What to expect in therapy

After the question how much, the question how long is often asked. How long will this take, how long do I have to come?  It’s a fair question, but not always easy to answer. If you enter a program, such as an addiction treatment program, you are usually given an expected length of stay, such as 5 days, 3 weeks, 2-5 months. This should be based on accomplishing the goals of treatment, or your treatment plan.

In individual therapy, the length of treatment is not as clear. It depends on what issues you wish to resolve, and how long it takes to resolve them. It is based on the definition of “resolve” that you and your therapist work out.  Does resolve mean the issue is completely gone from you life? Does resolve mean you can function relatively well on a daily basis, but still have some occasional, lingering emotional distress.

It can also depend on the type of therapy and therapeutic process just a few of which are: cognitive therapy, brief therapy, solution focused, psychodynamic, hypnosis, DBT (dialectical behavioral therapy).

Most of the time, I see clients between 6 months to two years.  Again, that depends on what your goals are, and what the problems you want to resolve are. After the acute stage, the crisis or final straw that brings you to therapy is managed,  the next stages of healing can be the focus.  Maintainance and ongoing support continue as long as it is beneficial to the you.  This is evaluated and discussed as therapy continues.  It is optimal that you and I, client and therapist agree when it is time to close, and set the goal to complete the treatment.

Sometimes, a “refresher” helps someone get through a tough time, or as my therapist used to say tripping over a wrinkle in the carpet.   Sometimes, you, a client, needs a break to process information, to practice living life with new ideas, coping skills and emotional clarity. I have client who came for therapy for about a year. She felt that she had gotten what she needed. She returned to treatment about 8 months later, ready to deal with the next “layer” of healing.  She commented that she feels that she is making progress so much faster now than during the first year. Indeed, she seems to be taking quantum leaps in emotional healing.  What a joy to be along on her journey!

Some clients may find that psychotherapy, or even addictions treatment is not what they need. They need support and feedback on another level, a level that has to do with personal growth and little to do with a “diagnosis”.  For these clients, coaching, or life coaching is a good fit.  More about coaching in future posts. Maybe it’s for you!

To your well-being!

Empowerment through choice

It’s about choice. Especially when it comes to mental health care. We have become captives of our health plans, thinking that we can only choose from within the network. On the medical side, there are more choices, but not always when you get to specialists. On the mental health side, it gets even more complicated, which is a shame, since most folks seeking therapy, at least initially, are especially fragile and vulnerable.

To be an empowered consumer, you need to be informed. Know your benefits. If you aren’t sure, then call your insurance carrier, and ask questions. Some information you need know:

What is my coverage for mental health, inpatient and outpatient? Does this include family therapy?

What is my coverage for substance abuse and alcoholism treatment, inpatient and outpatient?

What level of therapist is covered: psychiatrist, psychologist, social worker, licensed professional counselor, addictions counselor?

How many sessions per year? Is there a lifetime maximum?

How are biologically based diagnoses covered?

Do I have out of network services to cover a therapist who is not in your network?

What is my deductible for in-network services? Out of network services?

What are my co-pays for in-network services? Out of network services? If it is a percentage, what does that translate into in dollars out of my pocket?

Do the sessions have to be pre-certified or pre-authorized? If so, how do I get more sessions authorized?

 

Some very good therapists are in the networks. Not all therapist are in all networks.  Some are not in any network. It is not easy to pick a therapist. You have more choices than to have to pick a name from a list. Many people prefer to go to someone who has been recommended to them by a friend, co-worker or family member. That therapist may not be in your network, but may be the best fit for you. That’s about choice, and about empowerment. And sometimes, we need to pay a little extra for the choices and empowerment.  It is almost always worth it.

Psycho what?

Sometimes people ask me what I do. Often, when I say I am a therapist, they ask what kind of therapist: massage? physical? No, I tell me, psychotherapist. Ohhhhhhh, I see, they murmur, as they slowly back away from me. I think some people get hung up on the “psycho” part. And if they are saavy enough, they may ask my specialty. And when I say addictions, if I am lucky, I get a chuckle and a story; sometimes I am suddenly standing alone.

Okay, it’s not always that bad, but some folks do think that therapy is for crazy people. The politically correct term would be Mentally Ill. Mentall Illness occurs on a spectrum from mild to severe, but is not the only reason someone would seek out therapy. Problems with addictions is one reason, whether you are an addict or alcoholic looking to stop using, or a a family member who is affected by addiction in the family.  A crisis or change in life circumstances is what brings many people in to therapy, where they can talk in a safe place, and develop emotional skills to bring their life back into balance.

