Individual Therapy, Part 1

In this post, psychologist Josh Gressel starts to explain some of the mechanics of what it means to go to for therapy.

I want to shift directions today. After several months writing about relationships, I am going to switch gears and blog for a while on more individual issues. I am making this switch because I see individuals as well as couples, and because many people reading this also have questions about individual issues.

I will try to write about these issues with a minimum of technical terms. Do you know psychologists have created words called "ego syntonic" and "ego dystonic?" These simply mean something that feels good or bad, respectively. What's really scary is that this language starts to sound normal after several days in a professional conference.

Starting this topic is like standing before a blank canvass that stretches out for miles, and miles, and miles. There's so much potentially to say about it. What I think I will do, for my own sake if not for yours, is begin this process by telling you some of the things I tell clients who are coming to me for the first time. I always have to remind myself that the basics I consider givens are things that need to be spelled out. And in today's posting I will spell out some of the basic structure.

Most therapists work on a 45- or 50-minute hour. That is, if you have a 1 p.m. appointment, you will be done at 1:45 or 1:50. There are a number of reasons for this, mostly having to do with the logistics of running a therapy practice. I don't know if this story is true or not, but I also heard one reason therapists work on a 50-minute hour is because that's the longest Freud (who basically started the whole field of psychology and psychotherapy) could last without a cigar.

For the rest of us, it simply is necessary to have a few minutes to write case notes, shift gears, and go to the bathroom before the next person comes in. I sometimes wish someone could see what drastically different worlds we are exposed to from hour to hour. It's a little like being transported to completely different planets and the next person who comes to us rightly expects our full and undivided attention when they sit down before us.

Which brings me to my second basic point: I don't know of any sane therapists who see 40 clients in a week. I've worked at a lot of different jobs: some physically demanding and some mentally demanding. The reality of being a therapist is that each hour of therapy is equivalent to approximately 1.5 - 2.0 hours of anything else. So a therapist who's seeing 40 clients in a week is working the equivalent of 80 hours.

Clients who come for therapy may do so either via their medical insurance, which allows for a certain number of therapy sessions if the therapist determines they are "medically necessary" (I could spill a lot of ink on that term alone) or pay out of pocket. Copays using insurance vary from no copay (nearly unheard of anymore) to $50 per session. This depends on the plan, on whether the therapist is "in network" or "out of network" and a host of other things. The average copay for most people is in the $20-$40 range.

Next week I'll write about the kinds of things which make someone pick up the phone and reach out for help from a therapist.

Do you have a question about your marriage or relationship? Is there a particular topic on relationships or individual psychological issues you would like addressed in this blog? Ask Josh in the comments below or email him at josh@joshgressel.com.

Josh Gressel, Ph.D., is a couples and individual therapist based in Pleasant Hill, CA. Visit his website at joshgressel.com.

This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.

MIKE ALFORD December 01, 2012 at 04:29 AM
Now That is the a Real Right to the point a real straght Fact ! And I H ave Tried to Help Linda And bring the truth and the bare Facts of Reality To show her that she doesnt have to be so timid. she should just look athow much it could help her to seek out good and real therapy I have tried to really make her see the truth ! Well maybe she will get Help , only time and support will tell ---- we can only hope !
MIKE ALFORD December 01, 2012 at 04:36 AM
Chris A couple of months ago I met your dad I was down at Fullers He and your mom were just leaving --- He really took me by supprise he said Hi Mike Hows the campain going --- I didnt even know that he knew me But he sure seemed very alert and was very pleasent
MIKE ALFORD December 01, 2012 at 06:50 AM
What was just said ----- Isnt Excately True Here In Martinez --- Because Some really can Fool The people (here In Martinez) All the Time ! One Only has to look at our City Counsel, Planning Commission & the Lackeys that Keep them in office ---- Talk About Needing Therapy ! Need I Say More ! ----- Well Citizens Of Martinez Im Doing My Part --- 242 Straght Meetings ---- 242 straght Reality Sessions ! ----- Yes Im Giving At Least Three Minutes Of Truth & Reality At Each Meeting ------ I Guess You Could THERAPY ---- By Mike Alford -- Not To Worry Folks ------ No Charge To The City Of Martinez ! (JUST PURE FACTS)
subgirl December 07, 2012 at 08:45 AM
I'm not sure what's going on in the other comments, but Dr. Gressel thank you for taking the time to respond to mine. I am still struggling to find help and will be emailing you soon. I just wanted to touch base and let you know that I appreciated the honest reply. I got a virus or something and have been sick for several weeks now so everything got put on hold but I wanted to at least come back to this post and thank you for the reply. I've been truly shocked at how many therapists it seems there are in the area, yet so few compassionate people among them. It's been extraordinarily discouraging to say the least. As I said I will be emailing you soon. I truly hope you can offer some suggestions for directions to look or even maybe referrals. Thanks again. -subgirl
subgirl December 07, 2012 at 09:03 AM
Oh I also wanted to add that I have an excellent PCP that is great for colds and infections, but she is not at all equipped or trained to be a therapist or to prescribe psychiatric drugs for more than immediate short term needs. She has to have experience with so much that she just humanly cannot. One wouldn't take their child to a podiatrist or a vet for health care but they are doctors and practice medicine. I see therapy and behavioural health the same way. They are specialised and spend their career focusing in on one aspect of the human condition to better treat the needs of the patient. Ideally they would work with one's other doctors and healthcare would be a team effort. Also, my PCP doesn't do referrals to individual specialists. They would just pick a name from a list in a directory unless they knew someone personally. I, however, am able to, and have, spent weeks poring over documentation, histories, reviews, the provider's website, etc. to chose a few that would potentially "fit". This is the process for how I contact any specialist I am referred to by my PCP and yet therapists are the only ones that don't call back.


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