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Clinical Commentary: 10 Things Therapists Won't Tell You

8/9/2013

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I recently read an article that purportedly exposed therapists' secrets. You can read the entire article HERE. In this post, I am going to list the 10 things from the article and respond to each. From my perspective, the author's approach was to describe a worst-case scenario, and then generalize it to the entire field of psychotherapy. Let's get started:

1) “Your childhood was bad? Wait till you see your bill."

Most psychologists have a set hourly fee and this is almost always discussed during the initial phone consultation or certainly during the first session. On top of that, if you have insurance, you usually pay a fraction of the hourly rate.


2) “I may not have any training."

Does not apply to psychologists for the most part. All licensed psychologists are required to display their education and license in their office. All are required to earn continued education credits as well. A great question to ask a therapist is the type and length of their training.

3) “Will you ever stop talking?”

This one is somewhat funny as the article mentioned a therapist falling asleep during a session. I have honestly never asked myself "Will you ever stop talking?" However, I have thought, "This person is talking alot about non-issues, are they avoiding real issues?"

4) “I need you more than you need me.” 

The author suggests some therapist may drag therapy along for financial gain. Maybe this happens (saddens me to say that), but you always have the final say in your therapy. A therapist can't force you to continue therapy. Have goals for therapy and regularly review those goals with your therapist. If you aren't making progress, maybe it's time for change.


5) “Your secret is (sort of) safe with me.”“Maybe I’m the one who needs therapy.”

There was a saying in graduate school, "Research is MEsearch." I'm sure many folks chose the field of psychology because of their own background. I actually am a believer that all therapists should seek therapy for two reasons: 1) It's important to know what it's like to sit in the patient chair 2) It's important to know your own psychological makeup. 


6) “A morning run might work just as well.”

I actually agree with this idea and regularly encourage patients to find the relationship between their emotional and physical health. I know for me personally, exercising is directly associated with my emotional state, energy level, and self-esteem.

7) “I don’t have to practice what I preach.”

The author is referencing the idea that therapists should have to undergo therapy. I addressed this in #5.

8) “Your secret is (sort of) safe with me.”

One of the many things discussed during the first session is confidentiality. Whatever is discussed in session is confidential with a few exceptions: If there is an imminent threat to yourself or other(s), alleged child or elderly abuse, or in some legal situations. I am mandated by law to ensure the safety of the patient and citizens. If I ever share confidential information (which is rare), I always notify the patient ahead of time.

9) “I’ll be there for you, but your insurance might not.”

Unfortunately this is somewhat true. Things are improving, especially with the Mental Health Parity and Addiction Equity Act. However at the end of the day, insurance companies play a large role in treatment. Sad state of affairs, in my opinion. I'll say more about insurance companies in a later post.

10) “Time’s up. Here’s a pill.”

This refers to psychiatrist and not psychologists, as the latter do not have prescribing privileges. My personal opinion is medication is a very last resort, after at least a year of therapy. The exception is if there is some sort of immediate issue where medication can stabilize the individual.

As usual feel free to share via facebook, twitter, etc. Comments are appreciated.
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    Salmaan Toor is a licensed clinical psychologist practicing in Knoxville, TN.

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