Frequently Asked Questions About Psychotherapy

by Alan Brandis, Ph.D.

Do I Have To Lie On A Couch?

Only if you want to. Seriously, most psychotherapy takes place sitting up. Our offices are equipped with sofas and very comfortable chairs to help our patients feel relaxed, but the old style of psychoanalysis (lying on the couch) is rarely used these days, by anyone.

How Long Does Psychotherapy Take?

That depends on the problem being treated, and on the level of results you want to achieve.

Most people come for therapy with something troubling them - that is, they are unable to get rid of a bad feeling, they are unable to get along with someone they love, they are unable to stop a bad habit.

It is possible in many instances to treat the symptoms directly. For example, if arguing with your spouse is the problem (the symptom), specific communication skills can be taught and practiced in the safe atmosphere of marital therapy, and this may bring relief from the arguing.
Often, however, a symptom covers a deeper, underlying problem that is more complex, and that you may not even be aware of. For example, if arguing with your spouse is caused by feelings of anxiety which cause you to imagine that s/he is unfaithful, learning better communication skills will not alter the anxiety, so the underlying cause of the symptom (in this example, the anxiety) must be discovered and addressed, before relief can be obtained.

Discovering and addressing the underlying causes of symptoms usually takes longer than simply treating the symptoms. Sometimes symptomatic treatment is enough, and you may elect to end your therapy after the symptoms diminish. However, it is possible that simply treating the symptoms may not bring relief, in which case it will be necessary to explore where the symptoms came from, how they developed, and what factors are maintaining them.

You may also decide that you wish to delve deeper into the underlying causes, such as ideas about yourself you have carried since childhood, to resolve or alter that layer of yourself, simply to be more effective, enjoy life more, etc. Often, once the pain or discomfort stops, and it doesn't feel "broken" anymore, people discover that there are more issues they would like to work on, to "fine tune" themselves. So, they choose to continue in therapy even though the problem that initially brought them is mostly resolved.

Often, Psychological Testing can be used to help determine what some of the underlying causes of a symptom may be. Testing can often save time and money, because it helps the therapist zero in on the source of a problem faster.

What is the difference between a Psychologist and a Psychiatrist?

A Psychologist attends a four-year college, usually taking courses in psychology and human behavior as well as in the social sciences (sociology, anthropology, etc.). Then, he/she attends a graduate school in psychology for at least four years, during which time both class work and supervised practical training (an extern ship) in psychotherapy and/or psychological testing is provided. This is followed by an internship (supervised, advanced-level training) of at least a year. Additional supervised experience (for a total of up to 3000 hours) is usually required by state licensing agencies. Then, application for a state license is made and (usually) both a difficult written and oral exam are taken, in order to obtain a psychology license.

A Psychiatrist takes a "premedical" curriculum in college, including biology, calculus, chemistry, anatomy, etc. Then, medical school for four years of course work with practical rotations in most of the medical specialties (OB/Gyn, Oncology, Surgery, etc.). After that, a residency of two or three years is served in Psychiatry, usually in a hospital setting (where the most severe cases are seen and the use of psychotropic medications is emphasized). A written exam for medical licensure by the state medical board is taken, sometimes after medical school, sometimes during or after the residency. In addition, Board certification in Psychiatry (obtained by taking another tough exam) may be required to practice as a Psychiatrist.

We value psychiatrists for their knowledge of medications, and utilize their skill in this area frequently. However, you can see that the most intense training in face-to-face psychotherapy and the assessment of mental and emotional problems is obtained by psychologists.

Is Psychotherapy Confidential?

Everything you share with your therapist is confidential, with a few exceptions. Laws have been written that force therapists to reveal certain information, for the protection of the patient (you) or of other people.

The law requires that, If you have a serious plan to commit suicide, a therapist must tell someone to try to prevent it. Likewise, if you have a serious plan to kill someone else, the therapist must try to warn that person. If you are abusing a child, therapists (along with physicians, nurses, teachers, etc.) must report that for the protection of the child. And likewise, if you are abusing an elderly person it must be reported. Fortunately, the need for such reporting is infrequent and will probably not apply to you. Everything else, including the commission of past crimes, is confidential and can only be revealed with your written permission or by a court-issued subpoena.

If a Managed Care company controls your mental health coverage (if you must get permission to see a counselor or psychologist), then the person or company that gives permission has access to your complete treatment file. Usually, your therapist must fill out a Treatment Plan Form with detailed personal information about your situation and problems, in order to get your insurance to pay for your treatment.
If you want to maintain absolute confidentiality (with the exception of the legal requirements listed above), then you want as few people as possible to have access to your information. The way to accomplish that is to pay for treatment yourself and leave your health insurance “out of the loop.”

Can I Bring My Spouse / Partner / Friend To The Session?

We certainly encourage and support the participation of important people in the patient's life, in the therapy process, and we believe it may speed the healing process and make the treatment more effective. You and your therapist should first discuss the possibility of someone else attending your session (Family Therapy), since the timing of including them may make the difference between a helpful session and a difficult, uncomfortable one. AAPA therapists have a policy of attempting to make phone contact with each patient before the first visit, and you may wish to discuss this decision before you come in.

What If I Don't Like My Therapist?

All the therapists at AAPA are extremely likable, as well as competent - but, we realize that personal "chemistry" makes for different preferences. For example, you may find that, even after several sessions, you feel that you have difficulty "opening up" and talking comfortably about yourself. The best thing to do in that situation is to discuss it with your therapist. You may be worried about hurting his/her feelings, but we have found that such roadblocks are often overcome after honest and frank discussion. You are the one being served, not the therapist, and helping you get the help you need is the most important task.

Some people feel more comfortable with a therapist of a particular sex, or a particular age range, or a particular religion, and so on. It is OK to request those things when you call to make your first appointment. If we can accommodate your request, we will. But, try to keep an open mind - our therapists are very accepting and have worked successfully with many types of patients. Just because a therapist is a man, for example, does not make him less effective when working with a woman, or vice versa.