The patient sits before you, clearly uncomfortable. He says it wasn’t his idea to come. His wife or employer or doctor persuaded him to give it a chance. He doesn’t want to be here. It’s clear that unless you engage him in the next 15 minutes, he (or she) won’t return. Using your kindest, most supportive tone, you ask what it is about therapy that is so objectionable. Usually what comes back is some combination of prevalent myths about treatment.
Whether you are newly a therapist or have years of experience, it may be useful to review these common myths or concerns and some suggestions for how to respond to them:
Therapy is just for crazy people
It’s true that some people who are seriously mentally ill are treated in therapy. But only about 5% of the population has a mental illness that is so serious that they can’t function. Although 20% of people can be diagnosed at some time in their lives, most of those diagnoses are for episodes of things such as adjustment to a difficult change, anxiety or periodic depression. Further, lots of people use therapy to learn more about themselves, to help them cope with particular problems, or just for personal growth and self-understanding.
My family and friends will think less of me if I’m in therapy
First, no one has to know. It’s up to you whether you want to keep your therapy private. But in my experience, people close to my patients are usually happy that they are taking care of themselves. Some are relieved to know that the patient has extra help. If you do decide to share the information, you can stress that you decided you needed an objective sounding board for some of your worries and that you are just giving it a try.
I was having a hard time a month ago but I’m fine now
That’s terrific. Sometimes the best time to start therapy is from a position of strength. That allows you to take a step back and look with some objectivity at what happened that caused you so much distress. We can talk about what you learned from the experience and what you need to do to be able to better handle such things in the future.
I’ll get better on my own
You might. In fact, research shows that a third of the people who researchers think would benefit from therapy do get better on their own. But my guess is that if you could have done it on your own, you would have done it already. Why not give this a try?
I don’t need anyone to tell me what to do
It’s not my job to tell you what to do. It is my job to help you increase your own skills for figuring out problems and for coping with the inevitable challenges of life. It’s kind of like going for cooking lessons. The chef won’t tell you what to cook for the rest of your life. Instead, she will teach you the skills you need to be able to cook whatever you want.
I don’t want to become dependent on a shrink
I don’t want you to become dependent on me either. Initially, you may feel like you need to consult with me when you are trying something new. But my job is to help you develop the skills you need to handle things on your own or with your family and friends. No friends? Then it is my job to help you figure out why and to make real friends, not to become your permanent “purchased friend.”
Therapy lasts forever
Most people are in therapy for only a few sessions. Studies show that about 42% of people in psychotherapy use three to 10 visits for treatment. One study found that people had the most significant improvement between their seventh and tenth sessions. And some people get what they need in the way of support or a new approach to a problem in only one session. Yes, some people with a severe psychological disorder benefit from longer-term treatment. Some people decide to stay in therapy for a while because they like what they are learning about themselves. Ultimately, it’s up to you. You will get the most out of treatment if you work at it. You decide, not me, when you’ve had enough.
How do I know you won’t tell my boss/wife/another person about what I say in sessions with you?
My profession has strict rules around confidentiality. That means that what you say in session stays in session. The exceptions are if I think you are seriously considering harming yourself or someone else. Then I have to do what I can to save your life or the lives of others. If you disclose abuse of a child or a vulnerable person, I have to report to the authorities.
But that’s unlikely to happen. Although many people talk about being so angry or depressed that they think about ending their own life or killing someone, usually that’s an expression of how serious the situation is, not an actual plan. If that’s the case, we’ll talk it through and find other ways for you to cope. If reportable abuse is going on, we’ll talk about what I have to do and how best to handle it.
If I think it would be helpful to you for your spouse or another family member to know what is coming up in therapy, we’ll talk about having some joint therapy sessions. Ultimately, it’s your call.
I don’t like/trust you
You don’t like me or you don’t like therapy? If you still don’t like the idea of therapy, let’s talk some more. But if you don’t feel comfortable with me, maybe you should trust your instincts. The most reliable indicator of whether therapy will be successful is whether the client (you) feels like the therapist (me) can be helpful. Just like any relationship, some connections click and others don’t. If I remind you of someone you don’t like or if there is something about my style that bothers you or if you don’t have an intuitive sense that just maybe I can help you, please interview another therapist or two and see if you find someone who is a better fit.