photoHave you ever been in therapy? If so, what did you like about it? What did you dislike about it?

Psychotherapy isn’t as cut and dry as it may appear to some. You don’t just go in to an office and talk. You can do that with a friend. Psychotherapy includes the building of a professional relationship with boundaries and goals of the client to improve, learn, and grow. It is a relationship in which the therapist, trained for many years, listens and watches the client to psycho-analyze or evaluate need, barriers, and challenges. It is a limited relationship due to the power differential, knowledge obtained, and ethical as well as legal limits.

Sadly for some, it is not a friendship, a personal relationship, or a balanced relationship.

This article will discuss 12 misconceptions about therapy with the goal of encouraging you to think more realistically about the process.

I love my position as a therapist. I enjoy my career. A lot of therapists enjoy what they do which is why some chose it in the first place. It is rewarding to say the least. But what really inspires me about my field of study is the power of the therapeutic relationship to facilitate healing, peace of mind, and change. Many of my clients have come to therapy hoping for a change but feeling discouraged by previous experiences in therapy. I have sat across from them asking myself what contribution can I make to their lives. As the relationship begins to unfold I am able to see the client’s deep needs, fears, desires, and even misconceptions about therapy.

I have made it my habit to discuss, during the first session, what therapy is going to look like and the approach I am going to take for their situation. This has become a very important part of psychotherapy because many people come to sessions with all kind of incorrect perceptions and beliefs. One incorrect assumption is that therapy with “cure.” Therapy is one of many tools used to support and facilitate growth.

I have listed below a few common misconceptions or incorrect views that I have come in contact with through clients:

