practitioners who are biased against either of these mainstream often complementary approaches to reducing distressing inner experiences that interfere with the quality of life. Suffering and pain are not necessarily character building. You are entitled to know what treatment options are available and none should be shoved down your throat. The decision about taking any medications or what personal issues to talk about is ultimately your responsibility and your prerogative because you, not your therapist, has to live with the outcome.

Is useful to clients? The best way to find a therapist who is useful is by getting a referral from someone you know whose life has improved as a result of his or her experience in therapy. Therapy should produce some results within a few months—it should not take years to sense any change is taking place.

Is supportive of "informational interviews (shopping around)" to find a therapist or getting a second opinion during treatment?  What is there to say about a therapist who is incapable of considering someone else might be more appropriate for your needs or might have a fresh, more useful idea about your treatment?

Is not a cliché therapist? If a prospective therapist relies on  overly simplistic terms or vague "psycho-babble," it is not a particularly good sign.  In my experience, the therapists who are most useful to their clients rarely depend on trendy or cliché ridden language and speak just like regular people.

Is interested in you and not just diseases he or she thinks they know how to cure? A therapist should be interested in what you have to say and not too eager to rush to interpret your behavior.  A therapist   who becomes argumentative with you when you decline to accept his or her interpretation may not be as useful to you as a therapist who recognizes you are the ultimate authority on yourself and who works with you to discover what you can't see you can't see.

Is clear about legal and ethical issues related to the practice of psychotherapy? Your therapist should inform you about the limits of confidentiality; your rights as a client, including prohibitions of dual relationships; the fee arrangement; and the risks associated with various treatments.

Is willing to talk to you on the telephone in between sessions in times of necessity or crisis? While it is true that a great deal of potentially significant information is lost when communicating by telephone, sometimes there is no substitute for this form of communication.

Is kind and authentic in the therapeutic relationship and maintains clear and appropriate boundaries? Your therapist should leave you free to engage in your personal and professional life without regard for its effect on the therapist or the strength of your therapeutic relationship. It is for this reason that therapists refrain from sexual or business relationships with their clients. It is also why they do not become social friends, at least in the conventional use of the word. In all these types of relationships, there is an implied reciprocity whose absence may indicate the hallmark of exploitation. You should not have the burden of this reciprocity in your relationship with your therapist nor should your therapist put your therapeutic relationship at risk by interjecting him or herself into your personal or professional life unnecessarily. Even when therapists’ and clients’ motives are beyond reproach, it is not fair for therapists to ask their clients to risk everything, even if the client initiates the request to do so. In the case of sexual relationships, the law specifically prohibits therapists from treating clients with whom they have had sexual relations in the past; it prohibits therapists from having sexual relations with clients while they are in treatment; and it prohibits therapists from having sexual relations with former clients after treatment has concluded.

Is active and engaged in the session? You are entitled to a therapist that is responsive. Many therapists justify avoiding discussions or answering questions in a session in the name of preserving a therapeutic "blank wall." If sitting by yourself, talking to yourself, about yourself, was helpful; there would be no need for therapists.  Well, that's my opinion anyway.   Instead, I interpret the "blank wall" more as a metaphor reflecting the value of a therapist maintaining a general neutrality so as not to impede the spontaneity of what the client will discuss and to provide the best context in which to provide occasional interpretations of the client’s inner experiences and behavior.

Is educated, trained, and licensed conforming to the ethical and legal standards of his or her profession? These qualities do not guarantee high quality of service but they do set minimum standards for a therapist. It is important to work with a therapist whose qualifications you understand and respect.  You are entitled to, and you should make, an unhurried examination of a prospective therapist’s academic degrees and state licenses. These documents should be in plain view somewhere in the therapist’s office.  All other things being equal (and they never are!), the more academically and developmentally appropriate a prospective therapist’s credentials, the better.

Is able to communicate as well with parents as with their teen-age children? Many therapists ignore the rights of parents to participate in therapy. Parents know many important facts about their own kids. A good therapist wants parents involved in a young person’s therapy because the parents have a great deal of information about what goes on with their teen-ager outside the therapist's office. A delicate balance must be reached between respecting adolescents’ privacy and including parents the process of therapy.

Is flexible about who can be part of therapy sessions? Isolation is not part of healing.  Besides, should you feel the need arise, it would be disrespectful and presumptuous for a therapist to refuse to meet at least once with family members or friends you think it is important your therapist should meet.

Is fair and realistic about money and the policies associated with it? A fair fee should not be exorbitant nor should it only represent the relationship between supply and demand in the marketplace (all the traffic will allow).  Along the same lines, your therapist should have a reasonable cancellation policy. If you are to be charged for a cancelled appointment, it is reasonable to at least be given an opportunity for a free "make up" appointment if the therapist has an available opening during normal business hours of the same week.

Is as interested in your day to day pressures (i.e. a harassing boss, acting out adolescent, a long commute, marital tension) as with your childhood memories and inner experiences? It would be dramatic if psychological insight solved every problem and came from discovering a "smoking gun" event buried deep in your childhood memories; that’s why you see it portrayed that way in the movies.  In real life, it's a lot more complicated than that and life's events can seriously interfere with the quality of your life no matter how well integrated you are.

Is kind and reliable? To have appropriate boundaries and maintain a therapeutic neutrality that is useful, no therapist has to surrender his or her capacity for human kindness or decency; no therapist is required to pretend he or she has no human emotion or personal history to be effective with clients. Instead, the prerequisites for any useful psychotherapeutic relationship are that the therapist must have genuine (as opposed to affected) respect for the client, the therapist must be genuinely respectful of the client’s essential human dignities at all times; and the therapist must be emotionally dependable. In other words, a good therapist must be kind and reliable. Even if a therapist is very confrontational, it should not be done with unkindness nor should it be only because of the therapist having a "bad day."  When a therapist is having that bad a day (and being human, those days do happen), he or she has the obligation to reschedule your session rather than impose his or her emotional problems on you.  Life is hard enough.

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