Stress is a big reason someone might seek out psychotherapy. Life in general can be stressful, and techniques for dealing with stress make life easier. Just listening to the news today is especially stressful, to say nothing of talking to the neighbors and finding out who lost their job this week. And wondering if you are next. Or watching prices go up. Of worrying about the future for your children. Or just the overwhelming choices we face everyday, and to fit in all that we have committed to.  What if you have a child, or spouse or good friend heading for Iraq or Afghanistan? And…..well, I am sure you can fill in the blank for yourself.

One tip for dealing with stress is to learn to breathe. No, I mean really breathe. We tend to be high chest breathers, somewhat shallow breathing. If you take yoga or meditation classes, you are introduced to breathing. You can learn to breathe deeply, more slowly, giving your body more oxygen when the blood flows. A few deep, slow breaths can clear you head, even energize you.

Don’t think you have the time?   Make the time; it’s easier than you think. How about 5 minutes at your desk, instead of jumping up for a cup of coffee at break time, take off your shoes, sit back in your chair, drop your shoulders while you close your eyes and take in a deep breath. Slowly fill your lungs, count 1 to 5. Then slowly release the breath, counting back 5 to 1. Ahhhhhhhhh. Do that a few times, then open you eyes, put your shoes back on, and get on with the day.

Welcome to my office!

Last Monday was a snowy, winter wonderland in Northern NJ, again. A great day to snuggle in and prorastinate. Alas, now the snow is melted and spring is in the air,so there is no excuse to procrastinate. So without further ado, Welcome to my office!

 

This is the door of my main office; I do have a home office in Vernon, if you live in that area. The main office is located in Montville Twp, in the town on Pine Brook, NJ at 339 Changbridge Road.  As you can see, I have a few partners, who offers a variety of services, including DBT, Holistic Health Counseling, and child psychology.

 

 

The waiting room is open and airy, and you can make yourself a cup of coffee or herbal tea while you wait.  Waiting time is usually short, as I book one appointment every hour.

 

I am very excited that we recently expanded, which gave us a larger waiting area, and a nice sized multi-purpose room; where we offer group therapy, training and personal growth seminars and workshops.

Keeping it simple

That is the best way I can think to start blogging. Just setting up a blog is exciting and a little overwhelming!  So many options, so many directions, so many distractions!

So, to keep it simple, I’ll start with some basics about addiction and options and opportunities for moving into recovery.

As far a language and defintions, I will use the word addict to include those addicted to all drugs, including alcohol will strive to speak in gender neutral language.

One definition of addiction is the inabilty to stop using substances in spite of negative consequences. This can apply to self-destructive behaviors, such as gambling and overeating. The negative consequences generally continue to escalate, and the risks of continuing to use increase.

The concept of recovery also has many descriptions and definitions. Probably the simplest expectation is abstinence. A better description of recovery is the journey of getting and remaining abstinent, and is a more active experience. It is a time of enlightenment and joy, of struggle and self-acceptance. And a time when a support network is imperative.

A support network varies from person to person, but includes other sober and recovery people, family and friends. Friends and family often want to help and support, but don’t know how. They have their own recovery process, and need to learn more about addiction and recovery, the addict’s and their own.

Traditional recovery programs are 12-step based, and introduce addicts to 12-step recovery programs, such as AA and NA, to support their ongoing abstinence and recovery efforts. Other programs exist that are not 12-step based, and are often not in insurance networks; some are not in for good reasons, but others could benefit those for whom 12-step is not successful or of interest.

I fear this a somewhat heretical statement for me, as my initial training was in 12-step recovery programs. Over the years, I have seen many clients, in program and in my private practice succeed utilizing 12-step recovery programs. Others have not, for a variety of reasons. In the “old days” , these clients were told they were failures, that even if they were abstinent, they would fail if they did not embrace 12-step programs.; that they were “dry drunks.”Some did fail; other succeeded, and developed a solid pattern of abstinence, and a rewarding, successful life.

So which is the best approach? That varies from individual to individual. In my experience, the one factor that determines whether or not a person succeeds is a desire to do so. That is, that the person wants to recover. Can willpower alone do it? Maybe for some. It is more the concept of willingness, a willingness to do whatever it takes, to get on and stay on the path of recovery.

 

Suggested Readings:

AA and NA literature

The Tao of Sobriety by David Gregson and Jay S. Efran, PH.D.

Mindful Recovery: A Spiritual Path to Healing from Addictions by Thomas and Beverly Bien

The Thirst for Wholeness: Attachment, Addiction, and the Spiritual Path by Christina Grof

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