Maximizing Therapy

Maximizing Therapy

Person engaging in teletherapy

Have you wondered why excellent therapy can seem expensive?

Do you want to get the most out of the therapy process?

By the time a new therapist graduates from their masters program, they have spent more than 600 hours in graduate level classrooms taking courses dedicated to the art of helping people with life problems.  They have sweated almost 2000 hours on homework and completed 1000 hours of supervised internship.  All at a price tag of over $35,000 (minimum).  Upon graduation, they must work under supervision for at least two years, complete an additional 1500 hours of client service and pass a national competency exam.  When you show up in a therapist’s office, or log on to their teletherapy platform, you are meeting with a highly trained clinician who is there to help you reach your mental, emotional, and relational health goals.

Therapy is an investment in your future.  Since insurance companies will not cover therapy for life issues (there must be a mental health diagnosis), many pay for this vital care out-of-pocket.  Even with support for the cost, there is a significant investment of time establishing rapport with a therapist and digging in to the work.  With that in mind, here are tips for getting the most bang for your ‘buck’!

At Phenix, we generally follow a steady arc in therapy: establishing safety, deconstruction of the old story (how did we get here?), grieving and then constructing the new story.  We’ll look at tips for each stage but before we go there, here’s a foundational principle:

Recognize that therapy is just one hour out of 168 or one hour out of 336 if sessions are biweekly!  Clearly, a lifetime of thinking and behaving a certain way will not be fixed in such short bursts.  That means we must be ready to dedicate time outside of sessions to working on ourselves.

Establishing Safety –

  • Now is the time to be ruthless in clearing off your ‘plate’: Respectfully withdraw from commitments you don’t absolutely have to participate in.  Notify your friends and family that you will not be as available as before.  Setting boundaries poorly may be why you’ve come to therapy so this is a tough one.  Make short term changes (like putting off involvement in something for a few weeks instead of saying “no” all together) which will buy you time to build the muscles you’ll need for more sustainable transformation.
  • Focus on the basics: sleep, nutrition and movement.  Again, the point of therapy may be to get better at self care so take baby steps for now.  Try to get to bed at a consistent time, decide what you need to add to your diet (not take away) to feel good and find movement you actually enjoy – even if it is just for 10 minutes.
  • Be honest with your therapist.  Now is the time to share your concerns so that you can establish a strong working alliance.  They are your guides on what will be a difficult journey at times.  It is important you establish trust in their expertise and skill.
  • Try out the coping skills you and your therapist discuss so that you can determine what works for you and what doesn’t.  You don’t want to wait until you are in the thick of the process to figure this out.  Everybody is different and the possibilities are endless, so there is no substitute for testing things out.

Deconstruction of the old story –

  • Spend time between sessions reflecting on what you have discussed.  Your therapy hour is just the beginning of making sense of your story and connecting the dots as to why you think and/or behave the way you do.
  • Review the material your therapist gives you (books, podcasts, videos, etc.).  This is part of the process for understanding how you got to where you are.

Grieving –

  • Lean in to the discomfort.  This stage takes courage.  This is the stage when clients most often resist the therapist.  Despite the strong alliance they have built and the trust that has been established, all of a sudden, “maybe my therapist isn’t so great after all.  Why are they torturing me with this work?”  Trust the process, it will be worth it!
  • Avoid working on your process after dinnertime each day.  The end of your day should be spent winding down, not opening up Pandora’s box of emotion.
  • Experiment until you find a rhythm of self work time that works for you.  Perhaps a one-and-done session each week when everyone knows not to disturb you or maybe 20 minutes each morning.  It doesn’t matter the format – what matters most is consistency.

Constructing the new story –

  • This stage is about literally rewiring the brain.  That means your efforts will feel awkward and counter-intuitive and that is OK.
  • Your sessions will involve either learning new skills that you will need to cultivate on your own or generating plans for handling situations differently than you have before.  It’s all about action at this point so remind yourself constantly that different results demand different strategies.
  • Practice, practice, practice.  Practice makes progress.  Commit to take one baby step forward each day.  Nothing changes by coming to therapy and talking about it.  It changes when you leave the session and do things differently.  Therapy helps you break this down into manageable baby steps and strategize the most effective changes.

An excellent auto mechanic can easily garner upwards of $100 per hour to fix our cars.  We would consider it foolish to pay for their expertise, then do nothing to maintain the vehicle or prevent further issues.  Our health is far more valuable than our cars so we hope that this post inspires you to invest in yourself and maximize that investment for the best return!

