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The lies of suffering

parent sufferingIf you are unhappy then it’s time for something to change. Physical pain exists to keep us safe. It says, “Stop running on your broken leg! Take care of that scrape right this minute!”

It’s how emotional pain works, too. Emotional pain reminds us to take care.

I guess it’s our cultural Protestant work ethic that makes us forget this. So many of us take pride in our suffering:

  • I work 70 hours a week, never take a day off. It’s just what the job demands.
  • I haven’t slept through the night since my oldest was born. It’s been twelve years now.
  • No, no, I don’t mind. You go ahead and go to the movies while I stay home and clean up after the party.

It’s one thing if you’re truly happy — if you love your job, if you’re one of those rare people who only need a few hours of sleep, if you’d rather vacuum than go see the latest blockbuster. I mean, I’m not all that invested in telling people that there’s only one way to live a happy life. But so many of us are not happy with the way things are and we ignore it because we believe the lies of suffering.

You know, the lies that say:

  • Your value is in your paycheck.
  • Your kids are more important than you are.
  • You don’t get to enjoy things until you’ve earned them with your blood, sweat and tears.

Suffering, sad to say, is inevitable so why are we so bent on creating even more of it for ourselves?

Because I work so often with parents that’s where I see those lies crop up the most. I see moms and dads who put their own needs aside for so long that they don’t know how to pick them back up again. I know how it is; our children’s abilities creep up on us so sometimes we’re making them breakfast long after they could learn to pour their own cereal.

And you know what? That’s fine if we don’t mind pouring cereal and if we find other ways for them to stretch themselves a little bit. Again, I’m not saying that there’s a cut off point that you have to meet or everyone’s done for. But if you’re resentful, if you’re unhappy, if you want to be able to drink a cup of coffee before you fry up an egg, then it might be time to figure out how you can do that.

Unhappiness is the key that something should change. That’s how you know.

Parenthood should not relegate your needs to the trash heap. Yes, you’ll need to make allowances but that doesn’t mean 18+ years of purgatory.

So how do you do it?

  1. Surround yourself with people who get you and your values and who aren’t going to try to talk you into doing things any particular way. Whether you’re going to breastfeed into the preschool years or wean them at a few months, you get to decide because you’re the boss. It’s ok either way.
  2. By the same token, protect yourself from people who don’t get you and your values and who are going to try to talk you into doing things a particular way. In other words, you do not need to confess your struggles to your judgmental neighbor just because she asked.
  3. Get some good, basic books on child development and understand what your child is capable of doing so you can make informed decisions. Understand, too, that your child is a unique being and you are a unique parent; those books are guides, not infallible tomes. Remember, you’re the boss.
  4. Remind yourself that growing kids is a process. You can try something and then change your mind if it’s not working so don’t be afraid to just try it. It really is all right to make mistakes. So you push them a little too early, well, then you can pull back. But you might find out that they’re ready for a push. So if you’re ready you can give it a try just in case.
  5. Remember that you are your child’s model for self-care and self-love. Do you want your son or daughter to neglect themselves for the sake of their families?
  6. If you decide you want therapeutic help, call the counselor and interview her. Does she have strong feelings about co-sleeping? Veganism? Boarding school? Whatever it is, make sure she’s going to be able to hear you and support you and not get mired in her own biases.

Parenting is already plenty hard; there’s no need to make it harder.

When therapists are wrong

Patty vs Leslie

Two VERY DIFFERENT bosses

When you look at the ethical guidelines for therapists a whole lot of them are in place to address the power imbalance between therapist and client. In the minds of our clients, the things we therapists do or say hold greater weight than the same thoughts that, say, your hairdresser or mechanic might offer. (Except when it comes to how to do your hair or fix your car.) When we share our reflections about your life choices and relationships then we need to be aware that our clients will likely take those thoughts very seriously, which is why it can be painful and even dangerous to have a therapist get things really wrong with you.

I remember the second therapist I ever saw when I was a freshman or sophomore in college and was in love with a boy who didn’t love me back. (That’s what brought me to therapy although it turns out — no surprise — I had a lot more going on than just that.) Anyway, the therapist just loved all my stories about my super interesting boyfriend and would agree with me, “He does sound amazing! And in a band, too, wow!” which was not what I needed to hear. Now I understand that likely he was just trying to join with me (this thing where therapists go along with you to help build rapport) but at the time I thought, “Well, it’s hopeless. My boyfriend is too amazing for me to ever get over him and even my therapist loves him” and I quit going to therapy. What would have been better is if I’d come back and said, “Hey, I’m sick of hearing about how great you think my stupid boyfriend is” and then we could have had a discussion about it.

