In this post I’m focusing on Practice #2, the practice of doing therapeutic work. This practice is meant to be integrated with the other steps—ahem, like, started right along with Practice #1 (not after anything is ‘perfected’ ).
The Four Practices to Raise Yourself Up
#1 The Practice of Learning Who You Are & What Happened
#2 The Practice of Therapeutic Work
#3 The Practice of Taking Care of Yourself & Making Changes
#4 The Practice of Being Present in the Happiness You’re Creating
The intensity of feelings that uncovering our past traumas may bring up isn’t for the faint of mind, so you need a trustworthy therapist to help you navigate the terrain. If you do this kind of work on your own, it’s very difficult to sort out the monsters from the angels—that is, it becomes very difficult to know whether or not your actions stem from avoidance or courage. In truth, even the best therapist won’t be able to tell your monsters from your angels, but he or she will be able to give you the time and space within which to get enough perspective that you sure can.
Believe it or not, the act of choosing a therapist is part of the growth process. People raised by childlike parents don’t have the courage of their convictions, we don’t give ourselves permission to be treated well, we don’t feel heard….NOW is the time to take a step toward transformation.
This is a step that tells your spirit, “I care. I care to be happy.”
If you already have a therapist or have enjoyed the luxury of a series of therapists over time, reading this is a great way to take stock and evaluate how well its working for you and how effective your work with that person has been.
(Oh man, if you have stories about how you knew your therapist was the one for you (or so NOT the one for you)—I’d love to hear it and please share in a comment!)
THE COST OF THERAPY
Before you assume that you simply can’t afford $150 an hour therapy sessions—wait a minute! I don’t honestly believe anyone pays actual hourly rates, not really. With the exception of an instance where you want to go to a particular therapist who is The Only One you deign to hire (say a therapist to the stars or someone voted Best in New York or whatever) or in the exceptional instance in which you have a budget for $600-$1,000 per month for therapy (and, boy oh boy, please oh please donate to Guess What Normal Is if you do!)—except for those two exceptional instances, please know that AFFORDABLE therapy is a reality. It might take more time and more phone calls to find it, but—you’re worth it.
You are you are you are.
Sliding Scale Rates for Therapy
When you start making calls, ask if a sliding scale rate is available. Be prepared to say what you can pay per session (assuming one weekly session).
Therapy is important. What can you give up, assuming this cost isn’t already in your budget, in order to pay, say, $200 a month for therapy? ($200 a month will get you four $50 sessions a month.) Starbucks? Dinners out? New clothes? Lunches out?
Certain therapists will make room for a particular number of sliding scale clients, or “budget” clients, so that they can help people who can’t pay full price. So, don’t feel guilty about asking for a discount!
Talking about money? Never fun! Therapists often ask, during this initial conversation about money, how valuable therapy is to you. I find this question…irritating. Personally, I don’t think it’s possible to put a price on therapy—it’s “priceless” in my book. That said, you may find that you’re asked to enter into a conversation about what you’re willing to pay framed in terms of how important therapy is to you. My answer to that scenario is this: “Therapy is invaluable, priceless. That said, having examined my budget, I can afford $40 a session—which includes having cancelled my Netfliks account and daily Starbucks. Which is to say, it’s that important to me. How does $40 a session work for you?” If you want a discount, be prepared to say why. A therapist will want to know your reasoning, and that’s completely fair on their part.
(This is an important part of your healing by the way—taking initiative, haggling about the cost of your therapy!)
The key is to figure out what you can pay in advance. That will save you the discomfort of negotiating about something priceless before you’ve examined your budget.
I paid my first therapist $20 (San Francisco, 1992) per session; that went up to $30 a session by the time I was done. Total steal! And the woman was wonderful; I use tools I learned in my sessions with her to this day (inner child visualizations and conversations). She was part of Clement Street Counseling Center, where certain counselors who were done with their training and certifications were accruing hours to become licensed so that they could open their own independent practices. That’s also why she was cheap.
Ask around at your local counseling centers for therapists who’ve completed their training but who are working on getting hours of service under their belts.
I recommend group therapy as a supplement to individual therapy. There are two types of options – 12 Stepping it and psychotherapist-led, time-limited groups.
If you join a twelve-step program like Al-anon or Adult Children of Alcoholics, you’ll pay $2 or so each time—and that’s an optional donation, not a required fee. Otherwise, it’s free. If you want to join a group therapy project facilitated by a therapist, look into group sessions run by clinics, or institutes. First identify the local counseling centers and psychological institutes in your town or closest major city, then call and ask if they run group therapy sessions for processing relationship issues, childhood abuse, etc. Put your name on the list for the next group. Individual therapists in private practice are also known to run group sessions, so include them in your search as well.