 

 

Online Adventures

Over the years, I’ve worked with a number of therapists, beginning with a licensed social worker who was also a pastor at a local church.  Each one has walked a specific section of my journey with me, facilitating insight and clarity along the way.  Soon after arriving in Orlando, I worked with two different therapists during an exceedingly challenging time of my life.  As I ended 2017 in perhaps the best mental and emotional state I had experienced in years, I paradoxically sensed it was a good time to re-enter therapy.  I was facing several positive transitions and believed I had the emotional energy to tackle foundational concepts that would help me live life from the best level possible.  Though I did not have really specific issues I needed to resolve, I did know I wanted someone who would be able to sit with and explore whatever emerged.  Trouble was, all the therapists I knew who worked like that were my friends and so could not serve in this role.  My inquires for referrals turned up absolutely nothing that met my criteria.

I remembered one of my interns telling me he had experienced useful sessions online with Victor Yalom, the son of another therapist – Irwin Yalom who I admire in my approach to therapy – especially group work.  However, I had a skeptical view of online therapy:  I’m relational in my theoretical orientation – how on earth could there be great therapy in the absence of smell, touch, and the extra-sensory dynamics of physical presence I had come to rely on in terms of perceiving what clients were feeling?  As time wore on with no emerging options, I decided it couldn’t hurt to pursue the idea, even as a second-best one, and so I contacted Victor.  Many steps later, I started working with a therapist he recommended who lived in Paris – Anastasia – in January of 2018 and it was definitely the right decision!  Here was a humbling example of what I was teaching my students: Anastasia’s ability to connect with me, to hear what I wasn’t saying, to see the patterns beneath the stories I shared, mattered more than the method we were using to talk to each other. Yes, online therapy has its differences but what mattered was the therapist and his/her ability to build a relationship with the client regardless.  Wow!

Over the following months, I put aside my biases toward online therapy and considered its benefits: to English speakers living in non-English speaking countries, to individuals committed to deeper work but lacking therapy professionals in their part of the world, to my local clients with chronic illness who sometimes struggle to make it in to the office, to individuals like me across the state of FL who are looking for a specific therapeutic fit that they cannot find close by.

I happened to be visiting Paris some time later and so I had a session in person with Anastasia. I was shocked to find that it did not feel much different from the sessions we had been doing online. It was the final push I needed to start offering what I have received: greater accessibility to this business of going deeper.  I believe my experience as an online therapy client with a therapist who does it excellently is the best qualifier for providing this service but I am still pursuing specific training and education in this particular modality to ensure that I continue to grow.

2022 edit: How could I have known the benefit of this expansion?  It prepared us to transition to a fully online practice in March of 2020!  When you engage teletherapy with Phenix, you work with a team who truly believe in this modality.  Teletherapy offers major benefits when we are willing to explore the possibilities.  Your Phenix therapists have pursued the experiences and training necessary to maximize this exciting change in how healthcare is delivered.

Storm Sanity

I live in Orlando and so I am sitting here looking at reports showing Irma’s path headed directly toward us.  As I scan my social media news-feeds and talk to loved ones, it is clear that anxiety is high and coping skills are a must if we don’t want to end up losing a lot of sanity ground by the time this is all over.  I thought it would be helpful to explore ways to maintain our mental/emotional health through this storm.

As soon as you figure out where you will spend the storm – in place, at a shelter, with friends or completely out of town – make a plan for maintaining good sleep, nutrition and movement.  These are the first things to go in circumstances like these…we eat food that leaves us feeling terrible, barely move and sleep either too much or too little.  It just happens because we get caught up in the urgency of the moments and/or the confusion of the aftermath.  Make sure you have food options on hand that make your body feel good, figure out a reasonable sleep schedule you can stick to throughout your stay and brainstorm ways to get some movement in every day – whether it’s using the (non-electric) equipment you have in place, simple callisthenic movements like jumping jacks or adventure walks outside once the storm clears.  Get on Pinterest now while you can to find movement ideas that will work with the circumstances you’re in.

Make sure you have resources and materials in place to manage your emotions.  How do you think you will feel during this experience?  What are the things you normally need when you feel like that?  (Art supplies, journals, stress balls, stuffed animals, pets, etc.?) How can you adjust those strategies to your lock-down situation?  When you are stressed, upset or overwhelmed, you will not have the mental resources to figure these things out.  Do it now so you have a plan to express and manage your emotions.  Here’s a worksheet you may find helpful:

emotion management

This is not the time to play lone ranger.  Reach out.  Arrange to be with others throughout this experience if at all possible.  Don’t assume that family is your only option if you know they drive you crazy on a regular day.  Can you imagine being locked up with them for days in a stressful situation?  Think about your social circle…Who are the healthiest people in your life?  Gravitate to them first.  Yes, take some time each day to be alone…to breathe and to think but make sure you stay connected to share your thoughts and feelings with others.