Because therapists get stuff wrong. It happens. We’re not perfect and even the best therapist is not necessarily the best fit for any given client. We will get things wrong and it’s up to you, dear clients and potential clients, to help us get it right.

Sometimes we get things wrong because we don’t ask for enough information and sometimes this is because we don’t even know we need it. You say, “Hey, my boss!” and the therapist is sitting there merrily picturing Leslie Knope and really you’re talking about your boss who is more like Glenn Close in Damages only the therapist has already decided she knows what’s going on and so things just get confused.

That happens. Although eventually situations like that work themselves out if the therapist is a good listener and asks good questions.

What’s trickier is when the therapist is wrong only you don’t know she’s wrong because it’s nothing as clear cut as facts. Instead she’s operating with a set of biases that you don’t know about. Like say she is against beach vacations and thinks everyone should go hiking in Hocking Hills and you don’t know this so when she’s discouraging you from planning your vacation to Bethany Beach you think there really is something wrong with your ideas. You wonder, “Is this what’s wrong with me? That I always go to the beach?” and it’s confusing. Because sometimes it’s true — your ingrained thoughts or beliefs are part of the problem — but sometimes it’s not. Sometimes it’s just a matter of different priorities and opinions.

So what do you do?

First of all, if you feel like your therapist is being biased, tell her. Have a discussion about it. Heck, have a debate. Good therapists know their biases (we all have them) and will be willing to engage with you. She will be able to say, “Here is my bias” but she’ll also be willing to say, “My issue with the beach is not because I’m against beaches, it’s because you’ve told me that you are allergic to sand in previous discussions and I want to challenge your assumption that you should go to the beach anyway.”

Or the discussion might help you discover that your boss thinks Glenn Close in Damages makes a GREAT boss and that you should suck it up and let her murder people and violate legal ethics and blackmail everyone because your therapist places a high value on career achievement and that’s just her philosophical starting point. In which case you can decide for yourself if that’s the kind of therapist that you want to have.

Very often you and your therapist won’t agree about things and a lot of the times, that won’t matter because our ethical guidelines state:

Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.

(this is from the 2014 American Counseling Association Code of Ethics)

In other words, even if your counselor would personally love to work for Glenn Close, she ought to be able to appreciate that you would rather work for Leslie Knope. But if you’re not sure, ask her. Have that discussion. Find out what’s going on there if you feel like she’s misunderstanding your point of view or steering you away from your goals. Because even though we are therapists and sit in the big comfy chair (or at least the chair with good lumbar support because this job is hard on your back) that does not mean we know everything or that we’re the boss of you. Sometimes we’re wrong. Call us out when we are; good therapists will appreciate the discussion.

(For the record, I prefer a Hocking Hills vacation as long as there’s air conditioning and obviously I would prefer to work for Leslie Knope because I like waffles a lot more than I like murder and blackmail.)

 

 

Why? Because

mombeach-insideWhen our daughter was two she had a standard answer when confronted with angry parents.

“Why did you throw all the baby wipes into the toilet?” we’d ask.

“Because I do,” she’d answer. “Because I did.”

It never failed. Whatever the disaster – water sloshed all over the kitchen floor, her dresser drawers unpacked and the contents strewn across her room, her brother’s micropet collection hijacked and missing – we would ask why and she would answer, “Because I do, because I did.”

And it seemed like a fair enough answer because when you’re two years old how can you have the words to explain such a complicated situation? To explain the lure of developmentally-appropriate curiosity? The driving need to explore?

“I saw the full container of baby wipes,” she can’t say. “And I opened them just to smell but the smell – it reminded me of you and of daddy and then I wanted to feel the cool of them on my skin and wipe them across my eyes the way I’ve seen mommy do it to get off her mascara before bedtime. I imagined myself like mommy, wiping away the dirt of the day and then when the chill of the wipe went away, I tossed it aside and reached for another one. Before I knew it, they were gone and the toilet was clogged. But I didn’t mean to use them all up and I didn’t mean to break the potty.”

No, she couldn’t say any of that, she said, “Because I do” and “Because I did.”

I think about this not just with my kids but also sometimes when I’m working with a client (child or grown up) in therapy. Sometimes we won’t know why. Sometimes we won’t know why until later. And that’s ok because sometimes we don’t need to know why.

