On therapy – a Q&A with Dr. Andy Bernstein

This interview with Dr. Andy Bernstein from the Southern Arizona Psychological Association (SAPA) was conducted by Hilary T., Dusenberry-River Library and co-founding member of the Synapse Team.

From Dr. Bernstein:

All of these responses are my own personal views, and they are limited to seeking and working with therapists in the private sector.  Some responses are applicable to working with providers in the public mental health system, but that is generally a very different kind of help space, and one in which consumers have a bit less “freedom” to choose individual providers.

How can I find a therapist near me?

Two methods, other than looking at lists from your health insurance carrier, and asking friends and colleagues, are looking at the (1) Psychology Today website and (2) the SAPA website.

What if a therapist I would like to see doesn't take my insurance?

You can either pay their fees completely out-of-pocket, or try to find a different therapist who is in your plan’s network.  Some therapists who are not “in-network” can still be affordable if your insurance plan has an “out-of-network” benefit, which will reimburse you for some portion of the therapist’s fee.  In that case, you will most likely have to pay the therapist their whole fee up front, and then submit a claim form to your insurance for re-imbursement.  It would be wise to find out from your insurance how much they will “cover”.

How long do I need to wait typically to start therapy?

It depends almost completely on therapist availability, but also on what kind of flexibility you have with your own schedule.  There typically are fewer open “slots” in therapists’ practices for evening and weekend hours, and more for hours during the week.

What can I expect in the first session of therapy?

At the very least, there should be some discussion of the nature of the therapy relationship, the rules and limitations of confidentiality, and what situation is bringing you into therapy in the first place.  Also, perhaps, what kind of experience you’ve had in the past, if any, being in therapy. 

Is my information confidential? If I tell my therapist something personal, how do I know my therapist won't tell someone else?

Material discussed in a psychotherapy context is considered “protected health information,” and all therapists are bound by the rules and ethics of their profession related to maintaining client privacy and confidentiality. There are exceptions, however, and these need to be made clear at the outset. One exception is when someone indicates that they are seriously planning to hurt or kill someone, including themselves, and another is when a therapist learns or even suspects that a child or a vulnerable adult is being abused.  A therapist—like a teacher or any medical provider—is what is referred to as a "mandated reporter" in our state, which means that he or she has a legal responsibility to report child or vulnerable adult abuse to appropriate authorities, such as the Department of Child Safety or Adult Protective Services.  All of this should be discussed at the very beginning of a therapy relationship, so that you as the client or patient understand what is confidential and what is not.

How long will my therapy go on?

This depends on many factors, including what you are trying to accomplish by being in therapy as well as the kind of therapy the therapist does.  There are long- and short-term kinds of therapy, and doing some research about this is a good idea for people not familiar with therapy.  Also, what starts out as one goal in therapy sometimes morphs into another one, legitimately, as you begin to understand more and more about your situation and even your life.

What are the benefits of therapy?

When it goes well, you can feel more clear and resolved about issues you are struggling with or confused by, and you can even end up feeling empowered and more hopeful about many aspects of your life.  If you are in a great deal of distress about a situation, a relationship, or some other kind of personal challenge, a good therapy experience can help reduce this distress, but not necessarily in the first few sessions.  It can take time, especially if your difficulty has been chronic.  And sometimes people feel worse before they feel better, such as when they have not yet confronted or dealt with the magnitude or the implications of their problem(s).  Again, this depends on why you are in therapy in the first place. 

How can I tell if I am making progress?

You should be feeling better in some ways, or more clear about what your options are and how you can deal with what’s troubling you.  But it’s usually worth discussing this with the therapist, and hopefully coming to a joint understanding of how things are going.  Let a combination of your heart and your mind be your guide, however.

This therapist doesn't feel like a good match to me. What should I do next?

Two choices.  You can just decide unilaterally that it’s not working, and let the therapist know that you are going to stop coming, or you can bring up with the therapist your perception that it’s a bad match, and explain why you feel that way.  That takes some courage, insight, and self-confidence on your part, but it can sometimes lead to a valuable discussion around your expectations for getting help and how you experience and deal with unsatisfying relationships in general. 

A good therapist will generally not try to convince someone to stay in therapy with them if the person is really feeling strongly that it's not a good situation to be continuing, and many of us will suggest some alternative folks to try working with

Is it normal to feel afraid to start therapy?

Usually, at least a little bit, because presumably you are starting therapy out of a wish to change something in your life, and change is generally unsettling and often scary.  But if in the past you have had good experiences with therapy, and you are going to be working with someone who has been recommended by people you trust, then the fear factor can quickly be reduced, and some relief might actually take its place.