Finally, pay attention to what you expose your mind to.  Limit time on social media if it is filled with folks in a frenzy.  Watch the news/weather channel only long enough to hear time estimates of the storm’s approach.  Do internet searches for any specific information you may need for your preparation efforts – rather than watching TV endlessly, waiting to learn “everything”.  Avoid conversations with those who will only increase your stress and anxiety about this storm.  Decide now what reasonable truths you need to focus on.  Find resources that will align with those truths – write them down if you have to….whatever you have to do to ensure that what is coming at you repeatedly will be functional, encouraging and helpful!

 

 

 

I’ve never been in therapy…

We often get our view of reality from television but it only takes one hospital visit to learn that real life is not like Grey’s Anatomy.  Likewise, if you’ve never been to therapy, it’s a dangerous plan to assume it might be what you’ve seen portrayed on TV or in movies.  So, what can you expect? First of all, you don’t need a mental health disorder to come to therapy.  In actuality, most people seek counseling for a host of regular life problems: relationship struggles, major life transitions, parenting challenges, etc.  Yes, there will be questions to determine the severity of the issues you are facing but your therapist does not see you as “sick” or “crazy”.  A good therapist regularly sees her or his own counselor, for that matter.

Choosing the right therapist has two components: First – finding someone with the appropriate knowledge and skill for your particular concerns.  Second – finding someone with whom you have a personal chemistry.  That second component is tricky as it is difficult to predict who you will “click” with but this is such an important requirement.  It is possible to sit with a perfectly competent therapist but not make significant progress in your work due to a lack of connection between you and the therapist.  This is why Phenix offers a free initial consult to all new clients.  Hopefully, you have a network of friends and/or family to whom you can turn for referrals.  They know you best and can likely predict who might be a good fit for you.  Check the recommended providers’ websites to see what they specialize in. Finally, give your prospects a call to discuss what you are interested in addressing so that you can get a sense of how well you might connect to this person.  A few questions you could ask are:

  • What experience do you have working with this issue?
  • How do you typically approach helping clients with this issue?
  • What resources do you most often recommend to your clients?
  • How has your own personal therapy informed the work you do with clients?

Your first several sessions are usually quite different from subsequent sessions here at Phenix:

  • Our free consult gives you the opportunity to ask the questions needed to determine if you have chosen the right person to work with.  We also will complete basic mental health screenings to ensure that tele-therapy is the right level of care for you.  We intentionally utilize only a one-page information form prior to the appointment because we understand that we cannot expect full disclosure from someone we have not met and we have not yet established a therapeutic relationship.
  • If you choose to initiate therapy after the free consult, you will receive full disclosure documents electronically so that you can see the details of our therapeutic relationship but you do not have to sign it until after your first appointment where you can clarify anything that does not make sense to you. During this first therapy appointment, we discuss your goals and the potential ways in which we would be helpful to you, finalizing a tentative plan for moving forward if that is agreeable to you.
  • Intake documents are shared electronically after the first therapy appointment for you to complete.  By this time, you have met with your therapist twice and can feel a little more comfortable sharing detailed information.  The second therapy appointment is what we call an “intake” during which we ask a number of questions designed to obtain the details of your concerns as well as the context in which these concerns occur: social, physical, emotional and mental history as well as current status.  If you wish to include your spiritual journey – that is discussed as well.  This gives your therapist a window into your complex world.
  • At the third appointment, your therapist will generally offer a summary of all that has been shared as well as their understanding of the presenting concerns and it’s underlying components.  Often, your therapist connects dots, pointing out dynamics that may have gone unnoticed.  This is a collaborative process in which you participate to shape an overall narrative that then drives the action plan to be created.  You and your therapist establish goals and agree upon interventions for pursuing them.

From that point forward, appointments typically involve: discussions of progress, exploration of emerging insight, expressive activities (non verbal interventions such as art), skill learning and relational check-ins (monitoring your relationship with your therapist).  A sacred space is created where you can be fully who you are, saying/expressing exactly what you need to say with privacy and no judgment.  Your therapist guides these interactions according to the goals you established at the beginning, though those goals may be adjusted along the way.  Each time we meet, you create action plans for applying what happens in therapy to your daily life.  It is these experiments in your world that become a main topic of our meetings – determining what is working, what is not and why.  Clients always have control over what they wish to discuss though your therapist will challenge the areas you tend to avoid as they are often most relevant.  Even so, you are always in the driver’s seat.

There is no standard length of time for therapy.  The number of sessions clients come in for varies wildly. Much depends on the complexity of their goals and the depth they are willing to go in transformation of self.  Some clients reach a satisfactory level of growth after a few months…some clients who wish to tackle long-term, traumatic issues attend therapy for years – albeit spaced out such as monthly appointments.  Again, you determine how far you want to go and for how long. Hopefully, this helps bring clarity to the therapy process.  We are much more likely to take a new path if we have some idea of what to expect!