Sometimes all we can do — all that we need to do — is deal with the results. With kids, we can involve them in the clean up. With clients, it’s the same thing. We can deal with the results (the fall out, the grief, the anger) and then eventually if we’re patient with ourselves and each other, we’ll start to make sense of the why.

Meanwhile we can get comfortable with the reality of not knowing. We can work on trusting the process — our child’s growth, our own growth — and operate with the belief that learning is inevitable, if we don’t actively try to stop it, but that we can’t control the time line.

Life is a journey, right? Not a destination!

Helping Kids with Anxiety

Helping Kids with Anxiety

This is Goldilocks. She’s having a tough time.

This is the final post in the 3-part series about helping kids with anxiety. I reserve the right to blog more about it in the future because it’s a big topic and this is so general. Onward! To the helping!

Cognitive Behavioral Therapy or CBT is the counseling modality of choice for kids (and adults) with anxiety. Research on effective anxiety therapies tend to focus on these three areas:

  • Understanding and addressing the physical response to anxiety
  • Recognizing and challenging the thinking errors that perpetuate anxiety
  • Using controlled exposure to the anxiety-provoking situation and practicing the tools

Again this is super simplified and super general. Kids (and adults) have diverse learning styles, challenges, expectations and histories so how this works will look very very different depending on the child. But to help you get the gist, I’ll use Goldilocks as an example. We all know her story, right? On the very off-chance you don’t, you can check out this short version so we’re all on the same page.

So let’s say Goldilocks’s mom brings her to me because she’s gotten very anxious since her disastrous meet up with the three bears. She’s having trouble sleeping, she’s having some bad dreams, she is having tantrums at the drop of a hat and she hates leaving her mom to get on the school bus because she’s afraid the bears will come break into her house. She also can’t bear the thought of eating porridge ever again and will fall apart if her mom serves it at breakfast.

The first thing we would do is talk about Goldilocks’s physical experience of being anxious. We would talk about how being chased by bears would rev anyone up but now we need to help her calm her body back down. We would talk about how since this happened every time her heart starts beating or she starts breathing fast that her body immediately thinks BEARS! even if she’s faced with something much less concerning like shoes that are hard to tie or being a little bit late for school in the morning. We would work hard on helping her identify where in her body she feels the anxiety — is it in her stomach? Does her chest feel tight? Does she make fists with her hands or does her mouth go dry? We would talk about relaxation techniques and figure out which ones work for her. She might start keeping a worry diary or we might make a list of everything that makes her anxious.

What I tell kids is that we’re going to be detectives and we’re going to work together to solve the problem of their worries. I am very strengths based (that means I encourage focus on what’s going right even as we are talking about what’s going wrong) so we would also discuss times they have managed their anxiety in the past so we can figure out what shores them up.

The next thing we would do is look at thinking errors (also sometimes called “negative cognitions”). Here are some super common thinking errors:

  • All or Nothing Thinking: If I make one mistake then I’m an idiot.
  • Catastrophising: If I don’t turn in this one homework, I will flunk out of school.
  • Overgeneralization: I fell down at the roller rink one; I will fall down forever.
  • Personalizing: It rained on my birthday because nothing ever goes right for me.
  • Discounting the Positive: Sure my best friend likes me but that doesn’t count because she’s my best friend.
  • Mind Reading: I know everyone on my soccer team hates me.
  • Labeling: I’m taking so long to learn to ride my bike because I’m uncoordinated.
  • Should Statements: I shouldn’t have such a hard time learning math. I should know how to wrap this present without help.
  • Emotional Reasoning: I am in pain therefore I am right and you are wrong. I feel guilty and that proves I’m a bad person.

There are more but you get the gist and probably these are familiar to you either because your child does them or because you do them yourself. (Some of these are so ingrained in our cultural way of thinking that to confront them can be like wandering around in the dark your whole life and then stumbling over a flashlight and realizing you can use it to find the light switch and actually turn on all the dang lights.)

This is where I think counseling can help. I know in my own family that I can tell my kids something over and over but when they hear it from somebody else they believe it. Part of this is that they get tired of the sound of our voices (I haven’t seen studies on this but anecdotally I can tell you that my children get tired of the sound of my voice) and part of it is because it’s easy to get defensive with our parents. At least it was for me when I was a kid and then a teenager. If my mom disagreed with me it was automatically an opportunity for me to argue with her but if another adult said the same thing, it was an opportunity for growth and better understanding.

