Ask Dr. Carpenter

What is psychotherapy for?

We turn to psychotherapy with problems in living. Some important relationship may be very difficult, career choices may have led to a dead end, or we may be addicted to some substance or destructive activity. Our own behavior may be causing problems -- excessive anger, or shyness, or difficulty in communicating effectively, for example. We may be suffering from debilitating anxiety, perhaps even attacks of panic. Or we may be depressed, hardly able to maintain the pace of a normal life. Like the treatment we seek from medical doctors, psychotherapy is for the relief of suffering. In this case, however, the suffering is somehow due to emotional and behavioral patterns, and the treatment consists in understanding them in a caring way, and helping them to change.

How much does therapy cost?

Costs vary generally depending upon the level of qualifications of the practitioner. Therapy sessions with me usually cost $170 per 50 minute "hour." Most of the expense of therapy is covered by Medicare if you are covered by that.   Your insurance, other than Medicare, will probably defray some significant amount of the cost, but this will have to be determined by calling your plan and asking about "out-of-network benefits.".

How often will I need to come, and for how long?

Most often sessions are scheduled once each week, although more frequent sessions may be necessary if the problems are particularly acute, or if particularly deep work is desirable. Less frequent sessions may be scheduled in some cases, but the work done generally becomes less productive - more about situations and less about personal change.

Who will know about our sessions?

All responsible psychotherapists adhere to strict ethical guidelines about confidentiality. In my case, I will assure you that I will tell no one about your seeing me or any of the content of what we discuss. Any records I keep of what you say will have no identifying information attached to them, and will be kept securely locked away. If I feel the need to discuss some issue of your case with one of my peer-supervision groups, I will do it only with your consent and without identifying you in any way. If something you tell me suggests that you or someone else might be in danger, I may need to reveal that information. If so, I will do that in close consultation with you.

What happens in the the first therapy session ?

The first session is usually devoted to gathering information about what the most pressing problems are, and how they came to develop. It is also an opportunity for you, the client, to get to know the therapist and decide how comfortable you would be with that person if you choose to continue to see them. It is important fo feel free to listen carefuly to your own feelings about that, and to choose to look elsewhere if you wish to. A responsible therapist will welcome that if it is your choice, and will have other referral possibilities to offer if you need them.

Do I come to therapy alone ?

If the main problems involve other family members, or someone else with whom you are involved, it may be best to bring along the other person(s) initially. This can usually be decided on the phone when setting up the first appointment.

Isn't psychotherapy simply like talking with a good friend ?

No, not really. Therapy is unusual in several respects. If our other relationships could accomplish the same things, therapy never would have been invented. One difference is that therapy is one-directional: it is only about the needs of the client. All our other relationships involve mixtures of needs from both parties. Another important difference is that only one agenda guides it: learning about yourself and making the kinds of changes that you need to make. Other relationships always have a fabric of agendas issuing from both parties. Finally, a competent therapist really is an expert. A long process of intensive training, supervision, understanding of pertinent scientific research and theory, clinical experience, personal therapy, and continued professional development all go to create that expertise.

Will I need to take medication?

You and your therapist together may decide that medication could be an important element in your treatment, or not. It will need to be discussed. If your therapist is not a physician, he or she should be prepared to suggest a good psychiatrist to consult for an evaluation for medications if you do agree that it would be a good idea. Many of my clients use psychotropic medications and find them helpful, and many others elect to pursue treatment without them. I believe that they may be helpful, but they are seldom, if ever, a substitute for psychological treatment. Like pain-relievers, they may help but they do not address the deeper issues. In addition, research has come to show clearly that many if not most psychiatric medications have significant drawbacks, especially long-term negative side effects.  While long-term, or even life-long use is often recommended, it is now clear that conditions that would have usually been self-limiting if they were not treated with medication may indeed become lifetime disabilities simply because the medications are so very difficult to wean off of without incurring symptoms that may be much worse than any that led the medications to be used in the first place.  If you wish to have more information about this issue, I suggest the book Anatomy of an Epidemic, by Robert Whitaker.  In spite of what you may be told by a medical authority, I think that it is very unlikely that you have a "brain disease" that can only be treated successfully with medication.  This is an unscientific metaphor, not in most cases realy a medical entity.  Likewise, "chemical imbalance" is another popular but unscientific metaphor that was quickly proven to be nonexistent when it was tested in research.  Psychotherapeutic work on the deeper issues involved in your suffering may be hard-going at times, but the results will be long-lasting and freeing rather than debilitating.