  1. Therapy is short-term: Sigmund Freud was a strong supporter of long-term psychotherapy. He was of the belief that therapy takes a long time to work through due to defense mechanisms, “fights” between the ID, Ego, and Superego, as well as a host of other things. It is important to understand that therapy can be both short-term and long-term depending on the need for treatment and the presenting concern (i.e., problem). I have worked in a variety of capacities over the past 10 years in which therapy took 30-90 days, 1 year, 7 weeks, and even 18 months. It is a good idea to ask your therapist or the therapist you are interested in how long they believe, based on what you have shared with them, therapy would take. Some will give you an estimated amount of time, while others will say they don’t know.
  2. Therapy is for the “client” only: I have met with many families who believe the person they are bringing to therapy each week is the “patient” and not them. Sadly, families forget that they function very much like a machine. Each independent person has an affect on the other and when something is going wrong in the entire system, one part of that system may suffer the most. Take, for example, the functionality of a car. Although your car’s gas-line may be going bad, the engine may also be affected because the engine and the gas-line are connected in some fashion. The same is true for families. The “client” being brought to therapy may have challenges, but so too does the rest of the family in most cases.
  3. Referral means rejection: I have had to refer many clients out for further treatment, more intensive treatment, or treatment better fitted to their needs. Fortunately, I have only had to deal with a handful of clients who did not like the fact that I had to refer them out to someone else. But for some therapists, clients can struggle with this, especially if the client has been with the therapist for years. Therapy is an ongoing process that can often be derailed by a lot of things including changes in the client or therapist’s life, moods or feelings, preconceived notions about the relationship, burnout, and feelings of being stuck. When this happens, some therapists refer out because treatment has become stagnated by these things which means the client will not make progress. Sometimes referral is healthy and does not mean anything personal.
  4. Hospitalization (302) from therapist means they dislike you: Hospitalization is often a means to a better end for clients who are severely in need of care. Good therapists know when to hospitalize a client against his or her will. Hospitals will never admit a client to the hospital on the basis that the client “might harm” themselves. Clients are admitted against their will when there is firm evidence that the client needs immediate attention to keep themselves safe. Hospitalization against a client’s will is almost always in the best interest of the client or others who may be in danger. A therapist cannot hospitalize a client based on the fact that “they don’t like me.” The bottom line is always safety.
  5. Anyone with a degree and title is professional: I have always been of the firm belief that professionalism is internal, not external. What I mean by this is that a person cannot be “professional” or “appropriate” unless they live their lives in a fashion that maintains the principles of professionalism and appropriateness. A professional attitude, respect for self and others, grace, maturity, and appropriateness all seem to be personality traits that are strengthened after we are taught the value of displaying these traits in the world.  An example of this may be when a teen is trained on the job to politely and respectfully greet customers but goes home to a family that supports these same pro-social behaviors. My mother raised her children to be respectful, kind, and gracious. Once I got my first job in college, I continued those behaviors while learning how to be “professional.” Someone with a title of “therapist” or “mental health professional” and a degree should demonstrate grace as  a person despite their achievements. Always evaluate the person based on the character traits they display.
  6. Absence of negative reviews means therapist is good: I have heard many people say “if there are no bad reviews then they must be okay. No news is good news.” Wrong! Lets face it. Some people simply do not have time or the energy to write reviews (good or bad). Some people, when they are very angered by someone, will report a provider to the appropriate authority and possibly leave a review comment online. But most people don’t have time or see the sense in doing so. No reviews under a therapist’s name does not always mean they are not harmful. I encourage you to be on the lookout for signs that may signal the therapist isn’t properly trained.
  7. Therapist’s serve me and things go my way: Sadly, some people approach mental health providers with an arrogant attitude. They believe that they should get everything (including medication and abrasive procedures) that they want just because they ask for it. A mental health provider or therapist is the authority in the relationship working with you in a teamwork fashion. It is okay for you to suggest things, bring things up to discuss and evaluate, or ask questions. You are an educated partner in your care. But the moment a person starts acting as if they have the power and control over the provider, there’s a major problem with boundaries.
  8. It’s okay to argue with and force a therapist to do something: As stated above, you are a partner in your treatment but nothing more. The provider was trained and educated for a purpose. This doesn’t mean you have to just go along with everything. That’s not healthy! But what this does mean is that someone has been trained to understand things a little better than you which means you should always have an open mind. An open mind also should come with respect and grace toward the provider.
  9. We’re friends: Wouldn’t it be great to have a therapist as a friend? Some people have this luxury while others do not. Sadly, some clients attempt to make their therapist their friend out of emotional and psychological need. But this is unhealthy and will most likely never happen. The therapist has a position of authority over clients which causes a power differential. In other words, the authority the therapist has makes the relationship unequal and the client vulnerable. This is a very difficult reality for many clients who have bonded with their therapist. It was also difficult for me to conceptualize first starting out 10 years ago. I thought it wasn’t possible to help someone and not treat them like a friend. But I had to learn that boundaries are important in every relationship we have and that the client-therapist relationship should be the first relationship where boundaries are firm. You can have boundaries and still provide the support and compassion of a friend with limits.
  10. I can keep coming back even if I don’t pay: Payment for services is a must. The therapist has to have a way to be compensated for the time they spend in each session, preparing for sessions, and engaging in completing lots of clinical paperwork for the client. There is often a variety of duties therapist’s engage in before the client comes to therapy and after the client leaves. Payment for services is compensation for time spent doing these things. It is only fair that you compensate a person you highly respect and may need in your life. It’s a difficult topic for a therapist to have with a client because it can seem inconsiderate and uncaring. But the therapist should not be in a position of being taken advantage of. Some therapists resort to cancelling sessions or referring clients elsewhere when there is a long-standing challenge with payment of services.
  11. Therapy is long-term: As stated above, the duration of therapy will depend on a variety of things. In most cases, therapy is short-term ( 6months-1 year), especially modern day psychotherapy. In some situations, insurance will only pay for short-term therapy, believing that most clients can have their problems resolved in a matter of months.
  12. Therapy will continue as long as I need it to: Most therapists, based on what they are told by the client, set the duration of time for how long the client will need therapy. The goal of most therapists is to help a client resolve a problem and try their new found skills out in the real world without them. It’s almost like a car wash service. You begin the process by engaging in reviewing the issues and processing better ways to respond. Then you come out on the other side better than you were before. Resolution of challenges in full or in part is the goal.

 

What do you think about this misconceptions? Have you held some of them yourself? Can you think of something I may have missed?

As always, looking forward to speaking with you.

All the best

 References
 American Psychological Association. (n.d.). Myths versus Reality. Retrieved from, http://www.apa.org/helpcenter/psychotherapy-myths.aspx. 
Mohr, C.D,  Ho, J., Duffecy, J., Baron, G. K., Lehman, K.A.,  Jin, L., & Reifler. D.  Perceived Barriers to Psychological Treatments and Their Relationship to Depression.  Journal of Clinical Psychology 66 (4), 394-409: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907887/. 
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