Understanding what is involved can help you to decide whether therapy is for you – and how you can get the most out of it.
Here are some facts to help you decide if therapy will work for you at this point in your life.
Successful therapy often requires anywhere from several weeks to many months of therapy work. You need to plan ahead and set aside regular hourly sessions, often meeting weekly with your psychologist.
Most patients find they can be helped in 6-10 sessions for non serious mental illness issues, these being relationship, mood disorders, not getting along with people, phobias, and worries in general.
However serious mental health related problems will take longer and often require the involvement of other players (psychiatrists, GPs, fitness coaches, family members, employers, other professionals, etc).
Yet – many clients seem to give up on therapy and never return. This seems to be an overlooked but important point for both therapists and clients.
Are you a client who ‘gets cold feet’ after just one session? You’re certainly not alone. Data from a systematic meta-study in the USA demonstrates that about 20% of clients fail to complete their therapy (of 4-10 sessions)[i].
In the Australian context, I would put that figure at about 45%. In my experience and those of my colleagues about 25% of first attenders drop by Session 3 – not even one third of the way through their possible 10 sessions, as provided by the Better Access/Better Outcomes system of Medicare.
Such ‘non returns’ (or DNAs, for Did Not Attend) are a problem for several reasons, the obvious one being that you the client don’t finish out with the help you sought or needed.
There is also the bigger picture to consider. Most clinics are run so that they receive income per visit, so if you don’t show up (and there is no other client to fill your appointment), then both therapist and the clinic lose income.
Multiply such non-attendances by the number of all no-show clients across a longer time period, and you can see that a clinic can suffer.
The Cost of Therapy
Clients in Australia are lucky in that the government will subsidise Medicare rebates to the tune of just under $85 or $125 per session, depending on whether you consult with a general or a clinical psychologist. Most psychology services cannot survive or thrive on bulk billing, so you can expect to pay a gap amount unless you are a concession card holder. Local market conditions and APS guidelines will influence the size of the gap payment.
Clinics that work ethically will always tell you what the gap will be if you ask. Ring them before you come into the office to avoid disappointment.
Once you know what the gap payment is, multiply that by the number of sessions you and your psychologist work out in the first two sessions, and you will have some idea what the total costs will be in the long term.
Let your psychologist know whenever your employment or marital status changes, so they can work with you to adjust the fees.
Sometimes people resist therapy or returning to therapy because they fear they will be labelled and thus stigmatised (held in lower regard by others).
Many psychologists (mostly those with clinical college titles) will use a diagnosis procedure in session which then provides such a label (or labels) for you. These labels are taken from an authoritative text called the Diagnostic Statistical Manual or DSM. Though well intended to help in designing suitable treatment, if you let your label be known outside the therapist’s office, then others may react to you differently.
On the psychologist’s side: By law, a psychologist’s records (assessment, case notes) are required to be held in confidence (not shared unless specific written release is made by you, the patient).
However institutional processes (for example gaining insurance, making claims against insurance, obtaining employment) may require you to give permission to your doctor to provide a history as part of the application. Be sure to check with your GP before you get into this situation. Your psychologist cannot release your records (containing any diagnoses) unless you grant written permission. You also have the right to review your case notes/diagnosis and request a change.
Working with Your Therapist
For best results, you should be able to build an alliance with your therapist.
You don’t have to worship or fall in love with your therapist (in fact these will work against healing). However during the first 1-3 sessions you and the therapist should find common ground with the issues raised, what your goals/hopes are with therapy, and how your life will look differently 6 months post therapy.
It’s very important that if you and your therapist agree on treatment that you stick with the treatment plan and do the necessary weekly work outside of sessions.
When the Therapist doesn’t seem ‘Right’
Therapists are human beings, and like you they can at times get knocked about by the ‘slings and arrows of outrageous fortune’.
They too can have bad days with missed deadlines, unruly kids, interpersonal crises, and employment issues. These are sometimes hard to suppress or hide, and you may just happen to have an appointment coinciding with the therapist walking in with such barbs stuck in their mind and heart. But at least the therapist has shown up, made the extra effort for you versus calling in sick, despite all this. That’s not to be taken for granted!
So yes, a therapist may demonstrate the following: be unwell, a bad listener, be disorganised, forget essential facts in your file or your discussions, act hurriedly or rudely.
If you feel these things are happening, bite the bullet, raise your hand (“I need to say something about the therapy please”) and then just state these issues.
The Worst Case Scenario
In therapy if you start to feel judged or ridiculed by a Hard Chatter (like TV persona Tom Gleeson) or a Mad Hatter (somebody not making sense), then by all means bring these issues up with statements like: “I noticed X from you, and I feel Y (eg disregarded, ignored, demeaned)”. Then, wait for the response.
Listen carefully for the therapist to acknowledge and/or repair things. If the response is not of the “oops sorry I didn’t realise that, what can I or we do to make it right?” variety, then you need to take the matter up with the clinical manager, preferably within the next 24 hours. (It’s okay to go home and write down both what transpired and the reasons for your dissatisfaction first.)
Problems seldom get resolved in a day. But if after your discussion with first the therapist and then the manager doesn’t resolve things to your satisfaction, then you should ask the clinic manager and/or practice manager for a reassignment to a new therapist. This is usually not hard administratively to do. You also have the option to go externally to a new clinic or psychologist.
Answer Honestly: Is Therapy Working for You?
Finally, many therapists ‘check in’ with their clients periodically with a questionnaire or scaling question every Nth session or so, to detect problems early and thus avoid ‘off tracking’ (conflict or dissatisfaction). This is considered best practice.
By all means complete such questionnaires or scaling questions when asked, and be honest. Don’t soft pedal your answers if you are unhappy.
Rest assured that 99% of therapists enter the profession with the hope of helping and not harming clients. Clinic owners (most often who are trained psychologists themselves) will do their utmost to address your issue.
If after reading this article you have decided to answer “Yes” to the question, “Is therapy for you”, then I would welcome the opportunity to work with you.
Author: Dr Terry Olesen, BA (Hons), M Psych, PhD Psych, MAPS.
For over 25 years, Brisbane Psychologist Dr Terry Olesen has been helping people via psychology-based counselling. He finds it particularly rewarding to work with people with a ‘life situation knot’: feeling stymied, distraught, sad or angry, while facing external challenges such as job loss, health issues or getting over an ex. The topic of his doctoral research was work-life adjustment and mental health, which, in addition to his years of clinical practice, gives him the expertise to help people with a range of difficulties.
To make an appointment with psychologist Dr Terry Olesen, try Online Booking – Loganholme, or call M1 Psychology (Loganholme) on (07) 3067 9129.
- [i] JK Swift and RP Greenberg. Premature discontinuation in adult psychotherapy: a meta-analysis. Journal of Consulting and Clinical Psychology. August 2012; 80(4), pages 547-559.