Yeah, we parents get it coming and going.

BUT! Let’s not resort to Overgeneralization! Sometimes parents have a lot of success doing this work at home without a therapist and there are workbooks (note I haven’t reviewed these so I can’t recommend one in particular) to help parents help their kids. AND even when kids are in therapy, we really need the grown ups in their lives to help them do the work. (I see a child an hour a week. Their parents are the ones bearing witness to the other 167 hours.)

Anyway. That’s the cognitive part of CBT therapy and it can take awhile. We’re talking about challenging ingrained ideas that make perfect sense to the person thinking them. That’s HARD and it takes practice.

For lots of kids, this is when we’re really leaning on the play part of play therapy because every little step we take needs to be ensconced in trust, respect and acceptance, which means a lot of time just hanging out and enjoying each other. The play therapy space (and the talk therapy space) is a place to safety say anything and be anyone and sometimes anxious kids just need one place where they can come and PLAY away from their worries.

tumblr_lsne2yzAIw1qh59n0o1_250Particularly with anxious kids whose anxiety ends up all centralized in their need to Do Good and Be Good, too much CBT pushing just triggers their anxious need to perform well. So sometimes my office is all about creating an island where they can goof off a little and experience themselves in a new way.

I’m emphasizing the slow part of this time in therapy because sometimes parents get (understandably) frustrated. They want to see change. At the beginning they get some concrete tools (breathing, relaxation, etc.), which feels great and proactive but it’s not a cure all. And then at this point things slow down and they may not see the any progress. But progress really is happening. Not to mention that this is where grown ups start slowing down, too, because it’s one thing to hear about Personalizing but it’s another thing to really get it and see how that kind of thinking is actually impacting your life.

The other thing is that anxious kids (and adults) have had people trying to talk them out of being anxious for a long, long time and that can make people hold on to anxious feelings even more tightly. They don’t mean to do this but being anxious, which many of them see as being concerned or cautious or careful or responsible (“I study all of the time because I’m a good student and if I’m not anxious about it then I’m being irresponsible.”) and often they get a lot of praise for being “good” in other anxious ways. (Oh the perfectionist students I see in my office! The ones who are running themselves into the ground for the praise and academic rewards!) To ask them to give up this way of thinking, well, that’s scary. It takes time.

Goldilocks may say to me, “You know this is all well and good but the minute I let my guard down I’m pretty sure Papa Bear is going to come charging in here, paws waving, and I can’t risk it.”

And so we’d keep working on it.

The next step of CBT is taking it out into the world and confronting those anxieties. Remember we’re simplifying these steps and we’re making them look more clear cut than they are (although they’re presented pretty clear cut in the Coping Kids group because we have a curriculum but we will adjust it as needed).

Goldilocks and I would keep on playing detective, we’d see what’s working for her and where she gets stuck. Maybe her big issue is not being able to eat porridge. Maybe I would get an empty box of oatmeal to have in the play kitchen or maybe we’d pretend to feed breakfast to the dolls.  When she’s ready maybe we’d have ourselves some porridge together. We’d go slow and we would be mindful of how it feels. We would see any small move forward as a victory even if she never actually gets the spoon in her mouth for a long, long time.

Maybe I’d ask her mom and dad to take her for a walk in the forest and practice her relaxation techniques and see how that goes. She and I might might write a game plan beforehand that confronts the “what ifs” and has strategies in place for whatever scenarios she can imagine. Again, we’d go slow. She might only get herself out the door the first time and we’d applaud that step even as we think about how to get her off the stoop next time.

Or maybe she’d need to play out what happened, putting the bears in the sand tray and working to make sense of the event by playing out the scene over and over again, trying out new ways of experiencing it and new outcomes.

There are other more specific ways to deal with particular kinds of anxiety. Treatment for OCD, for example, is more complex. Which brings me to medication.

Medication for kids is a tricky thing. Although many family practice and pediatricians will prescribe medication, it’s best to seek out help from a child psychiatrist. But this is hard. Columbus — like lots of other areas — has a dearth of child psychiatrists and parents don’t always have time to go search one out. I encourage parents to have an ongoing conversation with their family physician and to be aware that having a psychiatrist becomes even more important as the child gets older because hormones can make getting the right meds in the right dose super challenging (and things can turn on a dime if someone hits a growth spurt).

