A few other things have occurred to me since I wrote the original blog, What Private Practice Therapists Wish You Knew. Listening to other clinicians, and facing some of these frustrating challenges myself, I figured it was worth another PSA to just put it out there. So, join me one more time for an enlightening journey into my thoughts and feelings, most of which I share with my peers in private practice.
I Am Not A Talk Therapist
Talking helps but it isn't going to solve your problems or create major changes in your life. My job, as I see it, is not to sit here and nod while you vent and occasionally ask you how that makes you feel (as television would have us do). Some therapists do this. I do not. I think it's bogus. I think it's a waste of our time together. I consider myself more of a proactive therapist; I'm here to help you facilitate your own growth by giving you education and tools and by challenging your thoughts and expanding your perception and I spend a ton of hours every year getting trained in the latest treatment modalities. Don't get me wrong, sometimes venting is what we need at the moment but that can't be the only thing we do. That's not helpful for you in the long run.
The way I see it, even PTSD is treatable. It is NOT the death sentence it has been perceived as for decades. I am trained to help you heal these wounds and you can heal from it. But you have to want it. I can't make you want it. There are many types of effective treatments for trauma but just talking about it is not one of them (if that worked venting to friends would put me out of business). So when you go to find a new therapist or are looking to start for the very first time, think about what it is that you want and ask the therapist if that is what they do but also understand that your therapist is (hopefully) highly trained and can tell you what is most effective. But, in the end, we can't force you to do something you don't want to do.
2. I Am Not An Adult Daycare
People may think that they want help but if you show up to therapy and you find an inner resistance to going deep or perhaps you've decided that your past doesn't need to be looked at and your symptoms aren't that bad, then maybe just forgo therapy until you're ready. In the interim, I'm not a placeholder for a lack of socialization. It might sound harsh, but my job is to help you process difficult traumas, give you skills to cope with your triggers, and guide you into a better relationship with yourself. If you're lonely, I can help you explore those emotions, and give you resources to meet people and tools to improve your social skills but I am not going to be the solution to your situation. I'm not here to adult-sit and I can't be your friend. I'm your therapist. It would be a waste of both of our time to entertain hours of chit-chat instead of actual therapy work and I'm going to continuously try to divert you back to the reason that you came to counseling. However, if that still doesn't work, I'm going to have to have a difficult conversation with you and it may end in us parting ways. While I wholeheartedly appreciate that you enjoy my company (an important part of the client-counselor relationship), company can't be the only role I play.
3. PLEASE Listen to The Voicemail Message
It's pretty amazing how many people don't listen to what a therapist's voicemail says and I get it, you're not feeling great and many of you are probably anxious to even pick up the phone. It takes a lot of courage to reach out for help but oftentimes our voicemail has very important info for you and you may be missing it. Recently, I changed my voicemail to say that I was only accepting clients who could be seen before 4 pm and that if they wanted to make an appointment to please email me. This was meant to cut down the time it takes to try to get in touch with someone by phone because I don't have a lot of time for phone conversations and I don't do consults anymore. I got a lot of messages saying they wanted me to call them back. I'm not the only one who feels frustrated by this. Other clinicians struggle with finding time to return phone calls especially when they've notated that they are not taking new clients but now feel obligated to call you back just to repeat that. Listening to what the voicemail prompts say could mean the difference between you getting help or not.
4. Boundaries, Boundaries, Boundaries
It's not personal. It's important. When you speak to a therapist about setting up an appointment consider your expectations. If a therapist says she has Tuesday and Wednesday to talk in order to coordinate services, she has Tuesday and Wednesday. Don't ask them for Monday. This isn't an auction where you keep calling out things to see if they bite. We don't haggle.
Some of the things people feel free to negotiate with therapists they would never dream of saying to a medical doctor or even their dentist. And while the relationship is slightly more warm and fuzzy than with your GP, this is still a business. Businesses have boundaries. If I tell you what my fee is for out-of-pocket services and you ask for a reduced rate, please do not take that personally when you're told that I can't do that. You may have a personal reason for needing the reduced fee but that doesn't necessarily inform our business decisions. Many therapists do have reduced rates, but those slots may be limited because if we reduced everyone's fee then we might not be able to sustain a healthy business. And while we are in the business of helping people, we are also in the business of showing healthy boundaries and part of that is not sacrificing our time, energy, and financial health beyond our business model and at the expense of our personal lives.
This may end up becoming an ongoing segment because I feel that the business of therapy, what therapy is, and how it works are widely misunderstood, and the expectations that the public has of how they should be served may be unrealistic and lacking clarity. I do not want to seem apathetic, that could be farther from the truth. But, I do want to normalize that your therapist is trying to run a business in order to create a life for themselves just like anyone else. At the same time, we want to make it easier for you to make decisions that are best for you with regard to your mental health care but you have to meet us halfway.