What to Google? Google this: “Group Therapy Seattle (i.e., your town) Children of Alcoholics (or ‘codependency’ or ‘childhood trauma’)”
Health Insurance-Covered Therapy
If you have health insurance, call your insurance provider and have them walk you through an explanation of your benefits. This is really important. Health insurance is tricky, and if you don’t write down the rules, you could get stuck accidentally choosing a therapist NOT covered or you might not get the proper authorization code, and get STUCK with high fees that you want the insurance carries to cover. Also, if your insurance is like the insurance my employer provides—the medical insurance and mental health insurance are provided by two separate entities (my medical is provided by United Health Care and my mental is provided by Value Options).
Once you get the what’s what, you can proceed to obtaining a list of in-network providers. You can have the health insurance customer service folks help you, or you can use the online self-service option.
HIRING YOUR THERAPIST
Here’s the fun part! This is where you get to ask questions of therapists and decide which one you want to hire. Think of it as car shopping, or buying a house, or hiring a daycare provider—you are the customer. Repeat after me: You. Are. The. Customer. As a child you had no choice. You had to endure and survive. In the act of choosing a therapist, you are coming into your voice, into choice. You do not have to go to a therapist because they are pressuring you, because they are the first one on the list, because your friend recommends them, or because they are close to your work or because their last name feels familiar.
It’s important to choose the therapist that passes muster with you.
How do you decide if the therapist passes muster with you? Well, you interview them.
Talk to each therapist on the list first, asking what their area of specialties are, and how many of their clients (not patients!) are trauma-survivors, or children or alcoholics, etc. Tell them what you’re struggling with, and ask what kind of approach they would take.
This saves your time (and theirs).
Any good therapist will spend up to 15, or more, minutes talking to you on the phone. If you don’t like their attitude, voice, attitude, or answers—move on to the next name on your list. Once you narrow it down from, say 15 to 5 potential therapists, call back and ask if they will give you a free consultation, and book a few appointments with a few different counselors—this will prevent you from feeling obligated to go with the first one you see.
Any good therapist will ask you, at the end of your first consultative session, if you feel it’s a good fit and if you’d like to continue. Only a bad, desperate therapist will obligate you or sell you on committing to them. Keep up your pressure radar and let it guide you. Remember—you’re the customer.
During your first session—which is an orientation, or intake, session—you’ll want to ask questions in person, and these will help you crystallize your decision.
Your interview questions can include:
How would they characterize their counseling style?
What should you expect from therapy?
How do they see their role vs. your role in the therapy process?
How would they describe the affects of a traumatic childhood as they’ve witnessed it?
Have they done therapy?
Why did they become a therapist, and what do they get from it?
Some therapists are weird about how you pay them. Let this, and all, interactions guide your decision—everything about your interaction with this person is information that will be part of your decision whether or not to hire the person.
When I asked my current therapist how he wanted to handle how I paid him, he asked me, “No particular way—but, what do you mean?” I explained that I’d met a therapist once who explained that I was to hand him a check (my co-pay) upon arrival, which he would place under the last page of his notepad out of sight, and then we’ll begin our session. (The therapist then enacted how he’d place the check under his notepad.)” Drama, anyone? For me, that ritual was way too complicated and way too rigid. (The way I pay my current therapist varies—I hand him cash before we start, after, or double up the next time if I don’t have cash or checks. It’s very much ‘no worries’.)
QUESTIONS FOR YOUR FIRST SESSION OR TWO
Questions to Keep in mind while you’re at the first, or first couple sessions—ask these types of questions of yourself:
Do you feel safe in the therapist’s environment?
Do you feel pressured in any way to come more often?
Can you challenge them—how do they respond?
Do they answer calls during your session? (Ugh. This happened to me once. I said, “Was that an emergency, or do you take calls during sessions? She explained that she was running a business, kept calls quick, and never lost focus on the person in front of her. I burst into tears saying I’d like her NOT to answer calls during my session. She said, No can do. I decided that that wasn’t going to feel safe for me, that I deserved 100% focus, and I never went back. Incidentally, I didn’t use any kind of process of ‘interviewing’ therapists back then–she was a name on a flyer at my gym–a nice-looking flyer.)
This is a partnership – do you feel like partners?
Does the therapist’s words make sense to you? Do you ‘click’?
Does he or she remember what you’ve told him, or attempt to satisfactorily?
Do you feel comfortable disagreeing with them? (You should feel totally safe doing so and they should get the immense value of doing so for you.)
Are they on time?
Are they funny about your being late, if you run late?
Do they ‘get’ you, accept you?
Again, you’re the customer. This is your investment in yourself, your healing, your next move—so be damn CHOOSY.
Be kind to yourself.