Not all anxiety disorders NEED medication but medication can certainly make sense if a child is completely hamstrung by his anxiety to the point that he isn’t going to be able to participate in his therapy. (Some kids are so anxious that relaxation techniques aren’t going to be enough to get them to a place where they can do the cognitive work.) Or if her behavior is so problematic (tantrums, rages, violence) that the rest of her life is at a standstill then medication can make sense.

Ultimately this is a parenting choice and I support parents in making their own informed choices for their kids. I do think, though, that medication alone isn’t enough. We all need to learn how to function as our best selves within the gifts and limits of our particular personality make-up. Medication can help us get functioning but we still need to understand ourselves and how we work. We need to know how to get help.

Eventually, too, our children will be adults and will make their own decisions about how to manage their anxiety (since for most anxious people it’s part of their lifetime experience since our personality can be molded but we are essentially who we are) and getting therapeutic support gives them options.

I like the idea of saying to kids, “Hey, counselors are there to help us when we need it. You need to know how to find the right one for you and how to do the work of therapy and I will help you do that when you’re young so you can help yourself when you’re older.” So we can teach them how to be good consumers of therapeutic support by helping them find someone they like and feel comfortable with (because it all comes down to the rapport in the relationship).

This is a positive way to talk about anxiety and anxious temperaments. After all, some of us more athletically gifted and some of us need more help. Some of us are terrific musicians out of the gate and some of us need more practice. Likewise some of us have more struggles with anxiety or depression and that’s why we have therapists and that’s why we learn about medication options and that’s why we learn to take good care of ourselves.

Have questions? Let me know. Want to sign your child up for Coping KidsLet me know. (I’m trying to plan summer offerings so if Coping Kids is something you’d like your child to attend then, please let me know so I can email you when I get scheduled and also find out if there are particular days or times that might work for your family.)

First in the series: Anxiety in Kids

Second in the series: Child Anxiety Symptoms

Why is therapy so expensive?

girlallowance-insideThere’s no getting around the fact that therapy can be expensive. Sure, you may pay less than you would for a hair cut and color or just a little more than you would for a massage, but most people don’t get their hair cut as often as they’re likely to go to therapy. I mean a dye job lasts what, six weeks? And most people see their counselors about four times a month.

The reasons therapy costs so much are:

  1. Schooling. In order to offer psychotherapy, your counselor needs an advanced graduate degree. Generally Counselors, marriage & family therapists and social workers need a masters and psychologists need a PhD.
  2. Licensing fees. Ongoing expenses include paying for our license and certifications as well as our professional memberships in organizations like the American Counseling Association or the National Association of Social Workers.
  3. Continuing education. Therapists need to have continued training to be sure we’re up on the latest research and that we’re staying abreast of what our professional ethics and the law require of us. States vary in their demands and the costs of training differs a lot, too, but most of us sink a few hundred a year into making sure we’re up to date. If we have other certifications — in, for example, hypnotherapy — we will need to take classes to maintain that certification, too.
  4. Insurance. We pay for professional liability insurance the same way that doctors do (fortunately our costs are a lot less). Most of us need the insurance to maintain our licenses.
  5. Rent and utilities. Even if we’re not in practice for ourselves, part of our income goes to keeping the office open and the lights on. Bigger cities, naturally, charge bigger rents and thus more expensive therapy. For those of us in private practice, rent is likely our biggest expense (I know it’s mine).
  6. Phones. Some therapists also pay for an answering service.
  7. The cost of doing paperwork. Those of us who take insurance (I do not) generally negotiate rates with each contracted insurance company. So you pay your co-pay and the clinician bills the insurance company for the rest of the rate initially agreed upon (and this is usually something the insurance company dictates; therapists can either agree or not). The paperwork required for insurance eats up a lot of time. Insurance companies differ in what they require and when and keeping track of it, submitting the billing, following up on payment (because insurance companies don’t always pay in a timely manner) and going back to the client if there’s something sticky takes up a great deal of office time, which could go to seeing clients so therapists bundle that time into their fees. Some of us farm these tasks out and pay a biller, which also obviously adds to the cost of therapy. For those of us who don’t take insurance, the paperwork demands are a lot less but ethically and legally we are required to keep certain documentation up-to-date. After a session with a client, we have to write up the session and again, our pay for this is bundled into the fee we charge the client. Note: Those of us who take insurance generally charge more than those of us who don’t because of the cost of doing business with the insurance company but most of us end up making about the same amount. People who take insurance spend more time on maintaining paperwork and those of us who don’t spend more time on marketing (since insurance companies do much of the marketing for you, giving your information to consumers who use their plan). A full-time therapist (i.e., someone who works a 40-hour week) isn’t seeing clients for all of those forty hours. Some of those hours are doing paperwork, getting training, meeting with supervisors or getting peer support, marketing, talking to insurance companies, printing out worksheets for the next session, reading research, calling to coordinate care with other providers, following up with clients who missed appointments or have questions or emergencies; etc.. Client fees have to also cover the invisible work of being a therapist.
  8. Miscellaneous supplies and fees. Therapist need to print out worksheets and forms, keep our furniture in reasonably good shape (and replace broken down chairs and sofas), maintain a working supply of pens and paper, and Kleenex. Most of us also need to pay for a web site and/or for inclusion in membership directories so clients know how to find us. If we work with kids, toys and art supplies need to be available and in good repair. Then of course there’s stuff like bank fees, the cut the credit card company takes, etc.

