You’ve decided that enough is enough and you know you need help but signing up for some kind of therapeutic service makes you nervous. You’ve never been the type to ask for help but lately the idea of getting unstuck is just a little bit exciting! What if this problem you have been dealing with for what seems like forever didn’t exist? What if you could lead your life taking the next step forward without all the worry and sadness? What if you no longer felt alone? Just the thought of this is giving you a flicker of hope. If you just knew a little bit more about what to expect from a helping professional it might allow you to enter the experience feeling more centered and confident that this is the right thing to do. I totally get this. Signing up for a mystery service doesn’t allow you to relax into the experience fully. I thought I would write about what to expect from the variety of services you could choose from hoping it would allow you to make your best decision.
Counseling, Therapy, Coaching or Psychiatry? Which one do I need?
Let’s look at your options and figure out what kind of help would be best. Since I am not sitting with you and hearing your problem, (Although I could. Just pick up the phone and call me right now and skip this whole blog.) it might be helpful to identify the differences between counseling, therapy, coaching, and psychiatry so you can enter the experience knowing what to expect and thus selecting the helping professional that fits your situation.
Psychiatry: A psychiatrist is a physician who specializes in treating mental health issues (mood and behavior problems) by prescribing medications. They are trained to differentiate between mental health symptoms and physical health symptoms which might present as mental health disorders. Although some psychiatrists do offer psychotherapy (talk therapy) most spend their time with patients in tracking how the medications are working related to the symptoms the person is struggling with. Psychiatry is an art and a science and figuring out just which medication or combo of meds to prescribe is complex. Should you find a psychiatrist who offers therapy please be aware that they tend to be more expensive given their credentials. It can, however, offer one-stop shopping if you get both meds and therapy all in one appointment.
Counseling: A counselor is a Masters’s level mental health clinician who usually identifies with the credentials of L.P.C. or Licensed Professional Counselor. Historically, counseling tended to be a short term model of care delivered to very specific problems, for example, drug and alcohol abuse or stress reduction and tended to be shorter in duration as it was specifically focused on an outcome of behavior like sobriety or calmness. More recently there is little difference between a person calling themselves a counselor or a therapist and the terms tend to be interchangeable.
Psychotherapy: A psychotherapist/therapist is a Masters or Doctorate level mental health clinician who identify with the credentials of LPC, LCSW, (Licensed Clinical Social Worker), LMFT (Marriage and Family Therapist), Ph.D. (Doctor of Philosophy), or Psy.D. (Doctor of Psychology). Psychotherapy historically has been considered a longer-term model of care. This relates to the idea that therapy works because it’s a “healing relationship.” Developing a relationship with someone takes a bit of time - it can’t always be done immediately. The therapist functions in a way that reparents the client in areas that they are underdeveloped in by allowing the client to be seen, heard and emotionally felt. The client through this process not only learns to trust themselves but also others. The therapist focuses the client to track their own patterns of behavior noticing the how’s and the why’s of what they do rather than on giving advice. This then allows the client to notice how they are contributing to their own problems. Therapy has a focus on how past pain, often from childhood, informs problems today usually relating to relationships with others. Identifying one’s “attachment pattern” is often a rich part of the work you will engage in. The attachment pattern is the way you learned how to get your needs met as a child by your relationship with your caregivers. It’s usually the very same way you get your needs met today.
Therapists now offer “telehealth” where therapy is delivered via a HIPAA compliant video platform which is super convenient. Therapists are bound by the laws of the state they live in related to working with people out of state. Working in PA only allows me to treat people in the state of PA.
Coaching: Coaches or life coaches are people who work with clients who want to reach a goal related to relationships, career or life transitions and are highly motivated for achievement. The coaching industry at this time has no requirements for licensure, education or training however many life coaches do get certified by coaching institutions. Coaching is an action-oriented service and you can expect your coach to take your personal goals and break them down into actionable steps. Because there is no licensure a coach can work with anyone living anywhere which differs from therapy. Services are frequently delivered by video platform or phone calls and usually involve homework after each session. Coaching sessions are usually more expensive than therapy sessions and are often sold in packages. Coaching is said to focus on the future and therapy in the past. This isn’t completely accurate as therapy deals with how the past controls today and additionally does involve future-focused goal setting.
As I am a Licensed Clinical Social Worker and AASECT Certified Sex Therapist who provides psychotherapy, I can’t share expert advice related to life coaching, but I can point you to an article called “10 Questions for Picking Your Perfect Life Coach” by Inc.Com.
I’ve gathered some important facts about therapy for you, which can set some realistic expectations for your experience in counseling.
Your therapist will try to meet with you weekly because weekly attendance creates progress.
When people reach out to me to begin therapy I tell them right off the bat that I require that they attend therapy weekly. In my experience you either need therapy or you don’t. My thoughts on this are that let’s get you focused so you can complete your work and be happy and get back to life! Coming every other week is just postponing the work and dragging things out which usually creates the doldrums for not only the client but also for me! What creates change in therapy is noticing and you can’t notice if you aren’t creating the time to slow down and take your life into your awareness. I find in my practice that the first month of treatment is really just identifying clearly what the problems are via the assessment. Most people enter therapy thinking they know what the problem is yet as they start to discuss it with more pointed questions from a therapist where the meaning of the problem gets identified things start to expand. In my couples therapy work, clients can expect a more action-oriented focus starting on month two. Moving from complaining to addressing what you actually want is where things start getting exciting but we can’t get there until you identify what is blocking you.
Your therapist wants you to initiate discussions on the topic for the day.
When clients come into sessions clear with what they want to discuss in session it’s the right order. It means that the session is going to hit the spot - that spot could be anger, sadness, abandonment, frustration or any other feeling. Most times it comes embedded in an event which occurred either in the past or recently. Within the story, the client tells is the “trigger” or the historic event held in one’s subconscious which continues to create pain for the client. The sooner the triggers are identified and sorted out the more quickly they lose power over you.
At times I start a session by swinging back to the last session’s topic to find out if my client noticed or processed more about the topic. I also will start by following up on a homework assignment given. Despite this all being relevant, I prefer when the client begins the session with an outcome they need. It ensures that we are talking about the right stuff and this illuminates for me what the target related to the client’s stuck points is. One of the old adages for therapists is to “follow the affect” (emotion) in a session because that is where the gold is.
Your therapist prefers you to let it all out rather than remain composed.
If there is one thing I know for sure it’s that therapy is for letting out your feelings no matter what they are. Many clients start with me trying to choke back tears and avoiding topics that trigger them or their partner. It’s very common for a new couple to sit on my couch and when asked what they want to talk about they nervously look at their spouse and say, “Gee, I don’t really have anything, do you?” At that moment I know that they have organized around the avoidance of conflict and the first job is to get them to start sharing their pain with their partner. It can be like pulling teeth in trying to get someone to take the risk of being direct and telling their truth at the beginning because they are so used to talking themself out of their pain and disappointment. This is normal but your therapist is going to be organized around getting you to speak up and start the work.
Your therapist wants you to take responsibility for your own thoughts, feelings, and behavior.
The first part of therapy is assessment, the second part is identifying the patterns in the client’s story with the client and the third part is helping the client to take responsibility for their part in their problems. Despite this seeming so simple it’s the hardest stage in therapy. What I know for sure is that the quickest and easiest way to make a happy connected life for yourself is to own your own problems and mistakes. Once you own it, it frees you to start fixing it. Most of us (myself included) will avoid owning our own ugly behavior and will go to any extent necessary to put the focus on the other person’s faults. This is the human condition but it doesn’t set us up for great relationships with others.
In fact some of our behavior, we are completely unaware of and have no idea how we create pain for others. This largely is due to the fact that we have a limited ability to see everything, especially when we are triggered. When triggered it is all about you because the fight, flight, and freeze instincts are driving the bus.
Couples’ work is challenging related to this part of therapy because every couple that comes in believes it’s their partner who’s the problem and they are usually waiting eagerly for me to agree with them and clear them of all wrongdoing. Despite this, if even one member of the couple can own their own “stuff” it miraculously motivates the other to also begin to own their own behavior too. Some couples are organized so tightly around the avoidance of conflict that they will actually show up to the first therapy session stating that they have nothing to talk about. What I know in these moments is that in order to make progress some conflict is going to have to be stirred up. It should be noted that therapy at points can be very painful and uncomfortable because we are unearthing pain that has been buried and not talked about.
Your therapist wants you to tell them when what they are doing isn’t working.
Your therapy is just that - it’s YOUR therapy. I think of therapy much like a hotel reservation. Space is held just for you and it’s your decision how you choose to utilize it. (Go back to point #7.) That being said, the therapeutic experience is created by both yourself and the therapist. If the therapy isn’t addressing the problem, you need to share that with your counselor. If the therapy leaves you feeling worse, that is clinically relevant information too. If nothing is changing, of course, nothing changes so this needs to be a transparent discussion between yourself and your therapist to sort out what is happening which is blocking your progress.
Your therapist keeps your secrets secret.
Counselors guard your privacy very carefully. We appreciate the honor it is to have your trust and recognize the sanctity of the therapy space. It’s what therapy is built on - having a safe space to talk so as to create trust. Aside from all of that, we are bound by US law - HIPAA - The Health Insurance Portability and Accountability Act. This requires all therapists to protect your personal health care information by keeping it private. This means we can’t share or get information without your permission in writing. There are stiff fines for breaking confidentiality which just reinforces the very principles that therapy is built on and therapists value.
The Consent to Treat are The Rules of the therapeutic Relationship.
Most therapists have a Consent to Treat document which you sign at the beginning of treatment which identifies all of their office policies. These policies are truly the boundaries of the therapeutic relationship which identify what the therapist and client are meant to do to keep it a good relationship. The Consent to Treat is very similar to a business contract and let’s face it you are entering a contract with the therapist and this is their business. The therapist is in the tricky position of being both a caring confidant as well as a business owner. Because their fee is how they pay their bills it requires that they enforce no-show and late cancel fees which at times may feel punitive. But if every client canceled a session when something better came up or after a hard day, the therapist would not be able to stay in business and you would be unable to get the skilled help that the therapist offers.
Your therapist does care about you.
Most of us therapists are in this work because we are natural helpers having grown up in families with problems where we were the helper. Our compassion for your problems is related to the suffering that we experienced in our own lives. We know how it feels to be overwhelmed and alone and most of us have engaged in therapy ourselves to course-correct our lives. That being said therapists are human beings first and therapists second. We are not perfect and we haven’t arrived at an endpoint related to our growth, development, and triggers. So if we screw up please tell us kindly and compassionately knowing we aren’t perfect (and never will be) and let us own our mistakes with you. What we do know about the effectiveness of therapy is that it works when there is a connection between the therapist and the client - that is the secret sauce!
I hope this list of what to expect from counseling, therapy, coaching, and psychiatry in Doylestown gives you a sense of what you can expect when engaging in a professional helping relationship. As I mentioned earlier, if you have any questions please give me a call and I can help you figure it out. If you are in the market for couples therapy, affair recovery, out of control sexual behavior therapy, therapy for men, or sex therapy I’d love to help. Simply click on the button below and I can get you scheduled for a call to talk about your goals for treatment.