After all of these expenses are taken from our hourly rate the rest goes toward our salary. Part-time and contract workers at agencies and practices as well as those in private practice for themselves also have to pay taxes (about a third of their income), health insurance and retirement (not to mention banking for sick or vacation days) out of that what they take in.

And that’s why therapy costs so darn much.

There are options to make therapy more affordable:

  • Use your insurance. Not all insurance plans offers mental health benefits and not all insurance plans that do make it more affordable. (Plans with high deductibles may take a lot of time and money before you see any savings.) You will need to find a therapist who takes your insurance and then you will need to receive a mental health diagnosis that your insurance company will cover. Once you get that diagnosis, your insurance company will need to approve the treatment plan your therapist gives. All of this sounds very complicated but therapists who take insurance generally understand how to make it work for you. Make sure you are clear about what the diagnosis and treatment plan mean and what exactly will become part of your health record. Also note that most insurance plans do not cover couple or family counseling and may not cover certain diagnoses. Sometimes you won’t find this out until your bill gets denied so take some time to make sure it all makes sense to you and your therapist.
  • Use your Health Savings or Health Spending Account. If you have a HSA card, see if it will cover counseling and if your therapist is able to charge HSA cards. Most of the time these plans will only need you to submit a monthly or quarterly receipt but check first to see.
  • Seek out a practice or agency that uses a sliding scale. Sliding scales tend to be needs based and different therapists and practices require different documentation; some will want proof of income and others will not. Not all therapists will advertise their sliding scale so if there’s someone you’d really like to see and you’re not sure if a sliding scale is available, call and ask.
  • Explore group therapy. Groups tend to be much less expensive than individual therapy (that’s one reason I decided to create the Parenting Challenging Children group — it’s a more affordable way for parents to get help) and research shows they can be be just as effective. I especially like groups because I feel that community can be incredibly healing for those of us who feel isolated in our struggles.
  • Seek out a publicly funded agency since they often have more generous sliding scales. Depending on your income, using a county agency (in Central Ohio those are agencies funded by the ADAMH board, a list of which you can find here) may allow you to pay very little and sometimes nothing for counseling. Because they receive outside grants to fund mental health support for underserved clients they can subsidize their services. There may be a wait list and depending on where you live, it may be long but check in regularly since cancellations do happen and sometimes the intake person can get you in more quickly than originally promised. (Sometimes if you call in the morning they may have a last minute slot open up in the afternoon.)
  • See your therapist less often. While meeting every week may be ideal (it’s easier to create and stick to change when you can devote an hour each week to working on it), you can go every other week or even less often if your therapist agrees.
  • See an intern at the practice. Not all agencies or practices hire interns but those that do sometimes charge less since those practitioners have less experience. Interns are supervised by other counselors with specialized supervisory training although what this means will depend on the practice. If you’re using this option, ask them what this will mean exactly so you know what you’re agreeing to. (Note: Research shows that new therapists can be just as effective as more experienced therapists in part because newbies have lots of enthusiasm, which can make up for their lack of real world experience.)
  • Do the work. Counseling is not a race and how long it takes will depend a lot on individual factors but the more energy you put into therapy, the more you’ll get out of it, the more quickly you can create change and the sooner you’ll be leaving therapy. This means showing up for appointments (and avoiding the no-show fees! another way to cut costs), being honest with your therapist and reflecting on what you’ve learned between appointments.

 

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